Q As an expectant mother, I am concerned about my baby's vaccination. I recently read an article in the Guardian about mercury-based DTP and Hib vaccines being used by GPs, even though these are supposed to be phased out for safety reasons. I understand that European guidelines advise against using such vaccines for children as they contain thiomersal which is almost 50% mercury. I had assumed that mercury was a toxic substance, and I'm not happy to give it to my newborn, even though I favour a vaccination programme. Can I request mercury-free vaccinations from my GP? If not, where can I go?
A There is some concern about thiomersal, a mercury-based preservative used in some vaccines and medicines. Thiomersal prevents bacteria contaminating vaccines, and inactivates viruses so they can be used to produce immunity without causing the disease itself. You can be allergic to thiomersal, but whether it causes serious long-term damage to health is hotly debated. However, because mercury is a poison that can cause neurological damage, both European and American authorities have recommended to vaccine manufacturers that they phase out use of thiomersal if possible.
No authority has recommended that any vaccines in current use be withdrawn, so they're obviously not too alarmed. MMR, for all its controversial reputation, does not contain thiomersal and neither does meningitis C. The triple vaccine for diphtheria, tetanus and pertussis (whooping cough) and the Hib vaccine - given at two, three and four months old - do contain thiomersal. So does hepatitis B, which is given to some babies facing increased risk of the disease. Happily, the newest vaccine to be introduced as part of routine immunisation of children doesn't contain thiomersal. This is the pre-school booster for diphtheria, tetanus and pertussis.
Q My husband is 56 years old and seems in reasonable health. The problem is that, as he falls asleep at night, his feet and legs (and occasionally his shoulders) begin to twitch, sometimes quite violently. On his worst nights I get kicked and bruised. This can continue for a couple of hours. Is there anything we can do to lessen the problem?
A It is most likely that he has restless legs syndrome, graced with an acronym (RLS) and an eponym (Ekbom Syndrome) after the Swedish neurologist who described it. It tends to run in families so a gene is suspected, though not yet identified. As soon as you lie or sit down, a crawling sensation starts in the legs - only relieved by moving them. The relief is short-lived, so the unlucky few end up kicking their legs around all night, waking exhausted and depressed and being unable to sit still for any period during the day without twitching.
RLS can range from being a bit of a nuisance to ruining your life. It is rarely a sign of any specific underlying illness, although it is said that a third of all people with rheumatoid arthritis have RLS and it can also be associated with diabetes, vitamin deficiencies, alcoholism and drug withdrawal. It's commoner among women than men and can get worse during pregnancy and around the menopause. Your husband should speak to a sympathetic doctor to check that there is no other possible cause of his thrashing about. It is sensible to be checked for diabetes, anaemia, slipped disc or poor circulation, all of which can produce similar symptoms.
There is no specific cure for RLS, though many are helped by regular exercise, swimming, yoga, avoiding prolonged standing and removing other impediments to a decent night's sleep such as caffeine. There was a vogue for prescribing the drug levodopa, used to treat Parkinson's, but it has side-effects and probably doesn't work. Sometimes RLS disappears as mysteriously as it appears.
Q I wonder if you can give me some advice about a long-standing sinus problem. I have used a variety of drugs over the years, including Flixonase nasal spray which I stopped taking because it didn't appear to have any effect, and I am reluctant to take steroids unnecessarily.
I try to improve things by washing out my sinuses with salt water, and I also inhale steam. I have seen a specialist, and about a year ago I had some polyps removed, but this hasn't improved matters. I can put up with sinus pain, but I find not being able to taste and smell anything very frustrating. My doctor seems at a loss to know what to suggest other than further prescriptions of Flixonase. My smell and taste do return briefly sometimes, especially when I've just played tennis.
A I get more letters about sinusitis than any other single subject. I think that's probably a reflection of the fact that it's a very common problem with no really good solution. Steam inhalation probably helps to clear a blocked nose, allowing the sinuses to drain. Steam is cheap and cheerful as long as you don't dunk your face into the boiling water by mistake. Humidifiers are dearer and more hassle, and can harbour nasty bugs if not kept clean. Decongestants are handy in the short term, but symptoms return when you stop using them.
Acute sinusitis is the short-term face ache you get after a cold when bugs invade the sinuses. These spaces - that keep our skulls light - are meant to stay empty, not fill up with pus and gunk as they do during sinusitis. Antibiotics such as amoxycillin improve symptoms in 84% of cases. Placebos can have a similar effect, with an average 69% better within a few days without the side-effects. Mind you, if I had a skull full of pus, I'd take the amoxycillin and to hell with the facts.
Lasting, chronic sinusitis is often related to an allergy. Polyps, which are lumps of nose lining protruding into your nasal cavity, are an almost inevitable result. Removing the polyps as you had done may help for a while, but symptoms often recur. Tracking down the source of your allergy may be useful. Antihistamines, nasal sprays and repeated courses of antibiotics don't really get to the heart of the matter. Many try homeopathy, often with good results. Echinacea, vitamin C and zinc, and anything that helps you to stave off colds, will help you to avoid acute flare-ups.
