Is this folic folly?
Q: A visiting friend had an early morning ritual of gobbling a handful of vitamins, minerals and supplements while I had toast and cornflakes. The one she set most store by was folic acid, to prevent heart disease. I took it in the early stages of pregnancy, then stopped. Should I take it too?
A: Cornflakes with milk, toast and some fresh fruit or orange juice is a nutritionally sound way to start the day. Folic acid (folate) lowers blood levels of a chemical called homocysteine, which we get from our normal diet. Very high homocysteine levels - brought about by a rare genetic disorder - are linked to increased risk of heart disease, strokes and possibly dementia, so lowering homocysteine levels ought to reduce those risks. However, proof that high levels actually cause these ailments is still awaited - the presence of homocysteine may reflect other risk factors, such as poor diet and smoking. There's no harm in eating lots of green veg which are rich in the substance anyway.
Dealing with Parkinson's
Q: My elderly father has been told he has early Parkinson's disease. He has slowed down considerably, his hands shake and he has lost a lot of his zest for life. The pills his GP has given him, carbidopa, don't seem to be making much impact. Is there anything else we can do?
A: Parkinson's is common in older people. Brain nerve cells that control movement and contain the chemical messenger dopamine deteriorate. The pills your father is taking contain a dopamine-like drug called levodopa, which can be very helpful. His lack of improvement could be because the diagnosis is wrong (he could be depressed and have a harmless tremor), the dose might need adjusting or he may need a different drug. New drugs that boost dopamine levels in the brain, such as ropinirole (ReQuip), appear to work as well as levodopa but with fewer side effects. The Parkinson's Disease Society (tel: 020 7931 8080) could recommend a neurologist if your father wants to be referred to a specialist.
Sperm counting
Q: My partner wants us to try for a baby now. I'd rather wait, as I'm only 21. He's 25 and reckons that sperm counts are falling all the time because of environmental poisoning, so we shouldn't hang around. Will four to five more years make any difference?
A: No. Tell him that men today produce just as many sperm as their grandfathers did, according to a US study completed in 1997 and comparing samples from a 1951 study. If he is worried about his own sperm count, he can get a semen sample analysed at the local hospital lab. At 25, if he hasn't had chemotherapy or serious illness or surgery that may affect his fertility, he shouldn't worry unduly.
Dosage disorders
Q: I contracted a severe urinary tract infection last July, requiring five days in hospital. Since then, I have had recurring infections. Last October a urologist prescribed long-term low-dose antibiotics (Trimethoprim), but now I have three weeks or so clear, then the pain returns, followed by nausea and dizziness. I am then prescribed another antibiotic then told to resume the low dose. Tests and scans have detected no under lying problem. I am 53 and had a hysterectomy at 37.
A: Constant antibiotics are clearly not a satisfactory long-term solution. It may be that your vagina has become dry, sore and susceptible to infections since you went through the menopause. HRT in the form of oestrogen pessaries or vaginal creams often helps. You could try HRT as oral tablets or patches. If you can't take HRT, antiseptic pessaries such as Aci-Jel are worth a try.
• These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.
