Health: A Question of Health

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I HAD a hysterectomy for heavy periods four years ago and I have recently been summoned by my GP to have a cervical smear test. Is this really necessary? I was under the impression that my cervix was removed with my uterus, so what's the point of a cervical smear?

If you had a total hysterectomy, the surgeon will have removed both your uterus and your cervix. Occasionally women have a partial hysterectomy, in which the cervix is not removed, but this is highly unusual. Assuming that your cervix was removed, the risk of cervical cancer is tiny, though there have been rare cases of cervical cancer occurring in the tissues of the vagina, just next to where the cervix once was. If you had regular smears before your hysterectomy and they were all normal, I think it is over-cautious to continue having regular smears. If you have had abnormal smears in the past, it may be sensible to go on having smears of the vagina Discuss this with your GP. The whole point of having cervical smears is to reduce your chance of developing cancer of the cervix. Your chance is already exceedingly low.

MY AMERICAN friends are all paranoid about Lyme disease. Can you catch it in Britain?

Lyme disease is an infection carried by ticks. Humans catch the disease if they are bitten by an infected tick. It was first discovered in Old Lyme, Connecticut (after which the disease was named), and there is great public awareness of Lyme disease in New England where it is not uncommon. The illness usually starts off with a circular rash at the site of the tick bite, followed by flu-like symptoms. If untreated it can progress to a debilitating illness, with complications including arthritis, depression, heart problems and nervous system involvement. It can be treated with antibiotics, and early treatment is important in order to prevent the development of chronic illness and complications.

There have been cases of Lyme disease in Britain, particularly in the New Forest area and in Scotland. The best ways to avoid it are to wear long trousers tucked into socks, and to check for ticks after you have been walking in forests and grassy areas.

WHENEVER I fly in aeroplanes I get excruciating pains in my ears as the plane descends. How can I prevent this?

Three things may help. Take a decongestant such as Sudafed for a couple of days before you fly. Try to unblock your ears as the plane ascends and descends by swallowing, sucking on sweets or yawning. Use the Valsalva manoeuvre to release the painful pressure in your ears. This involves gently blowing your nose while you pinch your nostrils together. These suggestions are all designed to open up the Eustachian tubes that connect the back of your nose to the middle part of your ear. The excruciating pain is caused by a failure of these tubes to open and equalise the pressure of both sides of your eardrums.

Please write to A Question of Health, `The Independent', 1 Canada Square, Canary Wharf, London E14 5DL; fax 0171-293 2182; or e-mail health@ Dr Kavalier regrets that he is unable to respond personally to questions