A Question of Health

'How many anaesthetics are too many? And what is meant by a portion of fruit or veg?'

IS THIS EXCESSIVE?

IS THIS EXCESSIVE?

I am a 39-year-old male and, within the last two years, I have had between 15 and 20 operations under general anaesthetic. I have been told that the effects of a general anaesthetic can take up to six months to work its way out of one's system. Is this true? I now get extremely tired at lunchtime each day and would be interested to know if there is any link. What are the cumulative effects of such a high number of general anaesthetics likely to be? Are there any recommended safety limits on the number of anaesthetics one should have?

The side effects of a general anaesthetic usually wear off quickly. These days it is common practice for people to be given general anaesthetics as day patients (without staying overnight in hospital). If you are put to sleep for, say, less than an hour you are likely to feel more or less back to complete normality within 48 hours. I can't think of any reason why a general anaesthetic should take up to six months to work its way out of your system. One anaesthetic called halothane can cause liver problems, but I would be very surprised if you have been given halothane. Anaesthetists tend to avoid this drug if someone is having repeated anaesthetics. I am interested to know why you have had to have so many anaesthetics over such a short period. Twenty anaesthetics over two years averages out at nearly one a month. Anyone who has had to go into hospital every month for two years is bound to have some underlying medical problem. Perhaps it's the underlying problem that's making you feel unwell. There are no specific recommended safety limits for the number of anaesthetics you can have. My simple rule would be: as few as possible.

A FRUITY CONUNDRUM

Am I particularly thick not to know what exactly is a "portion" of fruit? You see it advertised that the recommended daily intake of fruit and vegetables is five portions. But presumably a pomegranate seed is a portion, and so is an entire head of cabbage. Can I fulfil the daily requirement by eating five portions of the same fruit? Do not fruits and vegetables have different nutritional values? Can you elucidate?

One portion is 80g (about 3oz). If you get out your kitchen scales, I think you will find that one pomegranate seed is considerably less than one portion, and a whole head of cabbage is quite a bit more than one portion. The whole point of the Government's "five-a-day" campaign is to encourage people to eat more fresh fruit and vegetables. Of course it's true that different fruits and vegetables contain different nutrients, so it is better (and more interesting) to eat a variety rather than just one thing. The sad fact is that only 13 per cent of men and 15 per cent of women eat five portions of fruit and vegetables a day. If everyone ate five portions a day we might be able to prevent up to 20 per cent of deaths from heart disease and some cancers.

STEROIDS, OR OLD AGE?

Four years ago my GP diagnosed asthma. I now take two puffs of a steroid inhaler and two puffs of a salbutamol inhaler daily. Various books on asthma say that the steroid will cause thinning of the skin, easy bruising and lengthening of hairs on the arms. I have noticed all of these things and I wonder if these are side-effects from the steroid inhaler. I am now in my seventies and feel very fit otherwise. Should I stop the steroids, as I have never really had an asthma attack?

All of the steroid side effects that you mention can be caused by taking steroids. But the amount of steroid that is contained in two puffs a day from an inhaler will not cause any of these side effects. People who get these symptoms are usually taking large doses of steroid tablets. Thinning of the skin and easy bruising are also common signs of ageing, and I think this is much more likely to be why you have noticed these symptoms. As for longer hairs on the arms, I can't think of any reason why this is happening, but it's probably not of any medical significance. It's possible to have asthma without ever having had an attack. But it is also possible that you do not suffer from asthma. The next time your inhaler prescription is due, discuss the problem with your doctor. You might be advised to try reducing the dose, eventually stopping.

HAVE YOUR SAY

JSM from Dorset thinks she knows why a GP isn't prescribing ibuprofen gel on the NHS:

Has it not occurred to your correspondent that her GP might be trying to tell her that he does not want to prescribe ibuprofen gel on the NHS because it is freely available across the counter. Surely we all need to take some responsibility along these lines?

The Pill is a good treatment for period pains, says BSW from London:

You were absolutely right to recommend the Pill for severe period pains. I suffered for 30 years until I asked my GP to put me on the Pill when I was 43. He refused, so a psychiatrist friend of mine used to write the prescriptions for me. I had 10 years of complete heaven. I stopped after 10 years and appeared to have sailed through the menopause without a single hot flush. I am now 80 years old.

Please send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182 or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions