Tag Archives: know

Everything you’ve ever wanted to know about my colonoscopy (but never dared to ask)

The thing about writers – the thing that makes us hated and occasionally liked – is that very often we have our heads up our asses. There are two ways that people in my profession can address this.

We could develop a deeper sense of humility, looking beyond ourselves and try to use our voices to amplify the experiences of other people in this cruel, cruel world.

Or: we could bring you into our asses with us.

It’s January, a month where we tend to fall short of our ambitions, so I’m going to opt for the more realistic choice here. But before I invite you on a guided tour of my colon, there’s something you should know about it – it is not a happy place. It has not been happy for a very long time.

From the age of about 20, I’ve had inexplicable stomach aches accompanied by a red liquid that would dye a clear bowl of water or a bundle of white tissue. But I ignored it. Even when there was a lot of it. Even when I started to feel faint. The only person that could witness this was me, alone in the toilet stall and after a while, the only witness stopped noticing. For 10 years, I ignored it.

But early last year, something strange happened. My stomach started to hurt more than usual. The next day I had to take painkillers. A week later it hurt to sit down, it hurt to stand up and I had to go home early from work.

When I realized it was affecting my job, I started to see what I had been ignoring.

The first thing I did was research prevalence. About 16% of all adults experience some blood loss from the bum according to a survey of 1,643 adults published in the American Journal of Gastroenterology.

Source: American Journal of Gastroenterology, 2017


Source: American Journal of Gastroenterology, 2017 Illustration: Mona Chalabi

Another study found that that 59% of people who experience rectal bleeding have never sought any medical advice.

The contrarian in me decided to book an appointment with a gastroenterologist. To find one, like any good New Yorker, I turned to Yelp.

People have a lot to say about being sedated and probed. People like Nancy C in Manhattan, who issued a one-star review about her “south of the border colonoscopy” (what other kind is there?). She was infuriated, in part, that when she woke up she was greeted by orange juice rather than a cookie. Nancy seemed like a smart woman. I heeded her advice and booked an appointment elsewhere.

The night before the procedure you have to drink a liquid designed to “clean your system”, which is a gentle way of putting it. The drink makes you shit and shit and shit and shit until you’re shitting water so clear that your bum could be an Evian volcano. By the time you arrive for the procedure, you haven’t eaten anything for 24 hours, you haven’t slept and your stomach aches from the constant fart-clenching.

After getting changed, a nurse wheeled me into a small room with two huge TV screens where a camera inching through my colon would be projected like an episode of Blue Planet. The anesthetist came in and injected me with something. I got halfway through a sentence explaining that the injection wasn’t working and then woke up wondering where the hell my cookies were.

A week later, the doctor called to discuss my results with me.

On her desk lay five pages stapled together with photos of me on them. Specifically, photos of my colon. Using the tip of her pen, she gently pointed to different areas and explained that I had a slight tear to my rectum, but the pain didn’t quite seem to match up to the injury. She suggested eating more fiber and gave me a prescription for a suppository (which is currently tucked behind some sunscreen on a shelf in my bathroom).

On the train home, I took out her report and studied the pictures a little closer to see if she had missed something. I wondered if a string of veins might have been turned from blue to a wine-purple after Donald Trump was sworn in. A little smooth area that glowed white from the camera’s flash suddenly struck me as a chunk of my stomach lining that might have worn away as I watched the news in the days that followed.

The truth is, we really do have “gut-wrenching” experiences because our brains and our stomachs are closely related. In a review of 13 studies, patients who tried a psychological approach saw greater improvements in their digestive issues than those who didn’t.

Maybe the doctor who had inspected my inner workings had missed something important. We use euphemisms even when we’re talking to ourselves. Our bodies are even capable of this linguistic device. My stomach hurt because my brain couldn’t speak my anxiety to me about a new political reality.

Euphemisms make our world more comfortable. We say bathroom even when there’s no bath in sight, and we generally stay away from words like shit and blood though they are the substances of life. These are little gentle sidesteps from the truth. Tiny verbal hugs in a scary world. The scarier the world becomes, the more tempting it is to deal in them. But I think now, more than ever we need to speak the truth as plainly as we can to ourselves and to each other.

This piece was first performed at Chris Duffy’s You Get A Spoon in December 2017

Everything you’ve ever wanted to know about my colonoscopy (but never dared to ask)

The thing about writers – the thing that makes us hated and occasionally liked – is that very often we have our heads up our asses. There are two ways that people in my profession can address this.

We could develop a deeper sense of humility, looking beyond ourselves and try to use our voices to amplify the experiences of other people in this cruel, cruel world.

Or: we could bring you into our asses with us.

It’s January, a month where we tend to fall short of our ambitions, so I’m going to opt for the more realistic choice here. But before I invite you on a guided tour of my colon, there’s something you should know about it – it is not a happy place. It has not been happy for a very long time.

From the age of about 20, I’ve had inexplicable stomach aches accompanied by a red liquid that would dye a clear bowl of water or a bundle of white tissue. But I ignored it. Even when there was a lot of it. Even when I started to feel faint. The only person that could witness this was me, alone in the toilet stall and after a while, the only witness stopped noticing. For 10 years, I ignored it.

But early last year, something strange happened. My stomach started to hurt more than usual. The next day I had to take painkillers. A week later it hurt to sit down, it hurt to stand up and I had to go home early from work.

When I realized it was affecting my job, I started to see what I had been ignoring.

The first thing I did was research prevalence. About 16% of all adults experience some blood loss from the bum according to a survey of 1,643 adults published in the American Journal of Gastroenterology.

Source: American Journal of Gastroenterology, 2017


Source: American Journal of Gastroenterology, 2017 Illustration: Mona Chalabi

Another study found that that 59% of people who experience rectal bleeding have never sought any medical advice.

The contrarian in me decided to book an appointment with a gastroenterologist. To find one, like any good New Yorker, I turned to Yelp.

People have a lot to say about being sedated and probed. People like Nancy C in Manhattan, who issued a one-star review about her “south of the border colonoscopy” (what other kind is there?). She was infuriated, in part, that when she woke up she was greeted by orange juice rather than a cookie. Nancy seemed like a smart woman. I heeded her advice and booked an appointment elsewhere.

The night before the procedure you have to drink a liquid designed to “clean your system”, which is a gentle way of putting it. The drink makes you shit and shit and shit and shit until you’re shitting water so clear that your bum could be an Evian volcano. By the time you arrive for the procedure, you haven’t eaten anything for 24 hours, you haven’t slept and your stomach aches from the constant fart-clenching.

After getting changed, a nurse wheeled me into a small room with two huge TV screens where a camera inching through my colon would be projected like an episode of Blue Planet. The anesthetist came in and injected me with something. I got halfway through a sentence explaining that the injection wasn’t working and then woke up wondering where the hell my cookies were.

A week later, the doctor called to discuss my results with me.

On her desk lay five pages stapled together with photos of me on them. Specifically, photos of my colon. Using the tip of her pen, she gently pointed to different areas and explained that I had a slight tear to my rectum, but the pain didn’t quite seem to match up to the injury. She suggested eating more fiber and gave me a prescription for a suppository (which is currently tucked behind some sunscreen on a shelf in my bathroom).

On the train home, I took out her report and studied the pictures a little closer to see if she had missed something. I wondered if a string of veins might have been turned from blue to a wine-purple after Donald Trump was sworn in. A little smooth area that glowed white from the camera’s flash suddenly struck me as a chunk of my stomach lining that might have worn away as I watched the news in the days that followed.

The truth is, we really do have “gut-wrenching” experiences because our brains and our stomachs are closely related. In a review of 13 studies, patients who tried a psychological approach saw greater improvements in their digestive issues than those who didn’t.

Maybe the doctor who had inspected my inner workings had missed something important. We use euphemisms even when we’re talking to ourselves. Our bodies are even capable of this linguistic device. My stomach hurt because my brain couldn’t speak my anxiety to me about a new political reality.

Euphemisms make our world more comfortable. We say bathroom even when there’s no bath in sight, and we generally stay away from words like shit and blood though they are the substances of life. These are little gentle sidesteps from the truth. Tiny verbal hugs in a scary world. The scarier the world becomes, the more tempting it is to deal in them. But I think now, more than ever we need to speak the truth as plainly as we can to ourselves and to each other.

This piece was first performed at Chris Duffy’s You Get A Spoon in December 2017

This is the first Christmas without my mother. But I’ll always know where to find her | Gemma Carey

If you’ve never scattered someone’s ashes before you might think they’re just that – ashes. Like the fine powdery residue you find at the bottom of the fireplace that’s almost silky to the touch.

Human ashes aren’t powdery. The remains of a cremated human body are more like gravel. Fine ash mixed with small stony pieces of bone. And so those gritty remains should be – something so hard should not be soft to the touch.

My mother’s ashes sat in my father’s walk in wardrobe all year. In January, my mother died of inflammatory breast cancer, the rarest and most aggressive form of breast cancer. This is the first Christmas I will spend without her. Sealed in an unceremonious grey plastic tub, she would have been furious to know she’d been stuffed into a bottom drawer in the corner of my father’s house.

I wanted my mother in the ocean. A woman who lived most of her life in chronic pain, she would say she felt weightless and free in the ocean. She spent the last weeks of her life there, in our small house near a secluded lush beach just south of Canberra. She said in those weeks she wished she’d been born a fish.

We’ve visited that beach all my life. One rainy afternoon, while staying at our beach house, I said to my sister, “it’s time”.

My sister and I walked down to the beach, a grey sky above us, storm rolling in, carrying that grey plastic tub with our mother’s ashes inside. We waded into the surf, my sister bringing a Stanley knife to open the tub. Once we were waist deep in the cold water, she cut a small hole in the top and handed the ashes to me, not wanting to touch them or look at them.

I scattered the ashes all around me in circles. So much gravel poured through the small hole in the top of the tub. Slowly, I spun tiny fragments of bone and they sank to the bottom of the ocean, bright white against the yellow sand, before being pulled out to sea by the next wave. On and on it went, layer after layer of bone, then sand, then bone again.

Sitting on the shore afterwards I felt heavy. It felt both deeply right and deeply wrong. My mother was where she belonged and yet I no longer had her. In a plastic tub at the bottom of a drawer wasn’t exactly where I wanted to go and find my mother when I needed her, but at least it felt tangible. Now I had nothing. Yes, she was free, but she was also free from me.

Selfishly I regretted what we’d just done. I wanted to run back into the ocean and find all those pieces of white bone. Scoop up the pieces in my hands and take them safely back home so I could still have my mother.

I finally understood the line from Cheryl Strayed’s Wild: “I put her burnt bones into my mouth and swallowed them whole”. Strayed was writing about not wanting to let her mother go. To hold onto her, corporeally and emotionally, forever.

But my mother was gone. And her ashes scattered, the knowledge that my life had changed irrevocably washed over me again.

My sister and I walked slowly back to the house as the rain began to fall, torrential and warm after the cold of the ocean.

One week later, my sister and I went back to that beach. On a warm night we walked into the pitch black calm ocean. As we stepped into the water, much warmer now, my sister shouted, “look!”. Small sparkles moved about in the water around us. They were plankton, tiny and phosphorescent sea creatures drifting along the edge of an inky ocean.

I ran my hands through the water watching the sparkles shoot off the tip of each finger. I waded further out and the green lights became brighter. Searching, I swam a hundred meters out to sea in the pitch black night.

I spun in circles, much faster than the day I scattered the bones. Like the white fragments had done on that day, a swirl of light surrounded me. Not bone on sand, but green on black. I spread my fingers and ran them through the water, each one creating its own little trail of sparks. I kicked my feet and a green glow spread out underneath me.

Looking up, the clear sky was full of stars – mirrored in the sparkling lights I was creating in the ocean around me. I found my mother again. It was as though in that vast ocean each of those white pieces of bone had come and found me again.

In that moment, I realised I knew exactly where to find my mother, and I knew I always would.

Gemma Carey is a researcher at the University of New South Wales

Is the NHS being taken for a ride on drug prices? We need to know | Nils Pratley

The Competition and Markets Authority (CMA) has discovered a rich seam for inquiries – pharmaceutical companies allegedly gouging the National Health Service.

Pfizer, together with a small UK company called Flynn Pharma, was fined £90m last December for “excessive and unfair” pricing of an anti-epilepsy drug. GlaxoSmithKline and two small firms were later hit for £45m for conspiring to delay competition on an antidepressant.

Now comes an accusation that the Canadian firm Concordia Healthcare abused its dominant position to overcharge the NHS on a thyroid treatment. The price of the drug rose by almost 6,000% while production costs remained “broadly stable,” says the CMA.

The Concordia case is similar to the Pfizer one in that the price hikes followed the de-branding of a medicine. De-branding takes a drug into an unregulated pricing regime where competition from generic manufacturers is supposed to act as a brake on prices. In practice, competition doesn’t always arrive – thus a pack of Concordia’s liothyronine tablets rose from £4.46 before de-branding in 2007 to £258 by July this year.

The government has tried to address the problem by creating powers to control prices of generic medicines. But the open question is how severely the system has been abused. The CMA says its investigators are pursuing another seven cases involving several companies, which may suggest a pricing loophole has been quietly exploited for years.

The CMA is doing its bit, but there is a strong case for a wider investigation that looks beyond the narrow application of competition and consumer-protection laws. As it is, NHS England’s response felt limp – the CMA’s action “sends an important enforcement signal … that taxpayers and the NHS will not tolerate market abuses,” it said.

Well, yes, signals are important. But taxpayers and patients also want to know if the NHS has been taken for a ride on generics, whether officials are wiser to pricing games and whether the new law is up to the job. There is scope for a parliamentary inquiry. And, since the companies all shout about their ethical codes of conduct, they would surely be happy to be questioned in detail about how they deal with the NHS.

McCall will face more turbulence at ITV than easyJet

Dame Carolyn McCall, chief executive of easyJet, won’t regret her decision to quit to become ITV’s boss in the new year. She’s had seven mostly successful years at the airline and few executives get to lead two FTSE 100 household names. All the same, the medium-term job looks easier at the firm she’s leaving than the one she’s joining.

EasyJet’s full-year profits were knocked, as they were bound to be, by a £101m hit from the fall of sterling. But £408m, down from £494m, was a decent result. The European short-haul airline market was going through one its regular bouts of over-expansion and ticket prices fell. The position is now reversing – and quickly. Monarch and Air Berlin have gone bust, Alitalia is on its knees and Ryanair has cancelled a few winter flights while it hunts for pilots. Fares will rise for the first time in almost two years.

Air Berlin’s downfall has also allowed easyJet to bag 25 A320s plus landing slots in Tegel airport in Berlin on the cheap. The reorganisation costs are more severe – £60m of losses in year one plus £100m in one-off costs – but enhancement to earnings is promised in year two. In time, it’s possible that a similar attractive slice could be carved out of Alitalia. In short, the competitive landscape looks clearer than it has done in ages. McCall always boasted that easyJet is a “structural winner” – it rings true.

It’s harder to say the same about ITV on current form. The broadcaster has a near-monopoly on free-to-air commercial TV advertising slots in the UK – a useful structural advantage – but it is completing a second year of falling advertising revenues and the spectre of Netflix looms. ITV, even after a 25% fall in its share price this year, is still the bigger company in stock market terms – £6bn versus easyJet’s £5bn – but McCall will have done well if there’s still a £1bn gap seven years from now.

Did TCI go too far in its feud over Rolet?

The Children’s Investment Fund (TCI), the hedge fund seeking to oust Donald Brydon as chairman of the London Stock Exchange, should be careful not to overplay its hand. It asked a fair question – why is LSE chief executive Xavier Rolet leaving? And it called an meeting of shareholders to vote on Brydon’s survival, as is its right as a 5% shareholder.

But to accuse the LSE of threatening a character assassination of Rolet is bizarre. TCI called the meeting and the company has to issue a circular to shareholders. Brydon & co should have spoken up at the outset, of course, but they’re still allowed to give their side of the story.

Is the NHS being taken for a ride on drug prices? We need to know | Nils Pratley

The Competition and Markets Authority (CMA) has discovered a rich seam for inquiries – pharmaceutical companies allegedly gouging the National Health Service.

Pfizer, together with a small UK company called Flynn Pharma, was fined £90m last December for “excessive and unfair” pricing of an anti-epilepsy drug. GlaxoSmithKline and two small firms were later hit for £45m for conspiring to delay competition on an antidepressant.

Now comes an accusation that the Canadian firm Concordia Healthcare abused its dominant position to overcharge the NHS on a thyroid treatment. The price of the drug rose by almost 6,000% while production costs remained “broadly stable,” says the CMA.

The Concordia case is similar to the Pfizer one in that the price hikes followed the de-branding of a medicine. De-branding takes a drug into an unregulated pricing regime where competition from generic manufacturers is supposed to act as a brake on prices. In practice, competition doesn’t always arrive – thus a pack of Concordia’s liothyronine tablets rose from £4.46 before de-branding in 2007 to £258 by July this year.

The government has tried to address the problem by creating powers to control prices of generic medicines. But the open question is how severely the system has been abused. The CMA says its investigators are pursuing another seven cases involving several companies, which may suggest a pricing loophole has been quietly exploited for years.

The CMA is doing its bit, but there is a strong case for a wider investigation that looks beyond the narrow application of competition and consumer-protection laws. As it is, NHS England’s response felt limp – the CMA’s action “sends an important enforcement signal … that taxpayers and the NHS will not tolerate market abuses,” it said.

Well, yes, signals are important. But taxpayers and patients also want to know if the NHS has been taken for a ride on generics, whether officials are wiser to pricing games and whether the new law is up to the job. There is scope for a parliamentary inquiry. And, since the companies all shout about their ethical codes of conduct, they would surely be happy to be questioned in detail about how they deal with the NHS.

McCall will face more turbulence at ITV than easyJet

Dame Carolyn McCall, chief executive of easyJet, won’t regret her decision to quit to become ITV’s boss in the new year. She’s had seven mostly successful years at the airline and few executives get to lead two FTSE 100 household names. All the same, the medium-term job looks easier at the firm she’s leaving than the one she’s joining.

EasyJet’s full-year profits were knocked, as they were bound to be, by a £101m hit from the fall of sterling. But £408m, down from £494m, was a decent result. The European short-haul airline market was going through one its regular bouts of over-expansion and ticket prices fell. The position is now reversing – and quickly. Monarch and Air Berlin have gone bust, Alitalia is on its knees and Ryanair has cancelled a few winter flights while it hunts for pilots. Fares will rise for the first time in almost two years.

Air Berlin’s downfall has also allowed easyJet to bag 25 A320s plus landing slots in Tegel airport in Berlin on the cheap. The reorganisation costs are more severe – £60m of losses in year one plus £100m in one-off costs – but enhancement to earnings is promised in year two. In time, it’s possible that a similar attractive slice could be carved out of Alitalia. In short, the competitive landscape looks clearer than it has done in ages. McCall always boasted that easyJet is a “structural winner” – it rings true.

It’s harder to say the same about ITV on current form. The broadcaster has a near-monopoly on free-to-air commercial TV advertising slots in the UK – a useful structural advantage – but it is completing a second year of falling advertising revenues and the spectre of Netflix looms. ITV, even after a 25% fall in its share price this year, is still the bigger company in stock market terms – £6bn versus easyJet’s £5bn – but McCall will have done well if there’s still a £1bn gap seven years from now.

Did TCI go too far in its feud over Rolet?

The Children’s Investment Fund (TCI), the hedge fund seeking to oust Donald Brydon as chairman of the London Stock Exchange, should be careful not to overplay its hand. It asked a fair question – why is LSE chief executive Xavier Rolet leaving? And it called an meeting of shareholders to vote on Brydon’s survival, as is its right as a 5% shareholder.

But to accuse the LSE of threatening a character assassination of Rolet is bizarre. TCI called the meeting and the company has to issue a circular to shareholders. Brydon & co should have spoken up at the outset, of course, but they’re still allowed to give their side of the story.

Women have the right to know about injuries of vaginal birth beforehand | Sascha Callaghan and Amy Corderoy

It’s not just the constant pain. After a while, you learn to adjust to that new normal. It’s the feeling that you weren’t warned; that you never gave your consent for the risks you were exposed to.

That is the message coming out of the Senate inquiry into the use of vaginal mesh products to treat women who have vaginal prolapses.

The submissions are heartbreaking. Many are handwritten, intimate portraits of lives interrupted by constant infections and pain, of relationships disrupted.

One woman writes how she never had an orgasm again after her surgery.

Another describes a procedure performed on her: “It was the most painful experience and I screamed very loud and was crying. [The doctor] scolded me and told me I had scared the patients in the waiting room”.

Many say they were never warned of the risks of the mesh, never understood the treatment they were about to undertake.

Despite the clear importance of these stories finally being heard, there is concern in some quarters that speaking out loud about injuries after a vaginal birth is a dangerous thing. In their submission to the senate enquiry, the Australian College of Midwives’ submission warns that coverage of the issue “has increased fear around childbirth”.

“It is important that the issues surrounding the transvaginal mesh implants are separated from the issues surrounding vaginal birth,” they write.

The truth is however, that these injuries and others, such as prolapse, scarring, incontinence, chronic pain, and fistula are all risks of vaginal birth – particularly where complications necessitate the use of instruments such as forceps. The risk of these complications increases with the age of the mother, her BMI, and the size of the baby relative to the mother’s pelvis.

We expect women to be strong enough to run these risks when they give birth, but many clinicians and natural birth advocates seem to imagine that telling women about them beforehand might be too scary for them to handle.

This rhetoric is now so entrenched in health services that official birth policy in NSW emphasises that only one type of birth – vaginal birth – is “normal”. The policy states that “all pregnant women [should be informed] about the benefits of normal birth”, but does not specify that patients must be informed of risks of vaginal births. Many hospitals now aggressively pursue vaginal births, encouraging vaginal births after caesarean section, discouraging the use of effective epidural pain relief and aiming to use alternative interventions such as forceps to ensure babies can be delivered vaginally. All without fully informing patients of the known risks associated with that approach. Clinicians now actively promote the role for forceps in childbirth, even if they do note in their academic research the “trade-offs between risks of maternal and neonatal trauma”. These “trade-offs” include a four-times greater risk of stress incontinence and an eight-times greater risk of prolapse compared to no use of instruments, and a five-times greater risk of facial injury for the baby (compared to the use of a vacuum device). Yet all this is in aid of producing a “normal” birth, so there is apparently no need to ensure informed consent on the woman’s part.

This increasing trend towards paternalism in childbirth is not only disturbing, but it can also be unlawful. In a 2015 UK case, obstetrician Dina McLellan was found to have negligently harmed Nadine Montgomery and her baby because of a failure to inform Montgomery about a substantial risk that her large baby would become stuck in her pelvis during an attempt at vaginal birth. This was despite the fact that Montgomery, who had diabetes, had repeatedly asked about these risks and said she would have elected to have caesarean had she had been properly informed. The obstetrician gave evidence that she did not spend a lot of time, or indeed any time at all, discussing these risks with her patients. This is despite the fact that should a baby become trapped in the mother’s pelvis due to a complication known as shoulder dystocia, highly invasive manipulations are required to free the baby. In this case, this included pressing down on the mother’s pubis with clenched fists, while two midwives forced her legs back; pushing the baby’s head back up into the uterus, so as to be able to perform an emergency caesarean section, forceps, and an attempted symphysiotomy. This is a surgical procedure that involves breaking the pelvis to free the baby.

Despite these known risks, Dr McLellan took the view that if such “small” risks were mentioned “most women will actually say, ‘I’d rather have a caesarean section’”. Dr McLellan felt this was undesirable because “it’s not in the maternal interests for women to have caesarean sections”. For this reason she did not discuss the risks with her patient.

In this case, there were terrible outcomes for mother and baby. But even in the normal run of things, the law is designed to protect a patient’s right to autonomy – the freedom to decide what can be done to their bodies in a medical setting. Healthcare professionals must not only give patients enough information to get consent to a procedure, but enough to ensure that the patient’s right of autonomy, and control over their bodies, is protected. That includes giving information about the risks of having no procedure, as in the case of an attempt at vaginal birth, where known risk factors are present.

Much important work was done by our feminist foremothers in fighting for women to have the right to make choices about their births, to take control of their labours with active, natural births if they want them, and to be free of unnecessary interventions. This shift has been welcomed by many women, and is in line with international trends.

But we cannot lose sight of the fact that the goal of these shifts in practice has been to empower women, and in order to achieve that aim we cannot throw the baby out with the bathwater – so to speak – by deciding that all women have the same priorities and that it is acceptable to hinder informed decision-making in the cause of achieving those priorities.

The fact is that in modern medical practice, we have long let go of keeping the “awful truth” from patients. We let patients decide what is best for them – by informing them of risks as well as benefits, and allowing women to choose which set of risks they are more comfortable taking. Two perfectly well informed, intelligent women may have totally differing opinions about the type of intervention they are comfortable with. One might feel that a vaginal birth is an experience they value highly, and that the surgery involved in a caesarean section (with its associated recovery time, potential for complications, and increasing risk with each additional pregnancy) is something they would like to avoid at almost any cost. Another women may feel her personal circumstances make vaginal delivery unappealing, and believe that if such a delivery needed forceps then it is a risk that she would not be willing to take. Many more will fall somewhere between these two views.

Either way, the days of medical paternalism are over.

Midwives and doctors must ensure women are fully informed, and their wishes known, before the labour, so that they can inform clinical decision-making during it. There is no easy way to give birth to a baby, and most first-time mothers are apprehensive about labour and aware that once it begins you simply cannot have full control over what happens next.

Ensuring women are fully informed should not scare them off vaginal birth, but it will ensure that if something does go wrong they will not feel betrayed by the healthcare system itself.

  • Sascha Callaghan is a lecturer in health law and bioethics at the University of Sydney. Amy Corderoy is a freelance medical journalist

What You Need to Know About the Lone Star Tick, Which Is Giving People Red Meat Allergies

You already know that ticks pose a threat your health; these bugs, which thrive in the summer, can transmit Lyme disease, Powassan disease, and even a rare condition called tick paralysis.

If those illnesses aren’t enough to worry about, experts are sounding the alarm about another tick-borne condition that appears to be on the rise. A bite from the lone star tick has been leaving victims with a potentially dangerous allergy to red meat and sometimes even dairy products.

RELATED: Bug Bites: How to Prevent and Treat

Never heard of the lone star tick? Once mostly confined to the southeastern United States, it’s been stretching its boundaries over the last couple of decades, increasing in numbers and showing up from Maine to central Texas and Oklahoma, says the Centers for Disease Control and Prevention.

Along with that red meat allergy, this tick can also carry the bacteria that can cause monocytic ehrlichiosis (a rare infectious disease), Rocky Mountain spotted fever, and STARI, a rash that can be mistaken for Lyme disease, reports the University of Rhode Island’s TickEncounter Resource Center.

But it’s the risk of an allergy to bacon and burgers that has people most on edge right now. Here’s how it happens: just like other ticks, the lone star tick likes to feed on mammal blood, like deer and cow, explains Cosby Stone, MD, MPH, a clinical research fellow in allergy and immunology at Vanderbilt University Medical Center. When a ticks bites one of these animals, the tick can pick up a sugar called alpha-gal.

Then, the tick bites a human. The bite itself as well as the alpha-gal that is transmitted to the human host triggers a person’s immune system to make antibodies. “Because you don’t make this sugar in your body, it’s recognized as something foreign and you can become allergic to it,” Dr. Stone says. The result: an alpha-gal allergy.

Unfortunately, alpha-gal sugar is in a lot of foods and dishes you may eat all the time, like red meat, dairy, and gelatin. Once you have this allergy, your barbecue days might be over. You’ll react when you eat a steak, and a small cohort of victims will even react when they drink a glass of milk. For some people, gelatin in medications causes those antibodies to kick in and cause distress. “This can create a lot of trouble for people,” adds Dr. Stone. 

RELATED: Beat 16 Summer Health Hazards

The allergy might take months to develop after the tick bite. Yet typically it starts to present itself soon after you eat red meat. The signs are often hard to ignore and potentially serious: hives, shortness of breath, diarrhea, swelling of the face and hands, and/or low blood pressure. “There are plenty of stories where patients eat a burger at 6 p.m. and then wake up with anaphylactic shock at midnight,” says Dr. Stone. If that happens, seek medical attention ASAP.

Though the lone start tick seems to have hit the headlines out of the blue, experts have been noticing a rise in allergic reactions over the last decade. Tick-borne illnesses in general appear to be increasing; the National Pest Association stated that 2017 might be the worst season yet for ticks, due in part to mild winter conditions that allowed ticks to thrive.

To get our best wellness tips delivered to you inbox, sign up for the Healthy Living newsletter

As with all ticks, the advice remains the same when it comes to protecting yourself. Use a permethrin-based repellent on clothes, wear long pants when you’re out hiking or working in the yard (and tuck those socks in), and do a tick check on yourself, your kids, and dogs when you go back inside. If you spot one, remove it with tweezers ASAP and be alert for any kind of symptoms, from a rash to fever to fatigue or weakness.

What You Need to Know About the Lone Star Tick, Which Is Giving People Red Meat Allergies

You already know that ticks pose a threat your health; these bugs, which thrive in the summer, can transmit Lyme disease, Powassan disease, and even a rare condition called tick paralysis.

If those illnesses aren’t enough to worry about, experts are sounding the alarm about another tick-borne condition that appears to be on the rise. A bite from the lone star tick has been leaving victims with a potentially dangerous allergy to red meat and sometimes even dairy products.

RELATED: Bug Bites: How to Prevent and Treat

Never heard of the lone star tick? Once mostly confined to the southeastern United States, it’s been stretching its boundaries over the last couple of decades, increasing in numbers and showing up from Maine to central Texas and Oklahoma, says the Centers for Disease Control and Prevention.

Along with that red meat allergy, this tick can also carry the bacteria that can cause monocytic ehrlichiosis (a rare infectious disease), Rocky Mountain spotted fever, and STARI, a rash that can be mistaken for Lyme disease, reports the University of Rhode Island’s TickEncounter Resource Center.

But it’s the risk of an allergy to bacon and burgers that has people most on edge right now. Here’s how it happens: just like other ticks, the lone star tick likes to feed on mammal blood, like deer and cow, explains Cosby Stone, MD, MPH, a clinical research fellow in allergy and immunology at Vanderbilt University Medical Center. When a ticks bites one of these animals, the tick can pick up a sugar called alpha-gal.

Then, the tick bites a human. The bite itself as well as the alpha-gal that is transmitted to the human host triggers a person’s immune system to make antibodies. “Because you don’t make this sugar in your body, it’s recognized as something foreign and you can become allergic to it,” Dr. Stone says. The result: an alpha-gal allergy.

Unfortunately, alpha-gal sugar is in a lot of foods and dishes you may eat all the time, like red meat, dairy, and gelatin. Once you have this allergy, your barbecue days might be over. You’ll react when you eat a steak, and a small cohort of victims will even react when they drink a glass of milk. For some people, gelatin in medications causes those antibodies to kick in and cause distress. “This can create a lot of trouble for people,” adds Dr. Stone. 

RELATED: Beat 16 Summer Health Hazards

The allergy might take months to develop after the tick bite. Yet typically it starts to present itself soon after you eat red meat. The signs are often hard to ignore and potentially serious: hives, shortness of breath, diarrhea, swelling of the face and hands, and/or low blood pressure. “There are plenty of stories where patients eat a burger at 6 p.m. and then wake up with anaphylactic shock at midnight,” says Dr. Stone. If that happens, seek medical attention ASAP.

Though the lone start tick seems to have hit the headlines out of the blue, experts have been noticing a rise in allergic reactions over the last decade. Tick-borne illnesses in general appear to be increasing; the National Pest Association stated that 2017 might be the worst season yet for ticks, due in part to mild winter conditions that allowed ticks to thrive.

To get our best wellness tips delivered to you inbox, sign up for the Healthy Living newsletter

As with all ticks, the advice remains the same when it comes to protecting yourself. Use a permethrin-based repellent on clothes, wear long pants when you’re out hiking or working in the yard (and tuck those socks in), and do a tick check on yourself, your kids, and dogs when you go back inside. If you spot one, remove it with tweezers ASAP and be alert for any kind of symptoms, from a rash to fever to fatigue or weakness.

What You Need to Know About the Lone Star Tick, Which Is Giving People Red Meat Allergies

You already know that ticks pose a threat your health; these bugs, which thrive in the summer, can transmit Lyme disease, Powassan disease, and even a rare condition called tick paralysis.

If those illnesses aren’t enough to worry about, experts are sounding the alarm about another tick-borne condition that appears to be on the rise. A bite from the lone star tick has been leaving victims with a potentially dangerous allergy to red meat and sometimes even dairy products.

RELATED: Bug Bites: How to Prevent and Treat

Never heard of the lone star tick? Once mostly confined to the southeastern United States, it’s been stretching its boundaries over the last couple of decades, increasing in numbers and showing up from Maine to central Texas and Oklahoma, says the Centers for Disease Control and Prevention.

Along with that red meat allergy, this tick can also carry the bacteria that can cause monocytic ehrlichiosis (a rare infectious disease), Rocky Mountain spotted fever, and STARI, a rash that can be mistaken for Lyme disease, reports the University of Rhode Island’s TickEncounter Resource Center.

But it’s the risk of an allergy to bacon and burgers that has people most on edge right now. Here’s how it happens: just like other ticks, the lone star tick likes to feed on mammal blood, like deer and cow, explains Cosby Stone, MD, MPH, a clinical research fellow in allergy and immunology at Vanderbilt University Medical Center. When a ticks bites one of these animals, the tick can pick up a sugar called alpha-gal.

Then, the tick bites a human. The bite itself as well as the alpha-gal that is transmitted to the human host triggers a person’s immune system to make antibodies. “Because you don’t make this sugar in your body, it’s recognized as something foreign and you can become allergic to it,” Dr. Stone says. The result: an alpha-gal allergy.

Unfortunately, alpha-gal sugar is in a lot of foods and dishes you may eat all the time, like red meat, dairy, and gelatin. Once you have this allergy, your barbecue days might be over. You’ll react when you eat a steak, and a small cohort of victims will even react when they drink a glass of milk. For some people, gelatin in medications causes those antibodies to kick in and cause distress. “This can create a lot of trouble for people,” adds Dr. Stone. 

RELATED: Beat 16 Summer Health Hazards

The allergy might take months to develop after the tick bite. Yet typically it starts to present itself soon after you eat red meat. The signs are often hard to ignore and potentially serious: hives, shortness of breath, diarrhea, swelling of the face and hands, and/or low blood pressure. “There are plenty of stories where patients eat a burger at 6 p.m. and then wake up with anaphylactic shock at midnight,” says Dr. Stone. If that happens, seek medical attention ASAP.

Though the lone start tick seems to have hit the headlines out of the blue, experts have been noticing a rise in allergic reactions over the last decade. Tick-borne illnesses in general appear to be increasing; the National Pest Association stated that 2017 might be the worst season yet for ticks, due in part to mild winter conditions that allowed ticks to thrive.

To get our best wellness tips delivered to you inbox, sign up for the Healthy Living newsletter

As with all ticks, the advice remains the same when it comes to protecting yourself. Use a permethrin-based repellent on clothes, wear long pants when you’re out hiking or working in the yard (and tuck those socks in), and do a tick check on yourself, your kids, and dogs when you go back inside. If you spot one, remove it with tweezers ASAP and be alert for any kind of symptoms, from a rash to fever to fatigue or weakness.

What You Need to Know About the Lone Star Tick, Which Is Giving People Red Meat Allergies

You already know that ticks pose a threat your health; these bugs, which thrive in the summer, can transmit Lyme disease, Powassan disease, and even a rare condition called tick paralysis.

If those illnesses aren’t enough to worry about, experts are sounding the alarm about another tick-borne condition that appears to be on the rise. A bite from the lone star tick has been leaving victims with a potentially dangerous allergy to red meat and sometimes even dairy products.

RELATED: Bug Bites: How to Prevent and Treat

Never heard of the lone star tick? Once mostly confined to the southeastern United States, it’s been stretching its boundaries over the last couple of decades, increasing in numbers and showing up from Maine to central Texas and Oklahoma, says the Centers for Disease Control and Prevention.

Along with that red meat allergy, this tick can also carry the bacteria that can cause monocytic ehrlichiosis (a rare infectious disease), Rocky Mountain spotted fever, and STARI, a rash that can be mistaken for Lyme disease, reports the University of Rhode Island’s TickEncounter Resource Center.

But it’s the risk of an allergy to bacon and burgers that has people most on edge right now. Here’s how it happens: just like other ticks, the lone star tick likes to feed on mammal blood, like deer and cow, explains Cosby Stone, MD, MPH, a clinical research fellow in allergy and immunology at Vanderbilt University Medical Center. When a ticks bites one of these animals, the tick can pick up a sugar called alpha-gal.

Then, the tick bites a human. The bite itself as well as the alpha-gal that is transmitted to the human host triggers a person’s immune system to make antibodies. “Because you don’t make this sugar in your body, it’s recognized as something foreign and you can become allergic to it,” Dr. Stone says. The result: an alpha-gal allergy.

Unfortunately, alpha-gal sugar is in a lot of foods and dishes you may eat all the time, like red meat, dairy, and gelatin. Once you have this allergy, your barbecue days might be over. You’ll react when you eat a steak, and a small cohort of victims will even react when they drink a glass of milk. For some people, gelatin in medications causes those antibodies to kick in and cause distress. “This can create a lot of trouble for people,” adds Dr. Stone. 

RELATED: Beat 16 Summer Health Hazards

The allergy might take months to develop after the tick bite. Yet typically it starts to present itself soon after you eat red meat. The signs are often hard to ignore and potentially serious: hives, shortness of breath, diarrhea, swelling of the face and hands, and/or low blood pressure. “There are plenty of stories where patients eat a burger at 6 p.m. and then wake up with anaphylactic shock at midnight,” says Dr. Stone. If that happens, seek medical attention ASAP.

Though the lone start tick seems to have hit the headlines out of the blue, experts have been noticing a rise in allergic reactions over the last decade. Tick-borne illnesses in general appear to be increasing; the National Pest Association stated that 2017 might be the worst season yet for ticks, due in part to mild winter conditions that allowed ticks to thrive.

To get our best wellness tips delivered to you inbox, sign up for the Healthy Living newsletter

As with all ticks, the advice remains the same when it comes to protecting yourself. Use a permethrin-based repellent on clothes, wear long pants when you’re out hiking or working in the yard (and tuck those socks in), and do a tick check on yourself, your kids, and dogs when you go back inside. If you spot one, remove it with tweezers ASAP and be alert for any kind of symptoms, from a rash to fever to fatigue or weakness.