Home Remedies Menopausal Issues

 Once the oestradiol cream did its work, I was told KY Jelly was my only option if my drying episodes recurred. I wondered what have women done for centuries? Suffered? Or came up with home remedies? Surely women in families have talked to their daughters and vice versa, for am sure not everyone has a lack of sexual health care within their homes. As I have said before my sex education and information about sexual health was nil until I studied as a nurse and even so there is a distinct lack of enthusiasm of this topic in cultures like that of the Indian Subcontinent. This is what got me thinking and writing in the blog.

I thought maybe I should ask my friends if they have some handy tips as they are in my age group. Surely someone has had this issue, got tips from older women in the family for self-care. Again, I was surprised to find the reluctance to talk about it. I got one who laughed and asked if I was being serious? She was done with menopause and of course, she had no problems and does not need any care.

Another asked questions which was helpful as she was asking the right things. This was more of what the problem could be but focused on problems maybe with infection of urinary tract. Another came back with the name of one commonly used cream but with a rider that she did not have personal experience but got the info from a gynaecologist.

One came spoke to me separately but the rest just ignored the message. This friend actually talked about keeping the perineum and vagina clean and using a special wash which also helped to moisturise the area. Some others I spoke to were not reluctant to talk as long as it was focused on my issues. There was not much contribution regarding remedies.

One of my friends came up with some good information and I was pleased. She stated these remedies have been used by the ladies in her family and that she tells her patients about these remedies too.

• Take a teaspoon of fenugreek seeds. Wash thoroughly and soak overnight in a small amount of water. In the morning on an empty stomach drink the water and eat the seeds.
• Take about 5 -6 almonds wash well and soak overnight.  These will have to be skinned and eaten. The water in which the almonds were soaked should be thrown away.
• Other vegetables which should be regularly consumed are fenugreek leaves, tindora (ivy gourd), moringa pods (cooked with lentils). These help in hydrating the mucous membranes. Moringa powder is also now available and a table spoon can be added to cooked food like lentils. I will have to check what other foods are useful too.
• I do know soya has a high oestrogenic effect but I am allergic to it and so have to avoid it. Soya and soya products if you can tolerate will also help during menopause.
• Apply a drop of olive oil which is thicker than coconut oil daily to the vaginal and perineum. When experiencing burning avoid using toilet paper, wash and dab dry with a small towel and apply the oil every time you pass urine.

So, I started the fenugreek seeds and almonds daily along with applying olive oil after shower and I can say it has been working well. However, a word of advice the fenugreek seeds can sometimes be hot for the body. Suggestions are to have them with some yogurt or not having it daily. I have reduced it to twice a week. Aside for the oestrogenic effect the fenugreek is good for stabilising blood sugar reducing cholesterol and blood pressure too. If a small amount helps with these other issues too then it is worth a try.

All these have been tried but one needs to remember that not every remedy will suit everyone. For example, soya is seen to be very helpful but I am allergic so unable to take it. Indeed, now a days most processed foods have some form of soya in it. So, try carefully, speak to your doctor if he /she is sympathetic and interested in holistic care.

A Tale of Dry Fanny Woes

 Connective Tissue disease throws new curve ball every so often and sometimes it is hard to discern symptoms that are from the disease or this is something totally unrelated that the body has dreamt up. This blog follows on from my Time to Talk About Menopause.  Post-menopause is a gift that keeps giving and one of them is dryness of the vagina and perineum. It makes for a painful intercourse and also if the dryness extends to the perineum it will burn and pain when urine touches it and when you wipe your self dry. Oh yes you might not notice till the dryness extends outside the vagina if you are not having sex…. For after all your libido is most likely down and you cannot be bothered to have sex. However, with connective tissues which is also another gift that happily keeps updating symptom list you can have drying of mucous membranes like eyes, mouth and of course vagina and perineum.

With is background information I tell my tale of dry fanny woes. I noticed this dryness of the perineum and wondered what happened. With some contortion and a mirror, I could see that the perineum as dry, in fact there was a white patch as it was so dry. I had been applying some tea tree cream as it is anti-inflammatory as well. It seemed to get better after a few days. This went on for a few months and then it would not help so started applying some coconut oil which again was not thick enough to last long and so continued the pain and occasional itching which also comes from drying of surrounding skin as well. Eventually gave in and went to my GP and as I described the dryness and a white patch he goes, ‘thrush.... get something off the pharmacist’ all without looking at my face let alone my fanny! Am like ‘but it is not itching or having any flaking or discharge’ and he says get stuff for thrush.

So now I am at the pharmacy asking to talk to the pharmacist and hoping to get more sense. She asks me more questions than my GP and says maybe you need something thicker than oil and why not try Sudocream and you can apply if a few times (well I could apply the oil too many times but…) So, I pay for a small tube to try out and see if it helps. So off I went and religiously applying this white paste and happy as of course now the urine does not touch the naked perineum. Oh, ladies have you ever experienced the contortions we can do when weeing to avoid the dribble of urine on to the perineum. Bending forward and raising your butt at the end is a useful way if anyone was wondering. This helped for a couple of weeks and then we were back to square one.

Return trip to the pharmacy and this time a different lady who again went through the umpteen questions by now I was getting adept at describing the symptoms. She comes up with - if it hurts have you tried something with a bit of anaesthetic? Then she picks up a tube of haemorrhoids cream. I am like, ‘are you sure one can use this for my symptoms?’ She says of course you can use it we do tell people it is safe to use. Now I was pretty desperate so I nodded and went of with yet another useless cream. A word of warning to people who are not up with their pharmaceutical knowledge the haemorrhoids cream is to reduce the size veins which are bulging and thus reduce blood flow and the anaesthetic acts on the nerve endings to reduce pain. Now these would have little effect on the dry mucous membranes whether due to lack of oestrogen or connective tissue disease. If ever any one gives you this for your fanny kindly refrain from taking it. All it caused was even worse burning on application.

By now I was dreading passing urine and upending myself to avoid the trickle of urine that I was not quick enough to catch on the tissue. Time to go to the GP again and this time go to the wife of my GP who also works there. I say to her, I need you to actually physically look as I cannot diagnose what I cannot see properly. I said her husband had just said thrush with his head down. And so did my rheumatologist for that matter. Now this usual po-faced lady is giggling. I am like sure she is going to take the piss off her husband when she gets home. She asks about why I have had no smear test and I said cannot be bothered. (But that’s another story where they are not competent and appear to dig for oil than take a smear… and I am not bothered to find someone else.)

Then comes the well know lie on the couch and spread them. She gets a speculum out and I tense as she does not have a gentle touch. Says to me all the mucous membranes are red and dry. Her diagnosis is post-menopausal dryness and treatment is oestradiol cream twice a week for 3 weeks and then review. She does not like giving HRT so I am not to expect to continue this beyond the time it clears the dryness. Funny she never asked me about how did I not realise this extreme internal dryness as intercourse would be excruciating. She is a lady doctor who I have seen providing perinatal care and the serious lack of examining the sexual health and indeed the giggling was strange. She totally discarded my suggestion that it could also be due to my autoimmune disease. Well I was happy I got some medication and that would resolve my symptom.

So, oestradiol cream was duly applied twice a week. If you have never had to apply this maybe I should explain. There is a syringe which you screw on to the opening of the cream tube. Then you squeeze the tube to fill the syringe which is a fixed amount. Then you lie back and insert the syringe into the vagina and empty it. Hope you have a helper handy to take the syringe, wash it and put away as you need to lie flat for a while. The dryness seemed to get less along with less pain and burning. During this time, I had a migraine and had ibuprofen for a couple of days. Suddenly the last remnants of the symptoms vanished. Therefore, I think it was a combination of lack of oestrogen and local inflammation that caused my symptoms.

Went back for the review and po-face was back when I said I have ibuprofen and the last of the dryness went. Instead of showing concern and acknowledging there could be a dual reason she just clamed up and lectured me about how dangerous ibuprofen was and that I should take paracetamol before I try ibuprofen (all not necessary as I have been having ibuprofen for over a decade and am well versed with its effects and side effects). Ah she does not like being proved even partly wrong this one! So, after care was less amusing to her. I could have the cream for another week or so and then I should keep KY Jelly handy.

How very helpful and caring this whole experience has been … NOT. My problem though hard for me was actually not that serious and that as a nurse I had such a poor experience what happens to others?  I think we ladies should stop being shy and demand that we get support, care and treatment as required for our whole body and not just with bits that people are comfortable with. This lack of care from health staff leads to women being ashamed to talk about real and very traumatic reproductive organs diseases.

Communication Gap

Using words is an art some say

It helps to use the right words I say

Something simple can turn complex and confusing

Often people make things worse in explaining

Maybe it would be easier communicating in points

Rather than complicated sentences with complex joints

The conversation can be at cross- purposes

When reading is only for response purposes

Taking time to read and understand the message

Formulate a response addressing the questions in the message

Seems to have been brushed aside in the haste to respond

We are flitting from message to message like insect from puddle to pond

The speed of communication seems to have taken over

At the expense of quality and clarity forever

Surprising to see how many cannot write

Put forward their viewpoint in a manner that is understood right

Is it their ability to write or lack of understanding?

Or is it their ego and self-belief that their knowledge is all encompassing?

The short hand in communication is wide

Texting words and emoticons leaving room for meaning to hide

Leaving both parties confused and cross

For neither have got their message across

Leaving a feeling of something missing

A disappointment in coversing!

Personal Tutor Role in Professional Education - Quality of Student - Tutor Communication

Discussion of the fifth aspect of findings from the unpublished research –

Williams M, 1999, ‘Exploring the Role of the Personal Tutor in Nurse Education, Department of Education, University of Surrey, unpublished.

The research was carried out using a sample of students and staff from 7 campus sites. On examining the responses regarding the qualities of a personal tutor, three main themes emerged – knowledge, communication skills and interpersonal skills.

 The earlier related blogs are:

Personal Tutor Role in Professional Education - Allocation of Personal Tutor

Personal Tutor Role in Professional Education - Qualities of a Personal Tutor

Personal Tutor Role in Professional Education - Student Tutor Relationship

Personal Tutor Role in Professional Education - System of Tutorials

Maintain Confidentiality

Both the students and tutors appear to agree that confidentiality is important during interaction and for a good relationship. Students from all sites go on to state that it is easier to communicate and less stressful if confidentiality is assured, which is also a finding of Peelo (1994). But some tutors from sites A, B, C and F point out that the student needs to indicate this prior to a discussion. This does not appear to be a point that students feel, needs to be made, they appear to assume that maintaining confidentiality is a part of the relationship. Therefore, it is something that tutors must keep in mind, that students do not necessarily state the need for confidentiality but take it for granted that it will be provided. Some tutors clarify their point by stating that caution needs to be exercised, as they have to consider the legal implications as well as public safety. Students appear to be aware of this, as they have also pointed out, like the tutors, that should there be a need for disclosure, the permission of the student must be obtained. Students are also aware that the personal tutor may need help from others, but they would still need to inform the student.

This is further clarified when reviewing comments on confiding in the personal tutor. Most students and tutors from all sites clearly state that it should be allowed when necessary. A few students from all sites stated that this should not happen. The reasons for this no are better explained by the tutors who opposed the idea of allowing students to confide in them. They indicate that if the student is just venting their feelings or using this confidence to reflect on practice then it may be safe to allow the student to confide. But, it may not always be appropriate, as the tutors have to function within legal parameters and professional code of conduct. Also as suggested time and time again by both students and tutors, that personal tutor is not a counsellor and should deal with academic issues only. There are many students but only few tutors from site A, who chose not to make any comment. This may reflect their lack of surety regarding this issue. But comments made in other areas reflect an overall agreement with this.

Honesty in Interaction

Honesty, a quality spoken of earlier, is seen to be necessary for communication according to majority of the students and tutors. Both feel it is beneficial and essential to the relationship. Students are of the opinion that there is no point in being told untruths if they are to learn from their mistakes and feedback provided by the personal tutor, on their progress. Similarly, tutors explain that honesty is necessary to allow students to have realistic expectations and understanding of what is required of them. Though, they do point out, that honesty needs to be tempered by tact and constructive criticism, as occasionally honesty can hurt. Tutors also point out that sometimes it is difficult to maintain absolute honesty as in the case of knowing the student result, which has not yet been published, and so it is not always appropriate to be honest. However, ordinarily students do not ask such a question, and if they do surely it is possible to be honest and state that they are unable to give that information. After all, majority of the students and tutors find trust to be important and without honesty it is difficult to maintain trust.

                                     

Engender Trust

Trust is also seen to be the basis for a good relationship. A few students and many tutors from all sites except D feel that it is a two way process. But like Earwaker (1992) some tutors from sites B and D point out that this is essentially a relationship of ‘unequals’ and also that students do not know their personal tutor well enough, so asking for trust in a relationship can be difficult. Each, therefore, needs to prove to the other that they are trustworthy. Brown’s (1993) suggestion of self-disclosure by both the tutor and the student, over a period of time helps to develop trust. Initially, non-threatening social information to deeper private information is of enormous value in developing a meaningful relationship.

Be Friendly

Friendliness in interaction and therefore in the relationship is something majority of the students and tutors have identified, as after all this is one of the desired qualities of a personal tutor, as identified by both. The students want friendliness as it makes the tutor more approachable and therefore communication is easier. The tutors too, indicate an awareness of this reason and its impact on the relationship. Responses show, a word of caution from some tutors as they advocate avoiding overfamiliarity, in order to keep the relationship on a professional footing. Moreover, different students have different needs at different times. A good example for this is when a student is being disciplined friendliness is not entirely appropriate.

Supportive

Majority of the students and tutors from all sites see the provision of personal support, in times of need and difficulty, as a part of the role of the personal tutor. Students desire the support to be both academic and personal, though the tutor would have to know the student for this. While tutors from all sites except A are more in favour of providing academic support and deal with the pressures of academia rather than to baby sit students or get personally involved. Further, the provision of support must be limited to the personal tutor’s abilities and students should be referred on to appropriate agencies, rather than getting involved in personal problems, so that the time spent with the student is utilised judiciously. A small number of tutors, from sites B and F, are of the opinion that this is the role of student services and qualified counsellors. The provision of personal support is seen to be the pastoral role of the personal tutor by people like Bramley (1977). The same personal tutor also provides the academic support. But as discussed in an earlier blog, the changes within the nurse education have spilt this role up. The students do not essentially wish to see two different tutors to gain support for their course work. As content of the course is important they take up tutorial from the module operator who to some extent gives the academic writing skills support.

Therefore, the burden on a small number to tutors, who work within each module, having to support the whole cohort, can be as large as two hundred and fifty students. While the students do not meet their personal tutor, for after all not many students wish for pastoral care, because as MacGuire (1966) found that, students develop peer support. Also there are more mature students coming into nurse education who already have well developed support network outside of the system, as suggested by Earwaker (1992). So unless the academic support role for both the skills and knowledge is returned back into the domain of the personal tutor students will not get a holistic support. 

Comfortable

Other comments made by tutors relate to the interpersonal skills discussed earlier and the quality of interactions. The only issue that was not raised earlier related to a question posed by tutor for site C, whether a tutor and a student of opposite gender show be alone during tutorials? This could have stemmed from past experience of this individual. Offering privacy may often mean the closing of the office or classroom door. The tutor needs to be sensitive to the student’s reactions, and make appropriate responses, like using communication skills to break down barriers and ease any awkwardness or even leave the door of the room open unless specifically asked to close it.

This detailed understanding of the issues that impact on the quality of communication between student and personal tutor can be easily generalised to cover all student tutor communications. The level of each aspect may vary depending on the situation for which the communication is taking place.