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Some Medical Questions And Answers By Dr.Gita Mathai

The medicines don’t seem to work :-

Q: My father has become old and forgetful. His neurologist has started him on some very expensive tablets, but there hasn’t been much improvement. We are in a quandary as to whether the treatment is worth continuing.
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It is important to remember that medications for neurological diseases in old age may take time to act

A: Forgetfulness often occurs as people get older. In 10 per cent of them it is due to dementia. In others, it may be due to Alzheimer’s disease or caused by arteriosclerotic changes (fat deposits) in the arteries which compromise the blood supply to crucial areas of the brain. It is difficult to reverse damage that has already occurred. However, progression can be prevented by treating and controlling any underlying diseases like diabetes and high blood pressure and correcting lipid profile abnormalities. Mental exercises involving memorising, regular walking and physiotherapy are beneficial. There are also specific medications which do prevent progression and offer some improvement. These are expensive and take time to act. In the long run it may be better to follow the neurologist’s advice.

Too much gas :-

Q: I am badly constipated and when I am in public I release foul smelling gas. My stomach also feels bloated all the time. It is embarrassing and uncomfortable. I went to a gastroenterologist who said there is no block or disease.

A: Constipation in the absence of a physical block or a medical problem occurs when there is not enough roughage in the diet. Roughage is found in high fibre foods like whole grains, fruits and vegetables. The present recommendations for these are 4-5 helpings a day. In addition, fluid intake should be at least three litres a day. Milk increases the feeling of bloating and gas production. Reduce the intake of milk to 400 ml a day. Physical exercise like walking for 40 minutes a day will help the intestines function efficiently.

Immunise now:-

Q: I read about immunisation and when I questioned my mother found that she has not given me any injections after the age of one year. I am now 20 years old.

A: It is never too late to complete your immunisation schedule and make it up to date. Unfortunately, many adults feel “I did not receive all these new injections and I grew up without a problem.” This is an argument brought forth again and again. Immunisations prevent disease. Although 90 per cent of the people recover from these preventable diseases without sequelae, 10 per cent do develop problems. Some of these like paralysis, blindness, brain damage or sterility may be devastating, though not life threatening. You have probably missed MMR (measles mumps rubella), hepatitis A, hepatitis B, varicella (chicken pox), pneumococcus, menigococcus, typhoid and your boosters due at 1.5, 5 years, 10 years and 16 years.

Cold limb :-

Q: I am a heavy smoker (15 cigarettes a day) and now I feel that my left leg is cold, painful, heavy and weak.

A: The nicotine in cigarettes can compromise blood supply to the limbs. The vessels narrow and go into spasm. This is called thrombo anginitis obliterans or Berger’s disease. The limb becomes cold and numb. Eventually gangrene may set in. Please go to a vascular surgeon and check if this is the case. He may be able to release any block or bypass it. Any treatment offered will only succeed if you stop the precipitating factor — cigarettes. Remember, cigarette smoking is injurious to health.

Weaning time :-

Q: At what age can I wean my baby?

A: The World Health Organisation (WHO) recommends exclusive breast feeding for six months. That doesn’t seem very practical if the mother is working as most organisations don’t give more than three months of maternity leave. Weaning can be started after 120 days (4 months). It’s best to use home-made and home-cooked powders and cereals rather than precooked readymade tinned preparations. Try to use a bowl and spoon for feeding and avoid bottles and pacifiers.

Sources:The Telegraph (Kolkata, India)

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Some Questions & Answers on Gynaecology

Answers from Dr Amit De, consultant gynaecologist and obstretician, Bhagirathi Neotia Women & Child Care Centre:

Cysts in Ovaries:-

I am a 28-year-old woman married for three years. I have been trying to conceive but without success. My doctor has told me that I have polycystic ovaries. Are they cancerous? Will it be impossible for me to conceive?

These tiny cysts are not cancerous. One out of four women has this problem. However, not all women with such cysts have a problem in conceiving. Your doctor should have ascertained whether the problem lay with your husband or not by asking him to go for a check-up (including a semen analysis) before arriving at any conclusion as to why you haven?t been able to conceive. Cysts can create problems in egg production in the ovaries in rare cases. But even in such cases there are medical and other supportive treatments available. In case you have put on weight, try reducing the extra flab because it can lead to to a state of hormonal imbalance, making things more complicated.

SoS Contraceptive:-

We usually use condoms for contraception, but failed to use them a couple of times. Luckily I am not pregnant. Can you suggest some emergency contraceptives?

Although condoms prevent transmission of diseases, they aren?t the safest contraceptive. You can try out the female condoms. Some chemicals in the form of a cream can be added to kill the sperms and increase the efficacy of female condoms. In cases of unprotected sex, contact your gynaecologist as soon as possible. He will prescribe some medicines or else, insert a copper-T inside your womb within 72 hours. These will prevent the unnecessary termination of a pregnancy. The first anti-pregnancy tablet should be taken as soon as possible, and the second one 12 hours later.

Abnormal BP:-

I am around seven months pregnant. At a regular checkup with my doctor, I discovered my blood pressure (BP) was 140/95 mm of mercury. Need I be worried?

I need to know what your BP was when you conceived. Some wom-en can start a pregnancy with a high BP. In that case, there isn?t much cause for worry if the BP has shot up after five months of pregnancy and there is more than an acceptable amount of a protein (albumen) in the urine. However, if the BP has gone up after five months of pregnancy, and, on a routine checkup of your urine sample, the protein is found in moderate amounts, the condition needs to be monitored carefully. This condition is called pre-ecclampsia and is the result of a sick placenta (which is the source of a baby?s nutrition). Some blood tests need to be done to gauge the seriousness of the condition and both you and the baby need to be monitored more frequently. You should be happy with the baby?s movements. If you have a head-ache, problems of vision or pain in the upper part of your stomach, you should consult your obstetrician. In these circumstan-ces, blood pressure tablets mask the increasing BP. Since you are seven months pregnant, you can use tablets (which are safe in pregnancy) for the continuation of pregnancy for at least another month if the condition deteriorates.

Cervical cancer:-

My 38-year-old friend has been suspected of having cervical cancer. Is there any way to prevent the disease?

If treated in the precancerous state through regular screening, it is fully curable. Because it is related to some viral infections, the risk can be reduced by using condoms and not having sex with multiple partners. Women who smoke have a higher chance of developing cervical cancer. Sexually active women, or those who smoke, should ideally undergo a regular pap smear screening (every three years at least). It is a simple procedure which entails taking a few cells from the cervix (the neck of the uterus) and looking for precancerous cells. If unhealthy cells are found, further observation is required under a high-powered microscope (colposcope). Biopsy is done from the unhealthy sections. If it confirms the presence of such cells, the diseased portion is removed under anaesthesia.

Sources: The Telegraph (Kolkata, India)

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Some Health Questions And Answers

Q: I am a 21-year-old girl and am very skinny even though I eat healthy and nutritious food. I do not eat junk food nor do I go in for aerated drinks. I do feel healthy, but how do I shed this scrawny look? What kind of exercises should I do?

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A BMI of around 25 is optimum, irrespective of thinness or fatness

A: Size is no longer measured in terms of being skinny or fat. You need to accurately measure your Body Mass Index (BMI). This is calculated as weight in kilograms divided by height in metre squared. It should be around 25. If you simply try to gain weight, the fat may deposit itself in unsightly areas like the abdomen, leaving you with scrawny arms and a paunch! To look good, aerobic exercise needs to be balanced with anaerobic ones. Try jogging, walking, swimming or cycling for 30 minutes a day. Then do biceps and triceps curls to build up muscles on your arms using a baby dumbbell (1-2 kg). Around 20 repetitions need to be done, with each arm.

Always balance weight-bearing exercises with stretches. To increase your weight, you need to track your calories for a few weeks. Write down everything you eat. Then add 300-500 calories to your daily caloric intake. Continue this until you start to gain. An extra 3,500 calories will increase your weight by half a kilo. The number of calories you need to actually gain weight also depends on your activity level.

Basically though, if you aren’t gaining weight, you aren’t eating enough. Keep increasing your calorie intake until you see results. Also, try eating five or six meals a day instead of the traditional three.

No sweat to cool:-

Q: My brother, 23, suffers from a peculiar problem. He does not sweat at all. He goes for a brisk morning walk but still there is no sweating. During April, May and June, his body temperature rises to 101°F to 102°F, even if he stays indoors. This has been so for the last four years. Initially he was under medication but it proved ineffective. The body temperature returns to normal only when the weather cools down. He underwent medical tests but everything was normal. He has been advised to remain indoors and to keep the body cool by taking frequent cold water baths (twice or thrice daily). But it’s is not possible to stay indoors for a prolonged period. Please advise.

A: Sweat is produced by sweat glands that are situated all over the body. As the sweat evaporates, it cools the body, reducing its temperature. The inability to sweat in response to heat is called anhidrosis. It is dangerous and can be life threatening, especially in situations where the weather is dry and hot. Anhidrosis causes the body temperature to rise precipitously. It is often congenital (present from birth) or may be due to ectodermal (skin) dysplasia (malformation).

Some secondary causes are:-

* Certain drugs and medications

* Neurologic disorders such as Guillain-Barre syndrome

Investigations need to be done to establish a diagnosis. Until the cause is known, it is important to take steps to prevent heat exhaustion, heat stroke and dehydration with frequent baths, air conditioning and light, cotton clothes. If it is a congenital condition, this is the only treatment available.

Am I a dwarf? :-

Q: I am 22 years old and my problem is that I am very short. My height is only 4’2” and weight 50 kg. I heard about the YOKO Height Increaser. Would using it make me taller? Or are there are any exercises that may help?

A: Sometimes dangerous medications and hormones are dispensed unregulated via advertisements and the internet. These are accompanied by exaggerated claims about successful outcomes. They target anxious, unhappy people with genuine problems. Before you try the medication, consult an endocrinologist to find out why you are short. It is always better to spend some time and effort to arrive at a diagnosis instead of opting for random, unscientific, untested, treatments that may have dangerous side effects.

Busty isn’t beautiful :-

Q: My breasts are too large for my age. Could you suggest a way to reduce them?

A: You cannot really decrease the size of your breasts without plastic surgery. You can, however, tone your pectoral (chest) muscles by doing push ups (20 a day) so that the breasts do not appear too big and remain firm. Also, wear well-fitting undergarments. Sports bras will make your breasts look smaller and they will not wobble when you walk or run. Remember, flat-chested women envy those with big breasts!

Sources: The Telegraph (Kolkata, India)

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Some Health Questions And Answers

Q: I attained menopause two years ago. My neighbour said that if I have sex, I will contract diseases. Is it true?

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AGE NO BAR: Pregnancy can occur until menopause is attained

A: Menopause only marks the end of the reproductive phase of a woman’s life. The lack of hormones may cause the vagina to become dry. This may make penetration uncomfortable and cause irritation. Lubricating jellies such as KY jelly, vitamin E cream or an oestrogen cream can be used. Sex can be continued and without the fear of contracting diseases. Sexually transmitted infections (STIs), however, may occur if the relationship is not monogamous. But this has nothing to do with menopause.

Sweaty palms

Q: My son has excessive sweating on the soles and palms. The sweat smells of ammonia. Please advise.

A: About 1 per cent of the population suffers from excessive sweating (hyperhidrosis). This may be secondary to diabetes or thyroid dysfunction. In both cases, there may be a breakdown of muscles (protein) for energy, producing an ammonia smell in the sweat. These conditions need to be ruled out with appropriate blood tests. If the tests are normal, your son has primary hyperhidrosis. This can be treated with antiperspirant deodorants containing aluminum chloride (20-25 per cent). Apply it in the evenings, two or three times a week. Otherwise, ionotophoresis can be done. This is the application of low intensity electric current (15-18 mA) to the palms and soles while immersed in an electrolyte solution. Injections of botulinum toxin, surgical removal of the glands or the sympathetic nerve ganglia can be done in severe cases. There are no specific drugs available for the problem.

Goitre surgery

Q: I have a swelling in my throat. Sometimes there is a rasping sound while breathing. My doctor says it is goitre and that surgery is needed, but my thyroid tests are normal.

A: Goitre is a swelling of the thyroid gland. The gland may still be producing enough thyroid hormone to make the results of blood tests seem normal. The goitre could be due to cancer.

The swelling in your throat is large enough to press on the windpipe and cause the rasping sound. If you have been advised surgery, I think you should go for it.

Fall in libido

Q: I am a 46-year-old man who developed hypertension two years ago. I have been started on antihypertensives and since then have noticed decreased libido and impotence. Please help.

A: Antihypertensives can have side effects like decreased libido, erectile dysfunction and premature ejaculation. This is particularly true of the older, less cardio selective medications. The effects are often dose-related. There are many groups of antihypertensive medications. Each person experiences different side effects, so treatment and dosage have to be individualised. Speak frankly to your doctor so that he can alter and adjust the medications.

Contraception

Q: My husband and I have been using condoms for many years. I am now 51 years old. My husband says there is no need for contraception as I am too old to get pregnant.

A: Women can become pregnant until they attain menopause, which occurs when menstruation has completely ceased for one year. You need to continue using condoms or some other form of contraception until then.

Juice is healthy

Q: I am a diabetic. I read that regular intake of orange juice controls cholesterol, blood sugar, body toxins, etc. Can I drink the sugar-free orange juice packaged by prominent companies and sold in supermarkets?

A: Around 240ml (1 cup) of unsweetened orange juice, marketed by the companies you mentioned, contains the following ingredients (expressed as a percentage of the daily requirement): 100 per cent of vitamin C, 35 per cent calcium, 4 per cent riboflavin, 6 per cent pyridoxine, 10 per cent thiamine, 15 per cent folic acid, 6 per cent magnesium, antioxidants, carotene and 100 calories.

Orange juice is recommended by the American Heart Association. It has zero fat and the trace elements, antioxidants and vitamins, have a cardio protective effect. Nothing compares to control of sugars with a sensible diet and exercise.

Controlling diabetes

Q: I am a 43-year-old man with unhealthy eating habits, not to mention alcohol and chewing tobacco. Recently, I checked my blood sugar and was shocked to see the results. The glucose level was 202 mg/dl (fasting) and 311 mg/dl two hours after food. I was afraid that medications would make me drug dependent. So I adopted a restricted diet and strict exercise schedule. I also stopped drinking and the tobacco. Within a week my glucose levels fell to 110mg/dl (fasting) and 186 mg/dl PP. Can I continue with the regimen and avoid medication?

A: Congratulations on your success! You obviously are determined, motivated and dedicated. You can keep your sugars under control with diet and exercise. Buy a glucometer, check the sugars regularly and maintain a diary. If the sugar levels rise again, despite your strict regimen, you can consider medication.

All answers given by DR. GITA MATHAI

Source: The Telegraph (Kolkata, India)

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Some Health Questions And Answers

Q: I have a paunch. How can I reduce it?….CLICK & SEE

A: Spot reduction of a paunch alone is not possible. You have to attempt all-round weight reduction and toning exercises. This can be done with a judicious combination of diet and exercise. Either alone will work only in the short term.

Men tend to accumulate weight around their middle. It will probably be the first place you gain weight and the last place you lose it. The risk factors associated with a paunch are diabetes, hypertension and heart disease. In men the risk increases once the waist measurement crosses 102 cm.

No surgery
Q: My eight-year-old son has frequent attacks of tonsillitis when the weather changes or if he drinks or eats refrigerated things. The doctor says I should wait and not have them operated. Is that correct?

A: Years ago many children had their tonsils removed as they were considered a useless troublesome organ. Today, we know that the tonsils filter out harmful viruses and bacteria and prevent them from entering the body and causing disease. Surgery is seldom necessary. It is recommended if there are seven or more episodes of tonsillitis in one year, the swollen tonsils interfere with breathing or swallowing, or an abscess develops in the tonsils.

Infection occurs with bacteria and viruses. These are usually spread with close contact. The number of infections increases when the child starts school. The refrigerator probably has little to do with the frequent attacks.

The tonsils tend to decrease in size as the child grows older. Waiting and watching instead of rushing into surgery seems like a sensible option. Your doctor is right.

Safe period
Q: We are a newly married couple and do not want children. My wife dislikes condoms and refuses to take the pill. My friend advised natural family planning and the safe days. I was too embarrassed to find out the details. How do we go about it?

A: First, you have to calculate the length of your wife’s menstrual cycle. This can vary in different women and can be anywhere from 26 to 45 days. The first day of bleeding is taken as day one.

Pregnancy occurs if there is sexual intercourse around the time the egg is released. This is usually 14 days before the next period starts. The safe period is thus seven days before and seven days after menstruation. It is not a very reliable method though.

Some couples practice coitus interruptus. In this method, ejaculation takes place outside the vagina.

Medication and sterility
Q: My wife and I have been trying to have a baby for the last 20 years. She is now nearing 40. She has had two miscarriages in the past. I was given methotrexate on and off for my medical condition of psoariasis. I now think this may be the cause of our problem.

A: Gonadotoxins are substances that interfere with sperm formation and quality. They may be chemicals, medication (both prescription and non-prescription), tobacco, alcohol and illicit drugs. The severity and reversibility of the problem depend on the duration and amount of exposure. Methotrexate is one of the medicines that can do this if taken long term.

Consult a reproductive medicine unit in a hospital near you. They will be able to work with your physician to determine the best course of action.

Memory loss
Q: I am preparing very hard for my exams. My marks used to be very good. Now the more I study the less I remember. My marks are decreasing. All these late nights are making me irritable.

A: Sleep deprivation leads to memory loss, irritability and a decline in reasoning. All the three would work against good academic performance.

Most people need around eight hours of sleep a day. Your brain automatically knows how tired you are. If you are consistently using an alarm clock to wake up, it means that you are forcing your brain to function when it is not ready. This decreases efficiency and impairs memory.

Perhaps your marks will be better if you put in 30 minutes of physical activity a day and also got rid of your alarm clock.

Source:The Telegraph (Kolkata, India)

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