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Some Medical Questions and Answers by Dr.Gita Mathai

Q: I am 61 years old and have a fine tremor in both my hands. The doctor says it is not Parkinson’s disease. I drink 16-20 cups of tea a day and smoke 20 cigarettes.

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A: The caffeine in tea can aggravate an underlying tremor as can the nicotine in cigarettes. Try to stop both. If there is no improvement in two weeks, please consult a neurologist. You might be suffering from an underlying “essential tremor,” which is being aggravated by the tea and cigarettes.

Bleeding gums:-

Q: My gums bleed, even if I don’t touch or irritate them in any way. What should I do?

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A:
Bleeding from the gums usually follows a mild infection called gingivitis. This may be the result of a build up of tartar and plaque formation. The gums may also bleed owing to Vitamin C or K deficiency, or a reduction in the number of platelets in the blood. Or it could be part of an inherited bleeding or clotting disorder. Treatment with anti-coagulants may cause blood to ooze from the gums. Consult a dentist at the earliest.

Breast problem:-

Q: I am a 16-year-old boy with well-developed breasts. I feel very self-conscious as boys often make fun of me. Please advise.

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A: Enlarged breasts (gynaecomastia) are an embarrassing part of adolescence in many boys. About 90 per cent of them recover spontaneously. Overall obesity can give a false appearance of enlarged breasts. Losing weight with diet and exercise will correct this. The condition may be a side effect of medications, especially steroids. Liver diseases can also cause gynaecomastia. It may also be due to an abnormal genetic make up or syndromes such as Kleinfelter’s, though this is rare. You need a complete evaluation by a physician who will be able to tell you if the breasts are normal or if further tests are required. The eventual treatment depends on the final diagnosis.

Cancer survival:-

Q: My grandmother, her sister and my mother all had cancer of the breast. I read about genes being involved in this disease and decided to have a mammogram. The doctors found a small cancer and removed it. What are my chances of survival?

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A:
Survival in breast cancer is not dependent on the genetic make up. Carriers of the BRAC1 and BRAC 2 genes are more prone to developing cancers of the breast and ovaries, but their survival rate is the same as that of other suffers who do not carry the genes. Follow your doctor’s advice regarding surgery, medication and follow-up visits. Also, maintain a healthy lifestyle with a balanced diet and exercise. Women who exercise regularly cope better, physically and mentally, with cancer.

Painful period:-

Q: I am a 34-year-old woman with two children. I never had any problem with my periods; they were painless and always on schedule. Of late, however, the cycle has become irregular. The bleeding is heavy with clots and I also have severe pain in the stomach, back and legs. What should I do?

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A: Pain associated with periods is called dysmenorrhoea. Some women have pain from the time they first start menstruating. In your case, the pain is a recent phenomenon and is also associated with a change in the type and duration of the cycles. This needs evaluation. A gynaecologist will be able to tell you the reason for the changes after a pelvic examination complemented with an ultrasound. If there is a disease process, treating it will cure the pain. If there is no correctable reason, judicious use of painkillers like paracetamol or mefenemic acid will help.

Breathe easy:-

Q: I have asthma and use inhalers regularly. I am symptom free most of the time. How can I improve my health?

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A: Asthma is often precipitated by triggers. The common ones are cigarette smoke, mosquito repellents, agarbattis and room fresheners. All these are best avoided. The frequency, duration and intensity of the attacks can be reduced by breathing exercises. These involve deep breathing with a focus on the coordination between the muscles (diaphragm and intercostals) used while breathing. They can be learnt from yoga classes or from a physiotherapist. If you do not have access to either, there are sites on the Internet that demonstrate the exercises.

My daughter’s constipated

Q: My two-year-old daughter has been constipated from the age of two months. She passes motion with difficulty after four or five days and sometimes even a week. We have tried eliminating milk from her diet and also force her to eat three bananas a day. All this, however, has not helped.

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A: Your daughter needs to be evaluated by a paediatrician to see if there is any correctable cause for the constipation. Is there a thyroid problem or liver disease? Or is there some other abnormality in the gastrointestinal tract such as Hirshsprung’s disease?

If all the above are normal, the retention of stool may be voluntary and because of a failure in toilet learning. Normally, when an infant senses the need for bowel movement, he or she relaxes the buttocks and increases abdominal pressure. Functional faecal retention begins when the child fears bowel movement. This could be because the act hurt on some occasion. The child’s bottom then subconsciously starts to contract instead of relaxing, as he or she attempts to avoid bowel movement. The inside walls of the colon stretch to accommodate the contents and the urge to defecate passes, leading to chronic constipation.

Source: The Telegraph (Kolkata, India)

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Health Quaries

Some medical questions and answers by Dr.Gita Mathai

Trisomy, ugly nails and sedation:-

Self medication can be harmful, consult a doctor when your child is sick.
Q: My son has been diagnosed as suffering from trisomy 18. In a recent article, you said Down  Syndrome was trisomy 21. Are the two different?

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A: Chromosome 18, like chromosome 21, is prone to deletions, breakages and trisomy during early cell division. Trisomy is the presence of three copies of a chromosome rather than the normal two. The deleted part of the chromosome may disappear or attach itself elsewhere forming another extra long chromosome or a ring. Aberrations in this chromosome arise sporadically de novo and have not been associated with any paternal or maternal factor. The syndrome is marked mainly by mental retardation, midface hypoplasia (the area around the nose and cheeks is developmentally smaller than normal), deeply set eyes, carp mouth, mild obesity, ataxia (unsteady, lurching gait), hypotonia (floppiness marked by poor muscle tone), malformed ears, and hyperactive and aggressive behaviour.

Trisomy 18 occurs in one in 3,000 births. About 50 per cent of those diagnosed prenatally die in utero. Less than 10 per cent of the others reach their first birthday. If, however, all the cells are not abnormal and the person is a mosaic — that is, with a mixture of abnormal and normal cells, the chances of survival are greater.

Ultrasound scanning during pregnancy can pick up the anomalies like cleft lip, small head, webbed fingers and toes. This leads to a suspicion of an abnormal baby. Trisomy can be confirmed by amniocentesis. Decisions about whether to continue the pregnancy or terminate it can then be made.

Displaced testes:

Q: My son does not have his testes in his scrotum. Is this Down  Syndrome?

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A: This is not Down  Syndrome, but cryptorchidism, a condition where one or both testes are absent from the scrotum. It occurs in 3 per cent of full-term and 30 per cent of premature infant boys. Testes are formed in the abdomen and have to descend to the scrotum. This process may be halted anywhere along the line of descent. Sometimes the testes are not truly undescended but  eretractile  that is, they move up and down into the groin area and back spontaneously.

If the testes are undescended, they have to be brought down to the scrotum and fixed surgically. Leaving them in the abdomen makes them non-functional and can lead to sterility. They may get twisted leading to unexplained abdominal pain and shock. Also, they may eventually turn cancerous.

Genital warts :-

Q: I have warts near my vagina. They do not pain but itch. The allopath said I should ignore them, while the homeopath gave me some medications which haven’t helped.

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A: Genital warts is a sexually transmitted disease caused by a virus. It is important that they be treated, as they are one of the agents implicated in the development of cervical cancer. Trials are underway to introduce a vaccine to prevent the infection. Once warts have developed, both you and your partner need treatment. Treatment is not uniformly effective. The rate of recurrence is high. Patient-applied treatments are sufficient for uncomplicated external lesions. Topical gels and creams such as podophyllum, trichloroacetic acid, and imiquimod are 30-80 per cent effective in reducing the wart size. Repeated applications may be needed.

Other treatment options are cryotherapy (freezing), excision with scissors, shaving or curetting, cauterisation or laser therapy. Consult a dermatologist.

Pitted nails :-

Q: My nails are ugly as the skin over them is white and itchy. The nails also have holes in them. I went to the beauty parlour but it only worsened the condition.

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A: Scaly, itchy skin and pitted nails are caused by psoriasis. Normally, it is got from other family members with psoriasis. The disease is chronic with improvements and relapses. Treatment is long drawn out and best done in consultation with a dermatologist. Beauty parlours and nail polish are not the answer.

Sedation:-

Q: My uncle is very old and since his children don’t really like to look after him, they keep him sedated all day. Is this safe?

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A: Sedatives are Schedule H drugs which should be dispensed only with a doctor’s prescription. If you are buying the drugs without a prescription and dosing the person yourself, you run a risk of administering an overdose. Also, the elderly have medical problems. If your uncle is already on anti-hypertensive or diabetic medications, you have to know the drug interactions of medications you decide to add on.

Sedation may cause the person to become confused, dizzy and disoriented. This can lead to falls, especially in the toilet. Broken bones or injuries will only compound the problem.

Self medication:-

Q: My daughter, aged two-and-a-half years, frequently suffers from cough and cold. Visits to many doctors proved unfruitful until one paediatrician prescribed amoxycillin. I have been giving it to her every time she has fever. But now the fever has stopped responding to it and her mouth is red and sore with white curd-like formations.

 

A: Amoxycillin is an antibiotic which needs to be given in a particular dose (depending on the body weight) for a particular period of time. Randomly administering it will not reduce fever or tackle the infection. Repeated antibiotic use in your child’s case has resulted in avitaminosis (lack of vitamins) and a sore mouth on which there is probably an overgrowth of fungus. You need to consult a paediatrician for these multiple problems and also every time the child is sick. Please do not self medicate.

Source:The Telegraph (Kolkata,India)