My nose leaks all the time Q: I fell down and hit my head on the washbasin, after which there was a nosebleed. Later, I found that my nose leaks all the time. It is a watery, odourless fluid with no sneezing. No treatment has helped. Finally, a doctor said the cerebrospinal fluid is leaking out from a crack in the skull bones and that I need surgery. What if I do not opt for an operation?
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Q: I am 62 years old with gas and acidity problems. I was prescribed Pantoprazole 40 once daily. I have been taking this since 2003. Is it okay to take the pill for such a long period?
A: Pantoprazole is a proton pump inhibitor (PPI) and works by blocking acid production in the stomach. It is used to treat acid-related stomach and throat (esophagus) problems like acid reflux, GERD, erosive esophagitis and Zollinger-Ellison syndrome. Some of these conditions require long-term treatment.
If such a medicine is consumed for more than three years, it can cause vitamin B12 deficiency. This causes a type of anaemia called megaloblastic anaemia with numbness and tingling in the hands and feet. Consult your physician for further advice.
Q: My son grinds his teeth at night. The noise disturbs our sleep. But more important, his teeth are getting worn down to the gums. He wakes up in the morning with a mouth pain. He has been dewormed five times, but this has not helped. Please help.
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A: The exact reason for bruxism (grinding teeth) is not known. It is associated with certain personality types, people who are high achievers and frustrated by failure. The important thing is to prevent damage to the teeth until the stress issues are resolved. A dentist can fit him with a “mouth guard” to prevent damage to the teeth.
Q: I drink four litres of water everyday as part of water therapy. I feel bloated after that and vomit out the water. Is this good or harmful?
A: Water therapy is advocated by some systems of medicine to cleanse the body of impurities and toxins. However, you do not seem to be following the specifications correctly. You are supposed to drink 1.5 litres (not four) first thing in the morning on an empty stomach. Also, you should not do this if you have diabetes, high blood pressure, heart disease, or liver or kidney failure.
IPV or OPV?
Q: My daughter’s paediatrician has advised injectable polio vaccine (IPV). It is more expensive than oral polio vaccine (OPV). Is it worth it? Why doesn’t the government provide them free?
A: OPV has to be transported and maintained properly at the correct temperature to keep its potency intact. Also, the uptake is variable in normal children and not good in those with diarrhoea. Keeping these limitations in mind, many developed countries have switched to IPV, which is a killed vaccine and does not entail these problems. We should do likewise. The government has introduced it in a few states, but cost is a major constraint. It is definitely superior to OPV and should be given to your child if possible.
Pimples on my back
Q: I have a lot of acne on my back. I also have dandruff. Please advise.
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A: Dandruff aggravates acne. You need to tackle the dandruff by washing your hair everyday with anti dandruff shampoo. It is probably best to keep varying the shampoo. Buy three brands like Selsun, Nizral and Head and Shoulders, and keep alternating them. For your back, bathe twice a day, using a loofah and Neko soap. Avoid talcum powder as it blocks the skin pores and aggravates the acne.
Q: I was bitten by a co-worker during the course of an argument. I am apprehensive even though the company doctor said “there is no need to worry”.
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A: Human bite wounds are often underestimated and under treated. A person’s mouth is full of bacteria. Saliva contains as many as 1,00,000,000 organisms per ml, belonging to more than 200 species. Approximately 10-15 per cent of human bite wounds become infected by these bacteria. Potentially dangerous diseases like hepatitis B, hepatitis C, herpes simplex virus and tetanus can also be inoculated into the wound. Early cleaning of the wound and aggressive treatment are needed to prevent infection and its associated complications. Immunisation against tetanus and hepatitis B is available.
Today, approximately 60% experience occasional episodes of acid reflux, and about 25% deal with the problem on a weekly basis. The prevalence of the condition in North America is increasing by about 5% a year, according to a 2007 study in the journal Clinical Gastroenterology and Hepatology.
A report in January from the Agency for Healthcare Research and Quality found that more than 95,000 people in the U.S. were hospitalized with acid reflux as a primary diagnosis in 2005, up 4.5% from 1998. But the number of people hospitalized with reflux as either a primary or secondary diagnosis reached 3 million in 2005 — an increase of 216% from 1998.
…………………………………... As this old Alka-Seltzer commercial makes apparent, Americans have grappled with acid reflux for decades.
Gastroesophageal reflux disease, GERD or acid reflux, occurs when the small ring of muscle at the bottom of the esophagus weakens and allows stomach acid and food to back up, or reflux, into the esophagus after a meal. Common symptoms include heartburn, difficulty swallowing, an acidic taste in the mouth and nausea or vomiting.
The increase in obesity is speculated to be one cause of its growing prevalence. Excess fat in the abdominal area pushes on the stomach’s contents; stomach fat causes distention and relaxes the lower esophagus; and fat-laden foods slow down the stomach’s emptying process. Other factors include Americans’ notoriously poor nutritional habits and a heightened awareness of the condition induced by pharmaceutical advertising.
Medications also may be contributing to the problem.
“If people didn’t have good medications to treat it and something they ate made them sick, they would avoid it — but it’s human nature to pop a pill and continue eating,” said Dr. Prateek Sharma, a professor of medicine and director of the GI Fellowship Training at the University of Kansas School of Medicine.
Although medication is not a cure for acid reflux, a majority of patients find relief through prescription and over-the-counter drugs. Aside from traditional antacids, including Alka-Seltzer and Tums, there are now two main medications used to treat reflux.
H2 blockers reduce the amount of histamine-2, which produces acid in the stomach. They are recommended for people with less frequent and severe bouts of reflux. Zantac 75, Pepcid AC, Tagamet HB and Axid AR are some of the products available without a prescription.
A second medication is the proton pump inhibitor, which shuts down proton pumps in the stomach that produce acid. These are stronger than H2 blockers and recommended for people with more persistent, acute symptoms. Products such as Prilosec, Prevacid and Nexium are available only by prescription; Prilosec OTC is the only proton pump inhibitor available over the counter.
Even though there are a number of brands, Sharma said they all work similarly. He recommends patients use them for periodic acid reflux problems — once a week or twice a month.
There are some side effects associated with the medications, though most physicians say they are rare. Dr. Nicholas Shaheen, an associate professor of medicine and epidemiology and director of the Center for Esophageal Diseases and Swallowing at the University of North Carolina School of Medicine, said acid-suppressive medications are among the safest drugs he prescribes.
One potential issue is that stomach acid helps fight infection, so reducing acid could make individuals more prone to infections like pneumonia, said Dr. Stuart Spechler, chief of gastroenterology at the Dallas Veterans Affairs Medical Center and professor of medicine at the University of Texas Southwestern Medical Center at Dallas.
The medications also may block the absorption of vitamins and minerals such as B-12 and calcium, which could lead to hip fractures.
Surgical options:-For people who have responded to medication but continue to experience symptoms such as heartburn or regurgitation, surgery is an option. Only about 5% of reflux patients undergo the minimally invasive procedure in which the upper part of the stomach is wrapped around the lower esophagus to re-create the weakened valve.
Some doctors are skeptics of the surgery, Spechler included. He said the procedure tends to “break down” over time, and though many of his surgical patients tell him their symptoms are improved afterward, few are completely cured.
In the late 1980s, Spechler and his colleagues performed a study comparing the results of patients on medication and those receiving surgery. A follow-up study in 2001 found that almost two-thirds of the surgical patients were back on medication.
Dr. David Rattner, professor of surgery at Harvard Medical School and chief of gastroenterology and general surgery at Massachusetts General Hospital, said the surgery is relatively simple; most people go home after 24 hours and are “100%” after about two weeks. Side effects of surgery are rare. They include difficulty swallowing, excessive gas or return of symptoms, particularly among obese patients. Spechler said deaths occur in about one in every 1,000 operations.
One final way to treat reflux is through various endoscopic procedures, including stitching or using radio-frequency waves to restore the lower esophageal muscles. Studies have shown that these procedures can reduce medication usage, are relatively safe and can improve quality of life.
But they are not time-tested and not commonly used. In 2002, the American Gastroenterological Assn. said endoscopic treatment is not a recommended therapy for reflux sufferers.
If you smoke, consider stopping or decreasing the amount you smoke. This is a wise decision for a few reasons:……….CLICK & SEE Reason No. 1: Saliva Production Cigarette smoking slows the production of saliva. Saliva is one of your body’s defenses against damage to the esophagus. There are even acid-neutralizing chemicals in saliva, called bicarbonates. Research shows that the saliva of smokers contains smaller amounts of bicarbonates, thus reducing the ability of the saliva to neutralize the acid. Saliva also bathes the esophagus and lessens the effects of acid that has refluxed up from the stomach, and helps wash the acid down to the stomach.
Reason No. 2: Too Much Stomach Acid
Smoking stimulates the production of stomach acid.
Reason No. 3: Weakens Digestive Valves
Smoking can weaken and relax the lower esophageal sphincter (LES), which is a valve at the junction between esophagus and stomach……...click & see
If the LES isn’t working properly or relaxes inappropriately, stomach contents can reflux back up into the esophagus.
Reason No. 4: Changes Stomach Acid
Smoking also seems to promote the movement of bile salts from the intestine to the stomach, which makes the stomach acids more harmful.
Reason No. 5: Injures Esophagus
Smoking may directly injure the esophagus, making it even more susceptible to further damage from acid reflux.
Reason No. 6: Slows Digestion
Studies have shown that smokers have decreased gastric motility (digestion) while smoking, which can cause less efficient digestion because the stomach takes longer to empty.