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Ask Your Doctor 197 (14.04.2017)

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1. L.C., Mangalore

*I am 28 years of age and I have the problem of hyperhydrosis,i.e. sweating in hand and in my feet. I cant give hand shake to my friends due to this problem. I have consulted skin doctors and was advised medicines. I have tried  doctors of other types, but still is of no use. Is there any permanent solution for this problem.

** Excessive sweating or hyperhidrosis is a clinical condition where parts of the body are sweating beyond the body needs. It is commonly an inherited condition. A segment of the sympathetic nervous system is responsible for this presentation. The sympathetic is an autonomous part of the nervous system on which we have no control. (The autonomous nervous system has two parts to it, the sympathetic and the parasympathetic. Those systems affect blood pressure, heart rate, anxiety level and many other functions)

Commonly affected areas of the body are the hands, and feet. In smaller groups of patients the facial and armpit areas are affected as well.  Excessive hand sweating or as palmar hyperhidrosis is the most common form of excessive sweating.  Attempts to control this condition are numerous and they range from lotions, pills, herbal medications, bio feedback, electric currents (iontophoresis), and acupuncture etc and. to surgery. The benefits of these various modes of management are limited and in some they may not help at all.

In some centres endoscopic thoracic sympathectomy (ETS) is performed to relieve excess sweating in selected individuals. This operation is carried out in a relatively short period of time and the amount of pain and discomfort is limited. Benefits of the surgery are to be discussed with the surgeon before opting for it.

 

2. C.P., Bangalore

*I am 23 years of age. I wan to put on little weight. I get worried when people comment that I look very lean. Is my underweight because of tension or heredity? Please give me some tips to gain weight?

**Losing some kilograms of excess weight has been a major concern of many people. They are vigilant on their diet, do all type of exercises… but fail in their attempts. There are very few people, who are lucky that they are destined to grow thin and lean. They are otherwise healthy. You are probably one of them.  If you are destined not to grow fat, you may not gain weight by any means. However you can make some sincere efforts to put on weight. One has to look for a healthy weight gain, not just adding body fat. That means, instead of loading up on junk foods and high-fat nutritional nightmares like cookies and candies, treating yourself to nourishing foods that will help you add muscle and body mass. Here are a few tips:

  • Eat three meals every day. Yes, this means you need to get up in time for breakfast that you can't skip lunch, and that dinner actually needs to be prepared and eaten.
  • Eat three snacks every day. That's midmorning, mid-afternoon and evening. In order to gain weight, you need to fuel your body at regular times. The easiest way is to set up a schedule of three meals and three snacks.
  • Stop drinking non-caloric beverages. That includes diet soda, and plain coffee or tea. You have to look for calories. Choose skim or 1 percent milk (You need healthy calories, not fat, so avoid milk with higher fat contents), 100 percent fruit juice or sports drinks.
  • Choose calorie-dense foods. That means eating rice, chapattis instead of bland vegetable salads and banana chips. Make it a habit to routinely choose foods that are higher in calories.
  • Expand your meals. Each meal should include some type of starchy food (rice, bread, potato, and cereal), fruits and vegetables, and a protein source (chicken, red meat, fish, eggs, cheese). Use small quantities of butter or ghee in each meal to add moderate amounts of fat without going overboard.
  • Exercise. Regular exercise and activity will help your body gain muscle and not unwanted fat. One hour walk or thirty minutes of aerobic exercises is plenty to get your system moving yet not so much that you're burning up tons of calories. If you are more active, you'll need to increase your calorie intake.

 

3. S.N., Dubai

*I am 30 years. I have some small swelling on my scrotum; it looks like wart which is yellow in colour, but no pain or itching.

** This may not be a major problem. There can be several skin conditions on the scrotum without pain and irritation. You may consult a skin specialist for treatment.

 

4. W.D’s., Dubai

*I am 28 years of age have some white substance getting on my penis, it started recently. It is not continuous itch but some times it feel prickly. In the glans penis at the edge there is some rash like appearance very slightly. Is this something that I need to see doctor or is there any home remedies?

** It appears that you have a type of fungal infection on the glans. It may be better to consult a skin specialist. The infection if mild can be treated using ointments/creams for local application.

 

5.P.D’s., Mumbai

*I am 59 years of age. I was having pain in my knee joint for sometime. In MRI it was reported as meniscal tear in the joint. My doctor suggested me arthroscopic surgery and I was operated. Now it is 4 and half months and I still have stiffness and pain in the knee. Since 3 months I am going for physiotherapy and have been doing the exercises given very sincerely. Will I recover fully? How long this pain and stiffness may continue?

** If you have tear in the meniscus without injury like fall, it might be due to osteoarthrosis, the wear and tear of the joint. If it is due to osteoarthrosis, the pain may not go totally as the process of degeneration continues. If you had injury and meniscus tear is due to injury, it may require some more time for recovery. You may have to continue physiotherapy and exercises.

 

6. P.K., Mysore

*One of my relative aged 24 years had herpes infection a month ago in her vaginal area. She had taken proper treatment and it is cured now. She is scared that the infection may recur in few days again. she wants to know whether there will be any chances of recurrence and how it is caused and what are the remedies to avoid it in the future.

**Genital herpes is an infection caused by the herpes simplex virus or HSV. There are two types of HSV, and both can cause genital herpes. HSV type 1 most commonly infects the lips, causing sores known as fever blisters or cold sores, but it also can infect the genital area and produce sores. HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth. A person who has genital herpes infection can easily pass or transmit the virus to an uninfected person during sex.

Both HSV 1 and 2 can produce sores (also called lesions) in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where the virus has entered through broken skin.

Most people get genital herpes by having sex with someone who is having a herpes "outbreak." This outbreak means that HSV is active. When active, the virus usually causes visible lesions in the genital area. The lesions shed (cast off) viruses that can infect another person. Sometimes, however, a person can have an outbreak and have no visible sores at all. People often get genital herpes by having sexual contact with others who don't know they are infected or who are having outbreaks of herpes without any sores.

A person with genital herpes also can infect a sexual partner during oral sex. The virus is spread only rarely, if at all, by touching objects such as a toilet seat or hot tub.

Unfortunately, most people who have genital herpes don't know it because they never have any symptoms, or they do not recognize any symptoms they might have. When there are symptoms, they can be different in each person. Most often, when a person becomes infected with herpes for the first time, the symptoms will appear within 2 to 10 days. The first episodes of symptoms usually last for 2 to 3 weeks.

Early symptoms of a genital herpes outbreak include

  • Itching or burning feeling in the genital or anal area
  • Pain in the legs, buttocks, or genital area
  • Discharge of fluid from the vagina
  • Feeling of pressure in the abdomen

Within a few days, sores appear near where the virus has entered the body, such as on the mouth, penis, or vagina. They also can occur inside the vagina and on the cervix in women, or in the urinary passage of women and men. Small red bumps appear first, develop into blisters, and then become painful open sores. Over several days, the sores become crusty and then heal without leaving a scar.

Other symptoms that may go with the first episode of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.

Although there is no cure for genital herpes, certain anti-virus medications are used to treat it as well as to help prevent future episodes.

During an active herpes episode, whether the first episode or a repeat one, you should follow a few simple steps to speed healing and avoid spreading the infection to other places on the body or to other people.

  • Keep the infected area clean and dry to prevent other infections from developing.
  • Try to avoid touching the sores.
  • Wash the hands after contact with the sores.
  • Avoid sexual contact from the time one first feels any symptoms until the sores are completely healed, that is, the scab has fallen off and new skin has formed where the sore was.

If there are early signs of a herpes outbreak or visible sores, sexual intercourse or oral sex  should be avoided until the signs are gone and/or the sores have healed completely. Between outbreaks, using male latex condoms during sexual intercourse may offer some protection from the virus.

 

 7. N.D., Sharjah

 

*I am 29 years  of age, not married. From the past few weeks I am facing itching between my thighs as well as in my outer skin of my vagina. Now the skin has became very dry. If I  scratch it bleeds. I am using clean cloths everyday . Can you please suggest me some medicine I can apply for the same. It is very irritating.

** It is better to consult a dermatologist to get proper treatment. The problem can be inflammation of the skin(dermatitis) due to allergy to some local application to fungal infection. A specialist can diagnose and treat the problem effectively.

 

8. S.A., Dubai

*I am just 12 years. I got my first period when I was in 3rd standard.Now I am in 8th class.My problem is that my periods are irregular. For example I got my period in January then I didn't get in February and March.Why does this happen??

** Menstruation is controlled by a complex series of hormonal interactions between the thyroid, adrenal and pituitary glands, hypothalamus and the ovaries. Menstrual period changes are usually a symptom of some underlying physical or hormonal imbalance. Changes in the amount or timing of hormones released by the thyroid, adrenal and pituitary glands, or hypothalamus may cause the ovary to delay or skip ovulation. Without ovulation a period will not occur. However the same changes in hormones may trigger bleeding at abnormal times (in the middle of a cycle or several weeks late) or in abnormal amounts (very light or very heavy).As the irregularities of menstruation are mainly due to hormonal irregularities, ovarian hormones are given to set the menstrual cycle on track. Oral contraceptive pills contain these hormones in the optimal dose. The pills are normally advised to be taken for three to six months for women with menstrual irregularities. In most of the women the menstrual cycles become normal following the hormone therapy and continue to remain so even after discontinuing the medication.

 

9.  L. F.,  Mangalore 

*My son is 4 years old and he has speech problem, He speaks, but while talking he is trembling, he pulls the first letter of the word. Please advise me how to improve his speech. 

** You may show your child to speech therapist in any of the major institutions with speech and hearing department and  follow their suggestion. It appears that the child is very conscious about the defect and that may be reason for it to tremble while speaking. Do not pressurize the child to speak properly.  If you pressurize, it will cause stress on the child and the problem might aggravate. 

10. M. S. Mangalore 

* I am 21 years of age; I am masturbating from the age of 14, now I am suffering from severe back ache and leg pain. I am continuing it till date and I cannot stop it. Please suggest a remedy. 

** I hope you have gone through the previous editions of this column. I have answered several times earlier on this subject. There are no ill effects on physical growth or sexual   development. There is no physical illness reported so far due to masturbation. The back pain associated with leg pain may not be related to masturbation. In your age it can be due to variety of problems in the lower back, chronic strain is the commonest of these. Consult an orthopaedic surgeon and get proper treatment. You need not tell the doctor about your habit of masturbation unless you do it in bad posture. As the habit of masturbation is normal you need not give more stress on stopping it. 

11. A.G., Mangalore 

* I am 41 years of age. I am suffering with cervical spondylosis. I frequently get pain in my back, right shoulder, hand and fingers. I take a pain killer. Is there a treatment for the same?

 

**Cervical Spondylosis isalso known as “cervical arthritis,” Spondylosis refers to the degenerative changes in the spine that particularly affect the cervical (neck) vertebrae and/or intervertebral discs.  These changes gradually narrow the space in the vertebral foramen, the hollow part of the vertebrae that hosts the spinal chord.  This narrowing causes compression on the nerves leading from the spinal cord in the neck. These nerves travel along the shoulder, arm to forearm and to the hand controlling the movements and carrying the sensations from and to the entire upper limb. As these nerves become compressed, they are inflamed, causing pain in the neck that may radiate to the arms.

 The condition most commonly begins around age 40-50.  Nearly everyone over the age of 50 will experience some degeneration in the structures of the cervical spine, but not everyone will develop spondylosis.

 Though the pain killers are a part of the treatment of cervical spondylosis, taking pain killers for a long time may cause harmful effects. You may consult an orthopaedic surgeon for proper evaluation.

 Several different diagnostic tests may be done to determine whether spondylosis is the cause of chronic neck pain.  X-rays will indicate some vertebral (bone) abnormalities, the amount of degeneration.  CT (computed tomography) or MRI (magnetic resonance imaging) scans may be done to better examine particular structures in the spine. 

If the diagnosis is cervical spondylosis, treatment will depend on the severity of the symptoms. 

Most cases respond to conservative treatment.  In addition to rest, non-steroidal anti-inflammatory medications (NSAIDs), the pain killers,  may be recommended to decrease swelling and relieve pain. These have to be taken for a short period under proper supervision.  Heat (hot showers, hot cloths) and gentle massage may provide comfort.  

The doctor may also recommend physical therapy treatments such as, short wave diathermy, ultrasound or cervical traction.  Special support for the neck, such as cervical pillows, may also help if pain is severe. However the collars or belts should be used for a short period.

Surgery is normally not done to treat cervical spondylosis. It may be rarely necessary to fuse neck bones, remove a damaged disc or enlarge the spinal space, narrowed due to the formation of bony spurs.  Surgery is generally recommended only in more severe cases, when pain or loss of function is significant and unresponsive to other forms of treatment. 

 12. J. M. Mumbai 

* I am 19 years of age. My height is 6.6. I want to decrease it compulsorily to only 6 feet. In other words, I really do not want the height of more than 6 feet. So please give me the best suggestion to decrease and control my body's height. 

** As on today there is no treatment available to alter (to reduce or to increase) the height of a normal individual. Rarely the abnormal production of certain hormones related to growth may influence the height of the individual. Excess production of some hormones may be the cause for unusual height. You may consult a physician to rule out any such defects. We hope there are no defects in you, and hence you may have to accept your height. There are people taller than you who lead a normal life. Try to develop a positive attitude.  

13. K. G. Mangalore 

* I am 35 yrs old, my wife is 32 years old and we got married two years ago. I had my semen analysis done.  The result is: sperm count is 50million and motility 15%. Urologist prescribed certain tablets (name omitted) for 3 months. I am taking those tables from mid September. Still my wife has still not conceived. I have another problem. Whenever I prepare to have sex, I cannot do it properly. Because of my treatment, I have some feelings in my mind like, whether I can be father or no. The same feelings coming in my mind during intercourse and I get afraid and sweating. Please suggest me some medicines and whether I can overcome with this problem. I'm really worried. Whether Yoga is better to cope with my problem?

** The reported sperm count and motility, though low is sufficient to have a child. There are incidences  of positive results even with counts less than yours. As you are already put on medicines both the motility and counts might have improved now. You have to develop a positive attitude at your capacity to father a child. There are no medicines to imbibe this attitude, you have to develop it. You may take the help of a counselor or a psychiatrist for this; former is better. Once you get the confidence your apprehension at sexual performance might go.More than the medication for fertility, timing of physical union also plays a major role. For this you may have to know about window of fertility. Normally a healthy woman with regular periods will have ovulation on the 14th day preceding the day of onset of menstruation. Two days preceding it and two days following it are termed as the ‘window of fertility’. {For example if next menstruation is to start on 15th of June, then 1st June is the day of ovulation. (15-14= 1), Window of fertility extends from 29th May to 2nd June}  Window of fertility is the most likely period of ovulation and it is commonly advised for infertile couple to make use of, the chances of conception are better in this period. Most of the couple is advised to practice this at least 6 months before opting for costly tests of infertility and artificial methods as treatment. The incidences of conception are more if physical union is regularly performed during window of fertility.  

14. R.S., Muscat 

* My son is 7 year old. He is lean and not putting up weight. He is only 18 kg. Is this ideal for his age. Can you guide us to improve and put up weight? 

**As you have not mentioned the height of your child, it is difficult to opine whether your child is weighing less compared to his height. It may be worth consulting a child specialist to clear the doubt as well as to rule out any definite medical causes for under weight.  Obesity or excess weight is an alarming problem of several children today. But some of the healthy children grow lean right from childhood and nothing can be done to increase their weight. They have a lean body constitution which can not be altered. However some tips mentioned in the answer to the 1st question in this column may be adapted to your child also. In an attempt to increase his weight, 

15. R.R. Mangalore 

* I am 45 years of age. I am suffering from acute belching. Is it a gastric or acidity problem?  My intake of salt, oil and chilly is less; yet I keep belching now and then, which is embarrassing while I am with others around me. I consume strong tea thrice a day which might be one of the reasons. Kindly advise a solution.

 ** The ability to belch is almost universal. Belching is the act of expelling gas from the stomach out through the mouth. The usual cause of belching is a distended (inflated) stomach caused by swallowed air. The dissention of the stomach causes abdominal discomfort, and the belching expels the air and relieves the discomfort. The common reasons for swallowing large amounts of air (aerophobia) are gulping food or drink too rapidly, anxiety, and carbonated beverages. People are often unaware that they are swallowing air. 

Excessive air in the stomach is not the only cause of belching. For some people, belching becomes a habit and does not reflect the amount of air in their stomachs. For others, belching is a response to any type of abdominal discomfort and not just to discomfort due to increased gas. Everyone knows that when they have mild abdominal discomfort, belching often relieves the problem. This is because excessive air in the stomach is often the cause of mild abdominal discomfort. As a result, people belch whenever mild abdominal discomfort is felt-whatever be the cause.

You may consult a gastro-enterologist to know if there are any definite causes of belching. After a thorough medical history you might be advised to undergo certain tests. The treatment, if needed, will depend on the cause.

 16. V.M. Mangalore 

*I am 35 years married for 10 years; I have two girls aged 6 and 1. Around 8 years ago, when I conceived for the first time I had a miscarriage after 4 months. Then I was told that I had fibroids. I then had laparoscopy done and got the fibroids removed.   I conceived again and got my first baby girl under C-section. When I was pregnant for my second child I was informed that I had the fibroids again but they were outside the uterus. I delivered the second baby girl under C-section and the baby is normal. Now whenever I get my periods for the first two days the bleeding is very excessive with terrible backache. I just wanted to know is this because of fibroids?  Shall I remove the fibroids or just leave it.  Any other advice if you could give me 

** The condition you are referring is termed as menorrhagia. Menorrhagia is menstruation at regular cycle intervals but with excessive flow and duration. It is defined as total blood loss exceeding 80 ml per cycle or menses lasting longer than 7 days. Menorrhagia is one of the most common problems and is reported that 30% of all premenopausal women perceive their menses to be excessive. Women who lose more than 80 ml of blood are likely to develop iron-deficiency anemia as a result of their blood loss. Menorrhagia is the most common cause of anemia in premenopausal women.  The other medical terminology of menorrhagia is dysfunctional uterine bleeding (DUB). Most cases of DUB in younger age are secondary to anovulation. (No ovulation). 

If a young patient has had irregular menses since menarche, the most common etiology of her bleeding is anovulation. Without ovulation, the corpus luteum fails to form, resulting in no progesterone secretion. Unopposed estrogen allows the endometrium to proliferate and thicken. The endometrium finally outgrows its blood supply and degenerates. Anovulatory bleeding is most common in young girls and common in obese females of any reproductive age. (If a patient's bleeding normally occurs at regular intervals and the irregularity is new in onset, pathology must be ruled out, regardless of age).Anemia also can cause menorrhagia. Menorrhagia causes anemia and anemia in turn causes excessive bleeding. There can be other causes like intra-uterine devices (loop), polycystic ovarian syndrome, anatomic defects or growths within the uterus like fibroids, hormonal imbalances like hyper or hypothyroidism, galactorrhea, thrombocytopenia, renal failure etc. which are rare.As the back ache is related to bleeding, the problem that is responsible for bleeding also might be the cause for back ache.

You require further evaluation for the problem. As the fibroids are in no relation with the uterine cavity, they alone may not be the cause of menorrhagia.  

17. J.P., Dubai 

* Does the menstrual cycle change the mood at the age of 18-19 years? 

** It is the menstrual cycle that has an effect on mood than the mood changes affecting the menstrual cycle. Menstrual cycle can be regularly or irregularly irregular for no definite reason. In many women there can be varying degrees of mood changes just before menstruation, known as pre menstrual tension. This is more common in young women. 

18. A.R., Mangalore 

* I am 30 years. I am planning to marry this year. I have lost my hair and it would be difficult to find a bride. I am not interested in wearing a wig. How much would it cost for hair grafting and what are side effects? 

** The cost of hair transplant depends on the center where it is done, the doctor who is doing it and on the area on which the transplant has to be done. The success also depends on it. You will have to personally consult the doctor and get answers for your doubts.  

19. J.S., Mangalore 

* I am 39 years of age. I have hernia problem for both sides. I under went surgery for the hernia on the right side. After the operation, till date I have pain in the operated side. Sometime my left scrotum also pains. Doctor has prescribed pain killers but pain is bothering still. My question is, was my operation a failure? Why do I still get pain on my right side when I have already undergone operation? Is it common? I don't wish to go through another operation as it is very painful and unbearable especially when I sneeze it pains like hell. 

** The surgeries done to get rid off inguinal hernia are simple, definite and safe. Persisting pain at the surgery side indicates some problem may or may not directly related to surgery. If possible get a second opinion from another surgeon. 

20. S. R., Udupi 

* I am 31, and I am married for 10 months, my husband is abroad. He will be coming within 3 months and then will return. Is it possible for me to conceive within 3 months? I am worried because of my age whether I will have a child or no- I get tensed on this.  

** Even at in your age the woman can conceive by having physical union on  proper days. As your husband is going to stay with you for three months, there are good chances for you to conceive. However, as you are not young and again you are not staying for long with your husband, you have to try to conceive as early as possible. You can consult a gynecologist and get the basic tests done now. You can discuss your worries with your gynecologist who might advise you certain medications that might prepare you for conception. Have a positive attitude and you might be blessed with a baby


Dr. Edward Nazareth

Dr. Edward Nazareth: Born December 28, 1958. Dr.Nazareth holds medical degrees - M.B.B.S. (1982 Mysore Medical College, Mysore), D.Ortho (1986 Mysore Medical College, Mysore) M.S.(Ortho.) (1987 Mysore Medical College, Mysore).

At present Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Fr. Muller’s Medical College, Kankanady, Mangalore-575 002.

He is a resident of Kankanady.



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