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1.A.C. Dubai


* I am 32 years of age. I am having scrotal vericocele problem; as a result the sperm count, motility very low. Am on homeopathy medication. I heard that eating ginger with honey is good for this problem. Is it right?


** The scrotum is the sac covered with skin that holds the testicles, and it also contains the arteries and veins that deliver blood to these reproductive glands. An abnormality of the veins servicing the testicles may result in a vericocele. It is not certain what causes vericocele. However, many experts believe a vericocele forms when the valves inside the veins in the cord prevent  the blood from flowing properly. The resulting backup causes the veins to widen (dilate). This may then result in damage to the functioning of the testicle and result in worsened fertility. A vericocele can result in a decrease sperm production and quality. It can also shrink the testicles. 

There are no established risk factors for developing a vericocele. Vericocele often form during puberty. Vericocele usually occur on the left side, most likely because of the position of the left testicular vein. However, a vericocele in one testicle can affect sperm production in both testicles.


Vericocele is a common problem and it is found in about 40% of infertile men 20% of all men in the general population.  Vericocele is a surgical problem and can not be treated by medicine or diet. Any amount of medicines from whatever system unlikely to solve the problem. Similarly diet has absolutely no effect on vericocele. Urologists often diagnose and surgically repair vericocele. However, correcting a vericocele (surgical procedure) does not  always improve the semen quality enough to result in pregnancy for the couple. The success of the surgery largely depends on the sperm count prior to surgery. For example, if the count is under about 5 million per cc, or the motility below about 30% prior to surgery, it is unlikely that the semen quality will improve enough after vericocele repair to result in pregnancy.  Studies suggest that men with counts that are just slightly low (15-20 million) may be more reasonable candidates for vericocele surgery. Couples considering vericocele surgery should see a well trained urologist as well as an infertility specialist in order to become educated about all of their options before proceeding. Some couples will decide to proceed with the vericocele surgery and see what happens. It is not a big surgery and recovery is pretty easy. If they do not get pregnant within 6-9 months after the surgery, the other treatment options such as insemination may be considered.


2. A.G., Mangalore

*I am 49 years of age. For the past 2 months my menstrual bleeding has been increased from 7 days to 12 days. I had been to my gynecologist. She examined me  and advised me to get an ultrasound. It revealed multiple fibroids and that the uterus was bulky. My gynecologist found that there was erosion in the cervix. She has advised me for hysterectomy. I would like to know whether I should go for a laparoscopy or normal operation? Which is better? She says technically both are same (result wise). She says ovaries are required for the body.


**As you are approaching menopause,  irregularity in quantity and duration of the menstrual flow and cycle are not rare. Once the menopause is set in, the uterus along with the fibroids are likely to shrink and may not cause any further problem. You may wait for sometime till you attain menopause.


If your present gynecologist is insisting on surgery, it may be better to take opinion from another, ideally from a senior gynecologist about the need of hysterectomy. 


If feasible, laparoscopic hysterectomy is better. Laparoscopic hysterectomy uses several thin instruments and a video camera attached to a telescope to remove the uterus. Unlike the older procedure, there are no incisions made in the abdomen or vagina. An incision of about one-half inch is made in the bellybutton, and the camera and instruments are inserted through the incision. The camera transmits an image of the internal organs onto a television monitor, and the surgeon uses the image to guide him or her through the process of detaching the uterus and removing it through the same incision at the bellybutton.


This minimally invasive procedure offers many advantages to women over a traditional abdominal hysterectomy. Instead of several hours of surgery and an extended hospital stay, laparoscopic surgery can be performed on an outpatient basis; in most cases, the procedure itself takes less than an hour, and patients can go home the same day. There is very little to no blood loss, and minimal risk for complications. Pain is minimal—patients generally can use a non-narcotic pain reliever if one is needed. All of these factors lead to a faster recovery time as well; most lap patients can return to work in seven to ten days. Because the incision is minimal, so is scarring. Yet despite the many advantages of laparoscopic hysterectomy in contrast to an abdominal procedure, only about 15 percent of hysterectomies are currently performed laparoscopic ally. One reason for this is that relatively few gynecologists are trained specifically to perform the procedure.


3.V.D’S., Mangalore


*My daughter is 4 years of age. Her height is 105 cm and weight 20kgs. Is she overweight? If yes, what should I do reduce her weight? Is she going to face any complications in future? 


** The height of your child is normal and for her age but her weight seems to be more. Your child seems to be overweight for her age and height. Research shows that children who stay a healthy weight tend to be fitter, healthier, better able to learn, and more self-confident. They are also much less likely to have health problems in later life. Obese children are likely to develop health problems early in their life. Children whose parents encourage them to be active and eat well are more likely to stay a healthy weight and grow up healthy.


*Be a good role model: One of the best ways to instill good habits in your child is for you to be a good role model. Children learn by example. One of the most powerful ways to encourage your child to be active and eat well is to do so yourself. Set a good example by going for  exercises such as walking instead of watching TV, or surfing the internet. Playing in the park or swimming with your children shows them that being active is fun. It is also a great opportunity for you all to spend time together.


*Get active: Children need about 60 minutes of physical activity a day for good health, but it does not need to be all at once. Several short 10-minute or even 5-minute bursts of activity throughout the day can be just as good as an hour-long stretch. Walking or cycling short distances instead of using the car or bus is a great way to be active together as a family


*Do not over feed: Try to avoid feeding your child over-sized portions. There is very little official guidance on precisely how much food children require so you will need to use your own judgment. A good rule of thumb is to start meals with small servings and let your child ask for more if they are still hungry. Try not to make your child finish everything on the plate or eat more than they want to. And avoid using adult-size plates for younger children as it encourages them to eat oversized portions


*Eat healthy meals: Children, just like adults, should aim to eat five or more portions of fruit and vegetables everyday. Discourage your child from having sugary or high-fat foods like sweets, cakes, biscuits, some sugary cereals and sugar-sweetened soft and fizzy drinks. These foods and drinks tend to be high in calories and low in nutrients. Aim for your child to get most of their calories from healthier foods such as rice, wheat and from fruit and vegetables.


*Less entertainment and more sleep: Help your children to avoid sitting and lying around too much, as it makes it more likely for them to put on weight. Limit the amount of time your child spends on inactive pastimes such as watching television, playing video games and playing on electronic devices. There is no hard and fast advice on how much is too much, but experts advise that children should watch no more than two hours of television each day – and remove all screens (including mobile phones) from their bedroom at night. It also helps children stay trim if they sleep well. It has been shown that children who do not have the recommended amount of sleep are more likely to be overweight. The less children sleep, the greater the risk of them becoming obese. Lack of sleep can also affect their mood and behavior.


4. A.K., Mangalore


* I am 34 years of age. I am suffering from neck  and shoulder pain for more than a year. The shoulder pain is more during night. 


** It appears you have problems with your cervical spine. The nerves that supply the shoulder, arm  upto the fingers originate from the cervical region and any irritation there can cause pain at one or more regions supplied by these nerves. You may consult an orthopaedic surgeon for proper evaluation. Avoiding thick pillows, exercises to strengthen neck muscles may help you on a longer run. Initially some medication may be needed.


5. S.B., Mangalore 


*I am 40 years of age, married  and have a  child of 9 years. My wife is 35 years. I have much sexual desire  to satisfy myself  I masturbate. When I am with my wife, I get anxiety  and  tension for no reason and I do not get proper erection. This has been affecting our mutual relationship.


**  What you are doing is not proper; it can harm your marriage. You require counseling to overcome this problem. If you can get you may consult a marriage or family counselor or you may consult a psychiatrist who will be able to refer you to a proper counselor.


6. S.S.N., Coimbatore


*I am 54 years of age. I had undescended testis from my childhood. Recently I got married, due to unforeseen circumstances which was not done earlier. My wife  is aged 46 years, still getting her periods. I am happy with my wife. I consulted one specialist (Urologist), in Coimbatore and undergone semen analysis and biochemistry. The report is: Sperm concentration-nil. Total motility -00 Serum FSH level:50.53 mIU/ml Serum testosterone: 2.72 ng/ml Impression: Azoospermia. Moreover I had ultrasound scan. That report indicates as under: left testis is seen in the  left proximal inguinal canal at the level of the internal inguinal ring. Right testis is not seen in the right side of the scrotum and the same could not be traced in the  right inguinal canal and in the right side of the pelvis. There is right inguinal hernia with herniation of bowel. Recently during I had surgery for hernia and undescended testis. Please give me your suggestion whether I can have a child.


** Considering your age, your partner’s age and the problems you have, it is unlikely of you to get child now. You may discuss these issues with your urologist who will guide you about the future courses.


7. E.D., Dubai


* I am 62 years  of age, widow. My uterus was removed nearly 13 years ago. Since then I have not visited a gynecologist. Nowadays my face is becoming dark and also patches on the cheeks maybe due to pigmentation. My friends advise me to see a gynecologist. Is it required? My second problem is I have severe burning sensation in my legs and feet, whenever I sit, I keep my legs up on a table and when I get up, I can see my legs veins swollen up, then they become normal after walking few steps. Please advise the reason for this burning of feet.


** Though there is no harm, it may not be required to consult  the gynecologist at  your age as you already have undergone hysterectomy. If you are concerned about pigmentation on the face, consult a skin specialist. For burning feet problem with dilated veins, you may  have to see a general surgeon to rule out varicose vein problem.


8. D.P. Muscat


*I am 38 years of age. I have itching problem on arms, genital area,thighs,legs for the past one  and half year. I tried all medicines with almost all dermatologists in Muscat city. 


** You seem to be having some systemic allergy. You require proper evaluation. Take opinion from a physician who will be able to treat the problem or will refer you to an appropriate specialist.


9. M.F., Mumbai


*One of my friend is suffering from alopecia, he is in his thirty’s. What is the best method to treat it? He is getting bald above the forehead, losing hair, Can hair transplant be the solution. Is this method safe? 


**Loss of hair is the common problem. The influence of genetically inherited factors and male hormone (androgen) on the hair follicle (root of hair) is the main cause for hair loss. Hair loss can begin at any time after puberty. There is no cure for this. Your friend may have to consult a skin specialist for proper assessment and treatment. In milder forms local application of minoxidil is used. It may be used as per the prescription of skin specialist.

There are various other options available to conceal the hair loss. At some centers surgeries like hair grafting are available. The cost of such cosmetic surgeries has to be weighed at the benefits of concealing baldness. These surgeries are not life threatening.


10. I.D’s, Mumbai


* I am 33 years of age. I have acute pain in my knees for more than a year. It is so bad that I cannot sit with my knees folded for long. I visited an orthopedic doctor who advised me that I should exercise and reduce my weight. But I do not think that is the problem. These days, even while sleeping, with my legs stretched, I get acute pain. I read about tuberculosis in the knees and gout. My uric acid levels are also high. Kindly suggest.


** The problem appears to be related to uric acid, and unlikely due to tuberculosis. Tuberculosis of knee is rare, but is a serious problem which worsens over the time. Consult another orthopaedic surgeon or preferably a rheumatologist for proper evaluation.


11. P.C. UAE


* I am 39 years  of age. I had done my mammogram last month. The report says bilateral dense breasts. Specks of microcalcifications in both breasts as described (BI-RADS category-3). There is no abnormal skin thickening or puckering. The doctor said that such report can not be ignored and requires a review. Can you please tell me is it serious and is there any complications. 


** Breast density is a measure used to describe the proportion of the different tissues that make up a woman’s breasts. Breasts are made up of fat and breast tissue (the milk ducts and lobules, which may be called glandular tissue). Connective tissue helps hold everything in place. Breast density compares the area of breast and connective tissue seen on a mammogram to the area of fat. High breast density means there is a greater amount of breast and connective tissue compared to fat where as low breast density means there is a greater amount of fat compared to breast and connective tissue.


There are reports suggesting that women with high breast density are four to five times more likely to get breast cancer than women with low breast density. Although women with dense breasts appear to be at higher risk of breast cancer, it is not clear that lowering breast density will decrease risk. For example, getting older and gaining weight after menopause are both related to a decrease in breast density, but are also related to an increase in breast cancer risk. So the relationship of breast density and breast cancer is not well established.


You need not be under stress because of this report as it is not categorically true. However may have  tests once in a year or as frequent as advised by your doctor. This test can be a part of general medical check up.  


12. R.P., Mangalore


*I am 30 years of age. I am suffering from fungal infection for the past six months. I am not a diabetic. It is white cream forehead and  skin of my organ. I had shown to doctor but he is saying it ill cure but I am feeling itching and burning some time becomes dark red.


** The fungal infection may not be cured unless your diabetes is under control. In some of the couples, the woman may be harboring infection deep in her genital organs without any symptoms. Man is likely to get repeated infection from there during physical union. Unless your partner is treated it may not be possible to get rid off the infection. Consult a dermatologist for proper assessment and treatment.


13. L.P., Mumbai


*I am 38 years of age. I had sexual experience from the age of  19 years and I had no problem. However from the age of 24, I feel  my sexual urges are decreasing. If I watch adult movies or think of erotica I yet can not get an erection. I visited sexologist who conducted some test on me and said its normal. Another specialist did a sonography and said there was no beat in one of the vein but everything else was normal. Also the testosterone showed within range. Please advice. I am single and want to get married. 


** The desire as well as frequency of urge for physical union gradually declines in men as the age advances. It is natural and normal. More frequently you watch porn, its effect on excitement also comes down. 

Most of the sexologists are ‘fake doctors’ as none of the systems teach sex as a specialty. If you want proper and scientific advice, consult an urologist or psychiatrists.


14. M.D., Dubai


*I am 46 years of age. I had a cavity in my lungs when I was working in a hospital 22 years  ago it was treated. When I came to Dubai and started to work these many years it was fine; every year we have to renew our occupational health card, but for the past one year it is showing some spots in my lungs. I did investigation in India when I went on holidays recent. Everything was normal but my Gold quantiferon test was positive. I do not have any symptoms.


** This is a blood test that is an aid in the diagnosis of TB.  This test can help detect active and latent tuberculosis. This is a nonspecific test and can be positive in those who had tuberculosis earler. The test remains positive even if the disease is treated . In our country most of the people receive BCG vaccination and in them the test can be positive.


As you were treated and have no symptoms you can ignore the test. It will remain positive in you and does not require any intervention.


15. J.K., Mangalore


*I am 60 years of age. I had a arranged marriage and have not had good chemistry with my partner. The sex frequency was very rare. I am too much interested in sex and she is not my type and does not cooperate in bed as I think of a playful girl in bed. Our physical desires do not meet, and I am craving of sex with the right partner. Of recently, I started secretly dating one of the other married woman who seem to have the same problem and we both hit it off from day one and have great sex every time we do it. Even at this age I enjoy all sorts of sex plays with this woman who makes me so happy in bed. Morally, I may be doing something wrong, but is it wrong to get the sexual pleasure outside if you cannot get it from your spouse? 


** As rightly mentioned by you, your present behaviour is immoral and can lead to dangerous consequences.  Legally if you are not happy with your wife you have to divorce her and marry the woman whom you like once she is separated from her husband. This is all practically not possible. It may be better for you to chose that is morally, socially and legally acceptable.


16. A.L., Mumbai


*I am 60 years of age. I am suffering from ankle pain(swelling, burning),I consulted an orthopeadic doctor, he gave medicine, but not cured. He took x-rays,  there was no fracture. In the morning swelling is less. Evening time it increases. I am a diabetic patient. 


** Your present problem is unlikely due to orthopaedic reason. You may consult your physician who treats you for diabetic and he might refer you to other specialist if needed.


17. K.S.S., Udupi


*I am 25 years of age. My organ size is 5.5inch. I am worried because I see big organ in porn movies. I am getting married next month. Is with this size can I satisfy my partner?


** If you decided your penis is small after looking at  pornography, keep in mind that men in these  are often chosen because they have  large organs.  In marital sexual relationship the size of the penis matters very little. Marital sexual act is not a mechanical union. There are lots of feelings that are involved and the size of the organ hardly matters for proper physical union. There is one more interesting thing is that most penises are very much the same size when erect. The man whose non-erect organ is small it will usually achieve about 100 per cent increase in length during sexual excitement, while the man whose non-erect penis is on the large size will probably only manage about a 75 per cent increase. In round figures, this means that the great majority of men measure between 15cm (6") and 18cm (7") in the erect position, with the average figure being about 16.5cm (6 ½").


The size of the male organ can not be altered by any medications, local applications, exercises or even by plastic surgery. Men with small organ can perform as effectively as with the men having larger than average penis. 

18. S.M., Mangalore


*I am 27 years. I have erection problems and I have less sperm count. I had gone to the doctor, but my problems not resolved. What may be done?


** You have to consult an urologist for proper assessment and treatment. Both these problems may be inter-related and can be resolved.


19. R.K., Kasargod


*I am 25 years of age. In my groin region and thighs region there is some infection.I get some yellow color lesions on the scrotum also, which goes and comes back. How can I overcome this problem?


** It appears to be skin infection. Consult a dermatologist. With oral medication and local application, the infection can be treated.

 

20. D.R., Dubai


*I am 38 years of age. I have  developed some white patch on my private parts recently. I am scared


**It may be just a change in the normal pigmentation of the skin. For assessment consult a skin specialist.


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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