Dr Edward Nazareth Health Counselling Column Turns into Gold !
Dear readers,
When we launched the health counselling column by Dr Edward Nazareth just over two years ago as an innovative experiment, we did not imagine that it would soon become a runaway success. In fact, it has earned the place of one of the very vibrant columns. The doctor is being flooded with queries from countries all over the world. He has displayed absolute cool and patience and taken care in providing solutions to everyone's ailments. And the popularity of the column has been soaring with the passing of each fortnight.
As we present the 50th edition of the column, we are sure it has done a lot of good in improving the quality of health and changed the health-related lifestyle of hundreds of our readers. We feel a sense of contentment that our readers have made use of this 'golden' opportunity and have helped in sustaining the 'golden' achievement of the column.
We are grateful to Dr Nazareth for his steadfast commitment to Daijiworld.com and wish him all success in his career.
- Editor-in-chief
1. A. D’souza, Mangalore
* It is a common habit for doctors to blame smoking for many of the ailments. I have seen many people who are smoking and are healthy. Heart attack is also found in non-smokers. I demand you to be fair on smokers.
** Dear Mr. D’souza, it is universally accepted fact that smoking is one of the worst habits as far as health is concerned. In India on each packet of cigarette it is written ‘Smoking is injurious to health’, even then smokers do smoke. I am attaching a picture I got from one of my friends, which shows the anatomy of cigarette, the chemical content that is liberated when the cigarette is burnt and its effects on our body. Most of these are carcinogenic-cancer producing.
** Carcinogen means cancer producing.
Cigarette smoking is the most important preventable cause of premature death all over the world. It accounts for more than 440,000 of the more than 2.4 million annual deaths in US alone. Cigarette smokers have a higher risk of developing a number of chronic disorders. These include fatty buildups in arteries-known as atherosclerosis, several types of cancers-commonest being cancer of the lungs and a disabling disease after middle age known as chronic obstructive pulmonary disease (lung problems). Atherosclerosis (clogged arteries) is the chief contributor to the high number of deaths from smoking. Many studies detail the evidence that cigarette smoking is a major cause of coronary heart disease, which leads to heart attack.
I agree with you that all those who smoke do not die of its complications, but smoking definitely increases the risk. (It is a fact that all those who have physical union with AIDS infected individual do not get AIDS. But, can any one take a chance?). In regular smokers the risk of lung cancer is 12 times more than non-smokers, other lung disorders are 10 times more, and the risk of cancer of the throat (larynx) is 10 folds more than those who do not smoke. Most of those who die at a young age due to heart attack are smokers. The risk of heart attack is 6 times more.
2. L. Mendonca, Dubai
** My husband is 50 years, he is a chain smoker. He smokes pipe or cigars and says it is less harmful than cigarette smoking. Will you please give your opinion on this? Is smoking is dangerous for only those who have diabetes? What happens if others inhale the smoke-like in parties where many of the men smoke without caring for others, especially women and children?
**Cigarette and tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes are the six major independent risk factors for coronary heart disease that you can modify or control. The risk factor like family history of heart attack can not be modified.
Cigarette smoking is so widespread and significant as a risk factor that it is generally known as "the most important of the known modifiable risk factors for coronary heart disease” In the sense, if one is able to give up smoking, the risk of getting a heart attack reduces by about 6 times. Smoking along with another risk factor like sedentary life style increases the risk by about 12 times.
Cigarette smoking increases the risk of coronary heart disease by itself. When it acts with other factors, it greatly increases risk. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot.
Cigarette smoking is the most important risk factor for young men and women. It produces a greater relative risk in persons under age 50 than in those over 50.
Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with nonsmoking women who use oral contraceptives.
Smoking decreases HDL (good) cholesterol. Cigarette smoking combined with a family history of heart disease also seems to greatly increase the risk.
Studies show that cigarette smoking is an important risk factor for stroke. Inhaling cigarette smoke produces several effects that damage the cardiovascular system. Women who take oral contraceptives and smoke increase their risk of stroke many times.
*People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risk isn't as great as that of cigarette smokers. This is probably because they're less likely to inhale the smoke. Currently, there's very little scientific information on cigar and pipe smoking and cardiovascular disease. However their risk is definitely more than non-smokers. This is also true for beedi smokers. They are probably at less risk than cigarette smokers. But the risk enhances when there is one more associated problem like diabetes.
*The American Heart Association believes more research is needed on the effects of passive smoking (also called secondhand smoke or environmental tobacco smoke) on heart and blood vessel disease in nonsmokers. Several studies document the health hazards posed by passive smoking. About 37,000 to 40,000 people die from heart and blood vessel disease caused by other people's smoke each year. Of these, about 35,000 nonsmokers die from coronary heart disease, which includes heart attack.
3. R. P. Kuwait,
* I am 45 years, married. I have read your article on this web site. You have advised stop smoking as it is better for health especially for heart disease. I have been smoking at least 15 cigarettes per day. I have made several attempts to stop it, but I have not succeeded. I have read somewhere that instead of cigarettes nicotine patches are available. If I use them will I be able to stop cigarettes?
** I agree with you that once it is a habit, quitting smoking is very difficult, but is possible. There are many people who are able to say good-bye to smoking, having that habit for years. You require a strong will for that. You CAN quit smoking by using your own willpower. Lots of people use willpower to quit smoking. It is the most common method of quitting smoking. Willpower WILL help you succeed. People that use willpower to quit smoking are just like you. If they can do it, so can you. Changing one's approach to using willpower can mean the difference between success and failure when quitting smoking. You just need a better approach to quitting smoking that will help you take advantage of your natural willpower ability.
· Make up your mind to quit smoking. Remember one of those young men like you who had just passed away due to heart attack or stroke, who were smokers like you. It would have been you instead of him! You have got a chance to escape from this untimely tragedy- quit smoking, your risk gets reduced significantly. To remind you this, you can keep his photo on your table.
· Take an oath, that you will stop smoking by a fixed time-two months or four months from now. It is not possible for all to stop smoking at once. It can be gradual, may be one cigarette less per day per week. Reduce smoking to 14 cigarettes per day in the first week, then 12, reduce it to 10 then to 8! By one month you will be smoking 50% of your normal quota. Gradually, but with determination you can stop smoking.
· Never, never give up! See that you never increase the number of cigarettes you smoke per day. You may distribute the number of cigarettes for different parts of the day-one soon after break fast, not after lunch but one before going to bed. Next day do not smoke after lunch. Then gradually skip one by one. Follow this strictly.
· You may inform about this to your wife or children or other close friends. They will support you. Never take the support of another smoker unless he too is reducing smoking.
· You may inform your dear once- one of your children that the money so saved will be given to them as gift. Instead of this you my offer the savings to one of the charity work at your church or if you are too religious, the money may be offered as offering to the deity or saint.
· It is the persistence, determination and sincere attempt which will help you to stop smoking.
There are gums (to chew) and patches to apply over the skin to control the withdrawal symptoms of smoking. But these are not the medicines to stop smoking. Smoking has to be stopped by self determination. Nicotine therapy is most appropriate for heavily dependent and nicotine addicted smokers who find it difficult to quit even when they are highly motivated. Heavily dependent smokers can be identified by the withdrawal symptoms. Smokers are likely to be nicotine dependent if they smoke within 30 minute of rising from sleep, smoke more than 20 cigarettes a day, or have experienced symptoms during the first week of any previous attempt to quit. The most important physiologic barriers are the symptoms of nicotine withdrawal and tobacco craving, which are experienced by about 80 percent of abstinent smokers. Withdrawal symptoms include gastrointestinal disturbances and mild central nervous system disturbances (anxiety, irritability, difficulty concentrating, restlessness, headache and drowsiness). These symptoms are real, but that they will not last longer than two weeks. Tobacco craving after this period is psychological, not physical.
Smokers must stop smoking completely when starting replacement therapy because simultaneous smoking can produce symptomatically high nicotine levels or worsen addiction. Therapy should generally last for at least three months, during the period of greatest risk for a smoking relapse. Many failures in general medical use are associated with inadequate nicotine replacement for an insufficient period of time. Nicotine polacrilex (gum) and transdermal nicotine (patches) each have their own advantages and disadvantages. There are no guidelines about which form to choose. In general, a patch is the easiest for most patients, but patients who desire more control over their nicotine dose, such as for increased dosing in times of stress, may be started on the gum instead.
The advantages of nicotine gum over the patch are that the dose can be easily titrated to the individual and it may satisfy some oral craving. Disadvantage are that its use may cause side effects (unpleasant taste, throat irritation, mouth ulcers, hiccups, nausea, vomiting and palpitations), absorption of nicotine may be decreased by acidic foods and liquids (cola, citrus juices, coffee) which should be avoided, quitting smokers frequently under-dose or dose themselves inconsistently, nighttime use can result in morning tobacco craving, educating smokers on proper use takes more time than with the patch, and the gum may be difficult to use with dentures
The advantages of patches over the gum is that they are easy to use, have no oral side effects, can provide a steady nicotine concentration for up to 24 hours that helps to decrease morning withdrawal symptoms and may be easier to wean than the gum. Disadvantages include local skin reactions (redness, edema, itching, tingling, burning), allergic reactions to the adhesive, and an inability to individualize or self-titrate dosing. A short-lived topical irritation is very common but rarely severe enough to prevent patch use.
4. J. Pais, Mangalore (Gulf)
*I am 48 years, married. I was smoking heavily and I left it after a mild heart attack about 6 years ago. I am still on medicines like Sorbitrate, Ecospirin. I get occasional chest pain especially if I exert. This has started since last June. The cardiologist has suggested for angiography and then to decide. He told me if there were blocks angioplasty or by-pass surgery would be required. I was told by my friends that these surgeries do not increase longevity and there are risks of getting heart attacks again. Do you recommend me to go for it? Which one is better-angioplasty or by-pass surgery?
** There is lots of development in the field of cardiology; several new methods of management of coronary artery problems have improved the quality of life in people with ischaemic heart conditions. A few years ago by-pass surgery was the only option available for people who had deficient blood supply to the heart muscles due to blockade in the arteries. Now angioplasty is available, which without much pain relives the problem. The individual may have to be in the hospital for less than three days and can resume his usual work within 2 weeks of the procedure.
However recommendation for such procedures is left to the experts who will examine and decide which procedure is better for a particular individual.
The surgeries to establish the circulation in the blocked vessels of the heart do not give permission for carefree life. Even after the surgery, one should follow all the precautions required to be taken by any individual to prevent heart attacks. There are other arteries of the heart which might be blocked. Same artery also might be blocked at another site. Avoiding smoking, control of blood pressure, reduction in the level of cholesterol, regular exercises are required even after surgery. These to be followed as per the advice of the cardiologist. Several medications may have to be continued for weeks to months.
Angioplasty or bypass surgeries eliminate the effects of blockade hence the problems of ischemia like repeated chest pains on minor exertion etc. disappear. The day today life becomes comfortable as par as these problems are concerned. As the risks of heart attacks due to these blockades are eliminated life span also improves. Even after all the precautions, there can be blockade in other arteries. A certain percentage of people can still get heart attacks.
For further details of each procedure kindly follow the question below.
5. Mrs. L. S., Dubai.
* What is angioplasty? Is that a major surgery? What is stent placement? Is it an open heart surgery? How many days hospitalization is required? Is this facility available in Mangalore? What may be the cost?
** Angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), is a procedure in which a narrowed section of the coronary artery is dilated with a balloon catheter. Coronary arteries are the one which supply blood to the heart and their blockade causes heart attack. Angioplasty is less invasive and has a shorter recovery time than bypass surgery. Bypass surgery is done to increase blood flow to the heart muscle but requires open surgery.
Angioplasty relieves chest pain and improves blood flow to the heart. During angioplasty a small mesh like device called stent is placed at the site of blockade to open it. Angioplasty combined with stenting and certain medications show improved long-term outcomes compared to angioplasty alone, with short-term success rates of 96% to 99%. Long-term outcomes of angioplasty on single-vessel disease are similar to those of coronary artery bypass surgery.
Angioplasty is considered very effective for reestablishing blood flow during a heart attack. Angioplasty is at least as effective as (and possibly superior to) thrombolytics in the treatment of heart attack in medical centers where many procedures are performed.
After sedation, a thin flexible tube (catheter) is inserted through an artery in the groin or arm and carefully guided up the aorta into the blocked coronary artery. Cardiac catheterization, also called coronary angiography, is performed first to identify any blockages into the artery. After that stent is passed into the blocked vessel, then a small balloon is placed inside the stent and inflated, which opens the stent and pushes it into place against the artery wall. The balloon is then deflated and removed, leaving the stent in place. Balloon angioplasty is the most common method of inserting stents, although sometimes stents are placed without the use of a balloon. Because the stent is meshlike, the cells lining the blood vessel grow through and around the stent to help secure it. Stents are now used routinely during angioplasty and other revascularization procedures. Restenosis is less likely when compared to angioplasty without stenting. However, additional medications are usually needed to help thin the blood and prevent blood clots following the placement of a stent
Bypass surgery may yield greater benefits than angioplasty for people with diabetes or those with extensive coronary atherosclerosis. Additionally, bypass surgery may be the best option when there are blockages in the coronary arteries that cannot be reached during angioplasty or if angioplasty is tried but did not sufficiently widen the blood vessel, or when heart valve disease is present. Bypass surgery is a major procedure in which vessel from the limbs is placed on the heart, attached on either side of block. This by passes the block and blood supply is restored. (In this surgery, the heart is not opened-not an open heart surgery)
Reclosure (restenosis) of the artery is much less likely to occur after stenting than with angioplasty alone. Stent placement is standard during most angioplasty procedures. In addition, newly developed stents, called drug-eluting stents, could become one of the biggest breakthroughs in the treatment of cardiovascular disease, according to the American Heart Association. While conventional stents have proved to be a valuable tool in opening coronary arteries, many times the arteries closed again. Drug-eluting stents are coated with medications that prevent the growth of cells around the stent and thus are more effective than conventional stents in keeping the artery open.
The person can usually start walking within 12 to 24 hours after angioplasty. The average hospital stay is 1 to 2 days for uncomplicated procedures. Resuming other activities like driving may take a few more days.
Usually aspirin is given after angioplasty with stenting to help prevent the formation of blood clots. When a stent is also used, another platelet inhibitor may be given along with aspirin. The aspirin may have to be taken for long-term; the second platelet inhibitor usually is given for up to 3 months after the stent is placed.
There are at least three institutions in Mangalore where the facilities are available and are routinely done. The expenses differ from institution to institution and personal enquiry may be better. You may contact any cardiologist or these institutions directly to know about the expenses.
6. Y. R. Smith, Nassau, Bahamas
* I had sex on the second day of my period last month. We used a condom. The condom did not break and it was still intact. My period was supposed to start on either the 23rd or the 24th of this month but has not started yet. I took a bunch of pregnancy tests and they were negative. Am I pregnant? Is something wrong with me?
** The woman can conceive only during ovulation, which is normally about two weeks before the onset of menstruation. Normally one will not conceive if physical contact is on the second day after the menstruation. As you have used the barrier, the chances are almost negligible. The pregnancy tests have revealed the same.
There can be unusual delay in menstruation if the woman is tensed or worried. The ovulation might be delayed which in turn will delay the onset of menstruation. You may wait for two more weeks, and then you may consult the gynecologist.
7. J Forte, Philippines
*I gave birth last April 21, and had on and off bleeding for more than 2 months. I have been breastfeeding for 1 1/2 month and mixed feeding then on. I went to a gyne a month ago because I did not got my period yet, and later found out that I have polycystic ovaries. She advised me to take Primolut N because I might have hormonal imbalance, but I haven't taken it yet because she said it will make my breast milk dry-up and increase my blood sugar. Because as I've mentioned, I’m mixed feeding. My family also has a history of diabetes so, the gyne told me to take it only if my on and off bleeding worsens. About two weeks ago, I'm experiencing strange bitter taste in my tounge and my tounge is kind of itchy at times. I'm also experiencing a lot of thirst and choking sensation, tiredness and a little headache. I'm 3 months postpartum now. What could this be?
**Menstrual irregularities are not uncommon after delivery. Many of the women do not get periods for up to six months. The irregularities which you are experiencing might be due to hormonal imbalance due to polycystic ovaries and added effect of lactation. Primolut-N is given to correct hormonal imbalance. (Please refer the last edition of this column to know more about Primolut-N). Primolut-N does not cause diabetes; diabetes is common in those with polycystic ovaries.
The polycystic ovary without any problems need not be treated now. It is better for you and the baby not to take any hormones or related medicines when you are breast feeding. However if the bleeding is more, then consult the gynecologist again and follow her advice.
Your recent problems are unlikely to be related to menstruation. You may consult a physician for treatment.
8. S. P. Dubai
*I 34 years, married and having a kid. My problem is I have regular erection but I can not sustain it for more than a few minutes or seconds. I have a very early ejaculation. Because of this I cannot enjoy my married life fully. Please advise if there is any remedy or medicine for this problem.
**You have not mentioned whether your problem is of recent origin or it is there from the beginning of marriage. You may please go through my book on married sex life in Konkani. Various causes of these problems in the middle age and the solution for these are explained in detail in the book.
Here are a few tips to solve the problem:
· Improve the emotional relationship with your wife.
· Give up smoking and reduce alcohol intake.
· Reduce your body weight if you are obese.
· If these are not applicable, increase the frequency of union, try for various positions than having a monotonous type of sex. Variety is also required in sex life. It is said that ‘single partner many positions is enjoyable, many partners, single position is dangerous’
· Check your blood sugar. Diabetes Mellitus can cause sexual weakness.
· If problem persists consult an urologist. Do not use any medicines unless you are examined and the drugs/medicines are prescribed.
9. E. D’S, Mangalore
* I am 45 years of age. Are there any specific food/medicines you could suggest for having a proper erection so that I can have a good married life? In my case the erection is not the same as earlier.
** The desire for sex and frequency of intercourse gradually decreases as the age advances. This is normal in all men. Certain conditions as mentioned in the answer above may enhance the problem.
Though there are no fixed parameters, many of the men of your age may be having proper intercourse twice or thrice per week.
There are no food items which increase the desire or frequency of sex. The claim that certain foods increase the potency is a myth and many a times they have placebo effect.
It is said, the co-operative partner (wife?) is the best ‘medicine’ to increase the desire as well as frequency.
10. V. Alva, Udupi
*I have been having severe back pain; the pain is centered at the hip joint of the left leg and spread in a thin line (may be a nerve) to left leg 3rd toe. If I sit on the floor with legs stretched or sit folding my left leg then my left leg goes numb in say 3-4 minutes.
I took an x-ray 2 months ago and that reveals nothing as per the local doctors here in Muscat (I'm presently working in Muscat). The specialists suggested for an MRI.
I do not remember any accident or incident as a cause for this pain, I bear this pain since last one year and for the last 6 months it has been severe. I sleep with antibiotics /pain relievers. I used lumber belt for about 2 months as suggested by the doctor but it gave me more trouble, and the specialist told not to use it. Also doctor told me not to do any exercise or jogging. Only walking is suggested.
** It appears that you are having sciatic nerve irritation, known as Sciatica. There are varieties of causes for this, common being a protruding intervertebral disc irritating the nerve roots that form the Sciatic nerve. This nerve runs as a thin cord in the thigh up to the toes and is responsible for all locomotive functions of the leg and foot. Irritation of this nerve causes pain along its course.
You may consult an orthopaedic surgeon and if he suggests MRI scan might be the best to know exact cause of the problem. In many of the individuals, these problems can be cured by physiotherapy and rest for a certain period depending on the cause. Change in the life style, a few precautions in day today life and proper exercises reduce the risk of recurrence.
Surgery for removal of the disc is required only in 10% of the individuals with established disc protrusion. Remaining 90% can be treated without surgery. Precautions are required even after surgery.
11. Mrs. Fernandes, Goa / Kuwait
* I am a married woman with 2 kids. My age is 36 years. My height is 4.9. After my second delivery I gained lot of weight. Especially my belly is very big. Now my weight is 62 kgs. Please let me know how I can reduce weight. Since 15 days I am going for a morning walk. I am walking for about 45 minutes. I take very limited quantity of food. Still I gain weight. I need to loose minimum 10 to 15 kgs. Please advise urgently
** There are no methods by which the body weight can be reduced urgently! It takes more time to reduce the weight than to gain it. There are two main issues in reducing the weight. One is diet and another is exercises.
You may be aware that in our body excess of calories are stored as fat. Each food item we consume has calories. They are more in fatty food, less in vegetables. Even the rice, wheat, fruits contain calories. Probably except water all that we consume have calories. Calories are required for each and every living activity; they are needed for our daily work like walking, talking, writing, reading; calories are also needed for other activities like breathing, digestion, circulation. Whenever we consume more calories they are stored as fat. To reduce the weight one has to be calorie conscious. The quantity of the food intake should be such that it does not produce more calories.
To burn (or to eliminate) excess calories the exercises are required. It takes long time to appreciate the effects of exercises on body weight. Diet and exercises together may reduce the body weight gradually. Both- diet and exercises should be part of your living.
Certain exercises to strengthen the abdominal muscles are required to trim the belly. You may seek the help of physiotherapists to learn about the exercises.
12. J. D’souza, Mangalore
*I am 35 years of age. I have two kids both are boys. Since five and half years I am suffering from the diagnosis called Rheumatism. I wan to have one more child specially baby girl. I went through internet about my diagnosis that I come to know I can not conceive any more. It will effect to the fetus. It is true? Kindly explain about this matter.
**’Rheumatism’ is a general term used for varieties of conditions associated with joint pains. Two important of these are rheumatoid arthritis and rheumatic fever. You have not mentioned what exactly is your problem.
There are no contraindications for conception in rheumatoid arthritis. Rheumatic fever can complicate into rheumatic heart disease. Women with uncomplicated rheumatic heart disease are able to conceive, but they have to be careful during pregnancy and especially during delivery. However, none of these will affect the child. The foetus might be affected by the medicines taken for pain relief.
The information you have received through net have to be verified through an expert. Unless you are seen by a specialist you can not presume that you have problems.
It is not possible to predict that your next baby can be a girl child. There are no definite methods by which the sex of the child can be selected. Your next child can also be a boy! |
