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Ask Your Doctor 184 (17.11.2015)

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Please read this before you ask your question.....!

We are pleased that this column has become popular among our visitors. This column is purely of educative and informative type. We do not intend to suggest any definite treatment or give name of any specific drug or doctor either in India or abroad.

We are receiving questions from many of our visitors from different parts of the world. Though we have the desire to give the reply at the earliest, we are unable to do so. At present we are updating the column once in two weeks, but at times there is inadvertent delay. This results in lot of back log. We answer the questions in first come first serve basis. Even then to answer a particular question, it may take more than a month. We request our visitors to bear with us.
We regret, we are not able to help when reply is sought urgently. It is absolutely not possible to help in emergency situations. There is no facility to give personal reply through e-mail.

Please fill up all the relevant details in the columns when you send the question. Please give your correct name, e-mail address etc. While answering we are editing the name and try to conceal the identity of the person who sends the question whenever it is required. We will not attend the question when the details are not sent. This is just to see that the person is serious of his question.
You might have noticed that, the answers can not be perfect if all the details of the problem are not given. Please send all the details of the problem in the relevant question. Many such details where the identity might be revealed will not be published.
If you want further clarification or want to react to the answer please use the same column. Indicate the specific question or answer where further details/clarification is sought. Your reactions/suggestions are highly appreciated.

Even when a person consults the doctor in person, there can be error in diagnosis and treatment! Please remember the answers here are based on the perception of the problem sent in the questions. There can be an error in perception by us and the answer may not be suitable. It is always advisable to consult the appropriate doctor before taking any treatment.
Dr. Edward Nazareth

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1. S.J., Mangalore

*I am 52 years, having pain in the knees from a long time. I have taken several types of tablets and applied oil with which pain disappears but comes again. I get severe pain while climbing and getting down the steps.  

** By the description given by you, it appears that you are having osteoarthrosis of the knee joint. Osteoarthrosis, commonly known as osteoarthritis, is a wear-and-tear condition in which the natural cushioning between joints-the cartilage- wears away. When this happens, the bones of the joints rub more closely against one another with less of the shock-absorbing benefits of cartilage. The rubbing results in pain, swelling, stiffness, decreased ability to move. 

Though osteoarthritis can occur even in young people, the chance of developing osteoarthritis rises after age 45. The most common  cause of osteoarthrosis of  knee is age. Almost everyone will eventually develop some degree of osteoarthritis. However, several factors increase the risk of developing significant arthritis at an earlier age.  Over weight increases pressure on all the joints, especially the knees. Every pound of weight adds 3 to 4 pounds of extra weight on the knees.

Repetitive stress injury is another cause of knee joint wear and tear. These are usually a result of the type of job a person has. People with certain occupations that include a lot of activity that can stress the joint, such as kneeling, squatting, or lifting heavy weights (55 pounds or more), are more likely to develop osteoarthritis of the knee because of the constant pressure on the joint.

Athletes involved in soccer, tennis, or long-distance running may be at higher risk for developing osteoarthritis of the knee. 

The diagnosis of knee osteoarthritis is usually done on clinical examination, followed by X-rays. 

Regular exercises to strengthen the muscles acting on the knee joints can reduce the recurrence of pain. Certain activities like squatting, sitting cross legged, climbing the steps can reduce the stress on the knee joints. Weight reduction also helps to reduce the stress on the joints and reduces pain.

There are no medications which can reduce or stop the wear and tear. Only medicines that are used in osteoarthrosis is to reduce the pain, when the pain is severe. The pain relievers are to be used cautiously because certain pain relievers can damage the kidneys if taken for a long time. 

Physiotherapy also helps when the pain is severe.

There are certain surgical procedures which are to be done when the joints are damaged significantly affecting the movements.

You may consult an orthopaedic surgeon for further evaluation and advice.

 2. S.A., Mangalore

*I am 33 years of age. Married for 5 years. I would like to know whether having sex daily will affect the health? Will it cause 

** No, in fact daily sex is good for overall health. The production of semen is not dependant on the frequency of ejaculation. Its quantity does not increase if the frequency of ejaculation is increased or reduces if one stops ejaculation. Production of semen is dependant on age and general sexual health. 

It is a myth that semen is ‘Dhatu’- a precious product, of the body and in its production several thousand drops of blood are used. Blood has no role in the production of semen. Blood cells are not used to generate sperms. It is also wrong to believe that the excess drain of semen weakens the bones and depletes the bone marrow. Semen is an excretory product, whatever that is produced has to go out. It does not get back into the system. 

Sexual act is a physiological phenomenon, a biological urge that has several beneficial effects on health.

Sexual intercourse burns approximately 150 calories per half hour. Per day if one is able to engage in about 15 minutes in love act, per week he is likely to burn considerable amount of calories. 

Sex helps increase the blood flow to the brain and to all other organs of the body. Increased heart rate and deep breathing accounts for the improvement in circulation. . 

People having frequent sex often report that they handle stress better, so the normal stresses of living do not become distress. The profound relaxation that typically follows lovemaking, with orgasm for women and ejaculation and/or orgasm for men, may be one of the few times people actually allow themselves to completely let go, surrender and relax. Many indicate that they sleep more deeply and restfully after satisfying lovemaking. In the relaxing afterglow one may be able to let go of distracting thoughts. Being able to stop thinking has helped many to overcome insomnia. 

Through the touch magic of sex the hormone oxytocin is secreted in the body which in turn causes the release of endorphins. Because of these natural opiates sex acts as a powerful analgesic, elevating the pain threshold and helping to relieve the aches of conditions like arthritis, whiplash and headaches. Now there’s a novel approach, sex as a remedy for headache rather than an excuse for abstaining! 

A British study of 1,000 men found those who had at least two orgasms a week had half the death rate of their countrymen who indulge less than once a month. 

The hormone DHEA promotes sexual excitement and increases in response to it. DHEA may be the most powerful chemical in our personal world. It helps balance the immune system, improves cognition, promotes bone growth, and maintains and repairs tissues, keeping the skin healthy and supple. It may also contribute to cardiovascular health and even function as antidepressant. 

Some doctors believe that more than 75% of men over 50 have a somewhat enlarged prostate, and that virtually all men will suffer from prostate enlargement if they live long enough. This condition, called benign prostate hypertrophy (BPH), is normal and usually not dangerous. Regular sexual intercourse with frequent ejaculations will help to keep the prostate healthy. 

Regular sexual activity boosts testosterone and estrogen levels in men. Besides boosting the libido testosterone fortifies bones and muscles. Some physicians suggest that testosterone keeps hearts healthy and good cholesterol high. 

Sex increases women’s estrogen levels keeping vaginal tissues more supple and also protecting against heart disease. It is estrogen that makes a woman sexually receptive and responsive to a man’s approach. It is estrogen that makes her want to be touched and feel romantic. 

Sex is good, but sex with love is even better. According to Dr. Dean Ornish author of ‘Love and Survival: the Scientific Basis for the Healing Power of Intimacy’, “an open heart can lead to the most joyful and ecstatic sex”. His researches into intimacy and its effects on health have shown that “anything that promotes feelings of love and intimacy is healing”. If you have someone who really cares for you and for whom you care in return, someone you are intimately connected with in all ways - emotional, physical and more -- then you may be three to five times less likely at risk of premature death and disease from all causes. 

Part of this has to do with the positive effects of touch, what some one has referred to as Vitamin T. The chemical composition of the body is changed by touch. Caressing, hugging, stroking, cuddling send a chain reaction of chemicals to signal to the brain that this is pleasurable, nurturing, good. 

3. A.R., Kerala

*I am 33 years of age. I have pain in my knees from the age of 16 years. Earlier it was in one knee, now both the knee joints are paining. The doctors opined that it was osteoarthritis. I have flat feet. I work on the ship standing entire day. Due to this I get pain in my legs from knees down to feet. I find difficult to wear safety shoes which is compulsory when on duty.

** You may refer the answer to the first question of this update. In some people inherited abnormalities in the leg or foot also might affect the loading on the joints leading to wear ant tear early. At your age, regular exercises and weight reduction can help to minimise the stress on the knee joints. For your flat foot problem, you may have to get the shoes specially designed for flat feet. You may consult any orthotic centre for this.

4. L.L.C., Mangalore

*I am 26 years of age. I have the problem of excess sweating, my hands and feet become wet. I have difficulty to write and speak with friends. The doctor prescribed some lotion to apply and said there was no other remedy. Thyroid tests were normal..Is there any cure for this?

** 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.

 5. K.M. Dandi

* I am 28 years of age. Actually I have a problem with the size of my penis, I have had a look at other males and compared to them my size is really small; and one more thing is that my fore skin is still attached to the tip of my penis so my fore skin does not really come till the end. What can be done for this?

** The size of the penis is a common cause of worry in many of the young men. It's not difficult to find out about the size of the average male member - there are lots of surveys on the internet and in scientific journals, and one can easily work out the average size ranges. But how reliable are these figures? The answer seems to be - not very! When you ask men to measure their own penis, they consistently get longer results than when doctors or nurses measure it! So, taking all the surveys, working out the average, and then adjusting the results in favour of those where measured by others the guys' penises, here are the most reliable figures: Average soft (flaccid) penis length = 3.3 inches (8.4 cm) Average erect length = 5.9 inches (15.0 cm).

If  you decided your penis is small by looking at  your friends and  age mates, remember that the size of the  non-erect penis bears little or no relation to the size of the  erect one. If you decided your penis is small after looking at  pornography, keep in mind that men in these pictures and films are often chosen because they have  exceptionally large penises. If reports of figures made you decide you are small, remember many if not most men lie about the size of their penis when questioned, often exaggerate by several centimetres. 

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 smallish will usually achieve about 100 per cent increase in length during sexual excitement, while the man whose non-erect penis is on the largish 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. 

If the foreskin does not retracts, you may have to take appropriate treatment. Consult either a general surgeon or urologist for proper evaluation and treatment.

6. A.A. Dubai

*I am in Gulf for the last thirteen years. I am suffering from asthma for the last three years. I am using both ayurvedic and allopathic medicines. But these medicines give me only a temporary relief. Please suggest the right medicines for my problem.

I have the problem of cough when I get the asthma attack. I keep coughing continuously and my ribs and head pains. Please suggest a remedy for this too. I am a hypertension patient for the last 18 years. This is in my family. I am on medication for that.

** Are you sure that you are suffering from asthma or it is allergic bronchitis? Though both the conditions have similar symptoms the treatment and the prognosis differs. Allergic bronchitis can be cured completely where as asthma can be only controlled. Let me come to your topic-asthma:

Asthma attacks all age groups but often starts in childhood. It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day.

Asthma is due to inflammation of the air passages in the lungs. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs.

It is believed that the strongest risk factors for developing asthma are exposure, especially in infancy, to indoor allergens (such as domestic mites in bedding, carpets and stuffed furniture, cats and cockroaches) and a family history of asthma or allergy. Exposure to tobacco smoke and exposure to chemical irritants in the workplace are additional risk factors. Other risk factors include certain drugs (aspirin and other non-steroid anti-inflammatory drugs). The weather (cold air), extreme emotional expression and physical exercise also can exacerbate asthma.

Urbanization appears to be correlated with an increase in asthma. The nature of the risk is unclear because studies have not taken into account indoor allergens although these have been identified as significant risk factors.

Asthma cannot be cured, but could be controlled. Because asthma is a chronic condition, it usually requires continuous medical care. Patients with moderate to severe asthma have to take long-term medication daily (for example bronchodilators in tablet form or inhalers) to control the underlying inflammation and prevent symptoms and attacks. If symptoms occur, short-term medications (inhaled short-acting beta-agonists, steroid inhalers) are used to relieve them.

Medication is not the only way to control asthma. It is also important to avoid asthma triggers -- stimuli that irritate and inflame the airways. Each person must learn what triggers he or she should avoid.

You have to consult a physician and follow his advice. If you are asthmatic, you have to understand the disease. You may have to accept that the asthma can not be cured but can be controlled. Do not go from one system to the other in search of definite cure, it is not available in any system of medicine so far. Most important is, beware of quacks who offer magic cure and cheat the patients.

Cough is a symptom of asthma. If asthma is controlled cough will be reduced. Continue medication for hypertension. Hypertension also can not be completely cured; it only can be controlled through proper medication.

7. L. P, Mangalore

*My sons age is 15 years, he is having problem with his foreskin on his genital. When he was small I used pull it back to clean it, even though it was not coming back fully. The skin has stuck to genital on top. About a year back I took him to a physician for circumcision as I thought it might be phimosis. But doctor said operation is not required. Kindly give your advice, whether I should go ahead with circumcision or consult another doctor.

** There are two types of phimosis based on age and pathophysiology- congenital phimosis and acquired phimosis. Both terms imply the inability to retract the distal prepuce over the glans penis. Once the foreskin can be retracted so that the glans penis partially appears, a phimosis is no longer present. 

Congenital phimosis is entirely normal for young children, even into the teenage years. The congenital phimosis does not cause problems such as urinary obstruction, hematuria, or preputial pain. Congenital phimosis can be considered physiologic in the young male since the foreskin is always tight, nonretractable, and adherent to the glans at birth. The foreskin continues to be tight until progressive keratinization of the epithelial layers between the glans and the inner prepuce dislodges the foreskin from the glans. 

In most of the cases the problem resolves gradually, therefore surgical intervention is normally not required. A congenital phimosis can be left alone. Only the usual cleaning, without forceful retraction of the foreskin is necessary. Proper foreskin hygiene should be suggested to the child. 

If it is congenital phimosis, retraction will be possible gradually and circumcision may not be required. You may consult another doctor, preferably an urologist to assess the condition.

8. K.K. Mangaluru

*I am of 28 years. I started masturbating at a very young age (May be at the age of 15). Now I am working in Gulf and every day (sometime twice and thrice) I have that habit and without that I do not go to sleep. This has become a regular habit for me.

I was engaged last year and am getting married at the end of the year. Now I feel weak and I get an early ejaculation. After that I get a severe pain in my scrotal region which continues for one to two hours.  Is their any problem for my married life and for having children?

**Masturbation is normal and there is no harm from it-either physical or sexual. The pain you are feeling might be because of the pressure you are applying while masturbation. Try to relax and see if the pain disappears. If it is bothering, consult an urologist.  

The present problems of early ejaculation and feeling weak are psychological. They are likely to disappear once you marry and have normal physical union. These may not adversely affect your married life. 

9. S.S. Dubai

*I am 26 years old. I have got lot of blackheads on my nose. I also have very dark circles round my eyes. I have tried taking B-Complex tablets; applying cucumber etc. But still I am having blackheads and dark circles. I also have a lot a pimple spots on my face. How can I remove them and make my face clean. Also my hand and leg skin is very dry. 

**The black heads on the face are due to acne. Acne is caused by the over activity of the sebaceous glands that secrete oily substances onto the skin. The sebaceous glands of people with acne are especially sensitive to normal blood levels of a hormone called testosterone, found naturally in both men and women. Testosterone in people prone to acne triggers the sebaceous glands to produce an excess of sebum. At the same time, the dead skin cells lining the openings of the hair follicles (the tubes that hold the hair) are not shed properly and clog up the follicles. These two effects combined cause a build-up of oil in the hair follicles. This causes blackheads and whiteheads to form. For some people, their acne does not progress beyond this stage.

However in other people, the build-up of oil in the hair follicles creates an ideal environment for a bacterium called Propionibacterium acnes to grow. These bacteria normally live harmlessly on your skin but when this ideal environment is created, they grow. They feed off the sebum and produce substances that cause a response from your body's immune system. This inflames the skin and creates the redness associated with spots.

To get a proper treatment you may consult a skin specialist. Do not apply the medicinal creams. /ointments without consulting the doctor.

10. J. V. Mangalore

*I am 29yr old my height is 5.7 and weight is only 48kg, I am looking pale slim. My problem is body weight. The body weight is not increasing even though I take medicines and good food. My blood reports are normal. When I take medicine my body weight increases from 47 to 50kg and after that it doest increases. After completion of the medicine it comes down. What can I do to increase my body weight? My waist is 30 I want to increase it to around 32. 

** You might have observed that the commonest problems of many of the people is to lose weight. They are ready to do whatever possible to become slim and trim but are unable to lose weight or fat easily.

Some lucky persons like you are able to remain thin and slim even after eating fatty food This is probably genetically determined, they have less fat cells in the body and as a result there is no place for fat to deposit. If this is the case, nothing may be done to increase the weight. 

Please consider few points:

As long as your general health is good just ignore about the body weight. Slim people like you are unlikely to get problems like diabetes, hypertension, arthritis, spondylitis etc.

Do not worry about people enquiring. This is a habit of many of our people. They pass comments like—‘you look overweight than last time’ or ‘why you are so thin or you seem to have lost further weight’ etc. This is a habit and many of them in reality do not remember how you were on the previous occasion.

Adding good, quality weight takes some time, but you can speed up the process by ensuring that you're taking the necessary weight gaining steps. And THE most important weight gaining step is to consume enough calories to be used for gaining muscle and weight. 

The biggest weight gaining tip is: To get big, you MUST eat big! Gaining weight is calorie driven. You'll NEVER gain weight if you do not eat enough calories. To add size and weight, you must eat enough food to create a calorie surplus. That's a hugely important weight gaining fact! If your body requires 2000 calories a day just to maintain its current weight, you will not gain weight if you're only consuming 1800 calories. Start taking in a little more than your daily maintenance amounts. Use meal replacements or protein shakes to add some extra, weight gaining calories. Start eating 2200 calories a day for the first week and test your results. If nothing happens, go to 2400 calories. Adding calories a little at a time will allow you to find that number which will allow you to keep gaining weight without taking in so many calories that you quickly start adding a lot of fat. 

There are specific exercises for various groups of muscles in the body. It may appear odd, but you too can start body building exercises for limbs, chest or abdomen one or two at a time. It is not possible for me to give full account of these exercises. You may consult a physiotherapist to learn these exercises.

There is no harm in consulting a physician again to rule out any deficiencies/problems which may be the cause for low weight. However, in most of the ailments the one loses weight rather than failure to gain weight.

11. J. D’S, Sharjah

* I am 30 years. I got married 4 years ago. My problem is that I have very small breasts. I thought after marriage they would enlarge get into a proper size. But after 21/2 years I got a baby boy the size of the breast become smaller. What may be done to increase the breast size? 

**It is the amount of fatty tissue that makes some breasts bigger than others.  In other words, the milk producing organ is about the same in both small and big breasts.  Therefore breast size is not linked to the ability to produce breast milk and breastfeed per se.  Even flat-chested women, who don't have practically any fat cells in their breasts, can breastfeed.

Breasts not only develop differently from woman to woman, they continue to change shape and size throughout the life. The right breast may not even be the same size as the left.

One thing is common for all women: there is no medicine of any kind, any work-out machine or exercise that will significantly change the shape or size of the breasts.

It is understandable to feel bad when you have small breasts and there's nothing wrong if you wish to have it corrected.  If you are very unhappy with the breast size or shape, you may decide to have silicone implants. Unfortunately the implants will only lessen the milk supply and the probability of successful breastfeeding, besides forcing the woman to go through several surgeries throughout her lifetime, and putting her to a high risk of serious complications. For many it is a costly and often painful operation, but it is becoming more common. Plastic surgeons have become very skillful in this field. 

The implants are placed on the chest under the muscles, which leaves the breast tissue untouched and also means that the nipples will stay in natural contact with the gland tissue.

12. L. L. Mumbai

*I am 31 yrs old married this year and planning to have my first baby. I suffer from migraine for the past 15 years. Earlier I used to take aspirin but after consulting to a neurologist I was advised to take migranil and xenobid. I would like to know if there are any side effects or how safe it is to take it or will there be any effect on my child.

** If you are planning for the child, you will have to stop the medicines you are using now. Many of the medicines may adversely affect the child at its early stage of formation. Ideally no medicines should be consumed in the initial period of pregnancy except nutrition supplements like vitamins, iron-folic acid s etc. If you are planning for pregnancy, you may stop the medicines you are using now.   Instead of these, you may consult your doctor and get prescription for some other safe medicines when you get migraine head ache. As it is, migraine has no effect on the child.

13. P. P. Mangalore.

* I am 40 years. I am suffering from severe cervical spondylitis for the last four years. I tried all sorts of medicines including ayurvedic, and therapies like physiotherapy acupuncture but there is no relief. Will you please let me know a particular diet to strengthen the bones and to cure this sickness?

**Cervical spondylosis is a chronic degeneration of the vertebrae of the neck (cervical spine) and the cushions between the vertebrae (disks). Also known as cervical osteoarthritis, the condition usually appears in men and women older than 40 and progresses with age. Although cervical spondylosis affects both sexes equally, men usually develop it at an earlier age than women do. The problem is not related to diet. There is no diet that can strengthen the bone at your age; more over  strengthening the bone does not cure cervical spondylosis. 

The degeneration in cervical spondylosis most likely is a result of wear and tear on the neck bones as one age. The changes that accompany the degeneration, such as developing abnormal growths (bone spurs) on the spine, can lead to pressure on the spinal nerves and, sometimes, the spinal cord itself. This can cause radiating pain in the upper limbs and weakness of the muscles.

Mild cases of cervical spondylosis often require no treatment or may respond to conservative treatment, including wearing a neck brace and taking pain medication. More severe cases of cervical spondylosis, however, particularly those involving pressure on the spinal nerves or cord, may require treatment ranging from neck traction to stronger medications to surgery.

Mild cases of cervical spondylosis may respond to cervical collar during the day. Cervical collars help limit neck motion and reduce nerve irritation. When there is severe pain non steroidal anti-inflammatory drugs may help.    Exercises under the guidance of a physical therapist to strengthen neck muscles and stretch the neck and shoulders give a long lasting relief. Low-impact aerobic exercise, such as walking or water aerobics, also may help. In more serious cases hospitalization with bed rest and traction on the neck completely immobilize the cervical spine and reduce the pressure on spinal nerves. Traction may be required for a week or two.

14. K.R. Dubai

*I am 30yrs old, married for 4 yrs and do not have kids. Two years ago I got severe pain in the chest in the right side and was very difficult for breathing. Doctors diagnosed it as pluritic pain and I was put on anti tuberculosis drugs (9 months course). Now I am better.  My weight has increased from 52 kgs to 58kgs.I would like to know will this pain cause any complications in future.I would like to plan for a kid. Can I go for pregnancy? Will there be any health problems? Will there be any side effects of the medicine on my health or of the child? When I become pregnant will there be any breathing problem? 

** Normally the tuberculosis is cured by taking anti-tubercular medicines for a sufficient period. As you have already taken medication for nine months the disease would have healed. But at times during healing there may be adhesions at the site of the disease and it can be the cause for persisting pain. There is a possibility that the pain might disappear in due course of time. Try to do some breathing exercises; they might help you. 

You can go ahead with your plan to get a child. Normally the present pain may not increase during pregnancy; you will not get breathing problems during pregnancy because of earlier healed pluritic lesion.

The medicines are normally excreted within a day or two of consumption; the medicines which you took two years ago would not be present now in your system even in traces. The side effects manifest when the individual is on medicines not after they are excreted from the body. 

15. A. P. Muscat

* I am 32 years of age. I am having the Copper-T for the last 8 years. The doctor had suggested that I can keep the loop for 10 years. Please suggest whether it is safe to keep for such long time and any side effects if I keep it for long. I have one child ?

** It is said that the Copper-T loop(IUD) can be retained for 10 years if there are no side effects or complications from it. But majority of the gynecologists would like to replace the loop once in three to four years.

Women who want to become pregnant may have their IUD removed at any time. Normally they conceive once the IUD is removed. If you are planning for a second child, it may be better to remove the loop at the earliest.. While most women who stop using IUDs are able to become pregnant, IUDs can have negative effects on a woman's fertility. If perforation, embedding, or pelvic infection occurs the uterus or tubes may become damaged and lower the chance of pregnancy. 

16.M. Mumbai/Dubai

*I am 33 years old and my wife is 27 years. We got married 5 years back and we don’t have kids. We have done all the tests and everything is normal. A year ago my wife had an abortion. We are living in Dubai. My wife has a lot of menstrual problem. In the summer season she does not get her menses on date. Her date was on 13th May but 5 days later she had spotting. She does not like going to the doctor. Please advise what to do? 

**As your wife had conceived once (and had abortion), there are good chances for her to conceive again. She will have to consult a gynecologist and set right the menstrual problems. As she is already 27, further delaying the first child is not advisable.

17. M. M., Udupi

*I am 32 years; I use to have a headache for some time now on one side of my forehead. It was mostly associated with hot sun or strong perfumes. I get the headache immediately if I smell strong perfume. As soon as the headache starts I take paracetamol tablet and after about an hour it would stop.  Most of the time I work on the computers.

** As you are sure that the headache is triggered by strong perfumes and hot sun, I presume your head ache is one of the types of migraine. There are mainly three types in migraine. Classic: in this case the headache is preceded by an aura or visual disturbance. Common: in this type there is no aura. Cluster: this type is more painful and may occur daily for weeks or months. You are probably having common type of migraine.

Although there is, as yet, no miracle cure for migraine it is possible to bring the condition under control. There is now a wide range of treatments available which can be very effective, but migraine is a complex condition and a treatment which is successful for one patient may have no effect on another. 

Many people treat their migraine with simple pain killers purchased from the chemist. These usually contain aspirin, paracetamol or ibuprofen (sometimes combined with other ingredients such as codeine, caffeine or an anti-histamine) and can be very effective, especially if taken very early in the attack. For sufferers who experience nausea and vomiting painkillers combined with an anti-sickness ingredient can be helpful.

There are also drugs (5HT agonists sometimes known as triptans) which act directly to correct the serotonin imbalance in the brain during a migraine attack. These are available on prescription only and are not suitable for all patients.

If the attacks are very frequent the doctor may prescribe preventative medication which needs to be taken every day. These treatments sometimes take a while to show any benefit so it is important not to give up on them too quickly. They can reduce the frequency and severity of attacks but seldom eliminate them entirely so one may also need an effective compatible acute treatment for breakthrough attacks.

Stress often plays a role in triggering migraine, so stress management can be an important part of migraine management strategy. Relaxation in whatever form - walking, sport, yoga, etc. is important for everyone. For some people, a change of lifestyle can improve quality of life by lessening the frequency and severity of attacks.

You may consult a neurologist for proper assessment and advice.

18. R. S. Mumbai

*I am 25 years, I am married. While having intercourse we get the problem of dryness. What is the remedy?

**Women have glands on the entrance of the vagina, known as Bartholomew Glands. These glands, and other smaller glands inside the vagina, are responsible for the lubrication of the vagina when a woman is aroused sexually. However when there is not sufficient arousal, these glands do not produce the secretion. 

This will result in dry union and painful penetration. Lubrication is also inhibited when a woman has medical problems like hypertension or diabetes mellitus. Certain medications like antihistamines and drugs related to these can cause dryness.

The most common reason for dryness is not being sufficiently aroused in the moment with the partner. Loss of sexual attraction towards the partner and the inhibition or absence of sexual desire is the other causes of dryness.

Improper arousal will dry up and lead to painful sexual play. Of course the more pain the woman has less likely she would relax and would be anticipating pain and thus dry up immediately. 

The solution is to know what will arouse you and teach your man how to pleasure you in a way that will work for you. The techniques for arousal differ from woman to woman. Certain woman may like kissing on the lips more sensual and other may like to be aroused through clitoris. Let your partner know what is best for you. You may need proper foreplay for your arousal.

There are two ways to avoid a dry vagina during intercourse. The first is to avoid intercourse until woman is sexually aroused. The second way is to use an artificial water-based vaginal lubricant, such as K-Y jelly, Vagisil Intimate Moisturizer, as a substitute or backup for natural lubricant. 

Since vaginal secretion is usually an indication of a woman's sexual interest, it is usually recommend to wait for union till she experiences sexual arousal and natural lubrication. It is better for couples to avoid getting into the habit of sex that's passionless for both. But if natural secretion is an unreliable indicator of the sexual arousal, an artificial lubricant may be used. However prolonged use of artificial lubricants like jelly may not be feasible.

19. T.T. Mangalore

* I am above 60 years.  Kindly inform whether the long time use of drugs for blood sugar and hypertension cause kidney failure or any other urinary problems such itching? (The names of the drugs taken by me are enclosed)

** The kidney problems in diabetic patients (known as diabetic nephropathy) are not the side effects of drugs but they are normally due to diabetes itself. Diabetic nephropathy is the kidney disease that occurs as a result of diabetes. It is a leading cause of kidney failure in developed countries. 

After many years of diabetes the delicate filtering system in the kidney becomes destroyed, initially becoming leaky to large blood proteins such as albumin which are lost in the urine. This is more likely to occur if the blood sugar is poorly controlled. It begins with a tiny amount of protein appearing in the urine, this is called microalbuminuria. This continues and after about 10 to 15 years the normal functioning ability of the kidney is affected. 

The overall risk of developing diabetic nephropathy varies between about 10% of type II diabetics (diabetes of late onset) to about 30% of type I diabetics (diabetes of early onset). There are many factors, some known and others not, that affect the individual risk of developing diabetic nephropathy. 

Good blood glucose control can prevent the development and slow the progression of diabetic nephropathy, as well as preventing the other complications of diabetes, even if kidney failure has developed. The control of blood sugar can not be achieved by tablets and/or insulin alone, but requires a good diet too. Achieving these things will involve discussion with your doctor and dieticians. 

If diabetes is associated with hypertension, control of blood pressure is also required to prevent diabetic nephropathy. The recommended target blood pressure is 125/75mmHg in diabetic patients. This usually requires more than one type of tablet to achieve. If you are overweight, losing weight will help too.

20. R. R., Mangaluru

*I am 35yrs of age, I am married.  My husband is a known diabetic for 5yrs (he has a family history).Two months ago my FBS was 93mg. At present it is 103mg (self test). About a year ago I was twice treated for vaginal infections. My height is  5"3 & weight is 50kg.I am conscious about my diet. Whether the rise in blood sugar is matter of concern? By the time my husband was diagnosed diabetic  he had developed many complications. 

** The amount of glucose (sugar) in the blood does not remain constant but changes throughout the day and night. Any value within the normal range is considered normal and the diagnosis of the diabetes is made only if the level is beyond the normal range. Diabetes mellitus does not manifest over night. In potentially diabetic patients, the blood sugar level rises slowly and in some individuals it takes years for the problem to come to light. 

The values of blood sugar mentioned by you are within the normal range. A 10mg/dl rise within two months does not indicate that your blood sugar level has started to rise and soon you would be diabetic. The levels will vary depending upon when, what and how much one has eaten and whether or not has exercised. 

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