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Ask Your Doctor 173 (14.11.2014)

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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 Many such details where the identity might be revealed will not be published.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. P.D. Dubai

*I would like to know if drinking  beer is good for health or it is harmful. Can drinking beer quite often have a side effect on one's health? 

** Most of the people erroneously presume that beer drinking is harmless and may be good for health. There is some sort of propaganda favouring beerr consumption.  Beer, like any other alcohol is not good for health. If one does not have the habit of consuming alcohol, it is better he does not start at all.  However, if  one has to chose between beer and other alcohol beverages, then probably beer is the lesser evil.

Beer is typically made from water, grain, hops, and yeast. Malted barley is the most commonly used grain. It is usually flavored with hops to add bitterness to balance the sweetness of the malt. The hops also act as a preservative. Finally, brewer's yeast ferments the brew into alcohol.
Some brews are made with other grains: wheat, maize, or rice instead of barley. And some use fruits, herbs, and spices to create unique-tasting beers.

Beer's alcohol content ranges from less than 3% to 40% depending on the beer style and recipe. Most pale lagers are around 4% to 6% alcohol.
If one has the habit of drinking in moderation, beer (just like wine, spirits, or other alcohol) may not  have serious health effects. But alcohol is no way beneficial to health as claimed by some researchers.
If one has to consume alcohol in social gatherings, it is better to limit to no more than one drink per day for women, two drinks per day for men. One drink is 12 ounces of regular beer.
The hops, yeast, and grains in beer contribute carbohydrates, a small amount of B vitamins. But it is foolish to plan to get the nutrients from beer, or to drink beer or any other alcoholic beverage for health benefits. And if one does not drink now, it is strongly recommend not to start.
Drinking too much beer, or any other type of alcohol, is bad for health. Heavy alcohol consumption increases risk of cancer of liver, liver cirrhosis and obesity. There is increased risk of stroke, hypertension, cancer of colon and breast cancer.

2. A.K., Bangalore

*My sister, 23 years is diagnosed as having ‘Schizophrenia’ for more than a year now. She was on medication, which was tapered (reduced) by the doctor and was fine so was off the medication. Now after a year, there is relapse and again she is put on medicines.  Now her fear is reduced, but not completely gone. Will she be alright? Whether she has to take the medicines continuously? Will there be further relapses? Can she get married? Will her family life affected? 

** It may be better to discuss these issues in detail with the psychiatrist who is treating her. Medication may have to be continued till the treating doctor is satisfied with the progress. Marriage and family life are the issues that to be discussed with the psychiatrist and the prospective partner. Unless her condition is clearly known, it is not possible to give a proper advice about her future.  

Schizophrenia is a serious psychiatric disease. It affects people all over the world. Unlike some illnesses, the rates of schizophrenia are the same from state to state and from country to country. Whether you live in USA or in India the statistic is the same: about 1 in every 100 people has schizophrenia. The schizophrenia affects men and women equally. 

About seventy-five percent of people who get schizophrenia become ill between the ages of 17 and 25. Some people who later develop schizophrenia may have seemed "different" from other children at an early age. It is unusual for someone to get sick with schizophrenia after age thirty. 
A person is more likely to get schizophrenia if they have a parent, brother or sister with the disease. For example, if a person's mother had schizophrenia, that child would have about a ten percent risk of getting sick. This risk is much less — about one percent — for a person who does not have a relative with schizophrenia. 
Researchers are working hard, but there is still no known "cure" for schizophrenia. Prompt and effective treatment can make a difference. 
Unfortunately, the illness makes some patients take their own lives. The patients and their loved ones should be aware of the facts about the danger of suicide. About ten to thirteen percent of schizophrenia patients do take their own lives, compared to only one percent of people who do not have schizophrenia. Obviously, schizophrenia can have a major — and even tragic — impact on a person's life. That is why treatment is so important.
Schizophrenia is a complex illness. The patients have periods when they are very ill, and periods when they do much better. There are three stages of recovery in schizophrenia. These three stages are: 

Acute episode:  This is a period of very intense symptoms. These symptoms may start suddenly or begin slowly over several months 
Stabilization after an acute episode: This is a period when intense symptoms have been controlled with medication. This period is usually marked by a reduction of severe symptoms 
Maintenance phase or between acute episodes: This is the long-term recovery phase of the illness. Many of the intense symptoms have been controlled by medication. Milder symptoms may persist. Improvement is possible, but at a slower pace. 

3.J.G., Mangalore

*I am 24 years and I had the habit of masturbation daily. But now I have stopped it. I have lost weight. What are the effects of masturbation? Can you give me some tips so that I stop masturbation and gain weight.

** Masturbation is another issue on which we receive queries very often. The false beliefs or myths about masturbation are plenty. First of all, masturbation is a perfectly normal method of relieving sexual tension. It is estimated that over 70% of the male population masturbates. Masturbation is one of those issues that guys normally can't talk about. Most people masturbate. It doesn't matter who people are, what they do, or what they say, they masturbate or had masturbated. In fact, many people masturbate throughout their lives regardless of whether they have a sexual partner or not. 

Masturbation is a common and harmless habit during youth. Almost every man would have masturbated during youth. In a few of the men the habit persists even in marriage without affecting their marital life. It has no effect on general or sexual health. It is very difficult and almost impossible to stop the habit during youth. Some of the men stop it once they have natural outlet in marriage. 

Though it is harmless, if one worry about it then there can be psychological stress which might lead to sexual difficulties. The person with such worries has to be convinced that masturbation is a common habit and every man had this habit at one or other part of his life. If he is convinced that there are no problems because of masturbation, he will be able to lead a normal sex life.

As masturbation is not the cause of weight loss and if you have lost more than 5% of your weight consult a physician. At times there may be symptomless health conditions that may present only with weight loss. If there are no causes, nutritious diet and regular exercises might help you to gain weight.

4.J. L, Kuwait

*I am 38 years. My triglyceride levels have been very high (550) for the past three years though my LDL, HDL and total cholesterol and weight are normal. What could be causing this and what can be done for this?

*Triglycerides are the chemical form in which most fat exists in food as well as in the body. They are also present in blood plasma and, in association with cholesterol, form the plasma lipids. 

Triglycerides in our body are produced by two mechanisms. One mechanism is from fats eaten in foods and the other is manufactured in the body from other energy sources like carbohydrates. Calories ingested in a food and not used immediately by tissues are converted to triglycerides and transported to fat cells to be stored. Hormones regulate the release of triglycerides from fat tissue so they meet the body's needs for energy between meals.

Excess triglycerides in plasma are called hypertriglyceridemia. It is linked to the occurrence of coronary artery disease in some people. Elevated triglycerides may be a consequence of other disease, such as untreated diabetes mellitus. Like cholesterol, increases in triglyceride levels can be detected by plasma measurements. These measurements should be made after an overnight food and alcohol fast.

It is believed that in Indians with ischemic heart diseases hypertriglyceridemia is common than hyperlipidemia. Alcohol intake and smoking are the two factors blamed for this.

The normal accepted levels are:
Normal : Less than 150 mg/dl
Borderline : 150 to 199 mg/dl
High : 200 to 499mg/dl
Very high : 500mg/dl or more

Triglyceride measurement is part of a standard blood lipid profile. While high triglyceride levels have been associated with heart disease, no study has yet proven that high triglyceride levels are an independent risk factor for heart disease. The patients with elevated triglyceride levels almost invariably have other major risk factors for heart disease (mainly obesity, diabetes, and/or high blood pressure), and so far it has not been possible to sort out whether the triglycerides themselves pose an independent risk. However, recent evidence strongly suggests that an elevated triglyceride level is a significant risk factor for heart attack.

Changes in lifestyle habits are the main therapy for hypertriglyceridemia. These are the changes one need to make:
The body weight has to be maintained to the ideal level. 

The saturated fat and cholesterol content of the diet has to be reduced.  
The intake of alcohol has to be reduced considerably. Even small amounts of alcohol can lead to large changes in plasma triglyceride levels.  
Exercises like brisk walking will help to reduce the triglyceride levels. At least 30 minutes of brisk walk on all the days of the week is ideal.
When the triglycerides are very high, certain medications are now available with beneficial effects. You may consult your physician for proper evaluation and medication.

Because other risk factors for coronary artery disease multiply the hazard from hyperlipidemia, control high blood pressure and avoid cigarette smoking is also essential to prevent the risk from high triglyceride.  Even if drugs are used to treat hypertriglyceridemia, dietary management is still important. Patients should follow the specific plans laid out by their physicians and nutritionists.

5.S. P., Udupi

*I am 24 years of age, unmarried. I would like to know for successful results when should intercourse be made in a monthly cycle of 28 days.

**Normally in regular cycle, the woman ovulates on the 14th day prior to the day of onset of next flow. If it is a regular 28 day cycle, the woman will ovulate on the mid-cycle that is 14th day from either side. Normally the ovum survives between 8 to 12 hours after ovulation. The ovum gets fertilized during this period if it comes in contact with healthy sperm.

In order to facilitate fertilization, it is ideal for the couple to know the exact day of ovulation.  There are several methods to detect ovulation; one of them is mucus method. On the day of ovulation, the mucus in the female genital tract is thin, transparent and can be stretched between two fingers.
The couple should have sexual contact during the days of ovulation. It is advised to have physical contact at least for five days, on the day of ovulation and on two days before and two days after ovulation. This may not be successful in one or two attempts. Even if this is regularly followed it may take four to six months for the woman to conceive.

6. N.J. Dubai

* I am newly married, once in 3 months I am meeting my wife. But the problem is I am not satisfied in sex. When I am in sex within one minute I ejaculate and I lose interest. Because of this I cannot satisfy my wife also. Even I checked in masturbation but the result is same 1 minute. And before marriage  my organ’s length and width was more but now it  has reduced. What may be done? Is there any fruits that can help to increase to sexual interest?

** This is one of the problems repeatedly expressed in this column- it only indicates that this is a common problem. The culmination of the sex act in man before his sex partner reaches orgasm is defined as ‘premature ejaculation’. This is mainly a psychological problem and there are hardly any physical causes for it. Failure to take the partner to full pleasure once becomes a worry and repeats with every act. The fear of failure persists and repeats.

There are probably no definite drugs which can enhance the duration of act in man. However in some individual cases, anxiety relievers have been tried with various successes. Local anesthetic sprays also help some men by masking the hypersensitivity of the glans.  Drugs used for erectile dysfunction like sildenafil citrate (Viagra) are also used in certain individuals who have associated erectile dysfunctions. These drugs are to be used only if advised by a specialist. Local applications-sprays and ointments normally available on the counter and can be tried. You may consult an urologist or psychiatrist for appropriate prescription of the medicines. 

There are other therapeutic activities which are done by the partners together. Including the female partner as much as possible in the therapy (treatment and counseling) sessions is important to achieve the best outcome. The first step for treatment of premature ejaculation is to relieve any underlying performance pressure on the male. The couple may be instructed on sexual therapy, such as the stop-start or squeeze-pause technique popularized by Masters and Johnson. These are to be practiced with the help of trained therapist.
If the male always experiences ejaculation with initial sexual excitement or early foreplay, this is a difficult problem which then most likely requires treatment in conjunction with a psychiatrist. 
Premature ejaculation is not a disease that can be treated using drugs. It may not be cured by diet or fruits, vegetables etc.

7. F. R, Mangalore

 * I am 33 years of age. I was having palpitations off & on for which ECG &Echo was done, the doctor (cardiologist) who was treating me told me its normal but there is something called WPWS, he also gave me some type of beta blocker 3 months. I still get this palpitation Can you please advice me & tell me what WPWS is?

** You may be aware that the heart beat is regulated by some sort of electric currents generated and transmitted in the heart. This electric current regulates the heart beat. The electric current is transmitted through certain fibers in the heart musculature, which also form junctions termed as ‘nodes’. This is comparable to the electric wires, transformers and junctions of  the electricity of our daily use.

WPWS or Wolf Parkinson’s White Syndrome is a condition involving the electrical fibers in the heart.  Normally, an electrical signal starts at one part of the heart (the left atrium's sinus node) and is transmitted through the area between the atrium and the ventricles (AV node), to the other parts of the heart (Ventricles).  In this disease, there is an abnormal electrical connection that bypasses the AV node a condition, which can lead to irregular or rapid heart rates.

Symptoms usually are due to rapid heart beat that leads to palpitations and other associated symptoms such as dizziness or chest pain.  Some patients, however, never develop any significant heart problems, and the diagnosis is made during routine evaluations.
The cause of this disease is an abnormality in the electrical circuit within the heart.  In addition to the normal electrical circuit, patients with WPW have an additional direct connection between two portions of the heart.  The cause of the abnormal electrical circuit is unknown, but most patients are born with the problem.

A diagnosis is made by abnormalities (delta waves) detected on the ECG that suggest the possibility of the disease. In the absence of any symptoms, no particular treatment is necessary.  However, if any of the symptoms develop, patients should contact their physician. Normally the problem does not lead to major complications.
There are varieties of drugs to control the symptoms. If your problems are persisting, you may consult the doctor again

8. L.R., Mangalore

* Whether it is safe to conceive if the partner has high diabetic and cholesterol? Will it have effect on the baby later? Are there any possibilities of any effect if the partner consumes alcohol on the baby? 

** Though diabetes and high cholesterol levels in man may not affect the baby, diabetic man can have low fertility. However alcohol is more harmful. Alcohol can reduce a man’s testosterone levels, leading to loss of libido. It can also damage the quality, structure and movement of sperm by stopping the liver from properly metabolizing vitamin A, which is needed for sperm development. Alcohol is toxic to the testes. This can harm sperm when they are produced and stop them developing properly or reaching the egg, which may be the cause for infertility. However, baby born to alcoholic man may not have health problems becuase of alcoholism of the father.

9. J.P. Mangalore

* I am 29 years, married for four years. I have been trying to get pregnant since then, however I was diagnosed of endometrial cysts about a year after the marriage and underwent surgery. I conceived a year ago, but unfortunately I had still birth on the day of delivery. Now it is  almost 8 months after the tragic incident and I am unable to conceive again. I had visited the doctor she put me on clomiohene but nothing has worked yet. My present weight is 78 and i am 5.5 ft tall. I asked whether it could be my weight which is hampering , but she said' no' I feel depressed at times.

** As you have conceived once, there is great chance that you will conceive again. It may take few more months.
Stillbirth is common. It may affect anyone. There is no way to predict when stillbirth will happen or who will experience it. Stillbirth occurs in families of all races, religions, and income levels. Each year in the United States about 25,000 babies, or 68 babies every day, are born still. This is about 1 stillbirth in every 115 births. Most often a stillbirth is detected while the baby is in the mother’s uterus, sometimes not until labor is underway. Following a stillbirth, parents frequently ask, "Why did this happen?" Sometimes a reason is found; other times a specific cause remains unknown. Extensive and careful evaluation of the baby and placenta following delivery may help identify a reason in about 40%-50% of stillbirths. When a specific cause is not identified, evaluation may still be helpful by at least ruling out potential high risks for recurrence. Identifiable causes of stillbirth generally fall into one of three different categories: birth defects in the baby, problems with the placenta or umbilical cord, or maternal illnesses or conditions which may sometimes affect pregnancy.

If you are not comfortable with the gynecologist who was treating you during previous pregnancy, you may take second opinion from another experienced gynecologist.

10.N. S. Mangalore
*I am a man of 21 yrs. The problem I have got is I lack facial hair despite being of healthy growth and crossing my 21st birthday. Can you please advice any medication over this. This condition is affecting my confidence in facing people.
** Though by puberty beard and moustaches start appearing, their proper growth is not uniform and varies from individual to individual. Some have thick facial hair at a young age and in others they may be sparse even when they are in their third decade.
Most probable cause for this is inherited and little can be done to increase the facial hair growth. If other secondary sexual characters are normal, then no treatment may be indicated.

However in few individuals there may be deficiency of testosterone hormone, which will also manifest by delayed or absent secondary sexual changes.
You may consult a skin specialist to know why you have no facial hair. If it is genetic, you might get facial hair by another few years. If there are any obvious defects, certain blood tests may be sought.

11. L.R. Jamaica

*I am 68 years. How long does the virus remain in the body after one gets chikungunya. Will he be a carrier of the virus after the infection. How mosquito transmit the disease, whether by biting during the illness or even during the carrier state? 

** Chikungunya virus is transmitted to people through mosquito bites. Mosquitoes become infected when they feed on a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites. The virus can stay in a person's system for about a week, according to the World Health Organization. There is no carrier state, however the joint pains and disabilities can continue for months to years even after the fever has subsided.

When a mosquito feeds on an infected person, the mosquito can become infected and can bite and infect others. Chikungunya virus is most often spread to people by Aedes aegypti and Aedes albopictus mosquitoes. These are the same mosquitoes that transmit dengue virus. They bite mostly during the daytime.

12. P.K.T., Mumbai

*I am a man of 27 years of age. I do not know exactly when I contacted this problem. Might be a year ago, I had sex with  a man and forgot to use protection. After six months I got skin rashes in my palm and sole, then I went to dermatologist. Blood tests were done. The VDRL was positive 1:32 and TPHa 1:5. I was recently prescribed Azithromycin and supplement table for a month instead of penicillin injection by a doctor. Will you please advise as per my reports is it early latent, latent or secondary syphilis and how long time, it will take for cure,1:32 is high late latent syphilis? I am so worried about my VDRL and TPHA.

** By the reports it appears that you were infected by syphilis bacterium. Syphilis develops in stages, and symptoms vary with each stage. But the stages may overlap, and symptoms do not always occur in the same order. One may be infected with syphilis and not notice any symptoms for years.
The main symptom of primary syphilis is a painless ulcer, a chancre, that appears at the site of exposure 14 to 21 days after that exposure. A primary chancre usually occurs in the genital, perirectal, or oral cavity. If untreated, the lesion heals on its own in 3 to 8 weeks. Secondary syphilis occurs 4 to 10 weeks after the primary chancre. The classical presentation is that of a disseminated, symmetric,  raised rash that involves the skin of the trunk, palms, and soles. The infection is systemic with generalized lymphadenopathy and, less commonly, headaches, malaise, fever, hepatitis, and arthritis, as well as kidney, eye, and central nervous system involvement. Even without treatment, the patient’s symptoms will improve.

If one is not treated for syphilis, the disease moves from the secondary to the latent (hidden) stage, when the person may not have symptoms. The latent stage can last for years. Signs and symptoms may never return, or the disease may progress to the tertiary (third) stage. The patient with late latent syphilis may have neurological signs or symptoms  or  the VDRL is greater than or equal to 1:32. Many patients will not remember their initial infection and the length of time since exposure may not be known. 

Normally with the treatment the VDRL becomes negative. Treponema pallidum hemagluttin antigen (TPHA) positivity means that the person was exposed to (and infected with) the organism known as treponema pallidum that causes syphilis. TPHA can be positive even one has got infected with other nonveneral trpeonemas.  TPHA positivity is generally not a serious condition, unless left untreated for many years. However it may not be possible to reverse the TPHA positivity from the blood. It remains positive even if the disease is treated and cured.

13. L.D., Mumbai

*My daughter 14 years of age suffering from juvenile myocyclonic epilepsy since one year. If she is not sleeping for 8 hours during night time continuously or day time if she wake up suddenly she gets convulsion epilepsy attacks. Is this type of epilepsy is curable? She is taking allopathic medicine. As per doctors opinion this type of disease is only treatable not in curable in allopathy medicine. Is there any alternate medicine or is there any hopes of complete cure for her disease.

** Juvenile myoclonic epilepsy (JME) is the most common of the generalized epilepsy syndromes to emerge in mid-to-late childhood. It is characterized by the presence of absence (formerly called petit mal) seizures, myoclonic seizures and generalized tonic-clonic (formerly called grand mal) seizures. The first seizure type to present are absence seizures – these start anywhere between the ages of 5 and 16 years of age. Myoclonic jerks are seen about 1 to 9 years later, with an average age of 14 or 15 years. Generalized tonic-clonic seizures appear a few months later after that, although they can appear earlier.  Both males and females are affected equally.
The hallmark characteristics of juvenile myoclonic epilepsy are the presence of myoclonic jerks that occur on awakening from sleep either in the morning or from a nap. They are typically described as shock-like, irregular movements of both arms. Sometimes these movements are restricted only to the fingers making the patient or individual look clumsy or prone to dropping things.
Some types of myoclonus are normal and do not imply epilepsy. The most common of these is so-called hypnic jerks, which most of us have just as we are falling asleep.

One of the most important aspects of juvenile myoclonic epilepsy is the fact that there are two very common seizure-precipitating factors – sleep deprivation and stress. Sleep deprivation and fatigue are the most powerful precipitants of myoclonic jerks and generalized tonic-clonic seizures in JME. Other common precipitating factors include mental stress, emotion, and in particular excitement or frustration. Some people with JME experience seizures that are triggered by flickering light, such as strobe lights at dances, TV, video games, or light shining through trees or reflecting off ocean waves or snow. These are called photosensitive seizures. Occasionally, myoclonic seizures are also provoked by factors such as decision-making or calculations.

The treatment of juvenile myoclonic epilepsy starts with advice regarding lifestyle and avoidance of precipitating factors. Avoiding sleep deprivation is essential too. People with JME should make sure they get adequate rest and appropriate outlets for emotions and stress in order to lessen the potential for seizures. There are several effective medicines which should be taken as per the advice of the physician.
There is no complete cure for the problem, but with appropriate medication the problems are generally well controlled in up to 90% of patients. It is likely that lifelong treatment with a seizure drug is usually necessary, even in people with well-controlled JME. Withdrawal could result in a relapse of seizures, even in patients who have been seizure free for many years with appropriate drugs. In some individuals with mild forms of the condition, the dose of seizure medication may be reduced slowly over months, particularly in older aged individuals. If myoclonic seizures come back or persist, medications need to be restarted. In most of them there can be improvement after the fourth decade of life.

14.F.K.L., Karkala

*I am 42 years of age. My  hemoglobin level is always 8 to 9. But maximum is 9. It doesn’t go higher than 9. Why? Or is it maximum 9 only in my body ?

** Hemoglobin (Hb or Hgb) is the protein in the red blood cells that carries oxygen. A low hemoglobin count is a below-average concentration of the oxygen-carrying hemoglobin proteins in the blood. 
A low hemoglobin count is generally defined as less than 13.5 grams of hemoglobin per deciliter (135 grams per liter) of blood for men and less than 12 grams per deciliter (120 grams per liter) for women. In children, the definition varies with age and sex. The threshold differs slightly between medical practices. 

A low hemoglobin count is a commonly seen blood test result. In many cases, a low hemoglobin count is only slightly lower than normal, is not considered significant and causes no symptoms. A low hemoglobin count is not always a sign of illness — it may be normal for some people.
A low hemoglobin count can also be caused by an abnormality or disease. In these situations, a low hemoglobin count is referred to as anemia. 
If you have no symptoms like easy fatigue, short of breaths while working or walking, palpitations(faster than normal heartbeat during exercise or activity) then low hemoglobin levels may be ignored. I presume you have consulted  physicians and have undergone all other tests to rule out other causes of low hemoglobin levels.

15. A.D’s, Mangalore

*My  daughter who is 17 years of age is loosing her weight day by day. Her weight is only 34.9 Kg. and her height also 5”. We checked with the doctors but all the reports are normal. I read about malnutrition, what is this doctor? Her all symptoms are like malnutrition. Sometimes she is fainting, loss of weight, hair loss. By which test we can know about this. 

** It is difficult to opine why your daughter is losing weight despite her reports remaining normal. Malnutrition is a serious condition that occurs when a person’s diet does not contain the right amount of nutrients. Malnutrition is caused by either an inadequate diet or a problem absorbing nutrients from food. There are many reasons why this might happen, including having reduced mobility, a long-term health condition. If it is malnutrition with some cause, the doctors would have diagnosed it.

There is a condition known as anorexia nervosa. It is an eating disorder that causes people to obsess about their weight and the food they eat. People with anorexia nervosa attempt to maintain a weight that’s far below normal for their age and height. To prevent weight gain or to continue losing weight, people with anorexia nervosa may starve themselves or exercise excessively. To know about this you may consult a physician and discuss about your daughter’s problem. 

16. S.N. Byndoor

* I am 36 years of age.  I have few yellowish hairs in my under arms and in the groin. I do not have itching on those parts. I cut those and others hairs regularly. I bathe twice in a day most of the times still yellowish hairs reappear in both places. What should I do to avoid it? Is there any home remedy for this?

** It may be due to superficial infection of the hair follicles. Consult a skin specialist for proper assessment.  You may be advised local application ointments.

17. J.M., Mangalore

* I am 15 years of age. I have got a foot pain for several weeks now. I had ankle pain maybe about  two years ago. I had twisted my ankle but there was no pain at that time, but I started getting pain after about two months of injury.  I consulted a doctor,  the doctor said that it was not because of twisting the ankle but the doctor asked for a thyroid test but then the thyroid had no problem. So what might be the cause of my foot pain now?

** Most foot and ankle pain in the active teenagers are associated with minor trauma or repetitive stress combined with abnormal biomechanics of the foot and lower extremity. Often there is no clear memory of traumatic event. There are numerous, non-traumatic diseases that masquerade as injuries. You may consult an orthopaedic surgeon for proper evaluation and treatment.

18. S.D., Dubai

* I am 26 years of age. I have a girl friend and we are in relationship  for the past two years. I had sexual intercourse with my girl fiend nearly 11 to 12 times, in that only 3 times I could ejaculate after proper physical union that too after having sex of very long duration and with great difficulty. When I masturbate I ejaculate in just 2 minutes. I do not drink also I do not smoke. 

** Delayed ejaculation — sometimes called impaired ejaculation — is a condition in which it takes an extended period of sexual stimulation for a man to reach sexual climax and ejaculate. Some men with delayed ejaculation are unable to ejaculate at all. Delayed ejaculation can be temporary or a lifelong problem. Possible causes of delayed ejaculation include certain chronic health conditions, surgeries and medications. Treatment for delayed ejaculation depends on the underlying cause. 

It is normal for men to have delayed ejaculation from time to time. Delayed ejaculation is only a problem if it is ongoing or causes stress for you or your partner. Some men with delayed ejaculation need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate, or they may not be able to ejaculate at all (anejaculation). In the most common form of delayed ejaculation, a man can not reach orgasm during sexual intercourse — but can ejaculate with oral or manual stimulation of the penis. Some men can ejaculate only when masturbating. 
Delayed ejaculation can result from certain health conditions related to genito-urinary system, surgeries and medications. Or it may be caused by psychological conditions such as depression, anxiety or stress. In many cases, delayed ejaculation is due to a combination of physical and psychological concerns. 

For some men, a minor physical problem that causes a delay in ejaculation may cause anxiety about ejaculating during a sexual encounter. The resulting anxiety can worsen delayed ejaculation. 
You may consult an urologist for proper evaluation. If required he might sent you to other specialists depending on the cause.

19. A.S. Udupi

* I am 21 years. Is there any method to get fair skin?  I am a dark skinned and I want to be fairer  like my friends. Please suggest.

** Though  the fair skin is not at all the standard of beauty, many people want their skin to get fair at any cost. This might be because of the social  acceptance, one’s own inner desire to be beautiful in a specific way or the fascination to explore one’s own limits of beauty. There are lot of  information available about different methods and treatments to get the fair skin, most of these may not work or work only for a limited period. Many of these treatments/techniques are expensive and are used only to change the complexion of the face, not the whole body. Ideally one should not try to alter what has been endowed by nature and dark skin is one of them! Beauty lies in the eyes of the beholder. Whether fair or not, your admirers will always like you, love you! However if you are keen, you may consult a cosmetologist for further information.

20. R.S., Goa

* I am 22 years of age, at present I am working in Kuwait and it has been one year I am in Kuwait. When I was in India I was going to gym regularly. Now I notice that my left testicle is imbalanced.(I do get normal erection) What is reason for imbalance of testicle? and will there be any problem in future?

** Normally one scrotal sac is lower than the other. In most of the men the left scrotal sac is lower than the right. It is perfect and normal.

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