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Ask Your Doctor 169 (15.07.2014)

To know more about Dr. Edward Nazareth - Click Here

Ask Your Question with Dr Edward Nazareth – Click Here

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 Many such details where the identity might be revealed will not be published.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

Must Read Konkani Book on health:

Child Health & Care , and Health Tips
More details - 
Click Here

1. J.S., Mumbai

*I am 40 years. I am suffering from severe gas and indigestion problem. In the evening the upper part of the abdomen bulges. Have done complete health check up also and doctor has informed that everything is normal. Tried taking medicines but no effect. 

** The feeling of fullness in the stomach with or without eating/drinking and  discomfort in the upper abdomen is known as dyspepsia. In addition, other symptoms that may also develop include: heartburn (a burning sensation felt in the lower chest area), bloating, belching, quickly feeling full after eating, feeling sick (nausea) or vomiting. 

The main causes for dyspepsia  are any one or more of duodenal ulcer, stomach ulcer, oesophagitis (inflamed oesophagus), gastritis (inflamed stomach), etc. You have been examined, investigated and doctors have found no definite cause for the problem. This is termed as non-ulcer dyspepsia, dyspepsia without organic cause or sometimes termed as functional dyspepsia. It means that no known cause can be found for the symptoms. The inside of your gut looks normal (if you have an endoscopy). It is the most common cause of dyspepsia. About 6 in 10 people who have recurring bouts of dyspepsia have non-ulcer dyspepsia. 

The following are some theories as to possible causes:

Sensation in the stomach or duodenum may be altered in some way - an 'irritable stomach'. About 1 in 3 people with non-ulcer dyspepsia also have irritable bowel syndrome and have additional symptoms of lower abdominal pains, erratic bowel movements, etc. The cause of irritable bowel syndrome is not known.

A delay in emptying the stomach contents into the duodenum may be a factor in some cases. The muscles in the stomach wall may not work as well as they should.

Infection with a bacterium (germ) called Helicobacter pylori (commonly just called H. pylori) may cause some cases. This bacterium is found in the stomach in some people with non-ulcer dyspepsia. However, many people are carriers of this bacterium, and it causes no symptoms in most people. The role of H. pylori is controversial in non-ulcer dyspepsia (although it is the main cause of duodenal and stomach ulcers). However, getting rid of H. pylori infection helps in some cases.

Some people feel that certain foods and drinks may cause the symptoms or make them worse. It is difficult to prove this. Foods and drinks that have been suspected of causing symptoms or making symptoms worse in some people include: peppermint, tomatoes, chocolate, spicy foods, hot drinks, coffee, and alcoholic drinks. However, food is not thought to be a major factor in most cases.

Anxiety, depression, or stress are thought to make symptoms worse in some cases.

A side-effect of some drugs can cause dyspepsia. The most common culprits are anti-inflammatory medicines such as ibuprofen and aspirin. Various other medicines which sometimes cause dyspepsia, or make dyspepsia worse, include: antibiotics, steroids, iron, calcium antagonists, nitrates, theophyllines, bisphosphonates. If you suspect a prescribed drug is causing the symptoms, or making them worse, then see your doctor to discuss possible alternatives.

As there are no organic causes for the problem, no definite treatment is also available. Here are few tips that might help:

*The worries and anxiety that there might be a major disease can worsen the symptoms. It may be useful to know that you have non-ulcer dyspepsia, and not some other disease. However, you will have to accept that pain, discomfort and other dyspeptic symptoms are likely to come and go. 

*If you are infected with H. pylori, the first treatment usually tried is to clear the H. pylori infection. However, as mentioned, infection with H. pylori is probably a coincidence rather than a cause in most cases of non-ulcer dyspepsia. For example, one study found that only about 1 in 15 people with non-ulcer dyspepsia who were infected with H. pylori were cured by clearing H. pylori. Treatment, briefly, involves a one-week course of two antibiotics plus an acid-suppressing medicine. Your doctor is the best person to take decision on managing the infection.

*A one-month trial of medication that reduces stomach acid is often advised. This helps in some cases, but not all. It may work because the lining of your stomach may be extra sensitive to the acid. Or, it may work because you may have very mild inflammation in your stomach that comes and goes, but is never found if you have an endoscopy test to look into your stomach.

If medication helps, then further courses may be advised by your doctor  if symptoms persist. Many people take acid-suppressing medication as required. That is, waiting for symptoms to develop before taking a short course of treatment. Some people take acid-suppressing medication regularly if symptoms occur each day.

*Life style changes may help a lot:

Make sure you eat regular meals.

Lose weight, if you are obese.

If you are a smoker, consider giving up.

Don't drink too much alcohol.

2. P.P., Mangalore

*I am 41 years male. Recently during a routine check up I was found to have borderline diabetes. (Fasting 125mg). It was a shock for me. There is no history of diabetes in my family. I am advised low sugar diet and lot of exercise. Now the sugar level is within normal. Will you please inform the causes of blood sugar elevation? I read many articles on diabetic diet but they have confused me to some extent. Can you suggest which food I must have and avoid?

*Diabetes mellitus is a chronic disease that requires long-term medical attention both to limit the development of its devastating complications and to manage them when they do occur. 

There are two main types in diabetes mellitus-type 1 and type2.

Type 1 diabetes generally occurs in young, lean patients and is characterized by the marked inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells, the cells of the pancreas those produce insulin. This is also known as insulin dependent diabetes. The diabetes seen in children (Juvenile diabetes) belongs to this type. The distinguishing characteristic of a patient with type 1 diabetes is that they require insulin to keep the blood sugar under control. And if insulin is withdrawn, ketosis and eventually ketoacidosis develop. These patients are, therefore, dependent on exogenous insulin to sustain their lives.  

Type 2 diabetes typically occurs in individuals older than 40 years who may be having family history of diabetes. In the recent years this type is also seen in some obese individuals of age less than 40 years. Type 2 diabetes is characterized by peripheral insulin resistance with an insulin-secretory defect that varies in severity. There is insufficient production and utilization of insulin. These defects lead to increased glucose production in the liver, which results in fasting hyperglycemia. Most patients (90%) who develop type 2 diabetes are obese, and obesity itself is associated with insulin resistance, which worsens the diabetic state. Since patients with type 2 diabetes retain the ability to secrete some endogenous insulin, those who are on insulin do not develop ketoacidosis (a fatal complication) if for some reason they stop taking insulin. Therefore, they are considered to require insulin but not to depend on insulin. Moreover, patients with type 2 diabetes often do not need treatment with oral antidiabetic medication or insulin if they lose weight by successfully adhering to a physician-directed weight loss program including strict diet control and exercise

At your age, type 2 diabetes is seen in many people without a definite family history. These days diabetes is seen in many affluent and rich people, with no one else in the family having diabetes. Physical inactivity and obesity are the main causes precipitating this illness. Though it may be a shock, it has to be accepted and should be lived with. If blood glucose levels are maintained, diabetic individuals can live near normal life like non-diabetics. However, diabetic individuals are required to be disciplined in their diet, exercises and medication.

In diabetic individuals the treatment depends on each one’s diabetic status. A diabetic patient, always require the help and guidance of a doctor for control of the disease and to avoid complications. It is not easy to suggest in this column about the diet restriction. Your doctor will be the proper person for such an advice. The road to good health begins with a diabetes control plan. You and your doctor will come up with one-probably with the help of a dietician, who can help you make the best food choices for managing your blood sugar.

The basic steps for keeping your type 2 diabetes under control are eating right, getting enough physical activity, and managing your weight. Changing your eating habits and increasing your physical activity are usually the first steps you'll take to try to bring blood sugar levels down. Reducing body weight always helps to lower blood sugar levels, at least in the short term. Your doctor also may prescribe medications, including those that directly target insulin resistance, to help keep your blood sugar at healthy levels. 

3. L.L.C., Mangalore

*I am 24 years of age. For the past three years I have the problem of indigestion and hyperhydosis. What may be done?

** It appears to me, you have anxiety which might be the cause for excessive sweating-hyperhidrosis and indigestion. Anxiety may start in the mind, but it often manifests itself in the body through physical symptoms, like chronic digestive problems, aches and pains, breathing difficulties etc. The gut is very sensitive to psychological stress—and, vice versa, the physical and social discomfort of chronic digestive problems can make a person feel more anxious. You may consult a physician first to know why exactly you are having indigestion, whether it is related to some other disorder. He might refer to you other specialists if needed.

4. S.R., Kuwait.

*I am  27 years of age. In recent 7 months, I nearly got cold and cough 3 to 4 times. I am  in Kuwait and I would like to know whether this sickness is due to weather or some thing else, I had no fever but I had very bad running nose and cough. What may be done for this?

** It appears that you are repeatedly getting either common cold or allergic rhinitis. The common cold is a viral infection caused by any one of over 200 viruses. Colds occur throughout the year but are most common in late winter fall.

Running nose, red eyes, sneezing, sore-throat, dry cough, generalized body ache with or without mild fever are the symptoms of common cold. Normally same virus does not cause symptoms again, but there are many of them and they have a peculiar capacity to alter their characters to infect repeatedly. There is no treatment for common cold, but when there are symptoms, symptomatic relief is possible with certain medication.

There are few tips to avoid common cold: A good diet, adequate sleep and exercise helps keep the immune system strong. Hands should be washed well and frequently to reduce the possibility of spreading the virus. Hands should be kept away from the nose, eyes, and mouth and the mouth should be covered when coughing or sneezing. Close contact with people who have a cold should be avoided. 

Your problem seems to be more of an allergic response. You have to find out what exactly is causing this. It can be anything from food item, body spray to a particular dust in the environment. If you can pin point the allergen-the substance causing the problem avoiding it is the best solution. Depending on the frequency of the symptoms desensitization treatment is available at all major centers. You may not require it right now.

5. M.D. UAE

*I am 57 years. For the past 2 years due to high cholesterol and pressure - I was advised statin tables for both since then due to its side effect - I am suffering from heavy gas problems and heaviness in the body especially on my knee and ankle joints, chest and hips and back. Sometimes I can barely work or sit/stand due to heavy uneasiness - I have stopped taking these tables for some time to see if I feel better - what do you think is the cause of this heaviness and uneasiness. 

** Your symptoms are unlikely due to medication. Statins are a class of drugs that lowers the level of  cholesterol in  the blood by reducing the production of cholesterol by the liver. There are many types of them.  Headache, nausea, vomiting, constipation etc are the rare side effects of statins. They normally do not cause serious side effects. You may consult your physician and explain him your current symptoms. If you are not comfortable with statins, you may be advised other drugs. It is not possible to assume why you feel heaviness.

6. M.C. Qatar.

* I  am 40 years of age. My left shoulder is very painful and I can't lift my hand upwards and backwards. I consulted two doctors and both the doctors said it was periarthritis and gave same suggestion to use Gel + Tablets (pain killer)and to forget it. I am applying the gel but I have not taken the pain killers yet. Please let me know is there any serious problem? Whether I have to do a thorough check up as I am suffering since 3 months?

**Periarthritis is a common shoulder problem. Inflammation in soft tissues around a joint is often referred to as "periarthritis." There are many causes and verities of treatments for this problem. This condition is also known as ‘frozen shoulder’.  The diagnosis of frozen shoulder is often used for any painful shoulder condition associated with a loss of motion. Inflammation of tendons, ligaments and muscles, are the most common cause of shoulder pain. Pain can strike without warning, especially at night and when raising the shoulder.

There is a tendon on the front portion of the shoulder known as supraspinatus tendon. Tendonitis of the supraspinatus tendon (inflammation of the tendon) is the most common cause of periarthritis in the shoulder joint. Repeated use of the shoulder, such as during racquet sports, can cause this tendon to rub against the acromion process, a part of the shoulder blade and cause pain.

The condition is characterized by a decrease in motion, primarily seen in lifting the arm and turning it inwards. Frozen shoulder or periarthritis is most common in the 40-60 year old age group and it is twice as common in women as men. People usually experience pain as the first symptom of frozen shoulder, followed by the loss of motion and a decrease in pain. Normally a gradual return of motion will follow; however, the length of time for recovery from frozen shoulder can be prolonged, with an average duration of 18 months. 

Frozen shoulder treatment primarily consists of pain relief and physical therapy. Exercises and physiotherapy  for frozen shoulder serves two functions: It helps to increase the motion in the joint and to minimize the loss of muscle on the affected arm (muscle atrophy) . These are the key to successful frozen shoulder treatment. Physical therapists may also incorporate ultrasound, ice, heat, and other modalities into the rehabilitation for frozen shoulder. 

In rare cases, when the individual does not respond to the above therapy manipulation under anesthesia may be performed. This is a minor procedure in which manipulation is performed with the patient sedated under anesthesia. The doctor moves the arm to break up adhesions caused by frozen shoulder. There is no actual surgery involved, meaning incisions are not made when a manipulation is performed. 

Alternatively, or in conjunction with a manipulation, an arthroscope can be inserted into the joint to cut through adhesions. This procedure is called an arthroscopic capsular release. Surgical capsular release of a frozen shoulder is rarely necessary, but it is extremely useful in cases of frozen shoulder that do not respond to therapy. If surgery is performed, immediate physical therapy following the capsular release is of utmost importance. If rehabilitation does not begin soon after capsular release, the chance of the frozen shoulder returning is quite high. 

You may seek the help of an orthopaedic surgeon for proper assessment and treatment. You may not require a general check up for this particular problem

7. E.R., Mangalore

*I am 26 years of age, married.  I am having one child aged two years. I am suffering from hypothyroidism and polycystic ovarian disease. These were diagnosed in April 2014.  I am taking medicines for hypothyroidism. My problem is, I am not getting my periods since January 2014. The gynecologist  who diagnosed  the PCOD, did not give any treatment. If  I do not get the periods, how can I plan my next baby?

** You may discuss these issues with the gynecologist who is treating you. Ideally you may consult an endocrinologist who will be able to treat both the problems. You would be able to conceive if the problems are effectively managed.

8. J.M., Mangalore

*I am 39 years,  working abroad. I got piles which  are external thrombosed piles. I have taken medicines and applied cream. Now almost two and half months over, it is still there. A small blood clot is there. What may be done?

** Thrombosed external hemorrhoid is a common problem. Although conservative nonsurgical treatment (stool softeners, increased dietary fiber, increased fluid intake, warm baths, analgesia) ultimately results in improvement of symptoms for most patients, surgical excision of the thrombosed external hemorrhoid is the permanent solution to the problem. You may consult a surgeon for proper assessment. If you have improved now, you may have to take care that they do not recur. Proper fluid intake,  avoidance of constipation with a high-fiber,  and avoidance of prolonged straining may prevent recurrence.

9. R.D’S, Dubai

*My baby is now 7 months old. She was delivered by caesarian section because of breech presentation.  My baby hardly sleeps during the day and night. Even when she sleeps, her sleep is disturbed. Her problems are rubbing eyes and nose, twisting and turning. She is otherwise healthy. She is very good, doesn’t make fuss. In other words she is most adjustable kid. At night she sleeps hardly for 5 to 6 hour (and hardly for 2 hours during day. She sleeps late and gets up early). Why does she rub her eyes, nose and twists? This has caused me with sleepless nights. She weighs about 7.8kilos.

** Disturbed sleep or bad sleep is a common problem in many children. There are many causes for disturbed sleep in small children. The child may have got into a habit of not sleeping soundly. Or he may have difficulty going to bed because of distractions at home such as a television, music or other noise. It can also due to some physical and rarely mental illness.

By the description given by you, it appears that your child has nasal obstruction which may be the main cause of its disturbed sleep. Nose blocks are common in small children in dry cold weather. This is due to reduced humidity. Using room-heaters in winter may further reduce the humidity and may aggravate the problem. It is also possible that the child has some sort of nasal allergy. It may be worth consulting an ENT specialist to rule out the problem.

Bad sleep may be a habit formed by over doing certain things related to child care. For example, many mothers generally put the child to sleep in their lap and then put it to bed. On waking up the child realizes that it is not on its mother’s lap and it might either get up or cry. Then the mother will again put it on the lap and allow it to sleep. This may repeat and can become a habit. There are other mothers who have the habit of picking up the child whenever it makes the slightest noise or when it is in a state of semi-wakefulness. If the child is picked up for every trivial reason, chances are that the child will develop a habit of being carried around. There are many other causes of bad sleep. These are explained in detail my (Konkani) book “Child Health and Care”. It might help you to know exactly why the child has bad sleep.

Here are a few tips which might be helpful:

Infants and toddlers usually need about 12 hours of sleep. Older children need about 10 hours. Adolescents often need more than the 8 hours of sleep that adults need.

Start a bedtime routine for your child. The routine will help it get ready to sleep. 

Avoid caffeine, especially in the evening. Many of the bottled drinks contain caffeine.

Use a routine that your child can do even if you are away. Keep it simple. 

Settle down your child at night. Do quiet activities, like a bath, (reading books, coloring, or a puzzle for older children). Put toys away and keep child calm. 

Feeding and rocking your infant may help it sleep. Older children should be encouraged to go to sleep on their own. 

Cool, dark, quiet rooms are usually a better place for children to sleep. Noise and light may keep them awake. 

Do not seek sleep medications for children. 

Look for other problems that might make it hard for your child to sleep. 

Limit time in bed to sleeping time. Your child should learn that when it is in bed, it should sleep. 

Make the bedroom a sleeping room. Limit toys in the bedroom so your child is not distracted. Older children should be encouraged to do homework outside of their bedroom. 

10. J.P., Mangalore

*I am 39 years. My blood sugar is 106 in fasting and after food it was 103. For the past 10 days  about 2 hours after having food I feel exhausted, light giddiness and numbness in my fingers. My weight is 62kgs and I am housewife. I am not taking any medicines. Why my sugar level going like this?  Do I require any medical treatment? 

** Your blood sugar levels are normal and you do not appear to be diabetic. The symptoms of hypoglycemia normally manifest when the blood sugar levels reach below 70mg/dl. A number of different factors can cause hypoglycemia, including certain medicines and diet. Certain medical conditions can also make hypoglycemia more common in people with diabetes.

There may be other causes in you for feeling exhausted and giddiness. You may consult a physician for proper assessment.

11. M. M., Abudhabi

*My son is 3 yrs 11 months old.  In the last year May we went for holidays to India. I made a check up for my son.  The doctor told me that his weight is less according to his age and the white cells are also less, we took medicine for 3 months, then we came back to gulf.  Now he is studying in LKG.  Immediately he started going to school, I started working.  I have shift duties morning 8-12.30 & 4-8 pm so I cannot spend my time with my son in the evening.  In the afternoon when he gets up from the sleep he is crying for me & sitting in a corner.  My husband is there to take care of him, but still he is more attached to me.  Now with in 1 month he lost his weight by 2 kg. Now his weight is 13kg.  After going to school he got cold since then he is getting cold very often.  

He gets nose blocked & he cannot breathe through the nose.  May be because of the cold he is not taking his food properly.  We consulted with a pediatrician here and he said most of the nursery and UKG children are facing this problem. He told us that there are blockages in the ears of my son and he advised to go to India and do the operation to remove the blocks for both ears.  Some time he cannot hear what we say & he ask us 2-3 times, but we thought may be he is too small and cannot understand what we say.  Since I have only one child I am really depressed by this.  Since his birth only 2-3 times I put oil in his ears.  Should I put the oil regularly?  Is he taking tension in the absence of mine?  

** It is natural for a child of 4 years to be attached to the mother. You need not worry that he is crying for you when you are not at home. He will gradually adjust to the situation and at this age mother need not be always with the child.  He should learn to remain happy with the father too. Let him not get the impression that you are worried that he cries for you when you are not at home. You should avoid discussing this in front of your child.

Normally a child of 4 years should weigh around 15 kgs. A little less than standard weight is not abnormal. It is also normal for children to get infections like common cold in school going age. These are viral infections and normally nothing can be done to prevent them. There is no need of active treatment. The children will naturally develop immunity as they grow. By about the age of ten, most of the children have immunity for these infections and they are rare after that.

Do not put oil into the ears. It is a bad habit and should be condemned. Regarding the block in the ears, a proper assessment by an ENT specialist is required. Surgically removable obstructions are rare in small children, except hard wax. For this, oil is not the answer.

12. M.G., Dubai.

*I need information regarding Fibroid. What is the main cause? What is the cure in a lady of 33 years with fibroid problems?  Are there any problems for married life? 

**Fibroid tumors are non-cancerous masses that grow in the uterus. They are generally painless for most women and are usually undetected. Women usually have multiple fibroids of various sizes.

The definite cause of fibroids is unclear, but they are fairly common and very sensitive to  estrogen. The tumors grow in women who are estrogen dominant, and during pregnancy when more hormones are released. On the other hand, tumors tend to shrink or totally disappear when estrogen levels are moderated and progesterone levels are increased and after menopause when estrogen production decreases.

Diagnosis of fibroid tumors is generally made after by pelvic examination. They are felt as lumps associated with uterus. To confirm this, ultrasonography is normally done. CT scans may reveal more details of the tumor. These are painless procedures that allow the viewing of internal organs.

Many of these tumors may be small in size and do not cause any problems. These can be on the outer surface, inside the uterine musculature or may be protruding into the uterus. A small fibroid is relatively harmless when it is on the outer surface or in the uterine musculature. However small fibroid tumors do cause problems for some women and childbearing can be difficult if they protrude into the uterine cavity. If tumors are growing all along the uterus, implantation of a fertilized egg is less likely to occur. 

Surgical removal of the tumors (myemectomy), is an option for women who still want to have a family. Hysterectomy or removal of the uterus may be indicated when there are multiple or large fibroids causing symptoms like pain and or heavy bleeding. The choice of the procedure depends on the problems and the fertility requirements of the woman. However multiple fibroids or a large tumor which can not be removed sparing the uterus may warrant hysterectomy. Hysterectomy is relatively a safe procedure. Some of the women fail to conceive even after myemectomy, even if they do not have other associated problems.

Small fibroids without symptoms may be ignored. They do not cause problems for normal sexual or reproductive function except that a fibroid inside the cavity can be a cause for infertility

13. A.A., Mangalore

*I am 30 years, married for two years. For the past 2 months I get rashes and itching on my organ after having sex with my wife. My wife has no problem.

** Women can have deep seated infection with fungi(Candida) and other micro-organism(trichomonia) without any symptoms. The rashes on penis after intercourse could be due to the transmission of the vaginal infection (candidacies, trichomoniasis). It may also be because of using lubricants/vaginal perfumed douches or condom. You may consult a dermatologist. Even if your partner has no symptoms, please get her examined and treated by her gynecologist. If she does not have those things mentioned above, rashes could be due to condom allergy, if you have used them. Treatment depends on the identification of cause.

14. A.M., Muscat

*I am 30 years. I have serious problem of hair loss. I have not consulted any specialists so far.

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

15. A.S., Mangalore

*I am 26 years. My periods are regular with 29/30 days cycle. I want to have a male baby. We are planning for it. Please suggest.

** Having regular physical union will likely to result in conception. It should be more regular and frequent during the fertile days. Fertile days are normally the middle ten days of the cycle. 

It is very difficult and probably impossible for the parents to plan a baby of their choice. If it were ever possible, most of the parents would have chosen boys and the number of girls would have been so less that they would have been very precious! The dowry would have been from the other side, the bride would have demanded it from the grooms!

There are few who believe that physical union at a particular time of the fertile period will determine the sex of the baby. It is not practicable and probably not true. The modern medicine does not support it. 

Except praying God and trying the luck, there are no definitive ways of getting a baby girl or a baby boy. 

16. J.  F., Mangalore

*I am 29 years, still not married. My height is 6 feet and weight is 59 Kg.  I have a problem of back pain; it started 10 months ago when I lifted the water bucket. And when I went for the treatment in Bangalore the doctor said it was slip disc (after taking the x-ray). Then I went local hospital for the treatment and there doctor declared that it was slip disc there was no medicines except taking pain killer tablets and he said not to lift any wait in future…now my problem is I am not able to sit down on the floor, I can not bend and I can’t do any hard work. Now what best way can I control the pain? At what reason slip disc had developed?  Whether there is any medicine is available? Whether there is any problem if I marry, for my sexual life?  

**By your description, it appears that you are having a problem of the lower back known as lumbo-sacral strain and not the disc problem. Many of the doctors use the term disc problem to all those conditions producing low back ache, because people take more care if it is disc problem! 

Strains are defined as tears, either partial or complete, of the muscle-tendon unit. Muscle strains and tears most frequently result from violent muscular contraction during an excessively forceful muscular stretch. Most of those who sustain a low back injury do so while lifting weights or while performing unexpected coupled motions (e.g., lateral bending and flexion, lateral bending and axial rotation). During the aforementioned activities, tremendous loads are placed on the lumbar spine, which may cause a temporary instability with a subsequent injury to the soft tissue surrounding the spine.

The disc prolapse is entirely a different problem. The discs lie between the end surfaces of the vertebrae that make up the spine. They have a soft centre which is surrounded by a tough outer ring. The discs allow movement of the spine and also act as shock absorbers. A sudden increase in pressure on the disc causes a tear in the tough outer ring. If the tear extends right through the outer ring, some of the soft centre may prolapse. The local pressure on the nerve from the disc may cause swelling and inflammation of the nerve root. This inflammation is responsible in part for the severe pain caused by a disc prolapse. Any situation which increases the pressure within a disc can lead to damage and prolapse. Lifting heavy objects with the back bent is a common cause. Coughing or sneezing may also cause a prolapse to occur. Less commonly, a fall or injury damages the disc.

In most of the disc prolapses the pain radiates down from the lower back, along the gluteal region, thigh up to ankle or foot. This is characteristic of disc problem.

For either conditions there are effective treatments in the form of rest, physiotherapy and pain relieving medication. You will have to consult an orthopaedic surgeon for proper assessment.  In the majority of cases, surgery is not required. Initially patient will be advised to rest at home, lying flat, only getting up to go to the toilet. Anti-inflammatory drugs, muscle relaxants and painkillers will be prescribed. If the pain does not get better, then strict rest in hospital may be needed for a further 2 weeks. Traction may be used. This involves lying flat in bed, while weights pulling on ropes attached to the legs produce a slight stretching of the spine. This takes the pressure off the damaged disc.

There is no surgical treatment for lumbar strains. Even in case of disc prolapse, 90% of patients get better with conservative type of treatment as described above.  Only 10% with an established disc prolapse might require surgery.

You may consult one more orthopaedic surgeon and explain him your difficulties. A proper assessment is required before starting the treatment.

It is better to get your back pain treated properly before you marry. However, back ache is not a contraindication for marriage.

17. R.S. Kuwait

* I am 28 years. I damaged one of my testicle while playing at the age of 15. I got the treatment but that testicle  was gone smaller and smaller and disappeared (and I feel having one testicle only  now),But I do get normal erection and I am married to be two years this August. I was with my wife for 45 days during wedding and that time I was unable to do physical union. After one year I went on vacation and everything was fine. We had sex, but my wife did not conceive. I m going again this September. Is one testicle can produce enough sperms to conceive or should I do a sperm count? Where it can be done?

** One testicle is sufficient to normal sexual and reproductive function. I hope you know that in a month the woman remains fertile for less than 12 hours and the day on which she is able to conceive is known as fertile day. A woman will not conceive if there are no healthy sperms available on the fertile day. Regular physical union is required for conception especially during fertile period. 

Normally semen analysis is advised if woman doesn’t conceive even after regular physical union for six months. However there is no harm in going for semen analysis when there is doubt. This is done at all the major clinical laboratories and in major hospitals. You may undergo semen analysis with at least three days of abstinence from sex as well as masturbation. If there are any abnormalities in the count or motility you may consult an urologist for proper guidance.

18. R.D’S, Dubai

*I am 34 years; I have a habit of masturbating after watching porn movies. I used to surf net for sex and porn materials. I waste daily 4-5 hours on this. I am married for two years and I want to get rid of this 10 year old habit. 

**Normally there is no harm in watching pornography or in masturbation. It is a natural tendency and many of the men- both married and unmarried- watch pornography in various extent. However it should not become an obsession or an addiction. As you agree, you waste good number of hours on watching pornography, you have to make up your mind to stop it. I presume you are staying with your wife. Regular normal physical relationship with your wife may be the best way to get rid off the habit of masturbation and indirectly watching porno for it. Some of the men continue the habit of masturbation in married life especially when they are not able to have normal physical union for various reasons. Masturbation may be a better option than having extramarital sex, in situations where the natural partner is not available. But, if you are with your wife, you should try your best to switch on to normal sex life from masturbation. Developing a good sex life with the married partner may be the best way to stop surfing for pornography as well as masturbation.

19. T.P., Mangalore

* I am 43 years. I don't know if it is dandruff or other related but my head if full of it.  It just falls down like talcum powder - I have short hair and have tried all kinds of shampoos, oil massage therapy, dermatologist visit etc but it just does not work. I also have dry flakes on my ears and nose on which I apply Vaseline every night and clear off every morning.  

**Many people mistakenly believe dandruff is caused by dry scalp, frequent shampooing or poor hygiene. These popular misconceptions can lead to ineffective, and sometimes inappropriate treatments, and make it even harder on those who have dandruff - half of adults with dandruff are more self-conscious about their appearance.

Researchers now believe dandruff is a medical condition caused by an overabundance of an organism that normally exists on everyone's scalp - even people who don't have the condition. Dandruff is a minor infection of the scalp caused by an overabundance of a micro-organism called Pityrosporum ovale (P. ovale), a yeast-like fungus that is part of the normal skin flora.

The rapid growth of P. ovale often is triggered by an imbalance in environmental factors such as climate, heredity, diet, hormones and stress. As the body's natural defenses fight the excessive growth of this organism, the results are the symptoms of dandruff - flaking, scaling and itching.

Under normal conditions, P. ovale yeasts can live on the skin without causing any problems. For example, one study found that yeast-like organisms made up 46 percent of scalp flora in people without dandruff problems; 74 percent in those who had dandruff, and 82 percent in those who were diagnosed with seborrheic dermatitis.

For a long time, effective therapy for dandruff and seborrheic dermatitis has been seen with compounds whose only common link was antipityrosporal activity. But proof of this relationship was lacking until the introduction of antifungal drugs - in particular, ketoconazole. While many of antifungal drugs have produced a good inhibitory effect on P. ovale, studies have shown that ketoconazole was the most powerful.

20. A.D’S, Dubai 

*I am 38 years, suffering from neck pain for the past two years. I cannot move my neck freely. When I sleep using thin pillow even then I feel pain; when traveling, I cannot lean on the seat. I did an M.R.I.  Doctor suggested taking pain killer tablets. These tablets I cannot take more than 2 or 3 days because of mouth ulcers. I do the physiotherapy also every day morning; I am doing the neck exercise which are advised by doctor but still no improvement

**You have not mentioned the MRI report. I presume you are having cervical strain or early spondylosis. For this problem normally pain relievers are advised along with physiotherapy. Some people are allergic or show adverse reaction to a particular type of medication and it should not be continued in them. There are varieties of other pain relieving medicines which may not cause mouth ulcers. You may consult an orthopaedic surgeon for treatment. It is better to take physiotherapy from physiotherapist, rather than having it at home. Proper physiotherapy is possible only at well equipped physiotherapy centers. Most of the people with these type of problem get relief without surgery. Surgery is required if there are major disc herniations or other causes irritating the nerve.

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