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Ask Your Doctor 175 (17.01.2015)
 

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.
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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. V.P., Mangalore

*My son took breast milk only for two months. After that he never drank even if I forced him. He drinks powdered milk twice a day. Should I stop this and continue with cow's milk? Should I give him egg daily? He is fussy in eating and I keep him in baby sitting. All I want to know is what type of food should I give him? Which food contains iron in it?

** You have not mentioned the present age of your son. As the feeding depends on the age, it is not possible to give an accurate answer. However, I presume he is within 6 months of age. 

All mothers should remember that there is nothing on the earth which can substitute mother’s milk. The baby gets all of his nutrition from breast milk until he is six months old. Every attempt has to be made to continue breast feeding at least till the baby is of six months. Nothing else is required up to the age of four to six months. There is no need to supplement with water, juice or cereal at this time. Most of the babies refuse breast feeding because they are bottle fed. As sucking the (artificial) nipple of the bottle is easy the bottle fed babies naturally refuse breast feeds. Bottle feeding is the worst feeding habit; it spoils the health as well as the feeding habit of the baby. 

As you have already stopped breast feeding, you may feed your baby on iron fortified infant formulas. 

If your son is of four months of age, other than infant formula, you may gradually start giving cereals. The cereal is the first solid that should be given to the baby, even if the baby is on breast feeds. Cereals may be started by about 4 months of age and not before. Some mothers start it only when the baby is of six months. It can be mixed with breast milk, formula or water and fed with a spoon (not in a bottle). Feeding the cereals should be started by feeding one tablespoon of an iron-fortified rice cereal at one feeding and then slowly the amount  could be increased to 3-4 tablespoons one or two times each day. This is a very important source of iron for growing infant (even if the baby is on breastfeeding). One can then start with vegetables at about six months of age.

When the baby is of six months of age, 4-5 feedings of breast milk or formula (24-32 ounces) has to be continued. With this, four or more tablespoons of iron fortified cereal can be fed each day. Gradually baby might be started on well-cooked, strained, or mashed vegetables or commercially prepared baby foods. It can be started as one tablespoon of a mild tasting vegetable, such as green beans, peas, squash or carrots and gradually increased to 4-5 tablespoons one or two times each day. 

The fruits may be started about a month after starting vegetables and again, gradually increased to 4-5 tablespoons one or two times each day. The naturally available fruits-banana, apple, oranges etc. are the best. They have to be peeled and initially cooked. If canned fruits are to be started, care has to be taken that these are packed in light syrup or water and have been blenderized or strained. The baby can also be given 4-6 ounces of 100% fruit juices. The fruit juices may be started by mixing one part juice with two parts of water and offered it in a cup only. Do not put fruit juices in bottle. The finger foods or meat and other protein foods are better to be delayed until infants are eight to nine months old.

Unless your son was premature or is already anemic, your son will usually get all of the iron he needs from (breast milk or an) iron fortified infant formula. 

Once he is 4-6 months old though, he will likely begin to need some extra iron, which usually comes in the form of an iron fortified cereal. Later on, be sure to choose from a good variety of iron rich baby foods, which you can often find by comparing food labels and choosing foods with iron content. Or choose age appropriate iron rich foods when making your own baby food to make sure your infant gets enough iron. 

You may take the opinion from the pediatrician of your baby if you wish to give him iron in the form of medications.

{For more details you may refer my book on child health and care in Konkani}

2. S.D’S, Dubai

*I am 28 years and presently working in gulf. I used to masturbate once or twice in a week. Now since one year I am getting bad smell every time I urinate. Is it because of masturbation or some other reason? Can you please suggest me to reduce this bad smell?

** The problem is not related to masturbation.  

Bad odour of urine can be the symptom of certain problems in the kidneys or of the urinary bladder. You can consult an urologist and get yourself examined. A simple urine analysis might rule out possible infections in the urinary tract. If the tests are normal, then the smell may be due to other causes.

Normally first voiding of urine in the morning has a strong smell as at this time it is very concentrated. If you are at all dehydrated, as you may well be after being in a warm bed for several hours, there can be the distinctive smell of ketones even at other times of the day. The smell can be from the by-products of certain foods that might be the part of your diet. Asparagus is a typical example of a substance which when passed through the urine gives a strong smell. Even certain medications, food additives may do this too. In addition there are many other substances such as nitrates and phosphates in the urine that can colour and also give a distinctive odour. The more dilute the urine is and the blander the diet, the less will be the smells. This simply means drinking lots more water will reduce the bad smell of urine. 


3. P.P, Kuwait

*I am getting married this May. I am 23 years of age and my fiancé is 25 years. My problem is that we do not want to have kids for at least 2 years since we are having financial problems. I do not think natural family planning will be helpful for us.

** If you have no solid reasons to postpone the arrival of first baby in your married life other than ‘to enjoy life’, it is not correct. A baby can be a boon to your married life. In fact a baby enhances the understanding, co-operation and adjustment among the couple in the early years of married life. It becomes a source of mutual interest; many of the minor causes of initial mal-adjustment may go once the baby is born. It is said that the first baby is for the marriage as it builds solid bond between the couple. (Saying goes that the second baby is for the first!)

It is quite easy to follow harmless methods of family planning like natural family planning after the birth of a baby. The functions of the genital organs become regulated and even other methods like safe method, calendar method can be practiced.  As many of the couples find it hard to follow natural family planning methods, other method like the use of loop is possible after the first delivery. The loop is currently used by many to space the arrival of the second baby or to maintain a proper gap between the births of two babies. The loop can be very effective, relatively harmless and easily reversible.

However if you are keen on postponing the baby for two years, natural family planning method may be tried. It should be followed strictly as the casual attitude towards it may result in failure. Many of the other temporary methods also are available. Both husband and wife should understand the principles and details of practicing them. They may opt any of the method of their choice. It is not possible to suggest a particular method unless the requirements of the couple are understood. It should be remembered that none of the methods are 100% safe. There are chances of conception with every method. Such events are to be accepted as the God’s plan and should not be a temptation for abortion.

It is beyond the scope of this column to explain each method of family planning. You may go through my book on married sex life, where these aspects are dealt in detail or consult a gynecologist soon after the marriage.


4. J.F, Dubai

I am 29 years of age. Is it safe to use a sauna belt for stomach after inserting loop to avoid pregnancy?

** Though there is no contra indication of using a sauna belt or any other belts with IUD (loop), it may be worth knowing the effects of the belts which are used to reduce the size of the tummy.

You have probably watched those television commercials, which promise to give you a trim tummy by using sauna belt. What exactly does a sauna belt do? You place it around your waist and it supposedly helps you sweat away unwanted fat, eliminate cellulite and lose weight! Does it work? Is it safe to use?  

One should remember that fat deposited under the skin is different from the ghee stored in a tin. If the tin is warmed ghee melts. But to melt the fat under the skin one may have to sit inside the pressure cooker and get boiled under pressure for 15 to 20 minutes! You might have the experience of cooking animal fat (for example of pork) which does not melt even if it is cooked. One should be rationale while watching the television commercials.  Moreover there are reports of skin burns because of these belts.

5. T. V.,Oman

My husband has developed some patches on his right arm. The patches are red/black in colour (like blood clots) and the doctor has prescribed tablets (name given). Can he take these tablets or does it have side effects?

** The doctor has prescribed anti fungal medications. It indicates that the patches your husband has are due fungal infection known as Tinea Versicolor. It is caused by the yeasts known as, Pityrosporum orbiculare and Pityrosporum ovale. They are a part of the normal skin flora, means they reside in our skin. Certain factors, like debility, diabetes, excess heat, increased humidity and others convert these into a pathogenic form which causes the rash of tinea versicolor. Tinea versicolor can occur at any age, but is most common in adolescence. 

The rashes of tinea versicolor are a hypopigmented, hyperpigmented, or red flat eruptions that may increase into large patches with an adherent fine scale. These rashes occur mainly on the trunk, but can also occur on the extremities. There are a number of different medications used to treat tinea versicolor. Because the yeast inhabits the top layer of the skin, topical antifungal medications are very effective. If the rash is extensive, oral antifungal medications may be needed. It is important to note that even though the pathogenic yeast has been eradicated after treatment, the hypopigmentation may persist for weeks until the melanocytes start to produce melanin again. Because this rash has a high recurrence rate, medication may be needed periodically to prevent recurrence.

The oral medications are relatively safe and can be taken as advised.

6. R. V. Mumbai

*My son is 18 months old.  His birth weight was 3.4 kgs. At present he is 10.8 kgs. As we both are working, we keep him in the crèche. There I am told that he eats well. He likes to eat dosas, chapattis but doesn’t like fruits; has never eaten a single fruit.  If we give him fruits, he just puts it out of his mouth.  Even fruit juices are absolute no. He looks very skinny, but otherwise healthy.

He started walking late, i.e. in the 15th month and now he doesn't walk much, after some steps he falls down. Could you please advise what food I need to give him so that he puts on more weight and becomes stronger?

**At this age there should be no reason for a child to refuse particular type of food unless it has developed aversion to it. There is no definite cause for your son to hate fruits or fruit juices.  It is probably that he had some bad taste earlier, he has developed aversion and now he doesn’t like. This habit is likely to disappear in the days to come. You may totally avoid giving him fruits for some time, so that he forgets the bad taste of it and starts eating it. Instead feed him with small quantities of vegetables. If he doesn’t eat fruits and or vegetables he may go into deficiency of certain nutrients.

Most parents understand that vegetables should be an important part of their child's diet because vegetables are a good source of fiber, vitamins, and minerals. Unfortunately, many parents have a very hard time getting their kids to eat few if any vegetables on a regular basis. Here are some suggestions that might be of use:

Set a good example by eating vegetables and fruits yourself. 

Offer low-fat salad dressing and other dips as a side for vegetables. Start with low quantities. Even fruits may be cut into very small pieces and given. You may even prepare a small quantity of fruit salad and give to the child.

Offer a lot of choices, provide small servings at first, and keep in mind that some picky eaters won't try a new vegetable or fruits until they see it on their plate 10 or more times. 

In a grown up child (not at the age of 18 months), the vegetables may be mixed with foods that the child already likes, such as a topping on pizza, extra in spaghetti sauce, or mix in a casserole or soup. 

Provide raw vegetables, such as baby carrots, as a snack. 


7. R. F., Bajpe

** I am 28 years of age. About a year ago in Canada, I was diagnosed as having ‘Fibromyalgia’. I am not able to work or do anything because of joint pains, muscle pain, sleep disorder, irregular heart beat, bowel problem and many more. Presently I am taking Amitriptyline-10mg. I am told that there is no cure for this

**Fibromyalgia is a chronic condition characterized by fatigue, widespread pain in the muscles, ligaments and tendons, and multiple tender points — places on the body where slight pressure causes pain. Fibromyalgia is more common in women than in men. Previously, the condition was known by other names such as fibrositis, chronic muscle pain syndrome, psychogenic rheumatism and tension myalgias.

Although the intensity of the symptoms may vary, they'll probably never disappear completely. It may be reassuring to know, however, that fibromyalgia isn't progressive, crippling or life-threatening. Treatments and self-care steps can improve symptoms and the general health. 

Signs and symptoms of fibromyalgia can vary, depending on the weather, stress, physical activity or even the time of day. Fibromyalgia is characterized by pain in specific areas of the body when pressure is applied, including the back of the head, upper back and neck, upper chest, elbows, hips and knees. The pain generally persists for months at a time and is often accompanied by stiffness.  People with fibromyalgia often wake up tired even though they seem to get plenty of sleep. The constipation, diarrhea, abdominal pain and bloating associated with IBS are also common with fibromyalgia. Many who have fibromyalgia also have headaches and facial pain that may be related to tenderness or stiffness in their neck and shoulders. 

It may be better to see your doctor if you experience general aching or widespread pain that lasts several months and is accompanied by fatigue. Many of the symptoms of fibromyalgia mimic those of other diseases, such as low thyroid hormone production (hypothyroidism), polymyalgia rheumatica, neuropathies, multiple sclerosis and rheumatoid arthritis. The doctor can help determine if one of these other conditions may be causing the symptoms

In general, treatment for fibromyalgia is with a combination of medication and self-care. The emphasis is on minimizing symptoms and improving general health. Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include analgesics, anti depressants (you are already on), muscle relaxants. Your doctor might suggest any one or more of these depending on the symptoms.

Self-care is critical in the management of fibromyalgia. Some of these are:

Reducing the stress: Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. But don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation. 

Getting enough sleep: Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping. 

Exercising regularly: At first, exercise may increase the pain. But doing it regularly often decreases symptoms. Appropriate exercises often include walking, swimming, and water aerobics. A physical therapist can help to develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful. 

Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. 

  

8. V. V.G. Dubai

*I am completing 38 year and am married I have 8 ½ year old daughter. I want another child now. Is it possible to conceive now? Till what age I can get the baby? 

** A woman can conceive as long as she has the menstrual periods. Menstrual periods indicate that the woman is fertile- that the ovaries produce the ova which can be fertilized by sperm. As you are nearing forties, you may have to consult the gynecologist before you plan for pregnancy. You may also discuss about the possible complications and the precautions that might be required.  


9. JPL, Mangalore

*I am 30 years of age. I am married and had my last period 40 days ago. I have white discharge. Is this sign of pregnancy? Please let me know about this matter. 

** The symptoms of pregnancy vary from woman to woman. Some women have none while others can have most of them indicating that each expectant woman is different. One of the first early pregnancy symptoms is morning sickness and a missed menstrual cycle. 

A missed menstrual cycle can indicate pregnancy. It is usually the first indicator that a woman is pregnant. 

Tender swollen breasts are another early symptom. While tender breasts are a sign of an impending menstrual cycle, enlarged breasts are not. Sore and swollen breasts with a tingling sensation can be an early indicator of pregnanacy.

Nausea associated with morning sickness can be a tell tale sign that a woman is pregnant. Many women suggest that they've had nausea up to two weeks before an expected menstrual period and before any other symptom. 

Extreme fatigue can be another indicator of pregnancy, especially if other symptoms are present. 

Frequent urination in pregnancy usually occurs between 6 to 8 weeks after conception.

Headaches while pregnant are a common symptom of pregnancy and begins at about the 6th week

Some pregnant women experience light headedness during early pregnancy. 


10. P. M. Mangalore

* My dad, 62 years is suffering with abdominal pain on the left side. The doctor has done the tests and informed that the pain is due to a stone in between the kidney and the tube. What should be done to get the stone out? Is there any diet that helps to push out the stone?

** The stones found in the renal tract are to be removed. They are formed in the kidneys and are passed down. Some of the stones remain in the kidneys and others might get stuck on their way out. Minute stones may be passed off without causing any problems.

The stones that remain in the urinary tract are to be removed. The methods employed for removal of the stones depends on the size, number and site where it is stuck. It can be as simple as inducing excess urination to major surgery. Most of the stones can be removed by passing a small catheter through the urethral opening up to the kidneys. The procedure is known as cystoscopy. 

You may suggest your uncle to consult an urologist who would be a proper doctor to assess and manage the problem. Other than drinking plenty of water, certain home remedies are available to increase the urine out put. This may be helpful to plush out smaller sized stones.  


11. S. D’s, Mumbai

*I am engaged to girl and our marriage will be in January. My fiancé is not sure of her period dates and told me that she gets the periods once in three months. Is this any problem to our married life?

** The irregularity in the menstrual cycles is common in many of the women and does not affect the sexual activities. However it can have some bearing on the fertility. 

The irregularities in the menstrual cycle can be broadly grouped in two:

Irregularities due to unknown cause: 

For some unknown reasons in some of the women the menstrual cycles are irregular from the beginning. In some they are regularly irregular, that is in every month their cycle remains at 40 days or 45 days and in others they are irregularly irregular, in some of the months it is 40 days, in others it is 50 days, it may even go beyond 60 days. These irregularities are very difficult to correct. A few of them may respond to hormonal treatment, where as in majority of the women the cycles remain irregular throughout. There are incidences where the cycles resume regularity after child birth. 

Irregularities due to traceable causes: 

Menstruation is controlled by a complex series of hormonal interactions between the thyroid, adrenal and pituitary glands, hypothalamus and the ovaries. Menstrual period changes are usually a symptom of some underlying physical or hormonal imbalance. Changes in the amount or timing of hormones released by the thyroid, adrenal and pituitary glands, or hypothalamus may cause the ovary to delay or skip ovulation. Without ovulation a period will not occur. However the same changes in hormones may trigger bleeding at abnormal times (in the middle of a cycle or several weeks late) or in abnormal amounts (very light or very heavy).  One of the most common causes of anovulation (failure to ovulate) is body weight. Low body weight may cause a prolonged absence of periods. Excessive body weight tends to cause abnormal bleeding. Sudden changes in exercise levels or in body weight may cause temporary changes in bleeding patterns.

It may be better to consult a gynecologist for proper assessment of the problem.


12. B.S, Bangalore

*I am 24-year-old. I am married for 3 years; two years ago I had miscarriage in the third month of pregnancy.  From past 2 years we are trying very hard to have a baby, but I am not able to conceive. I am following ovulation days also.  I took clomid and Fertyl tablets. Even it did not work.  All tests are done and everything is normal even my husband sperm count is good. Are there chances of becoming pregnant?

** For some unknown reasons, some of the women do not conceive several years even when there are no detectable problems. Many of these get the good news as surprise. You have to keep on trying. As you had already conceived once, there are chances that you would conceive again.

You may take second opinion from another gynecologist to be sure that there are no other causes of infertility.


13. 1. J. Mumbai

* I am 27 year old I am married for 2 years. I was pregnant twice and both the times I had miscarriage in the third month and  in the  second month. What may be the reason and what can I do about it. I would like to conceive again. Please suggest what diet I may have to follow?

** A miscarriage (the word usually associated with a spontaneous event and almost synonymous with 'abortion') can occur due to a variety of known reasons, and possibly from reasons as yet unknown. One in every six pregnancies fails to go to full term - the most likely stage being between six to ten weeks of pregnancy (within the first three months). 

Many a times during conception the foetus has the abnormalities; such foetus if allowed to grow, will be a crippled and defective baby. Natural abortion is the method opted by nature to prevent these catastrophe. 

The causes of miscarriage can be many. Some of them are explained here:

Embryonic abnormalities; In this type the chromosomal defects occur at the time of fertilization and is the commonest cause of miscarriage. Up to 30% of spontaneous miscarriages have been attributed to this reason. 

Placental insufficiency: Some spontaneous miscarriages at a later stage are caused by an insufficiency in the placental bed where poor structure and function prevents proper development of the foetus. 

Defect in the womb:  In some of the cases, the maternal uterus (womb) has a minor fault that has been present since the time of its own development; this could contribute to the non-support of an early pregnancy. The cervix, or neck of the womb, may also have a structural weakness. This could be congenital (from birth) leading to recurrent miscarriages, or it may be acquired. In the latter case it could follow a previous over-stretching of the cervix at a dilatation and curettage procedure (a 'D&C' operation) In either of these two cases the miscarriage is normally at a much later stage of pregnancy - say 12 weeks. 

Maternal disease itself rarely causes miscarriage. However if  the mother has undiagnosed and untreated high blood pressure, disease of the kidneys, diabetes, or overactive thyroid, these are linked to higher miscarriage rates in the later stages of pregnancy. Prolonged high fevers or infections in the mother causing a general toxic state, can also affect a developing foetus. German Measles is a particular culprit. 

Folic acid is essential to the healthy development of a foetus. A severe shortage of this nutrient in the diet can sometimes cause foetal abnormalities resulting in miscarriage. Until recently it was also thought that a low level of the hormone progesterone was associated with problems in the early stages of pregnancy, and for some years women suffering recurrent miscarriage were treated with progesterone doses. There is now, however, doubt about its effectiveness. 

Certain medications, both prescribed, and non-prescribed, can sometimes be dangerous, especially during the first trimester, when they should be avoided unless there are compelling reasons to take as no drug is be absolutely safe. Heavy uses of strong, aspirin-like drugs such as Ibuprofen are included in this category. 

Stress: There does seem to be a link between environmental stress in the mother and miscarriage. Stress can affect the production of various brain chemicals, which in turn have an effect on the hormones responsible for uterine-cavity activity. There can also be a paternal cause: difficult to determine, but defects in the foetus as a result of abnormal sperms can be a contributory factor in an early miscarriage. 

As you had two abortions already, it is better for you to consult a gynecologist and try to find out if there are any treatable causes or any precautions you may have to take in early part of pregnancy. Normally there is no food item that can cause abortion. There are myths that certain normal food items can be toxic to the baby. These beliefs differ  in various communities.

You can still conceive and have a baby provided you abide by the suggestions given by your doctor.


14. W. D., Kuwait

*I am 22 years of age. My problem is till now I have no traces of facial hair. I am having good height (6 foot) and even good weight also (75 kg) except this problem everything is fine. Presently I am working in Gulf. Please send me the name of some cream which I can get here. Your suggestions can change my life and lifestyle

** 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. It is not possible to suggest medication without personally assessing the cause of the problem.


15. M.D., Mangalore

*I am 41 years of age. I am planning to marry a man aged 44 years. My periods are regular. Can I conceive? Can I have a normal delivery with normal baby? 

** It is possible for a woman to conceive normally till she has menstrual periods. Some women have regular periods even up to the age of 50 and there are incidences of pregnancies in them. There are some experiments where post-menopausal women were artificially induced to conceive with the help of hormones, though these experiments are not universally practiced. Most women over age 35 have healthy pregnancies and healthy babies. However older mothers have some risks. The risks of late pregnancies include conception difficulties due to falling fertility; a higher risk of deformation of the foetus and genetic diseases and difficulties during labour, especially for overweight or unfit women. All these risks can be diagnosed early and managed effectively.

The advances in medical care now help women in their late 30s and 40s to have safer pregnancies than in the past. However, women should be aware of the risks associated with later childbearing so that they can make informed decisions about their pregnancies.

* Women generally have some decrease in fertility starting in their early 30s. It is not unusual for a woman in her mid-30s or older to take longer time to conceive than a younger woman.  Age-related declines in fertility may be due, in part, to less frequent ovulation or to problems such as endometriosis. 

*Studies suggest that women over 35 are twice as likely as women in their 20s to develop high blood pressure and diabetes for the first time during pregnancy. Similarly women at the age of 40 and older were almost three times as likely to develop diabetes, and almost twice as likely to develop high blood pressure as women in their 20s during pregnancy. This makes it especially important that older mothers get early and regular prenatal care. With early diagnosis and proper treatment, these disorders usually do not pose a major risk to mother or baby.

* The mothers over 35 are more likely than women in their 20s to have difficulties in labor if it is their first pregnancy. Studies suggest that fetal distress and a prolonged second stage of labor are more common in older mothers. This may account, in part, for the increased rate of cesarean sections among women over 35.

* The risk of bearing a child with certain chromosomal disorders increases as a woman ages. The most common of these disorders is Down syndrome, a combination of mental retardation and physical abnormalities. It is recommended that women with singleton pregnancies who will be 35 or older at the time of delivery should be offered prenatal testing (with amniocentesis or chorionic villus sampling) to diagnose or, more likely, rule out Down syndrome and other chromosomal abnormalities. About 95 percent of women who undergo prenatal testing receive the reassuring news that their baby does not have one of these disorders.

Once you are aware of possible risks of late pregnancies you will be able to take more precautions during pregnancy and delivery. Pregnant women who are 35 or older face some special risks, but many of these risks can be managed effectively with good prenatal care. It is important to keep in mind that the increased risk, even for the oldest women, is modest.


16. S. D’s, Bantwal

*What can be done for itching all over the body, especially in winter? There are also black dots. 

** You have to consult a skin specialist and find out the cause of itching. You may be allergic to season specific materials like pollens, certain insects. In the management of allergic disorders, it is better to identify the cause of the problem and avoid it rather than taking general anti-allergic treatment.


17. R.P. Kuwait

* I am 26 years old and working abroad.  For the last one year I have noticed wax like substance forming around the tip of my penis, I clean my penis well then for around two there hours there is no problem, but again it reoccurs.  I have not approached any doctors till now. 

** The substance you have noticed is known as smegma. Both males and females produce smegma. In males smegma is produced and accumulates under the foreskin; in females it collects around the clitoris and in the folds of the labia minora.

Smegma is invisible, noticeable as a smooth or moist texture until it is allowed to accumulate, when it takes on its characteristic texture and appearance described as “cheesy”. Since smegma tends to accumulate under the foreskin in males, its presence is less common and less noticeable in circumcised males.

The moisture of smegma keeps the glans moist and may lubricate the movement of the foreskin. However, if allowed to accumulate and decay in the foreskin cavity it can provide an ideal medium for potentially pathogenic bacteria to colonise. The current medical opinion is that allowing smegma to accumulate freely is unhealthy. Accumulation of smegma can cause or aggravate a variety of irritations known as balanitis. 

Preventing accumulation is best done by rinsing the area with warm water while taking bath. Frequent cleaning is not required.


18. D.  D’S., Kuwait

* I am 32 years of age. I am suffering from high blood pressure. After going for a checkup I was advised to take the pills throughout and was asked to reduce salt and fried things. I find it difficult to eat without salt. Is there any remedy for this? Why high BP at this early age? What may be the causes? My wait is just 72 kgs. 

**Hypertension is the name of a condition in which blood pressure is persistently elevated (it stays high for a long period of time). Blood pressure is a measure of the pressure of the blood against the blood vessel walls. Persistent high blood pressure puts undue stress on the heart, blood vessels and other organs. Optimal blood pressure is 120/80 mm Hg. Till 130/85 mm Hg it is considered normal and above that level requires intervention.

The causes of high blood pressure are a bit of a mystery. Only about 5% of patients requiring hypertension treatment can trace their high blood pressure to a physical cause such as kidney disease. But for remaining 95% of patients who undergo hypertension treatment, the causes of high blood pressure are unknown. Diet and stress are suspected as prime contributors to hypertension, but medical experts aren’t exactly certain of all the mechanisms involved. Hereditary association is not always present.

There are no specific symptoms of the problem. Although some patients complain of dizziness, headaches or blurred vision, most patients only discover they need hypertension treatment when their blood pressure is checked by some medical personnel.

High blood pressure is a serious health risk for many people. Hypertension can cause hardening of the arteries, heart attacks and strokes. Heart and kidney disease, as well as hardening of the arteries, have been attributed to hypertension. Fortunately, hypertension treatment is well researched and now readily available.

Even though there aren’t any identifiable high blood pressure symptoms, there sure are risk factors that appear to contribute to hypertension. With all the risk factors involved, it’s a wonder that anyone has normal blood pressure. If high blood pressure symptoms exist, they’re well hidden in our lifestyles. Few of the risk factors are:

Excessive body weight

Lack of physical activity

Smoking

High cholesterol level in the blood

Excessive salt intake

Stress

To make matters more complicated, many of the risk factors vary from individual to individual. Some people thrive under stress levels that cripple others. People react to different foods in different ways: while researchers are certain that fat- and cholesterol-rich foods contribute to hypertension, other elements in our diets may also play as yet undefined roles.

Here are few guide lines that may help you to remain healthy even with increased blood pressure:

You may have to stop smoking and or using tobacco in any other form strictly. Tobacco users with high blood pressure have more risk of complications than the non-smokers. 

Exercises are important in the management of raised blood pressure. The general physical exercises like brisk walking, swimming are better. Walking seems to be a good exercise that can be followed by people of all ages with or without raised blood pressure. For people with high blood pressure walking is one of the best physical exercises. Start with moderate walking may be for 30 minutes initially, gradually increases it and make it a routine to have brisk walk for one hour per day, at least five days in a week.

You will have to chose one physician and go to him regularly for check-up and to see that your blood pressure is always under control. The complications of high blood pressure are found only in those whose blood pressure is not under control. 

You should never discontinue or change the dosage of the medicines without your doctor’s suggestion. Alteration or discontinuation may lead to complications.

Salt restriction does not mean stopping the use of salt.  One should avoid excess salt and salty food items like pickles, dried and salted nuts etc. Moderate amount of salt is required for normal body functions. 

There are people with known high blood pressure for decades that are healthy otherwise. They only require regular BP check-up and proper treatment. Some doctors may advise occasional ECG recordings. It is not bad to check blood sugar, cholesterol, triglycerides once in a year regularly.


19. S. S., Mangalore. 

*My 5 ½ year old daughter had thick long hair, recently I noticed that her hair is growing scanty and has thinned at both sides near the forehead. I heard many opinions that maybe it is due to pulling her hair into a tight ponytail or lack of necessary vitamins. She refuses to drink milk.  

** You may consult a skin specialist to know the causes for loss of hair. If she is refusing to drink milk, substitute milk by other food items like eggs and fruits.


20. T. R., Goa

 * I am 51 years of age. What is the permanent treatment of amobiosis disease?  I have taken so many Metrogyl 400 but so far I got no permanent relief 

**Amobiosis is caused by a micro-organism known as Entamoeba hystolitica. Amoebiasis is usually transmitted by contamination of drinking water and foods with fecal matter, but it can also be transmitted indirectly through contact with dirty hands or objects. For chronic amobiosis combination of drugs taken together might give permanent cure. You may consult a gastro-enterologist for proper treatment.

Prevention of amobiosis is very important. 

To help prevent the spread of amoebiasis around the home:

Wash hands thoroughly with soap and hot running water for at least 10 seconds after using the toilet or changing a baby’s diaper, and before handling food 

Clean bathrooms and toilets often. Pay particular attention to toilet seats and taps. 

Avoid sharing towels or face washers. 

To help prevent infection:

Avoid raw vegetables when in endemic areas as they may have been fertilized using human feces. 

Drinking water has to be boiled and cooled. Water is the main medium through which amobiosis spreads.



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