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Ask Your Doctor 192 (24.08.2016)
 

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 Many such details where the identity might be revealed will not be published.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
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1. M.D., Gulf

*I am married (27 yrs). My husband is a twin (30 yrs) and I am also a twin. There are no other twins in our families. We both have same blood group. Are there any complications if I conceive? Are there any chances that I also may get twins?

** Having same blood group is not a problem and may not lead to any complications.  But, there are possibilities of you having twin babies. You may be aware that twins can be identical or non-identical. Non-identical twins are the result of two separate eggs being fertilized by two separate sperm. There is a gene that makes a woman more likely to release two or more eggs during ovulation, and it's this gene that runs in families. Identical twins are the result of a single fertilized egg splitting, and this seems to be a random event. So if you're one with non-identical twins you're more likely to have twins. It is estimated that  a lady from non-identical twin is  about two and a half times more likely than average to have twins 

A man with a family history of twins may carry the gene, but it won't mean he can father a set of non-identical twins. The gene is only expressed through women who ovulate. If he has daughters, they may inherit the gene, and one day go on to have fraternal twins. 

This may explain why some people think that twins skip a generation in families. You may have heard, for example, that if your mum or dad is a twin but you're not, you're more likely to have twins yourself. There's no evidence to support this. What can happen, though, is that a dad can pass on the non-identical twin gene to his daughters and this may make twins appear to skip a generation.

2. J.M.D., Mangalore

* My son is 2 years of age. When he cries his breath is going up and he cant bring it down quickly. What may be done?

** These are termed as breath-holding spells. Breath-holding spells are brief periods when young children stop breathing for up to 1 minute. These spells often cause a child to lose consciousness. Breath-holding spells usually occur when a young child is angry, frustrated, in pain, or afraid. But the spell is a reflex. Children do not have breath-holding spells on purpose. 

There are two types of breath-holding spells: A cyanotic spell is caused by a change in the child's usual breathing pattern, usually in response to feeling angry or frustrated. It's the most common type. The other type is known as pallid spell  and is caused by a slowing of the child's  heart rate, usually in response to pain. Some children may have both types of spells at one time or another.

Breath-holding spells can occur in children  from six months through  six years of age. They are most common from 1 to 3 years of age. Some children have them every day, and some have them only once in a while.

Breath-holding spells are usually not serious and  do not cause lasting damage. With time, they go away on their own. 

Most children  with breath holding spells do not need treatment for breath-holding spells. Spells will go away  as the child gets older. The child’s doctor may advise treatment for any condition that precipitate pain and crying. To protect your child during a spell, lay your child on the floor and keep his or her arms, legs, and head from hitting anything hard or sharp. The child may stop breathing for up to 1 minute (60 seconds) during a spell. If your child doesn't wake up quickly and start breathing again, you may have to give rescue breaths which you may learn from your child’s doctor.

3.V.M., Mangalore

* My son is 14 years old. I came to know that now he is misbehaving with girls. How to educate the children about sex? Is there any counseling centre about it?

** You may contact his high school teachers and get proper counselors. Most of the schools have in-house counselors or they arrange for a suitable one.

4.L.L.R., Mangalore

*I am 42 years old I started masturbate at the age of 14 or 15. I continued it after marriage. My sex life is good. But as I am working in merchant navy site I masturbate 3 to 4 times in a week. Is masturbating will affect me?

**It is not unusual for married men to masturbate. There is nothing wrong in that and there is no harm in practicing masturbation. Many of the men masturbate even after marriage for one or other reason. It all depends on their need and on the circumstances. There are study reports indicating that the people who have regular sex partners, live with their sex partners, and/or are married, are more likely to masturbate than people without sexual partners and/or who live alone. This disproves the notion that adults who masturbate are sexual failures who lack the social skills to find sex partners or that masturbation is a behavior only for individuals who don't have partners or who are otherwise sexually deprived.

The foremost reasons adults give for masturbation are to relieve sexual tension, to achieve physical pleasure, to have sex when partners are unavailable, and to relax. For older adults, masturbation may serve as the primary means for sexual expression — especially if partners are ill or absent because of separation or other reasons. 

Masturbation is to be ignored just as a habit. It has no effect on the desire or performance in general. 

People who have positive feelings about their bodies, sex, and masturbation are more likely to be able to protect themselves against sexually transmitted infections, unintended pregnancy, and sexual abuse. By increasing our awareness of the sexual preferences, capabilities, and personal limits, masturbation may equip one to make better and more responsible sexual choices for himself. There is absolutely no harm in masturbation. You need not worry about it. 

5. R.N., Odissa

*Is psoriasis curable? Can you please suggest some home remedies?

** Psoriasis is a noncontagious common skin condition that causes rapid skin cell reproduction resulting in red, dry patches of thickened skin. The dry flakes and skin scales are thought to result from the rapid build up of skin cells. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

Some people have such mild psoriasis (small, faint dry skin patches) that they may not even suspect that they have a medical skin condition. Others have very severe psoriasis where virtually their entire body is fully covered with thick red, scaly skin.

Psoriasis is considered a non-curable, long-term (chronic) skin condition. It has a variable course, periodically improving and worsening. Sometimes psoriasis may clear for years and stay in remission. Some people have worsening of their symptoms in the cold winter months. Many people report improvement in warm climates, or with increased sunlight exposure.

The exact cause remains unknown. There may be a combination of factors, including genetic predisposition and environmental factors. It is common for psoriasis to be found in members of the same family. The immune system is thought to play a major role. 

Psoriasis is currently not curable. Research has shown it to be non contagious from person to person. One cannot catch it from anyone, and it does not pass to anyone else by skin-to-skin contact. You can directly touch someone with psoriasis every day and never catch the skin condition. Although psoriasis is not contagious from person to person, there is a known genetic tendency, and it may be inherited from parents to their children. It does tend to run in some families. Now there are effective medicines that can control the disease. Dermatologists are the specialists who are experts in treating psoriasis. You may consult a skin specialist and take proper treatment. It can not be treated by home remedies.

6.R.D., Mangalore

* I am 35 years old, married. I have 5 years old baby boy. I want to conceive for the second time. My husband is in gulf  and he will be coming on vacation for 1 month. Kindly suggest me the best days to conceive. I heard it is risky to conceive after 35 years. Is it true? 

** At your age it is ideal to consult a gynecologist and have thorough assessment before you plan the pregnancy. The specialist also will advise you regarding the days of fertility and the necessity of certain medication to improve the chances of conception.  Though the chances of complications related to pregnancy and childbirth are more in women with advanced age, proper precautions and safety measures in advance can minimize them and you can have healthy child even at your age.

7.N.D., Mumbai

*I am a lady aged 20 years. I regularly masturbate and then experience a guilt feeling. However it's something that I do on a regular basis. Belonging to a devotional family I get a sense of feeling that what I'm doing is wrong however I can't discuss this openly with anyone inside or outside my home. My question to you is are there any side effects from regular masturbation?

**Current research suggests that masturbation is very common. Research studies have shown that both girls and guys masturbate. It can become more frequent as teens get older and it’s a normal part of growing up. There may be few who do not masturbate. Masturbating and not masturbating are both normal behaviors! Although some cultures and religious practices may ban masturbation, it is normal and healthy when done privately. If you experience sadness, extreme guilt, or feel isolated, you may talk to a counselor. As in men, so in women masturbation does not lead to any ill effects on physical or sexual  or reproductive health. You may also refer the 11th question in this column for further details.

8.M.I., Kuwait

*I am 32 years of age and  I am  taking micardis 40  tablet for high BP. I am trying to conceive for my second child. Can I start with folic acid tablet now a month before conceiving ? is it advisable to take folic acid when I am taking this BP tablet.

** Folic acid tablets no way help in conception. If conceived, Folic acid may help in  preventing neural tube defects – serious birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly). These are not common defects and those who do not consume folic acid before or after conception need not have the babies with these defects. As the folic acid tablets have no serious side effects, using them in women who plan the pregnancy has become a routine.

As you are already having raised blood pressure, you may have to be careful during pregnancy to see that your blood pressure remains within normal limits. You will have to go for regular check up as advised by your doctor and use the medicines without fail.

9. S.P., Mangalore

* My dad is having pain in the knee & toes. He is 51. On testing it was reported that there was rise in uric acid i.e. 9.2mg. Doctor told him to avoid all fatty foods even spinach, cauliflower, tomato, bottle gourd etc. Now he is eating roti with milk &taking fruit juice only. Doctor has given him some medicines containing allupurinol. I want to know that what exactly the problem is? Is this Gout? What is the normal level of uric acid in our body? What is the diet and cure for this problem?

** By the description provided by you, it appears that the joint pain in your Dad is due to gout. An elevated blood level of uric acid is known as hyperuricemia. Normally the serum uric acid level should be less than 7 milligrams per deciliter. When hyperuricemia causes pain and swelling in the joints, the condition is known as gout.  All those with hyperuricemia may not have gout.

Gout is a systemic disease (i.e., condition that occurs throughout the body) caused by the buildup of uric acid in the joints. Hyperuricemia occurs when the liver produces more uric acid than the body can excrete in the urine, or when a diet high in rich foods (e.g., red meat, cream sauces, and red wine) produces more uric acid than the kidneys can filter from the blood. 

Over time, uric acid in the blood crystallizes and settles in the joint spaces, causing swelling, inflammation, stiffness, and pain. Gout usually affects the first metatarsal phalangeal joint of the big toe (hallux) or the ankle joints. 

It is more common in men between the ages of 40 and 50. In women, incidence increases after menopause. The condition is rare in children and young adults. 

Gout usually only affects one joint at a time (sometimes two) - most often the feet and ankles. The joint at the base of the big toe is the most common site. If there is no treatment the gout attack usually subsides in a week or so. After the first attack there may be intervals of many months or even years before there are other attacks. Over time these attacks tend to become more frequent and more severe and eventually may involve other and more joints. Without treatment, a state of chronic or continuous joint symptoms may develop with progressive joint damage.

There are many causes of  hyperuricemia:

Some people just have higher levels and is hereditary-there is deficiency of one enzyme. This causes hyperuricemia.

Obesity. 

High alcohol intake.

High intake of food that contain purines (purines are broken down into uric acid).

Some of the drugs used to treat high blood pressure can precipitate a gouty attack.  

Those with kidney disease may also develop high levels of uric acid.

The mainstay of gout treatment is correcting the factors that lead to the high levels of uric acid. This involves a combination of diet and drugs. Many people require taking drugs for a long time.

The following foods have higher levels of purines should be restricted or avoided: 

Offal foods like liver, kidneys, tripe, sweetbreads and tongue. 

Large amounts of red meat. 

Shellfish. 

Peas. Lentils and beans. 

Alcohol intake should be reduced. 

Being overweight and high blood pressure (hypertension) are the risk factors, so weight loss and control of blood pressure may be very important. 

When an acute attack of gout occurs, anti-inflammatory drugs (NSAID's) are usually very effective to help gain control of the gout symptoms in the first 12-24 hours (these drugs have no effect at lowering uric acid levels). Rest and elevation of the foot is also important.

Over the longer term, if diet changes are not lowering the uric acid levels, drugs can be used to lower the levels (these drugs have no effect during an acute attack). The drugs must be taken on a continuous and long term basis if they are to be effective. There are basically two kinds of drugs - one increases the elimination of uric acid by the kidneys and the others block the formation of uric acid.

Your Dad has to follow the advice of his doctor. Once the blood uric acid returns to normal, the problem of pain and disability may subside. He may reduce to take the food containing purines, but all other type of food can be consumed.

10. R.F., Udupi

* I am 20 years of age. Can you let me know the meaning of undescended testis, its causes, clinical manifestation, medications and all about the disease? 

** When the male baby is in mother’s womb, the testis start developing inside the abdomen, near to kidneys. Before the child is born the testicle migrates down from high in the abdomen and passes through abdominal wall and groin to take its normal position in the scrotum. They reach the scrotal sac sometime near to birth. 

When the testes fail to reach the scrotal sac, the condition is termed as undescended testes or Cryptorchidism.  This condition seen in newborns (may be present in 4% of boys at birth); there may be one or both of the testes have not passed down into the scrotal sac. Thirty percent of cases are bilateral (involve both testes). Cryptorchidism is more commonly seen in premature males because the testes do not descend from the abdomen to the scrotal sac until the seventh month of fetal development. However, three-fourths of undescended testicles will descend within the first three months of life.

When a testicle is not in the normal scrotal location several possibilities exist: 

There may never have been a testicle (congenital absence). 

The testicle may have atrophied (withered away) before birth due to torsion (twist) or blockage of the testicular blood vessels. 

The testicle may have descended incompletely and may lie within the inguinal canal (just above the scrotum). 

The testicle may have not descended properly, but remains within the abdominal cavity. 

In some children the testes may be found in the groin, but can be brought down into the scrotum during examination. These 'retractile' testicles also will be seen to descend when the child is in the bathtub. Retractile testicles are due to hyperactive muscles that temporarily pull the testicle into the groin. However, retractile testicles are not believed to injure the testicles and require no treatment. 

The scrotal location of the testicles keeps them cooler than the core body temperature. This lower temperature is important for the development of the testicle as well as for production of normal sperm. Studies have shown that there is an increased risk of infertility in men with a history of undescended testicles. Undescended testicles are also at increased risk for cancer. 

The undescended testicles are to be treated at the earliest and ideally before one year of age. There is evidence that early damage to the germ cells that produce sperm begins at this age. There are two options for treatment. Injections of a hormone, HCG, several times per week over several weeks can produce descent in some children. However, the success rates have been reported to be as low as 10% and this is not practiced. The most effective treatment is surgery. When a testis is felt in the groin area the testicles are explored in the area through a small incision. Most undescended testes are associated with a hernia that must be repaired. After this is done, the testis is brought down into the scrotum and anchored in a space created in the scrotum (This surgery is known as orchiopexy).

When a testis is not palpable on physical examination, its location must be determined. Normally abdominal ultra sound or in some cases laparoscopy may be required to locate the testes. In those patients found to have testes very high in the abdomen, additional surgery is required to correct the problem.

11. P.F., Mangalore

* I am 29 years of age. I have a problem of masturbating once in a day since the age of 13.  I do not have any other problems, I still feel as if I am only 18 years. My organ is bent like a banana. As I am intending to marry next year, I am worried whether this would result in any problem. I am physically strong, having good physique, stamina and fit body but I don’t have enough beard on my face, on my chest as well as around the genitals. Is it due to this regular masturbation? My friends are telling me that I will not be able to satisfy my wife and produce any issues. Kindly inform me what I shall do to overcome from this. Shall I marry or not?

** I have answered these types of questions several times on this column before. But, many visitors keep on repeating the question. 

First of all, masturbation is a perfectly normal method of relieving sexual tension. It has several names- ‘hand practice’ ‘self-abuse’  ‘hastmaithun’ etc.  It is estimated that over 70% of the male population masturbates. Masturbation is one of those issues that guys normally can't talk about. It doesn't matter who people are, what they do, or what they say, chances are they masturbate. 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 few of the men the habit persists even in marriage without affecting their marital life. It has no effect on general or sexual health.

But if one worries 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.

Masturbation is not evil, dirty or harmful - it will not make one  blind, drive insane, turn one in to a pervert nor it  stunt the growth, make one sterile.  These are all myths and are absolutely false. Masturbation is considered normal and healthy part of sexual development. The only real problems that come with masturbation are psychological and are the result of unhealthy or weary attitudes toward doing it (if you do it but are ashamed) or abnormal practices (for example, public masturbation). 

12. J. K.Mumbai

* I am 36 years of age; I am suffering with psoriasis and psoriatic arthritis. I continuously take pain killers (earlier I used to have one Reficoxib, or one/two Nimesulide or two Ibubrufen+Paracetamol combinations or one Diclofenac 100 mgm. a day). I found Reficoxib (Now it is banned) and Diclofenac 100mg more effective as it provides one full day relief. Probably due to that I have detected diabetes at the range of 130 fasting and -170 post pandial. (Of course hereditary factors too).

I sometimes use Betnesol+Neomicin cream whenever it increases. Though it is effective temporarily, once I stop it aggravates. I have never tried Melanocil or PUVA therapy. Are there any medicines available now which can control psoriasis / psoriatic arthritis?

** Psoriatic arthritis is linked to psoriasis, a disorder causing areas of the skin to become inflamed and be covered with silvery or grey scales. Psoriatic arthritis is a condition that causes swelling and pain in and around the joints. It can affect a number of joints including the fingers, wrists, toes, knees, ankles, elbows and shoulder joints, the spine and joints in the lower back (called sacroiliac joints). Psoriatic arthritis also affects tissues surrounding the joints including tendons and ligaments. It may cause a swelling of the whole digit called “sausage” finger or toe. There is also skin inflammation, particularly on the elbows, knees and scalp

Psoriatic arthritis is a less common form of arthritis.  It affects both men and women in equal numbers, and usually between the ages of 20 and 50.Up to 30% of people with psoriasis will also get psoriatic arthritis.  Although psoriasis may start at any age (commonly in the late teens), the arthritis component usually makes its appearance later - in the 20s, 30s and 40s. Commonly, psoriasis shows first, but in a small percentage of people (approximately 15%) arthritis may manifest first.

Psoriatic arthritis will generally develop in one of two ways:

“Localized” mild psoriatic arthritis develops slowly, with mild symptoms, and affects less than five joints. People with this type of psoriatic arthritis will often live without symptoms for an extended period of time. 

“Generalized” disabling psoriatic arthritis is a more serious form of the disease that affects five or more joints at the same time. This form of the disease will often lead to permanent joint damage and disability, and requires medication early. In severe cases, surgery and rehabilitation may be required.

At this time, there is no cure for psoriatic arthritis.  Therefore treatment is designed to minimize pain and stiffness.  Establishing the correct diagnosis is very important because something can be done to manage most forms of arthritis, and most therapies work best when started early in the disease. You have not mentioned whether you have consulted any specialists before starting medication. It may be better to consult a rheumatologist. 

The rheumatologist will probably be able to more easily diagnose you having psoriatic arthritis if you have psoriasis along with a single or several red, swollen fingers or toes. Usually, if your nails and skin are affected along with your joints, a firm diagnosis can be made.

However, since this form of arthritis is similar to other forms such as gout, Reiter's syndrome and rheumatoid arthritis, the doctor may perform a physical examination and order various tests to assist in diagnosis.  X-rays are often ordered to look for changes to the bone.  Blood and joint fluid tests may be done to rule out other conditions such as rheumatoid arthritis, reactive arthritis or gout.

Once the diagnosis is confirmed various treatments can help decrease your pain and stiffness and increase your movement. Treatment of psoriatic arthritis is for both the skin condition and the arthritis. For mild psoriatic arthritis the treatment plan usually is comprised of medication, physiotherapy and daily-living adjustments.  Your active involvement in developing your prescribed treatment plan is essential.

13. J.P., Kuwait

* I am 30 years. I have problem of drooling in the sleep which is uncomfortable. Can you please prescribe some medicines?

** Drooling in sleep may occur for many reasons including posture, illness and dental issues. Most symptoms of drooling can be controlled with minor treatment or a slight change in sleep or in lifestyle habits. When sleeping, we salivate less than how we salivate throughout the day but also do not swallow as frequently. The frequency slows at night. Mouth breathers are more prone to drool while asleep. This will also increase the likelihood of snoring and others could also be disturbed. It does not become a severe problem unless it is excessive. Drool while sleeping can disturb often during the night. Slumbering on a wet pillowcase can be irritating. While asleep, if one feels moisture on the pillowcase, often changing it will help and allow falling back asleep more comfortably.

While there is no cure, there are drugs available to help reduce the way one salivates during the night. You may consult an ENT surgeon for this. There may be other causes that may influence drooling. Cures for ailments that may contribute are also available. 

If there are no contributory treatable causes, you may have to accept the inconvenience. It can be uncomfortable and sleeping can be disturbed. This disorder is only inconvenient and does not pose more serious problems.

14. K.S., Mangalore

* I am 48 years of age. Is it normal to feel some pain on my lower tummy when I am desirously in need of sex? I also notice my breasts get bigger during fertility period and one week before my menstruation. Can I prolong my menopause, I enjoy making love.  Can I still get pregnant? My monthly period is still regular.

** It is not usual to get lower abdominal pain when the woman is sexually excited. It probably indicates congestion of the pelvic viscera. There may not be any major problems, but it is desirable to have a consultation with a gynecologist. You may be advised to undergo abdominal ultra sound examination.

Feeling of breast engorgement is normal. It is the normal response to the hormonal changes. 

If your cycles are ovulatory, that means if your ovary is still producing ova, you can become pregnant even at this age. Though a woman’s fertility falls after the age of 35, but women have been surprised when they have become 

pregnant unexpectedly in their late 40s or even early 50s. So late pregnancy can and does happen, it is important to think about contraception even after the menopause. The woman who reaches menopause at 50 or over should use contraception for at least 12 months after their last period and those who are under 50 when they have their menopause should continue to use contraception for two years after their last period.

In some parts of the world hormone replacement therapy is available which can post pone the menopausal symptoms. Hormone replacement therapy is not to maintain the sexual desire; desire for sex has little or no dependency on the hormones present.  As the hormone replacement therapy has lot of side effects, it is not universally practiced.  

Many women enjoy wonderful sex lives after they’ve passed the menopause – and continue to do so for a very long time. It is now known that women have much the same ability as men to enjoy sex in that age. Indeed, many females are a good deal more highly-sexed than their partners! Ironically, some women discover a renewed or even redoubled libido after the menopause. So to have a good sex life after menopause, nothing extra required to be done except probably having a positive attitude towards sex.

15. G.R., Qatar

* I am 35 years, am now in Qatar. I had loop inserted about three years ago. Can I get it replaced after another year? 

** Though it is recommended to change the loop once in three years, there may not be any harm in keeping it for one more year or so. 


16. M.D., UK

*I am 27 years of age; I am working in the UK. Since I came to UK I have lost around 16 kgs of weight and now I am 50. I feel very self-conscious when I look at other people, however it has not affected any other thing in my life, be it work or my other routine. Around 7 years back when I had been to Mumbai, I visited a doctor for the same problem, and the doctor prescribed me certain tablets(names given) and after that I had put on weight. Will these tablets affect my health? Is there any other way to put on weight? 

** Loss of 16 kilograms of body weight for no reason has to be investigated. You may have to consult a doctor to find out if there are any underlying causes for this. If you are declared healthy, find out from the doctor, what is the ideal body weight for your height. To put on additional weight you may have to go for nutritious diet and regular body building exercises. If we do not exercise and only go for rich diet, we may get obesity. The tablets are not ideal. Some of the tablets you are intending to consume may cause side effects and their role in increasing appetite is not proven.

17. K.D, Mangalore/Kuwait

* I a 42 years; I'm residing in gulf.  After several medications, I came to know that now I'm suffering from heartburn.  Sometimes I get severe pain in my chest (center), then sometimes pain in hands or back. I have normal pressure but at times a bit higher like 145/95.  I'm avoiding oily food. When I get pain I have cold milk and take pudinhara tablets and antacid Syrup.  Meanwhile I'm taking daily multivitamin tabs.  Before this I was take certain tablets (names given). But still I get either chest pain or hand pain, which is very severe.  Kindly advise the diet I should follow and any home remedies I can take or which is the best medicine I should take.

** Heartburn is a discomfort or pain caused by the stomach contents regurgitating from the stomach up into the gullet (oesophagus). The oesophagus is not made to withstand acid and is thus irritated and inflamed when acid from the stomach refluxes into it. This is known as reflux oesophagitis. 

The pain caused by the irritation of the oesophagus is a burning pain which is felt in the centre of the chest. There is often an associated awareness of acid and stomach contents in the back of the throat or mouth. Lying down or bending (eg in the garden) tend to increase the symptoms. 

The whole of the intestinal tract is in the form of a tube with muscles in the wall which move the food along (peristalsis). At the bottom of the oesophagus the muscles encircling the tube work rather like a valve to stop food going backwards. This is not a perfect valve, but in some people works less well than others: 

Obesity leads to a higher pressure in the abdomen. 

Pregnancy causes a higher pressure in the abdomen and there is also evidence that the changing hormone levels cause relaxation of the muscle valve. 

Large amounts to eat or drink cause back pressure. 

In hiatus hernia, which is quite a common condition, the top part of the stomach pokes through the muscle which separates the chest from the abdomen (the diaphragm), and results in disruption of the valve mechanism. 

Smoking causes the valve to relax and also increases acid production. 

It is better to consult a gastro-enterologist for this problem. The gastro-enterologist may well make the diagnosis from the symptoms that are described, but may wish to investigate further. 

Endoscopy is the most commonly used test and involves a fiber optic tube which is passed down your throat, enabling the doctor to examine the oesophagus, stomach, and duodenum. If any abnormal areas are seen a sample may be taken and sent to a laboratory for analysis. Sometimes an X-Ray is used, in the form of a barium meal, which monitors the passage of a drink containing a heavy element which shows up the oesophagus and stomach in silhouette.

There are certain hints which might help  to overcome heart burn:

To stop smoking. 

If one is overweight, lose weight.

Avoid eating just before bed and if taking any tablets, they should be washed down with a glass of water to avoid them sticking in the oesophagus and slowly dissolving there. Certain tablets can cause erosion on the site where they were finally stuck and these erosions can cause heart-burn.

Consider raising the head of the bed (one tends to slip down off extra pillows and so blocks or bricks under the head end of the bed may be better). 

Small meals regularly are better than large meals infrequently. 

Avoid tight clothing around the waist. 

Avoid aspirin and other anti-inflammatory medications (NSAIDs) eg ibuprofen, except after consultation with your doctor. 

Antacids neutralize the acid in the stomach, and often one containing a seaweed product (alginate) is used, as this floats on the stomach contents tending to keep them down. 

Various medications cause reduced acid secretion. Some of these are available over the counter and others only on prescription. 

There are medications which encourage the movement of food in the right direction (better peristalsis) and better valve action at the upper end of the stomach. 

Surgery is rarely done for heart burn, unless there is some other problem. 

18. J. C.,Dubai

* I am 43 years of age. I have a pain in the kidney on the left side for the last two years. And I have done x-ray scanning and found nothing wrong. What may be the cause of the pain?

** I could not make out what you mean by pain in the kidneys. The kidneys are located in side the abdominal cavity, close to the vertebral column in the mid back level. Pain in the mid back can be due to several causes and one can not say it is from the kidney. Most common cause in your age is due to chronic strain to the joints of your back-bone. You may consult an orthopaedic surgeon for proper evaluation. He might refer you to other specialists if required.

19. A. A., Mumbai.

I am 49 years of age. I am having multiple neurofibrosis since 8 years.  Initially I had only few swellings in my hands and gradually the number has increased to the whole part of my body, in particular, in my hands, stomach, chest, thighs etc.  During the last 3 years the number of swellings had increased drastically.  My cholesterol level and uric acid level were also little high.  I also suspected whether it is multiple lipomas or not.  I had consulted several doctors and they had informed there is no treatment.  Could you please advise me is there any treatment that can cure my problems?

**The neurofibromatosis is the genetic disorders of the nervous system that primarily affect the development and growth of neural (nerve) cell tissues. These disorders cause tumors to grow on nerves. These may grow in many parts of the body. The tumors are slow growing and after attaining a particular size-varying from that of a grain to a peanut. Some of them may be bigger than that. This disorder rarely associated with other abnormalities such as skin changes and bone deformities. The tumors are normally painless, unless they are at pressure bearing areas. Some tumors may grow in the nerve where it passes through a tight compartment such as carpal tunnel in the wrist. Such tumors may press on the nerve and may cause symptoms like weakness in the muscles supplied or numbness in the areas supplied by that nerve. Surgical removal of the tumors is done only when the tumor causes these symptoms. 

Asymptomatic tumors need not be removed and if the tumors are not progressing rapidly, the conservative approach of watchful waiting is recommended. Normally the tumor may not recur at the same site from where it is removed. However appearance of multiple tumors at other places is not dependent on surgery.

There is no permanent cure for the problem.


20. U.A., UAE

*My son is 13 years old.  His genital organ is very small and is not growing at all - it looks a bad and we are worried of his future.  Is there any treatment for this? Should we go for his hormones test?  Is there any is hormones test useful?

** The size of the male organ differs from man to man. As your son is probably just stepping into the growing age, there can be growth of his body along with genitals as the years move on. In males the growth normally starts by 12 to 14 years of age and it continues up to 21. The growth spurt is associated with puberty. The puberty is characterized by the appearance of secondary sexual characters like change in the voice, physical growth, appearance of hair around the genital region, in the arm pits etc. If there are no signs of puberty till the age of 16, you may consult a physician for appropriate tests.  

At this age do not ignite worries in your son that he has sexual anomalies which can have adverse effects on his psycho-sexual growth


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