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Ask Your Doctor 186 (02.02.2016)
 

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

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1. A.S. Dakha

*I am 40 years of age. I have undergone angioplasty about 5 month ago. Can I play badminton now?

** People with heart conditions who exercise regularly and make heart-healthy changes in their life style live longer than those who do not. After an angioplasty, the activities, exercises should be as per the advice of the cardiologist. Each individual’s cardiac status is different and the decision regarding resuming activities and exercises are to be discussed with the cardiologist. However here are few guide lines:

*Start slow: It is always better to start slow when recovering from heart surgery.  With time,  as the health improves, the level of activity can be increased. For instance, start with walking at a pace that is comfortable for you. Slowly increase the time and distance each time you walk. 

*Moderate physical activity : The moderate-intensity activities include walking, cycling, rowing,  are better than intense physical activities like playing badminton, football etc. 

*Strengthening exercises: In addition to aerobic exercise, the muscle-strengthening activities will help to build a stronger, healthier body. Strengthening exercises include lifting hand weights or free weights, using a weight machine, or using elastic bands that provide resistance. 

*Enjoy the exercise: The best exercise is the one person enjoys doing it. But consult your doctor what is safe for you.

2. N.K., Goa

*I am 25 years of age. I have hepatitis B infection. Is there any cure for this?

** Hepatitis means inflammation of the liver, and the most common cause is infection with one of 5 viruses, called hepatitis A, B, C, D, and E. All of these viruses can cause an acute disease with symptoms lasting several weeks including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. 

Hepatitis B is caused by a highly contagious virus that infects the liver. The virus is found in the blood and body fluids of infected people and can spread through sexual contact, the sharing of needles or razors, from mother to infant during birth, and by living in a household with a chronically infected person. The hepatitis B virus (HBV) is hard and can live outside the body for several days.

In much of the developing world, (sub-Saharan Africa, most of Asia, and the Pacific), most people become infected with HBV during childhood, and 8% to 10% of people in the general population become chronically infected. Hepatitis B virus can cause chronic infection in which the patient never gets rid of the virus and many years later may develop cirrhosis of the liver or liver cancer. HBV is the most serious type of viral hepatitis and the only type causing chronic hepatitis for which a vaccine is available.

All who come in contact with HIV (AIDS virus) may not get infected, but chances of infection of hepatitis virus (HBV) are more. In this way it is more contagious. But real danger of these viral infections is the complications: Though HBV is more contagious than HIV, in all those who are infected by HIV almost all of them will get AIDS. Where as in hepatitis B it is only around 8 to 10% of the infected people who will ultimately get the complications of the disease. Again a small number of them will get liver cancer. Compared to each other HIV is less contagious and more dangerous, HBV is more contagious but less dangerous.

Young children who become infected with HBV are most likely to develop chronic infection. About 90% of the infants infected during the first year of life and 30% to 50% of the children infected between 1 to 4 years of age develop chronic infection. The risk of death from HBV-related liver cancer or cirrhosis is approximately 25% for persons who become chronically infected during childhood.

Treatment is only recommended for people with chronic hepatitis B, based on a person’s age, overall health and the results of the various tests. The goal of therapy is to prevent cirrhosis, liver failure and liver cancer by reducing HBV viral load and the loss of HBeAg (either with or without detection of anti-HBe) while improving liver enzyme levels.

Deciding when to start therapy, along with which treatments to take, depends on a number of important factors: HBeAg status, HBV viral load, ALT levels, liver biopsy results and a person’s readiness to take medications exactly as prescribed. 

You may consult a gastro-enterologist for further advice. The specialist will decide and guide you.


3. A.C., Muscat

*I am 35 years of age. When I look at striped or checkered pattern shirts the stripes and checks appear to dance or vibrate. If I continue looking I feel a slight strain in the right eye, sometime the eye gets wet. I have migraine problem (irregular) and also see bright shooting dots when I sneeze loudly or do any activity that puts strain or pressure on the head. Are all these related? Why do I see the stripes dance? What is the reason for this? 

** These symptoms are related to migraine. You may discuss this with your neurologist who is treating you.


4. A.D., Bahrain

*For the past few  months back I am getting pain in my upper back(below neck.) Sometimes this pain is near to left shoulder and radiates to left hand. X-ray was taken after consulting doctor. It showed my cervical spine was straightened up a bit. (pain from C3 region as per doctor). Doctor suggested physiotherapy. I underwent 6 sessions and continuing my exercises now at home. But still I have pain, it varies in intensity. Pain is more while sitting. Please suggest what can be done to get rid of this pain completely.

**The pain appears to be related to irritation of the nerve due to changes in the cervical spine. It takes time to get complete relief. Pain relievers when there is severe pain, physiotherapy and exercises to strengthen muscles normally gives relief. You may consult a spine surgeon and get  your condition assessed further. If there is a disc problem you may need some other type of intervention.


5 R.A., Canada

* My daughter, 22 years of age has PCOS. Her testosterone levels are little high. Abdominal ultrasound is normal. She has hair on the face, legs and on the chest. She is depressed. She is dieting, her weight is 61 Kgs. Can it be cured naturally by dieting?

** Poly Cystic Ovaries syndrome(PCOS) or Stein- Leventhal syndrome is a condition in which there is an association between the presence of polycystic ovaries and signs of hirsutism, amenorrhea or oligomenorrhea and obesity. In this syndrome, other than an ovarian defect there can be biochemical, clinical, and endocrinal abnormalities. Although the condition is now referred to as polycystic ovary syndrome (PCOS) it may occur in women without ovarian cysts(Normal abdominal ultra sound). Women with PCOS have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production. High serum concentrations of androgenic hormones also may be encountered in these patients. PCOS is not a rare problem and approximately 6-10% of women in the developed countries have PCOS.

The extent of the problems associated with PCOS varies from woman to woman. However, there is effective treatment for the condition and it depends on the problems the individual has. The treatment can be medical with varieties of drugs- certain anti-diabetic agents like metformin, oral contraceptives etc. Other than medication, weight reduction, diet and exercises also are the part of treatment. Rarely surgery is done. Some of the women with PCOS are able to conceive if the hormonal abnormalities are set right. 

The problem can not be managed by diet alone. You may consult an endocrinologist for proper medication which is very much required.


6. C.B.V., Mangalore

*I am 24 years of age. I have piles(hemorrhoids). If I eat vegetarian and I will not have any problem but if I eat non veg and lot this problem reoccurs(pain and bleeding),when it starts it stays for 1-2 weeks then goes away, so does it needs to be operated to be fully cured or can it be cured without operation?

**Piles also known as hemorrhoids are the swollen but normally present blood vessels in and around the anus and lower rectum. These stretch under pressure, similar to varicose veins in the legs. The increased pressure and swelling may result from straining to move the bowel. Many anorectal problems, including fissures, fistulae, abscesses, or irritation and itching (pruritus ani), have similar symptoms and are incorrectly referred to as piles. 

Piles usually are not dangerous or life threatening. In most cases the symptoms of piles will go away within a few days. Although many people have piles, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, the internal hemorrhoids may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding, or prolapsed, hemorrhoid. Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. 

A thorough evaluation and proper diagnosis by the doctor is important when bleeding from the rectum or blood in the stool occurs. Bleeding is often due to hemorrhoids, but may also be a symptom of other digestive diseases. Consult a general surgeon. Many a times the problem of piles or other minor problems causing bleeding while passing motion can be treated with medicines. Surgical interventions are needed in certain conditions.


7. C.V., Mangalore

*I am 24. I am uncircumcised;  sometimes when I pee urine falls on my shorts, I am thinking of undergoing circumcision. I want to know whether it requires hospitalization?

** Circumcision is not required if you are able to retract the foreskin during normal as well as during erectile status of the organ. If you are unable to retract, then consult a general surgeon. It is a minor surgery, can be done without admission to the hospital, but it depends on what type of anaesthesia is given. 


8. L.D., Mangalore

*I am 36 years of age and I am having a son of 11 years. At the age of 26, I underwent shock treatment for depression and after that I am taking medicines. At this stage if we are deciding to have 2nd child is there any risk mental or physical? How safe is it to conceive?

** Considering your age and the medications you are on, it may not be a proper decision to conceive now. It may not be easy to conceive and secondly the medicines may have to be changed. However, you may consult your psychiatrist for further advice.


9. P.D., Mangalore

*My son aged 17 years, weighs 68 kgs and 172cm in height. Recently he developed swelling on the inner thigh just above the knee cap on the left side. There is no pain. The x-ray report was normal so surgeon asked to ignore as long as the condition doesn't changes.  Later he complained of sharp pain near the chest area at times and even he had complained of breathlessness. The doctor said it was due to anxiety. His ECG was normal. Eco-Mitral valve AML prolapse into LA during systole. I want to have your opinion on his condition 

** If you have consulted the specialists and they have opined that the swelling at the knee is normal you may ignore or else take second opinion from another specialist. The heart condition seems to be normal. At times worries about illness can cause anxiety. Your son may need proper assurance from a specialist.


10. S.D., Mangalore

*I am a lady, married for 7 years. For the past one month, I am getting cuts  and slight itching in my private parts after physical union. What to be done?

** Do you use any artificial material or medication during intercourse? You seem to be getting infection or allergic reaction. Consult your gynecologist for proper evaluation.


11. O.D, Bangalore

*I am a man of 35 years. I am working abroad. I use to do masturbate daily in my younger age and I was having premature ejaculation. Now my marriage is fixed. I am getting erection problems now and my semen is thin like water. I am really very tense. Can this be solved? Can I get married?

** Masturbation is a common habit and almost all men masturbate  during their youth. It is normal phenomenon and does not affect marital life or sexual health as long as it is understood and believed as normal. The problems associated with it are related to anxiety about losing energy, sexual power etc which are some of the myths associated with masturbation. Alteration of thickness in the semen is one such myth. Masturbation once or twice a day actually does not affect the consistency of semen.

Most men, even if they do not masturbate worry a lot about the consistency of semen-whether it is thin or thick. Interestingly, there is no research to back the idea that the thickness or thinness of semen has something to do with fertility or anything. The standard mean ejaculate volume for testing is 3.7ml, and it is considered normal even if it is below 1.5ml. It means that even a teaspoon of semen is normal in most cases.

It is important to understand that a substance comes out from penis when men are sexually excited – it's right at the tip of   the penis. This is not semen – it is pre-ejaculate (or precum) produced by the Cowper's gland. The fluid provides lubrication during sexual intercourse. Many people take it as watery semen, but it does not always contain sperm.

The thickness of semen is dependant on the frequency of  ejaculation. More often one ejaculates, thickness may become lesser and lesser.Overall, there is no real need to worry about watery  semen. 

 

12. N.A., Karnataka

*I am 46 years of age. I have a problem in my penis, upper side vein is at times painful during erection. One doctor informed me it was varicose veins and prescribed one gel and it is no use.

** In every man's penis there is a dorsal vein just under the skin. As  the man matures these veins can grow in size and become more prominent and noticeable. They do not cause pain or any symptoms. They will not cause any sexual dysfunction either. Varicosity normally not seen in these veins.

If you have pain on erection, it may be due to some other cause. You may consult an urologist for proper assessment and treatment. 


13. A.C.K., Dubai

*I am married for 6 years now. Of late am suffering with a strange problem during union. When my penis is erect and skin stretched the foreskin which is stretched back looks like dried up and cracking giving it a whitish look. During intercourse it causes too much pain turns red and some time there is little bleeding also. This pain  and burning takes 2 or 3 days to heal and it is painful especially  with an erection. Also every now and then a small about 1 mm cut happens near the foreskin joining area underneath for about 2 or 3 days , very painful during erection and union. I used anti fungal cream, but its only temporary relief. 

** This appears to be a fungal infection. In some of the couples, the female partner harbors fungi deep in her private parts. As the inner part is insensensitive they may not have any symptoms. The male partner gets infection each time they have physical union. Unless both the partners are simultaneously treated, the problem may not be solved. Your wife may have to consult a gynecologist and  same time you can see an urologist for proper treatment.


14. S.S., Mangalore

*I am working in BPO for the past 2 years; it is completely night shift. My hair is turning gray day by day. Please suggest me good natural  medicine.

** Graying of the hair is one of the natural phenomenon and there is no “miracle treatment” for turning gray hair back to black color as graying is simply a matter of genetics. It is certainly uncommon for someone your age to be developing gray hair, but not unheard of. There are many people younger than your age having their hair turned gray. Apparently, having gray hair is preferable to many than having them lost prematurely.  It may not be related to your work schedule or shift.    

There are many causes of premature graying of the hair other than genetics -illness, stress, poor diet/vitamin & mineral deficiency, and certain medical treatments can all be responsible for the hair turning gray. It can also be a simple matter of the genetics dictating that your hair will begin graying at precisely this point in your life. If you think this is not hereditary, you can consult a physician or dermatologist to find the possible causes for your graying hair.

There are no natural methods to get the original color. Only dyes can mask graying. Do not take away by the promises made by many of the “Natural Remedies” you see advertised. These won’t work unless your hair’s graying is a result of vitamin and/or mineral deficiency, which is something that you need to discuss with your physician.


15. A.K., Male

*I am a diabetic on allopathic medicine, My problem is, I have lost my sex power totally, after trying long it will erect for 10 to 20 seconds. 

** Erectile dysfunction — the inability to get or maintain an erection firm enough for sex — is common in men who have diabetes. The problem is caused by poor long-term blood sugar control, which damages nerves and blood vessels. Erectile dysfunction can also be related  to other conditions common in men with diabetes, such as high blood pressure and coronary artery disease.

It is well known that diabetes mellitus both type I and type II, is associated with a significant prevalence of erectile dysfunction. It is thought that at least 50% of diabetic men have erectile dysfunction. Erectile dysfunction occurs at a younger age in diabetic men and usually occurs within 10 years of diagnosis of the disease. It also is well known that not all diabetics develop erectile dysfunction, but those individuals with certain associated diabetic related complications such as peripheral neuropathy have a very high association of erectile dysfunction. It is also reported that the men who do not bother to keep their blood sugar under control have high incidences of erectile dysfunction. 

Many men are reluctant to discuss erectile dysfunction with their doctors. It is always better to talk to the doctor who treats  the diabetes about the problem. There are medications available now which are to be taken as per the advice of the physician as some of the formulations may be contraindicated in certain associated ailments.


16. A.D., Mangalore

*I am 26 year of age, I am bit confused about circumcision (fore skin removal). Is it necessary to undergo circumcision before marriage? 

** Circumcision is a religious or cultural ritual for many families, as well as certain aboriginal tribes in Africa and Australia. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. Sometimes there's a medical need for circumcision, such as when the foreskin is too tight to be pulled back (retracted) over the glans. Circumcision does not affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners. If the foreskin can be retracted back during erection, there is no need to undergo circumcision.


17. U.N., Mangalore

*I am 21 years of age. I have the habit of masturbation everyday. I  masturbate at night when I go to bed without it I cannot sleep I feel irritation. I am getting pimples. I want to stop masturbation.

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

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

It is very difficult and almost impossible to stop masturbation when there are no other ways of relieving sexual tension. More one worries, more one tries to stop the habit, the frequency of masturbation increases adding further stress.

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

Pimples are common during puberty; and at puberty most of the youngsters also get into the habit of masturbation. Naturally the relationship between the two is an issue. But, masturbation has nothing to do with the pimples. Pimples neither appear because of masturbation nor disappear if it is stopped.

18. V.T., Punjab

*I am 23 years of age. I am masturbulating for 9 years. Sometimes masturbating 3 to 4 times in a day. When me and my partner are at foreplay I ejaculate lot of precum and at that time I lose my desire. 

** As explained in the answer to the question above(17) the habit of masturbation has no ill effects on sexuality. You seem to be having the problem of premature ejaculation which is again very common in premarital encounters at your age. The problem is likely to be resolved once you marry and have frequent physical union. At present no treatment is needed.


19. P.P., Udupi

*My mother is aged 55 years is suffering from hyper thyroidism(overactive thyroid)  for the past one year. She was recommended Neomercazole tablets but till now it is not cure. Throat scanning also done doctor told surgery is not needed. The blood reports still show that her hormones are not normal. The doctor recommended to take Neomercazole 20 mg morning and night. Can she take these tablets? Are there any thyroid specialists?

** The medication given is proper, but if the hormone levels are not touching to normal level second opinion from an endocrinologist may be better. Endocrinologists are available in most of the major centers.


20. A.P., Mangalore

* My mother, 65 years of age is having severe pain in both knees for a long time. She was advised for knee replacement for right knee. Possible to under go operation for both the knees same time or to under go one knee & later for second after complete cure rest. 

** One or both knees may be affected by arthritis. If both knee joints show changes on X-rays and only one knee joint is painful, stiff, and disturbs daily activities of life, then only the painful knee joint should be operated on. If both knees are equally painful, then both should be operated on.

The surgery that replaces both damaged knee joints is called  bilateral total knee replacement. 

Some of the surgeons replace the arthritic knee joint one at a time, at two separate operations, often several days to several months apart. The patient will need two hospital stays, two anesthesia and two rehabilitation periods. This is called staged total knee replacements.

If both knees are equally painful and stiff, it is possible to have both knees replaced during one operation under one anesthesia. The operations are followed by a single rehabilitation period within one hospital stay. Such two simultaneous surgeries are called ‘simultaneous bilateral total knee replacement’ or ‘single sitting bilateral total knee replacement’. Both procedures produce equally good relief of pain and equally good return of function in the operated knees. The decision is based on the health status of the patient and is made in collaboration with the anesthetist


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