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Ask Your Doctor 170 (15.08.2014)

To know more about Dr. Edward Nazareth - Click Here

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Please read this before you ask your question.....!

We are pleased that this column has become popular among our visitors. This column is purely of educative and informative type. We do not intend to suggest any definite treatment or give name of any specific drug or doctor either in India or abroad.

We are receiving questions from many of our visitors from different parts of the world. Though we have the desire to give the reply at the earliest, we are unable to do so. At present we are updating the column once in two weeks, but at times there is inadvertent delay. This results in lot of back log. We answer the questions in first come first serve basis. Even then to answer a particular question, it may take more than a month. We request our visitors to bear with us.
We regret, we are not able to help when reply is sought urgently. It is absolutely not possible to help in emergency situations. There is no facility to give personal reply through e-mail.

Please fill up all the relevant details in the columns when you send the question. Please give your correct name, e-mail address etc. While answering we are editing the name and try to conceal the identity of the person who sends the question whenever it is required. We will not attend the question when the details are not sent. This is just to see that the person is serious of his question.
You might have noticed that, the answers can not be perfect if all the details of the problem are not given. Please send all the details of the problem in the relevant question. Many such details where the identity might be revealed will not be published.
If you want further clarification or want to react to the answer please use the same column. Indicate the specific question or answer where further details/clarification is sought. Your reactions/suggestions are highly appreciated.

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

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1. J.M. Karkala

* I am 40 years of age; I am informed that there are some medicines which will help to stop alcohol drinking and there is no need to be in the  de-addiction center. I had been to one such places, but I could not stop drinking alcohol.

** The medicine that is used to help the alcoholics to stop drinking is disulfiram. It works on the principle of aversion therapy. The medicine disulfiram is used alongside other treatments and counselling for alcoholism. It is only suitable for people who have been through detoxification and have stopped alcohol.

Aversion therapy attempts to break the association between alcohol and pleasure. The therapy involves the person drinking alcohol, at the same time having a negative stimulus administered. This negative stimulus is feeling extremely sick after taking alcohol. It may even include nausea and vomiting.

Disulfiram works by interfering in the process of breaking down of alcohol in the body. The body breaks down alcohol into a substance called acetaldehyde. This is then broken down further so that it can be removed from the body. Disulfiram blocks the enzyme which breaks down the acetaldehyde. This leads to high levels of acetaldehyde in the blood and causes unpleasant effect. 

If a person who has taken disulfiram consumes even a small amount of alcohol he will get throbbing headache, a flushed face, palpitations and  it will make the person feel very sick. This reaction starts within about 10 minutes of drinking alcohol and can last for several hours. The person is normally informed about the  unpleasant feelings. Knowing this will happen will help the person to avoid alcohol. 

Because drinking larger amounts of alcohol can cause potentially dangerous reactions, disulfiram is only prescribed by specialists to people who are determined to stay off alcohol. 

If you want to try this medication, you may consult the psychiatrist or the person in charge of the de-addiction centre. The drug should be used under the guidance of specialist and the dosage should be strictly followed as advised. It can produce dangerous side effects if the instructions are not strictly followed.

2. D.D., Mangalore

* About two years ago I underwent laparoscopic sterilization at a government hospital. I have two babies, but I have some guilt feeling and I wanted the reversal of the surgery. But the doctor who did the surgery now informed me that he would not be able to reverse the procedure. What can be done?

** The laparoscopy is the device used to see the intraabdominal structures during surgery. In laparoscopic sterilization, the fallopian tubes are visualised. In tubectomy or tubal ligation the sterilization procedure performed to block the fallopian tubes. The procedure to block the fallopian tubes vary. The fallopian tubes are sealed in one of two ways: with an electric current that makes the tube clot (electrocoagulation) or with a band or clip that is placed over the tubes. Some of the surgeons may also cut the fallopian tubes.

The women who desire to be pregnant after tubal ligation or tubectomy can undergo a procedure called tubal re-anastomosis to reverse tubal ligation. Tubal re-anastomosis is a surgical procedure where the severed ends of the fallopian tubes are rejoined. This is a delicate procedure and requires expertise.  The chances of successful pregnancy are reported to be 50% and are higher among women who are in their 20s and among those who have had clip tubal ligation.

You may consult a gynecologist and get further guidance.

3. G.D., Dubai

* I am 27 years. Can the hair fall be reduced by keratin treatment? How keratin treatment helps to reduce hair fall? what are the effects on hair and affects on health? What exactly keratin treatment is? is it helps to increase the volume of hair? Which type of keratin treatment is better to reduce hair fall?

** Keratin treatment is a hair straightening method which can cut down on frizz and curls. It gives the hair a temporary sheen and shine; as this is not permanent, it may have to be re-done every 4 months. This is a chemical treatment where formaldehyde is one of the ingredient used. This is not a method to prevent hair fall. It neither prevents nor aggravates hair fall. It is an effective alternative to straightening the hair every day, but it is expensive! 

There are several types of keratin treatment and an authentic keratin treatment is likely to use safe amount of formaldehyde.  This chemical is known to cause allergic reactions and health problems. 

If you have the problem of losing hair, consult a dermatologist.

4. L. C. Panjim

* I am suffering from back ache due to slip-disc. As a result I find it difficult to have physical union with my wife. Please suggest some solution. 

** You are probably having chronic back ache and not actually slip disc. The chronic back ache is not due to disc prolapse or slip disc. However an acute disc prolapse may lead to chronic back ache later. 

The slip disc is an acute problem where the intervertebral disc is ruptures and presses on the nerve root. This causes severe pain in the back and the pain radiates down to one of the limbs-the level of radiation may vary from buttock to heel. 

There are so many other causes of back ache which are also mistakenly grouped as ‘disc prolapse’. Your back ache appears to be one of them. You are most probably having some problem of the inter-vertebral and also sacra-iliac joints. These joints are bound by ligaments which can get strained due to sudden or repetitive stress. This is the commonest cause of back ache at  your age.

You may consult an orthopaedic surgeon. The x-ray of the spine is usually asked for. If required sophisticated scans like MRI may be taken to arrive at a diagnosis. The problem of back ache can be treated. Pain reliving medications for a short duration, physiotherapy and exercises are normally advised for back ache related to strain.

Till the pain is relived and if you are getting severe pain during usual position of physical union, you may seek an alternative position in which the back is not strained. There are so many other positions of physical union where man need not strain his back. Details of these are available in the net, if you do not know about these.

5. A.T., Udupi

* I am 32 years of age and my problem is my wife does not get satisfied in our physical relationship. I have normal organ, but my wife says it is small. She tells me to consult the doctor, but I do not know where or whom to contact regarding this?

** Failure to get satisfied in normal sexual act is termed as orgasmic dysfunction. It is a common condition in which a woman has difficulty reaching orgasm, even with proper stimulation. 

Orgasms are intense feelings of release during sexual stimulation. They can vary in intensity, duration, and frequency. Orgasms can sometimes occur with little sexual stimulation, while in some cases, it might take a lot more effort.  The main symptom of orgasmic dysfunction is the inability to achieve sexual climax. Having unsatisfying orgasms or taking longer than normal to reach climax are also symptoms. 

It is estimated that one in three women have difficulty reaching orgasm with a partner, even after ample sexual stimulation. Your wife must be having orgasmic dysfunction which she blames to your organ.

Women may have difficulty reaching orgasm due to physical complications or mental or emotional issues. It can be hard to figure out the underlying cause of orgasmic dysfunction. Contributing factors might be one or more of the following

cultural or religious views on sex

embarrassment or shyness

guilt about enjoying sexual activity

history of sexual abuse

hysterectomy (surgery in which the woman’s uterus is removed)

medical issues, such as diabetes or neurological disorders

use of certain medications, especially selective serotonin inhibitors for depression

performance anxiety

relationship issues, such as unresolved conflicts or lack of trust


Mostly of the time a combination of factors can make achieving an orgasm difficult. Stressing about the situation can make it even more difficult to achieve orgasm in the future. 

Treatment for orgasmic dysfunction depends on the cause. The inability to orgasm can be frustrating and have an impact on a relationship. However, the woman may be able to reach climax with proper treatment and an open mind. It may be worth consulting a therapist. You may consult a psychiatrist and get in touch with the therapist. 

The treatment may include

treating any underlying conditions

changing antidepressant medications

try some form of talk therapy, such as cognitive behavioral therapy

Couples therapy is a popular treatment option. It’s a way for couples to connect better intimately. This can address issues both in the relationship and in the bedroom. 

6. J.M., Kozhikode

* I am 67 years of age. Is there any effective treatment available in any system of medicine for M.N.D.(Motor neuron disease).

** The motor neuron diseases (MNDs) are a group of progressive neurological disorders that destroy cells that control essential muscle activity such as speaking, walking, breathing, and swallowing.  Normally, messages from nerve cells in the brain are transmitted to nerve cells in the brain stem and spinal cord and from them to particular muscles. In motor neuron disease,  there are disruptions in these signals as a result patient develops gradual muscle weakening. MNDs occur more commonly in men than in women, and symptoms may appear after age 40.  

The causes of noninherited MNDs are not known, but environmental, toxic, viral, or genetic factors may be implicated.  Common MNDs include amyotrophic lateral sclerosis (ALS), progressive bulbar palsy, primary lateral sclerosis, and progressive muscular atrophy.

There is no cure or standard treatment for the MNDs in modern medicine or in other types.  Symptomatic and supportive treatment can help patients be more comfortable while maintaining their quality of life. Physical and speech therapy, occupational therapy, and rehabilitation may help to improve posture, prevent joint immobility, slow muscle weakness and atrophy, and cope with swallowing difficulties.  Applying heat may relieve muscle pain.  Assistive devices such as supports or braces, orthotics, speech synthesizers, and wheelchairs help some patients retain independence.  Proper nutrition and a balanced diet are essential to maintaining weight and strength. 

Prognosis varies depending on the type of MND and the age of onset.  Some MNDs, are not fatal and progress slowly while some other forms are stable for long periods, but improvement should not be expected.  

7. L.D., Dubai

* I am 29 years. I am having from low sperm count, the report shows (before 3 months) Count:2 million/ml; active:5% sluggish:10% and dead:90%. I consulted an urologist and I was advised medication(name given). After three months use, my current report shows count:10 million/ml; active:10%; sluggish:20%; dead:70%. As we are planning for a baby so should I continue the medication and  if yes then how many months

** As there is improvement, you may consult the same urologist and take his advice about continuation of medication.

More than 40% of couples who are unable to have children are unable to do so because of problems with the man's sperm. About six percent of males between the ages of fifteen and fifty struggle with infertility. Male infertility can be caused by a variety of problems.

The reduction in sperm production is also related to various causes like exposure to extreme heat, ill fitting briefs, insomnia(lack of sleep), performance pressure and emotional stress. There can be definite causes of low sperm count, such as a vericocele. A low sperm count can also reflect lifestyle choices that negatively impact male fertility. The following are some that may influence the sperm count:

Stop smoking because smoking significantly decreases both sperm count and sperm-cell motility.

Prevent overheating of the scrotum: An increase of scrotal temperature (caused by tight underwear, long stays in a sauna or Jacuzzi, for example) can impair sperm production.

Prevent excessive stress and perform relaxation exercises: Since infertility and life in general can be stressful, learn to relax. Stress is sometimes responsible for certain infertility problems such as hormonal problems.

Maintain a healthy weight: Not too under or overweight since weight influences estrogen and testosterone levels.

Do not overly exercise: Overly intense exercise (high levels of adrenal steroid hormones can cause a testosterone deficiency).

Eat well, get hydrated and sleep well. Malnutrition and anemia can negatively affect your sperm count.

8. N. D. Kuwait

*I am 34 years, married for one year I am having pre-mature ejaculation.  I ejaculate early, some time before physical relation.

** Premature ejaculation is not a rare problem. I have answered regarding this in detail earlier in this column. The culmination of the sex act in man before his sex partner reaches orgasm is defined as ‘premature ejaculation’. This is mainly a psychological problem and there are hardly any physical causes for it. Failure to take the partner to full pleasure once becomes a worry and repeats with every act. The fear of failure persists and repeats.

There are probably no definite drugs which can enhance the duration of act in man. However in some individual cases, anxiety relievers have been tried with various successes. Local applications-sprays and ointments normally do not help.

You can try following hints to enhance the duration of the act:

Please remember that you do not have any defect in your sexual organs or in your body. The problem is in your mind. You are like any other men of your age and are capable to perform like them provided you develop the self confidence that you can. In most of the people, it is the lack of self confidence that causes the problem.

Spend enough time in foreplay and try your best to take your partner to near orgasmic stage in foreplay itself. Most common cause of non-orgasmic sex act for women is due to inadequate foreplay. I hope you know what is meant by foreplay!

Try to have sex act more than once per day. It might require about 6 to 8 hours gap for men of your age to get ready for the second act. In the subsequent act, (if performed as early as possible after the previous act) the duration of act is likely to prolong and most of the time your partner will reach to the peak. Even if you are not ready for the second act soon after the previous one, let your partner stimulate you and you will notice that you get enough excitement for the second act. This might help you to get self confidence.

I hope you know of different positions of the act. Let your wife take a dominant role once in a while and you might be able to reach her to the peak. In sex act both the partners are equal, both have to take enough time to prepare each other, both have to be active and there is no harm in changing the dominant role. It is said that everything is fair in love (act) and in war!

If you are not able to get solution by this then, consult a good psychiatrist. There are some medicines available which might reduce the anxiety which might help you to gain confidence and success in performance. You also might be taught some other methods where both the partners join together and solve the problem. However, this type of therapy is rarely required

9. R.P., Dubai

* My platelet count is low  for the past three and half years. It is 43000. I had consulted doctors at a reputed hospital in my native place and I was told  that if the platelet count  reduces below 30000 then treatment would be required. That time the count is 52000. Here in Dubai the doctor has advised me to eat papaya fruit daily. I do not have any bleeding problem. My blood pressure and blood sugars are in normal range. I want to know is there any medicine or any fruit name to increase the platelet count.

** The platelets are tiny components of the blood which help blood to clot when injured. They are also known as thrombocytes. They are made inside bone, in the bone marrow. They are released into the bloodstream and travel through the body for about seven days, before they are removed by the spleen. The spleen is an organ that lies at the top of the abdomen under the ribs on the left-hand side.

A normal number of platelets is between 150 and 400 x 109 per liter. This is found by a blood test. If one has too many platelets, the  blood will clot too easily. If a person does not have enough platelets, he/she may bruise and bleed more easily than usual. Many people with low platelets may not have any symptoms. Some of these may have unusual bleeding disorder known as idiopathic thrombocytopenic purpura (ITP). It is an autoimmune disease involving platelets. In autoimmune disorders the body makes an antibody that damages another part of the body. In ITP the antibodies are made against platelets. Once the antibodies have attached to platelets, the platelets do not work so well. They are also removed more quickly by the spleen because they are abnormal.

Idiopathic means that there is no known underlying cause found.

Thrombocytopenic means not enough platelets.

Purpura is a purple-red rash.

Although the cause of ITP is not clear, it is known to be something to do with the immune system. Therefore, the disease is increasingly being called immune thrombocytopenic purpura - which is still shortened to ITP.

Most adults with low platelet count or ITP do not require active treatment, unless they have significant symptoms or need to undergo surgery for any reason, including dental work. It is important to have adequate platelet levels before surgery in order to minimize the risk of severe bleeding during the surgery.

If treatment is needed, then the first treatments that tend to be used in an adult with low platelet or ITP are usually steroids  and immunoglobins. Surgery to remove the spleen (splenectomy) is used more often in adults to manage ITP. It is more likely to result in a longer-lasting normal number of platelets. About 2 in 3 people with ITP who have a splenectomy will have a normal long-lasting number of platelets. However, splenectomy is not without complications. 

I have no idea whether papaya helps in improving platelet counts. There have been reports where papaya leaf extract was used in patients suffering from dengue fever. But there are no conclusive reports supporting the benefit of papaya extract or papaya fruit in idiopathic thrombocytopenia. There may not be harm in eating papaya daily.

10. N.M., Pune

*I am 52 years and was diagnosed high BP  about 4 years ago when I had undergone a complete physical check up.  I was prescribed one tablet to be taken daily to reduce the pressure.  Now my BP is under control.  Whenever I find time I go for walk.  There is no problem of cholesterol and diabetes so far.  My colleagues who take "Ecosprin 75 mg" daily are advising me to cultivate that habit for smooth flow of blood in circulation so as to avoid stroke.  Kindly advise me whether it is safe to take 1 aspirin per day.  Is there any side effects? 

** Though the drugs like aspirin in small doses (75 mg per day) have anti-platelet action (prevent clotting), they are normally not prescribed for all the patients of hypertension. The risk of getting a stroke is minimal when blood pressure is under control. In patients with the risk of stroke (earlier mild attack, obese, diabetic, family history etc.) are advised to take aspirin. 

Aspirin is usually prescribed to avoid a secondary attack of stroke as well as heart attack. There are reports that long-term antiplatelet drugs like aspirin reduce the risk of stroke and other serious vascular events by 25%. The use of aspirin prevents 40 vascular events per year for every 1000 patients treated. As a prophylaxis aspirin is used because aspirin is cheap, relatively non-toxic, and is as effective as other antiplatelet drugs.

If you are keen on taking aspirin you may do so after consulting your physician. In small doses aspirin has minimal side effects. However it has to be taken with caution if there is history of peptic ulceration or asthma

11. S.S.Dubai

*I am 32 years, married for 4 years and have a kid of 2 years. I had normal delivery at my native place in a hospital. Recently I realized that I pass urine through my vagina also. I am pretty sure that urine passes out of both.  I ignored it for a long time, because I thought maybe I was just imagining things and was not sure if it was even possible. I do not have any leaking. Urine only comes out when I go to the bathroom. I wanted to make sure I was not imagining things, so I put a tampon in before I went to the bathroom. I took the tampon out after urination and it was wet top to bottom and had expanded. Why I am having this leakage? 

** By the description given by you it appears that there is an opening between the urethra and the vagina. The urethra, a tube like passage through which urine flows out during urination is in the close proximity of the vagina. The opening between the two is known as urethro-vaginal fistula. This opening between the urethra and vagina is usually due to obstetric injury. 

There can be another opening between the urinary bladder and vagina, known as vesico-vaginal fistulae. In this condition, there can be continuous leaking of the urine.

The symptoms of urethra-vaginal fistulae depend upon location of the opening. Fistulae in the urethra close to the bladder neck are often associated with incontinence. The doctor can see a larger opening by inspection, whereas urethroscopy, cystoscopy and vaginoscopy may be needed to detect a smaller one. It is important to rule out an associated vesico-vaginal fistula. 

If the problem is detected immediately after the injury, they are repaired after some 12 weeks to allow the original inflammation of the injury to settle. Symptomatic fistulae are best repaired by careful excision and layered closure. The use of a labial fat pad (Martius flap) or muscle flap may be useful. A catheter is left for about 14 days after the repair. Complications include incontinence, recurrent fistula formation and urethral stricture. You may consult the gynecologist for proper assessment and treatment. If you have fistulae, you may be advised surgery.

12. A. D., Mangalore

* My daughter who is 6 years of age is having large tonsils and adenoids. In every two months the tonsils get infected and she gets high fever/cough and she has to take antibiotics. She is snoring too much at night. Because of this she cannot sleep properly. Is there any treatment or surges required?

** In children there are two tonsils at the back of the throat and two adenoids are at the back of the nose. These can repeatedly get infected and can be a problem. Tonsils are seen by opening the mouth and adenoids can only be seen with a mirror. You may consult an ENT surgeon and get opinion. She might require removal of the tonsils and probably adenoids also. 

Normally the removal of tonsils or adenoids is required in the following conditions:

1. Repeated infections: There is no specific time to get rid of the tonsils or adenoids if they repeatedly get infected.

2. Repeated infections of the tonsils resulting in high fever and febrile convulsions in children. 

3. Enlargement causing obstruction in the airways. 

There are many ways of removing tonsils and adenoids. The most common way is the dissection method. This is the less traumatic and is a simple procedure. Other method of removal of tonsils is using laser. Laser vaporizes tissue. Laser has to be used under general anesthetic. Laser takes longer and is not as simple as the dissection method. 

13. J.R. Mangalore

* I am 29 years of age. I get my regular periods (28days) lasting about 3-4 days with medium flow. I get severe lower abdominal cramps which results in clots and then the pain relieves. I am married now; I want to know if this is normal. My Hb is 12mg/dl.

**The medical term for painful periods is dysmenorrhoea. There are two types- primary and secondary. 

Primary dysmenorrhoea: This term is used to describe normal pain experienced by many women around the time of their period. There is no underlying medical problem. It most commonly affects teenagers and young women. 

Secondary dysmenorrhoea: This term is used to describe pain around the time of the period that’s caused by an underlying problem. It is less common than primary dysmenorrhoea, and tends to affect women later in their reproductive lives.

Cramping lower abdominal pains are the most common symptom. Pain can also spread to the lower back and the thighs. When severe, the pain can be accompanied by nausea or vomiting, diarrhea, constipation or feeling faint. Some women may also get headaches.

Pain usually lasts two to three days and tends to happen in the first few days of the period, coinciding with the time of heaviest blood flow. Period pains do not cause any damage to the uterus and a pelvic examination or "internal" would show that the uterus and ovaries are normal.

Up to 15% of women have period pains severe enough to interfere with their daily activities. This can lead to missing days at work or decreased participation in social or sporting activities.

Period pains are often worse in adolescence and tend to improve as women get older. Many women notice that their periods are less painful after they have had a baby. Hence, delivering a baby is said to be the remedy for the problem, though this is not so in every women with dysmenorrhoea.

The cause of period pain is not certain. After ovulation, natural chemicals produced by the body called prostaglandins are made in the lining of the uterus (womb). Some prostaglandins cause the walls of the uterus to contract. Some women produce higher levels of prostaglandins, which may cause increased contractions of the uterus. These cramps may be more painful because there is reduced blood supply (and therefore oxygen) to the myometrium (muscle wall of the uterus) during the contractions. These contractions help in opening the cervix through which the menstrual flow comes out. After this, the contractions stop and pain may disappear.

Over the counter painkillers such as ibuprofen and paracetamol often help. There are also painkilling tablets available that contain the drug, hyoscine that may help prevent the muscle contractions. One can get the prescription for these drugs through the doctor.

Moderate physical exercise can also be helpful for relieving pain, and may help prevent period pain. Many women find a hot water bottle held to the abdomen or back is comforting. Self-heating patches or heat packs that can be warmed in a microwave are a convenient alternative.

If these measures do not provide enough relief, or if period pains are interfering with daily life, then it’s best to see a gynecologist. A gynecologist can usually diagnose period pains easily and several treatment options may be discussed.

14. S.P. Mangalore

*I am 30 years married lady having a 3 year old child.  I had a loop inserted three months after my delivery. My doctor had told me that with this loop I would not conceive for 3 years and three years are just getting over. I would like to know if there are any chances that the loop disappears automatically by the end of three years period. My husband is in Gulf for the past one year and he is about to come down and he will be here for one month. We would like to postpone the 2nd child at least for another one year. I checked with someone and they say nothing happens for three years but I am tensed. Could you please help me in this regard?

**Normally the loop once inserted is effective as long as it is in the uterus. As the loop can not be left for long and requires to be replaced with a new one at least after three years of insertion, it is informed that loop is effective for three years. The loop does not get absorbed in and disappear by itself. (Rarely loop may be expelled out unknowingly or due to improper insertion may penetrate out into the abdominal cavity—these complications are not time bound and  can occur at any time)

To be on the safer side you may consult a gynecologist and replace the loop with a new one. The newly inserted loop can be removed at any time later when you are ready for the second child.

15.E.V., Mangalore

* I am 55 years of age, having only raised cholesterol. I do not have  diabetes or hypertension. I do regular exercises. I am having erectile dysfunction. What may be done?

** The problem of raised cholesterol and erectile dysfunction are not related to each other. There are now effective medicines for erectile dysfunction. You may consult an urologist or a neurologist and get appropriate treatment.  

16. S. S. Mumbai,

*I am 23 years. I am married for one year. We do not have child till now.  The main problem I think is that the seminal discharge after physical union flows out from me.   Can you suggest why this is happening and any remedy for this?  

** Normally a part of the ejaculate after physical union flows out. This happens in almost all the women. This is not a defect and is not a cause for infertility. If you had regular physical union for the last one year and have not conceived yet then investigations may be done. The investigations normally are started from man, as these are relatively easy and less expensive. Your husband may consult an urologist first and if he is found normal then you may see a gynecologist.

17. E.Z., Mangalore

* I had fracture of leg bone(tibia) which was operated and a plate was put in 2010. Now I am 55 years. Is that plate required to be removed or I can retain it. Is there any side effects?

** Irrespective of the age it may be better to remove the implants(plate-screws or intramedullary rods or wires) from the bones once the fracture has healed. The implants are foreign material to the body and always there is risk of infection as they can be the nidus for infection. Removal of the implants after several years of insertion are difficult as there is the possibility of corrosion of the screw heads and the usual screw removal devices may not work. You may consult the surgeon who had operated on you and get the implants removed.

18. P.S., Dubai

* I am 32 years  of age. I have keloids in the middle of my chest for the past 7 years which is itching and painful. I am  using scar ointment. I checked in the net and it is informed that keloids should not be operated. I was given an injection, but it did not subside. I am about to get married. The keloid looks very bad. Please suggest.

** A keloid, sometimes referred to as a keloid scar, is a tough heaped-up scar that rises quite abruptly above the rest of the skin. It usually has a smooth top and a pink or purple color. Keloids are irregularly shaped and tend to enlarge progressively. Unlike scars, keloids do not subside over time. Although people with darker skin are more likely to develop them, keloids can occur in people of all skin types. In some cases, the tendency to form keloids seems to run in families. Keloids develop most often on the chest, back, shoulders, and earlobes. They seldom develop on the face.

There are several treatment options for keloid.

Cortisone injections: The steroids are infiltrated into the keloid. These are safe and not very painful. Injections are usually given once every 4 to 8 weeks into the keloids) and usually help flatten keloids; however, steroid injections can also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. The keloid may look better after treatment than it looked to start with, but even the best results leave a mark that looks and feels quite different from the surrounding skin. 

Surgery: Surgery for keloid is risky, because cutting a keloid can trigger the formation of a similar or even larger keloid. Some surgeons achieve success by injecting steroids or applying pressure dressings to the wound site for months after cutting away the keloid. Radiation after surgical excision has also been used. 

Laser: The pulsed-dye laser can be effective at flattening keloids and making them look less red. Treatment is safe and not very painful, but several treatment sessions may be needed. These may be costly, since such treatments are not generally covered by insurance plans. 

You may consult a plastic surgeon and take his advice.

19. J. F, Qatar

*I am married for the last 3 years. Soon after my marriage I conceived. But then I during  the 22 weeks of pregnancy I had a miscarriage in Dubai. Since then my periods have been very irregular. Doctors say I have polycystic ovaries, and I am taking Metaphage from last 3 months. But during this period, my weight is continuously increasing. I have put on 6 Kgs in 4 months. Now my weight is 72 kgs. Please advise, why my weight is increasing, and what should I do to conceive again. 

** Traveling may not be the cause of miscarriage. 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 Trimester). 

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

Polycystic Ovarian syndrome is not related to abortion. Many women get it for unknown reasons. 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 endocrinologic abnormalities. Although the condition is now referred to as polycystic ovary syndrome (PCOS) it may occur in women without ovarian cysts. 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. Many of these women are able to conceive if the abnormalities are set right. 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. The treatment depends on individual and it is not possible to suggest a specific remedy.  You may consult a gynecologist or an endocrinologist for proper treatment.

 You will have to follow a regular weight reduction programme like diet and exercises. Restricting high calorie diet and regular exercises like walking or swimming can help you to reduce obesity.

20. P.S, Mangalore

* Will you please inform me about low B.P.? What are the causes of it? Is it dangerous? Is it curable?

** Blood is carried from the heart to all parts of our body in vessels called arteries. Blood pressure is the force of 

the blood pushing against the walls of the arteries. Each time the heart beats (about 60-70 times a minute at rest); it pumps out blood into the arteries. The blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic pressure. When the heart is at rest, between beats, the blood pressure falls. This is known as diastolic blood pressure. 

Blood pressure changes during the day. It is lowest as we sleep and rises when we get up. It also can rise when one is excited, nervous, or active. 

Still, for most of your waking hours, our blood pressure stays pretty much the same when we are sitting or standing still. That level should be lower than 120/80. When the level stays high, 140/90 or higher, one has high blood pressure. With high blood pressure, the heart works harder, the arteries take a beating, and there are chances of a stroke, heart attack, and kidney problems are greater.

Low BP:

It is always better if the blood pressure remains within limits or lower. Many of the athletes and those who do regular physical exercises have blood pressure lower than the normal. In most of the people with good health, low blood pressure is not a disease rather it is ideal.  For example if most of the men at the age of 30 may have their blood pressure readings as 130/90mm of Hg, where as the blood pressure reading of an athlete of the same age may be 110/70 mm of Hg..

 However falling blood pressure in any individual can be pathological. In certain conditions or disease states, blood pressure can become too low, as in certain nervous system disorders (orthostatic hypotension, autonomic failure), endocrine disorders (parathyroid disease). Any non-athlete with persistently low blood pressure requires to consult a physician for further assessment of the cause of low BP.

Sudden fall in blood pressure can be dangerous in conditions like heart attack or heart failure, fainting (syncope), decreases in blood volume due to severe bleeding (hemorrhage) or dehydration, effects of certain drugs, severe infections (sepsis) or shock.

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