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Ask Your Doctor 172 (15.10.2014)

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 Many such details where the identity might be revealed will not be published.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

* My question is about my husband; he is aged 46 years. We had recently been to India. After coming back, my husband was complaining of severe gastric problem(which pokes anywhere in the upper body, besides releasing loud farts, which was quite embarrassing) & irregular bowel movements. After checking for serology, doctor said that the H. Pylori antibody serum test was positive and he had given medicine to be taken for months. However, on taking this the gastric problem is somewhat subsided but however, it causes constipation. 

** Gastritis means inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with Helicobacter Pylori(H.Pylori). Other main causes are regular use of certain pain relievers and drinking too much alcohol. Gastritis may occur suddenly (acute gastritis), or it can occur slowly over time (chronic gastritis). In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis  is not serious and improves quickly with treatment.

Passing excess gas or belching is often retalted to gastritis and termed as ‘gastric’(gas-trick?) problem. Passing excess gas or belching may not be the symptoms of gastritis. Gastritis is a specific problem with definite symptoms.

We have erroneous belief that the pains in the joints and back pain is caused by gastritis. Gastritis is a specific problem involving the inflammation of the stomach and is not  the cause of joint pains.

Although infection with Helicobacter pylori is among the most common worldwide human infections, only some infected people develop gastritis or a similar stomach disorder. The vulnerability to the bacterium could be inherited or could be caused by lifestyle choices, such as smoking and high stress levels.

Common pain relievers — such as aspirin, ibuprofen  can cause both acute gastritis and chronic gastritis. Using these pain relievers regularly or taking too much of these drugs may result in inflammation of the stomach. Alcohol can irritate  the stomach lining, which makes the stomach more likely to be harmed by digestive juices. Excessive alcohol use is more likely to cause acute gastritis.

Older adults have an increased risk of gastritis because the stomach lining tends to thin with age and because older adults are more likely to have H. pylori infection or autoimmune disorders than younger people are.

Treatment of gastritis depends on the specific cause. Acute gastritis caused by nonsteroidal anti-inflammatory drugs or alcohol may be relieved by stopping use of those substances. Chronic gastritis caused by H. pylori infection is treated with antibiotics. The gastro-enterologist or the physicians treat chronic gastritis.

For H. pylori infection a combination of antibiotics to kill the bacterium are used. Be sure to take the full antibiotic prescription, usually for 10 to 14 days. Simultaneously the medications that block acid production and promote healing also are used. The constipation may be one of the side-effects of the treatment. Let your husband consult the physician who is treating him. 

There are some lifestyle modifications which might be of use. These include:

If your husband is experiencing frequent indigestion, eating several small meals instead of three large ones whenever he can may be useful.

Avoiding foods that irritate the stomach, especially those that are spicy, acidic, fried or fatty.

Alcohol can irritate the mucous lining of the stomach. It is to be avoided.

2. R.B., Bantwal

* I am 45 years of age; I am  suffering from back ache due to slip-disc. This comes on the way of my married life with my wife. Please suggest some solution. 

** You are probably having chronic back ache and not actually slip disc. 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. At your age the common cause of pain in the lower back is due to repeated strain.

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 treated 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. I hope you know about various positions of physical union.

3. Q.S. Mangalore

* I am 32 years of age. I get my regular periods (28 days) 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 14-15mg/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, diarrhoea, 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.

4. S. K. Dubai,

*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.

5. J.P. , Bangalore

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

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

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

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

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

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

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

6. R.D. Mangalore

*I am 23 years of age and will get married in a year time. Just six months ago I was friendly with a boy and made love with him on two occasions. But now I regret for what I have done and with lot of courage I revealed it to my fiancée and he has forgiven me for it. I would like to know if my sexual part will remain loose or will it get back to it original tightness. Please help because I love my guy and don’t want to lose him

** Usual physical union does not cause any laxity in the sexual parts. Even after the childbirth the sexual parts of the woman remain tight. The laxity is normally due to untreated tear in the external genital region during child birth. If they are properly treated, even these tears do not lead to laxity. You need not worry that the physical changes might affect your marital relationship.

For the benefit of other visitors of this column, let me express few facts regarding pre-marital sexual experiences. Most of the men who had these do not consider them as offences, but when it comes for women men find it difficult to accept. Some of them might ‘forgive’ just to remind it often later, especially when there are conflicts in their married life. Most of the women who are into these are either lured or forced. The man/lover who promised to marry ditches and they are forced to marry someone else. In these situations most of the women have a fear that their husband might be able to detect the pre-marital relationship during physical unions. Some because of this fear and others during the ‘early excitement period of relationship’ reveal their past to their husbands. As stated above it is not possible to detect loss of virginity by mere physical changes. Even a doctor can not examine a lady and give a definite report on her virginity. Unless informed a man can not make out for sure whether his wife had physical relationship with someone else before.

Whatever may be the reason, it is not essential to reveal pre-marital relationship to the spouse. These revelations may cause problems. And if the partner is of suspicious nature (paranoid personalities), pre-marital relationship of the spouse may be the main cause for persistent bickering in marital life. It is my opinion that the pre-marital experiences, if any may be just forgotten for the benefit of married life.

7. M.M, Mangalore

*I have 2 months old baby boy. By birth it self he has nose block and sneezing but no running nose. He makes a noise like wheezing everyday but not continuous. We had shown him to doctors but they are saying that he has nose block. One doctor even told that his throat is thin. Kindly let me know the real cause might be?

** Nasal obstruction is a very common complaint in children. It usually resolves without treatment. Most of the time, the obstruction is only a minor inconvenience to the child and parents. The nose of the baby is so small that the normal mucus inside the nostrils tends to dry up and obstruct breathing. Since the baby is not used to breathing through mouth, as the blockade increase he will make odd sounds. This is most common cause of unusual sound during breathing in small children.

There is a simple method to solve this. If the baby’s nostrils are blocked, warm some water and after cooling it to normal room temperature put a drop in each nostril. This will soften the secretions. Use only one or two drops to each nostril, no more than three to four times in a day. If the secretions are seen they may be cleaned using a cotton bud. But, do not put the cotton bud inside the nostril. Medicated nose-drops should not be used in small children.

If you do not find relief, then consult an ENT specialist to know if there are any other causes. Rarely in small babies there can be deviated nasal septum causing difficulty to breath through nose. Adenoids and tonsils usually are not seen in small children, they  are seen in older children.

8. J.N. Kuwait.

*I am 29 years of age.  Recently for almost a month, I noticed that the foreskin of my organ dries and looks rough and the white dry skin on the head of the organ peels off every morning.  Sometimes foreskin and tip becomes itchy and the head of the organ becomes red. I went to the doctor, which he has prescribed a lotion instead of regular soap to wash and later to be dried. The doctor has also prescribed me an ointment to be applied twice a day and has also told me to keep the skin pulled back for air to circulate.  I read an article regarding this problem which is called by thrush, eczema and balanitis, yeast fungal and it says there is no permanent cure for this. My concern is how this problem has come to me when I properly clean my private parts everyday without fail.  Is it STD?  If so, I had no contact with anyone and have been married for 4 years.  Is it somewhere related to HIV?  Please advise as I am finding very irritating and do not feel like having sex.  Is it contagious? Or  could transmit to the opposite sex while having sex.  My wife is pregnant so is it safe to have sex?  She was recently tested and found without any infections. Please advise which medication is preferable for such problems?

** It appears that you have a type of fungal infection. This is a sexually transmitted disease, but not the one that are transmitted through commercial sex workers. This is due to a fungus known as Candida. The Candida which are normally found in the female genital tract multiply in greater numbers in certain situations. The man gets the infection from his sexual partner. This problem can not be resolved unless both are simultaneously and properly treated.

 Your wife must be harboring the fungi in her genitalia and you are constantly getting infected. She may not be having the symptoms if the fungi are deep inside the external genital tract. That region being insensitive, she may not feel itching or burning now. But soon it might extend down and if untreated she too might get the symptoms.

This is common in pregnancy. The infection is known as candidacies. Candidiasis, also known as a “yeast infection” or VVC, are a common fungal infection that occurs when there is overgrowth of the fungus called Candida. Candida is always present in the body in small amounts. However, when an imbalance occurs, such as when the normal acidity of the vagina changes or when hormonal balance changes, Candida can multiply. When that happens, symptoms of candidacies appear. Nearly 75% of all adult women have had at least one genital "yeast infection" in their lifetime. There are some other conditions that may put a woman at risk for genital candidacies: such as pregnancy, diabetes mellitus, use of broad-spectrum antibiotics, use of corticosteroid medications  etc.(Candidacies  of the mouth and intestine is a common problem of immune compromised individuals like HIV patients)

Antifungal drugs which are applied directly to the affected area, or used vaginally are the drugs of choice for vaginal yeast infections. Effective anti-fungal medicines are available. For vaginal infection anti-fungal pessaries are also available. There is no harm to the baby when pessaries or ointments are used by mother. There are creams (ointments) available for local application, which you can apply on your affected part. 

Pregnancy itself is not a contraindication to continue sexual relationship except in certain conditions like previous miscarriages, threatened abortion etc. In conditions like genital candidiasis, it is ideal to use condoms till both are cured of the problem.

You may consult a skin specialist and your wife may take the opinion from her gynecologist for proper assessment and treatment.

9. R.M. Mangalore

*I am 45 years old married working in a hotel in gulf. My family is in India. I never had a sexual contact with others except my wife. Two months ago unfortunately only one time I had a kiss for 2 to 5 minutes with one hotel housekeeping girl and did not have sex.  After that I have been depressed because I am worrying about AIDS. I have heard that AIDS may come through even kiss also. 

** It is unlikely that the girl with whom you had mouth to mouth contact, was having HIV infection. As the immigrants are tested for HIV, the possibility of that girl having the infection was remote. The chances of getting infection just by mouth to mouth contact is again very less. Considering all this you may hope that you do not have infection. If you want to be certain, just get a HIV test now. Normally the individual becomes positive within three months from the contact. If it is negative (most likely), be sure that you do not have the disease.

10. P.K. Oman

*I damaged one of my testicle while playing at the age of 16.I got the treatment but that testicle  was gone smaller and smaller and disappeared (and I feel having one testicle only  now),But I do get normal erection and I am married to be two years this December. I was with my wife for 45 days during wedding and that time I was unable to do physical union. After one year I went on vacation and everything was fine. We had sex, but my wife did not conceive. I m going again this September. 

Is one testicle can produce enough sperms to conceive or should I do a sperm count? Where it can be done?

** One testicle is sufficient to normal sexual and reproductive function. You were able to perform normally, it indicates that you are normal despite having one testis. 

I hope you know that in a month the woman remains fertile for less than 12 hours and the day on which she is able to conceive is known as fertile day. A woman will not conceive if there are no healthy sperms available on the fertile day. Regular physical union is required for conception especially during fertile period. In many of the couple it requires regular physical union during fertile days for normal conception. Sometimes it  may take more than 6 months  for woman to conceive.

Normally semen analysis is advised if woman doesn’t conceive even after regular physical union for six months. However there is no harm in going for semen analysis when there is doubt. This is done at all the major clinical laboratories and in major hospitals.

11. S. P. Dubai.

*I am 35 years; I have a habit of masturbating after watching porn movies. I used to surf net for sex and porn materials. I waste daily  several  hours on this. I am married for two years and I want to get rid of this  habit. 

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

12. W.N. Mangalore

*I am 46 years of age. I have the problem of palpitation of heart. Why I am getting this? What may be done to get relief? 

** Heart palpitations are the feelings of having rapid, fluttering or pounding heart. Heart palpitations can be triggered by stress, exercise, medication or, rarely, a medical condition. Although heart palpitations can be worrisome, they are usually harmless. In rare cases, heart palpitations can be a symptom of a more serious heart condition, such as an irregular heartbeat (arrhythmia), that may require treatment. I presume you have already consulted the doctor. The doctor would have advised you treatment if it were a serious problem. Unless your doctor finds that you have a heart condition, heart palpitations seldom require treatment. 

If you know why you get palpitations, the most appropriate way to treat palpitations is to avoid the triggers that may cause  the symptoms. Reducing the stress or anxiety also can help. Try relaxation techniques, such as meditation, yoga, or deep breathing or aromatherapy. Stimulants, including caffeine, nicotine, some cold medicines and energy drinks, can make  the heart beat quickly or irregularly. Avoid them if they are the cause.

13. R.S. D’S, Mangalore

* My uncle is suffering from liver problem ( lever is completely damaged ). His abdomen has become big and he is not able to eat properly. He is in the hospital and the doctors are telling that nothing can be done. Is there any treatment in any other systems? . 

** Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcohol abuse. The liver carries out several necessary functions, including detoxifying harmful substances in the body, cleaning the blood and making vital nutrients.

Cirrhosis occurs in response to damage to the liver. The liver damage done by cirrhosis can not be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening.

In advanced cases of cirrhosis, when the liver ceases to function, a liver transplant may be the only treatment option. A liver transplant is a procedure to replace  the  liver with a healthy liver from a deceased donor or with part of a liver from a living donor. Cirrhosis is the most common reason for a liver transplant.

Extensive testing is needed before a liver transplant to ensure that a candidate is in good enough health to have the transplant operation. Additionally, transplant centers typically require some period of abstinence from alcohol, often at least six months, before transplantation for people with alcohol-related liver disease. This facility is available in selected centers and is very expensive.

14. S.S., Kundapur

*I am 47 years and was diagnosed high BP some 4 years back when I had undergone a complete physical check up in Mangalore.  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.

15. L.D’s, Mangalore

* I am 30 years, I have one kid six months of age.. We are planning to use Copper-T for two years. Is there any effect on sexual feelings or other side-effects? Are there any chances of getting pregnant? In case it happens then what we will need to do? 

** Copper-T is an Intrauterine Device (IUD) - that is a small object that is inserted through the cervix and placed in the uterus to prevent pregnancy. A small string hangs down from the IUD into the upper part of the vagina. The IUD (this is the general term for all loops including Copper-T) is not noticeable during intercourse. IUDs can last 1-10 years. They affect the movements of eggs and sperm to prevent fertilization. They also change the lining of the uterus and prevent implantation. IUDs are 98-99% effective as birth control.

One can keep track of the IUD by checking its strings. The strings can be felt by putting a finger into the vagina. It is recommended that women check their IUD after each period. A shorter than normal string can be a warning sign of an imbedded IUD. Missing strings may mean that the IUD was expelled. If the string is missing, immediate consultation with the doctor is required. 

Every woman is different and IUDs are not recommended for all women.  IUDs are not recommended for women who are at risk for PID (pelvic inflammatory disease), have lower immune response, abnormal pap smear, heart disease, anemia, a history of severe menstrual cramping and heavy flow, a history of ectopic pregnancy, or previous problems with an IUD. 

There are definite advantages of using IUD.

IUDs are the most popular form of reversible birth control in the world. More than 85 million women use them. 

The ability to become pregnant returns quickly when IUD use is stopped Most of the women are able to conceive after the removal of IUD. Hence this is a popular method for spacing the children.

IUDs may improve a woman's sex life. There is nothing to put in place before intercourse to protect against pregnancy. Some women say they feel free to be more spontaneous because they do not have to worry about becoming pregnant.

Non-hormonal IUD like Copper-T does not change a woman's hormone levels. Hence there are no side effects of hormone preparations.

Serious problems with the IUD are rare. There are some risks associated with any method of birth control. IUDs offer much less risk to a woman's life and health than pregnancy. Spotting between periods is common with IUD use. Very rarely some women may have severe bleeding.

Up to seven percent of IUDs are partially or completely expelled from the uterus in the first year, especially in the first few months after insertion. If the expulsion is "silent" and the woman does not notice it, she can easily become pregnant. One out of five expulsions is silent. They cause one-third of the pregnancies that occur during IUD use. Expulsion is more likely among younger women and women who have never had a baby. Strenuous physical activity, however, does not affect the position of the IUD. 

The most pregnancies happen to IUD users when their IUDs fall out without their knowing it. When pregnancy occurs with an IUD in place, the best medical advice is to have it removed, if at all possible, as soon as  one knows she is pregnant. 

If one is  pregnant with an IUD in place, there is an increased risk of ectopic (tubal) pregnancy, pelvic infection, miscarriage. About 15-20 percent of all pregnancies end in miscarriage during the first 12 weeks. If an IUD is taken out early in the pregnancy, the risk of miscarriage is about the same. But if an IUD stays in the uterus, the risk of miscarriage increases to about 50 percent. 

16. N.R. Abu Dhabi

* My daughter, age 11 years and 7 months, weight 42 kg, height 148 cms is having scanty menstruation. She got her first menstruation (there was only little bleeding)  about two months ago. She had no pain when she got it. After 45 days, she got it for the second time, a slight bleeding, and it was there for two weeks.  She gets it mostly in the day time and that too very little. I have consulted a gynecologist here and she suggested hormonal treatment. She recommended tablets 'primolut/N', 5mg; this is to stop the bleeding. I did not give those, but I am giving her calcium tablets since the gynecologist recommended it. 

**The most of the issues teens confront when they start menstruating are completely normal. In fact, almost every girl and woman has had to deal with some of them at one time or another. Premenstrual tension, Cramps, irregular periods are the common problems.

It can take up to 2 years from a girl's first period for her body to develop a regular cycle. During that time, the body is essentially adjusting to the influx of hormones unleashed by puberty. Remember, what is regular varies from person to person. On average, the monthly cycle for an adult woman is 28 days, but the range is from 21 to 35 days. 

Changing hormone levels might make a girl's period short 1 month (just a few days) and long the next (up to a week). She can skip months, get two periods almost right after each other, or alternate between heavy and light bleeding from 1 month to another.

Menorrhagia is the other problem. More than just 1 or 2 days of a heavier-than-average flow, this condition usually leads to soaking through at least one sanitary napkin (pad) an hour for several hours in a row or periods that last longer than 7 days. Girls with menorrhagia sometimes stay home from school or social functions because they are worried they won't be able to control the bleeding in public. 

The most frequent cause of menorrhagia is an imbalance between the levels of estrogen and progesterone in the body, which allows the endometrium to keep building up. When the endometrium is finally shed during menstruation, the resulting bleeding is particularly heavy. Because many adolescents have slight hormone imbalances during puberty, menorrhagia is not uncommon in teens. 

Scanty flow or absence of one or more cycles is also common. This is again due to low levels of hormones. It will take some months for the regularity to set in.

Ideally no treatment is required for these conditions. Most of these irregularities turn to normal within two years of onset of menarche. Hormonal treatments may be required vary rarely and it is better to restrict their use in teens at the onset of menarche.

17. L. D's, Mangalore

*Kindly advise whether yoga is good to reduce the weight ?   

** There are certain Yogic exercises which have beneficial effect on weight control if practiced properly. Along with these, diet control is also required. Without diet control yoga or other exercises may not help in reducing the body weight. Yogic exercises may be better learnt through experts.

18. J.C. Mumbai

** My husband is 50 years, he is a chain smoker. He smokes pipe or cigars and says it is less harmful than cigarette smoking. Will you please give your opinion on this? Is smoking is dangerous for only those who have diabetes? What happens if others inhale the smoke-like in parties where many of the men smoke without caring for others, especially women and children?

**Cigarette and tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes are the six major independent risk factors for coronary heart disease that you can modify or control. The risk factor like family history of heart attack can not be modified.

Cigarette smoking is so widespread and significant as a risk factor that it is generally known as "the most important of the known modifiable risk factors for coronary heart disease” In the sense, if one is able to give up smoking, the risk of getting a heart attack reduces by about 6 times. Smoking along with another risk factor like sedentary life style increases the risk by about 12 times.

Cigarette smoking increases the risk of coronary heart disease by itself. When it acts with other factors, it greatly increases risk. Smoking increases blood pressure, decreases exercise tolerance and increases the tendency for blood to clot.

Cigarette smoking is the most important risk factor for young men and women. It produces a greater relative risk in persons under age 50 than in those over 50.

Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease and stroke compared with nonsmoking women who use oral contraceptives.

Smoking decreases HDL (good) cholesterol. Cigarette smoking combined with a family history of heart disease also seems to greatly increase the risk.

Studies show that cigarette smoking is an important risk factor for stroke. Inhaling cigarette smoke produces several effects that damage the cardiovascular system. Women who take oral contraceptives and smoke increase their risk of stroke many times.

*People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risk is not as great as that of cigarette smokers. This is probably because they are less likely to inhale the smoke. Currently, there is very little scientific information on cigar and pipe smoking and cardiovascular disease. However their risk is definitely more than non-smokers. This is also true for beedi smokers. They are probably at less risk than cigarette smokers. But the risk enhances when there is one more associated problem like diabetes.

*The American Heart Association believes more research is needed on the effects of passive smoking (also called secondhand smoke or environmental tobacco smoke) on heart and blood vessel disease in nonsmokers. Several studies document the health hazards posed by passive smoking. About 37,000 to 40,000 people die from heart and blood vessel disease caused by other people's smoke each year. Of these, about 35,000 nonsmokers die from coronary heart disease, which includes heart attack.

19. Y. R. Mangalore

* I had sex on the second day of my period last month.  We used a condom.  The condom did not break and it was still intact.  My period was supposed to start on either the 23rd or the 24th of this month but has not started yet.  I took a bunch of pregnancy tests and they were negative.  Am I pregnant?  Is something wrong with me?

** The woman can conceive only during ovulation, which is normally about two weeks before the onset of menstruation. Normally one will not conceive if physical contact is on the second day after the menstruation. As you have used the barrier, the chances are almost negligible. The pregnancy tests have revealed the same. 

There can be unusual delay in menstruation if the woman is tensed or worried. The ovulation might be delayed which in turn will delay the onset of menstruation. You may wait for two more weeks, and then you may consult the gynecologist.

20. R.F., Kuwait

* I am a married woman with 2 kids.  My age is 36 years.  My height is 4.9.  After my second delivery I gained lot of weight.  Especially my belly is very big.  Now my weight is 62 kgs.  Please let me know how I can reduce weight.  Since 15 days I am going for a morning walk.  I am walking for about 45 minutes. I take very limited quantity of food.  Still I gain weight.  I need to loose minimum 10 to 15 kgs.  Please advise urgently

** There are no methods by which the body weight can be reduced urgently! It takes more time to reduce the weight than to gain it. There are two main issues in reducing the weight. One is diet and another is exercises. 

You may be aware that in our body excess of calories are stored as fat. Each food item we consume has calories. They are more in fatty food, less in vegetables. Even the rice, wheat, fruits contain calories. Probably except water all that we consume have calories. Calories are required for each and every living activity; they are needed for our daily work like walking, talking, writing, reading; calories are also needed for other activities like breathing, digestion, circulation. Whenever we consume more calories they are stored as fat. To reduce the weight one has to be calorie conscious. The quantity of the food intake should be such that it does not produce more calories.

To burn (or to eliminate) excess calories the exercises are required. It takes long time to appreciate the effects of exercises on body weight. Diet and exercises together may reduce the body weight gradually. Both- diet and exercises should be part of your living. 

Certain exercises to strengthen the abdominal muscles are required to trim the belly. You may seek the help of physiotherapists to learn about the exercises.

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