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Ask Your Doctor 177 (20.03.2015)
 

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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. F. D’S, Mangalore

*I am 44 years. I have pain in the heels. They pain more in the morning and after sometime the pain disappears. It reappears each time I rest for sometime and begin to walk.

**The pain in the heels is a simple problem and not a major disease to be worried about. Some people term it as calcanial spurs and a few name it as plantar fasciitis. Both these are almost same. It is generally believed that a bony spur projecting from the back or underside of the heel bone (the calcaneus) makes walking painful.  The calcaneal spur is also called a heel spur. 

Not all heel spurs cause symptoms. Some are discovered on X-rays taken for other purposes. Spurs probably result from excessive pulling or stretching of the calcaneal periosteum by a fibrous structure, the plantar fascia. The stretching may also result in pain along the inner border of the foot, when the term plantar fasciitis may be appropriate. Exact cause for the problem is not known. Painful heel are more commonly seen in those who stand for a long time. Predisposing factors to heel pain/plantar fasciitis  include: flat, pronated feet, high arched feet, inappropriate shoes, running on the toes, hill running or running on the soft terrain, diabetes mellitus etc.  Overweight is not a predisposing factor for heel pain and reducing the bodyweight does not solve the problem of pain under the heel.

The treatment for heel pain is designed to reduce inflammation. If the pain is of sudden onset and is very severe ice packing may help. Anti-inflammatory agents can also help to reduce local inflammation as well as pain. The medications may be used only for short periods as advised by the specialists.. 

Heel lifts reduce stress on the Achilles tendon and relieve painful spurs at the back of the heel and donut-shaped shoe inserts take pressure off plantar spurs and relieve the pain in the heel. Physiotherapy in the form of moist heat also helps to reduce chronic dull aching pain.

Local steroids are to be used as the last resort. Steroids are to be infiltrated under aseptic precaution ideally by the specialist. Local steroid injection has no adverse reactions on the body. If proper care is not taken it may predispose infection which may worsen the condition


2. K.V. Kerala

*I am 30 years of age. I have the problem of constipation.  I am not getting proper motion even if I eat proper foo.In the early morning i am facing this problem. About an hour after taking food, I am geting motion and that too not properly.

** Constipation is passage of small amounts of hard, dry bowel movements, usually fewer than three times a week. People who are constipated may find it difficult and painful to have a bowel movement. Other symptoms of constipation include feeling bloated, uncomfortable, and sluggish.

Many people think they are constipated when, in fact, their bowel movements are regular. For example, some people believe they are constipated, or irregular, if they do not have a bowel movement every day. However, there is no right number of daily or weekly bowel movements. Normal may be three times a day or three times a week depending on the person. Also, some people naturally have firmer stools than others.

At one time or another, almost everyone gets constipated. Poor diet and lack of exercise are usually the causes. In most cases, constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.

To understand constipation, it helps to know how the colon (large intestine) works. As food moves through the colon, it absorbs water while forming waste products, or stool. Muscle contractions in the colon push the stool toward the rectum. By the time stool reaches the rectum, it is solid because most of the water has been absorbed.

The hard and dry stools of constipation occur when the colon absorbs too much water or if the colon's muscle contractions are slow or sluggish, causing the stool to move through the colon too slowly. Common causes of constipation are

• not enough fiber in the diet 

• not enough liquids 

• lack of exercise 

• medications 

• changes in life or routine such as pregnancy, older age, and travel 

• abuse of laxatives 

• ignoring the urge to have a bowel movement 

• specific diseases such as stroke (by far the most common) 

• problems with the colon and rectum 

• problems with intestinal function (chronic idiopathic constipation) 

In most cases, following these simple tips will help relieve symptoms and prevent recurrence of constipation:

o Eat a well-balanced, high-fiber diet that includes beans, whole grains, fresh fruits, and vegetables. 

o Drink plenty of liquids. 

o Exercise regularly. 

o Set aside time after breakfast or dinner for undisturbed visits to the toilet. 

o Do not ignore the urge to have a bowel movement. 

o Understand that normal bowel habits vary. 

o Whenever a significant or prolonged change in bowel habits occurs, check with a doctor.

o Most people with mild constipation do not need laxatives. However, doctors may recommend laxatives for a limited time for people with chronic constipation. 


3. M.R., Mangalore


*I am 29 years, unmarried. During masturbation I ejaculate very soon.I am worried that this may continue in my married life.

** There is lot of difference in masturbation and marital sexual act. You may be speeding up masturbation which may be the cause for early ejaculation. Same need not be continued in marriage. In fact, masturbation techniques can help men to learn to control the timing of their ejaculation, and to last longer if they would like to. One such method is the stop-start method, which basically involves a man stimulating himself until just before the point of orgasm, then backing off a bit to let his erection slightly subside, then starting up again. By practicing masturbation in this way, men can learn to pay attention to the feelings inside their genitals that signal they are approaching orgasm. With time and practice, they can learn to control the timing of their ejaculation.

4. G.K. Kuwait

*I am 36 years. I have multiple small tumors in my both  arm and on the back. I am confused whether it is lympoma or neuorfibromatosis. when I press, it gives pain otherwise  there is no pain.  I also get occasional pain in my knee on stretching.


** These must be neurofibromas. The small tumors or bumps that develop under the skin are most likely to be neurofibromas and the condition is known as neurofibromatosis. The neurofibromatosis is the genetic disorders of the nervous system that primarily affect the development and growth of neural (nerve) cell tissues. These tumors may grow in many parts of the body. The tumors are slow growing and after attaining a particular size-varying from that of a grain to a peanut. The tumors are normally painless, unless they are at pressure bearing areas. Some tumors may grow in the nerve where it passes through a tight compartment such as carpal tunnel in the wrist. Such tumors may press on the nerve and may cause symptoms like weakness in the muscles supplied or numbness in the areas supplied by that nerve. Surgical removal of the tumors is done only when the tumor causes these symptoms. Asymptomatic tumors need not be removed and if the tumors are not progressing rapidly, the conservative approach of watchful waiting is recommended. Normally the tumor may not recur at the same site from where it is removed. However appearance of multiple tumors at other places is not dependent on surgery. There is no permanent cure for the problem.

The pain in the knee may not be directly related to this problem. It appears to be due to chronic strain. You may consult an orthopedic surgeon for further opinion.


5. R.S. Goa

*I am 42 years. I am type 2 diabetic. I am on medication for the same. I have a child. Now my problem is I just cant get a hard on with my wife. Even if I take erection pills, I just cant satisfy her. I love my wife a lot. but to tell you frankly she does nothing to arouse me or satisfy me. As I can not,  she grumbles, ‘if its like this what will happen to us’ and stuff like that. in the mean time I also had sex with another woman out of desperation and I must say it was awesome.  There was no need of pills, and perfect and full hard on. why was it so different with my wife ? I’m desperate as I love my wife a lot. Do I need a psychiatric counseling ?

** The problem faced by you is known as partner specific erectile dysfunction. The problem starts with failures of sexual advances. This can have an effect on issues of trust, intimacy, and closeness. The man withdraws emotionally and physically because of fear of failure. The partner starts to believe that the man is losing interest in her, thereby impacting self-esteem and feelings of attractiveness. In reality, the man is not losing interest but may be manifesting signs of frustration and humiliation of not being able to complete the sex act. Many men think it is inappropriate to need nurturance, admit that he needs a hug, or seek affection. When a man cannot perform intercourse and satisfy his own and his partner's sexual needs, he can feel devastated and very much alone. From this cascade of events, the couple starts to alienate themselves emotionally and physically. 

The problem can be solved by counselling and therapy. Both of you may have to go for counselling . The problem can not be solved by medicines. You may consult a psychiatrist to know where the counsellors are available in your city. It is better to solve the issues as early as you can.


6. L.D’S., Kuwait

*I am 28 years of age. I am having  stones in my left kidney for several months. The biggest is 7mm & some small stones are also there. In the last month, the stones were also visible in the right kidney. I am taking Ayurvedic tablets, but still stones have not gone out. In Kuwait the doctor suggested me to go for laser treatment to break the stones, but I am scared of it. When I was in  India recently the doctor informed me that, the stones will go out in normal urine in the due course. My question  will the  7mm stone will pass out or I go for any other tablet or surgery. 

** Many kidney stones will pass spontaneously and will not require surgical treatment. Whether a stone can pass successfully primarily depends on the size of the stone. Based on several studies, a size criteria of 5mm  or less (about 0.2 inches) is generally felt to predict a reasonable chance (50-70%) for spontaneous passage.

The location of the renal stone when it is diagnosed also is predictive of likely success at spontaneous passage. Stones that are more distal (closer to the bladder) are more likely to pass than stones that are more proximal (closer to the kidneys).

You may consult a urologist and follow his advice. There are several methods of management of kidney stones and the urologist will be the best person to decide the appropriate treatment.


7. C.L., Mangalore

* My friend aged 42 years, lost her husband some years ago and has 2 kids. She is healthy and is now considering re-marriage but is concerned about health problems if she conceives at this age. Her blood group is negative and her second kid's blood group is positive, due to which she was told that if she conceives any more it may have problems for her. What are the chances that she will conceive and will it have any major problems for her.

** As the woman ages, the chances of fertility are reduced. As the woman ages, the maturation of egg decreases significantly, and older eggs are more likely to have chromosomal problems, raising the risk  of miscarriages  and birth defects. Though there are treatments to boost fertility, the results are not encouraging. The complications during pregnancy are another concern. In 40s the women are far more likely to develop problems like high blood pressure, diabetes during pregnancy as well as placental problems and birth complications.

Women older than 40 also have a higher risk of delivering a low-birth-weight or pre-term baby. Stillbirth rates are also higher, and studies show that children born to older mothers may be at increased risk of type 1 diabetes and high blood pressure (though this association isn't strong).

Although men are physically capable of fathering children in their 60s and even their 70s, sperm quality deteriorates with age. Older men's sperm has a higher rate of genetic defects than younger men's sperm. In recent years, studies have suggested links between the father's age and genetically related conditions such as Down syndrome, schizophrenia, and autism spectrum disorders.

One more thing to keep in mind: as your friend has negative blood group with a positive child, she can have problems related to rh incompatibility.

Awareness about the possible problems may help her to seek appropriate medical help to lessen the complications related to conception at her age and also with the problem of rh negative blood group.

8. G.K., Karwar

*I am 22 years. Recently I had blood in the sputum. Is it the early sign of cancer? I smoke cigarettes daily.

** There are several causes for coughing up blood. Coughing up blood can take different forms: the blood may be bright red or pink and frothy, or it may be mixed with mucus. Thi is also known as hemoptysis. Hemoptysis refers to coughing up blood from some part of the lungs (respiratory tract). Blood coming from elsewhere, such as  stomach, can mimic coughing up blood. It is important for the doctor to determine the site of the bleeding, and then determine why  the person is coughing up blood.  Though lung cancer is one of the causes, it is not common at your age. You may be having bronchitis due to smoking and it must have caused hemoptysis. Tuberculosi of the lungs is another important cause of hemoptysis in our country. You may consult a physician at the earliest to have proper treatment.

9. J.Q., Udupi

* Whether having rice for 3 times a day is the reason to get pauch belly. How to reduce the belly to get a flat one?

** Pot belly is a sign of obesity. In most of the obese men, the obesity manifests by pot belly where as in women the excess fat is accumulated mainly in the buttocks and thighs; rarely it is seen as pot belly. 

Obesity is a disease in itself. Obesity is a result of complex combination of various factors. Genetics, socioeconomic factors, metabolic factors, and lifestyle choices, hormonal imbalance can affect weight in men. There has been a significant increase in the incidence of obesity in men in recent times. Poor fitness level, decreased productivity and health risk are inherent outcome of obesity.

Eating rice need not cause obesity. Any food item that is consumed more than required for the body is converted into fat and gets accumulated(stored) under the skin and around the internal organs like heart, intestine etc. The fat that is accumulated around the internal organs is termed as visceral fat. This fat is more dangerous than the one that is stored under the skin.

An obese indiviuals are more likely to develop diabetes. Hypertension, heart diseases, cancer are closely associated with obesity. Hypertension inevitably leads to heart disease. However, obesity is also independently responsible for heart disease. Overweight people have a risk for cancer of colon and in men cancer of prostate. The cancer of breast is more common in obese women. Obese people also struggle with osteoarthritis and respiratory problems. In addition, obesity has great psychological effects on individuals. 


Other than reducing the calories in the diet, and aerobic exercises help to reduce obesity. The belief that the regular abdominal exercises(known as basic crunches) help to get flat abdomen. Abdominal exercises alone do not reduce belly fat; they only strengthen and tone the muscles. Unless the excess fat under then is gone the muscles will not  become flat. A full-body strength-training routine stimulates muscle tissue throughout  the body is required. This helps reduce belly fat and improve  the appearance, because muscle burns more calories and takes up less space compared to fat. Aerobic exercises like walking, swimming or cycling to burn excess fat along with regular exercis to tone the muscles can  result in flat belly.

10. D.K., Mangalore

*I am a lady of 25 years of age. I am a swimmer. Not yet married. I somewhere I read that by constant swimming one might lose virginity (that  the hymen  would break. Please let me know whether it has any significance?

**There are lots of misconceptions about hymen and its significance in virginity. Many people are under the impression that the hymen is located within the vagina, as a barrier for entrance. It is not. It is a mucous membrane that is part of the vulva, the external genital organs. It is located outside the vagina. 

Many girls and teens tear or otherwise dilate their hymen while participating in sports like bicycling, horseback riding, gymnastics or inserting tampons, or while masturbating. A girl may not even know this has occurred, since there may be little or no blood or pain involved when this happens. The presence or absence of a hymen in no way indicates whether or not a female is a virgin. The hymen is not an indicator of virginity. It is to be remembered that like men, in women also there are no physical signs of virginity.

Some hymens are elastic enough to permit a  male organ to enter during sexual encounter without tearing, or they tear only partially, and there is  no bleeding at all. The prominence and elasticity of the hymen varies and by no means do all women bleed after their first sexual intercourse. When adequately lubricated the vagina is fairly 'flexible' and will stretch without discomfort for most women. Sometimes, a woman has sex for years with no real 'tearing' at all, only stretching of the hymen and then at another time the same woman might tear from 'rough sex'.

Normally the vagina has the capacity to dilate almost to 10 centimeters during the delivery of the baby and it soon regains it normal elasticity. It does not lose the so called ‘tightness’ by sexual acts.

As these are the facts, you need not worry that your marriare partner would be able to make out that you had lost virginity. There are no physical signs of virginity. 


11. R.M., Mangalore

* I am 30 years. I get cracks on the skin of my organ after having sex with my wife.

** You are probably getting infected by the candida from your wife. Candida species can be present in healthy women in the vagina without causing any symptoms. In fact, it is estimated that 20% to 50% of women have Candida already present in the vagina. In some women, the normal balance of yeast and bacteria in the vagina is disturbed, allowing overgrowth of the yeast. While yeast can be spread by sexual contact, vaginal yeast infection is not considered to be a sexually-transmitted disease because it can also occur in women who are not sexually active, due to the fact that yeast can be present in the vagina of healthy women

Man get infected after sexual contact with a woman having the candida problem and in man it  leads to irritation and itching of the penis. Symptoms in men may include itching,burning, and pain at the tip of the penis. Discomfort during urination can also occur. The area may appear reddened or irritated. Symptoms may resemble those of other diseases, including some sexually-transmitted infections (STDs), so testing should always be carried out to determine the cause of symptoms in men.

Treatment for men, like for women, is based upon antifungal medications. These may be applied as topical creams or taken by mouth in pill or tablet form.  Both man and woman have to be treated simultaneously to get rid off the problem.

You may consult a urologist or skin specialist for treatment; your wife may consult a gynecologist.

12. U.N., Mangalore

* I am 30 years. Is having frequent sex affects the sperm count? We are trying to baby a baby. 

** No. It is a myth to think  that less sex  facilitates conception. Experts opine that the more number of time  the couple have sex, the better  their chances of getting  a baby. Having sex often ensures that the sperm in a man's ejaculate is as healthy as it can be. Storing it up can decrease its motility. While many couples believe they have to save the man's ejaculate until the exact moment of ovulation, that is not true. In fact some couples become so obsessed with timing sex during ovulation that they actually  spoil their chances of getting pregnant.  Too much stress over the timing of intercourse can affect maturation of ovum and decrease the chances of conception. Having sex as many times as the couple can be during the days of fertility is ideal. 

13. L.A.B., Sharja

* I feel dizy and get headache after workout. Whom shall I consult?

** Dizziness after a workout can have a variety of causes. One of the common causes of feeling faint after a workout is simply overexerting yourself. Pushing your body too hard can result in the heart working too hard and not getting enough blood to your head. You may also feel dizzy if you have not been  drinking enough water before exercise, or have been exercising in the heat. As part of the cooling response, the blood vessels throughout  the body dilate. The dilation of the blood vessels in  the brain can lead to dizziness. Dizziness may also be the result of exercising on a continual motion machine, such as an elliptical or a treadmill. Upon stepping off the machine,  one may experience vertigo, or the sensation  that  still in motion when  it is stopped.

 You may consult a physician to know if there are any other causes.

14.A.D’S., Mangalore

* My daughter who is 7 years of age is gaining her weight everymonth. Now her weight is 41 kg. Her belly is also very big. She is having breathing problem. So she can not take part in PT, sports, she cannot run. If she runs or plays she feels very tired and can't breath. She is asthamatic also. She is not eating vegetables. She likes non-veg (fish and chicken)and chocolates only. Doctor please advise how to reduce her weight and to treat her breathing problem. 

** Your child has the problem of over weight or obesity. This is a common problem in many of the affluent communities. It is reported that in US one out of every five children has the problem of obesity. Obese children are also seen in many of the cities of our country. Though obesity related problems are less in children compared to adults, overweight children are at high risk of becoming over weight adolescents and adults, placing them at risk of developing chronic diseases related to obesity. 

Children become overweight and obese for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Only in rare cases is being overweight caused by a medical condition such as a hormonal problem. It may be better to consult a pediatrician to rule out the medical condition as the cause for obesity.

Although  over weight  problems run in families, not all children with a family history of obesity will be overweight. Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves, but this can be linked to shared family behaviors such as eating and activity habits.

A child's total diet and activity level play an important role in determining a child's weight. These days many children spend a lot time being inactive. For example, the average child spends approximately four hours each day watching television. As computers and  mobile phones become increasingly popular, the number of hours of inactivity may increase.

Obese children are at risk for a number of conditions, including high cholesterol,high blood pressure, early heart disease, diabetes etc.

To reduce the obesity in children these tips might be of use:

• It is very important that you allow your child to know that you  are supportive. Children's feelings about themselves often are based on their parents' feelings about them, and if you accept your children at any weight, they will be more likely to feel good about themselves. It is also important to talk to your children about their weight, allowing them to share their concerns with you.

• The parents should focus on gradually changing their family's physical activity and eating habits. By involving the entire family, everyone is taught healthful habits and the overweight child does not feel singled out. There are many ways to involve the entire family in healthy habits, but increasing the family's physical activity is especially important. 

• Lead by example. If your children see that you are physically active, they are more likely to be active and stay active for the rest of their lives.Plan family activities that provide everyone with exercise, like walking or swimming

• Overweight children may feel uncomfortable about participating in certain activities. Feeling breathless during games may be the manifestation of frustration. It is important to help your child find physical activities that they enjoy and that are not embarrassing or too difficult.

• Make an effort to reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.

• Whatever approach parents choose to take regarding an overweight child, the purpose is not to make physical activity and following a healthy diet a chore, but to make the most of the opportunities you and your family have to be active and healthy. If you eat vegeterian diet it is more likely that your child also follow you.


15. C.P., Bangalore

*I am 26 years, working in an IT company. I have the habit of smoking. Many of my companions also smoke and we have weekend parties. Are people who smoke and drink are more prone to heart attacks than others?

** Compared to smoking and alcohol consumption, it is the smoking that causes more ill effects on health. Cigarette smoking is the most important preventable cause of premature death. In the United States alone it accounts for more than 440,000 of the more than 2.4 million annual deaths.( We have no reliable statistics from countries like India) Cigarette smokers have a higher risk of developing a number of chronic disorders. These include fatty buildups in arteries, several types of cancer and chronic obstructive pulmonary disease (lung problems). Atherosclerosis (clogged arteries) is a chief contributor to the high number of deaths from smoking. Many studies detail the evidence that cigarette smoking is a major cause of coronary heart disease, which leads to heart attack.

Excessive alcohol consumption may indirectly increase the cholesterol level and may affect the coronaries. However, alcohol as it is, has little or no influence on heart attacks. But it causes other health problems like alcoholic liver diseases.

How does smoking affect coronary heart disease risk? 

Cigarette or tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes are the six major independent risk factors for coronary heart disease( leading to heart attack) that one can modify or control. Cigarette smoking is so widespread and significant as a risk factor that it is termed as "the leading preventable cause of disease and deaths."

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. Smoking also increases the risk of recurrent coronary heart disease after bypass surgery.

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.


16. J. C.  Kuwait

*My sister is 21yrs old. She has the problem of heavy bleeding during her monthly period. The bleeding is like big pieces of blood clot. She also gets stomach and back pain during this time. Rest of the month she gets more white discharge which is light yellow in colour (no itching) and feels like vomiting. She is taking hemoglobin tonic as she is anemic. We did medication for both her problems but of no use.

** The condition you are referring is termed as menorrhagia. Menorrhagia is menstruation at regular cycle intervals but with excessive flow and duration. It is defined as total blood loss exceeding 80 ml per cycle or menses lasting longer than 7 days. Menorrhagia is one of the most common problems and is reported that 30% of all premenopausal women perceive their menses to be excessive. Women who lose more than 80 ml of blood, especially repetitively, are at risk for serious medical sequel. These women are likely to develop iron-deficiency anemia as a result of their blood loss. Menorrhagia is the most common cause of anemia in premenopausal women. 

The other medical terminology of menorrhagia is dysfunctional uterine bleeding (DUB). Most cases of DUB in younger age are secondary to anovulation.(no ovulation).  If a young patient has had irregular menses since menarche, the most common etiology of her bleeding is anovulation. Without ovulation, the corpus luteum fails to form, resulting in no progesterone secretion. Unopposed estrogen allows the endometrium to proliferate and thicken. The endometrium finally outgrows its blood supply and degenerates. Anovulatory bleeding is most common in young girls and common in obese females of any reproductive age. (If a patient's bleeding normally occurs at regular intervals and the irregularity is new in onset, pathology must be ruled out, regardless of age).

Anemia also can cause menorrhagia. Menorrhagia causes anemia and anemia in turn causes excessive bleeding.

There can be other causes like intra-uterine devices (loop), polycystic ovarian syndrome, anatomic defects or growths within the uterus like fibroids, hormonal imbalances like hyper or hypothyroidism, galactorrhea, thrombocytopenia, renal failure etc. which are rare.

Your sister requires a through check-up from a gynecologist. As there are many cause for the problem, treatment depends on the condition that causes the problem. 


17. V. M, Dubai

*I am m29 years of age. Since 3 months my cycle was of 45 days. When I did not get my periods for 60 days I checked with the help of pregnancy kit. The result showed positive. I also had backache. As I was nearing three months, I had just drop of bleeding. Next day I went to the clinic to check. Here they do the pregnancy test first and then they called after 3 days to collect the report and open the file. 

On 15th I had little more bleeding so I went to a private clinic. There the doctor did the ultrasound and he said the baby was only 5 weeks (which surprised me because according to me it was 2months 20 days) so he was not getting heartbeat. He advised me to comeback after 10 days. On 16th evening I had severe bleeding and I went to the same clinic but to different doctor. 

And the doctor told me the baby was not healthy and was going. Next 2 days I had severe stomach and backache and bleeding. The bleeding lasted for 7days. But now when I do little work I get one or two drops of blood. What should I do now? I would like to know whether it is must to do D&C after the miscarriage.


** Persisting irregular bleeding after a spontaneous abortion is known as incomplete abortion. The most common complication of pregnancy is spontaneous abortion, which occurs in an estimated 10-15% of pregnancies. Spontaneous abortions are categorized as threatened, inevitable, incomplete, complete, or missed. Spontaneous abortions can be classified further as sporadic or recurrent. By definition, an incomplete abortion is the partial expulsion of the products of conception before the 20th week of gestation. 

The timing of miscarriage suggests the cause of a spontaneous abortion. Genetic anomalies (e.g., trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester pregnancy loss. (Anatomic factors usually are associated with second-trimester pregnancy loss.).

You may consult a gynecologist. You may be advised to undergo ultrasound scanning which will reveal if there are any gestational products still present. If they are present you may have to undergo curettage. Otherwise certain other tests may be required to know the cause of irregular spotting. Treatment depends upon the cause. Most of the gynecologist may suggest D&C, as it is likely to solve the local problem. 


18. P. F. Mangalore

*I am 50 years of age. I had an abdominal hysterectomy in October 2010. Two weeks later I found have little or no sensation to void.  I am now having little or no sensation for my bowels.  I had the worst back pain after the surgery which has now subsided.

** You may consult a neuro-physcian at the earliest. If you had bowel sensation after the surgery, which you are losing now, it may be due to some cause not directly related to surgery. Some tests may be required to identify the cause of the problem.


19. V.  A., Mumbai

*I am 23 years of age. I am having allergic asthma from last two years. I did medications at many places without any benefit. I was in Pune for one year. At that time I suffered from pnuemonitis twice.  At present I am working in Mangalore. Last month I consulted a chest  & allergy specialist in Mangalore. He suggested me to take a course of treatment for 1 to 1&1/2 years. The course is to take allergen dosages thrice in a week for 1st 2 months & then gradually decreasing order(from allergy test he told that it's severe dust allergy).He also told me that  the asthma caused by allergy is curable. But I am in confusion now.

I believe asthma can be controlled, cannot be cured permanently-what about allergic asthma? Shall I start with this medication?Are there any other methods to cure allergic asthma? Apart from this, I have regular cough, chest pain on the left side. I get peculiar sound from left side chest when I take deep breath. 

**The allergic asthma is caused by a specific substance known as allergen. If you are sure that your problem is allergic asthma (allergic bronchitis) it may be cured provided you are desensitized to the allergen causing it. The desensitization treatment is known as allergen immunotherapy. Allergen immunotherapy is a form of treatment aimed at decreasing your sensitivity to allergens. Allergens such as pollen and cat dander trigger the allergy symptoms when one is exposed to them. There can be host of other substances causing allergy- cotton dust, cockroach droppings etc.  These allergens are identified by allergy testing. Allergy testing is an important step to identify the agent that causes the allergic reaction. Immunotherapy is currently the only medical intervention that could potentially modify/change  the allergic disease.

Immunotherapy involves injecting small amounts of the allergen(s) causing the allergy problem, i.e., ragweed or dust mites. Immunotherapy works by changing the way the immune system responds to the allergen(s) which results in tolerance to the allergen. Some individuals may experience a long-term remission after a treatment course of immunotherapy

Unlike anti-allergic medications, immunotherapy provides long-term relief of allergy symptoms even years after the person has discontinued the allergy injections. Medications, on the other hand, may work well to control symptoms but once the medication is discontinued, the allergy symptoms return.

The benefits of immunotherapy have been demonstrated both in allergic rhinitis and asthma and include reduced need for medication and improved symptoms. Immunotherapy has been shown to be highly effective in preventing serious life-threatening reactions in individuals who have wasp/bee/hornet/yellow jacket and fire ant allergic reactions.

The respiratory symptoms of allergic asthma and bronchial asthma are almost the same, but they are non-seasonal and severe in bronchial asthma compared to allergic asthma. If you are convinced about the problem and treatment you may go for immunotherapy. Other treatments available are only symptomatic and do not cure the problem. 

Bronchial asthma is entirely a different entity. From a physiological standpoint, bronchial asthma is a complex disease that cannot be cured. In most cases, however, with patient cooperation and diligent effort, it can be effectively managed - even in more severe cases - allowing the asthmatic individual to lead a relatively normal existence. 

During an asthma episode, the air tubes in the lungs (bronchi and bronchioles) which lead to air sacs (alveoli) become obstructed. As airways constrict, breathing becomes more labored, and the patient will often cough or wheeze. Most asthmatics are also allergic, and asthma attacks are often triggered by an allergic reaction. Some asthma patients do not have significant allergies, and even in allergic patients asthma flare ups can be provoked by non-allergic irritants such as common colds, chemical fumes and cigarette smoke. Cold air and exercise can also induce symptoms. 

20. T. R. Pune

*I am 61 years of age. I get pains (burning, tingling) down the back of both legs only while I am asleep, sometimes including the back of my feet, waking me up all night.  They go away in a few minutes. They get worse from walking during the day.  

** You seem to be having some problem with the spinal cord in the lumbar region. You may have to consult a neuro-surgeon for proper assessment of the cause. You may have to undergo certain tests to pin point the cause.


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