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1. P.D’s. Mumbai

*My child is 19 months of age, I keep it in the day care from morning to evening, as I am working. During the day at the day care he is very good but at home he bites us, pinches with anger and also sleeps on floor and bangs his head with anger and cries. He still eats semi sold food, if we give solids then he does not eat. he is very stubborn and cranky all the time at home. 

** This type of behaviour is known as temper tantrum. A tantrum is the expression of a young child's frustration with the challenges of the moment. 

Most 2-year-olds have a limited vocabulary. Parents might understand what a toddler says only some of the time. When your child wants to tell you something and you do not understand — or you do not comply with your child's wishes — you might have a tantrum on your hands. 

Typically, the best way to respond to a tantrum is to ignore it. When your child quiets down, you might say, "Tantrums won't get my attention. If you want to tell me something, you have to use your words." 

Remember, your ability to stay calm and in control will help your child feel secure. If you lose your cool or give in to your child's demands, you'll only teach your child that tantrums are effective. 

It might seem as if your child plans to misbehave simply to get on your nerves, but that is probably giving him or her too much credit.  Young children do not have evil plans to frustrate or embarrass their parents. For most toddlers, tantrums are simply a way to express frustration. 

There might be no foolproof way to prevent tantrums, but there is plenty you can do to encourage good behavior in even the youngest children. 

Be consistent. Establish a daily routine so that your child knows what to expect. Stick to the routine as much as possible, including nap time and bedtime. It's also important to set reasonable limits and follow them consistently.

Encourage your child to use words. Young children understand many more words than they are able to express. If your child is not yet speaking — or speaking clearly — you might teach him or her sign language for words such as "I want," "more," "drink," "hurt" and "tired." The more easily your child can communicate with you, the less likely you are to struggle with tantrums. As your child gets older, help him or her put feelings into words.

Let your child make choices. To give your toddler a sense of control, let him or her make appropriate choices. "Would you like to wear your red shirt or your blue shirt?" "Would you like to eat apples or bananas?" Then compliment your child on his or her choices. 

Praise good behavior. Offer extra attention when your child behaves well. Give your child a hug or tell your child how proud you are when he or she shares toys, follows directions, and so on. 

Use distraction to change your child's focus. If you sense frustration brewing, try to distract your child. Suggest a new activity or change location.

Avoid situations likely to trigger tantrums. If your child begs for toys or treats when you shop, steer clear of "temptation islands" full of eye-level goodies. If your toddler acts up in restaurants, make reservations so that you won't have to wait — or choose restaurants that offer quick service. 

As your child's self-control improves, tantrums should become less common. Most children outgrow tantrums by age 5.  If your younger child's tantrums seem especially severe, your older child is still having frequent tantrums or the tantrums have pushed you beyond your ability to cope, share your concerns with your child's doctor

2. J.R. Pune

*I am 32 years of age. I got married in Feb.2011.After marriage we were together only for one month, because I had to return to gulf. During this time my wife was not interested in physical union. After 2 years we met together during my vacation. She showed little interest because she wanted a baby. As soon as she came to know that she was pregnant she did not allow for physical union. After five month again I came to gulf. Now after five six months I am going back to India. But she says that she is not interested in physical union. Even she allows for physical union, she never takes part. I feel I am raping her. I am not happy with this. I tried to explain. My married life is become very tense. We have a baby one year old. Please give some suggestions. 

**The causes of low sex drive in women are many and unless your wife is personally counseled by a proper person it may not be easy to solve these. I recommend you to go through my book on ‘Married Sex Life’ (book is in Konkani). By going through the book you may be able to understand the problem better. I have suggested certain solution to the problems in the book 

Many woman and men are under the misconception that penetration alone will lead to orgasm. As written in the book, there are many phases and prerequisites to the female sex drive. Every woman’s erogenous geography is unique to her. The phases of the sexual response are desire, arousal, plateau, orgasm, and refractory period.  Stress, fear of pain, fear of pregnancy or other factors can inhibit a woman at any of these phases, when the brain focuses on other things instead of total relaxation. 

It is not possible to suggest total solution for the problem. However let me list a few of the causes here:

Your relationship with your partner may be the main issue. If your wife’s needs aren’t being met in the relationship, if the two of you don’t deal with problems openly and constructively, if she is not treated with respect and fairness, if you are self-absorbed or self-destructive – these common patterns destroy the intimacy and trust that keep sexual desire alive over the long term. 

Many women have been traumatized sexually at some point in their lives, and that experience may need to be dealt with now. It’s estimated that 1 in 3 women are sexually assaulted in some way during their lifetimes. If this is an issue for your wife, she deserves to explore her experience with professional help for many reasons beyond the sex drive. There are good counseling facilities are available in most of the cities including Mangalore.

Some women were raised to believe that sexual desire is shameful or inappropriate. Women who’ve been unassertive about their sexuality in the past may prefer to sacrifice their sex lives rather than become assertive now about what’s required to satisfy their sexual needs. 

Stress is an enormous factor. The body naturally puts survival ahead of pleasure. The over-burdened adrenal glands can rob the body of the building blocks it uses to make certain hormones, which are vital to desire and sexual response. Changes in your wife’s routines, a new form of creative self-expression, positive help and support from you, working on unresolved problems, time you devote to her – the positive effects can be profound

Open communication is so important in a relationship and this is especially true during this confusing time. Do not wonder and speculate about why the relationship with you has become one without intimacy and passion. Be open and share your feelings. Help your partner be part of the solution by asking for patience and encouragement while both of you work toward healthy and balanced relationship.  Be sure to show your love in other ways that have been meaningful to both of you. Remember your partner needs time and space to feel warm and comfortable without the pressure for sex. Facing this issue with openness and respect for each other will foster a mutual understanding and bring you closer.

3. N. P., Mangalore

* I am 46 years. My brown skin person now he is turning white. First it started on his legs, then hands now in his face. What is this? I want to know if it has anything to do with my kidneys. I had kidney stones.

** By the description it appears that you are having a skin problem known as vitiligo. This has nothing to do with the kidneys. You may consult a skin specialist and take appropriate treatment. I shall give you some information about vitiligo. 

Vitiligo is a pigmentation disorder in which melanocytes (the cells that make pigment) in the skin, the mucous membranes (tissues that line the inside of the mouth and nose and genital and rectal areas), and the retina (inner layer of the eyeball) are destroyed. As a result, white patches of skin appear on different parts of the body. The hair that grows in areas affected by vitiligo usually turns white.

The cause of vitiligo is not known, but researchers have several different theories. One theory is that people develop antibodies that destroy the melanocytes in their own bodies. Another theory is that melanocytes destroy themselves. People who develop vitiligo usually first notice white patches (depigmentation) on their skin. These patches are more common in sun-exposed areas, including the hands, feet, arms, face, and lips. Other common areas for white patches to appear are the armpits and groin and around the mouth, eyes, nostrils, navel, and genitals.

Vitiligo generally appears in one of three patterns. In one pattern (focal pattern), the depigmentation is limited to one or only a few areas. Some people develop depigmented patches on only one side of their bodies (segmental pattern). But for most people who have vitiligo, depigmentation occurs on different parts of the body (generalized pattern). In addition to white patches on the skin, people with vitiligo may have premature graying of the scalp hair, eyelashes, eyebrows, and beard. People with dark skin may notice a loss of color inside their mouths.

The disorder is usually progressive, however, and over time the white patches will spread to other areas of the body. For some people, vitiligo spreads slowly, over many years. For other people, spreading occurs rapidly.

The goal of treating vitiligo is to restore the function of the skin and to improve the patient's appearance. 

Therapy for vitiligo takes a long time--it usually must be continued for 6 to 18 months. The choice of therapy depends on the number of white patches and how widespread they are and on the patient's preference for treatment. Each patient responds differently to therapy, and a particular treatment may not work for everyone. Current treatment options for vitiligo include medical, surgical, and adjunctive therapies (therapies that can be used along with surgical or medical treatments).

1. Topical steroid therapy: Steroids may be helpful in repigmenting the skin (returning the color to white patches), particularly if started early in the disease. Patients must apply the cream to the white patches on their skin as directed by the doctor. It takes long time for the skin to regain its colour. It is the simplest and safest treatment but not very effective. 

2. Psoralen photochemotherapy: Psoralen photochemotherapy (psoralen and ultraviolet A therapy, or PUVA) is probably the most beneficial treatment for vitiligo available now. However, it is time-consuming and care must be taken to avoid side effects. Psoralens are drugs that contain chemicals that react with ultraviolet light to cause darkening of the skin. The treatment involves taking psoralen by mouth (orally) or applying it to the skin (topically). This is followed by carefully timed exposure to ultraviolet A (UVA) light from a special lamp or to sunlight. Patients usually receive treatments in their doctors' clinics so they can be carefully watched for any side effects. Patients must minimize exposure to sunlight at other times.

3. Depigmentation: Depigmentation involves fading the rest of the skin on the body to match the already white areas. For people who have vitiligo on more than 50 percent of their bodies, depigmentation may be the best treatment option. Patients apply the drug monobenzylether of hydroquinone (monobenzone or Benoquin*) twice a day to pigmented areas until they match the already depigmented areas. Patients must avoid direct skin-to-skin contact with other people for at least 2 hours after applying the drug. 

4. Surgical therapies: All surgical therapies must be viewed as experimental because their effectiveness and side effects remain to be fully defined. They include:-

A. Autologous skin grafts- In this procedure the skin from one area of a patient's body is removed attaches it to area where there is vitiligo. This type of skin grafting is sometimes used for patients with small patches of vitiligo.)

B. Micropigmentation (Tattooing):  Tattooing involves implanting pigment into the skin with a special surgical instrument. This procedure works best for the lip area, particularly in people with dark skin

C. Autologous melanocyte transplants: In this procedure, a sample of the patient's normal pigmented skin is cultured in a special cell culture solution to grow melanocytes. When the melanocytes in the culture solution have multiplied, they are transplanted into depigmented skin patches

5. Additional Therapies

A. Sunscreens

People, who have vitiligo, particularly those with fair skin, should use a sunscreen that provides protection from ultraviolet light. Sunscreen helps protect the skin from sunburn and long-term damage. Sunscreen also minimizes tanning, which makes the contrast between normal and depigmented skin less noticeable.

B. Cosmetics

Some patients with vitiligo cover depigmented patches with stains, makeup, or self-tanning lotions. These cosmetic products can be particularly effective for people whose vitiligo is limited to exposed areas of the body.


4.M. D’S, Mangalore

* I am 46 years of age. The problem is relating to my thyroid report.  The study showed multiple focal areas of decreased and increased tracer uptake involving both lobes of the thyroid. It is enlarged - its 33% the normal. The conclusion given is multi-nodular goiter. The readings are TSH 0.12, T3 is 31.00 and T4 is 8.4.  The doctor has prescribed neomercazole 5mg and has said he would do the tests later. Is my problem is dangerous? Can it be controlled by diet?

**A multinodular goiter is simply a thyroid gland that is usually enlarged and contains multiple thyroid nodules. The nodules can be very small, often only a few millimeters in size, or the nodules can be larger, perhaps several cm each. There are generally two questions that need to be answered in patients with a multinodular goiter. The first question: are all the nodules benign? The approach to this question depends on the clinical presentation, associated risk factors, the size of the nodules, and whether the nodules are functioning or non-functioning.

The second question that needs to be answered relates to ascertainment of thyroid function in patients with a multinodular gland, as these patients often exhibit mild to moderate degrees of hyperthyroidism. Hyperthyroidism refers to a group of problems due to excess production of thyroid hormone.

Your laboratory reports are suggestive of the second problem and the doctor has put you on the drug that is one from the groups of antithyroid drugs. These drugs accumulate in the thyroid tissue and block production of thyroid hormones. But they can not be taken for long. Although the hyperthyroidism may be treated initially with antithyroid medicines, these medications will not usually achieve a permanent remission in patients with a multinodular goiter and hyperthyroidism. Once the hyperactivity of the gland is reduced the doctor will reassess the condition and may decide to go ahead, most probably the removal of the majority of the gland by a surgery. The surgical treatment of multinodular goiter with hyperthyroidism is more appropriate and is safe in experienced hands. If surgery is warranted, it is important for you to let your doctor know of any concerns or questions you have about the options available.

The use of radio-active iodine is one more option available. Radioactive iodine is given orally (either by pill or liquid) on a one-time basis to ablate a hyperactive gland. Radioactive iodine is given after a routine iodine scan, and uptake of the iodine is determined to confirm hyperthyroidism. The radioactive iodine is picked up by the active cells in the thyroid and destroys them. Since iodine is only picked up by thyroid cells, the destruction is local, and there are no widespread side effects with this therapy. Radioactive iodine ablation has been safely used for over 50 years, and the only major reasons for not using it are pregnancy and breast-feeding. This form of therapy is the treatment of choice for recurring Graves' disease, patients with severe cardiac involvement, those with multinodular goiter or toxic adenomas, and patients who cannot tolerate antithyroid drugs. 

Remember that thyroid disease is very common, and in good hands, the disease that causes an excess of thyroid hormones can be easily diagnosed and treated. This is not a dangerous disease.

However, diet has no specific role in the control of the disease.

5. J. P. Mumbai 

*I am 33 years of age; I am having dandruff problem. I tried many shampoos,   but there is no relief. Could you please tell me the cause of dandruff?    I am using coconut oil. Is that good for hair?   Are there any medications to stop this problem?  

** Researchers now believe dandruff is a medical condition caused by an overabundance of an organism that normally exists on everyone's scalp – even people who do not have dandruff. Dandruff also known as seborrheic dermatitis, is a minor infection of the scalp caused by an overabundance of a micro-organism called Pityrosporum ovale (P. ovale), a yeast-like fungus which is the part of the normal skin.

Dandruff typically begins to appear in puberty, and the incidence is highest at age 40. Because people with dandruff often do not seek medical attention, no one knows exactly how widespread the problem is, but it is estimated that one in three adults - have experienced dandruff symptoms. Many people mistakenly believe that dandruff is caused by dry scalp, frequent shampooing or poor hygiene. These popular misconceptions can lead to ineffective and sometimes inappropriate treatments, and make it even harder on those who have dandruff - half of adults with dandruff are more self-conscious about their appearance. Unfortunately, these people needlessly suffer the flaking, itchiness, redness and scalp inflammation caused by dandruff. Most people do not realize that these symptoms, which range from slight to severe discomfort can be successfully treated.

Under normal conditions, P. ovale yeasts can live on the skin without causing any problems. The rapid growth of P. ovale often is triggered by an imbalance in environmental factors such as climate, heredity, diet, hormones and stress. As the body's natural defenses fight the excessive growth of this organism, the results are the symptoms of dandruff - flaking, scaling and itching.

The mechanism of dandruff was not well understood and there was no effective treatment. Now the cause of the problem is known as well as the treatment. While many of antifungal drugs have produced a good inhibitory effect on P. ovale, studies have shown that ketoconazole was the most powerful. This drug is available in preparations for local application-in the form of shampoo. You may consult the dermatologist for proper evaluation of your problem and for treatment. 

6. D. C., Kuwait

*How the snoring is developed? What are the ways by which this can be cured or suppressed? Is there any medical attention needed?

** Snoring is one of the common problems of sleep. It can be due to variety of causes. It is most important to stress that snoring, in most people, is due to multiple factors, each playing some part in the snoring process. Factors which are important in this regard include narrowing or blockage of the upper airway passages through anatomical or injury reasons. It can be also due to congestion of the soft tissues of the airways, e.g. smoking, alcohol, acid reflux from the stomach affecting the throat tissues, obesity, ageing and hormonal factors. 

Noises can result from a narrowing of the nasal passage, which generates a whistling noise. The vibration of the soft palate (or roof of the mouth) causes the fluttering vibration sounds.

In most of the people the problem of snoring is just ignored and no treatment is opted. Sleeping in supine position (on the back) can reduce snoring. If the problem really bothers then consultation with an ENT surgeon may be advisable. Depending on the severity of the problem surgical corrections can be done. Surgical assistance may include nasal, palatal or tongue and neck surgery. The surgical procedure will depend on the location of the tissues contributing to snoring.

Nasal surgery may include improving the nasal airway by straightening the nasal septum (mid line nasal cartilage partition), shrinking the lining tissue of the nose, particularly where this has been troubled by allergy or by the removal of nasal polyps. Previous nasal injury involving the external nose and the nasal septum may require correction.

The flapping of the soft palate in snoring may be assisted by palatoplasty involving either high frequency radiowave or laser surgery. Newer procedures for more severe forms of snoring including radiowave shrinkage of the back of the tongue as well as procedures to bring the tongue tissues forward may be of assistance in selected cases.

Because snoring is a multi-factor medical condition, repeat or additional operations may be required as part of the management plan. Not all patients can anticipate 100% control of snoring although the majority of patients do have useful improvement. 

7.S.K, Mumbai/Dubai

*I am a lady of 27 years and am married for past 1year.  I have a son of 7 months. After my delivery, I have the problem of white discharge, which is quite more, and because of which my body smells and that the smell is horrible. Because of that I am loosing weight and also not so comfortable to fulfill my husband at times.I consulted doctor both here and in India and they gave me a tablet which has to be inserted in my private part at night. But my problem is that that tablet does not suit me. I feel it makes me bleed and I am afraid to use it future. What suggestion do you give me?  Should I continue with that tablet as I am scared? Will such thing happen by using that tablet or is it my imagination? 

** You are probably having a condition known as vaginitis. Vaginitis is described as an inflammation of the vagina characterized by a discharge, odor, irritation of the vaginal wall and itching. The most common agents are bacterial vaginosis, trichomaniasis and candidaiasis -more commonly known as a yeast infection.  Bacterial vaginosis is the most common cause of vaginitis among women of childbearing age.  When bacterial vaginosis occurs it is due to a change in the vaginal environment.  

The primary symptom is an abnormal, odorous, vaginal discharge.  The fish like odor typically is more prominent after sexual activity.  Often times the cause for this type of infection is unknown. Currently the only way to determine a positive test for bacterial vaginosis is through a test of the vaginal fluid.  Antibiotics are used to treat the problem.  If ignored, this can lead to chronic pelvic inflammatory disease which can often lead to infertility and tubal pregnancies.  

The doctor must have diagnosed a fungal infection known as candidiasis for which antifungal pessaries are used. These are normally well tolerated and do not cause bleeding. Vaginal candidiasis is a common problem in certain women. Women are susceptible to infection if the body is under stress from poor diet, lack of sleep, illness, or if she is diabetic, taking antibiotics, or is douching too frequently.  Symptoms include vaginal itchiness and soreness, and a thick, cheese-like vaginal discharge.

Those who are at most risk are women with a new sexual partner, who have had multiple sexual partners, practice douching, or use an intra-uterine device for contraception. Since vaginitis is most closely associated with sexual activity it was found that those women who are not sexually active are rarely affected by this bacterial infection.  

Steps to prevention include the use of condoms, limitation on the number of sexual partners, reduction of douching, use of all prescribed medication even if signs and symptoms no longer are apparent, wear clean cotton panties to allow for absorption, and reduce the use of scented feminine products

You may take a second opinion from another gynecologist and have a proper assessment of the condition.

8. D. L. Kuwait

*I am 25 years. I am working in Kuwait since 4 years. I got married 4 months ago. I was having regular monthly cycle, but for the past 42 days there are no signs of periods. I don't want to get pregnant for at least 2 years. We are not using any contraceptive methods. Will you please give some advice to avoid pregnancy? 

** If you had regular periods and if there are no other causes for a missed period, it is most likely that you are pregnant now. You may confirm the same by simple pregnancy test. If you are pregnant, it may be better to continue with the pregnancy rather than opting abortion. There are no tablets with definite and safe abortificient action. Few of the tablets available in some part of the world are not used widely because of their side effects. These tablets instead of causing abortion might result in defects in the baby. Only other option left is going for medical termination of pregnancy. It is method in which mother kills its unborn, helpless child!

And, why? Just that mother does not want it! Just think over this. You are killing a baby whom you have not seen. The baby is so helpless—no one comes to its rescue!

You may be having your own reasons for not having a baby so soon. You do not know what God’s plans are for you and your family. He might be blessing you with a well talented child. Accept His gift. He will definitely show the means by which you can bring up the child. I agree there will be difficulties initially, but they will be rewarded later. If you are truly worried about the job, just analyze for whom you are earning? Is it not for your family? Is it not for your children yet to born? 

Do you know good percentage of women fail to conceive after an abortion? It is not rare. If this occurs to you?

Accept the present pregnancy as God’s gift for you and continue with it.

After you deliver the present child, opt for a definite method of family planning to space the arrival of second child. It is always better to plan the families and maintain a healthy gap between the children, than going for abortion.

9. S. F. Mangalore

*I am 29 years, married and residing in Gulf. Recently My first child, a baby girl is now 3 months of age. We did not go for family planning and now suddenly I realized I am pregnant again. We are not ready for another kid right now. Will you please let me know what is to be done as abortion in the Gulf is illegal? 

**Have you confirmed the pregnancy? Many women do not have periods when they are feeding the baby. If you are pregnant, I strongly recommend you to go ahead with the pregnancy. I have given my opinion about abortion in the answer to the question above (No: 6). My opinion regarding abortion is same in your case. You do not know what God’s plans are for you and your family. Accept the unborn baby as His gift. He will definitely show the means by which you can bring up two small children together. I agree there will be difficulties initially, but they will be rewarded later. When you deliver your second child, your first baby will be about a year old. They will grow like twins. Bringing up twins is more difficult than two children with a gap of one year. This is not an unusual thing. There are several families, where subsequent child is born within a gap of one year or less.

After you deliver the present child, opt for a definite method of family planning. Let this not repeat again!

10. A. K., Mangalore

* I am 26 years and my husband is 29. We are married for two months. I do not want to conceive now.  What are the safe days for having physical union?

**In calendar method of family planning, 10 days preceding and 10 days following menstruation are considered as safe period for physical union. This may be effective if the woman has regular periods, the duration of each cycle should be equal and more than 28 days. 

Normally a healthy woman with regular periods will have ovulation on the 14th day preceding the day of onset of menstruation. Two days preceding it and two days following it are termed as the ‘window of fertility’.

Window of fertility is the most likely period of ovulation and it is commonly advised for infertile couple to make use of, the chances of conception are better in this period. Most of the couple is advised to practice this at least 6 months before opting for costly tests of infertility and artificial methods as treatment. The incidences of conception are more if physical union is regularly performed during window of fertility. However this is not a guaranteed method. 

But the calculation regarding the fertile period (5days) is not always true. It varies from woman to woman. This is due to variable survival period of sperm in female genital tract after intercourse as well as the survival of egg after the ovulation. So in theory, middle 2 weeks are fertile and 1st and last weeks are 'Infertile'. Having said that, even if you follow this safe period (1st & last week of your cycle), this method has high failure rate. This is because, apart from reason mentioned above (survival time of egg and sperm), also there is large variation of ovulation timing in each cycle. Therefore this method is not normally recommended for effective family planning. In fact safe period can be highly unsafe!

 11.K. L. Kuwait

*I am 37 years of age, married, residing in Kuwait. For the past 15 days I am getting pain in my back and buttock. It was severe during the first 2-3 days. I was unable to move. I tried using pain relieving creams and sprays. I found great relief but the pain is still there. After three days visited the hospital. As advised by the orthopaedic specialist I took the x-ray.He informed me that I am suffering from mild arthritis. I am shocked and find it difficult to digest.

During the winter season I often used to get back pains and my only remedy for cure was local pain relieving cream, but this time pain is severe and I still feel a slight pain in my back. I find difficulty to walk, to sit for long in one position.  

The doctor has prescribed pain killers and muscle relaxants.

I would appreciate if you share more light on this sickness arthritis. How does it crop up, symptoms, and the cure? I am active, energetic and eager to work. But this pain has disturbed me completely, I am worried because my kids are very small,I am afraid I will face problems raising them up

**You seem to be very much disturbed and worried about the problem. This is one of the common problems in young men of your age. This will not incapacitate you or cripple you. By taking proper treatment now and adequate care of the back you can work till retirement. There is absolutely no danger to your life or activities.

The doctor who examined you must have detected early degenerative changes in the lumbar spine for which he must have used the term ‘mild arthritis’. Arthritis is a general term we use for degeneration. The degeneration in the vertebral column is known as ‘spondylosis’. Degeneration means wear and tear. Like any other mechanical device, wear and tear is common in our body parts that are involved in movements. 

The degeneration starts when we are very young, as young as twenty five to thirty years. Most of our joints start wearing out after that age.  The process of degeneration depends on lot of factors and it varies from person to person. Some people may not have any problems of degeneration, even if their joints are worn out very badly. 

The terms disc degeneration, degenerative disc disease and spondylosis are often used to describe the same problem. These are very common findings. By the age of fifty, 85 percent of the population will show evidence of disc degeneration or spondylosis.  Of course, the vast majority of these cases are without symptoms. It is only the patients who develop symptoms, chiefly low back pain, that need treatment.

Aging and injury are common causes of lumbar spondylosis and disc degeneration. Disc degeneration is seen as a loss of hydration of the disc material. This loss of water in the disc leads to a decrease in the normal height of the disc. The loss of height, in turn, may put increased stress on the facet joints of the spine causing them to degenerate and in the process advances gradually. These changes may eventually cause pressure on the nerve roots. This may result in sciatic-type pain.

The most common symptom of disc degeneration or lumbar spondylosis is no symptom at all. The vast majority of cases are asymptomatic. When symptoms are present, the most common is midline low back pain with or without radiation to the hips. Aching pain in the buttocks and or the backs of the thighs may be seen with walking. 

As always, a careful history and physical examination are the first steps in diagnosis. In most cases, the neurological examination will be normal. Sometimes, there will be decreased motion of the spine due to pain. MRI examination is not required if there are no neurological symptoms. The MRI will usually demonstrate the degenerative changes. This may be all that is needed for diagnosis. 

Most symptomatic cases of lumbar spondylosis/disc degeneration resolve with conservative (non-surgical) management. The absolute best treatment has yet to be determined. A short course, two days or so, of bed rest seems to be helpful. Medications such as non-steroidal anti-inflammatory drugs and muscle relaxants are often prescribed. In some cases, steroids injected into the epidural space may be used. Physical therapy and a home exercise program may be helpful. 

If conservative management fails to afford adequate relief after a reasonable amount of time (usually at least three months), then surgery may be recommended. In most instances, the surgery will involve a fusion of some sort. Surgery is so rare that it may be considered that there is no surgical treatment.

If you are still having the problem, you may consult the orthopaedic surgeon again. Other than usual medication you may be advised to undergo physiotherapy treatment. Once you are relieved of the symptoms, you may be advised certain exercises to build up the back muscles. To prevent the recurrence of the problem you will have to take care of the posture. Your doctor will advise you regarding this.

12.K.G.,  Mangalore

*If the condom tears while having sex what are the chances of getting HIV if the other person has AIDS?  How much time does it take to get positive in the medical test? 

** The risk is just like having unprotected sex with a HIV infected person. There are no reliable reports to indicate what percentage of unprotected sex can transmit HIV. There are incidences where HIV was not transmitted between the spouses even though one of them was infected. But this risk is unacceptable. As there is no treatment for AIDS so far, one should be extremely careful while having sex of any type with a stranger or potentially infected person.

The number of days taken for the antibodies to develop in the blood from the day of contacting infection is termed as ‘window period’. There is very little published research on this topic. It is very difficult to find a large group of people who can pinpoint the moment when they became infected and then test them at least once a week for several months. One study was done using a sample of health care workers who were infected by needle sticks. From this study the average time it taken for the antibodies to develop was estimated. Until antibodies are present, the infected person will continue to test negative. 

In a study of 51 health care workers infected through needle sticks the median window period was 46 days and the mean was 65 days. Two of the 51 did not seroconvert for more than six months. This means that 50% of people infected with HIV will develop antibodies by 46 days. At three months about "85-90%" of patients would develop antibodies, and by six months "over 95%." As you can see, the difference between a test at three months and a test at six months is minimal. For most people who had some risk, but are not certain they were exposed to HIV, a test at three months are enough. To be more certain, one should wait until six months. It is not required to test at one month, because retests are required and this is a waste of resources.

According to CDC guidelines on blood screening, the average length of the window period is less than one month (25 days). 

13.M N, Mangalore

*My problem is that I am overweight. Before  marriage, I was very slim and never above 52-53kgs.After my second delivery, which was a caesarean, I put on lots of weight. After the delivery, I used to drink lots of water as I was on antibiotics, everyone used to say that if you drink more water after delivery, your stomach will expand. Just recently I have been diagnosed as hypothyroid and am on Eltroxin since 6 months. But my weight has not gone down.

Also I tend to eat a lot as I get the urge to keep on eating. Is it because my stomach has enlarged because of drinking excess water after delivery? Kindly solve my problem.

**Drinking any amount of water is not the cause for overweight or pendulous abdomen. Normally the water gets absorbed and any excess of it will be excreted out within an hour. Drinking adequate water is required for maintaining good health.

The overweight seems to be due to excess eating, lack of exercises added to it is hypothyroidism. You have to check your thyroid hormones regularly and see that they are maintained. Your doctor will decide about the dosage of thyroid hormone replacement. You have to follow that.

Next step is to reduce the weight. It is difficult to reduce, but one can reduce the weight by constant and sincere effort. A few hints can be which might help you:

You have to reduce the intake of calories.  Calorie is the unit of energy. The food items we consume produce varying amount of energy in the body and the amount of energy produced by a gram of food is measured as the calorie content of that particular food. Oily food and sweets produce more energy than vegetables, hence have more calorie value. We require energy for day today work and for normal functions of the body. Whatever extra energy produced by the food we have consumed is converted into fat and gets accumulated in the body. You should be aware of your calorie requirement and should limit your calorie requirement. You may have to reduce the food items which are rich, and produce more energy.

It may not be practicable to measure the calorie value of each food item in our day today diet. To reduce weight, one has to reduce the food with high calorie values. The quantity of food one is eating is more important than the quality. Even if you eat large amount of low calorie food, you may not be able to reduce the body weight. Hence the diet is the first step in reducing excess body weight.

Eat more vegetables. Steam, boil, broil, or microwave vegetables, or stir-fry them in a small amount of vegetable oil. Season vegetables with herbs and spices rather than sauces, butter, or margarine. Try lemon juice or fat-free dressing on salad, or use a yogurt based dressing instead of mayonnaise or sour cream dressing. To reduce saturated fat, use vegetable oil instead of butter or ghee when possible.

Choose lean cuts of meat, and trim any visible fat from meat before and after cooking. Remove skin from poultry before or after cooking. Monitor portion sizes.

Many of us go on a diet to lose weight, but many refrain from taking up exercise. For people who are markedly overweight, it can be difficult to start an exercise program. But, the combination of aerobic and anaerobic exercise truly is the key to long term success. Walking off weight takes a combination of diet (fewer calories and less fat) and exercise. The key to success in the beginning is walking for distance rather than speed. Walking longer distances at a moderate pace is much more effective than trying to sprint your fastest mile or two, simply because you're more likely to do more walking--and do it more comfortably with fewer injuries or days off. In fact, consistency (exercising seven days a week) is equally important. To walk enough to lose weight, you need to discover your own optimum pace. That's the cruising pace that you can maintain for 45 minutes or longer without gasping, fatiguing, or developing muscle tightness or soreness. With consistency your fitness level will automatically improve, your pace will naturally increase and so will your fat-burning capacity. And if finding time is a problem, or if long walks fatigue your joints, do several shorter walks throughout the day. Three 15-minute walks can give you nearly the same benefit as one 45-minute walk.

14.L.E.F., Mangalore

*My daughter, 24 years of age is interested to marry her first cousin who is also 26 years. He is her father’s elder brother’s son. Please let us know any future problems in the health/maternity due to blood relations,more over boys parents also first cousins.

** The marriages among the blood relatives are called consanguineous marriages — sanguine meaning blood. Around the globe consanguineous marriages have been practised by many societies from time immemorial. It is widely practiced in Asia, North Africa, Switzerland, Middle East, some parts of China. 

Most common consanguineous marriages practiced in some communities in our country is among the first cousins — uncle's son marrying auntie's daughter or vice versa. 

However another type of marriage is where maternal uncle marries his niece (sister's daughter) also is present in some communities. Theoretical risk of having a genetic defect child is higher in the latter type of marriage than the former. Most of  the people do not even recognize the pros and cons of such marriages. 

Several scientific studies have shown that consanguinity leads to death of infants before, during or immediately after birth, increased incidence of birth defects, genetic diseases including blinding disorders, blood cancer (acute lymphocytic leukemia), breathing problems for children at birth (apnea), increased susceptibility to disease etc. 

In a study conducted in south India, the reasearchers reported that the consanguinity could increase the incidence of many blinding disorders like retinitis pigmentosa, Leber congenital amaurosis etc. Consanguinity could increase the risk of inheriting any one of the 4968 (autosomal recessive) genetic diseases that could affect any part of the body from head to foot. 

Some animal studies have shown that inbreeding or consanguinity could enhance longevity. It has been proved beyond doubt that consanguineous marriages farther than second cousins would not result in major genetic diseases. 

There are certain misconceptions regarding marriages amongst relatives, marriages between social relatives like wife's brother and husband's sister can get married, where there is no role for blood relationship. 

To know why the consanguineous marriages result in children with genetic diseases, we have to know about genetic inheritence.  Due to inheritance parents and children, and brothers and sisters, commonly share 50 per cent of their genetic make-up. 

Similarly uncle and niece share 25 per cent and first cousins 12.5 per cent of their inherited genetic material as it originates from a common ancestor. In such situations if there are any `silent' genetic defects, then such errors manifesting as a disease in the child of a consanguineous parents is high. 

Whereas in non-consanguineous marriages, where people marry in a random manner, then for both the partners to share the same `silent' genetic defect is extremely rare. 

Hindus in northern India as a practice outlaw the consanguineous marriage by avoiding the same `gothra' or patrilineal relationship between the probable bride and the groom. In some of the western countries including the United States consanguinity closer than the first cousins are considered to be legally incest. 

15. C.S., Mumbai

* I am aged 48 years. I  have got fibroids in the uterus. My  doctor advised me not to worry. But this month I had heavy bleeding. Even after bleeding almost for 8 days, still I got slight red coloured discharge. Is it normal? I even got cervical erosion. Is it harmful. Pap smear report was normal in September 2014.

** Approximately 30% of women have fibroid tumors.  These growths are almost always benign (non-cancerous), and most of the time does not cause symptoms.  Most of the fibroids are embedded in the musculature of the uterus and some may be found on the surface of the uterus or in its cavity. The fibroids found in the cavity of the uterus can cause problems for conception and during pregnancy.

Fibroids typically grow larger as a woman ages, and usually decreases in size after menopause.  They can range in size from pea to larger than a pear.  

If the fibroids are without symptoms, it may be worth waiting for the fibroids to shrink at menopause. But if they are the cause for the problem, they may have to be removed surgically. The need of removal depends on the problem caused by the tumor. A small tumor embedded in the musculature of the uterus or on its surface need not be removed. But a small fibroid inside the uterine cavity may require attention. 

You are now in perimenopausal period. During perimenopause, menstrual cycles may become shorter, then longer, and blood flow may vary from month to month. Some women skip periods, and then resume menstruating regularly. Some may be having excess bleeding. The main causes are erratic hormone levels and decreased frequency of ovulations. Fewer ovulations result in hormone changes that cause the endometrium to thicken more than usual before it sloughs off, resulting in heavier, erratic, and prolonged periods.

Although menstrual irregularity is normal during perimenopause, some unusual bleeding can be a sign of a problem that needs medical attention The  gynecologist has to be consulted if  the woman experience any of the following in the perimenopausal period:

very heavy monthly bleeding, especially with clots (for example, soaking through a sanitary product every hour for more than a day)

bleeding after sexual intercourse

spotting or bleeding between menstrual periods

several menstrual cycles that are shorter than 21 days

several periods that last three days longer than usual

more than three months without a period.

16. A.D’C., Mangalore

*I am 53 years, have erection problem. I tried Sildenafil, but after sex I feel heavy and tiered. I tried homeopathic medication for a month, but it is of no use.

** Have you consulted physician before using Sildenafil citrate tablets. It is essential that this medicine to be used only if prescribed by a competent specialist. Approximately 15% of persons taking sildenafil experience side effects. The most common side effects are facial flushing, headaches, nasal congestion, stomach pain, nausea, diarrhoea etc.Other important side effects include rare cases of sudden loss of hearing have been reported with phosphodiesterase inhibitors such as sildenafil, sometimes with ringing in the ears and dizziness.

You may consult an urologist and have proper assessment before you go for medication  for erectile dysfunction.


17. M.K., Dubai

*I am 37 years. I get bleeding and pain while passing motion. I think I have piles. I want to know whether surgery is needed?

** You are probably having piles, also known as haemorrhoids. Haemorrhoids are dilated blood vessels around the anus, which may become bulky and enlarge to the point of protruding through to the outside. When this occurs, you may feel a lump coming down as a result of straining at the stool. They may itch or feel generally uncomfortable and sometimes bleed. The degree of prolapse of piles varies from not at all, to persistently hanging down through the anus as you describe. It is better to consult a surgeon to know what exactly it is. The best treatment is prevention through avoidance of constipation through eating a high fibre diet and drinking adequate water and fluids. Minor haemorrhoids may settle down with the use of short courses of soothing anti-inflammatory creams or suppositories. If they should become a persistent nuisance, the piles may warrant surgical attention.

18. R.N. Dharwad

*I am 37 years. I have itching problem in my ears almost every day. Sometimes it is severe and when I get cold it is more and irritating. I have used ear drops prescribed by doctors but still no relief.

** Itching of the ears may be the first sign of an ear infection, but if the problem is chronic, it is more likely caused by a chronic dermatitis of the ear canal. There is really no cure for this problem, but it can be made tolerable with the use of drops and creams. Use of ear plugs, alcohol drops, and non-instrumentation of the ear is the best  to avoid for infection.  Allergy also can cause itching and it may need appropriate treatment. You may consult an ENT specialist and get proper treatment. 

19. O.L., Mangalore

*I am 45 years of age. I have been checking my sugar- it goes without food is 269 and after food it goes till 400. What should be the normal sugar and your suggestions

** You seem to be having diabetes mellitus. Consult a physician at the earliest.

The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes. After the person has fasted overnight (at least 8 hours), a single sample of blood is analysed in the laborotary. 

Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl).

Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes.

A random blood glucose test can also be used to diagnose diabetes. A blood glucose level of 200 mg/dl or higher indicates diabetes. 

When fasting blood glucose stays above 100mg/dl, but in the range of 100-126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG or prediabetes do not have the diagnosis of diabetes, this condition carries with it its own risks.


20.S.D., Mangalore

* Is gym activities are containdicated for a person having bronchial asthma?

** One of the goals of treatment of asthma is to help to maintain a normal and healthy lifestyle, which includes exercises and other physical activities. By taking medications as prescribed by the  doctor, avoiding triggers, and monitoring the  symptoms and lung function will help you achieve this goal.

Activities that involve short, intermittent periods of exertion, such as volleyball, gymnastics, baseball, and wrestling, are generally well tolerated by people with asthma.

Activities that involve long periods of exertion, such as soccer, distance running, basketball, and field hockey, may be less well tolerated. .

Swimming is a strong endurance sport, is generally well tolerated by many people with asthma because it is usually performed while breathing warm, moist air. It is also an excellent activity for maintaining physical fitness.

Dr. Edward Nazareth

Dr. Edward Nazareth

Dr. Edward Nazareth: Born December 28, 1958. Dr.Nazareth holds medical degrees - M.B.B.S. (1982 Mysore Medical College, Mysore), D.Ortho (1986 Mysore Medical College, Mysore) M.S.(Ortho.) (1987 Mysore Medical College, Mysore).

At present Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Fr. Muller’s Medical College, Kankanady, Mangalore-575 002.

He is a resident of Kankanady.

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