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1. P.C., Dubai

*My elder daughter is 9 years. Basically she is a very sweet child but hyperactive. She easily mingles with other children and people. Her IQ is very good but lacks concentration. Her main problem, she is scared of dark. Anybody can easily scare her by telling her ghost stories. She loves to watch TV but as you know be it cartoon or movies evil is shown a lot. She does not sleep alone, she does not like to be in her room alone even daytime. As she has always been a fussy and hyperactive child I always end up scolding her for which I feel guilty later. I always loose my temper with her. I have another daughter who is opposite of elder one. How can we make her free from fear of dark? 

** Fear is a normal part of life for all of us, including young children. It tends to start when we try something new, something that  we have never experienced before, something that is an unknown. For kids, this happens almost every day, so fear has a lot of opportunity to rear its ugly head, especially at night. The fear of the dark tends to evolve around the time children are old enough to have a sense of imagination. Usually, the fear of the dark hits home for kids around the ages of 2 or 3, when they are old enough to imagine, but not wise enough to distinguish fantasy from reality. Television is  described as one of the worst offenders of fear of the dark. The sights and sounds on TV are too stimulating for the kid’s brains exposing kids to things that might not be scary for an adult but are terrifying for a child.

The best thing a parent can do for a child with a fear of the dark is to communicate, be respectful, and show that  they understand.

* Give the child a sense that she is safe, that she can handle her fear. You may give the fear a name. Explain to your child what fear is, and help her understand it is normal.

*Reassure your child that her fear of the dark is normal. But you should not get frustrated just because you know what she is afraid of does not really exist. Do not say this is stupid or belittle or tease. While the monsters may not be real, the fear is.

*In the 30 to 60 minutes before bedtime, do not expose your child to scary movies, TV shows, frightening bedtime stories, scary music or videos, or other stimuli that may be upsetting to the child. 

* Normally kids regress at night. You may hear, ‘I want mommy,’ so let  her know that this is OK, and you are there to help if she needs.

* Although it may be tempting to let your little one crawl into bed with you, resist the urge. You still have to give your child the tools to cope with her fear.

*To provide additional comfort and sense of security, it is also helpful to allow your child to snuggle with his or her favorite soft toy or security blanket throughout the night. If your child would like the light on, leave it on in its dimmest setting or provide a night light. You may leave the bedroom door open too, provided the child knows that it is not acceptable to keep walking out. 

*Do not say to your child, ‘Let me make sure there are no monsters under the bed,’ or ‘If you are a good girl, the monsters will go away’. You are giving her the idea that her fear has credibility, and she will not be able to get over it until he understands it honestly

*With the support of an understanding parent, most kids can get over a fear of the dark in a few months. But if the fear lasts longer, better to consult the pediatrician to determine if its worthwhile for your child to get some help.

Fear of the dark, monsters in the closet, or simply anxiety about going to bed – these are all relatively common in young children at some point during their childhood. How you, as parents and/or guardians, address your child's fears and offer reassurance will affect his or her ability to fall asleep and stay asleep.

2. S.M. Bhopal

* My doctor has prescribed oral pills as we wanted some oral contraceptive pills. I am breast feeding my  baby who is now 16 months of age. I breast feed him only once in a day. Can I use the pills?

** As you are breast feeding your baby once in a day, taking oral contraceptives may not do any harm.

Let me share the information for those mothers who regularly breast feed their babies and are anxious  about using oral pills. Some oral contraceptives contain both estrogen and progestin, others progestin only. Estrogen- containing birth control pills are not considered compatible with breastfeeding since estrogens suppress milk production. The progestin-only pill (also called the mini pill), has not been reported to affect milk production.

A small amount of the synthetic hormones in the contraceptives does enter the milk, but there is no evidence that this is a danger to the baby. Follow-up studies have revealed no long-term problems in babies and children who continue to breastfeed while their mothers use hormonal contraceptives, with or without estrogen. Some physicians, however, do question the use of hormonal contraception in lactating mothers because of possible unknown effects on their children’s long-term sexual or reproductive development.

Because of concerns about estrogen-containing contraceptives affecting the milk supply, it may be better to opt progestin-only oral contraceptives during lactation. However, the progestin-only pill is slightly less effective in suppressing ovulation than the combined estrogen/progestin pill, so it has to be taken absolutely as prescribed. One cannot occasionally “miss a pill” and still expect to be protected against pregnancy.

It is recommend that  lactating mother delay the use of oral contraceptives until at least six weeks postpartum. There are two reasons for this: the milk supply and breastfeeding pattern should be well established by that time, and an older baby is better able to metabolize any hormones that may appear in the milk. If one decides to use the combined estrogen/progestin pill, it is ideal to wait until six months postpartum, when other foods in baby’s diet can make up for any drop in  the milk supply.

3. E.B., Manipal

*I am 20 years of age. I am diabetic diagnosed 8 months  ago. My sugar level used to be very high and  I am on insulin. My parents are free of diabetic. Even no one is in the family have diabetic. Please suggest me, is this is because of my life style? If I control my diet after some years will this disappear  and can I  be a normal person? 

** Your diabetes problem is known as type 1 diabetes. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. The exact cause of type 1 diabetes is unknown. In most people with type 1 diabetes, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain environmental factors, such as viruses, may trigger the disease. This is a life long problem and can not be cured. You can only control the disease by proper treatment.

The goal of treatment is to keep your blood sugar level as close to normal as possible to delay or prevent complications. Treatment for type 1 diabetes includes:

Taking insulin 

Carbohydrate counting 

Frequent blood sugar monitoring 

Eating healthy foods 

Exercising regularly and maintaining a healthy weight 

The diabetes treatment plan requires round-the-clock care, which can be frustrating at times. But realize that your efforts are worthwhile. Careful management of type 1 diabetes can reduce your risk of serious — even life-threatening — complications. 

Here are few tips which may be of use:

Be firm and disciplined in managing your diabetes: Take the medications as recommended by your physician. Learn all you can about type 1 diabetes. Make healthy eating and physical activity part of your daily routine. Remember diet and exercises are important part of diabetic management.

Keep blood pressure and cholesterol under control: Have regular check ups that your blood pressure and cholesterol levels are normal. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.

Do not smoke: Smoking increases the risk of diabetes complications, including heart attack, stroke, nerve damage and kidney disease. In fact, smokers who have diabetes are three times more likely to die prematurely than are nonsmokers who have diabetes, according to the American Diabetes Association. 

Moderation in alcohol use: Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation and always with a meal. And be sure to check your blood sugar levels before going to sleep.

 4. D.S., Dubai

*I am aged 50 years. For the past one year I have been suffering from chronic pulling/heavy sensation in my back (from the left shoulder to left side of head through neck). MRI scan of the brain and X-ray of left side neck is normal. Neurologist prescribed one tablet  and suggested that to consult a psychologist as he suspected this to be due to work pressure. I am working in the gulf for many years but this  did not happen before. 

** It appears that you are having pain related to the cervical spine, most probably due to cervical spondylosis. Cervical spondylosis is a general term for age-related wear and tear affecting the spinal discs in the neck. Cervical spondylosis is very common and worsens with age. More than 85 percent of people older than age 60 are affected by cervical spondylosis. Initial symptoms can be pain in the neck, often radiating to one or both the arms and sometimes to the back of the head. Initially radiographs of the cervical spine may not show any changes. Later on,  as the discs dehydrate and shrink, signs of osteoarthritis develop in the X-rays, including bony projections along the edges of bones (bone spurs).Most people experience no symptoms from these problems. When symptoms do occur, nonsurgical treatments often are effective. You may take opinion from an orthopaedic surgeon. When there is pain due to inflammation, anti-inflammatory medications help. Regular exercises to strengthen the neck muscles help in prevention of the recurrence of pain. You may have to take the help of a physiotherapist to learn the best exercises for the neck.

If you are using the computer, either a desktop or laptop at the work place, it is important to look at the workplace ergonomics as part of treatment and prevention of neck pain. Perhaps the placement of the desk, computer workstation and/or placement of the computer monitor and keyboard can be improved to encourage improved upper back and neck posture. Your doctor might advise you regarding this.

5. R.D’s, Bahrain

*I am 40 years. We have a boy child of 8 years and we want one more child. I am working at Bahrain and my wife is at my native. I visit home once in a year. I am planning a visit soon on my annual vacation. Kindly advise what kind of preparations we need to do  to get a baby?

** You have not mentioned the age of your wife. I presume your wife is in her late 30s.  The possibilities of conception, (known as fertility) gradually declines in the 30s, particularly after age 35. Each month that she tries, a healthy, fertile 30-year-old woman has a 20% chance of getting pregnant. By age 40, a woman’s chance is less than 5% per cycle. So if you are planning to spend two or three months with your wife, she may not conceive. You may have to be with her for a longer duration.

It may be better for your wife to consult a gynecologist and get her advice about conception. The doctor also might advise certain tests to know the health status of your wife is conducive for conception. 

As far as you are concerned, there are no special advice required except that you have to have regular physical union during fertile days. Your wife’s gynecologist will suggest your wife the ways to  find out the fertile period.

6. APKKT, Mumbai

*I am a man of 46 years. During sleep at night, I feel and experience numbness in my hands. This I experience in in all positions  that is sleeping left side up, right side up and also facing upside. This I am feeling for the past one year. Due to this numbness I can not sleep longer time in any direction. I have to change my side frequently otherwise it starts paining and end up with no sleep.

** You may consult a neurologist for proper assessment. It appears that you have compressive neuropathy of the nerves supplying your hands.

7. S.B., Mangalore

*I am a married man of 40 and have a child of 9 years of age. My wife is 35 years. I have much sexual desire, but I satisfy myself by masturbating daily. When I am with my wife, I get anxiety and tension for no reason and I fail to get proper erection. By this, I get tensed and I fail to perform. 

** You seem to be having some apprehension about sex and it must be the reason for anxiety. Both of you require proper counseling by a trained counselor to solve this problem. There are no medicines through which your problem can be resolved.

8. L.L., UAE

*I am a man of 27 years. Since childhood, I have the infection of thread worms. It is horribly irritating it is in  and around anus. I am learnt that, this infection is lifelong and there are no medicine available to permanently cure or evade this. Is there any medicine to get rid of these small tiny parasites which are as strong as snails!! 

** I presume you have some other problem and not really thread worms. Thread worms can be effectively eradicated by medicines. Consult a proctologist (or a gastro enterologist) for proper evaluation of your problem.


9. M.S. Oman

*I am 29 years of age; presently work in Oman. About six months ago my IGE level was 425,  and doctor had prescribed some tablets, I used regularly for two months but even after that nothing is changed. Even now I get rashes on my entire body if am exposed to sun or if I sweat or even a little dust. My whole body turns red with some patches  and I get itching. It is really embarrassing when I meet peoples or go out for some meetings. 

** An allergen-specific immunoglobulin E (IgE) blood test is done to check whether a person is allergic to a particular substance. An allergic reaction occurs when the immune system overreacts to something, often in the environment, that is harmless to most people.(This triggering subject is termed as allergen for the person who is allergic to it). Common allergens include pollen,mold,animal dander, dust mites, foods (including peanuts, milk, eggs, or shellfish), cockroaches etc. A particular individual develops allergy to a specific substance. Some of the allergens can be avoided but it is very difficult to identify and avoid all the allergens.

You may consult a skin specialist who might refer to other specialists who might be able to help you to get over the problem by certain specific treatments. However if you are able to identify the allergen and avoid it, that will be the best remedy. 

10. Z.M., Mumbai

 *I am 32 years of age. I feel there is over stiffness in my organ. Whenever erect it is too hard like a hard stick. After intercourse I get terrible pain in my organ. Is this because of rigidness? Somebody advised me to gently massage with castor oil but of no use.

** I presume it is normal and it is probably your perception that it is too hard. However you may consult an urologist to know if there is any problem. 

11. S.K., Mangalore

*I am 38 years. I want to increase the size my organ in length and width  as I have been suffering from early ejaculation. I can not satisfy my wife because within few seconds I finish. 

** There is no way one can increase the length or breadth of the organ. The size of the organ has nothing to do with mutual satisfaction. If premature ejaculation is the problem, consult an urologist. There are certain medicines now available which might be of use in preventing early ejaculation.

12. J.P. Mangalore

*I am 27 years of age. I am working in gulf for the past 2 years. My problem is my body smells; While sweating the smell is strong and repulsive. I tried all types of deodorants, perfumes, body lotions, but it smells.  I take bath everyday and keep myself clean even then I smell and it is a big problem to go to office. I can not face anyone. 

** Sweating and body odor are normal in most of the people. Heavy perspiration and body odor can happen during exercises, when atmosphere is too warm, or when  a person is nervous, anxious or under stress.

Human skin has two main types of sweat glands: eccrine glands and apocrine glands. Eccrine glands occur over most of the body and open directly onto the surface of the skin. Apocrine glands develop in areas abundant in hair follicles, such as the armpits and groin, and they empty into the hair follicle just before it opens onto the skin surface.

When the body temperature rises, the eccrine glands secrete fluid onto the surface of the skin, where it cools the body as it evaporates. This fluid is composed mainly of water and salt.

Apocrine glands, on the other hand, produce a milky fluid that most commonly is secreted when  a person is under emotional stress. This fluid is odorless until it combines with bacteria found normally on the skin. Bad odor is a perceived unpleasant smell the body can give off when bacteria that live on the skin break down sweat into acids - is the result of bacteria breaking down protein into certain acids. The smell is perceived as unpleasant, many believe, because most of us have been brought up to dislike it.

For normal sweating and body odor, however, lifestyle and home treatments can effectively manage  the symptoms. For unusual bad odor, you may consult a skin specialist to know if there are any other causes. If there are no other causes certain lifestyle modifications might help.

One can do a number of things to reduce sweating and body odor. The following suggestions may help:

Regular bathing: Regular bathing, especially with an antibacterial detergent or soap, reduces the growth of bacteria on the skin.

Proper clothing : For daily wear, choose natural fabrics, such as cotton, wool and silk, which allow the skin to breathe. For exercise wear, manmade fabrics are preferred as they help to wick moisture away from the skin.

Antiperspirants at night: At bedtime, apply antiperspirants to palms or soles of the feet. Try perfume-free antiperspirants.

Relaxation techniques: Consider relaxation techniques such as yoga, meditation or biofeedback. These practices can teach you to control the stress that triggers perspiration.

Watch your diet. Caffeinated beverages and spicy or strong-smelling foods may make the sweat more or have stronger body odor than usual. Eliminating these foods may help

13. G.K. Karwar

*I am aged 30 years. Recently I have developed problem with bowel movements. I need to go three to four times in the morning to relive myself completely and my stools are sticky and hard. I consulted a doctor who advised blood tests and as there was Vitamin D deficiency he advised tablets. These days I get pain in my knee and elbow joints if I stand for long. I am worried about these things. Whether it is related Vitamin D deficiency? What may be done? 

** The changed bowel movements are unlikely related to Vitamin D deficiency. Deficiency of Vitamin D is very common and in most of the individuals it is without any specific symptoms.

The unusual bowel movements than usual are more commonly related to change in the lifestyle and food habits. More-frequent bowel movements could also be related to a mild, self-limiting illness that will take care of itself. If there are no other signs or symptoms, you are probably in good health. 

However you may consult a  gastroenterologist for further assessment.

14. U.S., Mangalore

*I am 35 years of age. Now I am overweight(90kg).I want reduce at least 15 kg within three months. Can you please suggest me which is the best healthy diet to reduce body weight. 

** Some one has compared body weight to balance in the savings bank account. To increase you have to deposit more and to reduce you have to withdraw. In our body the same principle works. However here deposition is easy and withdrawal is difficult. 

The food contains the substances that finally form the energy in the body. The energy is measured by a unit known as ‘calorie’. Some food items like meat, fat produce more calories and others such as green leafy vegetables produce less calories. The calories are required for normal body functions like breathing, digestion of food, walking etc. The calories are also required for our daily work. If you do sedentary work (such as the office work, routine household work) then the amount of calories you require are much less. If you do physical exertion or hard work then the calories requirement is more. Many of us eat the food that produce large amount of calories, but we do very little work to use them. The extra calories thus produced in the body are finally stored as fat and it increases our body weight and disfigure us.

To reduce the body weight you have to reduce the quantity of the calories you intake.  The amount of food intake has to be reduced and the food should be such that it produces less of calories. The food items like cheese, ghee, oil, meat and meat products are to be reduced. The diet should contain more of vegetables. The overall quantity of food intake has to be reduced gradually.

Regular exercises such as walking, swimming, bicycle riding help in burning the extra calories that is stored as fat. These are to be started and followed regularly. It may take long time to lose the weight. 

For weight reduction or even for general health exercises like jogging or running are not advisable. It is always better to have brisk walking on a level ground. If there are facilities you may even opt for swimming. You may start to walk with moderate speed for about 20 minutes per day initially. Gradually increase the duration as well as the speed and you may have to walk for minimum of one hour per day for minimum of five days in a week. 

15. S. D’S, Bangalore

*Do men masturbate even after marriage? Its been 2 years we are married. I always feel my husband is not interested in sex, hardly we have sex. Always he gives some reason and escapes. But few months back I found out he masturbates every night before sleeping, he doesn’t know that I know it. I asked him few times he said after marriage he never did. I feel depressed, unworthy. How should I solve this problem without discussing with him?

** Many of the married people have sex, as well as masturbate, for all sorts of reasons and it is normal. Most men and women do indeed continue to masturbate when they are in a relationship, and it does not mean that there is anything wrong. In fact, research shows that those people who masturbate more also have more (and more satisfying) sex. But if a partner avoids sex and gets gratification only through masturbation then it is abnormal. 

Your husband needs counseling to overcome this problem. You may convince him to go for counseling.

16. W.F., Mangalore

*May I please know if there are any tests to know the existence of worms in the stomach?

** Simple stool test is used to identify the worm infestations. However if there are clinical suspicion, treatment is more easier, cheaper than a stool test. A single tablet can get rid off most of the common worm infestations.

17. A.D., Abudhabi

*I am 36 years of age. I have two children, both are boys. 1st one is 5 year and 2nd one is 3 years of age and both the deliveries were by caesarian section. Recently I got pregnant again, and due to some defect in the baby ( i.e. brain was not developed  and there was a gap of 13mm in the back bone  and the abdominal (belly) wall was also defective. The baby's intestines, liver were outside of the baby's body, through a hole in the belly button. The hole was large) I terminated  this pregnancy through caesarian section. The doctor tried for the normal, but it did not happen. And I told the doctor that I want to try again for a baby, but the doctor advised me not to get pregnant again, because of my weak placenta and multiple small sized fibroids in my uterus and it would be problem for my life, and doctor did the tubectomy. My question is- 1) can I get pregnant again. 2) Is there any risk for my life if I get pregnant ( after having 3 caesarian ). 3) Tubectomy is a permanent or can be reversible. I am badly need for the baby girl.

** Your age may be the reason for having conceived the baby with grave defects. As the age of the mother advances, the incidences of these type of complications also rise. As you have already undergone tubectomy, which is a permanent method to prevent pregnancy, your chances of conception are almost nil. Though tubectomy  can be reversible by another major surgery, the results are not encouraging especially in women of your age. It is better to accept the reality and take care of your male children. Moreover even if you conceive again after reversing the tubectomy(which is very very unlikely), you can not be guaranteed that you get a girl child. 

18. J.G.Mangalore

*I heard that, white patches (shubba) will come on our full body, if we eat fish items and curds together.  Is it true? 

** White patches on the skin are normally due to fungal infection and are not related to diet. None of the diet causes skin problems unless one is allergic to a particular item. Milk and fish either alone or together do not cause any problems as long as the person is not allergic to them.

White patches on the skin are due to a skin condition known as tinea versicolor. Tinea versicolor is a fungus infection that mainly affects the skin of young people. This common condition is unsightly, but it is neither permanent nor serious. Spots can be either light- or reddish- brown or else lighter than the surrounding skin (hence, the name "versicolor"). There may be just a few spots, or there can be so many that they run together (like a shawl) and make it seem that islands of normal skin.

The cause of this condition is yeast called Pityrosporum orbiculare. This yeast is lipophilic, which means it likes fat. This explains why the condition is common on areas of the body that have a lot of sebaceous (oil) glands; mainly the chest, back, and shoulders. Sometimes, a few stray spots appear on the arms, legs, or groin. For some reason (fortunately!), the face rarely is affected.

This yeast is actually a normal resident of our skin. Factors like heat, humidity, and sweat help it proliferate in some people, resulting in a visible rash. Tinea versicolor is not contagious. Mostly, the condition appears in warm weather, or, at any rate, becomes noticeable only when we wear more revealing clothes and the sun tans the rest of the skin and highlights the parts affected by fungus.

There are many antifungal agents available to apply to the skin for the treatment of tinea versicolor.  It is better to consult a dermatologist for proper assessment and treatment.

19. R.M., Kundapur

*I am 31 years of age. My weight 80kg, height 5.75 ft. My sperm count is 30millions/ cu mm. Motility 50% non motility 40%. Is this count & motility sufficient for pregnancy? Whether early ejaculation is the problem or not?

** The report shows that your sperm count is relatively low. It is better to consult an urologist and find out if there are any definite causes for low sperm count. If there are no surgically treatable causes, you may be advised to take certain medicines which might increase the count and improve the motility. 

There are incidences where pregnancy has been possible even with low sperm count. 

20. J.G., Bangalore

*I am 24 yrs old. I started masturbating at a very young age by lying down instead of using hand. Now I am not able to do this using hand as get swelling if I do so. Also there is problem with erection; it is not getting hard as before. Is this because of masturbation? 

** You have not mentioned where you are getting the swelling-whether in the hand or in the genital region. If you are getting swelling in the genitalia consult a surgeon (urologist in particular) to know if there is any organic problem in the genitals. As explained earlier in this column there is no harm in masturbation.

Hardness of the organ is a myth and many of the men feel that they lose hardness for one or other reason. It is enough if a man gets erection sufficient to facilitate penetration. The erection may have to sustain till both get satisfaction from the physical union.

As age advances the frequency of ejaculation as well as desire for sex reduces. Some of the men attribute this to loss of sexual capacity. As they become more and more worried on their sexual potency they feel that the strength of the erect organ has also lessened. 

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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