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1. K.M., Delhi

* We are planning to have a baby. My wife has a 26- 28 day cycle. I want to know the best possible to time for physical union to conceive.

** The most effective time to have sex is during  the fertile window, which can last up to six days every month. These six days are the five days leading up to, and the day of ovulation, when  the body releases an egg. The egg will survive for about a day once released. But sperm can survive for up to a week. Hence there is a six-day window for sperm to meet an egg.

Woman is most likely to conceive if she has sex one or two days before the ovulation. 

When the cycles are regular the day of ovulation is 14th day prior to the onset of periods. For example if the periods likely to start on 25th of a month, then the day of ovulation is 11th. (That is 25-14=11).  However,  the cycles may not be regular and it is tricky to pinpoint the exact day or two just before ovulation. It is normally advised to have physical union almost daily during the midcycle days. That is if the cycle is of 30 days, then regular physical union from 10th day to 20th day is advised for conception. 

Some women are able to identify the day of ovulation by checking the vaginal discharge. One of the simplest ways of working out  the fertile days is to check  the cervical mucus every day. Increase in  vaginal discharge  and if it can be stretched like egg white between two fingers, the woman has reached the day of ovulation. This is called fertile mucus. Physical union on that day likely to facilitate conception.

2. J.S., Karkala

*I am 47 years of age. For the past 5 months I have back pain which moves from the back up to ankle on the right side. I am taking medicines including steroid capsules. I was told by an orthopaedic doctor that it was sciatica and he advised physiotherapy. What shall I do?

** It is better to avoid steroids unless the problem is properly diagnosed by an expert and steroids are advised. There are lot many problems which can cause backache and radiating pain along the lower limb, sciatica. Sciatica simply means pain moving down in the back of thigh to the leg along the sciatic nerve and is not a diagnosis. Consuming steroids can mask the symptoms and at times may aggravate the disease.

You may consult another orthopaedic surgeon or a neurologist for further assessment to find out the cause for the problem. You can be relieved of the symptoms by appropriate treatment.

3. T.V., Mangalore

*My wife is 30 years of age had asthma attack during her high school time. After that she had seldom asthma attacks except sneezing. We are in Kuwait. After our vacation Mangalore last month, she started coughing and sneezing. Some times, she feels mild wheezing, not every day. She took anti-allergic tablets for 20 days. Except a little relief, still sneezing continued in the morning until noon. Kindly advice me what treatment can be done with out ant- histamines to stop this. 

** It may be better for her to consult a physician to know why the problem still persists. If the symptoms were due to some  external allergen in Mangalore she should have got relief after returing to Kuwait. She needs further assessment.

4.P.P., Dubai,

*I am  26 years, married for nearly 2 years and we are trying for a baby. I got pregnant now but my HCG level was 22.7 and on 34th day of last menstrual period, I was having bleeding without pain and after two days it was same 22.1 and after that again doctor told to HCG test after 3 days it was 29; I had spot bleeding. Doctor told me it was unhealthy pregnancy. Can I know in future I will get healthy pregnancy and why it has happened to me like this?

** Human chorionic gonadotropin, or HCG, is a hormone that appears in women during pregnancy. HCG is produced in the cells of  the  placenta during pregnancy. It can be detected in blood tests roughly 11 days after pregnancy begins. 

The abnormally high levels of HCG is seen in a rare type of growth or mass in  the uterus called a hydatidiform mole. This type of mole forms when tissue that should form part of  the placenta develops in excessive amounts. This is abnormal and termed as molar pregnancy. As this is not normal pregnancy it is recommend  to remove the abnormal mass by suction curettage procedure. The woman who had molar pregnancy is normally advised to avoid further conception for least six months. The problem may not recur again.

5.A.L., Kuwait

*I am 36 years. I am suffering from heavy dandruff. It is not normal one but very thick and now a days I started loosing my hair. It spreading to my ears, nose and eyebrows and chins too. I have tried medicines but no use. If I use shampoo on daily basis, I loose more hair. Kindly suggest me something new.

** It may be better to consult an experienced skin specialist and get proper treatment. Dandruff can be controlled with proper medication. Your condition may not be dandruff alone.

6. R.A., Mangalore

*My age is 30 years. I have some skin problems which are not cured from past 1 year. I have also met lot of doctors but they said there is no medicine for this. The name of the disease is neurofibromatosis. 

** The neurofibromatosis is the genetic disorders of the nervous system that primarily affect the development and growth of neural (nerve) cell tissues. These disorders cause tumors to grow on nerves. These 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. Some of them may be bigger than that. This disorder rarely associated with other abnormalities such as skin changes and bone deformities. There are two types of disorders termed as neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2). 

NF1 is the more common type of the neurofibromatosis. In this type there are tumors, changes in skin or bone abnormalities; there may be one or more of the family members having similar problem. NF2 is less common. NF2 is characterized by bilateral (occurring on both sides of the body) tumors on the eighth cranial nerve (responsible for hearing and maintaining the balance of the body). 

Your problem appears to be type 1 neurofibromatosis. In most cases, symptoms of NF1 are mild, and patients live normal and productive lives. 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. Surgical removal of the tumors is done only when the tumor causes the 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.

The problem of neurofibromatosis can not be controlled by medicines. Though the disease is genetic it is not hereditary, in the sense it is not transmitted to all the children or grand children.

7. M.O., Mumbai

*I  am 65 years, I have type 2 diabetes. I am now having the erection problem. 

** Diabetes and age both must be the cause for the problem. Now there are effective medicines for treating the problem related to erection. You may consult your physician who treats you for diabetes about the problem. It is better to take medicines only after consulting the physician and as per his advice as these medicines can cause dangerous side effects in certain individuals.

8. A.D., Mangalore

*My daughter is 19 years  of age. Every morning when she get up from sleep there will be blood drop on her pillow. We don't know from where this blood is coming from nose, mouth or throat. How can we find out? Which doctor we can  consult?

** This is more likely  through saliva drooling in sleep. Blood tinged saliva may be due to biting the tongue during sleep or damaging a tooth or gum tissue as a result of grinding or gnawing during sleep. Consult a dentist first. 

9. C.D., Mysore

*I am 79 years of age. I have diabetes. My feet burn,ache,pain etc. especially more so when I lie down. Because of this I am not able to sleep. Is there any remedy for this problem?

**  These symptoms are related to neuropathy secondary to diabetes. You may consult your physician or a neurologist. Though difficult to cure, consistently keeping blood sugar within a target range can help prevent or delay the progression of diabetic neuropathy and may even improve some of the symptoms already have.  The  physician will determine the best target range based on several factors, such as age, how long one has diabetes, and overall health and the presence of other medical conditions.

10. J. P., Udupi

*I am 22 years of age and I want to lose at least 15 kgs of weight. What is the best way to lost weight?

** Some one has compared body weight to bank balance in the savings account. To increase you have to deposit more and to reduce you have to withdraw the balance. 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 at least five days in a week. 

11. V. R, Mangalore

* I am 31 years of age and I am married for the last 4 years. After having physical union with my wife, the foreskin of my organ turns red. Is this any major problem?

** If the redness is not associated with other symptoms like itching or burning, then there is no problem. If it is burning or itching then consult a skin specialist.

12. C.P, Mangalore

*My husband is 37 years old and we live in gulf with our two kids. Of late my husband is addicted to alcohol and has no interest in his job. He has a good job. I do not understand   the reason for his drinking problem and I am worried with his behavior. Earlier he used to love his job but of late he has changed a lot. Could you please suggest what can be done to this problem?

** I hope you are aware of the alcohol de-addiction centers where the alcoholics are treated. The alcohol de-addiction centers are found in many of the cities in India and are also functioning effectively in Mangalore. Alcohol addiction is a ‘disease’ and it can be cured provided the ‘patient’ (the alcoholic) and his family co-operates with the treatment modalities.  Alcoholism is not a simple disease that can be treated by medicines alone. It can not be just stopped by one firm decision. The condition is characterized by the fact that the sufferer, despite many attempts at control, finds that their drinking and the attendant consequences continues to get worse over the period, and the dependent person's guilt, shame and remorse levels become increasingly more burdensome. Attempts to stop can result in withdrawal symptoms which are relieved by taking more alcohol. Attempts at control ('just a couple of drinks won't hurt') almost always end in drunkenness, and things seem to get progressively worse.  The treatment includes medicines to control the withdrawal symptoms, psychological counseling, group therapy, and support from others like alcoholic anonymous. The understanding and the support of the family is also very essential. As with all addictive behavior problems, it is very difficult for a person to acknowledge the existence of a drinking problem and to stop it. Unless he/she makes up the mind to get treated, it is hardly possible to get cured from the ‘disease of alcoholism’.

13. R.A., Mangalore

* I am 31 years. I am married for three years now. Initially we were not so serious of having a child but we were using condoms for nearly one year and we stopped using them. As I did not conceive we consulted one gynecologist where both of us were checked and reported as normal. But new problem cropped up. My husband is not able to maintain the erections and it is almost six months now, we hardly had intercourse. Earlier when he used condoms it was perfect and even later. But now when we are getting serious to have a child this problem is troubling us. We are based in a remote area in gulf where there is not much of entertainment and fun, and sometimes I feel that my husband gets sick of the place, environment. His work is hectic that he gets no mood.  I try to make him feel good and always ready for him and now I too am depressed as to what the problem is? 

** The problem your husband is having is termed as ‘erectile dysfunction’. Erectile dysfunction (ED) is the inability of a man to achieve or maintain an erection sufficient for his sexual needs or the needs of his partner. Most men experience this inability at some point in their lives, usually by age 40, and are not psychologically affected by it. Some men experience chronic, complete erectile dysfunction (impotence), and others achieve partial or brief erections. The erectile dysfunction can have a negative impact on self-esteem, quality of life and interpersonal relationships. It has many causes, most of which are treatable. 

The causes of erectile dysfunction can generally be classified as either organic or psychological. Although the majority of men with erectile dysfunction are thought to have an organic factor, psychological aspects of anxiety, depression, self-confidence, and partner relationship are important contributing factors.  Consequently, many men have a combination of organic and psychological factors.

The organic causes and risk factors of erectile dysfunction include vascular disease, diabetes mellitus, hypertension (high blood pressure), certain medications and neurological disorders, chronic alcoholism, prolonged heavy smoking, pelvic trauma and spinal cord injury,  hormonal abnormalities, and other medical and surgical conditions. 
Although erectile dysfunction is often assumed to be a natural consequence of aging because its incidence increases with age, it is not inevitable. However, many conditions associated with aging—vascular disease, diabetes, cancer, and their treatments—may cause erectile dysfunction.

Erectile dysfunction can cause emotional strain between a couple. Many times, men will avoid sexual situations due to their emotional pain associated with erectile dysfunction, causing their partner to feel rejected or inadequate. Some couples consider seeking treatment for erectile dysfunction together, while other men prefer to seek treatment without their partner’s knowledge. A lack of communication is the primary barrier for seeking treatment, and can prolong the suffering. 

As there is effective treatment for the problem, your husband may seek the help from an urologist first.  He will do a thorough assessment to find organic causes and suggest proper treatment. If there are no organic causes and if required the help from a psychiatrist may be sought. Your support and co-operation will go a long way in managing the problem. To appropriately treat erectile dysfunction, you have to strengthen your relationship with your partner, try to communicate openly and honestly about the condition. Couples may also want to seek counseling to confront any concerns they may have about erectile dysfunction and to learn how to discuss their feelings. Try to maintain this communication throughout the diagnosis and treatment process. In fact, treatment is often more successful if couples work together as a team.

14.  N.D, Mangalore

* I am 40 years of age. I have the  varicose vein problem. The vascular surgeon has advised me to wear the stockings [below knee only] to compress the one leg. Does it is of help? I am very confused. 

** For many people, varicose veins and spider veins — a common, mild and medically insignificant variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes the condition leads to more serious problems. Varicose veins may also signal a higher risk of other disorders of the circulatory  system.

Wearing the compressing stockings for varicose veins is often the first approach to try before moving on to other treatments. Compression stockings are worn all day long. They steadily squeeze the legs, helping veins and leg muscles move blood more efficiently.  The amount of compression varies by the type and the brand.

Some people think of compression stockings as being uncomfortable and unstylish, but their negative fashion reputation is no longer deserved. Stockings for Varicose Veins come in a variety of strengths, styles and colors. With the variety offered, you’re likely to find a stocking that you are comfortable in wearing.

When purchasing compression stockings, make sure that they fit properly. Using a tape measure, (you or your pharmacist) measure the legs to ensure you get the right size and fit according to the size chart found on the stocking package. Compression stockings should be strong but not necessarily tight. If you have weak hands or arthritis, getting these stockings on may be difficult. There are devices to make putting them on easier.

15. M. D’s. Mangalore

*I am 23 years of age. For the last one year I am experiencing great hair loss, I have taken treatment from local center which advertised in the periodicals but there is no improvement and it is still falling. I have tried ayurvedic oil also. I had read in the papers that it can be due to hormonal problem. How do I find out what the problem is?

** Loss of hair is the common problem. The influence of genetically inherited factors and male hormone (androgen) on the hair follicle (root of hair) is the main cause for hair loss. It is only the influence of the hormone causes baldness in certain individuals. It is not the deficiency or excess of androgen that causes the hair loss. Any medication to suppress androgen can cause lot of other problems; hence it is not practiced as a treatment for hair loss. 

Hair loss can begin at any time after puberty. There is no definite cure for this. If the hair loss causes baldness, various options are now available to conceal the hair loss. At some centers surgeries like hair grafting are available. One drug Minoxidil is available for local application. It may be used as per the prescription of skin specialist.
It is better to avoid repeated and frequent shampooing. Avoid using excessive use of oil on the scalp. If you have not consulted a specialist so far it may be worth consulting skin specialist. In some individuals certain medications might help to reduce hair breaking and loss of hair.

16. M. M., Dubai

*I am living in Dubai. I got married at the age of 21 and the first 2 ½ years we did not want to have a baby as it was too early for me (and followed safe days). Now we are going to complete 3 years of our marriage and I am trying to have a baby for the last 6 months but am not conceiving. I am scared to see a doctor and to do tests. For how long do you think we can continue in a natural way to conceive? 

** As you are already married for three years, it may be better for both of you to
consult specialist now. As the tests are easy in men it may be better for your husband to consult an urologist (or general surgeon) first. If he turns out to be normal then you can undergo some basic tests as per the advice of the gynecologist. There is nothing to get scared or ashamed of while consulting the doctors. They are trained to treat people like you.

17. B. R., Mumbai

*I am 24 years and got married last year. I am pregnant and am in the 3rd month. I am working and I have a lot of problems like weakness, headache, and severe stomach pain. I have been going for regular check ups and the doctor told me that I have urinary infection. I have done blood / urine tests and my hemoglobin are low. I am not able to eat properly. Are these problems jobs related or due to any other reason? There is a lot of office tension. Should I give up the job?

** It is difficult to presume the cause of your present problems-whether due to hormone changes related to pregnancy, urinary tract infection or related to the tension of your job. You may discuss this with your doctor and take appropriate decisions. Most of the initial problems related to hormone changes of pregnancy will gradually disappear as pregnancy approaches 2nd trimester, that is 4th month of pregnancy. If you feel that the job is giving too much tension, plan for a new job or some changes in the working pattern.

18. K. K., Mangalore

*Is it possible that even after a negative blood test for pregnancy (after 40 days of amenorrhea) to have a miscarriage? If yes how the baby could have been saved?

** What type of blood test revealed the pregnancy? Normally urine tests are done to detect early pregnancy. Some of these tests will be positive only after 45 days or so. The abortion at 40 days, without any signs of pregnancy can be just a prolonged menstrual cycle. For various reasons, once in a while the menstrual cycles can be altered and an extended cycle can give the impression of pregnancy.  Even if it is an early abortion, the most probable cause is the defective embryo. Such embryo does not grow and are removed by natural abortion. 

19. J.N. Bangalore

*I am 33 years of age having two children. I had normal deliveries. My height is 5.5" and weight is 72 kgs. After the delivery my weight increased 82 kgs, by dieting and with exercises on a treadmill, I managed to reduce it to my present weight. I have the problem of huge tummy. It is so much that I am not able to wear normal dresses. When I sit the lower part of my abdomen is touching my thighs. My periods were irregular initially, I took treatment to regularize them and I conceived. My periods have totally stopped. I want to get back my figure.

** First you have to consult an endocrinologist or at least a gynecologist to find out the cause of   amenorrhoea. You may be having some hormonal problem which might be the cause for excess weight gain as well as amenorrhea (absent menstrual cycle). For losing extra fat,   you may have to continue exercises and follow strict diet. Consulting a physiotherapist to know specific exercises to strengthen the abdominal muscles might help you to reduce the tummy size. If the obesity can not be managed by exercises and diet, plastic surgery might be of benefit.

20.  G.G., Mangalore

* I am 21 years of age. During sleep I am having wet dreams. I have taken medication to stop this but of no use.

** A wet dream is the uncontrolled ejaculation of semen from the penis during sleep. The fluid is creamy to clear in color. Wet dreams are caused by sexual excitement from dreams, and or by physical stimulation like rubbing against blankets, the bed, or a full bladder. It is very normal! Guys get them! When boys enter puberty a lot of hormonal changes occur. These changes will result in many, but not all boys experiencing episodes of spontaneous erections during sleep, during the day and wet dreams. If these episodes do occur there is no need to worry or feel guilty because they are part of normal sexual development. 

Most boys experience wet dreams between the ages of 12 to 18. Generally boys have fewer wet dreams once they start masturbating or once puberty is over. Also if teenagers become sexually active will experience fewer, or no longer have wet dreams.
Wet dreams are a normal part of the many things that are changing in the body during puberty. Not all boys have wet dreams and that's okay too, it doesn't mean anything is wrong with you. If you do have a wet dream, it just means your body is maturing sexually, which is a step towards becoming an adult. 

There is no treatment or medicines to stop getting wet dreams. Some traditional practioners give some medicines which do not work.

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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