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Magazine
To operate or not
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Problems like a sore throat, hernia and hair loss are common but cause tension and worry. Our panel of doctors offers advice and suggestions. There has been an overwhelming response from the readers to this column, which will be published as a monthly interactive feature. We carry below the answers to the first lot of letters.
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S.S. Balasubramanium of Salem:
My problem is that I have a hernia in the right groin (direct variety) for three years. I am managing without having an operation.Surprisingly, the bulge has not grown (in size) ... If I sit in a particular posture for 15 minutes, the pain subsides. Kindly advise me.
(We have received several letters from readers on groin hernia.)
Dr.Uma Krishnaswamy, General Surgeon, replies:
A groin hernia is a common problem and may be of two varieties: indirect or direct. A hernia may bulge when coughing, lifting weights or straining at toilet. It may slip back into the body when lying down or when the local muscles are relaxed. When a hernia becomes uncomfortable, it suggests that it is becoming trapped by the abdominal wall. This may damage the bowel within and necessitate emergency surgery. Ask your family doctor to refer you to a surgeon, before this happens. Routine hernia surgery is a simple affair, done by open or laparoscopy (keyhole) technique. Convalescence is short with patients returning to everyday activities and work early.
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Mr. Deendayal of Hyderabad:
I am 28 years of age, 5 feet 10 inches, weighing 70 kg. I defecate 4 times a day ... This is making my life difficult for the past 5 years. Please help me
(We have received several letters on Irritable Bowel Syndrome).
Dr.Uma Krishnaswamy answers:
It is likely that you have Irritable Bowel Syndrome, which is a disturbance in bowel function, for which no cause can be found as evidenced by normal tests. Dietary factors and stress can trigger symptoms, though they are not responsible for the underlying problem. Treatment has to be individualised and includes: dietary adjustment, stress management and medication. Dietary adjustment consists of avoiding food triggers. Yoga, meditation and biofeed back help in stress management. Medications may range from allopathic drugs to alternative medicines to kitchen shelf remedies.
Today, doctors have a better understanding of how to treat IBS and hence with treatment, your life need not be difficult.
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W. Ananthakrishnan of Arcot:
How can one prevent oesophagitis (and mild antral gastritis)?
Dr.Uma Krishnaswamy replies:
There are only two treatment options for gastro-oesophageal reflux disease: medicines or surgery. Medication works by suppressing or neutralising stomach acid or improving stomach motility or by providing a protective coating to the lining of the gullet or stomach. They have to be taken regularly under medical supervision.
Only your doctor can decide the appropriate medical management for you. There are many simple self-help preventive measures: Avoid eating large or fatty meals; Do not lie down within two hours of eating; Stop smoking; Avoid alcohol; Lose weight if overweight; Raise the upper end of the bed.
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Name withheld:
I have had piles for one and a half years and sometimes there is bleeding while passing motion ... Are there any side effects with laser treatment ?
Dr. Uma Krishnaswamy writes:
Piles or haemorrhoids are traditionally classified as first, second, third and fourth degrees according to the severity.
The standard treatment options are: For first degree, bulk laxatives (plus or minus sclerosing injection); Second degree, rubber band or sclerosing injection or infra-red coagulation or surgery (with or without laser); third and fourth degree, surgery or infra-red coagulation.
A laser is only a cutting and coagulating tool used for surgery. A laser haemorrhoidectomy is not superior to surgery without laser and also carries the same complications.
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Throat problems
T.S. Radhakrishnan of Chennai:
My 10-year-old daughter has tonsillitis. Is it necessary to operate though she has not suffered so far? Please clarify.
Dr. H. Ganapathy, E.N.T. Surgeon, replies:
The diagnosis of tonsillitis is made when one suffers from throat pain, fever, difficulty in swallowing, infected tonsils and glands in the neck. If your child did not have most of these, then a diagnosis of tonsillitis cannot be made. If the child did not suffer from tonsillitis then there is no need for tonsillectomy. Mere presence of tonsils does not warrant an operation unless they cause some sort of health hazard. I would also like to clarify that the only permanent solution for chronic tonsillitis is a tonsillectomy.
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Hair loss
P.M. Mohammed Haneefa from Kerala:
I am 32 years old. I have been losing hair excessively for the last four years. I am a `Hepatitis B' patient for four years. A skin specialist prescribed a few medicines and advised me not to take more medicines since that may adversely affect the function of liver. Even after using the medicines prescribed for two months, my condition has not improved. Can the hair loss be stopped completely or controlled to a great extent?
Dr. R. Muralidhar, Dermatologist, answers:
One will have to assess the cause or the hair loss before we promise you a cure. However, the mere fact that you have Hepatitis B will not produce continuous hair loss. I am sure your doctor would have done a complete medical exam for you and narrowed down the possibilities. The good news is that most forms of hair loss are treatable and the hair growth can be sustained with medications, thus preventing balding. Most of the medications that we use for treating hair loss do not affect the liver, and the presence of Hepatitis B is not an absolute contraindication. In general, we use vitamins, finasteride and topical lotions for the scalp, which are not hepato-toxic. The exact medication will depend on the type and cause of hair loss.
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Rajesh Jain from Karnataka:
I am 21 years old. I have had white patches on my body since I was 15. I have consulted many doctors but there has been no improvement. It is slowly increasing. I am tired of taking tablets for so many years. So please help me.
Dr. Muralidhar answers:
You probably have vitiligo, which is a loss of pigmentation in the skin and sometimes the hair. Sixty to 70 per cent of vitiligo patients do very well with therapies like PUVA and other variants of phototherapy. Those lesions, which are stable, non-progressive and unresponsive to medical therapy, can be tackled surgically. Of late there is a lot interest in antioxidant therapy of vitiligo and the role of vitamins. Newer modalities like pseudo-catalase and khellin are also being used. Discuss these options with your doctor. I assume that you have ruled out other causes like infections and some types of dermatitis.
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An aching head
Sanjay Jetty:
I am suffering from two types of headaches. 1. Single side (right). 2. Middle of the head (constant). I am 23-years-old and I have had this problem for at least six years. The pain is getting worse.
Dr. Prithika Chary, Neurologist and Neuro-surgeon, replies:
The headaches you describe could be migraine or tension headaches. Migraine is typically a one-sided headache, which can also involve the whole head, very severe, often associated with and relieved by vomiting, avoidance of light (photophobia), avoidance of loud sounds (phonophobia), tending to occur since childhood. Many family members may also have headaches. This is due to both abnormalities in the brain cells and blood vessels. This has specific preventive and curative treatment, which can lessen the frequency and severity of attacks. Do see a neurologist for a complete check-up including a CT scan of the brain, as a headache is also a symptom of more serious brain disorders.
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S. Hemachandran:
Could you tell me what is the sleep duration a person needs, with respect to age in general? I ask this because I heard one doctor say that one should not sleep for more than five hours if above 30 and that one should not sleep during the day on a regular basis. Of course, one has to sleep irrespective of the number of hours if he feels sleepy but I haven't seen any authentic reference. If possible please suggest some references on this topic also.
Dr. Prithika Chary answers:
The body is tuned by nature to do a lot of things at various parts of the day. This is known as chronobiology. Hormones are secreted in different amounts depending on whether it is night or day, and this is influenced by and also influences the sleep/awake cycle. The body needs rest once in 24 hours for a period of at least 6-8 hours and this is usually during the night. Sleep has two main components REM or rapid eye movement sleep and NREM or non-rapid eye movement sleep.
REM sleep is dream sleep and is more refreshing. The proportion of these two phases varies with age, children needing more sleep (almost 23 hours in newborns compared to the elderly who can get by with 4-5 hours of sleep.
Sleeping during the day is not necessary, but is not harmful. A "power nap" in the afternoon typically should not exceed 30 minutes when one feels fresh. A nap of around 90 minutes tends to leave one groggy and sluggish.
There are several references on sleep — go to Google search engine and type "sleep".
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A healthy heart
Mr. Shivaraman of Chennai:
I am 46 years old, wt. 71 kg, height 5-5'', bp.140/90. I am taking atenolol tab. I do not have either cholesterol or diabetes. I walk for 20 minutes in the morning. At 9 a.m., I have limited meals, at 3 p.m., tiffin and wheat rice at night. I have followed this for two months. During my work, I walk two km everyday.
Sometimes I feel some discomfort in my chest — heaviness/crushing/feeling of pinpricks. After a few minutes I am all right. Is there any major problem? Can changing my medicine rectify it?
My friend says I have to go in for angiogram to know the cause. Is it expensive? Last year I took a LIC policy for which they took an ECG and informed me that it was not normal. Subsequently, I underwent a treadmill test and found everything was normal. How is this possible? Also I want to reduce my weight. Please advise.
Dr. P. Ramachandran, Cardiologist, replies:
Long standing hypertension increases the risk of all types of coronary artery disease, chronic renal failure and stroke. Chest heaviness during walking suggests that you have significant angina. Another treadmill test along with consultation with a cardiologist will help to diagnose and treat.
Non-drug therapy for hypertension and coronary artery disease is very beneficial. First, you can reduce your weight from 71 kg to about 65 kg (for your height 5'5"/age 46 years). You can increase your intake of fresh vegetables and fruits and lessen the intake of oil and fried foods. Regular walking without chest discomfort is also beneficial.
As far as drugs are concerned, the dose of Atenolol can be increased to 50 mg twice daily, aspirin, lipid lowering drugs even if your cholesterol is normal, sublingual drugs like Sorbitrate and Isordil during chest heaviness or before exertion provide relief. Ultimately your full history, family history and clinical evaluation will be better.
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Incontinence
Name withheld:
I am 63 and suffer from incontinence due to prostrate enlargement. I was advised to take Duracard 1mg in the morning and 2mg in the night on a continuous basis. For almost a year I continued and presently stopped since I did not find any difference even if I stopped it. On some days I feel more urge and on others I am normal. At night, I hardly urinate even once. What is your advice?
Dr. Duraisamy, Urologist, writes:
Regarding your prostate enlargement you need some more investigations like Ultrasound KUB and Uro-dynamic evaluation following which the correct management can be advised. Tablet Duracard is useful only in early cases.
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Because of space constraints and the doctors' professional commitments, letters will be answered in batches. However, not all letters can be answered individually.
We request you to keep your letters short and focussed. Please do not send copies of your medical records.
Please indicate whether you wish to have your name published. Please mention your full postal address.
Send your queries to:
Sunday Magazine
(Ask the Doc Section)
The Hindu, Kasturi Buildings, 859-860,
Anna Salai,
Chennai - 600 002.
Or you can e-mail us at:
sundayhealth@thehindu.co.in
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