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Magazine
Ask the Doc..
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Irregularities with the senses and their remedies are some of the problems dealt with in the column.
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Nose trouble
G. Ramanathan, Chennai:
I have lost the sense of smell for the last 15 years due to chronic sinusitis, deviated septum and polyps. I underwent surgery in 1993. For a few days after that, I regained it but lost it again. Last year, an endoscopic test revealed multiple nasal polyps blocking the ``smell passage''. I was advised surgery. As the earlier procedure was a failure, I did not get operated again.
I am 63 years old and my general health is normal. I get the sense of smell periodically in the evening, for one or two hours. I do not have any problem in breathing.
Is there a way, without undergoing surgery, to regain some sense of smell?
Dr. H. Ganapathy,
ENT Surgeon, replies:
The loss of smell is most probably due to a mechanical block caused by the multiple polypi that you have. The only way to restore your sense of smell is to remove them. Leaving the polypi unattended to can lead to complications. The basic reason for the formation of polypi is an allergic reaction. Anti-allergic medicines prescribed by your doctor can temporarily control the symptoms. Polypi can be shrunk with the help of steroidal nasal sprays, but again it is temporary. It cannot be used on a long-term basis.
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In the genes
Name withheld:
My family has a history of `X'-linked recessive inheritance. Some of the male members have serious retinal disorders like high myopia, retinal detachment, total/partial blindness, vision in one-eye. My questions are: a) Is it possible to isolate the carriers in the family versus normal females? b) Is it possible to analyse whether an offspring of an affected person/carrier is either a carrier or an affected person? c) Is it possible to rectify this genetic defect in any way?
Dr. N.R. Rangaraj,
Eye Surgeon, replies:
Your question on `X'-linked recessive inheritance refers to genetic disorders in which the females are carriers and the affected persons are usually males. Female carriers of `X'-linked recessively inherited disorders can often be identified by some outward expression of the disorder. A female carrier's son will have a 50 per cent chance of inheriting the `X'-linked recessive characteristic. However 100 per cent of the daughters of the affected males are carriers and none of their sons inherit this `X'-linked characteristic. For eye conditions in which a genetic origin is suspected, a comprehensive ophthalmologic examination will establish the diagnosis of the eye disorder. A genetic workup will throw light on the genetic involvement. (A genetic workup consists of construction of a diagram called the pedigree to show the genetic relationships and medical history in a family. The pedigree allows establishing the patterns of transmission of the genetic disorder. This in turn enables the diagnosis of a genetic disorder and allows a risk assessment for family members). A woman who is known to be a carrier of a severe `X'-linked recessive disorder should have amniocentesis performed only if the information gathered is used. This procedure carries a small risk to both the mother and the foetus. The parents should make a decision for themselves based on the information given by the doctor. Treatment now is aimed at effectively managing heritable eye disorders. The most effective way to manage genetic disorders is by medical research in molecular and cell biology. This will ultimately lead to therapy and a cure for some of the disorders in the future.
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Eye strain
Name withheld:
I am 41 years old and work in a bank and experience blurred vision and eye strain after working for four to five hours. It is not a computerised branch.
When I had a complete check up, I was told I have power of + 1.5 and glasses to be used while working. But according to the brochure published by the Institute of Naturopathy, practising eye exercises can make me normal. I am trying this out continuously and the power has come down to + 1.
I would like to know whether it could be brought to normalcy? And also I would like to mention that my problem starts quickly only when I have not had proper rest i.e., up to eight hours on a particular day. Will this also contribute to my problem? I wear glasses for an hour or so on any particular day when the blurred vision commences. I sometimes experience a "pricking sensation" in the eyes. Is there a permanent solution?
Dr. N.R. Rangaraj replies:
You have a condition called Presbyopia, a natural aging process in which the human lens loses the elasticity in the lens fibres. The ability to focus at different distances is called accommodation. The aging process, or Presbyopia, causes the amplitude of accommodation to decrease in patients over 40 years.
The symptoms include: i) Longer reading distance required, i.e. the hands are too short to adjust for your situation. ii) Inability to focus on close work iii) Excessive illumination required for close work iv) Greater difficulty for near work as the day wears on. Presbyopia is treated by testing each eye, when the patient holds the reading card at the distance required for work. The weakest additional plus spherical lens that will give clear vision is then prescribed. This plus lens is also called the ADD. The ADD is the difference between the distance glasses correction and the strength of the lens needed for clear near vision.
The strength of this ADD also in part depends on the adjustments for work distance. For example, reading a book requires an ADD, which is, different from what is required for viewing a computer monitor. A person in his late forties will require +1.75 for a work distance of 30 cm and +1.00 for a distance of 45 cm.
There are no known exercises to improve the elasticity of the human lens and prevent Presbyopia. Reading glasses of the right power worn for Presbyopia makes reading and working strain free.
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Knee pain
Name withheld:
I am 80 years old and have pain in the knee point, experience stiffness, and find it difficult getting up and sitting down. Sometimes I wobble on my legs and there is a tendency to fall down! These are associated with aging. Is there a remedy to reduce the stiffness and pain of knee joints, in any of the medical systems?
Dr. S. Sivamurugan, Orthopaedic Surgeon, replies:
Your main problems are probably due to arthritis of both the knee joints. You will need to start using a walking stick immediately to prevent injuring yourself. The other methods of relieving pain in the arthritic knee are physiotherapy, medication with non-steroidal anti-inflammatory drugs and also using knee supports. If all these methods fail and you become more and more incapacitated, surgery may be recommended. This will help you remain independent and will relieve the pain, stiffness and unsteadiness.
However, surgery in the form of total knee replacement is chosen only after evaluating your physical fitness and medical condition very carefully.
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M.L.N. Murthy, Hyderabad:
I am 37 years old. I experience knee pain in cold weather. Is this arthritis?
Dr. S. Sivamurugan replies:
Pain in the knee joints during cold weather may be due to arthritis, but there are many other conditions that produce this problem. Only evaluation and investigations can help diagnosis. In arthritis, apart from pain, patients usually suffer from swelling, loss of movement and instability. In rheumatoid arthritis, small joints of the hand and foot are also involved. Osteoarthritis usually occurs in the elderly and since you are only 37, it is unlikely that you suffer from this. Please see an orthopaedician for further evaluation.
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'I have cysts'
Name withheld:
I have had irregular periods for the past six months. The USG investigation reveals that I have bilateral multicyst in both ovaries. I have abdominal pain during the period. What is the course of treatment?
Dr. Sumana Manohar,
Obstetrician and Gynaecologist, replies:
Irregularity in your menses pattern is because of anovulatory cycles (non-releasing of the egg on regular basis). This can at times be due to secondary to physiological changes like weight gain and secondary to hormonal problems. As your USG suggests that there are small cysts in your ovaries, there is a possibility of poly-cystic ovarian disease. But this needs to be confirmed by hormonal tests and a trans-vaginal ultrasound scan to look for a certain arrangement of the cysts.
Thyroid function and prolactin levels must also be performed to rule out the possibility of disturbances in these hormonal levels, which can also result in irregularity in your periods.
If you have gained weight, try to shed it. A low dose oral contraceptive pill or progesterone (hormonal tablets) cyclically can be considered in consultation with a gynaecologist to regulate your periods. Despite the above medication, if abdominal pain persists, antispasmodics and relevant painkillers will help.
Dear readers,
Please continue to write in at:
`Ask the Doc', The Hindu,
Sunday Magazine, Kasturi
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