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Thread: Medical Q & A.. 6

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    Default Medical Q & A.. 6

    Why is my BP fluctuating?


    Q. I am 30 years old and 32 weeks pregnant and my blood pressure sometimes goes up and sometimes is normal. My doctor suspected hypertension and suggested that I take Hypotone 500 mg. My only problem is that my diastolic is normal at 71 mmHg while systolic is sometimes below 140 mmHg and sometimes more. Before pregnancy, my blood pressure was always normal. Do you think that I could be pre-eclamptic or is it normal for the blood pressure to fluctuate during pregnancy?

    A.
    Hypertension during pregnancy can affect some women, especially in the older age and first pregnancy or if there is a family history of high BP in parents or siblings. Controlling the blood pressure with medications can be done, but frequent check ups at home, of the BP and testing for urine albumin are essential. There can be adverse effects on the mother or the baby due to this condition, but controlled BP avoids complications. Swelling of feet when associated with high BP, does signify pre-eclampsia. Taking a low salt diet, plenty of rest along with the antihypertensive, keeps things in control. Daily record of fetal movements too should be done.

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    What care is needed after a bypass?


    Q. I am 41 years old and have recently undergone a bypass surgery 57 days back. I went for my first review with the doctor and my blood report was as follows: serum creatinine: 0.98 mg/dl, cholesterol total: 179 mg/dl, triglycerides: 184 mg/dl (normal range is 34-150 mg/dl), HDL cholesterol: 30 mg/dl and LDL cholesterol: 113 mg/dl. Can you tell me the specific dos and don’ts on diet to bring down the triglycerides level? What is the diet advice to keep cholesterol levels within control keeping in mind HDL and LDL cholesterol levels? The doctor has cleared my chest incision. How long do I apply Betadine and Superiocin ointment after this? Can I undertake land travel now? Any dos and don’ts while travelling? Can I travel by air now? If yes, what are the dos and don’ts?

    A. One has to avoid fried and fatty foods and excess oil during cooking. Here one must be careful of hidden fats as is found in various confectionery products like biscuits, cakes and pastries. Regular brisk walking for at least 20-30 minutes a day and consumption of 3-5 servings of fresh fruits daily also helps. One must also try to consume plenty of fibre and avoid simple carbohydrates and those foods, which lead to sudden and rapid increase in blood sugar levels (foods with high glycaemic index) like white bread, chapattis made of refined atta, rice etc. One should also consume less of dairy products and even what little one consumes should be made out of skimmed milk. Besides these, healthy practices including Yoga and stress relief measures like transcendental meditation etc. are very useful. Following bypass surgery usually statin group of drugs are prescribed to keep the blood cholesterol level to as low as is possible. However, I would not advise you to start any medication on your own but to seek a consultation with your treating cardiologist in this regard.

    No ointment or medication needs to be applied to the incision site until and unless, there is a discharge from the incision or if the incision is infected.

    Normally after 6-8 weeks of bypass surgery, it is perfectly safe to travel both by road/air. However, before you do so, you must get a clinical consultation with your cardiologist and take any specific advice from him. Also during the flight, you must carry your medications and make sure that you don’t miss any dose.

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    Is surgery the only treatment for an epidermal cyst in an infant?


    Q. My daughter is 14 months old and she has a 7 mm epidermal cyst on her right cheek since 3 months. From above, it just seems to be a dark coloured dot but I can feel it when I palpate the area. She had dry skin in that area before. The paediatric plastic surgeon has advised excision. My question is does it need to be excised? Is there anything, which I can do to avoid surgery? I am really worried about the scar since it will be visible on the cheek. How big will the scar be and considering she is just 14 months, will it be less visible once she grows? Is there anything I can do after the surgery for getting a less visible scar? Can laser resurfacing be done in such young kids? My concern is about how much the scar will fade over a period of time with the use of any kind of oil?

    A. As your daughter has already been diagnosed to have a epidermal cyst, it has to be removed. Since the epidermal cyst arises from skin appendages, it has to be removed through a cut from the outside. Yes, there is going to be a scar no doubt.

    Please consult a plastic surgeon for its removal so the car can be made as inconspicuous as possible and kept within skin creases if possible. As it is in the cheek area as you say, it is very difficult to camouflage the scar. Secondly as time goes by the scar will fade.

    But as she is still a child as she grows older there are chances that the scar will stretch as she grows. But, that is a risk you have to take because now the cyst is small the scar is going to be smaller, if the cyst grows larger then the scar is going to be equally longer.

    Though I fully understand you concern as a mother, I would suggest that you please go ahead with its removal and after the removal please consult your plastic surgeon for scar care treatment. LASER resurfacing is not advisable for the child according to me. Also for the fact that, as she grows the scar is going to change, so please do not do anything right now apart from the removal and local scar care as advised by your surgeon.

    All the best to your daughter for the excision

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    Why do I have vertical ridges on my nails?


    Q.
    I am a 27 years old male having vertical ridges on the surface of my nails. Is this normal or indicative of upper abdomen disease or nervous disorder? I smoke heavily and have been consuming codeine in the form of corex daily (50 ml) for the last three years. Please tell me the side effects of codeine.

    A. Ridges in the nail plate are a natural occurrence - this is because the nail bed has vertical ridges and the underside of the nail plate has grooves. It is upon this rail and groove that the nail plate grows forward; much like a train rides forward on its tracks. When the ridges become apparent, it is usually due to a dried out nail plate. The nail plate is constantly being bathed by an upward tidal flow of oils and moisture from the nail bed that transmit through all the layers of the nail plate and is the reason why the nail plate has a semi-shine to the surface. This natural oil and moisture helps the nail cells plump, give them the ability to flex under pressure, and ride across each other under pressure. The nail plate cells lie across each other much like the scales on a fish. The lack of proper oil levels in the nail plate will allow the rail and groove to be seen as vertical ridges in the nail plate.

    I would suggest using good quality nail and cuticle oil that contains (among other essential oils) jojoba oil and vitamin E. The tiny molecular structure of jojoba oil can penetrate the surface layer of the skin and nails, open up the cells and allow the large molecule of the other essential oils to be drawn into the nail plate and the skin after it.

    A potentially serious adverse drug reaction to codeine, as with other opioids, is respiratory depression. This depression is dose-related and is the mechanism for the potentially fatal consequence of overdose. Please see a doctor about this issue at the earliest. It also causes constipation in many patients

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    When do the transplanted hair fall and re-grow?


    Q.
    When do the transplanted hair usually fall and new hair grow after the hair transplant operation? Is it possible that the transplanted hair never fall?

    A. Normally, any hair in the scalp has a life cycle, where they grow for 2-4 years (the growing phase is known as Anagen), after which it falls (the falling phase is known as Telogen), but the roots remain and take rest for 2 months (the resting phase is known as Catagen) and then grow again.

    Hair when transplanted, usually go into the falling phase, where the hair fall off 2-3 weeks after the operation, but the roots remain, take rest for 8-10 weeks, and then grow back 10-12 weeks after the surgery. This is the normal course. However, due to some medicines applied nowadays, the hairs may not fall, but this cannot be assured. The transplanted hairs will begin to grow 3 months after the surgery, if done properly.

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    Can I conceive after treating tuberculosis of uterus?


    Q. I am a 30 years old woman, suffering from tuberculosis in uterus and one of my tubes is blocked. I am taking medicines for treating tuberculosis. Can I conceive after 6 months?

    A. Once tuberculosis has been diagnosed in the uterus, the tubes are usually involved in all cases. One of your tubes is already blocked. The other one though open may not be functioning to transport the egg to the uterus. After completing 6 months of treatment, you need to undergo a uterine biopsy again to check the pathology report, AFB culture to see that you are responding to treatment. After a minimum of 9 months of treatment, you can undergo a hysterolaparoscopy by infertility expert. Accordingly the expert will be able to give you an idea regarding possible conception through IVF-ET (test tube baby). If you do not have TB anywhere else, your husband needs to have his semen tested to rule out genital TB in him (something that most people forget to do).

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    How do I cure my gastric problems?


    Q
    . I am a 30-years-old male suffering from headache and intestinal gas blockage for quite some time. To cure acidity, I take Digene. Please tell me how to get rid of headache and gastric problems.

    A. I note from your symptoms that you seem to be suffering from acid peptic disorder. Sometimes, similar complaints are also seen in those suffering from irritable bowel syndrome. However, it is advisable that you should undergo some basic evaluation, which includes blood counts, ESR, an ultrasound of upper abdomen. If your symptoms persist, then you may need an upper gastrointestinal endoscopy. It is common for patients to attribute their headache to their abdominal symptoms. But, I suggest that you should get a check up for your headache by a physician for specific causes such as migraine, refractive error of eye, high BP, etc.

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    What kind of a skin disorder do I have?


    Q. I am 40 years old and all of a sudden I develop hives on my left cheek, which leads to itching. The left part of my face then starts to swell and my head starts hurting. I took Benadryl (diphenhydramine) but the swelling is still there. My head turns cold too. What is my problem?

    A. You seem to be having a condition called angioedema. Angioedema is an uncomfortable and disfiguring type of temporary swelling and at worst a life-threatening one. It is very similar in many ways to urticaria, with which it often coexists and overlaps. Although both conditions may result from allergy, mostly this is not the case when they keep happening without apparent cause. The swellings happen especially in the lips and other parts of the mouth and throat, the eyelids, the genitals, and the hand and feet. If you get angioedema one or both of your lips may look like sausages, your eyelids may be nearly or even completely closed by swelling, or your tongue may be so swollen that you have difficulty speaking.

    Angioedema is life threatening if swelling in your mouth or throat makes it difficult for you to breathe. Less often the sheer amount of swelling means that so much fluid has moved out of your blood circulation that your blood pressure drops. Fortunately only a small minority of people with angioedema get these dangerous features, but if you are one of them you need detailed instruction by a specialist in the necessary safety precautions, and special care to make sure that some undiscovered cause of your trouble has not been overlooked.

    Angioedema is called acute if it lasts only a short time (minutes to days) and does not keep coming back. A typical example would be angioedema caused by eating shrimps or prawns if you are allergic to them. However, acute angioedema can also be caused by the same things, which cause chronic angioedema.

    If angioedema keeps coming back over a long period, it is called chronic angioedema.

    If one is hypersensitive to aspirin, or some other drugs, one may get swelling which can sometimes be life-threatening, not only from aspirin, but also from other painkillers such as ibuprofen and other drugs of a type also used for rheumatic conditions.

    The treatment of angioedema is in many ways very similar to the treatment for urticaria. You may need adrenaline (epinephrine) inhalers or injections if you have swelling in your mouth or throat, so that you have difficulty in breathing or if this seems a danger. In the rare form of angioedema caused by lack of C1 inhibitor, Adrenaline seems not to help particularly and antihistamines are of no use, though people still try adrenaline; other treatments are more important in C1 inhibitor deficiency.

    Avoid the cause if you or your doctor can find one. Allergy to nuts, latex, other foods, and medicines can all cause angioedema. Avoiding medicines, which cause angioedema in ways other than allergy may solve your problem. Aspirin hypersensitivity for example is not a true allergy, but is important and means you also have to avoid some other medicines and may have to avoid some foods.

    Antihistamines often help tremendously in preventing swellings, and it may be worth your while to take one regularly. Make sure you get one with no unnecessary side effects. If you take them by mouth it takes about an hour before they get into your bloodstream.

    But in some people antihistamines don't help the angioedema at all. This is very frustrating. Sometimes when this happens tablets used for hereditary angioedema (tranexamic acid and epsilon-aminocaproic acid) help when antihistamines have failed. We don't know the reason for this, but we are grateful when it works.

    If you feel an attack of swelling is not under good control, or might slip out of control, get yourself to a hospital with emergency facilities

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    Can we give antibiotic to a child in a feeding bottle?


    Q. Can we give antibiotic to a three years old child in his feeding bottle with the milk?

    A. Though there should not be any problem, but it would change the taste of the whole milk and the child may develop aversion. Anyway such a big child should not be drinking milk with a bottle now. You could mix the medication in a small amount of milk and give it separately.

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    Why is my daughter afraid of balloons and leaves?


    Q. My eight years old daughter is afraid of balloons and leaves. Till the age of five years, she was fond of balloons and would play with them. The fear started after that. We do not know why she is afraid or what made her frightened. She trembles at the sight of a balloon and runs away from the room itself and cries for a long time. Likewise with leaves she is afraid to touch the leaves but not afraid of seeing it. I have tried to make her understand that they do not do any harm but I could not force her to touch it because she trembles and starts crying. Can this problem be treated?

    A. Every condition can be treated. Perhaps your daughter was startled by the loud burst of a balloon. She carries the association of balloon with loud noise. Do not force her to handle leaves if she is unwilling to touch them. If she is happy and playing well, attending school and making friends, I would just ignore these points. But if she is generally scared of most things and wishes to be alone most of the time, you should take her and see a Child Psychologist.

    Make sure her diet and sleep and rest hours are taken care of and that she is not over-stimulated by TV

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