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Thread: Medical Question with Answers.. 2

  1. #41
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    Which is the best time for one to undergo a foetal echo test?


    Q. Could you tell me the best time during pregnancy to get a foetal echo test to rule out foetal congenital cardiac defect. Is foetal echo done by an ultrasonologist or a cardiologist? Please clarify.


    A. Foetal echocardiography refers to a detailed evaluation of the heart of the unborn baby. It can be carried out anytime after 13 weeks of pregnancy. It's accuracy is maximum at 22-26 weeks of pregnancy. However, since this period is beyond the outer limit at which a pregnancy can be aborted, fetal echocardiography is currently being performed extensively at 18-20 weeks of pregnancy. There are no rules on who should perform the examination. It takes appropriate training, experience and technology. It is currently being performed equally effectively by radiologists, cardiologists, pediatric cardiologists, gynaecologists and specialists in fetal medicine

  2. #42
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    Is my daughter's weight normal?


    Q. My daughter is 17 months old. She passes stools 3 to 4 times daily. It's not watery or hard, but every time she takes her feed, she empties her bowel. Is this okay? I'm still bottlefeeding her. How long can I continue? I'm afraid that once I stop feeding, my daughter won't get adequate milk. She weighs 10 kgs and is an active child. Could you tell me the amount of milk and solid food that should be given to a child of her age?

    A. It's okay to pass stool after feeding. But a weight of 10 kgs is too less for a 17 months old. Please get her haemoglobin tested. If its low then one needs to assess her caloric intake and rule out malabsorption.

  3. #43
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    What is Naltrexone used for?


    Q. What is the drug Naltrexone 50 mg used for?

    A. Naltrexone is indicated in (a) maintenance therapy for patients who were earlier opioid dependent, but now no longer take such substances and (b) part of the treatment of alcohol dependence.

  4. #44
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    Is a hole in the ear really serious?


    Q. I am 17 years old and have a hole in my ear. I looked up the Internet to find that it could be a sinus defect, and if it is not bothersome then there is no reason to worry. But my ear hurts badly. I have had the hole from my birth, but for the past 2-3 months I have started getting acute pain. There has also been some discharge for a few days accompanied by swelling. What could be the reason behind this? Do I need to consult any doctor? I get worried easily and have been thinking whether or not it is a tumour. Is it serious?

    A. Not all the holes in the ears can be ignored. There could be several diseases that lead to a hole in the ear drum. One such diseases is sinusitis. Almost all the types of ear perforations (holes) need closure surgery. The decision to leave it alone is taken when a patient is very old or otherwise not fit for surgery, or when there are other more serious diseases that require immediate attention.

    Regarding the perforation itself, there are two main types - safe and unsafe. The safe type is caused due to an infection ascending from the nose, sinuses and throat. This type is called safe because it does not lead to any complications, other than a hearing loss. This perforation can be closed by placing a graft, usually the tough membrane covering the temporalis muscle. This operation is called myringo plasty.

    The second type of perforation is the 'unsafe' type. In this condition, the infection would have spread further into the bone surrounding the ear. Once it shows a tendency to spread, the assumption is that its expansion may erode vital tissues like the facial nerve, the brain, the nearby balancing apparatus, etc. That is why it is called unsafe. Such a process usually takes several months. The two types may be differentiated by a clinical examination. Of course, a high index of suspicion is required, during such examination.

    Pain is one of the indications of impending complications. So, the policy of leaving it alone is not correct. You certainly need a personal consultation with an experienced ENT specialist.

    The medical web sites can only serve to spread awareness of medical conditions. Further, may I give you a personal and concerned advice: A lot of care is taken in these web sites to render the medical information understandable and to give a correct insight into the medical conditions. Hence, care should be taken in reading them. Perhaps, a second reading also would help. A casual attitude in reading them may lead to avoidable delays and problems. I may be mistaken; but when I read your letter, I get a creepy feeling that you are a little too casual in your query.

    Please consult an ENT surgeon. Many times, the pain could be due to an innocuous infection of the external ear canal skin, due to a discharge from a pre-existing ear perforation. An experienced ENT surgeon can certainly differentiate the wolf from the sheep.

  5. #45
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    How do I get rid of loss of libido and erectile dysfunction?


    Q. I am 34 years old. I was taking Fludac (SSRI) for depression nine years back. I completed the course and have been taken off anti-depressents. Since then I have a poor libido and erectile problems. I don't have spontaneous erections and maintaining an erection is a challenge. I have had successful sexual liaisons a couple of years back when these problems seemed to disappear miraculously without any medicines. You can say this is an on & off problem. I met a psychiarist who feels I am suffering from post SSRI sexual dysfunction. He has prescribed Bupiron SR 150 mg, Clonotril 0.25 mg and Revital. I don't want to have anti-depressants again after the first bitter experience. Otherwise, I have no health issues. Do you think my condition is reversible? I am extremely worried as I plan to get married soon.

    A. In my opinion your erectile dysfunction is primarily due to psychological (not psychiatric) reasons. There are many men who are potent with one female partner and yet impotent with another sexual partner. Once such men get into performance anxiety, they resort to unnecessary medication which makes matters worse. Fludac contains fluoxetine. Curiously it can result in short duration adverse effect on sexual functions (loss of libido, impotence) in males and sometimes even in prolonged erection (priapism). It is also important to remember that depression itself is a major cause of loss of libido and erectile dysfunction. Hence, it is extremely difficult to determine with any degree of accuracy whether erectile dysfunction is due to depression or adverse effect of an anti-depressant drug. Once the therapy is stopped, the level of Fludac starts falling and there is no medicine and hardly any effect after 3-4 weeks. If you stopped taking Fludac 3-4 weeks ago, then there is no Fludac left in your body. Hence, it being the cause of erectile dysfunction is not correct. Clonotril is the brand name of a medicine called clonazepam. It is primarily an anti-epileptic drug though it has some anti-anxiety properties, too. Unfortunately, one of its side effects is depression! Hence, its use in patients with history of depression is not recommended. Its side effects include loss of libido and impotence. Bupiron SR is the brand name of a medicine that contains bupropion. It is primarily approved for use in smokers to help them in smoking cession. Its other use is in the treatment of major depression. You have not given any information about your smoking problem if at all it exists. Hence, I presume it has been prescribed to you for depression. Its side effects include: loss of libido, ejaculation problems and impotence! It is also capable of making depression even worse and result in suicidal tendency. Its other side effects are: Insomnia, headache, fever, flushing, dry mouth, gastro-intestinal upset, loss of appetite, psychiatric effects (e.g. dizziness and anxiety), tachycardia, hypertension, rash, rarely may be serious (e.g. erythema and Stevens-Johnson syndrome), pruritus, constipation, asthenia, sweating, urinary frequency, taste disorders, increased intraocular pressure, risk of seizure increased in patients with history of alcohol, etc.

  6. #46
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    What is the normal range of left ventricular ejection fraction (LVEF) in a diabetic patient?


    Q
    . What should be the normal percentage of LVEF in the echo report for a person who is diabetic for the last 14 years and hypertensive for the last 10 years? Is it possible that a diabetic patient would not have symptoms of chest pain during heart attacks?

    A. LVEF or left ventricular ejection fraction in a normal person should be in the range of 60-70 percent. Presence of diabetes, high blood pressure, does not change the values of normal ejection fraction. However, in patients with long standing high blood pressure and diabetes mellitus, there may be some deterioration in the function of the heart, both in terms of its contraction and its relaxation. Diabetes patients have damage to the nerve endings (autonomic denervation) and therefore may not have the classical chest pain of either angina or heart attack and may have atypical symptoms in form of breathlessness, sinking sensation, increased sweating, gas or abdominal distension, restlessness or some times no symptoms.

  7. #47
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    Is it okay to consume these medicines on a long term basis?


    Q. I am a 60 years old male. I noticed swelling in my legs early this year. On testing, my BP was 180/100 mm og Hg, triglycerides 245 mg/dl, cholesterol 257 mg/dl and blood sugar 105 mg/dl. I was prescribed Telma H and Astor 10, one tablet each daily. I have cut down on salt, chilli, oil and tamarind. I am vegetarian and do not smoke or drink. Despite 5 months of treatment, my BP rose up to 130/90 mm of Hg and my weight increased by 7 kgs. This month my BP was 150/100 mm of Hg and weight 67 kg. I was asked to continue the same medicine in the same dosage. I want to know the side effects of prolonged consumption of these medicines.

    A. You have been diagnosed with hypertension, hyperlipidemia and you are pre-diabetic. It is critical that your blood pressure be below 140/90 mmHg and all your cholesterol fractions particularly LDL or bad cholesterol be normalized. In particular, your LDL level should be less than 130 mg/dl. Salt restriction and a body mass index (calculated from your height and weight) between 19 to 24.9 is critical. I calculated your BMI. It is 24.6 so you could lose another 10 lbs. I am not familiar with the trade names of the drugs you are on (I work in the US) but I am guessing that Telsar is an angiotensin receptor blocker and Telma is a calcium channel blocker. Both these medications are effective blood pressure medicine. Other than monitoring your kidney function and electrolytes, no other monitoring is necessary. If you have not felt any side effects you are highly unlikely to feel or develop any with prolonged use. Astor is probably a cholesterol lowering agent. The main problem is muscle aches and liver abnormalities. These are uncommon. Your physician should test your liver functions periodically. If you do not have side effects in the first few months you are unlikely to get any with continued use.

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    What is the treatment for diarrhoea during pregnancy?


    Q. I am 26 years old and 27 weeks pregnant. Since the last month I am suffering from loose motions. Initially, for a week I passed stools 12-14 times in a day. I was then admitted to the hospital, where I was administered Ringer's lactate, dextrose and normal saline for four days as the movement of fetus had reduced. After a few days, my loose motion came down to 4-5 times, but never stopped. Then I consulted an allopathic gynaecologist, who advised me to take metrogyl. I did not get any relief after taking the medicine. I am a doctor myself, but am really worried since the loose motions are affecting my baby. I am now just drinking more water and taking no medication. What is the treatment for my diarrhoea, such that my fetus is not harmed?

    A
    . Metrogyl contains metronidazole. Its use during the first three months of pregnancy is prohibited since it reaches the fetal blood circulation. Also, its safety has not been determined. Even otherwise it is to be used only if the diarrhoea is either due to infection with amoeba, giardia or certain specific bacteria. Most diarrhoeas are due to viruses which are self-limiting; if in doubt stool should be examined.

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