Thread: Medical Questions with answers.. 3

Can I take my last dose of Hepatitis B vaccine now?


Q. I am a 25-year-old female, and for the past five years I am suffering from chronic kidney disease with creatinine 3.9 mg/dl and blood urea 87 mg/dl. I had taken three doses of Hepatitis B (Engerix B - 20 microgram, one on each arm) last year. I was supposed to take my fourth and final dose ten months back, which I missed. What should I do now?

A. There are two basic schedules of vaccination for Hepatitis B (Engerix B 20mcg) in adults: 0-1-6 months plus a booster dose at 12 months (optional in most cases, except certain people at increased risk such as HIV positive, etc.) or the accelerated schedules, i.e. 0-1-2 months or 0-7 days -21 days. You have followed 0-1-2 months schedule. A booster dose can be taken, if required at all, 12 months or even five years from the first dose.

Am I on the right drugs for my prostrate and BP problems?


Q. My urologist has put me on Veltam 0.4 for my mild protrate problem for the past one week. I am also taking 50 mg of Atenol and 25 mg Losartan every day for my BP. I take Veltam 0.4 just before going to bed. My blood pressure comes down to 110/65 mm of Hg and pulse rate fluctuates between 50 and 92 per minute, which was not the case earlier. This started after my taking Veltam. Is there a relation between the two? I also feel very dull these days.

A. Veltam is the brand name of a medicine called Tamsulosin. It is used in the symptomatic treatment of benign enlargement of prostate. Apart from being helpful in the treatment of prostate enlargement, it also reduces blood pressure. You are also taking Atenolol, which not only brings down the blood pressure but also reduces pulse rate. Losartan is also meant to reduce blood pressure. Thus, you are taking three medicines that reduce blood pressure.

I am a bit concerned that you are taking Atenolol. Recent evidence suggests that it can precipitate diabetes; hence in advanced countries such as Britain, it is no longer recommended as a first line therapy. May be you can gradually reduce Atenolol and see if your problem gets solved. Asthenia is due to side effects of drugs.

How do we deal with our adamant child?


Q. I am 43 years old and have two sons aged 11 years and 3.5 years. For the last few months, our youngest child has become very adamant and starts crying without any reason. We cannot make him stop. As a child, he has been pampered a lot, but now he starts shouting whenever he wants something. If his demands are not met or if we shout at him a little, he starts crying loudly telling us that we should not scold him and give him what he wants. Many times we have beaten him and put him inside a closed room to correct his behaviour, but there is no result. Also, everybody in my family has the habit of talking a bit loudly, and my wife loses her patience when the child behaves irrationally. How should we deal with such a situation?

A. Please do not punish your child by shutting him up in a room. A three-year-old should not be beaten either. He is a child, not your enemy. It seems that the adults have become impatient and the result is that the children are getting confused messages. I think the word shout and cry occur many times in your letter and the shouting is from parents as well as child!

You should develop gentler ways of telling the child what he should do and conveying what behaviour you disapprove. Please tell the child's mother that discipline works best when it is reasonable and properly explained to the child.

Instead of focus on keeping the child quiet, you should provide him with picture books, toys he can manipulate and a ball he can catch. If possible, there should be children's music on CD played for him. Make sure he has enough rest and sleep, and that his diet is suitably planned and served. When the child is in a good mood, explain the rules you have made for him.

Children imitate the adults around them so remember to do what you would like him to follow.

How does Minoxidil work?


Q. I am 39 years old and just about to start using Minoxidil 5% lotion to manage the hair thinning and falling problem. Please clarify the following: (1) How does Minoxidil 5% work? (2) Does it make the existing hair thick and healthy or does it help to grow new hair? (3) What is the minimum duration to notice the benefits? (4) Can I apply oil to the scalp and wash with shampoos once a week while I am applying Minoxidil 5% lotion?

A. It would be unrealistic to expect major cosmetic benefit from the use of Minoxidil either 2% or 5%, even though the higher strength gives slightly better results. If the baseline hair count is 103-106 per square centimetre, then after 32 months use one can expect 39 new hair per square centimetre. However, if the baseline is 144 to 152 hair, then additional hair are unlikely to exceed 15 per square centimetre. It works by increase in the number of hair, but does not make existing hair thick. The lotion needs to be applied twice a day and nothing else should be applied for at least four hours, so that medicine can have effect. Beyond this four hours, one can wash the hair and apply non-medicated shampoo. It takes a minimum of four months for the effect to take place. If there is no benefit after 12 months, the therapy should be stopped. Cosmetically, the effect is not very encouraging though in terms of hair count there may be some improvement. Minoxidil is to be used only on otherwise healthy, normal scalp.

Does using an ozoniser lead to asthma?


Q. A few years back I purchased an ozoniser from India for air purification. While it was operating, my son (13 years old at that time) accidently inhaled the ozone gas for a couple of minutes. As a result, he got cough, and since then has been taking treatments for respiratory problems. He is 16 years old now and has asthma. I want to know if this is related to his inhaling ozone. Is there a permanent cure for asthma and related respiratory problems?

A. An ozoniser is not a cause of asthma, but as is the case with any other strong odour, the airways might be sensitive to the odour or fumes. All asthma patients should avoid irritants, since asthma is a disease that should be recognised as incurable while being preventable and controllable by minimising symptoms with careful use of medications. The occasional case of bad or unfavourable response depends on individual trial and assessment.

Is there a vegetarian diet for building muscles?



Q. I am 24 years old and into body building. I exercise a lot every day. Please suggest me an ideal vegetarian diet that will help me building a good body and pumping up muscles. Also, how long does the body take to recover after a workout? Should I wait for 12 hours or 24 hours before the next workout?

A. Many people frown upon protein from vegetable sources viewing it as inferior to animal based proteins. However, along with supplying the body with a valuable source of protein, plant foods also contain micronutrients, phytonutrients, minerals, vitamins and fibre that you will not find in meat. To gain weight rapidly, eat 1 gram of protein for each kilogram of lean body weight. Thus, if you weigh 75 kg and have 12% body fat, eat 75 g of protein every day. Start off on the lower end of the scale and work your way up. A wide range of vegetables, fruits, grains and nuts provides all the protein you need. Soybeans are also a good source of protein.

Next, get an ample supply of quality fats in your diet. Almonds, walnuts and pistachios are all high quality sources and are loaded with both protein and fat. Also, add a tablespoon of flaxseed oil (alsi oil) to your salads and protein shakes. Next, unlike the weight loss advice, eat several servings of rice, potatoes and bread. The key to gaining weight rapidly is an abundance of calories. Thus, do not hold back and have 6-7 high quality meals a day. Also, consider having a protein shake before and after workout as well as before bedtime.

It does not take much to stimulate muscle growth; heavy weight and low repetitions will get the job done. Base your workouts around these following guidelines:
Work each body part once per week.


Keep workouts under 45 minutes.


Lift heavy weight and low repetitions.


Perform 3-4 exercises for large muscle groups and 2-3 exercises for smaller muscle groups.


Keep your repetitions between 4 and 6 for core lifts (Bench Press, Deadlift and Squats) and 6-10 for all other lifts.
Recovery time should be 24 hours, and in case you are doing a core lift you can even maintain a 48-hour gap.

What has happened to my daughter’s nails?


Q. My daughter is 3.5 years old. Since last two months her nails on both feet have become dark brown, thick and ugly. It seems that the nails have been dried from inside and when we try to cut the nails some white powder comes from them. I went to a skin specialist in the beginning of this problem and he suspected this to be twenty-nail dystrophy and he said her all nails will become like this. But her nails on fingers are still normal. We are applying olive oil on her nails and the nails have got slightly better than earlier. Could you please advise for treatment?

A. Thick, ugly and dark brown nails are encountered in a number of conditions like fungal infection, psoriasis, lichen planus, etc.

Fungal infections are a common cause of such nail changes. However, I rarely see them in children who do not wear shoes most of the time. The doubt can easily be cleared by a simple KOH examination of subungual scrapes. The other conditions are usually associated with other tell-tale signs elsewhere on the skin. In a small number of cases, no cause can be found.

Is there anything wrong with my blood report?


Q. I am 46 years old male and my recent blood report shows ESR 18 mm, monocyte 0.0, basophil 0.0. May I know what does it mean? Is there anything serious?

A. Your report is normal. The five types of white blood cells present in blood (each of which helps fight infection), namely neutrophils, eosinophils, basophils, lymphocytes and monocytes, are expressed as a 'percentage' by doing a count on 100 white blood cells in a peripheral blood smear. This does not accurately reflect the number of cells present and thus 'absolute' counts are preferred. The absolute count is calculated by multiplying the total leukocyte count by the percentage of each cell type.

The normal ranges in an adult male are:

Total leukocyte count (TLC): 4,000 - 10,000/ml

DLC Percentage cells/ml
Neutrophils 40-60% 1,500 - 7,500
Eosinophils 0 - 8% < 450


Basophils 0 - 1% 40 - 700
Lymphocytes 15 - 40% 1,000 - 3,500
Monocytes 2 - 12% 100 - 1000


As is evident, sometimes no monocyte, eosinophil or basophil may be seen while doing a 100-cell differential count. It is the absolute number of cells which is of clinical relevance rather than the percentage of these white cells.

Why my son sneezes first thing in the morning?


Q. My son who is 5 years old sneezes consecutively along with irritation in nose and throat and has watery eyes whenever he gets up from sleep. As a result of all this he has cold and cough almost 15 to 20 days in a month. The doctors have advised not to give him anything to eat that contains preservatives. Also he was nebulised for 10 to12 days three times a day after which the frequency of sneezing has reduced. He has been taking homeopathic treatment for this for the last seven months but with no results. Please advise how to cure him of this problem?

A. Your son is probably suffering from "allergic bronchitis". As your doctor has rightly advised you, the ideal treatment will be prevention. This prevention includes 1. Not giving him any cold items, 2. Not giving any food items containing any preservative, 3. Protect him from dust and vehicle fumes, 4. Keeping away from pets, etc. This list can go on endlessly. Adherence to this long list of preventive measures is impossible.

However, avoidance of dust, removal of unnecessary furniture and curtains from the bedroom and keeping the child away from cold water and ice creams, staying away from household pets like dogs and cats might be possible. Several times, these kinds of allergy disappear in the next season. Hence, this sort of prevention may become unnecessary after a few months.

Whenever there is an acute episode, we have to tide over the episode with antihistamines, steroids, nebulisation and perhaps antibiotics. The one thing you have to rule out is a persistent bronchitis. Your doctor can do some tests and advise you accordingly.

Is my sister suffering from a thyroid problem?


Q. My sister is 25 years old. She is suffering from thyroid problem. She did the following tests with values T3 (CLIA) 800 ng/dl, T4 (CLIA) 28.40 ug/dl, TSH (CLIA) 0.01 uIU/ml. I am aware that these values are very high from the normal range. Is she hyperthyroid or hypothyroid? I need to know how we can permanently resolve this disease. Can we go for radioactive surgery? Will her thyroid dysfunction affect her pregnancy?

A. These reports are suggestive of thyrotoxicosis and hyperthyroidism is one of its causes. To make a diagnosis of hyperthyroidism we need to carry out Radioiodine Uptake/thyroid uptake. If it is easily available near your place please get it done. In hyperthyroidism the uptake will be high.

Once we make a diagnosis treatment is with medications for at least a year or so. Surgery and radioablation / radioiodine treatment is usually not required so even if someone suggests you do not go for it just take medications. The drug is called as Neomercazole to start with 10 mg thrice daily and dose will be adjusted with time.

There is no special diet except that she should take high protein diet and if possible avoid iodised salt.

She should not get pregnant till her thyroid profile is normal and if planning so she will need different medication called PTU.