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Magazine
It's in the heart
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This month, our panel of doctors offers advice and suggestions to readers' queries on pain and discomfort.
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N.K. Venkatarangan :
I underwent open-heart surgery in December 1994 for aortic value replacement (CHD). I am on anti-coagulant Acitrom of daily 1 m.g. dosage. Now I am 42 years old. How safe is to stop the anti-coagulent? Would it be better if I stay in a hospital during this period?
Dr. P. Ramachandran,
Cardiologist, replies:
Your valve prosthesis must have be metabolic. The anticoagulation for metallic prosthetic valves is life-long. Patients with such valves run the risk of infective endocaritis, inadequate anticoagulation and occasional valve dysfunction. Hence you need once in two to three months, a blood test called prothrombin time and to maintain the INR ration between two to four, an echocardiogram at least once a year to assess the pressure gradients across the valve, presence of any leaks, pattern of movements and, most importantly, the function of your left ventricle and an ECG and chest X-ray.
On a broader context, people around 40 also run a risk of developing hypertension, diabetes and CAD and preventive check-ups are recommended.
The other type of valve used primarily in young women wishing to have children and in the very elderly with limited survival expectation is known as Bioprosthesis. It requires anticoagulation for six months but the valve degenerates over four to six years and the patient may require another surgery.
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Name withheld:
I am a 29-year-old woman. I was experiencing transient pain in the chest. ECHO was done and the report was mitral valve prolapse with moderate regurgitation. The doctor said there was no problem but there would be occasional pain. This was done three years ago. Recently, I am experiencing severe pain and discomfort in the left side of my chest. Some times there is so much of pressure I feel that I want to puncture the area to relieve the pain and pressure. I experience frequent bouts of hiccoughs. After meals I tend to regurgitate involuntarily. I experience breathlessness and sometimes congestion leading to wheezing and hyperventilation.
Dr. P. Ramachandran replies:
Mitral valve prolapse is usually a genetically inherited condition. This condition is seen in tall, asthenic (thin) individuals of both sexes. There is a wide spectrum of complications from the presence of just prolapse to severe mitral regurgitation with rupture of supporting structure of the mitral valve called chordae tendinal. If you have moderate mitral regurgitation in which the blood from heart pump (LV) is unnecessarily pushed back to reservoir chamber (LA), you need six monthly echo to assess the degree of mitral regurgitation and to time surgery if need be.
MVPs may be associated with nasal allergy, bronchitis and bronchial asthma and such patients should not take beta blockers which are otherwise prescribed to MVP patients. You need X-rays of the chest and paranasal sinuses, pulmonary function tests along with ECG/Echo to ascertain the current position.
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A tumour?
Name withheld:
I am 20 years old and weigh 43 kg. For about six months, I can feel a small thick mass in my right breast. It is painless. Is it dangerous?
Dr. Uma Krishnaswamy, General Surgeon, replies:
A lump in the breast is most likely to be benign at your age. Indeed most breast lumps are benign. Please consult your doctor who will examine you, perform necessary investigations , and refer you to a surgeon for diagnosis and treatment. After assessment, many benign lumps require no surgery. If surgery is required, it is minor and these lumps seldom recur. Be assured that breast lumps are no cause for worry in young women. To clarify terminology: All discrete lumps that form in the body are called tumours. Tumours may be benign or malignant by nature.
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Knee pain
N. Sivaprakasam, Nellore
I am 56 years old and suffering from knee joint pains in both legs for the past two years. While walking it is severe. Early in the morning, it is very difficult to walk for a while. An orthopaedic surgeon said that it is due to degradation of bones in the joint and osteoarthiritis. What is the difference between osteoarthiritis and rheumatoid arthiritis? I am on volini and paracetamol tablets as per doctor's advice but there is no substantive relief. I am undergoing physiotherapy also.
Dr. S. Siva Murugan,
Orthopaedic surgeon, replies:
I presume that your surgeon diagnosed your condition as osteo arthritis of both knees after examining you and investigation with X-rays and blood tests. A joint is a special structure where the ends of two or more bones meet. The bone ends are covered with a material called hyaline cartilage that cushions the bone from excessive force or pressure and allows the joint to move easily. The joint is enclosed in a capsule called the synovium. This secretes the synovial fluid, which helps to lubricate the joint. The main difference between osteo arthritis and rheumatoid arthritis is that the first is a wear and tear disorder of the articular cartilage. Rheumatoid arthritis, on the other hand, is a generalised disorder affecting your body and, in particular, the synovial membrane.
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Ear pain
Madhavi Vemula:
I experienced ear pain six months ago. Our doctor said it occurred because of wax accumulation and that it would be relieved if I got my ear cleaned. But he said the procedure is even more painful. So I did not go and the pain disappeared in a few days. But after six months I am again experiencing pain in both ears. Please tell me what the problem may be. I want to know if it is psychosomatic.
Dr. H. Ganapathy,
ENT Consultant and Surgeon, replies:
Pain in the ear due to wax should be following an infection of the external ear or erosion of the external can skin by a condition called keratosis. This will remain as long as the condition is not treated. Spontaneous relief from pain in such a condition is unthinkable. Hence your ear pain could have been due to some other cause. Its recurrence also justifies such thinking. Pain in the ear can be due to a problem in the ear or elsewhere getting referred to the ear. The latter is called referred otalgia. This can occur from a problem in the teeth, tongue and throat. You require a detailed examination.
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Urological problems
Name withheld:
At 84 years, I recently noticed the left testicle has descended and larger than the right one. There is no pain and it is slightly uncomfortable when sitting down in a hurry. I continue with my normal 40-minute walk every morning. Please give me some non-surgical recommendations.
Dr. S. Duraisamy,
Consultant Urologist, replies:
The difference in the level of the testicles does not matter much. If the increase in the size of the left testicle is of sudden origin, it needs further investigations like blood tests and ultrasound study. If it has been there for quite some time, you need not worry. You can have a scrotal suspender to support the testicles during the day and it can be removed when you lie down. You can continue with the morning walks with the suspender.
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Bharat:
I have been diagnosed with mild hydronephrosis in the left kidney and mild hydroureter on the basis of a renal ultrasound. These were discovered after a routine urine test showed the presence of albumin, pus cells and RBC. The surprising fact is that I never felt any pain in my lower abdomen or the back region and neither had any burning sensation while passing urine. The urologist I am consulting says that I need not worry and wait for another two weeks before any curative action can be taken. He has advised me to take plenty of water and undergo an ultrasound again after two weeks to check if the problem still persists.
Please advise on the proper course of treatment and my chances of full recovery.
Dr. S. Duraisamy replies:
Your ultrasound has shown mild hydronephrosis on the left side and hydro ureter. I would strongly suggest that you check your renal functions and then go in for an intra venous urography, which will be very useful in pinpointing the cause for the left hydrouretronephrosis. After this, further treatment schedules can be planned.
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High cholesterol
Name withheld:
My children, aged 14 and nine, have high cholesterol but are otherwise healthy. We are vegetarians and mainly have a South Indian diet. They eat eggs very rarely, but eat cheese frequently — pizza and macaroni. I try to keep them active with school sports. My husband has high cholesterol and the doctor says it is genetic. He was taking Baycol but discontinued it because it was taken off the market. I do not want to start them on medication because of all the long-term side-effects. Can you suggest any remedy? Also advise about any dietary additions and omissions.
Dr. Usha Sriram, General Physician and Endocrinologist, replies:
Children have high cholesterol usually due to genetic reasons. But we have to rule out thyroid deficiency, nephrotic syndrome and obstructive liver disease. Use of certain medications, childhood obesity and diabetes are other causes. Since your husband has high cholesterol, the children probably have inherited the genetic form of dyslipidemia.
Diet and physical activity are the most important part of the treatment. Certain levels and forms of cholesterol are amenable only to a combination of diet, exercise and medication. Diet should consist of a low fat, low cholesterol, high fibre diet designed to promote adequate nutrition for growth and to maintain body weight within the accepted range for the age of the child. South Indian vegetarian diets need to cut out butter, ghee, cheese, sweets (made with milk, cheese, chocolate, sugar syrup), coconut oil, palm oil, whole milk, whole milk curds, and limit the use of coconut and egg yolk. Vegetables, dals, fruit and high soluble fibre foods like oats should be consumed in plenty.
Exercise should be fun and physically demanding like cycling, swimming, tennis, badminton, basketball and field hockey. Watching TV should be limited to 30 minutes only and computer work should also be limited to prevent a sedentary lifestyle.
Childhood cholesterol disorders lead to early coronary (heart) and other vascular problems. While all medications have some side-effects, the long-term known benefit of lowering cholesterol outweighs any risk the medications may have. In some cases, we use a technique similar to dialysis called LDL pheresis to remove the bad cholesterol from the circulation. We resort to these measures only in severe forms of genetic dyslipidemia unresponsive to medical management.
The good news is that we have more knowledge now regarding the cause of high cholesterol. Low fat foods like skim milk and Soy are easily available and medication like statins and fibrates have revolutionised the care of such children and adults.
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No sweat
T.D. Rajan, Chennai:
My daughter, 18, suffers from a peculiar problem. During April, May and June for two years, her body temperature goes up to 101°F to 102°F, even if she stays indoors. There is no sweating. She feels very tired but eats normally. Initially she was under medication but it had no effect in bringing down body temperature. The body temperature comes to normal only when the weather cools down. She underwent all medical tests prescribed and found to be normal. She has been advised to remain indoors, and to keep the body cool by having frequent cold water baths, even twice or thrice daily. Please suggest a remedy.
Dr. Usha Sriram replies:
Your daughter seems to be suffering from a condition called anhidrosis, which means no sweating. This can happen when there are no sweat glands by birth, ectodermal dysplasia or certain skin conditions blocking the sweat glands. Certain medications can cause decreased sweating. The functioning of the sweat glands can also be affected by certain neurologic conditions like Guillian Barre syndrome. The only effective treatment so far is preventive measures like staying in a cool area, frequent baths, plenty of liquids, avoiding exercise outdoors and avoiding vigorous exercise. Your physician seems to have given you the right advise. If possible, your daughter can consider spending the summer in a cooler place.
Dear readers,
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The Hindu - Sunday Magazine,
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