Ask the Doc
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Our panel of doctors offers advice and suggestions in response to queries from readers on their problems.
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Arthritic pain
A. Jagannathan:
I suffer from severe osteoarthritis in both legs. Given my age (72), the orthopaedic doctor gave three suggestions: to remain at home taking painkillers; to take steroid injections or to go in for knee cap replacement surgery. When I get up in the morning, my joints are stiff. What should I do?
Dr. S. Sivamurugan, Consultant Orthopaedic Surgeon, replies:
I infer from your letter that you are seriously disabled with pain in both knees. Regarding the options NonSteroidal Anti-Inflammatory Drugs (NSAIDS ) are useful to control pain, but they may notbe advisable in the long term. Steroid injections again do not give long-term relief and have to be given with necessary precautions. Total Knee Replacement is a good option for relief in the long term. It can give you pain-free living for many years but you will have to be fit to undergo this major surgery.
M. Jegannathan:
My wife (48) suffers from Rheumatoid Arthritis for seven years. She is also a diabetic. About five years ago, she developed unbearable pain in her knee joints and has been bedridden since then. Is there any treatment which can help her walk again?
Dr. S. Sivamurugan, Consultant Orthopaedic Surgeon, replies:
You should have your wife seen by an Orthopaedic Surgeon as she is getting bedridden. She will need immediate Orthopaedic evaluation to put her on her feet again. Prolonged bed rest will make the bones very weak and could mean an uphill task to enable her to walk again. These are excellent drugs now to relieve pain and there is also the option of surgery to completely change her life.
Babu:
I am 48. In 2003, I underwent a disc prolapse operation. There was no damage to the spinal cord. I am 176 cm tall. What is the maximum weight that I can gain? Will I have any problem in future though I take precautions like not lifting heavy weights and not doing regular exercises?
Dr. S. Sivamurugan, Consultant Orthopaedic Surgeon, replies:
In your letter you have not mentioned your weight. But for your height and age your ideal weight should be 76 or 77 Kg. Please maintain this ideal weight to prevent further complication of your back. Adding weight beyond this certainly burdens you back more. Make sure that you do regular spinal exercises that have been prescribed for you. With these simple precautions you will have a normal life with low complications.
Seetharavanna:
I am 38. For the last six months I have been suffering from pain in the left knee. The local doctor said my blood pressure was slightly high (140/90).
I was prescribed Atenolol and Valcob (20 mg) for the pain. Though the knee pain has subsided slightly, now I have pain in the right ankle. It is worse when I start walking after I have been at rest. Please advise.
Dr. S. Sivamurugan, Consultant Orthopaedic Surgeon, replies:
Your problem of pain in the left knee and right ankle will require an Orthopaedic consultation, X-rays and Blood tests. The Doctor will have to rule out Arthritis and further diagnose your condition.
Inadequate history
J.P. Banjare:
My niece is two years old. It was a normal delivery. She had jaundice as a baby and was treated in Raipur (Chhattisgarh). But now her growth is not normal. She is always sleeping and cannot walk and or eat by herself. Digital EEG test and CT scan of brain (unenhanced) are both normal. Chest p.a.(except for increased linearity of lung) is clear. Then why isn't she growing normally?
Dr. Prema Shankar, Consultant Paediatrician, replies:
As the history is inadequate, the cause of the problem is not clear. It is necessary for the child to be assessed by your local Paediatrician for her neurological status,i.e.; her mental and physical milestones and also her endocrine functions, i.e.; size and stature. Since the tests done are not suggestive, an MRI of the brain may help to rule out the neurological problem and metabolic screening tests could throw light on other causes. Thereafter your doctor can decide upon the modalities of treatment available.
R. Rama Krithika:
My son, who is three-years-old has been suffering from infections associated with cold, cough and wheezing. It is more pronounced since he joined school - almost twice a month for over a year. The doctor always advises antibiotics for five days. He also takes medicines for primary complex. Is it harmful to take antibiotics so frequently, almost 10 days a month? Does it mean that his resistance is low? If so, what can we do to increase his resistance?
Dr. Prema Shankar, Consultant Paediatrician, replies:
When children go to school for the first time, they are exposed to a lot more infection. Especially respiratory ones, because that is the commonest one to spread through droplet infection. Antibiotics are necessary only if there are constitutional symptoms like fever, loss of appetite, malaise and lung signs. So it is not necessary to give antibiotics, every time the child lands up with a cough, cold or wheezing. A symptomatic cough syrup will do. You could pep up his resistance, making sure he has adequate milk, vitamins, either as fresh fruit and vegetables or good multivitamin syrups.
Heart trouble
Name withheld:
I am 64 years old. I had a heart attack in 1990 still take tablets Betatrap, Ecosprin and Isordil (10 mg). In November 2002, my feet began to swell. The cardiologists suggested consulting a nephrologist too. My blood and urine were tested and the doctors did not prescribe any medicine but advised me to avoid salt. I feel tired and weak often. What should I do?
Dr. P. Ramachandran, Senior Interventional Cardiologist, replies:
After a heart attack in 1990, many changes would have taken place in the heart. This is known as "sequale". The injured and dead portion becomes weak and participates less in the pumping action. The rest of the heart muscle is overworked to compensate. Soon, these normal areas get fatigued and dilate progressively. Thus the heart loses its original oblong heart. This is known as "remodelling". This also causes swelling of legs, belly, profound exhaustion and limitation of activities including breathlessness at night.
Salt and water consumed has a tendency to be retained by the weak heart. Heart failure and drugs for heart failure can sometimes cause mild kidney disease. Kidney disease due to diabetes, hypertension can also cause heart failure after heart attacks.
The treatment calls for planned, divided routine work with sufficient rest; strict control on salt intake especially in winter; fluid restriction in patients with swelling of feet and belly; evaluation by a specialist with ECG, chest x-ray, 2D echo and blood tests; drugs like diuretics (to drain the fluids from the body), beta blockers (angiotension converting inhibitor to arrest remodelling), aspirin and lipid lowering drugs, sorbitrate or similar drugs (to lessen heart's work load and control chest pain) and avoiding painkillers. The sequalae of heart attack calls for heightened surveillance with frequent visits to the cardiologist. A second opinion from a cardiologist and nephrologist is recommended.
Mouth ulcers
Sudhakar:
I am 23. I have been suffering from mouth ulcers for eight years. It begins as a small white patch and then becomes big. I am unable to eat or speak clearly. I have taken Riboflavin, polybion injections, Mebryl Wysolone, Vibact but there has been no relief. My urine and blood tests were normal. What is my problem?
Name withheld:
My daughter (40) suffers from frequent mouth ulcers that appear on the sides of the tongue, cheek and lips. She cannot eat or speak properly. It subsides in about a week but reappears twice or thrice in a month. She takes vitamin B everyday. her diet is vegetarian.
Dr. Usha Sriram, Consultant Endocrinologist and General Physician, replies:
Mouth ulcers are a common problem. They may occur during times of stress or during menstrual cycles in women. It is believed to be an autoimmune problem (our own body producing antibpdies against our own cells) or an allergic reaction. Many conditions like oral thrush, herpex simplex, oral lichen planus, oral cancer, gingivis stomatitis can present as mouth ulcers. See a dentist or an ENT surgeon or your physcian about this.
Avoid sharp foods, powerful mouht washes with antimicrobial action and smoothen chipped or sharp teeth. Use yoghurt and other probiotics. Topical steroids, oral steroids topical antihistamines can also be tried.
L.A. Vetrikodi:
I am 38. I suffer from peptic ulcer and duodenal ulcers from 1990. In 2000, I had an operation for appendicitis. For two years, I have been suffering from stomach ache and chest burning. I was prescribed Lans-Od capsules and Allay 0.25. Though I have been taking these medicines for six months there is no relief.
Dr. Usha Sriram, Consultant Endocrinologist and General Physician, replies:
Your symptoms suggest peptic acid disease. You may have an ulcer, gastritis or reflux oesophagitis. The common reason for chronic or recurrent acid peptic problems is an infection called H. Pylori or use of pain medicines like aspirin or non-steroidal anti-inflammatory agents, smoking, alcohol, emotional stress or use of steroids. Too much acid production may be another reason. You will need an endocscopy to know what is causing your problem. Identification of H. Pylori is easy. If H. Pylori is identified use of antibiotics like clarithromycin, amoxicillin or tetracycline, metrinidazole along with medications like omeprazole, pantaprazole or lansapazole will help.
Stop smoking and drinking alcohol, avoid painkillers and reduce stress. This will help greatly.
Foot trouble
N. Gopalasamy:
I am 54. For five years, Ihave been suffering from burning sensation in my feet. I am not a diabetic. The sensation is more severe in summer. I take Benedan prescribed by a skin specialist and avoid orange and tomato. But still there is no releif. Please help.
Dr. Usha Sriram, Consultant Endocrinologist and General Physician, replies:
Burning feet may be due to diabetes, heavy alcohol use, thyroid dysfunction, being overweight, being on one's feet all day. vitamin deficiency and heavy metal poisoning. Athlete's foot and related conditions like Thrombocytopenia (low platelet count), pernicious anaemia may also cause this sensation.
The best way to treat this is to use cotton socks, avoid prolonged standing on one's feet, using creams and ointments with cooling properties, wearing proper slippers/shoes and reducing one's weight.
A. Shivaprakash
I am 46. While travelling for a few hours or trekking in hilly areas, my feet swell and come back to normal only after a few days of complete rest. Why does this happen?
Name withheld:
Why do my feet swell after travelling in a bus or train for more than a few hours. During the journey, I try to stretch, straighten or even take short walks. The fluid drains in about two to three days. I am 67 years and take Dilzem 30 and Calchek 1 for hypertension.
Dr. Usha Sriram, Consultant Endocrinologist and General Physician, replies:
Swelling of feet after prolonged sitting, standing is common, especially in overweight individuals or those with varicose veins.
If it persists, consult your doctor to rule out heart failure, liver disease, anaemia, kidney disease and blockage of veins. Certain medications like calcium channel blockers, steroids, non-steroidal anti-inflammatory agents and certain diabetes medications may cause such swelling.
Mrs. Anto
I am 46. I have severe pain in my heels. If I sit for a short while, I can't stand or walk smoothly for some time. This has been so for six years.
Dr. Usha Sriram, Consultant Endocrinologist and General Physician, replies:
Heel problem is a common problem due to a condition called plantar fascitis. The reasons are being overweight, sudden increase in activity, lack of arch support and inadequate flexibility of calf muscles. There may be a heel spur or a soft deposit of calcium. The best treatment is to apply ice and rest the foot. Stretching of calf muscles regularly and reducing weight are helpful. Stepping on ice (a few ice cubes wrapped in a towel or a chill bottle of water) for about five minutes after exercise or during pain helps. A good night's sleep and stress reduction have also been known to help.
Illustrations: VENKAT
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