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<font color=darkbrown>Child Health & Care , and Health Tips</font>
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1. J.L., Mangalore

*My mom is 62 years, recently she was complaining of pain and swelling in the breast. So I took my mom to a after examining and mammogram he informed that there was nothing to worry as it was an extra breast. He also informed that it could be removed if it was bothering or could be ignored as it would not cause any harm.

**The extra breast tissue can also be found in specific parts of the body other than the normal on the chest. This is known as accessory breast tissue. The accessory breast tissue are found in definite parts of the body which pass through a imaginary line known as ‘milk line’.

In the second month of its formation, the human embryo develops a ‘milk line’ that extends from the armpit to the groin. This usually disappears forming the breast tissue in its normal position on the chest. However in 2-6% of women this band persists and accessory breast tissue can occur anywhere along this line. This accessory tissue may be in the form of accessory nipples to fully developed and functioning breast tissue. The most common abnormality of development is the development of an accessory nipple that can occur along the milk line and is frequently mistaken for a mole. Accessory breast tissue can occur anywhere along this line and occasionally function if associated with a nipple during lactation (milk production).

The importance of accessory breast tissue is that it is susceptible to disease processes of the breast.( Like normal breasts, cancerous growths can develop in this tissue. However incidence of cancer does not increase if there are accessory breasts). Accessory breasts are common in the axilla. As informed by your doctor, the accessory breast tissue is as it is harmless and need not be excised unless it develops into any abnormal growth.

2.R.P., Dubai

*I am 32 years. I have herpes type 1 but no symptoms at all. Kindly let me know whether it would be transmitted sexually and any precautions that can be taken to prevent it from spreading?

** Genital herpes is an infection caused by the herpes simplex virus or HSV. There are two types of HSV, and both can cause genital herpes. HSV type 1 most commonly infects the lips, causing sores known as fever blisters or cold sores, but it also can infect the genital area and produce sores. HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth. A person who has genital herpes infection can easily pass or transmit the virus to an uninfected person during sex. 

Both HSV 1 and 2 can produce sores (also called lesions) in and around the vaginal area, on the penis, around the anal opening, and on the buttocks or thighs. Occasionally, sores also appear on other parts of the body where the virus has entered through broken skin.

Most people get genital herpes by having sex with someone who is having a herpes "outbreak." This outbreak means that HSV is active. When active, the virus usually causes visible lesions in the genital area. The lesions shed (cast off) viruses that can infect another person. Sometimes, however, a person can have an outbreak and have no visible sores at all. People often get genital herpes by having sexual contact with others who don't know they are infected or who are having outbreaks of herpes without any sores. 

A person with genital herpes also can infect a sexual partner during oral sex. The virus is spread only rarely, if at all, by touching objects such as a toilet seat or hot tub.

Unfortunately, most people who have genital herpes don't know it because they never have any symptoms, or they do not recognize any symptoms they might have. When there are symptoms, they can be different in each person. Most often, when a person becomes infected with herpes for the first time, the symptoms will appear within 2 to 10 days. The first episodes of symptoms usually last for 2 to 3 weeks. 

Early symptoms of a genital herpes outbreak include

• Itching or burning feeling in the genital or anal area 

• Pain in the legs, buttocks, or genital area 

• Discharge of fluid from the vagina 

• Feeling of pressure in the abdomen 

Within a few days, sores appear near where the virus has entered the body, such as on the mouth, penis, or vagina. They also can occur inside the vagina and on the cervix in women, or in the urinary passage of women and men. Small red bumps appear first, develop into blisters, and then become painful open sores. Over several days, the sores become crusty and then heal without leaving a scar.

Other symptoms that may go with the first episode of genital herpes are fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.

Although there is no cure for genital herpes, certain anti-virus medications are used to treat it as well as to help prevent future episodes. 

During an active herpes episode, whether the first episode or a repeat one, you should follow a few simple steps to speed healing and avoid spreading the infection to other places on the body or to other people.

• Keep the infected area clean and dry to prevent other infections from developing. 

• Try to avoid touching the sores. 

• Wash your hands after contact with the sores. 

• Avoid sexual contact from the time you first feel any symptoms until the sores are completely healed, that is, the scab has fallen off and new skin has formed where the sore was. 

If you have early signs of a herpes outbreak or visible sores, you should not have sexual intercourse or oral sex until the signs are gone and/or the sores have healed completely. Between outbreaks, using male latex condoms during sexual intercourse may offer some protection from the virus. 

3. P.R., Mysore

 *What are different types of worms exist in our body? Why do they exist in our body? Are they harmful? What’s the best practice to prevent worm infestation? 

** There are 3200 varieties of parasites that can infest humans. These are grouped in the four major categories, Protozoa, Trematoda, Cestoda and Nematoda. 

Most common among these are intestinal worms belonging to the category of nematodes.

Of these common are roundworm (Ascaris lumbricoides), hookworm, whipworm, pinworm, hook worm and trichinosis or tape worms.  Their size can vary from .2 to 35 centimeters.

Roundworms are the most common worm found in the human intestine worldwide. It looks similar to an earthworm and can produce 200,000 eggs in a day. These eggs pass out in the excreta. The drinking water polluted by human excreta is the common source of infestation to humans. The most frequent symptom from roundworm is upper abdominal discomfort. Other symptoms are asthma, eye pain, insomnia, and allergic rashes due to the secretions or waste products from the worms. 

Large numbers they can cause blockages in the intestinal tract, hemorrhage when penetrating the intestinal wall, appendicitis, peritonitis, abscesses in the liver, hemorrhagic pancreatitis, loss of appetite, and insufficient absorption of digested foods. Adults grow to 15 inches long.

Hookworm larvae, which are found in the human excreta, penetrate the skin. Bare foot walking is the main cause of infestation. These enter the skin of the foot and then enter the human gut through a tedious route. When hookworms reach adulthood, they can sap the victim's strength, vitality and overall well-being. Young worms use their teeth to burrow through the intestinal wall and feed on the blood. Symptoms from hookworm are Iron deficiency anemia, abdominal pain, loss of appetite, craving to eat soil, protein deficiency, dry skin and hair, skin irritations, edema, distended abdomen, stunted growth, delayed puberty, mental dullness, cardiac failure and death. These are about 1/2 inch long and are the common cause of anemia in farm workers.

Pinworm is commonly found in children and elderly. Worldwide, about 500 million are infected with pinworm. The worm is white and can grow to about a half inch in length. They can infest one in five children. 

Female worms crawl out from the intestine to the anus and lay about 15,000 eggs per day. As the area where eggs are laid causes itching, scratching can collect the eggs under the finger nails. Auto infestation is common- same eggs may get into the gut while eating through unclean hands. Symptoms are itching and irritation of the anus or vagina, digestive disorders, insomnia, irritability or nervousness. These eggs enter into healthy individuals through unhygienic food habits. Once airborne, the eggs can survive about two days anywhere in the living environment.

There are other worms which are not very common. 

Worm infestation can be prevented by certain easy habits:

• Drinking pure water can be the only way to avoid several types of worm infestations. Parasites are associated with many water-borne outbreaks and are highly resistant to conventional methods of disinfecting. Drinking water from common sources like municipality water supply or from open well has to be boiled at least for ten minutes before stored for drinking.

• Practicing good personal hygiene is another important habit that can prevent worm infestation. Washing the hands before eating and after going to the bathroom, changing diapers, or handling pets should be the part of this practice.  Keep the fingernails short and clean. Parasites can live for two months under the fingernails.

• Walking barefoot on warm, moist soil or while working in the garden is the common cause for hook worm infestation. Parasites are abundant in soil and can absorb (penetrate) through skin cells. Fertilizers are added to garden soil and it is the pet’s favorite place to go. Use gloves and shoes for protection.

There are effective medicines for treating worm infestation. These drugs are available in a single dose medication and have minimal or no adverse effects. Whenever there is a doubt of worm infestation it may be better to take a dose of de-worming medication after consulting your family physician.

4. J.R., Mumbai.

*My son is two years old. From the age of 1 he has this habit of keeping his hip portion on something such as a pillow and making jumping movements lying on his stomach. I read somewhere that this is a way children do to release their energy. But my nephew does this even when he is tired. Please let me know if this normal ,if it is not what is the solution to this problem .

 ** This type of problem is referred as Tourette Syndrome ("TS") or Tourette's disorder. It is a type of tic disorder. TS usually begin before age 18 months and are more common in males. Your nephew may be having jerking movements called "motor tics" that cannot be controlled. There are many varieties in this. The child may be biting or pinching, doing same things over and over, such as writing the same word many times., eye blinking or rolling eyes upward or side-to-side., finger movements or hand clapping, frowning, hopping or kicking., head banging or shoulder shrugging, hitting or touching things or people., jaw snapping or tooth clicking., jerking of any part of the body etc.  Some children may also make sounds called vocal tics that he also cannot control. Tics may cause the child problems in his daily activities. Temper tantrums are a common sign that the child may have TS. The child sometimes may not feel a need to have a tic. The tics may come back strongly when the child wants them to.

Many children with TS have learning problems and may also have attention deficit disorder ("ADD"). ADD makes it hard for the child to pay attention and he may be overly active. Sleep disorders are also common in children with TS. TS may cause the child to feel left out from other children, making him sad. He may be ashamed or anxious. He may feel guilty, helpless or angry. TS may cause a lot of stress for the child and for its family.

There is no cure for TS but medicine and other treatment can help the child. Most cases of TS are mild. Most people with TS get better as they get older. Without care, TS can lead to more serious problems like depression.

You may take the child to a pediatrician and seek his advice. The treatment depends on the severity of the problem. Certain medications to the child and various therapy sessions for the child and parents or care takers may be required in severe cases.

5. K.S., Kuwait

*I am 25 years of age. I have some black rashes on my hands that on my arms for the last three years. Since last 1 year it is spreading all over my body like my back, stomach & hands it looks like small heat-boils but it is red in color. I had shown to a doctor about two years ago. He told me that this problem was due to oily food and heat in body. 

** The problem is unlikely due to oily food. Consult a dermatologist for proper assessment and treatment. 

6. J.S., Bangalore

* I am 45 years of age. After 30 to 40 minutes of taking my dinner, I go for a brisk walk of 40 minutes. One of my friends says that to go for a brisk walk there should be a gap of 4 hrs after dinner or lunch. Is it true? Will there be any problem if one walks after food? 

** As the most people walk in the morning on empty stomach or in the evening without much food in the stomach your friend must have assumed that walking on empty stomach is the rule. It is said that walking on empty stomach helps in burning more calories; however it can happen even if one walks after taking food. There is no harm in walking after taking food. More important is that you go for walk. It can be at any time of the day.

7. P. F.. Mangalore

*I am 31 yrs. of age and married for four and half years. I have undergone laproscopy last year and also done IUI within 1 month after laproscopy. unfortunately it failed.  Recently I had gone for treatment at a fertility clinic. My husband's sperm count was 25million per ml. Doctor said the count is normal and suggested to do IUI. I did IUI but again it failed. Doctor said, it happened because during IUI husband's sperm count was less. I believe, during IUI they select the best sperm and inject.   Now the doctor is suggesting IVF and chances in IVF is 50%.   In my ultrasound report, it is clearly written that I have few endometriosis and also mobile uterus.

** You may be aware that IVF is also not 100% success. In IVF the eggs in the ovary are harvested. Typically 5-15 eggs are collected. These eggs are fertilized by adding approximately 100,000 motile sperms to each egg. If the sperm does not fertilize the eggs naturally it can be performed by intracytoplasmic sperm injection (ICSI). This may appear simple to understand but is complicated in practice. As the years have passed, IVF has improved greatly. Today it is arguably the most effective technique to treat infertility when compared with others on a month by month basis. IVF has created a lot of controversy also. First, it is very expensive.. It may not work on the first cycle. Second problem is of multiple pregnancies. Some patients may have very high odds of success: 45 - 60% chance per attempt. Others may due to their situation have only a 20% chance of success. The other complication is of multiple pregnancies. The multiple pregnancy risk varies with age. Generally 25% of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies.

It appears that there is some problem with you also. If you have unhealthy genital tract any of these methods will not be successful. Before proceeding with further procedures consult one more gynecologist.

8. J.J. Calicut

I am 26 years of age. I am doing the job of a technician.  My problem is after getting tired or after consuming lot of water, when I pass urine semen also is passing out. It happened 3 times and I am worried. Is this dangerous?

** Are you sure that you are passing semen after urination? It is unusual for semen to enter the urinary bladder in healthy individuals of your age. However, there is a condition in which semen may pass in opposite direction during ejaculation and enter the urinary bladder. This condition is termed as ‘retrograde ejaculation’. Retrograde ejaculation refers to the entry of semen into the bladder instead of going out through the urethra during ejaculation.

Retrograde ejaculation may be caused by prior prostate or urethral surgery, diabetes, some medications, including some drugs used to treat hypertension (high blood pressure) and some mood-altering drugs.

The condition is relatively uncommon and may occur either partially or completely. The presence of semen in the bladder is harmless. It mixes with the urine and leaves the body with normal urination. Men with diabetes and those who have had genitourinary tract surgery are at increased risk of developing the condition.

The problem is characterized by little or no semen discharged from the urethra in conjunction with the male sexual climax (during ejaculation)  and will be associated with cloudy urine after sexual climax.

What you are passing in the urine  may not be semen but may be the sediments in the urine. It is possible that you pass concentrated urine where the dissolved salts may be getting sedimented in the bladder and at the end when they pass  out it  may be looking like semen. 

You may get your urine checked and find out whether you are really passing semen in the urine. A urinalysis performed on a urine specimen that is obtained shortly after ejaculation will reveal a large amount of sperm in the urine, if at all one has retrograde ejaculation.

9.  K. B. Bangalore

* I am 25 years of age. I am planning for a baby.  Each month I get my periods regularly on 8th or 9th.  I want to know what the peak days are .  Last month for the first time we tried but couldn’t on all the fertile days.  This month, I got a drop of blood on 6th evening then little dark colored substance (same day), which is got while ending the period. Then 7th, 8th till 9th morning it was dry without anything.  On 9th around 10am, I got once again the flow.  This happened for the first time.  Otherwise it was on time lasting 3-4days starting from 8th or 9th of every month. Therefore, I want to know what will be my peak day/days. 

**Normally in regular cycle, the woman ovulates on the 14th day prior to the day of onset of next flow. If it is a regular 28 day cycle, the woman will ovulate on the mid-cycle that is 14th day from either side. ( In your case it may be on 25th or 26th day of the month). Normally the ovum survives between 8 to 12 hours after ovulation. The ovum gets fertilized during this period if it comes in contact with healthy sperm.

In order to facilitate fertilization, it is ideal for the couple to know the exact day of ovulation.  There are several methods to detect ovulation; one of them is mucus method. On the day of ovulation, the mucus in the female genital tract is thin, transparent and can be stretched between two fingers.

The couple should have sexual contact during the days of ovulation. It is advised to have physical contact at least for five days, on the day of ovulation and on two days before and two days after ovulation. This may not be successful in one or two attempts. Even if this is regularly followed it may take four to six months for the woman to conceive.

If you get irregular bleeding again consult the gynecologist.

10. S.S. Pune

* I am 22 years of age. I had my ACL injury in a football match about three years ago. I get occasional pain. What should I do now?

 ** One of the most common problems involving the knee joint in sports men is an anterior cruciate ligament tear. The anterior cruciate ligament (also called the ACL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. Of the four major ligaments of the knee, the ACL injury is the most common knee ligament injury. When an ACL injury occurs, the knee becomes less stable. The ACL injury is a problem because this instability can make sudden, pivoting movements difficult, and it may make the knee more prone to developing arthritis and cartilage tears. ACL injuries can strike anyone, but there are certainly some individuals more prone to ACL injury. Sports like football,  basketball, rugby, skiing, gymnastics, hockey, wrestling  etc  can cause high forces to be placed on the ACL. Participants in these sports are especially prone to ACL injury.

The treatment after three years depends on the problem you are facing and your need of the stable knee. If you are still participating in active sports, you may go for surgical reconstruction of the ligament. For this you may consult an orthopaedic surgeon who has been doing these procedures. He will assess your knee and  decide the need of surgery. In those who are not keen on surgeries or are able to undergo regular physiotherapy and exercises to build up the thigh muscles, the problem can be treated non-operatively.

11. G. C,  Muscat

*I am 29 years old and suffering from abnormal bleeding/ anovulation. Since the last 3 yrs. I want to conceive now and my doctor has asked me to start on Clomid.  Is Clomid safe and what are its side effects? Will it control my abnormal bleeding?

 **Clomiphene citrate is frequently referred to by its brand names, Clomid and Serophene. Clomiphene is used to induce ovulation, to correct irregular ovulation, to help increase egg production and to correct luteal phase deficiency. It is one of the selective estrogen receptor modulators that acts as an anti-estrogen and tricks the pituitary gland into producing more FSH (Follicle Stimulating Hormone) and LH (Leutic Hormone), which, in turn, stimulates the ovary into producing more eggs and follicles. Clomiphene citrate comes in 50-mg tablets that are taken on days 5-9 of the cycle or, less typically, on days 4-8 or 3-7. There is some preliminary research that indicates that an earlier start date may result in more pregnancies, but most gynecologists continue to prescribe it for days 5-9.

Just as women's bodies are so different from one another, their reactions to Clomid vary tremendously. Some women have virtually no side effects. Others do, but they are more frequently related to emotions. Other side effects may include mood swings, hot flashes, breast tenderness, and thinning of the uterine lining. Multiple gestation pregnancies may occur (about an 8-10 percent occurrence in those who get pregnant). Ironically, Clomid can cause hostile fertile mucous and thins the uterine lining in over 30 percent of the women who use it. The hostile mucus kills sperm, and the thin uterine can prevent implantation or cause an early miscarriage.

As with most ovulation-inducing drugs, there is a risk of ovarian hyperstimulation. Cysts can erupt and ovaries can be enlarged. This is rarely serious and is more common with other fertility medications. However, if one develops unexplained pain, then a gynecologist may be consulted. A quick ultrasound can determine if there are any problems. This drug should not be taken if the woman is pregnant or has a history of liver disease.

You have not mentioned what is the abnormal bleeding you are having.  Clomid may correct the irregular or abnormal bleeding if it is due to anovulation..

12. M.P., Mangalore

*My son has a snoring problem at nights. He had a problem when he was around 12 years we had a nasal operation performed for polyps removal as he was having difficulty while breathing & perhaps due to allergy from central air conditioner.  Now he does not have any problem at day time, but at nights, he snores badly. Is there any exercise or medicines to get rid of this? I also remember long time ago after checking his blood, there was  something like eosinophilia & was treated, but it was not a long term solution.

  ** Snoring is one of the common problems of sleep. It can be due to variety of causes. It is most important to stress that snoring, in most people, is due to multiple factors, each playing some part in the snoring process. Important in this are narrowing or blockage of the upper airway passages through anatomical or injury reasons. It can be also due to congestion of the soft tissues of the airways, e.g. smoking, alcohol, acid reflux from the stomach affecting the throat tissues, obesity, ageing and hormonal factors. 

Noises can result from a narrowing of the nasal passage, which generates a whistling noise. The vibration of the soft palate (or roof of the mouth) causes the fluttering vibration sounds.

In most of the people the problem of snoring is just ignored and no treatment is opted. Sleeping in supine position (on the back) can reduce snoring. If the problem really bothers then consultation with an ENT surgeon may be advisable. Depending on the severity of the problem surgical corrections can be done. Surgical assistance may include nasal, palatal or tongue and neck surgery. The surgical procedure will depend on the location of the tissues contributing to snoring.

Nasal surgery may include improving the nasal airway by straightening the nasal septum (mid line nasal cartilage partition), shrinking the lining tissue of the nose, particularly where this has been troubled by allergy or by the removal of nasal polyps. Previous nasal injury involving the external nose and the nasal septum may require correction.

The flapping of the soft palate in snoring may be assisted by palatoplasty involving either high frequency radio wave or laser surgery. Newer procedures for more severe forms of snoring including radio wave shrinkage of the back of the tongue as well as procedures to bring the tongue tissues forward may be of assistance in selected cases.

Because snoring is a multi-factor medical condition, repeat or additional operations may be required as part of the management plan. Not all patients can anticipate 100% control of snoring although the majority of patients do have useful improvement. 

He may get his blood examined for eosinophilia. The raise in eosinophil count may be due to allergy. The allergy can cause swelling of the airway passage which may in turn lead to snoring. An ENT consultation may be helpful to rule out eosinophilia. 

13. A.V. D's. Mangalore

* I am 21 year of age. Is there a need to take tetanus injection everytime there is nail prick. I am in a workshop and I get minor injuries now and then.

** It is myth that one gets tetanus if only rusted nails are pricked. Any injury to the skin or deeper tissues which are prone for contamination can cause infection by tetanus organisms. It can be rusted nail or unrusted nail. Even minor farm injuries, abrasions can allow the tetanus organisms to enter the body. If the person has taken anti tetanus toxoid within the last six months no further injection may be required if the wound is clean incised wound  or superficial graze or a  scald. But if the wound or burn over 6 hours old 0r any wound with one or more of the following may require tetanus prophylaxis:

• Contact with soil, manure, compost 

• Puncture type wound 

• Infected wound 

• Compound fracture 

• Large amount of devitalized tissue

• Animal or human bite

A dose of ‘Human Tetanus Immunoglobulin’ may be given if the risk of infection is considered to be especially high e.g. contamination with stable manure, large wounds of road traffic accidents.

Anti-tetanus treatment is available only in the form of injections, which are safe and relatively less painful.

The pain and swelling after a week of injury is not the sign of tetanus. The wound might have got infected. You may consult your family physician for treatment,

14. P.G. Mangalore

* I am 24 years of age.  I have been diagnosed as having essential hypertension about a year back. I had undergone all kinds of test, but doctors were not able to find out what the cause for this. My blood pressure readings were 150/90..145/80. I have been taking Tablet Aten 25mg for the past one year, but there is no significant drop. My weight is around 63 kgs and height 5'8''. Please advice me. 

** It is true that you are young to get this problem, but hypertension is not uncommon in young people. There are mainly two types of hypertension-primary and secondary. When there are no definite causes for rise in blood pressure, it is known as primary hypertension or essential hypertension. Lots of theories and hypothesis have been presented, but none of them are totally accepted. As a result this problem is also termed as ‘idiopathic hypertension’ (means cause not known). Occasionally few people get hypertension secondary to the disease of some other system. For example renal artery disease can cause hypertension. When hypertension is due to a known cause it is known as secondary hypertension.

In young individuals secondary hypertension is common where as primary hypertension is common after middle age. People with freshly diagnosed problem of hypertension are normally subjected to all possible tests to find the cause for blood pressure. Essential hypertension or primary hypertension is confirmed when there is no reason for the blood pressure to go up. 

Raised blood pressure has to be brought under control by medication. For some patient a single drug may be sufficient and for others more than one, at times three to four drugs may be needed to keep the pressure under control. Your doctor is the best judge to decide the number and dosage of each of the medicine required to control your blood pressure. It is wise to follow the doctor’s advice as long as the blood pressure is under control. It appears that your blood pressure is still on higher side. You may take a second opinion from some other doctor if the blood pressure still remains on the higher side of the scale.

Other than this, regular exercises like walking, swimming; relaxing exercises like meditation or yoga also helps to reduce the pressure. Yogic exercises have to be done under the guidance of experts. 

You should never stop or alter the dose of medication unless you are advised to do so by your doctor. There can be dangerous complications if the blood pressure persistently remains out of control.

15.R. P. Udupi

* I am 32 years of age. I have married 3 months ago, but I have problems while making love. I don’t have a proper erection. Friends advice me to go in for Viagra tablets. I am scared to use them. I don’t have any mental stress. Please advice me on the medicine I have to go in and also the diet. 

 ** Before going for the tablets you may consult a psychiatrist to know what the cause for loss of erection is. The loss or weak erection can due to multiple factors and proper assessment is required before therapy is started. Many a times it is due to some underlying tension in the mind.  

Viagra contains a molecule known as sildenafil citrate. The medicine sildenafil should be taken only after consulting a proper doctor. For more details on the medicine kindly refer 62nd update of this column.

16. C.F., Dubai

* I am 38 years of age. I had a problem two months back and doctors advised me to do the laparoscopic surgery for secondary infertility as I had pelvic adhesions. An ultrasound scan had demonstrated a retroverted uterus and adherent right adnexa. I have done hysterosalpingography. The tubes were patent. I have only one right tube. Laparoscopic evaluation findings were a mild moderately retroverted Uterus; an inflamed  right fallopian tube especially at its distal half; adhesions between the fimbriae and the lateral aspect of the uterus; normal ovary; right half of the pelvic peritoneum normal; normal visceral peritoneum; the adhesions between the right tube & uterus were cleared by surgery. Hydro floatation of the pelvic viscera was carried out at the end of the procedure.  Now I would like to know what the chances of conceiving after the surgery are.  Is it everything alright with me? 

My periods are regular & I am ovulating every month.  Step by step I have done all the necessary medication such as follicular scan, ultrasound & I have checked everything from my husband side he is perfectly alright.  After the surgery we had been trying to have baby from 4 months but nothing is working out. Doctor told me that after the surgery within 6 months I have to get pregnant now almost 4 months passed. Is it true that after six months there are no chances of conceiving I am really worried about this? I cannot wait for long time because I am ageing what are the other solution please advise me!! 

** I can not opine why the six months’ dead line was given. You may consult the same doctor and take his opinion regarding your problem. Considering your age and the problems in the genital organs your chances of conceiving normally are less. It may be better for you to discuss the whole issue with your gynecologist.

17. J.G. W.I..

* I am 44 years of age. I have had orthotics for over 10 years (replaced twice) for my plantar fasciitis/heel pain, but also have pain/tingling continually between the toes of both feet; the podiatrist didn't think I had neuromas,& we thought the orhotics would improve symptoms but it hasn't & they can't really come up  with anything; I am allergic to lots of synthetics & my skin  doctor thought all-leather non man-made component shoes may help, but they're tough to find & expensive, & the one time I tried some they hadn't even helped; my feet just about scream at times, I'm 30 # overweight(always have been)& am just wondering if you have any suggestions other than losing weight; am thinking some metatarsal pads may be worth trying, but those bones don't seem to be the culprit.    

 ** You may consult an orthopaedic surgeon again and get yourself assessed properly. The foot wear inserts depends on the problem you have in the feet. Varieties of silicone inserts are available which might help you.

18. M.B. Panjim

*Could you suggest what kind of slippers should a patient suffering from Calcaneum spur should wear? I was advised by a doctor to wear MCR slippers. But, unfortunately not been able to find any suppliers of the same.

** Calcaneal spur is a small out growth found in the walking surface of the heel bone. In a few people with persisting heel pain the x-ray of the heel bone may show this out growth as a beak. The pain in the heel is at times blamed for the presence of spur. But spur may be found in many without heel pain and heel pain is not always associated with spur. Inflammation of the fascia in the walking surface of the heel bone is the cause of pain and it is proper to name the problem as plantar fasciitis.

There are various modalities of treatments available depending on the severity of the problem. If the pain is mild, wearing soft cushioned footwear, physiotherapy and anti-inflammatory drugs help in relieving the pain. Local steroids are the next choice if the pain is persisting. If properly infiltrated in selective individuals, steroids are safe. Some patients may require a repeat dose.

Surgical intervention usually is not done, though there are reports of arthroscope being used to incise the tight fascial structures. This is not widely used and universally not accepted. Surgery has limited or no role in plantar fasciitis.

For MCR (micro cellular rubber) heel inserts you may have to go to an orthotic center. I am sure there are many of them in Mumbai. These days silicone inserts are available which are easy to use.  You may find them with the surgical dealers.

19. N.D. Mangalore

*I am 28 years of age, married for two years now. My problem is I have got severe knee problem, I can not sit on the floor, I can’t bend my knee and worst of all even I have to struggle to get up from my chair or car etc.

I delivered in September 04. My weight before conceiving was 62 and end of the delivery I was 83 and now I have around 77kgs weight. I thought it might be due to weight. I consulted the doctor who told me to take Hemoglobin tablets which I am still taking but no use... This is the third doctor I have consulted. One more thing doctor is copper "T" creates any such problem like joint pain, irregular periods etc? I have got this "T" since last Dec.04 ...After my delivery I got first periods in March05 thereafter every alternate month I get periods, which I think is also a cause for my weight. I request you to please give me some solution to reduce my weight. I can’t skip meals, if I am hungry then my hands/legs starts shaking like anything.  I will not be able to stand even.

** You have to consult an orthopaedic surgeon to know why you are having this problem. The knee pain has nothing to do with intra uterine loop. 

Skipping the meals is not recommended for weight reduction. It is better to reduce the quantity of each meal and to avoid high calorie diet. You may refer the 62nd update of this column for more details on weight reduction. 

20. . F.P. Kuwait

*We have been married for two years. I have not conceived yet. We are trying to conceive for two years. I consulted a gynecologist. After examining she suggested to have a laparoscopy. Should I go for it?

** While investigating infertility, normally men are subjected for test first. In about 50% of the cases of infertility the problem remains with the man. Semen analysis is done first as it is easy and less expensive. Woman is normally advised to undergo tests if her husband’s test results are normal. Initially simple investigations like hormone assays, ultrasound examination are done Laparoscopy is advised when all other tests are normal.