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Child Health & Care , and Health Tips
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1. S.P. Mangalore

*I am a 32 years of age. My weight is 63 kg and height 5’3”. I have a  son of 5 years. From the beginning I had regular period till my first pregnancy. My first delivery was a cesarean section. After that I had irregular periods.  I have to depend on some medicines like Diapason for periods. 

I had periods on February 15th next month on March 14th I had severe viral fever. I had to take antibiotics for almost one month. After that I had no periods. I went to doctor by 17th of April and had a pregnancy color card test which showed negative pregnancy result.

Doctor prescribed me PRIMOLUT-N 5mg for 4 days morning and evening from 18th of April.

Even after 12 days there were no signs of periods and I had a vomiting sensation. So I checked with a card and it showed positive. Doctor advised scan. The scan result is that there is a single live intrauterine pregnancy of 5 weeks 6 days gestational age. {Detailed report is enclosed}

Now I am very much worried.  It means that I took medicines about 3 weeks after getting pregnant. I am  worried that the medicines will  affect my child.

Similarly I was on fasting last week to reduce my weight. I don’t know what to do whether to continue this pregnancy or to abort.

** It is a bad tendency to terminate the pregnancy (kill the unborn baby) with anticipation that the baby might be born defective. At times for no known causes, the babies are born with some defects; or suppose the child is born  normal and later on it develops some defects due to accidental injury we do not kill the babies because they have defects! It is a criminal act forbidden by the law. Then why we think of killing a helpless  unborn baby even though we are not sure of it having some defects? It is not only the parents, many a times the doctors suggest to terminate the pregnancy just because the mother had taken some medicines which might cause some harm to the baby. This tendency has to be discouraged.

Though it is advised not to take medicines when there is a possibility of pregnancy, there are incidences where medicines are taken knowingly or unknowingly and the babies are born without defects; so also in all the cases of congenitally malformed babies definite history of consumption of medicines or some other causes are not found. There are no study reports indicating the percentage of defectives babies that might be born when certain medicines are consumed. Some medicines might affect the babies, but the percentage is not significant. Moreover, the nature has its own way of avoiding defective babies, most of severely defective babies are aborted naturally.

The harmful effects of the medicines or substances on the unborn fetus are known as teratogenic effects. Certain medicines and chemicals are known to be potentially teratogenic but not definite. Most of the medicines even though labeled as potentially teratogenic, in several incidences no teratogenic effects are manifested. The medicines you have consumed are hormones normally used for contraception. A review of information by World Health Organization suggests that there is no evidence demonstrating that any of the  hormone contraception methods are teratogenic. Evaluation of possible teratogenic effects of older, higher-dose OCs used on a daily basis in pregnancy has found no increased teratogenic risk. The hormones taken by you are in low dose and we hope and pray that they would have not caused harm to the baby.

The ultrasound report sent you does not  indicate any abnormality in the fetus. Considering all these aspects at present there are no indications or possibilities of damage to the baby in your womb. Let it grow there.

2. R. D., Dubai

*I  have been on  medication for depression for the past 8 years now. I want to stop that medication. Now I am fine but still night sleeping problem. I am getting proper sleep at night when I take that medicines. I am worried that taking these medicines  for long may  affect later. Please advice.

** Though it is not clearly well established, it is believed that the people with depression appear to have physical changes in their brains. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

The medications that are given are to maintain the normal function in the brain chemicals and if they are stopped there is a possibility of triggering depression again. Most of the medicines do not harm the body significantly and they need not be stopped. However your psychiatrist will be the best person to decide whether to stop or to alter any medicine

3. R. B., Dubai

* I have an early ejaculation problem(within 1 minute).I came to know about  this problem after marriage i.e. before 4 years. One of my friends suggested me to take medicines advertised. Can I use them?

** Now there are effective medicines available for the problem of early ejaculation during sexual act, or premature ejaculation. You may consult a psychiatrist or neurologist to get proper prescription. Most of the medicines sold through advertisements do not have any positive effect except the psychological assurance. Many of them are expensive and useless.

4. A. D', Mumbai

*I have got twin sons aged 9 years, and we are facing some problem of their diet. They weight only 16 kilograms each and are very lean. They are in the 4th standard, they are good in sports, and they play football and other games. Their main problem is that they are poor eaters. We ask them what they like to eat but they never tell us. We are ready to give them any food they like and my wife really gets upset when they don’t eat properly. Could you suggest a proper diet for them?

** Eating problems of children seem to be a major concern of many affluent parents. Most of the children refuse to eat because of faulty dietary habits. One must remember and appreciate that appetite is a built in mechanism. A child will eat as much as his body needs. There would be days when he eat more and other days when he hardly eat anything. This is physiological loss of appetite. Most of the parents out of ignorance start forcing the food down the throat of the child. Various means- threats, flattery, pampering- are tried. Such attempts often lead to what is known as psychological loss of appetite. Added to this some of the parents tend to make this a big issue and discuss this with others in front of the child. This can lead to an attention seeking matter for the child and child unconsciously keeps the issue alive. 

Majority of such parents tend to substitute the regular food by chocolates, fruit juices etc and at the dining table pressurize the child to eat. Most of these children who refuse to eat regular food remain healthy and grow normally. They do not eat regular food because they are fed with other things in between.  Feeding also should be disciplined. (There are many other issues influencing feeding habits of the children. I have written in detail about this in my book on child care)

Some children may grow lean and look weak. It can be constitution of the child and can be normal. For example Punjabi children grow fat and other children may look weak compared to them. If your children were lean from the beginning (as they are twins), they might grow lean till puberty and later on they might put on weight. If your children are weak and anemic then you may have to consult a child specialist to know if there are any other problems. If you have already consulted one, then second opinion may be required. Refusal to eat itself may not be the cause of the problem. It is probably secondary to some other cause then it may be set right.

Here are few tips in general for parents of small children:

* Do not feed the children when they are able eat; allow them to eat.  Do not serve them; instead encourage them to take as little as they want. If the children are healthy and have put on enough weight compared to the children of their age, then there is nothing to worry about. It means that the children are getting enough nutrition in spite of their bad feeding habits.

*Do not feed in between the feeds. Most of the parents allow the children to eat chocolates, sweets, fruits etc. in between the meals and on the dining table they force them to eat the full meal. Feeding in between two meals may be because parents feel that the child has not eaten properly during meals and allow the child to go for sweets etc. This kills the appetite and the child will refuse the next meal.

*Children also have taste preferences. If your children are not expressing their wants, prepare variety and let them eat what they like. Try to avoid junk food.

*If the child does not eat a particular meal, just do not force. Do not curse. Allow the child to go out without proper meals. The child will feel hungry and eat the next meal properly. Most of the children do not feel hungry because parents keep their stomach always fed! Let them also starve once or twice, nothing bad will happen.

*Forcing or cursing will never solve the problem. Few children use this as an ‘attention seeking’ and will repeat as long as you force or curse. Do you know that the children also have feelings and at times unknowingly they seek the attention of their parent?

*Just allow the children to have freedom on the dining table. You may feel that this advice is just impossible to follow, but remember nothing else you can do. No safe medicines are available to enhance the appetite in children.

5.A.D., Udupi

* I am 30 years  of age. Having a child of 3.5years. During pregnancy I came to know that I have endometrial cyst on right ovary. Since then its not grown. Now recently another large cyst of 9 cm  was found on the left ovary. The doctor has advised to undergo laparoscopy and to start birth control pills. We r looking for second child. What is the solution.

** Endometriomas are cysts caused by endometriosis, a condition in which the tissue normally lining  the uterus (endometrium) grows outside the uterus. These ovarian cysts may be associated with fertility problems. You may follow the advice of your gynecologist.

6. M.K.,  Mangalore

*I am 17 years of age. My foreskin reaches till the head of the penis but there is a small skin still attached to the down side of my penis. Can you help me with this problem.

**This is normal and is termed frenulum. It is a connecting membrane on the underside of the penis. If you have any doubt consult a surgeon.

7. R. R. Pune

*I am 21 years. My nipples remain swollen all the time. They become normal only when I press them. When I press them I feel something hard behind my nipples, some kind of hard flesh or may be cyst. I think this problem is due to masturbation which I do daily. Because when I stop masturbating for one month, nipples become normal. But when I start masturbating again, my nipples swell up again. I feel pain only when I press them hard. I can’t share this with anyone as it is related to masturbation and my friends also laugh on me when they see my nipples. 

** I do not know of any condition or problem in the male breasts related to masturbation. Masturbation is considered as a normal habit in most of the young men. 

The enlargement of male breasts is known as Gynecomastia or gynaecomastia. It is the development of abnormally large breasts on men. The term comes from the Greek gyne meaning "woman" and mastos meaning "breast". The condition can occur physiologically in neonates, in adolescents, and in the elderly. In adolescent boys the condition is often a source of distress, but for the large majority of boys whose pubertal gynecomastia is not due to obesity, the breast development shrinks or disappears within a couple of years. The causes of common gynecomastia remain uncertain, although it has generally been attributed to the tissue responsiveness to sex hormones. A root cause is rarely determined for individual cases. 

Breast prominence in men can result also from hypertrophy of either breast tissue or pectoral adipose tissue, and often a combination of the two. Breast prominence due solely to excessive adipose is often termed pseudogynecomastia.

You may consult a general surgeon when you feel the swelling of your breasts to determine the exact cause. If it is gynecomastia is small, no active treatment is required. In some men with moderately large breasts surgical intervention is suggested. For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.

8. T.M., Mangalore

*I lost my pregnancy in the sixth month.  My baby had not at grown, it was only 440 grams. As I consulted doctor after 3 months, the doctor told me, there was no problem and I could conceive again. We have been trying for the past 3 months, but no result.

** I hope your gynecologist have done necessary tests to rule out treatable causes of intrauterine growth retardation and still birth.  Many of the times the baby might have gross abnormalities and it could not have grown properly which may not repeat in subsequent pregnancies. As you had already conceived once, you are likely to conceive again. Consult your gynecologist for further advice.

9. M.A., Mangalore

*I am 29 years. I am working for a reputed company as assistant manager, but I get nervous while going for a meeting or giving some presentations. Kindly give your suggestions why this is happening. Is it  anxiety?

** This is a common problem at the beginning of any career. You will soon overcome it. If it troubles you significantly you may seek the help of counseling. The problem normally does not require medication.

10. F.F. Mumbai

*I am 22 years of age. I married last year.  (He is 32 years old) I am not getting my monthly period properly. The quantity is very little. (Before marriage I consulted with doctor, done all the tests.  Doctor said there is no problem to conceive.) Now we are trying for a child, but not conceiving.  I do not know what to do. What might be the problem? 

** The quantity of the menstrual flow varies from women to women. Excessive bleeding should be a matter of concern not the scanty flow. If the scanty flow is a regular feature, then it may be normal for you.

The causes of infertility need not be always with the woman. It is estimated that in about one third of the couple the defect can be with the man alone and in another one third there can be defect in both husband and wife.

Infertility is a problem to be approached step by step. If the couple is trying for a baby and has not succeeded within a reasonable period, say for six months then it should be considered as a problem and some active step has to be taken. 

Most of the couples are normal and they fail to get the baby because they are not able to find out the exact dates on which their physical union can result in pregnancy.  Normally it is not required to consult the specialists unless the couple has tried at least six months continuously for conception. If the couple is together for a few days in a month or one or two months in a year, there are ample chances that they miss the exact period of conception. This can be also true in those couple living together but not having regular physical union. 

You may be aware of the fertile days in the menstrual cycle of the woman. These are the only days in which proper physical union can result in conception. The ‘mid-fertile day’ is 14th day prior of the next menstrual flow. This is the day on which ovum comes out of the ovary (day of ovulation) and if sperm is available to unite with it, it will result in conception. The ovulation can differ slightly on either side. The unfertile ovum has only about 8 hours of life and it should become fertile within that period. (In contrast the sperm can live up to 72 hours in female genital tract waiting for the ovum!) That is, if a lady’s next period (the day on which flow starts) is 30th of the month, and then (30-14=16) 16th is the mid fertile day. The couple should have physical union on mid fertile day, two days preceding and two days following the mid-fertile day. That is on all the 5 days from 14th to 18th. (This is also one of the Natural Family Planning Methods, where the couple is advised to avoid physical union on these 5 days to prevent the conception naturally). There are few other details like the position used for physical union, precautions after union etc.   The doctor might prescribe certain drugs to the woman to increase the chances of ovulation, though it is not advisable in all cases. This is the natural method through the couple can get the child.

Suppose after trying this regularly for at least 6 months, the woman fails to conceive, gynecologists may be consulted initially. Normally the man is tested first. The analysis of the semen after minimum of three days continuous abstinence and collected properly is done. If there are defects, the man has to be treated first. Mean while the woman also may be tested by simple tests like ultrasound scanning initially. Surgical tests are normally done at a later stage if required only. If both the partners are normal then certain medications to improve ovulation alone may be sufficient, Along with this regular physical union during fertile period may give expected results.

11.L.D., Kuwait.

*My son is now 3 years 6 months of age. He is having constipation problem. Here doctor prescribed LACTULOSE 5 ML but no improvement. He had hernia problem by birth. He does not like to eat vegetables and fruits.

** Constipation in children is a common problem. Constipation in children is often characterized by infrequent bowel movements or hard, dry stools. Various factors can lead to constipation in children. Common causes include early toilet training and changes in diet. Encouraging your child to make simple dietary changes — such as eating more fiber-rich fruits and vegetables and drinking more fluids — can go a long way toward alleviating constipation. 

The laxatives as prescribed by your child’s doctor are not good for long term. Often, simple changes in diet and routine help relieve constipation in children: 

• A diet rich in fiber can help your child's body form soft, bulky stool. Offer your child high-fiber foods, such as beans, whole grains, fruits and vegetables. But start slowly, adding just several grams of fiber a day over several weeks to reduce the amount of gas and bloating that can occur in someone who is not used to consuming high-fiber foods. 

• Water and other fluids will help soften your child's stool. Be wary of offering your child too much milk, however. For some children, excess milk contributes to constipation.

• Encourage your child to sit on the toilet for five to ten minutes within 30 minutes of each meal. Follow the routine every day, even during holidays and vacations.

12. C.D., Bangalore

*I am 39 years of age. We are married for 12 years, I have a daughter aged 10 years. Now we are planning for the second baby. We have consulted gynecologist and all other relevant tests were done. Doctor said the egg was not growing so she has given me  medications for 5 days, after my periods. I have been having these tablets for over 6 months now, now till now I have not conceived. Can you suggest me what I need to do now. As I am already 39, do you think adopting a baby is the right option or should I wait for some more time.

** As you are not ovulating it may be impossible for you to conceive. It appears that your ovaries are not producing eggs even when they are stimulated by medication. Moreover, as you are already nearing 40, pregnancy and delivery have certain risks which your doctor will explain you incase you conceive.

13. V. K. Chennai

*I am 25 years; I am having swelling in my scrotum on the left side. And I consult a doctor he told me that I had the vericocele problem. I feel have less erection and also that my organ is small. Will their any problem for married life?

** You may be aware that there are two types of blood vessels in our body. The arteries bring blood from the heart to the organs and the veins are the one which carry the blood from the organ back to the heart. Like any other organ testicles also receive blood through arteries and it is flown back through the veins. Veins of the testicles contain one-way valves that work to allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum. These enlarged veins in the scrotal sac around the testicles are known as vericocele. A vericocele is a varicose vein of the testicle and scrotum that may cause pain, testicular atrophy (shrinkage) or fertility problems. The main concern of vericocele is that is associated with low sperm count and male cause of infertility. Untreated vericocele can affect the production of the sperms and is one of the common causes of infertility in men.  However, vericocele does not affect erections or normal physical union. Even the size of the organ has nothing to do with vericocele. 

Approximately 10 percent of all men have vericocele. Among infertile couples, the incidence of vericocele increases to 30 percent. The highest occurrence is in men aged 15-35. The vericocele is confirmed by ultra sound scans and can be treated by a simple surgery. You may consult an urologist (if urologist is not available a general surgeon may be consulted) for proper treatment of the problem.

14. S.J., Mangalore

*I have one son of 9 years. Now I want to have  second baby but problem is my husband's semen count is low. Now he is under treatment. whether  there is  the possibilities of increasing semen count .He s 43 years.

**It is possible to increase the sperm count as well as sperm motility by certain medications. If the medicines are not prescribed by urologist or physician, your husband may consult particular specialist.

15. J. C, Bangalore

* I am 29 years of age. I had vaginal fungal infection about a month ago and had taken medicine for almost a week but this month again the infection has recurred. The infection is in the form of thick discharge which is almost yellow in color, but not having any foul smell. The doctor that I had visited informed that I had just fungal infection. Could you please suggest how does this reoccur?  How I got this? I take good care of general hygiene. Is there any particular diet that I need to maintain? 

** Fungal infection in woman is commonly due to   fungus belonging to yeast family known as Candida. As many as 15%-20% of women with vaginal yeast infections are asymptomatic. The symptoms of vaginal Candida infection are fairly characteristic and duplicative upon recurrence. They include vulvar and/or vaginal itching (which may be intense), burning soreness (especially when urinating), irritation, dyspareunia (pain during intercourse), and the well-known curd-like discharge that adheres to the vaginal walls. Several noninfectious etiologies can produce similar symptoms, as allergy to soaps, deodorants, underwear, detergents, spermicides, douche, solutions, vaginal lubricants, perfumed cleansing wipes. It can be also due to excessive use of minipads or due to adverse reaction to vaginal antifungal product. Rarely woman can have allergy to partner’s sperm. In order to confirm Candida as the cause, certain tests are done. 

The Candida infections are effectively treated using anti fungal medications. The primary source of the inflammation can help to guide which treatment to use. If the problem is mainly intravaginal a suppository/tablet may be superior, while if the problem is primarily vulvar the creams may be preferable. For patients with both areas affected, the combination packs offering a vaginal suppository/tablet in combination with a small tube of cream may be the better option.

There are several risk factors for repeated fungal infections. Estrogen augments growth of Candida. Thus, both pregnancy and oral contraceptives can increase the risk of vaginal yeast infections. Immunocompromise can also induce Candida infection; use of systemic corticosteroids is associated with infection. Diabetes, glucosuria, thyroid dysfunction, and obesity are all thought to be possible predisposing factors. Use of antibiotics is widely perceived to be a risk factor for Candida vaginitis through alteration of the intravaginal flora. Certain types of clothing may predispose for Candida. Women should be cautioned to avoid wearing tight-fitting clothes and synthetic underwear. Frequent coitus and the use of intrauterine devices may also be contributing factors. 

It is better to avoid frequent bathing in hot tubs or Jacuzzis, as well as to avoid any situation in which the outer vaginal area is exposed to prolonged moisture, such as wearing a wet bathing suit throughout a long summer day at a pool or water park. The chemically treated water in hot tubs and overly chlorinated water in indoor pools may also be causal through irritation of delicate vulvar/vaginal tissues. 

There are such factors as stress, proximity to the onset of menses, and various dietary components (e.g., too great an intake of milk products, refined carbohydrates, or artificial sweeteners), but there is little evidence to support these hypotheses.

Although it would be tempting to assume that Candida infection can be sexually transmitted, there are few data to support that theory. Concomitant treatment of the male sexual partner seldom yields any benefit in lowering the incidence of reinfection.  Many women who contracted a vaginal yeast infection were not sexually active at the time proximate to the infection. 

16. R.P. Kerala

*I am an accountant, at present working in Gulf. I am 25 years of age & my weight is 50 Kg & I am very lean. Since  three years my hands become very cold when I am in air conditioned room, and I feel that it freezes like any thing, sometimes I am not able to type because of cold, whenever I type I feel like poking pain in my finger & on the wrist.  I was in north India for couple of years there during winter season I was having the same problem. Apart from this I am having joint pains but I am not sure whether it is arthritis problem. The previous pain was only in the knees and fingers but now I am having pain in my shoulders.

** The pain and other symptoms you are having in your hands and pain in joints may not be related to each other. The pain in the hands may be due to carpal tunnel syndrome, a common problem in computer users. The pain in the joints can be due to some sort of arhralgia precipitated by cold climate.  Though pain due to rheumatoid arthritis aggravates in cold climate, it does not exclusively manifest when the atmospheric temperature is low.

 You may consult an orthopaedic surgeon for proper assessment and relief.

17. F.D., Kuwait

*My daughter is 13 months of age. She is lean and is not putting on weight. She is only 8 kg.? When I checked with doctor he told me to do her complete blood check-up and was normal. The doctor told us, she was active so no need to worry about. She passes motion within 15 minutes of eating, 3 to 4 times in a day. Is this normal? 

** You may take the child one more doctor preferably a pediatric gastro-enterologist or pediatrician to assess the bowel habits. Some absorption problem in the gut can lead to mal-nourishment and failure to put on weight. If the doctor finds her normal and healthy, do not worry. If her physical constitution is such, then she would grow lean. Some of these children who are lean during early years put on weight as they grow. Parents should be more worrying if the children are obese and overweight than they are lean and marginally underweight. 

18. I.D, Kuwait

* I am now 44 years of age. I have 2 daughters. Elder one is 15 years & younger one is 9 years. Now my period is not on exact date. I get my periods once in every 2 months or 3 months. Is there any chance for pregnancy in this age? I am not using any birth control measures. 

** As long as a woman is having the menstrual cycles there are chances of conception, though the incidences are less in the pre-menopausal age. If you do not want to have a baby now, it may be safer to follow some temporary method of family planning to avoid conception. The choice of the method can be discussed with your gynecologist. If you are having frequent physical union, the most ideal may be a loop which can be inserted by the gynecologist and may be safely retained for a minimum of 3 years.

19 L.D’S, Mumbai

* I am 34 years. My periods had stopped completely for last 2 to 3 years then I visited a gynecologist and I had to undergo some tests. All my tests were normal. Now I take Duoluton-L and I get my periods. If I do not take these tablets I do not get my periods. Will there be any side effects if I take these tablets every month to get my periods. Can I conceive for my 2nd child?

** Have you not discussed these matters with your doctor? The medicines you are using are hormones and you will not conceive as long as you are on them. Prolonged use of hormones can have certain side effects, details of which are available with the product information that is normally available with the pack of medicines. 

 Find out from your doctor about the real cause of not getting the periods naturally and also express your desire for a second baby.

20. V.R.J, Mangalore

* I am 38 years; I am suffering from cracks in the toes and feet since 8 years. I have a lot of pain and also little bleeding. I have consulted many doctors who have been prescribing ointments but there is no permanent relief. Kindly advise me what is the cure for my problem. I do not use any detergent soap at home during housework.

** It is not possible to be sure of the cause without seeing your feet. The most likely condition is athlete’s foot, a fungal infection of the foot and toes. Athlete's foot is extremely common - it's a fungal infection that typically causes cracks between the toes, which may become itchy, sore and 'cheesy'. In most cases it's fairly mild and gets better with simple powder treatments or just keeping the toes dry and clean.

But sometimes it's more severe, causing the feet and toes to become red and swollen, and the soles of the feet to crack, which can be very painful. There may also be outbreaks of tiny blisters. These developments may also indicate that a second infection with the bacteria has occurred in the skin of the area. Severe athlete's foot needs intensive treatment, and a secondary bacterial infection requires particularly urgent attention with antibiotics.

Like any other fungal infection, the athlete’s foot also can recur in spite of treatment. You have to consult the skin specialists and get proper treatment. Once the condition has healed you may follow the precautions given below to avoid the recurrence.    

Because the fungus that causes athlete's foot thrives in warm, moist areas, infections can be prevented by keeping the feet and the space between the toes clean and dry. Athlete's foot is contagious and can be spread in damp areas, such as public showers or pool areas, so you need to take some extra precautions with the feet when you move in such areas. 

• Avoid walking barefoot in unknown or potentially dangerous areas. Better yet, wear some kind of foot covering or shoes. 

• Be extra careful about drying feet and between the toes after bathing or swimming. Examine your feet regularly for cuts or signs of fungus. 

• Wear waterproof shoes or flip-flops in when you walk out especially in damp areas. Take special precautions in locker rooms and gym shower areas. Keep anti-fungal spray or powder in your locker. 

• Wear clean socks with tennis or jogging shoes; dust with powder or spray. 

• Don't self-medicate or try to remove corns, plantar warts or calluses yourself; you may just make matters worse or even provide an open door for infection. 

• Sandals or other casual footwear may be fine for occasional wear, but your feet need proper support. If you are planning an outing where a lot of walking is required, choose more appropriate shoes

• Even when you are at home alternate shoes or sneakers to prevent moisture buildup and fungus growth 

• Avoid socks that trap moisture or make the feet sweat and instead choose cotton or wool socks or socks made of fabric that wicks away the moisture