Nowadays contact lenses are very popular, but are they suitable and effective to use? Do the lenses have any side affects? — Raj Badhyakar

Generally contact lenses are used for optical, cosmetic and therapuetic reasons. One of the most important pre-conditions for the use of contact lenses are that the individual patient should be thoroughly counselled on the risks and benefits of contact lenses.  The optical uses are for correction of vision as with spectacles, but used side-by-side with spectacles — not as a replacement.

Now-a-days, cosmetic contact lenses are becoming more popular, but should be used in consultation with your eye doctor or a contact lens expert. Patients, who have severe ‘dry eye’ are discouraged to use contact lenses. Proper counselling on the types and materials of contact lenses and more imporatntly on the contact lens solutions, as they are sometimes the cause of infections.

— Dr Sanduk Ruit

I am a 52-year-old diabetic with blood sugar level of 100-110 mg in fasting, and 130-140 at pp. Currently I am taking 80mg of Glizid twice daily and 500 mgm of Metformin thrice daily. My blood pressure remains at 130/70-80 and I am taking 10mg of Enalapril and 5 mg Amlodepine tablets daily.

My major problem is severe constipation for which I am compelled to take some herbal preparations like Kabjaher, Maheshwari Churna or other herbs which is quite problematic for me. Can I correct my bowel movement without those? I also suffer from erectile dysfunction though I have a good sexual sensation. What is the remedy for this? I also suffer from frequent headaches that may be due to gas. Does medical science have any remedy for this? — Amar

The major questions pertains to constipation. The normal frequency of bowel movements ranges from 3-12 per week. So by definition constipation would mean stool evacuation less than three times a week, hard stools, excessive straining or incomplete evacuation.

The most common causes are: inadequate fiber or fluid intake and poor bowel habits-one needs to take 10-12gms of fibre per day with two glasses of water per meal. The other causes are systemic diseases like of thyroid and diabetes among others, medications, structural abnormalities that obstruct stool passage or anorectal outlet

problems that impede stool passage. Since you been

taking some form of fibre/fluid supplements without results, your cause maybe something other than the common cause.

You should have physical examination including

digital rectal examination, laboratory test to rule out blood in stool, complete blood count, calcium, glucose, thyroid, and electrolytes. Barium enema and colonoscopy are also of diagnostic help. If all this fail, then investigate for slow colon transit. Still other tests are defecography, manometry and balloon expulsion test.

Treatment

Dietary: Fibre/fluid intake will benefit most but not those with colonic inertia or outlet disorders.

Stool surfactant agents: These are stool softeners like mineral oils or docusate sodium given orally or rectally.

Osmotic laxatives: These are again stool softeners which can be given with

fiber supplements. These

are the saline laxatives and glycol solution.

Stimulant agents: They stimulate fluid secretion

and colonic contraction. These are senna, cascara

and castor oil.

I would advice you to take adequate vegetables and fruits supplemented with cereals like bran that make the stool bulky and soft. The use of bulking agents of which bran, psyllium and methyl cellulose are the only laxatives that can be considered for long term use. Consult a gastroenterologist to find the cause of your constipation.

Regarding the erectile dysfunction (presuming it is of recent onset), the cause would be aging process in a diabetic. Sildenfil or cialis should serve your purpose after doing a treadmill test to rule out ischemic heart disease. Then if your cardiologist does not prescribe you a nitrate family medication, then these medications should solve your problem.

— Dr Ranjeet Baral

Is there any herbal method of whitening teeth? — Raj B

I am not aware of any proven herbal method of whitening teeth. However, many home remedies have been tried — rubbing the bark of a walnut tree, use of strawberries, rubbing the inside of an orange peel, brushing with apple cider vinegar and use of hard wood ash. The mechanism and level of whitening achieved by these products are unknown. In my opinion, some of these techniques might have a harmful effect on the teeth.

Today, teeth whitening products are the top selling cosmetic dental products all over the world. I would suggest you use one of the many products available in the market. It can range from toothpaste to strips to gel. Professional teeth whitening is also commonly practiced and is most effective till date. However, I would like to bring to your attention that there are no products available which will make your teeth permanently white.

— Dr Sameer Aryal