Take heed of what your body clock says

I have heard pregnant ladies should get rest in the afternoons. Is it true? A colleague of mine is pregnant (three months) and usually we are busy during the afternoons. Is it okay that she just sits and does her work, or is it necessary for her to lie down or put her feet up?

— Rupa Khanal

Usually pregnancy, if normal, does require any extra rest. The first three months of pregnancy are the most difficult for the expecting mother because there are so many changes going on in her body and she needs to adjust physically, physiologically and psychologically to her pregnant state. I usually recommend cutting down on too much physical, sexual and mental strain during the first three months as a lot of spontaneous miscarriages occur during the first three months. About rest, different women adjust to pregnancy differently: I usually tell the ladies to ‘listen’ to their bodies. If they feel tired and have pain, they should rest.

During the mid and latter half of pregnancy few women experience swell-ing of their legs. It helps if they could just rest awhile and have their feet up during midday. She can do this as she feels comfortable, sitting with feet up or lying down.

— Dr Kundu Yangzom

I am 20 and my eyes are yellow in colour. I had a blood test but there is no sign of jaundice. What should I do to remove the yellow colour of my eyes? Is this due to mental stress or less amount of water or something else?

— Victim J

The yellow discoloration of the white front membrane of the eye is not uncommon. This is the membrane which circles the central front black part of the eye. There are different reasons for this membrane to become yellowish or yellowish-brown. Firstly, somebody may have exposure to frequent allergy conjunctivitis in their childhood, which may give a dirty look to an otherwise clear membrane. Secondly, there may be deposits of either melanin pigment (mole), deposits of fatty substances and sometimes a little growth of tissue on the nasal side of the eye. Jaundiced eye look gives a more uniform yellow lintel like colour and can be seen pronounced in daylight, associated with a general feeling of malaise, nausea, et cetera. If you have any doubts, please consult your eye doctor.

— Dr Sanduk Ruit

I have been suffering from bad breath for years though I brush my teeth regularly. I think it is due to some stains on my tongue. Whenever I drink tea, eat rice I get more stains on the tongue. I try to clean it while brushing, but the strains are back after a few hours. What should I do?

— Gopal Acharya, Pokhara

There are various causes for bad breath — local (within the mouth) or related to your general health. Among the local causes, stains/coatings on the tongue are also a major cause for bad breath. Stains in the back part of the tongue are mainly the breeding ground for odour producing bacteria which gives off a rotten egg smell also known as ‘dragon mouth’.

There are various methods by which you can clean your tongue. You can scrape your tongue with one of many available products in the market. Or simply invert a spoon and scrape your tongue. Scraping your tongue can remove up to 75 per cent of the odour in your mouth. Studies suggest that brushing and flossing should be accompanied by tongue cleaning in order to achieve a truly clean oral hygiene. Proper brushing technique, duration and frequency of brushing are also an important factor. Use of antibacterial toothpaste and mouthwash should be practiced. Six monthly visit to dentist for scaling is highly recommended.

— Dr Sameer Aryal

I am 25 and for the last 8-9 months I’ve been suffering from pimples and acne. The blunder I made was that I squeezed them. The problem now is that I have cicatrices. What medicine should I use to get rid of these cicatrices and what should I do to prevent further eruption of pimples and acne? I drink 5-6 glasses of water daily and wash my face with soap twice a day — in the morning and at night.

— Navin Shrestha

Acne or pimples is a common skin problem faced by most youngsters. Keep your face a little dry. Wash with soap in the morning and evening as you are doing. A

normal soap will do. Do not use it excessively. Apply soap mainly on the upper half of the face. Avoid all oily creams, sunblocks, cosmetics and hair oils as far as possible. Do not squeeze, let the pimples dry gradually. Go slow on junk food — better a normal Nepali diet with added green vegetables and fruits. It’s good to drink a lot of water, but it does not have any relation with pimples.

The best way to avoid scars is to prevent, and when required, treat pimples. With time, scars reduce a lot, and mild to moderate scars become insignificant. Use creams based on vitamin A derivatives. This is to be used under prescription only.

— Dr Dwarika Shrestha

I have been suffering from constipation for many years. I am a pure vegetarian, drink 4-5 litres of water daily and exercise too. I have consulted many doctors and also taken medicines like Fibril and Laxil. However, I still suffer from the problem. What can I do?

— Rosnee 

Bajracharya, Bhaktapur

You should have physical examination including digital rectal examination to rule out anorectal outlet problems, strictures, rectal prolapse and all other pelvic floor disorders. Laboratory tests to rule out blood in stool, complete blood count, calcium, glucose, thyroid, and electrolytes. Then barium enema and colonoscopy are also of diagnostic help. If all this fail to give results, then we must 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 that can be given with fibre 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 the above to take adequate vegetables and fruits supplemented with cereals like bran which make the stool bulky and soft. Secondly, the use of bulking agents of which bran, psyllium and methyl cellulose are the only laxatives that can be considered for long term use. Finally, to consult a gastroenterologist to find the cause of your constipation. Since you have tried the fibre/fluid therapy, perhaps the cause lies somewhere else for which you will need a rectal examination besides other laboratory tests mentioned above. Then, there is always the issue of psychogenic constipation where counselling is the important criteria.

— Dr Ranjeet Baral

The doctors on THT Medical Board are

• Dr Sanduk Ruit

Medical Director, Tilganga Eye Hospital

• Dr Bhagwan Koirala

Director, Shahid Gangalal National Heart Centre

• Dr Upendra Devkota

Chief of Neurosurgery, National Institute of Neurological and Allied Sciences

• Dr Kundu Yangzom

Chief of OBGYN Services, Patan Hospital

• Dr Kishore Pandey

Pediatrician, CIWEC

• Dr Sameer Aryal

Dentist, Advanced Dental Care

• Dr Dwarika P Shrestha

Associate Professor, Department of Dermatology, Teaching Hospital

• Dr Ranjeet Baral

Consultant Cardiologist and General Physician, Member of International Aviation Medicine Panel

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