General Health Friday January 30, 2015

Dr Hilary Answers Your Questions: Part IV

It's time for the January instalment of our regular Dr. Hilary feature. January is typically a month where people like to focus on their health so, Dr. Hilary was flooded with lots of common health questions. Take a look below:

1. In September i strained my back after lifting some heavy boxes. It got better but recently i lifted some more heavy things while moving house and the pain came back. What do you think this could be, and what can i do to prevent it recurring?

Lifting heavy objects has been the trigger for your back pain in both instances. This points very strongly either to poor lifting technique or to weak extensor muscles of the spine or a combination of both.

Always make sure that when you lift anything heavy you keep your spine absolutely straight and bend your knees to lift the object with your thigh muscles. You should also embark on a course of core muscle strengthening exercises. Lie on your front with your hands clasped behind your head and arch your back upwards. These are called salmon flips. Build up to doing 200 crunch abdominal exercises each day with side flexion exercises also.

2. When I push on my trachea i hear cracking sounds - why is this?

The trachea consists of the cricoid cartilage at the top, which is a complete ring of strong supportive tissue. Below that are several incomplete rings of reinforcing cartilage, the ends of which are joined by the trachealis muscle, which in turn is joined vertically by bands of fibrous connective-tissue. The rings of cartilage give the trachea strength and flexibility, and when you push on your windpipe these cracking sounds are simply the sounds of normal movement in these supple structures.

3. What do you recommend to people who really love their food but need to lose weight? I can’t face cutting out all the foods i enjoy!

Good food is highly pleasurable and the most palatable foods of all are highly addictive. Enjoying these foods triggers the pleasure pathway in the brain to release happy hormones, which make you feel good and comforted. But the downside is the more you eat the more you will put on weight. This in turn will have a detrimental effect on your long-term health, such as an increased risk of diabetes and heart disease.

It is down to personal choice. Keep eating as you are and die prematurely, or enjoy your food in a more controlled way, by limiting portion size and ensuring a healthy well-balanced diet by keeping sugar fat and salt to a minimum and increasing the amount of fibre. Exercise more as well. You can still be a foodie but be healthy.

4. I have low blood pressure and suffer some adverse effects such as dizziness. Is there anything i can do to raise it?

The good news is that low blood pressure is generally very healthy. You are much less likely than people with high blood pressure to have a heart attack or stroke in the future. The downside is that occasionally you may feel dizzy, especially when standing up from a sitting position or getting out of a hot bath when all the blood is diverted to your skin in an attempt to lose heat.

Increase your fluid intake to boost your blood volume and take regular exercise. The latter sharpens up the cardiovascular reflexes, which sense when your blood pressure is low and rapidly increases the strength and frequency of your heart beats to restore BP to normal.

5. When i try to pee it comes out really slowly. Why could this be? (I am male)

In men whose urinary outflow has become slower and weaker there is usually an obstruction to the passing of urine from the bladder, caused by either an enlarged prostate gland or narrowing in the water pipe (urethral stricture). The former begins to occur in men over the age of 45 naturally and is known as benign prostatic hypertrophy. As men grow older, however, there is an increased risk that the enlargement is caused by a cancer, leading to the same symptoms. Strictures are usually caused by low-grade infection or inflammation that develops over many months or years. Tests to rule out a bladder infection and to assess the severity of prostate enlargement can be done by your GP. In some cases surgical reduction of the prostate gland, where medication is insufficient, may be required. Stricture is easily treated by stretching the water pipe with a special instrument under anaesthetic.

6. My lower back often hurts, could this be due to bad posture? I sit down all day at work. Is there anything i can do to improve this? We don’t have DSE assessments!

Yes bad posture is the commonest cause of an aching lower back. Many people tend to slouch when they sit in their office chair, slumped forward with their shoulders rounded and their entire spine gently curved. This puts immense strain on the ligaments and muscles in the lower back which in the course of time will ache.

Make sure that your desk is of a sufficient height so that your back can be straight as you look at your paperwork or computer. Try to keep the lower spine arched and supported with a lumbar support. Start on a course of core muscle exercises making sure that you do as many exercises for your back as you do for your side and front.

7. Are men today going bald at an earlier age? I’m sure i never used to see so many bald twenty year olds!

Whilst this is in keeping with many people's observations, there is surprisingly little medical research to support it. The predominant cause of male pattern baldness is an increased sensitivity of certain hair follicles to normal circulating levels of dihydrotestosterone. These have not changed significantly over the last half century. Male pattern baldness is also largely hereditary but there have been no major evolutionary changes in men's genetic make-up either in this time.

Environmental changes are therefore likely to be the cause. Hair loss is often attributable to stress but this makes little sense in a world which is relatively safer than in years gone by. Nutrition should in theory be better also and there is little evidence to support the notion that there are lots of oestrogens circulating in the environment. A more plausible explanation would be microcirculatory changes in the skin affecting the hair follicles, caused by central heating, air-conditioning and loss of natural oils as a result of overuse of cosmetics and shampoos.

8. I have developed a tiny lump on the side of my finger with a tiny red dot on it. My GP said it’s nothing to worry about but that i can’t get it removed on the NHS because it’s too small. Do you have ideas what it could be?

This sounds very much like a simple viral wart. The central red dot in the middle is typical of a small blood vessel supplying the virus but seen end on.

It's difficult to believe your GP could not come up with a diagnosis. I would get the local pharmacist to take a look and supply you with a simple wart remover chemical and kit to deal with it yourself.

9. I clench my teeth at night (not grind) and my dentist has told me i need to try and stop or i will develop serious jaw problems. It already clicks loudly and often hurts when i chew. Also my teeth hurt from being pressed together. The dentist told me to try to reduce stress but i am no more stressed now than before. Do you have any advice? I already tried a SleepRight guard but it made the problem much worse as i chewed on it.

This condition is known as a bruxism and is common. Teeth grinding is just like fist clenching or foot tapping and is often seen people who are slightly anxious or restless. The trouble is it does put strain on the joint between your jaw and your skull (the temporomandibular joint) and this can click and ache unless something is done. Hypnotherapy is very good at dealing with this condition and a tailor-made dental splint constructed by a reputable dentist will protect your teeth.

10. I have a habit of chewing the inside of my cheeks so the skin there is always damaged. I have done it since i was young and my mother does it too. Is it common to do this, and is it a problem?

I have certainly seen this habit in certain people over the years although in most people it is an accidental biting of the cheek brought about by misalignment of teeth or jagged fillings. It may be that you bite your cheek lining deliberately because you are conscious of the tissue there coming between your upper and lower teeth. If it isn't painful it probably is not a problem, however persistent trauma in the mouth can lead to inflammation, infection, scarring and other changes. Get your dentist to check that there are no dental cheek or gum problems and consider hypnotherapy to ease yourself out of the habit.

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