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Ask the experts

The follows are the questions post to the experts with their answers:

Question 1:SKIN SPLITS ON THE PALMS
I'm a 57-year-old man. In the past two months, I've had skin problems in both palms. The skin tends to split at the life lines on my palms. Sometimes the splits are quite deep but they seldom bleed although the wounds are reddish.
My doctor gave me some gel that I applied every night. During the day, I also constantly apply a moisturising cream he prescribed. The wounds take about a week to heal. But once this happens, the skin splits again after a couple of days, always at the life lines. I now wash my hands with mild detergents. But I don't normally wash dishes or come into contact with any chemical.

Answer:
What you probably have is chronic hand eczema. This condition is likely to be related to a genetic predisposition and especially occurs in people with a history of sensitive skin and nose. Although primarily endogenous, it can be aggravated by contact with external irritants such as harsh soaps and detergents.
When the skin splits, you could apply an antibiotic ointment which can prevent a secondary bacterial infection and also help relieve the pain somewhat. Doctors can prescribe a potent steroid ointment to reduce the underlying inflammation.
It is very important that you keep your palms moisturised, preferably with an ointment-based product, and that you continue to use only soap-free cleansers. If your hand condition continues to be disabling despite these measures, you should consult a dermatologist.
He may recommend more aggressive treatment measures such as phototherapy (the therapeutic exposure of selected wavelength ranges of ultraviolet or visible light to treat certain medical conditions, such as eczema, psoriasis or acne) or oral medication.

Dr Derrick Aw

Question:2 FLU LEADS TO OTHER WORRYING SYMPTOMS
I am 18, active and exercise regularly. Sometime ago, I fell very ill with the flu. After recovering, I began to have stomach discomfort, diarrhoea and nausea. I saw the doctor four times and was given progressively stronger medicine for controlling the urge to vomit and for stomach acid reflux.
All symptoms stopped for a few weeks before they returned. I saw the doctor again and was given the same medicine.
Once, I had palpitations while swimming. I stopped swimming, but the palpitations continued. A specialist gave me the same medicine and an additional one to normalise my bowel movements for six weeks. I had a blood test and an ECG and was told to wait for my next appointment.
Can my heart condition be related to my gastric conditions? I'm studying for exams. Can stress be the cause?

Answer:
Palpitation is a subjective increased sensation of a person's heartbeat. The most common cause is just extra heartbeats while the less common cause is atrial fibrillation (chaotic upper chamber heart rhythm). A heartbeat rate above 120 beats a minute may signal a heart rhythm problem while rates below 120 beats a minute are almost always benign in cause.
The heartbeat rate goes up as the body responds to illness (any illness - whether heart problems or not - causes physiological stress to the body), physical pain, and even to emotional stress or anxiety. All this can also lead to increased heartbeats. Also, people who are deconditioned (who lead sedentary lifestyles) tend to have higher baseline heart rates, whereas physically fit people tend to have lower heart rates.
Usually a simple blood test can rule out anaemia and thyroid gland dysfunction. However, in your case, it sounds like it is the result of several factors such as a sedentary lifestyle and test anxiety.
I recommend increasing the level of physical activity to improve your fitness. If shortness of breath limits this, you may want a cardiologist to evaluate your heart in more detail.

Dr Antono Sutandar

Question 3 TRYING FOR BABY WHILE HE'S ON MEDICATION
My husband and I want to have a baby. However, is it advisable to start planning a family while my husband is on medication? His neurologist has prescribed amitriptyline for his headaches. We understand that taking it is not advisable for pregnant women as there is a risk of birth defects. However, what happens if it is administered to the male partner instead of the female? Will it affect the quality of the sperm? Will the foetus be at risk when I do conceive?

Anwer:
Amitriptyline is often used for the management of migraine and depression. Although there are possible risks to the foetus when amitriptyline is used, there has been no study to show that its use will affect the sperm quality. Only trace amounts of amitriptyline have been found in semen, but there is no evidence that paternal exposures increase the risk of birth defects. Generally, agents that may cause birth defects do not reach the foetus through the father as they do from the mother.
However, a potential side effect of amitriptyline is ejaculatory dysfunction. If your husband has such concerns, he should discuss this with his neurologist and ask for alternative treatment.
There are many other issues that can affect a pregnancy. These include maternal age, smoking, diabetes mellitus and family history of congenital defects.
I would advise you and your husband to visit your family doctor for prenatal counselling.

Dr David Hau

Labels: flu, skin splits on the palms, trying for baby while on medication

The below questions and answers are compliments from Mind Your Body, Straits Times Singapore.

Questions on Allergic Attacks, Throat Discomfort and Chicken Pox Scars.

Experts answer on the following questions:
Question 1:
ALLERGIC ATTACKS IN YOUNG CHILD

I have a five-year-old daughter who was diagnosed with a nose allergy when she was two. Whenever she has an attack, she has a severe coughing fit and her nose runs. She coughs a lot when she lies down. The GP said that this is due to back drip from the nose. She takes all kinds of medicine but this gives her only temporary relief. She uses nose sprays and Ventolin.
I do not have any carpets, pets and soft toys at home. What triggers her attacks and why can't they be controlled?

Answer:
A I agree that your child is likely to have allergies. As she has not experienced relief after taking allergy medication, there could be additional reasons to account for her problem.
Young children with allergies often have associated adenoid enlargement and or sinusitis. These can cause significant and prolonged flu-like symptoms. These children may have constant runny noses, nose blocks, heavy/audible breathing and may also snore. It is often the case that their history would be one of multiple clinic visits and poor response to many different medications.
The way to resolve this problem is to first make the correct diagnosis. It would be best to visit an ear, nose and throat doctor. With the correct diagnosis, the most appropriate treatment for allergy and/or enlarged adenoids and/or sinusitis can be given. In virtually all cases, excellent improvement in the child's condition will be achieved.

Dr Stephen Lee

DISCOMFORT IN THROAT

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Question:
I'm a woman of 38 and I have suffered discomfort in the throat for more than two months. I think I accidentally swallowed a small chicken bone. But I've had an X-ray which showed nothing. Why do I still have this feeling?

Answer:
A Anyone who has discomfort in the throat with a possible history of having ingested a foreign body should have that cause excluded. An X-ray of the neck may not show the foreign body if it is lodged in the throat where bony structures of the jaw may obscure it or if it's lower down in the chest. An oral examination and an endoscopic examination of the throat needs to be done. A CT scan can be used to assess deep or migrated foreign bodies like chicken or fish bones in the neck and chest. These need to be removed as they can lead to severe infections.
If a foreign body is excluded, then other causes may be considered. A throat infection like laryngitis and pharyngitis may cause throat discomfort. Acid reflux from the stomach can irritate the throat causing inflammation and vocal cord polyp formation. If a nasal endoscopy suggests acid reflux to be the cause, medications may relieve the symptoms.
Lifestyle modifications like avoiding foods that increase the risk of reflux (fatty foods, large meals and caffeine), not eating before sleeping and not smoking can reduce the symptoms of reflux in the throat.
Another common cause is globus pharyngeus where patients often complain of a sensation of a lump in the throat with no swallowing problems. An endoscopic examination may show no abnormal findings. Gastric acid reflux into the throat, food allergies or a tight upper oesophageal pressure may have caused such a sensation.
I suggest you see an ear, nose and throat specialist so that appropriate treatment can be rendered.

Dr Raymond Ngo

GETTING RID OF CHICKEN POX SCARS

Question:
My little girl who is two years old has just had chicken pox. She didn't scratch the scabs. But some of them were rubbed off accidentally, or they just fell off. I can see that there are little indentations where that occurred. Does that mean she'll have deep scars? She has a couple on her forehead and a few on her body. Is there any cream I can use to minimise scarring?

Answer:
Indentation scars are quite common after a chicken pox infection. Some are more severe while others are milder. It is hard to predict now how deep her indentations are going to be while healing is taking place. You may want to consult a doctor before applying any medication on the scars. There are over-the-counter scar improvement creams e.g. ScarFade and Dermatix. Prescription-only creams are generally better than over-the-counter ones.

Associate Professor Wong Soon Tee

Labels: allergic attack, allergic attacks, chicken pox scars, throat discomfort