Dear Doctor,

I am 24 years old with a little body fat. Whenever I try to run or exercise I run short of breath immediately and find it difficult to draw breath. In fact most activities that require fast movement render me short of breath. What could be the issue?

Maureen

Dear Maureen,

For how long have you experienced this problem? How much overweight are you?

Obese people can have obesity hypoventilation syndrome (OHS). This leads to reduced ventilation, lower oxygen levels and higher carbon dioxide levels in blood. The result is that one gets breathless on moderate to severe exertion, depending on the severity of obesity and amount of physical exertion. During any physical activity oxygen demand of body is increased. Breathlessness occurs due to inadequate amount of oxygen reaching the tissues.

Breathlessness due to obesity is said to be because of reduced control of brain over ventilation. Excess weight over the chest, makes it harder for muscles to breathe in. Excess weight over chest also hampers good functioning of lungs. The person may have a flushed face, bluish discoloration of lips and fingers. Due to obesity one also suffers from obstructive sleep apnea, resulting in disturbed sleep. This can lead to day time somnolence and or depression.

Weight reduction can help solve this problem. This can be done by taking a low calorie diet including more of vegetables, fruits and whole grains, avoiding meat other than fish, avoiding alcohol. Regular physical exercise is very important. But one should exercise to their ability. The quantity of exercise should be increased gradually. Weight reduction should be gradual , not more than around 2Kg/month. Breathing exercises also help in regulating breathing and increasing amount of oxygen delivered to tissues.

It is also advisable to exclude any organic cause for obesity like hypothyroidism by relevant tests. If positive, treatment of this condition will help reduce extra fat and improve stamina for exercise.

*****

Dear Doctor,

I get a nosebleed whenever I have a cold. What could be the problem? 

George 

Dear George,

Nose bleed (epistaxis) with rhinitis is mostly the result of inflammation of the nose. The inner lining of the nose has very delicate capillaries (smallest blood vessels). They can become congested due to the acute inflammation and rupture causing nose bleed. Dryness of the nasal mucosa is one of the most common reasons for nose bleed. Excess dryness causes rupture of blood capillaries. Some people tend to prick their nose, when they feel dry and or itchy inside the nostrils, thus increasing risk of nose bleeds.

One may have a nose bleed due to high blood pressure. The high pressure in blood vessels can cause them to rupture anywhere in the body including the nose. Deficiency of elements causing clotting of blood like platelets, clotting factors, drugs like aspirin, coumadin, liver and kidney diseases, etc. conditions manifest as bleeding anywhere in the body including nose. 

Deficiency of vitamin C in the body also increases risk for nose bleeds or bleeding elsewhere.

Recurrent bleeding from nose is a potential source of anaemia due to the blood loss. The best way to prevent it is by preventing dryness inside the nostrils. One can use glycerine, vaseline or any lubricant for this purpose. It should be applied with a clean finger 2 to 3 times every day. Identifying and avoiding allergy causing substances can help in preventing cold due to allergy. A diet including green vegetables, fresh fruits like citrus fruits are also useful. Drinking much water keeps the body well rehydrated and also prevents dryness.

When epistaxis starts, one can pinch the nose very tight for few minutes with thumb and forefinger. This can stop it at the onset.

*****

Dear Doctor,

I used to be a heavy alcohol drinker but recently I made up my mind to cut out booze completely. My friends, however, tell me that it is not healthy to drop alcohol abruptly. Is this true? Does this mean I should take alcohol in moderation then finally quit or what I have done is equally fine?

Austin

Dear Austin,

What your friends say is partially true. When one drinks alcohol heavily, over time the body cells and also brain cells become habituated to it, causing dependence. This creates an urge to drink at the same time every day. Failing to get usual quantity of drink can cause, one to have uncomfortable withdrawal symptoms.

There can be palpitations, tremors of hands, sweating, difficulty in concentration, difficulty in sleeping, vague restlessness, one or more of these symptoms. These compel the person to drink again, thus creating a vicious cycle where he cannot do without booze. Drinking in small quantity is recommended by some people for overcoming the troublesome withdrawal symptoms, but is not a very good option. 

However, much depends on the mental make-up and lifestyle of an individual. Strong minded people are known to stop alcohol abruptly and get over withdrawal symptoms in few days. Keeping oneself occupied is also beneficial to overcome craving for drinking. When one gets the urge to drink, munching something harmless like nuts or drinking something non alcoholic helps to reduce the urge to drink.

Some become very stressed after stopping alcohol, needing hospitalisation, tranquilisers and sedatives are prescribed to a person to get relief from these problems. Alcohol provides only calories to the body, and no other nutrients. It also depletes body of essential vitamins like vitamin B complex. Hence after stopping alcohol, it is vital to take a balanced diet including fresh vegetables, fruits, whole grains, fish and milk products. Vitamin supplements are also useful. 

So if you have decided to quit alcohol, go ahead. Be mentally prepared for some discomfort for few days, try the measures suggested to overcome the craving for drinking. Over time you would definitely feel more healthy and fresh.

*****

Dear Doctor,

I am 25 years old but my hair is graying. What causes this and how can I stop it if it’s possible?

Enoch

Dear Enoch,

Hair starts to gray due to depletion of melanin (pigment present in hair follicles responsible for black hair). It is a normal process with advancing age, that is, after 50 years or so. But unfortunately, due to many reasons, currently even youngsters are having gray hair. With depletion of melanin, the hair instead of being black, become colorless. This combination of black and colorless hair gives a gray look.

Today’s life has become much more stressful than yesteryears and stress is one of the major reasons for premature graying of hair. Use of shampoos or soaps with harsh chemicals leads to excess dryness of hair and also depletion of melanin, thus resulting in graying.

Excess dryness of scalp, due to reduced production of oil from the oil glands of scalp is also responsible for early graying. Use of hair dryers causes early graying for the same reason. Washing hair with warm water also causes dryness of scalp. Excess dryness of scalp and premature graying also occur due to use of harsh chemicals in artificial straightening or perming of hair in salons.

It can be due to a dirty scalp, dandruff, infections like fungal infection of the scalp, e.t.c. It can be due to chemicals like hydrogen peroxide present in hair colours, which have a bleaching effect.

Deficiency of nutrients like vitamin B complex, copper, iron and iodine is known to cause premature graying.

Among disease conditions, recurrent cold as due to allergy, chronic sinusitis, chronic anemia, thyroid under activity are some of the conditions having early graying as one of the manifestations. Vitiligo, which occurs due to melanin deficiency, can cause early graying of hair as well, along with white patches on body. Toxic and heavy metal poisoning is also known to cause premature graying of hair. It can be a side effect of radiation or chemotherapy for cancers.

Prevention of premature graying consists of avoiding shampoos with strong chemicals and avoiding dryness of scalp. This can be obtained by massage of scalp by natural oils like coconut or olive oil, at least once or twice a week. Keeping scalp clean is also useful. But avoid using warm water to wash hair. If hair is naturally black, avoid use of hair colours/dyes.

Including fresh fruits and vegetables with whole grains in daily diet is useful in preventing and halting the progress of early graying. Regarding treatment, it is better to use natural colours like henna, indigo, gooseberry or juice of amaranth leaves, instead of synthetic dyes.

In case of an underlying disease process, treatment of the disease would help in stopping the progression of premature graying.

Most important is to remain relaxed physically as well as mentally.