Medical advice from Doc Wright

Australia's #1 media medic, as seen on InFocus.

25 June 2009

Reader's questions

Readers' questions

PERIOD PROBLEMS
Menstrual periods are part of the amazing internal time clock called "Circadian Rhythm", It is there from about age nine or ten, and silently operates whether you know it or not, like it or not. The so-called menstrual cycle. Women are born with two ovaries, containing around 250,000 potential eggs called primordial follicles. When the body clock also starts producing hormones, each month, from 25-35 (usually 40), a tiny egg wriggles to the surface. Pop, out it comes. To be swiftly swept into the outer ends of the "fallopian tubes" nearby.

CONCEPTION
If it chances to meet a male sperm here, conception occurs in an instant, and pregnancy has started. However, as this rarely occurs, the egg is swept along by tiny waving hairs called cilia to the uterus. Here, the walls have built up in the hope of receiving a fertilised egg. But if not, the thick lining called the endometrim disintegrates, and is quickly cleared as the uterine walls contract, and bleeding called a period or menses takes place over the next few days.
Then it starts all over again! Pain, varying from mild low pelvic or a back ache may occur. Usually mild, it may be severe or very severe, sometimes with vomiting and "agony". It is occasionally disabling.

PAIN RELIEF
What to do? If very severe every time, visit your GP, for sometimes pathological disorders such as endometriosis may be present. But most cases respond well to simple measures. Paracetamol is usually adequate. 2 x 500 paracetamol tablets give quick relief. Or panadol-osteo are stronger and last longer so less is needed, probably 2 tablets twice a day. Aspirin has been used for the past century. But this, like the many NSAID arthritis pain killers, such as ibuprofen and naprosyn (many brands available), and the oldest but still the safest), can offer relief.

There is a risk of stomach ulceration, and occasionally internal bleeding, but with small dose this is fairly uncommon. Take minimum medication for the minimum amount of time to gain relief. Some find sitting in a tub of hot water for 10-20 minutes gives relief. This is called a "sitz bath", after Dr Sitz, a German doctor who invented the idea in 1856. Hot wheat packs are also effective. More on ‘docwright.com.au'

Occasionally investigations may be needed. Manual examination by the doctor and ultrasound are widely used, and subsequent intervention will depend on these outcomes. Most do well.

Is there a simple cure for nappy rash?
Nappy rash occurs when urine and faecal material decomposes causing severe irritation to the skin. Therefore, changing naps quickly and regularly removes the major cause. Although disposable paper ones have virtually taken over, some still prefer the old fabric ones, dried in the sun, with a lovely smell, and nice and cosy for baby's tender skin. Exposure for a few sun kicks each morning toughen the skin, and aerates risk areas - but only for a few minutes. Keep area dry, use non alkaline soaps when bathing. Apply simple creams, like castor oil and zinc cream. Mild hydrocortisone cream, maybe mixed with anti-yeast and germ properties is often useful (doctor prescribed).

What is the best kind of soap for sensitive skin?
Best soap is no soap at all. Soaps are high in alkaline content which irritates the skin. Avoid these, and use a substitute. There are many good brands around, such as "Ego QV Bar, pH5.5, Dove, Cetaphil, These are very soothing. Use body warmth water when showering. Then dab dry with a very soft towel. Do not rub, for this aggravates. If dry, some find applying sorbelene cream with 10% urea a good nocturnal moisturiser. Cheap and available from any pharmacy.

My parents worry me. They lock their outside doors with at least two locks (including deadlock) and chains. What happens if a fire occurs?
Of course, they will be incinerated in no time flat. Hence the urgent need to make sure there are workable fire alarms in suitable places throughout the house specially the bedroom. If they awaken there is a fighting chance of escape. Death is usually from the toxins in the smoke rather than the fire itself. I believe a single deadlock is adequate for any home, with key in place for quick exit. You can help with encouragement, installing alarms and checking regularly.

I like muesli, which invariably contains lots of dried fruits, such as sultanas, raisins, maybe muscatels, banana, and others, plus unprocessed bran and other nutritional goodies. But an hour later, I feel bloated and uncomfortable. Should I change my menu?
Muesli is a good wholesome breakfast. However, dried fruit rapidly a absorbs water in the gut, swelling to its original size. Many find this causes bloating and flatulence. Try and find one without the fruit. Alternately, make your own. There are plenty of simple recipes around. Basically it is rolled oats, with bran, milk powder and probably wheat flakes and any other grains you care to add.

Please give me a simple remedy for a sore back. Do I go to bed?
Bed rest is out of favour. Keep moving, keep warm, avoid chills, keep dry. Apply heat. A hot "wheat bag" is fine, and can be used and re-used many times over. Massage deeply. Use a simple liniment (Lin Methyl Sal APF), Tiger Balm, Balmosa or any other heat producer. The non steroidal creams and gels which contain ibuprofen or naprosyn are also good. Paracetamol is the oral pain killer of choice.

Doc Wright is Dr John F Knight AM, a general practitioner, writer and broadcaster who lives Sydney, New South Wales.

For archives, to search specific topics, or submit a question go to http://www.docwright.com.au