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Your GP Questions Answered..

Dr. Ruhil Badiani MBBS, BSc RadSci, MRCGP, DRCOG answers your GP questions...

How do I know if I have a hormonal imbalance? What to look out for?

Hormones are chemical messengers that are produced in the endocrine glands. They tell tissues and organs what to do and help to control many of your body’s major processes, including metabolism and reproduction. While changes within the endocrine system and fluctuations in hormone levels can occur naturally throughout your lifetime, there are imbalances that can cause considerable health issues.

Hormonal imbalances can cause a broad range of signs and symptoms as they act upon the whole body. Symptoms will depend on which hormone or gland is not functioning properly. Common symptoms that affect both males and females include weight gain or loss, fatigue, changes in bowel habits, decreased libido, and mental health problems such as depression and anxiety. Females can suffer from changes to their menstrual cycle, infertility and hirsutism, hair loss, and decreased libido. Males often report erectile dysfunction, gynecomastia, and decreased facial hair growth when their hormones are not balanced. Children can also suffer from hormonal imbalances including thyroid disorders and diabetes. If they have hypogonadism, then they have imbalances in the sex hormones and will not go through puberty.

There are many causes for hormonal imbalances, hormone therapy, chemotherapy, tumors, stress, eating disorders, and some medications. Diabetes is one of the most common endocrine conditions worldwide but others include hyperthyroidism, hypothyroidism, Cushing’s syndrome, Addison’s disease, and congenital adrenal hyperplasia.

Treatment of hormonal imbalances is dependent on your diagnosis and can range from surgery, for example removing your thyroid or pituitary gland, to medications to treat the condition such as insulin or testosterone or to treat the symptoms like the combined contraceptive pill for PCOS. If you have any concerns about your hormonal levels, your doctor can investigate your symptoms which may involve bloods tests, ultrasound scans, MRI scan, urine tests and sperm count analysis. The tests done will be dependent on your symptoms and physical examination.

Gut health. How can we keep our gut healthy?

You have many bacteria in your body. In fact, you have more of them than you have cells and most are good for you.

Gut health refers to the balance of the bacteria, collectively known as your gut microbiome, that lives in your digestive tract and its importance to our overall health is a topic of increasing research in the medical community. Numerous studies have now shown and link between gut health and the immune system, mood, mental health, autoimmune disease, endocrine disorders, skin conditions and cancer.

How can we keep our gut healthy?

  • Eat a diverse diet full of whole foods which leads to a diverse microbiome.

  • Eat lots of fruits, vegetables, legumes and beans. Fruits and vegetables are the best sources of nutrients for a healthy microbiome. These food groups, including beans and legumes, are rich in fiber which can’t be digested by the body, but certain bacteria can digest fiber which stimulates their growth.

  • Eat fermented foods. Fermented foods, for example, yoghurt, kimchi, sauerkraut, are rich in Lactobacilli. Research has shown those who eat more fermented foods have more Lactobacilli and lessEnterobacteriaceae, which is a type of bacteria associated with inflammation and a number of chronic conditions. Yoghurt can improve intestinal bacteria and decrease symptoms of lactose intolerance.

  • Exercise and move more. Exercise, in particular longer and high-intensity workouts, has the potential to alter gut bacteria composition and functionality independently of diet.

  • Reduce your stress levels. Stress, anxiety and depression are affected by the gut and vice versa. While we don’t know everything about their relationship, we do know that mental health and the gut are intimately connected and are often referred to the “ gut-brain connection”.

How invested are you in building relationships with your patients?

In a nutshell, I am wholly invested in building relationships with my patients and it is an integral part of providing the best clinical care possible. The relationship I have with my patients is the foundation of the care they receive and can have profound positive and negative implications.

My patients need to trust my clinical judgment but also feel comfortable enough to questions and ask for clarification of the advice that I give. Patients need to feel connected and trust my guidance to help them understand their individual healthcare needs so that they can make informed decisions toward better health and wellness. The better I understand my patient, the more I can match unique resources, treatment options and information for my patient to use. Stronger patient relationships has been shown to demonstrate value that goes above and beyond quality treatment and care.

What age should you start getting your blood pressure and cholesterol taken?

Knowing your blood pressure numbers is the first step to a long and healthy life. Along with other tests such as your blood cholesterol, they’re a sign of how healthy you are overall, and whether your heart and blood vessels are in good health. Think of a blood pressure check as part of an MOT for your body.

The blood pressure should be checked at an early age by the pediatrician, and then when you're a teenager, and then when you're an adult. How often you should check your BP is dependent on your numbers, your risk of heart disease and your family history.

The American Heart Association (AHA) recommends the test at least every 4 to 6 years starting at age 20, as long as your overall risk of heart disease is low. After age 40, your doctor should calculate your risk of having a heart attack or stroke in the next 10 years. Your individual risk would help the doctor decide how often you should get screening. Generally speaking, after the age of 40 I would advise a cholesterol check every 2 years but more often if you have a higher risk of heart disease or have a diagnosis of raised cholesterol (hypercholesterolemia).

How often should I schedule an appointment with my doctor?

The recommendations regarding the frequency of routine checkups are based on your age, risk factors, and current health status.

While opinions vary, routine checkups with your doctor are generally recommended as follows:

  • once every 3 years if you’re under the age of 50 and in good health

  • once a year once you turn 50

If you have a chronic disease, like diabetes or COPD for instance, you should see your doctor more frequently, no matter how old you are. Your doctor may suggest more or less time between your checkups based on your risk factors, screening test results, and current health status.

How do I know if I am dehydrated?

Maintaining proper hydration is essential to overall good health. Without water, your cells can’t function, which is why humans can only survive a few days without fluids. Unfortunately, many adults and kids don’t consume enough fluids, which can lead to chronic dehydration. What’s more, conditions like diarrhea, vomiting, and excessive sweating can lead to acute or short-term dehydration. Dehydration can negatively affect many aspects of health and even be life-threatening in severe cases, so it’s important to know the potential signs and symptoms of dehydration in both adults and kids.

Signs and symptoms of dehydration include dark-colored urine, decreased urination, headaches, fatigue, dry skin, decreased skin turgor, and poor concentration. In babies and young children, they may not produce tears when they cry or will have a decreased number of good wet nappies.

If you are concerned about dehydration, especially in the very young or elderly, make sure to see your doctor as soon as possible for an assessment

How can I prevent headaches?

Even though there are more treatment options for headaches and migraine than ever before, preventing a headache can be a lot easier than trying to get rid of one. Once a headache strikes, especially if it’s part of a migraine attack, you might be out of commission for several hours or even days. Depending on the cause of your headache, migraine, tension headache, cluster headaches, and sinus headache to name a few, there are different ways to prevent them.

If you suffer from migraines or chronic headaches, it is a good idea to keep a headache diary. This can help you track when you are getting the headaches and what your triggers might be so you are able to avoid them. Take migraine medication as soon as the attack starts for the best results. Maintaining a good sleep schedule, drinking plenty of water, and doing exercise are all ways to help many types of headaches as well as avoiding triggers that are specific to you.

What would you suggest to support a restful sleep?

Sleep is an essential function that allows your body and mind to recharge, leaving you refreshed and alert when you wake up. A good, restful sleep also helps the body remain healthy and stave off diseases. Without enough sleep, the brain cannot function properly. This can impair your abilities to concentrate, think clearly, and process memories.

Good sleep hygiene is essential to a restful night’s sleep. Some tips to help you include:

  • Stick to a sleep schedule. Set aside no more than eight hours for sleep. The recommended amount of sleep for a healthy adult is at least seven hours. Most people don't need more than eight hours in bed to achieve this goal. Go to bed and get up at the same time every day. Try to limit the difference in your sleep schedule on weeknights and weekends to no more than one hour. Being consistent reinforces your body's sleep-wake cycle. If you don't fall asleep within about 20 minutes, leave your bedroom and do something relaxing. Read or listen to soothing music. Go back to bed when you're tired. Repeat as needed.

  • Pay attention to what you eat and drink. Don't go to bed hungry or stuffed. In particular, avoid heavy or large meals within a couple of hours of bedtime. Your discomfort might keep you up. Nicotine, caffeine and alcohol deserve caution, too. The stimulating effects of nicotine and caffeine take hours to wear off and can wreak havoc on quality sleep. And even though alcohol might make you feel sleepy, it can disrupt sleep later in the night.

  • Create a restful environment. Create a room that's ideal for sleeping. Often, this means cool, dark and quiet. Exposure to light might make it more challenging to fall asleep. Avoid prolonged use of light-emitting screens just before bedtime. Consider using room-darkening shades, earplugs, a fan or other devices to create an environment that suits your needs. Doing calming activities before bedtime, such as taking a bath or using relaxation techniques, might promote better sleep.

  • Limit daytime naps. Long daytime naps can interfere with nighttime sleep. If you choose to nap, limit yourself to up to 30 minutes and avoid doing so late in the day. If you work nights, however, you might need to nap late in the day before work to help make up your sleep debt.

  • Include physical activity in your daily routine. Regular physical activity can promote better sleep. Avoid being active too close to bedtime, however. Spending time outside every day might be helpful, too.

  • Manage worries. Try to resolve your worries or concerns before bedtime. Jot down what's on your mind and then set it aside for tomorrow. Stress management might help. Start with the basics, such as getting organized, setting priorities and delegating tasks. Meditation also can ease anxiety.

  • Most adults will the occasional sleepless night and it is normally caused by stress and life events. However, there are some medical conditions that can affect your sleep including hormonal imbalances, chronic medical conditions and sleep apnoea. If you are continuing to struggle with your sleep, despite trying the tips above, see your doctor who can identify if you have any underlying causes and treat accordingly.

How often should I have a smear test?

Cervical cancer is highly preventable and we urge all women over the age of 25 to be screened regularly. The UAE Ministry of Health & Prevention (MOHAP) and the Department of Health Abu Dhabi Guidelines for Cervical Cancer Screening recommends that all females:

  • Aged 25 to 29 years undergo a Pap smear test every three years.

  • Aged 30 to 65 years undergo a Pap/HPV cotest, where human papillomavirus (HPV) test and a Pap test are done at the same time, every five years.

Other factors also influence how often you should have your Pap smear including your personal and family history. If you are at high risk then you may need to have a Pap smear every year. If you are concerned that you are high risk then discuss this with your family doctor or gynecologist.

I am not losing weight despite working out daily and eating healthily, drinking lots of water etc. Why could this be?

The weight loss journey is often long and arduous and requires patience and resilience. There may be several factors that may be impeding your journey. Medical conditions such as thyroid disorders and polycystic ovarian syndrome may make it much more difficult to lose weight, so if you do feel like you have stalled, it is a good idea to visit your doctor for a review.

Calorie deficit is the best way to lose weight, however, if you are not eating enough protein or eating too many carbohydrates you might find your weight loss stops. Make sure to eat lots of plant-based proteins and whole foods, heavily processed foods can negatively affect your weight loss. Drink lots of water, get a good night’s sleep and avoid eating too often can also help to get the weight off. When exercising make sure to do cardio regularly and add in strength training as it maintains long-term fat loss.

If you think you are experiencing a weight loss plateau, you shouldn’t fret just yet.

It is incredibly common for the scale not to budge for a few days (or weeks) at a time. This does not mean that you are not losing fat.

Bodyweight tends to fluctuate by a few pounds and depends on the foods you are eating. Hormones can also have a major effect on how much water your body retains (especially in women). It is possible to gain muscle at the same time as you lose fat. This is particularly common if you recently started exercising. This is a good thing, as what you really want to lose is body fat, not just weight. It is a good idea to use something other than the scale to gauge your progress. For example, measure your waist circumference and body fat percentage once per month. Also, how well your clothes fit and how you look in the mirror can be very telling. Unless your weight has been stuck at the same point for more than 1–2 weeks, you probably don’t need to worry about anything.

Acne in mid 30’s: help!

Yes, adults get acne. Some adults continue to get acne well into their 30s, 40s, and even 50s. It is even possible to get acne for the first time as an adult. Dermatologists call this “adult-onset acne”. Acne is often not taken seriously enough, and it can lead to facial scarring which is very difficult to treat. The mental health impact of acne is also often disregarded.

Treatment options vary depending on the severity of the acne. Topical treatments including benzoyl peroxide and retinoid creams are very effective if the acne is affecting only the face. Oral treatments maybe required if topical treatments do not work or acne is over a widespread area, affecting the back and chest. The contraceptive pill, antibiotics, isotretinoin and spironolactone can be taken under the guidance of a dermatologist or family doctor. Other treatments include light therapy and lasers.

If you are suffering with acne at any age and have not been able to treat it with over-the-counter acne medications, see your doctor as soon as possible to avoid scarring. Remember, do not pop your pimples as it can leave worse scars.


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