Thu | Oct 18, 2018

Dear Doc | Can't wean my 4-y-o off the breast

Published:Sunday | December 24, 2017 | 12:04 AM

Q: Doc, I am still breast-feeding my four-year-old son. It is uncomfortable, as sometimes he bites me. No matter what I do, I cannot get him off my breast. I even rub aloe vera on them but this makes no difference. Can you please tell me how I can get him to stop?

A: Good day to you, I am sorry for your discomfort. In fact, one of the indications for discontinuing breastfeeding is when it poses harm to the mother or child. The biting of your nipples can create cuts, which can lead to infections. The best route is to offer the child a healthy substitute such as a fruit or a glass of milk each time he reaches for the breast along with the explanation that he is a big boy now and no longer needs mama's milk. Be careful of negative statements which may create psychological issues. There is no harm in continuing to apply the aloe vera.

The World Health Organization recommends exclusive breastfeeding for the first six months of life, or up to two or more years with age appropriate solid food after six months, so there is no official cutoff point. However, an indication for discontinuing is when it has a negative effect on the mother or child, which may be physical or psychological. Best of luck.


Do I have fatty liver?


Q: Dear doc, I've been having pain in my right side for a very long time. No painkiller seems to work. I went to the doctor, who sent me for an ultrasound which revealed that I have fatty liver. I am a very slim person, so how can this be? Can it be cured?

A: The liver, like most other organs, contains fat. However, when it becomes too much, it interferes with the normal functions of the liver, which can lead to other issues. The excess fat causes inflammation which causes abdominal discomfort/pain, and the condition is reversible once the underlying cause is addressed.

The most common cause is excessive/chronic consumption of alcohol. Alcohol damages the cells of the liver, so it cannot break down fat from the diet. Limiting alcohol intake, or total abstinence, usually alleviates the problem.

A diet high in sugar and refined carbohydrates causes obesity and fatty liver.

Diabetes mellitus, which is a disorder in carbohydrate metabolism (particularly glucose), can also cause fatty liver as the excess sugar in the blood is converted to fat.

Certain genetic disorders leading to excess cholesterol and other fats in the blood can cause this excess fat to be deposited in the liver and other organs rather than muscle/ beneath the skin, so the individual will appear slim but has a fatty liver. Blood tests are available which will determine if there is a problem with fat metabolism; this will guide your healthcare provider in applying the appropriate treatment.

Excessive use of certain over-the-counter medication such as panadol, prolonged use of aspirin, and certain antibiotics can also cause fatty liver.

The take-home message? Get tested for diabetes and cholesterol, avoid/ limit alcohol consumption, reduce intake of sugar/refined carbohydrates (especially during this holiday season when people tend to eat more!), and exercise regularly.


I can't climax during sex


Q: Doc, I am having a serious problem. I am now in my early 30s, and I cannot have an orgasm unless I masturbate. I enjoy intercourse with my boyfriend, but cannot have an orgasm that way. He does not want to perform oral sex, which can also make me have an orgasm. I had a boyfriend in my 20s who would perform oral sex, and I achieved an orgasm all the time. Can masturbation damage my clitoris? Is it possible for me to have orgasm from normal intercourse?

A: This is an issue faced by women around the world, a problem that could be alleviated by educating men about the female anatomy. Masturbation is not as common with women as with men, and there is no evidence that it damages the clitoris which, like the vagina, is built to withstand a lot of friction. The clitoris contains numerous nerve endings and adequate stimulation produces pleasurable sensations which can lead to an orgasm.

During intercourse in the missionary (face-to-face) position, most times sufficient contact is not made with the clitoris. This can be fixed by having the man 'ride higher' or trying different positions in which he can use his hand to stimulate the clitoris. Many women experience an orgasm due to indirect clitoral stimulation during intercourse, so yes, it's possible to achieve an orgasm this way. It's just a matter of technique and patience.

Many men are not keen on performing oral sex for various reasons. Having an open, honest discussion with your partner about your sexual expectations maybe helpful.


Pain in lower back


Q: Doc, I am 22 years old, and I am experiencing some discomfort in my lower back. It's not very painful, just very quick sharp pain. It mostly occurs when I sit down - I have to adjust myself to sit for long periods. Before, I used to feel it when I stood up for long periods, but not anymore. I heard that someone became paralysed due to the deterioration of the bones in his back. Do you think that is what is happening to me? I have tried to get an appointment at the clinic, but it's booked solid until the middle of next year. Is my case serious enough to seek immediate medical assistance?

A: Please be advised that this column is not a substitute for regular visits to your healthcare provider, so make the appointment just the same. In the interim, there are a few things to consider based on the scenario you described.

The most likely cause is muscle spasm due to sports injuries, prolonged sitting, muscle strain from strenuous activity, and poor posture. This may be alleviated by over-the-counter topical and oral painkillers and flexibility exercises like yoga which improve posture.

Sharp shooting pain can be caused by a 'pinched' nerve, which is often a sign of a serious back problem such as a herniated disc or a fracture of one of the bones in the lower back. These require urgent medical attention, and the outpatient department of any local hospital should be able to assist you.

Deterioration (rotting) of the bones in the back is usually due to an infection or cancer. These are usually accompanied by fever, weight loss, night sweats, dizziness, and loss of appetite, just to name a few. Seek immediate medical attention if any of these symptoms are associated with your discomfort.