Doc, how do I help my child stop wetting the bed?

I am a parent of two —  a 12-year-old daughter and a seven-year-old son. 
What worries me most is that the young one never wets the bed but the older one still does. We need your assistance on how we can go about the treatment.
 Worried parent

Dear worried parent,
Bed wetting in anyone above the age of six to seven years is considered a problem. 

In many cases, the cause may not be known. Some may have an overactive bladder or a problem with the nerves and muscles in the bladder. 

There are two kinds of treatment —  behaviour therapy and the use of medication. She needs to take adequate amounts of water during the day so that she is not thirsty in the evening. She should also make a habit of using the toilet regularly during the day, every two to three hours.

She should avoid taking large amounts of liquid after 6pm, and be sure to use the toilet just before going to bed. You can use an alarm to wake her up once or twice during the night so that she can go to the toilet. The timing of the alarm should be adjusted to just before she wets the bed. It might take some time to get the timing right, and patience is needed. Once she is used to this, she can manage herself, and usually within three months, she should be able to stay dry most nights. She needs to be reviewed by a doctor every few months until she is well. If the above measures do not work, she can also be started on medication to help “strengthen” the bladder muscles.

The most important thing for you and your daughter is to believe that she can get dry, and to maintain a positive attitude. Punishment and scolding do not help at all. She will need constant affirmation, and celebration of every victory.

Doc,

I am a 30-year-old woman and my problem is that I get tired easily — I am perpetually feeling tired. People close to me think that I am lazy because I can't handle so many household chores like they do. Anytime I try to do many chores I feel dizzy and very exhausted.

I asked a pharmacist for advice and he recommended multivitamins and ginseng to fight fatigue, but I took them for a while before I got tired of swallowing pills. I don't consider myself lazy, I just get tired easily. Does this signal an underlying health problem and what can I do about it? I once saw the concept of chronic fatigue somewhere, but I didn't really understand it. Please help.
Maya

Dear Maya,
Chronic fatigue can be due to quite a number of health issues including infections, anaemia, diabetes, autoimmune diseases like lupus and multiple sclerosis, hypothyroidism (an underactive thyroid), depression, fibromyalgia, alcoholism or even severe obesity. You should see a doctor so that these and any other possible causes can be checked for.

If you are not found to have any of these issues, then you may be suffering from chronic fatigue syndrome (CFS). CFS has no known cause though it may be associated with some viral infections, weak immune system or abnormal hormone levels. Those suffering from CFS have severe fatigue that interferes with daily activities for more than six months and there is no improvement with bed rest. Other symptoms of CFS include poor memory, poor concentration, sleep disorders like insomnia, unrefreshing sleep, severe fatigue after physical or mental exertion lasting more than 24 hours, muscle and joint pains, frequent headaches, frequent throat infections and swollen lymph nodes.

There is no test to diagnose CFS. The presence of chronic fatigue plus four other symptoms, and the absence of an underlying illness is what gives the diagnosis. Management involves having good sleep etiquette, graded exercise therapy with physiotherapist or qualified personal trainer and psychological support. Sleep etiquette includes getting a sleep routine —  sleeping at the same time each night and waking up at the same time each morning, start winding down your activities at the same time each evening, avoid screens (TV, computer, phone) at or around bed time, avoid taking a nap during the day, avoid caffeine, alcohol and smoking, especially near bedtime. Avoid physical and emotional stress. Do activities that you enjoy and do them at your own pace, taking time to rest during the day.

You may need medication for some specific symptoms such as painkillers for muscle and joint aches, medication for throat infections, among others. CFS symptoms may come and go or you may have them persistently but the condition has no cure.

I am 26.  A few years ago I decided to stop eating meat for personal reasons. Of late I have been having headaches and feeling dizzy. I went to the hospital and was told my blood level is low. I was told to start eating meat to help build up my blood. I was also given some supplements. Is there any way I can improve my health without eating meat and without taking medicine?
Angela

Dear Angela,

Every food group is important for a healthy body. Iron is the nutrient most responsible for building up your blood. If you are not getting enough iron, then the blood level (haemoglobin) goes down. Since haemoglobin carries oxygen to body tissues, when it goes down the body starts suffering from reduced oxygen, which leads to headaches, dizziness, fainting and even heart and kidney failure. If you have a deficiency of iron then, in addition to food, you need to take the iron supplements, otherwise known as blood builders, so that you can build up your haemoglobin quickly and your tissues can stop having oxygen starvation. Your body absorbs more iron from meat than from other foods. Since you have chosen to not eat meat, then you have to get those nutrients from other iron-rich foods like beans, peas, soya, dark green leafy vegetables, dried fruit like raisins and fortified cereals like fortified maize meal. You may also need to take iron supplements regularly.

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