Doc, why are my fingernails turning dark?

Dear Doctor,
Some of my finger nails have a darker colour and look disfigured. I have had this problem for the past one year. What could have caused it? Is it possible for my nails to go back to normal?
Juma

Dear Juma,

There are many causes for disfigured and discoloured nails, but the most common cause is fungal infection of the nail. Usually, the infection is very stubborn and can last for a long time, even years. Treatment is with anti-fungal tablets and some medication for applying on the nails. The treatment itself may take long and it is sometimes broken into phases otherwise known as pulsing. You should visit a doctor so that they can determine whether it is a fungal infection or it could be a result of other illnesses like psoriasis.

In most cases, the nails can be treated and go back to normal.

Dear Doc, 
What is hepatitis?

Dear reader,
Hepatitis refers to inflammation of the liver, which can occur due to infection with the hepatitis viruses (type A, B, C, D or E) or due to some medications, alcohol, toxins and substance abuse. Hepatitis can also develop as a consequence of another disease. When someone has hepatitis, they may have upper (right) abdominal pain, fever, vomiting, dark urine, light-coloured stools, fatigue and yellowness of the skin and mucus membranes. Sometimes the inflammation of the liver goes on for a long time (chronic hepatitis) in which case the symptoms may not be obvious. Rarely, hepatitis may lead to liver failure, which is potentially fatal. Sometimes hepatitis may also raise the risk of getting liver cancer.

The most common cause of hepatitis is viral infection. Hepatitis A and E are spread through contaminated food and water, while Hepatitis B, C and D spread through infected body fluids. To diagnose hepatitis, the following check may be done : Physical examination, blood tests, ultrasound scan and liver biopsy.

There is no cure for hepatitis. However, in many instances, the hepatitis resolves on its own after a short duration. Where there are severe symptoms or chronic infection, there are supportive treatments that may be given. 

The best way to manage hepatitis is to prevent it by getting vaccinated against hepatitis A and B, observing good water and food hygiene, observing safe sex practices, avoiding direct contact with another person’s blood and other fluids, and avoiding sharing toothbrushes, razors and needles.

Dear doctor,
 For the last six months, my sex drive and libido have gone abnormally low. How can I boost my libido and achieve an erection  after having an orgasm?  
Jeff

Dear Jeff,
Low libido means there is a decrease in desire for sexual activity. It is normal for the interest in sex to change from time to time based on life circumstances. For some people, however, this reduced or lack of interest may be due to underlying issues like low testosterone level, chronic illnesses (like liver disease, heart disease, cancer ...), sleep problems, aging, depression, stress, relationship issues, alcoholism and drug abuse, too little or too much exercise and some medications like antidepressants.

To manage it, eat a regular, healthy, well balanced diet, exercise, get enough sleep, address any relationship issues and manage stress. It would be advisable to be evaluated by a doctor and if there is an underlying illness, it should be managed. Medications that may be causing the problem can be changed. Low testosterone levels can be managed with testosterone replacement therapy. Counselling and psychotherapy can also help.

The normal sexual response cycle has four stages – arousal/excitement, plateau, orgasm and resolution. The intensity and time taken in each part of the cycle will differ from person to person, and even with every sexual encounter. During arousal, there is increased heart rate and breathing, increased muscle tension, increased blood flow to the genitals and development of an erection for the man. This can take from a few minutes to even hours. In the plateau phase, these symptoms increase to the brink of an orgasm. The orgasm is the climax and this is when ejaculation occurs. After the climax, the next phase is resolution —  when the breathing and heart rate go back to normal, the muscles relax and you lose the erection.

Men usually experience a refractory period – during this time, the body recovers and you are unable to get to a climax again until the period passes. This means that if you continue with sexual activity, it will take longer to achieve a climax a second time than the first time. This period is different for different people and it usually becomes longer as you grow older. For some people, the refractory period may even take days. Women do not have a refractory period and can experience multiple orgasms, one after the other.

It may be easier to delay ejaculation than to try to shorten the refractory period. Some of the ways to do this include:

Spend more time focusing on your partner.

Strengthen the pelvic muscles using kegel’s exercises – tighten the muscles that you would use to stop urine flow. Contract these muscles 10 times and repeat at least three times a day.

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