When the legs start to wear out

Dear doctor,

For the past five years, my work involves standing a lot. Of late, I have been experiencing a lot of pain in the legs and muscle cramps sometimes. The pain gets worse the longer I stand. Some days I even need to use pain killers. What could be causing this? Titus

Dear Titus,

Most of the time leg pain comes from continuous use or wear and tear of the muscles, ligaments, tendons, joints or bones. We use our legs every day — for those of us lucky enough to have functioning legs —  and at some point the hardware begins to wear out. This is especially true for those who walk or stand a lot.

Other causes of pain in the legs may be problems with the spine or the lower back, arthritis, inflammatory diseases, blood clot, circulation disorders, nerve disorders, infection, cancer, injury, gout, problems with calcium levels and even muscle cramps from dehydration.

It would be advisable for you to visit a doctor because you need a proper examination for the pain and weakness and some tests to establish the exact cause of the pain so that you can get treatment specific to the cause.

You can manage the pain by using painkillers and massaging with analgesic ointments. Also, try and rest your legs as much as possible, raise your legs when you are sitting or lying down and apply an ice pack to the area that is most painful. Depending on the cause of the problem, physical therapy/physiotherapy may be helpful as well as regular exercise. Wear comfortable shoes and take adequate water to avoid muscle cramps caused by dehydration

Dear Doc,

What causes scabies, and how is it treated?

Dave

Dear Dave,

Scabies is caused by a very small bug called the human itch mite. It gets into the top layer of the skin to live, feed and lay eggs. It burrows under the skin; producing thin lines. When the skin reacts to the bug, an itchy rash develops.

It is very infectious because the mite can travel from person to person or from clothes, beddings or furniture. When the mite is deposited on a surface or clothing, it can survive for three to four days without being on a human. It can affect anybody regardless of income level, race or level of cleanliness

The mites like to burrow in the skin between the fingers, around the nails, at the wrists and elbows and on skin that is usually covered by jewellery or clothing. It can take a few days to several weeks to develop the itchy rash after infection. Itching occurs mostly at night and many people develop a rash. This rash looks like many bumps forming a line. Some people get patches of scaly skin while others develop thick crusts.  Scratching a lot can cause sores or wounds to develop, which can then get a bacterial infection.

Scabies should be managed by a skin specialist (dermatologist). It can be diagnosed from examination and also from identifying the mite and/or the eggs from a skin scrapping, under a microscope. Different medications can be used like five per cent permethrin cream, one per cent crotamiton cream, 25 per cent benzyl benzoate lotion, 5-10 per cent sulphur ointment and one per cent lindane lotion. For most of the medications, you apply the medicine just before going to bed and wash it off in the morning.  Take a bath before then massage the medication onto clean dry skin and let it stay for eight to 14 hours after which you wash it off. Apply the medication to all skin from the neck and below, including between the fingers and toes, and under the nails. Children and the elderly may need to have the medication applied to the face and scalp, but avoid the eyes, nose and lips. The treatment can be repeated after a week. Sometimes oral medication (ivermectin) may be prescribed in addition. Other medications that may be used include anti-histamines or steroids to relieve the itching, antibiotics to clear any additional bacterial infection. Other persons who have been exposed should also be treated even if they do not have the symptoms yet because it is very contagious.

In addition, you need to clean all your clothes, towels and beddings with hot water then dry in the sun or in a dryer. Another option is to put all your clothing and beddings in a plastic bag and tie it tight for a week then clean them. The furniture and carpets also need to be cleaned and/or vacuumed. There is no need to treat pets because the mite cannot spread to animals.

Dr Flo,

I have a three-year-old daughter who has been vomiting often. Before throwing up, she complains of stomachache, but after vomiting she is fine. She doesn’t have diarrhoea and her appetite is okay. Kindly advise.

Worried parent

Dear Worried parent,

Your daughter may have cyclic vomiting syndrome (CVS). This is a condition where there are repeated attacks of nausea, vomiting and exhaustion for no apparent reason. The child may also have abdominal pain, headache, drooling or spitting, gagging or retching, thirst, low grade fever, diarrhoea and not wanting to talk. It starts suddenly and lasts for several days in a month (but not daily). It happens at around the same time and the person seems fine after that.

The exact cause is not known, but it may be triggered by migraines, anxiety, genetic or hormonal problems, respiratory infection, certain foods (chocolate, caffeine, cheese, or MSG  ( a flavour enhancer), physical exhaustion, over-eating, fasting or eating just before sleeping.

The symptoms may also be due to gastroesophageal reflux where food in the stomach comes back up the food pipe. It may also be due to ketotic hypoglycaemia, where hunger and low blood glucose in the middle of the night triggers vomiting. It may be due to hyperacidity, infection, or a problem with food movement through the digestive tract.

It would be advisable for your daughter to be seen by a paediatric gastroenterologist for thorough examination and tests to be done. There is medication given to prevent the attacks and medication that is given once the symptoms have started to control the vomiting. If any underlying problem is identified, then it will be treated as well.

Send your questions to [email protected]