Doc, should I be worried about my coffee drinking habits?

Dr Flo,
I am concerned about my coffee (black, sugarless) drinking habit. Nowadays, I sweat too much and would like to know whether I should be worried.
Martin

Dear Martin,
Taking a lot of coffee has advantages and disadvantages. Coffee has a significant amount of anti-oxidants and has small amounts of vitamins and minerals. It has caffeine, which is a stimulant that increases brain activity, makes you feel more alert and less tired. It may have a protective effect from some brain diseases (such as Alzheimer’s, parkinson’s diseases), liver disease, type 2 diabetes and depression. However, coffee can also make you feel anxious, jittery, get palpitations, sweat and lose sleep.
The sweating you are experiencing may be normal, or it may be triggered by the coffee if you develop anxiety or by release of adrenaline after taking coffee. In this case then, reducing coffee consumption will reduce the sweating.
The sweating may also be due to hyperhidrosis - this is sweating that is in excess of what the body needs for regulation of temperature. Most people have primary hyperhidrosis, which means the sweating is not caused by any disease or infection. It may be triggered by a part of the nervous system (neurological hyperhidrosis), by eating (gustatory hyperhidrosis) or have no obvious cause. In secondary hyperhidrosis, the sweating is due to another disease such as a thyroid problem or diabetes, nervous system diseases or some medications. The child of a parent with hyperhidrosis has a 25 per cent chance of suffering from the same.
Hyperhidrosis can affect the whole body or specific sites, for instance the face and head (craniofacial hyperhidrosis), the palms (palmar hyperhidrosis), the armpits (axillary hyperhidrosis) or the feet (plantar/pedal hyperhidrosis).
Because the sweating may be triggered by emotional responses like anxiety, fear and excitement, it may be beneficial to learn relaxation techniques to help reduce the sweating.
The condition cannot be cured, but it can be managed by applying aluminium chloride solutions or 0.5 per cent glycopyrolate solution; iontophoresis, which utilises an electric current that is run through the skin; use of anticholinergic medication; or by intra-dermal injection with a muscle relaxant. The iontophoresis, the medicine and injection should be prescribed and administered by a qualified dermatologist.

Dr Flo,
Is a goitre a serious ailment?
Alnashir

Dear Alnashir,
A goitre is a swelling of the thyroid gland. The thyroid is a small gland situated in the neck, right in front of the windpipe, and it produces thyroid hormones that help the body’s metabolism processes. When someone has a goiter, there is a swelling on the front of the neck that moves up and down with swallowing. If it is very big, it can cause difficulty with swallowing or breathing, throat discomfort, cough and change of voice.
The swelling of the thyroid gland may be associate with an overactive or underactive thyroid gland. Since the thyroid hormones are useful in almost all processes in the body, lack of them or having too much has significant effects on the body. The swelling may also happen due to the use of some medication, hormonal changes, inflammation of the thyroid gland, nodules or cysts, radiation therapy, iodine deficiency or thyroid cancer. To manage it, the exact cause has to be identified through blood tests and a thyroid scan, and managed through correcting hormone levels, replacing iodine in diet among other ways. If the size of the gland is not very big, the doctor may opt to monitor it. If the gland is very big and causing problems, or if there are suspicions of cancer, then the gland is removed surgically, either completely or a part of it. After surgery, one may need thyroid hormone replacement for the rest of their life.

Dr Flo,
What causes itching of the skin immediately after a bath and during hot temperatures? Which drugs can I use?
Kevin

Dear Kevin,
You may have cholinergic urticaria, which means that you itch when you feel hot, anxious, when you sweat from exercise, when you eat something hot or spicy, when you take a hot shower, or when you get angry. This causes an itchy red rash with wheals around the pimples, starting within six minutes and lasting between 30 minutes and two hours. It may also lead to headache, dizziness, hypersalivation, abdominal cramps, palpitations or shortness of breath. Rarely, the symptoms can be severe and life threatening. It has no known cause, but is thought to occur either because of a dysfunction in the nerve fibres in the sweat glands or due to an allergy to sweat. It is more common in people who have other allergic conditions.
You may also have aquagenic pruritus, which just means itching caused by water, a kind of allergy to water. Contact with water produces an intense itching of the skin, usually with a prickling sensation, without any observable rash or swelling. The symptoms can last anywhere from 10 minutes and two hours, and it usually resolves on its own.
There is no good reason for some people developing this problem, though sometimes it may be associated with some underlying blood conditions. Showering with hot water for some people actually prevents the itching because the heat affects the cells (mast cells) that trigger the allergic reaction. But if you take a shower that is too hot and for too long, you can also start itching because of drying out of the skin.
You can use anti-allergy tablets and creams/lotions for the itching. Avoid using harsh soaps for bathing or harsh detergents for your towels because the chemicals in the soap can also cause the itching; and clean your towel regularly, like once or twice a week, to avoid the growth of bacteria on a damp towel. Wear absorbent, loose fitting clothes and stay cool as much as possible. Cool your skin when you feel hot and avoid any exercises that trigger the itching. Stress management and relaxation techniques can help reduce stress and anxiety. If you have severe symptoms like difficulty in breathing, you may need emergency medication like an epinephrine shot.

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