Help! Is my knee pain causing heart problem?

Dr Flo,
I usually feel cold from my knees downwards. My heart beats so vigorously that I can hear it pounding especially when I am in a quiet place. Is there a problem?
William

Dear William,
Our bodies react differently to cold. Some people are more sensitive to cold than others. This is called cold intolerance. It has no specific cause and the only way to manage it is by dressing warmly. However, sometimes feeling cold may be due to a nerve problem or a problem with blood circulation resulting from blocked or narrowed blood vessels. In these rare instances, proper examination needs to be done to determine the exact problem and the underlying cause so that you get appropriate management.
Being aware of your heart beat is called having palpitations. In many instances, the palpitations are usually harmless. The best way to manage them at the time is to practise deep breathing exercises and to relax, and the symptoms usually pass in a few minutes. You should only get concerned if there is also chest pain, severe breathlessness, dizziness and/or fainting, and also if the symptoms last for long. I will assume that you have taken tests for heart and lung conditions.
Other possible causes of palpitations include:
Medical conditions like heart conditions, some lung diseases, severe heartburn or hyperacidity; thyroid disorders; hormonal changes; low blood sugar; low blood level, blood pressure problems, either high or low, potassium deficiency and also Vitamin B12 deficiency.
It could also be due to medication such as some asthma medication (like ventolin, franol, theophylline), some hypertension medicine, antidepressants, some antihistamines and also some antibiotics. Also, taking a lot of caffeine for instance in coffee, tea, cocoa, energy drinks and soda (Coke) can trigger the symptoms.
In case of psychological triggers – when someone is stressed, anxious, or excited, the hormones released into the blood stream can cause speeding up of the heart rate and breathing, causing a feeling of chest tightness, difficulty in breathing and palpitations. This can happen with day to day stress reactions and also in anxiety disorders, acute stress disorder, post-traumatic stress disorder and panic attacks.
Other causes may include exercise, lack of adequate sleep, alcohol overuse, smoking, also use of other drugs like miraa, bhang and cocaine.
You may require medical evaluation to find out what causes your symptoms, so that you can get the appropriate treatment.

Dr Flo,
Stroke leads to paralysis. Could you explain this medical term and shed light on the implication of this severe malady?
Alnashir Walji

Dear Alnashir,
A stroke happens when an area of the brain is damaged or dies because there is reduced or no blood supply to that area. The blood supply is interfered with if there is partial or complete blockage of a blood vessel due to narrowing (atherosclerosis) or due to a clot. It may also occur if a blood vessel ruptures. The blood vessels may be narrowed or blocked by fatty deposits in the blood vessel walls. A rupture may be a result of uncontrolled high blood pressure, aneurysms, use of blood thinners, or head injury.
The symptoms of a stroke depend on the affected area of the brain. These include headache, dizziness, weakness, confusion, difficulty producing or understanding speech, visual problems, numbness/weakness/paralysis of one side of the face, arm or leg, loss of balance and coordination. In severe cases, there may be permanent paralysis, difficulty in swallowing, speech difficulties, memory problems, emotional and behavioural changes, and it can also cause loss of consciousness and death.
Brain tissue that is already damaged or dead cannot be healed. However, with treatment of the underlying problem, further damage can be prevented. To prevent it eat a healthy diet, maintain a healthy weight, control high blood pressure, diabetes and cholesterol levels, reduce or avoid taking alcohol, quit smoking and exercise regularly. For people at high risk of getting stroke or who have already had a stroke, there are medications given to lower the risk such as aspirin.

Dr Flo,
My sweat smells really bad. It was not as bad as this before. What could have caused that change?
Pete

Dear Pete,
The bad smell from your body, or body odour, is known as bromhidrosis. Everyone has body odour and it occurs due to the bacteria on the skin breaking down the acids in the sweat. It becomes significant after puberty due to development of the apocrine sweat glands. Men tend to have worse body odour than women because they tend to sweat more. If you sweat excessively (hyperhidrosis), you may have more body odour, especially in the feet (bromodosis), or armpits (axillary osmidrosis).
Body odour can be worse if you are obese; you take alcohol, spicy foods or garlic; if you are taking some medication such as antidepressants; or if you have some illnesses like diabetes, liver disease, kidney disease, some cancers. There is a rare genetic disorder called trimethylaminuria which also causes someone to have a fishy odour.
To manage the body odour, shower daily, and if possible twice a day on hot days; wash your armpits thoroughly, if possible, with antibacterial soap; shave your armpits regularly; dry yourself thoroughly with a clean towel; wear clean clothes and socks made of natural fibres like cotton, silk and wool; use a strong underarm anti-perspirant/deodorant; use deodorant foot powder; wear open shoes or go barefoot as much as you can; use a pumice stone to clean off dead skin on the soles of the feet; and limit the amount of spices, red meat, coffee and alcohol you consume.
You can also apply aluminium chloride solutions or 0.5 per cent glycopyrolate solution on your armpits, preferably in the evening just as you are going to sleep, to reduce how much you sweat the following day. Some other procedures that can be done to the most affected areas include iontophoresis; anticholinergic medication; or by intra-dermal injection with botulinum. These should be done by a dermatologist. In severe cases, surgery may be done.

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