Can this strange disease be cured? I’m very stressed.

Dr Flo,
I am suffering from a complicated illness that I do not understand. My joints feel weak, loose and painful. My body is swollen, especially around the waist. I suspect I might have a kidney problem. I am restless and weak, and I feel so heavy that I struggle to climb up stairs. I cannot crouch down and I have difficulty standing up from a sitting or sleeping position. I am stressed out. I am single and jobless. Please advise me.
Emma
 

Dear Emma,
The generalised swelling is usually caused by accumulation of fluid in your body tissues. This accumulation is most likely contributing to your feeling of weakness, heaviness, pain and difficulty with activity. It can also lead to shortness of breath, difficulty breathing, cough or chest pain. This accumulation of fluid may happen due to kidney disease, liver disease, heart failure, thyroid disease, damage to your blood vessels, an immune disease, low blood levels, or severe protein deficiency. It can also happen as a side effect of some medication or when you are pregnant. It also seems that the illness plus your current life circumstances are affecting your mental health.
You need to urgently seek medical attention for examination, tests and scans to figure out the exact cause of the problem, and which organs are affected. After a proper diagnosis is made, you will be managed appropriately. You may be given medication to remove some of the excess fluid, and you would benefit from a low salt diet, maintaining a healthy weight and regular exercise. You would also benefit from seeing a mental health professional to help manage the psychological distress. Since you are short of funds, you can visit a government health facility, some of which charge a consultation fee as low as Sh20 to Sh50. There are also NGO-funded clinics, depending on where you are, that may either be free or provide services at very subsidised costs.
 

Dr Flo,
I am suffering from erectile dysfunction and even after visiting several urologists the problem persists. Please help me or refer me to a specialist.
Silas
 

Dear Silas,
Having a problem with achieving an erection once in a while is not a cause of concern. However, if it persists, it may be due to either a physical and/or a psychological issue. It may be due to psychological issues like stress, anxiety, depression, relationship issues and performance anxiety. You may also have a physical problem that is affecting the quality of your erections such as reduced testosterone levels, heart disease, high cholesterol levels, blocked blood vessels (atherosclerosis), diabetes mellitus, hypertension, nerve problems, some hypertension medicine, sleep disorders, obesity, alcoholism, smoking or other drugs, injuries to the spinal cord or pelvic region, peyronie’s disease (formation of scar tissue in the penis). Erectile dysfunction is also known as impotence, though it does not mean that someone is infertile. Low libido means that there is a decrease in desire for sexual activity, which can lead to a problem with achieving an erection.
I would advise you to stick with one urologist for adequate follow-up, so that he can help you figure out the source of the problem and a solution. It may also be beneficial to see a mental health professional to explore any possible psychological causes of the dysfunction. Your partner also needs to be very supportive, and they may be included in the sessions. In the meantime, maintain a healthy diet, exercise regularly, get adequate sleep (seven to eight hours a day), avoid alcohol and cigarettes, and find a way to manage the stress. You may also benefit from pelvic floor exercises: contract the pelvic muscles as though you are stopping the flow of urine. You can practise this to identify the specific muscles by stopping the urine mid-flow when you are urinating. Contract these muscles for about 10 seconds, 10 times in one set, six to 10 sets in a day.

Dr Flo,
I have always been overweight, but recently, I was told that my body mass index (BMI) shows I am obese. What is the significance of BMI? I have always been like this. What can I do?
Faith
 

Dear Faith,
Body Mass Index is calculated by dividing weight in kilogrammes by the height in metres squared. It is used to screen for weight that may lead to health issues. Healthy BMI is between 18.5 and 24.9. BMI below 18.5 is underweight and above 25 is overweight, above 30 is obese. Unwanted weight gain occurs when there is intake of more calories than the body requires. It is affected by unhealthy diet, inadequate exercise, genetics, hormonal changes, medication, poor sleep, and a slowing down of the body’s metabolism, which means the body needs less food and less energy to carry out its daily tasks. Obesity is associated with many health issues including diabetes, hypertension, heart disease, stroke, gall bladder disease, liver disease, arthritis, breathing problems, reproductive health issues and cancer. It may also affect your activity level and lead to psychological issues like low self-esteem, shame, guilt and depression.
The best way to manage obesity is to reduce calorie intake and increase physical exercise over a long period of time. Therefore, you should choose a diet and exercise plan that you can work with, possibly, for the rest of your life. See a nutritionist and a physical trainer to help you figure this out. While it is tempting to try rapid weight loss strategies, they are neither healthy nor sustainable, and the weight lost is easily regained if the diet and exercise are not managed as well.
 

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