Q I brush my teeth twice a day but I still have bad breath.

Check if any fillings in your teeth are cracked or broken. Food can get trapped in these and also in the tonsils. Bacteria can act on this trapped food. Saliva is required to wash away the bacteria. Dehydration from not drinking enough water causes the mouth to become dry and aggravates bad breath. A high fat diet can contribute by producing foul smelling ketones. All these factors need to be checked and eliminated.

A time to eat

Q I skip breakfast and eat a heavy dinner. The problem is that I then get up at night and snack uncontrollably. I am gaining weight.

In ancient times, we ate well in the evening (a heavy meal) but little in the morning (no refrigeration). This genetic adaptive imprint still regulates our food intake. We have to consciously eat breakfast to get us through the day. And, stop eating after one helping at dinnertime. If you feel hungry in the middle of the night, and tend to binge eat, try eating just a fruit and then drinking a glass of water.

Nose blocked

Q My two-year-old son's right nostril keeps dripping. Constantly wiping his nose has excoriated the skin around that nostril. It is now red and painful to touch.

Allergic nasal discharge or a common cold will cause bilateral discharge from both nostrils. If the dripping is consistently only on one side, you need to take him to an ENT specialist. Children of this age insert objects like peas, peanuts, erasers or chalk into the nose. Once the object or obstruction is removed, the discharge will disappear. Meanwhile, apply a mild antibiotic ointment to the nose morning and evening.

Too young to grey

Q Although I am 27 years old, I have noticed several strands of grey in my hair. Why am I going grey prematurely?

Premature greying is diagnosed in Asians only if it occurs before the age of 25. Also, unfortunately, the age of greying is genetically determined. Smoking accelerates it. It can also be due to vitamin B12 deficiency, vitiligo or thyroid disease. It cannot be reversed. You could hide the grey with henna or dye.

Surgery to lose weight

Q I want to opt for weight loss surgery even though it is expensive as I am 40kg overweight.

Most surgeons insist that you try diet and exercise for at least five years before such surgery. You need to maintain a journal and meet your doctor regularly. You have to be evaluated for serious health issues such as diabetes. Surgery is, unfortunately, not a magic wand offering a permanent solution. You will still be required to follow a diet plan and exercise regularly to maintain your weight.

Constant cold

Q I have recurrent sinusitis with a clogged nose, headache and thick mucous from my nose. My doctor gives me antibiotics but it just returns.

Sinusitis is often non-infectious and due to allergy. This can occur because of exposure to a wide variety of allergens, exposure to cigarette smoke or changes in temperature. The resultant swelling and inflammation of the mucous membrane in the nose causes pain. In the absence of fever or secondary infection, antibiotics will not help. Avoiding these triggers and taking steam inhalations three to four times a day may be more effective than any medication.

Wanted: a new knee

Q I have knee pain and am afraid I might eventually need knee replacement.

Knee pain is often due to osteoarthris caused by wear and tear in the joint over years of use and misuse. Getting your BMI (body weight divided by height in metre squared ) to 23 and exercising to strengthen the muscles around the knee can go a long way towards delaying any need for surgical intervention.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in