herald

Friday 19 July 2019

How can I shake this feeling of being run down?

Ask the doctor

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Dear Doctor, I've had a lot of colds and flus over the past few months, usually when I'm run down. Is there something I should do to help prevent them?

A The influenza virus results in symptoms of extreme fatigue, lack of energy, lack of appetite and, typically, a sore throat for a few days - often with fevers, shivers, shakes and chills, and joint or muscle aches. I would encourage you to buy a thermometer and check your temperature when you feel feverish, as this will establish whether you have a true fever or not.

If you develop a cough, this could point to a chest infection. A low-grade community-acquired pneumonia could have you feeling a little bit flu-like or 'under the weather'. Chronic cough is defined as lasting for more than eight weeks, and if you have any history of smoking or a lot of passive-smoke exposure, it would be worthwhile undergoing a chest X-ray.

In reality, the most common reason for feeling under the weather is an upper respiratory tract infection (URTI), a common head cold that can track down into the chest, causing bronchitis (airway inflammation). The associated cough may linger for many weeks.

The difficulty lies in differentiating between the two main types of infection - namely, viral or bacterial infection. It is well recognised that following a viral infection, you are more susceptible to a secondary bacterial infection. This does not mean you have an immune system deficiency. A healthy, well adult is allowed anything from three to five infections per year.

Most viral infections will just run their course and antibiotics will not help. Conversely, if you are not getting better within five to seven days of contracting a viral illness, then a week or two on oral antibiotics should clear a bacterial infection.

In terms of keeping your immune system strong and trying to avoid recurrent viral infections, it's back to good old common sense.

You should make sure you are getting good-quality sleep, eating a healthy, balanced diet, and engaging in weekly routine exercise (even a brisk walk will do).

Do your best to avoid ingesting germs on a daily basis. This involves washing your hands before you eat or prepare food, keeping your hands away from your face and mouth in general, and asking people to cough or sneeze into their elbow or a disposable tissue - you should also try to turn away from the droplet spread as quick as you can.

It's a good idea to clean your desk, work-top surfaces and door handles every day, and even more frequently if someone around you is currently unwell.

'Are there any health benefits to sea swimming?'

Dear Doctor, A number of my friends have started sea swimming and are trying to convince me to come. Does it provide many health benefits?

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A There are many people who believe in the health benefits of open-water sea swimming. Swimming is a great form of exercise and perfect for people who have been advised to engage in non-weight-bearing forms of exercise for medical reasons (eg. osteoarthritis of the hips or knees).

The magnesium in seawater improves the hydration status and appearance of the skin, and the natural saline solution provides some element of sinus washout for those with sinus problems.

Of course, engaging in any form of outdoor exercise will improve mental and cardiovascular health, and the cold water will provide a refreshing feeling.

I would caution anyone with an open skin abrasion, cut or wound to delay swimming until your skin is fully healed. The risk of skin or soft tissue infection is even higher if you happen to be on immunosuppressive medication or have an underlying liver disease.

I also advise you to wear sunscreen while sea swimming, particularly between March and October as the risk of sunburn is higher in water. Lastly, I suggest you wear a wetsuit to prevent hypothermia and take heed of the general Irish Water Safety advice.

'Should I take folic acid ahead of pregnancy?'

Dear Doctor, I am trying to get pregnant and I have been told that I should be taking folic acid. I thought I should only be taking this when pregnant, but should I also be taking it when I'm trying to get pregnant?

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A Yes, you should be taking folic acid (0.4mg) daily when actively trying to get conceive, as you will technically be about four weeks pregnant before you even know it. That is, by the time you 'pee on the stick', the neural tube of your unborn child will be almost one-third formed. In fact, 10-12 weeks of pre-conception, daily folic acid supplements are recommended.

Once pregnant and at the 12 weeks gestation point, the neural tube of your unborn child will be closed over and there is no more need for folic acid supplements. However, it is still advisable to eat fortified cereal, milk and bread throughout your entire pregnancy.

Some women need to take a higher dose of folic acid (5mg daily) when trying to conceive. This includes women with: epilepsy (and on anti-epileptic medication); diabetes mellitus; obesity (BMI >30); smokers; and patients with malabsorption syndromes, such as inflammatory bowel disease (IBD) and coeliac disease. Women who had a previous pregnancy with a neural tube defect (NTD), or with a family history of NTD, and women on folate antagonist medication (eg. methotrexate or sulfonamides) also need the higher dose of folic acid.

Making sure your diet is as healthy and balanced as possible is imperative to planning a pregnancy, optimising your fertility and having a successful pregnancy. Other dietary supplements recommended in the second trimester, or throughout pregnancy, include: iron (if advised by your nurse/doctor following blood tests); calcium (1,200mg daily); vitamin D (400-600iu daily); omega 3 fatty acids (200mg daily); and iodine (220ug-500ug daily). Most of these can be found in a healthy, balanced diet that includes eggs, green leafy vegetables, milk and dairy products, nuts, fish, chicken and red meat.

Another important factor to consider is your current body weight: being underweight, overweight or obese can affect your pregnancy-associated risks and that of your unborn child.

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