Your body's in overdrive
Q I had a baby four weeks ago and am a bit alarmed at the rate at which I'm losing weight. I did have a bit to lose and thought it would probably come off gradually, especially since I'm breast feeding. I'm eating like a horse but am already half a stone less than I was before I got pregnant. I'm looking a bit scrawny and washed out. I've also been getting rather anxious and feel jittery though friends tell me this is normal with a first baby. I'm also sweating more than usual. Do I need to worry?
A Get your GP to do a blood test to check your thyroid function. It's surprisingly common for your thyroid gland to run amok after pregnancy and pump out too much thyroid hormone. Thyroid hormones are the pacesetters of our bodies; too much and you're in overdrive, like having your car engine too highly tuned. You gobble up fuel and still lose weight, sweat buckets and experience your heart racing as palpitations and rising tides of anxiety.
For largely unknown reasons, up to 7% of women who have had a baby develop an overactive thyroid caused by antibodies you produce against your own thyroid gland. These destructive auto-antibodies attack the gland and make thyroid hormones leak out into the bloodstream. As the auto-antibodies continue to attack the thyroid, the thyroid cells that make the hormones become depleted so after a couple of months of being in over-active mode, you may find that your thyroid starts to underperform. That feels as though someone has turned your engine right down so you chug along slowly, everything's an effort, you put on weight even though you're eating the same or less, and instead of sweating, you'll be wrapping up in winter woollies to keep warm.
Within a year, 80% of women with this condition will be back to normal thyroid function and many will never even know they had it, having put all these alarming changes down to the challenges of parenthood.
Medication isn't always necessary unless you're getting unmanageable symptoms. Betablockers are the best bet for blocking those you get in the hyper phase, especially for palpitations. And you may want to take extra thyroid hormone if you feel sluggish in a few weeks' time. About 20% of women may need to stay on thyroxine for more than a year, though most women will be back to normal and off all medication by their child's first birthday.
If blood tests do confirm that you have developed this condition, you will probably get it in subsequent pregnancies too as there's a 70% recurrence rate. But like parenthood itself, second time round is never as alarming as being a first timer!
Four days of agony
Q I have just been through the most painful experience of my life. Out of the blue, I developed an excruciating pain in my anus. Passing a stool nearly killed me and the pain lasted for a couple of hours after each motion. My GP gave me an ointment to rub on which numbed the pain a bit and a laxative so passing my motions would be as smooth as possible. I also gobbled painkillers and now, four days later, the agony has almost passed. I'm terrified this will happen again. What can you recommend?
A Health warning; put down your breakfast while you read this. It sounds like an anal fissure; the sort of thing you wouldn't wish on your worst enemy. I'm sure your GP checked that there was no other cause of your anal pain such as infection, growths or trauma. Passing a hard stool can cause a fissure or ulcer in the part of the anus that lies just below the sphincter that keeps us faecally continent. This sphincter goes into spasm and it's probably the lack of blood supply to the sphincter that causes that terrible pain.
The fissure heals itself and if you're lucky, will never return. Warm baths and stool softeners such as glycerine suppositories and laxatives may help. For an unlucky few, the fissures recur frequently enough to drive them to surgery which cuts part of the sphincter (sphincterotomy). The old-fashioned treatment of stretching the sphincter works less well and causes more incontinence than cutting. Sphincterotomy cures the problem in more than 90% of cases but - and there's always a but - you have a 10% risk of becoming incontinent.
Non-surgical options exist but aren't much more effective than leaving it to time and nature to sort out. The three treatments that work best are Botox injections or rubbing on anti-angina drugs nitroglycerin or calcium channel blockers, all of which relieve spasm. Botox can be painful and nitroglycerin gives you a thumping headache so the calcium channel blockers such as nifedipine may be the best bet. Only the nitroglycerin ointment is readily available at the moment.
· These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email firstname.lastname@example.org or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.