Baldness seems to run in our family, what can I do to avoid it?

Dr Flo,

all my uncles are bald, and I’m afraid that I will end up just like them.

Is there any way I can avoid going down the same road?

Alfred

Dear Alfred,

By age 50, half of all men have some hair loss. Male pattern baldness or androgenic alopecia occurs due to male sex hormones called androgens and also due to genetics, especially if the men on the mother’s side of the family have it.

Hair has a growth cycle, and when the cycle ends, the hair falls off, and new hair starts to grow from the hair follicle. Androgens have many functions in the body, and one of them is regulating hair growth.

With male pattern baldness, the hair follicle shrinks, and produces hair that is shorter and finer/thinner, and eventually, no more hair grows.

The thinning and balding may be on the sides or on the top of the head, and it may be limited to a particular area or spread to include the whole head.

There is no way to effectively prevent male pattern baldness, though you may be able to delay it a bit by managing stress. Stress usually increases the levels of the androgen hormones that contribute to baldness.

Once it starts to happen, the best thing is to just accept it. If you have a skillful barber, he can come up with creative hairstyles to make your hair look thicker and fuller, and to hide the hair loss.

Some medications like minoxidil cream can slow down hair loss and stimulate the growth of new hair. Finasteride tablets, which block the androgen hormones, also slow down the hair loss.

Both of these medications should be prescribed by and monitored by a doctor, because they can have severe side effects. It takes between three months to one year for the effects of the medications to be seen.

Hair transplants can also be done, transferring hair from the areas with active growth and planting it in the areas with hair loss. This however, comes with the risk of scarring and infection at the site.

To avoid these risks, some men opt to use wigs or weaves to cover up the hair loss

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Dr Flo,

My son is four years old, and when he started kindergarten last year, we noticed that he was more hyperactive than the other children in his class. He was like that even before, but we thought it was just normal toddler behaviour. He is not doing very well in his class work and he also seems to forget what he is told very quickly.

What can we do?

Concerned Parent

Dear Concerned Parent,

Your child may be suffering from Attention Deficit Hyperactivity Disorder. It is a behavioural disorder with symptoms like being easily distracted, difficulty focusing on one task, forgetting easily, getting bored easily, problems learning a new thing, getting confused easily, problems following instructions, day dreaming, fidgeting, talking and moving around very fast, constantly moving, difficulty playing or doing tasks quietly, impatience, interrupting conversations, acting or speaking without restraint and blurting out comments.

All these are normal to some extent, but it is considered a disorder if it is interfering with how the child is doing at school, and how the child interacts with others.

In some instances, this disorder may also occur together with learning disorders, conduct disorders, and even poor social interaction. In older children and adults, it may occur together with anxiety, depression and substance abuse. The symptoms usually become more obvious when the child’s circumstances change e.g. when they start school or when they change schools. In about half of all those with the disorder, the symptoms improve with age, as the child learns how to control their behaviour.

There are no known causes of ADHD, but it has been associated with genetics (if someone has it, there is a likelihood that a close blood relative also has it), low birth weight, alcohol or substance abuse during pregnancy and exposure to environmental toxins like lead during pregnancy or early childhood.

The disorder can be managed when diagnosed. Care may involve a paediatrician, a psychiatrist, a psychologist or all three. Usually an assessment is done and the school also writes a report. If a diagnosis of ADHD is made, the child may be put on medication to help reduce the hyperactivity. You will also be advised on how you and the teachers can manage the child’s behaviour.

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Dr Flo,

I am Hellen, and I am 47 years old. Every time I start walking in the morning after I wake up, or after sitting for long, I get a sharp pain on the bottom of my left foot. The pain usually decreases the more I walk. This has gone on for six months. I went to hospital last month and an x-ray was done, and I was told I have a calcaneal spur.

What exactly is that? Is there a way to cure it?

Dear Hellen,

A calcaneal spur is a bony protrusion on the heel bone, which is called the calcaneus. Many people who have it do not have any symptoms. Some people have pain, if there is inflammation around where the spur has formed. This is because of repeated strain on the foot muscles, ligaments, and a thick band of fibrous tissue that runs from the heel to the toes called the plantar fascia. The constant strain, and small tears lead to formation of calcium deposits, and you end up with a spur.

The pain is usually sharp like a prick or like being stabbed, and is worst when you start walking; it reduces as you walk a bit more. The diagnosis is usually made by doing an x-ray.

Calcaneal spurs are more common in those who participate in running or jumping sports, have a job that requires standing for long, have an abnormal gait or walking style, wear shoes that are worn out, or that do not have good sole and arch support, have flat feet or a high arch, those who are overweight, those who have diabetes, and also in those who are over 40 years of age due to thinning of the heel fat pad, and having less flexible ligaments.

 To manage it, you may be given some medication to reduce the inflammation and the pain. You may also be advised to use heel cushions or arch support to reduce the strain on the feet. Always wear good shoes with a small or moderate heel, rubber soles and good inner soles, with arch support. Physiotherapy is also helpful in managing the pain.

If there is no improvement with these measures, a steroid injection can be given at the site with the most pain. In many cases, this usually works only temporarily.

If the symptoms are very severe, despite trying other methods, surgery may be done as a last resort. To prevent developing a spur, always wear the appropriate shoes for each activity, warm up and stretch before exercise and maintain a healthy weight.

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