Doctors say I’m fine, but I don’t feel okay. What’s ailing me?

Dr Flo, one day in March 2015, I woke up feeling more tired, hungrier and thirstier than usual. Taking water didn’t help much, it only led to frequent urination. I felt as if I had carried heavy stones like a mjengo guy.

I though these were symptoms of diabetes, so I went to hospital and a number of tests (random blood sugar, ECG test and lipid profiles) were done. The results showed everything was fine except for a higher white blood cell count which indicated an infection. The doctor prescribed medicine and told me the infection would clear.

A month later my symptoms had gotten worse. I was feeling even more tired and urinated even more frequently. I returned to the same hospital where I was served by a different doctor. He tested for metal content in my body, then told me that I had a viral infection which had no cure, meaning the first doctor had lied to me that the infection would go away.

I was referred to a specialist but that didn’t help. However, after two months some symptoms subsided, but a few remained. I stopped feeling hungry and thirsty, but there were remnants of fatigue and the frequent urination continued.

Since I had had sexual contact with a girl of questionable virtue, I thought I had been infected with a sexually transmitted viral infection like HIV. I had STI tests done, but the results showed I was fine. Last year I went for a general checkup and the test results showed I was fine. An STI test also showed I was fine and my white blood cell count was normal. Every test indicated I was fine, but I don’t feel fine.

Doctor, I’m wondering what is wrong with me. It has reached a point where I have to forego breakfast if I’m travelling long distances because I don’t want to feel the urge to go for a short call in a matatu and the crew will not stop randomly to let me relieve myself. Moreover, small tasks leave me feeling very tired. I use to ride a bicycle without a problem, but now it leaves me feeling completely exhausted. I have to take breaks in between the riding to get energy to continue. I also run out of breath when I’m speaking.

Another unusual thing is that ever since I was told I had an infection, my weight has increased gradually from a constant 70 kg to 90 kg, which isn’t good for my age (I’m 23).

Doctors say I am fine, but deep down I know I am not okay since it’s my body and I can feel it. Please help me. Fidel

Dear Fidel,

The main issues you are struggling with are passing urine frequently, weight gain, fatigability and running out of breath.

Frequent urination for a prolonged duration, without any identifiable cause may be due to interstitial cystitis. This is a condition where, due to unknown reasons, there is persistent inflammation, or sometimes there are ulcers in the bladder wall. This makes the bladder overly sensitive, and you may not be able to hold a lot of urine, and it may be painful to pass urine. It may also be due to an overactive bladder. This means that the bladder wall muscles contract more than usual, making you feel like passing urine more frequently. This may be due to a nerve problem, or due to obesity.

It would be good for you to visit an urologist for several tests like urinalysis, cystoscopy and cystometry (to check the urinary bladder) and an ultrasound scan.

To manage frequent urination, you need to do bladder retraining, by gradually increasing the intervals between urinating over a period of about three months. Also do Kegels exercises to strengthen your pelvic muscles. Contract the pelvic muscles as though you are stopping the flow of urine.

You can practice this to identify the specific muscles by stopping the urine mid-flow while urinating. Contract these muscles for about 10 seconds, 10 times in one set, six to 10 sets in a day.

Monitor how much fluid you are taking. Take about 1.5 litres during the day, but limit intake after 6pm to avoid waking up at night to pass urine.

Also avoid fluid intake when going on a long journey or where you will be away from a washroom. Diet modification to help manage this problem includes avoiding alcohol and caffeine, avoiding spicy foods and acidic foods like citrus fruits and tomatoes.

Take a high-fibre diet to avoid constipation because it worsens an overactive bladder. Also lose weight and do physical exercise. Medication like oxybutinine and imipramine also help to manage an overactive bladder.

The weight gain could be contributing to the easy fatigue and running out of breath when talking. You can talk to a nutritionist so as to know how to manage your diet. You also need to start exercising. Stress, anxiety or depression can also lead to weight gain, and so can anti-depressants and other medications like steroid medications. You could also have tests done to rule out thyroid disease, adrenal disease and levels of antidiuretic hormone.

Dr Flo, I have been suffering from noise in my ears. The volume increases while I’m sleeping. What should I do? HS

Dear HS,

Hearing sounds in the ear is referred to as tinnitus. The sound may be ringing, buzzing, humming, hissing or even beating in time with your heart (pulsatile tinnitus). In many cases, it is mild and disappears on its own. In severe cases however, it may be accompanied by hearing loss, dizziness and poor concentration.

Tinnitus can be caused by outer ear infection, or by a buildup of wax in the ears. You need to see a doctor to get examined, so that if an infection is present, it will be treated, and if there is wax, it will be cleaned out.

Tinnitus can also result from exposure to loud sounds. You may notice your ears ringing or buzzing after you leave a concert, after alighting from a matatu that had very loud music or when you remove ear/headphones after listening to music at high volume. Sometimes repeated exposure to loud sounds causes damage to the inner ear and recurrent tinnitus.

It can also occur due to advancing age with hearing loss, especially after age 60. This type of hearing loss is called presbycusis.

It may also be due to inner ear cell damage, a middle ear infection (otitis media), ear injury and other diseases like otosclerosis, Meniere’s disease, thyroid disease, heart and blood vessel problems, brain tumours, nerve problems, and some medications.

Wear ear protection if you are in an area with loud sounds and turn down the volume, especially if you use headphones.

Manage stress, avoid noisy environments, and avoid coffee and smoking. Playing soft music or radio static when you are in a quiet environment or when you are sleeping may help to mask the noise. Also reduce alcohol consumption because alcohol increases blood flow, especially in the inner ear. If you have high blood pressure or other blood disorders, they should be properly managed.

 It would be good for you to see an ENT (Ear/Nose/Throat) specialist for further investigations. You may benefit from using some medications prescribed by the doctor to reduce the symptoms. A masking device can also be given to reduce the discomfort.

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