Ask The Doctor - May 28, 2026

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[00:00:00]recognizing the story before the diagnosis arrives.

[00:00:04]Good evening and welcome to CNC3's Ask the Doctor. It is where science meets humanity, where medicine meets meaning, and where your health becomes more than just numbers on a page.

[00:00:16]As a reminder, we're streaming live on Facebook and on the CNC3 website. Don't forget to like our Ask the Doctor page, and you can follow my articles in Friday's Trinidad Guardian with a new We Health segment every Tuesday where your burning questions will be answered. But, let's start with the doctor's capsule.

[00:00:44]Doctors in the United States are warning about a growing and deadly health problem driven by a dangerous modern combination.

[00:00:52]Poor diet, increasing body weight, obesity, diabetes, and alcohol.

[00:00:58]So, the condition has been termed metabolic dysfunction-associated alcohol-related liver disease. So, you have metabolic problems exacerbated by alcohol use and misuse. And the experts say that it is emerging rapidly, especially among young adults and women.

[00:01:20]And what's concerning is that for years fatty liver disease was linked to obesity and diabetes, and we know that those have been separate pandemics.

[00:01:29]But, alcohol-related liver disease has also been increasing. This has been exacerbated since 2020 and COVID-19.

[00:01:38]But, now doctors are seeing patients affected by both at the same time. The obesity, the diabetes, hypertension, high cholesterol combined with alcohol misuse, and the combination appears particularly harmful to the liver.

[00:01:52]It occurs in people who already have metabolic risk factors, and I'll list them again. We're talking obesity, prediabetes.

[00:02:01]If your fasting blood sugar is 100 to 125, if a random blood sugar 140 to 199, or if you're a person with diabetes. If you have high blood pressure and high cholesterol, who also consume what many people may mistakenly consider social levels of alcohol. That's 10 drinks weekly for women or 15 for men. No amount of alcohol is safe human body.

[00:02:26]The frightening part is that many patients feel perfectly well for years, while silent liver damage progresses.

[00:02:34]And unlike the stereotype of liver disease affecting the older man who was a heavy drinker, doctors are now seeing severe liver injury in people in their 20s, 30s, and 40s. So, experts say that modern lifestyles are creating what is essentially a perfect storm for the liver.

[00:02:53]So, ultra-processed foods, sugary drinks, this thing called high fructose corn syrup, sedentary habits, increasing obesity, and alcohol layered on top of stress.

[00:03:05]And in in many ways, the liver has become the body's overworked biochemical casualty.

[00:03:12]What is especially important is that alcohol and metabolic disease do not simply add risk. They amplify each other biologically. They accelerate that to inflammation, leading to scarring, cirrhosis of the liver, and even long-term complications such as liver cancer.

[00:03:31]Symptoms of insidious liver disease may include fatigue, swelling of the abdomen, jaundice, a yellowing of the eyes and mucous membranes, nausea, or unexplained weight loss.

[00:03:44]But many people have no warning signs at all until advanced disease develops.

[00:03:49]So, it's a warning about a time for earlier screening, and perhaps we need to speak honestly about alcohol intake and increase public awareness that liver disease is no longer just a problem of alcohol alone or aging. Because the real danger appears to be the collision between modern diets and modern drinking habits.

[00:04:15]One of the most common hormonal conditions affecting women worldwide that interestingly is also associated with a fatty liver is getting a major rebrand and experts this week say the change could transform how the disease is understood and diagnosed.

[00:04:31]For years of years we've known about a condition known as PCOS or P-cos, polycystic ovary syndrome. But many specialists now believe that name has been misleading from the very beginning.

[00:04:44]A new paper was published in a journal called The Lancet that proposes renaming the condition to polyendocrine metabolic ovarian syndrome or PMOS.

[00:04:56]Experts say that P-cos was more about, you know, dealing on the ovaries. It focused on cysts. But many women with the condition did not even have ovarian cysts. Sometimes hair growth, acne, increasing body weight or fertility problems. So the disorder has been increasingly recognized as a complex metabolic and hormonal syndrome. So the symptoms in terms of the periods, infertility, weight gain and that hallmark insulin resistance driven by obesity, high circulating levels of insulin and then the blood sugar starts rising increasing the chance for type 2 diabetes, high cholesterol and heart disease.

[00:05:37]So the WHO has actually got involved and estimates that up to 1 in 10 women of reproductive age may be affected. It is the commonest hormonal abnormality for our young women looking out there. That is this polyendocrine metabolic syndrome or PMOS, a new name. And as many as 70% remain undiagnosed.

[00:06:01]Doctors say the old name created confusion and stigma. Many patients believed they had large ovarian cysts, or if they did an ultrasound said they didn't have it at all because doctor didn't find cysts and thought it only affected fertility. So, clinicians tended to overlook the serious metabolic consequences of diabetes, hypercholesterol, and of course cardiovascular risk. So, the proposed new name highlights what researchers increasingly understand.

[00:06:29]This is not simply an ovarian disorder, but a multi-system condition involving metabolism, hormones, the heart, and long-term health. It's also associated with problems like depression and anxiety. And this matters because early diagnosis can allow for timely intervention through lifestyle changes, weight management, dealing with this problem of insulin resistance. And it brings to the forefront a need for newer therapies on the market, such as the GLP-1 receptor agonists like semaglutide or tirzepatide. So, I'm hoping that this will improve awareness and reduce stigma. And of course, encourage more for women to seek evaluation for symptoms that are often dismissed or normalized.

[00:07:19]The last week reminded the world of something deeply uncomfortable.

[00:07:23]Modern medicine is powerful.

[00:07:25]Nature still has a vote. We learned that in 2020. But a suspected hantavirus outbreak aboard the expedition cruise vessel MV Hondius left several patients critically ill and at least three dead. It triggered rightfully an international public health response.

[00:07:43]Now, hantaviruses is a rare infection usually spread through contact with infected rodents. I want to stress is not COVID-19, and it's certainly not expected to become a pandemic.

[00:07:55]But, what has unsettled health officials is the possibility of limited human-to-human transmission among close contacts on board that ship. So, it's not a cruise ship virus, and the story has captured attention because these ships represent escape, comfort, and luxury. Now, from a medical standpoint, when you look at a cruise ship, you're looking at dense populations in a closed, crowded, close contact setting with shared ventilation and dining areas with constant human interaction.

[00:08:29]Or, as some infectious disease specialists might say, it's like an elegant petri dish with swimming pools.

[00:08:37]Now, it may be argued that the outbreak is more than just about a virus. It reflects a broader reality of human life.

[00:08:45]In the coming years, we're going to collide with the microbial world faster than ever before.

[00:08:51]Global travel means someone exposed during a remote wildlife expedition can cross continents before symptoms even appear.

[00:08:59]So, COVID-19 changed public trust in health authorities.

[00:09:05]Officials are now trying to walk this difficult line. They're trying to inform the public without triggering panic.

[00:09:12]But, many people are also wary of overly reassuring messaging after those years since 2020.

[00:09:19]And humans often fear dramatic rare diseases. It's interesting about human nature. They're afraid of rarities while quietly ignoring the chronic illnesses that kill far more people every day.

[00:09:34]We've spoken about some like diabetes, obesity, hypertension, or heart disease.

[00:09:40]Would you believe there was a study that showed people actually fear shark bites more than diabetes? So, they are afraid more of sharks than sugar.

[00:09:49]Ultimately, this hantavirus outbreak serves as a reminder that despite luxury travel, advanced technology, and modern medicine, humanity remains biologically vulnerable.

[00:10:02]Viruses don't care about passports. They certainly don't care about politics. And please, they are attracted to cruise ships.

[00:10:12]It's time for a short break, and when we return, it's time for the kiddies capsule. Stay with us.

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[00:12:15]>> The fact that they [music] ask the questions, those challenging questions that no other media house would ask. So, you know, shed light [music] on those things that are in the dark, those stories that no one else wants to cover.

[00:12:24]>> Um, I grew up reading The Guardian, actually. It's a household name.

[00:12:27]>> About The Guardian, one thing that I like, human interest stories have increased.

[00:12:32]>> The city investigative pieces on the human trafficking, I find that very interesting.

[00:12:37]>> Um, you go more in depth.

[00:12:39]>> On sports, especially local sports, and that's one of my highlights for The Guardian.

[00:12:44]>> Yeah, I read The Guardian since The Guardian started started coming out, started working. I was a newspaper man.

[00:12:50]>> [laughter] >> Because the stories that are being covered well detailed and you get more facts.

[00:12:56]>> Also, I think the editorials, I think they're doing a good job on the speaking and truths and you know, they they challenge the government to to make things better.

[00:13:05]>> Me in particular, of recently, the last two, three months, I've been reading The Guardian. I'm seeing a lot of news about the neighborhoods and the communities. I even saw my community featured and I was proud.

[00:13:14]>> For The Guardian.

[00:13:15]>> The Guardian.

[00:13:15]>> Guardian.

[00:13:16]>> The Guardian.

[00:13:17]>> The Guardian.

[00:13:17]>> The Guardian.

[00:13:18]>> The Guardian.

[00:13:19]>> The Guardian is my first choice.

[00:13:32]>> Welcome back to [music] CNC3's Ask the Doctor.

[00:13:35]They may be small, but every now and then children say something about health so simple and so honest that it leaves adults wondering, "Why did we ever make life so complicated?" It's time for the fan fave segment where youngest voices remind us about kindness, healthy habits, and the little things that often matter most. Let's hear from our little stars in this evening's Kiddies Capsule.

[00:14:06]>> [music] >> Hello. My name is Vincent from the Autism Specialist Learning Centre.

[00:14:14]Why do we feel sleepy? Feeling sleepy happens because our body uses two systems to guide sleep.

[00:14:21]A chemical called adenosine builds up in your brain during the day, making you feel more and more tired. When you sleep, your body clears it away so you can feel refreshed again.

[00:14:35]Our body also releases a hormone called melatonin when it gets dark, signaling that it is time to rest.

[00:14:43]So, one makes you feel sleepy and the other helps you know when to sleep.

[00:14:49]Do you want to fall asleep faster? Try no screens 30 minutes before bed and do something relaxing instead, like listening to calming music.

[00:15:00]It helps your brain switch off so you can drift off to sleep more easily.

[00:15:04]That's all for your Kiddies Capsule.

[00:15:05]Have a great night.

[00:15:07]>> Welcome to Therapy. Today's puppet mental health. What big word? Small people. Mental health means how your brain feels. And sometimes this makes you sad. Sometimes your brain is happy.

[00:15:23]I use some.

[00:15:25]Don't worry. That's normal.

[00:15:29]Do you feel worried sometimes? That's also normal.

[00:15:33]If you feel sad, talk to someone. Talk to your mommy, tell your daddy. You can even tell your teddy bear. Remind them of mine. And be kind to yourself. King and Queen.

[00:15:49]>> [laughter] >> Mental health matters. So do you.

[00:15:54]My name is Laraji. My name is Thea. We are tons run tally. This is your Kidz Cab School.

[00:16:03]>> [screaming] >> Good evening. Good evening everyone. Did you know that this week is salt awareness week? Yep. And even though that salt can improve the taste of your food, too much of it can seriously affect your overall health. Many people consume salt in large quantities through snacks, fast foods, and processed foods every single day without even noticing it. But, too much salt can lead to high blood pressure, which increases your risk of heart disease and stroke. But, wait.

[00:16:40]This problem may also affect children.

[00:16:43]Children who regularly eat foods high in salt may develop high blood pressure and put their future health at risk.

[00:16:54]Choosing a healthier diet and reducing the amount of salt eaten in our meals may help protect the body and help our overall health. Don't let a high salt diet today cost you your health tomorrow. I'm Abigail Cudjoe of San Fernando Hindu College. And I'm Bella Cudjoe of San Fernando Hindu Primary School. And this was your kiddie cartoon. Bye.

[00:17:26]>> And we say a special thank you to all concerned for those pearls of wisdom.

[00:17:30]And feel free to send videos of school-aged children discussing such health-related themes to Uncle Rajiv at 800 CNC3.

[00:17:39]It's time for a short break and when we return, the Medical Minds segment awaits.

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[00:19:40]>> We are more than headlines.

[00:19:43]More than stories on a page.

[00:19:46]>> The Trinidad and Tobago Guardian [music] newspaper, your favorite national newspaper, is relaunching its community feature section with one major focus in mind.

[00:19:56]>> It's all about we, we Trinidadians.

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[00:20:12]>> [screaming and cheering] >> Everything we love and adore.

[00:20:16]We are every part of Trinidad and Tobago. And now, we is a space where every reader sees themselves reflected.

[00:20:26]Introducing We, the Guardian's bold new celebration, a magazine dedicated to irresistible stories and features that celebrate the very best of Trini [music] life.

[00:20:37]Our stories, our culture, our life.

[00:20:51]>> Welcome back to your number one show for news, views, and interviews of all things medical.

[00:20:56]We walk thousands of steps every day.

[00:20:59]We stand on them, run on them, squeeze them into fashionable shoes, and often ignore them completely until pain forces us to pay attention. Yet, our feet tell remarkable stories about our health.

[00:21:15]Joining us this evening is no stranger to the Ask the Doctor family, podiatrist Anne Lima, whose work helps patients stay mobile, independent, and in many cases avoid devastating complications.

[00:21:28]Let's welcome her in this evening's Medical Minds.

[00:21:36]>> [music] [music] >> Good evening, everyone. I am podiatrist Anne Lima.

[00:21:47]Thank you, Dr. Jewel T. Lokansingh, for inviting me to your program Ask the Doctor.

[00:21:53]I would like to talk a bit on plantar warts, or verruca, also known by many as fish eye.

[00:22:02]Plantar warts are found on the hands, feet, and knees. They have been around for centuries. They are caused by a human papilloma virus and can enter the skin through minor abrasions.

[00:22:18]Thus, transmission by walking barefoot in communal areas, change rooms, showers, damp surfaces, and gyms.

[00:22:28]Children get it a lot because they run around barefoot by swimming pools.

[00:22:33]Sometimes these warts disappear on their own.

[00:22:37]It depends on one's immune system. They can occur singly or in groups. They can spread from one foot to the other.

[00:22:46]They appear covered with layers of skin and can be very painful.

[00:22:51]Plantar warts have a blood supply and a nerve supply of its own.

[00:22:58]And thus, has the appearance of a cauliflower head.

[00:23:03]The body's immune system may try to cure the virus. However, if the condition persists and becomes painful, there is risk of infecting other family members.

[00:23:16]The good news is that with appropriate treatment by your professional and follow-up with precise conservatory treatment, the disease all of warts will go away.

[00:23:31]Guidelines must be closely followed up to ensure success.

[00:23:37]Should you have recurrent foot issues, please consult your podiatrist or foot health professional.

[00:23:45]Good evening and thank you for listening.

[00:23:50]>> And we say a special thank you to Anne Lima for her love, service, and support.

[00:23:54]Always a firm fan of Ask the Doctor.

[00:23:58]Now, it's giveaway time as we come with questions, answers, and lucky winners.

[00:24:03]Healthy joints, a happy heart, and prizes you'll love. Two giveaway segments are coming up next.

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[00:26:21]>> You and your father have betrayed me, Safiya. You've been lying to me from day one.

[00:26:26]>> [music] >> Your father was in the hangar with a bag as he entered my plane.

[00:26:32]>> Wait, the Durados took that video so he could use it against me and my dad.

[00:26:35]>> Enough. Don't lie to me.

[00:26:37]>> But I'm telling the truth. That's the truth. I love you. Please believe me. I do love you.

[00:26:41]>> You're lying.

[00:26:43]And I won't let you lie to me anymore.

[00:26:45]>> Don't miss the gripping drama, Kabo, Sundays at 8:00 p.m. only on CNC3.

[00:26:53]>> In the ever-changing media landscape, >> [music] >> we at Guardian Media strive always to put you, our viewers and readers, [music] first.

[00:27:02]>> We strive to uphold the time-honored tenets of responsible journalism.

[00:27:07]>> For us, [music] accuracy is key.

[00:27:09]>> And in our reporting, we strive not only to be first, but fair.

[00:27:14]>> Impartial.

[00:27:15]>> And to uphold journalistic integrity.

[00:27:18]>> Above all, we are accountable to you, and we must respect the views of our audience. That is our solemn contract with you.

[00:27:25]>> Keen attention to detail.

[00:27:27]>> Rigorous verification of facts.

[00:27:29]>> Use of credible sources and sound editorial judgment.

[00:27:33]>> Keep track of our editorial policies and guidelines, including our corrections policy, [music] by logging on to www.guardian.co.tt for more.

[00:27:57]>> It's giveaway time with the compliments of Great Outdoors, and a special hello to Joseph Sandal and the rest of his brilliant team. So, the numbers are on the screen. We'd love to hear from you.

[00:28:08]And as a reminder, when you're patched into the studio, listen on your telephone rather than the TV set, because there is a delay that creates confusion.

[00:28:18]So, this evening, we delve into the medical lexicon once more.

[00:28:23]And our question, keyhole surgery is another name for minimally invasive surgery, but is better known by what word? It starts with the letter L. Keyhole surgery or minimally invasive surgery.

[00:28:41]If you're removing gallbladders, sometimes hysterectomies, different organs. It's from a Greek word meaning flank examination.

[00:28:50]Hello, good evening, and welcome to Ask the Doctor.

[00:28:54]>> Hi, good evening.

[00:28:55]>> Thank you for being part of our program, ma'am.

[00:28:59]What's our answer to keyhole surgery, minimally invasive surgery?

[00:29:04]That Greek word Well, it has Greek origin starting with the letter L.

[00:29:10]>> Laparoscopy.

[00:29:13]>> You You can try again or spell it if you wish.

[00:29:18]>> L A P A R O S C O P Y >> Congratulations, laparoscopy. You're a winner.

[00:29:26]>> Thank you.

[00:29:27]>> Our first caller has done the job. Have you tried these supplements before?

[00:29:32]>> Yes, I did.

[00:29:33]>> And what has been your experience thus far?

[00:29:36]>> Very good.

[00:29:37]>> I'm pleased to hear this, and so will our sponsors. Stay on the line because we want to take some of your personal information off the air. So, laparoscopy, very much in vogue because associated with short operating times, perhaps reduced risk of infection.

[00:29:52]You're under general anesthesia for a shorter period. So, keyhole or minimal invasive surgery, one of the changing paradigms in that specialty of medicine.

[00:30:01]Now, it's time for a short break, and when we return, there's a second giveaway. We're still in the month of May, still thinking about our mothers as we should. Don't go anywhere.

[00:30:20]>> Legends need to be celebrated while they can still hear the applause from Trinidad and Tobago. [music] Let's show our appreciation for this calypso giant in band queue David.

[00:30:30]>> Calypso.

[00:30:30]>> [music] >> Calypso.

[00:30:34]>> Saturday, June 6th at NAPA, Port of Spain. Sunday, June 7th at SAPA, San Fernando. Two nights, one [music] legend, countless unforgettable songs.

[00:30:42]Celebrating King David in his presence and performing some of his many hits include Roger George, Kevy Shaws, Chris Santos, Terry Lyons, Adrian Philbert, Arthur Naps, [music] Chuck Gordon. Special guest for Napa is Super Blue Man, Dingle Spen and the Lydian Singers. [music] Special guest for supper is world record holder Joshua Regrello and the Southern Esquire.

[00:31:04][music] MC Sunny Bligh. Tickets bought by this Saturday, 30th May, cost $25 less if [music] stock last. For more info, call 491-1802.

[00:31:15]>> Thank you, David. In every room, Vision sets the standard. For a limited time only, get your progressive transition lenses with [music] an anti-reflective coating, designer frames, and eye exams starting at 1650, only at See View Optical. Affordable eye care for everyone.

[00:31:33]>> Extra, extra, read all about it.

[00:31:36]>> We are more than headlines.

[00:31:39]More than stories on a page.

[00:31:42]>> The Trinidad and Tobago Guardian newspaper, your favorite [music] national newspaper, is relaunching its community feature section with one major focus in mind.

[00:31:52]>> It's all about we. We Trinis.

[00:31:55]>> We life and culture.

[00:31:57]>> We heritage.

[00:31:58]>> We health. [music] >> We food.

[00:32:01]>> We music.

[00:32:02]>> We community.

[00:32:03]>> We men.

[00:32:04]>> We women.

[00:32:05]>> We kids, yeah!

[00:32:08]>> [cheering] >> Everything we love and adore.

[00:32:12]We are every part of Trinidad and Tobago. And now, We is a space where every reader sees themselves reflected.

[00:32:21]Introducing We, the Guardian's bold new celebration, a magazine dedicated to irresistible stories and features that celebrate the very best of Trini life.

[00:32:33]Our stories, our culture, our life.

[00:32:38]>> Hakuna matata.

[00:32:41]It means no worries.

[00:32:44]>> Welcome back to the open forum of CNC3's Ask the Doctor. So, we'd love to hear from you with questions of a medical nature. And I just want to emphasize that when you're patched into the studio, listen on the telephone rather than the TV set. I know you don't want to miss a second of your favorite show.

[00:33:01]And as a reminder, we're live on Thursdays, but there's a rerun on Friday at 11:00 a.m. and Saturday at 11:30 a.m.

[00:33:10]As we dig into the birthday bag, too, blessings to my mother who celebrates her special day on May 16th. And of course, we we have a plethora of wonderful people just this week and indeed in the month of May ranging from Nilo on May the 25th. Then there's Miss Sharian Ramnarace, always tune into our show from Faizabad in South Trinidad, celebrates her day on May 14th. And Mr. Deau Balai from Endeavour had his earlier. Vena Danai, also from Endeavour, celebrates her day today.

[00:33:41]Molly Rampersad in this month of May.

[00:33:44]So, the list continues. We'll be talking about a few more. Patrina Mohammed, the wife of our famed producer at CNC3, Timmy, also has her birthday this week.

[00:33:55]Great great things in this month of May.

[00:33:58]So, the phone lines already burning up as I said. We head to Princess Town.

[00:34:03]Thank you for waiting and good evening.

[00:34:06]>> Good evening, and doctor.

[00:34:07]>> I recognize that booming distinguished voice. Thank you for being part of the show.

[00:34:12]>> Um doctor, I want to know whether there is any >> Hello.

[00:34:21]>> Hello.

[00:34:22]>> Yes, sir. Continue.

[00:34:23]>> Yeah.

[00:34:24]Uh I would I want to know whether there if there is any cure for cirrhosis of the liver.

[00:34:32]And uh there is a math- mathematical formula that is used to calculate what percentage of the liver um has deteriorated, and could you also say something about over-the-counter drugs, Nutri-Set and milk thistle as it relates to the liver?

[00:34:54]That I will listen off the air, and I want to wish all senior citizens all the best for good health and strength. Thank you, doc. I'll listen off the air.

[00:35:07]>> You're most welcome, and thank you for a very insightful question to open the batting on this segment, because as part of the opening news, we mentioned about this surging pandemic of metabolic dysfunction-associated fatty liver changes that can then cause inflammation, damage to the liver, scarring, including cirrhosis, and even uncommonly enhance the risk for liver cancer. Cirrhosis of the liver represents changes, and it's not only due to alcohol. We spoke about the problems of increasing body weight with diabetes, high cholesterol, and even some underlying medical conditions, including hypothyroidism and underactive thyroid. If you have certain immune-mediated problems, um if you have the disorders affecting the kidneys in which you're leaking protein in the urine, these may all contribute towards a fatty liver. Um so, it does not exclusively occur in the setting of someone who has um the use and abuse of alcohol, but there's a layer that is added, of course, if you have that as part of your social habits. Now, if there is cirrhosis of the liver, your main goal is to prevent what is known as liver failure or end-stage liver disease, and there are certain triggers, infections, if you're having bleeding from the gut, if you have changes to the salts in your body like a low potassium, a history of constipation, certain drugs which are normally metabolized by the liver may exacerbate problems in a liver that that is already under stress and tip the liver of course into failure. Now, the liver is involved with excretion of waste and if waste starts to accumulate, persons may be drowsy, confused, lethargic. There may be changes like nausea, vomiting.

[00:37:00]Sometimes if the doctors would do blood tests, high levels of ammonia or acids in the blood. So, there may be derangements in blood sugar, bleeding, and problems with clotting proteins. The liver is a marvelous organ and has a capacity for regeneration, but once it reached that stage of cirrhosis, the risk and your main goal is to prevent the symptoms from getting worse and also to be aware of some of these complications such as the low blood sugar, bleeding, infections, and even fluid in the tummy.

[00:37:33]Some sometimes it may be heralded by jaundice, that yellowing of the skin, eyes, and mucous membranes. Some of the remedies that you mentioned which are available um in pharmacies are touted as remedies for fatty liver disease, but the studies and the the broad swaths of evidence that we look at in the medical literature have not been able to prove that these drugs definitely help with the progression of such patients. Now, they may be used in conjunction with looking at risk factors like making sure your diabetes is well controlled, focusing on your diet, exercise, weight loss. Some drugs have been approved in the United States to prevent the progression of fatty liver disease or what used to be termed that. Um these new injections like semaglutide um indicated for diabetes and weight loss, but also have carved a niche in the management of patients with these fatty liver changes. So, it's an entire inflammatory process occurring within the body, and some of these liquids which are made of milk thistle or B vitamins may help certain patients, but not all. The main goal is to stop drinking if you do so. Look for underlying factors. We we we must also emphasize certain viruses like hepatitis B and C that may need separate forms of management. And if there is progression in persons who are not drinking, your gastroenterologist, that's the specialist that handles disorders including problems affecting the liver, may even want to consider in some parts of the world a need for a liver transplant, particularly if you're getting complications associated with end-stage liver failure. For those interested, the mathematical formula you mentioned is called a FIB-4 index, FIB-4, and that that involves using some of the values of your liver enzymes and blood tests to calculate your risk for scarring. And there's actually even a special scan that can be used to assess because we we may send people for a scan of the tummy, and a fatty liver is found incidentally.

[00:39:42]And to determine the extent of damage, the doctors may want to use that equation, consider that special scan, and if needed, if you're reaching the latter stages in somebody who has a cirrhotic scarred fibrose liver, you want to manage those aggressively.

[00:40:00]Our next caller hails from Sangre Grande. Good evening. Welcome to our show.

[00:40:04]>> Good evening, doc.

[00:40:05]>> Thank you for being part of our program, my lady.

[00:40:08]>> Oh, suave looking as usual.

[00:40:10]>> Thank you, ma'am.

[00:40:12]>> I have two things to ask you.

[00:40:15]>> Certainly, ma'am.

[00:40:16]>> Um, one, I um this week I was told that my cholesterol was high because I did I did some bloods.

[00:40:29]>> Okay.

[00:40:29]>> And I know sometimes it's said that the liver contributes to high cholesterol.

[00:40:35]>> Absolutely.

[00:40:36]>> And the other thing that I'm very concerned about that is affecting me right now is vertigo.

[00:40:44]>> Right.

[00:40:44]>> So, I really want to know, you know, I'm taking Symmetrel >> Yeah.

[00:40:49]>> whenever it acts up, but it is not a nice feeling.

[00:40:54]>> Cool.

[00:40:54]>> You feel like the entire room and the world is spinning, you know, when the vertigo um comes on. I I don't know if it is because of some anxiety or whatever, but it is not a nice feeling. It doesn't come all the time, but as I as I as I speak I'm speaking to you now, I am lying down because it has started since yesterday.

[00:41:21]>> Yes. So, I want to know if there's a a a a >> a period of time it would last when it comes on and if there's anything besides the Symmetrel which I could use. Okay, I will listen up.

[00:41:34]>> Well, thank you very much for taking the time to call in. Two sensational questions because they'll be very relevant to our Ask the Doctor family.

[00:41:42]Cholesterol is a soft waxy substance that forms a vital part of our bodies.

[00:41:48]Um it is used to make cell membranes, hormones, and even vitamin D. So, as you rightly alluded, the liver is a factory for our cholesterol and it may produce sometimes excessive amounts and may not be able to rid the body of it in appropriate way. When we look at a profile, um when you do a fasting blood test or even non-fasting, the total level is written sometimes under 200 may be viewed as normal. And there's another type of fat called triglycerides.

[00:42:18]HDL, the so-called high-density lipoprotein, H for high. That's the hero in the story, tends to protect your heart when it is elevated. L for low, you want to keep that as low as possible, the so-called low-density lipoproteins. And these of course may contribute to inflammation and the formation of plaque. And the problem is of course that we don't want blockages to start forming in the arteries, particularly if you're a person with diabetes, 40 to 75 years old, you may be moderate or high risk for having an event like a heart attack or stroke. You may want to consider being on a cholesterol-lowering tablet. If the low-density lipoprotein level is greater than 190 mg per liter, 190, similar, you may want to consider the use of a statin. Rosuvastatin has found its way on the seat up um list.

[00:43:11]If you are a person who have had a heart attack or stroke in the past, your doctor may want to consider regardless of those numbers for preventative action. That stabilization of plaque may be some of the effects of these drugs.

[00:43:24]And would you believe there is another mathematical equation? So doctors always have to use maths, but luckily with Google we can just plug in some values and decide if someone's risk in the future is deemed to be high. Now there are some fascinating blood tests which are also coming into the forefront because just a few weeks ago the cardiologist, the heart specialists in the United States, released updated guidelines on how we should manage the patient with high cholesterol. You may want to consider looking for underlying reasons. I mentioned some in the the earlier question. An underactive thyroid, treat that and it may improve the lipid profile, some immune-mediated problems affecting the liver. It's a mouthful, but one is primary biliary cirrhosis. If you're spilling out large amounts of protein in the urine, nephrotic syndrome. If you imbibe large volumes of alcohol, your triglycerides may be high. If your diabetes is out of control, you may find that if you get that hemoglobin A1C or your blood sugars for the last 3 months under 7%, that may help with the triglycerides, too. So, there may be secondary causes um and we're not trying to negate the impact of diet and exercise, but many persons find that as a result of genetics, they may overproduce. So, I always say that you can maybe as thin as a whip, eat a blade of grass, and your levels may be extremely elevated because of genes. There's another test called lipoprotein A that perhaps persons should do at least once in a lifetime.

[00:45:03]If the level is over 50, that's to be high risk. So, there are many nuances attached to the management of a patient with high cholesterol. I wish you all the best because it would be done in consultation with your primary care doctor, and then if needed, refer accordingly. With you at the center, of course. And you mentioned about the problem of vertigo, which is that sensation of the room spinning, and it may be associated with nausea, vomiting, and sometimes even falls. So, you'd want to be particularly vigilant. The inner ears involved with balance, and there are calcium crystals that float in active fit ladies like you in Sangre Grande. When you move your head from side to side or you bend to pick up an object, you may find that the symptoms are worse. You mentioned one of the one of the medications used um as just to help with symptoms, Serc or Stemetil.

[00:45:55]There are some which are available as well in any pharmacy. However, there is a maneuver that your doctor at primary care level or even a referral to an ENT specialist to do called the Hallpike maneuver. You may wish to Google or you may find it on YouTube. There's the Epley which can be done at the bedside that may actually assist with symptoms.

[00:46:18]So, vertigo, we're we're hoping that it's just a problem affecting the inner ear. If there are other symptoms that are worrying when your doctor examines you, he or she may even consider doing a scan of the brain. But with most people, if it's just fleeting, lasting a few seconds, and aborted with some of these drugs, then there may be nothing to worry about. The symptoms are unpleasant, but they may tend to come and go.

[00:46:47]We're back to the phone lines. Good evening and welcome to our show with Tupyaku.

[00:46:53]>> Hi, good night, doctor.

[00:46:54]>> Thank you for being part of our Ask the Doctor family and welcome, ma'am.

[00:46:59]>> Yeah, looking nice and sharp as usual.

[00:47:02]>> Thank you.

[00:47:04]>> Yeah. So, my question is Yes. Um Some conditions like nerve damage, spinal problem, diabetes, or shrinking of the brain cause neuropathic nerves? And what new research or treatment are showing promise for people suffering with severe neuropathic itch, including biologics?

[00:47:29]>> Thank you very much. And that's a very interesting question. And I know that our viewers on this show are always widely read, particularly with health-related topics. So, that idea of a nerve itch, a neuropathic itch. For the sake of our viewers, that word neuropathic, neuro meaning nerve and pathy meaning a disease. I've always said that the commonest reason this world is diabetes, the Western part. Um but it is by no means the only cause. A low level of vitamin B12, persons who imbibe or indulge in large volumes of alcohol. If you have had a history of cancer or treatment like chemotherapy or radiotherapy. If you have had an underactive thyroid. If you have an immune-mediated problem. The prototype is lupus in which antibodies are attacking those nerve cells. You may find that you have symptoms ranging from burning, numbness, tingling, the pins and needles or junjuny, but some individuals actually get an intractable itch. Now, it's important too to exclude other reasons for itching. The medical term is pruritus. So, ranging from skin infections like dermatitis or psoriasis.

[00:48:45]If you're having a allergic reactions.

[00:48:47]Sometimes you may be reacting to something like a pet in a household like a pet cat. And sometimes the medications that you're using for unrelated chronic disorders may also have that as a side effect.

[00:49:02]Problems affecting the kidneys, the liver. I always I always emphasize about the need to have a chat with your doctor because we're not attempting to diagnose. Some of the drugs do use in the management of neuropathic symptoms or problems affecting the nerves may include, apart from looking for the underlying cause, which a battery of blood tests, considering a consult with a neurologist, deciding if you need a scan of the brain or spinal cord or nerve conduction studies. The treatments may range from gabapentin, pregabalin, duloxetine.

[00:49:37]And you mentioned about some of the biological agents because if it's believed that there is an underlying immune-mediated cause, an autoimmune problem, these may also alleviate symptoms.

[00:49:51]Well, what a program we've had this evening.

[00:49:54]Some excellent questions, fascinating giveaways, and of course fan favorite segments. And our closing quote is from a firm fan and viewer of our show, Mrs. Aurelia Singh from Moruga.

[00:50:11]William Wordsworth, "The best portion of a good man's life is his little nameless, unremembered acts of kindness and of love."

[00:50:28]I think Wordsworth understood something medicine and life teaches repeatedly.

[00:50:33]Greatness is rarely found only in grand achievements.

[00:50:38]More often it lives quietly in ordinary moments.

[00:50:43]Like an assuring hand, a kind word, a sacrifice unnoticed by the world, but unforgettable to the person receiving it.

[00:50:54]The most meaningful lives are not measured simply by titles or wealth or applause, but by the countless small acts that ease another person's burden.

[00:51:07]So, once more we say thank you to Mrs. Singh from Moruga for those quotes.

[00:51:12]Mrs. Farial Khan always sends in blessings to her. And of course, all of our birthday blessings we dipped into that bag earlier.

[00:51:22]Thank you for trusting me to walk beside you each week in your homes and in your hearts.

[00:51:30]To my team behind the lens, to the selfless Neela, baby Daniel, and in studio this evening my sister, Angelica Rachel.

[00:51:40]And to you our viewers, stay strong, stay curious, and never stop choosing kindness.

[00:51:48]Rest, reflect, love deeply.

[00:51:53]God bless and we'll see you next week on Ask the Doctor.

[00:52:07]>> Parents will do it. They'll go to work, have a shitty day, bro, and come home and take that stress out on you.

[00:52:12]>> Welcome to another episode of Manhood.

[00:52:17]>> Everybody will do what they need to do to get what they want.

[00:52:20]>> And if they can't fit in to the norm,