The risk of a heart attack increases in those who have sedentary lifestyle. It is an established fact that majority of heart attacks occur in people at rest rather than during exercise

In this week’s column, our panel of experts answers your questions ranging from neck injuries to how an active lifestyle can help you keep heart problems at bay.

Q: I am a cricketer and 27 years old. A few weeks ago while fielding close to the batsman; a full-blown shot hit my rear right side of neck. After X-rays, the doctors cleared me of any serious injury. But since then, at least once or twice a day I experience a black-out for a few seconds. Is it related to my injury? —Mohammad Ashfaq

A: Your injury may be related to your symptoms. The injury could be much more. Simple X-ray can miss fractures in the neck in 10 percent of the cases. You need clinical assessment by a neurosurgeon. You may be advised additional tests like CT scan, CT angiogram and MRI to identify the problem, like instability, vertebral artery injury or a concussion. Please visit a neurosurgeon ASAP.

Prof. Dr. Salman Yousuf Sharif

FRCS (SN), FRCS (Eng)

Head of the Department | Department of Spinal and Neurosurgery

Liaquat National Hospital & Medical College

Q: I am 45 years old, and want to keep myself fit. I intend to start jogging on the track, but a friend of mine says if I start jogging at this age my chances of a heart attack will increase. Please advise. — Sibtain Ahmed

A: Heart attack is a complex process and has no relation with exercise. The risk of heart attack increases in those who have sedentary lifestyle. It is an established fact that majority of heart attacks occur in people at rest rather than during exercise. Jogging is a good form of aerobic exercise. People of all ages can get benefit of jogging. Jogging has lot of benefits. It improves bone strength, helps to prevent weight gain, keeps the mind healthy, helps to maintain blood pressure, cholesterol and blood glucose which all helps to prevent heart attack.

Due to the concerns over death during jogging, a research done on 4600 Danish men from 20 to 79 years of age and followed for 10 years. The death rates were found to be significantly lower among regular joggers as compared to non-joggers or those who left the habit of jogging. The American college of sports medicine recommends moderate aerobic exercise for 30-50 minutes three times a week or more. Those people who are inactive or overweight or have heart disease or diabetes should not start running or intense exercise suddenly. It is good for a beginner to have an exercise schedule. Initially, exercise should start with 20 minutes’ walk for at least four days a week. Gradually, more and more walking times should replace by running until at 14th week and thereafter, the workout should consist of 30 minutes of running each exercise day.

Dr. Hafeez Ahmed

FCPS (Medicine) FCPS (Cardiology)

Head of the Department, Assistant Professor | Department of Cardiology

Liaquat National Hospital & Medical College

Q: While batting in a match, the ball hit my ribs. It was painful. I was brought to hospital, where no fracture was found through X-ray, but I still feel a never ending pain in my ribs. I am 31 years old. Please advise which specialist doctor to consult? —Hassan Ali Khan

A: You have musculoskeletal injury or costochondritis. Need to consult thoracic surgeon. Costochondritis is an inflammation of the cartilage in the rib cage. The condition usually affects the cartilage where the upper ribs attach to the breastbone, or sternum, an area known as the costosternal joint or costosternal junction.

Chest pain caused by costochondritis can range from mild to severe. Mild cases may only cause your chest to feel tender to touch or some pain when you push on the area of your chest cartilage.

Severe cases may cause shooting pains down your limbs or unbearable chest pain that interferes with your life and doesn’t seem to go away. The condition often goes away within a few weeks, but some cases may require treatment.

The exact cause of costochondritis in most people is unknown. But conditions that may cause it include:

• Trauma to the chest (as in your case), such as blunt impact from a car accident or fall

• Physical strain from activities, such as heavy lifting and strenuous exercise

• Certain viruses or respiratory conditions.

• Certain types of Arthritis

You may also be at a higher risk for this condition if you:

• Participate in high-impact activities

• Perform manual labor

Improper handling of heavy loads can stress chest muscles. Younger people should lift heavy bags and backpacks with care. Treatment focuses on pain relief and physical therapy (for example, stretching exercises). Patients with costochondritis should be educated and reassured that this is a benign condition that will eventually resolve itself.

Dr. Syed Mahmood Ul Haq

FRCS

Head of Department, Assistant Professor | Department of Thoracic Surgery

Liaquat National Hospital & Medical College

Q: I was a swimmer of a competitive level. Last year while participating in a competition, I had a severe cramp in my left thigh which made me helpless, and was rescued by the life guards. Though I have recovered, fear of drowning has engulfed me so much that I can’t even go near the swimming pool. Please help me to overcome this fear. —Imran Ahmed

A: The fear of drowning following a near-drowning incident strongly suggests a diagnosis of Specific Phobia. The first step would be a complete psychiatric evaluation to confirm the diagnosis and to make sure that there are no additional conditions, such as another anxiety disorder or Post Traumatic Stress Disorder (PTSD). Once this is completed, and if the diagnosis is confirmed to be that of Specific Phobia, then your psychiatrist should refer you to a qualified psychologist for psychotherapy.

There are no medications that help specifically with this condition, and in fact, none are approved by the Food and Drug Administration (FDA) in the US. The treatment is primarily psychological. Cognitive-Behavioral Therapy (CBT) is effective for phobic disorders. This is a time-limited therapy, and the specific components will be guided by your psychologist. Briefly this involves developing a list of your fears, starting with the least anxiety provoking situation and culminating in your worst fears. Following this, the psychologist will instruct you in relaxation techniques followed by graduated exposure to the fearful situations as generated by you.

Dr. Mehmood A. Rehman

M.D, Diplomat of American Board

Consultant, Assistant Professor

Department of Mental Health

Liaquat National Hospital & Medical College

(All the specialists on our experts’ panel are associated with Liaquat
National Hospital. Please send your queries at khalidhraj@gmail.com or Anjum.Rizvi@lnh.edu.pk.)