This week, our panel of experts answers your questions on a variety of issues ranging from playing cricket despite a weak eyesight as well as dealing with stamina issues.

Q: I am into horse riding. Last year, I fell down from the horse while riding, and had a broken leg. It took a year for me to recover from the injury, and finally my doctor allowed me to resume horse riding, but when I rode, an element of fear gripped me, with shivers and black-out and heavy breathing. I cancelled the ride. Do I have to consult a psychologist? –Irfan Qadeer.

A: I am happy to hear that you have fully recovered physically. Unfortunately the psychological scars have not completely healed. The symptoms that you described when you attempted to ride a horse 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 such as Panic Disorder. If your anxiety symptoms are just triggered by riding a horse or even anticipating riding a horse, then you are likely suffering from a specific phobia. If anxiety symptoms happen out of the blue, then this suggests a diagnosis of panic disorder. Once a psychiatric assessment 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

Q: I am a swimmer and practice thrice a week. I want to increase the laps but after three laps heavy breathing hampers my swimming and I call off the session. Please advise how to improve my stamina. I am 34 years old. –Irshad Nazeer.

A: It is not clear from your question whether heavy breathing is a new symptom or has been there since when you started swimming.

Anyway, you need to be examined by an experienced physician or pulmonologist and cardiologist to rule-out heart, lung or diaphragmatic dysfunction in addition to biochemistry.

If clinical examination is normal then I would suggest ECG, Echocardiogram, Stress Echo, Thallium Scan, Full Blood Count (to exclude Anaemia), Urea, Creatinine Electrolytes (Kidney Function Test), Chest X-ray and Pulmonary Function Test.

If organic factors are completely excluded then my advice will be “to increase swimming sessions and timings” to the maximum level of tolerance. That’s the way to build up your stamina.

Prof. Dr. Syed Ali Arsalan

MRCP, FCCP

Head of Department | Department of Chest Medicine

Liaquat National Hospital & Medical College

Q: While participating in water sports at a local recreational park my elbow hit the rock. I rushed to a clinic where X-rays showed no signs of fracture. But over the night my elbow had a significant swelling with lots of pain. Please suggest what to do? –Arsalan Habib.

A: As per your trauma history, it seems that you have suffered from soft tissue injury around the elbow joint. Remedies to relieve your pain are:

Keep your arm in a polysling (a pouch like bandage with strap around the neck to hang the arm).

Apply ice packs for 10 to 15 min twice daily

Take an anti-inflammatory medicine (Tablet Diclofenac Sodium 50 mg twice daily)

Once the swelling subsides, you should consult an Orthopedic Surgeon for proper examination of your elbow and any further investigation if necessary.

Prof. Dr. Zaki Idrees

FRCS, A.O. Fellow

Professor | Department of Orthopaedic Surgery

Liaquat National Hospital & Medical College

Q: I play cricket regularly. I am an all-rounder. Lately my eyesight dropped and I started wearing spectacles. I feel very uncomfortable playing with specs. Please suggest any contact lenses which I can wear comfortably and continue playing. I am 26 years. --Farhad Raza.

A: Thanks for this question, I have personally been an avid cricketer and have worn glasses all my life and have played up to senior league in England. Zaheer Abbas is classic example of someone wearing glasses and playing cricket at the highest level. In my opinion wearing contact lenses in hot sweaty atmosphere, where hands are dirty is not a good idea. Technically eye hand coordination also is changed with contact lenses as image becomes slightly enlarged. If the refraction is small and corneal thickness is adequate one can have Lasik surgery which would be far safer than contact lenses, but obviously at a cost and intervention. Simple glasses are also a good option. One can consult an eye doctor especially in refractive surgery.

Prof. Dr. Imran Ghayoor

D.O, FRCS, FRC (Ophth)

Professor | Department of Ophthalmology

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.)

– Khalid Hussain