Health: A Question Of Health - My son is too embarrassed to see a doctor

A new series in which readers' health questions are answered by Dr Fred Kavalier

My 13-year-old son has developed firm lumps behind both of his nipples and he is convinced that he is going to grow breasts. He is so overcome with embarrassment that he refuses to show our family doctor. Is there anything we can do to stop them growing?

I'm not surprised that your son is alarmed. He is at a time in his life when he is expecting some of his body parts to grow, but not his breasts. He is showing signs of male adolescent gynaecomastia, which is a fancy name for breast enlargement in teenage boys at the time of puberty.

It can be frightening and even a bit painful. But it is entirely normal and never gets beyond the stage of a small circular lump behind the nipple. Try to reassure him that it is a sign that his adult hormones are coming into play, and point him in the direction of The Diary of a Teenage Health Freak, by Aidan Macfarlane and Ann McPherson (Oxford University Press). He doesn't need to see a doctor if he doesn't want to.

I've developed an inguinal hernia and I have been told that the only way to get rid of it is with an operation. Isn't there any other way of curing it, like exercises to strengthen the abdominal muscles?

Hernias (with one special exception) never go away by themselves, and I have never heard of any effective treatment for them apart from surgery. An inguinal hernia is caused by hole in the muscular wall that holds the intestines inside the abdomen. The lump that appears is a loop of intestine wiggling its way out through the hole in the muscle. If you are unlucky, it may get stuck, or strangulated, and it then has to be repaired as an emergency. The old-fashioned way of repairing hernias was very similar to darning a sock.

Newer techniques use a piece of mesh, which seems to work just as well, and causes less pain and scarring. The exception to the rule about hernias repairing themselves is when a baby is born with a hernia at the site of the umbilical cord attachment. These can be embarrassingly large, but almost always cure themselves by the age of three or four.

I've been told that I have a chlamydia vaginal infection. Will it make me infertile?

It could make you infertile by causing blocked fallopian tubes and that is why it is absolutely essential that it is effectively treated as soon as possible. Chlamydia infection is caused by a microscopic organism which can be transmitted sexually. It takes two partners to pass chlamydia infection from one to another, and it is equally important for both sexual partners to be tested and treated.

The treatment is with antibiotics. You and your partner should both arrange to go to a genito-urinary medicine clinic. There is increasing evidence in favour of screening all sexually active women for chlamydia, because infections can have no symptoms, but cause serious and long-lasting damage.

My hands are becoming increasingly shaky as I get older (I am now 52). The shaking disappears when I am not trying to hold something steady. My mother had exactly the same complaint and she was told that it is not Parkinson's Disease. Any ideas?

This sounds like essential tremor, a neurological condition which often runs in families. The tremor comes on in middle age and gets more severe with increasing age. Occasionally, there is also some shaking of the head, and the voice can also be a bit tremulous. When the muscles are tired, the tremor is worse. People sometimes notice that an alcoholic drink makes the tremor much better, but the effect of alcohol wears off quite quickly. Beta-blockers sometimes help this type of tremor. You need to talk to your doctor and, if there is any doubt about the cause of the tremor, perhaps you need to see a neurologist.

My toenails are unbelievably mangy and disgusting. Believe it or not, my doctor sent a sample of the nails to the laboratory and discovered that it was caused by a fungus. He refuses to treat them, however, on the grounds that I am a carrier of hepatitis C. This seems completely unreasonable to me.

The most effective treatment for fungal toe nail infections is a tablet called terbinafine, which has to be taken every day for several months. This will cure about 80 per cent of infections. The problem is that a small number of people who take this drug can develop serious liver problems.

If your liver is already damaged by hepatitis C, I can understand your doctor's reluctance to put you at risk of further damage, which can occasionally be life-threatening. There are some nail paints available on prescription for these infections, but none is as effective as terbinafine tablets.

Please send your questions to A Question of Health, The Independent, 1 Canada Square, Canary Wharf, London E14 5DL; Fax 0171-293 2182; unfortunately, Dr Kavalier cannot respond to individual inquiries

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