How can we stay healthy in India? And will I ever kick this habit?


Q. We are going to spend New Year in Goa, with our two children aged five and eight. We are lined up to have our vaccinations against hepatitis and typhoid, and we know we have to take malaria pills. But what can we do to prevent diarrhoea?

A. First of all, drink only bottled or boiled water from a reliable source. It is not unknown for street vendors and even restaurants to sell "bottled" water that is actually tap water. Make sure you only drink from sealed bottles that you open yourselves. When you brush your teeth, don't use tap water. Carbonated drinks in cans are safe. Beware of ice cubes, which are usually made from tap water.

I would avoid eating food from street vendors, there is no way of knowing whether it has been prepared in hygienic conditions. Be careful with fruit and vegetables. The safest fruits are those that you can peel yourself, such as oranges and bananas. Salads and raw vegetables are not a good idea, as they may have been washed in water that carries infection. Take some sachets of oral rehydration salts, such as Dioralyte or Electrolade.


Q. I am a mid-thirties male and have had trichotillomania for six years. It is stress related, but I cannot "kick the habit". Are there any treatments available?

A. Trichotillomania is the technical name for compulsive hair-pulling. People with trichotillomania feel an increasing sense of tension before pulling their hair out, and the tension is rapidly relieved when the hair is pulled out. It is sometimes part of a wider problem, such as obsessive compulsive disorder (OCD). Stress usually makes things worse, and some people with trichotillomania also suffer from anxiety, depression or personality problems.

Because the compulsion to pull out hair is so strong, most people who have this problem find it difficult to help themselves. There are three types of treatment that can help. Cognitive behaviour therapy, usually provided by a clinical psychologist or psychiatrist, helps some people. Medications, such as antidepressants, help a small number of people. There are also a number of support groups which aim to reduce the shame that often occur in people who are afflicted by trichotillomania. In the UK, you could have a look at the website of the UK Trichotillomania Support Group ( Try to discuss the problem with your doctor, and push for a referral to a clinical psychologist.


Q. Over the past two months I have had persistent urinary problems without any symptoms to speak of. It all started when I went to the GP for a blood-pressure check - I take a daily pill for my blood pressure, called enalapril. A urine test showed a tiny amount of blood, not visible to the naked eye - it was picked up by dipping a test stick into the urine bottle. I was given a course of antibiotics. A repeat urine test continued to show a small amount of blood, so I was given another course of a different antibiotic. This has now happened three times, and I am no better, no worse, but more worried that there could be something wrong. What should the next step be? I don't want to keep taking antibiotics.

A. Tiny amounts of blood in the urine can be caused by a bladder or kidney infection - a UTI or urinary tract infection. But UTIs are not the only cause of blood in the urine, and a UTI normally disappears after a course of an appropriate antibiotic. Persistent blood in the urine, even if it is invisible to the naked eye, needs to be investigated further. If you are middle-aged or older, one has to think about bleeding in the bladder, which might be caused by a growth. Bladder growth can be either malignant or benign, but it's important to find out if something is growing.

Some people persistently have small amounts of blood in their urine, and no cause can be found despite tests of the bladder and kidneys. You should not keep taking antibiotics. If your GP cannot discover where this blood is coming from, ask for a referral to a urologist.

Have your say: Readers write

MF of Middlesex is astonished to learn that flu jabs are not fully effective:

As one who for many years has regularly endured a flu jab in the belief that it would protect me, I was astonished, and not a little alarmed, to learn that over the last 15 years I, my doctor and the NHS in general have simply been wasting our time and money. If what The Lancet says is accurate - that flu vaccine does not prevent flu, flu-like illnesses or pneumonia in people over the age of 65 - then encouraging older people to get jabs, and their doctors to give them, is pointless, and the whole hullabaloo about a shortage of vaccines is a farce.

Send your questions and suggestions to A Question of Health, 'The Independent' 191 Marsh Wall, London E14 9RS; fax 020-7005 21 82; or e-mail

Dr Kavalier regrets that he is unable to respond personally to questions