Ask the Doctor: Why do I struggle to breathe yet I’m in the first trimester?

Dear doctor,
I am a few months into my first pregnancy but how come I struggle to breathe, yet I’m not asthmatic and my pregnancy is not big?
Maureen

Dear Maureen,
While breathlessness is most common during the latter part of pregnancy, some women may face this in the early stages of the pregnancy. This can happen because of so many reasons including anaemia, heart or a respiratory tract problem (like asthma). But usually these women’s condition is not associated with any illness and is merely breathlessness associated with pregnancy.

Breathlessness in the early stages of pregnancy is likely to be a result of an increased awareness of the need to breathe more. Also the pregnancy hormones can cause breathlessness as they try to make the lungs adapt to the body’s changing needs for air breathed in or out.

During the latter part of pregnancy (seven to nine months especially in first time pregnancies) any breathlessness commonly occurs due to the expanded uterus pressing upwards on the diaphragm thereby restricting lung expansion. This can be worsened when you exercise, take a small meal or drink fluids. However if there is sudden shortness of breath, with or without other symptoms like pain, your ante natal attendants should be informed. Sudden breathlessness is common if a pregnancy all of a sudden gets lots of waters (acute polyhydramnios) expanding the womb unexpectedly.

Dear doctor,
I’m a fairly fat woman and people advise me not to take sugar even at breakfast but when I don’t, I shake, get headaches, feel dizzy and also get blackouts. Then I feel hungry right after breakfast. What is wrong with me?
Annette

Dear Annette,
Fatness may be inherited or a result from a lifestyle of eating too many sweet or fatty foods and being sedentary at the same time. This could be the reason you were advised not to take sugar if you were to control your weight.

Sugar is digested in the alimentary canal to form glucose. If you do not take enough sugar or other foods (like starch which are also digested into glucose) you may be low in blood glucose, a condition medically referred to as hypoglycaemia.
Glucose is the primary source of energy for the brain, muscles, and other essential cells, so when its content is low in the blood, it will lead to symptoms and if not corrected can lead to death.

The body regulates its glucose level, by the actions of different hormones. When blood glucose is low, more glucagons, growth hormone, and adrenalin will be produced in a bid to increase the levels.

Adrenaline, one of the main hormones released during hypoglycemia is the cause of most of the related symptoms such as trembling, clammy skin, pounding or fast heart beats, anxiety, sweating, hunger, and irritability. When these symptoms are not followed by correction of hypoglycaemia, confusion, seizures, coma (black out) or even death may follow. Symptoms of hypoglycaemia vary and in many people may come when the glucose level falls to 50mg/dl and below (normal levels are around 60-120mg/dl).

Overmedication with insulin or antidiabetic pills in diabetics can cause this condition. In those who may not be diabetics or on its medication, use of drugs like quinine or septrin, alcohol, missed meals, a condition of delayed insulin release after a meal (reactive hypoglycemia), severe infection, kidney and liver problems can cause hypoglycemia.

It is likely that since you are fat you are involved in cutting down on food which keeps you low on blood glucose so that without taking some sugar in your breakfast you get hungry immediately after breakfast and eventually get hypoglycaemia symptoms. You therefore should take some sugar but in moderate amounts because taking a lot may lead to undoing your weight reduction plan and probably you becoming diabetic.

Dear doctor,
My sister and I have a problem with our legs. They are always sweaty and smelly. This has affected our relationship with friends. What do you advise us to do?
Sarah

Dear Sarah,
We sweat so that we cool down. However, some people sweat much more than is needed for one to cool down. Over sweating may affect the whole body or some parts and in your cases the legs (usually the feet). Over sweating of the feet, usually affects hands as well. This as a result of overactive nerves that control sweating (sympathetic nervous system). In most cases the condition may run in families and is worsened by fear, stress and anxiety. Many people with the problem get embarrassed and fear the public hence ending up sweating further. Synthetic socks and synthetic closed shoes also worsen the problem.

Sweat can soften the affected areas so that germs including bacteria or fungi enter and lead to the smell. When sweat stays on the affected areas for a long time, its breakdown by skin bacteria can also lead to a nasty smell.

People with sweaty feet therefore may complain of foot odour (the smell may also affect socks and shoes), athlete’s foot (fungus infection between toes), blisters, and secondary bacterial infections of the feet.

Proper management of stress, wearing cotton socks as well as open or spacious leather shoes, cleaning and drying feet properly can help. Many over the counter antiperspirants are not effective so if the said measures do not help, please consult with your doctor.

Answers by Dr Vincent Karuhanga