Spe­cial­ist sur­geon and lec­turer Dr Sarah Rayne an­swers your ques­tions on lumps, lu­pus, and weight gain af­ter giv­ing birth.


Spe­cial­ist sur­geon and lec­turer Dr Sarah Rayne an­swers your ques­tions

Q: I’m liv­ing with lu­pus and some days it’s im­pos­si­ble to get out of bed. What can I do to in­crease my en­ergy lev­els?

A: Lu­pus is a dif­fi­cult au­toim­mune dis­ease that can af­fect many dif­fer­ent parts of your body. ‘Au­toim­mune’ means that the body at­tacks some of its own cells, like those in the joints or other tis­sues, as if they were a bac­te­ria or an in­fec­tion. This leads to in­flam­ma­tion and chronic pain. Fa­tigue is a com­mon part of this.

The thing about se­vere tired­ness is that it is a symp­tom no one else can see. Nowa­days every­one com­plains of feel­ing tired, so it is dif­fi­cult for friends and fam­ily to un­der­stand the level of fa­tigue you feel. This can lead to iso­la­tion and feel­ings of de­pres­sion or hope­less­ness or, on the other hand, can cause you to overex­ert your­self to ‘act normal’, so you feel worse.

To help with fa­tigue, aim for 10 hours’ sleep a night (7–8 hours is rec­om­mended for healthy in­di­vid­u­als). In ad­di­tion, some ex­er­cise will help boost your en­ergy lev­els and make you hap­pier and more hope­ful about life. It will help with your weight too, which can in­crease with lu­pus. Be­cause you might feel tired at the start or end of the day, try to change your work prac­tice to make the most of the times you feel most en­er­getic. Fi­nally, en­sur­ing that you are be­ing treated to pre­vent flare-ups of the dis­ease will help, so see your doc­tor reg­u­larly and dis­cuss any changes in your symp­toms.

Q: A cou­ple of years ago I dis­cov­ered a lump in my breast. I had a mam­mo­gram and it came back clean. This lump has been dis­ap­pear­ing and reap­pear­ing but the doc­tor says it isn’t life-threat­en­ing. Please ex­plain.

A: I’m happy to hear that your mam­mo­gram was normal – well done on tak­ing that first step. When­ever you pick up a lump or change in your breast, get it checked out with a clin­i­cal exam, mam­mo­gram or sonar, and a nee­dle sam­ple, if re­quired. If there is a prob­lem it will be picked up, and if there isn’t, you’ll feel re­as­sured.

Non-can­cer­ous lumps in younger breasts, like a fi­broade­noma, can get big­ger and smaller as they are af­fected by the hor­monal changes around the time of your pe­riod. Later in life, cysts can be­come large and un­com­fort­able, but do not in­crease your risk of cancer. The lumps you are feel­ing may be ei­ther of these or some­thing sim­i­lar. If you haven’t had an­other mammo re­cently, get the lump checked out again and ask your treat­ing doc­tors to ex­plain whether it is ex­pected to change or re­solve over your cy­cle. Make a list of ques­tions, and write down the an­swers dur­ing your con­sul­ta­tion so you don’t for­get. Doc­tors are usu­ally happy to an­swer your ques­tions so that you are com­pletely re­as­sured.

Q: I’ve just found out that I’m ex­pect­ing my first child but I’m con­cerned about the weight gain. How much is normal?

A: Con­grat­u­la­tions! That’s great news, and the start of a very pre­cious re­la­tion­ship. But, as with all re­la­tion­ships, there’s give and take. In the first trimester you may bat­tle with nau­sea, vom­it­ing and tired­ness caused by the im­mense hor­monal changes that help sup­port and grow your baby. Some women who feel sick don’t want to eat; others find that eat­ing stops the nau­sea, and they put on un­wanted weight.

You are right to be con­cerned; stud­ies show that ex­ces­sive weight gain in­creases your risk of later obe­sity, es­pe­cially if you have mul­ti­ple preg­nan­cies with less than a year be­tween them. Also, gain­ing too much weight in­creases the risk of di­a­betes and high blood pres­sure in preg­nancy, and the risk of hav­ing a C-sec­tion. As if that weren’t enough, it in­creases the risk of child­hood obe­sity in your baby.

Ex­pect to eat a lit­tle more, but avoid ‘eat­ing for two’. In gen­eral you should gain only 1–2kg over the first three months and about 2kg each month af­ter that. Don’t cut out ex­er­cise, though your pro­gramme may need to be al­tered to suit your chang­ing body. If you get the munchies, eat small healthy meals that in­clude fresh fruit and veg­eta­bles. Avoid com­fort foods.

I hope you trea­sure this time. Every­one wants to give ad­vice, but lis­ten only to those you trust – and try not to worry too much!

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