ASK THE DOC

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!