Q: My niece, who just started kindergarten, has frequent urinary tract infections (UTIs). Is there any way to prevent them?

A: UTIs are common among children who just start school, and it is especially common among girls. Their new surroundings at school, including the new bathrooms, can cause children to be insecure about going to the bathroom when they need to. Also, if the bathrooms at school are not as clean as what they are used to, they may refuse to use the facilities. Instead, they might have more instances of holding in their urine. These challenges make it that much easier for kids to contract the infection. Additionally, children who do not yet know how to clean up properly after using the toilet are at greater risk of getting infected.
 

To prevent UTIs in children, explain to them what causes the infections. Teach them not to hold urine in and to drink plenty of water. Also, teach them how to properly clean up after using the bathroom. Most children at your niece’s age will understand this information. Parents should bathe their children as soon as they get home to remove any accumulation. These practices help prevent UTIs.

Assist. Prof. Dr. Phanida Dusitanond, a pediatrician, specializing in pediatric kidney diseases

I’ve heard that doctors can perform breast cancer and reconstructive surgery at the same time. Are there limitations to this method or long-term side effects?

A: There are two approaches for reconstructive breast implantation. One is to use the patient’s tissue taken from the lower abdomen or back to make a flap. The other is to use silicone. These two methods have their respective limitations. For example, a tissue flap from the lower abdomen is not suitable for obese patients or those with diabetes or related vascular problems because it may cause complications. For slim people, often the skin flap from the back is too small resulting in an unbalanced breast shape. Silicone is not suitable for patients with large tumors, big breasts, or patients who receive postoperative radiation therapy. In some cases, a tissue flap may be used together with silicone.
 

A breast cancer and reconstructive surgery operation is a major surgery that can take longer to perform than many other types. Side effects include risk of infection or hemorrhaging. It’s not a suitable procedure for elderly patients or those with chronic diseases. Patients who opt for silicone may get connective tissue diseases similar to those found in aesthetic breast augmentation. Moreover, removing the patient’s entire breast tissue causes thinness in the remaining skin. Silicone implants sometimes do not look or feel natural. Although aesthetics are important, and a patient’s ability to feel good about herself is not to be taken for granted, it’s important to note here that the first objective must always be to combat breast cancer, so taking unnecessary risks for the sake of beauty is not always recommended.

Assist. Prof. Dr. Youwanush Kongdan, a surgeon, specializing in surgical oncology

Q: I have type-2 diabetes. I’m not that fat at the moment, but my doctor still advised me to lose weight, which I haven’t accomplished yet. Will it be harmful if I stay overweight? And if I do lose weight, how much should it be?

A: You may not be “that fat,” but this false sense of security can be a dangerous thing if you go against a doctor’s advice to lose weight. Additionally, the complications associated with obesity are often related to where the fat is concentrated. Generally, belly fat is more dangerous than fat in other parts of the body, like the hips for instance. This is because people with belly fat are at a much higher risk for life-threatening conditions including heart disease.
 

The doctor’s advice to lose weight indicates that your weight is most likely to cause or exacerbate several diseases such as diabetes, heart disease, brain disease, hyperlipidemia, hypertension, fatty liver causing cirrhosis, as well as joint diseases, and body pains. Essentially, we can say that obesity leads to most diseases. Your doctor determines how much weight to lose on a case-by-case basis.
 

The success of obesity treatment depends on the patient’s willpower. No matter what people around you may say, the patient must have a sincere determination to lose the weight. If you have that determination and need support, your doctor’s input on diet and exercise will definitely aid you to achieve your weight-loss goals. Bumrungrad has weight loss programs for prevention of diabetes and other diseases designed to ensure success. Once you begin to feel and see good results, you’ll be encouraged to carry on.

Assist. Prof. Dr. Varaphon Vongthavaravat, a physician specializing in endocrinology (diabetes) and metabolism