Q: MY friend's husband was just diagnosed with cataracts. We were all astounded since he has just turned 40 and we thought that cataracts only occurred in old people. Could you please give me more information about them and what can be done to remove them? Dr Rose writes: We usually think of cataracts occurring only in old people. In fact, the majority of people over age 65 have some visual deterioration due to cataracts. In younger persons, cataracts may be caused by a direct injury to the eye, long-term intake of corticosteroid drugs or severe diabetes. Cataracts are usually painless although over time the ability to see clearly diminishes and colour perception is compromised. At this point, cataract surgery is usually recommended. In most patients, the lens is replaced by a small plastic implant, which is permanently fixed on the eye. Implants are not always advised in young patients because the lifespan of these devices has not been established. Contact lenses may be recommended for such patients. Cataract surgery is extremely successful and uncomplicated. About 90 per cent of persons who undergo surgery recover their eyesight although some patients may require corrective glasses after the surgery. Q: I heard that there is a disorder in which children have a craving to eat strange things like dirt, clay and laundry soap. Can you tell me more about this? Dr Rose writes: The disorder you heard about is an eating disorder, known as pica, in which the individual craves substances that are not food products and have no nutritional value. Once the substance is ingested the craving subsides. A range of substances including dirt, laundry starch, clay, ice, coffee grounds, ashes and plaster chips may be ingested. It is normal for children under age two to taste and ingest non-food substances. However, when this behaviour occurs in a child who is older than two, it should be investigated. The disorder is not confined to young children. Pica sometimes occurs during pregnancy, most often in women of low socio-economic status. It also occurs quite often in mentally retarded children. Pica seems to be hereditary in that many of the mothers ofchildren with the disorder also engage in this practice. Theories about why pica occurs vary. Some researchers claim that pica marks a form of regression to the oral stage of development occurring in infancy. Because pica is more common in poor children, other researchers believe that it is related to a nutrient deficiency. Still others theorise that pica is caused by a disorder of the hypothalamus (part of the brain which is sensitive to changes in iron levels). Because some of the materials ingested may contain lead, children with pica should be screened for lead poisoning. Q: From time to time I suffer from haemorrhoids. I don't like to bother my doctor with this minor complaint, but I would like some advice on how to deal with them. Also is there any way to prevent them from occurring? Dr Rose writes: Haemorrhoids are distended veins in the lining of the anus due to increased pressure. This is most often due to straining during a hard bowel movement. They may be near the beginning of the anal canal (internal haemorrhoids) or protrude outside the anus (prolapsed haemorrhoids). The prolapsed type sometimes form an extremely painful clot (thrombosed haemorrhoids). Haemorrhoids are very common, especially during pregnancy and after childbirth. Some people are more prone to them, due to a congenital weakness of the veins. Prolonged sitting in cars and aeroplanes can exacerbate haemorrhoids. Diet plays an important role in preventing haemorrhoids. The goal is to increase the amount of fibre in your diet so that your stools are soft and formed. Include whole grain breads and vegetables and eat a bran cereal each morning to help maintain bulk.Drink plenty of fluids and try to avoid highly refined foods. Changing your bathroom habits can also help alleviate some of the discomfort associated with haemorrhoids. As soon as you feel the urge, empty your bowels. Wipe gently with a soft tissue that is moistened with an anal lotion. Do not use water, as it onlyadds to the irritation. Avoid enemas. They can be harmful for persons with haemorrhoids. If you are experiencing pain or itching try sitting in a tub of warm water. This can be quite soothing following a bowel movement. Over-the-counter creams and suppositories can also help reduce the swelling and pain. If the haemorrhoids are thrombosed, apply an ice pack at short intervals during the day. When these more conservative methods are not effective in treating the haemorrhoids, a haemorrhoidectomy (surgical removal of the haemorrhoids) may be necessary. Dr Rose Ong is a certified family physician licensed in the United States. She welcomes enquiries but cannot answer them individually. Specific questions should be addressed to your own physician. Additional enquiries: Peak Corporate Health Management, 525-6600, fax 525-8100.