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Complications In Pregnancy

 

Pre-eclampsia, eclampsia or toxemia of pregnancy
Definition:
Pre-eclampsia or preeclampsia (PE) is a disorder of pregnancy characterized by high blood pressure and a large amount of protein in the urine. The disorder usually occurs in the third trimester of pregnancy and gets worse over time. In severe disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances. PE increases the risk of poor outcomes for both the mother and the baby. If left untreated, it may result in seizures at which point it is known as eclampsia.

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Toxemia of pregnancy is a severe condition that sometimes occurs in the latter weeks of pregnancy. It is characterized by high blood pressure; swelling of the hands, feet, and face; and an excessive amount of protein in the urine. If the condition is allowed to worsen, the mother may experience convulsions and coma, and the baby may be stillborn.
The term toxemia is actually a misnomer from the days when it was thought that the condition was caused by toxic (poisonous) substances in the blood. The illness is more accurately called preeclampsia before the convulsive stage and eclampsia afterward.

Preeclampsia affects between 2–8% of pregnancies worldwide. Hypertensive disorders of pregnancy are one of the most common causes of death due to pregnancy. They resulted in 29,000 deaths in 2013 – down from 37,000 deaths in 1990. Preeclampsia usually occurs after 32 weeks; however, if it occurs earlier it is associated with worse outcomes. Women who have had PE are at increased risk of heart disease later in life. The word eclampsia is from the Greek term for lightning. The first known description of the condition was by Hippocrates in the 5th century BCE

Symptoms:
Swelling (especially in the hands and face) was originally considered an important sign for a diagnosis of preeclampsia. However, because swelling is a common occurrence in pregnancy, its utility as a distinguishing factor in preeclampsia is not great. Pitting edema (unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on) can be significant, and should be reported to a health care provider.

In general, none of the signs of preeclampsia are specific, and even convulsions in pregnancy are more likely to have causes other than eclampsia in modern practice. Further, a symptom such as epigastric pain may be misinterpreted as heartburn. Diagnosis, therefore, depends on finding a coincidence of several preeclamptic features, the final proof being their regression after delivery.

The symptoms of toxemia of pregnancy (which may lead to death if not treated) are divided into three stages, each progressively more serious:
Mild preeclampsia symptoms include edema (puffiness under the skin due to fluid accumulation in the body tissues, often noted around the ankles), mild elevation of blood pressure, and the presence of small amounts of protein in the urine.

Severe preeclampsia symptoms include extreme edema, extreme elevation of blood pressure, the presence of large amounts of protein in the urine, headache, dizziness, double vision, nausea, vomiting, and severe pain in the right upper portion of the abdomen.
Eclampsia symptoms include convulsions and coma.

Risk Factors:
Known risk factors for preeclampsia include:

*Nulliparity (never given birth)
*Older age, and diabetes mellitus
*Kidney disease
*Chronic hypertension
*Prior history of preeclampsia
*Family history of preeclampsia
*Advanced maternal age (>35 years)
*Obesity
*Antiphospholipid antibody syndrome
*Multiple gestation
*Having donated a kidney.
*Having sub-clinical hypothyroidism or thyroid antibodies

It is also more frequent in a women’s first pregnancy and if she is carrying twins. The underlying mechanism involves abnormal formation of blood vessels in the placenta amongst other factors. Most cases are diagnosed before delivery. Rarely, preeclampsia may begin in the period after delivery. While historically both high blood pressure and protein in the urine were required to make the diagnosis, some definitions also include those with hypertension and any associated organ dysfunction. Blood pressure is defined as high when it is greater than 140 mmHg systolic or 90 mmHg diastolic at two separate times, more than four hours apart in a women after twenty weeks of pregnancy. PE is routinely screened for during prenatal care.
Causes:
There is no definitive known cause of preeclampsia, though it is likely related to a number of factors. Some of these factors include:

*Abnormal placentation (formation and development of the placenta)
*Immunologic factors
*Prior or existing maternal pathology – preeclampsia is seen more at a higher incidence in individuals with preexisting hypertension, obesity, antiphospholipid antibody syndrome, and those with history of preeclampsia
*Dietary factors, e.g. calcium supplementation in areas where dietary calcium intake is low has been shown to reduce the risk of preeclampsia.
*Environmental factors, e.g. air pollution
*Those with long term high blood pressure have a risk 7 to 8 times higher than those without.

Physiologically, research has linked preeclampsia to the following physiologic changes: alterations in the interaction between the maternal immune response and the placenta, placental injury, endothelial cell injury, altered vascular reactivity, oxidative stress, imbalance among vasoactive substances, decreased intravascular volume, and disseminated intravascular coagulation.

While the exact cause of preeclampsia remains unclear, there is strong evidence that a major cause predisposing a susceptible woman to preeclampsia is an abnormally implanted placenta. This abnormally implanted placenta is thought to result in poor uterine and placental perfusion, yielding a state of hypoxia and increased oxidative stress and the release of anti-angiogenic proteins into the maternal plasma along with inflammatory mediators. A major consequence of this sequence of events is generalized endothelial dysfunction. The abnormal implantation is thought to stem from the maternal immune system’s response to the placenta and refers to evidence suggesting a lack of established immunological tolerance in pregnancy. Endothelial dysfunction results in hypertension and many of the other symptoms and complications associated with preclampsia.

One theory proposes that certain dietary deficiencies may be the cause of some cases. Also, there is the possibility that some forms of preeclampsia and eclampsia are the result of deficiency of blood flow in the uterus.

Diagnosis:
Pre-eclampsia is diagnosed when a pregnant woman develops:

*Blood pressure >_ 140 mm Hg systolic or  >_  90 mm Hg diastolic on two separate readings taken at least four to six hours apart after 20 weeks gestation in an individual with previously normal blood pressure.
*In a woman with essential hypertension beginning before 20 weeks gestational age, the diagnostic criteria are: an increase in systolic blood pressure (SBP) of   >_ 30mmHg or an increase in diastolic blood pressure (DBP) of   >_15mmHg.
*Proteinuria  >_ 0.3 grams (300 mg) or more of protein in a 24-hour urine sample or a SPOT urinary protein to creatinine ratio  >_ 0.3 or a urine dipstick reading of 1+ or greater (dipstick reading should only be used if other quantitative methods are not available)

Suspicion for preeclampsia should be maintained in any pregnancy complicated by elevated blood pressure, even in the absence of proteinuria. Ten percent of individuals with other signs and symptoms of preeclampsia and 20% of individuals diagnosed with eclampsia show no evidence of proteinuria. In the absence of proteinuria, the presence of new-onset hypertension (elevated blood pressure) and the new onset of one or more of the following is suggestive of the diagnosis of preeclampsia:

*Evidence of kidney dysfunction (oliguria, elevated creatinine levels)
*Impaired liver function (impaired liver function tests)
*Thrombocytopenia (platelet count <100,000/microliter)
*Pulmonary edema
*Ankle edema pitting type
*Cerebral or visual disturbances
*Preeclampsia is a progressive disorder and these signs of organ dysfunction are indicative of severe preeclampsia. A systolic blood pressure ?160 or diastolic blood pressure ?110 and/or proteinuria >5g in a 24-hour period is also indicative of severe preeclampsia. Clinically, individuals with severe preeclampsia may also present epigastric/right upper quadrant abdominal pain, headaches, and vomiting. Severe preeclampsia is a significant risk factor for intrauterine fetal death.

Of note, a rise in baseline blood pressure (BP) of 30 mmHg systolic or 15 mmHg diastolic, while not meeting the absolute criteria of 140/90, is still considered important to note, but is not considered diagnostic.

Predictive tests:
There have been many assessments of tests aimed at predicting preeclampsia, though no single biomarker is likely to be sufficiently predictive of the disorder. Predictive tests that have been assessed include those related to placental perfusion, vascular resistance, kidney dysfunction, endothelial dysfunction, and oxidative stress. Examples of notable tests include:

*Doppler ultrasonography of the uterine arteries to investigate for signs of inadequate placental perfusion. This test has a high negative predictive value among those individuals with a history of prior preeclampsia.
*Elevations in serum uric acid (hyperuricemia) is used by some to “define” preeclampsia,[14] though it has been found to be a poor predictor of the disorder. Elevated levels in the blood (hyperuricemia) are likely due to reduced uric acid clearance secondary to impaired kidney function.
*Angiogenic proteins such as vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) and anti-angiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt-1) have shown promise for potential clinical use in diagnosing preeclampsia, though evidence is sufficient to recommend a clinical use for these markers.
*Recent studies have shown that looking for podocytes, specialized cells of the kidney, in the urine has the potential to aid in the prediction of preeclampsia. Studies have demonstrated that finding podocytes in the urine may serve as an early marker of and diagnostic test for preeclampsia. Research is ongoing.

Differential diagnosis:
Pre-eclampsia can mimic and be confused with many other diseases, including chronic hypertension, chronic renal disease, primary seizure disorders, gallbladder and pancreatic disease, immune or thrombotic thrombocytopenic purpura, antiphospholipid syndrome and hemolytic-uremic syndrome. It must be considered a possibility in any pregnant woman beyond 20 weeks of gestation. It is particularly difficult to diagnose when preexisting disease such as hypertension is present. Women with acute fatty liver of pregnancy may also present with elevated blood pressure and protein in the urine, but differs by the extent of liver damage. Other disorders that can cause high blood pressure include thyrotoxicosis, pheochromocytoma, and drug misuse
Treatment:
Preeclampsia and eclampsia cannot be completely cured until the pregnancy is over. Until that time, treatment includes the control of high blood pressure and the intravenous administration of drugs to prevent convulsions. Drugs may also be given to stimulate the production of urine. In some severe cases, early delivery of the baby is needed to ensure the survival of the mother.

Prevention:
Recommendations for prevention include: aspirin in those at high risk, calcium supplementation in areas with low intake, and treatment of prior hypertension with medications. In those with PE delivery of the fetus and placenta is an effective treatment. When delivery becomes recommended depends on how severe the PE and how far along in pregnancy a person is. Blood pressure medication, such as labetalol and methyldopa, may be used to improve the mother’s condition before delivery. Magnesium sulfate may be used to prevent eclampsia in those with severe disease. Bedrest and salt intake have not been found to be useful for either treatment or prevention.

Diet:
Protein or calorie supplementation have no effect on preeclampsia rates, and dietary protein restriction does not appear to increase preeclampsia rates. Further, there is no evidence that changing salt intake has an effect.

Supplementation with antioxidants such as vitamin C and E has no effect on preeclampsia incidence, nor does supplementation with vitamin D. Therefore, supplementation with vitamins C, E, and D is not recommended for reducing the risk of pre-eclampsia.

Calcium supplementation of at least 1 gram per day is recommended during pregnancy as it prevents preeclampsia where dietary calcium intake is low, especially for those at high risk. Low selenium status is associated with higher incidence of preeclampsia.

Aspirin:
Taking aspirin is associated with a 1% to 5% reduction in preeclampsia and a 1% to 5% reduction in premature births in women at high risk. The WHO recommends low-dose aspirin for the prevention of preeclampsia in women at high risk and recommend it be started before 20 weeks of pregnancy. The United States Preventive Services Task Force recommends a low-dose regimen for women at high risk beginning in the 12th week.

Physical activity:
There is insufficient evidence to recommend either exercise or strict bedrest as preventative measures of pre-eclampsia.

Smoking cessation:
In low-risk pregnancies the association between cigarette smoking and a reduced risk of preeclampsia has been consistent and reproducible across epidemiologic studies. High-risk pregnancies (those with pregestational diabetes, chronic hypertension, history of preeclampsia in a previous pregnancy, or multifetal gestation) showed no significant protective effect. The reason for this discrepancy is not definitively known; research supports speculation that the underlying pathology increases the risk of preeclampsia to such a degree that any measurable reduction of risk due to smoking is masked. However, the damaging effects of smoking on overall health and pregnancy outcomes outweighs the benefits in decreasing the incidence of preeclampsia. It is recommended that smoking be stopped prior to, during and after pregnancy

Restriction of salt in the diet may help reduce swelling, it does not prevent the onset of high blood pressure or the appearance of protein in the urine. During prenatal visits, the doctor routinely checks the woman’s weight, blood pressure, and urine. If toxemia is detected early, complications may be reduced.

Resources:
http://health.howstuffworks.com/pregnancy-and-parenting/pregnancy/complications/a-guide-to-pregnancy-complications-ga13.htm
http://en.wikipedia.org/wiki/Pre-eclampsia

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Blood Clots

Alternative Names: Clot; Emboli; Thrombi

Definition:
Blood is a liquid that flows within blood vessels. It is constantly in motion as the heart pumps blood through arteries to the different organs and cells of the body. The blood is returned back to the heart by the veins. Veins are squeezed when muscles in the body contract and push the blood back to the heart.

Blood clotting is an important mechanism to help the body repair injured blood vessels.

Blood consists of:

•red blood cells containing hemoglobin that carry oxygen to cells and remove carbon dioxide (the waste product of metabolism),

•white blood cells that fight infection,

•platelets that are part of the clotting process of the body, and

•blood plasma, which contains fluid, chemicals and proteins that are important for bodily functions.

Complex mechanisms exist in the bloodstream to form clots where they are needed. If the lining of the blood vessels becomes damaged, platelets are recruited to the injured area to form an initial plug. These activated platelets release chemicals that start the clotting cascade, using a series of clotting factors produced by the body. Ultimately, fibrin is formed, the protein that crosslinks with itself to form a mesh that makes up the final blood clot.

The medical term for a blood clot is a thrombus (plural= thrombi). When a thrombus is formed as part of a normal repair process of the body, there is little consequence. Unfortunately, there are times when a thrombus (blood clot) will form when it is not needed, and this can have potentially significant consequences.
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Thousands more people will have long term health problems as a result of a blood clot in the vein. Many of these people would have been completely unaware that they were at increased risk of venous thrombosis, so missing out on treatment which could be life saving.

Clots can form in any vein deep within the body, but most often can be found in the deep veins of the leg. These deep vein thromboses (DVT) form in the calf or lower leg, behind the knee, in the thigh or in the veins passing through the pelvis.
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Each year more than one in every thousand people in the UK develops a blood clot in a vein, known as a venous thrombosis. For as many as 25,000, the clot will prove fatal; more deaths than from breast cancer, HIV and road traffic accidents combined.

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Causes and risk factors:
There are several factors that significantly increase someone’s risk of developing a venous thrombosis:

•Slowing of blood flow through the veins, for example when someone is confined to bed by illness or to a chair on a long journey.
•Damage to the walls of the blood vessels, for example during surgery on the legs, hips or pelvis, or as a result of age-related changes.
•An increased tendency of the blood to clot, because of inherited problems with the blood’s clotting system, cancer, or the hormone changes of pregnancy (or the contraceptive pill).
You may click to see :Family history linked to increased blood clot risk

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Those particularly at risk include:

•The elderly – one in 100 over the age of 80 are at risk.
•Those who are immobile, because of illness, surgery or travel.
•People undergoing surgery on the hips and knees. More than half of those people having a total hip replacement will develop a DVT if not given preventative medicine.
•Heart attack or stroke patients.
•People with cancer, especially after surgery or if they’re having chemotherapy.
•Women during pregnancy, or if they’re using the contraceptive pill or HRT.
•Those with previous blood clotting problems (including inherited abnormalities of clotting which are much more common than most people realise).
•Smokers.
If the DVT damages the delicate valves which help keep blood flowing upwards towards the heart, a condition called post-phlebitic syndrome may develop (occurring in one in five after a DVT). As a result, blood pools in the lower leg, increasing pressure in the vessels, causing swelling of the leg and ankle and a heavy sensation, especially after walking or standing. Skin ulcers may also develop.
Symptoms:
When the clot forms, it blocks the vein, preventing blood from draining from the limb as it should. The result is that the leg becomes swollen and painful, may change colour (turning pale, blue or reddish-purple) or the skin appears tight or shiny.

More worrying is the risk that part of the clot will break away, forming what is known as an embolus which travels around the circulation, through the heart and into the lungs where it blocks a blood vessel. This is known as a pulmonary embolus (PE) and estimates suggest that as many as 50 per cent of those with a DVT will go on to develop a PE.

The symptoms of PE include chest pain and shortness of breath, which may be sudden and severe. Although some people develop a PE without noticing any symptoms, it can be extremely dangerous and cause damage to the lung tissues proving fatal in as many as one in ten unless treated.

Long term complications include chronic pulmonary hypertension, where the pressure in the blood vessels of the lung remains persistently high.

Possible Complications:
Thrombi and emboli can firmly attach to a blood vessel. They can partially or completely block the flow of blood in that vessel.

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A blockage in the blood vessel prevents normal blood flow and oxygen from reaching the tissues in that location. This is called ischemia. If ischemia is not treated promptly, it can result in tissue damage, or death of the tissues in that area.


Diagnosis
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Symptoms of a DVT or PE may be minimal and can often go undiagnosed. When suspected, it can be difficult to reach a definite diagnosis because tests aren’t straightforward and don’t always give a clear result.

Tests include:
•A blood test known as a D-dimer (although a negative result means that a clot is unlikely, a positive can occur in a number of other illnesses so it is not specific for a DVT or PE).
•An ultrasound scan (good for showing a clot behind the knee or in the thigh, but not so accurate for a DVT in the calf). A special type of ultrasound, known as Doppler ultrasound, is increasingly used and can show how fast the blood is flowing through the veins.
•An x-ray dye test known as a venogram (more invasive than ultrasound).
•MRI or CT scans.
•Ventilation/perfusion scan, where the parts of the lung being filled with air are compared with those with blood flowing through them.

Treatment and prevention:
Once a DVT or PE has been diagnosed, treatment is started to thin the blood (known as anticoagulant therapy), reducing the risk that the clot will grow or spread.

Immediate treatment is given in the form of injections of a drug called heparin, and warfarin tablets, which take several days to build effect. When the cause of the clot formation is clear, such as after surgery, treatment is continued for three months, but when there’s no obvious cause it may be continued for six months or even indefinitely.

The effects of warfarin can vary. Other illnesses and treatments, or even a change in diet, can interfere and it’s quite easy to become over – or under – coagulated, leading to a risk of either a haemorrhage or further clots. Those taking warfarin must have regular blood tests to monitor their clotting levels, and the dose of warfarin adjusted accordingly.

Newer drugs are being developed which are more consistent in their effect and which one day may replace warfarin.

When someone is known to be at risk of venous thrombosis, clots can be prevented by taking a few simple steps and giving small doses of anti-coagulant drugs.

Herbal Treatment:-There are certain proven herbal treatments for thrombosis. One of the most prominent herbal treatments for thrombosis is sweet potato. Scientifically it is called Ipomoea batatas. However in the US of A it is popularly known as Yam. This herbal fruit is an antioxidant. It is also abundant in Vitamin A and C.  This being the case it is very effective in treating thrombosis. Another very potent herbal treatment for thrombosis is lemon.  The imbibing of 300 ml of lemon juice for 2 months would lessen the symptoms of thrombosis. These herbal treatments have been tried with success by scores of people with success.

During long distance travel, or other periods of immobility, you should:

•Keep well hydrated
•Wear elastic compression stockings to support blood flow through the veins (it’s important that these are put on correctly)
•Take a little exercise at frequent intervals (if stuck in a seat, carry out simple leg exercises in the chair such as flexing your ankles).
Heparin treatment will reduce the risk of DVT following cancer treatment or hip or knee surgery by 70 per cent. People having major surgery have a 30 per cent risk of DVT which is reduced by about 60 per cent with anti-coagulants.

If you’re going into hospital for an operation or other treatment you should be assessed for your risk of developing a blood clot and in most cases will be offered preventative treatment with anti-coagulant injections. Compression stockings may also be used.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/bloodclots1.shtml
http://health.nytimes.com/health/guides/disease/deep-venous-thrombosis/overview.html
http://www.mayoclinic.com/health/blood-clots/MY00109/DSECTION=causes
http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm

http://www.herbalgranny.com/2009/08/24/herbal-treatment-for-thrombosis/

Not to Get Pregnant

 

I have done something wrong,” said the young woman. No, it was not theft or murder she was confessing to but unprotected sex. An unguarded passionate moment with her boyfriend had made her pregnant. She was terrified of the stigma — the boyfriend was still a student, there was no way they could get married right away.
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This is quite a common scenario in urban as well as rural India. Women increasingly face the problems of unplanned and unwanted pregnancies. It’s most important that they know how to take care of themselves, married or single.

First, women need to be in control of their bodies, especially when it comes to sexual intercourse, pregnancy and childbirth. Many safe women-oriented contraceptive methods are available.

Women become pregnant only on certain days of the month. The ovum or egg of a fertile woman is released 14 days before her next period. The egg survives 12 to 24 hours after release and the sperm for up to 72 hours. Couples may refrain from intercourse on these days if they wish to avoid pregnancy. This method, however, is not reliable as many women do not menstruate with clockwork precision.

Women may use contraceptive creams containing nonoxynol-9 in the vagina. These substances increase the effectiveness of the safe period. They are effective for about an hour. But they do not suit everyone and may cause vaginal irritation or allergic reactions. They are available in pharmacies without a prescription.

Diaphragms can be inserted prior to intercourse. These come in various sizes and need to be combined with a spermicide. An initial medical examination is needed to confirm the size. The device has to be left in the vagina for eight to 12 hours after intercourse but should be removed within 24 hours.

Women can also opt for an intrauterine contraceptive device (IUCD), popularly known as a “copper T”. These need to be inserted by a medical professional. They can work for three, five or 10 years, depending on the type and manufacturer’s recommendations. Imported devices can be purchased from the pharmacy. Also, free IUCDs are distributed by the government.

“Depo” injections of long-acting progesterone are available
. A woman needs to have an injection every 12 weeks. They can cause weight gain, irregular cycles, breakthrough bleeding or spotting. The irregular periods can raise the spectre of an unwanted pregnancy.

Oral contraceptive pills (OCP) prevent pregnancy if taken regularly.
There are combination pills containing estrogen and progesterone with different trade names. They are also provided free by the government (Mala D). The active ingredient is given for 21 days. Then there is a pill-free interval of seven days after which the next lot needs to be started. Sometimes placebo pills are administered during the pill-free period. They prevent pregnancy as well as regularise the cycle. They do not increase the risk of cancer.

Breast feeding women can opt for “progesterone only” pills. These are taken without a pill-free interval.

There’s a new contraceptive in the market — a plastic ring impregnated with estrogen and progesterone. The ring needs to be inserted in the vagina and left there for three weeks followed by a one week ring-free interval. A woman can purchase and insert the ring herself. An advantage of this over the pill is that the question of forgetting the latter does not arise.

Condoms can be used by the male partner. These have to be used from the beginning to the end of intercourse, and can be combined with a spermicidal cream.

Casual sex and multiple partners can result in sexually transmitted diseases. Some like Hepatitis B and HIV can eventually be fatal. Only condoms can prevent these diseases.

Even if you have had unplanned and unprotected sex, you can use emergency contraception (morning after) pills. Although theoretically these pills should be dispensed only by prescription, in many places they are available over the counter (OTC). The tablet should be taken after intercourse as soon as possible. It is 80 per cent effective if taken within 72 hours.

The morning after pill contains either progesterone or a combination of estrogen and progesterone in higher doses than in the 21 or 28-day packs of OCPs. An alternative is to take four low-dose or two “standard-dose” OCPs, and then take an equal dose 12 hours later.

If an unwanted pregnancy occurs, do not buy medicine OTC or rush to an unqualified quack out of shame or fear. Medical abortion pills are available and effective. They work up to the 49th day after the last period.

The last two are stopgap emergency measures. They are not to be considered regular methods of contraception. They are detrimental to health if repeatedly used.

Source : The Teleghraph ( Kolkata, India)

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Some Health Quaries & Answers

Protection during breast-feeding
Q: I am breast-feeding my nine-month old baby. I have not had my periods and am not using any contraception. I was told that if you are breast-feeding, you will not get pregnant. Is it true?


A:
It’s a myth, an old wife’s tale. You can become pregnant as soon as you have intercourse, even if you are breast feeding and have not had your periods. You need to check with your gynaecologist and ask for a reliable method of contraception which you can use until you are ready to have your next baby.

There are several options: your husband can use condoms, or you can have an intra-uterine contraceptive device (IUD) inserted, take progesterone-only pills daily or take an injection of a long-acting form of progesterone once in three months.

Familial cancer :-
Q: One of my maternal uncles had lung cancer and another had stomach cancer that spread to the brain. What precautions should I take so that I do not develop cancer?

A: Some cancers can be genetic or hereditary. But in your case, your uncles seem to have had different types of cancer. To reduce your risk of developing the disease, in general, lead a healthy life with one hour of exercise daily. Maintain your BMI (weight divided by height in metre squared) at 23. Eat four to five helpings of fruits and vegetables everyday. After the age of 50, do a PSA (prostate specific antigen) test. The PSA level rises in prostrate cancer which is very common in men.

Still no baby
Q: We have no children even after seven years of marriage. My wife became pregnant four times, but each time the pregnancy ended in an abortion. We also tried to have a test tube baby but that too was unsuccessful.

A: Your wife seems to have no problem conceiving since she become pregnant naturally four times. The difficulty seems to lie in retaining the pregnancy and carrying it to term. This may be due to congenital malformations or tumours (like fibroids) in the uterus, or diseases such as kidney problems, diabetes and hormonal imbalance. There are several reasons which need to be investigated by an obstetrician. Investing in a test tube baby is not a solution unless you also plan to use a surrogate mother.

Sweaty palms
Q: I sweat excessively on my palms because of which am unable to shake hands with people or use a keyboard. I have tried several creams and lotions but to no avail.


A:
Sweating excessively on the palms is due to overdrive of the sympathetic nervous system and is independent of the temperature regulatory sweating that occurs on other parts of the body. You need basic blood tests to rule out thyroid and other endocrine malfunctions. These can be treated.

To begin with, try soaking your hands in boric acid solution twice a day. Then apply an anti perspirant roll or deodorant. Wipe your palms frequently. Also, you could use a “plastic skin” on the keyboard to type.

Some doctors prescribe anti cholinergergic tablets, beta blockers or sedatives. However, these have side effects — such as dry mouth and sleepiness — which are usually more distressing than the disease. Surgery can be done to remove the nerve ganglia responsible for the problem. But this should be the last resort.

Migraine attack
Q: I suffer from migraine. The headaches are incapacitating and I lose several working days every month. I do not want to keep on taking tablets.


A:
Migraine can be treated in one of two ways. Some patients are able to accurately predict the onset of an attack. They do very well with stemetil, phenergan, codeine or sumatryptan, which have to be taken before the headache is well-established and vomiting starts.

In others, the headaches are frequent and unpredictable. They need preventive medication like propanalol or amitryptiline, which must be taken daily. Sometimes regular physical exercise combined with relaxation techniques in yoga reduces the frequency and severity of the attacks. Accupressure applied to specific sites at the onset of the headache may help.

Right weight
Q: I am 38 years old and have two children. I am a little plump, not fat. What should my correct weight be?

A: After the age of two, a person’s ideal weight is determined not by age but by calculating the BMI. It is a good indicator of the body fat. Ideally, the BMI should be 23.

Based on this calculation, figure out how many kilograms you need to lose. Exercising one hour everyday should work off about 350 calories. You can tailor your diet so that every day you have a calorific deficit of 500 calories. A 3,500-calorie negative balance will result in a kilogram of weight loss.

Source
: The Telegraph ( Kolkata, India)

Some Health Quaries & Answers

Storm in a teacup

Q: I have a ceramic mug that I bought from a street vendor. When I drink tea out of it I get a taste of clay

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A: Try drinking the beverage through a straw. If you can still taste the ceramic, discard the mug. Hot liquids can dissolve some of the clay and glaze. Some of these may be contaminated with dangerous heavy metals like lead. This is particularly true of poor quality stuff.

Breast-feeding & contraception

Q: I am breast feeding my four-month baby and want to use some safe and reliable form of contraception. I do not like the idea of an intrauterine contraceptive device.

A: You could ask your husband to use condoms from the beginning to the end of intercourse. If this does not appeal to both of you, or is not feasible, you can opt for progesterone injections. They are sold under the trade name Depo Provera. The injection has to be given every 12 weeks under medical supervision. Another option is “progesterone only” pills, the trade name of which is Cerazette. Unlike conventional oral contraceptive pills, these have to be taken every day. Both the injections and tablets can cause irregular menstruation. After one year (when you stop breast-feeding), you can switch to oral contraceptive pills.

Frequent itching

Q: I have recurrent itching in my vagina and it has been diagnosed as a yeast infection. Despite repeated treatment it comes back

A: Recurrent infection is likely to occur if the normal vaginal Ph changes. This occurs if the normal bacterial flora of the vagina changes. This can occur during pregnancy, diabetes, urinary tract infection, with the use of oral contraceptive pills or antibiotics. Vaginal douching or washing with too much soap can also cause a similar problem. Treatment is with medications like fluconazole (tablet) or clotrimazole (vaginal pessaries and creams).

Relapses are common as the organism is now becoming increasingly resistant to the common medication. Unless the underlying cause is treated, relapses will occur. Relapses can also occur if your partner has diabetes which is not very well controlled.

Sleepless nights

Q: I am 64 years old and have difficulty sleeping at night. I started taking alprazolam 0.25 mg at night. Now I find that even with 0.5 mg I do not get any sleep.

A: Alprazolam can be addictive if used as an over-the-counter (OTC) drug without medical supervision. Eventually higher doses may be needed for the same quality of sleep. It can also cause dizziness and loss of balance, particularly if you suddenly get up in the night. Other less addictive prescription medicines are available. Your doctor will be able to prescribe medication to help you sleep that will not react with any of the other medication that you might be taking for other illnesses like diabetes or hypertension. It is better to avoid “sleeping pills” altogether as far as possible. Try —

· Not sleeping in the daytime

· Exercising in the morning and evening

· Drinking a glass of warm milk at night.

Heat boils

Q: I have developed boils on my legs. They are painful and pus comes out if I squeeze them. I have this problem every summer. I am not diabetic.

A: Our skin has a number of harmless commensal bacteria living on it. If small cuts and breaks occur in the skin as a result of scratching, these bacteria can enter the body and produce superficial boils. You need to keep your skin clean by bathing twice a day. Use a germicidal soap like Neko which is bactericidal. Apply the soap using a loofah or plastic scrubber. Avoid using talcum powder. Apply an antiseptic skin ointment (without steroids) like Neosporin or Soframycin on the boils after a bath. Do not break or squeeze the boils. If you develop fever consult a physician.

Lower testes

Q: My right testes appears to be larger than the left one.

A: The two halves of the body are not same. There may even be differences between your right hand and the left one. In most people the right testicle not only hangs lower but may also be larger. As long as there are no lumps or pain, you can leave it alone. If you are really worried, do an ultrasound scan to make sure there is no hernia or hydrocoele.

Nan or Lactogen?

Q: My son is nine months old. Should I give him Nan or Lactogen?

A: Children should be weaned on to solid foods after six months. Substituting tinned milk for breast milk is not the answer. They can be started on soft home-cooked solids such as cooked rice, dal and vegetables like potato. Eventually, by the age of one, they should be on the same diet as the family. Tinned precooked cereals and biscuits should be avoided.

Source: The Telegraph (Kolkata,India)

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