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Why Irregular Periods?

Every woman is different — including her periods. Some happen like clockwork. Others are hit or miss and unpredictable. On average, a woman gets her period every 24 to 38 days. A period usually lasts about 2 to 8 days. If your menstrual cycle is irregular from time to time, it’s probably no big deal.

Is your period irregular — and if so, does it need treatment?

What’s Irregular?

You may have irregular periods if:

  • The time between each period starts to change
  • You lose more or less blood during a period than usual
  • The number of days that your period lasts varies a lot

Causes

Many things can cause irregular periods. Changes in your body’s level of the hormones estrogen and progesterone can disrupt the normal pattern of your period. That’s why young girls going through puberty and women approaching menopause commonly have irregular periods.

Other common causes of irregular periods include:

  • Having an intrauterine device (IUD)
  • Changing birth control pills or using certain medications
  • Too much exercise
  • Polycystic ovary syndrome (PCOS)
  • Pregnancy or breastfeeding
  • Stress
  • Overactive thyroid (hyperthyroidism) or underactive thyroid (hypothyroidism)
  • Thickening of or polyps on the uterine lining
  • Uterine fibroids

Should I Worry About Irregular Periods?

Talk to your doctor if you have had sex and have missed a period because you could be pregnant. Also let the doctor know if:

  • You were having regular periods that then become irregular.
  • You stop getting your period.
  • You have extra hair growth on the face, chin, chest, or abdomen.
  • You start having periods that last longer than 7 days, are heavy, or are coming more often than every 21 days.
  • Your period comes less often than every 45 days.
  • You have severe cramping or abdominal pain.
  • You have bleeding in between your periods.
  • Your periods are irregular for 3 years or more.

The doctor may prescribe hormone pills or other medicines, or recommend lifestyle changes that can help you to have regular periods.

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Why Pap smear Test?

A Pap smear, also called a Pap test, is a screening procedure for cervical cancer. It tests for the presence of precancerous or cancerous cells on your cervix. The cervix is the opening of the uterus.

During the routine procedure, cells from your cervix are gently scraped away and examined for abnormal growth. The procedure is done at your doctor’s office. It may be mildly uncomfortable, but doesn’t usually cause any long-term pain

What Happens During the Test?

It’s done in your doctor’s office or clinic and takes about 10 to 20 minutes.

You’ll lie on a table with your feet placed firmly in stirrups. You’ll spread your legs, and your doctor will insert a metal or plastic tool (speculum) into your vagina. He’ll open it so that it widens the vaginal walls. This allows him to see your cervix. Your doctor will use a swab to take a sample of cells from your cervix. He’ll place them into a liquid substance in a small jar, and send them to a lab for review.

The Pap test doesn’t hurt, but you may feel a little pinch or a bit of pressure

Who needs a Pap smear?

Current guidelines recommend that women get regular Pap smears every three years starting at age 21. Some women may be at increased risk for cancer or infection. You may need more frequent tests.

How often do you need a Pap smear?

How often you need a Pap smear is determined by various factors, including your age and risk.

Age Pap smear frequency
<21 years old, none needed
21-29 every 3 years
30-65 every 3 years or an HPV test every 5 years or a Pap test and HPV test together every 5 years
65 and older you may no longer need Pap smear tests; talk to your doctor to determine your needs

These recommendations only apply to women who have a cervix. Women who have had a hysterectomy with removal of the cervix and no history of cervical cancer do not need screening.

Recommendations vary and should be individualized for women with compromised immune systems or a history of precancerous, or cancerous lesions.

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What is postpartum care?

Caring for a new baby while feeling sore, tired and stressed can be a lot to handle. Taking care of yourself is one of the best things you can do for your baby. Learn how you can stay healthy as your body heals and you adjust to your new life.

Postpartum care can be divided as

External care refers to the physical body such as dealing with the change in body shape, coping with breastfeeding problems like engorgement or sore nipples, caesarean incision or even hair loss issues.

Internal care refers to things like physical fatigue, body aches, afterbirth cramps, perinea pain or constipation problems.

Mental care refer to emotions such as anxiety, impatient, confidence level or low self-esteem due to hormonal changes that trigger us to be more sensitive during postpartum period

You need to take good care of yourself to rebuild your strength. You will need plenty of rest, good nutrition, and help during the first few weeks.

  1. Get plenty of rest.Get as much sleep as possible to cope with tiredness and fatigue. Your baby may wake up every two to three hours for feeding. To make sure you’re getting enough rest, sleep when your baby sleeps.
  2. Seek help.Don’t hesitate to accept help from family and friends during the postpartum period, as well as after this period. Your body needs to heal, and practical help around the home can help you get much-needed rest. Friends or family can prepare meals, run errands, or help care for other children in the home.
  3. Eat healthy meals.Maintain a healthy diet to promote healing. Increase your intake of whole grains, vegetables, fruits, and protein. You should also increase your fluid intake, especially if you are breast-feeding.
  4. Exercise.Your doctor will let you know when it’s OK to exercise. The activity should not be strenuous. Try taking a walk near your house. The change of scenery is refreshing and can increase your energy level.

Things to Remember

  • Eat confinement food. Avoid cooling stuff such as cold drinks, fruits. Consume warming food like hot soups, hot non-caffeine drinks, stews or even some tonic wine.
  • Do not diet. Have regular three meals with some snack breaks throughout the day
  • Have ample rest. Catch up on short naps throughout the day
  • Leave the house chores to your partner or helper and do not move around too much
  • Have a postnatal massage for relaxation, reduce stress and also to ease the body aches
  • Maintain proper hygiene especially on your caesarean incision or episiotomy. Take a quick hot bath once a day.
  • Do not be shy to ask for help. Many new mums want to be a super mum but it is ok if you cannot cope everything fully. You should enjoy motherhood not to let stress takes over
  • Have some personal time, Read a book or listen to some music.
  • Try not to go out of the house too often or unnecessary to allow the body to recover faster
  • Talk to other mums. You gain more knowledge and also make new friends
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What Is Menopause?

Menopause is the end of a woman’s menstrual cycles. The term can describe any of the changes you go through just before or after you stop having your period, marking the end of your reproductive years.

Menopause Causes

A woman is born with all of her eggs, which are stored in her ovaries. Her ovaries also make the hormones estrogen and progesterone, which control her period (menstruation) and the release of eggs (ovulation). Menopause happens when the ovaries no longer release an egg every month and menstruation stops.

Menopause is a regular part of aging when it happens after the age of 40. But some women can go through menopause early. It can be the result of surgery, like if their ovaries are removed in a hysterectomy, or damage to their ovaries, such as from chemotherapy. If it happens before age 40, for any reason, it’s called premature menopause.

What are the symptoms of menopause?

Every woman’s menopause experience is unique. Symptoms are usually more severe when menopause occurs suddenly or over a shorter period of time.

Conditions that impact the health of the ovary, like cancer or hysterectomy, or certain lifestyle choices, like smoking, tend to increase the severity and duration of symptoms.

Aside from menstruation changes, the symptoms of perimenopause, menopause, and postmenopause are generally the same. The most common early signs of perimenopause are:

  • less frequent menstruation
  • heavier or lighter periods than you normally experience
  • vasomotor symptoms, including hot flashes, night sweats, and flushing
  • An estimated 75 percent of women experience hot flashes with menopause.

Other common symptoms of menopause include:

  • insomnia
  • vaginal dryness
  • weight gain
  • depression
  • anxiety
  • difficulty concentrating
  • memory problems
  • reduced libido, or sex drive
  • dry skin, mouth, and eyes
  • increased urination
  • sore or tender breasts
  • headaches
  • racing heart
  • urinary tract infections (UTIs)
  • reduced muscle mass
  • painful or stiff joints
  • reduced bone mass
  • less full breasts
  • hair thinning or loss
  • increased hair growth on other areas of the body, such as the face, neck, chest, and upper back

Complications

Common complications of menopause include:

  • vulvovaginal atrophy
  • dyspareunia, or painful intercourse
  • slower metabolic function
  • osteoporosis, or weaker bones with reduced mass and strength
  • mood or sudden emotional changes
  • cataracts
  • periodontal disease
  • urinary incontinence
  • heart or blood vessel disease

What Happens During Menopause?

During perimenopause, menstrual periods become irregular. Your periods may be late, or you may completely skip one or more periods. Menstrual flow may also become heavier or lighter.

Menopause is defined as a lack of menstruation for one full year.

Postmenopause refers to the years after menopause has occurred.

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What is Indigestion?

Indigestion — also called dyspepsia or an upset stomach — is a general term that describes discomfort in your upper abdomen. Indigestion is not a disease, but rather some symptoms you experience, including abdominal pain and a feeling of fullness soon after you start eating. Although indigestion is common, each person may experience indigestion in a slightly different way. Symptoms of indigestion may be felt occasionally or as often as daily.

Indigestion can be a symptom of another digestive disease. Indigestion that isn’t caused by an underlying disease may be eased with lifestyle changes and medication.

Indigestion can cause:

  • stomach pain or bloating
  • heartburn
  • nausea
  • vomiting

Other common symptoms of include:

  • feeling full during a meal and not being able to finish eating
  • feeling very full after eating a normal-sized meal
  • burning sensation in the stomach or esophagus
  • gnawing sensation in the stomach
  • experiencing excessive gas or belching

Don’t’ ignore severe symptoms of indigestion. See your doctor right away if you experience any of the following:

  • severe vomiting
  • vomit that is bloody or looks like coffee grounds
  • unexplained weight loss
  • black stools
  • trouble swallowing

Causes of Indigestion

Indigestion has many possible causes. Often, indigestion is related to lifestyle and may be triggered by food, drink or medication. Common causes of indigestion include:

  • Overeating or eating too quickly
  • Fatty, greasy or spicy foods
  • Too much caffeine, alcohol, chocolate or carbonated beverages
  • Smoking
  • Anxiety
  • Certain antibiotics, pain relievers and iron supplements

Sometimes indigestion is caused by other digestive conditions, including:

  • Inflammation of the stomach (gastritis)
  • Peptic ulcers
  • Celiac disease
  • Gallstones
  • Constipation
  • Pancreas inflammation (pancreatitis)
  • Stomach cancer
  • Intestinal blockage
  • Reduced blood flow in the intestine (intestinal ischemia)

Complications

Although indigestion doesn’t usually have serious complications, it can affect your quality of life by making you feel uncomfortable and causing you to eat less. You might miss work or school because of your symptoms. When indigestion is caused by an underlying condition, that condition can also have its own complications.

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What is Colon Cancer?

Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the final part of the digestive tract.

Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers.

Stage 1 colorectal cancer is the earliest stage. The stages progress up to stage 4, which is the most advanced stage. Here are the stages of colorectal cancer:

  • Stage 1. The cancer has penetrated the lining, or mucosa, of the colon or rectum but hasn’t spread to the organ walls.
  • Stage 2. The cancer has spread to the walls of the colon or rectum but hasn’t affected the lymph nodes or nearby tissues yet.
  • Stage 3. The cancer has moved to the lymph nodes but not to other parts of the body yet. Usually, one to three lymph nodes are involved at this stage.
  • Stage 4. The cancer has spread to other distant organs, such as the liver or lungs.

What are the symptoms of colorectal cancer?

Colorectal cancer may not present any symptoms, especially in the early stages. If you do experience symptoms during the early stages, they may include:

  • constipation
  • diarrhea
  • changes in stool color
  • changes in stool shape, such as narrowed stool
  • blood in the stool
  • bleeding from the rectum
  • excessive gas
  • abdominal cramps
  • abdominal pain

If you notice any of these symptoms, make an appointment with your doctor to discuss getting a colon cancer screening.

Lifestyle changes to reduce your risk of colon cancer

You can take steps to reduce your risk of colon cancer by making changes in your everyday life. Take steps to:

  • Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer prevention. Choose a variety of fruits and vegetables so that you get an array of vitamins and nutrients.
  • Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount of alcohol you drink to no more than one drink a day for women and two for men.
  • Stop smoking. Talk to your doctor about ways to quit that may work for you.
  • Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If you’ve been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise program.
  • Maintain a healthy weight. If you are at a healthy weight, work to maintain your weight by combining a healthy diet with daily exercise. If you need to lose weight, ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly by increasing the amount of exercise you get and reducing the number of calories you eat.
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What is Prenatal Care? Why it’s Important?

Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare for expectant mothers.

Prenatal Care

Prenatal care helps decrease risks during pregnancy and increases the chance of a safe and healthy delivery. Regular prenatal visits can help your doctor monitor your pregnancy and identify any problems or complications before they become serious.

Babies born to mothers who lack prenatal care have triple the chance of being born at a low birth weight. Newborns with low birth weight are five times more likely to die than those whose mothers received prenatal care.

Prenatal care ideally starts at least three months before you begin trying to conceive.

Some healthy habits to follow during this period include:

  • Quit smoking and drinking alcohol
  • Take folic acid supplements daily (400 to 800 micrograms)
  • Talk to your doctor about your medical conditions, dietary supplements, and any over-the-counter or prescription drugs that you take
  • Avoid all contact with toxic substances and chemicals at home or work that could be harmful

Lifestyle issues

Your health care provider might discuss the importance of nutrition and prenatal vitamins. Ask about exercise, sex, dental care, vaccinations and travel during pregnancy, as well as other lifestyle issues. You might also talk about your work environment and the use of medications during pregnancy. If you smoke, ask your health care provider for suggestions to help you quit.

Normal discomforts of pregnancy

You might notice changes in your body early in your pregnancy. Your breasts might be tender and swollen. Nausea with or without vomiting (morning sickness) is also common. Talk to your health care provider if your morning sickness is severe.

Regular checkups are also a great time to learn how to ease any discomfort you may be having, and ask any other questions about your pregnancy and the birth of your future baby.

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Article by

Dr Umalakshi Premnath MD, DM

Consultant, Gastroenterologist

Dr Mehta’s Hospitals, Chetpet

 

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What is Cardiac Marker Test?

Cardiac marker tests identify blood chemicals associated with myocardial infarction (MI), commonly known as a heart attack. The myocardium is the middle layer of the heart wall composed of heart muscle. Infarction is tissue death caused by an interruption in the blood supply to an area.

Purpose

Cardiac markers help physicians to assess acute coronary syndromes and to identify and manage high-risk patients. Creatine kinase-MB (CK-MB), myoglobin, homocysteine, C-reactive protein (CRP), troponin T (cTnT), and troponin I (cTnI) are all used for assessment of the suspected acute myocardial infarction. CK-MB, cTnT, and cTnI may also be used to identify and manage high-risk patients.

Precautions

C-reactive protein results may be affected by the use of oral contraceptives, NSAIDs, steroids, salicylates, and intrauterine devices (IUDs). Homocysteine levels may be affected by smoking, diabetes, and coffee.

These articles contained the following recommendations regarding cardiac marker laboratory testing.

  • Troponin T or I is the preferred cardiac marker.
  • CK-MB is an acceptable alternative, if troponin is not available.
  • Total creatine kinase (CK) is no longer useful & should be discontinued.
  • Troponin should be measured within 6 hours of the onset of symptoms.
  • If the first troponin result is negative, a second sample should be obtained between 6 & 12 hours of symptom onset.
  • Cardiac Marker results should be available within 30 to 60 minutes.
  • An abnormal troponin result should be defined as >99th percentile of a normal population
  • Troponin assay must have a low level of imprecision at the cutoff point (CV<10%).

Based on these recommendations, a group of physicians from Cardiology, Emergency Medicine and Pathology at our hospital decided to implement the following changes in cardiac marker testing.

  • Create a new Cardiac Marker Panel for the Emergency Department that includes CK-MB & Troponin at 0, 3 & 6 hours after admission.
  • Retain the current Acute Cardiac Injury Panel that includes CK-MB & Troponin at 0, 6 & 12 hours for admitted patients.
  • Eliminate total CK from all cardiac panels.
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Back Pain: Types & Treatment

Back pain can affect people of all ages; it may be caused due to a variety of reasons such as injury, improper sitting or sleeping posture, intense physical activity or medical conditions. The human back is composed of multiple complex structures of muscle, tendons, ligament, disc and bones. As people grow older the chances of them developing back pain increases since the human back is the most sensitive part affected by ageing and it is easy to develop degenerative disk disease.

The spine is the human body’s main structural support and it is responsible to bear and balance a lot of other parts of the body. It is necessary for it to remain flexible enough for movement and stable enough for a person to stand upright. The segments of the spine are cushioned with cartilage-like pads called disk and these disks start degenerating due to wear and tear caused by a person’s occupation health condition, age etc.

Any problem in these components can lead to back pain although in some cases it becomes hard to determine the cause of back pain most of these problems are usually believed to be caused due to strain on the back, medical conditions, occupation, poor posture among other reasons.

Back pain problems are classified into two types:

Acute Back Pain

These are generally caused due to some sort of strenuous activity, injury or being in a bad posture for a long time. The time duration this type of back pain lasts for is temporary and may extend up to 6 weeks. This type of aliment is much easier to diagnose and provide treatment.

Chronic Back Pain

This type of back pain is an ongoing problem and last for a longer duration it may last for over 3 months or continue for a lifetime. It is more difficult to diagnose and provide treatment as in some cases the cause for pain may be due to an incurable disease such as cancer and requires long term pain relief treatment.

Most acute back pains get better with a few weeks of treatment at home, however as every person is different the condition may last longer and the pain may become more persistent since back pain is a complex condition.

The following are a few of the common treatment procedures your physician may suggest for back pain problems:

MEDICATION

Over-the-Counter (OTC) Pain Relievers

Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen sodium can help relieve acute back pain problems. The medications will be prescribed by your physician but it is necessary to avoid overdosage as it can cause serious side-effects.

Muscle Relaxants

In cases where OTC drugs are ineffective, the physician might prescribe muscle relaxants to ease the pain. These medications can cause mild dizziness and induce sleep.

Narcotics

The prescription and medication regime is closely monitored by the physician and medicines containing opioids such as oxycodone or hydrocodone are used for treatment. This type of treatment is unsuitable for a longer duration thus it lasts for at most a week.

Topical Pain Relievers

These are external medications and are applied directly over the skin at the site of pain. These include oils, creams, gels, sprays, salves and ointments.

Anti-Depressants

Low doses of anti-depressants such as amitriptyline are sometimes prescribed for patients afflicted with certain types of chronic back pain.

Injections

In cases when oral or topical medication fail to relive the pain the physician may inject an anti-inflammatory medication such as cortisone into the space around the spinal cord to help inflammation around nerve roots and this effect can last up to a few months.

EXERCISE & THERAPY

People with a good diet and fitness regime are less prone to be afflicted with back pain unless they accidentally injure themselves. People with poor health maintenance or diet are more prone to develop diseases related to the back. Thus, physicians often recommend patients to exercise regularly and maintain a healthy diet.

In certain cases, they may also recommend a physiotherapist who can help relieve back pain by using a variety of treatments such as massage, ultrasound, heat, electrical stimulation and muscle-release techniques to ease back muscles and soften tissues.

SURGERY

Surgery is usually the last option available and mostly recommended for patients with structural problems such as those afflicted with:

  • Degenerating spinal condition due to spinal stenosis or narrowing of the spine.
  • Bone spurs usually caused due to arthritis and putting pressure on the spinal cord.
  • Ruptured or bulging disks.
  • Weakened or dysfunction of limbs caused due to nerves in the spine.
  • Spinal infection.
  • Injury to spine and related nerves due to an accident.
  • Tumour in spinal cord etc.

Some of the surgical procedures include:

Fusion

Two vertebrae are splinted together with a bone graft between them using metal plates, screws or cages.

Artificial Disk

An artificial disk is inserted to replace as a cushion between two vertebrae

Diskectomy

Removing a portion of the disk if it happens to irritate or press against a nerve on the spine.

Partial removal of vertebra

Removing a minor section of the vertebra in cases where it is pressing against the spinal cord or nerves

Surgery is a joint decision between you and your physician and often an option to be avoided if possible as it can cause more problems. However, if back pain persists for a few days without any improvement it is recommended you visit the physician.

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