Weaning foods for children

Tags

, , , , , , , ,

babyIntroducing your baby to solid foods – sometimes called weaning or complementary feeding – should start when your baby is around six months old.It’s a really important step in their development, and it can be great fun to explore new flavours and textures together.

Three signs your baby is ready for thir first food

There are three clear signs that, together, show your baby is ready for solid foods alongside breast milk or formula. It’s very rare for these signs to appear together before your baby is six months old.

  1. They can stay in a sitting position and hold their head steady.
  2. They can co-ordinate their eyes, hands and mouth so they can look at the food, pick it up and put it in their mouth, all by themselves.
  3. They can swallow food. Babies who are not ready will push their food back out with their tongue, so they get more round their face than they do in their mouths.

Some signs that can be mistaken for a baby being ready for solid foods:

  • chewing fists
  • waking in the night when they have previously slept through
  • wanting extra milk feeds

These are normal behaviours and not necessarily a sign of hunger or being ready to start solid food. Starting solid foods won’t make them any more likely to sleep through the night. Extra feeds are usually enough until they’re ready for other food.

When can I introduce weaning foods to my baby?

The World Health Organization (WHO) recommends exclusive breast feeding alone up to the age of 6 months. After 6 months babies need complementary feeding to provide adequate supply of nutrients.

Step 1: Your baby is now 6 months old (completed 6 months)

  • Purées of vegetables such as carrots, pumpkin , potato, sweet potato
  • Purées of fruits, such as ripe cooked apple, pear , or mashed banana
  • Gluten-free baby cereals, such as rice cereal mixed with baby’s usual milk

Milk is still a major part of the baby’s diet. If you are breastfeeding, you can continue breastfeeding till baby is two years old.

Purées may be easiest for your baby at first. However, babies can quickly learn to chew soft, lumpy food even if they have no teeth. Ensure the food is well mashed and gradually make the food a thicker consistency.

Try to limit the number of sweet or cereal purées to one a day, and always include a vegetable purée. 

Don’t add salt or sugar, honey or other sweeteners to your baby’s food. 

Step 2: Baby is taking puréed food well

If baby is taking puréed food well, time to increase the variety in their food.

  • Purées of lean meat or poultry
  • Purées of lentils or split peas 
  • Purées of mixed vegetables with potatoes or rice
  • Purées which include green vegetables, such as peas, cabbage , spinach or broccoli
  • Full cream milk, yoghurt, cream cheese, paneeror custard.

Do not give cow’s (or goat or sheep’ milk) as baby’s main milk till they are atleast one year old. 

Make changes in child’s diet when they are well. This is to avoid attributing the symptoms of illness to change in diet.

Some foods are more likely to cause allergies than others. These should be introduced one at a time. These foods are:

  • Milk products such as cheese, yoghurt, fromage frais, paneer etc (Use full fat variety)
  • Fish and shell fish
  • Soya beans
  • Citrus fruit (including orange juice)
  • Wheat, rye and barley based foods such as bread, flour, pasta, some breakfast cereals and rusks.
  • Nuts, especially if your family has a history of allergies.

Step 3: Baby food from seven to nine months

Now is the time to introduce more variety in baby’s food.

Remember that most baby food can be easily made at home. 

  • Mashed or minced food, not purées. Be sure to include some lumps.
  • A wider range of starchy foods such as khichdi suji upmasuji kheersabudaana kheerdalia, bread. Baby breadsticks, breakfast cereals, oats, in addition to cornmeal, potatoes, rice and millet are also good options. Give two to three servings a day of starchy foods.
  • Cooled, filtered and boiled waterfrom a sipper with a soft spout, when she is thirsty. This is in addition to her daily breastmilk or 500-600 mls of formula.
  • Keeping juice to meal times helps with iron absorption and reduces the risk of damage to emerging teeth.
  • Citrus fruits, such as oranges (santara), kinnow (keenu) and sweetlime (mosambi).
  • Fish, lean red meat, poultry and lentils. Aim for one serving of protein-rich food a day.
  • Nut butters as long as there is no family history of allergic diseases. Use unsalted smooth versions, or make your own.
  • Dairy products, such as paneer, yoghurt and cheese. You should wait until one year to introduce cow’s milk as a drink. However, it can be used in small amounts for cooking foods.
  • Follow-on formula, if you wish.
  • Finger foods such as cooked green beans (frans been) or carrots (gajar), cubes of cheese, slices of banana (kela) or soft pear (nashpati).

If you are buying canned food, do ensure they do not contain excess salt or sugar. Adult canned food is not recommended for babies as it contains excess salt or sugar.

Step 4: Meals from 10 months

Meals should be more adult-like now. They should be chopped or minced. You may like to follow a two to three meal a day pattern along with one or two snacks. Continue to offer breastmilk or 500-600mls of formula milk. 

At this stage your baby should be having:

  • three or four servings of starchy foods, such as khichdi, rice, daldalia, or potatoes, a day
  • one serving of meat, fish, well-cooked eggs, or two of pulses (lentils, peas, beans) or nut butters
  • one to two servings of cheese, paneeror yoghurt as well as breastmilk or formula milk.

What foods should I not give my baby if she is under a year?

  • Salt: Adding salt to baby food is neither needed nor recommended in the  first year of life
  • Honey. Even if she has a cough, your baby shouldn’t have honey until she’s one.
  • Sugar. Try sweetening desserts with mashed banana or a purée of stewed dried fruit. Or you could use expressed breast milk or formula milk.
  • Artificial sweeteners. Diet drinks or squashes containing artificial sweeteners are not suitable for your baby. They are not nutritious and can encourage a<style=”color: #000000;”>sweet tooth.
  • Whole nuts.These are a choking hazard.
  • Tea or coffee. The tannin in tea may prevent her from absorbing the iron in her food properly. Any caffeinated drink is unsuitable for your baby.
  • Low-fat foods. Single or double toned milk, yoghurts and reduced-fat cheeses aren’t right for your baby. Always offer your baby the full-fat versions. She needs the calories.
  • Foods which may carry a risk of food poisoning; such as soft mould-ripened cheeses (brie, camembert), liver pâté, and soft-boiled or raw eggs.
  • Cow’s (or goat’s or sheep’s) milkas a main drink under one year. 

Varicose Vein

Tags

, , , , , , , , , , ,

19705Varicose veins are swollen, twisted, and enlarged veins that you can see under the skin. They are often red or blue in color. They usually appear in the legs, but can occur in other parts of the body.

Causes

Normally, one-way valves in your leg veins keep blood moving up toward the heart. When the valves do not work properly, they allow blood to back up into the vein. The vein swells from the blood that collects there, which causes varicose veins. Smaller varicose veins that you can see on the surface of the skin are called spider veins.
Varicose veins are common, and affect more women than men. They don’t cause problems for most people. However, in some people, they can lead to serious conditions, such as leg swelling and pain, blood clots, and skin changes.
Risk factors include:
• Older age
• Being female (hormonal changes from puberty, pregnancy, and menopause can lead to varicose veins, and taking birth control pills or hormone replacement can increase your risk)
• Being born with defective valves
• Obesity
• Pregnancy
• History of blood clots in your legs
• Standing or sitting for long periods of time
• Family history of varicose veins

Symptoms

• Fullness, heaviness, aching, and sometimes pain in the legs
• Visible, swollen veins
• Mild swelling of feet or ankles
• Itching
Severe symptoms include:
• Leg swelling
• Leg or calf pain after sitting or standing for long periods
• Skin color changes of the legs or ankles
• Dry, irritated, scaly skin that can crack easily
• Skin sores (ulcers) that don’t heal easily
• Thickening and hardening of the skin in the legs and ankles
• Bleeding from ruptured veins

Diagnosis

Your doctor will examine your legs to look for swelling, changes in skin color, or sores. Your doctor also may:
• Check blood flow in the veins
• Rule out other problems with the legs (such as a blood clot)
• Do a colour scan for the leg veins

Treatment

Your doctor may suggest that you take the following self-care steps to help manage varicose veins:
• Wear compression stockings to decrease swelling. These stockings gently squeeze your legs to move blood up towards your heart.
• Do not sit or stand for long periods. Even moving your legs slightly helps keep the blood flowing.
• Raise your legs above your heart three or four times a day for 15 minutes at a time.
• Care for wounds in you have any open sores or infections. Your health care provider can show you how.
• Lose weight if you are overweight.
• Get more exercise. This can help you keep off weight and help move blood up your legs. Walking or swimming are good options.
• If you have dry or cracked skin on your legs, moisturizing may help. However, some skin care treatments can make the problem worse. Talk to your health care provider before using any lotions, creams, or antibiotic ointments. Your provider can recommend lotions that can help.
If your condition is severe, your doctor may recommend the following treatments:
• Laser therapy. Strong bursts of light are projected on smaller varicose veins, making them disappear.
• Sclerotherapy. Salt water or a chemical solution is injected into the vein. The vein hardens and disappears.
• Ablation. Heat is used to close off and destroy the vein. The vein disappears over time.
• Microphlebectomy. Small surgical cuts are made in the leg near the damaged vein. The vein is removed through one of the cuts.
• Bypass. Surgery reroutes blood flow around the blocked vein. A tube or blood vessel taken from your body is used to make a detour around, or bypass the damaged vein.
• Angioplasty and stenting. A procedure opens a narrowed or blocked vein. Angioplasty uses a tiny medical balloon to widen the blocked vein. The balloon presses against the inside wall of the vein to open it and improve blood flow. A tiny metal mesh tube called a stent is then placed inside the vein to prevent it from narrowing again.
Varicose veins tend to get worse over time. Taking self-care steps can help relieve achiness and pain, keep varicose veins from getting worse, and prevent more serious problems.

When to Contact a Medical Professional

Call your health care provider if:
• Varicose veins are painful
• They get worse or do not improve with self-care, such as by wearing compression stockings or avoiding standing or sitting for too long
• You have a sudden increase in pain or swelling, fever, redness of the leg, or leg sores
• You develop leg sores that do not heal

Gestational Diabetes

Tags

, , , , , , , , , , ,

Whats is Gestational Diabetes?
Diabetes (poor tolerance to blood sugars) diagnosed for the first time during pregnancy. It usually starts in the middle or ed of pregnancy.

CAUSES
Gestational diabetes occurs when you body cannot make enough insulin during pregnancy.High levels of hormones with weight gain of pregnancy causes your body cells to use insulin less effectively. The risk of developing pregnancy diabetes is higher in the following situations.

    • If you are overweight (BMI>30)
    • You had a previous large baby weighing more than 4.5 KG
    • You had diabetes in the previous pregnancy.
    • You have a family member like parents or siblings with diabetes
    • Some nationalities like Asians, Middle Eastern, African – Caribbean

 

DIAGNOSIS
Diagnosis is by checking your blood sugar level during pregnancy. It is done in early pregnancy if you have risk factors as mentioned. Routinely its done in the 6th or 7th (24 to 28 Weeks) month of pregnancy. The test is called GTT and it is done by checking your fasting levels of glucose and bp levels 1 to 2 hours after having a glucose drink.

 

What are the risks of diabetes to my baby?
If the blood glucose levels are too high , the baby can grow bigger which increases the risk of long labour, c section, birth injuries during delivery and still birth. The baby produces more insulin and can have low glucose levels after birth. Future risk to the baby include obesity and diabetes.

TREATMENT
Once you are diagnosed diabetic during pregnancy, the treatment involves 3 steps:
1. Referral to a Dietitian : Diet should reduce your blood sugar levels and it should give you the calories required for pregnancy
2. Medications : Medications are started if diet does not lower blood sugar levels within 2 weeks. Medications safe in pregnancy are metformin and insulin.
3. Exercise : It also helps lower blood sugar level.

 

MONITORING SUGAR LEVELS
1. You will have follow up visits every 2 weeks
2. You will be instructed how to monitor your blood sugar levels at home at least twice during the week
3. Aim of treatment is to maintain blood sugar level within normal range (fasting less than 90mg and post meals more than 1 hour = 140 mg / dl)

PLAN AFTER DELIVERY
1. Your baby growth will be monitored by Ultra sound
2. Increased fluid and large baby are signs of poor sugar control
3. If sugar levels are well controlled labour will be induced between 39 – 40 weeks.
4. If sugar control is poor baby is large and water around baby is increased. Labour will be induced soon after 38 weeks.
5. Normal delivery is possible if baby weight is average.
6. Large baby is many to be delivered by c section.
7. After deliver the baby’s blood sugar will be checked as it can be low.
8. Your diabetes medications may be stopped after checking your blood sugar levels.
9. You should check your fasting blood sugar 6 weeks after delivery.
10. Life style modification in the form of diet and exercise can postpone development of overt diabetes later in life.

Laparoscopic Abdominal Cerclage an Excellent Option for Women with Recurrent Fetal Loss

Cervical incompetence or cervical insufficiency is one of the causes of preterm birth, leading to increased perinatalmorbidity and mortality.Cervical insufficiency is defined as “a painless dilatation of the cervix resulting in bulging or ruptured membranes and midtrimestermiscarriage”. It occurs in 0.5% to 1.0% of allpregnancies and in up to 8% of women with repeated second-trimester miscarriages. Late miscarriages and extreme premature birth are very traumatic for a couple physically and psychologically and It may lead to them delaying or even deciding against a future pregnancy.

LAC1

Cervical cerclage placement is the treatment for this condition. Although most cerclages are placed transvaginally via the Shirodkar or McDonald technique, abdominal cerclage is necessary in women with a previous failed transvaginal cerclage or in those with minimal cervical tissue accessible vaginally .Approximately 13% ofpregnancies in women with cervical incompetence treated with vaginal cerclage will not be successful and will deliver previable infants despite this interventions .

CervicaStitch

Both laparoscopic and robotic approaches to this procedure have been developed, allowing patients to enjoy a more rapid recovery as well as to avoid an unnecessary laparotomy. The observational studies reporting outcomes for laparoscopic-abdominal cerclage quote fetal survival rates in the range of 81% to 100%.

Indications for abdominal cerclage
1. Short or no intravaginal portion of the cervix due to previous surgery like LEEP , LETZ and trachelectomy
2. Congenital malformation of uterus
3. Severe cervical lacerations during previous delivery
4. Previous failed vaginal cerclage

Laparoscopic Cerclage
Advances in the field of minimally invasive surgery resulted in development of a new approach to cervical cerclage placement. Laparoscopic cerclage offers the benefit of placing the cerclage at a higher level which reduces the chances of pretem delivery with added benefits of reduced blood loss, reduced postoperative pain, and fewer adhesions, as well as decreased length of hospital stay and overall faster recovery time. Laparoscopic cerclage can be placed either before conception (preconceptional or interval cerclage) or in early pregnancy (postconceptional).

Laparoscopic Cervical Cerclage before Pregnancy
Performing abdominal cerclage preconceptionally mitigates the concerns of difficult exposure due to an enlarged pregnant uterus, increased risk of bleeding, and possible risks to the pregnancy . Furthermore, it can be performed via laparoscopy, which is associated with a short hospital stay, lesspostoperative pain, and rapid recovery.

Yet preconceptionalabdominal cerclage had not been popular because of the possibility of a subsequent miscarriage or fetal loss in thepresence of the cerclage. This concern seems unwarranted.

One can still perfom dilation and curettage in the presence of abdominal cerclage without compromising its integrity . In the event of failed pregnancy in the secondtrimester, the cerclage can be removed laparoscopically. This will be followed by spontaneous expulsion of the fetus within a few days .

Laparoscopic cerclage during pregnancy

Postconceptional abdominal cerclage is required in pregnant women who for some reason cannot undergo vaginal cerclage. There is no differencein the rate of third-trimester delivery after abdominal cervical cerclage before
or during pregnancy.

LAC2

Advantages of laparoscopic cerclage
• Higher placement stich relative to internal os
• Decreased incidence of slippage(less suture migration)
• Ability to leave the stitch in place between pregnancies
• Eliminates the risk of foreign body entering the vagina
• Less risk of PPROM compared to transvaginal(9% vs 29%)

Patients undergoing laparoscopic cerclage should be delivered by cesarean section and stich can be left in place for future pregnancies.

Laparoscopic cervical cerclage is a procedure that offers hope to women with recurrent pregnancy loss related to cervical incompetence and in whom transcervical cerclage would be difficult or impossible .

ANAESTHESIA – AWARENESS ABOUT “NO AWARENESS”

Tags

, , , , , , , , ,

anaesthetist

A visit to the doctor confirms your worst fear: SURGERY. Suddenly you cease to think about the disease that is plaguing your body and it all becomes about the upcoming and seriously daunting surgery. You get anxious and scared and seek people who can answer some questions that are running through your mind. Will I be seeing the surgery? Will I wake up of the Anaesthesia? When will I wake up? What if I wake up in the middle of the surgery? Will there be pain? If yes, how much pain? What can be done to have no pain during and after surgery? What will happen if the said surgery doesn’t go well, or as predicted? Will I come out of the surgery alive? But often these questions are not directed to the right person who can give us the right information. Have you ever consulted an Anaesthetist before you go to the operation theatre for the surgery and have your queries been addressed to? After practicing Anaesthesia for close to a decade now, I have realized that most patients go into surgery scared and with many of these questions still unanswered. Let me try to solve this mystery for you by answering some of the frequent questions that plague a person’s mind before surgery:

 1. What is Anaesthesia? Anaesthesia literally means insensitivity to pain temporarily induced by drugs. It is a speciality of medicine which deals with temporary induced state with one or more of the following: Analgesia (relief from or prevention of pain), Amnesia (loss of memory), Paralysis (extreme muscle relaxation) and/or Unconsciousness. It is a temporary state where you are completely unaware of the surroundings controlled by various drugs given to you by a qualified Anaesthetist, who also take care of your vitals (heart beat, blood pressure, oxygen concentration, temperature, respiration or breathing and status of other organs like kidney, liver, etc.) while you are unaware of these experiences. Anaesthesia is science being researched and developed by medical science and is an important aspect of a successful surgery today.
2. Who is an Anaesthetist or Anaesthesiologist? An Anaesthetist (or Anaesthesiologist) is a highly trained specialist in the subject, (who has done specialisation/post graduation in Anaesthesia for 3 years, after 5 and half years of graduation i.e. M.B.B.S.), who makes all the decisions during surgery. She/he is responsible for the administration of anaesthesia and patients well being while under anesthesia and also the immediate post-operative care. Anaesthetists play a vital role in various areas of healthcare and hospitals these days. They are your perioperative physicians who take care of your illnesses prior to the surgery and also after the surgery. Anaesthetists are a vital team member of the Intensive care units or the critical care units. Some Anaesthetists also run pain clinics to take care of your long standing pain. Anaesthetists also take up the role of emergency physicians in trauma care and acute pain management. Anaesthetists are also key member of the hospital administration and management who can connect all the departments with ease.
3. What are the side effects of the anaesthesia that will be given to me? The medications given to you during anaesthesia are chosen as per your physical condition, and your pre-existing ailments. These medications are used in combination and the dosages are well calculated before administration and are associated with very minimal or negligible side effects. However, in some patients may experience reactions to the medications given, in the event of which the Anaesthetist will address to it immediately.
4. Does the Anaesthetist makes patients sleep during surgery and leaves the theatre? An Anaesthetist makes you sleep, takes care of your vitals throughout the surgery, awakens you, accompanies you to the recovery ward and takes care of you in the immediate postoperative period. She/he is mandatorily required to be present with the patient from the time the patient enters the operating room till the time the patient reaches the recovery room.
5. I am afraid of being in the operation theatre. Can you make me sleep before going in to the operation theatre? All patients are anaesthetised only after attachment of the standard monitoring and after securing an intravenous access. But for patients who are over anxious of the theatre they may be given some sedative or anti-anxiety medication in the preoperative ward, before going into the theatre. Usually your anaesthetist prescribes you some medications to be given in the ward which also helps you relieve anxiety and when you come to the theatre you might be in a light sleep.
6. I fear the needles. Is there any other way of making me sleep? Usually the anaesthetic medications are given to you through an intravenous cannula, secured in a vein in one of your hands which needs just one needle prick. It is mandatory for administration of anaesthesia. In children, they are either sedated with gases or an intramuscular injection and then intravenous access is secured. Same can be done for adults who have severe phobia for needle prick, as a special case.
7. Will I be seeing the surgery? Usually you will be completely unaware of the surgery; that means you will be under anaesthesia. In some cases where only part of your body is anaesthetised, either your lower half of the body or your any of your limbs, you may opt to see the surgery. Certain centres also record the surgeries to be seen later.
8. Will I wake up of the Anaesthesia? When will I wake up? Will I come out alive after the surgery? With the advancement of this medical speciality there are various medications whose combination is used for administration of safe anaesthesia and patients can be awakened within minutes of completion of the surgery. You will awaken, and very much alive, immediately after the surgery.
9. What if I wake up in the middle of the surgery? The Anaesthetised patient is closely monitored by the Anaesthetist who makes sure you don’t awaken in between surgery. The depth of anaesthesia can be well maintained safely with the advanced drugs available these days. Despite all the efforts, in certain cases where due to some genetic illnesses some patients awaken in between there is a very low chance of them knowing or remembering the said instance.
10. Will there be pain? If yes, how much pain? The patient undergoing anaesthesia is given Analgesia (pain killer) prior to the surgery and maintained throughout the surgery. You might wake up with a little burning sensation in the operated site but usually there is no pain or very minimal pain of the surgery for which your Anaesthetist will give you pain medication in the recovery ward. . Along with that, there are various techniques to block the pain mechanism of the surgery site which are done. This technique is also called Regional Anaesthesia. These injections are usually given while you are still asleep and when you awaken you are pain free.
11. What will happen if the said surgery doesn’t go well, or as predicted? Anaesthetists take all precautions for conduct of safe surgery. Despite all the efforts some patients might have complications during or after the surgery. All patients are monitored for such scenarios. Any patient who encounters such complication is taken to the intensive care units (I.C.U.) or critical care units for observation and further management.
12. What are the various Anaesthetic options I have? Anesthesia is broadly divided into General anaesthesia and Regional Anaesthesia. General anaesthesia is the one where you are completely unconscious and unaware of the surgery. Regional anaesthesia is again divided in various forms where a part of your body is anaesthetised during the surgery and can be combined with some sedation or even general anaesthesia. Spinal or epidural anaesthesia is one where lower half of your body is anaesthetised. Local anaesthesia is done in superficial surgeries where only the surgical part in anaesthetised. Nerve blocks are done, where the nerves supplying the surgical area are selectively anaesthetised and you feel no pain during the surgery and these can also be used for postoperative pain management. These are also combined in a surgery for better comfort and outcome.
13. I have heard from my relatives that Spinal anaesthesia causes backache. Is it true? Backache is predominant in mankind as a punishment for our standing posture. In pregnancy because of poor back care patients experience backache. Rather these days various types of epidural medications and treatment are given for various types of backache. In pregnancy the back pain is due to inadequate exercise, and back care. The spinal anaesthesia is safer option for you and your baby during a caesarean section (unless contraindicated for some coexisting illness). These days epidural Anaesthesia is being given for painless normal deliveries, which are also safe for you and your baby.
14. Minor surgery involves no risk. Is it true? The severity of surgery is not the only factor that determines the risk involved. Your coexisting diseases also play a major factor in risk assessment. For example – a patient with severe cardiac problem is very high risk for surgery even for a small biopsy.
15. The risk involved is due to Anaesthesia. Is this true? Some patients think that the risk involved in a surgery is only due to Anaesthesia, which is not true. The anaesthetists are well trained to administer you anaesthesia with your coexisting diseases safely, it is rather the stress of surgery (especially without anaesthesia) that is more risky than undergoing surgery under anaesthesia. The anaesthetists just want to correct the coexisting problems as much as possible and then take you for surgery so that the surgery is done more safely, medically optimise your health condition prior to surgery.

anaesthesia

Safe and successful surgery is a result of many factors involved in surgery including a good and responsible anaesthetist. It is very important to meet your Anaesthetist before any surgery, as your Anaesthetist evaluates your health status, your coexisting illness or diseases, status of your vital organs like the heart, kidneys, liver, etc and co-relates with the surgery involved and accordingly decides the Anaesthesia best for your surgery in your own health condition. This is also the best time to ask the questions you want to ask your Anaesthetist about the unawareness and postoperative care.

You Can Control Your Asthma

Tags

, , , , , , ,

Asthma affects more than 300 million people worldwide. It is characterized by recurrent difficulties with breathing, including symptoms such as shortness of breath, wheezing, chest tightness, and coughing. Asthma symptoms vary over time, and also from individual to individual. Although asthma cannot be cured; it can be treated and controlled. Good asthma control means no, or very minimal, symptoms, and a low risk of asthma attacks or other poor outcomes. A person whose asthma is under good control can go to work or school, exercise, and participate fully in life.WAD-2016-Logo-01-1

What can I do to prevent my asthma from getting out of control?

Medications: Take your asthma medication exactly as your doctor tells you. Work with your doctor to find a treatment plan Carry your relief/rescue inhaler with you at all times and follow the directions on your Action Plan for when to use it.

Regular visits to your doctor: Keep your regularly scheduled visits with your doctor so that your asthma can be monitored and treated before it gets out of control. Be sure to know how to contact your doctor and know what to do in case of an emergency.

Stay healthy: Eat nutritious foods and get regular exercise. Avoid people who smoke and those that may have an infection, especially a cold or the flu.

Prevent the flu and pneumonia: Get a yearly flu shot (vaccine) and a vaccine for pneumonia, as recommended by your doctor.

Cope with stress: Learn new ways to cope with stress. Coping with stress can help prevent and control your asthma.

By taking an active role in the management of your asthma by partnering with your doctor, you can breathe easier and live a healthier life

Anorexia

Tags

, , , , , , , , , ,

 

What is Anorexia?

Male-AnorexiaAnorexia Nervosa is a psychological and possibly life-threatening eating disorder defined by an extremely low body weight relative to stature (this is called BMI [Body Mass Index] and is a function of an individual’s height and weight), extreme and needless weight loss, illogical fear of weight gain, and distorted perception of self-image and body.

Additionally, women and men who suffer with anorexia nervosa exemplify a fixation with a thin figure and abnormal eating patterns. Anorexia nervosa is interchangeable with the term anorexia, which refers to self-starvation and lack of appetite.

Types of Anorexia

There are two common types of anorexia, which are as follows:

  • Anorexia Nervosa Binge / Purge Type – The individual suffering from anorexia nervosa binge / purge type, will purge when he or she eats. This is typically a result of the overwhelming feelings of guilt a sufferer would experience in relation to eating; they compensate by vomiting, abusing laxatives, or excessively exercising.
  • Restrictive Anorexia Nervosa – In this form of anorexia nervosa, the individual will fiercely limit the quantity of food consumed, characteristically ingesting a minimal amount that is well below their body’s caloric needs, effectively slowly starving him or herself.

Causes 

Anorexia is not a simple disorder. It has many symptoms and effects, and its causes are complex as well

  1. Environmental factors

The effects of the thinnessculture in media, that constantly reinforce thin people as ideal stereotypes

  • Professions and careers that promote being thin and weight loss, such as ballet and modeling
  • Family and childhood traumas: childhood sexual abuse, severe trauma
  • Peer pressure among friends and co-workers to be thin or be sexy.
  1. Biological factors
  • Irregular hormone functions
  • Genetics (the tie between anorexia and one’s genes is still being heavily researched, but we know that genetics is a part of the story).
  • Nutritional deficiencies

Signs and Symptoms 

Living with anorexia means you’re constantly hiding your habits. This makes it hard at first for friends and family to spot the warning signs. When confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you won’t be able to deny their instincts that something is wrong—and neither should you.

food behavior signs and symptoms

  • Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
  • Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
  • Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of
  • Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.
  • Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways.

appearance and body image signs and symptoms

  • Rapid weight loss with no medical cause.
  • Feeling fat, despite being underweight – You may feel overweight in general or just “too fat” in certain places, such as the stomach, hips, or thighs.
  • Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
  • Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws. There’s always something to criticize. You’re never thin enough.
  • Denial that you’re too thin – You may deny that your low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

purging signs and symptoms

  • Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
  • Throwing up after eating – Frequently disappearing after meals or going to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
  • Compulsive exercising – Following a punishing exercise regimen aimed at burning calories. Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or eating something “bad.”

Steps to recovery

  • Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight. The first step in anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowledging the physical and emotional damage that you’ve suffered because of it.
  • Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your anorexia a secret for a long time. You may be ashamed, ambivalent, or afraid. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
  • Stay away from people, places, and activities that trigger your obsession with being thin.You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-ana” sites that promote anorexia.
  • Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

The difference between dieting and anorexia

Healthy Dieting

Anorexia

Healthy dieting is an attempt to control weight. Anorexia is an attempt to control your life and emotions.

Your self-esteem is based on more than just weight and body image.

Your self-esteem is based entirely on how much you weigh and how thin you are.
You view weight loss as a way to improve your health and appearance. You view weight loss as a way to achieve happiness.
Your goal is to lose weight in a healthy way.

Becoming thin is all that matters; health is not a concern.

Learn to tolerate your feelings

Identifying the underlying issues that drive your eating disorder is the first step toward recovery, but insight alone is not enough. Let’s say, for example, that following restrictive food rules makes you feel safe and powerful. When you take that coping mechanism away, you will be confronted with the feelings of fear and helplessness your anorexia helped you avoid.

Challenge damaging mindsets

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, try to excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless.

Develop a healthier relationship with food

Even though anorexia isn’t fundamentally about food, over time you’ve developed harmful food habits that can be tough to break. Part of recovery is developing a healthier relationship with food.

Medical treatment

The first priority in anorexia treatment is addressing and stabilizing any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalized until you reach a less critical weight.

Autism or Autism Spectrum Disorder (ASD)

Tags

, , , ,

What Is Autism or Autism Spectrum Disorder (ASD)?
Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors.
ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art.

Autism-02
How Common Is Autism?
An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States.
What Causes Autism?
First and foremost, there is no one cause of autism just as there is no one type of autism. Over the last five years, scientists have identified a number of rare gene changes, or mutations, associated with autism. A small number of these are sufficient to cause autism by them. Most cases of autism, however, appear to be caused by a combination of autism risk genes and environmental factors influencing early brain development.
A growing body of research suggests that a woman can reduce her risk of having a child with autism by taking prenatal vitamins containing folic acid and/or eating a diet rich in folic acid (at least 600 mcg a day) during the months before and after conception.
What Does It Mean to Be “On the Spectrum”?
Each individual with autism is unique. Many of those on the autism spectrum have exceptional abilities in visual skills, music and academic skills. About 40 percent have average to above average intellectual abilities. Indeed, many persons on the spectrum take deserved pride in their distinctive abilities and “atypical” ways of viewing the world. Others with autism have significant disability and are unable to live independently. About 25 percent of individuals with ASD are nonverbal but can learn to communicate using other means. Autism Speaks’ mission is to improve the lives of all those on the autism spectrum. For some, this means the development and delivery of more effective treatments that can address significant challenges in communication and physical health. For others, it means increasing acceptance, respect and support.

Did you know …
• Autism now affects 1 in 68 children and 1 in 42 boys
• Autism prevalence figures are growing
• Autism is one of the fastest-growing developmental disorders in the U.S.
• Autism costs a family $60,000 a year on average
• Boys are nearly five times more likely than girls to have autism
• There is no medical detection or cure for autism

Chronic Kidney Disease (CKD)

Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time. The term chronic is used to refer to a condition which is permanent and irreversible. In addition, it progressively worsens even with treatment. This will eventually, over a period of time lead to need for dialysis or renal transplantation.
This is associated with complications such as high blood pressure, weak bones, low blood dialysis-access-management-the-miller-procedure-for-steal-syndromeDialysis-Treatment    hemoglobin and cardiac and nerve and brain damages.
Causes of Chronic Kidney Disease
The two main causes of chronic kidney disease are Diabetes mellitus and High blood pressure. These two diseases together are responsible for up to two-thirds of the cases.
High blood pressure, if uncontrolled, or poorly controlled, can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.
Several other conditions can cause chronic kidney disease.
• Glomerulonephritis:A group of diseases that cause inflammation and damage to the kidney’s filtering units. These are unique diseases which generally affect the kidneys primarily and as a result of kidney damage can cause damage to other organs of the body. These disorders are the third most common type of kidney disease.
• Polycystic kidney disease An Inherited diseases, which causes large cysts to form in the kidneys and damage the surrounding tissue.
• Malformations and developmental abnormalities that occur during intrauterine development.
• Systemic lupus erythematosos and other diseases that affect the body’s immune system.
• Obstructions to urine flowcaused by problems like kidney stones, tumors or an enlarged prostate gland in men.
• Repeated urinary infections.
Most people may not have any symptoms until their kidney disease is advanced. However, the following symptoms occur as the disease progresses.
Tiredness and feeling less energetic in day to day activities; have trouble concentrating have a poor appetite and have difficulty in sleeping. These are non-specific symptoms and occur very slowly and are difficult to recognize in the beginning.
In addition patient may also have certain specific symptoms like swelling in the feet, and puffiness of the face especially around the eyes more so in the morning. Decrease in urination sometimes associated with the need to urinate more often at night occurs.
In severe cases and advanced renal failure patients have breathing difficulty, headache, convulsions, visual disturbances, and loss of consciousness. This warrants emergency treatment.
Detection of chronic kidney disease: Important tests of kidney function.
The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.
Blood Urea Nitrogen: This is a chemical which accumulates in the body during day to day activities. It is normally excreted by the kidney and it accumulates in the blood in patients in whom the kidney function is reduced.
Serum Creatinine: this is also a waste material which accumulates in the body and if not cleared by the kidneys its blood levels raise. A raised blood urea and creatinine levels generally indicate kidney failure; however the values need to be interpreted taking in to account several other variables. Generally both blood urea and serum creatinine levels are to be considered.
If these tests are abnormal then several other chemicals in the body need to be measured to decide on the severity of the disease and to guide the treatment.
It is important to note that these tests indicate the severity of the disease and cannot confirm whether the disease is reversible or permanent.To decide if the damage is permanent or reversible renal scan is necessary
Ultra sound scan or CT scan of the kidneys will give information regarding the size of the kidneys and presence or absence of obstruction
In patients with Chronic kidney disease the kidney size is usually reduced to less than 9cms which is the normal size. In addition the appearance of the kidneys in the scan also is abnormal.
Kidney Biopsy:
In some patients if the kidney size is normal taking a small bit of kidney tissue though a needle and studying the microscopic structure may be necessary
Additional tests may be necessary to detect the complications or response to treatment measures.
Salient points:
Early detection can help prevent the progression of kidney disease to kidney failure.
Heart disease is the major cause of death for all people with Chronic kidney disease.
Hypertension can causechronic kidney disease and chronic kidney disease can cause hypertension
Persistent proteinuria (protein in the urine) means Chronic kidney disease is present and may in some cases lead to kidney failure.
High risk groups include those with diabetes, hypertension and family history of kidney failure.
Two simple tests can detect Chronic kidney disease: blood pressure, urine albumin and serum creatinine.
Treatment options

These include the following:
Supportive treatment in the early stages:
Renal replacement therapy when the disease is advanced:
Supportive treatment:
This is started when the patient has kidney failure but the degree of failure is not severe and the patient can be managed with medications and diet.
The aim of therapy is to
1. Control the symptoms
2. To delay the progression of kidney failure
3. To prepare the patient for eventual dialysis support.
Control of Symptoms:
These include medication to control blood pressure, blood sugars in patients with diabetes, and some medications to alleviate the problems due to alterations in electrolytes, water content of the body and the bone minerals. With strict control of blood pressure the progression of kidney failure can be significantly slowed down.
Diet:
Salt restriction:to control blood pressure and fluid accumulation in the body.
Fluid restriction: to control swelling and fluid accumulation
Low protein: Protein in the diet acts as an additional burden on the already malfunctioning kidneys. Moderate reduction in dietary protein intake is known to reduce the progression of the kidney failure.
Fruits; generally fruits are very rich in a mineral called potassium. This is normally excreted only through the kidneys. In conditions where kidneys are unable work normally potassium accumulates in the body. High blood potassium levels are harmful to the heart and require urgent treatment.
Dietary advice from an experienced dietician is very helpful.
Renal Replacement therapy:
There are two treatment options for kidney failure:
Dialysis (hemodialysis or peritoneal dialysis) and kidney transplantation
Briefly Dialysis means removing the waste products from the blood periodically with the help of an artificial kidney or the patient’s own abdominal membrane.
Transplantation involves placing a normal kidney surgically from a donor either living or cadaver.

Hemodialysis
Hemodialysis is a treatment that removes wastes and extra fluid from the blood.During hemodialysis, the blood is pumped through soft tubes to a dialysis machine where it goes through a special filter called a dialyzer (also called an artificial kidney). After the blood is filtered, it is returned to the bloodstream.-peritoneal-dialysis-catheter
Dialysis is necessary if the kidneys no longer remove enough wastes and fluid from your blood to keep the body healthy. This usually happens when there is only 10 to 15 percent of kidney function left. The patient usually has severe symptoms such as nausea, vomiting, swelling and fatigue. However, one can still have a high level of wastes in the blood that may be toxic to the body and yet have minimal symptoms. Your doctor is the best person to tell you when you should start dialysis.
Blood is removed from the body using needles placed in the veins or through tubes inserted in to major veins. This is called dialysis access
(Images)
For the peripheral veins to give good amount of blood for cleaning a small surgery to connect the vein to the artery is required. This needs to be done several weeks before dialysis is anticipated.
Dialysis is generally required 3 times a week each time lasting for 4-5 hours. This can be done as an outpatient procedure and the patients usually can get back to work after the session is over. Blood tests are done monthly to assess the adequacy of dialysis.
Peritoneal dialysis:
In this process a small soft rubber tube is placed in the abdomen and once the wound heals sterile fluid can be instilled in to the abdominal cavity through this tube. The fluid is left in place for 3-4 hours and during this time it takes up the waste material from the blood and it can then be removed through the same tube. This is called one exchange. Usually 3-4 exchanges are required daily and the patient is trained to do the same at home. The quality of dialysis is assessed monthly by the Nephrologist.
Renal Transplantation:
This is the most physiological way of replacing the kidney function. It involves placing a new kidney in the patient’s body usually the lower abdomen. The kidney can be donated by a close relative or it can also be from a brain dead person. The donor and recipient pair undergo a series of tests to confirm mutual compatibility and matching. The recipient will require medications life long and close and frequent monitoring.

ABDOMINOPLASTY (TUMMY TUCK)

Hanging abdomen with an apron is unsightly and uncomfortable for any woman. Not able to wear the dress of their choice is so depressing to anyone. The self esteem gets down with every morning seeing the self profile. But they can be happy that there is a sure way out.
Causes of hanging abdomen
1) Overweight or obesity : General adiposity (excess fat) as part of increase in Body Mass Index can cause an increase in abdominal circumference. The ideal BMI is 18-23. Once it is above 23 till 27.5 it is overweight and 27.5 onwards is obesity. BMI is calculated as weight in Kg/Ht in M2 e.g. If a person has 100kg weight and 2m height, BMI= 100kg/ 2m x 2m=25 Kg/M2

2) Truncal Obesity (Abdominal obesity) : Increasing abdominal obesity is more dangerous than the overall increase in weight. Ideally, the abdominal circumference at umbilical level should be below 80 cm in women. The increase in BMI and abdominal circumference leads to various medical illness like Diabetes, hypertension (increase in blood pressure), dyslipedemia (increase in cholesterol), sleep apnoea (breathing difficulty/ snoring with respiratory arrest), PCOS (Polycystic ovarian disease) and fatty liver. It also increase the risk of cancers of breast and ovary.

3) Divarication Recti (separation of muscles of abdominal wall) : This happens mainly and commonly following pregnancy when there is excessive stretch of abdominal wall muscles making it fall apart from the midline. This leads to bulging of abdomen and patient will have a state similar to pregnancy look. This is highly distressing to any woman. The abdominal bulge will be such that it projects out and comes anterior than breast level in a profile view.

4) Ventral hernia : muscle defect with herniation/ projection of abdominal contents in to the sac formed at the muscle weakness. The intestines or omentum get trapped in this defect and can cause life threatening problems.

5) Sagging fat and skin : The lower abdominal wall fat and skin is redundant (extra) and hangs down in an unsightly manner. The skin sagging may be unrelated to the muscle weakness. The pulling down of the abdominal wall by the weight of this apron itself will be causing discomfort and muscle weakness. The disfigurement in these patients is unexplainable.

Assessment
Patients need to consult a surgeon who is well-versed with the problem and its corrective measures. Detailed physical examination with abdominal girth, height, weight, BMI, BP, Pulse, oxygen saturation to be checked. The co-existing problems like diabetes, hypertension, snoring, respiratory difficulty with walking, menstrual irregularities, stress incontinence and psychological problem (mainly depression).
The psychological impact of these illness on the patient is very significant. They will be always worried about and other is depression seeing the bad body contour every day. Being not able to wear the dress they like and not able to move around comfortably also keeps them introverts and less sociable. Many jobs also demand people with normal BMI and body shapes. Even promotions are jeopardized by these abnormalities. The associated medical problems and the need for medication for the same will also be making patients uncomfortable and dissatisfied in life.

Treatment Options
Those who have increased BMI should be advised for weight reduction. To a good extend it is possible by diet regulations and exercise. There are some drugs available to reduce weight but it helps in reducing weight around 4-5 kg only. Those with higher BMI will be benefitted by intra-gastric balloon placement or by bariatric surgery of which sleeve gastrectomy is the best. Abdominal obesity also gets controlled to a great extent by these procedures.
Divarication of recti (the separation of muscle in the central abdomen), the ventral hernia and sagging skin with fat (the abdominal apron) needs tummy tuck (abdominoplasty). The exercises to tone the abdominal wall, weight reduction or application of any kind of solutions or application of slim devices like vibrators are not going to give any kind of benefit to these patients.
The procedure of tummy tuck involves a pre-hospitalization checkup including blood tests. Ultrasound abdomen is performed to rule out any other surgical problem in abdomen like an ovarian cyst or gall bladder stones which can be talked at the same time. The necessary consultations will also be done with other specialists as needed.
The operation is done under anaesthesia, either general or regional, so that patient will be comfortable. The incision will be made at the lowest skin crease of abdomen to give excellent cosmetic outcome. The skin and subcutaneous fat will be mobilized. The muscles which are far apart will be brought together. In case of hernia a net like material (mesh) will be used to give additional strength. The excess fat and skin will be removed and wound closed. The wound closure is also done in a careful manner with no stitches outside. This also will add to the perfect healing with very minimal scar. The scar will be completely hidden by the smallest of dress.
Patient needs to be in hospital for 2-3 days and can resume normal activities after that. All kinds of job can be started within two weeks time. Wearing an abdominal binder during this period will give additional comfort.
The outcomes are such great that patients get immediate results and regain self esteem. The profile changes and any modern dress will suit the person. The medical issues related to the divarication like dragging pain in abdomen and backache due to the abnormal posture and weight of ventral hernia will also get resolved. In those with higher BMI and sagging abdomen the procedure to reduce weight (sleeve gastrectomy) is done along with the tummy tuck thereby avoiding scars of the bariatric surgery and unnecessary second hospitalization. Combination of these procedures is an innovative method developed at our centre to give maximal benefit for patient with superior quality of life.

Feedback:
Dear Dr Padmakumar

My tummy tuck (abdominoplasty) was done in september 2013. I was very uncomfortable and had very strong inferiority complex due to my sagging abdomen and hernia. My friends are asking me ” oh you are pregnant again”. After my tummy tuck surgery , ” I can’t believe , all tummy had gone and I was flying in heights”.

Now am happy that I can wear any kind of dress I wish and my confidence level increased.

Thank you all doctors “you are all so special in my life”

Mrs. Liji Chandran

Untitled

Dr. R. Padmakumar MBBS, DNB, MNAMS, DipALS, FAIS
Specialist Surgeon , International Modern Hospital, Dubai

Senior Consultant Surgeon & Medical Director, Sunrise Hospital, Cochin (Specialist in Laparoscopy, Hernia, Cancer, Endoscopic Thyroid Surgery,
Thoracoscopy, Obesity and Diabetic Surgery)

GC Member – Association of Surgeons of India
National President Elect – Indian Hernia Society
Jt. Secretary – Indian Association of Endocrine Surgeons
Founder Member – Obesity and Metabolic Surgery Society of India &
Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Ileal Interposition (Diabetic Surgery)

Mob : +919447230370 (India) ; 00971567581025 (UAE)
Email : drrpadmakumar@gmail.com
Websites:
www.drrpadmakumar.com
www.diabetescuresurgery.com
www.obesitysurgeonkerala.com
www.endoscopythyroid.com