Alzheimer’s Disease

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anigif_sub-buzz-22090-1465935906-25Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.

Symptoms

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.

Just like the rest of our bodies, our brains change as we age . Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information because Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

imagesPeople with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible. At International Modern Hospital, we offer specialised care for such patients under the guidance of our psychiatrist, Dr. Shaju George

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Alzheimer’s is not the only cause of memory loss.

Many people have trouble with memory — this does NOT mean they have Alzheimer’s. There are many different causes of memory loss. If you or a loved one is experiencing symptoms of dementia, it is best to visit a doctor so the cause can be determined.

The role of plaques and tangles

 Plaques and tangles tend to spread through the cortex as Alzheimer’s progresses.

Two abnormal structures called plaques and tangles are prime suspects in damaging and killing nerve cells.

healthyvsadPlaques are deposits of a protein fragment called beta-amyloid (BAY-tuh AM-uh-loyd) that build up in the spaces between nerve cells.

Tangles are twisted fibers of another protein called tau (rhymes with “wow”) that build up inside cells.

Though most people develop some plaques and tangles as they age, those with Alzheimer’s tend to develop far more. They also tend to develop them in a predictable pattern, beginning in areas important for memory before spreading to other regions.

Scientists do not know exactly what role plaques and tangles play in Alzheimer’s disease. Most experts believe they somehow play a critical role in blocking communication among nerve cells and disrupting processes that cells need to survive.

It’s the destruction and death of nerve cells that causes memory failure, personality changes, problems carrying out daily activities and other symptoms of Alzheimer’s disease.

 Diagnosis of Alzheimer’s Disease

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Doctors use several methods and tools to help determine whether a person who is having memory problems has “possible Alzheimer’s dementia” (dementia may be due to another cause) or “probable Alzheimer’s dementia” (no other cause for dementia can be found).

To diagnose Alzheimer’s, doctors may:

  • Ask the person and a family member or friend questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality
  • Conduct tests of memory, problem solving, attention, counting, and language
  • Carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
  • Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to rule out other possible causes for symptoms.

These tests may be repeated to give doctors information about how the person’s memory and other cognitive functions are changing over time.

Alzheimer’s disease can be definitely diagnosed only after death, by linking clinical measures with an examination of brain tissue in an autopsy.

Treatment of Alzheimer’s Disease

Alzheimer’s disease is complex, and it is unlikely that any one drug or other intervention can successfully treat it. Current approaches focus on helping people maintain mental function, manage behavioral symptoms, and slow or delay the symptoms of disease. Researchers hope to develop therapies targeting specific genetic, molecular, and cellular mechanisms so that the actual underlying cause of the disease can be stopped or prevented.blog-alz

CONNECT, COMMUNICATE, CARE – World Suicide Prevention Day

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14231876_1060620760658541_7316520330448059815_oThe World Health Organization estimates that over 800,000 people die by suicide each year – that’s one person every 40 seconds. Up to 25 times as many again make a suicide attempt. There are many, many more people who have been bereaved by suicide or have been close to someone who has tried to take his or her own life. ‘Connect, communicate, care’ is the theme of the 2016 World Suicide Prevention Day. These three words are at the heart of suicide prevention.

CONNECT

14317628_1060620923991858_7388485385653221106_nSocial connectedness reduces the risk of suicide, so being there for someone who has become disconnected can be a life-saving act. Connecting them with formal and informal supports may also help to prevent suicide. Individuals, organisations and communities all have a responsibility here.

COMMUNICATE

14317602_1060620803991870_7393260786696702560_nOpen communication is vital if we are to combat suicide. We need to discuss suicide as we would any other public health issue if we are to dispel myths about it and reduce the stigma surrounding it. Equipping people to communicate effectively with those who might be vulnerable to suicide is an important part of any suicide prevention strategy. Showing compassion and empathy, and listening in a non-judgemental way is very important.

CARE

14212830_1060620883991862_138179977086114850_nAll the connecting and communicating in the world will have no effect without care. We need to ensure that we are caring ourselves. We need to look out for others who may be struggling, and let them tell their story in their own way and at their own pace.

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Know the noise around you !!!

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You can lose some hearing after being exposed to loud noises for too long, for example by standing close to speakers at a nightclub. Or hearing can be damaged after a short burst of explosive noise, such as gunshots or fireworks.

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If you work or frequently spend time in a noisy place or listen to loud music a lot, you could be losing your hearing without even realising it.

The best way to avoid developing noise-induced hearing loss is to keep away from loud noise as much as you can.

Here’s a guide to some typical noise levels, measured in decibels (dB). The higher the number, the louder the noise. The Health and Safety Executive (HSE) says noise levels above 105dB can damage your hearing if endured for more than 15 minutes each week. But lower levels, such as between 80dB and 90dB can also cause permanent damage if you’re exposed to them for hours every day. Find out some of the common noise levels around you which you may come across daily

  • normal conversation: 60-65dB
  • a busy street: 75-85dB
  • lawn mower/heavy traffic: 85dB
  • forklift truck: 90dB
  • hand drill: 98dB
  • heavy lorry about seven metres away: 95-100dB
  • motorbikes: 100dB
  • cinema: some films regularly top 100dB during big action scenes
  • disco/nightclub/car horn: 110dB
  • MP3 player on loud: 112dB
  • chainsaw: 115-120dB
  • rock concert/ambulance siren: 120dB

Ways to Protect Your Ears and Hearing Health

  1. Use earplugs around loud noises – Clubs, concerts, lawnmowers, chainsaws, and any other noises that force you to shout so the person next to you can hear your voice all create dangerous levels of sound. Earplugs are convenient and easy to obtain. You can even have a pair custom fitted for your ears by your local hearing healthcare provider.
  2. Turn the volume down – According to the World Health Organization, 1.1 billion teenagers and young adults worldwide are at risk for noise-induced hearing loss from unsafe use of audio devices.If you like to enjoy music through headphones or earbuds, you can protect your ears by following the 60/60 rule. The suggestion is to listen with headphones at no more than 60% volume for no more than 60 minutes a day. Earbuds are especially dangerous, as they fit directly next to the eardrum. If possible, opt for over-the-ear headphones.Don’t forget that any loud music, not just music played through headphones, presents a risk for noise-induced hearing loss. If you’re hosting a social event, keep the music at a volume which won’t force people to shout in order to hold a conversation
  3. Give your ears time to recover – If you are exposed to loud noises for a prolonged period of time, like at a concert or a bar, your ears need time to recover. If you can, step outside for five minutes every so often in order to let them rest.
  4. Stop using cotton swabs in your ears – It’s common for people to use cotton swabs to clean wax out of their ear canal, but this is definitely not advisable. A little bit of wax in your ears is not only normal, but it’s also important. The ears are self-cleaning organs, and wax stops dust and other harmful particles from entering the canal. Plus, inserting anything inside your ear canals risks damaging sensitive organs like your ear drum.
  5. Take medications only as directed – Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin, ibuprofen and naproxen, can sometimes contribute to hearing loss. Discuss medications with your doctor if you’re concerned that they’ll impact your hearing ability and take them only as directed.
  6. Keep your ears dry – Excess moisture can allow bacteria to enter and attack the ear canal. This can cause swimmer’s ear or other types of ear infections, which can be dangerous for your hearing ability. Be sure you gently towel-dry your ears after bathing or swimming. If you can feel water in the ear, tilt your head to the side and tug lightly on the ear lobe to coax the water out.
  7. Get regular checkups – Ask your primary care physician to incorporate hearing screenings into your regular checkups. Because hearing loss develops gradually, it’s also recommended that you have annual hearing consultations with a hearing healthcare professional. That way, you’ll be more likely to recognize signs of hearing loss and take action as soon as you do.

Taking action is important because untreated hearing loss, besides detracting from quality of life and the strength of relationships, has been linked to other health concerns like depression, dementia, and heart disease.

How to control Screen Addiction in your kid

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screen-time-and-games-heighten-aggression-and-decrease-social-skillsChildren are not immune to forces that have driven many adults toward healthy lifestyles and spa and wellness therapies. They too are living in an electronic-gadget-obsessed world, crouching over devices, as they’re fed information and images at incredible speed. Children spend more time than ever hunched over glowing screens.

  1. Talk with your child about his/her excessive computer usage.Find out if there are any specific reasons that he/she spends so much time on the computer – sometimes the computer functions as an escape from reality. If your child is facing problems that are causing a desire to “escape”, try to address those.
  2. Move the computer to an open area if it’s not already in one –it makes it easier to monitor their usage.
  3. Set a password for the computer so that only you can log on to it.Your child will have to ask to be logged on to the computer in order to use it. However, this is not recommended for older children in the house, who will need this for study etc.
  4. Set a time limit on the amount of time your child can spend on the computer each day.
  5. Replace the time that your child would normally spend on the computer with other activities – play board games with them, take them to the library, get them together with friends to play sports, etc.
  6. Be aware of what your child is doing on the computer.Check the Internet browser’s history to see what websites he/she’s visiting.

Make Sure Kids’ Eyes and Vision Are Perfect This School Year

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11325859 - eyeglasses over a blurry eye chart

With schools back in progress, parents may think they have crossed everything off on their checklist, but our eye specialist want to remind parents on their children’s eye health. Good vision and overall eye health are vital to learning and academic success. Because children are still growing, being vigilant about eye health is important. The earlier problems are identified; the sooner they can be addressed to the ophthalmologist. Dr.Tarek Makhlof, Ophthalmologist @ International Modern Hospital, recommends the following tips to for healthy eyes and vision:

  1. rubWatch for signals of eye problems– Parents should be alert to symptoms that could indicate an eye or vision problem, such as complaints of eyestrain, headaches and squinting when reading or performing other common activities like regular rubbing of the eye etc. Other symptoms to look for include a white or grayish-white coloring in the pupil, one eye that turns in or out, or eyes that do not track in sync together.
  2. Wear protective eyewear when playing sports– Eye injuries while playing sports can cause serious damage. Hence wear protective eye wears as a protective measure.
  3. Get regular childhood vision screenings 
    Children’s eyes change rapidly, making regular vision screenings an important step in detecting and correcting eye problems in early stages. eyetestFor school-age children, a vision screening, which is less comprehensive than a dilated eye examination by an ophthalmologist,

    can be performed by a pediatrician, family physician, nurse or trained technician during regular checkups. If the screening detects a problem, the child may need to see an ophthalmologist — an eye physician and surgeon.

  4. Know and share your family eye health history– Everyone should find out whether eye conditions or diseases run in their family. Parents should share that information with the person performing the screening when possible. Examples of common eye conditions include refractive errors (nearsightedness, farsightedness, astigmatism) crossed eye, known as strabismus, and lazy eye, known as amblyopia. If crossed eye and lazy eye are not treated in childhood, they can sometimes cause permanent vision loss in one or both eyes.
  5. kid-with-tablet_opt-100623783-primary.idgeBeware of television on hand held devices– It is now becoming more and more common for children to suffer from eye strain after staring at screens for hours and hours. This is sometimes known as computer vision syndrome. Watch out for dry, red and sore eyes. Sometimes, children may experience blurry vision and have problems with words moving on the screen because their eyes are not properly aligned. You can avoid eye problems setting in at an early age by making sure that sessions involving near screen work are limited to 30 minutes a time. Make sure that there are plenty of breaks and that outdoor activity is not neglected.

Weaning foods for children

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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

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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

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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.

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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.

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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”

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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.