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Suffering from Nasal Blockage & Congestion?

A new non-surgical treatment in the form of KOS therapy might be the answer for you

Allergic Rhinitis:

Symptoms of Rhinitis such as breathing difficulty, nasal congestion, nasal stuffiness, sneezing, post nasal discharge, and cough are common among patients.Allergic Rhinitis

This could be allergic rhinitis which is usually seasonal, and is associated with itchy nose, eye or throat. Patients can usually get relief with anti-allergic treatment such as with anti-histamines and with steroid nasal sprays.

Non-Allergic Rhinitis:

But there is another form of rhinitis (non-allergic rhinitis) which is not seasonal, is present round the year and where the symptoms of nasal congestion/nasal stuffiness do not get relieved with the aforementioned treatment. Patients with hormonal rhinitis (pregnancy associated rhinitis), rhinitis associated with hypothyroidism,rhinitis associated with changes of temperature (vasomotor rhinitis) or with rhinitis medicamentosa (patients addicted to nasal decongestants such as Otrivin) also face a similar dilemma.

There is a help available now in the form of KOS therapy for the aforementioned type of rhinitis (Non-allergic rhinitis).

KOS Therapy:

Kinetic Oscillation stimulation(KOS) is a new method to treat non-allergic rhinitis and primary nasal congestion and stuffiness.

The treatment is non-invasive, performed in an outpatient clinic, without anesthesia and is very patient friendly.

    • Benefits For the patient:

 

  • Patient friendly
  • Not surgically invasive and no anesthesia needed
  • No scars or bleeding
  • No pharmaceuticals
  • Fast acting relief, or within a few days for responding patients
  • A positive lasting effect of 4-10 months for responding patients
  • Typically repeated treatments have a stronger and longer lasting effect for responding patients

Principle of action of KOS therapy:

The KOS therapy stimulates the nasal mucosa and the autonomic nervous system(ANS), which may give the responding patients almost instant relief or within few days.KOS Therapy has been found to be effective for months following the treatment.

The treatment procedure:allergy treatment Dubai

The procedure is very simple.

An inflatable balloon at the end of the catheter is inserted into one nasal cavity at a time. Short kinetic oscillating stimulation in the form of vibrations is provided to each nostril which is intended to reset the balance of the nervous system and sensors, thus providing relief from nasal congestion and blockage.

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KOS Therapy has been newly introduced at the ENT department of International Modern Hospital; one of the few centers in Dubai offering the treatment.

The author, Dr. Rohit Gulati, is a Specialist Otolaryngologist and ENT Surgeon at International Modern Hospital with more than 13 years of experience in the field of Otorhinolaryngology.

Reconstructive Plastic Surgery

The incidence of Cancer both benign and malignant is on the rise worldwide. Cancer treatment especially for malignancy can damage or disfigure the body parts function and or appearance. Reconstructive Plastic Surgery helps to repair the damage and restore near normal appearance.

Plastic Surgery Dubai
Anti aging treatment and plastic surgery concept. Beautiful faces of young woman with arrows isolated on white

Unlike Cosmetic Surgery, most insurance companies cover Reconstructive Plastic surgery.

Reconstructive surgery is usually needed after a tumour is removed and there is a defect which needs to be covered. E.g. after Mastectomy ( surgical removal of breast) for cancer- the patient may choose to have the breast volume restored . Or after a jaw tumour when the onco-surgeon has removed one side of the jaw bone and cheek completely and there is a huge open defect.

Plastic Surgery In Dubai
Portrait collage of young, healthy and beautiful woman

Reconstructive Surgery can be performed immediately after removal of the tumour (Immediate reconstruction) or can be performed after completion of other cancer treatments like chemotherapy and radiation therapy (Delayed Reconstruction).

Reconstructive surgery can make use of several body parts solely or in combination to facilitate good reconstruction. Options of reconstruction may include use of only skin (skin graft) or flap surgery ( combination of skin, fat , muscle or bone).

With the advancement in Microsurgery and techniques, single stage reconstruction with good cosmesis is possible.  It works by taking tissue and blood vessels from one part of the patient’s body and placing it over the damaged part and joining the vessels under the operating microscope.

All options of reconstruction are to be discussed with the reconstructive plastic surgeon before surgery.

Reconstructive Surgery is no longer a social taboo, but a way forward to a better quality of life and better future.

How to help my toddler (between 3-4 years of age)?

What does (s) he understand?help my toddler

  • His or her complexity of understanding keeps extending. He / She now understands simple WHO? WHAT? And WHERE? Questions and hears you when you call from another room.
  • This is the crucial age where hearing difficulties may become evident. If you are in a doubt of his/her hearing, it’s wise to consult an audiologist.

how to help my toddlerWhat does (s) he speak?

  • (S)he talks about many things to you, what happened in preschools, what type of play they did, how is teacher to him/her, what are his/her friends, what funny, and new (s)he experiences, and also his imaginations.
  • His/her sentences are becoming longer and longer as (s) he combines four, five or more words. His /her speech is usually clear and fluent and easily understood by the strangers most of the time.
  • They become very loud and unstoppable.

How can I help my child?

  • Mix categories e.g. mix animals with picture of baby, cookies, ice cream. And make the child to sort them out and show what doesn’t belong to the category. Tell him/her that he is correct baby doesn’t belong to cat, dog, category because baby is not an animal.
  • Draw, glue a car without wheels, favorite cartoon with a mistake, glue a dog in driving seat and talk about how silly the pictures and encourage him/her to talk about what is missing, and what is correct.
  • Act out typical scenarios with the child like going to doctor with the pet, teacher and student, acting like the mother at home, cooking food, making baby dress up, superman. Allow her/him to guide you in acting. Be the student and let your child teach a lesson. Ask the child questions; make him repeat if you have not understood completely.
  • Expand the child’s vocabulary by acting, storytelling, singing, filling the blanks. Talk about new games, new ideas you and your child can do and have fun.How can I help my child?
  • Find out a simple and interesting story book read line by line, ask simple WH questions (what, Where, Who, Why).Talk about favorite part in the story, in the cartoon. This is the best time to talk about favorite things with the child talk about his/her favorite game, food, rhymes and tell him/her also your choices.
  • Bring your family album to the bed. Talk about the photo and ask the child can you remember this photo. Help him to explain what happened.
  • Do silly mistakes in game, apologize for your mistakes, and ask his/her help to play correctly.

Leave interesting books and materials lying around for your child to explore.

Attention Deficit Hyperactivity Disorder

Attention deficit / hyperactivity disorder (ADHD) is a highly prevalent condition in children that has generated considerable public interest and debate. It is a chronic, pervasive childhood disorder characterized by developmentally inappropriate activity level, low frustration tolerance, impulsivity, poor organization of behavior, distractibility, and inability to sustain attention and concentration (American Psychiatric Association, 2000)which occurs in 3% to 7% of school-age children (Egger et al., 2000).

Boys are at least four times as likely as girls to develop the disorder (4:1); indeed some studies have found that boys with ADHD outnumber girls with the condition by nine to one (9:1), possibly because boys are genetically more prone to disorders of the nervous system. In children between ages 5 and 15 years it was found that 3.62% of boys and 0.85% of girls have ADHD (Ford et al., 2003). In adults 3.4 % (1.2 to 7.3 %) are presented with ADHD, in individuals aged 18 – 44 years in low-income countries (1.9%) and in high-income countries (4.2%). (Fayyad et al., 2007; Barkley R et al., 2006). 0.6 –1.2% of adults retains the childhood diagnosis ADHD by the age of 25 years.

The causes of attention deficit hyperactivity disorder still remain unknown. It is transmitted in families and most likely is due to the influence of multimodal factors, e.g., the result of a complex set of factors including genetic inheritance, environmental factors, function in several brain regions and level of neurotransmitter activity. It is believed that mutations in several genes that are normally very active in the prefrontal cortex and basal ganglia, tends to play role in the genesis of ADHD. The right prefrontal cortex, vermis region of the cerebellum, caudate nucleus, and the globus pallidus are significantly smaller in children with ADHD than the normal children. Parents of children with ADHD are often noted to be experiencing mental difficulties, high levels of stress, and conflict- laden parent – child interactions. Non-genetic factors that are known to be linked to ADHD include premature birth, maternal alcohol and tobacco use, complications during pregnancy or birth and illnesses of early infancy, exposure to high levels of lead in early childhood, brain injuries that involve prefrontal cortex, overstimulation hypothesis, and metabolic dysfunction of the central nervous system.

The essential features of ADHD continue to include the triad of inattention, impulsivity, and hyperactivity. There are three subtypes: predominantly hyperactive –impulsive type, the predominantly inattentive type (PI), and the combined type. The DSM IV criteria indicate that symptoms must be present for at least 6 months, with onset before age 7. Attention span and sitting tolerance increases with the age of child. Inattention appears to be more evident in girls. The symptoms of the disorder can cause problems in learning; socialization and behavior for those individuals afflicted with it and put them at high risk for serious psychopathology in adulthood. There is growing literature on the ADHD- PI subtype with even later age of onset. These children have lower comorbidity with disruptive disorders, and higher levels of substance abuse, anxiety and mood disorders.

There are developmental differences in the presentation of symptoms. Given below are some of them:

Preschoolers:

  • Gross motor hyperactivity- running, climbing
  • Difficulty remaining quiet
  • Non-compliant
  • 3-5 years onset – 50% of them continue to have ADHD

 

School age:

  • Difficulty focusing
  • Losing things
  • Forgetfulness
  • Poor Organizing
  • Adolescents
  • Incomplete assignments and projects
  • Academic under-performance
  • Conflicts with peers, teachers and parents
  • Poor planning, organizing skills

Management involves two phases: Assessment and Treatment

Assessments are usually multimodal: Interview: Parent and Child, Observation, School workbook, Individual testing: cognitive functions, Rating Scale- Parent, Teacher, Self-report (e.g., Conners rating scale; Vanderbilt scale)
Treatment: Psychological and pharmacological Intervention of child ADHD

Evidence based treatments for ADHD include behavioral interventions such as parent behavior management training, contingency management, and cognitive- behavior therapies, administered individually or in group settings, or pharmacologic treatment, with a variety of stimulant formulations and the non-stimulant atomoxetine approved for this indication. For many patients, the optimal treatment is multimodal, meaning the combination of medication and psychosocial treatments addressing all the impaired areas of life.

Conclusion: Despite considerable progress over the past three decades, much is to be learned regarding the neurophysiological basis and genetics of ADHD. Psychological Assessment can serve to essentially validate the diagnosis of ADHD in children and Adults. There have been considerable advances in psychosocial, pharmacological and multimodal treatment of ADHD.

How to help my toddler (between 1-2 years of age)?

What does the toddler understand?

  • Her his receptive vocabulary is increasing day by day
  • The child points to pictures in a book when you name them, and also (s)he points to a few body parts when asked(nose, eyes, tummy, head).
  • She or He follows simple commands like push the chair, don’t touch, it’s hot, wash hands and understand simple questions (where is daddy, what is your frock, who is bunny).
  • Their interest shift from singing songs or say rhymes to simple story telling.
  • Your toddler now likes to listen to simple stories over songs.
  • This is the stage where you become exhausted with repeating the same story, game, rhymes many many times. But (s)he wants to listen the same again & again.

What does the toddler speak?

  • His/her expressive vocabulary keep increasing.,(s)he accumulating more and more words as each month passes.

  • (S)he can even combine 2 words and questions like mama ball, what is that, give me chocos, more chips, all gone, doggie ,daddy poo(car).

How to help my toddler?

Talk to the child while doing household things, going out or performing any activity. For an example Baby is going to bathe, run the tap. Water is coming ( put toys in the tub)Duckie is swimming, push push dickiee. Second example. I see a doggie, Doggie is running. It’s a big dog, Doggie says bow wow .Keep your language grammatically correct and easy to imitate. Talk about present activities what the child What does the toddler understand?sees around him/her. Use rhymes such as jonny jonny yes papa. Encourage the child to say hahahahaa/aaaaaa with you. Associate the object with sound e,g introduce the clock to the child, t-t-t-t-t clock, ding- dong- ding-dong .pi pi pi pi daddy car. Make him listen to the sounds of objects and create a sound associated with the object. mow mow mow mow cow. Use the sound like p-p-p-p-, m-m-m-m-, b-b-b-b-b, brooo-brooo, grrrr- ggrr while bathing, playing with toys, pampering him/her. These sounds will help him to learn better in preschool and kindergarten. Expand on words what the child says, for an example, if (s)he says car or sound likes car. Expand on words saying oh! yes it is a CAR, Biiig CAR, Big red CAR! Show the child big colorful picture book with large pictures. Name them, read aloud and talk about the picture. Wait your child to explore the picture, Ask him/her what is this and you answer. Make him/her point to picture Repeat the same several days. You would be surprised one day hearing(s)he names the picture.

Depression in children and adolescents: an overview

Depression – Let’s talk”, the World Health Day theme 2017 ring an alarm bell in our heart about the presence of this disorder amid our dear n’ near ones. Depression was once thought to be a disease of adults. It is no more considered rare among the children and adolescents, with an incidence of 2 – 4% and 4 – 8 % respectively. A youngster who appears withdrawn and lonely is most likely going through a period of “intense internal emotional turmoil”. They often feel sad and may consistently understand their plight as hopeless. They may frequently show poor concentration, lack of initiation; poor sleep and eating habits, negativity, get tired easily, feel guilty or worthless etc. Depression In ChildrenSubsequently, this often results in chronic depression, poor scholastic performance, psycho-social problems, substance abuse and even suicide. It’s equally prevalent in both sexes during pre-puberty stage whereas more in females with a ratio of 2:1 post-puberty. Mean duration of an episode of depression is 7 to 9 months. 70 to 80 % recover at the end of one year. Increased chance of recurrence is seen in children with early onset and those with the history of previous episodes, co-morbid psychotic symptoms, poor drug compliance, negative life events and positive family history in parents. 20 to 30 % of depressive children develop manic episodes (Bipolar Disorder) on follow up.
Majority of them may reach the general practitioner or the pediatrician with vague so called ‘functional symptoms’. A recent change in behavior with sad or irritable mood lasting for more than 2 weeks indicates a depression. Unfortunately, these disorders often go unrecognized by families and physicians alike. Early diagnosis and treatment of depressive disorders are critical to healthy emotional, social and behavioral development.
Clinical presentation varies according to the developmental stage of the child. They can be seen as given below:
Preschool child: apathetic, refuses food, unhappy and irritable, looks miserable, frequent crying spells, ‘failure to thrive’, insecure and unhappy child without any physical abnormality.
Middle childhood (Pre-adolescence): Apathy, verbal and motor retardation, and loss of appetite are the classic features of depression in this age group. Other features are: psychosomatic symptoms (e.g., head ache or pain abdomen); decline in academic performance with poor attention and concentration, irritability and social withdrawal, low self-esteem (I am not good enough compared to others), feeling bored and lack of interest in usual activities, sleep and appetite disturbances may be present though less common.
Adolescence: Clinical features are more similar to those of adult depression. Feeling sad, apathetic, lack of energy; sleep and appetite disturbances are more common. Bodily preoccupation, worries over his/her appearance or minor health problems (e.g., acne); suicidal thoughts are relatively common.
Etiology: There are multiple factors which individually or in combination with other factors, could contribute to depression. Depression In Children and adolescentsFew predisposing factors/ vulnerability factors are: Genetic; biological factors (neurotransmitters -monoamine metabolism and endocrine abnormalities); and temperament (e.g. quiet children with regular habits and slow to adapt to new experiences). Chronic life adversities are also likely to contribute to develop depression – broken homes, parental alcoholism, abuse, rejection etc. Undesirable life events in previous 12 months are important e.g., an event at home, or school and experience of loss.
Some points to be considered by a parent or caregivers to alleviate emotional disturbances:

  • Use positive reinforcement while disciplining them; avoid overprotecting and over directing.
  • Don’t expect absolute compliance. Don’t use your child to fulfill your own unachieved goals.
  • Take the problem seriously. It will be important to them and give them a feel of being understood.
  • Encourage them to talk to other people (may be a trusted adult friend or grandparents) as well as to you.
  • Treatment strategies for Depression – right time; right way; right people

A proper assessment is needed to establish depression – understand the nature, extent and Depression in Children: Symptoms, Causes, Treatmentsdisability by obtaining the history from all available sources; to explore into the stressors in the school/home; to consider differential diagnosis – Physical conditions like hypothyroidism; psychosis; normal reactive feelings of sadness and unhappiness; look for co morbid condition.
Treatment can include a combination of pharmacological management and various psychotherapeutic approaches – Supportive counseling and ways to relieve stress; Cognitive behavior therapy; Interpersonal therapy.
To conclude, Depression is a treatable emotional/behavioral condition. What is needed is treatment by “right technique at right time by right people” (trained mental health professionals).

Minimally Invasive Therapy (Lasers) in Treatment of Anorectal Disorders

Anorectal disorders are a group of medical disorders that occur at the junction of the anal canal and rectum. These disorders are very common in the UAE population due to the local climatic changes and lifestyle choices. Almost 50% of  all people experience this problem at least once in their lives by the age of 50. 75% of these disorders will worsen and progress if not treated at the right time.

The 4 most common problems encountered by people are hemorrhoids,anal fistula,anal fissure and pilonidal sinus.Almost 50% or more of patients seen by a Surgeon in his daily practice constitute these problems.Most of these disorders occur due to wrong diet ( lack of fibre and fluids), wrong lifestyle( less physical activity),constipation,laxative misuse, weak connective tissues and other causes. Of these, hemorrhoids are the most common and constitute around 60 to 65% of cases.

People who suffer from these problems present with bleeding while passing stools,painful stools,discharge,itching,swelling and at times fever.

Minimally Invasive Therapy (Lasers)It is important for these people to see a Surgeon at the earliest to enable an accurate diagnosis and initiate early treatment to prevent further complications. Over the counter medications  and creams are of limited use as almost all of these conditions present with more or less the same complaints, however the treatment is completely different for each one of them.

A proper history,physical examination by a Surgeon and relevant lab and other radiological tests may be required for a proper diagnosis and treatment of these conditions.

Till now, only traditional methods of surgery were available to treat these conditions causing a lot of pain, bleeding,large wounds and prolonged healing times for the patient. This prevented a lot of patients from seeking medical advice and undergoing treatment at the right stage.

However, with new developments in the field of surgery and  rapid advances in technology, new minimally invasive modalities are now available for treating these conditions. Of these, Lasers offer the most effective, safe and reliable method for treatment.Lasers have a tremendous benefit over an open operation in that they are painless, almost bloodless, have a short operative time of 15 to 20 minutes, cause no anal narrowing or loss of stool control,have no muscle or skin damage, no need for insertion of stitches or other foreign bodies and subsequently have much faster healing time. Patients can return to their normal work and activities in 4 to 5 days time.

Treatment Of Anorectal DisordersThese however, need to be performed by experienced Surgeons who have undergone extensive training in this specialty and have the know how and technical expertise.

Patients who suffer from these disorders should take full advantage of this new option available  to them with the host of benefits it offers. So, my advice to those with these problems is “ Act now ,don’t suffer in silence!”

Alzheimer’s Disease

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

 alzprogress

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

Varicose Vein

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

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.

Anorexia

 

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.

Preventing Dry, Irritated Winter Skin

Hydrate: 

Low humidity paired with artificial heating is the perfect recipe for parched skin. Protecting your skin should start with adequate water intake, so keep your bottle with you and stay hydrated during the day, even if you aren’t sweating. In addition, you can use a hydrating mist or toner on skin before applying a moisturizer. If you’re feeling extra dry, this step can go a long way to soothing irritation and helping your moisturizer do its work.

freshed face beauty

Moisturize:

Your skin’s protective layer can be damaged during winter, which prevents it from maintaining a normal amount of oil and protecting itself from water loss. Pair hydration with a good-quality natural moisturizer for both your face and body. For face, look for a serum, which offers the most concentrated source of protective oils. Don’t worry, serums won’t make your skin oily!. When paired with a hydrator like the Hydrating Accelerator, you’ve got a wrinkle-fighting, skin-plumping, winter-protective duo to keep your skin glowing throughout the season. For body, look for a balm or body oil that is rich in essential fatty acids and antioxidants. With a high concentration of camellia seed oil, this organic body serum absorbs deeply and helps restore skin’s moisture balance.

Be Gentle:

Are you combating acne and oily skin with harsh soaps? Are you using scented shower gel to wash your face? If so, now’s the time to nix cleansing products with alcohol, fragrance, preservatives, and dyes. For many, these kinds of products can exacerbate underlying skin problems, especially in winter. Instead, try a soap-free cleanser, a gentle soap-based cleanser, or an oil cleanser. By protecting your skin from harsh detergents, it will maintain its balance and be better able to protect itself from water-sucking conditions. Making the switch early on means less irritation and less reparative work on your end.

Treat: 

You can’t moisturize dead skin. If you’re looking flaky or lackluster, on a weekly basis use a gentle buffing exfoliant or antioxidant mask to gently reveal soft, glowing skin. Make sure to follow up with a hydrator and moisturizer! Also, be sure to keep a treatment balm for hands and lips with you at all times. Travel-size products are ideal for stashing in a purse, briefcase, or desk, and can be a simple skin-saving solution.

caucasian smiling woman applies moisturizer onto face

Nourish:

Oh, winter, how you toy with us. With sweaters and blankets keeping us cozy, cookies and cocoa add to our winter warmth, but they also contribute to dull skin, breakouts, and more generally, a sluggish demeanor punctuated by thoughts of regret. No one wants that, so indulge responsibly and try noshing on natural and whole-food snacks that are packed with vitamins, minerals, and healthy fats. Staying hydrated and nourished will help your skin from the inside out.

Winter Lipcare

Having healthy lips in winter, maybe a dream come true for many. The skin on your lips is very thin and has no oil glands to prevent it from chapping. So it is completely your potential to keep them healthy. Even the most expensive lipstick will not cure the dryness of your lips. Protecting your lips from dryness is not just important for appearance, but also for health. You may end up with bacterial infections, cold sores and other problems if they are chappy. They will also effect your smile and damage your self esteem..

Lip-balm-dries-lips-winter

Causes For Chapped Lips:
There are different reasons for chapped lips, but here are a few that are extremely common:
1. Weather change – heat or cold
2. Aging plays a very important role in causing dry lips
3. Biting your lips will result in bleeding and cracked lips
4. Licking your lips is the worst habit!
5. Touching lips with fingers will transfer the bacteria on your hands to your lips and cause infections ( also aggravate chapped lips)
6. Dehydration
7. Usage of excessive chemicals (Lipsticks)
8. Any form of alcohol can provoke skin irritation
9. Any product with chemical preservatives
10. Leaving the lipstick on, while going to sleep
11. Using lip balms with alcohol, retinol and menthol
Women who like to chew on their lips wearing lipstick, will consume about 4 to 9 pounds of lipstick in their life time! All these may seem common but they affect your health, severely. They make the skin on the lips dry, rough and sensitive.

Protecting Your Lips:
For a long lasting moisture on the lips, you need to treat them from outside as well as from the inside. It is extremely important to consume plenty of water everyday. This will keep your lips moisturized from within, as it nourishes and protects the skin. If your diet has low levels of vitamin B, you are more prone to chapped lips. Including red meat, fortified cereals, skim milk, Swiss cheese, eggs and silken tofu to your diet will bring about a great change in your lips. The most important points to protect your lips are:
1. Quit smoking! It will completely spoil your lips and it may become too late to regain the color and texture of your lips.
2. Always keep your lips moisturized by applying a natural lip balm.
3. Apply lip balm before going to bed.
4. Licking your lips is a bad habit. Yes, it may look like it is keeping your skin moisturized for a moment, but it worsens the situation! The wind will dry your lips in a minute and you have to keep licking them. This process is unending and will become a major condition, by spreading away from the lips. So it is better to keep them moisturized with a lip balm.
5. For the winter season, you need to choose lip balms with extra moisturizing agents. The lip balms you choose should have a long lasting effect. They will keep your lips moisturized for a longer period of time. It is an added advantage if the lip balm contains SPF in it. The lip balms which contain the following are the best for your lips.

 Shea Butter: Shea butter acts as a natural sun block and it has allantoin, which is a healing agent. This is the best ingredient to have in a lip balm. It gives a soothing effect to the lips.
 Aloe Vera: As we all know, Aloe Vera consists of anti-inflammatory and anti-bacterial agents which protect the skin from any kind of infections. Aloe Vera is also very soothing and moisturizing, when applied on the lips.
 Glycerin: Glycerin is a natural skin softer and it holds agents that bind moisture and skin together.
 Jojoba Oil: It is one of the best nourishing oils for the skin. It softens and lubricates the skin, when it is applied.
 Vitamin E: It is a powerful antioxidant and moisturizing agent. It protects the lips from the sun.
 Coconut oil: Coconut oil relieves dry and itchy skin. It also softens and moisturizes the lips.
 Beeswax: It is a non allergic skin softener, that moisturizes and nourishes the skin. It consists of anti-inflammatory and anti-bacterial agents that guard and protect the skin.
 Vitamin A and D: These are pro-active vitamin complexes that are skin friendly. They contain fatty acids that are easily absorbed into the skin. They help to soothe and heal the skin effectively.

6. If you are in a habit of using lipstick everyday, choose the ones with moisturizing ingredients. It is better to avoid lipstick, especially in winter. Instead, you can use a moisturizing lip balm, with a tint of lip color.
Home Remedies To Treat Chapped Lips:
The golden secrets of gaining fresh, soft and luscious lips are by using home remedies. They are cheap, surely available and accessible at any time. If you use these secret tips, your lips will look moisturized and healthy, even without using lipsticks or lip balms. So try these simple remedies to cure your lips and enjoy an ever lasting moisture.
Honey:
Using honey to moisturize your lips is the best. You need to apply this in the night, before going to bed. It is the best way to clean your lips. It will also cure dark lips, caused due to sun exposure.
Ghee:
Ghee has the same effect on the lips as honey. You need to apply a few drops of ghee on your lips, before going to sleep. It will give you smooth and soft lips, within no time.
Green Tea Bags:
The oldest home remedy followed by many is green tea bags. Press one used green tea bag, against your lips for at least 4 minutes. You need to do this everyday to increase the moisture of your lips. This is the best natural remedy used to cure chapped lips.
Lemon Juice:
This remedy will help to prevent aging of the skin. It nourishes the sensitive skin on your lips, leaving them smoother and softer than before. Take a small bowl and mix one teaspoon of cream (milk) with 3 drops of lemon juice. Place the bowl in the fridge for an hour. Remove the mixture and apply it on and around the lips, before going to sleep. If you repeat this procedure for three days, you will notice best results. You can also continue it everyday to prevent the lips from aging.
Rose Water and Glycerin:
Rose water and glycerin is a great combination. It provides glowing and amazing skin, with regular use. You need to take a tablespoon of glycerin and rose water. The measurement may vary according to the need of each person. You need to take equal quantities of both the ingredients. Mix it together and apply this mixture to your lips, as well as your whole face, before going to sleep. You will see mind blowing results in 5 days time!
Glycerin and Honey:
Honey and glycerin will help to prevent wrinkles and dry skin. You need to take a teaspoon of honey and add very few drops of glycerin to it. Apply this mixture on the lips and leave it on for 15 minutes. Wash it off with normal water. Apply a few drops of glycerin again and leave it over night. This tip is extremely useful and prevents the lips from wrinkling.
Jojoba Oil:
This remedy gives a natural instant relief from severely chapped lips. All you need to do is take a few drops of jojoba oil and apply it on the affected area. You need to leave it on for about 15 minutes. Jojoba oil helps in a speedy recovery of your lips. It will get the moisture back into your lips, by nurturing the skin cells in the lips. It helps in building new skin cells which will repair the skin immediately.
Cucumber:
Cucumber is a vegetable with all the goodness in the world. You need to take a peeled cucumber and crush it. Extract the juice and apply this onto your lips. Leave it on for 20 minutes and wash off with normal water. You will see a major difference if you use this remedy regularly.
Sugar Scrub:
You can exfoliate your lips by using a good scrub. Even a small brush will do to remove the dead cells on your lips. But the best scrub for lips is sugar. It is easily accessible from your kitchen. You can take 1/2 teaspoon of sugar and add 2 drops of olive oil to it. Scrub your lips gently with this mixture. After 3 to 5 minutes of scrubbing, you can wash it off with normal water. Apply a good lip balm after wiping your lips with a cloth. This remedy will make you lips shiny and softer than before.

Kidney Disease and Heart Health

CHRONIC KIDNEY DISEASE (CKD) is a worldwide public health problem, both for the number of patients and cost of treatment involved. Diabetes is the leading cause of kidney disease accounting for 30 per cent of these patients. Other causes of kidney disease are chronic glomerulonephritis (19.3 per cent), hypertension (14 per cent), chronic interstitial disease and vesico-ureteral reflux (12.6 per cent), obstruction and stone (9.3 per cent), cystic disease and other hereditary diseases (8.4 per cent), undiagnosed (6.2 per cent). Incidence of CKD has doubled in the past 15 years and is rapidly rising. One reason is the rapidly increasing worldwide incidence of diabetes and hypertension. Approximately 30 per cent of patients with diabetes mellitus develop diabetic kidney disease.

tumblr_ns8e3gmdCA1rklae9o1_500

Cardio V ascular Diseases – BURDEN

Many people with CKD would be surprised to learn that the biggest health risk they face is heart disease.But, it’s true! CKD patients have extremely high risk of developing CARDIO VASCULAR DISEASE (CVD, angina, heart attack, heart failure, sudden cardiac death, stroke/paralysis and peripheral vascular diseases) compared with the general population, so much so that in the early stages of CKD patients are more likely to develop CVD and die of CVD than they are to progress to ESRD (stage of advanced kidney disease requiring dialysis or renal transplant). This risk is more apparent in younger patients e.g. a 35 year old man on dialysis has the same risk of a cardiovascular death as an 80 year old not on dialysis. In addition CKD patients have a worse outcome with higher mortality after acute myocardial infarction (MI) and have a higher risk of recurrent MI, heart failure and sudden cardiac death.

RISK FACTORS

Much of the problems come from the fact that people with kidney disease often have many risk factors for CVD. Most CKD patients have a combination of ‘traditional’ and ‘kidney-specific’ risk factors.

TRADITIONAL RISK FACTORS

Some risk factors have been linked with a higher risk of CVD in the general population. These ‘traditional ‘risk factors include:

• Smoking

• High blood pressure

• Obesity

• High cholesterol

• Poorly controlled diabetes

• Family history of heart disease

• Male gender

There is increased prevalence of many traditional factors for cardiovascular risk in CKD (age, male gender, hypertension, diabetes, dyslipidemia and physical inactivity).

KIDNEY-SPECIFIC RISK FACTORS

Additional CVD risk factors are the direct result of kidney disease itself. Kidney-specific risk factors include:

• Anaemia

• Inflammation

• Reduced glomerular filtration rate

• Urine protein including albumin

• Abnormal calcium and phosphorus metabolism

• Fluid overload

cardiac

REDUCING CARDIAC RISKS

A comprehensive approach, rather than isolating treatment to a specific indication is required to lower cardiovascular risk. CKD patients with diabetes should achieve a good control of blood sugar levels by testing blood sugar frequently, taking medicines regularly and on time, and following prescribed meal plan. Drug treatment for hyperlipidemia (increased cholesterol), secondary hyperparathyroidism (calcium and phosphorus metabolism) and anaemia is recommended to decreases the CVD mortality. Folic acid and vitamin B supplements in selected group of patients helps in correcting anaemia and also may decrease CVD risk. An important aspect of strategy to decrease CVD risk in renal disease patients is lifestyle modification. A healthy lifestyle should be maintained by all CKD patients, including dialysis

Prepare your kids for exams!!!

Exams are important milestones in your children’s education. Younger children need much more assistance than older children in preparing for exams. The guidance that you provide in the early stages will enable your children to study with discipline and dedication later on, on their own. If your children are still in kindergarten or primary classes, you will need to invest much more time. However, with older children, you may face problems of a different kind—disobedience and rebellion, which require greater tact.

Prepare your kids for exams Prepare kids for exams

• Never let your children postpone studying until a day before the exams. This will only increase their anxiety and stress levels. Preparation is the key to success. Don’t listen to any excuses and don’t be swayed by assurances. The best course is to have your children study for some time everyday. Even if this is not possible, ensure that they begin preparing for the exams at least two to three weeks in advance.

• Do not impose yourself on your children. Some children require more support while others are happier studying on their own. This depends on your children’s nature. However, let them know that you’re always there to help them.

• It is not enough to read up matter. Your children should be able to recall the same in the examination hall. Hold question and answer sessions where you ask them random questions on the subject once they have finished studying.

• Prepare a timetable for each child. You can cover subjects in the order of the examination schedule or you can tackle difficult subjects first. For younger children, two to three hours of study a day should suffice. Children in the secondary and higher secondary classes should study for four or five hours a day when the exams are due. Alternate languages and practical subjects like mathematics to minimise boredom.

• Especially for older children, access to question papers from previous years is a must. These may be available in the school library, with teachers or you can secure them from the senior students. Have them solve at least one or two papers in each subject, within the given time limit. This is like a rehearsal and helps in mitigating exam nerves. It will also give your child an idea of how much time to allot for each question.

• Don’t allow your children to stay up or wake up too early. Make sure that they get at least eight hours of sleep. Inadequate sleep affects the brain’s functioning and will reduce your children’s retention. Discourage use of caffeine or other stimulants to remain awake.

• Children these days suffer from as much stress as adults. Do not pressurise your child ever. Do not entertain negativity and empower them with confidence if they start moaning about previous performances.

• Create a study-ritual for your children. Encourage them to use the same place to study everyday, preferably somewhere quiet and pleasant. The outdoors is a great option as well. Let them be silent and make a resolve to study well before beginning the session. End every session with a revision of what has been covered. Set small goals–one or two chapters or even topics. If they are studying for long durations, schedule breaks every one or two hours. Let them do what they like such as go for a walk, meditate or solve a puzzle.

• Older children may benefit from group study, especially for subjects that they find difficult. It is preferable if your child can go to his friends’ houses rather than having them over. This way, he can leave if the session is proving to be a waste of time.

• On the D-Day, wake your children up well in time and serve them a light breakfast. Set aside time for a disciplined revision. Teach them relaxation exercises. Ensure that they have their pens and pencils, examination pad and other necessary items before leaving the house. Wish them luck and hope for the best!

Don’t Procrastinate with Pelvic Pain

If you have recurring pain in your pelvis or bladder, you probably don’t think “interstitial cystitis.” It’s a long name for a condition that can be difficult to diagnose because it can have multiple, interrelated causes.

Interstitial cystitis, or “IC,” is a chronic health issue in which patients feel pain or pressure in the bladder area. An estimated 4 million people in the U.S. suffer from IC, approximately 80 percent of them female.

Pelvic Pain Women

Several different conditions – or combinations of conditions – can cause IC. That’s why it’s important to consult with your physician if you’re experiencing pelvic pain. A proper diagnosis may require time and you don’t want to suffer any longer than necessary.

To further complicate the diagnosis, symptoms range from mild to severe and vary from person to person. Any of the following could indicate IC:

  • Pain ranging from ‘nagging’ to ‘intense’ in the bladder and surrounding pelvic region
  • A sense of urgency and/or increased frequency of urination
  • Pain that worsens during menstruation
  • Painful sexual intercourse for women
  • Pain or discomfort in the scrotum or penis
Pelvic Pain Man

For many, IC feels like a bladder infection, though antibiotics make no impact because there’s no infection to treat. The exact cause of pain with IC is actually not clear, but several theories exist. These range from an allergic response to autoimmune reaction to an excessive inflammatory response to even the slightest stimulus which would not generally be perceived as painful in a patient who does not have IC.

IC can frustrate patients because besides a challenging diagnosis, not everyone responds the same way to the same treatment. In addition, IC treatments can take several weeks to several months to provide relief.

If you suffer from pelvic pain, begin with an open discussion with your physician. Whether or not you are diagnosed with IC, you can start to work toward solutions to your condition. Treatment options, such as pharmaceuticals, nerve stimulations or surgery can be evaluated and your doctor can help you decide on the appropriate approach for you.

Hysteroscopy

What is hysteroscopy?

Hysteroscopy is a procedure that allows a doctor to look inside the uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope – a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus.

hysteroscope

Why is hysteroscopy done?

One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less often or more often than normal. Bleeding between menstrual periods also is abnormal. Hysteroscopy may be either diagnostic or operative.

What is diagnostic hysteroscopy?

Diagnostic hysteroscopy is used to diagnose problems of the uterus such as abnormal uterine bleeding, infertility, repeated miscarriages, adhesions, fibroids, polyps, or to locate displaced intrauterine devices (IUDs). It may also be used to confirm the results of other tests such as hysterosalpingography (HSG). Other instruments or techniques, such as dilation and curettage (D&C) and laparoscopy, are sometimes used in conjunction with the hysteroscopy.

What is operative hysteroscopy?

Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy, avoiding the need for a second surgery. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope.

When is operative hysteroscopy used?

 Hysteroscopy may be performed to correct the following uterine conditions:

  • Polyps and fibroids – Hysteroscopy is used to remove these non-cancerous growths found in the uterus.
  • Adhesions – also known as Asherman’s Syndrome, uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow as well as infertility. Hysteroscopy can help locate and remove the adhesions.
  • Septums ­ – Hysteroscopy can help determine whether you have a uterine septum, a malformation of the uterus that is present from birth.
  • Infertility – tubal blockage at uterine end can be opened through hysteroscopy by cornual cannulation
  • Abnormal bleeding – Hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, as well as bleeding between periods.
  • Postmenopausal bleeding – Hysteroscopy is also performed to determine the cause of unexplained bleeding or spotting in postmenopausal women
  • Removal of foreign body or a missing IUCD

What are the benefits of hysteroscopy?

Compared with other, more invasive procedures, hysteroscopy may provide the following advantages:

  • Shorter hospital stay
  • Shorter recovery time
  • Less pain medication needed after surgery
  • Avoidance of hysterectomy
  • Possible avoidance of “open” abdominal surgery

How safe is hysteroscopy?

Hysteroscopy is a relatively safe procedure. However, as with any type of surgery, complications are possible. With hysteroscopy, complications occur in less than 1 percent of cases and can include:

  • Risks associated with anesthesia
  • Infection
  • Heavy bleeding
  • Injury to the cervix, uterus, adjacent organs
  • Intrauterine scarring

When should the procedure be performed?

It may be recommended to schedule the hysteroscopy for the first week after your menstrual period. This timing will provide the doctor with the best view of the inside of the uterus.

What type of anesthesia is used for hysteroscopy?

Anesthesia for hysteroscopy may be local, regional, or general:

How is hysteroscopy performed?

Prior to the procedure, one may be prescribed a medication to help you relax. You will then be prepared for anesthesia. The hysteroscope is inserted through vagina and cervix into the uterus. Saline is then inserted into the uterus, through the hysteroscope, to expand it and to clear away any blood or mucus. A light shone through the hysteroscope allows the doctor to see inside the uterus and the openings of the fallopian tubes into the uterine cavity. Finally, if surgery needs to be performed, small instruments are inserted into the uterus through the hysteroscope.

The time it takes to perform hysteroscopy can range from less than 5 minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is planned at the same time.

How will I be prepared for hysteroscopy?

If you are having general anesthesia in the hospital, you will be told not to eat or drink anything for a certain period of time (usually after midnight the night before) before the procedure. Routine lab tests may be ordered as well for women having a hysteroscopy in the hospital. You will be asked to empty your bladder and your vaginal area will be cleansed with an antiseptic

What can I expect after the procedure?

If regional or general anesthesia is used during your procedure, you may have to be observed for several hours before going home. After the procedure, you may have some cramping or slight vaginal bleeding for one to two days. However, if you experience any of the following symptoms, be sure to contact your doctor:

  • Fever
  • Severe abdominal pain
  • Heavy vaginal bleeding or discharge

Will I have to stay in the hospital overnight?

Hysteroscopy is considered minor surgery and usually does not require an overnight stay in the hospital. However, in certain circumstances, such as if your doctor is concerned about your reaction to anesthesia an overnight stay may be required.

Who is a candidate for this procedure?

Although there are many benefits associated with hysteroscopy, it may not be appropriate for some patients. A doctor who specializes in this procedure will consult with your primary care physician to determine whether it is appropriate for you.

Limb Lengthening

How Does It Work?

The limb lengthening process works by gradually growing new bone and soft tissues (skin, muscle, nerves, blood vessels, etc). This new growth is called tissue regeneration.

Bone and soft tissue regenerate when they are distracted (pulled apart) at a very slow rate of approximately 1 mm per day. If the rate of distraction is faster than this, bone may fail to form between the two ends of the bone that are being pulled apart. Then, soft tissues, such as muscle, may experience contracture (get too tight) or nerves may become paralyzed. If the rate of distraction is too slow, premature consolidation may occur (the bone may consolidate too soon), preventing the lengthening device from further pulling it apart.

There are many different lengthening devices used. The most common are external fixators, which are devices that attach to the bone by means of thin wires or thicker pins that have a screw threading at their attachment to the bone. There are also lengthening devices that are fully implanted inside the bone. These devices do not require external pins. The different devices are described separately.

There are two phases of lengthening until the bone is fully healed: the distraction phase and the consolidation phase. The distraction phase is the lengthening phase. After the desired length is obtained, the newly regenerated bone is still very weak because of lack of calcium within it. The hardening and calcification of this new bone is called the consolidation phase.

METHODS OF LENGTHENING:-

A variety of orthopedic devices are used to distract the bone and soft tissues. The decision regarding which device to use is an individualized one dependent upon the desired correction.

There are two general types of devices: external fixators and internal fixators. The external devices attach to the bone from outside the body by means of wires and threaded pins. The internal devices are implanted inside the body and lie on the bone or inside the marrow cavity of the bone.

The best known and most versatile techniques are with monolateral (one-sided or straight bar) external fixators (e.g., Orthofix, EBI) and circular external fixators (e.g., Ilizarov, TSF). External fixators are applicable to almost all cases. To shorten the time in the external fixator, combinations of the external fixator method with an internal nail to perform the lengthening over nail (LON) technique. However, this method is not applicable to all cases.

A fully implantable self-lengthening nail (ISKD) is also used. It has an internal mechanism that performs the lengthening and thereby eliminates the need for an external fixator. This method is available for certain cases.

External Fixation Alone
When only an external fixator is used, the fixator needs to remain in place for both the distraction and consolidation phases. If the fixator were removed at the end of the distraction phase, the new bone would collapse and re shortens. Therefore the external fixator needs to remain in place until the regenerated bone appears solid enough on the radiographs (x-rays). At that point, the device can be removed. Often, a cast is applied to temporarily protect the bone from breakage for an additional short time.

The total time in the external fixator can be estimated to be approximately 1 month for each centimeter lengthened in children and 1.5 to 2 months or longer per centimeter in adults.

Lengthening over Nail
Lengthening over Nail or LON was developed in order to decrease the external fixator treatment time, eliminate the need for post-removal casting, and decrease the risk of breakage of the new bone.

With LON, a metal rod is inserted into the bone along with the external fixator. The rod fits in the marrow cavity of the center of the bone, and the external fixator is applied around the peripheral part of the bone so that the external fixator pins do not come in contact with the metal rod. The bone is lengthened as described above.

After lengthening is completed, the patient goes back to the operating room for the insertion of special screws that lock the rod to the bone. With screws at both ends of the rod on opposite sides of the lengthening zone, the external fixator is no longer needed, and is removed during the same operation.

Therefore, the total external fixation treatment time is much shorter, and is equal to the distraction phase. This usually reduces external fixator time to less than half.

Fully Implantable Lengthening Nails and Prostheses
The most recent development is that of a fully implantable devices that can lengthen the limb from within. There is no need for an external fixator. This has many advantages, including no risk of pin infection, no muscle tethering by the pins, less pain, and better comfort. Unfortunately, , this method is mostly limited to older children and adults. Therefore, many patients cannot be treated by this method.

Leg length discrepancy correction

limb1

Bow leg correction

limb2

 
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