Breastfeeding is one of the foundations of child health, development and survival. For these reasons, the World Health Organization (WHO) recommends that infants should exclusively breastfeed for the first six months; meaning no food or drink other than breast milk is offered to breastfeeding baby for up to 6 months. Baby is fed on self-demand, day and night with no restrictions on the length or frequency of breastfeeding. Complementary foods can then be introduced, with continued breastfeeding until 24 months of age or older.
Breastfeeding has been known to have several advantages that make it ideal—benefits of breastmilk span not only for children but also mothers.
Benefits of breastfeeding for children
Breastmilk provides all the energy and nutrients that the infant needs.
It is safe, clean and contains antibodies which help protect against many common childhood illnesses.
Breastfed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life.
Reduce the risk of allergies, rickets and Anaemia.
Readily available, with no preparation and suitable to child’s need.
Benefits of breastfeeding to mother
Promotes mother and child bonding.
It prevents uterine bleeding in the mother after delivery.
A natural form of Family Planning.
Reduces the risks of breast and ovarian cancer in the mother.
Saves time and precious expenses need not be used for buying milk powder and health care.
Due to all numerous benefits, breastfeeding counselling should give to all pregnant women in the early antenatal period.
Nevertheless, contraindication to breastfeeding does exist. Some of them include:
Infant with Inborn error of metabolism; galactosemia, phenylketonuria.
Mothers on certain medications; anticancer therapy, radioactive isotope etc.
However, the success of breastfeeding depends on proper breastfeeding technique; the key of that is adequate latching. While breastfeeding one must keep check of the mother’s position:
The mother can nurse sitting or lying down
The mother should be in a comfortable and relaxed positionable to hold the baby close to her without undue effort, her feet be supported
The technique of breastfeeding also entails the infant’s position to be in check:
The baby’s head and body must be perfectly lined up
The baby’s face must face the mother’s chest, with his nose in front of the nipple
The baby’s body must be close to the mother’s, turned towards her
If the baby is newly born, the mother must cradle him with one arm and give support to the buttocks, not just to the head and shoulders
Another vital characteristic to keep in check is the Infant attachment to the breast:
The mouth is wide open
The chin touches the breast (or close to)
The lower lip turns outwards
More areola is visible above the infant’ top lip
There are many positions that a mother can use to achieve all the criterion required for effective breastfeeding, as mentioned above. However, the best positions can be separated into five categories that are mentioned in the picture provided below.
Even though the techniques of breastfeeding are essential, a mother must make sure that effective breastfeeding is taking place to ensure the baby’s health and development. The signs mentioned below will allow the mother to conclude if the infant is appropriately nurtured.
Signs of Effective Breastfeeding
Frequent feedings 8-12 times daily.
Intermittent episodes of rhythmic sucking with audible swallows should be heard while the infant is nursing.
Infant should have about 6-8 wet diapers in 24 hours once breastfeeding is established.
Infant should have a minimum of 3-4 bowel movements every 24 hours.
Stools should be about one tablespoon or larger and should be soft and yellow after day 3.
Average daily weight gain of 15 -30g.
Infant has regained birth weight by day 10 of life.
Sometimes, a mother may encounter barriers to effective breastfeeding that are caused due to:
Lack of confidence in mother;
Belief that breast milk is not sufficient;
Lack of adequate support system;
History of previous breast surgery;
Breast engorgement, cracked and sore nipples;
Retractile nipples.
Another method of breastfeeding is through expressed breast milk.
Indications include:
Preterm / sick baby
Working mother
Storage of Expressed breast milk
Clean wide-mouthed container with a tight lid
At room temperature 8-10 hrs.
Refrigerator – 24 hours, Freezer – 20° C – for three months
In conclusion, breastfeeding infants is the best way to ensure their growth and health. With mothers ensuring that proper techniques are used for effective breastfeeding, it can be concluded to be the most effective tool in the child’s development. Mothers are encouraged to ask the help of their Obstetrician or Pediatricians to understand the best techniques for breastfeeding infants.
Breastfeeding is a mother’s gift to herself, her baby and the earth.
Gestational diabetes is a condition in which your blood sugar level becomes high during pregnancy, affecting up to 10% of pregnant women, diagnosed by a blood test done at 24 to 28 weeks of pregnancy. Women with gestational diabetes don’t have diabetes before their pregnancy – and it usually goes away after giving birth.
What causes gestational diabetes?
Hormones produced by the placenta cause a build-up of glucose in the blood. Usually, enough insulin is produced to control blood sugar levels. However, if the body is unable to produce insulin or stops using it, then the blood sugar levels rise, causing gestational diabetes.
Who’s at risk of gestational diabetes?
At your first antenatal appointment, a healthcare professional should check if you’re at risk of gestational diabetes.
The likelihood of getting gestational diabetes increases if you:
• were overweight before you got pregnant.
• have had gestational diabetes in the previous pregnancy.
• have had a large baby in earlier pregnancy (4.5kg/10lb or more)
• have a family history of diabetes – parent or sibling.
• come from a South Asian, Black or African Caribbean or Middle Eastern background.
• have high blood pressure .
• have given birth to a stillborn baby.
• are older than 30 years.
Having gestational diabetes increases your risk of developing it again in future pregnancies. It also increases your risk of developing Type 2 diabetes later in life. You can reduce the risk of developing gestational diabetes by managing your weight, eating healthily and keeping active before pregnancy.
Gestational diabetes symptoms.
Women with gestational diabetes don’t usually have symptoms. Most find out that have it during a routine screening.
You may notice that:
• You’re thirstier than usual
• You’re hungrier and eat more than usual
• You urinate more than usual
Gestational diabetes tests and diagnosis.
Gestational diabetes is diagnosed by routine screening, called Oral Glucose Tolerance Test, also known as an OGTT. The OGTT is done when you’re between 24-28 weeks pregnant. If you’ve had gestational diabetes before, you’ll be offered an OGTT as soon as possible, and another OGTT between 28-32 weeks if the first test result is normal.
How do you manage gestational diabetes?
The goal is to reduce blood glucose to the normal levels exhibited by a woman without gestational diabetes.
This involves:
• Measuring your blood sugar level four times a day
• Eating a healthy and balanced diet
• Performing moderate physical activity for about 150 minutes per week (Running, walking and swimming are good options)
• Reducing stress as much as possible.
These measures must be taken while continuing regular checkup with your doctor and adjusting them as needed. Changes in habits will sometimes not be enough; in such cases, metformin or insulin injections should be used during the pregnancy.
Target blood sugar levels in pregnancy:
• Before a meal: 95mg/dl or less
• An hour after a meal: 140mg/dl or less
• Two hours after a meal: 120mg/dl or less
Tips for eating well with gestational diabetes:
• Eat regular meals.
• There’s no need to ‘eat for two’. Portion size will have the most significant effect on your blood glucose level.
• Include carbohydrates but look for low GI (glycemic index) options and keep the consumption to the optimum level
• Get your five vegetables a day for vitamins, minerals and fibre.
• Cut back on salt, too much salt is associated with high blood pressure, which increases the risk of diabetes complications.
• Stick to water or sugar-free drinks.
What are the potential complications?
In the child:
• Macrosomia (above-average weight)
• Risk of being born with low blood sugar levels and respiratory problems
• Risk of obesity and type 2 diabetes later in life
In the mother:
• Risk of a difficult delivery, possibly by C-section, depending on the baby’s weight
• Surplus of amniotic fluid, which could trigger premature delivery
• Gestational hypertension & Preeclampsia
• Risk of developing type 2 diabetes later
• Risk of suffering from gestational diabetes again in a future pregnancy
Most of the complications can be prevented with appropriate treatment.
In conclusion, in the vast majority of cases, gestational diabetes is easy to control, with your blood sugar levels likely to normal in about six weeks after childbirth. However, the risk of developing gestational diabetes in the next pregnancy increases, with the women also likely to develop type 2 diabetes in the future. It would help if you got follow-up tests every year. Many problems can be avoided through healthy lifestyle habits. Don’t panic and talk to your doctor to see how you can put the odds in your favour.
PCOS (Polycystic Ovarian Syndrome) is the most common endocrine disorder among women between the ages of 18 and 44. It is a condition that affects almost 1 in 5 women and the incidence is rising. Exact cause is not known but there is genetic tendency and Life style changes are contributors for development of PCOS.
In PCOS, there is hormonal imbalance in woman’s sex hormones with increase in male hormone levels and insulin resistance in body. This leads to spectrum of symptoms in PCOS. Symptoms vary from person to person but common are Menstrual irregularities with tendency to delay menses ,missed periods or medicines to get periods ,Acne , Excessive hair growth on face ,body and hair loss on scalp ,Weight Gain and difficulty in losing weight .
PCOS also causes difficulty in conceiving and is the leading cause of anovulatory infertility. On ultrasound, there will be multiple small cysts seen in ovary like string of pearl. These cysts are actually immature follicles. In normal menstrual cycle, follicle develops and grows to form an egg which ovulates, but in PCOS follicular development is arrested at early stage due to disturbed ovarian function and they form multiple cysts How do we treat PCOS?
PCOS can be controlled mainly by Change in life style with opting for healthy food habits and regular exercise keeps normal BMI (Body mass index). Gynecologist can prescribe medicines to increase the insulin sensitivity or pills to regularize cycles.
If fertility is a concern then further treatment to form egg may be required.
PCOS not only affects appearance, fertility but has long term health risks associated with metabolic effects like developing Diabetes, High blood pressure, dyslipidemia, heart disease and also risk of endometrial hyperplasia and endometrial (womb) cancer. Regular health checkups are recommended to control PCOS and its long term effects.
The sun is meant to be enjoyed – To lounge in, to play in, to bask in. But, you have to know the basics to make your time in the sun safer.
UVA and UVB rays from the sun can be damaging to the skin. If the proper sunscreen protection isn’t worn during sun exposure, this leads to aging, can cause unsightly skin damage and even skin cancers. While UVA rays go deeper into the skin causing damage to collagen leading to aging, wrinkles, and even skin cancers, UVB impacts superficially causing sunburn and skin cancers as well.
Sunscreens have ingredients that help in absorbing or scattering UV rays. These products are formulated to provide various levels of protection from UVA, UVB and Infrared radiation. The Sun Protection Factor (SPF) indicates how much longer an individual can be in the sun before being sunburnt when using a sun protection product than if he/she was not using it. It measures the protection only against UVB rays and not UVA. For instance, a fair skinned person who would normally start to feel the effect of sunburn after 10 minutes in the sun would receive 15 times the protection with an SPF 15 product i.e. 150 minutes of protection. If a person with darker skin takes longer to get sunburnt without protection, say 20 minutes, an SPF15 would give him/her 300 minutes of protection.
Most people do not apply enough sunscreen. An adult should use 2 tablespoons of sunscreen if they intend to protect the entire body while wearing a swimming costume. This should be applied 30 minutes prior to going outside. Apply 2 teaspoons full if only for the face, neck, and arms.
Some sunscreens may have an expiry date written on the box, however the active ingredients in the sunscreen deteriorate over time and this would happen faster if you leave it in direct sunlight, heat, or humidity. If it looks or smells differently or the texture is clumpy, then it might be expired.
Although kidney disease can affect people of all ages and ethnicities, women are prone to face more specific challenges tied to kidney disease. The incidence of Chronic Kidney Disease (CKD) is at least as high in women as in men and may even be higher. Studies have shown that CKD affects approximately 195 million women worldwide and is currently the 8th leading cause of death in women. There is a risk of morbidity associated with CKD and in many cases it progresses towards kidney failure, necessitating kidney replacement therapy i.e. dialysis and/or kidney transplantation.
Types of kidney diseases that are more common in women
Lupus Nephritis is a disease that leads to kidney damage, caused by an autoimmune disease called systemic lupus erythematosus (SLE). The disorder causes the body’s immune system to attack the body’s own cells and tissues. Kidney disease due to lupus may worsen over time and can lead to kidney failure. SLE is much more common in women often striking during the child-bearing years. It is estimated that 9 in 10 people diagnosed with SLE are women.
Pyelonephritis (kidney infection) is a kind of urinary tract infection (UTI) most commonly caused by bacteria which starts in the lower urinary tract. If untreated, it can move upstream to one or both of the kidneys. Kidney infections can cause sepsis, which can be life threatening. Due to their anatomy, UTI is more common in women and girls.
Health challenges that are unique to women
Conception – CKD is considered as a risk factor that affects fertility, especially in its advanced stage, when dialysis is required. While it may be challenging, conception is still possible while on dialysis and the results have been shown to improve with intensive treatment of daily or closely frequent sessions. The use of contraceptive pills as a birth control method is generally discouraged for women with CKD as it may cause an increase in blood pressure and blood clots that can make kidney disease worse. Pregnancy-related complications – CKD may be caused by both Acute Kidney Injury (AKI) and preeclampsia (PE – a complication in pregnancy which can lead to high blood pressure and kidney damage in the mother). It not only poses a threat to maternal health, but is also associated with fetal mortality, preterm birth and restricted intrauterine growth.
If the mother has any pre-existing kidney disease it can negatively affect the pregnancy and may pose a threat to the health of both the mother and the fetus. Increased chances of adverse pregnancy outcomes including preeclampsia, AKI, progression of CKD, spontaneous abortion, stillbirth, malformations, and other long-term issues have been observed.
While Pregnancy offers an opportunity for diagnosis of kidney disease, it is also a state where acute and chronic kidney diseases may develop which may impact the health of future generations.
As individuals, it is important for women to be aware of how important your kidneys are to your overall health and how you can prevent or slow down the progression of kidney disease.
Key questions to ascertain your risk
Do you have high blood pressure?
Are you diabetic?
Do you smoke?
Are you overweight?
Do you have a family history of kidney disease?
Are you over 50?
Are you of African, Hispanic, Asian or Aboriginal descent?
If your answer is yes to one or more of these questions, it is advisable to discuss with your doctor. Early chronic kidney disease is silent and has no signs or symptoms. By treating kidney disease early, you can help delay or prevent kidney failure.
The condition cause acne, weight gain and in extreme cases can lead to cancer.
Polycystic ovary syndrome (PCOS) is the most common gynecological problem that affects one in 10 women of childbearing age. It causes hormonal imbalance and metabolism problems that may affect their overall health and appearance. PCOS is also a common and treatable cause of infertility.
Do you have PCOS?
PCOS present with variety of symptoms during late teens or early twenties
Irregular period or no period at all
Difficult in getting pregnant as a result of irregular ovulation or failure to ovulate.
Excessive hair growth (hirsutism) usually on face, chest, back, buttock.
Weight gain or difficulty in losing weight
Thinning hair and hair loss from head
Oily skin or acne, darkening of skin along neck creases, skin tags.
PCOS is associated with developing health problem in late life like diabetes, high cholesterol level.
What causes PCOS?
The exact cause of PCOS is not known. But often it runs in family. It is associated with abnormal hormone level in body including androgen and high level of insulin. Women with PCOS are resistant to action of insulin in body and produce higher level of insulin that increases activity of hormone like testosterone Obesity and unhealthy eating habits, not exercising are also risk factors.
Is PCOS associated with other health problem?
It may associated with so many health problem such as,
Diabetese-50 present women will have diabetes
High Blood pressure- It may lead to heart disease and stroke
Unhealthy cholesterol
Sleep Apnea- Due to obesity and overweight
Depression and Anxiety
Endometrial cancer
How is PCOS diagnosed?
It need medical history, examination, and different test .It include,
Physical examination
Pelvic examination
Pelvic ultrasound
Blood test- Check androgen level
Once other condition rule out, diagnosis of PCOD made if two of following symptom is present
Irregular period
Sign of High androgen like hirsutism, acne, thin hair
Higher than normal blood level of androgen
Multiple ovarian cyst on one or both ovary
Treatment is not frightening
There is no cure for PCOS. Treatment is symptomatic including plans for children and risk for long-term health problems such as diabetes and heart disease. Many women need combination of treatment. That include,
Weight loss- Healthy eating habit and regular physical exercise relieve symptom. Even a 10 percent loss in body weight can resume regular menstrual cycle and improve chances of pregnancy.
Remove hair-Facial hair removal creams, laser hair removal, or electrolysis for removal of excess hair growth.
Slowing hair growth- A prescription skin treatment slow down growth rate of new hair.
TYPE OF MEDICINE TO TREAT PCOS-
Hormonal birth control, such as the pill, patch, shot, vaginal ring, or hormonal intrauterine device (IUD) is often used to improve acne, menstrual irregularity and reduce unwanted hair.
Antiandrogen medicine- Help to reduce unwanted hair growth.
Metformin- may help to restore ovulation.
For pregnancy planning, ovulating medicine like clomiphene (Clomid) may require.
In Vitro Fertilization (IVF) -It may be option if medicine do not work.
Surgical treatment –If other option are not effective a simple surgical procedure, laparoscopic ovarian drilling is recommended where few holes in the surface of ovary using lasers or a fine needle heated with electricity is made to destroy tissue that produces testosterone, it restores ovulation for 6-8 month.
To conclude, PCOS is lifelong condition that requires your attention but it’s manageable.
Finding out that you have ovarian cysts during a routine pelvic checkup can be a scary experience for any women. Most women immediately jump to conclusions about their condition and it’s severity. However, not all cysts are dangerous and malignant. For instance, ovarian cysts are one of the most common kinds of cysts that develops on a woman’s ovaries. Many women will develop at least one cyst during their lifetime.
However, cysts can be the cause of one or more menstrual discomforts and their prolonged presence can lead to female infertility. So in this blog, we will discuss more about ovarian cysts, their symptoms and how our gynecologists will treat the condition once diagnosed.
Understanding ovarian cysts
Ovarian cysts are small fluid filled sacs found on the ovaries. They are of various types like endometrioma cysts, functional cysts and dermoid cysts. Of these, the functional cysts are the most common type of cysts found in women.
Functional cysts are again divided into two types- the follicle cysts and corpus luteum cysts. A follicle is a sac like structure inside the ovary, in which an egg grows to maturity. During a woman’s menstrual cycle, this follicle breaks open to release the egg. However, in some cases, the follicle fails to break open, which leads the sac to fill with fluid, leading to the formation of an ovarian cyst.
Normally, the follicle dissolves away after releasing the egg. But in some women, this sac remains on the ovary, gets filled with the liquid and seal the opening over time, leading to the formation of a corpus luteum cyst.
Unlike the fluid-filled water cysts, dermoid cysts contain fat or hair tissues, while cystadenomas are non-malignant growth on the outer surface of the ovaries. Endometriomas are cysts that are formed due to the growth of endometrial tissue on the ovaries, which is classified as a separate condition called endometriosis.
Another cystic formation in the ovaries is polycystic ovary syndrome, where a woman’s ovaries develop a large number of smaller cysts, leading to enlarged ovaries. Leaving this condition untreated can lead to potential infertility in the long run.
Most often, ovarian cysts do not cause any symptoms. However, when the cyst grows bigger, it can lead to symptoms like abdominal bloating, pelvic pain during menstruation, painful intercourse, painful bowel movements, nausea and vomiting. If you suffer from any of these symptoms repeatedly, you might need immediate medical attention from our gynecologists.
Similarly, if the cysts are too big, it can lead to ovarian torsion (twisting of the ovary) or the rupturing of the water cysts. This will cause severe pelvic pain, fever, faintness and dizziness. If not treated on time, this condition can lead to ovarian necrosis, which causes the ovarian tissues to die due to lack of blood.
Diagnosis and treatment of an ovarian cyst
To diagnose the presence of an ovarian cyst, our gynecologist will subject the patient to an ultrasound test and routine pelvic examination. The ultrasound imaging will help the specialist to determine the location, size, shape and composition of the cyst.
As most cysts disappear on their own after a few weeks or months, our gynecologist might not recommend a treatment plan on the first go. If it is present even after several scanning and is slowly increasing in size, then the patient will be prescribed a treatment plan.
Our gynecologists usually treat ovarian cysts with the help of oral contraceptives, which prevent ovulation and development of new cysts. These contraceptive pills also reduce the chance of ovarian cancer in women. Sometimes, water cysts have to be surgically removed through a laparoscopy or keyhole surgery. The keyhole surgery is performed by making a tiny incision near the patient’s navel and inserting the surgical instrument to remove the cyst. Women must remain cautious about their reproductive health at all times. If you suffer from any of the symptoms discussed above, consult with our gynecologists at the earliest. Early detection and cure will ensure better health and quality of life.
Raising a family isn’t always easy. Parents are busy, and so are the children. Today, many kids suffer from obesity and its complications, allergy and asthma and mental health issues to name a few, all because of choosing an unhealthy lifestyle. According to the World Health Organisation (WHO), 60 per cent of the related factors to individual health and quality of life are correlated to lifestyle. Unhealthy lifestyle choice in parents largely influences their children to choose the wrong choice of food, activities and behaviour.
Simple ways to adopt a healthy lifestyle in children:
1) Drinking healthy: Choose water, fresh fruit juice and reduced fat milk over the sweetened beverages, carbonated drinks and energy drinks.
2) Eating healthy: Don’t skip meals, especially breakfast. Eat meals as a family in a fixed place and time. No television during meals. Don’t use food as rewards. Avoid fatty meats, sugary food and fried foods. Fruits and vegetables should be a regular part of the diet.
3) Physical activity: At least 60 minutes of moderate physical activity per day. Activities that strengthen the bones and muscles like running, swimming, sports or cycling should be chosen.
4) Switch off electronic gadgets:No more than 2 hours of screen time (including TV, laptops, mobile and tablets) per day.
5) Good sleep: Adequate sleep duration for age on a regular basis should be maintained. All screen to be turned off 30 minutes before bedtime and TV, computers and other screens should not be allowed in children’s bedrooms.
Parents should be role models with regards to food choices and choosing physical activity over sedentary lifestyle, which encourages the child in the long run to choose a healthy lifestyle as a part of life.
Women spend a lifetime looking after their families and often ignore their own wellbeing. It is important for women to take care of themselves. As time passes, our bodies change. Each one of us is unique and hence aging touches us in different ways. Thanks to the growing awareness and advances in medicine and nutrition, we are seeing higher life expectancies and healthier lives(average life expectancy of a US woman is 82 years).To be healthiest,we need to know our family medical history, understand our body changes, integrate beneficial habits into our lifestyle and keep up with routine preventive health screenings.
50s Body Basics:
Menopause:-Menopause:-For most women, her 50s mean menopause. But it is not really a pause at all. Menopause is more like a shift. Your hormone levels shift and change, and your body shifts out of its childbearing years into a new state of balance. Before that, you may experience hot flashes and night sweats, upset sleep and stress, mood swings, irritability, or depression.
Due to drop in estrogen, you may also notice other changes. Reduced vaginal lubrication can make sexual intercourse difficult, even painful, and increase your risk of urinary and vaginal infections.
Estrogen dips also cause you to lose bone density – putting you at risk of osteoporosis – and have been linked to a gain in belly fat.
Belly fat, in turn, may boost your risk of heart disease, diabetes, and cancer. To lose this fat, you may need to bump up your workouts and lower your caloric intake.
Your risk of colorectal cancer increases during this decade, so screening becomes crucial.
Weakened pelvic muscles may play a role in urination issues like incontinence and in some women a condition called pelvic prolapse. Women who are obese or have had children are more susceptible.
TOP CONCERNS
Other than Menopause, the main health concern are:-
Heart disease is the leading killer of both men and women. In women, the condition is responsible for about 29% of deaths, reports the CDC. Although more men die of heart disease than women, females tend to be underdiagnosed, often to the point that it’s too late to help them once the condition is discovered.
The earlier people adapt healthier behaviors, the lower their overall risk for heart disease or stroke outcomes.
Osteoporosis
Osteoporosis threatens 44 million Americans, of which 68% are women, reports the National Osteoporosis Foundation. Osteoporosis is largely preventable. The behaviors that women develop in their childhood and early adult years play a significant role in the development of the disease. That’s because bodies build up most of bone mass until age 30. Then new bone stops forming and the focus is on maintenance of old bone. It is never too late to keep bones strong and avoid fractures. Your body will do what it can to repair bone damage, but you have to provide the tools for it, such as adequate calcium consumption and weight-bearing physical activity
When you age, your body absorbs your old bone tissue faster than it can create new bone tissue, which makes your bones weaker. This condition is called osteoporosis. The bones become so thin and fragile that they can easily break when you fall or sometimes, while you are going about your daily lives. It is estimated that 1.5 million fractures happen every year because of osteoporosis. Women are more susceptible to osteoporosis because they lose more bone mass right after menopause.
Flu/Pneumonia: the elderly are more susceptible to it because the immune system does become weaker with the passing years. It also means that the flu can lead to pneumonia, if not treated on time. The research done by Centers for Disease Control and Prevention, US, believes that 71–85 percent flu-related deaths in occur in people around the age of 65 or more
Diabetes:
In countries like the USA, more than 25 percent people over the age of 60 have this health condition. When a person has diabetes, they have a very high level of blood sugar, which leads to complications like damage to the kidneys, nerves, eyes as well as stroke or heart disease. Some of the early signs to look out for are fatigue, extreme thirst or hunger, blurry eyesight, and a frequent need to urinate.
Incontinence: Women over the age of 50 are more likely to have urinary incontinence. This is because the pelvic muscles lose strength, and aren’t able to control the bladder as well as they did before. Some of the other reasons for incontinence after menopause include less elasticity in the vaginal tissue and thinning of the lining of the urethra. This leads to a few types of incontinence: stress incontinence, which means that you leak out some urine when you laugh, sneeze or cough; urge incontinence, when the need to urinate comes very suddenly; nocturia, where some women feel the need to use the bathroom several times at night; and, painful urination, which may happen because urinary tract infections that some may get more frequently after menopause.
Breast Cancer
It is second to lung cancer as the leading cause of death for women..
The American Cancer Society lists the following as risk factors for breastcancer:
American Cancer Society recommends controlling your weight, exercising, quitting smoking, and talking to your doctor about your risk and appropriate screening for breast cancer.
“Just because your mother didn’t have breast cancer, it does not mean you are immune to this problem,”. At the same time, it’s also important to note that some women who have one or more risk factors never get breast cancer.
Depression / Anxiety
Depression appears to affect more women than men. The National Institute of Mental Health reports that about 12 million women are affected by a depressive disorder each year compared to about 6 million men. Many women suffer silently as they battle with depression, which also impairs their daily functioning. Post-menopausal women are more prone to suffering from depression because when there is a dip in the level of estrogen in the body, mood-regulating brain chemicals like norepinephrine, dopamine and serotonin also get disrupted.
Anxiety is one of the least talked about health issues that women over 55 suffer from. Often undiagnosed or undertreated, studies in the US show that 18 percent of people over 60 suffer from anxiety issues. Women have more anxiety disorders than men due to chemical differences, hormonal changes and different responses to neurotransmitters. The affected person cannot stop worrying about a problem, situation or even the future, to the extent that sometimes it can hamper day-to-day living. Anxiety can even lead to panic attacks, high blood pressure, palpitations, dizziness and insomnia. If you suffer from any of these symptoms or suspect that you have an anxiety disorder, do not hesitate to reach out for help.
50s: healthy habits
Nutritional needs of your changing body.
As you pass through menopause, your changing body may require fewer calories. At the same time, you might contend with a slowed metabolism and become more prone to belly fat. Switch out high-fat foods for lower-fat options, and slice into leaner sources of protein, like chicken, fish, beans, or quinoa. Give your body an antioxidant advantage by increasing your intake of fruits and vegetables, and support healthy cholesterol and digestion with plenty of fiber.Cut back on salt and processed foods-aiming for 1500mg of salt(halfteaspoon/day).Eat colorful foods. It’s important for women over 50 to get plenty of fruits and vegetables. And eat more fatty fish (like salmon) to get heart-healthy omega-3 fatty acids. Learn to love whole grains, lentils, and skinless lean protein. Treat yourself to sweets, but only occasionally. When you use oils, lean toward the good ones,like extra-virgin olive oil.
Get fit
50-something fitness should focus on maintaining a healthy weight, supporting strong bones, and building muscles to boost a lagging metabolism. Cardiovascular exercise will help keep your heart strong, but you also need flexibility and muscle strengthening training like yoga or Pilates to help keep your joints mobile. You also need strength training or a weight-bearing workout like climbing stairs, jogging, lifting weights, to help bump up your calorie burn and support your bones and muscles. Keep up with regular physical activity, and you’ll be more likely to sleep well and to handle stress.
Medications:
Your first bone density test may occur in your 50s. Your mid-60s is when you are at a greater risk for osteoporosis, so you should work now to fortify and protect your bones. If you cannot reach your daily calcium quota of the recommended 1,200 mg from the foods you eat, consider supplements. And pair your calcium with vitamin D to get the full benefits. Some vitamin D can be found in foods you eat, but you may need to take supplements to get the 800 IU of vitamin D per day that is recommended for osteoporosis prevention. You could also spend about 5 to 15 minutes outside, 2 or 3 times a week, to soak up vitamin D from the Sun. Generally always wear sunscreen to help prevent skin damage that can lead to skin cancer. You can also add B12 supplements to your diet.
Mental health
Meditate, pray, visualize your day. Read something that inspires you. Focus on self-renewal.#Set aside quiet time every morning. Be optimistic. Take time to understand what you want out ofyour life. Find thepurpose and meaningin your life. Then spread the joy to others.#Have fun. Go bungee jumping, rock climbing, backpacking, skiing, and dancing,whatever makes you happy. Act like you feel, and you’ll feel youthfulness. Find a creative outlet. It helpsto prevent depression and depression affects memory. Having a creative outlet helps stimulate your mind. Take up painting. Create a wonderful garden. Engaging your creativity stimulates your brain more than reading, and certainly more than TV. Eliminate clutter. Fill your home with great music, books, and friends. Withdraw and recharge when you need to. Associate with positive-focused people. They will not drain your valuable energy with complaints. They will help you pursue the best that life has to offer.
Maintain proper Hydration
Skin care regimen should include moisturizing creams
Ensure adequate Sleep Maybe you got along with four hours a night when you were 40, but your body can’t take that abuse when you’re older.
Quit smoking
Stop or limit alcohol
Reach and maintain healthy weights.
Maintain protection from the Sun
Screening check-ups
Your 50s: checkup checklist
Bone density test:You may get your first bone density test during your 50s. Some people who fall into particular risk categories may need one sooner or more regularly. Taking certain medications may speed bone loss, and certain medical conditions can compromise bone density as well. Ask your doctor if you are concerned about osteoporosis, especially if it runs in your family.
Diabetes screening:If you are in your 50s, you may be at risk for type 2 diabetes. Your doctor can screen your risk by testing your levels of Hemoglobin A1C (a blood test that reflects your average blood glucose levels over the last 3 months) or your blood glucose levels. How often you need to be screened for diabetes will depend on your risk of diabetes. If you are overweight, your risk of diabetes will probably be higher and you should be tested earlier and/or more often. Ask your doctor how often you should be screened for diabetes.
Blood pressure and cholesterol:Anytime you go in for any health care visit, your blood pressure will be taken, and you should get a cholesterol work-up every 1 to3 If you fall into certain risk groups, your doctor may screen your levels more frequently. You may be at risk if you have diabetes or a large waist circumference, or if you smoke or are inactive or eat an unhealthy diet.
Colorectal cancer screening:A Fecal Occult Blood Test (FOBT) helps to identify polyps before they become cancerous. When caught early, 90% of colorectal cancers can be cured. This test should be conducted every 2 years. A flexible sigmoidoscopy or double-contrast barium enema may be done every 5 years as an alternative to the FOBT. Another screening option is a colonoscopy, which should be done at 50 and every 10 years after. If you have certain risk factors, you may need this test every 1 to 5 years.
Pap test and pelvic exam:You should be having routine pelvic exams and Pap tests every 2 to 3 years. Pap tests screen for cervical cancer, while the pelvic exam allows your health care provider to examine your cervix and vagina and to get a sense of the health of your uterus. Your health care provider might also look for signs of infections.
Breast exam:Breast cancer is a very common cancer among women. Your health care provider may do an exam when you go in for your Pap test and pelvic exam. If not, ask your doctor if you should have a clinical breast exam and, if so, how often? You should also become familiar with the look and feel of your breasts so you know what’s normal for you. If you fall into a high-risk category for breast cancer, your doctor may suggest you have a mammogram every year or so. Otherwise, mammograms should be done every 2 or 3 years when you are in your 50s.
Skin check:Anyone at any age can develop skin cancer. In addition to minimizing your risk with healthy sun habits, your health care provider should do a thorough skin check annually to screen for new or changed moles or marks. You can also do a skin check yourself (or with a helpful partner) each month.
Dental check-ups:Visit your dentist for preventive check-ups and routine cleanings. The frequency of visits will really depend on individual needs, though most authorities on the subject recommend at least once or twice a year.
Eye exams:Even if your vision is 20/20, you should have your eyes examined every 1 to 2 years. After all, optometrists check for other things besides how good your vision is – like signs of glaucoma. If you have a condition like diabetes or high blood pressure, or a family history of vision problems, your optometrist will let you know if you need more frequent eye exams and check-ups.
Immunizations:
Get shots to protect you from measles, mumps, and rubella (MMR)if you’ve never had the vaccination before.
The tetanus, diphtheria, and pertussis (Tdap)vaccine is recommended for everyone, once in adulthood (you may have received vaccinations against these in childhood). The Td (tetanus and diphtheria) vaccine is recommended every 10 years.
Each year, get the influenza vaccine.
Consider being vaccinated against meningitisand hepatitis A and B.
U.S Preventive Guidelines-
Guidelines are based on current U.S Preventive services Task Force (USPSTF) recommendations.
Preterm birth is defined as birth before 37 completed weeks of Pregnancy. Approximately 15 million babies are born preterm each year worldwide, and 1 million among these die.
Many survivors of preterm birth face a lifetime disability; including learning, visual and hearing problems.
Preterm births can take an emotional toll and can be a financial burden to the family and society.
Major Risk factors:
High or Low BMI(underweight or overweight)
Smoking
Pregnancy Interval(<18 months and >60months)
Low Blood Supply to placenta as in case of Diabetes and hypertension
Birth Defect in Uterus of mother
Previous Pre Term Birth
Infections in uterus and vagina.
Multiple pregnancy
Previous surgery on cervix.
What to do
Early detection and preventive measures during the pregnancy can drastically reduce the chances of Pre Term Birth.
Before pregnancy
Life style modification like prepregnancy weight reduction, cessation of smoking and alcohol
During pregnancy
Risk assessment play an important role in planning of prenatal care. It should be based on a combination of all risk factors including previous pregnancy history and screening tests.
Screening of vaginal infection: Infections during pregnancy like bacterial vaginosis is a major cause and hence screening for vaginal infections followed by antibiotics can significantly reduce the rates of Pre Term Birth.
Cervical length screening: A short mid-pregnancy cervical length (<2.5mm) is associated with a high risk of preterm birth. Screening for cervical length by transvaginal ultrasound (between 16-24 week of pregnancy) is recommended in high-risk group.
Fetal fibronectin :- Fetal fibronectin levels is used to predict delivery within next 7 days inwomen presenting with symptoms of Pre Term Labor. Patient may thus be admitted immediately under observation till delivery.
Education about warning signs of preterm labour allows women to attend hospital in time to prepare the baby for an early delivery.
Treatment and Management:
Progesterone:-Progesterone is a hormone known for its role in maintaining pregnancy. It is given to women with:-
History of previous preterm birthbetween 20-34 week of pregnancy
Short cervix detected with ultrasound.
Cervical cerclage: A cervical cerclage is a surgical procedure that place securing suture around the cervix to prevent cervical shortening and opening. It is considered for women in whom
Transvaginal ultrasound show short cervix
History of preterm birthbetween 20-34 week of pregnancy
History of injury to cervix.
WHO recommendations:
for treatment during pregnancyand newborn period for improving outcomes for preterm infants.
These are:-
Steroid injections to mother for maturity of baby lungs if there is threat of pre term birth.
Antibiotic therapy :- in cases of rupture of water sac before 37 weeks of pregnancy.
Magnesium sulfate :-for women at risk of preterm birth before 32 weeks of gestation for prevention of cerebral palsy.
Treatment for the newborn baby – thermal care, feeding support, (e.g. kangaroo mother care), safe oxygen useto help babies breatheeasily.
New developments in screening for PTB which are currently under research.
Bio markers as screening parameter-for early detection of risk of preterm birth at 10-12wk of pregnancy.
Probiotics as preventive measure – Probiotics can reduce infections hence are currently under research for reducing risk for pre term birth.
Ongoing Medical trials:-
Cervical pessary with progesterone – for cases of short cervix.
Aspirin – for increasing placental blood flow.
Prevention of Pre Term Birth is one of the main goals.Researchers, doctors, patient’s organizations, and governments must collaborate in the prevention of Pre Term Birth. By doing so, we give babies the best start in life and ensure lifelong health benefits.
So be in regular follow up with your doctor for effective reduction into chances for Pre term Birth and don’t hesitate to discuss.
Do you believe that babies can learn even before birth? Yes, they can
Latest research has revealed that babies can be stimulated while they are still in the womb by methods such as talking and singing and that it tends to boost their visual, language and motor development. Prenatal stimulation provides a safe environment for your baby before as well as after birth which is key for long term success.
Your fetus experiences many sensations; hearing being the fastest developing sensation. Towards the end of the second trimester, your baby starts to hear. The mother’s voice is well perceived while background sounds such as the mother’s heartbeat, breathing, pumping of blood, gurgles of the stomach, and air filling the lungs are heard internally. Your unborn baby can also hear muffled noises and music coming from outside.
How do we initiate communication with the baby?
Your baby is the one who initiates communication. Encourage him/her to kick; whenever he/she kicks, touch the opposite side (merely the place where the head is) and say, “Kick baby kick. Kick-kick-kick”. Keep your tone of voice enthusiastic, entertaining and patient. This can be repeated several times and eventually the baby will learn to kick a point on the abdomen in response to the mother touching that spot and saying, “Kick, baby, kick here’’.
Play relaxing music to the baby; can be nursery rhymes too. Although your baby is well protected inside the womb, make sure not to place high volume headphones directly on the baby bump. It’s wise not to play music too loudly and frequently to your baby. You can sing nursery rhymes to your baby when he/she is awake; caressing your baby bump.
Who’s my pretty baby
Who’s my pretty little baby
You’re my, my pretty little baby
Hey Hey pretty babe
Hey Hey pretty baby
Ho Ho pretty little baby
When you speak, sing or play music to your baby in the womb, her/his heart beat may increase and your baby may move more. Mothers are welcome to be creative in their own way to stimulate the baby and repeat the same after the birth. You may find a wiggly and alert response from your newborn to what they heard regularly in the womb.
Read small stories to the baby. This will make the baby comfortable while in the womb. The same voices and stories will then comfort the baby after birth, which comes in handy on nights when the baby is fussy and doesn’t want to sleep. The mother’s voice is heard best by the baby in the womb. Teaching parents how to talk to their unborn baby forms love and trust, and provides a strong supportive background for the child to grow and learn. Continuation of same story rhymes and songs are essential to incite the desired response from the baby. Development of speech and language skills is an ongoing process and prenatal stimulation definitely forms the strong baseline for long term success.
About the Author: Ms. Hiranthi Karunarathna is a Speech Therapist at International Modern Hospital with 4 years of clinical experience in Speech Language Pathology. She specializes in stuttering, autism spectrum disorders & other childhood communication disorders. Her experience includes both pediatric& adult rehabilitation care.
He or she now hears and understands nearly everything that is said at home or at pre-school or day care.
Your child’s ability to hear properly all the time should not be in doubt. If you are in doubt about your child’s hearing, see an audiologist. If you are in doubt about language comprehension, see a speech-language pathologist / speech and language therapist.
What does (s) he speak?
Your preschooler will speak more clearly and will use even more words, often in more complex sentences of about six words or more for examples. Mom went to the supermarket but I couldn’t go with her. We visited grand ma since she was sick.
You’ll be able to understand what (s) he’s saying all the time.
His/her pragmatic skills are really good that he can stick to a topic of his/her imagination and talk.
You probably experience that they have difficulties with certain sounds such as /r/,/th/, and /v/.(s)he admires the gathering of peers.
How can I help my child?
Give full attention to your child when (s) he is speaking. Let him/her feel that you’re always attentive to him/her speech. Praise and encourage him/her after speaking.
Before you speak to your child be sure to get his/her full attention. Don’t accelerate your speaking. Pause; allow him to respond to what you have said. Repeat, if (s) he hasn’t understood.
This is the best periods to work on lexical items in categories such as vegetables, fruits, animals, shapes, vehicles, house hold items, food items and so on. Build on your child’s vocabulary when you teach the categorization .for an e.g.: What can we see on the road? We can see car, bus, these are called Vehicles, Car is a vehicle, bus is another kind of vehicle. So what is the train?
Teach your child other concepts using the items categories. Make him sort out what are same and different.
(s)he is ready to sort items into categories on subtle differences such as vehicles into what goes in the water/air, cloths into women/men/children ware, house hold items into wooden/electronic appliances, hot and cold beverages. The child will learn multiples concept with sorting items.
Move to odd man out!!!! Ask the child what is different? Why it doesn’t belong in the given category. Let him explain why the item doesn’t’ belong.
Pretend that you don’t know how to play the game, follow his/her instruction to play. Do mistakes and allow him/her to correct you. Your child would value him/herself and (s) he will try to communicate more and more.
Give him/her two steps commands such as take your shoes off and keep on the rack. Take home work out and keep the bag on your table.
Make him/her involve in works like making juice, baking cake, painting, cleaning the floor and ask him/her how to make orange juice .Help him to explain steps. When playing with doctor set, cars, vegetable market ask them how did they give medicines? how did they shop? Write down, draw their steps as (s) he tells it. Your child will attempt to narrate stories and soon will build up interest to write letters.
Expand monologue to role play dialogues. Act different roles with the child. Explore new scenarios of acting, express new verbs, adjectives and how to combine them to a sentences.
Find the most interesting story with your child. Read, enact the story, make him actively participate in the story. Ask him/her WH questions (who, what, when, where, why) help him to predict what will happen next in the story.
Encourage your child to ask for explanation of new words (s) he heard.
Use pictures, story books, real situation to teach him/her spatial relationships (first, middle, last, left right) opposites (up and down, big and little, heavy and light) Use real life examples as much as possible.
Do guessing game with him. Give clues, and description about what is (s)he going to eat Where are they going, eg. your favorite with milk expecting the answer “chocos”
Make your child involve in plans and discussion at home . Get his/her suggestion in making list f or shopping, birthday celebrations, and festivals. What do you want to buy from the supermarket?
Your correct guidance would not only help in communication skills but also would improve the social and cognitive behavior of the child.
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.
What 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.
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.
By now (s)he will understand two steps commands take your shoe off and keep on rack.
And also understand opposites like hot/cold, stop/go, nice/ugly.(s)he hears ringing of the telephone , door bell and may become excited, get you to answer or tries to answer themselves
What does (s)he speak?
Your toddler’s vocabulary is going to explode. They seem to have a word for almost everything. Their sentence contains of one, two or three words.
Speech is probably not very clear, but family members can easily understand them.
Your toddler loves to hold your attention of what they hear and see.
They may draw your attention to something by naming it, for an example, Bus, Candy, Big, Hot, Wow, see.
How can I help my child?
Children learn by imitating adults. Use clear, simple words & sentences what is easy to imitate .Show your interest to their speech. When the child says doggie!!! ; Expand his/her word, Oh yes it’s a doggie, Doggie is running. Doggie says bow bow. It is black. Does Anny love doggie?
Have his/her help to arrange cloths, toys, food at home. These are what Anny eats put all into this bucket. Foods are here. We will put Anny cloths in this bucket. Teach the child basic function, features and class of objects with examples.
Encourage the child to increase the length of speech. Which puzzle do you want? Try to give him/her open ended questions than close ended. For e.g. rather than asking Do you want rice? Do you want bread? Ask would you like to eat rice or bread? This will simply limit Yes & No answers.
Reinforce the child effectively .Positive reinforcement is the key for the successful communication. How good Anny speaks, Thank you Anny, mommy understood.
Introduce books, picture books, games & activities to expand your child’s vocabulary. Use colorful picture books and name object with the child. And describe the object using a simple sentence. Create the situation to use newly learned words in context. E.g. his is an Apple. Anny eats apple./ Apple is red
Have the child have the habit of collecting pictures from magazines, books. Help him/her to glue then paste or write the name under each object.
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 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 – 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. Subsequently, 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. Few 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 disability 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).
Our parents are smart. They are really concern about their child talk and how he / she communicate. They also listen to his or her peers who are at same age and may compare what older brothers and sisters did at the same age. This is how our parents mentally compare their child’s performance with other children. They immediately create an impression of whether the child is developing speech & language at normal rate or not.
If parents feel that development is slow, they check their impression with the other parents, relatives, and their pediatrician. You probably get an answer such as Oh!! Don’t worry, he / she will outgrow it. Look at my child she was so quiet and now she is a chatter box, give him/her time.
But……suppose he / she doesn’t? Even after giving adequate time.
You would feel guilty waiting and then finding out that I should have acted earlier. Waiting is so hard, why we have to be frustrated at last . We want the best for our child. What’s a parent to do?
But…….You’re not sure of what to do.
It’s hard to say the exact age when they hit speech and language milestones. It varies a lot on factors such as the child’s inborn ability to learn language, other skills the child is learning, the amount speech and language input he/she gets. and how others respond to his/her communication attempts .
Do you praise him/her? Listen to him/her carefully?
These factors can slow down or accelerate the speed of speech and language development of our children. Be aware of the certain factors that may increase the risk of late-talking child in the 18 to 30 month old age range even with normal intelligence.
The sooner The Better
If you are concerned about your child’s speech and language development, you should see a speech-language pathologist. The speech-language pathologist may suggest on early intervention program with follow up sessions. It’s important to have formal therapy sessions in case of severe problems.
Do you really want to wait for him/her to outgrow???Don’t leave a chance which leads you to feel guilty that I would have done with everything I could
October is Breast Cancer Awareness Month, which is an annual campaign to increase awareness of the disease. While most people are aware of breast cancer, many forget to take the steps to have a plan to detect the disease in its early stages and encourage others to do the same.
Know the symptoms of breast cancer
Early breast cancer usually doesn’t cause symptoms. But as the tumor grows, it can change how the breast looks or feels.
A lump or thickening in or near the breast or in the underarm area
A change in the size or shape of the breast
Dimpling or puckering in the skin of the breast
A nipple turned inward into the breast
Discharge (fluid) from the nipple, especially if it’s bloody
Scaly, red, or swollen skin on the breast or nipple
The skin may have pitting so that it looks like an orange
These symptoms do not automatically indicate breast cancer. But, if you have any of these conditions, you should tell your health care provider so that the problems can be diagnosed and treated.
Knowing Your Body:
For women under 50-years old:
Employ annual clinical breast examinations and monthly breast self-examinations as your primary early detection protocol.
Once a year, every year, without fail, schedule an appointment with your healthcare provider to perform a clinical breast examination. We recommend you schedule it on or near your birthday.
Once a month, every month, without fail, set aside 15 minutes to conduct thorough breast self-examination. We recommend you schedule it on the first day of menstruation.
Schedule a mammogram only if needed for diagnosis of a suspected lump. Even then, be sure to schedule that mammogram within the first 14 days of your menstrual cycle.
For women over 50-years old:
Employ annual clinical breast examinations and monthly breast self-examinations as your primary early detection protocol.
Once a year, every year, without fail, schedule an appointment with your healthcare provider to perform a clinical breast examination. We recommend you schedule it on or near your birthday.
Once a month, every month, without fail, set aside 15 minutes to conduct a thorough breast self-examination. We recommend you schedule it on the first day of your period if you are still menstruating.
Schedule a mammogram if you discover a lump. Even then, be sure to schedule that mammogram within the first 14 days of your menstrual cycle if you are still menstruating.
Employ mammography screening every other year.
Steps to help you respond with maximum intelligence to this diagnosis and help you rebuild your self-healing functions.
The basic action points are:
Step back from the day-to-day pressures of your life to evaluate your current situation in its entirety.
Assess both current life issues that must be changed as well as future needs that must be met.
Create a simple plan to restore health and total well-being.
Work in partnership with health advisors who have your confidence. Begin a self-care plan to create whole-person well-being.
Conduct quarterly reviews of your progress, making adjustments as necessary.
Taken together, these action points will play the central role in mobilizing all your healing options and capacities, both external and internal.
The Breast Cancer Prevention Lifestyle
Yes, you can maximize your potential for actually preventing breast cancer! It’s all about personal choices in how we take care of ourselves.
American Cancer Society Releases New Breast Cancer Guideline – The new recommendations are :
Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45.
Women should be able to start the screening as early as age 40, if they want to. It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening.
At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
Regular mammograms should continue for as long as a woman is in good health.
Breast exams, either from a medical provider or self-exams, are no longer recommended.
The guidelines are for women at average risk for breast cancer. Women at high risk – because of family history, a breast condition, or another reason – need to begin screening earlier and/or more often. Talk to your medical provider to be sure.
Introducing 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.
They can stay in a sitting position and hold their head steady.
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.
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 upma, suji kheer, sabudaana kheer, dalia, 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, dal, dalia, 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.
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.
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.
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.
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 .
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.
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 .
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..
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.
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.
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.
Rising rate of caesarian sections and its complications.
Caesarian section is an operation done to deliver a baby when normal birth can pose a risk to mother/baby or both.
Historically, this operation was introduced to save the lives of mothers who were unable to deliver by the normal route and as a result, died during childbirth.
Globally, there is a concern over the rising rates of caesarian section. As per WHO, caesarian rate should be around 15%. In the US, rates are 32.8% (2012), in the UK 26.2% (2014) and in UAE around 29% in a tertiary care setting.
Reasons why Caeserean birth is increasing especially in the developed world include litigation costs,women wanting to make the choice about how they want to deliver and previous caeserian births.
Chlidbearing at a late age and assisted reproduction with multiple pregnancies have also contributed to the rising rate.
Caesarian section is usually performed for reasons related to mother and baby. Maternal reasons include narrow birth passage, failure to progress in labor, placenta being located low in the womb, growths like fibroids or cysts of ovary located near the neck of the womb.Repeat Caeserean section has to done if the woman has had 2 or more caeserians.Medical problems in the mother like high blood pressure and uncontrolled diabetes leading to large baby may also require caeserian section.
It can be done for risks to baby like slowing of heart rate during labor, umbilical cord slipping out ahead of the baby, baby with restricted growth, large baby, multiple pregnancy, baby being incorrectly positioned in the womb.
There are 3 types of caesarian section.
1. Planned procedure were normal birth is risky for mother/baby.
2. Emergency procedure when normal birth process is disturbed or there is a life threatening situation for mother/baby.
3. Caesarian section at mothers request.
Why is rising caesarian rate a cause for concern and why should it be monitored.
Though caeserian section is considered a safe operation ,concern over rising rate is related to maternal and fetal risks.
Immediate maternal risks are related to anesthesia, more blood loss during caesarian than normal birth, wound and urine infections,risk of clots in legs and lungs which can be fatal. There is a 4-fold increase in risk of death due to caesarian sections.
Remotely, caesarian section can affect future fertility.
Of grave concern is the complication called placenta previa – when the placenta implants near the neck of the womb and on the previous caeserian scar. This exposes the mother to serious bleeding during pregnancy and during delivery.
Life threatening bleeding may need removal of uterus. A risk of low placenta increases with a person having more than 1 caesarian section.
With 4 or more caesarians, the risk of placenta growing into the wall of the womb increases 9-fold.This condition results in failure of placenta to separate after the baby is delivered.Removal of the uterus in this condition is life saving due to risk of life threatening bleeding.
Babies also may be delivered earlier with resultant problems at birth, due to prematurity.
How can caesarian section rate be reduced?
Promoting natural childbirth practices can go a long way in reducing caesarian births.
Antenatal education of the mother about benefits of natural birth versus risks of caesarian births also will help.
Counselling of women who request caesarian section, about the dangers of operative delivery, will help them make the right choice.
Obstetricians should avoid inducing labor before 39 weeks of pregnancy,unless there is a strong reason to do so.
Counselling women that normal birth is possible even after 1 caesarean birth is important.
All hospitals should audit the caesarian births and make conscious efforts to reduce the rate.
These exercises won’t help you look better, but they do something just as important – strengthen the pelvic floor muscles that support the bladder. Strong pelvic floor muscles can go a long way toward preventing incontinence.
Why Kegel exercises matter
Many factors can weaken your pelvic floor muscles, including pregnancy, childbirth, surgery, aging and being overweight.
You might benefit from doing Kegel exercises if you:
• Leak a few drops of urine while sneezing, laughing or coughing
• Have a strong, sudden urge to urinate just before losing a large amount of urine (urinary incontinence)
• Leak stool (fecal incontinence)
Kegel exercises can be done during pregnancy or after childbirth to try to prevent urinary incontinence.
How to do Kegel exercises
It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them.
Find the right muscles. To identify your pelvic floor muscles,
• Stop urination in midstream. If you succeed, you’ve got the right muscles.
• Pretend you are trying to avoid passing gas.
• Pretend to tighten your vagina around a tampon.
Perfect your technique. Once you’ve identified your pelvic floor muscles, empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
Repeat 3 times a day. Aim for at least three sets of 10 repetitions a day. Spreading them throughout the day is better than doing them all at once.
When to do your Kegels
Make Kegel exercises part of your daily routine. You can do Kegel exercises discreetly just about any time, whether you’re sitting at your desk or relaxing on the couch. You might make a practice of fitting in a set every time you do a routine task, such as checking mail, waiting at a stoplight, riding an elevator, or standing in a grocery line.
When you’re having trouble
If you’re having trouble doing Kegel exercises, don’t be embarrassed to ask for help. Your doctor can give you important feedback so that you learn to isolate and exercise the correct muscles.
When to expect results
If you do Kegel exercises regularly, you can expect results — such as less frequent urine leakage — within about a few months. For continued benefits, make Kegel exercises a permanent part of your daily routine.
Keep in mind that Kegel exercises are less helpful for women who have severe urine leakage when they sneeze, cough or laugh. Also, Kegel exercises aren’t helpful for women who unexpectedly leak small amounts of urine due to a full bladder (overflow incontinence).One should seek medical advice in such cases and also if kegels have not benefited or one is not sure of doing these properly.
Dr. Preeti Tandon,
Specialist Obstetrics / Gynecology
MBBS, MD(Obs/Gynae), F.MAS(Laparoscopic Surgeon), FICOG,
Diploma in Adv Gynae Endoscopy (France),
Certified Robotic Surgery Training (USA)
It is the cancer of the entrance or mouth of the uterus(womb). It is a common cancer in women and if not detected early it can be fatal.
What causes cervical cancer?
It is caused by a virus called human papilloma virus(HPV) which is transmitted through sexual contact. There are many subtypes of the virus. It infects the cells of the cervix and causes abnormal changes in them,which if untreated and persistent can develop into cancer.
How can cervical cancer be prevented?
Cervical cancer can be prevented by regular screening with the PAP smear test which is done in the out patient clinic. In this test the cells on the surface of the cervix are scraped and sent for testing to identify any abnormal changes. Testing for cancer causing HPV virus can be done along with the PAP test. In this way the precancerous stage can be identified and treated to prevent the development of cancer.
Who should have PAP smear test and how frequently?
PAP test is recommended once every 3 years in all sexually active women aged 21-65 years.
If any result is abnormal then more frequent testing may be required.
After 30 yrs if HPV testing is done along with pap smear then 5 yearly testing is adequate.
If the pap smear is abnormal what is the next step?
In this case the gynecologist may recommend a further test called colposcopy and a biopsy may be taken if necessary. This is to confirm the presence of abnormality before any treatment is undertaken.
If precancerous changes are confirmed then a procedure known as LEEP/LLETZ(shaving off the abnormal area) may be advised.
If early cancer is detected it can be effectively treated and cured.
Is there any other method to prevent cervical cancer?
A vaccine against high risk subtypes of HPV is also available to prevent cervical cancer.it can be taken from 9-26 years of age. Ideally it should be taken before the first sexual contact but can give protection even if taken later.
Should women who have received HPV vaccine undergo PAP smear screening?
Vaccine does not protect against all the subtypes of HPV but only against the most high risk ones.So it does not prevent all cervical cancer.Hence women who have received the vaccine should still undergo regular screening though they are at much lower risk of developing cervical cancer.
The best way to approach television (and screen time of any kind) is to think of it as refined sugar: You want your kids to enjoy the seductive stuff without consuming it to excess. So you’ll need to stay on top of the time your child spends in front of a screen.
The average American child watches for three to four hours a day, despite the recommendation from the American Academy of Pediatrics (AAP) that kids 2 and older watch no more than one to two hours daily. The AAP recommends that kids under 2 watch no shows at all.
Starting out tough from day one is the key to keeping viewing time under control. It’s a lot easier to relax your standards later than to wean a 5-year-old from a three-times-a-day habit. Here are some tips for monitoring and limiting your child’s viewing time:
Monitoring your child’s watching
Limit the amount of time your child spends watching. More than two hours a day is too much. To make it seem to your child that he’s watching more — and to keep his little brain from going on autopilot as he watches — break up viewing into 10- to 15-minute increments. Keep screens out of the bedroom and turned off during meals.
Avoid setting a firm watching time “allowance” for your child. This seems counterintuitive, but it’s surprisingly effective. You may want to let your child come to you when he wants to watch and keep to yourself what the absolute maximum is. That way, you’ll avoid tacitly sending the message that there’s a certain amount he “should” be watching.
Make screens physically inconvenient. Too often, a screen is a backdrop to family life: It blares away in the den or great room while the kids are playing, Mom’s cooking, or the family is eating. Consider putting the TV in a small, out-of-the-way room in the house (on the second floor, if you have one). Another way to keep the TV from being front and center: Keep it in a cabinet that remains closed when the TV is off.
Choosing what to watch
Go with calm, quiet programs. Slower-paced viewing gives your child time to think and absorb. Lots of random activity, like the kind in action/adventure cartoons, confuses children. And some research suggests that children who watch violence on TV are more likely to display aggressive behavior. Stay away from scary shows, too. Choose simple programs that emphasize interactivity. Ideal are shows that inspire your child to makes sounds, say words, sing, and dance.
Watch programs, not television. Rather than allowing your child to sit down and watch whatever is on, select carefully what he is going to watch. Turn off the set when that show is over.
Your role
Watch with your children whenever possible. Try not to use videos or television as a babysitter. One study looked at three groups: children with unlimited access to television, children with moderate access who watched without a parent, and children with moderate access who watched with a parent. The last group scored significantly higher academically than did the other groups. That aside, just being there says to your child, “What you do is important to me.”
Help your child become a critical viewer. Even young children can learn to watch without “tuning out.” If you’re watching commercial television, talk about what’s going on in the show and in the ads (and clarify the difference between the two). Encourage your child to ask questions and relate what’s happening in the show to his own life. If you’re watching shows without ads, you can watch when you choose and pause to discuss what’s going on.
Make yourself a role model. Children are most affected by the example parents set, so don’t channel surf or keep the TV on as background noise. If your kids see you eagerly sitting down every so often to watch a specific show and concentrating on what you’re seeing, they’ll recognize the potential for enjoyment that movies and other shows actually promise.
Laparoscopic surgery is performed using an instrument called a laparoscope, a thin, lighted telescope that is inserted through a tiny, ½ -inch incision made in the navel. The laparoscope allows a surgeon to see and operate in the abdomen without having to use a long incision. Two or three smaller incisions are made along the sides of the abdomen, to allow passage of highly specialized surgical instruments. Laparoscopic techniques allow surgery to be performed with fewer traumas to patients, and minimal damage to body tissues
With miniaturized instruments, doctor can perform a variety of surgeries.
Laparoscopy generally has a shorter healing time than open surgery. It also leaves smaller scars.
Reasons for Gynecologic Laparoscopy
Laparoscopy can be used for diagnosis, treatment, or both. A diagnostic procedure can turn into treatment.
Indications for diagnostic laparoscopy are:
• unexplained pelvic pain
• unexplained infertility
• history of pelvic infection
• Hysterectomy (Removal of the uterus)
• Oopherectomy (Removal of the ovaries)
• Cystectomy (Removal of ovarian cysts)
• Myomectomy (Removal of fibroids)
• Laparoscopic uterine artery ligation (blocking blood flow to fibroids)
• Endometrial tissue ablation (endometriosis treatment)
• Adhesiolysis (separation of adhesion)
• Tuboplasty / reanastomosis (opening of blocked tubes)
• Burch procedure for incontinence of urine
• Sacrocolpopexy (vault suspension for vault prolapse)
Preparing for Gynecologic Laparoscopy
Preparation depends on the type of surgery. One will need imaging tests and relevant blood tests. You will be required to be fasting for 6-8 hours before the procedure. Tell your doctor about any medication you take. This includes over-the-counter drugs and supplements. You may need to stop them before the procedure.
Procedure
Laparoscopy is almost always performed under general anesthesia. This means you will be unconscious for the procedure. However, you may still be able to go home the same day. The surgeon will make a small cut in your navel. The laparoscope will be inserted. It transmits images to a screen. This gives your doctor a clear view of your organs. What happens next depends on the type of procedure. For diagnosis, doctor might take a look and then be done. If you need surgery, other incisions will be made. Instruments will be inserted through these holes. Then surgery is performed using the laparoscope as a guide. Once the procedure is over, all instruments are removed. Incisions are closed with stitches. Then you will be bandaged and sent to recovery.
Recovery after Laparoscopy
Once the procedure is over, nurses will monitor your vital signs. You will stay in recovery until the effects of anesthesia fade. Recovery time varies. It depends on what procedure was performed. You may be free to go home a few hours after surgery. You might also have to stay in the hospital for one or more nights.
After surgery, your belly button might be tender. There may be bruises on your stomach. The gas inside you can make your chest and shoulders ache. There is a chance that you will feel nauseated for the rest of the day.
Before you go home, you will be given instructions regarding medication and side effects. Your doctor may prescribe pain medication. You may also receive antibiotics to prevent infection.
Depending on the surgery, you may be told to rest for a few days or weeks. Serious complications of laparoscopy are rare. However, you should call your doctor if you experience:
• serious abdominal pain
• prolonged nausea and vomiting
• fever of 101 degrees F or higher
• pus or significant bleeding at your incision
• pain during urination or bowel movements
Outcomes of Laparoscopy
The results of these procedures are usually good. This technology allows the surgeon to easily see and diagnose many problems. Recovery time is also shorter compared to open surgery. Patient experiences less pain in postoperative period. This procedure requires shorter hospitalization and there is less blood loss associated with laparoscopy.
Dr. Preeti Tandon,
Specialist Obstetrics / Gynecology
MBBS, MD(Obs/Gynae), F.MAS(Laparoscopic Surgeon), FICOG,
Diploma in Adv Gynae Endoscopy (France),
Certified Robotic Surgery Training (USA)
Children need vitamin D for bone growth and development. So do babies developing in the womb. This is because vitamin D helps us absorb calcium,
Serious vitamin D deficiency can cause Rickets, delayed motor development, muscle weakness, aches and pains, and fractures.
Vitamin D deficiency in adults has also been linked to osteoporosis, some cancers, heart disease and diabetes
If women don’t get enough vitamin D during pregnancy, their children might develop neonatal hypocalcaemia (not enough calcium in the blood) or rickets later in childhood.
Vitamin D and sunlight
You need sunlight on your skin for your body to make vitamin D. You get about 80% of your vitamin D this way.
No matter where you live, you have to be careful about how much sun you get on your skin. Too much sun can lead to sunburn, skin damage and even skin cancer.
Other factors affecting how much sun you need
People with naturally very dark skin need 3-6 times more sun to make vitamin D than the amount fair-skinned people need.
It’s important to note that there is no conclusive Australian or New Zealand data on how much sun children need for good levels of vitamin D.
To get more information and advice about how much sun is right for you, speak with your GP.
Be sun smart
Spending too long in the sun isn’t good for your skin, so it’s important to use sun protection.
During summer, especially between 10 am and 4 pm, make sure your child is safe in the sun with sunscreen, a hat, sunglasses, clothing that keeps the sun off and access to plenty of shade.
Vitamin D and food
Most children won’t get enough vitamin D from food alone.
But food with lots of vitamin D can add to the vitamin D your child gets from sunshine.
Foods naturally containing vitamin D include fresh fatty fish (salmon, herring, mackerel and sardines), liver, mushrooms and egg yolks. Some of the best food sources of vitamin D:
• 1 ounce salmon: 102 IU
• 6 ounces fortified yogurt: 80 IU
• 1 ounce canned tuna, drained and packed in oil: 66 IU
• 1/2 cup orange juice, fortified with 25 percent of daily value for vitamin D: 50 IU
• 1/2 cup fortified milk (whole, low-fat, or skim): 49 IU
• one slice fortified American cheese: 40 IU
• 1/2 cup fortified, ready-to-eat cereal: 19 IU
• 1 ounce mackerel: 11.6 IU
• 1/2 large egg yolk: 10 IU
• 1/2 teaspoon fortified margarine: 10 IU
• 1/2 ounce Swiss cheese: 6 IU
The amount of vitamin D in a food varies somewhat, depending on the brand of the product.
Some foods have vitamin D added to them. These include margarine and some low-fat milk and dairy products. All infant formula contains vitamin D.
You can boost the benefits of being out in the sun for a little while each day by doing some physical activity while you’re there. This is because daily exercise helps your body make vitamin D.
Vitamin D deficiency
Children might be at risk of vitamin D deficiency if they:
• keep all their skin covered
• spend most of their time indoors and don’t get much or any sun
• have a condition affecting how the body controls vitamin D levels – for example, liver disease, kidney disease, problems with absorbing food (such as celiac disease or cystic fibrosis and some medicines can affect vitamin D levels
• have darker skin
• have been breastfed for a long time and have a mother whose vitamin D is low.
Signs of vitamin D deficiency include rickets, delayed motor development, muscle weakness, aches and pains, and fractures.
How much vitamin D does my child need?
Infants up to 12 months old need 400 international units (IU), or 10 micrograms (mcg), a day. Children older than 1 need 600 IU, or 15 mcg, a day.
Treating vitamin D deficiency
Talk with your Pediatrician if you’re worried about your child’s vitamin D levels, or you’re pregnant and think you might have low vitamin D.
Your Pediatrician can order a blood test, which is the best way to check vitamin D levels.
For mild deficiencies, your Pediatrician might say that your child needs to get a bit more sun.
If you or your child has a severe vitamin D deficiency, your GP might say you or your child should take vitamin D supplements, as well as getting more sun.
If you or your child can’t get more sun, the pediatrician might say that taking vitamin D supplements is the best thing to do. You might take a vitamin D supplement in one large, single dose, or you might take a supplement for several weeks or month.
Solariums aren’t recommended as way to improve vitamin D levels or to treat vitamin D deficiency. Solariums can cause skin cancer.
Vitamin D, pregnancy and breastfeeding
A baby’s vitamin D stores go up during development in the womb and go down after birth until the baby starts getting vitamin D from sunlight along with diet.
If a pregnant woman has low levels of vitamin D, she might not pass on enough vitamin D to her baby.
Breastfeeding babies don’t get much vitamin D from breast milk, because breast milk doesn’t have much. And if a breastfeeding mum has low vitamin D, it can be even harder for her baby to get enough vitamin D.
If you have any concerns about whether your baby is getting enough vitamin D, you can talk with your pediatrician about using a vitamin D supplement. Doctors often say a daily supplement of 400 micrograms is good for mothers who are breastfeeding babies at risk of vitamin D deficiency.
It’s still OK for you to breastfeed your baby if you’re taking a vitamin D supplement.
Infant formula has higher levels of vitamin D, so formula-fed babies don’t usually need a supplement.
Diabetes that develops during pregnancy is known as gestational diabetes. It occurs because body cannot produce enough insulin (a hormone important in controlling blood glucose) to meet its extra needs in pregnancy. This results in high blood glucose levels.
Gestational diabetes usually starts in the middle or towards the end of pregnancy.It may affect up to 18 in 100 women during pregnancy.
Following are the risk factors to develop gestational diabetes :
• Body mass index (BMI) is 30 or higher
• History of previously given birth to a large baby, weighing 4.5 kg (10lbs) or more
• Have had gestational diabetes before2
• Have a parent, brother or sister with diabetes
• Family origin is South Asian, Chinese, African-Caribbean or Middle Eastern.
Patients having any of the above risk factors, should be offered a glucose test during pregnancy. This may be a simple blood test in early pregnancy and/or a glucose tolerance test (GTT) between 24 and 28 weeks pregnant.
Most women who develop diabetes in pregnancy have healthy pregnancies and healthy babies but occasionally gestational diabetes can cause serious problems, especially if it goes unrecognised. Diagnosing and treating gestational diabetes reduces these risks.It is important to control the level of glucose in your blood during pregnancy. If not controlled well baby can become bigger thereby increasing the risk of caesarean section, serious birth trauma and still birth. Baby may also be at greater risk of developing obesity and/or diabetes in later life.Controlling your levels of blood glucose during pregnancy and labour reduces the risks of all thesecomplications.
Having gestational diabetes will mean more clinic visits at the hospital.Healthy eating and exercise. The most important treatment for gestational diabetes is a healthy eating plan and exercise. Gestational diabetes usually improves with these changes although some women, despite their best efforts, need totake tablets and/or give themselves insulin injections. A dietician can help to choose foods that will help to keep blood glucose at a healthy and stable level.If it does not reach a satisfactory level after 1–2 weeks, or if an ultrasound scan shows that your baby is larger than expected, there might be a need to take tablets or insulin injections.
Ideally delivery should be planned between 38 and 40 weeks of pregnancy, depending on individual circumstances.It is important that your blood glucose level is controlled during labour and birth and it should be monitored every hour during labour to ensure it stays at a satisfactory levelDuringlabour, baby’s heart rate should be continuously monitored.
• Breastfeeding is best for babies,
• Baby should have his or her blood glucose level tested a few hours after birth to make sure that it is not too low.
• Gestational diabetes usually gets better after birth and all diabetes medications should be stopped immediately after baby is born.
Being the right weight for height (having a normal BMI), eating a healthy diet and taking regular physical exercise before next pregnancy reduces the risk of developing gestational diabetes again.
Dr. Sagimole Tojichen Specialist Obstetrics / Gynecology
International Modern Hospital Dubai
For Appointments : 971 4 406 3000
Endometriosis is a very common condition where cells of the lining of the womb (theendometrium) are found elsewhere, usually in the pelvis and around the womb,ovaries and fallopian tubes. It mainly affects women during their reproductiveyears. It can affect women from every social group and ethnicity. Endometriosis isnot an infection and it is not contagious. Endometriosis is not cancer.
The main symptoms of endometriosis are pelvic pain, pain during or after sex,painful, sometimes heavy periods and, for some women, problems with gettingpregnant.Endometriosis can affect many aspects of a woman’s life including her generalphysical health, emotional wellbeing and daily routine.Some women do not have any symptoms at all.
Endometriosis occurs when the cells ofthe lining of the womb are found in otherparts of the body, usually the pelvis. Eachmonth this tissue outside the wombthickens and breaks down and bleeds inthe same way as the lining of the womb.This internal bleeding into the pelvis,unlike a period, has no way of leaving thebody. This causes inflammation, pain anddamage to the reproductive organs.
Endometriosis commonly occurs in the pelvis. It can be found:
• on the ovaries where it can form cysts (often referred to as ‘chocolate cysts’)
• in or on the fallopian tubes
• almost anywhere on, behind or around the womb
• in the peritoneum (the tissue that lines the abdominal wall and covers most ofthe organs in the abdomen).
Less commonly, endometriosis may occur on the bowel and bladder, or deep within themuscle wall of the uterus (adenomyosis). It can also rarely be found in other parts ofthe body.It is not yet known why endometriosis occurs.
Ultrasoundcan identify whether there is an endometriosis cystin the ovaries. A normal scan does not rule out endometriosis.For most women, having a laparoscopy is the only way to get a definite diagnosis;because of this, it is often referred to as the ‘gold standard’ test. A laparoscopy is asmall operation which is carried out under general anaesthesia.
The options for treatment may be:
• Pain-relieving drugs reduce inflammation and help to ease the pain.
• Hormone treatments. There is a range of hormone treatments to stop or reduce ovulation (the release of anegg) to allow the endometriosis to shrink or disappear.
• Laparoscopic surgery can be used to remove areas of endometriosis by destroying them or cutting them out.
Not all cases of endometriosis can be cured and for some women there is no long-termtreatment that helps. With support many women find ways to live with and managethis condition.
Dr. Sagimole Tojichen
Specialist Obstetrics / Gynecology
International Modern Hospital Dubai
For Appointments : 971 4 406 3000
PCOS (polycystic ovarian syndrome) is a condition that affects women. It is caused by an imbalance of a woman’s sex hormones which may lead to:
Menstrual cycle changes – irregular periods or no periods at all
Skin problems such as acne, oily skin
Increased hair growth on the face and body
loss of hair on head
Trouble getting pregnant
Being overweight, rapid increase in weight, difficulty losing weight.
depression and mood swings
The symptoms may vary from woman to woman. Some women have mild symptoms, while others are affected more severely by a wider range of symptoms
PCOS affects up to 20 percent of women. The cause is not yet known. It may be genetic since women with PCOS are likely to have a mother or sister with PCOS. Women are usually diagnosed in their 20s or 30s, or sometimes when they are teenagers.
Tips to deal with PCOS
Adopt healthy eating habits. By eating a diet low in carbohydrates and refined sugars you can help reverse the imbalances of glucose and insulin in your body that cause PCOS symptoms to flare up.
Choose better fats: Limit foods that contain saturated and trans fats. Instead of these choose smaller amounts of healthy unsaturated fats, which are found in vegetable oils like canola and olive oil, avocado and nuts
Increase fibre: Eating more fibre can help maintain blood sugar levels and lower your cholesterol
Enjoy protein: Make sure that you have some protein at every meal and snack. Instead of always choosing meat, try chicken, turkey or fish. Or, try vegetarian options such as legumes, soy or a quarter cup of nuts or seeds. Milk and low fat yogurt are also good sources of protein.
Foods to limit: Choose fewer foods that are high in sugar, salt, refined flour and fat such as: White rice, pasta or bread, baked goods, Regular soda, Candy and chocolate and Salty snacks.
Fit exercise into your daily routine. Exercise has proven to boost metabolism and burn calories which helps to control insulin levels and, in turn, results in weight loss. Exercise can also help to stave off diabetes, a health risk for women in PCOS. Take exercise regularly (30 minutes at least three times a week). Start with 10 minutes of activity and work up to longer times as your body adjusts.
Avoid stimulants. Avoid coffee or other stimulants
Get regular physical exams. Women with PCOS have a greater risk of developing cardiovascular disease, diabetes, and some forms of cancer. They are also more likely to suffer from high blood pressure and/or high cholesterol. Meeting regularly with your doctor to monitor and treat these issues will help you stay healthy
Women with PCOS are more prone towards experiencing depression and mood swings. Do something else that you really enjoy doing.
Ask questions.
With PCOS, there is no one size fits all solution to control the disease. Symptoms vary with each person so you really need to discuss with your gynecologist.
Get help if you are depressed.
Maintain a positive attitude.
Medical treatments aim to manage and reduce the symptoms or consequences of having PCOS. Medication alone has not been shown to be any better than healthy lifestyle changes (weight loss and exercise).
Dr. Preeti Tandon,
MBBS, MD(Obs/Gynae), F.MAS(Laparoscopic Surgeon), FICOG,
Diploma in Adv Gynae Endoscopy (France),
Certified Robotic Surgery Training (USA)
When a woman loses 3 or more pregnancies and none of these pregnancies go beyond 5 months ( 20 weeks ).
Pregnancy loss can be either in the first 3 months (12 weeks), with incidence of around 80% , in the second 3 months ( 12 – 28 weeks ) commonly because of anatomical defects of the uterus and in a condition called antiphospholipid syndrome , and in the last 3 months ( 28 weeks to term ) can be because of premature membrane rupture or malformations of the fetus .
In todays world with the onset of late marriages and fewer children are we justified in telling the couple to review back after she had 3 miscarriages or with the various investigative modalities available should we start investigating as soon as the lady has one miscarriage is debatable .But with the available data it was suggested that investigation need to be performed when the patient gives a history of 2 pregnancy losses.
Recurrent pregnancy loss complicates 0.5 – 3% of all pregnancies. Large proportion of these cases are unknown with no proper modalities of treatment .understanding of the causes of pregnancy losses will form the basis for investigation and treatment of the condition .
Chromosomal abnormalities : normally occur in 4% of patients commonly being balanced translocation
Anatomical defects : defects of the uterus and cervix like presence of fibroids ( tumor muscle mass in the uterus ) in a submucous location , presence of adhesions inside the cavity ,uterine anomalies like septate uterus and lastly incompetence of the cervix
Conditions like antiphospholipid antibody syndromes and inherent thrombophilias
Endocrinological disorders like PCOS ( hypersecretion of the hormone called LH ),thyroid dysfunction , diabetes
Immunological factors like presence of antithyroid antibodies
Infections – correction of a condition called bacterial vaginosis has been said to reduce the incidence of pregnancy loss
Lifestyle factors like – smoking , excess alcohol intake and , consumption of high quantities of caffine ( > 300 mg/ day )
All these conditions need to be investigated and treatment regimens designed accordingly .
Most importantly counseling and proper explanation of the condition is of utmost importance as even with correction of all the abnormalities does not guarantee a good pregnancy outcome .
Treatment in a nutshell will be – supplementation of folic acid and vitamin b12, supplementing with metformin in case of PCOS , asprin and low molecular weight heparin in conditions like APLA and thrombophilias , correction of diabetes , treatment of thyroid disorders and treatment of other specific causes
This school year, your children’s homework may be challenging for everyone. Discover which methods are best for helping them learn how to study and complete assignments.
“What’s the answer?” may be the question your child expects you to resolve. But handing over the answers will not help in the long run. Doing their homework for them will not earn them the top grades they’re seeking, even if it is tempting and seems easier.
The point of homework is to reinforce classroom material, add information, improve study habits and test knowledge. Your job is to ensure your children meet these goals in order to improve their grades and retain the knowledge. It’s the reason for education.
The following methods of assisting with homework are beneficial for developing long-lasting skills.
1. Stick with a schedule
Schedule specific times for homework—whether after school or after dinner, it should be free from television viewing, video games, texting or other social functions, even if they prefer to multitask. It’s proven that they aren’t as focused. Stick consistently with the same time and be flexible with other activities.
2. Pick a location
Whether at a desk in their room, the dining room or kitchen table, with siblings or alone, find out which space has the least distractions and is most conducive to productivity. Some kids prefer sound in the background in order to focus, but keep television, phone, internet (except for research) and other tech stuff off-limits.
3. Help them find the answer
“Look it up, you’ll remember it longer,” is a wise remark passed on over generations. Don’t do homework for your child just because you know how. Do one problem together and let them do the rest on their own. This helps them learn and problem solve, a critical skill to acquire. Show interest and be available. This improves a student’s performance.
4. Review work
Follow up to see how your child scored on an assignment and look over mistakes. Mistakes are opportunities for discussion to see if they understand the material. Suggest tips for remembering facts, use flash cards to review material or review concepts. An interactive way of learning is effective, perhaps with an older sibling or fellow student.
5. Meet with teachers
Parent involvement shows teachers that there’s a supportive environment at home that gives a student an advantage in the learning process. If your child lags behind, show concern and teachers will have suggestions to encourage your child and perhaps recommend supplemental studies with a tutor in a subject. Maybe other students don’t understand a lesson either, and the teacher needs to know a method needs reinforcement.
6. When you don’t know the answer
Ask questions. Your child’s homework is also an opportunity for you to learn. Do some research to find out the answers even though you won’t hand them over. Like a reference librarian, be a valuable resource to show kids how to research answers. Be sensitive to their needs. How do your child learn—are they a visual or audial type—by seeing or hearing or both?
7. Make a plan
Get an assignment schedule calendar. When the workload increases and kids are juggling various assignments, your support with timemanagement skills will offer valuable guidance in working through difficult tasks and completing homework. Find out about long-term projects in order to schedule and develop a work plan and get necessary supplies to avoid a last-minute rush to finish.
8. Offer incentives
Motivate children and show them how to prioritize their workload, such as studying for tests. If they receive good scores and maintain grade averages, give them certain privileges.
9. Set an example
Read books. Discuss ideas. Go to a science museum together. Augment their studies with relevant information, such as word and math games. Your actions speak volumes when advice may be ignored.
10. Offer praise
Show off work well done—a test with a high grade, an art or science project. Encourage your kids. If you show you believe in them, it builds confidence. Complimenting children gives them a sense of pride in their academic accomplishments.