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Breast Cancer and Pregnancy

Breast Cancer and Pregnancy

Breast cancer found during pregnancy, breastfeeding or within a year following the birth of a baby is considered Pregnancy-associated Breast Cancer. It is a comparatively rare phenomenon with the incidence rate varying from 1/3000 to 1/10000.

During pregnancy, the menstrual cycles stop in the mom-to-be and the levels of estrogen and progesterone go up. Prolactin, a hormone that tells the breasts to prepare for nursing, also increases during pregnancy.

Such changes in the hormone cause the breasts to change. They tend to feel larger, lumpy, and tender. This can make it harder for the mom-to-be or her doctor to notice a lump caused by cancer until it gets quite large.

Also, the increase in hormones tends to make a hormone-dependent variety of Breast Cancer to grow faster. Cancer tends to be of large size and it is usually at an advanced stage at the time of diagnosis.

Women diagnosed with breast cancer can possibly continue their pregnancy and take treatments as per the level of their pregnancy concurrently. They can proceed and deliver healthy babies. While it is not a blanket statement for all breast cancer patients, it depends on the age of the patient.

When deciding about pregnancy, it is important for the doctors to consider and talk to the patient about her age, family size and type of breast cancer to check aggressiveness and the risk of recurrence.

The diagnostic and staging investigations are limited to Ultrasound, MRI, and biopsy as we cannot expose a woman to radiation during pregnancy.

Treatment During Pregnancy

Surgery can be done during the pregnancy; it does involve some mild risk, associated with anesthesia, of early induction of labor/abortion and/or exposing the pregnant woman to infection.

Chemotherapy can be given during the 2nd or 3rd trimester. During the 1st trimester, chemotherapy can affect the organogenesis and fetal development. Also, it is avoided during the last three weeks of pregnancy

Radiation, hormonal and targeted therapy have to be avoided during pregnancy as they are more likely to adversely affect the baby.

It is also important to know that pregnancy after breast cancer does not increase a woman’s risk of a relapse.

The new Mom may experience some difficulty in breastfeeding post-surgery and radiation, but the possibility is higher with probable lower milk production on the treated side. Chemotherapy drugs can also be present in the milk. Radiation also definitely affects the milk production.

It is very important that the oncology team works very closely with gynecologists & fetal medicine specialists.

Post Breast Cancer Pregnancy

Breast cancer is the most common type of cancer among women. However, if intervention takes place at the right time then this factor cannot discourage motherhood.

As per many medical experts, pregnancy is possible for survivors of breast cancer since it does not increase risk of recurrence and neither does it cause any harm to the baby.

There were concerns raised by doctors earlier that there is increased risk of cancer recurrence in women who contemplate pregnancy, but the latest research show that there is no such phenomenon – there is no increased risk in women who conceive in comparison to women who do not.

Dr. Rohan Khandelwal, the Breast Cancer Specialist in Gurgaon at the Breast Centre, CK Birla Hospital to learn more about breast cancer. Book your appointment today with our best Breast Cancer Doctors

Gallbladder Stones – Everything you need to know

Gallbladder Stones – Everything you need to know

Gallstones are solid deposits that accrete within the gallbladder when there is a chemical imbalance in the digestive fluid bile. Their prevalence among adults has become increasingly common in recent years. Gallstones are a considerable risk factor for gallbladder cancer, which contributes to around 10% of cancer cases worldwide. Moreover, gallstones have been found in 80% of GBC patients in India. Their presence worsens the condition of cancer patients and decreases the chances of recovery. It is thus important to learn about gallbladder stone symptoms to detect them early and get timely treatment. 

This article provides a useful overview of some of the causes, symptoms, recommended treatment and/or surgery for gallbladder stones.

What Are Gallstones?

Gallstones are hard, pebble-like fragments that are caused mainly by an excess of cholesterol, bilirubin or other bile salts.

Their size can vary from as microscopic as grains of sand to as large as a golf ball.

There are two types of gallstones:

  • Cholesterol stones that are the consequence of more cholesterol in the gallbladder than the bile salts can dissolve
  • Pigment stones, which are composed of calcium salts and bilirubin and tend to develop in patients with pre-existing liver conditions such as cirrhosis, biliary tract infections and certain types of anemia

What Causes Gallbladder Stones?

The exact cause for gallstones or what is medically termed ‘Cholelithiasis’ has not been established yet. However, researchers believe that high concentrations of cholesterol, bilirubin or bile salts due to poor gallbladder functioning can contribute to the formation of gallbladder stones.

Several factors can contribute to the development of gallstones. Below are pointers to answer your question on what causes gallbladder stones?

  • Inflammation of the gallbladder
  • Bile duct infection 
  • Polyps
  • Porcelain gallbladder
  • Gallbladder cancer

Symptoms of Gallbladder Disease

Most gallbladder stone patients have what are called “silent stones” and, therefore, remain asymptomatic for quite a long period. When gallstones symptoms manifest, however, they can be agonizing and painful. They may even lead to complications and long-term effects such as inflammation of the gallbladder or cholecystitis, gallbladder cancer, and infection.

The following are some symptoms of cholelithiasis:

  • Biliary colic or dull pain in the upper right side of the abdominal area;
  • Intolerance to fatty foods;
  • Pain between shoulder blades;
  • Nausea and vomiting;
  • Flatulence or the buildup of gas in the intestines;
  • Fever and chills;
  • Sweating

Apart from these, other red flags that one must pay attention to are jaundice or yellowing of the skin and eyes, tea-coloured urine, and clay-coloured stools.

Who Is at Risk for Gallstone Disease?

As reported by the Medical University of South Carolina (MUSC), the following population groups are more likely to develop gallbladder stones:

  • Women aged 20 and over;
  • Men over the age of 60;
  • Obesity;
  • Pregnant women, women who have undergone estrogen replacement therapy, or women who have used birth control pills; and
  • People who have gone on extreme diets to lose weight quickly

How Can Gallstones Be Diagnosed?

Medical or healthcare professionals may use a combination of lab tests and imaging tests to diagnose gallstones.

The following are some of the tests that may be used to establish the diagnosis:

  • Blood tests, to check for evidence of gallbladder disease by evaluating blood count or measuring levels of amylase or lipase enzymes (key digestive enzymes)
  • Ultrasound testing, to capture images of the gallbladder
  • Computed Tomography (CT), for constructing detailed x-ray images of organs of the abdomen
  • A HIDA scan or cholecystography to assess bladder emptying function
  • Magnetic resonance cholangiopancreatography (MRCP), to generate detailed images of the biliary tree consisting of the liver, bile ducts, and gallbladder
  • Endoscopic retrograde cholangiopancreatography (ERCP), a more invasive test to help locate and treat problems of the bile duct and pancreatic ducts.

What Is The Gallbladder Stone Treatment?

Some gallstones treatment options may include:

  • Conventional Medicine such as oral bile acids like ursodiol and chenodiol
  • A wait-and-see approach
  • Non-surgical treatments such as MTBE Injections, Endoscopic retrograde cholangiopancreatography (ERCP), percutaneous cholecystostomy and in rare cases, shock wave lithotripsy to blast large gallstones into small pieces; or
  • Surgery to remove the gallbladder (cholecystectomy)

Surgical Procedures

Surgery to remove the gallbladder, or cholecystectomy, may be recommended if gallstones recur frequently.

Cholecystectomy is of two types:

  • Laparoscopic cholecystectomy, which is minimally invasive and commonly performed
  • Open cholecystectomy, is recommended when the gallbladder is severely infected, inflamed or scarred from other operations.

Home Remedies for Gallstones

Alongside following your doctor’s treatment plan, you could add alternative and complementary therapies for relief, too.

Some widely recommended home remedies for gallstones include:

  • Gallbladder Flush: This involves consuming a combination of herbs, olive oil and some type of fruit juice for 2 to 5 days.
  • Milk Thistle: Commonly taken in the form of capsules or a liquid extract, milk thistle is believed to help with detoxification of the liver and gallbladder.
  • Green Tea: This antioxidant herbal remedy has proven to protect against the formation of gallstones.
  • Turmeric: Turmeric is said to promote the emptying of the gallbladder and stimulate the formation of bile.
  • Globe Artichoke: Extracts of globe artichoke are shown to assist with bile production and support both gallbladder and liver function.

These remedies lack scientific evidence to render them effective treatments for gallbladder stone symptoms. Hence, one must consult a doctor before making use of these treatments.

How Can Gallstones Be Prevented?

Many risk factors of gallstone disease such as age, gender, ethnic background, and genetics cannot be modified to prevent the formation of gallstones.

However, gallstones can be effectively managed and prevented by:

  • Following a healthy diet plan that emphasizes high-fiber foods and healthy fats. Fried foods, processed meats, high-fat dairy products, refined carbohydrates, alcohol, and sugar should be restricted;
  • Maintaining a healthy weight by engaging in regular physical activity; and
  • Avoid smoking as it can contribute to the development of gallbladder stones.

Conclusion

If you experience acute cholecystitis or develop symptoms such as fever, chills, nausea or vomiting, seek immediate treatment. You can schedule an appointment with a gastroenterologist or surgeon at CK Birla Hospital.


FAQs

Q1. Can gallstones go away without surgery?

Yes, gallstones can clear up without any surgery through medicinal methods. 

Q2. What should I avoid eating with gallstones?

You should avoid the intake of fatty foods, high-fat dairy products and fatty meats if you have gallstones. 

Q3. What is the fastest way to relieve gallbladder pain?

Heat compression is the fastest way to relieve gallbladder pain.

Hernia – All you need to know

Hernia – All you need to know

A hernia can be seen as a localised bulge in the abdominal or groin region. It usually is harmless and painless, however, some may present with localised symptoms and hence require treatment.

A muscular wall keeps the abdominal organs in place. Weakness in the wall may lead to bulging of organs causing a hernia. The herniated mass protrudes outside the abdomen which can be pushed into the abdominal cavity with the help of minor pressure or it may disappear by itself when the patient lies down, however any activity like, sneezing, coughing, lifting weight or anything that increases intra abdominal pressure can make it reappear.

There are different types of hernia which affect different age groups and may develop along with different type of health conditions. There’s no exact cause for most of the types of hernia, except incisional hernia. The chances of occurrence of hernia increases with age as muscles tend to lose their tone and become more lax. Males are more likely to develop hernia as compared to females. Children may have hernia which can either be present right from birth (congenital) or may develop due to weak abdominal muscles. Femoral hernia is more commonly found where the bulge is seen right below the groin.

Types of hernia

Inguinal hernia is more common among males with the protrusion seen in the groin which might extend up to the scrotum. It is more common among aged males, chronic smokers, people with previous history of inguinal hernia, positive family history of hernia, people involved in lifting excessive heavy weight, and those who are overweight.

Another form of hernia called as hiatus hernia, develops when the stomach protrudes into the chest cavity through an opening in the diaphragm.

An umbilical hernia shows up more commonly in children. Babies born prematurely or those having excessively low birth weight are likely to develop umbilical hernia. Adult females who have undergone multiple pregnancies and are obese are also at a higher risk of suffering from umbilical hernia.

Some patients who have undergone an abdominal surgery in the past, might experience organs or tissues protruding through the site of incision, this is called as incisional hernia.

Medical conditions or activities that have a potential to increase intra-abdominal pressure over a prolonged period of time can increase predisposition to hernia. Persistent cough, habitual constipation, enlarged prostate, cystic fibrosis, lifting heavy weight, obesity, peritoneal dialysis, excessive straining for urination or stool can lead to hernia in the long term.

Some patients might feel a dragging sensation, some amount of discomfort, and swelling on straining, after prolonged standing, lifting heavyweight. The symptoms might become bothersome to some patients and they might want to see a doctor to get a permanent relief from them.

An immediate medical intervention must be sought in case of an inguinal hernia which shows sudden signs of enlargement, pain, nausea, vomiting and excessive pain. For a non symptomatic one, wait and watch can be the best approach.

The type of surgery required usually depends upon the location and the size of herniated mass. The two usually performed procedures are an open surgery or a laparoscopic surgery.

Some lifestyle changes may be advised in few types of hernia, for example, in hiatus hernia, the doctor will advise you not to lie down right after meals, avoid spicy food and alcohol.

Breast Cancer – Myths vs Facts

Breast Cancer – Myths vs Facts

Breast Cancer Awareness has been a crucial concern for nations across the globe. While the diagnosis of breast cancer can be frightening, it is important to understand that many of the known risk factors, such as genetics or ageing are beyond our control. As you read information, it is important to know what is right and what isn’t. For Breast Cancer too, there are multiple misconceptions that need correcting.

Read below to know the most common myths against breast cancer and the facts behind them.

Myth: Being at risk means there’s nothing much you can do but watch for sign

Fact: Like we mentioned earlier, there are some breast cancer risk factors that you have no control over, like your age and family history.  There are certain risk factors that can be addressed i.e. timely and natural pregnancy and proper and adequate lactation. In addition, there are certain lifestyle habits you should follow, that can significantly reduce your odds, including sleeping regularly, eating well, exercising regularly and maintaining a healthy weight, Reduce stress – It’s important to note that breast cancer risk is linked to increased levels of estrogen, and fat tissue produces excess amounts of it.

Myth: Breast lumps are cancerous.

Fact: While it’s unarguably important for you to see the doctor as soon as possible if you find something unusual in one of your breasts, in a number of cases, lump in breasts are not cancerous. Only 20 % of the lumps are cancerous. However, if the lump persists, it should never be ignored. Ensure that you do regular self-examination and also get an annual clinical exam done.

Myth: Wearing deodorant increases risk of getting breast cancer

Fact: It has been shared in a report by the National Cancer Institute that there’s no conclusive evidence linking the use of antiperspirants or deodorants, and the development of breast cancer. Other research studies have further suggested that since breast cancer risk is linked to increased levels of estrogen. aluminium-based compounds in Paraben creams used for controlling sweat that are applied frequently near the breast may be absorbed by the skin and cause estrogen-like effects.

Myth: Wearing an underwire bra increases a woman’s breast cancer risk

Fact: There is no scientific evidence to support this rumour. Bras do not obstruct the drainage of lymph fluid from the bottom of the breast so there’s no such boost to the risk of breast cancer.

Myth: Bumping or bruising the breast

Fact: This might come across as one of those old-school myths but bumping or bruising the breast is not known to cause breast cancer. However, it may be able to draw attention to an existing lump. An underlying lump which causes a bump or bruise represents an advanced stage breast cancer.

Myth: Your dad’s family cancer history doesn’t affect your risk

Fact: The hereditary variety of Breast Cancer is not sex linked – it can pass from either mother or father’s side. The chances of the affected gene to pass from one generation to the other is 50% and the chances of it being present in a sibling if a person has the affected gene is again 50%. Apart from Breast cancer itself the hereditary linkage is also to Ovary, Peritoneal malignancy.

 When evaluating family history, the male side should be considered. A history of breast cancer from the father’s side can, as a matter of fact, boost your risk. Even though the connection between a family history of prostate cancer and breast cancer is unknown, the possible signs include shared lifestyle factors or gene mutations.

Myth: The longer you breastfeed, the lower the risk

Fact: It’s not the breastfeeding, it’s the fact you don’t have periods. It’s the cyclical month after month.  The more periods you have in your lifetime, the higher you are at risk of getting signs of breast cancer. Breast cancer is the most common cancer in pregnant and postpartum women. When women are pregnant or breastfeeding, their breasts are naturally more tender and enlarged, which may make it harder to find a lump or notice other changes.

Myth: Tobacco smoke has nothing to do with breast cancer

Fact: Tobacco is the greatest preventable cause of cancer and while lung cancer is the main cancer linked to tobacco exposure, it has also been linked to breast cancer. The carbon in the smoke binds to the estrogen receptor which causes increase in Breast Cancer

Visit Dr. Rohan Khandelwal, The Breast Cancer Specialist at the CK Birla Hospital in Gurgaon to learn more about Breast Cancer and treatment options available. Book an appointment here with the best Breast cancer doctors of our Breast Centre .

ALSO READ | Breast Cancer Symptoms & Warning Signs

What to expect during the third trimester of your pregnancy
Sep 24, 2019|Dr. Astha Dayal

What to expect during the third trimester of your pregnancy

The third trimester of pregnancy starts from the 28th week and continues till delivery. Delivery of the baby usually takes place around 40th week of pregnancy. However, there can be a variation of a week or two on either side. Crossing your EDD might require induction of labour. Have a chat with your doctor regarding the same.

The baby will grow in this trimester to its full extent. The baby develops all its systems and organs to its entirety. By the time you reach the 34th week of pregnancy the head of the baby usually moves down with bottom up position. In some cases, however, the baby may continue to lie in the breech position. You will be experiencing lots of fetal movement during this trimester. Abdominal skin and round ligaments of the abdomen are stretching to accommodate the growing baby. Fatigue can be common during this trimester as the baby is growing and hence exerting weight on to your lower abdomen and back. Heartburns may recur as experienced in the first trimester, as the growing uterus pushes stomach and its contents upwards.

You may experience lack of bladder control leading to frequent urination/urine leakage, even when you sneeze. Try doing Kegels exercise to relieve the symptom. Leaky breast is another common phenomenon experienced in this phase of pregnancy. Keep the skin of the abdomen moisturized to combat itching, dryness and stretch marks.

Around the 36th week, you may experience something called lightening where the baby drops in the pelvis and the presenting part of the baby gets accommodated into the lower pelvic bone.

You may experience stringy mucus of a pink or brown colour which is a sign of labour being on its way. Labour contractions are like fetal movements but unlike the fetal movements experienced before, this time the contractions are not going to decrease in intensity upon movement but will only increase in intensity.

In case you have fever, vaginal bleeding, abdominal pain or any abnormal symptom drawing your attention, you must talk to your gynaecologist immediately. In this trimester, you will want to keep count of movements that you experience throughout the day. Be cautious about the number of fetal movements you perceive especially during the ninth month; the numbers and fetal movements are likely to reduce to some extent as you approach the day of delivery. After due consultation with your doctor, keep doing pregnancy exercises and taking relaxation massages in this trimester.

You can expect to undergo some diagnostic tests in trimester such as a sonogram for fetal growth and the blood flows along with physical examination which will include examining the pelvis. You will also be finishing your vaccination course by this time .

In case you are declared as a high-risk pregnancy, opt for a hospital well-equipped with advanced neonatal care support. Get a hospital booking done in advance to avoid last minute hassles. The Neonatal Care Unit at the CK Birla Hospital provides expert neonatologists to ensure that the treatment is as comfortable for the baby as far as possible.

Also Read | What to expect when your baby is in the NICU

Keep your hospital bag ready with all necessary items which will be required immediately post birth. Enroll yourself into classes and learn about the available options and healthy delivery, like a water birth, labour analgesia, pros and cons of a caesarean section, breastfeeding techniques and its benefits, etc.

Inform your family members and your doctor about any special arrangement that you would like to have at the time of childbirth.

Connect with one of our expert obstetrician at the CK Birla Hospital, top maternity hospital in Gurgaon to learn more about the basics of post-delivery care for the baby and yourself. Book an appointment today!

What to expect during the second trimester of your pregnancy
Sep 24, 2019|Dr. Astha Dayal

What to expect during the second trimester of your pregnancy

The second trimester begins from the 13th week of pregnancy and lasts till the 28th week. During this phase of pregnancy, women tend to get some relief from the symptoms of the first trimester including morning sickness, nausea, and headache. You will feel more energetic and relatively better in this trimester of pregnancy. You can expect to undergo some tests around the 20th and 27th week to check for the progress of pregnancy including the growth of the baby and the possibility of any abnormality which can affect the health of the baby or the mother in the long run. You can consider this as one of the best phases of your pregnancy as you feel relatively at ease and you can now start feeling the baby bump as it starts showing up bit by bit. You will also start to feel the movements of the baby within you.

However, there are some growing discomforts. The uterus will grow larger in size as the baby is growing now and exerting its weight towards your back leading to a sense of pain and discomfort. You should sit with your back straight, supported with a comfortable cushion. Keep a comfortable pillow in between your legs while you are sleeping and always try and sleep sideways. Avoid lifting heavy weights. Try to wear shoes with a proper arch and a comfortable sole and as far as possible avoid heels.

Many women may experience gum diseases during pregnancy. This happens due to an increased blood flow to the gums as a result of the hormonal changes. Practice proper oral hygiene and use a dental floss.

Like gum bleeding, nosebleeds are also not uncommon during pregnancy. Increased blood flow often leads to stuffiness of the nose and may result in bleeding eventually. You can use decongestants, but do so only after consulting with your doctor. However, you can use natural methods of the decongestion like nasal saline drip or other simpler natural methods.

You might feel some form of breast tenderness that you would have experienced in the first trimester. Your breasts are still enlarging to ensure proper nourishment for the baby post-delivery. You may require a bra that is a size larger than your normal.

Some amount of vaginal discharge is normal at this stage, if you feel uncomfortable you can use a panty liner, but do not use a tampon as external germs may be introduced into the vagina.  If the discharge smells offensive or has an abnormal colouring, you should talk to your doctor immediately.

Heartburns can become a regular issue if not paid much attention to. Pregnancy hormones relax the digestive system affecting the general process. Food rich in spices and oil increases the chances of heartburn. Take frequent meals. Have plenty of water and fibre rich food for proper functioning of the digestive system.

Around the 20th week of pregnancy, you may start feeling some movements in the abdomen, called as quickening. However, not all women may have quickening even till 28 weeks. But this should not be a matter of concern. Relax, there are some cases where women only start feeling quickening during the ninth month of pregnancy only.

The pregnancy hormones lead to some changes in the colouration on the face of the females often called as pregnancy glow. There can be some dark spots on the face and towards the midline from the navel. This usually disappears post birth. The skin at this time is highly sensitive to sun rays. You must use some form of sun protection in the form of lotions, clothing, hats and sunglasses.

You might start noticing some stretch marks in the lower abdomen and lower back. These are due to undue stretching of the skin to allow the growing foetus accommodate itself. Many stretch mark creams are available in the market which claim to reduce stretch marks to some extent. Keep your skin hydrated with proper moisture in order to get relief from itchiness and dryness of the skin.

As the morning sickness has subsided by now, your appetite will increase, and you can relish eating different types of food items you have been craving for. However, you should keep a watch that you do not overindulge. Keep your calorie count to not be significantly more than what you intake during your non pregnancy stage. Remember, some amount of weight gain is not only healthy but necessary in order to have a healthy pregnancy.

Be sure to consult your doctor if you experience any of the following symptoms:

  • Excessive vaginal discharge
  • Fatigue or dizziness
  • Severe cramping pain in the lower abdomen
  • Too much or too little weight gain or no weight gain

Speak with one of our expert obstetrician at the CK Birla Hospital, best maternity hospital in Gurgaon, to learn more on the do’s and don’ts during pregnancy for a healthy pregnancy. Book an appointment here.

Why is it important to maintain menstrual hygiene
Sep 24, 2019|Dr. Astha Dayal

Why is it important to maintain menstrual hygiene

The onset of menstruation is one of the most important physiological changes occurring in girls during the adolescent years. Menstruation heralds the onset of physiological maturity in girls. It becomes the part and parcel of their lives until menopause. Apart from personal importance, this phenomenon also has social significance.

Menstrual hygiene is a hygienic practice during menstruation which can prevent women from the infection in reproductive and urinary tract. In India, menstruation is surrounded by myths and misconceptions with a long list of “do’s” and “don’ts” for women. Menstruation and menstrual practices are still clouded by taboos and socio – cultural restrictions resulting in adolescent girls lacking knowledge and remaining ignorant of the scientific facts and hygienic health practices, which sometimes results into adverse health outcomes.

Hygiene-related practices of women during menstruation are of considerable importance, as it may increase vulnerability to Reproductive Tract Infections (RTI’s). Poor menstrual hygiene is one of the major reasons for the high prevalence of RTIs in the country and contributes significantly to female morbidity. Lack of knowledge regarding menstruation and menstrual hygiene lead to poor attitude and practice. There are various issues like awareness, availability and quality of napkins, regular supply, privacy, water supply, disposal of napkins, reproductive health education and family support which needs simultaneous attention for promotion of menstruated hygiene.

 Common repercussions of unhealthy menstrual practices

  • Irritation of the skin causes discomfort and can possibly result in dermatitis – a medical condition in which the skin swells, turns red, and at times becomes sore with blisters.
  • Introduction of bacteria into the urethra may cause urinary tract infections (UTIs). It can happen anywhere in the urinary tract and can be fatal as it can even damage the kidneys if left untreated.
  • Alteration of the pH of vaginal flora can happen. This can lead to change in environment and increased tendency to get bacterial vaginosis. It impacts the maximum when the women is trying to get pregnant.

Frequent episodes of such infections can lead to future consequences like difficulty in conceiving, increased risk of abortions and preterm delivery. Hence, not maintaining proper menstrual hygiene can affect entire reproductive career of woman.

Follow these healthy practices

  1. Change frequently – Changing sanitary napkins or tampons within every 4-6 hours is the cardinal rule to establish vaginal hygiene. Menstrual blood, when released from the body attracts various organisms from our bodies, which multiply in the warmth of the blood, and cause irritation, rashes or urinary tract infections. Changing your sanitary napkin or tampon regularly curbs the growth of these organisms and prevents infections.
  2. Wash yourself properly – Washing your vagina regularly is extremely important, because the organisms cling to your body after you have removed your sanitary napkin. Most people wash themselves regularly, but not the right way–which is, using your hands in motion from the vagina to the anus, not vice-versa.
  3. Don’t use soaps or vaginal hygiene products – While using vaginal hygiene products every day is a good idea ,avoid overusing them.Vaginas have their own cleaning mechanism which comes into play during menstrual cycles, and these artificial hygiene products can hamper the natural process leading to infections and growth of bacteria.
  4. Discard the sanitary napkin properly – Disposing off your tampons and sanitary napkins properly is an important step. Wrap them properly before you throw them away, so the bacteria and infections do not spread. Make sure you don’t flush them, since that will block the toilet causing the water to back up, spreading the bacteria all over it. Washing your hands properly is of utmost importance after you have wrapped and discarded the used tampons and sanitary napkins, since you’re likely to touch the stained area while wrapping them
  5. Stick to one method of sanitation – Using multiple methods can sometimes gives false sense of low menstrual blood loss and prolonged usage of items, leading to increased chances of infection after prolonged contact.

ALSO READ | Tips to tackle menstrual cramps

Case Study | Sameena: A Tongue Cancer Survivor
Sep 2, 2019|Dr Harsimran Singh

Case Study | Sameena: A Tongue Cancer Survivor

Background & Early Signs

Sameena is a 32-year-old, mother of 5 children. She has fought a successful battle against advanced oral(mouth) cancer, enduring complex treatment consisting of Radical Surgery followed by Chemo radiotherapy. She is now free of cancer and back to her normal life.

Sameena had been a tobacco user (she consumed ‘Gutka’) for close to 15 years, consuming it intermittently without her family’s knowledge. In November 2018 she developed a blister in her mouth. It was irritating her, but she thought it would go away. A week passed. Then two. And it didn’t. She saw some Doctors locally who gave her symptomatic medicines, but the blister didn’t heal.

So, she took matters into her own hands and massaged it vigorously causing it to burst. It broke up into a thousand of fragments inside her mouth and spread in her mouth and throat and she started experiencing pain.

Till that time, she had not spoken about it to her husband. But when the problem spread and she was in pain and discomfort, she told her husband. They visited a government hospital in Delhi who took a skin swab from the affected area and did a biopsy. The results of the tests were not good. Sameena was told that she had oral cancer. Life stopped that day for Sameena and her family.

Oral Cancer

India has the largest number of Oral (Mouth) Cancer patients, due to the rampant habit of tobacco chewing. Oral Cancer is described as cancer occurring in Buccal (cheek), tongue, floor of the mouth, jawbone and palate. Rampant smoking and alcohol abuse also contribute to the occurrence of oral cancer. Majority of times the formation of oral cancer is preceded by certain changes like difficulty in mouth opening, white or red coloured patches and/or presence of ulcers that do not respond to conventional treatment. There is a myth hat if we touch the cancerous area by way of any surgical methods including even a biopsy, it will spread, “Ched diya to badh Jayega.” These leads to the patient seeking alternative or conservative treatment methodology leading to a delay in diagnosis and treatment and at times loss of life as well.

The cure in oral cancer is hardly possible without surgery. Oral cancer surgery has two components, first part is to remove the cancer along with its nodal basin which is the territory of its spread followed by reconstruction or putting back the removed part so that the patient can eat, speak and have a near normal appearance. Early stage oral cancer involves less extensive resection (removal) of the affected area with simple reconstruction measures. But as the stage advances the resection becomes more extensive and reconstruction becomes more complex. Also, at an early stage we can achieve cure with single modality whereas in advance stages, surgery has to be followed by radiation or chemoradiation to achieve cure or prevent recurrence, i.e. multimodality.

When she came to us

Sameena came to us when the ulcer had involved half of her tongue and spread to her neck in form of nodal metastases. Had it spread, beyond the neck, her chances of getting cured from the cancer would have been minimal.  To save her life, surgical intervention was the only way forward. On hearing this, the world crashed down around her and she lost consciousness. The family toiled hard to mobilise resources for her treatment. The disease played havoc with the family’s finances and the children’s education was also interrupted. We subsidised the expenses of the treatment at the CK Birla Hospital as far as possible to support the patient.

Watch the video below as Sameena talks about her journey to recovery.

Surgery

Sameena underwent radical resection of the left half of tongue including the posterior most limit alongwith removal of lymph nodes from both sides of the neck. We used the tissue from the left cheek to reconstruct the tongue. The tongue is a complex and sensitive organ of the body – contributing or directly providing various functions such as tasting, swallowing, breathing, and speaking. Therefore, a tongue surgery for cancer is a complex procedure. The task before the surgeons was not just to get rid of cancer with adequate margins not leaving anything behind but also to replace the lost tongue so that patient can speak and swallow food and get back a life as normal as possible.

The surgery lasted for more than six hours followed by two days in the ICU.  The surgeons did a tracheostomy, (an artificial opening was created in the windpipe) to secure the patient’s breathing during the recovery period. Also, a feeding tube was put through the nose to feed the patient.  The surgery was successfully performed by Surgical Oncologist leading Head & Neck and Breast Oncologist at CK Birla hospital and a Consultant, Surgical Oncology. Sameena was discharged six days after hospitalization. So, within a week, she was able to walk out of the hospital without any assistance and speak as well. For six weeks post-surgery Sameena was on a liquid diet administered through the nasal feeding tube.

Post-Surgery

It is now three months since Sameena has completed her radiation. She is cancer free, eating soft food with decent speech and back to regular daily routine and involved in raising her kids. She has now taken a strong vow to never touch Gutka again.

IUI Treatment
Aug 30, 2019|Dr Tripti Raheja

IUI Treatment

Intrauterine insemination (IUI) is a relatively simple fertility process of inserting the male ready semen through the neck of the female internal reproductive organ (cervix) and into the uterus, close to the process of ovulation.

During IUI, a woman’s eggs are surgically retrieved from her ovaries; inseminated and developed into embryos inside a lab; then transferred into her womb. During IUI, the sperm (whether from your partner or a donor) when it is ready, is inserted into the womb through a soft tube.

IUI treatment

A typical IUI treatment cycle begins at the beginning of your menses and ends after you take a blood pregnancy test, concerning the period after your IUI.

First, you’ll get a blood test on the second or third day of your menses to confirm that you aren’t already pregnant. Your doctors can typically perform a transvaginal ultrasound to look at your uterine lining and your ovarian follicles.

During the weeks before ovulation, your doctor can perform further ultrasounds to make positive that your uterine lining is thickening, and your follicles are growing.

When a minimum of one mature egg (oocyte) on the ultrasound measures over twenty millimetres, ovulation is probably going to happen soon. At now, your doctor may instruct you to require a gonadotrophin trigger shot (which induces ovulation about 36 hours after the injection) and will schedule your IUI.

Or, your doctor may tell you to continue measuring the level of gonadotropin (which peaks 24 to 48 hours before ovulation) in your urine with a nurse at-home test. Once the test indicates that your LH levels have peaked, the IUI is usually performed the following day.

If you’re using sperm from a male partner, he can come to the clinic on the day of your IUI to deposit a sample, and therefore the fertility clinic can prepare it for insemination. This method involves washing it to get rid of unwanted substances like non-motile sperm, white blood cells and prostaglandins (hormone-like chemicals which will cause painful cramping once deposited into the uterus).

If you’re using frozen donor sperms, your clinic will thaw it on the morning of your IUI.

During the IUI, your doctor will insert a speculum into your vagina and thread a thin, versatile tube through your cervix to deposit sperms into your womb.

The entire method sometimes takes about 5 minutes. Your doctor can doubtless advise you to lie down for about ten minutes after the procedure to prevent you from feeling lightheaded or dizzy.

About a week later, several fertility clinics can check your progestogen levels with a blood test to see whether you ovulated around the time of the procedure.

About two weeks after your IUI, you’ll take a blood test to check if you’re pregnant. For most women, this “two-week wait” is the hardest a part of the IUI cycle. It is tempting to read into each symptom you experience. Do your sore breasts mean you’re about to get your period? Or does it mean that you’re pregnant? Solely the blood test can offer official confirmation.

Success rates of IUI

IUI is less invasive and less expensive than I.V.F., it tends to be less effective. Research suggests that women with unexplained infertility have about a 20-to-25-percent probability of getting pregnant over a few cycles. women under 35 years of age who choose to do IUI as a result of they aren’t getting periods often will see success rates as high as 50 % across 3 to 6 cycles.

Desirable Candidate

  • If you or your partner has been diagnosed with infertility, hostile cervical mucus secretion, minor sperm abnormalities or other male disorders, IUI is sometimes a winning option.
  • It also can be used when semen has been frozen due to a husband’s absence or before therapy or radiation therapy.
  • It is more useful in women who are not of advanced maternal age.

Rate of success for women in their 40s

Yes, however, the probabilities of becoming and staying pregnant are lower than they are for women in their 20s or 30s.

Risks

The IUI procedure carries few risks. While there’s a “theoretical” risk of infection with any procedure that involves “introducing something through the vagina and therefore the cervix and into the uterus,” infections are rare.

There is, however, the chance of becoming discouraged given the comparatively low success rates,

the main risk to IUI is that the couple might lose stamina and drop off having not even begun effective medical treatment for infertility “You’ve ought to be prepared for a negative pregnancy test 9 out of 10 times. If you’re ready for that, then IUI is unquestionably the first thanks to going for many of our patients.

The Essence

  • Intrauterine insemination, or IUI, is a non-surgical fertility procedure in which sperm is injected into a woman’s uterus through a thin, flexible catheter.
  • It is timed to occur just before ovulation and takes a few minutes to perform.
  • Women often try IUI before progressing to more expensive and invasive fertility treatments, like in-vitro fertilization, or I.V.F.
  • IUI is a modest intervention with similarly modest results. In the best-case scenarios, success rates can range from a 20 to 50 percent chance of pregnancy throughout a few IUI cycles. So, if it doesn’t work, don’t blame yourself.
  • Your success rate is typically dependent on your age and the reason you’re getting an IUI in the first place.
  • IUI is not supposed to hurt, though you may feel some cramping afterward.
    • After IUI, it’s O.K. to resume normal day to day activities.

Learn more about the IUI process best explained in the video here by Dr. Pankaj Talwar, the best fertility specialist at the CK Birla Hospital in Gurgaon. Book your appointment today!