Raja Shri Grandhim Speciality Hospital

With the increasing prevalence of diabetes, it is being considered as the next big epidemic – completely related to lifestyle. India has become the diabetes capital of the world with increasing prevalence. The age of onset of diabetes is reducing, with children having diabetes and requiring insulin. The complications arising out of diabetes are also more – there is no bodily system which is not affected by diabetes. For someone who is diabetic, keeping blood sugars under check is the constant challenge. Uncontrolled blood sugars can lead to transient complications including loss of consciousness and fatigue and long-term complications including neuropathy and retinopathy. 

What is CGMS: 

Continuous glucose monitoring system is an FDA approved device. This device has a sensor that is placed either in the belly area or on the arm. These sensors identify the sugar levels in the body fluid and send it to a wireless which is worn by the monitor patient as a belt. Readings can be obtained at regular intervals, ranging from every 5 to 15 minutes.

CGMS measures blood sugar levels every 15 mins, that is 96 times a day The data can be downloaded into a persona device – smartphone, tablet, or laptop and used for further analysis. It does not replace the need for routine monitoring, but helps improve vigilance with a constant monitoring. It can help detect trends and patterns and helps the doctor identify periods of the day when the sugars are too high or too low. The amount of insulin or antidiabetic medication required can be adjusted based on sugar levels. The exercise regimen can be defined including the type, time, and duration of workout. Meal planning can be customized to suit body needs in a better manner. Night-time sugar lows which often go undetected can be monitored with the alarm Highs or low between meals (especially with snacking) can be tracked Determine treatment efficacy. The biggest advantage of CGM devices is that they provide information on what is happening to your blood glucose level every few minutes.

CGMS measures blood sugar levels every 15 mins, that is 96 times a day. The newest devices display glucose readings on a screen so you can see – in real time - whether glucose levels are rising or falling. Some systems also contain an alarm to let you know when your glucose reaches high or low levels. Some devices are able to display graphs revealing glucose levels collected over a certain number of hours on its display screen. The data collected on all devices can be uploaded to a computer for graphing and further important trend analysis. 

Whom is it for?

If you think this is a great way to constantly watch your sugars, it is not required. The following people would benefit from this. People with insulin pump usage Those who have frequent fluctuations in sugar level, which is not clearly explained Those who are not aware of low sugars, and may have problems with fatigue or loss of consciousness Gestational diabetes. 

The Usage 

Continuous glucose monitoring systems (CGMS) may not make life with diabetes any easier. But they can definitely improve health, if you can deal with the hassle and expense. So how do you know if such a system is right for you? You can easily and discreetly view your current glucose values continuously throughout the day, without having to do a finger stick. It’s easy and discreet. The monitors have “trend arrows” that show you if your level is rising or falling quickly, so you can prevent highs and lows. 

Continuous glucose monitoring can help “identify fluctuations and trends that would otherwise go unnoticed with standard HbA1c tests and intermittent fingerstick measurements. The device can capture dangerously low overnight blood sugar levels which often go undetected, reveal high blood sugar levels between meals, show early morning spikes in blood sugar, evaluate how diet and exercise affect blood sugars, and provide up to a 72-hour complete review of the effects of changes made to your therapy by your health-care team. 

If you are a dedicated investigator, you can use CGMS to understand what’s happening with your blood sugar levels.

A woman is an extraordinary and beautiful creation of nature, and it is natural that she would want to see herself as perfect and complete. And, staying sexually attractive is one of the major factors that motivate a woman to seek the benefits of Cosmetic Gynaecology. Cosmetic Gynaecology or Intimate Aesthetic Surgerycovers procedures which alter the appearance of female external genitalia and make it seem more natural and youthful. These methods, aid in correcting congenital defects, enhances the self Confidence of a woman, and positively affects the intimacy she shares with her partner.

With age and life events like childbirth, the vagina and labia often change in appearance and structure, which not only hampers the feeling of self-worth in a woman, but also prevents her from enjoying sexual activities completely and Cosmetic Gynaecology emerges as the savior in such situations.

Here are some procedures, which are here to help the fairer sex rediscover the beauty of their body:

1. Vaginal Rejuvenation: With the help of laser technique, this process helps in tightening the internal diameter of the vagina, when it gets stretched during birth or owing to genetic factors.
2. Labiaplasty: Through this method, the contours of the labia majora or labia minora are changed. It may cover reconstruction, augmentation or reduction.
3. Hymenoplasty: It is done to create a pseudo hymenal membrane from hymenal tissue, which already exists or non*hymenal soft tissue. The intention is to cause bleeding when the membrane tears during intercourse.
4. Clitoroplasty: This procedure deals with the surgical transformation of the clitoris, which caters to conditions involving increased tissue volume. It can also aid in creating clitoris in transgender women.
5. Clitoral Hood Reduction: The method is focused on the loose skin around the clitoris, and can be conducted during labiaplasty or as a separate procedure.
6. Monsplasty: The contours of the Mons pubis can be changed through this process. It involves liposuction for the reduction of excess fat, subcutaneous fat, as well as skin. Often, techniques like laser and ultrasound are used during monsplasty.
7. Perineoplasty: Repairing and restoration of the loose, ageing or injured perineum is taken care of through this method. Perineum is the area between the vagina opening and the rectum. And this procedure is usually helpful for women who don't heal efficiently after a vaginal delivery or experience scars.

So if you are worried about the structure or appearance of your intimate area, don't fret.

Homeopathy, being an alternative form of medicine, is often misunderstood when compared to allopathic treatments. In fact, there are many myths and rumours about the working of this field of medicine. This has become a primary reason as to why many people think twice before trying out homeopathy. However, of late, more and more people are breaking the shackles of these myths and rumours and opting for this natural and alternative form of medicine. Here are certain myths and facts which disclose the truth about them.

1. It is often said that homeopathy first aggravates the symptoms and then reduces it. Most people shy away from this prospect and decide otherwise. The fact is, sometimes the condition worsens naturally due to the serious stage at which it is in. This is, however, not caused by side effects of taking any homeopathic pills. Thus, this line of treatment does not aggravate the symptoms. This is a myth and should be looked beyond.
2. A set of people believe that homeopathy, being natural, has the ability to cure any disease whatsoever. But it has to be kept in mind that homeopathy is, after all, a natural science of medicine. Just as allopathic cure sometimes fails to produce the desired results, homeopathy too fails at times in delivering. But this is no reason to not opt for such a treatment. Every field of medicine has its own sets of limitations.
3. At times, homeopathic doctors are not given the same respect that is given to those who practice allopathic treatment and deal in general medical sciences. Here, it needs to be discussed that homeopathy is an alternate form of medicine, which is practiced by those who have a proper degree in medicine, even in general medicine. In fact, many conventional doctors have thought it beneficial to switch streams of practice and have left allopathy for homeopathic treatments.
4. Homeopathy is believed to provide relief only from pains, allergies and maybe skin troubles. But it is not so. Recent developments and studies have shown that homeopathy, if administered effectively, can also bring about pathological changes in the individual.
5. People think that homeopathy takes time to show its results. But this is not true. In fact, at times while treating fever, cold and allergies, it shows rapid results. It is only when the disease is chronic that it takes time to heal.

These are some of the popular myths about homeopathy and it is needed that these myths are busted so that more and more people believe in the power of homeopathy.

When it comes to pregnancy, caring for your body begins even before conception. Preconception health care focuses on what you need to do before getting pregnant and increases your chances of having a healthy baby. For some women, it can take a merely a few months to prepare their body for pregnancy while for others, it can take longer.

Here are a few steps to help you get ready for a healthy pregnancy.

1. Visit the doctor: Your first visit to a doctor should be scheduled long before you conceive a child. Your doctor will typically want to know what medication you are on and if any vaccinations are scheduled. He or she will also discuss your medical history and any medical conditions that may affect the baby’s development. You may be asked to undergo a routine blood and urine test to check your hormone levels and rule out any infections. A visit to the dentist is also a good idea.
2. Start nutritional supplements: Expectant mothers are almost always advised to start folic acid supplements early in the pregnancy. This helps the development of the baby in its first few weeks of life and helps prevent birth deformities such as spina bifida. Other supplements that may be recommended include zinc and calcium. However, it is always a good idea to take these supplements only after consulting a doctor.
3. Make positive lifestyle changes: If you drink alcohol or smoke, now would be a good time to stop. Alcohol and nicotine can affect your baby’s health and hence it is important to cleanse your body of these toxins before conception. Alcohol and caffeine have both been linked to the risk of miscarriages and lower the chances of conceiving a baby. Consider moving if you live around a toxic atmosphere and shifting jobs if your work stresses you out too much.
4. Exercise: Regular exercise helps keep you fit and boosts your stamina and immunity. Regular exercise also helps avoid pregnancy complications such as preeclampsia and diabetes. Additionally, it helps keep weight gain under control and can help shorten labour time. However, do not start anything extremely strenuous but limit yourself to simple exercises like walking and swimming.
5. Maintain a healthy weight: Being overweight can increase your risk of pregnancy complications and hence if you are planning on conceiving a child, now is the time to reach a healthy BMI. To do this, you must follow a healthy diet and exercise regularly. Being underweight can also trigger problems and hence you should talk to your doctor about finding a way to reach the optimum weight.

In an age where contemporary and conventional medicine seems to cure an ailment only to cause significant side effects, it is only to be expected that people wish to take a look at alternative medicine. One of the primary forms of alternative medicine happens to be homeopathy. That being said, people do have concerns as to whether homeopathy has any side effects, as well.

The truth of the matter is that homeopathic medicine does have side effects. It is only to be expected to see side effects when any medicine, at all, is consumed in an amount which is greater than what it is to be consumed in. The good part when it comes to homeopathic medicine is the fact that the side effects are not close to as bad as those of allopathic and other medicines.

The only signs of an overdose and its accompanying side effects in terms of homeopathy is likely to be that the person will show effects of a high amount of energy. All this means is that the medicine has had its intended impact and has gone beyond that. Once the homeopathic medicine stops, all the symptoms are very likely to disappear without a permanent trace. Is this not better than conventional medicines whose side effects can lead to more medication being required in order to sort out the adverse side effects?

In a few of the many cases of treating patients by the way of homeopathic medicine, it is found that when the course of medicine is begun, the situation does get a bit worse prior to it getting better. This is known professionally by the term ‘homeopathic aggravation’ and is nothing to worry about, by any measure.

Most forms of homeopathic medicine feature a very high level of dilution of the actual medicine, so the risks are minimal. That being said, there are a few medicines which can have side effects if they are consumed in larger than prescribed doses. Arnica, which is a popular medicine, is one. It can cause some stomach irritation. However, as long as it is consumed in the right quantity, there is no need to worry about this. Isn’t that quite a relief?

The high degree of customization when it comes to homeopathic treatment is also good as what this does is that it reducing the risk of side effects. This is because, after all, a side effect is generally caused by the lack of suitability of an element in the medicine to the person who is under treatment. Because homeopathic treatment is customised, the scope of this is limited, which is quite a good thing!

The available eggs in the ovaries at a time are collectively called an ovarian reserve. Low reserve happens when the production of eggs reduces. This affects the chances of pregnancy. The general cause of low reserves can be aging ovaries. In such cases, the ovary may be healthy and functioning even if the reserve is low. Production of eggs lower as a woman ages. A woman starts with 250,00 to 500,000 eggs at puberty and ends up with 1000 eggs at menopause.

Causes:
Low reserves are caused by

1. Production of eggs decreases: Chromosomal abnormalities like Turner syndrome (lack of two X chromosomes) and genetic anomalies like Fragile X can decrease egg production.
2. Ovarian tissue damage: Rough torsion, endometriosis triggered ovarian cysts, malignant or benign tumours, surgical removal of ovary or any other part of it, chemotherapy or radiation, pelvic adhesions, immunological problems or high BMI (Body Mass Index) can destroy the ovarian tissues.

IVF Protocols:
If a woman has low ovarian reserves, then she will be put on the either of the following protocols:

1. Short GnRHa Flare: Gonadotrophin releasing-hormone-agonist (GnRHa) like Lupron, Nafarelin, Synarel or Buserelin is administered. This therapy is initiated at the onset of menstruation. The goal of the treatment is to stimulate the release of the follicular stimulating hormone (FSH) which augments the ovarian follicular growth.
2. Combined Clomiphene or Gonadotrophin/Letrozole Stimulation: Older women are mostly administered this protocol. But it is strongly advised not to, as this protocol can potentially harm the egg or the embryo.
3. Mid-follicular GnRH-antagonist protocol: Once the GnRHa-agonist protocol is commenced, the GnRH-antagonist is given several days later. Once the follicles reach the size of 12mm, GnRHa antagonists like Ganirelix, Orgalutran, Cetrotide and Cetrorelix are added. These drugs stop the pituitary from secreting the luteinizing hormone (FSH leads to secretion of this hormone).
4. Long GnRHa Pituitary Down Regulation Protocol: This is the usual approach to deal with low ovarian reserves.
5. Agonist/Antagonist Conversion Protocol: This protocol inhibits FSH production. This protocol generally yields good results.

The medical term bronchial asthma is also referred to as chronic respiratory illness that causes swelling of the air passageways. The main symptoms of the chronic respiratory illness includes shortness of breath, chest tightening, wheezing and coughing. More than 22 million people in the US suffer from this health condition. The main factor that causes asthma is air pollution and it occurs due to allergic reactions of airborne substances.

Important information on bronchial asthma

• About 5-10% of individuals suffer from this global health problem and it is mainly diagnosed based on a physical examination, clinical history and pulmonary functioning tests. 
• The treatment is provided by professional doctors mainly to control the symptoms of asthma.
• There are chances that acute shortness of breath occurs recurrently and it occurs either early in the morning or at night. 
• The four main conditions that are the cause of obstruction of the airway include edema of the airway walls, contraction of bronchial smooth muscle and irreversible changes in the lungs.
• About 5 % of adults and 10% of children are affected by bronchial asthma.

How to prevent bronchial asthma
It is very important that individuals who are affected by bronchial asthma stay away from the asthma triggers. The conditions that can trigger asthma include smoking of tobacco, air toxins and pollutions, food and airborne allergens, extreme weather conditions, dust mites, stress, food preservatives, anxiety and additives. To some extent it also happens due to singing, crying and laughing. Asthma attacks can also be triggered by respiratory infections such as cough and cold. It is very important to be healthy and have a strong immunity to be able to fight against infections.

How to diagnose bronchial asthma
The symptoms of bronchial asthma should be described properly to the doctor for treatment. The things that you do day to day and where you experienced unexpected flare-up must also be mentioned to the doctor. This way the doctor can identify the cause of inflammation of the bronchial passageways and shortness of breath. There are certain laboratory tests that can be performed to diagnose the health condition and these include chest X-ray, and spirometry.

Ayurvedic Bronchial Asthma Treatment
Ayurvedic treatment for Bronchial Asthma is initially focused on improving the digestive system. Herbal medicines are administered to clear the blockage from the channels by eliminating toxins (ama) from the body. They will then liquefy the Kapha present in the channels, allowing proper movement of Vata and fostering proper and easy respiration. Additionally, immune-booster herbal combinations are given to the patient in order to provide both physical and psychological strength, as the patient becomes weak due to repeated attacks of Asthma.

Babies can enter this world in one of two ways: Pregnant women can have either a vaginal birth or a surgical delivery by Caesarean section, but the ultimate goal is to safely give birth to a healthy baby.

A C-section, or Caesarean section is a surgical procedure to remove baby through an incision in the mother’s abdomen and then a second incision in the uterus.

A C-section may be a necessity in certain situations, such as delivering a very large baby in a mother with a small pelvis, or if the baby is not in a heads-down position and efforts to turn the baby before a woman gives birth have been unsuccessful.

Sometimes the decision by an obstetrician to perform a C-section is unplanned, and it is done for emergency reasons because the health of the mother, the baby, or both of them is in jeopardy. This may occur because of a problem during pregnancy or after a woman has gone into labor, such as if labor is happening too slowly or if the baby is not getting enough oxygen.

Some C-sections are considered elective, meaning they are requested by the mother for non-medical reasons before she goes into labor. A woman may choose to have a C-section if she wants to plan when she delivers or if she previously had a complicated vaginal delivery.

Reasons for a C-section may include-

1. Health problems in the mother
2. The mother carrying more than one baby
3. The size or position of the baby
4. The baby’s health is in danger
5. Labor is not moving along as it should

The surgery is relatively safe for mother and baby. Still, it is major surgery and carries risks. It also takes longer to recover from a C-section than from vaginal birth. It can raise the risk of having difficulties with future pregnancies. Some women may have problems attempting a vaginal birth later. Still, many women are able to have a vaginal birth after cesarean (VBAC).

How You Might Feel-

You won’t feel any pain during the C-section, although you may feel sensations like pulling and pressure. Most women are awake and simply numbed from the waist down using regional anesthesia during a C-section.

That way, they are awake to see and hear their baby being born. A curtain will be over your abdomen during the surgery, but you may be able to take a peek as your baby is being delivered from your belly.

However, women who need to have an emergency C-section occasionally require general anesthesia, so they’re unconscious during the delivery and won’t remember anything or feel any pain.

Recovering from a C-section-

After a C-section, a woman may spend two to four days in the hospital, but it may take her up to six weeks to feel more like herself again.

Her abdomen will feel sore from the surgery and the skin and nerves in this area will need time to heal. Women will be given narcotic pain medications to take the edge off any post-surgery pain, and most women use them for about two weeks afterward.

A woman may also experience bleeding for about four to six weeks after a surgical birth. She is also advised to not have sex for a few weeks after her C-section and to also avoid strenuous activities, such as lifting heavy objects.

Most women stay confused with the time of their ovulation or the duration of fertile period. A figure of 90% is often quoted as the proportion of couples, who are sexually healthy and are in their 20s and 30s and are not using any birth control measures, who will be expecting a child after staying together for a year. It is interesting to know that you have a high chance of getting pregnant at the time of ovulation. It is a small window period that comes each month. It is the time when your ovary produces ovum or egg and the egg is open for fertilisation. Even if you are having sex two or three days before ovulation, there is a high possibility of fertilisation. After ovulation is over, the window period gets shut for the next cycle. It is the safe period. Though doctors say that it cannot be considered 100% safe to have unprotected sex during this period, the chances of getting pregnant are considerably lower. 

When does ovulation actually start? 
It should be remembered that ovulation takes place at the middle of your menstrual cycle. It usually occurs halfway through the cycle. Commonly, the average time period of a cycle is 28 days. In such cases, ovulation will occur approx on 14th day (first day of bleeding is counted as day 1 of cycle). But, in some cases, women may have cycles as long as 23 to 35 days. In these women, ovulation day varies from 9th day to 21st day of cycle. 

How will you know that you are ovulating? 

1. Check your calendar: It is a healthy habit to keep a menstrual calendar. Now a days, a number of apps are available for maintaining menstrual calender. You must maintain the dates for a few months. This will give you an idea as to when you actually ovulate.It is difficult to know the actual time of ovulation if you are having irregular periods. 
2. Carefully listen to your body: It is a common thing that your body spontaneously sends a memo to you before ovulation starts. You get cramps or feel pain in the lower abdomen before ovulation starts. This pain is called mittelschmerz. It is a reminder of the coming periods. 
3. Chart your body temperature: Well, you will need to keep a record of your basal body temperature. You can measure it early morning before getting up from bed. Your basal body temperature changes throughout the monthly ovulation cycle. Progesterone hormone is responsible for the increase in body temperature. In the first half of the month, the progesterone levels are low and hence the temperature remains low as compared to the second half of ovulation. You can also use an ovulation detector kit to know the dates. 
4. Fertile Period: Three days prior to ovulation and two days after ovulation are considered the fertile period because a sperm can remain alive for 3 days inside female genital tract and an ovum once released, is available for 2 days for fertilisation.