Dr. Umadevi

Why is it hard to quit using smokeless tobacco?

Like cigarettes, smokeless tobacco (snuff or chewing tobacco) contains nicotine, a very addictive substance that causes changes in the way you think and act. If you are addicted to nicotine, you crave the “buzz” you get from using smokeless tobacco, and you have to use more and more to get the effect you want. Smokeless tobacco puts more ;nicotine into your bloodstream than cigarettes do. This is one reason why people who chew or dip tobacco regularly may think that quitting smokeless tobacco is even harder than quitting cigarette smoking. Using smokeless tobacco might also be a habit for you when you’re in certain situations or with certain people. For example, you may always chew tobacco when you go to a sporting event or when you watch tv. It can be hard to break this pattern of behavior. However, many smokeless tobacco users have quit successfully – and so can you. Psychiatrist can help you quit.

Good afternoon, I am Dr. Puneet Kocchar. I am a consultant gynecologist and a fertility specialist at Elixir Fertility Center, New Delhi. Today I will be talking about Recurrent miscarriages and abortions.

A positive pregnancy test is a very exciting news not only for the couple but for the entire family. However, sometimes there is a miscarriage and the chances of miscarriage in the normal pregnancy are about 10-15%. If you have had only one miscarriage, then the chances that you will carry on till term without requiring any medical extensive treatment in your next pregnancy are nearly 80% or more. For women who have had only one miscarriage, we will not recommend going for extensive testing or treatment.

What is recurrent abortion or recurrent miscarriage? 

If a lady has had 3 or more repeated abortion, it is called recurrent abortions. Even these days we start doing test and treatment if a lady has had 2 abortions and we do not wait for third one to occur.

So, why does an abortion occur?

In simple terms, either it is a fetus, that is, an embryo is not normal or the womb which is going to carry the pregnancy has some problems in it. What happens to a fetus if you are carrying a genetically abnormal baby, that can lead to miscarriage. It is nature's way to take care of the pregnancy and not letting the abnormal baby come into life. So, we do tests called genetic tests to check the chromosomic make up of a baby. They can be done on the products of conception. We also recommend that we have complete parental care, that is the blood test of both mom and dad to check the both of the chromosomal content.

Sometimes, in2-5%of the cases, there is balanced chromosomal translocation. Now this translocation will not cause any problem to the person who is guiding translocation. But when you produce an egg or the sperm, the embryo can be abnormal and this will lead to a miscarriage.

What happens to a person carrying a translocation?

If you are carrying a translocation which is leading to repeated miscarriages, it is better to plan IVF cycle along with PGD or PGS rather than normal conception.

IVF is where we create an embryo using the eggs from the lady and sperm from the husband. When the embryo is ready, we take a small biopsy and we subject it to test and a complete chromosomal analysis. And once the results are back, the normal embryo is transferred back into the lady's womb resulting in healthy pregnancy. This is one factor that we just addressed.

The second factor that we talked about is abnormalities in the womb. Now, simple test to analyze hormonal balance from the blood taken from the lady will tell us about thyroid status, diabetes, abnormal prolactin. These are all hormones which if are elevated or below the range can lead to abortions. THis can all be treated by giving oral tablets. So, these are important to be tested for any women having recurrent abortions.

• Then we look into other factors such as autoimmune problems which are very common, occurring in about 20% of the patients. During pregnancy, we advise you to take low dose aspirin tablets and low molecular weight hampering injections for the entire duration of pregnancy. And this results in more than 60% successful pregnancies.
• Another important factor that leads to abortion, which is Thrombophilias. THese are inherited problem which increases the tendency of blood to clot. Since the blood flow to the uterus is not occurring properly, you might again need blood gain agents such as aspirin.
• Some of the other common factors are an anatomical factor. So, if the uterus or a womb is carrying a fibroid can also lead to abortions. Now, these can be easily diagnosed by doing an ultrasound either 2-dimensional or 3- dimensional. If such a problem is present, we can treat it by doing a hysteroscopic procedure.
• Another important factor that leads to Abortion, especially in our part of the country, that is North India, is Tuberculosis. This is one of the commonest cause of miscarriages especially in our part of the country. It can be tested by doing Biopsy. Take a small amount of tissue from the uterus and check whether the lady is carrying Tuberculosis or not. It can be treated by giving oral medication of tuberculosis that has to be taken for the period of 6-9 months.
• Another common cause is the imbalance of Th1 or Th2 cytokines. These are the cytokines present in the uterus which may not let the embryo or the pregnancy to grow. And if these are found to be positive, we recommend Immunomodulation.

So, these are the various causes due to which a lady can have an abortion. An important thing here is do not loose hope and do not give up treatment. If you have had 2-3 abortions, you need to get complete panel of tests done and with the help of a treatment, you have 60% of the chance to deliver a baby normally.

If you wish to consult me, please contact me through Lybrate or you can visit my clinic directly.

Thank you.

Menstrual cramps are not new to women after puberty, and generally are manageable without specific care. However, when the abdominal cramps interfere with your regular activities, it is important to take some steps in relieving it. The pain is usually caused by chemicals known as prostaglandins that promote inflammation and aid in blood vessel constriction as well as the contraction of muscles. The chemical breaks down during menstruation while constricting blood vessels in the uterus which causes muscle contractions, referred to as cramps.

It is possible to manage the pain caused by these cramps by following a healthy diet that can include the following foods:

1. Soy milk: Some women have reported that having soy milk can help in reducing menstrual cramps. It is rich in natural plant chemicals known as isoflavones that act like estrogen in the body. Fortified soy milk also offers around 300 milligrams of calcium which will fulfill 1/3rd of the daily recommended intake of calcium.
2. Fatty fish: Fish is considered one of the prime sources of anti-inflammatory fats referred to as omega 3-fatty acids. Researchers have found that women who consume omega 3 fatty acids experience less intense pain. To get maximum benefits, you can consume mackerel, salmon or trout. You should also include ground flaxseeds in your daily smoothies and yogurt.
3. Legumes: Legumes such as lentils and beans offer a high amount of protein and fiber without the saturated fat that is found in animal-derived protein sources. Taking a high fiber diet that constricts intake of animal fats can improve the estrogen levels which, in turn, can help in reducing the menstrual pain.
4. Fruits and vegetables: Eating foods rich in antioxidants and reducing the intake of processed ones can help in improving period cramps. You should opt for different colored fruits and vegetables, from broccoli to berries, from citrus fruits to bell peppers to tomatoes, and anything else that comes to your mind. Many fruits and vegetables such as apricots, raspberries, and brussels sprouts are also rich in fiber that can help in reducing muscle cramps during periods.
5. Nuts: There is hardly any individual who doesn’t like eating nuts, particularly when they are roasted. It can help in alleviating the hunger for junk foods and the rich magnesium content is essential for reducing period pains.
6. Dark chocolate: Research suggests that dark chocolate is known for satiating cravings for junk foods while boosting the serotonin levels. When you are on your periods, you should take one ounce of dark chocolate every day for reducing depression and fatigue and alleviating the physical discomfort.

Adding these food items can contribute a lot in sparing you from the undesired stomach cramps during periods.

In case you have a concern or query you can always consult an expert & get answers to your questions!