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Dilation and curettage procedure which is commonly referred to as D&C is a minor surgical procedure where the cervix is dilated while a special instrument is used for scraping out the lining of the uterus. It is important to know what you can expect before, after and during the process so that you can stay ahead of unnecessary worries and help the process to be smooth and fruitful.
When do doctors recommend dilation and curettage process?
You may be required to undergo the dilation and curettage procedure for one of many reasons. It can be used for removal of tissues in the uterus during or after an abortion or miscarriage or to remove little pieces of placenta after delivery. This process aids in preventing infection as well as heavy bleeding. On the other hand, it can help in diagnosing and treating abnormal uterine bleeding including polyps, fibroids, hormonal imbalances and even uterine cancer. A sample of the tissues in the uterus is tested under a microscope to check if there is any abnormal cell present.
What can you expect during the dilation and curettage process?
The D&C procedure is a minor one and takes about 15 minutes even though you will have to spend about 4 to 5 hours in the healthcare facility. Before the procedure, your doctor would check complete history, and at this point, you should tell your doctor if you suspect that you are pregnant, you are sensitive to latex or any medicines or if you have a history of bleeding disorders. You will then be given anesthesia so that you don’t feel any pain or discomfort during the procedure. Before this procedure, you will have to empty your bladder.
The D&C procedure comprises two main steps, dilation, and curettage.
Dilation involves opening of the lower part of the uterus or the cervix for allowing insertion of a slender rod. This is done to soften the cervix so that it opens and allows curettage to be performed. Curettage involves scraping of the lining and removal of the uterine contents with the help of a spoon-like instrument known as a curette. This may cause some amount of cramping, and a tissue sample would be taken out for examination in the laboratory.
After the completion of the procedure, you may experience slight bleeding and cramping. In some rare cases, adhesions or scar tissues may start forming inside the uterus, and this condition is termed as Asherman’s syndrome which can cause changes in the menstrual cycle along with infertility. This problem, if arises, can be solved with the help of surgery and therefore, you should report any abnormality in your menstrual cycle to your doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!
These two words are enough to instil anxiety and assumptions in the minds of many. Replete with prejudices, myths and malpractices, this disease is more feared than managed or treated. For example, how often have women wondered if wearing a bra can cause breast cancer? How often have your spouse or a loved one talked themselves out of a diagnosis, because they were shy of the procedure, and also because they thought that there was no way they could have the disease? How often have they concluded that they need to get their breasts removed knowing a close blood relative had the disease or undergo an extremely painful chemotherapy regime if they were diagnosed with breast cancer?
Wondering and presuming these things isn’t their fault- it’s because of the general lack of awareness and hence, several myths the disease brings in its wake. In this section, we answer some of the most common myths surrounding breast cancer, in detail. It is of utmost importance to make women aware of these myths since this often leads to bad practices such as avoiding proper check-ups, which ultimately culminates into the delay in diagnosis treatment breast cancer, which can prove to be fatal.
Myth: Breast cancer risk is very low.
Fact: This misconception is one of the leading causes of a late diagnosis in India. Breast cancer is the most common cancer in Indian women, and according to the National Cancer Registry Program of India, it accounts for 27% of all cancer in women, as of 2012. About 1.5 lakh new cases are diagnosed every year of which, 0.75 lakh cases succumb to the disease within the 1st five years. India has the dubious distinction of having the highest incidence-to-mortality conversion in the world attributed to lack of awareness about symptoms, late-stage detection and poor treatment outcomes. In our country, this disease occurs at a much younger, premenopausal age, that is, the average age of around 45 in India as compared to 65 in the West. Approximately 1 in 22 Indian women carries a lifetime risk of developing the disease. Also, approximately 1 in 3 breast cancers will be identified as a triple negative breast cancer which is a aggressive breast cancer and is most prevalent in Indian women, compared to the 10-15% risk in other ethnicities.
Owing to the assumption that the risk is low and that cancer occurs at a much later age group, middle-aged women at a higher risk of breast cancer shy away from diagnosis and do not get annual mammograms done. In fact, according to a study carried out in Oldham, England in 2010, only 35% of Asian women were likely to attend the routine check-up done by National Health Service of England, as opposed to 70% of non-Asian women. The reasons behind shying away from getting an annual check-up done after 40 years of age could be ignorance, financial reasons, discomfort with the check-up procedure or anxiety of the reports. Regardless, this inertia in undergoing routine medically advised check-up of the breasts can result in missing an early diagnosis which then decreases the chances of effective treatment of the disease. At our clinic, we have seen cases where breast cancer has been diagnosed at a very early stage because the women underwent annual mammograms, and thus could be easily managed and cured. It is our humble request to all the women to break their inhibitions and get an annual breast check-up done under the supervision of a breast cancer expert after the age of 40.
Myth: If a woman is diagnosed with breast cancer, her breasts will be removed (mastectomized).
Fact: If breast cancer occurs, then there is 80% chance that the breasts will not be removed. Most women will have a single cancerous lump in their breast and the breast can always be saved by a well-planned, cosmetic surgery. Breast reconstruction is done in the same procedure with the same anaesthesia, resulting in better-looking breasts and cosmetics as they can be lifted and shaped according to the patient’s desire. A questionnaire conducted by our centre reported no depression and out of 147 patients surveyed, most were very satisfied with the reconstruction outcomes (94%). Mastectomy, or breast removal surgery, is performed in few percentages of patients- may be 20%, where there are multiple tumours. Therefore, it is of utmost importance that a woman does not fear the outcome of a diagnosis and delay getting examined altogether. Such bad practice can result in an advanced-stage breast cancer, which could have been diagnosed at an early stage and treated, now being treated by mastectomy, owing to the consequent delay in treatment.
Myth: General health check-ups are excellent for every diagnosis, including breast cancer.
Fact: This is one of the biggest and most dangerous myths. General health check-ups cannot diagnose any cancer, let alone breast cancer. Therefore it is pivotal for a woman to get a mammogram and clinical breast examination done at a specialized breast health centre, under the care of specialists and professionals. National expert panels do not recommend general health check-ups. The Canadian Task Force on the Periodic Health Examination as well as the United States Preventative Service Task Force, recommended focused health checks, as opposed to general ones, in 1979 and 1989, respectively. One review published in the Cochrane Library by Krogsbøllet al. in 2012 reported that “general health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes”, based on the trials that they conducted. According to an article published in 2015, in which a joint analysis was undertaken by medical liability insurers (Doctors Co. and CRICO, USA), amongst the 562 malpractice claims between 2009 to 2014, 39% related to the alleged negligent treatment of patients, including misinterpretation of diagnostic studies in general health check-up schemes.
In general, it is believed that about 48% of the delayed-diagnosis cases involved radiology, with primary care physicians or other clinicians have misread or misinterpreted the radiology report. General health check-ups is also a scheme by hospitals to pick up patients for treatment, with surgeons performing open breast biopsies (i.e, a surgical procedure where a cut is made through the skin to expose and remove tissues), which is an obsolete diagnostic modality for breast cancer. In fact, in America, according to sources, a doctor doing an open breast biopsy is liable to lose his registration. The biopsies should be done after careful radiological investigation and are only minimally invasive needle biopsies. Due to such myths and malpractices, women are afraid to present themselves for diagnosis, because they fear that every lump will be removed with a surgery. The fact is that out of 100 women presented with lumps, maybe 1 or 2 actually need a surgery.
Myth: Chemotherapy and radiation therapy should be avoided as they are extremely painful.
Fact: Both these types of therapies have been exaggerated to be ‘worse than death itself’. This is absolutely not true. Chemotherapy has improved leaps and bounds with drugs that are much easier to tolerate as they are targeted, which means that they predominantly affect the cancer cells and not the normal ones. Earlier, the known side effects of chemotherapy were nausea, vomiting, reduction of blood counts, and infections. Today with current improvements in the drugs with chemotherapy as well as antidotes against complications, chemotherapy has become extremely safe and the side effects have substantially reduced. In fact, some determined women take chemo and go to work. The only major, common side effect of chemotherapy as of today is the hair loss which is a temporary and reversible phenomenon A daycare facility is extremely proficient with the treatment, with most of the regimens needing just 5 hours or less. Many hospitals admit patients for chemotherapy, more for financial gains than an actual need for inpatient admission procedures. At our facility, chemotherapy is a procedure requiring maximum 5 hours, with loungers and personalized TVs, a counsellor and a nutritionist for free, private consultation in a spa-like ambience.
There are fewer side-effects of radiotherapy as well if done by adept radiotherapists and physicists with extremely sophisticated and state-of-the-art equipment. Both these procedures are extremely safe, with the woman not even needing hospitalization.
Myth: Wearing a bra, antiperspirants and deodorants can cause breast cancer.
Fact: It is due to the existence of these myths that the focus has been shifted from the actual risk factors to such obsolete ones. None of the aforementioned items has been shown to cause breast cancer. The real risk factors leading to breast cancer are of two types: the modifiable and the non-modifiable. The modifiable risk factors include alcohol, smoking, sedentary lifestyle, obesity, birth control pills, hormone replacement therapy, not breastfeeding and not having children or having them late. The non-modifiable ones include genetics, having a family history of breast cancer, older age, exposure to radiation, race and ethnicity, early menarche and late menopause. Most of the modifiable risk factors can be avoided if one took care of their health, diet and got sufficient exercise.
Myth: If a woman has a family history of breast cancer, she is likely to develop breast cancer as well.
Fact: While it is true that women who have a family history of breast cancer are at a higher risk of getting the disease, it is also true that most women who have breast cancer have no family history of the disease. Statistically, only 10% of the women diagnosed with breast cancer have a family history.
So what should you do if you have a family history of this disease?
That depends on your relation to that particular family member.
If you have a first-degree relative with breast cancer, that is, if your mother, sister or daughter developed breast cancer under the age of 50, you should consider some form of regular diagnostic breast imaging as well as genetic testing.
When should you consider it?
Starting ten years before the age of your relative’s diagnosis.
Having a first-degree male relative with breast cancer- however rare, but a clinically observed phenomenon also raises a woman’s risk of getting breast cancer.
If you have a second-degree relative with breast cancer, such as a grandmother or an aunt, your risk increases moderately, however, definitely not as much if you had a first-degree relative with breast cancer.
If you have multiple generations diagnosed with breast cancer on the same side of the family, or if there are several individuals who are first-degree relatives to one another or several family members diagnosed at the age of 50, you should be careful, as you have an increased probability of having a defective breast cancer-causing gene, given your breast cancer-prone family history.
In such scenarios, you should consult with a breast cancer specialist and undergo appropriate genetic testing only after prior genetic counselling of the family.
I am 46 year old I have slip discs problem in l-4, l-5 it is curebel? and what should I do to get my self cure in this regards.
I am Dr. Malvika Sabharwal from jeevan mala hospital and apolo spectral hospital in Karol Bagh, New Delhi India.
I am gonna tell you about uterus removal. Uterus removal is a very common operation. Bht commonly isko kara jata hai k patient ata hai apko bolta hai k ji hamary ko flah flah flah problem hai or ap hamara uterus nikal dijiye. Sb sy phly to main apko btaungi kya indications hain. Chahye wo fibroid k hn, ya bleeding zyada ho rai ho. Koi fibroid nai hai per bleeding bht zyada ho rai hai ya koi changes a rhy hain. Jaisa k agr mouth of the uterus main agr koi peps pal krty hain routinely jo k karna chahye, her ek marez k liye. Ap regular apasnaol kar ry hain us main koi changes any lag jaty hain ya aisi koi bhi problem ho to patient ata hai or wo bara clear mind sy kehta hai k ji mje uterus remove krwana hai. Kbhi kbhi wo refered cases hoty hain. Ya marez ko kahein kaha jata hai or hamary pas aty hain. Q k hamary pas jo uterus removal ka tareka hai wo hai durbeen sy or ek pait khol k. pait khol kr jo karty hain, ek bara 8 centimeter, 8 inches k kareeb ek insection hota hai pait k upper or us k through hm uterus ko, us ko pakar k baher nikal k us ki puri surgery kr k as pas disconnect kr k us ko nikal dety hain. Or abdomen ko stitch kr dety hain. Laparoscopic surgery jb sy hm ny shuru kari hai. Year was 92. I think ye sb sy bara bone hai. Doctor k lye bhi, patient k lye bhi. Ek to patient friendly surgery hai. Or doctor k liye offcourse, doctor ko sekhny main thora samain zaror lgta hai,but once you have commanded the technique of Laparoscopic surgery, it is the best. It is the best for the patient and for you it’s a very affective way of taking out the uterus without any problems. Ap us ko Laparoscopicly nikalty ho or Laparoscopicly jb nikalty ho 1 din ka stay rehta hai hospital main. 1 din main mareez back to normal work hota hai. Wo ghr ja kr k, serhioyon sy charhta hai. Serhiyon par jaye, upper rahy, ghar k khanay bnaye, baheer ghumny jaye, hr roz piture dekhy, us py koi issue nai hai. Bht minimal unko btaya jata hai do’s and don’t’s. unka upper charhny main koi problem nai ati. Sirf halki phulki jo problem, sirf 2 chezain ki hm log btaty hain which Is hardly any issue. So patient is back to normal routine. Ap apny ffice dubara ja skty hain itni jaldi. Loss of working days is very less. To loss of working days jaisy e kam oty hain, aj kal apko pta hi hai, mostly ladies are working, most of the women are working today. Chahy wo ghr py, ghr ka bhi kam itna hota hai. Bachon k aj kal kitny kam hoty hain, us k ilawa office girls bht hoti hain. Jo k office ko bhi sambhalti hain or ghr ko bhi sambalti hain. Let me tell you hamary bht patients hain un ko kbhi ye problem nai I k hum uterus nikalny k bad hm ghr ka kam nai kar paye. Ya office ka kam nai kar paye. Hamary pas doctors aty hain. Dur dur sy aty hain, in fact patients are coming from dubai, London, America, Canada all over. Wo aty hain apna operation krwaty hain or 2 din k bad they are ready to go home. Because this surgery has really picked up so much k jb o dekhty hain k kitny aram sy ye kam ota hai to unko aisa koi hesitancy nai lagti. Un k roz mara ki zindagi main koi change nai ata. Unko minimalistic thory sy do’s and don’ts hoty hain which is hardly anything. And aam tor per jb hum uterus nikalty hain, jaisa k main apko dekhati hn. This is one uterus. Two tubes and two ovaries. Aj agr main uterus nikal rai hn, lady ka age hai 45, I will tell her definetly ovary tubes to ap nikal hi lijye. Ovaries jo hain, wo apko hormones deti hain. Hormones ek lady ko femerity bna k rakhti hai. Femariti sy ye bhi matlab hai, tubes ka koi aisa role nai hai per ovaries apko hormones dy k, hormones k karan apka skin, hair, heart, sb k upper us ka zor hai. So ovaries ko hum bina puchy bilkul nai nikalty. Us k lye permission lety hain tabhi nikali jati hai. Per agr uterus nikal ry hain to aam tor per hum tubes ko bhi nikal dety hain.
Thank you very much.
A fracture requires quick and careful medical attention to ensure proper healing and alignment of the bone. Most fractures usually recover within six weeks but that is only half the problem. A lot of other tissues get damaged in the process when there is enough stress placed in the body to fracture a bone. Additionally, when you are unable to move that bone, you will have joint stiffness and significant muscle weakness.
After a fracture, physiotherapy might be recommended to guarantee that you come back to your ideal capacity. You might have to go for regular appointments to your physiotherapist in order to achieve full recovery. Usually, your physiotherapist will try to prevent your post-fracture stiffness in the nearby joints and muscles after the initial six weeks while you are recovering from your fracture. After six weeks or later, if x-rays show that the bone has not been fully healed, your physiotherapist can take a shot at recovering full movement of the joints and muscles near the affected area.
Here are five ways in which physiotherapy helps heal post-fracture:
- Physiotherapy after a fracture can help you enhance your muscle movement. In case you have fractured your leg, your physiotherapist can help you improve your walk and help you decide whether you need to take the support of a walking stick, crutches or a cane. In case you have broken an arm or shoulder, exercises focused on reaching and grasping are included.
- Modalities might be used to help with the pain and swelling. Your physiotherapist may choose to use ice, heat or whirlpool baths.
- Electrical stimulation can also be used to improve your muscle movement. You need to keep in mind that while inactive treatments like electrical stimulation or ultrasound might be used, you also need to keep your muscles physically active to better your movement and strengthen your bones.
- If you have had surgery to join the fractured bone, you may have surgical scar tissue. Scar massage can decrease scar attachments and increase movement around the scar.
- Exercise to improve the scope of movement and strength can also be started. Particular focus points need to be treated in the joints around the fractured area. If you have fractured a bone close to your elbow, exercises need to be included for your elbow, wrist, and shoulder. Moreover, a fracture in the shin needs to include exercises for the knee, lower leg, and hip. Exercise can guarantee that your bone can endure the load during daily routine work. Make sure to consult with your physiotherapist to learn the correct exercises for your condition.
A fracture can be very painful and might lead to a disability or problem in movement. Depending on the seriousness of the damage, the loss may be temporary or permanent. Physiotherapy can help you come back to your optimum function as quickly as possible. In case you have a concern or query you can always consult an expert & get answers to your questions!
Herniated disks or bone spurs in the vertebrae of the neck may become the reason behind severe neck pain. They sometimes take too much space and compress the nerves branching out from the spinal cord.
Can Physiotherapy Cure cervical disc prolapse and L5 S1 Disc bulge.I am suffering from Neck pain for the Past 6 years
Dear sir, my age is 36 years I have hypothyroid and using 75 mg tablets, recently I have taken mri the report is: posterior disc osteophytes at multiple levels, causing bilateral moderate neural foramen encroachment at C5-6 level, bilateral minimal neural foramen encroachment at 6-7 level. C 5 -6 disc disc shows posterior protrusion along with osteophytes causing bilateral moderate neural foramen encroachment. C6- 7 disc shows bilateral paracentral protrusion along with osteophytes causing mild thecal sac impingement and bilateral minimal neural foramen encroachment. Please tell me what is the problem and what care I have to take.
Lung cancer is the cancer killer of both men and women in the U.S. When you think of risk factors for lung cancer, what comes to mind? Most of us think about the risk associated with smoking cigarettes, but did you know that air pollution can also cause lung cancer? Overwhelming evidence shows that particle pollution in the outdoor air we breathe—like that coming from vehicle exhaust, coal-fired power plants and other industrial sources can cause lung cancer. Particle pollution increases the risk of dying early, heart disease and asthma attacks, and it can also interfere with the growth and function of the lungs.
What is particle pollution?
Particle pollution is a mix of tiny solid and liquid particles in the air and can be made up of a number of components, such as acids, organic chemicals, metals, soil and dust particles. It can be emitted directly from wood stoves, forest fires, vehicles and other sources, and it can also form from other types of pollution that come from sources like power plants.
Why does particle pollution harm our bodies?
While breathing in larger sizes of particle pollution can be harmful to our health, smaller particles are more dangerous. Bigger particles can irritate your eyes, nose and throat, but our natural defenses help us to cough or sneeze them out of our bodies. Unfortunately, those defenses don't keep out smaller particles, which get trapped deep in the lungs and can even get into the bloodstream, causing damage to our health.
Who is most at risk?
As for who is at risk for health problems from breathing in particle pollution. Those who live where particle pollution levels are high is at risk. Some people face higher risk, including children, the elderly, people with lung and heart disease and diabetes, people with low incomes, and people who work or exercise outdoors.
How do we protect ourselves from particle pollution?
Check the air quality index forecast for the day and limit your activity if pollution levels are high. Avoid exercising along heavily traveled highways regardless of the overall forecast.
As individuals, we can play our part in reducing air pollution levels by trying to avoid creating more of it. Choosing ‘active travel’ options where possible, like walking and cycling, can help reduce pollution levels from transport and is also a great way to be more active, which is linked to a reduced risk of cancer and other diseases.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.