Hunner's ulcers, simply put are painful ulcers in your urinary bladder. These ulcers are inextricably linked to another disorder called the painful bladder syndrome or intestinal cystitis. They occur in 10 to 15 percent of people with interstitia cystitis. These, in fact, are red patches or lesions on the bladder wall which can stiffen tissue and cause reduced bladder capacity. Hunner s ulcers bleed, ooze pus and can be of different sizes. The ulcers in the bladder can be extremely painful and uncomfortable.

These are called Hunner s ulcers because they were first described by Dr. Guy LeRoy Hunner, a Johns Hopkins gynecologist, in 1915. Since Hunner s ulcers are seen only in people with intestinal cystitis, it s important to know more about this painful life-altering bladder disorder before we can even understand how to deal with them.

Interstitial cystitis (IC)
IC is also called painful bladder syndrome. Another important thing to know about IC is that it strikes more women than men. IC is a chronic disorder and there s no cure for it. It causes recurring bouts of pain and pressure in the urinary bladder and the pelvic area. This is often accompanied by an urgent and frequent need to urinate. Sufferers may have to rush to the  loo  as much as 40, 50, or 60 times a day.

Diagnosis
Hunner's ulcers can only be accurately diagnosed by doing a cytoscopy which involves inserting a fibre-optic tube through the urethra to look at the bladder wall closely. During this procedure, a tissue sample from the bladder wall is usually also taken to rule out bladder cancer. Cytoscopy is usually done with hydrodistention under local anesthesia. This involves filling the bladder with a liquid for stretching it to provide a closer view of the bladder wall. Usually, a urologist performs this surgery along with a gynaecologist. IC and also Hunner s ulcers are both a diagnosis of exclusion. This means that they re diagnosed only after a number of other conditions have been ruled out.

Hence, the urologist will first take your thorough medical history, followed by a physical exam and a pelvic exam for women patients and perform tests for ruling out infection, and other disorders like bladder stones and cancer, kidney disease, multiple sclerosis, endometriosis, sexually transmitted diseases amongst others. Only after these tests are inconclusive or uncertain and if there is blood in urine, will the urologist go for cystoscopy.

Treatment
There's no cure for IC, but Hunner s ulcers can be cured by burning them off the bladder wall. Called fulguration, the process uses electricity or laser to burn the ulcers on the bladder wall. Resection is also used in which skin from around the Hunner s ulcer is cut for removing both the ulcer and the inflamed tissue around it. The problem is that ulcers may recur in the same location.
So, managing IC becomes critical. Your doctor can try to treat the patient with one treatment or with a combination of treatment depending on the condition of the patient.

Pain medicines are the first line of treatment to manage Hunner s ulcers and IC both, and many patients do go in for this. Patients also find relief by modifying their diet to remove foods and drinks like caffeinated beverages- tea, coffee, colas etc. Sodas, artificial sugars and fruit juices, especially Cranberry juice can trigger intense pain and discomfort, so these are usually contraindicated. Another important aspect is patient education about normal bladder function and tips on self-care and behavioural modifications like stress control to manage Hunner s ulcers.

Hunner's Ulcer In Urinary Bladder - How They Can Be Treated?

Problems with the arteries and veins present in the hands or legs can lead to vascular disorders. The arteries carry blood from the heart to other parts of the body in order to deliver nutrients and oxygen. The veins carry the blood back to the heart, after the nutrients have been used up. If these blood vessels of the arteries or veins become blocked or narrowed, it can lead to a vascular blockage.

A vascular blockage that occurs in the hands or legs comes under the category of Peripheral Artery Disease or PAD. These type of disorders are less common in the upper extremities of the arms or hands than in the lower extremities of legs. Few of the signs for the same are:

Pain and difficulty in movement due to decreased blood flow
Numbness or weakness of leg or fingertips
Sores on the toes or feet
If the blockage is deep, symptoms of redness, swelling, extreme pain or cramping can be experienced
Abnormal color changes in the fingertips
Ulcers or wounds that don t heal
Skin sensitivity problems when in cold temperatures
How can it be diagnosed?
The blockage can be detected by various methods namely-

Physical Examination   Your doctor may find decreased pulse at armpit, wrist or fingers, full veins, masses, wounds or gangrene.
Doppler or Ultrasound examination to determine the blood flow in the arteries and veins
MRI Scan of the affected area to pay special attention to the blood vessels
Cold Stress Test
Arteriography to show clear blood vessel details
Angiography to map blockages and narrowing of the arteries
What are the Risk Factors for Peripheral Artery Disease?
An individual is at risk for developing vascular blockages in the hands or legs if one or more of the following factors are present:

Smoking
Diabetes
Heredity Factors   A personal or family history of blood vessel disease
High blood pressure
High cholesterol
Aging   People aged above 50 years and older are more prone to vascular blockage
Can it be treated?
Treatments for vascular blockage can vary depending on the age, cause of the blockage, intensity and overall well-being.

Treatments can include:

Self-care   Reducing risk factors and making lifestyle changes to quit smoking, sedentary life or diabetes, blood pressure and cholesterol management can reverse symptoms of vascular disease.
Medications   A variety of drugs can be prescribed to lower the risk and progression of narrowing blood vessels or prevent blood clotting.
Interventional Procedures   Minimally invasive surgery like saloon angioplasty, stenting or removal of artery plaque build-up.
Surgery   If the blockage is severe, surgery may be performed to lessen the vessel narrowing, reconstruct the artery or tie it off, depending on the circumstances.

Pain in the Hands or Legs!

Pancreas are a small, but a pretty important part of a person s digestive system. So when it needs to be removed, the reason has got to be quite serious, to say the least, doesn t it? The procedure is known formally as a pancreatectomy and it is most often required for people who are suffering from cancer of the pancreas. Ideally, these people would only need the cancerous tumours removed, but things are not always this simple. As a matter of fact, only a little more than a tenth of the people who have pancreatic cancer can have the tumour alone removed. As a result, most need to go for a pancreatectomy, which involves removing the entire pancreas. Whether the pancreas can be kept is usually related to how soon the cancer was detected, with people who have done so in time being a majority of the 10% of people with pancreatic cancer who have not needed pancreatectomies.

If a person does not have cancer, the reason he or she may need a pancreatectomy due to an accident which has injured the area significantly badly. In this case, a procedure which is known as a partial pancreatectomy is carried out on the patient. The good news is that the success rate of this sort of operation is generally quite high and the long-term effects on the body are nil. This is the case in spite of a lot of the normal tissue of the pancreas being removed, pretty amazing, isn t it?

While it may be called a pancreatectomy, it does not always mean that the pancreas is the only thing that is removed. In fact, in a lot of pancreatectomies, the surgeons also remove other parts of the digestive system which are usually the common bile duct, the spleen and the gallbladder.

There is, of course, the case of chronic pancreatitis, which occurs when the organ just swells up repeatedly. The repeated swelling leads to permanent damage of it, which affects the rest of the body, too. In most cases, the cause of this happens to be a sustained addiction to alcohol. When this is the case, it is really hard to perform a pancreatectomy and the utility of the pancreas is greatly reduced. Not a good situation to be in, under any circumstances, at all!

A pancreatectomy is a process which nobody would voluntarily wish to undergo, but there are advantages to knowing what it is, in any case!

Pancreatectomy - When To Go For It?

Ringworm is a type of fungal infection occurring on the skin of a person. Ringworm does not involve the presence of any kind of actual worms whatsoever. It is so named because of the circular scaly infection on the skin, which almost appears as if a worm is present beneath the skin. 

Why the fungi arise on the skin is unclear. However, these skin infections are highly contagious, so people coming in contact with those already having the disease could naturally develop the ringworm lesions. The fungi also require warm and moist conditions to thrive in. People working in waterlogged conditions or those walking barefoot on wet floors near swimming pools; public washrooms etc could all develop ringworm based on their immunity levels.

Symptoms of Ringworm:

Reddish, scaly or white patches on the skin.

The lesions may appear raised and blistered.

The circular lesion might have a clearing in the center.

Hair loss is a common side effect of this disease. Ringworm of scalp especially is characterized by patchy hair loss where the hair might be bent and broken at an odd angle. Dandruff might also be present. Thankfully, there are many effective homeopathic remedies for ringworm on scalp.

Though mostly ringworm is treated with conventional medicines and allopathic treatment, there are certain recurring ringworms on which traditional medicines slowly lose effect. Such infections can be controlled and cured with the help of homeopathic medicines.

Homeopathy is based on the principle of  like curing like . This means, the homeopath takes a bit of the plant material, deactivates it and just like a vaccine, infuses the patient s body with small quantities of it. Popular homeopathic remedies for treating ringworm are:

Sepia: It is obtained from the ink of a squid. It has been found that contact with the squid causes symptoms similar to the ones caused by ringworms. Thus, it is a remarkable cure for this disease. However, before actually administering this medicine, the homeopath doctor would ask several questions to understand the nature of the disease occurring to you. Such questions would include your sensitivity to heat and cold or how many times in the past has ringworm infected you. Only when the practitioner is sure of the fact that sepia is the correct treatment, would he prescribe it to you. This is a great cure for ringworms occurring in children as well.

Sulphur: Ringworms not only affect a person on the skin of his/her body, it might also occur on the scalp. These ringworms can cause a lot of itching, irritation, hair loss, pus in the scalp etc. For treating such types of ringworm, one can apply sulphur-based creams or ointments on the affected area on the scalp. Sulphur is seen to help in fighting the ringworms and thus providing relief from all the itching and irritation on the scalp.

Rhus Toxicodendron: This medicine is obtained when leaves of the poison ivy plants are distilled overnight. Contact with poison ivy leaves also causes similar symptoms as ringworms and thus, it is known to be a good cure for the disease.

Ringworms on Animals-

At times, even animals like cats and dogs can be affected by ringworms. Symptoms would include loss of hair in patches, itchy hair, white or blackish patches on the body and others. A specialised vet should be referred to for a medicated shampoo besides a homeopath. Medicines like Sepia or Chrysarobinum are administered to treat ringworms in animals.

Thus, ringworm is a very common form of a disease and is easily treatable whether in humans or animals. One would need to follow the course of their medicine and take to patience for getting it cured as soon as possible.  

Homeopathic Treatment For Ringworm Fungal Infection

Bowel movement is one of the most important clues about an individual s health, as it gives a real idea of the gastrointestinal condition as well as overall health. One shall have to get familiar with the regular appearance of stool to spot the issues beforehand; however, the day to day alterations in the appearance does not mean that there is a problem with your health as one may notice short-term abnormalities based on what he or she is eating every day. 

But in case an unexplained change lasts for over a week or so, it is a sign of some strange happening in the gastrointestinal tract.

Hard pieces of faeces that are hard to pass: If the bowel movement is straining to pass, then the individual is constipated. Some people think that they are not suffering from constipation, but their stool is always hard and comes out in pieces rather than soft stool that passes out effortlessly. The most common reason behind such stool is a lack of fibre in the diet. According to general recommendations, an adult male must take at least 38 grams of fibre while an adult female must take about 25 grams of fibre. It is recommended to maintain a food journal to track the daily nutrients intake, and in case there is a lack of fibre in the diet, it can be stacked up with whole grains, fruits, beans and nuts.
Black or bright red coloured poop: If the stool has a deep red appearance, it would indicate that a part of the bowel is bleeding. In most circumstances, the blood in the stool is caused by the benign haemorrhoids, but it could also be due to some ulcers in the colon or stomach or even cancer. That is why it is extremely crucial to bring it to the doctor s notice. There are different types of over-the-counter medications which turn the stool into black colour. This sort of discolouration is entirely temporary and may stay along for a few days even after stopping the medicine.
A loose stool which is not diarrhoea: Loose stool but not diarrhoea may mean that the individual is suffering from celiac disease. Although the illness is quite uncommon, most people who suffer from it are not aware of the condition. The appearance of the stool is the largest and most reliable signs of having celiac disease. Individuals affected with celiac disease are not able to tolerate gluten, and it destroys the villi in the lining of the small intestine. As a result, the nutrients are unabsorbed, and the stool becomes loose. Switching to a gluten-free diet for about 2 to 3 weeks can aid in alleviating the disease.
If the appearance of the stool remains abnormal for weeks together, it is important to talk to a doctor to find out if there is something serious underlying. Bowel movement is the truest sign of the intestinal health, and thus, should not be ignored. 

Bowel Movement - What It Says About Your Health?


- hiv testing in pregnancy should be done early so as standard care can be taken for the pregnant women.


- this hiv testing must be repeated in the third trimester, usually before 36 weeks of gestation. This should be done in women with hiv-seronegative and also in pregnant women who are at a high risk of developing hiv infection.


- expedited hiv tests should be performed at the time of delivery and labor and this is a must in women who have not been documented for hiv. The results of the test should be available in one hour of the test and the testing should be available 24 hours. In case the results are positive then, infant postnatal antiretroviral and intrapartum drug prophylaxis should be started immediately.


- women who have not been able to be tested for hiv at the time of labor and delivery are suggested expedited screening for hiv. Their screening can be done immediately postpartum or their babies should undergo screening. In case the infant and mother, both are positive, then infant antiretroviral drug prophylaxis should be started immediately. These mothers should avoid breastfeeding their babies, until the supplemental hiv tests are negative. In infants with positive hiv, prophylaxis should be discontinued and antiretroviral drug therapy should be started.


- in case of acute hiv infection during pregnancy, that is in the intrapartum period, or during breast feeding, initial testing can be performed with an antigen/antibody combination immunoassay. If the supplemental test is negative, then an additional test which is the virologic test (dna, rna) are necessary for the diagnosis of the hiv infection.
- if the mother is hiv positive then this information must be documented in the infant's medical record and also communicated to the infants care provider.
The knowledge of an antenatal maternal hiv infection allows the:
- women with hiv infection to get the correct antiretroviral therapy along with prophylaxis for the infections which might occur due to the immunocompromised state of the body. This also prevents and decreases the risk of transmission to their partners.
- when there is provision for antiretroviral therapy for the mother during pregnancy and labor along with antiretroviral drug prophylaxis for the baby there is less risk of perinatal transmission of the hiv.
- the hiv infected women should be counseled for a cesarean delivery. The option of an elective cesarean reduces the perinatal transmission of the hiv.
- the hiv women should be counseled about the risk of breastfeeding.

Identification and Management of Perinatal HIV Treatment

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