Breast cancer is one of the most common cancers in women about 1 in 8 women in the USA  develop invasive breast cancer. The incidence of breast cancer has increased with changes in lifestyle including smoking, drinking and loss of physical activity. The risk factors are age, ethnicity and family history cannot be changed. However, there are some risk factors that can definitely be acted upon to reduce the chances of developing breast cancer.

Weight management: Obesity is one of the major risk factors for breast cancer and managing weight and a good body mass index will help reduce the risk of developing breast cancer. This is especially important in women undergoing menopause.
Reducing smoking: The benefits of quitting it are manifold and reducing the risk for breast cancer is one of them. This will, as a byproduct, also result in a host of other benefits including improved quality of life, reduced chances of heart disease, stroke, and other cancers.
Physical activity: In addition to helping in weight management, this also helps reduce the risk of breast cancer. Ideal recommendation is 30 minutes of physical activity per day, plus strength training.
Breastfeeding: This helps in reducing the risk of breast cancer. Prolonged feeding is shown to have a greater protective benefit.
Hormone replacement therapy: When possible, limit the use of hormone replacement therapy for prolonged periods of time. Explore options of non-hormonal substitutes or use the least permissible or required dose. Be sure to get periodic check-ups when on hormone therapy.
Reduce exposure to environmental pollution: Higher levels of pollutants are linked to a higher incidence of breast cancer. When possible, avoid getting exposure to environmental pollutants.
Screening: If there is a strong family history or other risk factors, then screening can help detect breast cancer very early in the process. Recommended ages for mammography are as follows:
If you are age 40   44: Go for annual mammograms after discussing risks and benefits with the doctor.
If you are age 45   54: Go for annual mammogram.
If you are age 55 or over: Mammograms are recommended every other year. You can choose to continue to have them every year. Self-breast exams are not sufficient. However, if being done, they can also be an input to an abnormality.
Cautious use of birth control pills: Birth control pill usage to be discussed with your gynaecologist if you are above 35 years of age and smoke. The good news is that the risk associated with it disappears slowly after the pill is stopped.
These will help reduce the risk of developing breast cancer, early detection, and improved prognosis.

Breast Cancer - 8 Things You Must Do To Avoid it!

Breast cancer begins when the cells that are present in the breast start to go out of control. These cells generally form a tumor which can be seen on mammogram or one can feel it as a lump. The tumor is threatening if the cells can grow into the tissues that surround it or spread to other areas of the body. Breast cancer happens mostly in ladies. Here are a few methods with which you can prevent breast cancer-

Keep your weight in check: Maintaining a healthy weight is important for everyone although, it is easy to tune it out since it is said so often. Being overweight can expand the danger of a wide range of cancers, including breast cancer, particularly after menopause.
Be physically active: Women who are physically active for almost or at least 30 minutes a day have a lower danger of breast cancer. Normal activity is additionally one of the ideal approaches to keep weight under control.
Eat Your Fruits and Vegetables and Avoid Too Much Alcohol: A balanced and healthy diet can bring down the danger of breast cancer. Attempt to eat a considerable measure of fruits and vegetables and keep liquor at moderate levels or lower. While moderate drinking can be useful for the heart in most grown-ups, even low levels of intake can build the danger of breast cancer. If you do not drink, don't feel you have to begin. In case you drink modestly, there is less risk.
Try not to Smoke: Smokers and non-smokers alike know how undesirable smoking is. It brings down a person s quality of life and expands the danger of heart and lung diseases, stroke, and no less than 15 types of cancer, including breast cancer. It additionally causes bad breath, awful teeth, and wrinkles.
Breastfeed, If Possible: Breastfeeding for almost one year or more brings down the danger of breast cancer. It additionally has extraordinary medical advantages for the baby as well, especially in terms of immunity.
Keep away from Birth Control Pills: Contraceptive pills have both dangers and advantages. In many cases, the more young a lady is, the lower the danger is. While ladies are taking birth control pills, they have more chances of falling prey to breast cancer as per various medical studies. This danger leaves rapidly in the wake of stopping the pill. The danger of stroke and heart attack is increased while on the pill, especially if the woman smokes. Long term use can likewise have essential advantages, such as bringing down the danger of ovarian cancer, colon tumor and uterine cancer and undesirable pregnancy. In case you are exceptionally worried about breast cancer, staying away from birth control pills is also an alternative to lower the risk.

Breast Cancer - 6 Ways You Can Prevent It!

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

It is perfectly normal for women to experience the periodic monthly bleeding cycle. However, if a woman experiences uterine bleeding which is abnormal and dysfunctional, it could be a symptom of infection. Other causes of abnormal uterine bleeding include hormonal imbalance, infection in cervix and cancer of the uterus. Many women can also experience abnormal uterine bleeding during first trimester of pregnancy.

The following are considered to be abnormal or dysfunctional uterine bleeding:

A menstrual cycles occurs between 21 to 35 days, anything shorter or longer than this is abnormal
No period for 3 6 months (amenorrhea) is abnormal
Spotting or bleeding between periods
Spotting or bleeding after intercourse
Bleeding that is heavier or lasts longer than usual
Spotting or bleeding after menopause
What can cause such a situation?

Some of the common causes leading to abnormal bleeding are as follows:

Miscarriage
Ectopic pregnancy
Pregnancy
Cervical or uterine infections
Fibroids
Hormonal imbalances
Problems with blood clotting
Polyps
Polycystic ovarian
Endometrial hyperplasia
Cancer of the reproductive tract
How to Diagnose it?

Most women tend to ignore abnormal bleeding, taking it as something to do with age or hormones. A detailed physical examination and history is done to understand menstrual cycle patterns and family history. In addition, the following would be used.

Ultrasound: The pelvic organs are examined through sound waves to locate the problem area
Hysteroscopy: Through a thin device that is inserted into the vagina, the doctor takes a look at the inside of the organs and identify the cause for the bleeding
Endometrial biopsy: The uterine lining tissue is removed and examined under microscope to look for tissue changes that could be causing the bleeding
How Best to Treat It?

This would depend on the reason for the abnormal bleeding. However, in most cases, combinations of the following are useful in treatment.

Hormone replacement can be done depending on the age and gynecological history, the type and the dose of the hormone would be decided upon. These could be in the form of tablets, vaginal creams, injections, or through an intrauterine device
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are useful in reducing bleeding and controlling cramps during excessive menstrual bleeding.
Antibiotics may be useful if there is infection of the pelvic organs.
Polyps, cysts, cancers, and other growths can be removed via hysteroscopy and sent for biopsy to confirm they are not cancerous.
Endometrial ablation where the endometrial tissue is treated with heat can be used to control bleeding permanently.
Hysterectomy would be done if other forms of treatment have failed. This could depend on their gynecologic history and other considerations as she cannot get pregnant after this.
Do not ignore if you see a change in the pattern of your uterine bleeding. It definitely calls for medical attention and if identified early, can be managed in much simpler ways. 

Abnormal Uterine Bleeding - How Best to Diagnose It?

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.

Dilation & Curettage Process - What To Expect From It?

Minimally invasive spinal surgery is a quicker and safer alternative to open surgery. The spinal discs, vertebrae and nerves are present deep inside the body. A small incision is made and the surgical instruments and a camera is inserted which push aside the muscles and reach the problem area.

Which medical conditions can be addressed with minimally invasive spine surgery?

1. Degenerative Disc Disease (osteoarthritis of the spine)
2. Herniated Disc (the disc protrudes from its right place)
3. Spinal Tumours
4. Vertebral compression fractures (collapse of the vertebra)
5. Lumbar spinal stenosis (narrowing of the space near the spinal cord)
6. Scoliosis (the spine curves sideways)
7. Spinal infections
8. Spinal instability

What are the goals of minimally invasive spine surgery?

1. Decompression: this procedure eases the pressure being exerted on the spinal cord or the nerve roots. This pressure can be the cause of pinched nerves.
2. Stabilization: sometimes, a segment of the spinal cord that has come loose can be the source of pain. A stabilizations surgery fuses the segment to the rest of the structure.



The three most common methods of minimally invasive spine surgery are-

1. Tubular: it is also called  muscle splitting  surgery. A tubular retractor passes through the muscles of the back and reaches the spine.
2. Mini-open: it is a lot like open surgery but with fewer risks and blood loss. The possibility of post-operation infection goes down significantly.
3. Endoscopic: it is also called a keyhole surgery. A small camera is introduced through a small incision and guided to the spine. The camera gives an internal view of the spine to the doctors.

The three types of Minimally Invasive Spinal Surgery are-

1. Microdiscectomy: involves the removal of the intervertebral disc that is putting pressure on the spinal cord.
2. Foraminotomy: spinal conditions can lead to narrowed foramen (the area where the spinal nerve exits the spine). The aim of the surgery is to expand the foramen.
3. Microlaminectomy: this is yet another type of decompression surgery. The aim is to relieve pain caused pinched nerves or a segment of the bone pressing down on the nerves.

What are the benefits of minimally invasive spine surgery?

  Speedy and pain-free recovery after surgery
  A patient is discharged the same day
  Very little loss of blood
  Reduced chances of infection
  Less scarring because the operation is done through small incisions
  Less muscle damage

Are there any risks attached to minimally invasive spine surgery?

No surgery is free of risks or side effects. Some common problems in the aftermath of minimally invasive spine surgery are-

  Allergies
  Reaction to anaesthesia
  Blood clots
  Infections
  In rare cases stroke and paralysis.

Minimally invasive spinal surgery incorporates the latest advances in the world of technology. It is the relatively hassle-free procedure and convenient for both doctors and patients.

Minimally Invasive Spinal Surgery - A Safer Alternative To Open Surgery!

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