Patient Review Highlights
I have consulted Dr. Preeti Pandya for Breast Augmentation procedure for my wife. After having a consultation with her I decided to go for the procedure and Iam very happy with the results and recovery period of the procedure. Dr. Preeti is amazing. I recommend her to my family and colleagues.
You've probably heard that a HPV vaccine can protect women against cervical cancer. In fact, the vaccine may be most effective when given to girls and young women. However the strains against which the HPV vaccine provides protection is limited. The vaccine does provide cover against the most prevalent strains (learn all about Cervical Cancer).
What Are the Benefits of the HPV Vaccine?
The main benefit of the vaccine is protection from cervical cancer.
Two HPV vaccines are currently on the market: Gardasil and Cervarix. In 2006, the FDA licensed Gardasil, the first cervical cancer vaccine. In 2007 Cervarix was approved. However, they don't protect against all types of cancer-causing HPV. Vaccines protect against these four types of HPV:
These types are responsible for 70% of cervical cancers and 90% of genital warts (learn more about warts).
What parents should know about the HPV or Cervical Cancer Vaccine
Does your daughter need the HPV vaccine to help protect against cervical cancer?
Pap screening in girls and young women should be recommended as follows:
Within 3 years of becoming sexually active.
By age 21.
Most girls taking the vaccine will probably need fewer Pap smears taken at longer intervals over their lifetimes.
Has your daughter already been infected with HPV virus?
If so, receiving the vaccine won't prevent disease from that particular type. However, the HPV vaccine will protect against infection from the other HPV strains included in the shot.
Why Should Girls Receive the HPV Vaccine?
Full benefit of the HPV vaccine occurs only if you receive it before you're infected with any of the HPV strains included in the vaccine. That's why, vaccinating girls between ages 11 and 12 is recommended .Ideally, this is before they become sexually active. The HPV vaccine can also be given to girls as young as 9 and to girls from age 13 to 26 who have not received it earlier.
You may question whether 11 or 12 is too early to vaccinate, the vaccine has been shown to be more effective in immunizing against HPV when it is given to younger girls who have never been infected with the dangerous HPV strains.
Cervical Cancer is most treatable when it is diagnosed and treated early. Problems found can usually be treated, depending on their severity and on the woman's age, past medical history, and other test results. Most women who get routine cervical cancer screening and follow up as told by their provider can find problems before cancer even develops. Prevention is always better than treatment.
Other HPV cancers are also more treatable when diagnosed and treated early. Although there is no routine screening test for these cancers, you should visit your doctor regularly for checkups.
Your doctor might recommend the HPV test if:
Your Pap test was abnormal, showing atypical squamous cells of undetermined significance (ASCUS)
You're age 30 or older
The HPV test is available only for women; no HPV test yet exists to detect the virus in men. However, men can be infected with HPV and pass the virus along to their sex partners.
What is a HPV Test?
The HPV test is a screening test for cervical cancer, but the test doesn't tell you whether you have cancer. Instead, the test detects the presence of HPV, the virus that causes cervical cancer, in your system. Certain types of HPV - including types 16 and 18 - increase your cervical cancer risk.
Knowing whether you have a type of HPV that puts you at high risk of cervical cancer means that you and your doctor can better decide on the next steps in your health care. Those steps might include follow-up monitoring, further testing, or treatment of abnormal or precancerous cells.
Pap- HPV Test:
HPV spreads through sexual contact and is very common in young women, so, frequently, the test results will be positive. However, HPV infections often clear on their own within a year or two. Cervical changes that lead to cancer take several years - often 10 years or more - to develop. For these reasons, you might follow a course of watchful waiting instead of undergoing treatment for cervical changes resulting from an HPV infection.
A combination Pap-HPV test is performed in your doctor's office and takes only a few minutes. You'll lie on your back on an exam table with your knees bent, your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of the vagina apart and a flat scraping device called a spatula or a soft brush is used to take samples of your cervical cells. This doesn't hurt, and you may not even feel the sample being taken.
Results of your HPV test are given as positive or negative
Positive HPV test:A positive test result means that you have a type of high-risk HPV that's linked to cervical cancer. It doesn't mean that you have cervical cancer now, but it's a warning sign that cervical cancer could develop in the future. Your doctor will probably recommend a follow-up test in a year to see if the infection has cleared or to check for signs of cervical cancer.
Negative HPV test: A negative test result means that you don't have any of the types of HPV that cause cervical cancer.
Depending on your test results, your doctor may recommend one of the following as a next step:
Normal monitoring:If you're over age 30, your HPV test is negative and your Pap test normal, you'll follow the generally recommended schedule for repeating both tests in five years.
Colposcopy: In this follow-up procedure, your doctor uses a special magnifying lens (colposcope) to more closely examine your cervix.
Biopsy:In this procedure, sometimes done in conjunction with colposcopy, your doctor takes a sample of cervical cells (biopsy) to be examined more closely under a microscope.
Removal of abnormal cervical cells:To prevent abnormal cells from developing into cancerous cells, your doctor may suggest a procedure to remove the areas of tissue that contain the abnormal cells.
Seeing a specialist: If your Pap test or HPV test results are abnormal, your healthcare provider will probably refer you to a gynecologist for a colposcopic exam. If test results show that you might have cancer, you may be referred to a doctor who specializes in treating cancers of the female genital tract (gynecologic oncologist) for treatment.
If you wish to discuss about any specific problem, you can consult the doctor and ask a free question.
What causes cervical Cancer?
Genital Human papilloma virus (HPV) is a very common virus in both men and women that can lead to the development of genital warts, abnormal cervical cells or cervical cancer.
This virus can cause normal cells on your cervix (Know more about Cervix Infection) to turn abnormal. Over many years, abnormal cells can turn into cancer if they are not found and treated by your doctor. It can take 10 to 15 years (or more) for cells to change from normal to abnormal, and then into cancer. Abnormal cells are sometimes called 'pre cancer ' because they are not normal, but they are not yet cancer.
You cannot see or feel HPV or these cell changes on your cervix. Screening tests help us to look for these changes or for abnormal cells (Learn more about sexually transmitted diseases)
How is HPV spread?
HPV is transmitted during genital skin to-skin sexual contact. This includes vaginal or anal sex and possibly oral sex.A person can get HPV even if years have passed since he or she had sex. They will never know it because HPV usually has no signs and symptoms.
In most cases, HPV goes away within two years, without causing any health problems. It is thought that the immune system fights off HPV infection naturally
What screening tests exist for HPV- related diseases?
Cervical Cancer: Cervical cancer can be detected with routine Cervical cancer screening (Pap test) and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops. Abnormal cells often become normal over time, but can sometimes turn into cancer. These cells can usually be treated, depending on their severity and on the woman's age, past medical history, and other test results.
An HPV DNA test, which can find certain HPV types on a woman's cervix, may also be used with a Pap test in certain cases (called co-testing). The HPV-DNA test is done to determine if you are infected with one of the high-risk types or if your doctor finds certain type of abnormal Pap test result.
Even women who were vaccinated when they were younger need regular cervical cancer screening because the vaccines do not protect against all cervical cancer strains.
Is there a treatment for HPV or related problems?
HPV vaccination could prevent most cancers and other diseases caused by HPV. There is no treatment for the virus itself, but there are treatments for the problems that HPV can cause:
Visible genital warts may remain the same, grow more in number, or go away on their own. The warts can be treated when they appear.
Abnormal cervical cells (found on a Pap test) often become normal over time, but they can sometimes turn into cancer. If they remain abnormal, these cells can usually be treated to prevent cervical cancer from developing. This may depend on the severity of the cell changes, the woman's age , past medical history, and other test results. It is critical to follow up with testing and treatment, as recommended by a doctor.
Post detection of ovarian cancer the doctors , depending on your cancer stage can recommend the treatment more- surgery, medical treatment, radiation therapy or chemotherapy.
Congratulations, that your Urine pregnancy test is positive and white stork will be visiting you soon! So it's your fourth week and you are advised an ultrasound in the coming week. With all the questions coming in your mind on what to expect from the ultrasound in regards to a normal pregnancy, I am here to help you month-wise. (Know more about dietary facts in pregnancy)
In the First Month (Learn more about First Trimester)
On ultrasound you will see the pregnancy sac and the doctor would describe the same as the womb-pregnancy sac. This highlights that the pregnancy is not ectopic (pregnancy outside the womb).Cheers! You will be called again a week or two later to see the further developments of the baby.
In the Second Month
On ultrasound you can now see a fetal node and the doctor makes you hear a typical galloping horse like sound-that's the fetal heart beat- the heart beat of your baby. You can also see a small ring like structure in the pregnancy sac which is yolk sac. It takes care in terms of nutrition until the placenta is formed
In the Third Month
You are asked to give your Dual test- a blood test which tests for hormones like B hcg and PAPP-A which indirectly indicate whether the baby has chromosomal abnormalities or risk of growth restriction later on. You will be told to have an 11-13 weeks scan .In this scan ,markers for chromosomal abnormalities like Nasal bone, Nuchal; translucency(fluid behind the neck) ,blood flow through the liver(Ductus venosus) , Tricuspid regurgitation along with Length of the baby and heart rate will be studied .During the ultrasound you will be shown the structure of the baby from head to toe. At the end you will be counselled whether you are a low risk or high risk for getting a baby with chromosomal abnormalities(especially Down Syndrome).
And if all is well you are called for the next scan at 5th month.
In the Fifth Month
This is the anomaly scan or Level 2 scan. You will notice your baby has grown significantly since you last saw. The doctor will see the structure of the baby including the brain and heart .The location of your placenta will also be reported. It you have a quadruple test/ triple test ,the results will be interpreted and explained.
If its a thumbs up, you are advised to follow up with your obstetrician and come for an ultrasound at 8th month if everything continues to be as expected.
In the Eighth Month
This scan checks the growth of the baby and the fluid around it. The medical experts check the blood flow through the essential structures like the brain,liver and umbilcal cor (fetal Dopplers ). The same is done to reassure you or decide further management. In some cases , this scan may be pre-pond starting at 7th month.
If along with the expertise, there is a high end ultrasound machine , you get a chance to see your baby moving/dancing/thumb-sucking in 4 dimensions. You and your hubby will surely fight over the nosy -its alike yours or your hubby's! And the experience is awesome and ever cherishing.
The early childhood period is considered to be the most important developmental phase throughout the lifespan. This period focuses on the physical, social/emotional and language/cognitive domains of development of a child, which have direct effects on their overall development as an adult in the future.
Physical Development: Physical developments of a child are associated with the motor skills and physical growth of the child. As a child grows and his or her nervous system become more mature, the child becomes more capable of performing increasingly complex actions such as walking, running, balance, and coordination which involve the larger muscles like arms and legs, as well as, some more intricate skills such as drawing, writing, grasping objects, throwing, waving, and catching, involving the smaller muscles in the fingers, toes, eyes, and other areas. Physical growth follows a directional pattern, such as the body's core, legs and arms develop before the small muscles in the fingers and hands. The muscles in the center of the body become stronger and develop before those in the feet and hands. Development goes from the head to the toes.
Cognitive Development: Cognitive abilities are associated with memory, reasoning, problem-solving and thinking that continue to emerge throughout childhood. There are four Stages of Cognitive Development:
Age Period Between
Birth to age 2
Respond to sensory stimuli by simple motor skills.
Age 2 to 6
Learn to use language, but do not understand logic or mentally manipulate information and understand others' point of view.
Concrete Operational Stage
Age 7 to 11
Begin to think logically about concrete events, but have difficulty understanding abstract or hypothetical concepts.
Formal Operational Stage
Age 12 to adulthood
Able to think about abstract concepts and develop skills such as logical thought, deductive reasoning, and systematic planning.
Language Development: It is the most remarkable development in children. According to several researches, it is found that language development begins at fetal level, as the fetus is able to identify the speech and sound patterns of the mother's voice and by the age of four months, a child can distinguish between sounds and read lips. Infants are able to differentiate between speech sounds from all languages; however, around the age of 10 months they lose this ability and begin to recognize their native language only.
Tooth eruption is not only a sign that your child is acquiring the ability to tear, bite, and chew food but it also effects the baby's weight gain, immunity strengthening and development of the brain indirectly.
It is observed that most babies get their first tooth at around 6 months after birth, but they may start gnawing as early as 3 months or as late as 14, and may vary from child to child. This depends on many factors, one of them being as when the parents started sprouting teeth and whether or not your baby was a preemie. In case of premature and low birth weight babies there may be a delay in their first tooth eruption. Children should have a full set of primary teeth by the time they are almost three.
Babies generally undergo the following Teething Timeline:
6 months: lower central incisors
8 months: upper central incisors
10 months: lower and upper lateral incisors
14 months: first molars
18 months: canines
24 months: second molars
Symptoms of Teething:
Babies start gnawing to relieve the pain of an emerging tooth.
Puffy and red gums
Irritation, especially at night
A change in eating habits
Methods to Soothe the Pain:
Teething is a physiological process, no major intervention is needed.
Distraction: You can often soothe your child simply by diverting their minds off the pain by any new toy.
You shouldn't use teethers and topical teething gels to soothe the pain as they might be toxic to babies.
Symptoms of teething usually disappear when the tooth breaks through the gum. In case your baby is teething and the pain prevails , the following signs and symptoms are seen - high fever, diarrhea, or vomiting, highly inflamed gums or blue gum (Cysts) or any kind of lesion or bumps on the gums. In such case you should consult the pediatrician for further guidance.
What a mother should expect about baby's hair growth.?
Every baby is special in his own way. Some are bald beauties and some have heaps of hair. Hair density mostly depends upon the genetic makeup of the baby. In the initial six months of life, babies hair tend to fall. Some may become totally bald and may not show any growth for some time.This is completely normal. Most babies show new hair growth between 9 months to 12 months of life. Almost all babies have growth till their second birthday. The colour and texture of the hair may vary from that present at birth. Curly hair can be replaced by straight hair. And thick dense hair can be replaced by thinner and sparse hair.
How to wash my baby's hair?
With newborn babies, In the early days the best way to wipe their hair is with a sponge. Support your baby's shoulders and head, which again should be tilted slightly, and gently pat the wet and warm sponge over the hair until it is sufficiently clean.
After 4-5 weeks in young babies use a small amount of baby shampoo on your baby's hair. Softly rub in a circular motion, and then use a plastic cup or your hand to rinse off the shampoo.
Always be gentle whenever you message a tearless baby shampoo into your baby's scalp. A too-brisk scalp massage can force hair follicles and speed up hair loss or breakage.
How often should I wash my baby's hair?
You should never wash your baby's hair everyday. Particularly with the newborns, there's just no requirement. Once, twice or on need basis baby's hairs can be washed. Instead of washing it every day, gently wipe it with a sponge daily to remove any dirt and fresh your baby up.
Which shampoo should I use?
Always use tearless nourishing natural ingredients shampoos. During first month try to avoid shampoo. Tearless shampoo can even hurt, avoid spillage in eyes. Adult shampoos should be avoided as it contains chemicals that can be toxic to the baby.
Will shaving head improve my babies hair growth?
Shaving your baby's head does not improve the hair growth. The hair just looks healthier with the dried, scraggly ends removed
From a husband's point of view "A Happy Wife Means a Happy Life". To keep most women happy is giving them unconditional love and support. If a husband wants to love his wife unconditionally, he should always be sure that her emotional tank is full. One of the best ways to do that is to affirm her constantly, let her know by words and actions that you value her, respect her and lover her.
For ages a husband's role has been that of a provider and protector. Men earn money to support the family and women would take care of home and children.
In the present scenario, most husband and wife are equally qualified but still women are and will always be mothers too, so they can never be free from the responsibilities of taking care of home and above all taking care of their children. While carry out all these responsibilities, her own goals and dreams take a back seat.
Give her the confidence: When a wife is handling various roles, her husband's support is very important for her to succeed. A husband supporting his wife through all phases also gives a very positive message to their children it indirectly evokes extreme confidence in them throughout their life.
Support her: A husband needs to give his wife confidence that you can do it and I will help you do it. Be it in taking care of children, progressing in career, adjusting with the in-laws and small or big things men should encourage and support their wives achieve happiness.
Treat her as an equal: Husband and wife in marriage are meant to be equal partners. Both need to work as a team in order to have a successful family. Though husbands and wives have different skills and characteristics, each of them contributes to the success of a happy home.
Make her feel special: Helping her in her responsibilities or small actions to make her feel special are enough. These give her the reassurance that you are around.
Be there when times are difficult: The best is when you there to sort out her problems and to make things easier for her. Be there to support her in times of stress. It could be work, family or a personal issue, handle it together.
How to Dry Baby's Hair?
Baby towels often have a hood attached to it that can be used to gently blot your baby's hair. Do not rub as the baby's hairs are fine and very delicate and vulnerable to damage. Also, never try to blow-dry a baby's hair, as babies' skin is very much sensitive than an adult's skin and can be very easily burnt. Their hair also dries very fast on its own.
How to Comb Baby's Hair?
Comb your baby's hair with a soft-bristle brush or a tooth brush that won't snag on tangles or pull your baby's hair. Avoid headbands or ponytails, as they pull your baby's hair back too tight, which can damage hair.
Cradle Cap-Should I worry?
Cradle cap refers to the fleshy, red flakes on the scalp of baby. This is not harmful but some may be bothered by it. Before a bath, massage a little bit of coconut oil into your baby's scalp to loosen the dry skin. Gently rub the oil into your baby's scalp with a ultra soft brush or wash cloth to release the flakes. Always wash your baby's hair with a gentle baby shampoo. Cradle cap should get better on its own. If it sticks around or spreads to the face of baby, or neck or other parts of the body, you should see your doctor.
What Oil should I Apply on My Baby's Hair?
Many new parents try to apply baby oil in the newborns scalp under the impression that it will lead to hair growth. This is a biggest misconception. Baby oil actually causes dryness of the scalp and clogs the pores of the head. Often the cause of cradle cap in babies is the usage of the baby oil. For healthy hair growth it would suffice coconut oil is applied onto your infant's hair and scalp.
When should I Plan the First Haircut?
There is no particular set time for a first haircut as it will not harm hair growth of the baby. Whenever you feel your child needs a trim, you should go ahead and get it done.
Why my Baby has Bald Spots? What Should I Do?
Sometimes babies have bald spots on their head because children lie in the supine position most of the time. Encourage the "tummy time" when your baby is awake, to allow their head to round out and prevent bald patches.
If you wish to discuss about any specific problem, you can consult a specilized dermatologist and ask a free question.
Food craving is absolutely normal during pregnancy. Junk food craving is a cause of concern, be it a pizza or a doughnut or any other junk food you can think of.
From the very onset of your pregnancy to delivery, you and your baby are undergoing constant changes. Major ones are:
- Food cravings
- Your weight
- Blood pressure fluctuation
- Blood sugar levels
- Mood swings
The following are the Do's and Dont's to ensure that your food cravings are healthy and benefit you and young one!
- Absence of Whole Grain: Fibre is a nutrient essential for energy and also helps in smooth bowel movements. The doughnut or pizza base does not have whole fibre even if they claim to, so there are more chances of you having bouts of constipation.
- Salt from Mayonnaise and Sauces: Without an extra blob of mayonnaise that Sub sandwich will not taste as good and moreover it has high amount of salt, which is just not friendly to a fluctuating blood pressure, it may also cause swollen feet due to water retention in your body.
- Limited Nutrient Quotient: Junk food has very limited meat or vegetables. The major portion of any junk food is the fattening, less nutrient cheese. This will surely affect the nutrient intake of the expecting mother and her baby.
- Sugars and Fats: Many expecting mothers have a craving for nibbling chocolates at unearthly hours. Foods high in sugar are known to cause mood swings and irritations. This could shoot up your blood pressure or even include gestational diabetes as a chain reaction.
- Expecting Mother to the Baby: By eating all the fast food which is fully loaded with sugar, salt and fat; rest assured it goes directly to the baby. Babies born obese and with other health disorders, tend to develop associated health disorders in their growing years or later on in life.
Tips to Stop Junk Food Cravings?
'You are what you eat' and so is your unborn baby. To make sure both of you get the rightly balanced, healthy, good nutrition, it is very important that you completely avoid fast food during pregnancy. Some tips to tackle junk food cravings:
- Clean your Kitchen Stock: Get rid of all junk food in the house and stock it up with healthy snacks – preferably organic. You can opt for baked options, rather than fried. Buying an oven is an excellent idea, so that you can make and eat tasty, healthy and nutritious snacks at home without preservatives and additives.
- Snack on Fruits and Nuts: These are so much better than artificially prepared munch bites you get from the local supermarkets. Have fruits and always keep dry fruits handy to fulfil the craving in you. Always eat fruits as soon as you cut them, as they lose their nutrients soon after they are cut.
- Photograph Therapy: Put up a nice, huge photograph of a curvy you, prior to pregnancy. The more you eat now, the harder you will have to struggle to get back into shape after delivery hence; this will surely make you strong enough to escape the lure of junk food.
It is important for you to always keep a watch on your pregnancy diet what you eat and want to eat. If you can't, do take the help of a family member or a friend to keep you away from junk food.
Bathing the newborn baby is a pleasurable experience both for the mother and the baby. It can also be defined as a process through which the mother and child bond. A mother understands the requirements of the child and the baby adapts itself to the cleanliness regime of the mother.
When should I start bathing my new born baby?
According to guidelines of WHO, initial bath for a term newborn weighing more than 2.5kg should be given 6 hours after birth. In the term low birth weight babies weighing less than 2.5kgs, only sponge bath is to be given, till the weight crosses 2.5kg.
Dip baths can be given once the umbilical cord falls off i.e. by 7 -10 days. Till then sponge baths are to be given.
How should I bathe my baby?
The room should be warm and free from draught of air as a wet baby can easily catch the chill. Check the temperature of the bath water before placing the baby in the bath tub. The depth of the water should be 5 cms upto the hip of the baby. Eyes can be cleaned by using one sterile water-soaked cotton swab for each eye. The Head should be washed last and dried first to prevent exposure due to large surface area. Pay special attention to skin folds of the neck, behind the ears, underarms, and diaper area. Also wash between the fingers and the toes.
What cleanser/ soap should I use for my baby?
Do not use soap for the first 1 month of life. After that, use any mild unmedicated soap or liquid cleanser with acidic/ neutral pH, that maintains the pH of the baby's skin. Avoid scented soaps and bubble baths.
How frequently should I bathe my baby?
In summer months, daily baths can be given. In winters, dip bath may be given twice/thrice a week and rest of the days, it is preferable to sponge the baby.
Hair wash can be given twice a week.
A word of caution:
Never leave your baby unattended to in the bath tub.Bath tub should be disinfected after use. If you wish to discuss about any specific problem, you can consult the doctor and ask a free question.
Once you have got the happy news of a little one coming soon in your life, you should start taking some special care so that you can enjoy the journey of pregnancy and get a healthy baby (learn about Dietary Dos and Don'ts for Pregnancy)
These are some pointers you have to follow during pregnancy:
Maintain good hygiene during pregnancy. Take bath regularly. Warm shower or sponge bath is considered better than tub bath.
Brush your teeth regularly and have a regular dental check up. Caries tooth can be extracted after 12 weeks of pregnancy.
Avoid wearing tight clothes and shoes with high heels. Wear loose and light clothes.
Take lots of fluid, fresh fruits & vegetables.
Take a diet which is light, nutritious, easily digestible & rich in protein, less fat, minerals and vitamins.
Stop smoking and drinking alcohol. It can cause miscarriage, defect in the development and growth of the baby.
Avoid jerky travelling, especially in 1st 12 wks and last 6wks of pregnancy. Prolonged sitting in a car or plane should be avoided. Air travel is not advisable to women who have high blood pressure, less hemoglobin (anemia) and low lying placenta.
Avoid taking any unprescribed drugs, exposure to X-Ray & chemicals especially in the 1st 12 weeks of pregnancy.
Take adequate rest in the lateral position and relax 1-2 hrs in the afternoon & 8 hrs at night.
Start taking folic acid at least 3 months before planning pregnancy & continue it till the 1st 12 weeks of pregnancy.
Start taking iron & calcium after 12 wks of pregnancy and continue it throughout pregnancy and 6 months post delivery.
Exercise regularly during pregnancy. Walking is the best exercise, but long periods of walking should be avoided. Also avoid heavy weight lifting and prolonged standing. Diving, water sking, gymnastic, netball, hockey, horse riding, cycling, rock-climbing, & scuba diving exercises should be avoided during pregnancy.
If you have any of these symptoms - vaginal bleeding, persistent abdominal pain, persistent vomiting, watery discharge from vagina, less or no fetal movement, severe headache, swelling on hands, face & feet, fever, dizziness, blurring of vision, double vision, spots before eyes, painful urination and diarrhea, immediately consult your gynecologist.
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.
Hepatitis C Is a Viral Infection That Is Little Talked About, but Can Be as Dangerous as Hepatitis B
Most people have head or what became in the 1980s and '90s the dreaded AIDS virus. With time and the availability of medicines, it ceased to be a killer. However, the knowledge of it helped stem its spread. Most people, unfortunately, don't realize that hepatitis C is also a killer, simply because not much has been said about it. In fact, it is also a virus, but is 10 times more infectious than HIV.
Hepatitis C is transmitted through the blood, and is usually passed on to women through infected needles and sex. At-home glucometers are often shared, or sometimes a woman's own lifestyle or her partner's lifestyle before marriage may put her at risk, because the virus can stay in the blood for years. It is also transmitted through blood products, like in the case of a transfusion, though in the case of pregnant women, this is not so common.
The dangers: The virus affects 1 in every 100 people in India, while globally 180 million are infected with it. Sometimes, it may just pass through the body, like many other viruses do, but sometimes, it can remain. If detected quickly, within six months or so, cure rates are high. the problem is that it is often not easy to detect, as symptoms resemble those of a regular seasonal viral infection: fatigue, nausea, loss of appetite. If it remains in the body, becoming chronic, then it may progress to liver disease. But the hepatitis C virus (HCV) doesn't have to be a killer. You can conquer it with these moves.
What you should do before: A number of couples who come to me have planned pregnancies-they opt for a baby, rather than the baby just 'happening' to them. This not only helps family planning, but it also helps us rule out infections or treat them if present. Usually, in the first trimester, your gynecologist will ask you to do a simple blood test for HIV, hepatitis B and C. In the case of a planned pregnancy, visit your doctor beforehand and ask if you need to take these tests before you conceive. However, there is no vaccine for HCV yet.
What you should do after: If a woman find out in the first trimester that she is hepatitis C positive, there's nothing much that can be done, as anti-viral medications cause birth defects, so a mother can only be put on them after delivery. She is advised to continue the pregnancy. A baby's chance of acquiring the infection in utero is between 5 and 7%. While this is not high, parents may like to avoid the risk. However, co-infection with HIV (if the mother is HIV positive) pushes the risk up to 19.4%. The pregnancy itself will not be hampered by the HCV infection. Nor does the risk of transmission to the child have anything to do with the mode of delivery-either vaginal or C-section. In India, there is little data on HCV transmission from mother to child. However, once the baby is born, the pediatrician may not do an immediate test to check for the virus, as it generally clears out from the baby's system in a year or so. Testing may only be done at 18 months.
What is Hepatitis B?
Hepatitis B can be defined as the viral infection of the liver. It is caused by Hepatitis B virus (HBV). It is the most common type of virus and can affect a person adversely if left undetected and untreated.
What are the risks to the baby born to Hepatitis B mother?
If the mother has Hepatitis B, there are chances of transfer of virus to the baby. Transmission can occur while the baby is in utero, during delivery and in postpartum period. Most of the cases are due to transmission of virus at the time of delivery due to exposure to blood. That virus can infect the baby and can cause hepatitis in the baby. Baby can become a chronic carrier and can develop liver cirrhosis and hepatocellular carcinoma in later life.
Does breast milk contain Hepatitis B Virus?
Yes, HBV can be found in the breast milk of 70% of carrier mothers, but there is no evidence of transmission of Hepatitis B through mother's milk.
Can Hepatitis B Positive mother give breastfeed to her baby?
Yes, according to WHO and UNICEF guidelines breastfeeding can be given, as breast milk is the natural and optimal feed to the baby. Mother feeding in hepatitis B positive mother infant can be made more safe by immunisation of the baby with Hepatitis B Vaccine and Hepatitis B immunoglobulin . Hepatitis B vaccine and immunoglobulins are to be given within 12hrs of delivery and the vaccine should be repeated after 1 month and 6 months. This will substantially reduce perinatal transmission and virtually eliminate any risk of transmission through breastfeeding or breast milk feeding. Immunization of infants will also prevent infection from all other modes of HBV transmission. Exclusive breast feeding is to be continued till 6 months of age .Start complementary feeds at 6 months of age and along with that continue breast feeding for two years.
What to do if Hepatitis B positive mother has sore or cracked or bleeding nipples?
Mothers should breastfeed the baby carefully so that she would not get cracked or sore nipple. In case she gets sore or cracked or bleeding for nipple ,stop breast feeding and take treatment for sore nipples. Because sore nipples or cracked nipples can transmit the virus through exposure to blood . During that period she should express the milk and discard it. She should resume the feeding after the nipples are healed.
Persistent infection of the uterine cervix with high risk human papilloma virus (HPV) leads to development of cervical cancer. Infection with HPV is common especially in sexually active young women, most infections are transient and spontaneously clear within 1 to 2 years without causing cancer. These transient infections may cause temporary changes in cervical cells. If a cervical infection with high risk HPV type persists the cellular changes can eventually develop into more severe precancerous lesions. If pre cancerous lesions are not treated, they can progress to cancer. Thus, an HPV DNA test is recommended to identify the high risk types of HPV.
Why is Pap Smear done?
An HPV test is done to:
Check for high-risk types of human papillomavirus (HPV) in women who had a Pap test that showed abnormal cervical cells called atypical squamous cells (ASCUS). An HPV test can help look for one or more high-risk types of HPV.
Check for HPV in women older than age 30 as part of screening for abnormal cervical cells.
Help check for abnormal cervical cells after treatment of a high-risk HPV infection.
When should one get screened for cervical cancer?
American Cancer Society does not recommend using HPV DNA test to screen for cervical cancer in females under 30. This is because females in their twenties who are sexually active are much more likely (than older females) to have a HPV infection that goes away on its own. For these young females, results of this test are not as significant and may be confusing.
For females age 30 and older, Pap & HPV co testing is less likely to miss an abnormality (i.e. lower false negative rate than pap testing alone. It also lengthens the screening interval to 5 years and still allows abnormalities to be detected in time to treat them.
Women of age >65 yrs who have had adequate screening history or those who have had total hysterectomy do not need any further screening.
Is HPV test as safe and effective as Pap Smear?
The advantage of the HPV test is that the Pap test misses a fair number of carcinomas as it has a lower sensitivity. Studies have also shown that a negative HPV test is better at predicting that a woman will be free of lesions for the next three years than a negative Pap test.
And while the experience for the patient is the same for both tests, the HPV test requires less material from the cervix to detect an infection so there's less concern that a sample will be inadequate.
How is the HPV test performed?
Before an HPV test, do not douche, use tampons, or use vaginal medicines for at least 48 hours.
In the HPV test, a doctor takes a swab of cells from the cervix, just as for the Pap test. The cells are then analyzed in a laboratory. The genetic material (DNA) of the HPV virus is studied. This test can identify 13 or 14 of the high-risk HPV types associated with cervical cancer. HPV test results are generally available in 1 to 2 weeks.
You may have a small amount of vaginal bleeding or gray-green discharge after this test.
Becoming a parent is the most cherishing moment in a couple's life, hence it is important to ensure that both the mother and the baby are healthy. In today's world lot of factors like environmental, socio-economic, lifestyle associated, and addictions such as smoking and alcohol affect the health of both men and women. If the parents have ill health or unhealthy lifestyle practices, the same can complicate matters and also cause infertility.
Prenatal Counseling: Today's life, especially in the metro cities, is fast and becoming more stressful. Pregnancy is a period when the health of the baby is directly dependent on the health of the mother and father. Also during the early phase of pregnancy the development of a baby inside the womb is very rapid and is the base for its future. Preconception counseling helps parents to understand and identify the different factors affecting the growth of the baby along with the modifications or complete illumination of these factors (if possible) to maintain the healthy development of the baby and the health of the mother as well.
Hence preconception counseling is a good initiative towards a healthy outcome. It not only guides the parent about the healthy lifestyle but also helps to find out the genetic factors causing any malformation or medical conditions, affecting the baby- the mother- the whole family through an emotional, psychological, social and economic point of view. It helps the parents to understand the condition, its future consequences so that they are able to take informed decisions.
The Prenatal Counseling Guides About:
- The right height and weight as per the BMI. This highlights the right attributes needed for conception
- Blood pressure to check any abnormality
- Medical history - whether they have had any medical treatment for any particular disease. If yes, then what are the medications? They check whether these are safe medications for pregnancy or not. The doctors then alter them accordingly to avoid any harmful effect on pregnancy.
- Abdominal & pelvic examination to rule out any abnormality
- Rubella screening- It is important to have a vaccine. As Rubella causes abortions or congenital birth defects in baby.
- Varicella screening to assess any chances of future abnormalities
- Depression screening as its medication are harmful for the baby & also if mother is not prepared for pregnancy then the outcome is usually affected.
- Blood tests like urine analysis, complete blood count, sugar, blood group & tests for -STDS (HIV, VDRL), Hepatitis B, thyroid dysfunction
- The importance of well-balanced nutritional diet and how to opt it
- The change or modification in the lifestyle to reduce stress
- Exercise and its benefits
- Any family history of any disease like Haemophilia and the steps towards it
- Quitting alcohol and smoking as they have adverse effects on the growth and development of baby
- Any kind of drug addiction having ill effect on the health of both mother and baby
Thus prenatal counseling in planning a baby is a step towards ensuring a healthy outcome.
Pregnancy is a life-changing experience, and you've got to be armed with the right nutrition to take it on!
For many moms-to-be, pregnancy is the time to rest, relaxation, and pampering and while for some, it may be stressful, especially if the pregnancy involves medical complications. Either way, it is a turning point in your life, physically, mentally, and emotionally. And food is an important part of this journey which requires a lot many changes in the diet, which has to be rightly balanced so that you are eating right for your belly and your baby.
A nutritious, balanced diet through pregnancy is important not only to maintain maternal nutritional needs, but also for the development of a healthy fetus. Remember, nutrition at this time needs to cater to the continuous adjustments in maternal body composition and metabolism.
The number of calories you will need to consume in addition to your regular diet is just 150 Kcal in the first trimester and 350 Kcal in the second and third. These surely need to be healthy calories, not empty calories. A clinical dietician will help you navigate the distribution of calories, but do keep them in check, as your maternal obesity puts you at risk for other serious medical conditions such as gestational diabetes. It may also put your baby at risk for future obesity and
Similarly, if you have morning sickness, you may not feel the urge to eat, and you may be underweight. In this case make each calorie count check, with nutritionally rich foods. Ensure that total weight gained throughout your pregnancy is between 12 and 14 kg. Cut down on refined sugar, and while ghee and butter are okay if you are not already overweight, avoid binging on them.
When it comes to pregnancy diet, there are certain foods that need to be definitely avoided. Foods that are too high in mercury or Vitamin A can pose a health risk to your baby, as can foods that are known to cause food borne illness such as Listeriosis and Salmonella poisoning. List of foods that are right for you and your baby.
For Boosting Your Baby Brain And Your Own Health:
Eat: fish, vegetable oils, nuts (especially walnuts), flax seeds, flax seed oil, dark leafy vegetables
Why: These are rich sources of Omega-3 fatty acids, an important component in boosting the development of the brain formation in the fetus, especially in the second half of pregnancy. According to the Harvard School of Public Health, US, Omega-3 is an integral part of the cell membranes and forms the building blocks of the fetal brain. While fish does contain mercury, US guidelines stipulate that two servings of fish in a week is safe. If you are not able to eat fish, ask your doctor if you should have a fish oil supplement. The two most beneficial forms of Omega-3s come from aquatic sources. But if you are vegetarian, you could try the other sources as well. This essential fatty acid is also known to reduce cholesterol, hence blood pressure.
For The Building And Strengthening Of Bones, For The Baby And You:
Eat: milk and dairy products, ragi (finger millet), broccoli, spinach
Why: To fulfill its own bone development requirement, the fetus will derive its calcium from the mother, whether or not the mother is getting adequate calcium herself. The National Institute of Nutrition has set the calcium needs for pregnant women and nursing mothers as double compared to non-pregnant women. You will need 1,200 mg per day. Two glasses of milk will give you approximately half the requirement. You can derive the rest from the other sources. Also make sure you get some sun, preferably in the morning, when it is not too warm, to help create vitamin D, necessary for good bone health.
Up Your Immunity:
Eat: colourful fruits and vegetables; probiotic foods such as yogurt
Why: Pregnancy is a time when you want to be safe and not catch any infections, especially those that can harm the fetus. Fruits and vegetables are antioxidant-rich. They have phytochemicals that naturally occur in plants, protecting them against infections. They'll help you do the same. Each colour gives a different benefit, so eat the rainbow through the week. Probiotic foods help maintain gut health. Set your own yogurt, as this contains many more 'good, healthful' bacteria than store-bought varieties.
For The Prevention Of Birth Defects In Baby:
Eat: legumes, green leafy vegetables, citrus fruits, nuts, beans
Why: Legumes include lentils, peas, beans, chickpeas, soybeans, and peanuts. The group is a rich source of folic acid, which helps in prevention of neural tube defects (birth defects of the brain, spine or spinal cord). Folate is one of the B-vitamins (B9), especially important in the first trimester. Your doctor will provide you with supplements, but you can also make sure you get the vitamin in your diet. Folic acid works closely with vitamin B12, to make red blood cells and make iron work properly in the body. If possible, eat organic, so you're not taking in too many chemicals.
For Overall Growth And Development:
Eat: small amounts of red meat, chicken, spinach
Why: Iron is an essential nutrient, and is needed for fetal and placenta growth, as well as for the development of the mother's own tissue. About 50-70% of Indians are anemic, and this is a cause of serious concern. Your doctor will prescribe additional iron in the form of a supplement; however, you can also get it in the diet.
Foods to be avoided when you're pregnant:
- Avoid unpasteurized milk.
- Avoid Alcohol.
- Avoid raw or undercooked meat, fish and eggs.
- Avoid unwashed vegetables and fruits.
- Avoid raw sprouts (Eating raw sprouts increases your risk of salmonella poisoning, which causes fever, vomiting and diarrhea. Be sure to cook sprouts thoroughly.)
- oid excess of caffeine.
Pregnancy is the most exciting period of a woman's life and has unique challenges. There are numerous well wishers - family members, friends, relatives- giving you free advice as what to do and what not to do for having a healthy baby. Many of these advices are just myths.
Following is a list of common myths and actual realities. It is best to follow your doctor's advice and not believe in myths:
- Your belly shape tells the gender of the baby: One of the most common myths during pregnancy is the shape of a woman's belly. If a woman is carrying high, it is a girl and if she is carrying low it is a boy. The fact behind this is the shape of a woman's belly during pregnancy depends upon her muscle size, tone, amount of fat deposited around her abdomen and also on the position of the baby.
- Your food cravings tell the gender of the baby: Craving for sweet food means it will be a girl and craving for salty food means you will be having a boy. According to literature food cravings have nothing to do with determining the sex of a baby.
- Eating more is needed for pregnancy: Another common myth is that pregnant mother must eat for two. Calorie requirements increase during pregnancy. Pregnant women require about 350kcals more to ensure that the baby is healthy. Eating a balanced diet during pregnancy rather than eating for two is required to fulfil the demands in pregnancy.
- Exercise will harm my baby : Exercises in pregnancy should be started after consulting your doctor and should be performed under a trained professional. Being fit improves your stamina and prepares you for the strenuous process of labour & delivery. Swimming, yoga, moderate amount of exercise, brisk walk are recommended during pregnancy, but should only be practiced after consulting with doctor.
- Sleeping on your back harms the baby: Sleeping on your back will not harm your baby, but you will feel better if you sleep on your left side. Sleeping on your left side actually increases blood flow to your body.
- Eating papaya increases chances of miscarriage: Raw papaya is suspected to be abortifacient. It contains chymopapain which is supposed to induce early labour. Ripe form of Papaya is a good source of vitamin A and is safe during pregnancy.
- Eating Saffron in milk affects the skin tone of the body: Remember skin colour depends upon the genes and food items have nothing to do with skin colour. Saffron has high nutritious content due to presence of Thiamine and Riboflavin. Because of its nutritional value it can be taken in pregnancy in very small doses.
Looking at Prince William holding his young one in his arms, leaving the hospital after the birth of his new born child was a pleasant sight. Men have a very important role in the process of pregnancy and child birth. It's challenging for fathers to be actively involved in pregnancy although no one doubts the fact that some of them become super dads while raising their kids.
- Research shows that Fathers are needed: Studies have proved that infants whose fathers had minimal involvement in pregnancy were more likely to be born premature and with low birth weight. Sometimes your physical and emotional presence is all that is required during pregnancy. So here let's have a look for role of dad in pregnancy and prepare quarterly roster.
- Be prepared to welcome the little one: Planning to start a family is a water shed moment for parents and the delivery of the ''Good news" certainly brings along mixed feelings of excitement and nervousness. It's like an examination schedule that has been pinned on the notice board. Husbands have a calming effect on moms in managing morning sickness. They have the responsibility to encourage her for a balanced and nutritious diet apart from planning antenatal visits to obstetrics clinic. They also take care of pregnancy mood swings of her partner because it's the hormones that are affecting and also be conscious and sensitive while making love in pregnancy.
- Be prepared for all circumstances: Dads need to be prepared to handle the odd symptoms of pregnancy and should find out about what they have should do. They can get references for mood related aspects. You can support the health of your partner by cooking and eating healthy meals together and exercising together. Prepare yourself for moving to a new place. Make a list of the hospitals that are not far and stay in touch always with your wife as it could be bit of emergency anytime. Plan for hospital stay and be a helping hand. Also try and engage your own parents so that they can also be a part of your training for baby care. Attending child birth classes together helps a lot to prepare you for arrival of new born.
Do get actively involved in labour and cord cutting also a father has a lot of role in successful breast feeding. It is best that you get more involved with your wife in the 9 months. The anticipation of a new one coming to your house should grip your imagination. Remember for many parents, it is the best time of their life's.