Dr. Sucheta Malhotra

While pregnancy is not a pathological condition, it is a happy time that can be marred by various conditions. Debilitating morning or all day sickness, which is usually characterised by nausea, reflux in the Gastroesophageal band, heartburn and acidity. This can also turn into vomiting and lead to complications if it does not stop. Persistent, almost daily vomiting can be termed as excessive vomiting in pregnancy, and this is known as Hyperemesis Gravidarum in medical terms. Let us find out more about this condition.

• Routine: Hyperemesis Gravidarum usually strikes as a matter of routine at a set time everyday where the patient will either be in unappetising company of acute and painful acidity and nausea, or will also be vomiting.
• Severity: The severity of the condition usually decreases as the patient's pregnancy progresses. Usually, this condition strikes around the fourth or fifth week of pregnancy, before becoming better towards the middle of the second trimester. There are cases, though, where it continues to be just as severe till the very end of the pregnancy.
• When to take action: The patient may have to be hospitalised in case too much vomiting takes place, so as to prevent excess loss of water and salt from the body, and resultant weakness which may affect the growth of the foetus. Also, it is best to call the doctor when you have experienced fainting and dizzy spells.
• Causes: Hyperemesis Gravidarum or excessive vomiting during pregnancy cannot be attributed to any specific or single cause. Usually, it is known to be a genetic condition passed down by mothers to their daughters. But in most cases, doctors believe that the condition is due to hormonal changes, where an increase in the HCG hormone, or Human Chorionic Gonadotropin hormone level during pregnancy may lead to a variety of symptoms such as morning sickness or excessive vomiting. This hormone is known to be at its peak during pregnancy.
• Risk Factors: It has mostly been seen that women who are carrying twins are at risk of suffering from this condition. Also, women who have suffered from chronic motion sickness in the past report excessive vomiting during pregnancy.
• Treatment: The best way to treat this issue is to prevent too much of nausea and vomiting with the help of a bland diet that does not have heavy to digest ingredients. Also, it is best to take small and frequent meals.

Working your way around excessive vomiting during pregnancy is a matter of ensuring that you take rest, fluids and other precautions.

Related Tip: "6 Do’s and Don’ts of Working During Pregnancy "

A nose surgery (rhinoplasty) is performed to alter the structure and shape of your nose and improve its function and or appearance. Here are a few things you should know about nose surgeries: 

Consult your doctor: Before deciding on undergoing a nose surgery, talk with your doctor regarding issues with your nose. Your doctor will check your problems and judge whether or not surgery is a feasible option. It is only with your doctor's confirmation that you should go for the surgery.

Procedure:

1. The surgery is done either with local anesthesia (your nose and surrounding areas will be numbed) or general anesthesia (you will fall asleep).
2. The surgeon will make incisions in your nostrils and base of the nose and alter the shape, structure and position of the cartilages in your nose for appealing shape and better functionality. Polyp removal is also done by rhinoplasty.

Recovery after the surgery: You will be required to wear a nose splint. You can expect swelling around the eyes, which will begin to subside after the third day. Swelling in the nose will go away after six months. Therefore, do not expect to see your results immediately, final condition of your nose will be apparent after the recovery period is over. You should avoid strenuous activity for 3 to 6 weeks. Do not smoke or drink alcohol during recovery. Smoking slows recovery time and alcohol reduces normal effects of drugs.

Will you develop scars? As with all cosmetic procedures, rhinoplasty can leave scars.

Closed rhinoplasty: Incisions are made inside the nostrils and hence there is no scarring.

Open rhinoplasty: An additional cut is made along the columella and this may result in scarring. However, the position of the scar is such that it is almost unnoticeable.

Risks: Any surgical procedure has certain risks. These risks associated with nose surgery include:

1. Infection
2. Adverse effect to anesthesia
3. Unfavorable outcomes
4. Visible scarring
5. Numbness
6. Difficulty breathing
7. Chronic nosebleeds
8. A perforated septum
9. Hematoma
10. Burst blood vessels
11. Nervous damage
12. Possibility of revision surgery

Treatment for painful intercourse:

Dyspareunia is painful sexual intercourse due to medical or psychological causes. The pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix. It can affect a small portion of the vulva or vagina or be felt all over the surface. Understanding the duration, location, and nature of the pain is important in identifying the causes of the pain.

Numerous physical, psychological, and social or relationship causes can contribute to pain during sexual encounters. 

Underlying causes determine treatment. Many women experience relief when physical causes are identified and treated. 

The treatment for pain with intercourse depends on what is causing the pain. After proper diagnosis one or more treatments for specific causes may be necessary.

For pain due to yeast or fungal infections, a clinician may prescribe mycogen cream (nystatin and triamcinolone acetonide), which treats both a yeast infection and associated painful inflammation and itching because it contains both an antifungal and a steroid.
For pain thought due to post-menopausal vaginal dryness, estrogen treatment can be used.
For women with diagnostic criteria for endometriosis, medications or surgery are possible options.
In addition, the following may reduce discomfort with intercourse:

Both of you shave the pubic region regularly.
Use vaginal vibrator.

Also, add pleasant, sexually exciting experiences to your regular interactions, such as bathing together (in which the primary goal is not cleanliness), or mutual caressing without intercourse. In couples where a woman is preparing to receive vaginal intercourse, such activities tend to increase both natural lubrication and vaginal dilation, both of which decrease friction and pain. Prior to intercourse, oral sex may relax and lubricate the vagina.
Apply water-soluble sexual or surgical lubricant during intercourse. Discourage petroleum jelly. Lubricant should be liberally applied (two tablespoons full) to both the penis and the orifice. A folded bath towel under the receiving partner's hips helps prevent spillage on bedclothes.
Ask your partner to control the insertion by her hand.
For those who have pain on deep penetration because of pelvic injury or disease, recommend a change in coital position to one with less penetration. In women receiving vaginal penetration: maximum vaginal penetration is achieved when the receiving woman lies on her back with her pelvis rolled up off the bed, compressing her thighs tightly against her chest with her calves over the penetrating partner's shoulders. Minimal penetration occurs when a receiving woman lies on her back with her legs extended flat on the bed and close together while her partner's legs straddle hers. 

Swelling feet in pregnancy is normal to some extent. This is due to increased water in the body. But if it is very much that is if it comes on the face it needs to be taken care off. Anemia, with high bp, are associated with this.