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Dr. Urvash Jain

Radiologist, Delhi

Dr. Urvash Jain Radiologist, Delhi
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My favorite part of being a doctor is the opportunity to directly improve the health and wellbeing of my patients and to develop professional and personal relationships with them....more
My favorite part of being a doctor is the opportunity to directly improve the health and wellbeing of my patients and to develop professional and personal relationships with them.
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Dr. Urvash Jain is one of the best Radiologists in Ashok Vihar, Delhi. You can consult Dr. Urvash Jain at Samyak Ultrasound Centre in Ashok Vihar, Delhi. Book an appointment online with Dr. Urvash Jain and consult privately on Lybrate.com.

Lybrate.com has an excellent community of Radiologists in India. You will find Radiologists with more than 29 years of experience on Lybrate.com. You can find Radiologists online in Delhi and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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MPT
Physiotherapist, Mumbai
Though not very common, but herniated disks or bone spurts in the vertebrae of the neck might take too much space and compress the nerves branching out from the spinal cord which may lead to severe pain in the neck.

How Is Breast Cancer Diagnosed?

MBBS, MD - Obstetrtics & Gynaecology
Gynaecologist, Delhi
How Is Breast Cancer Diagnosed?

Breast cancer is a form of cancer which develops from the breast tissue. Breast cancer is indicated by signs such as a lump in the breast, changes in breast shape, fluid flowing from the nipple, dimpling of skin, or the development of red scaly patches. Breast cancer is a fatal form of cancer in women and immediate diagnosis is required on observing the symptoms.

Diagnosis of breast cancer
Other than the regular breast screening, the diagnosis of breast cancer involves the following steps and methods:

  1. Seeing your general practitioner (GP): It is very important to visit your GP soon after noticing the symptoms of breast cancer. Your GP will examine you properly and in case your symptoms need more assessment, he/she will refer you to a breast cancer clinic.
  2. Mammogram and breast ultrasound: You will be required to have a mammogram, as recommended by a specialist breast unit. This is an X-ray of the breasts. An ultrasound scan may also be required. Breast ultrasound should be undertaken only if you are less than 35 years of age. This is because, young women have denser breasts and a mammogram is not as effective as ultrasound in the diagnosis of breast cancer. In ultrasound, high frequency sound waves are used for obtaining an image of your breasts. It is observed to notice any abnormality or lumps. A breast ultrasound is also important for determining whether a lump is solid or contains liquid.
  3. Biopsy: In this diagnosis process, a sample of the tissue cells is taken from the breasts and tested under a microscope to find out if it is cancerous. A scan and needle test for the lymph nodes present in your armpit is also done to check whether they have also been affected. A biopsy is undertaken in several ways, depending upon the condition and severity. A needle aspiration biopsy is used for testing a sample of your breast cells without the removal of the tissues. This is the most common form of biopsy and it is also used for draining a small fluid-filled lump or benign cyst. During the process, you will be given a local anesthetic. Usually, a needle biopsy is carried out guided by an X-ray, ultrasound and an MRI scan as well. This helps in distinguishing it from non-invasive changes such as ductal carcinoma in situ.

Another form of biopsy used for the diagnosis of breast cancer is called vacuum assisted biopsy or mammotome biopsy. In this process, a needle gets attached to a suction tube, which helps in obtaining the sample and for clearing the bleeding. If you wish to discuss about any specific problem, you can consult a general-surgeon.

3010 people found this helpful

Herniated Disc - What are the Risks Involved in it?

MCh - Neurosurgery, MBBS
Neurosurgeon, Chennai
Herniated Disc - What are the Risks Involved in it?

The symptoms caused due to herniated disc can be very severe and can also cause a bit of disability. The disc of the spine is like a cushion and separates the set of bones on the backside. The discs are shock absorbers of the spine and are mainly composed of 2 parts, a soft jelly centre called the nucleus and a tough outer covering called the annulus.

Effects of Herniated Disk
A herniated or cracked disc is a severe condition and it seems to happen most commonly in the lower back.  It happens when a fraction of the soft centre gets pushed through the destabilized area due to degeneration, trauma or by putting pressure on the spinal cord. 

Nerves are located precisely at the back of every disc and are responsible for controlling everything in our body. While a disc gets herniated, the external covering of the disc tears and creates a bulge. The soft jelly gets shifted from the centre of the disk to the region where the damage has occurred on the disc. Most commonly, the bulge occurs in areas where the nerve is located and it causes strain on the affected nerve. It has been observed that individuals do not feel any painful sensations even if their disc gets damaged.

When is Surgery Recommended for Herniated Disc?
Surgery for herniated disc is recommended only after options like steroid injections, pain relievers, exercise and non-steroid anti-inflammatory drugs do not work. If the pain persists even after these options, then it becomes important to go for surgery. There are certain risks involved in this surgery like infection, bleeding or nerve damage. 

There are chances that the disc may get ruptured again if it is not removed. If you are a patient suffering from degenerative disc disease, then there are chances that problem occurs in other discs. It is very important that a patient maintains healthy weight to prevent any further complications.

The main factor that increases the risk of herniated disc is excess body weight, which causes a lot of stress on the lower back. A few people become heir to a tendency of developing this condition. Even individuals with physically demanding jobs are prone to this condition. 

Activities like bending sideways, pushing, twisting, repetitive lifting can increase the risk of a herniated disk. At times, emergency surgery is also required to avoid paralysis in a patient. If you wish to discuss about any specific problem, you can consult an orthopedist.

3508 people found this helpful

I am 19 years old and I am having lower back pain (disc herniation l4-l5. I suffer pain everyday. What shall I do?

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Kindly show me a photograph of the affected part. Rule out diabetes & vit. D deficiency or any other metabolic disorder. Sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick matress are harmful use no pillow under the head. Do hot fomantation. Paracetamol 250mg od & sos x 5days. Caldikind plus 1tab od x10. Do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. If it does not give relief in 4-5days, contact me again. Do not ignore. It could be beginning of a serious problem.
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Diet Tips After Kidney Transplant

M.Sc. in Dietetics and Food Service Management , Post Graduate Diploma In Computer Application, P.G.Diploma in Clinical Nutrition & Dietetics , B.Sc.Clinical Nutrition & Dietetics
Dietitian/Nutritionist, Mumbai
Diet Tips After Kidney Transplant

Post kidney transplant, most people have a low immunity due to the powerful medications that are prescribed to avoid rejection of the organ. These medications tend to make the patients more prone to infections and hence, following strict dietary guidelines is necessary to avoid any complication. Also, as most people suffering from kidney failure are diabetic, hypertensive or suffer from heart disease, dietary control is mandatory. Moreover, the use of immunosuppressive drugs can increase your risk of diabetes, hypertension or heart disease. 

#1: eat a protein rich diet

After a kidney transplant, the body requires more proteins to aid in the healing process and improve immunity. This is the reason, why consuming proteins should not be limited. Also, patients who were previously on dialysis had a lower protein intake, post kidney transplant, the consumption of proteins is recommended to be increased. Here are 6 protein sources for vegetarians.


#2: do not eat raw fruits

Intake of raw fruits is not advised as there is a high risk of infection due to raw food. However, you can eat fruits in stewed form as cooking lowers the active bacterial load, thereby lowering your risk of infection.


#3: include curd in your diet

Curd contains good quality protein, which is required for healing post-transplant, hence, curd should be eaten. As far as sour foods like lime and tamarind are concerned, eating them is also okay. But avoid eating grapes as they are known to interact with immune suppressive drugs and hinder healing of the kidney. Also read about 11 diet do’s and don’ts for people with kidney problems.


#4: you need not avoid fruits/ vegetables with seeds

Foods with seeds like tomato, brinjal, ladies finger, guava, watermelon, etc are considered harmless and can be taken after transplant, provided other biochemical parameters like electrolytes and cholesterol are within normal range. Also, ensure that the level of potassium in the blood is within control. However, if you are suffering from kidney stones, it is better to avoid these foods.

#5: you might need to take protein supplements

People who undergo kidney transplants are recommended protein supplements during the initial stage, however, it varies from person to person. In most cases, post kidney transplant, patients recover their appetite, hence there’s no need for any supplements. However, if the patient feels that his protein intake is not optimal, he can continue taking supplements post-transplant, but only after consulting a nephrologist.

Unlike the common misconception that kidney transplant recipients can eat everything after a transplant, you need to follow a disciplined dietary routine with numerous restrictions, depending upon your overall recovery and health. You can start eating out after three to six months of kidney transplantation, as it is the average time taken for the immuno-suppression to be stable and be at a low level. However, raw food, salads, fruits and foods kept open should be strictly avoided, even in general.

1 person found this helpful

Abnormal Uterine Bleeding - 3 Ways to Treat it!

MD, MBBS
Gynaecologist, Vadodara
Abnormal Uterine Bleeding - 3 Ways to Treat it!

Any kind of bleeding from the uterus, which is not normal, can be termed as abnormal uterine bleeding. This refers to bleeding between periods or before periods, bleeding after having sex, spotting, abnormally heavy bleeding or bleeding after attaining menopause. If you are suffering from any of these issues, you need to consult with the doctor

Diagnosis
It is very important to diagnose abnormal uterine bleeding. There are several examinations and tests that have to be carried out, depending on age. For irregular spotting, a pregnancy test can be undertaken in case you think you could be pregnant. If your uterine bleeding is very heavy, a test has to be performed to check blood count. This is done to observe whether you have anemia. An ultrasound test of the pelvic region will also be advised by your doctor to know the cause of the bleeding. Several hormonal tests and thyroid function tests are required as well.

Other diagnostic tests include:

  1. Sonohysterography: When fluid is placed within the uterus and ultrasound images of the uterus are taken. An image of the pelvic organs is obtained.
  2. Hysteroscopy: It can be carried out when a device is inserted via the vagina and enables the doctor to examine the uterus internally.
  3. Magnetic resonance imaging: This is also used to get images of the organs.
  4. Endometrial biopsy:  It involves insertion of a catheter to take out a tissue which is microscopically observed. 

Treatment
There are different types of treatment for abnormal uterine bleeding depending upon factors such as the cause of bleeding and the age of the patient.

  1. Medications: Several medicines are used to treat abnormal uterine bleeding. Sometimes hormonal medicines are used. Birth control pills are also used to improve the regularity of periods. Hormonal infections, vaginal creams and an IUD device releasing hormone can be used. Non steroidal anti-inflammatory drugs are also used to control bleeding. Several antibiotics may also be prescribed.
  2. Surgery: In some cases of abnormal uterine bleeding, a woman has to undergo a surgery for the removal of growth such as polyps and fibroids, which results in bleeding. While some fibroids can be removed via hysteroscopy, others require different techniques for treatment.
  3. Endometrial ablation: It can be undertaken to control bleeding. This mode of treatment aims at reducing the bleeding permanently. In case all treatment methods fail, hysterectomy has to be carried out. This is a serious surgery and after it is performed, a woman does not have periods anymore and will not be able to conceive a child.

Abnormal uterine bleeding is a serious health condition, which may lead to severe complications. Immediate diagnosis and appropriate treatment methods should be undertaken in case of any abnormal uterine bleeding.

2638 people found this helpful

What should I be doing to releave the pain for two herniated disc's one above and one below a fusion surgery of the cervical spine.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Sleep on a hard bed with soft bedding on it. SPRING BEDS, FOLDING BEDS OR THICK MATRESS ARE HARMFUL Use no pillow under the head. DO HOT FOMANTATION. Paracetamol 250mg OD & SOS x 5days. Caldikind plus 1tab OD x10. Do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. If it does not give relief in 4-5days, contact me again.. Do not ignore .It could be beginning of a serious problem.
1 person found this helpful
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Prevention Techniques Of Breast Cancer

MBBS, MD - Obstetrtics & Gynaecology
Gynaecologist, Delhi
Prevention Techniques Of Breast Cancer

Medical science constantly challenges the boundaries by finding not only the cures to the most dangerous diseases, but finds a way to prevent them even before they occur. With years of research, practice and data available for analysis, scientists are using advanced technology in combination with years of research to create a predicting mechanism for often fatal diseases like cancer.

Breast cancer screening has always been done with mammography. The fact is that this method is only 75% accurate, laden with false positives and misses a whole set of women totally- and that too when cancer has already developed. Part of the problem comes from the dense breast tissue which one in three women have. This tissue masks the lumps, which makes it difficult for mammograms to accurately screen cancer.

Some breakthrough scientific methods are changing this by drawing on years of research to predict this deadly disease, years before it can manifest itself.

A genetic test to predict cancer 10-11 years ahead of time. This test was performed to see how environmental factors could influence cancer, along with habits like smoking, abusing alcohol or hormones, genetic changes that occur and are put a large percentage of the women at a high risk of developing this disease.

A simple blood test is used for the genetic analysis of hereditary cancer. Researchers found a biological marker, methylation of the ATM gene, which has a very high ability to predict the risk of developing cancer, several years before diagnosis. 'Methylation' concluded that when one biological indicator is exposed to carcinogenic substances, or other abusive substances like tobacco and alcohol, it may trigger the development of cancer.  On the flip side, this test will take time to reach the commercial market and even then cannot give an exact timeline as to when someone may develop the disease.

A simple blood test to predict breast cancer 5 years before it develops. This is the kind of medical miracle the world is looking for. Last year in April, researches in Denmark identified a simple blood test that can predict breast cancer five years before it actually develops with an accuracy of a whopping 80%.

It works by "measuring all of the compounds in the blood to build a 'metabolic profile' of an individual, in order to detect changes in the way chemicals are processed, during a pre-cancerous stage," says Laura Donnelly, health editor at The Telegraph, which covered this development. Danish researchers observed 57,000 participants over 20 years, gathering blood samples along the way, specifically comparing a set of 800 women who remained healthy or developed breast cancer within 7 years of their first blood sample. The researchers found they were able to predict, with 80 percent accuracy, which patients would be affected by the disease, just by looking at the metabolic profiles they built from the participants' blood samples. The results have been published in Metabolomics.

Herniated disk l3-14 mm L4-11 mm L5-10 mm S1-8 mm My age 23 /M Dr. suggest for surgery but I didn't want that any chances for normal.

MBBS, MD (Anaesthesiology)
Pain Management Specialist, Varanasi
It seems that you are having multiple disc herniation. I cannot comment unless I see you MRI but definitely you having at least two slipped disc at L4/5 & L5/S1. These days non surgical treatment are available like TFSI, Disc Fix and Percutaneous Endoscopic Lumbar Discectomy (PLED) done under Local anaesthesia, no blood loss, no stich required, patient walks within next few days. We will provide you detailed information if you wish or you may see on website. I may need your blood inv. Like TLC/DLC/ESR/CRP/HLA B-27 before giving further opinion.
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She is 63 years old suffering from diabetes-on Insulin+other allopathy medicines but the sugar level running from 70 to 200 and more. Today fasting 90 but PP is going high between 200 to 300. She is on Insulin from last 15 years. Can she be treated with you? And I am also suffering from Slip Disc. L4 L5 S1 and taken 15 days Ayurvedic treatment such as Katibastyi, Malish, Steam bath etc but there is nothing complete and permanent. Please advise us to permanent treatment.

PDDM, MHA, MBBS
General Physician, Nashik
This means either her diet is wrong or she is not receiving proper treatment kindly mention ongoing treatment in detail and revert. Slip disc is difficult to treat but you should use lumbosacral belt and proper posture is really important in your case. Avoid massages by inexperienced people.
1 person found this helpful
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I am 39 years my weight is 95 kg, my height is 5.4, I have ligament tear in my right knee, I have slip disc in l4, l5, high bp. Etc, please suggest how to loose weight. Rapidly fast if any medicine that can help to reduce the weight.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Weight reduction can not be done over night. You have to take it as a way of life. Do diet control. No sugar in tea, coffee, milk etc. No sweets take small frequent feeds. When you get used to it, skip one meal. You should do non weight bearing yoga exercises. For your knee problem you would need arthroscopic knee surgery. It is a very safe procedure in our hands with uniformly good results. We have very good well equipped center in delhi. Do ask for detailed treatment plan. Don? t ignore it lest it become beginning of a bigger problem.
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Abnormal Uterine Bleeding - How Best to Diagnose It?

Fellowship and Diploma in Laparoscopic Surgery, FOGSI Advanced Infertility Training, Royal College of Obstetricians and Gynaecologists (MRCOG), MS - Obstetrics and Gynaecology, MBBS
Gynaecologist, Gurgaon
Abnormal Uterine Bleeding - How Best to Diagnose It?

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:

  1. A menstrual cycles occurs between 21 to 35 days, anything shorter or longer than this is abnormal
  2. No period for 3–6 months (amenorrhea) is abnormal
  3. Spotting or bleeding between periods
  4. Spotting or bleeding after intercourse
  5. Bleeding that is heavier or lasts longer than usual
  6. Spotting or bleeding after menopause

What can cause such a situation?

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

  1. Miscarriage
  2. Ectopic pregnancy
  3. Pregnancy
  4. Cervical or uterine infections
  5. Fibroids
  6. Hormonal imbalances
  7. Problems with blood clotting
  8. Polyps
  9. Polycystic ovaries
  10. Endometrial hyperplasia
  11. 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.

  1. Ultrasound: The pelvic organs are examined through sound waves to locate the problem area
  2. 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
  3. 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.

  1. 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
  2. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are useful in reducing bleeding and controlling cramps during excessive menstrual bleeding.
  3. Antibiotics may be useful if there is infection of the pelvic organs.
  4. Polyps, cysts, cancers, and other growths can be removed via hysteroscopy and sent for biopsy to confirm they are not cancerous.
  5. Endometrial ablation where the endometrial tissue is treated with heat can be used to control bleeding permanently.
  6. 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.

3 people found this helpful

Breast Cancer Prevention:

Homeopath,

Breast Cancer Prevention:

  1. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

  2. Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer. Different ways to prevent cancer are being studied, including:

  3. Changing lifestyle or eating habits. Avoiding things known to cause cancer. Taking medicine to treat a precancerous condition or to keep cancer from starting.


 

General information about breast cancer:

Key points:

  1. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Breast cancer is the second most common type of cancer in india

  2. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

  3. The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

  4. Enlarge Drawing of female breast anatomy showing the lymph nodes, nipple, areola, chest wall, ribs, muscle, fatty tissue, lobe, ducts, and lobules.

  5. Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, lobes, lobules, ducts, and other parts of the inside of the breast are also shown.

  6. Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter lymph and store white blood cells that help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

     

Avoiding risk factors and increasing protective factors may help prevent cancer. The following are risk factors for breast cancer:

  1. Older agea personal history of breast cancer or benign (noncancer) breast diseasea family history of breast cancerinherited gene changesdense breasts

  2. Exposure of breast tissue to estrogen made in the bodytaking hormone therapy for symptoms of menopause radiation therapy


 

The following are protective factors for breast cancer:

  1. Less exposure of breast tissue to estrogen made by the bodytaking estrogen-only hormone therapy after hysterectomy,

  2. Estrogen-only hormone therapy after hysterectomyselective estrogen receptor modulatorsaromatase inhibitors and inactivators

  3. Risk-reducing mastectomy ovarian ablationgetting enough exercise


 

It is not clear whether the following affect the risk of breast cancer:

  1. Oral contraceptives

  2. Factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk


 

Older age:

  1. Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.

  2. A personal history of breast cancer or benign (noncancer) breast disease

     

Women with any of the following have an increased risk of breast cancer:

  1. A personal history of invasive breast cancer, ductal carcinoma in situ (dcis), or lobular carcinoma in situ (lcis). A personal history of benign (noncancer) breast disease.

  2. A family history of breast cancer

  3. Women with a family history of breast cancer in a first-degree relative (mother, sister, or daughter) have an increased risk of breast cancer.


 

Inherited gene changes:

  1. Women who have inherited changes in the brca1 and brca2 genes or in certain other genes have a higher risk of breast cancer, ovarian cancer, and maybe colon cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors.

  2. Men who have inherited certain changes in the brca2 gene have a higher risk of breast, prostate, and pancreatic cancers, and lymphoma.


 

Dense breasts:

  1. Having breast tissue that is dense on a mammogram is a factor in breast cancer risk. The level of risk depends on how dense the breast tissue is. Women with very dense breasts have a higher risk of breast cancer than women with low breast density.

  2. Increased breast density is often an inherited trait, but it may also occur in women who have not had children, have a first pregnancy late in life, take postmenopausal hormones, or drink alcohol.

  3. Exposure of breast tissue to estrogen made in the body

  4. Estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating.


 

A woman's exposure to estrogen is increased in the following ways:

Early menstruation: beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen. Starting menopause at a later age: the more years a woman menstruates, the longer her breast tissue is exposed to estrogen. Older age at first birth or never having given birth: because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant.

 

Taking hormone therapy for symptoms of menopause:

Hormones, such as estrogen and progesterone, can be made into a pill form in a laboratory. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy (hrt) or hormone therapy (ht). Combination hrt/ht is estrogen combined with progestin. This type of hrt/ht increases the risk of breast cancer. Studies show that when women stop taking estrogen combined with progestin, the risk of breast cancer decreases.


 

Radiation therapy to the breast or chest:

  1. Radiation therapy to the chest for the treatment of cancer increases the risk of breast cancer, starting 10 years after treatment. The risk of breast cancer depends on the dose of radiation and the age at which it is given. The risk is highest if radiation treatment was used during puberty, when breasts are forming.

  2. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast.

  3. For women who have inherited changes in the brca1 and brca2 genes, exposure to radiation, such as that from chest x-rays, may further increase the risk of breast cancer, especially in women who were x-rayed before 20 years of age.


 

Obesity:

Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy.


 

Drinking alcohol:

Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises.


 

The following are protective factors for breast cancer:

  1. Less exposure of breast tissue to estrogen made by the body

  2. Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways:


 

Early pregnancy: estrogen levels are lower during pregnancy. Women who have a full-term pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35. Breast-feeding: estrogen levels may remain lower while a woman is breast-feeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed.

Taking estrogen-only hormone therapy after hysterectomy, selective estrogen receptor modulators, or aromatase inhibitors and inactivators


 

Estrogen-only hormone therapy after hysterectomy

Hormone therapy with estrogen only may be given to women who have had a hysterectomy. In these women, estrogen-only therapy after menopause may decrease the risk of breast cancer. There is an increased risk of stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy.


 

Selective estrogen receptor modulators:

Tamoxifen and raloxifene belong to the family of drugs called selective estrogen receptor modulators (serms). Serms act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues.


 

Treatment with tamoxifen lowers the risk of estrogen receptor-positive (er-positive) breast cancer and ductal carcinoma in situ in premenopausal and postmenopausal women at high risk. Treatment with raloxifene also lowers the risk of breast cancer in postmenopausal women. With either drug, the reduced risk lasts for several years or longer after treatment is stopped. Lower rates of broken bones have been noted in patients taking raloxifene.


 

Taking tamoxifen increases the risk of hot flashes, endometrial cancer, stroke, cataracts, and blood clots (especially in the lungs and legs). The risk of having these problems increases with age. Women younger than 50 years who have a high risk of breast cancer may benefit the most from taking tamoxifen. The risk of having these problems decreases after tamoxifen is stopped.


 

Taking raloxifene increases the risk of blood clots in the lungs and legs, but does not appear to increase the risk of endometrial cancer. In postmenopausal women with osteoporosis (decreased bone density), raloxifene lowers the risk of breast cancer for women who have a high or low risk of breast cancer. It is not known if raloxifene would have the same effect in women who do not have osteoporosis. Talk with your doctor about the risks and benefits of taking this drug.


 

Aromatase inhibitors and inactivators:

Aromatase inhibitors (anastrozole, letrozole) and inactivators (exemestane) lower the risk of a new breast cancer in women who have a history of breast cancer. Aromatase inhibitors also decrease the risk of breast cancer in women with the following conditions:

Postmenopausal women with a personal history of breast cancer. Women with no personal history of breast cancer who are 60 years and older, have a history of ductal carcinoma in situ with mastectomy, or have a high risk of breast cancer based on the gail model tool (a tool used to estimate the risk of breast cancer).

In women with an increased risk of breast cancer, taking aromatase inhibitors decreases the amount of estrogen made by the body. Before menopause, estrogen is made by the ovaries and other tissues in a woman's body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body's estrogen. Aromatase inactivators stop the enzyme from working.


 

Possible harms from taking aromatase inhibitors include muscle and joint pain, osteoporosis, hot flashes, and feeling very tired.


 

Risk-reducing mastectomy:

Some women who have a high risk of breast cancer may choose to have a risk-reducing mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is much lower in these women and most feel less anxious about their risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling about the different ways to prevent breast cancer before making this decision.


 

Ovarian ablation:

The ovaries make most of the estrogen that is made by the body. Treatments that stop or lower the amount of estrogen made by the ovaries include surgery to remove the ovaries, radiation therapy, or taking certain drugs. This is called ovarian ablation.


 

Premenopausal women who have a high risk of breast cancer due to certain changes in the brca1 and brca2 genes may choose to have a risk-reducing oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. Risk-reducing oophorectomy also lowers the risk of breast cancer in normal premenopausal women and in women with an increased risk of breast cancer due to radiation to the chest. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the symptoms of menopause to begin. These include hot flashes, trouble sleeping, anxiety, and depression. Long-term effects include decreased sex drive, vaginal dryness, and decreased bone density.


 

Getting enough exercise:

Women who exercise four or more hours a week have a lower risk of breast cancer. The effect of exercise on breast cancer risk may be greatest in premenopausal women who have normal or low body weight.


 

It is not clear whether the following affect the risk of breast cancer:

  1. Oral contraceptives

  2. Certain oral contraceptives contain estrogen. Some studies have shown that taking oral contraceptives (" the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Other studies have not shown an increased risk of breast cancer in women who take oral contraceptives.

  3. Progestin -only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer. More studies are needed to know whether progestin-only oral contraceptives increase the risk of breast cancer.


 

Environment

  1. Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer.

  2. Studies have shown that some factors do not affect the risk of breast cancer.


 

The following do not affect the risk of breast cancer:

  1. Having an abortion. Making diet changes such as eating less fat or more fruits and vegetables. Taking vitamins, including fenretinide (a type of vitamin a). Cigarette smoking, both active and passive (inhaling secondhand smoke). Using underarm deodorant or antiperspirant. Taking statins (cholesterol -lowering drugs). Taking bisphosphonates (drugs used to treat osteoporosis and hypercalcemia) by mouth or by intravenous infusion.

  2. Cancer prevention clinical trials are used to study ways to prevent cancer.

I am a student. Usually I used to sit more than 8 hours a day in chair. Now a days I am feeling very much pain on regions of backbone and neck. Is this a chance of disk failure?

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
Neck advice hot fomentation x twice daily. Neck exercises. Neck stretching. Postural correction. Shoulder shrugs. Core strengthening exercises. Take frequent breaks at work use cervical pillow. Use back support. Back advice. Apply hot fomentation twice daily. Avoid bending in front. Postural correction- sit tall, walk tall. Extension exercises x 15 times x twice daily. Bhujang asana. Core strengthening exercises. Back stretching. Do the cat/cow stretch.
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I am a 25 years old male, I have been suffering from bulging disk at l5-s1. I have been resting for 2 months, now my neck has started paining too and left pelvic joint is making popping sound everytime it is bend. So I got my blood acid checked. And its been 8 for last two months, I have been drinking like 6 lts water everyday. Is uric acid main reason of pain? And how can I get it down as I don't want to start the medicine so early in life and drinking water is not working. Please suggest, my career is suffering a lot.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Requires detailed examination and investigation. Preliminary investigations suggested: hb, tlc, dlc, esr, blood sugar fasting & pp, uric acid vit d urine r/e x-ray of the affected part. Anyway it may be tried sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick mattress are harmful use no pillow under the head. Do hot fomantation paracetamol 250mg od & sos x 5days. Caldikind plus 1tab od x10. Do neck, back, knee & general exercises. It may have to be further investigated. Do not ignore it. Let it not become beginning of a bigger problem. Make sure that patient is not allergic to any of the medicines that he/she is going to take. If it does not give relief in 4-5days, inform.
5 people found this helpful
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I am bodybuilder I had a disc replacement due to bulge in my disc. Is it possible to continue bodybuilding. Lifting weights etc. Plzz help me.

Fellowship of the Royal College of Surgeons (FRCS), Membership of the Royal College of Surgeons (MRCS)
Orthopedist, Trichy
lifting weights is not advisable once you have had problems in your spine. there are other discs in the spine that can always create the same problem you had initially.
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Breast Cancer - In A Nutshell

Post Doctoral Research (Ph.D.) (A.M) (Oncology), Integrative Oncology for Physicians (MSKCC, N.Y, USA), Doctor of Natural Medicine (N.D/ N.M.D), Ayurveda (I) Cert., Advanced Strategic Management (APSM), B.E (Computer Sc. & Engg.), Clinically Relevant Herb-Drug Interactions (CME) - (Cine-Med Inc. USA)
Alternative Medicine Specialist, Bhubaneswar
Breast Cancer - In A Nutshell

Breast cancer begins when cells in the breast(s) start to grow out of control. It is understood as being the most common cancer, seen predominantly in females, globally. It is reasonably treatable and often curable.

1. Type: Adenocarcinomas constitute more than 95% of breast cancers with infiltrating ductal carcinoma (IDC) being the most common form of invasive breast cancer.

Frequently occurring breast cancers present as one of the following types mainly

1. Ductal Carcinoma In Situ (DCIS): Is the most common type of non-invasive breast cancer and is confined to the milk ducts of the breast. There is no invasion in the basement membrane. Pure DCIS metastasizes rarely. Non comedo cribrioform carcinoma is the most common DCIS found which, when compared to the comedo type, is mostly non-aggressive.

2. Infiltrating Ductal Carcinoma (IDC): Represents majority (about 3/4th) of the breast cancers, and is known to metastasize commonly to bones, lungs and liver.

3. Lobular Carcinoma In Situ (LCIS): Develops in multiple lobules of the breast (bilaterally). LCIS is less commonly seen, compared to DCIS.

4. Infiltrating Lobular Carcinoma (ILC): Represent about a tenth of all breast cancers and tends to metastasize to other regions of the body.

Less commonly occurring breast cancers such as

5. Inflammatory Breast Cancer: Is relatively uncommon and are caused probably owing to viral infections. The breast is warm, red and swollen.

6. Paget’s disease of the nipple: Is a rare form of breast cancer. It begins in the milk ducts and spreads to the nipple and areola.

7. Medullary Carcinoma

8. Mutinous Carcinoma

9. Tubular Carcinoma

10. Phylloides tumor etc all.

2. Gender: Affects the female populace predominantly. However, a small percentage of breast cancer is attributable to the male populace as well.

3. Etiology: No definite cause is known. However, diet, lifestyle, environment, hormonal/ reproductive factors, personal or family history of breast cancer especially in first degree relatives and also any benign breast disease history etc all are known to increase the risk of breast cancers. Specifically, excessive fatty diet, obesity, type 2 diabetes mellitus, benign breast disease, heredity/ inheritance of mutated breast cancer genes 1 (BRCA1) and 2 (BRCA2), smoking, alcohol intake, infertility, estrogen therapy/ hormone replacement therapy (long term) in post menopausal women, delayed age at first pregnancy, nulliparity (not having child), early menstruation, delayed onset of menopause, lactating mothers not breast feeding, exposure to ionizing radiation, sedentary lifestyle, depression, exposure to MMTV virus etc all can potentially increase the risk for breast cancer.

4. Features: Signs & symptoms, of breast cancer, manifest majorly in the following ways

  1. Lump/ nodule in the breast that gets attached to the skin of the breast over time. The lump / nodule could be hard and painless with irregular edges or it could also be soft, rounded, tender and painful.

  2. Enlarged lymph nodes in the axilla which are palpable.

  3. Swelling of whole or a part of a breast. This is even if there is no distinct lump felt.

  4. Retraction or thickening of the nipple(s).

  5. Pain in the breast or nipple.

  6. Discharge from nipple other than breast milk.

  7. Irritation/ scaliness of skin over the breast.

  8. Redness of nipples

  9. Rarely, red, swollen and tender breast.

5. Screening: Is generally recommended for asymptomatic populations goal of which, as usual, is to be able to detect & diagnose breast cancer at an early stage which is potentially curable. It is mostly radiologic with mammography/ USG being instrumental in raising suspicions for further diagnostics (i.e. biopsy) that help detect breast cancer, if any, early.

6. Diagnosis: A self-examination/ clinical exam of the breast(s)/ axilla that reveals a palpable mass prompts the following diagnostics. Abnormal blood test results may be indicative of malignancy, but a follow up imaging/ biopsy is always the gold standard for accurate diagnosis.

  1. Blood: ER/ PR/ HER2/neu, uPA, PAI-1, CA15-3, CA27.29 etc all tumor markers are helpful.
  2. Imaging: Mammography/ USG Scan usually, as relevant. Again, CT Scan of abdomen & pelvis and chest, PET CT scan, bone scan etc all help detect metastasis, if any, for cancers in stage III & above.
  3. Biopsy: either excisional, incisional, fine needle aspiration (FNA) or core biopsy technique, as contextually appropriate, is frequently employed and a histopathological examination (HPE) thereof clinches the diagnosis and the nature of the disease.

7. Treatment: Conventional treatment includes surgery, radiotherapy, hormone therapy/ chemotherapy as deems appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.

8. Prognosis: Preventive measures, earlier diagnosis and right early treatment is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage breast cancer are more. The cure/ recovery chances are influenced by the type, grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. Above-mentioned apart, age, menopause status, lymph node status, ER/ PR/ HER-2/ neu status, size & extent of breast cancer etc all also influence the treatment outlook in breast cancer. The five year survival rate is strongly correlated with the stage of breast cancer.

9. Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an increased focus on protective factors and avoidance of the risk factors can be of help. An adherence to a Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising (for at least 30 minutes daily), de-stressing and relaxation is highly recommended for reducing the risks of breast cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. It is advisable to limit milk/ dairy, preferably of low fat content, to 1 to 2 servings max daily. Although alcohol is optional and is not for everyone, the consumption of the same, if any, has to be strictly in moderation, and is best avoided. Smoking is to be avoided as well. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly or are best avoided too. Limiting dosage/ duration of hormone therapy, if any, especially to counteract post menopausal symptoms and also avoiding exposure to radiation and environmental pollution can help reduce the risks of breast cancer. Apart from the above-mentioned, for high risk cases, a prophylactic oophorectomy, prophylactic radical mastectomy, long term hormone therapy etc all can help reduce the chances/ risks of developing breast cancer significantly. Breastfeeding is known to confer protection against breast cancer risk too.

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Hello sir. I have lower back pain since 2 months back. I have done mri there is disk problem. What is permanent solution is surgery kindly help me.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Kindly show me a photograph of the affected part. Rule out diabetes & vit. D deficiency or any other metabolic disorder. Sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick mattress are harmful Do hot fomentation. Paracetamol 250mg od & sos x 5days. Caldikind plus 1tab od x10. Do neck, back & general exercises. It may have to be further investigated. You will need other supportive medicines also. Make sure you are not allergic to any of the medicines you are going to take. If it does not give relief in 4-5days, contact me again. Do not ignore. It could be beginning of a serious problem.
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