Dr. Vibhu Sharma

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.

What is ECMO?
Like dialysis for unfunctional kidney, Ecmo for unfunctional lung.

Ecmo stands for extracorporeal membrane oxygenation. It is a method of giving oxygen for the body when icu pateint lungs and/or heart are not able to supply oxygen on their own. 

Why ICU pateint put on ECMO?

Doctors place ICU patients on ECMO when patients are not able to supply oxygen to the body.

ICU patients’ lungs fail for a number of reasons including pneumonia, lung cancer, pulmonary edema, pulmonary embolism and COPD.

 When a patient’s lungs fail, he/she first is intubated (breathing tube) and hooked up to a ventilator (breathing machine).
 However, sometimes lungs are so damaged that providing oxygen through intubation is not enough.

This is when doctors turn to v-v ecmo.
A heart can fail for many reasons including heart attack, pulmonary embolism, bad valve disease, or worsening heart failure. When a heart fails, doctors try to fix the underlying problem. They may also start medications (called ionotropes) to help improve the pump function of the heart. If medications are not enough, doctors will turn to v-a ecmo.

How long can someone stay on ecmo?

That is a complicated question. Due to the risks of ecmo discussed above, doctors try to keep patients on ecmo for as short a time as possible. Often patient will be on ecmo for several days up to 1-2 weeks. Every day, several blood and imaging tests are done to determine if a patient is ready to come off ecmo. As the technology of ecmo improves, hopefully side effects will decrease and patients can remain on ecmo for longer periods of time.

What is the difference between ecmo and a ventilator (breathing machine)?

Both ecmo and a ventilator aim to provide oxygen to the body when the patient’s own lungs and breathing are failing. The ventilator assists the patient’s own lungs by pushing oxygen with pressure into the lungs. Ecmo instead provides oxygen directly via a catheter placed in a patient’s vein or artery. We almost always try oxygenating a patient with a ventilator first. However, when a patient’s lungs are too sick for this, we turn to ecmo to assist in providing oxygen to the body. V-v ecmo provides oxygen through a vein. This blood then has to travel to the heart and be pumped around the rest of the body through arteries. Therefore, with v-v ecmo or with a ventilator, a patient must have a well-functioning heart to get the oxygen pumped throughout the body. V-a ecmo has the additional advantage of pumping blood directly to arteries. This “by-passes” the heart and is therefore the method of ecmo we use when a patient’s heart is failing.

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.

When the skin of a breast looks uneven, it is known as a dimpled skin. Sometimes the skin might appear to be red or inflamed. In this condition, the breast tissue gets affected and this can be a serious sign of concern for cancer. Moreover, this sign is hard to detect on your own. Usually when the sign occurs, it only occurs in one of the breasts. If a woman has it in both the breasts, then likely that it has not been caused by cancer.

Causes of breast cancer dimpling are as follows
1. Advanced breast cancer
2. Breast abscess: A hollow space in the breast that is filled with pus and is at times surrounded by an inflamed tissue.
3. Duct obstruction: The ducts that carry the milk from the nipple are obstructed causing rapid abnormal growth and functioning of the cells present in the breasts causing cancer.
4. Fat necrosis: In this condition, the neutral fats are split into glycerol and fatty acids because the adipose tissue tends to degenerate.
5. Inflammation: Inflammation in the fatty tissue of the breast
6. Mastitis: The breast tissue tends to swell up and get infected. This happens because of the bacteria that enter the breasts through the nipple and this may cause infection in the milk glands.
7. Genetic: Carrying the faulty gene is one of the main reasons why many women end up literally inheriting breast cancer. This can usually be tested with a mammography, especially if one has a history of breast cancer in the family. Yet, one must remember that it is not advisable to take this test too many times as it puts you at risk of contracting breast cancer even if you do not have it, when there is repeated exposure.

First, the doctor might perform certain tests to diagnose and determine the problem. Tests like an ultrasound, MRI or even a mammogram might be used. Depending on what the diagnoses is, the doctor might even want to perform a biopsy. In case breast cancer is diagnosed, there are certain treatments that are available. These include:

1. Surgery: The cancerous tissue is removed from the breast or at times when the tissue is too big, the entire breast might have to be removed.
2. Chemotherapy: Chemotherapy is a medication that uses a method to send fluids that tend to kill the cancerous cells or prevent them from growing. It is a three to four hour long session at times.
3. Radiation: High beam x-rays are used in order to target and destroy the cancer cells present in the breasts.
4. Hormonal therapy: In this treatment, the hormones that fuel the growth of cancerous cells are blocked either through medications or surgically. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Brain surgery involves several medical procedures, which incorporate fixing issues with the brain, including changes in the tissues of the brain, cerebrospinal fluid and brain blood flow. Brain surgery is quite a complicated method of surgery and the type of surgery to be conducted depends on the underlying conditions.

Reasons for Brain Surgery:
Brain surgery is performed for the correction of physical brain abnormalities. These abnormalities could occur because of diseases, birth defects and injuries. A brain surgery is required when the following conditions arise in the brain:

1. Abnormal blood vessels
2. Aneurysm
3. Bleeding
4. Blood clots in the brain
5. When the protective tissue or dura is damaged
6. Epilepsy
7. Due to nerve damage
8. Parkinson's disease
9. Any kind of pressure after an injury
10. Abscesses
11. Skull fractures
12. In case of stroke and tumors

A surgery may not be required for all the above mentioned conditions, but in case of many, a brain surgery is very important as the conditions may worsen health problems.

Types of brain surgeries:

1. Craniotomy: During this open brain surgery, an incision is made in the scalp, and a hole is created in the skull, near the area, which is being treated. After this process is complete, the hole or bone flap is secured in its place using plates or wires.
2. Biopsy: This form of brain surgery helps in the removal of a small amount of brain tissues or tumors. After removal, the tissues or tumors are examined under a microscope. The creation of a small incision and a hole in the skull is indicated as a part of this process.
3. Minimally invasive endonasal endoscopic surgery: This form of brain surgery enables the removal or lesions and tumors via the nose and sinuses. Private parts of the brain can be accessed without creating an incision. An endoscope is utilized in the process which is used to examine tumors all across the brain.
4. Minimally Invasive neuroendoscopy: This process is similar to the minimally invasive endonasal endoscopic surgery. This method also involves the use of an endoscope for removal of brain tumors. Small, dime sized holes may be made in the skull to access some brain parts.

Risks:
Brain surgeries may be associated with several risks. They may be:

1. Allergic reactions to anesthesia
2. Bleeding
3. Blood clot formations
4. Swelling of the brain
5. A state of coma
6. Impairment in speech, coordination and vision.
7. Problems in memory
8. Strokes and seizures
9. Infections in the brain

A brain surgery is a serious and very complex surgery. There are different kinds of brain surgeries, which are conducted depending on the condition and severity of the disease. If you wish to discuss about any specific problem, you can consult a Neurosurgeon.

The most powerful and amazing organ in our body is the brain. It differs from many other organs of our body not only by its shape, but also by its special type of cell called neurons. When these cells gets affected or dead it can never be reverted or regenerated which is the most exclusive nature found only in brain cells. The cells in other parts of our body has the capacity to regenerate (can be replaced or new one can be grown or produced), but brain cells are exception. Hence any damage to the brain, injury or trauma is really a crucial thing to be considered with utmost care.

Brain surgeries really need skill, proper training, confidence and intelligence to perform this highly complicated and risky surgery.

Purpose:
Brain surgeries are performed to:

1. Remove the brain tissues that are grown abnormally
2. Aneurysm is clipped to prevent flow of blood cliff off an aneurysm
3. Biopsy purpose or to remove the tumour
4. Make a nerve free
5. Drain the abnormal blood or clot collection or to drain any excessive fluid collection caused by infection.
6. To implant artificial electronic device as a treatment for conditions like Parkinson’s disease

Types:

1. Biopsy: A part of brain tissue is removed for the brain or whole tumour is removed.
2. Craniotomy: The skull bone is opened to remove tumour, an aneurysm and drain fluid or blood from infection.
3. Minimally invasive endonasal endoscopic surgery: Endoscopic devices are inserted through the nose to remove the lesions or tumour.
4. Minimally invasive neuroendoscopy: Similar to endonasal surgery but small incision is made.

Risks:

1. Anaesthesia risks like breathing difficulty, allergic reaction to medications, excessive bleeding or clots and infection.
2. Risk related to the brain surgeries are seizures, coma, swelling of brain, infection to brain or meanings, surgical wound infection that intrudes to the brain structures, abnormal clot formation and bleeding.
3. General risks include muscle weakness, disturbances in memory, speech, vision, coordination, balance and other functions that are controlled by the brain. If you wish to discuss about any specific problem, you can consult a neurosurgeon.

1. Eat calcium-rich foods

In addition to dairy products, choose fish with bones such as salmon, sardines or whitebait. For additional benefits, serve them with a side of dark leafy green vegetables or broccoli. Almonds, dried figs, fortified tofu and soy milk are also calcium-rich choices, says registered dietitian laura jeffers, med, rd, ld.

2. Take calcium supplements

The u. S. Recommended daily allowance for calcium is 1, 000 mg a day during your 20s, 30s and 40s. But your need rises as you age. Check with your doctor before starting supplements to find out what amount is right for you. For example, after menopause, most women need 1000 to 1, 500 mg a day unless they take hormone therapy. Your body only absorbs 500 mg of calcium at a time, Ms. Jeffers notes, so spread your consumption out over the course of the day.

3. Add d to your day

To help absorb calcium, most adults need 1, 000 to 2, 000 iu of vitamin d daily, combined calcium-vitamin d pills usually do not meet this requirement. And most of us who live north of atlanta do not get enough vitamin d the old-fashioned way — from the sun. Taking a vitamin d supplement will ensure you meet your daily needs.

4. Start weight-bearing exercises

To boost your bone strength, try exercise that “loads” or compresses your bones, says exercise physiologist heather nettle, ma. “running, jogging, high-impact aerobics, repetitive stair climbing, dancing, tennis and basketball are best for building bones. But if you have osteopenia, osteoporosis or arthritis, try walking or using an elliptical or other machine,” she says. Be sure to clear any exercise plans with your doctor first.

5. Don’t smoke, and don’t drink excessively

Bad news for bad habits: loss of bone mineral density is associated with tobacco use and excessive alcohol consumption, Dr. Sikon says. If you smoke, look into a program to help you quit. If you drink, stick to no more than one libation a day, she advises.

6. Get your bone mineral density tested

Doctors can get a quick and painless “snapshot” of bone health using a simple x-ray test called dxa. This test measures bone mineral density and helps determine risks of osteoporosis and fracture. Dr. Sikon recommends testing for women within two years of menopause. Earlier tests are recommended for men and women with certain diseases and for those taking medications that increase risk, such as long-term steroid therapy.

7. Medication

Perimenopausal women may consider hormone therapy to increase waning estrogen levels, which are linked to bone loss. And women and men diagnosed with osteopenia or osteoporosis can take various medications to prevent dangerous hip and spine fractures.

Breast cancer is a type of cancer, which occurs due to the development of cancerous cells in breasts. Women are usually affected by breast cancer and breast cancer is one of the most common forms of cancer after skin cancer. Usually fatal if not diagnosed in its early stage, breast cancer is a very serious medical ailment. Read on more to find all about the different symptoms, causes, preventive measures and treatment of breast cancer.

Symptoms: Breast cancer has few distinct characteristics and if you have a few or all the following symptoms you could be more likely to suffer from breast cancer. 

• The formation of a lump in your breast, which is different from the surrounding tissue and usually more thickened.
• The discharge of bloody fluid  material from the nipples.
• Sudden change of the size, shape and appearance of the breast.
• Certain distinct changes to the skin over the breast for example an indentation in the skin similar to that of a dimple.
• Appearance of an extra nipple which is inverted.
• If the darkened area around the nipples known as the areola is flaking or peeling off. 

Causes: Studies and researches remain inconclusive on what causes breast cancer. Breast cancer occurs due to abnormal division of the cells located in the breast, which over time accumulate and form lumps. They
might spread to other parts of the body. Breast cancer is caused mainly due to a complex interaction of personal genetics, environment and lifestyle choices. Breast cancer can also be caused due to genetics as about 5% to 10% of cases are due to gene mutations which pass onto generations.

Risk factors: There are certain factors, which increase the probability of contracting breast cancer. Increasing age, personal and family history of breast cancer, obesity, radiation exposure, pregnancy at an older age, postmenopausal hormone therapy are some of the factors that increase the chances of breast cancer.

Treatment: Several forms of surgical methods exist to treat breast cancer. Depending on the condition and spread of the disease a suitable surgery is performed. These include mastectomy, lumpectomy, axillary lymph node dissection and removal of both breasts. Other forms of treatment include chemotherapy or the use of high doses of drugs to destroy cancerous cells. Radiation therapy where X-rays are used to destroy the cancer cells is also effective.