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Health Corners
Common Health Problems

There are a number of medical conditions that you might have to face in your lifetime as a woman. It pays to be aware of them beforehand. In some cases, there is a lot that can be done to prevent the condition and in others, early detection is helpful. The most common medical conditions that women suffer from are:

Fibroids

Fibroids are benign tumours (non-cancerous growths) in the wall of the uterus. They are also called leiomyoma uteri, leiomyoma or myoma. Fibroids are the most common tumours that are found in the female pelvis. Hysterectomy is often performed due to the presence of fibroids.

Hysterectomy: Hysterectomy is the most radical surgical procedure in the treatment of fibroids. During this surgery, the uterus is removed from the pelvis by cutting all the supporting ligaments. The cut ligaments need to be then reconnected to the upper part of the vagina. Thus one of the complications that can follow hysterectomy is loss of support of the pelvic floor. Hysterectomy is sometimes performed along with removal of the tubes, cervix and ovaries. There are two main methods of performing a hysterectomy. These are abdominal hysterectomy (requires major abdominal incision) and vaginal hysterectomy.

Myomectomy: Myomectomy is a surgical procedure during which fibroids are cut out of the uterine wall. Until recently, this operation was always performed by making an abdominal incision. Today, myomectomy can be performed through laparoscopy. Another way of removing fibroids is to insert a scope through the vagina into the cavity of the uterus. This is operative hysteroscopy where the hysteroscope is used to remove fibroids growing into the uterine cavity.

Uterine Artery Embolisation (UAE): In the 1980s, a gynaecologist named Jacques Ravina observed that, if a patient started to bleed after surgery, and the interventional radiologist was asked to embolise or plug up the uterine arteries, the bleeding stopped. He deduced that if these patients were embolised before surgery the incidence of bleeding during surgery would decrease. Then a great thing happened which has revolutionised the treatment of uterine fibroids. Patients who had uterine artery embolisations before their scheduled surgeries started to cancel their surgeries. Their symptoms of bleeding, pain, and bulk sensation were relieved by the embolisations alone.

UAE for management of fibroids is now considered a safe and effective therapy for fibroid disease. It is minimally invasive and takes less than an hour, and treats all fibroids simultaneously. It is effective regardless of the size of the fibroids. There is a significant reduction in the volume of the uterus. UAE also preserves fertility.

Medical Therapy: A number of drugs can be used in the treatment of fibroids. These include birth control pills, progestins and GnRH analogues. Non-steroidal anti-inflammatory drugs also help to control many symptoms caused by fibroids.

Endometrial Ablation: The lining of the uterus (endometrium) can be destroyed by a number of techniques to prevent bleeding at the time that a period would be expected. The destruction is called ablation. This can be done either using a hysteroscope to cut away and cauterise the lining, or by applying heat to the inner wall of the uterus. Endometrial ablation should not be used for women who want to become pregnant. In fact, the option of tubal ligation is offered to women undergoing this operation.

Osteoporosis

Osteoporosis is a disease in which the bones become brittle. Women are particularly susceptible to this condition as they grow older. Loss of calcium (bone mineral) causes the skeleton to weaken and become fragile. This leads to fractures. Frequently, patients with osteoporosis develop painless spinal fractures, which lead to a condition called dowager's hump. This is a curvature of the spine with protruding abdomen. Acute back pain in elderly women is often the result of a spontaneous vertebral fracture as a result of osteoporosis.

Who is at risk?

  • Post-menopausal women of small body frame with a previous history of smoking, excess alcohol and coffee consumption and lack of exercise.
  • Daughters of mothers with spinal or hip fractures.

How is osteoporosis diagnosed and treated?

Bone densitometry, a measurement of skeletal bone calcium content, has revolutionised the diagnosis of osteoporosis. Bone mass can be measures in those at risk for osteoporosis. Patients with lower than normal bone mass can be treated before osteoporosis develops. Calcium and hormone replacement therapies are used to treat this condition.

What is the role of calcium in life?

Calcium is an important mineral found in the skeleton. The inflow of calcium into the skeleton begins in infancy and reaches its peak in puberty. Calcium strengthens bones and teeth, regulates muscle and nerve function and hormonal secretions and activates enzymes and normal blood coagulation. Daily calcium requirements are usually met by adequate calcium intake in the diet. Over a prolonged period of time, a calcium deficiency state can lead to osteoporosis.

Does exercise help to prevent osteoporosis?

Calcium is an important mineral found in the skeleton. The inflow of calcium into the skeleton begins in infancy and reaches its peak in puberty. Calcium strengthens bones and teeth, regulates muscle and nerve function and hormonal secretions and activates enzymes and normal blood coagulation. Daily calcium requirements are usually met by adequate calcium intake in the diet. Over a prolonged period of time, a calcium deficiency state can lead to osteoporosis.

The best exercises for building bone include lifting weights, jogging, stair-climbing, step aerobics, dancing and racquet sports. Swimming and walking are not the best exercises for building bone. If you already have osteoporosis, you should exercise after consulting your doctor on the best regimen.

Arthritis

Arthritis is the inflammation of the joint. It refers to more than 100 rheumatic diseases which usually affect the area in and around the joints, including muscles and tendons. The most common types of arthritis include osteoarthritis, fibromyalgia syndrome, rheumatoid arthritis, gout, osteoporosis, systemic lupus erythematosus and ankylosing spondylitis. These diseases usually cause stiffness, pain and fatigue. How severe the symptoms are varies from person to person and from day to day. In some people, the entire body may be affected. Arthritis is most often chronic (it could last for a whole lifetime, coming at intervals). This section answers any questions you might have about arthritis in general.

Diagnosing and evaluating arthritis

Most types of arthritis show symptoms of joint inflammation. These include swelling, stiffness, tenderness, warmth or redness. There may also be weight loss, fever or weakness. If these symptoms last for more than 2 weeks, they may be caused due to rheumatoid arthritis. The symptoms could also be caused by infection. This could lead to septic arthritis. However, the most common form of arthritis, osteoarthritis, does not usually show joint inflammation. This is a degenerative disease of the joints. It is caused by mechanical abnormalities in the joint.

A full history will be taken during the evaluation of arthritis. Your current symptoms, level of function of your joints and your general health will be assessed. Blood and urine tests, tests on fluid removed from joints, biopsies of joint or muscle tissue and X-rays may also be carried out.

Arthritis medication

For arthritis, medication is of three types – drugs which reduce inflammation, drugs which slow down the progress of the disease and drugs which reduce the level of uric acid in your body. The most commonly prescribed medication for arthritis includes aspirin and related drugs, corticosteroids, cytotoxic drugs, gold treatment, methotrexate, and non-steroidal anti-inflammatory drugs (NSAIDs). Medication for arthritis must be taken under the supervision of a doctor.

Exercise and arthritis

Earlier, it was assumed that people with arthritis should not exercise because it would damage their joints. However, today it is known that when arthritis is under control, health and fitness can be improved through exercise, without causing damage to the joints. If you have arthritis, exercise can increase your energy levels, allow you to sleep better, control your weight, strengthen your heart, bones and muscles, and decrease depression and fatigue. In addition, it helps to keep your joints from becoming too stiff and to keep the bone and cartilage tissue strong and healthy. Exercise may also help prevent further joint damage.

Follow an exercise programme suggested by your doctor or physiotherapist. It will include special range-of-motion exercises to help keep your joints movable. General fitness exercise like swimming or walking is also important. You can start with a few exercises and slowly add more. If there is too much pain, stop and consult your doctor.

Pain and methods of coping

Strong painkillers are not advisable if you have arthritis, as your pain is most likely to be long lasting. Your pain is caused by inflammation, damage to joint tissues, muscle strain caused by overworked muscles attempting to protect your joints from painful movements and fatigue. Along with physical changes, the emotional challenges of arthritis also worsen your pain. Stress and depression can worsen your pain. But don’t lose hope. Many people with arthritis find that they can cope with their pain eventually. The answer to the pain is to make a determined effort to get the better of it in a sustained manner. There are many ways to control pain. Using a combination of methods is often the best bet.

First of all, you must get a hold of yourself and develop a positive attitude. Then try any of these methods: heat or cold treatments, physical therapy, exercise, relaxation or massage. Take as few pain-relieving medicines as possible.

Developing a positive attitude: You might well be feeling helpless and depressed because you have arthritis. Learning to think differently is very important, and having a more positive attitude will help you to cope better. Try not to build your life around your pain. Eat a balanced diet, follow your treatment plan and exercise regularly. Pursue your hobbies and interests. Remind yourself of all the things you can do rather than those you can’t. Instead of dwelling on your pain, try to distract yourself from it by doing things that take your mind off it. Alcohol is not a good solution. Try to avoid drinking as a habit.

Heat and cold treatments: These treatments can reduce stiffness and pain. Heat works by relaxing your muscles. Heating pads or lamps can be used, or a hot bath. Don’t go to sleep with a heating pad as you might get burned. Use an electric blanket instead, or a hot water bottle. Ask your doctor about paraffin baths. Cold deadens feeling in the affected area. Cold packs are recommended for severe joint pain and swelling. Don’t use cold treatment if you have poor circulation or vasculitis.

Don’t use either heat or cold if you have open cuts or sores. Don’t use extremes of either heat or cold. Creams and lotions are not advisable while using heat or cold.

Relaxation: When you’re in pain, you’re experiencing stress, and stress in turn makes you less able to cope with the pain. You tend to contract your muscles and breathe hard, while your blood pressure and heart rate increases. Relaxation techniques help you to break this pattern and ease the pain. It is not easy to relax when you’re in pain, but it is certainly worth your while to make the effort – and practice does make it easier.

One of the most common ways of relaxing is called guided imagery. First, take slow, deep breaths. Then think that you are in a place or situation where you felt comfortable and secure in the past. Try to relive all the details exactly as you then felt them. This helps to take your mind off the pain and think of more pleasant things. Never mind if you are distracted at first by other thoughts, just concentrate on your breathing. Most people are able to learn to relax with some practice.

Massage: Massage helps to relieve pain by increasing blood flow and delivering warmth to the area that is hurting. If the affected area is not your hands or fingers, you could learn to massage your own muscles. Otherwise your doctor could recommend a professional massage – make sure the person you employ for massaging knows enough about arthritis. If you are able to massage yourself, stop if you experience more pain. Don’t massage a joint if it is very swollen and painful. If you use a gel that contains menthol, make sure you remove it before using a heat treatment or could end up burning yourself.

Pregnancy and arthritis

If you suffer from arthritis and are trying to decide whether you will be able to have a baby, you must take a doctor’s advice. Some basic questions you could ask yourself are:

Arthritis usually does not affect the course of pregnancy or normal delivery. Rheumatoid arthritis tends to improve by the fourth month of pregnancy. Lupus may remain the same or flare up. Lupus patients should have been in remission for at least 6 months before conception. Women with lupus stand a risk of toxemia, spontaneous abortion, stillbirth and neonatal lupus in the baby.

Migraines

Migraine is a headache that affects people at intervals with complete relief between attacks. If you have migraine, your headache would usually be accompanied by any of the following symptoms: nausea, vomiting, constipation, diarrhoea, visual disturbances or numbness. The cause of migraine is still uncertain, though it is often brought on by stress, fatigue, exertion, hormonal factors and missing meals. Classical migraine is accompanied by what is called an aura, while common migraine is not.

What is an aura?

In classical migraine, which affects about 20 per cent of all migraine sufferers, an aura occurs about 20 minutes to an hour before the headache. The most common aura is visual. Numbness, tingling or paresis may occur on one side of the body. The aura is associated with a reduction in cerebral blood flow.

Symptoms of migraine:

If you have a headache that you think might be migraine, you would probably experience some of these symptoms: an aura before the headache, severe or dull throbbing on the sides of the head, dizziness and tingling or abdominal symptoms. Your migraine will be diagnosed based on the pattern of symptoms, history of migraine in the family and your response to treatment and medication.

Treatment of migraine:

The method of treating migraine that is frequently effective is to rest in a quiet, dark room. A reduction in the severity of symptoms often follows. Medication may be prescribed for migraine but each person responds differently. Mild pain relievers may be useful if they are taken at the onset of the attack. If these are not useful at all, your doctor may prescribe vasoconstricting drugs that constrict the arteries of your head. These drugs may be prescribed along with others such as caffeine, belladonna and Phenobarbiturates. Nausea should be treated early with an anti-emetic drug.

Your migraine headache will get better within hours. Treatment may or may not help. There are no other complications arising from migraine.

Menstrual migraine:

Migraine is a particular nuisance for some women in their reproductive years, when the pattern of the headaches is linked to the menstrual cycle. True menstrual migraine occurs during the menstrual period, but any migraine occurring within –2 and +3 days of the period can be classified as menstrual migraine. Treatment may involve establishing a stable oestrogen state and the prescription of non-steroidal anti-inflammatory drugs. Migraine that occurs a week to three days before your period is termed pre-menstrual migraine and is associated with PMS. Most women who suffer from migraine during the menstrual period complain of severe throbbing in the head, with nausea, vomiting, and dislike of light and sound.

Low Back Pain

Low back pain is also called lumbar pain. It refers to pain in the spine or the muscles of the lower back. If you have spasms of the large supportive muscles alongside the spine, you are likely to have low back pain caused by injury to the back. Pain caused by muscular strain is usually limited to the back, though in some cases it radiates to the buttocks or thighs.

The most common causes

Frequently, muscle strain or a pulled muscle in the back causes low back pain. This, in fact, is the most common cause. Other possibilities are ache in the muscles because of a viral infection, arthritis or poor posture. Women often suffer low back pain during their periods and sometimes as part of PMS.

There are other less frequent but serious causes of low back pain. Women may have this condition because of endometriosis, ovarian cancer or ovarian cysts. Bladder infection, pressure on a nerve root and ruptured vertebral discs are other serious possibilities.

Helping yourself

Once the cause of low back pain has been established as muscle injury, you can do a few things right at home to relieve the pain. When muscle spasms cause severe pain, rest and painkillers (on medical advice) can help you to beat them. Heat or ice applied to the back may also relieve the pain. A folded towel under your lower back and a pillow or cushion under your knees can help you to rest better. Anti-inflammatory medication also helps the pain. Always take your medicine along with food unless the doctor has specifically instructed otherwise, or you may suffer an upset stomach.

It’s also important to remember that when an injury has caused low back pain, drugs can only help to relieve the symptoms. They cannot heal the injury – it has to heal by itself. Resting flat on your back helps an injury to heal quickly. If you exert yourself during the six weeks following an injury, you can cause a relapse. A mild exercise programme after the injury will prevent the problem from coming back.

When to call your doctor

If you have fairly severe pain that lasts for more than a week, it’s time to visit your doctor. An unexplained fever accompanying the pain, redness or swelling on the back or spine, pain in the legs below the knee and weakness or numbness in the legs also call for medical attention. Also see a doctor if the injury you sustained was because of a severe fall or accident.

Evaluation of low back pain

You will undergo a thorough physical examination that will concentrate on your back, stomach, arms and legs. Your doctor will check the nerve function in your legs. If the history and the physical examination suggest that you have damaged the nerves leaving the spinal cord, other tests will be performed. You may undergo a myelogram (X-ray or CT scan of your spine after injecting a dye into your spinal column), a CT scan or MRI of the lumbosacral spine. If your condition does not improve over a long period of time, hospitalisation, traction or surgery may be called for.

Exercise to relieve low back pain

Exercise is one of the most important methods of treating low back pain. It helps to strengthen the muscles in your back and improve their flexibility. This lessens the chance of another attack of pain. If you have low back pain, there are 2 types of exercise you need to do regularly. One is aerobic exercise like walking and swimming. The other is specific exercise for your back muscles. You must consult your doctor about when you are ready for each type of exercise. Your doctor could also advise you about the correct posture and techniques for lifting and bending. If you aren’t used to exercising, begin slowly at an easy pace. Keep a good posture as this minimises the strain on your back. If you are doing stretching exercises, hold the stretch gently and steadily. Never try to bounce your way to greater flexibility.

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