DO’S AND DON’TS DURING PREGNANCY

By | Categories: Medical Articles | Tags: | Date: 29th September 2018

The weight in pregnancy gain varies every month. During 1st trimester there is no weight gain or less gain because of vomiting. Average weight gain should be 1Kg to 1.5 kg per month in 2nd and 3rd trimester. Baby’s growth is maximum in last trimester. Weight gain should not be more than 0.5 kg per week.

Following are the good examples of dos & don’ts in pregnancy

DO’S & DON’TS DURING PREGNANCY

  • Smoking should be avoided completely.
  • Partner should avoid smoking inside the house.
  • Passive smoking is also dangerous to the fetus.
  • Avoid alcohol in any form.
  • Reduce coffee and aerated drinks.
  • Avoid red fish like king mackerel, red tuna, red salmon and deep sea fish as mercury content is high in them.
  • Include more proteins like dal, green grams, nuts, eggs, fish and milk.
  • Eat fiber rich foods, whole wheat products.
  • Eat fruits and vegetables to avoid constipation.
  • Drink plenty of water.
  • Avoid strenuous exercise in 1st trimester.
  • Reduce frequency of sexual relationship in first three months and avoid completely in case of threatened abortion.
  • X-ray exposure should be avoided during pregnancy.

Generally almost all of the diseases or disorders of esophagus results in either pain while swallowing (odynophagia) or difficulty in swallowing (dysphagia). Difficulty while swallowing is more common than pain while swallowing. Difficulty while swallowing might be for type of food like solids, semi solids or liquids. This relationship of type of food and difficulty while swallowing can point towards certain disorders of esophagus. The progression of symptoms, in this case dysphagia is also an important thing to take into consideration. Progressive dysphagia starting from solid foods, then semi solids and then to liquid food is typical of various esophageal disorders.

Presence or absence of constitutional symptoms like fever, weight loss or loss of appetite may point towards a serious disorder. Occupation and social history may contribute towards the final diagnosis of the disease. The best initial test to come to final diagnosis for disease of esophagus is barium swallow or barium esophagram. If the results show clear signs of obstruction this should be followed by upper endoscopy.

Below are few esophageal disorders which might result in difficulty in swallowing. Each disorder is discussed in detail in separate articles.

    • Achalasia
    • Esophageal Cancer
    • Progressive Systemic Sclerosis (Scleroderma)
    • Diffuse Esophageal Spasm (Nutcracker Esophagus)
    • Plummer Vinson Syndrome
    • Schatki’z Ring
    • Esophagitis
    • Zenker’s Diverticulum
    • Mallory-Weiss Syndrome

These diseases might be associated with difficulty in swallowing or even pain while swallowing. Tests like barium swallow; upper endoscopy and manometry are done apart from taking proper history and understanding signs and symptoms of disease. Some of the disease may also be associated with chest pain like diffuse esophageal spasm which can be difficult to diagnose. Make sure you consult our General Practitioner if you are having problems in swallowing

The esophageal disorders even if when it is not cancer might be associated with weight loss, just because patients find it difficult to eat due to pain and difficulty swallowing rather than decrease in appetite. Previous drug history or tolerance to cold, anemia, personality disorder like bulimia, forced vomiting, retching may give an important clue for coming to the final conclusion as to what is the reason for esophageal discomfort.

This article was to give a general overview of esophageal disorders and disease which can cause difficulty or pain while swallowing. Each esophageal disorder is discussed in detail in a separate post.

Gastroesophageal Reflux Disease [GERD] is a term given to a condition when stomach acids flows upwards or backwards from stomach to esophagus. Normally, lower esophageal sphincter prevents the backward flow. LES most of the time is contracted and relaxes only when you swallow the food. If due to any reason the LES does not remain in the state of contraction the gastric acid flows from stomach to esophagus causing Gastoesophageal Reflux Disease or GERD.

Factors that can result in decreased tone of lower esophageal sphincter thus causing GERD

  • Caffeine
  • Nicotine
  • Peppermint
  • Alcohol
  • Chocolate
  • Drugs (Anticholinergic drugs, Nitrates, Calcium Channel Blockers)
  • Idiopathic (Unknown Cause)

As the tone of lower esophageal sphincter decrease the backward flow of gastric acid from stomach to esophagus results in GERD, especially when a person is lying flat.

SIGNS & SYMPTOMS

Usually, GERD causes dyspepsia or epigastric pain which is most of the time sub-sternal along with following differentiating symptoms:

  • Hoarseness
  • Wheezing
  • Cough
  • Metal like taste in mouth
  • Sore throat

Epigastric pain can be due to number of other diseases like gastritis, pancreatitis, ulcer disease etc. The above symptoms along with sub-sternal pain points the cause of discomfort related to Gastroesophageal Reflux disease.

DIAGNOSIS

Acid reflux disease is a condition where LES or lower esophageal sphincter is not able to remain in the state of contraction which results in back flow of gastric acids from stomach to esophagus. Diagnosis of acid Reflux Disease [GERD] is mostly clinical. Which means doctor does not have to do any specific test to diagnose GERD. The clinical signs & symptoms of GERD are enough for diagnosing Gastroesophageal Reflux Disease [GERD]. If a person has Epigastric pain which is radiating below the sternum with bad metallic taste in mouth GERD can be suspected and treatment can be started. If clinical diagnosis is made treatment can be started immediately.

Only if the diagnosis of GERD is not clear or the patient’s clinical presentation is equivocal a specific test called as 24-Hour PH monitoring is required. 24 hour PH monitoring is done by placing an electrode few centimeters below gastroesophageal junction (place where gullet and stomach meets). The instrument records the PH and average PH of that area is determined. Endoscopy can be done to see the changes in the lower esophagus, but a normal endoscopic finding does not exclude the presence of Gastroesophageal reflux disease [GERD]

TREATMENT

(1) MEDICAL TREATMENT:
Drugs can be used to treat Gastroesophageal Reflux Disease effectively. Three types of drugs can be used

  • Proton Pump Inhibitors (PPIs): Example: Omeprazole, Pantoprazole, Rabeprazole. All have equal efficacy. Goal is to keep PH of the stomach acid above 4.0.
  • H2 Blockers: These class of drugs are used if the symptoms are mild or moderate and are intermittent.
  • Prokinetic Drugs: Drugs like metachlopromide can be used to relieve the symptoms of GERD. Another prokinetic drug “Cisapride” was discontinued from US due to its fatal adverse effect. Cisapride was known to cause Ventricular Arrhythmias.

H2 Blockers and Prokinetic drugs have equal efficacy in treating mild intermittent forms of Gastroesophageal Reflux disease. But these drugs should not be used if symptoms are severe. For severe symptoms of GERD PPIs are the best class of drugs.

(2) SURGICAL TREATMENT

The goal of surgical treatment is to tighten the Lower Esophageal Sphincter (LES) so that stomach acids do not flow back or upwards to esophagus. The indications of surgical treatment for GRED are as follows:
If patient does not respond to medical treatment with Proton Pump Inhibitors

Side Effects of PPIs: diarrhea & headache

Alternative to life long or long term medical treatment with PPIs. Two surgical methods are most commonly used to treat GERD surgically:
Laproscopic Nissen’s Fundoplication
Purse-String Suture in LES to make it tighter.

Old people need healthcare services more frequently than any other age group. Over the course of one year of service in Al Nahda, Sharjah, we have identified two problems.

Most of the old age residents in UAE are dependents that mean they do not have any regular source of income of their own, which makes it difficult for them to visit doctors and pay for the services.
In this age group most residents of Sharjah have individual insurances, which means they if they have Insurance from Dubai, they do not have access to healthcare in Sharjah. Even if they do it is limited to very few health care facilities.
So we decided to take action. Yes, we do care for elderly. Bristol Medical Centre has decided to give special offer to old age and elderly residents of Sharjah & Dubai.

BRISTOL ELDERLY PACKAGE

Elderly Package includes following:

  • GP consultation: AED 50/- only
  • 25% flat discount on all other services offered at our clinic, including dental services.

Eligibility: 65 years or older.

We hope you appreciate our efforts and will help us spread the news to anyone who might benefit from our offer.

CIRCUMCISION PROCEDURE

The procedure of Circumcision is done to remove the foreskin of the tip of penis surgically. It is a very common procedure which is done for various religious, medical and cosmetic reasons. Most of the time in new-born circumcision is done for religious reasons, in adults and older children it can be done for various medical reasons like:

  • Balanoposthitis: inflammation of foreskin
  • Phimosis: Faliure of foreskin retraction
  • Paraphimosis: retracted foreskin cannot be returned to its original position.

BENEFITS OF CIRCUMCISION

Although in an infant there is no immediate benefit of circumcision which is why it is done because of religious requirement. Medically in long term circumcision has known to have following benefits:

  • Lower risk of urinary tract infections in childhood and infancy
  • Lower risk of penile cancer
  • Lower risk of STDs (sexually transmitted diseases)
  • Decrease risk of cervical cancer and some infections in female partner.
  • Prevents balanoposthitis, phimosis, paraphimosis
  • Better personal hygiene

WHO PERFORMS CIRCUMCISION?

It is usually done either by General Surgeon or Urologist. For new born circumcision the baby will lay on his back and his arms and legs will be secured. If not done previously, blood test is done to see if the blood clots on time and to know the blood group and hemoglobin levels. Local anesthesia is given in the form of an injection or foam to numb the penis. There are many techniques to perform circumcision. The preferred method is decided by the doctor depending on age of the baby and experience of the doctor. All of the methods work by cutting of blood circulation of the foreskin to prevent bleeding when the doctor cuts the foreskin. Circumcision procedure usually takes 30 minutes and the baby is discharged.

RECOVERY & FOLLOW-UP

Healing usually takes place within 7-10 days. After the procedure baby can be little fussy and irritable. Medicine is given to decrease the pain and prevent infection. Circumcision charges varies quite a bit depending upon hospital and clinic and which doctor is performing the procedure. It can range anywhere from 1000 AED to 3000 AED.

At Bristol Medical Centre, circumcision is performed by highly experienced General Surgeon, Dr. Bharti Chavda, who has more than 15 years of experience in Gen. Surgery. Call 065266615 for details, pricing and appointment.

RECENT POST

DO’S AND DON’TS DURING PREGNANCY
29th September 2018
PAIN OR DIFFICULTY IN SWALLOWING
29th September 2018
BEST ROOT CANAL TREATMENT IN SHARJAH & DUBAI
29th September 2018
ACID REFLUX & HEARTBURN : TREATMENT & CAUSES
29th September 2018

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