By: eris

Initiatives in Gynaecological Care

They say your choices as a parent begin before your child is even born. Parenting challenges begin with you starting to make health choices on what is good for your child and what is not.

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Initiatives in Pain Management

Pain is a complex, subjective and confusing phenomenon. Every person reacts differently to pain, depending on his or her awareness and capacity to bear it

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Initiatives in Cardiovascular Care

Maintaining a healthy heart is crucial for proper functioning of the body. People are often unaware that they have high blood pressure and it remains undiagnosed.

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Diabetic Care

Diabetes (Milletus) is a metabolic disease where the blood sugar levels are higher than the normal range. It is a condition where your body cannot process blood sugar A fasting blood sugar level less than 110 mg/dL (6.1 mmol/lit) is normal; a fasting blood sugar level from 110 to 125 mg/dL is considered prediabetes; and a fasting blood sugar 126 mg/dL or higher, from two separate tests, is diagnosed as diabetes.

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A BETTER APPROACH – For a Better You

At Eris our focus is not just on creating effective medicine, but creating a holistic ecosystem that puts the patients, medication, doctors and processes at its core.

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DIABETES – A CLOSER LOOK

DIABETES – A CLOSER LOOK

Diabetes mellitus (simply called Diabetes) is a metabolic disease where the blood sugar levels are higher than the normal range. Diabetes mellitus is a metabolic condition that prevents your body from properly using the energy from the food you eat because your body can’t make sufficient insulin or because you can’t use it correctly, resulting in high blood glucose levels (Hyperglycemia) that can lead to chronic hyperglycemia is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.

Type FPG (mg/d L) PPG(mg/d L) A1c (%)
Normal < 100 < 140 5.7
Prediabetes > 100 – < 125 > 140 – < 200 > 5.7 – < 6.5
Diabetes > 126 > 200 > 6.5

(Source: Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes – 2021. Diabetes Care 2021; 44(Suppl. 1):S15-S33)

Blood glucose levels can be ascertained through tests like fasting plasma glucose (FPG) that is done when fasting more than 8 hours. FPG less than 110 mg/dL is considered as normal; a fasting blood sugar ranges between 100 to 125 mg/dL is considered as prediabetes or borderline to develop diabetes, and an FPG range above 126 mg/dL is typically considered as diabetic.

An additional test is called postprandial plasma glucose (PPG). This test should be done 2 hours after a meal and if the results show blood glucose of more than 200 mg/dL then it may be considered a case of diabetes.

In some cases, the doctor may deploy a sensor of Continuous Glucose Monitoring System (CGMS) for 6-14 days. The CGMS is modern technology for diabetes monitoring; the CGM works through a tiny sensor inserted under our skin, usually on the belly or arm. The sensor measures our interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor records the blood glucose level at an interval of 5 minutes and records 288 blood glucose reading per day. After 6-14 days the sensor is removed and basis the report, the doctor prescribes either lifestyle modifications or medications.

The amount of glucose in the bloodstream is regulated by the hormone insulin that is secreted in small amounts by the pancreas. When the amount of glucose in the blood rises to a certain level, the pancreas release more insulin that pushes more glucose into the cells. This causes the glucose levels in the blood to drop.

Insulin also helps to store glucose in fat cells (Adipose tissue) and liver (for later use when we are not eating) and it increases the usage of glucose from the peripheral muscles.

Diabetes is caused if our body cannot produce sufficient insulin or if it cannot utilize insulin properly (Insulin resistance).

Type of diabetes

Gestational diabetes: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy.

Symptoms of diabetes

Most diabetes patients do not experience any obvious symptom, but some patients may experience weight loss, increased thirst, increased appetite, increased urination, blurry vision, elevated cholesterol levels, elevated blood pressure, sexual problems, numbness and tingling, fatigue, slow healing of wounds, and itchy skin.

Diabetes Complications

High blood glucose for a prolonged period may damage your micro-blood vessels of the eye (retinopathy), kidney (nephropathy), and nerves (neuropathy) and macro-blood vessels of the heart (coronary heart disease), brain (stroke) and lower extremities (peripheral vascular disease).

Prevention and management

Lifestyle changes such as losing weight, eating healthy and engaging in regular, moderate physical activity may reduce the progression of Type 2 diabetes.

The key to eating with diabetes is to eat a variety of healthy foods from all food groups, in the amounts your meal plan outlines.

The food groups are

  • Vegetables
    • nonstarchy: includes broccoli, carrots, greens, peppers, and tomatoes
    • starchy: includes potatoes, corn, and green peas
  • Fruits—includes oranges, melon, berries, apples, bananas, and grapes
  • Grains—at least half of your grains for the day should be whole grains
    • includes wheat, rice, oats, cornmeal, barley, and quinoa
    • examples: bread, pasta, cereal, and tortilla
  • Protein
    • lean meat
    • chicken or turkey without the skin
    • fish
    • eggs
    • nuts and peanuts
    • dried beans and certain peas, such as chickpeas and split peas
    • meat substitutes, such as tofu
  • Dairy—nonfat or low fat
    • milk or lactose-free milk if you have lactose intolerance
    • yogurt
    • cheese
You should follow advice
Exercise

Physical activity is an important component of the treatment plan for those with type 2 diabetes. It’s also important to have a healthy meal plan and maintain the blood glucose level through medications or insulin, if necessary.

Keeping a check on the blood glucose level is essential to preventing long-term complications, such as nerve pain and kidney disease.

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Understanding The Value of Nutrition

UNDERSTANDING THE VALUE OF NUTRITION

Nutrition is the foundation for healthy living. However, we seem to have lost sight of this fact.

“Let food be thy medicine and medicine be thy food,” said Hippocrates, the father of medicine, 2500 years ago. Yet, his wisdom was drowned out by the introduction of modern drug therapy in the 19th century.

Food stopped being medicine but what we are coming to realise is that what Hippocrates’ said is just as relevant today as it was back then.

Non-communicable diseases (NCD) such as diabetes, cardiovascular diseases, cancer and chronic respiratory diseases are found to be the leading causes of death in our country, accounting for 60% of total deaths ever year in India1 as against the global average of 68%.

This figure is only set to go up given the sedentary lives we are leading today, which is giving rise to health issues like obesity, are only making us more susceptible to NCDs.

In the 1900s, the important role of a diet containing specific nutrition in disease prevention and health promotion came to the forefront. Good nutrition — or a balanced diet — is the key to sound mental and physical health. It gives the individual a general sense of wellbeing and helps keep ailments and diseases at bay. Nutrition therapy has an integral role in disease management.

A balanced diet provides all the nutrients in an adequate amount. Nutrients are defined as the substances found in food that keep our body functioning. Nutrients are divided into two parts: Macronutrients and Micronutrients. As the name suggests, we need macronutrients in larger quantities, which include carbohydrates, protein, fats, and fibres. Micronutrients comprise a broad spectrum of vitamins and minerals, which, though required in very minute quantities, are essential and play a major role in metabolism and immunity.

General Dietary Guidelines
  • Eat a variety of foods including fruits, vegetables, whole grains.
  • While eating protein-rich foods, choose plant-based proteins and complete protein (i.e., proteins that have all essential amino acids). The general recommendation for protein is 0.8gm/kg of body weight/day.
    • Few examples of food with good protein source are legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat, low-fat milk, low-fat yoghurts, and cheese.
  • Choose food with high fibres such as guava, oranges, pomegranate, whole grain oats, broccoli, carrots, sweet corn, nuts and seeds.
  • Eat the whole fruit – do not juice it as juicing will increase the blood sugar level and will also get rid of essential fruit fibres.
  • Food rich in fibres not only helps in digestion but is also useful in the prevention of cardiovascular diseases, diabetes, colon cancer and as well as maintaining a healthy weight.
  • Choose unsaturated fat (Good fat) over saturated fat (bad fat) and completely avoid trans-fat.
    • Few examples of food containing unsaturated fat: avocado, almonds, walnuts, sunflower oil, olive oil, fish oil.
    • Few examples of food containing saturated fat: butter, cream, red meat.
    • Few examples of food containing trans-fat: baked foods, cookies, pie, Vanaspati ghee.
  • Exercise regularly to maintain ideal body weight.
  • Restrict salt intake – If you have high BP avoid pickles, papad, packaged food which have high salt/sodium content.
  • Drink plenty of water (8-10 glasses in a day) and avoid sugary/soda beverages.
  • Quit smoking and excessive drinking
  • Make a habit of reading the food label.
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Gynaecological Conditions

GYNAECOLOGICAL CONDITIONS

Most women experience distinctive gynaecological conditions from menarche to menopause (start of menstrual cycle to its end).

Facts about Women’s Health
  • Women’s bodies undergo major transformation throughout their lifespan and depending on their age, they may face distinctive gynaecological problems.
  • Women may experience menstrual problems, fertility issues, genital infections and specific health conditions in the post-menopause phase.

Through regular and proper health, screenings, it is possible to detect and manage most health problems affecting women.

Gynaecological Conditions
  • Gynecological diseases affect reproductive organs such as the uterus, ovaries, fallopian tubes, external genitalia and breasts.
  • To avoid future complications, it is important to recognize the symptoms and to consult the doctor for appropriate treatment.
  • The most common gynaecological conditions that affect women of different age groups are mentioned below:
    • Nutritional deficiency:
      Deficiency of various micronutrients and macronutrients can make women prone to developing numerous health-related issues like.

      Disease Deficiency
      Microcytic Anaemia Iron
      Megaloblastic anemia Vit B12 & Vit B6
      Thyroid diseases (Goitre) Iodine
      Osteomalacia (soft bones) Mainly Vitamin D
      Osteoporosis (reduced density) Calcium, Vit D, Phosphorus etc
      Weak Immunity Vit C, Vit D, Zinc, Vit A etc
      Eye diseases Vitamin A
    • Iron deficiency Anaemia (most common):
      Regular menstruation leads to loss of blood, which for its regeneration needs iron, vitamins and proteins. Anaemia is a global public health problem and it affects over 800 million women worldwide.1 Anaemia affects children, adolescents, women of reproductive age groups and lactating mothers worldwide. As per NFHS-IV data, the prevalence of anaemia in India is 53%.2
Treatment

Your doctor would recommend iron supplements and other nutritional supplements based on the severity of anaemia.

1. PCOS or Polycystic Ovarian Syndrome

In this condition, several follicles may appear on the ovaries, causing hindrance in releasing the egg, thus leading to fertility issues. Women with PCOS, often suffer from irregular or infrequent menstrual cycle. It is mainly because of the excessive secretion of male hormones or androgens. PCOS is very closely associated with metabolic syndrome (includes Type 2 Diabetes, Hypertension, Obesity, Atherosclerosis or blockage of blood vessels etc.). Lifestyle management plays a very important role in its treatment prior to medications.

Treatment: Reducing weight, redular excersize and yoga may be helpful. For symtomatic relief, doctors often prescribe medications.

2. Dysmenorrhoea

It is a condition in which women may suffer from excessive pain/cramps during menstruation. The pain can radiate to legs, hips and lower back. It can last for 12 to 72 hours and bring about various symptoms like nausea, vomiting, diarrhea and fatigue.
It can be primary or secondary based on its cause:

  • Primary: If the frequent, excessive, painful cramps are not related to any disease.
  • Secondary: These are related to the certain gynecological or endocrinal condition

Treatment: Includes lifestyle changes and to relieve pain, your doctor may prescribe certain pain killers.

3. UTI or Urinary Tract Infection

UTI is a quite common condition that can affect women of any age group.

This usually occurs when the bacteria present in the vagina or anus enters the urethra and infects urinary bladder.

It can be easily prevented with proper genital hygiene.

Signs and Symptoms of UTI

Treatment: You will be prescribed antibiotics medication depending on the severity of the infection.

Other Common Gynaecological disorders include:
  • Vaginitis: Mostly affects women of reproductive age. This condition is characterized by inflammation or infection in the vagina. Excessive discharge, itching or pain can commonly be seen.
  • Fibroids: They are muscular tumors that can form on the inside a woman’s uterine wallsus. These tumors are rarely cancerous. Usually, there are problems in urination, excessive pressure on uterus and urinary bladder, commonly associated with increased menstruation or painful menstruation.
  • Endometriosis: This condition occurs when the uterine lining called endometrium, which lines or covers the uterus, grows outside the uterus or on the other surrounding parts like ovaries, bowel and tissue in pelvis and lower abdomen. Excessive pain, heavy bleeding during menstruation, pain during coitus or bowel movement is common symptoms.
  • Dyspareunia or Painful Sexual Intercourse: This condition may affect women due to structural issues in the body or may occur because of psychological reasons.
  • Ovarian Cysts: They are very common and may affect women of any age group. There are sacs filled with fluid, present in the ovaries, they can be rarely connected with PCOS, but commonly associated due to functional / hormonal imbalance or cells from endometriosis or non-carcinogenic cyst like dermoid (skin, hair or teeth filled) and cystadenomas (water filled).
  • Other conditions may include: Infertility, Postmenopausal symptoms, cervical and breast cancer.
Prevention of gynaecological diseases:
  • Be physically active:  Moderate physical activity should be done for at least 30 minutes daily.
  • Eat a healthy diet: Eat a diet balanced in vegetables, fruit, lean meats, whole grains, low-fat dairy products and avoid foods high in cholesterol, trans fats, saturated fats, salt (sodium) and added sugars.
  • Stay hydrated: Drinking enough fluids and emptying the bladder helps in preventing UTIs.
  • Maintain a healthy weight: Limit your daily calorie intake.
  • Drink alcohol in moderation
  • Don’t smoke.
  • Regular intimate personal hygiene should be an integral part of every woman’s health care
  • Ask your doctor about taking calcium, vitamin D, iron, folic acid and other supplements if you have any gynaecological conditions. (Before starting any nutritional supplements, you should always consult your doctor!!)
  • Gynaecological Screening: A regular visit to your gynaecologists will help in ensuring better reproductive health.
Reference
  • International Scholarly Research Network Volume 2012, Article ID 765476, 8 pages doi:10.5402/2012/765476
  • Int J Community Med Public Health. 2017 Aug;4(8):2841-2846
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