Nutrition

Nutrition

Nutrition

The Diet for Two

Now that you’re pregnant, you can’t but help become intensely aware of the connection between your own nutrition and the health of your unborn baby. Most women feel motivated to modify their eating habits. As days go by, you find that you start craving for carbohydrates and you may not know why. Some women will start worrying about the growing weight due to this.

Studies show that severe malnutrition early in pregnancy can lead to birth defects and fetal deaths. Both your weight before pregnancy and your weight gain during pregnancy will greatly affect your baby’s weight at birth and its subsequent health. If you’re underweight, you’ll have fewer stores of essential nutrients to supply the baby, and your poor eating habits are likely to continue during pregnancy, making matters worse. Underweight mothers tend to have less healthy babies. If you’re overweight, the best time to lose weight is also before you become pregnant, especially since it may be harmful to your fetus for you to lose weight during pregnancy. Since the fetus doesn’t need to diet, significant weight loss in the mother can limit the fetus’s access to important nutrients and cause harmful metabolic stress. When you lose weight, your body must break down fat. This causes certain chemicals, called ketone bodies, to enter the bloodstream, which may cause metabolic and nervous system damage to the developing fetus. In this diet plan we advice that you discuss this with your obstetrician to get the best combination possible.

Fruit and vegetables

Eat at least five servings a day. This can include a glass of pure fruit juice. This food group includes fresh, frozen and canned fruit and vegetables, salads, dried fruit, fruit juices. Most fruits are a good source of vitamins which fall into two categories: fat soluble and water soluble. The fat-soluble vitamins include A, D, E, and K. These are stored in the body and need not be consumed every day. In high doses, vitamins A, D, and E may be toxic or teratogenic (teratogens are physical, chemical, or infectious factors that cause damage to the fetus). The water-soluble vitamins include the B vitamins and vitamin C. Since these are not stored in the body, you need to renew your supply of them each day. They are also quite fragile and can be destroyed by food processing.

Meats, alternatives and fish

We recommend that you eat 1-2 servings every day. It is better to choose lean meat, remove the skin from poultry and cook using the minimum of fat. Try to eat oily fish at least once a week. This food group includes meat (except liver), fish, poultry, eggs, beans, and nuts (except peanuts).

High fat and sugar foods

Limit the amount of carbohydrates you eat every day. This food group includes all spreading fats, oils, salad dressings, cream, chocolate, crisps, biscuits, pastries, ice-cream, cake, puddings, and fizzy drinks. It is important to note that excessive blood glucose levels in diabetic patients during early pregnancy can increase the risk of birth defects. In nondiabetic, the excessive sugar intake does not cause birth defects but may cause excessive poundage and tooth decay if you do not have good oral hygiene. On the other hand if you don’t include enough carbohydrates in your diet, you are in essence starving both you and your baby, and this can interfere with normal fetal growth. Too much consumption of sweet foods may replace other; more nutrient-dense foods in the diet, such as vegetables, fruits, and whole-grain products. Recommendations for health-promoting diets indicate that 50 to 60 percent of our total calories should come from carbohydrates, particularly food sources of the complex carbohydrates.

Dietary Fiber

Dietary fiber differs from starches in that it is not digested by enzymes produced by humans. Consequently, it is not considered to be a source of energy. Dietary fiber is found only in plants and comes in two basic types. One type is the fibrous components of plant cells, particularly plant cell walls. The other type is nonfibrous components of plant cells that are primarily found inside of cells. Dietary fiber, even though it is not absorbed into the body proper, has a number of effects. The specific effect varies according to what type of dietary fiber is consumed. Fibrous forms of dietary fiber, such as that found in bran and fruit and vegetable skins, helps prevent constipation, a common condition during pregnancy. Gel-forming nonfibrous fiber, such as that contained in the pulp of fruit, oatmeal, and dried beans, slows glucose absorption and decreases the amount of cholesterol that is absorbed from foods. This type of fiber also enhances elimination by forming bulk in the intestine that moves waste products along.

Your Exercise program

Your Exercise program

Your Exercise program

Your Exercise program

Now that you are pregnant, your exercise options become limited during but a number of excellent choices exist. Activities involving running or jogging, walking, aerobic dance, bicycling, swimming, and tennis can all be pursued to some degree. Some activities should be taken up before you conceive if you wish to continue them while you’re pregnant.

Running or Jogging

You should start this before conception; otherwise your muscles may not be able to support your loosening joints. If you have been doing this foe some time before becoming pregnant, you may continue to pursue these activities without harm.

Brisk Walking

In this activity, you can start brisk walking anytime, including during pregnancy. Begin slowly bearing in mind that the whole idea is to increase your activity level gradually. Start with 5 to 10 minutes at a time and slowly increase to 20 or 30 minutes three or four times per week. Avoid this in high temperatures or humidity but you may exercise outdoors.

Cycling

Cycling is important in that it gives you good cardiovascular workout. It’s not a weight-bearing activity and this means that the increasing weight of pregnancy will not affect your ability to continue. It is advisable to start on a regular cycling schedule before trying to conceive but even after conception this is safe. Remember always to start very easily and increase slowly. Stationary bicycles are probably the safest to use. With stationary ones you avoid road traffic accidents and other risks.

Swimming

Water supports your weight during this activity. This is the best program and you may even forget that you are pregnant. Some facilities provide aquanatal classes with qualified instructors. Medical evidence indicates that submersion in water may help reduce leg edema (swelling) which affects at least 50 percent of pregnant women. It is postulated that the pressure of the water squeezes excess water from your body tissues into your bloodstream, which then gets rid of it. Avoid Jacuzzis, hot tubs, and water that is above 100°F, you body overheats!

Other Sports

There some sports that must be avoided. Skiing or horseback riding can cause traumatic injury to the fetus or separation of the placenta. Scuba diving has been associated with fetal hypoxia (lack of oxygen) and should be avoided. Tennis involve frequent turning, twisting, and jumping are not highly recommended during pregnancy.

The body changes

The body changes

The body changes

The body changes

You may not notice any changes on the first day of fertilization since it has just started.

Changes in the baby

On the first day, the egg and sperm nuclei fuse to form a structure called the zygote. There is mixing of genetic material and within 12hours, the zygote creates a copy of it self. At this point the sex of the baby is determined. The are two sex chromosomes ( genetic material is carried in the chromosomes) X and Y. Females carry both X chromosomes and males carry the X and Y chromosomes. In preparation for fertilization, the egg losses one of the X pair while the sperm may carry either the X or the Y. So during the fusion, either XX or XY end up producing a girl (xx) or a boy (XY). There is no clear evidence that timing the time of fertilization can determine the sex of the baby.

Lifestyle

Congratulations! Now that you are pregnant, you have about 40 weeks ahead of you. Your life, body changes, needs, feelings and above all your baby will require special attention and care. A few things are of paramount importance to you and your baby during this period. Now that you have decided to have this baby, you will need to observe the following:

The American College of Obstetricians and Gynecologists suggests the following exercise guidelines for pregnancy:

  1. Make sure that your heart rate does not exceed 140 beats per minute.
  2. Never engage in strenuous activities for more than 1530 minutes. Before you do any exercise sessions, have at least five minutes of warm-up and follow it with a gradual cool-down period.
  3. Do not over heat your baby. Your inner body temperature should not exceed 38°C, or 101°F. Make sure that you guard against increasing your internal body temperature when exercising. Avoid getting too hot, work out less strenuously and for shorter periods than usual, and exercise in cool weather. And never exercise when you have a fever.
  4. Never exercise while lying flat on your back after the fourth month.
  5. Have regular exercise at least three times per week. See exercise program.
  6. Avoid jerky and bouncy movements. There is an increased laxity of your joints during pregnancy.
  7. Drink plenty of liquids before and after exercise to prevent dehydration.
  8. Make sure you wash your hands before and after handling foods. Thoroughly wash your vegetables before cooking or eating them.

Pregnancy Introduction

Pregnancy Introduction

Pregnancy Introduction

Introduction

The beginning of your menses starts from the first day of your period. If pregnancy is to take place, this is counted as the first week of your pregnancy. The ovaries do have immature egg cells (oocytes) resting within and may be invisible to ultrasound.

During the course of the cycle, as menstrual bleeding slows down, several of these immature egg cells begin to mature inside small, protective, nourishing, fluid-filled sacs called follicles. It has been estimated to last about 150 days to mature an egg. During ovulation, the follicles start becoming dominant and grow faster. A number of hormones help in this physiology to grow and mature the egg from the ovaries. In the event that you get pregnant, this is counted as your second week. Conception is known to occur during the second week counting from the first day of your last menstrual period.

The egg catching process

Once released, the egg is ‘caught’ up by the fallopian tubes and starts being transported to the uterus. The ‘finger like structures’ at the end of fallopian tubes, also called cillia, help to direct the egg down into the uterus. This process is called ovulation. At this same time, the uterine lining begins to thicken and the cervical mucus thins out to allow the sperm to swim through it more easily. The egg will however remain in the tube for at least 48 hour anticipating the arrival of the sperm for the special moment of fertilization. The follicle that released the egg forms the corpus luteum and starts to release progesterone that helps maintain the uterine lining. This is aimed at preparing for implantation in case fertilization takes place. In case the egg is not fertilized by a sperm, it is passed out of the body through the vagina. It is so small that it cannot be seen. The lining of the womb is also shed in the monthly period of bleeding.

Egg meets Sperm

In the event of coitus taking place, up to about 250 million sperm are released in the vagina. This begins a race to reach the top, where the egg is waiting. This being a race where the strongest will survive, it is estimated that the fastest sperm will reach the egg in about 30 minutes. In the womb are secretions produced by the woman that help channeling the sperm through. The environment is thought to be alkaline and helps the sperm to swim up. An acidic environ will kill the sperm. It takes the sperm 3 to 5 days to survive in the womb. Some may be released before ovulation. The timing of ovulation and or deposition of sperm at the vagina is important for pregnancy to take place. Once this happens fertilization will take place and the fertilized egg travels down to the womb for implantation. Once the sperms meet the egg, they have a hard task to do, penetrate the egg «»shell»». It may last about an hour for this to be successful. Only the strongest will make it.

The sperm with their drill like action will finally penetrate the shell and shed off the covering. The successful sperm then swims in to a fluid space surrounding the egg. An important thing to note is that several sperm will penetrate the shell and get in to a space between the shell and the egg membrane but only one will penetrate this membrane to fertilize the egg. The genes from the sperm are contained in the head and once inside the egg the head swells to become a nucleus which fuses with the nucleus from the egg to start a new process of creating a new individual. If fertilization occurs, the corpus luteum (the previous follicle that released the egg) persists and gets bigger during the first few weeks after conception. This happens in response to the hormone human chorionic gonadotropin (HCG) produced by the early pregnancy. The corpus luteum provides important hormone progesterone that prompts the uterus to provide increasing amounts of blood and nourishment to the growing baby. Occasionally, an ovary creates more than one dominant follicle at a time, thereby producing two or more mature egg cells. If all the eggs are fertilized, this could result in multiple pregnancies—twins, triplets, or more.

Kenya’s leadership crisis…

Kenya’s leadership crisis…

Kenya’s leadership crisis…

In 2007, Kenya defied its standing definition of a free and democratic state when communities rose against each other in the worst civil warfare in Kenyan history. Hundreds were murdered and thousands displaced from their homes and left landless. On February 28th this year, Kenya was celebrating two years since the signing of a peace deal brokered by former Secretary General to the UN, Koffi Annan after the Post poll chaos that rocked the country: a deal that saw the marriage of two rivaling parties working under one government. Since its birth, the grand coalition has been hit by massive tidal waves ranging from massive corruption, betrayal in allegiances to competition for power and might, all of which have constantly threatened to submerge it. I dare assert that the solution to our crisis lies not in the wisdom of a mediator who facilitated the signing of an accord, neither does it lie on the pressure mounted on our administration by foreign governments but rather on our leaders recognizing the “authority and power of one who was despised and rejected by men, a man of sorrows and familiar with suffering.”

I put it forth my position with great conviction and without the fear of contradiction that if the problem was with the leaders, then the solution will be based on the same leaders. But it’s not final with them. They have to recognize the power of the Most High. The leaders who acted as a dividing agent are the same leaders, in partnership with the church, under whose guidance this nation will stand up and move to be better than before.

To expound on this, I will use two classic examples:

First, there was Fiji. The documentary Let the sea resound, shows how it was transformed through fellowship and prayer from a place dominated by evil spirits, constant war and disease into a united and loving territory that fears and honors God led by the former president Josefa Iloilo.  It was moving to watch a president wake up early every morning to pray for wisdom before electing government leaders. It such a humbling act for a president to sacrifice his sleep and stand in the gap for the sake of his nation. Picture our president doing the same for our nation. Wouldn’t it be a great honor?

Then there is Pierre Nkurunzinza, current president of Burundi. A former rebel who took part in a massacre of civilians in his own country. He turned to God and became a hero in his country and a model of a mature Christian Servant Leader in the region. He transformed his country from a physical war zone to a spiritual prayer ground. He hosts a worship service every Sunday evening to pray and give thanks to God. When taking up office as the President, he committed himself to prayer every beginning of the week together with the speaker of parliament and other cabinet ministers.

See, our leaders only need passion and commitment like Josefa and purpose like Pierre to take our nation to greater heights. Only God can save us and our country from the mouth of the lion just like He did to Daniel in the lion’s den. Jeremiah 33:3 says, “Call upon my name and I shall show you great and mighty things that thou knowest not.” Our leaders can help write a new history of our country.

The power of faith

The power of faith

The power of faith

According to the bible, faith is a substance of things hoped for, the evidence of things not seen. This is the basis of many impossible things that we see happening around us.

Let’s look at two people from the Bible who did the impossible. But they did it anyway, because of God’s involvement.

By faith Sarah herself also received strength to conceive seed, and she bore a child when she was past the age, because she judged Him faithful who had promised.

Sarah had a child when she was 91 years old. Physically, it was impossible. She had long since lost the ability to bear children.

But she did what she could not do.

Sarah achieved this impossibility because of God’s promise, and because she believed God would keep His promise.

When Samson came to Lehi, the Philistines shouted against him. Then the Spirit of the LORD came mightily upon him; and the ropes that were on his arms became like flax that is burned with fire, and his bonds broke loose from his hands.

He found a fresh jawbone of a donkey, reached out his hand and took it, and killed a thousand men with it.

Samson killed 1000 of the Lord’s enemies with a bone.

He did what he could not do.

No human being is capable of single-handedly killing 1000 people at one time, with no weapon but a bone. No matter how strong or skilled any man may be, he could easily be overcome by such superior numbers.

But with God’s anointing and help — the situation is different.

With God helping you: you have God’s ability to do God’s will.

You can do whatever God’s Word says you should do.

Your sufficiency is of God.

Whatever God wants you to do — He will help you. God does not play favorites. Just as He helped Samson and Sarah to do what they could not do — He will help you to do His will — even if «it is impossible.»

The Future Begins Today

One thing I do, forgetting those things which are behind and reaching forward to those things which are ahead,

Today Is the first day of the rest of your life. And it will be what you and God make it.

Your past does not have to dictate your future. You can begin again. With God you really can have a fresh start.

God can forgive your past — and help you to forgive yourself.

But most importantly, God can change you. He can make you into the kind of person you know you should be.

Your life can be different. But don’t think it will be different if you continue to do things exactly the same as you always have.

For your life to change — you must MAKE changes.

If you want real change — God’s Word is the key. You must immerse yourself in the Word. What you feed in determines the output of your life.

«And now I entrust you to God and the word of his grace–his message that is able to build you up and give you an inheritance with all those he has set apart for himself.

God’s Word will build you up. Jesus said it would make you free
— if you continue in

The Bible is God’s answer to man’s problems. It gives life and hope and instruction so we can walk in victory.

Prayer is also vital. Prayer is communication with God. All relationships require communication to keep from growing cold.

So, actively involve God in your life. Consult with Him on every decision. God is the best helper you will ever have.

The future can be better. The choice is yours. If you invite and involve God in your future — it will be bright!

Chest Radiography (Chest X-Ray, CXR)

Chest Radiography (Chest X-Ray, CXR)

Chest Radiography (Chest X-Ray, CXR)

Why its done

Chest x-ray is used to diagnose cancer, tuberculosis (MTB) and other lung diseases, and disorders of the mediastinum and bony thorax. The chest x-ray provides a record of the sequential progress or development of a disease. It can also be use to give valuable information about the condition of the heart, lungs, GI tract, and thyroid gland

How to prepare

No special preparation is required. However, the patient will be informed of the purpose and procedure process for the test. There there should be no discomfort. Pregnancy should be screened or at least inform of the last menstrual period.

Risks

The is an increased risk of fetal teratogenicity. The ould be a vasovagal response (hypotension, bradycardia) when instructed on breath-holding.

Results

There should be a normal appearing and normally positioned chest, bony thorax (all bones present, aligned, symmetrical, and normally shaped), soft tissues, mediastinum, lungs, pleura, heart, and aortic arch.

How its done

The patient is positioned sitting or standing upright in front of the x-ray machine, with arms held slightly out from the sides, chest expanded, and shoulders pressed forward. The x-ray film is placed against the anterior chest. For lateral views, the patientwill stand with arms raised from the shoulders. The film is placed against the right or left side of the chest. The patient is asked to hold very still and takes in a deep breath and hold as radiographs are taken. For portable x-rays, the patient is positioned sitting in a high-Fowler’s position, and the portable x-ray machine is moved into place in front of the chest for the radiographic exposure onto the plate positioned behind the back and chest.

Interpretation

The chest x-rays do provide records of progress or development of a disease. X-rays must be done after the insertion of chest tubes or subclavian catheters to determine their anatomic position as well as to detect possible pneumothorax related to the insertion procedure. A postbronchoscopy chest x-ray is done to ensure there is no pneumothorax following a biopsy. In addition, the position of other devices such as nasogastric or enteric feeding tubes can be determined and adjusted if necessary. Abnormal chest x-ray results indicate the following lung conditions: Presence of foreign bodies, aplasia, atelectasis, coccidioidomycosis, hypoplasia, lung or liver cysts, pneumonia( bronchopneumonia, lobar, aspiration, or viral ), brucellosis, abscess ( lung or liver), middle lobe syndrome, pneumothorax, pleural effusion, pulmonary tuberculosis, sarcoidosis, and pneumoconiosis (eg, asbestosis).
Westermark’s sign (indicates decreased lung vascularity, sometimes thought to suggest pulmonary embolus)
Abnormal conditions of the bony thorax include the following: Hemivertebrae, Bone destruction or degeneration, Heart enlargement, kyphosis, Osteoarthritis, Osteomyelitis, Scoliosis, and Trauma.

Factors affecting results

  1. Misinterpretation of a chest x-ray is possible because of tumor, post-operative changes, massive pulmonary emboli, false ventricular aneurysm and esophageal varices. Knowledge of the patient’s history is importanten.
  2. Clothing, jewelry, and metal objects cause shadows on the film.
  3. Movement during the procedure obscures the clarity of the picture.
  4. Poor patient positioning makes x-rays difficult to interpret.
  5. Overexposure or underexposure results in inadequate visualization.
  6. The experience of the radiologist in interpreting the films affects the accuracy and outcome of the findings.

Female Condom

Female Condom

Female Condom

What is it?

  • A female condom is a soft, loose fitting polyurethane pouch. It is larger and looser than the male condom with a closed end that fits over the cervix, inside the vagina.
  • It is approximately 3 inches in diameter and 6 to 7 inches long and looks a bit like a miniature wind sock.
  • There is an open end that is made to hang slightly outside and helps to protect the lips of the vagina. The female condom has two flexible rings; the smaller ring that fits on the cervix and the larger ring that hangs outside the vagina and covers the lips (vulva).
  • The condom is lubricated form the inside.
  • It is stronger than latex and has less pores and tears less easily than the latex condom
  • Like the male condom, it is meant for one-time use.
  • You do not need a prescription to buy the female condom and anyone can purchase it from the drug stores.

How do I use it?

  • Browse the instructions that include it before using it thoroughly
  • The shut eliminate of the feminine condom is made to match over the cervix, and the open up eliminate ring addresses the lips of the vagina. To place the feminine condom, pinch small ring at the shut eliminate of the condom in the middle of your thumb and middle finger.
  • You may put in a drop or two of extra lubricant to the exterior of the shut eliminate of the condom to create it simpler to insert but understand that too very much lubricant can make it hard to understand the ring firmly.
  • Put the condom in so far as it shall go. Make sure it generally does not twist and that the external ring is hanging beyond your vagina. It could be inserted up to 8 hours before having sex anytime.
  • If you are unfamiliar with your vaginal anatomy, take a look before you try inserting the condom. To do this, you may use your middle finger to find your cervix at the upper end. The cervix feels somewhat like the end of your nose, and it is about 3 inches from the vagina’s opening.
  • Do find a comfortable position such as sitting on the edge of a chair with your knees apart, or sit on the toilet, or lie on your back.
  • Using your finger spread the lubricant evenly on the inside of the long pouch, from bottom to top. The lubricant is designed to make the inside of the condom feel similar to the normally lubricated vagina. You may even place a drop of lubricant either on the end of the male organ or at the starting of the condom. It could produce using the condom convenient also. The manufactures provide a little bottle of lubricant with the container of condoms.
  • When the person is inserting, if the penis will not slide in and out during make use of easily, you can add even more lubricant from the excess supply in the bundle. It really is good to steer the penis inside together with your hands also
  • Usually do not use both the feminine and male condoms simultaneously.
  • After the guy has ejaculated, stick to your back to remove the condom. You may do that by squeezing and twisting the outer ring. Carrying out this prevents the semen from leaking.
  • Grab the condom out and wrap it in a paper gently.
  • Discard it in the trash may.
  • Usually do not flush condoms down the toilet.
  • Don’t utilize the same feminine condom more often than once.

What are the benefits of female condoms?

  • The polyurethane material creating the sheath of the feminine condom better compared to the latex and will not allow penetration of the sperm, bacteria and viruses
  • The outer and internal ring prevents contact between your male organ and the vagina
  • Female condoms give females more control over safeguarding themselves from pregnancy, STIs, warts, herpes and HIV. By having it inserted independently, they do not need to convince somebody who could be unwilling to use a condom
  • It is certainly an alternative for individuals who are allergic to latex
  • It is less inclined to tear just like the male latex condom
  • You only utilize them when you need them.
  • Some women found that the ring part of the condom that lies outside the body tended to stimulate the clitoris, adding to their pleasure
  • You can put the female condom in place up to 8 hours before intercourse
  • You do not need a spermicide for extra safety.
  • It is stronger than latex and has less pores and tears less easily than the latex condom
  • It is easier for a woman to empower herself by using the female condom than trying to convince the males to wear a condom
  • It is not affected by some oil based products such as Vaseline
  • When it was tested in actual use, about 30% of the men said they preferred the female condom over the male condom because it was roomier and that it felt more natural to them because the penis could move freely in and out.

What are the disadvantages of female condoms?

  • Some women and men find it uncomfortable to use
  • It costs a lot more than the male condom
  • Some people find the appearance of the female condom unappealing or awkward, especially when using for the first time.
  • If lovemaking is usually lengthy, the lubrication may get used up and the polyurethane will become somewhat dry. Some condoms come with extra lubrication just incase
  • If not well guided by the lady, the penis goes in next to the condom instead of inside the condom.
  • The typical use failure rates are 12-22% for female condom
  • Some women find them hard to put in.
  • Some women statement that the condom could be noisy at period. That is when the lubricant inside isn’t spread around the external expire or if it’s not enough evenly

Who qualifies to really have the TCu380A IUD?

Who qualifies to really have the TCu380A IUD?

Who qualifies to really have the TCu380A IUD?

Read Intrauterine devices (IUD) first.

  • Lactating ladies or after delivery however, not after 4 weeks
  • Ladies with liver disease, hepatitis or using medicines that affect the liver
  • Women with breast tumor, hypertension, hyperlipidemia, background of ischemic cardiovascular disease, stroke or multiple risk elements for cardiovascular disease.
  • Ladies with current deep vein thrombosis/pulmonary embolism.
  • Women who’ve had major medical procedures or trauma
  • Women with migraines with or without focal neurological symptoms.

Who qualifies for LNG-IUS?

  • Women with severe menstrual bleeding (menorrhagia)
  • Women with painful menses ( dysmenorrhoea)
  • Women with endometriosis.
  • Women with bleeding disorders or on anticoagulation treatment with heparin or warfarin
  • Women with thalassemia, sickle cell disease, or iron-deficiency anemia.
  • Breastfeeding women after 4-6 weeks post delivery

Read moreWho qualifies to really have the TCu380A IUD?

Staging bladder cancer using the TNM system

Staging bladder cancer using the TNM system

Staging bladder cancer using the TNM system

Read Bladder Cancer First.

  • T0 ; No tumor in specimen collected
  • Tis ; Carcinoma in situ ( CIS)
  • Ta: Noninvasive papillary carcinoma
  • T1: Tumor invades lamina propria
  • T2: Tumor invades muscle
  1. T2a: Invades superficial muscularis propria
  2. T2b: Invades deep muscularis propria
  • T3: Tumor invades perivesical tissue
  1. T3a: Microscopic perivesical fat invasion
  2. T3b: Macroscopic perivesical fat invasion (extravesical mass)
  • T4
  1. T4a: Invades adjacent organs (uterus, ovaries, prostate stoma)
  2. T4b: Invades pelvic wall, abdominal wall

Invasive of nodal status:

  • N0 No nodal involvement
  • N1-3 Pelvic nodes
  • N4 Nodes above bifurcation
  • Nx Unknown

Invasive of metastatic status:

  • M0 No distant metastases
  • M1 Distant metastases
  • Mx Unknown

Symptoms of bladder cancer

There is painless urination with bleeding( hematuria)

  • Persistent blood in urine
  • Frequency of passing urine
  • Some patients will experience pain on passing urine ( dysuria)
  • Lower abdominal pain
  • Abdominal mass and swelling
  • Lymphedema
  • In severe cases, kidney failure as the cancer spreads to affect the kidneys
  • Nausea and vomiting
  • Metastatic spread to other sites such as the bones will cases pain at the affected regions

Diagnosing bladder cancer

The healthcare provider will perform a thorough medical history and examination in trying to find out how it started. You will be asked about the pain on passing urine, any change in color of urine, any frequency of passing urine and changes to it among others.

The healthcare provider will request for urine tests to rule out any infections such as TB, schistosoma cysts, and blood in urine

The definitive test for diagnosing bladder cancer is the Cystoscopy test. Most urologists will perform these diagnostic cystoscopies in an outpatient setting using a 16F flexible cystoscope and local Intraurethral lidocaine for topical anesthesia.

If a bladder neoplasm is detected, an outpatient transurethral resection (TUR) or biopsy is done with anesthesia.

Radiological tests such as intravenous pyelogram (IVP), retrograde pyelogram, or computed tomography (CT) or magnetic resonance (MR) urogram are used to identify additional tumors and obstruction of the upper urinary tract due to bladder cancer

Other tests done include the complete blood counts, blood indices, Fibrin Degradation Products (FDP) and bladder cancer tumor markers.

Treating Bladder cancer

There are several modes used in treating bladder cancer including, the use of drugs, radiotherapy or both. Most bladder cancers recur in the bladder, but can be managed with a combination of transurethral resection (TUR) and intravesical medications or immunotherapy. Here are some guidelines

  • Bacillus Calmette-Guérin (BCG) vaccine is the most effective agent for treating high-grade superficial lesions. The use of this vaccine leads to reduction in progression rates and increases survival
  • Radical cystectomy (removal of bladder) with diversion of urine bypassing the normal route is the most effective means to eliminate bladder cancer. Types of diversion include; orthotopic diversion with a neobladder.
  • Radiation therapy in combination with TUR and a drug such as cisplatin, has been shown to be effective in preserving the bladder
  • The use of medications using urinary catheters such as methotrexate, vinblastine, doxorubicin, and cisplatin, has shown high levels of toxicity with poor results.
  • New drugs such as paclitaxel and gemcitabine are active, and combinations of these agents with platinum-based compounds have better results with less toxicity.

Why cystectomy (bladder resection) is done

  • When there is a cancer within a bladder diverticulum
  • In cases of primary, and muscle-invasive or high-grade tumors that allow complete excision with adequate surgical margins
  • Patients in whom there is an inability to adequately remove tumor by TUR alone because of size or location
  • When there is a tumor overlying a ureteral opening that may require ureteral reimplantation
  • Patient refuses to have urinary diversion
  • In poor-risk patients where diversion is not possible

Epidemiology of breast cancer

Epidemiology of breast cancer

Epidemiology of breast cancer

Read Breast Cancer first.

  • It is estimated that, worldwide, more than 1 million new cases of breast cancer are diagnosed yearly.
  • The incidence and death rates for breast cancer differ between races but the rates are more common in the Western nations and lowest among the developing world.
  • About 1% of breast cancers is found in males and 90% are estrogen receptor (ER)-positive
  • The risk of breast cancer increases with age
  • The genetically defined group of women with BRCA-1 or BRCA-2 identified to carry lifetime risk of as high as 80%. Women who carry a germ line mutation in BRCA1 genes have a cumulative lifetime incidence of 50% to 85% of developing breast cancer and 40% to 60% of developing ovarian cancer

Genes and breast cancer

The genetically defined group of women with BRCA-1 or BRCA-2 identified to carry lifetime risk of as high as 80%. These genes function in cells in a variety of ways such as

  1. Repair of damages DNA
  2. Cell-cycle regulation
  3. Transcriptional regulation
  4. Remodeling of chromatin in cells. Chromatin are the gene carrying vehicles in all cells
  5. BRCA-2 is involved primarily in DNA recombination and repair

The reason why these genes predispose primarily to breast cancers remains unknown. BRCA1 and BRCA2 genes can be carried and passed to children by men as well as by women. A drug tamoxifen has been shown to reduce the risk of contralateral breast cancer by about 50% in both BRCA1 and BRCA2 carriers.

The characteristics of BRCA1 and BRCA2 genes

  • BRCA-1 is located in chromosome 17 where as BRCA-2 in chromosome 13
  • The percentage contribution of BRCA-1 genes to hereditary breasts cancer is about 20 to 40% where as the BRCA-2 is 1- to 30%
  • The lifetime risk of developing breast cancer with is 60 to 85% in both genes
  • The lifetime risk of developing secondary breast cancer is about 50% in both
  • The risk of developing male breast cancer is minimal in BRCA-1 and about 4-6% in BRCA-2 genes
  • The risk of developing other types of cancers such as the cancer of the prostate , pancreas , stomach, ovary and melanoma

HER2 genes

Another gene, HER2 presents with its protein over expression in 20% of newly diagnosed breast cancers. HER2 stands for Human Epidermal growth factor Receptor 2.

HER2 gene positive breast cancer is associated with a more aggressive clinical course and decreased survival time compared to tumors with normal levels of HER2. Each normal breast cell contains copies of the HER2 gene found in the DNA of the cell. HER2 contains information that helps to make HER2 proteins.

The HER2 protein is the HER2 receptor found on the surface of some normal cells in the body. The proteins help send growth signals from outside the cell to the inside of the cell and pass the message for cells to grow and divide.

In HER2+ breast cancer, the cancer cells have an abnormally high number of HER2 genes per cell. When this happens, too much HER2 protein appears on the surface of these cancer cells. This is called HER2 protein overexpression. This causes the cells to grow and divide more aggressively. This contributes to growth autonomy and genomic instability where the cells growing hev no control at all.
Symptoms of breast cancer

  • Breast cancer is usually first detected as a palpable mass or as a mammographic abnormality. These masses and areas of asymmetrical thickening of breast tissue are the most common manifestations of breast cancer.
  • There is nipple discharge, retraction and flattening of the breast. Spontaneous bloody or watery discharge from the nipple is commonly associated with underlying breast neoplasm. Presence of milky discharge almost always has a noncancerous cause.
  • Changes in the skin over the breast. There is skin swelling, and erythema.
  • Breast pain. the breast pain typically is associated with a palpable lump
  • Paget’s disease of the nipple is a form of adenocarcinoma involving the skin and lactiferous sinuses of the nipple; it usually appears as an eczematous lesion of the skin of the nipple. It’s frequently associated with excoriation of the skin and discharge.
  • Lumps in the armpits and above the clavicles

What are some of the tests done in lung cancer?

What are some of the tests done in lung cancer?

What are some of the tests done in lung cancer?

Read lung cancer and How do those with lung cancer present first.

  • The most important examination at the early stage is plain chest x-ray.
  • Other tests include the endoscopic studies
  • CT scan of the chest
  • MRI of the chest
  • Tissue biopsy ( done during the endoscopy)
  • Flexible fiberoptic bronchoscopy
  • A transbronchial needle aspiration: done via a special needle passed through the bronchoscope. This technique can be used to sample out mediastinal masses or paratracheal lymph nodes
  • Transthoracic fine-needle aspiration biopsy with fluoroscopic or CT scan guidance
  • Mediastinoscopy
  • Pleural biopsy in patients with pleural effusion
  • Thoracentesis of pleural effusion and cytologic evaluation of the obtained fluid

Read moreWhat are some of the tests done in lung cancer?

Treatment of Cervical cancer

Treatment of Cervical cancer

Treatment of Cervical cancer

Read Cervical Cancer First.

Treatment of cervical cancers depends on the staging and the depth of invasion. For example for invasion of less than 3 mm (stage IA-1) treatment includes a hysterectomy or the option of cervical conization in women who wish to preserve fertility. The staging of cervical cancer involves the following:

The International Federation of Obstetrics and Gynecology (FIGO). It permits assessment through biopsy, physical examination, cystoscopy, proctoscopy, excretory urography (intravenous pyelography or IVP), and plain film x-ray of the chest and skeletal system. The American Joint Cancer Committee staging is also involved.

Staging in cervical cancer

Read moreTreatment of Cervical cancer

Menopause : What is it and why do I need to know about it?

Menopause : What is it and why do I need to know about it?

Menopause : What is it and why do I need to know about it?

You may have heard about another friend’s menopause stories but menopause is different for every woman. It is therefore important to be well informed about this third stage of life in a woman.

It is a time of change. Change can be exciting, a bit scary….. BUT MENOPAUSE need not be scary. All the changes are perfectly normal.

What is menopause?

It is a time when women stop having their monthly periods. It is a change of life. It is a new beginning. It is a time when one’s ovaries have run out of follicles (eggs) and therefore stop producing hormones, especially estrogen. It is a normal part of being a woman, and all women go through it.

When?

No one can be sure. Every woman is different. Most women reach menopause around 50 years, but many women start the changes in their 40’s.

Your best clue to timing of your menopause is your mother. Your menopause will be around the time when she had hers, with few alterations depending on lifestyle e.g. women who smoke get menopause about 2 years earlier than they otherwise would have.

How do I know?

  • It doesn’t happen all at once. It is a slow process, usually taking 3-6 years, and is complete only when a woman hasn’t had periods for 12months in a row.
  • Natural menopause: Your body will give you few clues that the process might have started.
  • Changes in your periods: – Missing periods, having more frequent periods, bleeding lesser or more than usual. This may happen for one or more years before they stop forever
  • Hot flashes and nights sweats – feelings of heat in the face and upper part of the body for few seconds or minutes on and off.
  • Dry vagina with possible itching and uncomfortable feeling during sex.
  • Bladder control problems: – some women may leak urine when they sneeze; cough and sometimes if they don’t get to the bathroom on time.
  • Mood swings and easy irritability.
  • Memory changes.
  • Having aches in the bones. Bones become weak after menopause because of deficiency of estrogen hormone from the ovaries. The main bones affected are the back, hip and arms.

Will all these changes happen to everyone?

No!! Menopause is different for every woman. Some have many changes, others just a few.

What can one do to feel better and stay healthy at this time of change?

  • Don’t smoke.
  • Exercise regularly-walk, ride a cycle, use stairs.
  • Eat healthy and get enough calcium and vitamin D.
  • Stay in cool areas and wear loose clothing.
  • Talk to family and friends about it.
  • Learn new ways to relax e.g. meditation.
  • Laugh a lot.
  • Ask for HELP if you need it. Don’t suffer quietly.

Does one need to see a health care provider?

Yes. Your doctor can be a big help as you go through this transition. You can discuss about your changes in periods, how you are feeling and about your chances of having weak bones.

Does everyone need medication?

No!! Many women will not need medication during menopause, but some need them to help cope with severe symptoms.

Treatment options!

Treatment is varied and depends on the symptoms, ranging from dietary advice to herbal medicines (like soy proteins), to hormonal medicine for vasomotor symptoms and other medicines for bones only. One needs to see a doctor to advise an individualized management plan as per profile of the patient. Every woman is different and may require different treatment schedules.

Tips for Nail Maintenance

Tips for Nail Maintenance

Tips for Nail Maintenance

Read Nail Maintenance Tips first.

Step by step procedure

Shop for items such as the nail coat, tip guide strips, neutral polish and white polish.  Note that the neutral polishes are very pale, sheer shades with a pink, beige or peach cast.  Look for manicure kits that come with everything in one convenient box. Here is what you also need; alcohol swab, nail brush and files, manicure scissors, nail buffers, cotton, nail clippers and cleaners. The procedure:

  1. Cutting the nails. Make sure you do clip, file and shape your nails properly. Follow the contour of the finger cuticle. Tend to your cuticles, then wash and dry the nails completely.
  2. Apply the base/top coat and let it dry for some minutes. Make sure you do not react to the chemicals provided.
  3. After everything has dried up, remove the guide strip by peeling it off then fix it below the tip of a nail, following its natural curve. The guide will allow you to paint an even white tip with ease and precision. That’s how great painters work by the way.
  4. Be sure you place all guide strips on the nails you want painted. The longer the nail, the longer the white tip should be. Be sure that the arch of the guide is smooth and rounded and the lengths of tips are equal to give it a greater uniform look.
  5. Start by painting each nail tip white. Perform this by extending the brush stroke from the top of the guide to the end of the nail. Avoid getting any white polish on the body of the nail below the guide. Let the tips dry.
  6. After they are dry, remove all the guides.
  7. Dissolve leftover adhesive by rubbing it gently with an alcohol cotton swab
  8. Now apply 2 coats of the neutral polish, first by letting the first coat dry then apply the second coat.
  9. Finish with a thin layer of base/top coat.
  10. You can have your own color combination just to be different from the French style. Instead of the neutral, you may consider the white, red with black tips, red with gold tips or white with silver tips. It’s up to you.
  11. As you finish up, keep your hands very still as the polish dries to avoid denting or smudging it.

Important things to note

  • DO NOT USE YOUR NAILS AS TOOLS OR WEAPONS. Instead use your fingertip or knuckle to perform tasks.
  • You may trim cuticles once each week. First soften them with a specialized cuticle cream, and then trim carefully with a clipper.
  • You may moisturize nail beds regularly by rubbing nondrying nail lotion over the entire nail bed at least once a day or oil the nails daily by using creams such as aqueous cream with vitamin E. This helps to hydrate your cuticles and prevents peeling and separating of the natural nail from the acrylic.
  • Wear gloves whenever coming into contact with cleaning chemicals (kitchen/bathroom cleaner, bleach, ammonia, etc) as well as when gardening – dirt, fertilizer, and chemicals used for plant growth are harmful. Gloves protect your skin as well as your nails!
  • Do not use glue on your nails. Temporary patching with glue may trap dirt and /or bacteria in the nail which may damage the natural nail. In addition, glue is water soluble – so it will break down when you come into contact with water and you may re-break the nail, causing even more damage.
  • Eat a balanced diet especially full of vitamin B, calcium and protein to get stronger nails. You may also take supplements
  • Clip your nails regularly in a rounded or squared shape. On the toes nails, if you easily get ingrown toes nail conditions, trim the nails horizontally than curving them. Not that the more your nails point especially at the tips, the more likely it is to break off.
  • Avoid biting your nails as it is a sure way to create unhealthy and unsightly nails

Gout: Causes and also Diagnosis

Gout: Causes and also Diagnosis

Gout: Causes and also Diagnosis

Gout is some sort of arthritis. An attack could be due to it of unexpected burning pain, stiffness, and swelling in a joint, the big toe usually. These attacks can occur again and again unless gout can be treated. Over time, they are able to damage your joints, tendons, and other cells. Gout is many common in men.

What causes gout?

Gout is due to too much the crystals in the blood. The majority of the right time, having too much the crystals is not harmful many many people might never get gout therefore. However, when the crystals levels in the bloodstream are too high, the the crystals might form hard crystals in your joints.

Your likelihood of getting gout are higher in case you are overweight, drink an excessive amount of alcohol, or eat an excessive amount of fish and meats that are saturated in chemicals called purines. Some medications, such as for example water pills (diuretics), may bring on gout also.

Read moreGout: Causes and also Diagnosis

Side Effects of cigarettes

Side Effects of cigarettes

Side Effects of cigarettes

Read Health Hazards of cigarettes first.

Smoking around children:

The Dangers of Secondhand Smoke to a kid:

  • Low birth weight for gestational age
  • Sudden Infant Death Syndrome (SIDS)- children whose mothers smoked during pregnancy have an increased risk of SIDS.
  • The EPA estimates that passive smoking is responsible for between 150,000 and 300,000 of these infections in children under 18 months annually
  • Asthma – According to the EPA, between 200,000 and 1,000,000 kids with asthma have their condition worsened by secondhand smoke every year. Also, passive smoking may also be responsible for thousands of new cases of asthma every year
  • Chronic respiratory symptoms such as cough and wheezing may be attributed to secondhand smoke.
  • Children who breathe in secondhand smoke are more likely to suffer from dental cavities, eye and nose irritation, and irritability
  • Middle ear infections – exposure to ETS causes buildup of fluid in the middle ear, resulting in 700,000 to 1 1.6 million physician office visits yearly in the U.S.

Read moreSide Effects of cigarettes

Dating

Dating

DatingLooking for someone?

Dating is a kind of courtship, and could include any public activity undertaken by, typically, two people with the purpose of each assessing the other’s suitability as somebody in an intimate romantic relationship or as a partner. The word identifies the act of achieving and participating in some mutually arranged cultural activity. Traditional dating actions include entertainment or meals.

In lots of cultural traditions, a date could be arranged by a 1 / 3 party, who could be a grouped relative, acquaintance, or professional matchmaker. Internet dating is becoming popular recently.

Although dating etiquette is becoming more relaxed during the twentieth century, there are considerable differences between social and personal values. For example, when an activity costs money (for example, a meal), traditionally the man was expected to pay; but in recent times the practice of «going Dutch» (splitting the expenses) has become more common and more acceptable. With the wider availability of information about traditionally secretive issues individuals are more open about their interest in sexuality both in form of dating language and dress. The difference in expectation of a date in the male / female view of dating is very marked and obviously shown by the public guidance disseminated by popular media, e.g. magazines, which is in stark contrast. The average duration of courtship before proceeding to engagement or marriage varies considerably throughout the world.

Read moreDating

Testing for Fertility in Men part two

Testing for Fertility in Men part two

Testing for Fertility in Men part two

Read Testing for Fertility in Men first.

The semen liquefaction

Semen analysis should begin with a simple inspection soon after liquefaction. This is done preferably at 30 minutes after ejaculation but no longer than one hour to prevent dehydration or changes in temperature from affecting semen quality. Normal liquefied semen samples may contain jelly-like granules (gelatinous bodies) which do not liquefy. These do not appear to have any clinical significance. Poor liquefaction means the sperm may not be released to fertilize the egg.

The following are the normal settings

Read moreTesting for Fertility in Men part two

Valentines Day time: A complete woman’s guide

Valentines Day time: A complete woman’s guide

Valentines Day time: A complete woman’s guide

Read Valentines Day: A complete woman’s guide first.

How to look good for him, on this day

Let’s put it plain, Men have many traits in common;

  • They love their cars
  • They like to look at good breasts
  • They scan the best hips in the neighborhood
  • They love cute faces and the hair too.
  • Read the book of Solomon

Men are visual creatures by all means. Ever wondered why beer commercials have contents with the best hips and legs? The sexy connotations are not taken for granted. In her book called; Find a husband after 35, Rachel Greenwald advises women to wear dresses at all times. Studies prove that men love to see their women in dresses. With these parameters, you can use them to spice up your love. Remember, once in his eyes, some things are hard to forget. If you are walking down the streets with him and he notices a cute woman with a great body, this will linger in his mind for a while, if not a long time. You must erase it immediately. Tell you the truth, if you don’t erase it, and it happens over and over again, one thing will remain to be true; that the reason he is with you is that he can’t do better!

Read moreValentines Day time: A complete woman’s guide

How do those with lung cancer present

How do those with lung cancer present

How do those with lung cancer present

Read lung cancer first.

The early symptoms of lung cancer and their prevalence include:

  • Cough or altered cough in 60% of patients.
  • Coughing blood( Haemoptysis) in  27% of cases
  • Chest pain in 34%.
  • Difficulty in breathing (Dyspnea) in 46% of cases.
  • Loss of appetite
  • Weight loss 56%.

On examination of the patients

Read moreHow do those with lung cancer present

19 Mistakes Men Make During Sex

19 Mistakes Men Make During Sex

19 Mistakes Men Make During Sex

Introduction

This is for you men. And women who have guys who just wont get it, so that they can pass the message to them. Much as it is said that life is all about making mistakes and collecting bruises, learning from them, becoming transformed by them, some things are better learned once, even before making the mistakes. Men, lets admit that we will; change and do things better…no we will do things the right way. I have collected a few issues from women who during my practice and interaction with them, have candidly shared some of the crimes committed against them. Here are a number of them.

These are the crimes

  1. At first sight, you head straight to the groin. I wondered whether the name dogs came from
    this. Dogs at first sight will end up there, happy to see you back form where ever you have
    been. Women expect a kiss at first meeting ( OK this is for couples, pls don’t head for mouth to
    mouth with strangers). Avoiding her lips and heading straight to the 1% region as my colleague
    would call it makes her feel like she is not valued. Give her a proper passionate kiss as the
    Ultimate form of foreplay.
  2. Not calling her during the day. This is very common. Men a culpable in this by all means and expect it to be ok during the romantic moments. They say foreplay starts in the morning, or when you are leaving for work. As you part way in the morning, say goodbye with a kiss and immediately send her an email to her work address o leave a voice mail telling her how you miss her. That sets the ball rolling.
  3. Messing up her hair and massaging her roughly. You’re attempting to give her a sensual, relaxing massage to get her in the mood. Hands and fingertips are OK; If she has long hair, take time to brush with long slow strokes especially after she has had a shower or getting ready to bed.
  4. Breathing through her ear drum. There’s a clear difference between being erotic and blowing as if you’re trying to extinguish the candles on your 40th birthday cake. That hurts.
  5. Maintaining your shrubs. You must shave it off. Much as porcupines have their own means of romancing, remember she is human and steer clear of exposing her to your chin which you rake repeatedly across her face and thighs. If you have seen her turn her head from side to side, it’s not that she is fine, or having some passionate ,moments with you, it’s avoidance.
  6. Kneading her breasts and biting nipples. Most men still carry some traits from childhood, the attachment to the breasts. Please remember that those glands are heavily wired with nerve endings for touch, pain, and pressure. That makes them uncomfortable when you act like you are testing some oranges for ripeness. Do this; just gently stroke, caress, and smooth them, it takes them there. Never bite her nipples as if you are trying to deflate some balloons. Most nerve endings are located there and that increases the sensitivity. The best proven way is to lick, suck and flicking your tongue across them.
  7. Ignoring other body parts. Try to explore the who package lie you have just received some Christmas gift and you are trying to find a place to open it up. A woman is not a three point pit stop; Breast-ville East and West, and the subway tunnel. Other areas of her body are important too and may give you the same results.
  8. Unwrapping the gift awkwardly. Like the x-mas present, please find a gentle way of opening up the gift with a mind that you are environmental friendly and you will recycle the wrapping paper. That paper is her clothing. Another mistake comes with undressing prematurely. Always obtain consent for all procedures performed on them. Remember she will have to use it later. Be gentle.
  9. Attack on the clits. Too much direct pressure is painful and unpleasant. Be soft and try to caresses.
  10. Coming too soon. In fact this where the complaints come from. Women are not industrial plants, where the men stuff in the oil pipe ( penis) and pump in all the oil in to the plant and drop deada  sleep! Premature ejaculation is associated with ED, work on this. Build up slowly in sync wit her and take her there.
  11. Having a commercial break. Men are created differently. They can climb or near the climax, pause, then continue. In fact multiple orgasms happen this way. Women, unlike men, don’t pick up where they left off. When you stop, the go to have a drink or pick up a phone call, that it, they plummet back to square one very fast. If you can tell she’s not there, keep going at all costs, numb jaw or not. Please try and take her to climax,no matter what. Try to practice it. Most men would drop off dead asleep after the action with the lady wondering what’s up.
  12. Rough rides. Just be cause there are screams or near screams doe not mean you are the man. You could be causing some damage by going too hard especially when she is not ready or lubricated. If you are too heavy, try different styles. Lumping your whole body on her will turn her blue.
  13. Not coming too soon. Don’t think that because you thrust for an hour without climaxing is the mark of a Sex god. To her it’s more likely the mark of a numb vagina. You could just get her some wall hangings, so she has something to hold her interest while you’re on cross country business.
  14. Porn templates. Never use porn styles on her. In most scenes, the  women seem to love it when men ejaculate over them. In real life, it  means more laundry to do, more explanations to give too.
  15. Attempting anal sex and pretending it was an accident. This is how men earn a reputation for not being able to follow directions. Please ask before doing it and don’t think that being drunk is an excuse.
  16. Arranging her in weird poses. This is not a mannequin. If she wants to do advanced yoga in bed, fine, but unless she’s a Chinese gymnast, don’t get too ambitious. Just do what both of you are able to manage.
  17. Performing rectal examination. Read this carefully: Anal stimulation feels good for men because they have a prostate. Women don’t start looking for her prostate.
  18. Barking instructions. Please leave this to Sir Alex Ferguson.  It’s a big turn-off.
  19. Talking dirty during the action. If you have never done this before and especially if your spouse comes from a religious background, you have some explaining to do. If she wants  nasty talk, she’ll let you know

Typhoid fever

Typhoid fever

Typhoid fever

Introduction

Many times in Medical practice we come across patients who often complain of “Typhoid fever”. These patients have also been on treatment previously at peripheral centres for this diagnosis, commonly by unqualified personnel, or on a basis of non specific laboratory tests and often on clinical suspicion. This kind of practice has led to Overtreatment and irrational use, and thus potentially abuse, of antibiotic medications.

Other names

Enteric fever,Typhoid.

But what exactly is Typhoid fever?

Typhoid is a bacterial infection that is characterized by fever and abdominal pain and caused by dissemination of Salmonella Typhi or Salmonella Paratyphi types of bacteria. It is a clinically distinct diagnosis, though clinical features may resemble those of many other tropical diseases such as Malaria, Amoebiasis, Dengue fever, hepatitis, bacterial enteritis, Ricketsial infection, and Acute HIV infection among others.

It is thus important for you to note that there are many clinical scenarios similar to typhoid, thus it’s the duty of trained medical personnel to differentiate which one it is.

How is typhoid transmitted?

Salmonella that cause typhoid reside only on Humans, no Known Animal reservoir.
Infection is acquired by direct contact with an infected individual or indirectly via contaminated food or water. There is a story of “typhoid Mary” the cook in early 20th century NewYork who infected approximately 50 people, with 3 persons reported to have died,  highlights the person to person spread of this infection and role of asymptomatic carriers maintaining the cycle of infection.

Factors predisposing to infection include:

  1. Conditions increasing the PH of the stomach like
    • Increased use of Antacids
    • Low levels of hydrochloric acid in the stomach (Achlohydria)
    • Age of <1 year
  2. Inflammatory conditions such as Inflammatory bowel disease,
  3. Previous gastric surgery,
  4. Altered intestinal Normal Flora due to antibiotic usage.

What are the symptoms of Typhoid fever?

Following infection with Salmonella, there is an Incubation period of between 3 to 21 days, with average 10-14 days. There are no signs of disease at this time.

The length of this duration reflects the inoculum size and a person’s health and immune status. Infection leads to an onset of fever with other non specific symptoms. There non specific symptoms that often precede fever such as chills, headache, anorexia, cough, weakness, sore throat, dizziness, and muscle pains.

The Classic presentation of Typhoid in untreated person is divided into weeks is as follows:

First week of illness

Nonspecific symptoms including:

  • Persistent headaches
  • Malaise,
  • Rising remittent fevers also called the Step ladder fever. This is fever that rises exponentially over a tie period without remittion
  • Constipation
  • Mild nonproductive cough.

Second week

  • The patient looks toxic and apathetic
  • There is a sustained high temperature.
  • The abdomen slightly distended
  • There is an enlarged spleen (Splenomegally)

Third week

  • The patient becomes more toxic and ill.
  • There are persistently high fever episodes.
  • There may be intestinal bleeding and perforation, resulting in peritoneal infection (peritonitis).
  • There is abdominal distension that on auscultation, there are pronounced  scanty bowel sounds.
  • Diarrhoea common with liquid, foul smelling green-yellow stools.
  • The patient becomes delirious and a confusional state sets in (typhoid state)

Fourth week

  • Patients who survive have considerable weight loss.
  • Fever, mental state, and abdominal distension slowly improve.
  • Convalescence is slow.

How is Typhoid Fever Diagnosed?

Other than a positive culture, no specific laboratory test is diagnostic for enteric fever.
Cultures can be done on the following specimen:

  • Blood
  • Stool
  • Urine
  • Rose spots
  • Gastric or intestinal secretions
  • Bone Marrow; these remains positive in more than 90% of cases even after 5 days of good antibiotics.

Other tests that may give clues to the diagnosis of typhoid fever include a Complete Blod Count, Liver Function tests, Kidney function tests all which may change in various other disease states.

How about the Widal test?

The classic Widal test is widely available however, it has high rates of false positive and false negative, and thus this test is not clinically useful.

How is Typhoid fever treated?

Several Antibiotics are available for treatment of Typhoid fever, and since they are prescription only medicines, it’s wise to present to the doctor whenever you suspect Typhoid fever.