PREGNANCY

DOC I AM PREGNANT
Pregnancy is the carrying of a fetus or embryo in the womb of a woman. 

The term embryo is used to describe the developing offspring during the first 8 weeks following conception while the term fetus is used from about 2 months of development until birth.

Human pregnancy is divided into three trimester periods:
1.The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus).
2.The second trimester, the development of the fetus can be more easily monitored and diagnosed.
3.The third trimester often approximates the ability of the fetus to survive outside of the uterus.

 Fertilization
The process leading to pregnancy occurs earlier usually in the fallopian tube when the female egg is penetrated by the male spermatozoon following the act of sexual intercourse.
This process is referred to as fertilization or conception.
The fertilized egg then travel down the fallopian and implants itself into the inner lining of the womb or uterus.
Once implanted in the uterus the embryo will grow to become a fetus at 2 months before coming out of a normal pregnant mother's womb at 38 weeks from conception to become a newborn baby.
After implantation into the lining of the womb, the embryo secretes a hormone named human chorionic gonadotropin which in turn stimulates the corpus luteum in the woman's ovary to produce progesterone.
The progesterone act to maintain the lining of the uterus so that the embryo will continue to be nourished by the glands in the lining of the uterus.
The capillaries will be stimulated to grow from the wall of the uterus to form the placenta which allow the embryo to receive vital nutrients from the woman's blood supply.The umbilical cord is the connecting cord from the embryo or fetus to the placenta and allow nutrient uptake, waste elimination, and gas exchange via the mother's blood supply.

The expected date of delivery is 40 weeks counting from the first day of the last menstrual period and birth usually occurs between 38 and 42 weeks.Even though pregnancy begins at conception, it is more convenient to date from the first day of a woman's last menstrual period.

Diagnosis of pregnancy:
The beginning of pregnancy may be detected by a pregnant woman without medical testing through a number of symptoms of pregnancy:
1. nausea and vomiting,
2. excessive tiredness and fatigue,
3. cravings for certain foods
4. frequent urination particularly during the night.

Signs of pregnancy include:
1.the presence of human chorionic gonadotropin (hCG) in the blood and urine can be detected as early as 12 days after implantation
2.missed menstrual period,
3.implantation bleeding during the third or fourth week after last menstrual period,
4.increased basal body temperature sustained for over 2 weeks after ovulation,
5.Chadwick's sign (darkening of the cervix, vagina, and vulva),
6.Goodell's sign (softening of the vaginal portion of the cervix),
7.Hegar's sign (softening of the uterus isthmus),
8.pigmentation of linea alba – darkening of the skin in a midline of the abdomen, caused by hyperpigmentation resulting from hormonal changes, usually appearing around the 22nd week of pregnancy
9.Breast tenderness and darkening of the nipples is common
10.an early obstetric ultrasonography can determine the age of the pregnancy fairly accurately based on the last menstrual period.

LASIK SURGERY

DOC I HAVE LASIK SURGERY

LASIK (an acronym for laser-assisted in situ keratomileusis) is a type of refractive surgery done by ophthalmologists for correcting myopia, hyperopia, and astigmatism using excimer laser.

The LASIK technique use of the laser was to change the surface shape of the cornea first done in 1991.

The operation itself involves creating a thin flap on the eye, folding it to enable remodeling of the tissue beneath with a laser.
The flap is repositioned and the eye is left to heal in the postoperative period.

Preoperative:
Patients who are wearing soft contact lenses are instructed to stop wearing them 5 to 21 days before operation.

The patient's corneas are examined with a pachymeter to determine their thickness and to measure their surface contour.

This process also discover astigmatism and other irregularities in the shape of the cornea.

With this information the eye surgeon calculates the amount and the locations of corneal tissue to be removed during the operation.

The patient typically is given a course of antibiotic beforehand to minimize the risk of infection.

Operation:
The operation is performed when the patient is awake and mobile although he/she is sometimes given a mild sedative (such as Valium) and anesthetic eye drops.

LASIK is performed in three steps.
A corneal suction ring is applied to the eye, holding the eye in place.
1.create a flap of corneal tissue.

Once the eye is immobilized, the flap is created with a mechanical microkeratome using a metal blade, or a femtosecond laser microkeratome that creates a series of tiny closely arranged bubbles within the cornea.
A hinge is left at one end of this flap.
The flap is folded back, revealing the stroma, the middle section of the cornea.

2.remodeling of the cornea underneath the flap with the laser.
An excimer laser (193 nm) is used to remodel the corneal stroma.
The laser vaporizes tissue in a finely controlled manner without damaging the adjacent stroma.

3.the flap is repositioned.
After the laser has reshaped the stromal layer, the LASIK flap is carefully repositioned over the treatment area by the surgeon and checked for the presence of air bubbles, debris, and proper fit on the eye.
This flap stays in position by natural adhesion until healing is completed.

Postoperative care:
Patients are usually given a course of antibiotic and anti-inflammatory eye drops.
Patients are usually told to sleep much more and are also given a darkened pair of shields to protect their eyes from bright lights and protective goggles to prevent rubbing of the eyes when asleep and to reduce dry eyes.
They also are required to moisturize the eyes with preservative-free tears.
Proper post-operative care is important to prevent the risk of complications.

LASIK surgery results:
The surveys determining patient satisfaction with LASIK have found most patients satisfied, with satisfaction range being 92–98 percent.

Complications:
Intraoperative complications
1.flap complications
2.slipped flap (a corneal flap that detaches from the rest of the cornea) is one of the most common complications.
3.Flap interface particles

Early postoperative complications
1.dry eye symptoms at 6 months period post surgery.
2.diffuse lamellar keratitis (DLK),
3.infection responsive to treatment.Infection under the corneal flap is possible.

Late postoperative complications
1.A subconjunctival hemorrhage
2.Surgery induced dry eyes or in severe cases chronic dry eye.Due to 70% of corneal nerves that are severed during the Lasik operation , the lubrication system of the eye is affected and nerves may never recover to pre-operative condition.
3.Overcorrection or undercorrection
4.Vitamin D deficiency from Sun sensitivity
5.Visual acuity fluctuation
6.Halos or starbursts around light sources at night
7.Light sensitivity
8.Ghost images or double vision
9.Wrinkles in flap (striae)
10.Decentered ablation
11.Debris or growth under flap
12.Thin or buttonhole flap
13.Induced astigmatism
14.Corneal Ectasia -decrease in the number of corneal keratocytes (fibroblasts) after LASIK.
15.Floaters
16.Epithelium erosion
17.Posterior vitreous detachment
18.Macular hole.
19.flap dislocations have been reported 1–7 years post-LASIK.
20.intraocular pressure, essential in glaucoma screening and treatment.
21.retinal detachment
22.choroidal neovascularization
23.uveitis
24.keratomileusis effected at a later age increases the incidence of corneal higher-order wavefront aberrations.
25.Microfolding -an almost unavoidable complication of LASIK usually negligible
26.Blepharitis,  with crusting of the eyelashes can lead to infection or inflammation of the cornea after LASIK.

Newer methods like Femtosecond laser intrastromal vision correction via all-femtosecond correction (like Femtosecond Lenticule Extraction, FLIVC, or IntraCOR), or other techniques that avoid permanently weakening the cornea with incisions and deliver less energy to surrounding tissues will replace LASIK Surgery.

CONGESTIVE HEART FAILURE

DOC I HAVE CONGESTIVE HEART FAILURE

Congestive Heart failure occurs when the heart can not pump enough blood to the rest of the body.

This condition may affect either the right side or the left side of the heart. Often both sides of the heart are involved.

The Causes of Congestive Heart failure are:

When the heart is unable to pump enough oxygen-rich blood out to the rest of the body, blood may back up in other areas of the body.

Fluid builds up in the lungs, liver, gastrointestinal tract, and the arms and legs.

This is called congestive heart failure.

The main causes are:
1.coronary artery disease (CAD) a narrowing of the small blood vessels that supply blood and oxygen to the heart.

2.cardiomyopathy-Heart failure can also occur when an infection weakens the heart muscle and the heart muscle enlarges to compensate.

3.Congenital heart disease -defects in the heart of the newborn affects the pumping action of the heart

4.Heart valve disease - abnormal valves affects the blood flow through the heart

5.Some types of abnormal heart rhythms(arrhythmias) affects efficiency of blood flow through the heart

6.Emphysema - chronic lung disease affect the heart lung circulation

7.Overactive thyroid - fast heart beat affects the heart pumping action

8.Severe anemia -insufficient blood affects the blood flow in the heart

9.Underactive thyroid - slow heart beats also affects the heart

Symptoms:

Symptoms of heart failure usually begin slowly.
1.breathing problems occurs even while resting.

2.Cough worse at night

3.Fatigue, weakness, faintness

4.Loss of appetite

5.Need to urinate at night

6.Pulse that is fast or irregular, or palpitations(feeling of fast heart beats)

7.Shortness of breath when active or lying down

8.Swollen (enlarged) liver or abdomen

9.Swollen feet and ankles

10.Waking up from sleep as a result of shortness of breath

11.Weight gain

Heart failure symptoms can also begin suddenly; for example, after a heart attack or other heart problem.

Signs

1.Fast or difficult breathing

2.Irregular or fast heartbeat and abnormal heart sounds

3.Leg swelling (edema)

4.Neck veins that stick out (distended)

5.Sounds (creps) from fluid buildup in lower parts of the lungs

6.Swelling of the liver or abdomen

Diagnosis:
An echocardiogram (ultrasound) is the best test to diagnose, find the cause of, and monitor the heart failure because it can check on the blood flow through the heart.

Imaging tests are useful:
1.Cardiac stress tests
2.Heart catheterization
3.MRI of the heart
4.Nuclear heart scans

Laboratory tests are done to check on:
1. kidneys condition (BUN, creatinine, creatinine clearance, urinalysis)

2.low blood count or anemia -- full blood count (FBC)

3.Test for brain natriuretic peptide (BNP)

4.sodium and potassium levels in your blood

Treatment:

MONITORING

1.Follow-up appointments to check the heart function.

2.Knowledge of symptoms indicating heart failure is getting worse
a.changes in your heart rate,
b.pulse rhythm
c.blood pressure,
d.weight.

3.Weight gain within a day or two may be a sign of extra fluid in the body and the heart failure is getting worse.

4.reduce the salt eaten and limit the fluid taken during the day.

5.Avoid alcohol

6.Avoid smoking

7.Keep active walking or riding a stationary bicycle. Avoid exercise on days when there is increased fluid or weight.

8.Lose weight if overweight.

9.Lower your cholesterol by diet

10.Rest is needed for the heart .

MEDICATIONS

Medicines treat the symptoms, prevent the heart failure from getting worse, and prolong life

Medicines like diuretics,aspirin and digoxin will:
1.Help the heart muscle pump better

2.Keep the blood from clotting

3.Lower the blood pressure

4.Open up the blood vessels or slow the heart rate

5.Replace potassium

6.Rid your body of excess fluid and salt (sodium)

Surgery:
1.Coronary bypass surgery (CABG) and angioplasty may help improve blood flow to the damaged or weakened heart muscle.

2.Heart valve surgery may be done if damages to the heart valve are causing heart failure.

3.A pacemaker can help treat slow heart rates or help both sides of the heart contract at the same time.

4.A defibrillator sends an electrical pulse to stop life threatening abnormal heart rhythms.

SEVERE HEART FAILURE
Severe heart failure occurs when treatments no longer work.
Certain treatments may be used when a person is waiting for a heart transplant:
1.Intra-aortic balloon pump (IABP)
2.Left ventricular assist device (LVAD)

Prognosis:

Very often the heart failure can be controlled by taking medicine, changing to a healthy lifestyle, and treating the underlying condition.

Heart failure can suddenly get worse due to:
1.Angina
2.Eating high-salt foods
3.Heart attack
4.Infections or other illnesses
5.Not taking medicines correctly

Heart failure is usually a chronic illness, which may get worse over time.
Some people develop severe heart failure, in which medicines, other treatments, and surgery no longer help.

ANTIOXIDANTS

DOC WHAT ARE ANTIOXIDANTS

Antioxidants are substances that may protect the  cells in the body against the effects of free radicals.

Free radicals are molecules produced by:

1. Oxidation—one of the body's natural chemical processes—can produce free radicals which are highly unstable molecules that can damage cells.

Free radicals are produced when the body breaks down foods like carbohydrates, proteins and fats for use as glucose, amino acids or fatty acids or storage in the body

2.environmental exposures like tobacco smoke, radiation, and environmental contaminants can produce free radicals from chemical reactions in the environment .

These free radicals can start  chain reactions which can occur in a cell resulting in  damage or death to the cell.

Free radicals can damage  the cells in the body and therefore may play a role in Alzheimer's disease, cancer, eye disease, heart disease, Parkinson's disease, and rheumatoid arthritis.

Antioxidants are found in many foods.

1.fruits and vegetables, nuts, grains

2. meats, poultry and fish.

Antioxidants are substances that may protect the cells  of the body from potentially disease-producing cell damage that can result from natural bodily processes and from exposure to certain chemicals.

The body can produce its own antioxidants and also obtain them from food.

Antioxidants are abundant in vegetables and fruits and are also found in grain cereals, teas, legumes, and nuts.

Antioxidant substances include anthocyanins, beta-carotene, catechins, coenzyme Q10, flavonoids, lipoic acid, lutein, lycopene, selenium, and vitamins C and E

People take antioxidant supplements in an effort to improve their health and to prevent various diseases

Systematic reviews of the research literature have concluded that there is not enough evidence to support the use of antioxidant supplements for preventing cancer, cardiovascular disease, and eye disease, and reducing overall mortality in healthy people and people with various diseases

One exception is the combination of antioxidants and zinc reduced the risk of developing advanced stages of age-related macular degeneration (AMD) by 25 percent in people who had intermediate AMD or advanced AMD in only one eye. Antioxidant supplements used alone reduced the risk by about 17 percent.

Safety of Antioxidants

Antioxidants in foods are generally considered safe.
However beta-carotene supplements have been found to increase the risk of lung cancer in smokers.
vitamin E supplements may increase the risk of bleeding in certain people.

Use of Antioxidants

Do not use antioxidant supplements:

1.as a replacement for a healthful diet

2.as conventional medical care,

3.to postpone seeing a doctor about a medical problem.