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Post Menopausal Osteoporosis

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Menopause & Osteoporosis
There is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis. Fortunately, there are steps you can take to prevent osteoporosis, and treatments are available to slow the rate of bone loss if you have osteoporosis.

What is osteoporosis?
Osteoporosis is a disease that weakens bones, increasing the risk of sudden and unexpected fractures. Literally meaning "porous bone," it results in an increased loss of bone mass and strength. The disease often progresses without any symptoms or pain. Generally, osteoporosis is not discovered until weakened bones cause painful fractures (bone breakage), often in the back (causing chronic back pain) or hips. Unfortunately, once you have an osteoporotic fracture, you are at high risk of having another. These fractures can be debilitating. Fortunately, there are steps you can take to prevent osteoporosis from ever occurring. Treatments can also slow the rate of bone loss if you have osteoporosis.

What causes osteoporosis?
Though we do not know the exact cause of osteoporosis, we do know how the disease develops. Your bones are made of living, growing tissue. An outer shell of cortical or dense bone wraps trabecular bone, a sponge-like bone. When a bone is weakened by osteoporosis, the "holes" in the "sponge" grow larger and more numerous, weakening the inside of the bone.

Until about age 30, a person normally builds more bone than he or she loses. After age 35, bone breakdown overtakes bone buildup, which causes a gradual loss of bone mass. Once this loss of bone reaches a certain point, a person has osteoporosis.

How is osteoporosis related to menopause?
There is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis. After menopause, bone resorption (breakdown) overtakes the building of new bone. Early menopause (before age 45) and any long phases in which the woman has low hormone levels and no or infrequent menstrual periods can cause loss of bone mass.

What are the symptoms of osteoporosis?
Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. Collapsed vertebrae may be first noticed when the person suffers severe back pain, loss of height, or spinal deformities such as stooped posture.

Who gets osteoporosis?
Important risk factors for osteoporosis include:

Age. After maximum bone density and strength is reached (generally around age 30), bone mass begins to naturally drop with age.
Gender. Women over the age of 50 have the greatest risk of developing osteoporosis. In fact, women are four times more likely than men to develop osteoporosis. Women’s lighter, thinner bones and longer life spans are some of the reasons why they are at high risk for osteoporosis
Race. Research has shown that Caucasian and Asian women are more likely to develop osteoporosis. Additionally, hip fractures are twice as likely to occur in Caucasian women as in black women. However, women of color are more likely to die after a hip fracture
Bone structure and body weight. Petite and thin women have a greater risk of developing osteoporosis because they have less bone to lose than women with more body weight and larger frames. Similarly, small-boned, thin men are at greater risk than men with larger frames and more body weight
Family history. Heredity is one of the most important risk factors for osteoporosis. If your parents or grandparents have had any signs of osteoporosis, such as a fractured hip after a minor fall, you may be at greater risk of developing the disease
How can I know if I have osteoporosis?
A painless and accurate test can provide information about your bone health before problems begin. Bone mineral density (BMD) tests, or bone measurements, are X-rays that use very small amounts of radiation to determine bone density. In addition to measuring bone health, the test can determine how severe any osteoporosis is.

Please note that women with no other risk factors whose BMD T-scores are below -2.5 should begin treatment to reduce the risk of fractures. (T-scores compare a person’s BMD to the optimal, or best, density of a healthy 30-year-old woman to determine the risk of fracture.) Women with BMD T-scores below -1.1 and who have other risk factors should also consider beginning treatment to reduce the risk of fractures. Your doctor will talk to you about your own risks for fracture to determine if you need medication.

Who should have a bone mineral density test?
All post-menopausal women who suffer a fracture that is suspicious for osteoporosis.
All post-menopausal women under age 65 who have one or more additional risk factors.
All post-menopausal women age 65 and over, regardless of additional risk factors.

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Pimples

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What is Acne?

Acne is a chronic, inflammatory skin condition that causes spots and pimples, especially on the face, shoulders, back, neck, chest, and upper arms. Whiteheads, blackheads, pimples, cysts, and nodules are all types of acne. It is the most common skin condition in India, affecting up to 20 crore Indians yearly. It commonly occurs during puberty, when the sebaceous glands activate, but it can occur at any age. It is not dangerous, but it can leave skin scars.

The glands produce oil and are stimulated by male hormones produced by the adrenal glands in both males and females. At least 85 percent of people in India experience acne between the ages of 12 and 24 years.

Fast facts on acne
Here are some facts about acne.
Acne is a skin disease involving the oil glands at the base of hair follicles.
It affects 3 in every 4 people aged 11 to 30 years.
It is not dangerous, but it can leave skin scars.
Treatment depends on how severe and persistent it is.




Who are at risk to get affected by this disease?
Risk factors include genetics, the menstrual cycle, anxiety and stress, hot and humid climates, using oil-based makeup, and squeezing pimples. There are many suggested home remedies for acne, but not all of them are supported by research.

Diet: It is unclear what role diet plays in worsening acne. Scientists have found that people who consume a diet that offers a good supply of vitamins A and E and of zinc may have a lower risk of severe acne. One review describes the link between acne and diet as "controversial," but suggests that a diet with a low glycemic load may help.

Tea-tree oil: Results of a study of 60 patients published in the Indian Journal of Dermatology, Venereology, and Leprology suggested that 5-percent tea-tree oil may help treat mild to moderate acne.

Tea: There is some evidence that polyphenols from tea, including green tea, applied in a topical preparation, may be beneficial in reducing sebum production and treating acne. However, the compounds in this case were extracted from tea, rather than using tea directly.

Moisturizers: These can soothe the skin, especially in people who are using acne treatment such as isotretinoin, say researchers. Moisturizers containing aloe vera at a concentration of at least 10 percent or witch hazel can have a soothing and possibly anti-inflammatory effect.


What Causes Acne?
Human skin has pores that connect to oil glands under the skin. Follicles connect the glands to the pores. Follicles are small sacs that produce and secrete liquid. The glands produce an oily liquid called sebum. Sebum carries dead skin cells through the follicles to the surface of the skin. A small hair grows through the follicle out of the skin. Pimples grow when these follicles get blocked, and oil builds up under the skin. Skin cells, sebum, and hair can clump together into a plug. This plug gets infected with bacteria, and swelling results. A pimple starts to develop when the plug begins to break down.

Propionibacterium acnes (P. acnes) is the name of the bacteria that live on the skin and contributes to the infection of pimples.

Research suggests that the severity and frequency of acne depend on the strain of bacteria. Not all acne bacteria trigger pimples. One strain helps to keep the skin pimple-free.

Hormonal factors: A range of factors triggers acne, but the main cause is thought to be a rise in androgen levels. Androgen is a type of hormone, the levels of which rise when adolescence begins. In women, it gets converted into estrogen. Rising androgen levels cause the oil glands under the skin to grow. The enlarged gland produces more sebum. Excessive sebum can break down cellular walls in the pores, causing bacteria to grow.

Other possible triggers: Some studies suggest that genetic factors may increase the risk. Other causes include some medications that contain androgen and lithium, Greasy cosmetics, Hormonal changes, Emotional stress, Menstruation.

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Pelvic Pain in Pregnancy

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Symphysis pubis dysfunction (SPD) is a problem with the pelvis. Your pelvis is mainly formed of two pubic bones that curve round to make a cradle shape. The pubic bones meet at the front of your pelvis, at a firm joint called the symphysis pubis.

The joint's connection is made strong by a dense network of tough tissues (ligaments). During pregnancy, swelling and pain can make the symphysis pubis joint less stable, causing SPD.

Doctors and physiotherapists classify any type of pelvic pain during pregnancy as pelvic girdle pain (PGP).

SPD is one type of pelvic girdle pain. Diastasis symphysis pubis (DSP) is another type of pelvic girdle pain, which is related to SPD. DSP happens when the gap in the symphysis pubis joint widens too far. DSP is rare, and can only be diagnosed by an X-ray, ultrasound scan or MRI scan.
What are the symptoms of SPD?
Pain in the pubic area and groin are the most common symptoms, though you may also notice:

Back pain, pain at the back of your pelvis or hip pain.
Pain, along with a grinding or clicking sensation in your pubic area.
Pain down the inside of your thighs or between your legs.
Pain that's made worse by parting your legs, walking, going up or downstairs or moving around in bed.
Pain that's worse at night and stops you from sleeping well. Getting up to go to the toilet in the middle of the night can be especially painful.

SPD can occur at any time during your pregnancy or after giving birth. You may notice it for the first time during the middle of your pregnancy.
What causes SPD?
During pregnancy, your body produces a hormone called relaxin, which softens your ligaments to help your baby pass through your pelvis. This means that the joints in your pelvis naturally become more lax.

However, this flexibility doesn't necessarily cause painful problems of SPD. Usually, your nerves and muscles are able to adapt and compensate for the greater flexibility in your joints. This means your body should cope well with the changes to your posture as your baby grows.

SPD is thought to happen when your body doesn't adapt so well to the stretchier, looser ligaments caused by relaxin. SPD can be triggered by:

the joints in your pelvis moving unevenly
changes to the way your muscles work to support your pelvic girdle joints
one pelvic joint not working properly and causing knock-on pain in the other joints of your pelvis

These problems mean that your pelvis is not as stable as it should be, and this is what causes SPD. Physiotherapy is the best way to treat SPD, because it's about the relationship between your muscles and bones, rather than how lax your joints are. You're more likely to develop SPD if:

you had pelvic girdle pain or pelvic joint pain before you became pregnant
you've had a previous injury to your pelvis
you've had pelvic girdle pain in a previous pregnancy
you have a high BMI and were overweight before you became pregnant
hypermobility in all your joints

How is SPD diagnosed?
Your doctor or midwife should refer you to a women’s health physiotherapist. Your physiotherapist will test the stability, movement and pain in your pelvic joints and muscles.
How is SPD treated?
SPD is managed in the same way as other pelvic girdle pain. Treatment includes:

Exercises to strengthen your spinal, tummy, pelvic girdle, hip and pelvic floor muscles. These will improve the stability of your pelvis and back. You may need gentle, hands-on treatment of your hip, back or pelvis to correct stiffness or imbalance. Water gymnastics can sometimes help.

Your physiotherapist should advise you on how to make daily activities less painful and on how to make the birth of your baby easier. Your midwife should help you to write a birth plan that takes into account your SPD symptoms.

Acupuncture may help reduce pain and is safe during pregnancy. Make sure your practitioner is trained and experienced in working with pregnant women.

Other manual therapies, such as osteopathy may help. See a registered practitioner who is experienced in treating pregnant women.

A pelvic support belt may give relief, particularly when you're exercising or active.
What can I do to ease the pain of SPD?
Be as active as you can, but don't push yourself so far that it hurts.

Stick to the pelvic floor and tummy exercises that your physiotherapist recommends.

Ask for and accept offers of help with daily chores.

Plan ahead so that you reduce the activities that cause you problems. You could use a rucksack to carry things around, both indoors and out.

Take care to part your legs no further than your pain-free range, particularly when getting in and out of the car, bed or bath. If you are lying down, pull up your knees as far as you can to make it easier to part your legs. If you are sitting, try arching your back and sticking your chest out before parting or moving your legs.

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Loss Of Appetite During Pregnancy

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Always associated pregnancy with a voracious appetite for everything from pepperoni pizza to ice cream and pickles? Pregnancy is indeed that one special time of your adult life when gaining weight is applauded and eating every two hours is encouraged (lucky you!). But just as you begin stocking your refrigerator with healthy foods (and yes, sometimes those not-so-healthy cookies you’re craving), loss of appetite — plus its common sidekick, morning sickness — strikes, turning your nose at the sight and smell of your favorite foods.

Gaining enough pregnancy weight is the major signal that you’re eating enough to support your baby’s needs. Depending on your pre-pregnancy weight, most normal-weight women should aim to tack on between 25 and 35 pounds. During the first trimester, when morning sickness (known to many as all-day sickness) is at its worst, it’s common to only gain one to four pounds (or sometimes even lose weight). That’s okay. At this point your fetus is so tiny, it has fewer nutritional requirements — so as long as you’re taking your prenatal vitamin, you and baby-to-be should be covered.

After the first trimester, gaining about one pound per week is advised. If your appetite is still nowhere to be found by early in your second trimester, or if you aren't meeting the recommended weight gain in your third trimester, consult your doctor for a diet plan.

Still worried? Don’t be. You’re going to have easy days and difficult days — the big picture is what’s important. The good news is that most women find they can manage appetite loss with a few tricks. Here’s how to manage this particular pregnancy symptom.

Loss of Appetite in the First Trimester
What causes loss of appetite in the first trimester?
Loss of appetite often comes hand-in-hand with nausea during pregnancy, which affects about 75 percent of pregnant women (when you’re bent over a toilet on the regular, it’s no wonder your appetite is a bit shy these days). Morning sickness may be your body’s instinctual way of protecting the fetus from potentially harmful foods — explaining some of those food aversions women commonly experience.

Increasing hormones (including estrogen and the pregnancy hormone hCG — the ones responsible for making you cry at that car commercial) also play a role in increasing nausea and your sensitivity to smell while decreasing your appetite. You may even have a metallic taste in your mouth.

How can I meet my nutritional needs in the first trimester if I've lost my appetite?
Here are some tips for how to get the pregnancy nutrients you and baby-to-be if you're not very hungry early on.

Drink up. Ensuring you consume enough liquids is more important than a aiming for a certain caloric intake. Though it really depends on the mom-to-be and her lifestyle, try to aim for around eight to 10 8-ounce glasses a day from all sources, including fruits and vegetables. Warm water with lemon or ginger, ginger ale or ginger tea can be good substitutes for plain water if you're nauseous (always check in with your doctor before sipping any herbal tea or other drink, however, as some are off-limits during pregnancy).
Don’t overdo it. Eat six small meals a day (your body will probably let off hunger signals every two hours), which will satisfy your small appetite — instead of force-feeding yourself larger portions of food.
Eat lightly. For the moments during the day when your appetite makes a brief appearance, consume as much protein and complex carbs as you can, which will keep your blood sugar stable and keep you fuller for a bit longer. Fruits such as bananas may also be easier to stomach; pair with a spoonful of yogurt for added calcium and protein. And whole grain or plain crackers are almost always your friend.
Avoid strong-smelling foods. That includes spicy and fatty dishes — which may mean skipping fast food staples like burgers, fries and chicken nuggets and opting for something like a salad with grilled chicken or salmon if you can stomach it instead.
Use your good taste. Sure, variety is usually the spice of a good nutritional life. But if you find spinach makes you queasy while you can stomach kale, by all means eat the kale. You’ll get back to the spinach soon enough.
Change the temperature. Many women prefer their foods and drinks chilled when they're pregnant, while others like it hot. If you fit one of those categories, adjust your diet accordingly if that works.
Take your vitamin. Make taking your prenatal vitamin as routine as brushing your teeth. Ideally, start taking the vitamin at least a month before conception, or at a minimum, at the time of conception. This will help fill in temporary nutritional gaps.
Get additional help. To help combat nausea, talk to your doctor about taking a special prenatal vitamin with extra B6 or the FDA-approved Diclegis, which contains a combination of vitamin B and antihistamine (these may help decrease nausea and increase your appetite).

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Revealed! These Are The Superfoods That Are Amazing For Our Skin

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Our skin requires discipline, and by that I don't mean hours and hours of using beauty products and strict skin care regimes, but balanced and clean eating habits can do well to our skin and keep it radiant and glowing. Don't just eat anything greasy and spicy, after all its either going to reflect on your waistline or your skin. So, what are the foods that will help keep your skin young and glowing as well as soft and supple? You will be surprised to know that by adding these foods to your regular diet, you cannot only lose weight but can also have a flawless skin.


Green Vegetables
I always recommend adding more greens to your diet and with greens I mean all green veggies - be it spinach, broccoli, kale and green beans. These superfoods will give your skin the nutrition it wants. Rich in vitamin K and zinc, spinach is a powerhouse of nutrients that helps improve blood circulation and coagulation, reduces inflammation, and helps prevent acne breakouts. Not only they improve metabolism and digestion but also reduce the chances of having constipation. All of this in turn makes our skin happy and glowing.

Tomatoes
Tomatoes are one of my favourite fruits, not because of their versatility when it comes to cooking up some amazing recipes but because of their anti-ageing properties. Tomatoes are the best source of lycopene, and lycopene is an anti-ageing antioxidant. Tomatoes are a rich source of vitamin k, A, B1, B7 and C, zinc, potassium, phosphorous, iron, folate, and magnesium. So, be it soups or pastas or exotic curry, tomatoes in any form, preferably cooked, will do wonders to your skin.

Almonds
Almonds are the best source of natural vitamin, Eyou. One must have at least 10-15 almonds a day. Many people debate on how to eat almonds - soaked or as is. The answer is to just eat them regularly - it doesn't really matter how to eat them. Eating almonds every day will keep your skin problems like dryness, wrinkles and ageing at bay, and make sure you eat gulbandi or marmara almonds as they have higher amount of vitamin E. This nutritious nut supports the production of collagen and is packed with calcium, making it an excellent superfood for hair, teeth, nails and skin.

Flaxseed
A highly potent superfood, these tiny granule like seeds are high in omega 3 fatty acids and help in building healthy skin cell function as well as support the production of new collagen. All of this in turn helps keep our skin healthy and wrinkle-free. You can toss flaxseeds in your porridges, salads, poha or upma to reap its maximum benefits. The alpha linolic acids found in flaxseeds help reduce dryness, itchiness and flakiness, and the vitamin B content of flaxseeds help improve acne conditions like rocacea and eczema.

Salmon
Salmon is high in omega 3 fatty acids, which are good for your heart health and for people with blood pressure problems. These fatty acids help in production of collagen as well as protein that help keep our skin healthy and wrinkle free. Moreover, salmon contains selenium, which helps protect our skin from harmful rays of sun as well as keep our skin moisturised, soft and supple. This superfood also has high contents of vitamin D, is responsible for the absorption of crucial minerals like calcium, magnesium and phosphate, and other biological effects.

Oranges
Oranges are packed with vitamin c and act an excellent cleaning agent for our skin, giving us a glowing and radiant skin. Oranges also help improve texture of our skin and restore collagen, keeping our skin well-toned and wrinkle-free. I recommend everyone to eat at least two oranges daily.

Avocado
Avocados are quite popular all over the world for all the good reasons. They are packed with healthy oils and vitamin E that helps build healthy skin function as well as hydrate the skin. Eating avocado prevents the risk of psoriasis, plus deeply moisturises our skin, making it well hydrated and radiant. Avocado also prevent sun damage and help treat and cure acne conditions. Due to its hydrating properties, avocadoes help keep your skin looking younger and supple and wrinkle free. Avocados are a high source of oleic and palmitic fatty acids as well as rich in vitamin K, C, A, E and B6, carotenoids, and folate. Moreover, the fruit is an excellent source of potassium, magnesium and dietary fibre. All of these nutrients help improve collagen production, reduce inflammation and keep skin healthy and young.

Dark Chocolate
Strange as it may sound but dark chocolate can have magical effects on the skin! Flavonoids and phytonutrients found in dark chocolate have anti-inflammatory and antioxidant properties. All of these nutrients improve our skin condition, and help reduce photo damage and collagen breakdown. So, if you are cringing when eating chocolate, then don't, as it could help improve your skin health, giving us a smoother, hydrated and healthy skin. Make sure you eat two small cubes of dark chocolate three times a week for healthy and glowing skin.

Now, that you know that these superfoods are amazing for your skin, include them in your diet and see the results yourself. Not only will you be able to treat some common skin problems, but also slow down the ageing clock and reverse a fair amount of oncoming wrinkles.

Dr. Reshma P. Ransing
Dr. Reshma P. Ransing
BHMS, Family Physician, Pune
Dr. Varun kumar  PT
Dr. Varun kumar PT
BPTh, Homecare Physiotherapist Physiotherapist, 5 yrs, Pune
Dr. Ashok Lathi
Dr. Ashok Lathi
MS - Allopathy, General Surgeon, 37 yrs, Pune
Dr. Sayali Shinde
Dr. Sayali Shinde
BAMS, Pune
Dr. Yogesh  Gangurde
Dr. Yogesh Gangurde
BHMS, Family Physician, 10 yrs, Pune
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