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Seasonal Affective Disorder (SAD)

Does your mood change with the changes in the seasons? Does summer heat cripple you? Do the cold winter months deflate your moods? If so, you may be having seasonal affective disorder (SAD).

Seasonal depression is a mood disorder that gets triggered when season changes. It happens every year at the same time, usually beginning in fall or winter and ending in spring or early summer. In winters, nights are long and cold and sometimes days go by without sunshine. You may feel the winter blues, being stuck inside. This resolves once spring sets in.

Summer Depression and India

‘Summer depression’ is a rare form of seasonal depression that starts in late spring or early summer and ends in fall. In India, seasonal depression is more prevalent in the hot, summer months. Summer SAD accounts for only 10% of all SAD cases but studies have shown that in India, its actually more prevalent than regular SAD. In the hotter regions of our country, summer depression is common. In India alone, more than 10 million people experience similar symptoms of seasonal affective disorder. It should not be taken lightly as people with SAD are just as ill as people with major depression, according to psychiatrists.  

What causes seasonal affective disorder (SAD)

Though there is not much clarity on why seasonal depression occurs, the lack of sunlight is a major trigger for it. Seasonal affective disorder may be caused due to various reasons. A few of these are-

Shift in Circadian rhythm- as seasons change, people experience a shift in their circadian rhythm or biological clock that can shift their regular routine. Circadian rhythm is responsible for regulating our moods, sleep and hormones. When it changes, people may have trouble regulating their moods.

Chemical imbalance in the brain- neurotransmitters, our brain chemicals send communications between nerves. Two specific brain chemicals, melatonin and serotonin may be responsible for SAD. When the days are shorter and there’s less sunlight, melatonin which is linked to sleep increases and our serotonin levels responsible for our feelings of happiness decreases.  Serotonin production goes up when exposed to sunlight. Less sunshine in dark, winter days can cause low levels of serotonin leading to depression. 

Vitamin D deficiency– low dose of sunlight also means low vitamin D since sunlight helps produce vitamin D. This change can affect serotonin and mood.

Family history– people whose family members have a history of depression are at greater risk for SAD. 

Symptoms of SAD

Seasonal affective disorder is considered a type of depression occurring because of the change in season, with symptoms lasting for about 4 to 5 months in a year.  The signs and symptoms therefore are similar to those associated with major depression, and some specific symptoms that differ for winter SAD and summer SAD. It Is not necessary that a person with SAD will experience all of the symptoms listed below.

Symptoms of SAD may include:

  • Feeling of depression almost everyday
  • Lack of interest in daily activities
  • Experiencing changes in appetite and weight
  • Not getting adequate sleep
  • Feeling tired and agitated
  • Having low energy
  • Lacking concentration
  • Feeling of guilt, worthlessness or hopelessness
  • Having suicidal thoughts

SAD in the winter months comes with its added symptoms

  • Over sleeping
  • Over eating and carbohydrate cravings
  • Weight gain
  • Social withdrawal

Summer month SAD symptoms include-

  • Insomnia
  • Lack of appetite
  • Weight loss
  • Restlessness and agitation
  • Anxiety
  • Rash and violent behavior

Diagnosis

Consult a health care practitioner if your mood and behavior shift along with the calendar. They may advise certain tests and ask specific questions to determine if your symptoms are that of SAD. Tiredness, fatigue and low energy could be a sign of another medical condition called hypothyroidism or hypoglycemia so doctors may ask for a thyroid test. If your symptoms of depression are more frequent in particular seasons than other depressive episodes that you may have had during your lifetime, chances are, you have SAD.

Treatment for SAD 

SAD can be treated with counselling and therapy. There are also other treatments available to treat SAD. –

Light therapy– since lack of sunlight is a major cause for seasonal depression, one of the treatments include increased exposure to light during winter months. Light therapy involves sitting in front of a light box that emits a very bright light (filtering out harmful UV rays) for about twenty minutes every day, usually in the mornings.  This therapy is generally advised through the winters until enough sunlight is available outdoors. Symptoms tend to get better within a few days or sometimes within a few weeks. But this should strictly be taken under medical supervision. If the UV light is not administered properly, it may cause adverse reactions like eye and skin issues. While the side effects are minimal, a patient with a history of bipolar disorder must tread with caution while taking light therapy.

Cognitive Behaviour Therapy or Talk Therapy– CBT focuses on replacing negative thoughts and feelings associated with depression with more positive thoughts. CBT helps the patient ease the sense of isolation and loneliness that a person suffering from SAD often feels. The support and guidance of a professional therapist helps the patient to understand their condition as well as learn to prevent and minimize future bouts of seasonal depression.  Research has shown that CBT produces the longest – lasting effects in the treatment of SAD

Medications- Medicines that help to regulate the balance of serotonin and melatonin in the brain that affect mood and energy may be advised by the doctors. Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are the common medicines advised. Talk to your doctor before starting these medicines.  

Vitamin D- lack of vitamin D, which is dependent on sunlight affects our moods and may lead to depression. Doctors may advise vitamin D supplement to combat the deficiency.

Spend time outdoors– doctors often advise patients to spend more and more time outdoors, exercising and indulging in physical activities to uplift mood, get little sunshine and help alleviate the symptoms of SAD.

How do you prevent SAD?

Spending some time outside everyday helps in preventing SAD. Exercising, eating a well-balanced diet, keeping yourself well hydrated are other ways of making sure you do not let seasonal depression get the better of you. Talking to your friends or family always helps.If the symptoms of depression, fatigue and mood swings persist, reach out to a doctor.  At www.boardofdoctors.com, we have super specialist doctors who will help you understand SAD and treat it with compassion and empathy. All you need to do is click on www.boardofdoctors.com for a hassle-free appointment with our experienced doctor and you will soon be on your way to recovery. Our specialists include Dr Soumya Hegde, Dr Tanya Machado, Dr Sulata Shenoy, Dr Vyjayanthi Bonanthaya, and Dr Sujai Subramanian.

Precocious Puberty

A lot has changed in the post COVID world. The children, especially, have had to bear the brunt of being locked inside their homes, without much physical activity, having to spend time sitting in front of their screen for their online classes. This has led to a number of issues, one of them being precocious puberty.   

According to a Times of India report, ‘pediatricians are reporting an increase in the number of cases of precocious puberty in the past year or so. This could be an effect of the lockdown which saw kids holed up in their homes for months, lonely, gaining weight and eating unhealthy food. Globally too doctors are reporting this trend’.

What is precocious puberty?

Puberty is when children develop both physically and emotionally into young men and women. Puberty starts on an average in girls between ages 9 and 13 and in boys between 9 and 14. When a child’s physical signs of sexual maturity develop too soon and puberty comes early, it is called precocious puberty.  Early puberty is when girls have signs of puberty before 8 years of age and boys show signs of sexual maturity before 9 years of age. This includes breast growth, pubic hair and voice changes. Most children with precocious puberty grow fast at first. But they stop growing before reaching their full genetic height potential. 

What causes precocious puberty? 

There are two types pf precocious puberty-

Central Precocious Puberty- This gonadotropin- dependent disorder is the most common type of precocious puberty. Most children with precocious puberty have this type. The puberty is started by early secretion of hormones called gonadotropins. These hormones cause the testicles and ovaries to make other hormones- testosterone or estrogen. Gonadotropins include luteinizing hormone (LH) and follicle stimulation hormone (FSH). In girls, early puberty may be caused by the early maturity of the hypothalamus, pituitary glands and ovaries. There is usually no underlying medical problem or trigger. This can also be hereditary.  Precocious puberty is less common in boys and is more likely to be related to another medical problem. This condition is inherited for about 5% of boys. 

In rare cases, central precocious puberty may be caused by:

  • A tumor in the brain or the spinal cord
  • A birth defect in the brain
  • Radiation to the brain or spinal cord
  • Injury to the brain or the spinal cord
  • Hypothyroidism
  • McCune Albright syndrome– rare genetic disease that causes hormonal issues
  • Congenital adrenal hyperplasia-genetic disorders that cause abnormal hormone production by the adrenal glands.

Peripheral precocious puberty- This is a less common form of the disorder, started by the early secretion of high levels of sex hormones- estrogen and testosterone. There is no involvement of the brain or the pituitary gland but is caused because of problems with the ovaries, testicles, adrenal gland, or a severely underactive thyroid gland. 

In girls, peripheral puberty may be associated with ovarian cysts or ovarian tumors.

In boys, it may be caused by a tumor in the cells that make sperms or testosterone or a rare disorder called gonadotropin-independent familial sexual precocity caused due to a genetic defect, resulting in early testosterone production.

 What are the symptoms of precocious puberty?

There is no distinguishing factor between puberty and precocious puberty except the timing. Common signs in girls include-

  • Breast growth
  • Pubic and underarm hair
  • Early menstruation
  • Ovulation

Symptoms in boys are-

  • Penis and testicles start growing
  • Pubic, underarm hair
  • Facial hair
  • Deepening of voice

For girls and boys, the symptoms include-

  • Rapid height growth
  • Acne
  • Adult body odour

How is it diagnosed?

The healthcare provider may ask you to share-

  • Symptoms
  • Health history
  • Family history
  • He may do a physical exam 
  • Ask for blood tests to check the hormonal levels such as – Testosterone, luteinizing hormone, follicle stimulation hormone, estradiol and thyroid hormone.
  • GnRH test- Gonadotropin-stimulating hormone is made by the hypothalamus in the brain which causes the pituitary glands to release gonadotropins. These then cause sex hormones to be made by the ovaries in girls, or the testes in boys. The GnRH test may show the type of precocious puberty. 
  • Ask for an X-Ray of the hands and wrists of your child to determine the bone age. This indicates to them if the bones are growing too quickly.
  • MRI or CT scan to rule out uncommon cause such as tumor in the brain, ovary or testicle but this is rarely asked.

How is Precocious Puberty Treated?

The goal of treatment for precocious is to stop, and possibly reverse the onset of puberty. Treatment depends on the of precocious puberty and the underlying cause. Sometimes, doctors may suggest watching your child for a few months. 

GnRH analogue therapy is suggested if your child has central precocious puberty and no other condition. This is administered to your child once in a month, in a shot. This halts the development while they take it. This is given till your child reaches the normal age for puberty.

If there are other underlying causes for precocious puberty, the doctor will advise treating them which will stop the precocious puberty too. 

Sometimes, no treatment is needed.

Complications of precocious puberty

Short height- Precocious puberty ends earlier than normal puberty, hence the children with this disorder stop growing at an earlier age and do not reach their optimum height. 

Social and Emotional problems- Early puberty will lead to body and mood changes in your child, much sooner than his/her peers. This may make them self- conscious about the changes and may affect self-esteem and increase the risk of depression.

How can parents help?

While as parents, you may worry if you see early signs of puberty in a child, you can help your children cope with it positively. 

Always avoid making comments about your child’s appearance. 

Offer praise for achievements, even if little. 

Most important, consult a counsellor if you see your child suffer from low self-esteem because of precocious puberty.

If you see signs of early puberty in your child, consult your pediatrician, who may guide you to a pediatric endocrinologist. There is nothing to fear and the doctors will put you on a treatment to take care of precocious puberty.For a quick, hassle-free appointment with the best team of doctors, just click on www.boardofdoctors.com. Our expert Pediatricians include Dr Abraham Cherian, Dr. Akshay Ballal, Dr Chittur Radhakrishnan, Dr Edwin Dias, Dr Jagdish Chinnappa, Dr Naveen Kini, Dr Kavitha Bhat, Dr Priya Biswakumar, Dr Ravi Hiremagalore, Dr Sonal Agrawal, and Dr Suresh Kumar Surapaneni.

How to protect your eyes from Digital Services

A lot has changed over the last one year. Among all the other health hazards that COVID brought in, one just sneaked into our system.  COVID-19 has made us over dependent on our digital devices. From a five-year-old pre schooler to an 80-year-old man doing breathing exercises for healthy lungs, the source of information is computer screens, phones, television, iPads and tablets. While technology is helping us get through these tough times, our over reliance on these devices for everything may be exposing our eyes to dangers like blurred vision, retinal damage and digital eye strain. Overindulgence of screens, especially back lit LED screens at night, has a negative impact on vision and causes digital eye strain. In some cases, if you have any underlying eye condition, it may get exacerbated due to all the strain. It is important that you are aware of them and receive timely treatment.

Symptoms of digital eye strain

  • Dry or watery eyes
  • Itchiness or burning sensation
  • Blurred vision
  • Frequent headaches
  • A painful shoulder and aching back
  • Difficulty focusing
  • Increased sensitivity to light

6 effects of using digital devices on eye health

When your eyes are over exposed to digital devices, it may lead to-

  1. Digital Eye Strain- You have digital eye strain when you sit in front of your digital devices such as computers and mobile phones for two hour or more daily and develop problems with vision or eyes. You may have any of these symptoms such as eye strain, dry eyes, watery eyes, headaches, blurry vision and neck/shoulder/back pain. This happens mainly because of poor posture, decreased blinking because of constant staring at your screens and screen glare.
  2. Texting related issues- Messaging is a convenient way to keep in touch with your friends and relatives but it comes with its set of issues. Continuous texting can also cause vision issues, including dryness, eye strain, fatigue, headaches and sometimes even myopia and near sightedness.  These issues arise because you hold the phone too close to your eyes, staring at the screen for long duration, and you squint or strain to read text displayed in small fonts.
  3. Computer Vision Syndrome- The symptoms are same as digital eye strain, occurs if you stare at computer screens for long periods without blinking, or from too close. It may cause eye strain, headaches, dry eyes, double or blurred vision, burning, itchiness or watering in the eyes. 
  4. Tension Headaches- When you stare at your screen continuously, straining to read or see, it may cause headaches. Screen glare and high contrast between dark-coloured texts and bright screens are usually the reason as your eyes need to work harder while focusing on the screen, leading to headaches.
  5. Retinal Damage – Much has been said about the harmful effects of the blue light emitted by digital devices with LED screens. Direct exposure to these blue lights may cause retinal damage. According to a recent research, children’s eyes absorb more blue light than adults from digital device screens. Studies suggest that continued exposure to blue light over time could lead to damaged retinal cells. This can cause vision problems like age-related macular degeneration. 
  6. Ocular Migraines- One of the offshoots of sitting for hours in front of your screens is that it can trigger ocular migraines. Also known as retinal migraines, ocular migraines usually accompany flashing dots, nausea, sensitivity to flashing lights, temporary blindness, wavy lines, and may or may not accompany a throbbing headache.
  7. Dry Eyes- Dry and irritated eyes is another symptom of long hours of computer and digital devices’ exposure. Dry eyes also increase sensitivity to light and blurred vision. This should not be left unattended as it can adversely impact your eye sight. It is important that you wear anti-glare eyewear to protect your eyes from the computer screens. 

Who is at Greatest Risk of Vision Issues because of digital screen exposure?

Young children now use mobile phones and watch television without any restrictions. They are dependent on it for their studies too as COVID-19 made sure no physical classes could be conducted till the pandemic subsided. Children face a higher risk of vision-related issues, since their eyes are still developing. They do not have the natural defense against blue light found in adult eyes as a result of the lens yellowing with age, which keeps blue light from efficiently penetrating and reaching the retina.

Those who work on computers all day, use phone relentlessly and depend on their smart phones and digital devices for everything, are at a higher risk of eye strain, especially if they do not follow proper eye care practices.

How Can We Prevent Digital Eye Strain?

Here are 10 preventative measures that can help protect your eyes from damage

  1. Using an anti-glare screen or coating on devices that you use often to avoid glare from your screens can help prevent eye strain.
  2. Follow the “20-20-20” rule – look away from the screen every 20 minutes, at something 20 feet away, for 20 seconds. You can also massage your eyes periodically for lasting eye strain relief.
  3. Do not keep your phone screen very close to you while reading or watching something on it. Keep your phone as far from your eyes as possible, but at a distance where you can still comfortably read without straining.
  4. Adjust the brightness on your digital display so it matches the brightness of the area around it.
  5. It is very important to maintain a good position while working on your computer. Position yourself at an arm’s length from the computer screen, with the screen just below your eye level.
  6. Do not work continuously in front of the computer. Take frequent breaks to rest your eyes. Stretch, go outside or rest it out.
  7. Get an eye exam regularly to keep your eyes healthy and catch any eye related issue right at the onset, before they get worse.
  8. Make a conscious effort to blink more frequently, since this keeps your eyes clean and lubricated.
  9. Place a light source behind you instead of behind the device, so your eyes don’t have to work so hard to adjust.
  10. Wear glasses with an anti-reflective coating while using any digital device for prolonged periods of time.

If you face any of the symptoms mentioned above, schedule a consultation at www.boardofdoctors.com  to combat the negative effects of digital eye strain. Our experienced team of ophthalmologists are always there to help you. Our expert Opthalmologists include Dr Anil Wani, Dr Nitin Shetty, Dr Anand Shroff, and Dr Sudha Manjunatha.

Why regular dental checkups are important

You may not consider it important to visit the dentist every six months, but regular dental checkups are just as crucial as regular physical checkups. By visiting the dentist regularly, you may diagnose bigger problems early on, thereby preventing bigger problems from developing because of inattentiveness. Here are some of the most important reasons why you should see your dentist regularly-

Early detection of oral cancer

A dentist not only examines the teeth and the gums, but he also looks for signs of oral cancer, as well as head and neck cancer in the patient’s mouth. Without knowing the signs of its early onset, oral cancer often goes undiagnosed and can quickly progress and become life threatening. This is where that visit to the dentist comes to your rescue. A highly trained dentist will notice oral abnormalities, if any. The dentist will check for any lumps on your head or neck. They will also check for any red or white patches in the mouth. These are just precautionary checks and usually they will find nothing unusual, but an early detection can potentially save your life.

Prevent plaque, tartar, cavities and tooth decay   

While you may think you have good oral hygiene- brushing and flossing daily, there are small areas in your mouth you may have missed. Some plaque deposits build up and are difficult to remove. Gradually they solidify and turn into tartar, which is even more difficult to remove without professional help.

Tartar does a lot of damage to teeth, eroding them or creating holes in them, thus creating cavities. When a cavity is formed in the tooth, you may have a tooth ache without any warning, only to find your tooth has been decayed. Once the damage has been done, it is only a dentist who can take care of it by filling your tooth and fixing it. You can avoid this if you go for regular dental checkups and take care of tartar build up. 

Check for gingivitis and gum disease 

Your mouth’s gum tissues can be eroded by plaque and tartar buildup. This happens when tartar buildup causes an infection where the gum is connected to the tooth. As an infection, this is known as gingivitis. Usually, the early stages of gum disease have no symptoms. Once this progress, there will be swelling and bleeding, indicating gum disease. Not only is the treatment of gum disease expensive, but depending on its severity, may also include surgery. A regular visit to the dentist will mean early intervention preventing both gingivitis and gum disease. 

Finding hidden problems through X-Rays

Your dentist may suggest a dental X-Ray if he feels something needs to be probed further. Having your teeth and jaw X-Rayed will help your dentist find and diagnose issues that may be invisible to the naked eye. These problems may include impacted teeth, bone decay, cysts or swelling.  Finding these oral issues as soon as possible is critical in order to properly treat them. To take care of these hidden issues that may crop up, a bi-annual visit to the dentist is a must.

Monitoring bad habits

you never give your teeth a thought while using them to eat, grind, crush or chew. You may not realize it but some of these habits are bad for your oral health such as crushing ice, biting nails, grinding teeth, eating very sour food, brushing your teeth too hard or smoking.  A regular visit to the dentist will make sure these habits are under control. Being informed about a specific bad habit allows you to alter your lifestyle to prevent further damage. 

Good for your overall health 

There is a strong connection between good oral health and your well-being. You often ignore your oral health, assuming it to be unconnected with your overall health.  Your body organs are connected and a problem in one part may impact other parts of your body. It is said that there is a connection between your heart health and your oral health. Visiting a dentist will not just maintain good oral hygiene but also reduce the risk of other serious health issues. Finding a reliable dentist is crucial when it comes to regular dental check-ups.  At www.boardofdoctors.com, we have experienced dentists to take care of all your dental needs and issues. All you have to do book a hassle-free appointment  through www.boardofdoctors.com and get ready to be treated by the best. Our expert Dentists include Dr Yeshwant Narrain, Dr Moksha Narrain, and Dr Sandesh Mayekar.

Overactive Bladder and What you can do

‘I am too young to have bladder incontinence!’ You will be surprised to know age has nothing to do with over active bladder. While over active bladder (OAB) is more common in post-menopausal women, over 17% women and 17% men over age 18 have OAB. Having bladder incontinence can affect a person’s life and sleep quality. It greatly reduces their quality of life. An overactive bladder is a condition that occurs due to the sudden, involuntary contraction of the muscle in the wall of the bladder. An overactive bladder causes a sudden urge to pass urine, even when your bladder isn’t full. 

Why does OAB happen?

Your kidneys filter toxins and excess fluid from the blood which is then stored as waste(urine) in the bladder. Your nerves signal the kidneys to fill the bladder and also signal the brain when the bladder is full and needs to be emptied. Once the bladder is empty, the muscle in the bladder wall contracts, and the sphincter muscle that controls urine flow relaxes. Sometimes nerve signals can get mixed up, telling your bladder it’s time to go, even when it’s full. This causes overactive bladder.

What causes an overactive bladder? 

The cause of OAB is still a mystery but there are several factors or a possible combination of reasons that result in OAB. Some of the factors are-

  • Weak Pelvic muscles– Pregnancy and childbirth can sometimes weaken your pelvic muscles, causing the bladder to sag out of its normal position. This can cause leakage.
  • Nervous system abnormalities- sometimes nerve damage can send wrong signals to the brain to empty at the wrong time. These include-
  1. Spinal cord injury
  2. Stroke
  3. Parkinson’s disease
  4. Dementia
  5. Multiple sclerosis
  6. Radiation
  • Obesity– When you are overweight, excess pressure is placed on the bladder causing urge incontinence
  • Urinary Tract Infection- this infection can irritate the bladder nerves and cause the bladder to squeeze without warning
  • Estrogen deficiency after menopause- hormonal change due to menopause can cause loss of urine due to urgency.
  • Medications- there are some medications which can dull the nerves, thus affecting the signal to the brain. This could result in bladder overflow.

Symptoms 

Overactive bladder symptoms may include-

  • Sudden and overwhelming urge to urinate
  • Urge incontinence- when you suddenly leak urine after feeling an urgent and immediate need to go to the toilet
  • Frequent visits to the toilet
  • Nocturia- when your sleep cycle is disrupted because of overactive bladder.

Complications of an overactive bladder

Some common complications resulting from overactive bladder may include:

  • Disruptive quality of life
  • Diminished sexual activity
  • Reduced social interaction
  • Depression
  • Dehydration
  • Fatigue (from Nocturia)
  • Urinary tract infections (UTI)
  • Skin irritation and infections
  • Bladder stones
  • Falls and fractures in elderly

Diagnosis

It is advised to consult a doctor for correct diagnosis of the problem. He may even refer you to a specialist urologist. At www.boardofdoctors.com, we have super specialist doctors who will help you diagnose and treat overactive bladder. Your doctor may ask for few tests to ascertain the cause. These include-

Neurological exam to check your reflexes and sensory responses

Cough stress test to see if stress or physical exertion causes urinary incontinence

Urinalysis to check your urine sample for any abnormalities like blood, glucose or any bacteria.

Urodynamic test to measure the bladder’s ability to empty properly and to contract involuntarily.

Uroflowmetry to measure the volume and speed of urination and to check for bladder stones.

Treatment for an overactive bladder

Once the tests have been conducted, your doctor will suggest a one or a combination of treatments including lifestyle changes, medications and/or surgery to help combat the disorder.

Lifestyle changes

  • Bladder Training and Scheduled Voiding — This method teaches the bladder to steadily hold urine over time, which can help build a tolerance to the urgency that comes with an overactive bladder.
  • Double Voiding — This involves urinating twice within a few minutes in between to void any residual urine in the bladder.
  • Kegel exercises — These are pelvic exercises to help manage urge incontinence in an overactive bladder by helping strengthen the muscles of the pelvic floor and urinary sphincter.
  • Fluid and Diet Management including:
    • maintaining a schedule of the timing and amount of daily fluid intake
    • limiting caffeine and acidic drinks such as coffee, cranberry and citrus juices
    • limiting alcohol
    • eating foods high in fiber, such as flaxseed, or taking fiber supplements.
  • maintaining a healthy weight and a healthy body mass index (BMI)

Medications

Some medications have been known to help reduce and alleviate the symptoms associated with an overactive bladder. Take these medicines only if your doctor prescribes. 

  • Anticholinergics
  • Antidepressants
  • Estrogen
  • Botulinum Toxin Type A (Botox)

Overactive bladder is manageable and you have nothing to fear. Reach out to www.boardofdoctors.com for a quick, hassle-free appointment with our super specialist doctors and you will soon be on your road to recovery. Our expert Urologists include Dr Ajay Shetty, Dr Ajit Huilgol, Dr. Anup Ramani, Dr Chittur Radhakrishnan, Dr Deepak Dubey, and Dr Sudhir Chadha.

Braxton Hicks Contractions

Pregnancy takes your body through many changes, some expected, while others can be a little confusing.   For some of you, Braxton Hicks contractions can be particularly perplexing. They are painless and slightly uncomfortable but may feel like the onset of labour. That’s why they are sometimes referred as ‘false labour’. They may be false, but when in doubt, do not self-diagnose. It is essential to play safe when pregnant so, do not hesitate to call your doctor. 

What is Braxton-Hicks contractions?

Braxton Hicks contractions are intermittent or irregular contractions of the womb. They are usually felt in the third trimester of the pregnancy. These sporadic uterine contractions are one of your body’s ways of preparing for birth. Most often, they go unnoticed. These contractions do not directly lead to labour. Unlike labour contractions, Braxton Hicks do not dilate the cervix or cause birth of the baby. Though it is said that they can help with softening of the cervix closer to labour. They get their name from John Braxton Hicks, who in 1872, was able to recognize the difference between false contractions and real labour pains.

What do they feel like?   

Braxton Hicks contractions feel like a short hardening or tightening of the uterus for 30 to 60 seconds before they relax. Sometimes these contractions can last up to 2 minutes.   This experience can be different for each woman. You may feel as though your stomach has hardened into a ball. Unlike real contractions felt during labour pains, Braxton Hicks contractions are usually unpredictable and lack intensity and frequency. These contractions usually occur more frequently as you approach your due date. That is not to say, all women feel these contractions. They are more likely to occur in the afternoon or evening, after physical activity, or after sex.

What’s the difference between Braxton Hicks and labour contractions?

Timing of Contractions- Braxton Hicks do not come regularly and do not come one after the other. The labour contractions come at regular intervals and get closer together over time. 

Change with movement- Braxton Hicks contractions usually stop when you change your position by either walking a bit or resting. Labour contractions do not stop despite movement or resting.

Strength of Contractions- while the Braxton Hicks contractions are weak and painless, the labour pains get stronger over time.

Area of pain- Braxton Hicks contractions are usually felt only in the front. Labour pains are usually felt in the back first and then the pain moves to the front.

What signs of real labour should you look for?

When labour pains actually start, these signs may help you identify it-

  • Abdominal pain, menstrual like cramping. Pain gets intense with time.
  • Any vaginal bleeding or spotting
  • An increase in vaginal discharge or if you see a change in the type of discharge- it may become watery, have mucus or may even be bloody or pink.
  • Dull, rhythmic low back pain. The tightening of your uterus is accompanied by back, pelvic or abdominal pain or cramps. 

Why do the Braxton Hicks contractions occur?

There is still no definite reason why Braxton Hicks contractions occur, though it is assumed that they occur to tone muscles in the uterus to prepare for birth. Some doctors feel these false contractions may play a role in softening the cervix prior to labour.

What are the triggers of Braxton Hicks contractions?

Most times these contractions start randomly, without any reason. Other triggers include-

  • Dehydration
  • Movement of the fetus
  • When the mother is physically active
  • Having a full bladder
  • Sexual intercourse

How do you find relief from Braxton Hicks contraction discomfort? 

There are many ways by which you can alleviate the discomfort. They are by-

  • Hydrating yourself. Drink a few glasses of water.
  • Taking a short, warm bath
  • Changing your position, such as lying down or going for a walk
  • Getting a soft massage from your partner
  • Practicing your breathing exercises
  • Drinking warm glass of milk or tea.

When should I call my doctor about Braxton Hicks contractions?

Sometimes it’s hard to tell when labour begins. Do not hesitate to call your doctor if you aren’t sure whether you are in labour or are experiencing Braxton Hicks contractions. It is absolutely okay if you arrive at the hospital with false labour. It’s best to not take any chances. Consult your doctor, share your symptoms and follow his advice. Our super specialist gynecologists Dr Prathima Reddy, Dr Philomena Vaz, Dr Amrita Rao, and Dr Saba Fathima at www.boardofdoctors.com are very experienced and always at hand to provide you with the best care and advice. All you need to do is click on www.boardofdoctors.com for a quick, hassle-free appointment with the doctor of your choice. 

All about GERD

Have you ever had a burning sensation in your chest, travelling up to your neck? Have you felt a sour, bitter taste at the back of your mouth as though the food in your stomach has travelled to your mouth from your stomach?  Does this happen very often to you? You could be suffering from GERD

What is GERD?

Gastroesophageal reflux occurs when the food or contents in your stomach come back into your esophagus.  It happens when the muscle that connects the esophagus to the stomach fails to contract in time. This muscle called the lower esophagus sphincter plays a very crucial role in that, once the food is taken down our mouths, it opens to allow food to pass into the stomach and then closes again so that food and acidic stomach juice cannot flow back into the esophagus. When the esophagus eases up too much, irritating acid from the stomach stream back into the esophagus, sometimes causing inflammation and painful burning sensation behind the breastbone, often also defined as heartburn. While many people occasionally experience heartburn, if you consistently experience acid reflux more than twice a week, you may be diagnosed with GERD.

What causes GERD?

While heartburn is common in people of all ages, GERD occurs more likely in people who are

  • Overweight or obese as this increases the pressure on the abdomen
  • Pregnant as this also increases the pressure on the abdomen   
  • Suffering from diseases of the connective tissue such as rheumatoid arthritis or lupus. 
  • Bulging of the top of the stomach up into the diaphragm, also known as hiatal hernia.
  • Delayed stomach emptying

Sometimes your diet and lifestyle choices may play a huge role in this. They could be

  • Smoking
  • Having certain food in excess such as coffee, alcohol and fried foods
  • Eating too much
  • Taking certain medications such as antihistamines, asthma medications or antidepressants

Symptoms of GERD

You often burp, have an acid taste in your mouth and have heartburn. This is gastroesophageal reflux. It’s when these symptoms increase that you should consult a physician. At www.boardofdoctors.com, we have super specialist doctors to take care of you and suggest best course of action to tackle GERD. 

There are other symptoms that occur less frequently but are signs that you could have GERD. These are-

  • Nausea or vomiting
  • Difficulty or pain in swallowing
  • Sour taste in your mouth due to the stomach fluids surging up into your mouth
  • Tightness in your chest or upper abdomen
  • Sore throat
  • Hoarseness
  • Burning sensation in the chest usually after eating
  • Chronic cough 
  • Disrupted sleep
  • Bad breath

Complications with GERD

If left untreated, GERD can lead to complications such as-

Esophageal ulcer– stomach acids can weaken the tissues in the esophagus causing an open sore to form. An esophageal ulcer can bleed, cause pain and make swallowing difficult. 

Esophageal stricture– stomach acids damage the lower esophagus causing scar tissue to form. This leads to narrowing of the food pathway, leading to problem with swallowing.

Barrett’s esophagus- damage from acids can cause changes in the tissue lining the lower esophagus which may cause esophageal cancer.

When to see a doctor?

Consult a doctor if you see repeated incidents of acid reflux symptoms. You may be referred to a gastroenterologist for further investigation who may ask you further questions such as descriptions of your pain and symptoms, and if your symptoms are worse after a heavy meal of high fatty, fried foods and dairy.  He may suggest several tests to diagnose GERD, including 

  • X-ray of the upper digestive system to show up any physical abnormalities causing GERD
  • Endoscopy to examine the food pipe(esophagus)
  • Ambulatory acid test to monitor the amount of acid in the esophagus
  • Esophageal manometry to measure the strength of the sphincter

Treating GERD

Doctors usually suggest lifestyle changes and medicines before attempting other lines of treatment. They are

Eat smaller meals- doctors suggest eating smaller meals through out the day instead of having three large meals as a large meal takes a long time to digest, causing heartburn.

Chew your meals and relax while you eat- gulping food in a hurry triggers GERD. It’s advised to eat mindfully and be stress free while eating.

Lose weight- obesity is one of the factors that lead to GERD as it increases pressure in the abdomen, thus pushing stomach acid into the food pipe.

Avoid foods and drinks that are triggers– avoid high-fat foods, alcohol, spicy food, dairy, coffee, carbonated drinks that can irritate the esophageal lining.

Stop smoking– smoking can aggravate GERD as it affects the function of the lower esophageal sphincter.

Elevate your head– for nighttime reflux, elevate the head of your bed by placing a wedge (available in medical stores) under your upper body. This lets gravity lessen the reflux of stomach contents into your esophagus. Do not put pillows to prop yourself up as this puts pressure on your stomach.  

Wear loose clothing– avoid tight belts, waistbands and clothing that puts pressure on the stomach

 Your doctor may also advise you prescription medicines to treat your symptoms.

Antacids- these drugs provide temporary relief, helping to neutralize acid in the esophagus and stomach and stop heartburn. Long term use is a strict no-no as these can bring side effects such as diarrhea and constipation. They can also alter calcium metabolism and cause a buildup of magnesium.

H2 Blockers-   these reduce acid in the stomach and are advised for chronic reflux and heartburn. 

Proton pump inhibitors (PPIs)- these drugs block a protein needed to make stomach acid, effectively suppress the acid and help heal your esophagus.

Prokinetics- these are rarely advised as they have serious side effects like diarrhea. However, these   drugs help your stomach empty faster so there isn’t much acid left behind. 

Surgery for GERD

Doctors will suggest medicines and changes in lifestyle to control GERD but when all else fails, surgery may be suggested.

Fundoplication- This surgery sews the top of the stomach around the esophagus thus adding pressure to the lower end of the esophagus. This helps in stopping reflux. This is done either through a laparoscope or through open surgery.

LINX device– this procedure involves a ring of tiny magnetic beads wrapped around the area where the esophagus and stomach meet. The magnetic attraction among the beads is strong enough to prevent reflux but weak enough to let food pass through the food pipe to the stomach. 

Transoral incisionless fundoplication (TIF)- this surgery uses an endoscope to wrap the stomach around the lower esophagus sphincter with plastic fasteners. This procedure does not require surgery. 

GERD is painful and limits your daily activities. However, it is not life threatening. Consult with your doctor to start proper treatment for GERD. www.boardofdoctors is an easy and seamless way to book your appointment with experienced gastroenterologists such as Dr Raj Vigna Venugopal  and specialist doctors such as . All you need to do is click on www.boardofdoctors.com for a hassle-free consultation experience.

Prevention of Glaucoma

When you take care of yourself, it goes a long way in ensuring a healthy you for your tomorrow. As you grow older, you have to think about your eye health too. Going for a regular eye checkup is advisable after you turn forty. Sometimes, eye diseases come without warning and it may be too late before you realize you are losing vision. Glaucoma is a leading cause of irreversible blindness worldwide. It has been estimated that in India alone at least 12 million people are affected and nearly 1.2 million people are blind from the disease. 

What is Glaucoma?

Glaucoma is a disease that slowly damages the optic nerve, the important link between the eye and the brain. This damage is caused by an abnormally high pressure in your eye. People with glaucoma usually lose vision before they notice any problems with their eyes.  The effect is so gradual, it sneaks up on you! You may not notice a change until the condition is at an advanced stage.

Tips to prevent Glaucoma

Unfortunately, you cannot get back any vision you lose from glaucoma. However, there are ways to detect the onset of glaucoma, prevent serious vision loss or slow its progress.

  1. Regular eye checkup: It is advised to get regular comprehensive eye exams once every few years from an experienced ophthalmologist. As recommended by doctors, you must have eye examinations in the following frequency based on your age –

               Younger than age 40 – every 5 to 10 years

                Age 40-54: every 2 to 4 years

                Age 55-64 years: every 1 to 3 years

                Age 65 and older: every 1 to 2years

               If doctors see any risk of glaucoma in you, they will suggest regular screening and monitoring.

  1. Do not ignore your family’s eye history: if your parents or grandparents have/had glaucoma, chances are, you may too, as glaucoma tends to run in the family. If you run that risk, make sure you go for frequent screening.
  2. Diet goes a long way: you have to eat well to see well. Your eyes need good nutrition too! Rich coloured fruits, berries, vegetables and leafy greens contain vitamins and minerals that protect your body and your eyes. vitamins C, E, and A and minerals such as zinc, copper and selenium are beneficial for the eyes. Carrots are specially recommended. 
  3. Move that body but with caution: Moderate exercise and walking is advised to improve your overall health. It also helps lower your eye pressure. Avoid intense exercises that increase your heart rate as it may also result in a raised eye pressure. Hire a trained instructor to understand breathing while exercising. Right posture and breathing helps in maintaining your posture during exercise.
  4. Shield that eye from injury: eye injuries can cause glaucoma. Make sure you wear protective eye wear while playing sports or while doing any work that is a risk to the eye such as welding, any carpentry work etc.
  5. Clamp on that steroid medicine: steroid medicines, if consumed for a long period of time or in high doses can raise your eye pressure, especially if you have glaucoma. Consult with your ophthalmologist if you are on steroids.
  6. Avoid head-down positions: placing your head below your heart for long periods of time is not advisable if you have glaucoma or are at high risk of the disease. You may need to avoid certain yoga positions such as inversion postures. Head-down positions can greatly raise your eye pressure. Consult your doctor before starting any exercise that includes inversions.
  7. Sleep in the right position: while sleeping with your eye against the pillow or on your arm may be the most comfortable position for you, avoid this if you have glaucoma. If you snore heavily or stop breathing sometimes during the night because of sleep apnea, you are at a high risk for glaucoma. Consult your doctor and get tested for obstructive sleep apnea.  Never ignore the warning signs.
  8. Too much sunlight is not good: not only is excess sunlight not good for your skin, now evidence suggests sun’s UV rays can also be responsible for a type of glaucoma. Wear good quality polarized glasses and a large brimmed hat when out in the sun.
  9. Fresh and clean breath: gum disease can be bad for your heart and now some research connects optic nerve damage in glaucoma to gum disease. Brush and floss your teeth every day and pay that visit to your dentist from time to time.
  10. Keep your doctor informed about your blood pressure medicines: just as high pressure is not good for glaucoma; sudden low pressure can worsen glaucoma damage too. Inform your ophthalmologist if you take blood pressure medicines in the night or if you have low blood pressure symptoms. Do not change your medicines on your own. Consult with your primary care doctor for the same.
  11. Hydrate with love: drink fluids throughout the day but in moderate amounts. Gulping too much water suddenly may temporarily increase eye pressure.
  12. Cut that coffee: avoid drinking too much caffeine as studies have shown that it may result in sudden increase in eye pressure. 

Glaucoma is often a manageable disease. If you follow the advice of your ophthalmologist and primary care doctor, you will be able to manage your glaucoma and not let it affect your normal lifestyle.  Contact Specialist Ophthalmologists at the Board of Doctors for any queries on glaucoma or if you want to get your eyes tested. Our experienced team of doctors will ensure the right diagnosis and measures, all you need to do is click on www.boardofdoctors.com for a hassle free appointment.   Dr. Anil Wani, Dr. Anand Shroff, Dr. Sudha Manjunatha, Dr. Nitin Shetty