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UTI (Urinary Tract Infection)

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What is UTI?
Urinary tract infection is UTI, so first you should know about urinary tract. Urinary tract consist of two kidneys, two ureters, one bladder and one urethra. Kidney plays a very important role in excretion of metabolic waste products and formation of urine. The ureters drain urine from kidney and deliver it to the bladder. Function of bladder is to store urine and then release during micturition. The urethra is the tube through which urine passes from the bladder to the exterior of the body. The female urethra is around 2 inches long and ends inferior to the clitoris and superior to the vaginal opening. In males, the urethra is around 8 to 10 inches long and ends at the tip of the penis.
Infection in the urinary tract caused by microorganisms and most common bacteria is E.coli derived from gastrointestinal tract. UTI is the term commonly used to describe urethritis and cystitis, infection in the urethra called as urethritis and infection in the bladder is called as cystitis. But infection can be in any part of the urinary tract from the kidney to urethra. Microorganisms or bacteria can travel from urethra to bladder, bladder to ureter, and ureter to the kidney which may result in pyelonephritis (infection in the kidney).
Urinary tract is divided in to
Upper urinary tract consist of kidney and ureter and
Lower urinary tract consist of bladder and urethra.

Urinary-System
Causes of UTI
E.coli is the most common microorganism to infect urethra but other microbes proteus, pseudomonas, streptococci, staphylococci and klebsiella are also common. Chlamydia and Mycoplasma can infect the urethra and reproductive system but not the bladder. Chlamydia and Mycoplasma infections may be sexually transmitted and require treatment of sexual partners.
UTI is more common in women because in women, the ascent of organisms into the bladder is easier than in men; the urethra is shorter and the absence of bactericidal prostatic secretions may be relevant.
Sexual intercourse may cause minor urethral trauma and transfer bacteria from the perineum into the bladder.
Risk Factors of UTI
1. Poor Hygiene
2. Using dirty toilets
3. Multiple sexual partner or new sexual partner
4. Using a diaphragm for birth control, because it may slow urinary flow and allow bacteria to multiply.
5. Condom use may also cause UTI because of minor vaginal trauma during intercourse.
6. Tampons and spermicidal jelly may cause irritation of vaginal and surrounding skin which can result in UTI.
7. Pregnancy
8. Menopause (atrophic urethritis and atrophic vaginitis)
9. Nerve damage around bladder or in spinal cord injury patient can not completely empty bladder which can allow bacteria to grow.
10. Using catheters in bedridden patients.
11. Diabetes
12. Bowel incontinence
13. Any instrumentation in the bladder or urethra during surgery.
14. Kidney stones
15. Enlarged prostate
16. Inappropriate use of antibiotics (interrupt natural flora of gastrointestinal tract and urinary tract).

Symptoms of UTI
Symptoms of UTI depends upon age, gender, other associated disorders, presence of catheter and the site of infection.
1. Abrupt onset of frequency of micturition and urgency.
2. Dysuria (pain in the urethra or burning sensation during micturition).
3. Pain in lower abdomen during and after urination.
4. Cloudy urine with an unpleasant odor.
5. Sometimes blood in urine (hematuria which may be microscopic or visible).
6. Fever (when infection reached to kidney, usually in catheterized patients but it can be the first symptom in men).
7. Nausea and vomiting if infection is severe.
Acute Pyelonephritis is a condition when infection spreads to the kidney, recognized by fever with chills, rigors, nausea, vomiting, loin or back pain, hypotension, guarding or rigidity may be an indication of hospitalization.
Diagnosis-
1. Clinical symptoms with medical and surgical history.
2. Investigations/lab tests-

      Urine Dipsticks
Urine microscopy and cytometry
Urine Culture to know microorganism

For these tests patient is asked to collect clean catch urine by washing and wiping genital area and midstream urine sample in a sterile container, so that bacteria around the genital area cannot come in to the urine sample and will prevent the confusion of test results.
       Blood test for complete blood count, urea and electrolytes in infants, children and patients with fever or any complicated infection.
       Blood culture
Imaging tests-
USG (ultrasonography)– Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure.
CT scan – CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images.
MRI – MRI machines use radio waves and magnets to produce detailed pictures of the body’s internal organs and soft tissues without using x rays.
Radionuclide scan– A radionuclide scan is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive chemicals. Special cameras and computers are used to create images of the radioactive chemicals as they pass through the kidneys.
Urodynamics – Urodynamic testing is any procedure that looks at how well the bladder, sphincters, and urethra are storing and releasing urine. Most of these tests are performed in the office of an urologist—a doctor who specializes in urinary problems—by a urologist, physician assistant, or nurse practitioner. Some procedures may require light sedation to keep a person calm.
Cystoscopy – looking inside the bladder and urethra with a camera lens inserted via the urethra through a long thin tube.
Pelvic examination in women and rectal examination in men.
Investigations to diagnose UTI depends upon age, gender clinical symptoms and severity of infection thus use selectively.
Treatment of UTI
Because UTI caused by microorganisms mostly bacteria so antibiotics are recommended to treat the UTI, after getting the results of urine culture which usually takes 48-72 hours. For lower UTI usually 3 days course of antibiotics are recommended. Trimethoprim is the first choice of treatment if bacteria is trimethoprim sensitive, but for trimethoprim resistant bacteria nitrofurantoin or quinolones are effective.
In severe infections treatment may continue for 7-14 days, depending upon patient’s condition doctor decides for intravenous or oral treatment.
Penicillins and cephalosporins are safe to use in pregnancy but trimethoprim, sulphonamides, quinolones and tetracyclines should be avoided.
Fluid intake of 2-3 liters and urinating frequently is usually recommended to flush out the toxins of kidney.
Prevention of UTI
1. Good personal hygiene
2. Drink plenty of fluids around 3 liters per day
3. Urinate frequently if you feel to empty the bladder, do not hold for long time
4. Cranberry juice helps to prevent infection.
5. Urinate before and after sexual intercourse.
6. Wipe from front to back after toilet, in that way bacteria will not come from anal region to urethral region.
7. During menstruation change pads frequently and tampons use should be avoided.
8. Use non-spermicidal lubricated condoms, because spermicidal jelly is skin irritant which cause bacteria to grow and results in UTI.
9. Use cotton and loose fitting underwear and clothes to keep area around urethra dry.
10. Avoid irritant feminine products like deodorant sprays, powders or douches which irritate urethra.
11. Quit smoking
12. Choose healthy diet rich in fibers, protein.
13. Avoid caffeine, nicotine, carbonated soft drinks, spicy food and alcohol.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.

Image curtsey –shutterstock.com
Content source– Davidson’s Principles and Practice of Medicine (22nd edition), The National Institute of Diabetes and Digestive and Kidney Diseases niddk.nih.gov

Kidney Stones

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Kidney plays an important role in excretion of many metabolic breakdown products, including ammonia, urea and creatinine from protein and uric acid from nucleic acids, drugs and toxins. Kidney also plays an important role in regulation of fluid and electrolyte balance. Kidney regulates acid base homeostasis, calcium and phosphate homeostasis, Vitamin D metabolism and production of red blood cells. It has very important role in regulation of blood pressure also.

Renal stone or kidney stone disease is common which can affect all age group and in individuals living anywhere in the world.
Kidney stone consists of aggregates of crystals, which may be either calcium or phosphate or proteins. Kidney stones form in urine and can travel from kidney to bladder through the urinary tract, so It may be anywhere from the kidney to the ureter. Size of calculi or stone may vary greatly from a minute sand particle to large round stone usually in the bladder. Usually crystal deposition occurs in concentrated urine therefore dehydration is a major risk factor for stone formation. Very small stones usually pass through urine without any problem but larger stone causes obstruction and causes pain, infection and bleeding.

The common sites of obstruction from a stone in the upper urinary tract are located at the:
• Junction where the kidney meets the upper ureter,
• Mid portion of the ureter, or
• Lower ureter at its entry into the bladder

Based on the location of stone term used, for example; stone in the kidney called as nephrolithiasis, stone in the urinary tract termed as urolithiasis, stone in the ureter termed as ureterolithiasis.

Types of stones

Most common type of kidney stone is calcium oxalate around 60% and least common type of kidney stone is cysteine which is around 1%.

Calcium oxalate 60%
Calcium phosphate 15%
Magnesium ammonium phosphate (struvite) 15%
Uric acid 10%
Cysteine and others 1%

Calcium stones- when calcium combines with another mineral like oxalate or phosphate then Ca-oxalate, or Ca-phosphate insoluble crystals form. These can be easily seen on plain X –ray. Usually, no specific cause is found on why these stones develop, however they can occur in certain medical conditions such as hyperparathyroidism, certain types of weight reduction surgery, and in several types of kidney disorders.
Magnesium ammonium phosphate (struvite) – Most important cause is infection of urinary tract (by urease producing organisms), which causes rapid stone growth.
Uric acid stones– Uric acid is a product of purine metabolism. Uric acid is 100 times more soluble at a pH > 6 compared to a pH <5.5. Other than dehydration, the most common risk factor for uric acid stone is persistently acidic urine, more commonly due to excessive high protein diet, obesity or gout. These stones cannot be seen on plain X- ray.
Cysteine stones– these are rare and due to an inherited defect in amino acid transport within the kidney. An excess of cysteine crystals are found in the urine of affected patients which clump together to form stones. Patients who are affected tend to be young and develop recurrent kidney stones throughout life. Long term treatment involves close surveillance, education, dietary changes, fluids, and sometimes medications to prevent the stones from recurring.

Predisposing Factors for the Kidney Stones
1. Environmental causes– high ambient temperature and decrease fluid intake leads to dehydration which is a very important risk factor for the kidney stones.
2. Dietary causes – Diet high in protein, high in sodium and low calcium promotes the renal stone.
3. Medical causes – Hypercalcemia due to any cause, hyperparathyroidism, gout, renal tubular acidosis and urinary tract infection are major risk factors for the kidney stones.
4. Surgical causes– surgeries like ileal resection or gastrointestinal tract surgery, weight loss surgery can also promote the kidney stones.
5. Hereditary cause– If someone in the family has history of renal stone then there are more chances to develop renal stone in the individual. Some diseases like familial hypercalciuria, cysteinuria, medullary sponge kidney, primary hyperoxaluria are other conditions which can cause the kidney stones.
6. Medicines- People taking certain medications like diuretics, calcium based antacids, Indinavir (protease inhibitor used for treatment of HIV), topiramate (antiseizure) are also at increased risk of developing the kidney stones.

Symptoms
Symptoms are greatly vary. Sometimes patient is asymptomatic but most commonly it presents with acute severe pain at the flank (loin) which radiates to anterior abdominal wall or to the groin, it may radiate to testes or labium and anterior/lateral region of thigh. Pain intensity increases in few minutes, patient becomes restless and tries to change position, pain may be associated with vomiting, pallor and sweating. Sometimes hematuria (blood in urine), dysuria (difficulty in passing the urine), or fever with chills (if there is infection in urinary tract or in kidney) may occur due to the kidney stones. The intense pain usually subsides within 2-3 hours but constant or intermittent dull pain in the loin or back may persist for hours to days.

How to Diagnose?
1. Symptoms- Typical excruciating pain on the site of stone or loin and radiates to anterior abdominal wall or groin region, and other symptoms described above.
2. Physical exam, medical history, surgical history, family history and diet.
3. Urine analysis to know any infection, blood in urine, protein, glucose, amino acids, urea, creatinine, sodium, calcium, oxalate and uric acid.
4. Blood test will show any biochemical problem which can cause the kidney stone.
5. Imaging technique –about 90% stones contain calcium can be seen on abdominal X ray but CT scan of Abdomen(KUB-kidney ureter bladder) is the best way to diagnose the kidney stone.
6. Sometimes your doctor can ask for IVP to know the proper flow and excretion from the kidney or USG to know the stones within the kidney and if there is any obstruction in urine flow.

What is the treatment?
Treatment of the kidney stones depends on the size and location of stone, But immediate treatment is analgesic with antiemetic because renal colic is unbearably painful and demands strong analgesic.
If stone is less than 4mm diameter it may pass spontaneously through the urinary tract with increase intake of fluids. In certain situations, a tablet called tamsulosin may be beneficial in helping pass a kidney stone which is obstructing the ureter.
If an underlying infection is suspected (fever or chills), urgent medical treatment should be sought immediately with antibiotic coverage. Patients with kidney stones are at high risk for developing infection so antibiotic coverage is also important.
Stones bigger than 6 mm in diameter require endoscopic surgical intervention. Depending upon clinical presentation and site of obstruction your doctor may choose any of the following surgical procedure.
ESWL(Extracorporeal shock wave lithotripsy)– This procedure is performed by the urologist, in which shock waves generated outside the body are focused on the stone, breaking it into small pieces that can pass easily down the ureter.
PCNL (percutaneous nephrolithotomy) – This procedure is performed by urologist, by using nephroscope through small incision in the patient’s back to locate and remove the stone.
Occasionally, a temporary hollow tube called a stent will be required to assist in keeping the urinary tract unobstructed either before or after definitive stone surgery has been carried out.

Preventive measures-
Prevention is always better than cure.
1. Fluid intake- At least 3 liters of fluid intake is very important to prevent kidney stones formation. Even more oral fluids need to be consumed on hotter days due to insensible losses from perspiration (sweating). A good measure of success is the color of the urine should be clear or a very pale yellow.
2. Low salt intake- decrease sodium intake in the diet or salt restriction. The more sodium you take in and excrete, the more calcium you waste in the urine. Excess calcium in the urine can lead to new stone formation. Try to reduce dietary sources of sodium, including fast foods, packaged or canned foods, and salty snacks. Daily sodium intake should be less than 2000mg per day (around one tea-spoon of salt per day).
3. Low animal protein intake- Protein intake should be in moderate amount not very high.
4. Calcium intake- Maintain good calcium intake (calcium forms an insoluble salt with dietary oxalate, lowering oxalate absorption and excretion). The recommended daily requirement of calcium is 1000 mg, and two-thirds is consumed in dairy containing products. You are encouraged to consume two servings of dairy (but no more than two) or other calcium-rich food per day to maintain normal bone stores of calcium.
5. Oxalate- Avoid foods that are rich in oxalate (spinach, rhubarb)
6. Medicines to prevent stone formation- Diuretics, Allopurinol, Potassium citrate, Penicillamine. Avoid Vitamin D and Vitamin C supplementation.
7. Weight loss- Obesity is a risk factor for kidney stone, so maintain healthy lifestyle and weight loss can prevent kidney stone formation.

Few natural Tips to prevent kidney stones-
 Drink plenty of fluids.
Apple- an apple a day keeps the doctor away. Apple has a diuretic property, which helps to prevent kidney stone.
Pomegranate –Freshly squeezed pomegranate juice helps to prevent stone formation, it has astringent property too.
Celery- celery has high fiber content and natural diuretic so it prevents kidney stone formation.
Basil- Basil is a natural kidney toner, drinking basil tea every day or basil juice with honey is very good remedy for kidney stones.
Kidney beans- Kidney beans are not only very high in fiber, they’re also a great source of non-animal protein, B vitamins, and minerals that improve urinary tracts and kidney health.

 

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.

 

Content Source- Davidson’s Principles and Practice of Medicine (22ndedition) , stoneclinic.com.au

Depression

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What is depression?
Depression is a simple word but it has deep and vast meaning, In my words Depression is a feeling generated by your state of mind, it is a sad feeling, or feeling low, not feeling good, not feeling energetic are usually used to express depression and person say I am depressed. Depression is very common problem nowadays. It is a real medical illness which comes in many forms and really needs attention.
Though it is a feeling in your mind state but it may be a real illness or disease. So you have to know what depression is. Life is full of ups and down and sometimes person may not accept all aspects of life and can feels sad or goes in to depression, which not only affect the person who is depressed but also his surroundings or family members who are very close to the person.
Usually people think, feeling sad or feeling dull is depression, but it is more than that, there are few signs and symptoms which can help you to diagnose depression.
1. Persistent sad feeling or anxious, loneliness, emptiness.
2. Loss of interest in daily activity and hobbies. Person may lose the interest in daily activities and he or she may lose the interest in his or her favorite activity or hobby also. He may lose interest in sex too.
3. Sleep disturbance – problem in falling asleep or problem in waking up or disturbed sleep.(Either sleeping too much or less)
4. Fatigue, low energy – person will always feel tired (fatigue), or dull. No motivation to work. Ability to think and speak are slowed down which may affect body movements too.
5. Guilt or feeling of hopelessness or worthlessness.
6. Poor concentration – person cannot concentrate on work, affects ability to take decisions, impacts memory, person finds hard to remember or recall things.
7. Suicidal thought or harming himself by any mean
8. Change in appetite- Though decrease in appetite is common but in some people there may be increase in appetite. So weight loss and weight gain both can be seen.
9. Other psychological disturbances like irritation, agitation, mood changes may be seen.
10. Unexplained body aches may also be seen like headache, pain in abdomen or in any body part.
For diagnosis at least five of these symptoms should be present during most of days, almost every day for at least two weeks and severely interrupting daily activities. If you have these symptoms then make a doctor appointment and talk to doctor in detail.

It is not necessary that all these signs will be present in a depressed person but only few of them may also present so counselling and asking questions related to all these symptoms are very important for diagnosing the problem. And if you are asking questions you have to take the patient under your confidence and make sure that information provided by the patient will not go outside. The most important question asking about suicidal thoughts or any thought to harm him-self or her-self.

Causes-
There may be different causes of depression from genetic, biochemical, environmental to any life event. Depression can occur in any age but more often starts by the age 16. In teenagers stress may be related to school life, studies or friends, any trauma, love relations, loss of loved one or any other. In adults causes may be related to family life, stressful situation between partners, work load in the office, competition everywhere, infidelity, not getting success at work, unsatisfactory jobs, any trauma or loss of loved one and much more. Sometimes depression is medication induced, related to medical problems and long term illness. In women depression may be due to hormonal changes during menstrual cycle, before menstruation known as pre menstruation syndrome (PMS). After delivery of baby depression is called as postpartum blues which is more common in women due to hormonal and physiological changes in body and adding another responsibility in her life of taking care of baby.

Depending on symptoms, duration and cause depression may be of different varieties-
Major Depression- Symptoms are severe enough to interrupt daily activities, and presents at least two weeks with noticeable change in previous level of functioning.
Bipolar I Disorder-Mood disorder in which patient experiences manic symptoms (elated mood) for at least one week that cause significant distress or impairment in his/her level of functioning.
Dysthymic Disorder-It is a chronic disorder characterized by depressed mood that presents most of the time during the day and present on most days for at least two years.
Cyclothymic Disorder- A chronic disorder characterized by many episodes of depressed mood and in between many episodes of hypomanic mood (Mild elated mood) for at least two years.
Seasonal Affective Disorder-It is characterized by depressive symptoms usually in winter months and in snowy places,when there is absence of sunlight, people can not go outside, all the activities are limited inside the closed home.
Post traumatic depression- After any trauma or because of loss of loved one .It is different from Grief in which usually return of normal baseline functioning within two months but in depression patient do not returns to his baseline level functioning.
Postpartum Depression- Symptoms starts within one month after giving birth to baby and may continue for long time.

Diagnosis-
Usually symptoms and physical exam can diagnose the Depression ,no lab tests are necessary but sometimes to rule out medical causes doctor may order for lab tests.

Hyperthyroidism

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The term hyperthyroidism refers to any condition in which there is increased thyroid hormone produced in the body means the thyroid gland is overactive. Another term for this problem is thyrotoxicosis, which refers to high thyroid hormone levels in the blood stream, irrespective of their source.
Symptoms

  • Poor concentration
  • Fatigue/tiredness
  • Frequent bowel movements/Diarrhea
  • Goiter (enlarged thyroid gland) or thyroid nodules
  • Hair loss
  • Hand tremor
  • Heat intolerance
  • Increased appetite
  • Increased sweating
  • Irregular menstrual periods in women
  • Nervousness
  • Pounding or racing heart beat (palpitations)
  • Restlessness
  • Sleep problems
  • Weight loss despite a good appetite

Hyperthyroidism usually begins slowly but in some young patients these changes can be very abrupt. At first, the symptoms may be mistaken for simple nervousness due to stress.

Causes
The most common cause is overproduction of thyroid hormone by the entire thyroid gland. This condition is also known as Graves’ disease(autoimmune disorder). Graves’ disease is caused by antibodies in the blood that turn on the thyroid and cause it to grow and secrete too much thyroid hormone. This type of hyperthyroidism tends to run in families and it occurs more often in young women.
Other common causes include:

  • Thyroiditis-Inflammation of the thyroid due to viral infections, some medicines, or after pregnancy .
  • Taking too much thyroid hormone can cause thyrotoxicosis.
  • Nodules or lumps in the thyroid that may gradually grow and increase their activity so that the total output of thyroid hormone into the blood is greater than normal. This condition is known as toxic nodular or multinodular goiter.
  • Some tumors of the testes or ovaries (rare)
  • Getting medical imaging tests with contrast dye that has iodine (rare, and only if there is a problem with the thyroid).

Thyroid hormone regulation
The thyroid itself is regulated by another gland located in the brain, called the pituitary. In turn, the pituitary is regulated in part by thyroid hormone that is circulating in the blood (a “feedback” effect of thyroid hormone on the pituitary gland) and in part by another gland called the hypothalamus, also a part of the brain.The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. The rate of thyroid hormone production is controlled by the pituitary gland. If there is an insufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH is increased by the pituitary and TSH stimulates the thyroid to produce more thyroid hormone. In contrast, when there is an excessive amount of circulating thyroid hormone, the release of TSH is reduced as the pituitary attempts to decrease the production of thyroid hormone.

Diagnosis
Physician will ask questions about your symptoms, do a physical exam with reflexes, medical history, family history and order medical tests to diagnose hyperthyroidism.
Blood tests – to measure your thyroid hormones TSH, T3, and T4. A high level of thyroid hormone in the blood plus a low-level of TSH is common with an overactive thyroid gland.
Imaging tests of the thyroid-If blood tests show that your thyroid is overactive, your doctor may ask for
•   Radioactive iodine uptake and scan
•   Thyroid ultrasound

Treatment
No single treatment is best for all patients with hyperthyroidism. The appropriate choice of treatment will be influenced by your age, the type of hyperthyroidism that you have, the severity of your hyperthyroidism, other medical conditions that may be affecting your health and your own preference.

Antithyroid drugs
Methimazole , Propylthiouracil (PTU)
Methimazole is usually preferred one due to less severe side-effects. These drugs work well to control the overactive thyroid, bring quick control of hyperthyroidism and do not cause permanent damage to the thyroid gland.
Side effects – allergic reactions, red skin rashes, hives, fever and joint pain. Rare but serious condition called Agranulocytosis (decrease number of WBCs). If you are taking one of these drugs and get an infection such as a fever or sore throat, you should stop the drug immediately and check for a white blood cell count that day. Even if the drug has lowered your white blood cell count, the count will return to normal if the drug is stopped immediately. Liver damage is another very rare side effect. You should stop either methimazole or PTU and call your doctor if you develop yellow eyes, dark urine, severe fatigue, or abdominal pain.

Radioactive iodine
Another way to treat hyperthyroidism is to damage or destroy the thyroid cells that make thyroid hormone .The radioactive iodine taken just once by mouth in liquid or capsule form. Once swallowed, the radioactive iodine gets into your blood stream and quickly is taken up by the overactive thyroid cells. The response to treatment can take from 6 to 18 weeks, during which time drug treatment may be used to control hyperthyroid symptoms, radioactive iodine destroys the cells that have taken it up. The result is that the thyroid or thyroid nodules shrink in size, and the level of thyroid hormone in the blood returns to normal. Radioactive iodine is often recommended if you have Graves’ disease and are older than 50, or if you have thyroid nodules (toxic multinodular goiter) that are releasing too much thyroid hormone. Radioactive iodine is contraindicated if:
a. You are pregnant or you want to become pregnant within 6 months of treatment.
b. You are breast-feeding.
c. You have thyroiditis or another kind of hyperthyroidism that is often temporary.
Side effects – side effects of radioactive iodine treatment is for short-term, neck tenderness, swelling, nausea , vomiting, swelling and tenderness of the salivary glands, dry mouth, taste changes.

Beta-blockers
Beta-blocker drugs, such as atenolol or propranolol, do not block the production of thyroid hormone. Instead, they use for symptomatic control of hyperthyroidism, especially rapid heart rate, trembling, anxiety, and the high amount of heat the body produces.

Surgery
Removal of the thyroid gland is another permanent solution, but is often the last option. This procedure must be performed by a highly skilled and experienced thyroid surgeon because of complications include the risk of damage to nerves around the larynx (voice box) and to the nearby parathyroid glands, which control calcium metabolism in the body. Surgery is recommended when there is an enlarged thyroid gland that makes breathing difficult or when antithyroid drugs are not working, or when there are reasons not to take radioactive iodine. It may also be used in people who also have thyroid nodules, especially when the nodules may be cancerous.
Another important thing that after surgical removal of thyroid the source of your hyperthyroidism is gone and you will likely become hypothyroid. As with hypothyroidism that develops after radioiodine treatment, your thyroid hormone levels can be restored to normal by treatment once a day with a thyroid hormone supplement. So the patient will need to be monitored regularly for adequate thyroid hormone levels in the blood.

If left untreated, hyperthyroidism can lead to other health problems including congestive heart failure, abnormal heartbeat, and loss of bone mineral (osteoporosis).

Food to avoid
To increase the effectiveness of your radioactive iodine therapy, you may be prescribed a low iodine diet. The highest sources (and those to be avoided) are iodized salt, grains and cereals, some breads, fish from the sea, shellfish, beef, poultry, pudding mixes, milk and milk products.
Avoid restaurant foods
Consult your doctor before discontinuing or taking any medication.

Trying to get pregnant

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The most precious gift to women is that she can get pregnant and she can be a mother .Giving child birth is an amazing feeling of women.

Most of the women do not actually aware of the facts that how to get pregnant. If you are planning to get pregnant and have a baby, just go through these tips and knowledge about your menstrual cycles and ovulation periods.

Pregnancy

1.Menstrual  Cycle– first of all you have to know that your Menstrual cycles are regular or irregular.

On average, a woman’s cycle normally is between 28-32 days, but some women may have much shorter or much longer cycles. Work out the length of your average menstrual cycle.

Let me explain you…if you have 28 days cycle, it is easy to calculate ovulation periods. And if you know well about your menstrual cycle it would be easy to calculate ovulation period.

2. Ovulation period– Ovulation is when a mature egg is released from the ovary, moves down the Fallopian tube, and is available in the Fallopian tube to be fertilized.

Normally menstruation occurs 14th day after ovulation.

If you have 28 days cycle, ovulation period would be 14th day from the LMP (last menstrual period).

If you have 30 days cycle, ovulation period would be at 16th day from your LMP.

In 32 days cycle ovulation period would be 18th day from the LMP.

I want to clarify that after ovulation it takes 14 days to get period.

So if you want to calculate your ovulation period just go backward 14 counting from the next estimated date of menstrual period and that would be your ovulation period.

Simple formula

Days of menstrual cycle -14= ovulation period

Now you know about ovulation period.

Next is important to know that life span of egg is 24 hours and sperm is 4-5 days.

So Intercourse done during the fertile period would result in positive pregnancy, and chance of getting pregnant is 90 percent.

Conclusion is that Intercourse at 12th,13th, 14th,15th and 16th day would give you positive pregnancy.

3. Position during intercourse– male should be on the top.

Female should use a pillow under her waist making 45 degree angle for uterus so that path of sperm will be easy and directed towards uterus.

After release of semen (sperms) women should keep raise her legs for at least 20 minutes, it will help sperms movement directed towards uterus.

4. Abstinence – 5 days abstinence will help in collection of large amount of sperms and faster movement when they release after 5 days of abstinence.

5. Do not pass urine after intercourse at least 2 hrs.

6. Do not take hot water shower till 3 days after ovulation period.

7. Deep breathing exercises will help you stress free and blood purification, blood flow towards uterus and positivity in your thoughts.

Health Tips

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Few health tips

Health is wealth. It is easy to enjoy life if you are healthy. Only thing you have to balance life with work  .

Today life is very busy, and every one can say this easily that I don’t get time to keep me fit. Did you ever think that if you are working, means your body also working so in these 24 hours why you can not get time to stay your body healthy, just think and give few minutes from your schedule every day for your body only .  Only few things you have to keep in mind and follow me regularly, you will be happy to see changes in your life positively.

  1. Sleep– 6 hours sleep is very important for brain and body. The best time to sleep is between 10 pm to 4 am.
  2. Water -Drinking water when you wake up –keep water  overnight in a copper vessel and drink it in morning at least 4 glass of water. Drinking at least 10-12 glasses of water in a day is very good for health. Water plays a very important role in washout all the toxins from our body and maintains hydration.
  3. Yoga and meditation-the way you approach your morning can set the tone for the day ahead. Plays a very important role in keeping our body healthy and fit. After a night of rest your mind is clear, and research shows that will power is greatest in the hours after waking. When we meditate our brain centers get activated to secret relaxin hormone, at least 20 minutes per day yoga is very important to keep your body healthy.Yoga activates your nervous system and boost up your energy. Yoga rejuvenates the mind, body and spirit.
  4. Breakfast –We should always take healthy breakfast rich in protein ,fibers, and juices. Breakfast should be like a king. And the dinner should be the light meal of the day.
  5. Posture –Body postures plays a crucial role here. By positioning the body correcting while sitting and standing, there is even pressure on the spine, its muscles and ligaments. Having good posture can reduce physical stress on the body. Headaches, neck pain and back pain can be lessened when the body maintains a good upright position.
  6. Dietary habits– People can improve their overall eating patterns, the complete combination of foods and drinks in their diet, the eating pattern may be more predictive of overall health status and disease risk than individual foods or nutrients. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease. Say no to junk foods, only juices, whole fruits, food rich in fibers, water, sprouts, reduce sodium intake, low added sugar, low saturated fat.  Avoid oily food,  use whole grain food items, avoid frozen food.
  7. Brush your teeth twice a day.
  8. We should not drink water after meal at least for 2 hour.
  9. Dinner – Dinner should take at least 3 hour before going to bed.
  10. Physical activity –at least 30 min /day for 5 days in a week. Physical activity associated with work, home, and transportation has declined in recent decades and can be attributed to less active occupations; reduced physical activity for commuting to work, school, or for errands; and increased sedentary behavior often associated with television viewing and other forms of screen time.