Your questions on Breast Cancer answered

Since what age should women start a breast examination?

Breast cancer is one such cancer that can be cured if detected and treated during initial stages. It is extremely important for women to know what their breasts look and feel like normally so that they are able to differentiate in case of any changes. Breast cancer can happen to women across all age groups, although a majority of the cases of breast cancer occur in women over 40 years of age. However irrespective of the age, women should be aware of their body and its changes. Diagnosing breast cancer in women under 40 years of age is difficult because the breast tissue during that age is much denser than in older women. However self-breast examinations must be done once a month and can be done by women in their 20’s as well. During the teens, women tend to feel lumps in the breast which is quite normal as the breasts are developing and the lumps normally disappear on their own gradually. However, if the lump gets bigger in size or causes pain/discomfort it is better to consult a specialist in order to understand the cause.

A self-breast examination should be done by women whose breasts are fully developed (post-adolescence). Beginning the practice early will help women create a habit out of it and they will become much more familiar with their breasts and can address any changes that the breast undergoes. The self-examination should be done after the days of mensuration as during those days the breasts tend to be swollen. At a younger age, regular examination at frequent intervals is recommended in order to rule out any health condition. Mammograms are not recommended for women below 40 years of age because of the dense breast tissue women have at a younger age, hence mammograms may not be extremely efficient. Women over 40 years of age should screen themselves annually. In case of women who are at higher risk of developing breast cancer; i.e. women who have a family history of breast cancer, women who started menstruating before 12 years of age, women with poor lifestyle habits, women diagnosed with benign breast conditions previously etc. it is recommended to consult a specialist who would be able to advise on the right time to begin mammogram screening.

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Hyperlipidemia and the risk of cardiovascular disease

Hyperlipidemia is one of the major preventable cardiovascular risk factors and refers to increased levels of lipids (fats), such as cholesterol and triglycerides, in the blood.

Although hyperlipidemia does not cause symptoms, it can significantly increase your risk of developing cardiovascular disease, including diseases of blood vessels supplying the heart (coronary artery disease), brain (cerebrovascular disease), and limbs (peripheral vascular disease). These conditions can, in turn, lead to chest pain, heart attacks, strokes, and other problems. Because of these risks, treatment is often recommended for people with hyperlipidemia.

 

OTHER RISK FACTORS FOR CARDIOVASCULAR DISEASE

In addition to hyperlipidemia, there are a number of other factors that increase the risk of cardiovascular disease and its complications:

  • Diabetes mellitus, type 1 and 2
  • Hypertension (people with hypertension include those with a blood pressure at or above 140/90 and those who use blood pressure medication
  • Kidney disease
  • Cigarette smoking
  • Family history of coronary disease at a young age in a parent or sibling (young, in this case, means younger than 55 years for men and younger than 65 years for women)
  • Gender: Men have a higher risk of cardiovascular disease than women at every age
  • Age: There is an increased risk of cardiovascular disease with increasing age

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Ergonomic injuries

Ergonomic Injuries

1) What are ergonomic injuries and how are they caused?

Most people these days have desk jobs that require them to be seated at their desks for 8-10 hours straight. People often fail to realize how much havoc a simple desk job can create in their life. People tend to disregard a lot of simple symptoms by confusing them with symptoms of other conditions and fail to realize that they could be caused by seemingly harmless factors like sitting on a chair for prolonged hours. A lot of health conditions have been said to be caused because of sitting for prolonged hours. Ergonomic injuries affect the muscles, spinal disc, nerves, ligaments, joints etc. Hinged back, back pain, pain in the wrist, stiff neck and shoulder aches are a few of the most common health issues seen due to poor seating posture and continued sitting.

The most commonly suffered ergonomic injuries are;

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Prostate Cancer – Diagnosis & Tests

Prostate cancer is the cancer of the prostate gland, and one of the most common cancers that affects older, adult men. Although this disease has been found in adult men of various ages, the risk of getting it increases considerably once men reach the age of 50. Which is why hospitals and doctors recommend getting checked for the risk of prostate cancer at least once, as early as the age of 40.  The standout feature of prostate cancer is that unlike other forms of cancer, it does not manifest itself in the form of any physical symptoms until it becomes too late. However, the argument for screenings for men is made of the fact that statistics show that those men that get diagnosed with prostate cancer early, have a nearly 90% survival rate. So what exactly do the tests for diagnosing prostate cancer entail?

Prostate cancer screening tests are two distinct types:

  • Digital Rectal Exam (DRE): Is a physical exam where the doctor inserts a gloved, lubricated finger into the patient’s rectum in order to examine the prostate gland. This test is carried out in order to find and identify any abnormalities in the shape, size or texture of the prostate gland.
  • Prostate Specific Antigen (PSA) test: In this test, a blood sample is drawn and analysed for the substance, PSA which is naturally produced in the body by the prostate gland. High levels of PSA in the bloodstream may be an indicator of prostate infection, inflammation, enlargement or cancer.

If the DRE and PSA tests lead to the detection of an abnormality, your doctor might recommend getting an MRI or a biopsy done. Both these additional tests are used to determine whether the initial abnormalities that were discovered are because of cancer or some other prostate disorder such as a prostate infection or prostatitis.

Once the presence of prostate cancer has been determined, it now becomes imperative to go forward and analyse the cancer cells for their degree of aggressiveness and their degree of spread during the time of diagnosis. In order to determine the degree of aggressiveness of the cancer cells, they are sent to be examined by a pathologist. Once examined, the cancer cells are then given a Gleason score. These scores range from 2 to 10 and indicate how likely it is that a tumour will spread. A low Gleason score indicates that the cancer cells are similar to normal prostate cells and are less likely to spread (less aggressive). Conversely, a high Gleason score indicates that the cancer cells are very different from the normal prostate cells and are more likely to spread (more aggressive).

Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of cancer. If your doctor suspects your cancer may have spread beyond your prostate, imaging tests such as bone scan, CT scan, MRI, and PET scan might be recommended. Once the testing phase is complete, and the diagnosis and level of aggressiveness of cancer have been determined, the doctor then assigns cancer a stage. The stage at which cancer has reached is the most important factor in determining treatment options. The stages of prostate cancer are:

  • Stage 1 – This stage signifies very early cancer that’s confined to a small area of the prostate. When viewed under a microscope, the cancer cells aren’t considered aggressive.
  • Stage 2 – Cancer at this stage may still be small but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.
  • Stage 3 – Cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  • Stage 4 – Cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones, lungs or other organs.

Knowing the type and stage of cancer helps the doctor decide what treatment option would be best suited for a particular situation.

Dr.Rahul Bhatt 

Specialist Urologist 

Aster Clinic, Bur Dubai (AJMC) 

Dr.-Rahul-Bhatt

 

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Recurrent Headache

A headache is one of the most common and painful conditions for which a patient seeks medical attention. Globally, the percentage of the adult population with active headache disorders are 46% for headaches in general, 11% for migraines, 42% for tension-type headaches and 3% for chronic daily headaches. The disability attributable to tension-type headaches is larger, worldwide than that due to a migraine. On the World Health Organization’s ranking of causes of disability, headache disorders fall into the 10 most disabling conditions for the two genders, and into the five most disabling conditions for women.

Headaches are divided into two broad categories which are, primary headaches (without any underlying cause) and secondary headaches (with an underlying cause).

Primary headaches usually include Migraines, Tension-type headaches and Trigeminal Autonomic Cephalalgias. With migraines and tension-type headaches being the most common causes of headaches.

About 90% of headaches are caused by primary headaches, with the remaining 10% being caused due to secondary headaches. The responsibility of the clinician is to identify a secondary headache (which is more dangerous) as early as possible in order to prevent complications. There are some warning signs or red flags for the diagnosis of a primary headache. The presence of these red flags indicates the diagnosis of a secondary headache. The red flags are as follows.

  • A headache that is worse in supine, disturbs sleep or presents immediately upon awakening
  • A headache triggered by a cough, Valsalva, bending & exertion
  • A headache associated with Visual obscuration’s, double vision, transient changes in vision with change in posture
  • Vomiting preceding the headache
  • Headache onset after the age 50
  • First severe headache of life
  • Worsening of headache day by day
  • A headache associated with known systemic illness or systemic symptoms (Fever, neck stiffness)
  • A headache with abnormal neurological examination
  • New onset severe Headache during pregnancy or post-partum
  • A headache worsened in standing & relieved in supine
  • A thunderclap headache (time to peak headache intensity is sec to 5 min)
  • A new headache in a patient with AIDS and cancer patients

If the patient has a headache and presents any of the above features, it is important to rule out the secondary causes of a headache by doing the appropriate investigation (which in most cases is a brain MRI).

If the patient does not have any of the red flags, and their history is suggestive of one or more of the primary headache syndromes then the diagnosis does not require further tests and investigation.

The historical points in favour of the diagnosis of migraines are as follows:

  • One-sided headaches with alternating sides getting affected
  • The presence of visual or sensory aura symptoms before a headache begins.
  • Associated with nausea, vomiting, irritation of light, sounds and or smell during a headache
  • Pulsating nature of a headache
  • Triggered by a lack of sleep, stress, fasting, excess sunlight exposure, strong smell, travel, food items etc.
  • A headache worsened by and causing the restriction of the movements

The historical points in favour of tension-type headaches are as follows:

  • Both sided headache
  • Pressure like or band-like sensation
  • No or mild nausea, irritation of light or sounds (Any one of them)
  • Mild to moderate in severity
  • Usually not aggravated by movement

 

Patients with recurrent headaches should seek medical attention to decide whether they are suffering from the primary or secondary cause of a headache.

If it is a primary headache condition, it is important to prevent the medication over-use i.e. overuse of over the counter painkillers. They are detrimental because of two reasons 1) Painkiller overuse itself can trigger a headache 2) Long-term effects on the kidneys

If it a secondary headache condition, it is important to determine the appropriate cause by relevant investigations to prevent any further complications.

 

Dr.Vishal Pawar

Specialist in Neurology 

Aster Speciality Clinic, International City 

Dr.-Vishal

 

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