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Cancer can start anywhere in the body. They are a group of large cells that invades the organ or tissue and start growing aggressively if not controlled in time can lead to spreading to other parts of the body. Cancer is the second leading cause of death globally, accounting for an estimated 9.6 million deaths, or one in six deaths, in 2018.

Breast cancer is cancer that develops in the cells of the breast. Lobules are the glands that produce milk and ducts are the pathways that bring the milk from the glands of the nipples. The cancer cells are generally formed in these glands but they can also form in the fatty tissue or the connective tissue within your breast.

The lymph nodes are the general pathway that helps the cancer cells spread to the rest of the body parts. The unchecked cancer cells invade their way to healthy cells then can travel through lymph nodes under the arms.

Breast cancer cells can develop in both males and females, but it is most commonly diagnosed in females. It is the most common type of cancer. As per the American Society of clinical oncology 1 in 29 females develop breast cancer in India.

Breast Cancer Symptoms

In the early stages, it is difficult to detect breast cancer as it may not have any clear symptoms, sometimes the lump could be small making it hard to know. However, a mammogram could detect any abnormality.

The first symptom would a lump under your arms or on your breast that was not there before.

Other symptoms of Breast cancer are:

  • Pain in the breast
  • Rash around the nipples
  • Inverted nipples
  • Bloody discharge from the nipples
  • Redness and pit around the breasts
  • Change in the size and shape of the breast
  • Any change of appearance of the skin on the breast or nipples

All lumps are not cancerous it could also be a benign cyst but if there is any lump or other symptoms it is ideal to visit a doctor to exam further.

Key steps to prevent developing Breast Cancer in the future.

There is no way one could prevent breast cancer. But certain lifestyle decisions in one’s life can decrease the risk of breast cancer.

  1. Be active and maintain a healthy weight

It is necessary to have a healthy weight to prevent cancer. Hormone receptors can cause breast cancer cells to grow and develop. An increase in Hormone receptors can be caused due to excess fat in the body.

If you have a healthy weight maintaining it is very important as it decreases the chances of developing breast cancer. If you have an unhealthy try to get it under control through your diet. Adults should aim for at least 150 minutes a week of moderate activity.

  1. Avoid alcohol and smoking

There are pieces of evidence that show a strong link between smoking and breast cancer. Smoking is unhealthy and is linked to several cancers including lung cancer. Based on research it is advised to take not more than one glass of alcohol per day as having alcohol at a small amount still puts one at risk.

The more you drink or smoke the higher the chance of developing breast cancer.

  1. Regular visits to gynecologists and mammograms

It is ideal for women above the age of 40 to visit a gynecologist for an annual mammogram. Mammograms are effective to detect any abnormality and catching signs of cancer. Additional to regular visits and annual mammograms women should also self-examine their breasts as it will help to notice any changes in size and shape. Regular mammograms would not prevent cancer but help it detect at an early stage. If you detect any breast cancer symptoms it is important to communicate them to a doctor.

  1. Hereditary Factor.

Few women are at a higher risk of developing breast cancer due to hereditary factors. If a close relative in one’s family has or had breast cancer then the person’s chance increase. Women who carry certain mutations in the BRCA1 and BRCA2 genes are genes that produce a protein that repairs damaged DNA. Everyone has two copies of this gene that we inherit from our parents. They are also called tumor suppressor genes as they have certain changes that are harmful (pathogenic) variants (mutation) that can also have a higher chance of developing it. You may need to do a DNA test and to diagnose this mutation.

  1. Limitation in hormonal therapy

Discuss with your doctor the risks and benefits of hormonal therapy if you are taking it for menopause and chronic diseases. Combination hormonal therapy may put people at higher risk. That is why it is important to study and talk to your doctor regarding alternative medication and treatment.  If at all there is no substitute then consult your doctor and limit the dosage of medication.

Breast Cancer Treatment

Breast cancer treatment includes:

  • Surgery

There are two types of surgery depending on the size of the tumor.

  1. Lumpectomy- The tumor and small amount of healthy tissue around the tumor along with tissues under your arms are removed.
  2. Mastectomy- The surgical removal of the entire breast.
  • Chemotherapy

Chemotherapy is drugs used to destroy the cancer cells keeping the cancer cells from growing and multiplying.

It can be suggested to be given before surgery if the tumor is larger. As it will help it to shrink a bit making surgery go easier.

May also be given after surgery to reduce the risk of recurrence.

  • Radiation

The use of high x-ray particles to destroy cancer cells.

After lumpectomy radiation therapy is advised 3-4 times per week that is if the cancer cells have not spread to lymph nodes.

After a mastectomy, it is usually given 5 days a week.

The length of your radiation therapy depends upon the tumor and spread of cancer cells.

Following few steps and adding them to your lifestyle could be lifesaving. Be vigilant regarding any changes that are unusual and consult your doctor.

Today, Cancer is one of the most enigmatic topics in the field of medicine. Even though we know cancer as one of the most dreadful diseases, there’s more to it. To beat or prevent cancer, it is important to know its significance inside out. To put some light on Cancer treatment and its diagnosis, Dr Abhinav Deshpande (MBBS, MS, Mch Oncology, FIAGES), a well-known Cancer Surgeon from Nagpur, specialized in surgical oncology and a fellowship in Robotic surgery shares his experience and knowledge about Cancer via AMTL – Add more to Life’s Facebook LIVE conducted on the topic- Understanding Cancer: Diagnosis and Treatment on 11th February 2021 at 12 PM.

Here’s what Dr Abhinav Deshpande has got to say about the diagnosis and treatment of Cancer:

What is Cancer?

Very few people know the significance of the term ‘Cancer’. Cancer is derived from the Greek word Carcinos. Carcinos in layman’s term stands for ‘crab’. It is derived from this term because a crab has one main mass and its limbs spread in its underlying region. This formation of crab can be linked to Cancer. Because the swollen veins around a tumour mass resemble the limbs of a crab.

Cancer is not one particular disease. It is a group of diseases which involves the uncontrolled growth of abnormal cells.

 There are 3 important aspects to be considered while talking about Cancer.

–          Uncontrolled growth

–          Abnormal cells

–          Potential to spread or invade

Cancer is also known as ‘neoplasm’ or ‘malignant tumour’. This is very different from benign tumour- comparatively harmless.

Cancer in Numbers

Cancer is the second leading cause of death in the entire world. And globally, according to WHO, one in six deaths is unfortunately because of Cancer. According to the Indian Council of Medical Research, in India, one woman is dying of cervical cancer every 8 minutes. For every two females diagnosed with breast cancer, one woman dies of it in India. Now, due to tobacco, more than 3.5k people are affected in India, every day.

If we consider these and more such scenarios, there will be more than 15 lakhs cases of Cancer in India by 2025. That means 1 out of 10 Indians will suffer from Cancer and 1 out of 15 will lose their battle to cancer – according to WHO.

The best news is that if we are aware of this and if we receive the treatment early, it can be cured.

Beating Cancer

When surgeons try to treat cancer, there are 3 questions to be answered.

–          What are we trying to target?

–          Why are we trying to use the system?

–          How are we going to target it?

It’s like hitting the bull’s eye. Cancer has evolved over some time and undergoes different mechanics to escape the conventional mode of cancer treatment. This is one of the reasons why it is difficult to beat Cancer.

Risk factors
Various factors lead to certain types of cancers. These factors can be divided into 3 types.
–          Vulnerable factors
–          Contributing factors
–          Direct factors
Taking an example of Breast Cancer, here are various risk factors that can cause the disease in a woman.
Vulnerable factor – Early menses or late menopause
Contributing factors – Lack of exercise, excess of alcoholism, injection of pesticide or chemicals
Direct factors – Radiation, inherent mutations. If the genes are present already, these can be considered as direct factors.
These are the various factors that increase the chances of having breast cancer in a woman.  

Diagnosing Cancer

Diagnosing Cancer is major classified in steps. These are as follows.

Good clinical examination

Conventionally, a good clinical examination is the best possible way Cancer can be picked up and diagnosed at an early stage. It includes a general examination, followed by identifying the symptoms and confirming the underlying problem.

Pathological testing

After a good clinical examination, a pathological test is conducted, where a particular body part will be tested. Blood and urine test are usually put down on the list to detect Cancer. But apart from that, it also includes microscopic testing – which involves testing tissues using the needle test that helps is detecting Cancer and its types.

Radiology If after pathological testing, the results are positive, doctors need to understand the stage of cancer. Depending on that, the treatment will be subjected to patients which will include different radiology tests and nuclear.

How doctors all over the globe are coming together to fight cancer?

Due to advancement in technology, cancer specialists, cancer fighters, as well as cancer caregivers all over the world, has adopted ‘team-approach against this illness. Surgical oncologists may tackle this illness with surgery, medical oncologists will take care through chemo-therapy, immune-therapy, targeted-therapy or hormonal treatment, Radiation-oncologist may try to kill cancer via radiation protocols and radiation beams. According to literature, it is observed that more than 30-50% of patients have a significant amount of pain in Cancer. So, the pain-management teams help patients to tackle and minimize pain. Once Radiologists are specialized in finding out important parts affected by cancer through radiology. Another branch of the team consists of onco-pathologists that carry out the molecular diagnostics and genetic testing of Cancer. Oncoplastic surgeons, reconstructive surgeons, nursing staff, rehabilitation, physiotherapy department, nutritionists, etc all form an important part of this team approach.

There are times when cancer has already spread to various body parts of the patient. Such palliative cases are handled by palliative care experts who take care of the patient by trying to minimize his agony in the best possible way. Undergoing cancer treatment is a tremendous emotional turmoil for the patient. To aid the patient to live a normal life post-surgery and cope up with the situation, psychological and Physiatrist counsellors play an important role.

medicines scans. There are different types of radiological tests. For example, X-ray for lung, mammography for breast, CT Scan, MRI, thyroid scan, etc.

Once these steps are covered, the stage and the type of cancer is diagnosed.

This team-approach of the care-givers and doctors all around the world work as a multidisciplinary team to fight against Cancer.

Three important treatments

When it comes to treating cancer, three main options are available:

·         Surgical oncology

It deals with the surgical aspects of treating Cancer- ‘How do you remove cancer from the body through operations?’.  This process takes care of the parts affected with cancer as well as the potential organs where the disease might spread.

·         Medical oncology

This treatment deals with treating Cancer through medical processes like Chemotherapy.  targeted therapy, and Immunotherapy

Targeted therapy is very precise and targets only cancer cells minimizing any other side effects, unlike chemotherapy. In Immunotherapy, the body’s immune system fights against the cancer cell.

·         Radiation Oncology

It involves radiation therapy to target cancer tumours- the extremely focussed radiation branches like image-guided radiation therapy or immuno-guided radiation therapy reduces to treat cancer that prevents side effects on the surrounding organs and maximizes the effect on cancer cells.

How treatment patterns have changed in recent times?

With the advancement in technology, treatment options have evolved over some time. Following are a few patterns and what do they stand for:

Oncological clearance – It removes cancer and does not spread throughout the body.

Cosmesis of the patient – Cosmesis stands for preservation, restoration, or bestowing of body part’s structure affected with cancer.

Organ preservation – Normal organ function is safeguarded while tackling cancer.

Quality of life – An idea of improved lifestyle post-surgery for patients.

Can Cancer be prevented?

Yes. It can be prevented. Frequent tobacco smoking is one of the most important causes of cancer. If the person does not smoke, cancer can be prevented at an early stage. Other factors like alcohol consumption, excess body weight, obesity may also lead to cancer. Being physically active can help one to avoid cancer.

Certain vaccines like hepatitis B and hepatitis C can also help to prevent cancer.

Progression in Cancer Treatment

Knowing the basic cause of Cancer or knowing how to identify the basic symptoms can save a million lives. For example, if your immediate relatives have cancer or many people from one side of the family have some type of cancer, consult a doctor for genetic counselling. Self-examination in-case of breast cancer or even pap smear test for cervical cancer should be encouraged after a particular age group.

To conclude on a positive note, robotic surgery, personalized oncology, immune therapy, liquid-biopsy, and much more advancements are happening in the cancer treatments that boost self-esteem in cancer patients.

When it comes to the wellbeing of  COVID-19 and Cancer patients- one has to be more cautious and follow the hygiene guidelines applicable to everyone. Wash your hands frequently, maintain social distance and use an alcohol-based hand rub to stay safe.

It is important to look forward to optimistic survivors as Cancer awareness is a paramount step to fight and defeat cancer.

Introduction

When you become pregnant, you initiate a life-changing journey. You also experience changes in your body, emotionally, and in your lifestyle during pregnancy with your growing baby as he/she passes through each stage of growth. You need to have information to help you make decent decisions for a healthy baby as well as your well-being.

A) Getting Pregnant

Getting Started

If you are considering starting a family, you possibly have speculated how long it will require to become pregnant when to engage in sex, and how many times.

For the majority of couples trying to get a baby, the chances that a woman will get pregnant are 15% to 25% in any specific month.

But some factors can affect your odds of getting pregnant:

  • Age: Your chances of becoming pregnant in any given month decline, after you reach 30 years of age, dropping sharply in your 40s.
  • Irregular menstrual cycles: Having an irregular cycle makes it difficult to ascertain the best time to have sex.
  • Frequency of sex: The chances of getting pregnant increase with the frequency of sex.
  • Amount of time you have been trying to get pregnant: Your chances of becoming pregnant may be lesser if you haven’t become pregnant even after 12 months of trying. Talk to your doctor about tests for female and male infertility.
  • Certain medical conditions can affect your chances of getting pregnant.

Understanding Menstrual Cycles

A woman’s menstrual cycle starts on the first day when they notice bright red blood and it terminates on the day before the next cycle starts. The cycle can be 21 to 35 days long or even more. If their cycle differs in length by a few days from one month to another, that is termed irregular. Numerous women do not have regular cycles and it does not essentially reflect a presence of complication.

Having Sex, Getting Pregnant

Recent evidence has demonstrated the window of opportunity for conceiving is pretty small: Basically, it’s only 3-5 days before ovulation and the day of ovulation itself. Your ideal chances are 1-2 days before ovulation.

Signs of ovulation are as follows:

  • Rise in normal body temperature, characteristically 1/2 to 1 degree
  • Higher levels of luteinizing hormone (LH), measured on a home ovulation kit
  • Clearer and thinner vaginal discharge, resembling raw egg whites
  • Breast tenderness
  • Bloating
  • Light spotting
  • Minor pain or cramping

Sexual intercourse is recommended every alternate day by doctors starting the week before ovulation or beginning after the end of your period. Having sex at least two to three times every week is termed ideal. As long as the man’s sperm count is normal, having sex every alternate day or even every day further elevates your chances of conceiving.

Stopping the Birth Control Pill to Get Pregnant

After stopping the birth control pill consumption, it is possible to conceive instantly, however, it may require a few months for normal ovulation to resume again.

Pre-Pregnancy Checklist for You

Even if you have not conceived yet, you can engage in multiple tasks to achieve the required health for a growing baby. Such tasks are explained below:

1. Consult your doctor.

Even if you are getting pregnant for the second time, it is a commendable indication to consult your gynecologist before conceiving. It is vital to bring your co-morbid health condition under control before getting pregnant, if you have any, as they could decrease your chances of becoming pregnant or make your pregnancy riskier. You should get a pre-conception screening test if your family carries a history of genetic diseases.

2. Visit a dentist.

It is believed that a link exists between good oral health and healthy pregnancy. The disease of gums is associated with premature birth and low birth weight. Hence, it is advisable to consult a dentist to solve any problems before getting pregnant.

3. Quit smoking and drinking.

Tobacco and alcohol during pregnancy are never advisable. They are not good for a baby’s growth and can lead to health problems in them later in their lives. Also, smoking and drinking can make pregnancy tougher and elevate your risks of a miscarriage.

4. Restrict caffeine intake.

Consuming more than 250 mg of caffeine (approximately more than 2 cups of coffee a day) could make pregnancy harder for you and also raise risks of miscarriage.

5. Eat healthily.

Avoid junk food. Consuming lots of fruits, vegetables, whole grains, and lean protein daily is recommended. A healthy diet regimen before conceiving can minimize the risks of diabetes during pregnancy (gestational diabetes).

6. Bring your body weight to a healthy level.

Obesity/overweight can elevate occurrences of conditions like gestational diabetes and high blood pressure during pregnancy. It is not perceived as a good idea to lose weight during your pregnancy, so if you intend to lose weight, begin before getting pregnant.

Exercising every day not only helps you to achieve a healthy weight, but it will also bring you into shape for labor and delivery. Try to find special pre-natal exercise classes, once you become pregnant.

7. Ensure you have taken all your vaccines.

Some diseases during pregnancy might impact your baby. Visit your doctor to inquire about the vaccines you require and when you require them.

8. Inform your doctor about the medicines you consume.

Your doctor must know about all the medicines you are taking, including vitamins and supplements, as some of them could adversely affect your baby. It is suggested to initiate a prenatal vitamin or folic acid supplement to minimize your baby’s risk of birth defects.

9. Choose seafood wisely, if you are a non-vegetarian.

While you are pregnant, avoid consuming fish that are high in mercury. Consuming fish twice a week is acceptable, but avoid fish that have a lot of mercury.

Pregnancy after the age of 35

The majority of healthy women who get pregnant after 35 and even 40 years of age can conceive healthy babies. Problems can arise irrespective of your age during your pregnancy. But some become more probable, after 35 years, including:

  • High blood pressure, causing preeclampsia (seriously high blood pressure and organ damage)
  • Gestational diabetes
  • Miscarriage or stillbirth
  • Labor problems requiring a C-section delivery
  • Premature birth
  • Low birth weight
  • Genetic disorders in the baby

On the contrary, it is also believed that getting pregnant in your 30s is better for some ladies and their babies because of the following reasons.

  • Older moms incline to be better educated and have higher financial earnings, indicating better resources than younger moms.
  • Older moms are more likely to have longer lives.
  • Children of older moms may be healthier, more cooperative, and better educated.

How Can You Increase Your Chances of Conceiving a Healthy Baby?

When you decide you are ready to become a mother, take these steps before you get pregnant.

  • Visit your doctor: Get a checkup done to make sure you are physically and emotionally prepared for pregnancy.
  • Get early and regular prenatal care: The first 8 weeks of your pregnancy are vital for the development of your baby. Regular prenatal care can elevate your odds of having a safe pregnancy as well as a healthy baby. Prenatal care includes regular testing and ultrasound exams, education, and counseling. It lets your doctor stay attentive to many common health conditions. During prenatal visits, the doctor will check your blood pressure, check your urine for protein and sugar, and examine your blood glucose levels.
  • Take prenatal vitamins: All women of childbearing age should include a daily prenatal vitamin with at least 400 µg of folic acid, days before and during the first 3 months of pregnancy. It can support in preventing defects in the baby’s brain and spinal cord. It also adds extra protection for older women who are more probable to deliver babies with birth defects.

How Can I Lower My Risk for Pregnancy Problems?

  • Take care of yourself and manage any existing health problems and protect yourself from pregnancy-related disorders.
  • Be regular with other doctor appointments. If you suffer from a long-lasting health issue, don’t miss your regular doctor visits.
  • Prefer a healthy, well-balanced diet, rich in fruits and vegetables, whole grains, beans, lean meats, and low-fat dairy products. Every day, you should eat and drink ample dairy and other calcium-rich foods that will maintain your teeth and bones’ health, while your baby grows. Include food sources rich in folic acid, like leafy vegetables, dried beans, and some citrus fruits.
  • Gain/lose the amount of weight your doctor suggests.
  • Exercise regularly.
  • Stop smoking and drinking alcohol.
  • Consult your doctor about medicines during pregnancy and while breastfeeding. This includes prescription and over-the-counter medicines, supplements, and natural remedies.

Pregnancy Tests

A pregnancy test can enable you to discover whether you are pregnant. Pregnancy tests check your urine or blood for a hormone called human chorionic gonadotropin (hCG). Your body synthesizes hCG after a fertilized egg attaches to the wall of your uterus, usually happening about 6 days after fertilization. Levels of hCG elevate rapidly, doubling every 2 to 3 days.

  • Blood tests: These tests can detect pregnancy before a home pregnancy test can, about 6 to 8 days after ovulation. However, it takes a lengthier duration to get the results than with a home pregnancy test.

The two types of blood pregnancy tests are:

I) A qualitative hCG test: It just detects the presence of hCG.

II) A quantitative hCG test (beta hCG): It quantifies the precise levels of hCG in your blood. It can detect even very low levels of hCG.

  • Urine tests: You can use these tests at home or in a clinic. Home pregnancy tests are rapid and easy to use, apart from being private and convenient. They are also very precise if directions are followed exactly. All of these tests work comparably. You test your urine in one of these ways:
    • Hold the test stick in your urine stream
    • Collect urine in a cup and dip the test stick into it
    • Collect urine in a cup and use a dropper to put it into another container
    • You’ll need to wait a few minutes before seeing the results.
    • After you take this test, you can confirm your results by seeing your doctor, who can do even more sensitive pregnancy tests.

Urine home pregnancy tests are about 99% accurate. Blood tests are even more accurate.

When to Take a Pregnancy Test?

Some pregnancy tests can detect hCG before a missed period. But if you postpone testing until the first day of a missed period, the results will be more accurate. Results may also be more precise if you perform the test in the morning when your urine is more concentrated.

Early Symptoms that indicate you are Pregnant

  • Spotting and Cramping
  • Changes in Breast Size
  • Fatigue
  • Morning sickness (Nausea)
  • Missed Period
  • Frequent urination
  • Constipation
  • Mood swings
  • Headaches
  • Back pain
  • Dizziness or fainting

B) What to Expect during Different Trimesters of Pregnancy?

First Trimester

The first trimester refers to the first 3 months of pregnancy. It starts on the first day of your last period and continues until the end of the 13th week. Pregnancy differs for every woman. Some women demonstrate a pregnancy glow with good health while others feel depressed. Following changes might be noticed:

I) Bleeding: Around 1/4th of pregnant women experience minor bleeding during their first trimester. Light spotting may direct the implantation of the fertilized embryo in your uterus, early in the pregnancy. However, call the doctor if you experience severe bleeding, cramping, or sharp pain in your abdomen, as these events can indicate a miscarriage or a pregnancy where the embryo implants outside of the uterus (ectopic pregnancy).

II) Tenderness in your Breasts: Painful breasts are amongst the initial signs of pregnancy. They are caused by changes in the hormone levels, which enable your milk ducts to feed your baby. Your breasts will possibly remain sore during the entire first trimester.

III) Constipation: During pregnancy, high progesterone levels delay the muscle contractions that are involved in moving food through your digestive system. Additionally, iron supplements also contribute to constipation and flatulence (gas) which can cause bloating during your pregnancy. Consume more fiber-containing foods and drink additional fluids to ease this condition. Physical activity can also help. Your doctor may prescribe a mild laxative or stool softener during pregnancy.

IV) Discharge: It is common to observe a thin, milky white discharge (leukorrhea) initially in your pregnancy. Call the doctor, if the discharge is stinky, if it looks green or yellow, or if the amount of clear discharge is more than normal.

V) Fatigue: As your body is working more than usual to support a growing baby, you will get tired more quickly than normal. Rest when you feel the need. Ensure you are receiving sufficient iron through food and supplements throughout your pregnancy.

VI) Altered Food Cravings: Greater than 60% of pregnant women experience cravings for food. More than half consume foods which otherwise they don’t like. Giving in to cravings at timely intervals is fine, till you are eating healthy, low-calorie foods on most occasions. If you feel the urge for eating non-foods such as starch, report it to your doctor immediately.

VII) Increased Urination: Your baby is still pretty small, but as your uterus grows, it puts pressure on your bladder. As a result, you may experience the urge to urinate more frequently than normal. Don’t stop drinking water or other fluids, as your body needs them. However, minimizing caffeine intake is advisable, especially before going to sleep. When you feel the urge, use the washroom as soon as possible. Trying to hold the urine is not wise.

VIII) Heartburn: Your body makes extra progesterone hormone during pregnancy. It relaxes smooth muscles, including the ring of muscle in your lower food pipe. These muscles usually keep food and acids down in your stomach. When they get relaxed, you can experience acid reflux or simply, heartburn.

IX) Mood swings: Augmented fatigue and altering hormones can prove to be an emotional disaster for you. Talking to your loved ones or even consulting a specialist can be of great help.

X) Morning sickness: Nausea/Morning Sickness is one of the most frequent symptoms of pregnancy and up to 85% of pregnant women experience it. It occurs as a result of changes in the level of hormones in your body and can continue during the entire first trimester. Nausea is mild in some women, while others can experience aggressive symptoms. Try eating small, bland, or high-protein snacks and sipping water, clear fruit juice or ginger ale to ease your nausea. Avoid any foods that are harmful to your digestive system. Consult your doctor if you experience aggressive symptoms.

XI) Weight gain. Weight gain is considered a good thing during pregnancy but is not considered healthy beyond a certain level. Gaining about 3-6 pounds during the first trimester can be considered OK. You only need about an extra 150 calories per day during the first trimester, despite carrying your baby. You can achieve these levels, by consuming more fruits and vegetables, milk, whole-grain bread, and lean meat to your diet.

First Trimester To-Do’s

Becoming a mother is one of the most jubilant times in many women’s lives. However, you also need to take some practical steps during the first trimester, including:

I) Consult a doctor: As soon as you know you are pregnant, arrange a prenatal visit. The doctor will take a full medical history and discuss your lifestyle and health habits. They will comprehend your due date. You will also undergo blood and urine tests and probably a pelvic exam. Repeat your prenatal visits every 4 weeks. The doctor will check your weight and blood pressure, test your urine and examine your baby’s heartbeat during each visit. Your doctor may also prescribe some additional tests, such as tests to look for genetic problems with your baby.

II) Dietary Supplements: You will be asked to start taking a prenatal vitamin with at least 400 µg of folic acid to help your baby’s brain and spinal cord grow properly. Inquire your doctor regarding the safety of prescription and over-the-counter medicines you can still take. IITake a look at your diet and make any changes you need to make sure you and your baby get the right nutrition. Drink plenty of water.

III) Stop Smoking and Restrict Alcohol/Caffeine

IV) Maintain your Workout Schedule

Emergency Symptoms During the First Trimester

Any of these symptoms could be a sign that something is seriously wrong with your pregnancy. Don’t wait for your prenatal visit to talk about it. Call your doctor right away if you experience:

  • Severe abdominal pain
  • Heavy bleeding
  • Severe dizziness
  • Rapid weight gain or too little weight gain

Tests during First Trimester

I) Blood tests: During one of your initial examinations, your doctor will identify your blood type and Rh (rhesus) factor, screen for anemia, check for immunity to Rubella and test for hepatitis B, syphilis, and HIV and other sexually transmitted diseases.

You may be offered tests and genetic counseling to assess risks for diseases such as Tay-Sachs, cystic fibrosis, and sickle cell anemia. Tests for exposure to diseases such as toxoplasmosis and chickenpox may also be done if needed. Your health care provider may also want to check your levels of hCG, a hormone secreted by the placenta, and/or progesterone, a hormone that helps maintain the pregnancy.

II) Urine tests: You will also be asked to provide your urine sample so that to detect signs of kidney infection and, if essential, to confirm your pregnancy by measuring the hCG level. Urine samples will then be collected regularly to detect glucose and protein.

III) Genetic Testing: You will be presented with genetic testing in the latter part of the first trimester. Some people feel like these tests may cause them unwanted stress and they prefer to ensure the baby is genetically normal post-birth. Discuss with your doctor, whether genetic testing is right for you and your pregnancy. One of the first-semester genetic tests combines a blood test with an ultrasound to screen for Down syndrome. It may be available between 11 and 14 weeks of pregnancy.

IV) Non-Invasive Prenatal Testing (NIPT) screening: This cell-free fetal DNA test can be done as early as after 10 weeks of pregnancy. The test uses a blood sample to measure the relative amount of free fetal DNA in a mother’s blood. It is believed that the test can detect 99% of all Down syndrome pregnancies as well as some other genetic abnormalities.

V) Chorionic villus sampling (CVS): You will be offered this test usually between 10 and 12 weeks of pregnancy in case you are 35 or older, have a family history of certain diseases, or have had positive non-invasive genetic tests. CVS can detect multiple genetic defects, such as Down syndrome, sickle cell anemia, cystic fibrosis, hemophilia, and muscular dystrophy.

Second Trimester

The second trimester of your pregnancy continues from week 13 to 28. It is the middle phase of pregnancy, when you may start to see your “baby bump” and feel your baby move for the first time. The morning sickness and fatigue you may have felt during the last 3 months should diminish, as you enter your second trimester of pregnancy.

The second trimester is the easiest 3 months of pregnancy for many women. Your baby grows rapidly during the second trimester. You will have an ultrasound between your 18th and 22nd week of pregnancy, so your doctor can see how your baby is progressing. You also can learn the sex of your baby, however, it may be prohibited by law. Although you should be feeling better now, big changes are still taking place inside your body. Here’s what you can expect.

Changes in Your Body in Second Trimester

I) Pain in your lower abdomen

II) Backache

III) Bleeding gums

IV) Breast enlargement

V) Congestion and nosebleeds

VI) Discharge

VII) Dizziness

VIII) Frequent urination

IX) Hair growth

X) Headache

XI) Heartburn and constipation

XII) Hemorrhoids

XIII) Leg cramps

XIV) Quickening: By 20 weeks into your pregnancy, you will probably have started to feel the first delicate flutters of movement in your abdomen, which is often called “quickening.” If you aren’t feeling your baby move yet, don’t worry. Some women don’t experience quickening until their sixth month of pregnancy.

XV) Skin Changes:

XVI) Spider and Varicose Veins

XVII) Urinary Tract Infections

XVIII) Weight gain

Emergency Symptoms during Second Trimester

  • Severe abdominal pain or cramping
  • Bleeding
  • Severe dizziness
  • Rapid weight gain (more than 6.5 pounds per month) or too little weight gain (less than 10 pounds at 20 weeks into the pregnancy)
  • Jaundice
  • Vomiting
  • Profuse sweating

Tests during the Second Trimester

Here are the prenatal tests that may be performed in the second trimester of your pregnancy:

Maternal serum alpha-fetoprotein (MSAFP) and multiple marker screening: This test is an optional genetic screening test and as with all screening tests, talk with your doctor about the pros and cons to see if it is right for you. Abnormal levels indicate the possibility (but not the existence) of Down syndrome or a neural tube defect such as spina bifida, which can then be confirmed by ultrasound or amniocentesis.

Non-Invasive Prenatal Testing (NIPT) screening

Ultrasounds: Ultrasounds are commonly offered after week 20. It may be offered for multiple reasons, including verification of a due date, checking for multiple fetuses, investigating complications such as placenta previa or slow fetal growth, or detecting malformations like cleft palate.

Glucose screening: This is a routine test for pregnancy-induced diabetes, characteristically done at 24 to 28 weeks, which can result in overly large babies, difficult deliveries, and health problems for you and your baby.

Amniocentesis: This optional test is usually performed between 15 and 18 weeks of pregnancy for women who are 35 or older, or have a higher-than-usual risk of genetic disorders.

Fetal Doppler ultrasound: A Doppler ultrasound test uses sound waves to evaluate blood as it flows through a blood vessel. Fetal Doppler ultrasound can determine if blood flow to the placenta and fetus is normal.

Third Trimester

The third trimester is the last phase of your pregnancy and lasts from weeks 29 to 40. During this trimester, your baby grows, develops, and starts to change position to get ready for birth.

In the third trimester, your baby keeps growing. By the end, a full-term baby usually is between 19 to 21 inches long and between 6 to 9 pounds.

Your baby begins to turn itself head-down to get ready for delivery. At week 36, the baby’s head should begin to move into your pelvic area, also called lightening. It will stay in this down-facing position for the last 2 weeks of your pregnancy.

Your baby develops in other important ways in the third trimester. During this phase, it’s able to:

  • See
  • Hear
  • Suck on its thumb
  • Cry

Your baby’s brain continues to develop. Its lungs and kidneys mature. The bones at the top of a fetus’s skull are soft to ease delivery. Most babies have blue eyes at this stage, and they’ll stay that color until a few days or weeks after they’re born.

During the third trimester, the vernix caseosa, a protective coating, covers your fetus’ skin. Soft body hair called the lanugo falls out and is almost gone by the end of week 40.

  • Abdominal pain
  • Backache
  • Bleeding
  • Breast enlargement 
  • Nightmares
  • Clumsiness
  • Discharge
  • Fatigue
  • Frequent urination
  • Heartburn and constipation.
  • Hemorrhoids.
  • Leaky breasts.
  • Sciatica.
  • Shortness of breath.
  • Spider and varicose veins.
  • Stretch marks
  • Swelling
  • Weight gain

Red Flag Symptoms

Any of these symptoms could be a sign that something is wrong with your pregnancy. Don’t wait for your regular prenatal visit to talk about it. Call your doctor right away if you experience:

  • Severe abdominal pain or cramps
  • Severe nausea or vomiting
  • Bleeding
  • Severe dizziness
  • Pain or burning during urination
  • Rapid weight gain (more than 6.5 pounds per month) or too little weight gain

G) Third Trimester Tests

These tests are common in the third trimester of pregnancy:

  • Group B streptococcus screening
  • Electronic fetal heart monitoring
  • Non-stress test
  • Contraction stress test
  • Biophysical profile

H) Postpartum Care

Here are some steps you can take to feel better after delivery:

  • Limit visitors so you and baby can rest.
  • Get help with cleaning and meals.
  • Follow your doctor’s instructions for recovery.
  • Keep your feet raised to prevent swelling in your legs.
  • Sit in a warm bath to relieve vaginal discomfort.
  • Use creams or lotions to fade stretch marks.
  • Eat plenty of fruits, vegetables, and whole grains.
  • Wear a supportive bra to relieve sore breasts.
  • If breastfeeding, use nipple cream for sore nipples.
  • Not breastfeeding? Ask your OB about breast care.
  • Drink water and eat fiber to prevent constipation.
  • Schedule a follow-up visit with your doctor.
  • Don’t try to lose baby weight too quickly — go slowly.
  • If you feel sad, talk to a friend or family member.
  • If sadness lasts more than 2 weeks, call your doctor.
  • Take care of yourself so you have more energy for your baby.
  • Talk to your doctor about constipation or hemorrhoids.
  • Make time for yourself and ask for help when you need it.

I) Pregnancy Complications

  • Anemia
  • Bleeding during Pregnancy
  • Abdominal Separation
  • Pre-eclampsia and Eclampsia
  • Bed Rest
  • Premature Labor
  • Miscarriage
  • Ectopic Pregnancy
  • Placenta Previa

Out of everything that we have discussed above, the most important factor is managing stress. And, feeling stressed during pregnancy is quite common because it is a time of many changes including your life, body, family, and emotions. High levels of stress can take a toll on the pregnant mother and increase the chances of a premature baby. Hence, it is paramount to seek quick help if you are experiencing prolonged symptoms. Make sure you are having a decent sleeping cycle, plenty of time with your partner, and accept help whenever on offer from a trusted source.  Attend every prenatal care checkups with your doctor and monitor the baby throughout your pregnancy.

Cardiovascular disease continues to be the leading cause of death and disability worldwide. According to the World Health Organization, more people die (around 17.9 million every year)  from CVDs worldwide than from any other disease. About 80% of these deaths are due to coronary heart diseases (eg. heart attack) and cerebrovascular diseases (eg strokes). For both men and women, heart attack remains one of the leading causes of death but they may experience the symptoms of the disease a little differently. It is not necessary that the most typical signs e.g pain in the left hand is what a woman would experience while she is having a heart attack. Aged women above 65 years are more likely to have a heart attack but unhealthy lifestyle habits can also expose younger women to CVDs. Understanding the female-specific symptoms could help an individual seek medical attention faster, which could prove to be life-saving.  Let us now take a look at some warning signs of a heart attack that every woman should know and shouldn’t be overlooked at any cost.

1. Chest pain/ Angina:

This symptom is the most common hint of a heart attack. A woman could experience pain in any part of the chest and not just the left side. It is usually a feeling of tightness and extreme pressure in your chest.

2. Pain in Back, Arms, Neck, and Jaw

This type of symptom is slightly abrupt and gradually increases. It can come and go anytime and anywhere including both your arms at one time, back, or even neck. This kind of pain may be extreme and can wake you up from sleep. Even the jaw pain could be either on the left or right.

3. Stomach Pain

A lot of times this pain is overlooked and treated as an acidic burn or maybe ulcer, flu, etc. But, it could be a possible warning sign of a heart attack for women. It feels like there’s extreme weight kept on your stomach. 

4. Shortness of breath and Nausea

This could occur at one of the most unusual times for instance while you are resting and there’s no physical activity involved. This may increase over time and also lead to stress.

5. Sweating

A woman may experience this even in cool places. A nervous, cold sweat without a possible reason can be taken as a sign of a heart attack. It is very different than your regular warm sweats after a good run.   

6. Fatigue

This feeling is natural when you have a lot of tasks to finish but when you feel the same at a time when you haven’t exerted yourself could be a cause of worry.

And, once you recognize these symptoms of a heart attack, it is important to treat the situation on an emergency basis and rush to your nearest healthcare provider. Identifying the symptoms of a heart attack can save your and other’s life. Ideally calling for an ambulance is the safest way to go about it. Self-driving may worsen the situation and put you in more danger.

Heart attack prevention

Now that we have discussed the symptoms of a heart attack, let us move towards three  key factors that can help prevent a heart attack.  

Quit smoking and limit alcohol

Smoking increases the fatty deposits in the arteries which increases blood clotting and affects the blood lipid levels. Also, nicotine is the primary reason to accelerate the heart rate and increase blood pressure. Drinking too much alcohol can also raise blood pressure, increase cardiomyopathy, stroke, cancer, and other diseases.

Physically active

Doing any physical activity like weight training, endurance training, or playing any sport can boost our heart health. Even a 30 mins brisk walk every day can do wonders to your heart. Studies say that people who have achieved even a moderate level of fitness are less likely to die early than those with a low fitness level.

Good nutrition

The most important thing for any human body is the quality of food that we consume. Making the right food choices and having a healthy mix of protein, carbs, and fats in your diet can keep your heart health on top. It is also crucial to managing a ratio of bad vs good cholesterol. Intake of vegetables, fruits, and whole grains; includes low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts; and limits intake of sweets, sugar-sweetened beverages, and red meats can boost your heart health.

Lastly, routine check-up and discussion about your risk factors with your healthcare provider before making any alterations is a must.  A heart attack is a serious and most fatal medical event that requires emergency treatment and any symptoms should never be taken lightly. Right know-how and awareness can improve outcomes and prevent complications in the future.

Introduction

Though people have started receiving COVID-19 vaccine doses, it is believed that we have to face a great amount of time combating this virus as the vaccine will take a long time for the vaccine to produce a prominent effect, while the pandemic carries on. Till then, people should anticipate that multiple restrictions of the COVID-19 pandemic will be continued for some time as we will have to co-operate with the authorities to diminish transmission of COVID-19 infection. It is believed that you will probably be required to continue adorning a mask and keeping a physical distance from each other while in public for quite a few coming months, even after you receive the COVID-19 vaccine.

No clear change evident for the near future

Everyone must realize that there will be no “instant change” in our community because of limited vaccine production and high demand. Hence, our lives won’t be shifting back to our predetermined notion of “normal” anytime shortly.

Also, vaccines are being given on a priority basis to forefront healthcare workers and the high-risk elderly population. But in a country like India, there are not sufficient vaccine doses available, to meet the required demand.

In addition to the above constraints, some vaccines need “ultra-cold temperature facilities” with -80°C freezers for their storage, which is a challenge for some economically less-developed territories. This situation reflects that facilities having the capacity to store massive quantities of the vaccine properly will be required, and then equally distribute it to every area of a state. The COVID-19 vaccine will need two doses, 3 to 4 weeks apart, as with the majority of other immunizations and for this to be accomplished appropriately, strict public health tracking would have to be in place to ensure people recognize accurate timings to receive their second dose after receiving the first dose.

No more ‘old normal’

Experts believe that there is still no real-world data available to ascertain the safety and effectiveness of the COVID-19 vaccines with complete surety. As of current knowledge, it is likely you could be protected from the symptoms of the disease, but it “might not protect you from getting infected and transmitting the infection. This means that we still need to adhere to the same preventive protocols.

The long road ahead

The duration of effectiveness of the current COVID-19 vaccines is also not clear, unlike the vaccines for other viral diseases, which provide life-long immunization. It is thought that with this coronavirus vaccine, if you get it once, your immunity will leave sooner or later, matching other flu conditions.

However, there is a silver lining to the dark cloud of this virus. It doesn’t seem to transform at a rapid rate, like influenza. It means that it won’t require regular development of new vaccines.

However, “patience” is the need of the hour as it will take months for the COVID-19 vaccine to become available freely for a majority of the population. Hence, people must not assume at this juncture that they won’t be needing to wear masks after a couple of months. Instead, people should accept that they still need to follow preventive norms for COVID-19 in terms of face masks and physical distancing for the next 4 to 6 months.

What you can and cannot do after getting your COVID-19 vaccine shot?

Drives for coronavirus vaccination have been initiated all across the globe. In India, over 2 lakh people have been vaccinated as of now and more stages are already in motion to immunize elderly individuals, individuals with co-morbid conditions, subsequently the younger population. At present, vaccination is the only good way of accomplishing herd immunity and will give the authorities and all the people at large, an estimated time by when things would be improving.

However, vaccination does not promise a total end to the pandemic. The vaccines are still experimental, and there is no reliable evidence to support their effectiveness in a “real-world” scenario. Again, mass inoculation and rates of prevention also depend on the number of people getting the vaccine, and the doses accessible for use. Thus, the resumption of a total pre-COVID lifestyle won’t be so relaxed even if vaccines make life easier. Following is a list of actions you can safely perform, and the ones you cannot even after getting vaccinated

1) You can’t throw your mask away at this moment

2) You cannot consume alcohol for 45 days

A vaccine can only perform in the presence of a strong and healthy immune system. For the same reason, it has been recommended to people to avoid consuming alcohol and certain things that can make immunity weak for some days. Alcohol is alleged to destroy the functioning of the immune system and make a person incapable of developing adequate elicitation of an immune response after receiving the vaccine dose. Hence, as per the expert opinion, people should avoid alcohol consumption for at least 45 days after their vaccination.

3) You can resume caring for COVID-19 patients

Caregiving for COVID-19 patients can be initiated by the doctors and health care workers who receive their entire vaccine doses (In most cases, both the doses). Hence, vaccination has been prioritized for the frontline-healthcare workers, doctors, and indispensable staff.

While basic precautions will still need to be followed, with COVID immunized records, you will have faint chances of getting infected from direct exposure to patients, and relieve the anxiety of their loved ones.

4) You will still be required to follow physical distancing

5) You will still be required to avoid public places

Vaccination won’t give people a license to stroll or meet in large numbers- at least at the start. Till an ample proportion of herd immunity is reached, there will be an abundant number of non-immunized people who, if infected, can transmit it to other people.