Author: Sanjivani@admin

Fibroids are some of the most common reproductive systems tumours women experience. They are also known as uterine myomas, leiomyomas, and fibromas. On average, 20-50% of women between the ages of 13 and 50 have fibroids. However, not all large enough to be detected during a physical examination.

Below are some of the common questions my patients ask me about fibroids:

What Are Fibroids?

Fibroids are smooth muscle tumours arising from the muscular wall of the uterus.

How are they Diagnosed?

A woman may feel a lump in her abdomen, heavy menstrual cycle, or experience pressure-like symptoms such as frequent passing of urine and bloating. Fibroids are hormone-dependent and found in women between the ages 30 and 40. They can be diagnosed by a physical examination, an ultrasonography, or an MRI.

How are Fibroids Treated?

Smaller non-symptomatic fibroids could be observed with regular follow-ups, but fibroids symptoms need to be managed. Medical management with oral or injectable medicines could give temporary relief but may have undesired side-effects like bone loss.

Surgical removal of fibroids used to be done with a large cut in the abdomen, but now can it be achieved laparoscopically. In fact, laparoscopic removal is now a gold standard and has the following advantages:

• Magnified well-lit high definition visuals
• Precise and accurate surgical technique
• Lesser pain with minimal tissue handling and scarring
• Decreased blood loss
• Shorter convalescence and quick recovery
• Increased chances of fertility

How is Laparoscopic Myomectomy Performed?

During laparoscopic myomectomy, the patient is given general anaesthesia. Two to three tiny half  centimetre cuts are made over the abdomen. A one-centimetre telescope with an attached camera gives the visual and thin long instruments are used to perform surgery.

The fibroids are shelled out from a capsule and incisions stitched to reconstruct the uterus. The fibroids are then removed by cutting them into thin long strips through the keyhole cuts. Due to minimal handling of the surrounding tissues the risk of scarring decreases and the fertility outcomes improve.

Do Fibroids Recur After Treatment?

There is a 10% chance of recurrence in younger patients with well-functioning ovaries. The risk is more with a woman having multiple fibroids as compared to a single fibroid. Blocking the blood supply to fibroids can decrease the risk but is still being evaluated.

Recurrence could also have a possible genetic role. In case of recurrence after a few years, a laparoscopy can be performed skilfully with lesser trauma than with an open conventional procedure.

Can a Patient with Fibroids Avoid Removing the Uterus?

Yes, fibroids can be removed, and the uterus reconstructed for fertility. However, if a patient does not wish to have any more children, a hysterectomy can be done. Laparoscopy can be done with previous open surgeries or caesarean section. Women who are perimenopausal and have multiple recurrent fibroids may do well with removal of the uterus.

Can Fibroids be removed by Robotic Technology?

Removing fibroids using technically advanced and precise robotic technology fine-tunes the procedure to give superior results. Here the surgeon operates the console and the robotic arms perform challenging movements with greater accuracy.

Laparoscopic surgery for fibroids has revolutionized the removal, making the procedure patient-friendly while reserving and improving fertility outcomes. Laparoscopic removal of uterus for large fibroids is possible with lesser pain, minimal blood loss, and early recovery.

Laparoscopic myomectomy is possible with advanced technological equipment and expertise that includes a skilled surgical and anaesthesia team. Comfortable anaesthesia, overnight hospital stays, safety, lesser complication, shorter convalescence, and early return to work with better fertility outcomes make this procedure a gold standard.

Complementary feeding is the process of feeding foods other than mother’s milk for meeting his or her nutritional requirements. This process starts when breast milk alone is no longer sufficient for the infant, and hence other foods and liquids are needed.

But before starting complementary feeding for your baby, make sure you ask these questions to your paediatrician:

1. When Should I Start Complementary Feeding?

If a child is exclusively breastfed, after 6 months.

If a child is on formula or mixed feed, after 4 .5 months.

2. How Do I Know if My Baby is Ready for Complementary Feeding?

You know your baby is ready for solids, when he or she is:

• Able to sit up on your lap, and steadily hold their head up.
• Not pushing out their tongue as much, and instead becoming more accepting of food in their mouth.
• Reaching out for food when someone is eating nearby.
• Opening his or her mouth when you put a spoon near it.

3. How Should I Start Feeding Solids?

• Choose a time when the baby is happy.
• Provide a secured sitting or slightly reclined position, e.g. on the lap.
• Introduce a single food item at a time. One new food every 3 – 4 days.
• Make the food smooth and mushy by adding breastmilk or formula.
• Baby may only want a little at first. Give more as they get used to it.
• Babies take several tastes to accept new foods. Persevere, even if the baby rejects a food item at first. It can take at least 10 tastes for an infant to accept a food item.
• Continue to breast or formula feed on demand.
• Cooled boiled water can be offered from a cup with a spout or with a spoon after each meal.

4. What are Some Suitable First Foods?

Cooked cereal mixed with breastmilk or water e.g. khichdi, ragi porridge, suji, oats porridge, etc.

Vegetables – skins removed, cooked and finely mashed/sieved e.g. sweet potato, potato, pumpkin, carrot, zucchini, and peas.

Fruit – skins and seeds removed, cooked if necessary, pureed and sieved e.g. steamed apple or steamed pear, raw banana, mashed chikoo.

Meats – cooked, pureed and sieved e.g. fish, chicken.

5. How Much to Feed?

Make food smooth, pureed (use a blender, food processor, or sieve). Semi-liquid at first, then more paste like. Start with few teaspoons and build up to & frac12; to 1 cup.

6-8 months: 2-3 times/day

9-11 months: 3-4 times/day (1/2 cup of 250ml)

12-23 months: 3-4 times (1/4th to full cup of 250ml)

6. What are things to avoid while preparing food?

Adding sugar, honey, salt or soy sauce to baby’s food.

Giving foods that might make baby choke – nuts, hard raw vegetables, or fruit.

7. What about Trying New Food?

Offer each new food separately and offer for 3-4 days before introducing another new food. This allows any adverse reactions or intolerance to be identified. Once new foods have been introduced, mixed meals can be offered.

8. What to Give as Baby Grows

Move from smooth food to foods with lumps and different textures. This will help baby to learn how to chew and talk well.

By 9-12 months, fine motor control and pincer grip should have developed. Encourage your child to experiment with finger foods and self-feeding.

Include baby at the table for family meals. Baby will watch you and the rest of the family. If you eat healthy food, baby will learn to eat healthy food too.

By the time your child is one year old, they should be eating the same foods as the rest of the family. They should have at least 3 meals with 1-2 snacks in between.

By 12 months full cream cow’s milk and whole egg may be introduced in your baby’s diet.

Give small children plenty of time to eat. Let your child decide how much they want to eat.

Offer milk or water after eating.

Avoid sugary drinks and fruit juices.

9. Snacks That Can be Offered to the Baby

• Fresh fruit – apples, bananas, oranges or other seasonal fruits.
• Cooked carrot sticks or chopped cucumber.
• Yoghurt
• Cottage cheese
• Sandwiches (use brown bread).
• Boiled eggs

Remember that feeding times are periods of learning and love − talk to children during feeding, with eye to eye contact.

Children under the age of 5 are more likely to be hospitalized from influenza complications than those in other age groups. Annual flu vaccines are the best way to protect your child and family from the flu.

Seasonal Flu

Seasonal influenza is a contagious, but preventable, respiratory illness that can be dangerous for young children. Every year, approximately 20,000 children under the age of 5 are hospitalized because of complications from the flu, with some developing serious health problems such as pneumonia or bacterial infections. Although deaths are rare, dozens of children die from flu complications every flu seasons.

Common Cold Versus Flu

While influenza and the common cold are both caused by respiratory viruses, flu symptoms are significantly more severe. Although both illnesses can produce congestion, runny noses and coughs, flu symptoms often also include high fever (over 102°F), body aches, sore throat, vomiting and diarrhoea.

First Aid: Common Cold

Treatment is Not Always Needed

If symptoms aren’t bothering your child, they don’t need medicine or home remedies. Many children with a cough or nasal congestion are happy, play, normally and sleep peacefully. Only treat symptoms if they cause discomfort, interrupt sleep or really bother your child (hacking cough, for example).

Easing Discomfort

You can ease the discomfort using the following:

• Acetaminophen or ibuprofen as needed (check correct dosage appropriate for weight with the doctor)
• A cool-mist humidifier or steamy bathroom
• Saline (saltwater) drops for the nostrils
• Gentle suction of nasal mucus using a bulb syringe when necessary
• Offer lots of fluids (breast milk or formula for babies: water and warm fluids for older kids – but no caffeinated beverages).

Seeking Medical Care

Seek medical care if your child:

• Has severe cough spasms or attacks, wheezing or stridor (an almost – musical sound when inhaling)
• Has a cough that last 3 weeks, gets worse, happens the same time every year, or seems caused by something specific (such as pollen, dust, pets etc)
• Has a persistent fever for more than 48 hours
• Is younger than 3 months old and has fever with a cough
• Is breathing fast or working hard to breathe
• Has a blue or dusky colour in the lips, face or tongue during or after coughing

Prevention

Hand-washing, covering coughs and using alcohol – based gels can help stop the virus from spreading, but the most effective approach for prevention is the flu vaccine.

Unlike some viruses, influenza viruses vary from season to season. While some vaccinations provide life time protection against a particular disease, a new flu vaccine is formulated every year to contain the strains expected to be most common during the upcoming seasons.

Children with the flu should not go back to school until at least 24 hours after they no longer have a fever. children at higher risk of developing complications (such as those with asthma) and children with severe symptoms (such as trouble breathing or dehydration) should be examined by their paediatricians. They may receive anti – viral medications such as Tamiflu.

When to Vaccinate?

Flu seasons typically runs between late October and March. Children should receive the flu vaccine as soon as it becomes available as it takes about two weeks for the vaccine to develop flu – fighting antibodies. Your paediatrician can provide your child with vaccination services. Rare side effects include soreness or redness at the injection site, hoarseness, red eyes, cough and mild fever lasting one to two days. the flu vaccine, however, cannot make a child sick with the flu.