ECTOPIC PREGNANCY

a rebellious embryo may decide to implant itself outside the uterus!

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After the fertilization of the egg by a viable sperm, the resultant embryo travels from the fallopian tube down into the cavity of the uterus. Implantation occurs when the embryo is attached to the uterine wall and continues to develop until full term gestation.

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However, for reasons that are not fully understood, a rebellious embryo may decide to implant itself outside the uterus!

Ectopic Pregnancies (EP) account for about 11:1000 pregnancies. More than 80% of such rebels implant in the fallopian tube, hence the name “Tubal Pregnancy”, often used interchangeably with EP.

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Other recognized locations of EP are the abdominal cavity, ovaries, cervix and cesarean section scar.

Because of the limited space for growth within the tube or other ectopic sites, rupture and severe internal bleeding could occur starting from 6-8weeks. Ruptured EP is a life-threatening condition and one of the major causes of maternal mortality.

What are the risk factors for EP?

  • Previous history of EP
  • Previous history of infertility and its treatment (assisted reproductive techniques)
  • Pelvic inflammatory disease (PID)
  • Intrauterine contraceptive device use at the time of conception
  • Endometriosis (presence of the uterine lining outside of the uterus)
  • Pelvic or tubal surgery
  • Smoking

The only way to ensure prompt diagnosis and treatment of EP is to have a high index of suspicion by recognizing the telltale signs.

 

The symptoms are variable and non-specific but there is a classical triad reported by many patients:

  1. Missed period (6-8weeks)
  2. Lower abdominal pain
  3. Mild vaginal bleeding or brownish discharge. 

 Other symptoms include:Shoulder tip pain (sign of internal bleeding-ruptured EP),  Sudden collapse (due to severe blood loss)

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    A diagnosis is usually confirmed by identification via ultrasound scan, supported by the level of an early pregnancy hormone known as Human Chorionic Gonadotropin B (BHCG). The modality of treatment depends on the clinical status.

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    *Surgical management – in ruptured EP, with acute severe blood loss, emergency surgical intervention must be done, together with blood transfusion to save the patient. 

    *Medical management – using methotrexate, in clinically stable patients who are compliant 

    *Expectant/Conservative management – in small sized EP and falling BHCG where the body is expected to get rid of the “rebel” by itself. This is reserved for a select few cases.

    Below is a summary of events in a woman with ectopic pregnancy and how the doctor chooses how best to help her.

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    Cervical Cancer

    Cervical Cancer has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually.

    …..to her, she was doing this to help her only child whom she gave birth to while in the penultimate year of secondary school.  Regrettably, she said, ‘ i had aborted a couple of pregnancies and had sex with several men while in secondary school and by then i was seventeen because i had to fend for myself as an orphan who had no one to help me, but this child just could not be aborted’.     … that is the result the doctor said. She has stage III cervical cancer at age forty-five…

    Overview

    Womanhood is a world on its own and it takes patience, knowledge, and pity sometimes for one to dabble into such world. They have their own peculiarities in every sphere of life. In the medical world, as cancer remains one monster to deal with, peculiar to women are some cancers like breast, cervical cancer. In this article, I would focus on cervical cancer which from my own little experience most women don’t know about until they come down with it.

    Cervical Cancer

    The cervix ( pronounced: saviks) is the neck or narrow portion of the uterus(womb) where it joins with the vagina. Cancer is simply when cells of a particular tissue undergo uncontrolled (and often rapid) growth. Thus cervical cancer is the cancer of the cervix.

    Cervical cancer is the second commonest malignancy after cancer of the breast in women in developing countries ( Nigeria inclusive) and it remains the leading cause of death in these countries but the third commonest cancer in women in the world. Peak age when women present in Nigeria is 45 to 55 years. However, it is diagnosed in any woman of reproductive age group.

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    The causes have been attributed to

    • Genital infection with human papilloma virus
    • Sex at a young age
    • Multiple sexual partners
    • Promiscus male partners
    • One who had or has a sexually transmitted infections. It is important to point out that HIV infection is associated with a very high increase in risk of cervical cancer.
    • Also, a patient with cervical intra-epithelial neoplasia can progress to cervical cancer

    What makes the Doctor think A patient has it

    *Though, there are some that may not have any symptom but will come to the hospital with abnormal Papanicolaou (Pap smear) result. This is in those that do screening

    * abnormal bleeding from the vagina, majorly after sex

    * bleeding from the vagina between menstrual period or after menopause

    *offensive vaginal discharge which is characteristic

    *pain on pelvic side

    For those women that present late, they may have in addition

    • Backache
    • Leg pain/ swelling
    • Blood in the urine or bloody urine

    Or the doctor investigates by looking at the cervix called colposcopy

    How does the Gynaecologist treat

    The treatment modality depends on the stage of cancer the patient presents with.

    • It may be surgery if it is at the early stage or
    • The use of radiation and chemotherapy for the more advanced cases
    • Or the use of chemotherapy or radiation for palliation for cases that have developed other things from it

    Survival

    There is a similar 5-year survival rates for radiotherapy or surgery for someone with the cancer. This survival also depends on the stage of the cancer. If stage I there is 70-80% survival rate but stage IV has 18% survival rate.

    What is in this for YOU! 

    The major cause of this disease has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually. Condom use may not prevent the transmission. The HPV 16 and 18 are the major serotypes of the cause. Thus, a lady or woman who has been introduced to sex life should get screened two years into sex life and every 3-5 years. In essence, those who should have PAP SMEAR done are

    • Ladies who have started having sex
    • Or above age 21

    The American Cancer Society, American College of Obstetricians and Gynaecologist recommend that

    • 21-29 years should have pap smear alone every 3 years
    • 30- 65 years pap smear every 3 years or HPV and cytology testing every 5 years
    • Greater than 65 years no screening recommended
    • Less than 25 no screening recommended because women aged 21-24 are at low risk for invasive cervical cancer but they are at high risk for HPV exposure and associated lesions.

    Any Vaccine.

    The joy here is that, one could be vaccinated against the Human Papilloma Virus (which is not only for girls but also available for boys) but for girls majorly. The vaccine is useful in those who have not had the disease and no usefulness in one who already had it. The two HPV vaccines approved in the United States of America are Gardasil and Cervarix.

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    THE GIST HERE is, please go and get PAP SMEAR done today and tell others about it. It is for your future, in other to live a meaningful life insha Allaah. So please present YOURSELF at any Government health care facility for details.

    …. her sex partners were no longer patronizing her since they got to know about her disease as she even was no longer interested in that. She was no more lively, seems no hope for her. Her Chemotherapy drug has made her loose her hair, no beauty to display any longer. The radiotherapy also played it own part on the pelvis. At last, she gave up the ghost with a repentant soul. Don’t ask me if God would accept such repentance.  I leave YOU TO JUDGE…. this woman, this cervical cancer.

    I.O Dada (Haniif ibn Toyin)

    WHEN CANCER ATTACKS THE OVARIES

    The ovaries consist of different cell types, performing different functions. Any of these cells can develop into cancer

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    Ovarian cancer is the leading cause of death from gynecological cancers in the UK and USA. It is the 5th most common cause of cancer deaths in women (after lung, breast, colorectal and pancreatic cancers). Up to 20,000 new cases are diagnosed yearly in the US. The peak incidence is in women aged 75 – 84 years, but it can occur in younger women, and even (rarely) in prepubescent girls too.

     

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    CLASSIFICATION 

    The ovaries consist of different cell types, performing different functions. Any of these cells can develop into cancer, but 90% arise from the epithelial (outermost) cells. Ovarian cancers are classified based on the cluster of cells they originate from:

    • Epithelial
    • Sex cord-stromal
    • Germ cells

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    Different subclasses have been described and each has similar features but different growth behavior and response to treatment.

    RISK FACTORS

    Like most cancers, direct causal factors are largely unknown, but various risk factors have been identified:

    • Nulliparity (no previous viable pregnancy)
    • Early menarche (age at onset of menstruation <11 years)
    • Late menopause (age at cessation of menstruation >52 years)
    • Family history of ovarian, breast or colorectal (bowel) cancers
    • Family history of genetic mutations ( BRCA1, BRCA2, and HNPCC)
    • Previous history of ovarian, breast, endometrial and colorectal cancers (treated)

     SCREENING FOR OVARIAN CANCER

    Not routinely done unless one has strong risk factors.

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    SIGNS AND SYMPTOMS

    Ovarian cancer is a great mimicker as it doesn’t show any specific sign until an advanced stage as been reached. Early symptoms are no different from those attributable to other common diseases. These are:

    • Abdominal pain
    • Abdominal distension and bloating
    • Loss of appetite
    • Constipation or diarrhea (or alternation of both)
    • Abnormal menses or vaginal bleeding

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    Late Symptoms include;

     

    • Abdominal/pelvic mass – detected by palpation and confirmed by radiological tests
    • Significant weight loss
    • Difficulty in passing urine
    • Significant abdominal distension (ascites or solid mass)
    • Generalized body swelling (edema or anasarca)
    • Signs of spread to distant organs – uterus and tubes, urinary tract, bowel, stomach, lymph nodes, etc.

     

    INVESTIGATIONS

    After taking a full history and physical examination, specific tests must be done to confirm the diagnosis, determine the extent of the disease and work up for definitive treatment.

    • Full blood count
    • Kidney function test
    • Liver function test
    • Tumor markers – CA125, CEA, CA19.9, etc.
    • Imaging: ultrasound, CT scan, MRI, chest x-ray, etc

     

    MANAGEMENT 

    1. SURGERY: This is both diagnostic and therapeutic. In early stages, the ovaries, uterus, tubes and adjacent lymph nodes will be removed at once. In advanced stages, initial surgery is done to “stage” cancer (to know what stage it is). Subsequent operations may be needed depending on the result of the first surgery and response or recurrence.
    2. CHEMOTHERAPY: The different combination of anti-cancer drugs are available depending on the cell types involved. The platinum-based therapy is given in up to 6 cycles every 3 weeks. Side effects of the drugs include severe vomiting, hair loss, kidney damage, diarrhea etc. These can also be managed and ameliorated.
    3. NOVEL AGENTS: New drugs are being investigated through clinical trials. These include antibodies against cancer-promoting factors in the body (VEGF, EGFR and TKI’s)
    4. SUPPORTIVE TREATMENT: These are palliative measures put in place to alleviate the excruciating pain and suffering associated with advanced ovarian cancer. Such as drainage of ascites, painkillers (strong opioids usually, morphine), emotional support, hospice care, etc.

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    FOLLOW UP IS OFTEN CONTINUED LIFELONG.

    5-year survival rate ranges from 90% to less than 20% depending on the stage of cancer before treatment is commenced.
    PREVENTION 

    It is said that the only way to not have cancer is not to be born. Ovarian cancer can not be predicted 100% but individuals with strong risk factors can be followed closely so as to detect the disease early. They can also opt for prophylactic oophorectomy (removal of the ovaries) after completing their reproductive career (cf. Angelina Jolie). For younger women, eggs can be harvested, frozen and used for IVF when they’re ready to get pregnant later.

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    General healthy lifestyle helps to prevent cancer among other things – healthy diet, regular exercise, quitting alcohol and smoking, etc.

    Stress as a Lifestyle Disease

    Are you interested in hearing more about stress and its health effects?

    Stress is not really a disease or a diagnosis in itself. It is generally defined as a feeling of threat to your physical or mental well-being. This feeling is worsened  when you think your normal coping mechanism  is inadequate.  These may present in the form of job stress, relationship conflicts, or even money problems.

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    Chronic stress often may be experienced with symptoms of fatigue and low energy, but may also be associated with irritation, sleep disturbances, and feeling depressed or down. The physical symptoms of chronic stress can include headaches, GI upset, and muscle tension, among others.

    So what are the effects that stress can have on our bodies?

    Chronic stress may give rise to medical conditions such as heart disease, heart attacks, strokes, high blood pressure, depression, and anxiety disorders.

    The good news is there are many simple, inexpensive strategies available to choose from. When employed in a regular, consistent way, these strategies significantly moderate the impact of both acute and chronic stress.

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    There are no specific laboratory tests for stress. The doctor’s approach will be based on your presenting complaint (which can vary considerably with stress) and the presence of any suspected underlying disorders based on your history and physical examination. Generally, a full blood count to check your blood levels, other investigations to rule out infections will be done. A fasting lipid profile (cholesterol) may be needed and some hormones like the thyroid hormones may be screened.

    Inform the doctor of any supplements or herbal preparations that you are using or are considering to use. We doctors frown on some herbal mixtures, but we may just surprise you!

    How to deal with Stress

    Sleep
    Improving poor sleep patterns will have the greatest potential for fatigue reduction. Research has shown that poor sleep lasting one year is associated with a subsequent major depression, an anxiety disorder, and for substance abuse.

    Common sleep hygiene recommendations include the following:

    • Avoid evening use of caffeine, alcohol, or tobacco.
    • Establish a regular wind-down period one to two hours before bedtime, in which stimulating activities such as work or exercise are not done.
    • Avoid television late at night.
    •  Regulate noise and temperature extremes in the bedroom when attempting to sleep
    • Stimulus control methods include using the bed only for sleep and sex (no reading or TV in bed) and going to bed only when drowsy. If not asleep in 20 minutes you get up, go to another room, engage in a relaxing non-stimulating activity such as reading or very light housework, and do not attempt to sleep until you’re drowsy again (repeat this pattern as often as necessary). Stimulus control techniques are associated with a 58% reduction in sleep onset time
    • You can keep a sleep diary for the two weeks to help track any subsequent changes to your sleep status. As a way of monitoring progress you can rate your energy levels on a scale from 1 to 10 and record them on a daily basis.

    Exercise

    Regular aerobic exercise has been shown to have a positive influence on mental health outcomes largely in the area of mood enhancement. Moderate exercise is associated with improving;

    • Immediate mood and energy.
    • Mood and energy boost over weeks.
    • Long-term sleep quality (avoid within three hours of bedtime)

    Start small

    • 10- to 20-minute brisk walk at lunch during the week for at least three days a week.
    • The weekends may provide additional opportunity to exercise by being active or playing sports with your children, friends or colleagues.
    • You can use the gym, dance, walk up and down your staircase, just be creative and sweat!

    Behavioral methods

    Many activities can reduce tension and foster the feeling of calmness. Common activities can include physical activity, listening to music, walking with a friend, reading, or practicing a repetitive leisure activity such as gardening, pottery, or woodwork.

    More formal types of calming activities that involve inducing a relaxation response, such as meditation and yoga have been studied and often show an accompanying decrease in heart rate, breathing rate, blood pressure, and a metabolic slowing coupled with feelings of peace and relaxation.

    Relaxation techniques are also used to decrease sleep latency. In addition to a regular daytime relaxation practice, it is suggested that the relaxation response technique be used after closing the eyes when attempting to go to sleep at night. There is a significant improvement in sleep onset time if relaxation techniques are practiced and a greater benefit (up to 77% reduction in sleep onset time) if relaxation techniques are combined.

    Healthy lifestyle behaviors are protective and negative coping behaviors will likely worsen the long-term effects of stress. The following strategies should be avoided whenever possible:

    • Overuse of alcohol
    • Smoking
    • Frequent use of caffeine
    • Overeating or under-eating
    • Regular or inappropriate use of over-the-counter medications

    Alcohol does hasten sleep onset but the toxic effect of ethanol metabolites can disturb normal sleep architecture later in the night. In addition, regular alcohol use can worsen the effects of chronic stress.

    Consider limiting coffee to a maximum of two cups a day, as excessive use can be construed as negative coping as well. Although it may assist in reducing fatigue during the day, four to five 8 cups of coffee a day can increase subjective feelings of tension at work and amplify stress effects on blood pressure and heart rate.

    Social Support

    Social support is frequently under-assessed and under-utilized and they may protect against psychosocial stressors and subsequent adverse impact on health.

    Social support may assist by positively influencing an individual’s response to cognitive and emotional states, as well as improving self esteem, self efficacy, and effect. Social support can positively influence health behaviors such as alcohol consumption, exercise, dietary patterns, and illicit drug use. Social disconnection is associated with alcohol consumption, inactivity, and obesity. Social support in general and specifically perceived emotional support, are associated with a reduction in the risk of depression and depressive symptoms following stressful life events.

    Social relationships and contacts can also be negative and in turn be perceived as stressful. This is especially true with individuals who have frequent contact that includes conflict in the workplace or family. Negative lifestyle habits can also be influenced by social relationships. A person’s chances of becoming obese increased by 57% if he or she had a friend who became obese; and in marriage, if one spouse became obese, the likelihood that the other spouse would become obese increased by 37%.

    So ask yourself

    • Do you have someone who you can really count on to help you feel more relaxed when you are under pressure?
    • Do you have someone who you can count on to be dependable when you need help?

    If conflict or negative social relationships are contributing to stress, consider resolving this conflict first.

    Weight Management

    Weight gain combined with poor diet patterns increases the risk for developing metabolic syndrome. This can worsen stress coping mechanisms drastically. Abdominal obesity (waist circumference greater than 102 cm in men) as well as eating large amount of red meat/pork per day and consuming daily fried foods is associated with an increased risk of developing this metabolic disorder.

    Periods of high stress are associated with increased consumption of high fat, low fiber “fast foods”. The number of times eating fast foods may increase by 37% during stressful weeks, and men in particular will increase red meat consumption by 45% during weeks rated as high stress.

    A balanced diet and healthy nutrition are one of the most effective steps in weight management, especially when combined with physical activity. Explore taking a healthy lunch to work or alternatively looking for healthier and convenient restaurant choices.  Simple dietary guidelines such as reducing fat content and increasing dietary fiber (fruits and vegetables) have multiple long-term health benefits, and will contribute to maintaining a healthy weight when combined with a regular physical activity program.

    Take a vacation

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    This option is highly recommended for those who are tensed due to their work schedule and burn out almost on a daily basis in order to meet deadlines and cope with other work pressure. Work related stress accounts for majority of the complaints related to stress and it is because people tends to take their work home that they disrupt the environment that should refresh them in the first place.

    Hope you can form strategies to cope with stress now, don’t hesitate to ask us questions or share our pages with loved ones.

    Watch out for other articles on lifestyle diseases that will talk about obesity, hypertension and diabetes, chronic back pain and more.

    Greater things are yet to come!