Contraceptive for Nursing Mothers

I’m a 24 mother, nursing my 9 month old daughter and I’m afraid of getting pregnant, Dok, Is there a contraceptive pill that I can take?

Yes, you may take Lynestrenol( Exluton Tab) 1 tablet daily at the same time of the day without interruption for 28 consecutive days.May be taken with or without food.

SIDE-EFFECTS AND SPECIAL PRECAUTIONS
(a)
During the first few months of treatment irregular loss of blood may occur. Experience has shown that this is almost certainly a temporary problem. If it should occur, tablet taking should not be interrupted. If the irregular bleeding is severe or prolonged, the doctor should be consulted.
(b)
Occasionally menstruation fails to occur. If the tablets have been taken as directed, this will almost certainly not mean that the patient is pregnant. Tablet-taking should not be interrupted. If the bleeding is more than one month late, the patient must consult her doctor in order to rule out the possibility of pregnancy. She may of course consult her doctor earlier, if wanted.
(c)
Nausea, headache and breast tenderness may also be experienced during the initial months of treatment, but these are only temporary symptoms.
(d)
During the use of oral contraceptives the body mass may increase. Experience has shown that the body mass stabilizes after some time and, in most cases, can be easily controlled by diet.
(e)
Symptoms such as sudden and severe headache, pain in the chest, visual disturbances, and a swollen arm or leg require medical examination.
(f)
By regular medical control it is possible to detect thromboembolic processes (thrombophlebitis; cerebrovascular disorders, pulmonary embolism and retinal thrombosis) in an earlier stage. The use of the preparation should be stopped immediately in these cases.

Studies in England and in the United States have shown that women using oral contraceptives run a greater risk of thrombosis than non-users. As to how far this applies also to Exluton, which contains no oestrogenic substance, is not known. For the time being, it seems advisable to observe the same caution when using this preparation.
(g)
If jaundice should occur during the use of the product, administration should be discontinued immediately.
(h)
Since the glucose tolerance may diminish during the use of oral contraceptives, diabetic patients should be kept under strict control.
(i)
Because fluid retention may sometimes be possible during the use of the product, conditions which might be influenced by this factor, such as cardiac or renal dysfunction, epilepsy, migraine and asthma, require careful observation.
(j)
Caution should be observed in young women whose cycles are not yet established.
(k)
Since oral contraceptives may cause an increase of blood pressure in predisposed women, this should be checked regularly. In case of serious hypertension, further administration of the preparation should be withheld.
(l)
In case no withdrawal bleeding occurs it is advisable to rule out pregnancy. Important in this respect is, of course the question of whether tablets have been forgotten. If no bleeding has occurred in two consecutive cycles pregnancy should be ruled out anyway.
(m)
It is advisable to perform periodic physical examination once every 3 months during the first year of treatment and once every 6 months thereafter. These examinations should include special reference to duration of the cycle, body mass, blood pressure, breasts, pelvic organs, legs and skin

Allergic Rhinitis

CC., 42 year old, female, married, visited the clinic for frequent sneezing usually in the morning occurring for more than a month, with associated watery nasal congestion clearing after a few hours, occasional itchy eyes with no fever and body pain. Patient claims symptoms started when they moved in a new apartment.
After careful history and thorough physical examination, patient was advised on appropriate environmental measures and was given :

Cetirizine 20mg tab daily
Momethasone Aqueous Nasal Spray 2 sprays in each nostril once daily


Characteristic physical appearance of patients with allergy

Eyes
Patients may have injected conjunctiva; increased lacrimation; and
long, silky eyelashes.
Dennie-Morgan lines (creases in the lower eyelid skin) and allergic
Shiners (dark discoloration below the lower eyelids) caused by venous
stasis may be present.

Nose
A transverse nasal crease may be present because of the patient's
repeated lifting of the nasal tip to relieve itching and open the
nasal airway.
The turbinates are frequently hypertrophic and covered with a boggy
pale or bluish mucosa.
Nasal secretions can range from clear and profuse to stringy and
mucoid.
The presence of polyps does not necessarily indicate that the affected
individual has allergic rhinitis.

Face
Patients with allergic rhinitis frequently grimace and twitch their
face, in general, and nose, in particular, because of itchy mucus
membranes.
Chronic mouth breathing secondary to nasal congestion can result in
the typical adenoid facies.

Environmental controls and Avoidance of Allergens

Individuals who have seasonal allergies should avoid outdoor activities
when allergens are in the air. Home, rooms and workplace
should be kept as clean as possible since
house dust mites thrive in warm, humid conditions, and the antigen is
found in their feces. Control measures include removing reservoirs
like carpets, stuffed toys and heavy drapes.

How do I perform CPR ?

Dok , I saw someone who almost drowned in the beach yesterday, how do i perform CPR ?

Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone's breathing or heartbeat has stopped. CPR involves a combination of chest compression and mouth-to-mouth rescue breathing that keeps oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. When the heart stops, the absence of oxygenated blood can cause irreparable brain damage in only a few minutes. Death will occur within eight to 10 minutes. Time is critical when you're helping an unconscious person who isn't breathing. To learn CPR properly, take an accredited first-aid training course, including CPR and how to use an automatic external defibrillator (AED). Before you beginAssess the situation before starting CPR: Is the person conscious or unconscious? If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?" If the person doesn't respond and two people are available, one should call 911 or the local emergency number and one should begin CPR. If you are alone and have immediate access to a telephone, call 911 before beginning CPR — unless you think the person has become unresponsive because of suffocation (such as from drowning). In this special case, begin CPR for one minute and then call 911. If an AED is immediately available, deliver one shock if advised by the device, then begin CPR. Remember the ABCs Think ABC — Airway, Breathing and Circulation — to remember the steps explained below. Move quickly through Airway and Breathing to begin chest compressions. AIRWAY: Clear the airway Put the person on his or her back on a firm surface. Kneel next to the person's neck and shoulders. Open the person's airway using the head-tilt, chin-lift maneuver. Put your palm on the person's forehead and gently tilt the head back. Then with the other hand, gently lift the chin forward to open the airway. Check for normal breathing, taking no more than five or 10 seconds: Look for chest motion, listen for breath sounds, and feel for the person's breath on your cheek and ear. Gasping is not considered to be normal breathing. If the person isn't breathing normally and you are trained in CPR, begin mouth-to-mouth breathing. If you believe the person is unconscious from a heart attack and you haven't been trained in emergency procedures, skip mouth-to-mouth rescue breathing and proceed directly to chest compression. BREATHING: Breathe for the personRescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if the mouth is seriously injured or can't be opened. With the airway open (using the head-tilt, chin-lift maneuver) pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal. Prepare to give two rescue breaths. Give the first rescue breath — lasting one second — and watch to see if the chest rises. If it does rise, give the second breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. Begin chest compressions to restore circulation. CIRCULATION: Restore blood circulation with chest compressions Place the heel of one hand over the center of the person's chest, between the nipples. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders directly above your hands. Use your upper body weight (not just your arms) as you push straight down on (compress) the chest 2 inches (approximately 5 centimeters). Push hard and push fast — give two compressions per second, or about 120 compressions per minute. After 30 compressions, tilt the head back and lift the chin up to open the airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into the mouth for one second. If the chest rises, give a second rescue breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give the second rescue breath. That's one cycle. If someone else is available, ask that person to give two breaths after you do 30 compressions. If the person has not begun moving after five cycles (about two minutes) and an automatic external defibrillator (AED) is available, apply it and follow the prompts. The American Heart Association recommends administering one shock, then resuming CPR — starting with chest compressions — for two more minutes before administering a second shock. If you're not trained to use an AED, a 911 operator may be able to guide you in its use. Trained staff at many public places are also able to provide and use an AED. Use pediatric pads, if available, for children ages 1 to 8. Do not use an AED for infants younger than age 1. If an AED isn't available, go to No. 5 below. Continue CPR until there are signs of movement or until emergency medical personnel take over. To perform CPR on a child: The procedure for giving CPR to a child age 1 through 8 is essentially the same as that for an adult. The differences are as follows: If you're alone, perform five cycles of compressions and breaths on the child — this should take about two minutes — before calling 911 or your local emergency number or using an AED. Use only one hand to perform heart compressions. Breathe more gently. Use the same compression-breath rate as is used for adults: 30 compressions followed by two breaths. This is one cycle. Following the two breaths, immediately begin the next cycle of compressions and breaths. After five cycles (about two minutes) of CPR, if there is no response and an AED is available, apply it and follow the prompts. Use pediatric pads if available. If pediatric pads aren't available, use adult pads. Continue until the child moves or help arrives. To perform CPR on a baby: Most cardiac arrests in infants occur from lack of oxygen, such as from drowning or choking. If you know the infant has an airway obstruction, perform first aid for choking. If you don't know why the infant isn't breathing, perform CPR. To begin, assess the situation. Stroke the baby and watch for a response, such as movement, but don't shake the child. If there's no response, follow the ABC procedures below and time the call for help as follows: If you're the only rescuer and CPR is needed, do CPR for two minutes — about five cycles — before calling 911 or your local emergency number. If another person is available, have that person call for help immediately while you attend to the baby. AIRWAY: Clear the airway Place the baby on his or her back on a firm, flat surface, such as a table. The floor or ground also will do. Gently tip the head back by lifting the chin with one hand and pushing down on the forehead with the other hand. In no more than 10 seconds, put your ear near the baby's mouth and check for breathing: Look for chest motion, listen for breath sounds, and feel for breath on your cheek and ear. If the infant isn't breathing, begin mouth-to-mouth breathing immediately. BREATHING: Breathe for the infant Cover the baby's mouth and nose with your mouth. Prepare to give two rescue breaths. Use the strength of your cheeks to deliver gentle puffs of air (instead of deep breaths from your lungs) to slowly breathe into the baby's mouth one time, taking one second for the breath. Watch to see if the baby's chest rises. If it does, give a second rescue breath. If the chest does not rise, repeat the head-tilt, chin-lift maneuver and then give the second breath. If the chest still doesn't rise, examine the mouth to make sure no foreign material is inside. If the object is seen, sweep it out with your finger. If the airway seems blocked, perform first aid for a choking infant. Begin chest compressions to restore circulation. CIRCULATION: Restore blood circulation Imagine a horizontal line drawn between the baby's nipples. Place two fingers of one hand just below this line, in the center of the chest. Gently compress the chest to about one-third to one-half the depth of the chest. Count aloud as you pump in a fairly rapid rhythm. You should pump at a rate of about 100 to 120 pumps a minute. Give two breaths after every 30 chest compressions. Perform CPR for about two minutes before calling for help unless someone else can make the call while you attend to the baby. Continue CPR until you see signs of life or until a professional relieves you.

Penile Discharge "Tulo"

A 24 year old, male, married, OFW, visited the clinic for a light yellow discharge coming out of his penis for the past 3 days, staining his underwear, he also complains of pain during urination. He admitted having sexual intercourse with a prostitute about 5 days before symptoms appeared. He is scheduled to depart for the Middle East in 3 days.
After physical examination and confirming the creamy penile discharge, with no laboratory test and no possibility of follow up, I gave the following meds.
1) Doxycycline 100mg tab. 2 tablets initially then 1 tablet every 12 hours(2xday) for 10 days plus
2) Cefixime 200mg Tab , 1 tab every 12 hours for 5 days

Gonococcal urethritis (check my latest blog on GC Urethritis,"Tulo" here -http://wazzupdok.blogspot.com/2010/12/tulo-or-gonococcal-urethritis.html

Gonorrhoea is caused by the bactterium Neisseria gonorrhoeae that grow and multiply in the reproductive tract of women(cervix ,uterus, fallopian tubes) and men (urethra). The bacteria can also multiply in eyes, mouth, throat and anus.

Incubation period usually takes two to five days from infection to symptoms and without treatment,the symptoms of urethritis (inflammation of the urethra) and purulent (pus-containing) discharge peak within two weeks.

Most notable symptom is the penile discharge which occurs in 95 per cent of men and is purulent in 75 per cent, white or cloudy in 10 per cent and clear in 5 per cent. Recent urination can make the discharge appear less purulent. When the infection begins to resolve, the discharge changes from purulent to mucoid (mucus-like).

Transmission of the disease is usually by sexual intercourse, including oral sex and without treatment, the infection can continue for many months.

Complications can occur and spread up the urethra to the epididymis (sperm-storing tube connected to the testicles) but is rare and infertility can be a rare late complication. Anal infection is common especially, but not only, when the infection is transmitted by anal intercourse. Bloodstream infection occurs in less than 1 per cent of patients, causing arthritis of the knees, wrists and hands plus fever, chills and skin lesions, usually papules or pustules (red or pus-containing raised spots or bumps) on the hands or feet.

Reminder: Article was written as a physician's personal experience and should be viewed for information and guide only, and was not intended to replace actual consultation with a medical practitioner.

Photos and Images compiled fromGoogle.com

Breast Self - Examination

A 24 year old , single , female asked me how to perform breast self exam since she was bothered by their family's history of breast cancer.


When should I perform a breast self-exam?
It is good to start performing breast self exams in your 20's. You should examine your breasts once a month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month, such as the first day of the month or a day easy for you to remember, such as your birth date. With each exam, you will become familiar with the contours and feel of your breasts, and will be more alert to changes.

How do I perform a breast self-exam?
To perform a breast self-exam, follow the steps described below.
In the mirror Stand undressed from the waist up in front of a large mirror in a well-lit room. Look at your breasts. Don't be alarmed if they do not look equal in size or shape. Most women's breasts aren't. With your arms relaxed by your sides, look for any changes size, shape or position, or any changes to the skin of the breasts. Look for any skin puckering, dimpling, sores or discoloration. Inspect your nipples and look for any sores, peeling or change in the direction of the nipples.
Next, place your hands on your hips and press down firmly to tighten the chest muscles beneath your breasts. Turn from side to side so you can inspect the outer part of your breasts.
Then bend forward toward the mirror. Roll your shoulders and elbows forward to tighten your chest muscles. Your breasts will fall forward. Look for any changes in the shape or contour of your breasts.
Now, clasp your hands behind your head and press your hands forward. Again, turn from side to side to inspect your breasts' outer portions. Remember to inspect the border underneath your breasts. You may need to lift your breasts with your hand to see this area.
Check your nipples for discharge (fluid). Place your thumb and forefinger on the tissue surrounding the nipple and pull outward toward the end of the nipple. Look for any discharge. Repeat on your other breast. In the shower Now, it's time to feel for changes in the breast. It is helpful to have your hands slippery with soap and water. Check for any lumps or thickening in your underarm area. Place your left hand on your hip and reach with your right hand to feel in the left armpit. Repeat on the other side.
Check both sides for lumps or thickenings above and below your collarbone.
With hands soapy, raise one arm behind your head to spread out the breast tissue. Use the flat part of your fingers from the other hand to press gently into the breast. Follow an up-and-down pattern along the breast, moving from bra line to collarbone. Continue the pattern until you have covered the entire breast. Repeat on the other side. Lying down Next, lie down and place a small pillow or folded towel under your right shoulder. Put your right hand behind your head. Place your left hand on the upper portion of your right breast with fingers together and flat. Body lotion may help to make this part of the exam easier.
Think of your breast as a face on a clock. Start at 12 o'clock and move toward 1 o'clock in small circular motions. Continue around the entire circle until you reach 12 o'clock again. Keep your fingers flat and in constant contact with your breast. When the circle is complete, move in one inch toward the nipple and complete another circle around the clock. Continue in this pattern until you've felt the entire breast. Make sure to feel the upper outer areas that extend into your armpit.
Place your fingers flat and directly on top of your nipple. Feel beneath the nipple for any changes. Gently press your nipple inward. It should move easily. Repeat steps 9, 10 and 11 on your other breast.
Interestingly, cancerous tumors are more likely to be found in certain parts of the breast over others. If you divide the breast into 4 sections, the approximate percentage of breast cancers found in each area are (in clockwise pattern): 41% upper, outer quadrant 14% upper, inner quadrant 5% lower, inner quadrant 6% lower, outer quadrant 34% in the area behind the nipple Almost half occur in the upper outer quadrant of the breast, towards the armpit. Some physicians refer to this region as the "tail" of the breast and encourage women to examine it closely.

Welcome!!!!

............testing 123
im here to write mostly on medical stuffs,patients cases and answer questions the best way i can, ......................be it about problems in respiratory, urinary , sexually transmitted diseases, erectile dysfunction, gastrointestinal and a lot more.
ill try to make it very informal and at the same time informative.
you can post your inquiries about your medical problems and ill try to help you .
bye for now