What is a Pap smear?

The pap smear test or Papanicolau test is a test of the cells of the cervix and endocervix, done to detect any pre-malignant or malignant changes of the cervix. This would help in the detection of cervical cancer at an early stage. Detection of a cancer at an early stage would help in the better management of the patient and may lead to increased chances of survival.

How is Pap test done?

A pap test is usually performed by a Gynaecologist. The patient is placed in Sim’s position, with both legs separated and raised. This position enables easy insertion of the speculum into the vagina. The cervix is identified. Using a wooden spatula, the inside of the cervix is scraped. A brush is inserted into the cervix and a brushing of the inside of the cervix is taken as well. These samples are put in a preservative and sent to the lab for microscopic examination.

Is the procedure painful?

Pap test is not painful. But there might be slight discomfort because of the position and because of the feeling of the speculum inside the vagina. There might be slight bleeding after the procedure, but would subside soon.

What are the possible results of Pap test?

Pap test aims at finding any precancerous or cancerous changes in the cervix. The potential pre cancerous changes are cervical intraepithelial neoplasia or cervical dysplasia. The abnormal changes are usually caused by human papilloma virus which is the common cause of sexually transmitted diseases.

The abnormal results usually seen are

1. atypical glandular cells.
2. atypical squamous cells of undetermined significance.
3. low grade squamous intraepithelial lesion.
4. high grade squamous intraepithelial lesion.
5. squamous cell carcinoma.

Is it necessary to have a pap test?

For every sexually active woman, it is better to have a pap test as soon as she becomes sexually active. And it is advised for a sexually active woman who has not had a pap test to have the test done immediately after 35 years, at least once a year.

Are there any risks of a pap smear test?

There is no risk of pap test.

Are there any precautions to be followed before the test?

If you are scheduled to have a pap smear, you should avoid the following for the previous 24 hours.

1. douching.
2. intercourse.
3. tub bath.
4. tampons.

You should intimate the physician of the following.

1. suspected pregnancy.
2. previous history of papsmear- normal or abnormal.
3. intake of medications including oral contraceptive pills.

Any abnormal changes detected would be investigated further to diagnose cancer and manage effectively.

Laparoscopy or minimally invasive surgery is commonly known as ‘keyhole surgery’ and is beneficial in reducing the time the patient spends at the hospital in addition to other benefits like easy recovery and better wound healing.

What is laparoscopic surgery?

Laparoscopic surgery uses an instrument called a laparoscope, which is inserted to the patient’s body for the performance of the surgery. A laparoscope is a telescopic lens system and is connected to a video camera. The operative area of the patient’s body is visualized on a screen and the laparoscope is manipulated so to perform the surgery. There is also a fiber optic cable with a light source as well as a insufflator which is used to introduce carbon dioxide into the operative area. The light source is required, to help visualize the internal organs and the insufflation with carbon dioxide provides a work area so that there is no solid organ injury.

What are the common procedures done using a laparoscope?

With the advances in technology and modern medicine, almost all surgical procedures may be performed with the help of a laparoscope. The common laparoscopic procedures are cholecystectomy (removal of gall bladder), herniorraphy (repair of a hernia), surgery for GERD, splenectomy (removal of spleen), liver surgery, ulcer surgery, appendectomy (removal of appendix) and surgery for enteric perforation due to trauma.. But bariatric surgery (surgery for control of obesity) like lap band, gastric bypass surgery are also being performed under a laparoscope.

Is laparoscopic surgery beneficial?

A laparoscopic surgery is beneficial as compared to laparotomy ( a laparotomy involves opening of the abdominal cavity for the performance of the surgery). Some of the benefits of laparoscopic surgery are

1. The incision is very small. In case of laparotomy, the incision usually is midline or transverse and involves a lot of area on the abdomen. Where as, there are three or four small one or two centimeter incisions.
2. The blood loss during the surgery is minimal.
3. There is less amount of pain post operatively because of the smaller incision.
4. The recovery time is very less compared to laparotomy. After a laparoscopic surgery, the patient would be discharged from the hospital on the same day or the next day of surgery. The patient can resume his normal daily activities after two or three days, depending on the surgery performed. In a patient who had undergone laparotomy, the hospital stay would extend to atleast a week or two and would take more time till full recovery.
5. The chances of infection are very less when the procedure is laparoscopic.
6. The occurrence of complications is also minimal after a laparoscopic surgery.

Are there complications or risks of laparoscopic surgery?

As any surgical procedure, there is a chance of complications in laparoscopic surgery as well. Some of the complications that might occur are

1. Injury to a blood vessel or a solid organ in the abdomen. The insertion of the laparoscope is a blind procedure as visualization is possible only after the insertion. In case of an obese patient or a patient who has had some abdominal surgery before, there is a chance of injury to an organ within the abdomen. This may lead to perforation peritonitis and require further laparotomy and management.
2. Intolerance to pneumoperitoneum may occur. Some patients may not be able to tolerate the insufflation of the abdomen with carbon dioxide. The occurrence of this may change the course of the surgery and the procedure may be converted to an open surgery.

Since the chances of possibility of complications are minimal as compared to the benefits, many patients and surgeons prefer laparoscopy to laparotomy for the management of several surgical conditions.

Miraculous Survival After Impalment By A Metalic Pole (Iron Angle) - Our story gets published in a magazine. They have shown the story in the view point- how a mobile helped to save the lives of two guys. Here check out those pages.

I just don’t have time to exercise!

This is a common excuse everyone makes.. It takes a lot of courage to submit to a strict regime of exercise and diet control so to attain the fat loss desired. If you are not ready to make a life style change, you cannot escape the clutches of the life style diseases.

How does one start on this fat loss and exercise journey?

1. Think realistic. It is very important to set a realistic goal when trying to lose weight because losing more weight by starving yourself would only lead to more harm than good. A target of losing two to four pounds a week is reasonable.
2. Plan. Plan every activity and diet change that would lead you to your goal. The plan should be one you can follow regularly, or else it would not be effective.
3. Make the necessary diet changes. Decrease the intake of salt, sugar, processed foods & colas. All of the above mentioned items are just calories and no nutrition. Reducing the amount of unhealthy calories would inevitably result in more fat loss.
4. Eat more fruits and vegetables. The minimum requirement of fruits and veggies of a day is five servings. Check on the number of servings of fruits and veggies that you take on an average day and you would be surprised. Most people tend to ignore the healthy foods and gorge on white processed foods adding to their fat troubles. When you make a conscious effort to take at least five servings of fruits and vegetables a day, you would soon see you have more energy in addition to other positive effects, like the glow on your face.
5. Count your calories. Keep a food journal and count every morsel of food that goes in. you would be surprised to see how many calories you take. Aim for a calorie deficit of 500 per day to lose one pound in a week. The deficit of 250 calories should come from diet and the other 250 from exercise.
6. Move more during the day. Be as active as you can. If you are at a sedentary office job, get up every 30 minutes. Get a glass of water, make a quick round in the office and come back. A break of 5 minutes is enough to perk you up for the next hour reducing the need of coffee. And also it increases your physical activity through out the day.
7. Exercise. Exercise is the most important component of weight loss regime. Cardio exercises, strength exercises as well as flexibility exercises are all good aides in burning calories. Burning all the excess calories is the trick to getting a leaner and fit body.
8. You feel you are so overweight that you cannot exercise. This feeling is just in your mind. There are some or the other exercise form which you can always do and not feel the strain on your knees or feet. If you are overweight, start with walking slowly and gradually increase the pace and time. If you feel you cannot walk, try swimming. Swimming is a cardio exercise that burns as much or more calories as any other cardio exercise, but lacks the stain on your body. Water supports the frame of your body and reduces the strain.
9. Develop an interest for a physical game or activity. If you are interested in games like tennis, badminton, squash or other activities like dancing, take up these on a regular basis. These are fun activities burning an unbelievable amount of calories per hour. So your passion can be your fat loss device as well.
10. Add strength training to your exercise regime. Strength training would not increase the bulk, as is a misconception, but rather aid in defining the muscle mass and add to the lean muscle. It would help you get a leaner look even when you are not exactly at the target weight. Also addition of lean muscle would aid in improvement of metabolism, burning more calories in a day.

In short, fat loss is a life style change. Make small changes in your diet and fitness regimes and when you are comfortable with one change, add another. This is a sure shot way to attain the leaner and fit body you intend to have.

The most important manifestation of Alzheimer’s disease is dementia. Forgetfulness is very common in elderly people due to age related changes or due to the stress of the modern day living. This is clearly different from dementia due to Alzheimer’s disease.

Though Alzheimer’s disease is not curable, meaning there is no definitive treatment for the disease, diagnosing the disease at an early stage is important to ease the living of the patient as well as the caretakers. More often, it is the caretakers of the patient with Alzheimer’s disease most stressed out because of the problems occurring secondary to the disease.

How can diagnosing the Alzheimer’s disease help?

It is not helpful because the diagnosis of the disease would not change the management of the patient. But it would help gain an understanding of the reasons behind the behavior of the patient. At an early stage of the disease, the diagnosis would also enable the physician to start the medications to control the progress of the disease. These medications are only helpful during the initial stages of the disease, so an early diagnosis is very important.

How is Alzheimer’s disease diagnosed?

History: The evaluation of the patient would start with a detailed history. A young individual would recognize the symptoms and might be concerned. In case of an elderly, the family might be concerned of the patient. The recent behavior, the symptoms manifested, any unusual or uncommon patterns of behavior should be noted down. The date of onset of the symptoms or atleast the time duration of the present symptoms should be noted. Also, the mental status of the patient, the life style including the stress levels should be asked for. Any family history of the disease should be considered as well.

Cognitive tests: since dementia is the important symptom of the disease, a cognitive test to assess the level of forgetfulness is important. A mini mental status exam is conducted which might show lack of attention, affected problem solving, memory loss etc.

Investigations: Magnetic resonance imaging (MRI) and positron emission tomography (PET) scan could be conducted and may show brain changes, which may be considered as diagnostic.

A microscopic evaluation of the brain tissue is the only confirmatory test of Alzheimer’s disease. Since this is not possible, the physician has to depend on the history of the illness, the cognitive tests as well as the brain scans to make a diagnosis.