Obesity

Some Basics –

“Let thy FOOD be thy Medicine
Let thy medicine be thy food”
-Hippocrates

“Eat to live and not live to eat”

“Health is made or marred in the Kitchen ”

Now a days , menstrual abnormalities incidence have gone high,
we see only two types of young girls- one very lean with zero figure and others maximum in no a very Obese.

Obesity –
Obesity is a condition wherein the body weight is 20% or more above the ideal body weight.
Excessive accumulation of adipose tissue in relation to lean body mass.

Causes-
1. Overeating- and Fast food
This leads to excessive consumption of energy, which is stored in the body as fat. Consumption of high fat diet leads to increased triglycerides levels. Excess of Carbohydrate and Protein in food,which are not utilized,are stored as fat.

2. Physucal inactivity-
Lack of adequate exercise leads to a decreased energy requirements.Thus ,an imbalance between the energy intake and energy expenditure occurs.

3. Emotional disturbance-
During anxiety, frustration,tension or insecurity some people tend to overeat to allay their tension. Thus, they see food as a model of comfort resulting in overeating.

4. Heredity-
Studies indicate that if both parents are obese,there is an 80% chance of the child also becoming obese.

In postmenopausal women, estrogen levels are decreased, leading to the deposition of fat in abdominal region,thereby contributing to abdominal obesity.

MANAGEMENT OF OBESITY:

Behaviour modification together with diet and exercise help in prevention and treatment of obesity.
*Diet:
Do’s-
● High fibre foods like whole wheat flour, bajra,jowar, oatmeal etc
● Pulses,especially whole pulses and Sprouts.
●Use Skimmed milk
●More of Vegetables in raw or cooked form such as leafy vegetables, cabbage, gourds etc.
● Fruits like apple,Papaya,Orange,Sweetlime,guava,peach etc
● 8_10 glasses of water per day.
●Cut down on fruits like banana, chikoo,mango,custard apple and Vegetables like potatoes, sweet potatoes, yam etc.

Don’t-
● cut off sugar.
●Avoid refined products such as Maida,white bread,khari ,pasta etc.
● Reduce Consumption of Chocolates, Pastries,aereated drinks.
●Reduce /stop smoking,alcohol,tobacco chewing.

*Behaviour Modification
●Eat slowly -savour each bite.
● Regular meal pattern with frequent intervals
● Never skip meal
● Eat wisely and learn to say ‘No’ to temptation.

*Exercise-

Aim to increase your physical activity at least thirty minutes per day.

Exercise is excellent to burn calories out and improve both mental and physical health.

Dr.Rupali Mahadik

MD Streerog
Amrutwel Women’s Clinic
Kharghar

Neoplasm of the Lung

Neoplasm of the Lung ;
The incidence of lung cancer peaks between ages 55 and 65 years. Lung cancer accounts for 29% of all cancer deaths (31% in men, 26% in women). Lung cancer is responsible for more deaths in the United States each year than breast cancer, colon cancer, and prostate cancer combined; more women die each year of lung cancer than of breast cancer.

Aetiology
Most lung cancers are caused by carcinogens and tumor promoters inhaled via cigarette smoking etc.

Clinical Features
Although 5–15% of patients with lung cancer are identified while they are asymptomatic, usually as a result of a routine chest radiograph or through the use of screening CT scans.
Most patients present Central or endobronchial growth of the primary tumor which may cause cough, hemoptysis, wheeze and stridor, dyspnea, and postobstructive pneumonitis (fever and productive cough).
Peripheral growth of the primary tumor may cause pain from pleural or chest wall involvement, dyspnea on a restrictive basis, and symptoms of lung abscess resulting from tumor cavitation.
Regional spread of tumor in the thorax (by contiguous growth or by metastasis to regional lymph nodes) may cause tracheal obstruction, esophageal compression with dysphagia, recurrent laryngeal nerve paralysis with hoarseness, phrenic nerve paralysis with elevation of the hemidiaphragm and dyspnea, and sympathetic nerve paralysis with Horner’s syndrome (enophthalmos, ptosis, miosis, and ipsilateral loss of sweating).
Malignant pleural effusion often leads to dyspnea.
Pancoast’s (or superior sulcus tumor) syndrome results from local extension of a tumor growing in the apex of the lung with involvement of the eighth cervical and first and second thoracic nerves, with shoulder pain that characteristically radiates in the ulnar distribution of the arm, often with radiologic destruction of the first and second ribs. Often Horner’syndrome and Pancoast’s syndrome coexist.
Other problems of regional spread include superior vena cava syndrome from vascular obstruction; pericardial and cardiac extension with resultant tamponade, arrhythmia, or cardiac failure; lymphatic obstruction with resultant pleural effusion; and lymphangitic spread through the lungs with hypoxemia and dyspnea.
Common clinical problems related to metastatic lung cancer include:-
Brain metastases with headache, nausea, and neurologic deficits;
Bone metastases with pain and pathologic fractures;
Bone marrow invasion with cytopenias or leukoerythroblastosis;
Liver metastases causing liver dysfunction, biliary obstruction, anorexia, and pain;
Lymph node metastases in the supraclavicular region and occasionally in the axilla and groin;
Spinal cord compression syndromes from epidural or bone metastases.
Adrenal metastases are common but rarely cause adrenal insufficiency

Investigation:
Chest x-ray
CT scan of chest and abdomen
CT or MRI scan of brain and radionuclide scan of bone if any finding suggests the presence of tumor metastasis in these organs
Tumor tissue can be obtained by a bronchial or transbronchial biopsy during fiberoptic bronchoscopy; by node biopsy during mediastinoscopy; from the operative specimen at the time of definitive surgical resection; by percutaneous biopsy of an enlarged lymph node, soft tissue mass, lytic bone lesion, bone marrow, or pleural lesion; by fine-needle aspiration of thoracic or extrathoracic tumor masses using CT guidance; or from an adequate cell block obtained from a malignant pleural effusion.

Ayurved treatment by Panchkarma: (Purificative Procedure) especially Vaman is very useful. Associated therapy with following procedures may also be helpful.
Ura- basti
Lepa

Internal Medicine may be used:
Pushkarmula, (Inula racemosa), janjabilsami
Bharangi, (Clerodendron serratum)
Ashwagandha kshar (Withania somnifera), Winter cherry
Haridra, (Curcuma longa), Turmeric
Daruharidra, (Berberis species), Indian berberry
Bhallataka, (Semecarpus anacardium) Marking nut
Vansha, (Bambusa arundinacia), Bamboo manna
Shirish, (Albizzia lebbeck)
Pippali, (Piper longum), long pepper
Tulasi, (Ocimun sanctum), Holy basil
Brihat panchmula: It is group of 5 herbal drugs viz; Bilwa,{(Aegle marmelos), Bengal Quince}, Gambhari, {(Gmelina arborea)}, Patala, (Stereospermum suaveolans), Agnimantha, (Premna integrifolia), Syonaka, (Oroxylum indicum).

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur.. 

drsnojha@rediffmail. com   

SKIN CANCER

SKIN CANCER

Clinical Characteristics:
There are four types of cutaneous melanoma. In three of these—superficial spreading melanoma, lentigo maligna melanoma, and acral lentiginous melanoma—the lesion has a period of superficial (so called radial) growth during which it increases in size but does not penetrate deeply. It is during this period that the melanoma is most capable of being cured by surgical excision. The fourth type— nodular melanoma —does not have a recognizable radial growth phase and usually presents as a deeply invasive lesion, capable of early metastasis.
When tumors begin to penetrate deeply into the skin, they are in the so-called vertical growth phase. Melanomas with a radial growth phase are characterized by irregular and sometimes notched borders, variation in pigment pattern, and variation in color. An increase in size or change in color is noted by the patient in 70% of early lesions.
Bleeding, ulceration, and pain are late signs and are of little help in early recognition. Superficial spreading melanoma is the most frequent variant observed in the white population.
The back is the most common site for melanoma in men. In women, the back and the lower leg (from knee to ankle) are common sites.

Nodular melanomas are dark brown-black to blue-black nodules. Lentigo maligna melanoma is usually confined to chronically sun-damaged, sun-exposed sites (face, neck, back of hands) in older individuals. Acral lentiginous melanoma occurs on the palms, soles, nail beds, and mucous membranes.

While this type occurs in whites, it is most frequent (along with nodular melanoma) in blacks and East Asians.

A fifth type of melanoma, the desmoplastic melanoma, is recognized. This tumor type is associated with a fibrotic response to the tumor, neural invasion, and a higher tendency to local recurrence.

Occasionally, melanomas can be amelanotic, in which case the diagnosis is established histologically after biopsy of a new or changing skin nodule or because of a suspicion of a basal cell carcinoma. Sites appear to be the forearm and leg (excluding feet), while unfavorable sites include scalp, hands, feet, and mucous membranes.
In general, women with stage I or II disease have a better survival than men, perhaps in part because of earlier diagnosis; women frequently have melanomas on the lower leg, where self-recognition is more likely and prognosis is better.

Lymphadenectomy may control early regional disease. Liver, lung, bone, and brain are common sites of hematogenous spread, but unusual sites, such as the anterior chamber of the eye, may also be involved.

Biopsy: The recommended technique is an excisional biopsy, as that facilitates pathologic assessment of the lesion, permits accurate measurement of thickness if the lesion is melanoma, and constitutes treatment if the lesion is benign.
For large lesions or lesions on anatomic sites where excisional biopsy may not be feasible (such as the face, hands, or feet), an incisional biopsy through the most nodular or darkest area of the lesion is acceptable; this should include the vertical growth phase of the primary tumor, if present. Incisional biopsy does not appear to facilitate the spread of melanoma.

In ayurveda one can opt for Panchkarma: (Purificative Procedure) such as:
Vaman
Virechan
2. Associated therapy
Lepa
Snehan especially various abhyanga
3. Internal Medicine
Manjistha, (Rubia cordifolia), Indian madder
Haridra, (Curcuma longa), Turmeric
Daruharidra, (Berberis species), Indian berberry
Bakuchi, (Psoralea corylifolia), Malaya tea
Chakramarda, (Cassia tora), Fetid cassia
Nimba, (Azadirachta indica), Neem tree..

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com   - 

Eladi Choornam (Eladi Churna)

 Eladi Choornam (Eladi Churna) is herbal powder formulation containing Elaichi (cardamom) as a main ingredient. It has different formulations based on ingredients and each formulation has unique benefits and medicinal uses. Generally, all formulations are beneficial for nausea, vomiting, anorexia, excessive thirst etc.

ELADI CHOORNAM FORMULATION NO. 1 Ingredient Name Quantity

Elaichi (cardamom) 10% 

Laung (Cloves) 10% 

Kushta (Indian Costus Root) – Saussurea Lappa 10% 

Nagkesar – Mesua Ferrea 10% 

Ber (Indian Jujube) fruit pulp 10% 

Lajja 10% 

Priyangu 10% 

Mustak 10% 

Chandan 10%

 Kapoor – Cinnamomum Camphora 10% 

Reference: SAHASRAYOGAM, CHURNA PRAKARANA, ELADI CHURNA (26) 

Medicinal Properties

 1. Antiemetic Therapeutic Indications 1. Nausea 2. Vomiting Benefits & Uses This formulation of Eladi Choornam has antiemetic action. It is specially specified for Kapha, Vata ad Pitta type of vomiting. It has very balanced proportion according to Dosha, so it can be given without consideration of humours. It is generally found effective in vomiting with sour and burning vomitus. It also improves digestion and increases appetite. Dosage & Administration The general dosage of Eladi Choornam formulation No. 1 is as follows. Children 250 to 500 mg * Adults 1 to 1.5 grams * Pregnancy Contraindicated due to presence Kapoor * Twice or thrice a day with honey When to Take: before food Safety Profile The short-term use of Eladi Choornam formulation No. 1 is considerably safe and has no side effects when used in prescribed dosage. If unnatural camphor is added in the formulation, then its higher dosage may cause vertigo and camphor poisoning.

 ELADI CHOORNAM FORMULATION NO. 2 Ingredient Name Quantity Elaichi (cardamom) 2.4% Dalchini (Cinnamon) 4.7% Nagkesar – Mesua Ferrea 7.1% Kali Mirch (Black Pepper) 9.5% Pippali (Long pepper) 12% Sonth (dried ginger) 14.3% Misri (Sugar) 50% Reference: SAHASRAYOGAM, CHURNA PRAKARANA, ELADI CHURNA (29) Medicinal Properties 1. Digestive Stimulant 2. Appetizer 3. Anti-spasmodic 4. Anti-emetic 5. Liver stimulant Therapeutic Indications 1. Excessive Salivation 2. Loss of Appetite 3. Nausea and Vomiting 4. Pleuritic chest pain 5. Throat irritation or discomfort Benefits & Uses The effect of Eladi Choornam formulation No. 2 is on KAPHA and VATA imbalance. Excessive Salivation Eladi Choornam formulation No. 2 reduces salivation, so it is beneficial in excessive salivation. It helps digesting and eliminating AMA toxins. It works in excessive salivation when patient has any of following condition: 1. Excessive starch intake 2. Infections of oral cavity 3. Enlarged tonsils with white patches 4. White coating on the surface of the tongue 5. Loss of Appetite However, the most common cause of excessive salivation is acid reflux, GERD or hyperacidity, but in such cases, Eladi Choornam may not help well. In such cases, remedies that work on Pitta Dosha should be used. Eladi Churna formulation No. 2 works mainly on Kapha and Vata dosha. Loss of Appetite Eladi Choornam formulation No. 2 contains high amount of Sonth, Pippali, Kali Mirch and Dalchini in addition to cardamom. All these ingredients are well known appetizers and digestive stimulant. Nausea and Vomiting Eladi Choornam formulation No. 2 is good medicine for nausea and vomiting when vomitus is not sour, but it may be sweet, salty or tasteless. It digests AMA and improves digestion food. It is also effective in vomiting due gastroenteritis or food poisoning. It should not be used in vomiting with sour vomitus, burning sensation, gastritis and epigastric tenderness. Pleuritic chest pain Eladi Choornam formulation No. 2 is also used for pleuritic chest pain. It reduces inflammation of pleura and exerts smoothening effect, which reduces chest pain. Dosage & Administration The general dosage of Eladi Choornam formulation No. 2 is as follows. Children 250 to 500 mg * Adults 1 to 3 grams * * Twice or thrice a day with water When to Take: After food Safety Profile Eladi Choornam formulation No. 2 can cause burning sensation, heartburn, and gastric irritation in some people with PITTA body type or people suffering from GERD, gastritis, ulcers etc.

ELADI CHOORNAM FORMULATION NO. 3 Ingredient Name Quantity

Elaichi (cardamom) 4%

Nagkesar – Mesua Ferrea 4%

Dalchini (Cinnamon) 4%

Tejpata (Indian Bay Leaf) – Cinnamomum Tamala 4%

Talispatra (Indian Silver Fir) – Abies Webbiana 4%

Vanshlochan (Tabashir) – Bamboo Manna 4%

Munakka (Raisins) – Vitis Vinifera 4%

Anardana – Pomegranate seeds 4%

Dhania (Coriander) 4%

Kala Jeera (Black Cumin) 4%

Safed Jeera (White Cumin) 4%

Pippali (Long Pepper) 2%

Piplamool – Long pepper Root 2%

Chavya – Piper Retrofractum 2%

Chitrakmool – Plumbago Zeylanica 2%

Sonth – Zingiber Officinale 2%

Kali Mirch (Black Pepper) 2%

Ajwain (Carom Seeds) – Trachyspermum Ammi 2%

Tintidika – Rhus Parviflora 2%

Amalvet 2%

Ajmoda (Celery) 2%

Ashwagandha – Withania Somnifera 2%

Kaunch Beej (Velvet bean) – Mucuna Pruriens 2%

Misri (Sugar) 32%

Reference: Ayurved Sar Sangrah

Medicinal Properties

1. Strong Antiemetic Therapeutic Indications 1. Nausea 2. Vomiting 3. Dry mouth or throat 4. Excessive Thirst Benefits & Uses The effect of Eladi Choornam formulation No. 3 is on PITTA imbalance. Dosha action is major difference between Eladi Choornam formulation No. 2 and No. 3. Excessive Thirst Eladi Choornam formulation No. 3 helps reducing mouth dryness and reduces excessive thirst. Mainly, PITTA dosha is found in excess in people with excessive thirst. Eladi Choornam formulation No. 3 balances PITTA and reduces thirst. Nausea and Vomiting Eladi Choornam formulation No. 3 has potent antiemetic effects in vomiting with burning and sour vomitus. It reduces nausea and vomiting with PITTA dominance. Dosage & Administration The general dosage of Eladi Choornam formulation No. 3 is as follows. Children 1 to 3 mg * Adults 3 to 6 grams * * Twice or thrice a day with Misri (Sugar) and honey or water When to Take: before food or as required Safety Profile Eladi Choornam formulation No. 3 is considerably safe even from chronic patients suffering with nausea. It can also be used on long-term basis without any side effects

Dr. Atul Dnyanadeo Sanap

Mauli Ayurveda chikistalay panchkarma and research center

D 25 sidhivinayak complex

Sahayognager

Beed 9403330067 9890065637

BREAST CANCER

BREAST CANCER
Breast cancer is a malignant proliferation of epithelial cells lining the ducts or lobules of the breast. Epithelial malignancies of the breast are the most common cause of cancer in women (excluding skin cancer), accounting for about one-third of all cancer in women.

Aetiology
Increased caloric intake contributes to breast cancer risk in multipleways: earlier menarche, later age at menopause, and increased postmenopausal estrogen concentrations reflecting enhanced aromatase activities in fatty tissues.
Moderate alcohol intake also increases the risk by an unknown mechanism. Folic acid supplementation appears to modify risk in women who use alcohol but is not additionally protective in abstainers.
Breast cancer is a hormone-dependent disease. Women without functioning ovaries who never receive estrogen-replacement therapy do not develop breast cancer.
Breast Examination
Women should be strongly encouraged to examine their breasts monthly.
Breast examination by the physician should be performed in good light so as to see retractions of nipple and other skin changes.
The nipple and areolae should be inspected, and an attempt should be made to elicit nipple discharge.
All regional lymph node groups should be examined, and any lesions should be measured.
Physical examination alone cannot exclude malignancy.
Lesions with certain features are more likely to be cancerous (hard, irregular, tethered or fixed, or painless lesions).
A negative mammogram in the presence of a persistent lump in the breast does not exclude malignancy.
Palpable lesions require additional diagnostic procedures including biopsy.
In premenopausal women, lesions that are either equivocal or nonsuspicious on physical examination should be reexamined in 2–4 weeks, during the follicular phase of the menstrual cycle. Days 5–7 of the cycle are the best time for breast examination.
A dominant mass in a postmenopausal woman or a dominant mass that persists through a
menstrual cycle in a premenopausal woman should be aspirated by fine needle biopsy or referred to a surgeon.
If nonbloody fluid is aspirated, the diagnosis (cyst) and therapy have been accomplished together.
Solid lesions that are persistent, recurrent, complex, or bloody cysts require
mammography and biopsy, although in selected patients the so-called triple diagnostic techniques (palpation, mammography, aspiration) can be used to avoid biopsy.
Ultrasound can be used in place of fine-needle aspiration to distinguish cysts from solid lesions.
Not all solid masses are detected by ultrasound; thus, a palpable mass that is not visualized on ultrasound must be presumed to be solid
Better mammographic technology, including digitized mammography, routine use of magnified views, and greater skill in mammographic interpretation, combined with newer
diagnostic techniques (MRI, magnetic resonance spectroscopy, positron emission tomography, etc.) may make it possible to identify breast cancers even more reliably and earlier. Screening by any technique other than mammography is not indicated; however, younger women who are BRCA-1 or BRCA-2 carriers may benefit from MRI screening where the higher sensitivity may outweigh the loss of specificity.

Not Recommended Test in Breast Cancer
Complete blood count
Serum chemistry studies
Chest radiographs
Bone scans
Ultrasound examination of the liver
Computed tomography of chest, abdomen, or pelvis
Tumor marker CA 15-3, CA 27-29
Tumor marker CEA

Ayurvedic Treatment that can be recommended in breast cancer is as follows:

Panchkarma: (Purificative Procedure) especially Vaman (Vomiting induced by medicine) will be very useful as a preventive as well as curative therapy.

Internal Medicines which havea role in Breast Cancer are as follows:
Vacha (Acorus calamus), Sweet Flag
Kutki (Picrorrhiza kurroa), Picrorrhiza
Shilajit (Bitumen),
Guduchi (Tinospora cordifolia), Tinospora
Bhallataka ghrit, (Semecarpus anacardium) Marking nut

External Application in the form of paste following drugs may be used:
Kombadnakhi ,
Shigru (Moringa pterygosperma), Drumstick tree.

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
 drsnojha@rediffmail. com   -

Infertility - Emotional impact

        Most people take their fertility for granted.
Infact a common complaint from individuals and couples when they have difficulty conceiving is " we were so careful to avoid pregnancy until we were ready."

         Couple go in short order from an assumption of assured fertility to one of absolute dismay at what is experienced as unfair and wholly unexpected Infertility.

          The intensively painful experience of finding oneself defined as infertile leads to feelings of isolation and guilt and the inevitable questions: " why me ?" .

           Guilt may b as a primary response common to many couples diagnosed with infertility : guilt about waiting too long to start a family, guilt about previous life events such as pregnancy termination.

In addition to the emotional impact of Infertility are the rigorous, expensive and often humiliating demands of medical treatment.

        Some patients jokingly say , " I have learned more about the reproductive system than I ever imagined I would need to," whereas for others the treatment regimens are confusing and difficult to understand.
All results in stress depression and anxiety , loss of self confidence , loss health etc.
Dr Rupali Mahadik

MD ( Streerog )
Amrutwel Women's Clinic
9322187726

Infertility Treatment Current Scenario

Infertility Treatment Current Scenario-

It involves an initial evaluation of the

First step

-History ,
-Physical examination,
-Semen Analysis
-Hormone evaluation in 35% of patients

Second step

- Female Factor

One third of patients are thought to have disorders of Ovulation -this problem is treated by correcting body weight, and / therapy with Clomiphene citrate, bromocriptine, or prednisolone for 6 cycles .

No pregnancy results , 30% of the patients undergo Diagnostic and Operative Hysteroscopy and Laparoscopy

Half are thought to have a good prognosis. They attempt pregnancy for 6 months ; if no pregnancy results approximately 40% undergo 3 cycles of IVF.

If poor prognosis ( Tubal diseases ) they undergo 3 cycles of IVF.

-Male factor

If male factor is present out of total diagnosed 80% are oligospermic and varicocele- medicines and operated for varicocele , if no pregnancy occurs following surgery , 3 cycles of IVF are attempted.

The Azoospermic Pt undergoes 6 cycles of therapeutic donor insemination. If no pregnancy results, 2 cycles of IVF are attempted.

 Dr Rupali Mahadik
MD Streerog
Amrutwel Women's Clinic
Kharghar
9322187726