Editorial Note

Dr. Biji GeorgeEditor

Editorial Team

P.O. Box 198,PC 101, As SeebSultanate of Oman

Tel: +968 24557200, Email: info@starcarehospital.com

Web: www.starcarehospital.com

Issue: 09

Starcare Hospital welcomes our esteemed readers to our ninth

volume of our e-magazine “Health Splash”. It is heartening to note

that we are getting good feedback about our articles in the maga-

zine. We invite further constructive criticisms on our articles and

the magazine as a whole.

We can all remember the old days when our grandmothers used to

cook fresh food with freshly grown vegetables and locally available

produce. Now our diets are changed and wholesome food has been

replaced with oily and calorie rich food and fizzy beverages, result-

ing in multitude of physical ailments. Hyperacidity, Stomach Ulcers,

High blood pressure, Diabetes to name just a few. An ailment seen

especially in Oman is GERD (Gastro-Esophageal Reflux Disease). Dr

Grezl, our Senior Gastroenterologist, gives us a well written article

on the causes and diagnosis of GERD and how to manage this

common problem.

The “Red Days” are an innate part of the life of every woman. But

those suffering from excessive bleeding during menstruation suffer

a great deal more. Dr Visalakshi, our Gynecologist enlightens us on

the causes, diagnosis and treatment of heavy menstrual bleeding.

Excessive bleeding often requires blood transfusions to replace all

the lost blood. Blood comes from Blood banks obviously. But the

Blood banks depend a great deal on voluntary donors. Blood donation

does not require any education or skills and the satisfaction of having

done something good for others by donating regularly is one to be

experienced personally.

Our complement of other features including the quiz and updates

from the Starcare family will also interest you, as always.

Keep caring…

Editor:Dr. Biji Thomas George

Associate Editor:Dr. Yousef Abdel Mohsin El Qabbany

Issue Manager:Shyju Joseph

Magazine Coordinator:Anu Joseph

Design & LayoutDantis Mathew

Dr. VishalakshiMBBS, MDObstetrician & Gynaecologist

Heavy menstrual bleeding (HMB) is the excessive menstrual blood loss which interferes with women’s physical, social, emotional or material quality of life. Normal menstrual bleeding generally lasts for 5 – 7 days. If bleeding occurs for more than 7 days and you tend to pass clots the size of a quarter or larger, that is heavy bleeding or HMB.Usually, the cause is a hormonal imbalance between the hormones estrogen and progesterone. These hormones regulate the buildup of the lining of the uterus (endometrium), which is shed during menstruation. If a hormonal imbalance occurs, the endometrium develops in excess and eventually sheds by way of heavy menstrual bleeding. Here the woman may have a brief period of absent periods followed by heavy flow. Usually the bleeding is painless. Uterine fibroids: This is the commonest tumor arising from uterine muscle cells. These noncancerous tumors of the uterus appear during the childbearing years. They may be asymptomatic or result in HMB, which may be accompanied with pain. Uterine fibroids may cause heavier than normal or prolonged menstrual bleeding. Pelvic inflammatory disease (PID) is an infection of one or more organs that affects the uterus, fallopian tubes, and cervix.Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond your pelvic region. Pelvic Endometriosis can be painful with excessive bleeding.Functional cyst (a fluid filled bag which releases hormones) of the ovary can also give rise to HMB.Endometrial polyps are typically non-cancerous, growths that protrude from the lining of the uterus and results in HMB.Intrauterine Contraceptive devices, especially copper

containing devices sometimes act as a foreign body and prompts heavier bleeding. This usually settles by 2 – 3 months unless complicated with infection.Complications of Pregnancy can also cause HMB and should be excluded in all women of reproductive age.Women who are nearing menopause may have thickening of the lining of uterus and cancer of the uterus has to be ruled out. Sometimes thyroid disorders especially Hypothyroidism can cause HM bleeding. In some cases, the cause of heavy menstrual bleeding is unknown. Tests: Common Blood Profile is done to detect the cause and extent of resulting anemia. Tests are done to rule out genetic blood clotting or bleeding disorders in younger women with HMB. Ultrasound Scanning is done to detect fibroids, polyps, ovarian masses and also to see if any endometrial thickening is present. Treatment: Management of HMB depends on the cause. In earlier days, HMB was the main reason for the removal of the uterus. Most of the patients with HMB due to hormonal variations are started with simple analgesics like Mefanamic Acid, which helps in controlling the bleeding by 50% in most of the cases. The recommended treatment for pelvic inflam-matory disease is antibiotic therapy. Drugs which help to increase clotting of blood can decrease the bleeding but have to be used with caution. Hormone treatments where proges-terones are given from 5th – 15th or 5th – 25th day for 3 – 6 months have been used successfully, again with caution.Alternatively Oral Contraceptive Pills are given to those who are currently using contraceptives. Other choices like intra uterine hormonal devices give good control over HMB especially in women who are around the age of meno-pause. Minor surgical procedures like removal of polyps in the endometrium, D&C (Cleaning of the inside of the uterus) and hysteroscopy (using a camera to visualize the inside of the uterus) may be required in some patients. More major procedures include removal of the lining of the uterus and removal of the uterus itself as a last resort in severe cases.

Blood Disordersin WomenThe red days

Dr. L. GrezlMDConsultant Gastroenterologist

What is it ?GERD is the most common and costly disease of the digestive system and its prevalence seems to be increasing. Men and women are affected equally. Gastro-esophageal reflux is a back flow of stomach acid and contents into the esophagus. Over time, the backwash of acid irritates and can inflame and damage the lining of the esophagus. GERD is when reflux of gastric contents into the esophagus produce symptoms like heartburn and regurgitation and/or complications due to the acid damag-ing the esophageal lining. Gastric reflux may damage the esophagus causing inflammation with tiny ulcers - called reflux esophagitis. This is called erosive type GERD. When the esopha-gus is normal it is called non-corrosive type GERD.Cause: A muscular valve called the lower esophageal sphincter (LES) usually stops the backflow of stomach contents while allowing food from the esophagus to go into the stomach. So, to prevent backflow of stomach contents, it normally stays tightly shut if there is no food in the esophagus on the way to the stomach. But when there is temporary relaxation of this valve (LES) at this time or when it stays loose or open all the time, it causes GERD. Factors that decrease LES pressure and contribute to reflux are lifestyle factors like weight gain, smoking, eating immediately prior to bedtime, certain food and beverages like fatty and spicy food, coffee, chocolate, peppermint, alcohol, carbonated bever-ages like cola, tomato based products, citrus fruits and juices, vinegar and certain medicines.Symptoms: Typical esophageal symptoms of GERD are heartburn and acid regurgitation. Heartburn is defined as a burning discomfort in upper abdomen that radiates up toward the chest and throat and occurs after a high-fat or large volume meal. It can also be aggravated by ingestion of food and bever-ages mentioned above. Other symptoms associated with GERD include difficulty in swallowing, water brash, excessive salivation, feeling of a lump in the throat, nausea, vomiting and chest pain.GERD can also manifest with symptoms not related to the digestive system like involving ear, nose, throat and lungs due to micro-aspiration of gastric acid. These include bronchial asthma, recurrent upper respiratory infections, hoarseness, laryngitis and bad breath. A newly recognized manifestation is middle ear infection in children.Additional tests before starting treatment are not necessary when:• Patient experiences common symptoms of reflux like heartburn• Which is only episodic • Patient is younger than 45 years

• Alarming symptoms like weight loss, bleeding, anemia, difficult or painful swallowing are absent. Diagnosis, when all the above are true, is based on symptoms and when there is complete response for acid suppression by medications.Upper Endoscopy (Gastroscopy) is indicated when:• If symptoms do not respond to treatment• If alarming symptoms described above are present• Patient is older than 45 years• Symptoms are chronicThe Gastroscopy procedure:A doctor places a flexible tube with a camera at the end through the mouth into the esophagus, stomach and duode-num, under medication to lessen discomfort. Gastroscopy allows the doctor directly visualize the interior of these parts of the digestive system.

Gastroscopy helps to detect and grade severity of the inflam-mation of the esophagus (esophagitis) and detect complica-tions like ulcers, narrowing and pre-cancerous or cancerous lesions. It also allows the doctor to take a biopsy from suspicious areas.Antacids and Ranitidine are used to treat accidental heartburn, but are not used any longer to treat GERD.

First line treatment involves a class of drugs called Proton Pump

Inhibitors (like omeprazole, lansoprazole, pantoprazole, esome-

prazole and rabeprazole.) They are all highly effective and act by

blocking the final step of acid production in the stomach. They

should be taken a half an hour before breakfast. If symptoms

continue, the same dose can be added before dinner.

Standard treatment for acute symptoms involves 8-12 weeks

trial of a PPI.

Long term maintenance therapy can involve long term use of

PPI at the lowest effective dose or they may be also taken only

when symptoms occur along with lifestyle modification.

Although GERD can limit daily activities and may cause compli-

cations, it is rarely life-threatening. With proper treatment most

people will find relief and prevent possible complications.

Gastro-Esophageal Reflux Disease - GERD

Blood donation is a voluntary procedure. Millions of people

need blood transfusions each year. Some may need blood

during surgery. Others depend on it after an accident or

because they have a disease that requires blood components.

Blood donation makes all of this possible.There are several

types of blood donation:

• Whole blood. This is the most common type of blood

donation, during which approximately a pint of whole blood

is given. The blood is then separated into its components —

red cells, plasma, platelets.

• Platelets. This type of donation uses a process called apher-

esis. During apheresis, the donor is hooked up to a machine

that collects the platelets and some of the plasma, and then

returns the rest of the blood to the donor.

• Plasma. Plasma may be collected simultaneously with a

platelet donation or it may be collected without collecting

platelets during an apheresis donation.

• Double red cells. Double red cell donation is also done

using apheresis. In this case, only the red cells are collected.

To be eligible to donate whole blood, platelets or plasma, you

must be:

• an age between 18-65 years

• In good health

• At least 50 Kilograms weight

• Blood pressure - 70-140 mm.Hg

• Pulse - 50-100 per mm., regular

• Able to pass the other physical and health history assess-

ments

• not have donated blood in the last 56 days – ideal time is

after 90 days.

The eligibility requirements are slightly different for double

red cell donation.

Risks

Blood donation is safe. New, sterile disposable equipment is

used for each donor, so there's no risk of contracting a blood

borne infection by donating blood.

If you're a healthy adult, you can usually donate a pint of

blood without endangering your health. Within 24 hours of a

blood donation, your body replaces the lost fluids. And after

several weeks, your body replaces the lost red blood

cells.After donating you sit in an observation area, where you

rest and eat a light snack. After 10 to 15 minutes, you can

leave.

• Drink extra fluids for the next day or two.

• Avoid strenuous physical activity or heavy lifting for the next

five hours.

• If you feel lightheaded, lie down with your feet up until the

feeling passes.

• Keep the bandage on your arm for at least four hours.

• If bleeding or bruising occurs under the skin, apply a cold

pack to the area periodically during the first 24 hours.

• If your arm is sore, take a pain reliever such as acetamino-

phen. Avoid taking aspirin or ibuprofen (Advil, Motrin,

others).

Contact the blood donor center or your doctor if you:

• Continue to feel nauseated, lightheaded or dizzy after

resting, eating and drinking.

• Notice a raised bump, continued bleeding or pain at the

needle-stick site when you remove the bandage.

• Become ill with signs and symptoms of a cold or flu, such as

fever, headache or sore throat, within four days after your

blood donation. Bacterial infections can be transmitted by

your blood to a potential donor via transfusion, so it's impor-

tant to let the blood donor center know if you become ill so

that your blood won't be used.Results• Your blood will be tested to determine your blood type —

classified as A, B, AB or O — and your Rh factor. The Rh factor

refers to the presence or absence of a specific antigen, a

substance capable of stimulating an immune response, in the

blood. So you're either Rh positive or Rh negative, meaning

you carry the antigen or you don't.

• Your blood will also be tested for blood borne diseases, such

as hepatitis, HIV and syphilis. If these tests are negative, the

blood is distributed for use in hospitals and clinics. If any of

these tests are positive, the blood bank notifies you, and your

blood is discarded and not used.

Contributed by Mayo ClinicRef: http://www.moh.gov.om/en/mgl/Manual/TechnicalManualonBloodTransfusion/index.htm

HEALTH WELLNESS

&Donate Blood

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2013

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Tel: +968 24557200, Fax: +968 2455720, P.O. Box 198, PC 101, As Seeb, Sultanate of Oman, Web: www.starcarehospital.com,

Sept 29

Heart Diseases can affect people of all ages and population groups, including women and children.

However, their risk can be controlled, treated or modified through everyday heart-healthy behaviours, such as eating a healthy diet, taking regular exercise and avoiding tobacco use.

A fit healthy body gives a healthy heart !!!

Special discounts on Cardiac Consultations, Investigations & Cardiac Check ups

Take the roadto a healthy heartwww.worldheartday.com, theme:2013

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Disclaimer

This magazine does not attempt to endorse or promote any information presented. Please keep in mind that information about health matters changes constantly as new studies are performed and new treatments are discovered. Consult your physician or other health professional for your health related advice.

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Your feedback and opinions are important to us. Kindly write to usinfo@starcarehospital.com

Answer the below questions

Oman Special1. To the south east of Oman is which waterway ?

2. The Arabian Oryx Sanctuary in Oman is a UN World Heritage Site, an Oryx is

3. In the past, Oman was known by the name Majan. What does Majan mean? A) the land of copper B) the land of sand C) the land of gold

4. The Omani National Day which falls on November 18th marks:

A) the day when the Sultan came to power

B) the Sultan’s date of birth

C) the date the Omani civil war ended

Answers to Quiz in September issue:1. The fireman is the only man in the room. The rest of the poker players are women.

2. Pick from the one labeled "Apples & Oranges". This box must contain either only apples or only oranges.

3. 12

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2013

Organization Accreditedby Joint Commission International

Tel: +968 24557200, Fax: +968 2455720, P.O. Box 198, PC 101, As Seeb, Sultanate of Oman, Web: www.starcarehospital.com, Email-info@starcarehospital.com

Sept 29

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