Woman's Era - - Contents -

IAM A 40 YRS. OLD WORK­ING WOMAN I SUF­FERS FROM DI­AR­RHOEA and vom­it­ing for a long pe­riod but now I have de­vel­oped tre­mors, de­pres­sion, con­fu­sion and some­times hal­lu­ci­na­tions. For this prob­lem I con­sulted a physi­cian, af­ter tak­ing his­tory and on the ba­sis of symp­toms and in­ves­ti­ga­tions physi­cian di­ag­nosed me as a case of mag­ne­sium de­fi­ciency. I want to know about this prob­lem in de­tail.

Dis­or­ders of mag­ne­sium me­tab­o­lism are oc­ca­sion­ally re­spon­si­ble for oth­er­wise puz­zling clin­i­cal fea­tures and are sus­cep­ti­ble to ther­a­peu­tic con­trol. The most fre­quent cause of mag­ne­sium de­fi­ciency is pro­longed di­ar­rhoea or vom­it­ing, which has been treated with par­enteral fluid with­out mag­ne­sium sup­ple­ments. It is as­so­ci­ated with chronic di­ar­rhoea and se­vere un­der nutri­tion, such as oc­curs in pro­tein- en­ergy mal­nu­tri­tion and the mal­ab­sor ption syn­drome. Un­con­trolled di­a­betes mel­li­tus, al­dos­tero­nism, hy­per­para thy roidism, the di­uretic phase of acute renal fail­ure and chronic al­co­holism lead to mag­ne­sium de­fi­ciency from ex­ces­sive uri­nary loss. It oc­ca­sion­ally fol­lows on con­tin­ued di­uretic ther­apy. Clin­i­cal fea­tures are pre­dom­i­nantly neu­ro­mus­cu­lar with tremor, chor­eiform move­ments and aim­less pluck­ing of the bed­clothes. Men­tal de­pres­sion, con­fu­sion, ag­i­ta­tion, epilep­ti­form con­vul­sions and hal­lu­ci­na­tions also oc­cur. The di­ag­no­sis can be con­firmed by find­ing the con­cen­tra­tion of mag­ne­sium in the plasma to be less than 0.75 m mol/ L. Mag­ne­sium de­fi­ciency is best treated par­enter­ally 50 m mol of mag­ne­sium chlo­ride may be added to 1 litre of 5 per­cent glu­cose or other iso­tonic so­lu­tion and given over a pe­riod of 12 to 24 hours. The in­fu­sion should be re­peated daily un­til the plasma con­cen­tra­tion re­mains within the nor­mal range.

MY MOTHER IS ABOUT 70 YRS OLD, SINCE LAST TWO TO THREE years she is suf­fer­ing from pain in the back, some­times gen­er­alised pain and some­times a sharper pain of sud­den on­set. Her body has bent for­ward. We have con­sulted on ortho­pe­dic sur­geon, he told us that she is suf­fer­ing from se­nile os­teo­poro­sis. I want your opin­ion about the dis­ease.

Se­nile os­teo­poro­sis is char­ac­terised by dif­fuse os­teo­poro­sis of un­known cause. It af­fects the el­derly, es­pe­cially women but it may be seen also in pa­tients of mid­dle age. It may pos­si­bly have an en­docrine ba­sis. The whole skele­ton is af­fected but the changes in the spine are more ob­vi­ous than those else­where. There is a re­duc­tion of to­tal bone mass com­press­ing frac­ture of one or more of the ver­te­bral bod­ies is li­able to oc­cur from only triv­ial vi­o­lence. Even with­out frac­ture the tho­racic ver­te­brae tend grad­u­ally to be­come wedge shaped so that the spine bends for­ward to pro­duce a rounded kypho­sis. The long bones are also prone to frac­ture eas­ily. The pa­tient is of­ten a woman of over 60. The os­teo­poro­sis may be symp­tom­less and may be found only by chance. In other cases there is pain in the back. The pain oc­curs in two forms, a mild gen­er­alised ache and a sharper pain of sud­den on­set, de­not­ing a com­pres­sion frac­ture. Ex­am­i­na­tion re­veals a rounded kypho­sis in the tho­racic re­gion. The trunk is short­ened and there is a trans­verse fur­row across the ab­domen. X- Ray shows the re­duced den­sity of the ver­te­bral bod­ies, which be­come con­cave at their up­per and lower sur­faces from pres­sures of the in­ter­ver­te­bral discs. Metabolic bal­ance stud­ies may show a neg­a­tive cal­cium bal­ance. Treat­ment is rather un­sat­is­fac­tory. It may be pos­si­ble to re­store the pa­tient to pos­i­tive cal­cium bal­ance by cal­ci­ums sup­ple­ments to the diet but the gain is usu­ally small and a dra­matic im­prove­ment in the rea­dio­graphic ap­pear­ance can not be ex­pected. In the be­lief that the dis­or­der has an en­docrine ba­sis oe­stro­gen and an­dro­gen ther­apy has been used but with doubt­ful ben­e­fit. If back pain is trou­ble­some a light spinal brace should be pre­scribed.

● I AM 25 YRS OLD WOMAN AND HAVE FIVE MONTHS PREG­NANCY. From the be­gin­ing of preg­nancy I am suf­fer­ing from wa­tery vag­i­nal dis­charge. I want your opin­ion about this prob­lem.

A wa­tery vag­i­nal dis­charge is un­com­mon, apart from ob­vi­ous causes such as uri­nary fis­tu­lae where the high urea con­tents of the dis­charged fluid is di­ag­nos­tic. Dis­charges of this kind have been de­scribed in the con­di­tion known as hy­drops tubae proflu­ens when a hy­dros­alpinx has been sup­posed to dis­charge its con­tents through the in­ter­sti­tial por­tion of the tube into the cav­ity of uterus. In car­ci­noma of the fal­lop­ian tube the dis­charge has been aptly de­scribed as am­ber coloured. Dur­ing preg­nancy a wa­tery dis­charge is more fre­quent. In hy­dr­or­rhoea gravi­darum the wa­tery dis­charge is prob­a­bly due to leak­age of the liquor am­nii through rup­ture of the mem­branes above the level of the in­ter­nal os.

● I AM A 50 YEARS OLD LADY, LAST YEAR I DE­VEL­OPED SMALL, SLIGHTLY el­e­vated and blue black le­sions on my hands. I con­sulted a skim spe­cial­ist. He told me that you are suf­fer­ing from blue nevi. Skin spe­cial­ist told me that if these le­sions are grow­ing or may feel any change in the le­sions than it has to be eval­u­ated to rule out can­cer. What is you opin­ion.

Blue navi are small, slightly el­e­vated and blue-black le­sions. They are com­mon in per­sons of Asian de­scent and an in­di­vid­ual pa­tient may have sev­eral of them. If present with­out change for many years, they may be con­sid­ered be­nign ( Non Can­cer­ous), since ma­lig­nant ( can­cer­ous) blue nevi are rare. How­ever blue black papules and nod­ules that are new or grow­ing must be eval­u­ated to rule out nodu­lar melanoma (Can­cer).

– Dr San­jay Teo­tia.

“Leave me….. leave me.” Get your filthy hands off me I cry as loud as I can. Sud­denly my mother wakes me up, hands me a glass of wa­ter and calms me down. I have been sweat­ing be­cause of the night­mare. Again the same dream? My mother in­quired, to which I nod­ded my head. “I don’t get why do you get such dreams again and again, how many times have I told you to stop watch­ing those non­sense crime shows, they’re just pol­lut­ing your brain,” mom scolded me. And then, she slept next to me so that I feel safe. How funny that she was just calm­ing me down a minute be­fore she started scold­ing me in­stantly and be­fore I could re­alise she was sleep­ing next to me to com­fort me. Moth­ers are the best crea­tures on Earth. They can be ruth­less and sweet at the the same time. A friend when you need ad­vice, a philoso­pher when you are lost.

But sadly there are some se­crets deep down in our hearts which we are un­able to share even with them. Sorry, mom, sorry I never shared with you the rea­sons be­hind my night­mares, be­cause I fear its out­come. How would you and dad re­act; what will I say in my de­fence; and af­ter these many years will it even mat­ter to any­one like it does to me?

It has been seven years, and still seems a thing of yes­ter­day. Those were my school days and I was hardly 15 years old. I had some first ex­pe­ri­ences even those which I never wanted and one such was “Sex­ual ha­rass­ment”. It was when I was in class 10 and just like other days af­ter com­ing back from school as the clock struck 4, I left my home for coach­ing classes. It was a 15minute walk from my apart­ment, and I loved walk­ing alone.

26 De­cem­ber, I stepped out of my apart­ment and crossed the road like I usu­ally did. There’s one thing with our town, all shops and mar­kets are shut be­tween 3 and 5pm for lunch break. So, as usual, there was no crowd on the road, no honk­ing of ve­hi­cles and the sun was shin­ing bright. The road was empty as far as I could see, it was at that time I felt some­body whis­tled from the back. I turned to have a look at that scoundrel when some­one out of nowhere came and ripped my Tshirt from the right shoul­der. I was shocked and in­stantly put that hand away. But by the time I could do any­thing he was gone. The road was still empty and I could only see a bike rac­ing in the op­po­site di­rec­tion very far. I froze in that mo­ment, tears started to roll down my eyes and I wanted to run away. But more than that I wanted to know who did it, who tried to touch me. More than the fact that I was mo­lested, I was un­aware of the per­son do­ing it made me lose my senses.

Time was run­ning and I was still stand­ing there and fig­ur­ing out what just hap­pened and what I should do now. It was then I re­alised I shouldn’t be stand­ing there alone and that man could come back any­time. The thought of it sent chills down my spine. And I de­cided to ad­just my T- shirt, cov­er­ing it with the strap of my bag and headed back home. On reach­ing back I opened the door with my key as my mother took a nap at that time rushed into my room and changed my clothes. On be­ing asked I made a rea­son of hav­ing headache and cried my­self to sleep. The next day I did not share it with any­one, I didn’t want my par­ents to worry and my brother to get dis­turbed dur­ing his ex­ams. I let the time pass. But, as we say, time heals ev­ery­thing and that phase also went. I am an in­de­pen­dent girl to­day, work­ing and ca­reer ori­ented. I travel alone most of the time fear­lessly and that’s be­cause I know I can fight back any bad sit­u­a­tion. – Saumya Shresth, New Delhi.

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