What is an ectopic pregnancy?

In a normal pregnancy, a fertilized egg travels through a fallopian tube to the uterus. The egg attaches in the uterus and starts to grow. But in an ectopic pregnancy , the fertilized egg attaches (or implants) someplace other than the uterus, most often in the fallopian tube. (This is why it is sometimes called a tubal pregnancy.) In rare cases, the egg implants in an ovary, the cervix, or the belly.

There is no way to save an ectopic pregnancy. It cannot turn into a normal pregnancy. If the egg keeps growing in the fallopian tube, it can damage or burst the tube and cause heavy bleeding that could be deadly. If you have an ectopic pregnancy, you will need quick treatment to end it before it causes dangerous problems.

What causes an ectopic pregnancy?

An ectopic pregnancy is often caused by damage to the fallopian tubes. A fertilized egg may have trouble passing through a damaged tube, causing the egg to implant and grow in the tube.

Things that make you more likely to have fallopian tube damage and an ectopic pregnancy include:

• Smoking. The more you smoke, the higher your risk of an ectopic pregnancy.
• Pelvic inflammatory disease (PID). This is often the result of an infection such as chlamydia or gonorrhea.
• Endometriosis, which can cause scar tissue in or around the fallopian tubes.
• Being exposed to the chemical DES before you were born.

Some medical treatments can increase your risk of ectopic pregnancy. These include:

• Surgery on the fallopian tubes or in the pelvic area.
• Fertility treatments such as in vitro fertilization.

What are the symptoms?

In the first few weeks, an ectopic pregnancy usually causes the same symptoms as a normal pregnancy, such as a missed menstrual period, fatigue, nausea, and sore breasts.

The key signs of an ectopic pregnancy are:

• Pelvic or belly pain. It may be sharp on one side at first and then spread through your belly. It may be worse when you move or strain.
• Vaginal bleeding.

If you think you are pregnant and you have these symptoms, see your doctor right away.

How is it treated?

The most common treatments are medicine and surgery. In most cases, a doctor will treat an ectopic pregnancy right away to prevent harm to the woman.

Medicine can be used if the pregnancy is found early, before the tube is damaged. In most cases, one or more shots of a medicine called methotrexate will end the pregnancy. Taking the shot lets you avoid surgery, but it can cause side effects. You will need to see your doctor for follow-up blood tests to make sure the shot worked.

For a pregnancy that has gone beyond the first few weeks, surgery is safer and more likely to work than medicine. If possible, the surgery will be laparoscopy . This type of surgery is done through one or more small cuts (incisions) in your belly. If you need emergency surgery, you may have a larger incision.

Joint replacement involves surgery to replace the ends of bones in a damaged joint. This surgery creates new joint surfaces.

In shoulder replacement surgery, doctors replace the ends of the damaged upper arm bone (humerus) and usually the shoulder bone (scapula) or cap them with artificial surfaces lined with plastic or metal and plastic. Shoulder joint components may be held in place with cement. Or they may be made with material that allows new bone to grow into the joint component over time to hold it in place without cement.

The top end of your upper arm bone is shaped like a ball. Muscles and ligaments hold this ball against a cup-shaped part of the shoulder bone. Surgeons usually replace the top of the upper arm bone with a long metal piece, inserted into your upper arm bone, that has a rounded head. If the cup-shaped surface of your shoulder bone that cradles your upper arm bone is also damaged, doctors smooth it and then cap it with a plastic or metal and plastic piece.

Surgeons are now trying a newer procedure called a reverse total shoulder replacement for people who have painful arthritis in their shoulder and also have damage to the muscles around the shoulder. In this procedure, after the surgeon removes the damaged bone and smooths the ends, he or she attaches the rounded joint piece to the shoulder bone and uses the cup-shaped piece to replace the top of the upper arm bone. Early results are encouraging. This surgery is not right for everyone. And not all surgeons have done it. Success depends not only on careful evaluation to be sure it’s the right surgery for you but also on having a surgeon with experience in reverse shoulder replacement.

Doctors often use general anesthesia for joint replacement surgeries. This means you’ll be unconscious during surgery. But sometimes they use regional anesthesia, which means you can’t feel the area of the surgery and you are sleepy, but you are awake. The choice of anesthesia depends on your doctor, on your overall health, and, to some degree, on what you prefer.

Your doctor may recommend that you take antibiotics before and after the surgery to reduce the risk of infection. If you need any major dental work, your doctor may recommend that you have it done before the surgery. Infections can spread from other parts of the body, such as the mouth, to the artificial joint and cause a serious problem.

Right after surgery

You will have intravenous (IV) antibiotics for about a day after surgery. You will also receive medicines to control pain and perhaps medicines to prevent blood clots. It is not unusual to have an upset stomach or feel constipated after surgery. Talk with your doctor or nurse if you don’t feel well.

When you wake up from surgery, you will have a bandage on your shoulder and probably a drain to collect fluid and keep it from building up around your joint. You may have a catheter, which is a small tube connected to your bladder, so you don’t have to get out of bed to urinate. You may also have a compression sleeve on your arm. This sleeve squeezes your arm to keep the blood circulating and to help prevent blood clots.

A physical therapist may begin gentle exercises of your shoulder on the day of surgery or the day after. These exercises are just passive motion, which means you relax and let the therapist move your arm for you.

Most people who have shoulder replacement surgery are able to sit up and get out of bed with some help later on the day of surgery.

Your doctor may teach you to do simple breathing exercises to help prevent congestion in your lungs while your activity level is reduced.

The first few days

You will probably still be taking some medicine. You will gradually take less and less pain medicine. You may continue taking medicines to prevent blood clots for several weeks after surgery.

A physical therapist will move your arm for you to keep your shoulder loose as it heals. The therapist will also show you how to use a pulley device so you can move your arm when you go home from the hospital. Your therapist may also begin some simple exercises to keep the muscles of your other arm and your legs strong.

Rehabilitation (rehab) after a shoulder replacement starts right away. It is not too demanding early on, but it is very important that you do it. Most doctors will not allow you to use the shoulder muscles for several weeks after surgery. The main goal of rehab is to allow you to move your shoulder as far as possible so it’s easier for you to do daily activities, such as dressing, cooking, and driving. Most people eventually regain about two-thirds of normal shoulder motion after surgery. But other things that affect how much movement you get back after surgery are how much movement you had before surgery and whether the soft tissues around your shoulder were also damaged. It is very important that you take part in physical therapyboth while you are in the hospital and after you are released from the hospital to get the most benefit from your surgery.

Most people go home 1 to 3 days after surgery. Some people who need more extensive rehab or those who don’t have someone who can help at home go to a specialized rehab center for more treatment.

Risks

The risks of shoulder replacement surgery include:

• Blood clots. People can develop a blood clot in a leg vein after shoulder joint replacement surgery but usually only if they are inactive. Bloodclots can be dangerous if they block blood flow from the leg back to the heart or move to the lungs. Blood clots occur more commonly in older people, people who are very overweight, people who have had blood clots before, and those who have cancer.
• Infection in the surgical wound or in the joint. Infection is rare in people who are otherwise healthy. People who have other health problems, such as diabetes, rheumatoid arthritis, or chronic liverdisease, or those who are taking corticosteroids are at higher risk of infection after any surgery. Infections in the wound usually are treated with antibiotics. Infections deep in the joint may require more surgery. And in some cases the artificial joint must be removed.
• Nerve injury. In rare cases, a nerve may be injured around the site of the surgery. It is more common (but still unusual) if the surgeon is also correcting deformities in the joint. A nerve injury may cause tingling, numbness, or difficulty moving a muscle. These injuries usually get better over time and in some cases may go away completely.
• Problems with wound healing. Wound healing problems are more common in people who take corticosteroids or who have diseases that affect the immune system, such as rheumatoid arthritis and diabetes.
• Lack of good range of motion. How far you can move your shoulder after surgery depends a lot on how far you could move your shoulder before surgery. Some people are not able to move their shoulder far enough to allow them to do their regular daily activities, even after several weeks of recovery. If this happens, the doctor may give you a medicine to relax your muscles and will gently force the shoulder to move farther. This may loosen tissues around the joint that are preventing you from bending it.
• Dislocation of the upper arm bone (humerus). This usually only happens if the soft tissues around the shoulder are stretched too soon after surgery. To help prevent dislocation, do not allow your elbow to move past your body toward your back.
• Fracture of the upper arm bone. This is an unusual complication, but it may happen either during or after surgery.
• Instability in the joint. This can be the result of either the soft tissues being stretched too soon after surgery, or the new joint pieces loosening.
• The usual risks of general anesthesiarisks of general anesthesia. Risks of any surgery are higher in people who have had a recent heart attackand those who have long-term (chronic) lung, liver, kidney, or heart disease.

Achilles tendinitis is a condition that causes pain on the back of your leg near your heel. The Achilles tendon is strong and can take huge amounts of stress, but it can also develop tendinitis if over used.

Symptoms

• Pain after exercising
• Thickening of the tendon
• Pain and stiffness in the tendon in the morning
• Pain at the back of the heel
• Swelling
• Bone spur

Risk Factors

You are more likely to develop Achilles tendinitis:

• If you are starting a sudden exercise regimen that puts too much stress on the tendon
• You have extra bone growth
• You do very intense work out sessions

Diagnosis

Based on the symptoms, your doctor will examine your foot and look for signs of pain and discomfort or immobility. He will also run the following tests to rule out any other possibilities:

• X-Ray
• MRI scan

Treatment

Minor to moderate Achilles tendon injuries should heal on their own. To speed the process, you can:

• Resting plenty
• Applying ice packs on inflamed areas
• Exercising in moderation
• Practice stretching and strengthening exercises as recommended by your doctor, physical therapist, or other health care provider.
• Use a heel lift. Your doctor may recommend that you wear an insert in your shoe while you recover. It will help protect your Achilles tendon from further stretching.
• Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen will help with pain and swelling. Follow the instructions on the label to help prevent side effects, such as bleeding and ulcers. Take them with food. Check with your doctor first if you have any allergies, medical problems or take any other medication. If you need them for longer than 7 to 10 days, call your doctor.
• Raise (elevate) your leg. Prop your leg up on a pillow when you’re sitting or lying down.
• Compress your leg. Use an elastic bandage around the lower leg and ankle to keep down swelling.
• Ice it. Ice your injury for up to 20 minutes at a time as needed.
• Rest your leg. Avoid putting weight on your leg as best you can. You may need crutches.
• Getting Physiotherapy

Medication and Surgery

Medication for Achilles tendinitis includes steroidal and non-steroidal drugs.

Surgery should be considered a last resort, only if there are no signs of the pain reducing. Types of surgery include:

• Debridement and repair – This is recommended only if the tendon is less than 50% damaged
• Gastrocnemius recession (surgical lengthening of the calf muscle)
• Debridement with tend on transfer – This is recommended if the tendon is over 50% damaged

Prevention:

• Cut down on uphill running.
• Wear shoes with good support that fit well.
• Stop exercising if you feel pain or tightness in the back of your calf or heel.

While many people are familiar with the names of these conditions, there is less widespread understanding about how they differ. Both tennis elbow, or lateral epicondylitis, and golfer’s elbow, or medial epicondylitis, are injuries to the tendons attaching your forearm muscles to the bone at your elbow. The “epicondyle” part of epicondylitis refers to the bony bumps or protrusions at your elbow.

Lateral epicondylitis affects the tendons attached to the outer (lateral) side of your elbow, which are connected in turn to the muscles that extend your wrist backward and straighten your fingers. Medial epicondylitis affects tendons connected to the inner (medial) side of your elbow, which are attached to the muscles that flex your wrist and contract your fingers when you grip something.

Both injuries are usually the result of repetitive strain on the tendons, and although you don’t have to be a golfer or tennis player to experience them, the repeated forceful motions involved in both sports make them very common.

Symptoms

The anatomical structures involved in tennis elbow and golfer’s elbow are very similar and the symptoms are also similar, but they appear on opposite sides of the elbow and arm.

Common symptoms of tennis elbow include:

• Pain that radiates from the outside of your elbow and down your forearm
• Tenderness on the outside of your elbow
• Weakness in your forearm or a weak grip
• Pain when you grip things, twist something or, if you play tennis, especially with backhand strokes

Golfer’s elbow symptoms are similar, but occur on the inside of your arm and include:

• Pain and tenderness on the inside of your elbow
• Pain that radiates down your arm from the inside of your elbow
• Weakness in your hand or wrist
• Numbness or tingling in your ring and little fingers
• Pain when you grip or twist things
• Pain when you flex your wrist

Both tennis elbow and golfer’s elbow symptoms usually start gradually and get worse over time.

Causes

Both conditions are types of tendonitis, or inflammation of a tendon, and both are commonly caused by overuse. This may be due to excessive force on a regular basis (like hitting a tennis or golf ball) or due to other repetitive activities that involve the forearm muscles. The tendons over time can progress from inflammation, to partial thickness tears, and finally full thickness tears. Painters, plumbers, and carpenters or anyone performing repetitive gripping and lifting activities are also prone to both tennis and golfer’s elbow.

Treatment

Fortunately, most cases of tennis elbow and golfer’s elbow respond well to conservative treatments. Surgery is usually not necessary, although complete recovery can take weeks or even months, depending on the severity of the condition. As with other forms of tendonitis, the most important aspect of treatment is to reduce the amount of strain on the affected tendons. This may include resting the arm, using a brace or athletic taping, wrist splints, and once healed, correcting improper technique/form to prevent the recurrence of the injury.

Other treatments may include:

• Ice – depending on the severity, icing the affected area may be helpful for reducing pain and inflammation
• Anti-inflammatory medications – medications such as ibuprofen or naproxen are commonly recommended
• Stretching exercises – exercises which stretch the involved forearm muscles can help reduce strain on the inflamed tendons
• Physical therapy – stretches and strengthening exercises through physical therapy can aid and accelerate the recovery process
• Platelet Rich Plasma (PRP) – “blood spinning” therapy is another option you may have heard of; this is done for many professional athletes
• Cortisone injections – in severe cases, your doctor may recommend cortisone injections for pain relief and to reduce inflammation
• Surgery – if all else fails, surgery yields high success rates.

What is HIV? What is AIDS?

HIV (human immunodeficiency virus) is a virus that attacks the immune system, the body’s natural defense system. Without a strong immune system, the body has trouble fighting off disease. Both the virus and the infection it causes are called HIV.

White blood cells are an important part of the immune system. HIV infects and destroys certain white blood cells called CD4+ cells. If too many CD4+ cells are destroyed, the body can no longer defend itself against infection.

The last stage of HIV infection is AIDS (acquired immunodeficiency syndrome). People with AIDS have a low number of CD4+ cells and get infections or cancers that rarely occur in healthy people. These can be deadly.

But having HIV doesn’t mean you have AIDS. Even without treatment, it takes a long time for HIV to progress to AIDS-usually 10 to 12 years.

When HIV is diagnosed before it becomes AIDS, medicines can slow or stop the damage to the immune system. If AIDS does develop, medicines can often help the immune system return to a healthier state.