Dr. Sayalee Karve

Currently there is no specific treatment for managing white matter lesions/hyperintensities. The goal is to treat the reason of the damage and cease the progression and worsening of the disease. 

Depending on the reason of damage, the doctor will start you on blood pressure lowering or cholesterol lowering medicines. 

In case you have a social habit such as smoking, then it is suggested to quit smoking at the earliest for preventing any further damage.

Sacroiliac joint dysfunction is frequently assumed to be a source of lower back and/or leg discomfort, however it is sometimes difficult to diagnose. The sacroiliac joint, which connects the triangle bone at the bottom of the spine (the sacrum) to the pelvis, can cause discomfort if its natural mobility is disrupted. More precisely, sacroiliac joint discomfort can be caused by excessive or insufficient movement.

• Leg pain produced by sacroiliac joint dysfunction can be difficult to distinguish from radiating leg pain caused by lumbar disc herniation (sciatica) since they can feel quite similar.

• The major reasons of SI joint dysfunction include - Too much or lack of movement.

• Too much movement in the sacroiliac joint (hypermobility or instability) can cause the pelvis to feel unstable and produce discomfort. Excessive mobility causes pain in the lower back and/or hip, which can extend into the groin, whereas lack of movement (hypomobility or fixation) can result in muscular tension, discomfort, and a reduction in mobility.

• Sacroiliac joint inflammation (sacroiliitis) can also cause pelvic discomfort and stiffness. Inflammation may arise as a result of sacroiliac joint dysfunction or as a result of an infection, rheumatoid disease, or other cause.

• There is no one-size-fits-all solution for controlling SI joint discomfort. For successful pain management, a combination of non-surgical therapies is frequently required.

• Treatment includes – resting for 1 to 2 days, applying ice or heat (applying it to lower back reduces inflammation and alleviates pain and discomfort; applying around the joint provides relief from pain), pain relievers like paracetamol and inflammation treating agents such as NSAID’s are recommended in case of mild or moderate pain relief. Muscle relaxants or high-end pain killers can be prescribed in case of episodes of severe and acute pain, Manual manipulation can be effective if sacroiliac joint pain is caused due to too little movement, Support or braces can be used to stabilize the pelvic area and sacroiliac joint injections such as anaesthetics such as lidocaine along with anti-inflammatory medicine like corticosteroids are given to reduce inflammation and pain.

Although sacroiliac joint dysfunction is usually considered to be the source of lower back and/or leg pain, it can be difficult to diagnose. When the normal mobility of the sacroiliac joint, which joins the triangular bone at the bottom of the spine (the sacrum) to the pelvic, is interrupted, it can produce pain.

• More specifically, sacroiliac joint pain can be caused by either too much or too little movement. Because they can feel so similar, leg pain caused by sacroiliac joint dysfunction might be difficult to distinguish from radiating leg pain caused by lumbar disc herniation (sciatica). The most common causes of SI joint dysfunction are excessive or insufficient mobility.

• Excessive movement in the sacroiliac joint (hypermobility or instability) can make the pelvis feel unstable and result in pain.

• Excessive mobility generates pain in the lower back and/or hip that can spread into the groin, whereas lack of movement (hypomobility or fixation) causes muscle tension, discomfort, and a loss in mobility.

• The lack of menstruation, also known as amenorrhea, is the absence of menstrual bleeding. It occurs when a female does not get her first menstrual period by the age of 16. It can also happen when a woman does not menstruate for 3 to 6 months. Amenorrhea can occur for a variety of reasons.  

• Pregnancy is the most prevalent reason.  

• On the other hand, can be caused by a variety of lifestyle variables, including body weight and activity levels.  

• Hormonal imbalances or difficulties with the reproductive organs may be the reason in some circumstances.

• Breast pain can be associated with anything from Fibrocystic breast changes, menstruation related cyclic pain, pregnancy, breastfeeding, side effects of certain medications, infection such as mastitis to inflammatory breast cancer.

• Heaviness of breast is because of various reasons such as large breasts, breast cysts, mastitis, pain originating from chest wall or pectoral muscles but not related to breasts and in rare cases associated with Breast cancer.

Further investigation is required in your case so as to confirm the cause behind the breast pain which include:

 Mammogram - Mammogram may assist you in diagnosis where in case the doctor feels a breast lump or unusual thickening or detects a focused area of pain your breast tissue, an x-ray of breast will help in evaluating the area of concern.

 Breast examination - In which health care provider will examine your breasts as well as the lymph nodes in your lower neck and underarm for changes and will most likely listen to your heart and lungs and examine your chest and belly to see whether the discomfort is caused by another ailment. If your medical history, breast exam, and physical exam find nothing out of the ordinary, you may not require any extra testing.

 Ultrasound - An ultrasound exam, which employs sound waves to create pictures of your breasts, is frequently performed in conjunction with a mammogram. Even if the mammography seems normal, you may require an ultrasound to check a specific location of discomfort.

 Biopsy of the breast - Suspicious breast lumps, thickening regions, or unusual areas observed during imaging scans may require a biopsy before your doctor can establish a diagnosis. During a biopsy, your doctor collects a tiny sample of breast tissue from the affected region and sends it to a lab for investigation.

• Tamoxifen is usually prescribed in treatment of patients who have cancerous growth in the breast.

• Breast tenderness can be managed with application of warm or cold compresses, occasional use of pain killers, low fat and high complex carbohydrate involved diet and limiting the consumption of alcohol and caffeine.

• Based on the complaints, your mother is suffering from a disease associated with the liver function.

• Any disruption in liver function that produces ailment which is referred to as liver disease. The liver is in charge of several vital activities in the body, and if it becomes ill or damaged, the loss of such functions can cause serious harm to the body. Hepatic disease is another name for liver disease.

• Along with fever, vomiting, loss of appetite and extreme fatigue, stomach tightness bloating, abdominal pain can also be seen in individuals with liver diseases.

• Further investigations and procedures will provide you with a clarity.

• Laboratory investigations include AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase) Total Albumin, Lactic Dehydrogenase, Alpha protein, 5’nucleotide, mitochondrial antibody and PTT levels and procedures such as CT scan, MRI (for liver tissue damage) and biopsy (in case of chance of any cancerous growth).

• Infection, autoimmune liver illnesses such as cholangitis, Wilson's disease, cancer, alcoholic liver (due to alcohol overuse), non-alcoholic liver (due to excessive fat consumption), and drug-induced liver dysfunction are all possible causes of liver dysfunction.

• Lifestyle and diet changes can help in to reduce the further damage of liver.

• Fatty liver disease is a condition caused by fat buildup in the liver (i.e., when fat percentage exceeds 5 - 10% of your liver's weight), which can be caused by alcohol intake and/or a high fat diet. Individuals who are obese/overweight, have poor glycemic control/insulin resistance, have metabolic syndrome, and are taking specific drugs such as amiodarone, diltiazem, tamoxifen, or steroids are at risk of developing fatty liver.

• In some situations, it is thought to be symptomless, but in others, it can cause substantial liver damage. The good news is that it is frequently avoidable or reversible with lifestyle modifications.

• It progresses through 3 stages which include Steatohepatitis (swelling and damage of liver tissue), Fibrosis (scar tissue formation where your liver is damaged) and Cirrhosis (extensive scar tissue replacement with healthy tissue). Cirrhosis can lead to liver failure or cancer.

• Laboratory investigations consists of Liver functions tests such as AST, ALT, ALP and GGT; Total Albumin and Bilirubin, CBC, Test for viral infection, Fasting Blood Glucose, HbA1c and Lipid profile.

• Imaging procedures such as Ultrasound, CT /MRI, Elastography (for measuring stiffness of liver) and Magnetic resonance elastography and Biopsy (for ruling out any cancerous growth and for signs or any inflammation and scarring).

• If a patient has a fatty liver, he or she should be checked for the entire metabolic syndrome, which includes diabetes, hypertension, cholesterol, and thyroid issues.

• The best way to treat fatty liver is with making some lifestyle changes which can significantly improve your health which includes – Avoiding alcohol and High fat diet, Losing weight, taking medications for controlling glucose and fat(Triglyceride and Cholesterol) levels and Vitamin E with Thiazolidinediones in specific instances.

• Currently, no drug treatment is approved for management of fatty liver disease.

In order to prevent further progression of disease one can:

 Maintain a healthy weight by consuming food less/minimal in in its fat percentage.

 Follow a Mediterranean diet which is high in vegetables, fruits and good fats.

 Exercise regularly for 45 minutes where in you can include combination of cycling with walking, cardio, CrossFit and yoga with meditation.

 Restrict alcohol consumption

Based on the complaints and elevated bilirubin levels you seem to be suffering from a type of liver disorder, a condition wherein excess accumulation of bilirubin (a brown yellow coloured compound formed in breaking down of red blood cells) occurs. With loss of appetite, vomiting, stomach tightness and bloating; fever, extreme fatigue and abdominal pain can also be seen in liver diseases.

• There are multiple causes for development of liver dysfunction such as infection, autoimmune liver diseases like cholangitis, Wilson’s disease, cancer, alcoholic liver (due to alcohol abuse) and non-alcoholic (due to excessive consumption of fats) and drug induced.

• When using a medicine that is known to have the potential to cause liver damage, your doctor may recommend you to have blood tests done on a routine basis after starting the medication so that any signs of liver damage may be recognised before symptoms develop.

• Common medications that can cause damage to the liver include Paracetamol, Statins – drugs for lowering cholesterol levels and certain herbs.

• Other liver function parameters such as AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase) bilirubin are required to be evaluated and additional to this for determining the exact cause of dysfunction especially to confirm presence of jaundice; urinalysis, CT (for distinguishing between biliary obstruction and liver disease including cancer) and liver biopsy (for ruling out concern about possible liver cancer) needs to performed.

• The treatment is based on the underlying cause and damage levels and can range from dietary changes, medications such as antibiotics, sedatives, etc to liver transplants.

• Polycystic Ovary Disease (PCOD) is caused due to production of immature or partially mature eggs by the ovaries in response to poor lifestyle, obesity, stress and hormonal balance.

• Excessive hair growth in the face, chest and back is associated with imbalance in the male hormone called Testosterone. Other symptoms associated include menstrual irregularity, acne, obesity and insulin resistance.

• Treating the underlying condition which is PCOD will help you get rid of the excessive hair growth.

• Medicine such as Clomifene is recommended for treatment as it encourages monthly release of egg from the ovaries and Metformin is prescribed to reduce the insulin resistance.

Lifestyle changes include:

Dietary Changes –

  Optimum diet includes a range of foods from many food categories, including healthy carbohydrates like vegetables and fruits, lean meats like chicken, fish, and high fibre grains.  

 Foods with a low glycemic index enable the body to release insulin slowly and gradually, allowing your body to utilise food as energy rather than store it as fat. Fiber-rich foods also aid with blood sugar regulation.

 Avoid refined carbohydrates, which are found in processed meals such as white flour, rice, potatoes, and sugar. Sugary beverages, such as soda and juice, should also be avoided.

Maintain Healthy weight –  

 Weight loss should be about half to 1 kg per week for 6 months, with the other method based on the amount of weight lost.

 Avoid crash diets since they deprive your body of essential vitamins, carbs, proteins, and minerals.

 When you go on a crash diet, your body will actually destroy muscle tissue to supply enough energy for your brain to operate.

Exercise regularly –

 Aids in the fight against obesity by burning calories and increasing muscle mass, both of which reduce insulin resistance. Exercise can also help decrease cholesterol and other hormone levels, such as testosterone.

 Physical activity is also vital. Moderate amounts of physical exercise for 30 to 45 minutes per day, 3 to 5 days per week, should be encouraged at first.

Irregularity in periods, no periods, or abnormal bleeding which indicates that you are not ovulating and condition is clinically defined as anovulation.

Even though anovulation is usually be treated with drugs for inducing fertilization, it is vital to evaluate any additional conditions that can affect ovulation, like thyroid conditions or abnormalities of the adrenal or pituitary glands.

On ruling out other medical conditions, fertility drugs will be prescribed by your Gynaecologist to induce ovulation.

Drugs containing Clomid and Clomiphene are considered as first choice due to its effectiveness and are prescribed to women for years. In comparison to other infertility medications, they have the advantage to be taken orally instead of injection. It is used to induce and regularize irregular ovulation by increase in pick-up rate of egg by ovaries. Another drug named Letrozole is used for inducing ovulation.

Certain fertility inducers can make the cervical mucus hostile to sperm and as a result keep the sperm from reaching the uterus. In such cases, artificial or intrauterine insemination (IUI) is performed (injecting specially prepared sperm directly into the uterus -- to fertilize the egg) which also thins the endometrial lining.

Period of bleeding post use of unwanted kit is usually for 2 days. Bleeding can usually be managed with sanitary pads designed for heavy flow.

PCOS and pregnancy are closely associated with each other. Hormone imbalance and Ovulation issues are the reasons behind having problem in conceiving.

PCOS leads to increase in levels of androgen in women’s body. Androgens are vital in the growth of male sex organs and other male behaviours. Androgens gets converted into the hormone estrogen in women. Increase in the levels of androgens affect the development and regular release of your eggs.

Regulating your menses is important as it will can help women with PCOS to conceive and have healthy pregnancy.

PCOS is not curable, but there are treatments offered to treat the symptoms of PCOS and the infertility associated with this condition.

Through stimulation of ovulation, especially in case of women who are trying to conceive, and treatment of insulin resistance will help in regulating ovulation and restoration of periods.

Another way to treat PCOS is with known method of in vitro fertilization, or IVF. Estrogen and progestin hormone containing medications are prescribed as they decrease the production of androgen.

Getting a P-test as negative with irregular menses and movements in the stomach with this information the chances of being pregnant cannot be ruled out.

Most important factor associated with P-test is when and how it is being performed.

False Negative Pregnancy Test

- A false negative pregnancy test is in case you are pregnant but the test comes up negative. The most common reason behind false negative is that the test was performed too early.

Even though your period is late as per your usual cycle, you might have ovulated later in the month. It's not unusual to have an off or irregular cycle occasionally. In addition to it, you must have counted the number of days from your last period incorrectly

Pregnancy tests assess the pregnancy hormone hCG, which rises as pregnancy progresses. The standard range for hCG levels in pregnant women may differ. Pregnancy test before the specified time might pick and detect low amounts of hCG.

-Another reason behind the false negative is not having sufficient hCG in the urine while performing the test.  In the early days of pregnancy, there is chance that the hormone concentration can get diluted in case you consume a large amount of water before testing.

The hCG concentration is on the higher side in case you have hold the urine for long time and that is why it is recommended that you should take a pregnancy test in the morning.

• Hepatitis B carriers are persons who carry the hepatitis B virus in their blood but do not experience symptoms. Between 6% and 10% of persons infected with the virus will become carriers and will be able to infect others without knowing it.

• A considerable proportion of chronic hepatitis B (HBV) patients are in the inactive carrier state, which is characterised by normal transaminase levels, limited viral replication, and little liver necroinflammatory activity. After at least one year of frequent monitoring, a diagnosis is made, and lifelong follow-up is required to ensure that this status is maintained.

• In case there is no improvement in HBVDNA levels, consult your expert but do not stop the medication on your own.

• Drugs prescribed such as Tafero (tenofovir) acts by ceasing the production of new viruses, blocks or slows viral proliferation in human cells, and eliminates the infection and also boost the level of CD4 cells (white blood cells that fight infection) in your blood. Entaliv (entecavir) acts by inhibiting the viral replications processes like reverse transcription, DNA replication and transcription.

• Cirrhosis is a late stage of liver scarring (fibrosis) induced by a variety of liver disorders and conditions, including hepatitis and persistent drinking. When your liver is damaged, whether through illness, excessive alcohol intake, or another cause, it attempts to restore itself. Scar tissue arises as a result of the procedure.

• It causes scar tissue to grow, making it harder for the liver to function (decompensated cirrhosis) and is considered to be potentially fatal by nature. The liver damage is often irreversible. However, if detected early and the underlying cause is addressed, additional damage can be reduced and, in rare cases, reversed.

• It often has no signs or symptoms until liver damage is extensive.

• On damage the following signs/symptoms can be seen  - Fatigue , easy bleeding/bruising , Loss of appetite, Nausea, pedal/ankle odema, Weight loss, Itchy skin, Yellow coloured eyes and skin, ascites(fluid accumulation in abdomen), spiderlike blood vessels, redness of palms, absence/loss of periods (not related to menopause), libido and gynecomastia(breast growth in males)/testicular atrophy, Confusion, sleepiness, and slurred speech (hepatic encephalopathy)

• Usually, the total bilirubin test shows 1.2 mg/dL for adults and 1 mg/dL for children under the age of 18. The normal value for direct bilirubin is 0.3 mg/dL.

• Normal findings may differ somewhat between men and women, and results may be influenced by particular diets, drugs, or severe activity. Bilirubin levels that are lower than normal are typically not a cause for worry. Elevated levels might be a sign of liver injury or illness.

• Higher-than-normal amounts of direct bilirubin in your blood may suggest that your liver isn't adequately removing bilirubin. Elevated indirect bilirubin levels may signal other issues.

• Gilbert's syndrome, a lack in an enzyme that aids in the breakdown of bilirubin, is a frequent and innocuous cause of high bilirubin. Further tests may be ordered by your doctor to explore your situation. Bilirubin test results can also be used to track the evolution of specific illnesses like jaundice.

• Further laboratory investigations such as AST(aspartate aminotransferase), ALT(alanine transaminase), ALP(alkaline phosphatase) and GGT(gamma-glutamyl transpeptidase); Total Albumin, Lactic Dehydrogenase, Alpha protein, 5’nucleotide, mitochondrial antibody and PTT levels need to be determined and procedures such as CT scan, MRI (for liver tissue damage) and biopsy (in case of chance of any cancerous growth) need to be performed.