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Recreational exercise and pregnancy

KEY POINTS

Recreational exercise refers here to any kind of energetic (aerobic) exercise (such as swimming or running) and/or strength conditioning exercise.

  • During pregnancy, aerobic and strength conditioning exercise is considered to be safe and beneficial.
  • The aim of recreational exercise during pregnancy is to stay fit, rather than to reach peak fitness.
  • You should take extra care when doing exercises where there is a possibility of losing your balance, such as horse riding or downhill skiing

You should avoid contact sports where there is a risk of being hit in the abdomen, such as kickboxing, judo or squash.

  • If you experience any unusual symptoms, you should not continue to exercise. You should contact your healthcare professional immediately.
  • If you have a medical condition, you should discuss this with your healthcare professional before doing recreational exercise.
  • Pelvic floor exercises during pregnancy and immediately after birth may reduce the risk of urinary and faecal incontinence in the future.
  • For most women, it is safe to exercise as soon after the birth as they feel ready.
  • Recreational exercise does not affect the amount of milk you produce or its quality.

What is recreational exercise?

Exercise forms a part of our daily lives, whether we realise it or not. Actions such as climbing stairs, walking to the shops or running for a train all involve some form of exercise. Recreational exercise refers here to any planned regular exercise that a woman takes during her pregnancy, which involves energetic (aerobic) exercise (such as swimming or running) and/or strength conditioning exercise. The aim of recreational exercise during pregnancy is for a woman to stay fit rather than to reach peak fitness.

What are the benefits of recreational exercise during pregnancy?

 Benefits for you

Many women find that recreational exercise helps them to adjust to the physical changes that occur during pregnancy. It may help relieve tiredness, lower back pain and reduce varicose veins and swelling of the feet and ankles. Recreational exercise improves muscle tone, strength and endurance. It makes it easier to carry the weight you gain during pregnancy and helps prepare you for the physical challenge of labour. Recreational exercise promotes a sense of wellbeing. Staying fit during pregnancy may help to reduce feelings of stress, anxiety and depression. Recreational exercise also improves sleep.

Recreational exercise during pregnancy may help to prevent medical conditions such as:

  • Gestational diabetes mellitus (diabetes that develops during pregnancy)
  • Hypertension (high blood pressure).

Recreational exercise also reduces the risk of developing colon cancer and may reduce the risk of developing breast cancer later in life. If you have gestational diabetes mellitus  (diabetes that develops during pregnancy), exercise can help to improve your blood sugar levels. Women who do not do recreational exercise during pregnancy may become unfit.

Benefits for your baby

Women who do strength conditioning exercise during pregnancy tend to have a shorter labour time and fewer delivery complications.

Are there any risks?

Although recreational exercise can be beneficial during pregnancy, there may also be certain risks. These are related to the physical changes that occur as your body adapts to pregnancy. The risks are more likely to occur when you do inappropriate kinds of exercise  and when you overexert yourself. By making appropriate adjustments to your exercise routine, you can reduce the likelihood of harm to you and the baby.

The risks include:

Getting too hot (hyperthermia)

When you exercise during pregnancy, your overall body temperature increases more than it would do normally. If your body temperature rises above 39.2°C in the first 12 weeks, this may affect the baby’s development leading to disability at birth.

To reduce the risk of getting too hot, you should:

  • ensure that you drink lots of water before and during exercise
  • avoid over-exerting yourself, particularly in the first 12 weeks of pregnancy
  • avoid exercising in a very hot and humid climate until you have acclimatised – this will take a few days.

Low blood pressure (hypotension)

When you lie flat on your back, the growing baby presses on the main blood vessels. The effect is that less blood is pumped around your body and this may lead to low blood pressure (hypotension). This is more likely after 16 weeks of pregnancy.

To reduce the risk of low blood pressure, you should:

  • avoid exercises which involve lying flat on your back, particularly after 16 weeks.

Physical injury

During pregnancy you may notice that your joints become loser. You may also notice that you can flex and extend particular parts of your body more than usual, such as your elbows, wrists, fingers, and knees. This is often referred to as hypermobility. It occurs because hormonal changes affect the ligaments that normally support your joints, which in turn make the joints loose in preparation for birth. When your joints and ligaments are less stable, you are at increased risk of injuring yourself.

To reduce the risk of physical injury, you should:

  • make sure that you do warm-up and cool-down exercises
  • avoid sudden changes of direction, if you are doing aerobic exercise
  • consider wearing pelvic support belts during exercise.

Insufficient oxygen in the baby (hypoxia)

At high altitudes, the flow of blood to the womb is decreased and so the baby receives less oxygen. If a woman exercises at high altitudes, the amount of blood flowing to the womb is decreased even further. This leads to insufficient oxygen for the baby.

Blood sugar level

Blood glucose is a source of energy for both you and the baby.

It is important that you:

  • eat well during pregnancy
  • Exercise for no more than 45 minutes at a time.

If you have pre-existing or gestational diabetes mellitus, then you should take particular care when exercising. You should have your blood glucose monitored, eat at regular times, take rest at specific times, and ensure that your baby is carefully monitored. Your healthcare professional should provide you with further information.

Why aerobic and strength conditioning exercise?

The best forms of recreational exercise during pregnancy are:

Aerobic exercise, also known as cardiovascular (heart and lungs) exercise. When you do aerobic exercise your heart rate raises. This causes blood to circulate more quickly around the body and as a result more oxygen reaches the muscles. Swimming, running, fast walking, aqua aerobics and dancing are examples of aerobic exercises.

Strength conditioning exercise. This form of exercise helps to increase your overall fitness and involves slow, controlled movements such as weight bearing exercises.

If you do not exercise routinely and you are starting an aerobic exercise programme, you should be advised to begin with no more than 15 minutes continuous exercise three times per week, increasing gradually to a maximum of 30 minute sessions four times a week to daily.

What kind of recreational exercise should I avoid?

You should avoid exercises which involve lying flat on your back, particularly after 16 weeks.

You should avoid contact sports where there is a risk of being hit in the abdomen, such as kickboxing, judo or squash.

How can I be sure not to over-exert myself?

To ensure that you do not over-exert yourself, you should always have a warm-up and a cool-down period.

The ‘talk test’

During recreational exercise, you should be able to hold a conversation. If you become breathless as you talk, then you are probably exercising too strenuously.

When should I stop exercising?

If you have any unusual symptoms, you should not continue to exercise.

Unusual symptoms may include any of the following:

  • dizziness or feeling faint
  • headache
  • shortness of breath before exertion
  • difficulty getting your breath whilst exercising
  • pain or palpitations in your chest
  • pain in your abdomen, back or pubic area
  • pain in your pelvic girdle
  • weakness in your muscles
  • pain or swelling in your leg/legs
  • painful uterine contractions or preterm labour
  • fewer movements from baby
  • leakage of your ‘waters’ (amniotic fluid)
  • bleeding.

Can I exercise if I have a medical condition?

If you have a medical condition such as heart disease or high blood pressure, or develop this during pregnancy, then you should talk with your healthcare professionals (such as cardiologist and obstetrician) before doing any recreational exercise.

Can I exercise immediately after birth?

If you have had an uncomplicated pregnancy and delivery, then you should be able to do mild recreational exercise such as walking and stretching immediately after birth.

You should be advised to do pelvic floor exercises after the birth, as this reduces the risk of urinary and faecal incontinence.

Women, who do recreational exercise during pregnancy, tend to continue to exercise after birth.

The benefits of exercising at this time are that you:

  • feel better
  • feel less anxious and depressed
  • have more energy
  • lose weight
  • feel fitter (improved cardiovascular fitness).

Sources and acknowledgements: This information is based on the Royal College of Obstetricians and Gynaecologists (RCOG) Statement Exercise in Pregnancy

For more information contact:Dr.Sandeep Singh Sarpal Clinic

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57% male college students in Chandigarh into substance use-Research quoted in local newspaper

Yesterday ,research work carried out by our team was quoted by Hindustan times highlighting the substance use pattern among the students in the city

57% male college students in city into substance abuse’

Vishav Bharti, Hindustan Times
Chandigarh, October 08, 2013
First Published: 21:06 IST(8/10/2013)
Last Updated: 21:41 IST(8/10/2013)

More than 50% of the male college students in Chandigarh are into substance abuse, including alcohol,
smoking and tobacco chewing. The fact has come to the fore in a study conducted by department of internal
medicine of Government Medical College and Hospital, Sector 32 (GMCH-32).
The study titled ‘prevalence, pattern and familial effects of substance use among the male college students -a
north Indian study’ was published in the Journal of Clinical and Diagnostic Research.
For the study, a total of 256 male college going students were interviewed from different colleges. The study
found that 57% students were into substance abuse.
As far as the nature of the substance is concerned, the study found that alcohol tops the chart with 54% use.
It was followed by smoking with 27%, tobacco chewing 8%, cannabis 7%, opiate use 3% and solvent use
1%.
In this study, none of the students reported use of cocaine, amphetamine, sedatives or heroin. No student
reported injections as a source of drug abuse.
Highlighting the frequency of the use, the study found 49% of the users were using the substance on daily
basis, while 23% used it on weekly basis.
While highlighting the reason of use, the study observed that 66% were using for relief from psychological
stress and easy availability was another common reason of substance abuse.
The study also suggested some lifestyle-related interventions in order to reduce the problem of substance
abuse. “There is an utmost need to educate and counsel young students regarding harmful effects of substance
abuse. Health education may be imparted in the school curriculum. Parents should also be educated on what
was the best way to discourage their wards against drugs,” it observed.
Substance Abuse
Alcohol 54%
Smoking 27%
Tobacco chewing 8%
Cannabis 7%
Opiates 3%
Solvent 1%

About 94% substance abusers spend their pocket money on buying substance of their choice. 9% reported
that they had started using substances before attaining the age of 10. 97% were aware about the ill-effects of
substance abuse. 48% said they had tried to stop using substances at some time or the other. 4% said they
had undergone counselling to get rid of substance.
Substance abuse by streams
Medical 25%
Humanities 9%
Commerce 2%
Engineering 36%
Science 15%
Law 8%
Others 4.3%
What’s substance abuse
Substance abuse can simply be defined as a pattern of harmful use of any substance for mood-altering
purposes. Medline’s medical encyclopedia defines drug abuse as “the use of illicit drugs or the abuse of
prescription or over-the-counter drugs for purposes other than those for which they are indicated or in a
manner or in quantities other than directed.”

The complete article is available from

Prevalence,Pattern and Familial effects of substance use-A North Indian Study

News Link in Hindustan Times

 

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Patients Perspective on Doctors

Doctor Devil

Patients perspective on Doctors

When the death knocks upon the door, the doctor is looked upon as a God

When he accepts the challenge, he is looked upon as an Angel

When he cures the patient, he is looked upon as a Common man

When he asks for the fee, he is looked upon as a Devil

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Anesthesia Vs. Anaesthesia: Does It Really Matter?

Ashish Khanna, 1998 batch

Connections-May 2013 (Volume 10, Issue 2) 

The Oxford dictionary definition of Anaesthesia is “insensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations”. The Merriam-Webster dictionary defines Anesthesia as “loss of sensation and usually of consciousness without loss of vital functions artificially produced by the administration of one or more agents that block the passage of pain impulses along nerve pathways to the brain” Synonymous: yes?

Anyone would agree that the difference between Anaesthesia (British English) versus Anesthesia  (American English) is above and beyond the addition of a single alphabet of the English language. I started my journey as an anesthesia resident in a country where Anaesthesia was the correctly spelt version of the branch of medicine that dealt with this specialty. Today, three years after re-training the art and re-learning Anaesthesia to be spelt as Anesthesia in the United States, it is time to look back and ponder on the finer points.
The decision to leave your own country after finishing a residency always comes with a pinch of salt. As you look to expand your clinical and academic training beyond the horizon, you are faced with the uncertainty of the unexpected. The challenge is a system of medicine distinctly different from your home country and a culture to healthcare that demands considerable understanding. A question that I am very often faced with when I make my frequent trips back home is “What is different about Anesthesia practice in the United States?” It might come as a surprise to a lot of people if I say “nothing at all” in reply. Well, what is different is not Anesthesia or Anaesthesia, only the fine print!! The other very frequent question that is thrown at me is the almost rhetorical “Is it better there?” Let me step back today and say let’s keep all this better – worse talk aside. It never was and it will never be fair to compare two vastly different systems of medicine. As I direct this piece of writing to those friends of mine who are faced with doubts and internal struggles before they leave the comfort of their own homes I would like to emphasize one singular fact: forget about quality of medicine or quality of life and remember the biggest challenge is the ability to train to re-train or put
in more simple words another residency program after a prior residency in your home country. Starting a residency program in Anesthesia under the Accreditation Council for Graduate Medical Education (ACGME) at the Cleveland Clinic Foundation, I realized early on that the essence of getting the most out of this education is to wipe my slate clean and restart again. Tell the world that you are trained in your specialty in your own country and you are capable of doing your thing does provide you with the much-needed independence of clinical work at times, but can be your worst
enemy if you want to acquire new knowledge. It is important to understand that there will be days where the attending will hold your hand when you are doing a procedure that you have done so many times before or might tell you that “this is the way it is done here”. Days, when you need to keep you’re your ego at home. Days when you will feel your neurons are struggling to cope with erasing old skills and acquiring new skills for the same procedures again. But, hey did you want to  do things the way you were doing them in your own country? That said, what is the reason you
made this trip across 4000+ miles half way across the planet? The answer to these questions will help you understand that unless you let your guard down in a foreign land and show that you are an open book you will never learn anything new and in essence never grow as a clinician. Medicine is repetitive science; it is very easy to be lulled into a false sense of satisfaction practicing the same
things over and over again, the same very way every day. The only way to appropriately imbibe your area of expertise and to mature as a clinician is to step out and see what else can be done differently and is being done differently. My message here is not to train in the United States after training in India, but to train at different places and in that process acquire a new set of skills all the time.
Going further, another area of distress for the physician from India as he or she steps onto alien soil is the cultural aspect of medicine. The interaction between peer groups as resident doctors and patient physicians as healthcare providers is different to say the least. As you move away from the “yes sir/ma’am” policy to “yes Dr. XYZ” even when that Dr. XYZ might be your department chair, you will quickly realize that you have to prove your worth as a resident by the sheer quality of your work and not the weight of your courtesy and multiple salutations directed to your staff. Decision making for the betterment of your patient is another area where the young resident here is thrown into the deep end every single day. An ICU attending will ask you for your plan, and so will your anesthesia attending in the operating room. And yes, your plan will be plan that will be executed as long as you can justify it. And that holds true for every provider from the lowest level of an intern to upwards.
Protecting patient privacy and respecting that the patient is the true owner of his or her healthcare information is another moot point here. Not to discuss patients with names or anything that could identify them, not to talk about them in the hospital corridors or the escalators is a habit that is difficult to get rid of. The tendency to try to force your decision as a clinician on the patient or the patient’s family is also something that we live by all the time in India. The patient is the master of his/her own destiny here and whether it be morbid obesity, chronic smoking in a vasculopath or narcotic abuse in a chronic pain patient, your job will be to ask them whether they feel they can change theirlifestyleand not to enforce that change on them. Difficult times will also revolve around “End-of-Life” decisions in the ICU and DNR (Do Not Resuscitate) statuses. The ability of families here to think very practically for their dying loved ones and to let go of them when there is point of futility, is commonplace. Another challenge that is
beyond the understanding of anesthesia and different from back home, and is something that you
have to deal with on a regular basis.
How can I forget to include in my set of challenges also, the change from using pharmaceuticals as brand names versus names of salts back home. Or the different abbreviations that come inherent with another healthcare system. Yes, I gave my senior resident a quizzical look when he said “Did you tube your patient” ( a.k.a intubation) or “Can you do the A-line first?” ( a.k.a arterial line) or “ Is he off the vent ?” (weaning from the ventilator) or “When is your ICU patient going to the sniff?” (a.k.a skilled nursing facility). There are numerous more such which define the distinct cultural differences in healthcare here in the United States.
As I look back today, I know that things have evolved for me as a clinician but also more importantly as a human being. I look at medicine differently; I look and understand a patient’s emotions differently. That to me is the pivotal change. For all those fellow friends who are getting ready to step out on this often-treaded path of training in another country after training as a specialist in India, I hope this writing will give a better idea of what to expect. All said and done, the
difference is not in quality of healthcare or the quality of life that you can expect to live, but in what you can assimilate from the new system of medicine.

In the end, it is not Anesthesia versus Anaesthesia, and it really does not matter!

Dr.Khanna

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The President’s Visit

VIP duties for the medical persons usually means moving around them amid their tight securityFor I have done quite a number of them in the past few years; the craze and excitment I used to feel initially seems to have been washed away.

But this month when I got a letter from the hospital  administration regarding my deputation for honorable president of India’s visit on 15 march,I was super excited .

First of all it is an honor to be a part of medical  team of India’s first man.

Secondly I always have had this cherished dream of seeing the president ‘s security arrangements as it involves huge number of cars and men .Most of traffic on the roads is stopped when his team passes and as a common man I had watched it from outside but always wondered how it must feel to move along those fast cars traveling at high speeds .I wondered as if they had brakes in those cars !!!

Thirdly I have seen our honorable president Mr.Mukherjee enough number of times on T.V. and wanted to see him in live.

On the day of his visit , we asked to to join the duty at 6:30 am in the morning and we went to receive his excellency at the airport.It was jam packed with who-who’s of the region .I remember seeing probably every high up right from the governor to defense chiefs of the region along with seasoned politicians and bureaucrats.The whole atmosphere was filled with thrill of his arrival and on corner of the road you could see high security.

On his arrival he was given a customary march past along with dignitaries greetings .He had come with his wife and staff and then we went to the air force station.The Air force people had put up a splendid show but the best part was paratroopers jumping from the planes in Indian Flags colored parachutes and reaching the ground on a designated spot.It was really amazing and drew a lot applaud from the audience.

And  then we went along with Mr.President  to the governor house.All the roads on the way were empty due to high security and our caravan of nearly 100 cars zoomed past the city roads with police men all around the city .

I was wondering if Mr.President had even known the meaning of the word traffic jam !!!

After the lunch we went to PGI where convocation function was presided by his excellency.And there he was joined by the chief ministers of Punjab and Haryana.

Afterwards we went back to the airport along with the caravan which this  time around had about 150 cars.At the airport I got an opportunity to see all these high profile dignitaries form a very close distance .Actually I wanted to get photographed but the protocol did not allow that.But high point was watching the first citizen of the country amid his security and high profile dignitaries .

The driver of our ambulance had rightly remarked on the way:

           “Dr .Saab eh ta raje ne raje ,te asi ennadi praja,

        raje di shaan ta vakhri hi hundi hai

mai pichle janam rath chalanda si te es janam car”

Meaning : Doctor  they(President) are the modern day  kings and we are his people .

                   Kings magnificence is above all .

                    I was a chariot driver in last birth and a car driver in this birth !!!!!

president visit

Mr .President

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How do Doctors Study ?

exam life

All In a Days Work

Well Life can be tough and grueling sometimes
there will moments of joy and sorrows
well competition can take a toll on everyone and preparing for pg exam really requires best effort
he was spotted in lib at night had done days duty and still braved to come to study but sometimes its just not your day i believe


but still salutation to spirit behind the effort

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