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Guide to using a cast

Guide to using a cast   "Do not let pain be a problem anymore."   The Bone and Joint Surgery Center at Vibhavadi Hospital provides modern equipment and technology for diagnosis and treatment of bone and joint issues, with specialized surgical teams who have experience both locally and internationally to provide care.   Cast A cast is a device used to immobilize bones and joints. The part of the body that is covered by the cast is stationary, while other parts of the body outside the cast can still move. In addition, it can also protect other tissues that have been injured, reduce pain, swelling, and promote the healing of broken bones.   Actions to take in the first 3 days after applying a cast   After the doctor applies the cast, the cast may still be damp and fragile, which takes about 1-2 days to dry completely. Prevent the cast from cracking, breaking, or becoming deformed while it is still damp or not completely dry. Place the cast on a soft material, such as a pillow or foam, and avoid placing the cast on hard surfaces, such as a cement floor. Use the part of the cast that covers the ankle to prop up the cast while moving or getting out of bed, and avoid using the fingertips to push or squeeze the cast. Take care to dry the cast quickly. Place the cast in a well-ventilated area, avoid it getting damp, and do not cover the cast with blankets or anything else. Using a fan or hairdryer can help the cast dry faster, but do not expose the cast to fire.   What to do when the cast is dry?   Take care not to get the cast wet or dirty, such as walking on grass in the morning or getting it wet with water. When bathing, use a plastic bag to cover the cast and use multiple layers of bags with the mouth tied at different levels to help prevent water from entering.   Do not let the cast bear full weight unless it has a rubber sole as a weight-bearing device.   Do not bear weight or walk on the cast unless authorized by a physician.   Potential problems that may arise from being in a cast:   Cast looseness due to internal organ shrinkage or lack of tightness when first casted.   Cast tightness or excessive swelling after being casted.   Prolonged time in the cast causing joint stiffness.   Premature removal of the cast while the bones are not yet properly fused, leading to bone movement.   Itching and irritation caused by bacterial and fungal infections, as well as moisture buildup under the cast.   Compartment syndrome, a condition where there is a lack of blood flow to the affected limb.   Deep vein thrombosis and pulmonary edema.   Recommendations for Patients Using a Cast   You should frequently tense the muscles beneath the cast and move the parts that are outside the cast or the nearby joints, such as wiggling your toes and tensing your calf muscles if you have a leg cast.   Do not remove the cast or the padding material by yourself.   Avoid bumping the cast against hard objects frequently, and do not apply too much pressure that may cause the cast to crack or collapse, such as stepping on it or placing it directly on a hard surface.   Avoid getting the cast wet or exposing it to heat to dry it quickly.   Do not insert any objects into the cast to alleviate itching, as this may cause skin irritation or abrasion.   You should elevate the limb that is in the cast above the level of your heart to promote good circulation. Recommendations for patients using a cast Always keep your scheduled appointment with the doctor. If you experience any of the following abnormal symptoms, see your doctor immediately before your next appoint:   If you experience increasing pain.   If the fingers or toes on the side of the cast appear bluish-green or pale and become increasingly swollen or numb.   If you cannot move your fingers or toes on the side of the cast.   If a foreign object enters the cast.   If you notice that the cast is becoming loose, deformed, or cracked.   If there is blood, yellow fluid, or pus seeping out of the cast, or if there is a foul odor.   When sitting/lying down: Use a pillow to support the arm or leg that is in a cast.   When walking/standing: Use a neck brace for those who use arm casts. In the case of itching from wearing a cast, it is recommended to use a spray powder that contains Triclosan, Tea tree oil, Menthol, and Alcohol to help: Inhibit the growth of bacteria and fungi that cause itching.   Reduce moisture and itching inside the cast.   Speed up the healing of wounds.   Suppress unwanted odors.   Advanced technology at Vipawadee Hospital: The bone density measuring machine (Dexa Bone Densitometer) is the highest standard method used by leading hospitals. By using X-rays with 2 different energies, the machine scans the organ being examined. High-energy X-rays are used to examine bones while low-energy X-rays are used to examine tissues and fats. The results are then compared to bone strength standards to assess the risk of osteoporosis.   Orthopedic and Joint Surgery Center at Vibhavadi Hospital.

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Gout: causes, symptoms, treatment, what foods should not be eaten?

Gout Disease - Causes, Symptoms, Treatment, and Foods to Avoid   Gout is a group of symptoms that occur due to high levels of uric acid in the blood, accompanied by symptoms that result from the deposition of uric acid in the form of urate crystals in the joints or surrounding tissues of the joints.   This causes sudden inflammation of the joint or surrounding tissue, or the formation of urate crystal nodules within and beneath the skin surrounding the joint. If severe, it can lead to kidney stones.   Causes:   Gout is caused by the abnormal accumulation of uric acid in the body. Uric acid is derived from the breakdown of purines, which are dietary nutrients that the body synthesizes and are found in many types of food. Normally, the body breaks down purines and converts them into uric acid. In normal individuals, the kidneys perform the task of excreting uric acid, preventing its accumulation in the body. However, when there is an excessive accumulation of uric acid, it can lead to severe pain in the bones and around the joints.   In men, uric acid levels should not exceed 8 milligrams per deciliter, while in women, they should not exceed 6 milligrams per deciliter. This condition can be hereditary.   Symptoms:   Symptoms of gout include pain, swelling, redness, and heat, especially in the big toe joint, which is the most commonly affected joint. The pain may be intermittent or chronic and can occur in several joints.   Other joints that are commonly affected include the ankle, knee, wrist, fingers, and elbow. It is more common in men than women. In those who have had gout for a long time, kidney stones may develop.   Gout pain often occurs at night, and the pain increases gradually. Several factors such as alcohol consumption, obesity, high blood pressure, and certain medications can trigger gout attacks.   Food for Gout Patients   The food that gout patients consume can be divided into 3 groups according to the amount of purine in the food.   1. Foods with purine greater than 150 milligrams should be avoided or eliminated by gout patients.   These include: liver, boiled beef soup, broth, kidneys, extracts from concentrated meats, anchovies, fish sauce, shrimp paste, sardines, yeast, and fermented foods from yeast (such as beer), clams, tuna, some fish, chicken, duck, birds, and fish roe. Alcoholic beverages such as beer and liquor should also be avoided as they can cause elevated uric acid levels.   2. Foods with moderate purine content (50-150 milligrams) can be consumed in limited quantities by gout patients.   These include: beef, tripe, pork, fish, crab, shrimp, clams, soy beans, black beans, red beans, green beans, vegetables, asparagus, spinach, mushrooms, cauliflower, and acacia leaves.   3. Foods with low or almost no purine content (0-50 milligrams) can be consumed by gout patients without restriction.   These include: rice, all types of rice noodles, vermicelli, egg noodles, sandwich bread, macaroni, corn, crackers, eggs, milk and milk products (butter, ice cream), vegetable oil, coconut milk, butter, lard, vegetables, all types of fruits, chestnuts, cashew nuts, various Thai and western sweets such as cakes and cookies, and beverages such as coffee, tea, cocoa, and chocolate.   Treatment for gout during an acute attack involves taking pain relievers like paracetamol or other pain medications. For joint inflammation, Colchicine 0.6 mg should be used until the pain subsides. If the patient experiences diarrhea, the medication should be stopped immediately. Anti-inflammatory medication should also be taken during this time.   During an attack, it is important to rest and drink plenty of water to prevent uric acid crystals from forming. Elevating the affected area and avoiding standing or walking is also recommended. It is important not to massage or put pressure on the affected joint.   For long-term management of gout, medication should be taken as prescribed by a doctor. Drinking plenty of water can also help prevent kidney stones and reduce the concentration of uric acid in urine. Avoiding alcohol is important as it can lead to the accumulation of uric acid in the body. It is also recommended to avoid animal-based foods that are high in purines, as purines are broken down into uric acid in the body.   Regular follow-up with a doctor is necessary to monitor the condition, and weight management is important for overall health.   Best wishes from the Department of Orthopedic Surgery  

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Guidelines for Home Isolation

Guidelines for Home Isolation   Advice for Suspected or Confirmed COVID-19 Patients (as of March 26, 2020, from the Department of Medical Services)   Most COVID-19 patients have mild symptoms and may not require hospitalization or stay at the hospital for a short period of time before continuing their recovery at home or a recovery facility. Patients with mild symptoms will usually recover gradually until they are fully recovered, but some may experience worsening symptoms during the first few weeks. Patients must pay close attention to their symptoms and, when in doubt, consult their doctor or get evaluated at a hospital to receive proper care.   Patients with mild symptoms or those who are improving may still carry the COVID-19 virus in their nasal and respiratory secretions for at least two weeks after onset, so patients who are sick must isolate themselves from others at home for at least two weeks from the onset of symptoms to minimize the spread of the virus. For example, if the patient develops a fever on March 1 and is admitted to the hospital on March 3 and discharged on March 9, they should isolate themselves at home until at least March 15.     Suitable Accommodation for Home Isolation   During the isolation period, suitable accommodation should have the following characteristics; otherwise, patients may need to find another suitable location:   The accommodation should provide necessary food and supplies so patients don't have to leave the house to purchase them. The patient should stay alone or with others who are also in isolation, with separate bedrooms and bathrooms. If that's not possible, the patient should wear a mask and maintain a distance of at least six feet from others in the household. The patient's room should have good ventilation, natural light, and be cleaned frequently. It should also have access to a bathroom and a trash can with a lid to dispose of used tissues or masks. The patient should have access to a thermometer and be able to check their temperature twice a day. If they have a fever or other concerning symptoms, they should contact a healthcare provider immediately.   Patients with COVID-19 should follow these strict measures while in isolation:   Do not allow anyone else to visit while in isolation. Clean hands regularly with alcohol gel or soap and water if hands are dirty. Especially after touching nose or mouth secretions, coughing, sneezing, using the bathroom, or before touching common surfaces like doorknobs, handrails, refrigerator handles, etc. Stay in a separate room at all times and avoid close contact with other people in the living area, especially elderly people, young children, and individuals with chronic illnesses. While in a separate room, wear a face mask if still experiencing symptoms such as coughing and sneezing. If necessary to be close to other people, others must wear a face mask and stay at least one meter away or approximately an arm's length apart (except for breastfeeding mothers, who can breastfeed since the virus has not been found in breast milk. However, the mother should wear a face mask and wash hands thoroughly before touching or breastfeeding the infant). If coughing or sneezing, do not get close to others, or stay at least 2 meters away. While wearing a face mask, do not use hands to cover the mouth while coughing or sneezing since hands may be contaminated. If coughing or sneezing while not wearing a face mask, use the elbow or tissue to cover the mouth and nose. Use a separate bathroom from others. If you must use a shared bathroom, use it as the last person, close the lid, flush, and clean any contaminated surfaces with a solution of sodium hypochlorite bleach containing 5,000 parts per million (ppm) or 0.5% (1 part bleach to 9 parts water). Keep personal items separate from others, such as dishes, utensils, glasses, towels, phones, and computers. Do not share meals with others. If eating outside the home or preparing food in a shared space, have others provide food separately and eat alone. Wash clothes, linens, and towels with soap and water or detergent, using hot water at 60-90 degrees Celsius if possible. Separate personal trash and dispose of general waste immediately. Dispose of contaminated waste, such as used masks, tissues, etc., in a plastic bag with a solution of sodium hypochlorite bleach containing 500 parts per million (ppm) or 0.05% (1 part bleach to 99 parts water), then tie the bag tightly before disposing of it with general waste. Wash your hands with soap and water after disposing of the waste. Rest in a room with adequate ventilation and avoid very cold air. Drink enough clean water, avoid very cold drinks, and eat nutritional food. Avoid going to public places, workplaces, and schools until the period of isolation has been completed.   If you experience new or worsening symptoms such as high fever, persistent cough, chest tightness, shortness of breath, fatigue, or loss of appetite, please call and seek immediate medical attention at a hospital. This disease can worsen significantly during the second week of illness. If you need to travel to the hospital, please use a private car and keep the windows open. Alternatively, you can request an ambulance while contacting the hospital.   During isolation, clean and disinfect frequently-touched surfaces and equipment such as beds, tables, chairs, and phones with appropriate detergent and water. After completing the isolation period, thoroughly clean all areas that can be cleaned with 0.05% sodium hypochlorite bleach.   If you have any questions, you can contact the hospital where you received treatment or call the Department of Disease Control emergency hotline Tel 1422.   Reference: Department of Disease Control and Ministry of Public Health

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Is it risky to swim in a pool during the COVID-19 pandemic?

Is it risky to swim in a pool during the COVID-19 pandemic?   Swimming in a pool does not increase the risk of contracting the COVID-19 virus because pools have a system to kill germs and keep the water clean, such as adding chlorine, salt or using UV light. However, it is important to be cautious about public spaces, shared equipment and lockers, as well as being near someone who may be infected and coughing or sneezing in the pool. It is best to avoid swimming in a pool if you are sick or have respiratory symptoms. If you want your children to enjoy swimming during this time, it is recommended to purchase a ready-made pool for them to use at home to reduce the risk of exposure and help stop the spread of the virus.   Reference: Department of Disease Control, Ministry of Public Health / World Health Organization

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Top 4 questions about getting the COVID-19 vaccine for children

Top 4 questions about getting the COVID-19 vaccine for children   1. Is it necessary to vaccinate young children at this time?   It is necessary to strengthen the immunity of young children, especially those under 1 year old, against various severe diseases besides COVID-19. Delaying vaccinations can result in children missing necessary immunity building, as well as missing some types of vaccines with limited time frames.   2. What measures are being taken by service providers to prevent the spread of COVID-19?   Service providers are taking several measures, such as scheduling appointments for vaccine administration, clearly designating vaccine zones, and implementing appropriate disease prevention measures, such as regularly cleaning high-touch surfaces.   3. How should one prepare when traveling to receive a vaccine?   Individuals should wear face masks, and parents should closely monitor children aged one month and older. For newborns up to one month, face masks or face shields are not recommended; covering them with a cloth is sufficient. Parents should also teach children to avoid unnecessary physical contact and not to touch their faces, bring alcohol gel to frequently wash hands, practice social distancing, and bring their vaccination records.   4. Should children receive the flu vaccine?   Children should receive the flu vaccine to reduce the chance of getting sick and showing symptoms similar to those of COVID-19 (influenza-like illness), so that they do not have to quarantine or be monitored. While the flu vaccine does not prevent COVID-19, it can help reduce the burden on healthcare resources.   For more information, contact the Pediatrics Department, Vibhavadi Hospital Tel. 0-2561-1111 ext. 4201-2

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6 reasons why children should receive vaccines on schedule

6 reasons why children should receive vaccines on schedule   Age-appropriate vaccination timing is based on recommended vaccination schedules, such as those by the CDC. Vaccinations are scheduled according to age and the optimal timeframe for the body to build up immunity.   Delaying or missing vaccinations can increase the risk of contracting diseases. Vaccinating on schedule can help prevent and reduce the likelihood of serious illnesses in young children.   To achieve optimal immunity, vaccines often require multiple doses at specific intervals. Children need a certain amount of time to develop immunity against diseases, and delaying vaccinations can lower the effectiveness of the vaccine.   The best way to achieve strong immunity is for children to receive the recommended doses of vaccines at the correct time. Some vaccines require multiple doses to be effective, and vaccinating on schedule can help protect children from preventable diseases.   While breast milk can provide some immunity, it cannot protect against all diseases. Vaccines are the most effective way to protect children from a wide range of diseases in the long term.   Children who miss vaccines on schedule not only risk getting sick themselves, but also pose a risk to others by spreading disease. Therefore, it is important for children to receive vaccines on schedule to prevent the spread of preventable diseases.   Pediatrics Department Tel. 0-2561-1111 ext. 4201-2

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Providing special care for premature babies

Providing special care for premature babies   Premature babies may suffer from jaundice and breathing difficulties, it is crucial that they receive special care.   Caring for a premature infant involves close monitoring and regular physical examinations. Premature infants are those born before completing 37 weeks of gestation. While most premature infants do not have significant health problems, they require extra attention because they need to adjust to the outside world more than full-term babies. Premature infants may be born with low birth weight or at around 32-33 weeks of gestation, which can cause additional problems in proportion to the decreasing duration of pregnancy.   However, premature babies may experience delayed development because their brains grow most rapidly during the last 6-7 weeks of gestation, and being born before this period means their brains may not fully develop. Therefore, physicians will constantly monitor their developmental progress, such as their hearing and vision abilities. Parents can also promote their infant's development by exposing them to gentle music, talking to them frequently, and using appropriate colors and lighting.   Problems that premature infants may face:   Hypothermia is a common problem for premature infants because they are often small and have difficulty regulating their body temperature. Therefore, it is necessary to closely monitor and regulate their body temperature to keep them warm, which may require the use of an incubator as the primary tool to control temperature. Breathing difficulties are also common for premature infants, who are often born with low birth weight. For example, premature infants weighing only 1 kilogram at birth often have respiratory problems and may require mechanical ventilation because their lungs are not fully developed. Premature birth can cause low blood sugar levels because premature infants are prone to hypothermia. To maintain a body temperature of 37°C, the body will have to use stored energy as fuel, which can lower the blood sugar level. Premature infants are more susceptible to infections because their immune systems are not fully developed. This is particularly true for premature infants who are born before the end of the pregnancy term, and they are up to four times more likely to develop infections than full-term infants. Jaundice is another common problem for premature infants, as their liver function is not yet fully developed. This can result in prolonged jaundice, particularly in Asian babies. Premature infants often have difficulty swallowing because their bodies have not yet fully developed the coordination required for suckling and breathing. This can result in frequent episodes of choking while feeding. Premature infants may also develop hydrocephalus, which is an accumulation of fluid in the brain. Although this condition often resolves on its own, some premature infants may develop larger than normal heads due to the accumulation of fluid, without any impact on their developmental progress. Necrotizing enterocolitis, where a premature infant's intestines may inflame and decay without warning, without any means of prevention. This can manifest in various symptoms, such as temporary lack of blood to the intestines, intestines dying but not perforating, and intestines perforating. The cause of this condition is often unknown.   Guidelines for taking care of a premature infant at home:   You should provide a clean, well-lit, well-ventilated and noise-free environment for the baby. The mother should breastfeed the baby frequently as newborns often experience the desire to sleep most of the time. The baby should be encouraged to suckle frequently to ensure that the baby receives complete nutrition from the mother's milk, which is crucial for the baby's proper physical development. The baby's digestive and absorptive systems are still immature after breastfeeding. Therefore, the mother should take care not to allow the baby to become engorged or regurgitate milk by placing the baby in a position that helps the baby burp easily, which will also help reduce colic. Keep the baby warm at all times as infants are susceptible to feeling cold, which can cause discomfort. If the baby has a fever, a runny nose, or is producing phlegm, the mother should take the baby to the hospital immediately. The mother can stimulate the baby's development by playing soft music or hanging toys for the baby to look at, or holding and cuddling the baby to promote bonding. Preterm babies tend to have delayed development compared to full-term babies of around 2-3 months, but this may depend on other factors as well. Do not take the baby to crowded places with poor ventilation before touching or holding the baby. The mother should wash her hands thoroughly every time, and maintaining hygiene is essential as various infectious diseases may be brought in by relatives or friends visiting. The baby's belongings should not be kept in the same room where the baby is staying. If the baby is experiencing diarrhea, runny nose, abnormal skin conditions like unexplained blisters or dry skin, refuses to breastfeed or drink water, it is advisable for you to take them to the hospital for further examination by a pediatrician. When it is time for your child's health check-up, it is important for you to take your child to see the doctor on time and regularly, to ensure continuous monitoring by the doctor. Any potential health issues that arise can be addressed promptly. This matter is quite important. You should inform your relatives or anyone else who may visit your child or want to hold them, that your child may be at risk for contracting infections from those who visit, as their immune system is not yet fully developed. If you have another child who is also in the vulnerable age range, this could potentially create further problems as the older child may not understand the condition of the newborn. It is crucial for you to prioritize this issue.   With best wishes from the Obstetrics and Gynecology Department, Vibhavadi Hospital

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เรื่องที่ผู้หญิงควรรู้ “มะเร็งรังไข่” หากคุณเป็นหนึ่งที่เป็นกลุ่มเสี่ยง อาทิ มีกรรมพันธุ์, อายุมาก, โสดหรือไม่เคยมีบุตร

 มะเร็งรังไข่   มะเร็งรังไข่ เป็นมะเร็งที่พบมากเป็นอันดับห้าของมะเร็งที่พบในสุภาพสตรี และอัตราการเสียชีวิตเป็นอันดับสี่ เนื้องอกของรังไข่ เนื้องอกของรังไข่แบ่งออกเป็นชนิดใหญ่ 2 ชนิด คือ เนื้องอกที่ธรรมดา หรือที่เรียกว่า Benign Tumor เนื้องอกชนิดนี้ จะไม่แพร่กระจาย การรักษาทำได้ง่าย ผ่าตัดเอาก้อนเนื้องอกออกก็หาย เนื้อมะเร็ง Malignant เนื้องอกชนิดนี้อาจจะเรียกเนื้อร้ายหรือมะเร็ง หากวินิจฉัยได้ช้าเนื้อร้ายจะแพร่กระจายไปยังอวัยวะอื่น   ชนิดของมะเร็ง   มะเร็งรังไข่จะเกิดเซลที่เป็นส่วนประกอบของรังไข่ Epithelial Tumor เป็นเนื้องอกที่เกิดจากเซลผิวของรังไข่เนื้องอกส่วนใหญ่เกิดขึ้นจากเซลชนิดนี้ Germ Cell Tumor เป็นมะเร็งที่เกิดจากเซลที่ผลิตไข่ Stroma Tumor เป็นเนื้องอกที่เกิดเซลเนื้อเยื่อเกี่ยวพันซึ่งสร้างฮอร์โมนเพศ Estrogen และ Progesteron   สาเหตุของมะเร็งรังไข่   ยังไม่ทราบสาเหตุที่แท้จริงของมะเร็งรังไข่ แต่พบว่ามีความถี่ของการเกิด มะเร็งในคนที่โสดมากกว่าคนที่เคยมีบุตร และมักพบมากในช่วงอายุตั้งแต่ 40 ปี ขึ้นไป จะเกิดตอนวัยทองคนที่มีปัจจัยเสี่ยงมา มิได้หมายความ เขาจะเป็นมะเร็ง แต่เขามีโอกาสเกิดมะเร็งมากกว่าคนอื่น ปัจจัยเกี่ยวข้อง คือ   1.พันธุกรรม ท่านที่มีญาติเป็นมะเร็ง ก็กังวลว่าท่านจะมีพันธุกรรมของ •          มะเร็งหรือไม่ ให้ท่านไปปรึกษาผู้เชี่ยวชาญเกี่ยวกับพันธุกรรมเพื่อชักประวัติ •          เกี่ยวกับโรคมะเร็งในครอบครัว หากพบว่าท่านมีความเสี่ยง แพทย์จะแนะนำ •          ท่านตรวจคัดกรองหาโรคมะเร็งระยะเริ่มแรก ความเสี่ยงทางพันธุกรรมได้แก่ •          ญาติสายตรงของท่าน (แม่หรือพี่สาว หรือน้องสาว) เป็นมะเร็งรังไข่ 2 คน •          ญาติสายตรงคนหนึ่งเป็นมะเร็งรังไข่ อีกคนเป็นมะเร็งเต้านม ซึ่งเกิดก่อน •          อายุ 50 ปี •          ญาติสายตรงเป็นมะเร็งรังไข่ และประวัติคนในครอบครัว 2 คน เป็นมะเร็งเต้านมก่อนอายุ 60 ปี •          คนในครอบครัว 3 คน เป็นมะเร็งลำไส้ใหญ่ (หนึ่งคนเป็นก่อนอายุ 50 ปี)  และมีคนในครอบครัวคนหนึ่งเป็นมะเร็งรังไข่   2.อายุ อายุมากจะเสี่ยงต่อการเกิดมาก โดยเฉพาะอายุมากกว่า 40 ปี   3.ผู้หญิงที่มีประจำเดือนอายุน้อยกว่า 12 ปี และไม่ได้ตั้งครรภ์ และเกิดหมดประจำเดือนหลังอายุ 50 ปี จะเป็นกลุ่มเสี่ยงต่อการเกิดมะเร็ง   4.การตั้งครรภ์ พบว่าผู้ที่ไม่เคยมีบุตรจะเสี่ยงต่อการเกิดมะเร็งสูงกว่าคนที่เคยมีบุตร   5.ผู้ที่เคยเป็นมะเร็งเต้านม หรือมะเร็งลำไส้ใหญ่จะเสี่ยงต่อการเกิดมะเร็งรังไข่   6.ยากระตุ้นให้ไข่ตก ก็เพิ่มความเสี่ยงต่อการเกิดโรค แต่ต้องกินต่อเนื่องนานเกิน 12 เดือน   7.หลายการศึกษาพบว่า การใช้แป้งบริเวณอวัยวะเพศเป็นเวลานานจะเพิ่มความเสี่ยงต่อการเกิดมะเร็งรังไข่ แต่แป้งสมัยก่อนอาจจะมีสารปนเปื้อน หากท่านมีประวัติเหมือนตัวอย่างข้างต้น ให้ปรึกษาแพทย์เพื่อคัดกรองโรค หลายท่านที่มีความเสี่ยงว่าจะเกิดมะเร็งรังไข่อยากจะตัดรังไข่ทิ้ง ท่านต้อง ปรึกษาแพทย์พิจารณาถึงผลดีและผลเสียของการผ่าตัด   การค้นหามะเร็งแรกเริ่ม         โรคมะเร็งทุกชนิด จะเหมือนกันยิ่งพบเร็วการรักษาก็จะได้ผลดี มะเร็งรังไข่ก็เช่นกัน แต่มะเร็งรังไข่มักจะวินิจฉัยได้ช้าเนื่องจากอยู่ภายในช่องท้อง และมักจะไม่มีอาการในระยะแรกของโรค ผู้ป่วยร้อยละ 25 จะวินิจฉัยมะเร็งรังไข่ได้ก่อนที่มะเร็งจะแพร่กระจาย การค้นพบแรกเริ่มจะเพิ่มโอกาสในการรักษาให้หายขาด วิธีการค้นหามะเร็งแรกเริ่มได้แก่   -การตรวจภายในประจำปี การตรวจภายในจะค้นหามะเร็งปากมดลูก แต่ไม่สามารถตรวจมะเร็งรังไข่ในระยะเริ่มแรกได้ มักจะพบมะเร็งรังไข่ในระยะท้ายของโรค แต่การตรวจภายในก็เป็นสิ่งจำเป็นต้องตรวจเป็นประจำ มีคำแนะนำให้เริ่มตรวจตั้งแต่อายุมากว่า 18 ปี   -พบแพทย์เมื่อมีอาการ อาการที่ควรจะพบแพทย์โดยเร็วได้แก่ ท้องบวม แน่นท้อง เลือดออกทางช่องคลอดผิดปกติ แน่นท้องน้อย ปวดหลัง ปวดขา ปวดท้อง แน่นท้องโดยที่หาสาเหตุไม่ได้   -การเจาะเลือดหรือการตรวจพิเศษ การตรวจ Ultrasound ผ่านทางช่องคลอดจะช่วยพบก้อนในช่องเชิงกรานได้เร็วขึ้น การเจาะเลือดหา CA-125 ก็ยังไม่สามารถบอกมะเร็งในระยะเริ่มแรกได้ จึงไม่แนะนำการตรวจพิเศษทั้งสองแก่คนทั่วไป   -เจาะเลือดตรวจหา  CA-125  ซึ่งหากเป็นมะเร็งค่านี้จะสูง แต่ก็พบว่าผู้ป่วยที่เป็นมะเร็งค่านี้สูงไม่มาก   -การทำ Ultrasound ผ่านทางช่องคลอด ซึ่งจะใช้เครื่อง Ultrasound สอดเข้าไปในช่องคลอดซึ่งจะปล่อยคลื่นเสียงความถี่สูง เมื่อคลื่นเสียงกระทบกับวัตถุ คลื่นเสียงจะสะท้อนกลับเครื่องจะแปลงคลื่นเสียงเป็นสัญญาณภาพระหว่างการตรวจไม่มีความเจ็บปวด   อาการของมะเร็งรังไข่   มะเร็งรังไข่ในระยะแรกเริ่มมักจะไม่มีอาการ แต่จะมีอาการในระยะท้ายของโรคอาการที่พบได้   -แน่นท้อง อึดอัดท้อง (บางรายสงสัยว่ามีก๊าซในท้อง) -คลื่นไส้อาเจียน ท้องผูก ปัสสาวะบ่อย -เบื่ออาหาร -รู้สึกแน่นท้องหลังจากรับประทานอาหาร -น้ำหนักขึ้นโดยไม่มีสาเหตุ -เลือดออกช่องคลอด   การรักษา โรคมะเร็งรังไข่มีหลายวิธีขึ้นกับระยะของโรค สภาพโดยรวมของผู้ป่วย ซึ่งการรักษาจะประกอบไปด้วยแพทย์หลายแผนก เช่น สูติ-นรีแพทย์ แพทย์ทางรังสีรักษา แพทย์ทางเคมีบำบัด การรักษาโดยการผ่าตัดและเหตุผลของการผ่าตัด   การผ่าตัดผู้ป่วยที่สงสัยว่าจะเป็นมะเร็งรังไข่มีเหตุผล คือ   1.ผ่าตัดเพื่อการวินิจฉัยโรค โดยแพทย์จะผ่าเข้าไปดูเนื้องอกและตัดชิ้นเนื้อเพื่อส่งตรวจ   2.ผ่าตัดเพื่อบอกระยะของโรคโดยแพทย์จะผ่าดูเนื้องอกลุกลามแค่ไหนและตัดต่อมน้ำเหลือง   3.ผ่าเพื่อการรักษา      แพทย์จะผ่าตัดเอา มดลูก ท่อรังไข่ รังไข่ออก เรียกการผ่าตัดว่าHysterectomy  With  Bilateral  Salpingo-Oophorectomy  และตัดต่อมน้ำเหลืองไปตรวจ ระหว่างผ่าแพทย์จะส่งชิ้นเนื้อของต่อมน้ำเหลืองและน้ำในช่องท้องไปตรวจเพื่อจะได้ทราบระยะของโรค หากพบว่ามะเร็งเริ่มแพร่กระจายในท้อง แพทย์จะผ่าเอาส่วนที่สงสัยว่าเป็นมะเร็งออกให้มากที่สุด เพื่อที่จะให้การรักษาด้วยรังสีหรือเคมีได้ผลดีขึ้น     ผลเสียของการรักษา โดยการผ่าตัดระยะแรก ก็อาจจะปวดแผลบ้างแต่ก็บรรเทาโดยยาแก้ปวด ในระยะต่อมาเมื่อรังไข่ถูกตัดก็ไม่สามารถสร้างฮอร์โมนเพศ (Estrogen, Progesterone) ก็ทำให้ช่องคลอดแห้ง ร้อนตามตัวเกิดอาการของคนวัยทอง   เคมีบำบัด คือการให้ยาเพื่อทำลายเซลมะเร็ง ซึ่งยานี้ก็มีผลต่อเซลปกติของร่างกายมีด้วยกัน 2 วิธี คือ   1.การให้เคมีหลังการผ่าตัดเราเรียกว่า Adjuvant Chemotherapyจะให้ยา 4-6 ครั้งใช้เวลา 3-6 เดือน แพทย์จะพิจารณาให้ในกรณีที่แพทย์คิดว่าผ่าตัดเอาเนื้อร้ายออกไม่หมด หรือการผ่าตัดนั้นยาก   2.ให้เคมีก่อนการผ่าตัด Neo-Adjuvant Chemotherapy แพทย์คิดว่าเนื้อร้ายก้อนใหญ่ผ่าตัดยากหรือผ่าออกไม่หมด แพทย์จะให้เคมีเพื่อก้อนเนื้อจะได้มีขนาดเล็กลง   ยาเคมีมีทั้งชนิดรับประทานและชนิดฉีดซึ่งส่วนใหญ่ใช้ชนิดฉีด แต่ก็มีการให้ยาเคมีเข้าช่องท้องซึ่งอยู่ในช่วงการทดลอง หลังจากเคมีบำบัดแพทย์อาจจะผ่าเข้าช่องท้อง เพื่อดูว่ามะเร็งถูกทำลายมากน้อยแค่ไหนหากมีมะเร็งหลงเหลือแพทย์จะผ่าตัดเอามะเร็งส่วนที่เหลือออก ผลเสียของการรักษาด้วยวิธีนี้ขึ้นอยู่กับชนิดของยา และปริมาณยา ผลข้างเคียงที่พบได้คือ คลื่นไส้อาเจียน ท้องร่วง เบื่ออาหาร ผมร่วง   การฉายแสง แพทย์จะใช้รังสีฉายไปยังส่วนที่เป็นมะเร็งเพื่อทำลายมะเร็ง ผลเสียคือ อ่อนเพลีย น้ำหนักลด เบื่ออาหาร ปัสสาวะลำบาก การให้รังสีรักษามีสองวิธีคือ   1.การให้รังสีจากเครื่องที่อยู่ภายนอกร่างกาย External Besm Radiation Therapy โดยจะให้รังสีสัปดาห์ละ5วัน   2.Brachytherapy คือการฝังสารที่ให้รังสีใกล้กับมะเร็งเพื่อให้รังสีทำลายเซลมะเร็ง แต่ปัจจุบัน ไม่นิยมใช้รังสีในการรักษามะเร็งรังไข่          ด้วยความปรารถนาดี จากศูนย์สูตินรีเวช รพ.วิภาวดี

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Gynecologic Laparoscopic Surgery

Gynecologic Laparoscopic Surgery   A new option for women is laparoscopic surgery in gynecology, which is a surgical procedure aimed at treating abnormalities of the internal reproductive organs in women, such as the uterus, fallopian tubes, ovaries, and nearby organs. The procedure involves using a camera that magnifies the image by about 10-20 times, inserted into the abdomen through a small incision. This allows the surgeon to clearly see the abnormal tissue and organs that require surgical intervention, and to use surgical instruments with a diameter of approximately 5 millimeters to perform the surgery. Therefore, patients will only have about 3-4 incisions on the abdomen, each approximately 5-10 millimeters in size.   Laparoscopic surgery can treat several conditions, including:   Abnormal menstrual periods caused by fibroids or thickening of the lining of the uterus Pain caused by ovarian cysts or endometriosis Pain during menstruation due to chocolate cysts Ectopic pregnancy Other conditions such as infertility diagnosis, tubal sterilization, and dye injection for fallopian tube examination   However, there are some contraindications for laparoscopic surgery in gynecology, including:   1. Severe heart or lung disease 2. Intestinal obstruction.   Postoperative Condition:   After surgery, the patient will have an IV line in one arm and small incisions, typically 3-4, which may cause discomfort or a sore throat due to the breathing tube used during anesthesia.   Postoperative Care:   After surgery, it is recommended to lie on your side and move your body on the bed. Within 24 hours, you should sit up and walk around quickly to promote rapid recovery and reduce the risk of complications, such as bloating or intestinal obstruction. If you experience pain from the surgical incisions, inform the nurse so that pain relief medication can be administered. If you experience a tight, squeezing sensation in the throat that radiates to the shoulder, rest on the bed until the symptoms subside. If you experience nausea or vomiting (a side effect of anesthesia), inform the nurse so that medication can be given to relieve symptoms. There may be some vaginal bleeding after surgery, so it is recommended to use a sanitary pad. After surgery, you should be able to urinate on your own. If you cannot urinate or have difficulty urinating, notify the nurse.   Postoperative care at home:   When returning home after surgery, there are certain things that should be taken into consideration.   Firstly, it is important to consume nutritious food to help nourish the body. Vegetables and fruits should be consumed to facilitate comfortable bowel movements. Taking a shower is allowed, but it is important to observe the wound area afterwards for any signs of plastic sticking or water seeping into the surgical incision. Sexual activity should be avoided until the wound has fully healed and has been checked by a medical professional. Heavy lifting and strenuous activity should be avoided during the first week after surgery. However, walking up and down stairs is allowed. If there are no signs of pain or discomfort, normal work and exercise can resume within 7-10 days after surgery. If there are any abnormal symptoms, it is important to consult with a medical professional before the next scheduled appointment.   Abnormal symptoms that require medical attention include: An inflamed incision area that is swollen, red or has pus A continuous high fever for 2-3 days Severe abdominal pain accompanied by vomiting after eating Heavy bleeding from the vaginal area.   In cases where both ovaries and fallopian tubes are removed via laparoscopy, some women may experience symptoms due to a lack of female hormones. These symptoms include hot flashes, excessive sweating, palpitations, muscle aches, joint pains, and mood swings. It is important to inform the doctor to consider hormone replacement therapy.   Best wishes from the Department of Ob-Gyn, Vibhavadi Hospital

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11 Things About Sebaceous Cysts that Women Should Know

11 Things About Sebaceous Cysts that Women Should Know   Sebaceous cysts are growths that develop from a type of skin gland that produces oil. These cysts are characterized by a sac-like structure that contains fatty matter, sebum, hair follicles, sweat glands, or other body secretions, all enclosed within a wall that is made up of the components of the skin, such as hair follicle openings, sebaceous ducts, or sweat glands. Sebaceous cysts can appear as pouches because of blockages in the openings of these various glands or from the entrapment of skin cells within the dermis layer, which can occur after skin trauma, inflammation, or during fetal development. Cysts that develop from this latter mechanism are present from birth.   There are different types of sebaceous cysts, each with their distinct characteristics depending on their location and composition. Sebaceous cysts that have a wall that resembles the skin structure are called Epidermal Cysts, Milium, Steatocystoma Multiplex, Vellus Hair Cyst, and Dermoid Cyst. On the other hand, cysts that are composed of sweat gland structures are called Apocrine and Eccrine Hidrocystoma.   Epidermal cysts:   The most common types of cysts that occur on the skin. They form on the hair follicles and consist of keratin, which is a substance similar to the material found in hair and nails. These cysts are round and vary in size, and they have the same color as the surrounding skin. They are attached to the upper layer of the skin but not to the underlying tissue, and they may have an opening on the skin's surface where the cyst is attached. When the skin is pulled tight, a small bump may be visible on the cyst in this area, and if squeezed, a white substance similar to cottage cheese may come out. However, squeezing should not be used as a diagnostic method because it can cause the cyst to become inflamed, painful, and red. Epidermal cysts can occur in individuals of all ages and genders and on any part of the body, but they are commonly found on the face, neck, chest, and upper back.   Milium:   A type of cyst that has a similar structure and composition to an epidermal cyst, but is smaller in size. It appears as a small, white, hard bump that is located near the surface of the skin and has a central pore of approximately 1-2 mm. This type of cyst can occur at any age, from newborns to the elderly, and is equally common in both males and females. It is often found on the face, particularly on the nose in newborns, as well as on the eyelids and cheeks in children. Additionally, milium can also occur in areas of the skin that have been damaged previously, such as in areas with scars or after sunburn. Milium can also develop after a skin condition that causes clear, fluid-filled bumps or in areas where steroids have been applied for an extended period of time. Milium is most commonly found when the skin has experienced various types of damage, which may lead to the development of whiteheads.   Steatocystoma Multiplex:   A type of cyst that develops in the sebaceous ducts, which are the tubes that connect to the oil glands in the skin. The wall of this cyst is similar in appearance to that of an epidermal cyst, but the substance contained within the cyst is not keratin, but rather oil produced by the oil glands. This type of cyst is often found in adolescents and adults of both genders and appears as small, subcutaneous bumps that vary in size but are usually less than 5 cm. These cysts can be found on any part of the body, but are more commonly found on the central chest, upper arms, and thighs. When these cysts are near the surface of the skin, they appear as yellowish bumps, while deeper cysts may appear as a single flesh-colored lump.   Vellus Hair Cyst:   A small cyst that contains a wall and substance inside the cyst similar to Epidermal Cyst and Steatocystoma Multiplex, but with small vellus hairs enclosed within the cyst. This causes the cyst to have a dark-colored appearance and this type of cyst often occurs in multiple bumps throughout the body.   Dermoid Cyst:   A rare type of cyst that is often present from birth or in childhood and is the type of cyst that has the most components similar to the skin. The cyst's walls consist of skin cells, hair, sweat glands, and oil glands. The cyst is a round lump under the skin, about 1-4 cm in size and may have hair protruding from it. It is commonly found in the eyebrow area, nose, and scalp. If this type of cyst is located in the middle of the body, such as in the nose or back of the head, it may have an open connection to the brain.   Due to the fact that the walls of sebaceous cysts are composed of cells that produce skin, there is a chance that they could develop into cancer, just like normal skin cells. However, the incidence of cancer developing from sebaceous cysts is very low, so there is no need to worry excessively. Complications that may arise from sebaceous cysts are usually related to inflammation and infection, which often occur when the cyst ruptures due to puncture or pressure, or when the cyst is in a location that is frequently irritated. This causes the substances inside the cyst to leak out and stimulates an inflammatory response in the body, allowing bacteria on the skin to infiltrate and grow in the cyst, leading to enlargement, redness, and pain.   Treatment:   Since sebaceous cysts are benign and have a low risk of developing into cancer, it is not necessary to remove them surgically. However, it is advisable to remove the cyst if it is frequently infected or there is a chance of infection due to the cyst being in a frequently rubbed area. For small cysts located close to the surface, such as Milium, treatment can be provided by puncturing the cyst and using a tool to extract the material inside. Other types of sebaceous cysts can be treated by surgical removal, while Steatocystoma can be treated by using a needle to puncture and extract the oil inside the cyst and peeling off the cyst wall. If the cyst is infected, it must be treated with antibiotics in conjunction with surgical removal to drain the pus. For Dermoid Cysts located near the brain, a thorough examination and computerized tomography scan must be done before treatment to prevent complications.   Sebaceous cysts are generally nothing to worry about, as the risk of them developing into cancer is very low. However, regardless of the type of cyst or if one is unsure if it is a cyst, it is best to have a dermatologist diagnose it for peace of mind. It is important not to squeeze or puncture the cyst yourself as it can cause infection and lead to a wound.

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