Brief Answer:
Please upload reports.

Detailed Answer:
Hi,

Thanks for posting your query.

Please upload your reports and ask your query.

regards,
Shanti.V.

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Brief Answer:
ATT may be stopped temporarily if needed.

Detailed Answer:
Hi,

Thanks for writing back.

I have gone through the attached report. Rise in ALT can happen even with excess use of paracetamol while anti-malarial drug that has been prescribed is relatively recent in the market and its complete adverse effects are not completely known, but, so far, it is claimed to be safer than other drugs.

ATT can be stopped temporarily if needed and this does not lead to any drug resistance. Also, since you have completed most of the intensive course, you are safe.

Hope your query has been clarified. Please feel free to contact for further information. I will be happy to help.

regards,
Shanti.V.

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Brief Answer:
Raised ALT could be due to use of drugs.

Detailed Answer:
Hello,

Thanks for writing again.

Here are your answers:

1. I have not seen any hormone reports uploaded on this thread. If you have any, please upload. I have also checked all my previous answers, but I still did not find any reports of hormone assays. If you have had missed periods, several reasons are at play. They can be the disease, the medication, the stress, weight changes and so on.

2. This raises ALT values cannot be attributed straight away to some disease process of the liver. They can also be drug induced in which case they get back to normal after stoppage of the causative drug. Since your fatty liver is non-alcoholic, dietary changes and exercise to maintain a balanced weight usually suffices. As advised by your doctor, you may stop the ATT medication temporarily and observe the change in the values of LFT. Nausea can occur with anti-malarial therapy as well as ATT.

3. This can be considered an improvement since the platelet count has picked up and so is the WBC count within normal limits.

4. The reason for the persistently raised CRP could be the underlying inflammation and I remember suggesting that you have an opinion from an immunologist in one of my earlier responses.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Please attach all the reports you have mentioned.

Detailed Answer:
Hello,

Please attach all the reports and the prescription you want me to see.

All progestins have some influence on the liver function tests. Progynova can also affect the liver function. So, please use them under proper medical surveillance.

Essentiale-L contains essential phospholipids and is used in the treatment of fatty degeneration of the liver. Longifene is used to treat nausea, motion sickness etc. Zocef can be taken under medical supervision in your present condition.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Longifene can cause constipation.

Detailed Answer:
Hi,

Thanks for writing again.

Here are your answers:

1. Before taking any hormone to induce withdrawal bleeding, please check with your gynecologist. Drug interaction is a possibility and so is the impact of liver function. Constipation can develop after using antihistamines.

2. Essentiale is a multivitamin and can be taken as long as suggested by your doctor.

3. Cremaffin can be used, but I would prefer lactulose as it is a milder one.

4. Cyclosporine eye drops, unlike the systemic and parenteral use, do not cause immune suppression. Instead, they act as partial modulator of immune response, reversing the accumulation of dead lymphocytes in the tear glands and thus help in tear production.

5. Longifene is an anti-emetic. It can cause constipation as a side effect.

You can see a gastroenterologist if you experience recurrent feeling of bowel infection. It is true that use of several medications can lead to gastro-intestinal side effects, but usually the effects are temporary and disappear as the medications are stopped.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Adhesions can lead to swelling of the abdomen when there is obstruction.

Detailed Answer:
Hi,

Thanks for your queries.

Here are your answers:

1. Regestrone is a progestogen and can give rise to side effects as any other similar compound, like, bloating, breast engorgement, nausea, vascular and hepatic effects and so on. Heavy bleeding can be seen with hormonal withdrawal especially when the endometrium is thicker and there has been a prolonged delayed period. Adhesions do not impose restriction of usage of this medication. Intestinal infection can cause bleeding if left untreated, by itself, but not due to intake of Regestrone. It is a different composition from Meprate.

2. Missed periods do not cause any swelling. The associated problems may create such a picture. Adhesions may cause swelling when there is any obstruction. Fluid retention in the abdomen is also likely in such a case.

3. Essentiale is a multivitamin.

4. Serum beta-hCG is done commonly to test for the presence or absence of the human chorionic gonadotropin, the pregnancy hormone.

5. Adnexal pathology means there is something wrong with the adnexa or the fallopian tubes and the ovaries.

6. Uterine fibroids are generally visible in a trans-vaginal/pelvic sonogram with good resolution.

I do not see any attached prescription. Please make sure you have done it.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Hormones can cause generalized bloating.

Detailed Answer:
Hi,

Thanks for your queries.

Here are your answers:

1. Water retention can be seen in a sonogram. Fluid retention can cause abdominal swelling and so does constipation. Regestrone can cause generalized bloating and not specifically abdominal fluid retention which can become noticeable.

2. Primary wound healing is complete by 6 weeks while return of wound strength is 50% by 6 months-one year and complete by two years. Diagnostic laparoscopy can be performed now since you have been under treatment from six months. Wound healing can be hampered when the body's immune response is low as in tuberculosis infection.

3. Surgery is required when a mass develops in the pelvic region with associated symptoms as a result of the infection and also when adhesions with symptoms or possible symptoms are found. When a repair of fallopian tubes which are infected is needed, surgery has to be performed.

Hope your queries have been clarified. Take care.

regards,
Shanti.V.

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Brief Answer:
Pressure on the upper abdomen is a common measure during abdominal delivery

Detailed Answer:
Hi,

Thanks for your queries.

Here are your answers;

1. As I mentioned already, fluid collection can be seen in a sonogram.

2. Intestinal enlargement also can be seen in a sonogram. A mass in the pelvic region also can be visualized in the sonogram of the pelvis, better in the trans-vaginal route. Infection can manifest as pain in the pelvic region, swelling, pain during intercourse, abnormal menstruation with intermittent spotting, abnormal vaginal discharge etc.

3. When the case is one of repeated adhesions, it is not wise to operate again since every cut can trigger more adhesions.

4. Pressure is usually given on the upper abdomen during a cesarean section to help the baby delivery. This cannot harm the intestines and this is usually done by only one person.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Dextropropoxyphene is banned for sale.

Detailed Answer:
Hi,

Thanks for your queries.

Here are your answers:

1. Dextropropoxyphene, which was a content of the trade name Proxyvon plus has been banned. The company has replaced the drug with Tizanidine.

2.Tizanidine has its own side effects like any other analgesic medication and should be used with caution with elevated liver enzymes. It interacts with ATT.

3. Enzoheal plus contains Bromelain which acts as a muscle relaxant and is used in treating inflammation. This does not interact with ATT.

4. Pilorute cream is used for hemorrhoids' treatment and since systemic absorption is very less, interactions with ATT are unlikely.

5. Cremalax is a laxative and there are no known interactions with ATT.

6. Pegicol also has no known interaction with ATT.

7. Intestinal bleeding is not a known side effect of these medications, but, analgesics have a general tendency of causing gastric side effects.

8. If bowels are obstructed, you will know through the symptoms and also a plain X-ray of the abdomen followed by CT or contrast.

9. It is difficult to say whether bloating can settle after a period. If it is hormonal, it will. If it is due to an obstruction, it will not.

10. I did not understand what you meant by surrounding tissues getting hurt. Please elaborate.

11. Properitoneal space is the space lying in between the peritoneum and the fascia transversalis and is occupied by fat, loose connective tissue and membranous tissue. For a detailed description of this space you can go through the link given below.

http://www.yyyyyyyyyyyyyyyyyyyyyyyyy/article/S0039-6109(05)70394-7/abstract

12. Yes. The space can be visualized in laparoscopy.

13. Yes, it is possible for infection to have occurred in the space.

14. Yes, biopsy can be taken form that area if in doubt and if accessible.

15.Essentiale is a multivitamin and does not cause constipation.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Tramadol is an analgesic.

Detailed Answer:
Hello,

Thanks for your queries.

Here are your answers:

1. Tramadol is a strong analgesic,i.e., pain killer. Tizanidine is a muscle relaxant. Proxyvon plus is a combination of paracetamol and Tramadol, both of which have analgesic action.

2. Any medication is suitable for treating inflammation and your doctor, who has seen you in person, is the best judge.

3. Since you have had several investigations done on your abdomen, any tumor, if at all, would be visible. Infection and adhesions are a possibility. You cannot detect infection in a sonogram, only the associated changes like inflammation and adhesions are seen.

4. I have seen instances when the abdomen needed to be opened again after a laparotomy to clear adhesions that were causing obstruction to the bowels. This is done only when there is dire necessity as with every knife cut on the body, such patients have a chance to develop additional adhesions which is not good.

5. Since you have had the surgery less than a year ago, if I remember well, any hyperesthesias due to severed nerve endings during the surgery would cause symptoms for some more time. A surgical wound takes two years to regain original strength.

6.You should continue with vitamin supplements and get periodic assessment by the gynecologist. The physician who has put you on ATT would assess you for the same time to time. If a laparoscopy has been suggested as necessary now, please go ahead with it.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Can get laparoscopy done.

Detailed Answer:
Hello,

Thanks for your query.

Here are your answers:

1. MRI, being free of radiation effects can be repeated, but, the contrast can have side effects, being an invasive procedure. You should check with the attending radiologist also before planning for a test. A pelvic MRI was already done, if I remember. A repeat test may help in noting the changes in the anatomical situation since the earlier one.

2. The fact that you responded to hormone withdrawal shows that you have a responding uterus. To receive adequate endometrial growth, estrogen supplements are also needed. You can ask your gynecologist if such courses can be tried.

3. Any specialist can do it. You also can get surgeons who exclusively perform laparoscopy. You must choose a doctor who is efficient in performing operative laparoscopy.

It is difficult to say if this procedure can cause adhesions in future; the chances are less. Medications can be instilled during the procedure to lessen adhesion formation.

http://yyyyyyyyyyyyyyy/resources/yyyyyyyyyyyyy/laparoscopy-before-and-after-tips/

Please go through the above link. This gives you an overview of the procedure.

4. Your wound should mostly heal by this time and you can safely go ahead with the procedure after the consent of your consultant.

5.If you were my patient, firstly, I would preassess before going for a cesarean and take care that there is no intra-operative or post-operative event that can hamper healing. I would review after 6 weeks and again after 6 months and suggest proper postnatal exercises.

If you needed ATT as now, I would refer you to a specialist in treating infectious diseases and monitor. I would also not go for so many investigations, but do only the needful as I feel too many opinions on a single problem do not help solve it but only create confusion.

Finally, if adhesions developed in spite of all the precautions, and if medical management did not help, and if symptoms begin to show, I would go for laparoscopy.

Apart from all these, I would also ask you take psychological counselling since all these health issues definitely exert mental stress and this needs to be relieved to promote healthy thought process.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Laparotomy can be done at the same sitting.

Detailed Answer:
Hi,

Thanks for your queries.

Here are your answers:

1. Yes. Laparotomy can be done in the same sitting if needed. Any general surgeon can handle the situation; in fact usually in such a situation, general surgeons often team up with gynecologists for better results.

2. It is true that the lesser the handling of the tissues done during a surgery, the better and shorter is the healing process. Also, the lesser is the amount of the insertion of instruments needed, the better is the healing process. Finally, healing also depends on the individual tissue repair system; some people have better repair systems than others.

3. The antibiotic Linezolid has interactions with Dazit M and also with several other drugs. Please check with your doctor again for the change in prescription if possible.

4. You cannot test for drug induced hepatitis in LFT. This can be done by checking the signs of infection in the blood counts, absent in case of drug induced condition. Also, this hepatitis gets relieved quickly once the drug is stopped.

5. Yes. Reopening of the abdomen needs to be done several times; the causes vary. A gynecologist who is well experienced can handle.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Detailed below.

Detailed Answer:
Hi,

Thanks for posting your queries.

Here are your answers:

1. Your bloating could be a premenstrual symptom. If you get a natural period without using any hormone for inducing a period, do not use Regestrone now.

2. Mebiz SR is not used to treat gastritis. It is mainly used as an anti-spasmodic.

3. Maxiliv is used in the treatment of fatty liver.

4. Though 3.0 T MRI has its advantages of better resolution in solid organs, the use of high magnetic field has its own disadvantages. You can go through the 'conclusions' part in the following link for a better idea.

http://pyyyyyyy.ryyyyyy.org/doi/full/10.1148/rg.0000

5. If you are asking me about tests for detecting drug resistance in tuberculosis, I think I have already elaborated on them. Yet, for your convenience, I am giving you a link to go through.

http://www.yyyyyyyyy.org/yyyyyyyyyyyy/

6. No enema is advised if intestinal obstruction is suspected unless medical supervision can be provided. However, in partial obstruction and also when surgery is contemplated, it can be given as part of preparation. Proctoclysis enema is safer than soap water enema in such a situation.

7. Chymoral forte can be taken for 2-3 months also.

8. Panniculitis can be detected through skin biopsy. It is basically a skin condition which involves the subcutaneous tissue. I do not think your condition resembles this.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Polycystic ovaries can cause this condition.

Detailed Answer:
Hi,

Thanks for writing again.

If you need to induce a period every time using hormones, it is time to assess your hormone status. I feel, with all the medication and stress, you may have developed hormone imbalances. Added to this, if you already have polycystic ovaries, this clinical picture is a possibility. In a normal menstrual cycle, the uterus sheds its endometrium at 7-8 mm.; up to 11 mm also can be considered normal. Just bulky ovaries do not bloat the abdomen; it is the hormone effect that causes fluid and gas retention and hence the bloating. You should get treated for the ovarian condition instead of trying to induce a period each time. It is true that bloating which is seen premenstrually is relieved after a period sets in but this does not mean that the uterus should bleed to get bloating to subside. It is the hormone levels that cause this symptom.

Hope this helps.

regards,
Shanti.V.

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