What is bipolar disorder?

Bipolar disorder (sometimes called "manic depression") is a brain disorder that causes extreme changes in mood and behavior. Bipolar disorder can run in families.

What are the symptoms of bipolar disorder?

People with bipolar disorder can feel much happier or much sadder than normal. If you have bipolar disorder, you might feel very happy for many days and then feel very sad.

When your mood is very happy, you can also:

Get angry quickly

Be more active than normal

Feel like you have special powers

Feel like you don't need sleep

Make poor choices without thinking

Start lots of things and not finish them

 

Other times, your mood might be very sad for most of the day, every day. When your mood is very sad, you can also:

Lose or gain a lot of weight

Have trouble falling asleep or sleep too much

Feel very tired

Not enjoy things

Feel bad about yourself

Think about death or hurting yourself

 

People with bipolar disorder might have trouble at work or school. They might not get along well with their family and friends.

 

Is there a test for bipolar disorder?

No. There is no test. But your doctor or nurse should be able to tell if you have it by talking with you and your family. He or she will ask about your mood and what you have been feeling and doing. Your doctor or nurse might also do an exam and order blood tests to look for other problems.

How is bipolar disorder treated?

Bipolar disorder is treated with medicine. Medicines sometimes take a while to start working. Plus, it sometimes takes a few tries to find the right medicine or combination of medicines.

You and your doctor will work together to find the medicine that works best for you. All of the medicines for bipolar disorder affect the brain. They can:

Keep your mood stable and prevent big mood changes

Calm your mind

Make your sadness go away

 

Medicines sometimes cause side effects.

You might also need to stay in the hospital for a short time. When a bipolar disorder mood episode starts, you might be at risk of hurting yourself or others. You might hear voices that other people do not hear. You might believe things that are not true. But if you are at the hospital, the doctors can treat these symptoms and keep you safe.

Some people whose bipolar disorder makes them feel very sad might need "shock treatment" to get better. Doctors call this treatment ECT. During ECT, doctors pass a small amount of electricity (called an "electrical current") through a person's brain in a safe way. This causes chemical changes in the brain that relieve severe depression.

In addition to medicine, psychotherapy (counseling) can help. This involves meeting with a therapist to talk about your feelings, thoughts, and life. There are different types of psychotherapy. In general, they all focus on helping you learn new ways of thinking and behaving, so you can better cope with your bipolar disorder.

 

Is there anything I can do to prevent big mood changes in the future?

 

Yes. After your symptoms have gone away, you will probably:

Keep taking medicine every day to help prevent big changes in your mood and behavior

Go to psychotherapy sessions to help you get along better with family and friends

What are kidney stones?

Kidney stones are just what they sound like: small stones that form inside the kidneys. They form when salts and minerals that are normally in the urine build up and harden.

Kidney stones usually get carried out of the body when you urinate. But sometimes they can get stuck on the way out. If that happens, the stones can cause:

Pain in your side or in the lower part of your belly

Blood in the urine (which can make urine pink or red)

Nausea or vomiting

Pain when you urinate

The need to urinate in a hurry

 

How do I know if I have kidney stones?

If your doctor or nurse thinks you have kidney stones, he or she can order an imaging test that can show the stones.

What if I have kidney stones?

Once we have confirmed the stones, we also order additional type of tests to ascertain type, size and location so that we can create an individual treatment plan to get rid of the stones and also teach you how to prevent kidney stones in future.

Each person's treatment is a little different. The right treatment for you will depend on:

The size, type, and location of your stone

How much pain you have

How much you are vomiting

 

If your stone is big or causes severe symptoms, you might need to stay in the hospital. If your stone is small and causes only mild symptoms, you might be able to stay home and wait for it to pass in the urine. If you stay home, you will probably need to drink a lot of fluids. Plus, you might need to take pain medicines or medicines that make it easier to pass the stone.

Stones that do not pass on their own can be treated with:

A machine that uses sound waves to break up stones into smaller pieces. This is called "shock wave lithotripsy." This procedure does not involve surgery, but it can be painful.

 

A special kind of surgery that makes very small holes in your skin. During this surgery, the doctor passes tiny tools through the holes and into the kidney. Then he or she removes the stone. This is called "percutaneous nephrolithotomy."

 

A thin tube that goes into your body the same way urine comes out. Doctors use tools at the end of the tube to break up or remove stones. This is called "ureteroscopy."

 

How to prevent kidney stones from forming? 

One simple thing you can do is to drink plenty of water. You might also need to change what you eat, depending on what your kidney stones were made of. If so, your doctor or nurse can tell you which foods to avoid. Your doctor or nurse might also prescribe you new medicines to keep you from having another kidney stone.

 

Please tell me more about what dietary modifications I need to make?

It depends on the type of the stone. Ask us to do 24 hours urine test to understand what dietary contributing factors are responsible.  Based on that we can suggest changes. 

 

Some of the generic modifications we suggest are as follows.

From the viewpoint of diet, alterations in fluid, calcium, oxalate, potassium, phytate, animal protein, sucrose, fructose, sodium, and supplemental vitamin C intake may be beneficial. We therefore recommend the following for all patients with calcium oxalate stones:

Sufficient fluid intake distributed throughout the day to produce at least 2 liters of urine per day, including drinking at night (although it is not essential that the patient wake up several times per night to urinate). This will increase the urine flow rate and lower the urine solute concentration, both of which may protect against stone formation.

 

To reach this goal, the best strategy is to recommend how much additional fluid the patient should drink based upon his or her 24-hour urine volume. As an example, if the total urine volume is 1.5 liters, then we recommend two additional 8 ounce (240 mL) glasses of fluid each day to reach the goal of at least 2 liters of urine output per day.

 

Adequate dietary calcium intake. While excessive calcium intake should certainly be avoided, dietary calcium restriction is not appropriate, as it may increase the risk of stone formation and also lead to reduced bone mineral density. Several servings of dairy or other calcium-rich foods to reach 800 to 1000 mg/day are encouraged.

 

Avoiding excessive animal protein in the diet. Although it has not been proven that a low-protein diet will reduce the incidence of stone formation, a high-animal protein diet is a risk factor for renal stones in men and older but not younger women [13].

 

Limiting dietary sodium to 100 mEq/day. A low-sodium diet can enhance proximal sodium and calcium reabsorption, leading to a reduction in calcium excretion.

 

Increasing dietary potassium intake, as this is associated with substantially reduced risk in men and women.

 

Limiting dietary sucrose and fructose.

 

Limiting intake of high oxalate foods and supplemental vitamin C in patients with calcium oxalate stones. However, excessive restriction of oxalate is not likely to be helpful; patients should continue to consume a wide variety of fruits and vegetables.

 

Drug therapy is indicated if the stone disease remains active (as evidenced by the formation of new stones, enlargement of old stones, or the passage of gravel) or adequate improvements are not realized in urinary chemistries despite attempted dietary modification over a three- to six-month period.

Initial drug therapy varies with the metabolic abnormality that is present:

Thiazide diuretics for reducing urinary calcium excretion

Allopurinol for high urine uric acid

Potassium citrate or potassium bicarbonate for low urine citrate

There will be situations when you are admitted to hospital. Because of aggressive cost cutting by the third parties and other reasons, you are now instructed at the hospital to follow up with your physician. This follow up saves lot of harm to the patient.  Everyday we see patients who have been put on wrong medications with improper discharge planning. Hospitals are not only discharging patients quicker but also are using unsafe practice of using non physicians to discharge patients.

 

So getting a physician to properly go thorough your discharge papers and ensure that medications are proper and conditions are properly diagnosed is always a good idea. If hospital asks you to see your physician, book your office visit within 7 days of hospital discharge and bring your hospital discharge papers. Please do not mix your regular office visits with hospital discharge follow ups.  We provide same day or next day appointments when you need. 

Bacterial vaginosis (BV) is a common cause of unusual vaginal discharge. BV is not a sexually transmitted infection (STI), but it can increase your risk of getting an STI such as chlamydia.

 

Symptoms:

 

The most common symptom of bacterial vaginosis is unusual vaginal discharge that has a strong fishy smell, particularly after sex.

You may notice a change to the color and consistency of your discharge, such as becoming greyish-white and thin and watery.

But 50% of women with bacterial vaginosis do not have any symptoms.

Bacterial vaginosis does not usually cause any soreness or itching.

Diagnosis:

If physician feels that you have BV, she asks you to provide vaginal fluid sample. This sample collection can be done at our clinic and it is then sent to a lab for DNA amplification probe that tests for following infections.

 Candida species
 Gardnerella vaginalis
 Trichomonas vaginalis

The results then are typically available in two business days and if your sample is positive for any of these infections, appropriate medication is called in to your pharmacy. Your pharmacy will call you. 

 

You can get your results from the lab directly if you have an online account with them. You can also request a copy from us on your secure email or on the portal. 

Treatment:

Depending on the test results, we call in one of these medications to your pharmacy.

Metronidazole 500 mg orally twice daily for seven days

Metronidazole 250 mg orally three times daily for seven days

Clindamycin 300 mg orally twice daily for seven days

Why get treated:

The condition is not usually serious, but you'll need to be treated with antibiotics if you do have BV because BV increases your risk for getting other sexually transmitted diseases.

 

Prevention:

To help relieve symptoms and prevent bacterial vaginosis returning: 

  • use water and plain soap to wash your genital area
  • have showers instead of baths
  • do not use perfumed soaps, bubble bath, shampoo or shower gel in the bath
  • do not use vaginal deodorants, washes or douches
  • do not put antiseptic liquids in the bath
  • do not use strong detergents to wash your underwear
  • do not smoke

 

What to do if you still do not feel better after treatment?

 

Please book an appointment from online and see doctor once again face to face.  

Most people infected with HIV experience a short, flu-like illness that occurs 2-6 weeks after infection. After this, HIV may not cause any symptoms for several years.

It's estimated up to 80% of people who are infected with HIV experience this flu-like illness.

The most common symptoms are:

  • raised temperature (fever)
  • sore throat
  • body rash

Other symptoms can include:

  • tiredness
  • joint pain
  • muscle pain
  • swollen glands

The symptoms usually last 1-2 weeks, but can be longer. They're a sign that your immune system is putting up a fight against the virus. 

But having these symptoms doesn't necessarily mean you have the HIV virus. Remember: they're commonly caused by conditions other than HIV.

If you have several of these symptoms and think you've been at risk of HIV infection within the past few weeks, you should get an HIV test our clinic.

 

We have seen patients who were never checked this even with multiple hospital admissions and hence we are now proactively testing patients for this whenever your doctor feels it is necessary.