Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) usually occurs as a result of taking hormonal medications that stimulate the development of eggs in a woman's ovaries. These injectable fertility drugs may be prescribed to treat infertility. In ovarian hyperstimulation syndrome, your ovaries become swollen and painful.

About one-fourth of women who take injectible fertility drugs get a mild form of ovarian hyperstimulation syndrome, which goes away after about a week. If you become pregnant after taking one of these fertility drugs, however, your symptoms of ovarian hyperstimulation syndrome may last several weeks. A small proportion of women taking fertility drugs develop a more severe form of ovarian hyperstimulation syndrome, which can cause rapid weight gain, abdominal pain, vomiting and shortness of breath.

Symptoms

In most cases, the symptoms of OHSS begin within 10 days after you take medications to stimulate ovulation. The severity of OHSS symptoms varies, and symptoms may worsen or improve over time.

Moderate OHSS

·         Mild to moderate abdominal pain that may come and go

·         Abdominal bloating or increased girth

·         Nausea

·         Vomiting

·         Diarrhea

·         Tenderness in the area of your ovaries

Severe OHSS

·         Rapid weight gain, such as an increase of 5 to 10 pounds in one to two days, or weight gain of more than 10 pounds in three or more days

·         Severe abdominal pain

·         Severe, persistent nausea and vomiting

·         Decreased urinary frequency

·         Dark urine

·         Shortness of breath

·         Tight or enlarged abdomen

·         Dizziness

When to see a doctor
If you have any symptoms of ovarian hyperstimulation syndrome, tell your doctor. Even if you have a mild form of the syndrome, your doctor will want to observe you for weight gain or worsening symptoms. If your symptoms are severe, last longer than a week or get worse, seek medical attention.

Causes

Ovarian hyperstimulation syndrome develops after you take a type of fertility medication that acts directly on your ovaries, stimulating them to produce multiple eggs. This treatment is more likely to cause symptoms of ovarian hyperstimulation than is the more common approach to inducing ovulation — treatment with clomiphene (Clomid, Serophene), a medication that's given as a pill you take by mouth. Your doctor might prescribe oral medication at first before moving on to injectible medications because oral medications are easier to take and they're less expensive.

The hormonal drugs most likely to be involved with developing OHSS are:

·         Follicle-stimulating hormone (FSH), which stimulates the formation of multiple fluid-filled cysts (follicles) on the ovaries

·         Luteinizing hormone (LH), which supports egg maturation and triggers ovulation

·         Human menopausal gonadotropin (hMG), which has both LH and FSH

·         Human chorionic gonadotropin (HCG), a stand-in for the LH surge that, in natural cycles, causes the follicle to release the egg

OHSS usually happens after the follicle-stimulating phase of a fertility therapy, when you receive an injection of HCG to trigger ovulation. Typically, signs and symptoms appear within the first 10 days after the injection, when the ovarian blood vessels have an abnormal reaction to the hormone and begin to leak fluid. This fluid can swell the ovaries and sometimes moves into the abdomen in large amounts.

Some women may even develop OHSS during a pregnancy achieved following ovulation induction, as pregnancy itself causes a natural increase in HCG levels.

Risk factors

Factors that increase the risk of developing OHSS include:

·         Polycystic ovary syndrome — a common reproductive disorder that causes irregular menstrual periods, excess hair growth and unusual appearance of the ovaries on ultrasound examination

·         Large number of follicles

·         Young age

·         Low body weight

·         High or steeply increasing level of estradiol (estrogen) before an HCG shot

·         Previous episodes of OHSS

·         Migraine headache

·         Becoming pregnant with multiple babies at one time

Young women with polycystic ovary syndrome who have many follicles are at highest risk of ovarian hyperstimulation syndrome. But knowing these risk factors doesn't predict exactly who will get OHSS, and sometimes the syndrome affects women with no risk factors.

Complications

About 1 to 2 percent of women undergoing ovarian stimulation develop a severe form of ovarian hyperstimulation syndrome. Complications of severe OHSS may include:

·         Fluid collection in the abdomen (ascites) and sometimes the chest

·         Electrolyte disturbances (sodium, potassium, others)

·         Blood clots in large vessels, usually in the legs

·         Kidney failure

·         Twisting (torsion) of an ovary

·         Rupture of a cyst in an ovary, which can lead to serious bleeding

·         Breathing problems (acute respiratory distress syndrome)

Some of these complications may be life-threatening, but OHSS is unlikely to be fatal. Severe OHSS may increase the chance of pregnancy loss, either through miscarriage or termination because of complications.

Tests and diagnosis

The diagnosis of ovarian hyperstimulation syndrome is based on your symptoms rather than on any test. During treatment with fertility drugs, your doctor will regularly evaluate your ovaries with a vaginal ultrasound exam. This procedure uses sound waves to create an image of the inside of your ovaries. The ovarian follicles show up as dark, circular areas. If you have OHSS, the ultrasound may show that your ovaries are swollen, with large fluid-filled cysts where the follicles developed.

Treatments and drugs

Ovarian hyperstimulation syndrome usually goes away on its own within a week or two, or somewhat longer if you're pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications.

Moderate OHSS
If your symptoms worsen rapidly or last longer than a week, call your doctor. Treatment for moderate OHSS may involve:

·         Taking either anti-nausea medication or prescription painkillers or both

·         Having frequent physical exams and ultrasound exams

·         Weighing yourself each day and measuring your abdominal girth, noting any changes

·         Measuring your urine output each day

·         Seeing your doctor to get blood tests to monitor for dehydration, electrolyte imbalance and other problems

·         Drinking large amounts of fluids, such as sports drinks

·         Draining excess fluid via a needle inserted in your abdominal cavity

·         Staying as active as possible and wearing support stockings to help prevent blood clots

Severe OHSS
If you develop signs or symptoms of severe illness, you may need to be hospitalized for careful monitoring and more aggressive treatment, including intravenous (IV) fluids. Serious complications may require further treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. Treatment also may include anticoagulant medications to decrease the risk of forming blood clots in your legs.

Lifestyle and home remedies

Most women who develop OHSS can continue their day-to-day routine. For mild symptoms, follow these recommendations:

·       Avoid sexual intercourse, as it may be painful and can cause a cyst in your ovary to rupture.

·      Maintain a light physical activity level, but avoid strenuous or high-impact activities.

·      Weigh yourself on the same scale and measure around your abdomen each day; tell your doctor about any rapid or unusual weight gain, or any increase in abdominal size.

·      Call your doctor if your signs and symptoms get worse.

Prevention

To lessen the chance that you'll develop ovarian hyperstimulation syndrome, your doctor will create an individualized plan for your fertility medications, taking into account any risk factors you have for OHSS. Your doctor will also carefully monitor each treatment cycle with frequent or daily ultrasound exams to view the development of follicles, and with blood tests to check your estradiol level.

Your doctor may use a variety of strategies to help prevent ovarian hyperstimulation syndrome:

·         Adjusting medication dosage. Your doctor will use the lowest possible dose of gonadotropins to achieve the goals of stimulating your ovaries and triggering ovulation.

·         Coasting. If your estradiol levels are high or a large number of follicles have developed, your doctor may stop your gonadotropin injections and wait a few days before giving HCG, which triggers ovulation. This is known as "coasting."

Change attitude, not lifestyle

There are many who believe that to turn spiritual you have to change your wardrobe, diet and lifestyle and adopt a sombre and boring pattern.

This does not appeal to those who continue in their materialistic ways. A few inspired ones change everything except their thinking! They fail to benefit, get frustrated and give up. Rare is the wise one who focuses only on 'attitude'. And succeeds!

You have a fundamental choice in every situation, at every moment. You can be unhappy and complain. Or you can be happy and cheerful. It has nothing to do with the world or what it presents. You could have the best of things and still be miserable. You may have nothing and yet be deliriously happy. The difference is in your attitude.

In life, everyone is denied a few things. But all of us have been blessed with millions of gifts. If you focus on what you do not have, you will be unhappy. If you choose to focus on the things you have, you are grateful and you develop an irresistible desire to share, contribute, and give. This makes you happy. The most precious things come for free, which you do not even consider! Hence you live life feeling deprived and deficient when, in fact, you are could be totally fulfilled and abundant.

An object is red in colour because it reflects red. It gains what it gives and loses the other colours it takes. So shift your focus from 'what can I gain' to 'how can I add value to others' and success will be yours. Besides, all selfish people are unhappy. To the extent you turn unselfish you will be happy.

Do you have conflict with the people you love most? Do you blame the 'other person' for it? Maybe it has to do with your attitude. Do you have expectations of your family members? Do you make demands on your spouse and children? This is not love. It is attachment. Love tainted with selfishness is attachment. You only love yourself. You claim to love because they happen to cater to you in some way.

This causes conflict and untold suffering. In the end you lose them. Attachment is the single most important cause for breakdown in relationships. Physically hanging on to spouse and children does not make for meaningful relationships. You need to earn their love and respect. Shift your stance from 'hanging on' to 'letting go' -- from binding them to releasing them from your clutches; from focussing on your happiness to enabling their fulfilment. Accept them for what they are, not for what they can do for you.

The world and all that it offers is temporary, fleeting, passing. Understand the transient nature of the world while living in it and you will be happy. Transact with the world, enjoy it, but always remember that it will pass. Give it the right value, not the exaggerated value you have for it now. Begin the search for the permanent. The journey itself becomes thrilling. Then you will experience true happiness irrespective of what you have or do not have.

So change your attitude, not lifestyle. Your life will change from drudgery to revelry. From mediocrity to Excellence.

How exercise may boost your mood

If Jennisse Peatick, 36, ever had to stop exercising—well, the idea leaves her almost speechless. She doesn't know what would happen. "I started exercising because I was getting fat and I realized it was helping me deal with my ongoing depression," she says. Now the competitive cyclist and triathlete from Hillsborough, N.J., takes her daily exercise as regularly as she takes her antidepressant medication.

Exercise seems to be particularly important for some people. In a 2007 study in the journal Psychosomatic Medicine, depressed people who were engaged in an exercise program recovered about as well as people who took medication. Both groups did better than a third group that got only a placebo.

What kind of exercise will lift your mood?
While regular exercise may be as effective for mild or moderate depression as antidepressants, there is a big catch, one that triathlete Peatick has figured out: It has to be intense, for at least 30 minutes, according to Madhukar Trivedi, MD, professor of psychiatry and head of the Mood Disorders Research Program and Clinic at University of Texas Southwestern Medical Center in Dallas. He has authored several studies that show regular exercise can reduce depressive symptoms—in one case by up to 47%.

At least one German study showed that exercise worked in patients who had not responded to antidepressants.

Theories as to how exercise works abound. Dr. Trivedi has suggested that it may change levels of chemicals in the brain (such as serotonin), just as antidepressants might.

Exercise is good, but is it an antidepressant?
No one doubts that exercise is beneficial to general health and well-being, but Ken Robbins, MD, clinical professor of psychiatry at the University of Wisconsin–Madison, isn't convinced that it can help anyone with moderate or severe depression.

He recently reviewed all of the exercise and depression studies, and concluded that while working out regularly is a great idea, it is hard for most people to comply with it. "Also, there are a ridiculous number of variables here. We don't know if it was the socialization, the light, or just getting these people out of the house that helped.

"Nonetheless, of the few things that someone with depression can do besides antidepressants and therapy, this is something we can tell them to try."

Which spread is better for my heart — butter or margarine?

Margarine is made from vegetable oils, so it contains no cholesterol. Margarine is also higher in "good" fats — polyunsaturated and monounsaturated — than butter is. These types of fat help reduce low-density lipoprotein (LDL), or "bad," cholesterol, when substituted for saturated fat. Butter, on the other hand, is made from animal fat, so it contains cholesterol and high levels of saturated fat.

But not all margarines are created equal — and some may even be worse than butter. In general, the more solid the margarine, the more trans fat it contains — so stick margarines usually have more trans fat than do tub margarines. Like saturated fat, trans fat increases blood cholesterol and the risk of heart disease. In addition, trans fat can lower high-density lipoprotein (HDL), or "good," cholesterol levels. Spreads such as Benecol and Promise Activ are fortified with plant stanols and sterols, which can help reduce LDL cholesterol levels.

When selecting a spread, be sure to check the Nutrition Facts panel and pay particular attention to the grams of saturated fat and trans fat. Look for products that have the lowest combined amount. Also, look for products with a low percent Daily Value for cholesterol.

If you don't like the taste of margarine or don't want to give up butter completely, consider using whipped or light butter. Or look for products that are a blend of butter and olive or canola oil. Per serving, these products have less fat and calories than regular butter does. The important thing is to use them sparingly.

Depressed brains may hate differently

Depressed people are often withdrawn and antisocial. This doesn’t necessarily mean that they don’t like other people, but it could mean that their brains don’t process feelings of hate in a normal way, a new study suggests.

Scientists in China and the UK scanned the brains of people with and without depression, and they found a surprising pattern in nearly all of the depressed people: Their brain activity was out of sync in three regions collectively known as the “hate circuit”—so called because in previous experiments they have been shown to light up when people look at photographs of someone they can’t stand.

“We were a bit shocked when we first saw these results,” says lead researcher Jianfeng Feng, a professor of computer science at the University of Warwick who specializes in biology. Feelings of self-hatred are a common feature of depression, he explains, so one would expect those feelings to also be more intense when directed toward other people.

Instead, it’s as if the brains of depressed people hate incorrectly. The brain disruptions the researchers observed could be a sign that people with depression have an impaired ability to cope with—and learn from—social situations in which they feel hate, Feng says. This may explain why they often turn emotions such as hatred and anger inward, instead of handling them in more constructive ways, he adds.

The study, which was published today in the journal Molecular Psychiatry, is the first to connect disruptions in the hate circuit to depression, and the findings may help doctors understand why depressed people react the way they do to certain circumstances, says Madhkar Trivedi, MD, director of the mood disorders program and clinic at the University of Texas Southwestern Medical Center at Dallas.

“These patients start doubting themselves and they withdraw from social situations,” says Dr. Trivedi, who was not involved in the study. “The hate circuit might have something to do with that.”

Discoveries like this warrant a good deal of interest, Trivedi says, though he cautions that the results are preliminary. “It is exciting when something is this novel and this promising, but…I would of course like to see some results replicated by other researchers,” he says.

Feng and his colleagues used functional magnetic resonance imaging (fMRI) to scan the brains of 37 healthy people and 39 people who had received a depression diagnosis but had not sought treatment or responded to antidepressant medication. The makeup of each group was similar in terms of age, sex, and education levels.

In a healthy brain, the waves recorded by fMRI move up and down together in a continuous pattern. But when brain function is disturbed, the waves move out sync with each other—a phenomenon known as “uncoupling.”

The brain waves in the hate circuit were uncoupled in 92% of the depressed patients, the researchers found. Depression was also associated with disruptions in parts of the brain involved in action and risk-taking, emotion and reward-seeking, and attention and memory processing.

Most MRI research in depressed people has treated the brain as a group of discrete regions, by targeting very specific areas or by looking at how regions behave independently. This study, by contrast, observed the entire brain system at once—an approach that helped the researchers spot connections and patterns across multiple regions.

Feng and his colleagues performed the scans while the subjects were resting. This minimized interference from any outside stimuli, but it also means the researchers can’t be sure if the brain disruptions they observed are likely to carry over into active settings, such as social situations.

Further research will be needed to confirm and extend his team’s findings, Feng says. In the future, he says, a focus on the hate circuit may open new avenues for treatment—including new drugs and psychotherapies—that target this and other specific circuits in the brain.

“We might have to think about depression from more wide angles,” he says.

Too much television can give you diabetes

A new study from Harvard School of Public Health (HSPH) researchers has indicated that prolonged TV viewing is associated with increased risk of type 2 diabetes, cardiovascular disease, and premature death.

"The message is simple. Cutting back on TV watching can significantly reduce risk of type 2 diabetes, heart disease, and premature mortality," said senior author Frank Hu, professor of nutrition and epidemiology at HSPH.

"We should not only promote increasing physical activity levels but also reduce sedentary behaviour, especially prolonged TV watching," he added.

Hu and first author Anders Grontved, a doctoral student and visiting researcher in the HSPH Department of Nutrition, conducted a meta-analysis, a systematic assessment of all published studies from 1970 to 2011 that linked TV viewing with increased risk of type 2 diabetes, cardiovascular disease, and premature death.

Eight large prospective cohort studies from the United States, Europe, and Australia met the researchers'' criteria and were included in the meta-analysis.

The results showed that more than two hours of TV viewing per day increased risk of type 2 diabetes and cardiovascular disease, and more than three hours of daily viewing increased risk of premature death.

"Sedentary lifestyle, especially prolonged TV watching, is clearly an important and modifiable risk factor for type 2 diabetes and cardiovascular disease," Grontved added.

The study has been published in the Journal of the American Medical Association .

Never allow pets in your bed!

You may lavish attention on your pets, seeing that they are well fed and cared for. But don't let them share your bed, because they could infect you.

Jane Heller, veterinarian at the Charles Sturt University, says there is always some chance that bacteria or parasites will move from pets to humans and vice versa.

Heller urged pet owners to practice basic hygiene and to make sure pets and humans interact safely, taking care to avoid bites or scratches, during feed times, according to a varsity statement.

"For the average person with a healthy immune system, the risk of getting sick from a pet is low, even if you share a bed with them and are exposed to a bacteria or parasite.

However, the risk increases for people with compromised or reduced immune systems such as the very young, the very old, those with diseases such as HIV, those who are pregnant and those undergoing chemotherapy."

"While it's important not to overstate the risk of illness from your four-legged loved ones, with a few easy steps it should be possible to lower it even further," concludes Heller.

Heller recommends pet owners to wash hands after handling a pet and especially before handling food. Avoid sharing implements for human and animal food preparation, she advised.