Different organizations provide guidelines on cancer screening tests. Recommendations vary on which cancers people should have screening tests for, which screening tests should be used to screen for a particular cancer, and when and how often those tests should be done. It’s important for people to talk to their doctors to determine which tests are appropriate for their age and medical history.

Currently, screening tests are used widely to check for cancers of the breast, cervix, colon, and rectum:

Breast: A mammogram is the best tool doctors have to find breast cancer early. A mammogram is a picture of the breast made with x-rays. The NCI recommends that women in their forties and older have mammograms every 1 to 2 years. Women who are at higher-than-average risk of breast cancer should talk with their health care provider about whether to have mammograms before age 40 and how often to have them.

Cervix: The Pap test (sometimes called Pap smear) is used to check cells from the cervix. The doctor scrapes a sample of cells from the cervix. A lab checks the cells for cancer or changes that may lead to cancer (including changes caused by human papillomavirus, the most important risk factor for cancer of the cervix). Women should begin having Pap tests 3 years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first). Most women should have a Pap test at least once every 3 years.

Colon and rectum: A number of screening tests are used to detect polyps (growths), cancer, or other problems in the colon and rectum. People aged 50 and older should be screened. People who have a higher-than-average risk of cancer of the colon or rectum should talk with their doctor about whether to have screening tests before age 50 and how often to have them.

• Fecal occult blood test: Sometimes cancer or polyps bleed. This test can detect tiny amounts of blood in the stool.
• Sigmoidoscopy: The doctor checks inside the rectum and lower part of the colon with a lighted tube called a sigmoidoscope. The doctor can usually remove polyps through the tube.
• Colonoscopy: The doctor examines inside the rectum and entire colon using a long, lighted tube called a colonoscope. The doctor can usually remove polyps through the tube.
• Double-contrast barium enema: This procedure involves several x-rays of the colon and rectum. The patient is given an enema with a barium solution, and air is pumped into the rectum. The barium and air improve the x-ray images of the colon and rectum.
• Digital rectal exam: A rectal exam is often part of a routine physical exam. The health care provider inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. A digital rectal exam allows for examination of only the lowest part of the rectum.

Doctors consider many factors before they suggest a screening test. They weigh factors related to the test and to the cancer that the test can detect. They also pay special attention to a person’s risk for developing certain types of cancer. For example, doctors think about the person’s age, medical history, general health, family history, and lifestyle. They consider how accurate the test is. In addition, doctors keep in mind the possible harms of the screening test itself. They also look at the risk of follow-up tests or surgery that the person might need to see if an abnormal test result means cancer. Doctors also think about the risks and benefits of treatment if testing finds cancer. They consider how well the treatment works and what side effects it causes.

Screening benefits and risks

Deciding whether to have a screening test is not always as straight forward as it may seem. Screening has potential risks and benefits that a person should talk about with his or her doctor, especially in the context of his or her personal and family medical history. The benefits include a potential decrease in the number of deaths from cancer. The risks include:

• Overdiagnosis. Cancer screening tests may find slow-growing cancers that otherwise would not have been found or caused harm in a person’s lifetime. The result is that a person may receive potentially harmful, painful, stressful, and/or expensive treatment that the person didn’t need.
• False positives. Sometimes a cancer screening test will suggest that a person has cancer when they do not.
• Increased testing. Both overdiagnosis and false positives can lead to additional tests that a person may not need. These tests can be physically invasive, costly, and cause a person unnecessary stress and worry.
• False reassurance. Sometimes a cancer screening test will suggest a person does not have cancer when they actually do. As a result, a person may not get needed treatment.

You may want to talk with your doctor about the possible benefits and harms of being checked for cancer. The decision to be screened, like many other medical decisions, is a personal one. Each person should decide after learning about the pros and cons of screening.

Alcoholic liver disease refers to a range of conditions and associated symptoms that develop when the liver becomes damaged due to alcohol misuse.

Harmful drinking

Harmful drinking means drinking alcohol at levels that lead to significant harm to physical and mental health and that may cause substantial harm to others. Examples of harm include liver damage or cirrhosis, dependence on alcohol and substantial stress or aggression in the family.

Alcohol consumption can be measured by standard drinks. A standard drink is 1 can of beer, 1 glass of wine, or 1 mixed drink.

Women who regularly drink more than 3 drinks at one time or more than 7 drinks a week and men who regularly drink more than 4 drinks at one time or more than 14 drinks a week are at the highest risk of alcohol-related harm.

Women who drink heavily during pregnancy, put their baby at risk of developing fetal alcohol syndrome or fetal alcohol spectrum disorder. These disorders lead to lifelong intellectual and behavioral problems for the child.

Alcoholic liver disease is progressive

Fatty Change

A progressive illness, alcoholic liver disease first appears as a fatty change in the liver. Also known as steatosis or fatty liver disease, this accumulation of fat in liver cells can be seen through a microscope as large, fatty globules. In addition to alcoholism, these large globules can also be caused by diabetes, obesity, and starvation.

Alcoholic Hepatitis

Some people are more prone to alcoholic hepatitis, or acute hepatitis, than others. Also known as alcoholic steatonecrosis, alcoholic hepatitis is an inflammatory reaction to the fatty change in liver cells. Health experts speculate that this inflammatory condition lays the groundwork for the development of fibrosis.

Liver Fibrosis

While not normally accompanied by symptoms, liver fibrosis can develop into cirrhosis as it progresses. The fibrosis – also known as scar tissue – alters the very fabric of the liver to such an extent that liver functioning is seriously impaired.

Cirrhosis

Often referred to as end-stage liver disease, cirrhosis is characterized by replacement of liver tissue with fibrotic scar tissue and regenerative nodules, and permanent, non-reversible damage to the liver.

Cirrhosis is a condition whereby the liver is so extensively damaged that it may no longer function, which can result in death. In its advanced stages, the only option for cirrhosis is liver transplantation.

Symptoms of cirrhosis include, but are not limited to, changes to the nails and palms; strong, sweet-smelling breath; dark urine; jaundice (yellowing of the skin, eye, and mucus membranes); an increase in male breast tissue; impotence, infertility, or loss of sexual drive due reduced hormone secretion from the testes or ovaries; ascites; change in liver size; weight loss; weakness and fatigue; and anorexia.

But it’s hard to predict which drinkers will develop cirrhosis. Some people who drink huge amounts never get cirrhosis, and some who don’t drink very much do get it.  For some unknown reason, women seem to be especially vulnerable.

Fixable or Not-Fixable?

While fatty change and alcoholic hepatitis are considered reversible, the later stages of fibrosis and cirrhosis tend to be irreversible, but can sometimes be managed for long periods of time.

Malnutrition contributes to liver disease and is therefore a serious concern. It can develop as a result of empty calorie intake from alcohol, reduced appetite, and inadequate absorption of nutrients. Other serious complications associated with the advanced stages of the disease are alcoholic encephalopathy (brain tissue damage) and portal hypertension (high blood pressure within the liver).

Life expectancy is reduced if alcohol consumption is continued.

Treatment

The first step for treatment is STOP DRINKING.

Then your doctor would arrange a high-carbohydrate, high-calorie diet to stop the breakdown of proteins plus supplementation of thiamine and folic acid.

Counseling and an alcohol rehabilitation program to combat addiction may also be necessary, as well as a health regimen to manage the complications that arise from chronic liver disease.

By definition, stroke is a condition where there is inadequate blood supply to the brain. To make it simple, it may be caused by blockage or also known as a non-hemorrhagic stroke, or leakage / bleeding also known as hemorrhagic stroke. A human’s risk to get stroke increases by age following the physiological changes of the body.  The addition of unhealthy lifestyle habits and disease will give a higher chance for stroke.

There are 2 types of risk factors for stroke: controllable and uncontrollable. Controllable risk factors generally fall into two categories: lifestyle risk factors or medical risk factors. Lifestyle risk factors can often be changed, while medical risk factors can usually be treated. 

Controllable Risk Factors:

• High Blood Pressure
• Atrial Fibrillation
• High Cholesterol
• Diabetes
• Atherosclerosis
• Circulation Problems
• Tobacco Use and Smoking
• Alcohol Use
• Physical Inactivity
• Obesity

 Uncontrollable Risk Factors:

• Age
• Gender
• Race
• Family History
• Previous Stroke or TIA
• Fibromuscular Dysplasia
• Patent Foramen Ovale (PFO or Hole in the Heart)

How to prevent it?

• Do regular health check ups, you should detect early if you have high blood pressure, heart disease, high cholesterol or diabetes.
• Stop smoking
• Include exercise in your daily routine.
• Enjoy a low-salt, low-fat diet

Early detection is one essential part in medical management. Complications and late treatment can become a nightmare, for the doctor and the patient. Don’t be late in knowing what your body is facing. Everyone is advised to have an annual health checkup. At BIMC Hospital we provide Comprehensive Health Assessment Program. This comprehensive examination will be an important factor for early detection of a specific disease or as a baseline examination for further checkups.

So, you can still enjoy your holiday if you watch what you eat, drink and have enough rest and not concern yourself with having a stroke attack. But, as stroke is also a lifestyle disease, consider changing your lifestyle habits and have regular checks with your doctor.

 A food allergy occurs when the immune system mistakenly attacks a food protein. Ingestion of the offending food may trigger the sudden release of chemicals, including histamine, resulting in symptoms of an allergic reaction.  The symptoms may be mild (rashes, hives, itching, swelling, etc.) or severe (trouble breathing, wheezing, loss of consciousness, etc.).  A food allergy can be potentially fatal.  Food intolerance, unlike a food allergy, does not involve the immune system and is not life threatening. Lactose intolerance, trouble digesting the milk sugar lactose, is a common example.  Symptoms may include abdominal cramps, bloating and diarrhea.

Diagnosis

A skin prick test or a blood test (such as the Immulite or ImmunoCap test) for IgE antibodies is commonly used to begin to determine if an allergy exists.  A skin prick test is usually less expensive and can be done in the doctor’s office.

Positive skin prick tests or immunoassay test results will show that IgE is present in the body, but cannot alone predict that a reaction will occur if the patient were to eat a suspected allergy-causing food.

The results of the tests are combined with other information, such as a history of symptoms and the result of a food challenge to determine whether a food allergy exists.

Treatment

Strict avoidance of the allergy-causing food is the only way to avoid a reaction.  Reading ingredient labels for all foods is the key to avoiding a reaction.  If a product doesn’t have a label, individuals with a food allergy should not eat that food.  If you have any doubt whether a food is safe, call the manufacturer for more information.  There is no cure for food allergies.  Studies are inconclusive about whether food allergies can be prevented.

Epinephrine, also called adrenaline, is the medication of choice for controlling a severe reaction.  It is available by prescription as a self-injectable device.

Symptoms

Symptoms may include one or more of the following: a tingling sensation in the mouth, swelling of the tongue and the throat, difficulty breathing, hives, vomiting, abdominal cramps, diarrhea, drop in blood pressure, loss of consciousness, and even death.  Symptoms typically appear within minutes to two hours after the person has eaten the food to which he or she is allergic.

Prevention

Studies are inconclusive about whether food allergies can be prevented.  Parents should become familiar with the early signs of allergic disease such as eczema, hives, repeated diarrhea and/or vomiting in reaction to formulas, wheezing, and talk to a doctor about those symptoms.  At this time, no medication can be taken to prevent food allergies.  Strict avoidance of the allergy-causing food is the only way to prevent a reaction.  Medications are administered to control symptoms after a reaction occurs.

The basic facts

• 8 million travelers travel to a developing country.
• 1 in 10 seek medical care after travel
• 64% report 1 or more illnesses during travel
• 26% are ill upon return, 56% of those develops symptoms after arrival in their country.

Overall risk of exposure to infectious agents

• High risk (1 in 10 travelers): Diarrhea, URI, non-infectious illnesses such as injuries and cardiac problems
• Moderate risk (1 in 200): Dengue, enteroviral infection, gastroenteritis, giardiasis, hepatitis A, malaria, salmonella, STD, shigella
• Low risk (1 in 1000): Amebiasis, ascariasis, measles, mumps, enterobiasis, scabies, TB, typhoid, hepatitis B
• Very low risk (1 in >1000): HIV, anthrax, Chagas, hemorrhagic fevers, pertussis, plague, typhus, hookworm

Typical incubation periods for selected tropical infections

• <10 days (short incubation):  traveler’s diarrhea, dengue fever, anthrax, diphteria, malaria, rabies, typhoid fever, meningococcal infections, typhus
• <21 days (intermediate incubation): leptospirosis, viral hemorrhagic fever, malaria, enteric fever (typhoid, paratyphoid),typhus
• >21 days: viral hepatitis (A to E), malaria, acute HIV infection, amebic liver abscess
• Months: TB, malaria, viral hepatitis B&C, HIV, rabies, syphillis

The conclusion

You are at risk to get sick when you travel to a new environment, but don’t let these facts prevent you from traveling and having a great holiday.  Instead you can be more cautious and find the best way to prevent them and not let yourself end up in this fact list.

For those who already have certain medical problems and are taking regular medication, it is highly recommended to keep your medication list on hand when travelling.  Consult a travel medicine clinic or your general practitioner as soon as possible after planning a trip to any destination where significant health risk may be foreseen.  It is best to travel with enough medication for the duration of your travel and it is helpful if you can confirm the availability of your medicines in Bali.  Some medication may not be available.  Find out any particular hazards to your personal safety and security presented by the destination and take appropriate precautions.

If you have misplaced or lost any of your regular medication, it is reassuring to know that most medicines and vaccinations are available at BIMC Hospital for adults and children.

Source:

• Emergency Medicine, Tintinalli et al, 6th edition.

Kidney failure can be acute or chronic.  Early kidney damage may have no symptoms.  In fact, most people with early kidney damage do not have any change in their urine and do not have pain.  This is why it is also called the silent disease.  The kidneys have an amazing compensation mechanism and won’t breakdown or show any symptoms until it is at the severe damaged condition.  In chronic kidney failure, the damage is permanent and irreversible.

Diabetes and high blood pressure are the most common causes of damage to the kidneys, so controlling these conditions can slow down damage to the kidneys.

Treating Kidney Failure

There are a few options to treat kidney failure:

Hemodialysis

Hemodialysis cleans and filters your blood using a machine to temporarily rid your body of harmful wastes, extra salt, and extra water.  Hemodialysis helps control blood pressure and helps your body keep the proper balance of important chemicals such as potassium, sodium, calcium, and bicarbonate.

Dialysis can replace part of the function of your kidneys.  Diet, medications and fluid limits are often needed as well.  Your diet, fluids and the number of medications you need will depend on which treatment you choose.

Peritoneal Dialysis

Peritoneal dialysis is another procedure that removes wastes, chemicals and extra water from your body.  This type of dialysis uses the lining of your abdomen, or belly, to filter your blood.  This lining is called the peritoneal membrane and acts as the artificial kidney.

Kidney Transplantation

Kidney transplantation surgically places a healthy kidney from another person into your body.  The donated kidney does enough of the work that your two failed kidneys used to do to keep you healthy and symptom free.

Screening for your kidneys

 If you are 18 years or older and has one or more of the following:

• Diabetes
• High blood pressure
• A parent, brother or sister with diabetes, high blood pressure or kidney disease

You should consider having kidney screening test regularly and talk to your doctor.

The kidney screening test consists of 3 simple tests.

• Blood pressure measurement
• Urine test for protein
• Blood test for creatinine, which is used to calculate your GFR, or level of kidney function.

Early detection for any kidney impairment is one of the best prevention for kidney failure.  Other measures you can do to protect your kidneys:

• Control high blood pressure
• Control your blood sugar if you have diabetes
• Stop smoking
• Control your cholesterol
• Follow your recommended diet
• Be active; get regular exercise
• Lose weight if you are overweight
• Ask your doctor regarding which medications are safe and which can damage your kidneys.

Opening in early 2012, BIMC Hospital Nusa Dua is expanding their services which will include a Dialysis Centre.  For further information about our Dialysis Centre, please call 761 263 or email: nusadua@bimcbali.com

The 5k fun run was held on the 27^th November and followed by 300 participants with the categories of male, female and family. BIMC Hospital has participated in this charity event each year by providing a fully equipped ambulance on stand by with doctor and nurse in attendance.

The event went successfully once more with a closing ceremony on the beach.  Only 2 casualties were reported with minor wound injuries and mild dehydration.

This year, BIMC Hospital participated in some other events such as the Food Festival, Sanur Village Festival and the Bali Triathlon and will continue to support such events in the coming years.

For further detail information about our ambulance services, please contact BIMC Hospital on 761 263.

An echocardiogram often is referred to in the medical community as a cardiac ECHO or simply an ECHO.  An echocardiogram is a sonogram of the heart.  Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart.

Echocardiography has become routinely used in the diagnosis, management and follow-up of patients with any suspected or known heart diseases.  It is one of the most widely used diagnostic tests in cardiology.  It can provide a wealth of helpful information, including the size and shape of the heart, pumping capacity and the location and extent of any tissue damage.  It not only allows doctors to evaluate the heart valves, but it can detect abnormalities in the pattern of blood flow, such as the backward flow of blood through partly closed heart valves, known as regurgitation.  By assessing the motion of the heart wall, echocardiography can help detect the presence and assess the severity of any wall ischemia that may be associated with coronary artery disease.

Echocardiography also helps determine whether any chest pain or associated symptoms are related to heart disease.  An Echocardiography can also help detect any cardiomyopathy, such as hypertrophic cardiomyopathy, as well as others. The biggest advantage to echocardiography is that it is non-invasive (doesn’t involve breaking the skin or entering body cavities) and has no known risks or side effects.

For further information about this service and consultation, please make an appointment by calling BIMC Hospital on 761 263.

Chickenpox, also known as varicella, is a highly contagious and self-limited infection that most commonly affects children between 5-10 years of age. The disease has a worldwide distribution and is reported throughout the year in regions of temperate climate. Lifelong immunity for chickenpox generally follows the disease. If the patient’s immune system does not totally clear the body of the virus, it may retreat to skin sensory nerve cell bodies where it is protected from the patient’s immune system. The disease 

Chickenpox Causes

The Varicella-zoster virus (VZV) causes chickenpox. The disease is highly contagious — over 90% of nonimmune individuals will develop chickenpox following exposure. VZV is communicable by both direct skin-to-skin contact and via respiratory droplets (for example, coughing, sneezing) from the infected individual. While the average incubation period from viral exposure to onset of symptoms is 12-14 days.

Chickenpox Symptoms

Healthy children generally experience one to two days of fever, sore throat, and malaise approximately two weeks following exposure to VZV. Within 24 hours of these symptoms, a characteristic rash develops initially on the torso and then spreads over the next seven to 10 days outward to the head, arms, and legs. The rash progresses through a predictable evolution from a red papule (“bug bite”) appearance to blister (“vesicle”) to pustule and then scabs over. The vesicle and pustular fluids are highly concentrated with infectious virus particles. New lesions characteristically come in “waves” over the skin surface. The patient may thus have newly formed papules, middle-aged vesicles and pustules, and crusted lesions all at the same time. At the peak of the disease, a patient may have over 300 skin lesions at one time. Once all lesions are scabbed over, the person is no longer contagious. The lesions rarely cause permanent scarring, unless secondary infection develops (see below). Lesions may commonly be found in the mouth and may also involve the genitalia.

When to Seek Medical Care

Although most cases of chickenpox heal without complications, sometimes medical attention is required. Call the doctor if any of the following conditions develop:

• Fever higher than 103°F
• A rash involving an eye; eye pain (especially unusual sensitivity to light)
• Dehydration, vomiting, or decreased fluid intake
• Uncertainty of diagnosis or what medication to give
• Secondary skin infections
  • Signs of bacterial infection include the following:
    • Blisters leaking a thick yellow or green fluid
    • Areas around a blister are red, increasingly painful, or swollen, or have red streaking extending from the site

Exams and Tests

A doctor usually bases a diagnosis of chickenpox on the clinical history and physical findings. However, laboratory exams can be useful. Your doctor can test blister fluid if there is a concern about secondary skin infection by Staphylococcus or Streptococcus. If the blisters are infected with bacteria, such a bacterial culture can help determine which antibiotics may be needed.

Chickenpox Treatment

Self-Care at Home

Most cases of chickenpox can be managed at home. Chickenpox rash tends to be extremely itchy. Several treatments can be used at home to help a child feel better.

• Cool compresses applied to blisters may give relief, as may calamine lotion.
• You can give cool-water baths every three to four hours, adding baking soda to the water to calm itching.
• Trimming fingernails can help prevent infection from scratching the blisters. If you have a small infant with chickenpox, cover the child’s hands with mittens to minimize scratching.
• Antihistamines also can relieve itching. These medicines are available over the counter.
• Treat fever with acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil, Motrin, Excedrin, Nuprin, and Pamprin are common brand names). Never give aspirin to a child because aspirin has been associated with Reye syndrome.
• Occasionally a child will develop blisters in the mouth, making eating or drinking painful. A person should be encouraged to drink fluids to prevent dehydration. To alleviate pain, provide cold fluids (ice pops, milk shakes, and smoothies) and soft bland foods. Avoid any foods that are spicy, hot, or acidic (for instance, orange juice).
• Keep children at home from school and daycare until all blisters have crusted. A child with chickenpox is extremely contagious until the last crop of blisters has crusted.
• If you take your child to a doctor’s office, call ahead to let the staff know that you think your child has chickenpox. They may usher you to a special waiting or treatment room to avoid exposing other children.

Medical Treatment

• For people who have severe infections, an antiviral agent called acyclovir (Zovirax) has been shown to shorten the duration and severity of symptoms if given soon after the onset of the rash. Acyclovir may be given by mouth or by IV to help people at risk for severe infection.

Prevention

Varivax, a two-dose vaccine for chickenpox, is highly recommended for healthy children, adolescents, and adults. Set up an immunization schedule for your child with your doctor.

When fully immunized, the vaccine has been shown to be 95% effective in preventing childhood cases of chickenpox. A small percentage of newly immunized people will develop a mild rash. Pregnant women and infants younger than 1 year of age should not be vaccinated.