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Dengue Fever – Symptoms, Tests and Treatment

As summer approaches, the threat of dengue fever looms once again. This mosquito-borne illness is a serious concern in many parts of the world, causing flu-like symptoms and even death in severe cases.

But fear not, by understanding its causes, recognizing its symptoms, seeking proper treatment, and taking preventative measures, we can all do our part to protect ourselves and our communities from this deadly disease.

Dengue is an acute viral infection that continues to plague many countries across the world, including India. Almost over 40% of the world population is living in areas where there is a high risk of dengue. It is still considered one of the leading causes of illness in many countries.

While mild dengue can cause flu-like symptoms, severe dengue can present with potentially fatal complications. Dengue is caused by the bite of the female Aedes Aegypti mosquito, the same species responsible for spreading other viruses like Zika, Chikungunya, etc. It is a mosquito-borne disease caused by four related viruses (called serotypes) namely Dengue virus 1, 2, 3, and 4. Once you are infected with one of these viruses, your body tends to develop immunity to that particular virus, however, you can still catch the other three viruses and get infected at a later stage in life. Because of this very reason, a person can be reinfected with Dengue in his/her lifetime. Although outbreaks in India were mainly due to serotypes 2 and 3 (DENV-2 and DENV-3), dengue virus serotype 1 (DENV-1) was the predominant serotype reported in the 2010 Delhi outbreak.

Dengue Fever Symptoms

Dengue is a virus that is transmitted by mosquitoes. It can cause severe flu-like symptoms, including:

Nausea or vomiting
Headache
Vomiting
Rashes on the body
Muscle and joint pain
Body ache
Severe headache
High fever
Dengue can also lead to more serious complications such as hemorrhagic fever and death.

Causes of Dengue

The dengue virus is transmitted by Aedes mosquitoes. They are found in tropical and subtropical areas. The virus can cause a range of symptoms, from mild to severe. Dengue fever is the most common form of the disease. It is characterised by a high fever, headache, muscle and joint pain, and a rash. Dengue haemorrhagic fever is a more severe form of the disease. It can lead to bleeding from the nose or gums, as well as organ failure. Lastly, Dengue shock syndrome is the most severe form of the disease, and it can be fatal.

Tests for Dengue

Doctors use simple blood tests for diagnosing dengue fever. These tests can check for the viral antibodies or the presence of a specific antigen. The most definitive test for Dengue includes a rapid point of care test, known as Dengue NS1 antigen test which can help in identifying the fever early and with more promptness. It increases the likelihood of providing a confirmed diagnosis which enables the doctor to provide patients with appropriate and timely advice and quick follow-ups as well. For patients presenting more than 1 week after fever onset, IgM detection is most useful, although NS1 has been reported positive up to 12 days after fever onset.
Dengue fever usually results in a decreased platelet count in most people. Therefore, the platelet count should be monitored carefully and regularly. A complete blood count (CBC) test gives a complete blood picture along with the platelet count. Make sure to get tested on time.

Typically, if you have dengue, you will be positive for dengue-specific NS1 antigen, a decrease in platelet count, and a decrease in total white blood cells (WBC) count.

Treatment of Dengue

There is no specific treatment for dengue fever. The focus is on relieving symptoms and supporting the body as it fights the infection. This includes actions like:

Taking rest and consuming plenty of fluids to prevent dehydration

Using pain relief medications such as paracetamol and ibuprofen for headaches and muscle pain

Using anti-motion sickness medications such as meclizine and promethazine for nausea and vomiting

Consuming a fever reducer such as acetaminophen or diphenhydramine for fever

Utilising mosquito repellent to prevent further bites

Prevention is the best method of avoiding dengue fever, but these medications and measures can be used to effectively treat and recover from the illness.

Prevention of Dengue

Here are a few measures you can undertake to prevent the onset of this terrible illness:

Vaccination

In many parts of the world, a dengue vaccine has been developed. It is given in three doses over a year. However, you are eligible for this vaccine only if you have had the disease at least once, or have tested positive.

Use Mosquito Repellent

When outdoors, use mosquito repellent on exposed skin. Most mosquito repellents contain one of the following active ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanoate.

DEET is the most common and most effective active ingredient. Higher percentages of DEET provide longer protection time against mosquito bites, but won’t last any longer than 10 hours. Look for products with 20% to 30% DEET for adults and less than 10% DEET for children. Picaridin is just as effective as DEET but can be used safely on kids aged two months and older.

The oil of lemon eucalyptus is also as effective as DEET but should not be used on kids under three years old.

If you’re using a spray repellent, apply it to your clothing first and then rub it in so you don’t miss a spot.

Reduce Mosquito Habitats

Mosquitoes can lay their eggs in any stagnant water, no matter how small. Once the eggs hatch, the mosquitoes can start reproducing in as little as a week. To help prevent mosquito-borne diseases:

Reduce mosquito habitats by emptying standing water from flowerpots, gutters, buckets, pool covers, pet water dishes, discarded tires and anything else that can hold water.

Change the water in bird baths at least once a week.

Drill holes in tire swings so water drains out.

Keep swimming pools clean and chlorinated.

Wear Appropriate Clothing

When going outdoors, it is important to wear clothing that covers as much of the body as possible. This includes long-sleeved shirts, long pants, and socks.

If possible, choose light-coloured clothing since mosquitoes are attracted to darker colours. Wear closed-toe shoes instead of sandals or flip-flops.

If weather permits, consider spraying clothing with an insecticide such as permethrin. You can also find clothing that has been treated with permethrin.

Diagnosis of Dengue

Dengue is typically diagnosed based on the symptoms a person is experiencing. Doctors may also order a blood test to look for antibodies that are specific to the dengue virus, or they may order a PCR test to confirm the diagnosis. An important metric in these blood tests is the platelet count. If it goes beneath a certain number, it can be a cause for concern. In some cases, a doctor may also order an imaging test to look for signs of internal bleeding.

Risk Factors of Dengue

There are two specific risk factors associated with dengue. They are:

Living in Tropical Areas: The most important risk factor for dengue is living in or travelling to an endemic area. Dengue is found in tropical and subtropical regions around the world, including Latin America, Africa, the Caribbean, Southeast Asia, and Oceania. If you live in or are visiting one of these areas, you’re at risk of being infected with the virus.

Previously Infected with Dengue: If you have been infected with dengue in the past, you are at risk for developing more severe symptoms if you are infected again. This is because your body has developed antibodies to the virus, which can lead to a more intense immune response.

Conclusion

In closing, dengue is a potentially life-threatening disease. It affects millions of people around the world. It is important to be aware of the causes, symptoms and treatments so that you can recognize it in its early stages and seek prompt medical attention if necessary.

Additionally, taking preventive measures such as eliminating potential breeding grounds for mosquitoes should help reduce the chances of contracting this virus. By following these tips, you can keep your family safe from dengue fever and other mosquito-borne illnesses.

If you are displaying symptoms of dengue and want to make a clear diagnosis, then contact Metropolis Healthcare for a blood test.

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Kidneys play a critical role in eliminating metabolic body wastes and in maintaining the body’s overall water and electrolyte balance. The kidney function tests (KFT) help you understand whether your kidneys are working efficiently or not by examining how effectively your kidneys are removing wastes from your body. A 24-hour urine sample, a blood test, or both may be required for kidney function evaluation.

What Do Your Kidneys Do?

Your genito-urinary system includes your kidneys, which are positioned just below your left rib cage at the back of your belly. Kidneys help your body in removing waste products through urine excretion. The additional functions of the kidneys include:

Production of blood pressure-maintaining hormones
Production of the oxygen-carrying red blood cells that circulate through your body
Production of vitamin D, which keeps your muscles and bones healthy

So, it is evident that taking care of your kidneys is of utmost importance. You can get a kidney function test (KFT) for a proper evaluation of your kidneys’ current health.

What Symptoms Can be Caused By Kidney Problems?

Symptoms that may indicate a problem with your kidneys include:

Frequent urges to urinate
Difficulty beginning urination
Pain during urination
High blood pressure
Blood in the urine
Swelling of the hands and feet

Your doctor will evaluate your symptoms, correlates it with the test findings, and arrive at a diagnosis. Also, a single symptom may not always mean something serious.

What Are Kidney Function Tests?

Bodily waste or toxic substances including excess fluid are usually removed from the bloodstream by healthy functioning kidneys. Blood specimens and urine tests indicate how properly your kidneys are working and how effectively wastes are excreted from the body. Urine tests can help detect whether the kidneys are leaking any amount of excessive protein, which is a sign of kidney damage.

Here we will discuss various tests that are used to understand kidney function. Most of these kidney function tests assess the glomerular filtration rate (GFR). GFR measures how well your kidneys remove waste from your system.

What are The Different Types of Kidney Function Tests (KFT)?

To diagnose the proper health of your kidneys your physician may prescribe different types of kidney function tests. The following are the different tests that are commonly included in KFT:

Serum Creatinine

The body’s metabolism produces creatinine as a waste product. The kidneys remove it from the blood and excrete it via urination. Generally, creatinine is almost eliminated from the body through the kidneys. In this way, our bodies maintain a low level of creatinine because this creatinine excretion is an ongoing process. Therefore, a high creatinine level could be a sign of kidney issues. In general,

For adult men, the normal range of serum creatinine lies between 0.74 to 1.35 mg/dL
For adult women, the normal range of serum creatinine lies between 0.59 to 1.04 mg/dL

Uric Acid

When our body chemically breaks down organic compounds metabolically, uric acid is created. The kidneys filter and eliminate this uric acid waste product through urine. Therefore, both higher or lower uric acid levels could indicate kidney damage.

In general, the normal range of uric acid lies between 3.7-9.2 mg/dL.

Blood Urea Nitrogen (BUN)

When the body breaks down proteins, it results in urea nitrogen production. Urea nitrogen is also a waste product that the kidneys eliminate through urine. Generally, the level of urea nitrogen in your blood should fall between specific limits. Other than kidney issues, some medications may also cause a rise in urea nitrogen levels in our blood. Therefore, if your BUN level is greater than usual, talk to your doctor for a detailed diagnosis and also inform him about your current medications.

In general, the normal range of BUN lies between 7-25 mg/dL.

Electrolytes

Electrolytes are minerals present in the blood and body fluids that facilitate several body functions. They can be positively or negatively charged. An electrolyte test helps monitor the body’s electrolyte levels and is a strong indicator of how well your kidneys are functioning. Sodium, potassium, and chloride are some of the main electrolytes. The normal range for each electrolyte can vary to some extent in men and women, and different age groups.

Estimated Glomerular Filtration Rate (eGFR)

The GFR calculates your kidneys’ ability to filter waste materials from the body. Your normal GFR results may not always correspond to your normal serum creatinine level. To evaluate your proper renal function, it is, therefore, preferable to estimate glomerular filtration rate or eGFR, also known as the “gold standard” measurement. Your serum creatinine, age, race, and sex, all will be used to estimate your GFR. Because this test result roughly equates to your remaining kidney function, this test helps you get easy-to-interpret information regarding the degree of your kidney damage.

In general,

The normal level of GFR is considered at 60 or above
A below 60 GFR test result may indicate kidney-related diseases
A below 15 GFR test results may indicate severe kidney failure

Additionally, your doctor may also conduct 24-hour urine testing, such as:

Microalbuminuria: This test searches for a specific protein known as albumin in your urine. In general, a urine albumin level below 30 is considered normal, whereas an albumin level above 30 indicates that you may have kidney problems.

Urinalysis: This test examines your urine and looks for blood and proteins.

Purpose of Kidney Function Tests

Conditions such as high sugar levels or diabetes and high blood pressure or hypertension are two major conditions that have an impact on how well the kidneys work. If someone has either of these conditions, their doctor may prescribe KFT or kidney function tests to monitor their progress.

Similarly, if one is presented with symptoms that point to kidney problems, the person may also require a kidney function test. Among these symptoms are:

increasing blood pressure
blood present in the urine
frequent urination
difficulty urinating
pain during urination
buildup of fluids in the body leading to swelling of the hands and feet

Are There any Preparations Needed Before the Kidney Function Test (KFT)?

No, you do not need to take any preparation before your KFT test. You can either visit your nearest laboratory for KFT tests or can have your blood drawn for the KFT test at your home by trained professionals.

Procedure of Kidney Function Tests

As mentioned in the article earlier, 24-hour urine samples and blood tests are usually key requirements for kidney function tests.

Urine Test After 24 Hours

A 24-hour urine sample culture is often used to determine creatinine clearance tests. It helps to identify the level or amount of creatinine a patient’s body removes in a single day. Doctors provide a special container to store urination. During the collection process, it is advised to keep the container sealed and refrigerated. Make sure to properly mark the container and explain the reason to store it in the refrigerator to other family members.

Blood Samples

BUN and serum creatinine tests both require blood specimens to be taken in a lab or health clinic. Before drawing blood, the technician ties a band around the upper arm. This highlights the veins from which blood needs to be drawn. After that, the technician cleans the area and inserts a hollow needle into the patient’s vein through the skin. The blood will be collected with the help of a test tube and sent to a lab for further analysis.

When Should You Go for a Kidney Function Test?

KFT helps you detect any kidney-related health conditions that you might have. However if you have any of the following health conditions, or have certain lifestyle habits, kidney function tests are more crucial for you:

Any kidney-related health conditions
Any symptoms related to kidney damage
Any kidney-damaging health conditions, like high blood pressure or diabetes
Have a family history of kidney-damaging conditions
Aged above 60
A heavy smoker

If you think you have any of the above conditions, check your kidney health today. Book a kidney function test online and get tested from the comfort of your home by trained professionals.

Who Can Perform a Kidney Function Test (KFT)?

Generally, a healthcare provider, known as a phlebotomist, or any trained professional will draw your blood, for your kidney function tests. Your blood samples will be then sent to diagnostic laboratories for further diagnosis.

Can Your Kidney Function Get Better?

Kidney disease can be treated if diagnosed well within time. Advanced treatment options are also available to help delay or prevent kidney failure in severe kidney damage.

No matter what your results are:

Maintain your blood pressure, blood glucose, and blood cholesterol in your target range.
Cut back on salt and choose a balanced diet for kidneys.
Keep yourself physically active.
Take medicines the way your provider tells you to.
Get tested from time to time to keep an eye on kidney health.

Are Kidney Function Tests Risky?

The KFT blood tests are quite common and have no significant risk factors. However, at the time of blood collection, you may feel a little discomfort or pain which will go away eventually.

Conclusion

Kidney function tests help you ensure that your kidneys are functioning properly. Your body’s ability to eliminate waste materials is dependent on your kidneys’ health. You may face poor kidney functions due to health conditions like diabetes, high blood pressure, or due to other health-related concerns.

Book your kidney function test at Metropolis Healthcare which provides a wide range of blood testing and health check-up services. Qualified blood collection technicians will collect your blood by visiting your home at your convenience. Your blood sample will be processed at their cutting-edge laboratory using the 8-state MET Protocol. Your test reports will be sent to you through email. To download or share your reports, you may also download the Metropolis TruHealth app.

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Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders faced by women today, mostly in reproductive age. While there is no cure for PCOS, research suggests that certain dietary and lifestyle changes can help you manage the condition better. If you have PCOS, your doctor may recommend a personalised PCOS diet plan to help prevent the symptoms and potential complications that may occur due to the condition’s associated hormonal imbalances, insulin resistance, and inflammation.

Hustling at home and workplace? Ladies, do not ignore your health amidst these priorities! Book a comprehensive health check up here.

PCOS symptoms to watch out for

Many who suffer from this know what it is and what its symptoms are, but there are many who are not even aware that they suffer from it. So to begin with, let’s discuss what exactly it is. PCOS is considered a syndrome since it has various manifestations, including:

Irregular periods, missed periods or very light periods
Ovaries that are large or have many cysts.
Excessive body hair, including the face, chest, stomach, and back (hirsutism)
Weight gain, especially around the belly (abdomen)
Pimples
Hair loss
Fertility issues

At large, infrequent or irregular menstrual periods remain the primary concern which brings women to the doctor’s office.

Ignoring it may lead to several other complications like diabetes, infertility, sleep apnea, depression, cancer, and heart-related problems. To reduce the risk, it’s always best to consult a gynaecologist and start treatment as soon as you become aware of the problem.

Foods to include in your diet

Women with PCOS need to follow a diet where their nutritional needs are met while maintaining a healthy weight. Here is a look at the most important points while planning your daily diet in PCOS:

A low glycemic index (GI) diet: Foods with low GI get digested slowly and blood sugar rises gradually and slowly, thus insulin levels rise at a much slower rate. The improvement in insulin levels seems to be beneficial for PCOS. Any unprocessed low carbohydrate food, whole grains, nuts, seeds, fruits, starchy vegetables, and legumes all come under this category.

An anti-inflammatory diet: A diet that reduces fatigue and inflammation-related symptoms is helpful too. Here consuming berries, leafy greens, and extra virgin oil is recommended by experts.

The DASH diet: Or what is known as the Dietary Approach to Stop Hypertension- also helps to manage PCOS. Foods that are high in saturated fat and sugar are a big NO. A Dash diet is rich in whole grains, seasonal fruits and vegetables, low-fat dairy products, fish, and poultry.

Basically, whatever harms your heart, increases weight, and dysregulates insulin levels are to be avoided. Instead, what should be included in your daily food are the following-

1. Natural unprocessed foods enable vitamin absorption, and healthy nutrient intake and lead to weight loss.

2. High-fibre foods like oats and millets can lower cholesterol and inflammation in the body as well as stabilise blood sugar levels.

3. Fish –salmon, tuna, sardines, and foods rich in vitamins can aid in improving insulin resistance and decrease the severity of symptoms associated with PCOS.

4. Leafy greens like spinach, kale, and mustard leaves which are low in the glycaemic index but rich in phytochemicals, vitamins, and antioxidants can be eaten raw as in salads or pureed and made into exotic dishes.

5. Coloured fruits– red grapes, blueberries, blackberries, cherries, papaya, melon, are all rich in antioxidants and fibre but low in glycemic index and as such can prove helpful for PCOS patients. They also satisfy the sweet cravings. But going on an only fruit diet or consuming only fruits is not recommended. It’s better to eat most fruits with their skin and avoid drinking juices as the latter don’t have fibres and usually increase the sugar level faster than when we eat them.

6. Vegetables- broccoli, cauliflower, avocados, green beans, and carrots which are a rich source of magnesium, help to boost immunity and prevent obesity so are good for people suffering from PCOS. At least try to eat 25 gms of such veggies daily.

7. Legumes- dried beans like rajma, lentils, moong, and split peas all work to lower inflammation and insulin levels so ladies should include them in their diet.

8. Healthy fats- olive oil, coconuts, and vegetable oils with low omega 6 fatty acids help to increase hormone production, and fat is a biological necessity that aids in vitamin absorption and improving brain and heart function.

9. Nuts – pine nuts, walnuts, almonds, and pistachios all have the right balance of mono-saturated fats to help balance female hormones and should be consumed in moderation.

10. Chocolate- dark ones in moderation work as antioxidants, and hence curtail the effects of PCOS.

11. Spices- turmeric, cinnamon, black pepper, ginger, cumin, and saffron have proven to be very effective in dealing with PCOS, and including them in your daily diet is very beneficial for anyone’s health. Include most of the above-mentioned food in your daily diet in different combinations- the result should be to maintain a stable weight with controlled insulin levels. Eat small meals but at regular intervals.

Foods to exclude from your diet

All said and done, it is also necessary to know what should be avoided – what should be excluded from your diet. For unless one does that it’s no use eating healthy and negating the whole effect by eating unhealthy food too. Certain food that should be avoided in dealing with PCOS are-

1. Bakery products made using saturated fats

2. Fried and fast food

3. Sugary beverages and ready to drink energy drinks

4. Processed meats

5. Unhealthy fats that raises cholesterol like trans-fat

6. Excess red meat A good-balanced diet plays a pivotal role in dealing with the consequences of PCOS, especially losing weight, and controlling inflammation and insulin levels. The right diet can heal and help in dealing with PCOS better! Make healthy choices in your daily eating.

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What is a mammogram?

A mammogram is an X-ray of the breast used by doctors as a screening tool for breast cancer and to detect abnormalities in breast tissue.

A mammogram is considered a useful test to identify breast cancer early, even before symptoms develop. In a few cases up to three years before they can be felt or detected. This is called a screening mammogram. While a diagnostic mammogram is advised by a healthcare professional in case you develop any new symptom, such as a lump, pain, nipple discharge or breast skin changes. Breast cancer is the most prevalent cancer worldwide and is one of the leading causes of death in women. Although treatment approaches for breast cancer continue to improve, early diagnosis with the help of screening mammograms has significantly reduced the cancer-related deaths and impacted the survival rates of these patients.

Please note that not all breast lumps are breast cancers. Your doctor can ask for specific tests to differentiate between a cancerous and a noncancerous mass.

Why is a screening mammogram different from a diagnostic mammogram?

A screening mammogram is a routine, in most cases done annually to check for signs of breast tissue abnormalities before you have symptoms. It typically includes at least two pictures of each breast taken at different angles, from top to bottom and from side to side.

However, you can undergo a diagnostic mammogram if your screening mammogram detects an abnormal tissue in your breast. It includes extra views and utilizes additional imaging techniques which are supervised by the radiologist at the time of the study.

Who all should undergo a mammogram?

Various organizations such as American College of Obstetricians and the American College of Radiology, recommend an annual screening mammogram, starting at age of 40 years for all women with an average risk of developing breast cancer.

The American Cancer Society recommends the following:

Women with age 40 to 44 years should have the option to start annual breast cancer screening with mammograms.
Women with age 45 to 54 years should undergo mammograms every year.
Women who are 55 and older can choose to get mammograms every 2 years, or can continue yearly screening.
Screening mammograms should be continued if a woman is in good health and is expected to live 10 more years or longer.
All women should be aware with the benefits, limitations, and potential harms associated with breast cancer screening.

Occasionally, males who are at high-risk of developing breast cancer because of their family history may also get screening mammography. However, about 1 out of 100 males develop breast cancer.

Besides, your healthcare provider may ask you to take annual screening mammograms if you have any of the following risk factors:

Family history of breast or ovarian cancer
Personal history of breast cancer
Inherited genetic mutations
Certain noncancerous breast diseases such as atypical ductal hyperplasia or lobular neoplasia
Dense breasts.

How is a mammogram done?

A mammogram is a special X-ray designed to check only breast tissues.

You will stand in front of the machine and a technician will place your breast on a plastic plate
Another plate, known as paddle will firmly press your breast from above which will flatten it, you might feel some pressure at this moment
These two plates will hold the breast still while the X-ray is being taken
The machine creates X-rays that pass through your breast to a detector located on the opposite side
The detector transmits electronic signals to a computer to form a digital image
These steps are repeated to capture side views of the breast for both breasts.

How can you prepare yourself for a mammogram?

Although getting a mammogram is not usually an uncomfortable procedure for most women, it takes only a few moments and any discomfort, if present gets over soon. You will be required to remove all clothing and jewellery from your waist up for the imaging procedure.

Points to consider while scheduling your appointment for mammogram:

If you have been recently vaccinated for COVID-19, and are due for a mammogram, ask your healthcare provider for how long you should wait after vaccination to get your mammogram done
Avoid scheduling your mammogram the week before you get your period or during your period as your breasts may be tender during this time, which could make it uncomfortable
Try to inform your doctor if you are breastfeeding, pregnant or suspected to be pregnant
If you have breast implants, do not forget to mention it to your healthcare provider.

There are certain guidelines that you are required to follow on the day of your mammogram:

Follow your normal routine including regular medicines
You should remember to not apply the following substances as they can appear as white spots on the image and will interfere with the accuracy of mammogram:
Deodorants
Body powders
Perfumes
Ointments or creams on your breasts or underarms.

How safe are mammograms?

Although mammograms expose your breasts to small amounts of radiation, its benefits outweigh any potential harm from the radiation exposure.

Do you feel pain during mammograms?

A mammogram experience can be different for different people. The level of discomfort that you feel depends on the following factors, such as:

The size and density of your breasts
The compression your breasts need while capturing the image
If you are having or about to get on your period as your breasts may be more tender and sensitive to compression
The skill of the radiology technician
You will feel less discomfort if you are relaxed and position yourself in the best way for good images.

What does the result of mammogram signify?

If your mammogram is normal, continue to get mammograms according to recommended time intervals. Screening mammograms are most beneficial when a radiologist can compare them to your previous mammograms to analyse the changes in your breasts.

If your mammogram is abnormal, and shows one or more suspicious regions, it does not necessarily mean that you have cancer. You will be advised to undergo additional mammogram views, other imaging tests including a breast ultrasound, or a breast biopsy.

In nutshell, mammography is a fast and safe procedure. A mammogram can save your life as early detection of breast cancer reduces your risk of dying from the disease by 25-30% or more. Consult your doctor about your need for mammograms, so you can make sure to start screening as early as possible.

When did you have your last health check up? Book one now.

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Kidney cancers are predominantly a disease of old age with most patients diagnosed beyond 60 years of age. Kidneys are a pair of excretory organs located in the abdomen. Apart from their role in removal of toxic metabolic by products from the body they are also critical in maintaining the body electrolyte levels and blood pressure.

Who may get it?

The disease is seen to be related with carcinogenic exposure like smoking and is frequent in people employed in the dry cleaning industry having exposure with gasoline, solvents and heavy metals. The risk is also high among obese and hypertensive patients with long history of exposure to diuretic therapy and NSAIDs (pain killers). Apart from this patients with other benign kidney diseases and those having prolonged history of dialysis are also at increased risk of developing kidney cancers. As per some experts, the risk of Kidney Cancer is gradually growing due to a change in lifestyle and unhealthy food habits in urban cities.

Symptoms of Kidney Cancer

Kidney cancers are most commonly localised to the kidney at diagnosis however they have a potential for spread via blood and lymph to various organs with lungs, bone, brain and liver being the most common sites of spread.

Classically patients with localised kidney cancers present with symptoms of flank mass, pain and bleeding with urination. In a person presenting with cancer being spread to other organs (metastatic disease), the symptoms may vary from persistent pain in back to headache, vomiting, blurring of vision, seizures and difficulty in breathing.

Diagnosis of Kidney Cancer

Usually, a physical examination along with medical history can provide a lot of information to your doctor. He or she will enquire about signs of kidney cancer and other health problems. Many times, an abnormal lump is felt when the doctor examines the belly.

Most patients are diagnosed with the help of radiological imaging tests which require use of pre and post contrast CT and MRI images. Kidney biopsy and non-contrast Diffusion weighted MRI are useful in certain clinical scenarios. While most patients with radiological enhancement are correctly diagnosed as kidney cancers, as many as 20% of them are wrongly diagnosed making radiological diagnosis unreliable.

Doctors usually recommend a complete blood count for preliminary investigations. People with kidney cancer can have anemia (having too few red blood cells) very commonly, some may have too many red blood cells (called polycythemia) as well. Other lab tests include kidney function and urine analysis. These results become important for further imaging tests or if surgery is planned.

The most common benign kidney lesions confused with malignant disease radiologically are fat containing lesions of the kidney. While increasing tumor size on radiological imaging increases the likelihood of kidney cancer, a certain diagnosis requires kidney biopsy. It is majorly done for a certain group of people, those having advanced kidney cancer where the tumor has already spread.

Treatment of Kidney Cancer

Fortunately, most kidney cancers are diagnosed as localised disease as small renal masses. Historically these localised kidney cancers were treated with radical nephrectomy which required complete removal of kidneys but recently the treatment guidelines have evolved with acceptance for partial nephrectomy as well as active surveillance in selected patients. Partial nephrectomy requires complete removal of the tumor with maximum preservation of normal functioning kidney tissue on the affected side.

For larger localised kidney cancers where complete removal of tumor anyway results in unacceptable residual functioning of kidneys on the affected side, the radical nephrectomy is preferred over partial nephrectomy. Generally localised tumors beyond 7 cms are considered unsuitable for kidney preservation via partial nephrectomy.

For advanced metastatic disease, maximum removal of tumor tissues via nephrectomy and even removal of tumor from metastatic sites followed by systemic therapy is an accepted approach. Kidney cancer is a very vascular tumor and hence most systemic therapy in kidney cancers are targeted to block the generation of new blood vessels which are required for facilitating spread of kidney cancer.

Overall localised kidney cancers have good prognosis post treatment however for metastatic disease prognosis depends on factors like general well being of the patient, anaemia, high blood calcium and high blood WBC & platelet cell counts at the time of diagnosis. After treatment, it is advised to visit and consult your doctor for follow-up check ups or routine examinations.

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Prostate cancer is the cancer that develops in the prostate gland, a walnut-sized gland which is an important part of male reproductive system. The Indian Prostate Cancer Foundation states that prostate cancer is the second most frequently diagnosed cancer globally and sixth leading cause of cancer death in men. What’s more bothersome is that India has seen an increasing trend in the new cases of prostate cancer in recent years.

Most types of prostate cancers grow slowly and remain confined to the prostate gland. Also, there are high chances of a minimal and successful treatment if a prostate cancer gets detected early while it is still within the gland and not spread beyond. On the other hand, other types can be aggressive and may spread swiftly. A test, called the PSA blood test, is used to screen for prostate cancer. This simple test measures the amount of prostate-specific antigen (PSA) in blood, which is a protein made by the prostate gland. If PSA levels are high, it may indicate prostate-related problems including a noncancerous condition such as inflammation of the prostate (prostatitis), an enlarged prostate gland, or prostate cancer.

Red flag: Prostate cancer may cause no symptoms

It is quite common to not have any warning signs in its early stages. The symptoms when present can include:

Trouble in passing urine
Decreased force in the urine stream
Blood in the urine
Blood in the semen
Bone pain
Unexplained loss of weight
Erectile dysfunction

It is crucial to see your doctor if you have any persistent signs or symptoms that are worrying you, even if they are as general as losing weight unintentionally. Do not ignore testing. If you are advised a prostate blood test, get it done on priority and follow up with your doctor.

Prostate cancer risk factors you should be aware of

Advancing age:

The most common risk factor is age. About 6 in 10 cases of prostate cancer are found in men older than 65. The older a man is, the higher the risk of developing prostate cancer. It is quite uncommon for men younger than 40, but the risk rises rapidly beyond age 50.

Your organs also age as you age. The best way to keep track of your aging organs is a comprehensive body check up.

Family history of prostate cancer:

In some cases there may be an inherited or genetic factor. Having a father or brother with prostate cancer more than doubles a man’s risk of getting it.

Obesity:

Though being obese does not seem to increase the overall risk of getting prostate cancer, some studies have shown that obese men may be at greater risk for having more advanced prostate cancer.

Smoking:

The link between smoking and prostate cancer is neither direct nor conclusive but studies have linked smoking to a possible small increased risk of death from prostate cancer.

Sitting too much is new smoking:
While there are only a few studies that linked sedentary behavior and cancer risk, sedentary behavior and physically inactive lifestyle are considered risk factors for seeding many chronic conditions. It may also be associated with increased risk for certain cancers. Certain epidemiologic studies have suggested that staying physically active can help improve quality of life in advanced cancers. Some sources state that men with prostate cancer who have enough physical activity have a 33% lower risk of death from prostate cancer.

How much is enough

In general, 150 to 300 minutes of moderate-intensity aerobic activity, 75 to 100 minutes of vigorous aerobic activity each week is recommended by the guidelines. This physical activity can be done in episodes of any length. You can check the intensity of your workout through a talk test. If you can talk but not sing during exercise, it is moderate-intensity. If you cannot speak more than a few words, it is highly likely to happen during vigorous-intensity workout.

Here is a point to note

Having one risk factor, or even several, does not imply that you are bound to get the disease. Many people may have various risk factors but never get cancer, while there are others who develop cancer despite having no known risk factors. There is no proven strategy for preventing prostate cancer, but awareness is the key to staying safe. Make sure to get a PSA test done if you think you are at a higher risk, look for warning signs, and swear by rules for a healthy lifestyle.

A full body check up is a great start to kick off a healthy journey. Book here, get tested at home, and access your results online.

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Metropolis healthcare blood sugar levels

Diabetes is one of the most common diseases of the present times. It affects the ability to maintain normal blood sugar levels in the body. The affected person has higher than normal blood sugar levels in blood. These elevated blood glucose levels over a longer period of time affects the normal functioning of various organ systems in the body. As expected, the blood sugar levels in the body change largely according to your meals. The diagnosis commonly requires examination of blood while fasting (Blood sugar fasting test) and 2 hours post meals.

While the importance of maintaining a healthy diet and regular blood testing cannot be overstated, there are several factors both modifiable and non-modifiable more which determine the ease of maintaining normal blood glucose levels.

Some of the most common factors leading to inadequate blood glucose control despite medications are

Inadequate or irregular doses of medications which include both injectable insulin injections and oral medications. It remains to be the most common cause for high blood sugar levels in a diabetic patient on medications.
There is progressive levels of insulin resistance in the body, which means insulin though present in sufficient amounts is not able to exert its effect of bringing glucose inside body tissues. It results in excessive levels of blood sugars despite normal levels of insulin in the body. This is more common in patients of type II diabetes.
The blood glucose targets may not be achieved due to lack of adherence to a balanced diet, many times referred as diabetic diet. Consuming excessive amounts of carbohydrates, too frequent meals and diets poor in complex carbohydrates and proteins are the most common reasons. All these result in blood sugar levels which overwhelm the body’s capacity to produce insulin or the amount of insulin injected in the body.
You are less active physically. Exercise helps the body utilise excessive sugar in the blood.
Medications taken for other reasons may be adversely affecting your blood sugar levels like steroid, and diuretics.
Levels of emotional and physical stress have been historically related to poor blood control levels. Physical stress in the form of any acute illness, common cold, injury and infection mounts to increase body cortisol levels which in turn increase blood glucose levels. Similarly, prolonged durations of emotional stress in the form of family or work related stress mount to increased levels on blood sugar levels.

Think stress is affecting your overall health? Check your vitals with a comprehensive test package.

Other uncommon reasons

Hormonal disorders like Cushing’s syndrome causing excessive levels of natural cortisol hormone in the body, pancreatic diseases like infection, cyst, fibrosis or cancer affecting the body’s ability to produce enough insulin.
Pregnancy may cause excessive rise in blood glucose levels in some females. The condition is known as Gestational diabetes. It affects 4% of all pregnancies, and is due to production of excessive amounts of hormones promoting an increase in blood glucose levels along with decreased insulin sensitivity in susceptible females.
Surgery or trauma may induce stress in body and may cause a temporary rise in blood sugar levels

Maintaining blood sugar levels in a diabetic is difficult. But why should we stress on it anyway?

Blood glucose is required by various body tissues for normal functioning. It acts as an important source of energy within tissues. But for glucose to enter into most tissues insulin, a protein secreted from pancreas is required. So while glucose in blood is essential for energy requirements of tissues, it is unavailable to body tissues in absence of insulin.

Thus insulin has a central role in maintaining normal blood glucose levels and providing adequate glucose to tissues for storage and energy production. So it is either the lack of insulin or the resistance of the body to normal levels of insulin are commonly implicated in causing diabetes and are classically described as type I and type II diabetes respectively. Since excess blood sugar instead of reaching tissues remains in blood for prolonged periods this causes the symptoms and complications of diabetes.

Symptoms in a patient and possible complications of poor blood glucose control

The classical symptoms of diabetes are excessive thirst, hunger and frequent urination. However, in diabetic patient’s symptoms of excessive hunger, vomiting, breathing difficulty, abdominal pain and loss of consciousness suggest acute complications due to diabetes.

Even in absence of these symptoms suggesting acute complications, prolonged periods of poor blood sugar control adversely affect kidneys, vision and peripheral nerves of the body. If you are affected with diabetes and are showing any of these symptoms we suggest you get your blood sugar fasting test done.

Testing for blood glucose

The Fasting blood sugar levels are determined by drawing blood after 8 hours of fasting, which means blood samples are conveniently drawn early in the morning. A fasting blood glucose of 126 mg/dl or more suggests Diabetes. However, for blood samples drawn 2 hours post meals blood glucose of 200 mg/dl or more suggest diabetes. Apart from these Glycosylated haemoglobin (HbA1c levels) of 6.5% or more suggest poor blood sugar control over a period of 2 to 3 months. Fasting blood sugar range of 100 to125 mg/dl suggests a state of impaired glucose tolerance, which means if blood glucose levels are not adequately controlled by means of lifestyle modifications a person may later develop diabetes.

What can you do to maintain your blood sugar levels?

Physical activity helps you lower your blood sugar levels. You may want to work with your healthcare provider to provide you with a detailed work out plan to achieve desired goals.
Following your diabetic diet plan strictly. Basic understanding on how nutrients like carbohydrates impact your blood sugar may help you sustain your achieved goals. While diet remains the cornerstone of your diabetic control it is often neglected. It requires the help of a nutritionist to provide you with a well curated diet plan specifically designed to meet the demands of your body type and feeding habits.
Maintain a healthy body weight.
Avoid smoking.
Refrain from excessive consumption of alcohol.
Regular testing for blood sugar levels. Book your test here fasting blood glucose test.

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A healthy heart is what it takes to keep the clock running smoothly for the long haul. Anything that burns up energy from walking, running, cycling, swimming etc. involves function of the heart and if you plan on living a long and active life, you need to always ensure that the heart is functioning well. In fact, various incidences of heart attack in young adults have drawn attention to how crucial your heart health is.

Eating right accompanied by regular exercising is the basic need for a stronger heart and a healthier body. Apart from following certain healthy heart diet tips, you should also be wary of and subside by certain lifestyle changes such as quitting smoking, working on the belly fat, stretching, trying to keep the blood pressure, sugar, cholesterol and triglycerides in check, keeping the inner child alive, enjoying life, avoiding stress and meditating. Make sure to schedule your full body check up from time to time and keep an eye on your vital numbers.

Heart health needs a little care of other body systems to

The National Institute of Diabetes and Digestive and Kidney Diseases states, “High blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. Over time, this damage can lead to heart disease.” If you have diabetes, your chances of developing heart disease at a younger age are higher than people without diabetes. Those who have a family history of diabetes should get the HbA1c test, also known as glycated hemoglobin, which measures the average glucose levels. HbA1c normal range is between 4% to 5.6%; a higher range indicates excess of sugar in the body, meaning you are likely to develop diabetic problems. It is a vital part of full body check up too. Please note that the HbA1c test is a blood test and different from a regular finger pricking test.

As per some studies, optimum vitamin B12 levels and folic acid can help prevent heart disease by reducing the body’s levels of homocysteine. It is an amino acid homocysteine that has been shown to cause harm to the heart by raising clot formation in the blood vessels. Wondering when to get a vitamin B12 blood test? If one is feeling certain symptoms such as depression, fast heartbeat, poor memory or dementia, it may indicate vitamin B12 deficiency.

One should also go for a regular master health check up, including heart checkup that will help you keep your heart and overall body health in check and make recommendations for precautions and measures accordingly for a long, healthy and prosperous life.

Here are some dietary suggestions that will ensure the finely tuned machine is fueled right.

Fresh fruits and vegetables:
Rich in essential minerals and vitamins, these are high in dietary fibre and low in calories. Berries, papaya, tomatoes, oranges, kale, spinach etc. help improve arterial function, and keep blood pressure in check. Higher the portion of fruits and vegetables in your diet, lower are the risks of heart diseases.
Dark chocolates:
Interestingly yes, consumption of dark chocolates has been associated with lowering the risk of getting heart problems. Chocolates contain antioxidants like flavonoids that have been found to promote heart health as per some studies. Moderate intakes are advisable as chocolates are still high in calories and sugar.
Almonds and Walnuts:
They contain various vitamins and minerals and are a great source of fibre and other micronutrients. Incorporating them in your diet, soaking them overnight or keeping them on your office desk, will help reduce bad cholesterol, keep the arteries clear and ultimately shield us from heart diseases.
Olive oil:
With strong evidence based on various studies and experiments, olive oil is found to be an essential ingredient lowering the risk of developing heart problems. Thanks to its rich antioxidant properties, it has been proven to be a relief for inflammation as well as for treating hypertension. Sprinkle it on vegetables and enjoy the many benefits it offers.
Green tea:
Among the many benefits it has, green tea may prevent cell damage, improve insulin sensitivity and reduce inflammation. Replacing your regular tea with green tea can be a first step to manage blood pressure and blood sugar.
Protein enriched foods:
Fish, lean meat, poultry, dairy products, eggs etc. can be some good low fat protein sources to include in your diet. If you are a vegetarian, you can eat beans, peas, lentils etc. whereas non vegetarians can go for omega 3 fatty acids found in fishes like salmon, mackerel etc.
Flaxseed oil:
mixing it with about anything, be it morning cereal, afternoon veggies or yoghurt or dessert muffins, will yield high antioxidant properties. Rich is omega 3, flaxseed oil contains both soluble and insoluble fibre.

Eating right is vital for the heart. Changing eating habits is often tough, but controlling the portion size of what goes inside the belly can be your way towards a healthy heart and incorporating these dietary tips in your schedule can be a great way to kick start. Ultimately the power to maintain and keep ourselves fit is in your hands; so make healthier choices and live a lifestyle that keeps your heart healthy and always smiling!

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Back pain is one of the most common health conditions that affects 8 out of 10 people at some point during their lives. Usually, the symptoms of back pain can be troublesome but short-lived and can last for some days. However, your back pain can be chronic if the symptoms have been bothering you for longer than 3 months. While younger adults face back pain majorly due to lifestyle-related causes, elderly people are at risk due to advancing age. It is pivotal to schedule regular health checkup for senior citizens.

What may be giving you back pain?

Strain in the muscles is one of the most common causes of back pain. Factors like incorrect lifting of heavy objects, improper posture, and sudden body movements can lead to muscle strain. While the discomfort from a typical muscle strain can last between three to six weeks, more severe muscle strains can take several weeks or a few months.
Over activity after prolonged periods of inactivity (such as playing a sport once in a while) can also cause temporary stiffness and pain.
Injured discs (tissue that cushion the spaces between each vertebra) is a leading cause of back pain.
Spinal osteoarthritis that occurs due to damage of cartilages of joints in your lower back can lead to back pain.

Thinning of the bone, called osteoporosis, can result in small fractures in your vertebrae which can cause pain. Vitamin D is an important nutrient that can help manage bone thinning. Though there is not enough data, various studies have shown that low levels of vitamin D can be a cause of increased joint and muscle pain. Women are at a higher risk of developing osteoporosis than men.

Check out the vitamin D test price now and book within the comfort of your home.

When to worry and see a doctor for my back pain?

Do you keep ignoring back pain until it starts hampering daily routine activities? One primary reason for this is back pain can come and go. But, it may become chronic and be continuously present. You can benefit from taking over-the-counter pain relievers, anti-inflammatory drugs to reduce inflammation, and resting for 1-2 days. Compresses can help decrease pain and inflammation and work quite well for some people. However, certain symptoms alongside back pain may warrant an immediate action or the need to see a doctor.

Seek medical attention if any of the following symptoms accompanies your back pain:

Increasing weakness in your legs
Loss of bladder and/or bowel control
Sudden spike in pain, discomfort, weakness or numbness
High fever
Severe abdominal pain
The pain results from a fall or severe blow to your back.

Do I need tests for back pain?

If the cause of your back pain is not very obvious, your treating doctor may advise:

Blood work up
Urine tests (to check for kidney related conditions that can give back pain at certain times)
X-rays, CT, or MRI scans of the spine to assess your discs, muscles, ligaments, nerves, and blood vessels
Bone scan to look for any aberrations in the bone tissue

Here are 4 quick tips to keep back pain away

1. Safeguard your discs right after waking

Maintain a straight back for an hour or two after waking in the morning. As per some studies, the pressure within your discs increases up to 240% when you sleep at night. At this time, your discs can be at a raised risk of herniation if made to bend or lift forces.

2. Choose your bag wisely

Heavy laptop bags and purses can add unnecessary stress to your neck and back. Carry less (only what is really required) and use bags (backpacks) that have wide straps to distribute the weight more evenly.

3. Invest in an ergonomic office chair, if you are working from home

Many of us may be actually working from bed while working from home. However, not having proper sitting posture and slouching forward during long work hours on laptops lead to excessive pressure on the back and can cause pain. Use a chair that helps you align and support your neck, back and thighs accurately. Take regular stretch breaks in between work.

4. Protect your back while lifting

Common everyday activities, such as unloading heavy grocery bags or lifting a toddler can lead to lower back problems. Bend at your knees, not at your lower back and hold the object close to your chest while keeping your spine straight.

Along with your back, keep an eye on your overall health as it may result in generalized body ache. Advancing age demands a little extra care. Do not ignore long-standing pain or worsening symptoms, especially in elderly. A full body checkup for senior citizens can be a good starting point to kick off the health journey.

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The constant sneezing, running nose, congestion, etc. have just begun with this phase; and you are just one among hundreds of those who suffer from seasonal allergies. Just like other kinds of allergies, when the immune system is not able to grasp the external environmental changes and ends up overreacting to the outdoor allergens during spring, summer or fall, it leads to seasonal allergies i.e allergic rhinitis, or in layman’s terms hay fever. One can experience seasonal allergies in more than one season which can also be determined by where you live.

How can I get my allergy diagnosed?

While there might not be any certain treatment for such seasonal allergies, one can consult with the doctor for ease with the bothersome symptoms. If the symptoms are troublesome, the doctor might refer to an allergy test for better treatment. They will check the nose, ears, or throat. The allergy specialist can also conduct a skin test by pricking the surface of the skin with the allergen to understand the allergy and the cause, or may also order a blood test. Another resource to find out the cause of the suffering can be to opt for some of the best health checkup packages. Though the best cure would be to avoid contact with allergens that can be triggering, it may not always be possible. While there are certain medications such as over-the-counter decongestants and antihistamines or nasal sprays available for the cure, you can also get a health check-up done, the price for full medical checkup has now become affordable too.

Some people may develop allergies to specific food items too. Book an allergy test- Food panel here.

Symptoms to watch out for

While a few may suffer from mild symptoms, some others can have severe allergic reactions, a few common ones include:

Congestion
Itchy or watery eyes
Constant sneezing
Runny nose
Itchy throat or ear canals

Sometimes headache, wheezing and coughing or the formation of dark circles under the eye can also be the signs of allergic reactions.

Causes behind seasonal allergies

While we now know the symptoms to watch for, it is also important to understand what might be causing these. Symptoms of seasonal allergies vary from one season to another just like their triggers. We catch allergies when the immune system takes an airborne particle to be dangerous; in order to prevent and respond to the particle, the body system releases chemicals called histamines in the bloodstream which are said to produce the symptoms of allergy. So when the pollens or tiny dust particles or grains are present in the air, the body’s defence mechanism goes for a toss, thereby giving itchy throat, runny nose, watery eyes, etc.

While in the summer season, the hay cuttings and grasses are responsible, in fall, the plants drop their pollen, the leaves shed, making it one of the worst seasons for allergic sensitive people. Winter comes as a respite for such people unless they also react to dust mites, mould, cockroaches, etc. staying indoors. Pollen is found highest during the morning, whereas trees, grass, and ragweed pollen are more common during warmer days or colder nights. They increase when the day is windy. Apart from pollen, grass, mould, smoke, insect bites or sting, chlorine in swimming pools, etc. can also cause allergies.

What treatments work?

In case of mild symptoms, one can also take precautionary basic steps, such as using air purifiers, staying indoors, keeping the windows covered, wearing a mask or scarf when stepping outside etc.

The year-round allergic rhinitis can best be treated by avoiding getting in contact with the allergens as much as possible. If you are unable to avoid such allergens, there are other cures available such as going for over-the-counter medicines as mentioned, in severe cases; however, the expert may suggest allergy shots, which are basically immunotherapy to desensitize the immune system to these foreign particles. While the treatment works, most often these unnatural ways can have side effects such as dizziness, confusion, or drowsiness throughout the day. Some other effective steps can be-

Stay indoors in the peak allergies season: You can take precautionary medicines to ease the symptoms, or if possible best would be to stay indoors.

Avoid triggers: Wearing a mask if venturing outside works; avoid mowing lawns or other gardening activities. The best time to venture outside is after rains when the pollen from the air is clean, and the worst time is during the early morning when the pollen counts are highest.

Maintain clean indoors: If you have forced temperature maintenance in your house, like air heating or cooling, it is advisable to use high-efficiency filters and call for regular maintenance and cleaning of these. Using a highly efficient particulate air filter in the bedroom and cleaning the house with a vacuum equipped with this HEPA filter also works.

Cure for the itchy and runny nose: A quick cure to get rid of the nasal congestion is to rinse it with saline solution. This inexpensive cure can help get rid of the mucus and allergens from the nose, thus giving it relief from the constant itches and irritation.

A few not-so-common natural remedies: Also include quercetin, a nutrient that can be found in onions, apples, and black tea that is effective in blocking histamines. Another cure is stinging nettle leaves, using dried and cold leaves for treating allergies and calming the affected area, while some also suggest going for acupuncture, though little evidence is there that supports the same, nonetheless these are all inexpensive and harmless treatments that can be opted for carefully.

Symptoms of seasonal allergies can be irritating and uncomfortable. While much of these can be avoided, visiting and taking an expert’s opinion never hurts, they will help chart out the correct treatment plan and point out effective steps that can help ease the allergy and provide relief. There might not be any permanent solution, but these allergies can certainly be curbed following prescribed medications or home remedies as needed.

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