Lifestyle Disorders Flashcards

Question

Management of PCOS

Answer 1

For physicians, the mnemonic "MYPCOS" is a way to organize multisystem care of women with polycystic ovary syndrome. MYCOS - Metabolic intervention, cycle control, Psycho-social care, Cosmetic treatment, Ovulation stimulation and managing Sleep apnea. • Metabolic - Lifestyle modification is first line therapy with weight loss (if overweight), a healthy diet, and regular exercise. Even without weight loss, moderate intensity exercise can improve the metabolic status of women with polycystic ovary syndrome. In adults and adolescents with PCOS, daily strict physical activity sessions for at least 30min/day or 150min/ week are recommended. • Cycle Control - menstrual cycles should be regulated such that menses occur at least every 3 months. The first-line approach is with hormonal contraceptives, and because metformin increases ovulation rate, it can be considered second-line treatment for cycle control. • Psychosocial - it is important to screen for depression and eating disorders in women with polycystic ovary syndrome. Patients can be effectively screened for depression by asking 2 simple questions about mood and their interest in various day to day activities. • Cosmetic - Excessive growth of dark or coarse hair in a male-like pattern - face, chest and back, acne and male pattern hair loss are very commonly seen in PCOS conditions. Hormonal therapy with estrogen-containing oral contraceptives or anti-androgens as above can be very effective for treating these cosmetic conditions. • Ovulation and Fertility - If fertility is desired, ways to increase ovulation frequency should be discussed. If the patient is obese, weight loss is recommended. Given the benefits of diet, exercise, and weight loss in overweight and obese individuals, healthy lifestyle changes are recommended. • Sleep Apnea - is a serious sleep disorder in which breathing repeatedly stops and starts. The risk and severity of obstructive sleep apnea in polycystic ovary syndrome is strongly correlated with insulin resistance. Treatment with at least four hours per night of continuous positive airway pressure improves insulin sensitivity.

Answer 2

Change in body composition (muscle mass declines at rate of 1% annually after 30 yrs age with up 50% of muscle mass lost by the time they are 80s) Low musclar strength Sedentary lifestyle in late years results in low aerobic capacity and low bone mass density Low TDEE Hormonal changes affect the efficiency of metabolic systems and directly as well as indirectly affect muscle mass and bone loss (menopause - rate of muscle loss is 0.6% )

Answer 3

Time leading to delivery

Answer 4

Gestational Weight Gain (GWG) and Postpartum Weight Retention (PPWR)

Answer 5

Baby - 7.5 pounds Placenta - 1.5 pounds Amniotic fluid - 2 pounds Uterine enlargement- 2 pounds Maternal breast tissue - 2 pounds Maternal blood volume - 4 pounds Fluids in maternal tissue - 4 pounds Maternal fat stores - 7 pounds Most happen during 2-3 trimester

Answer 6

Morning sickness - 90% of women experience nausea from week 5 to week 18. Meals should be broken down into smaller meals - no large spicy meals since might cause gastric stress Cardiovascular adaptation- increase in blood volume, heart rate and stroke volume where the cardiac output is 30% more in order to deliver nutrients to baby Changes in abdominal wall - lower ribs and diaphragm is spread out during early phase of pregency. Rectus abdominal is stretched out by 20cm and the two bands may stretch out to allow more space called diastasis recti and 66% suffer from this Pelvic floor - foetus grows the uterus expands. Urinary incontinence (leaking) is sign of damage to pelvic floor. Core and pelvic floor strengthening can be done during pregnancy and after delivery. Hormonal changes - HCG hormone is produced in first trimester which indicates the placenta is being created. progesterone causes mood swings. Estrogen increases blood flow while maintaining endometrial lining for baby development. Relaxin is produced in second trimester to help relax smooth muscles in pelvic region Changes in centre of mass - expanding uterus puts pressure on lower part of spine so due to action of relaxin and estrogen the pelvic widens while ligaments and joints become lax

Answer 7

Energy req is 90. 300, 450 for first second and third trimesters respectively Supplemental of Zinc Iron Magnesium B6 Selenium and C

Answer 8

Swimming stationary cycling or walking Avoid exercises that might cause fall abdominal impact or joint stress Avoid any supine position activity (lying on back) exercises Benefits improved cardiovascular fitness, • Preventing excessive gestational weight gain, • Mood stability, • Boter pelvic control to manage urinary incontinence (but with specific exercises that target the pelvic muck) • Reducing the chances of gestational diabetes and hypertension • Higher chance of normal delivery

Answer 9

HCG hormone stops being produced after baby is delivered. Hypothalamus resumes which takes a while so women tend to eat more Also takes 6 weeks to reconvert from birth physically either though Caesarean or natural Breastfeeding cal is additional 670 on top of TDEE and protein requirements is 15-20 g p day extra Safe to exercise about days within delivery so light exercise for 4-6 weeks

Answer 10

Sleep deprivation which is alleviated by exercising Vaginal bleeding starts immediately after delivery and uterine discharge continue for 8 weeks after Up to 60% of women suffer from urinary incontinuence due to pelvic trauma so strengthen pelvic muscles for 12-15 times, twice a day Diastasis recti which is resolved by itself and if not direct clients to physiotherapist. No exercises that cause bulging in stomach muscles like sit-up, leg raises in lying position or anything that create torque (twist) in their abdominal muscles