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A muscular Dystrophy is a group of diseases that make muscles weaker and less flexible over time. This damage and weakness are due to the lack of a protein called dystrophin, which is necessary for normal muscle function. The absence of this protein can cause problems with walking, swallowing, and muscle coordination.

For some people, the disease starts early in childhood. Others don’t have any symptoms until they are teenagers or middle-aged adults. In muscular dystrophy, abnormal genes (mutations) interfere with proteins’ production needed to form healthy muscle. 

How muscular dystrophy affects an individual depends on the kind. Most people’s condition will worsen over time, and some people may lose the ability to walk, talk, or care for themselves. But that doesn’t happen to everyone. Other people can live for many years with mild symptoms.

There’s no cure for muscular dystrophy. But medications and therapy can help manage symptoms and slow the course of the disease. Some forms of muscular dystrophy may be present at birth and develop during childhood, while other forms develop during adulthood. 

Muscular dystrophy can be hereditary as well. More than 30 types of muscular dystrophy result in muscle weakness, which varies in symptoms and severity. There are nine different categories used for diagnosis. Let us explore each type in detail. 

Types of Muscular Dystrophy

Duchenne muscular dystrophy: This type of muscular dystrophy is the most common among children. The majority of individuals affected are boys. It’s rare for girls to develop it. The symptoms include:

• trouble walking
• loss of reflexes
• difficulty standing up
• poor posture
• bone thinning
• scoliosis, which is an abnormal curvature of your spine
• mild intellectual impairment
• breathing difficulties
• swallowing problems
• lung and heart weakness

People with Duchenne muscular dystrophy typically require a wheelchair before their teenage years. The life expectancy for those with this disease is late teens or 20s.

Becker muscular dystrophy: Becker muscular dystrophy is similar to Duchenne muscular dystrophy, but it’s less severe. This type of muscular dystrophy also more commonly affects boys. Muscle weakness occurs mostly in your arms and legs, with symptoms appearing between age 11 and 25.

Other symptoms of Becker muscular dystrophy include:

• walking on your toes
• frequent falls
• muscle cramps
• trouble getting up from the floor

Many with this disease don’t need a wheelchair until they’re in their mid-30s or older, and a small percentage of people with this disease never require one. Most people with Becker muscular dystrophy live until middle age or later.

Congenital muscular dystrophy: Congenital muscular dystrophies are often apparent between birth and age 2. This is when parents begin to notice that their child’s motor functions and muscle control aren’t developing as they should. Symptoms vary and may include:

• muscle weakness
• poor motor control
• inability to sit or stand without support
• scoliosis
• foot deformities
• trouble swallowing
• respiratory problems
• vision problems
• speech problems
• intellectual impairment

While symptoms vary from mild to severe, most people with congenital muscular dystrophy are unable to sit or stand without help. The lifespan of someone with this type also varies, depending on the symptoms. Some people with congenital muscular dystrophy die in infancy, while others live until adulthood.

Myotonic dystrophy: Myotonic dystrophy is also called Steinert’s disease or dystrophia myotonica. This form of muscular dystrophy causes myotonia, an inability to relax your muscles after they contract. Myotonia is exclusive to this type of muscular dystrophy.

Myotonic dystrophy can affect your:

• facial muscles
• central nervous system
• adrenal glands
• heart
• thyroid
• eyes
• gastrointestinal tract

Symptoms most often appear first in your face and neck. They include:

• drooping muscles in your face, producing a thin, lean look
• difficulty lifting your neck due to weak neck muscles
• difficulty swallowing
• droopy eyelids, or ptosis
• early baldness in the front area of your scalp
• low vision, including cataracts
• weight loss
• increased sweating

This dystrophy type may also cause impotence and testicular atrophy in males. In women, it may cause irregular periods and infertility.

Myotonic dystrophy diagnoses are most common in adults in their 20s and 30s. The severity of symptoms can vary greatly. Some people experience mild symptoms, while others have potentially life-threatening symptoms involving the heart and lungs.

Facioscapulohumeral (FSHD): Facioscapulohumeral muscular dystrophy (FSHD) is also known as Landouzy-Dejerine disease. This type of muscular dystrophy affects the muscles in your face, shoulders, and upper arms. FSHD may cause:

• difficulty chewing or swallowing
• slanted shoulders
• a crooked appearance of the mouth
• a wing-like appearance of the shoulder blades

A smaller number of people with FSHD may develop hearing and respiratory problems.

FSHD tends to progress slowly. Symptoms usually appear during your teenage years, but they sometimes don’t appear until your 40s. Most people with this condition live a full life span.

Limb-girdle muscular dystrophy: Limb-girdle muscular dystrophy causes weakening of the muscles and a loss of muscle bulk. This type of muscular dystrophy usually begins in your shoulders and hips, but it may also occur in your legs and neck. You may find it hard to get up out of a chair, walk up and downstairs, and carry heavy items if you have limb-girdle muscular dystrophy. You may also stumble and fall more easily.

Limb-girdle muscular dystrophy affects both males and females. Most people with this form of muscular dystrophy are disabled by age 20. However, many have an average life expectancy.

Oculopharyngeal muscular dystrophy (OPMD): Oculopharyngeal muscular dystrophy causes weakness in your facial, neck, and shoulder muscles. Other symptoms include:

• drooping eyelids
• trouble swallowing
• voice changes
• vision problems
• heart problems
• difficulty walking

OPMD occurs in both men and women. Individuals usually receive diagnoses in their 40s or 50s.

Distal muscular dystrophy: Distal muscular dystrophy is also called distal myopathy. It affects the muscles in your:

• forearms
• hands
• calves
• feet

It may also affect your respiratory system and heart muscles. The symptoms tend to progress slowly and include a loss of fine motor skills and difficulty walking. Most people, both male and female, are diagnosed with distal muscular dystrophy between 40 and 60.

Emery-Dreifuss muscular dystrophy: Emery-Dreifuss muscular dystrophy tends to affect more boys than girls. This type of muscular dystrophy usually begins in childhood. The symptoms include:

• weakness in your upper arm and lower leg muscles
• breathing problems
• heart problems
• shortening of the muscles in your spine, neck, ankles, knees, and elbows

Most individuals with Emery-Dreifuss muscular dystrophy die in mid-adulthood from heart or lung failure.

Treatment for muscular dystrophy

There is currently no cure for muscular dystrophy.

To help ease discomfort, reduce joint contractures, and prevent or delay scoliosis, physiotherapists offer advice on stretches and exercises and the prescription of orthoses and other orthopedic devices. Occupational therapists also provide advice on sitting positions and activities. Such treatment can keep affected people walking for more extended and maximize independence in daily living. Treatments depend on your symptoms.

Treatment options include:

• corticosteroid drugs, which help strengthen your muscles and slow muscle deterioration
• assisted ventilation if respiratory muscles are affected
• medication for heart problems
• surgery to help correct the shortening of your muscles
• surgery to repair cataracts
• surgery to treat scoliosis
• surgery to treat cardiac problems

Therapy has proven to be effective. You can strengthen your muscles and maintain your range of motion using physical therapy. Occupational therapy can help you:

• become more independent
• improve your coping skills
• improve your social skills
• gain access to community services

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Breast lumps are a common occurrence in women. While only 10 – 20% of breast lumps are malignant, the majority are benign lesions such as fibroadenoma in teenagers and young adults, and fibrocystic change and cysts in older women.

Only approximately 10 to 20% of breast lumps are malignant. You might be surprised to find a breast lump, but it’s important to remember that it may not affect your long-term health. Early detection of breast cancer can save lives, and women aged 40 and above are strongly encouraged to undergo regular mammographic screening.

How Your Breasts Should Feel

Breast tissue varies inconsistently, with the upper-outer part of your breast being firm and the inner-lower parts feeling somewhat softer. If you are a woman, your breasts can become more tender or lumpy during your menstrual cycle. Breasts tend to get less dense as you get older.

It is important to be familiar with how your breasts normally feel so you are aware of changes. We do not recommend to examine this on your own because there’s little evidence that breast self-examination reduces the risk of dying from breast cancer.

In fact, breast self-examination may cause harm because you’re more likely to find a noncancerous lump, which could be a source of worry. In some cases, this may lead to unnecessary medical procedures to ensure that the lump is benign.

Instead of performing breast self-examination, most experts recommend that women simply be aware of what their breasts normally look and feel like. You should report any changes or concerns to your doctor.

• a lump changes or grows larger
• your breast is bruised for no apparent reason

Signs You Should See a Doctor

Remember, most breast lumps are noncancerous. However, you should make an appointment to see your doctor if:

• you discover a new lump
• an area of your breast is noticeably different from the rest
• a lump does not go away after menstruation

• the skin of your breast is red or begins to pucker like an orange peel
• you have an inverted nipple (if it was not always inverted)
• you notice a bloody discharge from the nipple

At Saideep hospital, we recognize the needs women have when it comes to selecting and receiving expert consultations and treatments for any type of breast disease, cancerous, and non-cancerous. We offer a one-stop solutions center, dedicated to looking after breast health.

Our breast imaging center enables women to have their breast ultrasonography, surgical consultation, minimally invasive biopsies, and procedures all under one roof, and with quick turnaround time.

The center is governed and dictated by a multi-disciplinary team of breast surgeons, radiologists, reconstructive surgeons, oncologist together with pathologists and physiotherapists.

With digital mammography, more cancers are getting detected, earlier. It is also significantly more accurate in detecting breast cancers at the earliest stage, or when it is hidden by dense tissues. A screening mammogram is generally recommended for women age above 40 years of age or earlier if she has a family history of breast cancer.

We can help you if you

• Discover a breast lump
• Are concerned about your breast cancer risk
• Have an abnormal mammogram and/or breast ultrasound report
• Have an abnormal breast biopsy result
• Have been diagnosed with breast cancer and seek treatment
• Want a second opinion
• Need arm physiotherapy for prevention or management of shoulder stiffness, reduced arm mobility and/or lymphedema
• Want to learn about breast self-examination

Our Range of Services

• Breast imaging studies such as mammography and ultrasound
• Image-guided biopsy of breast lesions
• Minimally invasive breast surgery including core biopsy or lumpectomy
• Oncologic breast surgery including oncoplastic surgery and breast reconstruction where necessary
• Adjuvant chemotherapy and radiotherapy including neoadjuvant chemotherapy for downstaging of breast cancers
• Breast self-examination training and counseling
• Emotional and psychological support by medical professionals

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A lot of women suffer from depression, especially during pregnancy. This depression mustn’t go untreated as it can affect the mother’s health and hamper the child’s growth and development.

Antidepressants are usually the first-line drugs used. But during pregnancy, the question arises if it is safe to use these antidepressants and what effects, if any, occurs to the infant? 

What is depression?

Depression is a mental disorder that leads to a loss of interest and consistent sadness with low moods. It is caused by various reasons such as hormonal imbalances, genetic factors, or stressful environments, which leads to an alteration of neural activity in the brain.

Chemically there is a decrease in serotonin, norepinephrine, and dopamine levels. These hormones cause the feeling of pleasure and happiness, and without this, the mind remains in a state of despair.  

During pregnancy, many women can undergo symptoms of depression without even realizing it. Pregnancy can often take a toll on the body and cause decreased energy levels and appetite and changes in sleep cycles and mood. Funnily enough, these are very similar to the symptoms of depression. The main symptoms of depression include:

• Hopeless outlook

• Low Interest 

• Fatigue

• Anxiety

• Irritability

• Appetite changes

• Wavering emotions

• Suicidal thoughts

The Chemistry

Chemically, serotonin, norepinephrine, and dopamine are catecholamines secreted by the adrenal glands. Catecholamines play an essential role in learning, memory, mood control, anxiety, fear, social and reproductive behavior. When there is any change in the body’s emotional or physical conditions, these catecholamines are released to mediate the differences.

There is a decrease in these catecholamines during this phase, either by increased degradation by monoamine oxidases or hormonal imbalance. This is where the anti-depressants come to the rescue but inhibit the uptake or degradation of these much-needed catecholamines. 

Statistics

Almost 3-7% of women take antidepressants during pregnancy, which often increases after the fetus’s birth. Postpartum depression affects nearly 20% of the population. There is also an increased risk of depression by almost 20% of women who have suffered some kind of physical abuse or affective disorder. 

Making a decision 

Looking at these side effects, some women choose not to consume antidepressants, fearing for their fetus’s safety and wellness. However, when untreated, this condition can be fatal, and if the mother is not medically sound, it can directly affect the infant. 

Depending on the type of patient and the situation, it is up to the medicinal practitioner to decide whether it is suitable for the patient to undergo treatment or not. The administration is restricted in the third trimester unless necessary, and usually, only one type of drug is administered, i.e., monotherapy. 

In conclusion, depression is a severe mental disorder that should be handled effectively in the case of pregnancy as it affects the mother and the unborn fetus. Various therapies are found to be useful, but side effects do prevail in certain instances.

It is worth calculating the risks and benefits of treating this disorder to understand what works for the patient.

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