Bread is one of the members that are generally not needed at the family table, so that even traditionally has symbolized not only the food itself, but also to work. “He went out to get bread” … “That does not lack bread” … “Being on bread and water” … and “The day our daily bread” are some of the phrases that give evidence of this.

However, with the passage of time and change of societies, the bread is leaving the privileged to become a temptation almost ungovernable, that can derail any attempt to maintain a healthy diet.

The main current concerns on health issues include obesity and diabetes, caused by a sedentary lifestyle and a diet based on fat, sugar and carbohydrates (or carbohydrate). This is where the bread begins to leave the table healthy. Why? Because it is a major source of carbohydrates.

Carbohydrates or carbs are one of the most important nutrients the body needs, and which become energy for the organs to fulfill their functions properly, especially the brain and nervous system. Are classified as simple or complex, as the chemical structure of the food and the rapidity with which is digested and absorbed sugar.

Simple carbohydrates have one or two sugars. For example, fructose found in fruits, lactose and galactose that are found in milk (milk and its derivatives), and maltose containing certain vegetables and beer.
Complex carbohydrates, however, have three or more sugars and foods are often called “starchy.” This is where our friend the bread and cereals, as well as legumes and starchy vegetables, among other foods.

The problem with carbs is that if you consume too much can cause overweight or obese and eventually may also contribute to development of diabetes, although not all are equal or harmful. When you choose, always select the products made of whole grains as refined foods like white flour (which is made with bread and white pasta, for example), sugar and white rice, lack of vitamins and other important nutrients (unless they are marked “enriched”).

So what is healthiest to get carbohydrates, vitamins and other nutrients in the most natural way possible, for example, from fruit instead of table sugar, and whole grains, ie they retain their shell. Why? Because the shell accumulate nutrients cereal. Then, whole grains will provide you with more vitamins, minerals and fiber than white bread or other products made with refined flour. However, both can bring you many calories, so it is important to pay attention to the amount and do not overdo the recommended daily serving, if you want your diet to collapse.

In fact, studies show that people who follow a diet low in calories and include whole grains such as whole wheat bread, were more successful than those who ate only refined grains like white bread and rice. And research showed that those who carry this type of diet had better long term and able to maintain their desired weight when they took the diet and ate some bread when completely abandoned him.

So should you leave the bread completely? Not necessary. In fact, carbohydrates are very important to the diet. However, remember that most foods, even fruits and vegetables, have some carbs, so it is important to limit the amount of bread and refined products, like pasta, pizza and everything that includes masses.
And if you want to know more, here are some recommendations for you to choose the most appropriate bread to maintain health and shape:

- This is already what you have said but it bears repeating: selects products with whole grains as the first ingredient, such as whole wheat bread or oatmeal.
- Reduces daily servings of bread and increases the consumption of fiber and whole grains, for example, legumes (like beans (beans), peas (peas, peas) and lentils).
- When you go shopping, not only things easier by color. Grain products tend to be darker than white bread, but many manufacturers may add coloring. Therefore, it is best to always check the labels.
- Always choose products that provide at least three grams of fiber per serving.

In addition to these tips, remember to eat fruits and vegetables and always accompany your diet with an exercise routine. Thus you may find it easier to reach the desired weight and maintain it and, above all, improve your health and reach a better quality of life.

The pain from nocturnal leg cramps vary in intensity and can last from a few seconds to 15 minutes or more. Cramps are more common in the calves, but may also occur in the feet and thighs.

The risk of nocturnal leg cramps increases with age, although it is usually difficult to pinpoint the exact cause. Possible causes include dehydration, the sitting for an extended period, not getting enough potassium, calcium and magnesium in the diet, and medications such as diuretics, beta blockers and others used to treat blood pressure. The nocturnal leg cramps can be linked to thyroid disorders, diabetes or cancer that spreads to the spine.

The Mayo Clinic Health Letter offers these suggestions to prevent them:

- Stay hydrated, drink fluids because sufficient that helps muscles contract and relax more easily. It is also extremely important to replace fluids when you participate in physical activities.
- Stretching before going to bed can help those who suffer from nighttime leg cramps.
- Light exercise, like riding a stationary bike for a few minutes before bedtime, may help to avoid suffering from cramps during sleep.
- Choose the right shoes, wearing shoes that provide good support.
- Loosen the sheets and blankets at the foot of the bed because there have more slack may reduce the incidence of nocturnal leg cramps.

When a cramp in the calf, recharge your weight on the affected leg and slightly bend the knee may provide relief. If it is too painful to recharge the weight on the leg, flex the foot can help. Gently massage the affected muscle could relax, and apply ice or a cold could reduce pain. Another alternative is to apply heat with a warm towel, heating pad or taking a bath or a hot shower.

The Mayo Clinic Health Letter covers the symptoms and treatment of polymyalgia rheumatica. Fortunately, with proper treatment can often improve symptoms within days and even overnight. However, keeping at bay the disorder usually involves carefully administer the drugs for a year or two.

Polymyalgia rheumatica is a disorder in which inflammation in the body for no apparent reason. The pain and stiffness resulting from inflammatory cells and proteins that are part of normal immune system to fight disease. Apart from the pain in muscles and joints, other symptoms are fatigue, mild fever at first, anemia, loss of appetite and depression.

Most people who develop polymyalgia rheumatica over 65 years. The disease is more common in women and rarely occurs among people under 50 years. Blood tests are used to establish the diagnosis.

The primary treatment is with oral corticosteroids such as prednisone, and this therapy usually relieves pain and stiffness in the first two or three days.

Corticosteroid treatment is generally necessary during one or two years. Patients should also frequently go to the doctor for follow-up to control the condition, adjust medications at the lowest effective dose and monitor side effects of medications. Possible side effects are osteoporosis and decreased bone density, also other side effects of prolonged use of corticosteroids may be hypertension, diabetes, cataracts and depression.

Ill never good, but during pregnancy, there is no worse nightmare. Women should be careful, though Tilden exaggerated. Laura, who is 6 months pregnant, avoid all sick people “like the plague.” And the truth, even if they hurt her friends, Laura is absolutely right and the right to protect against viruses that are around out there and cause an annoying cold or common cold. There is a reason that many people do not know: During pregnancy the body’s defenses are weakened so that the woman’s body does not reject the baby. That’s why this stage of pregnancy makes women become more prone to viruses and infections. Until the flu.

If this is your case, and suddenly you wake up with a cough, nasal congestion, headaches and other discomforts of cold, do not run to the drugstore to buy any OTC medication. That’s right: aspirin, ibuprofen (Motrin, Advil), acetaminophen (Tylenol) and some herbs should be used with caution and never without asking your doctor.

This is because some medications contain substances that may be harmful to the developing fetus, or have not been well studied for use in pregnant women. This is the recommendation of experts and again confirmed by a pediatrician at the University of California at San Diego, USA.

Therefore, it is best to take precautions against cold medications during the months of your pregnancy. Notes!

- Avoid oral decongestants in the first trimester of your pregnancy, as their ingredients are harmful to the development of the fetal abdominal wall. Use saline drops to help with nasal congestion (in the nose) if you need. They sell them at the pharmacy or you can make at home with warm water, salt and baking soda.

- Beware of herbal ingredients (from herbs) found in many nonprescription drugs or recommend you, as the effect of some herbs can be detrimental to your pregnancy or have not yet been evaluated to determine if it has any effect harmful. So when in doubt err on!

- Do not abuse the candy for the throat, as though they may temporarily relieve, may contain vitamin C and zinc, which must be taken in moderation during pregnancy (80 to 100 milligrams per day of vitamin C and 11 milligrams of zinc )

- Note that the cold medicines contain ingredients to combat a variety of symptoms, and may not need all that to feel better.

- Most important: Talk to your doctor without fail!

If you have a cold or cold and you’re pregnant, you better get some rest, you take plenty of fluids, sleep inclined (with several pillows) and do their best to avoid drugs for the sake of your baby. Prevention is also key: eat well, wash your hands frequently and like Laura, stay away from sick people to keep viruses and infections at bay during your months of gestation.

About a week after returning from hospital to home, revisit your doctor for follow up. On this visit, your doctor will check your incision healing. After thyroid surgery, you may need regular blood tests to measure levels of thyroid hormone. They control the levels of calcium and phosphorus to evaluate the function of your parathyroid glands, which are sometimes damaged during thyroid surgery.

If the entire thyroid gland removed, you must take thyroid supplements for the rest of his life. More pain after surgery if you had a conventional thyroidectomy if you had an endoscopic thyroidectomy. However, most patients are not candidates for endoscopic thyroidectomy.

Risks

In general, thyroidectomy is a safe surgical procedure. However, some people have higher or lower risks, which include:
- Hemorrhage (bleeding) into the wound in the neck: if this happens, the stands and neck wound becomes inflamed, possibly compressing structures within the neck and interfering with breathing. This is a medical emergency.
- Thyroid storm, if the thyroidectomy is performed to treat an overactive thyroid (thyrotoxicosis) could be a surge of thyroid hormones in the blood. This is a very rare complication because they are medical patients before surgery to prevent this problem.
- Recurrent laryngeal nerve damage, since this nerve supplies the vocal cords, the damage can lead to paralysis of the vocal cords and produce a hoarse voice, either in the short or long term. In rare cases, if both vocal cords are paralyzed, it can obstruct the opening of the throat, causing breathing problems.
- Damage to a part of the superior laryngeal nerve: if this occurs, patients may not get to sing the high notes, and the voice may lose a bit of projection.
- Hypoparathyroidism: if parathyroid glands are removed by mistake or accidentally damaged during a thyroidectomy, the patient may suffer from hypoparathyroidism, a condition in which the levels of parathyroid hormone (a hormone that helps regulate calcium in the body) are abnormally low.
- wound infection

About a week before surgery, you are asked to stop taking aspirin or other blood thinning medication. To reduce the risk of vomiting during surgery, you will not eat or drink anything after midnight the night before surgery. As part of the general preparations for surgery, your doctor will review your allergies and medical and surgical history. If you could be pregnant, tell your doctor before surgery. Since the procedure involves an area will undergo shoulder top, you will be asked to remove necklaces and earrings before being taken to the operating room.

How it is done

In general, both types of thyroidectomy is performed under general anesthesia. However, if general anesthesia is too risky for a patient, could be used local or regional anesthesia to allow the patient to remain awake during the procedure. We introduce an intravenous (IV) in a vein to give fluids and medications.

Conventional thyroidectomy: a conventional thyroidectomy, an incision is made 3 to 4 inches into the skin at the bottom of your neck (bottom front of the neck above the collarbone and sternum). Next, make a vertical cut through the ribbon-like muscle located just below the skin, and these muscles will open to reveal the thyroid gland and other deeper structures. Then they cut and separate the thyroid gland and nearby tissues the extract. Throughout the procedure, the surgeon will take great care to preserve your parathyroid glands (two pairs of small glands located near the thyroid) and prevent damage to important nerves and blood vessels in his neck.

After removal of the thyroid gland will be one or two points to raise your muscles again. Then, the deepest layer of your incision is closed with stitches and the skin was closed with sterile tape. This will insert a small suction catheter (tube) near the area of ??your incision to drain accumulated blood inside your neck. After surgery, you will be taken to the recovery room, where they will be monitored for several hours until they are stable enough to return to his room at the hospital. After about 24 hours, you withdraw the suction catheter from his neck. Most patients go home one or two days after surgery.

Endoscopic thyroidectomy: an observational instrument called an endoscope and small surgical instruments are inserted into the neck through three or four small incisions. Each incision is about 3 to 5 millimeters long (less than ¼ inch). Then the surgeon uses a tiny camera on the endoscope to guide the instruments and remove her thyroid tissue. At the end of the procedure, the cuts in the neck is closed with stitches or surgical tape small.

- Partial thyroid lobectomy (a rare procedure): it removes only part of a thyroid lobe.
- Thyroid lobectomy: remove the entire thyroid lobe.
- Thyroid lobectomy istemctomia: remove the entire thyroid lobe, along with the thyroid isthmus.
- Subtotal thyroidectomy: a thyroid lobe is removed, the isthmus and part of the second lobe.
- Total thyroidectomy: removes the entire thyroid gland.

A thyroidectomy may be performed using conventional surgical approach or by a newer method in which endoscopic small incisions are made.

For what it is used

The conventional thyroidectomy was performed for the following reasons:
- To remove malignant thyroid tumors (cancerous)
- To treat a thyroid storm, a condition in which an overactive thyroid gland produces extremely high levels of thyroid hormone can not be controlled.
- To remove all or part of a goiter (enlarged thyroid gland) that is pressing on nearby structures in the neck, especially if this pressure interferes with swallowing and breathing.
- To remove and evaluate a thyroid nodule that had indeterminate results in a biopsy

In some people, as an alternative to conventional thyroidectomy can be performed endoscopic thyroidectomy thyroid remove cysts or small benign thyroid nodules (less than 4 centimeters, or about 1½ inches) endoscopic thyroidectomy is not used to treat multiple thyroid nodules , thyroid cancer or thyrotoxicosis.

Treatment of thrombocytopenia depends on its cause and severity. If your thrombocytopenia is mild and is not caused by significant bleeding, your doctor may decide that you do not need treatment. This is often the standard strategy in children with acute ITP, because 80 to 90% of these children recover with treatment within 6 weeks.

If your thrombocytopenia is induced by drugs, your doctor may prescribe another medicine. Many people with drug-induced thrombocytopenia recover without additional treatment once the medication discontinued.

Patients with profuse bleeding require more aggressive treatments. Treatment options include:
Medications called glucocorticoids that are placed through a vein or by mouth or a medicine called immune globulin that is injected into a vein (intravenously). This is done to treat thrombocytopenia caused by an abnormal immune reaction.

Platelet transfusions: usually reserved for patients with thrombocytopenia and active bleeding or high risk of bleeding.

Splenectomy (surgical removal of the spleen) is often done to treat ITP that has not improved with other treatment. If the spleen is removed, thrombocytopenia goes away in 60% of patients with ITP. If the removal of the spleen does not solve the problem then may be prescribed immunosuppressant drugs such as azathioprine (Imuran), cyclophosphamide (Cytoxan, Neosar), vincristine (Oncovin and others) or vinblastine (Velban).

When To Call a Professional

Call your doctor if you develop any symptoms of thrombocytopenia, especially if you notice unusual bruising or if you experience heavy bleeding in the nose, mouth, vagina, rectum or urinary tract.

Forecast

The episodes of thrombocytopenia can be fatal, especially if the bleeding is severe or affects the brain. However, the prognosis is generally good, especially if the cause can be identified and eliminated. It is often successful long-term control of this disease.

The duration of thrombocytopenia depends on its cause. For example, some patients with ITP is easily bruised skin for years and have heavy vaginal bleeding with frequent bleeding episodes more severe. Others suffer from mild thrombocytopenia and almost never seen any problems. Many people with drug-induced thrombocytopenia recover within 7 to 10 days after stopping the medication. Most children with ITP recover within four to six weeks.

Prevention

Most cases of prostatitis are not preventable. You can avoid drinking large amounts of alcohol to reduce their risk of developing thrombocytopenia caused by alcoholism.

If you have had an episode of drug-induced thrombocytopenia, there is much probability that the problem manifested again if you take that medicine again. To help prevent the problem, be sure to keep the drug name that caused the thrombocytopenia. Tell each of the health professionals who visit on their sensitivity to the drug.

If your doctor determines that you are at risk of developing thrombocytopenia, it may ask you to not take aspirin because it affects the function of platelets.

People with severe thrombocytopenia may have abnormal bleeding elsewhere in the body. Symptoms may include:
- Reddish patches on the skin or purple, often concentrated at the bottom of the legs.
- Excessive bruising, up to minor trauma.
- Blood in the urine or feces (stool)
- Excessive bleeding or abnormal mouth or nose, especially nosebleeds or bleeding when you brush your teeth.
- Abnormal vaginal bleeding, especially heavy periods.
- Bleeding into the intestinal tract and rectum.
- Heavy bleeding after surgery or dental work.
- Headache and other neurological symptoms caused by bleeding within the brain (cerebral haemorrhage).

Diagnosis

Your doctor will begin by asking about your medical history. I was recently asked whether surgery or received blood transfusions and if you take medications (including non-prescription drugs or home remedies). Your doctor may also ask about how much alcohol you drink. Also asked to consider what risk has to be infected with AIDS, including questions about how and when they did blood transfusions, had sex, if you ever put drugs intravenously (into a vein) and whether it could have been exposed infections of the blood or body fluid in circulation. If you are pregnant, your doctor will want to know your date of birth. Your doctor will also ask if you have had recent infections or vaccinations if you have joint pain or rash, and if a relative has had a low platelet count.

Your doctor will check you for specific symptoms of abnormal bleeding, such as bruises or blood spots on your skin. Your doctor will feel your abdomen to see if your spleen is enlarged and examined for signs of liver disease such as jaundice (a yellowing of the skin and eyes).

To confirm the diagnosis of thrombocytopenia, your doctor will order blood tests to measure blood platelet count (platelets). Your doctor will also test your blood under a microscope.

Once your doctor has determined that you have thrombocytopenia, the next step is to discover the cause of this disease. If your doctor thinks there might be reacting to a drug, it may ask you to stop taking this medicine to see if your platelet count rises. If this happens, you have drug-induced thrombocytopenia (drugs).
In some sunsets, your doctor will need to bone marrow biopsy. This procedure removes a small amount of bone marrow with a needle and examined under a microscope. The appearance of the bone marrow and megakaryocytes (cells that produce platelets) will determine what is causing the problem.