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    What are acute sports injuries? Acute sports injuries usually affect soft tissues (such as ligaments, muscles, tendons, skin). They can cause pain, edema (swelling) and difficulty in carrying out movements. They occur suddenly after, for example, a blow, an untimely effort or a poorly controlled movement, both in the context of competition and in the context of recreational/recreational sports. Some of the most common acute injuries are sprains and muscle injuries. Depending on their severity, they often immediately make it impossible for the person to continue their sports practice. CAUTION: Never apply massage, creams/lotions or heat to an acute injury! Action protocols after an acute injury Over the years, several action protocols have been developed in the face of an acute soft tissue injury. Each of these protocols was identified with an English word, in the form of an acronym, to function as a mnemonic. ice The most basic protocol for dealing with an acute sports injury is ICE, which is an acronym for: I = ICE (ice); C = COMPRESSION (compression); E = ELEVATION (elevation) Despite lacking scientific consensus, the application of ice or cold (cryotherapy) to the affected area is one of the most popular measures after an acute sports injury. Attention: It is not recommended to apply ice or cold for more than 5 to 10 minutes The ice must not be in direct contact with the skin in order to avoid the risk of burns (from cold) The ICE protocol also includes compression in the affected area using, for example, an elastic bandage (be careful to avoid serious injuries due to the tourniquet effect!) and elevation of the affected limb, as measures to control edema. RICE In the late 1970s, the RICE protocol was implemented: Regarding the ICE, only the R = REST (rest) was added as a basic form of protection of the affected area. PRICE Later, PRICE was created, in which P = PROTECTION (protection) was added, in which the use of orthoses or other means to promote the immobilization of the affected area is recommended in order to avoid worsening of the injury. POLICE There were other variations of these protocols (e.g. HI-RICE, PRICES, PRINCE, RICER), but the most significant was the evolution from PRICE to POLICE, where R = REST (rest) was replaced by OL = OPTIMAL LOAD (load controlled). More than a mere change of letters, this protocol represents a change of concept in which means of early mobility are valued (which favor a faster recovery) such as functional bandages (which are made by physiotherapists in order to immobilize a certain structure of selectively), light exercise and the progressive and controlled introduction of load (for example through body weight) on the affected area, which stimulate the repair process of the affected tissues. PEACE & LOVE In 2019, a new protocol was proposed with two acronyms to optimize the recovery of soft tissue injuries: PEACE & LOVE. This protocol includes a wide spectrum of measures for a more adequate management of injuries, from immediate care (PEACE) to subsequent intervention (LOVE). [PEACE] "Immediately after a soft tissue injury, do no harm and let PEACE guide your approach" (“Immediately after a soft tissue injury, do not aggravate it and let peace [PEACE] guide your way”) P = PROTECT (protect); E = ELEVATE (elevate); A = AVOID ANTI-INFLAMATORY MODALITIES (avoid anti-inflammatory means); C = COMPRESS (compress); E = EDUCATE (to educate). This protocol highlights the potential detrimental effect of anti-inflammatory means on the recovery process (including anti-inflammatory medication and ice). Education is also valued as a fundamental means of enhancing recovery. [LOVE] "After the first days have passed, soft tissues need LOVE" (“Once the first few days have passed, soft tissues need love [LOVE]”) L = LOAD(load); O = OPTIMISM (optimism); V = VASCULARIZATION (vascularization); E = EXERCISE (exercise). The PEACE protocol introduces the psychosocial component and reinforces early movement strategies as ways to enhance recovery. Conclusion The application of the ICE, RICE and PRICE protocols may not contribute to accelerating injury recovery, but they are a suitable means for immediate intervention in the first hours after injury, especially with a view to controlling pain and edema, and stabilizing the injury until evaluation by a healthcare professional. For a more comprehensive and effective approach, the concepts considered in the POLICE and PEACE & LOVE protocols are more in line with the most current scientific and clinical evidence, but lack specialized physiotherapy care. The role of the physiotherapist The physiotherapist is a first contact health professional qualified to assess and monitor this type of injury, with a view to optimizing recovery from the injury and a quick and safe return to sports practice. If necessary, the physiotherapist will refer you to the most appropriate professional or health entity for the situation. The early intervention of the physiotherapist after an acute sports injury promotes a faster return to physical activity, with greater safety, with a lower risk of recurrence and with lower costs. Unfortunately, many people are unable to return to full physical activity due to lack of effective monitoring of their injury. Ask for a physical therapist evaluation as soon as possible after an acute injury. Physical therapy can also be effective even in chronic injuries. At Clínica Sabeanas we can help you through an advanced, differentiated and personalized physiotherapy intervention in order to obtain the best results in the most efficient way. If you have any questions, please don't hesitate to contact us. ATTENTION! In the event of a serious injury (for example head trauma, deformity of a limb, severe pain, bleeding) it is advisable to resort to emergency means and/or seek healthcare in a hospital environment. Sergio Caneira Physiotherapist
  • O que é a Fisioterapia?
    A Fisioterapia é o serviço prestado por Fisioterapeutas a indivíduos e populações de forma a desenvolver, manter e restaurar o máximo movimento e capacidade funcional ao longo da vida. A Fisioterapia é prestada em circunstâncias em que o movimento e a função são ameaçados pelo envelhecimento, lesões, dor, doenças, distúrbios, condições ou fatores ambientais. O Fisioterapeuta procura maximizar a qualidade de vida e o potencial de movimento nas áreas de promoção, prevenção, tratamento/intervenção, habilitação e reabilitação. A Clínica Sabeanas possui um conjunto de serviços prestados por uma equipa de fisioterapeutas certificados e especializados para avaliar e tratar uma variedade de condições, em áreas como as lesões no desporto, as lesões músculo-esqueléticas, as perturbações posturais, a incontinência urinária, a preparação para o nascimento, a recuperação pós-parto, a recuperação pós-covid, a recuperação após cirurgias, a prevenção de quedas em idosos, entre outras. Para mais informações consulte
  • What is the ‘Physiotherapy Space’ at Clínica Sabeanas in Carcavelos?
    The ‘Physiotherapy Space’ was created by Sabeanas Clinic to provide well-being and health, in the areas of Physiotherapy, Osteopathy and clinical exercise, through a differentiated, personalized, human and holistic approach. At the ‘Physiotherapy Space’, services are provided in a personalized way, in an office context, following high standards of quality, aiming at the best speed and effectiveness in obtaining therapeutic results. Our team includes qualified physiotherapists and osteopaths, highly specialized and experienced in their areas of differentiation, who invest in continuous training, in order to provide quality and safe care, according to the best scientific and clinical evidence. The services provided include: CARDIORESPIRATORY PHYSIOTHERAPY: It acts on a variety of health conditions that have an impact mainly on the cardiac, respiratory, vascular and metabolic systems. SPORTS PHYSIOTHERAPY: Aimed at the prevention and treatment of injuries related to sports practice, such as muscle injuries and sprains, and for optimizing sports performance. MUSCULOSKELETAL PHYSIOTHERAPY: Aimed at the intervention of disturbances in the musculoskeletal system, such as low back pain, sciatica, tendinitis, or in other conditions where mobility and function are compromised. ONCOLOGICAL PHYSIOTHERAPY: It acts on oncological conditions, namely breast cancer. OSTEOPATHY: Approach to the individual in a global way, focusing on the causes and not just the symptoms, based on the principle that well-being depends on the good functioning of the entire neuro-musculo-skeletal system. PEDIATRIC OSTEOPATHY: Osteopathic approach in newborns, babies and children, including in situations of torticollis, plagiocephaly, reflux, postural deviations, sleep disturbances, etc. POSTURAL REEDUCATION: Intervention in posture changes, such as scoliosis, associated or not with other dysfunctions or pain. HYPOPRESSIVE GYMNASTICS: Physical exercise method that aims to promote the increase of tone of the abdominal muscles, posterior trunk muscles and pelvic floor muscles, based on postural and respiratory exercises, associated with training of intra-abdominal pressure, indicated for rehabilitation, training, aesthetic effects, prevention, postpartum recovery, urinary incontinence, etc. CLINICAL YOGA: Therapeutic means based on yoga. POSTPARTUM RECOVERY: Program based on education and exercise after childbirth. POST-SURGICAL RECOVERY: Recovery programs after orthopedic surgeries (knee, shoulder, spine, etc), or others where mobility and functionality are compromised. POST-COVID RECOVERY: Recovery from immediate sequelae after COVID-19 infection and sequelae associated with the so-called “Long Covid”, including those related to tolerance to effort. PREVENTION OF FALLS IN THE ELDERLY: Exercise program and teaching of strategies aimed at the elderly population and their respective family members/caregivers, with the aim of preventing falls and optimizing mobility and functionality. It may include a home visit for risk assessment and suggestion of solutions. Falling is one of the main risks associated with aging, and can result in serious injuries, hospitalization, dependence, decrease in general health condition and decrease in life expectancy. HOME PHYSIOTHERAPY: Suitable for people who need physiotherapy care, but who have a high commitment to their mobility and locomotion capacity. For more information, visit
  • O que faz o Fisioterapeuta, e como o pode ajudar?
    Os Fisioterapeutas são os únicos profissionais que podem exercer Fisioterapia. São profissionais altamente qualificados, que necessitam de possuir uma licenciatura em Fisioterapia e de estarem inscritos na Ordem dos Fisioterapeutas para poderem exercer a profissão. O Fisioterapeuta centra-se na análise e avaliação do movimento e da postura, baseadas na estrutura e função do corpo, utilizando modalidades educativas e terapêuticas específicas, com base, essencialmente, no movimento, nas terapias manipulativas e em meios físicos e naturais, com a finalidade de promoção da saúde e prevenção da doença, da deficiência, de incapacidade e da inadaptação e de tratar, habilitar ou reabilitar indivíduos com disfunções de natureza física, mental, de desenvolvimento ou outras, incluindo a dor, com o objetivo de os ajudar a atingir a máxima funcionalidade e qualidade de vida. A nossa Equipa de Fisioterapeutas é constituída por profissionais devidamente habilitados e inscritos na Ordem dos Fisioterapeutas, altamente especializados e experientes nas suas áreas de diferenciação; apostam na formação contínua, de forma a prestar cuidados de qualidade e em segurança, de acordo com a melhor evidência científica e clínica, o que permite elevada celeridade e efetividade na obtenção dos resultados terapêuticos. Para mais informações consulte
  • É necessário realizar uma consulta médica ou ter uma prescrição para fazer fisioterapia?
    O fisioterapeuta é um profissional de saúde autónomo, responsável pelos atos de Fisioterapia que pratica junto dos seus utentes. A Fisioterapia é reconhecida como sendo uma profissão de saúde de base científica, exigindo uma formação académica de nível superior e uma necessidade permanente de aprendizagem/educação ao longo da vida. Assim, o fisioterapeuta é um profissional de primeiro contacto que, através de competências de diagnóstico diferencial, determina se a condição em causa tem indicação para os serviços de Fisioterapia e/ou se deve ser referenciada para outro profissional. Após triagem, e em caso de indicação para Fisioterapia, o fisioterapeuta implementa um processo de avaliação, através de um processo de raciocínio clínico suportado pela evidência científica, a partir do qual estabelece objetivos e metas, planeia e executa o plano de intervenção mais adequado. O fisioterapeuta pode também integrar equipas multidisciplinares que atuam na área da reabilitação. A equipa de fisioterapeutas da Clínica Sabeanas é constituída por profissionais devidamente habilitados e inscritos na Ordem dos Fisioterapeutas, altamente especializados e experientes nas suas áreas de diferenciação; apostam na formação contínua, de forma a prestar cuidados de qualidade e em segurança, de acordo com a melhor evidência científica e clínica, o que permite elevada celeridade e efetividade na obtenção dos resultados terapêuticos. Na Clínica Sabeanas os utentes beneficiam de um acesso rápido a um fisioterapeuta, sem necessidade de referenciação ou prescrição médica prévia, com evidentes vantagens para a obtenção mais rápida dos resultados terapêuticos. Sempre que se justifique, o fisioterapeuta poderá referenciar para o profissional de saúde mais adequado. Para mais informações ou para saber como marcar uma consulta com um fisioterapeuta na Clínica Sabenas consulte
  • Cancro do Colo do Útero é possível eliminar até 2030? – Parte 2 – (Citologia, Pesquisa de Vírus HPV de Alto Risco e Colposcopia)
    Uma citologia em meio líquido com representação da zona de transformação é mais válida do que uma colposcopia feita por Ginecologistas não Colposcopistas. Uma colposcopia sem visualização da zona de transformação, caso das mulheres pós- menopausa ou nulíparas a tomar anticoncecionais, não tem valor. colposcopia é simplesmente a utilização de uma boa fonte de luz com uma ampliação de 12 vezes. A interpretação exige muito treino num centro de referenciação e controle de qualidade do colposcopista, que se pode fazer comparando o diagnóstico clínico da colposcopia que acompanha o pedido de diagnostico anatomopatológico da peça de biópsia enviada. Existem programas de computador que se podem acoplar ao colposcópio e assim obter um diagnóstico clínico de lesão de baixo ou alto risco. A lesão vermelha do colo, é vermelha porque tem apenas uma camada de células sobre os vasos sanguíneos. O diagnóstico colposcópico faz-se através da avaliação de alterações nas disposições dos vasos como: Ponteado, Mosaico, Vasos Atípicos e Epitélio Branco. Após a colocação de ácido acético a 5% a interpretação das alterações torna-se mais nítida, pois como o ácido acético a 5% provoca a precipitação das proteínas, as células com mais material genético, o ADN do HPV reage com mais intensidade. Se a reação ao ácido acético for fracamente positiva, tiver bordos pouco definidos e desaparecer rapidamente pressupõe-se ser uma lesão menos grave. Se for fortemente positiva, ficar branco muito tempo com bordos bem definidos é mais grave. No colo do útero este exame é indolor, mas na vulva e na vagina a mulher tem sensação de ardor, mais intenso e prolongado no segundo caso. O mesmo teste do ácido acético também serve para avaliar a entrada da uretra e o sulco da glande masculina assim como o escroto. 1º a visualização simples, 2º visualização após aplicação de acido acético, 3º aplicação de lugol, que como contém iodo e há muitas pessoas que são alérgicas, começou a evitar-se esta 3ª fase de observação. A aplicação de lugol tinha o resultado oposto à do ácido acético, aqui as lesões eram lugol negativas, pois como as células continham menos glicogénio não captavam o iodo e eram lugol negativas. 7. PONTOS IMPORTANTES A RETER: Uma colposcopia pode ser não satisfatória, não visualização da zona de transformação. - Uma colposcopia pode ter um efeito falsamente securizante, a biópsia efetuada revelar um CIN 1 e noutro local não valorizado pelo observador estar uma lesão CIN 2/3 ou mesmo um C.I.S. A paciente pode não voltar à consulta passados 6 meses para reavaliação. Dra. Ana Lúcia Nogueira Ginecologista e Obstetra
  • Prenatal diagnosis. What is it?
    The last 30 years have seen an increasing use of ultrasound in pregnancy surveillance due to technological developments. Increased quality of devices and images obtained. In the last 25 years, ultrasound has become a routine test in prenatal care, also because it is known to have no deleterious effects on the fetus or pregnant woman. In addition to its value in dating pregnancy, screening for chromosomal anomalies, detecting birth defects and fetal growth abnormalities, assessing fetal well-being and as a guide to invasive techniques such as amniocentesis, coronary villus sampling and cordocentesis, it has a very intense in the antenatal relationship established between mother, father and child and/or other family members who attend the ultrasound. Technology does not stand still and there are ultrasound scanners with better resolution and the ability to detect images in three dimensions and in almost real time (4D). These ultrasound machines are much more expensive and require a very large daily use so that their "leasings" are amortized and end up being used in reference ultrasound centers where radiologists or gynecologists are who are fundamentally dedicated to this area of activity or who have graduated in Health Sciences and Technology. Most gynecologists who work in medical and/or surgical clinics perform backup ultrasounds with less expensive ultrasound machines. I asked a colleague who is dedicated to level II and III ultrasounds how she explained the ultrasound detection of spina bifida to pregnant women who went to her center for ultrasounds, she explained it as follows: "The spine is usually already perfectly closed from 19-20 weeks. In some cases, mainly due to folic acid deficiency, but also if there are family members with the same problem, there is an opening at the level of the last vertebrae and, therefore, , the medulla or the membranes that cover the medulla, come out causing a bump on the lower back. other signs. We call this open spina bifida. Sometimes there is also a defect in the spine, usually smaller, which is covered with skin, this is very difficult to see with the ultrasound and is called occult spina bifida." It should be added that the detection of spina bifida is also suspected by increased levels of alpha-fetoprotein in the amniotic fluid, detected in amniocentesis or in maternal serum and suspected in the biochemical screening. In conclusion: it is more difficult to say what is the gestational age at which it is possible to determine a malformation than from what age a certain malformation can be excluded. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Cesarean section on request. What are the pros and cons?
    "What is your opinion? Each being is unique and unrepeatable, hence the discovery is so fascinating. What is right for some seems wrong to others. What is most favorable to some, puts others in danger. What to choose? Not alone! Choose a doctor who inspires you with confidence as a professional and as a person and try together and with the baby’s father, preferably, to walk the path to the birth of a new being. If you think you want everything naturally, fight for it, it can be a difficult path, but it is worth trying what we think is right. Try to walk this path to the end with the doctor you trust or follow her directions. If you think that the position of childbirth on the stretcher is not very dignified, you are afraid of pain and uncertainty. If you prefer to try to schedule your life. Don’t be ashamed to admit it. Don’t forget: We don’t always get what we want! Things are not always as we think! I have already scheduled cesareans on request in which the baby decided to be born before and it was an easy eutocic birth. I have already combined eutocic births and if the woman and the fetus are well, I followed the woman’s preference to the end, however difficult that path was. In a vaginal birth, it may become necessary to help with a vacuum and/or forceps. From a certain moment it may be necessary to help the fetus pass the birth canal and there is no longer time for a cesarean. Above all in a birth it is necessary: Cooperation; Trust; ADVANTAGES of a VAGINAL birth: If you can achieve an intact perineum or a small episiotomy, it is what has less morbidity for the woman. If it is not a prolonged labor it also does not have for the baby. There are pediatricians who say it is good for the baby’s lungs to be compressed in the birth canal. DISADVANTAGES of a VAGINAL birth for the mother: If it is a difficult birth or that needs help with a forceps and/or vacuum, it can cause serious damage to the perineum that needs surgical correction later: Widening of the vaginal introitus, cystocele and/or urinary incontinence, rectocele and/or incontinence of gases and/or feces. It is called perineal plasty, the surgery that needs to be done to repair the damage of childbirth. DISADVANTAGES of a VAGINAL birth for the baby: It more easily catches any maternal infection namely HIV, Hepatitis, Herpes, HPV, Streptococci. For example, group B Streptococcus can cause meningitis and blindness in the newborn. ADVANTAGES of a CESAREAN on request: Absence of pain in the pre-birth period, during childbirth and in the immediate postpartum. Greater asepsis for the baby. Greater convenience for everyone. DISADVANTAGES of a CESAREAN on request for the mother: Morbidity is greater than an easy eutocic birth although less than a difficult one. Any surgery can imply an increase in organ adhesions. If the surgeon does not take care to suture the endometrium separate from the muscle layers, a disease called adenomyosis can develop, which is the inner layer of the uterus (endometrium) mixed with the muscle layers. It can lead to an increase in menstrual pain and flow. DISADVANTAGES of a CESAREAN on request for the baby: Avoid doing before 38-39 weeks so that the lungs are ready. CONCLUDING: For economic reasons in the national health system, cesarean section on request is not allowed, but in the private system it is. The woman has the right to choose what she thinks is best for her, as long as it does not harm the baby. The obstetrician has the obligation to put her knowledge and experience at the service of the woman. Dr. Ana Lúcia Nogueira Gynecologist and Obstetrician"
  • What are the most common cancers in women?
    Vaccines generally save far more lives than they harm. It is known that 20% of cancers are caused by an infectious agent, virus or bacteria. Viruses are the 2nd biggest carcinogen after tobacco. Preventive medicine includes lifestyle changes, vaccination for hepatitis B, vaccination for cervical cancer, a vaccine for stomach cancer is coming soon, and there is already talk of a vaccine for lung cancer. The most common cancers in women are: Breast cancer, cervical cancer, uterine and ovarian cancer, colorectal cancer, lung cancer, stomach cancer and skin cancer. It is known that the HPV (human papilloma virus) that causes cancer of the cervix also causes cancer of the vulva and vagina, anorectal cancer, cancer of the oropharynx, cancer of the larynx and perhaps also some of the lung and breast . It is known that this virus also affects men and that it is a lie that they are mere carriers. During the annual or preferably half-yearly visit to your (or your) gynecologist, it would be ideal for you to talk about this and how it can be prevented. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Vaginal infections... What are the main ones? How are they provoked? How to identify?
    Complaints related to genital tract infection are the ones that most worry women and the ones that most often lead them to spontaneously resort to the gynecologist. These infections play an even more important role in pregnant women, as in addition to the maternal infection being more serious, the fetus itself can be compromised. Genital infections are not necessarily sexually transmitted and those that are can sometimes be contracted by other routes, in addition to being part of a general systemic syndrome. In addition to infections there are: - Contact dermatitis, seborrheic dermatitis, atopic eczema, genital atrophy in menopause, leukoplakia, lichen sclerosus, Behçet's disease, genital pityriasis (lice and nits), as well as reactions to medications. All of them cause genital itching and can be confused with genital infections. For example, recurrent candidiasis can be part of an autoimmune polyglandular syndrome, be the manifestation that there is diabetes, or simply caused by a decrease in local immunity, caused by a persistent virus and which may or may not be accompanied by infections recurrent urinary tract. The most frequent gynecological infections are caused by the following agents: - Fungi (Candida albicans), Anaerobic bacteria, Trichomonas, Gardnerella, Gonococci, Chlamydia, Mycoplasma, Syphilis. Viruses: Condyloma, Molluscum contagiosum, Genital herpes type I and type II. The main causes of vaginal infection can be related to differences in the vaginal pH, which optimally should be between 3.8 and 4.5. The maintenance of this optimal pH is achieved through the maintenance of the normal vaginal flora, the Doderlein bacilli. If there are reasons to acidify the vaginal environment in the diet or if antibiotics are taken that cause destruction of the normal vaginal flora, then the fungi proliferate. If there is a pH change towards alkalinity then bacteria proliferate. If there is a lack of oxygenation of the vagina (use of a daily panty liner, for example) then anaerobic bacteria proliferate. Usually the diagnosis of the presence of fungi is made because there is itching associated with white yogurt-like discharge and the diagnosis of the existence of bacteria by a yellow-green discharge with a bad smell. The diagnosis of Trichomonas infection is made by viewing the cervix which has a red dotted appearance and is called the "raspberry cervix". Gardnerella infection gives off an intense "fishy" odor. Bacterial vaginosis, which is so often identified in cervical cytologies, is an entity that is treated by replacing the normal vaginal flora. If the diagnosis is bacterial vaginitis, then this implies an inflammation of the vagina and a topical antibiotic should be used. Candidiasis can be treated just as effectively with topical and/or oral antifungals depending on the woman's preference, or for faster symptomatic relief, topicals accompanied by topical and/or oral treatment to replace the normal vaginal flora. It should be remembered that infections by Gardnerella, Trichomonas, Chlamydia and Gonorrhea imply the obligatory treatment of the partner with the same oral antibiotic, since they are also installed beyond the uterine cervix and female urethra in the male urethra and bladder. Chlamydia and Gonococci can travel upward through the cervix into the endometrium and cause endometritis, salpingitis, pelvic inflammatory disease or even pelvic abscess and are the main causes of female infertility. Gonorrhea is often accompanied by mucopurulent discharge and Chlamydia can also be, or simply and very often be the cause of insidious, prolonged, asymptomatic infection or causing chronic pelvic allergies and increased ectopic pregnancy. Chlamydia infection can also arise in association with: genital infection, conjunctivitis and/or arthritis (Reiter's Syndrome). I think it's important to warn that when you're young and have difficulty initiating sexual intercourse, lack of lubrication, pain on penetration and burning after intercourse, you should consult a gynecologist to screen for the possible existence of infection with HPV (human papilloma virus Any genital or urinary infection can cause contractions during pregnancy and threaten miscarriage or preterm delivery. Infections by Gonorrhea (Neonatal Gonococcal Ophthalmia), Chlamydia are particularly dangerous for the newborn in the birth canal. (Conjunctivitis and Pneumonia). 60 to 70% of babies are likely to contract the infection during passage through the birth canal, so all pregnant women should be screened and if the infection is demonstrated, treat with the appropriate antibiotic. Another infection that is only serious during pregnancy and childbirth is that caused by group B streptococci, which can cause, in addition to miscarriage or preterm delivery, blindness and meningitis in the newborn, so screening should also be carried out. and respective antibiotic treatment. Herpes Virus and Human Papilloma Virus are also dangerous for the baby passing through the birth canal. The recurrence rate of genital herpes during pregnancy is higher than in non-pregnant women, and the recurrence rate increases as delivery approaches. Of pregnant women with genital herpes, 25% will have a reactivation in the last month of pregnancy and approximately 14% at the time of delivery. If the first episode was during pregnancy the percentage of recurrence during childbirth is 36%, if it was before the pregnancy it is 10%. During pregnancy there is a relative immunosuppression (decrease of defenses) in addition to changes induced in the vaginal mucosa by the increase in progesterone and prostaglandins, as pregnancy progresses. The first infection with Herpes during pregnancy can cause: meningitis, hepatitis and shingles in pregnant women. In addition, there may be an increase in complications such as miscarriage, intrauterine growth retardation, preterm delivery and transplacental spread of the infection to the fetus. If the outbreak recurs before labor or rupture of membranes, it will not affect the fetus. There are no cases described of alterations in the fetus if it has survived an outbreak of primary infection during the first trimester of pregnancy. The main danger is intrapartum exposure, neonatal Herpes affects the nervous system, skin, eyes and mucous membranes, which is why cesarean delivery is indicated. The Human Papilloma Virus (HPV), in July 2010, 108 subtypes were known. The infections caused by them are confined to the epithelia (genital, oropharyngeal and anorectal mucosa) and skin surfaces, penetrating to the basement membrane, but there is no evidence that they enter the bloodstream. Transmission of HPV during labor is possible, it can cause juvenile laryngeal papillomatosis with severe and difficult-to-treat respiratory obstruction. In a situation of premature rupture of membranes, the infection in the newborn can remain subclinical, manifesting itself in the child months or even years after delivery. Since it has been shown that high-risk HPV is involved in cervical cancer, it should be noted that vaccines already exist for the 2 HPV subtypes (16,18) that are most common in Western countries, but that do not cover all subtypes, which does not dispense with their screening through cytology and going to the gynecologist to diagnose their existence in the cervix, vagina, vulva or perineum. Effective treatment is done through laser, cryocoagulation, electrocoagulation, chemical cauterization with 80% trichloroacetic acid or surgical excision. Primary syphilis appears 20 to 90 days after sexual contact and is diagnosed by the appearance of a small, painless, edematous ulcer associated with regional adenopathies and which passes spontaneously in 5-8 weeks. In the absence of treatment it evolves to Secondary Syphilis; generalized disease with hyperthermia, characteristic rash, red in color, symmetrical, without pruritus associated with mucous plaques in the mouth, pharynx, vulva and anus, hair loss, etc. Diagnosis of Primary and Secondary Syphilis is aided by serology (VDRL, FTA-ABS, TPHA). In the absence of treatment, Tertiary Syphilis appears 5 to 20 years later with neurological, bone, cardiovascular lesions, etc. At this stage, the diagnosis is already made by lumbar puncture and analysis of the cerebrospinal fluid (increase in proteins and cells). It has had a new increase, especially in women who are immunosuppressed or by immunosuppressive therapies or carriers of the HIV AIDS virus. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Can urinary incontinence be diagnosed and treated in the office?
    Yes. Urinary incontinence can be diagnosed and treated in the office. Read the full article here. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Profile of clotting factors in women. What to take into account?
    Profile of clotting factors in pre- and post-menopausal women with and without hormones. Read the full article aqui. Dr. Ana Lúcia Nogueira Gynecologist and Obstetrician
  • Vibroacoustic disease. What is it?
    Vibroacoustic disease, caused by prolonged exposure to low-frequency noise. Read the full article here. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Mullerian agenesis. What is it?
    Absence of uterus and part of vagina associated with eye disease. Read the full article here. in "Obstetrics and Gynecology Journal" (SEPTEMBER 1997: 269-271). Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Is Early Menopause an autoimmune disease?
    Yes. Early menopause is an autoimmune disease with anti-ovarian antibodies often associated with other autoimmune diseases. Read the full article here. in "Obstetrics and Gynecology Magazine" (JUL 1995: 251-254), "Early Menopause - Polyglandular Syndrome". Dr. Ana Lúcia Nogueira Gynecologist and Obstetrician
  • G-spot. What is it? What benefits does it have for the female orgasm?
    G-Spot is the suburethral connective tissue. This is where Skene's paraurethral glands are. These have all the structural and functional components of the male prostate. Women in whom this tissue is well developed have easy orgasms. In others, we can help with hyaluronic acid infiltration, for example. It is a very simple technique and is performed without anesthesia in the office. Dr. Ana Lúcia Nogueira Gynecologist and Obstetrician
  • Difficulty getting pregnant. What diagnosis to make? What to do?
    In about half of the cases it is male and the diagnosis is made through a spermogram with sperm culture. Female causes are divided into 1/3 ovary (anovulation and micropolycystic ovary syndrome), 1/3 fallopian tubes (pelvic inflammatory disease and endometriosis) 1/3 uterus (polyps, fibroids, septate or bicornuate uterus). The diagnosis is made with analysis, ultrasound, hysterosalpingography, hysteroscopy and laparoscopy. Only in cases of total obstruction of the tubes, azoospermia or oligospermia and cases in which donor sperm or oocytes are required is IVF necessary. Many couples who attend infertility clinics do not need it and enter a spiral of consumerism and anxiety that reduce the possibility of a spontaneous pregnancy. An IVF cycle can cost 5000 or more euros, the chances of success are 10% and the money is not returned. It is not explained that babies born from an IVF are 5 times more likely to have rare diseases like autism and cerebral palsy. At the age of 40, a woman is not accepted in state fertility programs and in private ones she is advised to get pregnant with donor oocytes to increase the chances of success. Women have their ideal fertile life between the ages of 20 and 40. Preferably from 25 to 35 years old. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Basal temperature curve. What is it? What is it for?
    The temperature method is more effective in helping to get pregnant than in preventing pregnancy. The measurement of internal body temperature (eg in the mouth), in the morning while still at rest, before getting up. The internal temperature is about 0.5ºC higher than the external temperature and may vary. But when there is ovulation, progesterone increases and this hormone is responsible for the rise in temperature. Those who use the temperature method (Ogino-Knaus) to avoid getting pregnant can have unprotected sex only when the temperature has just risen. In anovulatory cycles, which are very frequent, especially in women with micropolycystic ovaries (about 1/3 of women), the temperature does not rise and therefore they do not know when they can have unprotected sex. This method of temperatures used to get pregnant indicates that it is time to have sex when the temperature starts to rise. It can rise by 0.1ºC or a little more per day. Just have sex every other day during those 5 days. Because the sperm half-life is 48 to 72 hours and it can stay in the fallopian tubes waiting for the egg, which in turn only has a half-life of 12 to 24 hours after ovulation. So a normal temperature curve of an ovulatory cycle is a biphasic curve, where the temperature rises from 36.5ºC to 37ºC on these days is the best time to have sex. If the woman becomes pregnant, the temperature will remain high, if not, it drops at the beginning of the menstrual period. If there is ovulation, but then the production of progesterone by the corpus luteum is insufficient, the temperature is not maintained and becomes unstable, some days higher than others. These are the women who need to take progesterone supplements to maintain their pregnancies. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • What are the differences between childbirth in a public and private hospital?
    A birth in a public hospital if everything goes well and is done by a nurse or nurse. Doctors are only called in if something goes wrong so they can deliver with forceps and/or a vacuum. Or decide on a c-section. When a pregnant woman is hospitalized, she loses her autonomy, she cannot decide on the type of delivery she would like to have and enters an assembly line where she passes through the hands of several professionals. If it runs normally, great, the worst thing is when difficulties begin and she has to face the insistence on trying a low birth route that sometimes goes beyond any reason. A difference is also whether you can get an epidural done by an experienced anesthetist. Another difference is the surgical aptitude of the person who delivered and corrects episiotomies and tears. Sometimes they need an intimate postpartum surgery. Another difference is the possibility of being able to rest during the night because in the public hospital there are few nurses during the night for a ward with many puerperal women. Even if they wanted to help take care of the babies, it was humanly impossible. Free choice is an achievement of modern women. Childbirth in the Public Hospital is free for parents, it has the same cost as in the private one, except that it is the state, that is, the taxes that all of us pay. There are good insurances that pay for childbirth, some in full or almost. Private childbirth is already very affordable, about 4 to 6 times less than 20 years ago. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • First Trimester Combined Screening / Prenatal Screening for Fetal Chromosome Defects in Maternal Blood. What happens?
    Biochemical screening of the first trimester - evaluation of the value of beta hormones HCG and PAP-A in maternal blood at 12 weeks. Second trimester biochemical screening - assessment of beta hormones HCG, estriol and alpha-fetoprotein in maternal blood at 16 weeks. Combined tracking: Use of fetal measurements obtained in the 12-week ultrasound, such as the craniocaudal length, the nape crease and the length of the nasal bone. In combination with biochemical screening values. Second-trimester combined screening has been carried out for about 20 years and has a detection rate for Down Syndrome of 86%. When the first trimester biochemical screening was added about 10 years ago this detection rate increased to 92%. It is not known what the probability of detection of combined first-trimester screening not associated with second-trimester screening is. Much less want to compare it to the prenatal diagnostic test that searches for fetal DNA in maternal blood from 10 weeks onwards with a Down Syndrome detection rate of 99.9%. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • What is the prenatal diagnosis that detects Down Syndrome with maternal blood collection?
    Harmony prenatal diagnostic test for chromosomal disorders such as Down Syndrome, carried out by taking maternal blood from 10 weeks and detecting fetal DNA present in maternal blood circulation. It has a 99.9% probability of diagnosing Down Syndrome, practically equal to that of an amniocentesis, with the advantage that it is non-invasive and that it is carried out at an earlier stage of pregnancy, 10 weeks and not 16 weeks. This allows parents to make decisions earlier at around 12 weeks instead of 20 weeks. Inconvenient and more expensive than combined screening and costs the same as an amniocentesis. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • What is the purpose of collecting vaginal swabs during pregnancy to test for group B streptococci?
    The search for group B streptococci in pregnant women has two reasons. One at 28 weeks or sooner if there are contractions to prevent preterm labor. Because it is a bacteria that causes uterine contractions. In non-pregnant women it does not cause problems, and there are women who tend to have it recurrently. Another reason for your research at 35 weeks is the prevention of meningitis and blindness in the newborn. It is advantageous to use a probiotic from the beginning of pregnancy to balance the vaginal flora and avoid infections. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • What is Intimate Surgery?
    It is all the intervention that is made to the external female genital organs (reconstruction and rejuvenation of the labia minora, labia majora and perineum) and to the internal female genital organs (reconstruction and rejuvenation of the vagina, anterior wall with the bladder, posterior wall with the rectum, pelvic floor muscle lifting, G-spot infiltration). Women resort more to the external aesthetic part because most are still unaware of the existence of the internal part, usually it is the doctor who performs the cytology of the cervix who alerts to the existence of a descended uterus and/or bladder and/or rectum. That's why I decided that to all the women who come to me to improve their intimate area, I offer the correction of the entire set according to the needs of each one and my evaluation. The women are operated on an outpatient basis with local anesthesia and sedation and are discharged on the same day. This surgery does not have a painful postoperative period, you can go about your normal life except for sexual activity, which is advisable only after 4 weeks. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Should the cervical cancer vaccine be done? At any age? Should men do it too?
    Yes, to all questions! Dr. Ana Lúcia Nogueira Gynecologist and Obstetrician
  • Is cervical cancer a sexually transmitted disease?
    Yes. You only get cervical cancer if you sexually acquire an HPV virus (“Human Papilloma Virus”). Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • I did a cytology of the cervix, it came back negative. Can I be rested? Don't I have cervical cancer?
    Cytology detects the existence of changes in the endocervical cells if it says "presence of cells in the transformation zone". This is the area of the cervix where the HPV virus settles, if it says "absence of cells in the transformation zone", it is because there was not a good harvest. This is common in women who have never had a vaginal birth or after menopause where the external cervix orifice is very closed. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Is candidiasis a sexually transmitted disease?
    No. Although it can be transmitted through contact, therefore, if the partner has symptoms, it is also treated. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • I keep getting discharge and yeast infections. What can I do?
    Recurrent yeast infections may be due to a change in the pH of the vagina, which becomes more acidic with less doderlein bacilli, which are the normal vaginal flora. It happens when the blood becomes sweeter due to diabetes or frequent intake of sweets, and this is modified by eliminating sweets and following a low-carbohydrate diet. It happens more in people who do sports and sweat in lycra suits. It happens due to taking antibiotics because they kill the normal flora. It is advisable to take probiotics at the same time. If there is a viral infection in the cervix or vulva and/or vagina, local immunity is reduced and candidiasis is more frequent. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • I have urine leakage, do I need an operation?
    If the losses occur during exertion... When you cough, laugh, run or jump, this is stress urinary incontinence and you may need to suspend the angle between the bladder and the urethra. But first, you should try physiotherapy with pelvic floor stimulation and perineal Kegel exercises and improve the thickness of the layers of the vagina with local estrogens which may be phytoestrogens. If you leak urine when you hear water dripping or it's colder, that means you have a urinary emergency and this situation cannot be corrected with surgery. You may have to take appropriate medication. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • I'm pregnant, I'm losing blood, what do I do?
    Contact your gynecologist. She will tell you to rest and abstain from sex and will assess the situation according to how far along you are in your pregnancy. If it is bleeding in the 1st trimester, it may be due to chromosomal changes due to poor quality of the egg or sperm or because it has been exposed to substances that are harmful to the embryo. In these cases, you will end up having a miscarriage even if you rest and abstain. At the beginning of pregnancy, there may be blood loss due to a lack of hormones, in this case, when detected on ultrasound and tests, the doctor will prescribe these missing hormones in addition to rest and abstinence. An important cause of blood loss is gynecological or urinary infections, but they can also be caused by intestinal parasites such as Giardia Lamblia, for example. Blood loss can be from the cervix due to polyps or a bleeding lesion and not from inside the uterus and therefore does not put the pregnancy in danger. Blood loss in a more advanced pregnancy may be due to placental abruption. This is a serious situation for the mother and the baby and requires hospitalization and monitoring of the situation until the best time for the baby to be born is decided. It can wait for 1 or more months depending on the test values, the amount of blood lost and always trying for the baby to reach lung maturity, which can be stimulated by injecting the mother with corticosteroids. Dr. Ana Lúcia Nogueira Gynecologist and Obstetrician
  • Is what you do in a Gynecology-Obstetrics consultation the same as what you do in Family Planning at the Health Center?
    No. In the health center it is a General and Family Medicine doctor, not a Gynecology and Obstetrics specialist. The most frequent diseases are screened and, by age group, obeying the indicators issued by the Ministry of Health. It is important, but different from individual and personalized counseling and including screening for less frequent diseases such as ovarian cancer for example, which at the health center is not sought in any age group. Dr. Ana Lucia Nogueira Gynecologist and Obstetrician
  • Vírus HPV / Doença auto-imune / Neoplasia
    Todos sabemos que a doença de Hashimoto, doença auto-imune da tiróide é provocada por um vírus. As células de defesa do indivíduo não reconhecem as células do órgão como próprias e são produzidos anticorpos. O corpo vira-se contra ele próprio. Podemos pensar que na Vulva possa acontecer um fenómeno semelhante. Uma vez infectada pelo HPV, se esta infeção se torna crónica pode acontecer uma doença auto-imune da Vulva chamada Líquen. Para tratar a inflamação da auto imunidade usam-se corticoides, que diminuem as defesas para o vírus. A existência de vírus nas células diminui a imunidade localmente e assim proporciona que a mulher tenha infeções vaginais e/ou urinárias de repetição. Além de que o vírus existente no núcleo das células pode a qualquer momento começar a comandar a velocidade de divisão celular. Se as células se começam a dividir mais depressa estamos perante uma displasia ou neoplasia. Sendo que o que distingue as neoplasias benignas das malignas é a sua velocidade de multiplicação celular. Os vírus HPV são muito contagiosos, pensa se que toda a gente tem ou teve contacto com este vírus. A maioria tem as defesas bem e defendesse. O ardor vulvar desaparece assim como apareceu sem se fazer nada. Se quando há o contacto a mulher está numa fase de baixa das defesas, que até pode ser só outra virose do sistema respiratório por exemplo, ou na fase menstrual ou com alguma doença ou tratamentos que diminuam o seu estado de imunidade. Pode fazer com que o vírus se replique mais livremente. Atenção, se dura há mais de 6 meses estamos perante uma patologia crónica. O tratamento é difícil pois estamos a lidar por um lado com um agente infeccioso cuja gravidade depende do estado imunitário da mulher e por sua vez o estado imunitário depende do seu sistema nervoso que inevitavelmente fica alterado em consequência de uma patologia que impede a mulher de usufruir da sua sexualidade. Ainda com a agravante de que o companheiro ajuda a manter o ciclo. Tratando-se de uma doença que pode ser muito limitante, os sintomas de ardor intenso Levam a muitos episódios de ida às urgências em que muitas vezes sem serem observadas lhes é prescrito um antibiótico sem que este seja necessário e que lhe vai matar o microbioma vaginal, intestinal e urinário tornando assim o terreno ainda mais frágil para os vírus se continuarem a manifestar. Assim muitas mulheres não diagnosticadas, sofrem e o sexo torna-se uma experiência desagradável e dolorosa, por vezes essa experiência dolorosa repetida leva a uma contração involuntária dos músculos do pavimento pélvico, o chamado vaginismo. Muitas precisam de psicoterapia e medicação com psicotropicos. São estigmatizadas e vivem em sofrimento. Se pelo menos se conseguir compreender que o início esteve na infeção viral que a mulher sofreu numa fase mais frágil da vida e não o contrário, como muitos médicos acreditam, serem as alterações psicológicas que as fazem ter as queixas, podemos ajudar as mulheres a quebrarem uma a uma, todas as barreiras que as impedem de usufruir de uma vida plena. Não é fácil esta abordagem,pois a própria mulher dúvida de si própria e dos médicos que a tentam tratar. Ana Lúcia Nogueira
  • Cancro do Colo do Útero é possível eliminar até 2030!” – Parte 1 – (Vacinação e Acompanhamento)
    Cancro do colo do útero é possível eliminá-lo com vacinação e acompanhamento ginecológico adequado. Conseguir que todas as mulheres após o início da sua vida sexual (6-12 meses) façam um exame ginecológico. Há cerca de 25 anos que existe a possibilidade de fazer a colheita das células cervicais para um meio líquido, o que permite que mesmo com sangue, as células colhidas possam ser observadas pela anatomia patológica. Há zonas geográficas em Portugal em que a credencial do SNS para a citologia apenas permite que se faça um esfregaço das células colhidas numa lâmina seca. Este método mais antigo não permite a leitura correta e o diagnóstico se existir a presença de sangue. Uma lesão do colo do útero sangra e o seu diagnóstico histológico não deverá ser descartado por impossibilidade de leitura. Numa época em que até pelo SNS em algumas áreas geográficas se faz colheita também para identificação da presença de vírus HPV de alto risco no colo uterino, não se justifica que ainda se use o método em lâmina seca e assim deixar de diagnosticar atempadamente uma lesão que se pode transformar num cancro do colo do útero. Uma citologia em meio líquido, bem realizada pressupõe que exista representação da zona de transformação. A zona de transformação é a parte do endocolo em que se realizam mais divisões celulares, pois é onde o epitélio colunar simples do endométrio se transforma em epitélio pavimentoso estratificado do exocolo que tal como o da vagina é resistente ao traumatismo provocado pela penetração vaginal. A zona de transformação, assume particular importância porque como há muita divisão celular é um sítio privilegiado para os vírus se dividirem também. Os vírus são seres procariontes, isto é, não são capazes de se dividir sozinhos, têm que estar dentro de uma célula, até pode ser só uma bactéria ou um parasita. Juntando o seu material genético (ADN ou RNA) ao da célula hospedeira, eles dividem-se, procriam. Enquanto o ADN do vírus HPV respeitar a velocidade de divisão celular hospedeira, não provoca danos. Quando o material genético do vírus se sobrepõe ao da célula hospedeira e provoca um aumento da velocidade de divisão celular então estamos perante uma metaplasia, displasia ou mesmo neoplasia. O que distingue uma neoplasia benigna de uma maligna é a velocidade com que as células se dividem. Isto para o médico de Anatomia Patológica que faz a leitura do material biológico colhido pelo Ginecologista é o número de células por campo que distingue se o cancro já é maligno. Se o cancro ainda estiver localizado, carcinoma in-situ é facilmente tratado e com cirurgias minimamente invasivas. Se já atingir os vasos sanguíneos e linfáticos pode tornar-se metastático em qualquer lugar do corpo. A diferença de ser um cancro invasivo ou não, pode ser apenas de 1 mm de extensão ou de profundidade. Dra. Ana Lúcia Nogueira Ginecologista e Obstetra
  • HPV - What is it? What are the myths and taboos? How to diagnose?
    A vulva é o sítio tabu do corpo da mulher, ignorado até por alguns ginecologistas que tendo uma citologia do colo do útero normal ou com inflamação dizem estar tudo bem e ignorar as queixas da mulher de ardor no final das relações sexuais, dificuldade em lubrificar e conseguir uma penetração não dolorosa e queixas persistentes e/ou recorrentes de infeções vaginais e/ou urinárias há 1 ano ou mais. As verrugas na vulva são de transmissão sexual! Já observei uma criança que vinha acompanhada pelos pais para observação ginecológica e pareceu-me virgem e inocente, no entanto esta família confessou-me estar a viver o drama de “o caso da verruga” na vulva estar já declarado no instituto de medicina legal. O HPV é só problema da mulher! O homem é apenas transmissor e nenhum mal lhe acontece! Este ano a vacina contra o HPV 16 e 18 existente no plano nacional de saúde para as meninas no ano em que fazem 13 anos, começou a ser divulgada para ser utilizada também nos rapazes para prevenir os tumores da cabeça e do pescoço que são provocados na sua maioria pelo HPV 16, além da prevenção do cancro do pénis e do ânus. O QUE É O HPV (PAPILOMA VIRUS HUMANO)? Como o nome indica é um vírus que se reproduz através da sua inscrição no genoma (ADN) das células humanas que ao se replicarem ele o consegue juntamente com elas, tendo a particularidade de formar papilas na pele e nas mucosas infetadas (parecem dedinhos fininhos) e todos aglomerados podem formar a chamada verruga. Pode existir em qualquer local do corpo, pode passar de uns locais para os outros através de dedos ou o uso de objetos íntimos ou nas sanitas, jacúzis, etc. É IMPORTANTE SABER: A maioria dos HPV não são de alto risco. É altamente contagioso e por isto quase toda a gente tem contacto com ele durante a vida. Passa naturalmente em 7-8 meses em 70-80% dos casos e necessita de tratamento se persiste. Em Julho de 2010 eram conhecidos 108 subtipos de papiloma vírus humano (HPV) as infeções por eles provocadas são confinadas aos epitélios (mucosas genital, orofaríngea e ano-rectal) e às superfícies cutâneas, penetrando até à membrana basal, não há evidência que entrem na corrente sanguínea. A transmissão do HPV durante o parto é possível, pode provocar a papilomatose laríngea juvenil, com obstrução respiratória grave e de difícil tratamento. Em situação de rutura prematura de membranas, a infeção do recém-nascido pode manter-se subclínica, vindo a manifestar-se na criança meses ou até anos após o parto. Uma vez que está demonstrado que o HPV de alto risco está implicado em vários cancros, nomeadamente o do colo do útero deve ter-se em atenção a existência de vacinas para os subtipos HPV 16, 18, 45, 6 e 11, que são os mais frequentes nos países ocidentais, mas que não cobrem todos os subtipos e por isso a vacina não dispensa as visitas de rotina ao ginecologista. O HPV pode existir no núcleo da célula e não provocar alterações e a célula continuar a dividir-se a um ritmo normal ou pelo contrário provocar-lhe alterações que a levam a dividir-se mais rapidamente (displasia, neoplasia). No colo do útero existe uma “zona de junção”, que é a transição entre o endocolo (epitélio colunar simples) e o exocolo (epitélio pavimentoso estratificado). Como é uma zona de divisão celular, aqui o HPV pode causar mais facilmente problemas graves e que são assintomáticos pois o colo não tem recetores nervosos e só se deteta porque há queixas de perda de sangue após as relações sexuais ou através de uma citologia e/ou colposcopia. Para que o colo uterino fique infetado é necessário que a transmissão seja através da penetração. Pensa-se que uma virgem não pode ter cancro do colo uterino. A citologia do colo uterino consiste na colheita de células que são colocadas numa lâmina ou num frasco com líquido próprio e depois vistas ao microscópio por um citologista que diz se há alterações inflamatórias, infeciosas ou neoplásicas dessas células. A colposcopia consiste num exame que o médico realiza no consultório e que permite ver as células com um aumento de cerca de 15 vezes. As chamadas lesões vermelhas do colo são colos do útero com apenas uma camada de células e em que se veem os vasos que as irrigam e que não aconteceria se fossem várias camadas de células como pertence que seja o exocolo. Ficando assim expostas a traumatismos e infeções. Para um especialista em colposcopia é possível interpretar o padrão de alterações dos vasos que irrigam as células do colo (ponteado, mosaico, leucoplasia) e decidir se se trata de uma colposcopia de baixo ou de alto grau. Com a ajuda de dois líquidos que coloca na zona a estudar. Um é o ácido acético a 5% que provoca a precipitação das proteínas existentes nas células, fazendo com que as células que estão infetadas pelo vírus e que por isso têm o seu genoma maior, mais proteína e o núcleo maior, fiquem mais brancas. O padrão como ficam brancas, mais rápida e intensamente, vírus de alto risco, ou mais lenta e discretamente, vírus de baixo risco. O outro líquido utilizado complementarmente é o lugol (produto iodado) que ao contrário do outro, identifica a zona não infetada, pois ele é absorvido pelo glicogénio existente no citoplasma das células. As células que absorvem mais lugol e ficam castanhas são as células normais, com o citoplasma maior que o núcleo. As zonas do colo e vagina que não coram são as pobres em glicogénio, ou porque estão infetadas por vírus ou fungos, bactérias, parasitas ou porque estão atróficas por falta de estrogénios como é na menopausa. Mas para um especialista de colposcopia o padrão de coloração pelo lugol (se tem bordos bem delimitados ou dispersos por exemplo) permitem-lhe em conjunto com a avaliação feita com o ácido acético e primeiramente sem nenhum líquido chegar à conclusão se é necessário efetuar uma biópsia para diagnóstico histológico ou não. A biopsia retira um pedaço de tecido (não um esfregaço como a citologia) e o seu tratamento em laboratório e posterior exame ao microscópio é mais trabalhoso e dispendioso, pelo que é importante que a colposcopia seja efetuada por um colposcopista que saiba com segurança escolher o local certo da biopsia porque conhece bem os padrões vasculares existentes. De outra forma pode estar a efetuar-se a biopsia no local de lesão menos grave ou a efetuar uma biopsia desnecessária. O controlo de qualidade de uma colposcopia faz-se comparando o número de biopsias que vêm positivas para lesão em relação ao total de biopsias efetuadas. Se o colposcopista não for experiente o colposcópio funciona como pouco mais do que uma boa fonte de luz. Quanto à colposcopia da vulva e vagina deve ser feita sempre que existem queixas de ardor por parte da doente. Observa-se a reação das células ao ácido acético. Podem não existir lesões visíveis e, no entanto, depois da colocação do líquido num tempo maior ou menor, com mais ou menos intensidade de reação pode aparecer o que chamamos de condiloma plano. Existem papilas parecidas com as papilas provocadas pelo HPV, mas que são fisiológicas, estas são assintomáticas e não se visualiza o capilar sanguíneo central que têm as do HPV. Se visualizarmos isto e em simultâneo a mulher se queixar de ardor, tenho experiência positiva em fazer tratamento tópico. Se, contudo, não houve queixas, então não se trata e fica-se só vigilante. Se se verificar a existência de uma papila grande ou de um aglomerado de papilas que sejam sintomáticas, deve proceder-se à excisão ou com a pinça de biopsia se possível ou mesmo com um bisturi, sendo por vezes necessário fazer uma sutura com pontos absorvíveis. Parece-me errado fazer uma biopsia parcial para comprovar a existência de HPV e não tratar. A conduta do ginecologista em relação à vulva deve ser a mesma que a do dermatologista perante uma lesão a HPV noutro local, isto é: Tratar! Com agentes tópicos que promovem a dissolução da queratina e a morte das células (Ácido tricloroacético, podofilina, laser ou criocoagulação) Usar imunomoduladores que melhoram a defesa do sistema imunitário contra este tipo de vírus (imiquimod, ácido fólico, vitamina A). Redução do stress. Exérese cirúrgica da lesão. Dra. Ana Lúcia Nogueira Ginecologista e Obstetra
  • My doctor has detected that I have excess iron. What is that?
    Excess iron can be transient, related to inflammatory events, or be a chronic tendency of some individuals who accumulate iron throughout their lives. The accumulation of iron over years can lead to pathologies in some vital organs, which is why vigilance and iron spoliation in small amounts is recommended to prevent serious illnesses in the future (phlebotomy or hemapheresis).
  • I tend to bleed and bruise. Do I have an illness?
    Must be seen and analyzed for peace of mind. Von Willebrand Disease, for example, is characterized by a bleeding tendency, which is hereditary in most cases and, in situations of greater bleeding or the need for invasive interventions, may require medical treatment. In some cases, there may be a decrease in the number of platelets (thrombocytopenia) or another platelet pathology, and medical surveillance is also important.
  • I was put on one of the new oral anticoagulants. Do I need to do any control of this medication? And I can never stop?
    These drugs are indicated when there is thrombotic risk. They do not require the same control as in the case of medication with warfarin, but the patient must be monitored in an initial phase and whenever there is evidence of blood loss or when invasive tests are scheduled.
  • I am recommended to take Varfine and this medication requires close monitoring. Can this control be done here?
    The drug warfarin is indicated in several clinical conditions. Its effect on the body is greatly influenced by food and other medications, so the patient must undergo tests and the dose of warfarin adjusted according to the INR values, under medical supervision.
  • I have pernicious anemia. What do I do?
    Pernicious anemia is related to malabsorption of vitamin B12. Must be medicated with cyanocobalamin to keep vitamin B12 at healthy levels. You should also know the cause of this deficit, as several factors may be involved.
  • I'm vegetarian. Am I more prone to anemia?
    The avoidance of meat and/or fish in the diet can lead to some states of nutritional deficiency, so it is advisable to carry out analyzes and, if necessary, replace factors lacking. Anemia in these cases can be so subtle and progressive that it can go unnoticed and be detected late.
  • I'm very tired and I've been told that I don't have anemia. Could it be a blood problem?
    In fact, even without anemia, there can be a significant lack of iron (ferropenia), which translates into severe tiredness, hair loss, brittle nails and decreased well-being general. These asthenia conditions improve a lot with adequate iron treatments and/or specific vitamins.
  • Can breathing problems lead to blood disorders?
    In some situations of respiratory pathology, there is a deficit of oxygenation that the organism mistakenly interprets as the need to produce more red blood cells, which generates an increase in viscosity. Therefore, there is a need for consultation for surveillance and treatment of polyglobulia.
  • I have headaches, dizziness, feeling light or heavy in the head, blurred vision and they tell me that my face is always very flushed. Can I have a blood disease?
    There are cases in which these symptoms together are due to polyglobulia, that is, an excess of erythrocytes or red blood cells. Other symptoms may arise, such as: itching at the end of a warm or hot bath, tingling in the hands or feet. You should have a blood count and other medical tests to find the cause.
  • I have been diagnosed with thick blood. What is it? How is it treated?
    Usually, the expression “thick blood” refers to an excess of red blood cells, a situation that can bring risks of hyperviscosity, that is, an increased probability of thrombotic events. It must be monitored regularly. It is important to look for the cause of this increase in red blood cells, in order to reduce the risk of thrombosis. It may be necessary to extract small amounts of blood (phlebotomy or hemapheresis).
  • I feel fine, but the last few months I've seen T.A. (Blood Pressure) was always high. Since I have no complaints, do I need treatment?
    You will likely need medication, your T.A. It may allow classifying as being hypertensive. The doctor will order some tests to define your overall cardiovascular risk. The treatment will depend on the value of the T.A. and your exams. In any case, start the so-called hygienic measures and healthy living habits now, such as weight control, reducing salt intake, not smoking and exercising. The absence of any symptoms during the initial phase of the disease makes regular blood pressure measurement a habit to follow. All adults, particularly obese, diabetics and smokers or those with a family history of cardiovascular disease, should have their blood pressure measured at least once a year.
  • Can I have diabetes? I don't have family members with diabetes but is it possible to have the disease?
    Diabetes currently affects around 11.7% of the Portuguese population, more frequent in men and increasing with age. There is type 1 and type 2 diabetes, with type 2 diabetes accounting for about 80% to 90% of all cases. Type 2 diabetes is usually preceded by a long period of asymptomatic hyperglycemia that can last for years. In this pre-diabetic state, postprandial or post-ingestion glucose levels are moderately elevated while fasting blood glucose is usually close to practically normal values. Until recently, type 2 diabetes was considered a disease of middle-aged and elderly individuals, however with the transition from a traditional lifestyle to a current lifestyle we have more and more young individuals, adolescents and children with diabetes. Obesity, lack of physical exercise and marked changes in the family diet have thus contributed to the rise of this disease. Early diagnosis of diabetes aims to prevent long-term complications such as coronary heart disease and stroke.
  • I forget “things” easily. I'm afraid I have dementia. How can I know?
    The first step to getting a diagnosis is to talk to your doctor about your concerns. It is a good idea to bring a close family member or friend to the appointment to help provide additional information. It's also a good idea to bring a list of your memory changes, as well as any changes that are troubling you, including when you first noticed them and how often you notice them. You should also report on the medications you are taking. The doctor will discuss your medical history and order laboratory tests. Some dementias can be reversible as they cause brain damage such as brain tumors, vitamin B12 deficiency, alcohol abuse and others. So the doctor will guide you.
  • I don't sleep well at night, I feel tired. Will there be any treatment that will help me?
    Insomnia contributes to a decrease in quality of life and a decrease in work performance. The analysis of habits and sleep patterns carried out in the Neurology consultation allows the identification of the cause of insomnia and, in this way, initiates the most appropriate treatment for each patient.
  • I have headaches that bother me. Could it be something serious? How can I know?
    In most cases, headaches, also known as headaches, are benign. However, some headaches may be the manifestation of a potentially serious neurological disease (tumor, aneurysm, stroke, among others). Talk to your Neurologist and make a headache calendar. The headache calendar serves as a record of the days of the month in which you had a headache, as well as its intensity and precipitating factors. It is through the analysis of headache characteristics and neuroimaging methods that a benign headache is distinguished from a headache with warning signs, which must be diagnosed and treated in a timely and differentiated way.
  • I suffer from tremors. I'm afraid I have Parkinson's disease. What should I do to find out?
    There are several conditions that can be associated with tremor. It is your Neurologist who will be able to tell you if you have Parkinson's Disease and treat the disease in order to improve your symptoms.
  • I have tingling and pain in my hands and legs. What could it be?
    Tingling in the hands and feet and low back pain that radiates to the legs are frequent reasons for discomfort and discomfort that have an impact on family, social and work life. There are several neurological pathologies, namely neuropathies and radiculopathies, which can be associated with these symptoms. It is in the Neurology consultation and through carrying out the electromyography exam that the cause of these complaints can be discovered and appropriate treatment can be carried out.
  • I have a lack of memory. Will I have dementia? How can I know?
    The lack of memory is a very common complaint in the population, especially after the age of 65, being a reason for great concern due to the fear of being dealing with dementia. Not all memory complaints are associated with neurodegenerative diseases, such as Alzheimer's disease, there are dementias that are treatable and reversible. It is in the Neurology consultation, after evaluating the patient, that the diagnosis of dementia is made and its cause identified. This is the only way to start targeted therapy and understand the evolution of the clinical condition.
  • Is fever bad for my child?
    No! Most parents have grown up with fever myths that cause them to act out in panic when their child develops a fever. It is always necessary to bear in mind that fever is a natural defense mechanism of our organism which in most cases is reacting to the invasion of the organism by viruses which are self-limiting infections. Fever can only be harmful from 41.7ºC. The only reason we lower the fever is for the child's comfort and lower energy expenditure. The temperature varies according to various conditions and the time of day, but as a general rule it is not worth giving fever medication (eg paracetamol or ibuprofen) before 38ºC. In a young child (<12 months) with a fever that does not go away or that has persisted for several days, you should contact the attending Pediatrician to find out if observation is necessary.
  • Who is the nutrition consultation for?
    For everyone. Especially in cases of: Obesity and/or Overweight, Thinness, High Cholesterol, High Triglycerides; Diabetes mellitus; Gastrointestinal Diseases (Constipation, Gastritis); Child Nutrition, Nutrition in pregnancy; Kidney Diseases (Renal Insufficiency, Kidney Stones); Thyroid Dysfunctions; Allergies and/or Intolerance
  • What does the diet consist of?
    It consists of creating an individualized eating plan that respects your needs, meets your expectations and allows you to achieve your goals with greater efficiency, in a well-consolidated and healthy.
  • What does the nutrition consultation consist of?
    Assessment of clinical history; Assessment of anthropometric data and body composition (BIO): registration of weight, height, waist circumference and analysis of body composition (BIO) (% total body fat mass, kg fat-free mass, % body mass water); Assessment of resting and active metabolism; Food Questionnaire (food anamnesis); Setting goals and objectives; Elaboration of a personalized food plan.
  • Does oculoplastics help facial rejuvenation with blepharoplasty?
    Yes, procedures such as the removal of excess skin and/or fat pockets around the eyes for rejuvenation are performed by Oculoplastics in Blepharoplasty surgery, which makes it possible to obtain a happier and healthier look, which restores facial beauty and harmony and, above all, functional protection.
  • What are the surgeries performed by oculoplastics?
    The oculoplastic ophthalmologist uses various techniques for the surgical correction of cases of malpositioned eyelids, such as Entropion (inversion of the eyelid margin), Ectropion (eversion of the margin with eyelid laxity and tearing) and Ptosis (drooping of the eyelid) in the same way as the bad positioning of the eyelashes. Treatment of muscle spasms (facial tremors), clearing of tear ducts, excision of ocular or periocular tumors and eyelid reconstruction are also part of the oculoplastic surgeon's range of action.
  • What are technical aids?
    Technical aids are residual vision magnification aids, which, when correctly indicated, can contribute to improving performance in near or far vision. They thus make it possible to enlarge the image, in order to perform various tasks. A low vision consultation is not limited to the prescription of technical help, even because rehabilitation involves important steps for it to develop satisfactorily. Often, the person with Low Vision “discovers” some technical aids and uses them in their day-to-day life. Examples of technical aids: magnifying glasses, telescopes, microscope-type high magnification glasses, or electronic aids.
  • What is the purpose of visual rehabilitation? When to start?
    Rehabilitate the person with low vision to achieve the highest performance of residual vision, with the efficient use of this vision to perform tasks. It is a dynamic process and does not have a defined time to complete. However, we try to respect the time of each patient. If after conventional treatments with medications, surgery or optical correction by lenses, the person still has a considerable decrease in vision, then that person can start a process of visual rehabilitation. This effect effectively contributes to improving the quality of life and providing greater autonomy to that person.
  • What is low vision, subvision or subnormal vision?
    Low vision is an intermediate vision situation between normal vision and blindness. The person with low vision therefore has a significant reduction in functional vision, but is not blind.
  • What is oculoplastics?
    Oculoplastics is a specialized area of Ophthalmology that deals with abnormalities of the eyelids, tear ducts and orbit (bone cavity that surrounds the eye), and facial areas attached to the eyes. By analogy, we can say that the purpose of Oculoplastics is to treat the frame of a precious picture that is the eye.
  • I have "tonsillitis" with a feeling of tightness in the "throat" and even my voice has changed. What is it that doesn't pass me by?
    The "throat" is the seat of many organs with different functions. True tonsillitis, especially if they are frequent or with complications, must be treated and mainly prevented in consultation. The larynx, the organ where the vocal cords are located, can be affected by its own diseases (polyps, nodules, etc.) as well as by the malfunction of other organs such as the stomach or lungs. Only with an otorhinolaryngology assessment complemented by a technique, laryngoscopy, is it possible to make a complete assessment of the "throat".
  • When will I need a hearing aid?
    After the age of 45-50, the human ear begins to degenerate progressively and irreversibly. The only way to correct this type of deafness, which occurs predominantly in the elderly, is with a hearing aid. However, there are many other causes of deafness that can be very simple to solve (such as removing cerumen from the ear for example) to more complex causes that may eventually require surgery to correct it. Only a proper medical evaluation can establish a correct diagnosis and an adequate treatment plan.
  • My son snores when he sleeps. This is normal?
    Snoring means that there is obstruction of the airway during sleep. In children, snoring and poor sleep quality are associated with lower school performance, developmental delay, otitis, tonsillitis and even deafness. It is a condition that needs immediate evaluation by an otorhinolaryngologist and treatment to avoid complications in the future.
  • How can I ensure a healthy diet for my child?
    Uma alimentação saudável é essencial para promover um crescimento e desenvolvimento adequado das crianças. Em primeiro lugar, é preciso dividir as responsabilidades. Cabe aos pais definir quando são as refeições, onde acontecem e em que é que consistem, e às crianças cabe decidir quanto comem. Isto pode parecer um conceito estranho, mas é essencial para garantir um ambiente livre de stress que permita à criança ganhar autonomia. Aqui sugerimos alguns conselhos: Estabeleça um bom exemplo! A sua criança vê-a como a maior referencia da sua vida. Se não comer de forma saudável como esperar o mesmo do seu filho? Envolva a criança na preparação dos alimentos (adaptado à idade). Façam refeições em família. É um momento de partilha social que fortalece as relações familiares. Promova o consumo de carnes magras, peixe, cereais integrais feitos de forma saudável (cozido, assado ou grelhado). Água e o leite devem ser as suas bebidas de referência. Esqueça os refrigerantes e sumos! Nunca ofereça doces como recompensa! É um mau hábito nutricional e ao contrário do que pensa pode até reforçar o comportamento que quer eliminar. Introduza a fruta como snack ao longo do dia.
  • Are vaccines safe?
    With so much misinformation in the news, it's normal for some parents to wonder whether vaccines are good for their children's health. Currently, few drugs are as well studied as vaccines, both in terms of safety and efficacy. The truth is that without this combat “arsenal”, our children would be totally exposed to the thirteen diseases for which the National Vaccination Program of the DGS (Direção Geral de Saúde) protects. When children are not vaccinated, these diseases can reappear. An example of this are the growing cases of Whooping Cough in our country and the 2015 case of a Spanish boy who died of diphtheria (a disease that had not appeared since 1986)! If you want to protect your children, vaccines are a good way to start doing it.
  • Is Clinical Pilates given by a physiotherapist?
    Yes. Clinical Pilates is a complementary training to the Physiotherapy course. Currently, there are already other qualified professionals to guide Clinical Pilates programs. However, complementing it with Physiotherapy is a great asset, as it allows us to make a much more in-depth assessment of the movement and the causes of pain, and consequently a more specific planning for each person and each specific condition.
  • Is Clinical Pilates a suitable exercise for those suffering from osteoarthritis?
    Yes. Arthrosis is characterized by the wear and tear of the cartilage and joint surfaces, with a consequent decrease in the mobility and impact absorption capacity of the joint in question. Clinical Pilates favors mobility without subjecting the joint to excessive loads, as it favors its lubrication. By increasing muscle strength and joint stability, it helps to compensate for the wear and tear of the joint itself, which then performs its function better. These two aspects are fundamental to give greater protection to the joint, as well as to reduce and control pain.
  • Is Clinical Pilates suitable for those with a herniated disc?
    Yes. By recovering the pre-activation capacity of the spine's stabilizing muscles, we guarantee a good balance in the work of the remaining muscles, fundamental to keep the hernia itself stable and prevent future crises.
  • Does Pilates improve back pain?
    Yes. In situations of pain/pathology, the stabilizing muscles of the spine (in particular the Transverse Abdominis muscle) lose their pre-activation capacity relative to the other abdominal muscles. Clinical Pilates allows us to recover this capacity, thus ensuring good stability for a healthy movement, free from potential damage and pain to the spine.
  • What is the “Postpartum Blues” or “Baby Blues” and Postpartum Depression?
    Having a baby is a huge revolution in a family's life! As much as pregnancy is planned and desired, the birth of a child causes enormous and drastic changes in family dynamics. Alongside the physiological changes that occur throughout the trimesters of pregnancy, a series of changes also occur from an emotional point of view… In an initial phase, immediately after the birth of the baby, all women go through a phase of great emotional lability, which is called the Postpartum Blues, or Baby Blues. It is characterized by a state of heightened emotional sensitivity… so quickly the woman feels very happy, as extremely insecure, anxious and unhappy! If this phase continues for more than 15 days after the baby is born, postpartum depression may develop. This type of emotional disorganization can interfere with the ability to care for the baby, so it is extremely important to get immediate help. With family and professional support, she will be able to confidently return to her maternal role. Postpartum Blues or Baby Blues: The truth is that fewer and fewer babies are born and the age at which the first child is born is increasingly later... throughout life we have less and less contact with babies and the media around us does not prepare us for the great revolution that occurs when a child is born! It's supposed to celebrate the arrival of the newborn with family and friends, but unlike big celebrations, you just want to cry... were you prepared for great joy and suddenly you're exhausted, without energy, anxious and sad? Mild depression and mood swings are common in mothers who have recently given birth. The vast majority of new mothers experience at least some symptoms of postpartum depression, including sadness, difficulty sleeping, irritability, appetite changes and problems concentrating. Symptoms of postpartum blues usually appear a few days after giving birth and last from a few days to 15 days after the baby is born. All women go through this in the period immediately after the birth of the baby, due to the great hormonal changes that occur after childbirth. If going through this phase is no cause for alarm, you will feel better once your hormones balance. The support of those around her in the most basic tasks of her day-to-day life is essential and sufficient to overcome this phase! Baby blues: If this phase lasts for more than 15 days immediately after the birth of a baby, Postpartum Depression may be triggered. It is not necessary to have a predisposition to depression, or a history of the disease, for an emotional disorganization at this level to occur. As the name implies, it is a typical postpartum emotional disorganization and is much more common than you might think. Examples of some signs and symptoms of postpartum depression: Lack or excess of interest in the baby; Negative feelings towards the baby; Lack of interest in self; Loss of pleasure; Lack of energy and motivation; Feelings of worthlessness and guilt; Changes in appetite or weight; Sleeping more or less than usual; Recurrent thoughts of death or suicide. Postpartum depression usually appears shortly after the birth of the baby and develops over a period of several months, however it can also come on suddenly, and in some women the first signs do not appear until several months after giving birth. As causes of postpartum depression, hormonal changes are often mentioned, but also physical changes and stress. Seek professional help if you feel you are going through a similar situation. In addition to some strategies to deal with some of the typical postpartum difficulties, it is extremely important to take care of yourself and your mental health. The more you take care of your mental health, at the same time as your physical well-being, the better you will feel. Simple lifestyle changes can go a long way toward feeling better!
  • What are Parental Counseling consultations?
    Raising a child is undoubtedly one of the biggest challenges of any human being throughout life... Parental counseling consultations are intended to respond to the needs of families, given some of the difficulties they face during the development of their children.
  • What is Family Therapy?
    Family Therapy is based on a systemic intervention, where you work together with the different elements of a family, taking into account the constant relationships and interactions established between all. These consultations aim to enhance the skills of families, contributing to the well-being of all their elements; help and support families in order to deal in the best possible way with the challenges they face throughout their life cycle. A proper space for all the constituent elements of a family to expose their needs, objectives and expectations in sessions, actively involving them in the process of change. They are indicated for family therapy sessions in situations such as: - Divorce/separation or conflict of the couple; - Difficulties in terms of the couple's sexuality; - Difficulties in performing parental roles; - Conflicts with children in childhood, adolescence or adulthood; - Chronic disease; - Eating behavior disorders; - Drug addiction; - Mental illness; - Among others.
  • What is Psychological Assessment?
    Psychological assessment is a scientific method that analyzes and evaluates, through a battery of tests, the psychological functioning of children, adolescents, adults or seniors, emphasizing cognitive, memory and emotional skills. It is carried out through a reduced number of consultations: an interview, application of psychological tests and a final return report. It usually comes in response to a request from a healthcare professional or educator. Psychological assessment allows, after completion of the report, to provide a psychological diagnosis, establish and define a model of therapeutic intervention appropriate to the psychological disorder, or ensure that there is no need for psychotherapeutic intervention. Assessments are guided by different types according to different situations; from the assessment of cognitive/intellectual skills, personality assessment, verification of psychological disabilities, assessment for retirement, assessment at the request of the Judicial System.
  • What are Clinical Psychology consultations?
    The primary objective of clinical psychology consultations is to provide psychological well-being, minimizing emotional aspects that generate suffering for children, young people, adults or the elderly. They aim to develop skills and emotional resources that allow the patient to deal in the best possible way with symptoms that may reveal a depressive mood, anxiety, low self-esteem, low self-control, relationship difficulties or complaints of a physical nature, which often occur as a result of expression of psychic suffering. The clinical psychology consultation can be used as a one-off resource or there is an indication for more systematic follow-up in a Support Psychotherapy format. Some examples of situations that may lead to resorting to a psychology consultation: Depression; Low self-esteem/low self-concept/low self-control; Eating disorders (anorexia; bulimia; obesity; compulsive eating); Anxiety disorder/phobias or panic attacks; Relational difficulties (family, marital, social, professional); Divorce; Burnout (decompensated relationship with work); Additive behaviors; Personal development; Emotional instability; Grieving processes; Sleep disorders; Pregnancy; Victimization and abuse; Learning difficulties; Time management and problem solving; School and professional guidance.
  • What is the difference between Psychiatry and Psychology?
    Psychiatry is a medical specialty that focuses on the diagnosis and treatment of mental disorders through medication. Clinical Psychology, on the other hand, is an intervention based on the area of knowledge of Psychology, focusing on the study, understanding, evaluation and intervention of mental disorders or situations of suffering of the subject, based on scientifically studied techniques. Psychiatry and Clinical Psychology are thus two complementary areas of health, in which psychiatry, as it comes from an entirely biological knowledge of the human being, focuses more on the treatment of serious pathologies that endanger the autonomy and life of individuals with psychological disturbances. Clinical Psychology, on the other hand, aims to act in all cases of psychological suffering, whether these are of lesser or greater severity, although a referral to psychiatry may be requested in some cases (in cases where this is pertinent and the need for evaluation is assessed). a chemical action) or even to Neurology (in cases where the need for a neurological evaluation and intervention is assessed).
  • What types of problems make sense for me to see a psychologist?
    A person may seek out a psychologist for a variety of reasons, the most common being situations of particular psychological distress for the subject. In these cases, for example: The need to adapt to painful life events (Grief, Relationship separations, Illness, Moving House, etc.); Depressive feelings or emotions; Experience of high Stress, Phobias or Anxiety; Thoughts and emotions not controllable by the subject that make him suffer; Relational or family problems; Additive problems; Sexual problems; Among others. In addition to these, there are also situations in which people seek Clinical Psychology in order to seek self-knowledge and self-awareness. In these cases, of Psychotherapeutic Support, there is the purpose of personal enrichment of the subject, thus improving their quality of life and personal well-being through a constructive self-understanding of the subject himself, assisted by the psychologist.
  • I often get hoarse especially at the end of the day. Can Speech Therapy help me?
    Hoarseness or dysphonia is a very common problem in the population, being defined as any alteration in the character of the voice, as evidenced by the lack of sound clarity. In most cases, this is a transitory problem, associated with infections of the larynx. Hoarseness can be classified as acute (short duration) or chronic (15 days or more). If your hoarseness is frequent, you should first consult an ENT specialist. Through simple exams and procedures, the Otorhinolaryngologist can visualize your vocal folds and determine the origin of the problem. In functional cases, the main treatment involves Speech Therapy, where the patient re-learns to use his voice in a more balanced and adequate way. This is achieved by carrying out specific exercises and techniques, guided by a trained professional, the Speech Therapist.
  • I have a referral for Speech Therapy. But isn't this for stutterers or people who don't say L's?
    The Speech Therapist is the professional responsible for the prevention, evaluation, intervention and scientific study of human communication disorders, encompassing not only all the functions associated with the understanding and expression of oral language and writing, but also other forms of non-verbal communication. The Speech Therapist also intervenes at the level of swallowing (passage of food from the mouth to the stomach). It evaluates and intervenes in individuals of all ages, from newborns to the elderly, with the general objective of optimizing the individual's communication and/or swallowing abilities, thus improving their quality of life (ASHA, 2007). p> In this way, it is the responsibility of the Speech Therapist to intervene on the most diverse communication and swallowing pathologies, such as: prematurity, feeding difficulties, changes in communication, language, speech, reading and writing, dyslexia, stuttering, orofacial motor skills, swallowing, chewing, stuttering, strokes, Parkinson's, Alzheimer's, vocal pathologies (e.g.: nodules, polyps...), among others.
  • My son is 3 years old and still doesn't speak. Should I look for a Speech Therapist or is it too early?
    Speech Therapist intervention occurs from birth to adulthood, so it's never too early to seek their help. If you are not sure that your child is within developmental standards in terms of communication, language and/or speech, you should seek help from a Speech Therapist and schedule an evaluation. There are small gaps in development that, when treated in a timely manner, are easily resolved, while if detected later, they can have more serious repercussions and take longer to obtain results. Some of the warning signs to look out for are: 1 month - Does not follow the face; 2 months - Does not react to sounds; 4 months - Can't find the sound; 6 months - Stopped babbling, Does not vocalize, Does not localize the sound; 9 months - Does not use monosyllabic sounds like “mommy” or “daddy”, does not react to strangers; 10 months - Does not respond to your name; 12 months - Does not play, does not establish contact with adults or children; 15 months - Doesn't understand “goodbye”, “no”, “papa”; 18 months - Does not say a word; 24 months - Does not identify body parts, Talks a lot, Repeats everything he is told, Does not join words; 3 years - Speech unintelligible to strangers, Does not make simple sentences, Does not ask simple questions, Does not use “I”; 4-5 years - Systematic substitution of one sound for another, Frequent omission of sounds or syllables.
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