The physical, chemical and microscopic examination of the urine is called urinalysis. Number of various tests can be performed to measure and detect the various compounds and abnormalities in the urine, which can signify other diseases or ailments in the body.

 

Types of Urinalysis

There are many tests that can be performed; here are some of the common tests run on the urine to find out the problems.

  • Colour – The colour of the urine is the basis of this test, where the water content is of the prime concern along with the effects that some medicines that can cause.
  • Clarity – Generally normal urine is clear but the presence of mucus, blood, bacteria, crystals, sperm can make it cloudy.
  • Odor – Urine has a light smell, but some diseases or infection can cause it to have strong odour.
  • Specific Gravity – Kidney passes water with other substances in urine, this test analysis the water content in the urine and the other materials that kidney passes in the urine. The higher the specific gravity, it means the water content is low.
  • pH – pH test is used for measuring the nature of the urine, whether acidic or alkaline. A 7 in pH test means its neutral and a 4 is strongly acidic in nature whereas 9 is very much alkaline. A doctor can advise on how to maintain a balance to prevent kidney stone formation.
  • Protein – Kidney diseases, pregnancy, auto-immune conditions and other aliments can cause protein to be present in urine which is normally not there.
  • Glucose – Kidney ailments, damages or even diabetic patients are likely to have the presence of glucose in urine, which is normally not present in urine and can be found in blood.
  • Nitrites – Urinary tract infections (UTI) are caused due to bacteria and that transforms the urinary nitrates to nitrites.
  • Leukocyte esterase (WBC esterase) – This test shows the presence of leukocyte (white blood cells) in the urine and it generally means the presence of UTI.
  • Ketones – Ketone is the substance that is formed when the body breaks down the energy and it is then passed in the urine, but the presence of large amount of ketones means the person is suffering from some serious ailments of conditions.
  • Microscopic analysis – In this test the urine is taken in a test tube and put in the certrifuge (a special machine) where the tube is spun so that the solid materials would settle down at the bottom. The solid materials are then taken and put on a slide for further testing.

Here is a list of different tests performed under microscopic analysis.

1. Red or white blood cells,

2.Casts,

3. Crystals,

4. Bacteria, parasites, yeast cells, and

5. Squamous cells.

Why Urinalysis

Many diseases or ailments can be detected from urinalysis. Generally these are the primary reasons for which it is done.

  • Regular medical evaluation – A yearly or a regular check up for an assessment of the health or before surgery is done where the condition of the kidney and other diseases are checked with the urinalysis.
  • For Particular symptoms – A doctor can ask an individual to undergo urinalysis so that a particular condition or problem can be detected from the symptoms.
  • Diagnosing a medical ailment – Some chronic medical ailments or conditions can be detected from this test.
  • Monitoring the progression of a therapy – At times a doctor advises urinalysis within a short  or a particular time span to check the progression or the responses the patient has to the therapy to the ailments.

How to prepare

This test need the attention and the awareness in the technical aspect of the patient as the urine sample is to be collected by the individual. So listen to the advice the lab authorities give regarding collection of the sample.

Arthroscopy is also known as the arthroscopic surgery, where a damaged joint of the body is treated or diagnosed with a small invasive surgical procedure. In most of the cases arthroscopy is done on the joints of wrist, elbow, shoulder, hip, knee, ankle and foot.

What is Arthroscopy?

A small incision is made near the joint, there a tube-like viewing instrument is inserted, a type of endoscope, and is known as the arthroscope. The small tube or the arthroscope is about 5 millimtres in daimetre generally. It also comes in small sizes as 0.5 millimetre for the examination of the wrist joints. The arthroscope has multiple optical fibers and lenses with which the joint is examined after insertion into the skin. A video camera is attached to the arthroscope and the image of the joint and its interior can be seen on a television screen. When a surgery is performed on the joint with the help of arthroscope it is called arthroscopic surgery.

Arthroscopy is performed on whom?

Both inflammatory and non-inflammatory along with various types of arthritis can be treated or diagnose with arthroscopy. Even other joint injuries can be diagnosed and arthroscopy surgery can be performed.

Osteoarthritis is the non-inflammatory degenerative arthritis and can be examined and treated by arthroscopy. The frayed and irregular cartiledge can be seen, now days using the arthroscopy surgery the crevasses in the cartiledge can be repaired. Cartliedge cells are taken from the patient and harvested in the laboratory, where it grows and later on using the arthroscopy surgery it is pasted on the frayed cartiledge.

Rheumatoid arthritis is inflammatory arthritis, where patients can suffer from prolong and painful isolated swelling of the joints. Arthroscopic surgery can help these patients by removing the inflamed tissue joints known as (synovectomy). The tissue can then be examined to see if there is any other kind of infections.

Apart from arthritis any other joint, cartiledge or ligament tears, strains or deterioration can be examined and treated. Also loose tissues, foreign objects or chips of cartiledges or bones that might have got lodged within the joint can be removed with this method.

Preparation for Arthroscopy

The arthroscopy procedure is pretty easy and less painful than a surgery, but a patient’s condition is considered before conducting it. The important physical and medical conditions that are checked of a patient are blood pressure, the ability to withstand the anesthetic used, and existing heart or lung problems and whether they are adequate to function properly and the hemoglobin count. Patients suffering from diabetes, heart or blood pressure problems are given medication prior to the arthroscopy.

Why Arthroscopy

Many opt for arthroscopy over traditional surgery as there is less blood loss and less painful. Only two small incisions are made instead of opening the joint fully in arthroscopic surgery, one incision for the arthroscope and the other for the surgical instrument.  It reduces recovery time and due to less tearing of the connecting tissues the surgical success is likely to be more.

Taking care after Arthroscopy

There is likely to be swelling for seven to fifteen days where arthroscopy has been conducted. Numbness can follow with a bit of pain in the region when the effect of the anesthesia wears off. The patient is asked to take rest and elevate the joint where the procedure has taken place as well as apply ice pack. Exercise regime is set for the patient after some days; it will strengthen the muscle around the joint and prevent the surrounding issues from being scarred. In case of any problems the surgeon or the doctor must be consulted after arthroscopy.

Using magnetic fields for stimulating the nerve cells in brain can lead to the improvement in symptoms of depression. This procedure is called as Transcranial magnetic stimulation.

Transcranial magnetic stimulation is a relatively new procedure that is recommended in patients who do not respond to other standard treatments such as medications and psychotherapy.

Although the exact role played by transcranial magnetic stimulation in relieving depression is not clear, the magnetic pulses stimulate the nerve cells in brain and thereby improve the depression symptoms in patients.

Preparation for Transcranial Magnetic Stimulation

Transcranial magnetic stimulation is performed as an outpatient procedure in doctor’s office. There is no elaborative preparation needed as it is non-invasive procedure that doesn’t require anaesthesia.

  • Your psychiatrist will perform complete physical examination before surgery to ensure that it is a safe for you.
  • You may be asked to conduct blood tests or other laboratory tests to ascertain that you are medically fit for the procedure
  • You should inform your doctor regarding any medications you are taking as you may be asked to stop or adjust the doses of certain medications before the surgery
  • You should inform your doctor if you are pregnant or planning to get pregnant.
  • You should inform your doctor if there are any implanted metallic devices in your body because Transcranial magnetic stimulation is not recommended in such cases.
  • You should also inform the doctor of any previous surgeries or associated health conditions.

Duration of Transcranial magnetic stimulation

Patient needs a series of treatment sessions for optimal results. The procedure is usually performed daily at least five times a week for 5 to 6 weeks.

Transcranial magnetic stimulation procedure

Before the procedure, the psychiatrist identifies the most suitable region for placing the magnets on your head. Moreover, psychiatrist also decides about the optimal dose of magnetic energy for the treatment.

  • You may be asked to sit comfortably in a reclining chair and wear earplugs during the treatment.
  • Psychiatrist places an electromagnetic coil against your head. He/she switches the electromagnetic coil off and on repeatedly couple of times for producing stimulating pulses.  It causes a tapping sound that lasts only for few seconds followed by pause.
  • Doctor will determine the appropriate dosage of magnetic energy required and increases the magnetic dose until your fingers or hands begin to twitch.
  • Depending on your symptoms and side effects, the amount of stimulation is changed during the procedure.
  • After the placement and dose of electromagnetic coil are determined, your treatment begins and it lasts for about 40 minutes.

Risks of Transcranial magnetic stimulation

The Transcranial magnetic stimulation is a relatively safe procedure and causes mild side effects.

Most of these side effects are short term in nature and usually improve after the first week or two of treatment.

Common Side Effects

  • Headache
  • Lightheadedness
  • Spasms or twitching of facial muscles
  • Scalp discomfort at the site of stimulation
  • Tingling

Complications

In some rare cases, the procedure may lead to certain serious side effects.

  • Seizures
  • Mania in patients with bipolar disorder
  • Hearing loss due to inadequate ear protection

Results of Transcranial magnetic stimulation

  • In majority of the cases, depression symptoms will improve or diminish completely.
  • The optimal results are obtained after several weeks of treatment
  • Patient should continue to take antidepressant medication or attend psychotherapy sessions even after transcranial magnetic stimulation.
  • The effectiveness of transcranial magnetic stimulation may improve once the optimal sites for stimulation and numbers of stimulations needed are identified.

Brain Stimulation methods have been used successfully as effective treatment options for improving symptoms of chronic depression. They are usually recommended in patients who do not respond to other treatments.

A Vagus Nerve Stimulation is newly designed brain stimulation procedure where electrical impulses are sent into the patient’s brain for treating depression symptoms.

What is vagus nerve?

On each side of our body, a vagus nerve runs from brain through neck and chest to abdomen.

Indications for Vagus nerve stimulation

It is indicated as an added treatment for improving the symptoms of depression in patients who do not respond to following standard treatments.

  • Antidepressant medications
  • Psychological counselling (psychotherapy)
  • Electroconvulsive therapy (ECT)

Eligibility of vagus nerve stimulation

As per FDA guidelines, vagus nerve stimulation is performed in patients who satisfy below mentioned criteria.

  • Adults (age 18 or older)
  • Patients who have chronic and treatment-resistant depression
  • Patients who have not responded to antidepressant medications or electroconvulsive therapy (ECT)

Preparation for Vagus nerve stimulation

  • Your psychiatrist will perform complete physical examination before surgery.
  • You may be asked to conduct blood tests or other laboratory tests to ascertain that patient is medically fit for the procedure
  • Your doctor will prescribe antibiotics for preventing infection prior to the surgery
  • You should inform your doctor regarding any medications you are taking as you may be asked to stop or adjust the doses of certain medications before the surgery

Vagus Nerve Stimulation Procedure

During the vagus nerve stimulation, surgeon implants a device known as pulse generator in the chest of patient.  This pulse generator is connected to the left vagus nerve in patient’s neck through a wire threaded under the patient’s skin.

Doctors can monitor the activity of pulse generator and stimulates it to send out various electrical signals. These electrical signals are carried along the vagus nerve to the patient’s brain. It causes improvement in the symptoms of depression.

Risks of Vagus nerve stimulation

Although vagus nerve stimulation is a safe procedure, there are certain risks associated with surgery for implanting the device and during brain stimulation procedure.

Surgery risks

  • Pain at a point of incision
  • Infection
  • Heart problems
  • Incision scarring
  • Vocal cord paralysis
  • Breathing problems
  • Damage to the vagus nerve
  • Nausea

Side effects associated with vagus nerve stimulation

  • Chest pain
  • Cough
  • Throat pain
  • Voice changes
  • Breathing problems during exercise
  • Difficulty swallowing
  • Neck pain
  • Hoarseness
  • Prickling of the skin

Most of the side effects may improve over time, however certain side effects can be managed by adjusting the electrical impulses.

Other complications of vagus nerve stimulation

  • Pulse generator malfunction
  • Worsening of depression
  • Suicidal thoughts or behaviour

Results of Vagus nerve stimulation

  • In majority of the cases, depression symptoms will improve or diminish completely.
  • The optimal results are obtained after several months of treatment
  • Patient should continue to take antidepressant medication or attend psychotherapy sessions even after Vagus nerve stimulation.

How to prepare for Doctor’s appointment?

You are experiencing symptoms of depression and wondering what to do? You should stop worrying and think about seeking Doctor’s appointment. .

You should prepare for Doctor’s appointment because the appointments are usually brief and doctor needs to ask many questions.

Tips for preparing for doctor’s appointment

  • You should make a list of all the symptoms you are experiencing. You should also include those symptoms which may not be related to depression.
  • You should also make a list of recent major events in your life that had affected you including recent life changes.
  • You should also note down list of all medications you are taking including any supplements.
  • If you want to ask any questions from the doctor, you should prepare a list of such questions.
  • You should go for appointment along with a family member or friend for moral support. It is because you may not remember everything told by doctor. Also, your relative/friend may remember something that you might miss out.
  • As the time of appointment is limited, you should prepare a list of questions well in advance. Once the list is prepared, you need to prioritise the questions from most important to least important ones.

Basic questions to ask from your doctor

  • What are the major causes or symptoms of depression?
  • What are other possible causes apart from common symptoms?
  • What are the diagnostic tests for depression?
  • What are the various treatment therapies available for treating your depression?
  • What are the various alternative treatments suitable for your treatment?
  • What are the overall costs associated with treatment therapy?
  • Any restrictions that you should follow during the duration of treatment?
  • What are possible side effects for antidepressants medications?
  • Any generic alternatives available for the prescribed medicines?
  • Any brochures or printed material that you should read for learning more about disease?
  • Any recommended websites for learning more about disease?

During your conversation with your doctor, if you feel that you do not understand any terms or concept, you should not hesitate to ask.

Common Questions asked by Doctor

Your doctor may ask you many questions for identifying the exact cause of depression. You may prepare the answers for these questions well in advance so as to help the doctor in the diagnosis.

  • What are the various symptoms of depression experienced by you?
  • When did the first time, the symptoms of depression are noticed by you?
  • How long did the symptoms last?
  • What is the frequency of mood fluctuations?
  • Is there any set pattern for mood swings from feeling high to feeling low?
  • Any instances when you contemplate committing suicide?
  • How symptoms interfere with your daily life or relationships?
  • What is your daily lifestyle? Is it stressful?
  • Do you have any biological relatives with medical history of depression?
  • Do you have any associated disease or physical health conditions?
  • Are you addicted to smoking, alcohol or any other illicit drugs?
  • Do you have sleep disturbances?
  • Activities or any other things that improve your symptoms?
  • Activities or any other things that worsen your symptoms?

Thoracentesis or Pleural Fluid Sampling test is performed in severe cases of Pneumonia and other diseases that cause fluid accumulation in pleural cavity.

In case, you are wondering about Thoracentesis and why it is performed; let’s us understand the scenario where Pleural Fluid Sampling procedure is used.

In some severe cases of pneumonial infection/other diseases, the fluids gets accumulated in the space present between the lungs and the rib cage or diaphragm. This process of fluid collection is known as pleural effusion. It is usually detected on a Chest X-ray.

The sample of the fluid collected by pleural effusion is taken for analysis by the doctors. It is done for detecting the presence of germs in the fluid that had caused the infection.

Preparation for Thoracentesis

                     Patient may be shifted to a hospital for the procedure or it can be performed in the doctor’s clinic depending upon his/her medical condition.

                     Before the procedure, patient may be asked to sign a consent form that permits your doctor to perform this test.

                     Patient will be asked to undertake a chest x-ray or an ultrasound test prior to the procedure.

                     Doctor should be informed about any allergic reaction to the numbing medicine like lidocaine.

                     Doctor should be informed if patient is taking any medications such as aspirin, NSAID, or other drugs that affect blood clotting.

                     Patient may be asked to stop or adjust the dosage of various medications he/she is taking.

Thoracentesis Procedure

                     During the process, patient is asked to wear a hospital gown and made to sit on a bed. Patient is made to lean forward against the pillows.

                     Doctor uses stethoscope for listening to lungs sounds and slowly taps on the back for judging the amount of fluid collected in the pleural cavity.

                     Doctor applies the soap for disinfecting an area of skin and a small needle is applied for numbing a small area of skin between two lower ribs with the numbing medicine.

                     Doctor inserts a needle on an empty syringe into the fluid pocket and minor pressure is applied.

                     The syringe is used for collecting the fluid or it may be collected into bag by using plastic tubing.

                     Patient is instructed to hum out loud and avoid taking deep breath. The fluid is removed within 15 minutes and bandage is placed on back after the procedure.

Risks of Thoracentesis

Thoracentesis is usually a safe procedure with very less or no complications. However, there are few risks associated with the process.

                     Air leak may occur due to needle piercing the lung accidently. It is usually detected on X –ray and requires patient to spend few days in the hospital.

                     Infection or bleeding into the fluid space

                     Rapid pressure changes in your lung in case a large amount of fluid is removed

                     Pulmonary oedema due to leakage of fluids from bloodstream into the lungs

                     Shortness of breath

A Sputum evaluation test is recommended by the doctor in severe cases of Pneumonia. It is a very simple test and you need not put much effort in it. It is not only painless but also non invasive.

This test involves collection of sample of sputum from the patient and its subsequent analysis. It helps the doctor in detecting the type of germ that caused the infection.

Preparation for the test

There is no special preparation needed for the test. However, you may be asked to drink plenty of fluids the evening before the test. It helps in producing the sample of the sputum.

Sputum Evaluation Procedure

Your doctor may recommend you to get the sputum evaluation test done. It is indicated in cases where a patient is suspected to have pneumonia.

                    You will be asked to produce sample of your sputum by coughing out of your lungs.

                    This sputum is collected and sent to the doctor.

                    The doctor examines the collected sputum for identifying the kind of infectious agent like bacteria, virus, etc that had caused the infection.

Things to take care during the test

You should ensure that the cough needs to come from deep insure the lungs.

In case, your cough is too dry, you will be asked to breathe in a saltwater mist via a tube/mask. It helps in producing good phlegm sample by making you cough deeply.

Risks of Sputum evaluation test

The sputum evaluation test is a very safe procedure and there is no risk involved in the procedure.

After the procedure

Once the sputum test is over and sample is collected, it is sent to the technician. The technician stains the sputum sample and observes it closely using a microscope. The results of the stain test are available on the day of the test.

In some cases, doctor may ask the technician to grow the sputum culture. In this process, sputum is incubated for accelerating the growth of bacteria or any other germs present in it. These are used for further tests. The sputum culture needs several days to complete.

You would be amazed to learn that doctors remove a very small piece of lung for examination by performing lung needle biopsy. A lung needle biopsy is performed in severe complicated cases associated with lung and its tissues.

Doctors perform the biopsy after detecting the abnormalities on chest x-ray or CT scan.

The lung biopsy performed through the chest wall, is known as transthoracic lung biopsy.

Indications for Lung needle biopsy

                    Abnormal condition surrounding the lungs

                    Infections inside the lungs

                    Severe infection on the chest wall

                    To rule out the presence of cancer

Preparation for Lung needle biopsy

Patient should follow the below mentioned guidelines before lung needle biopsy procedure.

                    Patient is asked to not eat 6 – 12 hours prior to the procedure.

                    Patient should avoid certain medications like aspirin, NSAIDs or blood thinners, etc; few weeks before the procedure. However one should discuss with doctor before changing or adjusting the doses of these medications.

                    Doctors usually perform a chest x-ray or chest CT scan before the procedure.

                    Patient is administered with mild sedative for relaxation prior to biopsy.

                    Patient is asked to sign a consent form before the procedure.

                    Patient is asked to avoid coughing and remain as still as possible during the biopsy.

Lung needle biopsy Procedure

                    The exact spot for the biopsy is determined by using a chest x-ray or chest CT scan.

                    Patient is made to sit with his/her arms resting forward on a table. Patient is asked to avoid any coughing and remain still during the biopsy.

                    The small patch of the skin scrubbed and patient is asked to hold his/her breath. Doctor injects the local pain-killing medicine for numbing the area.

                    Doctor makes a small cut of about 0.12 inches into the skin and inserts the biopsy needle into the lung tissue. It is followed by removing a small piece of tissue with the needle.

                    The removed lung tissue is sent to laboratory for further examination. After the procedure, the bleeding is stopped by exerting pressure on the site.

                    Once the bleeding is stopped, a bandage is applied on the operated region. Patient is sent for chest X- ray immediately after the biopsy.

                    The time duration for the entire procedure vary from 30 – 60 minutes. The sample obtained from lung needle biopsy is sent for Lab analysis which takes few days to get completed.

Lung needle biopsy Results

The results of the lung needle biopsy are obtained after the analysis of obtained lung tissues is completed.

Normal Results indicate the presence of normal tissues and absence of any bacteria, viruses, or fungi.

Abnormal Results indicate the presence of following infections.

                    Bacterial or viral infection

                    Fungal lung infection

                    Cancerous cells

                    Pneumonia

Lung needle biopsy Risks

                    Occurrence of collapsed lung called as pneumothorax

                    Higher risk in case of certain lung diseases like emphysema

                    Air leakage from the lung that gets trapped in the chest

                    Risk of excessive bleeding (haemorrhage)

 

A chest X-ray is one of the simplest tests to be performed. It is not only painless but also non invasive. Your doctor will recommend chest X-ray to get detailed images of internal structures such as lungs, heart and blood vessels.

A chest X-ray assists in the diagnosis of conditions like pneumonia, chronic cough, chest pain,

shortness of breath, etc.

Preparation for Chest X Ray

You may follow the below mentioned points in order to prepare for Chest X ray.

                     Wear loose clothes like T-Shirt that can be easily taken off as you will be asked to undress from the waist up and wear a gown.

                     Avoid wearing metallic objects such as jewellery, eye glasses, belts, etc; while going for the chest X-ray. It is required so that there is no interference between metals and X-ray Image.

                     Inform the X-ray technician about any body piercings done by you on your chest.

                     Inform the doctor if you are pregnant as X ray test are usually avoided during pregnancy.

Chest X Ray Procedure

A Chest X ray procedure is performed by an X-ray technician and total time duration of the test is usually 15 minutes.

                     You will be taken to the X-ray room, and asked to undress from the waist up and wear gown.

                     You may be asked to stand, sit, or lie for the chest x ray as directed by your doctor. You need not worry as the technician will assist in maintaining correct position.

                     You will be covered with heavy lead apron for protecting your other body parts from radiation.

                     The X-ray technician will operate the X-ray machine and takes two view of the chest including back view and side view.

                     Back view: You need to sit or stand for resting your chest against the image plate. The x-ray tube is placed behind you.

                     Side view: You need to stand side ways and keep your arms above your head.

                     In case, you will be asked to lie down, you will need to lie down on table with X-ray tube located over the table.

                     During the procedure of taking X-rays images; you are required to remain still and hold your breath for a few seconds.

                     After the images are taken, they are checked by X-ray technician for their quality. The procedure is repeated if the quality of images is not good enough.

·         After the procedure

                     You may go home after the test and resume your normal activities. A radiologist will analyze the X-rays and prepare a report.

                     You may obtain your reports and show them to your doctor. Your doctor will observe the X-rays images and discuss the results with you.

Risks of Chest X Ray

Although the amount of radiation in Chest X-ray test is very small, it carries few risks.

During the procedure, patient is provided with a lead apron for protecting certain body parts from the harmful effects of radiation.