Contraception

 

 

 

 

J.L., a 27-year-old account executive, presents to the family medicine office for her annual checkup with her primary care provider. She has no significant past medical history except heavy menses. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. She is interested in a reliable form of contraception. After discussing the various contraceptive options, she is here for contraceptive counseling.

Questions:

1. Before prescribing an OCP regimen, what tests or examinations would you like to perform?

2. Identify three different contraceptive regimens that could be chosen for J.L. Note their differences and why you chose them.

3. Identify the potential side effects that need to be relayed to J.L. Note especially those side effects for which J.L. should seek immediate medical care.

 

 

Sample Solution

There are a number of methods available to help prevent pregnancy. Oral contraceptives are the most widely used form of contraception. Medical history and blood pressure measurement are the most useful screening approaches to detect contraindications to hormonal contraception use. Before you get birth control pills, your doctor may want you to have a pelvic exam with a Pap test. Your doctor should get a complete medical history before giving you a prescription for birth control pills. There are three types of oral contraceptive pills: combined estrogen-progesterone, progesterone-only, and continuous or extended use pill. The birth control pill is the most commonly prescribed form of contraception.

 

11 Dec ‘14339964.5/5

Brush with death

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By Nicholas Klacsanzky

GanpatipuleI was on an excursion in Ganapatipule, which is a town on the coast on the west side of India, arranged right on the Indian Ocean. I was with my long-term companion, Janu, and his mom, remaining in an inn for a couple of days. The get-away so far was the epitome of unwinding: eating crisp mangoes, getting up late, feasting out constantly (for the most part fish curry), swimming a couple of times each day in the Indian sea, and kidding around with old buddies.

Around three toward the evening on a cloudless day, the sea shore on our side was vacant of individuals other than my companion, his mom, and I. It was liberating to be distant from everyone else on this immense sea shore, known to be a blessed spot among Hindus. Ganapatipule is named after the god Ganesh, and there is a popular Ganesh hallowed place close there where a swayambhu (a model raised from the earth itself as a divine being) is venerated. Washing in the sea around this region should scrub individuals of their pessimism and visiting the place of worship decontaminates people also.

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As I began to swim in the warm sea, hopping over waves, I abandoned my companions. I was wearing a white kurta, or a conventional clothing for men in India, which was overwhelming in the water, however my feet was effectively contacting the sea floor consistently. I generally washed my garments by swimming in the sea when I was there.

In any case, at one moment, I felt that my feet couldn’t contact the sea floor any longer and I dove into the water, weighted somewhere near my garments. The waves continued coming and now they were threatening, as I was getting sucked into the profundities each opportunity they came—regardless of whether I emerged from the water and attempted to swim back to the piece of the sea where I could get an a dependable balance. I had been sucked into a riptide, truth be told, and was stuck in a plunging valley, in spite of my hard endeavors to arrive at security and my hollering to my companions out yonder.

In the wake of battling intensely for a couple, long minutes to conflict with the suction of the riptide, and yelling to my companions out there close to the shore without much of any result, I started to unwind, tolerating my destiny. I never again battled to arrive at the edge of the sea valley to get a decent footing, and during the time spent being maneuvered into the sea and returning up to the surface, I conversed with God so anyone can hear. I talked about what I had fouled up in my life and what I did well. I closed in reflection that my life was satisfying generally speaking, and I felt prepared to bite the dust, tolerating the current condition as the real world.

However as soon I gave up myself to the circumstance, a gigantic wave came and pushed me out of the riptide and the profound valley I was sucked into. On the float of the wave, I arrived close to my companions, who appeared to be bewildered at my demeanor and my expressions of depiction. They were ignorant that I experienced been difficulty. However, it didn’t make a difference at that point—I was glad to arrive at land again and felt my life was reestablished.

I later took in the time I swam was foreboding for swimming at Ganapatipule, as the locals accept the god Ganesh washes around three in evening in the sea there. Maybe Ganesh pardoned me for the interruption, and discharged me from the resentment of the sea against divine convention.

 

 

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