Paediatric Posting : 8th term

yeay!

I can play with the kids again!
Well, if they are not crying or getting irritated by us...

Yep,
 Dealing with petite patients requires patience and intelligence. And of course high level of perseverence to get the bloody blood pressure, to palpate their pulses,to listen to their heart beat,to check their ocular movements, to palpate their abdomen and do all complex cranial nerves examination all in 1 and half hour.

We finished our final year theory classes at 9am. Walking or waiting for bus to get us to the hospital and reached there by 9.15am. Go to Out Patient Deparment and any concerned doctor in charge on duty to take our attendance and off we go to wards which is situated at 5th floor. Going up the stairs everyday made me thinking that i can loose some extra calories residing at the lower portion of my body. So, i simply insist and tried not to use the lift as often as i can.

We start our posting at wards by 9.30am. Put the bags down, bring two different books, a note, a red pen, a blue pen, stethoscope knee hammer,measuring tape,tuning fork and we are set to go to find any relevant cases pertaining to our level of knowledge worthy to be presented to the doctors on duty.

Me being a foreigner in this foreign land, makes it hard for me when it comes to taking the history from patients. Well, tried not to make the communication barrier as an excuse not to take cases by my self. At least, i tried to actively join the discussion and prompt my fellow Indian friends any relevant questions pertaining to patients complaint and history. It has to be done neatly, a detailed and as accurately as we can if we do not wish getting yelled by doctors.

I learned basic instruction words in local language so i can do the examination part on my own and try not to depend to much on other people. As for taking the history, i got no choice other than waiting for my friends to finish talking to patients and discuss with me what else to ask to the patients.

Kids are difficult to deal with if u do not have the basic knowledge of them. They are scared by white coats, the glasses, and strangers. They cry when we get closer to them.They sob and finds the mother's warm hug as 20 studenst in white coats approach them. If they are not in pain,comfortable and playfull, we are lucky enough to get the case complete till the examination part. With the kids crying and constantly disrupts the conversation between mother and us, we couldn't even finish the history of presenting illness. The case will only be done halfway, and haphazardly not in order. Soon, when the doctors come around and when we still did not finish our job, get ready for the yelling and heartfelt-condemning words during presentation.

I have one more weeks to go. Hopefully, i survive this time.

Esok medicine.

Bace tak habes lagi.

Yang dah bace belum tentu ingat.

Otoke?

Yang penting habiskan.

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Faces in Medicine

Must see post
From left to right:
1. Acromegalic facies
2. Adenoid facies
3. Amiodarone facies

4. Bell's palsy
5. Bird facies
6. Asymmetric crying facies
7. Bovine facies
8. Chipmunk facies
9. Cushingoid facies
10. Elfin facies
11. Gargoyle facies
12. Leonine facies
13. MEN-2B Syndrome
14. Parkinsonian facies
15. Flat facies
16. Mitral facies
17. Hatchet facies
18. Snarling facies
19. Thyrotoxic facies
20. Myxedematous facies

Acromegalic facies (Acromegaly)
Large supraorbital ridge and frontal
bossing, thickened lips, enlarge
tongue, lower jaw firm and square
(protruding jaw = prognathism)

Adenoid facies (Adenoid
hypertrophy)
Long, open-mouthed, dumb-looking
face of children

Amiodarone facies
Deep blue discoloration around malar
area and nose

Bell’s palsy (Facial nerve
dysfunction)
The eyelids on the paralyzed side can’t
close. The mouth is drawn to the
unparalyzed side, producing a
somewhat grotesque appearance.
Food and drink dribble from the
mouth on the paralyzed side. The eye
with the involved lid dries due to
decreased tear production.

Bird facies (Pierre Robin
Malformation)
Small lower jaw, a slit like hole in the
palate of mouth (called cleft palate)
and the tongue appear to fall into the
throat (condition called as
retroglossoptosis)

Assymeteric crying facies (Cayler
cardiofacial syndrome)
Asymmetric appearance of the oral
aperture and lips at rest, but
significant depression of one side of
the lower lip with animation (crying or
smiling)

Bovine facies (Craniofacial
Dysostosis or Crouzon syndrome)
Convex nasal profile, shortened
mandible, macroglossia

Chipmunk facies (B-Thalassemia
major, Bullimia nervosa, Parotid
swelling)
Expanded globular maxillae, with BM
hyperexpansion into facial bones,
combined with prominent epicanthal
folds

Cushingoid facies (Cushing
syndrome)
A rounded face with a double chin,
prominent flushed cheeks, and fat
deposits in the temporal fossa and
cheeks

Elfin facies (William’s Syndrome)
Sunken nasal bridge, puffiness
around eyes, epicanthal fold, blue
starry eyes, long upper lip length,
small and widely spaced teeth, small
chin

Gargoyle facies (Hurler syndrome)
Head is large and dolichocephalic,
Tywith frontal bossing and prominent
sagittal and metopic sutures, with
mid-face hypoplasia, depressed nasal
bridge, flared nares, and a prominent
lower 1⁄3 of face, thickened facies,
widely spaced teeth and attenuated
dental enamel, gingival hyperplasia

Leonine facies (Lepromatous
Leprosy)
Peculiar, deeply furrowed, lionlike
appearance of the face

MEN 2B Syndrome
Usually there are numerous
yellowish-white, sessile, painless
nodules on the lips or tongue, with
deeper lesions having normal
coloration. There may be enough
neuromas in the body of the lips to
produce enlargement and a
“blubbery lip” appearance. Similar
nodules may be seen on the sclera
and eyelids.

Parkinsonian facies (Parkinsonism)
Mask-like, tremor of head, absence of
blinking, dribbling of saliva, weakness
of upward gaze, seborrhoea and
sweatiness

Flat facies (Down syndrome)
Flat appearing face, small head, flat
bridge of the nose, smaller than
normal, low-set nose, small mouth
which causes the tongue to stick out
and to appear overly large, upward
slanting eyes, epicanthal fold,
rounded cheeks, small misshapen
ears

Mitral facies (Mitral stenosis)
Rosy, flushed cheeks and dilated
capillaries

Myotonic or Hatchet facies
(Myotonic dystrophy)
Tented, open mouth, elongated face
and blunt affect

Snarling or Myasthenic facies
(Myasthenia gravis)
Drooping of the eyelids and corners of
the mouth and weakness of the facial
muscles

Thyrotoxic facies (Grave’s disease)
Alert, startled, flushed and anxious
appearance. Protrusion of of one or
both eyes (exopthamlos) associated
with retraction of the upper eyelids
(lid lag) which results in the exposure
of white conjunctiva above the cornea
(Von-Graef’s sign)

Torpid or Myxedematous
(Myxedema)
Skin generally thickened, alopecia,
periorbital oedema, xanthelasma,
coolness and dryness of skin and hair,
thinning of scalp hair, tongue swelling.

Others:
1. Ashen gray facies (Myocardial
infarction)
2. Cockayne facies (Cockayne
syndrome)
3. Frog like facies (Intranasal disease)
4. Hepatic facies (Chronic liver disease)
5. Hippocratic or Cachectic facies (close
to death after severe and prolonged
illness like Malignancy)
6. Marshall halls facies (Hydrocephalus)
7. Monkey facies (Marasmus)
8. Mouse facies (Chronic renal failure)
9. Pagetic facies (Paget’s disease)
10. Ricketic facies (Rickets)
11. Uremic facies (Uremia)

OBG : Presentation day again

1st Day. Unit 1.

Its going to be a free-willy journey. The stafs arent so scary and arent emotinal either.

They looked 'tamed' and full of love and passion to teach. Heheh.
Maybe i wont have to be so stiff around them during viva.

I just finished copying history and examination from fellow tempe. Today,i just need to palpate and tally everything with what i have written. At least i have to see and palpate her myself when my friend had already helped me with the case writing.

Let her finish partography and within 20 minutes i can palpate her.

Will i continue to be as consistent as i am right now?

Do pray for me.

Know what? I had my MCQ Obg today evening.
Only 3 questions were given but i failed to do well.
Maybe next time. So,please get ready tomorow. Dr LM will read the most interesting answers...

(--__--)"

Q.
.
1) Define caeserean section. Mention absolute indication for caeserean section.

2)Name the layers insiced and the layers sutures according to chronological order.

3) Name the complications that can occur during c.sect. Mention the difficulties of thus procedure.

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OBG : Final day with ease

Saturday, final day unit 2 OBG.

Ho yeah~! *\(*u*)/*

No more hospital melodrama. No more kena leter dan kena marah.

Last day in unit 2 was magnificent! Although i was a bit nauseated and a bit uneasy during normal vaginal delivery at  labour theater, i finally realized that how much strength Allah gave to women to endure the pain during labour. At first , that female was yelling and screaming "amma appa..ayyooo" in so much pain and accompanied by the yelling of the PGs who tried to calm her down, my ear and my head began to be in pain. "Amma, chill madi!", said the male PG in charge while he was holding a episiotomy scissor  getting ready to cut her 'down' there. I can see everyone's forehead fill with wrinkles and sneering faces. Cut her some slack please! She was in pain! I can't help my self but to frown too. But, i had different reason. I just want the staff to treat her better. No wonder lah, many people said that during labour, the staffs always yells at the pitiful mothers who doesn't even have their husbands to accompany them. I wonder if my-husband-to-be will be able to hold my hand and be with me along the way in labour. Maybe, one day i can have my own hospital exclusive for women in labour where all the staff are nice and caring and most importantly, i want to hire only FEMALE staffs to work with me. At least, i can provide a choice to mothers who are unwilling to have a male doctor putting his hands in side her vagina, slicing them and watching them in pain.

I knew that all medical students have to master in every subject reagardless of the gender monopoly (im trying to say that male doctors have to learn and see female anatomy, and vice versa), but as a Muslim, i have responsibility to provide healthcare that emphasizes not only to medical care and supervision but also supervision and care from aurh( areas where non marriable people can't see) invasion.

After watching the delivery in a cloudy-state-of-mind, we dashed off to wards to finish writing our history presentation case.This time my teammates pleaded me to present the case as i have the non-jackable-non-anger inducing-face regardless of my mistakes i do during presentation. Like what they have predicted, Dr S who was known to be very aggresive  in taking viva and presentation didn't even bother to get angry as i was caught bluffing with a smiling face. I can clearly remember her saying " if you want  to bluff the vitals score or the examintion, at least put it at a normal level..." with a sinister face. Hihih, gomenne mera dhosti! I was in a hurry to copy the case sheet and present it without noticing the abnormal levels! Haha, i told you i can't lie with a straight face! Cikgu, sorilah. We didnt mean to cheat you by not taking the measurement and examined her ourselves,its just that we don't have adequate time to finish taking the case.Plus, the patient went to USG examination. So, we had to make up the history ourselves! Teehee! Sorry! (--_--)''



Baru teringat nak update pasal pesakit cancer ovari. Yup, haritu, sempatlah jugak palpate patient ni. Abdomen dia penuh ngan air(ascites). So, bila masuk OT cegu sedutlah segala air dalam abdomen tu. Teringat jugaklah yang dia panggil cekgu surgery untuk buat stage laparoscopy. Puihhh, buakan main banyak lah ketul-ketul air(cyst) yang dah merebak kat usus kecil dia. Impression diagnosis : Sero-mucinous ovarian cyst.

p/s: Argh...sakit hati pulak bila tak sempat nak tengok macam mana PG tu suture episiotomy incision tu. 

OBG : Its a BOY

Day three,week three in unit 2.


Tak lama lagi masuk unit 1 yang cool and sporting.
Sila sabar untuk tiga hari lagi.



Today we got to see a baby. Finally after two weeks posted in unit 2 i can finally see a baby being born into this world. It was an elective caesarean section. The babt was healthy and cried immediately after cord was clamped. Seronok betol bila dengar baby nangis.

Heheh, BYu memang suke menyakat budak. Suka sangat buat diorang nangis. Dah maen,pukkk huaawaaawaaa. ...lepas tu lari jauh-jauh. Jahat tol kak awe ni.

Ok. Viva di OT hari ni.

- caeserian section
- adnexal tu sebenarnya ovary n tube.
-management of pre, during n post c section patients
-Absolute indication n relative indication of c sec.
-steps of c sec.
-suturing the layers of incised uterine layers.ar lower part,how long,which material,which method of suturing.
-advice to patients after discharge.

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OBG : Week Three 9th term

Day 13.

Its OT day again. Every alternate days in unit 2 OBG, we have OT. On wednesdays at 11am we have theory class with Dr. DKS in OPD.

Case we've seen in fibroid uterus. Its a 34 yr old female,unmarried,had h/o bleeding pv, abdominal mass... It was BIG! Maybe around 3-4kg. Lots of bleeding during myomectomy. She was conscious all the way due to epidural anaesthisia.

The HUGE BUT!

Before we were allowed to enter the room,i could see the VULGARITY of surgical procedure. She is unmarried and we could assume that she had not been sexually active,hence had never been exposed physically in front of anyone in her life.
However,like what my mom uses to tell ;

"Once in the OT, everything will be EXPOSED and you are no longer subjected to privacy."

It felt horrible towards the lady,who is conscious and aware that a lot of people are staring at her lower private part including the OT male assistant(the one who angkat her onto the bed since she is quite obese),male OT assistant,the male interns, the male medical students, the doctors and the anaestheticians.

Yeah. I knew that in a teaching hospital, this kind of situation is common.Nevertheless,if we put ourselves in her place,imagine the trauma and horrifying experience of being exposed in front of so many people that she had never seen in her life. I can just geleng kepala aje.

Well,what to do kan? If you want a cheaper cost of treatment at the expense of infiltration of your body privacy, teaching hospitals in the usual way out of financial insufficiency.

It is unbelievable that the ones that offer complete care of women physical privacy makes their patients pay for what supposed to become their human rights. Yeap,it is the 'special service,special price policy' nowadays.

*sighs*

Sempat jugak borak about my very first experience of warching normal vaginal delivery and reminincing the joy of endorphins running through my veins all day. It was an AWESOME feeling i had ever had. I just couldnt stop smiling! Hekk, it is even better from getting all A1's in SPM or getting having had to receive thr scholarships etc... It is a complete PURE OF JOY and HAPPINESS that i felt that day. It is a miracle of the birth of a life to this world and that feeling of ecstacy is what i am searching for in this path i have chosen.

Come on dear ME!

Wake up and remember that feeling!
Yosh!

Gosh! Tomorow we will have MCQs on caesarean section in class. Wish me luck! ^_^

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OBG :Lesson learned

Dr D.K.S. Graduated in Europe,did his internship there andcame to his homeland to serve his people.

Today,i've bewn reminded again how difficult to vain knowledge in medicine.

"You people are all USELESS peole! "

"You people dont even know the basic!"

"You are all BLOODY LAZY! "

"You don't even have any initiatives to read and find the basics in clinicals. Theory is important but during end of posting, your understanding in assessing the case is much more superior than your theory knowledge. "

Shame on me.

Shame.

Than goes on and on asking the basic questions. Nk one dared to answer. All of us are quiet as people at the funeral. He kept saying that we have to speak up and do mistakes now and nog during exams in which good examiners will never let IGNORANT medic students to PASS.

Passing is all i need. Distinction or first class won't even matter anymore. To pass is almost a miracle to me.

Dear me,please dont be disheartened by what they say. They are just doing their job as a teacher. Without them,you wont be here.

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OBG - Ot day

Yup,it is the second week of OBG postings. Today,the weather is super awesome!

Imagine yourself sitting in a nearly empty bus,the chilled breeze blew softly to your cold face,when you outside through the window, the only thing your eyes could see thick-magical-like mist surrounding the bridge. The bus ride seems more like a cloud ride to Alice's Wonderland.

What a good feeling to start your day.


Today, we were posted in OT. Again,got scolded by Dr N.

"You people never take the case before coming to OT! "

"Always shaking heads when asked!"

"You people dont know anything at all. Already ninth term but donno anything!"

"You people should come and see the case first before coming to OT."

Scoldings,nagging,smirking,jagging. All become our daily breakfast in OBG.

Ahah. I shall stop here. No more complaints ok. This was all things they should do. At least they nag and say something to wake us up. It would be worse to have staffs who doesnt even care to nag when we dont know the answers... Let them do their job dear.



Now..coming to the viva in OT.

-Differrence between thr pseudo and true broad ligament in fibroid uterus?

- Indications of hysterectomy and myomectomy. Age wise,family completion,recurrence,

-History findings in ovarian mass and uterus mass.

-Clinical features in mass per abdomen in ovarian mass and uterus mass.

-Complications of ureter injuri during operation.

-Post menopausal bleeding causes.

-Dysfunctional uterine bleeding.

-What can you feel when palpating mass per abdomen? Give differential diagnosis.

-Cystic feeling,firm consistency,Grooves sign.Bimanual feeling,continouity of mass in uterus through cervical examination.

-DNC,Currete instrument,Abortion.

-Menstrual irregularities in mass per abdomen.

-Why there is menorhagia in post menopausal women?
=Increase surface area,hyperplasia of the endometrium due to oestrogen level increase.

- DX of Surgical causes of mass per abdomen.TB,retroperitoneal carcinoma,...

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The Health Benefits of Water Fasting

By Stephen Harrod Buhner

Written 2003
Copyright © 2003 Stephen Harrod Buhner

Fasting is an exceptionally ancient, and powerful, approach to healing many common disease conditions. It allows the body to rest, detoxify, and to heal. During fasting the body moves into the same kind of detoxification cycle that it normally enters during sleep. It uses its energy during a fast, not for digesting food, but for cleansing the body of accumulated toxins and healing any parts of it that are ill. As a fast progresses the body consumes everything that it can that is not essential to bodily functioning. This includes bacteria, viruses, fibroid tumors, waste products in the blood, any build up around the joints, and stored fat. The historical record indicates that human beings are evolutionarily designed to fast. It is an incredibly safe approach to healing and the body knows how to do it very well.

The Physiological Changes of Fasting
Many of the most dramatic changes that occur in the body during fasting take place on the first three days of the fast. These occur as the body switches from one fuel source to another. Normally, the primary form of energy the body uses for energy is glucose, a type of sugar. Most of this is extracted or converted from the food we eat. Throughout the day, the liver stores excess sugar in a special form called glycogen that it can call on as energy levels fall between meals. There is enough of this sugar source for 8-12 hours of energy and usually, it is completely exhausted within the first 24 hours of fasting. (However, once the body shifts over to ketosis or fat as fuel, this new fuel is used to also restore the body's glycogen reserves.)
Once the liver's stores of glycogen are gone, the body begins to shift over to what is called ketosis or ketone production - the use of fatty acids as fuel instead of glucose. This shift generally begins on the second day of fasting and completed by the third. In this interim period there is no glucose available and energy from fat conversion is insufficient but the body still needs fuel. So it accesses glucose from two sources. It first converts glycerol, available in the body's fat stores, to glucose but this is still insufficient. So it makes the rest that it needs from catabolizing, or breaking down, the amino acids in muscle tissue, using them in the liver for gluconeogenesis, or the making of glucose. Between 60 and 84 grams of protein are used on this second day, 2-3 ounces of muscle tissue. By the third day ketone production is sufficient to provide nearly all the energy the body needs and the body's protein begins to be strongly conserved. The body still needs a tiny amount of glucose for some functions, however, so a very small amount of protein, 18-24 grams, is still catabolized to supply it - from 1/2 to 1 ounce of muscle tissue per day. Over a 30 day water fast a person generally loses a maximum of 1-2 pounds of muscle mass. This conservation of the body's protein is an evolutionary development that exists to protect muscle tissue and vital organs from damage during periods of insufficient food availability.
From the third day onward the rate of the breakdown of fatty acids from adipose or fat tissue continues to increase, hitting its peak on the tenth day. This seven day period, after the body has shifted completely over to ketosis, is where the maximum breakdown of fat tissue occurs. As part of protein conservation, the body also begins seeking out all non-body-protein sources of fuel: nonessential cellular masses such as fibroid tumors and degenerative tissues, bacteria, viruses, or any other compounds in the body that can be used for fuel. This is part of the reason that fasting produces the kind of health effects it does. Also, during this period of heightened ketosis the body is in a similar state as the one that occurs during sleep - a rest and detoxification cycle. It begins to focus on the removal of toxins from the body and the healing and regeneration of damaged tissues and organs.

Fasting and Healing
Fasting has been found to help a number of disease conditions, often
permanently. There have been a number of intriguing clinical trials and studies treating numerous disease conditions with fasting. Here are some of those findings.

* In one clinical trial of hypertension and fasting, 174 people with hypertension were prefasted for 2-3 days by eating only fruits and vegetables. They then participated in a 10-11 day water only fast, followed by a 6-7 day post fast in which they ate only a low-fat, low- sodium vegan diet. Initial blood pressure in the participants was either in excess of 140 millimeters of mercury (mm HG) systolic or 90 diastolic or both. Ninety percent of the participants achieved blood pressure less than 140/90 by the end of the trial. The higher their initial blood pressure the more their readings dropped. The average drop for all participants was 37/13. Those with stage 3 hypertension (over 180/110) had an average reduction of 60/17. All those taking blood pressure medication prior to fasting were able to discontinue it. Fasting has been shown in a number of trials like this one to be one of the most effective methods for lowering blood pressure and normalizing cardiovascular function. Blood pressure tends to remain low in all those using fasting for cardiovascular disease once fasting is completed.

* Fasting is exceptionally beneficial in chronic cardiovascular disease and congestive heart failure, reducing triglycerides, atheromas, total cholesterol, and increasing HDL levels.

* Fasting has been found effective in the treatment of type II diabetes, often reversing the condition permanently.

* Because of its long term effects on metabolism, fat stores in the body, leptin, and disease conditions associated with obesity, fasting has been found to be one of the most effective treatments for obesity.

* A number of studies have found that fasting is beneficial in epilepsy, reducing the length, number, and severity of seizures. Fasting is especially effective for helping alleviate or cure childhood epilepsy.

* In a 1988 trial of 88 people with acute pancreatitis, fasting was found better than any other medical intervention. Neither nasogastric suction or cimetidine were found to produce as beneficial effects as those from fasting. Symptoms were relieved irrespective of the etiology of the disease.

* A number of studies have found that fasting is effective for treating both osteoarthritis and rheumatoid arthritis. Fasting induces significant antiinflammatory actions in the body and researchers found decreased ESR, arthralgia, pain, stiffness, and need for medication.

* Autoimmune diseases such as lupus, rosacea, chronic urticaria, and acute glomerulonephritis have all responded well to fasting.

* Severe toxic contamination has been shown to be significantly helped with fasting. Clinical trials have found that people poisoned with PCB experienced "dramatic" relief after 7-10 day fasts.

* Poor immune function improves during fasting. Studies have found that
there is increased macrophage activity, increased cell-mediated immunity,
decreased complement factors, decreased antigen-antibody complexes, increased immunoglobulin levels, increased neutrophil bactericidal activity, depressed lymphocyte blastogenesis, heightened monocyte killing and bactericidal function, and enhanced natural killer cell activity.

* Other diseases that have responded to fasting are: psychosomatic disease, neurogenic bladder, psoriasis, eczema, thrombophlebitis, varicose ulcers, fibromyalgia, neurocirculatory disease, irritable bowel syndrome, inflammatory bowel disease, bronchial asthma, lumbago, depression, neurosis, schizophrenia, duodenal ulcers, uterine fibroids, intestinal parasites, gout, allergies, hay fever, hives, multiple sclerosis, and insomnia.

* The historically lengthy claim that fasting increases life span is beginning to garner some support in research literature. Regularly repeated 4-day fasting has been found to increase the life span in normal and immunocompromised mice.

* Although the use of fasting in the treatment of cancer is controversial, there is some emerging data SHOWING that fasting helps prevent cancer. Intermittent fasting (2 days weekly) has shown an inhibitory effect on the development of liver cancer in rats.

People Who Should Not Fast
Although most people can fast, there are a few who, because of special
conditions, should not.

* People who are extremely emaciated or in a state of starvation
* Those who are anorexic or bulemic
* Pregnant, diabetic women
* Nursing mothers
* Those who have severe anemia
* Those with an extreme fear of fasting
* Those with porphyria. Porphyria refers to a genetic metabolic defect that affects the body's ability to manage porphyrins. Porphyrins are a group of compounds that combine with iron to produce blood, are involved in the control of electron transport systems, and, within mitochondria, are intricately involved in the production, accumulation, and utilization of energy. Porphyria can cause malfunctions in the liver, bone marrow, and red blood cells and produces a wide range of symptoms including seizures.
* People with a rare, genetic, fatty acid deficiency which prevents THE INITIATION OF KETOSIS. This is a deficiency involving the enzyme acetyl-CoA, a mitochondrial fatty acid oxidation enzyme, that is essential to ketosis. Those with this deficiency who do fast can experience severe side effects, including hepatic steatosis, myocardial lipid accumulation, and severe hypoglycemia.

A Note on Pregnancy, Children, and Fasting
Although many fasting texts suggest that pregnant women not fast, those that have been found to suffer side effects were also diabetic. Ketosis during pregnancy can seriously harm the fetus if the mother is diabetic. Fasting during pregnancy if a woman is not diabetic has not been found harmful to either mother or fetus. However, fasts for nondiabetic pregnant women should be no longer than 2-3 weeks duration and be monitored by a health care provider. Children, even infants, can also fast without complications if the fasts are of relatively short duration. For infants 2-3 days, children 1-2 weeks depending on age. These fasts should also be monitored by a health care provider unless of short duration. The need for infants and young children to fast is rare.

Those Who Should Fast Under Health Care Supervision
While most people can fast safely there are some that should do so only under the supervision of a health professional experienced in fasting for healing.

* Those with serious disease conditions
* Pregnant women
* Infants and young children
* Type I diabetics
* Those with insufficient kidney function
* Those who are extremely afraid of fasting yet wish to do so anyway
* People with a high toxic contamination level of DDT. DDT is stored by the body in a highly concentrated form in fat tissue. Fasting can release huge levels of DDT into the bloodstream as the fat stores are released. This can be quite dangerous.