tag:blogger.com,1999:blog-63519968468160831252024-03-06T12:02:02.658-08:00Dr. B C Shah general and laprascopic surgeonAnonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.comBlogger42125tag:blogger.com,1999:blog-6351996846816083125.post-42684136691934052552013-06-10T03:57:00.000-07:002013-06-10T03:57:00.771-07:00Rectal Cancer (Bowel Cancer)<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiujGZSczH_SM_Z_pVLd3hXoQ_FH1B3dTWF_gQ_n6iKOF9xaCqB8zE3v_8PTH7BUOi-Ktuben-9uy7c-lQwDYSF6R-ZlhXZdj5PoxVmnU6-y1BU_JwTa44H_qnO58H9V0EBMOGW1lsbDGM/s1600/Rectal-Cancer-Bowel-Cancer.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="296" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiujGZSczH_SM_Z_pVLd3hXoQ_FH1B3dTWF_gQ_n6iKOF9xaCqB8zE3v_8PTH7BUOi-Ktuben-9uy7c-lQwDYSF6R-ZlhXZdj5PoxVmnU6-y1BU_JwTa44H_qnO58H9V0EBMOGW1lsbDGM/s320/Rectal-Cancer-Bowel-Cancer.jpg" width="320" /></a></div>
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Introduction</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="http://drbcshah.com/rectal-cancer-bowel-cancer/" target="_blank">Bowel cance</a>r is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon cancer or rectal cancer.</strong></div>
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Symptoms of bowel cancer include blood in your stools (faeces), an unexplained change in your bowel habits, such as prolonged diarrhoea or constipation, and unexplained weight loss.</div>
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Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.</div>
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Who is affected by bowel cancer?</h2>
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Bbowel cancer is the third most common type of cancer.</div>
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Approximately 72% of bowel cancer cases develop in people who are 65 or over. Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum.</div>
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Who's at risk?</h3>
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Things that increase your risk of getting bowel cancer include:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Age – around 72% of people diagnosed with bowel cancer are over 65</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Diet – a diet high in fibre and low in saturated fat could reduce your bowel cancer risk, a diet high in red or processed meats can increase your risk</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Healthy weight – leaner people are less likely to develop bowel cancer than obese people</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Exercise – being inactive increases the risk of getting bowel cancer</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Alcohol and smoking – high alcohol intake and smoking may increase your chances of getting bowel cancer</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Family history and inherited conditions – aving a close relative with bowel cancer puts you at much greater risk of developing the disease.</li>
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Bowel cancer screening</h2>
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Currently, everyone between the ages of 60 and 69 should go for bowel cancer screening every two years.</div>
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Screening is carried out by taking a small stool sample and testing it for the presence of blood (faecal occult blood test).</div>
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In addition, an extra screening test is being introduced over the next three years for all people at age 55. This test involves a camera examination of the lower bowel called a flexible sigmoidoscopy.</div>
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Screening plays an important part in the fight against bowel cancer because the earlier the cancer is diagnosed, the greater the chance it can be cured completely.</div>
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Treatment and outlook</h2>
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Bowel cancer can be treated using a combination of surgery, chemotherapy, radiotherapy and, in some cases, biological therapy. As with most types of cancer, the chance of a complete cure depends on how far the cancer has advanced by the time it is diagnosed.</div>
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If bowel cancer is diagnosed in its earliest stages, the chance of surviving a further five years is 90%, and a complete cure is usually possible. However, bowel cancer diagnosed in its most advanced stage only has a five-year survival rate of 6% and a complete cure is unlikely.</div>
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Signs and symptoms of bowel cancer </h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Early bowel cancer may have no symptoms and some symptoms of later bowel cancer can also occur in people with less serious medical problems, such as haemorrhoids(piles).</strong></div>
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See Dr. B C Shah if you notice any of the symptoms below.</div>
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The initial symptoms of bowel cancer include:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Blood in your stools (faeces) or bleeding from your rectum</li>
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As bowel cancer progresses, it can sometimes cause bleeding inside the bowel. Eventually, this can lead to your body not having enough red blood cells. This is known as anaemia.</div>
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Symptoms of anaemia include:</div>
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In some cases, bowel cancer can cause an obstruction in the bowel. Symptoms of a bowel obstruction include:</div>
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When to seek medical advice</h2>
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Visit Dr. B C Shah if you have any of the symptoms above. While the symptoms are unlikely to be the result of bowel cancer, these types of symptoms always need to be investigated further.</div>
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Causes of bowel cancer</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.</strong></div>
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Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps. However, if you develop polyps, it does not necessarily mean you will get bowel cancer.</div>
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Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it.</div>
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Family history</h2>
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There is evidence that bowel cancer can run in families. Around 20% of people who develop bowel cancer have a close relative (mother, father, brother or sister) or a second-degree relative (grandparent, uncle or aunt) who have also had bowel cancer.</div>
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It is estimated that if you have one close relative with a history of bowel cancer, your risk of getting bowel cancer is doubled. If you have two close relatives with a history of bowel cancer, your risk increases four-fold.</div>
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Diet</h2>
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A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams.</div>
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There is also good evidence that a diet high in fibre and low in saturated fat could help reduce your bowel cancer risk. Cancer experts think this is because this type of diet encourages regular bowel movements.</div>
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Smoking</h2>
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People who smoke cigarettes are 25% more likely to develop bowel cancer, other types of cancer and heart disease than people who do not smoke.</div>
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Alcohol</h2>
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A major study, called the EPIC study, showed alcohol was associated with bowel cancer risk. Even small amounts of alcohol can put you at higher risk of getting bowel cancer. The EPIC study found that for every two units of alcohol a person drinks each day, their risk of bowel cancer goes up by 8%.</div>
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Obesity</h2>
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Obesity is linked to an increased risk of bowel cancer. Obese men are 50% more likely to develop bowel cancer than people with a healthy weight. Morbidly obese men, who have a body mass index (BMI) of over 40, are twice as likely to develop bowel cancer.</div>
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Obese women have a small increased risk of developing the condition, and morbidly obese women are 50% more likely to develop bowel cancer than women with a healthy weight.</div>
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Inactivity</h2>
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People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Your risk could be cut by up to one-fifth if you do an hour of vigorous exercise every day or two hours of moderate exercise (such as vacuum cleaning or brisk walking).</div>
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Digestive disorders</h2>
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Some conditions may put you at a higher risk of developing bowel cancer. People with Crohn’s disease are 2-3 times more likely to develop bowel cancer. The risk of developing bowel cancer is much higher in people with ulcerative colitis, and as many as 1 in 20 of these people will go on to develop it.</div>
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Genetic conditions</h2>
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There are two rare inherited conditions that can cause bowel cancer. They are:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Familial adenomatous polyposis (FAP)</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome</li>
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FAP affects 1 in 10,000 people. The condition triggers the growth of non-cancerous polyps inside the bowel. Although the polyps are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Almost all people with FAP will have bowel cancer by the time they are 50 years of age.</div>
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People with FAP have such a high risk of getting bowel cancer, they are often advised to have their large bowel removed by surgery before they reach the age of 25. Families affected can find support and advice from the FAP registry at St Mark’s Hospital, London.</div>
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HNPCC is a type of bowel cancer caused by a mutated gene. An estimated 2-5% of all cases of bowel cancer are due to HNPCC. Around 90% of men and 70% of women with the</div>
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As with FAP, removing the bowel as a precautionary measure is usually recommended in people with HNPCC.</div>
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Diagnosing bowel cancer</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">When you first see Dr. B C Shah</strong> <strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">he will ask about your symptoms and whether you have a family history of bowel cancer.</strong></div>
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Dr. B C Shah will then carry out a physical examination known as a digital rectal examination (DRE). A DRE involves Dr. B C Shah gently placing a finger into your anus, and then up into your rectum.</div>
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A DRE is a useful way of checking whether there is a noticeable lump inside your rectum. This is found in an estimated 40-80% of cases of rectal cancer.</div>
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A DRE is not painful, but some people may find it a little embarrassing.</div>
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If your symptoms suggest you may have bowel cancer, or the diagnosis is uncertain, you will be referred to your local hospital for further examination. </div>
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Further examination</h2>
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Two tests are commonly used to confirm a diagnosis of bowel cancer:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
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Sigmoidoscopy</h2>
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A sigmoidoscopy uses a device called a sigmoidoscope, which is a thin, flexible tube attached to a small camera and light.</div>
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The sigmoidoscope is inserted into your rectum and then up into your bowel. The camera relays images to a monitor. This allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer.</div>
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A sigmoidoscopy can also be used to remove small samples of suspected cancerous tissue so they can be tested in the lab. This is known as a biopsy.</div>
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A sigmoidoscopy is not usually painful, but can feel uncomfortable. Most people go home after the examination has been completed.</div>
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Colonoscopy</h2>
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A colonoscopy is similar to a sigmoidoscopy except a longer tube, called a colonoscope, is used to examine your entire bowel.</div>
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Your bowel needs to be empty when a colonoscopy is performed, so you will be given a special diet to eat for a few days before the examination and a laxative (medication to help empty your bowel) on the morning of the examination.</div>
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You will be given a sedative to help you relax, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. As with a sigmoidoscope, the colonoscope can be used to obtain a biopsy, as well as relaying images of any abnormal areas.</div>
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A colonoscopy usually takes about one hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel drowsy for a while, so arrange for someone to accompany you home.</div>
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Further testing</h2>
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If a diagnosis of bowel cancer is confirmed, further testing is usually carried out for two reasons:</div>
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These tests can include:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan to provide a detailed image of your bowel and other organs </li>
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Staging and grading</h2>
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Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive and likely to spread your cancer is.</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Stage 1 – the cancer is still contained within the lining of the bowel or rectum</li>
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This is a simplified guide. Stage 2 is divided into further categories called A and B and stage 3 is divided into A, B and C.</div>
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There are three grades of bowel cancer:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Grade 1 is a cancer that grows slowly and has a low chance of spreading beyond the bowel</li>
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If you are not sure what stage or grade of cancer you have, ask your doctor.</div>
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Treating bowel cancer</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">People with bowel cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best treatment and care.</strong></div>
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The team often consists of a Dr. B C Shah, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist, and you may have access to clinical psychology support.</div>
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When deciding what treatment is best for you, your doctors will consider:</div>
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There are several treatments for bowel cancer, including:</div>
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Surgery is usually the main treatment for bowel cancer, but in about one in five cases, the cancer is too advanced to be removed by surgery. If you have surgery, you may also need chemotherapy, radiotherapy or biological therapy, depending on your particular case.</div>
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Your treatment plan</h2>
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Your recommended treatment plan will depend on the stage and location of your bowel cancer.</div>
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If the cancer is confined to your rectum, radiotherapy will usually be used to shrink the tumour, then surgery may be used to remove the tumour. Sometimes, radiotherapy is combined with chemotherapy, which is known as chemoradiation.</div>
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If you have stage 1 bowel cancer, it should be possible to surgically remove the cancer and no further treatment will be required.</div>
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If you have stage 2 or 3 bowel cancer, surgery may be used to remove the cancer and, in some cases, nearby lymph nodes. Surgery is usually followed by a course of chemotherapy to stop the cancer returning.</div>
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It is not usually possible to cure stage 4 (advanced) cancer. However, symptoms can be controlled and the spread of the cancer can be slowed using a combination of surgery, chemotherapy, radiotherapy and biological therapy where appropriate.</div>
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Preventing bowel cancer</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">There are several ways to reduce your risk of developing bowel cancer.</strong></div>
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Diet</h2>
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Research suggests a low-fat, high-fibre diet that includes plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains can help reduce your risk of getting bowel cancer. It can also reduce your risk of developing other types of cancer and heart disease.</div>
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It is recommended you do not eat a lot of processed meat and red meat. The Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams. .</div>
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Exercise</h2>
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There is strong evidence to suggest regular exercise can lower the risk of developing bowel and other cancers.</div>
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It is recommended adults exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week.</div>
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Healthy weight</h2>
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Try to maintain a healthy weight. Changes to your diet and an increase in physical activities will help keep your weight under control. Find out if you are a healthy weight with the Healthy weight calculator.</div>
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Smoking</h2>
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If you smoke, giving up will reduce your risk of developing bowel and other cancers.</div>
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Dr. B C Shah can also provide help, support and advice if you want to give up smoking.</div>
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How screening for bowel cancer works </h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Bowel cancer can be present for a long time before any symptoms appear. If bowel cancer is detected before symptoms appear, it is easier to treat and there is a better chance of surviving the disease.</strong></div>
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Screening for bowel cancer called an FOBt (faecal occult blood test) is done at a pathology Lab. A tiny stool samples on a special card. The card is then checked at the laboratory for traces of blood.</div>
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Results</h2>
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There are three types of result:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Normal: no blood was found in the samples. Screening will be offered again in two years’ time.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Unclear: there were possible traces of blood that could be caused by factors other than cancer, such as haemorrhoids (piles) or stomach ulcers. If you have an unclear result, you will be asked to repeat the test kit up to twice more.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Abnormal: blood was definitely found in the samples. Again, this could be from piles or bowel polyps(small growths not usually cancerous). If you have an abnormal result, you will be offered an appointment with Dr. B C Shah to discuss having an examination of the bowel, called a colonoscopy.</li>
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Colonoscopy</h2>
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A colonoscopy is an investigation of the lining of the large bowel (colon). A thin flexible tube with a tiny camera on the end is passed into your bottom and guided around the bowel. Only around 2 in every 100 people completing the FOBt kit will have an abnormal result and will be offered a colonoscopy. Of those who have a colonoscopy, only about one in 10 will have cancer.</div>
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New screening test</h2>
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As well as the FOBt described above, an additional screening test is being rolled out by 2016. This involves inviting people at age 55 to have a one-off flexible sigmoidoscopy test to examine the lower bowel with a camera.</div>
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If the flexible sigmoidoscopy shows polyps, the person will then be offered a full colonoscopy . Both FOBt and flexible sigmoidoscopy screening tests have been shown to reduce the risk of dying of bowel cancer.</div>
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Living with bowel cancer</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Being diagnosed with cancer is a tough challenge for most people. There are several ways to find support to help you cope.</strong></div>
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Not all of them work for everybody. but one or more should be helpful:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Talk to your friends and family. They can be a powerful support system.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Get in touch with others in the same situation as you</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Learn about your condition</li>
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Talk to others</h2>
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Dr. B C Shah may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist . Dr. B C Shah will have information on these.</div>
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Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 18px; font-weight: bold; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Recovering from colon or rectal surgery</span></h2>
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Surgeons and anaesthetists have found that using an “<u style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">enhanced recovery programme</u>” after bowel cancer surgery helps patients recover more quickly.</div>
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Most hospitals now use this programme. It involves giving you more information before the operation about what to expect, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy. </div>
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During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully, and after the operation you will be given painkillers that allow you to get up and out of bed by the next day.</div>
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Most people will be able to eat a light diet the day after their operation.</div>
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To reduce the risk of <u style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">deep vein thrombosis</u> (blood clots in the legs), you may be given special compression stockings that help prevent blood clots, or a regular injection with heparin until you are fully mobile.</div>
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A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home again within a few days.</div>
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With the enhanced recovery programme, most people are well enough to go home within five to six days of their operation. The timing depends on when you and Dr. B C Shah agree you are well enough to go home.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 18px; font-weight: bold; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Coping with colostomy</span></h2>
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If you need a colostomy, you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma (including stoma care, stoma products and ‘stoma-friendly’ diets) is available via the ileostomy and colostomy topics.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 18px; font-weight: bold; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Diet after bowel surgery</span></h2>
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If you have had part of your colon removed, it is likely that your stools (faeces) will be looser because one of the functions of the colon is to absorb water from the stools. This may mean that you experience repeated episodes of diarrhoea</div>
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You should inform Dr. B C Shah if diarrhoea becomes a problem because medication is available to help control symptoms.</div>
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You may find some foods upset your bowels, particularly during the first few months after your operation.</div>
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Different foods can upset different people, but food and drink that is commonly known to cause problems include:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Rich and fatty food</li>
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You may find it useful to keep a food diary to record the effects of different foods on your bowel.</div>
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If you find that you are having continual problems with your bowels as a result of your diet, and/or you are finding it difficult to maintain a healthy diet, you should contact Dr. B C Shah. You may need to be referred to a dietitian for further advice.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 24.44444465637207px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><b style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 24.44444465637207px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Sex and bowel cancers</b></span></h2>
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Having cancer and its treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment, if you have had a colostomy you may feel self-conscious or uncomfortable.</div>
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Talking about how you feel with your partner may help you both to support each other. Or you may feel you’d like to talk to someone else about your feelings. Dr. B C Shah will be able to help.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 24.44444465637207px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><b style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 24.44444465637207px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Financial concerns</b></span></h2>
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A diagnosis of cancer can cause money problems because you are unable to work or someone you are close to has to stop working to look after you.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 18px; font-weight: bold; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Dealing with dying</span></h2>
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If you are told there is nothing more that can be done to treat your bowel cancer, Dr. B C Shah will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com5tag:blogger.com,1999:blog-6351996846816083125.post-9288157322390984272013-06-05T05:01:00.000-07:002013-06-05T05:01:07.130-07:00Brain Abcess<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6WEttp_xEq4tsYrXHqDgEbZkQpS0dzSLhyfahQJqoilyMNtL0t3PBvSpFuZKGPIhlqU8I178XPsJQnDCim663c2yZ1tLsWJzQ3X3rCvxoKXPUBXhm53zhkRdBMjz2Sij9hf5Q-4vDCYg/s1600/Brain-Abscess.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="100" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6WEttp_xEq4tsYrXHqDgEbZkQpS0dzSLhyfahQJqoilyMNtL0t3PBvSpFuZKGPIhlqU8I178XPsJQnDCim663c2yZ1tLsWJzQ3X3rCvxoKXPUBXhm53zhkRdBMjz2Sij9hf5Q-4vDCYg/s320/Brain-Abscess.jpg" width="320" /></a></div>
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Introduction </h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">A <a href="http://drbcshah.com/brain-abscess/" target="_blank">brain abscess </a>is a pus-filled swelling in the brain caused by an infection. It is a rare and life threatening condition.</strong></div>
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It happens when bacteria or fungi enter the brain tissue.</div>
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Symptoms of a brain abscess include:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Headache – which is often severe and cannot be relieved by taking painkillers</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Changes in mental state such as appearing very confused</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Weakness or paralysis on one side of the body</li>
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What causes a brain abscess?</h2>
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There are three main ways that a brain abscess can develop:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">An infection in another part of the skull, such as an ear infection, sinusitis or <a href="http://drbcshah.com/dental-abscess/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">dental abscess</a>, spreads directly into the brain</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">An infection in another part of the body, such as the lung infection <a href="http://drbcshah.com/pneumonia/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">pneumonia</a>, spreads into the brain via the blood</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Trauma, such as a severe head injury, that cracks open the skull allowing bacteria or fungi to enter the brain</li>
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Although in around 1 in 7 cases the source of the infection remains unknown.</div>
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Treating a brain abscess</h2>
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A brain abscess is regarded as a medical emergency. This is because the swelling caused by the abscess can disrupt the blood and oxygen supply to the brain. There is also a risk that the abscess may burst (rupture). If left untreated, a brain abscess can cause permanent brain damage and can be fatal.</div>
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A brain abscess is usually treated using a combination of antibiotics (or in some cases, antifungals) and surgery. Dr. B C Shah will usually open the skull and drain the pus from the abscess or remove the abscess entirely.</div>
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The sooner the condition is diagnosed and treated the lower the chance a person has of developing long-term complications.</div>
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Complications</h2>
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Any damage to the tissue of the brain can result in long-term complications, such as:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Brain damage – which can range from mild to severe</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Epilepsy – where a person has repeated seizures (fits)</li>
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Who is affected</h2>
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Brain abscesses tend to only be significant problem in parts of the world where access to antibiotics is limited.</div>
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Brain abscesses can occur at any age, but most cases are reported in people aged 40 or younger. They are more common in men than women. It is not clear why this should be the case.</div>
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Outlook</h2>
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Because of advances in diagnostic and surgical techniques, the outlook for people with brain abscesses has improved dramatically. Nowadays, deaths only occur in an estimated 1 in 10 of cases. Many people make a full recovery.</div>
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<span style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Symptoms of a brain abscess</span></h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The symptoms of a brain abscess can develop quickly or slowly.</strong></div>
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In around two-thirds of people, symptoms are present for two weeks or less before they escalate to the point where the person needs to be admitted to hospital.</div>
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Common symptoms include:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Headache - the headache is often severe, located in a single section of the head and cannot be relieved with painkillers</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Changes in mental state, such as confusion or irritability</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Problems with nerve function, such as muscle weakness, slurred speech or paralysis on one side of the body</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A high temperature (fever) of or above 38C (100.4F) </li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Seizures (fits)</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Nausea and vomiting</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Stiff neck</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Changes in vision, such as blurring, greying of vision or double vision (because of the abscess putting pressure on the optic nerve)</li>
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When to seek medical advice</h2>
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Any symptoms that suggest a problem with the brain and nervous system, such as slurred speech, muscle weakness or paralysis, or seizures occurring in a person who had no previous history of seizures should be treated as a medical emergency.</div>
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Any symptoms that suggest a worsening infection, such as fever and vomiting, should be reported to Dr. B C Shah immediately.</div>
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<span style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Causes of a brain abscess</span></h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">An abscess is a pus-filled swelling caused by infection with either bacteria or fungi.</strong></div>
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The abscess is created by your immune system as a defence mechanism. If the immune system is unable to kill an infection, it will try to limit its spread. Your immune system will use healthy tissue to form a wall around the source of infection to stop the pus infecting other tissue.</div>
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The routes for brain infection</h2>
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Infections of the brain are rare because the body has evolved a number of defences to protect this vital organ. One of these is the blood-brain barrier, which is a thick membrane that filters out impurities from blood before allowing it into your brain.</div>
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However, in some people, for reasons not always entirely clear, germs can get through these defences and infect the brain.</div>
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The three most common routes for germs to enter the brain are:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Germs have already infected one of the nearby cavities in the skull (such as the ears or nose) and go on to infect the brain.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Germs have already infected another part of the body, get into the bloodstream, bypass the blood-brain barrier and then infect the brain.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Germs pass through the skull and enter the brain after the skull is damaged, for example after being hit by a blunt object or after a gunshot wound.</li>
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Though in around 1 in 7 cases no obvious cause for the infection can be found.</div>
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The causes of a brain abscess are explained in more detail below.</div>
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Germs from another infection in the skull</h2>
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In up to a half of cases, the brain abscess occurs as a complication of a nearby infection in the skull, such as:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A persistent middle ear infection (otitis media)</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Sinusitis (an infection of the sinuses, which are the air-filled cavities inside the cheekbones and forehead)</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Mastoiditis (an infection of the bone behind the eye)</li>
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This used to be a major cause of brain abscesses, but because of improved treatments for infections, a brain abscess is now a rare complication of these kinds of infection.</div>
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Germs invading the brain through the bloodstream</h2>
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Infections spread through the blood are thought to account for around 1 in 4 cases of brain abscesses.</div>
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People with a weakened immune system have a higher risk of developing a brain abscess from a blood-borne infection. This is because their immune system may not be capable of fighting off the initial infection.</div>
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You may have a weakened immune system if you:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Have a medical condition that weakens your immune system, such as <a href="http://drbcshah.com/hiv-and-aids/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">HIV or AIDS</a></li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Receive medical treatment known to weaken the immune system, such as <a href="http://drbcshah.com/chemotherapy/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">chemotherapy</a></li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Have an organ transplant and take immunosuppressant drugs to prevent your body rejecting the new organ</li>
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The most commonly reported infections and health conditions that may cause a brain abscess are:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Cyanotic heart disease, a type of congenital heart disease (a heart defect present at birth) where the heart is unable to carry enough oxygen around the body (this lack of a regular oxygen supply makes the body more vulnerable to infection) </li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Pulmonary arteriovenous fistula – a rare condition in which abnormal connections develop between blood vessels inside the lungs; this can allow bacteria to get into the blood and then into the brain,</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Lung infections, such as pneumonia or bronchiectasis</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Infections of the heart, such as endocarditis</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Skin infections</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Infections of the abdomen, such as peritonitis (an infection of the lining of the bowel)</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Pelvic infections such as infection of the lining of the bladder (<a href="http://drbcshah.com/cystitis/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">cystitis</a>)</li>
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Germs invading the brain after a head injury</h2>
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Direct trauma to the skull can also lead to a brain abscess and is thought responsible for 1 in 10 cases.</div>
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The most commonly reported causes include:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Skull fracture caused by penetrating injury to the head</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Gunshot or shrapnel wound</li>
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In rare cases, a brain abscess can develop as a complication of surgery.</div>
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<span style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Diagnosing a brain abscess</span></h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">An initial assessment will be made based on your physical symptoms and medical history, such as whether you have had a recent infection or a weakened immune system.</strong></div>
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Blood tests </h2>
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Blood tests will be carried out to check for the presence of infection. A high level of white blood cells in your blood indicates the presence of a serious infection.</div>
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Scans</h2>
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If a brain abscess is suspected, the diagnosis can be confirmed using a brain scan.</div>
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Computerised tomography (CT) scan</h2>
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A computerised tomography (CT) scan involves a series of X-rays taken of your body at different angles. This produces a detailed image of the inside of your body.</div>
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A CT scan can often detect the presence of the abscess and any associated swelling inside the brain.</div>
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Magnetic resonance imaging (MRI) scan</h2>
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A magnetic resonance imaging (MRI) scan uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body.</div>
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A MRI scan can provide a more detailed image than a CT scan so is sometimes used if the results of the CT scan are inconclusive. </div>
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CT-guided aspiration</h2>
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If an abscess is found, Dr. B C Shah can use a CT scan to guide a needle to the site of the abscess and remove a sample of pus for further testing. This is known as CT-guided aspiration. The sample of pus should indicate the type of germ causing the abscess.</div>
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Treatment with broad-spectrum antibiotics will usually begin as soon as possible, even before a CT-guided aspiration is carried out, because it can be dangerous to wait for the results.</div>
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Broad-spectrum antibiotics can be used against a wide range of bacteria. They will be used before a specific diagnosis is made because there is a high chance they will be effective if the infection is caused by bacteria.</div>
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If the test reveals the abscess is caused by a fungus, the treatment plan can be changed and antifungal medication given.</div>
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<span style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Treating a brain abscess</span></h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Treatment for a brain abscess will depend on the size and number of brain abscesses present. A brain abscess is a medical emergency, so you will need treatment in hospital and will stay there until your condition is stable.</strong></div>
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Medication</h2>
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Surgery will be avoided if thought too risky or if an abscess is small and could be treated by medication alone.</div>
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Medication is recommended over surgery if you have:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Several abscesses</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A small abscess (less than 2cm)</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">An abscess deep inside the brain</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Meningitis (an infection of the protective membranes that surround the brain) as well as an abscess</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;"><a href="http://drbcshah.com/hydrocephalus/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">Hydrocephalus</a> (a build-up of fluid on the brain)</li>
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You will normally be given antibiotics or antifungal medication through a drip (directly into a vein). Dr. B C Shah will aim to treat the abscess and the original infection that caused it.</div>
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Surgery</h2>
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If the abscess is larger than 2cm, it is usually necessary to drain the pus out of the abscess.</div>
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There are two surgical techniques for treating a brain abscess:</div>
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Simple aspiration involves using a CT scan to locate the abscess and then drills a small hole known as a burr hole into the skull. The pus is then drained through the hole and the hole sealed.</div>
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A simple aspiration takes around one hour to complete.</div>
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Open aspiration and excisions are usually carried out using a surgical procedure known as a craniotomy.</div>
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Craniotomy</h2>
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A craniotomy may be recommended if an abscess does not respond to aspiration or reoccurs at a later date.</div>
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During a craniotomy, Dr. B C Shah will shave a small section of your hair and then remove a small piece of your skull bone (a bone flap) to gain access to your brain.</div>
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The abscess will then be drained of pus or totally removed. A CT-guided localisation system may be used during the operation, which allows Dr. B C Shah to more accurately locate the exact position of the abscess.</div>
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Once the abscess has been treated, the bone is replaced. The operation usually takes around three hours which includes recovery from the general anaesthetic (where you are put to sleep).</div>
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Complications of a craniotomy</h2>
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As with all surgery, a craniotomy carries risks, but serious complications are uncommon.</div>
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Possible complications of a craniotomy are:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Swelling and bruising around your face, which is common after a craniotomy. This will die down after the operation.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Headaches. These are common after a craniotomy and may last several months, but should eventually settle down.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A blood clot in the brain (further surgery may be required to remove it).</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Stiff jaw. During a craniotomy, Dr. B C Shah may need to make a small cut to a muscle that helps with chewing. The muscle does heal, but can become stiff for a few months, causing your jaw to feel stiff. Exercising the muscle by regularly chewing sugar-free gum should help relieve the stiffness.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Movement of the bone flap. The bone flap in your skull may feel like it moves and you may experience a clicking sensation. This can feel strange, but it is normal and not dangerous. It will stop as the skull heals.</li>
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The site of the cut (incision) in your skull can become infected, although this is uncommon. You are usually given antibiotics around the time of your operation to prevent infection.</div>
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Recovering from surgery</h2>
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Once your brain abscess has been treated, you will probably stay in hospital for several weeks so your body can be supported while you recover. </div>
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You will also receive a number of CT scans, to make sure the brain abscess has been completely removed.</div>
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Most people will then need a further 6 to 12 weeks rest at home before they are fit enough to return to work or full-time education.</div>
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After treatment for a brain abscess, avoid any contact sport where there is a risk of injury to the skull, such as boxing, rugby or football.</div>
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<span style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Complications of a brain abscess</span></h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Possible complications of a brain abscess are outlined below.</strong></div>
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Brain damage</h2>
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Brain damage can range from mild through moderate to severe.</div>
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Mild brain damage can result in:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Memory problems</li>
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Moderate brain damage can result in:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Changes in mood such as feeling restless or agitated</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Problems with tasks that require high-level thinking such as planning and decision making</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Difficulties with balance and coordination – the medical term for this is ataxia</li>
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Severe brain damage can result in:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Weakness in certain parts of the body</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">And in the most serious of cases – coma or persistent vegetative state</li>
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Mild to moderate brain damage often improves with time. Severe brain damage is likely to be permanent.</div>
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Brain damage is more of a risk when the diagnosis of a brain abscess was delayed and treatment did not begin quickly enough. Brain abscesses can now be diagnosed very easily with a CT or MRI scan, so the risk of serious brain damage is now low.</div>
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Epilepsy</h3>
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A common complication of brain abscesses is <u style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">epilepsy</u>, a condition that causes repeated fits or seizures. Epilepsy is a long-term condition and symptoms can usually be controlled using medication..</div>
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Meningitis</h3>
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In some cases, especially those involving children, a brain abscess can develop into bacterial <u style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">meningitis</u>, a life-threatening infection of the protective membranes that surround the brain.</div>
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Symptoms of meningitis include:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">High temperature (fever) of 38ºC (100.4ºF) or over</li>
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Someone with bacterial meningitis will require urgent treatment in hospital; usually an intensive care unit (ICU).</div>
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Antibiotics will be used to treat the underlying infection. These will be given intravenously (through a vein in the arm).</div>
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At the same time a person may also be given:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Intravenous fluids (through a vein)</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Steroids or other medication to help reduce the inflammation (swelling) around the brain</li>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-2120201052629170132013-05-29T04:03:00.000-07:002013-05-29T04:03:12.617-07:00Belly Button<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVKME43RyNcxnMh_2DpsGIi7OWCr4SX5-QY10tfWjQpCRWvJKHrFi7k_VRlcO3KyIoXq4GJluNElumwSU3map_uw5FVF3kvCdHeQ8NkP6hu4dMgeFKjTl3x8qhXvIex_95BOzpdoMfNBc/s1600/Belly+button+pain.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVKME43RyNcxnMh_2DpsGIi7OWCr4SX5-QY10tfWjQpCRWvJKHrFi7k_VRlcO3KyIoXq4GJluNElumwSU3map_uw5FVF3kvCdHeQ8NkP6hu4dMgeFKjTl3x8qhXvIex_95BOzpdoMfNBc/s320/Belly+button+pain.jpg" width="320" /></a></div>
<span style="background-color: white; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 23.99305534362793px; text-align: justify;">Often female patients come with <a href="http://drbcshah.com/belly-button-pain/" target="_blank">belly button </a>pain or pain around belly button. There are many causes. Commonest cause is muscle stretching. In India its generally common in females because of multiple pregnancies, obesity, poor muscle tone & lifting heavy weight. The navel gets so stretched that it starts to tear and the contents which are suppose to be inside start protruding out. The belly button everts & protrudes out This is called herniation. Often due to obesity this protrusion is not recognized and the patients continues to experience pain and not realize the swelling in the belly button. Gradually these small defects grow to bigger defects. Most of these muscle defects in and around the navel can be repaired laparoscopically. Its a short procedure. The defect if very small can simply be closed by few stitches A synthetic material (mesh) is often used to reinforce the repair. This minimizes the chance of recurrence. So please report to your doctor if you experience a belly button or navel pain. One easy was to check if you are developing a hernia is by placing your tip of finger on your belly and coughing in standing position. If there is an expansile impulse or feeling that something is protruding out, there are chances that you may be developing an umbilical hernia. Report to your doctor. If diagnosed early, it can be repaired very easily. To prevent such</span><a href="http://drbcshah.com/hernia-repair-umbilical/" style="background-color: white; border: 0px; color: #ffa300; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 23.99305534362793px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; text-decoration: none; vertical-align: baseline;">umbilical (paraumbilical) hernia</a><span style="background-color: white; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 23.99305534362793px; text-align: justify;"> avoid lifting very heavy weights, do regular exercises especially after delivery and avoid obesity.</span></div>
Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-81126040945005580012013-05-15T03:34:00.002-07:002013-05-15T03:34:21.728-07:00Breast infection in infants<div dir="ltr" style="text-align: left;" trbidi="on">
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Baby L_____ S_____, one month old female infant was brought to me by her aunt with a huge left <a href="http://drbcshah.com/re-breast-infection-in-infants/" target="_blank">breast abscess</a>. The mother was too terrified to come inside my clinic & the father was also outside consoling the mother. It started as a small boil. They had taken her to pediatrician who gave them local ointment and oral antibiotics. However, it did not subside. IT grew very quickly and the child started to have fever. It was extremely painful and the child was constantly crying. The baby was being massaged by a servant. The possible reason is that many times such masseur, who are most often untrained try manipulation the delicate neonatal breast to express a clear or cloudy (milk-like) substance from nipple (also called witch's milk). This causes potential damage & bleeding inside which gets infected or possibly it causes cracks in the nipple thro which the bacteria enter inside. The main worry of the relatives & parents was – will she have a normal breast development or is her left breast completely destroyed?</div>
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I removed the pus from the infant baby's left breast under anesthesia. Subsequently she underwent daily dressings. The nipple restored back to normal and the wound healed very soon. I assured the parents that she will have normal breast. Nature is great!</div>
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<a href="http://drbcshah.com/breast-abscess-drainage/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Adult breast</a> is common especially in lactating mothers but neonatal breast abscess is not so common.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-61472388974494296312013-05-09T04:47:00.001-07:002013-05-09T04:47:05.014-07:00Percutaneous Endoscopic Gastrostomy PEG<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgP5sBT7p5xu4oIIPPNC5HJ6XdRlfMVvzR8BZcyIyUcHPTV4k2JYYhrAN9Kc-bECrWIHqiR4xI4oiIl4ziYC_oRqeGUFK5D4PUiPz8W8LZTd3dMR9X1c5Y-oqAHNG6HQFtv22ZfVMcZmcM/s1600/Percutaneous-Endoscopic-Gastrostomy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="211" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgP5sBT7p5xu4oIIPPNC5HJ6XdRlfMVvzR8BZcyIyUcHPTV4k2JYYhrAN9Kc-bECrWIHqiR4xI4oiIl4ziYC_oRqeGUFK5D4PUiPz8W8LZTd3dMR9X1c5Y-oqAHNG6HQFtv22ZfVMcZmcM/s320/Percutaneous-Endoscopic-Gastrostomy.jpg" width="320" /></a></div>
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What is a PEG?</h2>
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<a href="http://drbcshah.com/percutaneous-endoscopic-gastrostomy-peg/" target="_blank">PEG</a> stands for percutaneous <a href="http://drbcshah.com/endoscopy/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">endoscopic</a> gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus. This brochure will give you a basic understanding of the procedure – how it's performed, how it can help, and what side effects you might experience.</div>
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How is the PEG performed?</h2>
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Dr. B C Shah will use a lighted flexible tube called an endoscope to guide the creation of a small opening through the skin of the upper abdomen and directly into the stomach. This procedure allows him to place and secure a feeding tube into the stomach. Patients generally receive an intravenous sedative and local anesthesia, and an antibiotic is given by vein prior to the procedure. Patients can usually go home the day of the procedure or the next day.</div>
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Who can benefit from a PEG?</h2>
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Patients who have difficulty swallowing, problems with their appetite or an inability to take adequate nutrition through the mouth can benefit from this procedure.</div>
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How should I care for the PEG tube?</h2>
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A dressing will be placed on the PEG site following the procedure. This dressing is usually removed after one or two days. After that you should clean the site once a day with diluted soap and water and keep the site dry between cleansings. No special dressing or covering is needed.</div>
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How are feedings given? Can I still eat and drink?</h2>
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Specialized liquid nutrition, as well as fluids, are given through the PEG tube. If the PEG tube is placed because of swallowing difficulty (e.g., after a stroke), there will still be restrictions on oral intake. Although a few PEG patients may continue to eat or drink after the procedure, this is a very important issue to discuss with your physician.</div>
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Are there complications from PEG placement?</h2>
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Complications can occur with the PEG placement. Possible complications include pain at the PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction of the tube. Possible complications include infection of the PEG site, aspiration (inhalation of gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall). Dr. B C Shah can describe for you symptoms that could indicate a possible complication.</div>
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How long do these tubes last? How are they removed?</h2>
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PEG tubes can last for months or years. However, because they can break down or become clogged over extended periods of time, they might need to be replaced. Dr. B C Shah can easily remove or replace a tube without sedatives or anesthesia, although Dr. B C Shah might opt to use sedation and endoscopy in some cases. Dr. B C Shah will remove the tube using firm traction and will either insert a new tube or let the opening close if no replacement is needed. PEG sites close quickly once the tube is removed, so accidental dislodgment requires immediate attention.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com1tag:blogger.com,1999:blog-6351996846816083125.post-86563285908538107512013-05-06T04:54:00.002-07:002013-05-06T04:54:05.256-07:00Hemorroidectomy<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSc4GZMa7bP0Us_G0XKyWCZiWIuGio474S2otGAwZG61O-ffRNpakgNfyB4JaWe0FvVJcor-CR45VpGpS4WbwAL1ba32xF7NYWSXkB_w23bOG28329f-vY7ytSl6dflaadWjH8toLtRIk/s1600/piles-hemorrhoids+(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="318" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSc4GZMa7bP0Us_G0XKyWCZiWIuGio474S2otGAwZG61O-ffRNpakgNfyB4JaWe0FvVJcor-CR45VpGpS4WbwAL1ba32xF7NYWSXkB_w23bOG28329f-vY7ytSl6dflaadWjH8toLtRIk/s320/piles-hemorrhoids+(1).jpg" width="320" /></a></div>
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What are hemorrhoids?</h2>
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<a href="http://drbcshah.com/piles/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">Hemorrhoids</a> are veins, normally present in and around the anus and lower rectum, that have become swollen due to stretching under pressure. These are very common in both men and women, and about half the population have hemorrhoids by age 50. Hemorrhoids are also common in pregnant women due to the pressure of the fetus in the abdomen, as well as hormonal changes, which cause hemorrhoidal vessels to enlarge. The process of childbirth also puts severe stress of these vessels.</div>
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Hemorrhoids are either internal (inside the anus) or external (under the skin around the anus).</div>
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What causes hemorrhoids?</h2>
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Hemorrhoids may develop as a result of repeated straining during bowel movements, pregnancy, heredity, aging, and chronic constipation or diarrhea.</div>
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What are the symptoms of hemorrhoids?</h2>
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The following are the most common symptoms of hemorrhoids. However, each individual may experience symptoms differently. Symptoms may include:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Bright red blood present on the stool, toilet paper, or in the toilet bowl</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Irritation and pain around the anus</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Swelling or a hard lump around the anus</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Itching</li>
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The symptoms of hemorrhoids may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.</div>
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How are hemorrhoids diagnosed?</h2>
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The presence of blood in the stool can be indicative of other digestive disorders, including colorectal cancer, so thorough evaluation and proper diagnosis is important.</div>
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Diagnosing hemorrhoids may include:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Physical examination: This is done to check the anus and rectum and look for swollen blood vessels that indicate hemorrhoids.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Digital rectum examination (DRE): The doctor inserts a gloved, lubricated finger into the rectum to check for abnormalities.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Anoscopy: A hollow, lighted tube useful for viewing internal hemorrhoids is inserted into the anus.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Proctoscopy: A lighted tube, which allows the doctor to completely examine the entire rectum, is inserted into the anus.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Sigmoidoscopy: A diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine, and is helpful in identifying the causes of diarrhea, abdominal pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Colonoscopy: A procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.</li>
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Treatment for hemorrhoids</div>
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Specific treatment for hemorrhoids will be determined by your doctor, based on:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Your age, overall health, and medical history</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Extent of the condition</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Your tolerance of specific medicines, procedures, or therapies</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Expectations for the course of the condition</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Your opinion or preference</li>
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Medical treatment of hemorrhoids is aimed at relieving symptoms and may include the following:</div>
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Dr. B C Shah may also recommend increasing both fiber and fluids to soften stools. A softer stool lessens pressure on hemorrhoids caused by straining. Good sources of fiber include fruits, vegetables, and whole grains. Bulk stool softeners or fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), may also be recommended.</div>
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In some cases, it is necessary to treat hemorrhoids surgically. Several surgical techniques are used to remove or reduce internal and external hemorrhoids. These include the following:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Hemorrhoidectomy: A surgical procedure that permanently removes the hemorrhoids.</li>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-86774914625660547242013-05-04T02:44:00.000-07:002013-05-04T02:44:02.683-07:00HYDROCELECTOMY<div dir="ltr" style="text-align: left;" trbidi="on">
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WHAT IS A HYDROCELE, A SPERMATOCELE, AND AN EPIDIDYMAL CYST?</h2>
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A <a href="http://drbcshah.com/hydrocelectomy/" target="_blank">hydrocele </a>is an abnormal fluid collection between the outer tissue layers of the testicle. These tissue layers naturally secrete fluid and when this fluid is not reabsorbed, as it usually would be, a fluid collection or hydrocele forms. The cause of most hydroceles is unknown, although some may be related to trauma, infection, or past surgery.</div>
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A spermatocele is a cyst-like sac that is usually attached to the epididymis, the tube that sits behind the testicle and stores sperm. The sac of a spermatocele is filled with sperm. The exact cause of a spermatocele is unknown but it is thought that injury and obstruction may play a part in their formation.</div>
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An epididymal cyst is much the same as a spermatocele. However, the sac attached to the epididymis is a true cyst and is filled with cystic fluid and not sperm.</div>
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WHAT IS A HYDROCELECTOMY, SPERMATOCELECTOMY AND AN EPIDIDYMAL CYSTECTOMY?</h2>
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A hydrocelectomy is an operation to treat a hydrocele. An incision is made in the scrotum and the testicle containing the hydrocele is lifted out. The sac is then removed and the remaining tissue edges are stitched back. The tissue edges then heal onto themselves and the surrounding vessels naturally reabsorb any fluid produced.</div>
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A spermatocelectomy is an operation to remove a spermatocele from the epididymis of a testicle. An incision is made in the scrotum and the testicle with its attached spermatocele is lifted out. The spermatocele is then removed from the epididymis and any bleeding areas are sealed off.</div>
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An epididymal cystectomy is an operation to remove the cyst from the epididymis. The operation is performed in exactly the same way as a spermatocelectomy.</div>
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After all three types of surgery, once the operation is complete, the wounds are stitched closed with dissolving stitches that dissolve slowing in the weeks following surgery.<span class="Apple-tab-span" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline; white-space: pre;"> </span>No wound drains are usually required.</div>
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Hydrocelectomy, spermatocelectomy and epididymal cystectomy are usually not performed unless the hydrocele, spermatocele or epididymal cyst are causing pain or social embarrassment. All three operations are usually simple day stay procedures and complications are rare. Haematoma (blood clot collection), wound infection, abscess, and recurrence, are all very uncommon complications and success rates for surgery usually approach 100%.</div>
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YOUR CONSENT</h2>
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We need your permission for your operation to go ahead. Before you sign the consent form it is important that you understand the risks and effects of the operation and anaesthetic. These will be discussed with you by Dr. B C Shah and the nurse, should you have any questions, Dr.B C Shah would be happy to answer these.</div>
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If you would like any testicle tissue returned to you for personal reasons, please discuss this with your family and inform Dr. B C Shah before your operation.</div>
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ABOUT YOUR ANAESTHETIC</h2>
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You will NOT be allowed to eat or drink anything for at least six hours before your surgery. This includes chewing gum and sweets.</div>
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Before your operation you will be able to discuss the type of anaesthetic with your anaesthetist, who will see you prior to your operation.</div>
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There are two main types of anaesthetic used for this surgery; •<span class="Apple-tab-span" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline; white-space: pre;"> </span>General Anaesthetic: You will be asleep throughout the operation and remember nothing of it.</div>
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Regional Anaesthetic e.g. Spinal, Epidural or Caudal: A needle is placed into your back and a solution is injected that will numb your body from the waist down. You will be awake but you maybe sleepy and you will not feel the operation.</div>
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Feel free to discuss these options and your questions with the anaesthetist.</div>
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You must not drive any vehicle or operate any machinery for 24 hours after having an anaesthetic. You will have to arrange for someone to drive you home if you go home within 24 hours of your surgery.</div>
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YOUR OPERATION</h2>
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On admission you will be informed of your approximate time of surgery and prepared for theatre by your nurse.</div>
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Any shave of the surgical site is done in theatre once you are asleep.</div>
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You may be given some tablets before theatre. These are charted by your anaesthetist and may include tablets for tension, nausea and pain prevention.</div>
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You will be escorted to theatre where you will be transferred to the theatre table. Anaesthetic staff will then insert a drip in your arm and will attach various monitoring devices.</div>
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Once you have been completely prepared and given your anaesthetic, surgery will begin. The operation usually takes about 30 minutes to perform.</div>
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When the operation is completed you will go to the recovery room for a short while where you will be cared for until you are ready to be transferred to the ward.</div>
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AFTER SURGERY</h2>
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Dr. B C Shah will check your blood pressure, pulse and your wound routinely.</div>
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You may still have the drip in your arm so you get enough fluid until you are drinking. You can usually eat and drink when you return to the ward.</div>
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You may have a scrotal support in place, which is a special pair of underpants that support the scrotum. These underpants help prevent bleeding and keep you comfortable.</div>
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Once you have recovered from your anaesthetic you will be able to be up and about, but you must take things very quietly in order to avoid causing any bleeding or bruising at the operation site.</div>
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Our aim is to keep you as comfortable as possible, so please tell Dr. B C shah if you have any pain or discomfort so you can be given the appropriate care. At all times, your nurse is there to help you, please ring your bell if you need assistance and your nurse is not nearby.</div>
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GOING HOME</h2>
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Once you are up and about, eating and drinking and you have passed urine you will be able to return home. This may be later on your operation day or the following morning.</div>
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Before leaving the ward you will be given a discharge information letter which contains helpful information for when you get home.</div>
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Dr. B C Shah will give specific instructions about caring for your wound. You can shower daily to wash your wound but avoid soap and powders directly on the wound until it has healed. The area should be kept clean and dry and you will be given some dressings to take home that are to be placed over the wound to collect any slight ooze.</div>
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You will be given appointment to return to see Dr.B C Shah. The appointment is usually about 6 weeks after your operation.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 12px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">ONCE HOME</span></div>
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If you were a daystay patient, it is important to take things quietly for the rest of the day as the anaesthetic can still have some effects on your body.</div>
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You should wear your scrotal support or your own supportive underpants for as long as you need for comfort after your surgery.</div>
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Your wound should heal within about 3 to 5 days. During this time your wound may ooze very slightly. However, if your wound continues to ooze or you have any signs of an infection such as a red, hot, swollen, or painful wound please contact Dr. B C Shah as soon as possible.</div>
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You should avoid any heavy lifting, straining or strenuous activity for 2 to 3 weeks after your surgery. This includes things such as any digging and strenuous sports as these activities can cause the stitches below the skin to pull apart.</div>
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Before discharge Dr. B C Shah will inform you about taking mild pain relievers, should you have any pain or discomfort after you return home.</div>
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This is routinely a straightforward operation, after which most patients have a speedy recovery and experience little pain.</div>
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While you are in hospital we will do everything we can to make your stay as comfortable as possible. The nursing and medical staff are always available to help with whatever needs you have. If you are worried about anything before or after your surgery, or if you have any further questions or would like more information, please do not hesitate to ask Dr. B C Shah who will be more than happy to help.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-45067027778400949902013-05-03T02:00:00.001-07:002013-05-03T02:00:12.640-07:00Exploratory Laparotomy<div dir="ltr" style="text-align: left;" trbidi="on">
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">By definition, an <a href="http://drbcshah.com/exploratory-laparotomy/" target="_blank">exploratory laparotomy</a> is a laparotomy performed with the objective of obtaining information that is not available via clinical diagnostic methods. It is usually performed in patients with acute or unexplained abdominal pain, in patients who have sustained abdominal trauma, and occasionally for staging in patients with a malignancy.</strong></div>
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Once the underlying pathology has been determined, an exploratory laparotomy may continue as a therapeutic procedure; sometimes, it may serve as a means of confirming a diagnosis (as in the case of laparotomy and <a href="http://drbcshah.com/biopsy/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">biopsy</a> for intra-abdominal masses that are considered inoperable). These applications are distinct from laparotomy performed for specific treatment, in which Dr. B C shah plans and executes a therapeutic procedure.</div>
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With the increasing availability of sophisticated imaging modalities and other investigative techniques, the indications for and scope of exploratory laparotomy have shrunk over time. The increasing availability of laparoscopy as a minimally invasive means of inspecting the abdomen has further reduced the applications of exploratory laparotomy. Nevertheless, the importance of exploratory laparotomy as a rapid and cost-effective means of managing acute abdominal conditions and trauma cannot be overemphasized.</div>
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Indications</h2>
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Four primary indications for an exploratory laparotomy are noted, as follows.</div>
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Acute-onset abdominal pain and clinical findings suggestive of intra-abdominal pathology requiring emergency surgery</div>
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In these conditions, exploratory laparotomy is carried out both to diagnose the condition and to perform the necessary therapeutic procedure.</div>
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Peritonitis</h3>
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Patients with clinical features of peritonitis may have pneumoperitoneum on erect chest and abdominal radiographs. They usually have a perforated viscus, most commonly the duodenum, stomach, small intestine, cecum, or sigmoid colon. Exploratory laparotomy is done first to determine the exact cause of pneumoperitoneum, followed by the therapeutic procedure. In the absence of pneumoperitoneum, appendicular perforation and intestinal ischemia are possible diagnoses; a high index of suspicion for possible intestinal ischemia should be maintained.</div>
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Intestinal obstruction</h3>
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Patients with vomiting, obstipation, and abdominal distention are likely to have intestinal obstruction. Abdominal radiographs in these patients may reveal dilated intestinal loops and air-fluid levels. Hernia, especially an incarcerated inguinal hernia, should be ruled out as a possible cause of the obstruction.</div>
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Intra-abdominal collections</h3>
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Patients with pain in the abdomen and fever may have intra-abdominal collections. These are usually detected by means of ultrasonography or computed tomography (CT) and can often be managed percutaneously. A persistently high aspirate or the presence of enteric contents may suggest perforation, and laparotomy may be required to control the source.</div>
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Abdominal trauma with hemoperitoneum and hemodynamic instability</h2>
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Hemodynamically unstable trauma patients with hemoperitoneum should undergo exploratory laparotomy without any delay. They are likely to have intraperitoneal bleeding after injury to the liver, spleen, or mesentery. They may also have associated intestinal perforations that call for emergency repair.</div>
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Chronic abdominal pain</h2>
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Availability of good imaging facilities have restricted the use of exploratory laparotomy in these conditions; however, when limited facilities are available, exploratory laparotomy becomes an important diagnostic tool. These patients may have intra-abdominal adhesions, <a href="http://drbcshah.com/tuberculosis-tb/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">tuberculosis</a>, or tubo-ovarian pathology.</div>
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Staging of ovarian malignancy and Hodgkin disease</h2>
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The role of surgical staging in Hodgkin disease is controversial, and recommendations are restricted to patients who may be considered for primary radiotherapy as the sole modality of treatment.</div>
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Contraindications</h2>
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The primary contraindication for exploratory laparotomy is unfitness for general anesthesia. Peritonitis with severe sepsis, advanced malignancy, and other comorbid conditions may render patients unfit for general anesthesia.</div>
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Technical Considerations</h2>
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Exploratory laparotomy is sometimes a good diagnostic tool. However, anticipation of the diagnosis is necessary, and a hasty exploration should be avoided if the center is not well equipped to perform the therapeutic procedure that will be necessary if the suspected condition is confirmed.</div>
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Nontherapeutic laparotomy is associated with significant long-term morbidity, including adhesive intestinal obstruction and incisional hernia. Consequently, exploratory laparotomy should be performed in accordance with standard protocols and guidelines for laparotomy.</div>
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The authors have found that in equivocal cases of acute abdomen, diagnostic peritoneal lavage (DPL) is often helpful in determining the need for exploratory laparotomy. If DPL findings are positive, then an exploratory laparotomy is performed; if DPL findings are negative, the patient is closely monitored.</div>
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Periprocedural Care</h1>
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Preprocedural Planning</h2>
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The patient's physiologic status at laparotomy is an important determinant of outcome. Accordingly, whenever possible, efforts should be made to optimize the patient's general condition. This includes correction of fluid and electrolyte imbalances, blood transfusions, and bronchodilator nebulizations as required.</div>
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Before the procedure, a nasogastric tube and an indwelling urinary catheter are inserted to decompress the stomach and the urinary bladder. Decompression of the stomach reduces the risk of aspiration of gastric contents during induction of anesthesia. The risk of such aspiration is high in these patients because of the emergency nature of the procedure and because of paralytic ileus. Decompression of the bladder reduces the risk that the bladder may be injured as the midline incision is extended inferiorly for better exposure.</div>
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Equipment</h2>
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Exploratory laparotomy is performed in an operating room (OR). The OR should contain anesthetic equipment, overhead lights, electrodiathermy equipment, and suctioning systems. A standard laparotomy tray is usually sufficient for an exploratory laparotomy.</div>
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If vascular intervention is anticipated, vascular instruments may be required. If major abdominal organ resection may be needed, appropriate instruments, facilities, and expertise should be available. Similarly, abdominal trauma necessitates major abdominal surgery, for which appropriate infrastructure and expertise are required.</div>
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Patient Preparation</h2>
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Patient preparation includes adequate anesthesia and appropriate patient positioning.</div>
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Anesthesia</h2>
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Exploratory laparotomy is performed with the patient under general anesthesia. Patients who are anesthetized for emergency surgery are at higher risk for aspiration of gastric contents. Adequate care must be taken to empty the stomach before induction. Rapid-sequence induction considerably reduces the risk of aspiration.</div>
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Positioning</h2>
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The patient is placed in the supine position, with the arms abducted at right angles to the body. The lithotomy position may be employed instead when a pelvic pathology is suspected and a simultaneous vaginal or rectal intervention is necessary.</div>
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Technique</h1>
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Exploratory Laparotomy</h2>
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After appropriate preparation (see Periprocedural Care), exploratory laparotomy is performed as follows.</div>
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Midline incision and opening of peritoneum</h2>
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A vertical midline incision is the best choice: it affords a rapid entry into the peritoneum and is relatively bloodless and safe.The incision may be made in the upper, middle, or lower midline, depending on the anticipated pathology, and may be extended in either direction if necessary. Exposure of the peritoneum should never be compromised in an attempt to keep the incision small.</div>
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The skin is incised with a surgical knife. The incision is then deepened through the subcutaneous fat. Electrodiathermy in coagulation mode provides a bloodless access through this layer. The linea alba is identified as a glistening layer deep to the subcutaneous tissues.</div>
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Upper midline incision. Incision is deepened through subcutaneous tissue to expose linea alba.</div>
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The orientation of the fibers on the linea alba is appreciated; these fibers are directed medially and inferiorly from either side, and the midline is identified as the axis where they criss-cross. This is opened carefully by means of electrodiathermy or heavy Mayo scissors .</div>
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Linea alba is divided to reveal preperitoneal fat.</div>
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Abdominal incision is completed to reveal intra-abdominal organs.</div>
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Every effort must be made to avoid injury to the intraperitoneal contents. This can be done by lifting the peritoneum in 2 straight artery forceps placed close to each other at right angles to the incision. Use careful palpation to ensure that no bowel or omentum is picked up in the artery forceps. In reoperations, extreme care is necessary because the underlying bowel may be adherent to the parietal peritoneum. In these cases, the peritoneum is opened in a virgin area, preferably by extending the incision appropriately.</div>
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Exploration of abdominal cavity</h2>
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The steps of exploration depend on the initial findings and are governed by the principles of systematic survey and priority for life-saving maneuvers.</div>
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Massive hemoperitoneum suggests 2 things. First, the patient may have a major source of bleeding. Second, the presence of blood within the peritoneum interferes with adequate exploration. The ideal strategy is to lift the small bowel and its mesentery out of the peritoneal cavity, to rapidly suction the blood within the peritoneum, and to place laparotomy pads in the 4 quadrants of the peritoneum. Once this is done, each pad is carefully removed to allow inspection of each quadrant.</div>
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Identification of the source of bleeding is much easier in the absence of massive hemoperitoneum. Common sources include injuries to the liver (see the image below) or spleen, ruptured ectopic pregnancies, mesenteric tears, hollow visceral injuries, aortic aneurysms, and splenic or hepatic artery aneurysms. Once the source of bleeding is identified, necessary corrective measures must be taken.</div>
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Liver laceration in traffic accident victim who presented with hemoperitoneum.</div>
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If enteric contents are the finding, they are suctioned out with a sump suction catheter, and the source of the enteric contamination is sought. This search must be performed systematically, starting from the stomach. The anterior aspect of the stomach is inspected for a perforation, followed by the duodenum.</div>
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Subsequently, the small bowel is inspected carefully, starting from the duodenojejunal flexure.</div>
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Each segment of the intestine is held up by Dr. B C Shah, and all surfaces are inspected. Any slough on the serosal surface is gently separated to allow identification of an underlying perforation (see the image below).</div>
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Laparotomy in patient with peritonitis. Image shows perforated duodenal ulcer.</div>
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If no source of enteric contents is found in the small intestine, the appendix and then the colon are examined. Any perforation found in the intestine is controlled. Methods of controlling the source include direct repair, buttressed repair, resection, and anastomosis or exteriorization of the perforation with stoma formation. The choice between the different options depends on the site of perforation, the suspected pathology, the extent of the disease, and the patient's physiologic status.</div>
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In patients with intestinal obstruction, possible findings on exploratory laparotomy include adhesive intestinal obstruction, a single intraperitoneal band with intestinal compression or torsion, and tumors (see the images below).</div>
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Laparotomy in patient with intestinal obstruction. Intraoperatively, single peritoneal band causing intestinal obstruction was found.</div>
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Laparotomy in patient with acute intestinal obstruction. Sigmoid volvulus with gangrene was found intraoperatively.</div>
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Multiple omental deposits in patient with disseminated carcinoma of stomach.</div>
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Multiple metastatic deposits over small bowel in patient with colonic malignancy.</div>
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Staging laparotomy should include a thorough search for foci of malignancy, splenectomy, wedge and core liver biopsies, and sampling of retroperitoneal lymph nodes. In premenopausal women, oophoropexy is performed in anticipation of radiotherapy.</div>
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Completion and closure</h2>
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Placement of drains after an exploratory laparotomy is still a subject of debate. The evidence currently available is inadequate to support routine drain placement. Patients with extensive contamination may benefit from drains in the subhepatic space and the pelvis.</div>
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Once the procedure is completed, the abdominal wall is closed. Before closure, however, the instrument and pad counts must be double-checked. Dr. B C Shah should manually inspect the peritoneum for any retained pads or instruments, even if scrub nurse has found the count to be correct.</div>
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Closure is carried out with either nonabsorbable suture material (eg, polypropylene) or a delayed absorbable suture material (eg, polydioxanone) in either a continuous suture or interrupted sutures. The standard approach is to place sutures about 1 cm from the edge of the incised linea alba, maintaining a distance of 1 cm between successive bites.</div>
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Sometimes, the Smead-Jones closure technique (ie, single-layer mass closure) may be employed to close the abdomen if the abdominal wall is plastered and separate layers are unavailable as a result of previous operations. This technique makes use of figure-eight sutures.</div>
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At times, closure may be rendered difficult by an edematous or distended bowel. In such circumstances, forced closure may have adverse postoperative outcomes in the form of impaired ventilation, intra-abdominal hypertension, pain, and dehiscence. Laparostomy and delayed closure may be a better option in such cases.</div>
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Complications of Procedure</h2>
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An exploratory laparotomy is associated with the same complications that are associated with any laparotomy. Immediate complications include the following:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Paralytic ileus</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Intra-abdominal collection or abscess</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Wound infections</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Abdominal wall dehiscence</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Pulmonary atelectasis</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Enterocutaneous fistula</li>
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Delayed complications include the following:</div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Adhesive intestinal obstruction</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Incisional hernia</li>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-57985387696921978042013-04-30T03:02:00.000-07:002013-04-30T03:02:00.564-07:00Passing blood in stools – A rare disease<div dir="ltr" style="text-align: left;" trbidi="on">
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Mr. B______, a 50 year old patient from Saudi Arabia came to me with <a href="http://drbcshah.com/passing-blood-in-stools-a-rare-disease/" target="_blank">bleeding while passing stools</a> (also read this interesting case ) since childhood. He was often treated for piles in his country but there was no relief. Ultimately being frustrated with his disease, he came to India. He was skinny and pale. I examined his anal canal but did not see any plies. There appeared some mass in rectum. I posted him for colonoscopy. Almost whole of his colon from rectum to cecum was involved with multiple small grape like growths called polyps. I biopsied few of them and they came benign. The diagnosis of Multiple colonic polyposis was established. There was no one else is his family who had similar complaints. I discussed with him about the disease and the treatment. I proposed to him complete removal of his colon including rectum (Total proctocolectomy) as these polyps can become cancerous. His immediate concern was will he live a normal life after the surgery? I assured him that life will be not normal but much better. He will get rid of his bleeding and anemia. He will however have more frequency of stools and they will be more liquid then normal. I discussed with him about temporary ileostomy and assured him that he will eventually pass stools from his anal canal. The surgery was smooth. It took me about 6 hours to operate him.I removed his whole of colon including his rectum as it was diseased using modern ultrasonic energy device so that there was very limited blood loss.I removed his whole of colon including his rectum as it was diseased using modern ultrasonic energy device so that there was very limited and was now connected to his anal canal. The joints were made using the modern staplers. I removed his whole of colon including his rectum as it was diseased using modern ultrasonic energy device so that there was very limited blood loss.terminal part of small intestine was modified to make a reservoir (J-pouch) for his stools and was now connected to his anal canal. The joints were made using the modern staplers. In such major surgeries there is always a risk of leakage from this new joint. Hence, in order to protect this joint (anastomosis), I had to divert his stools. This will allow the joint to heal nicely without getting contaminated and infected as if this happens then there is a risk to his life. Hence, I performed a diverting ileostomy for some time till he recovers. This means he will pass stools thro a small hole on his tummy into a bag. He recovered well. After few weeks I carried out radiological test and colonoscopy to ensure that the new reservoir and the joint had healed properly. I took his for his second surgery in which I had to simply close his ileostomy. He started passing stools from below about 5 – 7 times daily. He had good sensation & control over his stools and and there was no urgency. He happily returned to his home in Saudi Arabia.</div>
Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-64512876706290189792013-04-27T03:30:00.002-07:002013-04-27T03:30:35.528-07:00Testicle Fixation<div dir="ltr" style="text-align: left;" trbidi="on">
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What is it?</h2>
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From what you tell us and from what we have found, it looks as if your <a href="http://drbcshah.com/testicle-fixation/" target="_blank">child's testis</a> is twisting round (undergoing torsion). The twisting nips the artery and veins (the pipes that give and drain blood respectively) of the testis and slows down or stops completely the blood flow to it. This gives pain and swelling of the testis.</div>
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The testis may die if it is not operated on. In fact, the whole testis may not be twisted, just a small tag on the testis can give the same picture.</div>
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Sometimes infection around the testis mimics a twist or torsion. However it is safer for your child to have an operation than to risk loss of the testis.</div>
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The operation</h2>
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Your child will have a general anaesthetic, and will be asleep for the whole operation.</div>
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After your child goes to sleep with the anaesthetic, a cut is made in the scrotum. Dr. B C Shah has a look at the testis through the opening. If it is twisted, he untwists it. He fixes it with stitches under the skin so that it cannot twist again. He does the same to the other testis, so that this one will not twist at a later date.</div>
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If the testis is already dead, it is best to take it out and it will be sent to the laboratory to be examined under a microscope. The other testis should be enough for all your son's needs in the future. If Dr. B C Shah finds something else instead, he will deal with that as needed. He will let you know the result of examination and the test.</div>
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Usually you can take your child home one or two days after the operation.</div>
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Any alternatives?</h2>
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If you leave things as they are, the testis is very likely to die. The same can happen to the other side, leading to serious hormone problems.</div>
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Special ultrasound tests can be helpful, but an operation is the only way of being certain. Massaging and trying to untwist the testis through the skin rarely works and can offer some comfort but there is a very high chance that the testis will twist again soon. Therefore, an operation is the only reliable and definitive solution.</div>
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Before the operation</h2>
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Your son will be welcomed to the ward by the nurses or the receptionist. He will have his hospital details checked. He will be put to bed in a gown. He will have some basic tests done to make sure that he is well prepared and that he can have the operation as safely as possible.</div>
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You will be asked to hand in any medicines or drugs he may be taking so that his drug treatment in hospital will be correct. Please tell Dr. B C Shah of any allergies to drugs or dressings.</div>
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Your son will be seen by Dr. B C Shah who will examine him. You and your child will have the operation explained to you and you will be asked to fill in an operation consent form.</div>
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Before you sign the consent form giving permission for the operation to go ahead, make sure that you fully understand all the information that was given to you regarding your child’s health, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.</div>
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The operation site will be marked with a skin pencil. Your son will be seen by Dr. B C Shah who will be doing the operation. He will check that all the necessary preparations have been made.</div>
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After – in hospital</h2>
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Your child will be sleepy after the operation and is likely to sleep for an hour or more afterwards.</div>
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The drugs given for a general anaesthetic will make your child clumsy, slow and forgetful for about 24 hours. This happens even if your child feels quite all right. The nurses will support you to help him with everything he needs until he feels better.</div>
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Your child will probably not notice any significant pains. If necessary he can take a painkiller by mouth, such as paracetamol in a liquid form. By the end of one week the wound should be virtually pain-free.</div>
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Your child will be able to drink again two to three hours after the operation. He should be able to eat normally the next day. There will be dissolvable stitches in the skin. They slip out after 7 to 10 days.</div>
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The wound will have a cellulose dressing rather like nail varnish. There may be some swelling of the surrounding skin which improves in two to three days. This can happen and you and your child should not worry about it.</div>
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After 7 to 10 days, slight crusts on the wound will fall off. The cellulose varnish will peel off. Occasionally minor matchhead sized blebs (blisters) form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so.</div>
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If stitches are still there after 10 days, phone Dr. B C Shah because they may have to be removed. Do not try to remove them yourself.</div>
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Your child can wash but try to keep the wound area dry until the stitches are out. Baths or showers with ordinary soap and water are all right. Salted water is not necessary.</div>
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You will be given an appointment to bring your child to the outpatient department, after leaving hospital for a check up.</div>
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Some hospitals arrange a check-up about one month after leaving hospital. By this time, the results of the laboratory examination of the removed testis (if this was the case) will be ready. Others leave check-ups to the general practitioner.</div>
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After – at home</h2>
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Your child may need frequent sleeps for a day or two. Although it is usually difficult to limit what he does, try to help your child avoid any excess physical activity for four to six weeks after the operation.</div>
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You need to make sure that he is careful and doesn’t aggravate the wound. This can be very painful, cause bleeding and, sometimes, an infection.</div>
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If your child goes to school he can return to lessons after about 10 days. He can restart any sport after about four to six weeks.</div>
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Possible complications</h2>
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As with any operation under general anaesthetic, there is a very small risk of complications related to the heart and the lungs.</div>
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If the testis is twisted and very painful, the risk from the anaesthetic is slightly higher when the operation is done as an emergency. The tests that your child will have before the operation will make sure that he can have the operation in the safest possible way and will bring the risk for such complications very close to zero.</div>
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If you think that all is not well, please let Dr. B C Shah know. There is often some swelling and even some redness around the wound. These usually settle in three or four days.</div>
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Bleeding is very rarely a problem and is usually stopped with some extra pressure on the wound area. Extremely rarely, another operation is needed to stop the bleeding. Infection in the wound area is a rare problem and settles down with antibiotics in a week or two.</div>
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There is also a chance that your child can experience some swelling of the testis. This also gets settled by taking antibiotics for a week or two.</div>
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There is a chance that the testis will stay alive after the operation but will have some shrinkage (atrophy). This can happen because the blood supply to the testis was affected for a long time while it was twisted or because after the operation the blood flow did not return to normal.</div>
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If the testis in fact dies despite the operation, the wound will get quite painful and swollen. Phone Dr. B C Shah for advice if you are in doubt. This situation will require prompt medical attention and another operation might be needed to deal with the problem.</div>
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Another rare complication that can happen during this operation is damage to the structures that carry the sperm from the testis. This can have an affect on your child’s fertility in the future (his ability to father children) since one of his testes will not contribute sperm. You should discuss the possibility of this rare complication with Dr. B C shah.</div>
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General advice</h2>
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The operation to untwist, fix and save the testis is successful in 80 to 100 per cent of cases if it is done within four to six hours from the moment the problem started and your child developed pain.</div>
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If the operation takes place six to eight hours after the initiation of the problem the chances of success are dramatically smaller and after 12 hours are diminished. Therefore, in the future, it is important to know that if you have even the slightest suspicion that one of your children develops a similar problem, it is vital to come to the hospital urgently.</div>
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These notes will help you and your son through your child's operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little.</div>
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If you have any queries or problems, please ask Dr.B C Shah.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com1tag:blogger.com,1999:blog-6351996846816083125.post-56957320411196039262013-04-24T03:16:00.001-07:002013-04-24T03:16:40.752-07:00Testicle Removal (Orchiectomy)<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="http://drbcshah.com/testicle-removal-orchiectomy/" target="_blank">Orchiectomy</a> is the removal of the testicles. The penis and the scrotum, the pouch of skin that holds the testicles, are left intact. An orchiectomy is done to stop most of the body's production of testosterone, which prostate<a href="http://drbcshah.com/cancer/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">cancer</a> usually needs in order to continue growing.</div>
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What To Expect After Surgery</h2>
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Orchiectomy can be done as an outpatient procedure or with a short hospital stay. Regular activities are usually resumed within 1 to 2 weeks, and a full recovery can be expected within 2 to 4 weeks.</div>
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Why It Is Done</h2>
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Orchiectomy may help relieve symptoms, prevent complications, and prolong survival for advanced prostate cancer. Radiation treatment is sometimes needed also.</div>
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How Well It Works</h2>
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Orchiectomy often causes the tumor to shrink and relieves bone pain.</div>
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This surgery does not cure prostate cancer, although it may prolong survival.</div>
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Risks</h2>
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Orchiectomy causes sudden hormone changes in the body. Side effects from hormone changes include:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Sterility.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Loss of sexual interest.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Erection problems.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Hot flashes.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Larger breasts (gynecomastia).</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Weight gain.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Loss of muscle mass.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Thin or brittle bones (osteoporosis).</li>
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What To Think About</h2>
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Removing the testicles is one way to cut down on testosterone and other male hormones, or androgens. Taking medicine is another way to reduce androgen levels in your body. Some men may prefer surgery over taking pills or having injections. But if you choose to take medicine, you can stop taking the hormone drugs. And the side effects from taking medicine may go away. An orchiectomy is permanent.</div>
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Some men choose to have reconstructive surgery after an orchiectomy, in which Dr. B C Shah replaces the testicles with artificial testicles.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-4781630221443145922013-04-23T01:58:00.002-07:002013-04-23T01:58:55.966-07:00512 stones found in Gall bladde<div dir="ltr" style="text-align: left;" trbidi="on">
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(Dr. B C Shah recently performed Laparoscopic Cholecystectomy on Mr. N_____ G______ who had 512 stones!)</div>
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Mr. N_____ G______ came to me with history of chronic pain in upper abdomen. The pain would get aggravated after meals. His sonography revealed that his gall bladder was distended & full of stones. I performed <a href="http://drbcshah.com/512-stones-found-in-gall-bladder/" target="_blank">Laparoscopic Cholecystectomy</a> on him. It was a difficult case as there were lot of adhesions. The gall bladder was delivered successfully It was a pleasant surprise to find 512 stones in the Gall Bladder. </div>
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One often wonders as to why patients wait so long. Many times patients come to me with Gall Stones. Often they have only one small stone. The common question asked is "Do I still need surgery for just a small stone?"</div>
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As per my observation of last 23 years, one stone or many stones – all have a potential to create complications including even death. Its not just the numbers or size. One small stone can just simply slip into the bile duct and is sufficient to trigger Pancreatitis. I personally know of a patient who developed severe pancreatitis due to a 3 mm small stone. She battled for two months in one of the best hospitals in Mumbai and ultimately died. </div>
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In kidney stones, one of the criteria on which the therapy is based is the number of stones and its size. Smaller stones can pass out spontaneously and the patient's problem gets solved naturally. However, this is not the situation with gall stones. A gall stone or its fragment passing out can be dangerous as it can cause blockage of bile in liver or swelling in pancreas. Such complications can occur any time and no doctor on earth can predict when this will occur.</div>
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Many patients wait for the stones to grow and multiply. Surely this has a potential of inviting big untimely trouble. Don't wait. There are no warning signs.As far as records go, the largest number of gallstones removed was 3,110 in an open surgery in Britain in 1983, reported in the Guinness Book of World Records. </div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-24830835186921919712013-04-19T02:49:00.003-07:002013-04-19T02:49:58.810-07:00Gallstone Ileus<div dir="ltr" style="text-align: left;" trbidi="on">
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Description</h1>
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<a href="http://drbcshah.com/gallstone-ileus/" target="_blank">Gallstone ileus</a> is obstruction of the bowel due to impaction of one of more gallstones. To achieve this, stones usually have to be at least 2.5 cm in diameter.</div>
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A fistula develops between a gangrenous gallbladder and the duodenum or other parts of the gastrointestinal tract, allowing passage of the stone. Occasionally the stone may enter the intestine through a fistulous communication between the bile duct and the gastrointestinal tract. Stones less than 2.5 cm in diameter may traverse the alimentary canal without causing obstruction. When the gallstone lodges in the duodenum and causes gastric outlet obstruction, it is called Bouveret's syndrome.</div>
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Epidemiology</h2>
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It accounts for only about 1-4% of causes of intestinal obstruction, but up to 25% of cases of intestinal obstruction in those over the age of 65. It is more common in women than in men and the incidence reflects the prevalence of gallstones with age and sex. It is regarded as 'rare and controversial'.</div>
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The most common site of impaction of gallstones is in the distal ileum, followed by the jejunum and the stomach.</div>
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Presentation</h2>
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The presentation is usually that of distal obstruction of the small bowel but the symptoms and signs of gallstone ileus can be vague. It is important to make the diagnosis, as there is a high mortality in the usual age group.</div>
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Symptoms</h3>
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Abdominal pain is an early sign with vomiting developing later. It tends to become progressively more severe.</div>
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Abdominal pain is colicky in nature, with freedom from pain between spasms. It is periumbilical and is not clearly localised.</div>
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Abdominal distension develops.</div>
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Initially the patient may pass stools or flatus but not later.</div>
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Vomiting occurs some hours after the onset of pain and it may be faeculent.</div>
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Signs</h3>
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Patients with gallstones are often, but not invariably, obese.</div>
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The patient tends to look unwell.</div>
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The abdomen may be bloated and small bowel peristalsis may be visible.</div>
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Some slight and nonspecific tenderness of the abdomen is common.</div>
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Auscultation will reveal rushes, gurgling and tinkling sounds at times of pain.</div>
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Features of dehydration will develop.</div>
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Differential diagnosis</h2>
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This is between other causes of intestinal obstruction. This may include adhesions from previous surgery. Malignancy almost never occurs in the small intestine. Large bowel malignancy tends to present as chronic blood loss when proximal and obstruction when distal. This is because the contents of the bowel are liquid in the first part and become progressively more solid as they traverse the colon.</div>
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Investigations</h2>
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Plain abdominal X-ray should show the typical features of small intestinal obstruction. It may be possible to see air in the biliary tract. It may be possible to see a radio-opaque gallstone.</div>
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Rigler's triad of small bowel obstruction, pneumobilia and ectopic gallstones may be occasionally detected by plain radiograph or ultrasound. Computed tomography (CT) scanning invariably demonstrates a fistulous communication, intraluminal gallstone in the small bowel, pneumobilia and any other co-existing pathology contributing to the impaction of the gallstone. The interpretation of subtle signs on CT scanning requires skill but can increase the accuracy of the diagnosis. From the practical perspective, plain abdominal films demonstrate small bowel obstruction, ultrasound shows biliary tract pathology and CT makes the final diagnosis. Helical CT can be especially useful.</div>
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Blood tests should include FBC, U&E and creatinine, and LFTs.</div>
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In an elderly person, routine CXR and ECG before anticipated surgery are wise.</div>
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In view of anticipated surgery, blood should be group and cross-matched.</div>
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Associated diseases</h2>
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Patients with gallstone ileus are often old and frail. Cases of gallstone ileus have been reported in patients whose intestines are strictured due to tuberculosis or other disease.</div>
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Management</h2>
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An intravenous infusion is required to correct dehydration and to reduce the risk of surgery.</div>
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A nasogastric tube will decompress the stomach and avoid further vomiting.</div>
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Removal of the obstruction at laparotomy should be accompanied by a careful search for other gallstones proximal to the obstruction. It is generally recommended that those with chronic gallstone problems should undergo a later cholecystectomy, but it can be performed concurrently. Some authors say that definitive treatment of biliary pathology at the initial operation is the management of choice. Others disagree as it is a longer operation in a high-risk group and so the risk of complications is increased. One retrospective study concluded that treatment should be individualised and that removal of the stone through the bowel (enterolithotomy) should only be accompanied by cholecystectomy if the patient has good cardiorespiratory reserve and with absolute indications for biliary surgery at the time of presentation (the one-stage procedure).</div>
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Some surgeons manage to use a laparoscopic technique.</div>
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Complications</h2>
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Complications are common as this is major surgery, usually in a group who are old and frail.</div>
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Prognosis</h2>
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Because the condition tends to affect the old and frail, there is a 20% mortality. There appears to be no real difference in terms of the operative procedure performed, eg simple enterolithotomy to fistula repair</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-75301478294202354932013-04-18T03:18:00.002-07:002013-04-18T03:18:49.107-07:00Miraculous healing from Burn Injuries<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="http://drbcshah.com/miraculous-healing-from-burn-injuries/" target="_blank">Hare Krishna Shri. K. Venkataramana,</a></div>
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I would like to express my deepest gratitude to you and the staff of your hospital for taking such a good care of my employee by the name Mr. Bhagyawan Behra. He had suffered burn injuries and was admitted to your hospital on 10th February 2013.</div>
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He was discharged from your hospital on 24/02/2013. It was miraculous recovery, considering the fact that whoever saw his burn injuries in the beginning was not sure of his recovery at all.</div>
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I sincerely feel that your hospital's holistic approach to patient care, is truly been helpful to his recovery and your motto, "Serving in Devotion", which is followed in spirit by every individual staff of your hospital, has been the secret behind his miraculous recovery.</div>
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Not only he received quick and highly professional care, but more than that he received care with love and compassion.</div>
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I am very grateful for the professional and personal service he received during his stay is already feeling much better.</div>
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Please give my regards and thanks to your winderful team of dedicated professionals, for an outstanding spirit in the execution of medical services.</div>
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Hare Krishna! </div>
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Your's Sincerely, </div>
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Ashok K Shah </div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-56660235630324301902013-04-15T03:46:00.004-07:002013-04-15T03:46:52.068-07:00Misdiagnosis can lead to rupture of appendix<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih5Ksulaff-k5g1WSJ8euin8jyeaclgcByQG4q34eDpXkVFjAG8jYWBunAnLJb1DG4ChZVXQTqv_hwHbuUF9R-U6-kNNks-LpnrY9VCxxXQ605gQ0sxU5HmQWKiXXotKET_Z3gOv6W1zU/s1600/appendix+4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih5Ksulaff-k5g1WSJ8euin8jyeaclgcByQG4q34eDpXkVFjAG8jYWBunAnLJb1DG4ChZVXQTqv_hwHbuUF9R-U6-kNNks-LpnrY9VCxxXQ605gQ0sxU5HmQWKiXXotKET_Z3gOv6W1zU/s320/appendix+4.jpg" width="320" /></a></div>
<span style="background-color: white; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 23.99305534362793px; text-align: justify;">Mr Khokan Roy, 30 yr resident of Bhyander came in emergency with complaints of pain in abdomen & vomiting since 3 days. So far he was taking treatment from a local general practitioner, who just gave him medicines thinking it to be acidity problem. Patient tolerated pain hoping to get better with his family doctor's medicines. but his condition slowly deteriorated in next two days as he continued to vomit & have increasing pain in abdomen. Clinical examination of this patient was sufficient to reach to the diagnosis of acute appendicitis. Subsequently his sonography confirmed that there was swelling in appendix. He was explained about the disease and prepared for emergency surgery – removal of the appendix. He was offered options of open appendectomy as well as key hole (laparoscopic) surgery. He said that he would not be able to take long leave and thus opted for Laparoscopic <a href="http://drbcshah.com/misdiagnosis-can-lead-to-rupture-of-appendix/" target="_blank">appendectomy</a>.The operative findings were that the appendix had burst & lot of pus had formed around appendix. Waiting for three days had caused the appendix to burst and spread of pus. The surgery was carried out successfully – removal of the appendix along with the pus. A drainage tube was placed for couple of days to let out the inside toxins. The patient made a rapid & uneventful recovery & the wounds healed very well..</span><br />
<span style="background-color: white; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 15.555556297302246px; line-height: 23.99305534362793px; text-align: justify;">Although appendix is situated in right lower abdomen, the initial manifestation of the disease can be upper or central abdominal pain. This is called refereed pain. Often such patients are diagnosed & treated for acidity. Important time is lost and such appendix are prone to rupture and cause more trouble to patient. A proper clinical examination along with the aid of ultrasonography can prevent such disasters.</span></div>
Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-80440804562447840252013-04-15T03:44:00.001-07:002013-04-15T03:44:25.019-07:00Intestinal Obstruction due to Stones<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 12px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">MRS R____ K________ , a 55 year old female was transferred from a local nursing home</span></div>
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She was admitted in a local Nursing home with abdominal pain & vomiting. She was treated as a case of acidity. In spite of the treatment for a week, she did not improve. </div>
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When she came to me, her symptoms were suggestive of intestinal obstruction (blockage). A CT scan of abdomen was undertaken. CT scan revealed that she had intestinal obstruction due to a large 5 centimeter stone. This is called <a href="http://drbcshah.com/gallstone-ileus/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 15.555556297302246px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">Gall stone ileus</a>.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 12px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="http://drbcshah.com/intestinal-obstruction-due-to-stones/" target="_blank">How did the stone land up in her intestine?</a></span></div>
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No it was not a swallowed stone. This stone had formed in her Gall Bladder over many years. Due to its weight & chronic inflammation, the stone gradually perforated into her small intestine (duodenum). Since the stone was very large it could not pass thro the small intestine and got stuck in the last part of small intestine. Patient was having pain & constantly vomiting due to this blockage. </div>
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The treatment was done using minimal access surgery instead of making a big cut on her abdomen – laparotomy. Using laparoscopy, the site of blockage was identified. A small incision was made on her abdomen. The stone was cut open from the intestine (enterolithotomy) and the intestine was placed back into the abdomen.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 12px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How did the stone land up in her intestine?</span></div>
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No it was not a swallowed stone. This stone had formed in her Gall Bladder over many years. Due to its weight & chronic inflammation, the stone gradually perforated into her small intestine (duodenum). Since the stone was very large it could not pass thro the small intestine and got stuck in the last part of small intestine. Patient was having pain & constantly vomiting due to this blockage. </div>
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The treatment was done using minimal access surgery instead of making a big cut on her abdomen – laparotomy. Using laparoscopy, the site of blockage was identified. A small incision was made on her abdomen. The stone was cut open from the intestine (enterolithotomy) and the intestine was placed back into the abdomen.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-51658947166337954972013-04-11T03:42:00.001-07:002013-04-11T03:42:17.538-07:00thyroid-gland-removal<div dir="ltr" style="text-align: left;" trbidi="on">
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What is a thyroidectomy?</h2>
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A <a href="http://drbcshah.com/thyroid-gland-removal/" target="_blank">thyroidectomy</a> is surgery to remove all or part of the thyroid gland.The thyroid gland is a small gland in the lower front of your neck. It takes iodine from the food you eat to make hormones. The hormones control the process of turning the food you eat into energy.</div>
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When is it used?</h2>
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You may need to have part or all of your thyroid gland removed if: You have a lump in your thyroid gland that could be cancer. If <a href="http://drbcshah.com/cancer/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;" target="_blank">cancer</a> is found, removal of the gland can keep the cancer from spreading.Your thyroid gland is overactive and making too much thyroid hormone (a problem called hyperthyroidism).Instead of this procedure, other treatments may include:If you have a lump, you may choose to have repeat exams over many months or years and then have surgery if the lump grows. If you have cancer in your thyroid gland, there is some risk that the cancer will spread to other parts of your body.If you have an overactive thyroid gland, medicine and radioactive iodine treatments can usually control the problem. You may need surgery if these treatments do not control your thyroid gland.You may choose not to have treatment. Ask Dr. B C Shah about your choices for treatment and the risks.</div>
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How do I prepare for this procedure?</h2>
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Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask Dr. B C Shah if you need to avoid taking any medicine or supplements before the procedure.You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell Dr. B C Shah about all medicines and supplements that you take.Your provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure. Follow any other instructions your healthcare provider gives you.Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do.</div>
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What happens during the procedure?</h2>
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This procedure will be done at the hospital.You will be given general anesthesia to keep you from feeling pain. General anesthesia relaxes your muscles and you will be asleep. Dr. B C Shah will make a cut in your neck just above the collarbone. He or she will then remove all or part of the gland. Lab tests will be done right away during the procedure to check for cancer. Based on the test results, the provider may end the operation or may remove another part or all of the thyroid gland. The cut in your neck will then be closed. Rarely, thyroid cancer spreads to lymph nodes. If this has happened, you will need further treatment.The procedure will take 1 to 3 hours.</div>
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What happens after the procedure?</h2>
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You may be in the hospital for 1 or 2 days. If all or a large part of the thyroid gland was removed, you will need to take thyroid hormone medicine for the rest of your life. If you have cancer, you may need to take radioactive iodine medicine to destroy any remaining thyroid tissue and cancerous cells. Ask Dr. B C Shah:how long it will take to recoverwhat activities you should avoid and when you can return to your normal activitieshow to take care of yourself at home what symptoms or problems you should watch for and what to do if you have them. Make sure you know when you should come back for a checkup.</div>
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What are the risks of this procedure?</h2>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 12px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Dr. B C Shah</span> will explain the procedure and any risks. Some possible risks include:Anesthesia has some risks. Discuss these risks with your healthcare provider.You may have infection or bleeding.The nerves that control your speech may be injured. Damage to the nerves could make your voice hoarse. The damage may be temporary or lifelong.The parathyroid glands may be injured when all of the thyroid gland is removed. The hormones made by the parathyroid glands control the amount of calcium and phosphorus in the blood. You need to have the right levels of calcium and phosphorus in your blood so your nerves and muscles work well. If the parathyroid glands cannot function after the operation, you may need to take calcium pills or hormones.If thyroid cancer is found, it can return to the neck or other parts of the body. Fortunately, removal of the thyroid gland usually keeps this from happening.There is risk with every treatment or procedure. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-22666053406863976252013-03-27T22:12:00.000-07:002013-03-27T22:12:13.655-07:00Difficulty Swallowing ,dysphagia<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhazpSgUciTBUEC4PvQYXDqCfkFOKgXUfpJ94hpns819kjsdOegRRK8L836bRrr9RHl8Xs_DzXpdGVlA4GI_i0Fy7uvPqBoUPZG3f4Eylsfw5DCxIvvE4zGpibT5I-HFOiCVY1-mDqK7rw/s1600/Difficulty-Swallowing-Dysphagia.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="267" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhazpSgUciTBUEC4PvQYXDqCfkFOKgXUfpJ94hpns819kjsdOegRRK8L836bRrr9RHl8Xs_DzXpdGVlA4GI_i0Fy7uvPqBoUPZG3f4Eylsfw5DCxIvvE4zGpibT5I-HFOiCVY1-mDqK7rw/s320/Difficulty-Swallowing-Dysphagia.jpg" width="320" /></a></div>
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What is difficulty swallowing </h1>
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Difficulty swallowing is also called <a href="http://drbcshah.com/difficulty-swallowing-dysphagia/" target="_blank">dysphagia</a>. It is usually a sign of a problem with your throat or esophagus -the muscular tube that moves food and liquids from the back of your mouth to your stomach. Although dysphagia can happen to anyone, it is most common in older adults, babies, and people who have problems of the brain or nervous system.</div>
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There are many different problems that can prevent the throat or esophagus from working properly. Some of these are minor, and others are more serious. If you have a hard time swallowing once or twice, you probably do not have a medical problem. But if you have trouble swallowing on a regular basis, you may have a more serious problem that needs treatment.</div>
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What causes dysphagia?</h1>
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Normally, the muscles in your throat and esophagus squeeze, or contract, to move food and liquids from your mouth to your stomach without problems. Sometimes, though, food and liquids have trouble getting to your stomach. There are two types of problems that can make it hard for food and liquids to travel down your esophagus:</div>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The muscles and nerves that help move food through the throat and esophagus are not working right. This can happen if you have:</strong></div>
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<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Had a stroke or a brain or spinal cord injury.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Certain problems with your nervous system, such as post-polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson's disease.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">An immune system problem that causes swelling (or inflammation) and weakness, such as polymyositis or dermatomyositis.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Esophageal spasm. This means that the muscles of the esophagus suddenly squeeze. Sometimes this can prevent food from reaching the stomach.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Scleroderma. In this condition, tissues of the esophagus become hard and narrow. Scleroderma can also make the lower esophageal muscle weak, which may cause food and stomach acid to come back up into your throat and mouth.</li>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Something is blocking your throat or esophagus. This may happen if you have:</strong></div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 16.363636016845703px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;"><a href="http://drbcshah.com/heartburn-and-gastro-oesophageal-reflux-disease/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Gastroesophageal reflux disease</a> (GERD). When stomach acid backs up regularly into your esophagus, it can cause ulcers in the esophagus, which can then cause scars to form. These scars can make your esophagus narrower.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Esophagitis. This is inflammation of the esophagus. This can be caused by different problems, such as GERD or having an infection or getting a pill stuck in the esophagus. It can also be caused by an allergic reaction to food or things in the air.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Diverticula. These are small sacs in the walls of the esophagus or the throat.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Esophageal tumors. These growths in the esophagus may be cancerous or not cancerous.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Masses outside the esophagus, such as lymph nodes, tumors, or bone spurs on the vertebrae that press on your esophagus.</li>
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A dry mouth can make dysphagia worse. This is because you may not have enough saliva to help move food out of your mouth and through your esophagus. A dry mouth can be caused by medicines or another health problem.</div>
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What are the symptoms?</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Dysphagia can come and go, be mild or severe, or get worse over time. If you have dysphagia, you may:</strong></div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 16.363636016845703px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Have problems getting food or liquids to go down on the first try.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Gag, choke, or cough when you swallow.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Have food or liquids come back up through your throat, mouth, or nose after you swallow.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Feel like foods or liquids are stuck in some part of your throat or chest.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Have pain when you swallow.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Have pain or pressure in your chest or have heartburn.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Lose weight because you are not getting enough food or liquid.</li>
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How is dysphagia diagnosed?</h1>
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If you are having difficulty swallowing, Dr. B C Shah will ask questions about your symptoms and examine you. He or she will want to know if you have trouble swallowing solids, liquids, or both. He or she will also want to know where you think foods or liquids are getting stuck, whether and for how long you have had heartburn, and how long you have had difficulty swallowing. He or she may also check your reflexes, muscle strength, and speech. Dr. B C Shah may then refer you to one of the following specialists:</div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 16.363636016845703px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">An otolaryngologist, who treats ear, nose, and throat problems</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A gastroenterologist, who treats problems of the digestive system</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A neurologist, who treats problems of the brain, spinal cord, and nervous system</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A speech-language pathologist, who evaluates and treats swallowing problems</li>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">To help find the cause of your dysphagia, you may need one or more tests, including:</strong></div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 16.363636016845703px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">X-rays. These provide pictures of your neck or chest.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">A barium swallow. This is an X-ray of the throat and esophagus. Before the X-ray, you will drink a chalky liquid called barium. Barium coats the inside of your esophagus so that it shows up better on an X-ray.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Fluoroscopy. This test uses a type of barium swallow that allows your swallowing to be videotaped.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Laryngoscopy. This test looks at the back of your throat, using either a mirror or a fiber-optic scope.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Esophagoscopy or upper gastrointestinal endoscopy. During these tests, a thin, flexible instrument called a scope is placed in your mouth and down your throat to look at your esophagus and perhaps your stomach and upper intestines. Sometimes a small piece of tissue is removed for a biopsy. A biopsy is a test that checks for inflammation or cancer cells.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Manometry. During this test, a small tube is placed down your esophagus. The tube is attached to a computer that measures the pressure in your esophagus as you swallow.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">pH monitoring, which tests how often acid from the stomach gets into the esophagus and how long it stays there.</li>
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How is it treated?</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Your treatment will depend on what is causing your dysphagia. Treatment for dysphagia includes:</strong></div>
<ul style="background-color: white; border: 0px; color: #4c4c4c; font-family: 'Open Sans', Arial, sans-serif; font-size: 16.363636016845703px; line-height: 26px; list-style-image: initial; list-style-position: initial; margin: 0px; outline: 0px; padding: 0px 0px 23px 16px; vertical-align: baseline;">
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Exercises for your swallowing muscles. If you have a problem with your brain, nerves, or muscles, you may need to do exercises to train your muscles to work together to help you swallow. You may also need to learn how to position your body or how to put food in your mouth to be able to swallow better.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Changing the foods you eat. Dr. B C Shah may tell you to eat certain foods and liquids to make swallowing easier.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Dilation. In this treatment, a device is placed down your esophagus to carefully expand any narrow areas of your esophagus. You may need to have the treatment more than once.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;"><a href="http://drbcshah.com/endoscopy/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Endoscopy</a>. In some cases, a long, thin scope can be used to remove an object that is stuck in your esophagus.</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Surgery. If you have something blocking your esophagus (such as a tumor or diverticula), you may need surgery to remove it. Surgery is also sometimes used in people who have a problem that affects the lower esophageal muscle (achalasia).</li>
<li style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-align: justify; vertical-align: baseline;">Medicines. If you have dysphagia related to GERD, heartburn, or esophagitis, prescription medicines may help prevent stomach acid from entering your esophagus. Infections in your esophagus are often treated with antibiotic medicines.</li>
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In rare cases, a person who has severe dysphagia may need a feeding tube because he or she is not able to get enough food and liquids.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-41732497088919178232013-03-27T22:10:00.001-07:002013-03-27T22:10:45.567-07:00upper endoscopy<div dir="ltr" style="text-align: left;" trbidi="on">
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What is upper <a href="http://drbcshah.com/endoscopy/" style="background-color: transparent; border: 0px; color: #111111; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">endoscopy</a>? </h1>
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Upper <a href="http://drbcshah.com/endoscopy/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">endoscopy</a> lets Dr. B C Shah examine the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). Dr. B C Shah will use a thin, flexible tube called an endoscope, which has its own lens and light source, and will view the images on a video monitor. You might hear Dr. B C Shah or other medical staff refer to upper endoscopy as <a href="http://drbcshah.com/understanding-upper-endoscopy/" target="_blank">upper GI endoscopy</a>, esophagogastroduodenoscopy (EGD) or panendoscopy.</div>
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Why is upper endoscopy done?</h1>
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Upper endoscopy helps Dr. B C Shah evaluate symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty swallowing. It's the best test for finding the cause of bleeding from the upper gastrointestinal tract. It's also more accurate than X-ray films for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum.</div>
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Dr. B C Shah might use upper endoscopy to obtain a <a href="http://drbcshah.com/biopsy/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">biopsy</a> (small tissue samples). A biopsy helps Dr. B C Shah distinguish between benign and malignant (cancerous) tissues. Remember, biopsies are taken for many reasons, and Dr. B C Shah might order one even if he or she does not suspect cancer. For example, he might use a biopsy to test for Helicobacter pylori, the bacterium that causes ulcers.</div>
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Dr. B C Shah might also use upper endoscopy to perform a cytology test, where he or she will introduce a small brush to collect cells for analysis.</div>
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Upper endoscopy is also used to treat conditions of the upper gastrointestinal tract. Dr. B C Shah can pass instruments through the endoscope to directly treat many abnormalities – this will cause you little or no discomfort. For example, Dr. B C Shah might stretch (dilate) a narrowed area, remove polyps (usually benign growths) or treat bleeding.</div>
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What preparations are required?</h1>
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An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately six hours before the examination. Dr. B C Shah will tell you when to start fasting as the timing can vary.</div>
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Tell Dr. B C Shah in advance about any medications you take; you might need to adjust your usual dose for the examination. Discuss any allergies to medications as well as medical conditions, such as heart or lung disease.</div>
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Can I take my current medications?</h1>
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Most medications can be continued as usual, but some medications can interfere with the preparation or the examination. Inform Dr. B C Shah about medications you’re taking, particularly aspirin products or antiplatelet agents, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Also, be sure to mention any allergies you have to medications.</div>
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What happens during upper endoscopy?</h1>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 12px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Dr. B C Shah</span> might start by spraying your throat with a local anesthetic or by giving you a sedative to help you relax. You'll then lie on your side, and Dr. B C Shah will pass the endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope doesn't interfere with your breathing, Most patients consider the test only slightly uncomfortable, and many patients fall asleep during the procedure.</div>
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What happens after upper endoscopy?</h1>
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You will be monitored until most of the effects of the medication have worn off. Your throat might be a little sore, and you might feel bloated because of the air introduced into your stomach during the test. You will be able to eat after you leave unless Dr. B C Shah instructs you otherwise.</div>
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Your physician will explain the results of the examination to you, although you'll probably have to wait for the results of any biopsies performed.</div>
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If you have been given sedatives during the procedure, someone must drive you home and stay with you. Even if you feel alert after the procedure, your judgement and reflexes could be impaired for the rest of the day.</div>
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What are the possible complications of upper endoscopy?</h1>
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Although complications can occur, they are rare when Dr. B C Shah who are specially trained and experienced in this procedure perform the test. Bleeding can occur at a biopsy site or where a polyp was removed, but it's usually minimal and rarely requires follow-up. Perforation (a hole or tear in the gastrointestinal tract lining) may require surgery but this is a very uncommon complication. Some patients might have a reaction to the sedatives or complications from heart or lung disease.</div>
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Although complications after upper endoscopy are very uncommon, it's important to recognize early signs of possible complications. Contact Dr. B C Shah immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain, or bleeding, including black stools. Note that bleeding can occur several days after the procedure.</div>
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If you have any concerns about a possible complication, it is always best to contact Dr. B C Shah right away.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com1tag:blogger.com,1999:blog-6351996846816083125.post-2829997766604153882013-03-25T23:16:00.002-07:002013-03-25T23:16:28.682-07:00Hernia Repair, Incisional<div dir="ltr" style="text-align: left;" trbidi="on">
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<a alt="Hernia Repair, Incisional" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgc9aJHk7_tlXq39KFXOSQalYiAn-l-fkDT630pZxiD22CR_fzSi5aELMB6UM7vMmlGUVTKZEiPpo5DvSdwStEHWJaHmPSJkcztJa4MFIHyk9gISNZFrMtephJ1hVVvt_2jh57n9aWjplI/s1600/incisional-hernia.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgc9aJHk7_tlXq39KFXOSQalYiAn-l-fkDT630pZxiD22CR_fzSi5aELMB6UM7vMmlGUVTKZEiPpo5DvSdwStEHWJaHmPSJkcztJa4MFIHyk9gISNZFrMtephJ1hVVvt_2jh57n9aWjplI/s320/incisional-hernia.jpg" width="320" /></a></div>
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What Is an Incisional Hernia?</h2>
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An incisional <a href="http://drbcshah.com/hernia/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">hernia</a> happens when a weakness in the muscle of the abdomen allows the tissues of the abdomen to protrude through the muscle. The hernia appears as a bulge under the skin, and can be painful or tender to the touch. In the case of an <a href="http://drbcshah.com/hernia-repair-incisional/" target="_blank">incisional hernia</a>, the weakness in the muscle is caused by the incision made in a prior abdominal surgery. An incisional hernia is typically small enough that only the peritoneum, or the lining of the abdominal cavity, pushes through. In severe cases, portions of organs may move through the hole in the muscle.</div>
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Who Is At Risk For an Incisional Hernia?</h2>
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Incisional hernias are most likely to occur in obese and pregnant patients. A history of multiple abdominal surgeries may increase the risk of an incisional hernia. If a hernia develops in the abdomen and the patient has not had surgery, it is not an incisional hernia.</div>
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A patient who gains significant weight after an abdominal surgery, becomes pregnant or participates in activities that increase abdominal pressure like heavy lifting is most at risk for an incisional hernia. The incision is weakest, and most prone to a hernia, while it is still healing. While incisional hernias can develop or enlarge months or years after surgery, they are most likely to happen 3-6 months after surgery.</div>
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Diagnosing an Incisional Hernia</h2>
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Incisional hernias happen after an abdominal surgery and may seem to appear and disappear, which is referred to as a "reducible" hernia. The hernia may not be noticeable unless the patient is involved in an activity that increases abdominal pressure, such as coughing, sneezing, pushing to have a bowel movement, or lifting a heavy object. The visibility of a hernia makes it easily diagnosable, often requiring no testing outside of a physical examination by a physician. The physician may request that you cough or bear down in order to see the hernia while it is "out".</div>
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Routine testing can be done to determine what area of the body is pushing through the muscle. If the hernia is large enough to allow more than the peritoneum to bulge through, testing may be required.</div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; font-size: 12px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Incisional Hernia Treatment</span></h2>
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An incisional hernia may be small enough that surgical repair is an option, not a necessity. If the hernia is large, causes pain or is steadily growing, surgery may be recommended. Another option is a truss, a garment that is similar to a weight belt or girdle, that applies constant pressure to the hernia.</div>
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When Is Incisional Hernia Surgery Necessary?</h2>
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An Incisional hernia may require surgery if:</div>
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It continues to enlarge over time</div>
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It is very large</div>
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It is cosmetically unappealing</div>
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The bulge remains even when the patient is relaxed or laying down</div>
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The hernia causes pain</div>
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When Is Incisional Hernia an Emergency?</h2>
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A hernia that gets stuck in the “out” position is referred to as an incarcerated hernia. While an incarcerated hernia may not be an emergency, medical care should be sought as it can become an emergency quickly. An incarcerated hernia becomes an emergency when it becomes a “strangulated hernia” where the tissue that bulges out is being starved of its blood supply. Untreated, a strangulated hernia can cause the death of the tissue that is bulging through the hernia.</div>
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A strangulated hernia can be identified by the deep red or purple color of the bulging tissue. It may be accompanied by severe pain, but is not always painful. Nausea, vomiting, diarrhea and abdominal swelling may also be present.</div>
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Incisional Hernia Surgery</h2>
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Incisional hernia surgery is typically performed using general anesthesia and is done on an inpatient basis. The surgery is typically performed using the <a href="http://drbcshah.com/laparoscopy/" style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #ffa300; font-size: 16.363636016845703px; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">laparoscopic</a> method, using small incisions rather than the traditional large open incision. Surgery is performed by a general surgeon or a colon-rectal specialist.</div>
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Once anesthesia is given, surgery begins with an incision on either side of the hernia. A laparoscope is inserted into one incision, and the other incision is used for additional surgical instruments. Dr. B C Shah then isolates the portion of the abdominal lining that is pushing through the muscle. This tissue is called the “hernia sac”. Dr. B C Shah returns the hernia sac to its proper position, then begins to repair the muscle defect.</div>
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If the defect in the muscle is small, it may be sutured closed. The sutures will remain in place permanently, preventing the hernia from returning. For large defects, the Dr. B C Shah may feel that suturing is not adequate. In this case, a mesh graft will be used to cover the hole. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.</div>
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If the suture method is used with larger muscle defects (approximately the size of a quarter or larger), the chance of reoccurrence is increased. The use of mesh in larger hernias is the standard of treatment, but it may not be appropriate if the patient has a history of rejecting surgical implants or a condition that prevents the use of mesh.</div>
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Once the mesh is in place or the muscle has been sewn, the laparoscope is removed and the incision can be closed. The incision is typically closed with sutures that are removed at a follow up visit with the Dr. B C Shah, a special form of glue that is used to hold the incision closed without sutures or small sticky bandages called steri-strips.</div>
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Recovering From Incisional Hernia Surgery</h2>
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Most hernia patients are able to return to their normal activity within two to four weeks. The belly will be tender, especially for the first week. During this time the incision should be protected during activity that increases abdominal pressure by applying firm but gentle pressure on the incision line. This is especially important for incisional hernia patients, as they are predisposed to an incisional hernia and can be at risk for another one at the new incision sites.</div>
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Activities during which the incision should be protected include:</h3>
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Rising from a seated position</div>
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Sneezing</div>
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Coughing</div>
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Bearing down during a bowel movement. Contact Dr. B C Shah if you are constipated after surgery, a stool softener may be prescribed.</div>
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Vomiting</div>
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Lifting heavy objects</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com1tag:blogger.com,1999:blog-6351996846816083125.post-74128527143926906152013-03-24T23:51:00.002-07:002013-03-24T23:51:11.494-07:00Colectomy<div dir="ltr" style="text-align: left;" trbidi="on">
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<a alt="Colectomy" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlw5DPbqfS_2XQ2LpQKwNArtUoCcLWVxdsc-hDjguwJGhkBe8Uit3u36McfayCuDzSJ1eUf1QOpEOHCf4EOAPH64yqLtmcSSic0vrgyWrJ4KPAowlPqrLFvGu9G2rp4Gv8K-R93XWynlU/s1600/colectomy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlw5DPbqfS_2XQ2LpQKwNArtUoCcLWVxdsc-hDjguwJGhkBe8Uit3u36McfayCuDzSJ1eUf1QOpEOHCf4EOAPH64yqLtmcSSic0vrgyWrJ4KPAowlPqrLFvGu9G2rp4Gv8K-R93XWynlU/s320/colectomy.jpg" width="293" /></a></div>
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Introduction<br /> </h1>
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<a href="http://drbcshah.com/colectomy/" target="_blank">Colectomy</a> is a surgical procedure to remove all or part of your colon. Your colon, also called your large intestine, is a long tube-like organ at the end of your digestive system. Colectomy may be necessary to treat or prevent diseases and conditions that affect your colon.</div>
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There are various types of colectomy operations:<br /> </h2>
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Total colectomy involves removing the entire colon.</div>
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Partial colectomy involves removing part of the colon and may also be called subtotal colectomy.</div>
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Hemicolectomy involves removing the right or left portion of the colon.</div>
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Proctocolectomy involves removing both the colon and rectum.</div>
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Colectomy surgery usually requires other procedures to reattach the remaining portions of your digestive system and permit waste to leave your body.</div>
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Why it's done</h2>
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Colectomy is used to treat and prevent diseases and conditions that affect the colon, such as:<br />
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Bleeding that can't be controlled. Severe bleeding from the colon may require surgery to remove the affected portion of the colon.</div>
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Bowel obstruction. A blocked colon is an emergency that may require total or partial colectomy, depending on the situation.</div>
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Colon cancer. Early-stage cancers may require only a small section of the colon to be removed during colectomy. Cancers at a later stage may require more of the colon to be removed.</div>
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<a href="http://drbcshah.com/crohns-disease/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Crohn's disease</a>. If medications aren't helping you, removing the affected part of your colon may offer temporary relief from signs and symptoms. Colectomy may also be an option if precancerous changes are found during a test to examine the colon (colonoscopy).</div>
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<a href="http://drbcshah.com/ulcerative-colitis/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Ulcerative colitis</a>. Dr. B C Shah may recommend total colectomy if medications aren't helping to control your signs and symptoms. Colectomy may also be an option if precancerous changes are found during a colonoscopy.</div>
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Diverticulitis. Dr. B C Shah may recommend surgery to remove the affected portion of the colon if your diverticulitis recurs or if you experience complications of diverticulitis.</div>
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Preventive surgery. If you have a very high risk of colon cancer due to the formation of multiple precancerous colon polyps, you may choose to undergo total colectomy to prevent cancer in the future. Colectomy may be an option for people with inherited genetic conditions that increase colon <a href="http://drbcshah.com/cancer/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">cancer</a> risk, such as familial adenomatous polyposis or Lynch syndrome.</div>
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Discuss your treatment options with Dr. B C Shah. In some situations, you may have a choice between various types of colectomy operations. Dr. B C Shah can discuss the benefits and risks of each.</div>
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Risks</h2>
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Colectomy carries a risk of serious complications. Your risk of complications is based on your general health, the type of colectomy you undergo and the approach your surgeon uses to perform the operation. In general, complications of colectomy can include:<br />
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Bleeding</div>
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Blood clots in the legs (<a href="http://drbcshah.com/deep-vein-thrombosis/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">deep vein thrombosis</a>) and the lungs (pulmonary embolism)</div>
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Infection</div>
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Injury to organs near your colon, such as the bladder and small intestines</div>
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Tears in the sutures that reconnect the remaining parts of your digestive system</div>
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You'll spend time in the hospital after your colectomy to allow your digestive system to heal. Your health care team will also monitor you for signs of complications from your surgery. You may spend a few days to a week in the hospital, depending on your condition and your situation.<br />
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How you prepare</h2>
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During the days leading up to your colon surgery, Dr. B C Shah may ask that you:</div>
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Stop taking certain medications. Certain medications can increase your risk of complications during surgery, so Dr. B C Shah may ask that you stop taking those medications before your surgery.</div>
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Fast before your surgery. Dr. B C Shah will give you specific instructions. You may be asked to stop eating and drinking several hours to a day before your procedure.</div>
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Drink a solution that clears your bowels. Dr. B C Shah may prescribe a laxative solution that you mix with water at home. You drink the solution over several hours, following the directions. The solution causes diarrhea to help empty your colon. Dr. B C Shah may also recommend enemas.</div>
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Take antibiotics. In some cases, Dr. B C Shah may prescribe antibiotics to suppress the bacteria found naturally in your colon and to help prevent infection.</div>
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Preparing for colectomy isn't always possible. For instance, if you need an emergency colectomy due to bowel obstruction or bowel perforation, there may not be time to prepare.</div>
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Plan for your hospital stay </h2>
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You'll spend at least a few days in the hospital after your colectomy, depending on your situation. Make arrangements for someone to take care of your responsibilities at home and at work.</div>
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Think ahead to what you might like to have with you while you're recovering in the hospital. Things you might pack include:</div>
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A robe and slippers</div>
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Toiletries, such as your toothbrush and toothpaste or, if needed, your shaving supplies</div>
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Comfortable clothes to wear home</div>
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Activities to pass the time, such as a book, magazine or games</div>
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What you can expect</h2>
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During your colectomy </h3>
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On the day of your surgery, your health care team will take you to a preparation room. Your blood pressure and breathing will be monitored. You may receive an antibiotic medication through a vein in your arm.</div>
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You're then taken to an operating room and positioned on a table. You'll be given a general anesthesia medication to put you in a sleep-like state so that you won't be aware during your operation.</div>
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The surgical team then proceeds with your colectomy. Colon surgery may be performed in two ways:</div>
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Open colectomy. Open surgery involves making a longer incision in your abdomen to access your colon. Dr. B C Shah uses surgical tools to free your colon from the surrounding tissue and cuts out either a portion of the colon or the entire colon.</div>
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Laparoscopic colectomy. <a href="http://drbcshah.com/laparoscopy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Laparoscopic</a> colectomy, also called minimally invasive colectomy, involves several small incisions in your abdomen. Dr. B C Shah passes a tiny video camera through one incision and special surgical tools through the other incisions. He watches a video screen in the operating room as the tools are used to free the colon from the surrounding tissue. The colon is then brought out through a small incision in your abdomen. This allows Dr. B C Shah to operate on the colon outside of your body. Once repairs are made to the colon, he reinserts the colon through the incision.</div>
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The type of operation you undergo depends on your situation and your surgeon's expertise. Laparoscopic colectomy may reduce the pain and recovery time after surgery. But not everyone is a candidate for this procedure. Also, in some situations your operation may begin as a laparoscopic colectomy, but circumstances may force your surgical team to convert to an open colectomy.</div>
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Once the colon has been repaired or removed, your surgeon will reconnect your digestive system to allow your body to expel waste. Options may include:</div>
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Rejoining the remaining portions of your colon. The Dr. B C Shah may stitch the remaining portions of your colon together, creating what is called an anastomosis. Stool then leaves your body as before.</div>
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Connecting your intestine to an opening created in your abdomen. Dr. B C Shah may attach your colon (colostomy) or small intestine (<a href="http://drbcshah.com/ileostomy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">ileostomy</a>) to an opening created in your abdomen. This allows waste to leave your body through the opening (stoma). You may wear a bag on the outside of the stoma to collect stool. This can be permanent or temporary.</div>
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Connecting your small intestine to your anus. After removing both the colon and the rectum (proctocolectomy), Dr. B C Shah may use a portion of your small intestine to create a pouch that is attached to your anus (ileoanal anastomosis). This allows you to expel waste normally, though you may have several watery bowel movements each day. As part of this procedure, you may undergo a temporary ileostomy.</div>
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Dr. B C Shah will discuss your options with you before your operation.</div>
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After your colectomy </h3>
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After surgery you'll be taken to a recovery room to be monitored as the anesthesia wears off. Then Dr. B C Shah will take you to your hospital room to continue your recovery.</div>
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You'll stay in the hospital until you regain bowel function. This may take a couple of days to a week. You may not be able to eat solid foods at first. You might receive liquid nutrition through a vein in your arm and then transition to drinking clear liquids. As your intestines recover, you can eventually add solid foods.</div>
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If your surgery involved a colostomy or ileostomy to attach your intestine to the outside of your abdomen, Dr. B C Shah will show you how to care for your stoma. He will explain how to change the ostomy bag that will collect waste.</div>
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Once you leave the hospital, expect a couple of weeks of recovery at home. You may feel weak at first, but eventually your strength will return. Ask Dr. B C Shah when you can expect to get back to your normal routine.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-14879750917781398642013-03-24T02:17:00.000-07:002013-03-24T02:17:11.585-07:00Spleen Removal (Splenectomy)<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGH37guJy2tJg3nwfYUiRh4VplbPVPmFOXZK_bXy6Vb994_cVuO7Yg9DLbMzbCxYNx202R96onyYWja24xLktyOvEkRKE2i7dIMw_DmHWuURCeWaDbhnKSVh9qB2WPFBEVUJQcAoU4RAA/s1600/spleen.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGH37guJy2tJg3nwfYUiRh4VplbPVPmFOXZK_bXy6Vb994_cVuO7Yg9DLbMzbCxYNx202R96onyYWja24xLktyOvEkRKE2i7dIMw_DmHWuURCeWaDbhnKSVh9qB2WPFBEVUJQcAoU4RAA/s320/spleen.jpg" ssa="true" width="320" /></a></div>
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What is a <a href="http://drbcshah.com/spleen-removal-splenectomy/" target="_blank">splenectomy</a>?</div>
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A splenectomy refers to taking out the spleen in surgery. Removing part of the spleen is called a partial splenectomy. Removing all of the spleen is called a total splenectomy. </div>
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What is a spleen?</div>
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The spleen is an organ that is located on the upper left side of the abdomen. About the size of a fist, the spleen is important because it helps fight infection in the body by filtering the blood. Another function is the storage of blood cells. The spleen keeps blood flowing to the liver. </div>
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Why would you need to have your spleen removed?</div>
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A splenectomy is recommended as a treatment for some conditions that cause hypersplenism and might be recommended as a treatment for others. Hypersplenism is not a disease itself, but is more of a syndrome, or a collection of symptoms. It means that the spleen has become overactive, enlarged, and is storing and destroying too many blood cells and platelets. </div>
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When is a splenectomy recommended?</div>
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There are two reasons that a spleen is always removed: to treat primary cancers of the spleen and to treat a disease called hereditary spherocytosis. </div>
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Hereditary spherocystosis (HS) is an inherited disease that involves the lack of ankyrin a specific protein, and the formation of abnormally-shaped red blood cells, called spherocytes. Spherocytes do not move as easily as they should and end up staying longer in the spleen. This almost always increases the size of the spleen. An enlarged spleen is called splenomegaly. The cells eventually become damaged and results in anemia and jaundice. Children with HS are given folic acid supplements on a daily basis. The spleen is removed after a child reaches the age of five. </div>
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Other conditions that are often treated with splenectomy</div>
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•Idiopathic thrombocytopenic purpura, a disease in which antibodies kill off platelets. The reason that the antibodies form is not known. <br />•Trauma, such as injury due to an auto accident <br />•Spleen with an abscess (collection of pus due to infection) <br />•Splenic artery rupture, possible during pregnancy <br />•Sickle cell disease (a blood disorder that is characterized by sickle-shaped, rather than disc-shaped, red blood cells) <br />•Thalassemia (inherited blood disorder resulting in inadequate hemoglobin production) <br />How are spleen disorders diagnosed?</div>
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•Blood tests <br />•Physical examination (an enlarged spleen may be felt by Dr. B C Shah) <br />•Imaging tests such as ultrasounds, X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans <br />•Bone marrow tissue biopsy <br />Removal of spleen tissue is not advisable due to the possibility of excessive bleeding. </div>
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How are spleens removed?</div>
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In most cases, splenectomies can be performed as laparoscopic surgeries if the spleen is not too enlarged. Using this technique, a tube is inserted into the abdomen and the space inflated with carbon dioxide. Dr. B C Shah will place other tubes into the abdomen through other small holes, allowing the placement of instruments. The spleen is cut free of all of connections, put inside a special bag and pulled through one of the largest holes in the abdomen. </div>
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If the spleen is too large for laparoscopic removal, the spleen will be taken out in an "open" procedure with a single larger incision. In addition to spleen size, Dr. B C Shah fmight opt for an open procedure if there is a lot of scar tissue from previous procedures, if there is an ability to see clearly enough to perform laparoscopy, or if there are bleeding problems. This decision may be made prior to or during surgery. </div>
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What are the possible complications of splenectomy?</div>
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Possible complications include the usual risks of all surgeries, including infection. There is also a risk of pneumonia or pancreatitis (inflammation of the pancreas). Immediately after the surgery, the patient is likely to be put on medications to prevent infection. </div>
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After having a splenectomy, the patient must always be extra careful about infections. Dr. B C Shah is likely to have immunized the patient before surgery. Other likely recommendations include: </div>
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•Have a pneumonia vaccine about every five years. <br />•Have yearly flu shots. <br />•A child who has had his or her spleen removed may be put on antibiotics for two to several years after the surgery, possibly until adulthood. <br />•Contact Dr. B C Shah immediately if you have a fever or other indications of infection. <br />•Avoid travel to places where you could contract malaria. </div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-71365225632352203072013-03-23T01:46:00.003-07:002013-03-23T01:46:43.522-07:00It is not always Piles or Fissures!<div dir="ltr" style="text-align: left;" trbidi="on">
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<a alt="It is not always Piles or Fissures!" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjncEyqowKFOW5h_Enyzt0YzydzyG9c8Z8nnGWouAr7nwHqK2CZDNSOZlmVKz0mNEB-DIZarJ617sMIAGZAHR9r403lVAkcNN8Fp9obxqRa1uMRCp4iBWVSiYAatVYIgIpZtnxBBeHlROk/s1600/dr-b-c-shah-young-patient-cancer-of-rectum+(1).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="262" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjncEyqowKFOW5h_Enyzt0YzydzyG9c8Z8nnGWouAr7nwHqK2CZDNSOZlmVKz0mNEB-DIZarJ617sMIAGZAHR9r403lVAkcNN8Fp9obxqRa1uMRCp4iBWVSiYAatVYIgIpZtnxBBeHlROk/s320/dr-b-c-shah-young-patient-cancer-of-rectum+(1).jpg" width="320" /></a></div>
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<a href="http://drbcshah.com/rare-case-young-boy-with-cancer-of-rectum/" target="_blank">A 19 yr boy</a> studying in college came with complaints of <a href="http://drbcshah.com/constipation/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">constipation</a>, bleeding & pain while defecating since 3 months. He had consulted many nearby family physicians. They told him that it was a <a href="http://drbcshah.com/piles/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">piles</a> problem and they had given him different types of oral <a href="http://drbcshah.com/laxatives-2/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">laxatives</a> and local ointments. However, unfortunately none of them had ever examined him. He was even advised <a href="http://drbcshah.com/hemorroidectomy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">piles surgery</a>. He latter consulted an Ayurvedic doctor, who examined him & said that it was not piles but <a href="http://drbcshah.com/anal-fissure/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">anal fissure</a>. He carried out a minor surgery for same in his clinic. The patient has no relief and his bleeding & pain did not subside. Feeling frustrated at last he came to Bhaktivedanta hospital. Details of patient were noted & a proper <a href="http://drbcshah.com/rectal-examination/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">rectal examination</a> was performed. He had no piles or fissure. On examination it was found that he had a large tumor which would bleed on touching. The provisional clinical diagnosis was "<a href="http://drbcshah.com/rectal-cancer-bowel-cancer/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Cancer of rectum</a>" He was asked to undergo a <a href="http://drbcshah.com/colonoscopy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Colonoscopy</a> and CT scan. The diagnosis was confirmed. The patient was nicely counselled and was advised further treatment in the<a href="http://drbcshah.com/colectomy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">form of surgery</a>.</div>
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Lesson: ALWAYS TAKE EXPERT OPINION FOR YOUR PROBLEMS. NEVER RELY ON G.P. FOR PROBLEMS PERSISTING BEYOND ONE WEEK OF TREATMENT.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-21622465299134548822013-03-21T22:59:00.001-07:002013-03-21T22:59:36.422-07:00Blood vomiting – Almost died<div dir="ltr" style="text-align: left;" trbidi="on">
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A rare surgery for a rare disease</h1>
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Sushma Bagwe came with severe <a href="http://drbcshah.com/blood-vomiting-almost-died/" target="_blank">blood vomiting</a> and with feeble pulse and blood pressure. An emergency <a href="http://drbcshah.com/understanding-upper-endoscopy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">upper GI scopy</a> was performed by me as the bleeding was profuse. With all the blood in stomach it was a tricky job. I noticed that she had a tumor growing in her stomach that was heavily bleeding. This tumor did not appear like a typical <a href="http://drbcshah.com/stomach-cancer/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">stomach cancer</a> or a<a href="http://drbcshah.com/peptic-ulcer-surgery/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">peptic ulcer</a>. In order to stop the bleeding, using the endoscope I injected medication around the tumor That stopped the bleeding. Subsequently she was shifted back to ICU and was transfused four units of blood to restore her blood. I also took mulitple biopsies to know what was the nature of the tumor but to my dismay it did not indicate much. I repeated the biopsy again but that also was not conclusive. Subsequently CT scan was performed but even that was not conclusive of the nature of the tumor. I planned out the surgery for her. Instead of opening her abdomen with a large incision, I decided to give her the benefit of Minimally invasive surgery. I performed a total <a href="http://drbcshah.com/laparoscopy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Laparoscopic</a> partial stomach removal (Partial gastrectomy) using harmonic scalpel and endostaplers. This gave her the benefit of fast recovery, minimal post operative pain and almost invisible scar. The diagnosis of the tumour was leiomyoma – benign stomach tumor. Her condition was solved. Thus minimally invasive procedure that I used on this patient (<a href="http://drbcshah.com/endoscopy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">endoscopy </a>and <a href="http://drbcshah.com/laparoscopy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">laparoscopy</a>) once again saved the life of a patient and cured her from her disease with minimal pain.</div>
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Anonymoushttp://www.blogger.com/profile/10431651843333230363noreply@blogger.com0tag:blogger.com,1999:blog-6351996846816083125.post-70346344443046314902013-03-11T22:53:00.003-07:002013-03-11T22:53:49.728-07:00Osteomyelitis <div dir="ltr" style="text-align: left;" trbidi="on">
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<a alt="Osteomyelitis " href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzjYJMKubFiQJRXVrIS75H09csKuvNwaKWw3lTHaNNM6UhFP4SuW1OUtBV2_klCRSYII_LNg8epKgzoFgLwZpr0Gre4x2q-ydgb12OuFNTyn7rB0LfWa7SzVhUS09e1uNU7jOQ-81ud3Q/s1600/Osteomyelitis1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzjYJMKubFiQJRXVrIS75H09csKuvNwaKWw3lTHaNNM6UhFP4SuW1OUtBV2_klCRSYII_LNg8epKgzoFgLwZpr0Gre4x2q-ydgb12OuFNTyn7rB0LfWa7SzVhUS09e1uNU7jOQ-81ud3Q/s320/Osteomyelitis1.jpg" width="320" /></a></div>
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Introduction</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="http://drbcshah.com/osteomyelitis/" target="_blank">Osteomyelitis </a>is a medical term that describes an infection of bone. The infection is usually bacterial. Symptoms of osteomyelitis may include:</strong></div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">high temperature (fever) of 38°C (100.4°F) or above</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">pain in the affected area, which can often be intense</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">swelling in the affected area </li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">a passageway that opens in the skin through which pus or fluid leaks (this is known as a discharging sinus)</li>
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Types of osteomyelitis</h2>
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There are two main types of osteomyelitis:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Acute osteomyelitis is where the bone infection develops within two weeks of an initial infection, injury or underlying disease and may respond to antibiotic treatment.</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Chronic osteomyelitis is where the bone infection has produced irreversible bony changes that cannot be treated by antibiotics alone.</li>
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Acute osteomyelitis</h2>
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There are two ways that acute osteomyelitis can occur:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Contiguous osteomyelitis is where an infection spreads directly into the bone as a result of an injury, such as a fractured bone or animal bite, during surgery, or as a result of another condition such as diabetes or vascular disease.</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Haematogenous osteomyelitis is where an infection spreads into a bone from the bloodstream.</li>
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Contiguous osteomyelitis is the most common type of acute osteomyelitis, accounting for four out of five cases. It mainly affects adults.</div>
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People who have a condition that affects the blood supply to certain parts of their body, such as <a href="http://drbcshah.com/diabetes-type-2/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">type 2 diabetes</a>, have an increased risk of developing contiguous osteomyelitis. Any surgical procedure on the skeleton may introduce infection into bone.</div>
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Haematogenous osteomyelitis mostly affects younger children, although adult cases may occur in anyone with a weakened immune system, such as those with rheumatoid arthritis or <a href="http://drbcshah.com/hiv-and-aids/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">HIV</a>.<br />
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People who regularly inject drugs, such as heroin, also have an increased risk of developing haematogenous osteomyelitis.</div>
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Chronic osteomyelitis</h2>
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Chronic osteomyelitis can sometimes start as acute osteomyelitis. If acute osteomyelitis is not treated properly it can become established and produce permanent, destructive changes to bone, resulting in pain, discharge and loss of function.</div>
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As with acute osteomyelitis, the infection can be spread through the blood or directly into the bone as a result of injury or other trauma.</div>
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Chronic osteomyelitis can also develop as a complication of a pre-existing infection such as tuberculosis (a bacterial infection) or syphilis (a sexually transmitted infection).</div>
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How common is osteomyelitis?</h2>
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At present, there are limited data on how widespread osteomyelitis is in adults.</div>
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Acute osteomyelitis is rare in children. It is estimated that one child in every 1,000 children under the age of one, and one in every 5,000 over the age of one will develop acute osteomyelitis.</div>
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The condition is known to be a common complication of certain health conditions. For example:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">30-40% of people with <a href="http://drbcshah.com/diabetes/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">diabetes</a> who experience a puncture injury to their foot will develop osteomyelitis</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">One in every 200 people with sickle cell anaemia (a hereditary blood condition) will develop osteomyelitis in any given year</li>
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Outlook</h2>
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The outlook for acute osteomyelitis is generally good because the condition usually responds well to antibiotics. However, for people with underlying risk factors for osteomyelitis, such as diabetes, there is a chance that the infection could come back.</div>
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The outlook for chronic osteomyelitis is mixed because the infection can be more challenging to treat, particularly if significant bone damage has occurred. Most cases will require a combination of antibiotics and surgery.</div>
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Symptoms of osteomyelitis</h1>
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Acute osteomyelitis</h2>
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Most cases of acute osteomyelitis involve one of the long bones in the legs. However, sometimes the bones in the arm or the vertebrae (in the back) can be affected.</div>
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The symptoms of acute osteomyelitis include:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">A sudden high temperature (fever) of 38°C (100.4°F) or above, although this symptom is often absent in children under one year old</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Bone pain, which can often be severe</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Swelling, redness and warmth at the site of the infection</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">A general sense of feeling unwell</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The affected body part is tender to touch</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The range of movement in the affected body part is restricted</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Lymph nodes (glands) near the affected body part may be swollen</li>
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Young children who cannot talk may be unable to report their painful symptoms to you. You should look out for the following signs and symptoms:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Irritability</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Eating much less than usual</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Reluctance to use the affected body part</li>
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Chronic osteomyelitis</h2>
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Once chronic osteomyelitis is established, the person affected may have periods of almost no symptoms. However, symptoms can flare up at any time. For example, you may experience:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Bone pain</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Feeling persistently tired</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Pus draining from the sinus tract (a passageway that develops near the infected bone)</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Local swelling</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Skin changes</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Excessive sweating</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Chills</li>
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When to seek medical advice</h2>
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You should always visit Dr. B C Shah if you or your child develops a high temperature (fever) and persistent bone pain.</div>
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Causes of osteomyelitis</h1>
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Routes of infection</h2>
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Your bones are usually resistant to infection. Bone can become infected when:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">A pre-existing infection in the blood spreads to a bone</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">There is an injury, such as a bone fracture, or a complication from a surgical procedure</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">There is a pre-existing health condition, such as diabetes, which means the bone does not get a steady blood supply, so infection-fighting white blood cells cannot reach the site of injury</li>
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Blood infections that spread to the bone are more common in children than adults. This may be because children’s bones are still developing, which makes them more vulnerable to this type of blood-borne infection than adult bones, which are fully grown.</div>
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In addition, a child's immune system (the body’s natural defence against infection and illness) is still developing, so it is less effective than an adult’s at fighting off infection.</div>
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When a bone becomes infected</h2>
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When an infection develops inside a bone, the immune system will attempt to stop it by sending infection-fighting white blood cells known as neutrophils to the source of the infection.</div>
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The neutrophils will try to kill the bacterial or fungal cells that are causing the infection, but sometimes they are unable to do so. If the infection is not treated, a collection of dead neutrophils will build up inside the bone, forming a pocket of pus known as an <a href="http://drbcshah.com/abscess-drainage-2/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">abscess</a>.</div>
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In cases of chronic osteomyelitis, abscesses can block the blood supply to the bone, which will eventually cause the bone to die. Dead bone with no blood supply must be removed if infection is to be cleared.</div>
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Risk factors</h2>
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There are several risk factors that can make people more vulnerable to developing osteomyelitis. They include:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Weakened immune system</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Poor circulation</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Diabetes and foot injury</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Injury and trauma</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Orthopaedic surgery</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Intravenous drug use</li>
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These risk factors are described below.</div>
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Weakened immune system</h2>
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If your immune system is weakened, it is more likely that an infection that develops in one part of your body will spread to a bone. Your immune system may become weakened for any of the following reasons:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">You have a health condition, such as HIV or AIDS</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">You are taking certain treatments, such as <a href="http://drbcshah.com/chemotherapy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">chemotherapy</a>,<a href="http://drbcshah.com/radiotherapy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank"> radiotherapy</a> or a long-term dose of steroid tablets</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">You have malnutrition, which is when your diet does not contain all the nutrients needed for good health</li>
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Poor circulation</h2>
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People with health conditions that affect the blood flow are at greater risk of developing osteomyelitis. This is because their bones may not be getting a steady supply of infection-fighting white blood cells.</div>
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Conditions that are known to cause poor circulation include:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="http://drbcshah.com/diabetes-type-1/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">Type 1 diabetes</a> and <a href="http://drbcshah.com/diabetes-type-2/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">type 2 diabetes</a></li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Sickle cell anaemia, which is an inherited blood disorder where the red blood cells do not function properly</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="http://drbcshah.com/atherosclerosis/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Atherosclerosis</a>, which is narrowing of the arteries, often caused by eating a high-fat diet and/or smoking</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="http://drbcshah.com/peripheral-arterial-disease-treatment/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;" target="_blank">Peripheral arterial disease</a>, which is where the main arteries in the legs get clogged up by a build-up of fat</li>
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Diabetes and foot injury</h2>
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People with diabetes are particularly vulnerable to osteomyelitis because they are at risk of developing foot injuries.</div>
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Increased levels of glucose in the blood can cause nerve damage. This means that people with poorly controlled diabetes may begin to lose sensation in their feet so small cuts or injuries to the feet go unnoticed. Due to poor circulation, a serious infection can quickly develop in the feet before spreading to the bone.</div>
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Injury and trauma</h2>
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If you break a bone or have a serious puncture injury that exposes deep tissue to germs, there is a chance you will develop osteomyelitis. This risk is increased if you also have a weakened immune system and/or poor circulation. Any broken bone with a loss of skin cover needs emergency surgery to clean the wound, get rid of dead tissue and stabilise the fracture. </div>
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Orthopaedic surgery</h2>
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If you have orthopaedic surgery (surgery that involves the bones or joints) or you have had metalwork implanted, there is a small chance you may develop osteomyelitis. The risk is less than 1%.</div>
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Intravenous drug misuse</h2>
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People who regularly inject themselves with illegal drugs such as heroin or methamphetamine (crystal meth) have an increased risk of developing osteomyelitis. This is because many people who misuse drugs do not use properly sterilised needles, which significantly increases the risk of introducing bacteria into their bloodstream. </div>
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Diagnosing osteomyelitis</h1>
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Physical examination</h2>
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To confirm a diagnosis of suspected osteomyelitis, Dr. B C Shah will first carry out a physical examination of your affected body part to check for signs of redness, swelling and tenderness.</div>
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They will want to know about your recent medical history, such as whether you have recently had an injury, surgery or a previous infection.</div>
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Blood test</h2>
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Dr. B C Shah may refer you for a blood test. This cannot confirm osteomyelitis, but it can indicate whether you have a high number of white blood cells in your blood, which may suggest that you have an infection. Also, if the osteomyelitis was caused by bacteria spreading in your blood, a blood test may be useful for detecting the bacteria.</div>
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Imaging tests</h2>
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If osteomyelitis is suspected, it is likely that you will be referred for further imaging testing. There are several imaging tests that may be able to detect bone damage caused by osteomyelitis. They include:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">X-rays, in which low levels of radiation are used to create an image of the affected bone</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Magnetic resonance imaging (MRI) scan, which is where a strong magnetic field and radio waves are used to build up a picture of the inside of the affected bone</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Computerised tomography (CT) scan, which is where a series of X-rays of your affected bone are taken and a computer is used to assemble them into a more detailed three-dimensional image</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Ultrasound scan, which is where high-frequency sound waves are used to create an image of the affected bone to highlight any abnormalities</li>
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Biopsy</h2>
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If earlier testing suggests that you have osteomyelitis, it is usually necessary to remove a small sample of bone for further testing. This is known as a <a href="http://drbcshah.com/biopsy/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">biopsy</a>.</div>
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A biopsy is usually necessary to confirm a diagnosis of osteomyelitis and it can help to establish the exact type of bacteria or fungus that is causing your infection. This can be very useful when deciding on the most effective treatment.</div>
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A biopsy is usually combined with surgery in chronic cases.</div>
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Treating osteomyelitis</h1>
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Treating acute osteomyelitis</h2>
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Acute osteomyelitis can usually be successfully treated using antibiotics</div>
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These medicines are usually given as a six-week course. For part of the treatment course you will need to take the medicine intravenously (directly into a vein). </div>
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Depending on your general state of health, you may need to stay in hospital during this time. Otherwise, you may be able to receive the injections as an outpatient (where you go home the same day). You will usually be able to switch to tablets for the rest of the treatment course once you are well.</div>
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In cases of osteomyelitis, there is usually a choice of antibiotics available to treat the infection and often two antibiotics are used in combination. This is known as dual therapy.</div>
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Occasionally, the bacteria causing the infection are resistant to standard antibiotics and less-frequently-used antibiotics are needed.</div>
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All antibiotics have side effects, which you should discuss with Dr. B C Shah in charge of your care.</div>
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A much less common cause of osteomyelitis is a fungal infection.</div>
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In cases of fungal osteomyelitis, an antifungal medication called voriconazole is usually the treatment of choice. </div>
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Treating chronic osteomyelitis</h2>
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People with chronic osteomyelitis will usually require a combination of antibiotics medication and surgery to remove any damaged bone. Dr. B C Shah may need to make an incision (cut) near the site of the infection to drain away any pus.</div>
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If there is extensive bone damage, it will be necessary to surgically remove any diseased bone and tissue. This procedure is known as debridement. Debridement can often leave an empty space in the bone, which is sometimes packed with antibiotic-loaded cement. If Dr. B C Shah does this, a second operation will be required to remove the cement within a few weeks of the first. Not all centres use cement and no difference is found in the clearance of infection.</div>
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In some cases, it may also be necessary to transfer muscle and skin from another part of the body to repair the tissue surrounding the affected bone.</div>
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Hyperbaric oxygen therapy</h2>
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Some researchers have argued that a type of non-surgical treatment called hyperbaric oxygen therapy may be useful in treating cases of both acute and chronic osteomyelitis that do not respond to conventional treatment.</div>
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During hyperbaric oxygen therapy, you are placed in a specially designed chamber that is similar to a decompression chamber used by divers.</div>
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The chamber is filled with oxygen, which is administered at a much higher pressure (hyperbaric) than the normal level of oxygen in the atmosphere. The high levels of oxygen are thought to speed up the healing process and slow the spread of infection.</div>
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There is currently only limited evidence supporting the effectiveness of hyperbaric oxygen therapy for treating osteomyelitis. From the evidence available, it would appear that it is most effective in treating osteomyelitis associated with a diabetic foot ulcer. </div>
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Complications of osteomyelitis</h1>
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Recurring osteomyelitis</h2>
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The underlying factors that often cause osteomyelitis, such as poor circulation or a weakened immune system, can be difficult to treat, particularly if you have severe diabetes or HIV. Therefore, if you have had a previous episode of osteomyelitis, there is a chance that it could return.</div>
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The risk factors for recurring osteomyelitis vary depending on your circumstances. It may be possible to reduce your risk by making lifestyle changes, such as lowering the amount of saturated fat in your diet and by taking precautions against infection.</div>
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Amputation</h2>
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Amputation is sometimes necessary when someone has a condition, such as diabetes or peripheral vascular disease, that affects the normal blood supply to parts of their body. With a reduced blood supply, the affected body part will receive fewer infection-fighting blood cells. This means that the infection may spread beyond the bone and into the surrounding soft tissue. The tissue will then begin to die, which is known as gangrene.</div>
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Once gangrene develops, it is sometimes necessary to amputate the affected limb to prevent the spread of infection and prevent further damage to healthy tissue.</div>
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Preventing osteomyelitis</h1>
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<strong style="background-color: transparent; border: 0px; color: #1c1c1c; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">If you have a weakened immune system, take extra precautions to avoid infection and boost your immune system:</strong></div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Do not smoke, because it will weaken your immune system.</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Keep your vaccinations up to date. Dr. B C Shah will be able to advise you about this.</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Eat a healthy diet to help boost your immune system.</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Take regular exercise to help boost your immune system.</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Wash your hands regularly with soap and hot water, particularly after going to the toilet, before and after preparing food and after being in crowded places.</li>
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If you have poor circulation, avoid activities that could make it worse, such as smoking. Some lifestyle changes will also help to improve your circulation, such as taking regular exercise.</div>
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Stop smoking (if you smoke)</h2>
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Smoking cigarettes can clog up your arteries and increase your blood pressure, both of which are bad for your circulation.</div>
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If you smoke, it is strongly recommended that you quit as soon as possible. Dr. B C Shah will be able to recommend and prescribe medication that can help you give up.</div>
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Eat a healthy diet</h2>
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High fat foods can cause a build-up of fatty plaques (deposits) in your arteries, and being overweight can lead to <a href="http://drbcshah.com/high-blood-pressure-hypertension/" style="background-color: transparent; border: 0px; color: #ffa300; margin: 0px; outline: 0px; padding: 0px; text-decoration: initial; vertical-align: baseline;">high blood pressure</a>.</div>
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To improve your circulation, a low-fat high-fibre diet is recommended, including plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains.</div>
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It is also recommended that you eat a Mediterranean-style diet. This means you should eat more bread, fruit, vegetables and fish and less meat. Replace butter and cheese with products that are vegetable and plant-oil based, such as olive oil.</div>
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Oily fish is recommended as it contains a type of fatty acid called omega-3, which can help lower your cholesterol levels. This can help to improve your circulation. Two to four portions of oily fish a week are recommended. Good sources of omega-3 include:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Herrings</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Sardines</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Mackerel</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Salmon</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Trout</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Tuna</li>
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If you are unable or unwilling to eat oily fish, Dr. B C Shah may recommend that you take an omega-3 food supplement. However, you should never take a food supplement without first consulting him. This is because some supplements, such as beta-carotene, can be harmful.</div>
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Weight management</h2>
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If you are overweight or obese, try to lose weight and then maintain a healthy weight by using a combination of a calorie-controlled diet and regular exercise. Once you have achieved a healthy weight it will help keep your blood pressure at a normal level, which will help improve your circulation.</div>
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Alcohol</h2>
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If you drink alcohol, don't exceed the recommended daily limits. These are:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Three to four units a day for men</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Two to three units a day for women</li>
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A unit of alcohol is roughly half a pint of normal-strength beer, a small glass of wine or a single measure (25ml) of spirits. Regularly exceeding the recommended alcohol limits will raise both your blood pressure and cholesterol level, which will make your circulation worse.</div>
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Contact Dr. B C Shah if you are finding it difficult to moderate your drinking. Counselling services and medication can help you to reduce your alcohol intake.</div>
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Regular exercise </h2>
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Regular exercise will lower your blood pressure and make your heart and blood circulatory system more efficient.</div>
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For most people, 30 minutes of moderate to vigorous exercise a day, at least five times a week, is recommended. However, if your overall health is poor, it may be necessary for you to exercise using a programme that is tailored specifically to your current needs and fitness level. Dr. B C Shah will be able to advise you about the most suitable level of exercise for you.</div>
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Activities that you could incorporate into your exercise programme include:</div>
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<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Brisk walking</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Hill climbing</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Running</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Cycling</li>
<li style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Swimming</li>
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If you find it difficult to achieve 30 minutes of exercise a day, start at a level that you feel comfortable with. For example, you could do 5 to 10 minutes of light exercise a day before gradually increasing the duration and intensity of your activity as your fitness starts to improve.</div>
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