Difficulty Swallowing ,dysphagia

What is difficulty swallowing 

Difficulty swallowing is also called dysphagia. 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.

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.

What causes dysphagia?

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:

The muscles and nerves that help move food through the throat and esophagus are not working right. This can happen if you have:

• Had a stroke or a brain or spinal cord injury.
• Certain problems with your nervous system, such as post-polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson's disease.
• An immune system problem that causes swelling (or inflammation) and weakness, such as polymyositis or dermatomyositis.
• Esophageal spasm. This means that the muscles of the esophagus suddenly squeeze. Sometimes this can prevent food from reaching the stomach.
• 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.

Something is blocking your throat or esophagus. This may happen if you have:

• Gastroesophageal reflux disease (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.
• 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.
• Diverticula. These are small sacs in the walls of the esophagus or the throat.
• Esophageal tumors. These growths in the esophagus may be cancerous or not cancerous.
• Masses outside the esophagus, such as lymph nodes, tumors, or bone spurs on the vertebrae that press on your esophagus.

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.

What are the symptoms?

Dysphagia can come and go, be mild or severe, or get worse over time. If you have dysphagia, you may:

• Have problems getting food or liquids to go down on the first try.
• Gag, choke, or cough when you swallow.
• Have food or liquids come back up through your throat, mouth, or nose after you swallow.
• Feel like foods or liquids are stuck in some part of your throat or chest.
• Have pain when you swallow.
• Have pain or pressure in your chest or have heartburn.
• Lose weight because you are not getting enough food or liquid.

How is dysphagia diagnosed?

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:

• An otolaryngologist, who treats ear, nose, and throat problems
• A gastroenterologist, who treats problems of the digestive system
• A neurologist, who treats problems of the brain, spinal cord, and nervous system
• A speech-language pathologist, who evaluates and treats swallowing problems

To help find the cause of your dysphagia, you may need one or more tests, including:

• X-rays. These provide pictures of your neck or chest.
• 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.
• Fluoroscopy. This test uses a type of barium swallow that allows your swallowing to be videotaped.
• Laryngoscopy. This test looks at the back of your throat, using either a mirror or a fiber-optic scope.
• 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.
• 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.
• pH monitoring, which tests how often acid from the stomach gets into the esophagus and how long it stays there.

How is it treated?

Your treatment will depend on what is causing your dysphagia. Treatment for dysphagia includes:

• 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.
• Changing the foods you eat. Dr. B C Shah may tell you to eat certain foods and liquids to make swallowing easier.
• 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.
• Endoscopy. In some cases, a long, thin scope can be used to remove an object that is stuck in your esophagus.
• 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).
• 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.

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.

upper endoscopy

What is upper endoscopy? 

Upper endoscopy 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 upper GI endoscopy, esophagogastroduodenoscopy (EGD) or panendoscopy.

Why is upper endoscopy done?

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.

Dr. B C Shah might use upper endoscopy to obtain a biopsy (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.

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.

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.

What preparations are required?

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.

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.

Can I take my current medications?

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.

What happens during upper endoscopy?

Dr. B C Shah 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.

What happens after upper endoscopy?

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.

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.

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.

What are the possible complications of upper endoscopy?

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.

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.

If you have any concerns about a possible complication, it is always best to contact Dr. B C Shah right away.

Hernia Repair, Incisional

What Is an Incisional Hernia?

An incisional hernia 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 incisional hernia, 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.

Who Is At Risk For an Incisional Hernia?

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.

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.

Diagnosing an Incisional Hernia

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".

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.

Incisional Hernia Treatment

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.

When Is Incisional Hernia Surgery Necessary?

An Incisional hernia may require surgery if:

• It continues to enlarge over time
• It is very large
• It is cosmetically unappealing
• The bulge remains even when the patient is relaxed or laying down
• The hernia causes pain

When Is Incisional Hernia an Emergency?

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.

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.

Incisional Hernia Surgery

Incisional hernia surgery is typically performed using general anesthesia and is done on an inpatient basis. The surgery is typically performed using the laparoscopic method, using small incisions rather than the traditional large open incision. Surgery is performed by a general surgeon or a colon-rectal specialist.

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.

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.

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.

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.

Recovering From Incisional Hernia Surgery

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.

Activities during which the incision should be protected include:

• Rising from a seated position
• Sneezing
• Coughing
• Bearing down during a bowel movement. Contact Dr. B C Shah if you are constipated after surgery, a stool softener may be prescribed.
• Vomiting
• Lifting heavy objects

Colectomy

Introduction
 

Colectomy 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.

There are various types of colectomy operations:
 

• Total colectomy involves removing the entire colon.
• Partial colectomy involves removing part of the colon and may also be called subtotal colectomy.
• Hemicolectomy involves removing the right or left portion of the colon.
• Proctocolectomy involves removing both the colon and rectum.

Colectomy surgery usually requires other procedures to reattach the remaining portions of your digestive system and permit waste to leave your body.

Why it's done

Colectomy is used to treat and prevent diseases and conditions that affect the colon, such as:

• Bleeding that can't be controlled. Severe bleeding from the colon may require surgery to remove the affected portion of the colon.
• Bowel obstruction. A blocked colon is an emergency that may require total or partial colectomy, depending on the situation.
• 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.
• Crohn's disease. 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).
• Ulcerative colitis. 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.
• 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.
• 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 cancer risk, such as familial adenomatous polyposis or Lynch syndrome.

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.

Risks

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:

• Bleeding
• Blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism)
• Infection
• Injury to organs near your colon, such as the bladder and small intestines
• Tears in the sutures that reconnect the remaining parts of your digestive system

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.

How you prepare

During the days leading up to your colon surgery, Dr. B C Shah may ask that you:

• 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.
• 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.
• 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.
• 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.

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.

Plan for your hospital stay 

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.

Think ahead to what you might like to have with you while you're recovering in the hospital. Things you might pack include:

• A robe and slippers
• Toiletries, such as your toothbrush and toothpaste or, if needed, your shaving supplies
• Comfortable clothes to wear home
• Activities to pass the time, such as a book, magazine or games

What you can expect

During your colectomy 

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.

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.

The surgical team then proceeds with your colectomy. Colon surgery may be performed in two ways:

• 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.
• Laparoscopic colectomy. Laparoscopic 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.

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.

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:

• 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.
• Connecting your intestine to an opening created in your abdomen. Dr. B C Shah may attach your colon (colostomy) or small intestine (ileostomy) 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.
• 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.

Dr. B C Shah will discuss your options with you before your operation.

After your colectomy 

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.

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.

  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.

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.

Spleen Removal (Splenectomy)

What is a splenectomy?

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.

What is a spleen?

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.

Why would you need to have your spleen removed?

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.

When is a splenectomy recommended?

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.

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.

Other conditions that are often treated with splenectomy

•Idiopathic thrombocytopenic purpura, a disease in which antibodies kill off platelets. The reason that the antibodies form is not known.
•Trauma, such as injury due to an auto accident
•Spleen with an abscess (collection of pus due to infection)
•Splenic artery rupture, possible during pregnancy
•Sickle cell disease (a blood disorder that is characterized by sickle-shaped, rather than disc-shaped, red blood cells)
•Thalassemia (inherited blood disorder resulting in inadequate hemoglobin production)
How are spleen disorders diagnosed?

•Blood tests
•Physical examination (an enlarged spleen may be felt by Dr. B C Shah)
•Imaging tests such as ultrasounds, X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans
•Bone marrow tissue biopsy
Removal of spleen tissue is not advisable due to the possibility of excessive bleeding.

How are spleens removed?

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.

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.

What are the possible complications of splenectomy?

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.

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:

•Have a pneumonia vaccine about every five years.
•Have yearly flu shots.
•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.
•Contact Dr. B C Shah immediately if you have a fever or other indications of infection.
•Avoid travel to places where you could contract malaria.

It is not always Piles or Fissures!

A 19 yr boy studying in college came with complaints of constipation, bleeding & pain while defecating since 3 months. He had consulted many nearby family physicians. They told him that it was a piles problem and they had given him different types of oral laxatives and local ointments. However, unfortunately none of them had ever examined him. He was even advised piles surgery. He latter consulted an Ayurvedic doctor, who examined him & said that it was not piles but anal fissure. 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 rectal examination 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 "Cancer of rectum" He was asked to undergo a Colonoscopy and CT scan. The diagnosis was confirmed. The patient was nicely counselled and was advised further treatment in theform of surgery.

Lesson: ALWAYS TAKE EXPERT OPINION FOR YOUR PROBLEMS. NEVER RELY ON G.P. FOR PROBLEMS PERSISTING BEYOND ONE WEEK OF TREATMENT.

Blood vomiting – Almost died

A rare surgery for a rare disease

Sushma Bagwe came with severe blood vomiting and with feeble pulse and blood pressure. An emergency upper GI scopy 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 stomach cancer or apeptic ulcer. 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 Laparoscopic 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 (endoscopy and laparoscopy) once again saved the life of a patient and cured her from her disease with minimal pain.