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Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.
I am 29 years old. I am from bangladesh. I have a problem with my backbone. I have slipped disc. I have been suffering from this since 2011. I consulted with some local doctors. They prescribed me with some exercise but no improvement till now. I feel that a bone or two is/are displaced somewhere my waist. I need expert suggestion.
I have severe lower back pain for last 18 years which increases during periods. I'm 32 years old and unmarried. It's constant, it always pains. Is it slip disc or what Please help.
As per my MRI report for lumber spine, disc protrusion seen at L5-S1 indenting anterior thecal sac and narrowing left neural recess. Disc hydration is Los at L5-S1. I have severe lower back pain for last one month. What is the ideal plan for treatment?
This is my Mri report impression. Disc degeneration and disc bulge is seen at L5/S 1 level indenting the thecal Sac without any nerve root compression. Annulus tear is noted. 2 this r my x ray report impression. Pid L5. S 1.
My wife is suffering from slip disc I already have consulted orthopedic surgeon now, will homeopathy be more effective than doctors medicine. Please advise.?
I am male 39 I have a problem of obesity combined with disk problem. If to reduce tummy I go for walk the backache develops. If I take rest for improving disk problem then tummy gets large. Suggest solution.
Am 24 years old and facing disc bulge from past 4 years (L4, l5, l6) I have taken treatment with exercises, massages and Physio therapy. Which is best way to cure in a quick time.
I am 45 years of age, there are ligament disorder in my left side knee & slip disc problem too in both side feel heavy pain you are requested to advice me for better treatment & earlier relief in the same.
Breast cancer is a form of cancer which develops from the breast tissue. Breast cancer is indicated by signs such as a lump in the breast, changes in breast shape, fluid flowing from the nipple, dimpling of skin, or the development of red scaly patches. Breast cancer is a fatal form of cancer in women and immediate diagnosis is required on observing the symptoms.
Diagnosis of breast cancer
Other than the regular breast screening, the diagnosis of breast cancer involves the following steps and methods:
- Seeing your general practitioner (GP): It is very important to visit your GP soon after noticing the symptoms of breast cancer. Your GP will examine you properly and in case your symptoms need more assessment, he/she will refer you to a breast cancer clinic.
- Mammogram and breast ultrasound: You will be required to have a mammogram, as recommended by a specialist breast unit. This is an X-ray of the breasts. An ultrasound scan may also be required. Breast ultrasound should be undertaken only if you are less than 35 years of age. This is because, young women have denser breasts and a mammogram is not as effective as ultrasound in the diagnosis of breast cancer. In ultrasound, high frequency sound waves are used for obtaining an image of your breasts. It is observed to notice any abnormality or lumps. A breast ultrasound is also important for determining whether a lump is solid or contains liquid.
- Biopsy: In this diagnosis process, a sample of the tissue cells is taken from the breasts and tested under a microscope to find out if it is cancerous. A scan and needle test for the lymph nodes present in your armpit is also done to check whether they have also been affected. A biopsy is undertaken in several ways, depending upon the condition and severity. A needle aspiration biopsy is used for testing a sample of your breast cells without the removal of the tissues. This is the most common form of biopsy and it is also used for draining a small fluid-filled lump or benign cyst. During the process, you will be given a local anesthetic. Usually, a needle biopsy is carried out guided by an X-ray, ultrasound and an MRI scan as well. This helps in distinguishing it from non-invasive changes such as ductal carcinoma in situ.
Another form of biopsy used for the diagnosis of breast cancer is called vacuum assisted biopsy or mammotome biopsy. In this process, a needle gets attached to a suction tube, which helps in obtaining the sample and for clearing the bleeding. If you wish to discuss about any specific problem, you can consult a general-surgeon.
How does neuclus pulposus take to decay when it comes out of annulus fibrosus and extruded to nerve root as for example in L5-S1? Does it decay over the time or it never?
Cancer is the abnormal, uncontrolled growth of cells in a particular body part. With continued growth, pieces of this tissue travel through the blood to different body parts and continue to grow in the new area. This is known as metastases. Breast cancer is one of the most common forms of cancer and affects about 1 in 8 women in the USA. Read on to know more details of breast cancer – breast anatomy, causes, symptoms, risk factors, detection, prevention, and of course treatment.
Anatomy: The main function of the breast is lactation through its milk-producing tissue that are connected to the nipple by narrow ducts. In addition, there is surrounding connective tissue, fibrous material, fat, nerves, blood vessels and lymphatic channels which complete the structure. This is essential to know as most breast cancers develop as small calcifications (hardened particles) in the ducts or as small lumps in the breast tissue which then continues to grow into cancer. The spread can happen through lymphatic or blood flow to other organs.
Warning signs/symptoms: The following are some symptoms that need to be watched out for if you have a predisposition to breast cancer.
- A lump in either of the breasts or armpits
- Change in size, shape, or contour of either breast
- Redness of your breast or nipple
- Discharge of clear or bloody fluid
- Thickening of breast tissue or skin that lasts through a period
- Altered look or feel of the skin on the breast or the nipple (dimpled, inflamed, scaly, or puckered)
- One area on the breast that looks very different from the other areas
- Hardened area under the breast skin
Either one or a combination of these should be an indication to get a detailed checkup done. Early diagnosis results in controlling the disease with minimal treatment and reduced complications.
Causes and risk factors: The exact cause for breast cancer is yet to be pinned down. However, risk factors are clearly identified, and women with risk factors need to watch out for warning signs.
- Family history: Of all the risk factors, the family history is the most important. Breast cancer runs in families, and if there is a first-degree relative with the breast cancer, the chances of developing it are almost double. Two genes BRCA1 and BRCA2 are the carriers of the disease, and this testing can be done in women to identify if they are at risk.
- Family history of other cancers: Even if there is no breast cancer, if there are other cancers that run in the family, watch out.
- Age: Women over 50 are at higher risk of developing breast cancer.
- Race: Caucasian and Jewish women are at higher risk of breast cancer than African-American women.
- Hormones: Greater exposure to the female hormone estrogen increases the chances of developing breast cancer. Women who use birth control pills for contraception and hormone replacement after menopause are at a higher risk of developing breast cancer.
- Gynecologic milestones: Women who have abnormal menstrual milestones need to watch out. These include those who attain menarche before 12 years of age, get pregnant after 30, attain menopause after 55, and have menstrual cycles shorter than 26 days or longer than 29 days.
- Obesity and alcohol abuse are also likely to increase a woman’s chances of developing breast cancer.
Stages: Starting from stage 0, higher stages indicate advanced disease.
- Stage 0: The growth which has begun in the milk-producing tissue or the ducts has remained there (in situ) and not spread to any other area, including the rest of the breast.
- Stage I: The tissue slowly becomes invasive and has begun to affect the surrounding healthy tissue. It could have spread to the fatty breast tissue and some breast tissue may be found in the nearby lymph nodes.
- Stage II: The cancer at this stage grows considerably or spreads to other parts. There are chances that cancer may grow and also spread.
- Stage III: It may have spread to the bones or other organs but small amounts are present in up to 9 to 10 of the lymph nodes in the armpits and collar bones which makes it is difficult to fight.
- Stage IV: The cancer is widespread to far-flung areas like the liver, lungs, bones, and even the brain.
Screening: This is one of the most effective ways to identify the disease in its early stages. This will help in controlling cancer from spreading with minimal treatment.
- Self-examination: A thorough self-examination to look for changes in terms of shape, size, colour, contour, and firmness should be learned by all women. Watch for any discharge, sores, rashes, or swelling in the breasts, surrounding skin, and nipple. Examine them while standing and when lying down.
- In most women, annual screening mammograms are advised after the age of 40. However, in women who have a strong family history or genetic makeup, it is advisable to have screening mammograms starting at age 20 every 3 years and then annually from the age of 40.
- Women in high-risk categories should have screening mammograms every year and typically start at an earlier age.
- Ultrasound screening can also be given in addition to mammograms.
- Breast MRI is another way to screen for breast cancer if the risk is greater.
Breast Cancer Prevention: Now that there is so much awareness about causes and risk factors, there are definitely ways to prevent or delay the onset of the disease.
- Exercise and a healthy diet with reduced amount of alcohol are definitely effective in minimising the chances of developing cancer.
- Tamoxifen is used in women who are at high risk for breast cancer.
- Evista (raloxifene) which is used to treat osteoporosis after menopause. It is also widely used in preventing breast cancer.
- In high-risk women, breasts are surgically removed to prevent the development of cancer (preventive mastectomy).
Treatment: As with all cancers, treatment would depend on the stage at which it is identified and include a combination of chemotherapy, radiation, and surgery. As noted earlier, if you are at risk, look out for warning signs as early diagnosis is the key to maximum recovery.
I have slip disc l4, l5 Should I avoid carrying weights. More over what are the exercise I must follow?
Breast cancer begins when the cells that are present in the breast start to go out of control. These cells generally form a tumor which can be seen on mammogram or one can feel it as a lump. The tumor is threatening if the cells can grow into the tissues that surround it or spread to other areas of the body. Breast cancer happens mostly in ladies. Here are a few methods with which you can prevent breast cancer-
- Keep your weight in check: Maintaining a healthy weight is important for everyone although, it is easy to tune it out since it is said so often. Being overweight can expand the danger of a wide range of cancers, including breast cancer, particularly after menopause.
- Be physically active: Women who are physically active for almost or at least 30 minutes a day have a lower danger of breast cancer. Normal activity is additionally one of the ideal approaches to keep weight under control.
- Eat Your Fruits and Vegetables and Avoid Too Much Alcohol: A balanced and healthy diet can bring down the danger of breast cancer. Attempt to eat a considerable measure of fruits and vegetables and keep liquor at moderate levels or lower. While moderate drinking can be useful for the heart in most grown-ups, even low levels of intake can build the danger of breast cancer. If you do not drink, don't feel you have to begin. In case you drink modestly, there is less risk.
- Try not to Smoke: Smokers and non-smokers alike know how undesirable smoking is. It brings down a person’s quality of life and expands the danger of heart and lung diseases, stroke, and no less than 15 types of cancer, including breast cancer. It additionally causes bad breath, awful teeth, and wrinkles.
- Breastfeed, If Possible: Breastfeeding for almost one year or more brings down the danger of breast cancer. It additionally has extraordinary medical advantages for the baby as well, especially in terms of immunity.
- Keep away from Birth Control Pills: Contraceptive pills have both dangers and advantages. In many cases, the more young a lady is, the lower the danger is. While ladies are taking birth control pills, they have more chances of falling prey to breast cancer as per various medical studies. This danger leaves rapidly in the wake of stopping the pill. The danger of stroke and heart attack is increased while on the pill, especially if the woman smokes. Long term use can likewise have essential advantages, such as bringing down the danger of ovarian cancer, colon tumor and uterine cancer and undesirable pregnancy. In case you are exceptionally worried about breast cancer, staying away from birth control pills is also an alternative to lower the risk. If you wish to discuss about any specific problem, you can consult an oncologist and ask a free question.
Sir I am FROM CHENNAI having back pain when mri scanned impression as follows Early lumbar spondylosis. Mild disc bulge with focal posterocentral and bilateral postrtolateraldisc at l3_ 4 disc level causing thecal sac ibdentation and bilatrral mild beural foranimal narrowings (L>R) MILD ligamentum flavum hypertrophy at L3_4 & L4_5 disc level causing mild posterior thecal sac indention Disc desiccation in L4_5 & L5_ S1 DISC LEVEL AS LOSS OF HYPERINTENSE SIGNAL ON T2W1 PLEASE HELP I REPLY ME POSITIVELY
Becoming a mum can lay down a whole lot of stress on you. But now you know that your brain is going to help you with all the adjustment s! ah ah a relief you get when your baby gives you a hug by kissing your cheecks the joy you get is amazing and gratitude to the almighty creater