Lymphedema is a condition that typically affects the arms and legs. The most common cause of this condition is damage to the lymph nodes or their removal as part of a cancer treatment program. There is no known cure for this condition. However, surgeries such as Vascularized lymph node transfer surgery may help deal with it better.

Vascularized lymph node transfer surgery involves replacing the affected lymph nodes with healthy lymph nodes from other parts of the body. This allows blood to flow more easily and restores or augments the lymphatic drainage system. In most cases, the healthy lymph nodes are harvested from the patient s groin. This procedure is relatively new, and its limits are still being explored by doctors. In cases of breast cancer that causes lymphedema in the upper limbs, this procedure may be performed along with breast reconstruction.

To be a viable candidate for this procedure the patient must have maximized control over lymphedema through other forms of lymphedema therapy. This therapy will need to be restarted after the surgery to ensure good results. The lymphedema diagnosis should also be less than 5 years old such that the patient s lymphedema is in its early stages.

As with any other surgical procedure, there are certain risks associated with this procedure. These can include

Reaction to anesthesia
Bleeding
Infection
Scarring at the site and poor healing
Damage to adjacent blood vessels
Nerve damage that can cause a temporary loss of sensation
Muscle weakness
Numbness ta the sites from where healthy lymph nodes were harvested
Risk of Lymphedema in the area where the lymph nodes were harvested from
After the surgery, the patient will need to keep pressure off the site where the lymph nodes have been transferred. The surgery site may be bandaged but compression garments will not need to be worn. On being discharged the patient may resume normal activities such as driving and work. High-intensity exercises that involve the use of the operated limb should be avoided for at least a month after the surgery. Compression garments should not be used until recommended by the doctor or a minimum of 2 weeks post-surgery. They will also need to schedule review consultations with the doctor. The schedule followed usually involves check-ups after 2 weeks, 1 month, 3 months, 6 months, 9 months and 1 year. 

Lymphedema - Vascularized Lymph Node Transfer Surgery!

Dizziness is now a very common problem among the adults. Maybe people do not take this to be a serious problem in many of the cases, but repeated feeling of dizziness may lead them to visit a doctor. When in the case of such situation, you visit a general physician, not knowing the causes of such problem; often the doctor will refer you to an ENT. There have been some reasons of why you should visit an ENT for dizziness.

Symptoms of Dizziness

Often dizziness occurs along with some other symptoms too. Some of the symptoms that are accompanied by dizziness are:

Anxiety
Nausea
Buzzing noise in the ears
Pressure in the ears and the head
Hearing issues
Some Important Reasons for Dizziness
If you are facing dizziness on regular grounds, then it may happen that it is due to some very serious health complications that you are suffering from. Some of the problems that may cause dizziness are:
Inner ear issues,

Issues in the central nervous system,
Issues related to the cardiovascular system,
Bacterial or viral infection,
Side effects of any medicine.
Diagnosis of The Problem
Diagnosis of the problem is the most important step in case of dizziness. It is because the diagnosis is not about whether you are feeling dizzy or not, it is the diagnosis about why you are feeling dizzy. There are some tests related to balance to diagnose the cause of dizziness. To get the tests done related to balance, you need to visit an ENT because the balance system of the human body is there located in the inner ear.
Though the balance of the body is there to the inner ear, also the test of other sensory organs such as eye and brain is also done. This is because balance disorder or dizziness happens when there is a problem in the communication system of the body. One of the most important ways to diagnose balance is by doing an eye test that is known as nystagmus.

Treatment of The Problem
After several tests of various sensory organs, when the ENT expert reaches a particular result, then the treatment starts depending upon the diagnosis. Today treatment for such balance disorder or dizziness has become common. Some problems can get solved by a changed diet only while other may need the help of medicines. Again, some of the problems may get cured by doing exercises while for some; you may need the help of a physiotherapist too.

When it is about dizziness, it is surely about balance disorder due to some major problems. Balance is controlled from with the inner eye and other sensory organs also, hence it is important to visit the ENT in this case.

Why Should You Consult An ENT For Dizziness?

An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.

Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.

Symptoms

Pain- Constant pain which gets worse when sitting down
Irritation around the anus, like swelling, redness and tenderness
Discharge of blood or pus
Constipation or pain while evacuation
Fever
Diagnosis
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.

Treatment
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.

Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.
Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place. 

Whatever the surgical technique, one can experience minor changes in continence. Patients usually don t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation.

Fistula-in-Ano or Anal Fistula - How It Can Be Treated?

The lungs take in oxygen and leave out carbon dioxide through breathing. It often does not get noticed but is the most vital function. When a person is not able to breathe properly, then the overall physical ability of a person is reduced. Even walking a few steps or doing simple chores can seem daunting tasks. Therefore, shortness of breath can be very limiting and may alter the quality of life of the patient.

The medical term being dyspnea, it can be short or long-term, acute or chronic. Any problem in the heart or lungs can cause shortness of breath.

Shortness of breath can be caused by various conditions including:

Asthma
Lung infections
Heart conditions including congestion and failure
Allergies
Fever
Any systemic illness or infection
Chronic obstructive pulmonary disease
Pneumonia
Bronchitis
Given that shortness of breath is caused by almost any ill health condition, especially in people with chronic conditions, it is best that the lungs are empowered to improve their function and do not cause shortness of breath. The idea is to delay the onset of shortness of breath and also to reduce the severity.

Some techniques to reduce shortness of breath are:

Breathe by reducing the rate of respiration. This reduces shallow breathing, which often happens, and so improves the amount of oxygen that reaches the system with each breath.
The patient should learn to relax, sit, and pace around without exertion.
Become aware of air movement during respiration   controlled breathing and active cycle of breathing techniques.
Postural drainage   Depending on the area of the lung that is causing shortness of breath, the person is made to lie prone and turn to a side that will allow the fluid in that region to drain out.
Overall relaxation techniques to improve airflow and control short of breath.
Avoid bending down, as it can induce shortness of breath.
Over-eating at one go in one meal should be avoided.
Weight needs to be maintained, especially if not under control. This can lead to shortness of breath without any associated medical condition either.
The patient should learn to push objects instead of pulling them.
Heavy objects should not be lifted but moved down at ground level.
Avoid extreme hot or cold showers.
Quit smoking as it causes various lung problems.
Help physiotherapy provides for people who are short of breath:

Improve exercise tolerance
Calms the person
Allows the person to control symptoms
Improve the quality of life
Provide manual treatment

Can Physiotherapy Cure Shortness Of Breath?

HIV is a systemic disease which affects all parts of the body. The oral cavity also has some tell-tale symptoms which indicate HIV / AIDS. A careful examination and detailed history of symptoms is essential. In some cases, the oral manifestations could be the area where HIV is suspected. This can help in reducing morbidity and improves prognosis. The oral lesions that occur in HIV patients can vary and differ significantly in children and adults. While there are a variety of oral lesions in HIV-infected individuals, listed below are some common infections seen in HIV patients. These are a combination of fungal, viral and bacterial infections.

Candidiasis: Candida is an opportunistic fungus that is normally present in the oral cavity and with reduced immunity of HIV, recurrent bouts of the infection begins to show up. It can be in the form of regular thrush which is whitish and cannot be scraped off (pseudomembranous candidiasis), hyperplastic candidiasis (white patches which can be scraped off) or erythematous (reddish patches). Candida can involve any part of the oral mucosa including the pharynx and the palate.
Herpes Simplex: This is the most common viral infection seen in patients with HIV/AIDS. There could be primary or secondary infection of herpes virus, especially inside the mouth and the vermillion border of the lips.
Herpes zoster: This virus, when already present in the body, can be reactivated with HIV/AIDS and with oral herpes. The distinction with herpes simplex is from their distribution. These are unilateral, along the distribution of the maxillary or mandibular nerve. The lesions appear both on the facial skin and the oral mucosa. While the facial ones break open and form crusts, the mucosal ones coalesce to form larger lesions.
Hairy Leukoplakia: This is present in about 20% of asymptomatic HIV patients. Onset of hairy leukoplakia is an indication of rapid progression of HIV with increased CD4 counts. The typical lesion is a non-movable, hairy lesion along the side of the tongue and can spread to the top and the undersurface of the tongue. There are large amounts of Epstein-Barr virus (EBV) identified from biopsies of hairy leukoplakia.
Cytomegalovirus: If the ulcers have a necrotic base with a halo surrounding it, it is CMV infection, usually seen on any oral mucosal surface.
Periodontal disease: This is one of the bacterial infections that manifests itself in HIV patients. It can take two forms such as Linear Gingival Erythema (LGE) which can subsequently lead to Necrotizing Ulcerative Periodontitis (NUP). The oral hygiene is generally good with minimal plaque and there is rapid bone loss and soft tissue reddening and swelling. The, mouth, therefore is certainly a window to one s health.
Diagnosing HIV with Western Blot Test-

It is a series of blood screenings are performed to test for HIV. The enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is the first test that your healthcare provider will order to screen for HIV. ELISA, like the Western blot test, detects HIV antibodies in your blood. Antibodies are proteins your immune system produces in response to the presence of foreign substances, such as viruses. If you test positive for HIV on the ELISA test, your provider will order the Western blot test to confirm HIV infection. 

Can HIV Be Diagnosed Through Oral Manifestation?

Psychogenic breathlessness or pseudo-dyspnea is a condition where the patient suffers from shortness of breath time to time. This disease is often confused with a similar breathing disorder called Chronic Dyspnea. While there are a lot of factors involved in chronic dyspnea, like allergens and pulmonary diseases, psychogenic breathlessness has more to do with the current state of mind.

One of the most challenging factors is the diagnosis and differentiation between both conditions. Sometimes, the psychogenic breathlessness is so concentrated that there is no way to differentiate between the two.

Procedure of Diagnosis of Psychogenic Breathlessness:

Here are the steps that doctors typically follow to diagnose Psychogenic Breathlessness

To differentiate between the two diseases (Chronic Dyspnea and Psychogenic Breathlessness), the doctor will ask the patient to try breathing harder. A patient with chronic dyspnea will find it even harder to take a breath when he or she tries to. However, a person with psychogenic dyspnea will show improved conditions when they try to breathe harder

A thorough examination of the chest will be done

Blood tests and lung function test (spirometry) will also be conducted to rule out pulmonary diseases

Causes of Chronic dyspnea:

Allergens causing allergic bronchitis (also known as asthma) is the main reason behind Chronic Dyspnea. Other common causes of the true or chronic dyspnea are heart diseases, COPD which occurs because of smoking. Then there are rare disorders like ILD (sarcoidosis), neuromuscular diseases, infections, anemia, obesity/deconditioning.



Causes of Psychogenic dyspnea or psychogenic breathlessness:

Acid reflux: Acid reflux can cause certain sensation on the inner lining of the esophagus (esophagitis). The esophagus has several nerve endings on the inner linings, when the acidic reflux touches these nerve endings, a temporary breathlessness occurs.

Anxiety: People with anxiety can also develop breathlessness. Though exercises help for a short period of time, a patient needs to see a psychiatrist for this condition.

Panic Attacks: These are also a cause for breathlessness. The temporary feeling of choking is common in people who experience panic attacks.

Treatment:

Medication: Medicine for acidity is prescribed to patients having Pseudo-Dyspnea, due to acid reflux.

Anxiety pills and Talking therapy: People suffering from anxiety are recommended to see a psychiatrist for better evaluation of their problem. Medications (anxiety pills) prescribed by the psychaitrist may help in controlling the breathing pattern in a person. Psychological therapies (Talking therapy) have been effective for people suffering from breathlessness due to anxiety.

Placebo: If the problem remains unsolved and unknown, sometimes doctor prescribes placebo medication, for example sweetened aerosol. Doctors believe that if the patient thinks he/she is taking a real medication, his/her condition can be controlled by eluding the mind.

It is important to remember that Psychogenic Breathlessness is as real as chronic breathlessness and patient doesn t pretend to have this condition. When the first symptoms of it start appearing, a specialist doctor (pulmonologist) should be consulted who after confirming the diagnosis of psychogenic breathlessness, may refer you to a psychiatrist or psychologist for further treatment.

Psychogenic Breathlessness - Causes, Symptoms and Treatment of It!

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