Celiac disease is an autoimmune disease caused due to intolerance to the protein called gluten found in common foods like wheat, barley, and rye. The exact reason for the disease is not known, but gluten attacks the small finger-like projections in the intestine called the villi, which help absorb nutrients during the digestion, leading to malnourishment.

Onset of the disease is usually once the child has started on solid foods and can include diarrhea, abdominal discomfort, underweight, skin rashes, anemia, mouth sores, etc.
Diagnosis usually happens with a detailed discussion and checking the level of antibodies against gluten in the blood. In rare cases, an intestinal biopsy may also be required. Once confirmed, the following are ways to manage celiac disease-

Dietary changes: avoiding gluten-containing foods is the first step to treating celiac disease. These are common food substances like wheat and barley. In some cases, the entire family may choose to or need to take this diet, just to provide moral support to the child.
1. Breads, cakes (made from wheat)
2. Creamed or breaded vegetables
3. Processed meats
4. Dry roasted nuts (as agents used in processing could have wheat)
5. Fried chicken
6. Pastas
7. French fries (that are coated in flour)
8. Spreads, soft cheeses, and dips
9. Salad dressings
10. Gravies and sauces (including some tomato and meat sauces)
11. Soup mixes and canned soups
12. Crab or other seafood
13. Malt or malt-flavored drinks (usually made from barley)
14. Modified food starch (modified corn starch is ok; modified wheat starch is not)
15. Nondairy creamer
16. Soy sauce and soy sauce solids (may be fermented with wheat)
17. Wheat-free products (may contain barley or rye flour)
18. Yogurts containing wheat starch
Read the labels of foods to ensure they are free of gluten. Organic/natural food stores and health food stores contain wide range of gluten-free products that can be used with minimal effect on the child's food habits.

Eating out: just because the child has celiac disease, eating out is not ruled out. Carefully choosing what to eat is suggested. Also, letting the chef know is a good idea, as most chefs will prepare something safer for the child.

Cross-contamination: avoid cross-contamination: in schools or in cases where the child could potentially eat from other children's boxes, make sure the child is well informed and ensure he does not eat from other kids' lunch boxes. It is also a good idea to keep the class teacher and a couple of his close friends informed of the child's condition.

Most children are easy to educate and adapt well to the changes required, knowing very well that it is for their own good.

Tips to Deal With Celiac Disease in Children

The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

The build-up of fat in the liver may lead to the development of a condition known as nonalcoholic steatohepatitis or NASH. This condition is not related to the consumption of alcohol and the inflammation is due to the buildup of fats in the liver. In most cases, there are no symptoms till the stage when the fat deposition causes inflammation and damages the liver cells. This also hinders the normal functioning of the liver and if not treated, it may lead to an extreme condition known as cirrhosis. However, NASH does not always get worse and with some precaution, it can be treated.

The cause behind the development of this disease is not alcohol consumption and it could be some environmental factor that triggers liver inflammation or heredity might be another reason. However, the risk of developing this disease is high for people who are obese, have metabolic syndrome, have high cholesterol or are resistant to insulin.

There are hardly any symptoms of NASH that are seen in the early stage of this condition. However, at a much-progressed stage, the following symptoms may be seen:

Weight loss
Fatigue and weakness
Upper abdomen pain
Diagnosing NASH requires undergoing several tests that include a blood test, a CT scan, an MRI scan and also an abdominal ultrasound.

Benefits of Ayurvedic remedies in managing NASH



There are remedies which help in detoxification of the liver. They also enhance the body s capacity to digest fats and prevent it from accumulating in the liver.
A few remedies are rich in vitamin C content as they are very effective in treating liver problems.
Some remedies are packed with the antioxidant and vitamin C. And, it is this vitamin C that helps the liver in producing the enzyme, glutathione, which neutralizes the toxins and detoxifies the liver of all of the toxins.
Some remedies contain catechins, which are known to enhance the functioning of the liver. They are great for blocking the fat stored in the liver and works wonder in fighting against diseases associated with the fatty liver disease.
There are some fruits that are effective in treating fatty liver diseases. These fruits burn the dietary fat rapidly and also improves the functioning of the liver if consumed regularly.
Some Ayurvedic remedies are a storehouse of the fat-soluble Vitamin E, and are known to protect your liver against the accumulation of fats and will keep your liver healthy.
Apart from including these natural ingredients in your diet, you will also have to reduce your body weight, reduce cholesterol level, control your diabetes, exercise regularly and stop consuming alcohol. However, home remedies are just supportive, but not a complete line of treatment for NASH so you cannot depend completely only on them. As mentioned NASH can disturb your normal liver functioning and if not treated it can lead to liver cirrhosis so take proper Ayurvedic treatment under the guidance of an Ayurvedic doctor.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Nonalcoholic Steatohepatitis (NASH) - Home Remedies That Can Help Treat It!

Severe to moderate pain in the rectum during and after bowel movements is an
indication of anal fissure. If it is accompanied by bright red stool and an itching
sensation around the anus, it is more likely to be fissure than anything else. Fissure
is usually treated with sits bath and enhanced intake of fibrous food. If that does not
heal the problem, the doctor may go for a surgery. However, surgical intervention of
fissures is not always a permanent solution. For permanent solution, patients are
now turning to homeopathy. Yes, homeopathy can address the problem at its root
and gift you a permanent cure.
What Need to Know About Fissure?
  The problem mostly precipitates due to inflammation and dryness of the
mucosal end of the anorectal area.
  Straining during bowel movements and passing hard stools strain the anal
mucosa. That is likely to result in fissure.
  People suffering from chronic diarrhoea are also likely to suffer from this
problem.
  People suffering from some kind of inflammation of the anal area due to
diseases like Crohn&#39;s disease or some kind of inflammatory bowel disease
may also suffer from fissure.
  The patient may feel a lump in the area surrounding the anus.
  He or she may also experience spasms at the end of the rectum.
  Even infants may suffer from this problem.
  Many women suffer from fissure after childbirth.

Homeopathic Treatment of Fissure
  Homeopathy is known to address diseases to their roots.
  In case of fissure, homeopathic medicine can address the problem by
preventing and treating dryness and inflammation of the palpable mucosal
area around the anus. If this area is moist, it can stretch better in response to
straining during bowel movements and thereby prevent tearing.
  Since constipation is one of the main causes of fissure, homeopathic doctors
may prescribe medicines for preventing constipation too.
  However, homeopathic medicine is not a one-size-fits-all remedy. The
medicine depends on the constitution of body. The doctor may try to judge
body constitution of the patient by asking him questions about sleep pattern,
food habit, emotional state, working schedule, etc. The doctor needs to take
all these into consideration to prescribe the most appropriate medicine.

  A homoeopathic doctor first gets a conventional diagnosis. If fissure is
confirmed in the diagnosis, the doctor may launch an all out attack on the
problem so that the problem can be nipped in the bud.
Conclusion
Anal fissure is a painful condition that is mostly precipitated by straining during bowel
movements and passing hard stools. Homeopathy can offer permanent solution to
this problem by preventing constipation on one hand and preventing as well as
treating inflammation and dryness of the anal mucosa on the other hand.

Fissure - An Overview!

One of the most common problems with the gastrointestinal system, peptic ulcers occur when the lining of the stomach - the esophagus or the small intestines, gets damaged. The damage occurs due to the development of sores on the lining which may be due to inflammation caused by certain bacteria, or due to erosion caused by the stomach acids. This can be a very painful disorder and end up severely limiting your life. Peptic ulcers can cause intense abdominal pain, vomiting nausea, indigestion and sudden unexplained weight loss.

The Homeopathic Approach to Curing Peptic Ulcers

The treatment of peptic ulcers in conventional medicine primarily revolves around the treatment of symptoms. The symptoms may be suppressed for some time but eventually come back sooner or later. This results in a vicious cycle where the treatment becomes less and less effective over time. Homeopathy, on the other hand, has an approach of trying to correct the problems from the root and over time, remove the very cause that results in the problem. Some of the things a homeopathic doctor may ask you would include  

Family history of ulcers
General health history of the family to determine hereditary health problems
Physical characteristics
Psychological tendencies and likes and dislikes among other information
Homeopathy takes into account not just the symptoms but the general constitution of the patient as well. This helps not only cure the ulcers but also the pre disposition to developing it again.

Effective Homeopathic Medications

Some of the most effective homeopathic medications used in the treatment of peptic ulcers are mentioned below. However, you shouldn t try to self-medicate as it is best to consult with a doctor who can properly diagnose the problems and prescribe medication which are specifically tailored for you.

Argentum Nitricum   One of the most effective medication in treating ulcers, Argentum Nitricum is usually prescribed when you experience sharp burning pains from peptic ulcers that radiate to different area of the abdomen. The pain is akin to the feeling of gnawing inside the stomach. Other symptoms such as vomiting, belching and nausea may also be present.
Nux Vomica   If you have peptic ulcers and even eating the slightest amount of food causes pain, then Nux vomica may be a good option and thus be prescribed by your doctor. Another indication in such cases is where the abdominal region is very sensitive and you may feel pain even with the slightest touch. Nux Vomica is also very effective if your peptic ulcer symptoms tend to get worse after the consumption of tea, coffee, spicy foods or alcoholic beverages.
Kali Bichromicum   Sometimes, peptic ulcers may cause the food in your stomach to sit like a heavy load immediately after meals. This can make you very uncomfortable and unable to do any other form of work. This is often times accompanied by a low appetite. In such cases, Kali Bichromicum has been seen to work wonders.
Lycopodium Clavatum   If you have burning pain in your stomach along with the bloating of your abdomen, then Lycopodium Clavatum is the best medication for you. Other indications for this medication are when ingestion of warm water helps relieve pain. If consuming certain vegetables such as cabbage and beans worsens the situation, then Lycopodium Clavatum could be the best medication in such a case.
Carbo-veg   An all-rounder in the field of homeopathy, Carbo-Veg is also effective when treating peptic ulcers which are accompanied by heartburn and acidity as well as sour belching. The pain from the ulcers may extend from the stomach all the way to the back. Other indication wherein Carbo-Veg may be effective is where the stomach area becomes very sensitive to touch and even small amounts of food may suddenly cause the symptoms to deteriorate.
Hydrastis Canadensis   Stomach or abdominal pain accompanied by weight loss is one of the major indications where this medication may be prescribed. The patient may become emaciated and have sharp cutting pains in the stomach. In such cases, Hydrastis has been seen to be very effective.
Graphites   This medication is extremely useful where along with the ulcer pain, you may end up vomiting your food immediately after a meal. A sensation which is painful and constrictive may be present in your stomach. Along with these symptoms, Graphites are also very effective when you suffer from excessive belching.
Phosphorus   If you exhibit typical symptoms of peptic ulcer such as sour belching and a burning sensation in the stomach after eating, Phosphorus could well be the panacea.

Treating Peptic Ulcers With Homeopathy

Pancreatic cancer is an aggressive form of cancer. The disease shows no early symptoms and often spreads to other organs long before it is properly diagnosed. Due to such poor prognosis, only around 6% of the pancreatic cancer patients are healthy and alive 5 years after the first diagnosis.

One of the most common surgeries to remove tumours from the pancreas is Pancreaticoduodenectomy, that is commonly called Whipples surgery. The primary aim of the procedure is to cure cancers or disorders that are identified in the pancreas, bile duct or the duodenum. Here, the tumour is removed to prevent it from spreading to other organs, thus improving the life expectancy of the patient. 

Whipple's Procedure

Before the surgery, an intravenous line will be injected to your arm, to provide you with the necessary medication. Medicines may be passed through this line to soothe your nerves. A spinal injection or an epidural catheter may be placed. This helps you to recover painlessly after the surgery.

The surgery can be carried out in different ways  

Open surgery

Here, the surgeon makes a small incision in your abdomen to access the pancreas and other organs. This is the most common method. This is a complicated operation where the tip of the pancreas, the gallbladder, the bile duct and the initial portion of the small intestine are removed. It is performed to treat cancers that are present on the head of the pancreas. 

Laparoscopic surgery

Here several small incisions are made in your abdomen to insert a camera that transmits the live video of the abdomen to a monitor. According to the live feed, the surgeon performs the operation by using surgical tools. It is a common form of minimally invasive surgery.

Robotic operation

This is another type of minimally invasive surgery where the surgical tools are attached to a special robot. Here, the doctor uses a console to control the robot to perform the surgery. This is used because surgical robots can reach and operate in spaces and corners where the human hands may not reach during surgery.

 The Whipples surgery can take 4 to 12 hours depending upon the approach being used and the complexity of the process. During the surgery, you will be given general anaesthesia, so you will be asleep.

In some cases, a part of your stomach or nearby lymph nodes may be removed to treat the cancer growths. After the process, the doctor will reconnect the other organs so that you can digest food normally.

After the procedure, you may face problems while emptying your bowels. The condition improves around 7 to 10 days after the surgery. Most patients are able to return back to their normal life usually around 6 weeks after the procedure.

It is recommended that you follow the doctor s instructions after the surgery and stick to the diet prescribed. Additionally, keep the incision protected from sunlight and remove the bandages only after consulting the doctors. 

 

 

Whipples Surgery & Pancreatic Cancer - Know About Them!

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