Hernia are bulges protruding form a weak point on belly (abdomen) through which intestine and abdominal fat comes out to lie just below the skin. It can also be found in groin, upper thigh and chest. There are several types of hernia like inguinal hernia (direct and indirect), femoral hernia, umbilical hernia, umbilical hernia, epigastria hernia and incision hernia.

Who get hernia?

Conditions that lead to increased abdominal pressure are at more risk of developing hernia  

o Persistent cough

o Being overweight or pregnant

o Lifting, carrying or pushing heavy loads

o Straining on the toilet

What are the symptoms of hernia?

o Mostly they are asymptomatic/ no symptoms.

o People just notice a swelling or bulge which gets bigger while standing or straining and disappear while lying down/sleeping.

o Some might feel a dragging/aching sensation.

o The swelling tends to get bigger with time.

o Symptoms develop when there is a complication like strangulation. This happens when the content of abdomen (intestine) come out and can not go back. There will be severe pain in the region and vomiting. Overlying skin will become red. Urgent surgery is needed in this situation otherwise the blood supply to intestine gets cut-off and the intestine in hernia might die (gangrene).

How are hernia treated?

Surgery is the only treatment for hernia. Now a days, most of the hernias are operated laparoscopically (key hole or minimally access technique)

Minimally Invasive Hernia Repair - The surgery is done with a laparoscope which has a small tiny camera, hernia mesh and small tool with it. So the patient can return back to their normal routine earlier as the incision made is smaller.

Advantages of Laparoscopy:

Laparoscopy has clear advantage over open repair in the way of less pain, less complications like wound infection, small and more cosmetic scar, shorter hospital stay, early return to work and daily activities and less chance of recurrence (repeat formation of hernia after surgery).

Before undergoing hernia surgery:

* One week before surgery it is much essential to stop taking drugs that are causing the thinning of the blood. Drugs like Clpodogrel and Acitrome or Warfarin should be stopped with the doctor s advice. 
* Stop herbal supplements and check the fitness of your cardio and diabetes. 
* Gain adequate knowledge about surgery and be prepared for post surgical care.

After hernia surgery:

* Avoid heavy weight lifting, exercises, and physical works with excessive strain a few weeks after surgery 
* Cough or laugh loud only with support to the surgical site until one week after surgery

DO s & DON T s in patients of Hernia:

DO s:

1. Increased intake of fibers in diet. ( Fruits, vegetables and grains)

2. Drink plenty of water and other fluid to prevent constipation.

3. Exercise regularly: sweat and loose excess weight and toxins.

4. Eat small meals more frequently in place of one or two large meals

DON T s:

1. Stop smoking and drinking

2. Don t reduce the amount of food you eat

3. Avoid lying down or bending after meal

4. Avoid wearing tight clothes

5. Avoid food difficult to digest

6. Avoid strenuous activities like heavy weight lifting

Types of Hernias:

Incisional hernia:

This happens at the site of previous surgery. This occurs as a result of poor wound healing at the time of previous surgery or as a result of complications like in infection. It is rare after laparoscopic or key hole surgery.

Umbilical hernia:

This occurs through or around belly button (umbilicus). It can be present at the time of birth and needs no repair as most of them resolve by the end of one year. If it persists or appears after 5 years of age then operation is required.

Inguinal hernia:

These are most common hernias and occur in groin region. They are more common in men.

All You Need To Know About Hernia!

Adrenal Glands are endocrine glands located right above the kidneys. They produce important hormones such as adrenaline, aldosterone and cortisol which are involved in a number of biological functions. The dysfunction of the adrenal glands can cause serious endocrine diseases.

Need for Surgery?
The adrenal glands may not function properly due to a number of reasons, including any kind of infection in the glands, kidney disorders, genetic ailments, lesions, tumours on or around the adrenal glands. Due to the irregularity in the release of hormones and enzymes that are essential to the normal functioning of a human body, a number of serious illnesses arise. There is an excess or absolute insufficiency in the release of hormones. This can even turn into a medical emergency. It can lead to uncontrollable obesity, very high or low blood pressure, dermatological problems, menstrual irregularities, blood sugar level irregularities, severe headaches, cramps, fluctuations in potassium levels and so on. That is when surgery is required.

How surgery is performed?
Laparoscopy is the type of surgery which requires minimum invasion. This is fairly a new and successful method of surgery. The patient recovers speedily and is able to go back home within a short span of time after the surgery. Removal of adrenal glands can be performed by making a maximum of three or four-and-a-half inches incision. This results in quicker cosmetic recovery compared to other patients of open surgery.
The surgery is performed under general anaesthesia. A narrow tube-like instrument, known as the cannula is placed into the upper abdominal cavity, below the ribs. Through the cannula, a tiny telescope, known as the laparoscope is inserted. It is connected to a special camera that provides a magnified view of the patient s internal organs on a large monitor. Using such technology, the adrenal glands are dissected free from other organs and removed.

Post Operative Care
In case of a simple laparoscopic surgery, there are hardly any post operative complications. In case of mild pain or discomfort, the doctors may however prescribe some medications. It is important to go for a medical check up after a couple of weeks of the surgery, to make sure you are completely fine.

Laparoscopic Adrenal Gland Removal Surgery - What Is It?

Raise a toast to great skin with vodka!

The Russians love their national drink, the vodka, as much as the french love their fine wines. And just like wine, vodka can be easily used in your daily beauty regime to add a much wanted healthy white glow to your skin.

Vodka is a great astringent or toner. Soak a cotton ball in a mix that is equal parts vodka and water and then lightly dab all over your skin. It will cleanse the skin and tighten pores.

You can add a dash of lemon juice to the mixture and freeze it. Rub these beauty cubes onto your face to bring down skin bloat as vodka and lemon juice together tighten pores and brighten the skin.

If you would like to consult with me privately, please click on consult.


Raise a Toast to Great Skin with Vodka!

Neurosurgery mainly deals with treating of functional disorders that affect the nerves, brain and muscles through major or minor surgery. The field of neurosurgery makes use of advanced surgical procedures. The different techniques are used to treat brain tumors, trauma to the head, cerebral hemorrhages, spinal disc herniation, brain aneurysms and peripheral neuropathy.

Neurosurgery Treatment
The main aim of neurosurgery treatment in patients suffering from stoke is to prevent neurologic deterioration as well as the recurrence of stroke. The advancement in medical treatment has increased to a great extent, however the mortality and morbidity in stroke patients is very high. The second leading cause of death all over the world is stroke, and hence, through neurosurgery stroke can be managed. Each year in the U.S there are about 800,000 people who suffer from stroke which causes disability.

Symptoms of Stroke and its Effects
The main symptoms of stroke are not identified easily by people. However, the symptoms that are caused on delay of treatment include difficulty in speaking, weakness on one side of the body, drooping on one side of the face and difficulty in walking.

Stroke at times is life threatening and it is also referred to as brain attack and can occur at any time to an individual. It is caused when the flow of blood supply to the brain is cut off and oxygen is deprived to the brain cells. Brain dysfunction occurs due to the dead brain cells and hence some patients lose their memory and control over their muscle movement. The treatment of stroke in such cases includes a neurosurgery by a neurological specialist.

Types of Stroke
The abrupt interruption to the flow of blood that causes hindrance in the neurological function can be best treated if detected early and by accurate diagnosis by a neurosurgeon. There are 3 different types of stroke that can occur and these include Hemorrhagic stroke, Ischemic stroke and Transient ischemic attack. The Ischemic stroke mainly occurs when blood vessels that supply blood to the brain are blocked. It is a common form of stroke and its underlying cause is known as atherosclerosis. The main procedures that are used for treating ischemic stroke include tissue plasminogen activator and endovascular procedure.

In the tissue plasminogen activator procedure, the patient is given medicine intravenously. The blood flow to the affected area of the brain is improved when the blood clot dissolves through this method. The medication is given immediately after 3-4 hours on occurrence of the stroke symptoms. In the second procedure, a catheter is used, which is injected in the area of the obstructed blood vessel. The blood flow to the area is restored by the endovascular procedure. Even anticoagulants are given to thin the blood and prevent clogging.

Neurosurgery In Management Of Stroke!

What is Palpitation?
Palpitation is a feeling of awareness of your own heart beat. It is usually described as heart rate being either too fast (racing), too slow or a sensation of missing a beat.

Types of palpitations?
Normal (Benign)
- These palpitations occur as a response to physical or mental stress like exercise, fever, pain, fear, anxiety etc. 
- They are harmless and settle on their own once the precipitating factors disappear. They do not require any medical treatment.

Abnormal
- These palpitations occur due to some underlying abnormality in either the structure of heart or the beating of heart. 
- These can be dangerous and at times life threatening. They may or may not settle on their own and require some medical treatment.

Warning signs that suggest palpitations are abnormal?
Palpitations are abnormal, if they are associated with chest heaviness, chest pain, uneasiness, sweating, weakness, giddiness, feeling of black out, fainting, nausea, vomiting, seizures. Palpitations are more likely to be abnormal in people who have some existing heart disease and these patients should report to their doctor at the earliest.

What to do during palpitations?
1. Stay calm. 
2. Call for help. If u are alone avoid driving, use a taxi or auto, go to your nearest hospital/doctor and try to get an ECG during the palpitations. If you are helping someone having palpitations, if they faint, call for help, start CPR if they remain unresponsive and take them to the nearest hospital. 

Which doctor can treat palpitations?
Doctors who specialise in the treatment of palpitations are called Electrophysiologists. They specialise in heart rhythm and are capable of performing a variety of complex tests to identify and treat different types of palpitations.

Which investigations are used to diagnose palpitations?
ECG: Taken during palpitations and when the patient is normal is a very helpful tool. 
Holter: Externally applied recorder, which continuously records heart rhythm for 24 hrs. 
ELR: Extended loop recorder, is like holter, but it records rhythm for longer durations. 
ILR:  Internal loop recorder is attached within the body for recording rhythm for long duration. 
EPS: Electrophysiology study, is the most sure shot test to diagnose, identify and treat 
Palpitations.

What is EPS?
EPS stands for Electrophysiology study. By this test a trained Electrophysiologist studies the conduction and formation system of heart beat, to understand the source, cause and type of palpitation. It is a simple and safe procedure of 2 to 3 hours and can be done as a day care procedure (by admitting the patient for a few hours in hospital, with discharge on same day).

It requires fasting for 4 hrs, some standard blood investigations and is done with local anaesthesia and if required it can be combined with treatment like ablation in the same sitting.In the procedure Electrophysiologist take catheters into your heart to study and stimulate the palpitations and understand them. Once found they can use various techniques to stop the palpitations, the techniques are called Ablation.

What are the treatment options available for palpitations?
There are many options depending upon the nature of palpitations and condition of the patient: 
- Drug therapy 
- Cardioversion where either a drug or electric shock is given to stop palpitations immediately. 

Ablations using many sophisticated computer softwares 
Device Therapy like ICD (Internal cardiac defibrillator) 
Combination of all the above therapies.

Your Electrophysiologist and you as a team can make a choice about the options that will be best for you.

Palpitations - Everything You Need to Know

A hernia occurs when a weakened area of muscle in the abdominal wall gives way and the internal organ/tissue bulges out through this weakened are or  defect'. This can happen in many different areas of the abdomen. A hernia that develops in the groin region is called "inguinal hernia". It may be very painful especially if a part of the intestine gets trapped in the bulge.

The only treatment option is surgical repair as the weakened area "defect" needs to be repaired and will likely need reinforcement by a prosthetic material called a "mesh". Doctors may resort to Open Surgery or Laparoscopic Inguinal Hernia Repair depending on his/her evaluation of the patient. 

Who is a candidate for Laparoscopic surgery?

Laparoscopic surgery is the preferred treatment option for most people with inguinal hernia. Special situations in which laparoscopic surgery is much superior to open are

  Failure of a previous open surgical repair. Laparoscopic surgery is performed from "behind" the hernia and abdominal wall in comparison to open surgery which is performed from "the front". So, in case of failure of the open surgery, laparoscopic surgery is done through a fresh, non-scarred area and is technically safer and easier than doing an open surgery once again.

  If there are hernias on both sides and both need to be repaired at the same time, laparoscopy has a great advantage as both the hernias can be tackled and repaired through the same three tiny cuts, and two separate large incisions need not be made. 

Who is Not a Candidate for Laparoscopic Surgery?

The person is not a candidate for Laparoscopic Surgery if he has:

  Some patients who have undergone previous Abdominal Surgery or prostate surgery may not be suitable candidates for laparoscopic inguinal hernia surgery.

  Some underlying medical conditions, that make him unfit for general anaesthesia, as usually laparoscopic surgery can only be done under general anaesthesia.

How Laparoscopic Inguinal Hernia Is Carried Out?

In a Laparoscopic Intervention, two to three small incisions are made in the lower abdominal area. The laparoscope is passed through one of these incisions and the surgical instruments are inserted through the other incisions. The abdominal cavity is inflated using Carbon Dioxide to help the surgeon visualize the lower abdominal area clearly. Using the laparoscope, the surgeon visualizes the Hernia and uses long instruments to operate on it. She covers the hernia with a mesh and may fix the mesh to abdominal muscles using either stitches or stapler-like instruments.

Benefits of Laparoscopic Surgery

1. Two or three tiny cuts (5-10 mm in size), hence there is less pain after laparoscopic surgery

2. Better cosmetic results

3. Quicker recovery

4. Early return to daily activities like walking, working, etc

5. Shorter hospital stay 

Role of Laparoscopic Surgeon In comparison to many other minimally invasive surgeries:

Laparoscopic Inguinal Hernia Repair is more demanding in terms of technical capability of the surgeon. In general, Laparoscopic Inguinal Hernia Repair is more difficult to carry out in obese people than others. However, if the doctor is well trained and technically advanced with long experience, he can carry out such minimally invasive surgeries smoothly irrespective of the BMI of the patient. Everybody is not a candidate for Laparoscopic Inguinal Hernia Repair.

It is the doctor who decides if a particular patient is suitable for such surgery or not. However, the conclusive factor in any such repair is the experience and expertise of the doctor. This is why there are not many Laparoscopic Surgeons who carry out Laparoscopic Inguinal Hernia Repairs. Owing to the complexity of this procedure, it is important to get it done from an expert surgeon only.

Laparoscopic Inguinal Hernia Repair !

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