Any kind of injury on the surface of the skin is immediately noticed by us, but when something happens to one of our internal organs, it can take a little longer to get to your notice for example, an obstruction in the bile duct. The bile duct is a tubular structure responsible for carrying bile from the liver and gall bladder through the pancreas to the small intestine. This bile helps the digestion process and the absorption of fat.

An obstruction in the bile duct can be triggered by a number of factors. Some of these are:

    Gallstones
    Inflammation of the bile ducts
    Cysts
    Traumatic accidents
    Bile duct or pancreatic tumors
    Hepatitis infections
    Cirrhosis or severe liver damage
    Abnormal narrowing of the bile duct

This can affect anyone, but the people who have a history of gall stones or tumors in the abdomen are at a higher risk of suffering from bile duct obstruction. Chronic pancreatitis, sudden weight loss or obesity can also increase this risk. The symptoms of biliary obstruction include light coloured stool, dark urine, pain in the upper right abdomen, nausea, vomiting and fever. Your doctor will also probably need an X-ray of the bile ducts, blood tests, a hepatobiliary iminodiacetic acid scan and ultrasonograph to confirm a diagnosis before they can start treating you for the same.

If not treated in time, bile duct blockages can lead to a dangerous buildup of bilirubin in the body and trigger a number of life threatening diseases. Treatment for biliary obstruction can be through medication or surgery with surgery being the more preferred mode of treatment. It is aimed at resolving the underlying cause of the obstruction and alleviating the blockage. Treatment for biliary obstruction can be two common forms of treatment include a cholecystectomy and ERCP. The former involves the removal of the gall bladder and is suited to obstructions caused by gallstones. The latter is a procedure to remove small stones from the bile duct or place a stent inside the duct.

There are many ways bile duct obstruction can be prevented which first and foremost includes following a healthy lifestyle. If you are overweight, exercise for at least half an hour a day to regulate your weight and reach a healthy BMI. Decrease your intake of sugar and saturated fats as both these can cause gall stones. Also, increase the amount of fibre in your diet. All the above mentioned tips will certainly help you in preventing bile duct obstruction.

Bile Duct Blockage -  8 Factors Behind it!

Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.

As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.

The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.

Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.

Sometimes, problems that may be faced are:- 

Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.

Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.

Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.

Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.  

Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.

Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.

Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.

Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to  2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.

Bariatric Surgery - Know Problems Of It!

If you are concerned about your heart s health, it is important for you to make some dietary modifications. Simple changes in your everyday diet may offer benefits, which help in preventing future heart problems. If you suffer from high blood pressure or high cholesterol or have atrial fibrillation.

Here are some tips regarding the best diet for protecting your heart:

Believe in the food hype: Having healthy meals is certainly beneficial and makes a big difference to your heart health. Consuming meals which contain vegetables, grains, low fat dairy and lean meat will allow you to live a longer and healthier life.
Avoid crash diets: A crash diet may be effective, if you want to fit in a dress within one month. However, for improving your heart health, undertaking different fad diets is not useful. Meals in which a certain type of nutrients such as carbohydrates or fats are ruled out are not beneficial as well. You should have a sensible approach towards your diet and focus on food products such as vegetables, whole grains and lean meat.
Do not overeat: Overeating will lead to weight gain and commonly, many people get heart attack after taking a big meal.
Eat less salt: You should consume less amount of salt in your diet and do not eat more than one teaspoon of salt a day. Avoid any food item which contains high amounts of sodium. Salt is responsible for increasing blood pressure.
Limit your intake of alcohol and caffeine: In case you suffer from atrial fibrillation, you should avoid caffeine and any other stimulant as they tend to trigger the symptoms. You must drink moderately as consuming more than one drink a day increases your risks of having heart problems.
Choose meat wisely: You should avoid red meat, which contains large amount of saturated fats as these are not good for the heart. You should choose the leanest cuts of meats and trim all fat from it. You should opt for cuts such as flank, rump roast, tenderloin and sirloin. Pork tenderloin, chicken and turkey breast are other alternatives.
Add fish to your diet: Fish is essential for improving your heart health. Try to avoid having deep fried fish and choose grilled fish or roasted fish, which are rich in Omega-3 fatty acids. Consume fishes like tuna, salmon, trout and sardines.
You should also add whole grains to your diet. They are effective in controlling blood sugar and lower the chances of diabetes. Hence, the risks of heart diseases are less if you do not have diabetes. Whole grains also help with weight loss, which is beneficial for the heart.

7 Tips for a Healthy Heart

Stroke is a medical condition in which the flow of blood towards the brain is poor and causes the death of certain cells. There are two common types of stroke: 

1. Ischemic- due to lack of blood flow
2. Hemorrhagic- due to bleeding

Signs and symptoms of stroke 

Problems with movement
Inability to feel  on one side of the body
Problems understanding or in speech
Vertigo
Loss of vision
Difficulty in carrying out everyday activities
Role of Physiotherapy for Patients with Stroke

The main focus of physiotherapy is to help you use your arms and legs to regain as much strength and movement as possible. 
If you have one-sided paralysis, correct positioning is important to prevent spasm or injury.
It helps you to sit up as this will help you avoid blood clots in your legs, improve your breathing and help you recover quickly.
If you are unable to move, you may be given chest physiotherapy to keep your lungs free of infection.
What does a Physiotherapist do?

A physiotherapist advises you on how you should be positioned when lying or sitting, and how often you need to be moved.
Motivates you to be actively involved in your physiotherapy sessions to help you relearn normal patterns of movement
Decides when you should begin to start walking and what equipment is needed to move or support you
Provides therapy to strengthen your limbs and teach you how to move again as independently as possible
Takes care of the fact that no complications should arise and you have a smooth recovery.
Treatment Techniques:

Strength Training: It is evident that strength training can improve upper-limb strength and function without increasing tone or pain in individuals with stroke.
Gaming: Goal orientated computer gaming has proven to significantly reduce upper limb impairment in stroke survivors.
Virtual Reality: Virtual reality training has been shown to be effective in restoring upper limb motor impairments and motor-related functional abilities.
Mirror Therapy: Mirror therapy has been shown to have a beneficial effect on motor control and function compared to conventional therapy.
Robot-Assisted Therapy: It has been shown to have a beneficial effect on motor recovery and function.
In the upper extremity with severe impairment and/or poor prognosis for recovery, Chedoke McMaster Stroke Assessment (CMSA) of Arm and Hand < Stage 4) treatment should focus on maintaining a comfortable, pain-free, mobile arm and hand. Engage in repetitive and intense use of novel tasks that challenge the stroke survivor to acquire necessary motor skills to use the involved upper limb during functional tasks and activities. Engage in motor-learning training including the use of imagery.

Stroke - How Physiotherapy Can Help With It?

Orange Peel Scrub For Flawless Glowing Skin

An orange is much more than just a refreshing tangy fruit. Orange, rich in Vitamin C, is the best all rounder when it comes to your skin. It’s rich in antioxidants and helps your skin to get younger looking, glowing and healthy. It’s almost a miracle for your skin.

Ground orange peels (and nothing else) just on their own make for the perfect scrub. 

It has these 4 effects on your skin.

1. Scrubbing off Dead Skin: The leathery granular texture & calcium present in it, serves as a gentle but extremely effective scrub, removing layers of dead and decaying skin. 

2. Moisturizing: The natural oil & potassium present in orange peel moisturizes & hydrates your skin simultaneously. 

3. Anti-ageing: The antioxidants neutralize the free radicals keeping wrinkles and sagging cheeks at bay.  Vitamin C & Magnesium present in it make skin glowing, youthful & healthy.

4. Skin Lightening: The orange peel also serves as a natural bleaching agent which helps with skin whitening. 

How to Get the Glow: To get an instant glow, all you need to do is rub frozen orange peel cubes onto your skin.  Continue rubbing till the cubes dissolve onto your skin into a scrub/mask. Splash your face with water to reveal the magic!

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

4 Magical  Effects Orange Peel Has On Your Skin

The prostate gland in a man begins to grow in size on reaching 25 years of age quite naturally, and this is known as benign prostatic hyperplasia abbreviated as BPH. Now the problem arises when the enlargement of the prostate is more than normal.

In men, the urine flows through the urethra from the bladder. An abnormally enlarged prostate blocks the flow of urine through the urethra. The cells of the prostate slowly multiply to cause it to enlarge. This puts pressure on the urethra thereby giving rise to a number of problems, most of which manifest as symptoms.

Common Symptoms of an Enlarged Prostate Gland
The condition of enlarged prostate gives rise to some noticeable symptoms which provide the signs that you need to visit a doctor to get it treated. A weak or slow urinary system is one of the most common symptoms of being affected with an enlarged prostate. This includes urinating more often, an increase in the urgency to urinate, difficulty in starting urination and a feeling of incomplete bladder emptying immediately after urinating. At times, it is seen that passing urine becomes very strenuous. All these above symptoms indicate that there is an enlargement of the prostate gland and medical help should be sought immediately to prevent the condition from worsening.

Steps to Manage an Enlarged Prostrate

Effective medication is usually the first step in the management of an enlarged prostate gland. Alpha blockers are the drugs that are most commonly used in this situation. These drugs do not reduce the size of the prostate, but they are great in relieving the symptoms to allow free and painless passage of urine. Another group of drugs known as 5-alpha reductase inhibitors can help in shrinking an enlarged prostate. The drugs work by the reducing the levels of the male hormone called dihydrotestosterone.
In some advanced stages of prostate enlargement, minimally invasive treatments are used for the effective management of the condition. Transurethral Microwave Thermotherapy or TUMT is used to treat mild blockages that reduce the frequency of urination, the urgency, and straining. However, it is not able to correct the bladder emptying issues. Transurethral Radio Frequency Needle Ablation or TUNA helps in the destruction of the prostate tissues resulting in an improvement in the flow of urine.
Prostatic stents are also sometimes used for the management of the condition of an enlarged prostate. In this treatment procedure, a small metal coil is inserted into the urethra for widening it and keeping it open. In most severe case of prostate enlargement, only surgical methods remain as the opted method of treatment. Laser surgeries are performed to destroy the tissues of the prostate for easing of the condition. Ultimately, an open prostate surgery is performed when the transurethral procedure cannot be used. In this surgery, the tissues of the prostate are removed by the surgeon in case of great enlargement.
The condition of an enlarged prostate gland requires medical attention and treatment for the most effective management, and it is best that a medical professional is consulted as soon as any of the symptoms surface.
Enlargement starts usually after 50 years. Surgery 'Transurethral resection of prostate (TURP)' either by monopolar or bipolar electrocautery. Enucleation of prostate by laser is also an option.

Enlarged Prostate - How Can It Be Managed?

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