The prostate is a vital organ that located between the penis and the bladder. The prostate is involved in the release of the prostate fluid that keeps the sperm properly nourished. Prostate cancer, as the term indicates, is characterized by the abnormal and uncontrolled growth of cancerous cells in the prostate. Though the incidences of prostate cancer are low in India, necessary precautions and diagnostic steps should be carried out to prevent the condition from jeopardizing our lives.

Prostate screening includes two tests known as the Digital Rectal Exam (DRE) and Prostate-Specific Antigen test (PSA). PSA combined with DRE helps to identify prostate cancer at a very early stage. If any of the tests show an abnormality, a doctor might prescribe an ultrasound such as MRI Fusion or Prostate Biopsy to confirm the diagnosis.

Immediate treatment may not be necessary
For low-risk prostate cancer, doctors often recommend active surveillance that includes periodic blood tests, rectal exam, and biopsies.
Active surveillance helps a doctor to continuously track the growth of cancer cells and the possibility of their spread to other areas of the body.
Surveillance is fit for those who are already suffering from a serious condition or for those patients who are above the age of 60.
A surgical procedure to remove prostate cancer
Surgery is considered when the cancer has metastasized to surrounding tissue and the lymph nodes. There are two kinds of surgeries that a patient can go through- a Robot-Assisted surgery and a Retropubic surgery.
Radical Prostatectomy might have risks involved. It is, therefore, wise to discuss the pros and cons of the surgery with the doctor well in advance.
Understanding the treatment options

Radiation therapy: Radiation therapy involves the use of high-powered and high-frequency energy beams to kill cancer cells. Radiation therapy is often used to shrink the size of the cancer cells. There could be two types of radiation therapy-Brachytherapy and External beam radiation. Radiation therapy too can have its side effects. Doctors prescribe several medicines during therapy.
Hormone therapy: Hormone therapy helps to stop the production of a male hormone known as testosterone. This treatment option includes medication that completely stops the production of testosterone, the medications may also block the flow of testosterone on the cancer cells, and surgery to remove the testicles. Hormone therapy is used in advanced cancer stages.
Chemotherapy: Chemotherapy is a drug that goes into the body and kills rapidly growing and metastasizing cancer cells. It is administered through IV (intravenous), or orally as pill or both. This treatment option is employed when cancer spreads to a remote body location and does not respond to hormone therapy.
Biological therapy: Biological therapy involves the usage of the body s immune system to fight cancer. A type of biological therapy known as the sipuleucel-t is used to treat patients with advanced cancer stage and recurring cancer as well.

Prostate Cancer - How Biological Therapy Will Help?

Cancer can affect even small glands like the adrenal glands. Adrenal glands are responsible for the production of hormones like cortisol and aldosterone. These glands are located above the kidneys and have two parts; the cortex and the medulla. Adrenal cancer generally affects the cortex of the adrenal glands. This type of cancerous tumour is rare and can be difficult to diagnose.

Most adrenal cancer symptoms are triggered by an excessive production of estrogen and androgen. Symptoms can also be caused by the pressure put on other organs by the tumour. Adrenal cancer symptoms are most easily noticeable in children as this is the stage where the body is changing and developing. Some of these symptoms are:

Facial hair growth
Excessive pubic and underarm hair
An enlarged penis or clitoris
Early onset of puberty in girls
Development of enlarged breasts in boys
Symptoms of adrenal cancer in adults includes:

Excessive weight gain in the abdomen and above the collar bone
High blood pressure
Irregular menstruation
Easy bruising
Depression
Frequent urge to urinate
Muscle cramps
Additionally, men with adrenal cancer that causes excessive estrogen production may notice an enlargement of breast tissue and tenderness in the area. Women suffering from excessive androgen production triggered by adrenal cancer may notice their voice deepening and facial hair growth. In most cases, adrenal cancer symptoms in women do not appear until the tumour presses on other organs. This includes symptoms like pain around the tumor, a feeling of fullness in the abdomen and difficulty eating because of this feeling.

The cause of adrenal cancer has not yet been determined, but conditions such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, familial adenomatous polyposis and multiple endocrine neoplasia can increase a person s risk of suffering from this disease. A thorough physical examination and a detailed medical history is required to diagnose this disease. The doctor will also need a blood test and urine test. Additional tests that may be required include:

Biopsy of the tumor
CT scan
MRI scan
PET scan
Adrenal angiography
Adrenal cancer can be cured if diagnosed in its early stages. There are three types of treatment for adrenal cancer; surgery to remove the adrenal gland, chemotherapy and radiation. However, adrenal cancer can recur and hence it is important to schedule and maintain regular check-ups with your doctor.

Adrenal Cancer - Know Its Symptoms!!

Laproscopic Bariatric Surgery allows Surgeons to perform minimally-invasive treatments to obese patients who have had repeated failure in losing weight through diet change and exercise. Bariatric Surgery is a procedure that does not require any incisions. Patients can return home within 2-3days without much discomfort. In this procedure, inserting operative instruments through multiple holes along with a camera which displays video images on monitor without making a single incision. The camera allows the Surgeons to witness the internal condition and perform the procedure safely. The three most well-known Laproscopic bariatric surgery procedures include gastric bypass, gastric sleeve, and mini-gastric bypass. 

Most common types of Laparoscopic bariatric surgery: 

Gastric sleeve: This is a more drastic mode of surgery and is a new addition to the bariatric endoscopic surgery procedures. Through this procedure, 90 percent of a patient s stomach is removed to facilitate the loss of hunger. This also helps in portion control of food. 
Gastric bypass: This is the most widely used bariatric procedure to cut down fats and control hunger across the globe. The digestive system is re-routed to suppress the hunger of the patient in this procedure. It also contains minimal risk to a healthy individual. 
Mini-Gastric bypass: Similar to Gastric bypass but shorter procedure with approximately equal results in comparison to gastric bypass. 
Other procedures for weight loss are: EndoBarrier therapy and Intra-gastric balloon The procedure is decided by the Surgeons and depending on which types of the procedure will suit you the most. 
Bariatric Surgery allows doctors to perform minimally-invasive treatments to obese patients who have had repeated failure in losing weight through diet change and exercise. Bariatric Surgery is a procedure that does not require any incisions. Patients can return home within the few day without much discomfort. A keyhole procedure involves inserting camera and instructions within abdominal cavity and operations performed by viewing over the monitor. The camera allows the doctor to witness the internal condition and perform the procedure safely. 

Benefits of Laparoscopic Bariatric Surgery: 

Being a minimally-invasive procedure, laparoscopic bariatric surgery has its own advantages. Since minimal incisions are made, the risk of operative complications is easily mitigated. Bariatric surgery is also a long-term solution.

Most Common Types Of Laparoscopic Bariatric Surgery!

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!

Hernia surgery is performed for the correction of a hernia which refers to the bulging of internal organs or tissues through an abnormal opening. It is easy to detect hernia through any pain or discomfort while lifting heavy objects, cough and strain during urination or bowel movements or during prolonged standing or sitting. It can be found in both men and women. The Hernia can be congenital or can be developed over a period of time. If it doesn t get better over time and also does not go away by itself, then surgery becomes the only option.

Types of Surgery
There are two types of surgery for hernia treatment. One is the conventional open method, which requires an incision in the skin directly over the hernia. The other one is the Laparoscopic hernia repair in which surgery is performed using a small telescope known as a laparoscope. In this type of surgery minimal invasions are made and the hernia is repaired with only small incisions adjacent to the hernia. Most hernia operations are performed on an outpatient basis, which means that you can go home the very same day.

Tips for early recovery

    Wear comfortable clothing with expandable waistbands.
    Keep yourself active by moving around as much as you can as it increases circulation, which further speeds up healing.
    Eat a diet rich in fibre, fresh fruits and vegetables.
    Drink lots of water and other fluids to avoid constipation.
    Do not lift any objects even if it is very light as it can bring back pain.
    Do not to pick up things from the floor as it will be difficult to bend.
    Hold a pillow against your stomach while sneezing or coughing to lessen the pain.
    Use stool softener for a few days before and after surgery to help you with your bowel movements.
    Avoid driving till the time you feel any pain and as long as you are taking narcotic pain medicines.
    Band-Aids which cover the incisions should be changed as and when needed.
    Refrain yourself from intercourse as it can be painful.
    Check with your doctor when to take a shower so as not to hurt your incisions, and make sure to gently dry your incisions and replace the Band-Aids after taking a shower.
    Do not consume any alcoholic drinks for at least 24 hours.

The tips mentioned above will definitely provide help to cope up with post surgery blues. However, in case of fever, excessive sweating, difficulty in urinating, bleeding or any prolonged pain consult your doctor immediately.

Hernia Surgery - 13 Tips to Help You Recover from it

Is there a relation between weight loss surgery and type 2 diabetes? Yes, there is and a very promising one. Many diabetics may not know this but a key hole procedure called metabolic/ bariatric surgery can help resolve type 2 diabetes.

It s scientifically proven that these surgeries can normalize blood sugar levels and control diabetes in most patients. This means that you may not need any medicines post such a surgery. One long-term study which tracked 400 people with type 2 diabetes showed that six years after bariatric surgery, 62% diabetics showed normal blood sugar levels. Apart from this, they also showed better blood pressure, cholesterol and blood triglyceride levels that can cause heart disease.

Should you get a metabolic/bariatric surgery done? You are a fit candidate for bariatric surgery if your:

BMI is 27.5 or higher
And if are finding it difficult to maintain blood sugar with medicines & lifestyle changes.
Your doctor will give you a physical exam to check whether you are fit for a major surgery and if you are emotionally ready to commit to necessary lifestyle changes like eating healthy and exercising regularly.

Types of weight loss/diabetes surgery:

The most popular type of weight loss surgery is one in which the size of your stomach is reduced so that you feel full even after small meals. Other types of bariatric surgeries change the way your body absorbs calories and nutrients and vitamins. A few other types of bariatric surgeries do both.

Gastric Bypass: In this surgery, your surgeon makes a small stomach pouch by dividing the top of the stomach from the rest. This small pouch is connected to intestine so other part of stomach is bypassed. So, when you eat, food goes into this small pouch, which makes you feel full faster and also makes it possible for your body to absorb fewer calories. This is a very promising type of bariatric surgery for diabetics as up to 80% of people have normal blood sugar after it. And they also lose 60% to 80% of their extra weight on an average.
Gastric Sleeve: In this surgery, your surgeon will remove a major part of your stomach. When your stomach is small, you will feel full faster. It also reduces hunger pangs. This type of surgery is also very effective in reducing diabetes and losing weight.
Adjustable Gastric Band: In this surgery, your surgeon puts an inflatable band around the top of your stomach. This forms a small pouch which makes you feel full faster. The good point is that your stomach is not cut and your intestines are not shifted. There are thus lesser complications. It also helps in controlling diabetes. The con is that you lose less weight in this type of surgery.
Biliopancreatic Diversion: This is an uncommon surgery but most effective for diabetics. In this the doctor removes a large part of your stomach and also changes the way the food goes to your intestines. This helps in losing weight but also affects digestion long term.
As with any major operation, all bariatric surgeries come with potential risks of bleeding, infection, and leaks in the digestive system. It is necessary to change lifestyle to avoid weight regain.

Is There A Relation Between Weight Loss Surgery & Type 2 Diabetes?

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