GERD is a digestive disorder that affects the lower esophageal sphincter, which is the ring of muscle between the esophagus and stomach. Gastroesophageal reflux is the backward flow of acids from the stomach into the esophagus. Doctors believe that some people usually suffer due to a condition called hiatal hernia. Pregnant women usually suffer from heartburn or acid indigestion caused by Gastroesophageal Reflux Disease.

The primary goals in the treatment of this disease are relief from symptoms, healing of erosive esophagitis and prevention of complications of esophagitis. The symptoms include heartburn and regurgitation. The setting includes a proton pump inhibitor (PPI). Patients suspected due to GERD with non-cardiac chest pain are recommended to have diagnostic evaluation before institution of therapy. For diagnosing GERD, barium radiographs should not be used.

The other points that must be remembered to diagnose GERD are
1. Endoscopy is recommended only in case of alarming symptoms. Even in typical symptoms, the upper endoscopy is not recommended.
2. For preoperative evaluation, esophageal manometry is recommended, but it has no role in diagnosing GERD.
3. Ambulatory reflux monitoring is a test that can assess association of reflux symptoms.

Management:
The suggested lifestyle modifications for the patients with GERD are

    Weight loss is recommended for patients who are overweight. So, avoid large meals and decrease dietary fat intake.
    Avoid alcohol, chocolate, onions, garlic, acidic foods and peppermint.
    Do not lie down within 3 to 4 hours after meal (recommended for nocturnal GERD patients).
    For symptom relief and to heal erosive esophagitis, a 8-week course of PPIs is the therapy of choice.
    Medications that help in potentiating GERD symptoms, including alpha-adrenergic agonists, nitrates, calcium channel blockers and theophylline should be avoided.
    For patients without diagnostic evaluation, therapy for GERD other than acid suppression, including prokinetic therapy should not be used.
    For patients with partial response to PPI therapy, additional symptom relief can be achieved by increasing the dose twice daily or switching to a different PPI.
    It is recommended to elevate the head of the bed 10 to 20 cm.
    Avoid wearing clothes which are tight around the waist.
    If patients experience heartburn relief, Histamine-receptor antagonists (H2RA) therapy can be used as a maintenance option in patients without erosive disease.

Some surgical options
1. For long-term therapy for patients suffering with GERD, surgical therapy is the best treatment option.
2. In patients who have no evidence of erosive esophagitis, preoperative ambulatory pH monitoring in mandatory.
3. Gastric bypass is the preferred operation for patients who are suffering with obesity and are contemplating surgical therapy for GERD.

Apart from these, there are potential risks that are associated with PPIs such as switching them can be considered in setting of side effects and the therapy can be a risk factor for Clostridium difficile infection.

Management of Gastroesphageal Reflux Disease (GERD)

Top 10 Everyday Skin Care Hacks

You skin needs just a little care daily. There are some very simple ways in which we can provide that much needed affection and get back radiance and softness. And all this without any extra effort!

Try these everyday regimes for the glow.

1. Adopt Hydration - The first thing your skin needs to stay beautiful is adequate 'hydration,' or what they call in plain terms as plenty of water. So bottoms up to at least two liters of water daily.

2. Avoid Dehydration  - While you are busy hydrating your skin, remember to be careful and not dehydrate by staying out under the harsh sun for longer than 10-15 mins at a stretch. Ditch the caffeine habit (Soda, coffee, tea) as it dehydrates your body on the cellular level, inviting the onset of those dreaded wrinkles early than anticipated. 

3. Apply Lesser Layers - Your skin is your body's largest organ and it needs to breathe. So try and not swathe it under layers of heavy makeup and pore clogging chemical body butters on a regular basis.

4. Give It Fresh Air - To get your skin breathing truly fresh, put on your exercise gear and head outdoors to spend some quality time with Mother Nature at the nearest park or maybe you can take that long pending weekend trip out of the city!

5. Don’t Stress - Do not be stressed all the time unnecessarily. Learning how to manage stress effectively can take away years from your skin. 

6. Exercise - Run. Jump. Dance. Get moving, in short. The more your skin sweats, the better will it look and the elasticity would improve dramatically too. 

7. Get Nutrition - Get in the habit of starting the day with plenty of fruits and a healthy breakfast with the right amount of protein, carbs and essential fats. Fats are required by your skin to lubricate and moisturize from the inside. But make sure you stick to good fats found in olive oil, eggs, yogurt (the ones without any additives or artificial sugars), and whole grain breads etc.

8. Go Smoke-free - Just stop smoking and you would see a dramatic improvement in your skin tone within a few weeks (yes, it takes time to reverse that kind of damage) 

9. Wear Sunscreen - Slather on the sunscreen before you leave the house but make sure it's SPF index must be 30 and above for it to be effective under the harsh Indian sun.

10. Exfoliate & Detox - Scrub-rub-a dub every week. NOT every day though.. Make sure you use organic scrubs made with rice granules or sugar grains instead. Use a natural face mask such as Banana mash or a Tomato-Cucumber-Honey paste every alternate day to detoxify, cleanse and moisturize your face and body. 

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

From Lybrate: If you found this tip useful, please thank the doctor by clicking on the heart icon below. Also, spread good health by sharing this tip with your loved ones over WhatsApp, Facebook and other media.


10 Only Skin Care Hacks You Will Ever Need

It is an extremely embarrassing situation to have a bladder leakage. Social life could be altered, with reduced socialising for fear of losing control in the presence of others. Though not discussed frankly, it is an extremely common issue and about 25 million people in the United States suffer from this, with 75% of these being women.

Treatment depends on the type of incontinence, such as stress, urge, overflow, functional, or mixed. It starts with least invasive methods like lifestyle changes moving over to surgical approaches.

Ways to manage it

With trips to the toilet increasing considerably when you have urinary incontinence, simple measures can help manage leakage.

Bladder training: Train your bladder to control the urge for another 10 minutes. This happens by voluntarily contracting the muscles and holding up the urge to go to the toilet. Gradually, it will help increase the frequency of the visit to 4 to 6 hours.
Scheduled toilet trips: Whether or not there is an urge, visit the toilet every 4 to 6 hours.
Double emptying: Even after you have voided, force yourself to void one more time. The residual urine, which is almost always present in the bladder, also gets emptied.
Food/diet modifications: Stress incontinence is worsened by alcohol, spicy foods, acidic foods, and caffeine. Avoiding these can help reduce bladder leakage.
Kegel exercises: The simple repetition of contracting the pelvic floor muscles, holding it in place, and releasing it can do wonders for strengthening the pelvic floor. This can be done anywhere and any time of the day and is very effective for improving bladder control.
Catheters: These can be used if the incontinence is short-lived; the person would need to learn how to safely insert and remove it.
Absorbent pads and medical devices: The absorbent pads are helpful in preventing embarrassment during social situations. On the other hand, medical devices like pessary are inserted into the vagina to support the bladder neck and thereby prevent leakage from the bladder.
Drugs: Anticholinergics/antimuscarinics are useful to control a leaking bladder. Botox injections can help paralyse the overactive bladder muscles and provide a solution. Topical oestrogen may be used in small amounts to improve tone and reduce incontinence. Alpha blockers are also used in some people with good results. There are muscles that relax the bladder and increase the amount of urine it can contain.
Surgery: In the event that all these measures are not useful, surgical correction is possible. Sling procedure where an artificial mesh is used to support the urethra. Bladder neck suspension is where the bladder neck is given support to prevent leakage. If there is a pelvic organ prolapse, that is corrected to rectify the bladder leakage.

 Bladder Leakage - Solutions To Help You Manage It!

Hernia is a small protrusion or escape of any structure or organ through nearby weak spot or muscle. There are several types of hernia like inguinal hernia (direct and indirect), femoral hernia, umbilical hernia, umbilical hernia, epigastria hernia and incision hernia. This hernia can be removed and relocated to its original position and secured with special type of hernia mesh to prevent the recurrence of hernia.

When hernia surgery is required?
Hernia is not a serious health issue that requires surgery immediately. But surgery is essential only during the following situation-

Size of hernia is more than half an inch.
Hernia causes severe pain and causes much physical discomfort.
Hernia causes disfigurement.
Types:
There are two different methods used for hernia surgery:

Open hernia repair: Open surgical incision is made near the herniated site and the surgical procedure is done and secured with a mesh work. This surgical procedure requires several preparatory measures to be done before surgery. There is also blood loss and recovery period after surgery is also more than other type of surgeries.
Minimally invasive hernia repair: The surgery is done with a laparoscope which has small tiny camera, small synthetic hernia mesh and small tool with it. So the patient can return back to their normal routine earlier as the incision made is smaller.
Before undergoing hernia surgery:

One week before surgery it is much essential to stop taking drugs that are causes the thinning of the blood. Drugs like aspirin 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 the post surgical care
After hernia surgery:

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

Hernia Surgery - What You Need To Know About It?

Breast examination is a way of detecting early changes that help in detecting lumps or other growth in the breast. This is a manual form of examination that may be carried out by the doctor or even by the patient. This kind of examination helps in detecting the onset of breast cancer and helps in successful treatment of the same. It is an essential screening strategy that all women must go through. Let us cast a glance on the various details regarding this examination, and also how frequently it must be conducted.

Age: Women who have reached the age of 18 are said to have matured physically and sexually. They should perform this examination once they have reached the said age in order to detect any anomalies in the way the physical changes occur in the breast tissue.
Procedure: One should begin by looking at one's reflection in the mirror to find any rashes or dimpling in the breasts. The shape, size and colour of the breasts and nipples must also be studied so as to check for any anomalies. Inverted nipples, redness and soreness must also be reported to the doctor. Once you are done checking the visuals, you can raise your arms and look for any changes. Then, you will need to lie down and feel your breasts by using a circular motion. The finger pads must be used in order to check for any lumps. One must start from the centre and move the breasts sideways. Any wet and slippery feeling must be reported to the doctor immediately.
Pressure: During the breast examination, you must use light pressure for the skin and tissue that lie beneath the breasts, while medium to moderate pressure should be used for the middle portion of the breasts. One must use a firm hand to check the tissue that lies at the back of the breasts, near the rib cage.
Frequency: One must get into the habit of conducting a breast examination at least once a fortnight or once a month, without fail. You can also go to the gynaecologist for an examination in case you are not confident of conducting it on your own with proper movements and accuracy. You may also journalise your breast examination findings.
Menstrual Cycles: When you are going through your menstrual cycle or period, it is important to remember that your breasts can become tender just before or after the start of the cycle. So, do not panic if you think you have found a lump or any other growth at this time. It is best to check again after a week and then visit the doctor about checking the same.

How Frequently Should a Breast Examination Be Done?

Cholecystectomy is an operation performed to remove the gallbladder. The gallbladder is a kind of a small sac found just below the liver, on the right hand side of the abdomen. The gallbladder stores a liquid known as bile. Bile is made in the liver and it gets released into the intestine along with the meals. The importance of bile lies in the fact that it helps to digest the fat in foods.
As gallbladder is not really an essential organ, so a child would do well after cholecystectomy. Once the gallbladder gets removed through this pediatric surgery, bile will continue to get released from the liver right into the intestine along with meals.

What is the necessity behind cholecystectomy?
The necessity for performing this surgery of Cholecystectomy can be outlined as follows:

The main reason behind the surgery is gallstones and pain.
Gallstones are small rocks, which form inside the gallbladder
These stones prevent the release of bile out from the gallbladder.
This blockage results in pain as well as jaundice
If a child comes across these problems, he or she would be recommended by his or her primary doctor to visit a paediatrician.
A paediatrician can get rid of the gallstones by removing the gallbladder through performing the surgery if Cholecystectomy.
How is the surgery performed?
The surgery is performed in the following manner:

A Cholecystectomy is performed on most of the occasions by way of laparoscopy.
A small telescope and tiny instruments are placed through very small incisions made on the abdomen.
The surgery normally gets completed within two hours.
When a child gets hospitalized, he or she receives intravenous fluids, antibiotics as well as pain medication.
As and when a child feels well, he/she would be allowed to eat, drink and also take pain relievers through mouth.
Cholecystectomy surgery involves very less loss of blood. Only in a rare case, when there is an emergency, a child needs to receive blood.
Children are released from hospital, one or two days after the surgery as and when they are able to eat, drink and be comfortable about themselves.
Homecare needed after the surgery
There are certain guidelines which parents must follow when their children get back home after the surgery. They include:

Pain management: The pain medication prescribed by the paediatrician is not required at a routine basis after discharge from the hospital. Most of the children only require Acetaminophen (Tylenol) or Ibuprophen once they are at home.
Healing ridge: Once the small incisions get healed, children would be able to feel a firm ridge just below it. It would last for few months, slowly get softened and then disappear.

Cholecystectomy - Know More About It!

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