If you are experiencing pain in the muscles and joints, an enhanced craving for salt, symptoms of low glucose in the blood or low blood pressure, you could be suffering from adrenal insufficiency (AI). The outer layer or cortex of our adrenal gland produces three forms of steroid hormones. In adrenal insufficiency, the cortex fails to produce enough steroid hormones. Some people do not know that they have been affected with adrenal insufficiency until they experience a sudden worsening of symptoms. This is called an adrenal crisis.

Causes
The different types of adrenal insufficiencies occur because of different reasons. Primary AI is commonly caused by autoimmune diseases in which our body s defence system destroys the body s tissues. Bleeding in glands, genetic diseases and infections are other likely causes.

Secondary AI occurs because of problems with the pituitary gland. The pituitary gland produces a hormone named adrenocorticotrophic hormone (ACTH) because of which the adrenal glands produce cortisol. In the case of secondary AI, the pituitary glands stop sending ACTH to the adrenal glands, and cortisol is hence not produced. This may occur by taking certain prescribed medicines.

Diagnosis
A patients s medical symptoms and medical history are observed. The blood levels of cortisol, sodium, potassium and glucose are checked for the detection of AI. The adrenal glands and the pituitary gland are observed by imaging tests. X-rays, ultrasound, and CT and MRI scans may be required.

Treatment
The treatment of adrenal insufficiency aims at ensuring proper levels of hormones in the body. You may require regular replacement of hormones for life. You have to take glucocorticoids for replacing the cortisol which your body does not provide anymore. Mineralocorticoids should be taken when the body does not produce aldosterone. Extra glucocorticoids may be required during times of intense stress such as a surgery or serious health conditions.

Glucocorticoid helps the body in coping with stress, injury and illness. It helps in the regulation of blood glucose levels and blood pressure levels. It performs the function of cortisol.
Mineralocorticoid helps in maintaining a proper balance of water and salt in our body. This is actually carried out by aldosterone.
Adrenal androgens, which are weak male sex hormones, present in both men and women, help in the regulation of pubic and armpit hair growth in women.
If you experience any symptoms of adrenal insufficiency, it is recommended that you visit a doctor immediately. Early diagnosis will enable early treatment, which is beneficial for you.

Adrenal Insufficiency (AI) - Ways It Can Be Treated!

This surgery involves the removal of Gallbladder, which is a pear-shaped organ that lies right beneath the right side of the liver. The main function of the gallbladder is to collect and concentrate bile, which is a digestive juice produced by liver after eating, aiding digestion. The most common disorder of the digestive system is presence of Gallstones, which are the stones made up of a mixture consisting of cholesterol, bile pigment and calcium salts.

These Gallstones don t cause any problems in most cases. But prompt treatment is required if stones block ducts and cause infections and inflammation in the pancreas. This may lead to removal of the gallbladder through a surgery, known as cholecystectomy, which further includes techniques such as laparoscopic (keyhole) cholecystectomy or open surgery.
Although it is a less vital organ, the body can cope up even after removal.

Procedure of surgery:

    The surgery involves removal of gallbladder and gallstones through several incisions in the abdomen. In order to see clearly, the surgeon inflates the abdomen with air or carbon dioxide.
    A lighted scope attached to a video camera is inserted into one incision near the belly button. The video monitor is used as a guide for inserting other surgical instruments into the other incisions to remove the gallbladder.
    Intraoperative cholangiography is the X-ray procedure which shows the anatomy of bile ducts. This is done before the surgeon removes the gallbladder.
    Bile flows from the liver through the common bile duct after the surgery into the small intestine. As the gallbladder has been removed, the gallbladder can no longer store bile between meals but has no effect or little effect on digestion.
    In case of open surgery, the surgeon reaches the gallbladder through a large, single incision in the abdominal wall.

Complications after gallbladder surgery:
This surgery carries some degree of risk like any other surgery. Complications such as internal bleeding, infection, injury to nearby digestive organs, injury to the bile duct and injury to blood vessels.

Types of gallstones:
There are three main types of gallstones. They are
1. Mixed stones: They are made up of cholesterol and salts. They tend to develop in batches.
2. Cholesterol stones: Mainly made of cholesterol, which is crucial to many metabolic processes. They can grow large enough to block the bile ducts.
3. Pigment stones: The colour of bile is greenish-brown, due to some particular pigments.

Medical factors to consider before cholecystectomy:
The most important factor is a consideration of your medical history. This is because the pre-existing conditions influence decisions on surgery and anaesthetic and information about any bad reactions or side effects from any medications would be helpful for surgery.

Self-care after the surgery:
Taking rest is the most important thing after surgery. Avoid things such as heavy lifting and physical exertion. The usual recovery period after the surgery is one week. 

Gallstone Surgery - Things You Should Know About It 

Colorectal cancer is otherwise known as cancer of the colon or the rectum. This can affect both men and women with age being a major risk factor. Majority of such cancers are seen to occur after age of 50 years.

Type: colorectal cancers can present as one of the following types: 

Adenocarcinomas are the most common type of colorectal cancers. These cancers begin in the cells making mucous and other fluids. Certain colorectal cancers begin as adenomatous polyps (adenomas) that turn cancerous over a period of time. This is precisely why the adenomas are regarded as pre-cancerous or pre-malignant.

Gastrointestinal (GI) carcinoid tumors, GI stromal tumors, primary colorectal lymphoma, leiomyosarcoma, melanoma & squamous cell carcinoma are certain other colorectal cancers

Carcinoid tumors: start in specialized cells that produce hormones, in the intestine.

GI Stromal tumors: start in the interstitial cells of Cajal (ICC), in the wall of the colon.

Lymphomas: start typically in the lymph nodes but they may also start in colon or rectum.

Sarcomas: can start in the muscle and the connective tissue in the walls of the colon and rectum.

Gender: it affects both male and female populace.

Etiology: mostly, the factors that are associated with increased risk of colorectal cancer include the following  

Age exceeding 50 years.

Racial & ethnic background such as African Americans, in the USA, are known to have the highest incidence of colorectal cancer, and mortality rates.

Low fibre and high fat diet. Excessive consumption of red meat (e.g. goat meat, beef, pork, lamb, or liver), processed meats, butter, refined grains, sweets, sugary drinks etc all can increase the risk of colorectal cancer.

Personal history of inflammatory bowel disease (IBD) (e.g. ulcerative colitis), Crohn s disease, adenomatous colorectal polyps, colorectal cancer etc all.

Family history of colorectal cancer or adenomatous polyps etc all.

Inherited syndromes such as familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC).

Sedentary lifestyle/ associated Obesity.

Type 2 diabetes.

Tobacco and alcohol abuse.

Features or symptoms can vary from person to person depending on the size and location of the tumour. Following are the signs & symptoms mainly -

Changes in bowel habits, diarrhea or constipation or an alternating diarrhea and constipation.

Occult/ blood in the stool, and 

Problems related to blood loss (e.g. anemia, weakness, fatigue, intolerance to exercise, shortness of breath, increased heart rate, chest pain etc all),

Abdominal discomfort (frequent gas/ flatulence, bloating, fullness, cramps, and pain), vomiting etc.

Unexplained weight loss,

Pain with bowel movement,

Feeling that bowel does not empty completely,

Stools are narrower than usual.

Diagnosis: Following are the diagnostics employed. Abnormal blood test results may be indicative of malignancy, but a follow-up imaging/ biopsy is always the gold standard for accurate diagnosis.
Blood: fecal occult blood test, Carcinoembryonic Antigen (CEA) assay values are raised, Hb/ RBC counts may be low.
Imaging: Colonoscopy, Endorectal Scan/ CT Scan followed by Biopsy clinches the diagnosis and the nature of the disease.
Apart from the above-mentioned barium enema X-Ray, USG, Chest X-ray, PET CT scan etc all help detect metastasis, if any. An increase in level of the serum tumor marker  CEA  is indicative of metastatic spread/ proliferation that can be ascertained through a PET CT scan.
Treatment: Conventional treatment includes surgery, radiation and chemotherapy as contextually appropriate. Simultaneously, an adjunctive/ integrative naturopathic treatment with suitable complementary & alternative medicines (CAM)/ therapies too can help improve clinical outcomes and facilitate recovery as feasible contextually.
Prognosis: preventive measures, earlier diagnosis and right early treatment is key for better prognosis and efficient/ effective therapeutic management. Usually, the chances of cure for an early stage cancer are more. Above-mentioned apart, recovery chances are influenced by the grade, stage of cancer, recurrence and the patient s general health & vitality etc all too.

Prevention: rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an adherence to a Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising (for at least 30 minutes daily), de-stressing and relaxation is highly recommended for prevention or reducing the risks of colorectal cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. It is advisable to limit milk/ dairy, preferably of low fat content, to 1 to 2 servings max daily. Although alcohol is optional and is not for everyone, the consumption of the same, if any, has to be strictly in moderation, and is best avoided. Smoking is to be avoided as well. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly or are best avoided too. Apart from the generic preventive measures as mentioned above, certain pre-malignant conditions, of which adenomas are the most common, can be successfully treated with complementary and alternative medicines too.

Colorectal Cancer - In a Nutshell!

The gall bladder is a very small organ located behind the liver. This organ stores the bile created by the liver and releases it whenever needed. We rarely pay attention to this organ until there is a problem and most gallbladder related problems are very painful. Unknowingly you may be harming your gall bladder by eating certain types of food like red meats and saturated fats. On the other hand, eating some types of food can improve your gall bladder health. Some such foods are:

Fiber-rich foods: Fruits and vegetables are rich sources of fiber and a must in a balanced diet. Fiber helps keep the gall bladder healthy and also helps prevent gallstones from developing. An easy way to add more fibre to your diet is to incorporate a salad with your lunch and dinner.
Water: Water not only helps hydrate the body but also helps maintain the water levels required in bile. Ideally, a person should drink 8 glasses of water a day. This should not all be drunk at one time but should be spaced out through the day. Drinking too much water at one time will result in the body expelling it in the form of urine instead of absorbing it.
Foods rich in Pectin: Pectin is a dietary fiber that binds cholesterol in the stomach and helps in its removal from the body. Since cholesterol is one of the major causes for gall stones, eating pectin-rich foods helps reduce the risk of gallstones. Some foods that are rich in pectin include citrus fruits, strawberries and apples.
Flaxseeds: Eating just one tablespoon of flax seeds a day can boost your health in a number of ways. One of the many benefits of including flaxseeds in your diet is a healthy gall bladder. Flax seeds contain mucilaginous fiber or fiber that forms a gel. This type of fiber aids in the liver s synthesis of bile acids and thus keeps the gall bladder healthy.
Omega 3 Fatty Acids: Not all fats are bad for the body. Omega three fatty acids play an important role in producing anti-inflammatory compounds. Some rich sources of omega 3 fatty acids include olive oil, avocados and flax seeds.
Citrus fruits: Citrus fruits are very rich in vitamins like vitamin C. a deficiency of this particular vitamin can cause gall stones. For this reason, eat plenty of citrus fruits and other fruits and vegetables such as bell peppers and broccoli that are rich in vitamin C. 

Gallbladder Health - Foods that Can Help maintain it!

When blood clot blocks one or more arteries in your lungs the condition is known as pulmonary embolism. It can cause a decrease in the oxygen levels in your blood, damage to your lungs due to sudden restrictions in the flow of blood along with adverse effects on other parts of your body. Life threatening blockage can cause death if left untreated and you should immediately contact your health care provider to get proper diagnosis. Pulmonary embolism requires various lab tests and generally requires short time to resolve.

Symptoms:
The symptoms of pulmonary embolism mainly depend upon many factors pertaining to your previous medical history. Pulmonary embolism varies with the size of your lungs, the size of the clots formed in your blood, and any other underlying history of the heart or lungs. That said, pulmonary embolism has symptoms which are not similar to any two persons and will vary accordingly.

The common symptoms however may include the following and you are advised to opt for a health checkup if these are persistent in your body:
1. Cough along with bloody sputum is a common symptom.
2. Shortness of breath, which will become worse as the days passes by. They will appear suddenly and cause huge discomfort in breathing.
3. Chest pain which may give you the feeling of a heart attack. The pain will intensify when you sit to eat or cough. Deep breath will cause problems too and will not go away easily with exertion.
4. Some other symptoms include fever, excess sweat, irregular heartbeat and dizziness.

Pulmonary embolism can be diagnosed by the following methods:
1. Electrocardiography (also known popularly as ECG) to measure your heart's electrical activity and functioning.
2. CT plumonary angiography is gold standard for diagnosing pulmonary embolism.
3. Chest x ray, which is a common and non invasive test to check your heart and lungs as well as the problems with any bones surrounding them.
4. ECHO can detect secondary changes in heart due to pulmonary embolism.

Treatment of pulmonary embolism can be done with medicines if it is detected at an early stage or also if the clot is small. However, if the size of your clot is problematic and blocks the blood flow to your lungs or heart then surgery may be necessary. Open surgery and clot removal surgery are common in the treatment of pulmonary embolism and will require good regular follow up check ups. Regular leg exercises will also reduce the chances of any underlying disease and you should hence consult your doctor.

What Is Pulmonary Embolism?

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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