Ulcerative Colitis is a chronic inflammatory disease that affects the lining of the intestine and the rectum. It is located just above the anus. Patients suffering from ulcerative colitis tend to have small ulcers in their rectum and the colon. These eventually flare up leading to diarrhea, bloody stools, anemia and abdominal pain. The inflammation starts from the rectum and eventually, spreads to the colon. Ulcerative Colitis tends to flare up and remit in an alternate phase. The remission can last from few weeks to few years.

Methods adopted to diagnose Ulcerative Colitis-
Ulcerative Colitis is very similar to an inflammatory bowel disease known as Crohn s disease. The only differentiating factor is the fact that, ulcerative colitis affects the colon whereas, Crohn s disease affects the digestive system and the small intestine. A doctor might prescribe certain tests such as the colonoscopy, blood tests, CT scan, pill camera, stool sample tests etc.

Why is surgery necessary to treat Ulcerative Colitis?
An estimated 40 percent of all Ulcerative Colitis patients need to undergo surgery to recover completely. The reason surgery becomes necessary to treat ulcerative colitis are the following:

Drug therapy and medication become ineffective.
Without undergoing surgery, the condition might increase the risk of developing cancer.
The colon has the risk of getting ruptured if surgery is not performed on time.
There could be excessive bleeding.
Toxic megacolon might set in.
Types of surgery available to treat Ulcerative Colitis
A procedure where the entire colon is removed is known as the colectomy. In case both the colons are removed, the procedure is termed as proctocolectomy. In this procedure, an external pouch needed to be attached to the stoma that collects the stools. There is another method known as pouch surgery. 

Pelvic pouch or ileal pouch is also termed as IPAA. This procedure doesn t involve permanent stoma. In this procedure, both the colon and the rectum are eradicated from the body. The small intestine is then used to form a J-shaped pouch, that serves as the new rectum. The pouch is then connected to the anus. The whole procedure is done via two surgeries.

What are the surgical complications of this procedure?

There could be an excessive bowel movement.
There are instances where an inflammation of the pouch is observed. This condition is known as pouchitis.
There could be a situation of intestinal blockage from adhesion due to surgery.
There could be pouch failure that can happen inside within 5 few years. This is observed in 4 out of 100 patients who are treated. In this case, the patient should go for a permanent ileectomy.

Ulcerative Colitis - What You Need To Know?

The heart is a muscular organ that pumps blood to the entire body through a network of arteries and veins. This network contains big vessels which branch out further to supply blood to the distant organs. There is, therefore, some pressure that the heart and thereby the vessels need to exert to push the blood through these vessels. This is known as blood pressure, and normal pressure levels range from 90-140(systolic)/60-90(diastolic) mm of Hg. However, due to various reasons, this pressure could be more, which is one of the first signs of heart disease. 

Causes of increased blood pressure: 

Thickening of the blood vessels. With age, the elastic blood vessels naturally turn rigid and less elastic, so there is more pressure required to push blood. It is natural for people over 55 years of age to have higher readings of blood pressure. This is known as primary hypertension (HTN) 
Narrowed blood vessels. This happens due to cholesterol accumulation along the walls of the blood vessels. Faulty dietary habits along with sedentary lifestyle have increased the incidence of hypertension due to this condition, known as atherosclerosis. Critical atherosclerotic narrowing of renal arteries lead to renovascular HTN that is one of the commonest of secondary HTN. 
Other Causes of secondary hypertension are: 

Kidney problems 
Thyroid hormone disorders 
Congenital heart defects 
Chronic alcohol abuse 
Adrenal gland tumours 
Chronic use of medications like birth control pills, pain killers, etc. 
Unidentified and uncontrolled hypertension can be silent and can lead to more severe conditions like heart attack and stroke. India is fast becoming the new hypertension capital of the world. Some of the common risk factors are: 

Age 
Family history 
Being obese or overweight 
Sedentary lifestyle 
Smoking 
Alcohol consumption 
Excessive salt intake 
Stress levels 
Ethnic background 
Symptoms: 

Hypertension can go undetected for years together, but if there are risk factors like diabetes and high cholesterol, it is advisable to periodically monitor blood pressure. 
Headaches, nosebleeds, and shortness of breath should not be ignored. These can be the first warning signs of hypertension, and if detected early, preventive measures can be taken. 
If there are co-morbid risk factors, it is advisable to constantly keep a check on BP readings. 
Management: 

This includes a combination of diet and lifestyle modifications. 

Quit smoking and alcohol: Of the many wonders quitting smoking can do, reducing BP readings is just one. The improvement would be almost instantaneous. Quit or else reduce alcohol and see dramatic improvements. 
Weight management: Through a combination of diet and exercise, ensure that weight is brought under control. Set a target BMI (Below 26 kg/m2) and work towards it religiously. 
Diet: Reduce salt, increase potassium, increase vitamin D, eat a heart-healthy diet, and see the hypertension readings improve. Please find attached and reviewed copy for health tip for posting

High Blood Pressure - All You Need To Know About It!

Knee replacement can be extremely painful. Previously, opioids or narcotics were administered for pain relief. But excessive addition of opioids is not exactly effective for controlling pain. 

Multimodal pain management has become an important part of the perioperative care of patients undergoing total joint replacement. The principle of multimodal therapy is to use interventions that target several different steps of the pain pathway, allowing more effective pain control with fewer side effects. Many different protocols have shown clinical benefit. The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients.

Multimodal denotes administering two or more than two types of medications that work with different mechanisms. The following are the techniques used:

Pre-operative Femoral Nerve Block: Prior to the surgery, a catheter is placed beside the femoral nerve for blocking it. This nerve is located in the upper thigh. Medication is delivered through the catheter for the nerve to be numbed for 24 hours. Thus, pain signals to the brain are blocked. This method reduces the use of narcotics and the consequent side effects.

Patient Controlled Analgesia (PCA): This method is also known as  Pain Pump . An intravenous pump is used to administer pain relief medications, such as oxymorphone or morphine, after the surgery. The control button of the machine could be pressed, by the patient for 6 to 10 times per hour. The machine is used for two post-operative days.

Oral Medications: The oral medications include Non-Steroidal Anti-Inflammatory drugs or NSAID; such as Celebrex which is similar to aspirin, structurally. Alternatively, acetaminophen, such as Tylenol or its equivalent composition, can also be used.

Acetaminophen: It acts on the Central Prostaglandin Synthesis and relieves the patient of pain through multiple mechanisms.

Epidural Analgesia: It produces lower pain scores and involves less time for achieving physical therapy goals. However, this is subject to side effects such as dizziness, urinary retention and itchiness.

Gabapentinoids: These medications include membrane stabilizers such as Gabapentin and Pregabalin.

The objective of multimodal treatments is to provide quick relief to the patient and immediately so. Earlier the rehabilitation, more successful will be the knee replacement surgery.

Multimodal Pain Relief After Total Knee Replacement

When other treatments fail to provide relief, the last resort to treat spine problems is the spine surgery. Spine surgery is conventionally referred to as open surgery which indicates that the area that needs to be operated is opened with a long incision so that the surgeon is able to view and have access to the anatomy.

In the recent times, advances in the field of medical science have made it possible to treat back and neck conditions through minimally invasive surgical techniques that don t involve an elaborate incision. Let us understand more about it.

How is minimally invasive spine surgery carried out?
Minimally invasive spine surgery fusions and decompression processes are performed by exploiting different approaches. The most commonly utilized technique involves the use of the tubular retractor. In this process, the surgeon makes a small incision and then inserts the retractor through the skin right into the spinal column. It leads to a tunnel to the accurate area where the problem persists in the spine. The functionality of tubular retractor lies in the fact that it helps in holding the muscle open throughout the procedure.

A number of particular processes have been designated for the minimally invasive spine surgery. Some of the most common options include spinal decompression, discectomy, and transforaminal lumbar interbody fusion. Each of these processes is different and only an expert in this arena can determine what s suitable for you.

Minimally invasive spine surgery is also called less invasive spine surgery where surgeons make use of special instruments. One of the most compelling drawbacks of open surgery is that the pulling of the muscle can lead to damage to both the muscle and the tissues in close vicinity. On the other hand, minimally invasive spine surgery allows the surgeon to see the precise location of the affected area. Besides, it also leads to smaller incisions, reduced bleeding and short stay in the healthcare facility.

Consulting an expert about the surgery:
It is very important on part of the patients to discuss the suitability of minimally invasive spine surgery with their doctors since it is not a good option for all patients. It is generally suggested for patients having spinal tumours, spinal instability, spinal infections, vertebral compression fractures, lumbar spinal stenosis and spinal deformities like scoliosis.

When you know that you will have to undergo the surgery, it pays to gather information about the surgery and what you may expect from the recovery process. The most commendable benefits of minimally invasive spine surgery include better cosmetic results owing to lesser skin incisions and reduced dependence on the medications. Moreover, it is performed as an outpatient procedure and it makes use of local anaesthesia only. Thus, there is also a reduced chance of suffering from an adverse reaction to general anaesthesia.

So, depending on the pros and cons and depending on the individual condition, your doctor will decide on the course of action.

Everything You Need To Know About Minimally Invasive Spine Surgery!

Many people are embarrassed to talk about their urine colour or urine problem with anybody, including their doctor. But, what people always forget is that strong smelling urine and the change in the colour of the urine is a serious issue. Your urine colour directly tells you about your health, especially your inner body. So, without being embarrassed you should consult a doctor, if and when, you find foul odour in your urine. Following are some of the reasons for the causes of strong smelling urine.

You are dehydrated: Urine is not supposed to leave odour. It should be odourless, but if you find strong smell in your urine, you should consult a doctor immediately. The most common reason of foul odour in your urine is dehydration. If the amount of water needed in your body is not enough then, there will be less water in your body as a result the waste products will not be diluted in water being more concentrated making the urine darker and more odour. But once you start drinking water, it should go normal. Normally, this kind of situations occur in early morning when your water intake is less or not at all. But drinking lot of water will solve this issue immediately.
More alcohol or caffeine intake: If you are habituated to drink a lot of coffee then it may happen that you find strong smell of coffee in your urine. Although it is not very problematic yet it is healthy if you reduce the intake of coffee in your daily life in order to have a healthy digestive system. Not just coffee but even alcohol could be the reason of irregular or need to urinate a lot more than usual.
Bacterial Infection: There could be bacterial infection or kidney infection which could lead to strong smell of urine. In order to ensure you should go to a doctor and get important tests done. Then the doctor can suggest treatment according to your results and if all the results are normal then you could be suggested to maintain a balanced diet on regular basis.
Imbalanced Diet: The problem can sometimes come from the use of certain vitamins from imbalances in your diet. There are substances like nitrates and phosphates in the urine which can give dark colour and odour. You should always have a proper diet and follow it in order to have a healthy digestive system. Eating lot of garlic and onion can also bring odour in your urine.
Diabetes: If you are diabetic, it may be possible that you find dark urine and odour in your urine. It indicates that your sugar level is not normal and gone much high than normal. If you are not diabetic then it may be a sign of diabetes so you should get diagnosed immediately with your doctor.
There are multiple causes of strong smelling urine but most of them could be cured easily if diagnosed immediately. But in order to avoid this issue it is better to be careful with your diet and drink a lot of water. At least three litres of water a day is an absolute necessity!

Strong Smelling Urine - 5 Common Reasons Behind it!

Living with ulcerative colitis can be very challenging. Patients of this disease will have to deal with pain in the abdomen and several digestion related issues in their daily lives. It is known to adversely impact the digestive tract. There can be extreme discomfort at the time of flare-ups. A patient can find life extremely difficult while dealing with symptoms like abdominal pain, fever, weight loss, and chronic diarrhea.

What is Ulcerative colitis (UC)?
It is a serious inflammatory disease. It is caused due to inflammatory bowel movements in the digestive tract. It can affect your daily life adversely. The worst part about this disease is that it relapses in the individual. It is characterized by flare-ups. You need to know fist what is an UC flare-up. Well, it is a term to refer to an exaggerated condition in the disease. It refers to a state when things turn worse. These flare-ups can be caused due to a number of factors. Some of these include:

Side-effect of certain medicines
Hormonal imbalance, especially during pregnancy
Sudden withdrawal from medication
Any infection or other medical condition
How to deal with the UC flare-ups?

Doctors often prescribe corticosteroids to deal with the flare-ups. Some of the most common drugs are Prednisone and budesonide.
Doctors prescribe the intake of steroids, 5-Aminosalicylates, antibiotics, and biologics.
Lifestyle changes are helpful in treating this disease. You can work towards detoxification and de-stressing yourself to get rid of the flare-ups. Take up some exercises, meditation and Yoga for best results.
You can also control chronic diarrhea by keeping a check on what you eat. You should avoid eating fibrous diet. Fibres are tough to digest for patients with UC. You must maintain proper hygiene as well to stay away from diarrhea.
Surgical Management of Ulcerative Colitis

Ulcerative colitis (UC) is an inflammatory disease of the colon and rectum limited to the mucosa, and may vary in severity from a mild intermittent disease to an acute fulminant and potentially fatal disease requiring urgent surgery. Management of ulcerative colitis depends on severity, extent, and duration of the disease, response and tolerance to medication, patient age and comorbidity as well as patient preference.

Surgery plays an important role in the management of UC both because of the premalignant nature of the disease, and because of the periodic failure of medical management. The underlying rationale for surgical treatment of the disease is that the disease is confined to the colon and rectum, and therefore proctocolectomy is curative. The goal of surgical therapy for ulcerative colitis is to remove the disease with as little alteration of normal physiological functions and lifestyle as possible.

Four surgical options exist for patients with ulcerative colitis and each has its own advantages and disadvantages.

The surgical choices are:

Proctocolectomy and Brooke ileostomy.
Abdominal colectomy and ilcorectal anastomosis.
Proctocolectomy and Kock pouch.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA).
The choice of operation requires consideration of the advantages and disadvantages of each option and must be tailored to an individual patient's needs and circumstances. Important factors to be considered in the choice of operation include the indication for surgery, age, associated medical conditions, body habitues, and quality of the anal sphincter. Extensive preoperative education is required which should include discussion with a specialized Gastroenterologist.

Ways To Deal With Ulcerative Colitis!

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