Prostate cancer is one of the most common cancers that men are diagnosed with. It is accompanied by a number of difficulties of urination and ejaculation. It can also cause difficulty in achieving and sustaining an erection. If cancer advances and affects the bone structure and the spine, it can cause weakness in the limbs, and also result in urinary and fecal incontinence. If it is diagnosed in its early stages it can be treated quite easily before it spreads.

Treatment for Prostate Cancer-
Prostate cancer generally does not show any symptom in the early stage but progressively degenerates with time. If you suspect having any of the symptoms of prostate cancer such as urination difficulty, erectile dysfunction and discomfort in the pelvic region, then consulting an oncologist is the next step. Your doctor will perform certain diagnostic tests like digital rectal examination (DRE) and prostate-specific antigen (PSA) test. After the diagnosis of prostate cancer, doctors generally check the stage and rate of growth of a tumour by determining its Gleason score.



Once the extent of the prostate cancer is known, a treatment plan is devised by the doctor. If the cancer is localised and small, your doctor will either prescribe active surveillance or surgery. During active surveillance, there is a blood test, rectal examination, and biopsies on a regular basis to monitor the growth of a tumour. However, the tumour can also be deftly removed with surgical intervention in the form of Radical Prostatectomy. There are two types of radical prostatectomy- laparoscopic prostatectomy and robotic laparoscopic prostatectomy

Robotic Radical Prostatectomy-
A radical prostatectomy is one of the most common methods of treating prostate cancer. It involves the surgical removal of the prostate gland along with some of the surrounding tissues. This curtails the spreading of the cancerous cells to other parts of the body. A robotic radical prostatectomy is a minimally invasive procedure that involves the use of a robotic instrument that is controlled by surgeons to make the removal of the gland precise and efficient. The surgeon controls the robot by sitting at a console and makes several small incisions to enter the abdomen. This procedure reduces the risks of blood loss and any possible side-effect that includes erectile dysfunction and urinary difficulties.

Robotic Radical Prostatectomy For Cancer Prostate!

Gastroesophageal reflux disease (GERD) is also called as acid reflux. It is a long-term digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach which causes the stomach contents to come back up into the esophagus resulting in either symptoms or complications. Gastroesophageal reflux disease is mild acid reflux that occurs at least twice a week or moderate-to-severe acid reflux which occurs at least once a week.

Epidemiology

In western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition. In developed nations, the prevalence rate of GERD is associated with age; with adults aged 60 to 70 being the most commonly affected.

Signs and Symptoms

Esophageal symptoms include:

Heartburn
Regurgitation of food or sour liquid
Dysphagia
Sensation of a lump in the throat
Extraesophageal symptoms include:

Coughing and/or wheezing
Hoarseness, sore throat, or laryngitis
Otitis media
Noncardiac chest pain
Enamel erosion or other dental manifestations
New or worsening asthma
Disrupted sleep
Risk Factors

Obesity
Pregnancy
Hiatus hernia 
Scleroderma and systemic sclerosis
The use of medicines such as prednisolone
Delayed stomach emptying Zollinger-Ellison syndrome which can show an increase in gastric acidity because of gastrin production
A high blood calcium level which can increase gastrin production, leading to increased acidity
Visceroptosis or Gl nard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.
Factors that can increase acid reflux involve:

Smoking habit
Eating heavy meals or eating late at night
Eating fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Medications, such as aspirin
Tight clothes
Increased intra-abdominal pressure
Differential Diagnosis

Heart disease causing chest pain
Laryngopharyngeal reflux OR extraesophageal reflux disease
Infection
Peptic ulcer
Esophageal spasm
Complications

Narrowing of the esophagus (esophageal stricture): Stomach acid causes the formation of a scar tissue which narrows the food pathway.
An open sore in the esophagus (esophageal ulcer): Acid causes an open sore which bleeds, causes pain, and makes swallowing difficult.
Precancerous changes in the esophagus (Barrett's esophagus): Damage from acid can cause changes in the tissue lining the lower esophagus
Anemia
How to arrive at the diagnosis?

Upper gastrointestinal endoscopy/esophagogastroduodenoscopy
Esophageal manometry
Ambulatory 24-hour pH monitoring
Treatment

The goals of treatment are controlling symptoms, healing esophagitis, and prevention of recurrent esophagitis or other complications.

Lifestyle modifications include the following:

Losing weight (if overweight)
Eating small and frequent meals instead of large meals
Waiting 3 hours after a meal to lie down
Elevating the head end of the bed by 8 inches
Avoiding bending or stooping positions
Medications

H2 receptor antagonists (ranitidine, cimetidine)
Proton pump inhibitors (omeprazole, pantoprazole)
Prokinetic agents (aluminum hydroxide)
Antacids (magnesium hydroxide)
Surgery

Transthoracic and transabdominal fundoplication
Placement of a device to augment the lower esophageal sphincter

Gastroesophageal Reflux Disease - What Should You Know

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!

The kidneys are responsible for the elimination of waste from the body. The blood is filtered in the kidneys and all toxic wastes are filtered out and excreted through urine. When this filtration does not happen effectively, a lot of waste can be found in the blood, which affects normal body function.

Kidneys may lose their functioning either due to age, injury, or disease conditions. Whatever the reason, when kidney function is hampered, the body suffers. If there was an injury or congenital problem, it could be unilateral and the non-affected kidney could still do the function. However, if it is infection or old age, normally both kidneys are affected and then replacement should be looked for externally. This is where a kidney transplant comes into the picture.

What is it?

It is a surgery where a healthy, functioning kidney is placed into the body. The donor could be

Living: These donors have to be related or unrelated. Related is often termed someone, who is a family member and is willing to donate one kidney (one kidney is sufficient for normal, healthy individuals) to the diseased person.
Cadaver: If a person is willing to donate kidneys post death, these are used for transplant, within a specified time.
Identifying the right donor and recipient:

Blood type and tissue type should be matched; a good tissue type match improves the chances of success
Overall health of the donor to ensure there is no heart disease, lung disease, or diabetes
The recipient also should be healthy
What to expect during surgery?

Once a donor is identified, in living donors, the surgery to remove the kidney and to transplant it are done simultaneously
The surgery usually takes about 3 to 4 hours
Antibiotics are given prior to the surgery to prevent infection
The blood vessels and ureter are connected back to the kidney after the transplant
Hospital stay can range from 5 days to 2 weeks, depending on the overall health of the patient and the anticipated risk of rejection.
Most transplanted kidneys work effectively almost immediately. A kidney stored from a cadaver may take a little longer compared to a fresh kidney from a living donor
People who have had transplants are put on immunosuppressants on a chronic basis to reduce chances of rejection. The new kidney will always be recognised by the body as a foreign body, and so this is essential.
Kidney transplant success rates are quite high, and more and more people are opting for transplants as opposed to dialysis.

Kidney Transplant - What To Expect From It?

Ovarian cancer takes place when the cells in either of your ovaries have an abnormal growth. The ovaries are two small organs, situated on either side of your uterus. They deliver female sex hormones and store and discharge eggs (ova) that help a woman reproduce. Ovarian cancer is a serious disease that emerges from various sorts of cells and growths inside the ovary.

Specialists do not know precisely what causes ovarian cancer. Hereditary qualities, for example and other DNA changes, are a danger element for few ladies. Around 10 out of 100 ovarian cancers are thought to be brought about by quality transformations in the BRCA1 or BRCA2 genes. Women who go through changes due to these carrier genes are more at risk of contracting ovarian cancer.

The earliest symptoms of ovarian cancer are as follows

    Frequent bloating in the uterus or stomach area.
    Pain in your pelvis or belly.
    Inconvenience while eating, or feeling full quickly.
    Urinary issues, for example, a critical need to urinate or urinating more frequently than expected.


Treatment options for ovarian cancer

The decision of treatment and the long-term result for ladies who have ovarian cancer relies upon the sort and phase of cancer they are in. Your age, general wellbeing, personal satisfaction, and wish to get pregnant should be considered. The primary treatment methods for ovarian cancer are:

    Surgery to see whether you have cancer or not and to treat it. This may include taking an ultrasound and biopsies to check for the spread of cancer.
    Chemotherapy, which uses medications to kill the cancerous cells. It is suggested after surgery for most phases of ovarian cancer.
    Women who are in a more progressive stage of ovarian cancer may have a portion of their chemotherapy before surgery and whatever is left of it after surgery. This can make the surgery more secure for these women.
    Radiation treatment might be utilized to pulverize the cancer cells with the help of high-measurement X-ray beams or other high-vitality beams.

Side Effects of Treatment Methods:

Most medications for ovarian cancer cause reactions. They may vary, depending upon the kind of treatment, your age and general well-being. Reactions of surgery rely on the degree of your surgery and spread of the disease. In case your specialist removes your ovaries, you lose the capacity to bear children or get pregnant. Furthermore, in case you were all the while bleeding before your surgery, you will begin with your menopause.

Symptoms of chemotherapy may incorporate loss of appetite and weight, queasiness, fatigue, vomiting, nausea and hair loss. There is also a possibility of getting a very serious infection. One should get regular or annual check-ups done to see if there are anomalies in either parts of the bodies since natural symptoms of cancer are only visible after a certain stage. 

Ovarian Cancer - 4 Highly Effective Treatment Options Available

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!

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