A hysterectomy is an operation to remove the uterus and, usually, the cervix. The ovaries and tubes may or may not be removed during this procedure, depending on the reasons for the surgery being performed. If the ovaries are removed, you will commence menopause. A hysterectomy is a major surgical procedure with physical and psychological consequences.

Why is a hysterectomy performed?

Common reasons include painful or heavy periods, pelvic pain, fibroids or as a part of therapy for cancer. You should have a clear understanding of your reason for this surgery.

How is this done?

The procedure is normally performed under a general anesthetic and takes approximately one hour. To commence your anesthetic a drip is inserted into your arm. Once you are asleep, you will have a urinary catheter inserted. The importance of the catheter is to reduce the size of your bladder, keeping it away from the operation site and reducing the risk of complications.

There are three ways to remove the uterus:

Vaginal hysterectomy - The removal of the uterus and the closing of the wound is performed through the vagina. There is no cut in the abdomen. 
Laparoscopic hysterectomy - About four small keyhole cuts are made in the abdomen to divide the attachments of uterus, ovaries, and tubes in the pelvis. The uterus is usually then removed through the vagina.
Abdominal hysterectomy - The uterus is removed through a cut in the lower abdomen. The cut is about 15 20 cm in length and runs across your abdomen, usually below the bikini line. Less commonly, it may be necessary to have a cut that runs from the belly button down to the pubic area.
What are the risks of undergoing this procedure?

Although the risks associated with hysterectomy are low, you should be aware that every surgical procedure has some risk. This may also depend upon the type of surgery you have. 
Severe bleeding from large blood vessels around the uterus or top of the vagina. This is not common. A blood transfusion may be required to replace blood loss. A vaginal pack may also be used to control the bleeding.
Infection in the operation site, pelvis or urinary tract.
Nearby organs such as the ureter (tube leading from kidney to bladder), bladder or bowel may be injured expected to happen to approximately one in every 140 women. Further surgery will be needed to repair the injuries.
The bowel may not work well after the operation; this is usually temporary. Treatment may include a drip to give fluids into the vein and no food or fluids by mouth.
Things to do before you come to the hospital

It is important for you to have all the tests ordered at your outpatient clinic appointment completed prior to coming to the hospital these include blood tests and an ECG and chest X-ray, if you are more than 50 years old

You may be required to have a bowel preparation, which will empty your bowel prior to the surgery.

You should stop eating and drinking at the following times on the day of your surgery unless otherwise notified

At midnight if your procedure is in the morning

At 6 am if your procedure is in the afternoon.

You will need to shower and dress in clean clothes prior to coming into hospital. It is important that you do not shave your operation site as this increases the risk of wound infection.

Please remove all body jewelry.

After your surgery

When you wake from the anesthetic, you will be ready to be transferred, in your bed, for recovery.

Having an anesthetic can make you feel sick and may cause vomiting. You will have a drip in your arm which is necessary to maintain fluid intake and provide pain relief. This will remain in until you can tolerate food and fluids and your pain control is changed to oral medication.

Your nurse will take frequent observations of your vital signs e.g. temperature, pulse, blood pressure.

You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.

If you have pain or nausea, please tell your nurse. Effective pain management is important.

You will have a urinary catheter in place. The catheter will normally be removed the day following your surgery.

Recovering at home

What to expect

You may have a blood-stained vaginal discharge which is similar to a light period. This will gradually reduce to nil over 4-6 weeks as your internal wounds heal

You may need to take some simple analgesia for pain/discomfort, especially on waking and settling at night

You may feel fatigued

You may require up to four to six weeks off work. You should have returned to normal activity by two to three months, depending on the type of surgery, although full recovery may take longer

After the operation, you will no longer have a period

For the majority of women, hysterectomy surgery does not have a negative effect on sexual function

What to avoid

For the first two to three weeks lift nothing greater than two kilograms. Increase gently as tolerated over six weeks.

It will take about three weeks before you should drive a car. Only when you know you can act confidently with emergency breaking should you attempt driving the car.

Avoid sexual intercourse for six weeks to allow healing to take place.

Avoid inserting anything into the vagina for six weeks to allow time for healing to take place (e.g. use sanitary pads and not tampons).

It is important to avoid constipation and straining immediately after your surgery as this will assist healing and improve your comfort.

Contact your doctor if you develop any of the following complications:

Your wound becomes red or inflamed, painful.

You have heavy vaginal bleeding heavier than a normal period.

You have offensive vaginal discharge.

You develop a fever i.e. temperature of about 38  C, or you are feeling unwell.

You have pain that is not relieved by simple analgesia.

You are having difficulty passing urine or opening your bowels.

 In case you have a concern or query you can always consult an expert & get answers to your questions!

Surgery For Womb Removal - What You Need To Be Aware Of?

GERD or gastroesophageal reflux disease is a chronic digestive disease which occurs when the stomach acid and at times the contents in your stomach flows backwards into the food pipe. The backwash or reflux irritates the esophagus's lining and hence causes GERD. Individuals may manage GERD's discomfort by changing their lifestyle and by taking over-the-counter or OTC medications. But, certain people might also require stronger medications or surgery for reducing the symptoms.

Some of the basic signs include chest pain, burning sensation in the chest, dry cough, difficulty in swallowing, sore throat, etc. If you experience such symptoms at least twice a week or if your physician notices damage in your food pipe, then you might undergo diagnosis. Though drugs are the primary GERD treatment yet, an individual can manage it by following certain tips which may give relief.

Few ways to manage GERD- self-care tips:

One of the effective ways to help yourself is by consuming smaller meals. Instead of taking three big meals regularly, you may try having smaller meals frequently and avoid stuffing.
Almost all individuals tend to have dinner just half an hour before sleep, but this might affect GERD patients. It is best to eat 2 hours before going to bed as by doing so your stomach will get enough time to digest the food.
Due to a hectic schedule and fast paced lifestyle, people tend to eat as quickly as possible. To manage GERD, one must eat slowly and put down the spoon or fork in between each bite.
Changing the daily diet by striking off the trigger foods is beneficial in managing GERD symptoms. Though the food triggers vary from one person to another yet, it includes coffee, chocolate, peppermint, alcohol, tomato, citrus juices, onions, spicy and high- fat foods, etc.
Sleeping with the head end of the bed elevated by 6 inches is a very effective way of reducing night time reflux. It is also advisable to sleep on your left side . Never sleep on the right side as this position promotes reflux. Medications to reduce acid production are the mainstay of the medical treatment. 
One always has to ensure that they are following the various lifestyle changes along with the medication. Other medications include pro kinetic medicines which help the stomach empty. Surgery always remains the last resort in the treatment of GERD. Endoscopy is required for the diagnosis or GERD Prior to any surgery a Manometry and 24 hr ph merry test is compulsory.
If you are suffering from GERD symptoms frequently, then you may maintain a diary for figuring out which foods are giving you trouble.

When is a surgery required?
If lifestyle changing tips and other medications fail to provide any relief, then physicians recommend undergoing surgery.

Surgery is done for strengthening lower esophageal sphincter and also for reinforcing it. The surgery for reinforcing lower esophageal sphincter is performed by surgeons laparoscopically. The surgeon inserts instruments like a tiny camera and flexible tube by making 3-4 incisions in the abdomen. This surgery for managing GERD may be quite effective.
Experts state that candidates who undergo GERD surgery are those who are unwilling to take GERD drugs or are not getting relief from them. While choosing a surgeon, it is better to consider one who possesses huge experience of the particular operation which you need and also with a good track record.
So, you must visit a doctor if you experience frequent gastroesophageal reflux disease symptoms. It won't be a good decision to take OTC medications without your doctor's recommendation if you notice arm or jaw pain along with difficulty in breathing as these are signs of heart attack.

Gastroesophageal Reflux Disease - How Best Can You Manage 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!

Colorectal surgery deals with the disorders of the rectum, anus and colon. Another name of colon is  large intestine . These three body parts form the last stages of the digestive process. When the human waste passes through the colon, its salt and water are extracted before it exits the body as human excreta.

Colorectal disorders

Swelling and inflammation of the veins in the anus (also called as Haemorrhoids)
Anal fissures- unnatural cracks and fissures in the anal area
Fistulas or the unnatural connections between the anus and other anorectal areas
Conditions of constipation
Incontinence in passing of faeces
When the walls of the rectum protrude through the anus- also called as Rectal prolapse
Birth defects such as imperforate anus
Anal cancer- this condition is rare
Colorectal cancer- cancer of colon and rectum
Any injuries to the anus
Removal of any objects inserted into the anus
Bowel habits after colorectal surgery
Many patients report cases of diarrhoea, leakage of stool or gas, urgency to use the toilet and a feeling of insufficient evacuation of faeces. Relax; these conditions are not going to last forever. Your rectum and anus are adjusting to new conditions after this surgery. These organs may take six to twelve months to adjust to new bowel habits.

Is there a need to take a laxative or stool softener?
There is no need to take laxatives after a colorectal surgery. Drink lots of water to make your stool softer and easy to pass. If there is a water deficiency in your body, then it may lead to your faeces becoming hard. In that case, take milk of magnesium, colace etc.

Activities post surgery
You can continue with your normal schedule after this surgical procedure. Carry on running, jogging, exercising, climbing up the stairs etc. even after your surgery. Gastroenterologists recommend that patients should desist from lifting loads weighing more than 10 pounds so that there are no post surgery complications.

Diet after colorectal surgery
Avoid spicy and heavy to digest meals after your surgery. Once the intestines begin working normally, you can continue having your spicy food. Chew your food well to aid its digestion.

Returning to work after colorectal surgery
Most people are back to their work after taking a break of 2-5 days. If the surgery is pretty detailed, you may have to take a break of up to a month. Patients undergoing laparoscopic surgery may have to take a rest of 2- 4 weeks before they report back to work. Take it easy before slipping into your regular schedule. If working hurts after your surgery, don t do it.

Colorectal Surgery - Disorders It Can Treat!

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!

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)

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