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Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.
Hi doctor. I have a severe backache as per Dr. Advice I have done mri. My mri report is as under kindly advise in matter degenerative lumber spondylitis are seen in the form of marginal osteophytes and multilevel disc dessication. 1. D12-l1 & l1-l2 discs show mild bulge, indenting anterior thecal sac without significant never root compression 2. L2-l3 disc reveals right paracentral disc extrusion, indenting anterior thecal sac and causing right lateral recess narrowing, impinging on right traversing l3 nerve root. 3. L3-l4 disc shows mild diffuse disc protrusion, indenting anterior thecal sac and causing bilateral mild neural foraminal narrowing, minimally abutting bilateraltraversing l4 nerve roots. 4. L4-l5 disc reveals mild diffuse disc protrusion, indenting anterior thecal sac and causing bilateral mild neural foraminal narrowing, minimally abutting right existing l4 nerve root-bilateral traversing l5 nerve roots. Nerve roots. Cord is seen ending at d11 vertebral level. Distal cord and conus appear normal. Both hip and si joints are normal. No pre / paravertebral, epidural soft tissue or haematoma is seen. Bilateral psoas and posterior paraspinous muscles are normal. Please advise for home exercise / medicine.?
Left paracentral L5-S1 disc protrusion causing compression of left traversing nerve roots associated with diffuse L1-L2 Disc bulge. Now what is best treatment for me.
Breast cancer awareness
October is breast cancer awareness month and a great time to highlight the importance of maintaining healthy habits to support breast health. One disease that most women fear these days, you would probably reply" breast cancer.
Understand what you can do to reduce your breast cancer risk. So follow these guidelines and know that you are doing all that you possibly can to protect yourself from developing breast cancer. Be thankful every day that your breasts are healthy.
Check your own breasts regularly. Do monthly self-breast examinations after your period is over. If you find any lumps or tenderness that concerns you, have it checked out right away. Fortunately, 80% of breast lumps are benign. When you examine your breasts, remember that lumps which are soft, movable, and change with your menstrual cycle are much less likely to be cancerous. Any discharge from the nipple other than breast milk should be checked out by your health professional.
Get regular mammograms. In a woman without breast symptoms and with no significant risk of breast cancer, I recommend mammograms beginning age 35 or 40 every two years. For women without breast symptoms who are at higher risk of breast cancer, I recommend yearly mammograms beginning at age 35. Beginning at age 50, the rate of breast cancer goes up, so yearly mammograms are advised.
Limit alcohol intake. The more alcohol you drink, the greater your risk of developing breast cancer.
Get to and maintain a healthy weight - if your bmi is out of the healthy range, find a program and tools to help you get to a healthy weight, which is important for maintaining health in general, including breast health. Obesity, particularly after menopause, can greatly increase your risk of breast cancer. Aim for gradual weight loss by choosing minimally processed foods and eating smaller portions.
Don't smoke - accumulating evidence suggests a link between smoking and breast cancer risk, particularly in pre -menopausal women.
Exercise regularly - physical activity can help you maintain a healthy weight, which, in turn, helps prevent breast cancer.
Limit dose and duration of hormone therapy - if you're taking hormone therapy for menopausal symptoms, ask your doctor about other options. You might be able to manage your symptoms with non-hormonal therapies and medications.
Choose the right supplements - filling in nutrition gaps with supplements can help you support breast health. Look for options that contain vitamin d and omega-3 fatty acids, as they have both been associated with maintaining breast health.
Breast-feed your babies for as long as possible - women who breast-feed their babies for at least a year in total have a reduced risk of developing breast cancer later.
Sir my mom suffering from pain in almost all of the body specially in the backside, headache is there and also some sort of problem in breathing. Her protein is 9.8,albumin is 3.0,globulin 6.8,crp, alp,creatinine, vit D all are normal. Her MRI report says "study revels central & bilateral paracentral disc herniations with annular tear at L4-L5 and L5-S1 levels with thecal compression & bilateral traversing nerve root impingement. Mild retrolisthesis of L4 over L5 vertebral body is noted. There are degenerative osteophytes & disc desiccation as described in the text. Sir please tell me how can I treated her, doctor advice her tab maxgalin and accuvin what is the problems she can relief or not or any serious concern. Please help Sir.
Sir I am 62 l have got disc prolapse of my spine spine. Backpain- radiated toy right leg causing severe pain please give remedy.
Sir I am suffering from. L4-5 problem since 2 years there is any treatment with out operation please help me.
While you cannot cure breast diseases, family history and maturing, but there are some hazards or risks that you can control. Keeping in mind the fact that there is no certain approach to forestall breast cancer, there are things you can do that may bring down the hazard. Here are five approaches to ensure your breast's well-being:
- Watch your weight: Being overweight or hefty expands breast cancer chances. This is particularly true after menopause and for women who have put on weight as grown-ups. After menopause, the vast majority of your estrogen originates from fat tissue. Having more fat tissue can heighten your chances of getting breast cancer by raising the estrogen levels. Additionally, women who are overweight have a tendency to have more elevated amounts of insulin, than other hormones. Higher insulin levels have been associated with a few tumors, including breast cancer.
- Exercise routinely: Many reviews have found that exercise is the sign of having a healthy breast. Studies show that one to two hours of energetic walking each week, lessened a woman’s cancer risk by eighteen percent. Walking ten hours seven days decreased the hazard all the more.
- Constrain liquor: Women who have two to five mixed beverages every day have a higher danger of breast cancer than women who have just one drink a day or none . As much as three to six glasses of wine seven days have been found to somewhat increase breast cancer chances. It is not clear how or why liquor raises the hazard. In any case, constraining liquor is particularly essential for women who have other hazard variables for breast cancer, like, breast cancer running in their families.
- Restrain time spent sitting: Research has shown that sitting time, regardless of how much exercise you get when you are not sitting, increases the probability of growing cancer, particularly for women. Women who sit six hours or more a day outside of work have a ten percent more serious risk for breast cancer compared to the ladies who sit under three hours a day, and an increased hazard for other cancer types as well.
- Stay away from or confine hormone substitution treatment: Hormone Replacement Treatment (HRT) was utilized frequently in the past to control night sweats, hot flashes, and other troublesome manifestations of menopause. In any case, specialists now realize that postmenopausal ladies who take a blend of estrogen and progestin might probably create breast tumors or cancer. Breast cancer disease seems to come back within five years in the wake of ceasing the blend of hormones. Therefore, get a breast cancer test even if you feel a small lump. If you wish to discuss about any specific problem, you can consult a gynaecologist.
I am 33 years old, I have backache from last 1 year, x ray indicate there is borderline slip disk, what kind of precaution can I take for future?
I'm 25 years old. I've mild disk bulge in L4 and L5. Whether I can lead normal life or not? And it's curable completely or not? Pls tell me.
Different methods to treat Disc problems
Breast cancer is an abnormal growth of cells in the tissues of the breast. Mainly it occurs in females but less than 1% of all the breast cancer cases develop in males. The majority of breast cancers start in the milk ducts. A small number start in the milk sacs or lobules. It can spread to the lymph nodes and to the other parts of the body such as bones, liver, lungs and to the brain.
With more reliable early detection methods as well as the trend towards less invasive surgery, there is hope that even more women with breast cancer will be treated successfully and will go on to resume their normal lives.
Signs & Symptoms
It is painless, especially, during the early stage. Watch out for the following changes in the breast:
- A persistent lump or thickening in the breast or in the axilla.
- A change in the size or shape of the breast.
- A change in the colour or appearance of the skin of the breast such as redness, puckering or dimpling.
- Bloody discharge from the nipple.
- A change in the nipple or areola such as scaliness, persistent rash or nipple retraction (nipple pulled into the breast).
Consult a doctor immediately if you notice any of these changes.
Being a woman puts you at risk of getting breast cancer. There are certain factors that increase the risk of breast cancer. Some of them have been listed below:
- The risk increases with age; most cases of breast cancer develop after the age of 50
- Genetic alterations in certain genes such as BRCA1 and BRCA2
- Family history of breast cancer
- Being overweight
- Early menarche (onset of menstruation before the age of 12)
- Late menopause (after the age of 55)
- Never had children
- Late childbearing
- No breast feeding
- Excessive consumption of alcohol
- Use of hormonal replacement therapy (HRT) for a long period of time
However, most women who have breast cancer have none of the above risk factors. Likewise, not having any of these risk factors does not mean that you will not get breast cancer.
Early Detection and Screening
More treatment options are available when breast cancer is diagnosed at an early stage and hence the chances of recovery is also higher. So regular breast screening is important for early detection even if there are no symptoms. Following are the ways of screening:
- Breast Self-Examination (BSE): Perform BSE once a month about a week after your menses are over. If you no longer menstruate, choose a date each month which is easy to remember e.g. your date of birth or anniversary.
- Clinical Breast Examination: Get a breast specialist to examine your breast once a year if you are 40 years and above.
- Mammogram: Go for a screening mammogram once a year if you are 40 to 49 years old and once every two years if you are 50 years and above even if you do not have any symptom. It is not recommended for younger women (less than 40 years of age) as they have dense breasts, making it difficult for small changes to be detected on a mammogram. So ultrasonography of the breasts is advisable to them.
Types of Breast cancer
- Non-Invasive Breast cancer: These are confined to the ducts within the breasts. They are known as Ductal carcinoma in-situ (DCIS).
- Invasive Breast cancer: It occurs when cancer cells spread beyond the ducts or lobules. Cancer cells first spread to the surrounding breast tissue and subsequently to the lymph nodes in the armpit (Axillary lymph nodes). These cells can also travel to the other parts of the body such as bones, liver, lungs or brain and hence known as metastatic breast cancer.
Making A Diagnosis
If you notice any unusual changes in your breasts, you should see a doctor immediately. He will examine you clinically and may ask you to undergo some tests so that a definitive diagnosis can be made. Further, the staging work up is done to find out the stage of the disease and management accordingly.
Treatment of breast cancer may include various methods such as surgery with or without breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and targeted therapy. Treatment options offered, depend upon the number of factors such as the stage of cancer and likelihood of cure, your general health and your preference. If you wish to discuss about any specific problem, you can consult an oncologist.
I am 30 years old. Diagnosed with 11 % of vitamin D. Calcium and phosphate levels are also down. Besides cervical 6-7 disc have chronic black bulge. Pain in neck shoulder upper back. Also lumbar spine 4-5 also bulge. It is sending pain down till sole of feet. What is the treatment ways?
What are the alternatives to avoid surgery for my brother aged 47 identified with Listhesis with foot drop and disc extrusion. In fact I had disc bulge (L3 L4 L5) at the age of 41 in 2013 and took oil massage in Kerala for 15 days and I am doing good now.
I am 45 years of age, there are ligament disorder in my left side knee & slip disc problem too in both side feel heavy pain you are requested to advice me for better treatment & earlier relief in the same.
This is my Mri report impression. Disc degeneration and disc bulge is seen at L5/S 1 level indenting the thecal Sac without any nerve root compression. Annulus tear is noted. 2 this r my x ray report impression. Pid L5. S 1.
How to prevent sagging of breasts?
Home remedies for sagging breasts
Breast sagging is a natural process that happens with age wherein the breasts lose their suppleness and elasticity. Breasts do not have muscle. They are made of fat, connective tissues and milk-producing glands, and they need proper care to keep them in good shape.
The benefits of yoga for the entire body have been widely studied, and it is primarily a mechanism of toning the body and increasing flexibility. Some of that toning can occur within the breast, depending on which positions you commonly practice.
Massage your breasts at least 2-3 times per week with olive oil. It will help add firmness to the skin as well as improve the skin tone and texture. It will also tone your chest and increase the elasticity of the skin.
Pomegranate is considered a wonderful anti-aging ingredient and can help prevent sagging breasts. Pomegranate seed oil is rich in phyto-nutrients that can lead to firm breasts.
Make a paste of pomegranate peel and some warm mustard oil. Use it to massage your breasts in a circular motion for 5 to 10 minutes daily before going to bed.
You can also use pomegranate seed oil to massage your breasts 2 or 3 times daily.
Another option is to mix 4 teaspoons of neem oil with 1 teaspoon of dried and powdered pomegranate rind. Heat this mixture for a few minutes. Allow it to cool and then use it to massage your breasts twice daily for several weeks.
Avoid loose fitting bra / wrong bra size
Some women feel that they would feel comfortable if they wear loose bra. But this is totally a wrong step. You are going to invite your saggy breast by doing this. Avoid this and go for the best fitting bra to keep your breast stay upright and firm. For more details visit us at www.malhotraayurveda.in