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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.
Patra panda sweda(ela kizhi) is a specialized therapy which is performed for the diseases related to Bones, muscles and nerves. Patra means leaves of medicinal plants. Pinda means a bolus. Sweda means Fomentation or sudation. The swedana karma or sudation therapy which is given by using a bolus which is prepared by the different combination of medicinal leaves which is processed with medicinal oil along with the medicinal herbs is called as patra panda sweda or ela kizhi. This procedure is unique, which comprises both snehana (oleation) and swedana (sudation) (snehayukta swedana)
Benefits of Patra Pinda Sweda:
It strengthens and rejuvenates the bones, muscles and nerves
Strengthens the tissues
Increases the circulation
Provides color and complexion of the skin
Helps to Reduce pain, inflammation and stiffness of the muscles
Induces good sleep and reduces the stress.
Sprains and cramps
What is ECMO?
Like dialysis for unfunctional kidney, Ecmo for unfunctional lung.
Ecmo stands for extracorporeal membrane oxygenation. It is a method of giving oxygen for the body when icu pateint lungs and/or heart are not able to supply oxygen on their own.
Why ICU pateint put on ECMO?
Doctors place ICU patients on ECMO when patients are not able to supply oxygen to the body.
ICU patients’ lungs fail for a number of reasons including pneumonia, lung cancer, pulmonary edema, pulmonary embolism and COPD.
When a patient’s lungs fail, he/she first is intubated (breathing tube) and hooked up to a ventilator (breathing machine).
However, sometimes lungs are so damaged that providing oxygen through intubation is not enough.
This is when doctors turn to v-v ecmo.
A heart can fail for many reasons including heart attack, pulmonary embolism, bad valve disease, or worsening heart failure. When a heart fails, doctors try to fix the underlying problem. They may also start medications (called ionotropes) to help improve the pump function of the heart. If medications are not enough, doctors will turn to v-a ecmo.
How long can someone stay on ecmo?
That is a complicated question. Due to the risks of ecmo discussed above, doctors try to keep patients on ecmo for as short a time as possible. Often patient will be on ecmo for several days up to 1-2 weeks. Every day, several blood and imaging tests are done to determine if a patient is ready to come off ecmo. As the technology of ecmo improves, hopefully side effects will decrease and patients can remain on ecmo for longer periods of time.
What is the difference between ecmo and a ventilator (breathing machine)?
Both ecmo and a ventilator aim to provide oxygen to the body when the patient’s own lungs and breathing are failing. The ventilator assists the patient’s own lungs by pushing oxygen with pressure into the lungs. Ecmo instead provides oxygen directly via a catheter placed in a patient’s vein or artery. We almost always try oxygenating a patient with a ventilator first. However, when a patient’s lungs are too sick for this, we turn to ecmo to assist in providing oxygen to the body. V-v ecmo provides oxygen through a vein. This blood then has to travel to the heart and be pumped around the rest of the body through arteries. Therefore, with v-v ecmo or with a ventilator, a patient must have a well-functioning heart to get the oxygen pumped throughout the body. V-a ecmo has the additional advantage of pumping blood directly to arteries. This “by-passes” the heart and is therefore the method of ecmo we use when a patient’s heart is failing.
Age 51 years male. Slip disc happened jan'2010 and get to normal after 4 years doing only exercise till now and used lumbo scrarol belt when out of home. Due to filling uneasy during walking, a tmt brace protocol suggested. Is it ok to do the test.
Can Physiotherapy Cure cervical disc prolapse and L5 S1 Disc bulge.I am suffering from Neck pain for the Past 6 years
Hello sir. I have lower back pain since 2 months back. I have done mri there is disk problem. What is permanent solution is surgery kindly help me.
Hello Dr. My mother facing the problem regarding slip disk in the year of 2012 now she is fine but some time he faced pain what I will do so he will get normal.
I am having problem in my spinal cord disc L4 -L5. With some loss of fluid. Now my knee joint also getting pain. What you wil suggest.
Did you know barley water is good for kidney stones?
Barley (jau), a member of grass family, is a cereal that has been cultivated for over 13, 000 years. Packed with carbohydrates (78%), fat (1%), protein (10%) and water (10%), barley is a rich source of essential nutrients, dietary fiber, vitamins such as niacin, manganese, phosphorus and vitamin B6.
With several health benefits to its name, barley water is termed as the elixir to good health. It has been found to be beneficial in reducing chances of heart disease, soothing bowels, reducing blood cholesterol levels, improving blood sugar regulation in the body and acts as nutritive broth for fever, cold and cough. Additionally, studies support that barley water has also been found to play an integral role in maintaining renal health.
What is a renal stone?
A renal stone is a solid stony piece consisting of crystal forming substances in the urinary tract. They are usually formed when the urine is abundant in substances such as calcium, oxalate and uric acid and lack substances that inhibit their accumulation. While small kidney stones can pass through the urinary system without any symptoms, a stone larger than 5 mm can result in blockages in the urinary tract causing severe pain in the back and lower abdomen.
What causes renal stones?
- A family history for stones, lack of adequate water in the body, high BMI, excessive intake of diets rich in protein, sodium and sugar have been found to be some of the common causes for stone formation.
Try protein foods &amp; supplements
- Medical conditions such as hyperthyroidism, inflammatory bowel syndrome and renal tubular acidosis have also been found to alter the digestion of calcium.
How does barley water aid the dissolution of renal stones?
Studies show that regular use of barley water can dissolve and eliminate existing kidney stones and prevent the occurrence of stones and other kidney problems. Use of diuretics either natural or synthetic can help speed up the expulsion of the stone.
Diuretic in nature, barley water helps to flush toxins from the kidneys by creating bladder pressure and increasing the frequency of urination.
- It helps maintain the PH levels in the body, making it alkaline, preventing various urinary tract issues, including kidney stones.
- The vitamin B6 and magnesium in barley helps break down the masses of toxic calcium oxalate (primary cause for stones) in the kidney.
Dietary fiber in barley reduces the amount of calcium that is excreted by the body through urine, restoring renal health and cleansing the kidneys.
Ways to prepare barley water:
- Boil 1 litre of water with a tablespoon of barley pearls and boil on a low flame for about 30 minutes or until the water has reduced to half.
- Strain and cool this mix and drink it through the day.
- Add lemon juice or honey to make the mix tasty
Regular use of barley water ensures that the renal system is hydrated, healthy and free of depositions such as renal stones. So, go ahead and add this elixir to your diet to ensure a healthy renal system and a healthier you. Eat healthy, stay healthy!
As per my MRI report for lumber spine, disc protrusion seen at L5-S1 indenting anterior thecal sac and narrowing left neural recess. Disc hydration is Los at L5-S1. I have severe lower back pain for last one month. What is the ideal plan for treatment?
She is 63 years old suffering from diabetes-on Insulin+other allopathy medicines but the sugar level running from 70 to 200 and more. Today fasting 90 but PP is going high between 200 to 300. She is on Insulin from last 15 years. Can she be treated with you? And I am also suffering from Slip Disc. L4 L5 S1 and taken 15 days Ayurvedic treatment such as Katibastyi, Malish, Steam bath etc but there is nothing complete and permanent. Please advise us to permanent treatment.
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.
Hello doctor plzz say me is surgery essential for Diffuse annular disc bulge seen at l4 and l5 level causing indentation over thecal sac with bilateral recess narrowing and significant nerve decompression.
Noncancerous growths of the muscle tissue surrounding the uterus are known as uterine fibroids. This is a common disease which about 70 to 80% of women contract by the time they are 50 years of age. The uterine fibroids can sometimes be very big and cause heavy periods as well as severe abdominal pain while at other times, uterine fibroids give no signs or symptoms whatsoever and go away on their own. This is why it is crucial to know what type of uterine fibroids you have and how to diagnose them. Here are the types of uterine fibroids and how to diagnose them;
There are three main types of uterine fibroids. They are;
1. Intramural fibroids
The most common type of uterine fibroids are intramural fibroids. They typically appear in the endometrium and may grow larger which results in your womb getting stretched.
2. Subserosal fibroids
Subserosal fibroids are called so because they form on the serosa. The serosa is the outside of your uterus. Sometimes, Subserosal fibroids may grow so large that your uterus appears bigger on one side.
3. Pedunculated fibroids
Pedunculated fibroids tumors are basically Subserosal fibroids with a stem. A base which supports the tumor is called the stem.
There are a number of tests done to diagnose uterine fibroids. They are;
1. Pelvic exam
A pelvic exam is a thorough inspection of a woman’s pelvic area. The organs which are in the pelvic area include the cervix, ovaries, uterus and vagina. Normally, this and the next test in this article are enough to diagnose uterine fibroids.
2. Medical history
The history of your periods as well as the other symptoms you have will often be enough to diagnose the uterine fibroids. If your medical history is not enough, then you might need to undergo a pelvic exam.
3. Pelvic ultrasound
An ultrasound is when high-intensity sound waves are used to produce images of the pelvic area. This is only done when a pelvic exam and your medical history are not enough to diagnose uterine fibroids.
I am 22 year running. I am suffering from slip disc problem since last 1 & half year. My pain is increasing day by day. Its start with lower back and now its come in my left leg. I am done many things for it but still I am suffering for with this. What can I do I cant understood.
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.