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1. What are the symptoms of liver disease? When to see a doctor?
Most of the liver diseases present with similar symptoms with some variations. Some of the common symptoms can be loss of appetite, nausea and vomiting, vomiting of blood, jaundice(yellowish discoloration of the eye), abdominal pain, itching, distension of abdomen( accumulation of fluid- ascites), swelling of lower limbs, weight loss, altered sensorium, confusion, and in a late stage- coma.
2. Can liver disease be prevented?
Liver is a crucial body organ which is responsible for processing essential nutrients from the food you eat, synthesizing bile and most importantly removing harmful toxins from the system. To ensure that your liver keeps performing its functions, you need to follow a healthy lifestyle.
Some of the liver diseases are metabolic and hence inherent at the time of birth and manifest later. However, some of the more common liver diseases are preventable like alcohol induced liver disease, fatty liver induced liver disease (NAFLD), Hepatitis A, B and C.
3. What is liver transplantation? What is the average cost of liver transplantation?
Liver transplantation is the treatment for end stage liver disease in both adults and children. In this operation, the diseased liver is removed and replaced by a healthy one. The success rate for the operation is high and terminally ill patient can return to normal lives.
The average cost of liver transplantation is Rs 18 to 20 Lakhs at Sahyadri specialty hospital, Pune Maharashtra. The cost of investigations of the donor and recipient is Rs 90,000. When patients are too sick and require prolonged stay following liver transplantation, the cost of treatment can escalate; hence it is advisable to patients to have the liver transplantation before they develop complications secondary to the liver disease (Cirrhosis).
Most of the patients seek help at a very late stage or referred late to a Surgeon. It is advisable for patients to seek the opinion of a Surgeon at a very early stage of the disease. The patient needs to take medicines for the rest of his life to prevent rejection of the new liver. The cost of medicines and the investigations in the first year is approximately Rs 10-15000/-. The number of medicines and the frequency of blood investigations are much less after the first year of liver transplantation.
The cost of liver transplantation in India is one-twentieth when compared to USA, UK and other European Countries.
4. When should a liver transplant be performed?
When a person’s liver is severely damaged and cannot function properly or complications may develop and liver transplantation should be considered. Conditions like hepatic coma, massive upper gastrointestinal bleeding, and liver cancer is the best treated by complete removal of the liver (cirrhotic liver).
In general, when a patient needs a new liver, the earlier the operation, the higher the success rate is.
Urgent liver transplantation is recommended in patients who have acute liver failure and this could be due to many reasons. The common conditions are Hepatitis B, Hepatitis A, Hepatitis E and drug induced. In such patients, liver transplantation is urgently needed in order to save the life of the individual.
5. What are the advantages/benefits to the recipient of getting a living donation vs cadaver?
A new liver can come from either of the two sources: A living donor or a brain-dead deceased donor.
Living donor transplantation:
It is technically feasible to remove part of the liver from a living person and transplant it to a patient who needs a new liver. The operation has now been done since 1989. Depending on the size matching of the donor and recipient, either the left side (about 35-40%) or the right side (60-65%) of the liver will have to be removed. The liver remnant in the donor will grow to its original size in 6-8 weeks time.
This process helps in an earlier transplantation before the recipients’ conditions deteriorates. It is a planned procedure whilst cadaver liver transplantation is an emergency procedure. It avoids the risk of death while waiting for a deceased donor liver graft(40% overall and 75% for patients in Intensive care units). The survival rate of a living donor transplant is over 90%.
There are risks like complications of the investigations and surgical procedures but the possibility of donor death rate is of 0.2-0.5%. Seventeen donor deaths have been reported in Brazil, France, Germany, Egypt, Hong Kong, Japan, USA and India.
This is well established in the Europe and USA. Unfortunately, the availability of deceased donor liver is not very often in India. Depending on your blood group, you may have to wait for 0 to 6 months before you get a new liver.
During this waiting period, you may develop complications like spontaneous bacterial peritonitis (infection of the fluid in the abdomen) which, if repetitive may produce severe adhesions in your abdomen rendering liver transplantation difficult if not impossible.
It is important for everyone to register for organ donation, so that when we die, this noble act will help many people to lead normal lives. In the Western world the organ donation rate is between 15-18/million population where as in Indi it is less than 1/million.
6. Who can be a suitable living donor?
The most important criteria is that the donation of portion of the liver is done voluntarily. The donor has to be less than 50 years of age, body mass index of less than 25 and is a near relative of the recipient. Both the donor and the patient should have the same Blood group or O Blood group.
Besides, the potential donor should understand clearly that
- The donor operation carries complication rate of 10-15%.
- The recipient is successful in 90-95%, which means that there is 5-10% chance of dying.
- The donation is done out of his/her own wish and without any coercion.
- There is no financial gain related to the act of donation.
- The donor has the right to withdraw at any time without the need of giving any reasons to do so.
7. Which patients are excluded from liver transplantation procedure?
Patients who have cancer in another part of the body, active alcohol or illegal drug abuse, active or severe infection in any part of the body, serious heart, lung or neurological conditions or those who are unable to follow doctors’ instructions are excluded generally.
8. What are the risks to the recipient from the surgery?
The overall success rate of liver transplant is over 94% and the majority of recipients can return to normal activities and achieve 95% of their quality of life which they had prior to liver disease. Since the recipients’ body may reject the new liver, it is essential for them to take immunosuppressive medications and continue follow up at the liver transplant clinic. They will need to continue these medications for life, at a reducing dosage.
The risk for the recipient is the return of the original problem that necessitated the liver transplant in the first place, e.g. hepatitis C, recidivism (return to alcoholism), noncompliance of medications. The other complications that can arise are thrombosis of blood vessels going into or out of the liver, primary or delayed graft non-function, bile duct complications, renal failure and other infections.
9. What are the side effects of having a liver transplant?
After a successful liver transplantation (95% of patients) – the patient is advised to take care of infections and to take anti-rejection medicines for life. The patient can return to normal quality of life and can return back to work in three months time. The patient has to regularly follow up with the surgeon in the first year and later at regular intervals as advised by his doctor. He will require blood tests to determine that his liver functions and to adjust his medications in the beginning and later the tests are infrequent. The patient is advised not to take any herbal or alternative drug treatment.
The transplant patient is assessed regularly for various complications like rejection, infection, narrowing of blood vessels etc., and appropriate treatment is initiated. Post transplantation, he is under the guidance of his doctor throughout his life. Any health problems that do come up have to be investigated and treated, though they are infrequent.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Breast cancer begins when cells in the breast(s) start to grow out of control. It is understood as being the most common cancer, seen predominantly in females, globally. It is reasonably treatable and often curable.
1. Type: Adenocarcinomas constitute more than 95% of breast cancers with infiltrating ductal carcinoma (IDC) being the most common form of invasive breast cancer.
Frequently occurring breast cancers present as one of the following types mainly
1. Ductal Carcinoma In Situ (DCIS): Is the most common type of non-invasive breast cancer and is confined to the milk ducts of the breast. There is no invasion in the basement membrane. Pure DCIS metastasizes rarely. Non comedo cribrioform carcinoma is the most common DCIS found which, when compared to the comedo type, is mostly non-aggressive.
2. Infiltrating Ductal Carcinoma (IDC): Represents majority (about 3/4th) of the breast cancers, and is known to metastasize commonly to bones, lungs and liver.
3. Lobular Carcinoma In Situ (LCIS): Develops in multiple lobules of the breast (bilaterally). LCIS is less commonly seen, compared to DCIS.
4. Infiltrating Lobular Carcinoma (ILC): Represent about a tenth of all breast cancers and tends to metastasize to other regions of the body.
Less commonly occurring breast cancers such as
5. Inflammatory Breast Cancer: Is relatively uncommon and are caused probably owing to viral infections. The breast is warm, red and swollen.
6. Paget’s disease of the nipple: Is a rare form of breast cancer. It begins in the milk ducts and spreads to the nipple and areola.
7. Medullary Carcinoma
8. Mutinous Carcinoma
9. Tubular Carcinoma
10. Phylloides tumor etc all.
2. Gender: Affects the female populace predominantly. However, a small percentage of breast cancer is attributable to the male populace as well.
3. Etiology: No definite cause is known. However, diet, lifestyle, environment, hormonal/ reproductive factors, personal or family history of breast cancer especially in first degree relatives and also any benign breast disease history etc all are known to increase the risk of breast cancers. Specifically, excessive fatty diet, obesity, type 2 diabetes mellitus, benign breast disease, heredity/ inheritance of mutated breast cancer genes 1 (BRCA1) and 2 (BRCA2), smoking, alcohol intake, infertility, estrogen therapy/ hormone replacement therapy (long term) in post menopausal women, delayed age at first pregnancy, nulliparity (not having child), early menstruation, delayed onset of menopause, lactating mothers not breast feeding, exposure to ionizing radiation, sedentary lifestyle, depression, exposure to MMTV virus etc all can potentially increase the risk for breast cancer.
4. Features: Signs & symptoms, of breast cancer, manifest majorly in the following ways
Lump/ nodule in the breast that gets attached to the skin of the breast over time. The lump / nodule could be hard and painless with irregular edges or it could also be soft, rounded, tender and painful.
Enlarged lymph nodes in the axilla which are palpable.
Swelling of whole or a part of a breast. This is even if there is no distinct lump felt.
Retraction or thickening of the nipple(s).
Pain in the breast or nipple.
Discharge from nipple other than breast milk.
Irritation/ scaliness of skin over the breast.
Redness of nipples
Rarely, red, swollen and tender breast.
5. Screening: Is generally recommended for asymptomatic populations goal of which, as usual, is to be able to detect & diagnose breast cancer at an early stage which is potentially curable. It is mostly radiologic with mammography/ USG being instrumental in raising suspicions for further diagnostics (i.e. biopsy) that help detect breast cancer, if any, early.
6. Diagnosis: A self-examination/ clinical exam of the breast(s)/ axilla that reveals a palpable mass prompts the following diagnostics. Abnormal blood test results may be indicative of malignancy, but a follow up imaging/ biopsy is always the gold standard for accurate diagnosis.
- Blood: ER/ PR/ HER2/neu, uPA, PAI-1, CA15-3, CA27.29 etc all tumor markers are helpful.
- Imaging: Mammography/ USG Scan usually, as relevant. Again, CT Scan of abdomen & pelvis and chest, PET CT scan, bone scan etc all help detect metastasis, if any, for cancers in stage III & above.
- Biopsy: either excisional, incisional, fine needle aspiration (FNA) or core biopsy technique, as contextually appropriate, is frequently employed and a histopathological examination (HPE) thereof clinches the diagnosis and the nature of the disease.
7. Treatment: Conventional treatment includes surgery, radiotherapy, hormone therapy/ chemotherapy as deems appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.
8. Prognosis: Preventive measures, earlier diagnosis and right early treatment is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage breast cancer are more. The cure/ recovery chances are influenced by the type, grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. Above-mentioned apart, age, menopause status, lymph node status, ER/ PR/ HER-2/ neu status, size & extent of breast cancer etc all also influence the treatment outlook in breast cancer. The five year survival rate is strongly correlated with the stage of breast cancer.
9. Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an increased focus on protective factors and avoidance of the risk factors can be of help. 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 reducing the risks of breast 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. Limiting dosage/ duration of hormone therapy, if any, especially to counteract post menopausal symptoms and also avoiding exposure to radiation and environmental pollution can help reduce the risks of breast cancer. Apart from the above-mentioned, for high risk cases, a prophylactic oophorectomy, prophylactic radical mastectomy, long term hormone therapy etc all can help reduce the chances/ risks of developing breast cancer significantly. Breastfeeding is known to confer protection against breast cancer risk too.
My MRI report says, Mild posterior broad base protrusion of L4-L5 intervertebral disc resultant mild central and lateral canal narrowing causing mild compression over thecal sac and right traversing L5 nerve root. I am doing bed rest from 10 days, what's the report says.
My husband hs cirrhosis of liver stomach very distended+an ugly umbilical hernia+very dry skin+rash on legs +occasionally loose motions+disinterested in everything+lathargy+very weak+no energy+ frequent urination at nite with the result doesnt sleep well at nite. Medications urimax, lasilactone, lasix, heptapro. Are all these symptoms related to the cirrhosis. Latest sonography report shows right lobe of liver is contracted n left lobe is enlarged with coarse bright echogencity with nodular surface. Intraheatic biliary radicles normal. Cbd normal. Portal vein is patent. Gallbladder is distended with no calculi or polyps spleen is borderline enlarged. Free fluid is noted approximately 200cc impression cirrhosis of liver borderline splenomeagly. Cortical calcific speck in both kidney s free fluid 200cc can you tell how serious is this condition his sodium is low 126.
The spinal cord is like a cable consisting of millions of nerves that transmit messages in the form of electrochemical signals from the brain to the rest of the body, and also sensations from the body back to the brain. We are able to perceive pain and move our limbs because of messages sent through the spinal cord.
The spinal cord is soft and vulnerable to injury. It is protected by the bony structure of the vertebral column. A spinal cord injury can happen if there is a fracture of the spine. Sometimes, even if the vertebral column is intact, violent shaking can cause cord contusions. It’s an extremely serious type of injury that is likely to have a lasting and significant impact on most aspects of daily life.
If the spinal cord sustains an injury, some or all of these impulses may get blocked. The result is a loss of sensation and mobility below the level of injury. A spinal cord injury closer to the neck will typically cause paralysis throughout the body, while one in the lower back may affect the legs but spare the hands.
A spinal cord injury is often the result of violent trauma. Events like spontaneous hemorrhage, infection, tumors or autoimmune diseases can also cause spinal cord damage. Some causes of traumatic injury to the spinal cord are :
- trauma during a car accident (specifically, trauma to the face, head and neck region, back, or chest area)
- falling from a significant height
- head or spinal injuries during sporting events
- electrical accidents
- a violent attack such as a stabbing or a gunshot
- Diving head first into water that’s too shallow and hitting the bottom
Some symptoms of a spinal cord injury include:
- Neck or back pain
- Pain radiating along limbs, or numbness/ pins and needles sensation along the arms or legs.
- Weakness of particular muscle groups in focal injury, to complete paralysis in severe injury.
- Clumsiness during finer actions using the hands.
- Unsteadiness or loss of balance while walking.
- Loss of control of the bladder or bowels You must take immediate precautions
If there is the slightest suspicion that someone has a back or neck injury:
- Call 911 or your local emergency medical assistance number
- Do not move the injured person – permanent paralysis and other serious complications may result.
- Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives • Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck
- If movement is absolutely necessary, arrange a cervical collar, then log-roll onto a stiff spine board or flat surface, taking care that all parts of the body move together and that any relative movement between one part of the spine to the next is avoided.
Because spinal cord injuries are often due to unpredictable events, the best you can do is reduce your risk. Some risk-reducing measures include:
- always wearing a seatbelt while in a car
- wearing proper protective gear while playing sports
- never diving into water unless you’ve examined it first to make sure it’s deep enough and free of rocks
- increase protective measures to avoid falls from height
Seek the opinion of a Neurosurgeon or an Orthopedic spine surgeon as soon as possible. X-rays, CT scan or MRI scans may be advised for assessing bony or soft tissue injuries of spine. Minor injuries require only immobilization and rest. Severe injuries, however, may require steroid injections and surgical intervention. Time is of essence, and an early surgery in certain situations may save a limb that would otherwise be paralyzed for life.
Becoming a mum can lay down a whole lot of stress on you. But now you know that your brain is going to help you with all the adjustment s! ah ah a relief you get when your baby gives you a hug by kissing your cheecks the joy you get is amazing and gratitude to the almighty creater
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.