Doctors in Fortis Escorts Hospital - Jaipur
Cardiothoracic Vascular Surgery
Patient Review Highlights
I read about Dr.Neeraj Nagaich on one of the social media platform. The facilities available in the Fortis Escorts Hospital are very nice. Even though it's been more than a year to his treatment, still if I sometimes feel pain and call him, and Neeraj Nagaich still takes my call in case of any emergency. It was so quite pleasant in the Fortis Escorts Hospital. He never gets frustrated, even when I ask a number of queries. Overnite my gastric problem aggravated. Over the period of time I noticed a number of changes in myself.
I was suffering from severe constipation. Thanks to my Dr Neeraj Nagaich perfect advice. He has so much knowledge that for everything my family takes herreference. It was amazing, the Fortis Escorts Hospitall was so nicely made. I feel strange that I am suffering from constipationHe is not just friendly, but also is very motivating.I am glad that i visisted herclinic for the treatment.
So many doctors I consulted, but His/Her treatment was the best.I went to dr Neeraj Nagaich at Fortis Escorts Hospital in Delhi.He is so pleasant to talk to and always ready to answer your doubts.I am so much benefitted with his treatment, that i am perfectly fine now.
I am very happy with dr Neeraj Nagaich and his treatment he gave me for anxiety problems.it changed my life I feel happy and normal which I was not since last two three years. I gathered courage and visited him for therapy at Fortis Escorts Hospital in Delhi.
dr Neeraj Nagaich gave me a very effective and good treatment for my anal fissure issue at Fortis Escorts Hospital in Delhi. He is a very friendly and understanding doctor. God bless him!!
Consultation with Dr. Neeraj had been a superb experience for me. It's amazing to have a Fortis Gastroenterologist responding in such a detail oriented, cooperative & timely manner.
There may be a million jokes on constipation but anyone suffering from this condition knows that it is no laughing matter. Constipation can be described as a condition where a person has difficulty to pass stool. Lack of fiber in the diet is one of the most common causes of constipation. This can also be caused by irritable bowel syndrome, lack of exercise, medicinal side effects and a change in routine. Constipation can be easily treated at home and rarely needs medical attention unless it triggers a more serious condition.
Some ways of treat constipation are:
1. Exercise: Inactivity can hinder the digestion process. Taking a short walk every day can be a very effective way of dealing with constipation. However, you should maintain an interval of at least an hour between your last meal and exercising. Ideally, you should walk for a minimum of 20 minutes a day.
2. Drink more water: Water not only hydrates the body, but also helps food move smoothly down the digestive system. A lack of water can lead to blockages in the digestive system triggering constipation. Drinking 8 to 10 glasses of water a day is the minimum amount of water each person. However, water must not be substituted with sodas and flavoured drinks. Alcohol and caffeine can actually dehydrate the body and make you feel more constipated.
3. Eat more fiber: Adding fiber to your diet is a sure shot way of curing constipation. To do this, add a serving of fruits and vegetables to your daily diet. Oats and cereals are also good ways of adding fiber to your breakfast.
4. Create a schedule: The body craves order and when that order is disturbed one of the ways the body reacts is by triggering constipation. Schedule time for your bowel movements and try sticking to your routine as far as possible.
5. Change your position: The way you sit on the toilet can make a difference to your bowel movements. To combat constipation, try raising your feet by putting them on a stool in front of the toilet. This helps flex the hips and puts your bowel in a squatting position that makes it easier to pass stools.
If none of this helps, you could also take an over the counter laxative or stool softener. However, do not use a laxative for over 2 weeks without consulting your doctor. Overuse of laxatives can make the body dependent on it and affect the body’s ability to absorb vitamin D and calcium. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.
The largest internal organ in the body, the liver, is also one of the silent heroes, which performs close to 500 functions. It produces energy, fights infections, gets rid of wastes, and is a metabolic factory.
There are four major types of liver diseases out of which alcoholic liver disease accounts for about 40% of them. Other types include non-alcoholic liver disease, viral hepatitis and autoimmune (chronic) hepatitis.
Risk factors: The severity of drinking habit is directly proportional to the chances of developing alcoholic liver disease. People who consume more amount of alcohol are more likely to develop the disease. However, it is also not necessary that every person who consumes alcohol develops liver disease.
Following are obvious risk factors for developing alcoholic liver disease.
1. Alcohol dependency: While enjoying a drink is not barred, getting the body dependent on alcohol for regular functioning is definitely a no-no. The rate of developing the disease in people dependent on alcohol is as high as 70%.
2. Females: The way alcohol is metabolized in females could have an effect on the higher risk they face in developing alcoholic liver disease.
3. Obesity: Excessive weight puts additional stress on the metabolic effects of the liver and therefore has a higher tendency to develop alcoholic liver disease.
4. Family history: Strong familial history increases the risk of developing alcoholic liver disease.
Symptoms: The difficulty in diagnosing the disease lies in the fact that there are no clear-cut symptoms that can indicate the diagnosis. Initial general symptoms include fatigue, poor appetite, abdominal pain, nausea, weight loss, loss of energy, and red spider nevi (spider-like blood vessels) on the skin.
As the liver function continues to worsen, there are additional symptoms like swelling of the legs due to fluid accumulation, swelling of the abdomen, jaundice (yellow mucous membranes and skin), redness of palms, impotence, breast swelling, easy bruising, cognitive problems and clay-colored stools. This stage will see liver scarring and subsequent cirrhosis. The second set of symptoms is more diagnostic. An experienced practitioner will be able to suspect and diagnose the alcoholic disease with a detailed history and some liver function tests.
Treatment: If identified early and alcohol habits are reversed, the damages of the liver can be completely reversed. In addition, the following lifestyle changes are suggested:
1. Low-salt diet
2. Hepatitis vaccines (A and B)
3. Medications to manage fluid retention, spontaneous bleeding and infections as the case may be
4. Excessive fluid accumulation in the abdomen may require removal
5. Shunt in the liver to repair blood flow
6. If cirrhosis stage is reached, a liver transplant may be required
While there are many ways to manage alcoholic liver disease, prevention is the best way. Limiting alcohol consumption can definitely help in the prevention of the disease. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.
The human body with its multiple organs is a highly complicated structure and one or more organs often malfunction for various reasons. However, for some, no reasons are identified for this problem. One such is irritable bowel syndrome or IBS as it is commonly referred to.
It is a common disorder affecting the large intestine leading to alternate bouts of diarrhea and constipation, abdominal cramps and a feeling of fullness. It is common in people younger than 45 years of age, affects women more than men, and though the exact reason is not known, the following are attributed.
1. Signal issues between the brain and intestines: For various or even unknown reasons, the brain may not be able to send the right signal to the stomach to process food, making the stomach to be hyperactive and have an increased sense of pain or sensitivity or discomfort. Neurotransmitters, which are chemicals responsible for sending signals to various organs also could be involved.
2. Hormonal connection: Menstrual periods tend to aggravate symptoms of IBS, while postmenopausal women are largely free of IBS symptoms.
3. Genetics: People with a family history of IBS are more likely to develop IBS too.
4. Aggravating foods: Foods rich in carbohydrates, spicy foods, fatty foods, caffeine and alcohol aggravate IBS symptoms. Ability to absorb sugar could be a cause too.
5. Infections: Some people with IBS have certain bacteria identified in their gut which produces excessive gas and this could lead to altered bowel movements.
6. GI Motility Issues: Alterations in the way the food passes through the stomach can lead to either constipation (slow movement) or diarrhea (quicker movement). There could also be spasms and contractions after eating, especially if the stress levels are high.
7. Psychological issues: Panic disorder, anxiety, depression, and post-traumatic stress disorder are common in IBS patients. It is possible that they are not able to express their psychological stress, it manifests as physical symptoms. Stress increases symptoms of IBS and vice versa.
1. Manage stress: Meditation, yoga, support groups, medication and even hypnosis in severely stressed people helps control stress, providing great relief in IBS symptoms.
2. Lifestyle changes: Reduce alcohol and smoking
3. Dietary changes: Avoid aggravating foods, increase the amount of fiber if you have diarrhea and space out meals to avoid intestinal overload
4. Herbal remedies: Probiotics, peppermint oil and a variety of herbal medicines are available.
5. Symptomatic medications: Based on presenting symptoms, different medications including antibiotics for infections and motility drugs can be used. Anti anxiety and antidepressants are also prescribed to manage the psychological issues.
In terms of causes, symptoms, or treatment, IBS requires a very individualized approach and your doctor is the right person to discuss this with and decide. If you wish to discuss about any specific problem, you can consult a gastroenterologist.
In healthy individuals, the liver contains little or no fat. In overweight or obese people, gradual fat accumulation leads to significant liver disease. Interestingly, these individuals may be consuming minimal to no alcohol. So, alcohol, which is the main cause for liver damage, does not have a significant role to play.
The non-alcoholic fatty liver disease (NAFLD) has 4 significant stages as outlined below. It is a chronically progressive disease and may take years to reach the final stages of cirrhosis and fibrosis.
1. Simple fatty liver (steatosis): This is usually identified when diagnostic tests are done for some other suspected conditions. There are usually no symptoms obvious in this stage, other than the buildup of fat in the liver.
2. Non-alcoholic steatohepatitis (NASH): The second stage where the liver is inflamed to a greater extent due to fat accumulation.
3. Fibrosis: The next degree of inflammation where blood vessels may be narrowed leading to scarring in the liver with impaired liver functions.
4. Cirrhosis: This is the most severe stage that occurs due to years of cumulative inflammation. The liver shrinks in size, is scarred, and liver functions are markedly impaired and can also result in liver cancer.
Risk factors for NAFLD: The exact reason why a person develops NAFLD is not established, but some of the risk factors include
1. Obesity, with more weight concentrated around the abdomen
4. High cholesterol levels
5. Age greater than 50
Symptoms: This will depend on the stage in which it is identified. While there are no symptoms in the early stages, in some people there could be a dull, aching below the ribs, unexplained weight loss, weakness, and extreme tiredness. As it progresses to cirrhosis, there could be jaundice, fluid accumulation in the abdomen and feet, and itching of the skin.
Management: While there is no treatment aimed at curing the disease per se, there are ways to manage the symptoms, as noted below.
1. Weight loss: Reducing excess accumulated fat will help reverse symptoms and prevent further progression of the disease. A BMI of 18 to 26 is considered optimal.
2. Dietary changes: Modify your diet to a carbohydrates and protein rich and reduced fats and sugars. Increasing fiber through fruits and vegetables is highly recommended.
3. Exercise: Whatever your choice of workout, it will do wonders for NAFLD. Keep a target of an hour or two of moderate to intense exercise per day to reduce weight.
4. Smoking: This is another risk factor and can also help prevent other effects of NAFLD such as diabetes and heart disease.
NAFLD is highly controllable with these changes and other damages can be reversed too. If you wish to discuss about any specific problem, you can consult a gastroenterologist.
The new epidemic that has taken the world by storm is obesity. The proportion of obese people is increasing and the age of onset of obesity is decreasing gradually. There is an optimal weight for a given height of a person. Obesity is when a person's weight is 20% more than the optimal weight. It brings with it a host of other health conditions, as it impairs the body’s overall functioning.
- Diabetes 2: In a normal person, food gets broken down into glucose to provide the required energy for the body using insulin. The body’s inability to produce sufficient insulin to convert the excessive amount of sugar in the body leads to diabetes. Growing to be a leading cause of early death, diabetes brings with it a host of complications affecting almost all systems and parts of the body including stroke, kidney disease, blindness, and death. Diabetes and obesity have a direct correlation and can be prevented and managed by eating a balanced diet, losing weight, exercising, and having a healthy lifestyle.
- Heart problems: An increased BMI also ups the risk for coronary heart disease (CHD), where the blood vessels are narrowed due to constant accumulation of fat in their inner walls. This gradually reduces the blood flow through these and may when complete cut-off happens, it could result in heart attack or stroke, affecting the heart or the brain. There could also be cases where the heart fails to pump sufficient blood to the rest of the body, affecting their effective functioning. Obese people also have a higher blood pressure than people who maintain a good BMI.
- Breathing problems: One of the main causes of labored breathing is excessive weight. The condition called sleep apnea which is sudden bouts of absence of breathing during sleep is very high in obesity. It can cause snoring, daytime sleepiness, increase the risk of heart disease and stroke. In people with sleep apnea, weight loss is one of the first and most recommended therapies. Asthma and general breathing disorders are also higher in obese people.
- Abnormal body cholesterol: Obese people also tend to have abnormally higher levels of body fat, especially the bad cholesterol, which again leads to coronary disease. It is a vicious cycle with one leading to the other and aggravating the other.
- Osteoarthritis: Added weight leads to pressure on the hips, knees and lower back. There is added wear and tear and pain, which further limits movement.
- Cancer: Some cancers, of the colon, endometrium, kidney, pancreas, gallbladder, breast and esophagus are more prevalent in obese people.
These are just some, there are more. The best way to avoid all these is to watch your weight. If you wish to discuss about any specific problem, you can consult a doctor.
A cut on your skin can be seen by the naked eye, but injuries and infections to internal organs are not so easily visible to the eye. The procedure to view and operate on the body’s internal organs is known as an endoscopy. An endoscopy is performed using a flexible tube with a camera attached at one end known as an endoscope. This is inserted into the body though a natural opening in the body such as the mouth or through a small incision on the body.
While the camera gives the doctor a view of the internal organs, forceps or a pair of scissors can be used to operate or remove tissue that needs to be biopsied. Since an endoscopy is performed without making large incisions, it negates the development of scarring.
Types of Endoscopies
Endoscopies can be used for both diagnostic and therapeutic purposes. It is also one of the means for early detection of cancer. There are 11 main types of endoscopies which include:
1. Arthroscopy: This is used to get a closer look at joints. In such cases, the endoscope is inserted into a small incision near the joint being examined.
2. Bronchoscopy: This procedure is used to examine a patient’s lungs. It involves the insertion of a scope into the nose or mouth to give a view of the lungs.
3. Colonoscopy: In this procedure, a scope is inserted through the anus to get a view of the colon.
4. Cystoscopy: When the bladder needs to be examined closely, an endoscope is inserted through the urethra. This is known as a cystoscopy.
5. Enteroscopy: This is a procedure where the scope is inserted through the mouth or anus to get a look at the small intestines.
6. Hysteroscopy: Here a scope is inserted through the vagina to get a look at the inside of the uterus.
7. Laparoscopy: It is an endoscopy to examine the abdominal area is known as a laparoscopy. This scope is inserted through an incision in the abdomen.
9. Mediastinoscopy: By inserting a scope into an incision above the breastbone, doctors can get a look at the area between the lungs. This is known as a mediastinoscopy.
10. Upper gastrointestinal endoscopy: Examining the esophagus and upper intestinal tract by inserting a scope through the mouth is known as an upper gastrointestinal endoscopy.
11. Ureteroscopy: This procedure is used to examine the patient’s ureter by inserting a scope through the urethra.
In most cases, pain anywhere in the body can be explained as a symptom of some other problem, but sometimes, there is no reason for abdominal pain. This type of pain is known as chronic functional abdominal pain. This is a gastrointestinal disorder that cannot be explained through X-ray or laboratory findings. It can be triggered by altered sensitivity to nerve impulses in the brain and gut. People suffering from this condition are often so debilitated by the pain that it becomes the central focus of their life.
This condition cannot be cured, but with proper treatment, it can be managed so that it does not affect the quality of your life. The aim of treatment for this condition is to control the symptoms and improve functioning. When it comes to treating this condition, the patient’s relationship with his or her doctor plays an important role as the condition cannot be proven through any form of testing and it has a great psychological effect on the person. Regular checkups are also a key to managing this condition effectively.
The first step towards achieving this is to identify possible emotional and situational triggers. Maintaining a journal that records these experiences can help with this. Further treatment is usually either through psychological treatment or antidepressants.
Psychological treatment is based on the understanding that the brain can block pain by diverting attention elsewhere. Nerve impulses that travel from the abdomen to the brain must pass through a type of ‘gate’ that is controlled by nerve impulses generated by the brain. When these impulses close the gates, pain is blocked while when these gates are open, the pain can be magnified. Psychological treatment for chronic functional abdominal pain can be in the form of relaxation techniques, imagery, hypnosis and cognitive behavioral therapy. While relaxation techniques such as meditation and hypnosis help a person shift focus from the pain, cognitive behavioral therapy teaches a person how to change thoughts and perceptions in order to control the pain.
Antidepressants can also act as pain relievers. This form of medication stimulates the production of brain signals that close the ‘gates’ of nerve transmissions. This blocks the pain but can take several weeks to be effective. Some people may experience side effects such as drowsiness and nausea and hence should never be taken without a doctor’s supervision. In some cases, antidepressants may also be combined with cognitive behavioral therapy or medication to regulate bowels. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.
For a healthy body, proper digestion and absorption of food is very important. The digestion is an extremely intricate process and involves many organs. Impairment in any of the organs can hamper the digestive process, leading to a very common condition called dyspepsia. It is caused by malfunction of one of the muscular organs along the digestive tract including esophagus, stomach, small and large intestines and colon.
Causes: While dyspepsia is more a symptom, there are various reasons that lead to it including gastritis, peptic ulcer disease, infections, motility disorders, gastroesophageal reflux disease (GERD), cancers of the digestive tract or any other abnormality in the digestive tract.
Evaluation: When a patient has chronic dyspepsia or indigestion, the first thing to do is a thorough evaluation to find out the underlying cause. As noted above, there are functional and nonfunctional causes leading to dyspepsia. While gastric ulcers or polyps are visible during an endoscopy, conditions like gastritis and malignancy can only be diagnosed under microscopic examinations.
Some of the tests that are used for evaluation of the cause of dyspepsia include:
1. X-ray: Any growth would be visible on an x-ray and further testing can then be done to confirm the exact nature of it.
2. Endoscopy: This will allow the doctor to see the actual digestive tract and identify any structural abnormalities or growth.
3. Colonoscopy: If the problem is suspected to be in the lower gastrointestinal tract, then a colonoscopy may be in indicated.
4. Gastric emptying study: This study can also reveal the abnormalities in the digestive tract
5. Culture: Dyspepsia caused by Helicobacter pylori can be diagnosed through cultures of the stomach contents.
Treatment: The treatment of dyspepsia is quite complicated and cannot be clearly outlined given the various conditions that it is associated with. Even specific foods can induce indigestion in some people. Therefore, a multipronged approach is required to treat dyspepsia.
Education: The affected person should be educated about the non-life-threatening nature of the problem and its chronicity. Some of the drugs used in treatment include:
1. Proton pump inhibitors: These reduce the amount of acid produced in the stomach and thereby help in relieving symptoms.
2. Promotility drugs: They improve the movement of the muscles in the intestinal tract and are so used in managing dyspepsia.
3. Antibiotics: If an infection is suspected, antibiotics are effective.
4. Smooth muscle relaxants: Drugs like hyoscyamine and methscopolamine have been shown to provide relief in some patients.
5. Psychotropic drugs: Anxiety and depression are frequently seen in people with dyspepsia, and managing these can help reduce the dyspepsia.
As noted, the causes, symptoms, and management are very specific to individuals and needs to be managed by the doctor.
Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.
This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.
This is inserted through the patient’s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient’s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor’s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.
ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:
• Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.
• Persistent upper abdominal pain
• Unexplained weight loss and loss of appetite
• Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater
ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient’s needs.