Fortis Hospital - Noida

Hi, I am Dr. Deepak. Rathi, Ayurveda Specialist. Aaj mein aap ko piles ke bare mein bataunga. Is problem mein patient ko bohot pain hota hai. Ismein patient ko bleeding, pain or kabhi-kabhi masse bhi bahar aane lagte hain. Ismein swelling aa jati hai. Ismein wound ho jata hai and bleeding bhi hoti hai. Ye external and internal problem hoti hai. Ismein aap medicines le sakte hain ya fir surgery kra sakte hain ya fir ayurvedic sharsutra therapy le sakte hain. Is therapy se is disease ko manage and control kia ja skta hai. Ismein bleeding and pain ki problem 7-10 days mein hi control ho jati hai. Ismein internal masse shrink bhi ho jate hain. Surgery major hoti hai jismein aap ko anesthesia diya jata hai.

Logon ke liya ye ayurvedic therapy boon hai. 3-4 days mein ye thread shed off ho jata hai. Ayurvedic medicines se roots bhi khatam ho jati hain is disease ki. Is disease ko control karne ke liya aap constipation ko control rakhen. Iske alwa pani jayada piyein. Fibre rich diet len. Fruits and vegetables jayada len. Fast food and maida kam khayein. Fried chizen na khayein. Agar aap ko koi information chaiye to aap mujhse Lybrate ke through contact kar sakte hain. Thank You.

Hi,

I am Dr. Atul Mishra, director and head of the department orthopedics. Now we are talking about osteoarthritis of the knee. Osteoarthritis of the knee joint is the most common cause of pain in the knee, ghutne mein sujan, dard aur iss tarah ki pratikriya jo hai at the age of around 55 to 60 years hoti hai patients ko, isi ko osteoarthritis bolte hain. Osteoarthritis mein jo basic abnormality hai wo ye hai ki ghutne ke andar jo surface pe jo cartilage hai vo cartilage ke andar chote chote ghaav ban jate hai, vo ghaav andar bleed karte hai or pain karte hai jisse patient ko dikkat hoti hai chalne mein, roz marra ka apna kaam karne mein, sidhi chadne utarne mein. In fact, kuch mareez hamare paas is condition mein bhi aate hai jisme vo apne bed se uthke toilet tak bhi jane mein asamarth hote hai.

To hume ye dekhna hai ki awareness badhe, patients jo hai vo sahi samay pe doctori salah le paye or osteoarthritis se ek jo crippling vise jo stage hoti hai jisme insaan itna majboor apne aap ko feel karta hai ki vo thoda bohot bhi na chal paye vaise paristithi na aye. Kul mila ke 10 lakh se zada log hamare desh mein is bimari se peedit hai. Shuruvati lakshano ke andar ghutne mein sojan hona, jaha tahan ghutne ke aajo bajo aas pas dard hona, rozmarra ki activity jisme sidhi chadna utarna, niche baith ke prarthana karna, puja karna ye sab cheeze patient karne mein asamarth hojata hai. Ye bimari jo hai isme dard ek waxing and waning type phenomena hota hai, patient do mahine theek rehega or teesre mahine patient ko ye problem ayegi, phir wo kuch pain killers, kuch balm, iodex laga ke apna kaam chalata hai, problem kam ho jati hai lekin andar hi andar joint ka degeneration jo hai vo hota rehta hai. Ultimately the best possible way is to consult a doctor as early as possible or doctori salah ke andar kuch minimum amount of pain killers taki soojan aur dard kam ho vo shuru karna chahye aur ek X-ray jo hota hai jisme ghutne ki paristhiti pata lagti hai vo kara lena chahiye. X-ray se ye clear-cut define ho jata hai ki haddi ya haddi ke andar ka cartilage vo damage hua hai ya nahi hua hai.

Ek MRI scan usse bhi kafi kuch pata lagta hai. MRI cartigram naam ki ek nayi jaanch hai jo ki aaj kal hamare desh mein uplabdh hai, usme cartilage ka volumetric analysis bhi ho jata hai jisse ye maloom chalta hai ki kitna healthy articular cartilage ghutne ke andar bacha hai aur is tareeke se hum bimari ka prognosis jo hai woh determine kar sakte hai. Activity modification upchar ke liye bohot jaroori hai. 3 activities aisi hai jo ki hum patient ko bolte hain ki three activities like climbing of stairs woh kam se kam kare agar disease active hai to, niche ukdu baithna Indian style toilet mein woh kam se kam kare aur padmasan laga ke baithna yani ki ghutne ko 120 degree se zada mod ke rakhna ye aisi 3 cheeze hai jo aap apni activities daily activities mein thoda kam karein to ghutne ke andar articular cartilage mein pressure kam padega or pressure kam padega to uska wear and tear jo hai vo slow hojaega. Iske saath saath physiotherapy, regular exercises, cycling, swimming or walking iska ek apna mehtva aur apna role hai. Ye activities hamesha patient ko hum salah dete hai ki vo karte rahe taki disease badhe na.

Disease ka ghutne ke andar jo progression hai vo slow rahe. Pain killers kam se kam lene chahiye kyunki pain killers se kidney ke upar or pet ke andar gastritis, ye 2 cheeze aisi hai jispe iska dushprabhav jo hai pain killers se padta hai. Disease modifying agents kafi sare available hai aur kuch injections bhi available hai jo ki ghutne ke andar lagaye ja sakte hai, jo ghutne ko andar se lubricate karte hai or cartilage ki healing process jo hai use enhance karte hai. Activity modification aur injections in sab cheezo ke saath saath mein ek nayi padhti jisko sarkar se manyata abhi mili hai wo hai autologous chondrocyte transplant. Autologous chondrocyte transplant jo hai vo ek jo young patients hai hamare jinko bohot jaldi jo hai ghutne ke andar cartilage ka wear and tear ho jata hai khaskar chot lagne se, jab cartilage ke andar chot lagti hai, ghutne ke andar chot lagti hai or cartilage jo hai woh scruff off hoke, rub off hoke us ek chip ki tarah vo nikal jati hai, aisi paristhiti mein vo samay ke sath bohot hi kharab tareeke se ghutne ko kharab kar sakti hai.

Early stage ke andar khaskar young patients mein jinko chot lagne ke bad cartilage ki problem shuru ho, vaha par autologous chondrocyte transplant jaisi padhti jo hai vo bohot upyogi hai. Is padhti ke andar hum patient ke cartilage ke kuch cells jo hai vo lab mein regenerate karte hai aur fir 1.5-2 mahine me jab vo cells kafi regenerate ho jate hai lab mein, to fir ghutne ko chota sa incision laga ke, ghutne ko khol ke unko hum re-implant kar dete hain ghutne ke andar. Lekin ye padhti young patients ke andar kafi successful hai aur iske iski jabse abhi manyata jabse sarkar se mili hai to isse kafi mareez jo hai laabhanvit hue hai. Autologous chondrocyte transplant ke alava jab mareez ki condition aisi ho jati hai jiske andar vo cripple hona shuru hojata hai yani ghutne ki bimari ke sath mein pair ke andar alag alag tareeke ki deformity woh sab develop ho jaye aur pair tede ho jate hain, to aisi condition ke andar knee replacement naam ki jo padhti hai woh bohot kargar hai. Knee replacement surgery koi nayi ya koi vishesh tareeke se kari jane vali nahi hai, pichle 10 ya 12 saal mein is surgery ke andar bohot sare technical advancements hue hain.

Mai ye kehna chahunga ke actual mein knee replacement aisa surgery hai jo ki jisme hum ghutne ke andar pura ghutna nikal ke koi kambje vala jod nahi dalte. Basically ye surgery ki philosophy ye hai ki hum iske andar ghutne ke upar ke surface jo hai vo change karte hai. To sahi mayne mein isko surface replacement kaha jata hai. Ye ek model hai jiske andar ye ek artificial knee hai aur is artificial knee mein knee replacement kaise kaam karta hai ye dikhaya gaya hai. Jo upar ki haddi hai jise femur bolte hai usme ye is tareeke se cap ki tarah se ye upar ka component lag jata hai aur niche ki haddi yani tibia uske andar ye tibial tray ki form mein lag jati hai aur upar aur niche ke components ke beech mein ek ye high density polythene hota hai. To upar ka component is high density polythene pe glide karta hai is tareeke se aur yahi kritrim joint ya knee replacement ya surface replacement ya pratyaropad hai. Ab aaj kal jo technical advancements hai usme biomaterials ke upar nayi cheez samne jo ayi hai vo pichle 2-3 saal se naye biomaterials jaise ki gold knee naam se available hai.

Inn biomaterials ka jo sabse bada advantage hai vo ye hai ke inke implantation ke baad patient ko kisi bhi tarike ka koi allergic phenomena nahi hota hai kyunki usme ek alloy ka upar se coating hota hai. Dusri yeh hai ki woh zada uski surface property jo hai woh zada acchi hai, vo zada chikna hota hai to isse patient ko artificial jo hum surface lagate hai uski jo longivity hai vo mil jati hai. Normally ek knee replacement ka life jo kritrim joint hai uska life 10-15 saal hota hai lekin nayi technological advancement se, naye biomaterial se ab iski life 20-25 saal tak badh gyi hai. Dusra inke banavat mein, kafi revolutionary design mein, kafi technical advancements hue hai, pehle jo designs hote the wo kafi crude the lekin ab jo designs hai unki surface geometry ek is tareeke se hai joki ek insaan ke ghutne ko bohot closely match karti hai. Isilye ye knee implantation ke baad mein patient ko kafi kuch original joint jaisa hi feel hota hai, natural feel hota hai aur usme patient ko ek jo pehle ek abnormal sensation ati thi vo nahi ati hai.

Dusri cheez hai kyunki ye itna disabling disease hai aur pehle logon ke mann mein dar tha lekin ab patients ka acceptability is surgery ke liye bohot badh gya hai aur ye bohot hi safe operation hai aur agar ye ek ache centre par, ek experienced surgeon se aap karvayenge to patient ko hamesha laabh milega aur kisi tareeke ki pareshani nahi ayegi.

Thank you very much!

Hi!

I am Dr. Nitin Jha, Fortis Hospital, Noida me a senior consultant, laparoscopic surgeon hun. Stomach ke major problems ko hum laparoscopic surgery se treatment krte hain. Aaj me sabse common symptoms acidity and gas ke bare me discuss krenge. Kuch logon ko khana khane ke baad peat fulna or gas formation, khatte dakar aana or kbhi kbhi adha pacha hua khana vapsa muh me aana. Ye sab upper GI ke symptoms hote hain. Iska sabse common cause hai gallbladder stones. Iske or bhi symptoms hai jaise muh me kadva pani aana, khatte dakkar aana, indigestion hona. Isko noral condition maanke hum normal tablets lete rehte hain.

Or fir kuch time baad jab pain jhela nhi jata to hum hospital jate hain. Uske baad diagnosis hota hai jisme kbhi gallbladder stone paya jata hai or hiatal hernia milta hai. GERD me khana upar se niche jane ke baad niche se upar bhi aa skta hai. Is bimari me itna major ho jata hai ki stomach bhi chest tak aane lgta hai. Hiatal hernia ko medicines se control krne ki koshish krte hain. Ise prevent krne ke ek baar me heavy khana nhi khana, thoda khana khana or bar bar khana, khana khane ke baad turant nhi letna and thoda walk krna, in sabse isko control kia ja skta hai. Bina surgery ke hi ise thik kia ja skta hai. Lekin in sab ke bad bhi agar ye overcome na ho to surgery di jati hai.

Iska operation laparoscopy se kia jata hai. Laparoscopic nissen fundoplication surgery ka name hai. Isme hum stomach ko niche late hain. Chest and stomach k bich ke gap ko thik kia jata hai. Is se stomach abdominal cavity me rhega and chest me nhi jayega. Isme khana niche ko hi puch krega. Islia simple advice hai ki acidity and gastric problem ko avoid na kren. Iska proper diagnosis bhut important hai taki surgery tak jane ki requirement na pade. Medicines lene se bhi apko problem ho skta hai. Islia kbhi bhi aisa problem ho to consult your surgeon. Agar aap mujhse koi information lena chahen to Lybrate ke through contact kar skate hain.

Thank You!

Hernia: Types, symptoms and treatment

Yeah! Hi, I’m Dr. Nitin Jha, I’m a senior consultant laparoscopic surgeon at Fortis hospital, Noida and I also have a clinic in sector 61 Noida which goes by the name of Agarwal Clinic and today we’ll be discussing about Hernia.

By Hernia we mean that there is a small gap in the muscle of the abdomen wall and through this gap there is a protrusion of the contents which are inside of the abdomen like small intestine or the, even large intestine or the omentum fat and which tries to come out of this hole and as long as they go out and then they come back it’s okay. But the day it gets stuck, you know if you have a swelling in which the swelling refuses to go in, that means it is like an emergency then you have to immediately go to the hospital and get it operated upon.

Now, what is the cause, the basic cause of any hernia is, the weakness in the muscle wall and it can be even sometimes without any cause. That is called as Idiopathic. Now, there are basically there are three types of common hernia that we all encounter. The one is the Inguinal Hernia which are present in the lower part of the abdomen on the left as well as on the right side. Then you have our Umbilical hernia which is a hernia in the umbilicus itself, so that in the umbilicus instead of being a pit it becomes a elevated out pouching and then you have something called Incisional hernia in which after any surgery in the abdomen you can have a small bulge occurring from that incision side which is called basically insicional hernia. So be it any type of hernia the treatment is always surgical only. In contents, the usually, the intestine, the small ball, the large ball or the omentum fat can be the content of the hernia.

Now, What is the problem? Why to get it operated? As long as, as I told you, as long as it comes out and then goes back in, it is okay. But the day it refuses to go back in, that means it has become a bit complicated hernia. It starts with irreducibility, matlab, it doesn’t go back inside. Then there is something called as obstruction in which the intestine gets stuck in that pouch and it causes obstruction of the intestine. That is obstruction to the flow of the contents of the intestine. In that case the abdomen becomes bloated, the patient is not able to pass gas or motion from below and he or she can have a continuous vomiting from up. So, and obviously if the time goes on like this because of a decrease in blood supply of the intestine, the intestine can sometimes become strangulated. In that case it is an emergency and we have to immediately go to the surgeon and get it operated upon because if we give it more time the intestines can lose its blood supply and then we have to do a proper, major, big surgery. In which we have to cut the caught part of the intestine and rejoin the normal part. So, obviously we should definitely avoid this kind of circumstances which increases the cost also and plus it increases the morbidity, the trouble to the patient also.

Talking about surgery we initially had only open surgery, in which a small cut almost of this size used to be given whether it was inguinal or umbilical or incisional, but it had its own problems. The issue was, with open surgery, was you had to have a big incision on the belly. Then the bigger the incision the more the pain. The bigger the incision the more the chances of infection. But usually now we don’t do it by open surgery. We do it by something called laparoscopic surgery, in which there are almost two or three small, small holes of the size of around 5 millimeter or 1 centimeter and through, without cutting open the abdomen, through these small, small holes only the whole surgery is done. So the advantage is the patient becomes alright much faster. He needs to stay in the hospital for lesser number of time. He can be back to his work probably in three to four days. But as the thing is you know is any good thing is costly. Similarly the laparoscopic surgery is costly because the mess and the things which are required to fix the mess to the abdominal wall are costly. But if you compare between these two methods, laparoscopic surgery is far, far, far better than open surgery.

My specialty is doing the same surgery which is usually done by all other laparoscopic surgeons by three or four small, small cuts, I do it by only one single cut. So, especially with a uncomplicated simple hernia of the anteroapical wall, be it incisional or be it umbilical or super umbilical hernias which is commonly referred as ventral hernia. They are done by single incision only. That means I just put a small cut almost of this size around 1 to 1.5 centimeters size in the left part of the abdomen and through this same incision we conduct the whole surgery. So, the patient has not three small cuts but only one small cut. That’s the advantage of single incision laparoscopic surgery. So, you can consult me at my clinic in

So, you can consult me at my clinic in sector 61 Noida, Agarwal Clinic C122 and, otherwise you can also meet me in Fortis hospital Noida. Plus you can take an appointment via Lybrate and we’ll be glad to discuss your problems, thank you.

Hi, I’m Dr Nitin Shah. I’m a senior consultant at Fortis hospital, Noida. I’m a laparoscopic surgeon. I do all sorts of abdomen surgeries. Today we are going to be talking about the gallbladder disease, in which there are stones formed in the gallbladder. We need to understand that patients can initially be absolutely asymptomatic. The patient can have no pain or any discomfort. Many times it is detected by routine health examinations when the patient undergoes an ultra sound of the abdomen.

The initial stages after asymptomatic, the patient starts having little bloating in the abdomen which is commonly referred as gas and acidity. So people have a tendency of neglecting it and keep on taking some antacid or pantocid or Digene and this kind of stuff to suppress the symptoms. So after dyspepsia, the patient starts having pain in the abdomen. This pain can initially very simple pain. It can even progress into severe pain. It starts usually in the pre-gastric region, upper abdomen and goes to the back. This is very typical of a bilicuric and increases after any fatty meal like any extra oily friend. This kind of stuff when we eat, the patient has more pain and then depending on the severity of the inflammation, even patients are known to have pus in the gallbladder, thereby, increasing the mobility of the disease.

Some stones can slip from the gallbladder into the bile duct thereby obstructing the bile duct and producing something that is called obstructive jaundice. In which the patient has severe pain and has visible jaundice also. These stones not only block the bile duct but also can block the pancreas duct thereby causing something called as gall stone pancreatic. So, this is another very severe problem. As we all know, gall bladder cancer is quite common these days. In 4% of the cases, the gall stones are the causes of gallbladder cancer. So, for a simple disease like a gall bladder stone, if not treated at the immediate time this can land up into very very severe problems. now once the diagnosis is confirmed it is a simple surgery called as lap coly cystectomy in which we remove the gallbladder in very small three to four cuts that is called the laparoscopic surgery. The same surgery was previously done with a big cut that’s called the laparotomy, cutting open the whole abdomen and then removing the gall bladder. Now it is done by three or four small cuts. In fact, my specialization is getting the same surgery done by a single incision in the ablycus. In which there is one cut in the navel and no cut anywhere else in the abdomen and hence the surgical cut is hardly seen. Probably, even after two months, the surgeon will also not be able to make out whether any surgery is done on the patient or not. The scar is hardly seen and it is very cleverly hidden in the ablycus.

So, for any further information or any question that you want to ask I am available at lybrate.

You can log onto lybrate or even text me or video chat with me on lybrate and I will be more than happy to clear all your doubts regarding any surgical disease and help you in the best way I can.