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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.
One of the things that Shannen Doherty and Rita Wilson, the wife of Tom Hanks, have in common, apart from their fame is that both were affected by breast cancer. No matter how normal a person may seem, breast cancer can strike anyone. In fact, it usually strikes one in eight women. So, it makes good sense to know what it can appear as!
Breast cancer makes up a rather big amount of the general cancer cases as 15% of the cancer cases which are reported on a yearly basis are usually breast cancer cases. That being said, there are quite a few things which can be done in order to reduce a person’s risk to breast cancer.
Effective ways to prevent breast cancer-
As with any other types of cancer, breast cancer is a condition characterized by uncontrolled and rapid cell proliferation and division in the breast, resulting in the formation of a malignant tumor. While breast cancer is known to be one of the most common types of cancer affecting women, men are also susceptible to the condition.
An early diagnosis of the condition gives a mercurial boost to the treatment for breast cancer, often ensuring a full recovery. Unfortunately, in most cases, breast cancer gets diagnosed at a later stage. Some of the symptoms commonly associated with breast cancer include:
- A change in the breast shape, size, or even the contour.
- The appearance of a lump in the breast, often pea sized.
- There may be a fluid discharge (can be clear or blood-stained) from the nipples. In addition to this, the skin around the nipples or the breast may undergo some change. It may appear red, inflamed, scaly or even puckered and dimpled.
In addition to the medications and treatment, a person with breast cancer can benefit by practicing the following tips diligently:
- Self-awareness: Nobody can know your body better than yourself. The associated complications of breast cancer can be averted if only people stop overlooking the early signs and symptoms. There are many government sponsored campaigns and programs to create awareness about breast cancer. Once a while, self-examine your breasts. Feel your breasts for any lumps or thickenings. If you notice any abnormalities, waste no time and consult a doctor at the earliest.
- BRCA1 and BRCA2 human genes: The BRCA1 and BRCA2 genes are important with regards to the breast cancer. These genes are responsible for the production of tumor suppressor proteins, which play a pivotal role in the repair of DNA damage (often resulting from mutations or diseases). A mutation (often genetically triggered or hereditary trait) in BRCA1 and BRCA2 genes can wreak havoc, elevating the instances of breast cancer and many other types of cancer (ovarian cancer, prostate cancer, acute myeloid leukemia, and pancreatic cancer, to name a few). Thus, people who have a family history of breast cancer triggered by a mutation in BRCA1 and BRCA2 genes should get themselves tested as a precautionary measure.
- Obesity is a big No: Maintaining a healthy body weight is the need of the hour. Various research has found a link between obesity and increased risk of breast cancer. According to the American Cancer Society Cancer Prevention Study-II, women who put on extra weight (60 pounds or more) after the age of 18, are at a greater risk of developing breast cancer post-menopause as compared to their healthy counterparts. Thus, it is important to keep the body weight within healthy limits. Take care of your diet. Indulge in physical activities and exercise.
- Avoid excessive alcohol consumption: People, particularly women who consume alcohol in excess (2-6 drinks daily) are at an increased risk of breast cancer. Limit your daily dose of alcohol (1 drink or less per day).
Prevention is Prudent-
Get Fit: The first thing which should be done is that a reasonable level of fitness should be maintained. Many studies have found that if a person is significantly heavier than her recommended weight, she is at a far great risk to develop all sorts of cancer and breast cancer, in particular, than a person who is able to keep her weight in check. The difference in cancer risk rates is about 40%. This is because a greater amount of fat leads to more estrogen being produced, which increases the risk of breast cancer.
Quit Smoking: While most people associate smoking as something which increases the risk of cancer to the lungs and are not aware that it increases the risk of breast cancer, too. So, the best solution is to kick the habit!
Get Off the Pill: Once a woman crosses past her mid-thirties, she should try to avoid relying on birth control pills to reduce the risk of pregnancy. This is because these pills have an effect which increases the risk of breast cancer, which heightens as a woman gets older. As long as the woman cuts out the use of the pill, the risk quickly gets cut, as well.
Get Regular Check Ups: While screening for breast cancer by making use of mammograms does not cut the risk of it, the screening helps detect breast cancer early if it does exist. As a result, a woman has a much better chance of fighting breast cancer. So, a woman who is past the age of forty should try to have a mammogram on an annual basis with the frequency of the same increasing as she gets older. However, it is to be kept in mind that going for a mammogram too often is also not a good idea as the tests themselves pose risks of DNA changes.
Women all around the world are susceptible to breast cancer. While there isn’t a 100% chance of avoiding it, taking care of yourself and leading a fit and active lifestyle can significantly cut down your risk of contracting this condition. Remember, your health is in your hands, so the earlier you start, the better!
In case you have a concern or query you can always consult an expert & get answers to your questions!
Heavy or prolonged bleeding during menses is medically known as 'menorrhagia'. It is more common as you approach menopause but can occur at any age. The bleeding has to be severe enough to interfere with your daily activities.
The cause could be hormonal, pregnancy complications, bleeding disorder or a structural lesion like a fibroid, polyp, endometriosis or adenomyosis.
In advanced age cancer of the uterus or cervix has to be ruled out.
Symptoms of heavy periods
- Soaking a pad or tampon every 2-3 hrs or less in a day
- Passage large blood clots during menstruation
- Your period lasts more than seven days
- You become anemic due to excessive blood loss
How to manage excessive bleeding
- Maintain a record: Maintain a record of the no of days and pattern of heavy bleeding.
- Increase your intake of fluids and salt: You should increase your intake of fluids and especially salty fluids during heavy menstruation. You can have vegetable juices like tomato juice as well as salty broths during such times. This will help you especially when your blood volume goes down (which is characterized by dizziness or pounding of heart) when you get up after lying down. Your body would need more than four to six cups on such a day.
- Increase the intake of iron: Increase your iron intake through natural sources like green vegetables, egg yolks, red meat, liver and dried fruits like raisins and prunes. You can also start an iron tablet once a day for faster recovery from anemia.
- Visit your gynecologist: A good history, few blood tests, and a simple ultrasound generally leads to the diagnosis. Sometimes a biopsy is required to rule out cancer. Multiple new drugs have been added in the last few years which have avoided the need for surgery.
An early diagnosis ends up with better results. Hence, it is important to act early. If you wish to discuss about any specific problem, you can consult a gynaecologist.
The human brain is the most complex and least understood part of the human anatomy. There may be a lot we don’t know, but here are a few interesting facts that we’ve got covered.
Nerve impulses to and from the brain travel as fast as 170 miles per hour. Ever wonder how you can react so fast to things around you or why that stubbed toe hurts right away? it’s due to the super-speedy movement of nerve impulses from your brain to the rest of your body and vice versa, bringing reactions at the speed of a high powered luxury sports car.
The brain operates on the same amount of power as 10-watt light bulb. The cartoon image of a light bulb over your head when a great thought occurs isn’t too far off the mark. Your brain generates as much energy as a small light bulb even when you’re sleeping.
The human brain cell can hold 5 times as much information as the encyclopedia britannica. Or any other encyclopedia for that matter. Scientists have yet to settle on a definitive amount, but the storage capacity of the brain in electronic terms is thought to be between 3 or even 1, 000 terabytes. The national archives of britain, containing over 900 years of history, only takes up 70 terabytes, making your brain’s memory power pretty darn impressive.
Your brain uses 20% of the oxygen that enters your bloodstream. The brain only makes up about 2% of our body mass, yet consumes more oxygen than any other organ in the body, making it extremely susceptible to damage related to oxygen deprivation. So breathe deep to keep your brain happy and swimming in oxygenated cells.
The brain is much more active at night than during the day. Logically, you would think that all the moving around, complicated calculations and tasks and general interaction we do on a daily basis during our working hours would take a lot more brain power than, say, lying in bed. Turns out, the opposite is true. When you turn off your brain turns on. Scientists don’t yet know why this is but you can thank the hard work of your brain while you sleep for all those pleasant dreams.
Scientists say the higher your i. q. The more you dream. While this may be true, don’t take it as a sign you’re mentally lacking if you can’t recall your dreams. Most of us don’t remember many of our dreams and the average length of most dreams is only 2-3 seconds–barely long enough to register.
Neurons continue to grow throughout human life. For years scientists and doctors thought that brain and neural tissue couldn’t grow or regenerate. While it doesn’t act in the same manner as tissues in many other parts of the body, neurons can and do grow throughout your life, adding a whole new dimension to the study of the brain and the illnesses that affect it.
Information travels at different speeds within different types of neurons. Not all neurons are the same. There are a few different types within the body and transmission along these different kinds can be as slow as 0.5 meters/sec or as fast as 120 meters/sec.
The brain itself cannot feel pain. While the brain might be the pain center when you cut your finger or burn yourself, the brain itself does not have pain receptors and cannot feel pain. That doesn’t mean your head can’t hurt. The brain is surrounded by loads of tissues, nerves and blood vessels that are plenty receptive to pain and can give you a pounding headache.
80% of the brain is water. Your brain isn’t the firm, gray mass you’ve seen on tv. Living brain tissue is a squishy, pink and jelly-like organ thanks to the loads of blood and high water content of the tissue. So the next time you’re feeling dehydrated get a drink to keep your brain hydrated.
I am 20yr old male. I had an accident 2 years ago & I had suffered severe back pain. My spinal cord's disc had moved a bit so that I have pain in my back till now. What should I do for this?
Hi, My age 54 have problem in l1, l2,l3, l4 and in l5 bulged I am under treatment. I saw in my MRI report letting large haemangioma is seen in l1 body when I checked in new it tells it is not cancerous and it may be cancerous I am worried when I asked my doctor he said nothing to worry right now there is no problem because of this please tell me what it is exactly whether it will be a problem in future for me.
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!