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Blood in Stools Tips

Upper Gastrointestinal Tract - How To Administer It?

Dr. Manash Ranjan Sahoo 85% (10 ratings)
MBBS, MS (General Surgery), Fellowship in Surgical Gastroenterology
General Surgeon, Cuttack
Upper Gastrointestinal Tract - How To Administer It?

It is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood is often observed in vomit (hematemesis) or in the stool (melena). Upper gastrointestinal bleeding denotes a medical emergency and typically requires hospital care for primary diagnosis and treatment. The incidence of upper gastrointestinal bleeding is 50-150 individuals per 100,000 annually. Depending on its severity, it carries an estimated mortality risk of 11%.

The causes of upper gastrointestinal bleeding are as follows:

Esophageal causes (gastrorrhagia):

  • Esophageal varices
  • Esophagitis
  • Esophageal cancer
  • Esophageal ulcers
  • Mallory-Weiss tear

Gastric causes

Dieulafoy's lesions

  • Duodenal causes
  • Duodenal ulcer
  • Vascular malformation, including aorto-enteric fistulae
  • Hematobilia or bleeding from the biliary tree
  • Hemosuccus pancreaticus or bleeding from the pancreatic duct
  • Severe superior mesenteric artery syndrome

The signs and symptoms of upper gastrointestinal bleeding are as follows:

  • Hematemesis - Vomiting of blood
  • Melena - Blood in the stool
  • Hematochezia - Passage of fresh blood through the anus, usually in or with stools
  • Syncope - Loss of consciousness (fainting)
  • Presyncope - State of lightheadedness, muscular weakness, blurred vision, and feeling faint
  • Dyspepsia – IndigestionEpigastric painHeartburnDiffuse abdominal pain
  • Dysphagia - Difficulty in swallowing. Weight lossJaundice - Yellow discoloration of the skin, mucous membranes, and sclera

The diagnosis of upper gastrointestinal bleeding is made when hematemesis is present. In the absence of hematemesis, an upper source of GI bleeding is likely in the presence of at least two factors among - Black stool, age < 50 years or blood urea nitrogen/creatinine ratio 30 or more

If these findings are absent, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper GI bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a GI bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test. Also, the following diagnostic tests are done:

  • Orthostatic blood pressure
  • Complete blood count with differential counts
  • Hemoglobin level
  • Type and crossmatch blood
  • Basic metabolic profile, BUN,
  • Coagulation profile
  • Serum calcium
  • Serum gastrin
  • Endoscopy
  • Chest radiography
  • Nasogastric lavageAngiography (if bleeding persists and endoscopy fails to identify a bleeding site)

Upper gastrointestinal bleeding can be managed in the following ways:

  • Airway management and fluid resuscitation using either intravenous fluids and or blood
  • Medications to stop the bleeding (Proton-pump inhibitors are often given in the emergency)
  • Surgical intervention
  • Treating the consequences (like anemia) that the bleeding may have caused
  • Precautions are taken to prevent rebleeding

Kshar Sutra & Fistula - How Can Former Handle The Latter?

Dr. Anju Srivastava 90% (10 ratings)
BAMS
Ayurvedic Doctor, Jodhpur
Kshar Sutra & Fistula - How Can Former Handle The Latter?

The modern lifestyle, along with providing comfort, has also made us susceptible to a host of diseases and ailments. The regular and indiscriminate intake of junk foods, high-salt content foods, and sugar-laden fizzy drinks deprives the body of necessary fiber and essential nutrients. These habits can cause the condition known as the fistula. What more, stress and sedentary lifestyles also figure among the primary causes of the disease.

Problem
Fistula can generate extreme pain and bleeding during or after passing stool, blood spots in the stool, and an uncomfortable feeling of something hanging from the anus. The disease can trigger a discharge of pus from the anus or the anal region, along with itching and a burning sensation. Constipation is an associated symptom.

Therapy
Traditional medicines, such as Ayurveda, recommend the Kshara Sutra treatment which is designed to offer both preventive care and relief from fistula. Kshara Sutra is a minimally invasive surgical procedure which helps patients and Ayurvedic practitioners to manage anorectal diseases. It is a safe and cost-effective means to treat fistula, hemorrhoids, and other similar diseases. Indian sages such as Sushruta and Charaka have attested to the efficacy of such Ayurvedic interventions. In modern times, the efficacy of the procedure has been re-evaluated by the Department of Shalya Tantra in the Benaras Hindu University. The technique is widely practised in India and some other countries.

Procedure
Patients undergoing Kshara Sutra are anesthetized with either local or general anesthesia. Then a malleable probe is passed through the external opening of the fistula to the internal aperture in the anal canal. The probe is taken out gently through the anal opening along with the Kshara Sutra. Later, both ends of the sutra are tied together. The process is repeated once every week and gradually helps in healing the infected tract.

Benefits
The treatment helps to cut, drain, and heal the fistulous track which causes the discomfort. It also destroys and helps in the removal of unhealthy tissues, thereby facilitating fast healing of the fistula tract. The Kshara Sutra therapy also controls infection through its microbicidal action. It separates the debris and completely cleans the wound.

Also, this simple and safe para-surgical process is ambulatory, and patient need not stay overnight in the hospital. They may freely pursue their day to day activities immediately after the process is administered. The treatment does not trigger any complications, such as incontinence or stenosis, or strictures. This makes it suitable for patients of all ages.

The procedure being natural, and promises prevention and cure, is recommended to patients that suffer from fistula. However, patients must be advised to seek consultations from trained medical practitioners.

2444 people found this helpful

Rectal Bleeding - Causes Of Painful Or Painless Bleeding!

Dr. Arnab Ray 89% (24 ratings)
Bachelor of Ayurveda, Medicine and Surgery (BAMS), MS (Ayurveda) in Surgery, PhD Surgery
Ayurvedic Doctor, Kolkata
Rectal Bleeding - Causes Of Painful Or Painless Bleeding!

It is important to remember that, rectal bleeding or blood in the stool is never normal and while it may come from a relatively benign cause like hemorrhoids, more serious causes like colon cancer can be life-threatening. Rectal bleeding may be painful or painless. Fresh blood may come out before, during and/or after passing stool or it may be mixed with the stool. Sometimes one may have black color stool which indicates high up bleeding source.

The common causes of painful rectal bleeding are :

* Anal fissure (fissure-in-ano)
* Perianal fistula (fistula-in-ano)
* Rupture of perineal hematoma
* Cancer in anal canal and rectum
* Rupture anorectal abscess
* Injury in the anus

The common causes of painless rectal bleeding:

* Hemorrhoidal diseases (Piles)
* Cancer in the rectum and anal canal
* Anal or rectal polyp
* Rectal prolapse
* Ulcerative colitis
* Crohn’s disease

5234 people found this helpful

Ayurvedic Treatment For Dysentery!

Dr. Bharat Ramavat 86% (15 ratings)
Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Ayurveda
Ayurvedic Doctor, Ahmedabad
Ayurvedic Treatment For Dysentery!

Dysentery is the inflammation of the intestine that causes the appearance of blood and mucus in stool. It is caused by bacteria or parasites. In this condition, the patient passes semi liquid stool many times in a day. It is a contagious disease and is transmitted via the fecal-oral route. Thus, a group of people like a family living together or students in a hostel is more prone to picking up the infection. This infection is also transmitted via anal sex. 

Ayurveda is a herbal medicinal treatment, originated in India. It is known to have a cure for various health problems. Usually, Diarrhoea cures itself through diet change, but in the case of dysentery, medication is required to combat bacteria and parasites. Some ways to treat Dysentery with Ayurvedic remedies are as follows:

  1. Isabel for Chronic Amoebiasis: Isabel is a formulation that treats dysentery caused due to Amoebiasis. When the stool contains mucus and the infected patient feels a cramp before passing stool, it is considered an Amoebiasis infection. Isabel is very good for bacillary dysentery as well. It is advised to consume 1 teaspoonful twice daily with water for 5 to 7 days for best results. 
  2. Ambimap for dysentery: Ambimap herbal formulation possesses a multi-purpose approach to control and cure dysentery (Pravahika). It is known to treat and cure all types of parasitic infection and provides immediate relief. For best results, 1 or 2 tablets should be taken 2 to 3 times a day with water.
  3. Churna for dysentery: Churna is a polyherbal Ayurvedic medicine in powdered form and is highly beneficial in treating dysentery.

You can also opt for Ayurvedic remedies that can be formulated at home. They are as follows:

  1. Combine powdered dry ginger root, amla powder, long and black pepper in equal proportions. It is advisable to store this dry mixture in a glass container. For best results, consume one teaspoon of this mixture with lukewarm water two times a day. 
  2. Another great way to combat dysentery is to drink buttermilk. Just add a bit of rock salt as well as powdered roasted cumin seeds. Drink this mixture two times a day preferably with breakfast and at lunchtime. 
4721 people found this helpful

Anal Fissure - Say No To Surgery!

Dr. S K Singh 93% (1291 ratings)
M.S. (Ayurveda), Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurvedic Doctor, Delhi
Anal Fissure - Say No To Surgery!

Anal Fissure is a small tear in the anal area. This can happen due to injury while passing hard formed stool or even by repeated bowel motion. It may be very painful especially at the time of passing hard stool.

Symptoms

Most commonly sought symptoms in Anal Fissure are as given below:

• A noticeable tear in the skin close to the anus.

• Cutting or burning pain in anal passage while passing stool which may persist for a considerable time

• Sometimes pain is so severe that patient stops eating in an attempt to avoid defecation to avoid pain

• Blood stains on stools may also be there

• If not treated in time; skin starts growing from the lower end of fissure to form a tag known as sentinel tag/sentinel piles.

• At times; sentinel tag may get inflamed.

Causes

• Passage of hard stool through anus.

• Chronic Diarrhoea

• Trauma to the anus and anal canal like during childbirth

• Inflammation in anus because of crohn's disease or some other inflammatory disease

Anal Fissure treatment: Diet: High fiber diet like green leafy vegetables, salads, fruits like papaya, chikku are advised. Resins with milk can also be taken in night. Adequate quantity of liquids especially butter milk is advised. Banana, apple etc. should be avoided.

Graded Kshar Karma & Ksharsutra: Anal Fissure can be completely treated by Graded Kshar Karma and Ksharsutra treatment. In acute anal fissure; stool softener along with Graded Kshar Karma is advised. In this treatment; Graded Kshar - a specialized Ayurvedic medicine is applied in fissure region. This medicine debrides the fissure and induces healing. Usually pain subsides in a week or 10 days time period when fissure is still in healing phase.

Considering pain has subsided; some patients discontinue the treatment to further aggravate and complicate the problem. For complete healing of anal fissure usually 3-5 Graded Kshar Karma sittings are required at a weekly interval. In between these weekly sittings patients are advised to apply certain medicines in anal passage by themselves. If anal fissure has progressed to development of sentinel tag then Graded Ksharsutra TM treatment is the treatment of choice.

In this treatment Graded Ksharsutra TM is ligated at the root of sentinel tag. Medicine released from Ksharsutra blocks the blood supply of sentinel tag and it sheds off in a week or 10 days time period. No hospitalization or bed rest is required in this treatment. Patient can continue his normal routine activities as usual during his treatment. So, you can say no to surgery in Anal fissure.

5666 people found this helpful

Anal Fissures - How To Treat It?

Dr. Dinesh Ramaswamy 92% (22 ratings)
M.Ch ( Surgical gastroenterology), M.S, Diplomate Of National Board
Surgical Gastroenterologist, Chennai
Anal Fissures - How To Treat It?

Anal fissures are the small tears formed in the anal lining. They are also known as anal ulcers. An anal fissure causes a lot of pain and bleeding during your bowel movements. Usually a fissure heals automatically in a few days time. It can be treated with simple home remedies as well.

CAUSES:

1.  You can suffer from an anal fissure if you pass hard and large stools. 

2.  Also strained childbirth or suffering from violent spells of diarrhea might get you an anal fissure. 

3.  Chronic constipation may also be cause of a fissure. 

4.  Other rare causes may be anal cancer, HIV, tuberculosis or herpes. 

Individuals of all age groups can suffer from anal fissures. It is not a very serious problem, and heals on its own in a few weeks. Although it can heal itself, there are certain treatments which can help relieve the pain you get from an anal fissure.

SYMPTOMS:

An anal fissure has quite a lot of symptoms for you to understand what you are suffering from:

1.  There will be a very visible tear around the anal region. You will be able to spot the tear on the skin very easily.

2.  A small lump of skin may form next to the tear.

3.  When you will be undergoing your bowel movements, you will feel a very sharp pain in the anal region.

4.  You will find spots of blood on the stool passed.

5.  You will also feel a burning or an itching sensation in the anal region.

TREATMENT:

Although most fissures do not require treatment, there are a few remedies that will help cure them faster:

1.  Stool softeners: You get certain medicines at the chemist, which are known for their stool softening functions. These stool softeners help to soften the hard stools and initiates smooth bowel movements.

2.  Eat fibrous foods: Eat foods rich in fiber like fruits, whole grain cereals, raw vegetables, etc.

3.  Take warm baths: Take a bath in warm water as it relaxes your anal muscles, helps to relieve irritation in the region, and increases blood flow in the anorectal region.

4.  Use ointment: Apply nitroglycerin ointments and topical pain relievers to promote blood flow to the anal region and to relieve discomfort from the region respectively.

2837 people found this helpful

Can Hemorrhoids Be Healed Without Surgery?

Dr. Arun Singh 90% (302 ratings)
BAMS, MD - General Surgery, Phd in Ayurveda
Ayurvedic Doctor, Varanasi
Can Hemorrhoids Be Healed Without Surgery?

Piles are the tortuous veins which bulge out in the anal canal. There are so many factors responsible for this engorgement of the anal veins. The most common cause is chronic constipation. In such condition patients have to strain for defecation which puts pressure on the veins leading to congestion & engorgement.

When these veins get ruptured by passing hard stools or due to straining it initiates characteristic painless bleeding. Bleeding may be in the form of fresh blood drops or spurts of fresh blood. At this stage bleeding is the only symptom that patients complain of. This is known as 1st degree hemorrhoid. When these congested rectal veins increase in size, the pile mass may protrude out during defecation. After passing stool, the pile mass reduces by itself and sometimes patients have to reduce the pile mass manually. This stage is labeled as 2nd degree piles. When these pile masses further increase in size they may protrude out during walking or sitting etc this is known as third degree piles.

Types of piles-

Piles also known as hemorrhoids are dilated, engorged veins carrying blood in the anal canal. In simpler words, these are dilated blood veins that are located near the areas of anus. Piles are mainly of two types in nature namely

1. Internal hemorrhoids and

2. External hemorrhoids.

The internal ones are more common in occurrence in the human body than the external ones. Most often, these appear around two centimeters above the opening in the anal canal. As the name suggests, the external piles occurs on the outside area of anus. Whereas the internal piles are present inside the anal canal. Here are different stages of internal piles.

  1. In First stage patient complains of painless bleeding during defecation.
  2. In 2nd stage- There is painless bleeding along with mass protruding out per rectum during defecation which gets reduced by itself or manual reduction is necessary.
  3. In 3rd stage; pile mass could not be reduced back or if reduced by force; these come out even on coughing, walking or sitting.
  4. Some classify piles differently as when manual reduction is required; it is the 3rd stage while when pile mass is not reducible; it is the 4th stage of internal piles.

Symptoms of piles-

Following are the symptoms commonly seen in patients of Piles:.

  1. Blood drops with the passage of stool. Blood spurts may also be noticed while passing stools.
  2. Moreover, there are instances when there is unbearable itchiness around the anus specialty in ext. piles.
  3. A soft mass or lump may be noticed coming out through anus during passing stools which is reduced spontaneously & if it is large in size then it may be manually inserted back in the anus.
  4. Acute cases when the pile masses get infected or inflamed there may be symptoms of acute pain

Treatment of piles without surgery!!!

Yes; It is possible to treat piles without having to undergo the knife of doctor. Ayurveda is well known for treatment of piles without surgery.

A. In the first stage of piles, Kshar Karma therapy (application some kshar or medicine on the pile mass that cause shrinking of the mass) is performed which leads to arrest of the bleeding & regression of the pile mass. No surgery is required.

B. In the second & third stage of piles, the pile mass is ligated by the Ksharsutra as an opd procedure. After ligation pile mass shed off in some days. Usually hospitalization or bed rest is not required & patients can go home after the treatment. It is not advisable to ignore the problem as it will only aggravate with time. Earlier is always better to treat pile. Even at first stage; it is very important to see the doctor because the blood loss during passing stools may lead to anemia. .

Home remedies for Piles

1. Piles are the resultant of putting too much strain while defecation or sitting too long for defecation. So these should be avoided.

2. Avoid fast foods, spicy and too much oily foods.

3. Increase consumption of fibrous foods like green leafy vegetables, fruits and salads;

4. Increase intake of fluids and butter milk etc.

5. You should exercise regularly.

6. If the pile mass protrude out during defecation these should be reduced and it is better to keep them inside.

4515 people found this helpful

Piles - An Overview!

MBBS, MS - General Surgery, Fellowship of Indian Association of Gastrointestinal Endo Surgeons (FIAGES), Fellowship of Association of Colon and Rectal Surgeons of India (FACRSI)
Proctologist, Mumbai
Piles - An Overview!

PILES

Piles are also known as Hemorrhoids. These are normal cushions of the anal opening. When they swell they are called as piles. Piles contain supportive tissue, blood vessels, muscle and elastic fibers. Piles occur due to increased intra-abdominal pressure such as due to constipation, lifting heavy weights, etc. Piles can be graded on a scale from I to IV:

● GRADE I: These are small, invisible inflammations inside the lining of anus having painless bleeding or itching with no prolapse.

● GRADE II: These are larger than grade I, but they may protrude out while passing the stool and retract back into the body upon completion of bowel movement.

● GRADE III: These appear outside the anus and one can feel them hanging from the rectum.it does not retract of its own but they can be easily re-inserted.

● GRADE IV: Grade IV piles can not be pushed back. It needs treatment. They are huge and remain hanging outside the anus.

Symptoms of Piles

In some of the cases, the signs of piles are not very serious and normally resolve within a few days on their own. An individual suffering from Piles can experience one or more of the following:

● A lump can be felt around the anus and it may contain blood.

● After passing stool, patient still feels that the rectum is full.

● The area around the anus is itchy and red.

● There may be mild to moderate pain while passing a stool.

● If the piles are severe, one will experience excessive anal bleeding.

Causes of Piles

Piles are caused by an increase in pressure in the lower rectum. This may occur:

● When one passes a stool less than 3 bowels in a week, that leads to chronic constipation.

● When one passes a loose stool for around 4 weeks, that leads to chronic diarrhoea.

● If a person is lifting heavy weights during exercise or any other work.

● It can happen at the time of pregnancy.

● It can also happen when one is forced to pass a stool.

● It can also happen as a consequence of cancer in the lower part of large bowel.

Treatment of Piles

A doctor can usually diagnose piles after going through a physical examination or even a digital rectal examination. In most cases, it resolves on its own. However, some treatments are there which lessen the itchiness. Some of the popular ones are listed below:

● The initial recommendation by a doctor is to change one’s lifestyle, this can cure piles in grade I and II easily and effectively.

● A change in diet can also help easy bowel movement.

● Losing body weight may help reduce the incidence of piles.

● Regular exercise may lead to passing of the stools easily.

● Doctors may prescribe some laxatives that will help pass the stool easily without extra force.

● If it does not get treated with any medication, then surgery is sometimes the only option.

Surgery

No surgery is required for Grade I. For Grade II piles can be treated with LASER. Grade III and IV piles can be treated with Conventional methods like excision of haemorrhoides, LASER haemorrhoidopexy, DGHAL or Stapler Haemorrhoidopexy. Bleeding piles does require treatment because bleeding may cause anaemia and further complications which may sometimes be life threatening.

4486 people found this helpful

Piles - How Efficient Is Homeopathy In Treat it?

Dr. Anuj Kumar 89% (67 ratings)
BHMS, ND, Reiki Level 2
Homeopathy Doctor, Noida
Piles -  How Efficient Is Homeopathy  In Treat it?

Piles also known as haemorrhoids. It is a condition in which there is swelling and inflammation around the anus and in the lower rectum. It is a condition in which the person experiences extreme pain while pooping and there may also be blood in few cases. It is very common, both in men and women. There are as many as four types of piles, such as internal, external, protruding and blind piles. There are several factors, which cause piles such as:

  1. No physical activity
  2. Prolonged sitting with no movement
  3. Diet containing more fats and carbohydrates and less fibre content
  4. Excessive alcohol intake
  5. Obesity
  6. Chronic constipation
  7. Pregnancy

The signs and symptoms of piles may vary according to your type. The most common being severe pain with blood appearing along the passage of stool or on the tissue paper. If you are suffering from internal haemorrhoid it might protrude through the anus outside your body, which is extremely painful and irritating. In case of external haemorrhoids you might feel a hard and painful lump around the anus. Excessive rubbing and cleaning the area may also cause itchiness, pain and bleeding.

  1. Homeopathic medicine for piles with extreme pain: Aloe is one of the homeopathic medicines you should take if you suffer from piles with severe pain. It appears like a bunch of blue grapes around the anus. The condition is accompanied by tenderness and soreness around the region. If you feel extreme pain and soreness at the slightest touch then Muriatic Acid is extremely helpful. If you experience a burning sensation and the pain lasts for more than an hour after excretion, Ratanhia works pretty well.
  2. Homeopathic medicine for bleeding piles: Bleeding when passing stool is one of the very common sign of piles. Hamamelis and Phosphorus are both equally helpful in curing piles that bleeds and the blood is bright red in colour. Backache and extreme weakness are also accompanied with bleeding.
  3. Homeopathic medicine for the Blind Type piles: If your piles do not bleed and it is purple in colour along with hard and dry stool, Aesculus will work well for you.
  4. Homeopathic medicine for piles with constipation: Nux Vomica and Collinsonia are both effective in dealing piles with constipation. You pass hard and dry stool and it is always unsatisfactory.
3195 people found this helpful

Hemorrhoids: Fibre Rich Diet is the Simple Solution

Dr. Rakesh Dhupia Jain 89% (12 ratings)
MBBS, DNB ( General Surgery )
General Surgeon, Indore
Hemorrhoids: Fibre Rich Diet is the Simple Solution

Many women experience a temporary encounter with hemorrhoids when they are pregnant. Quite surprisingly, most people tend to experience this in their daily lives. By the age 50, majority of people have encountered one or more symptoms of this ailment, including rectal pain, bleeding, itching and may be prolapse where the hemorrhoids protrude out of the anal canal. Though this ailment can be rarely detrimental, it can be a painful intrusion. But thankfully, there are a lot of things we can do about them.

How may this be diagnosed?
Hemorrhoids are usually diagnosed from a plain medical history and health exam. External hemorrhoids, more commonly known as piles, are normally apparent, particularly if a blood clot is formed. Your physician shall perform a digital rectal test to detect blood in the stool. Then the physician may also inspect the anal tube with the aid of an anoscope, which is a short plastic channel interjected into the rectum with illumination. If he finds any evidence of microscopic blood or rectal bleeding in the stool, then there may be a need to perform colonoscopy or flexible sigmoidoscopy to determine the probable causes of bleeding like cancer or colorectal polyps, specifically in women aged over 50.

Is it possible to treat hemorrhoids at home?
Most of the common symptoms of piles can improve drastically with simple in-home measures. If you are suffering from occasional flare-ups, you may try the following:

  1. Eat a lot of fibre: It is recommended to add fibre in the diet; may be a fibre supplement like Citrucel, Fibre con, etc. When you drink a lot of water along with loads of fibre, stools get softened making them effortless to pass, which will reduce the pressure on the swollen veins. Eating broccoli, wheat, oats, beans, fresh fruits every day will help in decreasing bleeding caused due to piles. It also reduces swelling and inflammation. If you feel digestive issues with a sudden splurge of fibre in your diet, you may start slowly and gradually increase the amounts.
  2. Take a sitz bath: A sitz bath is a lukewarm water bath for the lower back portion of the body, which can help in relieving irritation, itching as well as spasms occurring in the sphincter muscle. You can either get small plastic tubs for a sitz bath or sit in a normal bath tub. Most physicians suggest a half an hour sitz bath after every bowel movement. Then tenderly dry the area and avoid wiping it hard.

There are several invasive treatments that can be opted if these conservative treatments are not able to help your condition. In such an instance, it is always wise to seek advice of a medical practitioner.

2772 people found this helpful
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