Monday, 10 December 2018

Why the type and quality of hernia surgery is crucial!


    Hernia is a very common problem and its surgery is available at every nook and corner. Most of the times, neither hernia nor its surgery is life threatening. This makes the case for ignoring the need for perfection in surgery by a specialist.

    Most of the people including many doctors fail to understand, that the abdominal wall (the wall of your tummy with its different muscles) is an organ in itself, with its special functions. The muscles of the wall of your tummy along with the muscles of your back are needed to function optimally, for the core functions of your body. These core functions are breathing, coughing, sneezing, passing motion and urine. And many other activities like sports, running, swimming and other strenuous work are dependent on the efficiency of your breathing.

    Thus, hernia which is a defect in the muscles of your tummy, impacts many of your activities and your core body functions. Hence, surgery for hernia is not done just to stop the intestines from coming out of your tummy and create an emergency, but also to normalise your activity level to best possible. Anything less than the best possible in your case, depending on your hernia type, other medical problems and age, will not serve the purpose of restoring the function of the wall of your tummy. Type of surgery, type of anaesthesia, type of mesh and sutures and precision of surgery, each play a crucial role in the outcome and none can be ignored.

      In a nutshell, all the hernia surgeries are not the same, but each type is suited to a particular kind of hernia and patient. And overall, the aim is not just to cure hernia but to optimise your tummy wall function, so that you can leave your life as actively as possible.

     





Tuesday, 27 November 2018

GERD / Acid Reflux / Heartburn: Does surgery really solve the problem?

       Acid reflux is a problem that troubles a large number of people. Many of them are very young, and find themselves in a state of inefficiency at work due to this problem. Is surgery an ideal solution to there problem or it is just a gimmick? Lets discuss.

       I encounter a large number of these patients, taking medications for years for heartburn and acid reflux. Still not feeling completely normal. On and off have a bad day due to heartburn and either have to skip work or continue suffering at work place. Missing medication for a day brings very harsh punishment for these people. Thus starts their search for an effective solution to their problems.

      The problem of acid reflux, if it has been very convincingly confirmed with endoscopy and pH study, certainly gets cured by a laparoscopic surgery. The problem is many a times people have additional digestive issues like constiaption and IBS (Irritable bowel syndorme) along with acid reflux. The person may require medications for these conditions even after surgery. If these conditions are not recognised before surgery and explained to the patient, they are likely remain dissatisfied with the surgery.

     Even larger is the problem of misdiagnosis. If someone having IBS or constipation or functional problems are wrongly diagnosed as acid reflux (which is quite possible even with experienced doctor if complete evaluation is not done) and a surgery is considered, then they are not likely to benefit from the surgery. And hence we always recommend to get a complete work up including an endoscopy, esophageal manometry and 24 hr pH study before surgery. So that we can pick the patient who is unlikely to get benefited from surgery and avoid the surgery. 

    All in all, those finding themselves stuck in this situation, should not feel hopeless. Should get themselves thoroughly evaluated. If these tests confirm the diagnosis of acid reflux, then should consider laparoscopic surgery with the confidence of leading a normal life after that.

   Watch some of our videos to understand these problem and solution in a way that you would understand better. Directly form the ones who have faced it.         


Review of patient one year after surgery




Review of the patient after a laparoscopic acid reflux surgery



How thorough evaluation can change treatment and avoid surgery


            

Wednesday, 14 March 2018

Having chronic cough and breathing problems! Is it due to Obesity or Acid Reflux?


     Hello friends, am writing this because it is a very common practice to ignore Obesity and acid reflux as the primary cause of cough and breathing problems. I am not saying your doctor is not aware of this possibility. But it is commonly seen that patients and their primary physicians both many a times don't give Obesity and Acid reflux its due importance. And the treatment and evaluation is focused on lung problems. The reason for such a casual approach to these conditions is our human nature. Obesity and Acid reflux do not pose any immediate threat to one’s life, so it is taken casually by all of us.

               But the problem is, if not addressed in a proper way these conditions, Obesity and Acid reflux affects your quality of life in a major way. Without treating obesity and acid reflux, complete relief form cough and breathing problems is not achieved even with aggressive lung treatments. I see a lot of patients who have a very compromised quality of life, they have to take frequent leave form work, don’t get a good sleep, can’t concentrate on work, the personal life is affected, are forced to stop physical activity and exercise. I have also seen patients who have eventually developed psychological problems due to years of poor health.

And it feels terrible when you see life being lost because of a preventable and treatable condition. And it is never a single life that is affected; just think the life of a spouse or children or parents of these patients. They all suffer along with the one who is having this disease.

So my appeal is “If you are suffering from a long term cough and breathing problem, do ask your chest physician if Obesity or GERD could be a reason for this. If you are obese, then reducing weight by any means will be the primary treatment that you need. Recall if you had in past or are now having heartburn and feeling of food coming back after eating. If yes, than you should see a Gastro-surgeon and get evaluated by an endoscopy and pH study." 

Studies show that when a pH study is done on all the patients with chronic cough and breathing problems,  32-50  % had acid reflux even if they had no acid reflux symptoms. This percentage goes up to  50-82 % for those who had acid reflux problems. 

So apart from obesity if you have even a mild problem of acid reflux, you should get yourself evaluated by a 24 hr pH study. This may change your line of treatment and improve you cough and breathing problems like never before.

Saturday, 27 January 2018

Pain relief in the immediate post surgery time: Importance of not just to treat the disease but also to decrease suffering

            World is progressing very fast. Centuries back the treatment was primarily aimed at relieving pain and other symptoms. At the time there was lack of the understanding of what is going on inside, so the treatment was not aimed to cure the diseases but relieve the pain. Then gradually medical science developed and developed. The understanding for the underlying disease improved, various ways of detecting the disease in detail improved along with the various ways of treatment aimed at cure of the underlying disease. The negative thing about these developments brought along was a tendency to partially ignore the symptoms due to a deep focus of the disease itself.   
     
             There was no lack of good intent for the patient. But the thinking was "We are doing the right treatment for the cure of the disease. Even if the patient is bit in pain now, he will be cured in coming time". This thinking led to the scenarios where you can see patients in agony and pain after an excellent surgery by a doctor. There was apathy towards the pain of patients by doctors and the healthcare workers. And patients would eventually be doing great in the coming weeks being cured of the disease."  Partly this was because of the belief that this is what we can do with all our effort.  Cure him of the disease by a surgery and in doing so he will have to bear some pain. I am sure any surgeon who undergoes a surgery would surely think of developing ways of decreasing this pain. 

              And due to thoughts of such doctors medical science have further improved to level where not just curing the disease, we are able to significantly reduce the pain and discomfort of a surgery. Thanks to development of minimal invasive surgical techniques like laparoscopy and thoracoscopy, and also the development of many pain relieving therapies like nerve blocks. Apart from the pain killers that are given after surgery, a lot of surgeons now make the maximum use of a local anaesthetic agent to block the pain sensitive nerves at the site of operation. Hence the patient wakes up after surgery with very minimal pain and is ready to get up in few hours. The improved understanding of the futility of many procedures like putting a tube through the nose and a urinary catheter in many surgeries have decreased the patient discomfort. Years back we used to do that in many more surgeries than we do now, just because that was thought necessary.    

               Now our patients wake up after surgery without any tube coming out of their nose or private parts. There are in very minimal pain, walk around in few hours, go to washroom. Most of the cases they drink and eat on the same day and go home on the same day or next.    

              I would like to share a few videos of our patients taken on the same day or next day of surgery. Some had a bit complex surgeries done laparoscopically but you can yourself make out their comfort level.

To watch click the links below






                                                                                                                                                                                 




Friday, 13 October 2017

Laparoscopic Surgery: Why it is a boon?


                        
                            Laparoscopic surgery is not a new word for most of us. People in general are quite aware of this mode of surgical treatment, that it is better than formal open surgery in terms of recovery. And it is not uncommon for patients to demand laparoscopic surgery for various surgical treatment they need. It is really good that people are aware of their options and are asking for it. 

                             Today  I feel like talking  about aspects of this modality of surgical treatment that people are not much aware about. Laparoscopy means Lapro that is your tummy and scopy means a telescopic camera, thus any surgery of abdomen that is done by a minimal invasive method using a telescope is called Laparoscopic surgery. Similar modality used for any surgery of your chest is called Thoracoscopic surgery. Thus a surgery is performed by making very small incision (cuts) in your tummy and inserting instruments and a telescopic camera through it and performing surgery. Whatever is done in your tummy  is seen on the monitor in the operation theater and thus a big cut in your tummy is avoided.   
                     
                           The general perception is that the faster recovery is due to the small cut on the skin. My patients commonly ask me " Sir how many stitches I will get?" , and I always say it does not matter. What people don't know is that, the wall of your tummy is itself an organ. Just like your leg and hands, and it is not just skin but multiple layer of muscles, fat and skin. It has many important function also, like they are the key muscles in your basic body function like breathing, coughing, passing stool and urine. They are also very important for different body movements like bending, lying and getting up. Any decrease is the health of the wall of your tummy affects you in multiple ways. And laparoscopic surgery does not just reduce the length of scar on the skin but also on the whole wall of your tummy. Hence it helps to maintain the natural strength of your tummy, causes faster recovery, less breathing problems after surgery and decreases the chances of hernia through the operation site.     

                            It is a technically demanding skill, and also needs very specialized equipment. Fortunately with time there has been significant advances in the instruments and skills of surgeons. So the technique which was previously used for some basic surgeries like gallbladder and appendicectomy is now widely used for even very complex surgeries like cancer, weight loss and other major surgeries of your tummy and chest. For a lot of medical conditions, surgery was previously avoided due to the complications and poor recovery with open surgery and patents used to suffer, with no option of an effective treatment with low complication rate. But with laparoscopy, the recovery being faster and complications less, many of these diseases are very effectively treated with laparoscopic surgery with acceptable rate of complications. The patients are being able to walk within hours of surgery, can take liquids and diet very early depending on the type of surgery and are being discharged very early due to laparoscopy.         

                           Thus I would like to again reaffirm that " There is much more to Laparoscopic surgery than mere small scar and your tummy wall is not just skin but an active organ of your body".

Disclaimer: The same article has been published by me on practo.com


Sunday, 1 October 2017

Making genuine information available to the patients: Need of today's time

                      A lot of doctors get irked by the patients who come to their clinic with a self made diagnosis by reading a lot of things on Google. Sounds fair to some extent, because they come with the wrong facts firmly embedded in their head. This makes it difficult to treat them, as they are not convinced easily by the genuine advice that is given by doctors. The doctors have to spend more time to convince them and prevent them from making wrong decisions, which may harm them rather than being of any help.

                  What we doctors fail to understand is, the problem is not Google or the patients who search Google for their problems, and even if it is the fact is this is going persist. The problem is the false and confusing or wrong information that is there and the way to counter it is to provide the people in general with more and more genuine and authentic information. So that it helps them in making proper choices for their problems, especially when they are being advised different treatment options by different set of doctors. If we see from their perspective, they feel totally confused and clueless what to do when different qualified and expert doctors give a different opinion about their treatment.

                   To believe that someone is not capable of understanding the problems they are facing, and not capable of taking an informed decision is big mistake. So we as doctors should strive to get as much information about different problems as possible, in a language that is easily understood by a non medical person. This will not only help them take better decision, this will improve the compliance of patient to the advice of doctor as they will understand the reason behind the advice.
But with this the responsibility of the patient also increases, as they are now the active partner in their own treatment. They need to learn the art of understanding what is genuine and what is fake.

                       A lot of patient’s complaint that some doctors misguided them to a wrong treatment. From my experience I can say, all such patients had opinion of multiple doctors and among these doctors were also those gave them proper guidance. But they chose to follow the one who gave the wrong advice, either deliberately or out of their poor knowledge. Not going into the discussion who is to blame, it is very clear that only the patients are at an immediate loss. But it the responsibility of both the public and the doctors both to make sure that people in need of guidance should get a correct one. We are in a new age and literacy is no more just the ability to read and write. Literacy in today’s time is ability to read between the lines, and the ability to send a true message in a stronger way such that it is louder the wrong ones. The onus is on all of us, and surely we will achieve that mark.

Disclaimer; The same article had been published by me on practo health feed with the below link
https://fit.practo.com/#!/content/29965

Tuesday, 12 September 2017

Dilemma of a patient with Heartburn: How long to suffer? When to seek a permanent solution?

Acid reflux causing ulcers and damage to the foodpipe
I will briefly talk about a patient with severe
heartburn, suffering for the past 7 years. I saw him a year back with his latest endoscopy report showing Grade A esophagitis that is a mild form of damage to the foodpipe due to acid coming back into the foodpipe from the stomach. But his was despite high dose of acid suppressing medications he was having since past few years.

24 hr pH with Impedance study
He was unable to stop them due to severe heartburn giving him sleepless nights and a affecting his daily work. Significantly affecting his
quality of life. I suggested him to undergo a 24 hr pH with Impedance study and undergo surgery for a permanent solution. The pH with impedance study showed severe reflux and also suggested that all his symptoms are due to reflux (good symptom reflux correlation by high Symptom association probability or SAP). All this point to surgery as a permanent solution. Surgery is laparoscopic with very quick recovery.

But like all humans he being scared of surgery, differed it. Took opinion of multiple doctors physicians, gastrophysicians, surgeons and G I surgeons. All having their own opinion further confusing him. After a year that showed further worsening of his symptoms he is finally planned for surgery in a couple of days.

While I am sure of giving him a permanent solution to his problems with a Laparoscopic Fundoplication surgery, the question is when a patient should say enough is enough? Many doctors not used to see the outcomes of these surgeries may not be confidant in suggesting surgery for your problems. Again in our society sleepless nights and a poor quality of life is considered acceptable. But in doing so we just deffer the inevitable to a later date rather than able to prevent it completely. In  doing so we just push the patient to have a few more years with a poor quality of life.

To know more about acid reflux and its surgery watch our patient information video by clicking this link https://www.youtube.com/watch?v=jbI3o4K_7xM&t=52s
Disclaimer: The same article has been published by me on practo health feed with the link
https://fit.practo.com/#!/content/29646