Are Your Joints Begging You To Lose Weight?

When discussing health conditions caused by obesity, we most often hear about diabetes and heart diseases. But did you know your weight can have a significant impact on your muscles, bones and joints, too? With 135 million obese individuals in India alone, it has become one of the most common conditions to adversely affect bone and joint health.

The percentage of adults with obesity has more than doubled over the past 30 years, and at the current rate, 50% of Indian adults are expected to be diagnosed as obese by 2030. With such staggering statistics, it is time to take a closer look at the impact of obesity on bone and joint health.

Obesity, Orthopaedics and Outcomes

There are two ways in which being overweight can raise the risk for developing osteoarthritis – the most common joint disorder, resulting from the wear and tear of a joint.

First, excess weight puts additional stress on weight-bearing joints (for example, the knee)
Second, inflammatory factors associated with weight gain might contribute to trouble in other joints (for example, the hands)

Let’s look at weight and your knees:

When you walk across level ground, the force on your knees is equivalent to 1½ times that of your body weight, indicating that a 90kg man will put approximately 135kg of pressure on his knees with each step. In case of an incline, the pressure is greater: the force on each knee is twice or thrice your body weight when you walk up or down the stairs, and four to five times your body weight when you squat to pick up an item you’ve dropped or to tie a shoelace.

Childhood Obesity and Musculoskeletal Health

Childhood obesity, too, can have a harmful effect on the body in several ways. Bones grow in size and strength during childhood. Excess weight can damage the growth plate — the area of developing cartilage tissue at the end of the body’s arm, leg and other bones. Growth plates regulate and help to determine the shape and length of a bone during maturity.

Too much weight places excessive stress on the growth plate, leading to early arthritis, a greater risk for broken bones and other conditions, such as Blount’s disease and slipped capital femoral epiphysis.

Bariatric surgery is usually not recommended by doctors for children, however, in rare cases, it may be advised for youngsters with BMIs of 40 or above to avoid long-term musculoskeletal complications. In most children, a diet rich in calcium and other nutrients, alongside regular physical activity for at least 35 minutes can help minimize weight gain, while helping maintain strong bones.

How Obesity Affects Orthopaedic Surgery

Obese patients have a higher risk of arthritis of the knee and hip, as well as a much greater risk of lifetime disability from back pain, arthritis and spinal stenosis.

Even though obese surgical patients often have good results from orthopaedic surgery, they are also at a higher risk of complications in pre- and post-surgery, including:

Increased blood loss
Increased length of surgery
Increased risk of wound infections and wound non-healing
Hip or knee implant complications such as pain, loosening and infection
Spine implant breakage and non-unions of fusion due to increased loads
Postoperative pneumonia
Blood clots and pulmonary embolism
Peripheral swelling
Lengthy recovery periods and poorer progress in rehabilitation
Increased need for personal assistance after surgery

How Weight Loss Improves Arthritis

Improved quality of life is probably the most impactful and tangible effect. Even if you lose just a few kilos, you will be able to walk better, with much less pain. Benefits of weight loss include the following:

Reduced joint pain and inflammation: Less body weight means less pressure and often less pain. According to a study published in the Journal of the American Medical Association, adults with osteoarthritis who lost weight through a combination of diet and exercise over a period of 18 months reported less knee pain. The study also showed inflammatory compounds associated with arthritis decreased.

Better joint function: Weight loss improves joint function in obese people with osteoarthritis because compressive forces inside the knee joint improve.

Lower risk of co-morbid conditions: Cardiovascular disease may be the result of both arthritis and obesity. The same holds true for diabetes and depression. Losing weight can help mitigate the risks.

More energy: As counterintuitive as it sounds, exercise is the best thing you can do to improve fatigue. It releases endorphins, which not only increases energy but also improves your mood. Staying within recommended BMI is best pain medication and energy giver of all.

Sounder sleep: Musculoskeletal pain interferes with sleep, leading to insomnia. Weight loss helps improve sleep.

How to Lose Weight and Keep It Off

Studies show that a sustained 5-7 kilo weight loss in obese people can result in a lower risk of osteoarthritis and other bone and joint-related problems later in life. You can begin by:

1. Setting Realistic Weight Loss Goals

If you’re overweight or obese, start out with a goal of lowering your weight by 5%. Once you reach the first goal, set another one of losing another 5%. Setting doable goals is important, especially if you have arthritis as you may be limited in the number of physical activities you can carry out.

2. Finding Your Diet Strategy

There is no one-size-fits-all approach. Indeed, those who have been successful have tried several approaches before they found the one that worked best for them. If you’ve tried and failed, think about the method that worked and those that didn’t.

3. Dining In and Reducing Calories

Restaurant meals are usually loaded with excess salt, fat and calories. If you go out for your meals, divide oversized portions in half before eating and maybe, pack the rest. Better still; try cooking and eating at home because when you cook at home, you control how much you eat and what you eat.

4. Exercising for Weight Loss

Cutting back on the calories you eat is half of the weight-loss equation. The other half is expending calories through physical activity. Exercise poses challenges for people with arthritis, of course. Bad knees, especially, can make many activities painful. Still, there are activities that even people with osteoarthritis can do such as light resistance exercises.

5. Finding a Weight Loss Buddy

Enrolling in a weight loss programme or forming your own support group can help you lose weight.

Losing a few kilos can go a long way toward reducing the pressure on your knees — and protecting them.

Jaundice May Signal Trouble!

Yellow eyes! Jaundice! That is the most obvious conclusion one draws when the eyes looking back at you in the mirror seem yellow or you hands have a curious yellow tinge that has nothing to do with the turmeric in your food. But did you know that the change in your eyes or skin colour is not the only indication of the condition that essentially suggests a problem in your liver?

Let us try to understand some basic facts about the condition called ‘Jaundice’.

It is a symptom of an underlying problem in your liver that causes the bilirubin level in your blood to go up. Bilirubin is the yellow-orange matter in your bile that is essentially the waste product left behind after iron gets absorbed by blood. Bile produced by the liver helps in carrying this waste along with other harmful chemicals out of the body.

Why does bilirubin build up?

The reasons can be broadly placed under three categories:

It could be a result of iron-deficiency or anaemia (usually caused by destruction of blood cells before their normal lifespan is over)
Infections like hepatitis, result of auto-immune conditions, alcoholism, genetic or metabolic defects, effect of some medicines
Obstructions like gallstones, gall bladder or pancreatic tumour

What causes the yellow colour?

When there is an excess of bilirubin in the blood, it has a tendency to leak out into the surrounding tissues. This condition is called hyperbilirubenimia and it causes the yellow colour in the skin and eyes.

My skin and eyes have not turned yellow but I have been feeling very tired and lost a substantial amount of weight for no apparent reason. Could it be jaundice? If these signs are accompanied with pale stool, dark urine, itchiness, and nausea, it may well be jaundice. It is advisable to consult a hepatologist, who may ask you to run through a battery of tests to diagnose the condition. In fact, itching is a complication of jaundice that can sometimes become so severe that it can result in insomnia and even thoughts of suicide.

Is jaundice cause for major worry?

That depends on the underlying cause. To treat jaundice the doctor needs to diagnose the medical condition that caused it. If the condition is related to anaemia or infection, medications and lifestyle changes are the recommended treatment plan. Obstructive jaundice, however, is likely to require surgical intervention.

Jaundice in newborns is a common health issue that is experienced by almost 60% of the infants and 80 % of premature babies. The reason is the frequent breaking down of the red blood cells in new born babies leading to formation of excess bilirubin. Since livers of newborns are not very well developed, they are often unable to get rid of this excess bilirubin. In most cases the condition will resolve by itself in about two weeks time. However, if the bilirubin levels are very high, the child will need to be treated to avoid risk of brain damage. The doctor may recommend phototherapy or, in rare cases, blood transfusion.

Can I do anything to prevent jaundice?

Since the condition is related to the health of your liver, you can certainly do your bit in preventing its onset by trying to keep your liver healthy. What you choose to eat and drink forms a primary part of this. Foods that are difficult to digest will make your liver work harder, hence it is advisable to avoid large amounts of refined sugar, salt and saturated fats. Toxins like alcohol and some medications can also harm your liver. Including fresh fruits and vegetables in your regular diet will go a long way in keeping you liver healthy. Remember to hydrate yourself well – plain water, not carbonated drinks or juices should be your choice of drink. And regular exercise is the mantra that your liver will respond to as much as the other organs of your body.

It is wise to remember that while jaundice itself may not be a serious or worrying condition, determining the underlying cause is very important. Leaving conditions that cause the affliction untreated can cause serious complications over a period of time and may even become a threat to life.

Gallstones: Stones That Compromise the Gallbladder

Have you been living with on-off acute abdominal pain? Are you one of those people who believe a visit to the doctor is not justified for a ‘minor discomfort’ that disappears after a while with basic pain medication and antacids? Well, perhaps you are right. But then maybe you are not. An acute pain in the abdomen, particularly when it is recurrent and often accompanied by slight fever and chills, can signal a condition that can be more serious than mere indigestion. The culprit may well be a small stone lodged in your gallbladder.

However did I manage to get a stone in my gallbladder!?

A question that may not be easy to answer without some examinations to see the size, position and number of stones lodged in your gallbladder (click here to know more about this). However, you are likely to find that your lifestyle may have played a major role in this. Ask yourself these questions:

Am I a smoker?
Do I consume more than an optimum amount of alcohol?
Do I have a preference for fried and high-fat food?
Am I on the heavier side with a rather ample waistline?
Is my job of a sedentary nature that keeps me tied to my chair for most of the day?
Am I a ‘not too keen’ on the exercise front kind of a person?
Am I not a great believer in maintaining regimens when it comes to my meal times?
Do I have a preference for proteins like meat and fish over a more fibre-rich diet with vegetables and fruits?

You will find that answers to these questions may give you some indication to the ‘Why me?’ Most gallstones are formed by undissolved cholesterol in our bile, the enzyme produced by the liver. This may largely be related to your lifestyle conditions. Sometimes, however, stones are formed when there is an excess of bilirubin in your bile. This may be the result of a disorder or medical condition like liver disease, diabetes, being pregnant, or a genetic disorder.

So does that mean that if I make changes in my lifestyle, start having a fibre-rich diet, give up smoking and begin exercising, the condition can be resolved?

Well, no. The stones once formed will not dissolve by themselves over some time. In most cases, you will not even be aware of their presence as they rarely give any trouble. However, if you start getting pain with associated symptoms, then it is cause for worry, as it may indicate an infection or a more serious condition.

Will medicines help?

The preferred treatment for gallstones always is the surgical removal of the gallbladder. But why remove the gallbladder when the offending pieces are just the stones? Well simply because once stones develop, gallbladder function gets compromised and it just becomes a site for future health complications, including cancer. So while medications can be used to dissolve the stones, it will not be a complete treatment. It would be something like leaving a wound attended, to fester and come back with a vengeance to bite you again and again.

What if I have stones but am unaware of it?

A very likely situation since gallstones often do not manifest in any symptoms. There have been cases where the presence of stones in the gallbladder has been discovered during examination for some other conditions, like jaundice, pancreatitis or other conditions related to the gastrointestinal system. In such cases, the doctor would always recommend surgical removal if he/she feels the condition is related. In instances where there may be no indication of any direct co-relation, one can adopt a wait and watch approach. However, there’s a rider to this. There have been instances where gallstones have been left untreated as they were not giving any trouble, yet at a later stage in life have developed malignancy. So there really is no sure shot way of identifying which cases require surgery and which don’t. Nowadays doctors usually recommend surgical removal of the gallbladder when stones are detected as a means of preventing future complications.

To know more about the treatment methods and complications associated with gallstones, click here.

Living with IBS

Acidity, indigestion, constipation, diarrhoea are conditions all of us are familiar with and have suffered from at some time of our life or the other. Sporadic bouts of these conditions can usually be written off as a food-related temporary abnormality that can be fixed with an antacid or minor diet corrections. However, if any or all of these problems become chronic, recurring without any apparent reason, and are accompanied by mild to severe pain in the abdomen, then the culprit may be IBS or Irritable Bowel Syndrome, a condition that affects the large intestine and is usually related to our lifestyle habits.

What is IBS?

IBS is a chronic condition that affects the large intestine, causing stomach cramping, gas, bloating, diarrhoea, constipation (or both), and sometimes severe pain. It is a condition that cannot be cured but can be effectively managed with lifestyle and dietary changes and medication as and when required.

Symptoms of IBS

Most of the people with the condition do not have any symptoms, and hence, are unaware of its existence. Triggers like spicy or untimely meals, excessive stress, smoking or consumption of alcohol can cause periodic aggravation leading to pain and discomfort. In some people, however, the symptoms are more obvious and they recur at frequent intervals. Following are the common symptoms:

Abdominal pain – mild to severe
Cramping, bloating that is typically relieved with passing a bowel movement
Excess gas
Frequent urge to pass stool, but unable to do so
Alternating bouts of constipation and diarrhoea
Mucus in stool

The symptoms may come and go, can at times be severe, and can completely disappear in good times.

When does it need a doctor’s attention?

If you observe a persistent change in your bowel habits or the severity of the symptoms does not subside over a while, you need to see a doctor. If your discomfort is accompanied by the following conditions, then an immediate visit to the doctor is warranted:

Weight loss
Diarrhoea at night
Rectal bleeding
Anaemia (iron deficiency)
Unexplained vomiting
Difficulty swallowing
Persistent pain

Causes of IBS

Though the exact cause leading to the condition is not known, some factors appear to play a role in its occurrence.

Disruption in muscular contractions in the intestine: Food movement in the intestine is largely dependent on the contractions of muscles lining the intestine walls. Stronger contractions that last longer can cause diarrhoea and gas, and weak contractions can slow food passage and are likely to cause constipation.
Abnormalities in the nerves in the digestive system: This leads to poor coordination of signals between brain and intestine, which in turn can cause your body to overreact to normal changes that occur during the digestive process. This, in turn, leads to more than normal discomfort when your abdomen stretches due to gas or passing of stool.
Increased number of immune cells in the intestine: Some people have this problem and it causes inflammation in the intestines, which in turn can lead to pain and diarrhoea.
Severe infection: Infection caused by a bacteria or virus, like gastroenteritis, can trigger IBS. Bacterial overgrowth results in aggravated symptoms.
Changes in the bacteria in the stomach: Our stomach contains some good bacteria (microflora). They play a key role in our good health. However, research has shown that some changes occur in the microflora in people with IBS which triggers the symptoms.

What are the triggers that aggravate the condition?

Food allergy and intolerance: Though the relation between food and aggravation of the symptoms of IBS is not known, it has been found that some foods cause more discomfort in some people. The kind of food may vary from person to person. Wheat, milk and dairy products, citrus fruits, beans, cabbage, carbonated drinks are some foods that may cause adverse reactions in people with IBS.

Increased stress: Though stress is not known to cause IBS, it is a factor that can make the symptoms worse.

Hormonal changes: Studies have shown that women are more susceptible to the condition. In some women, the condition aggravates during their menstrual cycle. This suggests hormonal changes may play a role in the aggravation of the symptoms.

What are the risk factors?

Age: The condition is more common in people below 50 years of age. Though it would be wise to remember that if you have the condition, it is not likely to go away as you grow older. Lifelong management with lifestyle modification would be required
Gender: It is known to be more common in women, particularly if you are on oestrogen therapy
Genetic factors: If you have a family history of the condition, then you are more at risk. There could be a genetic trigger, or a shared family environment, or both, that may cause the problem
Mental health issues: Factors like anxiety and depression are known to trigger IBS in many individuals. People who have gone through sexual, physical or emotional abuse are more prone to the condition

IBS can cause certain health complications that, though not fatal, can seriously affect one’s quality of life as people with the condition are more likely to miss workdays. They are also likely to suffer from depression and mood disorders. Chronic constipation or diarrhoea can cause haemorrhoids.

Is there a way to prevent IBS?

Since the reason for the onset of the condition is not known, it is difficult to prevent it. However, it can be managed and the symptoms kept in check with lifestyle modifications and taking certain precautions.

Diet correction: Low-fat diet works best for most people with IBS. Avoid fried food and animal fats, focus more on lean meats, fruits, vegetables, grains and low-fat dairy products. Certain carbohydrates which include whole wheat, milk, fruits (like pears, mangoes, watermelon), and sweeteners may be difficult to digest, so regulate the quantity. Since different people with IBS react differently to certain foods, it is recommended to talk to a dietician.

Mind training or meditation: Can be helpful in keeping stress at bay. Anxiety control is essential to keep the symptoms under check, so staying focused on the positives acts as a healer.

Counselling: Since depression and mood swings are common long-term effects of the disorder, a counsellor’s help may be required to deal with the mental health issues. In some cases, a psychiatrist consultation may be required as certain medications may need to be prescribed.

Exercise: Physical activity and regular exercise can help in not just keeping you fit, but also help in relaxing your mind. Obesity is a trigger for IBS, so keeping fit with optimum body weight is of utmost importance.

Diagnosis and Treatment: The condition is usually diagnosed by the doctor based on your symptoms and family history. You may have to undergo tests like sigmoidoscopy or endoscopy, X-ray or a CT scan. The doctor may also ask you to do certain blood and stool tests to check for lactose intolerance and other indicators.

Treatment for IBS usually comprises medications, lifestyle recommendations and therapy to manage the symptoms.

Medica’s IBS clinic offers comprehensive services, including dietary and counselling options, for long-term management of the condition. To know more click here.

Non-Alcoholic Fatty Liver Disease (NAFLD)

NAFLD encompasses the entire spectrum of fatty liver disease (fatty liver to steatohepatitis to cirrhosis) in individuals without significant alcohol consumption. Significant alcohol consumption is defined as 21 standard drinks per week for men and 14 for women. According to the National Institute on Alcohol Abuse and Alcoholism, a standard alcoholic drink is any drink that contains about 14 grams of pure alcohol.

A person is diagnosed with non-alcoholic fatty liver when investigations reveal his/her liver contains more than 5% fat (hepatic steatosis) without any evidence of hepatocellular injury in the form of ballooning of the liver cell (hepatocyte) or any evidence of fibrosis. NASH (non-alcoholic steatohepatitis), on the other hand, is a condition when along with more than 5% liver fat, there is inflammation and hepatocyte injury with or without fibrosis.

Risk factors

The presence of metabolic syndrome (high blood pressure, blood sugar, excess body fat around the waist, abnormal levels of cholesterol, and triglycerides) in a person increases the risks of developing of NAFLD. The most common risk factor is obesity followed by type 2 diabetes and dyslipidaemia (abnormal amount of lipids). The condition is two times more common in men than women.

The most common cause of death in patients with NAFLD is cardiovascular disease, independent of other metabolic co-morbidities. Although liver-related disease or condition is the 12th leading cause of death in the general population, it is the second or third cause of mortality among the patients with NAFLD. NAFLD now considered the third most common cause of hepatocellular carcinoma (cancer).

Symptoms and Diagnosis

Most people with NAFLD are asymptomatic but may experience vague abdominal pain in the right upper quadrant, fatigue and malaise. Signs of chronic liver disease such as splenomegaly ascites (enlarged spleen with fluid accumulation) etc are, however, more common in patients with cirrhosis. Lab tests usually show 2 to 4-fold elevation in serum ALT and AST levels with serum ALT greater than AST. Other parameters of LFTs (liver function test) like bilirubin albumin or prothrombin time are normal.The diagnosis of NAFLD requires evidence of Hepatic Steatosis by imaging or histology, no significant alcohol consumption, and no co-existing causes of chronic liver disease.

Role of Liver Biopsy in patients with NAFLD

Liver biopsy is the gold standard for diagnosing NAFLD but it is usually avoided because of its invasiveness. Newer imaging techniques have been successful in identifying hepatic fibrosis that surpasses the need for liver biopsy. The most commonly used non-imaging technique is transient elastography, a non-invasive technique that uses ultrasound and low-frequency elastic waves to quantify liver fibrosis. The speed at which the wave moves is correlated with liver stiffness and measured in kilopascals. Another non-invasive imaging technique available is MR Elastography.

Treatment

Lifestyle modifications, including diet, exercise and weight loss has been advocated to treat patients with NAFLD. Moderate calorie restriction – daily reduction by 500-1000 kcal – and moderate-intensity exercise 4-5 times weekly for 30-45 minutes, or resistance training 3 times a week, with a total exercise time of around 45 minutes, is likely to be most effective. It has been seen that consumption of coffee (2-3 cups daily) decreases the risks of hepatic fibrosis and it is highly recommended in patients with NAFLD.

Pharmacotherapy

Medications that reduce the generation of reactive oxygen species are potential agents for the treatment of NAFLD. The most-studied antioxidants are vitamin E, vitamin C and Betaine among which vitamin E is most effective. Most studies have shown modest improvement in serum aminotransferase levels as well as improvement in steatosis, but with no effect on hepatic fibrosis. Omega-3 fatty acids should not be used as a specific treatment of NAFLD but they can be used to treat hypertriglyceridemia in patients with NAFLD.

Take-home message

The following measures can lead to a happy and healthy life in patients with NAFLD:

Avoidance of alcohol
Weight reduction
Calorie restriction
Moderate intensity exercise

(Dr Sethy is Director Gastroenterology of Medica Superspecialty Hospital. He is a Senior Gastroenterologist and Hepatologist)

Hernia: Causes, Treatments and Diagnosis

Mr Mukherjee, a retired school teacher, had lately been observing pain in his groin area, particularly when he coughed or bent to lift something. In the days that followed, no number of painkillers, ice or massaging eased what he wanted to believe was a temporary strain of some sort. Soon, the pain consolidated into a small spot at the front of his hip that sent a burning sensation into his belly, lower back and the outside of the leg. He consulted a physician, who suspected it was Hernia. Investigations confirmed the diagnosis. The doctor explained that surgery was unavoidable. And since he was in so much pain, it must be done immediately.

What is Hernia?

A hernia is the abnormal exit of an organ or a tissue, such as the bowel through the wall of the cavity in which it normally resides. Hernias can be of several types. Most commonly they involve the abdomen, especially the groin.

What Causes Hernia?

Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of fascia or muscle; the pressure pushes a tissue or organ through an opening or a weak spot. Sometimes, muscle weakness is present at birth; more often, it occurs later in life. Anything that causes an increase in pressure in the abdomen can result in a hernia, including:

Lifting heavy objects without stabilizing the abdominal muscles
Constipation or diarrhoea
Persistent sneezing or coughing

Besides, obesity, poor nutrition and smoking can also weaken muscles and make it more likely for hernias to happen.

Common forms of Hernia are:

An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles. The resulting bulge can be painful, especially when you cough, bend over or lift a heavy object. An inguinal hernia isn’t necessarily dangerous.

A femoral hernia is the result of tissues or parts of the intestine pushing through into the groin at the top of the inner thigh. They are less common than inguinal hernias and mainly affect older women.

An umbilical hernia occurs when the fatty tissue or part of the intestine pushes through the abdomen near the navel.

Hiatal (hiatus) hernia usually forms when a part of the stomach is pushed up into the chest cavity through an opening in the diaphragm.

Other types of hernias include:

An incisional hernia is one that occurs in the area of a previous surgery is known as an incisional hernia.

Epigastric hernias are generally small and occur in the middle of the belly, a between the breastbone and belly button</p?

A Spigelian Hernia, unlike other types of hernias, develops below the layers of fat, Spigelian hernias occur in the middle of abdominal muscles. So, Spigelian hernias may not be visible as a lump or bulge

A Diaphragmatic hernia occurs when the abdominal organs move into the chest through an opening in the diaphragm

The Causes

A hernia develops due to a combination of abdominal wall muscle weakness and persistent pressure on this weakness, over a while. Some of the causes are:

A congenital defect
Muscles which weaken due to age
Poor nutrition
Constipation
Straining during urination
Constant coughing or sneezing
An abdominal injury or surgery
Improper lifting of heavyweights
Being overweight/obese
Ascites or fluid build-up in the abdominal cavity
Peritoneal dialysis
Smoking

Symptoms of Hernia

Signs that you or a loved one may have a hernia include the following:

A bulge in the groin or swelling in the scrotum
Discomfort in the groin area that worsens when you lift or bend something
Heaviness in the abdominal or groin area
Pain or discomfort during urination or bowel movement
Pain or discomfort, especially if you were standing for a long period

Any symptoms of a strangulated hernia, which include fever, vomiting, nausea, and severe cramping.

If you’re a parent, you may notice a lump in your infant’s groin area while he/she cries, coughs or during a bowel movement. If so, contact your paediatrician to determine if any treatment is needed.

Treatment

Abdominal wall hernias with no associated symptoms may not even require treatment. Consult a doctor to discuss your options that are likely to include surgery or watchful waiting.

Larger hernias or hernias that are extremely painful, may require surgery to relieve the pain and prevent complications.

There are two types of surgical hernia repair: open and minimally invasive surgery. The type of surgery chosen will depend on the severity and type of hernia you are diagnosed with, the predicted recovery time, past medical history and the surgeon’s expertise.

To know more about the treatment options available at Medica, click here.

Hydrocephalus

Hydrocephalus can happen to anyone, but occurs frequently among infants and adults, 60 and over. It is the buildup of fluid in the cavities deep within the brain. This excess fluid expands the ventricles and puts pressure on the brain.The Cerebrospinal fluid flows through the ventricles and bathes the brain and spinal column. But too much cerebrospinal fluid causing pressure can damage brain tissues and cause a range of impairments in brain function.

Common signs and symptoms of hydrocephalus

Infants

An unusually large head, rapid increase in the size of the head, a bulging or tense soft spot (fontanel) on the top of the head may be signs of Hydrocephalus among them. Other symptoms may be: vomiting, irritability, poor feeding, seizures, poor growth and poor responsiveness.

Toddlers

Common symptoms in toddlers may be Headache, Blurred or double vision, Eyes fixed downward, abnormal enlargement of a toddler’s head, Sleepiness or lethargy, Nausea, loss of balance, Poor coordination, Poor appetite, Seizures, Urinary incontinence. They may also become irritable, have a change in personality, school performance may decline, Delays in walking or talking.

Young and middle-aged adults

Symptoms faced by young or middle aged adults may like Headache, Lethargy, Loss of coordination or balance, Loss of bladder control or a frequent urge to urinate, Impaired vision, Decline in memory, concentration and other skills that may affect job performance

Older adults

Adults of age 60 years and above face symptoms of hydrocephalus like:incontinence or a frequent urge to urinate, Memory loss, Progressive loss of thinking or reasoning skills, Difficulty in walking, Poor coordination or balance etc.

Causes of Hydrocephalus

Hydrocephalus is caused when there is excess of cerebrospinal fluid produced but not much is absorbed into the bloodstream.

This fluid is produced by tissues lining the ventricles of the brain. It flows through the ventricles into spaces around the brain and spinal column. It is generally absorbed by blood vessels in tissues near the base of the brain.

Role of Cerebrospinal fluid:

Helps the heavy brain to float within the skull
Cushions the brain and prevents injury
Removes waste products of the brain’s metabolism
Maintains constant pressure within the brain cavity and spinal column compensating for changes in blood pressure in the brain

Excess cerebrospinal fluid in the ventricles may occur due to:

Obstruction in thenormal flow of cerebrospinal fluid, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorptionwhenblood vessels are unable to absorb the excess cerebrospinal fluidproduced due to disease or injury.
Overproductionsometimes cerebrospinal fluid is created more quickly than it can be absorbed.

Factor that lead to Hydrocephalus

Newborn-Hydrocephalus present at birth may occur because ofabnormal development of the central nervous system, bleeding within the ventricles, infectionssuch as rubella or syphilis in the uterus during a pregnancy

Among other age groups–Among others the causes for Hydrocephalus may be due toLesions or tumors of the brain or spinal cord, infections of central nervous system such as bacterial meningitis or mumps, bleeding in the brain from a stroke or head injury, other traumatic injury to the brain

Prevention of Hydrocephalus

Hydrocephalus cannot be prevented but there are ways to reduce the risk of hydrocephalus:

Pregnant women should get regular prenatal care to reduce the risk of premature labor, which may put the baby at risk of hydrocephalus and other complications
Protect against infectious illness andget vaccinated and screenedto reduce the risk hydrocephalus.

Use appropriate safety equipment to prevent head injuryuse helmets andseatbelts to prevent any head injury and reduce the risk

Get vaccinated against meningitis

Meningitis is one of the common causes of hydrocephalus. The Centers for Disease Control and Prevention recommends vaccinations for preteen children and boosters for teenagers to prevent the risk of Meningitis. Younger children and adults may be at increased risk of meningitis if:

Traveling to countries where meningitis is common
Having an immune system disorder
Having a damaged spleen or having had the spleen removed
Living in a college dormitory
Joining the military

Brain Aneurysm

A brain aneurysm is a bulge formation or ballooning in a blood vessel in the brain. A brain aneurysm can leak or rupture, causing bleeding in the brain which leads to a haemorrhagic stroke. It generally occurs in between the brain and the thin tissues covering the brain. This type of haemorrhagic stroke is called a subarachnoid haemorrhage. It could prove to be fatal if prompt action is not taken in such situations. However, most of the times Brain Aneurysms do not rupture, cause any health problems or present any symptoms. They can only be detected during tests.

What are the symptoms of Aneurysms?

Symptoms of Aneurysms may differ depending on the type of Aneurysm it is. The different types of Aneurysm are: Ruptured Aneurysm, Leaking Aneurysm &Unruptured Aneurysm

Symptoms

Ruptured aneurysm

The main symptom of a ruptured aneurysm is the “worst headache” ever experienced.

Some common signs and symptoms of a ruptured aneurysm include:

Severe headache
Nausea and vomiting
Stiff neck
Blurred or double vision
Sensitivity to light
Seizure
Drooping eyelids
Loss of consciousness
Confusion

‘Leaking’ aneurysm

In some aneurysm a small amount of blood may leak from it. This leaking may cause only a sudden, extremely severe headache. Often a more severe rupture follows leaking.

Unruptured aneurysm

An unruptured brain aneurysm may produce no symptoms, particularly if it is small. However, a larger unruptured aneurysm may press against the brain tissues and nerves, resulting in:

Pain above and behind one eye
A dilated pupil
Change in vision or double vision
Numbness of one side of the face

Risk factors associated with Brain Aneurysm

There may be several factors which leads to the weakness in an artery wall and increase the risk of a brain aneurysm or its rupture. Brain aneurysms are more common in adults than in children and more common in women than in men.

Some of these risk factors of Brain Aneurysm develop over time while others may be present at birth.

Risk factors that develop over time Include

Old age
Cigarette smoking
Hypertension
Drug abuse, particularly the use of cocaine
Heavy alcohol consumption

Aneurysms may also occur after a head injury or from certain blood infections like mycotic aneurysm

Risk factors present at birth

Given birth conditions can be associated with a higher risk of developing a brain aneurysm:

Inherited connective tissue disorders such as Ehlers-Danlos syndrome, weaken the blood vessels
Polycystic kidney disease an inherited disorder that results in fluid-filled sacs in the kidneys leads to the increase in blood pressure
Abnormally narrow aorta or the large blood vessel that deliver oxygen-rich blood from the heart to the body
Cerebral arteriovenous malformation is an abnormal connection between arteries and veins in the brain that interrupts the normal flow of blood between the two
Family history or first-degree relative, such as a parent, brother, sister having the condition may increase the risk of developing a Brain Aneurysm

Complications of a ruptured Brain Aneurysm

The blood from a ruptured Aneurysm can cause damage to surrounding cells and can damage or kill other cells. It also increases pressure inside the skull, which when too high can lead to the disruption in the blood and oxygen supply to the brain resulting in loss of consciousness or even death.

Complications after the rupture of an aneurysm include:

Re-bleeding An aneurysm that has ruptured or leaked is at risk of bleeding again which can cause further damage to brain cells
Vasospas After a brain aneurysm ruptures, blood vessels in your brain may narrow erratically (vasospasm). This condition can limit blood flow to brain cells and cause additional cell damage and loss.
Hydrocephalus Rupture of an Aneurysm may lead to bleeding in the space between the brain and surrounding tissue, which can block circulation of the fluid surrounding the brain and spinal cord. This condition can result in collection of an excess cerebrospinal fluid that increases the pressure on the brain and can damage tissues
Hyponatremia A ruptured brain aneurysm can disrupt the balance of sodium in the blood. This may occur near the base of the brain. A drop in blood-sodium levels or hyponatremia can lead to swelling of brain cells and cause permanent damage.

When to see a doctor

Aneurysms can appear anywhere in the brain, but they are most common in arteries present at the base of the brain. If you develop a sudden, extremely severe headache seek medical attention immediately. Call your local emergency number if someone complains of a sudden, severe headache, loses consciousness or has a seizure.

Spinal Tumour

While spine tumours are relatively rare (only one person in 100,000 develops a spine tumour each year), if you have one, the impact can be life-altering. When it comes to spine tumours whether they are cancerous or noncancerous, found on vertebrae or the spinal cord, back pain is the most common red flag.

A spinal tumour is a growth that develops within your spinal canal or within the bones of your spine. Spinal tumours can be benign (non-cancerous) ormalignant (cancerous). Primary tumours are generally formed in the spine or spinal cord, and metastatic or secondary tumours result from cancer spreading from other site to the spine. Spinal tumours are often named according to the region of the spine in which they occur. These areas are mainly cervical, thoracic, lumbar and sacrum. They can also be classified by their location in the spine into three major groups: intradural-extramedullary, intramedullary and extradural.

Intradural-extramedullary–Thesetumours usually develop in the spinal cords arachnoid membrane (meningiomas), in the nerve roots that spread out from the spinal cord or at the base of the spinal cord. Although meningiomas are often benign, they can be difficult to remove and have a tendency to recur. Nerve root tumours are also generally benign, although neurofibromas may become malignant over time.

Intramedullary: These tumours grow inside the spinal cord, most frequently occurring in the cervical (neck) region.Astrocytomas and ependymomas are the two most common types of tumours here. They are often benign, but can be difficult to remove. Intramedullary lipomas are rare congenital tumours most commonly located in the thoracic spinal cord.

Extradural: These lesions relate to metastatic cancer or schwannomas derived from the cells covering the nerve roots. An extradural tumour extends through the intervertebral foramina, lying partially within and outside of the spinal canal.

Symptoms of a Spinal tumour: –
Abnormal sensations, loss of sensation : –

Especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg) may worsen

Back pain : –

Gets worse over time
In any area middle or low back are most common
Is usually severe and not relieved by pain medication
Is worse when lying down
Is worse with strain, cough, sneeze
May extend to the hip, leg, or feet (or arms), or all extremities
May stay in the spine

Early diagnosis is key
Cancerous and noncancerous spine tumours that push against spinal nerves can be painful, debilitating and many a times even life-threatening. They can lead to loss of movement and sensation below the location of the tumour, and affect bladder and bowel function as well. If undiagnosed and left untreated, nerve damage can be permanent.

Diagnosis of Spinal Tumours

Diagnosis of spinal tumours begins with:

Checking the history and physical examination of patients
Plain X-Rays
Spinal Magnetic Resonance Imaging (MRI)
CT Scan
Myelogram
Biopsy- to determine whether the tumour is benign or malignant

Treatment of Spinal Tumours
Non-Surgical Treatment of Spinal Tumours

Surgery and radiation therapy may cause inflammation inside the spinal cord, thus doctors sometimes prescribe corticosteroids to reduce swelling either following surgery or during treatment.

Surgical Treatment of Spinal Tumours
Surgical options for the treated of spine tumours vary from complete to partial removal. Surgery may be necessary as a result of instability caused by tumour itself or the surgery to remove it. This surgery may be done from the front or back of spine. It may involve going through the neck, chest or abdomen. Newer techniques and instruments allowsareas that were once inaccessible. The high powered microscopes used in microsurgery for instance make it easier to distinguish tumours from healthy tissue. The typical hospital stays after surgery to remove a spinal tumours range from approximately 5 to 10days

Radition therapy

This therapy is used following an operation to eliminate the remnant of tumours that can’t be completely removed or to treat inoperable tumours.

Brain Tumour

According to reports, in India, every year 40,000-50,000 people are diagnosed with brain tumour. Of these 20 per cent are children. The average survival rate for all malignant brain tumour patients is only 34.4%. A brain tumour is a mass or growth of abnormal cells in your brain.There are more than 120 different types of brain tumours showing different symptoms. But, broadly, it may be mainly of two types:

Primary Brain Tumour – Here the tumor begins in the brain tissue.
Secondary Brain Tumour – If the tumour starts somewhere else in the body e.g. the lung, then spreads to the brain, it is known as a secondary brain tumour or metastases.

The signs symptoms of brain tumors depend on their size, type, and location.

Symptoms that depend upon the position of the tumour:

Brain stem: Lack of co-ordination when walking, double vision, difficulty in swallowing and speaking and facial weakness in the form of one-sided smile or a drooping eyelid.
Cerebellum: Flickering and/or involuntary movement of the eyes, vomiting and stiffness of the neck and uncoordinated walking and speech.
Temporal lobe: Speech difficulties and memory problems and strange sensations – fear, blackouts, strange smells
Occipital lobe: Gradual loss of vision on one side.
Parietal lobe: Problems with reading, writing or simple calculations, navigation-related difficulties, numbness or weakness in one side of the body and difficulty in understanding words or speaking.
Frontal lobe: Unsteadiness and weakness on one side of body, changes in personality and loss of smell.

What causes brain tumours?

The risk factors which may lead to Brain Tumours are:

Genetics – A small portion of brain tumours occur in people with a family history of brain tumours or a family history of genetic syndromes that increase the risk of brain tumours.
Radiation – People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumour.

Diagnosis

If it’s suspected that you have a brain tumour, your doctor may recommend a number of tests and procedures, including:

A neurological Exam – A neurological exam among other things may require checking your vision, hearing, balance, coordination, strength and reflexes. Difficulty in one or more areas may provide clues about the part of your brain that could be affected by a brain tumour.
Imaging tests -< /strong>Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumours. In some cases a dye may be injected through a vein in your arm during your MRI study. Other imaging tests may also be recommended, including computerized tomography (CT), Positron emission tomography (PET)
Tests to find cancer in other parts of your body. If it’s suspected that your brain tumour may be a result of cancer that has spread from another area of your body, your doctor may recommend tests and procedures to determine where the cancer originated. One example might be a CT or PET scan to look for signs of lung cancer
Biopsy – Many a time a stereotactic needle biopsy may be done for brain tumours in hard to reach areas or very sensitive areas within your brain that might be damaged by a more extensive operation. Your neurosurgeon drills a small hole into your skull. A thin needle is then inserted through the hole. Tissue is removed using the needle, which is frequently guided by CT or MRI scanning.The biopsy sample is then viewed under a microscope to determine if it is cancerous or benign. Sophisticated laboratory tests can give your doctor clues about your prognosis and your treatment options.

Treatment

People with brain tumors have several treatment options. The options are surgery, radiation therapy, and chemotherapy. Many people get a combination of treatments. The choice of treatment depends mainly on the following:

The type and grade of brain tumor
Its location in the brain
Its size
Your age and general health

Surgery
Surgery is the removal of the tumour and some surrounding healthy tissue during an operation. It is usually the first treatment used for a brain tumour and is often the only treatment needed for a low-grade brain tumour. Removing the tumour can improve neurological symptoms, provide tissue for diagnosis, help make other brain tumour treatments more effective, and, in many instances, improve the prognosis of a person with a brain tumour

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy tumour cells. Doctors may use radiation therapy to slow or stop the growth of the tumour. It is typically given after surgery and possibly along with chemotherapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy tumour cells, usually by ending the cancer cells’ ability to grow and divide. The goal of chemotherapy can be to destroy tumour cells remaining after surgery, slow a tumour’s growth, or reduce symptoms. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating tumours with medication. Chemotherapy may also be given by a neuro-oncologist.

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