Wednesday, October 12, 2016

How to manage a case of Elephantiasis

Hi friends, 
Elephantiasis is a disease in which lymph vessels are blocked by a parasite and it gives rise to swelling in legs, hands and scrotum. The name of the disease is Filarisis or Filaria. It is caused by Waucheria bancrofti and it is a tropical disease. In India, it occurs mainly in Bihar, bangal and Odisha. 

The treatment is very unsatisfactory. It is better to manage the disease in acute condition in order to avoid the chronic course. It damages the penis gives rise to Ram's horn penis and extensive solid oedema is noticed in scrotum, legs, hands etc. 


The treatment is very challanging and our main aim is to minimize the deformity caused by chronicity of the disease. 
We have some drugs to cleanse the lymphatic system so that the residual edema should be reduced. 

Thanks

Surgery in Ayurveda - reality and facts

Dear Friends,
India has been seen a country of spiritual discourses and occult sciences. However, there are some sciences who gave world a vision to develop and excel. Ayurveda is one among them. Since, we lived under foreign rule for a considerable period of time and it influenced our thought process as well as behavioural pattern.
When I ineract to my allopathic doctor friends, they outrightely reject the scientific aspects of Ayurveda and say that Ayurveda is an empirical medicine.
It is pertaining to mention here that the first surgical procedure and instruments were designed by famous Ayurvedic surgeon of India, the Sushruta. It is documented and variefied by Sabiston in his textbook. He mentioned that western writers ignored these ancient Indian surgeons.
The surgery in Ayurveda is a very developed discipline and many procedures and instruments have been mentioned in the Sushruta samhita. As a follower of this discipline, my efforts are to convince the people that we are still in a very confortable condition to treat some diseases. I am not against the allopathic medicines, even I admire the developments in that field.
It is a ripe time to practice and make some research in this field to propagate the science and it is the moral duty of all scientist to prove that Ayurveda is a scientific knowledge and not an empirical one.


Sushruta, the father of surgery didn't get the desired status in the world on account of geopolitical reasons. 



I have also seen that some unqualified and untrained persons practising some Ayurvedic procedures bring bad name to our system. I urge the people that please be sure that your treating physician should have a degree from a recongnised university. I have also seen some surgeons doing modern surgical operations in the name of ksharsutra. There are some graduates of Ayurveda who have been carrying out modern surgical procedures in the name of ksharsutra, it is not ethical practice and one should condemn such practices. 

We are sure that we would be able in near future to minimize the use of antibiotics and painkillers; instead, Ayurvedic drugs may be supplemented in their place. 

Jai Ayurveda



Friday, September 16, 2016

Extensive surgical exploration in and around anal canal ought to be avoided

I do come across many patients, who have undergone extensive surgical excisions in and around anal canal and they come with the complaint of stenosis or stricture and hard tissue formation. It is common in cases of surgery of fistula in ano and haemorrhoids. Even after this, the recurrence is seen.

The common complaints are:
1. Difficulty in passing stool in terms of discomfort and holding the urge.
2. Difficulty in sitting for a long period.
3. Lack of natural softness in perianal area.
4. Soiling of clothes.
5. Passing of stool with urge of flatus.
6. Something holds the urge of defecation.
7. Persistence of previous symptoms presented prior to surgery.

My preceptors told me one important thing that complications such as stenosis, stricture and hypertrophic scar. I am fortunate enough that I have not come across a single patient of strciture after following some basic rules.

Results of extensive excisions:

Great degree of tissue loss:

Here you can appreciate the tissue loss and even after that the recurrence of fistula is seen and patient came to our hospital. 
Why perianal fat is important?
The perianal area is very rich in fat particularly the ischiorectal fosse where the abundance of fat is responsible for smooth passage of stool as it gives the space for streching of lumen. The fat is lost after surgery and it hampers the streching which is required during stool movement. 

Why stenosis or stricture?
The incorrectly performed procedure for haemorrhoidectomy or fistulectomy may result in these complications. The extensive excision of skin during these procedure and ligation of internal sphincter may be the cause.


Many alternative therapies are available:

1. Ksharsutra therapy is an alternative. 
2. Medicines in cases of first and second degree piles are suffiecient.
3. Fissure may be managed by anal dilatation and bowel regulation. 

It is my personal advise, that a patient and a doctor should think before advising or performing extensive excisions and jeopardizing precious tissue.

Regards
Dr Praveen Choudhary
9968686823


Thursday, July 28, 2016

Psoriasis - a notorious skin disorder

Hi Friends,
I do come across several patients of long standing skin ailments in my outpatient department and psoriasis is one among them. As you may be aware that it is an autoimmune disorder. Owing to this reason, the complete eradication is remote.

How it looks?

It is characterized by skin patches with silver flakes on the lesions. It may be localized or generalized.




These are two videos showing the psoriasis lesions. 

How to manage a case of psoriasis?

1. Maintain healthy lifestyle
2. Vegetarian diet 
3. Plenty of fluids
4. Use of natural immunity boosters such as tinospora. neem, chirata etc. 
5. Anti-inflammatory drugs
6. Cytotoxic therapy in chronic and severe cases.

Local application of Writia tinctorea is found helpful in the form of paste or ointment. 

Regards

Dr Praveen Choudhary 

Wednesday, July 6, 2016

The Ways to Keep The Health of the Heart in best condition

A few months before, I visited a village in hill area in Uttarakhand. I observed considerable high population of old people in the village. When I asked why?

The reply was, "Young people went to earn livelihood and children for education in cities." These elderly people were in best of residual health and brought some logistics by climbing on treks in mountains.

This is the best example how can we keep our heart in best of health.

The 10 ways to improve heart health:

1. Exercise - Aerobics or jogging for at least half an hour.

2. Sleep - For at least 6 to 7 hour and it should be deep sleep without dreams and rapid eye movement. 

3. Keep your stress levels as low as possible. It can be done by minimising your necessities and sparing quality time with family and friends.

4. Smile and laugh a lot.

5. Eat walnut and apricot daily along with gram and jaggery. 

6. Avoid fat in excess and take your energy from proteins such as milk, soya and pulses. 

7. Finish your work in time be it office or somewhere else. 

8. Don't smoke and drink. 

9. Drink a lot of water.

10. Check your sugar levels at regular intervals. 


Wishes for a healthy heart and life. 


Regards

Dr Praveen Choudhary

Friday, July 1, 2016

Fistula in ano - Challenges in the treatment

Fistula in ano:
It is a chronic discharging wound in periphery of anal canal. There is recurrent discharge of pus and blood from the wound. Initially it may look like a boil in the anorectal region which is ignored by the patients.

How it looks?
It looks like a boil, a swelling or a small wound. A streak of pus or blood may be noticed on the wound.


Symptoms:

1. Pain
2. Bleeding
3. Pus discharge
4. Swelling

On careful digital examination, a cord like structure may be seen running from opening towards the anal canal. It is the fistula track. It starts from internal to external. The internal opening of the fistula in ano can be appreciated by a surgeon on careful digital examination. 

Treatment Options:
1. Medicines - Only temporary relief, no permanent cure.
2. Surgery - Chances of recurrences are fairly normal in surgical procedure. 
3. VAAFT and LIFT - Less pain but chances of recurrences are fair even more than surgery
4. Ksharsutra: It may be painful a little but chances of recurrences are minimal. 

What is ksharsutra?
It is a thread smeared with medicines and it is placed in the fistula track and it causes slow cutting and healing of the track. 

How it is done?



Benefits of Ksharsutra therapy:
It is safe and it can be performed by using local anaesthesia. Patient can go home after having this therapy. He or she can perform normal duties during the therapy.


Thanks
Dr Praveen Choudhary
praveensurgeon9@gmail.com

Friday, June 24, 2016

Is it worth worrying having cystic swelling on different parts of body?

I do come across an important question asked by many patients who have been suffering from cysts or lumps in different body parts, "Doctor, is it cancer?'

And my answer is no dear it is a simple cyst, don't worry and take some simple action like medicines or surgical removal followed by biopsy.

How to decide severity?

It is an important factor that these cysts are specific to some body parts and usually give no symptom except mild discomfort. They are purely a cosmetic issue.

The first question:

It is single or multiple?

The multiple swellings on body are mainly due to Lipoma or neurofibromatosis. Apart from these diseases lymph node swelling may be multiple. The difference is that the Lipomatosis (multiple lipoma) are typically occur on side wall of chest and abdomen, hands and back. The Neurofibroma occurs on entire body and lymphadenitis occur at anatomical site of lymph nodes such as neck, axilla, groin etc.

Lipoma:
Neurofibromatosis:



Lymph node enlargement:


Single swelling:

Post auricular dermoid:


External angular dermoid:


These are a few examples. Now the question is that what are the chances of malignant transformation of these lumps. There are negligible chances of malignant transformation in these cysts. 

Malignant nodules:
Let us have a look at the metastatic cancerous nodes below the skin.

What action should be taken?
I suggest the patient not to ignore even a small nodule and excisonal biopsy should be carried out after complete removal of the lump.

Regards

Dr Praveen Choudhary
New Delhi

praveensurgeon9@gmail.com




Sunday, June 12, 2016

Should we ignore frequent boils on the jaw angle?

Hi friends,
I do come across several patients suffering from boil like eruptions on the angle of jaw or jaw region. They ignore such lesion considering the likelihood of acne, seborrhoea or pimples due to oily skin. But it may prove fatal in some cases. It is because the OTC sale of antibiotics and antiinflammatory drugs. The symtoms subside and ready to recur in near future.

What to exclude?
There is a possibility of infection in the root of teeth that is the gums on account of dental caries. It is sometimes get unnoticed. In frequent infections and pus formations, if it ruptures outside on face, it gives rise to a sinus. The sinus becomes chronic and then patient visits a clinician.

Dental caries should not be ignored

If you have been suffering from dental carries then it should be taken care of by a dentist so that future complications should be avoided.

How the alveolar abscess and dental sinus looks?

Let us have a look on the video:

1.



2. There is one more video:




What to do:

The dental infection should be dealt adequately and after that, the sinus should be debrided. 


Thanks 

Dr Praveen Choudhary
9968686823


Tuesday, May 17, 2016

Bulging of swelling on cough (Impulse on cough) - A primary test for hernia

What is hernia?
It is protrusion of a viscus or a part of it through an abnormal opening in the body. It is primarily due to the weakness of muscle, a defect in supporting tissue and presence of some congenital pouches.

Which is a common hernia in males?

The commonest hernia in males is inguinal hernia. Situated in inguinal region or groin, it is of two types - Direct (due to muscle weakness) and indirect (due to presence of a patent processus vaginalis).


Which is commonest hernia in females?
Femoral hernia is mainly occurs in females and it is because of the broad pelvis and resultant broad femoral canal. The hernia comes through femoral canal. 



Incisional hernia?
It occurs on account of the weakness in the scar of previous surgery.


Congenital hernia?
It is presented since birth.



Treatment Options:
It is a surgical disease. The surgery includes three types of procedures such as:
1. Herniotomy: Removal of the sac in which hernia lies.
2. Hernioraphy: Repair of weak wall
3. Hernioplasty: Putting a mesh in wall to reinforce it

Thanks
Dr Praveen Choudhary


Wednesday, May 11, 2016

Lichen Planus Hypertrophicus

It is a skin ailment associated with some immune response of the body; hence, it seems to be a difficult disease to tackle and cure. It is also known to be an autoimmune disorder.

Predisposing factors:
1. Genetic causes
2. Allergic reactions
3. Stress
4. Viral afflictions
5. Unknown factors

Is it harmful?
It is not harmful. It is more of a cosmetic problem. It is also not contagious. It has several variation such as hypertrophic lesions. pigmented lesions and mucous membrane lesions.

Clinical features:

Treatment:
1. Healthy lifestyle 
2. Drink plenty of water and juices
3. Topical steroid applications
4. Systemic steroid in case of severe symptoms
5. Immunosuppressents

Thanks

Regards
Dr Praveen Choudhary

Friday, May 6, 2016

Does sitting in Indian style reduce the chances of varicose veins?

Varicose veins:
These are dilated and twisted veins seen most commonly in lower extremities and they can be diagnosed easily by inspection itself.

Causes:
1. Valvular incompetency giving way to backflow; hence, increased pressur
2. It may have genetic predisposition
3. Pregnancy
4. Long standing and long sitting in western style
5. Obesity
6. Increased intraabdominal pressure

How they look?

 What is the difference between varicose veins and telengiectasia?
One should not get confused between varicose veins and telengiectasia. The varicose veins look blue on inspection while telengiectasia are superficial small dilated veins look red on inspection.

Telengiectasia:


Complications:
1. Dermatitis or venous eczema
2. Lipodermosclerosis
3. Ulceration (Varicose Ulcers)




Incidence were very less in ancient India on account of sitting habits:
It is very interesting to note that in Indian culture, the sitting was specific. It is known as Paalthi and most of the sitting work were performed by sitting in palthi. The use of chair and table was not a part of Indian culture, It is interesting to note that even after multiple pregnancies, the incidence of varicose veins in women were negligible.
Due to the increase in western lifestyle in India, the cases are on increasing pattern in India.

I strongly recommend to use the sitting on ground cross leg or paalthi. Also some yog postures are good to reduce the chances of varicose veins,

Regards

Dr Praveen Choudhary, New Delhi
9968686823
praveensurgeon9@gmail.com

Monday, May 2, 2016

The Natural treatment of Lichen Planus skin ailment

As you may be aware, that Lichen is a immune system related skin disease. The immune response may be triggered by stress, allergy, viral ailments and may also be genetically linked.

It is dangerous?

No, it is not dangerous, but it is quite discomforting and it causes severe cosmetic peoblems when a larger area of the skin is involved.

How it looks?

Let's have a look on the video of a patient suffering from hypertrophic Lichen planus.

What are the treatment modalities?

The treatment includes immunosuppresants, corticosteroids, retinoids, antihistamines etc. 

Natural cure:
1. Detoxification - Emesis, purgation and enemas are used to detox the body, it gives dramatic relief.
2. Soaking in oatmeal bath
3. Mud bath
4. Phototherapy


Thanks

Dr Praveen Kumar Choudhary
praveensurgeon9@gmail.com
9968686823

Friday, April 29, 2016

Do all hernia need surgical intervention?

Hi Friends,
I do come across many patients in my OPD who afraid of the idea of being treated by surgical interventions in diseases like hernia. The hernias are of different types according to the anatomical sites and contents. The commonest are:
1. Inguinal Hernia - Common in males
2. Ventral hernia - Hernia of the abdominal wall - Common in females
3. Femoral hernia - Common in females, but incidence are not common
4. Hernia of anterior abdominal wall such as Epigastric (Above umbilicus in the epigastrium), periumbilical and Umbilical.

Inguinal Hernia:

Umbilical Hernia:
Epigastric Hernia:
Incisional Hernia:
These are a few examples of certain hernias seen in human beings. Now come to an important question, whether one requires to perform surgical procedures in all these hernia. My point is that although the hernia is a surgical disease, yet there is no need to perform surgical procedures in all hernias.

Inguinal and Umbilical hernias are prone to get obstructed and there are chances of complications in these hernias. Therefore, they should be get operated. 

Epigastric and Periumbilical hernia may be managed by certain methods like wearing supports and taking care of flatulence etc. 

However in case of sudden pain and discomfort, medical attention should be sought immediately.   

Sunday, April 24, 2016

Umbilical Hernia

What is Hernia:
It is prolapse of an organ or a part of it through an abnormal opening. It is named after the anatomical site of hernia such as inguinal, femoral, umbilical, epigastric etc.

Symptoms:
1. Swelling which increases on exertion, walking, coughing and weight lifting
2. Mild discomfort
3. Severe symptoms when it is obstructed particularly inguinal and umbilical.

Treatment:
The treatment is surgical only.

Palliation:
1. Avoid exertion
2. Wear support

When to consult:
sudden increase in size
Sudden increase in pain
Pain not relieved by medicines

Then

Go to ER


Thanks

Friday, April 22, 2016

Hodgkin's Lymphoma

There is bilateral symmetrical enlargement of lymph node of cervical, axillary and inguinal lymph nodes. These are rubbery, firm and painless.


Congenital Torticollis - Shortening of Sternocleidomastoid muscle

It occurs on account of shortening of sternocleidomastoid muscle.

Symptoms:
Patient is not able to turn the head to opposite side and in severe cases the turning of head toward shoulder occurs and it is permanent.

Treatment:
Only corrective surgery is the treatment of choice.

Sunday, April 17, 2016

Severe Jaundice in Viral Hepatitis - Yellow Eyes and skin



Jaundice:

It means yellow discolouration of skin and mucous membrane. Jaundice is of three types:

1. Hemolytic - Due to excessive hemolysis in blood disorders and Malaria etc.

2. Infective: Viral, bacterial or protozoal

3. Obstructive: Obstruction to the passage of Bile flow

Investigations:

LFT

Hepatitis profile

Ultrasound examination of Liver

Thursday, April 14, 2016

Ayurvedic Ksharsutra Therapy in Pilonidal Cyst Sinus

Pilonidal Sinus is a chronic discharging sinus present in gluteal cleft and it is common in age group of 16 to 30 years and commonly occurs in male with abundance of hair.
Depilation and Ksharsutra therapy is best in dealing with such sinuses. Surgical excision ought to be avoided as it is a frustrated experience.

https://youtu.be/mTGFrvaxvWE







Portal hypertension - Tortuous veins demonstration





Portal hypertension means raised pressure in portal vein and it is because of obstruction to the flow of fluid on account of liver cirrhosis and cardiac causes.