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Jan15
Intestinal Obstruction due to Stones
MRS R____ K____ , a 55 year old female was transferred from a local nursing home

She was admitted in a local Nursing home with abdominal pain & vomiting. She was treated as a case of acidity. In spite of the treatment for a week, she did not improve.

When she came to me, her symptoms were suggestive of intestinal obstruction (blockage). A CT scan of abdomen was undertaken. CT scan revealed that she had intestinal obstruction due to a large 5 centimeter stone. This is called Gall stone ileus.

How did the stone land up in her intestine?

No it was not a swallowed stone. This stone had formed in her Gall Bladder over many years. Due to its weight & chronic inflammation, the stone gradually perforated into her small intestine (duodenum). Since the stone was very large it could not pass thro the small intestine and got stuck in the last part of small intestine. Patient was having pain & constantly vomiting due to this blockage.

The treatment was done using minimal access surgery instead of making a big cut on her abdomen – laparotomy. Using laparoscopy, the site of blockage was identified. A small incision was made on her abdomen. The stone was cut open from the intestine (enterolithotomy) and the intestine was placed back into the abdomen.

The blockage was cleared and the patient recovered smoothly and was discharged in few days.

See more at: http://drbcshah.com/intestinal-obstruction-due-to-stones/


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Jan13
Hernia Becomes Gangrenous
Often Indian ladies have large bellies. Common causes are multiple pregnancies, sedentary lifestyle, poor physical exercises and health neglect. At times scars on abdomen of surgeries compound the weakness of the tummy.

It is not uncommon to notice a protrusion (hernia) thro natural scar (umbilicus) or surgical scars. "My mom also had it" is a common answer which denotes that they have a metabolic error whereby the scars are inherently formed weak. They move around with such bulges on their huge tummies. At times there is no umbilicus visible because of huge hernias. At times they are huge protrusions of the intestines and other contents.

So when the patients are advised to get operated their argument is that so many have it and for so many years they are carrying on without any complaints, so why operate? Well the reason to get it operated is that slowly all of them grow. More and more contents of the tummy start protruding out and one day it becomes so tight or overcrowded that they get strangulated and there is no space for blood to nourish the intestines and other contents. Thus a simple problem gets complicated. The patient all of a sudden suffers from great pain as a result has to be rushed to the hospital. The surgery becomes lengthy and riskier. The recovery period increases and so does the cost. Why wait so long?

- See more at: http://drbcshah.com/hernia-becomes-gangrenous/


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Jul27
Post radiation bowel perforation
At times treating a patient of cancer in abdomen can be a nightmare for the surgeon. Multiple operations and radiations performed as a treatment for cancer changes the anatomy and physiology of abdomen. Now in this situation if a patient comes with a perforation in the bowel becomes a tough challenge to the surgeon.
I recently has to operate such patient. He has sever pain and his bowel had perforated due to radiation effect.There was no virgin area left due to multiple operations. I had to find a relatively safer place to enter my thin laparoscope for visualization of inside mystery. Gradually I explored his abdomen and located the perforation. I made a small incision on his skin to deliver the diseased bowel out. I sutured the hole in the small intestine and placed it back.
This way a major opening up was avoided. The patient's sister who happened to be a doctor was very happy that I could solve the problem with minimal cutting. The recovery was uneventful and patient resumed his previous lifestyle very quickly. This was his quickest recovery compared to all his multiple previous surgeries.
- See more at: http://drbcshah.com/post-radiation-bowel-perforation/#sthash.prZ9VOOL.dpuf


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Jul04
Waited too long
I got a call from emergency that a 32 year old female had come with severe pain in abdomen & vomiting. She had pain since five days and no she was also running fever. I went to examine her. She looked familiar. She had my old case papers. She meet me couple of years back. She had Gallstones but refused to get operated because she said it was hardly causing any symptoms.She felt that the stones were very small and her granny had carried all her life without any trouble. Now she had come with big complication. Her gall bladder stone had impacted in the neck choking the gall bladder. As a result the gall bladder was full of pus, a condition called Empyema of the gall bladder. To complicate the matters she had since her delivery developed diabetes. I took her up for an emergency laparoscopy surgery. First I evacuated the pus. his allowed me the hold & move the gall bladder so as to dissect it out from the liver. I delivered the gall bladder successfully. Took me double the average time. I had to keep a drainage tube so that the toxins from her abdomen will gradually come out. I had to keep a nasogastric tube so as to avoid fluid and gas accumulation. There was not much blood loss. She took longer time to recover but eventually did very well. If she has got operated couple of years back, she would have recovered faster and would have spend much less money. - See more at: http://drbcshah.com/waited-too-long/#sthash.YqOrR8J4.dpuf


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Jun10
Rectal Cancer (Bowel Cancer)
Introduction
Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon cancer or rectal cancer.
Symptoms of bowel cancer include blood in your stools (faeces), an unexplained change in your bowel habits, such as prolonged diarrhoea or constipation, and unexplained weight loss.
Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.
Who is affected by bowel cancer?
Bbowel cancer is the third most common type of cancer.
Approximately 72% of bowel cancer cases develop in people who are 65 or over. Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum.
Who's at risk?
Things that increase your risk of getting bowel cancer include:
Age – around 72% of people diagnosed with bowel cancer are over 65
Diet – a diet high in fibre and low in saturated fat could reduce your bowel cancer risk, a diet high in red or processed meats can increase your risk
Healthy weight – leaner people are less likely to develop bowel cancer than obese people
Exercise – being inactive increases the risk of getting bowel cancer
Alcohol and smoking – high alcohol intake and smoking may increase your chances of getting bowel cancer
Family history and inherited conditions – aving a close relative with bowel cancer puts you at much greater risk of developing the disease.
Related conditions – having certain bowel conditions can put you more at risk of getting bowel cancer
Bowel cancer screening
Currently, everyone between the ages of 60 and 69 should go for bowel cancer screening every two years.
Screening is carried out by taking a small stool sample and testing it for the presence of blood (faecal occult blood test).
In addition, an extra screening test is being introduced over the next three years for all people at age 55. This test involves a camera examination of the lower bowel called a flexible sigmoidoscopy.
Screening plays an important part in the fight against bowel cancer because the earlier the cancer is diagnosed, the greater the chance it can be cured completely.
Treatment and outlook
Bowel cancer can be treated using a combination of surgery, chemotherapy, radiotherapy and, in some cases, biological therapy. As with most types of cancer, the chance of a complete cure depends on how far the cancer has advanced by the time it is diagnosed.
If bowel cancer is diagnosed in its earliest stages, the chance of surviving a further five years is 90%, and a complete cure is usually possible. However, bowel cancer diagnosed in its most advanced stage only has a five-year survival rate of 6% and a complete cure is unlikely.
Signs and symptoms of bowel cancer
Early bowel cancer may have no symptoms and some symptoms of later bowel cancer can also occur in people with less serious medical problems, such as haemorrhoids(piles).
See Dr. B C Shah if you notice any of the symptoms below.
The initial symptoms of bowel cancer include:
Blood in your stools (faeces) or bleeding from your rectum
A change to your normal bowel habits that persists for more than three weeks, such as diarrhoea, constipation or passing stools more frequently than usual
Abdominal pain
Unexplained weight loss
As bowel cancer progresses, it can sometimes cause bleeding inside the bowel. Eventually, this can lead to your body not having enough red blood cells. This is known as anaemia.
Symptoms of anaemia include:
Fatigue
Breathlessness
In some cases, bowel cancer can cause an obstruction in the bowel. Symptoms of a bowel obstruction include:
A feeling of bloating, usually around the belly button
Abdominal pain
Constipation
Vomiting
When to seek medical advice
Visit Dr. B C Shah if you have any of the symptoms above. While the symptoms are unlikely to be the result of bowel cancer, these types of symptoms always need to be investigated further.
Causes of bowel cancer
Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.
Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps. However, if you develop polyps, it does not necessarily mean you will get bowel cancer.
Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it.
Family history
There is evidence that bowel cancer can run in families. Around 20% of people who develop bowel cancer have a close relative (mother, father, brother or sister) or a second-degree relative (grandparent, uncle or aunt) who have also had bowel cancer.
It is estimated that if you have one close relative with a history of bowel cancer, your risk of getting bowel cancer is doubled. If you have two close relatives with a history of bowel cancer, your risk increases four-fold.
Diet
A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams.
There is also good evidence that a diet high in fibre and low in saturated fat could help reduce your bowel cancer risk. Cancer experts think this is because this type of diet encourages regular bowel movements.
Smoking
People who smoke cigarettes are 25% more likely to develop bowel cancer, other types of cancer and heart disease than people who do not smoke.
Alcohol
A major study, called the EPIC study, showed alcohol was associated with bowel cancer risk. Even small amounts of alcohol can put you at higher risk of getting bowel cancer. The EPIC study found that for every two units of alcohol a person drinks each day, their risk of bowel cancer goes up by 8%.
Obesity
Obesity is linked to an increased risk of bowel cancer. Obese men are 50% more likely to develop bowel cancer than people with a healthy weight. Morbidly obese men, who have a body mass index (BMI) of over 40, are twice as likely to develop bowel cancer.
Obese women have a small increased risk of developing the condition, and morbidly obese women are 50% more likely to develop bowel cancer than women with a healthy weight.
Inactivity
People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Your risk could be cut by up to one-fifth if you do an hour of vigorous exercise every day or two hours of moderate exercise (such as vacuum cleaning or brisk walking).
Digestive disorders
Some conditions may put you at a higher risk of developing bowel cancer. People with Crohn’s disease are 2-3 times more likely to develop bowel cancer. The risk of developing bowel cancer is much higher in people with ulcerative colitis, and as many as 1 in 20 of these people will go on to develop it.
Genetic conditions
There are two rare inherited conditions that can cause bowel cancer. They are:
Familial adenomatous polyposis (FAP)
Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome
FAP affects 1 in 10,000 people. The condition triggers the growth of non-cancerous polyps inside the bowel. Although the polyps are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Almost all people with FAP will have bowel cancer by the time they are 50 years of age.
People with FAP have such a high risk of getting bowel cancer, they are often advised to have their large bowel removed by surgery before they reach the age of 25. Families affected can find support and advice from the FAP registry at St Mark’s Hospital, London.
HNPCC is a type of bowel cancer caused by a mutated gene. An estimated 2-5% of all cases of bowel cancer are due to HNPCC. Around 90% of men and 70% of women with the
As with FAP, removing the bowel as a precautionary measure is usually recommended in people with HNPCC.
Diagnosing bowel cancer
When you first see Dr. B C Shah he will ask about your symptoms and whether you have a family history of bowel cancer.
Dr. B C Shah will then carry out a physical examination known as a digital rectal examination (DRE). A DRE involves Dr. B C Shah gently placing a finger into your anus, and then up into your rectum.
A DRE is a useful way of checking whether there is a noticeable lump inside your rectum. This is found in an estimated 40-80% of cases of rectal cancer.
A DRE is not painful, but some people may find it a little embarrassing.
If your symptoms suggest you may have bowel cancer, or the diagnosis is uncertain, you will be referred to your local hospital for further examination.
Further examination
Two tests are commonly used to confirm a diagnosis of bowel cancer:
A sigmoidoscopy is an examination of your rectum and some of your large bowel.
A colonoscopy is an examination of all of your large bowel.
Sigmoidoscopy
A sigmoidoscopy uses a device called a sigmoidoscope, which is a thin, flexible tube attached to a small camera and light.
The sigmoidoscope is inserted into your rectum and then up into your bowel. The camera relays images to a monitor. This allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer.
A sigmoidoscopy can also be used to remove small samples of suspected cancerous tissue so they can be tested in the lab. This is known as a biopsy.
A sigmoidoscopy is not usually painful, but can feel uncomfortable. Most people go home after the examination has been completed.
Colonoscopy
A colonoscopy is similar to a sigmoidoscopy except a longer tube, called a colonoscope, is used to examine your entire bowel.
Your bowel needs to be empty when a colonoscopy is performed, so you will be given a special diet to eat for a few days before the examination and a laxative (medication to help empty your bowel) on the morning of the examination.
You will be given a sedative to help you relax, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. As with a sigmoidoscope, the colonoscope can be used to obtain a biopsy, as well as relaying images of any abnormal areas.
A colonoscopy usually takes about one hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel drowsy for a while, so arrange for someone to accompany you home.
Further testing
If a diagnosis of bowel cancer is confirmed, further testing is usually carried out for two reasons:
to check if the cancer has spread from the bowel to other parts of the body
to help decide on the most effective treatment for you
These tests can include:
A computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan to provide a detailed image of your bowel and other organs
Ultrasound scans, which can be used to look inside other organs, such as your liver, to see if the cancer has spread there
Chest X-rays, which can be used to assess the state of your heart and lungs
Blood tests to detect a special protein, known as a tumour marker, released by the cancerous cells in some cases of bowel cancer
Staging and grading
Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive and likely to spread your cancer is.
Stage 1 – the cancer is still contained within the lining of the bowel or rectum
Stage 2 – the cancer has spread into the layer of muscle surrounding the bowel
Stage 3 – the cancer has spread into nearby lymph nodes
Stage 4 – the cancer has spread into another part of the body, such as the liver
This is a simplified guide. Stage 2 is divided into further categories called A and B and stage 3 is divided into A, B and C.
There are three grades of bowel cancer:
Grade 1 is a cancer that grows slowly and has a low chance of spreading beyond the bowel
Grade 2 is a cancer that grows moderately and has a medium chance of spreading beyond the bowel
Grade 3 is a cancer that grows rapidly and has a high chance of spreading beyond the bowel
If you are not sure what stage or grade of cancer you have, ask your doctor.
Treating bowel cancer
People with bowel cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best treatment and care.
The team often consists of a Dr. B C Shah, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist, and you may have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
The type and size of the cancer
Your general health
Whether the cancer has spread to other parts of your body
What grade it is
There are several treatments for bowel cancer, including:
Surgery
Chemotherapy
Radiotherapy
Biological therapy
Surgery is usually the main treatment for bowel cancer, but in about one in five cases, the cancer is too advanced to be removed by surgery. If you have surgery, you may also need chemotherapy, radiotherapy or biological therapy, depending on your particular case.
Your treatment plan
Your recommended treatment plan will depend on the stage and location of your bowel cancer.
If the cancer is confined to your rectum, radiotherapy will usually be used to shrink the tumour, then surgery may be used to remove the tumour. Sometimes, radiotherapy is combined with chemotherapy, which is known as chemoradiation.
If you have stage 1 bowel cancer, it should be possible to surgically remove the cancer and no further treatment will be required.
If you have stage 2 or 3 bowel cancer, surgery may be used to remove the cancer and, in some cases, nearby lymph nodes. Surgery is usually followed by a course of chemotherapy to stop the cancer returning.
It is not usually possible to cure stage 4 (advanced) cancer. However, symptoms can be controlled and the spread of the cancer can be slowed using a combination of surgery, chemotherapy, radiotherapy and biological therapy where appropriate.
Preventing bowel cancer
There are several ways to reduce your risk of developing bowel cancer.
Diet
Research suggests a low-fat, high-fibre diet that includes plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains can help reduce your risk of getting bowel cancer. It can also reduce your risk of developing other types of cancer and heart disease.
It is recommended you do not eat a lot of processed meat and red meat. The Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams. .
Exercise
There is strong evidence to suggest regular exercise can lower the risk of developing bowel and other cancers.
It is recommended adults exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week.
Healthy weight
Try to maintain a healthy weight. Changes to your diet and an increase in physical activities will help keep your weight under control. Find out if you are a healthy weight with the Healthy weight calculator.
Smoking
If you smoke, giving up will reduce your risk of developing bowel and other cancers.
Dr. B C Shah can also provide help, support and advice if you want to give up smoking.
How screening for bowel cancer works
Bowel cancer can be present for a long time before any symptoms appear. If bowel cancer is detected before symptoms appear, it is easier to treat and there is a better chance of surviving the disease.
Screening for bowel cancer called an FOBt (faecal occult blood test) is done at a pathology Lab. A tiny stool samples on a special card. The card is then checked at the laboratory for traces of blood.
Results
There are three types of result:
Normal: no blood was found in the samples. Screening will be offered again in two years’ time.
Unclear: there were possible traces of blood that could be caused by factors other than cancer, such as haemorrhoids (piles) or stomach ulcers. If you have an unclear result, you will be asked to repeat the test kit up to twice more.
Abnormal: blood was definitely found in the samples. Again, this could be from piles or bowel polyps(small growths not usually cancerous). If you have an abnormal result, you will be offered an appointment with Dr. B C Shah to discuss having an examination of the bowel, called a colonoscopy.
Colonoscopy
A colonoscopy is an investigation of the lining of the large bowel (colon). A thin flexible tube with a tiny camera on the end is passed into your bottom and guided around the bowel. Only around 2 in every 100 people completing the FOBt kit will have an abnormal result and will be offered a colonoscopy. Of those who have a colonoscopy, only about one in 10 will have cancer.
New screening test
As well as the FOBt described above, an additional screening test is being rolled out by 2016. This involves inviting people at age 55 to have a one-off flexible sigmoidoscopy test to examine the lower bowel with a camera.
If the flexible sigmoidoscopy shows polyps, the person will then be offered a full colonoscopy . Both FOBt and flexible sigmoidoscopy screening tests have been shown to reduce the risk of dying of bowel cancer.
Living with bowel cancer
Being diagnosed with cancer is a tough challenge for most people. There are several ways to find support to help you cope.
Not all of them work for everybody. but one or more should be helpful:
Talk to your friends and family. They can be a powerful support system.
Get in touch with others in the same situation as you
Learn about your condition
Don't try to do too much at once
Make time for yourself.
Talk to others
Dr. B C Shah may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist . Dr. B C Shah will have information on these.
Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.
Recovering from colon or rectal surgery
Surgeons and anaesthetists have found that using an “enhanced recovery programme” after bowel cancer surgery helps patients recover more quickly.
Most hospitals now use this programme. It involves giving you more information before the operation about what to expect, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy.
During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully, and after the operation you will be given painkillers that allow you to get up and out of bed by the next day.
Most people will be able to eat a light diet the day after their operation.
To reduce the risk of deep vein thrombosis (blood clots in the legs), you may be given special compression stockings that help prevent blood clots, or a regular injection with heparin until you are fully mobile.
A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home again within a few days.
With the enhanced recovery programme, most people are well enough to go home within five to six days of their operation. The timing depends on when you and Dr. B C Shah agree you are well enough to go home.
Coping with colostomy
If you need a colostomy, you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma (including stoma care, stoma products and ‘stoma-friendly’ diets) is available via the ileostomy and colostomy topics.
Diet after bowel surgery
If you have had part of your colon removed, it is likely that your stools (faeces) will be looser because one of the functions of the colon is to absorb water from the stools. This may mean that you experience repeated episodes of diarrhoea
You should inform Dr. B C Shah if diarrhoea becomes a problem because medication is available to help control symptoms.
You may find some foods upset your bowels, particularly during the first few months after your operation.
Different foods can upset different people, but food and drink that is commonly known to cause problems include:
Rich and fatty food
Fruit and vegetables that are high in fibre, such as beans, cabbages, apples and bananas
Fizzy drinks, such as cola and beer
You may find it useful to keep a food diary to record the effects of different foods on your bowel.
If you find that you are having continual problems with your bowels as a result of your diet, and/or you are finding it difficult to maintain a healthy diet, you should contact Dr. B C Shah. You may need to be referred to a dietitian for further advice.
Sex and bowel cancers
Having cancer and its treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment, if you have had a colostomy you may feel self-conscious or uncomfortable.
Talking about how you feel with your partner may help you both to support each other. Or you may feel you’d like to talk to someone else about your feelings. Dr. B C Shah will be able to help.
Financial concerns
A diagnosis of cancer can cause money problems because you are unable to work or someone you are close to has to stop working to look after you.
Dealing with dying
If you are told there is nothing more that can be done to treat your bowel cancer, Dr. B C Shah will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.


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May31
Breast Biopsy (Excision)
What is the test?
In an excisional biopsy of the breast, Dr. B C Shah makes an incision in the skin and removes all or part of the abnormal tissue for examination under a microscope. Unlike needle biopsies, a surgical biopsy leaves a visible scar on the breast and sometimes causes a noticeable change in the breast’s shape. It’s a good idea to discuss the placement and length of the incision with your surgeon beforehand. Also ask Dr. B C Shah about scarring and the possibility of changes to your breast shape and size after healing, as well as the choice between local anesthesia and general anesthesia.
How do I prepare for the test?
You’ll undergo a breast exam and possibly a mammogram before the biopsy to determine where the lump is located. If you are having a sedative with local anesthesia, or if you are having general anesthesia, you’ll be asked not to eat anything after midnight on the day before the surgery
Tell Dr. B C Shah if you’re taking insulin, NSAIDs, or any medicine that can affect blood clotting. You might have to stop or adjust the dose of these medicines before your test.
What happens when the test is performed?
A surgical biopsy is done in an operating room. An IV line is placed in your arm so that you can receive medicines through it. Dr. B C Shah may use local anesthesia with sedation to help you relax during the procedure, or general anesthesia. Surgical biopsies take about an hour, and the recovery period is less than two hours.
An open biopsy that removes only part of a lump of suspicious tissue is called an incisional biopsy; one that removes the entire lump is called an excisional biopsy. An incisional biopsy is usually done when the lump is quite large, since removing a larger lump completely can alter the appearance of the breast. This procedure is appropriate for larger lumps in order to secure a diagnosis while minimizing the effect on the breast’s appearance. If the tissue proves to be cancerous, the remaining portion of the lump will be removed surgically, usually during a second surgical procedure that may be more extensive and involve removal of lymph nodes to determine whether the cancer has spread.
When a breast mass or an area of calcification cannot be felt, Dr. B C Shah may choose to use a procedure called wire localization to help identify the tissue for later surgical biopsy. The first part of this procedure is a mammogram. After applying a local anesthetic, he inserts a hollow needle into the breast and, guided by ultrasound or mammography, places the tip of the needle in the suspicious area. He then inserts a thin wire with a hook on the end through the hollow needle and into the breast alongside the suspicious area. Dr. B C Shah will then removes the needle, leaving the wire in place to serve as a guide to help him find the area of breast tissue to be removed later.
Must I do anything special after the test is over?
Dr. B C Shah will monitor you for a few hours after your surgery to make sure that you’re recovering well and not having any adverse reactions to anesthesia. Contact him if you develop a fever, strong pain at the incision site, or bleeding from the incision. You may need a follow-up visit so that Dr. B C Shah can remove stitches and make sure you are recovering well.
How long is it before the result of the test is known?
A preliminary report from the pathologist might be available when your surgery is over. A final report typically takes three to four days.


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Mar28
Understanding Upper Endoscopy
What is upper endoscopy?
Upper endoscopy lets Dr. B C Shah examine the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). Dr. B C Shah will use a thin, flexible tube called an endoscope, which has its own lens and light source, and will view the images on a video monitor. You might hear Dr. B C Shah or other medical staff refer to upper endoscopy as upper GI endoscopy, esophagogastroduodenoscopy (EGD) or panendoscopy.
Why is upper endoscopy done?
Upper endoscopy helps Dr. B C Shah evaluate symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty swallowing. It's the best test for finding the cause of bleeding from the upper gastrointestinal tract. It's also more accurate than X-ray films for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum.
Dr. B C Shah might use upper endoscopy to obtain a biopsy (small tissue samples). A biopsy helps Dr. B C Shah distinguish between benign and malignant (cancerous) tissues. Remember, biopsies are taken for many reasons, and Dr. B C Shah might order one even if he or she does not suspect cancer. For example, he might use a biopsy to test for Helicobacter pylori, the bacterium that causes ulcers.
Dr. B C Shah might also use upper endoscopy to perform a cytology test, where he or she will introduce a small brush to collect cells for analysis.
Upper endoscopy is also used to treat conditions of the upper gastrointestinal tract. Dr. B C Shah can pass instruments through the endoscope to directly treat many abnormalities – this will cause you little or no discomfort. For example, Dr. B C Shah might stretch (dilate) a narrowed area, remove polyps (usually benign growths) or treat bleeding.
What preparations are required?
An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately six hours before the examination. Dr. B C Shah will tell you when to start fasting as the timing can vary.
Tell Dr. B C Shah in advance about any medications you take; you might need to adjust your usual dose for the examination. Discuss any allergies to medications as well as medical conditions, such as heart or lung disease.
Can I take my current medications?
Most medications can be continued as usual, but some medications can interfere with the preparation or the examination. Inform Dr. B C Shah about medications you’re taking, particularly aspirin products or antiplatelet agents, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Also, be sure to mention any allergies you have to medications.
What happens during upper endoscopy?
Dr. B C Shah might start by spraying your throat with a local anesthetic or by giving you a sedative to help you relax. You'll then lie on your side, and Dr. B C Shah will pass the endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope doesn't interfere with your breathing, Most patients consider the test only slightly uncomfortable, and many patients fall asleep during the procedure.
What happens after upper endoscopy?
You will be monitored until most of the effects of the medication have worn off. Your throat might be a little sore, and you might feel bloated because of the air introduced into your stomach during the test. You will be able to eat after you leave unless Dr. B C Shah instructs you otherwise.
Your physician will explain the results of the examination to you, although you'll probably have to wait for the results of any biopsies performed.
If you have been given sedatives during the procedure, someone must drive you home and stay with you. Even if you feel alert after the procedure, your judgement and reflexes could be impaired for the rest of the day.
What are the possible complications of upper endoscopy?
Although complications can occur, they are rare when Dr. B C Shah who are specially trained and experienced in this procedure perform the test. Bleeding can occur at a biopsy site or where a polyp was removed, but it's usually minimal and rarely requires follow-up. Perforation (a hole or tear in the gastrointestinal tract lining) may require surgery but this is a very uncommon complication. Some patients might have a reaction to the sedatives or complications from heart or lung disease.
Although complications after upper endoscopy are very uncommon, it's important to recognize early signs of possible complications. Contact Dr. B C Shah immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain, or bleeding, including black stools. Note that bleeding can occur several days after the procedure.
If you have any concerns about a possible complication, it is always best to contact Dr. B C Shah right away.


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Mar22
Blood vomiting – Almost died
A rare surgery for a rare disease
Sushma Bagwe came with severe blood vomiting and with feeble pulse and blood pressure. An emergency upper GI scopy was performed by me as the bleeding was profuse. With all the blood in stomach it was a tricky job. I noticed that she had a tumor growing in her stomach that was heavily bleeding. This tumor did not appear like a typical stomach cancer or a peptic ulcer. In order to stop the bleeding, using the endoscope I injected medication around the tumor That stopped the bleeding. Subsequently she was shifted back to ICU and was transfused four units of blood to restore her blood. I also took mulitple biopsies to know what was the nature of the tumor but to my dismay it did not indicate much. I repeated the biopsy again but that also was not conclusive. Subsequently CT scan was performed but even that was not conclusive of the nature of the tumor. I planned out the surgery for her. Instead of opening her abdomen with a large incision, I decided to give her the benefit of Minimally invasive surgery. I performed a total Laparoscopic partial stomach removal (Partial gastrectomy) using harmonic scalpel and endostaplers. This gave her the benefit of fast recovery, minimal post operative pain and almost invisible scar. The diagnosis of the tumour was leiomyoma – benign stomach tumor. Her condition was solved. Thus minimally invasive procedure that I used on this patient (endoscopy and laparoscopy) once again saved the life of a patient and cured her from her disease with minimal pain.

You can visit my site http://drbcshah.com/blood-vomiting-almost-died/ for more information and photos.


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Feb19
Cancer
Information on cancer
Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs.
Cancer sometimes begins in one part of the body before spreading to other areas. This process is known as metastasis.
There are over 200 different types of cancer, each with its own methods of diagnosis and treatment. You can find out more about specific types of cancer by using the links on this page.
Spotting signs of cancer
Changes to your body's normal processes or symptoms that are out of the ordinary can sometimes be an early sign of cancer.
For example, a lump that suddenly appears on your body, unexplained bleeding or changes to your bowel habits are all symptoms that need to be checked by a doctor.
In many cases, your symptoms will not be related to cancer and will be caused by other, non-cancerous health conditions. However, it is still important that you see Dr. B C Shah so your symptoms can be investigated.
Reducing your risk of cancer
Making some simple changes to your lifestyle can significantly reduce your risk of developing cancer. For example, healthy eating, taking regular exercise and not smoking will all help lower your risk.
How common is cancer?
Cancer is a common condition. More than one in three people will develop some form of cancer during their lifetime.
The most common types of cancer are:
Breast cancer
Prostate cancer
Lung cancer
Bowel cancer
Bladder cancer
Uterine (womb) cancer
Cancer treatment
Each specific type of cancer has its own set of treatment methods.
However, many cases of cancer are treated using chemotherapy (powerful cancer-killing medication) and radiotherapy (the controlled use of high energy X-rays). Surgery is also sometimes carried out to remove cancerous tissue.
Waiting times
Accurately diagnosing cancer can take weeks or months. As cancer often develops slowly, over several years, waiting for a few weeks will not usually impact on the effectiveness of treatment.
Patients suspected of having cancer and urgently referred by their doctor, should have no more than a two week wait to see a specialist.
In cases where cancer has been confirmed, patients should wait no more than 31 days from the decision to treat to the start of their treatment.
Signs and symptoms of cancer
It is important to be aware of any unexplained changes to your body, such as the sudden appearance of a lump, blood in your urine or a change in your usual bowel habits
These symptoms are often caused by other, non-cancerous illnesses, but it is important you see Dr. B C Shah so he can investigate.
Other potential signs and symptoms of cancer are outlined below.
Lump in your breast
See Dr. B C Shah if you notice a lump in your breast, or if you have a lump that is rapidly increasing in size elsewhere on your body.
Dr. B C Shah will refer you to a specialist for tests if he thinks you may have cancer.
Coughing, chest pain and breathlessness
You should visit Dr. B C Shah if you have had a cough for more than three weeks.
Symptoms such as shortness of breath or chest pain may be a sign of an acute (severe) condition, such as pneumonia (a lung infection). Go to see Dr. B C Shah straight away if you experience these types of symptoms.
Changes in bowel habits
Go to see Dr. B C Shah if you have experienced one of the changes listed below and it has lasted for more than a few weeks:
blood in your stools
diarrhoea or constipation for no obvious reason
a feeling of not having fully emptied your bowels after going to the toilet
pain in your abdomen (tummy) or your anus (back passage)
persistent bloating
Bleeding
You should also go to see Dr. B C Shah if you have any unexplained bleeding such as:
Blood in your urine
Bleeding between periods
Blood from your back passage
Blood when you cough
Blood in your vomit
Moles
Go to see Dr. B C Shah if you have a mole that:
Has an irregular or asymmetrical shape
Has an irregular border with jagged edges
Has more than one colour (it may be flecked with brown, black, red, pink or white)
Is bigger then 7mm in diameter
Is itchy, crusting or bleeding
Any of the above changes means that there is a chance you have malignant melanoma (skin cancer).
Unexplained weight loss
You should also go to see Dr. B C Shah if you have lost a lot of weight over the last couple of months that cannot be explained by changes to your diet, exercise or stress.


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Feb10
Non-alcoholic fatty liver disease
Introduction
Non-alcoholic fatty liver disease (NAFLD) is the term for a wide range of conditions caused by a build-up of fat within the liver cells. It is usually seen in people who are overweight or obese.
A healthy liver should contain little or no fat. Most people with NAFLD only carry small amounts of fat, which doesn't usually cause any symptoms and isn't harmful to the liver. This early form of the disease is known as simple fatty liver, or steatosis.
Simple fatty liver is very common, reflecting the number of people who are obese or overweight.
However, just because simple fatty liver is harmless, it doesn't mean it is not a serious condition:
In some people, if the fat builds up and gets worse, it can eventually lead to scarring of the liver
As the disease is linked to being overweight or obese, people with any stage of the disease are more at risk of developing a stroke or heart attack
NAFLD is often diagnosed after liver function tests (a type of blood test) produce an abnormal result and other liver conditions, such as hepatitis, are ruled out.
This page explains:
The four stages of NAFLD and the symptoms at each stage
Who is affected, and the causes of NAFLD
Living with NAFLD
Four stages of NAFLD
NAFLD is very similar to alcoholic liver disease, but it is caused by factors other than drinking too much alcohol. The four stages are described below.
Stage 1: simple fatty liver (steatosis)
Hepatic steatosis is stage 1 of the condition. This is where excess fat builds up in the liver cells but is considered harmless. There are usually no symptoms and you may not even realise you have it until you receive an abnormal blood test result.
Stage 2: non-alcoholic steatohepatitis (NASH)
Only a few people with simple fatty liver go on to develop stage 2 of the condition, called non-alcoholic steatohepatitis (NASH).
NASH is a more aggressive form of the condition, where the liver has become inflamed. Inflammation is the body's healing response to damage or injury and, in this case, is a sign that liver cells have become damaged.
A person with NASH may have a dull or aching pain felt in the top right of their abdomen (over the lower right side of their ribs).
Stage 3: fibrosis
Some people with NASH go on to develop fibrosis, which is where persistent inflammation in the liver results in the generation of fibrous scar tissue around the liver cells and blood vessels. This fibrous tissue replaces some of the healthy liver tissue, but there is still enough healthy tissue for the liver to continue to function normally.
Stage 4: cirrhosis
At this most severe stage, bands of scar tissue and clumps of liver cells develop. The liver shrinks and becomes lumpy. This is known as cirrhosis.
Cirrhosis tends to occur after the age of 50-60, after many years of liver inflammation associated with the early stages of the disease.
People with cirrhosis of the liver caused by NAFLD often also have type 2 diabetes.
The damage caused by cirrhosis is permanent and can't be reversed. Cirrhosis progresses slowly, over many years, gradually causing your liver to stop functioning. This is called liver failure. Learn more about cirrhosis of the liver, including the warning signs.
Who is affected?
You are more likely to develop NAFLD if you:
Are obese or overweight
Have type 2 diabetes (this causes an increased uptake of fat into the liver cells)
Are over the age of 50
Have high blood pressure
Have high cholesterol
Have experienced rapid weight loss, for example after weight loss surgery or after being malnourished
Living with NAFLD
Most people with NAFLD do not develop serious liver problems and just have stage 1 of the disease (simple fatty liver).
Simple fatty liver may go away if the underlying cause is tackled. For example, losing excess weight or controlling diabetes better can make fatty liver go away.
Many people do not have symptoms, although it's common to feel tired and some people have a persistent pain in the upper right part of their abdomen (where their liver is).
It is important to make lifestyle changes to prevent the disease progressing to a more serious stage and to lower your risk of having a heart attack or stroke.
Losing weight and exercising
The most important thing that people with NAFLD can do is to go on a gradual weight loss programme and exercise regularly. This helps in two ways: by reducing the amount of fat in your liver cells and by lowering your risk of stroke and heart attack. Start losing weight.
Losing weight is particularly important if you have type 2 diabetes.
Stopping smoking
If you smoke, it's really important to give up, as this will also help to reduce your risk of heart attack and stroke.Take steps now to stop smoking.
Medication
If you have high blood pressure or high cholesterol, you may need medical treatment for these.
If you have type 2 diabetes, you may need medicines that reduce high levels of blood sugar. At first, this will usually be in the form of tablets, sometimes a combination of more than one type of tablet. It may also include injections of insulin. Learn more about the medical treatment of type 2 diabetes.
Alcohol
NAFLD is not caused by alcohol, but drinking alcohol may make the condition worse. It's therefore advisable to stop drinking alcohol.


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