Fortis Hospital

Hello,

I am Dr. Suresh Kumar Bhagat, Urologist. Today I will talk about kidney stones. Sabse pehle mai bataunga ki kidney stones ka rate 10-12% hota hai. India mein 100 mein se 12 logon ko kidney stones hain. Jismein se 50% logon ka kidney kharab ho jata hai. Sahi samay pe agar ilaj na kia jaaye toh ye problem hoti hai. Ab iska karan kya hai?Iske 2 factors hain. Ek factor hai jo humare body ke andar hai jisko hum change nhi kar sakte. Dusra hai bahar ke factors jisko hum kuch hadd tak badal sakte hain. Kuch age range hain jaise 20-45 ki age mein stones jyada hote hain. Male mein females se jyada stones hota hai. Plus ye hereditary bhi kam karta hai. Next hai aap ka climate, water intake, toh ye bhi affect karte hain. Iske symptoms kya hote hain?

Agar 2mm ka stones hai toh jyada problem nahi hoti hai agar vhi vo 6mm se jyada ho gaya toh aap ko pain hota hai. Agar stones bada hai jo kidney ko block kar deta hai ya fir chota stone ureter ko block kar deta hai toh aap ko severe pain hota hai. Vomiting hoti hai aap ko pain ke sath and emergency mein aap ko hospital jana padta hai. Ismein aap ko injection ke through medicine di jaati hai. Kabhi kabhi yadi vhi ureter ka stone aap ignore kar dete hain timely treatment nahi karate hain toh us se infection hota hai. Jiski vajaha se aap ko thand lagti hai and bukhar hota hai. Plus ye infection blood mein jata hai. Agar aap ko aisi problem ho rahi hai toh aap ko kisi na kisi urologist ko dikhani chaiye. Aur vo aap ko sahi salah denge. Dusri baat hai ki iska treatment kaisa kia jata hai. Ab latest technology ke according agar aap ke stones ka size up to 15-20 mm hai toh kidney mein surakh kia peshab ke raste se plastic ka durbin daal kar nikalate hain. Ye treatment mein deta hun.

Ab dusra point hai ki agar aap ne ilaj kar dia toh uske baad kya karna hai. Iske baad hum stones analysis karte hain. Hum aap ko salah dete hain ki aap ko kya karna hai ki stones formation na ho. Stones na form hon iske lia sabse badya dawayi hai paani. Paani ki matra badhayein. Jis se aap ka urine clear hoga. Is se stones banne ke chances kam ho jaate hain. Jisko ek baar stone hua hai use 1 saal ke anadar hi 5-10% stones dubara banne ke chances hote hain. Iske lia humein paani ki matra badhani chaiye. Kidney stones ko kabhi bhi ignore na karein kyuki jab vo chota hota hai toh use nikalana asan hota hai. Kabhi kabhi log puchte hain ki kya y apne aap dissolve hota hai? Aisa nahi hai. Koi bhi kidney stones apne aap dissolve nahi hota hai.

Surgery ki jarurat bhi tabhi padti hai jab stones bada hota hai. Aap ko medicines di jaati hai 3-4 weeks ke lia urologist ke dwara. Yadi bukhar aa raha hai ya fir pain hai toh use nikalna padta hai. Kab kab stones nikalna jaruri hai. Agar aap diabetic hain, ureter stones hain toh wait na karein aur treatment lein. Agar aap ko ek hi kidney hai toh use endoscopic technique ke dwara stones nikalana jaruri hai. Prevention is better than cure. Isliye adhik matra mein paani pijiye. Red meat kam khayein. Namak kam lein. In sabko karne se aap ko stones ki samasya fir se nahi hogi. Asah karta hun ki aap ko meri baat samajh aayi hogi.

Thank You.

Hello friends,

I am Dr. Sanjay Bhatia, ENT specialist and Neurotologist. Today I am going to give you some information regarding blocked ear and decreased hearing. Most importantly we should understand how our ear is? Our ear is divided into 3 structures. Outer ear, middle ear and inner ear. So most commonly people think that my ear is blocked I can't hear well is wax. Wax in the ear is just basic secretion which is having antiseptic properties of the external auditory canal. It does cause the blockage of the ear and decreased hearing. One of the commonest cause of accumulation is a small canal or habitual use of earbuds. We do not educate used of earbud to remove the wax Because it tends to push the wax inwards towards the tympanic membrane. The best way to remove the wax is to meet your ENT surgeon If you think it is blocked. We do give wax solvents to make the wax soft and it can be removed by suction, irrigation or by probing.

The next other common things we see is the fungal infection or the discharge in the external auditory canal, which does form a film or pseudomembrane in front of the tympanic membrane and causes blockage of the ear. This can be removed by giving antifungal ear drops and then after a week or so it will come out with suction. Further down you have tympanic membrane which is a border between the outer ear and the middle ear space so tympanic membrane, If it has a perforation does cause decreased hearing or blocked the sensation of the ear. So it can be in different quadrants, you have perforated eardrums can be of acute onset or it can be a chronic eardrum perforation, if it is an acute perforated eardrum with active discharge going on, you can have the blockage feeling in the ear. Normally in the acute situations, we do observe, we give antibiotics, we give major decongestant usually these acute infections are ascending infections secondary to the nasal infections.

If it is a chronic perforated eardrum, the best thing is to get a test of hearing called pure tone audiometry done and prepare yourself for ear surgery called tympanoplasty. Tympanoplasty means the repair of the eardrum, inspection of the ear ossicles, these are the 3 ossicles which are situated behind your tympanic membrane and the middle ear space. Other conditions you can get a blocked ear or decreased hearing is a cold accumulated behind your eardrum, the eardrum may be intact so this fluid which is accumulated could be a sterile fluid we call it middle ear effusion or it could be purulent infected fluid usually common in children and they cause severe ear pain as well as decrease hearing.

The treatment is antibiotics, decongesting the nose where we have to do a small opening of the eardrum called myringotomy. Another condition where you have a decreased hearing and the block sensation of the ear is fixation or immobility or discontinuity of the ear bones or the ossicles. Depending on the various situations you can do the ossicular reconstruction if there is a discontinuity or aversion of the hearing bones. In case of the fixation of the bones of hearing you have to work on and around the ossicle usually it is the stapes, we do a stapedotomy procedure and we put an implant of telfon or gold implant or titanium prosthesis. The last concern is your inner ear space or organ of hearing called cochlea.

Usually, the hearing loss which is neural in origin is causing the blockage of the ear so you feel that I can not hear and my ear is blocked, the eardrum is normal, the middle ear spaces are normal, there is no infection, so what could be the cause? Get pure tone audiometry done it will show you in the document that we are now hearing and particular frequencies are going weak. In case the social life is not affected you can go on with your life, but if you think socially you are not hearing well please meet the otologist and get hearing tet done. Lastly, there are nerves of hearing which come in to the cochlea there can be some tumors called acoustic neuroma which can cause decreased hearing and other expected things are the acoustic traumas, the head injuries and the central hearing loss. So these are the few common causes of decrease hearing and the blocked ear.

Thank you very much.

Hi,

I am Dr. Suresh Kumar Bhagat, Urologist. Aaj mai aap ko blood in urine ke baare mein btaunga. Agar aap ko ye problem hai toh ise andekha na karein. Urine mein blood aane ke kayi reason ho sakte hain. Agar aap ka age 40 above hai aur aap ko urine mein blood aa raha hai and pain bhi nahi hai toh aap urologist se suggestion lein. Agar aisa hota hai toh aap ko kidney ke aas pass kahin tumor ho sakta hai and cancerous sabit ho sakta hai. Agar aap ko aisi problem hai toh without fail urologist se consult karein. Kyuki jab bhi koi tumor initial stage mein hota hai toh iska ilaj asan hai and kafi successful hai.

Urine mein blood aane ke kayi karann hain. Aap ko prostate ho sakta hai, dusra peshab ke thaile mein tumor ho sakta hai, kidney stone ho sakta hai ya fir aap ko kidney ya fir kidney ki naali mein TB bhi ho sakta hai. Toh mai aap ko yahi salah dunga ki agar aap ko urine mein blood aya hai toh isko ignore na karein. Infection ho sakta hai, tumor ho sakta hai jo cancerous ho sakta hai, stone ho sakta hai and TB ho sakta hai. Isliya aap ko aisa kuch bhi dikhta hai toh aap jaldi ho urologist se consult karein. Peshab ke thaile ka cancer, kidney ya kidney ki naali ka cancer, ye bimariyan cigrette peene vale ya fir die factory mein kam karne valon mein jyada dekha gaya hai. Isliye aap urologist se consult jarur karein. Agar aap initial stage pe hi consult karte hain to durbin se bimari ka ilaj asani se kiya ja sakta hai. Treatment ka outcome bhi patient ke liya acha hota hai. Mai umid karta hun ki aap ko meri baat samajh mein aayi hogi.

Thank You.

Hi

I am Dr. Suresh Kumar Bhagat hai. Aaj hum aapko kidney failure ke bare mein kuch batana chahte hain. Jo kidney failure ke 2 mukhya karan hain. Diabetes aur high blood pressure. India mein diabetes ka incidence bohot jyada hai aur India ko world ka diabetic capital bola jata hai. Ab main aapko thoda bohot diabetes ke bare mein bataun jo aaj kal humare jeevan ki shaili jo hai hum Jyada gaadi use karte hain, paidal kam chalte hain, jo hamara khane peene ka Jo lifestyle hai usme kafi change ho gaya hai. Hum chalte nahi hain, hum exercise bhi nahi karte hain, junk food khate Hain, tel-gheei Jyada kehte hain aur sabse badi baat hai ki aaj kal ka jo jeevan hai wo kaafi (stressed) tanavpurn ho gaya hai to hum diabetes se kaise bache. Sabse pahli baat ki aap santulit khana khayein, aap Jada urja wala khana nahin khaya, jaise ki aapke khane Mein salaad hona chahiye aadhe sex adhik aur carbohydrate kam hona chahiye aur tel-ghee barabar kamm matra mein hona chahiye.

Jo kidney failure hota hai uske do mukhyatar Karan hain, madhumeh Ki bimari aur ucch rakt chaap(Diabetes aur high blood pressure). To hum diabetes ko control rakhen aur high blood pressure wale jo bhi marij hain wo niyamit roop se dawai lein aur namak kam khaye aur jo sabse jaroori cheezein hain wo hai vyayam. Aadmi ko physical activity karni chahi kam se kam aap Saptah(week) mein 4 Din 45 minutes brisk walk karen aur aapko ye dhyaan rakhna chahiye ki aapki Jo kaamr hai aur aap ka jo pet hai, kamar Se Jyada pet ki motayi nahi honi chahiye. Dusra hai diabetes. Diabetes ke liye bhi Jin logo ko diabetes hai madhumeh hai usko diabetes ki dawa niyamit roop se leni chahiye. Blood pressure niyamit roop se janch karni chahyie aur aapko Kidney failure se bachne ke liye aapko apne doctor ki salah leni chahiye aur koi bhi bina salah ke koi bhi dawai nahin khaye. Ab Jo kidney failure hai uske mukhya kya karan hote hain?

Mukhya karan maine aap ko bataye madhumeh ki bimari aur ucch eakt chaap. Iske lakshan kya hai? Shuru mein Jab kidney bimari hoti hai, kidney failure Ki bimari hoti hai to uske bohot lakshan najar nahin aate hain to kaise maloom hoga ki jo patient ko high blood pressure hai aur diabetes ki bimari hai uska kidney failure to nhi develop ho raha unko? Uske liye bohot aasan screening test hai. Blood test karte hain usme serum creatinine dekhte hain, proteinuria dekhte hain proteinuria mein protein to nahin aata hai. Serum creatinine badh to nahi raha hai aur samay samay par ultrasound karte hain kidney ka uski andruni bnawt dekhte hain ki usme koi changes to nahi aa rahe hain, yadi aapka creatinine normal hai, urine mein protien nahi aa raha hai to aapka kidney sahi hai. Kidney failiure ke Mukhyta jo lakshan hai, aapke chehre par sujan aana jo aakh ka eye lid hai usme bhi sujan aata hai, pairon me sujan aata hai, aapko bhukh Lagna kam ho jata hai aur aapko peshab ki matra bhi kam ho jati hai. To is tarah ka yadi lakshan hai to aap kidney ke chikitsak se milen jisko nephrologist bolte hain aur nephrologist ki salah lein aur kuch haad tak kidney failure ko roka ja sakta hai. Nephrologist ki salah se.

Jab aapko kidney failure ka lakshan najar aane lage to aap kidney ke physician ki salah lete hain aur dheere-dheere uska ilaaj karte hain. Lekin ek samay aisa ataa hai ki jab aapka kidney permanently fail ho jata hai usko bolte hain CKD stage 5 aur usme aapka kidney ka jo kam karne ki shmta Hai vah 10% se bhi kam ho jata hai us samay aapko dialysis ki jarurat padti hai. Dialysis ki jarurat Kabh padti hai yadi aapka saans full raha hai, aapke shareer mein potassium ki matra jyada ho gayi hai aur aapke poore body mein sujan ho gaya Hai. Is tarah ke lakshan jo hote hain usme dialysis ki jarurat padti hain. Dekhiye dialysis ki jarurat aap temporary dialysis kar sakte hain. Jo Kidney failure ka last stage hai uska end stage renal disease ya CKD 5 stage bolte hain. Uska jo best treatment hai wo kidney transplant hai, Gurde ka pratyaropan. Ab mai ye batana chahta hoon Ki dialysis aur kidney transplant mein kya antar hai. Dekhiye dialysis se aap sirf khoon ki safai karte hain lekin jo transplant hai usme aapko ek normal kidney aap ke shareer mein lagaya jata hai kyunki blood filtration ke alawa kidney jo blood ko saaf karne ka kaam karta hai uske alawa kidney se khoon banne mein bhi sahayata hoti hai.

kidney se ek hormone bhi release hota jisko erythropoietin bolte hain wo khoon banne mein sahayata karta hai, fir vitamin D ke synthesis ko bhi madat karta hai kidney aur kaafi saare cheezein hai jo ki aapki normal kidney se nikalta hai. To normal kidney or dialysis mein bohot fark hai. Yadi aap dialysis par rehte ho toh aapko hafta-hafta khoon banne ka injection diya Jata hai aur fir vitamin D ki goli khani padti hai aur dialysis ke liye aapko hafte mai 3 bar hospital jana padta hai aur aapke saath ek adami hota hai. Jiska bhi kam apna rojgar band karke aapke sath hota hai. To dialysis ka jo kharcha hai kaafi jyada hota hai mahine mein kam se kam to 30,000 rupaya jata hai ek admi ko dialysis karne mein kyunki aapko injection lagta hai aur aap ka jana aana aur aap ke saath jo aadmi jaate hain unka bhi jo kaam hota hai wo kaam band karke jana padta hai. Yadi aap dialysis par rehte hain jo diabetic patient hai usme dialysis mein logon Ko 4 ya 5 saal ya 6 saal mein logon ki death ho jati hai. Kafi logon ki kam se kam 30% se 40% logo ki death ho jati hai aur jo transplant hota hai usko karne ke 2 tarike hote hain.

Ya to aapke family member, aapke mata, pita, bhai, behen, aapki patni aapko ek gurda de se agar wo normal hai to. Normal kahane ka matlab ki jo donor hai jo aapko gurda dena chahte hain unko diabetes ki bimari nahi honi chahiye, high blood pressure hai to bhi de sakte hain to bhi gurda de sakte hain bas shart hai ki unka end organ damage nahi hai. End organ damage ka matlab hota hai unko aankh mein retina mein koi bimari na ho, urine mein protein na aa raho ho aur yadi aap ECG karte hain ya echo karte hain to usme heart mein koi soojan nahi ho, left ventricular hypertrophy bolte hain wo nahin hona chahiye aur aapka blood pressure ek single medicine par control hai to aap kideny de sakte hain. Abhi aapke pass 2 kidney hai or koi bhi adami, normal aadmi jiski umar 18 se 65 saal tak hai apni 1 kidney donate ker sakta hai isko bolte hai live related kideny transplant aur dusra tarika hota ha dusra hota hai cadaveric transplant iska matlab hua ki yadi kisi bhi vayakti ka road-traffic accident mein head injury hota hai ya kisi ko brain hemorrhage ki wajah se behosh ho jata hai aur vah ICU main admit rehta hai aur usko neurosurgeon intensivist sab log braindead ghoshit kar diya jata hai.

Braindead ka matlab hua ki aap bina life support ke ventilator ke aur blood pressure maintain karne wali dawa ke bagair aap nahi raha sakte hain aap ka jo saans ki parkriya hi nahi chal rahi hai aur aap ka blood pressure nahin maintain ho raha hai to us patient ko braindead bolte hain. Uske liye hum log apnea test karte hain aur yadi ye test positive hota hai to usko braindead declare karke aur unke family walon se unki consent ya sehmati karke aapka kidney transplant ho sakta hai Jisko cadaveric transplant bolte hain to mai yahan par kafi transplant karta hoon, cadaveric bhi karta hoon aur live related bhi karta hun aur sabse badi baat hai ki jo donor nephrectomy hai, mai laproscopic method se nephrectomy karta haun jisme ki marij ko pain kam hota hai aur 3 din se 4 din ke andar uski chutti ho jati hai aur kafi accha patient ki recovery hoti hai Kafi achha hota hai.

To jo transplant hota hai, transplant karne ke baad aapko 3 se 4 din ICU mein rakha jata hai. Transplant ICU mein aur dheere-dheere aapka jo serum creatinine hai. Urine output sab measure karte hain, blood pressure monitor karte hain aur aap haft-din mein chutti hoke ghar chale jate hai. To transplant ke kitne fayde hain ki aapko dialysis se chutkara mil jata hai aur ek normal zindagi vyatit karte hain to kidney transplant ke bohot fayde hain lekin Yehi hai ki aapko zindagi bhar immunosupression wali dawa Di jati hai jisko khana padta hai aur Iske alawa dialysis aur kidney transplant mein kafi difference hai. Mai yahi samajhta hoon ki kidney transplant jo hai kidney failure ke liye sabse best ilaaj hai sabse uttam ilaaj hai aur logon ko kidney transplant ke liye aage aana chahiye aur jo aapki family hai unko acche se council karke ek gurda de sakte hain normal aadmi usme koi takleef nahi hoti hai logon ko.

Ek aur mahatvapurna baat batana chahta hoon ki India mein kaafi saare patient kidney transplant ke hote hai jinko ki organ nahi milta hai ya to unke family mein diabetic patient hote hain aur kyunki aajkal to jo family ka size hai kafi chhota ho gaya hai wife, husband, ek ya do bacche to jyadatar live donor milne mein takleef hoti hai isliye mera ye aapse nivedan hai ki aang-daan kare aap 1 organ donor bane jisse ki aap 5 se 6 logo ka jeevan bacha sakte hain aur logon ko jeevan daan de sakte hain yadi bhagwan na kare kisi road traffic accident mein aapko head injury ho aur apka bachana mushkil ho jaaye to us condition mein aap 1 organ donor bane aur un logo ko jeevan daan dein. To kidney failure se bachne ke liye kya upay hai main aapko shortcut mein, bohot brief mein batana chahta hoon ki aapko yadi diabetes hai to diabetes yani blood sugar ka control kare. Regular apna routrin urine dekhte rahe, blood urea, serum creatinine check karte rahe aur BP (blood pressure) ko control rakhe aur koi bhi aadmi yadi dard ki dawa regular khate hai to ek isko nonsteroidal anti-inflammatory Jaise combiflame hua, ibuprofen hua, diclofenac hua ye sab dawa khaane se bhi kidney par bhi iska nuksandeh asar hota hai aur mera to yahi sujav rahega ki jab aapko jod aur ghutne ka dard ho to bina doctor ki salah se dawa na khaye aur apna blood urea, creatinine hamesha karte rahe. Apne man se kabhi bhi dard ki dawa naa lein adhik matra mein kyunki wo aapke gurde ke liye hanikarak siddh ho sakti hai. Main asha karta hoon ki meri baat aapko samajh mein aayi hogi.

Thanks!

Hi,

I am Dr. Suresh Kumar Bhagat, Urologist. Aaj hum aap ko kidney stone ke baare mein btayenge. Kidney stones ko kabhi bhi andekha na karein. Agar aap ki kidney mei 4-5mm ka stone hai toh pani jyada peejeye lekin ek baar urologist ki salah jarur lein. Yadi vahi stone ureter mein aake fus jata hai toh vo aap ke gurde ko nuksan phucha sakta hai. Jyadatar yahi dekha gaya hai ki 6mm se chote stones nikal jaate hai. Stones ka problem jyadatar un logon mein dekha jaata hai jo bahar kam karte hain and paani kam peete hain ya fir patient ki family mein vo bimari run kar rahi hai ya fir unmein ye problem hoti hai jo mountains ya fir desert jaisi jagaha mein rehte hain. Isliya main aap ko ye suggest karta hun agar aap ko stones hai toh urologist se consult karein. Unse khaane peene ke baare mein puche ki kya khana chahiyai and kitna paani peena chahiyai.

Agar aap ka stine 5-6 mm se bada hai toh stones ki problem aap ke liya dangerous ho sakti hai. Aur agar aisa stone hai toh aap ko niklvana chahiyai kyuki aise case mein apne aap stones nikalne ka instances kam hota hai. Aise stone ko ignore nahi karna chahiyai. Jarur urologist se consult karein kyuki agar aap ko fever ho raha hai ya vomiting ho raha hai toh aap ko kidney mein infection ho sakta hai. Isliya aapke ureter ka kam karna kabhi bhi band ho sakta hai. Logon ko lagta hai ki ayurveda medicines lene se stone dissolve ho jata hai. Agar stone 4-5 mm ka hai toh stone dissolve ho jayega lekin aap ko diabetes nahi hona chahiyai, single kidney nahi hona chahiyai, aap ko fever nahi aana chahiyai.

Aise condition mein aap 2-3 weeks wait kar sakte hain. Paani piyein and Dr se consult karein. Agar aap ka stone nahi nikal raha hai toh use nikalne ka bahut hi easy method hai. Endoscopy method se nikala jaata hai. 6mm se bade stone ka apne aap nikalne ka chance bahut kam hota hai. Isliye urologist ka suggestion leke use nikalwayein. Aur puchein ki aisa kya karna hai ki kidney stones aap ko baar baar na ho. Sabse easy way hai ki paani jyada lein. Aap ko kaise pata chalega ki aap pani sahi matra mein le rahein hai. Aap ka urine color paani jaisa hona chahiyai. Main aasha karta hun jo maine aap ko kidney stones ke baare mein bataya hai vo aap ko samajh aaya hoga.

Thank You.

Hello!

I am Dr. Sanjay Bhatia, ENT specialist and neuro-otologist. Today we are going to speak on nasal obstruction; the common cause what I see in my clinical practice. If we start, nasal obstruction most commonly seen in paediatric age group is nose block, mouth breathing and nasal discharge. These are predominantly seen with a small adenoid growth at the end of the nose. Deviated nasal septum, hypertrophic reactive turbinates or allergic colds are treated with medications. Adenoids usually do subside with medication but persistent and recurrent episodes of adenoiditis will require surgical management. As the age progresses, around teenage, adolescent ages we see buckling of the nasal septum called deviated nasal septum causing nasal obstruction. The correct age would be around 15, 16 to 18 years if there is a persistent nasal obstruction causing difficulty in breathing, mouth breathing, snoring.

So, the surgery for that is septum correction called septoplasty which can be done in a conventional way or an endoscopic septoplasty. As we go further, we have this constant environmental agent which causes sneezing, watery nose and persistent nasal discharge which chokes the nose causing nasal blockages. These are known as allergic rhinitis which can also have a resulting in nasal obstructions and frequent episodes of allergic rhinitis can lead to soreness of nasal lining leading to nasal polyposis. The early treatment is medication, nasal sprays and anti-allergic tablets. If the symptoms persist and there are nasal polyps which are not regressing in spite of good medications and systemic steroids one has to undergo sinus surgery to remove the nasal polyposis. Another factor for nasal obstructions can be recurrent rhino-sinusitis, bacterial infections and masses in the nostrils.

So this can be tumors, can be in adolescent ages in males we see is vascular masses called as angiofibromas, there can be other tumor factors in the nose which has to be addressed according to the lesion. How effective are the nasal surgeries for the above symptoms? This is a common question asked and discussed with my patients. Now depending on the etiology, the recurrence rates are known. If it is allergic symptoms, we do not control the allergies by surgery. Allergies are controlled by medications only. How severe is the response of your lining to the allergy will show us the recurrences of the symptoms? That's why most of the consultants will tell you nasal polyposis is just to clear the nostrils from the polyps, create a wide surface area for the medications to reach.

Regarding the removal of adenoids, there are various techniques today. Apart from the conventional curate technique, we have nasal endoscopic technique where it is visualized under the vision and shaver system and coblation is used to remove adenoids and the division. So it is no longer applying procedure so the success rate of removal of adenoids is much higher and better. Septoplasty we have already discussed. Sinus surgery for bacterial infections and infective causes is how well we open up the affected sinuses. You create a larger area of drainage and a good antibiotic serves the purposes. Regarding the tumor and other masses, it depends on the etiology and pathology of the tumor, how bad or good the disease is for the recurrence kind of thing. Thank you and you can go through the post and other things on the lybrate website.

Thank you.

Hi,

I am Dr. Kailash Kothari, Pain Management Specialist, Mumbai. I am interventional pain and spine pain management specialist. So, in pain clinic, we identify that what is the cause of your pain by the specialized treatment called diagnostic nerve blocks or diagnostic block of particular structure which all examination we feel might be a cause of pain. So, coming one by one. I will just tell you, how we diagnose it. So, if the disc is coming back again and it is compressing the nerve, the procedure called discography. So, we just put the small needle in the disc, we try to see whether the disc is causing pain. If the disc is painful, the patient will feel a lot of pain, so, we can identify whether the disc is causing pain or not. There are various treatments option like decompressor, disc affects, which are non-surgical and kind of injection technique through which we can remove the bad disc and we can cure disc without doing any open surgery.

Another is inflammation of nerves because of the fibrosis the procedure called transforaminal epidural dialysis. In that, what we do, there is a small catheter which is inserted through the tailbone. The area which is operated where the fibrosis is happening or the nerve is getting compressed, we put the catheter and that catheter we inject, open up space, then injecting certain medicines, editions are broken and the nerve is freed. That is very effective and post-operative editions. So, this is about nerve. If we have joint pain, we do test injection of the joint under x-ray control. We block that medial branch. We ask immediately to the patient, whether they have pain or not. If the patient has pain because of the facet joint, they will immediately say that they have pain relief. They can stand, sit, move, the activities they were not able to do, they can do all those activities. We can do level 1, 2 & 3 blocks and we can see that how many joints patient have which are bad. If we have confirmation, we can start radiofrequency ablation of the nerve which is causing pain. The best part about pain management technique is, these are all daycare procedure. You come in the morning, get the procedure done and you will be back within a few hours. It will not cause you to go on the bed. You don't need any rest.

You can go back to your work immediately after the procedure or maybe next day depending upon what procedure are we doing. These are very good to improve the quality of your life without surgery. In certain cases, where the muscles are involved which is causing pain. So, similarly, as we did for disc, nerve, for facete joint we can also block the muscles with a local anesthetic. And we see whether you have pain or not. If you have pain, we can confirm that muscles are having pain. And there are certain symptoms, we identify what muscle or joint or disc might be causing pain. By examination, we pinpoint, what is the area or which is the structure which might be causing pain and then we do a diagnostic injection or block that area and confirm our clinical diagnosis by diagnostic injection. Once we get confirmation, we do the therapeutic treatment by injecting some kind of steroids, radiofrequency ablation. But a few patients are really bad. They have so much pain. They have pain 10/10. We tell the patient to identify what is the level of their pain. And if your pain is not improving after trying everything, this is not the end of your treatment.

So, there are certain patients, who do not respond to surgery, to nerve blocks or radiofrequency ablation. For them, there is a certain specialized treatment called neuromodulation. Basically, pain is what? Pain is carried by nerves to the spinal cord and from there it goes to the brain. So, we need to identify the pain pathway and you can block the pain going to the brain. So, we put a small electrode or a small wire through a small needle. This is called spinal cord stimulator. And that wire is connected to a small battery which is implanted in the abdomen just under your skin. Wire applies the current over the spinal cord. We call it spinal cord stimulator. So, in the area where the pain is going will be replaced by some tingling or soothing sensation. This is a very effective treatment especially for the patient who does not respond to any kind of treatment. Some patient comes to us with 2-3 surgeries, even I have treated the patient with 6 surgeries they have in the past. And they have responded really well to spinal cord stimulator. So, this is a very effective treatment which is available in our clinic.

The 2nd is called morphin pump implantation in short, it is called intrathecal pump implantation. A catheter is being inserted through the needle. It is implanted just below your belly. It is under the skin. It is superficial. Then the drug is directly delivered to the spinal cord in microquantity. So, you do not have any side-effects of the drug. It is very safe. It is a very effective treatment. So, these are a few treatment options which are available and if you want you can always call us. You can go on websites and find out more information about these procedures. And I am sure that you will get very good relief. You will be back to your quality of life to be achieved by these procedures. You do not need any further surgery. If one surgery has not worked then there is no chance that another surgery will work for you. So, better to identify the pain structure, go for pain management treatment which is not surgical. Do call us if you have any query.

Thank You!

Hello friends,

I am Dr Kailash Kothari. I am Interventional Spine & Pain management Specialist . Hum ye pain ki treatment karte hain aur hamare jo doosre centres hain usme K M Hospital jahan pe mein honorary physician hoon. Wahan par bhi hum kafi patient jo hain pain ke wo treat karte hain. Hamare paas kafi tarah ke patient atey hain usme hamari jo back pain aur neck pain ke patient hote hain wo kafi hote hain. Aur ek bada percentage hota hain jo hamare ghootno ke dard ka hota hain knee pain. To aj maine socha ki knee pain ke jo treatment hain uske barey mein hum kuch baat karein. To knee pain jaisa aap ko sabko pata hain ki yeh ek bada karan hain jiske liye log hospital mein atey hain. Aur yeh knee pain aisa nahi hain ki aapko jo umar jyada hoti hain unhi logo mein hogi wo. Wo pain aapko young patient mein bhi ho sakti hain wo aapko umar darar logo mein bhi ho sakti hain. Aur iska karan yehi hain ki knee hamari ek continuosly kaam karnewali ek part hain body ki.

Yahan par hum chalet hain byath te hain bhagte hain aur uthte hain niche jamin pe byatna parta hain to har cheez mein ghutna apna kaam ata hain. To iski wajey se uski jo ligamants hain muscles hain cartilages hain wo sab under strain hotey hain unke upar kafi pressure hota hain. To uski wajey se kafi logo mein ye samasya ati hain. Aj mein jo aapko batane wala hun yeh knee, knee hamri ek simple sa joint hain jisme aapko upar femur yeh bone hota hain iske niche tibiaaur yeh fibula. Yeh 3 bono ka ek joint hota hain jisko hum knee joint kahatey hain. Uske ilava hamare ek doosra bone bhi hota hain jisko hum Patela bolte hain. Isko hum Marathi mein wati bolte hain aur hindi mein katori bolte hain jo jiske upar yeh muscles slide hotey hain aur hamare ghutne ko modne ka kaam karti hain.

Toh hamare jo ghutne hotey hain usme kaafi cheezey hoti hain jo hamare knee ko dard pain kar sakti hain. Jaise yeh ligaments hain yeh hum medial collateral ligaments usme kabhi kabhi sprain ata hain toh use pain ho sakta hain. Yeh jo patella hain iske liye ek special grove hota hain. Patella agar right ya left mein convert slip ho jaata hain toh yahan pe friction ho sakta hain yahan pe arthritis develop ho sakti hain yahan par aapko inflammation ho kar pain ho sakta hain. Uske ilava humare ghutno mein andar ki taraf kaafi ligaments hotey hain ACL aur PCL anterior cruciate ligament aur posterior cruciate ligament. Yeh ghutne ko friction aur extension matlab aap jab pura ghutna modte ho matlab jab aap pura sidha karte ho tab usko excessive friction aur excessive extension issey rokta hain taki aapka ghutna jyada extension ya jyada flexion na ho. To yeh limit karta hain at the same time stability deta hain. Uske ilava joy eh dekh rahey hain aap, do ghutney ke beech mein do bone ke beech mein yeh hain meniscus yeh kaafi logo mein meniscal injury ho jati hain aur yeh meniscus cartilages hotey hain jo cushioning effect dete hain apne ghutne ko. Yeh itni saari cheesey hoti hain jo ghutne ke andar aur uske aas paas ki jagayon mein pain kar sakti hain. But uske ilava yahan pe muscles hoti hain jo quadriceps muscles jisme 4 muscle ka ek group hota hain jo agey ki taraf ghutne ko pakarke rakta hain aur piche ki taraf hamstring muscles hoti hain toh hamstring muscles bhi ghutno ko support karti hain.

Uske ilava side se bhi muscle hoti hain dono bahar ki taraf aur andar ki taraf dono sides mein muscles hoti hain. Toh ye knee joint jiske upar kaafi dependent hotey hain hum chalet hain phirte hain baithte hain uthte hain usko support karne ke liye kaafi kaafi cheesey hoti hain. Koi bhi ek cheez agar damage ho jaye toh hamare ghutna sahi dhang se kaam nahi karega aur humko taklif dega. Toh humare paas jo ghutne ki itni saari bimariyan hain jisme sabse jo common bimari hain jiske liye log hamare paas atey hain uska naam hain osteoarthritis jo jaise umar badti hain humare ghutno ki cheesey jo ligaments muscles or cartilages hotey hain wo dhire dhire kamjor hotey jaatey hain wo patley hote jaatey hain thin out. Uski wajey se kya hota hain ki knee joint ka jo cushioning aur oiling effect hain jo fluid hain knee joint ke andar wo fluid kaafi kam ho jata hain. Aur uski wajey se hamare ghutney sooj jatey hain aur movement karne mein kaafi dikkat ati hain. Hamarey old age patient jo hotey hain wo ghutna fold nahi kar patey hain baithte hain to uth nahi patey hain uthte hain to chalne mein dikkat hoti hain thoda chalne mein pyarr dard hone lagta hain aur kabhi kabhi aas paas mein sujan a jati hain.

Toh aise situation mein normally hum kya karte hain anti inflammatory medicine lete hain. Anti inflammatory medicine yane sujan kam hone ki dawai sujan a gayi hain to doctor kya karte hain sujan ki dawai dete hain. Par kya yeh treatment hain? Sujan ki wajey se jo aapka regeneration process hain naye cells jo banna chahiye wo aur kam ho jata hain. Jaise umar badti hain humara nayi cells generation capacity kam ho jati hain aur hum kya kar rahey hain anti inflammatory medicine de rahey hain. Use hamari joy eh capacity aur bhi kam ho jayegi. Toh agar kisiko hum anti inflammatory medicine dete hain toh wo sochta hain mera pain kam ho gaya aur wo bohut khush ho jata hain. Kya arey wah main to chal sakta hun main baith bhi sakta hun niche par actually wo cheese ghutne ke liye achhi nahi hain. It is not good for your knee. Because it hampers further regeneration of the knee so we don’t want that. Toh hum kya karte hain. Hum aise treatment karte hain jiski wajey se apke jo ghutne mein ghisao ho gaya hain naya cells banne nahin ho raha hain regeneration nahi ho raha hain us regeneration ko hum stimulate karte hain. Aur uske liye ek treatment hotey hain jisko hum bolte hain prolotherapy.

Prolotherapy yaney proliferative therapy. Jo cells wapas nahi ban rahey hain hamare body ki capacity utni nahi rahi wo stimulate nahi kar pa rahi hain because of ageing umar ke hisab se toh ye therapy us chees ko stimulate karti hain. Toh hum kya karte hain hum ek simple sa treatment karte hain jisko bolte hain dextrose prolotheraphy jisme hum ek glucose jaisa substance hota hai dextrose it’s a sugar, uski ek particular concentration aur local anaesthetic injection isko hum ek combination banate hain aur us combination ko ghutno mein hum alag alag jagah par jahan pe uski jarurat hoti hain wahan pe inject karte hain. Aur sugar hamare body ke liye kuch damage nahi kar sakta it is very safe. It is a 100% side effect free treatment aur isme jo hamare body ke jo tissues hain usko wo stimulate karti hain cartilages ko ligaments ko muscles meniscus aur andar jo sinural fluid, jo fluid suk chukka hain hum kafi time sunte hain osteoarthritis mein ki fluid andar ekdum suk chukka hain andar oiling nahi hain toh us oil ko wo create karta hain kyon. Kyon ki yeh cells ko regenerate karta hain. Jo ghutne ke andar fluid hota hain usko bolte hain synovial fluid aur synovial fluid banta hain synovial cell se. us cells ko wapas banana ka kaam prolotherapy karti hain.

Aur ye koi doosri therapy nahi kar sakti hain. Uske ilava jab prolotherapy karte hain to humare muscles ligaments cartilages ye sab majboot hotey hain, kyun hote hain kyonki unke naye cells nirman hotey hain aur because of that they become more stronger. So you feel good aap ki joint ka stability a jati hain apko achha lagta hain pain kam hota hain aur wo pain killer je waje se nahi hota hain because of your knee which is getting better by recreating new cells. So yeh ek bohut bara part hain jo osteoarthritis ke patient mein hum karte hain. Aur hamare pas almost 30 to 40% patient hotey hain jo osteoarthritis ke patient atey hain. Aur hamare paas hazaro se jyada patient treatment le chukle hain aur unko kafi fayda hua hain. So this is one of the very very common treatment which is not done commonly anywhere in India but we are known for this therapy called prolotherapy. You can go on internet you can find a lot of papers research papers and there are lot of evidence about this therapy. Toh aur bhi information agar apko iske barey mein chahiye toh aap Lybrate dot com pe jakar apni queries daal sakte hain. Aur hum aapke queries ko answer karne ke liye will be more than happy. Humko bohuti khushi hogi ke hum apke queries ko answer karey. Hopefully apko yeh video pasand aya. Thank you very much and visit us on our website also.

Thank you.

Hello,

I am Dr. Kailash Kothari, Pain Management Specialist. We treat every type of pain and maximum patients are coming to us with knee, back and neck pain. So, today I will tell you about knee pain. So many patients are visiting the hospital because of knee pain and not only old but young people are also suffering from knee pain. The knee is the part of the body which works continuously during the regular walk, running, frequent sitting and then getting up from the place, sitting on the floor with folded legs. This causes strain to ligaments, muscles and cartilage. In our knee, we are having 3 types of joint: femur, tibia and fibula. A part in the knee is patella. Patella, we call vatti in marathi and katori in hindi. Patella is a muscle which slides over the knee joint and helps us in bending knee. So many things are there in the knee which can affect our knee badly. Injury to patella can cause arthritis, friction and inflammation.

The types of ligaments in our knee: ACL and PCL. These ligaments control flexion and extension of the knee while bending and straightening the leg. In the knee, between 2 bones, there is a meniscus which functions as a cushion to the knee. Apart from these, there is a quadriceps muscle which is a group of 4 muscles which holds the knee from the front and hamstring muscle which supports knee from the back. We also have muscles at the sides of the knee.

Many types of problems are there which affect knee and maximum patients are coming to us for osteoarthritis. As we get older, our ligaments, muscles, cartilage start getting weak and thin. This may result in the swelling of the knee and it gives problem at the time of the knee or leg movement. At an older age, the patient is not able to fold his legs. They suffer from problems while sitting, getting up, walking. In such situations, the patient takes anti-inflammatory medicines which only reduce the swelling. By taking these anti-inflammatory medicines, the regeneration of cells in the knee gets reduced. For that particular time, the patient gets relief and able to do all the activities but these medicines are not at all good for knee. So, we stimulate the regeneration of the cells at the time of the treatment. For this, the therapy is called prolotherapy. This therapy helps our body in increasing cells capacity. This treatment is called dextrose prolotherapy.

We prepare a combination of dextrose and local anesthesia and inject the same into the knee. This is 100% side-effect free treatment. This procedure stimulates our body tissues, cartilage, ligaments, muscles and this also reactivates the synovial fluid which gets dried in osteoarthritis patients. Prolotherapy is the only way to recreate the cells and strengthen our muscles, ligaments, cartilages. This gives stability to your joint. 30-40% of patients are coming to us to get rid of osteoarthritis and till date, we have given successful results to over 1000 patients. Now they are able to do their regular activities and avoided knee surgeries successfully.

We also have many patients who are in sports. Mostly we have seen that sportsmen are getting more affected with knee injuries as they do physical activities. There is a knee problem in sportsmen and we call it runner's knee. Sometimes our ligaments get twisted into the knee which causes pain. In such cases, prolotherapy helps to proliferate the normal cells, strengthen the muscles, ligament. If we will not keep our knee strengthen then it will cause instability which causes the problem to the patient in walking, running and routine activities. This treatment is not for the short term. People who play cricket, basketball, football can suffer from ligament injury or ACL & PCL tear and sometimes meniscal tear. This is a problematic situation in which if the patient straightens his legs, the knee gets locked and it becomes impossible for the patient to bend it again. We call this lock knee. It becomes difficult for us to pull the same back.

It also happens when our ligament gets damaged and we are able to move tibia, this is called instability of the joint. This instability causes pressure over the bones and also it creates osteophyte to create the new bone formation. Due to this new bone formation, our knee gives more pain. The best part of the treatment is that it gives you pain-free life for the longest time and makes the knee more stable. We repair the ligaments and cartilage with the help of prolotherapy. We stimulate the cells so as to build cartilage or fibrous tissues. This is the very common treatment which is not done pan India. We are known for this prolotherapy in India. These details can be found online and it has lots of successful evidence also. There is another therapy called PRP which helps in regenerating our tissues but for this dextrose prolotherapy is equally important and we treat the patient with both the therapies. Combination of these therapies gives better results.  If you want to know more about this, contact me through Lybrate.

Thank You.

Hello,

I am Dr. Kailash Kothari. I am an interventional pain management specialist. So we have this pain management centers who caters to chronic pain in patients and I am also attached to KEM Hospital which is one of the pioneer municipal hospitals in India and it has a very good pain department. So I am one of the consultants there. I also visit Fortis Hospital & Global Hospital in Mumbai and we try to manage these patients who are coming from all over India for their chronic pain conditions. So today what I am going to talk to you about certain pain conditions what we treat and we try to manage their pain so that the quality of life improves. Now one of the most common conditions for which patients come to us is back-pain. I am sure you must have heard many of the videos you must have read many books or many articles on back pain how they manage it. So basically at pain clinic when we treat patients when we see patients they come with years of pain sometimes one year sometime 15 or 30 years of pain.

And they are in so much pain that there are some patient who actually tell me that they want to die, they don’t want to live with the pain. Now, this is the fact most of the time our science present science is not able to diagnose what is happening with this patient why they are in pain. Inspite of managing them with conservative line of management like medicines, physiotherapy, some people go for ayurvedic some people go for homeopathic, still their pain is not diagnosed well from where it is coming and many time the pain is so severe that they want to die. So we come across so many patients and when pain becomes so chronic they also have a lot of psychological issues. So many time the patient who comes to us and he has chronic pain our main target our main idea of treating them is to diagnose the source of pain from where the pain is coming from. Because we believe that diagnosis is of utmost importance. If you cannot diagnose the source of your pain then we would not be able to manage your pain. It is like you are just doing the things and treating you with a blind eye.

So you are not able to see what is happening and we are just giving you treatment which might be effective which might not be effective. So it is fluke, we don’t believe in fluke. We just go for a diagnosis. And there are various ways by which we diagnose a patient. So when patient comes to us for example if the patient is having backpain with a pain going down in the leg we know back-pain and leg pain can be caused by something which is happening in the back. So if you see this so this is your spine. So there are a lot of vertebras there are a lot of discs between 2 spine there are a lot of nerves behind and between 2 vertebra there is a joint which is called facet joint. And there are a lot of muscles and a lot of ligaments which are lying in front of that. So it is the muscles are supporting the back of the spine and in front of the spine. So when you bend and when you do an extension that is when you bend backward or bend sideways these muscles and ligaments they hold your spine in right place so you don’t fall at the same time it gives you strength to move. So the spine it is at risk of getting damaged by these repetitive movements because there is the opposite force which is acting from the front and from behind.

So there is a lot of traction which is happening on the spine and that is the main reason why the spine is very very vulnerable to damage. Now suppose you have back pain which is here and there is a pain going down in the leg. So the most common situation is because of the slip disc. If you see here there is a bone this is called vertebra and in between the disc and the disc if it bulges it slips this is how it slips here it compresses the nerve here. And this nerve is like a wire which is supplying a particular area of the leg. So if you have a pressure here there is an inflammation there is a swelling of this nerve and this can cause pain going down in the leg. Now, what happens when there is an inflammation that your pain become chronic if it is not relieved in time. And this bulge may increase over time. So this can produce lot of space reduction so we many patients come to me and say my gap is reduced so this is what is the gap when the disc comes out this gap reduces.

Nerve does not get much of the place to come out from the spinal canal. Now here most of the people say surgery is the only answer and most people don’t want to go for surgery. So we have a treatment where we can give painkillers where we can give physiotherapy if that doesn’t improve we directly go for surgery. And most people don’t go for surgery and keep on suffering they keep on suffering from chronic pain. Now there is a huge gap between just a simple medical therapy and surgical therapy. There is nothing in between.so this pain management this pain clinics they offer something in between which can avoid your major surgery and this is what we do. We first do a simple injection hereunder X ray control we locate where the compression is happening. Under X ray control we give some small injection called selective nerve root block or trans permanent epidural injection.

This is a X ray guided injection. We put the needle we inject a small contrast which can be seen on MRI sorry on the SIUM which is a X ray machine. Once we see where the drug is spreading is it spreading in the right area which nerve it is spreading to whether it is the same nerve which is getting compressed by the disc that we confirm then we inject our drug which is a small dose of corticosterone. So once the corticosterone is injected you will have immediate relief of symptom. Sometimes pain is relieved in 2 or 3 days sometimes it takes up to 1 week. But the idea here is to reduce the pain by reducing the inflammation. So once it is reduced sometimes it works for a long long time, you don’t have to come back and you can go on doing your routine work without any trouble of pain caused by slip disc. Sometimes the pain comes back and you might have to take repeat injections which is ok.

There is no problem in taking repeat injection as long as your pain is reduced and weakness in your legs. Then you can always go for injection. So usually we repeat this injection once or twice. If it is working well and you have months and years of pain relief. You are not bothered you don’t have to do any other treatment except for physiotherapy and exercises. But if the pain comes back inspite of this injection we know where the pain is coming from now. Because after this injection if you have good relief that confirms the pain source if in this area then we have certain advanced therapies. And these advanced therapies are called intradiscal therapies. So we have certain we can say minimal invisible techniques by which without cutting the body without putting any cut on the skin we can just through the needle we can remove the disc. These are techniques which are called bikeloplasty disc effects or sometimes we do something called Endoscopic Discectomy. And in all these treatments we don’t have to give any anesthesia except local anesthesia in the same area. And that’s the beauty of pain management.

We can reduce your pain without doing any major surgery. So, friends, this was about slip disc or herniated disc what I was talking about. But there are many other situations which can cause back pain. One of the most common is facet joint problem. This is the joint between 2 vertebra and this is called facet joint. A similar problem can be there in si joint this is sacroiliac joint. Many times there are muscles which can cause pain. We don’t know where the pain is coming from. Most of the time this all pain which is coming from the different structure they may have a similar presentation. So what we do in this case is we do a simple injection to diagnose by injecting a local anesthetic in a particular area.

If I give injection here and I make patient stand up after the injection he should be pain-free if the pain is coming from here. And that is what is called a diagnostic block. Once we get the diagnosis if we don’t get a diagnosis here pain is not relieved we go to another structure. So by doing a differential block of diagnosis we can find out which is the source of your pain and we can apply different treatment modalities most common is radiofrequency ablation. Basically, it is the radiofrequency current which is applied to the particular structure to block the pain coming and you are relieved off your pain for one and a half to 2 year. So one of this beauty of pain management is without surgery we manage your pain and we make sure that your quality of life is very very good and you enjoy your life with your family. And if you want more information then always contact us on Lybrate.com thank you very much for watching and I hope you will see more videos like this which will be informative for your pain condition.

Thanks!