Does your gall, often give a painful call?

Have we all, ever wondered, what all our human body can do? There are so many biological systems which are connected with one another intertwined to form one human body, yet each one is so different from the other in functionality.

There are organs which are essential for our survival such as the brain which is the body`s control system and helps in sending and receiving signals from the nervous system, the heart which is responsible for pumping the blood throughout the human body, the kidneys to remove the excess waste and extra fluid from the blood, the liver for detoxifying the harmful chemicals and the lungs for removing the oxygen from the air and transferring to the bloodstream.

But with these vital organs which we have, there are few organs which can be completely separated from the body without any issue as well.

According to CNN Health; there are 10 organs which can be removed entirely without affecting the body and Gallbladder ranks the top of the list. This truly means that Life can still go without a gallbladder, isn’t it?

According to a study in USA and Canada, 1 in every 15 undergoes a surgery on gallbladder and chances are very high that doctors advised them to go for a removal. Most of the     Doctors and practitioners believe that once the surgery is done people don’t notice any change in their overall

Daily activities but a little attention, in the long run, will reap wonders.

Living without a Gallbladder

Now, this is something which is amazing but it is true that most animal species in the world don't have gall bladders. As most of the animals eat on a regular basis and in a continuous manner they don’t require bile (i.e. a liquid that helps in digestion of fatty foods) for storage. Examples such as cow, sheep, deer and many other herbivorous animals.

But obviously, living without a gallbladder means that there is no production of bile juice as it can no longer be able to store bile.

However, when the gallbladder is removed, the reservoir is also removed so practically speaking, even though we will have the same amount of bile in our body, but we will not have as much bile in our intestine after the gallbladder is gone.

Reasons to remove gallbladder?

Gallbladder problems usually occur due to the presence of gallstones which are uniquely very small and hard, consisting of cholesterol fats and bile salts that form in the gallbladder or in the duct.

These gallstones can block the flow of bile out of the gallbladder through the duct, causing it to swell and also result in, vomiting, indigestion, sharp abdominal pain and, high fever.

Gallstones are also more common as you get older, during pregnancy and some people may have a family history of gallstones. Many times there is no known means to prevent gallstones inside the body thus doctors encourage to go for gallbladder removal surgery.

How the Gall Bladder removal surgery takes place?

Gallbladder removal surgery or cholecystectomy is a process of removing the gallbladder through to possible methods.

1. ·         Open Method.
2. ·         Laparoscopic method.

Gall Bladder Surgery

Open (traditional) method; One incision of 3 to 6 inches long made in the upper right-hand side of your belly just below the rib cage area. The surgeon finds the gallbladder which will be present below the pancreas in the shape of a pear, properly cut along the top making sure the nerve ending is taken care and then carefully remove it.

Laparoscopic method; This method uses 3 to 4 very small incisions in different areas. It is called the laparoscopic method because it uses a long, thin tube called a laparoscope. The tube has a small camera attached to it which reach the location and gives a projection on the TV monitor to the doctor which helps them reaching to the right area with the surgical tools. Then finally the gallbladder is removed through one of the incisions which were done initially during the surgery.

Precautions needed after Gall Bladder surgery?

• ·         Restricting to go on a diet which is high in fats and stick with clear liquids, broths, and gelatine.
• ·         In total don’t keep more than 20 percent of the daily intake as fats.
• ·         Slow reintroducing of high-fiber foods, as those are known for causing gas and diarrhea, but will help in curing the wounds faster.
• ·         Drinking plenty of water to stay hydrated. Drinks with sodium, chloride, and potassium are best after any surgery and for avoiding dehydration. Also, proper intake of juices also helps in faster recovery.
• ·         Try to avoid/restrict alcohol, drinking containing caffeine and if possible, try to quit smoking habit for about few months, as this can impact central nervous system and also the respiratory system. Caffeine and alcohol can also cause an upset stomach in some people and can cause severe health issues.
• ·         Last but not the least, Stay positive. Do not be disheartened by stomach discomfort at regular intervals and the limited diet if required or as prescribed by the doctor after gallbladder removal surgery. The probability of getting back to your normal diet within a few weeks is high. Chances are also good that you might continue with the same diet plans as it was before.

Even if, despite following all the medical advice, the medical prescriptions and taking sufficient amount of rest makes you feel uncomfortable at times then it’s suggested to be in contact with your doctor, further he/she can give you a personalized solution for your problem if required.

So if anybody is planning for a gall bladder surgery in the near future then chances are high that they can go for a safe removal of the same without any worries. 

Are you jogging between 140 to 190?

It’s a busy world isn’t it and all are working our way to make our life even better day in and day out. We wake up, travel to work, work for n number of hours, come back and go to sleep and repeat so that we can reach towards our goal every day. See what a perfect life we have, relaxed, calm, easy going, and serine. But in the process of our journey of pushing our selves every day, we try to forget why we actually started for and that’s when our consciousness hits us and we start to think about something.

Now, to the point, if we think and execute your plan its well and good, but after a while when things are not in the order we often think more and then is the time we start getting tense about something. One similar case which is going for a prologued period is time is Hypertension.

What is Hypertension and what causes it?

Hypertension is often called as the silent killer and rightly so because elevated blood pressure increases the load on the heart.

According to the American Heart Association, 1 in 6 people suffer from increased blood pressure and are unaware of it.

Now let’s see what`s blood pressure, so when the blood is pushed inside the heart, the heart pumps the blood throughout the body and the pressure with which it is done or the process takes is called blood pressure. Now hypertension increases the work of the heart as the blood vessels become stiff thus increasing the pressure in the valves. This further causes stroke, Kidney damage, and even heart failure.

List of surgeries

What are the symptoms of Hypertension?

Hypertensive patients often do not have symptoms that will alert them to their condition but, headache and dizziness might be some of the causes

An extremely elevated Blood pressure can be associated with warning symptoms and signs such as

•                    Moderate to a severe headache, pulsating in nature, often at the back of the head.

•                    Fatigue and Tiredness.

•                    Impaired vision.

•                    Chest pain, especially at exertion.

•                    Difficulty in breathing.

•                    The irregular and loud beating of the heart.

•                    Pounding in the chest.

So, how high is too high?

Blood pressure is measured in mm hg means millimeters of mercury.

Over years, various studies have been carried out to identify what should be your optimal systolic and diastolic blood pressures.

Normal: In between 80 to 120 (120/80)

Elevated: In between 120 to 129/less than 80

Level 1 high blood pressure: On between 130 to 139/ (80-89)

Level 2 high blood pressure: little over 140 and above/ (90 and above)

Extreme level Hypertension: higher than 180/higher than 120

When should I see a doctor?

It is important to recognize the warning signs and act if any of the symptoms listed above appear. However, often it is too late by the time the warning signs appear and the persistent increase in Blood Pressure can damage kidneys, heart, eyes, and brain. 

However, it is even more important to identify if you are at risk for Hypertension.

Common Risk Factors are       

•                    Age: the older you are, the higher the chance of developing hypertension. Though, Sadly Age is No Longer a Bar in Today’s Era and Lifestyle.

•                    Gender: Young males are more prone to develop elevated pressure until the age of 45. Post 60, women are at a higher risk.

•                    Family History: If you have a parent, sibling or close relative who has high blood Pressure then chances are again very high that it may pass to their next generation too.

•                    Sedentary Lifestyle: Irregular physical activity or no physical activity. Sitting, reading, sleeping for a long duration.

•                    Unhealthy Diet: Not getting proper carbohydrate, proteins, vitamins supplement in the food or skipping the meals often.

•                    Obesity: Abnormal body mass index (BMI) is an independent risk factor to develop hypertension.

•                    Lifestyle: Irregular sleep, skipping meals, too much time in front of gadgets.

•                    Alcohol or Smoking: Regularly engaging in smoking or drinking can contribute to damage arteries.

If detected early and kept in control, hypertension and its complications are easily manageable and patients can live a normal, symptom-free life.

Lifestyle and home remedies

Changes in the lifestyle can help you control and simultaneously prevent high blood pressure, here’s how:

•                    Eat healthy foods: Eat a healthy diet focus more on fruits vegetables, whole grains, poultry, fish and low-fat dairy foods also try to get plenty of potassium, in your diet. Eat less saturated fat and Tran’s fat.

•                    Decreasing the salt content: A lower sodium level will help in reducing diabetes or chronic kidney disease.

•                    Maintain a proper BMI: Keeping a healthy weight can help you control your high blood pressure and lower your risk of related health problems. Also, it increases the fatigue in the body urging the body to do more work.

•                    Increase physical activity: A regular visit to the gym or to the nearby park can increase your physical activity further enhancing your lifestyle.

•                    Limiting alcohol: Alcohol can increase raise your blood pressure when consumed in large amounts

•                    Quit smoking: If you smoke, ask your doctor and your family member to help you quit the same.

•                    Manage stress: Reduce stress as much as possible. Regular physical activity, yoga and plenty of sleep can help you achieve the same.

•                    Periodic monitoring of blood pressure: Get help from your family member to check your blood pressure at home. There is a different compact instrument which can be used to check the same.

•                    Precautions in pregnancy: Although there is no cure as such for chronic hypertension, it is always suggestive to be healthy during pregnancy. Taking proper care of you in the best possible way.

Medication and Treatment of Hypertension

•                    Thiazide diuretics. Also called water pills, these are medications help you to eliminate sodium and water further reducing blood volume.

Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications.

•                    Beta blockers. This medication increases the workload on your heart and also manages abnormal heart rhythms. They protect the heart and open its blood vessels, causing your heart to beat slower with less force.

•                    Calcium channel blockers. They help you to relax the muscles of your blood vessels making the heart rate steady. Generally, the trend shows that calcium channel blockers work better for elderly people.

•                    Renin inhibitors.  Renin, an enzyme produced by your kidneys that starts a chain of chemical steps which in a result increases blood pressure.

If you have a high blood pressure then it is recommended to go for a combination of low dose medication as it will be effective in the long run, finding a good combination of drugs also helps you to control the blood pressure under all times.

But for the best result, it is always recommended to see a doctor on a regular basis as he can address the issues in a much broader sense and will also help you to be in your limits.

Ouch! Does it hurt on the couch?

We all know how it feels when we take the pleasure of laying around on our favorite couch when we need it the most. Yeah, it’s the most relaxing thing ever right. Sit, lay back, roll over, read something or even watch TV, you feel the most like you are holidaying.

Now just think if these leisure's of life are taken away and one is left with pain. If sitting for a long duration, wearing tight clothing, and regular pain due to friction in one's buttocks or just above it, creates an everyday problem in their day to day activities then the chances are high that they might have a sinus known as Pilonidal sinus cyst.

But nothing to worry “Every Problem has a solution attached to it, the only thing is we have to find it". So, keep calm and let's see how we can make the best out of one's couch.

Pilonidal sinus cyst, So how it all started?

Once during the Second World War, thousands of US army jeep travelled for several days, in between the travel their condition became so bad they were not able to take rest for more than an hour at the same place further it got so widespread that they all developed the same disease it was nicknamed as "jeep seat” or "jeep disease" initially then later on due to advancement in science and technology it was renamed as “Pilonidal sinus cyst.”

What is this Pilonidal sinus cyst and how is it caused? 

It is a cyst or a lump on the cheek of the buttocks which is generally painful, causes swelling, makes the area red, often results in high fever and might cause weakness as well. This can also lead to "Pilonidal sinus cyst" in the long run which means pus that has built up within the tissue of the buttocks. 

In a study done in the UK regarding Pilonidal sinus cyst, it is told that around 300 in every million people generally at age of 15 to 40 suffer from this. 

Although the exact cause for this is not known doctors believe that changes in the hormonal tendencies, hair growth, and excessive sweating can be few of the reasons. Also, recent trends show that people who have a sitting job, having an irregular lifestyle and having hygienic issues can develop such kinds of diseases as well. 

List Of General Surgeries

What are its symptoms which arise due to Pilonidal sinus cyst? 

The symptom can start from itchiness, as many people in the age range consume oily or fatty foods due to their busy work schedule and lack of time, resulting in reddening the area due to regular inching. 

The next can be a hair loss in the affected area, making it more vulnerable resulting in more friction while sitting, walking or wearing tight clothes. Thus, if not treated at this stage may cause a cyst which may have higher implication causing thick pus or maybe blood draining from the abscess causing a foul smell. 

It can cause regular pain, increasing the swelling and also can boil which can be pretty heartening.

Researchers also have proved that if not taken care at an early stage than the cyst can cause a permanent damage to the tissue of the skin.  

 

How can a Pilonidal sinus cyst be treated? 

Generally, a Pilonidal sinus cyst can be diagnosed by at what stage it is and sometimes by location as well. The doctor has to examine the cyst to confirm a diagnosis; regular tests are also taken care focusing more towards the reason for the same.

Though there are many Treatment methods right from Conservative treating, antibiotic therapy, Lancing, or phenol injection it lot depends upon one's day to day activity and hereditary issues.

For an early stage of symptom, it is recommendable to go with a conservative method wherein there is no such sign of inflammation and hair loss, the doctor can prescribe few medicines, paying high attention to regular hygiene and essential food. Also making sure one`s wearing clean clothes on a regular basis.

The second stage is antibiotic Therapy which means treating the wound externally. The doctor first analysis it as to what might have caused by asking several questions about day to day routine and then treats it accordingly. Lancing and Phenol Injection are processes which are used in the modern era of medicine, this is an external process which makes sure that the abysses in the body are completely removed it also be removed via a  small surgery but it also depends upon the patient how intense the cyst is and will operate it accordingly. 

Above are some of the different ways on how to treat pilonidal sines but is it always recommendable and advisable to go for a medical consultation when symptoms arise. 

What are the Precautions one need to take care?

So now we all have seen what Pilonidal sinus cyst is so it's better if we take care beforehand. Some of the precautions can be as follows: -

1.      If there is excessive body hair then its recommendable to trim it so that it doesn’t get pulled off often.

2.      Reducing oily foods and removing junk food in one`s daily intake can be a great ad on.

3.      Avoid Sitting for a long duration at one place.

4.      If in family anybody had a history of Pilonidal sinus cyst then it's better to go for a check up on a regular basis.

5.      Having regular baths or maybe taking bath twice a day.

6.      People, who are obese, make sure that they maintain a healthy diet and focus more on green leafy vegetables in their diet plan.

Though any disease can happen at any point as they all say "Prevention is better than cure". So why to take a second chance, let’s take action before it becomes a bigger issue in the future.

And follow the above steps as it can help to reduce the occurring of such kinds of diseases and at least provide space in our busy lives for a leisurely couch experience.  

Does Your hernia wet your cornea?

What is a hernia? Do you have it? If you do have it, how do you know? Is it painful? Is it hereditary? What exactly causes it? Does the belly bump cause hernia, the lump? Do you need surgery to correct it? So many questions! Let’s start by addressing the first one.

What are the different types of hernia? Depending upon the site of the uneventful, there are different types of hernias. An umbilical hernia, femoral hernia, incisional hernia, epigastric hernia, and hiatal hernia. In this article, an inguinal hernia is being discussed.

A Hernia – It’s an abnormal protrusion of an organ or part of it through a weak point in the body. An inguinal hernia is the most common one among hernias, affecting mainly men than women in 7:1 ratio, respectively. You don’t want equality in these matters, ladies, trust me! A hernia can be direct or indirect. In GOT (game of thrones), remember Hodor? The scene where the white walkers attack Bran and they’re running for their lives? Hodor holds the door So that the white walkers don’t kill Bran and turn him into one of them. If Hodor played security at the entrance of the tower and the white walkers still got in? It would be an indirect hernia. Here, the white walkers can be the abdominal viscera mainly the colon and Hodor is the deep inguinal ring. Similarly and also how it happened in GOT, Hodor stood at the back door of the tower and white walkers crawled out eventually. Here, it’s a direct hernia and the iconic Hodor, being the posterior wall of the inguinal canal.  

What is this inguinal canal? It is a muscular canal containing structures running through it. They are the spermatic cord (in males), round ligament (in females), Ilioinguinal nerve, there is a genital branch of what’s called a genitofemoral nerve and lastly remnant of processes vaginalis. The weak area of all groin hernias is the site between the inguinal ligament and the iliopubic tract called the myopectineal orifice of Fruchaud.

What causes a hernia? Sometimes, people are born with it. There can be a collagen disorder due to which the ligaments become weak, the prune-belly syndrome is congenital and acquired collagen deficiency is due to smoking. Yes, smoking not only causes cancer but also a hernia. They forgot to put that on the pack. Basically, anything increasing the intra-abdominal pressure adds to the causation of a hernia like coughing, constipation, ascites, obesity, pregnancy, straining during micturition and lifting heavy weights. Hernia cases have been recorded post appendectomy as well.

Younger you are an indirect hernia is a possibility and older you get a direct hernia occurs. An inguinal hernia usually presents itself as a groin swelling and is painful in nature and it might be radiating to the umbilical region.

Normal investigations are done for diagnosis are,

·                     The routine blood tests and urine examination. The elderly might need an additional bunch few tests like a chest X-ray, ECG, and PFTs. Urinary complaints are checked for prostatic enlargement and urethral problems.

·                     Ultrasound can detect a sac where a hernia cannot be diagnosed by clinical assessment. It is useful in postoperative swellings, hematoma, and recurrence.

·                     CT (computed tomography) for giant hernias.

·                     MRI (magnetic resonance imaging) is ideal for a sportsperson, to differentiate between muscle spasm and a hernia.

Treatment for a hernia depends on its presentation. Herniotomy, herniorrhaphy, and hernioplasty are the three important operative techniques which are performed. For adolescent patients with a hernia, herniotomy is preferred.

Herniorrhaphy - Modified bassini’s herniorrhaphy is in practice now for patients who have a good muscle tone with an indirect and direct hernia. In this procedure, the surgeon repairs the stretched out ligament and herniotomy is also conducted. Shouldice repair is another type of herniorrhaphy where herniotomy is done with correction of a hernia using the surrounding tissues by absorbable and non-absorbable sutures in different layers.     

The third operative method is the hernioplasty, which is done in patients with or without good muscle tone having an indirect or a direct hernia and also in a recurrent hernia. This approach is done so as to strengthen the posterior wall of the inguinal canal. Firming up is done by repairing the weak posterior wall by a prolene mesh or Marlex mesh. A thick fibrous layer is hence formed as it acts as a foreign body and our immune system provides the required cement to it. An artificial deep ring is also done. This mesh technique is quietly brilliant as it has a long life, preferably socioeconomic; risk of infection is minimal when handled in a sterile environment and also due to its amazing biocompatibility. Prolene darning is also done in a few cases, which is basically sewing up the loose ends and making it stronger.

There are few other techniques like the Kuntz operation usually done in elderly, Mcvay, Nyphus repair, Stoppa repair, Marcy repair. Newer advancements are game-changing procedures like the Dasarda technique, creating a hernia system which is exceptional and mesh plug repairs are gaining popularity as they have much better patient compliance.

List of hernia surgeries.

Laparoscopic surgery or open surgery? In my opinion, open is a better choice for this condition. But both have their own pros and cons. Open surgery does interfere with the bowl function. Also, if there are any complications during the laparoscopic surgery the surgeon would have to open up and go old school. Plus, open surgeries are cheaper as compared to laparoscopic but the recovery period varies indistinguishably.

Complications are often common after a surgery. They can be during, before or after the surgery. They aren’t worrisome but few need to be attended by the surgeon. Care must be taken to avoid post-operative wound infection by the patient or their caretakers. In very few cases patients complain of lower abdominal pain a characteristic dragging pain months after surgery which might be due to injury to the surrounding nerves. This is treated by nerve blocks with anesthetic agents and steroidal injections.

If a hernia is not treated at the right moment it can give rise to a number of complications which are troublesome like,

·                     An obstructed a hernia.

·                     A strangulated hernia is quite notorious as it can cause shock and sepsis and need immediate surgical care as the bowel might get gangrenous.

·                     A Sliding hernia is an incarcerated hernia in which the fecal matter may slide into it.

·                     Inflammation is yet another impediment which might range out from a simple hernia to a life-threatening one.

·                     Recurrent hernia is common is 10 percent of the lot who has been treated earlier.

With all due advancements in the surgical and medical field hernia is one of the most common cases till date which need effective, relentless and instantaneous treatment. So, don’t ignore a lump because it is not so Gump.

Written By (Dr) Apoorva Manjunath

When something that you love makes you weak in the knees!

Before your mind runs wild, let me make it clear that this isn’t completely dirty and painful. Or is it? Each person is on their own, picking up what they like and love persuading towards that particular activity. While you’re at it, doing what you love there are often times when a small misjudgment or a miscalculation might end up giving months of terrible and excruciating pain. One such incident might be A LIGAMENT TEAR.

Ligament tear usually occurs in the joints of our body when a great force is applied to a particular joint. Let’s focus on the knee joint as of now. The knee joint has 4 ligaments namely,

• Anterior cruciate ligament(ACL)
• Posterior cruciate ligament(PCL)
• Medial cruciate ligament(MCL)
• Lateral crucial ligament(LCL)

These ligaments hold the knee joint in place and help in locking and unlocking the joint. When you walk, run, dance, gym or jump these ligaments work continuously. When the knee joint is locked, the greater force applied on it ends up tearing the ligament depending upon the direction of this unaided force.

Injury to PCL - Ligament tears are also common in a road traffic accident. Usually, in a car accident, the posterior cruciate ligament is torn. The harm occurs when the tibia is forced back to the femur. This is rather rare in a sports person whose anterior cruciate ligament is at risk.

Injury to ACL - Twisting a semi-flexed knee, which already made you say “ouch” is quite cumbersome to deal with as it often causes injury to the medial meniscus and MCL. (O’Donoghue triad)

Injury to MCL – Any force the pushes the tibia towards the femur in an inside fashion causes the rupture of this ligament.

Injury to LCL – MCL, and LCL are attached to either side of the joint, media is on the inner side and lateral on the opposite. So the damage to the lateral ligament occurs when the force is applied to adduct the tibia to the femur.

So now, describing the proper anatomy. The knee joint is a hinge joint.

A hinge joint is one which is made up of more than 2 bones and moves along one axis only. Elbow joint is another such synovial joint. Knee joint consists of the tibia and the femur, a tibiofemoral joint. Then there is patella which glides over the front of the tibial end of a femur, forming the patellofemoral joint. The knee Ligaments act like the joint’s best friend, providing support and stability. When this harmony is disturbed, a painful unstable state happens to be.

The ligament injury can be associated with,

• Chipping of the bone to which the ligament it is attached.
• A mid-substance tear ( tear in the ligament)
• Severity may vary on the tear being complete or incomplete.
• One ligament involvement or more.

The combination depends upon the force acting on the joint. More severe the injury more intricate the treatment regimen gets.

Diagnosis can be made through clinical examination and a detail on the event of the grievance. Complications that present with the tear are dislocation of the joint, blood clots, swelling. The pain may be localized over the torn ligament. Radiological examination of the knee joint is important to check if the bone has been chipped off, which might have been avulsed from the ligament attachment. Contrary to the Stress X-rays, MRI is a non-invasive method to diagnose ligament injuries. The arthroscopic examination may be needed in a few cases.

Treatment of this condition was conventionally done by non-operative methods. Now that there are better techniques and with the recent advances, better results are achieved through operative reconstruction. Operative reconstruction has become popular in high demand athletic individuals like Tom Brady, Alex Morgan Adrian Peterson and a lot more NBA players. Celebrity or not we are all made up of the same cells and same anatomy and ligament injury can be treated and normal functioning of the knee can be obtained and hence decreasing your time not spent on doing what you love.

Methods that are undertaken are,

• Conservative method – The blood clot/ hematoma is aspirated and the knee is immobilized in a cylinder cast or a knee immobilizer. If the injury is grade I or grade II, a conservative method is successful for treatment. Followed by this, strengthening physiotherapy is required.

• Operative methods – These are to be done when there is a combination of ligament injuries, involving multiple ligaments especially in young athletes or dancers. Usually, the surgery is done 2-3 weeks after the injury when the inflammation is fairly reduced.

What do the surgeons do actually? They first go by repairing the ligament. It is performed on grade III ligament tears, which means the ligament is completely torn. If the surgery is done after the 2-3 weeks, an additional reinforcement is provided by a tendon or fascial graft as the original torn ligament would have lost the strength due to a complete tear.

https://surgeryxchange.com/best/acl-surgery-cost-in-bangalore

they reconstruct the unstable knee injuries which present later than usual. An allograft or an autograft of a tendon or a fascia lata is used; a synthetic graft can also be used. Auto is better than also as there are lesser chances of rejection.

Knee ligament tears are very common and are often undiagnosed. Ligament tears are usually not seen on X-rays and might get neglected. The usual presenting symptom is the instability of the knee joint. Treatment is biased depending upon the activity level of the patient. If you’re a ninja then you’ll probably need surgery. If you’re a person who probably has a sedentary lifestyle, the doctor might perhaps recommend physiotherapy. Usually, the ACL tends to get damaged more often than the others. ACL reconstruction is done with the help of an autograft and bio-absorbable screws. Arthroscopic ACL reconstruction is the surgery of choice as it is minimally invasive, and results are outstanding as the patients revert back to normal with negligible risks.

By (Dr) Apoorva Manjunath

Should you get a mammogram and if so when?

Worldwide, breast cancer is the most common cancer (other than skin cancers) and the second most common cause of cancer deaths among women.

Screening with mammography is recommended based on age, risk factors and overall benefit to the patient. Large Trials conducted in the Western population have shown about a 20% reduction in the likelihood of dying from breast cancer with annual screening mammography. 

Typically, this is recommended starting at age 50, every other year for women at average risk. Between 40-50 years of age, the recommendations are individualized based on the risk factors for the patient. A baseline at age 40 and then every 2-3 years until age 50 may be a reasonable option. The age of cut off for mammography is not clear. It is not so much the numerical age as the physiologic age of the patient that matters. However, there is no clear-cut benefit beyond age 75.

This does not apply to high-risk patients such as patients with a gene e.g., BRCA mutation who may need MRI screening yearly along with mammography starting at earlier ages. Patents with 2-4 fold increase risk of breast cancer should also consider yearly mammogram between ages of 50-75 and every other year starting at age 40.

Risk factors typically include genetic mutations such as BRCA, early onset of menstrual cycles, late onset of menopause, late or no childbirths etc. 

So, why the controversy regarding screening when studies have shown a decrease in mortality? Some of this comes from the potential complications with all screening, such as false positive mammogram possibly leading to anxiety, more frequent imaging, unnecessary biopsies etc. there is a small radiation exposure associated with mammography which in itself can lead to a small risk of breast cancer over a number of years

When routine mammographic screening was first introduced in the US, there was an increase in the incidence of breast cancer, more cancers were diagnosed which has led to the concept of “over diagnosis”. Are we diagnosing small cancers, which may never truly cause any problems during the life span of a woman? Currently, there are no methods available to determine which early cancers may progress to actually cause life-threatening problems in a woman.

This is of major concern as it may lead to treatments such as surgery, radiation etc which may result in harm.

Mortality from breast cancer has been declining over the last few years; some of this has been attributed to screening, but also to the major advances in treatment. The argument is made that patients diagnosed without screening will also likely survive breast cancer with modern day treatments.

However this generalization does not take into account that without awareness of screening and education as well as close relationship with a family physician or gynecologist many of these cancers may be diagnosed at a late stage leading to increased mortality once again from breast cancer. We have made too much progress to return to Ground zero. There should be a well thought out, individualized plan for each woman in conjunction with her Primary provider taking into account her risk and preferences. Mammography guidelines serve as a good template for such a tailored plan.