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Diarrhea or loose stools is mainly a potential side effect of sleeve gastrectomy with duodenal switch.Diarrhea may be seen with Roux-en-Y gastric bypass,but would not be associated with lap adjustable gastric banding.Post Duodenal switch( DS ),the usual alteration is soft or loose stools.Frank diarrhea is related to fatty acids directly passing into the colon which normally would have been absorbed in the small intestine.Once in the colon they induce irritation.It can also be due to relatively undigested food passing rapidly through the GI tract.A third contributing factor is sorbitol,found in fruits,berries and artificial sweeteners.In the colon it gets fermented.This causes increased gas and diarrhea .The number of loose stools after DS may vary from 2-3 upto 10--20 per day when it becomes really problematic and very inconvenient.Diet is a major influence on bowel movements after DS.Reducing the amount of fat will have a direct beneficial effect on the number and quality of bowel movements.Usually with close questioning some trigger type foods can be identified and avoided.
Both the DS and RNYGBP(Gastric bypass)may unmask previously unidentified lactose intolerance.An early step is to eliminate dairy products completely from the diet. Management of diarrhea(provided there is no identifiable pathologic or dietary factors)is varied.A dose of imodium at bedtime can reduce the early morning onset. If beneficial,some patients stay on a maintainance dose for long term control under doctors supervision.
Many patients may benefit from a course of probiotics.They are a form of natural colonic flora that is administered orally to restore the natural bacterial milieu towards a normal state.In any post operative patients with watery diarrhea,foul flatus and abdominal cramping the doctor may also consider clostridium difficile(c-diff)colitis or antibiotic associated diarrhea.

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Stress and Solutions Dr. SHriniwas Kashalikar
Even if we are prone to get dragged by the beast within us, and make life miserable for ourselves and the others, we still have potentials to blossom together; and they can be manifested!

Even as we are individuals and hence fallible; and make mistakes; we still have freedom to make efforts to be objective and accurate.

Even as we have limitations to our capacities, and are unable to achieve miraculous feats, we have freedom to make choices in terms of actions; from the options in front of us.

Even if it is true that the options available to us are depressing, degenerating, deteriorative, disastrous and destructive, we still have freedom to blossom through NAMASMARAN and make benevolent options available for ourselves, the people of the world and the subsequent generations.

This is exactly why I am writing this. I am convinced that; even as we are shackled in casual, petty, superficial, piecemeal and ad hoc approach on a variety of problems causing stress (and mismanage the stress); we still can develop holistic approach and work for individual and global blossoming and overcome stress! Some of the examples of how we can do this; in brief; (as the details are described in many books and articles; of mine and others); are as follows.

For health problems; our solution is; more hospital buildings, more gadgets and more equipments.

Actually we need a thrust on study, practice and training of Holistic health and Holistic medicine. For example training in NAMASMARAN, byhearting hymns from different languages, learning about the medicinal uses of common foods and herbs, yoga, pranayama etc.

For the lack of education; our solution is licensing more institutions and greater use of learning aids and stationary.

Actually we must emphasize on Holistic Education (One which includes development and training in spiritual and productive domains in addition to cognitive, affective and psychomotor domains)

For unemployment and beggars on the road; our solution is payment to unemployed people and anti–begging law.

Actually we require to eradicate; with priority; the causes of unemployment such as policies, which destroy the self employment and small scale and home industries (e.g. excessive production of water coolers, air conditioners, auto rickshaws etc) and restrictions on traditional jobs (such as pot making, cane work, circus and others).

For traffic jam our solution is; building more flyover bridges.

Actually we need to reinforce the public transport system and curb the production and import of private cars and two wheelers, besides taking adequate measures to reduce the movement of people from villages to cities.

It is true that stern actions must be taken against rule and law breakers. Discipline must be enforced. Condition of roads must be improved. But these steps have their limitations and can not be heavily depended on. In fact corruption, cutting of trees, congestion, chaos and crimes can multiply, besides pollution.

For suicides of farmers; our solution is subsidy package.

Actually the solution is; to resort to empower the farmers and reorient them from market oriented harvests to what can be called soil friendly and health friendly harvests. The farmers have to be reoriented to the traditional wisdom of culture, agriculture and organic farming. They have to be reminded of; the use of neem, cow urine, cow dung etc. What is required; in addition; is making; water and electricity available with topmost priority. The ban on slaughter of animals would go a long way in improving the farmers’ conditions.

For price rise; our solution is import.

The actual solution is; to ban all deceptive, aggressive and imposing advertisements, which create artificial demands leading to wasteful and luxurious economic (apparently pleasurable but effectively poisonous) activity in a small section of the society; leading to price rise; at the cost of the rest. For example; cold drinks, ice creams, fast foods, bars, restaurants, five star hotels, wines, alcoholic drinks, cosmetics and other luxuries are thriving but the vast majority is deprived of basic needs. In fact; the policy of production of and “marketing” for few, has to be reversed to; production and “exchange”; for the vast majority.

For socioeconomic backwardness; our solution is reservation policy.

Actually we require “productive and earn and learn” kind of education for all; so that unproductive unemployed and needy population would become empowered, productive, self sufficient and dignified in every way.

For the growing injustice and crimes; our solution is increasing the number of laws and police.

Actually we require simple and honest laws drafted in peoples’ language and understandable to people so as to discipline the people for their growth; and simultaneously remove all the laws, which were created to suppress and exploit the people by the previous alien rulers. We require policies by which the traditional and ethnic art, sports, cuisine, remedies and skills are NOT ALLOWED to be suppressed by the tactics of the exploitative and individualistic marketing culture. In fact in the interest of everyone, the concept of individual and global blossoming; which we call SUPERLIVING or Total Stress Management has to be universalized; to overcome the globally disastrous individualistic, exploitative globalization!

For so called “lack of progress”; our solution is more foreign investment.

Actually; we must define progress in terms of holistic health and restructure our policies in every field such as health care, agriculture, industry etc rather than stooping and surrendering to the culture of pettiness, glamour and glitter.

For shortage of electricity; our solution is load shedding.

Actually we are required to shift our priorities from “appeasing the exploitative and luxurious few”; to the “welfare of all”, by stern energy saving measures; coupled with development of pollution free, low cost, low investment alternative energy sources.

For road accidents; our solution is compulsion of helmets.

Actually the number of private vehicles on the road has to be reduced, the number of public vehicles has to be increased, the weekly offs have to be different and the working hours also have to be different so that most people do not travel at the same time. Moreover, the on campus or nearby residence has to be insisted as and when feasible. Most importantly, holistic education and rejuvenation of traditional jobs must be ensured so that the helpless and forced movement of people to the cities and the inhuman crowding of cities can be reduced.

For shortage of fuel; our solution is; generalized sermons to common people (who in no way consume fuel) to reduce fuel consumption.

Actually the fuel needs can be reduced if public transport in improved and the bicycles are promoted. There has to be shift of policies from development of airports; to the improvement in public transport and the infrastructure in the villages, such as solar energy, wind mills, gobar gas and such many, food storage etc.

We can cite hundreds of examples to show how we; by NOT going to the roots of the problems; work brilliantly and artistically but in a superficial and petty manner, with individualistic, fragmented, sectarian and divisive perspective, in misguided direction of increasing stress! Hence our work is rendered ineffective and/or counterproductive! Further our talents are drained in extremely selfish and cheap entertainment options such as gambling, drinking, casinos, prostitution etc.

All the solutions provided can possibly be modified, or refined in terms of details, because, they are not the solutions provided by experts from those fields. But they surely indicate the most essential core or the crux of the solutions. There could be many more holistic solutions also. All these can be cooperatively and complementarily implemented universally; if the third eye of cosmic consciousness is opened through the ways of self development; such as NAMASMARAN.

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The pill sized capsule passes naturally through your digestive tract transmitting video images to a data recorder worn on your abdomen for approx 8 hours.At the end of the procedure the recorder is removed so that the images can be put on a computer screen for the physician to review.
Most patients consider the test comfortable.The capsule endoscope is about the size of a large pill until it is excreted you should not be near an MRI device or schedule an MRI examination.Vigorous physical activity is not advised during tjhe study.
You will be able to drink clear liquids after two hours and eat a light meal 4 hours following the capsule ingestion unless your doctor instructs you otherwise.

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Capsule endoscopy lets your doctor examine the lining of the middle part of GI tract.Your doctor will give you a pill sized video camera to swallow.thats wierd isnt it?This camera has its own light source and takes pictures of your small intestine as it passes through and these are sent to a small recording sensor device which you wear on the outside of your body.
The most common reason for doing a capsule endoscopy is to search for the cause of bleeding from the small may also be useful for detecting polyps,IBD(Crohn's disease),ulcers and tumors of the small intestine.
An empty stomach allows for the best and safest examination.

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What is endoscopy?
Upper GI endoscopy or Gastroscopy is a procedure by which a flexibile tube, the thickness of a fountain pen is passed through the mouth into the food pipe and stomach.
It is always done on an empty stomach because presence of food in the stomach will interfere with good interpretation of the endoscopic findings. Moreover there may be chance of the patient aspirating food into the lungs during the procedure.

It is not painful when some local anesthetic spray is used in the throat. If you insist it can be done under a short genral anesthetic which of course is the most comfortable way of getting it done.

The duration of this procedure can be anything from 3 to 10 minutes. Pictures are taken for the records during the procedure. If necessary small bits of tissue will be taken for examination. This will be absolutely painless.

If not under an anaesthetic the procedure may cause discomfort and maybe breathlessness for a shortwhile.

One can start taking food an hour after an endoscopy. So if indicated or advised by your doctor donot hesitate or postpone your upper GI endoscopy.

Dr.Patta Radhakrishna
Surgical Gastroenterologist

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Nasal Rinsing for asthma, sinusitis, chronic nasopharyngitis, and cough
Nasal rinsing ( Jal Neti) has a long history amongst Yoga, meditation and breathing exercise enthusiasts. Many people consider routine nasal rinsing to be as much a part of their personal hygiene as teeth brushing and bathing. The constant exposure to air pollution, secondhand
smoke, breathing bacteria, and mucus-forming diets makes this form of personal hygiene particularly important today. I see a number of patients with asthma, chronic cough, frequent URT infections every day in Chennai. This simple procedure ( that costs nothing!) can provide huge relief & even eradicate mild conditions. Please share this with all your patients to breathe free to a healthy life.

Chronic low-grade infection in the nasal passages and sinuses is very widespread today. Japanese medical research has associated this with a wide range of health problems. Aside from the obvious respiratory system afflictions like sinusitis, chronic cough and asthma, nasopharyngitis affects the body through a number of mechanisms:

1. Chronic focal infection can eventually become systemic and cause inflammation and/or weakness of soft tissue (fascia, ligaments, tendons and muscles) throughout the body. Soft tissue dysfunctions as wide ranging as sciatica, neck pain, shoulder pain, TMJ, diaphragmatic
problems and fibromyalgia have been successfully treated in part or completely through long-term cleansing of the nasopharyngeal system.

2. Unresolved infection chronically stresses many of the coping mechanisms of the body, resulting in fatigue of and imbalances in the autonomic nervous system. For example, Physicians in Japan have successfully treated illnesses involving autonomic nervous system
imbalance such as essential hypertension and depression by resolving chronic nasal and sinus infection through the rinsing program described below.

3. Sinus congestion puts pressure on the sphenoid bone, which in turn can affect pituitary functioning and, with this, the entire hormonal system (the pituitary gland is one of the control towers of the body’s hormonal system).

At the very least, a routine nasopharyngeal rinsing program will provide you with improved sense of smell, improved sense of taste, a heightened clarity of thought, and increased sense of vitality.

Required Materials:
A Nasal Rinsing Device (dropper or netty pot), Bancha tea or echinacea and goldenseal combination, sea salt.
Preparation of Nasal Rinsing Solution:

Prepare a rinsing solution with a pinch of sea salt for every quarter of a cup of strong green tea (Bancha tea).

The point is to create

a hypertonic solution so that water does not cause swelling of the tissues. Salt content can be adjusted, as you become familiar with the procedure. Bring the solution to body temperature, by cooling it or mixing in some cold water.

The Rinsing Procedure:
- Fill the nasal rinsing device with the solution.
- Hang your head over a bathtub or sink.
- Place your thumb over the large hole on the rinsing device.
- Rotate your head 90 degrees to the right.
- Plug your left nostril.
- Insert the tapered hole of the device into your right nostril.
- Release your thumb from the large hole.
- Allow the solution to drain by gravity (do not inhale) into your nose.
- The solution will eventually work its way to the back of your throat (this may not occur the first time, but when it does, spit the
solution out)
- Perform this procedure with at least two rinsing device volumes through each nostril.
- After each volume, gently blow out through the rinsed nostril to expel loosened material (plugging the opposite nostril while you do this)
Frequently Encountered Problems / Concerns:
Depending on how congested your system is, you may find it takes several times before the procedure runs smoothly. It may take several times before encrusted material is moistened and dislodged. Do not force things. Be patient.

The rinsing procedure may produce uncomfortable burning sensations and headaches the first few times you try this. You may need to adjust the salt content. You may need to ensure you are not using chlorinated tap water. But be patient. After a few days, these problems will pass and you will be on to a brighter and clearer experience. Do not stop at the first signs of discomfort.
You can perform this with water and sea salt but the green tea is found to have an antibacterial effect. Some people also use 10-15 drops of Echinacea tincture (or equal proportions of Echinacea, Goldenseal and Dandelion) with the sea salt.

It is important to eventually run the solution through your nostril to the back of your throat.
It is important not to inhale when allowing the solution to drain into your nostril by gravity.
To obtain lasting and maximum benefit, it is very important to commit to this procedure 4-5 times a week for up to 2 months at a time

Some additional information for Doctors


Traditionally, the upper respiratory system is the first system in the body to be attacked by external pathogenic factors. These “attacks” will mostly present as ENT (ear, nose throat)
infections, acute common colds and/or the flu. If the pathogenic factor is not treated, it may proceed and invade the inner layers of the body, influencing and disturbing all systems1. In some cases, when the invading pathogenic factor is not sufficiently treated, the patient may appear healthy from a symptomatic point of view but some pathogenic bacteria, virus and/or
fungi may remain alive and they will reside in a hidden location which the initial (sometimes partial) treatment did not reach. This focal infection2 can reside in the body for years, weaken the immune system and erupt every time the body is stressed and/or weakened. In this case,
the upper respiratory system (usually the sinuses, oropharynx and the nasopharynx) may be the
origin of many systemic disturbances.

Upper respiratory system disorders may be caused by and, in turn, cause a multitude of systemic imbalances. For example, the liver may be disturbed by a chronic cough or visa versa;
a swollen liver pressing against the diaphragm might cause a chronic cough. Before treating
specific points for disorders such as asthma, cough or sinus infections, one must find and treat
the underlying causes for the upper respiratory system weakness. Often this weakness stems from the nasopharynx.

According to Shinsaku Horiguchi, M.D., Ph.D. the chronic disturbance of a latent (or hidden) infection at the nasopharynx may cause a multitude of local and systemic problems such as asthma, dermatitis, allergic rhinitis, autonomic nervous system disturbances as well as digestive system disorders, etc.
The chronic swelling of the nasopharyngeal lymph
nodes (pharyngeal tonsil) may press against the first
and second vertebrae (Illustration 67) and cause neck
and shoulder pain as well as chronic headaches,
problems with the upper limbs, etc.

This chronic swelling may also cause an exhaustion of
the immune system resulting in recurring episodes of
common cold and the flu as well as recurring sinus and
ear infections.

Deviation of nasal septum - This condition may be one
of the causes of chronic nasopharyngitis as well as
create a susceptibility to recurring sinus infections
(which, in turn, weakens the immune system).


The nasopharyngeal rinsing is a very effective method to eliminate the focal infection and the disturbance field associated with it. This physical treatment of the nasopharynx washes pollutants, pollen, bacteria as well as fungus away and keeps the tonsilar tissue in this area from swelling as well as reduces the possibility for infections. Dr. Horiguchi used to cauterize the
nasoparynx with special instruments dipped into a solution of 1% ZnCl. He used two procedures
for this cauterization, one entering through the nasal cavity and the second through the mouth. In
an acupuncture practice, a sea salt, echinacea and golden seal mixture or a sea salt and Bancha
tea mixture are recommended. The proportions are as follows: In a 1/4 glass of luke-warm water,
one pinch of sea salt should be mixed with ten to fifteen drops of echinacea and goldenseal
tincture8 (one can also use an equal mixture of Echinacea, Goldenseal and Dandelion). A quarter
glass of strong Bancha tea with a pinch of sea salt mixed in it can be used as well.
A dropper full of the above-described mixture should be inserted into the nostril while keeping the head up so that the solution can run through the nose into the throat (Illustration 68). Once the solution is in the throat the patient should spit it out.
Two droppers full are used in each nostril, twice a day. The patient should be reminded that it is very important for the fluid to pass through the nose into the throat.
The following page is an example instruction sheet given to patients who should be on the nasopharyingeal rinsing protocol.
Shinsaku Horiguchi, M.D., Ph.D., used a special instrument to reach the nasopharyngeal area (Illustration 69). His treatments consisted of swiping the nasopharynx with a 1% zinc chloride solution. He would treat a patient twice or three times a week for several weeks until the symptoms associated with chronic nasopharyngitis would disappear.

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Dear friends,
I would like to bring to your notice that if you have any query for antenatal counselling and prognosis of fetal anomalies,kindly write to me. I wil get back to you.
Tk care

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Dyspahiga or difficulty in swallowing
Dysphagia or difficulty in swallowing is another common complaint often seen in gastroenetrological practice. It can be very mild and transient but it can be severe and persistent. Odynophagia is painful swallowing.

Transient dysphagia is often seen in throat disorders like tonsillitis and pharyngitis but these conditions may also have odynophagia, fever, redness of throat , hoarseness at times and fairly easy to diagnose and treat and a ENT consult is necessary.

Commonest cause of dysphagia is reflux esophagitis. This is a condition associated with heartburn where contents of the stomach and acid regurgitates back into the food pipe due to a faulty valve between the food pipe and stomach. This is usually transient and settles down with postural treatment and drugs.

Another group of disorders of the food pipe called the motility disorders can also cause dysphagia, some of them of a severe variety called the achalsia of the cardia. These are diagnosed by the esopgaeal manometry and respond well to medication .Some of them like achalsia may require surgery.

The most dreaded condition causing dyasphagia is cancer of the food pipe, fairly frequent in India especially among smokers and this will require advanced tests, surgery and maybe chemotherapy or radiotherapy .

So dysphagia is yet another important digestive symptom which should not be ignored and will require a specialist consultation and endoscopy if persistent.

Dr.Patta Radhakrishna
Surgical Gastroenterologist

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Stress and Acting
One of the possible objections to the idea of global consensus on international welfare policies; is that; this could jeopardize the regional peculiarities and regional honor; especially in creative and artistic fields.

But this fear or apprehension is uncalled for; as the consensus is meant for; clear cut universal issues and not anything that would come in the way or suppress regional or even individual characteristics and pride (if they do not harm the society).

Further, the NAMASMARAN and the associated universal perspective can not be “wished away”! The days have come; when NAMASMARAN i.e. remembering the name of God i.e. true self; would be joyously practiced in every house of every religion or ideology and the consensus of global welfare is bound to materialize further and worldwide; from here onwards. There is no other way of Total Stress Management i.e. individual and global blossoming.

It has been the practice to talk more, write more, profess more and practice less with respect to NAMASMARAN, self realization and its expression in different walks of life, especially politics! But, it is necessary to talk, write and profess also; the NAMAMSARAN and its implications on global welfare, because of the worldwide glamorization, glorification and hype of antisocial ideas and passive support to it by the confused (oblivious) elements.

The talking, writing, preaching and promoting NAMSMARAN is urgent because we are otherwise intoxicated by the talks, writing and professing on glamour, glitter, manipulating, maneuvering, conspiring etc as is in films and showbiz and party politics (falsity)!

We the common people are dominated by every kind of acting; whether on podium, stage or pulpit!

We must practice and promote NAMASMARAN much more, so that acting of the stars can not delude us, acting of the models can not stupefy us, acting of the politicians can not cheat us and our own (common people’s) acting (adopted feelings and behavior) can not distract us away from the process of individual and global blossoming!

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Stress and Blessing
Some years back “stress” was not heard of. We were never taught “stress” in our undergraduate and postgraduate medical curriculum.

In contrast, these days everybody is talking about or rather hyping the “stress”. In stead of identifying and healing the stress like any other problem, the “stress” is being used as a weapon to threaten and exploit us. The so called Stress Management experts, godmen and godwoman are mercenarily selling and “pumping in” and “forcing down” the so called “stress relaxation and stress management” full of false promises; through our throats!

In stead of providing holistic solutions, hollow sermons and impotent advices are being poured!

Actually stress is normal and inseparable part and a hallmark of life. It is a physio-gnomonic symptom of life! In other words; presence of stress indicates normalcy and liveliness. If we don’t have stress, it means we are dead!

Stress is like fire; if not managed (channelized) properly it can burn us and if managed (channelized) properly it can enliven and enlighten us! But if it is absent then we are cold, clammy and dead.

When we are stressed we go to godmen god women and counselors and long for blessings or advices. They give blessings and advices.

The meaning of the word BLESSING and KALYAN; incorporates simultaneous blossoming of an individual and the universe. It incorporates every development and gain that helps in such blossoming. The blessings are not just wishes given for our mere monetary profit or some such mundane gains; they are meant for fulfillment in our life. They are meant for the holistic blossoming of us and the society!

However many of us think that our stress would go away if we get material gains as often promised by mercenary “stress management experts” and "godmen and godwomen” . So we expect their “blessings” to provide petty gains and when we don’t get those gains, suffer miserably.

If a godman/godwoman (or any one whom we approach for relief from stress) is properly trained and adept in stress management he/she would never give false promises and/or guarantee. He/she would know how to bless you and also actually catalyze your blossoming and fulfillment in life. Hence if we are free from petty expectations, it would help us gain more from the blessings and protect us from bogus stress management professionals or godmen; who guarantee and promise many things other than holistic fulfillment!
If we practice NAMASMARAN, it can help us grow stronger and immune to the basal temptations of deceiving and exploiting as well as getting deceived or exploited.

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