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Category : All ; Cycle : February 2013
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About twenty years ago I had sent a working hypothesis (a guesswork or conjecture) to a medical journal. In that hypothesis I had suggested stress as a root cause; in essential or idiopathic hypertension and ischemic heart diseases (apart from many others). By the use of word “stress” I imply mismanagement of stress; as stress is universal and ubiquitous.
The hypothesis was rejected as baseless.
Today I wish to reiterate that hypothesis; in this article for free download; so that everyone can read and decide if it makes sense or not.
The hypothesis is:
1. The cholesterol, triglycerides and chemicals in blood called risk factors for ischemic heart disease and blood pressure; increase due to acute and/or chronic over activity of sympathetic nervous system; due to acute or chronic stress; respectively. Hence the root cause of ischemic heart disease and essential (idiopathic) hypertension; is stress.
2. The root cause of spasms in coronary (heart) blood vessels is also acute and/or chronic over activity of sympathetic nervous system; due to acute or chronic stress.
3. The root cause of constriction of the vessels of kidneys resulting in increase in rennin angiotensisn activity and subsequent increase in blood pressure and is also (in most cases); often (unnoticed) stress.
4. The root cause of atherosclerosis; is due to the increased friction and mechanical damage and roughening of the constricting vessels; especially arterioles. As the constriction is due to over activity of sympathetic nervous system; the commonest cause of which is acute and/or chronic stress; the root cause of atherosclerosis also; in most cases; is stress.
5. It is agreed that some people would be genetically more prone to stress and subsequent ischemic heart disease and blood pressure. But that does not disprove or even create a doubt about the hypothesis of stress as a root cause of bad lipids, spasms and atherosclerosis and subsequent ischemic heart disease and essential (idiopathic) hypertension; as genetic predisposition and stress; are not mutually exclusive.
6. We can apply common sense and reason out; how stress can disturb the metabolic, endocrine, neuroendocrine, autonomic nervous and central nervous activities and influence various tissues including heart vessels and other blood vessels in body.
7. It is important to remember that stress is often subconscious, during sleep and even during embryonic life and hence goes unnoticed.
8. In short; the first line preventive as well as healing measure (treatment) for ischemic heart disease and essential hypertension (and several other diseases mentioned in my book on Total Stress Management); is learning and practicing Total Stress Management.
9. What is Total Stress Management?
It is a process of continuous evolution in cognition, affect and conation; i.e. perception, feelings and behavior. This is a natural (but not arbitrary) and accentuated blossoming; from inaccuracy and inappropriateness to accuracy and appropriateness; without any regimentalization.

In philosophical and spiritual literature (Jnaneshvari also called Dnyaneshvari) this is called a stepwise process of self realization or KRAMA (stepwise) YOGA. NAMASMARAN (JAP, JAAP, JIKRA, SUMIRAN, and SIMARAN i.e. remembering and reorienting to the true self) is acclaimed to be universally and unconditionally helpful in this process. Apart from the study of physiology, pathophysiology, statistical surveys, clinical studies, experimental work; the verification of this hypothesis is essentially through the practice of NAMASMARAN.

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Multiple Sclerosis
Multiple sclerosis (MS) is a disease affecting nerves in the brain and spinal cord, causing problems with muscle movement, balance and vision.
Each nerve fibre in the brain and spinal cord is surrounded by a layer of protein called myelin, which protects the nerve and helps electrical signals from the brain travel to the rest of the body. In MS, the myelin becomes damaged.
This disrupts the transfer of these nerve signals, causing a wide range of potential symptoms, such as:
Loss of vision – usually only in one eye
Spasticity – muscle stiffness that can lead to uncontrolled muscle movements
Ataxia – difficulties with balance and co-ordination
Fatigue – feeling very tired during the day
Types of multiple sclerosis
Around 8 out of 10 people with MS will have the relapsing remitting type of MS.
Someone with relapsing remitting MS will have periods of time where symptoms are mild or disappear altogether. This is known as remission and can last for days, weeks or sometimes months.
Remission will be followed by a sudden flare-up of symptoms, known as a relapse. Relapses can last from a few weeks to few months.
Usually after around 10 years, around half of people with relapsing remitting MS will go on to develop secondary progressive MS.
In secondary progressive MS, symptoms gradually worsen and there are fewer or no periods of remission.
The least common form of MS is primary progressive MS. In this type, symptoms gradually get worse over time and there are no periods of remission.
There is currently no cure for MS but there are a number of treatments that can help.
Relapsing remitting MS and secondary progressive MS can be treated with disease-modifying drugs. These are designed to slow the progression of the disease and reduce the number of relapses. But they are not suitable for all people with MS.
For example at the moment, there is no treatment that can slow the progress of primary progressive MS.
There are also a wide range of treatments, including steroid injections and physiotherapy, that can help relieve symptoms and make day-to-day living easier.
MS is known as an autoimmune condition. This is where something goes wrong with the immune system (the body’s defence against infection) and it mistakenly attacks healthy body tissue – in this case, the myelin covering of nerves.
This can cause multiple sections of the brain and spinal column to become damaged and hardened (sclerosis), which can disrupt the nerve signals passing through these areas.
Exactly what causes the immune system to act in this way is unclear, but most experts think a combination of genetic and environmental factors are involved.
Who is affected
Symptoms usually first develop between the ages of 15 and 45, with the average age of diagnosis being about 30.
For reasons that are unclear, MS is twice as common in women than men, and more common in white people than black and Asian people
MS can be a challenging and frustrating condition to live with but new treatments over the past 20 years have considerably improved the quality of life of people with the disease.
MS is not fatal, but some complications which can arise from more severe MS, such as pneumonia, can be.
As a result, the average life expectancy for people with MS is around 10 years lower than the population at large.
Symptoms of multiple sclerosis
The central nervous system (brain and spinal cord) controls all of your body's actions. When MS damages the nerve fibres that carry messages to and from your brain, symptoms can occur in any part of your body.
There are many different symptoms of MS and they affect each person differently. Some of the most common symptoms include:
Numbness and tingling
Blurring of vision
Problems with mobility and balance
Muscle weakness and tightness
Most people with MS only have a few of these symptoms and it is unlikely someone would develop all possible symptoms.
The symptoms are unpredictable. Some people's MS symptoms develop and increase steadily over time, while for others, they come and go periodically.
Periods when symptoms get worse are known as relapses. Periods when symptoms improve or disappear are known as remissions.
Visual problems
In around one in five cases of MS, the first noticeable symptom is problems with one of your eyes. You may experience:
Some loss of vision in the affected eye – this can range from mild to severe (total loss of vision occurs in 1 in 35 cases)
Colour blindness
Eye pain; usually made worse when moving the eye
Flashes of light when moving the eye
These symptoms are the result of optic neuritis, which is inflammation (swelling) of the optic nerve that transmits visual information to the brain. This normally only affects one eye.
Other visual problems that can occur in MS include:
Double vision
Eye pain in both eyes
Involuntary eye movements (usually from side to side), known as nystagmus
Abnormal sensations
Abnormal sensations can also be a common initial symptom of MS. This can take the form of numbness or tingling in different parts of your body.
Muscles in your arms and legs may also feel unusually weak.
Muscle spasms and spasticity
MS can damage nerve fibres in your brain and spinal cord, which can cause muscles to contract tightly and painfully (spasm). Your muscles may also become stiff and resistant to movement, which is known as spasticity.
Around half of people with MS experience pain, which can take two forms:
Neuropathic pain – caused by damage to the nerve fibres in the brain and spinal cord. It can be a stabbing pain, extreme skin sensitivity, or a burning sensation.
Musculoskeletal pain – this is not caused directly by MS, but can occur if there is excess pressure on muscles or joints as a result of spasms and spasticity.
Mobility problems
MS can affect balance and co-ordination. It can make walking and moving around difficult, particularly if you also have muscle weakness and spasticity. You may experience:
Ataxia – difficulty with co-ordination
Tremor – shaking of the limbs, which is rare, but can be severe
Dizziness and vertigo can happen late on and can make you feel as if your surroundings are spinning
Extreme tiredness (fatigue)
Feeling extremely tired (fatigue) is a common symptom of MS that many people describe as one of the most troublesome.
It is estimated as many as 9 out of 10 people with MS will experience episodes of fatigue.
People with MS have reported feeling an overwhelming sense of weariness where even the most simple physical or mental activity seems to be a tremendous struggle to carry out.
Fatigue may be worse in hot weather, after exercising, or during illness.
Problems with thinking, learning and planning
Around half of people with MS have problems with thinking, learning and planning (known as cognitive dysfunction) in the early stages of the disease. They may experience:
Problems understanding and using language
A shortened attention span
Problems learning and remembering new things (long-term memory is usually unaffected)
Problems understanding and processing visual information, such as reading a map
Difficulty with planning and problem solving – people often report that they know what they want to do, but can’t grasp the method of how to do it
Problems with reasoning, such as mathematical laws or solving puzzles
Mental health issues
Around half of all people with MS experience at least one episode of depression at some point in their life.
It is unclear whether the depression arises from the damage to the brain caused by MS, or due to the stress of having to live with a long-term condition, or both.
Anxiety can also be a problem for people with MS, especially during the start of a relapse, as they are naturally anxious about the return of their symptoms.
Some people with MS can sometimes experience rapid and severe mood swings, suddenly bursting into tears, laughing or shouting angrily for no apparent reason.
Many people with MS lose interest in sex.
Men with MS often find it hard to obtain or maintain an erection (erectile dysfunction). They may also find it takes a lot longer to ejaculate when having sex or masturbating, and may even lose the ability to ejaculate altogether.
Women may find it more difficult to achieve orgasm.
Bladder problems
Bladder problems are common in MS.
These may include:
Difficulty emptying the bladder completely
Having to urinate more frequently
Having a sudden, urgent need to urinate which can lead to unintentionally passing urine (urge incontinence)
Having to get up frequently during the night to pass urine (nocturia)
Constipation affects around half of people with MS. They may pass stools much less frequently than normal, and find this difficult.
Severe constipation can lead to faecal impaction, where a large, solid stool becomes stuck in the back passage (rectum) and begins to stretch the muscles of the rectum, weakening them. This can cause loss of normal bowel control (bowel incontinence), where watery stools leak out.
Causes of multiple sclerosis
Multiple sclerosis (MS) occurs because of damage to the nerve fibres of the central nervous system. Your central nervous system consists of the brain and spinal cord and is responsible for controlling every action, conscious and unconscious, of your body.
When you perform an action, your brain sends messages to the appropriate part of your body through the nerve fibres in your spinal cord. These nerve fibres are covered by a substance called myelin. Myelin insulates the nerve fibres and helps carry messages to and from your brain quickly and smoothly. In MS, the myelin around your nerve fibres becomes damaged. This disturbs the messages coming to and from your brain.
Autoimmune condition
MS is an autoimmune condition. This means your immune system mistakes the myelin for a foreign substance and attacks it. The myelin becomes inflamed in small patches (called plaques or lesions), which can be seen on an MRI scan. This process is called demyelination.
Demyelination disrupts the messages travelling along nerve fibres. It can slow them down, jumble them, accidentally send them down a different nerve fibre, or stop them from getting through completely.
When the inflammation goes away, it can leave behind scarring of the myelin sheath (known as sclerosis) and sometimes damage to the underlying nerve cell.
Why do people develop multiple sclerosis?
It is not understood what causes the immune system to attack myelin, although there are several theories. Most experts agree that MS is probably caused by a combination of genetic and environmental factors. This means it's partly due to genes you inherit from your parents and partly due to outside factors that may trigger the condition.
Genetic factors
MS is not defined as a genetic condition because there is no single gene that causes it. It's not directly inherited, although research has shown people who are related to someone with MS are more likely to develop it.
Researchers have found that if one twin develops MS then the second twin has around a one in four chance of also developing MS.
The chances of a brother, sister, or child of a person with MS also developing MS themselves is less than 1 in 30.
It's possible that different combinations of genes make developing MS more likely, and research into this is continuing. However, genetic theories cannot explain the wide variation in occurrences of MS throughout the world.
Sunlight and vitamin D
Research into MS around the world has shown that it's more likely to occur in countries far from the equator. For example, MS is relatively common in the UK, North America and Scandinavia, but rare in Malaysia or Ecuador.
It’s possible that people living further from the equator are exposed to less sunlight and, therefore, have less vitamin D in their bodies. Some studies have found a link between lower levels of vitamin D and incidence of MS.
Some researchers have suggested that vitamin D supplements may reduce the risk of MS. However, this has not been proven.
Viral infection
Another theory is that MS may be the result of viral infection of the nervous system and /or the immune system.
The idea is that the virus lies dormant for many years and then periodically ‘re-awakens’, triggering an autoimmune response against the nervous system.
This could explain the relapse-remission nature of most cases of MS.
A virus called the Epstein-Barr virus (EBV) is known to act in this way, but there is currently no firm evidence that EBV, or any other virus, is responsible for MS.
Problems with blood flow
A new and controversial theory is that some cases of MS may actually be due to problems with the flow of blood inside the body.
The idea is that some people may have narrowing of veins inside their brain and spinal cord and the blood supply from the brain and spine has trouble returning to the heart (known as cerebrospinal venous insufficiency).
This could lead to a build-up of tiny iron deposits inside nerve tissue, which may damage the nerves and /or trigger an immune response.
Some studies have found higher-than-expected levels of cerebrospinal venous insufficiency in people with MS, but others have not.
Further research is ongoing looking at larger groups of people and using more sophisticated brain imaging scanning.
Diagnosing multiple sclerosis
If you have unexplained symptoms that are similar to those of multiple sclerosis (MS), see Dr. B C Shah. If Dr. B C Shah suspects MS, they will ask you for a detailed medical history, including past signs and symptoms as well as the current state of your health.
Dr. B C Shah can refer you to a neurologist (a specialist in conditions of the central nervous system).
If Dr. B C Shah suspects MS, you should see a neurologist within six weeks.
Diagnostic tests
Diagnosing MS is complicated because no single laboratory test can positively diagnose it.
Several conditions have symptoms similar to those of MS, so your neurologist may rule them out first.
It may also not be possible to confirm a diagnosis if you have had only one ‘attack’ of MS-like symptoms. A diagnosis can usually only be made with confidence once a person has a relapse (return of symptoms).
To confirm MS, your neurologist may carry out a number of tests.
Neurological examination
Your neurologist will look for changes or weakness in your eye movements, leg or hand co-ordination, balance, speech and reflexes. This will show whether your nerve pathways are damaged.
Magnetic resonance imaging (MRI) scan
An MRI scan creates a detailed image of your brain and spinal cord.
MRI scans can show whether there is any damage or scarring of the myelin in your central nervous system. Over 9 out of 10 people with MS are diagnosed using an MRI scan.
The procedure is painless and usually takes between 10 and 30 minutes. A standard MRI scanner is like a giant tube or tunnel. You may feel claustrophobic when going into the tunnel and the machine is noisy.
Tell your neurologist if you have any concerns about this experience.
Evoked potentials test
An evoked potentials test involves placing small electrodes on your head. These monitor how your brain waves respond to what you see and hear. It is painless and can show whether it takes your brain longer than normal to receive messages.
Lumbar puncture
A lumbar puncture is also sometimes called a spinal tap. A sample of your cerebrospinal fluid (the fluid that surrounds your brain and spinal cord) is taken using a needle inserted into the area around your spinal cord.
This is done under local anaesthetic, which means that you will be awake but the area that the needle goes into will be numbed. The sample is tested for antibodies, the presence of which means that your immune system has been fighting a disease in your central nervous system.
A lumbar puncture is usually only needed if other tests for MS are inconclusive.
Blood tests
Blood tests are usually performed to rule out other causes of your symptoms, such as vitamin deficiencies. In addition, antibody tests may be required, for example to rule out a special type of MS called Devic's disease.
Diagnosing the different types of multiple sclerosis
Once a diagnosis of MS has been made, your neurologist may be able to identify which type of MS you have.
However, this often only becomes clear over time as the symptoms of MS are so varied and unpredictable.
A diagnosis of relapsing remitting multiple sclerosis (RRMS) may be made if:
You have two relapses of your symptoms more than 30 days apart
You have one relapse and an MRI scan shows new myelin damage or scarring three months later
A diagnosis of secondary progressive multiple sclerosis (SPMS) may be made if:
You have had relapses of your symptoms in the past
You have become steadily more disabled for at least six months, with or without relapses
A diagnosis of primary progressive multiple sclerosis (PPMS) may be made if you have had no previous relapses of your symptoms, and:
You have become steadily more disabled for at least one year
An MRI scan shows damage and scarring to myelin
a lumbar puncture shows antibodies in the fluid surrounding your brain and spinal cord
Treating multiple sclerosis
Multiple sclerosis (MS) is a complex disorder that can impact on many aspects of your life so you will need to receive treatments from Dr. B C Shah and his team working together.
Members of your care team may include:
A neurologist (a specialist in treating conditions that affect the nervous system)
A physiotherapist
A speech and language therapist
An occupational therapist
An incontinence adviser
A psychologist
A pharmacist
A specialist MS nurse who will often serve as a point of contact
Living with multiple sclerosis
A diagnosis of MS is life changing. You may need long-term treatment to control your symptoms and you may have to adapt your daily life.
Self-care is an integral part of daily life. It means you take responsibility for your own health and wellbeing, with support from people involved in your care. Self-care includes the things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions. People living with long-term conditions can benefit enormously if they receive support for self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life, and be more active and independent.
Regular reviews
Because MS is a long-term condition, you'll be in regular contact with your healthcare team. A good relationship with the team means you can easily discuss your symptoms or concerns. The more the team knows, the more they can help you.
Keeping well
Everyone with a long-term condition such as MS is encouraged to get a flu jab each autumn to protect against flu (influenza). It's also recommended that they get an anti-pneumoccocal vaccination. This is a one-off injection that protects against a specific serious chest infection called pneumococcal pneumonia.
Healthy eating and exercise
Regular exercise and a healthy diet are recommended for everyone, not just people with MS. They help prevent many conditions, including heart disease and many forms of cancer. Try to eat a balanced diet, containing all the food groups, to give your body the nutrition it needs. Exercising regularly can help relieve stress and reduce fatigue.

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Is gallstone removal done by laser?
Everyone seems to be offering "Laser surgery" for Gall bladder. Is laser really used?
A young unmarried girl in her early twenties came to me with ultrasonography report of multiple stones in her Gall Bladder. After listening to her complaints, I examined her. I went thro the reports and gave my opinion – she requires removal of her gall bladder (Cholecystectomy). The first question her father asked, "Will this be removed by laser or surgey?". Her mother got up from chair indicating that she was not interested and said, "My daughter is unmarried and we want only laser to be done"
So this is a common misconception – Laser for Gall bladder stones.
It is a very funny misconception that many patients have that the gallbladder is removed by a laser. The gall bladder is removed only by two techniques open surgery or by laparoscopy. Practically no where in the world is laser is used for removal of gall bladder. I have spend many months in world renowned hospital in New York – Mount Sinai Hospital. I never evenheard of laser for Gall bladder.
When I replied to the parents that I do not use laser for gall bladder removal, they looked confused. Father replied, "We came here because we have heard lot of good reviews about you and this hospital. Our family physician had send us to ****** hospital. The surgeon there told me that he will perform laser removal of Gall bladder. We came to this hospital because we thought this is a bigger hospital and hence you will have better facilities."
This is Laser misconception has been created by the surgeons and used as a very effective marketing & money making tool. I saw the previous surgoen's case paper. He had scribbled an estimate that was nearly twice that of our hospital. Forget about the laser, that hospital does not even have standard laparoscopic instruments.
I made her parents come closer to my desk and showed them on internet about the standard gold standard procedure used for gall bladder removal – Laparoscopic cholecystectomy and made it very clear to them that there is no laser used in the surgery.
Subsequently I operated her and after a week she was back to her college.
Surgeon might be using the word "Laser" in their practice for following reasons:
To indicate that the surgery is hi-tech
To make patient feel that he is offering them something unique
To charge patients more
I have been performing Laparoscopies since 1994 and have attended many international hospitals and conferences. Its a perfect example where science has been used for reducing the trauma of open surgery. Patient just has a small cut in the belly button and 2 or 3 very small cuts instead of an incision of 10 – 20 cms length required in open surgery. In my early residency days I have seen the patients suffer after the open surgery and I can clearly see great benefit that Laparoscopic surgery offers. Although it requires a much more skill its really worth it. The hospital stay is less, pain is less, scar is negligible & the cost is nearly the same as open surgery.
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Suddenly in the New Year celebrations the noise changed into whispers and loud discussions.

The news had taken everybody by surprise.

Someone had noticed God Himself sitting on a nearby hillock.
All of them agreed that this was a wonderful opportunity and great boon to meet Him personally.

As they were approaching Him; someone said; “We always pray and put forth our demands and desire to God! But won’t it be wiser to ask Him; His desire?”

Even though it was unusual; ultimately all agreed on this point.

As they reached God; they prostrated in front of Him and saluted in their different ways!

As God asked them to tell what they wanted; all of them unanimously said; “This time; we have come to fulfill; NOT our desire; but your desire!

God laughed!

He said; “Thinking this way; is a great achievement! You have come closer to me! Actually ‘my desire’ operates through you as ‘your desire’; even if you are unaware of it!! Your awareness and concern about ‘my desire’ is also my desire! My desire is self sufficient and omnipotent! Instantly it becomes a reality!
In this New Year and the years to come; the practice of remembering me i.e. remembering your true self (called jikra, jaap, jap, sumiran, simaran, NAMASMARAN) would spread in all the continents, nations, provinces, cities, villages, homes, institutions, industries, hospitals, farms and every nook and corner.

Further; this practice would not be aimed at petty gains! It would be selfless and blossom into holistic perspective, policies, plans and programs and their implementation! The spiritualism and materialism, theism and atheism would be culminated in holistic renaissance, superliving or individual and universal blossoming! The profundity and prosperity would go hand in hand!
Individualism and socialism would be culminated in; Self realization and SAMSHTI YOGA; respectively!”

The people were thrilled to hear all this!

However; one of them, who was very curious to know; how this could happen; asked; “But how would all this happen?”

God said; “Just as 75 trillion cells unite and live in unity, complementarity and harmony; where; every cell participates in its own well being and also homeostasis i.e. well being of the individual; every individual; from every nook and corner of the world; would participate simultaneously and inseparably; in his own well being as well as that of the universe!”

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

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sex and pregnancy
If you want to get pregnant, you have sex. No surprises there. But what about sex while you're pregnant? The answers aren't always as obvious.
Here's what you need to know about sex during pregnancy.
Is it OK to have sex during pregnancy?
As long as your pregnancy is proceeding normally, you can have sex as often as you like — but you might not always want to.
At first, hormonal fluctuations, fatigue and nausea might sap your sexual desire. As your pregnancy progresses, weight gain, back pain and other symptoms might further dampen your enthusiasm for sex.
Your emotions might take a toll on your sex drive, too.
Concerns about how pregnancy or the baby will change your relationship with your partner might weigh heavily on your mind — even while you're eagerly anticipating the addition to your family. Fears about sexual activity harming the baby or anxiety about childbirth might team up to sap your sex drive. Changes in your self-image might play a role as well, especially as your pregnancy progresses.
Can sex during pregnancy cause a miscarriage?
Although many couples worry that sex during pregnancy will cause a miscarriage, sex isn't generally a concern. Early miscarriages are usually related to chromosomal abnormalities or other problems in the developing baby — not to anything you do or don't do.
Does sex during pregnancy harm the baby?
Your developing baby is protected by the amniotic fluid in your uterus, as well as the strong muscles of the uterus itself. Sexual activity won't affect your baby.
What are the best sexual positions during pregnancy?
As long as you're comfortable, most sexual positions are OK during pregnancy.
As your pregnancy progresses, experiment to find what works best. Rather than lying on your back, for example, you might want to lie next to your partner sideways or position yourself on top of your partner or in front of your partner.
Let your creativity take over, as long as you keep mutual pleasure and comfort in mind.
What about oral and anal sex?
Oral sex is safe during pregnancy. If you receive oral sex, though, make sure your partner doesn't blow air into your vagina. Rarely, a burst of air might block a blood vessel (air embolism) — which could be a life-threatening condition for you and the baby.
Generally, anal sex isn't recommended during pregnancy. Anal sex might be uncomfortable if you have pregnancy-related hemorrhoids. More concerning, anal sex might allow infection-causing bacteria to spread from the rectum to the vagina.
Are condoms necessary?
Exposure to sexually transmitted infections during pregnancy increases the risk of infections that can affect your pregnancy and your baby's health.
Use a condom if:
Your partner has a sexually transmitted infection
You're not in a mutually monogamous relationship
You choose to have sex with a new partner during pregnancy
Can orgasms trigger premature labor?
Orgasms can cause uterine contractions, but these contractions are different from the contractions you'll feel during labor. Orgasms — with or without intercourse — aren't likely to increase the risk of premature labor or premature birth.
Similarly, sex isn't likely to trigger labor even as your due date approaches.
Are there times when sex should be avoided?
Although most women can safely have sex throughout pregnancy, sometimes it's best to be cautious.
Your health care provider might recommend avoiding sex if:
You have a history of preterm labor or premature birth
You have unexplained vaginal bleeding
You're leaking amniotic fluid
Your cervix begins to open prematurely (cervical incompetence)
Your placenta partly or completely covers your cervical opening (placenta previa)
What if I don't want to have sex?
That's OK. There's more to a sexual relationship than intercourse.
Share your needs and concerns with your partner in an open and loving way. If sex is difficult, unappealing or off-limits, try another type of contact — such as cuddling, kissing or massage.
After the baby is born, how soon can I have sex?
Whether you give birth vaginally or by C-section, your body will need time to heal. Many health care providers recommend waiting four to six weeks before resuming intercourse. This allows time for your cervix to close and any tears or a repaired episiotomy to heal.
If you're too sore or exhausted to even think about sex, maintain intimacy in other ways. Stay connected during the day with short phone calls, email messages or text messages. Reserve a few quiet minutes for each other before the day begins or while you're winding down before bed.
When you're ready to have sex, take it slow — and use a reliable method of contraception if you want to prevent a subsequent pregnancy.

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Love between; relations such as husband and wife, mother and baby; have always been the central themes of many great novels, plays, films, paintings, sculptures, dances, poetry etc. But in all these; love is also associated with treachery, cheating, hatred, dread and vengeance.

Why is this so?

This is because; this involuntary love and hate phenomenon; is a product of physiological, biochemical, psychological and social factors. Love and hate result from the involuntary autonomic, neuroendocrine, endocrine and metabolic activities. Such love and hate happens to most of us. It is not “done” by us.

This love and hate phenomenon determines our attitudes, predispositions, ideologies, behavior, consciousness and conscience. Through NAMASMARAN (JAP, JAAP, JIKRA, SIMARAN, SUMIRAN; i.e. remembering true self) this phenomenon blossoms into objective, unprejudiced and selfless love without hatred. It is like oxygen that enables and empowers us; to perceive the world more objectively and provide holistic solutions to individual and global problems.

This process of individual and universal blossoming; however; involves billions of us (as is being increasingly evident in many parts of world) and consumes us completely; to our satisfaction; and is not accessible to casual, superficial or mercenary approach!

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Guru: You may ask your question.

Disciple: My Lord, theoretically; I agree that all “my” prayers, "my" NAMASMARAN and “my” work; belong to you; as you are the soul; of “my" whole existence!

But practically; I am always ridden in stress; emerging from some unidentified, indefinite, and unknown source! It may be one or many things; ranging from my genotype, phenotype, metabolic activities, hormonal interactions, neurological events and psychological phenomena, including the changing; external (physical, chemical, biological, psychological, political, social, religious etc) atmosphere!

Sometimes I feel; that my stress; is a part of the pandemic of stress spread ubiquitously in the world; and hence; can be rectified through universalization of NAMASMARAN! But universalization of NAMASMARAN (and its potential); as well as; the anticipated or foreseen emergence of holistic renaissance; are “unending and never complete”! Hence; the idea of “complete rectification” of the pandemic of stress; is as illusory; as the pandemic of stress itself!

Being inseparable from this illusion; I am in stress and want to know whether stress management is a reality or illusion!

Guru: Indeed; your stress; is a part of the pandemic of stress spread ubiquitously in the world; and hence; you have to go through the practice and universalization of NAMASMARAN (and its potential); to usher in holistic renaissance, even if they are “never ending and ever incomplete” and hence appear illusory!
My dear friend! Stress is a magic of remembrance (NAMASMARAN) and forgetfulness (NAMAVISMARAN)! Being totally involved in NAMASMARAN; is total stress management; and being in NAMAVISMARAN to a variable extent; is being in stress! Through the process of practicing and promoting NAMASMARAN; and its benevolent and pivotal role; in holistic renaissance; at appropriate time; you will be totally involved; in NAMASMARAN (state of total stress management) and hence; zero NAMAVISMARAN (zero stress)!
Disciple: Thank you Master! Thank you very much!!

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Huge Hair ball in stomach
Father brings his 14 year girl with complaints that she is unable to eat, dull stomach pain and she is growing weak. I looked at this skinny girl. She appeared malnourished. Her height was shorter and she was thin for her age. I looked directly at her eyes but she was avoiding direct contact. I caught her hand to gain her confidence. I asked her some simple questions like her school’s name, etc. She initially was reluctant to answer but slowly she started to respond to my questions. During my course of discussion with her, I realized that she had lot of anger build up in her self. She was not dumb but was quiet smart. I made her lie on the examination cot. I saw that she suffered from malnutrition and vitamin deficiencies. I put my hand on her thin tummy to feel her inside organs. I found that she had a hard lump in upper part of her abdomen. The lump was large and relatively mobile. Besides the blood investigations, I specifically ordered for an ultrasound of her abdomen.
Father – daughter came back with reports next week. The sonologist found a large mass in her stomach. It was so large that it was filling up her stomach completely. I was feeling sorry for this girl – she was surely in trouble. I asked her father to get her CT scan done. He was reluctant. He said he did not have enough money. He had four children and he was the sole bread earner. Also, he was worried about the treatment cost. I assured him that I will try my best to assist him in his difficult financial situation. I advised him to get her CT scan done in a Government hospital and gave him all necessary directions.
A week latter they came back with the CT scan report. The child seem not happy with me as I had made her undergo a major test. Poor child. She stay in Mumbai slums. She was small and skinny. She had to sleep on the CT scan gantry in a cold environment with a big hi-tech machine going over her. The CT scan confirmed my diagnosis – a huge hair ball in her stomach. It was so big that it was not only occupying her whole stomach but distended it so much that it appeared that she had a big feast! Now how did such a huge collection of hair occur in her stomach? The hair ball in stomach was ten times larger than the amount of hair that she had on her head! I took his father in confidence and asked her about her behavior. He told me that she has a habit of anger feats. She gets angry over small issues and in the feat of anger she pulls her hair ( medically called Trichotillomania) and many times eats it (medically called Trichophagia). She has developed this habit since childhood. This made things clear. Being the smallest child and probably unwanted and mistreated she had developed a psychological habit of pulling her hair and eating it. The father was also appearing angry on her. I had a long discussion with her father and realized that for his the child was a burden and now a trouble as he has to spend money for her treatment.
I made a call to the administration of the hospital. Convinced them that this was a genuine case and the child needed help. If help was not given the father would probably leave the child to her fate. The hospital social worker took up her case and told the father to deposit a extremely small sum of money and the hospital will take care of the rest by arranging donors for her treatment.
The child was admitted, surgery performed next day and she was discharged form the hospital after five days. The father was extremely thankful to me for arranging everything for the treatment. From a doctor I became a friend for the girl. I had kept the hair ball specimen next to her bed in a preservative. Everyday I would council her. She promise that she will never swallow hair again. Her father also agreed that he will try his best to treat her nicely.
Ten days latter, I removed the last stitches from her body. The child had started to eat properly & gain weight. Now the next problem I anticipate is will the father have enough money to feed her? Before she was not eating much and now the child was eating normally. Would the father have enough money to feed her?
Read more about Trichotillomania, Trichophagia, Trichobezoar, Rapunzel Syndrome and view my operation photos. Yoy can view the photos on my website

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Cystic Fibrosis
Cystic fibrosis is a genetic condition in which the lungs and digestive system become clogged with thick sticky mucus.
Symptoms usually start in early childhood and include:
Persistent cough
Recurring chest and lung infections
Poor weight gain
Symptoms of cystic fibrosis usually become apparent in the first year of life.
An early sign is that an affected child’s sweat is unusually salty, which can be noticeable when you kiss your child.
Treating cystic fibrosis
There is no cure for cystic fibrosis. So the aim of treatment is to ease the symptoms and make the condition easier to live with. Treatment can also prevent or reduce long-term damage caused by infections and other complications.
Treatment options include:
Bronchodilators – which are a type of medication that helps expand the airways inside the lungs making it easier to breathe
Antibiotics – to treat chest and lung infections
Physiotherapy – there are a range of exercises that can help clear mucus from the lungs
In some cases a lung transplant may be required if the lungs become extensively damaged.
What causes cystic fibrosis?
Cystic fibrosis is caused by a genetic mutation; specifically a mutation in a gene called CFTR. A genetic mutation is when the instructions found in all living cells become scrambled in some way, meaning that one or more of the processes of the body do not work in the way they should.
The CFTR mutation allows too much salt and water into cells. This results in a build-up of thick, sticky mucus in the body's tubes and passageways. These blockages damage the lungs, digestive system and other organs, resulting in the symptoms of cystic fibrosis.
Who is affected
Cystic fibrosis is most common in white people of northern European descent.
The condition is much less common in other ethnic groups.
A small amount of the baby's blood is taken by a heel prick and transferred onto a card. The blood sample on the card is then analysed in the laboratory for cystic fibrosis and other inherited conditions, such as sickle cell anaemia.
In previous years most children with cystic fibrosis would die of related complications before reaching adulthood.
The outlook has improved considerably in recent years due to advancements in treatment, although most people with cystic fibrosis will have a shorter than average life expectancy. However, this may well improve in the future.
Symptoms of cystic fibrosis
When a child is born with cystic fibrosis, symptoms usually appear in the first year, although occasionally they develop later.
The thick sticky mucus in the body affects a number of organs, particularly the lungs and digestive system
The symptoms and related problems of cystic fibrosis can vary in severity from person to person.
The main symptoms and problems are detailed below.
It is common for people with cystic fibrosis to have difficulties such as:
Persistent coughing and wheezing; the body tries to shift the thick mucus in the lungs by coughing it up
Pecurring chest and lung infections; infections are caused by the continual build-up of mucus in the lungs, which provides an ideal breeding ground for bacteria
People with cystic fibrosis are vulnerable to harmful lung infections caused by certain strains of bacteria (these bacteria are rarely harmful to people without cystic fibrosis).
Two strains of bacteria that commonly infect people with cystic fibrosis are Pseudomonas aeruginosa and Staphlyococcus aureus. They multiply in the thick mucus inside the lungs and may cause serious health problems, such as repeated chest infections.
The danger is that a person with cystic fibrosis who has such an infection can easily pass it on to another person with cystic fibrosis through close personal contact or by coughing near them. This is known as cross-infection.
As more and more people with cystic fibrosis become infected with these bacteria, the bacteria may become resistant to antibiotic treatment, which is why cross-infection is such a problem.
There is a concern that people with cystic fibrosis are more likely to pick up strains from each other than from the environment. For this reason, it is recommended that people with cystic fibrosis do not come into close contact with each other.
Patients infected with these dangerous bacteria may be treated in separate clinics to those without the bacteria, to avoid cross-infection.
Digestive system
Cystic fibrosis can also cause mucus to block the ducts in the pancreas. The pancreas produces essential food-digesting enzymes. When it is blocked, not enough of the enzymes reach the intestines to help break down food, which can cause a number of troublesome symptoms. These are outlined below.
Large, smelly stools
If the digestive enzymes are not being produced, food is not adequately digested and excess fat is lost in the stools (‘poo’), making them bulky, oily, smelly and difficult to flush away.
Because the body cannot digest essential nutrients in food (particularly fat), it is often difficult to gain weight and infants may struggle to put on weight and grow. The medical term for not consuming sufficient nutrients is malnutrition.
Adults with cystic fibrosis often find it difficult to gain and maintain weight. In children with cystic fibrosis, this can result in delayed puberty if they are severely underweight.
In older people with cystic fibrosis, the pancreas can become more damaged. Diabetes can develop if the pancreas does not produce enough insulin, a hormone that controls the level of sugar in the blood.
Diabetes in people with cystic fibrosis is different from diabetes in people without cystic fibrosis. Usually, the symptoms of diabetes include feeling constantly thirsty, frequently needing to pass urine and feeling extremely tired.
This is less common in people with cystic fibrosis. Instead people with cystic fibrosis who develop diabetes may find it difficult to gain weight or may lose weight and see a decline in their lung function.
Cystic fibrosis-related diabetes is usually controlled by regular injections of insulin. Diabetes rarely occurs in children with cystic fibrosis.
Ears, nose and sinuses
People with cystic fibrosis can be prone to sinusitis (an infection of the cavities behind the cheekbones), which may need to be treated with nasal sprays or antibiotics.
Some older children and adults develop nasal polyps, which are fleshy swellings that grow from the lining of the nose or sinuses. If they become troublesome, they may need to be removed.
Bones and joints
Some older children with cystic fibrosis develop a form of arthritis(swelling and pain of the joints), usually in one or two large joints such as the knee. In most cases, symptoms improve with time and treatment.
Older children and adults may also be prone to thin bones, for many reasons, including repeated infection, poor growth or weight, lack of physical activity and lack of vitamins and minerals due to digestive problems.
People with cystic fibrosis are more at risk of developing osteoporosis if they are taking steroid medication (corticosteroids) to help with lung infections. Osteoporosis can cause joint pain and bones may fracture (break) more easily. Some people need to take drugs called bisphosphonates to help maintain their bone density.
Both men and women with cystic fibrosis can have problems conceiving children.
In virtually all men with cystic fibrosis, the tubes that carry sperm do not develop correctly, making them infertile.
Women with cystic fibrosis may find that their menstrual cycle becomes absent or irregular if they are underweight.
There is also an increased thickness of cervical mucus, which can sometimes reduce fertility.
However, some women with cystic fibrosis can have a successful pregnancy, though it may take longer than usual before conceiving a baby.
In a few people with cystic fibrosis, the tiny bile ducts in the liver can become blocked by mucus. This can be serious as the disease progresses, and in some cases it may be necessary to have a liver transplant.
People with cystic fibrosis, especially females, are more likely to have urinary incontinence (loss of bladder control) as urine can leak out of the bladder during coughing fits.
Causes of cystic fibrosis
Cystic fibrosis is a genetic condition. It is caused by a faulty gene (known as the CFTR gene) that blocks the normal workings of a protein. This then allows too much salt and not enough water into cells.
This results in a build-up of thick, sticky mucus in the body's tubes and passageways. These blockages damage the lungs, digestive system and other organs, resulting in inflammation (swelling) and, in the lungs, repeated infections.
How the CFTR mutation is passed through families
Genes come in pairs. You inherit one set of genes from your mother and one set from your father.
To develop cystic fibrosis you would have to inherit the faulty gene from both your mother and your father.
A carrier can be completely healthy and have no symptoms of cystic fibrosis.
If two carriers of the faulty gene have a baby, there is:
A one-in-four chance that the child will not inherit either of the faulty genes (the child will not have cystic fibrosis and will not be a carrier of the condition)
A one-in-two chance that the child will inherit one copy of the faulty gene from either their father or mother (the child will not have cystic fibrosis but will be a carrier of the condition)
A one-in-four chance that the child will inherit both copies of the faulty gene (the child will have cystic fibrosis)
Diagnosing cystic fibrosis
Most cases of cystic fibrosis are now identified through screening tests carried out early in life. However, some babies, children and even young adults are identified later following unexplained illness.
Diagnosing cystic fibrosis
There are three main ways of diagnosing cystic fibrosis:
Newborn testing
Antenatal testing
Sweat testing
Newborn screening
A small amount of the baby's blood is taken by a heel prick and transferred onto a card. The blood sample on the card is then analysed in the laboratory for cystic fibrosis and other inherited conditions, such as sickle cell anaemia.
The sooner cystic fibrosis is diagnosed, the sooner treatment can begin and the better the outlook.
Antenatal testing
A test can be done on a woman when she is pregnant to see if her unborn baby has cystic fibrosis. This can be carried out from 10 weeks of pregnancy.
The test uses chorionic villus sampling (CVS), where a fine needle is passed through the abdomen into the womb. Sometimes, a fine tube is passed through the vagina into the cervix (neck of the womb) instead. A tiny piece of the developing placenta, known as the chorionic tissue, is taken and the chromosomes in the cells of the tissue are examined for the faulty gene that causes cystic fibrosis.
Antenatal testing for cystic fibrosis is usually only offered to mothers who are thought to be at high risk of having a child with the disease, such as women with a family history of the condition.
Sweat test
If someone has cystic fibrosis, their sweat will have higher levels of salt than normal. A parent may first notice their child's symptoms of cystic fibrosis when they kiss them, as their skin can taste salty.
A sweat test measures the amount of salt in sweat. It is usually done by applying a very weak and painless electric current to a small area of skin to which a harmless chemical has been applied. This causes that area of skin to sweat. A sample of the sweat is then collected and analysed. If the salt content in the sweat is abnormally high, this confirms cystic fibrosis.
A sweat test may be carried out if:
Newborn screening tests are abnormal
A child has symptoms of cystic fibrosis
A child is born with a serious bowel obstruction known as meconium ileus
A child or adult has symptoms suggestive of cystic fibrosis
Genetic testing
A genetic test checks for the faulty cystic fibrosis gene by either analysing a saliva sample taken from inside the cheek using a swab or a blood sample. It can be useful to confirm cystic fibrosis if a sweat test gives a borderline result.
It can also be useful to find out which members of a family are carriers of the cystic fibrosis gene.
Carrier testing
There is a simple test that uses a mouthwash to identify whether a person is a carrier of the cystic fibrosis gene.
Swishing the mouthwash collects a sample of cells from the mouth. This sample is then sent to a laboratory and the cells it contains are checked for the faulty cystic fibrosis gene.
It is important to have this test if the person’s partner is a known carrier, or if someone in the family has cystic fibrosis or knows that they carry it.
Testing in later life
Older children and adults may require regular testing to check how well (or not) their lungs and digestive system is working.
Tests that can be used for this purpose are described below.
You will be asked to breathe into a machine called a spirometer.
The spirometer takes two measurements: the volume of air you can breathe out in one second (called the forced expiratory volume in one second or FEV1) and the total amount of air you breathe out (called the forced vital capacity or FVC). You may also be given a type of breathing test known as a spirometry.
You may be asked to breathe out a few times to get a consistent reading.
The readings are compared with normal measurements for your age, which can show if your airways are obstructed.
Chest X-rays
A chest X-ray can be a useful method for assessing the state of your lungs
Computerised tomography (CT) scan
In a CT scan a series of X-rays are taken; these are then assembled by a computer into a more detailed ‘3D’ image of your lungs and digestive system.
Treating cystic fibrosis
People with cystic fibrosis should be treated with help and advice from a team of healthcare professionals at a cystic fibrosis centre. With regular visits, the patient or parent can learn how to best manage the condition. As each case is different, they can receive tailored care for their or their child's condition.
There is no cure for cystic fibrosis. The aim of treatment is to ease the symptoms and make the condition easier to live with. It can also prevent or reduce long-term damage caused by infections and other complications.
Different types of treatment for cystic fibrosis are detailed below.
Medical treatments for cystic fibrosis help clear and control infections in the lungs and digestive system. They can also be used to treat some of the other health problems related to cystic fibrosis.
Bronchodilators are a type of medication that are inhaled to help the person breathe more easily. They are also used for asthma and relax the muscles that surround the airways in your lungs, helping them to open up.
Antibiotics are taken to fight infections in the lungs. They can be taken by mouth as pills, capsules or liquids, be inhaled through a nebuliser (a device that turns medication into a mist that can be breathed in), or they may be given intravenously (through a tube into a vein) if the infection is more severe.
All young children diagnosed with cystic fibrosis will be started on a course of antibiotics to protect them from certain bacteria, which will be continued for some years. For more advice on the use of antibiotics, see the Cystic Fibrosis Trust information on medication.
Steroid medication (corticosteroids) reduce the swelling of the airways, which can help with breathing in some patients. Steroid nasal drops and sprays can also be used to treat nasal polyps (small growths inside the nostrils).
Pulmozyme (DNase) is an enzyme, usually inhaled via a nebuliser, which helps to thin and break down the sticky mucus in the lungs so it is easier to cough up.
In most cases DNase will not cause any noticeable side effects
People who have diabetes as a result of their cystic fibrosis will need to take insulin and manage their diet to stabilise blood sugar levels. The dietary advice usually given to people with diabetes who do not have cystic fibrosis does not apply to most people with cystic fibrosis-related diabetes.
Bisphosphonates can be taken to treat osteoporosis (weak and brittle bones), which can occur as a result of cystic fibrosis. Bisphosphonates help maintain bone density and reduce risk of fractures.
Vaccinations and flu jabs
It is particularly important that people with cystic fibrosis are up to date with all the required vaccinations. People with cystic fibrosis should make sure they have an annual flu jab, as they are more susceptible to complications as a result of infection.
Digestive system, diet and nutrition
For people with cystic fibrosis, getting the right nutrition is vital. A healthy body weight is necessary to help fight off infections, and it is important there is enough reserve energy to rely on when the person is ill.
Cystic fibrosis causes mucus to build up and block the small channels that carry digestive juices and enzymes. Over time, this causes the pancreas to become damaged. The effect of cystic fibrosis on the pancreas varies from person to person, but most people have to take digestive enzymes from birth to help them digest food and get the nutrients they need, with every meal and snack. They also need to take vitamin supplements.
The diet of someone with cystic fibrosis should be high in calories, as they will not be able to digest all the food they eat.
A special diet should start as soon as cystic fibrosis is diagnosed, which will need to be adapted as people get older.
Babies with cystic fibrosis
Babies with cystic fibrosis may be breastfed as usual, otherwise most baby milks and formulas will be suitable. In some cases, if the baby is not gaining enough weight, a high-energy formula may be needed or nutritional supplements added to milk feeds to give the baby more calories (energy).
Ask a dietitian at the cystic fibrosis centre if you are unsure about this.
Before a baby moves onto solid foods, they may need extra salt as both breast milk and baby milk are very low in salt. Cystic fibrosis makes sweat much saltier and more salt than normal is lost through skin.
If the baby needs extra salt, the dietitian or doctor at the cystic fibrosis centre will advise on the appropriate amount and prescribe a salt solution.
Never add salt to a baby's food or drink without specific advice from cystic fibrosis specialists.
Babies can eat any normal solid baby foods, but they will need vitamin supplements to compensate for the loss of vitamins A, D, E and K in their stools.
These are available in two liquid preparations. Vitamins A and D are usually combined in one, and there is usually a separate one for vitamin E. Vitamin K is now prescribed by many doctors to older children.
A baby with cystic fibrosis will also need pancreatic enzymes to help them digest food. These take the place of the food-digesting enzymes missing from their digestive system. They usually come in the form of microspheres or minimicrospheres (granules), which can be mixed with a little formula, expressed breast milk or fruit puree and spoon fed ideally at the start, during and after the feed.
The granules should never be given dry as they can be a choking hazard. A dietitian can advise on the amount to use and the most suitable way to give the enzymes.
Children with cystic fibrosis
Children who have cystic fibrosis should eat a varied diet, with a large amount of protein and calories. Meals should include meat, fish and eggs, as well as starchy foods like bread and pasta. If a child's appetite is poor, give them food little and often, and offer snacks in between meals.
Children who find it particularly hard to gain weight can be given dietary supplements in the form of milk shakes or fruit juices. You can talk to a cystic fibrosis dietitian about these.
Like babies, children with cystic fibrosis will need to continue taking vitamin A, D, E and K supplements to compensate for the vitamins they lose.
Children also need to continue taking pancreatic enzymes with all fat-containing meals, snacks and drinks. The capsules should be taken before and during the meal and the number of capsules will vary depending on the fat content of the meal. Enzymes can be taken in easy-to-swallow capsules.
A dietitian may recommend salt supplements for a child with cystic fibrosis, especially in hot weather or if they are going on holiday to a country with a warm climate, where sweating may cause a loss of salt.
Children with cystic fibrosis are likely to eat more sugary foods than normal due to their high-calorie diet, so it is important to make sure they brush their teeth properly and visit the dentist regularly.
If a child cannot gain enough weight and dietary supplements have not helped, they may need to be tube fed.
This will usually be either nasogastric (the tube is inserted through the nose and goes down to the stomach), or gastrostomy (a small operation is carried out to insert the tube directly into the stomach). The other end of the tube is attached to a bag of high-calorie/nutrient food that is delivered straight to the stomach, usually while the child sleeps.
Adults with cystic fibrosis
Adults who have cystic fibrosis do not need to avoid any particular food, but it is important they have a diet high in protein and energy to maintain their weight. They should eat regular meals and snacks as this helps to maintain energy intake. They should eat three meals a day, including plenty of meat, fish and eggs, and eat several high-calorie snacks in between.
If someone with cystic fibrosis wants to be a vegetarian, they should talk to their dietitian about alternatives to meat. A vegan diet is not advised for people with cystic fibrosis as it tends to be especially low in energy.
Most adults with cystic fibrosis need to continue taking pancreatic enzymes with all fat-containing meals, snacks and drinks. The capsules should be taken before and occasionally during the meal and the number of capsules will vary depending on the fat content of the meal. There are different types and strengths so talking to the cystic fibrosis specialist team will help the person find one that suits them.
People with cystic fibrosis should not stop taking pancreatic enzymes unless they are told to do so by their dietitian or doctor, as this can lead to a serious blockage of the bowel.
Most adults need to continue taking vitamin A, D, E and K supplements. These come in the form of prescribed multivitamin tablets.
People with cystic fibrosis who lose a lot of weight due to an infection or illness may need to be tube fed to help them gain weight.
As in tube feeding for children, this will be either nasogastric or gastrostomy, depending on how long the tube must stay in for. A gastrostomy tube (which is inserted directly into the stomach) is best for longer periods of time or repeated courses of treatment as it is unlikely to be dislodged during coughing or physiotherapy.
The management of cystic fibrosis with physiotherapy differs for each person with the condition, and is specifically tailored to their needs.
Traditionally, physiotherapy for cystic fibrosis focused mainly on airway clearance (clearing mucus from the lungs). This still makes up a large part of daily treatment, but the role of the physiotherapist in cystic fibrosis has expanded to include daily exercise, inhalation therapy, posture awareness and, for some, the management of urinary incontinence.
Airway clearance
It is beyond the scope of this article to discuss all of the airway clearway techniques available (your care team should be able to provide more information on airway clearway techniques).
The most widely used is called active cycle of breathing techniques (ACBT).
Active cycle of breathing techniques (ACBT)
ACBT involve you repeating a cycle made up of a number of different steps. These are:
A period of 20-30 seconds of normal relaxed breathing
3-4 deep breaths, where you hold each breath in for three seconds before breathing out
‘Huffing’ – huffing involves taking a medium size breath in followed by a fast breath through your open mouth while using the muscles of your chest and stomach to help force the breath out – this should help push the mucus / up to a point where you can cough it out
Coughing – you should then cough every 2-3 huffs; but don’t try to force out sputum if it does not feel ready to be coughed out
You then repeat the cycle for 20-30 minutes.
(Do not attempt ACBT if you have not first been taught the steps by a suitably trained physiotherapist as performing the techniques incorrectly could damage your lungs).
If you are otherwise in good health you will probably only need to perform ACBT once or twice a day.
If you develop a lung infection you may need to perform ACBT on a more frequent basis.
Postural drainage
Changing your position can also make it easier to remove mucus from your lungs. This is known as postural drainage.
Each technique can involve a number of complex steps but to summarise, most techniques involve you leaning or lying down while the physiotherapist or a carer uses their hands to vibrate certain sections of your lungs as you go through a series of ‘huffing’ and coughing.
There are also a number of devices that can help remove mucus from your lungs. These include:
The flutter – which is a handheld advice, shaped like an asthma inhaler, which delivers vibration to the airway of your lungs, making it easier to cough out mucus
RC cornet – which is shaped like a small section of garden hosing which works in much the same way as the flutter
The Acapella – which is a device, shaped like a small torch, that uses a combination of vibration and air pressure to help remove mucus
Some techniques use large pieces of equipment, which can be very expensive and are usually only available for use in a hospital, such as a high frequency chest wall oscillation (HFCWO). This involves using an electric air compressor that connects to an inflatable jacket (vest) to vibrate the chest
Exercise is recommended for everyone with cystic fibrosis. This may vary from taking part in normal school activities to individualised exercise programmes. Infants and toddlers with cystic fibrosis should have some exercise included in their normal daily routine.
Any sport or exercise that gets a person with cystic fibrosis moving is good, but if there are any concerns or worries, they should ask their physiotherapist.
Children and adults are also encouraged to include stretching exercises into their routine to mobilise the joints and muscles around their chest, back and shoulders, and to be aware of maintaining good posture.
Lung transplants
In severe cases of cystic fibrosis, when the lungs stop working properly and all medical treatments have failed to help, a lung transplant may be recommended.
Both lungs need to be transplanted as they will both be affected by the condition. A lung transplant is a serious operation that carries certain risks, but it can greatly improve the length and quality of life for people with severe cystic fibrosis.
The outlook for people with cystic fibrosis is often better than average for transplant patients as they are often younger and in better health than other transplant candidates.

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