SINGLE PORT INSTRUMENT DELIVERY EXTENDED REACH OR 'SPIDER' is a surgical system that introduces a new concept to minimally invasive surgery or SILS ( SINGLE INCISION LAPAROSCOPIC SURGERY) It works by providing multiple, tiny, flexible instrument channels through one small incision near the patients belly button. A unique feature of the SPIDER is the way it opens up like an umbrella once it is within the abdomen and once the procedure is completed how the system closes up and is removed through the same incision site. Most surgical devices of traditional laparoscopy use rigid or semi rigid instruments whereas the SPIDER system introduces flexible articulating arms with structural strength. It provides two flexible channels for right and left hand instruments with 360 degree range of motion, and two rigid channels for small cameras and other instruments hence it overcomes many of the challenges of single site surgery by eliminating the need for criss- crossing of instrments to achieve true surgical triangulation, minimizing tissue trauma and allowing surgery through a single 18 mm incision site. A robust retractor is included in the system that allows excellent exposure of cystic structures. So this is how it works. This device is inserted through a small incision in or near your belly button, once inside, the system expands in an umbrella like fashion and the surgeon can use a variety of instruments through the single port to perform the procedure. Once the procedure is complete, the surgeon collapses the system in preparation for removing, the tools and the system are removed through the original incision. Many bariatric ( weight loss) surgeries, cholecystectomies, cyst removals, urologic procedures are done effectively using this system. This system's single incision method allows for a shorter and less painful recovery time. The patient is usually left with little or no visible scarring.

TONSILLECTOMY
(Patient information sheet)

Why is this surgery done?
The indication for this surgery has reduced a lot in recent times and the common indication that remains now a days is
� Recurrent tonsillitis ( more than 3-4 /year)
� Tonsil enlargement causing sleep disturbance ( snoring , mouth breathing)

How is this surgery performed:
This is performed from inside the mouth and there is no external scar

How long does the surgery last:
Varies for each patient but ranges from 30 min to 90 min

Does this require overnight stay in hospital :
Many centers include this in day care but I feel at least one day admission is a must to keep a check on any minor bleeding.

What are the complications? :
Tonsillectomy is generally a safe surgery. Few children have some amount of bleeding occasionally. But that can be controlled. This surgery is done under general anesthesia so there is a minimal risk of anesthetic complication that is associated with any other surgery.

What do we expect after surgery :
The child has lot of pain for which pain relief medicines are prescribed. Still child will have some difficulty in swallowing food. So he is kept on fluids and icecreams. This lasts for 2-4 days

What is adenoid?
Adenoid is a tonsil like lymphoid part present behind the nose. In children who have enlarged adenoids these have to be removed during the tonsil surgery and is called as adeno tonsillectomy

How do I know if my child has adenoid ?
Constant mouth breathing, snoring are common symptoms. Rarely child may develop reduced hearing.

What precautions to be taken for food after surgery :
For 5 days child will need soft food and icereams and plenty of water. Nothing HOT should be given.
After pain subsides he can be given all food except spicy and very hot food for 15 days. After 15 days all regular food can be given.

Will my child never have throat pain after surgery :
This is myth even after removal of tonsil child can have throat pain due to other reasons but the repeated attacks of tonsillitis will definitely not happen.

Will the height /weight of my child increase or decrease after surgery : Tonsillectomy has no relation in increase or decrease of height/weight . However after removal of a chronic source of infection from body definitely the general well being of child improves.

For any other queries please feel free to contact me
Dr ( major) Prasun Mishra
MS ENT ( AFMC), DNB,
Pune
+91 9881676449
majorprasun@yahoo.co.in

ANGER MANAGEMENT: DR SHRINIWAS KASHALIKAR

Anger is a strange phenomenon! We like it as well as we hate it!

Thus; we feel; though we may not overtly say it; that anger is a sign of liveliness, heroism and even divinity. Thus; we find that anger against injustice, oppression, exploitation, fanaticism, barbarism, inequality, is directly or indirectly; not only justified; but actually adored!

But having said that; we read several examples where anger is condemned and loathed! Thus; the anger that leads to hatred, vengeance, revenge, indiscriminate violence, terrorism and other malicious crimes; is abhorred!

In short; anger is like electricity, which if properly channellized serves constructive purpose and if short circuited, leads to hazards.

If and when the anger within us erupts uncontrollably like a volcano; it manifests in indiscriminate violence in our speech, writing, physical behavior and other transactions. Thus in a spur of moment we may shout, abuse some one in public interview, write harsh letters or articles, physically assault some one, file a suit in a court of law, or actually go further and get involved in worse sociopathic violent activities.

Thus; if our anger in social matters is not managed properly, our otherwise selfless and divine anger against injustice, oppression, exploitation, crimes, corruption etc; may turn into indiscriminate violence against self or the other innocent people and may turn into antisocial or criminal elements in the society and may also; have to be convicted, jailed and punished in accordance with the gravity of the bout of our anger!

If our anger related to personal matters, is not managed properly; then we may lose friends, may get distanced from our parents or children, or may get isolated and become lonely. Is it not true that we often repent because of unleashing a violent bout of anger on our parents, children, friends or spouse? Mismanaged anger is a source of �avoidable pain, agony and misery� for self and others.

Having seen these hazards of mismanaged anger; it is obvious that anger management is extremely important and essential. We have to mange anger properly so that we or the others; don�t have to suffer and/or repent.

Let us realize that the anger; can not be eradicated. To a greater or lesser extent; it is going to be with us for ever. Hence we should not keep trying to be free from anger! Instead; our anger has to be transformed into objective and benevolent force.

How can we achieve this? Some essential steps are described in my book �SUPERLIVING�, which is available in google search; for free download. These steps lead to culmination of; every metabolic, endocrine and nervous activity responsible for anger; into �most fulfilling; holistic perspective, thinking, feelings and behavior; conducive to individual and universal blossoming! One may not believe in this but verify oneself!

References:
1. Stress: Understanding and Management; Dr. Shriniwas Janardan Kashalikar
2. Namasmaran: Dr. Shriniwas Janardan Kashalikar
3. Smiling Sun: Dr. Shriniwas Janardan Kashalikar
4. Conceptual Stress: Dr. Shriniwas Janardan Kashalikar
5. New Study of Bhagavad Geeta: Dr. Shriniwas Janardan Kashalikar
6. Holistic Medicine: Dr. Shriniwas Janardan Kashalikar
7. Holistic Health: Dr. Shriniwas Janardan Kashalikar
8. Namasmaran (Marathi): Dr. Shriniwas Janardan Kashalikar
9. Tanavmukti (Marathi): Dr. Shriniwas Janardan Kashalikar (Assistance Dr. Suhas Mhetre)
10. Bhovara (Marathi): Dr. Shriniwas Janardan Kashalikar
11. Sahasranetra (Comprehension of Vishnusahasranam; Marathi): Dr. Shriniwas Janardan Kashalikar
12. Thakawa Ghalwa (Marathi): Dr. Shriniwas Janardan Kashalikar
13. Tanavmuktisathi Upayukta Lekh (Marathi): Dr. Shriniwas Janardan Kashalikar
14. SUPERLIVING: (English) Dr. Shriniwas Kashalikar
15. SUPERLIVING: (Marathi) Dr. Shriniwas Kashalikar

ETERNAL LOVE AND WAR DR SHRINIWAS KASHALIKAR

The tides continue eternally.

The tide of attraction, love, union, harmony rises and begins to recede and being replaced by the tide of repulsion, hatred, disunity and disharmony replaces it!

On the backdrop of the ocean that I am; the tides keep playing eternally. Whether I like and love the tides or dislike and hate them; they continue! I don�t know whether to call their interaction with me an eternal war or eternal love!

When I am caught in the tides I am away from myself and experience; trivial, petty and elusive happiness or pain. I experience slavery and helplessness. It is this state which is my �enemy�! When I am not trapped in the tides; I am the real myself the ocean! It is this state that is my �friend�.

The state of being one�s friend; is far more difficult; when the tides are monstrous and stormy, which is what is today! Hence the practice of NAMASMARAN and the sharing of its global benevolence; become far more important, essential and urgent.

There are many interpretations of the 5th and 6th shlokas in 6th chapter of Geeta.

More often than not these shlokas are �used� to emphasize and prove �individual supremacy� and refute the subtler insights, perceptions and experiences; of true self (guru, god, almighty, absolute truth, super consciousness, cosmic consciousness).

This fact appears innocuous.

But such hype of individual supremacy unleashes the barbaric elements within us; and leads to self aggrandizement and megalomaniac behavior that disrupts and destroys the unity and the harmony inside us and also in the society.

As a result of this understanding; I used to think that the shlokas imply presence of higher self and lower self. Higher self being friend and lower being foe.

But the next question would arise if higher self is friend; then whose friend is it; itself, lower self, or both? If lower self is foe; then whose foe is it; itself, higher self or both?
Dnyaneshvari seems to explain this is with perfect clarity and pragmatism.

The state of remembering oneself is friendly (benevolent to one and all) and the state of forgetfulness is inimical (disruptive and destructive to all). The state of self remembrance; is friendly (embodies individual and universal blossoming, holistic renaissance, unity and harmony and profundity and prosperity) and the state of self forgetfulness; is fiercely inimical (embodies individual and universal degeneration, disease, decay and death, holistic retrogression, disunity, disharmony, pettiness and poverty).

If and as we �see� this subtle reality; we would �see� the universal benevolence of NAMASMARAN (the state of self remembrance) and rise from our slumber, lethargy, indolence, irresponsibility on the one hand and meanness, insecurity, agitation and petty selfish obsessions (the state of NAMAVISMARAN i.e. self forgetfulness). We would then; not only practice NAMASMARAN with topmost priority; but try to share its holistic benevolence with maximum people.