If we learn some Self Management Tips and Tricks,we can make our life better and and our family,society,country all more safe and strong.

We should accept that we are responsible for everything that happens in our life.We oftern say it is not our fault or misdeed which broght pain,sorrow or difficulties but it is either nature or our destiny �BHAGYA� or �LUCK� did it,but ofter relly it is not true.We have to Learn to accept total responsibility for ourself. If we do not manage ourself, then we are letting others have control of our Life. These tips will help "us" manage "us."Please live present cautiously and patiently at every momment with joy and happiness taking difficulties and failures easily ,behave more as youth or kids in tackling these failures rather than very seriously raisingBlod pressure,hear attack,brain stroke etc.


Our present form of style of living put under a quantum of tension,fear,apprehensions, doubts,anxiety and strss leading to a lot of mental or Psycho social disbalaces making us a patients of mmental or Psyciatric patients full of Anxiety Neurosis and depression,leading to MDP and SCHIZOPHRENIA,not only this these Psycho social disease also make us a patient of GASTRIC PROBLEMS,ULCERS,COLITIS,IBS,CARDIAC DISEASES,DIABETES,HYPERTENSION, KIDNEY DISEASES and so on many more somatic diseases.SO CHANGE IN LIFE STYLE IS A MUST AND NEED NOT IT TO BUY SIMPLY READ AND PRACTICE FOLLOWING FEW SUGGESTIONS WHICH WILL ABLE US TO GET IT AND PROTECT US FROM SUCH FATAL DISEASES.

Here is a list of things that help you in self management and which will in turn lead you to the path of success: -

-) Look at every new opportunity as an exciting and new-life experience.

-) Be a professional who exhibits self-confidence and self-assurance in your potential to complete any task.

-) Agree with yourself in advance that you will have a good attitude toward the upcoming task.

-) Frequently ask, "Is what I am doing right now moving me toward my goals?"

-) Do it right the first time and you will not have to take time later to fix it.

-) Accept responsibility for your job successes and failures. Do not look for a scapegoat.

-) Do not view things you do as a "job." View all activities as a challenge.

{mosgoogle left}-) Use your subconscious mind by telling it to do what you do want. Instead of telling yourself, "I can't do that very well," say, "I can do this very well."-) Give yourself points for completing tasks on your "to-do" list in priority order. When you reach 10 points, reward yourself.

-) Practice your personal beliefs. It may be helpful each morning to take 15 minutes to gather your thoughts and say a prayer.

-) Make a commitment to show someone a specific accomplishment on a certain date. The added urgency will help you feel motivated to have it done.

-) Practice self-determination, wanting to do it for yourself.

-) Believe that you can be what you want to be.

-) Never criticize yourself as having a weakness. There is no such thing. You are only talking about a present undeveloped skill or part of yourself that if you so chose, you can change. You do not have any weakness, only untapped potential.

-) Be pleasant all the time-no matter what the situation.

-) Challenge yourself to do things differently than you have in the past. It provides new ideas and keeps you interested.

-) Talk to yourself. A self-talk using positive affirmation is something that is common among all great achievers. They convince themselves that they can accomplish their goals.

-) Create your own "motivation board" by putting up notes of things you need to do on a bulletin board or special wall space. It is an easily visible way to see what you need to work on. When an item is done, remove the note. Also keep your goals listed and pictured on your board.

-) Stay interested in what you are doing. Keep looking for what is interesting in your work. Change your perspective and look at it as someone outside your job would,

-) Establish personal incentives and rewards to help maintain your own high enthusiasm and performance level.

SHORT CUT TO HAPPINESS DR SHRINIWAS KASHALIKAR

The essential mainstream of our life ( apart from various other aspects) is the ASCENT (through obvious or latent study, practice and growing insights in NAMASMARAN). We gradually ascend from the dependent stage of childish selfishness (pained or pleased by even trivial matters); through the adult selfishness (temporarily pleased and pained by gratification or deprivation of physical needs, desire, instincts, emotions (ego) in many ways); through grown up selfishness (being happy or sad in the happiness or griefs of others respectively); through the realization of the vital and pivotal role of NAMASMARAN in the individual and universal blossoming; through maximum possible efforts to share this realization (viz. efforts for globalization of NAMASMARAN) with the others; to the subsequent stages of revelations and greater freedom, peace, benevolence and fulfillment viz. Gurukrupa, which are indescribable.
The stages may vary in their details; in different individuals.
But there is no shortcut.

NAMASMARAN AND THE GERMS OF STRESS: DR. SHRINIWAS KASHALIKAR

It is true that NAMASMARAN is a means of salvation, liberation, moksha, self realization and/or immortality.

But �Practicing NAMASMARAN� without some essential stages of development given below; and waiting for salvation; is like a child expecting Ph D, without going in a school; and leads to gullibility, frustration or hypocrisy.

One example that highlights this; in spite of �practicing NAMASMARAN�; is our advertisements of disinfectants, washing powders, washing bars, toilet soaps, tooth powders, tooth pastes and water filters/ mineral water bottles; spreading the �stress of germs� and �germs of stress�!

Actually germ is a NOT a singular cause of infective and infectious diseases. If it were to be true; then in the mass of germs (approximately 100 times the mass of us); we would have been extinct long back. Moreover; the germs are not always harmful. Often they are symbiotic (beneficially dependent on each other), commensals (harmlessly coexisting together) and saprophytes (living on dead tissues), which are harmless and/or useful germs. Even those germs, which can infect and harm us (referred to as virulent or pathogenic); do so; only when our immune system i.e. body resistance is relatively inefficient (usually due to malnutrition); and/or their number is suddenly increased to defeat the body mechanism of resistance.

We would live far more healthily and happily, as; our hitherto closed door to swadharma, true self and God, would be open; if in the process of practicing NAMASMARAN; we pass through the stages of; SADICCHHAA, SADVASANA, SADBHAVANA, SADPRERANA, SADPRAVRUTTI, SADVICHAR and SADSANKALP (instincts, emotions, thoughts, perspective (policies, plans and programs) of individual and global blossoming) and desist from cheating or getting cheated.

EXAMPLE OF SATSANKALP, SADVASANA, SADBHAVANA, SADVICHAR AND SATPRERANA (ASPIRATIONS, PASSIONS, FEELINGS, THOUGHTS/POLICIES, AND PERSPECTIVE/MOTIVATION) OF AND FROM; TRUTH; THROUGH NAMASMARAN(JAAP, JAP, JIKRA, SUMIRAN, SIMARAN etc; i.e. remembering God): DR. SHRINIWAS KASHALIKAR

The policy of excessive production and marketing (and passively buying and using) of cars and two wheelers (for the affluent few) and suppression of the production buses, trams, trains and other modes of public/mass transport; can be reversed by policy makers, whose mind has undergone purification through NAMASMARAN; and suffering of billions in many ways given below; can be prevented and/or shunned.

1. Excessive increase in number of vehicles on roads that leads to congestion and load on traffic police
2. Increase in fuel consumption, chemical pollution and import expenses; leading to increase of fuel prices and subsequent increase in the food prices and unbearable load on the farmers living in villages, where electricity is barely available for few hours. Thus the farmer community which is the heart of society becomes sick and moribund! This alarms real danger!
3. Increase in wear and tear of roads increases. Consequently there is increase in accidents due bad condition of roads as well as increase in the maintenance expenses and disturbance and delay to smooth traffic
4. Increase in noise pollution results due to; blowing of horns; which is especially troublesome; to hospitals, schools, and other places; where silence is essential.
5. Increase in traffic jams adding to further increase in fuel consumption and wastage of time, disastrously affecting the performance and/or productivity of the people of different occupations.
6. Increase in the number of vehicular accidents is largely contributed by simply the huge and increasing number of vehicles on road apart from other factors
7. Increase in vehicular exhaust causing global warming
8. Excess of load on local trains and other means of public transport [where ever available] and consequent accidents, quarrels and mishaps
9. Overall increase in tardiness in the traffic and increase in anxiety and tension, further increasing the quarrels, traffic crimes the number and severity of accidents and difficulty in providing medical aid (and disaster management) and other emergency services; due to difficulty in movement of ambulances and fire fighters.
10. The eco-friendly bicycles production and sale suffers due to �imposing and threatening� presence of cars, motorcycles, rickshaws, scooters etc.
11. Excessive production of vehicles; is associated with; unproductive and wasteful work; such as insurance, registration and traffic policing!
12. Increase (due to difficulty in enforcing law and order) riots, thefts etc due to slowing of police movement
13. Excessive production of un-degradable solid waste.
14. The need and construction of excessively wide and cement or asphalt roads at the cost of irreplaceable trees (extremely important for avoiding global warming, pollution, rain and organic manure) and open earth surface (extremely important and vital for absorbing and holding rain water) and unnecessary disruption of the natural habitat of the animals.

1. Name of Specialty: General Surgery



2. Name of System of Body: Gastrointestinal system




3. Title of Thesis
and year of submission of thesis: A Study of Surgical Management of Hemorrhoids using Minimally Invasive Procedure for Hemorrhoids (MIPH) -Recent Modality of Treatment . - June 2010



4. Name of the candidate: Dr. Sanap Narayan Arjunrao




5. Name of the Supervisor: Dr. N. Raghupathi RAO, M.S., MAMS, FICS, FICA




6. Name of Hospital: Apollo Hospitals Jubilee Hills Hyderabad.





7. Objectives of the study: to study the efficacy of stapled haemorrhoidectomy in terms of ease of use, time of surgery, intraoperative complications, associated morbidity & advantages and disadvantages.





8.1 Study area: Apollo Hospital Jubliee Hills Hyderabad is a well equipped 334 bedded tertiary care hospital with General Surgery Units serving the population of Hyderabad and surrounding regions. Being a tertiary care hospital, referrals are common for various grades of hemorrhoids for management with minimally invasive procedure. This Study was designed to understand the efficacy of the minimally invasive procedure for hemorrhoids done at our centre in dealing with various grades of hemorrhoids.



8.2 Study population: Data was collected from inpatients cases, mixed population of male and female patients from Hyderabad, and the refereed cases to the hospital from other centers.


8.3 Sample size & sample technique: Total 50 patients were selected randomly according to the inclusion and exclusion criterion.
-Inclusion criteria: 1. Grade II, III, IV Internal or external hemorrhoids in 20 to 70 years age group patients.

-Exclusion criteria: 1. associated with synchronous & metachronous malignant lesion found on
Colonoscopy
2. Exclusion of chrohns� disease
3. Patient where the internal diameter of rectum will not accommodate the instrument and accessories
4. Patients with associated Grade I hemorrhoids



8.4 Data collection technique and tools: It was a prospective study and data was collected as an interview in the proforma mentioned with the desertation.

8.5 Data analysis: Information collected was categorized as per variables and demonstrated as bar charts.

9. Salient findings:
Age distribution of patients

Majority patients found to be in 41-50yrs age group followed by 51-60yrs group. The youngest was 26 years old and the oldest was 65 years old.

Sex distribution of patients

Incidence of males undergoing stapled hemorrhoidectomy was about 76% in males and about 24% in females.

Associated history

Constipation is seen as most associated history, followed by alcoholism.

Grades distribution

Most of presentation was with grade III, grade II contributes 56% & 30% respectively.

Indication for intervention

Bleeding & prolapse constitutes most common indication for surgery.

Emergency surgery

Total no of 50 cases which were studied over two years 42 cases were operated in routine operation theatre timings and 8 cases were operated on emergency basis

Intraoperative Time of surgery

Peri-operative time for application of stapler for hemorrhoid surgeries about 27.1 min which mostly depends on factors mentioned below

1) Patient position
2) Pursue string suture
3) Surgeons Experience

Mode of anesthesia

We recommend that general anesthesia, epidural or spinal anesthesia as per the requirement and patient fitness for it. It results in an increased relaxation of the anal sphincter muscles and therefore facilitates the insertion of the circular anal dilator without the manual stretch






Early complications

Out of 50 cases, 8 % cases had minimal bleeding, 6% suffered from retention of urine, 2% had haematoma. Most of patient had so minimal pain score of 1-2 in 90% cases. Out of 4 patients 3 had mild bleeding & 1 had moderate bleed, which was on anticoagulant agent.

Time of ambulation

Mostly patients ambulated in same day of surgery 66% in 6-12 hrs &
26% in 12-24 hrs.

Time of rejoin to work

Patients resume their work normally in 2- 3 days and without any discomfort for their daily activities to be performed normally
.
Late complications

During Postoperative follow-up found stricture at anal canal in 1 patient.
Study group was found to be recurrence free over six month follow-up

Follow-up

All the operated patients then were followed up to 6 months.
100% patient followed first visit at day 10, then follow up patient�s decreases to 72% in second visit at 3 month & further 38% at third visit at 6 months, may be due to not having any clinical symptoms.

Stay in hospital

Most of patient treated as day care admission & discharged at home same day advising proper analgesics if necessary with anti constipation agent. Some patients needed 1 day admission in view of insurances policy terms. Very few patients admitted for evaluation & other co morbidity.








10. Conclusions: we concluded that staplers is going to become the part and period considering its various advantages as increased speed, efficacy, less tissue trauma, access to difficult areas of the body, reliability and thus increases the quality of life of the patient by decreasing morbidity to some extent. It can eliminate hemorrhoidal bleeding, successfully eliminates pain in hemorrhoidal disease. It is a minimally invasive procedure which is simple when performed by an expert in it. Operative time for stapled hemorrhoidectomy was shorter compared with conventional techniques. Resumption to pain free defecation was significantly faster in stapled hemorrhoidectomy also was the shorter hospital stay and patients resumed there daily activities and work faster compared to others. No continence and defecation problem was noted neither recurrence seen in all theses studied patients. Staplers being precision devices, they are prone to mechanical faults in careless hands and hence proper training and technical expertise is a must before the application of staplers. Despite of its various advantages this technique is prohibitively costly. However like laparoscopy which was also costly to begin with, the cost of staplers may drop down with its frequent use. Indications for their adequately to other treatment grade two and three hemorrhoids also indicated in the uncomplicated grade four hemorrhoids also. Active sepsis, full thicknesses rectal prolapse is some of its contraindication for using this device. It has been concluded that the staplers are a novel way of doing hemorrhoidal surgeries and has increased the horizons of hemorrhoidal surgery to a great extent. However, technical skills, good on table judgment, intelligence and knowledge of all possible pitfalls and errors of stapling are required to achieve optimal results.





11. Recommendations:
1) Being a simple surgery, short operative time, early ambulation and minimal pain; this procedure can be widely accepted as day care surgery.

2) In the initial stages of learning procedure should be carried out under supervision of a senior surgeon as we technical difficulty and error may lead to inadequate or excess excision & sever post operative pain.

3) Despite of its various advantages this technique is prohibitively costly. However like laparoscopy which was also costly to begin with, the cost of staplers may drop down with its frequent use.

4) We recommend that minimally invasive procedure for hemorrhoids (MIPH) should be used as standard treatment for grade II, III, IV hemorrhoids, as good patient compliance is increasing.

5) Randomized trial and long-term follow-up warrant to determine
possible surgical and functional outcome.