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HOLISTIC PRESCRIPTION

DR.SHRINIWAS KASHALIKAR
As we go on evolving; we begin to appreciate that a doctor�s prescription has to be aimed at healing; the body, instincts, emotions, motivations, thoughts, vision and behavior of an individual; and also the society.
This is because; just as the health of an individual affects the health of society; the vice versa is also true. Not only the international, national, regional and local policies, plans and programs in health care (which obviously influence the health of an individual); but also; those in different fields; such as education, agriculture, industry; influence the health of an individual.
Hence ideally; the prescription should include guidelines; to the patient; about preventive and curative measures; but also to the policy makers of health care and other fields.
However; all the details of such guidelines cannot be expected from the treating doctor, who is trained merely in a particular field of medicine such as Homeopathy, Naturopathy, Ayurveda or Allopathy.
In such a situation; there has to be a �key instruction� that can �inspire� the appropriate guidelines in the patient (who may be a policy maker of education, practice, research, production and marketing; in all health care and other fields; or a common individual).
The essential core of such key instruction has to be; its potential to �free� any individual; from subjective and sectarian perspective, thinking, policy making, planning and behavior; and empower him or her to be objective and holistic and conceive the appropriate preventive and curative measures.
After decades of extensive study, research and experimentation for such a �key instruction�, which would be common to all prescriptions and making them holistic; I found one; to my satisfaction. This �key instruction� is nothing else; but the traditional, simple, inexpensive and universally practicable practice of NAMASMARAN (JIKRA, JAAP, JAP, SIMARAN, SUMIRAN or remembering God�s name i.e. one's true self)!
NAMASMARAN rectifies our physical needs, passions, feelings, motivations, thoughts; and vision (perspective) and thus rectifies our behavior. This in turn leads to a continuous development of holistic health, which means; prosperity and profundity in individual and social life i.e. individual and global blossoming.
However; NAMASMARAN is not a pill or a tincture; and does not produce any tangible results! It is an invisible and intangible process of reaching and rejuvenating the seed (NAMA); of the tree (our individual and universal existence); and flowering and fruiting (in the form individual and universal blossoming).
I am away from holistic health. But like an ailing doctor; I too can prescribe this �key instruction� to the doctors, parents, teachers, leaders; to make their prescriptions to their patients, children, students and followers respectively; holistic! As it is from my Guru, and I won�t be at peace without doing so!

STRESS AND NAMA SANKALP

DR SHRINIWAS KASHALIKAR
We often feel that the ultimate destination of life; is beyond SANKALP (a kind of motivation, purpose, plan, aspiration, desire, ambition, determination etc, which leads to a variety of activities in life). Hence; we are often skeptical and/or cynical about NAMASANKALP (a planning of specific count in certain specific time; of NAMASMARAN); by an individual or a group.
Even as this is natural; we have to realize that; most of us; are not really freed from every kind of SANKALP. In fact; we are knowingly or unknowingly; and consciously or subconsciously involved; in several trivial preoccupations, which drag us away from our true selves. This is a root cause of stress, which manifests in different ways.
These preoccupations cannot be conquered by any voluntary effort; as they are intricately mingled with our ego.
This can only be done; if we consciously adopt a powerful SANKALP; that can nullify these preoccupations and catalyze surrender to our Guru (Self realization, Total Stress Management)! Such infinitely powerful SANKALP; is the time tested NAMASANKALP. This can save us from succumbing to our ego and stress; and empower us to reach the ultimate destination of life; beyond SANKALP!

We need not believe in this; but verify it by practice.

What Is an Incisional Hernia?
An incisional hernia happens when a weakness in the muscle of the abdomen allows the tissues of the abdomen to protrude through the muscle. The hernia appears as a bulge under the skin, and can be painful or tender to the touch. In the case of an incisional hernia, the weakness in the muscle is caused by the incision made in a prior abdominal surgery. An incisional hernia is typically small enough that only the peritoneum, or the lining of the abdominal cavity, pushes through. In severe cases, portions of organs may move through the hole in the muscle.
Who Is At Risk For an Incisional Hernia?
Incisional hernias are most likely to occur in obese and pregnant patients. A history of multiple abdominal surgeries may increase the risk of an incisional hernia. If a hernia develops in the abdomen and the patient has not had surgery, it is not an incisional hernia.
A patient who gains significant weight after an abdominal surgery, becomes pregnant or participates in activities that increase abdominal pressure like heavy lifting is most at risk for an incisional hernia. The incision is weakest, and most prone to a hernia, while it is still healing. While incisional hernias can develop or enlarge months or years after surgery, they are most likely to happen 3-6 months after surgery.

Diagnosing an Incisional Hernia
Incisional hernias happen after an abdominal surgery and may seem to appear and disappear, which is referred to as a "reducible" hernia. The hernia may not be noticeable unless the patient is involved in an activity that increases abdominal pressure, such as coughing, sneezing, pushing to have a bowel movement, or lifting a heavy object. The visibility of a hernia makes it easily diagnosable, often requiring no testing outside of a physical examination by a physician. The physician may request that you cough or bear down in order to see the hernia while it is "out".
Routine testing can be done to determine what area of the body is pushing through the muscle. If the hernia is large enough to allow more than the peritoneum to bulge through, testing may be required.
Incisional Hernia Treatment
An incisional hernia may be small enough that surgical repair is an option, not a necessity. If the hernia is large, causes pain or is steadily growing, surgery may be recommended. Another option is a truss, a garment that is similar to a weight belt or girdle, that applies constant pressure to the hernia.

When Is Incisional Hernia Surgery Necessary?
An Incisional hernia may require surgery if:
It continues to enlarge over time
It is very large
It is cosmetically unappealing
The bulge remains even when the patient is relaxed or laying down
The hernia causes pain

When Is Incisional Hernia an Emergency?
A hernia that gets stuck in the �out� position is referred to as an incarcerated hernia. While an incarcerated hernia may not be an emergency, medical care should be sought as it can become an emergency quickly. An incarcerated hernia becomes an emergency when it becomes a �strangulated hernia� where the tissue that bulges out is being starved of its blood supply. Untreated, a strangulated hernia can cause the death of the tissue that is bulging through the hernia.
A strangulated hernia can be identified by the deep red or purple color of the bulging tissue. It may be accompanied by severe pain, but is not always painful. Nausea, vomiting, diarrhea and abdominal swelling may also be present.

Incisional Hernia Surgery
Incisional hernia surgery is typically performed using general anesthesia and is done on an inpatient basis. The surgery is typically performed using the laparoscopic method, using small incisions rather than the traditional large open incision. Surgery is performed by a general surgeon or a colon-rectal specialist.

Once anesthesia is given, surgery begins with an incision on either side of the hernia. A laparoscope is inserted into one incision, and the other incision is used for additional surgical instruments. Dr. B C Shah then isolates the portion of the abdominal lining that is pushing through the muscle. This tissue is called the �hernia sac�. Dr. B C Shah returns the hernia sac to its proper position, then begins to repair the muscle defect.
If the defect in the muscle is small, it may be sutured closed. The sutures will remain in place permanently, preventing the hernia from returning. For large defects, the Dr. B C Shah may feel that suturing is not adequate. In this case, a mesh graft will be used to cover the hole. The mesh is permanent and prevents the hernia from returning, even though the defect remains open.
If the suture method is used with larger muscle defects (approximately the size of a quarter or larger), the chance of reoccurrence is increased. The use of mesh in larger hernias is the standard of treatment, but it may not be appropriate if the patient has a history of rejecting surgical implants or a condition that prevents the use of mesh.
Once the mesh is in place or the muscle has been sewn, the laparoscope is removed and the incision can be closed. The incision is typically closed with sutures that are removed at a follow up visit with the Dr. B C Shah, a special form of glue that is used to hold the incision closed without sutures or small sticky bandages called steri-strips.

Recovering From Incisional Hernia Surgery
Most hernia patients are able to return to their normal activity within two to four weeks. The belly will be tender, especially for the first week. During this time the incision should be protected during activity that increases abdominal pressure by applying firm but gentle pressure on the incision line. This is especially important for incisional hernia patients, as they are predisposed to an incisional hernia and can be at risk for another one at the new incision sites.
Activities during which the incision should be protected include:
Rising from a seated position
Sneezing
Coughing
Bearing down during a bowel movement. Contact Dr. B C Shah if you are constipated after surgery, a stool softener may be prescribed.
Vomiting
Lifting heavy objects

Introduction

Colectomy is a surgical procedure to remove all or part of your colon. Your colon, also called your large intestine, is a long tube-like organ at the end of your digestive system. Colectomy may be necessary to treat or prevent diseases and conditions that affect your colon.

There are various types of colectomy operations:

Total colectomy involves removing the entire colon.
Partial colectomy involves removing part of the colon and may also be called subtotal colectomy.
Hemicolectomy involves removing the right or left portion of the colon.
Proctocolectomy involves removing both the colon and rectum.
Colectomy surgery usually requires other procedures to reattach the remaining portions of your digestive system and permit waste to leave your body.
Why it's done
Colectomy is used to treat and prevent diseases and conditions that affect the colon, such as:

Bleeding that can't be controlled. Severe bleeding from the colon may require surgery to remove the affected portion of the colon.
Bowel obstruction. A blocked colon is an emergency that may require total or partial colectomy, depending on the situation.
Colon cancer. Early-stage cancers may require only a small section of the colon to be removed during colectomy. Cancers at a later stage may require more of the colon to be removed.
Crohn's disease. If medications aren't helping you, removing the affected part of your colon may offer temporary relief from signs and symptoms. Colectomy may also be an option if precancerous changes are found during a test to examine the colon (colonoscopy).
Ulcerative colitis. Dr. B C Shah may recommend total colectomy if medications aren't helping to control your signs and symptoms. Colectomy may also be an option if precancerous changes are found during a colonoscopy.
Diverticulitis. Dr. B C Shah may recommend surgery to remove the affected portion of the colon if your diverticulitis recurs or if you experience complications of diverticulitis.
Preventive surgery. If you have a very high risk of colon cancer due to the formation of multiple precancerous colon polyps, you may choose to undergo total colectomy to prevent cancer in the future. Colectomy may be an option for people with inherited genetic conditions that increase colon cancer risk, such as familial adenomatous polyposis or Lynch syndrome.
Discuss your treatment options with Dr. B C Shah. In some situations, you may have a choice between various types of colectomy operations. Dr. B C Shah can discuss the benefits and risks of each.
Risks
Colectomy carries a risk of serious complications. Your risk of complications is based on your general health, the type of colectomy you undergo and the approach your surgeon uses to perform the operation. In general, complications of colectomy can include:

Bleeding
Blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism)
Infection
Injury to organs near your colon, such as the bladder and small intestines
Tears in the sutures that reconnect the remaining parts of your digestive system
You'll spend time in the hospital after your colectomy to allow your digestive system to heal. Your health care team will also monitor you for signs of complications from your surgery. You may spend a few days to a week in the hospital, depending on your condition and your situation.

How you prepare
During the days leading up to your colon surgery, Dr. B C Shah may ask that you:
Stop taking certain medications. Certain medications can increase your risk of complications during surgery, so Dr. B C Shah may ask that you stop taking those medications before your surgery.
Fast before your surgery. Dr. B C Shah will give you specific instructions. You may be asked to stop eating and drinking several hours to a day before your procedure.
Drink a solution that clears your bowels. Dr. B C Shah may prescribe a laxative solution that you mix with water at home. You drink the solution over several hours, following the directions. The solution causes diarrhea to help empty your colon. Dr. B C Shah may also recommend enemas.
Take antibiotics. In some cases, Dr. B C Shah may prescribe antibiotics to suppress the bacteria found naturally in your colon and to help prevent infection.
Preparing for colectomy isn't always possible. For instance, if you need an emergency colectomy due to bowel obstruction or bowel perforation, there may not be time to prepare.

Plan for your hospital stay
You'll spend at least a few days in the hospital after your colectomy, depending on your situation. Make arrangements for someone to take care of your responsibilities at home and at work.

Think ahead to what you might like to have with you while you're recovering in the hospital. Things you might pack include:
A robe and slippers
Toiletries, such as your toothbrush and toothpaste or, if needed, your shaving supplies
Comfortable clothes to wear home
Activities to pass the time, such as a book, magazine or games
What you can expect

During your colectomy

On the day of your surgery, your health care team will take you to a preparation room. Your blood pressure and breathing will be monitored. You may receive an antibiotic medication through a vein in your arm.
You're then taken to an operating room and positioned on a table. You'll be given a general anesthesia medication to put you in a sleep-like state so that you won't be aware during your operation.
The surgical team then proceeds with your colectomy. Colon surgery may be performed in two ways:
Open colectomy. Open surgery involves making a longer incision in your abdomen to access your colon. Dr. B C Shah uses surgical tools to free your colon from the surrounding tissue and cuts out either a portion of the colon or the entire colon.
Laparoscopic colectomy. Laparoscopic colectomy, also called minimally invasive colectomy, involves several small incisions in your abdomen. Dr. B C Shah passes a tiny video camera through one incision and special surgical tools through the other incisions. He watches a video screen in the operating room as the tools are used to free the colon from the surrounding tissue. The colon is then brought out through a small incision in your abdomen. This allows Dr. B C Shah to operate on the colon outside of your body. Once repairs are made to the colon, he reinserts the colon through the incision.
The type of operation you undergo depends on your situation and your surgeon's expertise. Laparoscopic colectomy may reduce the pain and recovery time after surgery. But not everyone is a candidate for this procedure. Also, in some situations your operation may begin as a laparoscopic colectomy, but circumstances may force your surgical team to convert to an open colectomy.
Once the colon has been repaired or removed, your surgeon will reconnect your digestive system to allow your body to expel waste. Options may include:
Rejoining the remaining portions of your colon. The Dr. B C Shah may stitch the remaining portions of your colon together, creating what is called an anastomosis. Stool then leaves your body as before.
Connecting your intestine to an opening created in your abdomen. Dr. B C Shah may attach your colon (colostomy) or small intestine (ileostomy) to an opening created in your abdomen. This allows waste to leave your body through the opening (stoma). You may wear a bag on the outside of the stoma to collect stool. This can be permanent or temporary.
Connecting your small intestine to your anus. After removing both the colon and the rectum (proctocolectomy), Dr. B C Shah may use a portion of your small intestine to create a pouch that is attached to your anus (ileoanal anastomosis). This allows you to expel waste normally, though you may have several watery bowel movements each day. As part of this procedure, you may undergo a temporary ileostomy.
Dr. B C Shah will discuss your options with you before your operation.
After your colectomy
After surgery you'll be taken to a recovery room to be monitored as the anesthesia wears off. Then Dr. B C Shah will take you to your hospital room to continue your recovery.
You'll stay in the hospital until you regain bowel function. This may take a couple of days to a week. You may not be able to eat solid foods at first. You might receive liquid nutrition through a vein in your arm and then transition to drinking clear liquids. As your intestines recover, you can eventually add solid foods.
If your surgery involved a colostomy or ileostomy to attach your intestine to the outside of your abdomen, Dr. B C Shah will show you how to care for your stoma. He will explain how to change the ostomy bag that will collect waste.
Once you leave the hospital, expect a couple of weeks of recovery at home. You may feel weak at first, but eventually your strength will return. Ask Dr. B C Shah when you can expect to get back to your normal routine.

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Second Opinion Home � Disease Information � Spleen Removal (Splenectomy)
Posted in Disease Information

Spleen Removal (Splenectomy)


What is a splenectomy?

A splenectomy refers to taking out the spleen in surgery. Removing part of the spleen is called a partial splenectomy. Removing all of the spleen is called a total splenectomy.

What is a spleen?

The spleen is an organ that is located on the upper left side of the abdomen. About the size of a fist, the spleen is important because it helps fight infection in the body by filtering the blood. Another function is the storage of blood cells. The spleen keeps blood flowing to the liver.

Why would you need to have your spleen removed?

A splenectomy is recommended as a treatment for some conditions that cause hypersplenism and might be recommended as a treatment for others. Hypersplenism is not a disease itself, but is more of a syndrome, or a collection of symptoms. It means that the spleen has become overactive, enlarged, and is storing and destroying too many blood cells and platelets.

When is a splenectomy recommended?

There are two reasons that a spleen is always removed: to treat primary cancers of the spleen and to treat a disease called hereditary spherocytosis.

Hereditary spherocystosis (HS) is an inherited disease that involves the lack of ankyrin a specific protein, and the formation of abnormally-shaped red blood cells, called spherocytes. Spherocytes do not move as easily as they should and end up staying longer in the spleen. This almost always increases the size of the spleen. An enlarged spleen is called splenomegaly. The cells eventually become damaged and results in anemia and jaundice. Children with HS are given folic acid supplements on a daily basis. The spleen is removed after a child reaches the age of five.

Other conditions that are often treated with splenectomy

�Idiopathic thrombocytopenic purpura, a disease in which antibodies kill off platelets. The reason that the antibodies form is not known.
�Trauma, such as injury due to an auto accident
�Spleen with an abscess (collection of pus due to infection)
�Splenic artery rupture, possible during pregnancy
�Sickle cell disease (a blood disorder that is characterized by sickle-shaped, rather than disc-shaped, red blood cells)
�Thalassemia (inherited blood disorder resulting in inadequate hemoglobin production)
How are spleen disorders diagnosed?

�Blood tests
�Physical examination (an enlarged spleen may be felt by Dr. B C Shah)
�Imaging tests such as ultrasounds, X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans
�Bone marrow tissue biopsy
Removal of spleen tissue is not advisable due to the possibility of excessive bleeding.

How are spleens removed?

In most cases, splenectomies can be performed as laparoscopic surgeries if the spleen is not too enlarged. Using this technique, a tube is inserted into the abdomen and the space inflated with carbon dioxide. Dr. B C Shah will place other tubes into the abdomen through other small holes, allowing the placement of instruments. The spleen is cut free of all of connections, put inside a special bag and pulled through one of the largest holes in the abdomen.

If the spleen is too large for laparoscopic removal, the spleen will be taken out in an "open" procedure with a single larger incision. In addition to spleen size, Dr. B C Shah fmight opt for an open procedure if there is a lot of scar tissue from previous procedures, if there is an ability to see clearly enough to perform laparoscopy, or if there are bleeding problems. This decision may be made prior to or during surgery.

What are the possible complications of splenectomy?

Possible complications include the usual risks of all surgeries, including infection. There is also a risk of pneumonia or pancreatitis (inflammation of the pancreas). Immediately after the surgery, the patient is likely to be put on medications to prevent infection.

After having a splenectomy, the patient must always be extra careful about infections. Dr. B C Shah is likely to have immunized the patient before surgery. Other likely recommendations include:

�Have a pneumonia vaccine about every five years.
�Have yearly flu shots.
�A child who has had his or her spleen removed may be put on antibiotics for two to several years after the surgery, possibly until adulthood.
�Contact Dr. B C Shah immediately if you have a fever or other indications of infection.
�Avoid travel to places where you could contract malaria.