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Apr28
Gallstone Ileus
Gallstone ileus is obstruction of the bowel due to impaction of one of more gallstones. To achieve this, stones usually have to be at least 2.5 cm in diameter.
A fistula develops between a gangrenous gallbladder and the duodenum or other parts of the gastrointestinal tract, allowing passage of the stone. Occasionally the stone may enter the intestine through a fistulous communication between the bile duct and the gastrointestinal tract. Stones less than 2.5 cm in diameter may traverse the alimentary canal without causing obstruction. When the gallstone lodges in the duodenum and causes gastric outlet obstruction, it is called Bouveret's syndrome.
Read more : - http://drbcshah.com/gallstone-ileus/


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Jan27
Sebaceous Cyst Removal
Sebaceous cysts (epidermal cysts) may be a foreign term to you, but many women have indeed experienced them — perhaps without really knowing what they were at the time.
Sebaceous cysts are small lumps or bumps just under the skin. To be more specific, they are closed sacs that contain keratin — a "pasty" or "cheesy" looking protein that often has a foul odor.
Although they are usually found on the face, neck, and trunk, they also occur in the vaginal area or other parts of the genitalia. In cases of the latter, it is not uncommon for women to fear that they are the result of genital herpes. But genital herpes create a blister-type sore that eventually becomes crusty, not just a bump or lump under the skin.

What Causes Sebaceous Cysts?
Sebaceous cysts are often the result of swollen hair follicles or skin trauma.

Symptoms and Signs/Symptoms of Infection

Sebaceous cysts are usually painless, slow-growing, small bumps or lumps that move freely under the skin. It's important not to touch or try to remove the substance inside to prevent tenderness, swelling, and infection of a sebaceous cyst.
Occasionally, infections may occur. Signs or symptoms that may indicate infection of sebaceous cysts include:
Redness
Tenderness
Increased temperature of the skin over the bumps or lumps
Greyish white, cheesy, foul-smelling material draining from the bump or lump

How Are Sebaceous Cysts Diagnosed ?

Sebaceous cysts, to the trained eye, are usually easily diagnosed by their appearance. In some cases, a biopsy may be necessary to rule out other conditions with a similar appearance. You should see your doctor to get a formal diagnosis if you suspect that you have a sebaceous cyst.

Treatments for Sebaceous Cysts

Sebaceous cysts most often disappear on their own and are not dangerous. As stated, however, they may become inflamed and tender. Sometimes sebaceous cysts grow large enough that they may interfere with your everyday life. When this happens, surgical removal may be necessary, and this procedure can be done at your doctor's office. Small inflamed cysts can often be treated with an injection of steroid medications or with antibiotics.

Complications of Sebaceous Cysts

If sebaceous cysts become infected, they can form into painful abscesses.
The surgical removal of a sebaceous cyst that does not involve the excision of the entire sac may cause the cyst to come back (although, recurrence is not usual).
Remember to consult Dr. B C Shah anytime you notice any type of growth, bump, or lump on your body. Although sebaceous cysts are not dangerous, your doctor should examine you to ensure that another more dangerous concern is not present.

- See more at: http://drbcshah.com/sebaceous-cyst-removal/#sthash.FpyyRl4g.dpuf


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Jan22
Colonoscopy
A colonoscopy is an internal examination of the colon (large intestine) and rectum, using an instrument called a colonoscope.

The colonoscope has a small camera attached to a flexible tube that can reach and examine the entire length of the colon.

How the Test is Performed

You will usually be given medicine into a vein to help you relax and not feel any discomfort. You will be awake during the test and may even be able to speak, but you will likely not remember anything.

You will lie on your left side with your knees drawn up toward your chest. The colonoscope is inserted through the anus. It is gently moved into the beginning of the large bowel and slowly moved as far as the lowest part of the small intestine.

Air will be inserted through the scope to provide a better view. Suction may be used to remove fluid or stool.

Because Dr. B C Shah gets a better view as the colonoscope is pulled back out, a more careful examination is done while the scope is being pulled out. Tissue samples may be taken with tiny biopsy forceps inserted through the scope. Polyps may be removed with snares, and photographs may be taken.

Specialized procedures, such as laser therapy, may also be done.

See more at: http://drbcshah.com/colonoscopy/


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Jan18
512 stones found in Gall bladder
(Dr. B C Shah recently performed Laparoscopic Cholecystectomy on Mr. N_____ G______ who had 512 stones!)

Mr. N_____ G______ came to me with history of chronic pain in upper abdomen. The pain would get aggravated after meals. His sonography revealed that his gall bladder was distended & full of stones. I performed Laparoscopic Cholecystectomy on him. It was a difficult case as there were lot of adhesions. The gall bladder was delivered successfully It was a pleasant surprise to find 512 stones in the Gall Bladder.

One often wonders as to why patients wait so long. Many times patients come to me with Gall Stones. Often they have only one small stone. The common question asked is "Do I still need surgery for just a small stone?"

As per my observation of last 23 years, one stone or many stones – all have a potential to create complications including even death. Its not just the numbers or size. One small stone can just simply slip into the bile duct and is sufficient to trigger Pancreatitis. I personally know of a patient who developed severe pancreatitis due to a 3 mm small stone. She battled for two months in one of the best hospitals in Mumbai and ultimately died.

In kidney stones, one of the criteria on which the therapy is based is the number of stones and its size. Smaller stones can pass out spontaneously and the patient's problem gets solved naturally. However, this is not the situation with gall stones. A gall stone or its fragment passing out can be dangerous as it can cause blockage of bile in liver or swelling in pancreas. Such complications can occur any time and no doctor on earth can predict when this will occur.

Many patients wait for the stones to grow and multiply. Surely this has a potential of inviting big untimely trouble. Don't wait. There are no warning signs.As far as records go, the largest number of gallstones removed was 3,110 in an open surgery in Britain in 1983, reported in the Guinness Book of World Records.

- See more at: http://drbcshah.com/512-stones-found-in-gall-bladder/


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Jan15
Intestinal Obstruction due to Stones
MRS R____ K____ , a 55 year old female was transferred from a local nursing home

She was admitted in a local Nursing home with abdominal pain & vomiting. She was treated as a case of acidity. In spite of the treatment for a week, she did not improve.

When she came to me, her symptoms were suggestive of intestinal obstruction (blockage). A CT scan of abdomen was undertaken. CT scan revealed that she had intestinal obstruction due to a large 5 centimeter stone. This is called Gall stone ileus.

How did the stone land up in her intestine?

No it was not a swallowed stone. This stone had formed in her Gall Bladder over many years. Due to its weight & chronic inflammation, the stone gradually perforated into her small intestine (duodenum). Since the stone was very large it could not pass thro the small intestine and got stuck in the last part of small intestine. Patient was having pain & constantly vomiting due to this blockage.

The treatment was done using minimal access surgery instead of making a big cut on her abdomen – laparotomy. Using laparoscopy, the site of blockage was identified. A small incision was made on her abdomen. The stone was cut open from the intestine (enterolithotomy) and the intestine was placed back into the abdomen.

The blockage was cleared and the patient recovered smoothly and was discharged in few days.

See more at: http://drbcshah.com/intestinal-obstruction-due-to-stones/


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Jan13
Hernia Becomes Gangrenous
Often Indian ladies have large bellies. Common causes are multiple pregnancies, sedentary lifestyle, poor physical exercises and health neglect. At times scars on abdomen of surgeries compound the weakness of the tummy.

It is not uncommon to notice a protrusion (hernia) thro natural scar (umbilicus) or surgical scars. "My mom also had it" is a common answer which denotes that they have a metabolic error whereby the scars are inherently formed weak. They move around with such bulges on their huge tummies. At times there is no umbilicus visible because of huge hernias. At times they are huge protrusions of the intestines and other contents.

So when the patients are advised to get operated their argument is that so many have it and for so many years they are carrying on without any complaints, so why operate? Well the reason to get it operated is that slowly all of them grow. More and more contents of the tummy start protruding out and one day it becomes so tight or overcrowded that they get strangulated and there is no space for blood to nourish the intestines and other contents. Thus a simple problem gets complicated. The patient all of a sudden suffers from great pain as a result has to be rushed to the hospital. The surgery becomes lengthy and riskier. The recovery period increases and so does the cost. Why wait so long?

- See more at: http://drbcshah.com/hernia-becomes-gangrenous/


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Jul27
Post radiation bowel perforation
At times treating a patient of cancer in abdomen can be a nightmare for the surgeon. Multiple operations and radiations performed as a treatment for cancer changes the anatomy and physiology of abdomen. Now in this situation if a patient comes with a perforation in the bowel becomes a tough challenge to the surgeon.
I recently has to operate such patient. He has sever pain and his bowel had perforated due to radiation effect.There was no virgin area left due to multiple operations. I had to find a relatively safer place to enter my thin laparoscope for visualization of inside mystery. Gradually I explored his abdomen and located the perforation. I made a small incision on his skin to deliver the diseased bowel out. I sutured the hole in the small intestine and placed it back.
This way a major opening up was avoided. The patient's sister who happened to be a doctor was very happy that I could solve the problem with minimal cutting. The recovery was uneventful and patient resumed his previous lifestyle very quickly. This was his quickest recovery compared to all his multiple previous surgeries.
- See more at: http://drbcshah.com/post-radiation-bowel-perforation/#sthash.prZ9VOOL.dpuf


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Jul04
Waited too long
I got a call from emergency that a 32 year old female had come with severe pain in abdomen & vomiting. She had pain since five days and no she was also running fever. I went to examine her. She looked familiar. She had my old case papers. She meet me couple of years back. She had Gallstones but refused to get operated because she said it was hardly causing any symptoms.She felt that the stones were very small and her granny had carried all her life without any trouble. Now she had come with big complication. Her gall bladder stone had impacted in the neck choking the gall bladder. As a result the gall bladder was full of pus, a condition called Empyema of the gall bladder. To complicate the matters she had since her delivery developed diabetes. I took her up for an emergency laparoscopy surgery. First I evacuated the pus. his allowed me the hold & move the gall bladder so as to dissect it out from the liver. I delivered the gall bladder successfully. Took me double the average time. I had to keep a drainage tube so that the toxins from her abdomen will gradually come out. I had to keep a nasogastric tube so as to avoid fluid and gas accumulation. There was not much blood loss. She took longer time to recover but eventually did very well. If she has got operated couple of years back, she would have recovered faster and would have spend much less money. - See more at: http://drbcshah.com/waited-too-long/#sthash.YqOrR8J4.dpuf


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Jun10
Rectal Cancer (Bowel Cancer)
Introduction
Bowel cancer is a general term for cancer that begins in the large bowel. Depending on where the cancer starts, bowel cancer is sometimes called colon cancer or rectal cancer.
Symptoms of bowel cancer include blood in your stools (faeces), an unexplained change in your bowel habits, such as prolonged diarrhoea or constipation, and unexplained weight loss.
Cancer can sometimes start in the small bowel (small intestine), but small bowel cancer is much rarer than large bowel cancer.
Who is affected by bowel cancer?
Bbowel cancer is the third most common type of cancer.
Approximately 72% of bowel cancer cases develop in people who are 65 or over. Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum.
Who's at risk?
Things that increase your risk of getting bowel cancer include:
Age – around 72% of people diagnosed with bowel cancer are over 65
Diet – a diet high in fibre and low in saturated fat could reduce your bowel cancer risk, a diet high in red or processed meats can increase your risk
Healthy weight – leaner people are less likely to develop bowel cancer than obese people
Exercise – being inactive increases the risk of getting bowel cancer
Alcohol and smoking – high alcohol intake and smoking may increase your chances of getting bowel cancer
Family history and inherited conditions – aving a close relative with bowel cancer puts you at much greater risk of developing the disease.
Related conditions – having certain bowel conditions can put you more at risk of getting bowel cancer
Bowel cancer screening
Currently, everyone between the ages of 60 and 69 should go for bowel cancer screening every two years.
Screening is carried out by taking a small stool sample and testing it for the presence of blood (faecal occult blood test).
In addition, an extra screening test is being introduced over the next three years for all people at age 55. This test involves a camera examination of the lower bowel called a flexible sigmoidoscopy.
Screening plays an important part in the fight against bowel cancer because the earlier the cancer is diagnosed, the greater the chance it can be cured completely.
Treatment and outlook
Bowel cancer can be treated using a combination of surgery, chemotherapy, radiotherapy and, in some cases, biological therapy. As with most types of cancer, the chance of a complete cure depends on how far the cancer has advanced by the time it is diagnosed.
If bowel cancer is diagnosed in its earliest stages, the chance of surviving a further five years is 90%, and a complete cure is usually possible. However, bowel cancer diagnosed in its most advanced stage only has a five-year survival rate of 6% and a complete cure is unlikely.
Signs and symptoms of bowel cancer
Early bowel cancer may have no symptoms and some symptoms of later bowel cancer can also occur in people with less serious medical problems, such as haemorrhoids(piles).
See Dr. B C Shah if you notice any of the symptoms below.
The initial symptoms of bowel cancer include:
Blood in your stools (faeces) or bleeding from your rectum
A change to your normal bowel habits that persists for more than three weeks, such as diarrhoea, constipation or passing stools more frequently than usual
Abdominal pain
Unexplained weight loss
As bowel cancer progresses, it can sometimes cause bleeding inside the bowel. Eventually, this can lead to your body not having enough red blood cells. This is known as anaemia.
Symptoms of anaemia include:
Fatigue
Breathlessness
In some cases, bowel cancer can cause an obstruction in the bowel. Symptoms of a bowel obstruction include:
A feeling of bloating, usually around the belly button
Abdominal pain
Constipation
Vomiting
When to seek medical advice
Visit Dr. B C Shah if you have any of the symptoms above. While the symptoms are unlikely to be the result of bowel cancer, these types of symptoms always need to be investigated further.
Causes of bowel cancer
Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.
Most cases of bowel cancer first develop inside clumps of cells on the inner lining of the bowel. These clumps are known as polyps. However, if you develop polyps, it does not necessarily mean you will get bowel cancer.
Exactly what causes cancer to develop inside the bowel is still unknown. However, research has shown several factors may make you more likely to develop it.
Family history
There is evidence that bowel cancer can run in families. Around 20% of people who develop bowel cancer have a close relative (mother, father, brother or sister) or a second-degree relative (grandparent, uncle or aunt) who have also had bowel cancer.
It is estimated that if you have one close relative with a history of bowel cancer, your risk of getting bowel cancer is doubled. If you have two close relatives with a history of bowel cancer, your risk increases four-fold.
Diet
A large body of evidence suggests a diet high in red and processed meat can increase your risk of developing bowel cancer. For this reason, the Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams.
There is also good evidence that a diet high in fibre and low in saturated fat could help reduce your bowel cancer risk. Cancer experts think this is because this type of diet encourages regular bowel movements.
Smoking
People who smoke cigarettes are 25% more likely to develop bowel cancer, other types of cancer and heart disease than people who do not smoke.
Alcohol
A major study, called the EPIC study, showed alcohol was associated with bowel cancer risk. Even small amounts of alcohol can put you at higher risk of getting bowel cancer. The EPIC study found that for every two units of alcohol a person drinks each day, their risk of bowel cancer goes up by 8%.
Obesity
Obesity is linked to an increased risk of bowel cancer. Obese men are 50% more likely to develop bowel cancer than people with a healthy weight. Morbidly obese men, who have a body mass index (BMI) of over 40, are twice as likely to develop bowel cancer.
Obese women have a small increased risk of developing the condition, and morbidly obese women are 50% more likely to develop bowel cancer than women with a healthy weight.
Inactivity
People who are physically inactive have a higher risk of developing bowel cancer. You can help reduce your risk of bowel and other cancers by being physically active every day. Your risk could be cut by up to one-fifth if you do an hour of vigorous exercise every day or two hours of moderate exercise (such as vacuum cleaning or brisk walking).
Digestive disorders
Some conditions may put you at a higher risk of developing bowel cancer. People with Crohn’s disease are 2-3 times more likely to develop bowel cancer. The risk of developing bowel cancer is much higher in people with ulcerative colitis, and as many as 1 in 20 of these people will go on to develop it.
Genetic conditions
There are two rare inherited conditions that can cause bowel cancer. They are:
Familial adenomatous polyposis (FAP)
Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome
FAP affects 1 in 10,000 people. The condition triggers the growth of non-cancerous polyps inside the bowel. Although the polyps are non-cancerous, there is a high risk that, over time, at least one will turn cancerous. Almost all people with FAP will have bowel cancer by the time they are 50 years of age.
People with FAP have such a high risk of getting bowel cancer, they are often advised to have their large bowel removed by surgery before they reach the age of 25. Families affected can find support and advice from the FAP registry at St Mark’s Hospital, London.
HNPCC is a type of bowel cancer caused by a mutated gene. An estimated 2-5% of all cases of bowel cancer are due to HNPCC. Around 90% of men and 70% of women with the
As with FAP, removing the bowel as a precautionary measure is usually recommended in people with HNPCC.
Diagnosing bowel cancer
When you first see Dr. B C Shah he will ask about your symptoms and whether you have a family history of bowel cancer.
Dr. B C Shah will then carry out a physical examination known as a digital rectal examination (DRE). A DRE involves Dr. B C Shah gently placing a finger into your anus, and then up into your rectum.
A DRE is a useful way of checking whether there is a noticeable lump inside your rectum. This is found in an estimated 40-80% of cases of rectal cancer.
A DRE is not painful, but some people may find it a little embarrassing.
If your symptoms suggest you may have bowel cancer, or the diagnosis is uncertain, you will be referred to your local hospital for further examination.
Further examination
Two tests are commonly used to confirm a diagnosis of bowel cancer:
A sigmoidoscopy is an examination of your rectum and some of your large bowel.
A colonoscopy is an examination of all of your large bowel.
Sigmoidoscopy
A sigmoidoscopy uses a device called a sigmoidoscope, which is a thin, flexible tube attached to a small camera and light.
The sigmoidoscope is inserted into your rectum and then up into your bowel. The camera relays images to a monitor. This allows the doctor to check for any abnormal areas within the rectum or bowel that could be the result of cancer.
A sigmoidoscopy can also be used to remove small samples of suspected cancerous tissue so they can be tested in the lab. This is known as a biopsy.
A sigmoidoscopy is not usually painful, but can feel uncomfortable. Most people go home after the examination has been completed.
Colonoscopy
A colonoscopy is similar to a sigmoidoscopy except a longer tube, called a colonoscope, is used to examine your entire bowel.
Your bowel needs to be empty when a colonoscopy is performed, so you will be given a special diet to eat for a few days before the examination and a laxative (medication to help empty your bowel) on the morning of the examination.
You will be given a sedative to help you relax, after which the doctor will insert the colonoscope into your rectum and move it along the length of your large bowel. As with a sigmoidoscope, the colonoscope can be used to obtain a biopsy, as well as relaying images of any abnormal areas.
A colonoscopy usually takes about one hour to complete, and most people can go home once they have recovered from the effects of the sedative. After the procedure, you will probably feel drowsy for a while, so arrange for someone to accompany you home.
Further testing
If a diagnosis of bowel cancer is confirmed, further testing is usually carried out for two reasons:
to check if the cancer has spread from the bowel to other parts of the body
to help decide on the most effective treatment for you
These tests can include:
A computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan to provide a detailed image of your bowel and other organs
Ultrasound scans, which can be used to look inside other organs, such as your liver, to see if the cancer has spread there
Chest X-rays, which can be used to assess the state of your heart and lungs
Blood tests to detect a special protein, known as a tumour marker, released by the cancerous cells in some cases of bowel cancer
Staging and grading
Once the above examinations and tests have been completed, it should be possible to determine the stage and grade of your cancer. Staging refers to how far your cancer has advanced. Grading relates to how aggressive and likely to spread your cancer is.
Stage 1 – the cancer is still contained within the lining of the bowel or rectum
Stage 2 – the cancer has spread into the layer of muscle surrounding the bowel
Stage 3 – the cancer has spread into nearby lymph nodes
Stage 4 – the cancer has spread into another part of the body, such as the liver
This is a simplified guide. Stage 2 is divided into further categories called A and B and stage 3 is divided into A, B and C.
There are three grades of bowel cancer:
Grade 1 is a cancer that grows slowly and has a low chance of spreading beyond the bowel
Grade 2 is a cancer that grows moderately and has a medium chance of spreading beyond the bowel
Grade 3 is a cancer that grows rapidly and has a high chance of spreading beyond the bowel
If you are not sure what stage or grade of cancer you have, ask your doctor.
Treating bowel cancer
People with bowel cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best treatment and care.
The team often consists of a Dr. B C Shah, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist, and you may have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
The type and size of the cancer
Your general health
Whether the cancer has spread to other parts of your body
What grade it is
There are several treatments for bowel cancer, including:
Surgery
Chemotherapy
Radiotherapy
Biological therapy
Surgery is usually the main treatment for bowel cancer, but in about one in five cases, the cancer is too advanced to be removed by surgery. If you have surgery, you may also need chemotherapy, radiotherapy or biological therapy, depending on your particular case.
Your treatment plan
Your recommended treatment plan will depend on the stage and location of your bowel cancer.
If the cancer is confined to your rectum, radiotherapy will usually be used to shrink the tumour, then surgery may be used to remove the tumour. Sometimes, radiotherapy is combined with chemotherapy, which is known as chemoradiation.
If you have stage 1 bowel cancer, it should be possible to surgically remove the cancer and no further treatment will be required.
If you have stage 2 or 3 bowel cancer, surgery may be used to remove the cancer and, in some cases, nearby lymph nodes. Surgery is usually followed by a course of chemotherapy to stop the cancer returning.
It is not usually possible to cure stage 4 (advanced) cancer. However, symptoms can be controlled and the spread of the cancer can be slowed using a combination of surgery, chemotherapy, radiotherapy and biological therapy where appropriate.
Preventing bowel cancer
There are several ways to reduce your risk of developing bowel cancer.
Diet
Research suggests a low-fat, high-fibre diet that includes plenty of fresh fruit and vegetables (at least five portions a day) and wholegrains can help reduce your risk of getting bowel cancer. It can also reduce your risk of developing other types of cancer and heart disease.
It is recommended you do not eat a lot of processed meat and red meat. The Department of Health advises people who eat more than 90 grams (cooked weight) of red and processed meat a day to cut down to 70 grams. .
Exercise
There is strong evidence to suggest regular exercise can lower the risk of developing bowel and other cancers.
It is recommended adults exercise for at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week.
Healthy weight
Try to maintain a healthy weight. Changes to your diet and an increase in physical activities will help keep your weight under control. Find out if you are a healthy weight with the Healthy weight calculator.
Smoking
If you smoke, giving up will reduce your risk of developing bowel and other cancers.
Dr. B C Shah can also provide help, support and advice if you want to give up smoking.
How screening for bowel cancer works
Bowel cancer can be present for a long time before any symptoms appear. If bowel cancer is detected before symptoms appear, it is easier to treat and there is a better chance of surviving the disease.
Screening for bowel cancer called an FOBt (faecal occult blood test) is done at a pathology Lab. A tiny stool samples on a special card. The card is then checked at the laboratory for traces of blood.
Results
There are three types of result:
Normal: no blood was found in the samples. Screening will be offered again in two years’ time.
Unclear: there were possible traces of blood that could be caused by factors other than cancer, such as haemorrhoids (piles) or stomach ulcers. If you have an unclear result, you will be asked to repeat the test kit up to twice more.
Abnormal: blood was definitely found in the samples. Again, this could be from piles or bowel polyps(small growths not usually cancerous). If you have an abnormal result, you will be offered an appointment with Dr. B C Shah to discuss having an examination of the bowel, called a colonoscopy.
Colonoscopy
A colonoscopy is an investigation of the lining of the large bowel (colon). A thin flexible tube with a tiny camera on the end is passed into your bottom and guided around the bowel. Only around 2 in every 100 people completing the FOBt kit will have an abnormal result and will be offered a colonoscopy. Of those who have a colonoscopy, only about one in 10 will have cancer.
New screening test
As well as the FOBt described above, an additional screening test is being rolled out by 2016. This involves inviting people at age 55 to have a one-off flexible sigmoidoscopy test to examine the lower bowel with a camera.
If the flexible sigmoidoscopy shows polyps, the person will then be offered a full colonoscopy . Both FOBt and flexible sigmoidoscopy screening tests have been shown to reduce the risk of dying of bowel cancer.
Living with bowel cancer
Being diagnosed with cancer is a tough challenge for most people. There are several ways to find support to help you cope.
Not all of them work for everybody. but one or more should be helpful:
Talk to your friends and family. They can be a powerful support system.
Get in touch with others in the same situation as you
Learn about your condition
Don't try to do too much at once
Make time for yourself.
Talk to others
Dr. B C Shah may be able to reassure you if you have questions, or you may find it helpful to talk to a trained counsellor, psychologist . Dr. B C Shah will have information on these.
Having cancer can cause a range of emotions. These may include shock, anxiety, relief, sadness and depression. Different people deal with serious problems in different ways. It is hard to predict how knowing you have cancer will affect you. However, you and your loved ones may find it helpful to know about the feelings that people diagnosed with cancer have reported.
Recovering from colon or rectal surgery
Surgeons and anaesthetists have found that using an “enhanced recovery programme” after bowel cancer surgery helps patients recover more quickly.
Most hospitals now use this programme. It involves giving you more information before the operation about what to expect, avoiding giving you strong laxatives to clean the bowel before surgery, and in some cases giving you a sugary drink two hours before the operation to give you energy.
During and after the operation, the anaesthetist controls the amount of IV fluid you need very carefully, and after the operation you will be given painkillers that allow you to get up and out of bed by the next day.
Most people will be able to eat a light diet the day after their operation.
To reduce the risk of deep vein thrombosis (blood clots in the legs), you may be given special compression stockings that help prevent blood clots, or a regular injection with heparin until you are fully mobile.
A nurse or physiotherapist will help you get out of bed and regain your strength so you can go home again within a few days.
With the enhanced recovery programme, most people are well enough to go home within five to six days of their operation. The timing depends on when you and Dr. B C Shah agree you are well enough to go home.
Coping with colostomy
If you need a colostomy, you may feel worried about how you look and how others will react to you. Information and advice about living with a stoma (including stoma care, stoma products and ‘stoma-friendly’ diets) is available via the ileostomy and colostomy topics.
Diet after bowel surgery
If you have had part of your colon removed, it is likely that your stools (faeces) will be looser because one of the functions of the colon is to absorb water from the stools. This may mean that you experience repeated episodes of diarrhoea
You should inform Dr. B C Shah if diarrhoea becomes a problem because medication is available to help control symptoms.
You may find some foods upset your bowels, particularly during the first few months after your operation.
Different foods can upset different people, but food and drink that is commonly known to cause problems include:
Rich and fatty food
Fruit and vegetables that are high in fibre, such as beans, cabbages, apples and bananas
Fizzy drinks, such as cola and beer
You may find it useful to keep a food diary to record the effects of different foods on your bowel.
If you find that you are having continual problems with your bowels as a result of your diet, and/or you are finding it difficult to maintain a healthy diet, you should contact Dr. B C Shah. You may need to be referred to a dietitian for further advice.
Sex and bowel cancers
Having cancer and its treatment may affect how you feel about relationships and sex. Although most people are able to enjoy a normal sex life after bowel cancer treatment, if you have had a colostomy you may feel self-conscious or uncomfortable.
Talking about how you feel with your partner may help you both to support each other. Or you may feel you’d like to talk to someone else about your feelings. Dr. B C Shah will be able to help.
Financial concerns
A diagnosis of cancer can cause money problems because you are unable to work or someone you are close to has to stop working to look after you.
Dealing with dying
If you are told there is nothing more that can be done to treat your bowel cancer, Dr. B C Shah will still provide you with support and pain relief. This is called palliative care. Support is also available for your family and friends.


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May31
Breast Biopsy (Excision)
What is the test?
In an excisional biopsy of the breast, Dr. B C Shah makes an incision in the skin and removes all or part of the abnormal tissue for examination under a microscope. Unlike needle biopsies, a surgical biopsy leaves a visible scar on the breast and sometimes causes a noticeable change in the breast’s shape. It’s a good idea to discuss the placement and length of the incision with your surgeon beforehand. Also ask Dr. B C Shah about scarring and the possibility of changes to your breast shape and size after healing, as well as the choice between local anesthesia and general anesthesia.
How do I prepare for the test?
You’ll undergo a breast exam and possibly a mammogram before the biopsy to determine where the lump is located. If you are having a sedative with local anesthesia, or if you are having general anesthesia, you’ll be asked not to eat anything after midnight on the day before the surgery
Tell Dr. B C Shah if you’re taking insulin, NSAIDs, or any medicine that can affect blood clotting. You might have to stop or adjust the dose of these medicines before your test.
What happens when the test is performed?
A surgical biopsy is done in an operating room. An IV line is placed in your arm so that you can receive medicines through it. Dr. B C Shah may use local anesthesia with sedation to help you relax during the procedure, or general anesthesia. Surgical biopsies take about an hour, and the recovery period is less than two hours.
An open biopsy that removes only part of a lump of suspicious tissue is called an incisional biopsy; one that removes the entire lump is called an excisional biopsy. An incisional biopsy is usually done when the lump is quite large, since removing a larger lump completely can alter the appearance of the breast. This procedure is appropriate for larger lumps in order to secure a diagnosis while minimizing the effect on the breast’s appearance. If the tissue proves to be cancerous, the remaining portion of the lump will be removed surgically, usually during a second surgical procedure that may be more extensive and involve removal of lymph nodes to determine whether the cancer has spread.
When a breast mass or an area of calcification cannot be felt, Dr. B C Shah may choose to use a procedure called wire localization to help identify the tissue for later surgical biopsy. The first part of this procedure is a mammogram. After applying a local anesthetic, he inserts a hollow needle into the breast and, guided by ultrasound or mammography, places the tip of the needle in the suspicious area. He then inserts a thin wire with a hook on the end through the hollow needle and into the breast alongside the suspicious area. Dr. B C Shah will then removes the needle, leaving the wire in place to serve as a guide to help him find the area of breast tissue to be removed later.
Must I do anything special after the test is over?
Dr. B C Shah will monitor you for a few hours after your surgery to make sure that you’re recovering well and not having any adverse reactions to anesthesia. Contact him if you develop a fever, strong pain at the incision site, or bleeding from the incision. You may need a follow-up visit so that Dr. B C Shah can remove stitches and make sure you are recovering well.
How long is it before the result of the test is known?
A preliminary report from the pathologist might be available when your surgery is over. A final report typically takes three to four days.


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