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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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Hair Care- The Ayurvedic Concept
Ayurveda- The Indian traditional system of health care believes in a holistic approach to health care and hair care is one of the vital parts of it. Ayurveda believes that just external application and precautions are not sufficient to keep it full of life, strength, luster, sheen, color, vitality and healthy life long. This issue is discussed in almost every classical text in detail which shows that our Rishis (sages) were also aware of the importance of this field. Ayurvedic Ahara-Vihar (Diet and Lifestyle) concept are two major factors that influence whole body and the health of the hair as well. Irregular dietary habits, Poor diet, Illness and Deficiencies of any particular Vitamin and Mineral affects the quality of hair and problems like dandruff, thinning hair, early baldness, premature graying, spoil the hair quality. In an individual the condition of the hair is the reflection of the complete constitution of his physical state. If the person is not healthy then the bad health will reflect from the hair. Ayurvedic classical literatures thrust upon overall regulation for hair care. Basic guidelines one should follow in life for wellbeing of hair are as follows:

(I). Massage scalp regularly: Topical application of medicated hair oil improves nourishment to the scalp which helps to keep your hair long, lustrous, strong, shining and thick. The warm oil head and scalp massage, especially when done with oil infused with Keshya (hair-friendly) herbs, nourishes the hair and scalp, alleviates dry scalp, enhances circulation. Coconut oil or Sesame oil, infused with herbs like Amalaki (Emblica officinalis), Brahmi (Bacopa monnieri), Bhringaraj (Eclipta alba) or Japa (Hibiscus), helps maintain the color and luster of hair. Ayurvedic herbal hair oils contain a blend of hair-friendly herbs. If you can massage two or three times a week preferably in morning (1-2 hours before bath) for nourishment. Apply Narikela (coconut) oil or Sarshapi(mustard) oil (depending upon availability and suitability) at least three times in a week. Use of Classical Ayurvedic Medicated Oils like: Bhringraja oil, Neelibhringadi oil, Mahabhringraja oil and Brahmi-Amla oil helps to control complaints related to the scalp and hair.

(II). Regular cleansing of scalp and hair: Always keep your hair and scalp clean to avoid clogged hair follicles and itching of scalp. Cleanse with a gentle herbal shampoo or baby soap or soft home made herbal based shampoo. Over or excessive shampooing, especially with a harsh shampoo can lead to dry out the scalp and damage hair. Use lukewarm or fresh water to wash your hair, and follow with a natural conditioner. Let the hair dry naturally rather than blow-drying it. Trim hair regularly to take care of split ends and natural wear and tear. Regularly cleaning and brushing the hair is very important. When the hairs are brushed, oil-producing glands in the scalp get stimulated. This natural oil makes the hair glossy and healthy. To give extra shine to the hair, after washing rinse the hair with some lemon juice mixed in a cup of warm water.

(III). Regulate dietary habits: Irregular or unhealthy eating habits affect over all performance of all of our systems. Healthy eating is just as important for effective digestion and absorption as the healthy diet itself. Food should be fresh and whole and prepared lovingly. Ayurveda advocates that every one should have food in properly ventilated, calm, quiet corner and should not do any other job at the time of having food like watching your favorite television show or talking and discussing any business issue. Eat with your attention on the food, in a calm and serene frame of mind, and one should chew food properly before swallowing. For a good digestion a healthy person should not drink too much water during meals, few sips of water in between bites is fine, otherwise proper watering time is half an hour after food. One should drink luke warm water if oily, spicy and non vegetarian food is consumed. Dinner should always be light. All of such restrictions are important if you wish to keep your body free of Ama (toxins). Toxins build up in the body obstructs nutrients from reaching the cells and tissues of the body. The food articles and bad habits which one should get rid off are discussed also. They are as follows: Excessive intake of tea, coffee, alcohol, meats and smoking should be avoided. Eating too much fried, oily, greasy, spicy, sour and acidic foods is always harmful. Chemical or synthetic medicines should be avoided. Low blood circulation, anemia, general weakness after disease, stress, anxiety and mental tension should be treated by improving dietary habits and routine. Diseases like typhoid fever, jaundice and hormonal imbalance cause excessive falling of hair and aggravate the incidence of dandruff.
Especially after the age of forty, it is important to undergo periodic internal cleansing to flush away Ama (toxins). Triphala (mixture of equal quantity of fruits of Amalaki - Emblica officinalis, Vibhitaka – Terminalia belerica and Harad – Terminalia chebula) is a very popular, gentle, non- habit forming cleanser that can be taken frequently to regulate the digestive system.

(IV). Nutritious diet: Ayurvedic concept of way of life strongly is of the view, that healthy and nutritious food improves body of hair, so a balanced assortment of nutrients is necessary to prevent premature hair loss and early graying.
List of beneficial hair foods include white Sesame seeds, fresh Coconut, Green vegetables, whole Grains, Dates and Raisins, Dadhi (curd), Sprouted mixture of beans, Nuts and Seeds and healthy fats such as Ghee or Oil. Ayurvedic system of medicine advises to cook food with spices and aromatic herbs as they improve digestion and detoxify our body tissues. Ayurveda advocates for regular intake of Haridra (Turmeric), Maricha (Black pepper), Methi (Fenugreek), Dhania (Coriander) and Jeera (Cumin) are both flavoring and Agni (digestive fire) enhancing. Herbs like Amalaki (Emblica officinalis), Haritaki (Terminalia chebula), Hingu (Asafoetida), Bhringraja (Eclipta alba) and seasonal fruits especially citrus fruits help to improve digestion and immunity for all age groups and all Dosha types.

(V). Sleep Sufficiently: As per Ayurvedic concepts: Sleep is as important as nutritious food for well being of human body. Improper or irregular sleeping schedule causes disturbance to our body clock. Sleep is the phase when our body repairs tissues and reorganizes systems. One should retire to bed before 10 p.m. and should finish dinner two hours prior to sleep. Light dinner with less spice followed by a glass of milk (an hour after dinner) is always found to induce good quality sleep. Lack of sufficient sleep can lead to poor health of hair.

(VI). Stress management: Everybody faces high levels of mental and emotional stress due to fierce competition in day to day life of modern times. Living regularly in such state of stress can lead to excessive falling, premature graying, dry, dull-looking, lifeless appearance of hair. Herbal tea enriched with any one or more of Brahmi (Bacopa monnieri), Mandookparni (Centella asiatica), Ashwagandha (Withania somnifera) and Jatamansi (Nardostachys jatamansi) supports natural ability to manage stress. Always spare time to rest and relax and practice relaxing yoga techniques and meditation to keep stress under control. Massaging scalp with medicated herbal oils is found to be helpful to mental relaxation and to control mood swings.

*Ayurvedic hair cleanser - Blend together coarsely grinded Amalaki (Embilica officinalis) – 50 Gms., Shikakai (Acacia concinna) – 30 Gms. and Arishtaka (Sapindus trifoliatus) – 20 Gms and Water – 1.5 Ltrs. make a decoction by boiling contents so that the water is reduced to 1 Ltr. and keep after straining it for washing the hair, but application of oil is always advisable prior to it. This should be made fresh .This a quantity of ingredients in this formulation is for reference only; quantities should be adjusted as per one’s daily requirement. Use of freshly made hair wash solution is always advisable.

This article in nutshell:
- Shape or condition of your hair is reflection of your internal health.
- Good quality sleep relieves stress which is one of the causes of bad hair health.
- Following healthy food habits is always beneficial for wellbeing of hair.
- High protein diet improves condition of hair, controls excessive falling of hair.
- Crash dieting, hormonal imbalances, anemia and low blood circulation cause hair falling.
- Regular milk intake, sesame seeds, almonds and dry fruits help to make hair full of life.
- Application of Sesame oil or Coconut oil or Mustard oil is always good for healthy hair.
- Regular shampooing with undiluted shampoos should be avoided as it will damage hair.
- Hair oils enriched with Keshya (Hair friendly) herbs are always beneficial for hair.
- Regular maintaining of scalp hygiene is of prime importance to control hair disorders.
- Brushing naturally dried hair stimulates circulation to the scalp and hair follicles.
- Cleaning with hard water should be avoided, as it makes hair dry, rough, messy and dull.
- Always dilute shampoo by adding 100 times soft or mineral water to it.

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Hair Loss
Hair loss is medically termed as alopecia, meaning loss of hair from any hair bearing area of the body.
Hair in primitive animals served an important function as it covered entire body surface and helped in maintaining body temperature, with the evolution of animals into human beings the hair coverage of the body declined gradually, in the end the hair coverage practically covering the scalp, eye brow, eye lashes. In human beings, function of hair is practically cosmetic as it forms an important part of appearance of a human being. Loss of hair causes significant psychological effect in many human beings.
Hair is appendage of the skin, which grows in a cycle. There are 3 phases in a hair cycle, namely
Anagen – this is the growing phase, the duration of this phase determines the length of the hair. Most of the hairs are in this phase.
Catagen – this is the stage where hair growth stops and it starts involuting. This phase lasts for few weeks
Telogen – this is the resting phase, here the hair which have stopped growing are held till they are shed off, this lasts for 2-3 months
Exogen – this is the phase of hair shedding
Every hair goes through this cycle, to keep producing the hair. Any disturbances in this hair cycle can cause significant hair loss. As some of the hairs are in a phase where they have to be shed, it is normal for some of the hairs to be shed daily. Normal average hair loss daily is 75-100 per day.
Hair loss is a very common problem for which a patient consults a dermatologist. In a broad way the cause of hair loss is most often simple, it depends the loss of hair is in a patch or it is diffuse occurring all through the scalp. Causes of these 2 different types of hair loss are varied.
Diffuse hair loss – this is much more common than the patchy hair loss. Most of the patients who come for consultation complain of diffuse hair loss. This hair loss can occur in a patterned manner in both the sexes; this is what is called as male-pattern and female-pattern baldness. The pattern of hair loss differs in males & females, in males it starts with recession of hairline from the front, while in females it starts as widening of central partening or loss of density of hair on the vertex i.e top of the head. This patterned hair loss is genetically determined process and is a gradually progressive condition.
The next common causes of hair loss particularly in a woman are Iron deficiency anaemia, thyroid disorders, malnutrition etc; this is termed as Chronic telogen effluvium. In some cases any acute sever illness like fevers (malaria, typhoid etc.), surgery, trauma, post-partum, severe stress can be followed by a bout of hair loss about 2-3 months following the event, this is called as Acute telogen effluvium. Some of the medications can also be a cause of hair loss; the common medications that can be a cause of hair loss are anti-cancer drugs, heparin, anti-thyroid drugs, retinoids etc.
The next form of hair loss is the patchy form this can be divided into scarring or non-scarring depending on the presence of opening of hair roots (hair follicles). The various causes of non-scarring patchy alopecia are:
Alopecia areata, this is a common cause of non-scarring patchy hair loss more so among children. It is an autoimmune disorder i.e the body starts damaging its own organ in this case the hair. It is most often a self-limiting disorder but sometimes when it is rapidly spreading or involves extensive areas it responds poorly to treatment. It can be precipitated by stress. There are several treatment options for managing it properly.
In children another common cause of patchy hair loss is the fungal infections of the hair on scalp i.e tinea capitis. This can present in several ways, like a scaling patch on the scalp or a patch of hair loss with broken hair at the surface of the hair root opening.
Another not so common cause of hair loss is the trichotillomania, which is an obsessive compulsive disorder in which the patient’s pulls off his/her own hair resulting in patches of hair loss. This form shows a characteristic tuft of broken and twisted hair.
Traction alopecia is a form of alopecia commonly seen at the front of the hair occurring due to some of the hair styles that exert an excessive pull on the hair.
Next form of hair loss is the scarring type, in which there is destruction of the hair roots, resulting in patches of hair loss that is permanent. It can occur because of several skin disorders like discoid lupus erythematosus, lichen planus, folliculitis decalvans, severe fungal infections like kerion, favus etc. Severe bacterial infections like recurrent folliculitis, furuncles etc. The causes of scarring alopecia are plenty. Management of scarring alopecia is difficult and most often it is permanent.
In addition to the above mentioned causes there are several more causes of hair loss.
Hair Care measures:
1. Hairs are a pure protein structure so a good diet is necessary for good hair.
2. Don’t use too harsh shampoos or cosmetics on hair.
3. Never comb hair when they are wet.
4. Don’t use shampoo’s more than 2 times in a week.
5. Don’t undergo procedures like hair straightening, curling etc.
Management of Hair loss: depends on its cause; there are several treatment options available for the various forms of hair loss. Whatever the treatment used it takes time for the response to be obtained as the hair grow in a cycle and the dynamics of the hair cycle need to be altered to get response, and it takes time for these things to happen. So, any treatment used for hair loss should be given a trial for at least 2 months before thinking of any response.

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