Q. I am very thin and friends poke fun at me because of this. I eat a lot, both vegetarian and non-vegetarian food, but it does not seem to help.
A: Being thin or fat is a perception. Before you decide you are underweight, calculate your BMI (body mass index). This is your weight divided by height in metre squared. The normal value is 23. If your BMI is less than this and you feel you are eating a lot, you need to consult a physician to rule out metabolic diseases such as diabetes and hyperthyroidism. If your BMI is 23 or more, maybe you only need to improve your physique with weight training and aerobic exercises like jogging.
Q: My four-month-old baby is breast fed exclusively and passes stools only every three or four days. Is this normal?
A: Breast milk is almost completely digested so there can be very little solid waste to eliminate. The frequency of stools in a breast-fed infant can vary. Some do it soon after a feed. That’s because of an active “gastrocolic reflex”. In others, it may happen only once in three or four, or even seven days. Both ends of the spectrum are normal. The stool in breast-fed infants is a golden yellow in colour. If there is a sudden change in the frequency or colour, or if it contains blood, consult your paediatrician. Changes may occur in the colour, consistency and frequency of stools once you start weaning foods.
Q: Are condoms safe for long-term use? Do they cause side effects? Is the liquid used in them safe?
A: Condoms are safe for long-term use. It’s a male contraception that must be used from the beginning to the end of intercourse. However, it has a failure rate of around 15 per cent. So if the woman misses a period, she should do a pregnancy test.
There are no side effects unless the person is allergic to latex, the substance of which condoms are made. The liquid in them is a lubricant. It may be silicone, water or a spermicidal agent.
Post menopausal bleeding
Q: I attained menopause six years ago. For the last six months, however, I had a little bleeding. It’s just a few drops, and then it stops. Do I need to take it seriously?
A: What you are describing is post menopausal bleeding. This is any kind of bleeding or spotting that may occur after you have not menstruated for a full year. It occurs in 30 per cent of women. It could be harmless, due to weight gain or hormonal changes. Or it could be due to the endometrium (lining of the uterus) suddenly and inexplicably beginning to grow (endometrial hyperplasia). This needs evaluation as it can progress to cancer. You need to consult a gynaecologist.
Aortic valve disease
Q: My father developed a peculiar chest pain brought on by climbing stairs. He was evaluated by echo and doppler studies and found to have a “calcified aortic valve”. He is 79 years old.
A: About 4 per cent of the elderly develop stenosis (narrowing) or regurgitation (leaking) of a deformed calcified aortic valve. In either case, the work of the heart, particularly the left ventricle, increases as greater effort is required to pump blood through the defective valve. Moreover, since the coronary vessels – which supply the heart muscle – arise very close to the aortic valve, it can compromise blood supply to the heart muscle. Aortic valve disease can, therefore, cause fainting or chest pain with exercise. In your father’s case, the effort involved in climbing stairs may be too much.
Surgery, either to relieve the narrowing or replace the valve, has been successful in many elderly people and considerably improved their quality of life.
Hole in the heart
Q: My son was diagnosed with a hole in his heart. A doctor cured it with medicines when he was a year old. Now he has a persistent cough. Another doctor says that’s because of the hole and that it remains.
A: About 2 to 5 per cent of children have “ventricular septral defect” at birth. In 90 per cent, the hole closes shortly after birth. If it does not and continues to remain large, surgical intervention is recommended.
Source: The Telegraph ( Kolkata, India)
Video-assisted thoracic surgery (VATS) is a recently developed type of surgery that enables doctors to view the inside of the chest cavity after making only very small incisions. It allows surgeons to remove masses close to the outside edges of the lung and to test them for cancer using a much smaller surgery than doctors needed to use in the past. It is also useful for diagnosing certain pneumonia infections, diagnosing infections or tumors of the chest wall, and treating repeatedly collapsing lungs. Doctors are continuing to develop other uses for VATS. ..VATS->… CLICK & SEE
When compared with a traditional open chest procedure, VATS has reduced the amount of chest wall trauma, deformity, and post-operative pain. While an open procedure generally requires a 30-40 cm incision, video-assisted biopsies can be performed through three 1 cm ports , and a VATS lobectomy, a resection of one lobe of the lung, is performed using a 5-8 cm incision.
How do you prepare for the test?
Discuss the specific procedures planned during your chest surgery ahead of time with your doctor. VATS is done by either a surgeon or a trained pulmonary specialist. You will need to sign a consent form giving the surgeon permission to perform this test. Talk to your doctor about whether you will stay in the hospital for any time after the procedure, so that you can plan for this.
You may need to have tests called pulmonary function tests (see page 33) before this surgery, to make sure that you can recover well.
If you are taking insulin, discuss this with your doctor before the test. If you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test.
You will be told not to eat anything for at least eight hours before the surgery. An empty stomach helps prevent the nausea that can be a side effect of anesthesia medicines.
Before the surgery (sometimes on the same day), you will meet with an anesthesiologist to go over your medical history (including medicines and allergies) and to discuss the anesthesia.
What happens when the test is performed?
VATS is done in an operating room. You wear a hospital gown and have an IV (intravenous) line placed in your arm so that you can receive medicines through it.
VATS is usually done with general anesthesia, which puts you to sleep so you are unconscious during the procedure. General anesthesia is administered by an anesthesiologist, who asks you to breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube is put down your throat to help you breathe. Your anesthesiologist can use this tube to make you breathe using only one of your lungs. This way the other lung can be completely deflated and allow the surgeon a full view of your chest cavity on that side during the procedure.
If VATS is being used only to evaluate a problem on the inside of the ribcage (not the lung itself), then it can sometimes be done using regional anesthesia. With regional anesthesia, you are not asleep during the surgery, but are given medicines that make you very groggy and that keep you from feeling pain in the chest. This is done with either a spinal block or an epidural block, in which an anesthesiologist injects the anesthetic through a needle or tube in your back or neck. You do your own breathing with this type of anesthesia, but one of your lungs will be partly collapsed to allow the doctors to move instruments between the lung and the chest wall.
When you meet with the thoracic surgeon, a physical exam will be performed and your treatment options will be discussed. The thoracic surgeon will discuss the benefits and potential risks of the surgical procedure that is recommended for you.
In general, preoperative tests include: (links will open in a new window)
Your surgeon will determine if any additional preoperative tests are needed, based on the type of procedure that will be performed. If a cardiac (heart) evaluation is necessary, a consultation with a cardiologist will be scheduled in our internationally-renowned Miller Family Heart & Vascular Institute.
As part of your preoperative evaluation, you will meet with an anesthesiologist who will discuss anesthesia and post-operative pain control.
The thoracic surgery scheduler will schedule any additional tests and consultations that have been requested by your surgeon. In general, after your first meeting with your surgeon, all tests are scheduled on a single returning visit for your convenience.
You spend the surgery lying on your side. A very small incision (less than an inch long) is made, usually between your seventh and eighth ribs. Carbon dioxide gas is allowed to flow into your chest through this opening, while your lung on that side is made to partly or completely collapse. A tiny camera on a tube, called a thoracoscope, is then inserted through the opening. Your doctor can see the work he or she is doing by watching a video screen.
If you are having a procedure more complicated than inspection of the chest and lung, the doctor makes one or two other small incisions to allow additional instruments to reach into your chest. These additional incisions are usually made in a curving line along your lower ribcage. A wide variety of instruments are useful in VATS. These include instruments that can cut away a section of your lung and seal the hole left in your lung using small staples, instruments that can burn away scar tissue, and tools to remove small biopsy samples such as lymph nodes from your chest.
At the end of your surgery, the instruments are removed, the lung is reinflated, and all but one of the small incisions are stitched closed. For most patients, a tube (called a chest tube) is placed through the remaining opening to help drain any leaking air or fluid that collects after the surgery.
If you are having general anesthesia, it is stopped so that you can wake up within a few minutes of your VATS being finished, although you will remain drowsy for a while afterward.
How long will you stay in the hospital after thoracoscopic surgery?
The length of your hospital stay will vary, depending on the procedure that is performed. In general, patients who have thoracoscopic lung biopsies or wedge resections are able to go home the day after surgery. Patients who have a VATS lobectomy are usually able to go home 3 to 4 days after surgery. Risk Factors:
It is easier for patients to recover from VATS compared with regular chest surgery (often called “open” surgery) because the wounds from the incisions are much smaller. You will have a small straight scar (less than an inch long) wherever the instruments were inserted. There are some potentially serious risks from VATS surgery. Air leaks from the lung that don’t heal up quickly can keep you in the hospital a longer time and occasionally require additional treatment. About 1% of patients have significant bleeding requiring a transfusion or larger operation.
Sometimes, especially if cancer is diagnosed, your doctors will decide that you need a larger surgery to treat your problem in the safest manner possible. Your doctors might discuss this option with you ahead of time. That way, if necessary, the doctors can change over to a larger incision and do open chest surgery while you are still under anesthesia. Death from complications of VATS surgery does occur in rare cases, but less frequently than with open chest surgery.
General anesthesia is safe for most patients, but it is estimated to result in major or minor complications in 3%-10% of people having surgery of all types. These complications are mostly heart and lung problems and infections.
Irritation of the diaphragm and chest wall can cause pain in the chest or shoulder for a few days. Some patients experience some nausea from medicines used for anesthesia or anxiety.
What will happen after your thoracoscopic surgery?
Your thoracic surgery team, including your surgeon, surgical residents and fellows, surgical nurse clinicians, social workers and anesthesiologist, will help you recovery as quickly as possible. During your recovery, you and your family will receive updates about your progress so you’ll know when you can go home.
Your health care team will provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care and diet.
Most patients stay in the hospital for at least one day after a VATS procedure to recover from the surgery. Most patients have a chest tube left in the chest for a few days, to help drain out leaking air or collections of fluid. You should notify your doctor if you experience fever, shortness of breath, or chest pain.
Follow-Up Appointment: A follow-up appointment will be scheduled 7 to 10 days after your surgery. Your surgeon will assess the wound sites and your recovery at your follow-up appointment and provide guidelines about your activities and return to work.
Most people who undergo minimally invasive thoracic surgery can return to work within 3 to 4 weeks.
How long is it before the result of the test is known?
Your doctor can tell you how the surgery went as soon as it is finished. If biopsy samples were taken, these often require several days to be examined.