Dr. Dasari Blog

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A COMPLETE GUIDE TO HERNIAS

Hernias are one of the most common medical conditions. Hernias are more prevalent in men than in women. Each year, more than one million Americans opt-in for hernia repair. Out of which 800,000 involve the inguinal hernia repair. Abdominal hernias, especially inguinal hernia, is more common than other types of hernia. Every 24 out of 100 men are likely to suffer from an inguinal hernia in their lifetime.

Hernias are initially asymptomatic but can easily be diagnosed clinically. There are many types of hernia, such as inguinal, femoral, umbilical, epigastric, incisional, Spigelian, and traumatic.

Hernia

A hernia is a bulging part of the internal organ or fatty tissue protruding out of the weakened opening in the muscular wall or fascia containing it.

Types of Hernias

INGUINAL HERNIA

Inguinal hernia appears at the site of the groin extending into the scrotum. It is a bulge of internal tissue such as the intestine sticking out through a weakness in the abdominal wall. It may appear close to the groin. A lump can extend from the pubic tubercle into the scrotum.

It is main risk factor includes aging and increased pressure on the abdominal cavity. It is 75% more prevalent than any other abdominal hernia. It is most common in men than women, with an incidence rate of 28 per 100 000 in the US. It is congenital in young children and acquired among​​adults.

FEMORAL HERNIA

A femoral hernia is a rare acquired condition. It also takes place at the site of the groin. It is more prevalent in women than in men. It is more 5% prevalent than other abdominal hernias.

  • UMBILICALHERNIA

An umbilical hernia occurs near the belly button. It is 6-14% more prevalent among adults making it the second most common hernia. It is likely to occur in babies if the umbilical cord doesn’t close properly.

  • HIATAL HERNIA

In the hiatal hernia, the part of the stomach pushes through the weakness of the diaphragm and poke out in the chest. It is more common in men than in women. The exact cause of hiatus hernia is not known. However, age is one factor that might influence the weakness of the diaphragm, and straining on the tummy results in hiatus hernia.

EPIGASTRIC HERNIA

It occurs when the tissue sticks out of the abdominal wall between the belly button and the sternum.

INCISIONAL HERNIA

It occurs when a tissue of an organ sticks out at the site of the surgical incision. It might happen when the surgical wound does not heal properly. The other rare types of hernias are Spigelian hernia (occurs at Spigelian aponeurosis), diaphragmatic hernia (congenital disability of the diaphragm), and muscular hernia (muscle tissue protrusions)

Symptoms

Some of the hernias are asymptomatic such as an inguinal hernia. A patient may notice a bulge while standing or doing any physical activity that causes a hernia to appear. Most of the patients usually seek medical help when they experience chronic pain or a recurrent hernia.

Anyone with a hernia is likely to experience the following symptoms:

  • The small bulge at the site of a hernia
  • The appearance of hernias while coughing, lifting something, a bowel movement, or any other physical activity (which make the hernia to reappear)
  • Bulge size increases over time
  • Minimal discomfort
  • Incarcerated hernia (which can’t be pushed back or reduced) can be painful​.​ If not treated, an incarcerated hernia can become strangulated.

Symptoms for strangulated hernia are

  • Dragging and aching pain
  • Nausea
  • Vomiting
  • Abdominal distention
  • Persistent coughing
  • Constipation
  • Tender hernia
  • Temperature
  • Hiatal hernia symptoms are specified. They include:
  • ​​Absence of bulge
  • ​​Regurgitation, bloating or burping ·​ ​Shortness of breath
  • ​Acid reflux ·​ ​Chest pain
  • ​Difficulty swallowing food or drinks

If you are experiencing the above symptoms, please ​contact our Henderson clinic immediately and receive a consultation from Dr. Dasari.

Causes

The leading causes of hernias involve:

  • Aging
  • Obesity
  • Straining due to lifting a heavy load
  • Persistent coughing
  • Giving birth
  • Chronic bronchitis
  • Intra Abdominal masses
  • Enlarged prostate
  • Distention Increased bowel sound
  • Visible peristalsis etc.

Diagnosis

Most of the hernias can be clinically diagnosed on physical examination, but it may require an ultrasound and CT scan for confirmation. The hernias are so common, especially inguinal hernia, that even you may self-diagnose it, but it’s best to check and confirm with your doctor before making any conclusions. Initially, a lump is small and becomes more obvious when you cough or perform any strenuous exercise such as lifting.

A surgeon will initially examine your lump while you are standing. When you lie down, a surgeon may notice a reduction in the size of the bulge. The surgeon may also determine whether the hernia is indirect or direct. Furthermore, cough impulse helps demonstrate the hernia as well

Treatments

Non-surgical treatment

If the hernia is asymptomatic, your surgeon is likely to exercise watchful waiting. During this period, a surgeon may observe your hernia to make sure it can be pushed back and doesn’t grow in size and become painful.

While some surgeons recommend watchful waiting, others recommend early surgical repair to avoid any later obstruction or strangulation, especially in the case of femoral hernia.

Patients are likely to develop bowel strangulation after 2 years of diagnosed femoral hernia. ​In the case of hiatal hernia, anti-acid reflux medications are prescribed to relieve pain and discomfort. The specialist is in the best position to recommend the best possible solution.​Call us to book an appointment now.

Types of surgery

Although surgery is recommended based on the severity, size, location, and pain of hernia, there are two primary surgical options for hernia repair.

  • open surgery
  • laparoscopic operation

Each surgery has its benefits and may also carry some risks. Your doctor will thoroughly evaluate on a case by case basis regarding the whole procedure and post-complications (if any). The best option in your interest is then decided by your surgeon, depending on the condition of your hernia.

Open surgical repair

In an open surgical repair, a surgeon may make a 5-inch incision at the location of a specific hernia. The bulge is put back into its place, and the weakened abdominal wall is closed via sutures, and mesh is added to help strengthen and support the weakened area.

Laparoscopic repair

Laparoscopic surgery may involve one incision of 1 inch in size or 2 incisions of 0.5 inches. Surgical instruments are inserted through the incisions. Mesh is added to support the weakened area of the abdominal wall.

Advantages of laparoscopic repair

The advantages of laparoscopic surgery over open surgery are:

  • May have a faster recovery of 2 weeks.
  • It may be less painful.
  • May experience fewer complications.
  • May get a same-day discharge for most of the patients.

Both surgeries’ recurrent rate is almost the same, but laparoscopic surgery may have fewer complications and associated risks. However, the specialist will be in the best position to decide what’s ideal for you.

Conclusion

All hernias are ultimately treated surgically. It is important to visit your local practice if you observe a bulge in the abdominal cavity. Your surgeon will decide the best course of treatment for you. Suffering from a hernia? Call our clinic today! (702) 602-6600


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EVERYTHING YOU NEED TO KNOW ABOUT PILONIDAL CYSTS

Each year, around 70,000 Americans are diagnosed with pilonidal disease. Pilonidal disease is 2.2 times more common in males than females. Fortunately, the pilonidal cyst is a rare condition; therefore, it can easily be mixed up with other perianal diseases such as anal fistula and abscess of the perianal region. It is mainly treated surgically with a significant chance of recurrence, depending on the risk factors and lifestyle choices.

WHAT IS PILONIDAL CYST?

Pilonidal cysts are the fluid-filled sacs of tissue containing hairs and cellular debris that lies close to the crease of the buttocks and tailbone. Pilonidal cysts occur when coarse and small hairs penetrate the skin and become embedded into it. Later, they can form pus and cause a painful infection called “pilonidal abscess” or sinus cavities.

WHAT IS THE DIFFERENCE BETWEEN PILONIDAL CYST, PILONIDAL ABCESS, AND PILONIDAL SINUS?

A pilonidal cyst is simply a non-infectious fluid-filled cavity containing hairs mainly and other cellular debris and dirt. However, if the cyst is taken lightly, it can form a cavity and swelling of pus termed as a pilonidal abscess. After the infection, the pus will drain out through the pilonidal sinus (a small space formed in the skin and allows the drainage of the pus towards the outside).

WHAT ARE THE CAUSES OF PILONIDAL CYST?

A pilonidal cyst is mostly acquired due to the hairs being the main cause for the formation of a cyst. Conversely, it can be congenital due to the presence of post-coccygeal epithelium remnants since birth.

It is more prevalent among young males and males with a military background. The following are the causes of the pilonidal cyst that determine its susceptibility to disease.

  • Young males (aged around 20s)
  • Military background
  • Prolonged sitting position
  • Presence of a dimple on the skin around the tailbone
  • Obesity
  • Think hairy skin
  • Tight clothing
  • Any activity (such as cycling) that causes prolonged pressure on the crease of the bottom and forcing the penetration of hairs into the skin.

WHAT ARE THE RISK FACTORS OF PILONIDAL CYSTS?

The following are the risk factors for the occurrence of the pilonidal cysts.

  • Male gender
  • Young age around 20
  • Diabetes
  • Obesity
  • Excess thick and coarse body hair

WHAT ARE THE COMMON SYMPTOMS OF PILONIDAL CYST?

Patients with pilonidal cyst don’t experience a wide variety of symptoms as the cysts are non-infectious. Localized symptoms around the tailbone are the main indications for the presence of cysts then generalized symptoms. If you have the pilonidal cysts, then you are likely to experience:

  • Redness
  • Swelling
  • Pain
  • Discharge of pus and sometimes blood
  • Foul odor from the discharge
  • Fever

Seek medical attention if you are experiencing any symptoms mentioned above.

HOW DO YOU DIAGNOSE PILONIDAL CYSTS?

Luckily, there’s no need for any pathological test or radiograph for the diagnosis of pilonidal cysts. A doctor will clinically examine the region around the tailbone to determine whether you have the pilonidal cysts. Ultrasound or MRI can be taken if the diagnosis is not clear.

WHAT ARE THE AVAILABLE TREATMENTS FOR PILONIDAL CYSTS?

There is no need to be afraid or stressed out if you have pilonidal cysts because of the availability of reliable treatments. Treatment can be divided into two broad categories – Non-operative treatment, operative treatment, or a combination of both treatments.

NON-OPERATIVE TREATMENT

It mostly depends on the efforts of patients, what a patient can do to reduce the occurrence and recurrence of pilonidal cysts. It mainly involves the lifestyle changes of patients.

  • Weight loss and Exercise
  • Maintenance of good and healthy hygiene
  • Improve the way of habitual sittings

Hair removal treatment – Hairs being the main factor for the pathogenicity of the cysts, they can easily be removed by laser hair removal procedure or epilation such as waxing, shaving, or hair removal creams.It has been proved by many studies that laser hair removal treatment decreases the recurrence of pilonidal diseases. Usually, the recurrence rate of pilonidal disease is 13.3% with laser treatment. It is especially ideal for patients with sensitive skin and anal mucosal allergy to hair removal products.

OPERATIVE TREATMENT

Incision and drainage – Despite many non-operative available options, it is widely marked as a surgical procedure. The surgical treatment usually requires incision and drainage. The overall success rate of incision and drainage is 76%, and the overall recurrence rate of pilonidal disease is 21%. Initially, the local area is anesthetized for numbness. Once the area to be operated on is numb, a surgeon makes a small diamond-shaped cut in the lower back to drain out the hair follicles, fluid, and dirt. The wound will be left opened and packed with gauze.The healing period takes around 3 weeks, and regular dressing is needed until the wound is healed completely.

Advantages

  • Removal of cysts

Disadvantages

  • Painful dressing
  • Doesn’t necessarily involve same-day discharge
  • Bed rest needed
  • Slow recovery of 3 weeks

Flap Surgery – Another treatment involves removing a flap of skin, but this procedure is avoided due to its complications. The downside of this treatment is the occurrence of flap necrosis in some patients.

Laser Surgery – Currently, the most advanced and less invasive treatment is laser treatment. A diode laser of 1470nm is used during the surgery.The laser treatment involves the excision of the pilonidal cyst area, and it can also treat the superior and inferior extensions. It involves a small 1cm cut instead of a flap or a larger cut.

Advantages

The advantages of laser surgery are

  • Quick surgery
  • Same-day discharge
  • No bed rest needed
  • No wound
  • Painless dressing

WHAT IS THE POST-CARE OF PILONIDAL CYSTS’ TREATMENT?

The post-operative care for laser treatment involves:

  • Take a painkiller if the pain is mild
  • Antibiotics course of 3-4 days after the surgery
  • Dressing

Conclusion

A pilonidal cyst can be a one-time problem or could be chronic (recurring). The pilonidal cyst doesn’t cause problems until they become infected; therefore, it shouldn’t be ignored or taken lightly. If you have a small or large pimple close to your tailbone, make sure to visit your doctor immediately for consultation and treatment. For more information, contact our Henderson clinic (702) 602-6600.


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Gallbladder disease: symptoms, treatment, and management

An estimated 20 million people in the US have gallbladder disease. The incidence  increases with age and is more prevalent in women than in men.

The best way to address the symptoms of gallstones and gallbladder disease is by taking the time to learn more about your gallbladder health. This comprehensive guide is an overview of gallbladder diseases, types, symptoms, treatments, and tips to maintaining a healthy gallbladder.

 

What is a gallbladder?

The gallbladder is a sac-like and pear-shaped organ located under the liver. The  gallbladder stores bile, and when a person eats a meal, the gallbladder deflates and releases the bile into the intestine for active absorption of fats.

 

What is gallbladder disease?

Gallbladder disease is commonly prevalent in developed countries. It involves  chronic inflammation within the walls, stones formation, cholesterol, and other lipid  depositions, eventually leading to a gallbladder blockage.

 

Types of gallbladder disease

  1. Gallstones (Cholelithiasis)

Gallstones are one of the most common problems in the western world. Among  those who experience gallstones, only 20% tend to suffer from biliary or gallstone colic  (pain associated with gallstones migration).

Gallstones involve the formation of cholesterol and solidified bile pigments containing  calcium bilirubinate and calcium salts. These stones increase in size and become  trapped in the ducts. Gallstones are usually asymptomatic; however, in some cases, the migration of these stones causes biliary colic (pain), which radiates from the right  lower ribs to the back and may rarely spread to the right shoulder blade.

 

  1. Cholecystitis

The inflammation of the gallbladder is called cholecystitis. It can be acute or chronic.  Acute cholecystitis may require surgical intervention.

 Acute Cholecystitis

Around 90% of the acute cholecystitis cases involve gallstones blockage inside the  cystic duct resulting in swelling and an inflamed gallbladder. The remaining 10% is due to the recent childbirth, previous surgery, dehydration, injuries, burns, diabetes  mellitus, or bacterial infection. It can cause severe and recurrent pain. A patient may  experience:

  • Severe pain in the upper right abdomen
  • Fever
  • Nausea and vomiting
  • Slight jaundice
  • Abdomen swelling

Please get urgent medical attention in the case of acute cholecystitis. Call us now to  book an appointment.

Chronic Cholecystitis

The chronic cholecystitis is usually present with the gallstones. The reason for the  initiation of the inflammatory response is still vague. In some cases, the recurrent  attacks of dull acute cholecystitis may cause chronic cholecystitis.

The symptoms are not adequately defined. A patient with this condition may experience:

  • Epigastric discomfort after a meal
  • Dull pain in the upper right abdomen
  • Nausea and vomiting.

 

  1. Cancer of Gallbladder

It is a rare type of cancer; according to the CDC, it is more prevalent among women  than men (ratio 4:1). It usually occurs in the 7th decade of life. The carcinoma is often diagnosed at a later stage when it becomes inoperable. Gallbladder carcinoma symptoms are similar to gallbladder disease.

 

  1. Gallbladder polyps

Gallbladder polyps are the abnormal tissue growth on the inner lining of the mucosa of the gallbladder. It’s rare for a polyp to become cancerous. An estimated 5%-10% of polyps are likely to become cancerous, while most polyps are benign.

In the case of a symptomatic malignant polyp, cholecystectomy may be performed.

 

  1. Biliary Dyskinesia

It is a symptomatic motility disorder of the gallbladder when bile doesn’t properly drain out of the gallbladder.

A patient usually comes to the hospital or general practice with pain similar to that of biliary colic and can easily be diagnosed with ultrasound. If the ultrasound scan doesn’t show clear results, the HIDA scan is preferred. Cholecystectomy is the only available option to treat biliary dyskinesia.

 

  1. Biliary Hyperkinesia

It is a motility disorder of the gallbladder. It involves the rapid contraction and emptying of the gallbladder. A patient with biliary Hyperkinesia will experience biliary related symptoms and will have more than 80% of gallbladder ejection fraction (CCK).

Usually, no gallbladder stones are observed in ultrasound imaging. Therefore CCK-HIDA scan is used to diagnose biliary hyperkinesis. The treatment is cholecystectomy.

 

What treatment options are available?

Depending on the severity of gallbladder disease and patients’ history, a doctor may  advise different treatment options on a case by case basis. For patients suffering  from the large gallstones, various calcium-containing gallstone stones, chronic  cholecystitis, and gallbladder cancer, a surgeon usually recommends removing the  gallbladder after ruling out other possible treatment regimens.

 

Gallbladder Removal Surgery

Your physician will aim to provide symptomatic treatment of the disease and reduce the inflammation inside the gallbladder. The initial steps involve:

  1. May require to stop certain medications as per the surgeon’s advice. 2. Antibiotics preoperatively.
  2. Fasting night before the surgery as directed by the doctor.
  3. Intravenous fluid intake to minimize dehydration.

 

Gallbladder Removal Surgery Options

In America, around 500,000 patients undergo gallbladder removal surgery each year.

Keyhole surgery (laparoscopic cholecystectomy) or open surgery is performed for the removal of the gallbladder. The recovery takes place within a week for both surgeries.

Laparoscopic Cholecystectomy or Keyhole surgery remains the surgical choice for symptomatic and complicated gallstones. It involves general anesthesia and minimally invasive 3 to 4 small incisions in the abdomen.

Note: Laparoscopic cholecystectomy is generally a minimally invasive procedure. But in some circumstances, your surgeon may find it necessary to increase the incision size based on the complications involved.

Open surgery is the preferred modality for pregnant women and obese patients. It involves general anesthesia and a single incision, ~ 15 cm long.

The last step involves suturing the incision and aftercare for wound healing. The duration of both surgeries is anywhere from 30-90 minutes.

 

Extracorporeal shock wave lithotripsy:

It is a non-invasive procedure involving a series of shock waves to break down the stones into small pieces that can easily pass through the urinary tract and leave the body, given that the gallstones are small.

 

Non-surgical treatment

If calcium ions aren’t present in the stones, then a specialist generally recommends a healthy diet and NSAIDs for pain management. Suppose the pain and other symptoms recur and affect the daily life of a patient. In that case, a few non-surgical and surgical options are available to treat the gallstone disease depending on the severity.

  1. Antibiotics and painkillers

To prevent the spread of infection, the doctor may prescribe antibiotics. NSAIDs if the patient is in pain.

  1. Ursodeoxycholic acid treatment:

Ursodeoxycholic acid oral treatment involves taking a course of tablets for up to 2  years when the gallstones are small, and the stones don’t contain calcium ions. However, a person may develop gallstones again after discontinuation.

  1. Oral dissolution therapy:

Doctors may recommend oral dissolution therapy and the ursodeoxycholic acid  treatment for patients with gallstones who have high cholesterol. It takes around 6-18 months for the treatment.

 

How to live a healthy life without a gallbladder?

Fortunately, you can live a perfectly healthy life without a  gallbladder. However, it’s still important to follow a balanced diet and to exercise regularly. After a cholecystectomy, the liver can still make enough bile to continuously drain into the intestine to digest and absorb fats.

Follow the diet plan advised by your doctor to avoid post-cholecystectomy  syndrome, which involves diarrhea, bloating, and fever. Luckily, you don’t need to  follow this for long as the complications may disappear within weeks.

 

Easy tips for maintaining a healthy gallbladder

Maintaining a healthy gallbladder is the same as maintaining a healthy diet. Eating a  healthy balanced diet, exercising regularly, and staying hydrated is key to keeping  your gallbladder healthy.

  1. Take fiber-enriched fresh vegetables, fruits, beans, and nuts.
  2. Eat a whole-grain diet such as oats, wheat bread, etc.
  3. Eat healthy fat with low cholesterol, such as olive oil and fish oil.
  4. Eat a plant-based diet containing a balanced amount of calcium, proteins,  Vitamin B9 (folate), and magnesium.
  5. Exercise the right type of moves regularly that specifically promote the health  of the gallbladder.
  6. Maintain a healthy weight within the normal BMI range.
  7. Avoid refined carbohydrates–diets containing white flour and added sugars such as baked desserts, cakes, candies, and chocolates.
  8. Avoid unhealthy fat-containing diets such as processed meat, fat-enriched  meat, sauces, fried food, other fast food, etc.
  9. Quit smoking
  1. Avoid quick weight loss or any weight loss surgery.

Dr. Dasari is a top gallbladder removal surgeon and physician specialist in Las Vegas and Henderson. He is affiliated with the Valley Health System, Dignity Health, Boulder City Hospital, and Valley View Surgery Center. If you are  experiencing symptoms of gallbladder disease or gallstones, call his henderson clinic to schedule a personalized evaluation.


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Are you tired of abdominal pain? Sick of constipation or diarrhea? Embarrassed by explosive wind at inconvenient times?

Irritable bowel syndrome, otherwise known as IBS, strikes almost one in four Americans​. Its effects can be profound. When patients first attend our clinic, many report reduced quality of life, missed workdays, and history of incomplete or absent recovery. The frustration is palpable: People are understandably sick of feeling sick.

Sadly, IBS is as common as it is misunderstood. Patients pack the consultation rooms of gastroenterology clinics around the world. But without in-depth knowledge, the core causes are never addressed. The gut remains unhealed. The legacy of suffering continues.

In this comprehensive guide, I want to halt the needless suffering IBS brings. I will walk you through what you need to know about irritable bowel syndrome: What it is? Why does it happen? The common and infrequent signs and symptoms. Then we’ll discuss treatment options that work, like powerful dietary best practices that help to trigger remission. In short, you’re about to learn the evidence-based advice and approaches I use to treat my patients.

IBS: The current definition

The current medical definition is based on symptoms alone. It is also a diagnosis of exclusion, meaning there is no other cause for your symptoms. The ​National Institute of Diabetes and Digestive & Kidney Diseases(NIDDK) ​defines IBS​ as “A group of symptoms that occur together, including repeated pain in your abdomen and changes in your bowel movements, which may be diarrhea, constipation, or both.”

When you are diagnosed with irritable bowel syndrome, you will likely be given a subtype: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), or IBS with mixed bowel habits (IBS-M). These are as they sound.

IBS-C means that constipation is the primary stool type. On days where you have an abnormal bowel movement, 25% or more of your stools are hard. Less than 25% are loose.

IBS-D means that diarrhea is your main complaint. On days where you have an abnormal bowel movement, 25% or more of your stools are loose or watery. Under 25% are hard.

IBS-M means that constipation and diarrhea both occur frequently. On days where you have an abnormal bowel movement, more than a quarter of your stools are hard and more than a quarter are loose or watery.

But being labeled with IBS or one of its subtypes only describes your symptoms. You are well aware of these already! While a diagnosis can guide the medications prescribed, it really offers nothing by way of understanding the cause or any triggers. And if you don’t know the cause, you can’t adequately address this condition and it becomes nigh on impossible to achieve remission.

With this in mind, let’s look at what we really know about IBS.

Irritable bowel syndrome: Why does this common condition occur?

When we understand why IBS happens, we can look at eliminating its causes. Thorough investigation and evidence-based advice is how our patients achieve remarkable results. We must begin with the truth.

A study published in ​World Journal Gastroenterology ​noted that:

“Altered gastrointestinal motility, visceral hypersensitivity, post infectious reactivity, brain-gut interactions, alteration in fecal micro flora, bacterial overgrowth, food sensitivity, carbohydrate malabsorption, and intestinal inflammation all have been implicated in the pathogenesis of IBS.”

As you can see, it’s a complex problem. One or several sources can underlie IBS. Understanding the triggers leads to relief but finding them can be difficult. Wonderfully, there are simple approaches and advice that help to solve the riddle and provide relief.

But first…

What are the common and less common symptoms of IBS?

IBS can cause:

  • Abdominal pain and cramping
  • Bloating
  • Brain fog
  • Constipation
  • Diarrhea
  • Excessive wind
  • Feelings of incomplete evacuation (when it feel like you haven’t completely emptied your bowel)
  • Food sensitivities
  • Insomnia
  • Joint pain
  • Mental illness, including anxiety and depression
  • Tiredness

The basics: What happens in the gut?

When most people think about the gut, their mind flicks to the inside of the body. But, in reality, the digestive tract is like the hole through a donut. It passes through us but its contents are not part of us. This is a good thing.

When we eat, we place food into the mouth, chew, and swallow. This propels partially digested food into the stomach. Here it is dissolved further to release its life-sustaining nutrients. When ready, the sphincter at the bottom of the stomach opens allowing the “food” to move into the small intestine.

Here, most of the nutrients are absorbed. The indigestible material is then pushed into the large intestine. The remaining water and nutrients are extracted. Feces are formed and shunted toward the exit point: the anus. It’s here, within the large intestine, that irritable bowel syndrome flares.

5 issues that underpin irritable bowel syndrome

There are a number of issues that contribute to irritable bowel syndrome. This is one of the reasons IBS can be so difficult to treat. To find respite, you must remove the problem. First you have to suspect it!

Here are five issues I see often that contribute to irritable bowel syndrome in my patients…

Altered gastrointestinal motility: Is your gut speed off?

Motility describes the ​muscular contractions​ that mix and propel the contents of the digestive tract. In health, the gut muscles happily contract and relax. This moves food from the stomach to the small intestine to the large intestine and then out. At the right pace, this allows for optimal nutrient and water absorption and pain-free passage.

Sometimes, though, motility becomes altered. ​Accelerated intestinal transition​ happens when the muscles propel the contents too quickly. The increased speed means that excess water remains in the stool and diarrhea results. Delayed intestinal transition can also occur, resulting in increased water removal and the hard, dry stools of constipation.

Visceral hypersensitivity: Is your gut too sensitive?

Visceralsimply relates to the organs and ​hypersensitivityto being overly responsive or aware. So, in IBS, visceral hypersensitivity means that people respond more readily to the changes that occur in the bowel. They sense and feel them more.

Just as some people are hypersensitive to emotional events, in some people the bowel is hypersensitive to internal pressure. When you also have this kind of sensitive gut, there is a lower threshold for the awareness of stimulation. Internal pressure is, therefore, sensed as pain. This is sadly not theory: Research shows that when mechanical pressure is applied to the large bowel, ​IBS symptoms​ can be reproduced.

Visceral hypersensitivity can also result from an inflammatory process following a gut infection. It’s a little like when you stub your toe. It becomes tender to touch; whereas, before the injury, it just felt like a normal toe. If your IBS started after a gastric infection, this may be why.

Your brain and your gut talk too!

I find it odd that many health professionals only look at the gut in IBS. I can all but guarantee this will fail; It will miss important pieces that are needed to complete the healing puzzle.

We humans are intricate and complex. By design, the body and brain continuously “talk.” Sending information back and forth is how we are able to respond so quickly and precisely to a threat or a change. When this communication happens between the digestive tract and the brain it is called brain-gut interaction​.

We constantly consciously and subconsciously change our responses because of this shared information. This is why psychological stress can trigger IBS symptoms. It also plays a role in visceral hypersensitivity; the brain increases awareness of the gut’s inner workings.

An imbalanced gut microbiome

There is an incredible array of gut bugs thriving in your bowel. In fact, up to 100 trillion tiny living creatures call this organ home. But when an imbalance in the quantity and type of bacteria, viruses, and fungi occurs, the gut can suffer.

A change in bacterial communities is referred to as dysbiosis. It triggers the gut’s immune system and may create ​low-grade inflammation​. As I’ve written above, this is linked to visceral hypersensitivity and increased IBS symptoms. But it’s so much more than this…

An increase in the “bad” bugs can creep upstream. This movement from the large and into the small intestine is called small intestinal bacterial overgrowth, or SIBO. The consequences include gastrointestinal symptoms, immune activation, motility problems, increased visceral sensitivity, immune activation, trouble digesting and absorbing carbohydrates, and increased intestinal permeability.

Think back to the earlier study from the ​World Journal Gastroenterology. It becomes quite obvious that the large and the small gut and the experience of IBS are deeply linked.

Increased intestinal permeability: Is your gut leaky?

To summarize, increased intestinal permeability seems to play an important role in IBS. What natural healers have called leaky gut for eons, science has more recently dubbed increased intestinal permeability.

The gut is covered by a one-cell thick lining. Its incredible structure allows water and nutrients to cross while stopping potentially harmful products, like foreign invaders. In a leaky gut, the digestive tract acts like a sieve rather than a funnel. Damaging compounds can pop through these holes. In doing so, they move from the relative safety of the inside of the gut and into our body proper.

As a study published in the journal ​Pain ​noted:

“Increased intestinal permeability allows the passage of bacteria and antigens through the mucosal layer of the gut. This may then lead to activation of mucosal immune responses and subsequent chronic diarrhea and abdominal pain seen in IBS patients.”

This means, in essence, that a leaky gut can cause downstream problems and cause or contribute to irritable bowel syndrome.

So how can we fix these problems?

Relief: The IBS treatments that work

As you can imagine, successful remedies need to target the cause or causes of IBS and soothe the problems that they produce. A mismatch here is why many treatments fail. Getting this right matters.

The right diet for a healthy gut

The best place to start is at the beginning: diet. The number one influence on gut health is diet. Healthy foods heal. Many of my patients find a ​low FODMAP diet​ therapeutic. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. While it is a mouthful to say, this diet restricts the foods known to increase gut distention and gas. The result is often relief from ​IBS pain and symptoms​.  In my opinion, avoid all processed foods, and high glycemic foods which cause bacterial imbalance. Also, meat, cheese, and wheat may cause some issues as well.

What foods are limited on a low FODMAP diet?

Fruits: apples, blackberries, cherries, Nashi pears, peaches, plums, figs, mangoes, and dried fruit.

Vegetables: artichoke, cauliflower, garlic, leek, onion, and spring onion.

Legumes: baked beans, falafel, red kidney beans.

Plus, wheat, cow’s milk, processed meats and honey.

What foods do I personally encourage for patients with IBS?

Phytonutrient rich foods: These are foods that have high amounts of polyphenols, flavonoids, terpenes, and chlorophyll. As a whole, these phyto-compounds will help boost gut health. They are found in many vegetables, but if you are having trouble intaking a substantial amount, you may consider caffeine-free herbal teas, such as Rooibos and Peppermint. One of my personal favorites is the “Three Mint” tea by Pukka. Some of my patients have reported drinking two cups a day of each tea (4 cups total) and seeing a noticeable difference in their digestion in 3 days.

Plant-Based Digestive Enzymes: These complex proteins elicit a bloating and immune response in the gut. I encourage the use of digestive proteases with large meals to help with this issue. Some of my favorite enzymes in this category can be found here.

Prebiotics: The foods that feed the good gut bugs are called prebiotics. These can be wonderfully therapeutic. Celery, chicory root, flax seeds, and seaweed are suitable options.

Probiotics: The term probiotic refers to microorganisms that are introduced to raise the good microbiome count. These can be taken in supplement form. They can also be consumed in foods like water kefir and almond yogurt. Even something as simple as a spoonful of fat-free greek yogurt four times a day is generally well tolerated (even in people with IBS and lactose intolerance).

Anti-inflammatory foods:Foods that ease inflammation calm the digestive tract, too. Find out more in my article, ​A Crash-course on Inflammation and Nutrition​.

Keep a food diary (date and time) of all problem foods, and when you experience symptoms. This is helpful for determining whether food preparation methods or certain combinations/timing of food is problematic. I once worked with a patient that had severe issues with pineapple, and raw spinach. Once she steamed lightly steamed the spinach, the problem went away. Cara is a low-cost app you can download to start tracking your symptoms today!

Stress management: Calming your body, mind and gut

Are you stressed? Does worry permeate your life and often?

Stress is known to ​trigger IBS symptoms​. But you likely know this already. This happens because psychological strain increases visceral hypersensitivity, reduces motility, changes the gut microbiota, alters gut-brain interactions and leads to leaky gut. This means managing stress well is crucial.

Simple enjoyable strategies to create calm include:

  • Mindfulness
  • Meditation
  • Focused breathing
  • Regular exercise
  • Sufficient sleep
  • Healing foods: Foods rich in B vitamins, zinc, and omega 3 fats are recommended. Wild-caught salmon, free-range eggs, and sunflower seeds are ideal.

Struggling with IBS? It’s time to finally get the help you deserve

As you’ve learned, irritable bowel syndrome is common. Yet, many needlessly suffer from life-changing symptoms. This is because IBS is a complex condition that requires a holistic, evidence-based approach. One pharmaceutical script may provide some relief but it cannot correct IBS at its core.

As a board-certified medical doctor and renowned surgeon with a passion for nutrition and its power to heal, I focus on what’s needed to get you well. A detailed history and time spent listening to your experiences and concerns allow me to uncover your IBS triggers. We can then, together, create a tailored treatment plan to bring much-needed relief. Remission is possible. To book your in-clinic or telehealth consultation, visit our Book Appointment tab from our ​home page now​.

We look forward to helping you to live a good life.

Dr. Chanu Dasari


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Reputation, Trust, Availability, Skill: A surgeon’s guide to choosing a surgeon.

My friends and family often call me asking me for advice on “so-and-so” surgeon, and how to know if s/he is “good or not.” Unfortunately, even in the age of the internet, bad surgeons can have their deficiencies masked with glowing reviews, and oftentimes good surgeons do not have the reputations they deserve. Is there a more reliable, substantive way to evaluate a surgeon? I’m hoping the following 4 guiding principles will help you make the right decision.

What are my options?

Every surgeon needs to be prepared to discuss the risk and alternatives to surgery. They need to discuss non-operative treatment options, non-opiate pain regimens, as well as different surgical approaches (minimally invasive when applicable).

Is your staff reliable in scheduling and communication?

A surgeon’s staff needs to be reliable. Often, poor scheduling and communication can get in the way of good treatment. Even though this is not a direct reflection of the surgeon’s ability, effective healthcare delivery, unfortunately, involves lots of moving pieces. Having unreliable office staff may result in big problems down the road.

What is your experience with this procedure?

A surgeon needs to know the latest techniques but also needs thorough experience. This is the principle of “not too young” and “not too old.” Ideally, your surgeon has enough experience to avoid complications, but older surgeons are sometimes not technically proficient at newer techniques (e.g. laparoscopic and robotic minimally invasive surgery techniques). You should do your research in advance and prepare to ask your surgeon about modern modalities. Also do not be afraid to ask how many procedures s/he performs each year.

What is your availability?

Availability. As simple as that. If a “good” surgeon is too busy to see you, or rushes through your appointment without answering your concerns, move on. On the flip side, if you reside in a health care shortage area or rural area, your choices for available surgeons may be limited. You may consider traveling a short distance for the expertise you deserve.

I routinely evaluate people who travel from other states and countries to come see me. Typically, appointments are kept in a timely fashion and coordinated with clients’ schedules. I leave enough time between patients for questions to be asked and answered thoughtfully. Should you need expertise addressing issues related to digestion, inflammation, immunity, cancer, or other surgical diseases, please request an appointment.

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Always be true, and surround yourself with people who affirm your wellbeing. Find a doctor who will slow down and listen; find one who carefully considers your concerns; find one who cares.


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A good gallbladder gone bad. 8 Reasons to consider gallbladder surgery.

When gallbladders act up, some can be salvaged, but others cannot.  While some people in my practice follow the “gallbladder diet,” for others, even a strict low-fat diet does not seem to quell symptoms.  Unlike kidney stones, gallstones cannot be selectively “broken-up” with sound waves or lasers. They also cannot be “dissolved” with medications (although several are unsafely marketed for this purpose).

Here are 8 scenarios for when the gallbladder has got to go:

  • Gallstones – These cholesterol/bile stones can cause infections and inflammation resulting in a surgical emergency. Sometimes symptoms can be as mild as chronic fatigue.
  • Pancreatitis – Concentrated bile, biliary crystals (also called microlithaisis) can cause pancreatitis. If you have experienced pancreatitis in the past for unknown reasons, surgical consultation is highly recommended.
  • Chronic cholecystitis – Even without stones (acalculus), the gallbladder can become inflamed and cause pain.
  • Biliary Polyps – Small growths on the gallbladder require careful surveillance by a trained professional. Polyps which grow in size can harbor cancer and should be appropriately managed.
  • Low Ejection Fraction, Biliary Hypokinesia – The HIDA nuclear medicine scan with CCK injection may demonstrate a “lazy” gallbladder which functions at a lower rate.
  • High Ejection Fraction, Spastic Gallbladder – Sometimes a spastic gallbladder will function at a higher than normal rate on the HIDA scan with CCK.
  • Painful Ejection Fraction, Biliary Dyskinesia – With CCK administration, if pain is experienced during the nuclear medicine exam, promptly report this finding to your technologist and physician. Even with normal “EF” Ejection Fraction, the painful contractions may be dysfunctional in nature.
  • Sphincter of Oddi Dysfunction (SOD) – At the end of the common bile duct,  a control valve called the Sphincter of Oddi can develop a faulty mechanism.  In this case, the gallbladder is the bystander organ that develops problems.

 

Always be true, and surround yourself with people who affirm your wellbeing. Find a doctor who will slow down and listen; find one who carefully considers your concerns; find one who cares.


Dr. Dasari is board-certified by the American Board of Medical Specialties, American College of Surgeons, and is a qualified, licensed medical practitioner by the National Board of Medical Examiners and Federation of State Medical Boards. Dr. Dasari provides unparalleled expertise in minimally-invasive treatment options for digestive disease, chronic inflammation, and cancer.

 

Minimally Invasive Surgery

710 Coronado Center Dr Suite 200,Henderson, NV 89052

Monday: 8AM - 5PM

Tuesday: 8AM - 5PM

Wednesday: 8AM - 5PM

Thursday: 8AM - 5PM

Friday: 8AM - 5PM

Saturday - Sunday: Closed


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Disclaimer : The complex nature of surgery means Individual experience will vary. This page is intended for general informational purposes, cannot replace practitioner recommendations, and should not be used to make specific decisions regarding medical care.

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