Heart Burn Basics for Your Benefit

What is heart burn?

Heart burn is a burning sensation you experience in your upper stomach, or just below your breastbone. Most of us would have experienced the symptom of heart burn at some point of time in our life. The name 'heart burn' appears to be closely related to the heart. But in reality, it has nothing to do with your heart. However, a couple of symptoms of a disease, related to chronic heart burn, are similar to a heart condition.

The name 'retrosternal burn' or 'behind-the-breastbone burn' will be the more appropriate name for this sensation, as it has no relation at all to your heart. This feeling of 'burning' is a common experience for almost all of us, especially after a fat-rich heavy meal. You do not have to bother about it at all, if it is an occasional occurrence.

But if you undergo this discomfort too frequently to bear, and if it interferes with your day-to-day activities, it needs early medical attention: it may be a symptom indicative of a deeper and more serious problem - a disease called gastroesophageal reflux disease (GERD).

Basic human anatomy for the understanding of GERD

UES

The food pipe (medical term: esophagus) is a vital part of your body; it serves to carry from the throat to your stomach the food you eat, and the liquids you drink. At the top of the food pipe you have a bunch of muscles called the upper esophageal sphincter (UES); you use them consciously when you breathe, eat, belch, or vomit; also, you use them to prevent food, drink, and secretions from entering your wind pipe, which you use for breathing air in and out.

LES

At the lower end of the esophagus you have another door-like structure of muscles, called the lower esophageal sphincter (LES); this bunch of muscles can open to let pass food and drink into the stomach; they can close tightly to prevent stomach acid and other contents from traveling backwards from the stomach into the food pipe.

Acid reflux

Unfortunately you cannot control consciously the LES muscles. If the LES does not close when it should, stomach acid and other contents can travel back into the food pipe; this upward splash of acid causes the burning sensation of what is commonly known as 'heart burn'. In medical terminology, it is called 'acid reflux'.

(Stomach acid and other contents travel back into the food pipe through open LES)

GERD

When acid reflux becomes chronic and assumes bothersome proportions, it becomes gastroesophageal reflux disease (GERD); it can cause many complications such as: narrowing of the food pipe; ulcer in the food pipe leading to bleeding, severe pain and difficulty in swallowing; in extreme cases, even cancer.

Well-known causes of GERD

The following are well-known reasons for GERD:

Stomach abnormality , pregnancy, smoking and acid reflux foods (alcohol, carbonated beverages, chocolate, citrus fruits like oranges or lemons, coffee or tea, fatty or fried foods, foods prepared with tomato - spaghetti sauce, salsa, pizza - garlic and onions, mint, and spicy foods prepared with chili or curry).

There are a few other reasons as well for GERD: obesity; sleeping with your face up after a heavy snack or meal; some medications like muscle relaxers, or blood pressure prescriptions.

Get treated

You will do well, therefore, to consult a gastroenterologist (physician for the digestive system), if you experience frequently and for long the following symptoms: burning sensation with a sour taste in your mouth, difficulty in swallowing, sore throat, dry cough or feeling of a lump in your throat.

There are excellent medications available to treat the condition. In fact the treatment of GERD involves mid-term to long-term therapy with a specific class of medication called proton pump inhibitors. These medications have been found to be safe over the past two decades with excellent results.

Along with medical therapy, dietary and life style measures including exercise and weight reduction are important in the management of the disease.

Also you need to be aware of what are called 'red flag symptoms' such as difficulty in swallowing, weight loss, and anemia. If you experience any of these symptoms, you need to consult a gastroenterologist at the earliest; prompt detection and treatment of complications related to the disease would save you a lot of avoidable bother.

Article by Dr. M.A.Arvind, MBBS., M.D., DM (Gastroenterology/Hepatology)
Consultant Medical Gastroenterologist, Kauvery Hospital

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Cervical Cancer Basics You Should Know

Cervical cancer is the most common cause of cancer deaths worldwide, especially in the developing nations. In developed nations, the occurrence of this dangerous disease has decreased drastically, thanks to rigorous screening tests and timely follow-up action.

In India, on the other hand, cervical cancer is the cause of most cancer deaths. According to the Chennai Cancer Registry alone, the occurrence is 19.2 per lakh population.

Our country is in need of raising urgent and widespread awareness about cervical cancer, its screening and prevention.

It is important to understand that cervical cancer is a preventable disease with regular screening and follow-up care. It can be cured completely, if found early and treated properly.

What is cancer?

Cancer is an abnormal condition: cells in a specific part of the human body suddenly start growing, and get reproduced without any control. These highly harmful cells can attack and destroy healthy tissues including whole organs around the affected part.

What is cervical cancer?

The cervix is the mouth of the womb above the vagina and below the womb, as illustrated in the figure. Cervical cancer is the growth of highly harmful, abnormal cells on the mouth of the womb. If their uncontrollable growth is not detected early, and preventive measures are not taken promptly, it can lead to death.

What is the cause for cervical cancer?

A virus called Human Papilloma Virus (HPV) is the cause in almost all cases of this disease. The virus spreads through sexual contact with a person who has it already. It can disappear on its own in healthy people.

This infection can lead to less dangerous genital warts (skin growths on or around genitals or on anus). Unfortunately, in some other cases, it leads to cervical cancer.

It is therefore absolutely necessary for all women to undergo regular detection tests for this disease.

Screening for cervical cancer

Screening is the process of examining people for the presence of a disease. There are two detection tests available for cervical cancer: the Pap test and the HPV DNA test.

The Pap test

The Pap test (named after Papanicolaou, the doctor, who developed it) is an examination of sample cells taken from the cervix or vagina. It is done in order to examine whether the sample cells show any changes indicative of cancer or conditions that may lead to cancer.

The HPV DNA test

The HPV DNA test or simply HPV test is used to check for high-risk HPV infection in women. HPV infection around the genitals is a common occurrence. It can spread during sex.

The Pap test checks your cervix for abnormal cells that could turn into cervical cancer.

The HPV test checks your cervix for the virus (HPV) that can cause abnormal cells and cervical cancer.

Screening should begin at least by 30 years, with a Pap test done every 3 years till 65 years of age. It can be combined with HPV DNA test every 5 years.

Symptoms of cervical cancer

The following are the symptoms of cervical cancer:

• Abnormal vaginal bleeding such as bleeding between menstrual periods, after sex, or after menopause
• Pain in the lower abdomen or pelvis
• Pain during sex
• Vaginal discharge that isn't normal

Even these symptoms aren't always noticeable. There may be no symptoms at all in some cases until the illness has reached an advanced stage. That's why periodical Pap test is necessary for all women.

Prevention of cervical cancer

There is no single way of preventing cervical cancer. However, the following measures can help reduce the risk of this illness:

• Safer sex: As HPA is the culprit that causes this cancer through sexual contact, practicing safer sex with condoms can help prevent this disease.
• Regular cervical screening: Periodical screening of the cervix, every three years or five years depending on the age is absolutely necessary; it can help early detection of abnormal changes of cervical cells, and thereby cure this illness in its early precancerous stage itself.
• Cervical cancer vaccination: The HPV vaccine Gardasil can significantly reduce the risk of cervical cancer, and prevent formation of genital warts too.
• Giving up smoking: People who give up smoking can get rid of the HPV infection better from their body than those who do not.

Please do consult your gynecologist to clarify all your doubts, and to get answers for all further questions.

Even after vaccination (if that was your choice), make sure you continue the cervical screening through Pap/HPV DNA tests as per guidelines.

Article by Dr. Karpagambal Sairam, DGO., DNB., MRCOG.,Obstetrician & Gynaecologist, Kauvery Hospital, Chennai

I CAN AND WE CAN PREVENT CERVICAL CANCER!

Let us spread its awareness and education!

Let us save millions of lives!

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Catheter Procedure for Babies: A Novel Method of Closing Holes in the Heart without Surgery

Uma is a one-year old baby girl from Assam. Her parents brought her to Kauvery Hospital, Chennai, with complaints of lung congestion and breathing difficulties. Uma was unable to feed well, and did not gain weight like a normal baby of her age. She was diagnosed with a heart problem called patent ductus arteriosus (PDA). She was in need of proper treatment without any delay in order to get saved.

What is patent ductus arteriosus?

The PDA is a little tube-like structure, which connects the umbilical cord and the two major blood vessels that take blood out of the heart. It is present in all babies prior to birth. Its major function is to provide a short-cut passage for mother's oxygenated nutrients-rich blood straight to the baby’s heart; this supply of blood is done away from the lungs, as they are filled with fluid during pregnancy.

The supply has to be done through the PDA for the healthy upkeep and growth of the baby, as long as it is in the womb. The ductus arteriosus normally closes on its own soon after birth. When the baby starts breathing, the lungs begin to function, taking in oxygen from the air and pumping out the fluid. But in certain cases, the PDA continues to remain open for long.

Complications caused by open PDA

As the lung pressure is lower than the blood pressure, a patent ductus arteriosus allows increased flow of blood to the lungs; this leads to congestion in the lungs, which in turn causes, in PDA-babies, symptoms such as frequent chest infections, breathlessness, excessive sweating while feeding, and difficulty in feeding and poor weight gain.

If left untreated, the increased flow of blood to the lungs can do irreparable damage to the lungs and heart over a period of time. The inevitable result would be a shortened life span for the affected child.

An echocardiography, which is an ultrasound examination of the heart, done for Uma, confirmed the diagnosis of patent ductus arteriosus. I discussed with her parents the option of catheter procedure, the novel method of closing this opening without doing conventional heart surgery.

What is done during the catheter procedure?

In this procedure, a small, specially made device is placed in the PDA to close and seal off the hole in the heart. Under sedation, a needle puncture is made first in a vein in the upper thigh; through this puncture, the closure device is inserted with the help of a catheter (a thin flexible tube), and guided to the hole in the heart.

Once the device is positioned in the right place, the catheter is gently pulled out, and the puncture is closed. The entire procedure takes just a few minutes, and the patient can get discharged the next day. Within six months, normal tissue grows over this device; the latter gets dissolved into the body, when it has served the purpose.

Uma's parents agreed readily to this novel catheter procedure, as they understood how simple and easy it is. Its advantages, as listed below, are quite a few, when compared to traditional surgical closure.

Advantages of catheter procedure over open heart surgery

1. As the device is guided to and positioned across the PDA through a tiny puncture mark in the groin, the child is spared of any scar on the chest.

2. The patient is ready for discharge the day following the procedure; so, the period of stay in hospital is limited to 3-4 days.

3. The pain associated with non-surgical closure of the PDA is significantly less compared to surgical closure.

4. In older children, the procedure can be done under sedation, thereby avoiding the need for general anaesthesia in advanced cases of PDA.

How Uma underwent catheter procedure

With parental consent, Uma was taken to the catheter laboratory, anaesthetized as her case was rather serious, and prepared for the echocardiography-guided procedure. An initial angiography was performed. This involved injecting a contrast dye into the chosen vein; as the dye was carried by the circulating blood to the heart, a profile of the hole in the heart - the PDA - was viewed clearly on the monitor.

Once the PDA was accurately located, the suitably sized closing device was guided with the help of the catheter to that exact location, and positioned. A repeat angiography was done to confirm the satisfactory positioning of the device with complete closure of the opening in the PDA.

Thus the catheter procedure was completed successfully for Uma. She recovered a few hours later, and was found in good health. After overnight observation and investigations, she was discharged the following day to the delight and complete satisfaction of her parents.

The present scenario

Closing such holes in the heart has been a practice for some time in the field of Paediatric Cardiology. The advent of newer, user-friendly devices designed specifically for such purposes have made catheter procedure very safe for the patients. Moreover, the outcome assures a high percentage of success in skilled hands.

Other holes within the heart such as atrial septal defect (ASD) and ventricular septal defect (VSD) can also be safely closed nowadays, following this procedure and using such devices. You can thus avoid open heart surgery altogether, in case your child is diagnosed with a hole in the heart.

Article by Dr.R.Prem Sekar M.B.B.S., MRCPI., FRCP (Glasg)

Consultant Interventional Paediatric Cardiologist, Kauvery Hospital

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Things You Need to Know about Cataract Surgery

Image courtesy - www.hillvisionservices.com

At the age of 50 plus years, most of us are likely to hear the eye doctor tell us, "You have cataracts." As we age, proteins in the lens of our eyes may begin to break down, and the lens may become cloudy. What we see may appear blurred. This condition is known as a cataract.

Thus cataract is an eye disease - a clouding of the natural, crystalline lens inside the eye, causing partial or total blindness. It cannot be corrected with glasses, contact lenses or corneal refractive surgery like LASIK. As frightening as it might sound, cataract surgery is one of the safest and most effective surgical procedures performed today. In the vast majority of cases, this procedure produces excellent visual outcomes.

Cataract Surgery Basics

During cataract surgery, the natural lens inside your eye that has become cloudy is removed, and replaced with an artificial lens (called an intraocular lens, or IOL) to restore clear vision. The surgery is performed typically as an outpatient procedure. It does not require an overnight stay in the hospital.

Most modern cataract procedures involve the use of a high-frequency ultrasound device. It breaks up the cloudy lens in the eye into small pieces, which are then gently removed with suction. This procedure is medically called phacoemulsification or ‘phaco’ for short. It can be performed with smaller incisions of 2-3 mm, thus promoting faster healing and reducing the risk of surgical complications.

After all the remnants of the cloudy lens are removed from your eye, the cataract surgeon inserts a clear intraocular lens into the eye. It is positioned securely behind the iris and pupil, exactly in the same location occupied by your cloudy natural lens before the surgery.

Laser Cataract Surgery

Recently, a number of femtosecond lasers - similar to the lasers used to create the corneal flap in all-laser LASIK - are being used in cataract surgery.

These lasers have gained approval for the following steps in cataract surgery, reducing the need for surgical blades and other hand-held tools:

• Creating corneal incisions to allow the surgeon access to the lens
• Removing the anterior capsule of the lens
• Fragmenting the cataract (so, less phaco energy is required to break it up and remove it)
• Creating peripheral corneal incisions, when needed, to reduce astigmatism i.e., faulty vision resulting from defective curvature of the cornea or lens of the eye.

Preparing for Cataract Surgery and Choosing an IOL

Prior to cataract surgery, your eye doctor will perform a comprehensive eye exam to check: a) the overall health of your eyes; b) evaluate whether there are reasons why you should not have surgery; c) identify any risk factors you might have.

Also, a refraction (i.e., the ability of the eye to bend light so that an image is focused on the retina) test will be performed to accurately determine the amount of nearsightedness, farsightedness and/or astigmatism you have prior to surgery. Additional measurements of your eyes will be taken to determine the curvature of your cornea and the length of your eye.

These measurements are essential to help your cataract surgeon identify the proper power of the artificial intraocular lens that would give you the best vision possible after surgery.

Today you have many types of IOL to choose from for your cataract surgery, depending on your specific needs. In addition to IOLs that correct nearsightedness and farsightedness, there are now toric IOLs that correct astigmatism as well.

If you don't mind wearing glasses after cataract surgery, a monofocal lens is usually inserted surgically. Just part-time use of reading glasses is often needed after cataract surgery with monofocal IOLs.

May be you like the idea of being less dependent on glasses after cataract surgery. If so, one way to correct presbyopia (i.e., a reduced ability to focus on near objects caused by loss of elasticity of the crystalline lens after age 45) and reduce your need for reading glasses is to have your cataract surgeon adjust the power of one of your monofocal IOLs. This is done (assuming that you have cataract surgery performed in both eyes) to give you a monovision correction, similar to monovision correction with contact lenses.

Another option is to choose one of a variety of advanced presbyopia-correcting IOLs to improve your reading vision without sacrificing your distance vision. Presbyopia-correcting IOLs include accommodating IOLs and multifocal IOLs; both the types are designed to provide a greater range of vision after cataract surgery than that of conventional monofocal IOLs.

Beware using these premium IOLs for two reasons: a) you may not be a right candidate for this procedure; b) choosing a presbyopia-correcting IOL will increase the out-of-pocket cost of your cataract surgery, since its additional cost is not covered by insurance plans.

Discuss with your eye doctor all medications you are taking, including non-prescription ("over-the-counter") formulations and nutritional supplements. Some medications and supplements can increase your risk of cataract surgery complications and might need to be discontinued prior to surgery.

Article by Dr. B.S. Anil Chandra, MS (Ophthal)
Senior Consultant Phaco and Refractive Surgeon, Kauvery Hospital, Chennai

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Learning Disorder in Children

Image courtesy - www-tc.pbs.org

When a child is found to face problems at school, it is important to ascertain the nature of and reasons for the problems. An assessment can reveal all aspects and levels of the problem areas. More often parents find it difficult to accept the situation, and they need counseling themselves.

Children with special needs require unique instruction by specially trained professionals. It will help these kids achieve their highest potential and strive to progress beyond their limitations.

Based on a child’s condition, after an assessment, an Individualized Education Program (IEP) is developed by a team that includes the child’s parents and school staff. This is a program that lists, among other things, the special educational services that the child requires.

Well-known problems of school-going children are learning disabilities, learning disorders, slow learning, ADHD and autism. Reasons for these problems may include genetic factors, prenatal issues, environmental conditions, parental/peer pressure, fear complex triggered by teachers/peers, dislike of the subject, peer comparison and competition, bullying by peers or seniors or teachers etc. All these factors can retard learning.

Effective management of these problems depends crucially on: early identification; careful designing of an appropriate IEP; sympathetic and committed implementation of the IEP with the fullest co-operation of parents, special education teachers and the institution.

What is learning disability?

Learning disabilities are neurologically-based processing problems. These processing problems can interfere with learning basic skills such as reading, writing and/or math. They can also interfere with higher level skills such as organization, time planning, abstract reasoning, long or short term memory and attention.

It is important to realize that learning disabilities can affect an individual’s life beyond academics and can impact relationships with family, friends and in the workplace.

Dyslexia, dyscalculia, dysgraphia, dyspraxia, visual perception disorders, auditory processing disorders, and language disorders fall under the umbrella of learning disorders. Many children with Attention Deficit Hyperactivity Disorder (ADHD) too have coexisting learning disabilities.

Learning disabilities listed above are the reasons for poor reading comprehension, reading fluency, listening comprehension, oral expression, written expression and poor performance even in basic mathematics. Kids with such learning disabilities need to learn differently with the help of sympathetic specially trained teachers.

With the proper testing and evaluations, every child's learning disabilities can be diagnosed and an individual education plan devised so that the child can learn, and be taught to compensate and overcome the learning problems. The child can thus lead a happy and productive life like any other normal child.

The slow learner, by appearance and function, is normal, has adequate memory and possesses common sense. S/he requires more time and attention to learn. Her/his condition is elusive and difficult to identify, and requires formal evaluation by a special educator.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is the commonest childhood brain disorder, and can continue through adolescence and adulthood. Symptoms include: difficulty in staying focused and paying attention; difficulty in controlling behaviour; hyperactivity (overactivity) that makes it difficult for an ADHD child to succeed in school, get along with other children, or adults, or finish tasks at home.

Inattentive ADHD children are easily distracted, cannot easily focus on one task, and may daydream. ADHD children have trouble sitting still, being quiet, and being patient, among other behavioural symptoms. These behaviours significantly interfere with daily life, and are present in more than one domain in youthhood.

The brain matures in a normal pattern but is delayed, on average, by about 3 years as far as learning goes. The delay is most pronounced in brain regions involved in thinking, paying attention, and planning.

To be diagnosed with this disorder, a child must have symptoms for 6 or more months, and to a degree greater than other children. The consequences of having ADHD are diagrammatically represented as given below:

Duties of a Special Educator in early intervention:

• assess development
• plan intervention
• implement intervention
• coordinate services
• follow through with recommendations from others
• assess family resources, priorities, and concerns
• plan and implement services for families
• coordinate interagency services
• conduct program evaluation
• serve as an advocate for children & families

Treating these children

Some or all of these options will help plan carefully appropriate treatment of these children: psychological analysis, guidance, encouragement and fixing the goal; memory tips, self reading, sincere practice and special expert guidance.

Interventions should be individually and developmentally appropriate, and properly attuned to age.

Mrs. Srithi Kannan is available for consultation on Tue/Wed/Thur between 11 am and 1 pm at Kauvery Hospital, Alwarpet, Chennai.

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Hip Replacement [Part 2]

Having examined the hip replacement procedure in the previous part of this blog, it is now time to look at the things you can and cannot do immediately following the surgery and how long you can expect your new hip to last.

What Not To Do

Your doctor will advise you about any specific precautions that need to be taken after the surgery. This will vary depending on a range of health factors. In general:

• When lying down you should be on your back or on the side which has not had the surgery. Your doctor will tell you when you can resume any other sleeping positions.
• For six to twelve months after the surgery you should avoid pivoting on or applying any twisting pressure to the new joint.
• Do not cross the involved leg past the mid line of your body or turn the leg inwards.
• When bending forward, ensure that you do not bend the hip past a 90 degree angle.
• When sitting down do not cross the affected leg over the other one.

During the course of your regular checkups after the operation, your doctor will tell you when you can stop taking some of these precautions. Some will need to continue for the rest of your life to prevent dislocation or damage to the new hip joint. Ask your doctor before resuming any sporting activities or anything that could place stress on the new hip.

What You Can Do

Once you return home, you will have to use a walker or crutches to move around the house. You will be taught some exercises that you will have to do to strengthen the hip muscle and tissue. Ensure that you follow the exercise plan you are given and if you experience any pain or discomfort while exercising, inform your doctor or the physiotherapist immediately. As your wound heals, you will find walking easier. While walking is an essential part of the recovery process, do not overdo it as this could slow down the recovery. In due course you will be able to replace the walker / crutches with a cane and then walk without any aid or support. Your objective is to return to your normal life and activities. As your mobility with the new hip increases, slowly start returning to your normal routine. Your body will tell you what you can and cannot do as your recovery progresses. In case of any doubt, ask your doctor.

How Long Will Your New Hip Last?

When hip replacement surgery began in the 1970s, the designs of the artificial joint and the material used were such that the joint was expected to last about 10 years before needing to be replaced. With the improvement in the design and materials used, modern hip joints can be expected to last 20 years or more. The aim of the hip replacement procedure is to relieve you of pain and limited mobility that the hip joint was causing. The new hip should return you to a normal pain free lifestyle with almost normal mobility. However, there will be precautions that you will have to take to protect your hip. Your doctor will brief you about them. How well you follow the instructions will affect how long your new hip lasts.

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Healthy Antioxidant Salad

Adding a salad to your daily diet is a great way to develop healthy and nutritious eating habits. Here is one that is easy to make and uses easy to procure ingredients. This is a perfect example of how healthy does not mean tasteless and bland. After you have tried this recipe a few times, you can start experimenting with different ingredients change the taste.

Ingredients

• 1 medium head Broccoli
• 1 small zucchini
• 1 small purple cabbage
• 3 to 4 lettuce leaves
• 1 clove fresh garlic
• 1 tablespoon flax seeds
• 1 tablespoon sunflower seeds
• 1 tablespoon lemon juice
• Salt and fresh black pepper to taste

Preparation

• Wash all the raw ingredients and place them in a colander to drain.
• If the lettuce leaves remain excessively damp, spin them to remove any remaining moisture. This will ensure that they remain crunchy and add texture to the salad.
• Place the leaves in a salad bowl to form the base of the salad.
• Break the broccoli florets into approximately 2 inch size pieces and place them in a pan of hot water. The water should be hot but not boiling.
• Do not peel the zucchini as this will reduce the nutrition value. Cut it lengthwise into 2 inch long pieces and place them in the same pan as the broccoli.
• Cut the cabbage into 2 inch size pieces.
• The flax seeds can be used raw or toasted, depending on personal preference.

The Dressing
Pour the lemon juice into a small bowl. Crush the garlic clove and add it to the juice. Add salt and pepper to taste and allow the mixture to rest for a few minutes.

Assembly
Drain the broccoli and zucchini and place them on top of the lettuce leaves in the bowl. Place the cabbage on top. Pour the dressing over the salad and gently toss until all the ingredients are coated with the dressing. Pour the flax and sunflower seeds on the top and serve.

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Urinary Stone Disease

Urinary stone disease is a well-known common problem in our country, affecting 10 to 15 % of the population. What is of increasing concern is that most of them are between 20 and 50 years of age. Men are affected three times more than women. People who are more likely to be affected by urinary stone disease include those: living in hot and dry climate; having a sedentary life style; exposed to high temperature while working; eating foods high in salt, and junk food. Obesity is another key risk factor, besides family history and urinary tract infections.

Stone formation occurs when minerals in the urine become very concentrated, leading to precipitation and crystal formation. This, in turn, may lead to crystal nucleation, aggregation and growth. There are various types of urinary stones, the commonest being calcium oxalate. Other types of stones are calcium phosphate, uric acid, struvite etc.

Symptoms of stone

Symptoms of stones in the kidney are hardly noticed until the stones grow big enough to irritate and tend to block the urinary system. You may experience dull back pain, suffer from urinary infections and notice rarely blood in urine. Unattended large stones in the kidney may lead to loss of kidney function, spreading of infection to your blood and very rarely septic shock, a life-threatening condition.

Sometimes, a kidney stone may travel into the ureter, the tube between the kidney and the bladder, and stay there. Such a ureteric stone may cause you severe pain in your sides below your ribs; you may roll in the bed with unbearable pain, as you may not respond to oral tablets, and may get some relief only with injectable pain killers.

Also, you may vomit, experience pain while passing urine, notice blood in urine and suffer frequent urination. Even though the symptoms are severe, such stones are spontaneously flushed out when you pass urine, provided they are less than 6 mm.

Stones in either ureter, or a single functioning kidney with ureteric stone may lead to sudden stoppage of urine production with no warning symptoms. Unless treated as emergency cases, such patients will suffer acute renal shut down. Stones in bladder or urethra can cause painful urinary retention.

Diagnosis

Ultra sound imaging of the kidneys, ureters and bladder is an ideal screening test to identify the problem of urinary stones. Blood test should be done to examine kidney function, and a routine urine examination to rule out urinary infection. However, a CT scan or an IVP (intravenous pyelogram), which is an x-ray test, is a ‘must’ to plan treatment for the stone. It is like a road map for treatment planning.

Management

The first step of urinary stone management is to relieve the pain with a safe pain killer. Once pain subsides, the medical condition of the patient has to be evaluated. Stone size of 5 to 6 mm in the kidney and up to 6 mm in the ureter can be safely managed with medication. Interventional treatment becomes necessary if the patient has abnormal kidney function, sepsis or intolerable pain even after medication or stones larger than 6 mm in the ureter and kidney.

Pictures above show in a 5-year child a large stone in the right kidney removed through a key hole in the back with Holmium laser Percutaneous Nephrolithotomy (PCNL).

Pictures below show stones in the kidney and ureter treated by flexible ureteroscope retrograde intrarenal surgery (RIRS) and Holmium Laser.

There are different methods available for urinary stone breaking like pneumatic, ultrasonic, electro-hydraulic etc. However, Holmium laser is a versatile laser in stone treatment; stones of any size in the kidney, ureter or urinary bladder are best managed, irrespective of the nature and hardness of stones, with least complication and best results.

Various setting options in the 100-watt laser help in the fragmentation and dusting of the stones, with superior stone clearance rate and shorter time than those of shock-wave lithotripsy (a procedure that uses shock waves to break up stones). Also, Holmium laser is quite effective in patients who are unhealthily obese, or pregnant, or on blood thinners, whereas shock-wave lithotripsy is not medically advisable.

Prevention

Patients with urinary stone disease must reduce salt intake, increase fluid intake and cut down on red meat. Medication and periodic check-up with an Ultrasound Sonography Test (USG) or an x-ray would help plan appropriate treatment and avoid recurrence of the disease.

Further metabolic evaluation is needed in cases of frequent stone formation, single functioning kidney, anatomical defects in the urinary system, chronic diarrhea with stone disease, infected stones and strong family history of stone disease.

Myths

There are certain popular beliefs which are not medically true. For example, the common belief is that reduced sodium intake helps prevent urinary stone formation. But, in fact, reduced calcium intake beyond normal requirement is not advisable. Reduction of the daily required calcium in our diet usually results in increased absorption of oxalate from the gut, which in turn increases the oxalate in urine leading to stone formation.

There isn’t enough scientific evidence to support the belief that restriction of a particular fruit, nut or vegetable helps in preventing stone disease. However, it really helps to eat all the vegetables and fruits, in moderation. There is no relationship between stone formation and hardness of water.

Carbonated water and beer tend to increase urinary excretion of oxalate leading to stone formation. Eating leafy vegetables after cooking is safer than taking uncooked fresh ones as in salads: boiling prevents absorption of oxalate. Yet another myth is that once a patient has had a procedure, recurrence of the illness is a certainty, which is simply not true. A careful reevaluation has to be done at the time of completion of treatment through confirmatory tests.

Conclusion

The most important thing in urinary stone disease management is its early identification and timely expert advice on treatment. Taking home remedies, following the advice of quacks and neglecting proper treatment may lead to increased stone size, kidney dysfunction, and infection and in some rare cases, life-threatening sepsis.

Healthy life style, eating any food in moderation with low salt, avoiding red meat, drinking plenty of oral fluids and more importantly, periodic check-ups will surely prevent stone formation and its recurrence.

Article by Dr. Jeevagan, Senior Consultant Urologist, Kauvery Hospital

Dr. Jeevagan, Senior Consultant Urologist is acclaimed for his excellent work in the field of laser laparoscopy and endourology. He has nearly 10 years of experience in the management of stone disease by endoscopic and percutaneous procedures. He has performed numerous reconstructive laparoscopic procedures for kidney, ureter and bladder diseases. He is one of the very few laser-trained surgeons in Tamil Nadu who can perform holmium laser enucleation of prostate (Holep). Kauvery Hospital has a 100 W Holmium laser facility for this purpose.

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