Hernia

HERNIA⛑️

What Is a Hernia?💥

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

In an inguinal hernia, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. About 96% of all groin hernias are inguinal, and most occur in men because of a natural weakness in this area.

In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery.

A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese.

In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children.

A hiatal herniahappens when the upper stomach squeezes through the hiatus, an opening in the diaphragm through which the esophagus passes.

Symptoms👑

Inguinal hernia signs and symptoms include:

🖋 A bulge in the area on either side of your pubic bone, which becomes more obvious when you're upright, especially if you cough or strain

A burning or aching sensation at the bulge

Pain or discomfort in your groin, especially when bending over, coughing or lifting

🖋 A heavy or dragging sensation in your groin

🖋 Weakness or pressure in your groin

🖋 Occasionally, pain and swelling around the testicles when the protruding intestine descends into the scrotum

Signs and Symptoms in children🚨

Inguinal hernias in newborns and children result from a weakness in the abdominal wall that's present at birth. Sometimes the hernia will be visible only when an infant is crying, coughing or straining during a bowel movement. He or she might be irritable and have less appetite than usual.

In an older child, a hernia is likely to be more apparent when the child coughs, strains during a bowel movement or stands for a long period.

Signs of Trouble🔔

If you aren't able to push the hernia in, the contents of the hernia may be trapped (incarcerated) in the abdominal wall. An incarcerated hernia can become strangulated, which cuts off the blood flow to the tissue that's trapped. A strangulated hernia can be life-threatening if it isn't treated.

Signs and Symptoms of a strangulated hernia include🎈

- Nausea, vomiting or both

- Fever

- Sudden pain that quickly intensifies

- A hernia bulge that turns red, purple or dark

- Inability to move your bowels or pass gas

- When to see a doctor

- Seek immediate care if a hernia bulge turns red, purple or dark or if you notice any other signs or symptoms of a strangulated hernia.

See your doctor if you have a painful or noticeable bulge in your groin on either side of your pubic bone. The bulge is likely to be more noticeable when you're standing, and you usually can feel it if you put your hand directly over the affected area

What Causes Hernias?🔰

Ultimately, all hernias are caused by a combination of pressure and an opening or weakness of muscle or fascia; the pressure pushes an organ or tissue through the opening or weak spot. Sometimes the muscle weakness is present at birth; more often, it occurs later in life.

Anything that causes an increase in pressure in the abdomen can cause a hernia, including:

🖋 Lifting heavy objects without stabilizing the abdominal muscles

🖋 Diarrhea or constipation

🖋 Persistent coughing or sneezing

🖋 In addition, obesity, poor nutrition, and smoking, can all weaken muscles and make hernias more likely.

Risk factors 📍

Factors that contribute to developing an inguinal hernia include:

- Being male. Men are eight times more likely to develop an inguinal hernia than are women.

- Being older. Muscles weaken as you age.

- Being white.

- Family history. You have a close relative, such as a parent or sibling, who has the condition.

- Chronic cough, such as from smoking.

- Chronic constipation. Constipation causes straining during bowel movements.

- Pregnancy. Being pregnant can weaken the abdominal muscles and cause increased pressure inside your abdomen.

- Premature birth and low birth weight.

- Previous inguinal hernia or hernia repair. Even if your previous hernia occurred in childhood, you're at higher risk of developing another inguinal hernia.

Complications📌

Complications may arise post-operation, including rejection of the mesh that is used to repair the hernia. In the event of a mesh rejection, the mesh will very likely need to be removed. Mesh rejection can be detected by obvious, sometimes localized swelling and pain around the mesh area. Continuous discharge from the scar is likely for a while after the mesh has been removed.A surgically treated hernia can lead to complications such as inguinodynia, while an untreated hernia may be complicated by:

- Inflammation💥

- Obstruction of any lumen, such as bowel obstruction in intestinal hernias   - - Strangulation

- Hydrocele of the hernial sac

- Hemorrhage

- Autoimmune problems

- Irreducibility or Incarceration, in which it cannot be reduced, or pushed back into place,at least not without very much external effort.In intestinal hernias, this also substantially increases the risk of bowel obstruction and strangulation.

 Hernia investigation🔬

- A GP will usually be able to identify a hernia by examining the affected area.

- In some cases, they may refer you to a nearby hospital for an ultrasound scan to confirm the diagnosis or assess the extent of the problem.

- This is a painless scan where high-frequency sound waves are used to create an image of part of the inside of the body.

-  Once a diagnosis has been confirmed, a GP or hospital doctor will determine whether surgery to repair the hernia is necessary.

- A number of factors will be considered when deciding whether surgery is appropriate, including:

* the type of hernia – some types of hernia are more likely to become strangulated or cause a bowel obstruction than others

* the content of your hernia – if the hernia contains a part of your bowel, muscle or other tissue, there may be a risk of strangulation or obstruction

* your symptoms and the impact on your daily life – surgery may be recommended if your symptoms are severe or getting worse, or if the hernia is affecting your ability to carry out your normal activities

* your general health – surgery may be too much of a risk if your general health is poor.Although most hernias will not get better without surgery, they will not necessarily get worse.

In some cases, the risks of surgery outweigh the potential benefits.

MANAGEMENT ✂️

Surgery for a Hernia

There are 2 main ways surgery for hernias can be carried out:

1. open surgery – where a cut is made to allow the surgeon to push the lump back into the tummy

2. keyhole (laparoscopic) surgery – this is a less invasive, but more difficult, technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia

Most people are able to go home the same day or the day after surgery and make a full recovery within a few weeks.

If your doctor recommends having surgery, it's important to be aware of the potential risks, as well as the possibility of the hernia coming back.

Make sure you discuss the benefits and risks of the procedure with your surgeon in detail before having the operation.

Lecture Tung acupuncture techniques by MK Sastry, an attendees's perspective

Lecture on tung therapeutic and six channels theory , from Mk Sastry. So inspiring.

"Acupuncture is a indepth knowledge treating both the symptoms and cause of the disease , but without knowing the symptoms and treating the cause of the disease the entire effort shall be futile , and frustrating, disgrace to the efforts you made. the body has a defense of six channels. The foundation of Traditional Chinese medicine lies upon three basic theories which are referred to as the three pillars of TCM. These are the Yin Yang Five Element theory, Zang Fu theory and Meridian Channel theory. Yin Yang and the Five elements form a basic 

code that can describe all phenomena, events and existence in the universe. They allow the description of all things by an arrangement tocategories, initially by the division to Yin and Yang opposite pairs of duality and then further 

into the 5 distinct categories of the elements. 

Together they form the language that 

describes TCM in the ancient classics. While the rules of the outer universe are discussed inthis language, the environment and the climate of the inner body and it's arrangement into functional systems is described by the Zang Fu theory, the theory of the internal organs. The major subject of discussion in the cassics refers to physiology and pathology in terms of the 5 Zang and the 6 Fu organs. Meridian Channel Theory is the connecting pathway between these two theories of outer and inner climates. The channels are describes and referred to as the avenue that balances external influences and climatic factors and 

regulates their entries and exits into and out of body. This creates a balanced internal climate that permits the harmonious function of the internal organs. 

According to Meridian Channel Theory, the external influences are specific climate factors which are referred to as the 6 Qi. These are Cold, Summer-Heat Fire, Dampness, Dryness, Fire and Wind. It is important to note that the 6 Qi are functional climatic forces which are necessary for the function of the internal organs and are therefore not 'Evil' factors. The 6 Qi may become 'the 6 Evil Qi' if the function of the Meridian-Channel system is not balanced or if they are excessively strong and invade the body. The Meridian Channel systems have both external and internal roles. 

The external role is to balance and regulate the movement of the 6 Qi into and out of the Body. As extensions of the organs, the internal role of the Meridian Channels is to balance and Regulate the functions of the Zang and Fu by creating an infinite web of inner connectionsand by creating the appropriate inner climatic environment specifically needed for each Organ. These relations are specific and bond each climate of the 6 Qi to a specific organ system. The overall structure is referred to in the classics as the 6 Channel Theory and is structured in the body as Tai Yang (Si,UB-cold); 

Shao Yang (Tw,Gb-summer heat fire),Yang  Ming (Li,St-dryness), Tai Yin (Lu,Sp-dampness), Shao Yin (Ht, Ki-fire) and Jue Yin (Pc, Liv-wind),

Part 2 

Many people knows “prescribed herbs not forming a formula (you yao wu fang) and “a formula without modified herbs (you fang wu yao)” while learning herbal prescriptions. The same problems happen to acupuncture too. The so called “using a formula without modified herbs (you fang wu yao)” means rigidly using the formula without changes or modifications according to individual patient’s condition. As the “prescribed herbs not forming a formula (you yao wu fang)” means merely gather a bunch of herbs without following any principles. Some acupuncture treatments fall into the above two circumstances. The acupuncturist merely puts one needle here, one there, without any principles. It is like shooting birds in the dark (making random attempts). One needs to understand the principles of herbal combination to successfully prescribe an effective formula. The same applied to acupuncture too. For instance, some acupuncturists needle Linggu (22.05), Dabai (22.04), Jioil (88.25), Xinmen (33.11), Shouwujin (33.08), Shouxienjin

(33.09), Biyi (1010.22), etc. all together to treat sciatica. Sometimes they even add more points from the 14 channels. This is a typical example of gathering a bunch of points without principles. Certainly the treatment result will not be good. Acupuncture needs to be like prescribing a formula. It is said “Having Songs of Tang Tou Formulas (sets of prescriptions) in mind, one needn't to worry in clinic.” One needs to have sets of point prescriptions in mind as basis before selecting treatment points.

First is to memorize the application principles of the special points. For example, for the Five Transport points, one can memorize the texts in the Ling Shu in chapter 44 (’The Sequence of Qi and the Four Seasons within a Single Day’): When the disease is at the Zang, needle the Jing-Well point. If manifesting as a change in the color, needle the Ying-Spring point. When the disease attacks intermittently, needle the Shu-Stream point. When the disease manifests as changes in the patient’s voice, needle the Jing-River point. If there is disease of the stomach and irregular appetite, needle the He-sea point. In Ling Shu, in chapter 4 Disease Patterns of Zangfu as Caused by Pathogenic Qi says: the Ying-spring and Shu-stream points treat the exterior channels; and He-sea points treat the internal Fu. Classic of Difficulties (68th Difficulty) says “Jing-well points for fullness below the heart, Ying-spring points for heat of the body, Shu-stream points for heaviness of the body and pain of the joints, Jing-River points for dyspnea, cough, chills and fever, He-Sea points for rebellious Qi and diarrhea. If one can memorize those texts, he/she can apply them to the clinic practice potentially. Whenever encounter the pain, first select the Shu-stream point of the disease channel, because Shu-stream points govern the pain syndromes. When encounter the diseases of qi reverse, select the He-sea points of the channel. For example, cough is the qi reverse of the Lung, so first thing is to select the He-sea point of the Lung, Chize (LU5) to treat it. Hiccup, the qi reverse of the Spleen, select the He-sea point of the Spleen, Yinlingquan (SP9), or Jienshi (PC5) in the Pericardium channel, because “the disease manifested with voice (sound) change, select the Jing-river points, and also that the communication of the Pericardium and the stomach.

Secondly, memorize three to five classical songs or odes. For example, Bai Zheng Fu (Ode of a Hundred Patterns), Zhou Huo Ge (Song to Keep Up Your Sleeve), Biao Yo Fu (Song of Elucidate Mysteries), Xi Hong Fu (Ode of Xi Hong), Tong Xiuan Zhi Yao Fu (Ode of the Essentials of Understanding), Zha Bing Xue Fa Ge (Song of Points for Miscellaneous Diseases), Shen Yu Ge (Song More Precious Than Jade). All those are very popular and useful songs and odes. By memorizing those songs and odes myself, I gained very strong foundation in acupuncture. I also recommended my students to memorize those songs and odes so to skillfully select points in practice. Those songs and odes are set prescriptions. For example, in Xi Hong Fu (Ode of Xi Hong) and Zha Bing Xue Fa Ge (Song of Points for Miscellaneous Diseases), they both say the combination of Lei Xue (LU7) and Tai Yuan (LU9) treats the qi stabbing the two breasts, and temporal and frontal headache. The clinical experience proves it. Also, in Bai Zhen Fu (Ode of a Hundred Patterns), it says “sore throat, Yi Men (SJ2) and Yu Ji (LU10) can treat.” In my decades of clinical practice, I use Yi Men and Yu Ji to treat sore throat and always receive instant results. Another example, Za Bing Xue Fa Ge (Song of Points for Miscellaneous Diseases) says, “Urination obstruction, needling Yinlingquen (SP9) and Zusanli (ST36) will drain the urine like stream flow.” There are too many such examples to enumerate piece by piece. Those point prescriptions are very refined. They usually contain one or two points.

Having those prescriptions at hand make clinical practice convenient and create high efficacy. Besides, those prescriptions are very refined and contain only a few points.

PIVD cases

From Mk Sastry

This type of procedure has good future outlook without having side effects or complications where by charges to this procedure is less than 70 us dollar including Hospital charges and OT charges. Instant and quickest results , in major PIVD(Prolapsed, herniated, or extruded intervertebral disc ) cases. Not in all but in many cases this procedure with life style changes can give stable and instant results . In my clinical cases of more than 1.5 million cases and ten times the procedure , I feel lot can be achieved. Patient satisfaction is better because cost factor is low. So far I m concerned I make my charges free. 

I truly believe that , such type of innovation will provide new and non invasive and painless treatment . To major cases of PIVD or acute pain where Surgery might not be possible due to economic conditions and other might not be suitable for other  procedures

DEGENERATIVE SPINE Cases specially disc lesion which is 2nd most reason of spine surgery can be very well supported by the procedure. I have a experience of more than 250000 OT  cases , which I believe will give long term recovery relationship for the Patient.

Some useful links

• Disk herniation
• PIVD
• Spinal disk herniation

NIBS, Micro stimulation using dry needles - MK Sastry

From Mk Sastry 

Founder Scientist , Non Invasive Brain Mapping and Stimulation , through skull based approach. 

Nibs , micro stimulation. promising future , for rewiring and renetworking,  the brain .Skull based approach for Brain stimulation using   dry needles . 

Neuro Anatomy will play a greater role and it's deeper understanding for getting deeper level approach for providing stimulus to the Brain for cognitive deficit  and Neuromascular cordinatotion. 

 

Noninvasive Brain Stimulation: Applications and Implication 

In March the Advance  Institute of  Neurosciences  held a workshop on electrical and magnetic dry needles  modes of Non-Invasive Neuromodulation of the Central Nervous System. I had the pleasure of being the Traning Instructor  in this dynamic event, in Hyderabad which covered a range of relevant topics, specially in Post Op cases .   Participants discussed the growing number of opportunities as well as challenges and ethical considerations associated with the use of devices to non-invasively stimulate the brain and nervous system.

Medical indications for Nibs 

(Noninvasive brain stimulation) is of great interest to clinicians and researchers,  its potential role in studying brain physiology and in treating diseases of the brain. It offers advantages as a diagnostic tool in that it can be used to observe disease-related changes in brain activation, inhibition, or connectivity.

But owing to cost factor , a dry needles based approach through skull stimulating the brain will have a promising factor. 

The greater advantage is the cost factor, and instant results with no side-effects noted upto now. 

Traning is easy to be provided. 

Most important is deeper level of stimulation using inner and skull pathway using various  nerve and muscular junction , reorganising the neural cordinatotion from  surface of skull based stimulation.

Detailed study on NIBS, Skull based dry needles - MK Sastry

MK Sastry 

Detail study forwarded to International journals 

Software used latex 

Nibs , skull based  Dry Needles  stimulation  in cortical areas , in Post ICU cases. In patient of TBI , Hemorrhagic , SCI cases. 

 

The new pathway developed will bring major understanding to recover internal areas of the brain  by surface stimulation. It was my long study based on Neural Anatomy and Neuro Physical and Neuroendocrine approach in Post Op Cases perticularly in Post Tumour cases., TBI , and has lead a great step towards rehabilitative medicine , the purpose of the study was to study efficacy of D5 injection theraphy in Spasticity and to retrained recover the high spastic muscles , supported  with dry needle , mapping the brain in Neuroanatomy  , and Providing calculative stimulation , derived on Matlab calculation using Artificial Inteligence , Neural Networks. 

Network connection can be reestablished inside the brain. By cortical stimulation. Same pathway can be used to bring significant changes in gait patern in paraplegic tranjection injury cases in perticular to SCI cases. 

The beauty of the part of work  is that many significant changes can be seen and predefined stage wise recovery could be observed  using Ashworth Scale. 

Together a group study taking 3 groups of 200 patient period of study 3 months and three months follow up  was done in next  three months   dobule placebo one group was provided dry needle based Nibs with D5 injection in Spastic muscles , and other group was included only Physiotherapy by qualified Physiotherapist as per regular protocols . The use of Botox injections was totally exculded in the case. 

After 15 days a significant changes could be seen in control group of NIBS inclusive of  Physical therapy..

And 2nd group changes could not be of significantly contribution based only on Physical theraphy . 

No major conservative changes was done in the cases except regular medication .

Psychologically stable patient were only taken in the group .

Mean age in SCI was taken as 25 to 35 years , mean time was taken as 1. 5  years of injury 

Hemorrhagic stroke and TBI . 

Mean time was taken 1. 5 years 

The conclusive study was recorded on result based on 15 days treatment . And monthly placebos. 

Both the group did not restore to any complain . 

The conclusive study was encouraging and significant results could be seen group 1 where dry needle based cortical stimulation was provided   

Although the group was too small for any future inclusion but on other way it has raised the hope of the victim and bedridden in Post ICU cases giving them chance to recover and enjoy a beautiful life.