Ulcerative Colitis – drugs, scope or scalpel

Geetha (name changed) was suffering from ulcerative colitis for nearly eight years. She responded well to medical treatment for the initial five years but had frequent relapses of the disease since.

She had been on prolonged course of mesalamine, steroids, immune modulator drugs, Humira etc. Despite best efforts to control the disease with medications, she needed frequent hospital visits and her symptoms of loose stools with blood continued unabated.  A senior medical gastroenterologist for surgery referred her after best efforts to treat her with all available medical options failed. Her quality of life was seriously compromised and she was in tears during her first out patient consultation for surgery. After two sessions of detailed counseling regarding surgery and preoperative evaluation she underwent a ‘restorative procto-colectomy’ a procedure wherein the entire large intestine was removed and a reservoir (pouch) for stool was constructed from the last one foot of small intestine and connected to the anal canal. The operation removed the entire diseased portion and the pouch performs the function of the large intestine. She made a smooth recovery from surgery and three months after surgery she is glad that her normal life is restored.  The most satisfying part for her was that the operation was performed laparoscopically (key hole) and she made a much faster recovery than she expected.

Surgery is required in about ten percent of patients with Ulcerative colitis. The clear indications for surgery would be

• Non-responders to medical treatment
• Need for prolonged steroids and related complications
• Complications of disease – intestinal obstruction, perforation, development of cancer
• Precursor of cancer detected during long term screening (one out of ten patients with ulcerative colitis stands the risk of developing cancer in the large intestine)

Patients fear surgery for several reasons and the foremost concern with this operation is the perceived need to have a permanent stoma (motion outlet from abdomen wall). Current surgical treatment avoids need for a permanent stoma in nearly all patients. In the last decade I have been performing this entire operation laparoscopically giving the advantages of lesser pain and early recovery, and this has increased the acceptance of the operation by patients, Dr Srikanth said. A temporary stoma may be required for few weeks during recovery from surgery. Risks from surgery are comprehensively evaluated during preoperative workup of patients.

Ulcerative Colitis – At a glance

• Typical symptoms would be loose stools with mucus and blood. Fever, weakness, decreased appetite, joint pains, etc may be present in 15-20% patients
• Diagnosis is established by colonoscopy and biopsy
• Majority (90 %)of patients can be treated with medical therapy and avoid surgery
• Patients not responding to medical therapy or requiring steroids for longer than six months and/or complications of the disease and medications, must have an expert surgical consultation
• Surgical expertise is not available in many centres in the city under one roof. This may cause delay in referral with persistent medical treatment with steroids, immune modulators, the prolonged use of which can have serious side effects and drains the patient of their finances to the extent that they are left in a hopeless situation and in no position to explore the surgical option.

“When patients have a word to say” case of granulomatous mastitis

My experience with Granulomatous Mastitis changed the way how I look at life right now.  It all started a year ago, 2016. The painful experience started as a lump on the right breast that would not go away. I went to the Gynaecologist and she just had me take anti inflammatory medicines. After a month the lump came back and I consulted a different gynaecologist this time and suggested that I go for ultrasound. They referred me to a different surgeon back then. I did all the tests, MRI, FNA Biopsy, etc.   I decided to agree on the surgeon’s suggestion to remove the lump even though it was benign and had no signs that it was cancer.

I was afraid I would develop breast cancer as my grandmother had it and died from it. The mass taken from my right breast was tested for bacteria, and acid fast bacilli for tuberculosis, all tests that was done to me returned negative. No bacteria, No Tuberculosis, nothing inside my breasts. Thought the pain and horror of lump excision will be over after the operation. Two months after, I developed fever and my breasts are red, super sore and painful. I had developed breast abscess on the left breast (the breast which was not operated on).

The experience on this new developed condition is more painful than the lump excision I had before. The current surgeon I was consulting with suggested I have breast incision and drainage. After a month or two of going to the same surgeon, he suggested I transfer to Rheumatology department as I have to take steroids to get well as my breasts are not closing on its own like it is supposed to. The Rheumatologist suggested I take 40mg of steroids which I did not agree with as the steroids had adverse effects on other parts of my body and I still plan to have a baby after my son. This started my quest to find a new doctor. I have seen a few doctors asking for advice on my condition and all suggested I take Steroids as the Rheumatologist suggested. After all hope of finding a specialist who has experience on my condition is almost lost, I tried to find in Google the keywords “Abu Dhabi Doctor Granulomatous Mastitis”. Lo and Behold, the Name of Dr. Ritu came in the search with her website and I tried contacting her via Whatsapp. She was out of the country back then. When she came back, she agreed to see me.

That started the journey to healing for me. She is the only doctor who explained what really happened to my breasts. She is very accommodating to think that my health card was not covering ACDS last year. After 2 months of taking a low dose of steroid, only 5mg compared to what was the rheumatologist was suggesting which 40mg, my breasts started to heal is.  It was a slow healing process but it never got worse than it was before. Until now, I am consulting Dr. Ritu every three months to check and both breasts are closed now for about a month or two. Dr. Ritu is the only doctor I think who has experience with Granulomatous mastitis here in Abu Dhabi. If you have similar case, I think consulting her would be the best option.

Unusual causes of abdominal pain.

Unusual abdominal pain

Mr. Riad was visiting Dubai for business purposes when he developed stomach pain and loose motions. He initially attributed it to food that he may have eaten while traveling. But since pain persisted for the whole day, he visited our hospital to meet a gastroenterologist in Dubai, where I evaluated him. Mr. Riad was an otherwise healthy gentleman in his mid-forties and did not have any other illnesses. He had been having intermittent gastro problems such as stomach pain and cramps, bloated feeling and increased gasses since the past one year. Occasionally he used to have diarrhea that used to last a couple of days. There was no weight loss of fever check https://burniva.com/. In between these episodes he used to absolutely fine. Continue reading Unusual causes of abdominal pain.