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Jan 17 Comments Off

Anal Fistula – An Overview on Modern Update

Posted by Dr. Sarfaraz Jalil Baig

Introduction

Anal fistula is a medical condition that often goes unnoticed or misunderstood. In this comprehensive guide, we’ll delve into the causes, symptoms, and various treatment options available for anal fistulas. Understanding this condition is crucial for those affected and seeking the right information.

What is an Anal Fistula?

It is a small tunnel that develops between the anal canal and the skin near the anus. It typically occurs as a result of an anal abscess, which is a collection of pus in the tissues around the anus. If an abscess doesn’t heal properly or is inadequately treated, it can lead to the formation of a fistula.

Causes of Anal Fistula

The development can contribute several factors, including:

1. Anal Abscess: The primary cause, as mentioned earlier, is an untreated or improperly treated anal abscess.
2. Crohn’s Disease: A chronic inflammatory condition affecting the digestive tract, Crohn’s disease increases the risk of fistula formation.
3. Infection: Sexually transmitted infections or other bacterial infections can also lead to anal fistulas.
4. Trauma: Injuries or trauma to the anal region may result in the formation of a fistula.

Symptoms of Anal Fistula

Recognizing the symptoms of this is crucial for prompt diagnosis and treatment. Common symptoms include:

1. Persistent anal pain
2. Discharge of pus or blood from a perianal wound
3. Swelling and tenderness around the anus
4. Painful defecation

Treatment Options for Anal Fistula

There are various treatment approaches for fistulas in anal, depending on the severity and individual circumstances:

1. Fistulotomy: This surgical procedure involves cutting open the fistula tract to allow for proper drainage and healing. This is the commonest procedure done but it is not safe to do it when the tract involves a lot of anal sphincter.

2. Seton Placement: A seton, a piece of thread-like material, may be inserted to help drain the fistula and keep it open. This is a staged operation for complex fistula when the fistula tract is high/ involves a lot of anal sphincter/ infected. This is one of the efficacious and safest method to treat fistula.

3. LIFT: This is another novel technique for complex fistula where the fistula tract is cut between two sutures at the inter-sphincteric level. It is feasible in some cases where the tract is single and straight.

4. Excision of Fistula and Sphincter Reconstruction: This is another option for complex anal fistula where an experienced and trained surgeon can excise the entire tracts and reconstruct the anal sphincter in the same sitting. This has great success rate and is also the favoured technique at our center.

5. Fibrin Glue Injection: This non-surgical option involves injecting a special glue into the fistula to seal it and promote healing. It can be used in straight tracts. Although, almost devoid of any side effects, the success rate is less than 50% as per published literature.

6. LASER Ablation: This is a current trend and addition in fistula surgery. It is useful in ablating secondary tracts of a complex anal fistula. Simply ablating the tract without treating the internal opening has not met with much success. It is important for readers to beware of the hype and social media marketing around this technique since it is not substantiated in published literature.

Conclusion

If you suspect you have an anal fistula or are experiencing symptoms, it’s crucial to consult with a healthcare professional for an accurate diagnosis and appropriate treatment. Understanding the causes, symptoms, and available treatment options empowers individuals to make informed decisions about their healthcare. An expert and experienced surgeon knows how to use various techniques in different categories of anal fistula. Like everything in science, one surgery does not fit all.

Remember to seek medical advice for personalized guidance tailored to your specific situation.

Where to find the Best Treatment for Anal Fistula?

The best treatment we can find in Kolkata for Anal Fistula is at Digestives Surgery Clinic (https://www.digestivesurgeryclinic.com/), which is a center of dedicated doctors, who are passionate about the field of gastro surgery.

Jul 01 Comments Off

On #Doctor’sDay, allow me to talk about something we deal in as a part of our Profession- Death!

Posted by Dr. Sarfaraz Baig

It is sad and surprising we never think or talk about the most inevitable moment of our lives.

Discussing it is said to be bad omen, waste of time and even ridiculous. As a doctor I have seen patients and their families frequently in denial of death. And it is the very reason why many go into shock listening to the news of death of a loved one. Lawyers have a busy time deciding on the inheritance disputes because someone left without a Will.

Death being the most certain event of life can be taken more seriously. And objectively. We should definitely entertain the idea of thinking about it to begin with. Eventually forming a concept or belief.

If Death is thought to be an end of Life, a halt to goodness and pleasure, then it will always remain in mind as an unpleasant event. Haruki Murakami said – Death is not the opposite of Life, but a part of it!
Even religions state that Life is a journey and Death is the beginning of another. The concept that our Creator left us on this journey of Life and Death is when He receives us back is beautiful. We are promised a chance to meet the very source of our existence.

Even if one does not believe in God, reminding ourselves and talking about death has many advantages:

1. It can make us more humble during our stay on Earth. If we cannot hold onto something forever, chances are, we will attach less importance to it. It has the potential of making us less materialistic and less prone to human obsession with hoarding.

2. It takes away our illusion of control. The fact that we are uncertain about our end in the COVID pandemic, makes many of us jittery. Our made-believe-eternal life has suddenly been truncated! Our control over our Life is gone! But the fact is- we never were in control!

3. It may push us to be more productive. After all, we don’t have an eternity to live.

4. It may help us plan better for people who we leave behind. Mostly!

5. It may address the overt and the subconscious thanatophobia (fear of death). This can be a source of anxiety to a lot many than we think. Thanatophobia may also make us take decisions that are compromising to our values and ethics. By removing the fear, which is what oppressors employ to dominate, we may even create a better society.

Hence, it does appear that we should talk, think and form a belief about death. Even, psychologists are aware that talking about problems and phobias is the first step to managing it.

So if we modify our existing belief about Death, it can become less of a danger and more of a relief. It may even be something to look forward to for spiritually active individuals.

As Peter Pan says- To Die will be an awfully Big Adventure!

Who knows!

Jun 23 Comments Off

“Science is not infallible!” teaches the COVID 19

Posted by Dr. Sarfaraz Baig

The men practising the science of medicine are an esoteric lot who commanded a lot of respect. Till recently.

And then the virus struck!

And it showed the world the true picture.

It exposed the weaknesses of the white coat industry. The public at large now sees us as a vulnerable lot, frequently not at the top of things, experimental and perhaps a failing mess. A few may even have been disappointed at the chaos we generated. The highest body for health, the WHO – the highest body for health- has not shone either and may also have suffered a hole in its bag of credibility.

So, in this war between man and disease, have we lost the game? Has medical science claimed more than it could deliver? Have our achievements and experiments been in the wrong direction?

These questions would take experts and policymakers to do a lot of introspection and research to answer it comprehensively.

But there is one thing we could all agree. And it is about the true nature of science. It is indeed trials and errors that has been propelling it. There are more failures in the history of medicine than success. All students of medicine who read history know that. For every antibiotic that worked there are dozens which got nowhere beyond the lab. For every medical appliance that was tried, not all stood the test of time and safety.

But that is not what the public knows.

In the last few decades we have been overdosed with half-news comprising essentially of successes. Failures are hardly reported.

Let’s go through an example.

Most of us would remember reading more than two decades back that a sheep has been cloned. And that was good news for many patients especially for those waiting for organ transplant!

Right?

And where are we today with the cloning?
Nowhere. We have not seen or heard about cloning in clinical practice.

Why?

Because the news do not tell us that these are in experimental stage, are basically a trial and error endeavour, has huge technical issues and may not take off. Failures, of course, are not reported. At least, not in mainstream media.

The same is broadly true for many anti cancer therapy, surgical procedures, biologics, robotics, artificial intelligence and the list goes on.

This is the only field where news is made only around successes. It gives us humans a kick and a sense of pride and achievement.

Let’s take an example from another sphere.
If a rocket project went haywire, how long do you think the TV and newspapers will talk about it. Days and weeks perhaps.
Questions would be raised-
What happened?
Who is to blame?
How much money was lost or squandered?
Who was running the project?

But have you ever heard of a medical project or a trial about a drug or a treatment that failed and millions were lost?

I don’t remember reading or hearing one of those.

Somehow, failures of medical trials do not cut any ice with the news makers. And therefore, the public at large has a huge and unrealistic expectations from this sector.

This is also one of the reasons why patients expect so much from the clinical practitioners. And possibly why there is so much litigation, resentment and even mob violence in some parts of the world.

The medical science is conceived as something so infallible that if it does fail, there must be something wrong with the dispenser, not the science!

In that way, the COVID 19 has been a great leveller bringing reality to the forefront and eclipsing the incorrectly perceived supremacy of the white coats!

This equilibrium and balance should be welcomed!

It has the potential to restore sanity and see things as they are. Science is a logical attempt to rationalise this huge creation! It is approximate, frequently non-linear and hypothetical, always in evolution, and definitely not the final answer to everything.

But it tries. More than anything else.

And if we look around, mammoth efforts around us have already started to combat the virus. The search for antivirals, vaccines and rapid tests are all underway.

2020 may have been the worst year of the century so far but who knows!

This may be the year when Virologists started conquering yet another deadly disease.

It may also be the year when people started tempering their expectations from medical science! And started looking at scientists and especially doctors as humans who try to make a difference!

May 18 Comments Off

Back To The Basics

Posted by Dr. Sarfaraz Baig

If you look at the bigger picture, food, clothes and a house can be viewed as tools to survive. Purely functional at the basic level!

Food nourish us. Clothes shield us from the weather . House shelter us from the scorching sun, gusty winds and the bitter cold. It also provides a roof for relationships to foster.

That’s it! That’s our backpack for the journey called life!

How much of time and importance should we give to preparing the backpack than actually leading the beautiful path through the woods ?

A small proportion, right?

And yet modern life has convinced us somehow that buying the survival toolbox is the sole purpose of our lives.

Food can become something that is prepared with exotic fruits or a Lamb shipped from a particular region in the world and prepared by a gentleman who can add spice so perfectly that it excites the tongue like nothing before. And I forgot to mention, you may pay a hundred times more than what it takes to prepare it in the house.

Clothes in the primitive period was only a protecting rag and then evolved into a status symbol (a chieftain wore differently from a blacksmith). Jewellery and the fine silks became the legacy of the royalty. Modern life has taken “clothes make a man” very seriously and cinemas and ads have made us believe in the importance of clothing. Consequently, we spend a great deal on their purchases. Branded stuff can be our ticket to the uppermost class of the society and what would we not do to afford them? This does not stop here. Many of us spend a bomb ( I plead guilty) on ancillary fashion stuff like watches, bags, belts and shoes.

If there is one need of life that entices us to an extent that we can go crazy buying them, it’s a house. It can range from a one apartment residence to a palatial bungalow. The address also matters to the modern society. Our desires to embellish them has become so disproportionate to our income that sometimes it can drain our entire life’s earnings. Frequently, we take loans from our future to buy them. EMIs are not abnormal anymore but the new normal of living life. Even Darwin would wonder how a thatched hut has evolved so much!

Now I must admit that I love to eat good food, prefer to have a serene private space with books and a laptop (a diary would do too). I am also a man who loves adorning good clothes. And I have a good house with an open space that brings in the sunrise every morning

So I know a little bit of good living. And I have done my bit of struggle to buy all these. As human beings, we all want to improve our current status and there is nothing wrong with that.

However, this can become pathological if the struggle to get them becomes a lifelong process. There may be no end to fill this bottomless pit!

If we simply step back a little and examine our lives, we might see that these needs get overemphasis usually fuelled by peer pressure, comparisons and competition.

In this context, the Quran says beautifully – this World is a passing delight, a place of mutual boasting of riches and children!

We may not realise but our expenditure on basic needs can be low if the basic needs were indeed kept as basic. But it’s not. We are losing our purpose of existence with it. And the only people profiting are those who run these industries feeding the never-satisfied eternally-starving consumer.
Great minds have been talking about the merits of Minimalistic Living and the Joy of Less for ages. It is not about living frugally, rather it is being aware what is it that will make Living a gratifying experience.

Except for the very unfortunate who live in penury, Life cannot be an eternal struggle trying to afford these survival kits. Ideally, we should be able to backpack our things for our journey requiring no more than a little effort and then take off to enjoy this path called Life!

May 08 Comments Off

Human Bias Is A Virus That We Should Be Aware Of

Posted by Dr. Sarfaraz Baig

Human bias is like a virus.

We have it and we don’t know we have it.

A large majority of us have subconscious or unconscious biases.

But first, let us see what is a bias?

It is defined as “disproportionate weight in favor or against an idea or thing usually in a way that is unfair.”

To expand on it- it is a thought that is based on what appears to us as truth or a rightful conclusion based on what we have seen in our upbringing and environment. It comes from our parents, family members, TV, social media, friends we keep, the books we read, etc.

Since it is an offspring of sorts connected with powerful emotions, it is difficult to question them. Coming out of them is almost impossible for the large majority. That is unless we make a conscious and mindful effort to deal with them.

To do that, we need to first dissect our biases a little and probe deeper.

According to J Marshall Shepherd, meteorologist, there are 3 kinds of biases that shape our worldview. To explain these, I have to use expressions that may seem bombastic but are actually simple.

They are – confirmation bias, Dunning-Kruger phenomenon, and cognitive dissonance. I know how you feel about these terms but relax, once I explain you will say- Aha, that I knew!

Read on!

Confirmation bias is looking and hearing only those stuff that reinforces what we think we already know. Basically, prove us right!

Dunning-Kruger means overestimating our ability at a task. It is simply an illusion of superiority and not realizing our domain or limitation or ignorance.

Cognitive dissonance means having two contradictory beliefs that lead to internal conflict. Generally, we make adjustments in our beliefs to become comfortable. Remember the fox who could not reach the grapes and said it is sour.

Common and Practical examples of bias are gender bias and racism bias. But let’s look at a contemporary bias.

Now if we believe that the coronavirus is a man-made biological weapon then it is a bias that is difficult to uproot even if the counter-arguments were made by the best of virologists. Now I must confess here, it is not relevant whether this belief is correct or not. It is just a bias that we may have.

We would see posts on conspiracy theories that confirm our bias and make us say- I told you so! That is confirmation bias.

We would not be ready to acknowledge that we are not competent enough to comment on whether this is a man-made virus. Remember, we are not virologists! That is Dunning–Kruger happening to us.

Finally, if reports were getting published how this virus came from a bat, and our belief may be getting shattered, we may start saying that the bat was taken to the lab where the virus was dissected off it and developed in the proverbial petri dish of mischief. That is cognitive dissonance.

Now that we are done with the academic part of it let us see why some biases can be innocuous and why harboring some may be very dangerous.

Let us study bias on religion. One may have a bias against a religion- Islamophobia being the current favorite. This is not new; only 80 years back, anti- Jew sentiments were the source of one of the worst genocides of all times in human history. And that is what makes it dangerous. Bias can be a powerful motivator to hate, kill, and even torture.

So how do we treat this malady if we don’t even know it exists within us!

Dolly Chugh, author of “how good people fight bias” tells us methods of how to dislodge our biases. Even if one is unsuccessful, at least, one would recognize it. These are-

1. Learning mindset – having a mindset where we grow lifelong is a wonderful idea to cherish. Even when we have stopped growing taller, our thoughts are evolving and we are getting better. How joyous is that! So, with that will come the thought- I could be wrong. And that can shake the bias. At least question it. So when confronted with evidence that is clashing with our belief, with a learning mindset, we may start hearing an inner voice- is my belief correct?
2. Developing kindness and listening to people with contrarian views, especially those who are marginalized or whose words are not heard, help in overcoming bias. By this method, you overcome your own confirmation bias because now you are engaging with people with opposite beliefs.
3. Believe that there is luck or providence or God, whatever you call it, behind your success. That may keep you humble and keep the illusion of superiority away. Kill the Dunning–Kruger at its inception.

To end this article, and being fair to this issue of bias, it is also important to remember that bias may not be as bad as we make it sound.

Sometimes, we need them. Scientists, for instance, start with a bias and look for evidence through research and trials. They call it a hunch. These bias may pave the way for the most astonishing and valuable discoveries. However, remember, scientists by their definition, recognize that they have started with a hunch or a bias and would generally be ready to change their stance if they found evidence to the contrary.

Therefore, do have a bias, but do pay attention to and be careful of how you think and what you believe. Because your Reality is getting shaped by your Biases.

May 08 Comments Off

Bariatric Surgery- Your Fairy Godmother’s Magic Scalpel?

Posted by Dr. Pallawi Priya

We keep telling our patients that bariatric surgery is not a magic pill. Neither is it a quick-fix to lose all your extra weight.

It is just a head start for the people who find it difficult to adopt a healthy lifestyle due to their health issues.

Some people do very well with bariatric surgery and become fitness icons. Some do reasonably well and reclaim a healthy lifestyle. Some only lose a moderate amount of weight but are happy to have better health. Some do not do well at all.

It is a bell-shaped curve. Just like the marks on a math test in a large class. There are people at both extremes. About 95% are in between.

Just like a math test, it is possible to improve. It is also possible to get worse. It is okay to do badly on one test, once in a while.

Of all the things we know about obesity- the most important is that- It is a progressive disease. Obesity “begets” obesity. For every pound we gain, the likelihood of us gaining the next pound goes up. Therefore, while it is okay to fall off the fitness wagon once in a while, it is extremely important to get back on it.

Most people who have bariatric surgery face problems at one time or another. They may be related to adjusting to a new diet. They may be related to starting and maintaining an exercise regime. Or they may be psychological because unreal presurgical expectations do not match the results.

Adopting a healthy lifestyle in today’s era is not easy. But most of the people who do well become masters of creative suffering. Once you are past the difficulties of the initial few years, you are probably gonna stick to healthy living for the rest of your life.

We ask our patients to talk to others who have been through the same journey. Or talk to us- who have been companions to many on similar journeys. The first few years may be hard when we are alone. With companions, they are fun.