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Anti-Ageing

Management Team

Anti-Ageing

Overview

Ageing gracefully is always something that all men and women desire. Collagen breakdown and facial ageing is primarily controlled by our genetics. Recent advances in aesthetics have shown that epigenetics (the effects of the environment on genetics) plays a very important role in ageing.

We can ensure that our skin ages well by consuming collagen-boosting foods, using topical products that encourage the stimulation of collagen, and consuming supplements that promote collagen build up. There are several treatment options available for these purposes:

  • Monopolar and Bipolar Radio frequency treatment to stimulate collagen, for example, Thermage and Ultherapy
  • PRP therapy or vampire facial
  • Derma pen
  • Treatment with Er:YAG (erbium-doped yttrium aluminium garnet) laser (a laser that emits infrared light and is useful for skin rejuvenation and treating ace scarring and skin pigmentation)
  • Threading
  • Application of dermal fillers
  • Botox injections
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Anal Fissure

Management Team

Anal Fissure

Overview

An anal fissure is a small tear or crack in the skin around the anus that can cause pain, discomfort, and sometimes bleeding during bowel voiding. Anal fissures can affect people of all ages; however, they are more frequently encountered in individuals who experience chronic constipation.

Anal fissures typically occur when the skin around the anus is stretched or torn due to various factors. Common causes include:

  • Constipation: Passing large or hard stools can cause strain, leading to tears in the anal skin.
  • Chronic diarrhoea: Frequent bowel movements can irritate and damage the delicate skin around the anus.
  • Childbirth: Vaginal delivery can cause trauma or stretching to the anal area.
  • Anal intercourse: This can sometimes lead to tearing of the anal skin.
  • Poor blood flow: Reduced circulation to the area, often due to conditions like diabetes or anal trauma, may hinder healing.
  • Infections: Certain infections (e.g., sexually transmitted infections) may result in fissures.
  • Inflammatory bowel disease (IBD): IBD can lead to anal fissures.

Common symptoms include:

  • Visible tear: A small crack or tear might be visible in the skin around the anus, though it is not always obvious.
  • Pain: The hallmark symptom of anal fissure is sharp or burning pain during or after a bowel movement. The pain may last from minutes to hours.
  • Bleeding: The tear might cause bleeding (bright red blood on toilet paper or in the toilet bowl).
  • Itching or irritation: Affected individuals may feel itchy or an irritating sensation in the area around the anus.
  • Spasms: Some people experience painful muscle spasms in the anal sphincter muscle, which can worsen the pain.

Anal fissures are diagnosed based on the following:

  • Physical examination: A simple visual inspection of the anal area is often enough to identify a fissure.
  • Anoscopy or proctoscopy: In some cases, a doctor may use a small instrument (anoscope or proctoscope) to get a closer look at the anal canal.
  • Other tests: If there are concerns about underlying conditions like IBD or infection, blood tests or stool cultures may be performed.

Most anal fissures are acute (short-term) and can heal with conservative treatments, but chronic (long-term) fissures may require more advanced intervention.

  • Conservative (non-surgical) treatment:
    • Increasing the fibre intake: Eating a high-fibre diet helps soften the stool and decreases straining during bowel voiding.
    • Stool softeners: These can be used to make bowel movements easier and less painful.
    • Warm water baths: Soaking the affected area in warm water for 10–15 minutes daily (a few times) can provide pain relief and promote healing.
    • Analgesic creams: These can help manage pain.
  • Medical treatments
    • Botox injections: Botulinum toxin (Botox) can be injected into the anal sphincter muscle to relax it and help heal chronic fissures.
    • Topical hydrocortisone or nitroglycerin: These creams can help reduce pain, inflammation, and itching. Further, they promote healing,and relax the anal sphincter to ease muscle spasms.
    • Calcium channel blockers: Topical medications like diltiazem or nifedipine can relax the anal sphincter and reduce spasms, promoting healing.
  • Surgical treatment (for chronic fissures): If conservative treatments fail and the fissure becomes chronic (lasting more than 6-8 weeks), surgical options may be considered:
    • Lateral internal sphincterotomy: In this surgery, a small portion of the anal sphincter is cut to relieve pressure, thereby promoting healing.
    • Fissurectomy: This surgery involves removal of the fissure and surrounding scar tissue.
    • Flap surgery: In rare cases, a tissue flap from nearby areas is used to cover a chronic fissure that is not healing.

Consult a medical professional if you have persistent pain or bleeding during bowel movements.

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Anal Fistula

Management Team

Anal Fistula

Overview

Anal fistulas are tunnel-like connections between the inner lining of the anus or rectum and the skin surrounding the anus. These abnormal structures typically develop as a result of infection in an anal gland, leading to the formation of an abscess. If the abscess doesn't heal properly, it can form a fistula.

  • Anal abscesses: Infections of the anal glands that become walled off and then drain through an abnormal passage.
  • Inflammatory bowel disease (IBD): IBD Conditions like Crohn's disease or ulcerative colitis can increase the risk of developing anal fistulas.
  • Trauma or injury: A previous injury or surgery in the anal region can lead to fistula formation.
  • Sexually transmitted infections: Some infections, like HIV, may increase susceptibility to anal fistulas.
  • Cancer: In rare cases, rectal or anal cancers can lead to fistula formation.

The symptoms of anal fistula include:

  • Pain around the anal region, especially when sitting, during bowel voiding, or when passing gas.
  • Persistent drainage of pus, blood, or stool from the opening of the fistula.
  • Irritation or itching around the anus.
  • Fever and chills (in cases where the fistula is associated with an infection).
  • Swelling or redness around the anus, indicating inflammation or infection.

  • Physical examination: This involves investigation of the anal area for visible signs of infection, abscesses, or openings.
  • Anoscopy or proctoscopy: These modalities help look inside the anus and rectum for signs of abnormalities like fistulas.
  • Fistulography: In this imaging test, a contrast dye is injected into the fistula tract, and this is followed by X-ray to visualise the path taken by the dye.
  • MRI or ultrasound: Thes modalities help assess the length and complexity of the fistula, particularly in cases that involve multiple tracks or are difficult to diagnose.

Treatment often involves surgery to drain the abscess and repair the fistula, as conservative methods like antibiotics are generally not effective in healing fistulas. There are several surgical options depending on the fistula's complexity:

  • Fistulotomy: This is most common procedure for treating anal fistulas. In this procedure, the fistula is cut open and allowed to heal from the inside out.
  • Seton placement: For more complex fistulas, a piece of thread (seton) is inserted through the fistula to help drain it and promote healing.
  • Advancement flap procedure: This is often used when the fistula involves a significant amount of tissue and there is concern about damaging the sphincter muscles (which control bowel movements).
  • LIFT procedure (ligation of intersphincteric fistula tract): In LIFT, the fistula tract is closed off to prevent drainage.
  • Fibrin glue or collagen plugs: A less invasive approach may be used to seal the fistula tract.

  • Maintaining proper anal hygiene
  • Avoiding trauma to the anal area
  • Managing underlying conditions
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Advanced Airway Procedures

Management Team

Advanced Airway Procedures

Overview

  • Thermal Ablative Therapy: This therapy is used for removing or debulking the tumours that are blocking the main airways and causing bleeding or difficulty in breathing. Electrocautery, argon plasma coagulation (APC), laser therapy and cryotherapy are the various modalities that enable us to achieve this.
  • Airway dilatation/Balloon bronchoplasty: A surgeon inserts a deflated balloon into a section of abnormally narrowed airway. By inflating the balloon with water, the airway is expanded, potentially relieving the symptoms. Balloon bronchoplasty may be performed prior to airway stent placement to help expand the bronchus.
  • Airway stenting (bronchial stent): Advanced cancer or certain other conditions like tuberculosis can constrict or compress an airway tube (bronchus). When the bronchus becomes blocked, it causes difficulty in breathing, cough and pneumonia. Using a bronchoscope, a surgeon can insert a wire-mesh stent into a narrowed airway. Expanding the stent can open a bronchus and relieve symptoms caused by the constriction.
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Allergy Tests

Management Team

Allergy Tests

Overview

Allergy tests are conducted at specialised allergy clinics within the hospital. An allergy test is a diagnostic procedure conducted to identify specific substances or allergens that trigger allergic reactions in an individual. Allergies occur when the immune system reacts strongly to ordinarily harmless substances, such as pollen, dust mites, certain foods, or animal dander. The purpose of allergy testing is to identify these triggers, so that steps can be taken to avoid them or manage symptoms effectively.

 

There are several methods of allergy testing, each with its own advantages and limitations. Your doctor will decide which test is suitable for you depending on your history:

  • Skin Prick Test: This is the most common allergy test. A tiny amount of allergen extract is pricked into the upper layer of the skin, usually on the forearm. If a person is allergic to the substance, a small raised bump (called a wheal) surrounded by a red area will appear within 15‒20 minutes. It is a safe and painless test and is the gold standard for allergy testing all over the world.
  • Intradermal Test: It is similar to the skin prick test but involves injecting a small amount of allergen under the skin. It is more sensitive but carries a higher risk of causing an allergic reaction.
  • Blood Allergy Test (Specific IgE test): This test measures the amount of allergy-specific antibodies (IgE) in the blood. It is useful when skin testing is not possible or advisable, e.g., in case of patients with severe skin conditions or patients taking medications that interfere with test results.

 

Before conducting any allergy test, it is important to discuss the symptoms and medical history with the consultant doctor or allergist. They will determine the appropriate test based on the suspected allergens and the patient's health status.

Once the allergens are identified, the next steps involve educating the patient about avoidance and prevention strategies, and possibly prescribing medications (such as antihistamines) to manage allergic reactions. In some cases, allergen immunotherapy (allergy shots) may be recommended to desensitise the immune system over time.

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Adrenal Cancer

Management Team

Adrenal Cancer

Overview

Adrenal cancer is a rare disease in which malignant cells form in the adrenal glands (small glands placed above the kidneys).

Abdominal pain, unexplained weight loss, and hormonal imbalances leading to high blood pressure and excess hair growth.

Imaging studies like CT or MRI, blood and urine tests to assess hormone levels, and sometimes a biopsy.

Surgery to remove the tumour, followed by radiation or chemotherapy, if necessary. Early detection and treatment are crucial for improving outcomes. Regular follow-up is important to monitor for recurrence and manage any ongoing symptoms or complications.

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Addison’s Disease

Management Team

Addison’s Disease

Overview

Addison’s disease refers to a disorder arising due to the insufficient production of hormones by the adrenal glands, especially cortisol and aldosterone.

Fatigue, low blood pressure, weight loss, and skin darkening. If left untreated, it can be life-threatening.

Blood tests to assess hormone levels and imaging studies to evaluate the adrenal glands.

Lifelong hormone replacement therapy to compensate for the deficiencies. Regular monitoring and adjustment of medication doses are essential for managing the condition. Prompt recognition and treatment of adrenal crises, which can be triggered by stress or illness, are critical to prevent severe complications.

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Acromegaly

Management Team

Acromegaly

Overview

Acromegaly is caused by excess growth hormone, usually due to a benign tumour of the pituitary gland.

It leads to enlarged hands, feet, and facial features as well as joint pain and thickened skin. If left untreated, it can cause health concerns such as diabetes, high blood pressure, and heart disease.

Measuring growth hormone and IGF-1 levels as well as imaging studies like MRI to locate the tumour.

Treatment may include surgery to remove the tumour, medications to reduce growth hormone production, and radiation therapy. Regular monitoring and managing complications are essential to improve the quality of life in affected individuals. Acromegaly often develops slowly, so the condition sometimes takes a long time to recognise. Early detection is crucial for receiving the right care as untreated acromegaly can result in severe health issues.

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Asthma

Management Team

Asthma

Overview

Asthma (also known as bronchial asthma) is a chronic respiratory condition which affects both children and adults, and is the most common chronic disease among children.

Asthma triggers. Author credits: 7mike5000 on Wikimedia Commons

Asthma has multiple causes, and based on the causes, it can broadly be divided into two categories:

  • Allergic: Allergens (e.g., moulds, pollen, pet dander, dust mites) and irritants (e.g., smoke, strong odour, cold air) are responsible for the asthma attack.
  • Non-allergic: Outside factors, such as exercise, stress, illness and weather cause an asthma flare-up.

Importantly, asthma can also be genetic.

Three things can happen during an asthma flare-up (also known as an asthma attack or exacerbation):

  • Bronchospasm- The muscles around the airways tighten, making them narrow. This results in difficulty in air flow through the airways.
  • Inflammation- The lining of the airways swells up, and swollen airways make air flow (to and from the lungs) difficult.
  • Mucus production- During an asthma flare-up, the body creates more mucus, which clogs the airways.

All these result in the production of a wheezing sound when one tries to breathe.

The diagnosis of asthma is based on a combination of symptoms, physical examination findings and lung function tests (especially spirometry). The culprit allergens are identified using an allergy test.

Asthma care focuses on controlling symptoms and preventing exacerbations, which involves: 

  • Trigger Avoidance: Identifying and avoiding triggers that worsen asthma symptoms, such as allergens or irritants.
  • Medications: Inhalers are the mainstay of asthma treatment, including quick-relief medications (short-acting beta-agonists) to relieve acute symptoms and long-term medications (inhaled corticosteroids, long-acting beta-agonists) to reduce inflammation and prevent symptoms. 

Biologic therapies: If routine medicines are ineffective, an add-on controller therapy called biologics might be an option for some patients with severe asthma. Biologics work by disrupting cells or blocking specific molecules that trigger inflammation. 

  • Monitoring: Regular monitoring of lung function is essential using peak flow metres or spirometry to assess asthma control. 
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Allergy

Management Team

Allergy

Overview

Allergy is the excessive response of our immune system to otherwise harmless substances in the environment. These substances, known as allergens, trigger an immune reaction that can lead to various symptoms and affect different organs in the body.

The prevalence of allergic disorders is increasing worldwide. Risk factors include:

  • Genetics (a family history of asthma or allergies)
  • Age (children are more susceptible to developing allergies)
  • Environmental changes
  • Hygiene hypothesis

Common allergic triggers may be through food, insects, latex, pollen, pets, drugs, mold, or gluten.

  • Allergic Rhinitis: Often known as hay fever, atopic rhinitis is characterised by sneezing, itching, nasal congestion, and watery eyes. This condition can be triggered by pollen, dust mites, pet dander or mould.
  • Asthma: Asthma is a chronic respiratory condition characterised by inflammation and narrowing of the airways, leading to breathing difficulties, wheezing, and coughing. In addition to allergens, respiratory infections as well as exercise can also trigger asthma attacks.
  • Atopic Dermatitis: Also known as eczema, atopic dermatitis is characterised by itchy and inflamed skin. It often develops during early childhood and its intensity can be increased by allergens like pet dander, irritants, or certain foods.
  • Food Allergy: Food allergies occur when the immune system reacts to specific proteins present in certain foods, triggering symptoms that can range from mild itching to severe anaphylaxis.
  • Anaphylaxis: Severe allergic reaction is called anaphylaxis and it can be life-threatening. Typically, it occurs rapidly after exposure to an allergen. Symptoms include difficulty in breathing, swelling of the throat, rapid pulse, and a drop in blood pressure.

Diagnosis involves the steps that your healthcare professional takes to find out whether you have an allergy. Your healthcare professional will likely:

  • Ask detailed questions about your symptoms.
  • Do a physical exam.

If you have a food allergy, your healthcare professional will likely:

  • Ask you to keep a detailed diary of the foods you eat.
  • Ask if you've stopped eating the suspected food during the allergy exam.

Your healthcare professional also may recommend one or both of the following tests.

  • Skin test: A healthcare professional uses a tiny needle to prick or scratch your skin and expose you to small amounts of the proteins found in your potential allergens. If you're allergic, you'll likely develop a raised bump called a hive at the test area on your skin. 
  • Blood test: This test measures the amount of antibodies that the blood makes to destroy allergens. Your blood sample is sent to a lab to find out if you're sensitive to suspected allergens.

Allergic disorders are managed by identifying the culprit allergens using an allergy test, avoiding known and potential triggers where possible. Anaphylaxis management involves cardiopulmonary resuscitation (CPR; if the patient stops breathing) and medications, such as adrenaline (to reduce the allergic response), oxygen and intravenous (IV) antihistamines and beta-agonists. Immunotherapy for allergies (allergy shots) may also be recommended to desensitise the individuals to specific allergens.

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