Signs and Symptoms of Peptic Ulcer

Nowadays, peptic ulcer affects more than 10% of the Americans. It is mostly caused by a bacterium (H. Pylori) and by inadequate use of medication. Peptic ulcer causes an injury upon the stomach or duodenum lining, known as gastric ulcers or duodenum ulcers.

Because of this erosion, abdominal pain and burning might occur during the night, when the stomach is empty, or two-three hours after eating. Also, nausea, vomiting, belching and indigestion might occur. These are the general symptoms of a peptic ulcer.

If you vomit blood, or see that your stool is bloody or black, call for a doctor immediately, because a complication of the peptic ulcer might have occurred. Also, an increased abdominal pain is urgency.

Peptic ulcer occurs when inside your stomach and duodenum increased levels of acid are produced. This acid injures the line of stomach and duodenum and so ulcer appears.

The level of acid inside the stomach increases because some factors interfere within its production. For example, following a treatment with NSAIDs for a long time could increase the level of produced acid inside your stomach. To prevent ulcer from occurring your current doctor will prescribe some antacids, inhibitors of the proton pump (Omeprazole, Lansoprazole, and Pantoprazole), and H2-Receptor antagonists (Famotidine, Cimetidine, Nizatidine, and Ranitidine).

Another factor that leads to ulcer is a bacterium (H. Pylori). This bacterium weakens the natural barrier that protects the lining of your stomach against the acid’s action. A lot of people possess this bacterium inside their stomach but not all of them develop ulcer. This is quite an interesting thing for scientists and is still studied.

People who suffer of Zollinger – Ellison Syndrome might develop ulcer because they have tumors in the pancreas that produce a hormone called gastrin, which increases the acid production in the stomach.

Alcohol, smoking, intensive stress, radiation therapy and other direct physical injuries can also lead to an ulcer. Ulcer has even a genetic predisposition.

People who have a weakened immune system and live in unsanitary conditions are exposed to H. Pylori.

In order to diagnose the ulcer, the doctor will ask you about your symptoms, will want to know for how long have you been having them, and will inquire about your lifestyle and diet.

After that the doctor will perform a physical exam to see if there are any signs of bleeding. A blood test is also required to see if you are anemic.

If the doctor suspects a peptic ulcer has occurred he will prescribe you antacid drugs.

But if you continue to feel abdominal pain and burnings even after treatment the doctor will have to perform other investigations like: endoscopy and an upper gastrointestinal test with barium.

These tests are quite accurate in detecting H. Pylori, the bacterium which could have caused your peptic ulcer. In this case antibiotic drugs are recommended, alongside with antacid medication.

For more resources about Ulcer or especially about Ulcer Symptoms please click this link

What Is Chronic Fatigue?

Do you experience symptoms of fatigue, mood changes, weight gain, depression, headaches, insomnia and bloating? Are you struggling to lose weight? These symptoms can all be caused by hormones. Chronic fatigue can be a sign of adrenal exhaustion or adrenal fatigue.

Chronic Fatigue and Adrenal Exhaustion

Adrenal exhaustion is brought about by chronic stress which affects your hormone levels by increasing your levels of cortisol and decreasing your levels of DHEA. Decreased levels of DHEA can have a cascading effect on other hormone levels, such as oestrogen, progesterone and testosterone as DHEA is a precursor to these hormones.

Chronic Fatigue and Irritable Bowel

Stomach problems such as irritable bowel syndrome, candida overgrowths, digestive dysbiosis or Helicobacter pylori bacteria infection can place further strain on your adrenals. In addition the adrenal and thyroid glands work together, meaning decreased adrenal function can interfere with thyroid function.

Chronic Fatigue and Thyroid Imbalance

With decreased adrenal hormones, the thyroid tries to compensate by producing more thyroid hormones. Eventually the thyroid becomes depleted causing hypothyroidism. In fact, thyroid disease is one of the most common hormonal disorders, after insulin resistance and diabetes. The majority of women with thyroid imbalance have hypothyroidism (under-active thyroid), while a minority have hyperthyroidism (overactive thyroid).

The problem is that symptoms of low thyroid function are often mistaken for depression, signs of ageing, or are not identified. What does your thyroid do and how does it cause chronic fatigue? Your thyroid – a small butterfly-shaped gland located in the front of your neck – controls the functioning of every cell, organ and gland in your body. In addition, your thyroid regulates your libido and fat metabolism.

Four main hormones produced by your thyroid gland directly affect your metabolism and body fat. They are thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine/levo-thyroxin (T4), and calcitonin (used in calcium metabolism). Although your thyroid gland secretes and regulates these hormones, about 80% of the body’s T3 is produced outside the thyroid gland, in the liver, by chemical modification of T4. Hypothyroid women gain weight and find it difficult to lose weight because (i) their T4 is not being converted by the liver to the metabolically active form of T3 or (ii) the converted T3 hormones is not getting to the cellular level of the body – meaning that they are producing it, but their body can’t use it.

Let’s assume you are stressed, overweight and think you have hypothyroidism. You’ve been to the doctor with complaints of weight gain, slow weight loss, chronic fatigue, cold hands and feet, and ‘brain fog’. The doctor examines you and performs some blood tests, including thyroid tests, but all the tests come back in the normal range. You go home, sentenced to a life of weight gain, chronic fatigue and feeling plain unwell. This scenario is played out again and again until one day you finally fall below the ‘reference’ ranges for the tests.

Testing for Chronic Fatigue

Most conventional practitioners only test for the inactive T4 hormone level, even though it is active T3 thyroid hormone works inside every cell of the body – not only in the blood. If T3 isn’t available at the cellular level, then those cells can’t function properly. The T4 blood test does not test for this and it also fails to test for thyroid antibodies that may be present and contributing to fatigue. Sadly, many hypothyroid symptoms are frequently dismissed by physicians as being a normal part of ageing, a psychological problem, overwork, or some other condition. As a result, thyroid tests are often not performed and the patient never receives the proper medical treatment they require. If you are doing everything right but are still felling unwell and suffering from chronic fatigue, there is definitely something going on that needs to be addressed. Getting to the cause is not as easy as just doing routine blood tests. An interconnected approach to the review of your signs and symptoms encourages a multidimensional treatment strategy that will make a difference. So explore your options and strive for a better, healthy life!

New Health Care Trends Involve Environmental Endocrinology for Women in Menopause

Today’s fervor for environmental preservation has also hit the medical industry as researchers, scientists and doctors are discovering the importance of the newest emerging field called environmental endocrinology. Doctors are now learning how environmental endocrinology, or the effect of daily stressors like light, food and crowding on multiple endocrine systems, controls the rate of aging and the quality of life. This also covers reproductive endocrinology, converging to become what we call menopause medicine.

Envronmental endocrinology has roots in the earliest calendars, which historically were lunar calendars, based on the time interval from one new moon to the next, or also known as lunation. In colder countries, the concept of the year was determined by the seasons, specifically by the end of winter. But in warmer countries, where the seasons are less pronounced, the Moon became the basic unit for time.

Calendar consciousness first developed in women because their natural body rhythms corresponded to observations of the moon, and as it turns out, 28 days is not the true average of the natural female cycle. In ancient mythologies it is clearly related to the full moon, but in the modern world the female cycle is disturbed by what some researchers believe to be the existence of artificial lights and the use of artificial hormones. Many light sources including TV and computer screens, have probably perturbed the female cycle, and shortened it.

A woman’s menstrual cycle responds to many subtle environmental cues and one of these is the presence of other women. Those who work closely together, or who live together, can set off each other’s menstrual cycles. It happens via pheromones-chemical substances that are secreted by the skin. After the nasal receptors pick up the scent, the pheromones stimulate their endocrine systems, driving their menstrual cycles towards a similar pattern.

There’s also evidence for photoperiodicity controlling estrogen reception along with the obligate melatonin response. Melatonin blocks estrogen receptors. Once light increases with the waxing moon, melatonin secretion diminishes, and allows more estrogen.

Doctors who are studying environmental endocrinology are in the vanguard of an elite group of forward-thinking physicians and researchers trying to put the scientific method back into medicine, spearheaded by a researcher named T.S. Wiley.

The courses focus on the following topics: Insulin and cortisol metabolism over the course of a lifetime; the interplay of insulin, SHBG and estrogen; the effect of quality of sleep on sex steroid production; the seasonal variation in hormone fluctuation through shunt physiology; the action of sex steroids on immunological, emotional and neurological disorders; how to use the Wiley Protocol for the side effects of menopause, hot flashes, migraines, joint pain, incontinence, hemorrhaging, endometriosis, hypo and hyperthyroidism, fibroids, PCOD, insomnia, acid reflux, gall bladder disease, thinning skin, vulvodynia, low libido, IBS, depression and anxiety; the connection of insulin and sex hormones to cancer; C-reactive protein and cardiovascular risk: the eyes of the hippopotamus; non-Genomic actions of steroid hormones in the reproductive tissue; complex actions of sex steroids in adipose tissue; and the cardiovascular system and brain: insights from basic science and clinical studies

“Since my involvement with Wiley and environmental endocrinology, I have become more keenly aware of the nuances of hormonal interaction and understanding the molecular aspects of hormonal relationships,” said Courtney Paige Ridley M.D.”It answers the questions being posed regarding cancer and other dysfunction afflicting not only menopausal women but those women with significant alteration of cycle created by interaction with our estrogen toxic environment.”

Sinus Polyps Awareness: What You Should Know

Polyps can be one of the causes of sinus infection that gives pain and suffering to someone. But how did polyps become responsible for sinus infection? There is actually a type that is called sinus polyps which are tear-shaped tissue swellings or growths within the sinuses. These are thought to have occurred as a result of an ongoing inflammatory process within the sinuses.

Consequently, polyps may block the nasal airway and the proper drainage of sinus cavities, resulting to stagnant secretions within the sinuses that may become infected. Polyps can be small or large, but good thing is that they are not known as cancerous.

Symptoms Indicating Sinus Polyps

How will you know whether a person has sinus polyps? There are several indications that may suggest their presence. Symptoms include but are not limited to:

-difficulty of nasal breathing

-pain in and around the nose

-feeling congested

-poor sense of smell and taste

-smell in the nasal drainage

-snoring while sleeping

-chronic sinusitis

-a feel of “as if having colds all the time”

Awareness may be a problem because some patients do not realize the occurrence of this condition. The symptoms above can direct a person to think of an ordinary case of sinusitis that does not involve polyps. Patients may also know nothing about the possibility of developing polyps. Usually, the only time that a person knows that he or she has developed such is after a doctor recommends further tests because the patient has already suffered increasing number of sinus infections.

Nevertheless, it is never too late because there are medications and treatments which are available to help patients get relief from sinus polyps. Do not be clueless, and equip yourself with some basic knowledge and overview on how this condition is being treated.

Identifying Polyps

The most common procedure to identify polyps is done by simply placing a lighted scope into the nose through the nostril. A procedure called endoscopy uses a tube with a tiny camera on it that is inserted in the nose to spot polyps in the sinuses. Doctors may also use a computerized tomography scan which helps delineate precise locations of high numbers of polyps. Additionally, the scan ascertains absence of cancerous tumors or other problems. Allergy testing and swabbing the nose for presence of bacteria and fungi can also be performed to check any existence of polyps.


Once polyps are found, various medical treatments can be initiated depending on the description of the polyps as to their cause, size or location for instance.  Physicians may prescribe antihistamines to reduce allergic response if the polyps are caused by allergic inflammation.  Anti-inflammatory sprays, decongestants, systemic steroid medications, and nasal sprays that contain corticosteroids are among the medications that can also be recommended. It should be remembered though that these medications are to be sustained on a long term basis in order to reduce polyp size or prevent re-growth.

Surgical treatments are required in some cases. When polyps are large, surgical excision may be proposed by the doctor. After the surgical removal, continued monitoring of the nose and sinus cavities are extremely important to prevent recurrence of these polyps.

As pointed out earlier, awareness that this condition in our sinuses exists, helps us decide on the importance of getting immediate medical treatment.

Uterus Fibroid Surgery: Reliable Destination India

What are uterine fibroids?

Uterine fibroids (also referred to as myoma, leiomyoma, leiomyomata, and fibromyoma) are benign (non-cancerous) tumors that grow within the muscle tissue of the uterus. Between 20-50% of women of childbearing age have uterine fibroids. While many women do not experience any problems, symptoms can be severe enough to require treatment.

Fibroids range in size from very small (coin sized) to larger than a melon. A very large uterine fibroid can cause the uterus to expand to the size of a six or seven-month pregnancy. There can either be one dominant fibroid or a cluster of many small fibroids.

What are common symptoms of uterine fibroids?

  • Very heavy and prolonged menstrual periods
  • Pain in the back of the legs
  • Pelvic pain or pressure
  • Pain during sexual intercourse
  • Pressure on the bladder which leads to a constant need to urinate, incontinence, or the inability to empty the bladder
  • Pressure on the bowel which can lead to constipation and/or bloating
  • An enlarged abdomen which may be mistaken for weight gain or pregnancy

How do I know if I have uterine fibroids?

During a visit to investigate these symptoms, your doctor will check the size of your uterus. If it feels enlarged, your doctor may order an ultrasound or a magnetic resonance imaging (MRI) session, which can confirm the presence, location and size of fibroids. After identifying the size and location of your fibroid(s), and possibly after other diagnostic tests, your doctor may be able to rule out other potentially more serious conditions, and advise you of your options and a recommended course of treatment for the fibroids. If you do not notice any symptoms caused by fibroids there is no need to treat them. Your doctor may want to watch them and check for any growth.

India finds the infrastructure and technology at par with that in USA, UK and Europe. Uterus fibroid surgery is one the common treatments for patients coming to India. The good facilities provided in India are certainly beneficial but also the skyrocketing medical costs and long waiting lists to get treated by the specialists in the western countries are helping Indian medical tourism industry. India is all set to capitalize on the opportunity through low costs and highly trained doctors to appeal to the medical tourists. India has a large pool of professionally qualified doctors, nurses and paramedics. The world-class facilities and infrastructure is further supported by low cost airfare and other facilities related to their stay in India. The hospitals of uterus fibroid surgery in India at Delhi, Chennai, Mumbai and Hyderabad are providing low cost treatment for uterus fibroid without compromising with the health of the international patients. The cost of surgery less when it is compared with the other western countries, It is relatively cheap because that is the way the international economy runs. For more details on uterus fibroid surgery in India please visit and

Eye Cyst – Causes, Symptoms and Treatment

Eye cyst or medically termed as chalazion is a little lump on the lower or upper eyelids which is caused by the inflammation of the gland found in the lids. Consistency may be firm, soft or fluid-filled. Eye cyst is also known as  tarsal cyst, meibomian cyst and conjunctival granuloma.

What are eyelid glands?

The eyelid glands are called meibomian glands. It is also known as tarsal glands, palpebral glands or tarsoconjunctival glands. Each of our eyelids, both the upper and lower eyelids, may contain 30 to 40 eyelid glands. Each of these glands has tiny openings wherein they secrete their thick liquid secretion into the tear film of the eyes. It is composed of sebum, a mixture of mucus and oil. This liquid is responsible for keeping the eyes lubricated at all times.

What causes eye cysts?

The tiny openings of the glands may be clogged due to hardening of the secretions near the opening. As the glands keep on secreting sebum, the lids swell which then in turn inflame the eyelids. The swelling and the inflammation is known as the eye cyst or chalazion. This is common for individuals with dry skin.

If the clogged opening is infected with bacteria, then the gland may become infected. When this occurs, it is called hordeolum. Hordeolum looks like pimple and is tender to touch. Unlike eye cyst or chalazion, the gland is not infected at all. However, it may precede a hordoleum if not managed early.

What are the symptoms of eye cysts?

The eyelid has a lump and is painful, red and swollen.  

How is eye cyst treated?

Most eye cysts are treated using a warm compress directed to the affected eyelids. This is to promote circulation of blood to the inflamed area thus hasting its healing. In addition to that, most doctors would prescribe an antibiotic ointment or drops to prevent infection. This is applied immediately after the compresses. There are cases where surgery is needed. This happens when the eye cyst persists and is causing an unsightly swelling of the lids.

Thrush in Women – How To Best Treat A Thrush Infection?

Most women experience thrush most often during pregnancy and menstruation because it is during these times that the body goes through major hormonal fluctuations which changes the vaginal acidity (pH levels) and contributes to a yeast infection. Women experience troublesome vaginal discharge, persistent vaginal burning and itching alongside with fatigue and lethargy. It is no surprise that it becomes quite stressful for some women and this imposes a great infliction to their overall lives and relationships.

Thankfully there are several methods to successfully treat thrush at home, here are some well documented and proven methods that will help bring fast relief and treat symptoms better than most antibiotics drugs and creams that are out there.

Treat Thrush at home with Yogurt

It’s common knowledge that natural yogurt is good for the digestive system and that’s because it contains friendly bacteria such as acidophilus that helps our digestive tract from the bad bacteria. Yogurt has been reported by many women to be a great thrush treatment which gets rid of all yeast infection fast.

Apply yogurt topically, as you would a vaginal cream. Apply it to the affected area for best results.

Yogurt is also very soothing and relaxing so this should bring relief to the burning and soreness.

Treat Thrush at home with Garlic

Garlic is a powerful natural antibiotic which helps fight off many types of bacteria and fungi. It’s especially effective when it comes to treating thrush and other yeast infection types.

Apply garlic directly to the affected area for best results.

These are just a few of the best home thrush treatments used to successfully cure a yeast infection without any of the serious health side effects that are often associated with prescribed antibiotics. Many women have reported success with implementing the holistic natural home treatment.

It is important to get a guide to help you use these remedies properly and specify how much or how frequent they should be used. You can easily get rid of your thrush within days using natural remedies with proper guidance.

Types of Hepatitis, Symptoms of Major Types of Hepatitis

Hepatitis is inflammation of the liver, which can be caused by viruses, medications, or toxic agents.

Hepatitis known as an inflammation of the liver , is a gastroenterological disease. Hepatitis is generally categorized as a viral or non-viral hepatitis. Viral hepatitis can be considered “rapid” a position that comes on frequently with severe symptoms and for a short time or “chronic” a position that comes on slowly, may or may not have symptoms for a long time.

Viral infections are the cause of most acute Hepatitis. Hepatitis comes in 7 not so delicious flavours: Hepatitis A, B, C, D – Agent (which requires the presence of the hepatitis B virus to form), Hepatitis E, F, and G. None of these are very yummy, and should be avoided at all costs.

When most people refer to hepatitis, they are probably talking about viral hepatitis, which is classified into several types. Hepatitis A, which is very common in underdeveloped countries, is acquired from water or food sources. This type of hepatitis is usually mild and may sometimes be discovered only by blood testing. Hepatitis A never leads to chronic liver disease.

Hepatitis A is a highly infectious disease caused by Enterovirus referred to as Hepatitis A Virus(HAV) and the incubation period for this disease is about 2 – 8 weeks and the disease is called Short Incubation Hepatitis. The virus replicates in the liver of the host.

With hepatitis B, the liver also swells. Hepatitis B can be a serious infection that can cause liver damage, which may result in cancer. Some people are not able to get rid of the virus, which makes the infection chronic, or life long. Blood banks test all donated blood for hepatitis B, greatly reducing the risk for getting the virus from blood transfusions or blood products.

Hepatitis C is also passed on through contaminated blood and is similar to hepatitis B, but it is caused by a different type of virus. Infection with the hepatitis C virus (HCV) is the number-one reason for liver transplant in the U.S. Unlike hepatitis A and B, there is no vaccine to prevent hepatitis C.

Two other hepatitis viruses are known, hepatitis D and E. The D agent, an RNA passenger virus, cannot proliferate without the presence of hepatitis B virus, because its genome lacks certain essential genes. Hepatitis E produces a picture quite similar to hepatitis A, although it can take a fulminant course in some patients, particularly pregnant women; it is more prevalent in the Indian subcontinent. Hepatitis D is caused by the hepatitis D virus (HDV). It occurs only in people who have hepatitis B. Hepatitis E is caused by the hepatitis E virus (HEV), which can be found in the stool (bowel movements) of infected people. It is uncommon in the United States but is a risk to international travelers.

Cirrhosis Dangers Lowered By Eating Dark Chocolate, Research Reports

Cirrhosis of the liver – simply called cirrhosis by medical professionals – causes 10,000-15,000 deaths annually in the United States alone. It recently ranked as the 12th leading cause of disease-related deaths in the country.

Anything that helps a cirrhosis sufferer live longer definitely comes as good news. But one recent study found some extremely interesting results about eating dark chocolate: it appears dark chocolate can actually help prolong the lives of cirrhosis patients.

The announcement was made at the Annual Meeting of the European Association for the Study of the Liver in Vienna, Austria, in April 2010. The report described data revealing that dark chocolate reduced portal hypertension in patients with cirrhosis.

It’s easier to understand the research if you know what portal hypertension is, and the causes of cirrhosis.

When normal liver tissue is sufficiently damaged, it is replaced by fibrous scar tissue. When a sufficient amount of scar tissue replaces healthy tissue in the liver, the condition is called cirrhosis. Under normal circumstances, your liver can regenerate new cells and replace those that have been damaged. Unfortunately, scarring that has built up to the cirrhosis stage is irreversible. Blood cannot flow through scar tissue, so as the scarring progresses, liver function degrades. Eventually, the liver will fail, which is a medical emergency and a life-threatening situation.

Cirrhosis results most often from two causes: drinking an excessive amount of alcohol, and hepatitis. No matter how you get it, cirrhosis can lead to some very dangerous liver trouble and complications.

One of these complications is a problem known as portal hypertension. Portal hypertension is a form of high blood pressure that occurs in the portal vein, which brings blood to the liver from the digestive organs. Portal hypertension can cause blockages in the blood flow around the esophagus and stomach. So the body develops veins (varices) in these areas to bypass the blockages. These veins are fragile and they’re already under substantial pressure. Ruptures become more likely. Known as bleeding varices, such cirrhosis-related blood vessel ruptures can be extremely dangerous.

But data released by a group of researchers in Spain reveals that eating dark chocolate may lower the risk of portal hypertension causing bleeding varices in cirrhosis patients.

It’s typical for blood pressure in your abdominal area to bump upward shortly after you’ve eaten. This is due to increased blood flow to the liver. This can be a dangerous time for people with cirrhosis, because they already have high blood pressure in the portal vein. Adding more pressure greatly increases the chance of a rupture.

Dark chocolate contains a lot of flavenoids, which are chemicals that have been proven to be beneficial for the body – especially the heart. Flavenoids also help reduce blood pressure because they relax veins and arteries, allowing blood to flow more easily. Many kinds of chocolate do not contain flavenoids, but they are certainly present in dark chocolate. In fact, the darker the chocolate, the more flavenoid content is present.

The participants in this study were given either 85 percent dark chocolate to eat, or a meal of white chocolate which contained no flavenoids. The researchers found that those given the dark chocolate had a statistically significant smaller rise in portal hypertension than those given white chocolate. These results seemed to indicate that cirrhosis patients who eat dark chocolate lower their risk of blood vessel ruptures.

Dark chocolate is no longer placed in the same category as other chocolate as “just candy.” The flavenoids it contains actually make it a nutritious health food when eaten moderately. Flavenoids, in fact, offer many of the same healthy food benefits as darkly colored vegetables and fruits. There are eight times as many flavenoids in dark chocolate as can be found in strawberries.

Anyone with cirrhosis should actively search for strategies to prevent portal hypertension and bleeding varices. Based on the work done by the Spanish researchers, it appears eating dark chocolate would benefit cirrhosis sufferers by helping them reduce portal hypertension.

Code by Type of Stone Removal To Ensure Correct Payment

When a patient has more than one stone in one kidney (multiple stones), or stones in both kidneys or ureters (bilateral stones), the urologist can gain more reimbursement and avoid fraud by coding based on the type of removal performed.

Different types of stone removals are outlined below with the correct coding solutions.

Removal by Lithotripsy

Code removal by extracorporeal shock wave lithotripsy (ESWL) with 50590 (lithotripsy, extracorporeal shock wave). The urologist can often ethically gain more reimbursement for treating multiple and/or bilateral stones.

  • Multiple Stones. The urologist performs ESWL to break up a kidney stone. But neither the technique nor the code allows the urologist to target just one stone, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services in Denver. The ESWL procedure is the same regardless of the number of stones in the kidney, so there is no justification for billing extra for multiple stones. Whether the stones are in the renal pelvis, the calyx, the ureteropelvic junction, the ureter, or all four locations, use 50590 only once per kidney. The code is valued at a high rate because it is intended to cover those occasions when multiple stones are treated as well.
  • Staged Treatment. Most urologists would treat bilateral stones with ESWL at different times one within the global period of the first ” says Michael A. Ferragamo MD assistant clinical professor of urology at the State University of New York at Stonybrook. “So they would need to indicate in the preoperative note that the ESWL will be staged with one kidney initially and another several weeks later.” Append modifier -58 (staged or related procedure or service by the same physician during the postoperative period) to the second 50590 if done at a different time.

Note: When a patient has stones in both kidneys some urologists may treat both with ESWL at the same time although this is unlikely. Report 50590 with modifier -50 (bilateral procedure) in this case.

Use -LT and -RT modifiers to indicate on which kidney the 50590 is per-formed. If the left kidney stone is treated first use 50590-LT; for the second ESWL use 50590-RT-58.

Sometimes stones are treated more than once. For example the left kidney is treated in July and again in August and the right is treated in September. Code 50590 -LT for July 50590-LT-58 for August and 50590-RT-58 for September.

Removal by Ureteroscopy

Removal by ureteroscopy is coded 52320 52325 52330 52352 or 52353. Only ureteroscopy codes 52353 (cystourethroscopy with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]) and 52354 (… with biopsy and/or fulgration of lesion) can be billed bilaterally says Cynthia Jackson RRA CPC coding specialist for Emory University Urology Group in Atlanta. “It is appropriate to bill these with a -50 modifier ” she says. When performing ureteroscopic stone removals sequentially do not use modifier -58 because ureteroscopies have zero-day global periods.

  • Cysto with stone removal. When performing stone removal under fluoroscopy without a ureteroscope bill for multiple stones in one ureter by appending modifier -22 (unusual procedural services) to 52320 (cystourethroscopy [including ureteral catheterization]; with removal of ureteral calculus). Include the operative report and a short note explaining why the extra stones took more work.

    Use layman’s terms in the note because it’s unlikely that a medical person will be the first to see your claim. For example note excessive bleeding the number of stones removed and most important how much longer than usual it took to perform the procedure.

    “If it normally takes you half an hour to do 52320 and it took 1 hours due to the multiplicity of stones indicate that time at the top of your note to the carrier ” Ferragamo says. “Explain exactly why it took you so much time.” Because of the delay in payment and frequent denials of increased payment some urologists choose not to bill modifier -22 for removing two or three stones from the same ureter unless a lot of time is spent on the procedure.

    If the urologist removes stones from both ureters at the same session use 52320-50.

  • Cysto with stone removal or manipulation. When the urologist must either remove or manipulate stones ureteroscopically use 52352 (cystourethroscopy with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus [ureteral catheterization is included]). If there are multiple stones in one kidney append modifier -22 and file the claim on paper with an operative report.

    Medicare will not allow modifier -50 on 52352. The dollar value of the code includes the occasional time that the procedure is performed bilaterally.

    If one stone requires manipulation and another requires removal you may append modifier -22 to 52352. You cannot bill for the procedures separately because Medicare does not allow bilateral billing on 52352.

    Ferragamo does not recommend adding modifier -22 for every case in which multiple stones are treated. “Only use modifier -22 if the work performed is significantly increased.” Medicare expects modifier -22 to be used in less than 5 percent of cases Ferragamo says adding that greater use increases the chances of an audit. If you specialize in difficult cases your use of modifier -22 will likely exceed 5 percent.

  • Cysto with lithotripsy. When performing a combination of lithotripsy and ureteroscopy bill 52353. If there are multiple stones in one ureter append modifier -22 and include the operative note.

When performing 52353 in both kidneys append modifier -50.

Diagnostic Ureteroscopy

Medicare will not allow 52351 (cystourethroscopy with ureteroscopy and/or pyeloscopy; diagnostic) to be billed bilaterally says Morgan Hause CPC CCS-P coding specialist with Urology of Indiana an 18-provider group in Indianapolis. This is likely due to the valuation of the code at a rate that would include both ureters and/or kidneys. Because it’s diagnostic it is more frequently performed bilaterally than the therapeutic ureteroscopy procedures.

Appending the Modifiers: -50 LT/RT and -59

Most coders prefer to use modifier -50 instead of modifiers -LT and -RT for Medicare because it allows one-line billing for bilateral procedures. While a urologist may like identifying which ureter he or she is performing a procedure on the coder can replace the -LT and -RT modifiers with modifier -50 and adjust the fee to 150 percent.

But under certain circumstances it is appropriate to use modifiers -LT and -RT rather than modifier -50.

“Using -LT and -RT helps the payer understand why you need bilateral payment ” says Jules Geltzeiler MD who practices with Shore Urology in Long Branch N.J. For example the patient has stones in each ureter that need to be pushed back into the kidneys with ESWL procedures anticipated in the future. Bill 52330-LT and 52330-RT linking 592.1 (calculus of kidney and ureter; calculus of ureter) to each. “Then you insert the permanent stents ” Geltzeiler says. ” Code 52332 -LT-51 (cystourethroscopy with insertion of indwelling ureteral stent [e.g Gibbons on double-J type]; -multiple procedures) and 52332-RT-51 if the payer is an HMO and 52332-LT-59 ( … distinct procedural service) and 52332-RT-59 if the payer is Medicare.”

Despite this coding scenario you may have to appeal if the payer doesn’t understand that two separate problems were handled with the two ureteroscopies and two stents. (For more on stents and modifiers see reader question on page 70.)

In another example the urologist performs a cysto with lithotripsy in the left ureter (52353) and a diagnostic ureteroscopy (52351) on the right ureter. Use 52353-LT and 52351-59. Appending modifier -59 pulls 52351 out of the bundling edits. Also bear in mind that CPT states that surgical cystourethro-scopy includes diagnostic urethroscopy. Since Medicare does not allow bilateral billing for 52351 the use of -LT and -RT modifiers is inappropriate as is the use of modifier -50.

Note: If the carrier computer system assumes that 52351 is bilateral and throws out the second listing of the code you should appeal explaining that two different procedures were performed.

Coding Bladder Stones

Bladder stones cannot be billed bilaterally. The bladder stone fragmentation codes — 52317 (litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small [less than 2.5 cm]) and 52318 (… complicated or large [over 2.5 cm]) — are unilateral only. For fragmentation of multiple stones use 52318. Neither code allows modifier -50. The bladder cannot be a bilateral organ.”

What is Emetophobia?

I wanted to take the time to answer what is emetophobia? Most people haven’t heard of this because only a small minority of people actually suffer from this. It is something that has been growing more common though. If you’re unfamiliar, it is a person that has an irrational fear of vomiting. It may not sound so much different than yourself because I don’t ever want to vomit, but sufferers actually have a very irrational look at the world that causes them problems. I’m going to bring you into the life of a emetophobia suffer and help you understand the way they live.

This is the fear you’re going to have and it’s the fear that someone else might induce vomiting in you. Think about it for a minute. Germs will make you sick. You could be walking down the street and be afraid that someone might cough on you. It’s a totally reasonable assessment for any person, especially a person with emetophobia. Imagine going to restaurant with friends, a sufferer would be bombarded with questions in their mind. “Is the kitchen Clean”, “Did the chef wash their hands”, etc. These can consume a person and take over their life.

The emetophobia sufferer will eventually pull away from society because it’s something they can’t control. They don’t want to vomit, and they only way for them to do that is by controlling their environment. There home is really the only place. This isn’t an enjoyable thing and I know most people don’t want to have this problem, but there are treatment methods available that do work wonders, that don’t require pills or anything like that.

Food Allergies & Food Poisoning

Many of the symptoms caused by allergies are also similar to food poisoning. This is especially true of stomach upset, diarrhea, and unpleasant side-effects along those lines (see gluten allergy symptoms for some specific examples).

With the possibility of having identical symptoms, how do you know if you really have allergies, or if you are dealing with food poisoning?

First of all, the allergy symptoms are not identical to food poisoning symptoms in most cases. There are often other effects that are not the same as food poisoning.

In most cases, food poisoning is a one-off thing. Someone left the meat out of the fridge for too long. The food was contaminated during processing. One of the ingredients went bad, and was added to the dish unnoticed. There are many causes for food spoilage, but they are usually not consistent. In other words, don’t expect that since you got food poisoning from the left-overs last week, that you will get sick every time you eat left-overs.


Food poisoning has become a way of life for those that enjoy the taste of new types of food. The good chances of getting indigestion do not prevent them from searching for exotic restaurants where they can devour large quantities of strange and delicious food. Until severe food poisoning occurs and a hospital stay is had, the experimental eater will continue playing roulette with new types of food.

The animals in the forest and the fish in the sea understand the meaning of food poisoning very well. There is a large variety of food in the forests and in the sea, it is much larger then the variety we have in our supermarkets, but animals and fish will eat only food that they are accustomed too. Nature has provided them with that wisdom, and few break nature’s rules. If they do they will surely get sick or die. The only species that disobeys natures command to eat food that is customary is the human species. Is it any wonder that they often get indigestion and many times die?

Avoid Food Poisoning

Always wash your hands and everything else that comes in contact with food. This includes utensils, cutting boards, countertops, table ware, and cook ware. Wash hands with warm water for at least 20 seconds before handling food, after handling uncooked meat/produce and wash between preparing each type of food. Separate raw foods from other kinds of food and use a separate cutting board for meat and vegetables. Do not use the same utensils or dish ware with uncooked or other foods. Keep it out of the danger zone (40 F and 140F) by cooking it thoroughly. Check the internal temperature of meat with a clean thermometer and make sure it’s at least 140 F. It is not good enough to just eye ball it to see if it’s brown.

*Keep the area near the utensils food and food products clean.

*Wash the row food products properly before cooking.

*Don’t keep the food at the room temperature for more than two hours.

*Cook the food properly.

*Temperature of freeze should be 0 to 4 degree Celsius.

*Light charcoal barbecues well in advance, making sure you use enough charcoal and waiting until it is glowing red (with a powdery grey surface) before starting cooking.

*Always wash your hands thoroughly – before preparing food and after touching raw meat and before eating.

*Keep pets away from food, dishes and preparation surfaces.

*Keep hot food hot and cold food cold after you serve it. Never leave food out at room temperature for more than two hours, and keep it protected with a clean cover at all times.

Treatment/cure for Varicose Ulcers

Varicose Ulcers

If you have poor circulation in your legs, which becomes more likely as you grow older, the blood flow through the lower parts of your body, especially your calves and ankles, becomes sluggish. You may already have varicose veins . In addition, any small injury or crack that appears in the skin is unlikely to heal because the tissues are filled with stagnant fluid and are not getting enough fresh blood. The injury or crack enlarges and gradually becomes a varicose ulcer. The condition is common in the elderly and in pregnant women.

What are the Symptoms?

The ulcer is shallow, it weeps, and it may have pus in the center. Once it has formed, it may remain unchanged, or constantly keep healing and returning. The most common site for a varicose ulcer is the skin on the inside of the leg, just above the ankle. Quite often both legs are affected. The skin around the ulcer becomes red, flaky and itchy, and the ankles often swell. The ulcer may persist for months, or even years. If you think you have a varicose ulcer, see your physician and also adopt the self-help measures described below.

What is the Treatment?

Self-help: Whenever you sit and relax at home, raise the affected ankle. Sleep with your feet higher than your chest. This can be done by raising the foot of your bed about 20 cm (8 in). Avoid standing for long periods of time, and exercise moderately by taking walks on a regular basis.

Professional help: Your physician may suggest that you wear a knee-high elastic bandage or thick elastic stocking during the day. If the ulcer is severe, the doctor or nurse may teach you to clean it with a mild antiseptic, and cover it with a dressing. This should be done frequently.

If the ulcer fails to heal, your physician may coat it with a white paste and then bandage it up. In some cases this still fails to clear up the problem,and you may be advised to go into the hospital for a few weeks there you can rest in bed in the proper position, and your ulcer will be constantly observed and treated as necessary .to hasten healing ,a skin graft may be needed.

Acidity (Amlapitta) and Best of Ayurveda

“Acidity” refers to a set of symptoms caused by an imbalance between the acid secreting mechanism of the stomach and proximal intestine and the protective mechanisms that ensure their safety.

The stomach normally secretes acid that is essential in the digestive process. This acid helps in breaking down the food during digestion. When there is excess production of acid by the gastric glands of the stomach, it results in the condition known as acidity.

Acidity is responsible for symptoms like dyspepsia, heartburn and the formation of ulcers (erosion of the lining of the stomach or intestines). Acidity tends to have a much higher incidence in highly emotional and nervous individuals. Consumption of Alcohol, highly spicy foodstuffs, non-vegetarian diets, and Non Steroidal Anti-Inflammatory Drugs (NSAID’s) also predispose to gastric acidity. Most of the times, acidity is not caused by a serious medical condition.

Acidity or Hyperacidity / Gastritis is correlated to “AMLA PITTAM” in Ayurveda. Viruddhahara Sevana (Incompatible Foods), Dustaahara Sevana (Unhygienic & Infected foods), Ritu Vishesha (Seasonal Factors), Desa Vishesha (Geographical Factors), excessive intake of Amla, Vidahi and Pitta aggravating Foods. Spicy food intakes, Supression of natural urges, intake of poisonous substances etc are the causative factors for Amlapittam according to Ayurveda.

Amla pittam is closely interlinked with Ahara, Vihara and Achara; as such “NIDANA PARIVARJANAM (Avoiding the root cause)” constitutes one of the primary line of treatment, along with PATHYASEVANA (Beneficial food consumption & Good Life Style) Measures.

Eliminative Procedures like VAMANAM (Induced Emesis / Vomiting), VIRECHANAM (Purgation) and VASTI (Specialised Enema Procedures) should be adopted as per the need of the case. Shamana Chikitsa (Pacification Treatments) by using Researched Internal Medicines is the common line of treatment. Irritant, Processed, Spicy and Stored food has to be avoided. Foods and drinks consisting mainly of Bitters, Particularly products of Yava and Godhuma (Barley & Wheat) are to be consumed more.

We give the Best Treatments for “Acidity” with High Success Rates at Dr. Kranthi’s Institute of Ayurvedic Sciences & Research, The Kerala Ayurvedic Care, Speciality Panchakarma Centre, 3-6-101/1, St no: 19, Basheerbagh, Hyderabad-29. Contact Dr Kranthi R Vardhan on 9246166636 for Appointments, Evaluation and Treatments. Visit us at or write to us at

Best Ayurvedic and Herbal Treatment for Gastritis

Gastritis is a common name for all kinds of inflammation of the inner lining of the stomach, which is known as the mucosa. It is characterized by severe stomach ailments like cramps in the stomach, diarrhea and constipation and even blood with the stools.

In Ayurveda, gastritis is known as Urdhavaga Amalapitta. It is caused in people with pitta constitution. When the pitta dosha gets vitiated in such people, there are greater chances of getting gastritis.

There are many causes of gastritis. Food poisoning can lead to gastritis, and so can consuming alcohol and drugs like aspirin and steroids. Allergies to certain foods can cause gastritis. Oblique causes for gastritis are physical stresses caused due to flu, some major surgery, severe burns or injuries.

Nowadays the infection of the bacteria Helicobacter pylori is looked upon as an important cause of gastritis.

(1) Useful Herbs in the Treatment of Gastritis

– Asparagus (Asparagus racemosa) Asparagus is known to be an antispasmodic. It reduces the fire in the stomach. The root of the asparagus is effective in reducing the hyperacidity of the digestive system.

– Bitter Chamomile (Matricaria chamomilla) The tea of the bitter chamomile is effective in allaying the gastritis that is caused due to tensions and worries.

– Cardamom (Elattaria cardamomum) Cardamom has soothing effects on the stomach. It is especially beneficial if the gastritis causes heartburn.

– Fennel (Fenneliculum vulgare) Fennel is used as a digestive traditionally by Indians. After each meal, there is a tradition of chewing some seeds of fennel. Fennel soothes the stomach, facilitates digestion, reduces flatulence and relieves the stomach of excess acidity.

– Ginger (Zingiber officinale) The extract of ginger is effective in treating the acid dyspepsia that is associated with gastritis. It is especially useful for people who consume more of a non-vegetarian food.

– Indian Gooseberry (Emblica officinalis) The Indian gooseberry, or amla, is very beneficial in the treatment of several stomach ailments, gastritis included. The other digestive ailments it is used for dyspepsia, burning sensation, anorexia, vomiting and hemorrhage.

– Licorice (Glycyrrhiza glabra) The root of the licorice can soothe the inflammation and the injury to the stomach. It is also known to reduce the proliferation of Helicobacter pylori.

– Rhubarb (Rheum emodi) Rhubarb is a mild agent; so it is effectively used in treating gastritis problems in children. It can reduce the acidity in the stomach.

– Sandalwood (Santalum album) Sandalwood helps in gastritis because it has cooling properties. It can soothe the stomach muscles inflamed by gastritis.

(2) Dietary Treatments for Gastritis

A careful dietary regime is needed in case of gastritis. The following points must be noted.

– Only rice that has been aged for one year must be used. Wheat and barley are beneficial.

– Among vegetables white pumpkin, bitter gourd, cucumber, green banana and banana flower are effective.

– Cow’s milk is preferable to buffalo’s milk.

– People suffering from gastritis must not confuse their stomach glands with different kinds of foods at the same time. It is beneficial if the person is kept on a single diet. Ideally the person must be kept on a milk diet or on a diet of old rice.

– Vitamin C has the capacity to help in the absorption of iron and calcium salts in the body. This eases the digestive process. Therefore, the diet must be rich in vitamin C. Foods that contain vitamin C to a commendable quantity are amlas, oranges, etc.

– Pungent and sour tastes must be avoided. Even chocolates, tea and coffee must be avoided as these can increase the acidic contents in the stomach.

– The person must never eat till the stomach is fool. In gastritis it is better to eat little quantities each time, so that the stomach gets proper time to digest the food.

– Sesame seeds and curds must be avoided.

– There should be a total stop to alcoholism.

(3) Ayurvedic Treatment for Gastritis

Amalaki choorna or Triphala choorna is given in a dose of three grams thrice a day for seven days.

If there is constipation along with gastritis, then Avipattikara choorna is taken as the medicine of choice. The dosage is two teaspoonfuls at bedtime.

There is a list of other Ayurvedic preparations that are useful in the treatment of gastritis. Some of these are Dhaatri loha, Sukumara ghrita, Sootashekhara rasa, Kaamadudha rasa, Leela Vilas rasa, Chandrakala rasa and Amalapittantaka rasa.

(4) Home Medications

– Take one teaspoonful of licorice root powder and mix it with pure ghee and honey. Take this twice each day on an empty stomach.

– Have a banana early in the morning. Drown them with milk. This reduces the acidity within the stomach in some days.

– After each meal have a glassful of milk with Isphagula in it.

– Squeeze the juice of an orange and add some roasted cumin seeds in it. Have this with some salt in it. It provides immense relief in gastritis.

Apart from these, keep the mind always stress-free. Do not go to bed immediately after a meal. There should be an ideal gap of an hour between taking a meal and going to bed.