#Dysphagia Diagnostics Clinic

[hillcountrydysphagiadiagnostics]

Know More About Dysphagia Diagnostics Clinic in SA

Discover top-notch care at our Dysphagia Diagnostics Clinic in SA. Specializing in thorough evaluations and tailored treatment plans, we ensure optimal patient outcomes. Trust our expert team for all your swallowing disorder needs. Visit us for unparalleled diagnostic services.

[chronic-gastro-illness-culture]

is ARFID related at all to digestive / stomach disorders?

oh hell yeah

firstly eds can cause digestive disorders

Gastrointestinal (GI) Issues During and After Eating Disorder Treatment

Eating Disorders and Gastrointestinal Diseases

but also if u look at the dx criteria for arfid disgestive disorders can cause or worsen arfid bc of health anxiety i assume n the fear of triggering symptoms

DSM-V Diagnostic Criteria for ARFID

An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about averse consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

Significant nutritional deficiency.

Dependence on enteral feeding or oral nutritional supplements.

Marked interference with psychosocial functioning.

The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

arfid is highly comorbid w ocd bc of fear of contamination n catching a illness n fear of triggering a digestive disorder episode would work the same way but instead of triggering a phobia or obsession n compulsions its reflux/ibs/food allergies/dysphagia/indigestion/nausea/pain/etc some other negative consequence to eating that wants to be avoided

like it goes beyond just following a restrictive elimination style diet ur doc gave u to control n manage symptoms to see what trigger foods to avoid n goes into phobic n neurotic territory were u want a lot of control over how ur food is prepped eating food made by someone other then urself makes u nervous n maybe u avoid that altogether or u would rather starve/skip a meal that isnt prepped by u just bc it makes u too nervous to eat it u need to know its safe n that it wont trigger a episode n if u cant guarantee that u just avoid it all together or eat just a lil n hope its not enough to trigger a episode

[hospitalasiancancer]

Navigating Throat Cancer: Early Symptoms, Effective Treatment, and Top Specialists in Jaipur

Throat cancer is a type of cancer that affects the throat, voice box (larynx), or the windpipe (trachea). As with many cancers, early detection can make a significant difference in the effectiveness of treatment and overall recovery. If you or a loved one are experiencing symptoms related to throat cancer, it is essential to understand the signs, seek professional care, Consulting with the best cancer surgeon in Jaipur ensures that you receive the best treatment options available.

Recognizing the Early Symptoms of Throat Cancer

The early signs of throat cancer can be subtle, often mistaken for common illnesses like a cold or sore throat. However, it’s important to stay vigilant. Common symptoms include:

A persistent sore throat that doesn’t go away

Difficulty swallowing (dysphagia)

Hoarseness or a change in the voice

A lump in the neck or throat area

Persistent cough or coughing up blood

Ear pain or difficulty hearing

Unexplained weight loss

If these symptoms persist for more than two weeks, it’s crucial to consult a specialist for a proper diagnosis.

Effective Treatment for Throat Cancer

Treatment for throat cancer depends on the stage of the disease, the location of the tumor, and the overall health of the patient. Common treatment options include:

Surgery: Removal of the tumor or affected area of the throat.

Radiation therapy: Often used for early-stage cancer or to shrink tumors before surgery.

Chemotherapy: Used in combination with surgery or radiation, particularly for advanced-stage cancer.

Immunotherapy: A newer approach that helps boost the body’s immune system to fight cancer cells.

Each patient’s treatment plan will be personalized to their specific condition, ensuring the most effective approach for their recovery.

Finding the Best Oncologists in Jaipur

If you or a loved one is dealing with throat cancer, Look for the right Best oncologist in Jaipur for Successful Treatment , Asian Cancer Hospital is a top-tier medical facility known for its expertise in oncological care. The hospital is equipped with the latest technology for accurate diagnosis, staging work-up, and comprehensive cancer treatment.

At Asian Cancer Hospital, their team of expert oncologists provides:

Cancer Prevention: Early screenings and assessments to identify risks.

Early Diagnosis: Cutting-edge diagnostic tools to detect throat cancer at the earliest stages.

Staging and Work-up: Thorough evaluations to determine the extent of the cancer.

Comprehensive Treatment Plans: Personalized treatments to ensure the best outcome for each patient.

The hospital’s mission is to provide world-class care with compassion, ensuring that every patient receives the support they need throughout their treatment journey. With a focus on the latest research, clinical trials, and patient-centered care, Asian Cancer Hospital is committed to fighting and winning the battle against cancer.

Why Choose Asian Cancer Hospital in Jaipur?

Experienced Oncologists: The hospital boasts a team of internationally trained oncologists who specialize in the treatment of various cancers, including throat cancer.

State-of-the-art Technology: With advanced diagnostic tools and treatment methods, the hospital ensures the highest level of care for patients.

Holistic Care: Along with medical treatment, the hospital provides emotional and psychological support to patients and their families.

Comprehensive Treatment Options: From early diagnosis to complex treatments, Asian Cancer Hospital offers a full spectrum of services under one roof.

Conclusion

When it comes to treating throat cancer, early detection and the expertise of a skilled oncologist can significantly impact the outcome. Choosing the best cancer surgeon in Jaipur ensures that you are receiving the highest level of care and the most effective treatment options. Asian Cancer Hospital in Rajasthan is home to some of the best cancer specialists in the region, offering advanced diagnostic services, personalized treatment plans, and comprehensive care for patients. Whether you are seeking a second opinion or starting your treatment journey, the dedicated team at Asian Cancer Hospital is here to support you every step of the way. For the best cancer care in Jaipur, trust the experience and commitment of the best cancer surgeon in Jaipur.

[global-research-report]

Global Huntington's Disease Treatment Market: Opportunities and Emerging Therapies

The global Huntington’s disease treatment market size is expected to reach USD 1,871.2 million by 2030, according to a new report by Grand View Research, Inc. The market is expected to expand at a CAGR of 23.20% from 2023 to 2030. This growth is due to high R&D investments for new product development, research collaboration, and the high HD burden in western countries. Huntington's disease is a rare inherited neurodegenerative disease that affects several generations. It affects people between the ages of 30 and 50, impairing their capacity to work, care for their families, and, eventually, complete daily tasks.

The prevalence varies by more than ten-fold between geographical locations, which can be related to variations in case ascertainment and diagnostic criteria. The prevalence varies by more than ten-fold between geographical locations, which can be related to variations in case ascertainment and diagnostic criteria. As a result, the prevalence of enlarged repetitions in the general population may be greater than expected. The Asian population has consistently had a lower prevalence, while Europe, North America, and Australia have a higher prevalence.

The key players, such as Neurocrine Biosciences, Inc. and Azevan Pharmaceuticals, Inc., are focusing on research and development of symptomatic therapies for HD. Azevan Pharmaceuticals is developing SRX246 as an experimental drug to treat neuropsychiatric symptoms in Huntington's disease. SRX246 is a drug that works by blocking the vasopressin 1a (V1a) receptor in the brain. In the neurological system, V1a receptor is the major vasopressin receptor. SRX246 works by inhibiting the V1a receptor, restricting vasopressin from attaching to the receptor, and generating irritable and aggressive behavior, which is seen in Huntington's disease patients.

However, currently approved drugs provide symptomatic and palliative care and do not target the underlying cause of the disease. While medications can decrease the severity of symptoms, they are often associated with adverse effects such as somnolence, gait issues, dysphagia, and apathy, which can have serious impacts on a patient’s quality of life. Given the lack of a cure for the disease, it is critical to evaluate how Health-related Quality of Life (HRQOL) is affected in these patients. HD patients in early to middle stages of the disease need coordinated multidisciplinary healthcare services, including assessment of cognitive function and counseling.

Drug development for HD has faced significant obstacles as several therapies have failed to demonstrate efficacy or were associated with significant toxicity. Vaccinex Inc.'s phase II trial of Pepinemab failed to satisfy pre-specified co-primary endpoints in patients with early manifest and prodromal HD, in September 2020. The two co-primary endpoints-a family of two cognitive evaluations from the Huntington's disease Cognitive Assessment Battery and Clinical Global Impression of Change (CGIC)-did not attain statistical significance in the early manifestation population in the SIGNAL study.

Huntington’s Disease Treatment Market Report Highlights

The symptomatic treatment segment accounted for the largest revenue share in 2022 owing to the product availability and patent protection. Disease-modifying therapies is anticipated to be the fastest-growing segment over the forecast years due to the entry of SAGE-718, and Cellavita-HD

Companies are now focusing on the development of treatments that can be injected directly into the brain to directly inhibit the formation of mutant HTT protein, instead of targeting the mutant protein

Drugs with novel targets in early-phase development include Cellavita and Azidus Brazil’s Cellavita HD (stem cell therapy), Sangamo Therapeutics, Inc. mHTT ZFP (zinc finger protein), and UniQure’s AMT-130 (gene therapy)

North America held the highest revenue share in 2022 and is expected to dominate the market over the forecast period due to better reimbursement facilities and the high burden of HD in the U.S. and Canada

Huntington’s Disease Treatment Market Segmentation

Grand View Research has segmented the global Huntington’s disease treatment market report on the basis of treatment, end-use, and region:

Huntington’s Disease Treatment Treatment Outlook (Revenue, USD Million, 2018 - 2030)

Symptomatic Treatment

Disease-modifying Therapies

Huntington’s Disease Treatment End Use Outlook (Revenue, USD Million, 2018 - 2030)

Hospital Pharmacy

Retail Pharmacy

E-commerce

Huntington’s Disease Treatment Regional Outlook (Revenue, USD Million, 2018 - 2030)

North America

U.S.

Canada

Europe

Germany

U.K.

Spain

France

Italy

Denmark

Sweden

Norway

Asia Pacific

Japan

China

India

South Korea

Thailand

Australia

Latin America

Brazil

Mexico

Argentina

Middle East & Africa

South Africa

Saudi Arabia

UAE

Kuwait

Order a free sample PDF of the Huntington's Disease Treatment Market Intelligence Study, published by Grand View Research.

[drarunnair]

Dysphagia Treatment

Have you or your loved one experienced the problem of swallowing food or Water? Food stuck in the Esophagus? Also Difficulty in Breathing? Then you may have dysphagia disease. Don’t worry, Dysphagia disease is treated with different methods. Dr. Arun S. Nair is one of the best gastroenterologists in Thrissur and all over Kerala having expertise in the management of esophageal disorders. He has completed a Fellowship in “Esophageal Cancer Surgery” at the National Cancer Center, Chiba Japan under Prof Daiko 2017 & International Fellowship in minimal Invasive Esophagectomy at Fudan University, under Li Jie TAN, China. Dr. Arun S. Nair is the first Gastro surgeon in Thrissur, Kerala having 14+ years of experience in Esophageal disease management. he has almost 1500+ patients suffering from esophageal disease whether it may be cancerous or noncancerous conditions.

Currently, Dr. Arun Nair is a Senior Consultant in the Department of Surgical Gastroenterology and Advanced Laparoscopic Surgery at Elixir Clinic, Thrissur, and other well-known hospitals similar as Daya General Hospital, Thrissur, Sun Medical and Research Centre, Thrissur, and. Gregorios Medical MissionMulti-Speciality Hospital, Thiruvalla, Kerala, consulting Dr. Arun Nair for Esophageal disorders in Thrissur can give effective treatment and expert care.

What is Dysphagia?

Dysphagia is the medical term for difficulty swallowing. It can happen at any stage of the swallowing process, from the mouth to the throat and esophagus. This condition can lead to serious health complications if not rightly treated.

What are the signs of swallowing difficulty?

Food feels stuck in the throat or chest.

Painful swallowing or burning sensation.

Coughing or choking while eating or drinking.

Difficulty controlling saliva or drooling.

Food or liquid coming back up after swallowing.

Changes in voice quality or hoarseness.

Avoiding certain foods leads to unintended weight loss.

Recurrent respiratory infections due to inhalation of food or liquid.

How does Dr. Arun Nair Diagnose Dysphagia?

Dr. Arun Nair diagnoses dysphagia( difficulty swallowing) through a thorough evaluation and technical individual methods, which may include

Endoscopy: An adjustable pipe with a camera to visually examine the throat and esophagus for abnormalities.

Barium Swallow: X-ray imaging after swallowing a discrepancy material( barium) to observe the swallowing process and describe structural effects.

Manometry: Measures muscle condensation in the esophagus to charge swallowing function and collaboration.

CT Scan or MRI: Provides detailed images of the throat and esophagus to identify excrescences, strictures, or other structural abnormalities.

Swallowing Evaluation: Clinical assessment of how liquids and solids are swallowed, observing for any difficulties or abnormalities.

Dr. Arun Nair a laparoscopic surgeon in Thrissur utilizes these diagnostic tools and techniques to accurately diagnose the underlying cause of dysphagia and develop a personalized treatment plan tailored to each patient’s needs.

Treatment options for Dysphagia:

Medication: Prescription medicines to address underpinning causes like GERD or infections affecting swallowing.

Esophageal Dilation: Non-surgical procedure using a balloon or dilating device to widen narrowed sections of the esophagus, salutary for conditions similar to strictures.

Surgical Interventions: Procedures performed when dysphagia persists despite other treatments, including removal of obstructions or repair of damaged tissues.

Lifestyle Adjustments: Changes in diet consistency and methods for easier swallowing, frequently recommended by a speech therapist or nutrition specialist.

Swallowing Rehabilitation: Therapy sessions concentrating on strengthening swallowing muscles and enhancing coordination, guided by a specialist.

Management of Underlying Conditions: Addressing and treating neurological, muscular, or structural issues contributing to dysphagia.

Dr. Arun S Nair specializes in treating esophageal cancer in Thrissur, where each approach is customized to meet the patient’s specific needs, aiming to enhance swallowing function and improve quality of life.

Why choose Dr. Arun Nair for Dysphagia treatment in Thrissur?

Expertise: Dr. Arun S. Nair is a highly experienced gastroenterologist and gastrointestinal surgeon based in Thrissur, Kerala, famed for his expertise in treating dysphagia. He specializes in both surgical and non-surgical approaches to effectively manage swallowing difficulties.

Personalized Treatment Approach: Dr. Arun Nair provides individualized treatment plans acclimatized to each patient’s specific requirements. His approach integrates advanced surgical ways and innovative surgical methods to ensure comprehensive care.

Advanced Treatment Options: As a leading authority in dysphagia management, Dr. Arun Nair offers the most advancements in treatment options. These include surgical interventions similar to medications and remedial dilations, as well as advanced surgical procedures like Heller myotomy and robotic-assisted surgeries for precise and minimally invasive treatments.

Patient-Centered Care: Dr. Arun Nair prioritizes patient well-being through clear communication and cooperative decision-making, ensuring patients are informed and involved in their care journey.

State-of-the-Art Facilities: Located in Thrissur, his practice offers access to ultramodern facilities and a comfortable care environment, ensuring patients receive high-quality medical care with compassion and expertise..

[chocolatedetectivehottub]

Laryngologia,

Laryngologia

Laryngologia, the branch of medicine concerned with the study and treatment of disorders affecting the larynx or voice box, plays a crucial role in diagnosing and managing conditions that impact voice, swallowing, and airway function. This specialized field, often referred to as laryngology in English, focuses on a range of issues from benign voice disorders to complex laryngeal cancers. This article provides an in-depth look at the scope of laryngology, highlighting key aspects of the discipline, common conditions, diagnostic techniques, and advancements in treatment.

Scope of Laryngologia

Laryngologia encompasses both the clinical and surgical aspects of laryngeal health. It involves the diagnosis and treatment of:

Voice Disorders: Conditions such as vocal cord nodules, polyps, and vocal fold paralysis that affect the quality, pitch, and volume of the voice. Swallowing Disorders (Dysphagia): Problems that make swallowing difficult or painful, often due to structural or functional issues with the larynx. Airway Obstruction: Conditions that can block or restrict the airflow through the larynx, including tumors, congenital abnormalities, and inflammation. Laryngeal Cancer: Malignancies that originate in the larynx, necessitating a multidisciplinary approach for management. Common Conditions in Laryngologia

Laryngitis: Inflammation of the larynx often caused by viral infections, overuse, or irritants. It commonly leads to hoarseness and discomfort. Vocal Cord Nodules: Often referred to as "singer's nodules," these are benign growths on the vocal cords due to chronic vocal strain. Laryngeal Cancer: A serious condition where malignant cells form in the tissues of the larynx. Early detection and treatment are crucial for a favorable prognosis. Acid Reflux: Gastroesophageal reflux disease (GERD) can lead to irritation of the larynx, causing symptoms like chronic cough and hoarseness. Diagnostic Techniques

Laryngoscopy: A procedure using a flexible or rigid scope to visualize the larynx and vocal cords, allowing for direct observation of abnormalities. Stroboscopy: An advanced technique that uses flashing light to visualize vocal cord vibrations and assess their function in detail. Imaging Studies: CT scans and MRIs can provide detailed images of the larynx and surrounding structures, helping in the assessment of tumors or structural anomalies. Voice Evaluation: Specialized tests to assess voice quality, pitch, and strength, often performed by speech-language pathologists in conjunction with laryngologists. Advancements in Treatment

Minimally Invasive Techniques: Advances in endoscopic surgery allow for the treatment of laryngeal conditions with minimal disruption, promoting quicker recovery times. Voice Therapy: Tailored voice therapy programs can help individuals with vocal cord disorders improve voice function and prevent recurrence. Targeted Therapy and Immunotherapy: For laryngeal cancer, newer therapies offer more precise treatment options, reducing side effects and improving outcomes. Telemedicine: The rise of telemedicine has enabled remote consultations and follow-ups, making it easier for patients to access care and receive ongoing support. Conclusion

Laryngologia is a vital field within otolaryngology, dedicated to maintaining and restoring vocal health and airway function. With ongoing advancements in diagnostic and treatment technologies, patients with laryngeal disorders have access to increasingly effective and less invasive interventions. Continued research and innovation promise to further enhance outcomes for those affected by voice and swallowing disorders.

References

Stemple, J. C., & Lee, L. (2014). Voice Disorders: Assessment and Treatment. Plural Publishing. Johns, M. M., & Koenig, L. L. (2015). Laryngology: A Comprehensive Approach. Springer. National Institute on Deafness and Other Communication Disorders (NIDCD). (2023). Voice, Speech, and Language Disorders. Retrieved from NIDCD website.

[sarojinirai]

Understanding Voice and Swallowing Treatment at Bombay ENT

Voice and swallowing disorders can significantly impact a person's quality of life, making everyday activities such as speaking and eating challenging. At Bombay ENT, we specialize in diagnosing and treating these conditions with a comprehensive, patient-centered approach. Under the expert guidance of Dr. Maqsood Ali Khan, our clinic offers state-of-the-art treatment options to help patients regain normal Voice swallowing Treatment in Byculla.

What Are Voice Disorders?

Voice disorders occur when the vocal cords, located in the larynx (voice box), are unable to produce sound properly. This can be due to various factors, including inflammation, nodules, polyps, or even more serious conditions like vocal cord paralysis. Common symptoms of voice disorders include:

Hoarseness

Loss of voice

Strained or breathy voice

Pitch changes

Throat pain when speaking

Causes of Voice Disorders

Voice disorders can be caused by several factors:

Overuse or Misuse of the Voice: Yelling, speaking loudly for extended periods, or incorrect singing techniques can strain the vocal cords.

Infections: Viral or bacterial infections can cause inflammation of the vocal cords.

Growths on the Vocal Cords: Nodules, polyps, cysts, or even tumors can affect voice production.

Neurological Conditions: Conditions like Parkinson’s disease or stroke can affect the nerves controlling the vocal cords.

Reflux: Gastroesophageal reflux disease (GERD) can cause stomach acids to irritate the vocal cords.

Diagnosis and Treatment of Voice Disorders

At Bombay ENT, Dr. Maqsood Ali Khan uses advanced diagnostic tools to identify the cause of voice disorders. These include laryngoscopy, stroboscopy, and voice analysis software. Once a diagnosis is made, treatment options may include:

Voice Therapy: Specialized exercises and techniques to improve vocal function and prevent further damage.

Medications: Anti-inflammatory drugs, antibiotics, or medications to treat underlying conditions like reflux.

Surgery: In cases where growths need to be removed or structural abnormalities need correction, minimally invasive surgical procedures may be recommended.

Understanding Swallowing Disorders

Swallowing disorders, or dysphagia, occur when there is difficulty in moving food or liquid from the mouth to the stomach. Dysphagia can be caused by problems in the mouth, throat, or esophagus. Symptoms of swallowing disorders include:

Difficulty swallowing

Pain when swallowing

Choking or coughing while eating or drinking

Sensation of food being stuck in the throat

Unexplained weight loss

Causes of Swallowing Disorders

Swallowing disorders can be attributed to several factors:

Neurological Disorders: Conditions such as stroke, multiple sclerosis, or amyotrophic lateral sclerosis (ALS) can affect the nerves and muscles involved in swallowing.

Muscular Disorders: Diseases like muscular dystrophy can impair the muscles necessary for swallowing.

Obstructions: Tumors, strictures, or foreign bodies can block the passage of food.

Reflux: GERD can cause scarring and narrowing of the esophagus, leading to swallowing difficulties.

Aging: As we age, the muscles involved in swallowing can weaken, leading to dysphagia.

Diagnosis and Treatment of Swallowing Disorders

Dr. Maqsood Ali Khan at Bombay ENT employs various diagnostic tests to assess swallowing function. These include barium swallow studies, endoscopic evaluations, and manometry. Treatment options are tailored to the specific cause and may include:

Swallowing Therapy: Exercises and techniques to improve muscle coordination and strength.

Diet Modifications: Altering the texture of food and liquids to make swallowing easier and safer.

Medications: Drugs to reduce acid reflux or treat underlying conditions affecting swallowing.

Surgery: Procedures to remove obstructions, dilate strictures, or correct anatomical abnormalities.

The Importance of Early Diagnosis and Treatment

Voice swallowing Treatment in Byculla disorders can have a profound impact on a person's life, affecting their ability to communicate and enjoy food. Early diagnosis and treatment are crucial in preventing complications and improving quality of life. At Bombay ENT, we emphasize a multidisciplinary approach to ensure comprehensive care for our patients.

Patient-Centered Care at Bombay ENT

At Bombay ENT, we believe in providing patient-centered care that focuses on the individual needs of each patient. Our treatment plans are tailored to address the specific symptoms and underlying causes of voice and swallowing disorders. Dr. Maqsood Ali Khan and his team are dedicated to offering compassionate care and support throughout the treatment process.

Success Stories from Bombay ENT

Case Study 1: Vocal Cord Nodules

A 35-year-old teacher came to Bombay ENT with hoarseness and voice fatigue. After a thorough examination, Dr. Maqsood Ali Khan diagnosed her with vocal cord nodules caused by excessive Ent surgeon Mumbai. The treatment plan included voice therapy sessions to learn proper vocal techniques and avoid strain. Within a few months, her voice improved significantly, allowing her to continue her teaching career without discomfort.

Case Study 2: Swallowing Difficulties Post-Stroke

A 70-year-old man experienced difficulty swallowing following a stroke. At Bombay ENT, a comprehensive swallowing evaluation was conducted, revealing weakened swallowing muscles. Dr. Maqsood Ali Khan prescribed a combination of swallowing therapy and diet modifications. With consistent therapy, the patient regained much of his swallowing function, improving his overall quality of life.

Advanced Technology and Techniques

Bombay ENT is equipped with the latest technology to diagnose and treat voice and swallowing disorders. Some of the advanced techniques we use include:

Videostroboscopy: A specialized imaging technique that allows for detailed visualization of the vocal cords during phonation.

High-Resolution Manometry: A technique to measure the pressure and coordination of muscles involved in swallowing.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES): A minimally invasive procedure to assess swallowing function in real-time.

Preventing Voice and Swallowing Disorders

While not all voice and swallowing disorders can be prevented, certain measures can reduce the risk:

Maintain Vocal Health: Stay hydrated, avoid excessive yelling or speaking, and practice good vocal hygiene.

Manage Reflux: Control acid reflux with diet changes, medications, and lifestyle modifications.

Regular Check-ups: Routine examinations can help detect and address issues early.

Healthy Eating Habits: Chew food thoroughly, eat slowly, and avoid foods that can cause choking.

Conclusion

Voice and swallowing disorders are complex conditions that require specialized care. At Bombay ENT, Dr. Maqsood Ali Khan and his team are committed to providing the highest quality of care to help patients regain their Voice swallowing Symptoms. Through advanced diagnostics, personalized treatment plans, and compassionate care, we strive to improve the lives of those affected by these disorders.

If you or a loved one are experiencing voice or swallowing difficulties, don't hesitate to contact Bombay ENT. Early intervention can make a significant difference in managing these conditions and enhancing your quality of life. Reach out to us today to schedule a consultation with Dr. Maqsood Ali Khan and take the first step towards better health and well-being.

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[kamalsmilesdental]

Best Mouth Cancer Treatment in Arakere Bannerghatta Road Bangalore — Kamal Smiles Dental Care

Mouth cancer, also known as oral cancer, is a serious health condition that requires prompt and effective treatment. If you or a loved one is facing this diagnosis, finding the best care is crucial. In Arakere Bannerghatta Road, Bangalore, Kamal Smiles Dental Care is renowned for its expertise in treating mouth cancer. Let’s explore why Kamal Smiles Dental Care is the top choice for mouth cancer treatment and how they can help you navigate this challenging journey.

Understanding Mouth Cancer

What is Mouth Cancer?

Mouth cancer refers to cancer that develops in any part of the mouth, including the lips, tongue, cheeks, floor of the mouth, hard and soft palates, sinuses, and throat. It can be life-threatening if not diagnosed and treated early.

Common Causes of Mouth Cancer

Tobacco Use

Tobacco use in any form, including smoking cigarettes, cigars, pipes, and chewing tobacco, is one of the leading causes of mouth cancer. The harmful chemicals in tobacco can damage the DNA in cells in the mouth, leading to cancer.

Alcohol Consumption

Heavy alcohol consumption is another major risk factor for mouth cancer. Alcohol can irritate the cells in the mouth and make them more susceptible to cancerous changes, especially when combined with tobacco use.

Human Papillomavirus (HPV)

HPV, particularly HPV-16, is a sexually transmitted virus that has been linked to mouth cancer. This virus can cause changes in the cells of the mouth and throat, leading to cancer over time.

Symptoms of Mouth Cancer

Early Signs

Mouth Sores

Persistent mouth sores that do not heal within two weeks can be an early sign of mouth cancer. These sores might be painless initially but should not be ignored.

White or Red Patches

White (leukoplakia) or red (erythroplakia) patches inside the mouth are common early indicators. These patches can become cancerous if not monitored and treated early.

Advanced Symptoms

Persistent Pain

Persistent pain in the mouth, jaw, or ear can be a sign of advanced mouth cancer. This pain might be constant or come and go, but it should always be taken seriously.

Difficulty Swallowing

Difficulty swallowing, known as dysphagia, can indicate that the cancer has progressed. This symptom requires immediate medical attention to determine its cause.

Importance of Early Detection

Screening Methods

Early detection of mouth cancer significantly improves the chances of successful treatment. Regular dental check-ups and screenings can help detect mouth cancer in its early stages. Kamal Smiles Dental Care uses advanced screening methods to catch any abnormalities early on.

Benefits of Early Detection

Early detection of mouth cancer can lead to less invasive treatments and better outcomes. It increases the chances of complete recovery and reduces the risk of cancer spreading to other parts of the body.

Why Choose Kamal Smiles Dental Care?

About Kamal Smiles Dental Care

Kamal Smiles Dental Care, located on Arakere Bannerghatta Road, Bangalore, is dedicated to providing exceptional dental and oncological care. The clinic’s focus on patient comfort and advanced treatment options makes it a leader in mouth cancer treatment.

Expertise in Oncology

The team at Kamal Smiles Dental Care includes highly trained oncologists and dental professionals who specialize in diagnosing and treating mouth cancer. Their combined expertise ensures comprehensive care tailored to each patient’s needs.

Advanced Diagnostic Tools

Kamal Smiles Dental Care uses state-of-the-art diagnostic tools, including digital imaging and biopsy techniques, to accurately diagnose mouth cancer. These advanced tools help in formulating precise and effective treatment plans.

Best Treatments for Mouth Cancer

Surgical Options

Tumor Resection

Surgical removal of the tumor is often the first step in treating mouth cancer. This procedure involves excising the cancerous tissue along with a margin of healthy tissue to ensure all cancer cells are removed.

Reconstructive Surgery

After tumor resection, reconstructive surgery may be necessary to restore the function and appearance of the affected area. This can involve skin grafts, bone grafts, and other reconstructive techniques.

Non-Surgical Treatments

Radiation Therapy

Radiation therapy uses high-energy rays to target and destroy cancer cells. It can be used as a primary treatment or in conjunction with surgery to eliminate any remaining cancer cells.

Chemotherapy

Chemotherapy involves using drugs to kill cancer cells or stop their growth. It can be administered orally or intravenously and is often used in combination with radiation therapy for more effective results.

Targeted Therapy

Targeted therapy focuses on specific molecules involved in cancer growth. This treatment can be more effective and less damaging to healthy cells compared to traditional chemotherapy.

Post-Treatment Care and Rehabilitation

Follow-Up Visits

Regular follow-up visits are crucial after mouth cancer treatment to monitor for any signs of recurrence and to manage any side effects of treatment. These visits help ensure long-term health and recovery.

Speech and Swallowing Therapy

Mouth cancer treatment can affect speech and swallowing. Specialized therapy can help patients regain these functions and improve their quality of life after treatment.

Nutritional Support

Proper nutrition is essential during and after mouth cancer treatment. Nutritional support can help patients maintain their strength and support healing and recovery.

Patient Testimonials

Patients treated for mouth cancer at Kamal Smiles Dental Care often praise the clinic for its compassionate care and professional expertise. Testimonials highlight the clinic’s supportive environment, advanced treatment options, and the positive outcomes achieved.

Conclusion

Facing mouth cancer can be daunting, but with the right care, there is hope for recovery. Kamal Smiles Dental Care in Arakere Bannerghatta Road, Bangalore, offers expert, compassionate treatment for mouth cancer. With their state-of-the-art facilities and dedicated team, you can trust them to guide you through every step of your treatment journey. Don’t let mouth cancer define your life — seek the best care at Kamal Smiles Dental Care and take the first step towards healing.

[draymanabdelhameed]

Continuing Education Activity

Esophagogastroduodenoscopy (EGD) is a diagnostic endoscopic procedure used to visualize the oropharynx, esophagus, stomach, and proximal duodenum.

It is one of the most common procedures for gastroenterologists.

This activity describes the diagnostic and therapeutic capabilities of upper endoscopy and highlights the role of the interprofessional team in looking after patients with pathology of the upper digestive tract.

Objectives :

Identify the indications for esophagogastroduodenoscopy.

Describe the technique for performing upper endoscopy.

Review the complications associated with esophagpgastroduodenoscopy.

Explain interprofessional team strategies for improving care coordination and communication to advance the appropriate and safe use of esophagogastroduodenoscopy to improve patient outcomes.

Introduction

Esophagogastroduodenoscopy (EGD) is a diagnostic endoscopic procedure that includes visualization of the oropharynx, esophagus, stomach, and proximal duodenum.

It is one of the most common procedures that a gastroenterologist performs.

Anatomy and Physiology

Esophagus

The esophagus is located posterior to the trachea and begins distal to the cricoid cartilage and ends at the cardiac orifice of the stomach.

It ranges in diameter from 4 to 6 mm and in length from 9 to 10 cm in the term infant to approximately 25 cm in the adult.

The change in the mucosa color from pale- to reddish-pink marks the transition from the esophagus and gastric epithelium (Z line).

Stomach 

The stomach is usually located beneath the diaphragm and is approximately 40 cm distal to the incisors in an adult.

The area of the stomach where the esophagus enters is known as gastric cardia.

The portion of the stomach above the junction of the esophagus and stomach is known as fundus. It is visible in a retroflexed endoscopic view.

The majority of the stomach is known as stomach body.

Along the lesser curvature of the stomach is the incisura which divides the gastric body from the antrum. Endoscopically, the transition from the body to the antrum is from rugae to flat mucosa. The pylorus is the muscular opening between the lower end of the stomach and duodenum bulb.

Duodenum

The duodenum extends from the pylorus to the duodenojejunal angle.

The duodenum bulb is an expanded region immediately distal to the pylorus.

The duodenum then forms a C-shaped loop and endoscopically turns posteriorly and to the right for 2.5 cm, then inferiorly for 7.5 to 10 cm (descending portion), then anteriorly and to the left for approximately 2.5 cm, and finally connects to the jejunum at the level of ligament of Treitz.

Indications

Diagnostic

Persistent upper abdominal pain or pain associated with alarming symptoms such as weight loss or anorexia.

Dysphagia, odynophagia or feeding problems.

Intractable or chronic symptoms of GERD.

Unexplained irritability in a child.

Persistent vomiting of unknown etiology or hematemesis.

Iron deficiency anemia with presumed chronic blood loss when clinically an upper gastrointestinal (GI) source is suspected or when colonoscopy is normal.

Chronic diarrhea or malabsorption.

Assessment of acute injury after caustic ingestion.

Surveillance for malignancy in patients with premalignant conditions such as polyposis syndromes, previous caustic ingestion, or Barrett esophagus.

 Therapeutic

Foreign body removal.

Dilation or stenting of strictures.

Esophageal variceal ligation.

Upper GI bleeding control.

Placement of feeding or draining tubes.

Management of achalasia (botulinum toxin or balloon dilation).

Contraindications

Absolute Contraindications

Perforated bowel.

Peritonitis.

Toxic megacolon in an unstable patient.

Relative Contraindications

Severe neutropenia.

Coagulopathy.

Severe thrombocytopenia or impaired platelet function.

Increased risk of perforation including connective tissue disorders, recent bowel surgery or bowel obstruction.

Aneurysm of the abdominal and iliac aorta.

Equipment

Gastroscopes

The standard gastroscopes have a diameter of 10 mm with an instrument channel of 2.8 mm. In children weighing less than 10 kg, endoscopes smaller than 6 mm in diameter for routine endoscopy should be used.

A gastroscope with a large operating channel measuring 3.8 to 4.2 mm is useful in severe acute upper GI bleeding.

High-definition gastroscopes with optical zoom should be available to screen for pre-malignant gastric or duodenal lesions.

Accessories

The biopsy forceps (standard and jumbo) are needed for tissue sampling. For retrieval of a foreign body during esophagogastroduodenoscopy (EGD), rat tooth forceps, alligator forceps, retrieval net, polypectomy snare, overtubes of esophageal and gastric lengths, and a foreign body protector hood should be available. Additional equipment may be required if therapeutic procedures are anticipated.

Preparation

Routine endoscopy in children and adults is usually performed in an outpatient setting using parenteral or general anesthesia.

Occasionally, endoscopy is necessary at the hospital bedside or in an operating room.

Diet :

Preparation for elective upper endoscopy procedure involves a period of fasting.

As per American Society for Anesthesiologists (ASA) guidelines, patients should fast a minimum of 2 hours after ingestion of clear liquids and 6 hours after ingestion of light meals.

In emergency situations or in conditions where gastric emptying is impaired, the potential for pulmonary aspiration of gastric contents must be considered to determine (1) level of sedation, (2) whether endotracheal intubation should be considered to protect the airway or (3) whether the procedure should be delayed.

Medications :

Most medications can be continued and are usually taken with a small sip of water before endoscopy, although diabetes medications need to be adjusted due to the period of fasting before the procedure.

American Society for Gastrointestinal Endoscopy (ASGE) guidelines should be followed for decisions regarding the management of anti-thrombotic agents or for the use of antibiotic prophylaxis in at-risk patients before the endoscopy.

Sedation and Monitoring

Sedation is used in most patients not only to minimize discomfort but also to provide amnesia for the procedure.

All patients undergoing upper endoscopy require pre-procedural evaluation to assess their risk for sedation and to manage potential problems related to pre-existing health conditions.

The choice of sedation varies from conscious sedation delivered by the proceduralist or monitored anesthesia care provided by an anesthesiologist, and preferences for one type of sedation over another are largely based on training and available local resources.

For routine upper endoscopy, many endoscopists utilize intravenous sedation using propofol.

For therapeutic endoscopic procedures such as foreign body removal or in patients in whom cooperation is not anticipated, including very young patients, general anesthesia may be required.

ASGE guidelines recommend routine monitoring of vital signs in addition to clinical observation for changes in cardiopulmonary status during all endoscopic procedures performed under sedation.

Informed consent

Patients, parents, or legal guardians should provide informed consents before the Esophagogastroduodenoscopy (EGD) and for the administration of sedation.

Technique or Treatment

Handling the Endoscope

The endoscope is mostly held in the left hand.

The control section of the endoscope should rest comfortably in the palm of the left hand.

The thumb controls up or down movement of the tip of the endoscope using a large wheel.

The index finger and, at times, the middle finger control the suction, air, and water valves.

The right hand is used to advance and withdraw the endoscope and its axial rotation.

The right hand is also used to insert instruments such as biopsy forceps, cytology brushes, needles for injection, hemostatic clips, polypectomy snares, foreign body retrieval instruments, and syringes for irrigation via the biopsy channel.

Esophageal Intubation 

For esophagogastroduodenoscopy (EGD), patients are typically placed in left lateral decubitus with neck flexed forward.

A bite block is placed in the mouth before the endoscope is inserted into the oral cavity.

The endoscope is introduced into the mouth and to the base of the tongue under direct visualization.

The tip of the scope is then gently angulated downward until the vocal cords, epiglottis, both piriform sinuses, and cricoarytenoid cartilages are visualized.

The scope is then passed behind and to the right of the arytenoid cartilage towards the upper esophageal sphincter.

The upper esophageal sphincter is passed under direct visualization, often with application of gentle pressure while insufflating air.

Esophagus and Esophagogastric junction

After intubating the esophagus, the scope is advanced down the esophagus lumen while simultaneously examining the mucosa for any inflammation, ulcerations, furrowing, varices, narrowing or strictures.

The location of the esophagogastric junction should be noted.

The squamocolumnar junction, also referred as Z-line, is the area where the squamous epithelial lining of the esophagus (pale pink colored) meets the columnar lining mucosa of the stomach (salmon-colored).

The level of the Z-line should also be noted. If the Z-line is displaced proximal to the gastroesophageal junction, biopsies should be taken to evaluate for Barrett esophagus.

Stomach

The stomach is entered after passing the esophagogastric junction.

Once the stomach is entered, any residual gastric secretions should be suctioned, and air is insufflated to improve visualization.

The endoscope is then advanced while torquing to the right. The endoscope is advanced along the lesser curvature towards the pylorus, but to fill the greater curvature with the endoscope is usually necessary before the cannulation of the pyloric canal.

The pylorus is a small opening with radiating folds around it.

To pass through the pylorus, the endoscope is positioned in front of the pylorus, and a little air and gentle pressure should be applied against the orifice.

Duodenum

After passing through the pylorus, the endoscope enters the duodenum bulb.

The duodenum bulb should be examined on endoscope insertion rather than during withdrawal as passage of  the instrument can cause possible mucosal changes.

After all four quadrants of the bulb are inspected the scope is advanced to the posterior aspect of the bulb; here the duodenum turns right sharply and takes downward turn. To pass the superior flexure of the duodenum and enter the second part of the duodenum, the instrument is advanced using the dials and shaft torque, usually down and to the right followed by an upward spin of the dial.

The superior flexure of the duodenum is often passed blindly and examined on the way back.

The lower part of the second portion of the duodenum is reached by straightening the endoscope, in other words, pulling the endoscope slowly backward while maintaining the view of the lumen. This maneuver reduces the loop along the greater curvature of the stomach and, paradoxically, advances the endoscope into the distal duodenum.

The duodenum distal to the bulb has distinctive circular rings called valvulae conniventes.

The ampulla of Vater is found in the second portion of the duodenum and examined while withdrawing the endoscope.

After careful examination of the duodenum, pylorus, and antrum, the endoscope is retroflexed to visualize the gastric cardia and fundus.

The endoscope is then returned to a neutral position.

Once the stomach has been fully inspected, and biopsies, if necessary, are obtained, the endoscope is then withdrawn.

Before leaving the stomach, air should be suctioned.

The esophagus is again examined on withdrawal of the endoscope.

The average duration of a diagnostic EGD is 5 to 10 minutes under optimal sedation conditions.

Tissue sampling is obtained from suspicious lesions during EGD, although many gastroenterologists perform routine biopsies from designated sites, as a clinically significant disease may be present in an apparently normal looking mucosa.

Specimens obtained include biopsies, brushings of mucosal surface, and polypectomy.

Specimens are sent for histological, cytological, or microbiologic analysis based upon the type of the sample and clinical situation.

Complications

Complications following esophagogastroduodenoscopy (EGD) are rare, occurring in less than 2% of patients.

These could be related to sedation, endoscopy, and complications related to diagnostic or therapeutic maneuvers.

The most frequent and serious complications of sedation are cardiopulmonary.

Adverse events from over sedation include hypoxemia, hypoventilation, hypotension, airway obstruction, arrhythmias, and aspiration.

The complications following diagnostic EGD include infection, bleeding, duodenal hematoma, and bowel perforation.

The risk of bleeding following EGD with biopsy is 0.3%. Post mucosal biopsy bleeding can occur as intraluminal hemorrhage or intraluminal hematoma.

A duodenal hematoma is a rare complication of EGD with an unknown incidence and seems to occur more often in children than adults.

Bowel perforation occurs in less than 0.3 % of cases, and infection is rarely reported.

Complications typically are identified in the first 24 hours after the procedure.

Bleeding presents with hematemesis or bloody output from the gastrostomy tube.

Perforation is identified due to fever, tachycardia, abdominal pain or discomfort.

An abdominal x-ray should be done to reveal extra-luminal air.

Conservative therapy with bowel rest and antibiotics is the typical treatment, although some patients might require surgical repair.

Clinical Significance

Esophagogastroduodenoscopy (EGD) has become a key element in the diagnosis and treatment of esophageal, gastric, and small-bowel disorders.

The many accepted indications for EGD include evaluation of dysphagia, GI bleeding, peptic ulcer disease, medically refractory GERD, esophageal strictures, celiac disease, and unexplained diarrhea.

During EGD evaluation, diagnostic biopsies can be performed as well as therapies to achieve hemostasis and dilation for significant strictures.

If properly performed, it is generally a safe and well-tolerated procedure. EGD's availability and use in the pediatric population have increased.

Decisions surrounding the conditions and time for EGD use in children remain more of an art than a science, and additional critical review of this tool's use is needed to maximize results and minimize risk.

Enhancing Healthcare Team Outcomes

In the pediatric population, endoscopy is typically performed by a pediatric endoscopist with the medical knowledge and technical competency specific to perform safe and effective GI procedures in this population.

The American Society for Gastrointestinal Endoscopy (ASGE) published practice modification guidelines to provide guidance regarding performing endoscopy in infants and children.

If it is not possible for a pediatric-trained endoscopist to perform the procedure, an adult-trained endoscopist should perform endoscopic procedures in children in coordination with a pediatrician and pediatric specialists.

During endoscopic procedures, procedural and resuscitative equipment appropriate for pediatric use should be readily available.

If sedation is needed for the procedure, personnel trained specifically in pediatric life support and airway management should also be readily available.

In symptomatic children with known or suspected caustic ingestion, endoscopy should be performed within 24 hours.

It is recommended to perform emergent foreign body removal of esophageal button batteries as well as two or more rare-earth neodymium magnets.

[dysphagia264]

Understanding Dysphagia in Tampa: Causes, Symptoms, Diagnosis, and Treatment

Introduction

Dysphagia is a medical condition characterized by difficulty swallowing, affecting millions of people worldwide, including those in Tampa, Florida. While it can occur at any age, it is more prevalent in older adults and individuals with certain medical conditions. Understanding dysphagia, its causes, symptoms, diagnosis, and treatment options is crucial for effective management and improved quality of life for those affected.

Body

1. Causes of Dysphagia

Dysphagia can arise from various underlying causes, including neurological disorders such as stroke, Parkinson's disease, multiple sclerosis, or traumatic brain injury, which affect the nerves and muscles involved in swallowing. Structural abnormalities like esophageal strictures, tumors, or conditions such as gastroesophageal reflux disease (GERD) can also lead to swallowing difficulties. Additionally, muscular disorders like myasthenia gravis or conditions affecting the esophagus such as achalasia contribute to dysphagia.

2. Symptoms of Dysphagia

The symptoms of dysphagia can vary depending on its severity and underlying cause. Common signs include difficulty swallowing solids or liquids, pain while swallowing, frequent choking or coughing during meals, regurgitation, hoarseness, unexpected weight loss, and recurrent pneumonia due to aspiration. These symptoms can significantly impact an individual's ability to eat, drink, and maintain proper nutrition, leading to further health complications if left untreated.

3. Diagnosis of Dysphagia

Diagnosing dysphagia involves a comprehensive evaluation by healthcare professionals, including speech-language pathologists, otolaryngologists, gastroenterologists, and neurologists. The diagnostic process may include a thorough medical history review, physical examination, swallowing assessments such as videofluoroscopy or fiberoptic endoscopic evaluation of swallowing (FEES), and imaging studies like CT scans or MRIs to identify any structural abnormalities or neurological conditions contributing to swallowing difficulties.

4. Treatment Options for Dysphagia

The management of dysphagia aims to address underlying causes, alleviate symptoms, and improve swallowing function to enhance quality of life. Treatment options may include:

Speech Therapy: Speech-language pathologists specialize in dysphagia therapy, offering exercises to strengthen swallowing muscles, techniques to improve coordination, and strategies to facilitate safer swallowing.

Diet Modifications: Altering food textures (e.g., pureed or thickened liquids) and modifying meal consistencies can make swallowing easier and reduce the risk of aspiration.

Medications: Depending on the underlying cause, medications such as proton pump inhibitors for GERD or botulinum toxin injections for conditions like achalasia may be prescribed to manage dysphagia symptoms.

Surgical Interventions: In cases of structural abnormalities or severe dysphagia resistant to other treatments, surgical procedures like dilation, myotomy, or tumor removal may be necessary to restore swallowing function.

Feeding Tubes: In extreme cases where oral intake is not feasible, feeding tubes may be recommended to deliver essential nutrients directly into the stomach or intestines.

5. Dysphagia Care in Tampa

In Tampa, individuals with dysphagia have access to a comprehensive range of healthcare services and resources for diagnosis, treatment, and ongoing management. Leading medical institutions, hospitals, and rehabilitation centers in the area offer specialized dysphagia clinics staffed with multidisciplinary teams of experts, including speech therapists, gastroenterologists, and otolaryngologists, dedicated to providing personalized care tailored to each patient's needs.

6. Coping Strategies and Support

Living with dysphagia can present numerous challenges, but with the right support and coping strategies, individuals can effectively manage their condition and maintain a good quality of life. Support groups, online forums, and community resources in Tampa provide valuable emotional support, education, and practical tips for coping with dysphagia, helping individuals and their families navigate the physical, emotional, and social aspects of living with swallowing difficulties.

Conclusion

Dysphagia is a complex medical condition with various underlying causes, symptoms, and treatment options. In Tampa, Florida, individuals affected by dysphagia have access to comprehensive healthcare services, specialized clinics, and supportive resources to address their needs. By raising awareness, promoting early diagnosis, and implementing effective management strategies, healthcare professionals and communities can improve outcomes and enhance the quality of life for individuals living with dysphagia in Tampa and beyond.

[hillcountrydysphagiadiagnostics]

Hill Country Dysphagia Diagnostics: A Leading Clinic for Treatment of Dysphagia Patients in SA

Finding a leading clinic for the Treatment of Dysphagia Patients in SA? At Hill Country Dysphagia Diagnostics, our highly skilled team specializes in the assessment and treatment of dysphagia. We understand the unique challenges that each patient faces and tailor treatment plans for optimal results.

[gicancerindia]

 Understanding Esophageal Cancer: Causes, Symptoms, and Treatment Options

Understanding Esophageal Cancer: Causes, Symptoms, and Treatment Options

Introduction:

Esophageal cancer is a malignant tumor that develops in the esophagus, a long, muscular tube connecting the throat to the stomach. It is a relatively uncommon type of cancer, but its prevalence has been increasing over the years. This article aims to provide a comprehensive overview of esophageal cancer, including its causes, symptoms, diagnosis, and treatment options.

Causes and Risk Factors:

Esophageal cancer can be attributed to various factors, including:

a) Tobacco and Alcohol: The excessive and prolonged use of tobacco and alcohol significantly increase the risk of developing esophageal cancer.

b) Gastroesophageal Reflux Disease (GERD): Chronic acid reflux, a common symptom of GERD, can lead to changes in the lining of the esophagus, increasing the likelihood of cancer development.

c) Barrett's Esophagus: This condition occurs when the cells lining the lower part of the esophagus change, increasing the risk of esophageal cancer.

d) Obesity: Being overweight or obese is associated with a higher risk of developing esophageal cancer.

e) Diet: A diet lacking in fruits and vegetables and high in processed foods may contribute to an increased risk.

Symptoms and Diagnosis:

Esophageal cancer may not present noticeable symptoms in its early stages. However, as the disease progresses, common symptoms may include:

a) Difficulty swallowing (dysphagia)

b) Unintentional weight loss

c) Chest pain or discomfort

d) Chronic cough or hoarseness

e) Frequent hiccups or indigestion

If these symptoms persist, it is important to seek medical attention. Diagnostic procedures such as endoscopy, imaging tests (CT scan, MRI), and biopsies are typically used to confirm the presence of esophageal cancer.

Treatment Options:

The treatment of esophageal cancer depends on several factors, including the stage of cancer, overall health, and personal preferences of the patient. The main treatment modalities include:

a) Surgery: Surgical intervention aims to remove the tumor and a portion of the esophagus. This may involve a partial or complete removal of the esophagus (esophagectomy).

b) Radiation Therapy: High-energy radiation is used to target and destroy cancer cells. It can be administered externally (external beam radiation) or internally (brachytherapy).

c) Chemotherapy: Anti-cancer drugs are used to kill cancer cells. Chemotherapy can be given before surgery to shrink tumors (neoadjuvant therapy) or after surgery to destroy any remaining cancer cells (adjuvant therapy).

d) Targeted Therapy and Immunotherapy: These newer treatment approaches focus on specific molecular targets or boosting the body's immune system to fight cancer cells. They may be used in certain cases or as part of clinical trials.

Support and Prevention:

Living with esophageal cancer can be physically and emotionally challenging. Patients can benefit from support groups, counseling, and other resources to help them cope with the impact of the disease and its treatment.

In terms of prevention, adopting a healthy lifestyle can significantly reduce the risk of esophageal cancer. This includes quitting smoking, moderating alcohol consumption, maintaining a healthy weight, and following a balanced diet rich in fruits and vegetables.

Conclusion:

Esophageal cancer is a serious condition that requires prompt medical attention. Recognizing the risk factors, understanding the symptoms, and seeking early diagnosis can improve treatment outcomes. With advancements in treatment options and ongoing research, there is hope for better outcomes for those affected by esophageal cancer.

[evoendo]

EvoEndo® Announces Ambulatory Payment Classification (APC) Reassignments for Flexible Transnasal Esophagogastroduodenoscopy (EGD)

DENVER, CO, EvoEndo®, Inc. (“EvoEndo”), a medical device company developing systems for Unsedated Transnasal Endoscopy (TNE), is pleased to share recent decisions announced by the Centers for Medicare and Medicaid Services (CMS) in its CY 2023 Hospital Outpatient Prospective Payment System (OPPS) final rule. Based on information submitted to CMS including the cost of the EvoEndo® Model LE Single-Use Gastroscope, and its recent 510(k) FDA clearance, CMS decided to modify the APC assignments for CPT codes 0652T, 0653T and 0654T.  Effective July 1, 2023, the APC assignment for CPT 0652T (transnasal diagnostic EGD) and 0653T (transnasal EGD with biopsy) will change from APC 5301 (Level 1 Upper GI Procedures) to APC 5302 (Level 2 Upper GI Procedures).  Additionally, CPT 0654T (transnasal EGD with insertion of intraluminal tube or catheter) will be move from APC 5302 (Level 2 Upper GI Procedures) to APC 5303 (Level 3 Upper GI Procedures).1

“We thank CMS for its consideration. We look forward to sharing this new payment alignment with healthcare providers as they consider the clinical and financial value of unsedated transnasal endoscopy,” said Heather Underwood, Chief Executive Officer at EvoEndo®. 

“Unsedated transnasal endoscopy with the EvoEndo® Single-Use Endoscopy System is designed to reduce preparation and recovery time for upper endoscopy procedures and to eliminate potential risks associated with sedation. This is especially important for our pediatric patients needing diagnostic endoscopy with Eosinophilic Gastrointestinal Disorders,” remarks Dr. Ali Mencin, Chief of Pediatric Gastroenterology, Hepatology, and Nutrition at Columbia University Medical Center. 

The EvoEndo® Single-Use Endoscopy System received FDA 510(k) clearance in February 2022. The EvoEndo® System includes a sterile, single-use, flexible gastroscope designed for unsedated transnasal upper endoscopy, and a small portable video controller. The EvoEndo® Comfort Kit includes virtual reality (VR) goggles for patient distraction during the unsedated transnasal endoscopy procedure. Unsedated TNE can be used to evaluate and diagnose a wide range of upper GI conditions that may require frequent monitoring including eosinophilic esophagitis (EoE), dysphagia, celiac disease, gastroesophageal reflux disease, Barrett’s esophagus, malabsorption, and abdominal pain. The EvoEndo® System is only intended for use by medical professionals. Physicians and other medical providers interested in learning more about EvoEndo’s TNE system or scheduling demonstrations and training can contact the company here.

1As is always the case, providers should independently verify procedure and product codes. 

About EvoEndo®

EvoEndo®, Inc. is a medical device company developing sterile single-use, flexible endoscopes that enable unsedated endoscopic procedures. EvoEndo’s technology allows pediatric patients and adults alike to consider an unsedated option for routine endoscopies in a clinic setting without the use of general anesthesia or sedation. To learn more, please visit: https://evoendo.com

News Source: https://www.evoendo.com/news/evoendo-announces-ambulatory-payment-classification-apc-reassignments-for-flexible-transnasal-esophagogastroduodenoscopy-egd

[chocolatedetectivehottub]

Laryngologia,

Laryngologia,

Laryngology is a specialized branch of otolaryngology (ear, nose, and throat medicine) that focuses on disorders of the larynx (voice box), including issues related to voice, airway, and swallowing. This field has gained significant importance due to the critical role the larynx plays in speech, breathing, and protecting the airway during swallowing.

Anatomy and Function of the Larynx The larynx is located in the throat and performs several vital functions:

Voice Production: The vocal cords within the larynx vibrate to produce sound, enabling speech. Airway Protection: During swallowing, the larynx closes to prevent food and liquid from entering the lungs. Breathing: The larynx controls airflow to the lungs, allowing for normal respiration. Understanding the intricate anatomy and functions of the larynx is essential for diagnosing and treating its disorders.

Common Laryngeal Disorders Laryngologists diagnose and treat a variety of conditions affecting the larynx:

Voice Disorders:

Laryngitis: Inflammation of the vocal cords, often due to infection or overuse, leading to hoarseness or loss of voice. Vocal Cord Nodules and Polyps: Benign growths on the vocal cords caused by vocal strain, resulting in hoarseness and breathiness. Vocal Cord Paralysis: Weakness or immobility of the vocal cords, which can lead to voice changes, swallowing difficulties, and breathing problems. Airway Disorders:

Subglottic Stenosis: Narrowing of the airway below the vocal cords, which can cause breathing difficulties. Laryngomalacia: A condition in infants where the soft, immature cartilage of the larynx collapses inward, leading to noisy breathing. Swallowing Disorders:

Dysphagia: Difficulty swallowing, which can result from structural abnormalities, neurological conditions, or muscle dysfunction. Laryngopharyngeal Reflux (LPR): A condition where stomach acid flows back into the throat, causing irritation and inflammation of the larynx. Diagnostic Techniques Accurate diagnosis of laryngeal disorders requires a combination of clinical evaluation and specialized diagnostic tools:

Laryngoscopy: A procedure using a laryngoscope to visualize the larynx and vocal cords directly. Stroboscopy: A technique that uses a strobe light to assess vocal cord vibration and function. Imaging Studies: MRI, CT scans, and X-rays can help identify structural abnormalities or lesions in the larynx. Treatment Approaches Treatment for laryngeal disorders varies depending on the condition and its severity:

Medical Management: Includes medications such as antibiotics, anti-inflammatory drugs, and proton pump inhibitors for conditions like laryngitis and LPR. Voice Therapy: Speech-language pathologists provide exercises and techniques to improve vocal function and reduce strain on the vocal cords. Surgical Interventions: Procedures such as microlaryngoscopy, vocal cord injections, and laryngeal framework surgery are performed to remove lesions, repair vocal cord damage, and improve airway patency. Advances in Laryngology Recent advancements in laryngology have led to improved diagnostic and therapeutic options:

Minimally Invasive Surgery: Techniques such as laser surgery and transoral robotic surgery offer precise treatment with reduced recovery times. Regenerative Medicine: Research into stem cell therapy and tissue engineering holds promise for repairing and regenerating damaged laryngeal tissues. Telemedicine: The use of telehealth platforms allows for remote diagnosis and management of laryngeal disorders, increasing access to specialized care. Conclusion Laryngology plays a crucial role in maintaining and restoring essential functions related to voice, breathing, and swallowing. Continued advancements in this field promise to improve the quality of life for individuals affected by laryngeal disorders. Through a combination of innovative diagnostic techniques, targeted therapies, and cutting-edge research, laryngologists are better equipped than ever to address the complex challenges of the larynx and its associated functions.

[researchinhealthcare]

Esophageal Dysphagia Market Research Report Covers, Future Trends, Past, Present Data and Deep Analysis 2027

Esophageal Dysphagia Market Highlight :

The esophageal dysphagia market is expected to witness tremendous growth owing to the rising prevalence of oral cancer. Other key factors such as the change to sedentary lifestyle, increase in smoking and increasing of fungal infection are contributing towards the growth of the market.

However, factors such as the high cost of surgical procedures, the allergic reaction of medication and the side effects associated with treatments are expected to restrict the market growth during the forecast period.

Esophageal Dysphagia Market Segmentation :

The global esophageal dysphagia market is segmented on the basis of diagnosis, treatment, products, and end-user. The esophageal dysphagia market, by diagnosis, is categorized into X-ray, Dynamic swallowing study, Endoscopy, Manometry and Imaging scans. Imaging scans is sub-segmented into MRI scan, CT scan. On the basis of treatment, the market is segmented into esophageal dilation, surgery, medications, lifestyle changes. Surgery is sub-segmented into stent placement, and laparoscopic heller myotomy.

On the basis of products, the market is segmented into feeding tube, nutritional solutions and drugs. Feeding tube is sub-segmented into the nasogastric tube, percutaneous endoscopic gastrostomy. Nutritional solutions are sub-segmented into thickeners, beverages, and purees. On the basis of end-user, the market is segmented into hospitals and clinics, ambulatory surgical centers, diagnostic centers, research centers, and others.

Esophageal Dysphagia Market Regional Analysis :

The Americas is the largest in the market owing to the increasing prevalence of cardiac diseases, trauma to the neck, head, or spine and growing healthcare expenditure. Other risk factors for esophageal dysphagia are human papillomavirus, Plummer-Vinson syndrome and irradiation of the esophagus. According to the Genital HPV Infection, (GHI) Fact Sheet 2017, 79 million American adults were infected with human papillomavirus. Such a high incidence of (HPV) drives the market growth in this region.

Get Sample Report @ https://www.marketresearchfuture.com/sample_request/6464

Europe (UK, Belgium, France, and Netherlands) is expected to be the second largest esophageal dysphagia market during the forecast period. The increasing occurrence of cancer drives the market in this region. According to Cancer Research UK in 2015, there were 359,960 new cases of cancer. Thus, the growing cases of cancer facilitate the market growth.

Asia-Pacific was projected to be the fastest growing region for the global esophageal dysphagia market in 2017. The market is expected to witness growth owing to the rising prevalence of alcohol ingestion and smoking in this region. According, to the World Health Organization in 2015, 47.6% and 33.7% of people smoked tobacco in China and Japan, respectively. This is expected to provide favorable backgrounds for the market to grow.

The Middle East and Africa accounts for the least share due to low per capita income and lack of availability of well-trained healthcare professionals. However, the rising oncology and palliative care services both at the hospital level and in the community are expected to influence the market in a positive way.

Esophageal Dysphagia Market Key Players :

Some of the key players in the global esophageal dysphagia market are Merck Sharp & Dohme Corp., Biostagel, Torax Medical, Inc., NinePoint Medical, Inc., Elekta AB, Eisai Co Ltd, Cipla Ltd., AstraZeneca Plc, Kent Precision Foods Group, Inc., Nestlé Health Science France, Nutricia Ltd, C.R. Bard, Inc., Cook Medical Incorporated, and others.

Access Report @ https://www.marketresearchfuture.com/reports/esophageal-dysphagia-market-6464

[neuro-whump]

Lost in Transit, Part 5

This is my entry to the Box Boy Extended Universe which was originally created by sweetwhumpandhellacomf and written by shameless-whumper and I’m using a lot of world-building which was done by @ashintheairlikesnow. Still somewhat vague on hospital procedure here and also despite my research, I may be misrepresenting acquired dyscalculia here, pubmed is not helping me out and neither is google scholar.

CN: Dehumanization, human trafficking, amnesia, mistaken identity, box boy universe, IVs, panic attack, hospitals

798591 was woken with a start the next morning by a dream he didn’t remember and didn’t know where he was.

He was lying in a bed, in a small white room with an IV in his arm, and his heart was fluttering with nerves and he felt sore and battered and didn’t know why. There was something about the room. Something he’d remembered — but he didn’t remember it now.

He was in his new home, with his new owner. He remembered that and it made his heart slow down. But a few more memories trickled back and made his heart speed up again, he’d got lost and he’d been sick and he thought he remembered being in trouble, already. But he was definitely in the right place now, his owner - the person who wanted him - had been there, he remembered her face and that made him feel better. He would just wait here, and she’d be back, it still seemed like it was early in the morning.

The first person who came in wasn’t Dr. de Courcy though, it was a rumpled man with ruffled hair. 798591 stared at him for a moment before he remembered that he’d seen him last night. He couldn’t remember his name though.

The rumpled man came and peered at him, “how are you feeling this morning?” he asked.

“I’m okay,” said 798591.

“Do you still have a headache?” asked the rumpled man.

798591 nodded.

“Can you tell me how bad the pain is, out of ten?” asked the rumpled man.

798591 thought about it, his head didn’t feel very bad, but he couldn’t figure out how to turn it into a number, and trying made the pain spike up behind his eyes. And not answering the question was making a sinking, anxious feeling low in his belly.

“Hey now,” said the rumpled man, “its okay, don’t answer if its too hard. Just relax now. Take some deep breaths.”

798591 took a few big gulps of air and the rumpled man nodded encouragingly.

“That’s good,” he said, “let’s try again. Can you tell me if your headache is better or worse than last night?”

“Its better?” whispered 798591, “I think?”

“Well that’s good,” said rumpled man, “and do you have any other pain at all?”

He did, but he wasn’t supposed to complain and the questions were making the fluttery, anxious feelings worse, so he shook his head.

“That’s good,” said rumpled man, and smiled at him, so it was probably good he hadn’t said anything, “are you still feeling nauseous at all?”

798591 shook his head, he didn’t even have to keep that to himself, his stomach wasn’t turning over in unhappy ways any more.

“Good,” said the rumpled man, “good. Can you sit up for me?”

798591 sat up and the rumpled man came over and pressed his stethoscope against his chest, and then his back, and then his belly. He had 798591 hold his hands out with his eyes shut so he could press down on them the way Dr. de Courcy had the day before, and then shone a light in his eyes. He still didn’t understand why. But when he was done, he stepped back and nodded to himself.

“Okay,” said the rumpled man, “do you know your name?”

“798591,” he said, which earned him a frown. But he knew he remembered it. He knew that number.

“And what’s the date?” asked the rumpled man.

“I don’t know,” said 798591.

“Do you know what month it is,” asked the rumpled man, “or the season?”

798591 shook his head.

“Do you know how long you’ve been in the hospital?”

“Since yesterday,” said 798591.

“Yeah,” said the rumbled man “that was a good effort. You’re doing fine. Someone will bring you breakfast in a couple of hours.”

He turned around as if to go.

798591 summoned up his courage and asked, “is Dr. de Courcy coming back?”

“Huh?” asked the rumpled man, “yeah at some point today, rounds are usually early, but everything’s still off this morning, from the accident.”

He hurried out before 798591 could work up the nerve to ask anything else. He huddled down into his blankets and tried not to be afraid. He didn’t know what was making him feel so scared, but he wanted it to stop. He wanted Dr. de Courcy to come back and take him somewhere else. He’s not supposed to want things, it sent a twinge of pain shooting through his head.

The next person to come in was a small woman with lots and lots of curly brown hair carrying food on a tray and more pills for him to take. She looked comfortingly familiar but it took him a while to come up with her name. Like his brain was going very slowly.

“Remember me?” she asked with a nice little smile.

“Kenna?” He asked, he still wasn’t totally sure.

“That’s right,” she beamed, “you remembered. That’s really good. I brought you some breakfast, sorry its late, there was a thing with the dietetics orders. And I’m supposed to stay with you and make sure you’re swallowing okay, alright?” She came over and put the food in front of him and asked, “can I sit here? I promise I won’t come and loom over you every time you eat.”

It took him a moment to figure out that Kenna was actually asking his permission, like he got a say in where people sat. He nodded and she perched on the edge of his bed.

“Do you feel like you can eat anything?” Kenna asked him, “or are you still feeling too sick?”

He wasn’t feeling sick, having food in front of him made him suddenly realize that he didn’t know when he’d last had any food and he was awfully hungry. He shook his head hard.

“Well that’s a good sign,” said Kenna. She gave him another nice little smile. “But I want you to eat this very slowly so we can make sure you’re not having any trouble with it okay? We normally have a speech path to do this, but everything is still sort of mad and we didn’t want to make you wait that long to have some food,” she added.

798591 didn’t really know what that meant, he was just happy to be fed, and to have Kenna there. He did as he was told and took small, slow mouthfuls Kenna encouraged him a bit while he ate, and patted his legs a few times through the blankets and it made it easier to eat slower, so she would stay and he wouldn’t be left alone again. He could only drag it out for so long before he didn’t have any food left.

“You did really well,” said Kenna, getting up and patting his shoulder, “I’ll be back at some point to take you to imaging, but I’ve got to run.”

And then she left, and 798591 was left alone for hours and hours.

A stranger came in at one point and brought him more food but they didn’t stay or talk to him and even after another meal he was still lingeringly hungry. It felt familiar, and that made him feel anxious and he just wanted it all to stop. Everything felt wrong and he didn’t know why.

He lost track of the time a little, but it was sometime after that that a group of people in white coats, including the rumpled man again filed into the room followed, at last, by Dr. de Courcy. 798591 immediately straightened up and tried to look alert and tidy. Dr. de Courcy’s eyes brushed over him briefly before she turned to face the rumpled man.

“Dr. McCormick?” she said, and then stared expectantly at him.

The rumpled man, who must be Dr. McCormick and who looked more rumpled than ever, picked up the pad of paper that hung off the edge of his bed and looked from it, to Dr. de Courcy.

“An unidentified and unclaimed male patient, admitted yesterday afternoon and believed to have been involved in the shipwreck. He was assessed by you and by Joey Mallory and presented with disorientation and - pure retrograde amnesia - and moderate dehydration and nausea, believed to be secondary to - ingesting salt water, treated with oral H2 inhibitors. The patient experienced more nausea and headache overnight and I administered oral acetominophen. As of this morning he reported reduced headache and no further nausea. And the RN noted no dysphagia or nausea with breakfast this morning. Initial labs taken during admission showed minor electrolyte imbalances but no other abnormalities, and follow-up labs taken during the early morning are entirely normal.”

He ended his long report by gasping in a big breath, like he’d just run.

“Where are we in the imaging queue?” Dr. de Courcy asked. 798591 still didn’t really understand what that meant.

“They’re hoping to get him in this evening,” said a woman who was standing behind Dr. McCormick.

“Are the labs in epic?”

“Yes,” said Dr. McCormick.

“I want them redone every day until I say otherwise,” said Dr. de Courcy, “maintain the H2 inhibitors for 48 hours to be on the safe side. What’s the obvious next step diagnostically?”

“We need brain imaging,” said one of the women.

“Does everyone agree with Dr. Yeo that imaging is going complete our clinical picture?”

The woman who was standing behind Dr. McCormick spoke up again, “we need to do a neurological exam.”

“Thank you Dr. Halabi,” said Dr. de Courcy, “yes, don’t ever neglect diagnostic exams just because you have, or expect to have imaging. And frankly, becoming over dependent on high tech imaging is a bad idea. You never know when you might suddenly not have it, as we’re currently experiencing. However, because this patient is showing some atypical symptoms I’m going to be doing his work up today and full neurological exam tomorrow, so you will all have to practice on our next patients.”

Dr. Yeo put her hand in the air.

“Yes,” said Dr. de Courcy.

“Shouldn’t we also do a psychological exam? I thought pure retrograde amnesia was usually psychiatric?”

“Yes,” said Dr. de Courcy, “that is correct, your reward will be contacting the psychiatry department and scheduling the exam. Do not conflict with my exam we can’t do both at once.”

“Yes Dr. de Courcy,” said Dr. Yeo.

Some of the other people scrambled for notebooks and scribbled notes.

“And what else?” Dr. de Courcy said.

The scribblers stopped scribbling.

“We have a completely unidentified patient,” said Dr. de Courcy, “we need the police. The world outside the hospital does continue to exist during your shifts. I realize you’re tired, but please attempt to retain object permanence.”

They scribbled some more.

798591 looked between the cluster of people as they talked and tried to figure out what was going on and why Dr. de Courcy wouldn’t look at him or speak to him. He didn’t feel sick anymore, and he didn’t know why Dr. McCormick had said he was unclaimed. He had been delivered. Someone wanted him, someone had to want him, or he would be sent back and refurbished and -

“Well,” Dr. de Courcy said suddenly, and everyone else looked as confused as he felt, “begin the neurological exams on our next set of patients.” she barked, “and go find me Kenna.”

“But -“ Dr. McCormick started.

“Now,” she snapped, and he ran away.

They were alone in the room but 798591 suddenly didn’t feel good about it.

Dr. de Courcy moved a bit closer and leaned over him.

“Take deep breaths,” she said to him.

798591 obediently sucked air deep into his lungs.

“Slowly now,” she said, “good. Try and stay calm, we’re nearly done. We’ll leave you alone soon.”

No, no, she couldn’t leave, he didn’t know what he was going to do, he didn’t want to be alone again.

“Please,” he whispered, “please, I’m better, I’ll be good, please don’t send me away,” he tried desperately not to cry again.

Dr. de Courcy frowned down at him, “what are you talking about? And stop biting your lip you’ll make it bleed.”

798591 opened his mouth like he’d been told, but then he couldn’t stop tears dripping out of his eyes. He wasn’t supposed to cry. She really wasn’t going to keep him if he couldn’t stop crying.

“Oh no, Fawn, what happened?” Kenna said, and wrapped her arms around his shoulders, he didn’t know when she’d come in, “you were doing so good earlier. Are you hurting?”

“Fawn?” said Dr. de Courcy.

If Kenna said anything in response he didn’t hear her, but he felt a little better while she was stroking his shoulders, and he managed to blink away the rest of the tears.

“That’s better,” said Dr. de Courcy, “now, what are you crying about?”

798591 risked a glance up at her. She was frowning down at him with her arms crossed.

“Did you sleep much last night?” she asked.

“S-some,” he said, timidly, “I can do better - I’ll be better.”

“I may write you a prescription for a sleeping pill, just for the night,” she said, “there’s no point in spending an hour on a neurological exam that will just tell me you’re exhausted. Would that be easier?”

“Whatever you like ma’am,” said 798591.

“Kenna,” said Dr. de Courcy, “I’m hours behind as it is, when you’re finished here, I need you to go contact the hospital legal department, about contacting the police and about what we discussed yesterday. Hand off your other patients if you need to and blame me for it, I want this handled.”

798591 felt his breathing pick up again and he couldn’t stop it, even though he did try.

“Oh is that what got you all wound up,” said Dr. de Courcy, “you’re not about to be arrested, we always call the police when someone gets lost.”

“You’re okay,” said Kenna, “you’re safe here. You’re safe.”

798591 gasped in a very shaky breath, and then his stomach gurgled loudly, and he couldn’t stop it. He also couldn’t stop himself from blushing.

“Are we starving you?” said Dr. de Courcy.

“No,” said 798591, “no I’m alright.”

“Feed him before you talk to legal,” Dr. de Courcy said to Kenna.

“Will the kitchen -“ Kenna started.

Dr. de Courcy took a wallet out of one of her pockets and handed Kenna a folded bill, “the cafeteria will be faster. Hopefully he’ll be less panicky when he’s comfortable.”

She swept out of the room.

Kenna stood up and looked at him, which meant she wasn’t holding him any more, “what would you like?” she asked him.

“I don’t need anything,” 798591 whispered, “its okay.”

“Don’t be silly,” said Kenna, “ you need to eat if you’re hungry. And you’ve had a time of it, I’ll get you a treat, kay? I’ll be right back.”

And she dashed off, and he was alone again.

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