To: drkkumaresh@hotmail.com

Subject: Fw: Pt.information

Date: Sat, 24 Sep 2011 16:32:29 +0530

Good morning Doctor, I feel a lot relieved person today, than when I first saw you for my recurrent sinus and migraine headaches six months back. I want to sincerely thank you for patiently listening through my problem, for all your help, advice, empathy, care and treatment. When I look back, my days were filled with pain, anxiety and depression owing to the continuous headaches. The bilateral FESS surgery that you performed on me has brought me at a lot ease with myself now. I am happy that I can breathe obstruction free, I feel a lot lighter and I don’t have to keep popping pills all the times. I am thankful to you for the painful procedures, which I cried through and wanted to give up but you didn’t.you kept your cool and assured me that all will be well and ensuring that all really went well and I came out smiling.

There’s definitely magic in your hands and the way you cure.

Thanks always,

JOIN THE CAUSE

Read and be shocked how few surgeons are being unethical and pocketing lakhs of money and misguiding deaf…

My patients have always been with me, it was proved it when I joined work after a break of 1.5 years due to my treatment and now Mr. Grover after a decade…

Thank you for being such a good surgeon. I have recovered fully and can breathe freely from my nose now, something i couldn’t do for a long time. What I liked best about you is that you were very reassuring and kind to me right from the start. This is the first time I was undergoing any operation and I was a bit scared, but you gave me lot of confidence and I am so glad we came to you!!

Thank you again for being my doctor and I hope to meet you the next time I am in India.
Thanks again!
Vedant Shankar (Auckland)
(12 years old)

I feel a lot relieved person today, than when I first saw you for my recurrent sinus and migraine headaches six months back. I want to sincerely thank you for patiently listening through my problem, for all your help, advice, empathy, care and treatment. When I look back, my days were filled with pain, anxiety and depression owing to the continuous headaches. The bilateral FESS surgery that you performed on me has brought me at a lot ease with myself now. I am happy that I can breathe obstruction free, I feel a lot lighter and I don’t have to keep popping pills all the times. I am thankful to you for the painful procedures, which I cried through and wanted to give up but you didn’t…you kept your cool and assured me that all will be well and ensuring that all really went well and I came out smiling.

Thanks always,

Kind Regards,

SG

Details of the Recommendation: “Hi,

I consulted Dr.Kumaresh for my Deviated Nasal Septum in year 2008. I had regular sinusitis, allergic rhinitis, lot of irritations and severe head ache due to DNS from year 2002. I checked multiple sources for the treatment and found that the success rate of surgery is very very low as most of the surgeons don’t know the real work. I searched and found Dr.Kumaresh through web and consulted him. I decided to go with the surgery considering the burden I am carrying. Dr.Kumaresh gave me confidence as well as explained the procedure technically & medically and I went through the surgery. He told me finally after the whole process “This is how you are gonna breath for the rest of your life”. Prior to surgery, I was breathing hard through the nose and it was a great effort and most of the time I was breathing through mouth. Ultimately my Nose became like a National Highway after the surgery and I am able to breath properly through the nose and its alright even after 3 years. I heard from some source that it may regrow if its not done properly. My case its perfectly alright. I could understand that its more of an Engineering activity like Tunnel boring + the medical aspects of all the tissues, cells and cartilage. He chisled my cartilege bone and there is one more astonishing output for his craftmanship. My nose became little sharp in the centre and my looks improved.

I consulted some other ENT doctor for a minor problem and told her about my DNS surgery and her comment was really encouraging “We rarely hear from people that DNS problem is solved after surgery”. And most importantly I could understand that most of the people have a DNS problem and the complication varies. If you are having DNS problem and have severe headache and sinusitis, please do the surgery as I know the difference and quality of life after that.

So my experience tells that “Here’s the right man with the right skills”. Most importantly he cracks jokes to ease out our tension and make us comfortable. One week surgery pain relieves bloody headache for rest of the life.

Thanks & All the best, Dr.Kumaresh.”
Service Category: Doctor
Year first hired: 2008 (hired more than once)
Top Qualities: Great Results, Personable, Creative

If you have vertigo you feel as if the world is spinning around you, and you feel very unsteady. Often you will also feel sick, and may vomit. Benign paroxysmal positional vertigo is a condition of the inner ear. It is a common cause of vertigo, especially in older people.
• Benign means that it is not due to a serious cause.
• Paroxysmal means ‘recurring sudden episodes of symptoms’.
• Positional means that the symptoms are triggered by certain positions.
• Vertigo is dizziness with a spinning sensation.

There are three semicircular canals. These are roughly at right angles to each other and sense movement in different directions – left-right, forward-back, and up-down head movements. The three semicircular canals are connected to a larger fluid filled chamber called the vestibule, which in turn is connected to the fluid filled canal in the cochlea.
Head movements are sensed because when you move your head, the fluid in the labyrinth within the semicircular canals moves too. The movement of the fluid moves tiny fine hairs that are on the inside lining of the labyrinth. When the hairs move, this triggers nerve messages to be sent to the brain via a nerve called the vestibular nerve. This gives the brain information about the movement and position of your head, even when your eyes are closed.
Looking with your eyes, and nerve messages from the joints and muscles of the body also help to tell your brain about your position and posture. However, a properly working labyrinth in each ear is needed for a good sense of posture and balance.

What happens in BPPV?
It is thought that BPPV is caused by one or more tiny solid fragments (‘debris’) that float about in the fluid of the labyrinth. The fragments are made up of calcium carbonate crystals which are thought to have broken off from the inside lining of the vestibule part of the labyrinth. These tiny fragments are called otoconia. These cause no problems if the fragment remains in the vestibule. However, problems occur if a fragment gets into one of the semicircular canals.
The posterior canal is the usual one affected. In this situation, when your head is still, the fragment ‘sits’ at the bottom of the posterior canal. But when the head moves in certain directions the fragment gets carried along with the flow of fluid.
The fragment brushes along the delicate hairs that line the semicircular canal and this bombards messages down the vestibular nerve.
The extra messages from the affected ear conflict with the normal messages from the other ear. The brain becomes very confused and ‘reacts’ to cause vertigo.
It is not clear why these solid fragments (otoconia) form or drop off from the inside lining of the labyrinth. Most cases of BPPV occur in people over the age of 40. Therefore, it may be an age related thing. BPPV is one of the commonest causes of vertigo in older people. However, some younger people develop BPPV following an injury to the ear, or following a previous infection in the inner ear. Sometimes it occurs in younger people for no apparent reason. Women are affected about twice as often as men.

What are the symptoms of BPPV?
The main symptom is vertigo. The vertigo lasts just a short time – typically just for 10-20 seconds and usually no longer than a minute then goes away completely. The vertigo is usually triggered by a change in head position. For example, getting out of bed and rolling over in bed are two of the most common movements that trigger a short episode of vertigo. Sometimes just looking up triggers an episode of vertigo. With each episode of vertigo you may feel sick (nausea) but it is not common to vomit. The nausea may last an hour or so even though the vertigo lasts just seconds. Between episodes of BPPV you feel well. Many people who develop BPPV realize which head movements trigger their symptoms and so instinctively avoid doing those movements.
In most cases, the symptoms clear away within several weeks or months. The fragments of debris may ‘dissolve’ or float out from the posterior semicircular canal and lodge in the vestibule where they cause no symptoms. However, after the symptoms have gone, some people have recurrences of symptoms months or years later. In some cases, symptoms persist for years.

What is the treatment for BPPV?
Meidcations do not work in this condition. Labyrinthine sedatives help if the vertigo lasts for more than 30-45 minutes, not for conditions wherein the symptoms lasts less than 5 minutes.
The Epley manoeuvre
This simple cure may be tried by your doctor. This often works if you have fragments of debris (otoconia) at the bottom of your posterior semicircular canal (the common situation). This is done by a series of four movements of the head, and after each movement the head is held in the same place for 30 seconds or so.
The movements of the head basically cause the posterior semicircular canal to rotate around in such a way that gravity moves the otoconia fragments out form the posterior canal and into the vestibule where then settle and cause no symptoms.
Following a successful Epley manoeuvre, to allow the otoconia to settle in their new situation in the vestibule, and to reduce the risk of them falling back into the posterior semicircular canal, the following are commonly advised:
• Do not lie flat for 48 hours. During this time sleep sitting in a chair.
• Do not lie on the affected side for one week.
• Ideally, try to avoid bending over (such as to tie shoelaces) for a week.
Studies report that the Epley manoeuvre is successful in stopping symptoms in about 8 in 10 cases with just one treatment. If the first treatment does not work, there is still a good chance that it will work in a repeat treatment session a week or so later.
If successful, the Epley manoeuvre is one of the few procedures that can be done in a doctors surgery in a few minutes that can dramatically cure a patient of symptoms! If symptoms return at a later date, the manoeuvre can be repeated.

No treatment
If the Epley manoeuvre is not successful, or not done, you can still remain optimistic. BPPV is a condition that often goes away on its own after several weeks or months without any treatment. One study said the condition had resolved in an average of 10 weeks. The otoconia are thought to either ‘dissolve’ or move to a place in the labyrinth where they cause no symptoms.