Hi,
Thank you for your query.

Thank you for the detailed history. What you are suffering from the common symptoms of Dyspepsia.

Dyspepsia is a common problem and is frequently caused by
1.Gastroesophageal reflux disease (GERD)
2. Gastritis
3. In a small minority it may be the first symptom of peptic ulcer disease
4. IBS-IBS is characterized by frequent diarrhea, abdominal pain and gas or constipation and bloating.

The symptoms of dyspepsia include chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating; it can be accompanied by bloating, belching, nausea, or heartburn.

Your symptoms are inter related to lack of sufficient vitamin B-12 affects the digestive system because the vitamin is essential in the metabolism of carbohydrates, fats and protein.
A chronic lack of vitamin B-12 can result in the development of pernicious anemia, also known as vitamin deficiency anemia, which causes fever, irritability, dizziness, difficulty breathing, weakness, fatigue, weight loss, paleness and tingling in the feet and hands.
Hence your symptoms of Tiredness even after eating, anxiety, bloating, deep breath intention.

Treatment includes-
1. Supplementation by oral pill; sublingual pill, liquid, or strip; intranasal spray; transdermal patch or by injection. B12 supplements are available in forms including cyanocobalamin, hydroxocobalamin, methylcobalamin, and adenosylcobalamin.Oral treatments involve giving 250 µg to 1 mg of B12 daily.

2. Vitamin B12 can be given as intramuscular or subcutaneous injections of hydroxycobalamin, methylcobalamin, or cyanocobalamin. Body stores (in the liver) are partly replete with half a dozen injections in the first couple of weeks

3. Vitamin B12 can be found in large quantities in animal products, including meat, poultry, fish, seafood, eggs, and dairy products

Coming to anal fissures.
An anal fissure or rectal fissure is a break or tear in the skin of the anal canal. It is a very painful condition which is characterized by Bleeding from anal region, irritation, itching and burning sensation.
Anal fissures are noticed by bright red anal bleeding on toilet paper, sometimes in the toilet.
Its association to cancer is very, very rare. The symptoms of bleeding and pain subside as soon as the fissure is treated.

Treatment includes-
1.Warm sits baths, topical anesthetics, high-fiber diet and stool softeners

2. Surgery -Lord's plication or lateral sphincterotomy where the XXXXXXX anal sphincter muscle is incised.


Some home tips-
1. Avoiding straining when defecating. This includes treating and preventing constipation by eating food XXXXXXX in dietary fiber, drinking enough water, occasional use of a stool softener, and avoiding constipating agents.

2. Careful anal hygiene after defecation, including using soft toilet paper and/or cleaning with water.

3. In cases of pre-existing or suspected fissure, use of a lubricating ointment. Hemorrhoid ointment is contraindicated because it constricts small blood vessels, thus causes a decrease in blood flow, which prevents healing.

Hence there is no need to worry,
All of your symptoms will subside by taking proper B12 medication and management of the anal fissure. It is not a cancer scare, and if you still want to be sure you can get an Endoscopy done by a general surgeon.

I would also advise you to-
1. Continue the current medication
2. Have lots of fiber containing fruits and vegetables
3. Exercise in moderation
4. Proper meal times and sleep habits.

Thank you,
Wishing you good health.
You can contact me for further queries

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Hi,

Fatty liver is a condition wherein large vacuoles of triglyceride fat accumulate in liver cells. This occurs due to abnormal retention of lipids within a cell.

These days there is an increase in the prevalence of Fatty liver cases due to the change in lifestyles and increase in Work load.

Since you say you don't drink alcohol, what you are experiencing is called as Non Alcoholic Fatty Liver Disease or NAFLD. This too is of two types.

1. Some people who don't drink and excess fat in the liver simply have fatty liver. Although this is not normal, it is not serious if it doesn't lead to inflammation or damage.

2. Others have what's called nonalcoholic steatohepatisis (NASH). XXXXXXX can lead to permanent liver damage. The liver may enlarge and, over time, liver cells may be replaced by scar tissue. This is called cirrhosis.

The causes for NAFLD are-
1. NAFLD tends to run in families. It also shows up most often in people who are middle-aged and overweight or obese. These people often have high cholesterol or triglycerides and diabetes or prediabetes (insulin resistance).
2. Other potential causes of fatty liver disease include:
- Medications
- Viral hepatitis
- Autoimmune or inherited liver disease
- Rapid weight loss
- Malnutrition

Treatment and some tips-

1. Start with exercise in Moderation. Losing weight and toning the body is a very good for for the body's metabolism.
2. Next comes eating a balanced and healthy diet. Avoid diets XXXXXXX in refined, rapidly digested carbohydrates. This includes limiting foods such as bread, grits, rice, potatoes, corn, and concentrated sugar that is found in sports drinks and juice.
3. Avoiding unnecessary medications can also help slow or reverse the disease
4. Increase intake of anti-oxidants such as Vitamin E,selenium, etc.
5. Lower your cholesterol. A healthy plant-based diet, exercise and medications can help keep your cholesterol and your triglycerides at healthy levels.

I would also suggest you to get a 6 monthly USG abdomen, blood tests including liver enzymes done to keep a track of the fatty liver.

The best approach now would be attempts at controlling the existing fatty liver and also preventing the development of further damage.

Thank you,
Wishing you good health

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Hi,

I am glad could clear your doubts.
Happy to be of some help to you.

You can contact me for any further queries.

Thank you,
Wishing you good health.

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