Category Archives: IVH Blogs

Ensuring Access To Timely Treatment Of Cancer Patients

With very little percentage of cancer patients having access to comprehensive and timely treatment support, a need to face this issue has arisen. Take a look at the ways in which this issue can be resolved

Dr. Harit Chaturved

 It might seem like a contradiction – that in the field of oncology, we are doing much better than before, yet we have a long way to go. I often feel we have hardly covered any significant ground. Not more than 15 per cent of our population has access to timely and comprehensive treatment support. To add to this difficulty, we are expecting that cancer incidences will double within the next decade, because of demographic profile, life expectancy, growing economy, lifestyle, etc. Are we prepared to face this challenge?

Major issue

A major problem is that a big chunk of our resources are spent on advanced stages of cancer and that too in the last six months of treatment in a patient’s journey. If the same resources are spent on cancer prevention and early diagnosis, it would be extremely beneficial for the patients and society at large. It is heartening to realise that almost 60 per cent of cancer is preventable. Tobacco contributes to more than two-thirds of patients in this segment and the other preventable causes are related to diet, lifestyle, vaccine for cervical cancer, liver cancer, etc. Proper education using IT and mass communication tools, with focus from primary education level onwards, could change the scenario rapidly.

Establishment of diagnostic centres

In early stages, the treatment outcomes are very gratifying, less expensive and there is minimal treatment-related morbidity. The operational cost of such a setup would be less than 5 per cent of operational cost of a hospital. These centres could be attached to nearby larger treatment facilities. Probably lot of diagnostic load from hospitals would also shift. These centres should be well equipped with imaging, endoscopies and biopsy procedures. The SOPs should ensure that more than 80 per cent of the patients are adequately attended in less than 72 hours. No cancer facility is complete without a comprehensive palliative care setup as an integral part, and it’s high time we bring the palliative care program centre stage.

Need for infrastructure

In the last two decades, we have seen dramatic growth in trained manpower and number of comprehensive cancer centres. In fact, in the last fifteen years, these numbers would be more than the total work done in the hundred years before that. There is a need to understand our disease pattern and response to treatment. To execute this, we need the infrastructure for research.

Chairman – Max Institute of Cancer Care
Max Super Speciality Hospital, Saket, New Delhi

 

 

 

Arthroscopic Surgery In India

Dr. Raju Vaishya

Arthroscopic surgery of the joints have come a long way in India over the last 25 years. Growing interest in the learning the skills of arthroscopic surgery has attracted many young surgeons in this field. Until, recently there were only countable arthroscopic surgeons in India, but  it is expected that in near future, there would be a tremendous increase in the trained manpower in this field.

Arthrosocpic surgery is a key hole surgery of the joint, which is now being done for variety of problems in almost all the major joints of the body, especially the knee, shoulder, hip, elbow & ankle. With this endoscopic procedure, there is minimal trauma to the tissues during surgery & it offers an excellent & full view of joint from inside. Thus, helping in accurate diagnosis of the problem & most of these problems can now be treated through the key holes using sophisticated & delicate arthroscopic instruments.

Arthroscopy has revolutionized the understanding & treatment of various joint injuries & diseases. Now, numerous new injury & disease pattern have been found & understood as the cause of problem to the patients. Until now, these problems were not recognized & hence not treated adequately. Other supportive investigations like MRI, CT scan etc have also helped in the diagnosis of joint disorders.

In knee & shoulder injuries, arthroscopy has become a gold standard in the diagnosis & treatment. The most common knee injuries, involve the meniscus (cartilage) & the ligaments (ACL/PCL etc). Not only one can remove the torn portion of the damaged meniscus with arthroscopy, but

It is now possible to even repair the damaged portion in selected cases. Cruciate ligament injuries (ACL & PCL) are very disabling & usually occur in young person involved in sports, when the knee is twisted abnormally. These injuries have almost limited or no capability of healing on its own & hence thos involved get repeated episodes of recurrent instability of their knee. This can be totally corrected by doing arthroscopic reconstruction of the ligament. In a recent study, at Indraporastha Apollo Hospitals by Dr Raju Vaishya & his team, on 110 Indian patients with ACL injuries, it was found that 9 out of 10 these patients have had associated generalized joint laxity & this predisposed them for ACL tears.

The damaged articular cartilage  of the joint surface has no capability of healing & hence if damaged & untreated, lead to permanent damage & early onset of arthritis in that joint. Now, it is possible to grow the cartilage in a tissue culture lab in India also & later applied to the damaged area of the joint (Autologus Chondrocyte Transplantation). This leads to re growth of the normal cartilage & thus prevention of arthritis & need for future joint replacement surgery.

The most common problems related to shoulder joint are instability, rotator cuff tears, impingement & frozen shoulder. All these can now be addressed with day care arthroscopic surgery. Young people are more  prone to have instability of the shoulder joint, leading to recurrent dislocations of their joint. Until now, no satisfactory treatment options were available. But arthrscopic stabilization of these shoulders have changed the scenario with outstanding 95% success rates. Elderly people, on the other hand have more rotator cuff tears, leading to persistent pain, weakness & inability to lift their shoulder above their heads. Arthroscopic repair of the rotator cuff can bring significant relief in pain & improvement in their function. Resistant cases of frozen shoulder, which do not respond to conventional treatments like physiotherapy etc can be treated effectively by arthroscopic surgery.

Other joints which are gaining recognition for arthroscopic surgery are hip, ankle & elbow joints.

Is renowned Orthopaedic Surgeon. He is President, Arthritis Care Foundation & Senior Consultant Orthopaedic & Joint Replacement Surgeon, Indraprastha Apollo Hospitals, New Delhi,He is  President of Indian Cartilage Society, India.

What Are Different Cosmetic Surgery Procedures Done In India?

  Dr. P. K. TALWAR

The procedures of cosmetic surgery are mainly focused on enhancing a patient’s appearance. Improving aesthetic appeal, symmetry, and proportion are the key goals. Cosmetic surgery can be performed on all areas of the head, neck, and body.

Different cosmetic surgery procedures in India are :

1) Facelift: Is a cosmetic procedure that is performed to remove wrinkles, to remove excess skin from the face and provide a more youthful appearance. Tightening of the face is optional depending on its requirement.

2) Tummy Tuck: It is to perform to give the abdomen a tighter and leaner look. This surgery helps to flatten the tummy.

3) Liposuction: It targets a certain part of the body to remove fat and restore its original shape. Liposuction is performed on the certain areas of the body like calves, back, arms, abdomen, thighs, buttocks, chin, and neck.

4) Rhinoplasty: It changes the look of a person by making necessary adjustments and modifications in ones nose. It also helps in proper breathing as it helps in removing structural nasal defects as well.There are two procedures in which a rhinoplasty is performed. In an open rhinoplasty, the surgeon makes an incision on the cartilaginous tip of the nose known as columella to make modifications required whereas the closed rhinoplasty is performed with the help of an endoscope. No incisions are made in case of closed rhinoplasty.

5) Breast Augmentation: It is performed to restore the firmness and shape of the breast. It is executed with help of breast implants. Incisions are generally made inconspicuous as they are done under the breasts or near the armpits or near the nipple. The incision during breast implant also depends upon the kind of breast implant being used, the degree of breast enhancement to be done and your anatomy. The breast implant is inserted and positioned either under the pectoral muscle or directly behind the breast tissue. Incisions are finally closed by layered sutures or sutures.

6) Hair Transplantation: The cosmetic procedure of hair transplantation helps one to restore one’s hair growth and volume even after aging. Hair follicles are extracted from the donor site of the patient’s head. These grafts of hair follicles are resistant to balding which then, with minimal invasion, are transplanted to the bald scalp.

7) Body Lift: A body lift is a procedure that sculpts the patient’s body into a perfect form. It tones and tightens the skin, tissues, and muscles of various areas in the body to give a youthful look. The procedure of body lift involves circumferential incisions, especially to tighten and tone the lower body constituting of abdomen, waist, groin, thigh, and buttocks. The procedure gets rid of the excess fat and skin in the body. Body lift also involves other procedures to provide the perfect structure and contours to the body.

8) Eyelid Surgery : An eyelid surgery is performed to reduce the lump from the lower eyelids and excess skin and wrinkles on the upper eyelids. Incisions are made on the natural lines of the upper eyelids to separate the skin from the tissue beneath it. Excess fat and skin are removed and the incision is finally closed with very small sutures. For the inner eyelid, the cosmetic surgeon either makes the incision inside the lower eyelid or on the eyelash margins. The extra skin, loosened muscles and fat are then removed.

 Is one of the leading cosmetic and plastic surgeon in India. Since 1996 he has been running Cosmetic Laser Surgery Centre of India. He was also associated with the Indraprastha Apollo Hospitals, New Delhi (India) as a Senior Consultant, Cosmetic Surgeon. His clientele includes Top Models and Film Stars from neighbouring countries, Sport Stars and a lot of foreign tourists.

Effects Of Diabetes On The Oral Health

Dr. Priyanka Goyat

Diabetes is a dangerous health issue that arises when the human body starts losing or has completely lost its ability to process sugar.  One can either be afflicted with Type I of diabetes or Type II of the same, but once caught hold with any of them the functioning of human body starts degrading.  This degradation can affect any body organ, especially the eyes, kidneys, hearts, gums, and nose in particular and soon turns them into a complete disaster. According to the recent National Family Health Survey-4 conducted by the health ministry of Government of India, around 20.3 per cent people from the overall country’s population are afflicted with diabetes.

Several research works and surveys have further predicted that diabetes will soon become an epidemic if not handled with acute precaution and seriousness as the number of its patients is rising at a very fast pace of 30-50% increase each year. It is most commonly observed that the first signs and symptoms of diabetes occur in the human mouth. So paying adequate attention to the oral health needs to be a priority to ensure timely diagnosis and treatment. Periodontal (gum) disease, tooth decay, a dry mouth, fungal infections etc. are some of the most common oral and dental problems found in with the people already facing the risks of diabetes.

Is Diabetes deteriorating your beautiful smile?

Diabetes enters the human body alarmingly with the dangerously high blood sugar levels that can derogate the entire body- including the teeth and the gums.  Controlling this deadly disease from causing any harm to your beautiful smile is entirely in your hands. Remember, you need to control those steeply moving blood sugar level because the higher the level is, the higher becomes the risk of:

Tooth decay (cavities): The human mouth naturally homes numerous types of bacteria. When an excess of starches and sugars from all the foods and beverages we consume come in contact with these bacteria’s, a sticky film known as plaque forms on the teeth. The acids in plaque deteriorate the surface of your teeth, at times further leading to the irritating and painful cavities. The higher the blood sugar level, the greater becomes the supply of sugars and starches- causing the wear and tear of teeth.

Early gum disease (gingivitis): Diabetes weakens the body’s strength to fight against the bacteria. And, if you are not regular with brushing and flossing, then this will surely land you in big trouble. Because, the longer the plaque remains on your teeth, the more irritating it becomes for gingival (part of the gums around the teeth). This results in gingivitis which causes bleeding and swelling up of the gums.

Advanced gum disease (periodontitis):  The severe most phase of gingivitis is periodontitis, which erodes the soft tissue and bone that support your teeth. Eventually, this leads to complete erosion of gums and jaw-bones which possibly makes the teeth loose and fall. Periodontitis becomes an even more severe issue for the diabetics as the increase in blood sugar level decreases the body’s ability to resist infection and even slows down the healing process.

What are some common Dental Procedures?

Dental procedures are designed to clean, strengthen, and protect teeth against the rigors of daily use and (sometimes) abuse, and to repair damage when possible. Here are some of the most common dental procedures performed today by dental professionals.

Bonding

Applying composite tooth bonding is a restorative procedure that uses tooth enamel-colored composite resin (plastic) to repair teeth that are decayed, chipped, fractured or discolored. Tooth gaps can also be closed. Unlike veneers, which require laboratory work, bonding is done in the dental office.

Braces

A dental brace is a device used to correct the alignment of teeth and bite-related problems (including under bite, overbite, etc.). Braces straighten teeth by exerting steady pressure on the teeth.

Bridges and Implants

Bridges and implants are two ways to replace a missing tooth or teeth. Bridges are false teeth anchored in place by neighboring teeth. The bridge consists of two crowns on the anchoring teeth along with the false tooth in the center. Dental implants are artificial roots used to support replacement teeth.

Crowns and Caps

Crowns are dental restorations that protect damaged, cracked or broken teeth. Dental crowns often referred to as caps; sit over the entire part of the tooth that lies above the gum line.

Extractions

Although they are no longer handled without pain medication, teeth do still need to be extracted for various reasons. Simple extractions are usually handled by the dentist using a local anesthetic and are a quick, outpatient procedure. More complex extractions (sometimes including the common extraction of the wisdom teeth) may require the services of an oral surgeon and may even require general anesthesia and a brief hospital stay. The most common reasons for tooth extraction is trauma that has damaged a tooth beyond repair or decay that has not been treated early or effectively enough to save the tooth.

Dentures

Dentures are prosthetic devices replacing lost teeth. There are two types of dentures – partial and full. Full dentures are often referred to as “false teeth”.

Fillings and Repairs

Restorative materials are used to repair teeth, which have been compromised due to tooth decay (cavities) or trauma. Your dentist may use several methods to determine if you have tooth decay such as cavity detecting dye, x-rays and laser fluorescence cavity detection aids. Tooth trauma can be caused by cracked or broken teeth, teeth that are worn from unusual use such as nail biting, tooth grinding (bruxism)  and using your teeth to open things. Different materials can be used to repair teeth, the most common being composite fillings made from a tooth-colored resin which looks and feels like natural teeth. Ask your dentist what material is best for you and specific needs.

Gum Surgery

Periodontal or gum disease is an infection that affects the gums and jaw bone, which can lead to a loss of gum and teeth. There are two major stages — gingivitis and periodontitis. Gingivitis is the milder and reversible form; the periodontal disease is often more severe. In some cases, gum surgery will be required to reverse the effect of the disease.

Oral Cancer Examination

Oral cancer starts in the cells of the mouth, tongue or throat. Oral cancer screening is usually a routine part of a dental examination. In this exam, your dentist will feel for lumps or irregular tissue changes in your neck, head, face, and inside your mouth. Your dentist will also look for sores or discolored tissue in your mouth.

Root Canals (endodontics)

Root canals treat diseases or abscessed teeth. Once a tooth is injured, cracked or decayed, it is necessary to open the tooth and clean out the infected tissue in the center. This space is then filled and the opening sealed.

Sealants

Dental sealants, usually applied to the chewing surface of teeth, act as a barrier against decay-causing bacteria. Most often, the sealants are applied to the back teeth, e.g., premolars and molars.

Teeth Whitening

Teeth naturally darken with age, however staining may be caused by various foods and beverages such as coffee, tea, and berries, some drugs such as tetracycline, smoking, or a trauma to a tooth. There are various teeth whitening options available, including in-office and at-home bleaching.

Veneers

Veneers are strong, thin pieces of ceramic or resin material that are bonded to the teeth. Veneers are used to repair chipped, decayed or stained teeth and may help in closing gaps between teeth.

What To Expect Before, During And After Angioplasty?

Dr. Subrat Akhoury

Once a patient has been selected to undergo angioplasty, before the procedure, part preparation (shaving) of groin and wrist are usually done. Depending upon the need and decision by treating cardiologist other parts may also be prepared. Few necessary blood investigations are sent especially complete blood count, kidney function tests and viral biomarkers. Your treating cardiologist will review any risks of the procedure and the anesthesia if needed as well as obtain your informed consent which gives your cardiologist permission to perform the procedure. In case you are not able to give consent – one of your relative will give the consent.

During the procedure you will lie on a table in cardiac catheterization laboratory and be mildly sedated if you are too anxious but you will remain awake throughout the procedure unless indicated otherwise.

The interventional cardiologist will use a small needle to inject local anesthetic idocaine in groin or in the forearm. (This needle prick could be the only pain you will feel throughout the procedure)

Sometimes while balloon is inflated to open the blocked artery you may feel chest pain transiently.

After the procedure, you will have to follow the instructions by cardiologist like immobilization of limbs, when to eat. You should ask your doctor if you have queries.

Associate Director, Cath Lab & Interventional Cardiologist, Asian Institute of Medical Sciences (AIMS), Faridabad

How is Cancer Diagnosed?

Dr. Navile Aditya Murli

There is no single, simple method to diagnose cancer. It may take several months or years for malignant cells to multiply to the point where they become a detectable cancer. The symptoms produced by a cancer depend on its location and unfortunately it is possible for cancer to become widespread before it starts to produce any symptoms at all.

Sometimes cancers may be discovered accidentally during routine tests or the investigation of non-specific symptoms.

The cancers that are easiest to detect are those that are on the skin and which show, for example, as a change in a mole or wart. Others may start close to the surface and can be seen or felt as a lump or thickening. There are also some parts of the body that are relatively easy to examine for early signs of cancer such as the mouth and throat, the cervix and vagina or the rectum and anus.

What is Biopsy ?

Cancer is usually diagnosed by an expert who has looked at cell or tissue samples under a microscope. In some cases, tests done on the cells’ proteins, DNA, and RNA can help tell doctors if there’s cancer. These test results are very important when choosing the best treatment options.

Tests of cells and tissues can find many other kinds of diseases, too. For instance, if doctors are not sure a lump is cancer, they may take out a small piece of it and have it tested for cancer and for infections or other problems that can cause growths that may look like cancer.

The procedure that takes out a piece of the lump, or a sample for testing is called a biopsy. The tissue sample is called the biopsy specimen. The testing process is sometimes referred to as pathology.

How Biopsy is done ?

A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist  then looks at the tissue under a microscope to see if it is cancer. The sample may be removed in several ways:

  • With a needle: The doctor uses a needle to withdraw tissue or fluid.
  • With an endoscope: The doctor looks at areas inside the body using a thin, lighted tube called an endoscope. The scope is inserted through a natural opening, such as the mouth. Then, the doctor uses a special tool to remove tissue or cells through the tube.
  • With surgery: Surgery may be excisionalor incisional.
    • In an excisional biopsy, the surgeonremoves the entire tumor. Often some of the normal tissue around the tumor also is removed.
    • In an incisional biopsy, the surgeon removes just part of the tumor.

Lumps that could be cancer might be found by imaging tests or felt as lumps during a physical exam, but they still must be sampled and looked at under a microscope to find out what they really are. Not all lumps are cancer. In fact, most tumors are not cancer

 Is a CONSULANT MEDICAL ONCOLOGY at Oncoplus Cancer Care Centre, Defence Colony, New Delhi. He did His Senior Resident and fellowship for three years in Cancer Institute Adyar Chennai.

What is body liposuction, how is it done& what are its risks?

Dr. P. K.Talwar

What is body Liposuction

Liposuction is a surgical procedure that uses a suction technique to remove fat from specific areas of the body, such as the abdomen, hips, thighs, buttocks, arms or neck. Liposuction also shapes (contours) these areas. Other names for liposuction include lipoplasty and body contouring.

Liposuction isn’t typically considered an overall weight-loss method or a weight-loss alternative. If you’re overweight, you’re likely to lose more weight through diet and exercise or through bariatric procedures — such as gastric bypass surgery — than you would with liposuction.

You might be a candidate for liposuction if you have too much body fat in specific spots but otherwise have a stable body weight.

How it is done

Befor surgery, your surgeon will recommend that you stop taking certain medications, such as blood thinners or NSAIDs, at least two weeks prior to surgery. If your procedure requires the removal of only a small amount of fat, the surgery might be done in an office setting. If a large amount of fat needs to be removed — or if you plan to have other procedures done at the same time — the surgery might take place in a hospital followed by an overnight stay. In either case, arrange for someone to drive you home after the procedure.

Before liposuction, the surgeon might mark circles and lines on the areas of your body to be treated. Photos also might be taken so that before and after images can be compared.

How your liposuction procedure is done depends on the specific technique that’s used:

 Tumescent liposuction

This is the most common type of liposuction. The surgeon injects a sterile solution — a mixture of salt water, which aids fat removal, an anesthetic (lidocaine) to relieve pain and a drug (epinephrine) that causes the blood vessels to constrict — into the area that’s being treated. The fluid mixture causes the affected area to swell and stiffen.

The surgeon then makes small cuts into your skin and inserts a thin tube called a cannula under your skin. The cannula is connected to a vacuum that suctions fat and fluids from your body. Your body fluid might be replenished through an intravenous (IV) line.

  • Ultrasound-assisted liposuction (UAL)

This type of liposuction is sometimes used in conjunction with tumescent liposuction. During UAL, the surgeon inserts a metal rod that emits ultrasonic energy under your skin. This ruptures the fat cell walls and liquefies the fat for easier removal.

  • Laser-assisted liposuction (LAL)

This technique uses high-intensity laser light to liquefy fat for removal. During LAL, the surgeon inserts a laser fiber through a small incision and emulsifies fat deposits. The fat is then removed via a cannula.

  • Powered liposuction

This type of liposuction uses a cannula that moves in a rapid back-and-forth motion. This vibration allows the surgeon to pull out tough fat more easily. Powered liposuction might sometimes cause less pain and swelling and can allow the surgeon to remove fat with more precision, especially on smaller areas, such as the arms, knees or ankles.

During the procedure

Some liposuction procedures might require only local or regional anesthesia — anesthesia limited to a specific area of your body. Other procedures might require general anesthesia, which induces a temporary state of unconsciousness. You might be given a sedative, typically through an IV injection, to help you remain calm and relaxed.

The surgical team will monitor your heart rate, blood pressure and blood oxygen level throughout the procedure. If you feel pain, tell your surgeon. The medication or motions might need adjustment.

The procedure might last up to several hours, depending on the extent of fat removal. After the procedure, the surgeon might leave your incisions open to promote fluid drainage.

If you’ve had general anesthesia, you’ll wake up in a recovery room. You’ll typically spend at least a few hours in the hospital or clinic so that medical personnel can monitor your recovery. If you’re in a hospital, you might stay overnight to make sure that you’re not dehydrated or in shock from fluid loss.

What are the risks of liposuction

As with any major surgery, liposuction carries risks, such as bleeding and a reaction to anesthesia. Possible complications specific to liposuction include:

  Contour irregularities. Your skin might appear bumpy, wavy or withered due to uneven fat removal, poor skin elasticity and unusual healing. These changes might be permanent. Damage beneath the skin from the thin tube (cannula) that’s used during liposuction might give the skin a permanent spotted appearance.

  Fluid accumulation. Temporary pockets of fluid (seromas) can form under the skin. This fluid might need to be drained with a needle.

  Numbness. You might feel temporary or permanent numbness in the affected area. Temporary nerve irritation also is possible.

 Infection. Skin infections are rare but possible. A severe skin infection might be life-threatening.

  Internal puncture. Rarely, a cannula that penetrates too deeply might puncture an internal organ. This might require emergency surgical repair.

  Fat embolism. Pieces of loosened fat might break away and become trapped in a blood vessel and gather in the lungs or travel to the brain. A fat embolism is a medical emergency.

  Kidney and heart problems. Shifts in fluid levels as fluids are being injected and suctioned out can cause potentially life-threatening kidney and heart problems.

The risk of complications increases if the surgeon is working on larger surfaces of your body or doing multiple procedures during the same operation. Talk to your surgeon about how these risks apply to you.

Is one of the leading cosmetic and plastic surgeon in India. Since 1996 he has been running Cosmetic Laser Surgery Centre of India. He was also associated with the Indraprastha Apollo Hospitals, New Delhi (India) as a Senior Consultant, Cosmetic Surgeon. His clientele includes Top Models and Film Stars from neighbouring countries, Sport Stars and a lot of foreign tourists.

 

When Should One Go For A Joint Replacement Surgery?

Dr. Raju Vaishya

When your knee pain is so bad it actually interferes with the things you want or needs to do, the time may be right for a joint a joint replacement surgery. Knee replacement may be an option when nonsurgical interventions such as medication, physical therapy, and the use of a cane or other walking aid no longer help alleviate the pain. Other possible signs include aching in the joint, followed by periods of relative relief; pain after extensive use; loss of mobility; joint stiffness after periods of inactivity or rest; and/or pain that seems to increase in humid weather.

Your physician may refer you to an orthopedic surgeon who will help you determine when/if it is time for knee surgery and which type of knee surgery is most appropriate. Your surgeon may decide that knee replacement surgery is not appropriate if you have an infection, do not have enough bone or the bone is not strong enough to support an artificial knee.

Doctors generally try to delay total knee replacement for as long as possible in favor of less invasive treatments. With that being said, if you have advanced joint disease, knee replacement may offer the chance for relief from pain and a return to normal activities.

If you have been experiencing long term joint pain, lasting more than few days, visiting an orthopedist in time will prove to be beneficial. Depending on your condition, your doctor will make a treatment plan, which will include medications, exercise, physical therapy and a few steps in lifestyle modification. In some cases he may recommend either keyhole surgery or even joint replacement.

People with joint pain need to follow a strict daily routine to keep their condition under control and minimize pain and discomfort. This routine includes a religious devotion to daily exercise, use of physiotherapy and heat therapy to keep the joints mobile and check inflammation as well as using supporting devices such as knee braces and orthotic shoes to ensure comfort. At the same time, it is important to understand that unhealthy habits like smoking and drinking tend to have a further negative effect on arthritic conditions. Most important is to check weight gain as excessive body weight puts greater pressure on the knees and the feet and accelerates damage.

Dr. (Prof.) Raju  Vaishya is President of Arthritis Care Foundation & a Senior Orthopaedic & Joint Replacement Surgeon at Indraprastha Apollo Hospitals, New Delhi. He is also well known for his academic contributions. 

What is Bypass surgery & when is it performed ?

What is heart bypass surgery?

Bypass surgery, or coronary artery bypass surgery, is used to replace damaged arteries in your heart muscle. A surgeon uses blood vessels taken from another area of your body to repair the damaged arteries. It is a surgical procedure that diverts the flow of blood around a section of a blocked or partially blocked artery in your heart. By creating a new pathway to the heart, coronary bypass surgery improves blood flow to your heart muscle.

After coronary bypass surgery, symptoms, such as chest pain and shortness of breath due to poor blood flow to the heart, generally improve. For some people, coronary bypass surgery may improve heart function and reduce the risk of dying of heart disease.

Most coronary bypass surgeries are done through a long incision in the chest while blood flow is diverted through a heart-lung machine (called on-pump coronary bypass surgery). The surgeon cuts down the center of the chest, along the breastbone. The surgeon then spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily stopped and a heart-lung machine takes over to circulate blood to the body.

The surgeon takes a section of healthy blood vessel, often from inside the chest wall (the internal mammary artery) or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is diverted (bypassed) around the narrowed portion of the diseased artery.

What are the different types of heart bypass surgery?

  • single bypass: only one artery is blocked
  • double bypass: two arteries are blocked
  • triple bypass: three arteries are blocked
  • quadruple bypass: four arteries are blocked

When Coronary bypass surgery is done ?

When patient has severe chest pain caused by narrowing of several of the arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest. Sometimes angioplasty and stenting will help, when more than one diseased coronary artery and the heart’s main pumping chamber — the left ventricle — isn’t functioning well then bypass surgery may be the best option. Your doctor may recommend heart bypass surgery if your coronary arteries become so narrowed or blocked that you run a high risk of a heart attack.

You and your doctor can consider whether coronary bypass surgery or another artery-opening procedure, such as angioplasty or stenting, is right for you.

Coronary bypass surgery is an option if:

  • Patients have severe chest pain caused by narrowing of several of the arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest. Sometimes angioplasty and stenting will help, but for some types of blockages, coronary bypass surgery may be the best option.
  • Patients have more than one diseased coronary artery and the heart’s main pumping chamber — the left ventricle — isn’t functioning well.
  • Patient’s left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.
  • Patients have an artery blockage for which angioplasty isn’t appropriate, you’ve had a previous angioplasty or stent placement that hasn’t been successful, or you’ve had stent placement, but the artery has narrowed again (restenosis).

Coronary bypass surgery may also be performed in emergency situations, such as a heart attack, if your doctor sees that you’re not responding to other treatments.

Some time, patient may not have any symptoms in early coronary artery disease, yet the disease will continue to progress until there’s enough artery blockage to cause symptoms and problems. If the blood supply to your heart muscle continues to decrease as a result of increasing blockage of a coronary artery, you may have a heart attack. In this condition, bypass surgery is done to restore blood flow