Shoulder replacement Surgery in Faridabad is one of the best places to get done with the Shoulder replacement Surgery and get the best results. These are very critical type of surgeries and require expert guidance and control. Even a small mistake can lead to a permanent injury to the patient and ruin their rest of the life.
Professionals perform Shoulder replacement Surgery in Faridabad successfully and have been doing this since past many years which has helped them to reach where they are currently. Performing over numerous of patients in the past years have helped them to gain experience and confidence in the acquired field
Complete Hip Replacement
Regardless of whether you have quite recently started investigating treatment alternatives or have as of now chose to go through hip substitution medical procedure, this data will assist you with understanding the advantages and constraints of absolute hip substitution. This article depicts how a typical hip functions, the reasons for hip agony, what’s in store from hip substitution medical procedure, and what activities and exercises will assist with reestablishing your versatility and strength, and empower you to get back to ordinary exercises.
On the off chance that your hip has been harmed by joint inflammation, a break, or different conditions, normal exercises like strolling or getting in and out of a seat might be excruciating and troublesome. Your hip might be firm, and it could be difficult to put on your shoes and socks. You might even feel awkward while resting.
Life structures
The hip is one of the body’s biggest joints. It is a ball-and-attachment joint. The attachment is framed by the hip bone socket, which is essential for the pelvis bone. The ball is the femoral head, which is the upper finish of the femur (thighbone).
The bone surfaces of the ball and attachment are covered with articular ligament, a smooth tissue that pads the closures of the bones and empowers them to move without any problem.
Normal Causes of Hip Pain
Osteoarthritis.
Rheumatoid joint pain
Post-horrendous joint pain.
Youth hip infection
Is Hip Replacement Surgery for You?
The choice to have hip substitution medical procedure ought to be a helpful one made by you, your family, your essential consideration specialist, and your muscular specialist. The most common way of settling on this choice normally starts with a reference by your primary care physician to a muscular specialist for an underlying assessment.
Total hip replacement surgery in Faridabad is one of the best places to get done with the hip replacement surgery and get the best results. These are very critical type of surgeries and require expert guidance and control. Even a small mistake can lead to a permanent injury to the patient and ruin their rest of the life.
Professionals perform total hip replacement surgery in Faridabad successfully and have been doing this since past many years which has helped them to reach where they are currently. Performing over numerous of patients in the past years have helped them to gain experience and confidence in the acquired field
Complete Hip Replacement
Regardless of whether you have quite recently started investigating treatment choices or have as of now chose to go through hip substitution medical procedure, this data will assist you with understanding the advantages and impediments of all out hip substitution. This article depicts how an ordinary hip functions, the reasons for hip agony, what’s in store from hip substitution medical procedure, and what activities and exercises will assist with reestablishing your portability and strength, and empower you to get back to regular exercises.
In the event that your hip has been harmed by joint inflammation, a break, or different conditions, normal exercises like strolling or getting in and out of a seat might be agonizing and troublesome. Your hip might be hardened, and it could be difficult to put on your shoes and socks. You might even feel awkward while resting.
Life structures
The hip is one of the body’s biggest joints. It is a ball-and-attachment joint. The attachment is framed by the hip bone socket, which is important for the pelvis bone. The ball is the femoral head, which is the upper finish of the femur (thighbone).
The bone surfaces of the ball and attachment are covered with articular ligament, a smooth tissue that pads the closures of the bones and empowers them to move without any problem.
Normal Causes of Hip Pain
Osteoarthritis.
Rheumatoid joint pain
Post-horrendous joint inflammation.
Youth hip infection
Is Hip Replacement Surgery for You?
The choice to have hip substitution medical procedure ought to be a helpful one made by you, your family, your essential consideration specialist, and your muscular specialist. The most common way of settling on this choice normally starts with a reference by your primary care physician to a muscular specialist for an underlying assessment.
Most types of pain in the lower back can be treated without any surgery. In fact, in non indicated cases, surgery often does not resolve the pain; studies suggest that almost 20 to 40 percent of surgeries of the back are not successful to relieve the pain. This failure to correctly diagnose and prevent inadvertent surgery is so common that a medical term is coined for it: Failed back surgery syndrome.
Nonetheless, at times back surgery is a very viable option or necessary to treat serious musculoskeletal injuries, nerve compression or neurogenic claudication. Surgery should be considered only after exhausting all other options. Urgent surgery should be considered only in the case of Cauda Equina, impending Cauda Equina or post-traumatic unstable spine or paralysis or weakness in the limbs
When should I consider back surgery?
The following conditions can be considered for surgical treatment:
Herniated or ruptured disks which are compressing the nerves and severe pain is radiating to the legs. Disks are cushion like materials alternating between the bones of the spine and act like shock-absorbers
Spinal stenosis or narrowing of the spinal canal causing significant pain and limitation in walking distance due to pressure on the spinal cord and nerves
Spondylolisthesis is instability of the spine resulting in one or more bones in the spine slip over the other
Vertebral fractures caused by trauma to the bones in the spine or by osteoporosis
Degenerative disk disease or arthritis, or other form of damage to spinal disks as a person gets older
Occasionally,a tumor, an infection, or a nerve root problem like cauda equina syndrome is found as a cause of back pain. In these cases, surgery is advised right away to resolve the pain and prevent complications.
What are some types of back surgery?
There are multiple types of surgeries for back pain which is listed below. But clarity is still not there as to which procedures work best for any particular conditions.
Vertebroplasty and kyphoplasty. These procedures are used to treat compression fractures of the vertebrae caused usually by osteoporosis. These procedures include injecting a glue-like bone cement which hardens in a few minutes and strengthens the bone.
Spinal laminectomy/spinal decompression. This is done to treat spinal stenosis causing narrowing of the spinal canal that results in pain, numbness or weakness in the limbs. The surgeon removes the bone walls from around the spinal cord and any bone spurs. This opens the spinal column to remove pressure on the nerves and the roots.
Discectomy. This removes the offending part of the disk which has herniated and compresses a nerve root or the spinal cord. Laminectomy and discectomy are frequently done together to achieve an optimal result.
Foraminotomy. In this procedure, the surgeon enlarges the bony canal where a nerve root exits the spinal canal and provides larger space for movement of the vital structures without getting compressed by bulging disks or joints thickened with age from pressing on the nerve.
Nucleoplasty or plasma disk decompression. This surgery uses radiofrequency waves to treat low back pain due to a mildly herniated disk. The surgeon inserts a long needle into the disk under guidance of portable X-ray. A plasma laser device is then connected into the needle and the tip is heated, tissue in a small field around is vaporised in the disk. This reduces the size of the disk and relieves pressure on the nerves.
Spinal fusion. The intervertebral disk between two or more vertebrae is removed by the surgeon. The adjacent bones are then fused using bone grafts or metal implants secured by screws. Spinal fusion usually results in some loss of flexibility in the spine which is partially compensated by the spinal segments below and above it. Spinal fusion usually requires a long recovery period to let the bone grafts to get assimilated and fuse the vertebrae together.
Artificial disk replacement. This is a newer alternative to spinal fusion for the treatment in patients suffering from severely damaged disks. This procedure involves complete removal of the disk material and is replaced by an artificial disk. This helps restore the height and allows for movement between the vertebrae.
Other treatment modalities like intradiscal electrothermal therapy and radiofrequency denervation are not found to have any benefit in the long term.
What are the risks of back surgery?
Surgery to the back or spine carries higher risks due to its proximity to the spinal cord and nerves. The most serious of these are a rare possibility of paralysis and infections.
Even with a successful surgery, at times recovery can take a long time. Sometimes healing and complete recovery can take months depending on the type of surgery performed and your condition prior to the surgery. Surgery may cause some loss of flexibility permanently.
What type of anaesthesia is delivered during surgery?
Back surgery is almost always done under general anesthesia. Along with the usual risks of drug reaction, high sensitivity of the body associated with anesthesia, there are risks due to the patient lying face down on the surgical table.
Lying face down or in a prone position changes the flow of blood through the body. This position also limits the anaesthesia team’s access to the patient’s airway. This needs extreme care in the positioning of equipment and monitoring of the patient.
How do I manage pain during my recovery?
Back surgery if not managed correctly often leads to significant pain in post-operative period. You can consider a number of options for pain relief prescribed by the doctor in the days after surgery. These options can be considered after discussion with a pain management specialist to explain the pros and cons including effectiveness, side effects, addiction and recovery process.
Some factors to consider:
Many of your options will involve medications which may be opioids, non-steroidal anti-inflammatory drugs, corticosteroids and local anesthetics. Sometimes a combination of more than one drug will be taken. Multimodal therapies can improve pain control and limit opioid use.
Opioids use should be with care to prevent addiction and other side effects.
Alternative or complementary methods for pain relief which doesn’t include medicines must also be considered.
Many hospitals have a dedicated pain management team which include physician anesthesiologists who specialize in pain management can be important both before and after surgery to develop a tailored plan for your condition and preferences. They consult, and adjust your pain medications, based on the intensity of pain you are experiencing.
Back pain is one of the commonest reasons for absence from work. And it is also the commonest reason to seek medical treatment. It can be uncomfortable, debilitating or disabling.
Back pain can result from injury, extraneous activity or some medical conditions. Back pain affects people of any age, for a variety of reasons. With increasing age, the chance of developing back pain increases, especially in the lower back. This can be due to various factors such as previous work and degenerative changes in spine or any disease.
Lower back pain is commonly linked to the bones in the lumbar spine or the discs between the vertebrae but can also be due to ligaments around the spine and discs, spinal cord and nerves, the lower back muscles, internal organs in the abdomen and pelvis, or the skin around the lumbar area.
Pain in the upper back is usually more sinister and may be due to the disorders of the large blood vessels aorta or vena cava, tumors in the chest, lungs and or the spine.
Causesback pain
Problems with the spine such as osteoporosis commonly seen in the elderly can lead to back pain.
The human or mammalian back is made of a complex structure of muscles, ligaments, tendons, intervertebral discs, and bones, which form a framework together to support the body and enable us to dynamize our movements.
The individual bones of the spine are cushioned alternatively with soft cartilage-like shock-absorbing pads called disks.
Problems with any of these constituents can cause back pain. Still in some cases, the cause of back pain remains unclear.
Damage to spine or supporting structures can result from excessive strain, medical conditions, poor posture and other unknown causes.
Strain
Back pain commonly results from excessive strain, tension, or injury. Common causes of back pain are:
overstrained muscles or ligaments
a paraspinal muscle spasm
muscle tension
damaged or degenerated disks
Injuries or fractures
Activities causing strains or spasms include:
lifting things improperly
lifting too heavy things
abrupt and awkward movements of the back
Structural problems
A number of structural problems in or around the spine can result in back pain.
Ruptured disks: Vertebrae in the spine is cushioned by disks on both top and bottom. If one of these disks ruptures, it bulges out and puts pressure on a nerve, resulting in back pain that can radiate to the limbs.
Bulging disks: Similar to ruptured disks, a bulging disk can cause more of a back pain but is less likely to have radiating pain in the limbs.
Sciatica: common term for sharp and shooting pain from the buttock and down the back of the leg, caused by pressure on the nerves in the spinal canal.
Arthritis: Osteoarthritis or degeneration of any of the three joints between two vertebrae can cause pain in the hips, lower back, and other places.
Lumbar canal stenosis: The space around the spinal cord narrows due to thickening of the ligaments. This is known as spinal stenosis.
Abnormal curvature of the spine: Any change in the normal curves of the spine changes the mechanics and weight transmission, back pain can result. Scoliosis is one such condition, in which the spine curves and rotates to the side.
Osteoporosis: With aging bones, including the vertebrae of the spine, become porous, less denser and brittle, causing compression fractures even with minor injury or even body weight.
Kidney problems: Stones, infection or other disorders of kidney can cause back pain.
Movement and posture
Most of us use a desk for our work, especially while using a computer. Invariably we tend to get into a slouched or hunched posture for a long time. This is usually a cause for upper back and shoulder pain among the urban population or white collar workers.
Back pain also results from few day to day activities or poor posture.
Examples include:
Overzealous twisting
coughing or sneezing
muscle tension or strain
over-stretching
bending awkwardly or suddenly
pushing, pulling, lifting, or carrying out heavy manual activity
standing or sitting for long periods in same posture
straining the neck forward
long driving without a break
sleeping on an uncomfortable bed or position
Other causes
Some medical conditions can lead to back pain.
Cauda equina syndrome: The cauda equina is the bundle of spinal nerve roots coming out of the lower end of the spinal cord. Symptoms can vary from a dull pain in the lower back and upper buttocks to numbness in the buttocks, genitalia, and thighs along with loss of bowel(defecation) and bladder(micturition) control.
Cancer of the spine: A tumor in the spine arising from any structure can give rise to pressure symptoms and destruction of nearby tissues. All this can manifest as back pain.
Infections of the spine: Tuberculosis of the spine is a common condition seen in the 3rd world population. Apart from back pain fever is another common symptom.
Other infections: Inflammatory disease in the pelvis, infections of the bladder, or kidney may also lead to back pain.
Sleep disorders: In studies, it has been noticed that individuals with sleep disorders are more likely to experience back pain.
Shingles: Infection of the nervous system may lead to back pain.
Risk factors for back pain
Studies over the years have found the following associated factors for developing low back pain:
occupational activities
pregnancy
a sedentary lifestyle
poor physical fitness
older age
obesity and excess weight
smoking
strenuous physical exercise or work, especially if done incorrectly or without proper stretching or warmup
genetic factors
medical conditions, like arthritis and cancer
Lower back pain is also seen more commonly in women than in men, probably due to hormonal factors. Stress, anxiety, and mood disorders along with other psychological conditions have also been linked to back pain.
Symptoms of the back pain
Back pain is the commonest symptom in spinal problems which at times may shoot down all the way to the buttocks and legs.
Some back problems can cause pain in other parts of the body, depending on which nerves are affected.
The pain is usually temporary and often goes away with rest, but if it recurs or is associated with any of the following, you must visit a doctor:
weight loss
fever
inflammation or swelling on the back
persistent back pain, where lying down or resting does not help
pain down along the legs
pain that radiating below the knees
Pain due to recent injury, blow or trauma to the back
urinary incontinence or other disturbance
fecal incontinence, or loss of control over defecation
numbness around the genitals
numbness around the anus
numbness around the buttocks
When to see a doctor
You should seek medical care if you experience numbness or tingling, or if the back pain:
that is not relieved with rest
Caused due to an injury or fall
with numbness in the legs
With numbness in saddle area
with weakness in legs
with fever
with significant weight loss
Diagnosis
Your doctor will be able to diagnose your back pain with few questions about symptoms and a physical examination.
Few imaging scan and other tests may be done to confirm if:
back pain is a result from an injury
there is some underlying cause for the pain
the pain persists for a long period
An X-ray, MRI, or CT scan can help confirm the diagnosis by giving visual information about the state of the tissues in the back.
X-rays help see the alignment of the bones and find signs of arthritis or bones, but they can’t reveal damage in the soft tissues like muscles, spinal cord, nerves, or intervertebral disks.
MRI or CT scans give spatial visualisation of herniated disks or problems with other tissues such as tendons, nerves, ligaments, blood vessels, muscles, and bones as well.
Bone scans pick up even very early changes in bone and can detect bone tumors or subtle compression fractures due to osteoporosis. A radioactive substance or also called a tracer is injected into a vein. The tracer gets concentrated in the high activity areas in bones, which is then visualised with the aid of a special camera.
Electromyography or EMG measures the conduction of electrical impulses. This can help confirm nerve compression, due to a herniated disk or spinal stenosis or any other cause.
Your doctor may also advise a blood test if the infection is suspected.
Chronic or acute back pain?
Back pain is for management purpose categorized into two types:
Acute back pain is a sudden abrupt start of the pain and may last for up to 6 weeks.
Chronic or long-term pain develops gradually over a longer period, lasts for months, with or without waxing and waning phases and causes ongoing problems.
Some people have both occasional bouts of intense pain with intervening periods of fairly continuous mild back pain. This Makes it difficult for a doctor to ascertain or categorize the pain as acute or chronic back pain.
What is intragastric balloon surgery or balloon in stomach for weight loss
Intragastric balloon surgery or balloon in the stomach is a weight loss procedure where a saline-filled silicone balloon is placed in the stomach. This limits the capacity or volume of the stomach. It helps lose weight by filling up the stomach with lesser quantities of food.
The intragastric balloon procedure can be considered for those who are obese and are not satisfied with their diet and exercise results.
As with other weight loss surgery, strict adherence to a healthier lifestyle is necessary. These lifestyle changes should include a healthy diet, regular exercise to help ensure the success of intra-gastric balloon surgery in the long run.
Why it is done
The primary aim of an intragastric balloon surgery is to help lose weight. Weight loss lowers the risk of many potentially serious health problems related to weight, like:
Gastroesophageal reflux disease (GERD)
Heart disease
Brain stroke
High blood pressure (Hypertension)
Obstructive sleep apnea
Nonalcoholic fatty liver disease (NAFLD)
Diabetes
Any of the weight loss medical/surgical procedures including Intragastric balloon procedure are to be done only after improving diet and exercise habits.
Who should opt for intragastric balloon surgery
Intragastric balloon procedure can be considered for if:
Body mass index (BMI) is between 30 and 40
Willing to adhere to a healthy lifestyle, regular medical follow-up, and other changes in behavior
No previous stomach or esophageal surgery
Intragastric balloon procedure can not be considered a staple choice of treatment for every overweight individual. A screening process will help customize an ideal treatment for each individual.
Intragastric balloon placement and its removal, later on, is usually not covered under health insurance and therefore is usually paid from the pocket. This is the biggest reason why people from around the world head to countries like India, Turkey, and Thailand for intragastric balloon surgery and other cosmetic or aesthetic procedures.
Risks with Intra-Gastric Balloon surgery
An intra-gastric balloon in the stomach for weight loss is a mechanical object placed inside the stomach, hence causing mechanical symptoms like pain and nausea in about a third of people soon after the procedure. Once the body adjusts to the balloon in the stomach the symptoms subside, usually in a few days. These symptoms are easily managed with oral medications at home.
Serious side effects are very rare but may occur after intragastric balloon procedure. A doctor should be consulted if nausea, vomiting, and abdominal pain occur at any time after surgery.
An intra gastric balloon can deflate and move through the digestive tract and may cause blockage of the digestive tract. This is a potential risk with intragastric balloon surgery. This may necessitate a need for an endoscopic or surgical procedure or to remove the deflated balloon.
Overinflation, acute pancreatitis, ulcers, or perforation, or a hole in the stomach wall, are other possible risks that might require surgical intervention.
How to prepare
Once a decision is taken for intragastric ballooning, regular exercise must be started and restriction in diet. Multiple lab tests to assess and minimize the risk of surgery is done.
What to expect
During Intragastric Balloon surgery
Intragastric balloon surgery is done as an OutPatient procedure. This procedure is done by passing a thin tube called an endoscope through the mouth into the stomach under sedation in an Operation Theatre.
During Intragastric balloon surgery an endoscope with a camera at the tip loaded with a silicone balloon is inserted into the stomach. The camera allows the doctor to visualize and correctly place the balloon into the stomach and inflate it with the saline to the desired size.
The procedure just takes about half an hour. The patient is discharged on the same day one to two hours after the procedure.
After the procedure
Once back from the procedure, the patient can start taking small amounts of clear fluids about six hours after the procedure. A liquid diet is usually continued into the second week when soft foods are started. Regular foods can be taken after about 3 weeks if the insertion of the intragastric balloon.
Intragastric balloons are usually left in the stomach for up to 6 months, after which it is removed with a similar procedure with an endoscope. A new bariatric balloon may or may not be inserted then depending upon the results and advice of the doctor.
Patients may need to meet with a nutritionist, psychologist to get the best out of the intragastric balloon procedure.
Results of Intragastric balloon surgery
An intragastric balloon restricts the space available for food in the stomach and hence restricts the food intake by making one feel full with less food. Other factors which like slowing of the movement of food from the stomach to the intestine keeps one satiated for a longer time and reduces the frequency of eating. Intragastric balloons also seem to alter the levels of hormones that control appetite.
The amount of weight loss after the intragastric balloon surgery also depends on the adherence to and ability to change lifestyle habits, diet, and exercise.
On average an individual tends to lose about 7% to 15% of body weight during the initial six months after the intragastric balloon procedure. A total weight loss of 30% to 47% is expected in the long run.
Intragastric balloon procedure after weight loss can help resolve or cure certain medical condition especially which arise out of being overweight, these may include:
Gastroesophageal reflux disease (GERD)
Heart diseases (CAD)
High blood pressure (Hypertension)
Obstructive sleep apnea
Osteoarthritis (joint pain) especially of knee joints
Type 2 diabetes
High cholesterol level
Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
Failure of intragastric balloon surgery
No significant weight loss or weight regain may still happen after an endoscopic gastric balloon surgery as is possible with other weight loss procedures. This may happen even if the weight loss procedure is working properly. The primary reason for the failure of the procedure is the inability to make necessary changes in lifestyle and dietary habits. For a weight-loss surgical procedure including balloon therapy to succeed, permanent changes in the diet, along with regular physical activity and exercise, are more than necessary.
Replacement of a dead, damaged or failed liver with a healthy liver from a deceased donor or a part of liver from a healthy living donor done through a surgical procedure is known as liver transplant.
Liver is the largest largest internal organ and works to perform several critical functions, which includes:
Processing of nutrients, medications and hormones
Production of bile, to help body absorb and metabolise fats, cholesterol and fat-soluble vitamins
Production of important proteins
Filtering of blood of bacteria and toxins
Managing immune responses and fighting infections
Liver transplant is usually done in people who suffer from major complications arising due to end-stage chronic liver disease. Liver transplants are also done in sudden liver failure cases which usually happen in younger cases.
All over the world more number of patients with failed liver are waiting for a deceased donor than its available.
Living-donor liver transplant is a better alternative to waiting for a deceased-donor liver as when a part of the liver is removed from the donor, it regenerates and returns to its normal size shortly after surgical removal.
India is one of the major centers for liver transplant in the world. In india all Liver transplants are done in JCI accredited hospitals by an internationally trained and experienced team of surgeons who follow internationally accepted protocols.
Types of Liver Transplant
1. Living Donor liver transplant
Cut a section of a normal liver and cirrhotic liver
Liver transplant is done in people whose symptoms due to liver failure cannot be controlled or who have liver cancer.
Liver failure can be acute or chronic depending upon progress of disease or symptoms. In acute cases failure occurs quickly within a matter of weeks. It is not a common condition and happens usually as a result of complications of medications, drug overdose or ingestion of toxins or heavy metals.
Chronic liver failure is much more commoner and occurs over a period of months or years. Chronic liver failure is usually caused by a plethora of conditions. When non-functional scar tissue replaces the normal tissue of the liver is called cirrhosis. Cirrhosis is the most common cause of chronic liver failure and liver transplant.
Major causes that lead to cirrhosis of liver and liver transplant include:
Chronic infection with Hepatitis B and C.
Excessive regular alcohol consumption for a long period of time.
Pathological fatty deposition in the liver is called non-alcoholic fatty liver disease, causing inflammation and liver cell damage.
Hemochromatosis, Wilson’s disease and other genetic diseases causing excessive deposition of metals in the liver.
Inborn, acquired and chronic infectious disease of bile duct.
Liver transplant can treat acute liver failure, but it is more commonly to treat chronic liver failure. Liver transplant is also a good treatment option for certain cancers that originate in the liver.
Risks in Liver Transplant
Risks in liver transplant can be due to the surgical procedure or with the drugs that need to be given to prevent rejection of the donor’s liver.
Risks in the surgical procedure include:
Leakage, blockage or contraction of bile duct
Excessive bleeding
Thrombosis or blood clots formation
Failure of survival of donated liver
Infection
Rejection of donated liver
In few conditions if the underlying disease is not treated or controlled properly there may occur recurrence of liver disease in the transplanted liver.
Anti-rejection medication side effects
After a liver transplant, immuno-supressant medications are needed for the rest of life to prevent rejection of the transplanted liver by the patient’s immunity. These anti-rejection medications can cause:
Bone loss or thinning
Loss of blood sugar control or diabetes
Loose motion
Increased blood pressure
High cholesterol
Immuno-suppresants also increase risk of infection as well.
Evaluation
Patient needs to be evaluated prior to final decision for transplant:
To understand if patient is healthy enough to undergo transplant surgery and will be able tolerate lifelong anti-rejection medications
To manage any medical conditions that may interfere with transplant success
Specific tests, procedures and consultations prior to transplant surgery:
Laboratory tests, like blood and urine tests to assess the general condition of body, including the liver
Imaging studies, like an ultrasound
Heart tests which may be ECG and Echocardiogram for assessment of cardiovascular system
A general health exam, to check for other illnesses that may affect liver transplant
Other evaluations can be:
Nutritional assessment and counseling with dietitians
Psychological evaluation
Addiction testing and counseling
Waiting for a new liver usually takes a heavy toll on the patient and family in terms of finances, socialization, and mental health as well. Most countries have a long waiting list depending upon the severity of the disease and the availability of donors.
Liver transplant in India if a patient’s relatives are willing to donate has no waiting and can be performed in any of the top JCI accredited hospitals.
Complications due to end-stage liver failure are serious, and patients may need to be frequently hospitalized.
Living liver donors
A small portion of liver from the donor is transplanted into the recipient by a surgical procedure. Eventually the liver portions in both the donor and the recipient grow to normal size within a few weeks.
Living-donor liver transplants are a better alternative to waiting for a deceased-donor liver as it:
Prevents the hazardous health complications of living with a failed liver.
Prevents financial losses to the patient and family
Survival and success rate of Living liver transplant is better than a deceased liver transplant.
Prevents psychological and mental health issues.
Prevents damage to other organs including brain from unmetabolized toxins building up in the body
Usually living donors are close family members or friends. It is always advised and better to find willing family members for liver transplant.
Apart from some surgical risk to the donor, advantages of living liver transplant greatly outnumbers deceased donor liver transplant.
Domino liver transplant is a less common living liver donor transplant type where the donor already suffers from a condition called amyloidosis. Amyloidosis liver causes abnormal deposition of proteins in the body organs causing their damage, but the liver functions well. So the donor receives a normal liver from another donor or deceased person and in turn donates his amyloidotic liver to another person. The recipient of the amyloidotic liver will also eventually suffer from amyloidosis but that takes decades. This type of liver transplant is reserved for elderly patients.
2. Deceased donor liver transplant
Is a more common procedure due to unavailability of living donors because of various social, psychological, mental and other issues. In this type of liver transplant a liver is harvested from a brain dead victim whose still might be pumping blood to the organs including liver. The liver is harvested from the body with either relative’s consent or if the dead person prior to the death had pledged to donate organs. In such cases multiple organs can be harvested and one dead donor can give life to many.
The harvested liver is then surgically transplanted into the recipient very similar to the living donor liver transplant.
Cost of liver transplant surgery
Liver transplant is a very complex and specialised surgical procedure and can only be performed in hospitals with top of the line infrastructure. Huge investments in infrastructure and high cost of training of the transplant team results in a whopping high cost of liver transplant surgery.
Cost of liver transplant surgery in the western world can be as high as USD 300000. But in the asian countries like India the cost of liver transplant in a JCI accredited hospital with an internationally trained and qualified transplant team is almost 10% of the cost of western countries. On an average the cost in India is about USD 35000-40000. Given the cost benefit and the success rate as good as the western countries, India is the most cost-effective country for liver transplant surgery.
During the procedure
Living liver donor procedure
Living-donor liver organ regeneration
During the transplant surgery the surgical team starts by harvesting the donor liver from the donor. For this surgeon makes an incision in the abdomen to access your liver. After harvesting a part of the donor’s liver the incision is closed with stitches.
By this time another surgical team removes the diseased liver from the recipient and places the donor liver in its place and secured. Then blood vessels and bile ducts are connected to the donor liver. Surgery can take several hours up to 12 hours.
After closure of the incision with stitches, the recipient will need to stay in ICU for upto couple of days.
The transplanted liver portion in the recipient’s body and the left chunk of liver in the donor’s body regenerate rapidly. They regenerate to normal volume in several weeks.
After a liver transplant
Few days of stay in the intensive care unit (ICU) for monitoring patients and looking for early signs of complications.
A total stay in hospital for 7-10 days
Frequent follow-ups after discharge from hospital during the first month.
Continue medications for the rest of the life to prevent rejection of the transplanted liver.
A recipient can resume normal activities and go back to work within a few months after liver transplant. But complete recovery from a liver transplant can take upto six months which depends upon the general condition and health of the patient prior to the surgery.
Results
A successful liver transplant depends on many factors, but the most important of which is the health condition of the recipient prior to the transplant and other organs involvement. The higher the involvement of other organ functions and longer the wait period before transplant the lower the chances of success. The world over overall survival rates of recipients after liver transplant at 5 years is 75%. Indian Doctors and hospitals very well match the success of liver transplant in the developed countries and have similar at 5 years survival rate.
It has been researched that people who receive living donor liver transplant have better short-term survival rates than compared to those who receive a deceased-donor liver.
Diet and nutrition
A healthy well-balanced diet after a liver transplant is very important for recovery and keeping the transplanted liver healthy.
A discussion with a dietician regarding food habits and diet chart helps maintain a healthy diet. The important things include:
Well balanced diet low in salt, cholesterol, sugar and fat
Avoid alcoholic beverages and use of alcohol in cooking
Fruits and vegetables must form a big portion of daily diet
Grapefruit and grapefruit juice affect post transplant medications and must be avoided
Processed food to be avoided and whole grain foods should be preferred
Foods must be high in natural fibres
Dairy products should be low-fat or fat-free to maintain optimal calcium and phosphorus levels
Stay well hydrated with plenty of water and fluids
Lean fat free meats like fish or poultry can be consumed in limited amounts.
Exercise
In the post liver transplant period habit exercise and physical activity should be developed to help improve overall well being.
Walking regularly is a good activity and can be started in the immediate post transplant period. It improves physical as well as mental health.
Walking, bicycling, swimming, and other low-impact strength training and physical activities can immensely modify lifestyle.
Knee replacement is increasingly being done all over the world. A few years back once thought to be very complex surgery and was performed by only a few well-known, established, foreign-trained knee replacement surgeons. Osteoarthritis is the most common indication for one to undergo knee replacement surgery.
According to reports and studies about 13% of women and 10% of men above the age of 60 years suffer from knee arthritis. These numbers are constantly increasing due to increasing life expectancy and an increasing tendency for obesity. In simple terms millions are suffering from knee arthritis today and that number will only increase.
Osteoarthritis is one of the most common conditions that leads to disability in elderly. Initially arthritis was thought to be a condition in the more affluent western countries. But with the increasing prosperity in the 2nd and 3rd world countries, lifestyle diseases have increased to epidemic proportions.
Patients with osteoarthritis are at a higher risk of mortality mainly because of disability caused due to severe pain which inturn leads to invitation of other lifestyle diseases such as diabetes, obesity, cardiovascular disease etc.
More and more knee replacement surgery is being done on the younger population due to increasing incidence in younger people especially due to obesity. Though knee arthritis starts in the joint cartilage but slowly it involves other components and disturbs the mechanism of weight-bearing and walking.
अर्थराइटिस या गठिया जोड़ों की एक बीमारी है। अन्य प्रकार के होने वाले जोड़ों के घटिया बाय से यह अलग होता है, क्योंकि यह जोड़ों के सिवा शरीर के किसी और अंग या कोशिका को प्रभावित नहीं करता है।
हालांकि ओस्टियोआर्थराइटिस या गठिया या अर्थराइटिस शरीर के करीब करीब किसी भी जोड़ को प्रभावित कर सकता है, घुटना अक्सर ही गठिया से सबसे ज्यादा प्रभावित होने वाला जोड़ होता है।
अर्थराइटिस या गठिया का सबसे आम लक्षण जोड़ों का दर्द होता है, जो कि बार-बार के जोड़ों के इस्तेमाल से होता है। जोड़ों का यह दर्द अक्सर ही शाम के समय पर अधिक होता है। जोड़ों के दर्द के साथ ही ओस्टियोआर्थराइटिस से गठिया या अर्थराइटिस जोड़ के गतिविधि या सामान्य हरकत की सीमा को सीमित कर देता है।
जोड़ों में दर्द के साथ सूजन गर्माहट एवं कचर कचर की आवाज भी हो सकती है। अधिक समय तक जोड़ों में हरकत ना होने के बाद जोड़ों दर्द के साथ जकड़न भी होता है, जैसे कि कुछ घंटों तक सिनेमा हॉल में यह गाड़ी में बैठे रहने के बाद। गंभीर रूप से प्रभावित जोड़ में कार्टिलेज कोशिका अक्सर पूरी तरह से नष्ट हो चुकी होती है, और यह हड्डियों के बीच में होने वाली घर्षण को रोकने में नाकामयाब रहती है। इस गंभीर स्थिति में दर्द अक्सर ही बिना किसी जोड़ के हरकत के भी हो सकता है। कई बार मनुष्य इस कारण से रात को ठीक से सो भी नहीं पाता।
गठिया या अर्थराइटिस से होने वाले लक्षण मरीज से मरीज में अलग अलग हो सकते हैं। कुछ मरीज में यह उनके जीवन को इतना प्रभावित करता है कि वह चलने फिरने से भी मजबूर हो जाते हैं, दूसरी तरफ ऐसे भी गठिया के मरीज होते हैं जो गंभीर रूप से जोड़ों के नष्ट होने के बाद भी सामान्य तौर पर बिना किसी परेशानी के अपना जीवन निर्वाह करते हैं। गठिया से होने वाले जोड़ों के दर्द या अन्य लक्षण रुक रुक कर भी हो सकते हैं। ऐसे मरीज भी देखे गए हैं जो गंभीर गठिया या अर्थराइटिस होने के बावजूद लंबे समय तक बिना किसी लक्षण के रहे हैं।
घुटने का गठिया या अर्थराइटिस अक्सर उन मरीजों में देखा गया है जो सामान्य से अधिक मोटे या जिनके घुटने में पहले कभी कोई चोट लगी हो या कोई घुटने की शल्यक्रिया हुई हो। कार्टिलेज कोशिका के प्रचलित प्रगतिशील भ्रष्ट या पतन होने से जोड़ों में विकार या तेढापन आ जाता है, और घुटने बाहर की तरफ निकलने शुरू हो जाते हैं। जिन मरीजों में घुटने का घटिया होता है उनको अक्सर ही लंगड़ा कर या अपने पैरों को घसीट कर चलते देखा गया है। गठिया के कारण जैसे-जैसे यह पीड़ा यह दर्द बढ़ता है, मरीज का चलना फिरना कम हो जाता है और उसका वजन बढ़ने लगता है, इससे घुटनों पर और भी अधिक प्रतिकूल प्रभाव पड़ता है, और उनके क्षतिग्रस्त होने की गतिविधि और तेज हो जाती है।
अक्सर ही घटिया के ऐसे मरीज दर्द की दवाइयों के आदी हो जाते हैं जिनका दुष्परिणाम शरीर के अन्य अंगों जैसे कि गुर्दा पर पड़ता है। कई मरीजों में गठिया या अर्थराइटिस इतना गंभीर होता है की उनका दर्द या पीड़ा दवाइयों या अन्य साधारण उपायों से भी काबू में नहीं आ पाता।
भारत में या पूरे विश्व में ओस्टियोआर्थराइटिस गठिया या अर्थराइटिस सबसे ही महत्वपूर्ण घुटने की प्रतिस्थापन चल शल्यक्रिया का कारण है।
Being an elderly in itself is a huge risk factor for various medical conditions such as diabetes and hypertension and as well for fractures. With the world finding itself in the clutches of the Corona virus, it has become ever more difficult to stand up to the challenges in treating an elderly with a fracture, suffering from various comorbidities with topping of COVID-19.
With no dearth of information about Corona virus, most of us have come to understand that it is the elderlies in our population who are most susceptible not only to contract infection and suffer most complications but they are also the most common to succumb to the novel Corona virus.
Fractures of the hip are one of the most common orthopedic injuries in elderly. Hip fractures were considered a death sentence in elderlies before the era of internal fixation started. Hip fracture patients were treated with traction on a complete bed rest. An elderly already suffering from multiple age related comorbidities would soon develop bed sores, chest complications with decrease in lung capacity and oxygen diffusion.
An orthopedic surgeon has to not only fix the fracture in a grossly osteopenic bone but also to manage comorbidities and prevent complications. With the general population increasingly getting infected with COVID-19, an orthopedic surgeon has to face new challenges.
We also have to deal with the fear of the Corona virus not only among the healthcare staff but also the attendants and relatives. All of us are reluctant to see a corona patient let alone handle and provide healthcare.
Here we will exemplify the above mentioned situation with such a similar case we had in our hospital. We received an 83 year old frail, old gentleman in our emergency room with the history of fall at home. One look at the patient and no one would bet his money on him. Patient was managed well and examined, diagnosed with fracture of right femur at the trochanteric level and admitted to the orthopedic unit. All routine investigations and COVID-19 investigations were sent for. All routine investigations were in normal limits for the age and as the patient was being optimised for surgery next day waiting for COVID-19 report which came out positive.
This report threw everything out of gear, the patient was shifted to quarantine, nursing staff were removed and sent for quarantine, patient was transferred and treated under pulmonologist, attendants and relatives self quarantined themselves in their homes. The priorities changed.
That frail eldery 83 year old looking gentleman who had a right hip fracture,was bed ridden now had a bigger enemy to fight. Soon with the proper care and treatment he turned COVID-19 negative in a few days and was tested twice to confirm it. Patient successfully underwent hip surgery and was so positive with energy that when he was discharged a few days after surgery, he went home walking with the help of support.
A recent article published in COVIDSurg collaborative under the heading
Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study
revealed
“Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery.”
Though we must avoid or delay surgery in a COVID-19 positive patient, at times it is imperative to undertake the surgery as not doing so poses a bigger risk to the life of the patient.
Arthritis is inflammation of the joint. Inflammation is a complex reaction of the body to harmful stimulus such as, infection, injury or irritation. Inflammation is characterized by redness, swelling, warmth, pain and stiffness at the affected site.
A joint consists of ends of the bone held together in a strong ligamentous pouch called capsule. This joint capsule is lined by the synovium which secretes synovial fluid into the joint and keeps the joint nourished and healthy. Synovial fluid is the lubricant and energy drink of the joint. End of the bones are covered by tough highly smooth cap called cartilage. A very thin layer of slimy synovial fluid between the cartilage makes joint movement extremely smooth and efficient.
Knee joint is the most common joint to suffer from arthritis. Knee arthritis can be due to various reasons like, degenerative changes, after injury or fracture of the cartilage, rheumatoid arthritis.
Most common type of knee arthritis is osteoarthritis. Osteoarthritis is continuous and gradual wear and tear of the structures of the joint. There is gradual loss in secretion of quality synovial fluid, wearing of the cartilage cap exposing the bone ends. Further progression of the arthritis leads to bony spurs formation in an attempt by the body to decrease pain. There is also significant change in the load distribution through the knee and biomechanics of weight transmission. In due course there is bone loss after the cartilage is eroded leading to bowing of knee joint.
Knee joint can be roughly divided in to three compartments, the medial, lateral and patella-femoral. It is the medial compartment where osteoarthritis usually starts first.
Causes of knee arthritis
It has not been possible till now to find out the exact reason for arthritis of knee joint, though it can be associated with certain risk factor.
Age- Knee osteoarthritis has been reported in as young as 35 years and there are innumerable people with healthy knee even at the ripe age of 100. Age is definitely the most common risk factor for not only knee arthritis but for arthritis elsewhere.
Sex- A majority of patients with knee osteoarthritis are female up to the extent of about 75-80%.
Weight- higher the weight, the more chances of it causing wear and tear of the already compromised knee joint. Though this is not the rule.
Genetics- it is seen that osteoarthritis runs in the family, and when it does so present at a younger age than general population.
Previous injury especially that has damaged the cartilage or the other stabilizing structures like ligaments in the knee joint cause secondary arthritis.
Whatever may be the cause of arthritis, it is certainly affecting our elderly in epidemic proportions. If not all there are few things like change in lifestyle and weight reduction can certainly delay arthritis and improve quality of life.
Losing hair is not something anyone would desire, however despite not liking it this is the reality which a large section of people faces these days. In the simplest terms, the baldness (alopecia) can be explained as the effect of testosterone metabolites in the vulnerable hair follicles of men & women. Hair loss occurs without scarring of the scalp when large number of hairs fall. It’s important to note that hair loss should be distinguished from the breakage of the hair which occurs due to decreased hair strength.
Apart from the biological effect, there is a psychological impact on the patient suffering from partial or complete hair loss especially when it is at earlier stages. In the ever-competitive professional life, hair loss may lead to career problems as it is believed to adversely affect the confidence and may lead to insecurity and non-performance at work. Although the hair fall is gender-neutral however Baldness more prominently affects the male population. It’s psychologically established that the people who have public appearances and public interactions are more worried about the baldness impacting their presentation skills. Baldness often is seen as characteristics of old age whereas a healthy hair pattern represents youth.
Hair Regrowth
Medical Advancement and Hair Transplant
Hair replacement procedures have come across the long way over the time horizon. In yesteryears, while people hid their bald scalp by wearing cap it was later replaced by hair wigs that were worn by the patients affected by baldness. In the following years, hair plugs were introduced which looked a step ahead from hair wigs however it didn’t look so natural and with time it used to wither and get dull.
Hair Transplant which is the fair outcome of various stages of baldness cure is the most advanced medical procedure to overcome hair loss. The successful hair transplant depends on many factors and at the nucleus level it may vary from patient to patient. The hair transplant can be understood as the process of replacement of healthy hair grafts in the thinning scalp area. The successful hair transplant procedure may require below criterions
A. The presence of healthy hair follicles on the scalp which can be transplanted
B. The bald hair area can regrow the implanted hairs naturally
C. Hair Surgeons are able to perform the surgery correctly
Hair Transplantation Growth
Before undergoing the procedure of hair transplant the surgeon undertakes various tests on the patient to ascertain the cause of hair fall which helps to derive successful surgery on the patient.
Hair restoration surgery has taken a giant leap and the number has risen at the rate of 60-70% in recent years. The desire to get hair back on the scalp in a natural way is so tempting that it is propelling the medical segment in a big way. India offers one of the best hair transplant destinations in the world. The edge which India possesses in the medical field is lesser costs, advanced medical technologies, and more adherence towards International compliance. The trained surgeons in India are rated top-notch and the wide adaptation towards English makes India a most preferred hair transplant destination. The estimated costs for a similar procedure costs one-tenth in India as compared to the US or Europe.
The Chirurgie is an emerging medical facilitator with a wide network of Indian medical centers providing a cost-effective hair transplant procedure in India. The Chirurgie has an expert team of the medical professional who counsels patients from the very initial stage and our team helps in VISA assistance and final itinerary of the patients traveling to India for medical treatments.
The Chirurgie team can be reached out easily at care@thechirurgie.com or +91 82874 59882
Injuries caused to the Tendons and Ligaments are devastating to the athletes. It not only sets them back in competitive world, but often leads to sub-optimal recovery leading to decrease in strength and performance.
Tendon injuries have always been found to heal incompletely and often with fibrosis, which lead to assumption that there exists no stem cells in tendons. But discovery of stem cells in the patellar tendons at Carnegie Institution for Science has given hope for altogether a different mode of treatment with possibility of near complete and natural treatment.
Stem cells in Tendons just like stem cells anywhere in body are capable of developing into different kind of mature tissues. In Tendons under appropriate conditions these stem cells may outgrow fibrous tissue.
Research is underway to find methods to prevent fibrous scar tissue formation and encourage stem cells to differentiate into normal tissue.
This needs to undergo further research and extensive trials. If successful, it can revolutionise the way sports injuries are managed world over. It will lead in better outcome and can put back the injured athlete faster on track.
Recent research has concluded that a group of men suffering from prostate cancer havebenefited with a new drug even though they had poor prognosis before the trial.
In a recent study in men suffering from end-stage prostate cancer, it has been found that about 5% of the patients responded to the treatment with pembrolizumab well and survival rates increased by years.
Some patients were found to have mutaions in their DNA repairing genes. These type of patients were benefited the most with Immunotherapy trial.
The Institute of Cancer Research in London along with The Royal Marsden Foundation Trust conducted a trial in 258 men having advanced prostate cancer who were not responding to other modalities of treatment such as docetaxel chemotherapy and androgen deprivation.
Leading journal on cancer Clinical Oncology has published this research.
There was evidence of shrinkage or disappearance of the tumor on scans in about 5 percent of the patients and a reduction in prostate-specific antigen (PSA) level in about 19 percent.
Currently trials are conducted on larger level to confirm if patients should receive pembrolizumab as standard treatment.
37.9 Million is the estimated number of people living with HIV at the end of 2018
1.7 million people were newly infected with HIV in 2018
0.77 million people died of HIV-related causes in 2018
Ending the HIV epidemic is possible.
Of the 37.9 million people living with HIV at the end of 2018, 79% received testing, 62% received treatment, and 53% had achieved suppression of the HIV virus with reduced risk of infecting others.
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