Wockhardt Hospitals Blog

Doctor Sameer Diwale, Cardiovascular and Thoracic Surgeon, Wockhardt Heart Center at LB Nagar talks about the procedure for doing a Bypass Surgery and the benefits which accompanies this surgery

Cardiovascular and Thoracic Surgeon, The term “bypass surgery” was very prominent in the headlines across the media recently. This was due to the fact that our Minister Dr. Manmohan Singh underwent this procedure a couple of months ago .

What does bypass surgery mean? When is it recommended for patients? What are the benefits of this operation? What are the different ways in which it can be performed? These are some common queries that came immediately to mind when one hears this term.

Bypass surgery means exactly what it says. Wherever there is an obstruction to the smooth flow of blood to the heart, heart surgeons can create a “bypass” road so as to restore the blood supply to the heart. This is exactly like building a flyover over a busy junction that is blocked due to heavy traffic. Surgeons are trained to remove (spare) arteries or veins from the patient’s own body and use them to construct bypass channels.

Bypass surgery generally is recommended for patients who have more than one block in their arteries that supply blood to the heart. Bypass is also recommended if there is a single block but it is at a critical location. In this situation, balloon angioplasty/stent placement is not possible or is considered risky. Bypass Surgery is strongly recommended for diabetic patients with one or more blocks in view of its superior long term results.

The greatest benefit of the bypass operation is that it eliminates the risk of having a sudden major heart attack in patients suffering from blocked circulation to their hearts . Therefore, this is a life-saving operation. The other major benefit is that a patient’s quality of life improves dramatically after the operation as he/she no longer suffers from chest pain. The patient is free to pursue an active lifestyle without the constant worry and anxiety associated with heart disease. Moreover, the beneficial effects of this operation lasts for 15 to 20 years if due care is taken.

Bypass surgery is conventionally carried out using a heart-lung machine and the heart is stopped for the duration of the operation. This is a very safe and standard technique and millions of patients have undergone the operation in this manner. The operation is also done on a beating heart which is a more recent technique and has certain advantages over the traditional method, especially in patients suffering from lung or kidney disease and patients who are at risk of having a stroke (paralytic attack).

Wockhardt Hospitals Heart Care is a Center of Excellence and offers both the above techniques of bypass surgery. Great care is taken to assess the profile of each patient so as to select the most appropriate technique. This approach has resulted in outstanding success rate for bypass surgery, that is at par with the best hospitals in the world. Our focus is to offer all our patients an active, long and healthy life.

By Dr. K N Krishna, Consultant Neuro Surgeon, Wockhardt Hospitals

A brain tumor is a disease in which certain cells of the brain and it’s covering called the meninges grow without any control inside the brain.

(2) Secondary or metastatic brain cancer spreads to the brain from another cancer site in the body like lung cancer and breast cancer. This is again a very difficult tumor to treat and the tumor can regrow after treatment.

The cause of primary brain cancer is unknown. As mentioned above, secondary brain cancers grow from a cancer elsewhere in the body.

1.Due to addition of extra mass (tumor and fluid retention) inside the skull which increases the pressure. They may be headache, vomiting, blurring of vision/double vision, vertigo

2.Due to irritation or paralysis of the part of the brain or the nerves coming after the brain resulting in seizure, weakness of one limb or one half of the body, vertigo with imbalance, buzzing sound in the ear with diminished hearing (specially one sided), pain or numbness in one half of the face, difficulty in swallowing, nasal regurgitation, change in voice, repeated aspiration into the lungs.

The doctor may ask about symptoms and medical history and perform a physical exam, with particular attention to the neurologic exam such as muscle strength, co-ordination, reflexes, response to stimuli and alertness. The doctor will also look into your eyes to check for signs of brain swelling

Diagnostic Tests may include:MRI Scan a test that uses harmless (even to foetus and elderly) magnetic waves to scan the brain and nerves. CT Scan a type of x-ray that uses a computer to make pictures of structures inside the brain.

The main aim of treatment is not only to prevent further damage to the brain but also recover the functions of the brain by removal of the tumor itself and additionally by using the medication.

Medicines: The doctor prescribes medicines to reduce brain swelling (steroids), seizures (anti epileptic), etc. the latter might have to be taken for longer duration.

Craniotomy and Resection of tumor: Most of the tumor surgeries are done under general anesthesia so that the patient is relaxed and do not suffer from any pain.However in recent times certain brain tumors are removed under local anesthesia where in patient will be awake and talking but not feel the pain , this special procedure is done in such situation where the tumor is growing in close proximity to vital centers like the speech centers ,center for movement etc in the brain.

To access the brain tumor, a portion of the skull bone is delicately cut using high speed pneumatic bone dissector so that it can be replaced and fixed after the surgery. Neurosurgeons operate under high magnification and lighting by using special operating microscope and endoscopes which help in reaching various parts of the brain through narrow gaps safely without damaging the normal brain around the tumor.

In addition operative tools like operative imaging, neuronavigation, etc. help the surgeon in accurately localizing and precisely delineating the tumor from the normal structure and then remove it radically. Special equipments such as CUSA and lasers are sometimes necessary to breakdown deep routed or a difficult tumor.

By using a special stereotaxy frame or Computor assisted Neuro Navigation system the tumor site is localized to an accuracy of 1mm. Thena small needle is pushed in to the tumor through the hole and a sample of tumor tissue is obtained. This tissue is sent for pathological tests to identify the tumor. This type of surgery is done for tumors located deep inside the brain or near critical areas. Depending on the pathological tests, further treatment is recommended.

DR (Prof). K.N.Krishna
M.Ch (Neuro Surgery).
Chief Consultant Neuro Surgeon
Wockhardt Hospitals,Bangalore

To schedule an appoinment with Dr K.N.Krishna,write into enquiries@wockhardthospitals.net or log on here

Bladder cancer is one of the common cancer affecting our population. Surgical removal of the urinary bladder along with the cancer is offered as a preferred treatment option to those patients who are affected by more aggressive cancers. The urinary bladder serves as a reservoir for storage of urine, which is periodically emptied via the urethra ( the natural urine passage). Therefore after surgical removal of the bladder the surgical team has to reconstruct a passage for conveying the urine from the kidneys to outside the body.

In the neo bladder reconstruction the bladder is reconstructed using the intestine of the patient. The small intestine is reconfigured to make a spherical reservoir. This serves as a storage reservoir for the patient. The ureters, which convey urine from the kidneys to the urinary bladder, are then surgically attached to drain into the neo-urinary bladder. This reservoir is then attached to the urethra. This allows the patient to hold urine without the help of any external collecting device. When the patient desires to void, he is able to pass urine via the natural urine passage.

Before the advent of this procedure urinary reconstruction after radical cystectomy would require the patient to wear an external bag to collect the urine. The neo-urinary bladder procedure allows the patient to avoid the usage of any external device thereby not altering the body image or the life style of the patient.

Long term follow-up studies have shown that this procedure does not affect the cancer cure rate and the after mild adjustment in the life style the patient can continue with normal daily activity which he was used to.

This procedure is an advanced reconstructive procedure, which requires a highly skilled and coordinated team approach. Therefore such a major reconstructive procedure can be performed only at selected uro-oncological centers. With recent acquisition of technological advances this advanced procedures are being delivered in eastern India at Wockhardt Hospital & Kidney Institute, Kolkata. Wockhardt Hospital and Kidney Institute is the only dedicated centre for Urology & Nephrology in the eastern part of India.

For an Online appointment with our Kidney Specialtist in Kolkata please log on here

Successful pregnancy in kidney transplant recipients is not uncommon and worldwide about 12000 such cases have been reported. A reasonably good graft function is a prerequisite. Immunosuppressive medications must be continued throughout the pregnancy period, however safety of some of these agents is not well documented. We report successful pregnancy in one of our patients who had undergone kidney transplantation in Wockhardt Hospital & Kidney Institute four years back. To our knowledge this is the first such instance in Eastern India.

A patient of 26 years old, presented to us in July 2002 with hypertension, swelling and pallor. Investigations revealed elevated Creatinine (2.5mg %), albuminuria, microscopic hematuria. Ultrasound showed echogenic small kidneys. ANA, ANCA were negative. She was diagnosed to have Chronic Kidney Disease presumably due to glomerulonephritis. Renal biopsy was not done for confirmation as the kidneys were small and it was considered unlikely to be of any major therapeutic benefit. She was treated with antihypertensive, phosphate binders and Erythropoeitin and the family was counseled regarding the prognosis and eventual need of renal replacement therapy.

Conservative management yielded good results initially with improvement of Hb levels and stabilization of renal function. Towards the end of 2003 she again started to feel weak and serum creatinine started rising rapidly reaching values of 6.5mg% by November. The family was again counseled regarding the need for transplantation and her mother (56years) was willing to donate. She underwent preemptive renal transplantation in February 2004.

The graft kidney functioned very well in the initial period. She was on standard triple immunosuppression with Cyclosporine, Azathioprine and steroids. Serum Creatinine stabilized around 1.6mg%. Although slightly high this was attributed to the relatively older kidney of her mother. By the end of 2005 serum creatinine started creeping reaching levels of 1.9mg% and there was mild proteinuria. Cyclosporine toxicity/ Chronic Allograft Nephropathy was considered; Cyclosporine dose was reduced and Sirolimus started with improvement of graft function. She was also put on a small dose of Losartan.

In 2006 she was married with the groom fully counseled of her condition and uncertainties regarding pregnancy. They were advised barrier contraception for the time being and it was explained that pregnancy is possible in future after a change in immunosuppression. Losartan is potentially teratogenic and Sirolimus is a relatively new drug with no safety data. In fact it is not recommended in pregnancy.

She presented to us in early August 2007 with a confirmed pregnancy of 6 -7 weeks. Though this was unplanned and attributed to failure of contraception the family was extremely keen to continue as it was felt to be their best chance. Her serum Creatinine was 1.7mg%. Losartan was stopped immediately and Amlodipine was started. Although Sirolimus is not a preferred drug in pregnancy a switchover to other agents would bring in other uncertainties regarding graft function and rejection, and since drug levels were low for some time it was decided to carry on with the same regimen. It was explained that she might have to terminate the pregnancy at the slightest hint of a problem.

Fortunately the entire course of pregnancy was smooth. The normal GFR increase during pregnancy could be seen as the Serum Creatinine dropped to 1.4mg%. Serial USG studies showed normal foetal growth. On 2nd March 2008 a baby girl weighing 2.8 Kg was delivered by Caesarean section. The post operative period was uneventful and she was discharged on the third day.

This case is indeed unique in many ways. She had a preemptive (without long period on dialysis) transplantation from a closest relation (mother) which is the best possible approach. The fact that she was married after transplantation is very encouraging and the role of the society is commendable. Overall the successful pregnancy outcome indicates great progress in the science of renal transplantation and offers new hope to similar couples.

Wockhardt Hospitals,Kolkata recently released a booklet to generate awareness about kidney ailments, their prevention and getting the correct treatment for Nephrological diseases.

Releasing the booklet How Well Do You Know Your Kidneys? at the Press Club, well known Bengali actress and television personality Sreelekha Mitra said: "I only know drinking a lot of water helps keep our kidneys in good know Shape,I hope this booklet gives me more details. This can be a good guide for those who believe prevention is better than cure."

Each year an additional 1.50 lakh new patients of end-stage chronic kidney disease requiring dialysis or kidney transplant are added to the list of Kidney patients. in India.Out of this only 5 -7 per cent of the patients are able to get some form of treatment, while the rest die without getting any treatement to a study conducted by All-India Institute of Medical Sciences.In India one in ten people has some form of chronic kidney disease. Diabetes and hypertension are responsible for more than 60 per cent cases of chronic kidney diseas

Wockhardt Hospitals,Kolkata will initially print 4,00,000 booklets and distribute them free to patients. It will gradually print the booklet in Bengali and Hindi as well. "Those interested in acquiring a free booklet can contact our hospitals," said Shivaji Basu, Wockhardt's chief urologist.

The eight-page booklet outlines the functions of kidneys in detail, besides listing symptoms of kidney ailments and ways to treat them.

Wockhardt Hospitals have recently been featured in CNN Health on a story on Medical Tourism Titled Medical Tourism:Have Illness ..Will Travel.

Mark Tutton of CNN Health talks about the growing trend of Medical Tourism and identifies Wockhardt Hospitals along with Apollo and Max Healthcare which have revolutionized Healthcare Treatements in India.

India has been only ranked second after Thailand as the most favored medical tourism destination.Wockhardt Hospitals International Accreditation's like JCI and Tie up with Harvard Medical Association has made it the most sought after SpecialtyHospitals among Internations patients across the world.

Medical tourism: Have illness, will travel - CNN.com: "Medical tourism is one of the hottest topics in health care as patients around the world are increasingly traveling abroad for treatment.

Josef Woodman, author of Patients Beyond Borders, a guide to medical tourism, told CNN that two to three million people travel outside their home country for treatment each year, while consultancy firm Deloitte calculates that 750,000 Americans traveled abroad for treatment last year.

Bumrungrad International Limited (BIL), based in Thailand, owns and operates over 70 health care facilities in seven countries. According to BIL, its Bangkok flagship hospital treats over 400,000 foreign patients a year, with over 90,000 coming from the Middle East.

India is only second after Thailand in terms of the most favored medical tourism destination in the world.For a country that spends 1.2% of GDP on healthcare needs and has approximately 143 doctors for every 10,000 people as compared to USA's 234 doctors per 10,000 people that is by all means quite an achievement.

However the difference between India and Thailand is almost three fold. While India was home to 450,000 medical travelers across the globe ,Thailand treated 12 lakh patients globally.

This is according to a study by Deloitte Consulting,which also talks about the emerging trends of India getting more medical visitors from US and UK. Earlier most medical travelers included patients from Middle east,West Asia, and the Asian Subcontinent

Cheaper treatment is a huge attraction and, during recession, that's a big fact and often more cost effective for Westerners. But other factors, too, have contributed to the growth of medical tourism in India. "Indian clinical and paramedical talent is globally appreciated and with JCI accreditation of some hospitals, international standard is proven. Third-party intervention through health insurance has also given it a boost," said Vishal Bali, CEO, Wockhardt Group of Hospitals.

"Thailand, which revolutionized medical tourism, is more into cosmetic surgery; India focuses on cardiac, neurological or orthopaedic problems," Bali said.

Wockhardt Heart center, LB Nagar, Hyderabad has in recent days seen a string of patients coming in from Uzbekistan

Recently Mr. Radjabov Toshmurot a 55-year-old man diagnosed with Triple vessel Disease and is also a Diabetic and Hypertensive along with a history of Renal Failure, got operated at Wockhardt Heart Centre,Hyderabad. He was diagnosed with a Triple vessel disease back in Uzbekistan, and was advised to undergo a Bypass Surgery.

Normally a patient from Uzbekistan would choose Russia as his Health Care destination and in recent times some people have even recognized India as a quality provider for Healthcare services, but mostly it’s been limited to Delhi, because of direct connectivity that Delhi has with Uzbekistan.

However in the last few Months we at Wockhardt Heart Centre have treated about 10 people from Uzbekistan with Complex Clinical History. What was common to all these people was that they were all High Risk Procedures with associated complications. Mr. Radjabov is one such case as since he has a Renal Failure Complication and it was essential that his kidney was kept away from developing more complication during the surgery.

That is why the Doctors at Wockhardt Hospitals performed a Beating Heart Coronary Artery Bypass Surgery, for him. The surgery lasted for approximately two and a half hours and during this entire duration there no Cardio Pulmonary support. Similarly the last patient that we had received from Uzbekistan had an Associated Double Valve Replacement along with the CABG, We had to operate on that patient for six hours straight.” Says Dr. Sameer Diwale, Cardiothoracic surgeon, who’s expertise have attracted these patients to Wockhardt Hospitals Hyderabad.

At Wockhardt Hospitals ,it gives us a great pleasure to see that we are not only establishing Quality Healthcare but we are now doing these complex surgical operations at the Global level.
Dr. Sameer has been invited to participate in Continuous Medical Education Programmes by the doctors From Uzbekistan. Dr Sameer adds, “ Its not only patient care, its also about changing the way Healthcare is administered world over. I feel that it is of immense importance that people keep abreast of what is happening in the Medical field, and its through little exchanges like these that we learn.”

This is a perfect example of a Globalized Healthcare System at its best, good for the country good for the World but most Importantly good for every individual who demands quality Health care. It’s about Empowering people at the Individual level.

Bangalore, March 26, 2009: Wockhardt Hospitals Bangalore set yet another benchmark in cardiovascular surgery with one of its consultants Dr. Ganeshakrishnan Iyer, Consultant Cardio Vascular Surgeon,Wockhardt Hospitals performing a Mitral Valve Replacement surgery through Minimally Invasive Endoscopic Technique called the Minimal Thoracotomy Approach. The most important benefits being reduced surgical trauma and a shortened hospital stay.

Two patients were operated through this method with small incision in the right side of the chest measuring 3-4 inches as against the conventional midline sternotomy where the incision is in the front of the chest and measures about 12-14 cms. The rarely used minimally thoracotomy incision can confer the advantages of a smaller surgical wound, reduced blood loss, decreased risk of infection, shorter ICU stay, early discharge, decreased postoperative pain and a smaller cosmetically more acceptable postoperative scar.

T. Ashokan, 46 year old gentleman from Vellore was suffering from exertional dyspnea (breathlessness on exertion) for the last 4-5 years. He is a known case of Rheumatic Heart Disease (RHD) and his echocardiography showed severe mitral stenosis. After diagnosis he was advised for a Mitral Valve Replacement. Mr. Ashokan was admitted at Wockhardt Hospitals and underwent Minimally Invasive Endoscopic Mitral Valve Replacement. His post operative recovery was uneventful and recuperation has been very speedy.

Mrs. Ana Fernandes a 52 year old lady from Goa was suffering from breathlessness on exertion. She is a known case of rheumatic heart disease and her echo report revealed severe mitral stenosis and mild mitral regurgitation and was advised for a Mitral valve replacement surgery. She was admitted at Wockhardt Hospitals and underwent Minimally Invasive Endoscopic Mitral Valve Replacement. Her post operative recovery has also been uneventful and speedy recovery is seen.

Traditionally Mitral valve replacement is an open heart procedure performed by cardiothoracic surgeons to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve. The mitral valve is the "inflow valve" for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, and into the heart through the mitral valve. When it opens, the mitral valve allows blood to flow into the heart's main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body. It has two flaps, or leaflets. Occasionally, the mitral valve is abnormal from birth (congenital). More often the mitral valve becomes abnormal with age (degenerative) or as a result of rheumatic fever.

In rare instances the mitral valve can be destroyed by infection or a bacterial endocarditis. Mitral regurgitation may also occur as a result of ischemic heart disease (coronary artery disease). Often the mitral valve is so damaged that it must be replaced. Through this new and advanced minithoracotomy method the heart is approached between the ribs, providing the surgeon access to the mitral valve. There is no sternal incision or spreading of the ribs required for this surgical technique. The surgeon inserts special surgical instruments through the incision to perform the valve repair.

An aneurysm is a bulge or "ballooning" in the wall of an artery. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body. If an aneurysm grows large, it can burst and cause dangerous bleeding or even death.

Most aneurysms occur in the aorta, the main artery traveling from the heart through the chest and abdomen. Aneurysms also can happen in arteries in the brain, heart and other parts of the body. If an aneurysm in the brain bursts, it causes a stroke.

Aneurysms can develop and become large before causing any symptoms. Often doctors can stop aneurysms from bursting if they find and treat them early. Medicines and surgery are the two main treatments for aneurysms.

Aortic dissection occurs when the layers of the wall of the aorta separate or are torn, allowing blood to flow between those layers and causing them to separate further. When the aortic wall separates, blood cannot flow freely, and the aortic wall may burst.

Any condition that causes the walls of the arteries to weaken can lead to an aneurysm. The following increase the risk of an aneurysm or an aortic dissection:

Aneurysms can be detected by physical exam, on a basic chest or stomach x-ray, or by using ultrasound. The size and location can be found through echocardiography or radiological imaging, such as arteriography, magnetic resonance imaging (MRI), and computed tomography (CT) scanning.

• Aortic dissection may cause sudden and severe pain, and patients often feel like something is ripping or tearing inside of them. The pain is mainly felt in the chest, but it can spread to the back or between the shoulder blades. Aortic dissection may also cause sudden stomach pain, lower back pain, or flu-like symptoms. If blood leaks from the dissection and builds up in the chest, the blood may enter the pericardial space (the sac that surrounds the heart) and prevent the heart from filling properly. This can lead to a life-threatening condition called cardiac tamponade.

Treatment depends on the size and location of the aneurysm and your overall health.

Aneurysms in the upper chest (the ascending aorta) are usually operated on right away.

Aneurysms in the lower chest and the area below your stomach (the descending thoracic and abdominal parts of the aorta) may not be as life-threatening. Aneurysms in these locations are watched regularly. If they become about 5 centimeters (almost 2 inches) in diameter, continue to grow, or begin to cause symptoms, your doctor may want you to have surgery to stop the aneurysm from bursting.

For aortic aneurysms or aneurysms that happen in the vessels that supply blood to your arms, legs, and head (the peripheral vessels), surgery involves replacing the weakened section of the vessel with an artificial tube, called a graft.

For patients with smaller or stable aneurysms in the descending aorta or abdominal parts of the aorta—those farthest from the heart, doctors usually ask patients to come in for regular check-ups so they can follow the growth of the aneurysm. If the aneurysm does not grow much, patients may live with the aneurysm for years. Doctors may also prescribe medicine, especially medicine like a beta blocker that lowers blood pressure, to relieve the stress on the aortic walls. Medicine to lower blood pressure is especially useful for patients where the risk of surgery may be greater than the risk of the aneurysm itself.

For patients with aortic dissection, surgery is usually recommended right away, especially if the dissection is in the part of the aorta closest to the heart. For dissections farther from the heart, patients will be given medicines (such as beta-blockers to lower blood pressure), and the dissection will be watched closely. But, if the dissection begins to leak blood, cause a blockage, or get bigger, surgery is needed.

They New York Times yesterday published an article on Medical Tourism outlining the benefits of medical tourism specially in times of increasing depressing economic conditions.

The article talks about an American executive working for Bank of America chose to go to Costa Rica for his double hernia operation rather than going to a local hospital in Columbia
Going Abroad to Find Affordable Health Care - NYTimes.com

With over 85,000 Americans choose to travel abroad for medical procedures each year, according to a recent report by the consulting firm McKinsey & Company.

Most American patients or medical travelers which they are mostly known as , Treatment includes dental implants, hip and knee replacements, heart valve replacements and bypass surgery. The cost of surgery performed overseas can be as little as 20 percent of the price of the same procedure in the United States, according to a recent report by the American Medical Association.

While the Nytimes reports accepts that the bulk of medical tourism candidates are uninsured and underinsured people paying their own bills and looking for low-cost alternatives to American care. Most Medical tourism advocates and Americans who have actually been to countries like India argue that the quality of care overseas is often equal to or better than that in the United States. Many countries have high success rates, American-trained English-speaking doctors and the newest facilities, often built specifically to attract foreign patients.

While this is not the first time that the mainstream US media has started to cover medical tourism in a big way,what would be interesting if this Medical Tourism Growth has any affect on the Obama's proposed rehauling of the American Health care system While it is clear that outsourcing has been one of the issues that the Democrats has taken on a very tough stand on, Medical Outsourcing of Health is something that is independent of Government Regulation or Idealogy. As long as Hospitals in the Developing countries provides quality at competitive costs medical Tourism will continue to grow..

The American Medical Association, has issued guidelines on medical travel, which ymou can check here issued guidelines on medical tourism . (They’re available on the Web at tinyurl.com/cpklcw.)

The Human heart pumps nearly 5 quarts of blood through your body every minute. Even while sitting still, your heart beats 60 to 80 times each minute. These heartbeats are triggered by electrical impulses that begin in your heart's natural pacemaker, called the sinoatrial node (SA node). The SA node is a group of cells located at the top of your heart's upper right chamber (the right atrium.

Any irregularity in your heart's natural rhythm is called an arrhythmia. Almost everyone's heart skips or flutters at one time or another, and these mild, one-time palpitations are harmless. But if you have recurrent arrhythmia's, you should be under the care of a Cardiologist or Rather an Electrophysiologist.

Arrhythmia's can be divided into two categories: ventricular and supra ventricular. Ventricular arrhythmia's happen in the heart's two lower chambers are, called the ventricles are affected. Supraventricular arrhythmia's happen in the structures above the ventricles, mainly the atria, which are the heart's two upper chambers are affected.

Arrhythmia's are further defined by the speed of the heartbeats. A very slow heart rate, called bradycardia, means the heart rate is less than 60 beats per minute. Tachycardia is a very fast heart rate, meaning the heart beats faster than 100 beats per minute. Fibrillation, the most serious form of arrhythmia, is fast, uncoordinated beats, which are contractions of individual heart-muscle fibers.

Heart block happens when the SA node's electrical signal cannot travel to the heart's lower chambers (the ventricles).

Many factors can cause your heart to beat irregularly. Some people are born with arrhythmia's, meaning the condition is congenital. Some medical conditions, including many types of heart disease and high blood pressure, may be factors. Also, stress, caffeine, smoking, alcohol, and some over-the-counter cough and cold medicines can affect the pattern of your heartbeat.

Whether you have symptoms and what those symptoms feel like depend on the health of your heart and the type of arrhythmia you have. Symptoms also depend on how severe the arrhythmia is, how often it happens, and how long it lasts. Some arrhythmias do not produce any warning signs. Contrary to popular belief, heart palpitations do not always mean that you have an arrhythmia.

Symptoms of Bradycardia: You may feel tired, short of breath, dizzy, or faint.

Symptoms of Tachycardia:You may feel a strong pulse in your neck, or a fluttering, racing heartbeat in your chest.

Symptoms of Fibrillation:You may feel chest discomfort, weak, short of breath, faint, sweaty, or dizzy.

• A standard Electrocardiogram (ECG or EKG) is the best test for diagnosing arrhythmia. This test helps doctors analyze the electrical currents of your heart and determine the type of arrhythmia you have.

• Holter Monitoring gets a non-stop reading of your heart rate and rhythm over a 24-hour period (or longer). You wear a recording device (the Holter monitor), which is connected to small metal disks called electrodes that are placed on your chest. With certain types of monitors, you can push a "record" button to capture your heart's rhythm when you feel symptoms. Doctors can then look at a printout of the recording

• Electrophysiology Study (EPS) are usually done in a cardiac catheterization laboratory. A long, thin tube called a catheter is inserted into an artery in your leg and guided to your heart. A map of electrical impulses from your heart is sent through the catheter which helps doctors find the kind of arrhythmia. During the study, doctors can give you controlled electrical impulses to show how your heart reacts. Medicines may also be tested at this time to see which will stop the arrhythmia. Once the electrical pathways causing the arrhythmia are found, radio waves can be sent through the catheter to destroy them. (See radiofrequency ablation in treatment section below.)

• A tilt-table exam is a way to evaluate your heart's rhythm in cases of fainting. The test is noninvasive, which means that doctors will not use needles or catheters. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted to 65 degrees. The angle puts stress on the area of the nervous system that maintains your heart rate and blood pressure. Doctors can see how your heart responds under carefully controlled times of stress.

How is arrhythmia treated?

Dr V. RAJASEKHAR a Consultant Cardiologist and Electrophysiologist with Kamineni Wockhardt Hospital. He has successfully implanted many ICD devices and Pacemakers and is considered to be one of the leading experts in this field. Dr. Rajasekhar is also an expert in EP study as well as Radio Frequency Ablation. He can be contacted at enquiries@wockhardthospitals.net

The words "heart failure" sound alarming, but they do not mean that your heart has suddenly stopped working. Instead, heart failure means that your heart is not pumping as well as it should to deliver oxygen-rich blood to your body's cells.

Congestive heart failure (CHF) happens when the heart's weak pumping action causes a buildup of fluid called congestion in your lungs and other body tissues. CHF usually develops slowly. You may go for years without symptoms, and the symptoms tend to get worse with time. This slow onset and progression of CHF is caused by your heart's own efforts to deal with its gradual weakening. Your heart tries to make up for this weakening by enlarging and by forcing itself to pump faster to move more blood through your body.

According to the American Heart Association, people 40 and older have a 1 in 5 chance of developing CHF in their lifetime. This is because people are living longer and surviving heart attacks and other medical conditions that put them at risk for CHF. People who have other types of heart and vessel disease are also at risk for CHF.

• Previous Heart Attacks
• Coronary artery disease
• High blood pressure (hypertension)
• Irregular heartbeat (arrhythmia)
• Heart valve disease (especially of the aortic and mitral valves)
• Cardiomyopathy (disease of the heart muscle)
• Congenital heart defects (defects you are born with)
• Alcohol and drug abuse

Symptoms can help doctors find out which side of your heart is not working properly.
If the left side of your heart is not working properly (left-sided heart failure), blood and fluid back up into your lungs. You will feel short of breath, be very tired, and have a cough (especially at night). In some cases, patients may begin to cough up pinkish, blood-tinged sputum.

If the right side of your heart is not working properly (right-sided heart failure), the slowed blood flow causes a buildup of fluid in your veins. Your feet, legs, and ankles will begin to swell. This swelling is called edema. Sometimes edema spreads to the lungs, liver, and stomach. Because of the fluid buildup, you may need to go to the bathroom more often, especially at night. Fluid buildup is also hard on your kidneys. It affects their ability to dispose of salt (sodium) and water, which can lead to kidney failure. Once CHF is treated, the kidneys' function usually returns to normal.

As heart failure progresses, your heart becomes weaker and symptoms begin. In addition to those listed above, here are some other symptoms of CHF:

• You have trouble breathing or lying flat because you feel short of breath.
• You feel tired, weak, and are unable to exercise or perform physical activities.
• You have weight gain from excess fluid.
• You feel chest pain.
• You do not feel like eating, or you feel like you have indigestion.
• Your neck veins are swollen.
• Your skin is cold and sweaty.
• Your pulse is fast or irregular.
• You feel restless, confused, and find that your attention span and memory are not as good as they were.

• Electrocardiography (ECG or EKG) can be used to check for an irregular heartbeat (arrhythmia) and stress on the heart. It can also show your doctor if you have had a heart attack.

Other imaging techniques, such as nuclear ventriculography and angiography, can provide a firm diagnosis and show doctors how diseased your heart is.

Many therapies can help to ease the workload of your heart. Treatment may include lifestyle changes, medicines, transcatheter interventions, and surgery.

• If you smoke, quit.
• Learn to control high blood pressure, cholesterol levels, and diabetes.
• Eat a sensible diet that is low in calories, saturated fat, and salt.
• Limit how much alcohol you drink.
• Limit the amount of liquids you drink.
• Weigh yourself daily to watch for fluid buildup.
• Start an aerobic exercise program that has been approved by your doctor.

• Angioplasty is a procedure that is used to open arteries narrowed by fatty plaque buildup. It is performed in a cardiac catheterization laboratory. Doctors use a long, thin tube called a catheter that has a small balloon on its tip. They inflate the balloon at the blockage site in the artery to flatten the fatty plaque against the artery wall.

• Stenting is used along with balloon angioplasty. It involves placing a mesh-like metal device into an artery at a site narrowed by plaque. The stent is mounted on a balloon-tipped catheter, threaded through an artery, and positioned at the blockage. The balloon is then inflated, opening the stent. Then, the catheter and deflated balloon are removed, leaving the stent in place. The opened stent keeps the vessel open and stops the artery from collapsing.

• Bi-ventricular pacemaker is recommended for patients with Moderate to severe heart failure who have a low ejection fraction , as the name suggests this device stimulates both the heart ventricles simultaneously so that they co-ordinate in synchrony. This improves the ejection fraction (which is a measure of the pumping capacity of the heart) thereby improving the quality of life of the patient. Commonly known as a CRT device is a device which is smaller than the palm of an adult hand. A specially trained cardiologist implants the device.

• Studies have shown that Heart Failure patients are at a higher risk for Sudden cardiac arrest. Special CRT devices are available which can potentially stop life threatening ventricular fibrillation (very fast heart rates) by delivering an electrical shock (called defibrillation in medical terms) to the patient. This device is a combination of a conventional Implantable Cardioverter Defibrillator (the “shock box”) and the pacemaker. It is commonly called as a “Combo” device or a CRT-D (D stands for Defibrillator).

The best way to prevent heart failure is to practice healthy lifestyle habits that reduce your chances of developing a heart problem. It is also important to find out if you have any risk factors that contribute to heart failure, such as high blood pressure or coronary artery disease. Many patients with congestive heart failure can be successfully treated, usually with a percutaneous coronary intervention.Patients should carefully follow their doctors' advice. In doing so, they can continue to live full and productive lives.

Minimally invasive spinal surgery has revolutionized the surgical treatment of sciatica, disc prolapse, canal stenosis. Minimal Access Spine Surgery has become a boon to patients suffering from these problems, who dread a spinal surgery due to the fear of postoperative pain, rehabilitation and risk of general anesthesia.

The spinal cord is a delicate fluid filled long tube with multiple nerves coursing through it like tendrils. The above-mentioned diseases cause pressure on the bag or the nerve roots giving rise to pain, tingling, numbness and even weakness in the lower limbs. Left neglected it can lead to permanent weakness of the leg, foot, or urinary system. The vertebra encloses delicate structures within it, protecting the vital cord & nerve from injury.

To remove the pressure on the nerves and the cord it is imperative to remove the prolapsed disc, thickened ligaments or the bony growths.

In Standard Laminectomy surgeries the whole posterior part of 1 & 2 vertebrae would be excised, so as to access the diseased part. This procedure does relieve the patient of his symptoms but due to the excision of the lamina & Interspinous ligament it predisposes the patient to developing spinal instability & Postoperative adhesions. Laminectomy has a high incidence of repeat surgeries and also the postoperative recovery is prolonged (1 – 3 days).

As a commitment towards improving the quality of life by enhancing the level of medicare, we at Wockhardt Hospitals, continuously strive to make the best use of cutting edge Medical Technology. The YESS system is being used in India for the first time at Wockhardt Bone and Joint Hospital, Hyderabad. With the help of YESS apparatus, Endoscopic spine surgeries can be carried out under local anesthesia and the postoperative stay of the patient is reduced to only a few hours..

Tennis elbow is an inflammation around the bony knob on the outer side of the elbow. It occurs when the tissue that attaches muscle to the bone becomes irritated. The bony knob is called the lateral epicondyle, and tennis elbow is also called lateral epicondylitis (ep-ih-kondah- LY- its).

Playing a racket sport can cause tennis elbow. So can doing any thing that involves extending your wrist or rotating your forearm- such as twisting a screwdriver or lifting heavy objects with your palm down. With age, the tissue may become inflamed more easily.

The most common symptom of tennis elbow is pain on the outer side of the elbow and down the forearm. You may have pain all the time or only when you lift things. The elbow may also swell, get red, or feel warm to the touch. And it may hurt to grip things, turn your hand, or swing your arm.

The muscle that allows you to straighten your fingers and rotate your lower arm and wrist are called the extensor muscles. These miles extend from the outer side of your elbow to your wrist and finger. A cordlike fiber called a tendon attaches the extensor muscles to the elbow. Overuse or an accident can cause tissue in the tendon to become inflamed or injured.

Your doctor can usually diagnose tennis elbow from your symptoms and from the look and feel of your elbow. He or she may order an x-ray to be sure the bone is not diseased or fractured. In some cases, other tests may be needed.

Wearing a tennis elbow splint allows the inflamed tendon to rest, so it can heal. Using your other hand or changing your grip also helps take stress off the tendon. And oral anti inflammatory medications and heat or ice can relieve
pain and reduce swelling.

To prevent flare-up after treatment , you may need to change the way you do some things. Gripping with the palm up, lifting heavy objects with both hands ,or vary activities through out the day will help reduce stress on the tendon. When you play racket sports or golf ,be sure to condition your muscles ,do warm-up and cool-down exercises, and use the correct strokes.

About Wockhardt Hospital, Bone and Joint care :The Wockhardt Hospitals Bone and Joint care is one of our super specialties and is a center of excellence with highly skilled clinical expertise.

The Wockhardt Bone and Joint Care is equipped to treat all types of musculo-skeletal problems ranging from Trauma Surgery to Minimally Invasive Arthroscopy Surgery. The hospital also specializes in surgery for joint replacements, sports medicine, ligament repair, knee surgery, spine surgery and physical therapy for rehabilitation.

Wockhardt Bone & Joint Care has complete technology and advanced skills to perform Microscopic Lumber & Cervical Discectomy, Endo-scopic Spine Surgery and Arthroscopic surgeries such as Ligament Reconstruction in the knee, Subacromial Decompression in the shoulder.For online appointments write into enquiries@wockhardthospitals.net or logon to our website at wockhardthospitals

Doctor Sachin Bhonsle,(MS (Orthopaedics, FRCS Glasgow, UK) Consultant Joint Replacement and Orthopaedic Surgeon Wockhardt Bone and Joint Care, Mumbai,India answers some most commonly asked questions on Knee Surgeries .



1. Evolution around knee surgeries in India over the years.

This decade has been very progressive for orthopaedics in India to the extent that we can call it an orthopaedic decade. A lot is now on offer to improve quality of life to those with arthritis and joint injuries. As late as 1980s most people with worn out joints had no choice but to lead an invalid life. There are very few surgeons in our country with resources to provide reconstructive joint surgery. Also to those few who could afford, the treatment options were limited as well as expensive. In late 80s Arthroscopic or keyhole surgery started gaining popularity in India. This was a boon to youngsters involved in sports. Around the same time Joint replacements became more readily available. This is when Indian companies started coming up with reliable prostheses. As we rolled into the third millennium standard knee and hip replacements were optimised in a number of cities and centres across the country.

2. Percentage of Indian undergoing Knee Replacements every year

This varies greatly compared to western countries. Reliable figures are not available but a vast majority of Indian patients tend to procrastinate on knee arthritis rather than having surgery. Knee tends to be most commonly replaced joint in India because of higher incidence of knee arthritis compared to hip in our subcontinent.

3. Who is a candidate for knee replacements?

Any person with a painful and irreparably worn out knee joint can be a candidate. There has been a classic approach to do it after the age of 60 because older prostheses tended to last only 10 to 15 years and revision surgery was difficult. But now the contemporary designs are long lasting, techniques are more refined and revision surgery facilities have been developed optimally. Therefore we contemplate doing joint replacements at much younger ages.

4. What advancements have been made in total knee replacements? Advancements in surgical methods and how it has been revolutionized over the years
To know more about Bone and Joint care at Wockhardt Hospitals, or to schedule an appointment with Doctor Sachin Bhosel,please write to enquiries@wockhardthospitals.net

It is not everyday we get to hear real life examples of customer services from Institutions ,that manages to surprises us pleasantly. True Customer service is not led by individuals but are most often powered across the length and breadth of the Organization

Mr Ramanujam Sridhar CEO, of brand-comm, also the author of "One Land, One Billion Minds" writes about some exceptional customer services which he had experienced in recent times and Wockhardt Hospital features in this list of handful of companies.. In a recent article is Hindu Business Line,Mr Ramanujam writes about how some companies has managed to raise the bar when it comes to service standards. You can find the entire article here..

When it comes to Wockhardt Hospitals.. he narrates an incident which happened recently.

"On February 1, in the middle of the night, a shock awaited me. I got a frantic call around midnight that my mother was unwell. We rushed there, only to find that she was seriously ill. Her pulse was failing and one of us had the presence of mind to c all the emergency care of Wockhardt hospital on Bannerghatta road in Bangalore, close to where we stay. Even as my mother continued to struggle over the next half hour we sat around hoping against hope that she would be okay. The emergency unit arrived from the hospital in time with all the paraphernalia - ambulance, stretcher, life-support equipment, a team of five including the duty doctor. They tried to revive her, even as we kept watching and praying. Sadly, it was too late. They left saying that there was very little they could do and it was all over.

Amidst all the grief I still realized that they were providing a necessary service and had to be paid for it. I asked them how much I should pay and at first one of them said that I had to pay for the injection. Then he called the hospital and said there would be no charge for the emergency visit of the entire team. While my mother was a patient of the hospital and used its services regularly this was still something that any hospital would have been justified in charging for. Today, a month later, I am able to talk about this and with effort even write about it. But clearly there was an element of surprise in their handling of the situation. Given the reputation that some hospitals have of being more commercial than they ought to be, this sensitive handling of a tragic incident came like a breath of fresh air to someone who was in a state of shock. "

You can read the entire article called "Empathy with the consumer should be the guiding principle of service."

Doctor Atul Ganatra,Gynecologist,Wockhardt Hospitals,Mumbai shares his thoughts on Pre-eclampsia and eclampsia.

Pre-eclampsia is a complication of pregnancy.Women with pre-eclampsia have high blood pressure, protein in their urine, & may develop swelling of feet etc .The more severe the pre-eclampsia, the greater the risk of serious complicationsto both mother and baby.

Pre-eclampsia is thought to be due to a problem with the afterbirth (placenta), and so delivering the baby early is the usual treatment.Medication may be advised to help prevent complications.

• Are pregnant for the first time, or are pregnant for the first time by a new partner. About 1 in 30 women develop pre-eclampsia in their first pregnancy.

Pre-eclampsia runs in some families so there may be some genetic factor.Pre-eclampsia can also affect various other parts of the mothers body. It is thought that substances released from the placenta (afterbirth) go around the body and damage the blood vessels, making them become leaky.

Pre-eclampsia can develop anytime after 20 weeks of pregnancy. Pre-eclampsia is present if:

Just a high systolic pressure, for example, 170/70 mmHg or just a high diastolic pressure, for example, 130/104 mmHg. Or both, for example, 170/110 mmHg.

However, any substantial rise in the blood pressure from a reading taken in early pregnancy is a concern, even if it does not get as high as the levels listed above. (You may have quite low blood pressure to start with.)

No. Many pregnant women develop mild high blood pressure. Most do not have pre-eclampsia. With pre-eclampsia you have high blood pressure, plus protein in your urine, and sometimes other symptoms and complications listed below. About 1 in 5 pregnant women with high blood pressure progress to pre-eclampsia.

Therefore, if you develop mild high blood pressure, it is vital that you have regular ante-natal checks which can detect pre-eclampsia, if it occurs, as early as possible.

• Headaches.

• Blurring of vision, or other visual problems.


• Vomiting.

HELLP syndrome occurs in about 1 in 5 women who have severe pre-eclampsia. HELLP stands for 'haemolysis, elevated liver enzymes and low platelets' which are some of the medical features of this severe form of pre-eclampsia. Haemolysis means that the blood cells start to break down. Elevated liver enzymes means that the liver has become affected. Low platelets means that the number of platelets in the blood is low and you are at risk of serious bleeding problems.

The only complete cure is to deliver the baby. At delivery the placenta (often called the afterbirth) is delivered just after the baby. Therefore, the cause of the condition is removed. After the birth, the blood pressure and any other symptoms in the mother usually soon settle.
It is common practice to induce labour if pre-eclampsia occurs late in the pregnancy. A caesarean section can be done if necessary. The risk to the baby is small if he or she is born just a few weeks early. However, a difficult decision may have to be made if pre-eclampsia occurs earlier in the pregnancy. The best time to deliver the baby has to balance several factors which include:

• The severity of the condition in the mother, and the risk of complications occurring.
• How badly the baby is affected.
• The chance of a premature baby doing well. As a rule, the later in pregnancy the baby is born, the better.

However, some babies grow very poorly if the placenta does not work well in severe pre-eclampsia. They may do much better if they are born, even if they are premature. As a rule, if pre-eclampsia is severe, then delivery sooner rather than later is best. If the pre-eclampsia is not too severe, then postponing delivery until nearer full term may be best

Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.