Wockhardt Hospitals Blog

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.

Doctor Archana Juneja,M.D (Med.),DM (Endo), DNB (Endo),Consultant Endocrinologist at Wockhardt Hospitals, Mumbai shares her thoughts with us on "Thyroid Disorders"

The thyroid is an endocrine gland located in the front of the neck, overlying the wind pipe (trachea) and food pipe (oesophagus). It produces the hormones triiodothyronine (T3) and thyroxin (T4) which circulate in the blood. These hormones control the metabolism and function of our body cells. Thyroid Stimulating Hormone (TSH), a hormone produced by the pituitary gland in our brain, regulates the production of T3 and T4. T3 and T4, in turn, exert a negative feedback effect on the TSH production.

Iodine is the main constituent of the thyroid hormones.

Thyroid disorders arise either because of abnormal production of thyroid hormones (excess or under), abnormal structure or congenital developmental disorders.

Goiter: Goiter refers to an enlargement of the thyroid gland. Common causes for goiter are iodine deficiency and auto immune thyroid disease wherein antibodies, which slowly destroy the thyroid, are produced in the body. The symptoms of thyroid dysfunction are very subtle and can be easily overlooked. Hence a high index of suspicion is required to diagnose these disorders.

Hypothyroidism :Hypothyroidism refers to reduced activity of the thyroid gland leading to underproduction and low levels of T3 and T4 hormones in the blood. The TSH levels rise due to the negative feedback effect of the low hormone. This can occur because of primary damage to the thyroid gland by antibodies or because of drugs like lithium, amiodarone or iodine containing solutions. Very rarely, some pituitary tumors cause low TSH levels and thereby reduce the production of T3 and T4. This is called secondary hypothyroidism.

Hypothyroidism is more common in females. The usual symptoms of hypothyroidism (uncontrolled) include slowing of metabolism with tiredness, lethargy, cold intolerance., weight gain, mood changes, dry coarse skin, hoarse voice, heavy menses, infertility, anemia, high cholesterol etc. In children hypothyroidism leads to short stature and low IQ.

This is diagnosed by checking blood hormone levels which show low normal T3 and T4 with elevated TSH in primary hypothyroidism and a normal TSH with low T3 and T4 in secondary hypothyroidism. Tests like anti-microsomal or anti-thyroglobulin antibodies establish the cause of the problem.

Treatement

Treatment is replacing the deficient hormones by thyroxine tablets (T4 tablets eg: Eltroxin, Thronorm, Thyrox). The dose required is 1.6-1.8 mcg/kg to be taken every day in the morning on an empty stomach. Drugs like iron, calcium and antacids interfere with thyroxine and need to be spaced out. Treatment is usually lifelong except in rare circumstances. Yearly monitoring of TSH is required to decide the appropriate dose for each patient.

It can affect both sexes but is more common in males. The usual symptoms of uncontrolled hyperthyroidism include weight loss, palpitations, increased sweating, tremulousness, prominence of eyes, heat intolerance etc. In addition to these, silent diseases like irregular heart rate, heart failure, osteoporosis and worsening of diabetes can occur. Cigarette smoking can worsen this state.

Diagnosis is by detecting high normal T3 and T4 with low TSH levels in blood. Further investigations like technetium or radio-iodine scans may be useful to distinguish between thyroiditis (temporary hyperthyroidism, no treatment required) or Graves' disease (definitive therapy required).

There are various options like drugs, surgery and radioactive iodine depending on various factors like age, goiter size, eye complications, recurrent disease etc. In addition, beta-blockers for controlling symptoms and calcium and Vit. D supplements should be given to prevent osteoporosis.

Refers to benign growth of thyroid in patches leading to formation of nodules (single/multiple). The thyroid enlarges slowly and most common symptoms are of compression of the trachea or the esophagus. Thyroid hormone levels are usually normal. An ultrasound, a technetium scan or fine needle aspiration cytology (FNAC) of the nodule may be required.

Treatment options are watchful observation, surgery or radioactive iodine ablation depending on the clinical condition.

Thyroid malignancies are rare and usually seen with single nodules. Risk factors are extremes of age, large size and a rapid increase in size. The prognosis is good if detected early. Surgery followed by radioactive iodine therapy and thyroxin supplementation lifelong is the usual protocol of treatment.

Thyroid disorders can lead to infertility and miscarriages in women. Thyroid hormones are essential for normal brain development in the fetus. The developing fetus does not have a functioning thyroid gland till, at least 6months of pregnancy. It is totally dependent on the mother’s thyroid hormone, which should be maintained in the normal range. Both low and excess thyroid hormones in the mother can adversely affect the fetus. Low thyroid hormone levels in the fetus causes mental retardation. Hence, a hypothyroid mother should continue her thyroxin tablets in pregnancy and if necessary, may need to increase her dose. Similarly hyperthyroidism can cause low birth weight and heart failure in the fetus. A hyperthyroid mother should take tablets to control he hormone levels and should have blood tests done at regular intervals.

All babies born to mothers with thyroid problems should have thyroid hormone levels done on the 7th day of life.

Dr. Archana Juneja brings with her to Wockhardt Hospitals dedicated training and clinical expertise in Endocrinology from K.E.M. Hospital, Mumbai. She has also worked as a Consultant Endocrinologist at Chennai and has managed a comprehensive spectrum of endocrine cases including the extremely rare Carney’s complex and intersex disorders.

has extensive research experience on Polycystic Ovarian Syndrome, Cushing’s syndrome, thyroid disorders in pregnancy, and insulinomas and has also worked in collaboration with Interventional Radiologists on projects like Inferior Petrosal Sinus Sampling (IPSS) for ACTH and Arterial Stimulation and Venous Sampling (ASVS) for insulin, which is being done at very few centers in India.

To schedule an online Appointments with Dr Archana Juneja Please write into enquiries@wockhardthospitals.net or click here

Doctor Ashish Anand, consultant, sports medicine and orthopedic surgeon, Wockhardt Hospitals, Talks to us about "Rotator Cuff Injuries" causes , treatments and preventing them

Dr Ashis Anand is a highly qualified Orthopedic Surgeon who has worked in India and US. His areas of interest include Arthroscopy and Joint Replacement (Hip, Knee and Shoulder). With more than 450 replacements (Primary and Revision). He has also excelled in Unicompartmental Knee Replacement which is done by very few centers in India.

Cardio workouts on the treadmill, elliptical trainers and stairclimbers or weight training with bench press, leg extensions, leg curls and hip adductor and abductor - they could all make you fit, but could also injure you if done improperly.

The increasing number of gym-related injuries is certified by many of the city’s orthopedics and sports medicine specialists. They say that gym-related injuries now constitute anywhere between 40 to 90 per cent of their cases.

Rotator cuff is made up of the muscles and tendons which connect your upper arm bone with your shoulder blade. They along with the Deltoid also help hold the ball of r upper arm bone firmly in your shoulder socket. The combination results in the greatest range of motion of any joint in your body.

A rotator cuff injury includes any type of irritation or damage to your rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities — especially those done overhead, such as throwing a cricketball or placing items on overhead shelves.

Most of the time, a rotator cuff injury heal on its own with self-care measures or exercise therapy.

Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons constitute the Rotator Cuff and connect the upper arm bone (humerus) with the shoulder blade (scapula). A rotator cuff injury, which is fairly common, involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

Tendinitis: Tendons in your rotator cuff can become inflamed and irritated due to overuse or overload, especially in athletes involved in overhead activities, such as in tennis or racquetball.

Bursitis:The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed.

Strain or tear: Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear. Stress from overuse also can cause a shoulder tendon or muscle to tear.

Common causes of rotator cuff injuries include:

1. Normal wear and tear:This is commonly seen in people who are less than 40 years and most often occurs due to repetitive damage to the tendons.Age related wear and tear on your rotator cuff can cause a breakdown of fibrous protein (collagen) in the cuff's tendons and muscles. This makes them more prone to degeneration and injury. With age, one may also develop calcium deposits within the cuff or arthritic bone spurs that can pinch or irritate your rotator cuff.

2. Lifting or pulling: Lifting an object that's too heavy or doing so improperly — especially overhead — can strain or tear your tendons or muscles.

3. Repetitive stress: Repetitive overhead movement of your arms can stress your rotator cuff muscles and tendons, causing inflammation and eventually tearing. This occurs often in athletes such as swimmers and tennis players. It's also common in painters and carpenters.

4. Faulty posture: When you slouch your neck and shoulders forward, the space where the rotator cuff muscles reside can become smaller. This can allow a muscle or tendon to become pinched under your shoulder bones (including your collarbone), especially during overhead activities, such as throwing.

The most common symptom is pain. You may experience it when you reach up to comb your hair, bend your arm back to put on a shirt or carry something heavy. Lying on the affected shoulder also can be painful. If you have a severe injury, such as a large tear, you may experience continuous pain and muscle weakness.

1. When did you first begin experiencing shoulder pain?
2. Have you experienced any symptoms in addition to shoulder pain?
3. How severe is your pain?
4. What movements and activities aggravate and relieve your shoulder pain?
5. Do you have any weakness or numbness in your arm?

Once you see the Shoulder Specialist and after a proper evaluation and investigations , you may be offered one or combination of treatments.

To know more about Sports Injuries Centre at Wockhardt Hospitals,Please write to enquiries@wockhardthospitals.net

Ankylosing Spondylitis Graphic Illustration

Ankylosing spondylitis (AS) was previously known as Bechterew's disease, Bechterew syndrome, Marie Strümpell disease

Ankylosing Spondylitis is approximately three times more common in men than women.It is generally seen in people in the age group of 20 to 40 years. However it is also known to affect children.

Ankylosing Spondylitis is believed to be genetically inherited. People with a particular gene called HLA-B27 are at a much higher risk of developing Ankylosing Spondylitis although not everyone with this gene will have the disease. There is no consensus in the medical community as to the other factors that causes the disease; some researchers put it down to a combination of factors i.e. genetics and environment.

The symptoms of Ankylosing Spondylitis are due to inflammation of the spine and joints . Hence pain in the lower / mid back, buttock and neck is usually the initial symptom. Pain is generally worse while resting and more prevalent in the early morning hours resulting in disturbed sleep. It reduces with physical activity and anti-inflammatory pain killers. The onset of pain is generally gradual, progressive with worsening over a period of time and in some cases the progression can be rapid and very disabling.

Patients with severe disease can develop complete fusion of the spine (known as Ankylosis), once fused the pain disappears but spinal mobility is lost resulting in severely compromised quality of life. The disease could affect hips and knees resulting in permanent damage.Some people with ankylosing spondylitis develop problems other than in the spine viz. eye inflammation (uveitis), skin rashes (psoriais) and chronic diarrhea (inflammatory bowel disease).

The diagnosis of Ankylosing Spondylitis is based on the patient's symptoms, a physical examination, x-ray findings and blood tests. The changes on X-ray are apparent only in the later stages of the disease. Magnetic resonance scan (MRI) is helpful to diagnose the disease in its early stages and also to delineate the severity.

Traditionally the treatment for Ankylosing Spondylitis involved the use of painkillers, physiotherapy and exercise. These only gave partial relief from pain but did not prevent the progression of the disease. Joint replacement surgery is recommended for those with severe hip or knee arthritis.

More recently, over the last few years, newer drugs (Biological therapy /anti-TNF therapy) have been discovered for this disease. The advent of biological therapy has revolutionized care for patients with this disabling disease. Infliximab (Remicade) and Etanercept (Enbrel) are the two drugs that are now available in India. They have been shown to cause dramatic reduction in pain, stiffness and resulting in greatly improved mobility of the spine. They are also believed to prevent the progression of the disease which had not been possible with the older treatments. This would hence reduce the intake of pain killers, reduce deformity and prevent the need for future joint replacement. In order to be more effective they should be used earlier in the disease rather than in the late stages.

It is important to diagnose and treat patients with Ankylosing Spondylitis early so as to enable the patient to lead a relatively normal life. The disease is chronic and hence long-term care is necessary.

More awareness needs to be created among the medical community and the general public to ensure early diagnosis and appropriate treatment.

To know more about Ankylosing Spondylitis and to schedule an appointment with Doctor Ramesh Jois,please write to enquiries@wockhardthospitals.net

picture courtesy : Albert Einstein Healthcare network

The NGO Needy Heart Foundation (NHF) has just completed 1000 heart surgeries in eight years. The NGO Needy Heart Foundation is an an initiative of the current NHF chairman O P Khanna, consultant cardiothoracic surgeon of Manipal Heart Institute Joseph Xavier and consultant cardiovascular surgeon of Wockhardt Hospitals,Bangalore Dr N S Devananda.

The NGO last week celebrated this successful milestone while organising`Keep The Beat' on Sunday at The Leela Palace for patients, their families, donors and doctors from partner hospitals.Giving a breakdown on the number of surgeries performed, The NHF chairman said that out of one thousand heart surgeries that has been performed so far, 506 were children and 57 senior citizens.

The NHF has been leading by example for the last few years by treating patients from the lower socio economical background with an objective of preventing finance from being a hurdle in the treatment process.The trusts vision is to eliminate deaths due to heart disease, for lack of money or knowledge.

While the Needy Heart Foundation has been supporting patients from across the country,a majority of them are from Karnataka and neighbouring states.

Over 1.4 million Indians need critical heart surgery annually. Currently about 55,000 surgeries are done, largely because the rest cannot afford it. They die a slow painful death.More than 1,50,000 Indian children are born with congenital heart disease. Only about 5,000 manage to get treated mostly with sponsorships and government aid while the rest are left to die untreated and unheeded.

"We hold our meetings at our partner hospitals at Manipal, Wockhardt Hospitals and Jayadeva Institute of Cardiology. With the support of hospital staff, management and through our website, we coordinate with patients, doctors and donors," Xavier said. "And we don't have a corpus fund either."

He calls the journey a miracle and narrated his experience in working for NHF. "An autorickshaw driver found treatment for both his children. Now, he talks about us and the organization with most of his commuters."

Here is hoping that the Needy Heart Foundation reaches the next one thousand surgeries milestone very soon.

If anyone wish to donate to the NHF or wishes to know more about Needy Heart Foundation,You can check out their website at http://www.needyheartfoundation.org/index.html

Please contact the Wockhardt Health Insurance Helpdesk ( for Bangalore and Mumbai).The Wockhardt help desk would validate the identity of the patient prior to giving a request form of the concerned TPA /insurance Company

Part A : to be filleld by the insured /patient with assistance from the helpdesk
Part B : To be filleld by the treating doctor at the hospital in detail
PartC : To be filled up by Wockhardt Hospitals

• The request will be submitted to the concerned TPA,the turnaround time for the authorization is approximately 6-24 hours.

• The TPA will send an authority or a rejection latter as the case may be ,directly to the hospital and the printout of the letter will be available at the helpdesk.

Authority letter are valid only for the period of Hospitalization sought as per request.Please inform the help desk if there is any change in these dates in case of planned hospitalization.

Final Discharge/Billing Turnouround Time:

The final billing clearance from the TPA could take atleasy 4 hours from the time your consulting doctor discharge .

Circumstances under which a request for cashless hospitalization can be rejected

Please keep in mind that the rejection of the request for pre-authorization is only denial of cashless service and is no way to be treated as a denial of treatment.The insured retains the right to get treated and submit the bills to the TPA for subsequent reimbursements.