Joint Replacement Consultants at Mulund,Mumbai
Monday, August 3, 2009
Our Joint Replacement Surgeons at our Mulund Facilty,Mumbai
Doctor's Name: Dr Kaushal Malhan
FRCS (Orth) U.K., FRCS (Surg) U.K, Dip. Sports Medicine U.K.
MS (Orth) Bombay, D (Orth) Bombay
Joint Replacement / Resurfacing and sports Surgeon
Click here to see Dr Malhan's profile and Click here for appointments
Doctors Name : Dr Sachin Bhonsle
MS (Orthopaedics); FRCS (Glasgow, UK)
Senior Consultant in Joint Replacements and Orthopaedic Surgery
Click here to see Dr Sachin Bhonsle's Profile and Click here for an appointment
Doctor's Name: Dr Sawant Milind
FRCS Orth, FRCS(Edin), FRCS(Glasg), MS Orth, FCPS Orth, D Orth, DNB Orth.
Knee Surgeon
FRCS Orth, FRCS(Edin), FRCS(Glasg), MS Orth, FCPS Orth, D Orth, DNB Orth.
Knee Surgeon
Click here to see Dr Milind's profile and click here to an appointment
The The "Specialist Knowledge" Series on Clinical Specialties
The advent of new treatment modalities in medicine brings with it the opportunity to develop better clinical outcomes, while emphasizing a higher level of comfort and safety to our patients. You will, find in the pages of The Specialist, the acumen and expertise of our highly accomplished clinicalteams in Cardiology/Cardiac Surgery, Neurology/Neurosurgery, Orthopaedics, GI & Advanced Laparoscopic surgery besides Womens health.
‘The Specialist’ is a part of our Clinical Knowledge Series which we hope to share with with fellow doctors and medical fraternity on our latest clinical outcomes across various specialties.In this issue, we have some interesting case studies in all our core specialities mainly Heart care, Brain & Spine, Bone and joint and digestive care.
The Specialist Knowledge Series on Clinical Specialties Wockhardt Hospitals,Bangalore
Total Knee Replacement in Severly Deformed Rheumatoid Knee: A Case Study
Rheumatoid arthritis is a well known systematic inflammatory disease wherein arthritis of synovial joints is a major component. This disease is common in females and affects during third, fourth and fifth decades of their life. Initially the disease starts with pain and joint stiffness in small joints of hand and later involves big joints like hip, knee, shoulder and elbow. In an advanced rheumatoid arthritis all the joints of the body are involved.
Treatment of rheumatoid arthritis is ideally to be done by rheumatologist. Start with NSAIDS and later go on to combination therapy of DMARDS (steroids, methotrexate, leflunomide, sulfasalazine chloroquine and oral gold salts).
An Orthopedics role comes only after joint pain/ swelling and deformity are not controlled by medical treatment.
Indication of joint replacement in rheumatoid arthritis.
1. Severe pain in joints
2. Inability to do daily activities
3. Progressing deformity
4. Joint stiffness
Advantages of joint replacement
1. Painless and stable joints
2. Good functional movements of joints
3. Improvement in quality of life
4. Better disease control after surgery
With advent of new implants, good operation theatres, laminar flow and surgical expertise, it is possible to perform joint replacements even in severely deformed joints which was thought impossible previously.
Knee Replacement on a patient with severe Rheumatoid Arthritis
A 58 year old female patient consulted us with severe knee pain for four years. She was a known case of rheumatoid arthritis on medical treatment,she was unable to stand or walk and had severe pain on bending the knee.
This lady was poorly nourished and anemic. Local examination of both knees revealed that she has wind-swipe deformity. Right knee was in 30 varus deformity and range of movement was 0-90. Left knee was in 40 valgus and further valgus till 70. Range of movement was 0-30. X-ray of right knee showed severe varus deformity with medical tibial condyle defect and lateral subluxation of tibia. Left knee - severe valgus deformity with central tibial bone defect and lateral patellar subluxation.
Patient was admitted and complete pre-operative work done. The team of Orthopaedic surgeons headed by Dr. Sanjay Pai, Rheumatologist .A total knee replacement was done in a staged manner. First the right knee with varus deformity was operated using a revision total knee replacement implants. After five days, the left knee with severe valgus deformity was operated. Post operative period was uneventful and without complications.
The patient was mobilized on the third day with walker and was discharged on the sixth day. On the 12th day, the patient was able to walk without support, able to climb stairs and do her daily activities.
With Good surgical expertise along with highly efficient support staff now available in India and , these patients can get back their normal daily life style which was thought impossible in the past.
Courtesy: Dr. Sanjay Pai, M.S.
Dr. Srinivas J V, M.S.
Dr. Vasudev N Prabhu, M.S.
Department of Orthopaedic Surgery Wockhardt Hospitals, Bangalore
Treatement in Movement Disorders
Movement is triggered through the pyramidal system, the basal ganglia and the cerebellum in the brain.These are discrete parts of the brain which perform specific but different functions, which are wired to each other for the performance of normal movement. The movement disorders are a diverse group of pathological dysfunctions in the nervous system, giving rise to any of these: an abnormal movement, a paucity of movement, an abnormality of muscle tone or a disturbance in posturalreflex.
The common movement disorders are Tremors, Chorea, Parkinson's disease, Dystonia and Writer's cramp.
The patient gives a detailed history of what has been occurring in terms of the symptoms. The investigation is followed by a neurological physical examination. Scales are used(basically written proformas) to assess the severity and type of movement disorder. Various movement sequences are recorded on video as a baseline before any treatment, to later compare the patient's performance in specific functions. This is followed by basic bloods tests, a CT/ MRI brain scan and EEG or EMG along with some specific tests that may be needed, depending on the diagnostic possibilities that the physician is thinking of.
The various treatments in Movement Disorders that are generally followed includes
1) Medications: Medications that either stimulate or inhibit the specific receptors for central nervous system chemicals (neurotransmitters) are the mainstay of treating such disorders
2) Botulinum toxin injection: This toxin is injected into muscles to partially paralyze them, and thereby control the abnormal movement.Several sites are injected in one sitting, and several such sessions may be required at 4 week intervals.
3) Stereotactic surgery: After detailed visualisation using CT/ MRI and mapping the brain, ablation (destruction) of certain parts of the brain nuclei and/ or its circuits will generally give relief from the abnormal movement.
4) Deep brain stimulation: The position of the basal ganglia nuclei are identified using CT/ MRI brain scans. Electrodes are placed onto specific brain nuclei and electrical signals are sent from a generator placed under the skin, in the chest. The patient has the option of controlling the current from the generator, for symptom relief.
The first task of the physician is to arrive at a diagnosis, or a highly probable diagnosis, using variouslines of investigation.The best line of treatment: Each patient would need to be tried on a specific combination of drugs which may vary from 1 to 3 months, to assess the best outcome with drug management.
Specific Medical Concerns on Movement Disorders
Specific Medical Concerns on Movement Disorders
Following this minor adjustment in drug dosages may be required once every three months
.
Likely outcomes: It is usually expected that the abnormal movement decreases to a remarkable extent. If the problem had been one of rigidity and paucity of movement, then movements should be more easily performed. A small sub-set of patients are not likely to improve on medications, for which deep brain stimulation or Stereotactic surgery should be considered to give optimal relief.
.
Likely outcomes: It is usually expected that the abnormal movement decreases to a remarkable extent. If the problem had been one of rigidity and paucity of movement, then movements should be more easily performed. A small sub-set of patients are not likely to improve on medications, for which deep brain stimulation or Stereotactic surgery should be considered to give optimal relief.
Movement disorders are generally progressive degenerative disorders, which means that the pathological course cannot be greatly altered, though significant improvement in function can be provided. However, the goal of management is to provide optimal relief and restore normal functionality, with the least side effects and thereby significantly improve the quality of life for the patients.
source:
The Department of Neurology at Wockhardt Hospitals
Dr. Chandran Gnanamuthu ,MD, DM, FIAN, FAAN DM PhD (Neuro Sciences)
Dr. C. Udaya Shankar,Specialist in Movement Disorder
Dr. Vijay Chockan,Consultant Neurologist Consultant Neurologist Consultant Neurophysiologist
source:
The Department of Neurology at Wockhardt Hospitals
Dr. Chandran Gnanamuthu ,MD, DM, FIAN, FAAN DM PhD (Neuro Sciences)
Dr. C. Udaya Shankar,Specialist in Movement Disorder
Dr. Vijay Chockan,Consultant Neurologist Consultant Neurologist Consultant Neurophysiologist
World Insulin Day :India will be home to over 70 Million Diabetics in the next 6 years
Thursday, July 30, 2009
Indian which is already a diabetic capital of the world will have the rare distinction of being home to over 70 million diabetic patients by 2015. This figure was expected to be reached by 2025,however increasingly lifestyles of Indians are likely to help reach this number by 2015 according to a global Diabetic report conducted by "Diabetes Atlas"
Fueling the alarming trend is the rise of diabetes in the rural areas.A recent report by "Diabetes Atlas"shows an increase in prevalence of 40% in urban areas in 6 years and 49% in rural areas in the same duration.
According to the Diabetes Atlas, there are 246 diabetic patients in the world. India leads with being the home to about 41 million diabetics followed by China with 40 Million. US,Russia,Germany and Pakistan trail India and China.
These data on Diabetic Projection in India, comes on the day which is Insulin Day. Insulin day is observed on July 30th .On this day in 1921,when Frederick Grant Banting and Charles Herbert Best injected a dog with 4cc of extract of degenerated pancreas ,the dogs blood sugar stopped.This was the beginning of the ultimate end for the search of diabetic cure.This extract was later named Insulin and the day is now observed as World Insulin Day
Fueling the alarming trend is the rise of diabetes in the rural areas.A recent report by "Diabetes Atlas"shows an increase in prevalence of 40% in urban areas in 6 years and 49% in rural areas in the same duration.
According to the Diabetes Atlas, there are 246 diabetic patients in the world. India leads with being the home to about 41 million diabetics followed by China with 40 Million. US,Russia,Germany and Pakistan trail India and China.
These data on Diabetic Projection in India, comes on the day which is Insulin Day. Insulin day is observed on July 30th .On this day in 1921,when Frederick Grant Banting and Charles Herbert Best injected a dog with 4cc of extract of degenerated pancreas ,the dogs blood sugar stopped.This was the beginning of the ultimate end for the search of diabetic cure.This extract was later named Insulin and the day is now observed as World Insulin Day
US Spends more money in fighting Obesity than Cancer
pic source:healthyamericans.org
According to US Health Secretary Kathleen Sebelius the US medical system spends around twice as much treating preventable health conditions caused by obesity than it does on cancer.
We're spending just under 150 billion dollars a year on health conditions related to obesity," Sebelius told the first-ever national conference on obesity to be organized by the federal Centers for Disease Control and Prevention (CDC)."We have a situation where health conditions related to obesity have nearly twice the cost- impact on the health system as all the cancers combined in this country."
The American Cancer Society estimates that all cancers combined cost the health system around 93 billion dollars a year.
Her comments came a day after a study released at the conference found that medical spending on obesity-related conditions could reach a whopping 147 billion dollars a year.The journal "Health Affairs" has just published a study showing that almost 10% of US medical costs may be due to obesity.
The recent IHRSA/ASD Obesity/Weight Control Report 3.8 million people are over 300 pounds, over 400,000 people (mostly males) carry over 400 pounds and the average adult female weighs an unprecedented 163 pounds!
The National Center for Health statistics shows some alarming data
- Between 1962 and the year 2000, the number of obese Americans grew from 13% to an alarming 31% of the population.
- 63% of Americans are overweight with a Body Mass Index (BMI) in excess of 25.0.
- 31% are obese with a BMI in excess of 30.0.
- Childhood obesity in the United States has more than tripled in the past two decades.
- According to the U.S. Surgeon General report obesity is responsible for 300,000 deaths every year.
According to the CDC(Center of Disease Control ), the percentage of overweight children 6-11 has nearly doubled since the early 1980's, while the percentage of overweight adolescents has almost tripled.The extent to which USA has fattened up shows in the dress size which US wears.The most commonly purchased woman's dress size presently in America is 14. In 1985, it was a size 8!
Mississippi had the highest rate of adult obesity at 32.5 percent, a feat which it has be able to repeat for the fifth time in a row followed by Alabama,West Virginia and Tennessee.
57 Year Old Journalist from Mysore manages to Smile after a Decade
Wednesday, July 29, 2009
A Team of doctors at Wockhardt Hospitals put the smile back on the face of Mr. B M Ramesh. Dr. Deshpande V Rajakumar, Consultant Neurosurgeon, Wockhardt Hospitals performed a minimally invasive Microvascular Decompression (MVD) surgery to relieve Mr. Ramesh of his facial pain.
Mr. B M Ramesh, a 57 year old gentleman and a former journalist who hails from Mysore, was compelled to take early retirement from his job as he was suffering from excruciating pain on the right side of his face. He was suffering from this unbearable facial pain for the past 10 years and was under medication for a long period. But nothing really brought him relief and in due course of time he became refractory to even maximum dose of medication.
Since then he continued to live with his pain, managing himself by avoiding the precipitating factors, restricting his social life to within home and the medication. He was barely able to speak, chew food as jaw opening and sensory stimulus to upper jaw triggered the pain on the right side. At times he even used to keep a piece of wood in between his teeth to avoid biting his own tongue due to sheer pain.
Since then he continued to live with his pain, managing himself by avoiding the precipitating factors, restricting his social life to within home and the medication. He was barely able to speak, chew food as jaw opening and sensory stimulus to upper jaw triggered the pain on the right side. At times he even used to keep a piece of wood in between his teeth to avoid biting his own tongue due to sheer pain.
Having suffered for so long Mr. Ramesh finally visited Wockhardt Hospitals where he was diagnosed with a neuro disorder called - Trigeminal Neuralgia, a disorder of one or both of the facial trigeminal nerves (the fifth cranial nerve, also called the fifth nerve or simply V which is responsible for sensation in the face)
“Trigeminal neuralgia" is an uncommon disease with an incidence 4.7 per 100,000 (prevalence of 155 per million) and occurs more frequently in the middle or later age groups, more in females than in males. It is more common on the right side of the face rather than the left side. It generally affects the lower jaw zone (mandibular) more than the upper jaw (maxillary).Microvascular Decompression (MVD) surgery is done through an approach behind the ear.
Around 70-80% of patients respond well to medical therapy and can either be pain free or tolerably relieved of pain. However around 30% of the patients become refractory to it after 2years and some develop drug intolerance due to adverse effects. About half of all patients eventually require surgery for pain relief. Microvascular Decompression is the only surgical option that allows for obtaining long-term pain relief while avoiding any sensory disturbance.
The pain is usually precipitated by a sensory stimulus or a ‘trigger’ such as
• light touch on that side of face, a breeze of wind or a splash of water on the face • acts of swallowing food or liquids • mastication(chewing/biting) • talking
The pain is usually precipitated by a sensory stimulus or a ‘trigger’ such as
• light touch on that side of face, a breeze of wind or a splash of water on the face • acts of swallowing food or liquids • mastication(chewing/biting) • talking
Trigeminal Neuralgia is one of the worst known facial pains. The pain is paroxysmal or episodic in occurrence; each episode consists of a cluster of lancinating or ‘electric shock’ like pains, severe to excruciating in intensity lasting from a few seconds to a few minutes and keeps recurring.
For an appointment with Dr RajKumar or to contact our Brain and Spine Doctors, please email enquiries@wockhardthospitals.net
Doctor Spotlight: Dr Prathima Reddy,Gyanecologist at Cunningham Road,Bangalore
Tuesday, July 28, 2009
Dr Prathima Reddy
MRCOG,FRCOG (London)
Consultant Obstetrician & Gynaecologist
Wockhardt Hopitals, Cunningham Road, Bangalore
Areas of Interest:
Consultant Obstetrician & Gynaecologist
Wockhardt Hopitals, Cunningham Road, Bangalore
Areas of Interest:
- Vaginal Surgeries including complex hysterectomies.
- Removal of large fibroid uterii through the vagina, Anterior and Posterior repairs.
- Surgeries for urinary incontinence
- Laparoscopic and Hysteroscopic surgeries
- Colposcopy and Colposcopic directed treatment for the abnormalities of the Cervix
- High Risk Obstetrics
Dr Prathima Reddy is a Fellow of the Royal College of Obstetricians and Gynaecologists, London, She was trained in the United Kingdom and obtained her MRCOG and FRCOG from there. She then worked in the UK for 9 years before coming back to India.
In Bangalore she was one of the first consultants to introduce evidence based, protocol led management of patients. This contributed enormously to changes in practice and reduction in Caesarean Section rates in all the hospitals that she worked at.
Dr Reddy has special training and experience in complicated vaginal surgeries, laparoscopic and hysteroscopic surgeries including colposcop
She is an active member of the ObGyn Society and is a very popular speaker. She has been invited several times over to deliver lectures and participate in their workshops.She also has several publications to her credit.
She is an active member of the ObGyn Society and is a very popular speaker. She has been invited several times over to deliver lectures and participate in their workshops.She also has several publications to her credit.
Consultation Timings : Tuesday to Saturday: 10am-12.00 Noon. Click here for requesting an appointment Or please write to enquiries@wockhardthospitals.net
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