Wockhardt Hospitals Blog

The Wockhardt Hospital Heart Care is the pioneer of the world's First Awake Bypass surgery .Dr Vivek Jawali,Chief Cardiothoracic and Vascular Surgeon had performed this surgery first in 2005 and had set a benchmark by successfully performing an Awake Minimally Invasive Heart Valve Repair Surgery (AMIHVRS) on a 49-year-old woman .This surgery was conducted without using general anesthesia or ventilator support, while the patient was on a heart lung machine.

While the patient had multifaceted medical complications, including an aortic valve disorder. Her lung condition did not permit the use of a ventilator and she was at high risk for general anesthesia.

Though the patient had been advised aortic valve replacement surgery,The cardiac care team at Wockhardt had devised a surgical procedure to repair, rather than replace the aortic valve through a minimal incision, while using the technique of high thoracic epidural analgesia.

The Annual 2009 Indian budget promises to pave way for some big ticket economic reforms. While the Industry is expecting the finance minister to give a pep pill to the Indian Economy by accelerating Government Spending in Infrastructure ,the Indian Healthcare Industry needs some urgent reforms to take care of its large population and their healthcare needs.

Here is Vishal Bali,CEO Wockhardt Hospitals who lists out his "Budget Wishlist" to improve the "Wellness Index of India"

Around 30 Heathcare professionals and international healthcare leaders are due to speak in Singapore at the Healthcare Travel Congress 2009 , organised by Informa Life Sciences from 29 to 30 June 2009. These leading medical and healthcare experts will share their vision and insights on medical tourism, with topics varying from cross-border marketing, patient care and safety, medical insurance, strategic partnerships,telemedecine initiatives and quality accreditation.

Ruben Toral, President, International Medical Travel Association, will open the Healthcare Travel Congress 2009 at Fairmont Hotel, Singapore. The congress theme, The Globalisation of Healthcare, underscores the need to address areas crucial to the expansion and sustainability of the booming medical tourism businesses in Asia.

• US Payer Insight: What Payers want from International Providers
• Promoting Physicians To Attract Local and Global Patients
• Riding On The New Online Marketing Platform
• Leveraging On Telemedicine Technologies To Enhance Post Operative Care
• Dealing with Malpractice and Liabilities: Protection Strategies for the
• Providers
• Developing and Managing International Patient Centres (IPCs)
• Effective International Preferred Provider Organization (IPPO)

For more information,pleae visit Healthcaretravel-singapore

Proper foot care for diabetic patients is very important. Poor foot care with diabetes can lead to serious health problems, including Foot ulceration, sepsis, and amputation are known and feared by almost every person who has diabetes diagnosed. Yet these are potentially the most preventable of all diabetic complications by the simplest techniques of education and care.

However some people have very low risk while some have very high risk. Grading the risk helps the individuals and the health professionals to take appropriate measures without being too relaxed or too strict. This is not only good for the individuals, it also helps to direct valuable health care resources to people who need it. Patients at low risk only need general advice. Patients at high risk need detailed, specific and practical footcare instruction.

The overall risk of an individual developing a diabetic foot ulcer is determined by a combination of factors. In general, the risk is higher if:

To schedule an health check or a diabetic check ,please email to enquiries@wockhardthospitals.net

courtesy:
Diabetic Foot Diseases
Webmd.com

Patients in rural India are finally being able to get expert advice from a specialist in a metro or even from a doctor from India's top corporate Hospitals like Wockhardt Hospitals without having to move out of their environs which was unthinkable in the past,but is a growing reality today.

The healthcare industry seems to be venturing into telemedicine in a big way with hospital groups trying to `virtually' expand their reach.

Telemedecine has provided Healthcare Companies the opportunity to have the tie-ups by creating linkages among smaller hospitals and larger super-speciality healthcare centers within the group, connecting with hospitals overseas as well as educational institutions.

Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries.

Wockhardt Hospitals have already put in place 2 tele-medicine centres - one in Chitradurga in Karnataka and the second one at Erode in Tamil Nadu. Both these centres are catering to rural / semi urban patients and are linked to the state of the art tertiary care hospital at our Hospital at Bannerghatta Road in Bangalore. Through this network, patients are in a position to utilize the services of specialist doctors at the Wockhardt Hospitals which in the normal course would not have been accessible to them on account of both affordability and distance. Tele consultations are provided free of cost to all patients.

A third centre is expected to be commissioned by July 2009 in the Coorg district of Karnataka - which again is an area that is severely under served in terms of healthcare facilities. Over the next one year, the Company expects to put in place tele medicine centres in the Konkan areas of Maharashtra as well as in some North Eastern States.

The NEST birthing suites at Bannerghata Road Center at Wockhardt Hospitals,fulfills two big concerns during pregnancy and delivery,safety and comfort. Today's women juggles between her career demands and family’s needs. With more and more nuclear families on the rise, the support system that a woman earlier was used to is no longer there.

With increasing responsibilities at work besides managing home, she has barely has time to look after herself. A lot of questions that a pregnant woman looks forward remains unanswered. and is left to the hands of the caregiver . The Nest Birthing Services is an one stop destination for Women for the next nine months.

The Nest is a part of Wockhardt Hospitals Woman Care that derives its safety standards from Harvard Medical International ( HMI)

The” Nest Birthing center is backed by Wockhardt clinical specialties. with a wide choice of eminent obstetricians and gynecologists and specialties from other disciplines. Along with a team of highly trained nurses and paramedics our excellence in clinical care is complemented by the latest technology in terms of investigations, diagnosis and treatments. Our state of the art Neonatal Intensive Clinic Unit (NICU), blood bank and emergency service stand by as a guard against surprises in the last moment.

For nine months the Nest offers you superlative care in a homely and caring environment. Our ante –natal program prepares you and your spouse both physically and emotionally for the birth of your baby. Our (Labor Delivery Postpartum) LDRP and elegant birthing suites are designed to make your stay during your delivery memorable and pleasant. We emphasis on natural birthing and provide you support services like Lamaze and ante natal classes. We give you the option of comfortable natural birthing with painless delivery techniques. Pregnancy is something to look forward to at the “ Nest Birthing Center.


Wockhardt Hospitals “Nest TLC Package” (Tender Loving Care)For Pregnant Women


The baby in the womb goes through the same emotions as you do. The Nest TLC privilege package monitors your health and after your delivery, your babies health. This special TLC package performs all ante-natal tests, routine investigations and support services like Lamaze and yoga and of course plenty of Tender Loving and Care.

Details of the TLC Package for Pregnant Women

Extra Value Added Services Provided in the TLC Package

Lab tests included along with the TLC Package are

Ultrasound Included are

The Following are not a part of standard charges

Consumables over the limit
Cost of certain drugs and medicines used under special circumstances
Visit of consultants of other specialties like a urologist
Vaccine cost for the baby
Any additional physiotherapy sessions
Investigations, medication and treatments for any pre-existing diseases
Additional investigation lab tests in addition to the regular pregnancy tests in case of any complications
3D/4D Scan
Cost for epidural Analgesia
Triple Market tests

For consulatations and enquiries email us at enquiries@wockhardthospitas.net

Dr. Manjeet S. Juneja

Dr.Manjeet .S.Juneja has joined Wockhardt Hospitals, Mumbai after an extensive stint at the Prince Charles Hospital, Brisbane, Australia and various hospitals of Cardiac Care in India.

In Australia, Dr.Juneja was extensively trained in complex interventions including the use of rotablators and intra vascular ultrasound. Whilst in India and in Australia, he aggressively pursued the Primary Angioplasty program and had standardized a regimen for the use of intravenous Nicorandil in these patients to prevent no flow, slow reflow phenomenon.

He has vast experience in cardiac care and his area of interest is Adult Interventional Cardiology including primary angioplasties, complex interventions and balloon valvuloplasties.He has more than 25 publications in peer reviewed National and International journals and had served on the editorial board of Medicine Update 2002. He has participated in various stent trials including the RESOLUTE &ZOMAXX II and was involved in the early research on the use of Bivalirudin during percutaneous interventions in acute coronary syndrome.


Professional Qualifications and Fellowships:

(1990-1995) M.B.B.S - Seth G.S.Medical College and K.E.M. Hospital, Mumbai
(1995-1999) M.D. - Topiwala National Medical College and B.Y.L.Nair Hospital, Mumbai
(1999-2002) D.M. - Grant Medical College and Sir J.J.Group of Hospitals, Mumbai


Earlier Work of Dr Manjeet Juneja

• Lecturer-Grant Medical College and K.E.M Hospital ,Mumbai(1990-1995)
• Staff Cardiologist-Madras Medical Mission & Institute of Cardiovascular Diseases, Chennai(2004-2005)
• Associate Consultant Cardiologist- Madras Medical Mission & Institute of Cardiovascular Diseases, Chennai(2005-2006)
• Fellow in Interventional Cardiology-The Prince Charles Hospital,Brisbane,Australia(2006-2008)
• Consultant Interventional Cardiologist-Bombay Hospital &Medical Research Centre, Mumbai(2008)

Papers, Publications and Awards:

• Faculty and Chairperson. Euro PCR 08. “Call For Clinical Cases’, Barcelona, Spain, May 2008.
• Award winner. Euro PCR 07. “Percutaneous Closure of an Ascending Aorta Pseudo-Aneurysm by an AmplatzerTM Septal Occluder’. Third prize. Barcelona, Spain, May 2007.
• Best Speaker. Mumbai Medical Congress, April 1997.
• National Talent Search Scholar. June 1987.

For Consultation please email to enquiries@wockhardthospitals.net
To Fix an Appointment call : 022-67994121 and 022-67994123

A 14 year old girl from Uganda who came to India with a dilating heart showing signs of heart failure has undergone a complicated open heart surgery at Wockhardt Hospitals. The cardiac team at Wockhardt Hospitals led by Dr. Vivek Jawali, Chief Cardio Thoracic Surgeon performed risky and complicated open heart procedure to replace the mitral valve, repair a leaking tricuspid valve and maze procedure to correct her abnormal heart rhythm.

Abigail Kanyonyozi was brought to Wockhardt Hospitals when she was on the brink of heart failure. Abigail was diagnosed to have a blood cancer called acute myeloid leukaemia in 2000 and Lynda’s saga of her fight for her daughter began. Abigail had undergone a prolonged and expensive treatment in South Africa for her blood cancer. This led Lynda (her mother) exhaust her all finances to bring Abigail back to normal life. After few years of fully recovering from her blood cancer Abigail was diagnosed with heart disease called dolurebecin cardio myopathy which dilates the heart resulting in cardiac failure.

Dr. Vivek Jawali, Chief Cardio Thoracic Surgeon, Wockhardt Hospitals said, “On further examination it was found that the child had a heavy heart and was suffering from rheumatic heart disease (a condition in which permanent damage to heart valves is caused by rheumatic fever), with severe leakage of her heart valves – mitral and tricuspid valve (a valve located between the right atrium and the right ventricle). The leakage had caused stretching of the heart and irregular heart rhythm called Atrial Fibrillation (AFib) which was primarily contributing to her heart failure. Her condition was very critical and immediate surgery was the only option to save the child.” Abigail had to undergo a complex and prolonged surgery which involved replacement of her mitral valve, repairing of tricuspid valves and a complicated maze operation to correct her heart rhythm.

The surgery was successfully performed and the heart was contracted to a great extent. Abigail was no longer suffering from breathlessness and body swelling and her heart was strongly beating. “The child can now live a robust life adds DR. Jawali”. Abigail was discharged from the hospital within a week’s time post her surgery.

Atrial fibrillation is a condition where the speed or rhythm of the heart beat is affected due to a disorder in the hearts electrical impulses. The heart may beat too fast or too slow or it may vary in pace as the hearts upper and lower chambers beat out of sequence.

About Doctor Vivek Jawali:Dr.Vivek Jawali is the pioneer of minimally invasive cardiac surgery in India. Dr Jawali performed India's first minimally invasive bypass surgery and also performed India's first awake bypass surgery on a fully conscious patient without general anesthesia or ventilator, using the technique of continuous high thoracic epidural analgesia.

Dr Jawali performed the world's first awake open heart surgery, which involved an aortic valve replacement with a triple bypass on a 74-year-old patient. He has many indexed publications and the world's highest experience on this procedure. Click here To know more about Dr Vivel Jawali and to schedule and appointment with him,or email us at enquiries@wockhardthospitals.net to schedule and appointment with Dr Jawali

While covering the Iraq War as an embedded journalist ,NBC reporter David Bloom who was with the US Marines, began to feel a sudden pain behind his knee. He reportedly sought out medical advice by satellite phone, However he decided not to follow the advice which were on the lines of "Go to a doctor". However he popped a few aspirin, and kept right on going. Three days later, Bloom died of a pulmonary embolism caused by DVT( deep-vein thrombosis). He was only 39.

Most of us tend to take a pain very lightly unless it keeps on re-appearing and affects our life style or work. However according the Mens Health Magazine,their are a few kinds of pain which should never be taken lightly, and medical intervention should be sought immediately
Severe Back Pain

The condition: "If it's not related to exercise, sudden severe back pain can be the sign of an aneurysm," says Sigfried Kra, M.D., an associate professor at the Yale school of medicine. Particularly troubling is the abdominal aneurysm, a dangerous weakening of the aorta just above the kidneys.A less threatening possibility can be also of a kidney stone.

A CT scan using intravenous radiopaque dye does the best job of revealing the size and shape of an aneurysm. Once its dimensions are determined, it'll be treated with blood-pressure medication or surgery to implant a synthetic graft.

A pain in The Foot or Shine

A nagging pain in the top of your foot or the front of your shin that's worse when you exercise, but present even at rest and even ibuprofen and acetaminophen does not seem to be having a difference

These kinds of pain are probably a stress fracture. Bones, like all the other tissues in your body, are continually regenerating themselves. "But if you're training so hard that the bone doesn't get a chance to heal itself, a stress fracture can develop," explains Andrew Feldman, M.D., the team physician for the New York Rangers. Eventually, the bone can be permanently weakened.

Sharp Pain in the Abdomen:Since the area between your ribs and your hips is jam-packed with organs, the pain can be a symptom of either appendicitis, pancreatitis, or an inflamed gallbladder. In all three cases, the cause is the same: Something has blocked up the organ in question, resulting in a potentially fatal infection. Exploding organs can kill a guy. See a doctor before this happens.

Transient Chest Pain

The condition could be indigestion. Or it could be a heart attack. "Even if it's very short in duration, it can be a sign of something serious,

A blood clot may have lodged in a narrowed section of a coronary artery, completely cutting off the flow of blood to one section of your heart.

How much wait-and-see time do you have? Really, none. Fifty percent of deaths from heart attacks occur within 3 to 4 hours of the first symptoms. You're literally living on borrowed tim

Leg Pain with Swelling

Specifically, one of your calves is killing you. It's swollen and tender to the touch, and may even feel warm, as if it's being slow-roasted from the inside out.

Leg Pain with Swelling :if you sit in one place for 6 or more hours straight without taking a talk with taking time out,then you wait for the blood that pools in your lower legs to form a clot ( deep-vein thrombosis, or DVT). This would be big enough to block a vein in your calf, producing pain and swelling.

Unfortunately, the first thing you'll probably want to do—rub your leg—is also the worst thing. "It can send a big clot running up to your lung, where it can kill you," warns Doctors

Painful Urination :A painful Urination can be in the worst cases a sign of bladder cancer. specially for Men .According to Joseph A. Smith, M.D., chairman of the department of urologic surgery at Vanderbilt University, "The pain and the blood in your urine are symptoms of this, the fourth most common cancer in men."

Smoking is the biggest risk factor. Catch the disease early, and there's a 90 percent chance of fixing it. Bladder infections share the same symptoms.


disclaimer: This is a part of patient education series and may not represent Wockhardt Hospitals or their Doctors Views. These views are taken from MensHealth Magazine

Dr. Latha Venkataram specially qualified and trained in OBG and Medicine, has an extensive experience in Medical disorders in Pregnancy (high risk) both in United Kingdom and Bangalore, India. She is currently the senior OBGYN specialist and Chief Co-coordinator, Department of OBGYN, Wockhardt Hospital, Bangalore.

She has held many executive posts including President, Bangalore Society of OBGyn and she is presently the secretary for Bangalore RCOG trust.

She is associated with several organizations both rural and urban projects promoting quality care, targeting Maternal Mortality. She is actively involved in establishing the efficacy of Yoga and other Alternate systems of medicine in the treatment of OBGyn related problems. She has to her credit papers published in International indexed journals. Currently she is guiding Doctoral candidates in the field of Yoga and pregnancy.

She has special interest in Obstetric intensive care and emergency Obstetric care and has treated many patients who are critically ill. Her main interest in the field of Gynaecology is vaginal surgeries and has skill and experience in removing large Uteri vaginally.

Wockhardt Hospitals, Kalyan successfully performed a revolutionary minimally invasive spine surgery - Percutaneous Endoscopic Lumbar Discectomy (PELD) on a 49-year-old man suffering from severe backache.

Truly a minimally invasive spinal surgery, the procedure known as PELD was performed with a single 0.6 cm incision using a technically evolved Yeung endoscopic spine system (YESS) method under local anaesthesia. The PELD Technique is known to be an innovative spine procedure that can help appropriately screened patients recover faster without scars or stitches and more importantly, helps patients walk immediately after the procedure without any pain.

The patient, Sunil Ghag, was suffering from acute back pain as a result of prolapsed inter-vertebral disc, more commonly known as slipped disc. With the severity of the pain only increasing with time, conservative treatment with non-steroidal anti-inflammatory drugs (NSAID) and intermittent pelvic tractions was of little help, forcing him to seek surgical intervention.

An MRI confirmed the prolapsed disc, revealing disc degeneration. "The patient had two options," recalls Dr Vikas Gupte, consultant spine surgeon, Wockhardt Hospitals. "He could either opt for the conventional open discectomy, or the minimally invasive PELD under local anaesthesia." The patient was convinced about going for it as the chances of root injuries were minimal with PELD, promising immediate normalcy and discharge from the hospital.

As Dr Gupte explains, "In the PELD procedure, the patient is made to lie prone on a special operation table and the exact entry point is mapped on the patient's body using image intensifier x-ray system. A long spinal needle is then passed from the side of the back which goes into the disc directly by-passing other bone and ligaments. Through this needle, a guide wire is passed and after making a 6mm incision under local anaesthesia, a dilator and working cannula are passed through the incision. The camera and the monitor are attached to an endoscope that is passed through the incision and the prolapsed part of disc is removed under vision. Advanced instruments like radio-frequency and laser machine are used for such surgery. The surgery lasted for 40 minutes and the wound was closed with a single stitch."

Dr Deepu Banerjee, Neurosurgeon, Wockhardt Hospitals points out that the instrumentation using YESS technique consists of a 6 mm scope that facilitates direct view of the disc fragments in the spine thus minimizing muscle, ligament and tissue damage, while alleviating chances of nerve root injury. "Even the nerve roots are clearly visible through the powerful camera of the Yeung endoscope," he added.

Post-op, the patient was able to walk without any pain and was discharged after 24 hours. According to experts, PELD with YESS technique is the ultimate form of minimal invasive spine surgery in appropriately screened patients.

This Post is in response in connection with the story of Rashmi BT's experience at Wockhardt hospitals. While we are firmly behind her at this time of extreme grief as an institution we thought it appropriate to bring it to the public domain our version of the real story at wockhardt Hospitals and what we believe actually happened The below post gives you the complete details of the case and the facts have been clearly explained down before everyone

However in case anyone of you does not have the time to go through the same in detail we would like to let you know that Wockhardt Hospitals had followed all the necessary medical protocols that any reputed institution across the globe would have followed. We have always tried to question the limits to which medical science can progress and have been also largely responsible for the positive changes that the Indian healthcare industry has been witnessing in recent years. It is but unfortunate that certain risks in medicine cannot be completely mitigated how much ever one might strive.

Please do read our version and if you find it convincing forward the same to whoever you might think appropriate.

Reputations take a lifetime to build, is it right to destroy them without understanding true facts and make a hospital and its doctors look inhuman?


Ms. Rashmi B.T. was under the care of a senior gynaecologist in Bangalore for her second pregnancy. She made a conscious decision to shift under Dr. Latha Venkatram’s care at Wockhardt Hospitals, Bangalore in the 35th week of her pregnancy largely because she was aware that Vaginal Birth after Caesarian Section (VBAC) was an option and wanted to select that option for her second delivery. She had collected information that Dr. Latha Venkatram was one of the senior gynecologists in the city who offered this option to her patients. From the OPD records filed by Dr Latha Venkatram it is evident that Rashmi was counseled and given ample information about the procedure and the risks associated with it and she took an informed choice to select this procedure.

Vaginal Birth after Caesarian Section (VBAC) is the term used when a woman gives birth vaginally, having had a caesarian delivery in the past. Worldwide VBAC, if possible, is being recommended and preferred over repeat C-Sections as its advantages substantially outweigh the disadvantages. According to the Royal College of Obstetricians and Gynaecologists patient information guideline 2008 “Birth after previous Caesarian Section”, overall three out of four women with an uncomplicated pregnancy would give birth vaginally following one caesarian section delivery. The short-term and long term complications inherent in a C-Section make it preferable that a woman is offered the choice of a VBAC. The US Federal Government in its healthy people report 2010 proposed a target for VBAC of 37%.
Repeat Caesarian Sections are associated with:

o A possibly more difficult operation
o Longer recovery period
o Possibility of injury to bladder or bowel
o Possibility of blood clots developing in legs and pulmonary thrombosis
o Breathing problems for the baby. Higher in C-Section than in VBAC
o Serious risks increase with every Caesarian delivery
o Higher chance of infection
o Future complications for the mother who has had repeated opening of the abdomen
o Higher costs

VBAC has a shorter stay in the hospital, faster recovery as well as lower cost for the patient. There is a risk of uterine rupture but this risk is approximately 0.5%. In spite of this risk the benefits of VBAC far outweigh the risks.

As in all medical procedures there is no way to predict which patient would fall under the 0.5% risk of uterine rupture or any way by which this rupture can be prevented. A VBAC delivery is more demanding of the gynaecologist, as it takes 6-8 hours as compared to a C-Section, which in a planned fashion would be over in less than 40-45 minutes. Also the mother and child need close monitoring it is estimated that one will have to do as many as 200+ unnecessary C-Sections to prevent the occurrence of 1 uterine rupture. In most cases a uterine rupture is not fatal. However in the best interest of Ms Rashmi, Latha Venkatram gave her both the choices and Ms Rashmi chose to opt for the VBAC option.

Ms. Rashmi B.T. was a fit candidate for a VBAC. She had a breech presentation (where the legs of the baby present itself first instead of the head at the time of delivery) in the earlier pregnancy which required a C-Section. A breech presentation in the earlier pregnancy which necessitated a C-Section is in fact an indication to offer a VBAC to the patient in the subsequent pregnancies.

An age of 35 is not a contraindication to a VBAC. The fact that she was 5 days past her due date was also not a contraindication to a VBAC because less than 5% of patients deliver on their due date.

During her antenatal visits to Dr. Latha Venkatram, Ms Rashmi B.T. was explained in detail about the pros and cons of VBAC and she agreed to undergo the procedure. The OPD case records have these notations. She was also clearly informed by Dr. Latha Venkatraman that she works along with Dr. Prabha Ramakrishna as a team and either of them would be present during her delivery. Doctors particularly in the area of obstetrics frequently prefer to work as a team since many times an emergency may hold one of them which would make it possible for the other team member to attend to the delivery as the date and time of delivery cannot be predicted. In a VBAC considering that a consultant needs to be around for most of the labor period it is prudent that a team takes care of the patient. Both Consultants of the team Dr. Latha Venkatram and Dr. Prabha Ramakrishna are Fellows and Members of the Royal College of Obstetricians UK respectively.

Ms Rashmi B.T was admitted to the hospital early morning on the 4th of March 2009 in spontaneous labour. She was connected to monitors for a close monitoring of both maternal and fetal parameters. She was visited by Dr. Latha Venkatram soon after admission. An experienced nurse and a fully qualified gynaecology registrar were monitoring her constantly. The Consultant Dr. Prabha Ramakrishna was also available on the same floor and repeatedly examined her. She was kept informed about the progress of the labour.

The labour progressed normally until 1.50 p.m when a sudden decrease in the fetal heart rate was noted (fetal bradycardia). The tracings before 1.50 p.m were normal. The moment fetal bradycardia occurred, the consultant Dr. Prabha Ramakrishna who was on the same floor was called in by the gynecology registrar. When Dr. Prabha Ramkrishna examined Ms Rashmi, the baby’s head position was a little high. She was asked to push to see if the baby’s head would come to +2 position in which case she could do a forceps in the labor room itself and deliver the child. When the baby’s head did not descend as required she asked for the patient to be shifted to the Operating room. After this Ms.Rashmi was not asked to bear down any further.

Shift to the OT was rapid since the dedicated Operation Theatre for Caesarian sections is situated within the labour room complex and this theatre is not used for any other procedure. Within 7-8 mins the patient was in the theatre. The anesthetist had a choice of going in for an emergency general anesthesia which has inherent risks for a pregnant woman or to go in for epidural anesthesia. Since the patient was already receiving pain medication (epidural analgesia) it was decided that for the safety of the mother increasing this analgesia to achieve anesthesia was the preferred option. In the OT the fetal heart rate was recorded as 180 b.p.m on the Doppler. On the OT table an examination was done and it was found that the head had receded and a forceps delivery was not attempted. An immediate emergency C-section was then performed.

The anesthetists, Neo-natologists and the surgical nursing team had assembled in the theatre within a few minutes of the emergency being declared. The hospital has full- time anesthetists, Neo-natologists and a surgical nursing team working round the clock to attend to all kinds of medical emergencies.

At the time of birth the baby did not have a heart beat or respiration. Resuscitation was started and the heart beat started about half a minute later. The child was immediately shifted to the Neonatal ICU and put on the ventilator. The baby’s weight at birth has been recorded in the NICU as about 3 Kg. The only reason an exact weight could not be taken in the NICU was that the child was already attached to various lifesaving equipments and the neonatologist had to make the closest estimate. However it must be noted here that a birth weight of 4 Kg is not a contraindication for a VBAC.

In the neonatal ICU the clinical team met the family on a daily basis and kept them informed about the status of the baby and the prognosis. The poor prognosis was explained to the parents on the 2nd day itself. An opinion from an external eminent neonatologist was also sought who concurred with the poor prognosis. All decisions regarding further care were made only after extensive discussions with the parents of the baby. Dr.Prakash Vemgal our Neo-natologist is not only highly experienced but has also gone through some of the highest training in Neo- natology in high patient volume and reputed international centres.

The doctors and the management (including senior management personnel) of the Wockhardt Hospitals group spent long hours with the parents understanding and trying to address their concerns. As is the normal practice in such a case a complete internal review was done. The family sent to us a detailed list of areas they wanted us to look into during our investigation. We did go into each of these areas and sent them a detailed reply addressing most of these issues including taking the opinion of two leading and senior external gynecologists of the city who do substantial VBAC work. It is unfortunate to note that inspite of providing her all clarifications Ms Rashmi has been projecting an extremely poor image of Dr. Latha Venkatram and the hospital.

Our internal review involved discussions with our own team of gynaecologists, meetings with two external gynaecologists who practice VBAC and the entire clinical care team. Our findings after this detailed internal review are summarized below.

a. Ms Rashmi BT was a fit candidate for a VBAC. She would have been offered this procedure as a first choice by any gynecologist or hospital which practices advanced obstetrics anywhere in the world. Her age or the week of pregnancy were not contraindications to go in for a VBAC.
b. She had made a conscious and informed decision about going in for a VBAC. She had changed her senior gynecologist whom she was consulting until the 35th week of her pregnancy primarily because that gynaecologist was not in a position to offer VBAC.
c. The OPD case notes of which she was given the duplicate copy recorded that she was willing for VBAC and she was informed about all risks of her decision.
d. Both the mother and the child had been monitored carefully right through the labour
e. All medications used for progressing labor were prescribed agents and safe for use in VBAC
f. She did have a uterine rupture which in VBAC carries a risk of 0.5%. This rupture could in no way be predicted or prevented. In spite of the rupture the gynecology team was able to save the uterus for future child bearing.
g. The Operation theatre was ready at the time it was required.
h. All the staff were present in the Operation Theatre within a few minutes of the emergency being declared
i. While the baby was in the NICU Dr.Prakash Vemgal the head of Neo-Natology met up with the parents at regular intervals and kept the family clearly informed about the status and prognosis. All major decisions were taken only after discussion with the parents.
j. Senior management of the organization met up with the family on multiple occasions to understand and address their concerns

A minute by minute account of her story as is being spread through the various emails circulated by various people who were neither physically present during her admission to the hospital nor were involved in her care process exhibits to us a determined effort to harm the reputation of the gynecologist and the hospital without having any understanding of the clinical facts of the case.

Is medicine now going to be judged through the lens of only opinions running across chain mails or through the untiring efforts of institutions and doctors which toil endlessly to save lives but remain spectators to their actions being judged by emotive outbursts?

We do understand the pain and suffering of Ms Rashmi BT. As a hospital every life is precious to us but we are also are in the world of medicine where unfortunate rare complications can be counteracted but every procedure cannot be made risk free. There are many lives which we save each day when all has been given up and each such case teaches us that to pursue medicine is to pursue the limits of the unknown but does that mean that we become victims of public misinformation

We have taken all necessary care and followed every medical protocol that any reputed institution across the globe would have followed. However it is unfortunate that even though Ms Rashmi has not been a victim of any medical negligence she has chosen by this random spread of irrational mails to use a redressal system that is purposely harming the reputation of Dr Latha Venkatram, Dr.Prabha Ramakrisha and our institution.We will not stand to be mute spectators to this form of intentional disreputation.

The case can be subjected to analysis by any competent authority.

According to a recent editorial in New York times "Overseas Under the Knife" Wockhardt Hospitals has been featured as one of the alternative medical tourism destinations abroad. Commenting on the rising healthcare cost coupled with the long waiting times for critical procedures and surgeries,It lists Indian Hospitals as one of the most traveled destinations by US patients

"One consequence of the high cost of medical care in the United States has been the rise of medical tourism. Every year, thousands of Americans undergo surgery in other countries because the allure of good care at half the price is too good to pass up.

"Average total fees at well-regarded hospitals like Apollo and Wockhardt in India are 60 percent to 90 percent lower than those of the average American hospital, according to a 2007 study by the consulting group Mercer Health and Benefits (where Dr. Milstein is affiliated). Even compared with low-cost American hospitals, the offshore fees are 20 percent to 50 percent lower"

Typically, they are people who have either no health insurance or meager coverage. Though not poor enough to qualify for Medicaid, they cannot afford a good health plan. But lately, even some people with good coverage have been encouraged to take advantage of cost savings abroad.

A few pioneering American insurers like Blue Cross Blue Shield of South Carolina and self-insured employers like the Hannaford Brothers supermarket chain sent American doctors to evaluate foreign hospitals. Favorably impressed, they now offer payment for travel expenses and cash incentives as high as $10,000 for choosing offshore hospitals.

For very costly operations like open heart surgery or hip joint replacement, savings far exceed these payments. That is not to say that offshore surgery could substantially lower health care costs. Less than 2 percent of spending by American health insurers goes to the kind of non-urgent procedures that Americans seek overseas. "

Read the full story here

69 year old Mr. Ramgopal Mundhra who underwent bilateral knee replacement at Wockhardt Hospitals 10 months ago, completed 5 kilometer Majja Run in the recently concluded Bangalore Marathon. Mr. Mundhra, a businessman from Bangalore, was suffering from pain in both his knees for the past 20 years and in the last two years had lost complete mobility and was unable to even complete the simple chores of daily life without assistance.

Mr. Mundhra consulted Dr. Sanjay Pai, Consultant Orthopedic Surgeon Wockhardt Hospitals and was diagnosed with Osteoarthritis in both his Knees and was advised to undergo a total knee replacement. He underwent bilateral knee replacement within a span 2 days, post which he went through a comprehensive rehabilitation program. His recovery was remarkable and at the time of his discharge he was able to walk with the help of a walker. Not only this Mr. Mundhra started driving on the 5th week of his surgery and on the 6th week he was able to swim.

Addressing the media Dr. Sanjay Pai, Consultant Orthopedic Surgeon, Wockhardt Hospitals said “Mr. Mundhra stands out as an example to all who are apprehensive of undergoing knee replacements. Osteoarthritis is the degradation and degeneration of the cartilage in the knee. As the disease progresses the cartilage becomes thinner and even in some wears away altogether, necessitating total knee replacement. The surgery greatly improves the quality of life for patients who are in the advanced stage of the disease. The procedure is extremely safe with a high success rate and patients can get back to living a normal life with only a short recovery period”

“Forget the run; I never expected to walk a few steps on my own. The pain which I have gone through over the last two years was crippling. Thanks to the doctors at Wockhardt Hospitals, who reassured me and dispelled my fears of undergoing surgery. I can now run again and I am looking forward to the next marathon in 2010, who knows I may participate in the 10K run” said an overjoyed Mr. Ramgopal Mundhra.

According to Mr. Joseph Pasangha, Head of Physiotherapy, Wockhardt Hospitals, “Mr. Mundhra’s case shows the importance of proper rehabilitative care post surgeries. With proper training and a comprehensive rehabilitative program there can be immense improvement in a person’s quality of life post a surgery. The patient’s attitude goes a long way in speeding up the recovery. Mr. Mundhra is a very positive person and he is always ready to take up a challenge. Faced with adversity he came out smiling.”

He ran 5 kilometers during the Bangalore Marathon on 31st of May 2009 without any hitch, displaying the benefits of bilateral knee replacements and dispelling the fears and myths around total knee replacements.

The Wockhardt Hospitals 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 specilalises 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, Endoscopic Spine Surgery and Arthroscopic surgeries such as Ligament Reconstruction in the knee, Subacromial Decom-pression in the shoulder.

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Our Bone and Joint care at Mumbai and Bangalore has been a center of ,excellence in Joint Replacements and Orthopedic Treatments.Our Bangalore and Mumbai centers are equipped to treat all types of muscular-skeletal problems ranging from Orthopedic Trauma Surgery to Minimally Invasive Arthroscopic Surgery. The hospital also specializes in surgery for joint replacements, sports medicine, ligament repair, knee surgery, spine surgery and physical therapy for rehabilitation.

Wockhardt Hospitals 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.

1)We were the first hospital chain in Western India to perform Hip Resurfacing or Surface Replacement

2)We are the first hospital in India to perform mobile bearing Hi-flex Uni Knees (Half Knee Replacement )

3) Wockhardt Hospital was among the first Hospital to have performed India's first bilateral knee replacement surgery. In a bilateral knee replacement, both the knees are replaced in the same surgery which is performed on the same day.

4)We are Credited performing the largest number of "tissue preserving joint replacement surgeries".This is a technique where by making a superior incision, rather than a posterior incision, neither the posterior hip capsule, nor the gluteus medius or minimus are dissected. This results in improved post-operative results in the form of less dislocations and better healing.


to schedule an appointment with our Bone and Care doctors,please email us at enquiries@wockhardthospitals.net

A complicated beating heart surgery was performed by the cardiac team at Wockhardt Hospitals.Mulund,Mumbai on a 59 year old patient without blood transfusion. Mr. Kabilar a resident of Kalyan had successfully undergone an emergency beating heart bypass graft surgery without receiving a single drop of transfused blood. The surgery was performed by Dr. Ajay Chaugale, Consultant Cardiovascular Surgeon, Wockhardt Hospitals and his team.

Mr. Kabilar was suffering from a coronary artery disease, leaving his heart with a capacity to pump blood only up to 20 percent ejection fraction. In addition to this, he was a diabetic (type II) and suffered low weight. His hemoglobin count was a discouraging 8.5 gm/dL as against the standard count of 13-15 gm. “The patient was required to undergo Coronary Artery Bypass Graft (CABG) procedure to enhance the blood pumping ability of the heart. The patient was ready to check options available for treatment, but was firm about not accepting blood, however much the quantity,” explains Dr. Ajay Chaughule, Cardiovascular Surgeon, Wockhardt Hospitals addressing the press meet.

The fact that Mr. Kabilar is a member of Jehovah Witness and as per their religious belief they oppose blood transfusions made the case all the more complicated. “The case of this patient presented with several complications and serious potential risks was far more challenging to treat when compared to any other patient with similar complications,” said Dr. Bharesh Dedhia, Chief Intensivist, Wockhardt Hospitals.

Under normal circumstances doctors generally look into the possibility of conserving blood when operating and one way of blood saving procedure known as autologus blood transfusion. In this procedure, a required quantity of blood is drawn from the patient prior to the surgery. The blood is preserved and then transfused back into the person, should there be a need for it in the course of a certain surgical procedure. These procedures also aid in conserving the patient’s blood in terms of hemoglobin counts” explained Dr. Ajay Chaugale.

Being a staunch believer of his religion, the Mr. Kabilar was not even ready for an autologus blood transfusion. So the next option the doctors suggested to him was `Cell Saver’ technique. In this procedure the blood that is lost during the surgery can be sucked and purified in order to extract the patient’s RBC that can be given back to the patient.

“The Cell Saver technique could have been a good option to consider for the patient’s CABG (Coronary Artery Bypass Graft) procedure, but what came in the way this time around was the high cost. The technique did not seem financially viable for the patient. The challenges to get everything working in his favour were many” said Dr. Ajay Chaugle.

The next best alternative was to put the patient under therapeutic agents (hematenics) to increase hemoglobin concentration and to enhance the overall quality of the patient’s blood. According to Dr. Ajay Chaugle “We put the patient on hematenics for about a month and the results were quite encouraging, his hemoglobin count jumped from 8.5 gm/dL to 11 gm/dL within a month.”

With his hemoglobin counts encouraging, doctors decided to go ahead with a beating heart surgery for Coronary Artery Bypass Graft (CABG). As the name suggests, the surgery is performed without stopping the heart. A special device stabilizes the part of the heart that gets being operated upon. In beating heart surgeries, blood circulation to the heart muscles is not modified. Predictably, the risk of complications associated with temporarily stopping and restarting the heart function and the complicated arising from blood flowing through (fusion )

The biggest advantage of Beating Heart CABG are

The more common conventional CABG surgery is performed on a stopped heart. The heart is temporarily made to stop beating by administering a special solution – cardioplegia – every 25 minutes during the surgery. The functions of the heart and the lungs are isolated with a Cardio Pulmonary Bypass Machine (heart-lung machine). With the blood flowing to the oxygenator through this machine comprising several tubes, the blood cells may be subjected to some wear and tear. Complications can arise following injury to the blood cells.

But all that and more was shelved in the case of this patient and more importantly, accomplished without blood transfusion despite complications in the patient. The three-hour Beating Heart CABG was performed successfully and the patient was discharged after 3rd post operative day. “Surgeries on members of the Jehovah Witness community have been performed in the past, but it was the complication and the risk associated with this patient that made this case a rare one,” says Dr. Ajay Chaughule.

Gynaecologist Wockhardt Hospitals,Mulund,Mumbai

Dr. Bela Kedia is a well trained Gynaecologist and Obstetrician from Mumbai University. She trained from Wadia Maternity Hospital, which is affiliated to KEM. Hospital – a premier Medical Centre of our country.Her areas of interest include Minimally invasive Gynaecological surgery, which includes laproscopy ,Hysteroscopy and Microsurgery, and has been practicing Minimal Access Surgery since 1996 and has been involved in over 1000 surgeries

Pennsylvania and Columbia University with Dr. Harry Reich
Dr. Herbert Goldfarb Centre for minimally invasive Gynaecology

1. Sliver Medal at DGO Exam – CPS Board.
2. N. D. Patel Scholarships in Surgery – KEM Hospital.
3. P. G. Merit Scholarship – Mumbai University for Postgraduate Studies in Gynaecology

You can also email us at enquiries@wockhardthospitals.net for scheduling an appointment

Doctor's Name :Dr.Mandakini Parihar
Gynecologist & Fertility Specialist
M.D. DGO

Dr. Mandakini Parihar brings to Wockhardt Hostpital a vast experience in infertility treatement. She did her training in Reproductive Endocrinology at the University of Texas Medical School, USA. She returned to India and started Fertility Clinic and IVF Centre. During her stay at USA, she has received extensive training in Endoscopic surgeries and has further attended Advanced Laparoscopic and Hysteroscopic training in USA, UK Germany and The Netherlands.

Gynaecological Laparoscopic Surgeries including Laparoscopic hysterectomy, myomectomy, ovarian cysts. Endometcriosis, adhesiolysis etc.

You can also email us at enquiries@wockhardthospitals.net for scheduling an appointment

Dr. Venkatesh S, MD, DM,Consultant Cardiologist Wockhardt Hospitals,Bangalore shares his thoughts on the "Risks of heart diseases and stroke for diabetic patients"

To have diabetes mellitus or Pre diabetes (a condition where blood sugar levels are high but not high enough to be labeled as diabetes) increases your risk of heart disease and stroke. According to medical research two out of three diabetic people die form heart disease or stroke.

Diabetes is a condition caused when the body fails to produce enough insulin or when there is resistance to the action of circulating insulin. Insulin is a hormone produced by the pancreas (a gland behind the stomach), that is required by the body to move glucose from the blood stream into the cells of the body where it converted into energy.

The human body converts digested food into energy that sustains the cells in the body. Most of the food we eat is broken down into glucose (a form of sugar) and dispersed into the blood stream to be used as energy. When there is deficiency of insulin the cells in the body fail to get the required energy resulting in a build of glucose in the blood stream and hence the cells starve when there is not energy in the body.

High glucose levels in the blood can lead to several complications and disorders such as heart disease & Stroke. It left uncontrolled there could be several other complications i.e. Blindness, kidney failure and amputations of the limbs caused by damaged arteries.

High blood sugar over a period of time leads to damaged nerves and blood vessels. There is hardening of the blood vessels and increased deposit of cholesterol on their walls – a process termed as atherosclerosis. Atherosclerosis can lead to narrowing of the blood vessels and also causes increased tendency for clot formation within. These two processes are the ones responsible for most heart attacks and strokes.

A Diabetic patent is twice as likely of having heart disease or stroke as compared to a normal person. Diabetic patents tend to develop heart disease and stroke at a younger age than people without diabetics. People with diabetics are also more likely to have a second heart attack as compared to healthy people. Women with diabetes are also at a much higher risk of developing heart disease and stroke. Heart attacks in diabetic patents are generally more serious and complex and are more likely to be fatal.

• Since diabetes is a chronic disease that can only be controlled it is very important to stick to the advice given by the doctor and to take your daily dose of medication at the right times. Go for regular check ups and monitor your pressure and blood sugar regularly.

In Women the symptoms may be very subtle and difficult to diagnose. A regular check up is very essential.

o Sudden severe headache
o Weakness an numbness that comes on suddenly
o Disorientation and confusion or sudden difficulty in recognizing people and speaking
o Dizziness and loss of balance
o Blurred and double vision

If you have the above symptoms it is of utmost importance that you receive treatment at the earliest. Remember the earlier the heart attacks and strokes are recognized the more effectively they can be treated and complications prevented. Delay in treatment can result in loss of life. So, if there is a suspicion that you or someone around you is having a heart attack or stroke, immediately seek medical help. Keep important telephone numbers and emergency numbers always at hand.

Summarizing, diabetes is a chronic disease which can throw up sudden surprises in the form of heart attacks and strokes. Good control of diabetes helps prevent these conditions. Periodic monitoring, regular diet and exercise and strict adherence to the doctors’ treatment is of paramount importance. If symptoms and signs of heart attack or stroke are noticed, getting medical help quickly can make a difference between life and death.

To Do For keeping Heart Risks at Bay

Maintain a healthy blood pressure for people with diabetes, this means less than 130/80.. Medication may be necessary for this

Get your cholesterol tested regularly and, if needed, take medication to lower it. Your LDL-cholesterol levels should be under 100mg/dl.

For consultation with our Doctors at Wockhardt Hospitals, please email us to enquiries@wockhardthospitals.net