Dr. Ashit Shah – knee replacement surgery expert talks about when a patient needs knee surgery, the different techniques, implants and the advantages of the procedure.
With over 13 years of experience as an Interventional Cardiologist in the UK, Dr. Nimit Shah takes the time to explain the various causes of heart attacks in the country and the different treatments available for the same.
Hernia’s are a common ailment with over 10% of the world, men, women and children, developing one at some point in their life. It occurs when an organ pushes through the muscle or tissue opening holding it in place. A hernia is referred to the sac that consists of the lining of the peritoneum/abdominal cavity after it enters through the hole in the stronger muscle region of the abdominal wall surrounding the muscle or fascia. A hernia may be visible as a bulge in the abdomen, upper thigh, belly button and groin areas, depending on the location of its occurrence. Groin hernias are the most common, making up to 9/10 of hernia cases.
Types of hernia: 1. Inguinal Hernia: Occurring mostly in men due to the improper closure of the inguinal canal after postpartum testicle descent. This is a groin hernia.
2. Incisional hernia: When the organ pushes through the surgical incision after surgery, mostly abdominal. It can occur many years later through the scar of the initial surgery too.
3. Femoral Hernia: Another groin hernia, but one which is more common in women. Usually observed as a bulge on the upper thigh, exactly below the groin.
4. Umbilical Hernia: Almost exclusively seen in children and babies under 6 months old. This bulge around the navel is usually seen due to the improper closing of the muscles around the navel.
5. Hiatal Hernia: This is an abdominal hernia that occurs in the stomach’s upper region. This is observed when a part of the stomach’s upper part enters the hiatus, an opening in the diaphragm.
What can cause a hernia? A hernia is usually the result of a combination of weak muscles and straining due to lifting heavy objects. It is more likely to affect those born with weak abdominal muscles.
How do I know if I have a hernia? In a majority of cases, hernia patients do not exhibit many symptoms. What they might complain of though , is discomfort or pain which is exacerbated during standing, straining or while lifting heavy materials. Another common symptom is a sore and growing bump in the abdominal area. Major symptoms like nausea, vomiting, not being able to expel gas or have bowel movements occur when the hernia is strangulated, i.e., when it gets stuck due to increasing size and restricted blood supply. This is a medical emergency and should be operated on immediately.
Is surgery the only option? Not in all cases. Hernia treatment depends on the size of the hernia and the severity of the symptoms. In mild cases, lifestyle changes and medication may be enough to manage the situation. This is mostly true for hiatal hernias where dietary changes like avoiding heavy meals, lying down or bending over after meals can alleviate the symptoms. Keeping one’s body weight in check can also help. Hiatal hernia patients can also benefit from medications like antacids, H-2 receptor blockers, and proton pump inhibitors that reduce stomach acid.
If the hernia patient requires surgery, there are two options available depending on their case history. ● Open hernia repair or herniorrhaphy: The patient is provided either spinal, general or a combination of both anesthesias. An incision is then made in the groin and the hernia is moved back into the abdomen and the wall is reinforced with stitches. The weak muscles are reinforced through hernioplasty wherein they are provided additional support through the use of a synthetic mesh or screen. ● Laparoscopic surgery: A minimally invasive option that takes place under general anesthesia. Three incisions are made in the abdomen, one of them being through the umbilicus. The laparoscope, which is a thin tube with a camera at its end is then inserted through the umbilical port or opening. The camera then sends a magnified image from inside the body to a monitor, which gives the surgeon a close-up view of the hernia and allows them to repair the hernia with the help of a mesh. Patients undergoing laparoscopy experience a much shorter recovery period overall.
The type of surgery one undergoes totally depends on the surgeon, the type of hernia, its size and the patient’s history.
Is the recovery very painful? As with any surgery, there is a certain level of discomfort that is to be expected. However, this can be managed with pain medication. Resumption of normal activities depends on the patient’s progress and doctor’s evaluation, though vigorous activity and heavy lifting are restricted for several weeks. This holds true for both adults as well as children.
Living with hernia is no joke and left untreated, can cause fatal complications. If you or your loved ones are exhibiting symptoms of hernia, then going to a doctor for a full evaluation of the condition is a must. Early treatment is the best way to ensure a positive outcome.
The word aortic stenosis may seem alien, but the condition is one of the most common valvular heart diseases in the world. Usually seen in the elderly, with symptoms surfacing mostly after the age of sixty, Aortic stenosis may also be a congenital condition. Our heart contains four valves, the mitral, tricuspid, pulmonary and the aortic. The former two control the flow of blood from one chamber to another while the pulmonary and aortic direct the blood away from the heart. The pulmonary artery directs the blood to the lungs and the aortic artery directs the blood to the rest of the body. In this condition, an aortic valve begins to show signs of stenosis or narrowing, thus reducing its operating capacity. This results in a reduced supply of oxygenated blood to the body which leads to symptoms like breathlessness, chest pain, fainting and palpitations. If the symptoms are mild or not present, the cardiologist may decide to simply monitor and follow up. However, if the stenosis has shown significant progress and has started to exhibit major symptoms, then the best option is to undergo Transcatheter Aortic Valve Replacement (TAVR).
TAVR is a minimally invasive surgery, as in, the chest bones are not opened up as in a bypass. It is instead a lot like a stent placement procedure. Small incisions are made in one’s groin to access the femoral artery and a hollow tube is placed in it. The new valve is placed on a tube with a balloon tip on one end and crimped to fit the hollow tube. The hollow tube is then inserted into the femoral artery and pushed through until it reaches the diseased valve. At this point, the balloon is inflated which in turn expands the new valve and helps it take its place. The new valve pushes the leaflets of the original valve to secure its place. Once the new valve is up and running, the balloon is deflated and removed.
Transcatheter Aortic Valve Replacement is relatively new. As a result, it is advised only for high and immediate risk patients by regulatory authorities and has shown promise in treating patients at low risk too. As shown by extensive research, heart valve replacement is a safe and suitable option for elderly patients, with recent studies demonstrating a 94%   survival rate in 5 years. The survival rate for any individual patient also depends on other factors like their overall and cardiac health, co-morbid medical conditions and age. While early TAVR procedures demonstrated success rates of merely 70-80%, advanced cardiac care, surgical technologies and tools have increased the rates to as high as 92%. The overall procedure is also deemed to be nominally risky with a 2% chance of complications and fatalities across all age groups. This holds true even for elderly patients above 80.
The recovery process for Transcatheter Aortic Valve Replacement can take quite a few weeks. Most cardiologists recommend a course of blood thinners to prevent clots and antibiotics to prevent infection for their patient’s optimum recovery. Patients can expect to resume their normal activities gradually once they are totally recovered but will still have to undergo regular check-ups from their cardiologist. These check-ups are vital as they are meant to ensure that the patient’s heart and new valve are working properly.
When it comes to one’s heart, any risk is too big to take. For those whose lives have been restricted by aortic stenosis, Transcatheter Aortic Valve Replacement therapy provides an opportunity to lead a normal life with normal activities again. With experienced surgeons, advanced tools and techniques, this minimally invasive surgery is sure to change the lives of those who are suffering from the advanced stages of the disease.