Surgery: Archives

Heart Attack April 25, 2020

Stenting – Can It help Prevent another Heart Attack?

The mere thought of getting a cardiac arrest can make your heart beat faster for a moment. But today, even if a heart attack is a perilous event, there are many ways to circumvent the same.

Angioplasty or stenting can be a lifesaver option, mainly when performed right after a heart attack. Putting in a stent helps prevent the narrowing of arteries, which improves your blood flow and prevents further damage to your heart. Once patients are diagnosed with coronary artery disease many of them undergo angioplasty, because for two reasons: a doctor suggests it because of its high success rate and less invasive technique, and secondly, it improves the lifestyle significantly by reducing the risk of getting another heart attack.

Now, let us go deeper into understanding what these stents are and how can they help reduce further problems.

Stents are tiny mesh tubes inserted to keep arteries open post angioplasty. The coronary arteries are responsible for carrying blood and oxygen to heart muscle cells. A heart attack often occurs when plaque breaks open and causes the formation of a blood clot in a partially clogged artery, blocking the blood flow. This is when stenting comes in and is used and can be a lifesaver option. Stents come in various forms but DES (Drug Eluting Stent) is the most commonly used ones during Angioplasty worldwide.

After implantation, DES releases a drug from its outer coating to help in preventing blockage at the particular site. Hence, DES are preferred over BMS (Bare Metal Stent) for the majority of the patients as they prevent recurring blockages in the arteries. Also, the recent DES are termed to be at least as safe as BMS. However, there are chances blood vessels could again get blocked after stent placement. In the case of BMS, post-implantation as the vessel heals, tissue begins to grow around the stent but in some cases, the scar tissue overgrowth can lead to re-blockage of the vessel. A DES implantation can avoid this from happening as it prevents scar tissue formation thus maintaining proper blood flow. But, you will require to regularly take blood-thinning medicines to avoid blood clot formation in the stent and prevent the blood vessel from getting blocked again. There are various DES & BMS brands available and they come with their own set of benefits and a cardiologist may suggest one to you based on the requirement.

In other words, Drug-Eluting Stent is effective and can reduce the chances of future heart attacks to some extent. But, remember that stenting can be a life-saver option only if you continue with suggested medication and lifestyle modification like eating healthy food, regular exercise, etc. that your doctor has advised you to follow post the angioplasty.

Heart Attack April 25, 2020

Tips for a Heart-Healthy diet that speed up Recovery after Angioplasty

Want to adopt a heart-healthy diet post angioplasty, but aren’t sure where to start?
One way to begin is by giving a complete makeover to your current diet plan. Focus on making meal plans that emphasize vegetables, fruits and other necessary products with an adequate amount of proteins, carbohydrates and other nutrients. We know, that the main question here is about what exactly to consume and what to avoid post implanting a stent as you may not be that well versed with every food category and ingredients benefiting a person. Hence, we have stated below foods to intake and to avoid after implanting a stent.

Firstly, it is very important that you consult a doctor before jumping onto conclusions and making your diet plans, especially after angioplasty. It is important to understand that each one of us is built differently and one particular diet plan isn’t going to work for all of us. And, hence we believe that even minor differences in your diet post angioplasty can make a huge difference to your heart health. Now, let us read more about it.

Consume more whole-grain foods every day: Eating whole grains is associated with various benefits, including a lower risk of diabetes, heart disease, and high blood pressure. They are rich in nutrients, minerals, fibers, antioxidants and has also proven to reduce the risk of a heart attack.
Eat more quantities and varieties of fruits and vegetables: People who eat more vegetables and fruits as part of an overall healthy diet are likely to have a reduced risk of some chronic diseases like stroke, cancer, diabetes, influenza or any respiratory disease. They provide nutrients vital for health and maintenance of your body.

Reduce salt and sugar intake: Salt and sugar are needed for health. However, we require very little of it to survive. While salt is essential for the transmission of nerve impulses and normal cell function, sugar is a real source of energy with glucose being the most important of all. But, due to rapid urbanization and changing lifestyles, dietary patterns have seen a major shift and processed foods are being consumed more which is indirectly increasing the risk of heart diseases and strokes due to the high amount of salt and sugar content in it. And, for a person who has just undergone Angioplasty, it becomes highly important to maintain a healthy balance of salt and sugar to avoid any further heart illnesses.
Cut down on the consumption of fatty foods, rich in LDL, trans fats and saturated fats: Eliminate fatty meats like pork, lamb or fried items, butter, or coconut oil from your diet. There are two main types of potentially harmful dietary fats, trans fat and saturated fat. These types come mainly from animal sources of food, such as red meat, poultry and full-fat dairy products especially whole milk. They raise high-density lipoprotein (HDL or “good”) cholesterol and low-density lipoprotein (LDL or “bad”) cholesterol levels, which may increase your risk of cardiovascular disease.
Include good fats in your diet: Dietary fats are important for your body as it is responsible for supplying energy and to support cell growth. They also help in protecting your organs and help in absorbing nutrients and produce important hormones. The simplest way to differentiate good and bad fats is, good fats remain in liquid form at room temperature. Monounsaturated fats and polyunsaturated fats are known as “good fats” because they are good for your heart, cholesterol, and overall health. Some of these sources are nuts, olives, flax seeds, fish oils, etc. Bad fats are of two types, Saturated fat and Trans fat and these have been identified as potentially harmful to your health. Most of the foods that contain these types of fats are solid at room temperatures, such as butter, coconut/palm oil, margarine, beef or pork fat, etc.

Fish and lean meat are good options for individuals taking non-vegetarian meals: Lean meats and fish have relatively low-fat content and have high amounts of protein. Protein is an essential part of a balanced diet. Beyond protein’s essential roles in building and maintaining muscle and tissues in your body and helping regulate many body processes, it also promotes satiety fullness and may help in managing your weight.
Avoid consumption of red meat: Red meats (beef, pork and lamb) have more saturated (bad) fat than chicken, fish and vegetable proteins such as beans. Saturated and trans fats can raise blood cholesterol and make heart diseases worse.

Finally, remember that a healthy diet is a mixture of all foods you eat and not only power foods that you think are filled with necessary nutrients. Having the right mix of everything (protein, fats, carbohydrates and other nutrients) after Angioplasty is always regarded as healthy. So, speak to your cardiologist, get expert advice on it and work towards building meals that are aimed towards a better and faster recovery.

Hip Replacement April 16, 2020

Is Hip Replacement Surgery the Best option for Hip Pain?

Hip pain is not normal and can cause serious trouble if not treated wisely. Any discomfort or painful sensation near the thighbone or pelvic girdle can be termed as hip pain. The hip joint is a ball and socket synovial joint that is responsible for providing a wide range of motion for the lower torso. It is because of the hip joint one can stand, walk, dance or lift. It is also considered as one of the most important joint when it comes to stability. However, as the person ages, the joint may undergo wear and tear.

Though hip pain to an extent can be treated with medication, injections and physical therapy, hip replacement surgery is the safest and the best option to treat hip-related problems when nothing else finds success in relieving the pain. A hip replacement could be recommended to any patient, in case they are suffering from chronic hip pain which is hindering their daily activities and other non-invasive methods of pain reduction have proved to be ineffective or are no longer effective to improve their condition. A patient with symptoms of severe hip arthritis, including as stated below, could be suggested to go for Hip replacement surgery.

1) Hip pain: An aching hip can make any patient’s life miserable. The most vital factor in selecting to have a hip replacement is quantifying the extent to which pain is affecting a patient. Pain that leads to interference in performing daily activities, even not letting anyone have a sound sleep, and is restricted between hip and knee could indicate arthritis of the hip. Some patients need the support of a cane or are also seen limping. A set of such patients regularly rely on pain-killer consumption to deal with their pain. In such cases, doctors usually suggest a patient with a replacement surgery to get long-lasting relief.

2) Stiffness: Difficulty in performing certain normal activities like doing weight training, cycling or even bending down for picking basic objects

3) Sprain: A sprain in a muscle occurs when the ligament is stretched than the usual limit causing the area to swell. A sprain can be caused by any sudden fall, twist, and turn of the muscle groups/joints.

4) Difficulty in weight-bearing: In case a patient is not able to stand on his/her paining leg even for a minute with support, it indicates that their hip’s condition is very bad and they need a total hip replacement surgery.

5) Muscle stress: When the body is stressed, muscles tense up. Muscle tension is the body’s way of guarding against injury and pain. For e.g when you sit in one position for some time, you may end up making them stressed. This causes a change in the body’s nervous system by contracting blood vessels and reducing blow flow.

6) Fractures. A hip fracture is a fracture of the upper region of the femur or the thighbone. Fractures lead to swelling, difficulty in walking, sitting, etc causing severe pain.

Also, if the patient is suffering from Osteoarthritis or Osteoporosis, they can be advised to undergo a Total Hip Replacement. With Osteoarthritis, the joints become stiff and swollen due to inflammation and a breakdown of cartilage, causing pain and deformity are observed. Talking about Osteoporosis, it is a bone disease that occurs when the body loses too much bone, makes too little bone, or both.

So, in case you are experiencing severe pain with no sign of pain killers bailing you out of the dreadful situation, a hip replacement surgery then can be regarded as the best treatment option. Remember that the surgery option should only be considered when all other conservative treatment options have failed to provide relief from continuous hip pain and restricted mobility.

Also, remember that whatever the cause is, hip pain is more common as you grow older. And over time, your joint will see a lot of wear and tear. So make sure you are taking adequate care of the joints by eating healthy and doing the right exercises to keep your bone health at its best.

Heart Attack August 21, 2019

Stent Implantation Demystified: The Whats And The Whys

Undergoing a stent implant is daunting for most people, but having information at hand can demystify the process and make the situation a tiny bit less scary. While most of your questions can and should be answered by your cardiologist, here are a few things you should know about before getting a stent.

What is a stent made of?
After all, in some situations like metal stents, it is likely to be a permanent part of your body going forward. To understand what stents are made of, let us quickly go over what stents are and what they do. As the cardiologist may have already informed you, our hearts are supplied blood by a network of arteries known as coronary arteries. With age and improper lifestyle, these arteries narrow and become filled with plaque deposits which can lead to Coronary Artery Disease, heart attacks, or even death. A coronary artery stent is simply a small, self-expanding, metallic mesh tube meant to be inserted inside the artery post a procedure referred to as balloon angioplasty. The stent keeps the artery wide open and the blood flow, continuous. Now as to their make, stents were traditionally made of a metallic or plastic mesh-like substance; however, stent-grafts are manufactured from fabric. These metallic stents are classically composed of medical-grade metal alloys including stainless steel, nitinol (nickel-titanium alloy), cobalt-chromium alloys (L605). However, these stents are fast falling out of favor. The most common type of stents in use these days, in fact, the ones that are the standard of care presently, are DES or Drug-Eluting Stents. These stents are not only made of polymers that dissolve in one’s blood after a few years but are also coated with drugs that reduce the risk of blockages.

Why is DES the standard of care?
The biggest advantage of DES is that they have thinner struts which can be as thin as < 100 μm, with some ultrathin struts reaching approximately 60 μm. This is vital as the thinner the strut, the lesser chance there is of restenosis or the recurrence of abnormal narrowing of an artery. Thinner struts have also been found to cause a lower inflammatory response which could potentially lead to clotting.
The other benefits of these stents are that they allow the artery to return to its natural shape and curvature, promote early healing, and allows for flexibility and normal dilation and constriction.

Advantages of stents
1) First and foremost, stents literally save lives by alleviating the damage that happened to one’s heart muscles during the heart attack. It does so by replenishing blood flow to one’s heart.
2) Immediately relieve/decrease symptoms of heart disease.
3) Reduce the risk of heart attack or stroke in the future.
4) Getting a stent placement may diminish the need to undergo a CABG (Coronary Artery Bypass Grafting).
5) Stenting is not only comparatively much less invasive versus CABG it also boasts of a much shorter recovery period.

Disadvantages of stents
1) One can get an allergic reaction from one’s stent
2) Angioplasty can result in hemorrhage of a blood vessel or even heart damage, or arrhythmia.
3) In rare cases, complications such as heart attack, stroke or renal failure can also occur.
4) Post-stenting scarring may occur that may require another procedure to remove it.
5) There is a risk of further blood clot formation; however, the cardiologist will already have you on blood thinners for prevention.
6) Stenting is not a cure for coronary artery disease. One needs to be vigilant about one’s diet and exercise while managing the contributing risk factors for coronary artery disease such as hypertension, higher body weight, diabetes, or high cholesterol.

So there you have it, a short primer on stents, how they are made and what you should be aware of while getting them implanted. Hope it has been of help!

Knee Replacement August 21, 2019

From Pain To Freedom: A Total Knee Replacement Patient’s Journey

Mr. Gonsalves was leading a normal and active life till arthritis crept up and set his life in turmoil. From being an active 60+ grandpa, he soon became confined to his bed and dependent on his walker. After years of physical therapy, medication and non-invasive procedures, the pain simply did not subside. Faced with debilitating pain that prevented the senior citizen from even getting a good night’s sleep, his family doctor and orthopedic surgeon recommended a Total Knee Replacement as the solution to the problem at hand. Six months post-surgery,
Mr. Gonsalves is now a changed man who has gained a new lease at life. Here is his side of the story.

What made you choose to undergo a Total Knee Replacement?

Unfortunately, all the initial efforts at managing my condition like physical therapy, medicine and more, failed and I was left battling the pain and restricted movement. As someone who previously led a very active life, picking up my grandchildren from the bus stop, going for a walk with my friends every morning, this condition started affecting me mentally and emotionally. Lastly, my family doctor and orthopedic surgeon recommended Total Knee Replacement as the solution to my condition.

Was it an easy decision to make?

To be honest, I was a little apprehensive about undergoing the surgery as would anyone who is in this situation. Fortunately, both my family doctor and orthopedic surgeon were very helpful when it came to assuaging my doubts and fears. They told me that this procedure is one of the most common orthopedic surgeries in the world with a vast majority of people experiencing significant improvement in pain and mobility after the procedure. The final decision to undergo the surgery was made cooperatively by me, my family, my family physician, and my orthopedic surgeon. Here I must add that my family physician first referred me to an orthopedic surgeon for a thorough evaluation to determine whether I might benefit from this surgery.

Would you recommend a knee replacement surgery to lakhs of people suffering from knee pain?

Only if your condition is unmanageable through non-invasive means like mine was, will they recommend the surgery. In fact, your orthopedic or family doctor won’t recommend you undergo one without due cause. In most cases, the patient’s family doctor will recommend the patient to an orthopedic surgeon who will evaluate if the patient is the right candidate for Total Knee Replacement. This was the process that I myself underwent before undergoing the surgery. From what I realized after having spoken at length with my orthopedic surgeon is that they only recommend surgery if:

The patient has severe knee pain that restricts their movements. These include regular movements like walking, climbing stairs and sitting in and getting off chairs. The knee pain in such cases is usually so severe that one cannot walk too far without significant pain or the use of a cane or walker.
The pain interferes with the patient’s resting or sleeping both during day and night.
The inflammation and swelling are severe and do not improve with rest and medications.
The knee starts showing signs of a deformity like bowing in and out.
Lastly, when everything from anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries have failed.

How is your life post-surgery?

To say that it is incredible is an understatement! I feel as if I have got a new lease in life. The reduction in stiffness was almost immediate after the surgery. The pain took some time to go, but that was because of the surgery itself. Now I can confidently state that I am pain-free and happy! I was able to walk with the help of a walker almost 24 hours after surgery and was driving within 6 weeks. I am back to my old routine and my grandchildren are thrilled to have their grandpa back at school pick-up duty! Going for walks and socializing with my friends is also something I really enjoyed getting back to. All those years of pain and discomfort seem like a bad memory now. I am so glad to have undergone the surgery and would advise anyone in severe and unmanageable knee pain to undergo the surgery instead of waiting for their condition to worsen. I made my choice and I am truly thankful that it was the best one for me!