Patient Education

Seek second opinion before planned surgery!
When it may be heart attack! (Dr. H.Sahota)
  • Chest pain, or pressure or tightness, palpitation-sudden or gradual
  • Shortness of breath, weakness, tiredness, arm or shoulder pain
  • Numbness; neck or jaw.- consult cardiologist
  • Tests done to confirm:  EKG, Echocardiogram, Stress Echocardiogram or Cardiac Nuclear test
  • 24 hour Holter, may require Angiogram
  • If intervention necessary-First thing to try is Balloon Angioplasty,( Perfusion Balloon ).
  • Bare Metal Stent or Drug Coated Stents required in patients with Recurrent Stenosis or with Diabetes, HT
  • Prevention with Life Style Changes  and Avoid Stress, Maintain weight, moderate exercise like walk for half an hour, no smoking, remain active

Stent insertion is one of the most abused interventions, go for it when essential. Take second opinion where possible

 

Dr. H.Sahota MD,FACC,FSCAI

LA USA, 001 714 272 03309

When Removal of uterus is mandated? (Dr. Dilpreet K)
  • Uterine, cervical and ovarian cancer
  • Abnormal Uterine bleeding not amenable to medical treatment
  • Dysmenorrhea of severe nature
  • Prolapsed pelvic organs
  • Large fibroid/ bulky uterine leiomyoma
  • Complication rate: 24.5% for vaginal hysterectomy, 42.8% for abdominal hysterectomy
  • Chronic AUB, desirous to retain uterus, uterine removal is inappropriate
  • Early age removal might result in health issues like cardiovascular diseases, osteoporosis, hip fracture, neurological and psychiatric disorders because of the hormonal disequilibrium
  • Need for optimal intervention with least morbidity

Dr. Dilpreet K

Consultant gynecologist GMCH

Chest ailments: most do not require hospitalization (Dr. S. K. Jindal)
  1. Lung ailments account for over 50% of visitsto doctors in India. Cough and phlegm from different causes constitute the most important symptoms for their visits.
  2. Respiratory infections inclusion tuberculosis (TB), asthma and other chronic lung disease are most common causes of respiratory disability.
  3. Most of the lung diseases can be adequately treated and/or controlled once the diagnosis is made and appropriate treatment started in time.
  4. Cough and sputum: The most common causesinclude Upper Respiratory Catarrh, Asthma, Lung Infection such as Tuberculosis and Interstitial Lung Diseases. Cough may be dry or productive with sputum expectoration. Sputum may sometimes be accompanied with blood i.e. hemoptysis.
  5. Breathlessness: It is an important symptom of various lung diseases but can occur due to heart ailments or other systemic illnesses including the presence of severe anaemia.
  6. Wheezing: Wheezing is the presence of whistling sounds due to the bronchial narrowing (i.e bronchospasm). The most common cause of wheezing is asthma. Wheezing can also occur in some other lung diseases such as Chronic Obstructive Lung Disease (COPD), Bronchiectasis, and Bronchial Obstruction due to as tumour (etc).
  7. Most of the lung diseases can be treated on outpatient day-care basis. Hospitalization is required for acute care or for purposes of specialized investigations and/ or treatments. Some of the important indications for hospitalization include the following:
    1. Acute severe attack of asthma
    2. Acute exaggeration of COPD
    3. Severe pneumonia
    4. Intensive care such as Acute Respiratory Distress Syndrome or other causes of Acute Respiratory failure.
    5. Specialized diagnostic or treatment interventions.

Dr. S. K. Jindal

(Ex-Professor & Head, Deptt of Pulmonary Medicine,

Postgraduate Institute of Medical Education & Research, Chandigarh)

Medical Director, Jindal Clinics

SCO 21, Sector 20 D, Chandigarh, India 160020

DENTAL IMPLANTS: use or abuse (Dr. Davinder)
  • Dental implants are newest method of replacement of missing teeth where functional as well as aesthetic loss is restored. Though, costly treatment but patients are opting for this method. In market its price ranges from 30,000- 45000, depending upon the design, size and manufacturing company.
  • Mostly done in where the bone is in healthy condition both in width as well as length wise.
  • Dental Implants are also done to replace fractured tooth, badly carious tooth and root stumps. The first line of treatment should always be for restoring the original fractured/ carious tooth rather than going for dental implant.
  • Some Dentists in the market are doing unethical practice by suggesting for replacement of above said tooth with implants. But restoration of original tooth should always be kept in mind how long may that tooth gives function instead of implant.
  • Misleading public notion that implant will survive forever sometimes leads to early tooth extraction. As dental professionals, we should avoid basing our treatment plans on thoughts and beliefs and stick as much as possible to evidence – based dentistry practice.

Dr. Davinder  MDS

Consultant dental surgeon GMSH 16

Have faith in Doctor! Seek second opinion before planned surgery!! (Editor)

A culture of over-investigation and over-treatment has set in with paradigm shift in seeking healthcare from specialists instead of family physician. It is now one of the greatest threats to health. It is estimated that at least a third of all healthcare activity brings no benefit to patients. Examples include excessive use of antibiotics, MRI/CT for simple headaches, use of surgery when watchful waiting is better and unwanted intensive care/ventilators for patients at the end of life who would prefer home care. ….. a fee-for-service model encourages high volume and expensive procedures. So called routine or comprehensive test done annually is another activity that robs the person and enriches the diagnostic centre.

Medical professionals have been guilty of exaggerating the benefits of medications often perceived as magic pills by patients when their benefits are often modest at best. This also detracts from more meaningful lifestyle interventions by giving the public the illusion of protection. One recent study revealed that those taking statins consumed considerably more food and ended up heavier after several years compared to those not taking statins. Over-obsession with cholesterol-lowering by any means has become “the end in itself.” Use of such medicines appears to be influenced by corporate interests.  At best, this is a contribution to over-medicalisation; at worst, this may seem like the behavior of a sort of lobby group for the device and pharmaceutical industry. Encouraging patients to ask specific questions will also help them understand that sometimes doing nothing is the best approach. Questions such as: do I really need this test or procedure? What are the risks? Are there simpler safer options? What happens if I do nothing? And how much does it cost-can the cost be saved? (New England Journal of Medicine)

However doctor can risk even his own life?

All is not decadent. Most doctors work for welfare of the patients.  A doctor can risk even his own life when it comes to saving a patient’s life! Recent earthquake brought out an example of such nobility!

“I was stitching up her uterus when the tremors came. I had to close it to stop severe bleeding. There was no question of evacuating the building as she would have died within minutes,” Sapkota told HT. The surgery was successful; the woman saved. Six hours after the quake, he found himself working at the same operating table, performing a caesarean section on a woman whose baby was in transverse lie- medical jargon for a baby lying sideways.”She delivered a healthy baby. And there I was holding new life, with death all around,” he smiled. “Nature’s ways are inscrutable.”

Protocol for Cataract Surgery (Dr. Jagat Ram)

How cataract occurrence manifests?

  1. Gradual progressive diminution or blurring of vision
  2. Increasing difficulty with vision at night
  3. Glare or halos around light
  4. frequent changes in eyeglass
  5. as if seeing through cloud

When to operate?

  1. When patient having cataracts begin to affect quality of life or interfere with ability to perform normal daily activities, such as reading or driving at night or professional work.
  2. When best corrected  visual acuity is 6/12 or less
  3. When density of cataract is appreciable on examination

What eye surgeon looks for ?

It  includes visual acuity, intraocular pressure, dilated pupil fundus examination to rule out age-related macular degeneration, retinal pathology, type of cataract, density of cataract, to rule out posterior polar cataract, associated pseudoexfoliation , subluxation or any corneal pathology like fuch’s atropy- is required. Other exam like blood pressure, blood glucose level and ECG also required

What type of cataract surgery?

Mostly it is Phacoemulsification with posterior chamber intraocular lens implantation. One should also explain what type of intraocular lens is being implanting i.e hydrophobic acrylic or hydrophilic or silicone. We prefer hydrophobic acrylic IOLs. One should explain whether mono-focal or multifocal IOL is being implanted and why along with cost issues!

Ethical issues in Cataract Surgery:

  1. Performing cataract surgery in a case where there is no cataract or only early cataract changes, is unethical unless there is other indications for performing cataract surgery such as associated narrow angle glaucoma or gross anisometropia, which must be explained to patient in details.
  2. Forcing patient to undergo cataract surgery when patient is not willing or is happy with the present vision
  3. Implanting multifocal IOL without explains its outcome/cost – advantages or disadvantages are unethical.
  4. Performing cataract surgery with intraocular lens implantation without explaining the outcome, without taking consent and without telling actual cost effectiveness is unethical.
  5. In case of occurrence of any complications during surgical procedure- hiding the actual complication and its management modality is unethical.

Dr. Jagat Ram

Professor AEC PGI

Joint Replacements - When It Is Essential and When Avoidable (Dr. Sarvdeep Singh Dhatt)

Joint replacement surgery has rapidly become one of the most commonly performed surgeries in our age.Earlier, we saw many old people suffering due to painful joints and receding to a mundane lifestyle. But, now we are seeing that many of these same patients get a healthier and more active lifestyle after these surgeries. Patients with painful knees on painkillers and when their activities of daily living are effected require to see an Orthopaedic surgeon to discuss their option of surgery.

The absolute indications for surgery are:

• – Intractable pain

• – Severe Osteoarthritis

• – Limitation of motion – Inability to flex the knee more than 90 degrees

– considerably limits functional capacity to rise from a chair.

• – Life expectancy is an important consideration because of the duration of the joint implant and the risk of future loosening or implant failure.

The most important contraindications are:

• – Acute infection

• – Severe obesity

• – Poor health and high anesthetic risks.

• – Poor bone stock

• – Significant deformities

• – Severe neuropathy

• – Poor knee extensor function.

• – Significant arterial disease.

• – Genu recurvatum knee deformity

• – Presence of a good knee arthrodesis.

Many of these patients can be managed with some exercises, and lifestyle modifications. According to an article published last year in Arthritis &Rheumatism, it was found that only 44% of the knee replacement surgeries could be classified as appropriate, with 22% rated inconclusive and 34% deemed inappropriate in the USA. The importance of preoperative function as a prognostic factor has prompted clinicians to intervene earlier, rather than later, in the course of functional decline. The question to be debated is that do the benefits in terms of prevention of work loss/loss of independence outweigh the risks of requiring another surgery [revision] down the road and/or costs of providing these surgeries in younger folks with less severe knees?” Therefore, whether to have Joint replacement today or not should actually be a shared decision-making process between the surgeon and the patient, where the benefits and complications of this surgery should be discussed in detail.

Dr Sarvdeep Singh Dhatt,

Consultant  Orthopaedic PGI

Getting rid of spectacles! (Dr. Arun K Jain)

LASIK surgery is one of the commonest types of cosmetic surgery for getting rid of spectacles.    Other alternatives for LASIK surgery are PRK [phtorefractive keratectomy] or ICLs [implantable collamer lens]. Before the surgery a number of screening tests/invetigations are done to know about the safety of the procedure. In any refractive surgery clinic approximately one third of the subjects are rejected for surgery because of contraindications or the individual opting out for the surgery for whatever reasons.  Even if all the tests are normal, still there is no surety that complications, won’t occur. It is very important to familiarize one-self with the procedure, educate yourself about various risks involved, discuss it with your eye doctor and once you are fully informed then only make a decision either way.

It is quite important to go through the consent form and discuss various issues regarding surgery.

Some risk factors:

  • When spectacle power is unstable or frequently changing.
  • Spectacle number is very high
  • Corneal thickness is too less
  • Tests like Corneal topography and tomography are not normal
  • Post LASIK residual corneal thickness is not adequate
  • keratoconus: subclinical or progressive

Problems after LASIK surgery

  •  Dry eyes 100%
  • Glare and haloes around light in most patients
  • Though rare, post LASIK ectasia is an important risk

Dr. Arun K Jain

Professor AEC PGI

When is removal of gall bladder mandated? (Dr. Amandeep S.)
  • Gall Bladder Trauma
  • Gall Bladder cancer
  • Acute cholecystitis
  • Gall stones; large sized or several with non functioning gall bladder and pain
  • Gall bladder can be removed with Open abdomen or
  • Laparoscopic mode
  • 5 to 40 % patients develop symptoms like gastrointestinal distress and persistent pain in right upper abdomen after surgery, 20% develop chronic diarrhoea, may require medical treatment.

Dr Amandeep S.

Surgical Specialist, GMSH-16, Chandigarh.

Corneal Transplants: what is New? (Dr. Ashok Sharma)

*Corneal Transplant has been the standard of care for corneal opacification.

*Cornea being free from blood vessels, results of corneal transplants are good.

* Modern microsurgical techniques and availability of quality donor corneas have enabled corneal surgeons to perform successful corneal transplants even in children. * Patients with blood vessels in the cornea are prone to failure

*Recent advances in corneal transplant surgery aim to replace only the diseased layer also termed as component corneal transplants. The various components of the cornea, epithelial cells, epithelial stem cells, stroma and endothelium can be transplanted individually.

* Newer surgical procedures  viz. epithelial cell sheet transplants, deep anterior lamellar keratoplasty and endothelial keratoplasty are in practice.

*Surgical procedures such as cultured limbal stem cell transplant improves the ocular surface in limbal stem cell deficiency disorders.

*Patients with multiple graft failure and ocular surface failure not amenable to cultured limbal stem cell transplants (chemical injury, Stevens Johnson syndrome and ocular cicatricial pemphigoid) may be visually rehabilitated by performing keratoprosthesis.

* These patients need to be closely monitored for corneal melts, infection and intra ocular pressure rise.

*In the current scenario, judicious use of corneal surgeon’s armamentarium may eliminate corneal blindness. There is a caution to abuse of technology!

Dr Ashok Sharma

Director, Cornea Centre,SCO 833-834,  Sector 22 A Chandigarh

E mail: asharmapgius@yahoo.com; ashok.cornea@gmail.coM