Hip Replacement [Part – 1]

Hip replacement surgery is a common procedure to treat severe cases of osteoarthritis and injuries (fractures) that affect the hip joint, resulting in pain and reduced mobility. The procedure involves removing the affected hip joint and replacing it with one made of metal, plastic or ceramic components. The surgery is usually performed when other treatment options have proven to be ineffective and once completed the patient can usually look forward to the disappearance of the pain and the regaining of mobility with the new joint.

The Procedure

There are two ways of performing the surgery – the traditional one where the incision on the side of the hip is 8 to 10 inches long and what is called the minimally invasive technique where the incision is usually 2 to 5 inches long. The minimally invasive technique is thought by many surgeons to reduce blood loss during surgery, reduce post-operative pain, shorten the hospital stay and minimize the scarring. The decision on what type of procedure to use will depend on patient related specifics.

In general the process is the same in both cases. 

• The patient is given either general or spinal anesthesia to put him or her to sleep and prevent any sensation of pain during the surgery.
• An incision is made along the side of the hip though which the muscles connected at the top of the thigh bone are moved aside to provide access to the hip joint.
• The ball section of the joint is then removed by cutting the bone with a special surgical saw.
• The artificial joint is then put into place and attached to the thighbone using either special cement of some other material that will allow the new material to attach to the bone.
• The surface of the hip bone is then cleaned of any damaged cartilage and the replacement socket is attached.
• The ball is then inserted into the socket.
• A temporary drain may be put in place to drain any fluid that collects over the next few days.
• The muscles are then reattached and the incision closed.

The Recovery

A typical recovery will be as follows:

• The post-operative hospital stay is normally between 5 to 7 days.
• While in bed a cushion or other object is usually taped between the legs to ensure the new joint remains in place.
• A drainage tube will be placed in the bladder to allow for urination.
• A drip of glucose and / or any other substances or medications or pain relievers the doctor advises will be put in place.
• Physical therapy will normally begin the day after the surgery.
• Walking with the use of a walker or crutches may begin after 2 or 3 days.
• Physical therapy and exercise will continue for some months after the surgery until the muscles return to normal and the hip movement is free and without pain.

On Returning Home

The amount of rest and relaxation at home will depend on the health of the individual. It is important to not over do things and follow the doctor’s instructions. In general:

• Avoid climbing stairs until approved by the doctor.
• Sit in a chair with an upright back. Avoid the use of recliners.
• Remove all carpets and rugs from the floor to reduce the chances of tripping while walking.
• Avoid excessive bending that will place stress on the new joint. Use an elevated toilet seat to prevent bending the hip too much.
• Be careful in the presence of small children and pets who may jump on you and cause a fall.
• Get adequate rest and nutrition.

The next stage of the recovery process will be covered in the second part of this blog.

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The Ignored Ache

No textbook of Psychiatry could have taught me better to decode and to comprehend the sufferings of the unrest mind as patients do.

This patient walked me through the agonies of his mind which was fast sinking through unfathomable depths and a mind which kept trying hard with utmost rationality to decipher the reasons behind the struggle. I have never understood Depression better.

"I am no longer what I am doctor..." and thus he started his narration and his ordeal with his mind. It started with nagging headaches and near constant aches that refused to wash away with cups of caffeine or pain killers. Gradually unending episodes of fatigue & exhaustion started sapping me up and I realised that it was not just physical any more. My mind refused to lighten up. The smiles of my children were no longer contagious, music and television appealed to me no more. I stopped reading and talking to my friends..the world no longer mattered to me..The most minuscule acts of daily life like showering or dressing seemed totally overwhelming. I remember the dreadful long hours I looked at the comb with an absolutely shocking lack of will and drive to groom myself. Darkness loomed large and my mind kept rapidly filling up with irritatingly repetitive thoughts of doom, dread and catastrophe. I wished to sleep it all off but I realised that darkness was even more agonising. Sleeplessness haunted me..My wishes to end it all kept growing by the day. I feared the day when my death instincts would overpower my reasons to live. Panic and uncertainty kept ripping through me..I kept cuddling up near my child just like an infant wanting to be nursed. I wanted to be embraced, wanted something or someone to get rid of my soul shattering pain. I failed to find a reason try as I might. I am no longer a father, a husband, a boss ..I am no longer what I am doctor"

The sufferings of a depressed mind cannot be explained better. Depression is a medical disorder. It is one of the biggest public health challenges because of its high incidence. Research globally as well as in India suggests that at least one in 5 women and one in 10 men suffer from major depressive disorder at sometime in their lifetime. Medical science has given neurobiological underpinnings to the disorder. Genes, faulty neural circuits, abnormal levels of chemical messengers in the brain can all be important causal variables. Psychosocial factors like recent losses, relationship failures, and stressful environment intertwine with biological vulnerability leading to this illness. It is time to clear common misperceptions of the illness.

1. It is important to understand that Depression need not have a psycho social cause all the time. In several cases it occurs out of the blue. It is then called an endogenous or melancholic depression which endorses the biological nature of the problem.

2. Having a Depressive Disorder does not equate with 'weakness of mind'. In fact the strongest willed are sometimes more susceptible to it.

3. Depressive Disorder can be treated. Pharmacotherapy, psychotherapy or a combination of both works. What works for whom is decided by the mental health professional on the basis of the severity of the illness, symptom profile and cause.

4. Anti depressants work by helping regulate the disordered brain chemistry and are not sedatives as widely believed.

5. The usual course of treatment is between 6-9 months and not life long as widely misconceived. Being in good health includes being in good mental health.

Let's fight and help fight those with the ache in the psyche. Let's fight depression! Only then you can be truly who you are!

Article by Dr. Yamini Kannappan, Psychiatrist, Kauvery Hospital

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Flooding and Communicable Diseases

Chennai, Kancheepuram and Tiruvallur Districts of Tamil Nadu experienced unprecedented amounts of rain, followed by devastating floods in the first week of December, 2015. The immediate need of the hour in these areas is to take precautionary measures to prevent post-flood epidemic outbreak of communicable diseases. Against the backdrop of typical tropical climate, these three districts are at an increased risk of the outbreak of the following communicable diseases.

•     Waterborne diseases such as Typhoid, Leptospirosis, Hepatitis A and Cholera
•     Diseases such as Dengue Fever, Malaria, Yellow fever and Hemorrhagic Fever  
      spread mainly by mosquitoes

When there is a significant displacement of population and when post-flood water sources become contaminated, the potential of an epidemic of such diseases is rather high. Of the diseases named, Cholera is one dreaded disease to be doubly guarded against.

Causes, Symptoms and Treatment of Cholera

The bacteria Vibrio Cholerae that cause this dangerous disease can contaminate easily the following common sources of food and drink.

•     Food and drinks sold by street vendors
•     Ice made from municipal corporation water
•     Municipal water supplies
•     Raw or undercooked fish/seafood caught in polluter waters, especially if contaminated by sewage

When food prepared with contaminated water is eaten, or contaminated water is drunk, the bacteria release a toxin that produces severe diarrhea.

Symptoms

The symptoms of cholera can be noticed as soon as a few hours, or in about 5 days after the infection has occurred. Symptoms are often mild, but sometimes they can be very serious too. One in 20 may have severe watery diarrhea together with vomiting.

Diarrhea accompanied by vomiting can lead to dehydration. Even people only mildly affected are potential carriers of the infection; if they are not identified and treated immediately, the illness can spread quickly from them, causing an epidemic.

Dehydration will lead to:

•     Low blood pressure
•     Rapid heart beat
•     Loss of skin elasticity
•     Increased thirst
•     Dry mucous membrane in the nose, as well as the mouth, eyelids and throat
•     Muscle cramps

When dehydration is left untreated, it can lead to shock and consequently certain death, in a matter of hours.

Treatment

Though a vaccine is available to prevent cholera, its effects last only a few months and it may not save one in two who receive it; taking other precautionary measures, therefore, for prevention of the infection is a much better solution.

The mainstay of treatment for cholera is to stay hydrated. Depending on the severity of the diarrhea, the treatment will comprise oral medications or intravenous solutions, to compensate the loss of fluids from the body. In mild cases, antibiotics may be prescribed but not as part of emergency care treatment.

Protective Measures

Ensure that you use only boiled, chemically treated, disinfected or bottled water for the following purposes:

•     Drinking
•     Preparation of food or beverages
•     Washing vegetables, fruits and other edible products that require to be washed
•     Making ice
•     Washing hands and face
•     Brushing teeth
•     Washing utensils and dishes used to prepare food or to serve

To ensure that you have clean water, boil water for a minute, filter, and add a commercial chemical to disinfect.

Furthermore, avoid eating raw foods, including:

•     Raw and under-cooked meat or seafood
•     Unpeeled fruits and vegetables
•     Fish caught in waters which could be contaminated
•     Unpasteurized milk or milk products

In the event of developing watery and severe diarrhea self or any other, please notify and seek immediate medical help. Cholera is treatable if reported promptly, but the ensuing dehydration can cause serious complications, and therefore it is important to seek treatment immediately.

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Know Your Child’s Heart

Every year, at least 3 to 8 out of every 1000 babies are born worldwide with defective heart. In addition, a small proportion of children who are born with normal heart acquire heart conditions such as Rheumatic heart disease, Kawasaki disease, Myopathies etc.

Rheumatic heart disease usually follows a simple throat infection caused by the bacteria called beta-haemolytic streptococcus, which in some children damage the heart valves causing their malfunction.
Kawasaki disease starts as a fever, subsequently affecting the coronary arteries leading to complications such as heart attacks in children.

Myopathies are diseases of the heart muscle usually caused by some viral infections. The heart muscle weakens and becomes ineffective in its function as a pump, resulting in heart failure.

It is very important to suspect and diagnose these heart defects early. All these defects CAN be corrected with appropriate treatment. It IS possible for you to protect your children from these illnesses and help them live normal and full life.

Who is a paediatric cardiologist?
A Paediatric Cardiologist is a Children’s Heart Specialist who specializes in diagnosing heart diseases in children and offers solutions for normal life and growth.

When do parents need to take their children to a paediatric cardiologist?

• When either of the parents OR a previous child OR a close relative in the family has been diagnosed with a heart defect previously
• When the parents suspect that their child may have a heart problem

When should the parents suspect a heart problem in their child?
When the child shows any of the following symptoms:

As a baby: Breathing fast (tachypnoea), very slow interrupted feeding (suck-rest-suck cycle), sweating over the head while feeding (diaphoresis), poor weight gain (failure to thrive), going blue or dusky all over the body while crying (central cyanosis).

As an older child: Getting tired easily while playing (exertional fatigue), getting frequent chest infections (pneumonia), complaining of chest pain (palpitation), complaining of giddiness (syncope) and bluish discolouration (cyanosis).

How does the Paediatric Cardiologist check the baby’s heart?
The Paediatric Cardiologist checks the baby clinically for abnormal discolouration (cyanosis), abnormal pulse (rhythm disturbances and heart function) and abnormal heart sounds (murmurs). The common tests undertaken are Chest X-Ray (to see the position and size of the heart), ECG (to check the heart rhythm) and Echocardiography (to check for any structural problems in the heart and assess the heart function).

Can heart problems of babies be detected during pregnancy?
Yes, it can be done by using Foetal Echocardiography at 16-20 weeks of pregnancy. Elderly diabetic mothers, those with birth defects of the heart, and those who have previously given birth to babies with heart defects are advised foetal echocardiography.

What are the heart problems usually seen in children?
Heart problems in children may be CONGENITAL: these are defects at birth which are of two kinds – simple and complex.

Simple defects are those such as holes in the heart (ASD, VSD, PDA) and blocked valves (Aortic stenosis, Pulmonary stenosis, Coarctation of Aorta).

Examples of complex defects are blue baby conditions (TOF -Tetralogy of Fallot, TA -Truncus Arteriosus, TGA - Transposition of Great Arteries).

Heart problems in children may also be ACQUIRED: children have a normal heart at birth and then their heart becomes diseased (Cardiomyopathy, Rheumatic heart disease, Kawasaki disease).

Can these heart problems in children be cured?
About 95% of heart problems in children can be treated successfully. Majority of the simple problems can now be cured without operations by device closures and Angioplasty. Conditions cured without surgery are ASD, VSD, PDA, Coronary fistulas, Aortic stenosis, Pulmonary stenosis, Coarctation of Aorta. These procedures are carried out first by inserting small tubes called catheters into the heart through the blood vessels in the leg. Next with careful manoeuvres through the catheter, the holes in the heart are closed with devices; or the blockages in the heart are opened up with balloons and stents.

The advantages of these procedures are:

• complete cure of the heart without a visible scar on the body
• without blood transfusions
• without pain
• minimal hospitalisation period (usually 2-3 days)
• without a need for post-procedure resting period.

The complex blue baby conditions also have very good surgical solutions these days, providing the growing child with an excellent quality of life.

For more details on these procedures log on to www.hxplain.com

Article by Dr. R. Prem Sekar, Senior Consultant Interventional Paediatric Cardiologist, Kauvery Hospital, Chennai

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Importance of Immunizing a Child

Remember the old adage – “Prevention is better than Cure”? Well, immunizing your child is just that. There are certain diseases prevalent worldwide, especially in India, which can lead to dire consequences – even death. Diseases such as measles, diphtheria, mumps, polio, whooping cough, tetanus, rubella or German measles, Haemophilus influenza and rotavirus can all be prevented with vaccinations.

For instance, “Small Pox”, one of the most disfiguring diseases has been wiped off the face of our planet, thanks to the invention of an excellent vaccine. Immunizing your child helps not only protect your child effectively, but also prevent all the diseases named above.

Vaccines contain antigens that help the body produce antibodies to fight the disease causing germ. True, a vaccine contains in part the viruses or bacteria that cause the disease, but the immune system fights and destroys or weakens the viruses/bacteria, so that your children do not become sick. Children develop immunity through vaccinations and thus we, as parents, can help protect our children from contracting the actual disease.

Here are a few more facts why immunization is important.

1. A newborn baby is immune to many diseases as the baby has got the necessary antibodies from mother. The immunity, however, is effective only for the duration of the first year of life.
2. Prior to the advent of vaccinations, many children died from diseases such as measles, polio, and whooping cough. An unvaccinated child exposed to any of these diseases is not usually strong enough to fight the disease. Immunization with proper and timely vaccinations gives the baby better protection and a better fighting chance against these harmful diseases.
3. Diseases caused by failure to administer vaccinations lead to frequent visits to the doctor, hospitalization, loss of time, dislocation of work, avoidable medical bills and in some cases premature death.
4. Immunization of every child assures a healthy and wealthy future of the nation, as health is the real wealth.

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Stay Safe from Dengue Mosquitoes

Stagnant waters of any type are favorite breeding grounds for all types of mosquitoes. With the recent downpour and flooding of Chennai City and many districts in Tamil Nadu, there are pools of undrained stagnant water in many places.

Rainwater by itself is harmless, though it does carry many pathogenic material, such as bacteria, pollutants, algae, plant parts, soil, mold, fungi, amoeba, pesticides, dust, protozoa, lead, arsenic and insect parts. This kind of contamination can be expected in a large city. Pools of stagnant water or slow draining water provide ideal breeding grounds for many insects, including mosquitoes. Add poor and inadequate sanitation facilities to the mix, and an epidemic is waiting to happen.

Lay to rest the thought that Dengue mosquitoes only breed in clean water. Research has clarified that these mosquitoes may breed in clean waters sprinkled with dust or in muddy waters that have been stagnant for 6 days and more.

Dengue flourishes in Chennai, in the months of July, October, November and peaks in January. July generally is the month when the Monsoons from the west coast of India, drop a few showers in Tamil Nadu, but October and November are generally the months when the East Coast Monsoons inundate the state.

For the year 2014-2015 dengue cases and deaths are reported to be 2357 cases from January to Mid-September, which includes 5 deaths. Of the 2357 cases, 80 cases were from Chennai City. There has been a rise in the number of dengue fever cases, as against 1146 cases reported in the previous year.

The following districts in Tamil Nadu have been earmarked as high risk districts for cases of dengue fever.

1. Dharmapuri
2. Krishnagiri
3. Salem
4. Theni
5. Tirupur
6. Trichy

Symptoms

Children and teenagers may not exhibit signs or symptoms in mild cases of infection. The symptoms normally surface 4 – 10 days after the person has been bitten. Signs and symptoms to watch out for:

1. High Fever (106F or 41C)
2. Pain behind the eyes
3. Headaches
4. Bone, Muscle, and joint pain
5. Rash all over the body
6. Minor bleeding from gums or nose
7. Vomiting and nausea

Recovery is generally within a week, but in cases where the infection is severe, the following symptoms will be prevalent, as the blood clotting ability of the body drops:

1. Bleeding from the nose and mouth
2. Bleeding under the skin, which could look as if there are bruises
3. Severe abdominal pain
4. Lungs, liver and the heart show signs of distress
5. Persistent vomiting

Causes

There are 4 types of dengue viruses spread by mosquitoes that flourish around human dwellings. After a mosquito bites a human being having dengue virus, it in turns becomes the vector. When this mosquito vector bites the next person, that person gets infected with the dengue virus. If a person has had dengue fever once, though they do develop an immunity to that particular strain, they, however are now at high risk to being infected by the other three strains. Besides, such people are in the high risk category to develop dengue hemorrhagic fever.

Prevention

Dengue fever vaccines are still in the nascent stage of development. Therefore, it behooves that precautionary measures be taken to stay safe.

• Live or stay in air-conditioned housing or dwellings where there are mosquito screens on windows / mosquito protective gear
• Ensure good lighting. Contrary to some understanding, that these mosquitos bite in the dawn, dusk and evening hours, it has been proved by research, that dengue causing mosquitos like to feed (bite) in the dark
• Wear long sleeved protective clothing, long pants, socks and shoes when in mosquito infested areas
• Use mosquito repellents, coils and chemicals
• Ensure you do not create mosquito breeding habitats such as old automobile tires

If you have been unfortunate to have been affected by Dengue Fever, please contact a doctor immediately and get treated. 

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Removal of Gallbladder by Laparoscopy

The Gallbladder is a small organ located under the liver. Its purpose is to store the extra bile produced by the liver, and secrete it to the small intestines, where the bile aids in the digestive process. The bile is a fluid and is composed of:

• Cholesterol
• Bile Salts
• Bilirubin (an orange-yellow pigment in the bile formed as a breakdown product of haemoglobin)

The bile thus helps digest the fat in the food that is consumed.

Gallstones that are formed in the gallbladder can happen due to several reasons, such as genetics, reduced motility in the gallbladder, diet and body weight. There are two types of gallstones:

• Cholesterol stones: In 80% of the cases, the gallstones are of this type. They are greenish yellow in colour. The cholesterol stones form when there is too much cholesterol in the bile. Another reason for cholesterol stone formation is attributed to the inability of the gallbladder to empty itself quickly.
• Pigment stones: Made of bilirubin, these stones are smaller in size and darker in colour. These stones are more common in people with certain medical conditions like cirrhosis of the liver, and blood disorders such as sickle cells or anaemia.

Risk factors for developing gallstones

• Hereditary factor: Anybody with a family history of gallstones is at risk.
• Uncontrolled weight/obesity: Being one of the biggest risk factors, obesity can cause rise in the cholesterol levels in the bile, which prevents the gallbladder from emptying itself.
• Estrogens: High levels of estrogens too can reduce motility in the gallbladder. Pregnant women and those who have undergone hormone replacement therapy are at greater risk.
• Gender and age: Women and elderly people are more prone to develop gallstones.
• Cholesterol Medications: A few types of cholesterol-lowering medications can increase the amount of cholesterol in the bile, thus increasing the possibility of developing gallstones.
• Weight Loss and Fasting: Losing weight rapidly causes increased levels of cholesterol formation in the bile, which in turn causes the development of gallstones. Fasting causes the gallbladder to contract less, thereby increasing the chances of gallstones formation.
• Diabetes: Diabetic people tend to have a higher level of triglycerides in their blood. This is a big risk factor for formation of gallstones.

The Procedure
Laparoscopic gallbladder removal surgery or cholecystectomy is a very safe and effective procedure. There are very low risks involved in this surgery.

The surgeon makes four small (keyhole size) openings in the abdomen. A laparoscope with a lighted scope attached to a camera is inserted into the incision closest to the belly button. The surgeon uses a video monitoring screen for guidance while inserting the surgical instruments through the remaining incisions, to remove the gallbladder. Prior to removing the gallbladder, a special X-ray procedure called intraoperative cholangiography may be performed to view the anatomy of the bile ducts.

Anaesthesia
General anaesthesia is administrated prior to the procedure.

Post Laparoscopic Surgery

• The recovery time is very quick. You may be required to stay in hospital for 3-4 days.
• The bile will flow directly from the liver to the small intestine and will not affect the digestive process.
• Some discomfort maybe there for a week, but 10 days (normally), after the procedure, you will be able to resume all normal activities.
• No special diet is required.

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