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Studies show that heart disease is the leading cause of death worldwide. And, aortic stenosis is the most common valvular heart disease and the third most common cardiovascular disease after hypertension and coronary artery disease in the western world. It is also often referred to as a disease of the elderly however a lot of young adults have also been diagnosed with aortic stenosis. The disease can occur in a single valve or in a combination of the four valves.  Usually, aortic stenosis is most common in heart’s aortic valve and mainly occurs due to the buildup of calcium deposits that narrows the valve.  When it comes to the treatment for aortic stenosis, it completely depends on the severity of the patient’s condition. Suggesting a valve replacement surgery or advising patients with medication and lifestyle changes completely depends on the doctor. But, it is important to understand that no pill can cure aortic stenosis completely but there are few medications that may help in lowering down the risk and complications involved. Let us now look at the treatment choices available for treating aortic stenosis along with its cost in India.

Treatment of Aortic Stenosis

Aortic stenosis is a progressive disease, which means it will get worse with time. Due to this, aortic stenosis is measured as mild, moderate, or severe stages depending on how damaged your aortic valve is. Treatment options for aortic stenosis generally range from simple medications such as statins or surgical repair or replacement of the diseased aortic valve. No pill can cure aortic stenosis, but medication like statins can help you lower your cholesterol which can control your symptoms and lower the risk of heart attack and stroke for some time. However, anyone with aortic stenosis should be checked with an echocardiogram to determine treatment options. Although, medication may be appropriate only for a person for whom surgery is not an option or for someone who’s aortic valve condition is in a very mild stage without any major visible symptoms.

In most of the cases, aortic stenosis treatment requires surgical treatment to protect the heart from further damage. Generally, surgery for aortic stenosis treatment depends on each patient’s unique requirements and factors responsible for their condition. Two of such major surgical treatment options for aortic stenosis include aortic valve replacement and Balloon/surgical Aortic Valvuloplasty (BAV).

  • Aortic valve replacement: In this procedure, your diseased aortic valve will be replaced with the mechanical valves made of metal or with valve tissue from pigs, cows or human donors using traditional open-heart surgery or Transcatheter Aortic Valve Replacement (TAVR).  Undergoing a TAVR surgery is a better treatment option as it is a minimally invasive procedure involves placement of a new valve over the patient’s diseased valve via a catheter inserted through the femoral artery and hence result in quicker recovery post procedure enabling the patients to go back to their normal lives.
  • Balloon/surgical valvuplasty (BAV): It is a less invasive procedure because it is done by inserting a long flexible tube with a deflated balloon on its tip into the blood vessel from the groin. When the tip reaches the valve, the balloon is inflated which helps to open up the stenotic or stiffed heart valves and increase the blood flow through the heart.

Why consider India for aortic stenosis treatment?

According to doctors, aortic stenosis treatment in India can be obtained at highly economical rates as compared to the Western world. Due to low treatment cost and a high level of expertise for cardiac diseases including aortic stenosis, India has become a leading destination for medical tourism in the world. Generally, the treatment cost for aortic stenosis in India depends upon multiple factors such as the selected treatment procedure, used technology, the severity of the disease, location, pre- and post-operative care demanded and other selected services. However, irrespective of any procedure selected for aortic stenosis treatment such as a SAVR, TAVR or balloon valvuplasty, the cost is less than the hospitals in western countries. People visiting India for treatment are not only from neighbouring countries like Bangladesh, Afghanistan and Nepal but also from far off countries like Kenya, Nigeria, Iraq, Yemen, Kazakhstan, Iran, Uganda and Oman. In India, aortic stenosis treatment is preferably carried out at a number of well-renowned multi-specialty and super-specialty hospitals located across a number of metropolitan cities of India such as Mumbai, Delhi, Chennai, Hyderabad, Pune, etc. These hospitals offer world-class facilities and doctors who are well-versed in performing these surgeries, even in the most challenging situations.

According to global standards, the cost of aortic stenosis treatment in India ranges from a few thousand rupees a month. As per an estimate of 2016, the mean cost for TAVR procedure in the US were 69,592$ vs 58,332$ for SAVR. As compared to these estimates, TAVR cost in India is roughly half (34,900$) to that of the US hospitals. In simpler terms, the cost of TAVR surgery in India is estimated to be 18 to 20 lakhs which is 3 times lower versus any hospital in the western world.

These numbers along with the quality of treatment provided in India and effectiveness of TAVR are clearly responsible for a spike in the numbers of international patients. This means that the trend has clearly changed in the past decade in terms of treating a faulty valve and allowing individuals to live those additional years with greater quality of life or in an improved health state.

Today, the healthcare industry is simmering with innovation and new ideas. Transformation is happening at an astonishing pace and redefining the way in which patients are treated for any health-related issues. New-age technologies have boosted the success rate and are also turning out to be less invasive as compared to older methods. Especially, when it comes to treating hip pain and improving patient’s quality of life, hip replacement surgery is one of the most advanced and successful procedures in today’s medical space. Traditionally, Orthopaedic surgeons use to prefer a total hip replacement surgery by incising back or on the side of your hip. However, in recent times, surgeons prefer incising a cut in the upper part of the front thigh. This approach is called an anterior approach or anterior hip replacement. These surgeries may also be called mini, modified, minimally invasive, or muscle-sparing surgeries. The procedure involves replacing a damaged hip joint with an artificial hip that can be of metal or ceramic.

Though there are various approaches to the hip that can provide an exemplary outcome, over the past several years, the anterior approach has become more popular because of its minimally-invasive technique. Also, it lowers the risk of complexity before, amid and after the surgery. However, adopting this technique is highly preferred in patients with arthritis, but can also be used for patients undergoing THR due to any other reason like hip fracture, disorders that cause unusual bone growth (bone dysplasias), etc. A lateral or posterior hip replacement surgery and anterior hip replacement approach vary in certain ways but both the approaches share the same objective. Both the approaches are devised to provide adequate pain relief from the hip joint and allowing the patient to perform their normal chores with great comfort. Now let’s take a look at some benefits of Anterior Total Hip Replacement.

Benefits of anterior Total Hip Replacement

  • Compared to ancient science, after anterior THR, a patient suffers from less pain without causing much damage to surrounding tendons and muscles, which leads to a rapid and smooth recovery.
  • The patient will no longer need to be kept under observation post-surgery and can be allowed to go home immediately as per doctor’s advice.
  • Once the surgery is completed, it allows an option for the patient to walk out of their bed and cover small distances independently using any walking aid as soon as it’s comfortable.
  • The patient can also navigate through stairs with ease and comfort. While pursuing the stairs, lifting the stronger leg first onto the steps and starting with the weaker leg when coming back down through the stairs helps in preventing dislocation of the new implant. It is common for the patients to use cane, walker or any other equipment for walking assistance immediately after the surgery.
  • With the lateral or posterior approach, patients have to avoid bending and even sitting with their legs crossed for 6 – 8 weeks as this could result in hip dislocation. But with anterior approach patients are not restricted from any of these activities.

Life after anterior Total Hip Replacement

After implementing a successful anterior THR surgery, patients are able to bear weight on their new hip and can walk easily using any walking aid as per their support. The only thing that patients need to make sure is that their home stairs have a guardrail or banister installed, as to avoid any temptation of walking up or down the stairs unsupported. However, patients will need a personal trainer to restore the strength and movement in their joints and surrounding muscles. Mostly it will take up to 4-6 weeks to gain ample strength for the movement and performance of the daily routine activities. One can resume work after anterior THR, as it allows the majority of patients to start working after a month but we would recommend waiting for up to 3 months if it involves physical labour. Patients can expect their lifestyle to be a lot like how it was before having surgery but without the pain.

Summing up, anterior hip replacement by far is less painful and leads to a faster recovery of mobility and strength compared to a lateral or posterior approach. However, the recovery process still involves distinct phases to ensure the tissue is healing properly which will allow optimum functionality. It is important for every patient to know that every case is unique and the progression will completely depend on their unique set of circumstances. But, an anterior hip replacement approach is mostly likely to add more quality to a patient’s life.

TAVR (Transcatheter Aortic Valve Replacement) is a fairly new therapy that has been developed in the last 15 years. It is a minimally invasive procedure invented to replace the diseased valves of the heart. Because of its high success rate and relatively less complicated nature as compared to the open heart approach, today TAVR therapy is at the top of the list when it comes to treating Aortic stenosis. From Europe to the United States to the Asian countries, TAVR therapy clearly is the preferred option for most of the surgeons in the new-age era. 

Earlier, more than 50 percent of patients were not recommended surgery due to various factors such as old age or other medical conditions. With TAVR entering the scenario, it has become easier for patients with complications to opt for better options. While TAVR comes with lower risk, it gives helpful treatment choices to individuals who might not have been otherwise considered for valve replacement. You are more likely to spend less time in the hospital after TAVR and it comes with fewer complications as compared to surgical valve replacement. 

If by any chance you have been lately identified with severe aortic stenosis then need not to panic. The best advice is to seek immediate medical care. The earlier you’ll pay medical attention, the quicker you’ll be able to get back to your normal life. Usually, your doctor determines the best possible way for replacing your faulty valve with a procedure that suits best for you. With TAVR, a small incision is made in the leg and hollow tube called a sheath is inserted into your femoral artery.

The thought of a heart valve replacement can be frightening. Fortunately, the less invasive TAVR is an option for more patients unlike earlier. Presently, only two Indian companies are making valves. TAVR is being performed in around 30 centers in India. Out of these centers, only 7 are considered to be the major ones. This is significantly less than the total number of cath labs present in India. The progress for TAVR in India remains rather slow with barriers at various levels. The probable reasons for such a lower number could be:

  • Reluctance among professionals.
  • High operative cost as compared to other procedures.
  • Regulatory approvals.
  • Lack of dedicated heart teams and specialized centers.
  • Lack of proficiency in TAVR.
  • Anatomical constraints amongst Indians not suited for the procedure.

As per the latest evidence, the average life expectancy post TAVR largely depends on the age factor of a patient. For example, for a 50-year-old patient, the average life expectancy is 31.5 years while it is just 4.6 years for a 90-year old patient. As per trials, the survival benefits are very limited when treating octogenarians (people between the age of 80-89 years) with TAVR. Also, co-morbid conditions of the patients such as diabetes or hypertension have a significant impact on the survival of patient after TAVR. More importantly, the quality of life in terms of activity and overall health receive a substantial boost after TAVR which is more beneficial in old age as compared to mere living.

As per an estimate of 2016, the cost for TAVR procedure in the US was 69,592$. As compared to these estimates, TAVR cost in India is roughly half (34,900$ i.e. Rs 26,11,387) to that of the US hospitals. In simpler terms, the cost of TAVR surgery in India is estimated to be 18 to 20 lakhs which is 3 times lower versus any hospital in the West. However, this cost is around six times higher vs. open-heart surgery. But, open-heart surgery is not suited for every patient. Particularly, for elderly patients with co-morbidities who are deemed to be at high surgical risk and form the major patient population. Hence, they need to undergo TAVR. At this moment, this procedure sets an extremely daunting task for the surgeons and the patient’s family to manage such a huge expenditure. Technical innovation in terms of device and procedural advancements coupled with the availability of indigenous device may ultimately aid in reducing the huge cost of this extremely useful treatment.

The choice to treat aortic stenosis with TAVR is made after you ask a group of heart surgery specialists, who cooperate to decide the best treatment option for you. Without a doubt, TAVR therapy is changing the trend and is already proving to alleviate the signs and side effects of aortic valve stenosis. With local manufacturers entering the space with top-notch products satisfying all the necessary standards, TAVR therapy seems to be the best possible option available for treating aortic stenosis even in India.

The word ‘arthritis’ is used to describe pain, swelling, and stiffness in one or more joints. However, it is not a single condition and there more than 100 types of arthritis and related conditions. The underlying cause varies with specific types of arthritis. It can cause everlasting joint changes and the common joint symptoms may include swelling, pain, stiffness, and decreased range of motion gradually.

These differences may be noticeable, such as lumpy finger joints, but usually, the damage can only be detected on X-ray. Apart from joints, some types of arthritis also affect the heart, eyes, lungs, kidneys, and skin. Although there are numerous types of arthritis, the two most common ones are Osteoarthritis and Rheumatoid arthritis.

Osteoarthritis

Osteoarthritis is a chronic (long-lasting) joint condition, affecting millions of people globally. In this case, the cartilage (protective tissues covering the ends of bones forming a joint) breaks down, causing the bones within the joint to rub together. Other causes may include dislocated joints and ligament injuries.

Signs that you may have Osteoarthritis:

  • Joint stiffness and soreness
  • Grating sensation
  • Bone spurs
  •  Loss of flexibility

Treatment of Osteoarthritis

A) General Management

Patients with osteoarthritis of the hand may benefit from assistive devices and instruction on techniques for joint protection; splinting (a rigid or flexible device that maintains in position a displaced or movable part) is beneficial for those with symptomatic osteoarthritis.

Patients with mild to moderate osteoarthritis of the knee or hip should participate in a regular exercise program (e.g. a supervised walking program, hydrotherapy (water cure) classes) and, if overweight, should follow a healthy and balanced diet. The use of assistive devices can improve functional status.

B) Medical Management

  • Oral nonsteroidal anti-inflammatory drugs (NSAIDs) – Common NSAIDs are ibuprofen and diclofenac; painkillers.
  • Topical therapies – Topical NSAIDs are applied to unbroken skin where it hurts in the form of gels, creams, sprays, or plasters.
  • Intra-articular injections – A term used to define a shot delivered directly into a joint with the primary aim of relieving pain.

C) Surgical Measures

Total hip and knee replacements provide excellent symptomatic and functional improvement when the involvement of that joint severely restricts walking or causes pain at rest, particularly at night. Total Knee Replacement is one of the most common surgeries in the world with a large majority of patients going on to lead rich, happy and healthy lives. It requires a surgery of 1-2 hours followed by a hospital stay of 2-3 days.

The knee is human body’s largest joint and is made up of the lower end of the thighbone, the upper end of the shinbone and the kneecap. A knee replacement includes replacing some or all of the component surfaces of the knee joint with artificial implants. A knee replacement is performed to repair the damaged weight-bearing surfaces of the knee joint caused due to inflammatory diseases or injury. The damage overtime leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease; a condition in which your immune system mistakenly attacks your body. It happens when your immune system targets your joints lining. While RA affects joints on both sides of the body such as both hands or both knees, it can also affect your whole body.

Signs that you may have Rheumatoid arthritis:

  • Joint pain, swelling, and tenderness
  • Morning stiffness for at least 30 minutes after waking up
  • More than one joint affected (hands or wrists)
  • Fever

Treatment of Rheumatoid arthritis

The primary objectives in treating rheumatoid arthritis are reduction of inflammation and pain, preservation of function, and prevention of deformity. Success requires early and effective medication. Disease-modifying anti-rheumatic drugs (DMARDs) should be started as soon as the diagnosis of rheumatoid disease is certain and then adjusted with the aim of suppressing disease activity. NSAID drugs are members of a drug class that reduces pain, decreases fever, prevents blood clots, and in higher doses, decreases inflammation and provides some symptomatic relief in rheumatoid arthritis but do not prevent erosions or alter disease progression. They are not appropriate for monotherapy (therapy that uses one type of treatment) and should only be used in conjunction with DMARDs, if at all.

Possible causes of arthritis may include injury, abnormal metabolism, inheritance, infections, or immune system dysfunction. Seek immediate medical care if you have swelling or stiffness that doesn’t go away in a few days or if it becomes too painful to touch your joints. If joint pain isn’t connected to any recent injury, you must immediately consult your doctor.

It’s normal to have joint pain occasionally, but when the pain starts interfering with your daily movements, it’s time to seek medical help. The initial move is to get an accurate diagnosis of what’s causing your joint pain.  You may be later referred to a rheumatologist or orthopedist (Doctors who specialize in arthritis and related conditions). During the medical examination, your doctor may ask questions related to your symptoms and medical history to assess your situation.

Although there’s no particular cure for arthritis, treatments have developed gradually. The treatment for arthritis aims at controlling pain, lessen joint damage, and enhance the quality of life. A variety of medicines and lifestyle changes can help accomplish this and protect joints from additional damage.

If you have coronary artery disease then there’s a high possibility that your doctor might suggest you to go for a stent placement surgery. But do you really need it? It’s a call of your doctor, considering your case he will suggest the best treatment for you. Stent placement is helpful but may pose risks in some cases. For those who don’t know what exactly is the purpose behind using stents and what stents are, this blog will help you get better insights.

Stents are tiny mesh tubes inserted to keep coronary blood vessels (arteries) open post angioplasty (a procedure to restore blood flow through narrow or blocked arteries). The coronary arteries supply blood and oxygen to heart muscle cells. If a coronary artery narrows, you may develop signs of angina, shortness of breath, a cold sweat, and light headedness. That’s when a stent can be lifesaving.

DES (drug-eluting stents) release a drug slowly from their outer coating to aid in preventing blockage at the particular site. Hence, DES are preferred over BMS (bare-metal stents) for the majority of the patients as they prevent recurring blockages. Stent technology has progressed over the years. In today’s scenario, stents are easier to implant and cause fewer complications and side effects.

Your doctor normally embeds a stent applying a minimally invasive method. They can help prevent arteries from becoming narrow or blocked again, however, they don’t cure heart diseases. But what is living with stents like?

Benefits of living with Stents:
  • Saves your life and alleviates damage to your heart muscles at the time of heart attack by replenishing blood flow to your heart.
  • Immediately relieves/decreases symptoms of heart disease.
  • Reduces the risk of heart attack or stroke in future.
  • Stent placement may diminish your requirement of a CABG (Coronary Artery Bypass Grafting).
  • Stenting is comparatively much less invasive versus CABG and also has a much shorter recovery period.
Harms/Risks of Stenting:
  • You may get an allergic reaction because any foreign object introduced inside can cause flaring up of immune reaction causing an allergic response. However, it’s rarer with currently used stents.
  • Angioplasty can lead to blood vessel damage or heart damage. The procedure requires the surgeon to enter the blocked artery via a catheter (tube). The catheter is entered via a distant artery, usually radial (arm) or femoral (leg). To enter an artery in the heart from such a distant site may cause damage to the artery, and when reached the heart artery (coronary), there are chances of damaging the small artery or the heart itself which can be taken care by the surgeon.
  • Rarely, some potential complications such as heart attack, stroke or renal failure (kidney failure) can also happen.
  • A scar tissue formation can happen inside your stent post stenting procedure necessitating another procedure for removing it.
  • Stenting also carries a risk of blood clot formation which needs medicines for prevention.
  • It cannot ultimately cure your CAD (Coronary Artery Disease). You have to continue managing your contributing risk factors for CAD such as hypertension, overweight, diabetes or high cholesterol.

You generally should be able to return to work or your normal routine a week after stenting. Avoid strenuous exercise and lifting heavy objects for a while. Consult your doctor about any other restrictions.

Consult your doctor immediately if:

  • The place where your stent was inserted starts bleeding or swelling.
  • You feel pain or discomfort.
  • You have symptoms of infection such as redness, swelling, drainage or fever.
  • You feel weak.
  • You experience chest pain or shortness of breath.

To prevent blood clots around your stent, your doctor may prescribe antiplatelet therapy post stenting. Antiplatelets are a combination of medicines that prevent blood cells (called platelets) from sticking together and forming a blood clot. The expected lifespan of a patient post multiple stent implantation really rests with the patient and how they manage their disease.

If you manage your risk factors well as per your cardiologist’s advice, you may live a prolonged and productive life even after getting stent implantation done in your major arteries. However, the most vital aspects which you should consider are diet and regular activities. The type and amount of food you consume can control your risk factors for a heart attack such as diabetes and obesity. Even minor modifications in your dietary habits can make a huge difference in the health of your heart.

If you get a minor cut or scrape at home while chopping food or while playing then it usually is self-treatable through the use of bandages or any home remedy. But, what if you get a nasty cut then how will you comprehend in case of a suture or a staple requirement? Usually, severe gash or wounds require the use of sutures, staples or surgical glues in order to close the wounds or surgical incisions. Doctors choose appropriate methods depending on the type of the wound or the surgery required.

Having said that, both sutures and staples have peculiar benefits and limitations that make them more or less appropriate for specific conditions. In many cases, sutures are essential for convenient healing. Severe wounds and deep cuts are prone to infection and other complications, and the longer a wound stays naked and vulnerable, the greater the risk of infection becomes. Sutures are one of the most common methods used for closing wounds of the skin. However, in cases of major wounds, the selection of an optimum method of wound closure is extremely vital. The type of material and technique depends on many factors such as depth, appearance, size, location, bleeding, age, material availability, and your doctor’s preference. 

Sutures

This is the most common method used for closing skin wounds. Sutures are basically thread-like medical devices that can either be permanent or temporary in nature, depending on their material of the composition.

Your doctor uses a surgical thread to sew or stitch two ends of the skin together. Temporary sutures get degraded in the body. However, the suture type to be used is decided by your surgeon based on your medical history. Your doctor may prefer to use permanent sutures in case you have:

  1. A major wound that might take a prolonged period to heal.
  2. To close your surgical wounds.
  3. Tying off blood vessels or bowel parts.
  4. If your wounds involve connective tissues or muscles.

Biodegradable sutures are preferred in cases of lower skin layer wounds, internal mouth surface wounds, internal soft tissue or smooth muscle wounds. Wounds with vasculature close to the skin surface are also preferred to be stitched by biodegradable sutures.

Sutures must be removed within 1-2 weeks of their placement, depending on the intensity and location of the wound. Immediate removal reduces the risk of marks, infection, and tissue reaction.

Staples:

Doctors prefer to use a surgical stapler in case of a long skin wound or an incision in a difficult-to-reach area. Alike sutures, staples can also be permanent or dissolvable in nature. Permanent staples need to be removed by your doctor. However, with dissolvable staples you have a lower risk of getting infected.

There are a plethora of benefits associated with the use of staples:

  1. They permit rapid wound closure causing the lowest damage.
  2. They are easier to apply and remove as compared to sutures, and anesthesia is given for a much lesser time.
  3. The most vital advantage of using staples is a decreased infection risk.
  4. Wounds also heal better with staples and lower are the chances of scar formation.

Surgical staples need to stay in for some days or up to 21 days in some cases before they can be removed.  How long the staples must stay in place depends mostly on factors such as:

  • Size and placement of the incision.
  • The type of surgical procedure. 
  • The complexity or severity of your incision or wound.

Numerous signs that your surgical staples may be ready to be extracted include:

  • The area has recovered completely and the wound won’t reopen.
  • There’s no pus, fluid, or blood drainage from the area.
  • There aren’t any symptoms of infection.

It is evenly important to take post-care of your injury or wound, once the stitches or staples are removed. Check with your doctor on how to take the necessary precautions which will help restore and heal your scars.

Despite the fact that they differ in many ways, sutures and staples are cosmetically equal when it comes to scarring. Conclusively, a doctor will decide the choice of technique and device based on his or her experiences and preferences according to the case.

A hernia repair surgery is usually very safe but several risk factors determine patient’s morbidity and mortality. Incarceration and strangulation are some of the common complications of hernias. The surgery complications include infections, fascial dehiscence, recurrence, visceral injury, and mesh erosion preset by many risk factors.

Strangulation and Incarceration:

A strangulated hernia occurs when the blood supply to the affected tissue has been cut off. This situation forces to release toxins and infection into the bloodstream, which could lead to sepsis or death in some cases. An incarcerated hernia occurs when herniated tissue becomes trapped and cannot easily be moved back into place. This state can lead to bowel obstruction.

Surgical complication:

As compared to laparoscopic surgery, an open approach has higher chances of complications. Most of the serious complications occur while accessing the abdominal cavity. Most common injuries occur to the small bowel and the iliac artery. Patients with past abdominal injuries or abdominal surgeries are more prone to severe complications.

As per the available evidence, surgical repair is the only current effective way to treat a hernia and it could be of two types – conventional and non-invasive. Hernia surgery can assist relieve pain, return the hernia abdominal organs to their exact place thus reinforcing the weak muscle area. A hernia operation usually takes around an hour as a day case procedure. It is a routine procedure, but as with all surgeries, there are risks of complications.


The conventional procedure being the open procedure whereas the non-invasive method includes laparoscopy. Though the hernia surgery is termed as “safe”, however, all surgical procedures come with certain risks. Probable risks involved in a hernia surgery could be:

  • Wound Infection at the cut- Despite the latest technologies and advancement in the surgical procedure, post-operative infection is still the leading cause of complications in hernia surgery. Infections can occur due to various reason including sutures, mesh that fails to suit the human body.
  • Recurrence of hernia- This state is occurred due to deep infection or when there’s extra pressure on repaired site or when a person resumes to physical activities much earlier than suggested by the doctor. However, it is preventable by mesh implantation.
  • Post-operative risk- This occurs as a direct result of fascial tissue failure to heal post laparotomy. Factors that can add to the misery is excessive smoking, obesity, age, malnutrition etc.
  • Blood clot formation due to prolonged bed rest.
  • In some cases, an open hernia procedure may lead to nerve damage and the patient can develop chronic pain in the affected area post-surgery.

The recovery process may depend on the surgical procedure itself. Majority of patients undergoing open hernia surgery can return home the same day and the estimated recovery time frame is proximately 3 weeks to 1 month. Depending upon your nature of work, total recovery may require one to six weeks. In the case of laparoscopic hernia surgery, the patient can return home the same day and estimated recovery period is about 1 to 2 weeks. One must wait for a month before starting any heavy exercises or activities that may cause strain.

Usually, the faster you return to your regular lifestyle, the better is the recovery rate. However, consult your surgeon before making any assumptions yourself because a prolonged approach can also lead to several complications. Your doctor may suggest that you wear a corset or a truss to lessen the pain. These supportive undergarments apply gentle pressure on the hernia and hold it in place. They may relieve any kind of discomfort or pain and are used only for temporary relief.

Among surgeries, a laparoscopic procedure is preferred because it shortens the duration of recovery post-surgery. However, a hernia recurrence post-surgery is not uncommon. A recurring hernia can be identified as a lump, occasionally painful, appearing at or near the site of the initial hernia. If the recurrence is progressive, it can lead to major complications.

There could be various reasons adding to the factor such as infected hernia wound, resuming heavy physical activities soon after surgery, chronic cough, and obesity. Other common predisposing factors are smoking, old age, and muscle weakness. Hence, it’s always advisable to practice a certain healthy lifestyle which includes maintaining a healthy body weight, avoid lifting heavy objects without supervision and eating a fiber-rich diet to make bowel movements softer and easier to pass

Hernias are rather usual and can confound anyone. However, how can you know that you have developed one? There are various causes of hernia such as straining of muscles due to heavy weight lifting, multiple pregnancies, congenital reasons or you can get one even from a recent accident. Additionally, lifestyle variables such as obesity, smoking, and not having a nutritious diet can cause a hernia.

The abdomen is the most common area for developing a hernia, however, it can also be seen in the upper thigh or chest. A hernia can take time to show symptoms and sometimes those symptoms can lead to intense pain thus leading to surgery. The conventional symptom of a hernia is the appearance of a bulge in the groin area. You may observe a lump in the pubic region if you have an inguinal hernia whereas hiatal hernia has more characteristic symptoms such as heartburn, chest pain, breathing, and swallowing problems etc. In many cases, a person may not complain of any symptom at all and it may be accidentally detected during a routine examination. As your hernia grows, discomfort may grow as well.

Early signs of a hernia may include:

  • A bulge in the groin area or scrotum or swelling in the scrotum.
  • Pain or discomfort in the affected area which worsens during bending or heavy lifting.
  • Heaviness in the abdomen and burning or aching sensation in the bulge.
  • Pain or aching sensation while passing stools or urinating.
  • Pain in the abdomen, typically during evenings after you have remained standing for most of your day.
  • In case of a strangulated hernia, you may also have a fever, vomiting, nausea, and severe abdominal cramps.

While a hernia may begin as an innocuous lump, it can get bigger and begin to trouble with time. In some cases, it can even be perilous. So regardless of whether it doesn’t appear to be a serious deal, it’s ideal to see your primary care physician in case you have indications of a hernia, similar to a bump or lump you can’t clarify.

Seek medical attention immediately if you have a hernia and these symptoms:

  • The bulge appears to be dark, purple, or red.
  • You can’t pass stools.
  • You have a high fever.
  • The pain quickly worsens.
  • You’re throwing up or have an upset stomach.

The diagnosis of a hernia is generally a clinical one, which implies that your doctor will go through a history of your symptoms followed by a brief physical examination. In the great majority of cases, where there is a conspicuous swelling in the groin/abdominal area, which increases in size on standing, straining or coughing, a clinical diagnosis of hernia is made and no tests are needed. More challenging diagnoses are best performed by hernia specialists.

Usually, your doctor can determine if you have a hernia with just physical examination. They may ask you a variety of questions along with cross-checking your medical history. During this diagnosis of a hernia, your doctor may ask you to perform activities like standing and coughing to confirm the possibility of a hernia.

Furthermore, your doctor will confirm that you have a hernia by prescribing some tests such as ultrasound of your abdomen, A CT or MRI scan which is like X-rays. Your doctor may also ask you to undergo an endoscopy; a non-surgical procedure used to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a colour TV monitor.

For adults, particularly if the medical procedure could be dangerous for you, your primary care physician may propose simply watching out for it as long as the hernia’s small and not creating any serious issues for you. However, in some cases, you can always lower your odds of getting a hernia by following simple steps such as following a well-balanced diet and staying at a healthy weight, quitting smoking, talking to your doctor if your cough won’t go away, and using the correct form while doing any physical activity (bend from your knees instead of the waist while weight lifting).

Wearing face masks is just a part of an inclusive strategy for preventing and controlling the spread of viral infectious diseases, including COVID-19. Masks can be worn by healthy persons (for self-protection while accidentally coming in contact with an infected patient) or by an already infected patient for preventing further spread of the infection (source control). But, solely using a mask cannot provide optimum protection or source control. The WHO advises people to wear masks when unable to maintain social distancing. Compliance to other infection prevention and control (IPC) measures, such as maintaining social distancing and practicing hand hygiene are imperative to prevent human transmission of the viral disease.

Guideline for using masks in the health care settings

A) Use of medical masks (surgical or procedure masks) and respirators (N95 masks) for caring suspected or confirmed COVID-19 patients

It is recommended that health workers who directly provide care or come in direct contact with COVID-19 patients, should wear a medical mask (along with other PPE components that are a part of aerosol and contact precautions), in the absence of aerosol-generating procedures (AGPs).

In areas where AGPs are being performed, it is recommended to health care personnel that they should wear a N95 or FFP2 or FFP3 or equivalent standard respirator.

B) Targeted continuous use of medical mask by health workers in locations of known or suspected COVID-19 community transmission.

In the context of areas, where community spread of COVID-19 is suspected or an intense COVID-19 outbreak exists, following recommendations are provided:

Health workers practicing in clinical area should always wear a medical mask during their routine activities throughout the entire shift; apart from the duration when they are having their meals and changing their medical mask after caring for a patient who requires droplet/contact precautions for other reasons

It is particularly vital to adopt the strategy of continuous use of masks in areas with a potentially higher risk of transmission such as triage, waiting lounges of family physicians or OPDs, designated COVID-19 hospitals, cancer units, transplant units etc.

While continuously using medical masks, it is also vital to:

  • Change the mask if it gets wet, soiled or damaged.
  • Not touch the mask to adjust it.
  • If you have touched it, safely remove it, perform the hand hygiene procedure and use a fresh mask.
  • Discard the mask and the PPE and use a new set after coming in contact with a patient for contact or droplet precautions.
  • Personnel not working in clinical areas need not wear a medical mask during routine activities.
  • PPEs including masks should not be shared between workers and be suitably disposed after use and not to be re-used.
  • In addition to above recommendations, precautions of social distancing and hand hygiene practices should not be avoided as they are equally important.
Table 1: Recommended type of mask for use by health workers

Considerations for using non-medical masks

The utility of medical masks by the non-affected population may lead to a shortage of this extremely important supply to the health workers, who need them the most. In settings where medical masks are in short supply, medical masks should be reserved for use by only health workers and at-risk population when need arises.

Non-medical or fabric masks are prepared from varied woven and non-woven fabrics like polypropylene. Non-medical masks may be composed from differing fabric compositions, sequences or layers and shapes. However, a non-medical mask is neither a medical or surgical device nor a PPE.

Usage Considerations

The use of non-medical masks, prepared from woven fabrics such as cloth, and/or non-woven fabrics, should only be considered for used by infected persons in unrestricted settings and not for prevention. They can be used temporarily for activities such as travelling on public transport when social distancing cannot be maintained, and their use should without fail go with frequent hand hygiene and physical distancing.

Table 2: Recommended material, source and structure of non-medical masks

Elastic materials are not preferred to prepare masks as they get stretched after each use, causing increased pore size and lower effectiveness of the mask to filter droplets.

Layers

A minimum of three layers is needed for a non-medical mask, as per the used fabric. However, cotton handkerchief masks should consist of a minimum of 4 layers. Cotton gauze is found to be very porous with a filtration efficiency of only 3%.

The ideal material combination for non-medical masks should include three layers as follows: 1) an innermost layer of a material which absorbs water (e.g. cotton or cotton blends); 2) an outermost layer made of non-water absorbing material (e.g., polypropylene, polyester, or their blends) which may restrict external impurity from penetration through to the wearer’s nose and mouth; 3) a middle non-water absorbing layer of synthetic non-woven material such as polyproplylene or a cotton layer which may enhance filtration or retain droplets.

Shape

Shape of the non-medical mask should be flat-fold, fitting closely over the nose, cheeks and chin of the wearer. If the mask’s edges are not close to the face and shift, during activities like  speaking, air penetrates through the mask’s edges rather than getting filtered through the fabric. The mask should be equipped to be held in place by the use of elastic bands or ties.

Coating

Coating the mask with materials like wax may raise the barrier and make the mask liquid-resistant, but too much coating may cause difficulty in breathing through the mask due to complete blocking of pores.

Maintenance

  • Mask should be used only by a single person and not shared by multiple individuals
  • All masks should be changed immediately, if they get wet or are visibly soiled
  • When required, masks should be removed without touching the front portion of the mask and after mask removal, do not touch the eyes and mouth
  • Discard the mask, if you wish or keep it in a sealable bag until you wash it. After washing, immediately perform hand hygiene
  • Cloth masks should be frequently washed as per the cloth’s recommended washing temperatures
  • Wash in warm hot water, 60°C, with soap or laundry detergent.
  • Non-woven polypropylene (PP) may be washed at high temperatures, up to 125°C.
  • Natural fibres may resist high temperature washes and ironing.
  • Wash the mask delicately (without too much friction, stretching or wringing) if non-woven materials are used.
  • The combination of non-woven PP and cotton can tolerate high temperatures; masks made of these combinations may be steamed or boiled.
  • Where hot water is not available, wash mask with soap/detergent at room temperature water, followed by either i) boiling mask for one minute OR ii) soak mask in 0.1% chlorine for one minute then thoroughly rinse mask with room temperature water, to avoid any toxic residual of chlorine.
Table 3: Recommendations of areas where the general public should be advised to use masks in established or suspected community transmission areas

Wearing a face mask is not a substitute for physical distancing and basic hand hygiene but in some situations where you can’t follow social distancing and other preventive measures, wearing a mask can give you some layer of protection. It is important to follow the Government’s latest guidance on safeguarding yourself during the coronavirus pandemic, including travel advice within and outside the country.

If you think getting your surgery done is the last piece of the puzzle then you may be wrong because you might still have to show some resilience till the time your stitches or sutures don’t come off or are dissolved as instructed by your surgeon. Though getting done with the surgery covers the majority of the procedure, adequate post-operative care of your stitches or sutures is still an important aspect that needs to be managed well to avoid any future problems. Before moving on to the post-operative management of the wound, let us first understand more about sutures or stitching.

Sutures and stitches are used for the same purpose – to close wounds or surgical incisions. For sutures, doctors use a thread or strand of material to perform wound closure. The term ‘stitches’ refers to the surgical procedure of closing a wound with the help of sutures. There are basically two types of sutures, absorbable and non-absorbable. Absorbable sutures don’t require your doctor to remove them, while the Non-absorbable sutures will have to be removed at some point in time by your doctor. The kind of material to be used for sutures will completely depend on your doctor’s observation and analysis of the wound and the material type that’s appropriate for the wound or procedure. From piles to bariatric surgery to a hernia repair surgery, suturing is a part of most of the surgeries with incisional cuts and has to be performed with utmost precision and accuracy. Sutures are used for maintaining tissue contact until optimal healing is achieved to provide internal wound strength. When it comes to hernias, the selection of suture and suturing technique is based on the type of underlying hernia, its dimensions and the operative technique used for a hernia repair.

Though there’s no clear evidence that says one particular type of suture is better than others, it is important to care for your sutures irrespective of the material type so that it helps the healing process. Any negligence can slow down the recovery process and cause a lot of pain to the patients.

Below are some of the common symptoms that indicate that your wound has split or is damaged.

  • Inflammation
  • Bleeding from the wound
  • Broken suture
  • Pain near the wounded site
  • Swelling
  • Fever
  • Puss formation

Open wounds often require immediate attention and doctors usually opt for antibiotics or debridement (removal of dead tissue from the wound). It is always advisable to get in touch with your doctor in case any such symptoms are observed. Classically, your sutures require to stay in play for some days to even 1-2 weeks, as per the severity of the incision and its location. Usually, as your sutured wound starts to heal, your doctor will instruct you to take proper care of your sutures, which includes cleaning, dressing and drying your wound.

How to care for your sutures/stitches

Moisturise: Applying moisturizing creams with high Vitamin and Aloe vera content can help the wound’s faster recovery

Massage: Massaging the wound gently over time can help in reducing the scar and also increases the blood flow near the wound which can help in faster recovery. However, the pressure applied should be moderate and should not initiate any pain or discomfort near the operated area.

Avoid activities that expose the wound:It is advisable to avoid exposing the wound to any physical activity that adds pressure on the wound or makes it dirty, increasing the chances of an infection.

During the removal of your stitches, your doctor will analyze, observe the state of your wound and then only give a go-ahead. Removing sutures is a much quicker procedure than applying one. You might simply experience a minor pulling sensation and some pain which is due to your body trying to guard itself against organisms trying to enter inside through the cut. As a protective mechanism, the body releases chemicals for aiding your WBCs to fight against infections. As a result of this mechanism, you will feel pain and inflammation due to your nerve stimulation in the area.

If the pain is intense and you are not able to tolerate it, you can take paracetamol as a pain-killer. Avoid take aspirin, ibuprofen or any NSAID to relieve pain, as they may make it difficult for your blood to clot during wound healing. Or else, you may place an ice pack to decrease your pain and inflammation at the affected area for 15 to 20 minutes every hour. This procedure can also reduce bruising. Also, remember that removing stitches on your own is not a good idea. When doctors remove stitches, they look for multiple signs such as infection, state of healing, and wound closure. But when you try to do it on your own, you skip this final observation step which could be lethal for you in the coming future.