Surgery: Archives

Knee Replacement November 26, 2020

Osteoarthritis: Symptoms, Causes & Treatment

The knee is the human body’s largest joint and its healthy maintenance is required to perform most of the everyday activities, easily. The knee joint is formed by the thighbone’s (femur’s) lower portion, the shinbone’s (tibia’s) upper portion, and the cap of the knee referred to as the patella. The ends of these three bones where they meet are covered with a smooth substance that protects the bones and enables them to move easily (articular cartilage). The C-shaped wedges present between the thighbone and the shinbone are known as menisci. They function as the natural “shock absorbers” protecting the joint. The thigh and shinbones are held together by large ligaments, lending stability to the joint whereas the long thigh muscles make the knee strong. All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane secretes a liquid that moistens the cartilage, minimizing friction to almost zero in the case of a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

Although there are more than 100 types of Arthritis, the three most common types are Osteoarthritis, Rheumatoid arthritis and Post-traumatic arthritis. In this article, we will majorly focus on Osteoarthritis.

What is Osteoarthritis (OA)?

Osteoarthritis is an age-related “wear and tear” type of arthritis. It generally affects persons aged 50 years or more, but may also affect younger individuals. In this type of arthritis, the cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. Osteoarthritis (OA) of the knee happens when the cartilage, the cushion between the knee joints deteriorates. This can cause pain, stiffness and swelling. Appropriate treatment can help relieve discomfort and slow the damage. It can also improve your quality of life facilitating you to better keep up with your day-to-day activities.

What are the causes of Osteoarthritis?

Age: The risk of developing OA increases as someone gets older because bones, muscles and joints are also aging.
Joint injury
Using the same joints over and over in a job or sport can result in OA.
Obesity: Extra weight puts more stress on joint and fats cells to promote inflammation.
Weak muscles: Joints can get out of the right position when there’s not enough support.
Hereditary: People with family members having OA can also suffer from OA.
Women are more likely to develop OA than men.

What are the signs & symptoms of OA?

Joint stiffness and soreness
Grating sensation
Bone spurs
Loss of flexibility
Pain or aching in the joint during activity
Limited range of motion that may go away after movement
Clicking or cracking sound when a joint bends
Swelling around a joint.

How to Diagnose Osteoarthritis?

Osteoarthritis of the major joints is most effectively diagnosed through a combination of medical history, physical examination, and various lab tests including imaging studies such as X-ray. A physician can diagnose most of the cases but in some cases, he may refer you to an Orthopedic surgeon, physiatrist for further evaluation.

Medical History

Medical histories can often be the most useful tool for physicians in diagnosing osteoarthritis. The doctor will look for a family history of the disease as well as the presence of various risk factors to indicate the need for further testing.

Physical Examination

A physical examination will usually follow the medical history as the physician looks for physical signs of the disease. These include signs like swelling and tenderness of the joints, loss of movement in specific joints, or visible joint damage such as bony growths in the surrounding area. The patient may also be asked to perform a variety of physical tasks so the physician can evaluate the range of motion and general joint mobility.

What are the treatment options for Osteoarthritis?

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.

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.

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 the 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 over time leads to extreme pain and can restrict joint mobility. Knee replacement is a major surgical procedure requiring hospital admission for 2 to 3 days.

Depending on the severity of the disease your doctor will suggest the best line of treatment to treat Osteoarthritis.

Bariatric November 24, 2020

Possible Side Effects Of Bariatric Surgery

The study says, India, with 41 million obese people, ranks third after the US and China in having the highest number of overweight people in the world. Together, India and China represent 15% of the world’s obese population which leads to the rise of the weight loss industry in the country like never before. And, so as the number of weight loss surgery. Obesity can be considered a modern-day epidemic that’s slowly spreading all over the world that includes the young as well as the old. However, the problem with obese people is not just about the excessive fat but the condition that invites a lot of life-threatening diseases like diabetes, stroke, blood pressure, etc. The common treatment for obesity includes losing weight through healthy eating, regular exercising and being more active but who have extreme obesity are advised treatment options like weight loss device, weight loss medicines, or weight loss surgery.

Weight loss surgery is one of the fastest-growing segments of the surgical discipline. Gastric bypass and other weight-loss surgeries — known collectively as bariatric surgery — involve making changes to your digestive tract that aids in losing weight. However, bariatric surgery is not for everyone who is extremely overweight as it has some risks and complications. You may need to meet some medical guidelines and have an extensive screening process to qualify for bariatric surgery. Let’s dig in a dip to understand the risks and side effects associated.

Risks and side effects of Bariatric Surgery

Risks and side effects are part of any surgery or treatment. As evident with any major surgery, bariatric surgery is no exception and this procedure too has its own set of risks and side effects in the short- and long-term. Up to 40% of patients suffer from side-effects post-bariatric surgery. However, serious complications are seen in <5% of patients.

The most usual risks associated with bariatric surgery include:

Constipation
Too much internal bleeding
Infection
Blood clot formation
Trouble in breathing
Gastrointestinal Leaks, after surgery, there is a small chance that food could leak out into your stomach
In rare cases, Death

Longer-term risks and complications of bariatric surgery include:

Obstruction of bowels, a gastrointestinal condition in which digested material is prevented from passing normally through the bowel.
Stone in the gall bladder
Hernia
Low blood sugar
Low nutrition
Ulcer formation
Vomiting and Nausea
GERD or Acid reflux occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach
Dumping syndrome- It is a group of symptoms, such as diarrhea, nausea, and feeling light-headed or tired after a meal, that is caused by rapid gastric emptying. Rapid gastric emptying is a condition in which food moves too quickly from your stomach to your duodenum.

Unavoidable conditions, emergencies, or under some special circumstances, weight loss surgery or bariatric surgery could only be the treatment option. Though some complications are inevitable, with proper guidance from the doctor one will be able to overcome the challenges post-surgery.

Recovering from the surgery will be the next important step for the ones undergone the surgery. Below are some important tips to note for a speedy recovery.

Recovery from the bariatric surgery

Recovery in the hospital: After undergoing bariatric surgery, the patients have to spend around 2 to 5 days in the hospital, or longer if complications develop. If the surgery was laparoscopic, you can expect a shorter stay at the hospital. It is normal to experience any tiredness, GI symptoms such as nausea, vomiting, flatulence, loss of hunger, etc. in the immediate days to weeks after surgery. You may feel pain at the surgery site for a few days, but if it is unbearable, you may consult your surgeon, who may prescribe an IV analgesic or an oral pain-killer when you resume taking food through your mouth. Performing simple activities such as walking or even frequently altering position in bed can aid in circulation, seeding the recovery process and prevent any complications. Deep breathing and coughing exercises will also aid in preventing any lung infections.

Recovery at home: Your discharge from the hospital will be decided by your doctor based on your health progress. You will be needed to follow a certain diet and activity restrictions at home after discharge. After you get home, don’t rush into performing all activities at once. Proceed gradually. Also, keep up all follow-up appointments with your doctor regularly.

However, it is possible to not lose enough weight or to regain weight after undergoing any weight loss surgery, even when the procedure works correctly. This weight gain, after the surgery, can happen if you fail to follow the doctor’s recommended lifestyle changes, such as consuming a healthy diet, following regular physical activities and having good sleep.

Bariatric November 24, 2020

What Is Bariatric Surgery And Its Types?

You’ve probably heard this term ‘Obesity’ a lot of times in your life. Obesity is recognized as a significant public health hazard, as it increases the risks for multiple diseases such as type 2 diabetes and other cardiovascular diseases. Obesity is a complex disease involving an excessive amount of body fat that increases the risk of other diseases and health problems, such as diabetes, heart disease, high blood pressure and certain cancers. Today, more than one-third of the world’s population has been affected by this complex, multifactorial, and largely preventable disease. If these secular trends continue, by 2030 an estimated 38% of the world’s adult population will be overweight and another 20% will be obese. This epidemic of overweight presents a major challenge to chronic disease prevention and health across the life course around the world.

Increasing ease of life, owing to minimize physical labour and automated transportation, a sedentary lifestyle, and liberal access to calorie-dense food has turned a once-rare disease of the affluent into one of the most common diseases of this century. Luckily, overweight and obesity, as well as their related non-communicable diseases, are largely preventable. Common treatments for this disease include losing weight through being more physically active, healthy eating, and making other changes to your habits. But, for the people who have extreme obesity and haven’t been able to lose enough weight are advised other treatment options like weight-loss medicines, weight-loss devices, or weight loss surgery (bariatric surgery). Let us dig in deep to understand more about bariatric surgery and its types.

What is bariatric surgery?

Bariatric surgery is a kind of surgical procedure that aids in weight loss by altering your digestive tract. This surgery leads to weight loss by reducing the quantity of food your stomach can hold, causing you to feel full in a lesser quantity of food uptake. Generally, it is performed when lifestyle changes like diet or exercise plan fail to work or your excess body weight is causing serious complications. Some bariatric surgery procedures restrict your food consumption, while others reduce the capacity of your body to absorb nutrients from your meals and a different kind of surgery can work in both ways.

Types of bariatric surgery

The type of surgery that may be best to help a person lose weight depends on several factors. One should discuss with their doctor what kind of surgery might be best for them. Gastric Bypass, Sleeve Gastrectomy, Adjustable Gastric Band and Biliopancreatic Diversion with Duodenal Switch are the most frequently performed bariatric surgery types. Each type is associated with its own merits and limitations.

Gastric Bypass or Roux-en-Y Procedure: This surgery is typically a non-reversible procedure and functions by reducing the capacity of food you can eat in a single meal as well as decreasing the absorption of nutrients. In this procedure, the surgeon incises across the top portion of your stomach, separating it from the remaining part. The resulting portion will be approximately like the size of a walnut and will be able to hold just a small quantity of the food as compared to the usual capacity. Then, your surgeon will incise the top portion of the small intestine and joins it directly onto the separated pouch of the stomach. Thus, the food directly enters this portion of the small intestine from the stomach, bypassing the majority of your stomach and a part of the small intestine. This procedure leads to a significant weight loss of 60% to 80% and bears a >50% excess weight loss maintenance. This procedure also raises expenditure of energy and leads to favourable alterations in gut hormones, which suppresses hunger, decreases appetite and improves satisfaction.

Sleeve Gastrectomy: This procedure removes around 80% of your stomach, leaving behind just a tubular pouch, which cannot hold much food. The advantages of sleeve gastrectomy include faster and major weight loss of >50%, similar to Roux-en-Y, does not need re-routing of food, associated with a shorter hospital stay and leads to favourable alterations in gut hormones, which suppresses hunger, decreases appetite and improves satisfaction. However, it causes long-term Vitamin deficiencies and possesses a higher complication rate at short-term vs. AGB procedure.

Adjustable Gastric Band or AGB: It is often referred to as simply “The band”. This procedure involves the placement of an inflatable band around the stomach’s upper part, forming a small pouch above the band, leaving the rest of the stomach’s portion below. In simpler terms, it works by decreasing hunger, aiding the patient to decrease calorie consumption. It leads to an excess weight loss of 40 to 50%. It does not need cutting of the stomach or any intestinal rerouting. It needs a hospital stay of just 24 hours or even less and the procedure is also reversible and adjustable. It possesses the lowest early complications’ rate and also the lowest death rate amongst bariatric surgery procedures. The risk of Vitamin and mineral deficiencies is also minimal.

However, the speed of achieving excess weight loss is lower than the rest and most of the patients fail to lose at least 50%. It needs the placement of a foreign object causing object erosion or other band-related adverse effects. It also needs strict diet plan adherence post-surgery and you need to attend follow-up with surgeon without fail. It is associated with the highest re-operation rate.

Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This procedure is a two-part surgery. Firstly, a creation of tubular stomach pouch as in sleeve gastrectomy and secondly, connecting the end portion of the intestine to the duodenum near the stomach (duodenal switch and biliopancreatic diversion), bypassing the majority of the intestine. This surgery leads to a greater excess weight loss of 60-70% at 5 years. It permits patients to eat a normal diet in due course of time. It decreases fat absorption by approx. 70% and leads to favourable alterations in gut hormones, decreasing appetite and raises satisfaction. This procedure is termed to be most effective in diabetes patients. However, this technique possesses higher rates of complication and risk for death. It needs a prolonged hospital stay and causes protein, vitamin and mineral deficiencies. Also, strict adherence is required in post-operative diet restrictions and follow-up doctor visits.

Each of the surgery types has pros and cons and various patient factors affect which procedure is chosen including body mass index, eating habits, other health issues and previous stomach surgeries. The patient should discuss the most suitable option with the surgeon by considering the benefits and risks of each type of surgery. However, bariatric surgeries may not be suitable for everyone and so they are only performed if there is a serious health threat to the patient due to their excessive weight.

Cancer November 10, 2020

Cancer Surgery: Benefits, Success Rate And More

If you have been recently diagnosed with cancer then there must be a lot going in your mind. It can put you in shock and make you feel out of control and overwhelmed. From treatment to actual success rate to life after any cancer treatment, there’s a lot of anxiousness and nervousness attached to every possible aspect related to the disease. By staying informed can help you alleviate these feelings.

It is important to know that not all cancers require emergency treatment and you may have time to learn and understand in detail about your diagnosis and treatment options, ask for answers and get a second opinion. Cancer is one of the deadliest causes of death worldwide and hence it shouldn’t be taken for granted at any cost. With multiple treatment options available, cancer if detected at an early stage can surely be cured. Usually, when suggested a Chemotherapy or radiotherapy, many unpleasant thoughts are created in your mind but as the journey of survival begins and the final output is picturized then there are more than a few reasons to be happy with it. And, for all those who are not completely aware of the treatment options available especially when it comes to cancer surgery, we will help you learn more about the treatment and what to expect afterward.

Cancer treatment:

Cancer surgery is the first option considered in the treatment of many firm malignant tumors. It helps in removing the cancerous tumor and the healthy tissue surrounding it to prevent the spread further. In simple words, the objective of any cancer surgery is to get rid of the cancerous cells from the body. But, it depends on the doctor who is diagnosing it to whether suggest you surgery or any other standard procedure considering the seriousness of the disease.

Tumors that cannot be treated with other treatments like radiation or chemotherapy are removed through surgeries. The cancer cells that produce blood-borne factors, responsible for stimulating the growth of cancer in distant body parts, are removed by surgery. Surgery alone can completely remove cancer cells that are confined in a small restricted area, which eliminates the need for any other treatment. But in some cases, surgery does not aim at removing the entire tumor because of the location of the tumor. If the tumor mass is sizeable then surgery is suggested to diminish the size of the tumor so that it is eliminated with the help of other treatment options like chemotherapy or radiotherapy. Surgery enables one to examine the cancerous tumor for deciding the most suitable treatment option for each patient based on the pathology. It can also guide the future course of treatment and also helps to analyze the treatment response. Above all, it is comparatively convenient to the patient, as it needs to be performed in a day and lasts only a few hours.

Benefits of Cancer surgery

Out of all the above-discussed treatment options available to treat cancer, surgery is by far the most common treatment for treating cancer. As mentioned earlier it eliminates the cancerous cells that help in increasing life expectancy. It also helps in reducing the pain, symptoms and problems with digestion. Cancer surgery can tackle existing weight issues effectively and support the human body to respond better to other medical conditions. Sometimes, surgery may be used to help with body functions, such as breathing and getting enough nutrition. On the other hand, it surely gives a boost to the self-esteem of the patient. Most importantly, a surge in energy levels is observed post cancer surgery. Patients have a better sleep cycle and a positive attitude in life.

The success rate of cancer surgery

The rate of success of cancer surgery is directly dependent upon the extent and type of tumor along with the overall health status of the patient. Many other factors influence survival in addition to cancer type, including age and stage at diagnosis, treatment, insurance status, competing for health conditions, and financial resources. Cancer treatment can be more challenging and complex for older adults. This is because older adults are more likely to have chronic health conditions, such as blood pressure, diabetes, etc. The success, failure and survival rates for cancer patients vary for each individual depending on the changing traits of each patient including tumor location and tumor type. Physician and patient factors, including never give up attitudes, beliefs, preferences, and implicit or explicit biases, also influence treatment recommendations and delivery and likely contribute to the survivorship of a person. As per multiple surveys, tumor surgeries carry a greater chance of success in the younger patient subgroup as they are more fit physically.

Similarly, access to high-quality cancer care defines the outcome of the treatment. It increases the chances of survival and is directly proportional to the patient’s improved quality of life.

To conclude, cancer surgery is a part of the cancer treatment plan and may be used along with other cancer treatment options such as chemotherapy and radiation. Surgery can be used to prevent cancer, removing cancer, diagnosing the stage of cancer, relieving symptoms, support other treatment and body functions. Also with recent advancements in medical technology, the success rate of cancer surgery is improving day by day and patients have seen a drastic improvement in their quality of life. Cancer surgery has surely given a new lease of life to a million people worldwide.

Cancer November 10, 2020

Understanding Risks Associated With Cancer Surgery

Cancer is to a large extent avoidable. Some of them can be detected at their initial stage of growth, treated and cured. Even the last stage of cancer’s progression can be slowed and the pain can be reduced. Though cancer remains the world’s second leading cause of death, there are still many treatment options and drugs available to treat cancer, with many more being studied. The types of treatment chosen depends on the type of cancer one has and how radical it is. Few types will have only one treatment option available. But most people get a combination of treatments. Some are local treatments like surgery and radiation therapy, which are used to treat a specific tumor or area of the body. And, drug treatments such as chemotherapy, immunotherapy, or targeted therapy are often called “systemic” treatments because they can affect the entire body. It completely depends on your doctor to make a reasonable treatment decision, depending upon the type of your cancer and its stage. At the same time, every patient needs to follow some ground rules like acceptance, realistic expectations, beliefs and attitude towards the disease before exploring treatment options. Let’s now dig in deep and learn about the effectiveness and risks associated with surgical cancer treatment.

Surgery is the conventional form of treating cancer. It is very effective in removing the majority of cancer types before their spread to lymph nodes or distant sites, referred to as metastasis. Surgery may be used alone or in combination with other treatments such as chemotherapy or radiation. Surgery may cure cancer if it has not spread to distant locations in the body. But, it is highly impossible to predict every time whether cancer has spread or not with complete surety. Hence, surgeons frequently remove the lymph nodes surrounding the tumor (sentinel nodes) to confirm whether cancer has spread.

The primary aim of surgery in cancer treatment is to eliminate the cancerous tumor from a specific area of the body. Hence, surgery is considered to be highly effective at complete removal of cancer in its initial stage, which is restricted to its area of origin and hasn’t spread to other adjacent or distant parts of the body (Solid Tumors). However, surgery can also be performed to treat cancer that has spread from the primary site or primary tumor to other parts of the body. Typically, a surgery to remove a cancerous tumor lasts 3 to 6 hours depending on multiple factors such as tumor size, tumor location and access to the tumor, surrounding organs, presence of nerves and blood vessels around the tumor, co-morbid conditions and the number of procedures being performed in a single session.

Risks and side effects of cancer surgery

Risk is a part of any surgery. Though technology has made surgery a safe and authentic treatment option, there are always some potential risks or side effects.

Cancer surgery, like any other treatment option, is associated with benefits as well as side effects. However, the type and extent of side effects differ for each patient, depending on the type and cancer location, surgery type, involvement of concomitant treatment like chemotherapy or radiation and the patient’s general health. In many cases, however, the positive effects outweigh the risks or side effects.

Common side effects of surgical treatment of cancer include:

Pain: It is common to have some pain after surgery.
Tiredness: Most people feel tired after undergoing surgery, particularly when it involves the chest or abdomen.

Loss of Appetite: The patient may feel a loss of appetite after surgery. It may be associated with temporary weight loss.
Swelling surrounding the surgical site: It is natural to experience some swelling as the body’s natural response to injury is inflammation.
Drainage from the surgical site: In some cases, the fluid that formed at the surgery site drains through surgical wounds. The patient should contact their surgeon if they develop signs of infection like drainage that smells bad, fever, and redness around the wound.
Bruising surrounding the surgical incision: Bruising is a common occurrence after surgery caused due to some blood leakage from small blood vessels under the skin.
Numbness at the incision site: Commonly, numbness is because the nerves in the skin are cut at the time of surgery.
Bleeding: Mostly, when a patient undergoes surgery, they lose some blood which is usually very little and does not affect the body.
Surgical site infection: It is common to have infections at the surgical site, but it can also occur elsewhere in the body.
Lymphedema: Collection of lymph in areas around the excised lymph nodes.
Organ Dysfunction: It happens most commonly when the surgery is done in certain areas such as the abdomen and chest.
Concerns related to diet causing GI problems like constipation and decreased ability to absorb nutrients from food.
Change of body image due to the distorted appearance of the body due to the removal of a certain body part.
Depression: It is a common experience one can feel after surgery.
Decreased sexual drive especially if surgery is performed for colorectal, prostate or bladder cancers.
Fertility: It sometimes affects a woman’s ability to maintain a pregnancy and a man’s ability to father a child.

It should be your first call before you decide to have any surgery or any other treatment, that you utterly understand the risks and side effects associated with it. As any type of medical treatment has its risks and side effects. Be sure, you discuss the details of your case with your physician or surgeon before undergoing any treatment so that you can have a better idea about what your risks might be. The most important thing one should consider that the expected positive effects of the surgery outweigh the possible risks.