Safer surgical treatment for life-threatening ailments
Dr Harinder Singh Bedi

Endovascular surgery is a new modality of treatment with the help of which minimally invasive "endograft" repair of any diseased artery can be done without a major operation. This therapy is revolutionising the management of some vascular diseases which carry a high risk with conventional surgery.

The major vessels of the body can be affected by atherosclerosis --- deposition of fat in the layers of the vessel. This can lead to a ballooning of the vessel called aneurysm. If untreated, this can rupture and lead to sudden death. The conventional open surgery, though time-tested and with good long-term results, carries the risk of death during surgery.

Another common affliction is a tear (called a dissection) in a major artery. This can be due to an accident, high blood pressure or due to a congenital weakness of the arterial wall. Tears to the aorta -- the main artery leading from the heart to the rest of the body --are the second most common cause of death in people injured in vehicle crashes or falls. Nine out of 10 people who suffer a tear to the aorta bleed to death on the spot. Many patients who do make it to the hospital die because open-chest surgery to repair a tear in the aorta is extremely risky.

Endograft use is less risky. Placing an endograft allows the correction of a life-threatening problem sooner and in a far less invasive and less dangerous way. Then, associated injuries which are quite often present can also be treated.

A unique hybrid technique of combining surgery with endovascular stenting has been developed by the author in Punjab. The technique has been endorsed worldwide and has been selected to be presented at the prestigious 7th International Congress on Coronary Artery Disease in Venice and at the TCT (Trans-Catheter Therapeutics) in Washington this year.

However, like any new procedure and because the diseased area is still left behind there are a few potential complications of endovascular stent grafting which include the leakage of blood around the graft, rupture, infection and fracturing of the graft. Endovascular stent grafts can sometimes leak blood through the areas where the graft components join together, or they can allow blood to leak back into the aneurysm sac through small arteries feeding the aneurysm sac. These leaks are called "endoleaks".

Some of the leaks stop by themselves and are not dangerous, but others need to be treated immediately. The risk is about 1.5 per cent at four years compared to a low risk of rupture-type complications for surgical repair (less than 1 per cent) where the diseased vessel is removed. Thus, surgeons require their patients to undergo periodic surveillance with CT scans for the rest of their life to detect and treat problems before they become threatening.

The long-term risks of the stent graft implant are not yet known, so the patient will have to be monitored at least once a year throughout his life with imaging devices such as computed tomography (also known as CAT scan or CT). This frequency and type of monitoring is generally not required after the standard treatment. Also the procedure may have to be abandoned at any stage and converted to a standard surgery.

So, it is important that the safety net of surgery be present at the site. In fact, the procedure is ideally performed in a hybrid operation room which is equipped with a catheterisation laboratory - this is already available in Punjab. The technique should only be performed by a surgeon with a strong foundation and expertise of performing the conventional surgery. Various large scientific trials like the EVAR I and II and DREAM trials have documented the efficacy of this technique.

Thus endovascular techniques are an exciting development for the treatment of diseases which can be life-threatening. With continuous improvements in design and technology, results will improve and the time is not far when after this major procedure the patient could be discharged on the same day.

The writer is Director and Chairman, Cardiac Sciences, Ludhiana Mediciti, Ludhiana

Take frequent acidity attacks seriously
Dr Vikas Sharma

Acidity refers to a burning pain in the upper abdominal and chest area. This condition is medically called "heartburn". It is not uncommon for people to have heartburn episodes, but if these attacks occur very frequently they indicate a disorder called as Gerd (Gastro-esophageal reflux disease) or acid reflux disease. Although many people are able to manage heartburn with lifestyle changes, for those who do not respond and frequently suffer from it, homoeopathic medicines can be of great help.

To understand Gerd, one will have to first understand how our esophagus (food pipe) and stomach handle food and acid. As the food reaches the lower end of the food pipe, a circular muscle present around the food pipe opens up and allows the food to enter the stomach. Once it enters the stomach, this muscle closes the lower end of the food pipe. This actually behaves like a valve stopping the food and the acid in the stomach from moving back into the esophagus.

Gerd if left untreated can lead to a more serious complication called erosive esophagitis; which in turn can lead to ulceration, bleeding and narrowing of the food pipe.

Symptoms of Gerd are frequent attacks of heartburn. The main symptom of heartburn is burning pain in the lower part of mid-chest usually after eating or lying down (as the acid back-flow is more while lying or bending over).At times patients may even have vomiting and bitter risings of acid in their mouth. Obesity, pregnancy and smoking are known as the contributing factors. Foods that are known to increase the symptoms of heartburn are citrus fruits, chocolate, drinks with caffeine or alcohol, fatty and fried foods, garlic and onions, mint flavourings, spicy foods, tomato-based foods and various masalas.

Homoeopathy can be of great help for those who do not show much improvement even after lifestyle modifications.

Medicines like Iris, Arsenic Album and Robinia are the leading drugs in treating the symptoms of reflux. Nux Vomica is very effective for those who frequently eat foods that are known to trigger heartburn.

These and other medicines are apt in treating acute episodes of heartburn; but for treating Gerd permanently, constitutional treatment is required.

Lifestyle changes that can help in reducing the symptoms of reflux are losing weight (if one is overweight), avoiding trigger foods, stopping smoking, eating small frequent meals, and avoiding lying down for at least three hours after the meal. Elevating the head of the bed by adding a wooden block underneath the bed post can be of help.

The writer is a Chandigarh-based homoeopath

How to prevent gym injuries
Dr Ravinder Chadha

WITH increased awareness regarding fitness, gymnasiums and fitness centres have gained immense popularity. However, fitness regime must be individualistic and should always be followed under proper guidance.

As there are few institutions to groom fitness trainers or instructors, self-qualified trainers have become the order of the day. Leave alone the metropolitan cities, even small towns have fitness centres coming up at every nook and corner.

Such regimens should be result-oriented and carried out slowly but steadily. If performed incorrectly or with increased intensity over a short span of time, it could lead to injuries and short or long-term disabilities.

Undertaking exercises without proper warming up and with an incorrect technique can also incur injuries.

• Shoulder/elbow injuries are sustained when heavy weights are lifted with a jerk, without proper warm up and increasing either the load or repetitions too soon.
• Knee/shin pain usually occurs while suddenly increasing the time or intensity while running on the treadmill. It is imperative to adopt a way that the pressure on the knee cap is minimal e.g. during cycling low gears should be used rather than high gears and adjusting the height of the saddle that suits the individual, strengthening of the muscles of the thigh, especially quadriceps, also prevents knee injuries.
• Low-back pain is suffered while lifting heavy weights in a squatting position or while performing abdominal exercises incorrectly.

Useful tips

• Warming up for 5-10 minutes of cardio and stretching go a long way in preventing gym injuries. Stretching should be done after a warm-up and following an intense workout. Stretching before a warm-up can cause injury.
• Avoid training when you are tired or in pain. Some soreness is common after exercising, but if it continues, you are pushing too hard. Allow at least 24-48 hours for muscles to recover after a strenuous workout. Then resume the same exercises or activity but at a lower intensity.
• Injuries can occur when the training intensity is increased too much too soon. One should increase the volume and intensity of the work-out gradually and in a progressive manner. An increase in training should be matched by an increase in resting.
• Treat even seemingly minor injuries very carefully to prevent them becoming a big problem.
• Introduce new activities very gradually.
• Shower and change immediately after the cool-down. Have regular sports message.
• While exercising one can lose 6-12 ounce of fluid every 20 minutes of activity which should be replenished. It is advisable to drink 10 to 15 ounces of fluid 10 to 20 minutes before the start of the exercises and every 20 to 30 minutes during the activity.
• Proper clothing is important during exercises. In summers, porous clothing whereas in winters dressing in layers is recommended.
• Proper foot wear is important to bear the load while working in the gym. Good shoes which have more cushioning for shock absorption are important.
• One should know how to properly use equipment in the gym, whether it is the cardio machines or the numerous weight-training machines.

The writer is a former doctor/physiotherapist, Indian cricket team.

Health Notes
Exposure to pesticide doubles asthma risk

LONDON: Researchers have found that exposure to pesticidal chemical sprays doubles the risk of developing asthma.

Scientists have discovered from the first of its kind study that adults who come into contact with pesticides are at a higher risk of developing respiratory problems.

“The possible scope of the link between pesticides and adult-onset asthma raises a problem of broader interest, given the considerable quantities of pesticides used in the domestic and urban environments,” the Daily Mail quoted a spokesman for the researchers as saying.

“Their impact on a population which, while less exposed, has a greater risk of allergies and a higher prevalence of asthma, remains to be determined,” he said.

These findings will further increase concerns about the impact of chemical sprays on food and the nearness of schools and homes to farms where they are utilised. — ANI

Cholesterol hinders estrogen’s benefits

LONDON: Researchers at the UT Southwestern Medical Center have found that a byproduct of cholesterol metabolism blocks the health benefits of estrogen.

The finding, the researchers state, provides a better understanding of the relationship between cholesterol and estrogen, the primary female sex hormone, in heart disease.

It may also, says lead researcher Dr David Mangelsdorf, shed light on why hormone replacement therapy fails to protect some postmenopausal women from heart disease.

The researchers carried out their study in mice, and noted that a molecule called 27-hydroxycholesterol, or 27HC, binds to the same receptors in the blood vessels of the heart to which estrogen binds.

The normal result of this is that blood vessel walls remain elastic and dilated, and damage to the vasculature is repaired, among other heart-protective effects.

However, earlier studies have shown that postmenopausal women — who no longer produce estrogen — lose this protective action and become more susceptible to heart disease. — ANI

Drug that kills cancer cells developed

LONDON: A drug called STA-4783 has been developed to kill cancer cells.

Unlike current treatments, the drug has very few side-effects, and those who have started taking it have already doubled their life expectancy, with researchers believing that survival rates could be even higher.

“This is the most exciting cancer treatment I’ve seen in 10 years,” Daily Express quoted cancer specialist Dr Tony Williams of Synta Pharmaceuticals, who is developing the drug, as saying.

STA-4783 works by increasing the amount of free radicals in the body and healthy cells can control these damaging molecules. Cancer cells can’t, and react by destroying themselves.

“Giving this drug to cancer cells pushes them over the critical threshold. It’s like speeding up a banged-up car being driven round at 95 mph. After a while the engine blows. Normal cells are like a well maintained quality car driven within the speed limit which can easily handle something which throws it off course. The older generation of cancer drugs were so toxic some probably did as much damage as they did good. These drugs are much safer. This is a great step forward and will give new hope to patients,” Williams said. — ANI

Blood test may help assess fat around organs

LONDON: A team of US and German researchers has found that measuring levels of a specific protein in the blood may help assess accurately how much fat coats the body’s organs.

Researchers from Harvard University and the University of Leipzig analysed 196 people, and found that genes that produce the protein RBP4 were up to 60 times more active in obese people with high levels of visceral fat than in lean people.

In contrast, the researchers found that the same genes were only 12 times more active in obese people with a preponderance of fat lying just under the skin.

The findings attain significance as the build-up of visceral fat has been linked to an increased risk of heart disease and type 2 diabetes.

According to the researchers, a treatment to cut levels of RBP4 may help provide health benefits. — ANI