SEPTEMBER 2018 ISSUE 30 - Best Super Speciality Hospital ... · BLK Super Speciality Hospital Pusa Road, New Delhi-110005 (India) 24-Hour Helpline: 011- 3040 3040 Email: [email protected]

BLK Super Speciality HospitalAccredited by JCI

FAST FORWARD TO RELIEF P4 A MOTHER TO THE RESCUE P8

A change of

Terrorism Affected Heart: 51-year old Iraqi gets a new lease of l i fe with Artificial Heart in India

Radiant

PULSESEPTEMBER 2018 | ISSUE 30

BLK Super Speciality HospitalPusa Road, New Delhi-110005 (India)

24-Hour Helpline: 011- 3040 3040Email: [email protected]

[email protected]

Nanavati Super Speciality HospitalSwami Vivekanand Road, Vile Parle WestMumbai, Maharashtra-400056 (India)24-Hour Helpline: +91-22-26267500marketing@nanavatihospital.orgwww.nanavatihospital.org

FROM THE DIRECTOR’S DESK

Dear Reader,

Our never-ending passion for healing is the core motivation that has inspired us to push the frontiers of quality care. It is this unwavering passion that has catapulted us to the ranks of one of the best hospitals in the world attracting patients from different parts of the globe. We feel humbled to be able to make a difference in people’s lives.

For this month's cover story, we have featured a miraculous case of a 51-year old Iraqi who was kidnapped for ransom and was shot several times while trying to escape from captivity. Fortunately, he survived the ordeal. However, the injuries and gunshots left him with a very weak heart which needed urgent attention. An artificial heart and expert intervention of the specialists at BLK gave him a new lease on life. An interesting piece on Breast Cancer Screening aims to provide good-to-know facts about guarding oneself against Breast Cancer. From our group hospital in Mumbai, we have featured a unique case of a 48-year-old patient suffering from hypertension and chronic kidney disease.

We have also featured another inspiring story of how our doctors at Nanavati help restore the facial structure of a 17-year-old patient with facial trauma. You will also find an informative piece and the technological aspects on Fast Track Knee Replacement and a relating case of a 58-year-old patient with complaints of a severe medial aspect of knee joint pain persistent for the past 2 years.

02 Radiant Life Care | Newsletter | September 2018 03BLK, New Delhi | Nanavati, Mumbai

I am also very happy to announce the launch of our newest Centre of Excellence - BLK Centre for Chest and Respiratory Diseases, which will be the latest addition to our growing repertoire of key specialities. The Centre spearheaded by our top specialists and aptly backed by an exclusive state-of-the-art sleep laboratory will provide unmatched comprehensive care for respiratory problems and all interventions related to respiratory diseases.

It is said that change is the law of nature. With this is mind and looking forward to a meaningful transformation, I am excited to inform our readers and patrons that we are giving "Pulse" a whole new makeover. Starting with this month's issue, our monthly newsletter will have a new look - we have tried to retain its original essence whilst redefining it in a contemporary way, bringing you the same sense of wonder but with a more captivating visual format. We hope you'll like the new transformation of our newsletter.

I would like to thank all the contributors for sharing their stories and articles for this newsletter. We hope to receive the same support from you in future as well. If you have any material that you feel should be ideal for this newsletter, please do share with us through our mail at: [email protected].

Stay Healthy, Stay Happy!

Dr. Mradul KaushikDirectorOperations & Planning BLK Super Speciality Hospital, New Delhi

CONTENT SHIKHA GIRGLA MAMTA SINGH

Nanavati Super Speciality HospitalMumbai, Editorial Team

PRAJAKTI SHIRSEKARSHYAM SHIRSEKAR

EDITOR-IN-CHIEF PARUL CHHABRA

CREATIVE CONCEPT PARUL CHHABRA SHIKHA GIRGLA

SUNIL KUMAR

DESIGN & VISUALISATION

SUNIL KUMAR

A CHANGE OF HEARTby Dr. Ajay Kaul

6 - 7

FAST FORWARD TO RELIEFby Dr. Vivek Mittal

4

GAME CHANGING SOLUTIONSby Dr. Pradeep B. Bhosale

5

A MOTHER TO THE RESCUEby Dr. Anup Chaudhari & Dr. Harish Pathak

8 - 9

HAPPINESS AT FACE VALUEby Dr. Parag Vibhakar

11

A STITCH IN TIME by Dr. Amit Agarwal

& Dr.Khushboo Singh

10

EVENTS ANDACTIVITIES

12 - 13

BLK & NANAVATI IN NEWS

14 - 15

CONTENTS

FAST FORWARD TO RELIEFThe Difference Fast Track Knee Replacement can make for Knee Osteoarthritis

Dr. Vivek MittalAssociate DirectorBLK Centre for Orthopaedics, Joint Reconstruction & Spine Surgery BLK Super Speciality Hospital, New Delhi

Knee Replacement is one of the most successful Orthopaedic procedures and has been practised widely over the past 30 years. A vast number of the world’s population, especially women, suffer from Osteoarthritis of the knee joint. The prevalence of Knee Osteoarthritis above the age of 60 years is around 85%. As the ageing population continues to surge, Joint Replacement surgeries will also increase in time to come. The number of Knee Replacements that happen in India alone is around 1.5 lakh per year at present, and it is expected to grow by at least 20% annually.

and requires intensive involvement of Anaesthetist, Intensivist, Physiotherapist along with the surgeon to achieve desired results.

All Knee Replacement surgeries performed at BLK Hospital are protocol driven. Usually, the patients are investigated along with pre-anaesthetic check-up on an outpatient basis. Latest anaesthesia techniques along with minimally invasive surgical procedures are used. This involves smaller skin incisions, minimal tissue dissection and less blood loss. Mostly, these patient are operated without tourniquet leading to lesser thigh pain and early recovery.

Post-operative pain management involves multimodal techniques with epidural analgesia with PCA pumps and oral analgesics. Overall, these modifications have resulted in reduced post-operative pain. The patient is made to walk 2-4 hours after the surgery with the help of support. By the third day after surgery, the patient is able to walk to the washroom and is self-supporting. Most patients with bilateral Total Knee Replacement leave the hospital on the 4th day with minimal support and return for suture removal fourteen days after the surgery usually without any support. Quick discharge has an added advantage of cutting down hospital expenditures, reduce hospital-acquired infections and improve patient satisfaction rates.


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GAME CHANGING SOLUTIONSPartial Knee Replacement relieves 58-year-old patient from chronic pain

Dr. Pradeep B. Bhosale Director – Arthritis & Joint Replacement SurgeriesOrthopaedics & Joint ReplacementNanavati Super Speciality Hospital Mumbai

A 58-year-old patient with complaints of a severe medial aspect of knee joint pain, persistent for the past 2 years, was brought to Nanavati Super Speciality Hospital. His pain aggravated while walking and felt relieved after taking rest. His disability had progressively intensified in the past 2 months. A detailed clinic-radiological assessment confirmed a Medial Uni-compartmental Osteoarthritis. Consequently, he was recommended for a Partial Knee Replacement (Medial UKR). An expert team at the Specialised Joint Replacement OT at Nanavati Super Speciality Hospital successfully performed a Partial Knee Replacement (Oxford Mobile bearing UKR) on him. As per the routine protocol, he was able to walk on the same day of the surgery after an interval of 7 hrs. After 15 days post the operation, the patient is pain-free and has regained near-normal activity level including sitting on the floor.

Knee Replacement is one of the best options available for Arthritis of the knee when it comes to excellent functioning, correction of deformity and providing stability. However, when only a single compartment of the knee is arthritic, it is possible to replace the single compartment preserving both the Anterior and Posterior Cruciate Ligaments (ACL & PCL) unlike Total Knee Replacement (TKR) where the ACL is absent, and PCL is sometimes sacrificed.

Subsequently, for people in the age group of 50 to 70 years with younger symptomatic knee Arthritis where only the single compartment gets destroyed by a degenerative process with pain as the main symptom, this technique is popularised with refined modern technology. With adequate pre-operative planning in a select patient group, Uni-compartmental Knee Replacement (Partial Knee Replacement) provides the best functional results. It offers excellent pain relief, and because the ACL & PCL are preserved in this technique, it also maintains near normal knee kinematics and functions.

Partial Total Knee Replacement needs good pre-operative planning, exacting indication and extremely precise surgical technique. It is a highly demanding and rewarding surgery. The partial knee does not offer correction of knee deformity and therefore is not recommended if the deformity is more than 15 degrees. Likewise, it is not advised in advanced arthritis and also for stiff knees.

Pre & Post-operative X-rays

Patient sitting cross legged post

the operation

"Partial Knee Replacement surgery is performed to replace only one part of a damaged knee. It can replace either the inside (medial) part, the outside (lateral) part, or the kneecap part of the knee."

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Recently, there has been a significant improvement in terms of technology, surgical technique and understanding of kinematics of the knee joint. Post-operative pain management and focused physiotherapy have made a huge difference in recovery.

Fast Track Total Knee Replacement is a new way of personalised care for Knee Osteoarthritis patients. This technique is also a preferred treatment option at BLK Super Speciality Hospital. The main objective of this technique is to make Knee Replacement procedure less painful, facilitate quicker recovery and early return to normal lifestyle, lesser need for prolonged physiotherapy and ultimately achieving good results. This is a team effort

"Fast Track Knee Replacements aim for optimising peri-operative management using a multidisciplinary and individualised patient approach and allows an earlier discharge from the hospital."

BLK Centre for Orthopaedics, Joint Reconstruction & Spine Surgery focusses on the ADVANCED TECHNIQUES in Joint Replacement, Spine Surgery, Sports Injuries and Trauma Care. The Centre is also ably supported by a WORLD-CLASS PHYSIOTHERAPY AND REHABILITA-TION UNIT for post-surgical care.

weak that he was not able to do his day-to-day work on his own. He had complaints of vomiting, severe LV dysfunction – threatening to heart failure. He was left with the option of a heart transplant or an artificial heart.

"Mohammed came to us with a terminal heart condition (Cardiomyopathy) which was a result of gunshot injuries he had suffered during captivity. We found that his heart was very weak and couldn’t eject blood. We tried to treat him medically first but his breathlessness kept increasing and he was completely crippled. He was waiting for a transplant but due to acute shortage of donors it was not feasible at that point of time.”

He was operated by Cardio Thoracic and Vascular Surgery (CTVS) team of BLK Heart Centre led by Dr. Ajay Kaul – Chairman & Head of Department, CTVS and was implanted with an artificial heart. The six hours long surgery involved 12 specialists from different departments including three surgeons.

A CHANGE OF HEARTAfter ordeal with kidnappers, 51-year-old Iraqi gets a new lease of life with Artificial Heart

A 51-year-old Iraqi man fatally injured in a kidnapping and ransom plot by a deadly local gang got a new lease of life thanks to the doctors at BLK Super Speciality Hospital. After having 7 bullets riddled in his body and several rounds of surgeries in his native country and later in India as well, Hani Jawad Mohammed lived to tell his tale. The trials and tribulations he faced at the hands of the terrorists and his road to recovery from the dead was nothing short of miraculous. Hani was kidnapped by a terrorist group for ransom and was shot several times while trying to escape from captivity. Presumed dead, the terrorists left him, however, fortunately, Hani survived against all odds. He underwent treatment for his gunshot wounds and was given a fresh start with a ‘new artificial heart’ in India.

Gunshots and injuries had crippled Mohammed. And his heart, due to multiple surgeries, had become very weak and needed a proper transplant. Hani was familiar with the healthcare landscape of India and had complete confidence in the expertise and experience of Indian doctors as he had previously undergone surgeries here as well. With the support and advice of his family and friends, he once again flew to India and opted for BLK Super Speciality Hospital this time.

Mohammad was advised for Heart-Left Ventricular Assist Device (LVAD)or normally referred to as an artificial heart. He was admitted to the Hospital and diagnosed with Dilated Cardiomyopathy which made him so

Dr. Ajay KaulChairman & HOD Cardio Thoracic and Vascular Surgery (CTVS) BLK Heart Centre BLK Super Speciality Hospital, New Delhi

When I was diagnosed with a weak heart which needed immediate attention, I decided to fly to India for my treatment. When Dr. Kaul explained to me that my heart had failed completely and the only feasible option for survival was an artificial heart (LVAD) in absence of donor for a heart transplant, I immediately agreed for an artificial heart implant. – Mohammed

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Dr. Kaul added, "Mohammed was explained that there is an option for him where an artificial heart can be implanted which can improve his chances of survival and keep him alive till a heart is available for replacement. Even if a heart is not available, he can survive for 10 years on this miniature machine."

Post implanting the LVAD, Mohammed's recovery was uneventful and he was able to return back to his normal life.

On July 28, he flew back to Iraq with an artificial heart successfully implanted.


“India is fast becoming the preferred healthcare destination for people suffering from various terminal diseases and critical cases like the one Mohammed had. Affordable treatment, state-of-the-art technologies and growing compliance with international quality standards are paving the way for the demand of medical treatment in India.”DR. AJAY KAULCHAIRMAN & HODCARDIO THORACIC AND VASCULAR SURGERYBLK HEART CENTRE

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LVAD functions like a heart and offers a ray of hope to thousands of patients whose hearts are too weak to survive. It is a life-saving surgery for those waiting for a heart transplant. LVAD has now become a revolutionary technique which could increase the chances of survival for 10-12 extra years.

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”The doctor and the patient post the successful implant

Polycystic Kidney Disease population may slow the progression of the disease. Patients with Autosomal Dominant Polycystic Kidney Disease and Renal Failure are most commonly treated with Hemodialysis or undergo Renal Transplantation.

A 48-year-old man suffering from Chronic Kidney Disease (CKD V) Hypertension, due to Autosomal Dominant Polycystic Kidney Disease, was admitted to Nanavati Super Speciality Hospital with high-grade fever, chills and serum creatinine of 14mg%. He was diagnosed with cyst infection and was initiated on dialysis for uremia. He was treated for cyst infection for 14 days with antibiotics but had a recurrent infection. He was then counselled about Renal Transplant, the best form of treatment for his case.In view of persistently infected cyst

in kidney bilaterally, he underwent Bilateral Nephrectomy. Each kidney was 36 cm in length. Post-operative, his anti hypertensive requirement increased to 3 times and he was put on 6 different types of anti hypertensives with a total of 24 pills per day for BP control. His 72-year-old mother came forward as the donor after a full work up. Considering the donor’s age, the Urology and Nephrology team was extremely cautious.

The recipient was taken to the operation theatre with on-flow NTG to control blood pressure which later was tapered and stopped. Intra-operative, Basiliximab was used for induction

A MOTHER TO THE RESCUEBilateral Nephrectomy saves 48-year-old man suffering from Chronic kidney disease

Polycystic Kidney Disease (PKD) are inherited diseases that cause an irreversible decline in kidney function. Polycystic Kidney Disease may be inherited as an autosomal dominant or recessive trait. The Autosomal Dominant form (ADPKD) is the most common genetic cause of Chronic Kidney Disease (CKD). Majority of the individuals with Polycystic Kidney Disease eventually require Renal Replacement Therapy.

Patients with Autosomal Dominant Polycystic Kidney Disease are usually present with Hypertension, Hematuria, Renal insufficiency or Flank pain

attributable to Renal Haemorrhage, Calculi, or Urinary Tract Infection. Patients may also be present with symptoms that are secondary to cysts in other organs such as the liver or pancreas. Renal function usually remains normal until the fourth decade. Thereafter, Glomerular Filtration Rate (GFR) declines on an average by 4.4 to 5.9 ml/min per year.

Promising specific therapies include vasopressin receptor antagonists (tolvaptan) and increasing fluid intake to suppress plasma vasopressin levels. Early usage of pravastatin in the paediatric Autosomal Dominant

Dr. Anup ChaudhariSr. Consultant Nephrology (Renal Specialist) Nanavati Super Speciality Hospital Mumbai

Dr. Harish PathakSr. Consultant Nephrology (Renal Specialist) Nanavati Super Speciality Hospital Mumbai

and Tacrolimus MMF/Steroids for maintenance. Post-operation, the patient’s anti-hypertension requirement decreased to 10% and creatinine on follow up was 1 mg%. Both the donor and recipient were fine after the surgery.

Though Bilateral Nephrectomy is rare nowadays in Autosomal Dominant Polycystic Kidney Disease, however, in this case, the patient underwent Bilateral Nephrectomy for recurrent cyst infection and mega size of the kidney. His anti-hypertensive requirement was increased to 3 times. He also required NTG infusion to control blood pressure in pre, intra, and post operations, along with 24 pills per 24 hours. Till his last follow up after Renal Transplant, his blood pressure medicine requirement reduced to 10%, with normal renal function. Mega anti-hypertensive requirement makes this case a rare scenario and excellent post-operative recovery encourages us to take such challenging cases in the future.


"The high requirement of anti-hypertensives to control the patient's blood pressure in pre, intra, and post operations made his case a rare and critical scenario. However, excellent post operative recovery encourages us to take such challenging cases in future."

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TOP-OF-THE-LINE CRRT THERAPYThe Nephrology Department at Nanavati Super Speciality Hospital is equipped with CRRT (Continuous Renal Replacement Treatment) Therapy machines (BM 25 Baxter) for bedside dialysis by CVVHD (continuous venovenous haemodiafiltration) for critically serious ICU patients who are on ventilators with fluid overload and hypotension.

A STITCH IN TIMEBreast Cancer Screening – the first step towards early detection and prevention

Dr. Amit AgarwalDirector & HODMedical OncologyBLK Cancer CentreBLK Super Speciality Hospital, New Delhi

Dr. Khushboo SinghSenior Resident Medical OncologyBLK Cancer CentreBLK Super Speciality Hospital, New Delhi

What is Breast Cancer Screening?It is the medical screening of healthy women in an attempt to detect Breast Cancer in the early stage.

How is Breast Cancer Screening beneficial?Breast Cancer Screening helps to detect Cancer at an initial stage and enables early treatment to prevent the Cancer from spreading. Over the years, Breast Cancer Screening has helped reduce the mortality rate.

How is Breast Cancer Screening done?Breast Cancer Screening can be done in two ways:

1. Breast Self Examination (BSE)2. Medical Examination

1. Breast Self Examination: Every woman after the age of twenty years should start conducting breast self-examination, once a month or just after a menstrual period when breasts are not tender or swollen. During examination check for any lump, change in shape of the breast or texture of skin and any secretion from nipples. Consult a local Oncologist to learn the method of self-examination.

2. Medical Examination: According to the American Cancer Society guidelines

for the early detection of Cancer, women aged more than 50 years should get mammograms done every 1-2 years interval. Screening should continue as long as the woman is in good health and is expected to live 10 more years or longer. Women having a family history of Breast or Ovarian Cancer have a higher risk of developing Breast Cancer at an early age. Such women should undergo genetic testing (BRCA gene mutation test ) after consulting an Oncologist. Women having this gene mutation need special attention and should take preventive measures as advised by their Oncologist. Women at higher risk are those who have a family history of Breast, Ovary, Prostate and Pancreatic Cancer in any close relative like siblings, parents /grandparents or uncle / aunt.


HAPPINESS AT FACE VALUEExpert intervention restores the face of a young girl

Dr. Parag VibhakarSr. ConsultantPlastic, Reconstructive,Microvascular and Cosmetic SurgeonNanavati Super Speciality Hospital Mumbai

A 17-year-old patient with facial trauma was transferred to Nanavati Super Speciality Hospital from a peripheral hospital. Initial assessment of the patient in the Emergency Department reported that the patient was stable. CT scan revealed facial bone fractures, however, no head injury or respiratory distress was detected. There was also no bodily injury. At the time of admission, she had a dressing on the left side of her face and a slab on the right forearm. The patient was admitted to the CCU and was immediately started on antibiotics and analgesics. A full investigation of profile was scheduled. The patient also suffered from edema, and the left side of the face had drooped down with a large gamgee wrapped across the head like a turban.

The initial look of the patient showed a degloved left side face completely black and containing gravels. A lot of tissues were also missing in the cheek and temple region. An immediate bedside wash was given, and the patient was posted for debridement and closure. The patient was given tetglob and aggs cover. Debridement and immediate reconstruction were the most challenging decision; however, early management proved to be a preferable choice. It took more than an hour to remove each and every speck of gravel from

the nook and cranny of orbit pterygoid fossa skin subcut lower lid and upper lip.

The face back was suspended to the zygomatic arch and temporalis fascia to close a large tissue defect partially. The patient also had a right forearm circumferential degloving injury. After a few days, the temple and forearm were grafted along with facial bone fracture plating to restore shape and occlusion. Together with Dr. Anshuman Manasvi – Consultant, Plastic Surgeon, the team was ultimately able to provide her with a decent reconstruction.

The patient was discharged following a progressive recovery but will require further interventions in the future to remove the small area of graft in the left temple region.

Early detection of Breast Cancer improves long-term outcome. Therefore, regular screening tests is highly recommended. – Dr. Amit Agarwal

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“When the patient was brought to the hospital, she had suffered a major facial trauma and the left side of her face had drooped down. No bodily injury was recorded."

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Pre & Post-surgery images

The Cosmetology Centre at Nanavati Super Speciality Hospital upholds HIGH STANDARDS OF EXCELLENCE and has the distinctive strength of having both COSMETIC AND RECONSTRUCTIVE SURGERIES under one roof. The centre offers a range of extensive services including Craniofacial Surgery, Reconstructive Microsurgery, Plastic Surgery, Burns and Acid Injury Surgeries, among many others.


EVENTS AND ACTIVITIES

BLK Super Speciality Hospital was recently acknowledged as the Hospital with the Highest Standard in Patient Care at the CIMS Medica Healthcare Excellence Award 2018.

Nanavati Super Speciality Hospital in association with Indian Medical Association, Juhu had organised a CGP Refresher Course (College of General Practitioner Refresher Course) from 7th - 10th August, 2018. Prominent speciality doctors of Nanavati spoke about various new techniques in surgeries and medical advancements. The event also had a Q&A session with the experts followed by a panel discussion with the specialists. Nearly 390 medical experts attended the program across 4 days.

Dr. Vivek Venkat has joined Nanavati Super Speciality Hospital as a Consultant, Uro-Oncology and Robotic Urology. He is an MCh Urology (Gold-medalist) from CMC, Vellore with a fellowship in Urologic Oncology & Robotic Urology from the University of Miami. He has a vast experience in all aspects of Uro-oncology & Robotic Surgery (over 600 cases). He is presently a Visiting Assistant Professor at the University of Miami.

Nanavati Super Speciality Hospital had organised a Paediatric Cardiac Screening Camp in Osmanabad district of Marathwada region in Maharashtra. Dr. Rohit Shahapurkar, Senior Consultant – Cardiovascular & Thoracic Surgery and Dr. Parag Bhalgat, Consultant – Paediatric and Interventional Cardiology screened around 50 patients.

Dr. Rajesh Modi, Consultant – Gynaecology had organised a CME at Nanavati to explain the technique of Day Care Hysterectomy to Gynaecologists. 120 Gynaecologists from across India attended the masterclass wherein 8-9 Hysterectomy and Myomectomy surgeries were performed using 3D Laparoscopy system.

WELCOME ABOARD! NANAVATI CME WELCOME ABOARD!

CAMP

Renowned Orthopaedician, Dr. Deepak Chaudhary, has recently joined the expert team at BLK Hospital. Before joining BLK, he has held the position of Director & Professor, Sports Injury Centre, Safdarjung Hospital. With more than 25 years of experience, Dr. Chaudhary was the main force behind conceptualisation, subsequent commissioning and operationalisation of mordern Sports Injury Centre, a first-of-its-kind in India. A distinguished expert in the field of Orthopaedics with more than 12,000 complex arthroscopic knee and shoulder surgeries to his credit, he will be leading the Arthroscopy and Sports Medicine Centre at BLK Super Speciality Hospital.

AWARD & ACCOLADE

Dr. Deepak ChaudharyDirector - Arthroscopy and Sports Medicine Centre

NEWEST ADDITION!BLK Super Speciality Hospital recently launched its latest centre of excellence – CENTRE FOR CHEST AND RESPIRATORY DISEASES. Spearheaded by the hospital's top specialists and aptly backed by an exclusive state-of-the-art sleep laboratory, the centre will provide unmatched comprehensive care for respiratory problems and all interventions related to respiratory diseases including: Management of Respiratory Allergy & Sleep Apnea, Pulmonary Rehabilitation for Chronic Lung Diseases and Specialised Pulmonary Paediatric Care, among others.

Dr. Vivek VenkatConsultant, Uro-Oncology and Robotic Urology


BLK AND NANAVATI IN NEWS

Documents

SEPTEMBER 2018 ISSUE 30 - Best Super Speciality Hospital ... · BLK Super Speciality Hospital Pusa Road, New Delhi-110005 (India) 24-Hour Helpline: 011- 3040 3040 Email: [email protected]