Doctor in Aster Cmi Hospital
Cardiothoracic Vascular Surgery
Liver Transplant Surgery
Nuclear Medicine Physician
Best and professional doctor. I had the best experience. Superb diagnosis and treatment of my baby. Very approachable and patient . I will always cherish her advice and grateful to have found this doctor for my baby.
Doctor is good... booked @12.30... but OK started after 3.30pm only...
Naveen Kumar G
very very good and caring, friendly doctor, may god bless him
Very nice and she explained the problem indetail
One of the best doctor related to lungs
Children achieve control of urine around 2-5 years of age initially in the day then at night, bowel or toilet training is usually accomplished prior to it. Any child bed wetting after five years of age should consult their pediatrician for it can affect the well being of the child.
This is of paramount importance because bed wetting may reduce the child's self esteem, prevent sleep overs with friends, fear harsh disciplining by the caregivers.
Around 6-12 % above six-year-old children are bed-wetters many of them are humiliated, beaten, teased or even punished after bed wetting. This increases their stress and cause more bed wetting, so it should not be done. Parents should understand that bed wetting is not the child's mistake and completely curable which should be expressed to the child also.
Bed wetting is commonly found as isolated problem in the night due to immaturity of brain-kidney-bladder-urine pathway leading to more urine production in night and deep sleep with difficult arousal, whereas day time wetting or urgency may denote other kidney/urinary bladder/spine problem.
Some times a child who was dry at night previously may again start bed wetting due to emotional stress, urinary tract infections, adenoids, diabetes, etc. Stressors range from simple things like arrival of younger sibling or beginning new school to serious issues like learning disability, poor academic performance, abuse, etc. So, let's seek medical help for bed wetting and help your child to be dry for a bright future!
Ways To Ensure A Good Health Of The Heart:
The Magnitude of the problem:
A 45-year-old man wakes up at 4.30 a.m and complains that he feels some discomfort in the chest, it may be “gas”, he surmises. His wife says we can go to the doctor after breakfast, drink some water and go to sleep. He went to sleep never to wake up; this is a real-life incident.
The leading cause of death in India is coronary heart disease. Added to this is a significant burden of congenital heart diseases, rheumatic heart disease, degenerative heart disease and arrhythmia-related cardiac problems.
The burden of heart disease is rising rapidly in India with the westernisation of our diet/reduced physical activity and a genetic predisposition to develop blockages in the blood vessels.
We have a high incidence of diabetes/hypertension/central obesity which contributes to coronary artery disease at a younger age and more severe disease as compared to a Caucasian/Chinese/African population.
Action to be taken -
Awareness: As a doctor, the most important problem faced is one of suspicion and denial. People are unable to accept that one of them or a dear one can possibly develop a heart attack. "He was fine till 2 hours ago", is the usual refrain. Unfortunately, most heart attacks happen suddenly. ”Time is Muscle” - the sooner you treat the better are the outcomes. Going from one hospital to another in an emergency wastes precious time. One should go to the nearest facility which is equipped to handle these situations.
In chronic conditions, there is enough time and scope for multiple opinions and hospital visits.
Prevention: The old adage prevention is better than cure is very appropriate in this context.
Ischaemic heart disease occurs due to plaque formation in the coronary arteries. It cannot be attributed to one single cause but is usually due to multiple risk factors.
Some of them are modifiable and therefore more relevant. These are,
The Non-modifiable risk factors are:
- Family history
- Ethnicity (Indians are more prone than Caucasians/Chinese/ Japanese)
Diabetes: Diabetics are 3-5 times more prone than non-diabetics to develop IHD. It is important that people with diabetes should have their cholesterol levels checked and treated appropriately. Good blood sugar control has also been associated with lesser cardiac events.
Smoking: Smokers have a 3-5 fold higher risk of IHD. They develop blockages at a younger age and have a higher propensity to develop plaque rupture and acute heart attacks. SMOKING CESSATION is the single most important health intervention that can be done with least cost to the individual.
Hypertension: All individuals should know their blood pressures and check it periodically. High blood pressure is a silent killer as it is mostly asymptomatic and inflicts damage gradually. All individuals should know their blood pressure and should be treated appropriately if it is high.
Physical Inactivity: With the advance in technology and availability of gadgets for every need, physical inactivity has become rampant. Lack of physical activity causes diabetes/hypertension/ high cholesterol and increased risk of heart attacks.
The moderate physical activity of 30- 45 minutes are recommended to maintain a healthy heart.
Obesity: Obesity is a rising pandemic in Asian countries and all efforts should be done from childhood to avoid obesity. Obese individuals have a much higher likelihood of hypertension, diabetes and heart disease. Non-alcoholic Steatotic hepatitis, osteoarthritis, sleep apnoea are some of the other drawbacks of obesity.
Cholesterol: High cholesterol is a major cause of heart disease. Checking one's cholesterol values at least once in
5 years and taking remedial action (Lifestyle changes and/ or medications) is a very important step in reducing heart disease.
When should I seek medical attention?
- Chest pain - Whenever one develops central chest pain which may radiate to either arm, throat or back. When the pain increases on eexertion. When the pain is associated with sweating, giddiness or loss of consciousness. Rarely heart attacks can present as abdominal pain and vomiting.
- Breathlessness - Breathlessness on exertion or on lying down may be a symptom of heart disease.
- Palpitations - Exertional palpitations or sudden onset palpitations with giddiness or loss of consciousness may be a symptom of heart disease.
Easy fatiguability can be a symptom of heart disease.
Bluish extremities, Loss of consciousness can be due to heart-related problems.
Any of the above-mentioned symptoms should alert one to a possibility of heart disease.
Being told that your child needs a liver transplant may be scary but the truth is that this surgery has a very high success rate. Most children who have had a liver transplant lead long, healthy lives. Here are 10 facts you should know about pediatric liver transplants.
Fact 1 - Liver transplant is usually the last resort.
Doctors advise a liver transplant only when medication and other types of therapies fail to provide desired results. Hence, do not ignore the doctor’s advice if they say the child needs a transplant.
Fact 2 - A liver biopsy may be needed before a liver transplant
Not every child is a viable candidate for a liver transplant. Hence, a biopsy is usually conducted to check the child’s candidacy for the transplant.
Fact 3 - Children are scored along the MELD and PELD system to determine the urgency of a transplant
This stands for the Model for Endstage Liver Disease (MELD) scoring system and Pediatric End-stage Liver Disease (PELD) scoring system. The higher the score, the more urgent the need for a transplant.
Facts 4 - It may take a while for a donor liver to become available
Most donor livers come from recently deceased persons. Depending on the urgency of the child’s condition, the child will be placed on the waiting list for a donor liver. This can take anywhere from a few days to a few months.
Fact 5 - The only part of a healthy liver is transplanted to the child.
In the case of children, only part of the liver is transplanted as their liver has not yet reached its full size. Often a healthy liver will be partially transplanted to a child and partially transplanted to an adult.
Fact 6 - The child’s family members can donate part of their liver for a child’s liver transplant.
Family members with the same blood type can donate part of their liver to the child.
Fact 7 - Liver transplant surgery is performed under general anaesthesia.
This surgery is performed while the child is under general anaesthesia and hence he or she will not feel anything during the procedure.
Fact 8 - Your child may have to be hospitalized for a few weeks post-surgery
Children are usually hospitalized for a few weeks after the surgery so that the doctor can keep an eye on how the body is reacting to the new organ.
Fact 9 - There is a chance your child’s body may reject the donor organ
In some cases, the child’s body identifies the transplanted organ as an antibody and rejects it. Medication can help reduce the risk of this happening.
Fact 10 - Regular check-ups are needed after a transplant
Check-ups are required to check for any complications that may arise post-surgery. Eventually, this is needed only once or twice in the year.
A person with liver cancer or failed liver is required to undergo a liver transplantation, where the old liver will be replaced by a new liver. A liver transplant rejection, which is also called organ rejection, is faced by people who have recently undergone liver transplantation. One of the main reasons for this rejection is that the immune system of the body does not accept any foreign bodies. It will start attacking them as it treats them as a threat to the body.
Symptoms of liver rejection
Symptoms and signs of liver rejection vary from person to person. However, it is very important to understand these signs. Here is a small list of some common symptoms of liver rejection:
- Severe pain in the area of transplant
- High fever, usually above 100-degrees F
- Severe itching
- Dark urine
- Swelling in the abdominal area
- Problem in breathing normally
Things you must remember
- If you see any of these signs or if you feel any kind of abnormality in your body after the liver transplantation, you must get in touch with your doctor immediately.
- In most of the cases, the symptoms are visible, but in some rare cases, the symptoms will not be visible at all. In such cases, a liver biopsy is done on the patient who has undergone a liver transplant. In this biopsy, a small piece of the liver is taken out and sent for testing. This is one of the best ways to be sure if the newly placed organ is rejected by the body or not.
Acute and chronic organ rejection
- Usually, within one year of your liver transplantation, you may experience the signs of rejection. This is called acute rejection. These rejections can result in chronic rejections. Chronic rejection is a condition where your organ will be attacked slowly and it gradually stops functioning normally.
- As time passes post liver transplantation, the chances of getting rejected become lower. But that is never guaranteed by any doctor. Rejection can happen even after years of liver transplantation, and you may experience any of the above-listed signs and symptoms.
- An early detection of the rejection symptoms will help in stopping the liver to fail completely. It Undergoing another liver transplantation will be quite difficult as it hard to find the right donor for your body. To avoid infections, the doctor should be able to detect the signs and prescribe the right medicine in the right dose after studying your medical history.
After any kind of organ transplant, most of the patients recover very fast and are able to get back to their normal life. But this does not mean that there will not be any further complications. Yes, when a new organ enters into the human body, the immune system may not accept it and starts attacking. It is important for a doctor to diagnose this at an early stage and treat it. Different organ transplants have different symptoms.
What is a rejection after a liver transplant?
When a foreign body enters into your body, then your body will react to the foreign body treating it as an enemy. Now, when your failed liver is replaced by a new liver, the body will see it as some threat and will reject it. This is called rejection. The immune system of your body will start producing antibodies, which will help in killing the new liver. Your body will not be able to realize that the new liver is beneficial for it.
In order to avoid rejection and for successful organ functioning, you need to take certain medications. This medication is going to trick the immune system of your body and the new liver will be treated as its own organ and not any foreign body. You may have to take this kind of medication along with other medications that prevent side effects of these medicines throughout your life. Some of the common signs of rejection that you must watch out for include dark urine, jaundice, severe body aches, cough, nausea, itching, tenderness in the abdominal area, high fever, and problem in breathing normally.
How to prevent rejection after a liver transplant
The patient who has undergone liver transplant should be given medicine to fight the attack and rejection. This medicine has to be used for a lifetime. Every person is different and every doctor is different. Each doctor would prefer a different medicine for each patient based on the condition of the patient.
Some of the common medications used after a liver transplant to prevent a rejection are:
You need to be very careful when you are taking any of these medications or something prescribed by your doctor. You should take exactly the same dose prescribed and nothing more than that. High dose of these medicines will increase the chances of infection as that affects the immune system. So, the dose prescribed will be balancing the infections and rejections in your body. Frequent blood tests are also done to make sure that there is no trace of infection after liver transplant due to the anti-rejection medications. You need to be extra-cautious during the first few months after transplant as a high dose of anti-rejection medicine is given during this time and hence, chances of infection are high.
Did you know that liver stands second among the most transplanted organs in the human body? Liver diseases are becoming more prevalent today. A liver transplant becomes necessary when a person’s liver is diseased or injured. Through surgical procedures, a part or the complete healthy liver is transplanted from the donor.
Here are some of the typical reasons for a liver transplant:
- Autoimmune Hepatitis: In this kind of hepatitis, the body's immune system is not able to recognize its own liver tissue. It thus begins to injure the liver cells and that finally leads to scarring, liver cirrhosis, and end-stage liver disease. Unlike chronic viral hepatitis, this disease is not caused by a virus.
- Chronic viral hepatitis B, C, D: Hepatitis is caused by the viral infection which results in swelling, inflammation, and cell damage. All these lead to liver destruction or scarring. The different types of hepatitis are A, B, C, D and E. Hepatitis B is the leading indicator of liver cancer worldwide.
- Non alcoholic fatty liver disease: Fat accumulation in the liver cells causes this disease. It is said that excessive alcohol is the leading cause of a fatty liver. But this condition is also seen in patients with diabetes and obesity. This condition can cause liver cirrhosis.
- Primary sclerosing cholangitis: In this disease, the bile duct becomes progressively damaged by inflammation. This results in scarring that narrows the bile duct and causes obstruction to the flow of bile.
- Biliary cirrhosis: Sometimes there is a blockage in the bile duct. The liver creates bile which passes from the bile duct to the gallbladder. From here it is slowly released into the small intestine and helps in digesting fats. When the bile duct is blocked, all the bile that is produced accumulates in the liver and causes swelling and eventually loss of liver function.
- Active liver failure or toxic exposures: People suffering from acute liver failure caused by other reasons such as viral infection, fatty liver, etc. can undergo liver transplant surgery. Exposure to certain pesticides, herbicides, lead, asbestos and other hazardous pollutants can be the cause of a potentially life-threatening liver disease.
- Caroli's disease and choledochal cyst: The bile ducts become dilated and result in the formation of cysts or sacks. This causes infection and obstruction of the bile ducts. Choledochal Cyst, On the other hand, is a congenital disorder. A choledochal cyst is formed due to a structurally flawed bile duct. In both these scenarios getting a transplant is mandatory.
- Hepatic tumors: Tumors that spread either from other parts of the body or those that develop in the liver itself can cause severe damage to this organ.
It is best to consult an expert to know if a liver transplant is necessary for you. Hence, when you have problems related to liver seek medical advice without delay.
Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.
Many types of minor knee pain respond well to self-care measures like ice packs, hot water formentation, local application of analgesics and oral analgesic medications, physical therapy and knee braces also can help relieve knee pain.
The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:
Swelling and stiffness
Redness and warmth to the touch
Weakness or instability
Popping or crunching noises
Inability to fully straighten the knee
When to see a doctor?
Can't bear weight on your knee
Have marked knee swelling
Are unable to fully straighten or bend your knee
See an obvious deformity in your leg or knee
Have a fever, in addition to redness, pain and swelling in your knee
Feel as if your knee is unstable or your knee "gives out"
The liver is a key metabolic organ and plays a vital role in digestion and absorption of foods. It can be severely diseased or injured due to various causes listed below, and one of the definitive measures of an injured or a diseased liver is a liver transplant. A liver transplant involves removing the failed liver and replacing it with a healthy liver from a donor.
Some reasons requiring liver transplant include:
- Alcoholic liver disease
- Liver cancers or tumors
- Fatty liver disease (non-alcoholic steatohepatitis or NASH)
- Severe hepatitis C
- Severe alcoholic cirrhosis
- Biliary atresia in children
- Acute liver failure
Some of the symptoms that indicate liver failure are:
- Black, tarry stools
- Blood in the vomit
- Fluid accumulation in the abdomen (ascites)
- Mental confusion
- Tendency to bleed even from minor wounds
There are primarily two types of liver transplant:
- Deceased donor transplants: In a person who is brain dead, the liver can be removed and transplanted into a person who needs a transplant. The entire liver is usually transplanted.
- Living donor transplant: A liver is known for its regenerative properties, and in some people, a part of the liver can be removed and transplanted into another, usually a close family member. The replaced part grows into a full-size liver over a period of time and becomes fully functional.
Anyone with severe liver cirrhosis with a life expectancy of less than a year is usually required to undergo a liver transplant. In terms of survival rates, here are some statistics:
- After a year, more than 90% survive a liver transplant.
- After 5 years, more than 85% survive a liver transplant.
- After 10 years, more than 75% survive a liver transplant.
It is not uncommon for people to survive for more than 10 to 15 years, if they maintain regular follow up and discipline.
Factors affecting survival rates
The overall health status of an individual determines the success rate of a liver transplant. The following are considered to bring down the survival rates:
Most liver failures start as hepatitis, and when diagnosed early, treatment can be done effectively. However, if left untreated, it can lead to cirrhosis which then requires a liver transplant in most cases.
Evaluation before transplant
A detailed recipient evaluation is done to confirm that liver transplant is indeed required to improve success rates. The following factors are determined:
- Diagnosis and severity of the condition
- Urgency of the transplant
- Overall health status
- Emotional preparation for a transplant
The patient is then placed on the list for a cadaveric transplant. Alternately, if a donor is available, the donor evaluation and transplant is done.
Foot pain contributes around 3-5 % of patients visiting Orthopedic OPD, with heel pain being predominant complaint. Heel pain commonly involves the underside or back of your heel. Although not a symptom of a serious condition, it’s disabling as it can interfere with your routine activities.
The below few conditions which are prone to developing heel pain like:
- Abnormal walking style (gait)/altered alignment of the foot
- Ill-fitting shoes/ badly-worn shoes
- Standing, running or jumping on hard surfaces
- Injury to the heel, such as stress fractures
- diabetes and arthritis
The most common causes of heel pain are plantar fasciitis (bottom of the heel) and Achilles tendinitis (back of the heel).
- Pain which is usually intense in the mornings or after a long period of res,
- Discomfort or swelling in the back of your heel
- Skin on your heel overly warm to the touch
- Burning sensation over heel
- Numbness or tingling in your heel
- Swelling around ankle etc
Remedies you can try:
- Avoid activities that aggravate your heels, such as running, standing for long periods or walking on hard surfaces.
- Ice application on your heel for 10-15 minutes at least three times a day.
- Well fitting shoes.
- Non-steroidal antinflammatory drugs can reduce inflammation and pain
- A splint is worn at night
- Flexibility exercises
Prevention of heel pain:
- Wear a well-fitting & comfortable shoe
- Always warm up and cool down when exercising or playing
- Silicone insoles
Consult your doctor immediately if, Heel pain persists in spite of home remedies. Try these tips to put Heel pain at rest!
Liver transplants are considered a safe procedure and has a high success rate. However, it is important for patients to follow proper aftercare instructions as given by the doctor. The liver helps process food and filter toxins and hence the patient’s diet must be carefully monitored after a transplant surgery. Weight gain after liver transplant can cause fatty liver disease and damage the sensitive transplanted liver.
Here are a few tips on the ideal diet to be followed after a liver transplant surgery.
- Avoid alcohol: Alcohol is a big no-no after a liver transplant surgery. In addition to not drinking any type of alcohol, patients should also abstain from any food cooked in alcohol or wine.
- Avoid pomegranates and grapefruits: Fruits are very good for recovery but certain fruits such as pomegranates and grapefruits should be avoided. This is because they may have an effect on the immunosuppression medications being prescribed to keep the body from rejecting the donor liver.
- Eat plenty of vegetables: Vegetables are essential during recovery process after a transplant surgery. This gives the body the necessary nutrition it requires and also acts as a good source of fibre.
- Eat lean meat: Lean meats like poultry and fish act as rich sources of proteins. This helps the body speed up the recovery process. Other forms of protein include soy, eggs, legumes and nuts. Avoid fatty meats as these are difficult to digest and can put a strain on the liver.
- Drink plenty of water: Water helps in hydrating the body and is essential during recovery from a major surgery such as a liver transplant. Water also helps improve blood circulation and eases the filtration of toxins. Patients should ideally drink 8-10 glasses of water a day.
- Limit sugar consumption: One of the side effects of medication prescribed after a liver transplant includes high blood sugar. To avoid this, limit your consumption of sweets and sugars. Avoid cakes, jams, jellies, packaged juices and chocolate.
- Have plenty of fibre: Fibre helps ease digestion and helps control cholesterol levels. An increase in cholesterol levels may be due to the medication being prescribed. Hence eat plenty of fibre. This could be in the form of whole grain foods, vegetables and fruits. As far as possible avoid processed foods.
- Get enough calcium: Medication prescribed after a liver transplant may make the patient’s bones lighter. This can increase the risk of conditions such as osteoporosis. To counter this, it is important to get enough calcium.
Before consuming any kinds of foods and supplements, it is essential to consult with the doctor about the diet that needs to be followed. A proper diet and aftercare can do wonders in recovering from the surgical procedure.