Apollo Spectra Hospital - Karol Bagh

I am Dr. Malvika Sabharwal from jeevan mala hospital and apolo spectral hospital in Karol Bagh, New Delhi India.

I am gonna tell you about uterus removal. Uterus removal is a very common operation. Bht commonly isko kara jata hai k patient ata hai apko bolta hai k ji hamary ko flah flah flah problem hai or ap hamara uterus nikal dijiye. Sb sy phly to main apko btaungi kya indications hain. Chahye wo fibroid k hn, ya bleeding zyada ho rai ho. Koi fibroid nai hai per bleeding bht zyada ho rai hai ya koi changes a rhy hain. Jaisa k agr mouth of the uterus main agr koi peps pal krty hain routinely jo k karna chahye, her ek marez k liye. Ap regular apasnaol kar ry hain us main koi changes any lag jaty hain ya aisi koi bhi problem ho to patient ata hai or wo bara clear mind sy kehta hai k ji mje uterus remove krwana hai. Kbhi kbhi wo refered cases hoty hain. Ya marez ko kahein kaha jata hai or hamary pas aty hain. Q k hamary pas jo uterus removal ka tareka hai wo hai durbeen sy or ek pait khol k. pait khol kr jo karty hain, ek bara 8 centimeter, 8 inches k kareeb ek insection hota hai pait k upper or us k through hm uterus ko, us ko pakar k baher nikal k us ki puri surgery kr k as pas disconnect kr k us ko nikal dety hain. Or abdomen ko stitch kr dety hain. Laparoscopic surgery jb sy hm ny shuru kari hai. Year was 92. I think ye sb sy bara bone hai. Doctor k lye bhi, patient k lye bhi. Ek to patient friendly surgery hai. Or doctor k liye offcourse, doctor ko sekhny main thora samain zaror lgta hai,but once you have commanded the technique of Laparoscopic surgery, it is the best. It is the best for the patient and for you it’s a very affective way of taking out the uterus without any problems. Ap us ko Laparoscopicly nikalty ho or Laparoscopicly jb nikalty ho 1 din ka stay rehta hai hospital main. 1 din main mareez back to normal work hota hai. Wo ghr ja kr k, serhioyon sy charhta hai. Serhiyon par jaye, upper rahy, ghar k khanay bnaye, baheer ghumny jaye, hr roz piture dekhy, us py koi issue nai hai. Bht minimal unko btaya jata hai do’s and don’t’s. unka upper charhny main koi problem nai ati. Sirf halki phulki jo problem, sirf 2 chezain ki hm log btaty hain which Is hardly any issue. So patient is back to normal routine. Ap apny ffice dubara ja skty hain itni jaldi. Loss of working days is very less. To loss of working days jaisy e kam oty hain, aj kal apko pta hi hai, mostly ladies are working, most of the women are working today. Chahy wo ghr py, ghr ka bhi kam itna hota hai. Bachon k aj kal kitny kam hoty hain, us k ilawa office girls bht hoti hain. Jo k office ko bhi sambhalti hain or ghr ko bhi sambalti hain. Let me tell you hamary bht patients hain un ko kbhi ye problem nai I k hum uterus nikalny k bad hm ghr ka kam nai kar paye. Ya office ka kam nai kar paye. Hamary pas doctors aty hain. Dur dur sy aty hain, in fact patients are coming from dubai, London, America, Canada all over. Wo aty hain apna operation krwaty hain or 2 din k bad they are ready to go home. Because this surgery has really picked up so much k jb o dekhty hain k kitny aram sy ye kam ota hai to unko aisa koi hesitancy nai lagti. Un k roz mara ki zindagi main koi change nai ata. Unko minimalistic thory sy do’s and don’ts hoty hain which is hardly anything. And aam tor per jb hum uterus nikalty hain, jaisa k main apko dekhati hn. This is one uterus. Two tubes and two ovaries. Aj agr main uterus nikal rai hn, lady ka age hai 45, I will tell her definetly ovary tubes to ap nikal hi lijye. Ovaries jo hain, wo apko hormones deti hain. Hormones ek lady ko femerity bna k rakhti hai. Femariti sy ye bhi matlab hai, tubes ka koi aisa role nai hai per ovaries apko hormones dy k, hormones k karan apka skin, hair, heart, sb k upper us ka zor hai. So ovaries ko hum bina puchy bilkul nai nikalty. Us k lye permission lety hain tabhi nikali jati hai. Per agr uterus nikal ry hain to aam tor per hum tubes ko bhi nikal dety hain.

Thank you very much.

I’m Dr. Malvika Sabharwal, from Jeewan mala hospital and Apollo Spectra hospital, New Rohtak Road in Karol Bagh. In fact I’ve been a laparoscopic surgeon since the year 92, I introduced it in the North of india. 2000, we had got recognition at this hospital for managing most of the gyne problem laparoscopically.

Today I will tell you about fibroid uterus. It’s a very very common problem, seen almost in 25% of cases and at all ages, at any age and It causes various problems. In case agar ye bleeding cause kar ra hai, to bleeding k sath to mareez fatafat aatay hain k han g hamay bleeding ho rai hai, un ka diagnosis b ho jata hai. Kabi kabi wo infertility cause karta hai, infertility ka matlab k pregnancy nai ho rai hai. In such cases, agar pregnancy nai ho rai hai to b mareez aa jaat hain sooner or later. Par kai fibroids aise hain jo k hotay hain even after having couple of children. 2,3 bachay ho gae phr b wo fibroids hai. Ab basically fibroids hotay ki hai, ye normal uterus hai, 2 tubes hain 2 ovaries hain, ye muscle wall jo hai agar is me se ek bhi fibre barh jata hai, ye fibroid cause karta hai aur fibroids jo hain wo is tarha k tumors hain uterus k andar. Agar ye uterus me fibroid andar ki taraf jhukav de ga, agar 2cm ka b hai, wo bleeding cause karay ga aur us k liye aap fatafat doctor k paas pohnchen gey aur us ka samadhan ho jae ga. Agar fibroid boht barha hai, wo upper ki taraf jae ga aur us ka pata b nai chalay ga aapko. Kabi kabi kuch pata b nai chalta, kabi kabi us se aata hai patient k g hamy urine nai ho paa ra, hum peshaab nai kar pa rae aur ye hamay boht tang kar ra hai, tou tab diagnose hota hai. Any which ways, hamaray paas 2 hi options hain, ya tou uterus ka nikaalna ya fibroid ka nikalna. Agar hamay uterus ka kaam lena hai, patient young hai, aagay bachay paeda karne hain tou definiteky fibroid ko nikalna hi better hai par agar family complete hai, agar us ko bachay aur nahi chahye aur us ki umer b towards the maybe 40 years or above hai or even otherwise agar boht zaada takleef ho rai hai, many options are there par durbeen se hum fibroid b nikalte hain aur uterus b nikalte hain. Agar fibroid nikala jae tou sirf fibroid ko nikaal kar k hum bolte hain ab aap pregnancy shuru kar sakte hain. Once fibroids are removed laparoscopically ya ek aur tareeka hota hai hysteroscopically, uterus ko andar se ja kar k hum dekhte hain, muaaena karte hain aur jahan fibroid hota hai us ko nikaal letay hain. It’s a non-touch technique hysteroscopy wala. Laparoscopic jo karte hain, us me 2, 3 holes bante hain pait k andar aur us kop hr morselate kar k tareekay se nikaala jata hai. Ye morselation b boht zaada ajkal controversy me b aaya , is k baaray me tarah tarah k hare k forum me discussions hue k karna chahye ya nai karna chahye aur ye jo fibroid ko nikalne ka tareeka morselation ka hai, aaj kal in-bag b hai matlb aap bag k andar fibroid ko daalo aur us ko nikalo. Is se wo cheez jo hai wo phailti nai hai aur boht araam se wo aap k nikal aati hai. Ye ek din ka stay rehta hai hospital me fibroid nikalne k liye. Laparoscopic fibroid removal me patient is there in the hospital just for one day. Us k baad you’re back to normal and aap ko koi rok thaam nai hai, serhiyon pe jaana utarna, aap ko koi jhukna, travel karna. Log Hindustan k bahr se b aatay hain is ko remove karwanay k liye. So, this is one thing which is available in our hospital and we’ve been doing it since 92. 2000, we have already got to recognized training center for fibroid removal. Now there are situations jahan pe fibroids nahi nikal paatay, tou us me b koi aisi baat nai hai, it’s not k it’s the end, like k agar tubes k boht paas ho, agar boht zaada paas hai tou kabi kabi situationally aap nai nikaal paatay but that is something jo k aap ko us k liye koi aisi wo baat nai hai as long as the tubes are patent, matlb aap tube ko test karte ho aur pregnancy amooman hojati hai. Fibroid removal k baad sab ka question hota hai hum kab shuru Karen pregnancy? 3 maheenay is the ultimate time jo l hum log detay hain k us k baad hum kehte hain aap zarur us ko shuru karlo and jo ye fibroid ki problems hain this is something which is so common. I feel that we should look into it, regular checkup is the only answer at every age. Har ek umer ki larki ko apna every year checkup kara lena boht zarurui hai.

Different methods to treat Disc problems

Hello friends, I am Dr Gaurav Khera. I am an orthopaedic surgeon, doing joint replacements and spine surgeries at the Access healthcare. Now today I will be talking about the lumbar degenerative disc disease. Now it sounds very big, but it is not as complicated as it sounds. It basically is what you people commonly know as a disc disease. So it is a fairly common problem that is seen in our population today. In fact about 30 or 40% of the patients who come to our OPD have lower back pains, some have other disc problems and very commonly seen after 40 years of age and this incidence gradually increases up to 60-70 years of age. The other ecological factors which are associated with this are, first of all smoking, secondly it is, mild to moderate trauma, thirdly its seen in people who lift heavy weights, fourth is obesity, especially central obesity, that is if you have a very heavy waistline.

Now what is Lumbar degenerative disc disease? Now, our spine is composed of multiple bones, which are starting from your neck and they come all the way down to your hip, divided into the cervical, dorsal, lumbar and sacral spine. And between these bones, there are these small pieces of discs, which act as cushions. When your body walks, these act as shock absorbers between your body’s bones. Now this discs, when these come out of their normal place, it gives or presses against the nerves which are passing through these areas and it causes pain. This is what happens in the disc disease. Basically, in the patient it will come as a lower back pain, and this pain will be travelling down to the hip, and it will also be coming down to the legs. Some people complain that as they walk, the pain increases.

They also complain of tingling numbness. They complain that sometimes their fingers or their toes are feeling numb. These are some of the very common symptoms which are being seen. Few people may have only lower back pain, and these are the people who do not have very significant disc disease. Now there are two main causes of the disc disease. First is an inflammatory reaction that occurs in the disc, and second is the micro motion instabilities that occur. Inflammatory reactions may occur as a result of some small traumas which may occur such as when you may injure your back. Such inflammatory reactions occur in the form of small swellings in the body. And micro motion instabilities are when the body ages, the disc which has an outer fibrous thick layer, that degenerates, and as it degenerates, the pulp which is there at the centre, of the discs, tends to degenerate. What I mean is it comes out of its normal space. And as it comes out of the normal place, it comes and tends to press on the nerves and these are the two most common causes.

All disc patients are not to be operated. When we get these patients, the first and foremost investigation that we do is a X-Ray. And if required, we go in for a MRI. Frankly MRI is the known standard to diagnose the disc disease. The findings of a MRI are always coordinated with the clinical findings. Once we have diagnosed that it is a disc problem, we have to establish that what the compression on the nerves is. If the nerve compression is a lot, and if we think that we cannot do anything other than surgery, then we take the patient for a surgery.

If not, we take the patient fro physiotherapy, lifestyle changes and few medications. These medications may carry on for few weeks to few months. And a lot of exercise has to be carried on regularly. Lifestyle changes such as weight loss, stoppage of smoking is very important. And if you can achieve this, then your problems are very easily solved. If you have any queries regarding your disc problems or back pains, then you can get in touch with me for the same.

You can reach me in my clinic, which is there in Indrapuri, by the name of Dr Khera’s Wellness Clinic or you can also contact me through Lybrate for the same. Thank You.
 

Benefits of Knee Replacement

Hello, friends, I am Dr. Gaurav Khera I am a consultant orthopedic surgeon joint replacements and spine. Today I will be talking to you about total knee replacement. Knee replacement is the most common surgery which is being done these days it is also a surgery which has got a lot of bad name to it because of a few complications that are associated a few myths which are associated. I'd like to clear all those out today.

Before I start talking about knee replacements I would like to tell you something about the anatomy of the knee joint. (Displaying knee model) now this is the knee joint knee joint is a type of a hinge joint, a modified hinge joint, it has three compartments, it has the middle or the inner compartment the lateral or the outer compartment and the patella femoral compartment. now what basically happens in osteoarthritis that is the reason why we do a total knee replacement is that the joint it starts to age or it starts to degenerate, and as the joint degenerates this blue coloured cartilage cover it starts to go away, as the cartilage cover goes the joint tries to recover from this degeneration process and in doing so in the repetitive process these osteophytes which are like bony specules they are formed, now these bony spicules as they are getting formed they start pinching into the surrounding tissues, surrounding tissue means the ligaments, basically 4 ligaments are in the joint 2 of which are inside and 2 of which are outside. the outside ones are the lateral and the middle collateral ligament and the inner other anterior and posterior cruciate ligament now the first ligament to get involved is the medial collateral ligament which is on the inner aspect of the knee joint and there is tightening of this ligament which takes place as the recommend gets tightened this middle compartment it starts to tighten up and there is further rubbing of these bones as these bones are out this blue cartilage it goes away and the bone gets exposed and the raw bone Easter surfaces they rub against each other causing severe excruciating pain.

The patients  come to us then they complain of pain when they are going up and down stairs they complain of funny sounds which are coming, they complain of difficulty and squatting difficulty in cross leg sitting. so this is the reason why you get all these pains. now Osteoarthritis is not the only reason why were doing knee replacements. knee replacements are also being done father causes like hemophilia, septic arthritis, septic arthritis means infections. a few other causes like imposed tuberculosis, again its an infection. now there are two types of knee replacement surgeries which are being don,e one is the unicondyler knee replacement and one is the total knee replacement, a unicondyler knee replacement what we do is we change only the middle aspect of the joint or the inner aspect of the joint and in total knee replacement we change the entire joint. now changing of the joint does not mean that we remove the bone from the top and bottom and we just put in a new knee, basically were just changing the damage surface so this is the model of a knee replacement surgery.

Basically there seven cuts which is involved in a total knee replacement the main cut being the table cut and the other cuts are the femoral cuts now the femoral cuts are again you know the distal anterior posterior the chamfer the box so once these cuts are done this is how the femur of the knee joint looks like of the implant. this is then fitted onto these cuts with the help of a bone cement and on the tibia we put a tibial plate which is again fixed with a cement and then we put a insert. the size of the cuts and the amount of bone which is being cut is generally decided inter operatively. the types of implants which are being used are different, the types of implants vary we have patient-specific implantations we have computerized implantations you know in which we can do computerised cuts during the surgery and we have high flex knees we have normal needs so huge variety of things which are coming. now coming to rehabilitation process after the surgery the rehabilitation process for you as a patient is the most important, see normally the patient requires two to three months to recover after the knee replacement.

We make the patient walk after 24 to 48 hours .now the reason why we are making you walk so early is so that we can get your knee to start moving we can prevent complications like DVT and we can start your physiotherapy for muscle strengthening as soon as possible. your physiotherapy will continue for at least two months after the surgery and you will be able to lead a completely normal life that is hardly any activity which is going to be restricted after your surgery, you can go for your cycling you can go for your mountaineering you can go for your running you can go for your walks, we will only advise you not to be squatting and not to be cross leg sitting other than these you will be allowed to do all other activities. the complication rates of the surgery has come down tremendously. about 10 years back the complication rates were much higher now the complication rates have really come down that is because the most common complication is infection. now infection the methods which we are using in this surgery they are better antiseptic methods that we are using, there are better barriers which are there in the hospital, better antibiotics so infection rates have come down. the other thing is the failure of the implants there is a much better understanding of how the knees functioning, there is a much better understanding of what the soft tissue balancing is required. so all these complications have really come down so I would advise you that

If you are really suffering from a lot of knee problem if you’re having to take a lot of painkillers if youre not being able to do your daily activity then you should get in touch with us and you start thinking of a knee replacement surgery. you can contact me and come and meet me at my clinic at dr Kheras wellness clinic, I am here everyday in the evening from 6 to 9. I am also available at Apollo spectra hospital, you can call text or video chat with me through Lybrate. Thank you.

Know more about the symptoms and types for frozen shoulder

Good morning everybody, I am doctor Rakesh Kumar, I am senior consultant in orthopedics in Apollo hospital, Jivan mala and MGS hospital. Today I am going to give health tips on frozen shoulder. Frozen shoulder is named as Adhesive Capsulitis. Adhesive Capsulitis is a condition in which contracted thickened joint capsules that seem to be drawn tightly around a humeral head in the absence of synovial fluid and chronic inflammatory changes within the subsynovial layer of the capsule occurs. The underlying pathological change in adhesive capsulitis are sinonasal inflammation, with subsequent reactive capsular fibrosis, cytokines and metaloprotanysis have been implicated in the process but the initial triggering event in the cascades is unknown. Incidence is 2%, but several conditions are specified with increased incidence, includes gender—i.e more common in females, more common in older ages—between 40 to 70 years, 5 times more common in diabetes mellitus, cervical disc diseases, prolonged immobilization, hyperthyroidism, stroke, or myocardial infections, the presence of autoimmune disease and trauma.

Individuals between ages 40 to 70 are more commonly affected, approximately 70% patients are females. 20% to 30% of affected individuals develop adhesive capsulitis in the opposite shoulder. Frozen shoulder in patients who report no inciting event and with no abnormality are designated as primary whereas in patients with precipitant traumatic injuries are designated as secondary. We have noted that internal rotation frequently is lost in sleep followed by loss of fluctuation and external rotation, most often our patients can internally rotate only upto the sacrum, have 50% loss of external rotation and have less than 90 degree of abduction.

Primary frozen shoulder have three phases-

Phase 1 is a phase of pain, patients usually have a gradual onset of diffused shoulder pain which is progressive over weeks to months, the pain usually is worse at night, and is exacerbated by lying on the affected side as the patient uses the arm less leading to stiffness.

Phase 2 is stiffness, Patient seeks pain relief by restricting movements this heralds the beginning of stiffness phase which usually lasts for 4 to 12 months. Patients describe difficulty in activity of daily living, men have trouble getting to their wallets in their back pockets while females have trouble with fastening their brassieres.

Phase 3 is pain thawing phase, this phase lasts for weeks or months. And as motion increases pain diminishes without treatment other than benign neglect motion return is gradual in most but may never objectively return to normal. Although most patients subjectively feels near normal, they make adjustments in ways of performing activities of daily livings.

Treatments- Frozen shoulder has been considered as self limiting condition lasting 12 to 18 months without long term sick leave.  Approximately 10% of patients have long term problems. The best treatment of frozen shoulder is prevention. But early intervention is paramount. A good understanding of the pathological process by the patient and the physician also is important.

If you need further clarification and have any question and need any treatment you can contact me through Lybrate.
 

Here are some health effects of snoring 

Hi I’m Dr. Rajeev Nangia, senior consultant ENT. Today I’ll be talking on a very important and common topic- Snoring. It is taken to be a very common thing but now it has been proved scientifically that there are a lot of bad effects of snoring too. It is caused by obstructive sleep apnea, whenever there are obstructions in the upper airway then there is a reduction in the oxygen levels to the body which leads to further effects on the body and can cause hypertension, diabetes, and weight gain and even affect your heart and can seldom lead to sudden death.

We should not ignore snoring but rather should always go for a complete ENT examination followed by a nasal endoscopy followed by a sleep test. It is nothing but while you’re sleeping we just attach some instruments and note the apnea and the hypopnea plus we note the oxygen levels and other things. So then we evaluate the severity of the sleep apnea whether it is in the mild, moderate or severe category. If it is mild then we can change our habits or we can reduce weight and other things, we can get over it.

Moderate or severe category can be a serious problem because sometimes people can have a daytime sleeping pattern and have a road accident which can be fatal. So for the moderate we have two things basically: we can either operate which is known as UPPP operation and or we can go for the BiPAPS but for severe category we have to go for the BiPAPS and for any other thing regarding snoring or its problems, you can consult me at this wonderful site called Lybrate or can consult ma directly online.