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Following is the top ten surgeon in India, in the five most common surgical specialities: heart, orthopaedic, neurosurgery, ophthalmic surgery and reconstructive surgery from HindustanTimes article.

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NEUROSURGERY
Dr Vipul Gupta, 41, Head, Neuro-intervention, Medanta – The Medicity

Vipul Gupta watched his 33-year-old brother die of a malignant tumour in the brain eight years ago. “We knew it was hopeless but we went all the way. He was operated on thrice, at the All India Institute of Medical Sciences in India and Cleveland Clinic in Ohio and Memorial Sloan-Kettering Cancer Center in New York. That’s when I realised that even when the chips are down, the family does not give up, so you have to give it your best,” says the Delhi-based Gupta. He’s a little embarrassed about the emotional outpouring. “Surgeons can’t be emotional, it won’t help the patient on the table. You have to be calm and think clearly,” he says. At 41, Gupta heads neuro-intervention at Medanta – the Medicity, where he moved after doing his MBBS from Delhi’s Maulana Azad Medial College in 1996 and training in neuro-radiology at All India Institute of Medical Sciences (AIIMS) for three years. “I’m out-doorsy and enjoy swimming, rafting and rock-climbing. I broke my knees twice in school. The operation and forced bed-rest for six months slowed me down, forcing me to study which helped me crack the MBBS easily,” he laughs.

Dr Deepak Agrawal, 40, Associate professor, Neurosurgery, AIIMS
He’s the guy at the frontier, treating accident victims at the AIIMS Trauma Centre, best known for treating some of the bloodiest and most bizarre accident cases in the country. “Most accident victims we get are people with severe head or spinal injuries that are often fatal. It does get you down, but nothing can beat the high of seeing a patient everyone including your colleagues had given up on, walk into your clinic for a follow-up. That’s when you know that miracles do happen,” says Dr Agrawal. Agrawal did his MBBS at the University College of Medical Science in 1994 – where he met his onco-surgeon wife Swati – and his training in neurosurgery at AIIMS. “My professional high was being awarded the ‘Young Neurosurgeon of the Year’ Award by the American Congress of Neurosurgeons in 2008. The personal one was my daughter Ayushi, who is five,” he says. His father Dr Ved Prakash was also a neurosurgeon at AIIMS, so Agrawal’s becoming a surgeon was almost pre-determined. “I like to catch up on my emails before breakfast, so I begin work at 5.30 am. I leave home at 7.30, doing rounds of the ward for three hours, which is followed by surgeries that usually go on till 7. Then come the evening rounds, which finish at 9 pm. Add to this administrative work, teaching and writing and correcting research papers, and my day never seems to end,” says Agrawal.

OPHTHALMIC SURGERY
Sri Ganesh, 44, Eye surgeon and chairman, Nethradhama Hospital, Bangalore

Bangalore residents are used to seeing Dr Sri Ganesh zooming down the streets to his farm on his Suzuki Intruder, which he exchanges for his Audi Q7 or BMW 5-Series when he visits the hospitals he set up. “Both my grandmas were blinded with cataract, one because of a botched up surgery. I think seeing them faltering around the house made me decide I wanted to do all I could to help people see,” says the 44-year-old. Eye surgery techniques have become much safer now. “Back then, there were no intraocular lenses (artificial lenses put inside the eye in place of the natural ones) and the failure rate of a simple cataract surgery was 30 per cent, largely due to infection. Now, less than 0.1 per cent cataract and vision-correction surgeries have complications,” he says. Sri Ganesh met his wife Sumanshree at a paratrooping camp in Agra. He was 17, she was 16. “Someone stole my things and she was very sweet,” he says. They married six years later, in 1990, after Sri Ganesh did his MBBS. The couple have three children, Supriya, Sushant and Skanda. Apart from running six hospitals – four in Bangalore, one in Mysore and one in Mangalore – Sri Ganesh runs a 90-bedded charitable hospital in Padmanabhanagar that does 8,000 free cataract surgeries a year.

Dr Mahipal S Sachdev, 52, Centre for Sight Group of Hospitals

Mahipal S Sachdev, eye surgeon to the rich and powerful, never invests in anything but health. “My last investment was Harshad Mehta and I burnt my fingers there,” says Dr Sachdev. His investments in healthcare – time, energy and money – have shown better results. Sachdev was told he was crazy when he quit as associate professor at the All India Institute of Medical Sciences (AIIMS) to join the newly-opened Indraprastha Apollo Hospital in Delhi in 1996. He was 37. The skeptics got it very, very wrong. Within 15 years of that, he’s running 17 eye hospitals that have become one-stop shops for eye disorders in north India. A year-long fellowship to Georgetown University in Washington DC in ’89-’90 opened his eyes, literally, to the technological imaging and surgical revolution happening in the field of ophthalmology. “I realised less invasive radical surgeries were the way forward, but I needed equipment and trained staff for that. I could not get that in a government set-up. So I set up my own centre, which started in a 8×10 foot room in Safdarjang Enclave in 1996, but we’ve grown a little since then,” he says with obvious pride. Sachdev is arguably the best person to go to for cataract and lasik surgery in India. “This is all I want to do, medicine is in my genes. My mother and brother are doctors, so is my wife Alka and daughters Ritika, 29, and Gitansha, 25,” says Sachdev. Sachdev also has an unexplored, fun side to him. “I did my MBBS from AIIMS, where I was the secretary of the students’ union. We were the ones who threw open Pulse, the students’ festival at AIIMS, to fashion, jam sessions and music. Before that, it was a sporting event. We made it socio-cultural,” he says.

COSMETIC SURGERY
Sunil Choudhary, 42, Aesthetic and Reconstructive surgeon, Max Speciality Hospital, Delhi
Quite like modern day Dr Frankensteins, attaching a hand and replacing chopped fingers with toes is all in a day’s work for reconstructive surgeons. Some, like Sunil Choudhary, who head the aesthetics and reconstruction at Max Speciality Hospital, start a conversation with, “Today, I attached two toes and one finger in the right hand of a 16-year-old who’d lost his fingers in a farming accident. He’ll be able to write now”. This is followed by an MMS of a surgery to fix a congenital defect in which a child’s skull stops expanding naturally, squeezing the brain and making it bulge out of the forehead. Unlike popular perception, silicone implants and other cosmetic procedures make up less than a third of a cosmetic surgeon’s case load. “A lot of what we do is related to reconstruction after cancer surgeries and accident cases, including burns and acid attacks,” he explains. Choudhary grew up in Delhi, went to school in DPS RK Puram and did his MBBS from Maulana Azad Medical College, after which he joined the training programme of the UK’s National Health Service.

Dr Shahin Nooreyezdan, 49, Plastic & reconstructive surgeon, Indraprastha Apollo

He insists on giving you a business card. “I’m the only one in the world with this name, so people often get it wrong,” says Dr Shahin Nooreyezdan. There is, however, a little boy called Shahin Sharma, who was called Golu before his grateful parents renamed him after the surgeon who reattached his finger. “It was deeply touching, but also strange. I guess now there’s another person in the world with a very unusual name,” he says. Nooreyezdan grew up in Mumbai, where he lived with his parents in a flat above Russi J Manekshaw, the granddaddy of plastic surgery in India. “Each day, I’d walk past his door on my way home from school and pass this display box with before- and after-surgery pictures, which kept changing every week. I was hooked and decided this was what I wanted to do,” says the Delhi-based Nooreyezdan. He moved to London in 1996, where he worked at St Andrew’s Hospital for three years and met his wife Neda, a British citizen. “When we decided to move back and I went to the Indian High Commission for a visa for my wife, the clerk there said, why are you going? You have a great future here!” he laughs. Most of his work in India is reconstruction. “Unlike other surgeons who can walk in to do the critical part of the surgery, I have to be there from the first incision to the final stitch because what I do is for everyone to see,” says Nooreyezdan, who gets women as young as 19 who need reconstruction after breast cancer surgery. The deft fingers that reconstruct tissues and reattach blood vessels 1.2-1.5 mm in diameter also help him pursue his hobby: collecting and repairing antique clocks. Nooreyezdan has a collection of over 125 pendulum clocks from all over the world, including grandfather clocks from the UK, clocks from ships and railway stations. “It started when I was 17, when I noticed an old, broken, clock at an Irani dhaba. I bought it for R170, got it home and fixed it. I still do it, though I have to pay a guy to wind them up in rotation once a week,” he says. He clearly knows how to wind down.

ORTHOPEDIC SURGERY

Dr Vijay C Bose, 44, Head of orthopaedic surgery, Apollo Chennai
He was part of British orthopaedic surgeon Derek McMinn’s crack team that developed the ‘Birmingham Hip’ – a hip implant that allows people to play contact sports and twist without shouting after a hip transplant – in the late ’90s. Yet what gives Dr Vijay Bose the greatest joy is recognition from his peers. “Three weeks ago, a renowned joint replacement surgeon from the US got his son to our centre for surgery. He’s one of the best in the world and could have done it himself, he could have got it done by the best in his own country, but he still came to India. That’s the quality India offers to the world now,” says Bose. Bose, who joined Apollo Hospital in Chennai in 2000 after six years in Birmingham and Liverpool in the UK, now routinely gets so many patients from overseas that he’s became the face of medical tourism in India for 60 Minutes on CBS News. “I did the first implant in Apollo in 2000 and since then, I have demonstrated the technique across 80 hospitals in India,” says Bose, who did his MBBS from Madras Medical College in 1990. Apart from hip replacement, he does knee and shoulder joint reconstructions.

Dr Suraj Guruv, 36, Orthopaedic surgeon, Asian Heart Institute, Mumbai
Dr Suraj Guruv’s last holiday was spent shooting wildlife at Bandhavgarh National Park in Madhya Pradesh, but he did not break any laws. Guruv is an amateur photographer and rarely leaves home without his Nikon Digital SLR. “I’m crazy about wildlife photography,” he says. When he’s not shooting, Guruv is fixing damaged hips and knees using minimally invasive bone-conserving surgeries in India that make it possible for people to run, drive and work just as they did before, after hip or knee replacements. Guruv is a Mumbai boy, who grew up in Prabhadevi, went to a neighbourhood school, did his MBBS at Mumbai’s Topiwala National Medical College and worked in Bombay Hospital before going to train in Singapore General Hospital. “I belong to a family of chartered accountants, my dad is one, so is my older brother. So when dad said try something else, I thought, why not?” says Guruv, who aced his entrance exam. “Even though I don’t invest in the markets, I still follow financial news very closely, perhaps because that’s what I’ve grown up hearing,” he says. He returned to India because he wanted to be part of the boom in medical care that India is witnessing. “We now have medical facilities at par with any other in the world, with better care,” he says.

HEART SURGERY
Dr Raja Joshi, 40  Paediatric cardiac surgeon, Apollo
He’s called the ‘bandana guy’ because he wears a bandana instead of a surgical cap while operating. Apart from his training as a paediatric heart surgeon during a five-year stint at Cleveland Clinic in the US, what defines Raja Joshi is his bandana collection. “You have to strike a chord with the kids you’re treating, and a bandana with Dalmatians on it sure helps to break the ice,” says the Delhi-based Joshi who, at 36, became one of the youngest surgeons in the country to set up a paediatric cardiac surgery unit in a major hospital. “My dad was in the air force, I grew up wanting to be a fighter pilot. It was after my class 10 boards that my dad told me there were other ways to earn a living,” he recalls. The idea of being a heart surgeon for children came a year later, after a Doordarshan show on a hole-in-the-heart being fixed. “It was so dramatic, the lights and the surgeons in scrubs, this child being immersed in ice to bring the body temperature down. Suddenly, that was the only thing I wanted to do,” says Joshi. He’s had no regrets. “It’s one of the few surgeries where the patients outlive the surgeons. You won’t believe the number of birthday invites I get. Anyone can do adult heart surgery, paediatric is what separates the boys from the men,” said Joshi. His wife Reena Joshi, 36, is a paediatric anaesthetist who’s helped him introduce innovations such as letting the mother stay with the child in the operation room till he sleeps. “Taking away a baby from the mother makes anxiety levels shoot up. Keeping them together till the baby is anaesthetised improves surgery outcomes,” says Joshi.

Pranav Kandachar, 37, Paediatric heart surgeon, Asian Heart Institute, Mumbai
Heart surgery is one of the cleanest surgeries there is, it’s like mathematics. The result is directly related to what you do, there are few surprises,” says Pranav Kandachar, the newest heart surgeon to join Asian Heart Institute’s team of surgeons. “Of course, there are some conditions in which you cannot play god, but in most cases, children can lead active, normal lives after surgery,” he says. After doing his MBBS from Bangalore Medical College in 1997, Kandachar worked at Sion in Mumbai, Apollo Chennai and Colombo, did a year long stint in New Zealand, returned to Bangalore to work at Shirdi Sai Baba Charitable Hospital, and joined the Asian Heart Institute, Mumbai, in January this year. “When you’re training, one institute can’t offer you everything. I’ve trained with the best,” he says. Kandachar describes himself as a nature kind of guy, being big time into hydroponics, a scientific method of growing plants in water – without soil – using mineral nutrient solutions. “I have a virtual vegetable garden in my little balcony, where I grow spinach, beans, cauliflower, coriander and mint. I’m planning to grow strawberries next,” he says. He’s also into ornithology and is part of a nature club that goes birdwatching to sanctuaries at least once a month.

Source: HindustanTimes, April 10

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In vitro fertilization

What is fertility?
Fertility is the natural capability of giving life. As a measure, “Fertility Rate” is the number of children born per couple, person or population. Infertility is a deficient fertility.

Both women and men have hormonal cycles which determine both when a woman can achieve pregnancy and when a man is most fertile.

Women’s fertility peaks around the age of 23-24, and often deteriorates after 30. With a rise in women postponing pregnancy, this can create an infertility problem.

In vitro fertilization
The term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in.

In vitro fertilisation (IVF) is a technique in which egg cells are fertilised by sperm outside the woman’s womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy. Babies conceived as a result of IVF are also known as test tube babies.

For IVF to be successful, it requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Cost considerations generally place IVF as a treatment when other less expensive options have failed.

Success rates
While the overall live birth rate via IVF in the U.S. is about 27% per cycle (33% pregnancy rate), the chances of a successful pregnancy via IVF vary widely based on the age of the woman (or, more precisely, on the age of the eggs involved). Where the woman’s own eggs are used as opposed to those of a donor, for women under 35, the pregnancy rate is commonly approximately 43% per cycle (36.5% live birth), while for women over 40, the rate falls drastically – to only 4% for women over 42.

Complications
The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage.

For affordable IVF treatment overseas, please contact Healthbase. Healthbase is a medical tourism expert connecting patients to leading healthcare facilities worldwide. Healthbase also offers medical tourism plans for self-insured businesses looking for affordable healthcare benefits for employees.

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DENTAL SURGERY

Dental surgery is any of a number of medical procedures which involve artificially modifying the development or arrangement of teeth in the mouth.

Dental surgery falls into 4 major categories:
1. Endodontics: It deals with the tooth pulp and the tissues surrounding the root of a tooth. The pulp (containing nerves, arterioles and venules as well as lymphatic tissue and fibrous tissue) can become diseased or injured, and is often unable to repair itself; if it dies, endodontic treatment is required.

2. Prosthodontics: It is the specialty of implant, esthetic and reconstructive dentistry. It involves the restoration of oral function through prostheses and restorations (i.e. complete dentures, crowns, implant retained/supported restorations). Cosmetic dentistry, implants and joint problems all fall under the field of prosthodontics.

3. Orthodontics: It is a specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both. Orthodontic treatment can focus on dental displacement only, or can deal with the control and modification of facial growth. Orthodontic treatment can be carried out for purely aesthetic reasons – improving the general appearance of patients’ teeth and face for cosmetic reasons – but treatment is often prescribed for practical reasons, providing the patient with a functionally improved bite (occlusion).

4. Periodontics: It is branch of dentistry which studies supporting structures of teeth (supporting tissues are known as periodontium) and diseases and conditions that affect them. It involves treating diseases and conditions of the periodontium. Periodontists specialize in the management of patients with periodontitis, gum recession and surgical placement of implants.

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WHAT IS CANCER?

Cancer, which causes about 13% of all deaths worldwide, is a group of diseases in which cells are:
1. aggressive – grow and divide without respect to normal limits,
2. invasive – invade and destroy adjacent tissues, and
3. sometimes metastatic – spread to other locations in the body.
These three malignant properties of cancers differentiate them from benign tumors, which are self-limited in their growth and do not invade or metastasize (although some benign tumor types are capable of becoming malignant).

CAUSES OF CANCER

Cancer may be caused by:

– Chemical carcinogens such as tobacco smoke and alcohol
– Ionizing radiation such as radon gas and UV rays from the sun
– Ifectious diseases associated with viruses like human papillomavirus, hepatitis B and hepatitis C virus, Epstein-Barr virus, and human T-lymphotropic virus
– Hormonal imbalances
– Immune system dysfunction like HIV
– Heredity

Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth. Complex interactions between carcinogens and the host genome may explain why only some develop cancer after exposure to a known carcinogen. New aspects of the genetics of cancer pathogenesis, such as DNA methylation, and microRNAs are increasingly being recognized as important.

SIGNS AND SYMPTOMS

Roughly, cancer symptoms can be divided into three groups:
Local symptoms: unusual lumps or swelling (tumor), hemorrhage (bleeding), pain and/or ulceration. Compression of surrounding tissues may cause symptoms such as jaundice.
Symptoms of metastasis (spreading): enlarged lymph nodes, cough and hemoptysis, hepatomegaly (enlarged liver), bone pain, fracture of affected bones and neurological symptoms. Although advanced cancer may cause pain, it is often not the first symptom.
Systemic symptoms: weight loss, poor appetite and cachexia (wasting), excessive sweating (night sweats), anemia and specific paraneoplastic phenomena, i.e. specific conditions that are due to an active cancer, such as thrombosis or hormonal changes.

Every symptom in the above list can be caused by a variety of conditions (a list of which is referred to as the differential diagnosis). Cancer may be a common or uncommon cause of each item.

TREATMENT

Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. As research develops, treatments are becoming more specific for different varieties of cancer. There has been significant progress in the development of targeted therapy drugs that act specifically on detectable molecular abnormalities in certain tumors, and which minimize damage to normal cells. Cancer may be treated by:

– Surgery
– Radiation therapy
– Chemotherapy
– Targeted therapies
– Immunotherapy
– Hormonal therapy
– Symptom control

PROGNOSIS
Cancer has a reputation for being a deadly disease. While this certainly applies to certain particular types, this is increasingly being overturned by advances in medical care. Some types of cancer have a prognosis that is substantially better than nonmalignant diseases such as heart failure and stroke.

Cancer patients, for the first time in the history of oncology, are visibly returning to the athletic arena and workplace. Patients are living longer with either quiescent persistent disease or even complete, durable remissions.

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MEDICAL TOURISM AND JCI HOSPITALS

With the growth in the number of medical tourism providers quality standards become all the more important. To demonstrate their commitment towards quality some international health care organizations choose to be accredited by the US-based Joint Commission Internationa (JCI). JCI accreditation has gained worldwide attention as an effective quality evaluation and management tool. A JCI hospital is an international hospital outside of the United States which has been accredited by the Joint Commission International. There are over 120 JCI hospitals worldwide and many more are in the process of receiving accreditation.

The JCI accreditation program was launched by the Joint Commission in 1999 in response to the growing interest in accreditation and quality improvement worldwide. Accreditation is usually voluntary. The health care organization interested in a JCI accreditation has to meet a set of standards requirements designed to improve quality of care. JCI accreditation standards are usually regarded as optimal and achievable. Accreditation provides a visible commitment by an organization to improve the quality of patient care, to ensure a safe environment and to continually work to reduce risks to patients and staff.

JCI makes sure accredited hospitals have state-of-the-art health care facilities and technology along with advanced transportation and communication systems. JCI accredited hospitals’ health care standards, professionalism and quality of their doctors are equivalent if not superior to those you find in the United States of America.

JCI ensure the quality of hospitals in its network using the following criteria:
• Coverage From Patient Entry to Discharge
• Assessment for All Aspects of Management
• Culture of Patient Safety
• Access to and continuity of care
• Assessment and care processes
• Education and rights of individuals
• Management of information and human resources
• Quality leadership
• Infection control
• Collaborative integrated
• Facility Management

The above is a partial list of assessment criteria. For details, refer to Medical Tourism FAQ.

For affordable overseas medical treatment at a JCI hospital, please contact Healthbase. Healthbase is a medical tourism expert connecting patients to leading healthcare facilities worldwide.

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