shoulder replacement


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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Shoulder Replacement

Provided by Wockhardt Hospital
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Shoulder ReplacementSimilar to other joint replacement procedures, shoulder replacement surgery is generally done to address persistent pain that is not controlled by non-surgical therapy. Less commonly, poor shoulder motion may also be a reason for replacement surgery.

The shoulder is a ball-and-socket joint, with the top of the arm bone (humeral head) fitting into a socket known as the glenoid. Muscles and tendons, such as the rotator cuff, help hold the joint in place. Surgery involves replacing the humeral head and the glenoid with artificial components. The humeral head replacement is generally made from a metal alloy, while the glenoid component is made from polyethylene plastic. The new components may be anchored by cement or press-fit into place so that the bone grows in around them.

During surgery, a three- to four-inch incision is made along the space between the arm and the collarbone. The procedure lasts about 90 minutes, and the incision is then closed with staples or stitches. Patients typically stay in the hospital for one to two nights, and full recovery usually takes six to 12 weeks.

 

Rehabilitation

 

Arthritic shoulders are stiff. One of the major goals of total shoulder replacement surgery is to relieve much of this stiffness. However, after surgery scar tissue will tend to recur and limit movement unless motion is started immediately. This early motion is facilitated by the complete surgical release of the tight tissues so that after surgery the patient has only to maintain the range of motion achieved at the operation. Later on, once the shoulder is comfortable and flexible, strengthening exercises and additional activities are started.

A careful, well-planned rehabilitation program is critical to the success of a shoulder replacement. You usually start gentle physical therapy on the first day after the operation. You wear an arm sling during the day for the first several weeks after surgery. You wear the sling at night for 4 to 6 weeks. Most patients are able to perform simple activities such as eating, dressing and grooming within 2 weeks after surgery. Driving a car is not allowed for 6 weeks after surgery.

Here are some “do’s and don’ts” for when you return home:

  • Don’t use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles.

  • Do follow the program of home exercises prescribed for you. You may need to do the exercises 4 to 5 times a day for a month or more.

  • Don’t overdo it! If your shoulder pain was severe before the surgery, the experience of pain-free motion may lull you into thinking that you can do more than is prescribed. Early overuse of the shoulder may result in severe limitations in motion.

  • Don’t lift anything heavier than a glass of water for the first 6 weeks after surgery.

  • Do ask for assistance. Your physician may be able to recommend an agency or facility if you do not have home support.

  • Don’t participate in contact sports or do any repetitive heavy lifting after your shoulder replacement.

  • Do avoid placing your arm in any extreme position, such as straight out to the side or behind your body for the first 6 weeks after surgery.
    Many thousands of patients have experienced an improved quality of life after shoulder joint replacement surgery. They experience less pain, improved motion and strength, and better function

Frequently Asked Questions

 

What are the symptoms to detect Shoulder Replacement?

 

Patients with arthritis typically describe a deep ache within the shoulder joint. Initially, the pain feels worse with movement and activity, and eases with rest. As the arthritis progresses, the pain may occur even when you rest. By the time a patient sees a physician for the shoulder pain, he or she often has pain at night. This pain may be severe enough to prevent a good night’s sleep. The patient’s shoulder may make grinding or grating noises when moved. Or the shoulder may catch, grab, clunk or lock up. Over time, the patient may notice loss of motion and/or weakness in the affected shoulder. Simple daily activities like reaching into a cupboard, dressing, toileting and washing the opposite armpit may become increasingly difficult.

 

How do I know if I am ready for shoulder replacement surgery?

 

Patients who have tried the usual treatments for shoulder arthritis, but have not been able to find adequate relief, may be a candidate for shoulder replacement surgery. Patients considering the procedure should understand the potential risks of surgery, and understand that the goal of joint replacement is to alleviate pain. Patients generally find improved motion after surgery, but these improvements are not as consistent as the pain relief following shoulder replacement surgery.

 

How long is the recovery following shoulder replacement surgery?

 

Hospital stays vary from one to three days for most patients. You will be sent home wearing a sling and you should not attempt to use the arm except as specifically instructed by your doctor.

Most physicians will begin some motion immediately following surgery, but this may not be true in every case. Usually within two to three months, patients are able to return to most normal activities and place an emphasis on strengthening the muscles around the shoulder and maintaining range of motion.

 

What are the symptoms of severe arthritis of the shoulder?

 

Common symptoms of shoulder arthritis include:

  • Pain with activities

  • Limited range of motion

  • Stiffness of the shoulder

  • Swelling of the joint

  • Tenderness around the joint

  • A feeling of grinding or catching within the joint

Can rehabilitation be done at home?

 

In general the exercises are best performed by the patient at home. Occasional visits to the surgeon or therapist may be useful to check the progress and to review the program.

 

When can I return to ordinary daily activities?

 

In general, patients are able to perform gentle activities of daily living using the operated arm from two to six weeks after surgery. Walking is strongly encouraged. Driving should wait until the patient can perform the necessary functions comfortably and confidently. Recovery of driving ability may take six weeks if the surgery has been performed on the right shoulder, because of the increased demands on the right shoulder for shifting gears.

With the consent of their surgeon, patients can often return to activities such as swimming, golf and tennis at six months after their surgery.


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