Coronary Artery Bypass Graft Surgery in India

 The life-saving coronary artery bypass was first performed in the USA in 1960 by Robert Goetz, but the surgery though successful could not extend the life span beyond thirteen months. Discouraged perhaps he did not repeat the efforts. It was in 1962 that David Sabiston performed the next which was not successful, anyway the process had started, and eventually, coronary surgery success came much later after some of these disheartening results.

India has a long history of understanding heart functions right from the Vedic Times onwards. The palliative and curative roles of Yoga and transcendental meditation were understood well, and effectively applied but these were more lifestyle improvement factors that assisted the heart functions. Yoga and TM are still in vogue for improvement in general health including vital organs.

In spite of our heritage knowledge dating back to 4000 BC, there was a gap in the research and development of surgical interventions that are being used today to treat various cardiac malfunctions.

Our knowledge is acquired from dominant institutions and scientific fraternity pioneers in the research and development of health sciences. Nevertheless, with a solid healthcare system empowered by sacred institutions of learning and well-equipped hospitals, we are providing the best health treatments at much lower costs than in many other countries.

India has some of the finest surgeons that excel in cardiac surgery and doctors experienced in the noninvasive treatment of ailments.

Modern Cardiology in India was established in the post-World War II period. The Cardiology Society of India was formed in the year 1948 thus opening the door for future surgeries and treatments. . Interestingly this was before the American College of Cardiology in the year 1949. In a short time, many societies and communities were formed which contributed to the development of cardiac science in India.

The first positive developments in cardiac surgical treatments took birth in AIIMS New Delhi. Subsequently, an army of teachers proliferated medical colleges and some of the complex surgeries were performed by doctors in Indian hospitals in that era.

CABG has now become a common surgical intervention and more than 800,000 surgeries are performed globally. The first CABG was performed successfully by doctor K.M. Cherian in Chennai in India.

The global coronary artery bypass graft market size was a whopping 77.6 million in the year 2016 with an annual CAGR of 5.8 percent. The key drivers are the introduction of technology besides the rise in the prevalence of CAD, CHD, and MI. The rise in the prevalence of heart-associated diseases and hypertension is also a contributory factor that is propelling CABG.

Modern lifestyle factors are worsening human health and contributing to various ailments. Some of the common lifestyle factors are excessive consumption of alcohol, smoking, consumption of junk food universally, and a sedentary lifestyle among the affluent.

CABG was first performed in India in the year 1975 almost a decade later and since then the country performs more than 60000 CABG or coronary artery bypass graft surgery every year. As a matter of fact, stent implants and bypass surgery are routinely performed in many hospital chains spread all over the metros and two-tier towns. Stents are manufactured in India for those undergoing angioplasty and stent implants.

Both open heart and beating heart surgeries are performed in the country. While the former is done using a heart and lung machine, the off-pump or beating heart procedure is performed without the machine. This is done by stabilizing the part of the heart the surgeon is operating on using a special medical device. Beating heart surgery is a low-risk option besides early discharge from the hospital and quicker recovery are the other benefits that accrue. Many different types of procedures are performed nowadays using the off-pump or beating heart procedure.

In an open procedure where the beating comes to rest, a restart is required after the procedure is over and this can be risky if the tissue is damaged during the process known as reperfusion.

India offers coronary artery bypass surgery in the top hospitals at a reasonable cost thus fortifying its status as a hub of health care delivery hub in Asia. The success rate of cardiac surgeries including CABG is as high as ninety-eight percent. The cost of this procedure ranges from 100000 t0 500000 INR.

The prices are lower in smaller hospitals and those established in smaller towns. Nevertheless, the service is and medical outcomes stand good with an equal rate of success. The varied hospital setup and availability of a large number of specialists assure low-cost treatments of cardiac ailments in the country.

Cost ranges higher in the best hospital chains established in metros and major towns of India. The augmentation is due to the luxuries and amenities provided, some of which are tantamount to the luxury of five-star hotels. Even with all the star facilities and ambiance, the cost of CABG in the country is far lower than that provided by most Asian and EU Countries including the USA.

Spinal Deformities in India and its Treatments

A vital skeletal masterpiece by the creator, the spine or the vertebral column comprises 33 vertebras. These vertebras are simple bony structures that are compact and shaped like a marshmallow. It is the vertebral arch and body both are part of this single bone structure. It is the vertebral body that acts as a balance and bears the weight of the spine which in turn bears the weight of the upper body to a great extent. The vertebras are interlinked by a cushion, the intervertebral discs that accord great flexibility to the structure that is responsible for balancing our stance and the biomechanical movements.     

Spinal Structure & Deformities 

Much depends upon the shape of the spinal column not only for composure but also for cosmetics. While the latter does not create problems the former certainly does. A deformity results in bending and stooping and difficulty in standing erect.  

The upper spine with a greater-than-normal curve is deformed and this is called kyphosis and which can cause sagittal imbalance. Other conditions that can cause sagittal imbalance are hyperkyphosis, chin-on-chest syndrome, flatback syndrome, and ankylosing spondylitis. This type of imbalance causes stooping, and difficulty in looking ahead and if it exceeds the limit, it can compress vital organs in the chest. 

Idiopathic scoliosis  

Scoliosis happens due to side-to-side curvature of 100 either on one side (C) or on both sides (S). This is caused by adolescent idiopathic and degenerative scoliosis, neuromuscular imbalances, congenital anomalies, and tumors. Unfortunately, this can impact the heart as well as the lungs but on rare occasions. 

If interference in internal organs occurs surgical intervention may be required.  The surgery is not a cure but rather it is a correction. 

Treatment is provided if surgical intervention is not needed to alleviate pain and other systems associated with the malady.  

Corrections and Stabilization 

The main procedures are: 

• Posterior Column Osteotomy 

• Pedicle Subtraction Osteotomy

• Vertebral Column Resection

• Spinopelvic Fixation

Osteotomy creates 10 to 25 degrees of correction. This procedure removes little bone from the vertebral arch. This is useful in correcting long curves in patients suffering from kyphosis.  This operation can be performed at several levels. Very little removal of bone takes place in the osteotomy. 

More bone is removed in pedicle subtraction osteotomy than in the procedure described above. Here removal of pedicles that connect the vertebral arch to the vertebral body part which itself is removed. This procedure can be combined with osteotomy and the correction achieved is to the extent of 30deg.    

Pedicle Subtraction Osteotomy is used to correct: 

• Ankylosing spondylitis

• Flatback syndrome

• Angular kyphosis 

• C-shaped scoliosis

VCR or Vertebral Column Resection

A large portion of bone is removed in VCR much more than removal in the previous procedures described here. Implants called cages are used to replace the vertebrae. Cages are basically bone grafts used as implants. After the bone grafts heal screws and rods are used to restore stability. This procedure provides a correction of 80deg plus. 

In VCR more vertebrae can be removed to accord a greater degree of correction. 

In this procedure called Spinopelvic Fixation hardware comes into the picture. In this, screws, rods, or other elements are rigidly connecting the base of the spinal column and the bones of the hip. This procedure helps put the strain off healing bone fusion. The stress during bending and rotation betwixt the lumbar spine and the sacrum at the joint. 

Spinal surgical interventions are difficult procedures and are performed in special hospital theatres by expert surgeons. The healthy vertebrae column that is well structured needs no intervention it is when a structural anomaly develops or happens at birth then intervention is required. Surgery may not be the necessary recourse if non-surgical treatments are able to mitigate suffering. 

India has the largest cases of spinal deformities in the World. A nationwide screening takes place in the country to find out the extent every year.  

This surgery is performed in many major hospitals, especially those dealing with neurosurgery. The average cost of kyphosis or hunchback surgery in India is Rs. 374,000.00 while the cost is about USD 140000 in the USA. 

The average cost of surgical interventions in Indian hospitals ranges from Rs.180,000 to Rs.800,000 depending upon the complexity.   The cost in the country also depends upon the medical facility chosen and the city it is based in. In the metros and capital cities cost is higher than in 2-tier towns. But very few hospitals will perform complex operations related to the spine in 2 tier cities in India.  

Each of the kyphosis cases is unique and the treatments or surgical procedure varies as well. A customized plan will include various therapies before and after the operation hence the cost of cumulative procedures would rise. Physiotherapy and chiropractic care may be required in some cases the latter being an alternate healing process used in correcting mechanical disorders in musculoskeletal systems. Often home exercise with corrective bracing is prescribed post-treatment.  

Looking at the gravity of the procedures used for correcting scoliosis surgery should be the last resort. It can alter a patient’s life for good or bad.    

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Ancient India Now a Modern Land of Healing & Wellness

India’s progression in modern medicines has been exponential, a phenomenon recognized all over the World. Thanks to the rising popularity of medical tourism in India, the World has come to comprehend the unique health ecosystem that the country has created in modern times.

The country is home to the finest medical institutions dealing with a wide spectrum of therapeutics, surgery, and wellness treatments. Patients suffering from serious illnesses arrive here for tertiary treatment related to terminal cancers, liver and kidney transplants, and heart ailments to name a few. The country also attracts people for secondary health care related to cosmetics, hair transplants, and dentistry to name a few.     

India boasts one of the finest and largest platforms for education in modern medicine. But in spite of extreme reliance on allopathy, the inclusion of traditional pathways of healing has not been shunned. The ancient healing systems have been absorbed along with the rising tide of modern medicine in a syncretistic approach.      

Ancient Healing Systems

Healing as a science is an age-old phenomenon in India dating back more than 5000 years. The Hindu sages although born with a religious bent were explorers of spiritual mind and body as well. They created a society with a propensity towards research and development, as did few other civilizations flourishing in the World in ancient times.

In the centuries that followed, they developed numerous sciences not only those associated with healing but also with civics, art, and cultural aspects.  As a human entity, India was a conglomeration of robust cultures with an inclination toward science.

Ayurveda

Yoga and Transcendental Meditation are recognized globally for the immense health benefits they promote. Ayurveda too is slowly being accepted with greater result-based research being carried out. The benefits of herbs used in Ayurvedic practice are being understood far better now. The country exported 330.18 million USD worth of herbs in the period 2017 – 2018. The trade holds greater potential due to a projected growth rate of 14 % CAGR.  

Herbal cosmetic and value-added extracts were shipped overseas to the tune of 456.12 million USD in the same period.  With the standardization of organic agricultural practices, the demand for herbs and value-added herbal products will increase exponentially in the near future.  To prevent biopiracy, the Government of India has set up Traditional Knowledge Digital Library which serves as the repository for Indian formulations.

Yoga Tourism

Major centers of Yoga Tourism include Rishikesh and Mysore. Yoga holidays have become a mainstream tourism activity not only in India but in many countries due to the rising popularity of science which deals both with the physical and mental aspects of the human body. The ashrams or Yogi ashrams were the ones to popularize Yoga. The activity became commercialized with the spawning of a number of centers pan India in form of spa and wildlife resorts and five-star hotels. Experts teach yoga in private schools as well and certify learners. TM is delivered side by side in most of these centers. The AYUSH Ministry plays a vital role in the promotion within.

Yoga tourism is secondary to medical tourism, and it generates revenue according to health to the of overseas visitors. A drop-in class fee in Rishikesh ranges from INR 200 to 500. The classes are well organized and headed by a Guru, and most of the followers are overseas visitors from the UK, EU, and the USA.     

Wellness resorts are flourishing all over the country promoting therapy based on diet, Naturopathy, Yoga, and Ayurvedic treatments the latter including the most sought-after massages. There is no fine line that segregates indigenous healing therapies, as a matter of fact, the delivery is often mixed in these resorts.   

Towards Syncretism

Most practitioners of modern medicine or allopathy tolerate patients undergoing alternate healing. As a matter of fact, some doctors prescribe innocuous Ayurvedic herbal formulations along with their treatments.   The rate of patients using indigenous formulations along with allopathic drugs is 3.5 % percent but this does not include habitual users of the formulations. Ayurvedic herbal formulations are used in every Indian household. This is evident from the growing exports and mushrooming of small units manufacturing the formulations. The popularity of herbal cosmetics and therapeutics that line the stores all over the country is another indicator of the increasing demand.    

Across the World, around 80 percent of 6 billion people use herbal medicine for primary healthcare. Although describes as pseudoscientific, a good number of Ayurvedic products have proven their efficacy abroad, but a lot of studies proving the efficacy of many other formulations need to be carried out. 

Herbal medicine is culturally accepted throughout the World as part of traditional healing that promotes a healthier living besides offering a moderate approach to healthcare. 

With a robust healthcare infrastructure, India is attracting international patients from many countries. Reach and the cost has been the criteria upon which to base the visit for international patients everywhere. This applies to India as well, but the alternative healing and wellness holidays act as additional criteria upon which the patients base their visits. Hence it is not only neighborhood visitors that arrive from Bangladesh, Pakistan, Afghanistan, and Nepal traveling to India for medical treatments. Yoga, TM, and Ayurveda are proving as additional determinants that are attracting people from developed countries as well as propelling health tourism in India.             

Bone Marrow Transplant in India

When things go wrong with the bone marrow, it leads to a life-threatening situation. A mass of tissue with a dense network of nerves and highly vascularized bone marrow as the name suggests is found enclosed in bone cavities all over the body. It is part of the vital lymphatic system comprising red marrow and yellow marrow.

This lymphatic system performs a number of vital functions besides the removal of old and dead cells from the body. Most of the platelets, white and blood cells are formed in the red marrow while the white marrow produces fats, cartilage, and bone. This makes the microarchitecture a vital system for life support. The red blood cells perform the function of oxygen carriers while the white ones act like the sentinels and are indispensable for body immunity which keeps harmful pathogens at bay.   

During a lab test excess production of red blood cells or white blood cells is an indication of an abnormality and calls for medical attention. For example, excess white cell production in your bloodstream is usually a sign of disease. In a contingency especially when there is a deficiency of the RBC, WBC, or platelets body hormones trigger excess production to make up for the loss. 

Bone Marrow Transplant

When contingency strikes and the marrow becomes diseased to the point of no return then a transplant is the only recourse. In the case of cancers of various types and blood-related disorders, transplantation is lifesaving.

In this kind of procedure, stem cells play a major role. Stem cells are a special type of developing cells that turn into the RBC, WBC, and platelets depending upon their genetic coding. Thus, the diseased cells are removed and healthy stem cells are transplanted into the bone marrow. The success rate of this procedure is almost 85% and immensely helps those suffering from bone marrow disease especially those afflicted by cancer.

BMT or bone marrow transplant is required not only when the marrow is affected by cancer but the damage is also by severe infections, aplastic anemia, sickle cell anemia, and thalassemia.  

In case of a malignancy, BMT is most successful in the following instances

• ·        Hodgkin’s lymphoma
• ·        Non-Hodgkins Lymphoma
• ·        Multiple Myeloma
• ·        Acute Myeloid Leukemia
• ·        Chronic Myeloid Leukemia
• ·        Acute Lymphoblastic Leukemia (
• ·        Neuroblastoma
• ·        Myelofibrosis

Usually, the marrow is harvested from some specific bones in the body in order to find an anomaly or damage to it. The harvesting is done under general anesthesia and complications are limited. In the case of harvesting from a donor, most countries have stipulated a limit to extraction.

Allo & Auto Transplant

In the case of ALLO, the transfer takes place between two persons provided the marrows match. In order to prevent rejection a protein named HLA in WBC is matched, this protein is responsible for preventing a rejection whence the introduced cells begin attacking those already present in the body.  ALLO transplant can be impacted with a high or low dosage of chemotherapy and thus the process is differentiated accordingly by the experts.

In the case of AUTO Transplant, the healthy stem cells are removed and stored as frozen before chemotherapy or radiation. These cells are then retransferred after the cancer treatment.

The pre-transplant procedures include increasing the production of healthy stem cells, the chemotherapy is then carried out followed by reinjection of the bone marrow.

Some other types of BMT are:

• ·        Syngeneic Transplant
• ·        Haploidentical Transplant

Before the BMT takes place a number of tests have to be conducted in order to detect problems and infection if any.  Hence a variety of blood tests, CT scans, X-rays, biopsies, and heart function tests are all that the operating surgeon may deem necessary. 

Though the success rate is high almost up to 85% some complications may arise post the procedure. But the complications rarely result in death and as a result, they are becoming more and more popular.  

Nearly 100000 BMT are being carried out around the world. The rate of increase in the procedures being carried out is 7 percent which is suggestive of a growing number of ailments that afflict the marrow. 

In India, a number of bone marrow transplants are being carried out in top-rated hospitals. The cost of this procedure ranges anywhere from 20 lakhs to 45 lakhs. The cost difference arises from the type of hospital chosen and the BMT procedure itself. As compared to India the cost of BMT in The USA is as much as 200,000 USD.

Some of the best hospitals for BMT are:

• ·        Max Hospitals
• ·        Medanta
• ·        Kokilaben Dhirubhai Ambani Hospital
• ·        Global Hospital Chennai

The cost difference and the quality of service available in Indian Hospitals make them an attractive health travel destination. These factors are proving beneficial to international health travelers and they are actively seeking treatments in India.   

Understanding Ayurveda amidst Modern Day Therapies

It all started five thousand years back whence Vedic civilization was flourishing. Hinduism was the backbone. It is an ideology with a propensity for vegetarianism which albeit it surfaced much later but I believe it had taken roots by then. Today almost 30% of Indians are vegetarian. Another feather in the cap was the development of another wellness therapy and that was Yoga. 

The two gems of Indian healing systems are very much popular today in India as well as overseas. Most of the proponents of Yoga have been initiated in the Vedic Era or earlier perhaps. The guru shishya tradition has been instrumental in exporting the wellness system to many countries. The sages left no stone unturned to discover the holistic healing sciences. Although considered as an alternative or pseudoscientific term according to some Western prejudiced practitioners and scientists.     

Ayurveda is in existence since its inception and the system is growing. New scientific logic is being applied to the system now subject to research and the quest for evidence as in the case of modern medicine. The sheer magnitude of consumption in the country of origin, and the growing popularity overseas should make habitual detractors of this ancient Indian medical science think. 

Ayurveda is close to nature since Hindu or Santam Dharma is nature-centric. A majority of formulations comprise vegetative matter, and the animal matter used is derived from creatures not subject to killing. The use of ghee or clarified butter and honey is one such example. 

The use of minerals and some metals are a cause of concern as rightly pointed out by scientists and modern medicine practitioners Some of them are toxic in large quantities. Hence all pharmaceutical concerns should create a standard for this usage that is suggestive of medicinal value. 

Ayurveda practitioners are registered practitioners with degrees from colleges and universities. They are familiar with modern medicines. Many of the pharma companies that make Ayurvedic medicines are global or National concerns that will follow standards. 

The formulations are available as tablets, powders, and liquids. Most of the popular formulations are consumed in India and abroad by the masses. Although the medicine comprises a complex mix of ingredients - herbs, roots, and minerals they are all mentioned in quantity in branded formulations.  

This Indian healing system also prescribes diet regimen, exercise, and in some instances abstinence which means it advocates lifestyle changes necessary to deal with an anomaly in the system.  Thus, it may still be not evidence-based but the lifestyle changes augur wellness, and the ingredients from the medicinal plants have beneficial properties many of which have been studied although more needs to be done to quantify. 

The system lays more emphasis on lifestyle and consuming elements in harmony with nature. Many natural remedies like Isabgol or psyllium husk, ashwagandha, shilajit, sankphuspi, and Brahmi have become popular and are used by the masses. There are more herbal ingredients on the list may be in thousands. 

India is biodiversity-rich and more herbs with medicinal properties would be discovered in time to come. Around 7000 herbs have already been classified. 

**Never consume the medicine without the advice of a doctor

**Do not stop modern medicine treatments suggested by your doctor

**Consult doctor at every step. 

Be safe and healthy! 

Taking Care of Your Heart

Your lifeline to good health and survival is your heart and blood circulatory system. The heart is the most powerful organ in your body and is tireless. It keeps on working day and night till death takes place. A person may die of heart failure, blockage, or many other diseases that afflict this organ. 

Most of the anomalies in the heart and blood circulatory system take place due to lifestyle factors. Bad food habits, lack of exercise, undue stress, smoking, alcohol, and high cholesterol are reasons for being afflicted by a diseased heart. Some anomalies in the circulatory system and heart can be congenital. 

The disorders in circulation and in this vital organ can be prevented. Whatever is good for health is good for the heart and blood circulation. Eating fresh fruits, boiled vegetables and white meats, fish and all things healthy keeps the heart strong and working well. Regular exercise is a must. The exercise preferred would be light aerobics, yoga, or long regulated walks in the fresh air. 

In most cases, the beginning of heart disease is indicated by high blood pressure. If this is checked and lifestyle changes are made the damage to the heart can be controlled. If not then many problems can occur some can be life-threatening. 

In circumstances like these, a heart specialist should be contacted and advice taken. There are many methods to control and treat heart disease. Initially, medication is advised in case of serious threat surgery is prescribed. There are many alternative treatments for heart diseases. One of the most popular is chelation therapy, artery clearance therapy, and 3-D cardio angiography. These are noninvasive treatments non surgical bypass is also very popular. Apart from being non-surgical, the cost of the treatment is affordable and less risky than heart surgery. 

3D cardio angiography is not at all risky. Traditional coronary angiography is invasive with a risk of reaction to the dye used and artery rupture can take place. Prevention is the best cure but if damage to the heart occurs, alternative non-surgical procedures are a good option.

Green Tea & Healthy Heart

Eat Healthily! Sleep Well! Exercise Daily & Sip Green Tea 

Above is the formula for a healthy heart and long life. Well, how does green tea keeps a heart healthy? 

Here is the answer: 

First, the leaf contains many antioxidants and beneficial chemicals that act as a general tonic. These very chemicals have disease-fighting capacity hence protecting our body from illness. This thus assists in having a long life.       

The tea lowers harmful LDL cholesterol and triglycerides which aids in the reduction of heart ailments and stroke.  Many studies have shown that participants that drank at least four to five cups of this brew every day suffered much fewer ailments relating to the cardiovascular system.