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Life After Kidney Transplant

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The Technological advances in transplantation have enabled thousands of procedures that benefit organ and tissue recipients worldwide. Transplantation benefits patients who need solid organs, tissues and cells by means of the development and improvement of surgical techniques, inputs, equipment and immunosuppressive drugs needed to this therapy. The number of kidney transplant performed has increased significantly.

In most situations these procedures are presumed as the only resource for sustaining life. However, this treatment option is not always available for those who are waiting for organ transplantation because it requires a donation.

Kidney transplantation requires compatibility between tissues obtained for the Human Leukocytes Antigen typing (HLA).While waiting for a donor, the chronic renal disease patients have other forms of Renal Replacement Therapy (RRT) which allow the maintenance of their life and also justify the increasing number of patients registered on the waiting list for kidney transplantation.

Renal Insufficiency and the complications associated with its treatment constitute a serious public health problem worldwide, with social and financial burden resulting from increasing rates of young patients with renal function failure.

A number of diseases are capable of destroying renal function in all age groups. The most common causes for renal disease leading to kidney transplantation are the following:

Diabetes -31%

Chronic glomerulo nephritis -28%

Polycystic kidney disease -12%

Nephrosclerosis ( Hypertensive)-9%

Systemic lupus Erythematosus (SLE)-3%

Interstitial nephritis -3%

Thus, measurement of the patient’s quality of life after kidney transplantation is a relevant topic for many individuals who are on dialysis and receive care in a dialysis center.

Renal transplantation is the best therapeutic option for patients with chronic kidney disease. The surgical procedure is relatively simple, and post transplantation certain actions are necessary such as the use of immunosuppressive drugs and the outpatient follow-up. Therefore for these patients, the clinical management, the evaluation of treatment results and impacts on quality of life are important issues.

Health –related quality of life contains multiple aspects of health related issues from the patient’s perspective including physical, psychological and social functioning and overall well being. Numerous clinical trials have established the importance of health related quality of life in various diseases and it is increasingly popular to evaluate disease specific health related quality of life as a measure of patient’s subjective state of health.

Kidney transplantation is the treatment of choice for end stage renal disease (ESRD). Advances in renal transplant procedures and immunosuppressive therapies have increased dramatically the survival over the last decades, one year allograft survival rates are currently over 90%.

The major goal of transplantation is the achievement of maximal quality and quantity of life while minimizing the effects of disease.

In renal transplantation the costs are not only limited to the transplant procedure but also to the evolving costs to treat adverse events, some of them caused by the immunosuppressive therapy.

Since the first successful kidney transplantation as early as the early 1950s, immunosuppressive therapies improved considerably, the most revolutionary development being the introduction of cyclosporine in the early 1980s. The introduction of new immunosuppressive agents has further increased the therapeutic options for immunosuppressive combination therapies in transplanted patients.

In parallel to better patient care and new immunosuppressive regimens the median survival of renal allograft improved continuously. Hand in hand with these achievements, greater attention has been given to long term quality of life. It is generally accepted however, that patients with a functioning renal allograft have a improved health-related quality of life as compared to patients on dialysis.

Summary Points:

·         The global burden of End Stage Renal Disease is increasing.

·         Renal transplantation increases patient survival and quality of life and reduces the cost of care for patients with End stage renal disease.

Longer life with a transplant

On the other hand, patients who receive a kidney transplant typically live longer than those who stay on dialysis. A living donor kidney functions, on average, 12 to 20 years and a deceased donor kidney from 8 to 12 years.

·         Most donor kidneys come from ‘brain death’ or ‘cardiac death’ donors, but donations from living donors are increasing.

·         Pre-emptive transplantation from a living donor is the best treatment choice for patients with end stage renal diseases and has been associated with improved allograft and patient survival. ***

·         Long term outcomes in kidney transplantation are improving

·         Better Quality of life

Even though kidney transplant is major surgery with a phased recovery period, it can, in comparison to dialysis, offer you the opportunity for a longer, more satisfying life. Most patients who have been on dialysis and then had a transplant report having more energy, a less restricted diet and fewer complications with a transplant than if they had stayed on dialysis. Transplant patients are also more likely to return to work after their transplant than dialysis patients.

*** Data from the Organ Procurement and Transplantation Network for transplants performed in 2002-2004 show that the 1-year survival rate for grafts from living donors is approximately 95% and the rate for deceased donor grafts is approximately 89%. The half life for grafts from living donors increased steadily from 12.7 to 21.6 years.

Preemptive transplantation refers to kidney transplantation before a patient needs to start dialysis therapy. Patients who get a preemptive transplant receive their kidney when their health is generally good, which can improve new kidney function and enhance overall health and life expectancy.

                                Epidemiological data from the past decade suggest that the global burden of the patients with renal failure who receive renal replacement therapy exceeds 1.4 million and that this figure is growing by 8% a year.

Transplantation is the renal replacement modality of choice for patients with diabetic nephropathy and pediatric patients.

PRETRANSPLANT EVALUATION:

Candidates for renal transplantation undergo and extensive evaluation to identify factors that may have an adverse effect on outcome.

Mostly, all transplant centers have a committee that meets regularly to discuss the results of evaluation in a patient and select medically suitable candidates only to place on the waiting list.

In addition to a thorough medical evaluation the committee also evaluates the social background of the patient to determine conditions that may interfere with the outcome of transplantation, such as financial and travel restraints or a pattern of noncompliance.

Laboratory Studies in transplant candidatesInfectious profile in transplant candidates
Blood ChemistriesHepatitis B And C serology’s
Liver function testsEpstein –Barr Virus, serology (IgM and IgG)
Complete Blood Count (CBC)Cytomegalovirus (CMV) serology’s (IgM and IgG)
Coagulation  ProfileVaricella –zoster virus, serology’s (IgM and IgG)
 Rapid plasma reagin (RPR) test for syphilis
 HIV
 Purified protein derivative (PPD)- tuberculosis skin test

Urine analysis, Urine culture and cytospin should be ordered when indicated.

A complete cardiac workup and immunologic evaluation (ABO blood group determination, Human Leukocyte Antigen (HLA) typing, serum screening for antibody to HLA phenotypes, cross matching) are also done.

Management

In addition to the surgical transplantation procedure itself, management includes the following:

·         Organ procurement

·         Provision of immunosuppressive therapy to the recipient

·         Short and long term follow-up to look for indications of renal allograft dysfunction and other complications

Organ Procurement

·         Identification of potential donors

·         Assessment of donor suitability

·         Determination of donor brain death

Immunosuppressive therapy after transplant

All kidney transplant recipients require life-long immuno suppression to prevent a T-cell alloimmune rejection response. The goals are as follows:

·         Prevent acute to chronic rejection

·         Minimize drug toxicity and rates of infection and malignancy

·         Achieve the highest possible rates of patient and graft survival

The critical considerations in medical follow up are as follows:

·         Rejection

·         Nephrotoxicity of calcineurin inhibitors (i.e. cyclosporine, tacrolimus)

·         Recurrence of native kidney disease

Transplant recipients tend to be highly experienced patients. Many dealt with their chronic illness for years have been treated and examined by innumerable doctors, have undergone dialysis and its attendant intrusions on their lifestyle, have managed a complicated regimen of medications and have (in many cases) developed a certain expertise related to their own care.

Such patients are invariably grateful for any recognition or acknowledgment of their ordeal. Thus, it is advisable that they are educated about and encouraged to participate actively in their disease management to the fullest possible extent. That said, these patients problems are often complex and decisions regarding their care should be made after consulting the appropriate transplant team.

It is worthwhile to mention-

·         Till date, more than 250,000 kidney transplants have been performed in United States alone.

·         In 2007,6037 kidney transplants were performed from living donors and 10,082 from deceased donors.

·         Currently more than 100,000 people in the United States are living with the functioning kidney transplant.

This number represents 27% of the nearly 350,000 persons enrolled in the US ESRD program.

In1973, congress enacted Medical entitlement for ESRD treatment to provide equal access to dialysis and transplantation for all patients with ESRD in the Social security system by removing the financial barrier to care.

Currently, the main obstacle is donor organ shortage. An increasing rise in ESRD coupled with a lack of donor organs has resulted in an average waiting time of more than 4 years for a deceased donor renal transplant.

The social factors and the perception of the complications of donation by the donor, family members or even the recipient can affect the act of voluntary donation. In India, the Human Organ Transplantation Act of 1994 and its amendments discourages unrelated transplant due to ethical reasons and to avoid exploitation of the financially disadvantaged people.

The latest statistics says that the donors volunteer themselves for transplant evaluation in 28% of the cases and in the rest, it is either requested by the recipient or suggested by the recipient’s physician.

Of all the donors who come for evaluation, 46 (22%) report at least one instance of an attempt to discourage donation and donor’s spouse is the commonest (47.8%) identified cause. Similarly the commonest cause for some of the possible donors declining to even come forward for donor evaluation is again the spouse refusing to give consent.

This emphasizes the fact that the donor’s spouse is always a part of decision making along with the donor to alley some of the fears associated with donation.

It takes courage to ask others for help- and there’s no bigger ask than asking for a kidney and it is always good to help others and there is no greater help than donating an organ and giving a new lease of life to someone.

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WHAT HAS CHANGED IN REGARD TO JOINT REPLACEMENT SURGERY?

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Total Knee and Total Hip replacements are highly successful operations that can dramatically improve the quality of life of a person riddled with end- stage arthritis. An increasing number of people are having these now as the technology and expertise has become easily available across our country. At the same time, the rapid expansion of the Healthcare industry in India has led to mushrooming of several facilities, all of which market their wares quite aggressively. In this scenario, it is possible that the opinion seeking patient is offered the solution that is available within the premises of the particular healthcare facility rather than the treatment which might be best suited for that patient’s specific needs. It is therefore important that one is aware of the options available when at the receptive end of this gamble.

First of all, replacement surgery works for severe arthritis that has caused significant pain and disability. If there are symptoms from early or mild arthritis, there are a variety of non- surgical treatments like exercise, medications and injections which must be explored. A thorough consultation with a specialist helps decide which option is the best suited for a particular individual. Similarly, Total Joint Replacement works well in people over the age of 60 years. At younger ages with severe arthritis, surgical options like bone re-alignment and Partial Joint Replacement exist.

Joint Replacement is an elective procedure and must never be decided upon in a hurry. It must never be forced upon an individual or the success and satisfaction will be less, as any operation involves going through pain and risk. At the same time, new developments have enabled many of the previous myths associated with such procedures to wane.

For patients wanting to undergo such surgery, there are good services available in most Indian cities. There are an increasing number of dedicated firms doing exclusive work, where the standards are bound to be better. At the same time, I would discourage people from travelling too far to have these procedures undertaken at the more famous centres, as travelling back home soon after such surgeries is not without risk. Similarly, one must be in a position to manage stairs within three to four days of surgery too, unless one has not been doing stairs at all before. Only with a reasonable amount of independence, usually achieved within four to five days of surgery is a patient deemed fit to leave hospital, as we cannot guarantee good rehabilitation with the currently available infrastructure of home care services. The cost of surgery varies a lot with the city and set up. However, it does not mean that increased cost would guarantee important things like theatre standards (having a separate theatre for clean planned cases), water impervious drapes, etc. What materials are being used should be transparent and patients must demand for records of what is implanted into their bodies.

Patients in our country are given a choice of “Indian” or “Imported” prostheses. There is however a large armamentarium of prostheses available from across the world. We have some very good quality prostheses manufactured in India now. Similarly, there are ones manufactured abroad with less sound engineering. Every joint replacement surgeon should ideally be comfortable using a range of prostheses. The question to tackle is the disability experienced by the individual person leading to joint replacement. Design of prosthesis should be selected as per that very need. Differently manufactured prostheses are based on different engineering. The pattern of movement allowed by each prosthesis is thereby slightly different. Different designs of prostheses can hence be chosen to suit the individual patients’ specific needs and to match their pattern of arthritis. The price often depends on an individual companies marketing strategies. Expensive pricing certainly does not equate with better design always.

Even though an operation of this nature is a large attack on the body, there is worldwide evidence that shows better results when patients are made to get up and walk right from the day of surgery. With the patient visiting the toilet on the day, urinary catheterisation can be avoided. Patients even manage stairs in a couple of days. Hospital stay and complications like infection thereby are much reduced. Modern techniques of pre- operative medication and anaesthesia combined with sound surgical measures make this ‘Enhanced Recovery’ possible. As these procedures are planned, we have the opportunity to optimise the patient’s status before the surgery.

The technique of making a patient walk early has been used in reputed centres worldwide for the last three to five years with documented success and decreased complication rates as compared to the conventional technique. At the same time, marketing sometimes go over the top and advertise Joint Replacement as ‘day surgery.’ A technique is good and viable when it can be reproduced easily for most patients undergoing Joint Replacement, not for a select few younger and fitter ones. Even in a smaller setup in Mangalore, we have employed this over the last six months, and 100% of our patients of ages between 62 and 79 have stood up and taken a few steps on the day of surgery.

Elective surgery is an entirely different ball game as compared to emergency or traditional fracture related orthopaedic operations. It is a matter of changing the quality of somebody’s day- to- day life. Seemingly small alterations in technique can hence make a large difference in rehabilitation of a patient into their desired life activity following joint replacement procedures. With the increasing scale of these operations across our country, it is imperative that dedicated units offering such services incorporate the best standards of care and rehabilitation.

The author Dr. Yogeesh D. Kamat is a Consultant Hip & Knee Specialist Orthopaedic Surgeon. He practises exclusively in Joint Replacement, Arthroscopy and Sports Injury related to the lower limb joints and is available at KMC Hospital

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A new Microscope can scan tumors during surgery and examine cancer biopsies in 3-D

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A new microscope could provide accurate real-time results during cancer-removal surgeries, potentially eliminating the 20 to 40 percent of women who have to undergo multiple lumpectomy surgeries because cancerous breast tissue is missed the first time around.

When women undergo lumpectomies to remove breast cancer, doctors try to remove all the cancerous tissue while conserving as much of the healthy breast tissue as possible.

But currently there’s no reliable way to determine during surgery whether the excised tissue is completely cancer-free at its margins — the proof that doctors need to be confident that they removed all of the tumor. It can take several days for pathologists using conventional methods to process and analyze the tissue.

That’s why between 20 and 40 percent of women have to undergo second, third or even fourth breast-conserving surgeries to remove cancerous cells that were missed during the initial procedure, according to studies.

A new microscope invented by a team of University of Washington mechanical engineers and pathologists could help solve this, and other, problems. It can rapidly and non-destructively image the margins of large fresh tissue specimens with the same level of detail as traditional pathology — in no more than 30 minutes.

“Surgeons are sort of flying blind during these breast-conserving surgeries,” said mechanical engineering professor Jonathan Liu. “Oftentimes they’ve left some tumor behind which they don’t know about until a few days later when the pathologist finds it.”

“If we can rapidly image the entire surface or margin of the excised tissue during the procedure, we can tell them if they still have tumor left in the body or not. And that would be a huge benefit to cancer patients,” Liu said.

The new light-sheet microscope — which is described in a new paper published June 26 in Nature Biomedical Engineering — offers other advantages over existing processes and microscope technologies. It conserves valuable tissue for genetic testing and diagnosis, quickly and accurately images the irregular surfaces of large clinical specimens, and allows pathologists to zoom in and “see” biopsy samples in three dimensions.

“The tools we use in pathology have changed little over the past century,” said co-author Dr. Nicholas Reder, chief resident and clinical research fellow in UW Medicine’s Department of Pathology. “This light-sheet microscope represents a major advance for pathology and cancer patients, allowing us to examine tissue in minutes rather than days and to view it in three dimensions instead of two — which will ultimately lead to improved clinical care.”

Current pathology techniques involve processing and staining tissue samples, embedding them in wax blocks, slicing them thinly, mounting them on slides, staining them, and then viewing these two-dimensional tissue sections with traditional microscopes — a process that can take days to yield results.

Another technique to provide real-time information during surgeries involves freezing and slicing the tissue for quick viewing. But the quality of those images is inconsistent, and certain fatty tissues, such as those from the breast, do not freeze well enough to reliably use the technique.

By contrast, the UW open-top light-sheet microscope uses a sheet of light to optically “slice” through and image a tissue sample without destroying any of it. All of the tissue is conserved for potential downstream molecular testing, which can yield additional valuable information about the nature of the cancer and lead to more effective treatment decisions.

“Slide-based pathology is still an analog technique, much like radiology was several decades ago when X-rays were obtained on film. By imaging tissues in 3-D without having to mount thin tissue sections on glass slides, we are trying to transform pathology much like 3-D X-ray CT has transformed radiology,” Liu said. “While it is possible to scan microscope slides for digital pathology, we digitally image the intact tissues and bypass the need to prepare slides, which is simpler, faster and potentially less expensive.”

“If we can do this without consuming any tissue, so much the better,” said co-author Dr. Larry True, professor of pathology at UW Medicine. “We want to use that valuable tissue for purposes which are becoming ever more important for treating patients — such as sequencing the tumor cells and finding genetic abnormalities that we can target with specific drugs and other precision medicine techniques.”

The light-sheet microscope also offers advantages over other non-destructive optical- sectioning microscopes on the market today, which process images slowly and have difficulty maintaining the optimal focus when dealing with clinical specimens, which always have microscopic surface irregularities.

The UW microscope can both image large tissue surfaces at high resolution and stitch together thousands of two-dimensional images per second to quickly create a 3-D image of a surgical or biopsy specimen. That additional data could one day allow pathologists to more accurately and consistently diagnose and grade tumors.

“Pathologists are currently very limited in how much they can look at on a glass slide,” said co-author Adam Glaser, a postdoctoral fellow in the UW Molecular Biophotonics Laboratory. “If we can give them three-dimensional data, we can give them more information to help improve the accuracy of a patient’s diagnosis.”

The UW team achieved these improvements by configuring various optical technologies in new ways and optimizing them for clinical use. Their open-top arrangement, which places all of the optics underneath a glass plate, allows them to image larger tissues than other microscopes.

The team is currently working on speeding up the optical-clearing process that allows light to penetrate biopsy samples more easily. Future areas of research include optimizing their 3-D immunostaining processes, as well as working with machine learning experts to develop algorithms that can process the vast amounts of 3-D pathology data that their system generates, with the ultimate goal of helping pathologists zero in on suspicious areas of tissue.

Story Source: Materials provided by University of Washington. Original written by Jennifer Langston.

URL: https://www.sciencedaily.com/releases/2017/06/170626124605.htm

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One surgeon says you need an operation. Another says you don’t. Here’s why that happens!!

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In 2002, when Tim Copeland was just 12 years old, he started having seizures and difficulty speaking. His physician in San Diego couldn’t figure out what the problem was. When Copeland eventually went to see a neurosurgeon in Escondido, California, he was diagnosed with cerebral cavernous malformation, a disorder of the blood vessels that causes them to leak into the brain.

The surgeon told Copeland that his brain was inoperable and the best option was radiation therapy to slow the bleeding.

But Copeland’s mother wanted a Second Opinion. So the family flew to Rochester, Minnesota, to seek advice from a surgeon at the Mayo Clinic.

The Mayo doctor recommended surgery as soon as possible to cut the problematic lesion out of Copeland’s brain.

Within weeks, the boy was on an operating table. Now 26, and a research associate at University of California San Francisco, he hasn’t had a seizure since.

After the operation, the neurosurgeon told Copeland the uptick in symptoms was due to an increase in the severity and frequency of the hemorrhage in his brain.

“I was very lucky that my mom had a bad feeling about my diagnosis,” Copeland added.

Copeland’s story is probably a familiar one. Many Americans get radically diverging opinions from surgeons on the question of whether to operate. These contradictory viewpoints can be a source of great stress and confusion, leaving patients unsure about what to do in what are often life-or-death situations.

There’s plenty of guidance out there for surgeons, so why is this so common?

A new study, published in the Annals of Surgery, tried to get to the bottom of that question. The authors found it all seems to come down to how different surgeons perceive risk — a reminder of how terrible humans are at risk perception, even highly skilled surgeons.

For the research, led by Greg Sacks, a surgical resident at the University of California Los Angeles, a national sample of more than 750 surgeons was presented with four detailed clinical vignettes, asking the doctors to judge the risks and benefits of both operating and not operating in cases that could go either way.

When faced with identical scenarios, the surgeons came up with vastly different estimates for the potential harms and advantages of surgery or nonsurgical management of the disease.

In three of the four cases, surgeons were nearly split on the decision of whether to cut. One vignette, for example, involved the question of an appendicitis on an otherwise healthy 19-year-old with fevers and pain in her right lower abdomen. Here, 49 percent of respondents suggested surgery while 51 percent recommended against it.

In another vignette — involving a 68-year-old patient with a blockage in the small bowel — there was more agreement: 84 percent thought surgery was a good idea. Still, 15 percent of the doctors thought the harms of the surgery outweighed the benefits, once again displaying the variability in surgical decision-making.

This variation seemed to come down to surgeons’ perceptions of risks and benefits, the researchers wrote: “Surgeons were less likely to operate as their perceptions of operative risk increased and their perceptions of nonoperative benefit increased.”

And those risk perceptions were very predictive of whether or not a surgeon would recommend an operation: “Surgeons were more likely to operate as their perceptions of operative benefit increased and their perceptions of nonoperative risk increased.”

But the surgeons differed by as much as 0 to 100 percent when it came to estimating the risks of a surgery, such as the chances a patient might experience a serious complication.

“The truth is that most of the surgeons in their sample are quite experienced, and yet have wildly different assessments of risks and benefits among similar patients,” said Ashish Jha, a Harvard professor of health policy.

Jha, whose research focuses on improving the quality of health care, called the findings “disturbing” and “enormously important.” They should remind us, he said, of how difficult it is for people to evaluate risk, how bad we all are at it, and “how even surgeons are not able to escape these deeply human deficiencies.”

Another implication of this research, Sacks said, is that individual surgeons may be communicating very different risks and benefits to their patients when talking about a potential operation.

Patients need more accurate information about the risks and benefits of surgery

This new research should also remind us of how varied individual surgeons’ advice can be — and that we need to develop better tools to reduce that variation.

One possibility is using a risk calculator, like this one developed by the American College of Surgeons: It takes high-quality data from millions of patients around the country who have had similar operations and uses variables — such as how sick a patient is and the patient’s age — to come up with estimates on the risks of surgery.

In another study, Sacks found that surgeons who used the tool made more accurate predictions and were less varied in their judgments compared with those who didn’t rely on data. In the end, however, the tool didn’t change their decision on whether to operate.

“Although the size of the effect of the risk calculator is modest,” Jha said, “it reminds us that surgeons are trying their best based on limited information — their own experience.”

Tools that provide data like the risk calculator — can help doctors make better choices, or, at the very least, better inform patients of risks and benefits.

“It’s clear we need to develop more resources like this to be additional input beyond personal experience for surgical decision-making,” Jha said.

Copeland, who had the brain surgery that saved his life, would like to do just that. His experience led him to pursue a PhD in epidemiology, and he wants to figure out how to bring decision support systems and evidence-based medicine into consultations with surgeons.

“[These can] supersede the personal biases and subjectivity of physicians,” he explained. “They’re highly skilled at interpreting and practicing medicine — but that leaves a lot of room for error. We can’t expect them to be encyclopedias.”

Source: https://www.vox.com/2016/5/19/11691622/surgery-second-opinion-research-jama

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Second Opinion Leads to Less Invasive Surgery!!

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Nineteen years ago, I had a laminectomy, a major spine operation that removes a portion of the vertebral bone. I didn’t have any problems until this past year when I started experiencing intense back pain that would radiate down my legs all the way to my ankles. I tried taking over-the-counter pain relievers and tried exercises I learned in physical therapy, but nothing was helping. On top of that, my job is very physical; I’m often standing or walking for long periods of time which would aggravate the pain.

Eventually, I went to see my primary care physician who put me in contact with the same surgeon who performed my laminectomy. He recommended that I undergo another laminectomy and a discectomy, removal of abnormal disc material that presses on a nerve root or the spinal cord.

I wasn’t too excited when I heard this, so I wanted to have a Second Opinion to make sure my diagnosis was accurate and to confirm that surgery was the best way to proceed. Fortunately, my Ohio Laborers Benefits offers Grand Rounds as a benefit to its employees. It was exactly what I was looking for.

I reached out to Grand Rounds for a Second Opinion and was matched with Dr. Eric Elowitz, a top neurological surgeon at Weill Cornell Medicine. Dr. Elowitz reviewed all of my records and wrote up an opinion on my case that answered every question I had. The opinion explained my condition in great detail. And while it did not change my course of care, the expert did recommend moving forward with a less invasive surgery.

“After reviewing Dave’s records, I felt that if surgery was needed, I would favor just a microdiscectomy. The reason for this is that a laminectomy is a more extensive surgery and was not needed in Dave’s case. A microdiscectomy is a common procedure which can be performed in a minimally invasive fashion. The procedure usually takes about 40 minutes, and patients go home within a few hours,” said Dr. Elowitz.

Overall, while the opinion did not dramatically change my course of care, I was able to move forward with a less invasive procedure based on my Expert Opinion. Just knowing that the procedure I was going to move forward with was appropriate gave me peace of mind.

Source: https://grandrounds.com/patient/successes/

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Miracle: Doctors Revive Dead Patient On The Operating Table

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50-year-old woman suffered a cardiac arrest just before the surgery.
When 50-year-old Saraswati Devi from Uttar Pradesh was revived on the operating table, 20 minutes after her heart stopped beating, it was nothing short of a miracle. On August 14, Devi, a resident of Sonebhadra district, was undergoing a bypass surgery at the Fortis Escorts Heart Institute to treat the 90 percent blockage in her heart. She was also a diabetic. However, just before the surgery began, she suffered a cardiac arrest on the table.

“Her heart stopped beating and her blood pressure dropped to zero. If we stopped even for a second, the heart monitor was a straight line,” said Dr. SN Khanna, Associate Director, FEHI, Delhi. The doctors wasted no time, and for the next 20 minutes, kept giving her a cardiac massage to keep pumping blood. They could then have either not gone ahead with the surgery and informed the family, or perform the bypass on a still heart. “We chose the latter. We didn’t have a second to waste. After 20 minutes of external cardiac massage, we prepped for surgery. It then took us another 10 minutes to clean her, intubate her, and open the rib cage to reach the heart,” said Dr Khanna.

Usually, lack of blood supply to the brain for over four four minutes can lead to irreversible damage; in Devi’s case, she went without supply for close to 10 minutes.

“It was difficult for us to say whether she will wake up with brain damage or not. It was only when she regained consciousness that we figured that the surgery was successful,” said Dr Khanna.

Devi was discharged from the hospital on August 24 and the doctors have since been monitoring her recuperation closely.

Source: http://www.dnaindia.com/health/report-docs-revive-50-year-old-bypass-patient-dead-for-30-minutes-2547188

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