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Sunday, October 6, 2019

What is Metastasis Cancer?

Metastasis means cancer has spread to different body parts from where it has originated, often by way of the lymph system or bloodstream. Metastasis is also called as "metastatic cancer," "advanced cancer," or "stage 4 cancer". The main reason why this cancer is serious is its ability to spread in the body. Cancer cells can spread locally by moving into nearby normal tissue and spread regionally by one Metastatic cancer has the same type of cancer cells as primary cancer or by lymph nodes, tissues, or organs.

Metastases can occur in three ways:

They can grow directly into the tissue surrounding the Tumor.
Cells can travel through the bloodstream to distant locations; which can carry them to another part of the body.
The lymphatic system is another way through which cells travel to the lymph system to nearby or distant lymph nodes.

A Tumor that formed from cell and spread is called secondary tumors. Cancer that may have spread to areas near the primary site is called regional metastasis. Or spread to another part of the body is called distant metastasis.

When does metastatic cancer develop?

The term metastatic is used to describe when the solid Tumor has spread to another part of the body. cancers, such as leukemia, lymphoma and multiple myeloma, are considered widespread when they are diagnosed and are not referred to as metastatic cancer. Metastatic cancer develops after several years the primary cancer is first developed. Whether or not cancer spread depends on many factors including:

Thursday, June 13, 2019

IVF Treatment in India

In vitro fertilization (IVF)- A planned parenthood

In-vitro-Fertilization (IVF) infertility treatment is one of the more widely known types of assisted reproductive technology. During this procedure, a doctor takes the eggs from the ovaries using a small needle and fertilizes them with sperm in a specialized lab. The embryo is then transferred to the uterus. This one cycle of IVF takes about two weeks.

In the normal process, an egg and sperm are fertilized inside a woman's body. If the fertilized egg attaches to the lining of the womb and continues to grow, a baby is born about 9 months later. This process is called natural or unassisted conception. Whereas IVF is a form of assisted reproductive technology. Here special medical techniques are used to help a woman become pregnant.

Monday, January 28, 2019

Q&A on ASD and VSD with Dr. Suresh Rao

Dr. Suresh Rao:

Director, Children's Heart Centre and Consultant, Pediatric & Congenital Heart Surgeon, MBBS, MS (Gen.Surg), MCh (CVT Surgery), Dip. NB (CT Surgery), FIACS.

Dr. Suresh Rao heads the Children Heart Centre at Kokilaben Hospital in Mumbai, India. He has more than 25 years of experience in the field of Paediatrics & Congenital Heart Surgery and has performed more than 12,000 surgeries.

Before joining Madras Medical Mission (MMM) at Chennai, Dr. Rao got his training of CVT Surgery from Sree Chitra Institute Trivandrum. Later he worked at New Zealand, Australia, and USA and got trained in Pediatric and Congenital Heart Surgeries.

In India, Dr. Rao has pioneered the practice of Modified Ultrafiltration after Congenital Heart Surgery and is equipped with, Special skills for simple and complex heart defects, cosmetic approaches and valve repairs including Congenital Heart Surgery in neonates, infants, children, and adults.

1. What is Congenital Heart diseases?

Ans - Congenital heart disease is the defect in the heart which is present since the when the heart is being formed in mother's womb.

2. Can we detect Congenital heart defect?

Ans - Yes, We have the technology like "Ultrasound" which can detect the congenital heart defect before birth. The best time to detect is between 16 to 18 weeks of pregnancy.

3. Is it a proper cardiac test?

Ans - Yes. however, the ECHO test has to be performed by a trained pediatric cardiologist. A doctor will counsel the parents about the defect, whether it required the surgery or not and what's the quality of life a child will be having. the parents can be informed about all these before the child is born.

4. Is this procedure only present in India?

Ans- This technology is pretty well established in North America and European countries. In India it is growing, it can be seen in metro cities. Only it has to be performed by the specialist (pediatric cardiologist)

5. What is ASD?

Ans - The atrial septal is the hole in the wall between two upper chambers of atria. About 1 on every 100 babies is born with a congenital heart defect. ASD is the simplest form in Congenital heart defect,. the defect type could be complex or simplest. ASD doesn't cause very much problem after birth. But as the child grows the presence of the hole leads the child to low in the weight, activity wise child is normal.

Left untreated this ASD can be trouble in later part of life, it is recommended to fix this lesion before school going age. Straight forward simple ASD is also called as "Secundum ASD" usually detected accidentally either in school, or when the child has gone for some other problem while checking with a stethoscope if doctor hears a murmur they get the ECHO test done and then ASD in seen.

ASD can be small, large or big in size., Mostly tiny ASD doesn't require treatment, it might close up on its own as the child grows up, we treat moderate to large ASDs.

Complex ASD requires surgeries certainly, but for the simplest form we have surgical treatment now, which is called a "closure of device". For this treatment, we required a certain prerequisite and that should be assisted by a cardiologist before we proceed a device Closure. If you can't close by the device, surgery has to be done which is pretty close to open heart surgery and in today's practice gives 100% success rate. Once the surgery is done the child is a cured for the lifetime. They can live a normal life, can take part in sports, girls can become a mother. There is no side effect of this surgery.

6. What is the ideal age for ASD treatment?

Ans - Generally in ASD, we don't need to treat when the child is very small, unless any indication. if they don't gain weight or a child don't feed well.

Usually, the ideal age is 2 to 5 years of age. and certain before school going age.

7. Is there any weight specification?

Ans - There is no specific weight condition. we treat whenever the indication arises.

8. In Africa, they have a rule they don't treat a child below 10 kg, do we follow such rule?

Ans - We have the specialized unit for children. We are operating new-borns to up forwards. it's an indication in which the surgery has to be done.

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9. How many days should a child has to be admitted in Hospital?

Ans - For ASD's, to do the basic blood test, we admit the child a day before surgery and after surgery, for observation, they have to stay for 5 to 7 days. For non- surgical treatment, they can get discharge within 3-4 days. For girls particularly, we perform the surgeries from the back, so that there is no scar in the front and it is only cosmetic. We assure parents that there is certainly no risk in this approach, so parents of girl child prefer that we perform the surgery from the back.

10. What different technology we used in India on ASD treatment?

Ans - The expert team who does a lot of these procedures. Till date, we have done thousands of such surgeries, in fact, ASD is the first surgery any cardiac surgeon starts with. Cardiologist uses hundreds of devices. In such an extremely critical procedure, an experience of a cardiologist and the surgeons matters a lot.

11- What is the cost comparison as compared to USA or Singapore?

Ans - Well, there is no comparison, we are close to about 10th of their cost with the similar or higher success rate.

12. What is VSD?

Ans - The second common lesion is VSD (Ventricular septal defect) in congenital heart diseases. It is more common than ASD. VSD's are trickier as they have a hole between the pumping chamber of the heart. The amount and the pressure of the blood going to the lung complicates the VSD as compared to the ASD.

If a child is born with VSD, the size of VSD depends on a lot how a child is going to behave. If it's a small VSD, it's good for the child. If its large VSD the child become symptomatic earlier. In a new-born child, some kind of VSD's tends to come down in size in a few months' time. And some of them may be lucky to close on its own. Whenever we see a VSD in the new-born child we don't try to rush in and close the VSD. If it is only a VSD and not with any other problem, we try to give a child a months' time, monitor it closely on how it feeds, how it grows and at the end of one month usually the VSD shows itself, how it is going to behave in future. So generally, the VSD's are close anywhere between two to three months upwards. But certainly, large VSD's have to be close by the 6th month of age because we know that if we leave it for too long the large VSD can cause damage to the lungs.

13. What advice do you give to the parents whose child have similar symptoms and what are the advanced equipment we have so a patient is willing to travel to India?

Ans - If the child is two to three months of age having large VSD, making a child symptomatic like not feeding well and has lost weight, I would prefer that such VSD get close at our center. because they are extremely delicate children and they required a full unit of children's heart surgery specialist for them to recover. Having specialized center in India, two to three-month age child having VSD is not considered a very complex problem. Usually, they get operated and about 8 days' time they can go home.

14. Does VSD have the same success rate?

Ans - Yes, VSD is close to 100% success rate.

15. Is there any non- surgical VSD?

Ans - There are few VSDs which can close non-surgically also. But, this usually happens in older children, VSD's are away from some of the important structure of the heart. They have to be chosen very carefully by the cardiologist depending on the ECHO.

16. Do children with ASD VSD need regular follow-up?

Ans - Yes, For ASD after 4 to 5 years of age they are free from the follow-up. Similarly, with VSD. However, in some VSD cases, the kids need to follow up unto 5-7 years of the age, especially those with large VSD and high lung pressure. They need a follow up to see what is happening to the lung pressure. Even a small percentage can continue to have high lung pressure.

17. For follow up, do they need to travel to India?

Ans - For ASD may be every year they have to come for the follow-up checks or they can get the same done locally and send us an adequate report.

For large VSD they can get the ECHO done locally and send us the ECHO report.

18. What is more complex in the kids' heart?

Ans - After ASD and VSD, there is PDA or Coarctation

Thursday, January 24, 2019

VSD Symptoms every parent should know

A ventricular septal defect is congenital heart disease. Congenital heart defects are problems with the heart's structure that are present at birth. Congenital heart defects also known as hole in a heart. this disease changes the normal blood flow to the heart. Ventricular septal defect commonly known as VSD is a hole between the hearts lower chamber. this defect can occur anywhere in chamber muscle that divides the two sides of the heart. VSD’s are the most common congenital heart defect.

VSD is more common than Atrial Septal Defect (ASD). VSD's are trickier as they have a hole between the pumping chamber of the heart. The amount and the pressure of the blood going to the lung complicates the VSD as compared to the ASD. Our heart has two sides, separated by an inner wall called the septum. ASD and VSD defect allows blood to pass from the left side of the heart to right side. This means the rich oxygen blood can mix with poor oxygen blood. sometimes the oxygen-rich blood is pumped to the lungs instead of the body.

VSD can be small, medium or large. A small VSD may close by their own as small VSD allows a small amount of blood flow between the ventricles. Small VSD's doesn't cause any symptoms.

Medium VSD's are less likely to close by their own, it may require the surgery and may show symptoms.

Large VSD needs surgical repair early in life to prevent complications. Large VSDs often cause symptoms in infants and children. Usually, large VSD's have to be close by the 6th month of age because if kept untreated for a long time it may cause damage to the lungs.

Dr.Suresh Rao says" In a new-born child, some VSD's tends to come down in size in a few months' time. And some of them may be lucky to close on its own. Whenever we see a VSD in the new-born child we don't try to rush in and close the VSD. If it is only a VSD and not with any other problem, we try to give a child a months' time, monitor it closely on how it feeds, how it grows and at the end of one month usually the VSD shows itself, how it is going to behave in future".

Ventricular septal defect Symptoms:

(VSD) symptoms in a baby may include:

1. Pale skin coloration

2. Becomes breathless when eating or crying

3. Is not gaining weight

4. Easy tiring

5. Frequent respiratory infections

6. A child turns bluish especially around the lips and fingernails

A child born with VSD may have a single hole or more than one hole in the wall that separates the two ventricles.

Doctors classify VSD’s based on the:

1. Size of the defect.

2. Location of the defect.

3. A number of defects.

4. Presence or absence of a ventricular septal aneurysm-a thin flap of tissue on the septum.

What are the causes of Ventricular septal defect?

Congenital heart defects arise early when the child's heart if form in the mother's womb. Genetics and environmental factors may play a major role. VSD may occur alone or with other heart issues (congenital heart defects)

Children who have a genetic disorder like Down syndrome often have a congenital heart defect. Smoking during pregnancy also linked to several congenital heart defects.

"There are few VSD's which can close non-surgically also. But this usually happens in older children, and if VSD's are away from some of the important structure of the heart. they have to be chosen very carefully by the cardiologist depending on the ECHO" – says Dr.Suresh Rao a pediatric cardiologist from Kokilaben Dhirubhai Ambani Hospital.

Complications:

1. Small VSD's may never cause any problem. Medium and large VSD can cause some disabilities.

2. Heart failure- A heart with medium or large VSD heart need to pump enough to the body.

3. Endocarditis. This is a heart infection.

4. Pulmonary hypertension- This complication can cause a reversal of blood flow through the hole.

5. Other heart problems.

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Prevention

1. Get early parental care.

2. Eat a balanced diet.

3. Exercise regularly.

4. Avoid alcohol, tobacco and illegal drugs.

5. vaccinations before becoming pregnant.

6. Keep diabetes under control.

How Are Ventricular Septal Defects Diagnosed?

Usually, VSD are found in the first weeks of life by the doctors during a routine check-up. doctor listen to babies’ VSD murmur sound through a stethoscope. The cardiologist will do an examination and take your child's medical history. If the doctor suspects VSD, the cardiologist may order one or more of these tests:

1. A chest x-ray- picture of heart other organs

2. An electrocardiogram (EKG) -This is often the primary tool used to diagnose a VSD.

3. A cardiac catheterization - this provides information about the heart's structures and the blood pressure and blood oxygen levels in its chambers.

Treating Ventricular Septal Defect (VSD)

The doctor will observe children who have ventricular septal defects. Small VSD close before the child goes to school. Generally, the VSD's operates anywhere between two to three months upwards. large VSD's have to be close by the 6th month of age.

The doctor may recommend surgery if your child has VSD:

1. Is large

2. Is causing symptoms

3. Is medium-sized and is causing enlarged heart chambers

4. Affects the aortic valve

How are Ventricular Septal Defects Treated?

VSD treatment depends on a child's age, VSD size, location, and severity. There are few VSD's which can be close by non-surgically also. non-surgical usually happens in older children. If the VSD's are away from some of the important structure of the heart. They have to be chosen very carefully by the cardiologist depending on the ECHO.

Wait and watch approach

If the VSD is small and but causing any symptoms then a doctor may recommend wait and watch approach. Your pediatric cardiologist will carefully monitor your baby's health to make sure your babies condition improves.

Ventricular Septal Defect Surgery

For large VSD doctor will recommend surgery. The surgery is required to repair the damage. Most surgeries to correct a VSD are open-heart surgery. surgery may be needed if:

1. The child fails to gain weight.

2. Medicines are needed to control the symptoms of heart failure

In some VSD cases, the kids need to follow up unto 5-7 years of the age, especially those with large VSD and high lung pressure. They need a follow up to see what is happening to the lung pressure. Even a small percentage can continue to have high lung pressure.

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