Curves, not so appealing….

When 11-year-old Deepthi’s parents found something extra-ordinary in her body shape, they only knew that she was having some problems with her spine. But it is only when they brought her to Coimbatore Ganga Hospital all the way from Visakapattanam, their hometown, they realized that their daughter was suffering from scoliosis, a disease which would have worsened and disfigured her if went unnoticed.

 Deepthi was suffering from scoliosis with a 110 degree curve on her spinal cord. After a surgery performed by a team of orthopaedic surgeons under Dr S Rajasekaran, director of Orthopaedic Department, Ganga Hospital, her spine was made straight and the smile was brought back on her face, thanks to the modern technologies in the field of spinal surgery.

 Scoliosis is an abnormal lateral curvature of the spine that makes the spine look more like an ‘S’ or ‘C’ than a straight one. It is mostly diagnosed during childhood or adolescence. But in some cases, it may be diagnosed during adulthood also.

 The normal spine is curved in the front to back direction with a forward curvature at the neck and the lower back, a backward curvature at the chest and the level of the pelvis. The spine does not have any normal sideways bend. But in the case of scoliosis it will have a sideways bending.

 According to Dr S Rajasekaran, scoliosis can occur due to different reasons. “In a congenital type of scoliosis, abnormalities in formation of spinal vertebrae during the fetal stage cause spinal deformity as the child grow. Uneven growth of the vertebrae causes the spine to bend towards one side,” he said.

 In some other cases, the children will have nerve or muscle diseases that cause spinal deformities, for example polio or cerebral palsy. Here the abnormal curvature is caused by the uneven muscle pull on the spine.

 The deformity is usually noticed due to the cosmetic disfigurement in the child. “Uneven shoulders or waistline, a prominent chest wall on one side, leaning slightly to one side or a hump on one side of the back are the most common findings in a child with scoliosis. Scoliosis, as it creates a disfigurement can create many psychological problems in the child. The child can gradually turn an introvert as he or she faces difficulty in facing the society,” he said.

  Since there won’t be any pain in scoliosis, unless the curvature is so large causing some neurological abnormality, it is again hard to detect scoliosis at its early stage.

  “If the spinal curvature happens in the thorax, called as truncal decompensation, the whole trunk of the person will bend to one side. In sequestrated hemi vertebrae condition, which is one of the worst variety of scoliosis, the multiple hemi vertebrae is formed and it grows into the spinal canal and hits spinal cord leading to nerve weakness. In the case where the curvature occurs in the chest region, the volume of the region would reduce and expansion of lungs would become difficult. The person will ultimately become unable to breath. Since it can lead to secondary cardio respiratory failure, the surgery also becomes complicated,” he noted.

 The children with tuberculosis are more prone to scoliosis since the disease can melt the vertebrae and cause a curve, generally coming under developmental scoliosis. “Children with spinal tuberculosis can never be completely discharged even after cure of the disease. He or she should be kept under observance until their growth period is over,” Rajasekaran explained on spinal tuberculosis.

  The scoliosis can have progressively worsening curves which is to be diagnosed and treated as early as possible. The diagnosis is very easily confirmed by just clinical examination but investigations are necessary to evaluate the severity of the curve and decide on the best treatment. On the assessment, the doctor will decide whether to treat it with bracing or surgery depending on age, severity of curve and degree of breathing difficulties.

 Mild to moderate curves, between 20 degree and 45 degree which do not appear to be progressing very quickly can be treated using a brace. A brace will be developed depending on a particular curve. The patient will need to wear the brace almost all the time until the end of growth. This will be followed by specific exercises and will require close monitoring by a surgeon.

 On the other hand, surgery becomes important in children with large curves rapidly progressing curves or when bracing fails to prevent curve progression.

 It is easy to bend a plant than to bend a tree. This is what Dr Rajasekaran tells about the difference in spinal surgery between a child and an adult. In children, the spine will be more flexible. So if operated earlier in childhood itself, the success rate of surgery will be more.

 But people are often not ready to undergo spinal surgery, especially during the younger age. There is a huge fear among the public for spine surgeries. So they try to overcome the crises for time being doing some exercises or waiting for the child to grow old. But this worsens the condition.

 Awareness should be created among the public about the modern technologies and increase in the success rate of spine surgeries these days. Not only the public, but also many general physicians are unaware of the condition. Many have postponed the surgery till it become acute only because their family doctors asked them to wait.

 Now, the spine surgery can be aided by computer navigation technology. Usually for the surgery in scoliosis, the deformed vertebra is removed and screws are fitted in to the spine to correct the gaps between other vertebrae. The risk lies here. When the screw is implanted, if it goes 20 degree out, it will pierce aorta, the largest trunk artery, and if gone 20 degree in, it will hit spinal cord. This may lead to a completely paralyzed stage or even death.

 The use of computer navigated technology comes to help at this point. Through this technology, a three dimensional picture will appear on the screen when the surgery is carried on. This system is scientifically proven to improve accuracy rates of screw placement and allows placement of screws in challenging situations in scoliosis.

 Ganga Hospital is the first of its country to use computer navigation technology in spine surgery. “We have been regularly using computer navigation in various spine surgeries and have particularly found it to be extremely useful in deformity surgeries,” Dr Rajasekharan remarked.

 Scoliosis can’t be prevented, but can be diagnosed and cured. The dressing patterns often prevent the disease to be detected at an early stage. But people should come forward once the deformity is seen rather than waiting for the condition to get acute. Early the best must be the attitude among the people towards treating scoliosis, he pleaded. 

 

  Published in Expresso, The New Indian Express, on 10.12.2008

 

 

 

Heart-y facts on daughters’ day

“Our sons may have brain, but it’s our daughters who have heart,” giggles Dr G Bakthavathsalam, chairman and managing trustee of KG Hospital & Post Graduate Medical Institute, Coimbatore, commenting on World Heart Day and Daughters’ Day falling on the same day, September 28 this year.
Which of the organs in your body is the most important one, the brain or the heart? If you think it’s brain, then you are wrong, he says.
And with 45 years of experience in the field of cardiac care, Bakthavathsalam knows how important it is to have a healthy heart.
“All the people whom you come across in your day-to-day life need not have a working brain. But definitely they will be having a beating heart,” he reasons out.
“Heart is not simply a pumping machine or an anatomy that needs a detailed study,” he elaborates on the need to possess a strong heart and how it hurts to have a weak heart.
If you lose one eye, thank god, there is another one. It is the same with the ears, kidney and even limbs. A physically-challenged, with two of his legs gone, can win an Olympic marathon. You can be alive with your brain dead. “But if your heart stops, even for a second, you are no more,” he sighs.
Heart should always be at its full energy for it to function healthy. It should be used to its full. Our heart is always alert with each of its lub-dub rhythm, closing and opening the heart valves, 72 times a minute. The very situations, which may destroy the rhythm of that beat, may be different for everyone.
“The heart can lose its rhythm any moment. A lottery ticket can make it happen, or the demise of someone close to your heart. To overcome such situations, you should have a bold heart,” he said.
Now, the question is how to have a bold heart. It’s quite easy to have a bold heart than to have a weak heart. Exercise is the best mantra. When it comes to heart, it is called cardio-vascular exercise.
“A simple walk through the Race Course cannot be called an exercise. An exercise by definition should increase your metabolic rate, which in turn will warm up your body making you sweat. An ideal exercise should increase your heart rate,” he explained.
To increase the heart rate to a target set is the most important thing in cardio-vascular exercise. It is not that a human heart should beat 72 times per minute. It is the condition when a person is resting. There is a simple formula to determine the rate of heart rate that a person should attain through exercise. It is ‘220 minus your age’, i.e. if you are 25, then your heart rate should be 195 and not merely 72.
There are many different ways to increase your heart rate. It can be walking, jumping, running, swimming… But it should be done consistently for about three quarter of an hour and at least three days a week.
“If you have done with it, be sure, you also own a bold heart,” he assured.
“It’s not necessary that you should ask your doctor’s permission to have a walk or a ride as a part of exercise. But when it comes to some special ways of exercising, that you are not used to, like trekking, skating etc, that too after the age of 35, you must seek the permission of your doctor. This is to make sure that your heart is capable of bearing what you are doing,” he suggested.
The doctor can check the functioning of your heart with an Electrocardiogarm (ECG) and echocardiography. Making you walk on a treadmill with electrodes connected from your heart to the computer, the doctor will determine the capacity of your heart.
“Don’t let your heart go out of energy. Exercise is the primary necessity, next comes the diet,” he says explaining the importance of diet in heart care.
During exercise, the energy is released. For energy to release, it should be first deposited inside us. So optimal intake of food is required for a perfect heart.
“Even though the heart rate is increased to the target needed, it may at times come across some speed-breakers. They affect the healthy functioning of heart. It can happen with both men and women, though the risk factors may be different,” he began with the risk factors.
For men, it is smoking that proves to be the prime threat. Some recent studies in Japan have proved that if the smoking score is more than 400 for a person, then he is most vulnerable to heart disease. If a person smokes 10 cigarettes a day for 40 days, then his score is 400, he detailed.
Junk food is also another risk factor. All the food that tastes good may not be good for heart. The oil content, butter or ghee and the spices that add to taste can ‘attack’ your heart. A man is more vulnerable for a heart disease if he smokes, is having high blood pressure or diabetes and if he is above the normal body weight. The optimal weight for a man is 80-85 kg, he be 5 ft or 6. The increase in weight can also cause osteoarthritis. The circumference of the belly should not increase more than 36 that it shows accumulation of fats.
“When it comes to women, the risk of heart diseases starts after the menopause. Till then, they are protected from heart attacks by a hormone called estrogens produced in them during menstruation. But 15 percent of men and also the same rate of women after menopause are under the risk of heart attack. The women should not gain weight more than 60 kg and increase belly circumference more than 32,” he said.
Now even teens suffer from heart ailments. Stress and strain would explain this new trend. Meditation, Yoga and breathing exercises can slow down the hyper activeness of brain. Anger is a temporary madness that should always be kept under control.
To create awareness is the only way to bring down the risk. As this World Heart Day talks, ‘Know your risk’. Catch them young, so that the awareness is created from kinder gardens. “Let the ones who have to build up tomorrow’s nation behold a bold heart,” he said.