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Update January 2018

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Update by Natrakorn Paewsoongnern

Doctor's Consultation  by Dr. Iain Corness


Saturday, January 20, 2018 - January 26, 2018

Angioplasty – will you need one?

What is angioplasty? Coronary balloon angioplasty is an invasive method of opening blocked arteries that might stop blood flow to the heart, resulting in heart attack or death.

The medical name is percutaneous transluminal coronary angioplasty (PTCA): percutaneous means “through the skin,” transluminal means “inside the blood vessel,” coronary means “relating to the heart,” and angioplasty means “blood vessel repair.” Other techniques to relieve coronary narrowing, such as stents, are called percutaneous coronary interventions (PCI).

Angioplasty involves inserting and inflating a tiny balloon, which compresses some of the blocking plaque against the arterial wall. When the balloon is deflated and removed, the blockage (plaque) still remains compressed, clearing space in the artery and improving blood flow. More than 90 percent of all procedures are immediately successful.

Since angioplasty is a less invasive procedure than bypass surgery, it has less risk and a quicker recovery period than bypass. Candidates for angioplasty are chosen based on age, physical history, and severity of the blockage or damage.

Angioplasty was first performed in 1977, and more than 1 million procedures are done worldwide each year. Studies suggest that angioplasty patients are doing better today because doctors are better able to target blockages, and because patients are getting better medical treatment through new techniques and drug therapies. The success is due in part to the increased use of tiny wire mesh tubes called stents, which more cardiologists began using in the 1990s to help keep arteries open following angioplasty. About 70 to 90 percent of all angioplasty patients receive a stent, which is inserted permanently at the site of the blockage.

Studies show stents are better than angioplasty alone in preventing restenosis, which is one of the most common problems associated with angioplasty.

Although restenosis is not uncommon, it does not affect every patient, and the prognosis for many angioplasty patients is excellent. Studies have shown nearly identical survival rates for bypass and angioplasty patients over five years following the original procedure.

Your blocked arteries will be widened. First, a special dye is injected into the bloodstream. Then a thin catheter with a guideline is fed into your body through the femoral artery in your leg, near the groin, or an artery in your arm. Using X-rays that detect the flow of dye, the doctor feeds the catheter up to the heart, and into the blocked part of the coronary artery. The doctor then replaces the guide catheter with a balloon-tipped catheter. The balloon is inflated, and the plaque is compressed against the arterial wall.

When a stent is used, it is placed over a catheter and inserted after the artery has been cleared using balloon angioplasty. When the balloon is inflated, the stent expands and stays permanently in the artery.

The general consensus among patients is that angioplasty is a sometimes uncomfortable, but not painful, procedure. You may feel some twinges in your chest when the balloon is inflated, but once the blockage is compressed, the pain should disappear. You also may feel nauseous, feel your heart skip a beat, or have a headache during the procedure; these are all normal, brief side effects.

Let your doctor know whatever symptoms you are feeling during the procedure. You will have an IV line throughout the procedure, and can be given medicine as needed for pain or discomfort. You also may be given additional sedatives during the procedure so that you are able to remain motionless, but awake.

Following this procedure, you will need to see your doctor for an evaluation and possible stress test to measure how effectively the blockage was eliminated. You will be encouraged to exercise regularly and your doctor will want to see you several times a year to make sure no more blockages have occurred.

While some of the causes (age, gender, family history) of coronary artery disease are out of your control, there are lifestyle choices that often contribute to blockages. Some of these are obesity, smoking and physical inactivity. While these factors can contribute to your condition, they can be modified. Receiving appropriate treatment for other cardiovascular risk factors such as high blood pressure, diabetes, and high cholesterol can also reduce the likelihood of developing severe coronary blockages.

Saturday, January 13, 2018 - January 19, 2018

Will you develop Diabetes this year?

Amazingly, you survived Xmas and New Year. Well done, despite the excess parties, pies and pints. The waistline has swelled, anti-flatulents have been purchased, following which, New Year’s resolutions have been made regarding weight loss. But are there good reasons for the resolutions? Unfortunately the answer is a very resounding ‘yes’! Just take the word “Diabetes” on board.

Diabetes is a nasty condition that affects just so many organs and makes you more likely to develop everything from cataracts to a cardiac arrest. Diabetes UK warns that excessive food and drink consumption over the festive period will increase your risk of developing Type 2 diabetes.

Over-indulgence in too many calorific treats such as mince pies (around 200 calories each), Christmas cake (approximately 250 calories per slice) and mulled wine (about 250 calories in a glass) can leave us all struggling to buckle our belts in the New Year. Having a large waist has been shown to mean that you are up to eleven times more likely to develop Type 2 diabetes and being overweight or obese is one of the strongest risk factors for developing Type 2 diabetes. And it’s too late to start sucking in your stomach as you read this article!

‘At risk’ waist measurements are 80 cm or more for women, 94 cm or more for men and 90 cm or more for South Asian males. As well as having a large waist, people are more likely to develop Type 2 diabetes if they are overweight, over the age of 40, of South Asian origin, or have a family history of Type 2 diabetes. If you have two or more of these risk factors you really should have a fasting blood sugar test.

Research found most people perceive themselves to be slimmer than they really are. When 500 people were asked to estimate their waist size, most under-estimated by an average of 6.7 cm. Men were the most deluded and underestimated their waist size by a significant 7.9 cm, whilst the estimates of South Asian women were generally the most accurate. “Do I look fat in this g-string?”

Diabetes can lead to heart disease, stroke, kidney failure, blindness and limb amputation. There are 2.5 million people diagnosed with diabetes in the UK but shockingly more than half a million people have this Type 2 diabetes but do not know it. A potentially fatal condition and the people do not know!

To reduce your risk of Type 2 diabetes, Diabetes UK, which keeps some very comprehensive statistics, recommends you should eat a healthy balanced diet, maintain a healthy weight and be physically active. Even a moderate degree of physical activity can reduce your risk of developing Type 2 diabetes by up to 64 percent. Similarly, if you reduce your weight by between 5-10 percent you reduce your risk of developing Type 2 diabetes by 58 percent.

Diabetes UK Chief Executive Douglas Smallwood said, “The Type 2 diabetes epidemic is one of the biggest health challenges facing the UK today. Watching our waistlines at this time of year is vital as we all need to do our best to reduce our chances of developing this often preventable condition. It is important to remember that around 80 percent of people with Type 2 diabetes are overweight at diagnosis.” Coincidence? I don’t think so.

“There are around half a million people in the UK unaware they have Type 2 diabetes. The condition can be undiagnosed for up to 12 years and 50 percent of people who have it show signs of complications at diagnosis. The sooner Type 2 diabetes is diagnosed and becomes well managed, the better your long-term health is protected and the lower your risk of developing devastating complications.”

Now while that is a quotation from the UK Diabetes group, the recommendations are just the same for all of us, even though we are a numerically smaller group, and the overall percentage of overweight people is less.

However, that percentage always increases after the Xmas-New Year blowout, so my first message for 2018 is to step on the scales, put the tape measure around the waist, and do something about it – before it is too late!

Update Saturday, Jan. 6 - Jan. 12, 2018

Transportation for replantation

Accountants need ten fingers, so a nine fingered one is pretty dodgy. However, every day there are people lopping off one of their ten. There are about 10,000 cases of job-related amputations in the United States each year; 94 percent of these involve fingers. Few statistics are available for the outcome of replantations, but with modern surgery the success rate is increasing.

I did come across a report on a series of 208 digital replantations from the frigid zone within the People’s Republic of China. The extremely cold climate (down to 30 degrees below) presents the additional problem of warming the amputated digits prior to replantation. An overall replantation survival rate of 94 percent was reported, and this included 45 cases of multiple digit amputation. Clever people, these Chinese, but you never know, were they ‘copy’ fingers.

Now, to successfully sew the finger(s) back on needs the patient to appear fairly smartly at the hospital, and to also bring the missing digit. Despite some claims to the contrary, we are not yet at the stage of being able to grow new fingers for you.

I was reminded of this recently when an injured person arrived at ER with his nine good fingers, but without the 10th one that had been lopped off. The wound was clean and so the hand surgeon sent the patient’s friends off to find the missing finger, as there was a good chance of successful replantation. They appeared later with a bag of chicken giblets straight from the refrigerator, proclaiming the missing digit was inside. When the surgeon looked, the bag of chicken pieces, which still had the name of the supermarket on it, had not been opened! There was certainly no finger inside with the giblets, and all that could be done was to trim up the traumatic amputation, and hope that the patient was not an accountant.

So, if the chap’s friends had located the missing finger, how should you transport missing body parts? (People get more than fingers lopped off. Ask the ducks.) To save the tissue from further damage, keep the amputated bit wrapped in cling film, preferably in a jar or cup with a lid. Do not put it directly in water as this will cause it to shrivel up and become unusable for the surgeon trying to reattach the finger. Put the container with the finger or whatever inside another large bag with cold water, to keep the amputated part cold. Some authorities say ice water, others say just cold water, and I tend to go along with the ‘cold’ concept.

Be sure to gather up all parts of a severed digit, no matter how small. The body cannot grow a new nail bed, the tissue directly under the nail, so being able to use the original tissue makes a big difference to whether a full reconstruction can take place.

Generally, the tissues will survive for about six hours without cooling, and if the part is cooled, tissue survival time is approximately 12 hours. Fingers, by the way (and not chicken giblets) have the best outcome for transportation survival, since fingers do not have a large percentage of muscle tissue.

The micro-surgery required to successfully replant fingers (and the other bits that were lopped off and offered to the ducks) is very exacting, as nerves, arteries and veins all have to be reconnected. Very often the surgeon has to shorten the finger, so that there is no tension on the sewn up structures. All this takes an enormous amount of time and patience. With one celebrated case in the UK, a woman lost six fingers and it took a team of surgeons working in relays to reattach all six fingers during 17 hours of microsurgery. It is said to be the first time so many fingers have been replanted in one operation.

Many other factors are involved in whether there is a successful outcome. Generally, severe crushing or avulsion (tearing away) injuries to the fingers make replantation difficult. Additionally, older persons may have arteriosclerosis impairing circulation, especially in small vessels.

But if you are unfortunate to cut off a finger, remember to bring it with you, not the chicken giblets!

HEADLINES [click on headline to view story]

Angioplasty – will you need one?

Will you develop Diabetes this year?

Transportation for replantation



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