by Dr. Iain Corness
Saturday, January 20, 2018 - January 26, 2018
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
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).
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.
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?
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.
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
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
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
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
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.
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
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
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
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!