Refractive Surgery And Lasik Treatment In Mumbai

 

What is LASIK?

LASIK or ‘Laser-Assisted In Situ Keratomileusis’ is one of the most trusted laser eye surgeries for the treatment lasikasaof Myopia (near-sightedness), Hyperopia (far-sightedness), and Astigmatism (blurred vision). This laser vision correction technique is performed on the cornea so that light entering the eye can be focused on the retina for clearer vision. LASIK will completely eliminate your dependence on spectacles or contact lenses in a short 15 minute surgery.

What Is Custom Lasik?

Custom LASIK is a procedure that involves the use of a wavefront analyzer which helps the surgeon to customize the LASIK procedure to every individual eye. Customized procedure enables a person to see clearer and shaper than before and thus improves the quality of vision.

Custom LASIK uses an equipment called the wavefront analyzer (aberrometer) to accurately measure the way light travels through the eye.The resulting map of the eye is then programmed into the laser, which then treats the eye, based on the personalized 3Dmap. Custom LASIK helps to treat “higher order” aberrations,which are tiny imperfections in the optical system of the eye. They have a significant impact on the quality of vision especially at night . In fact, higher order aberrations are not treatable with contact lenses, glasses or conventional LASIK.

Is Custom Lasik Procedure Same As Conventional Lasik ?

The procedure for both custom LASIK and Conventional is the same but the pre assessment tests differ greatly. The wavefront analyer used with custom LASIK brings a whole new level of knowledge and accuracy for the surgeon to perform this advanced procedure. This treatment has a significant impact on quality of vision and eliminates the problem of glare and halos at night. Topography, Aberrometry and Pachymetry are pre-operative tests required.

Opti Lasik

Opti Lasik combines today’s advanced surgical technologies into a procedure optimized for individual vision needs with minimum tissue ablation.

• Many measurements are taken to determine the unique shape of the eye
• The Laser reshapes the cornea using energy pulses based on the individual unique correction profile
• This allows incoming light to be precisely focused on the retina.

Advantages

• Smooth treatments
• High level of comfort
• Excellent accuracy
• Proven safety

EPI-LASIK

Epi-LASIK is a newer laser eye surgery procedure that was developed to solve some of the potential problems with LASIK and LASEK. It’s somewhat of a cross between the two, but differs in a few key areas. With advent of Intralase Bladfree technique Epi-lasik is now obsolete.

Presbyopic Lasik

Presbyopia-test1PreLEX treatment (Presbyopic Refractive Lens Exchange) is a lens replacement procedure wherein the natural lens is replaced with a multi-focal intra-ocular lens implant. This is done to improve vision for those generally above the age of 40, as it is after this age that one’s eye sight begins to naturally become weak—causing blurred near vision while reading or working at the computer, or blurred far vision when looking at something from a distance.

ICL (implantable collamer lenses)

ICL are an alternative to LASIK and PRK eye surgery for severe myopia (nearsightedness)or high hypermetropia ( far sightedness) or in cases with very thin cornea where LASIK is contraindicated, and in some cases produce better and more predictable vision outcomes than laser refractive surgery. ICLs are clear implantable lenses that are surgically placed either between the the iris and natural lens without removing the natural lens. ICLs enable light to focus properly on the retina for clearer vision without corrective eyewear. Surgery is minimally invasive day care procedure which is very safe.

ICL Vs Contact lenses

Implantable lenses function like contact lenses to correct the eye power. The difference is that ICLs work from within your eye instead of sitting on the surface of your eye. ICLs offer a permanent correction , where as contact lenses are temporary and need daily wear and removal. Unlike contact lenses, you can’t feel a phakic intraocular lens in your eye (much like you don’t feel a dental filling for a cavity) and, apart from regular eye exams, ICLs typically do not require any maintenance.

ICLs vs. LASIK Eye Surgery

• LASIK, which uses a computer-controlled laser to reshape the cornea, is the most popular refractive surgery to correct myopia, hyperopia and astigmatism, in part due to continual technological advancements such as wavefront custom LASIK and femtosecond laser technology.
• Not everyone is a candidate for LASIK, though. Contraindications to LASIK surgery include: a very high degree of myopia having a cornea that is too thin or irregular in shape; eye conditions such as keratoconus; and chronic dry eyes. In these cases surgery gives excellent results.
• ICL is an additive procedure whereas LASIK is an subtractive procedure.

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Cataract Surgery in Mumbai | Cataract Treatment in Mumbai - Ojas Eye Hospital

 The opacification of the normal transparent lens is called cataract. The Latin word ‘cataracta’ means ‘waterfall’. Imagine trying to peer through a sheet of falling water or through a frosted or fogged-up window. Development of Cataract varies from person to person but as a general rule, most cataracts develop slowly over a period of time. A cataract can take months or even years to reach a point where it adversely affects vision.

Causes of cataract

Age-related cataract

The cataract occurs as a result of the natural aging process of lens fibres which become opaque over a period of time.

Traumatic cataract

• Due to a direct penetrating injury.
• Concussion- Electric shock and lightning.
• Ionizing radiation done as treatment for ocular tumors.
• Surgical trauma

Metabolic cataract: Defect in body metabolism

• Diabetes
• Galactosaemia -inborn error of metabolism
• Calcium disorders

Steroid-induced cataract

This occurs as a result of excess intake of oral steroid or putting steroid drops in the eye.

Secondary cataract

Here, cataract develops as a result of some other primary ocular disease such as chronic eye inflammation or glaucoma.

History of Cataract treatment

The earliest surgery treatment was started in India, by Maharshi Sushruta. It was known as ‘couching’, where the cataractous lens was dislocated backward into the bottom of the eye and out of visual axis.

This procedure was performed for more than two thousand years until the mid-eighteenth century. Great progress in cataract surgery has been made in recent years with the introduction of micro-surgical instruments, microscope and modern surgical techniques like phacoemulsification, which has made couching obsolete.

In the early stages of cataract development, all that is needed to correct your vision with glasses is a change in prescription. As the cataract develops and begins to affect your lifestyle, it needs to be removed. Cataract surgery, the most commonly performed operation, is safe and effective in 95% patients with enhancement in vision.

Methods of evaluation of cataracts:

Visual acuity: Checking vision of both eyes unaided and aided with glasses and pin-hole vision to know the improvement as well as to get the general idea about the macular function of the eyes. This will help in prognostic evaluation of visual recovery after cataract surgery.

Intra ocular pressure: If intra-ocular pressure increases as a secondary to cataract surgery is needed to prevent further complications.

Slit-lamp examination: To know the type of cataract along with its opacity, morphology and etiology or any associated ocular pathology.

Direct and indirect ophthalmoscopy: for complete retinal evaluation. Dense cataract will prevent retinal evaluation and such cases need B-scan for retinal evaluation.

A-scan biometry: To calculate the AL and IOL power for implantation in cases of mature cataract the posterior segment of the eye is evaluated.

Optical biometry: this is an advanced non contact method to measure IOL power. It is patient friendly and highly precise

Treatment Options Available For Cataract

Extra Capsular Cataract Extraction (ECCE): is a conventional technique.

• ECCE requires an incision of 10-12mm
• The doctor removes the clouded lens in one piece.
• Multiple stitches are required.
• Doctor implants a non-foldable lens.

Phacoemulsification – A Micro Incision Cataract Surgery

Phacoemulsification is latest technology in Cataract surgery. It is a micro-incisional stitch less operation where cataract is emulsified by ultra sound energy, liquefied & sucked through the phacoemulsifier probe. A foldable intra- ocular lens is then implanted in the eye permanently.

Vision restoration is possible in a short period of time & is least traumatic with early rehabilitation & recuperation.

Advantages

• It is Stitchless. Hence healing is very fast.
• It is done under Topical anaesthesia (by putting drops.) So no need to patch the eye except in special circumstances
• Vision correction for far & near is possible
• Patient can get back to work in the shortest possible time

Lens implants

During cataract surgery, the natural lens of the eye that has turned opaque is removed, resulting in loss of focusing power of the eye. This situation would be parallel to clicking a photograph without a camera lens–the picture would be extremely blurred. When the natural lens of the eye is removed an artificial implant is placed in the eye.

Intraocular Lens

An intraocular lens (IOL) implant is a synthetic, artificial lens placed inside the eye that replaces the natural lens which is surgically removed usually as a part of cataract surgery.

Monofocal intraocular lens can be used to give clear point focus either at a distance or close up, but one can choose only one focal point.

Multifocal IOLs are popular as they allow correction of vision for both far & near distance.

Trifocal IOLs provides excellent vision not only for near and far, but also for intermediate distances, especially for people who have routine usage of computers.

Apodized Diffractive Multifocal IOL

Gradual diffractive steps on the IOL implant that create a smooth transition between focal points. The IOL bends incoming light to the multiple focal points to increase vision in differing light situations.

Accomodative IOL

Crystalens and Trulign Toric currently are the only US-FDA -approved intraocular lenses (IOLs) that use a method called accommodation, enabling sharper vision at multiple distances for people who have undergone cataract surgery.

An accommodating IOL shifts position with the action of eye muscles and movement to improve eyesight.

Toric IOL for astigmatism

This is a monofocal IOL with astigmatism correction built into the lens.

• Astigmatism: This eye condition distorts or blurs the ability to see both near and distant objects. With astigmatism the cornea (the clear front window of the eye) is not round and smooth (like a basketball), but instead is curved like a football. People with significant degrees of astigmatism are usually most satisfied with toric IOLs.
• People who want to reduce (or possibly eliminate) the need for eyeglasses may opt for an additional treatment called limbal relaxing incisions, which may be done at the same time as cataract surgery or separately. These small incisions allow the cornea’s shape to be rounder or more symmetrical.

Protective IOL filters

IOLs include filters to protect the eye’s retina from exposure to UV and other potentially damaging light radiation. The eye doctor selects the filters that will provide appropriate protection for the patient’s specific needs.

Other important cataract lens replacement considerations

• In some cases, after healing completely from the cataract lens surgery, some people may need further correction to achieve the best vision possible. Their ophthalmologist may recommend additional surgery to exchange an IOL for another type, implant an additional IOL, or make limbal relaxing incisions in the cornea. Other laser refractive surgery may be recommended in some cases.
• People who have had refractive surgery such as LASIK need to be carefully evaluated before getting IOLs because the ability to calculate the correct IOL prescription may be affected by the previous refractive surgery.

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Struggling With Pain After Breast Cancer Surgery? Learn More About Post Mastectomy Pain

 Breast Cancer Surgery

Breast cancer is a common cancer among women worldwide. A variety of problems can occur during treatment, and persisting pain after surgery is one such issue. It can affect 20% to 50% of women after mastectomy (operation involving removal of breast) and is defined as pain in the chest, armpit, upper arm, and shoulder persisting for more than 3 months post-surgery. Treating this pain is important as persisting pain besides causing suffering, can negatively impact on mood, sleep, activities of daily living, social interactions, and overall quality of life. Reduced working ability and financial implications are obvious consequences as shown in one study where 54% of individuals reported reducing their workload to part-time as a direct result of pain. As the survivorship is increasing, enabled by the technological advancements in medicine, the focus needs to be equally on quality of life and reducing suffering. Phantom breast sensation (where one feels that the removed breast is still present) has an even higher incidence (60-80% of patients). The actual problem and pain may be underreported due to reasons such as worries about cancer reoccurrence, barriers in discussing personal issues, fear of being misconstrued etc.

Another subgroup of patients undergoing mastectomy are those who want to reduce their risk of developing breast cancer such as those with gene mutations (e.g., BRCA1, BRCA2) and a strong family history. Advances in surgical treatment like breast-conserving approaches have enabled patients to realistically consider this option.

Who are at risk of developing persisting pain ?

Some factors associated with increased risk of persisting pain include:

Type of surgery: Nerve preservation approaches are associated with reduced incidence of sensory deficits (53 % vs. 84 %) but may not be possible in all cases.

Different breast cancer surgery options include

• Radical mastectomy – involves removing the breast, skin, fat, chest muscles (pectoralis major and minor), and all the lymph nodes of the affected side.
• Modified radical mastectomy spares the chest (pectoral) muscles when compared to the surgery mentioned previously.
• Lumpectomy with axillary node dissection involves removal of the tumour with surrounding margin of normal tissue and the axillary (armpit) lymph nodes.
• Breast-conserving surgery (lumpectomy) also known as breast preservation, conservative breast surgery, wide local excision, partial mastectomy is generally used in early breast cancer  and involves removal of the tumour and a margin of normal tissue.
• Lumpectomy with sentinel lymph node biopsy involves removal and examination of the first axillary node (sentinel node) receiving drainage from the breast. The node is identified by injection of a special dye/ radiolabeled substance prior to the operation. If this node is free of disease, axillary dissection is not required.

Axillary nodes dissection leads to increased chances of lymphedema (arm swelling due to inadequate drainage) and poses risks to one of the nerves (intercostobrachial nerve) which is responsible for the sensation of the inner aspect of the upper arm. Both of these factors can become a source of persisting pain. The wide variation in the size, location, and branching patterns of the nerve make it more vulnerable to injury. Damage may occur as a result of stretching during surgery or direct nerve injury, presenting with numbness and pain in the area supplied by the nerve. As per one study women with axillary node dissection are 3.1 times more likely to experience moderate-to-severe pain at rest.

Other nerves in the area are also at risk of injury and can become a source of persisting pain. These include 

• Medial cutaneous nerve of the arm (provides sensation to the lower medial skin of the upper arm (damaged during section of the tributaries of the axillary vein)
• Medial and lateral pectoral nerves (control the chest wall or pectoral muscles)
• Long thoracic nerve (controls the serratus anterior muscle present along the side of chest wall close to armpit)
• Thoracodorsal nerve (controls the latissimus dorsi muscle)

Other treatments like radiation therapy administered in conjunction with surgery increase risk of persisting pain. This may be due to increased tissue fibrosis, neural entrapment, and impaired shoulder movement. Moreover, radiotherapy also increases risk for lymphedema which is another reason for persisting pain. Later-stage disease also is likely to require more aggressive treatment (i.e., chemotherapy) and may be associated with higher rates of pain. Regardless these are necessary treatments and when indicated should be pursued. 

Pre-existing pain prior to surgery is one of the most consistent factors related to increased risk of persisting pain after surgery. Even those patients with unrelated pain conditions such as headaches or low back pain are more likely to develop chronic pain after surgery. 

Severe pain after the operation requiring high doses of painkillers increases the likelihood of persisting pain.

Age: In several studies, younger age was seen to be associated with greater likelihood of persistent pain. Although the exact reason is not known, some postulated factors include presence of more aggressive cancers requiring more aggressive treatment, higher preoperative anxiety, and the need for adjuvant chemotherapy in this group.

Psychosocial distress can be both a risk factor for and a consequence of chronic pain. Preoperative anxiety has been found to be related with immediate postoperative pain levels. Numerous studies have found correlations between persisting pain after surgery and depression, stress, and psychological vulnerability. 

What are the symptoms of postmastectomy pain syndrome?

Postmastectomy pain syndrome may cause persistent or intermittent burning, shooting, stabbing, pulling, tightness, heaviness sensation or aching pain in

• Chest
• Axilla (armpit)
• Arm
• Shoulder

Other symptoms in addition to pain may include

• Numbness
• Tingling or prickling pain 
• Increased sensitivity in the area
• Spasms
• Severe itching 
• Phantom breast sensation & pain

What are the causes and different types of pains found after breast surgery?

Pain may persist after surgery due to numerous reasons such as surgical injury- nerve or muscle damage, nerve entrapment, lymphedema, mechanical causes, radiotherapy and chemotherapy, post-surgical scarring, recurrence of tumour, etc. Nerve injury pain has been further divided into the following types

Phantom Breast Pain

Phantom pain is seen after amputations where the absent body part (phantom) hurts. The patient may experience sensation as if the removed breast is still present and is painful. Often patients are confused and reluctant in sharing this with others as they feel unsure if this is actually real and possible, but phantom pain is real and not just in one’s head. Controlling this can be challenging and requires a multi-modality (using many treatment options in combination) approach.

Nerve Injury & Neuroma pain

Nerve injuries can lead to the formation of neuromas which in simple language can be explained as swelling at the end of the injured nerve. These neuromas can generate spontaneous or provoked tingling, electric shock like sensation with increased sensitivity in the area. Neuroma pain may be more common following lumpectomy than mastectomy. I have come across a few cases where the patient experienced pain as if she was having a heart attack requiring multiple visits to hospital emergency whilst the actual problem was injured pectoral nerves and the pain responded to nerve blocks. 

Post-Mastectomy Pain Syndrome (PMPS)

These patients present with persisting pain and sensory abnormalities following surgery. It is more common after operations involving the upper outer portion of the breast or the underarm area. Pain may be felt in axilla, inner side of upper arm, chest wall, shoulder or the surgical scar. Intercostobrachial nerve damage which can occur with axillary node dissection is considered as a common cause. 

Mastectomy patients are also at increased risk for pain in the shoulder and/or scapulothoracic area (upper back and back of shoulder area). In one study approximately 27% of patients reported such problems even after 6 months of surgery and the possible causes can include 

• Axillary web syndrome
• Adhesive capsulitis
• Myofascial dysfunction
• Brachial plexopathy 
• Rotator cuff injury

Reduced movements and guarding can lead to further decline in function, reduced lymphatic drainage and increase in pain.

What is the prognosis of post breast cancer surgery pain and what are the treatment options?

There is paucity of good quality evidence regarding the long-term outcomes in post mastectomy pain with some studies suggesting reduction in chronic pain /sensation abnormalities whereas others reporting long term persisting pain in a significant proportion of patients. Persisting pain after surgery can be multifactorial and hence besides pain management, addressing psychosocial and functional disruption, using a multimodal approach, is equally important. Some of the options used in the treatment include

Medications: These may include different classes of medications such as special types of painkillers used for nerve pain called anti neuropathic medications. These include the anticonvulsants and antidepressants which are well known painkillers.

Before starting painkillers, an assessment to identify the likely pain generators is carried out and the therapy is tailored accordingly. Sometimes even the side effects of medications are utilised to our advantage like the sedative side effect to improve sleep. There are numerous other painkillers which can be utilised like opioids, anti-inflammatory agents, topical agents (e.g. capsaicin), numbing patches, painkiller patches, oral tablets, pain relieving nasal sprays and lollipops etc. 

Physical therapy. Early initiation of physical therapy with gradual increase from range of motion exercises to active stretching, followed by strengthening is recommended. The aim is to preserve glenohumeral and scapulothoracic movement, strength, and to minimise arm dysfunction. Early initiation of physical therapy is supported by research evidence demonstrating  better range of motion at 2 years post axillary node dissection surgery.

Another subgroup that can benefit from early therapy is those experiencing pain secondary to lymphedema. Apart from physical therapy other interventions such as occupational therapy, compression garments, manual lymph drainage, lymph-reducing exercises, skin care and weight loss may also be required. 

Psychological treatments these may include options such as cognitive behavioural therapy (CBT), hypnosis, mindfulness-based therapies, meditation, self-management programs (individual vs. group) etc. Self-management programs focus on education, cognitive restructuring  to modify thought processes and reduce distress, coping skills training (e.g., pacing, communication) and relaxation training (e.g., hypnosis, mindfulness).

Interventions/ Injections– these are discussed in the next section

What other interventions can be performed for postmastectomy pain?

The most appropriate intervention is decided keeping in mind the likely pain generator. Some of the options include

Trigger point injections Muscles ability to contract and relax plays an important role in body functioning. When muscles fail to relax, they form knots or tight bands known as trigger points. Common causes include inflammation, injury of the muscle or the neighbouring structures. Injection of local anaesthetic and steroid at the points of maximal tenderness can relieve chronic post mastectomy pain. The local anaesthetic blocks the pain sensations and the steroids help in reducing the inflammation, swelling. I prefer to perform these injections under ultrasound guidance as it improves the accuracy and reduces the chances of complications. Post injection physiotherapy is essential to prevent recurrence and maximise the benefits. 

Nerve Blocks & Pulsed Radiofrequency – Intercostal, Pectoral Nerves 
Intercostal nerves run in between two ribs to supply the chest wall. They carry messages from the chest wall to the brain and vice versa. Indications for intercostal block can be diagnostic or therapeutic. The procedure involves injecting a mixture of local anaesthetic and a small amount of steroid under ultrasound guidance. Using ultrasound helps to visualise the spread of drugs and reduce the chances of complications as the needle can be kept away from important structures such as lungs. Pulsed radiofrequency treatment can be performed to prolong the effects of the injections.

Cryoablation of Nerves The primary aim in cryoablation is deactivation of the nerves transmitting the pain signals and this is achieved by freezing the nerves in a controlled fashion to temperatures as low as minus 80 degrees. The procedure is performed using a special probe called cryoprobe, which is guided to the correct location using ultrasound, x-rays and nerve stimulators. The extremely low temperatures achieved at the tip of the cryoprobe results in formation of an ice ball which freezes the nearby nerves thereby reducing pain. This technology is a minimally invasive pain-relieving alternative that does not require any cuts or incisions. It is a safe, day care procedure with the potential of providing quick and lasting relief.

Plane Blocks – Ultrasound guided Serratus Plane Block (SPB) & PECS Block
These injections are commonly used during anaesthesia for breast surgery and can sometimes be useful in chronic pain situations. They involve injection of local anaesthetics and steroids, using ultrasound guidance, in specific planes between the muscles ensuring blockage of multiple nerves with a single injection. Serratus plane block can also block the intercostobrachial nerve, which is implicated in chronic post-mastectomy pain. In chronic pain conditions they are often used to break the pain cycle enabling patients to start physiotherapy.

Botox injections
Botox injections can help in situations where muscles are the source of pain and their spasm is an issue. They can also be useful when muscle pain is produced by the temporary expander as a part of the breast reconstruction. They work by temporarily paralysing the muscles thereby producing relief. Injections are best performed under ultrasound guidance to ensure accuracy and may need to be repeated after a few months if the problem persists. 

Pulsed radiofrequency (PRF) of dorsal root ganglion (DRG)
DRG can be looked at as the modulator of the pain signals being transmitted from the periphery to the brain. By performing a block and pulsed radiofrequency procedure the pain impulses reaching the brain can be modulated/ reduced and this can produce pain relief. PRF of the DRG is considered for patients with inadequate response to other treatments discussed previously. 

Stellate Ganglion Block this can be helpful in some cases in reducing pain and improving range of shoulder movements. These injections target special nerves called the sympathetic nerves, that can get involved in transmitting the pain signals to the brain.  Sometimes a series of injections may be required to produce lasting relief. 

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Sport Injury Treatment in Delhi

  

Sports Injuries Prevention

 

Overuse and trauma are two common factors responsible for sports injuries. Both intrinsic (such as age, fitness level, muscle strength etc) and extrinsic factors (such as equipment, environment, type of activity etc) play a role in injuries.

Prevention of injuries may involve changing of training schedule, gear, training, practicing environment and style and many other factors. Primary prevention deals with prevention of an injury whereas secondary prevention is about prevention of re occurrence of injury. As "Prevention is better than cure," here are some tips that can help you prevent sports injuries. Whilst most of these may seem like common knowledge, you would be surprised by how many injuries can be avoided by following these tips.

Tip 1: Understand the importance of physical conditioning and know your limits

This factor is often overlooked by amateurs who easily succumb to temptation and overindulge.  It is easy to get carried away when you return to sports after a long time. Knowing ones limits, gradually increasing the intensity and duration of training can help in injury prevention. Regular exercise is an effective way to energize your body and keep fit.  On the other hand aggressive training beyond ones capabilities and the resulting overuse, fatigue, poor judgment makes injuries more likely.

Be mindful of old injuries and listen to your body. Warning signs such as joint pain, tenderness, and swelling are reasons to re-evaluate your technique and routine.

Tip 2: Invest in the right sporting gear

This includes every essential bit of equipment required for playing a particular sport, starting from the right shoes to the protective equipment such as helmets, gloves, protective pads etc. Right gear not only protects you from injuries but can also enhance your performance.

Tip 3: Warm and stretch your muscles

Warmed up muscles are less prone to injuries and overlooking warm-up sessions can cost one dearly. Warm up raises the core body temperature and gears up the body for the intended exercise.  It helps by increasing the blood flow to muscles improving the muscle efficiency, range of motion and stretching the muscles being used in particular sports. Stretching to the point of tension (not pain) helps to reduce stiffness and improve flexibility, thereby reducing the chances of injury.

Warm up may be general or specific to the intended sport.  The right exercises would vary depending on the sports. Starting the sport at a slow pace can be helpful. If you closely observe your sporting idols, you will always see them warm up prior to any game.

Tip 4: Use the right technique and follow the rules of the game

Correct techniques to play a sport are defined to minimize the chances of injuries and maximize your performance. The same can be said about the rules of the game. Incorrect overzealous manoeuvre can predispose one to injuries and hence the importance of concentrating on the precise technique. One example which I can quote as I commonly see this in my clinic is back injuries due to incorrect dead lift technique. Often that temptation to add the extra 5kgs compromises the technique predisposing one to injuries.

Selecting the appropriate surface for sports is equally important especially for repetitive activities such as running, jumping where the impact force on the body is magnified by 3- 12 times. Impact force on hard surfaces is much higher increasing the injury chances. 

Tip 5: Cool down

Cooling down is another injury prevention technique that helps to return the heart rate, breathing, and blood pressure to the pre-training levels. It can also help to limit the post exercise muscle soreness and flush out toxins produced during the training.

Tip 6: Adequate recovery

Adequate recovery is essential no only for avoiding injuries but also for the full training effect. Inadequate recovery can lead to tiredness, lethargy, mental fatigue and impaired performance. Adequate recovery includes warm down sessions, re stand sleep, psychological and nutritional advices.

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About Hysterectomies And The Different Types of Hysterectomies

Surgery to remove the uterus (womb) is called a hysterectomy. You won’t menstruate (have periods) or be able to become pregnant after a hysterectomy. A common procedure for different disorders affecting a woman’s reproductive organs is uterus removal.

What is a hysterectomy?

The uterus is removed during a hysterectomy, along with the ovaries and fallopian tubes sometimes. Your choice of hysterectomy will be based on your medical condition.

Different Types of Hysterectomies

Hysterectomies are of several types.  Your health doctor will go over the drawbacks, advantages, and possible side effects of each operation. It’s crucial to find out whether your doctor recommends removing your fallopian tubes and ovaries during your hysterectomy. Types of hysterectomy include:

• In a total hysterectomy, the uterus and cervix are both removed (most common type).
• The cervix is not removed during partial hysterectomy, also known as supracervical hysterectomy, which only removes the upper portion of the uterus.
• In a radical hysterectomy, the uterus, cervix, and upper vaginal wall are removed (usually for cancer treatment).

How long is the hysterectomy procedure?

It might take one to four hours to perform a hysterectomy. The kind of surgery you undergo and how it is done will determine how long it takes.

Reasons for a hysterectomy

Your doctor may suggest a hysterectomy for a variety of reasons such as:

• Adenomyosis.
• Endometriosis.
• gynaecological cancers, such as those of the cervix, uterus, ovary, or endometrium.
• heavy or persistent period bleeding (menorrhagia).
• Fibroids.
• bladder repair may be paired with uterine prolapse.

Abdominal Hysterectomy

Through an incision (cut) in your belly, a surgeon conducts an abdominal, or open, hysterectomy. Typically, the belly incision is low and horizontal, right above the pubic bone. If your uterus is very big, a surgeon could occasionally make a longer vertical incision.

What to expect with an abdominal hysterectomy:

• Anaesthesia: General
• Days spent in the hospital: two to three.
• Size of incision: Longer for vertical incisions; 6 to 12 inches for horizontal incisions.
• One to two hours for the procedure.
• Four to six weeks for recovery.

Robotic or laparoscopic hysterectomy

Hysterectomy procedures can frequently be carried out with less invasive methods. Instead of one major incision, a laparoscopic hysterectomy is performed through numerous tiny abdominal incisions.

Through one incision, a surgeon inserts a laparoscope, a small, flexible tube with a video camera. The surgeon can see your pelvic organs on a video monitor due to the laparoscope. Your uterus may be removed whole or in pieces by using tiny surgical tools.

Another kind of less invasive uterine removal is a robotic hysterectomy. Through tiny abdominal incisions, your surgeon removes your uterus with the help of a robotic arm.

What to expect with a Robotic or laparoscopic hysterectomy:

• Anaesthesia: General
• Days spent in the hospital: One to Two.
• Size of incision: 5 to 12 millimetres.
• One to three hours for the procedure.
• Three to four weeks for recovery.

Hysteroscopic Hysterectomy

The least invasive method of removing the uterus is a hysteroscopic (vaginal) hysterectomy. There are no visible scars since the uterus is removed through a surgical incision at the top of the vagina.

You may be a candidate for a hysteroscopic hysterectomy depending on a number of circumstances, such as:

• Need for ovary and fallopian tube removal due to conditions that might restrict vaginal access to the uterus, such as severe endometriosis or adhesions (scar tissue).
• History of vaginal births
• The size and form of your uterus and vagina

What to expect with a Robotic or laparoscopic hysterectomy:

• Anaesthesia: General
• Days spent in the hospital: One to Two.
• Size of incision: 5 to 12 millimetres.
• One to three hours for the procedure.
• Three to four weeks for recovery.

Side Effects and Risks of Hysterectomy

A hysterectomy often has high success rates and is safe. However, following are some possible risks and adverse effects of the procedure:

• The removal of the ovaries might cause early menopause with symptoms including hot flashes or insomnia. 
• The removal of the ovaries might cause early menopause with symptoms including hot flashes or insomnia. 
• Bladder or bowel damage-related incontinence
• Anesthesia-related reactions
• Vaginal prolapse
• Wound infection

Recovery from Hysterectomy

Your level of recovery following a hysterectomy will vary depending on the treatment. You should anticipate a four to six-week recovery period following an abdominal hysterectomy. Three to four weeks are needed for recovery following a robotic, laparoscopic, or minimally invasive hysterectomy. Avoid intense exertion and heavy lifting at this time. When you can resume daily activities including employment, exercise, and sexual activity will be determined by your doctor.

Treatment at Department of Gynaecology, Orchid Medical Centre, Ranchi

Your general health, your preferences about fertility and your capacity to carry a pregnancy or parent biologically, as well as other factors, may all influence the procedure or procedures that you and your gynaecologist may ultimately choose. If you want to get your uterus removed, you can consult one of the best gynaecologists in Ranchi, Jharkhand at Orchid Medical Centre.

TAG- Hysteroscopy in Ranchi, Best Gynaecologist in Ranchi

For More Information- https://www.orchidmedcentre.com/