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PM's health: Doctors say no need for panic

Vicky Nanjappa in Bengaluru and Priyanka Jain in Mumbai | January 21, 2009 18:45 IST

Prime Minister Dr Manmohan Singh [Images], who underwent an angiography as part of a series of heart-related tests at the All India Institute of Medical Sciences, New Delhi [Images], can continue to live a normal life and even discharge his duties as prime minister according to Dr Vivek Jawali, chief cardio-thoracic and vascular surgeon, Wockhardt Hospitals, Bengaluru [Images].

Meanwhile, has learnt that doctors from the Asian Heart Institute, Mumbai [Images] have been flown to the capital to figure out the future course of medical treatment for the prime minister.

Dr Jawali told that going by what has been reported there is no cause for panic and the prime minister's health problems are curable. He said that the treatment for Dr Singh would depend on the nature of block in the arteries.

He said that if the block is mild then it could be cured by medicines and lifestyle changes. If the block is significant then it would require mechanical revasculation. In case there is a single or a double block then it could be removed by a simple angioplasty. In case the block is long and multiple then Dr Singh would have to undergo a bypass surgery, Dr Jawali pointed out.

Dr Jawali says that all these procedures are absolutely safe and the patient can lead a normal and active life after treatment. He says that he conducts 2000 such surgeries every year and the failure rate is less than one per cent.

Dr Jawali also points out the examples of former prime minister P V Narasimha Rao who too undergone a similar surgery. After the surgery he returned to office as prime minister and went about discharging his duties normally. Even former US President Bill Clinton [Images] underwent a similar procedure while in office.

On the future course of action, he said that Dr Singh would have to take care of himself and if he does so he would lead a long and active life. There are standard procedures in such cases and the most important of them all is a low calorie diet, Dr Jawali points out.

Dr Tilak Suvarna, interventional cardiologist, at the Asian Heart Institute, said: "The fact that a person complains of chest pain after he has undergone by pass surgery means he has not been following the lifestyle changes or medication that was prescribed. The blockages can recur if suggested lifestyle changes are not followed and the risk factors are not kept under control."

"Depending on the symtomatic status [patient complaining of chest pain] of the patient, I would advice him/her to at least take two to four weeks of rest. However each case is different from the other and depending on the severity of blockages, we advice patients about the period in which they can resume work," the doctor said.

"However, there is a possibility in such a case that angioplasty is done again. In this situation, the patient needs at least a week of rest and post that follow-up medication and lifestyle changes suggested by the doctor," Dr Suvarna said.

What happens if Dr Singh needs surgery:

Dr Aashish Contractor, Head of Department, preventive cardiology & rehabilitation, Asian Heart Institute, explains:

"Normally after bypass surgery, angiography is not done for up to 7-8 years unless a patient complains of chest pain. Hence if the situation arises one needs to know if the blockages are fresh? Are they old? How old? Are they significant blockages? Where are these blockages situated -- in which part of the heart? How many are there?"

Dr Contractor said that since he did no have complete information in this particular case he would explain the routine post-surgical course.

"After surgery the patient typically spends two days in the ICU. This is the average stay when the surgery is done on a 'beating heart'. In this method a device called 'Octopus' is used and surgery is done while the heart is beating. Otherwise surgery is done using a heart-lung machine. This machine allows the heart to be 'stopped' for a while to perform the grafting.  Surgeries done on the beating heart result in patients spending less time in the ICU, less blood transfusion and complications as well as a shorter hospital stay.

After the ICU stay, the patient typically spends 5-6 days in the hospital. Early activity is begun in the ICU itself on the second day after surgery. The patient is encouraged to take a few steps at a time to avoid the ill effects of prolonged bed rest.

"After discharge the patient returns in a week to remove the stitches. In the first week at home, the person should not be sleeping in bed but should be encouraged to walk; a few minutes at a time.

"After two weeks at home the person should enroll in a cardiac rehabilitation program at a hospital to accelerate the recovery process and to learn more about risk factor reduction.  This helps reduce the risk for future complications and heart attacks.

"We generally advise patients to wait for at least 1-2 months after surgery before returning to work. However, each individual is different and some people may be able to return sooner. It also depends on the type of work. Those having labour intensive jobs or jobs involving high mental stress should wait for a longer time. It is also wise to start work a few hours a day for the first week, and then gradually return to working all day. Please consult with your doctor before returning to work."

Note: Dr Contractor was not told the patient's name, just the age and symptoms

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