A 30 year old educated female along with her husband came for consultation.
Before I could ask what was her medical problem she said, "Doctor, I have just been diagnosed to have gall stones. Can you remove my stone but keep the Gall bladder? i do not want to lose my organ., I need it for my digestion & I am too young to lose it. Ultimately God must have given it so it must have some inportant function!"
After asking her symptoms, examining her and studying the ultrasonography report I gave my verdict, "You need removal of gall stones. The International Gold Standard treatment for gallstone disease is removal of gall bladder along with stones.
After few seconds of silence, the husband spoke," Doctor I had kidney stones treated. My surgeon only removed the stones but not the Kidney. Why is it that you are saying that we need to remove the Gall bladder? Can we not remove just the stones?"
Intelligent comparision. Almost all patients have this worry – removal of an organ. Generally this worry is more when one is young.

Avinash Tahkur, a 45 year male patient resident of Palghar came to me with pain in chest and difficulty in swallowing (dysphagia) since one month. He took treatment form local doctors but with no relief. It was extremely difficult for him to swallow and he would take only liquids. If he would eat solids he would get excruciating pain in chest and would immediately throw out the food. Both he and his wife appeared quiet nervous. They felt it was cancer and his days were numbered. I told him that it would be very difficult for me to draw any conclusions and give him treatment unless endoscopy was done.
I took him to the endoscopy room. He was made to lay down on his left. I sprayed local anesthesia in his mouth and throat. I inserted a Japanese make upper GI flexible videoscope into his food pipe. The culprit was found. There was a large fish bone impacted in his upper part of food pipe. It was impacted since one month and had created ulcers on opposite walls of the food pipe. Using the operating channel of the videoscope, I inserted a Dormia basket. Dormia basket is a tiny apparatus consisting of four wires. In resting position they are close. When opened within the body, it opens up and forms like a cage. I manipulated the dormia basket and trapped the fish bone. I gradually withdrew it from the food pipe without causing any injury to his food pipe. Patient was relived instantaneously. His chest pain reduced and he could swallow water. He went home immediately with some simple medication and followed up in evening His wife was so relieved and thanked me. Her husband could now eat food. I had also take a biopsy of the ulcer just to be 100% sure that it was not cancer.
Such procedure are difficult. While one is doing these kind of procedure one has to be very careful that he does not cause and injury to the food pipe while dis-impacting and removing the foreign body. Even a slightest error can land up the patient for a major surgery. All such procedures are possible if there are good equipments & perfect skills available. In this case what had happened was that patient had accidentally swallowed a large piece of fish bone but not realized it. I have removed dozens of bones by using endoscopes. Often patient is unaware of it. Many times I have removed dentures. They are also quiet difficult. i have removed many coins, toy pieces, & even safety pins in children. So far by God's grace it has always been successful At times it takes longer time and i have to be extremely cool. The patient is constantly breathing and at times moves just at the critical time. The foreign bodies are also many times very difficult to grip. Coins are slippery, bones are sharp and one is worried about injuring the organ while removing. I prefer general anesthesia for children as its very difficult to get co-operation. Also general anesthesia relaxes the sphincters and its easy to pull out foreign bodies. In children general anesthesia protects the airway and reduces the chance of the foreign body accidentally going into the food pipe while removing it.

Introduction
Coronary heart disease (CHD) is the biggest killer, around one in five men and one in seven women die from the disease.
CHD affects more men than women, and your chances of getting it increase as you get older.
About the heart
The heart is a muscle that is about the size of your fist. It pumps blood around your body and beats approximately 70 times a minute. After the blood leaves the right side of the heart, it goes to your lungs where it picks up oxygen.
The oxygen-rich blood returns to your heart and is then pumped to the organs of your body through a network of arteries. The blood returns to your heart through veins before being pumped back to your lungs again. This process is called circulation.
The heart gets its own supply of blood from a network of blood vessels on the surface of your heart, called coronary arteries.
Coronary heart disease
Coronary heart disease is the term that describes what happens when your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries.
Over time, the walls of your arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma. If your coronary arteries become narrow due to a build-up of atheroma, the blood supply to your heart will be restricted. This can cause angina (chest pains).
If a coronary artery becomes completely blocked, it can cause a heart attack. The medical term for a heart attack is myocardial infarction.
By making some simple lifestyle changes, you can reduce your risk of getting CHD. If you already have heart disease, you can take steps to reduce your risk of developing further heart-related problems. Keeping your heart healthy will also have other health benefits, and help reduce your risk of stroke and dementia.
Symptoms of coronary heart disease
If your coronary arteries become partially blocked, it can cause chest pain (angina). If they become completely blocked, it can cause a heart attack (myocardial infarction).
Some people experience different symptoms, including palpitations and unusual breathlessness. In some cases, people may not have symptoms of coronary heart disease (CHD) at all before they are diagnosed.
Angina
Angina is a symptom of CHD. It can be a mild, uncomfortable feeling that is similar to indigestion. However, a severe angina attack can cause a feeling of heaviness or tightness, usually in the centre of the chest, which may spread to the arms, neck, jaw, back or stomach.
Angina is often triggered by physical activity or stressful situations. The symptoms usually pass in less than 10 minutes and can be relieved by resting or using a nitrate tablet or spray.
Heart attacks
Heart attacks can cause permanent damage to the heart muscle and, if not treated straight away, can be fatal.
The discomfort or pain of a heart attack is similar to that of angina but it is often more severe. During a heart attack you may also experience the following symptoms:
Sweating
Light-headedness
Nausea
Breathlessness
The symptoms of a heart attack can be similar to indigestion. For example, they may include a feeling of heaviness in your chest, a stomach ache or heartburn. A heart attack can happen at any time, including while you are resting. If heart pains last longer than 15 minutes, it may be the start of a heart attack.
Unlike angina, the symptoms of a heart attack are not usually relieved using a nitrate tablet or spray.
Heart failure
Heart failure can occur in people with CHD. The heart becomes too weak to pump blood around the body, which can cause fluid to build up in the lungs, making it increasingly difficult to breathe. Heart failure can happen suddenly (acute heart failure) or gradually, over time (chronic heart failure).
Causes of heart disease
Coronary heart disease (CHD) is usually caused by a build-up of fatty deposits on the walls of the coronary arteries. The fatty deposits, called atheroma, are made up of cholesterol and other waste substances.
The build-up of atheroma on the walls of the coronary arteries makes the arteries narrower and restricts the flow of blood to the heart. This process is called atherosclerosis. Your risk of developing atherosclerosis is significantly increased if you:
Smoke
Have high blood pressure
Have a high blood cholesterol level
Do not take regular exercise
Have diabetes
Other risk factors for developing atherosclerosis include:
Being obese or overweight
Having a family history of CHD: the risk is increased if you have a male relative with CHD under 55 or a female relative under 65
Cholesterol
Cholesterol is a fat made by the liver from the saturated fat that we eat. Cholesterol is essential for healthy cells, but if there is too much in the blood it can lead to CHD.
Cholesterol is carried in the blood stream by molecules called lipoproteins. There are several different types of lipoproteins, but two of the main ones are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).
LDL, often referred to as bad cholesterol, takes cholesterol from the liver and delivers it to cells. LDL cholesterol tends to build up on the walls of the coronary arteries, increasing your risk of heart disease. HDL, often referred to good cholesterol, carries cholesterol away from the cells and back to the liver, where it is broken down or passed from the body as a waste product.
The current government recommendation is that you should have a total blood cholesterol level of less than 5mmol/litre, and an LDL cholesterol level of under 3mmol/litre and this should be even lower if you have symptoms of CHD.
High blood pressure
High blood pressure (hypertension) puts a strain on your heart and can lead to CHD.
Blood pressure is measured at two points during the blood circulation cycle. The systolic pressure is a measure of your blood pressure as the heart contracts and pumps blood out. The diastolic pressure is a measure of your blood pressure when your heart is relaxed and filling up with blood.
Blood pressure is measured in terms of millimetres of mercury (mmHg). When you have your blood pressure measured, the systolic pressure is the first, higher number to be recorded. The diastolic pressure is the second, lower number to be recorded. High blood pressure is defined as a systolic pressure of 140mmHg or more, or a diastolic pressure of 90mmHg or more.
Smoking
Smoking is a major risk factor. Carbon monoxide (from the smoke) and nicotine both put a strain on the heart by making it work faster. They also increase your risk of blood clots.
Other chemicals in cigarette smoke damage the lining of your coronary arteries, leading to furring of the arteries. If you smoke, you increase your risk of developing heart disease by 24%.
Thrombosis
A thrombosis is a blood clot within an artery (or a vein). If a thrombosis occurs in a coronary artery (coronary thrombosis), it will cause the artery to narrow, increasing your chance of having a heart attack as the blood clot prevents the blood supply from reaching the heart muscle. Coronary thrombosis usually happens at the same place as where atherosclerosis is forming (furring of the coronary arteries).
Diagnosis and risk assessment
If your doctor thinks you may be at risk of developing coronary heart disease (CHD), they may carry out a risk assessment for cardiovascular disease, heart attack or stroke.
Your doctor will ask about your medical and family history, check your blood pressure and do a blood test to assess your cholesterol level.
Before having the cholesterol test, you may be asked not to eat for 12 hours so there is no food in your body that could affect the result. Dr. B C Shah can carry out the blood test and will take a sample either using a needle and a syringe or by pricking your finger.
Dr. B C Shah will also ask about your lifestyle, how much exercise you do and whether you smoke. All these factors will be considered as part of the diagnosis.
To confirm a suspected diagnosis you may be referred for more tests. A number of different tests are used to diagnose heart-related problems including:
Electrocardiogram (ECG)
X-rays
Echocardiogram
Blood tests
Coronary angiography
Radionuclide tests
Magnetic resonance imaging (MRI)
Electrocardiogram (ECG)
An ECG records the rhythm and electrical activity of your heart. A number of electrodes (small, sticky patches) are put on your arms, legs and chest. The electrodes are connected to a machine that records the electrical signals of each heartbeat.
Although an ECG can detect problems with your heart rhythm, an abnormal reading does not always mean that there is anything wrong, nor does a normal reading rule out heart problems.
In some cases you may have an exercise ECG test or 'stress test'. This is when an ECG recording is taken while you are exercising (usually on a treadmill or exercise bike). If you experience pain while exercising, the test can help to identify whether your symptoms are caused by angina, which is usually due to CHD.
X-rays
An x-ray may be used to look at the heart, lungs and chest wall. This can help to rule out any other conditions which may be causing your symptoms.
Echocardiogram (echo)
An echocardiogram is similar to the ultrasound scan used in pregnancy. It produces an image of your heart using sound waves. The test can identify the structure, thickness and movement of each heart valve and can be used to create a detailed picture of the heart.
During an echocardiogram you will be asked to remove your top and a small handheld device, called a transducer, will be passed over your chest. Lubricating gel is put onto your skin to allow the transducer to move smoothly and make sure there is continuous contact between the sensor and the skin.
Blood tests
In addition to cholesterol testing, you may need to have a number of blood tests that are used to monitor the activity of the heart. These include cardiac enzyme tests, which can show whether there is damage to the heart muscle, and thyroid function tests.
Coronary angiography
Coronary angiography, also known as a catheter test, is usually performed under local anaesthetic. As well as providing information about your heart's blood pressure and how well your heart is functioning, an angiogram can also identify whether the coronary arteries are narrowed and how severe any blockages are.
In an angiogram, a catheter (flexible tube) is passed into an artery in your groin or arm and it is guided into the coronary arteries using X-rays. A dye is injected into the catheter to show up the arteries supplying your heart with blood. A number of X-ray pictures are taken, which will highlight any blockages.
A coronary angiogram is a relatively safe procedure and serious complications are rare. The risk of having a heart attack, stroke or dying during the procedure is estimated at about one or two in every 1,000. However, after having a coronary angiogram, you may experience some minor side effects including:
A slightly strange sensation when the dye is put down the catheter
A small amount of bleeding when the catheter is removed
A bruise in your groin or arm
Radionuclide tests
Radionuclide tests are used to diagnose CHD. They can also indicate how strongly your heart pumps and show the flow of blood to the muscular walls of your heart. Radionuclide tests provide more detailed information than the exercise ECG test.
During a radionuclide test, a small amount of a radioactive substance, called an isotope, is injected into your blood (sometimes during exercise). If you have difficulty exercising, you may be given some medication to make your heart beat faster. A camera placed close to your chest picks up the radiation transmitted by the isotope as it passes through your heart.
Magnetic resonance testing (MRI)
An MRI scan can be used to produce detailed pictures of your heart. During an MRI scan, you lie inside a tunnel-like scanner that has a magnet around the outside. The scanner uses a magnetic field and radio waves to produce detailed images.
Treating heart disease
What is good care for heart disease?
Effective treatment of coronary heart disease (CHD) saves lives. Since 2000, there has been a 40% reduction in deaths from heart disease in people under 75. A national review of heart disease services set out standards that define good heart disease care:
Tackling the factors that increase the risk of heart disease, such as smoking, poor diet and little physical exercise
Preventing CHD in high-risk patients and where patients have CHD, avoiding complications and tackling the progression of the disease
Rapid treatment for heart attack, including the choice of angioplasty in a specialist cardiac centre
Rapid diagnosis of heart disease and access to diagnostic tests
Rapid access and choice of treatment centre for specialised cardiac care
Treatment overview
CHD cannot be cured but it can be managed effectively with a combination of lifestyle changes, medicine and in some cases surgery. With the right treatment, the symptoms of CHD can be reduced and the functioning of the heart improved.
Recovering from heart disease
The purpose of cardiac rehabilitation is to help you to recover and resume a normal life as soon as possible after having a heart transplant, a coronary angioplasty or coronary artery bypass surgery. It may also be useful if you have other heart-related conditions, such as a heart attack, angina or heart failure.
Cardiac rehabilitation programme
If you have heart surgery, a member of the cardiac rehabilitation team may visit you in hospital to give you information about your condition and the procedure that you are having. This care will usually continue after you have left hospital. For the first few weeks following your surgery, a member of the cardiac rehabilitation team may visit you at home or call you to check on your progress.
What happens in cardiac rehabilitation programmes can vary widely throughout the country but most will cover the following basic areas:
Exercise
Education
Relaxation and emotional support
Once you have completed your rehabilitation programme, it is important that you continue to take regular exercise and lead a healthy lifestyle. This will help to protect your heart and reduce the risk of further heart-related problems.
Self-care
Self-care is an integral part of daily life and is all about you taking responsibility for your own health and wellbeing with support from the people involved in your care. Self-care includes the actions you take for yourself every day in order to stay fit and maintain good physical and mental health, prevent illness or accidents and care more effectively for minor ailments and long-term conditions.
People living with long-term conditions can benefit enormously from being supported so they reach self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent.
Support groups
If you have or have had a heart condition or if you are caring for someone with a heart condition, you might find it useful to meet other people in your area who are in a similar situation.
Relationships and sex
Coming to terms with a long-term condition such as heart disease can put a strain on you, your family and your friends. It can be difficult to talk with people about your condition, even if they are close to you. Be open about how you feel and let your family and friends know what they can do to help. But do not feel shy about telling them that you need some time to yourself.
Your sex life
If you have coronary heart disease (CHD) or you have recently had heart surgery, you may be concerned about having sex. Usually, as soon as you feel well enough, you can resume sexual activity. Communicate with your partner and stay open-minded. Explore what you both like sexually. Simply touching, being touched and being close to someone helps a person feel loved and special.
Returning to work
After recovering from heart surgery, you should be able to return to work, but it may be necessary to change the type of work that you do. For example, you may not be able to do a job that involves heavy physical exertion. Dr. B C Shah will be able to advise you about when you can return to work, and what type of activities you should avoid.