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HEALTH
WA+CH
Quack,
Quack? Not Quite.
In
the past couple of years, medicine has unleashed a slew of designer techniques
to cure mostly chronic conditions, from heart arrhythmias and thrombosis
to cerebral palsy and gynaecological complaints. Unlike the cut and thrust
of conventional surgery, many of these methods are minimally invasive
and often do not even require a scalpel or local anaesthetic-a boon for
the weak or debilitated who cannot withstand either. Others lessen the
trauma of existing procedures, ensuring that the patient returns to his
normal routine in a matter of days. But the biggest advantage is that
they improve the quality of life: no more hobbling along on crutches or
depending on others for the most basic tasks.
However,
these "miracle cures" are not for everyone. Patients are selected
for treatment taking into account the severity of the condition and the
limitation of the technique. And, of course, these cures are not applicable
in life-threatening problems where surgical intervention is the only answer.
What they do offer is an option between medication-which provides only
symptomatic relief with inevitable side effects-and invasive surgery,
with its accompanying risks. But for many silent sufferers undergoing
traumatic therapy, it's like being born again.
For years,
Sujata Ghose, a Mumbai housewife and mother of three, bore the indignity
of menorrhagia, or excessive menstruation, a common problem before menopause.
Sometimes it got so bad, she didn't move out of the house for days for
fear of sitting on a chair and staining the upholstery. "Every gynaec
had only one solution-a larger sanitary napkin," she says. The other
option was a hysterectomy or hormonal treatment, both drastic measures
that she refused to undergo. Then someone suggested uterine balloon therapy
(UBT).
"It's
ridiculously simple," says Dr Rishma Pai, a consultant gynaecologist
at Mumbai's prestigious Jaslok Hospital who specialises in the technique.
A thin catheter with a balloon attached to one end is inserted into the
uterus through the cervix. The balloon is gradually filled with water.
As it expands, the water is heated to a temperature of 87° C with
the help of a computerised UBT machine. Within eight minutes, explains
Pai, the excessively spongy endometrium or inner uterine lining which
causes the abnormal haemorrhage is scorched, after which the balloon is
deflated and removed. The entire procedure takes only 15 minutes and is
conducted under local anaesthesia-perfect for high-risk patients suffering
from diabetes, heart disease or obesity and who are generally not advised
surgery.
Unlike conventionally
prescribed hysterectomy that takes weeks to heal, UBT patients are discharged
in a couple of hours and can resume normal routine in two to three days.
In 30 per cent of cases, the bleeding stops completely while 65 per cent
experience a significant reduction. The caveat: "UBT cannot be used
on patients suffering from fibroids, cancer of cervix and uterus or any
other gynaecological complication," explains leading Mumbai gynaecologist
Avy Dadina. But for women like Ghose it's nothing short of a marvel.
Now, a toxin
that causes food poisoning is transforming the lives of many spastic children
imprisoned in their bodies by cerebral palsy. Caused by nerve damage during
birth, the disorder inhibits voluntary muscle movement and is incurable.
It is traditionally treated by vigorous physiotherapy to encourage muscle
movement. However, botox, a toxin found in stale food that causes diarrhoea,
is actually making many cerebral palsy patients walk. It is injected into
the nerve-muscle gap to loosen stiff muscles and encourage normal coordination
for smooth movement. Mild cases can do with a single shot while severe
ones require repeated injections.
"Progress
with physiotherapy is usually slow and painful, but thanks to botox, we
can make some wheelchair-bound children walk within a month," says
Dr G.P. Dureja, a cerebral palsy specialist who has used the technique
successfully on 75 patients at the All India Institute of Medical Sciences,
Delhi. The treatment costs Rs 14,000 for seven to eight sittings and the
effect lasts for six to nine months. Needless to say there are eager takers
all over the country.
Some of
the most simple and spectacular new techniques have emerged in the field
of cardiac care. While bypass surgery is still the cornerstone of cardiology,
Dr Sukhbinder Singh Sibia, a Ludhiana-based heart specialist, believes
it is now possible to "bypass the bypass" through chelation
therapy, a technique he learnt at the John Buckley Arterial Diseases Clinic,
London. The method offers new hope for arteriosclerosis patients with
dangerous amounts of fatty deposits in their arteries, claims Sibia.
It's a chemical
process whereby a metal or mineral like lead, mercury, copper or iron
is introduced intravenously to "bond" with other toxic elements
in the body and excrete them through the urine. The treatment usually
involves 15-20 infusions over four weeks. They gradually reduce elements
that damage the blood vessel lining, removing calcium and other heavy
metals that block arteries and cause heart attacks or strokes. The treatment
requires no hospitalisation-you can almost fit it into your lunch break.
Cost: Rs 1,500 a sitting, but compared to the Rs 5 lakh charged by top
hospitals for a bypass, chelation is a relatively cheap option that is
already winning a number of converts.
"Although
the American College of Cardiology still does not accept chelation as
a recognised technique, it's occasionally effective for weak or debilitated
patients who cannot risk major bypass surgery," says Dr Shahrukh
Golwalla, a leading Mumbai cardiologist. Prognosis: 50-50.
Another cardiac technique, radiofrequency ablation, is being used to cure
common "heart flutters" or arrhythmias. It occurs when the heart's
natural, in-built pacemaker slows down or when its normal electric frequency
short circuits due to the presence of extra tissue, causing a clutch of
chronic symptoms like palpitations, headaches and dizziness. Dr Amit Vora,
a specialist who trained in electrophysiology and radiofrequency ablation
at Milwaukee in the US, has corrected over 1,500 jumpy hearts at his Glenmark
Cardiac Centre in Mumbai. By simply passing a catheter into the affected
area and introducing a mild current the rhythm is corrected in less than
two hours. Vora claims a success rate of 98 per cent.
Yet another
state-of-the-art procedure is tackling an ophthalmological bugbear-glaucoma.
Closely associated with diabetes and myopia, glaucoma is usually a hereditary
condition where an aqueous build-up in the eye exerts pressure on the
retina, and can lead to blindness. "Formerly, the only way to treat
it was using special drops or puncturing the outer membrane and allowing
the fluid to drain out," explains Mumbai ophthalmologist Dr Keki
Mehta. Today, the most common procedure for treating glaucoma is trabeculoplasty.
It takes 10-20 minutes, is painless, and can even be performed in either
a doctor's office or in an outpatient facility. A high-energy laser beam
shrinks the abnormally swollen trabecular mesh, the inner membrane that
allows the eye to drain naturally. Patients can resume normal activities
48 hours after surgery and complications are minimal.
Another
common geriatric problem, prostate enlargement, can also be treated non-surgically
through thermo therapy. The gland which swells with age sometimes blocks
the urethral tubes, making urination painful for older men. While conventional
transurethral resection surgically removes the organ, in thermo therapy,
a catheter attached to a computerised machine is inserted through the
patient's urethra. When it reaches the prostate, the catheter is slowly
heated to 44° C for five to seven minutes. This destroys the prostate
cells shrinking the gland and removing the obstruction. "The treatment
is normally recommended for diabetics and heart patients who are high-risk
cases for surgery," says Dr Feroze Soonawalla, a top Mumbai urologist,
"but over several months the prostate can grow back to its original
size and the procedure has to be repeated." Cost: Rs 15,000 a go.
Surprisingly,
most of these cures are being offered not by surgeons but ordinary physicians
because they don't require any felicity with a scalpel, and can easily
be learnt at training courses abroad. These doctors import the expensive
equipment and set up their own centres. Reason: niche marketing, says
a medic cryptically. With medical colleges churning out general practitioners
by the thousands every year, only the fittest-and most innovative-survive.
As such, specialising in a new technique adds value to a medical degree.
There is,
however, another viewpoint. "Physicians are increasingly becoming
aware that modern medicine can only offer palliatives, not cures,"
shrugs Vora. "On the other hand, conventional surgery is often dangerous
and used indiscriminately." However, the new cures offer an option
without the side effect of drugs or trauma of surgery. But mainstream
doctors are still sceptical. "Most of these techniques are too new
to comment on," shrugs a leading Mumbai physician who headed the
team attending on Vajpayee. "Besides, they don't work on everyone,
especially in severe cases. As of now, things are very much at an experimental
stage." But there seems to be no dearth of guinea pigs queuing up
for the elusive cure.
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METRO TODAY
As
the Government brings in more people and mops more money in taxes, it
must be seen to be rewarding those who come forth and pay up, writes India
Today Associate Editor V. Shankar Aiyar in 