Medical Tourism 2017 Jan-Mar - for Web

A Complete Magazine on Healthcare in Asia 1

2 Medical Tourism Jan - Mar 2017

Media Partner:

A Complete Magazine on Healthcare in Asia 3

Vol.1 | Issue No.4 | Jan. - Mar. 2017 All about surgery and care for visitors

Medical Modern medicine has dovetailed science fiction-style foray into the art and
tourism smartness of surgical procedures, protecting the life and limbs of human beings.
Life is a one-time affair, there can be no substitute, therefore the essential point
RNI No. KERBIL/2016/68979 is to maintain the body proper of the person with all one’s fallacies and foibles so
that it does not snuff out, with the help of adequate manoeuvre. Developed nations
Editor & Publisher like the US, UK and those in Europe have been monumentally erecting medical
Benny Thomas bulwark against the onslaught of life-threatening diseases and malfunctioning
organs and systems. They have succeeded in their efforts to a great extent, albeit
Consulting Editor at humongous cost which ordinary people cannot afford. The first decision taken
O.J. George by new US President Donald Trump was to scrap the Obamacare health scheme
under which people could hope to get medical attention, even though it was not all-
Executive Editor embracing. As of now details about new medical assistance scheme have not been
TKV.Mani divulged and everyone hopes there would be a better package.
The situation has come to such a pass that it is increasingly difficult for people
Editorial Co-ordinator of average income to meet medical expenses there. Meanwhile, facilities offering
Ninu Susan Abraham similar services have sprung up in Asia, Middle East etc over a period of years that
would cater to the needs of the people at a fraction of the bills levied by the big
Vice President-Marketing nations. Medical Tourism magazine has been projecting availability of regional
Sunil Nair facilities beckoning visitors for treatment of ailments and hospitalization, including
for surgical procedures.
Layout & Design Surgical interventions form the crux of this issue of Medical Tourism, highlighting
Lal Joseph availability of ample facilities in Asia, including India, Malaysia, Singapore and
Thailand as also West Asia, particularly United Arab Emirates and the Sultanate of
Legal Advisor Oman.
Adv. Biju Hariharan Medical tourism is an over $100 billion business, which is continually expanding
offering huge potential, if genuine services are provided. In the bargain,
BUSINESS ASSOCIATES Overseas malpractices and unacceptable activities have crept in here and there which
should be nipped in the bud. Therefore, care has been taken to sift the grain from
USA : CHICAGO: Vincent Joseph the chaff, honestly reporting on the best practitioners, aiming to give a balanced
view for our readers. We feel that anything related to healthcare is specifically a
Mob: 847 299 9954 service to people as it deals with human health and well-being and endorse the
ancient Sanskrit invocation, Loka Samastha Sukhino Bhavanthu, which means
USA : Houston: Shaju Joseph "let all the people of the world be happy." We had our representatives and stalls
at all major healthcare and travel exhibitions last year that included Oman Health
Mob: 847 899 2232 Exhibition & Conference in Muscat, International India Medical Tourism Congress
(IIMTC) Hyderabad, Advantage Healthcare-India 2016 in New Delhi and World Travel
USA : NEW YORK Vincent Sebastian Market, London. Above all, Medical Tourism was the official magazine of Oman
Health Exhibition and Conference 2016.
Mob: 917 992 9629 Riding on our reputation, we will be one of the media partners of the 5th Oman
International Medical Tourism Exhibition and Conference (IMTEC) in Muscat in April.
USA : CALIFORNIA: Wilson Nechikat, The current issue is designed as a special edition for the Arab Health Exhibition in
Dubai, to be held from Jan 30 to Feb 2. We would definitely be at the ITB Berlin in
Ph: 408 903 8997 March as well.
We are also delighted to inform our readers that we have expanded the magazine’s
Canada : Jose Sebastian, Ph: 416 - 509 – 6265 content and coverage to include modern medical equipment, major hospitals
and hospital profiles. Surgical interventions form the crux of this issue of Medical
UK : Dileep Mathew, Ph: 044 787 743 2378 Tourism.
Our cover story, Before Going Under the Scalpel, gives complete information on
Switzerland : Dr. George Sebastian, Ph: 527204780 surgery from planning to execution of a surgical procedure. It covers issues before
surgery, the day of surgery, post-surgery, emergency surgery and different sorts of
Ireland : Thomas Mathew surgical procedures.
There are also stories on some wonderful surgical procedures that have been
Mob: 00353 87 123 6584 attempted. There is also an insightful article on neuro surgery. Apart from this,
there are special stories on Ovarian Cancer, Cervical Cancer and Breast Cancer.
Middle East : Anil Nath, There are Daily tips for good oral hygiene, foot health, sexual health and travel
health plus our regular features.
Ph: 506854500 We are at your service always and wish every one happy reading.

Singapore : Mahesh A, Ph: +65 906 22828 - Editor

Germany : Thomas Vallomtharayil

Ph: 02305 4455 100

Austria : Monichan Kalapurackal

Ph: 0043 6991 9249829

Korea : Dr. A. Thomas, Ph: 0082 10 5822 5820

Australia : S. Mathew, Ph: 61247026086

BUSINESS ASSOCIATES India

New delhi : V Murugan, Mob: +91 989 9931 879

Mumbai : Mohan Iyer, Mob: +91 22 6450 5111

Chennai : C. Shankar, Mob: +91 9840978060

Eastern India : Sanjay D. Narwani Mob: +91 983120 7202

Ahmedabad : Madanan MA, Mob: +91 98980 02522

Hyderabad : Vinod Menon, Mob: +91 08143617672

Puducherry : K. Ramasubramanian, +919894977161

Goa : Olavo Edviges Lobo - 9822589237

Trivandrum : Balagopalan, Mob:+91 9544181188

Kozhikode : T. Rajendran Nair, Mob:+91 9539009305

CORPORATE OFFICE Printed, published and owned by Printed at Sterling Print Disclaimer: The statements in this magazine have not been
FM Media Technologies PVT Ltd, Benny Thomas House Pvt Ltd, Door No. evaluated by the Food and Drug Administratin of USA or
Penta Square, Opp.Kavitha, MG FM Media Technologies Pvt. Ltd, 49/1849, Ponekkara- any other country. Information provided in this magazine
Road, Cochin -682016, Kerala, India. Penta Square, Opp.Kavitha, Cheranellur Road,Aims, are not intended to diagnose, treat, cure or prevent any
Tel/Fax: +91 484 403 4055 MG Road, Cochin -682016, Ponekkara P.O, disease. If you have a medical condition, consult your
Email: [email protected] Kerala, India. Cochin-682041, physician. All information is provided for research and
www. asianmeditour.com Editor: Benny Thomas Ph: 0484 2800406. education purpose only.

4 Medical Tourism Jan - Mar 2017

A Complete Magazine on Healthcare in Asia 5

inside 22

Medical Events 8

Health News 10

Hospital 12

In The News 13

Medical Equipments 14

Interview 16

Bangkok Hospital: A Class Apart 18 Cover story:
Before going under the
Hats Off To The Service, Make It Cost-Effective Too 20 scalpel

Cover Story: Before Going Under The Scalpel 22 32

5 Weird And Wonderful Surgical Procedures 28 Magical healing possible
through Modern
Magical Healing Possible Through Modern Neurosurgery 32 Neurosurgery

Blood Pressure Matters 34

Alzheimer’s Care Giving Tips 36

Best Foot Put Forward 38

Exercise Tips For Travellers 39

Alcohol & Asthma: What’s The Connection? 40

Healthy Lifestyle Can Lower Breast Cancer Risk 42

Ovarian Cancer: The Silent Killer 48

Cervical Cancer Can Be Prevented 50

Beware Of Measles 52

Daily Tips For Good Oral Hygiene 54

Safer Sex On Holiday 56

Sexual Problems 60

6 Medical Tourism Jan - Mar 2017

Healthy lifestyle 50
can lower
Breast Cancer risk Safer Sex
on holiday

56

42 Cervical
Cancer can be prevented
Ovarian Cancer:
The silent killer 52

Sexual
problems

Beware of
Measles

48 60

A Complete Magazine on Healthcare in Asia 7

Medical Tourism
Medical Events

Arab Health 2017 (30 Jan. - 02 Feb., 2017)

Dubai International Convention and Exhibition CentreDubai, U.A.E
The largest gathering of healthcare and trade professionals in the MENA region
Contact: Informa Life Sciences Exhibitions, 30-32 Mortimer Street, London, W1W 7RE, UK.
Ph.: +971-4-4072797.
E-mail: [email protected] and/or [email protected] (Ross Williams). Website: www.arabhealthonline.com

Health Tech India 2017 (Feb. 3-5, 2017)

Pragati Maidan New Delhi, India
An Exhibition on Medical Equipment, Technology, and Healthcare Services
Contact: Mr. Naveen Lawrence, Asst. Vice President - Sales & Projecs, TFCI Events Private Limited,
Mobile : +91-9867831994. Email: [email protected] and/or Mr. Kunal Joshi, Mobile: +919840906930.
E-mail: [email protected] ; Website: www.healthtechindia.com

KOACON 2017 (Feb. 3-5, 2017)

Hotel Denissons , Hubballi, Karanataka, India.
Contact: Vama Events Pvt. Ltd., Office No. 4, Ground Floor, Anmol Co-Operative Housing Society,
Sakharam Keer Road, Parallel to L.J. Road, Shivaji Park, Mumbai-400016, India.
Tel.: +91-22-4383499. E-mail: [email protected] or [email protected]
(Dr. Suryakant Kalluraya, Head - Dept. of Orthopedics - KIMS). Website: www.koacon2017hubli.com

MediTech Healthcare Asia 2017 (February 10-12, 2017)

Gujarat University Convention & Exhibition Centre, Ahmedabad, Gujarat, India
Contact: Radeecal Communications, 402, 4th Floor, “Optionz” Complex, Opp. Nest Hotel, off C.G. Road,
Navrangpura, Ahmedabad- 380009, Gujarat, India.
Cell: +91-9099091102, Ph.: +91-79-26401101/02/03.
EMail: [email protected] (Kaveesha Doshi). Website: www.mthasia.com

Medical Japan 2017 (February 15-17, 2017) INTEX ,Osaka, Japan

The 3rd International Medical Expo and Conference which covers all the products, services for healthcare, clinical testing and
medical diagnostics and medicine
Contact: MEDICAL JAPAN Show Management, Reed Exhibitions Japan Ltd.,
18F Shinjuku-Nomura Bldg.,1-26-2 Nishishinjuku, Shinjuku-ku, Tokyo 163-0570, Japan.
Tel: +81-3-3349-8519, Fax: +81-3-3349-8530. E-mail: [email protected] Website: www.medical-jpn.jp/en

MEDICAL EXPO 2017 (March 3-5, 2017) Plus Convention Hall, M.G. Road,Vijayawada, AP, India

The premium International Exhibition and Conference on Hospitals & Equipment, Lab, Surgical Equipment,
Medical Infrastructure and Health Care Solutions,
Contact: Shiny Trade Events & Exhibitions, D.No. 59A-15-28, 2nd floor, Pantakalva Road,
Near NTR Statue, Patamata, Vijayawada-520010, Andhra Pradesh, India. Tel.: +91-9246472036.
E-mail: [email protected], Website: www.apmedicalexpo.com

Kuwait Health 2017 (March 6-8, 2017)

Hall 6.2 Kuwait International Fair, Kuwait City, Kuwait
Kuwait Health Exhibition & Conference
contact: ATEX International Exhibitions L.L.C. Middle East, 1003 Aspect Tower, Zone 1,
Business Bay, P.O. Box 413520, Dubai, U.A.E., Tel.: +971-4-4312734, Fax: +971-4-3746014
Email: [email protected], Web.: www.kuwaithealthexhibition.com

Remote Healthcare Middle East 2017 (March 7-8, 2017)

Westin, Abu Dhabi, UAE
The second annual Remote Healthcare Middle East conference. The Event is supported by the Emirates Society of Emergency
Medicine (ESEM).
Contact: Thomas Gaunt, Event Director. Tel.: +971-4-4356101, +971-55-3143339.
E-mail: [email protected]

IDS 2017 (March 21-25, 2017)

Tradefair grounds , Cologne, Germany
The 37th edition of International Dental Show, purely dedicated to dental industry
Contact: Koelnmesse GmbH, Messeplatz 1, 50679 Koeln, Germany. Tel.: +49-221-821-3857, Fax: +49-221-821-3271.
E-mail: [email protected] / [email protected], Website: www.ids-cologne.de

Wound Care Conference 2017 (March 21-25, 2017)

Abu Dhabi National Exhibiltion Centre ,Abu Dhabi, U.A E. 8th Annual Abu Dhabi Wound Care Conference
Contact: Medetarian Conference Organizing, 1st Floor, Office Tower, BHS Building, Hamdan Street, Abu Dhabi, U.A.E.
Tel.: +971-2658-8717 and/or +971-2627-5509, Mobile: +971-55-5860152.
E-Mail: [email protected]; Website: www.mco.ae

8 Medical Tourism Jan - Mar 2017











Medical Tourism
Medical Equipments

OptiVac Aspirator (Cardinal Health) Artis Zeego Multi-Axis Imaging DIRA Angiography Syste
System (Siemens)
The OptiVac® Aspirator can service a variety DIRA Angio system is designed for x-ray sur-
of today´s medical environments. It is self-con- As part of the Artis zee family of intervention- gical procedures on the heart, blood vessels of
tained, minimizing the potential contamination al imaging systems, Artis zeego is the first the brain, chest, abdomen, and pelvis. The sys-
or damage to the compressor and battery. It has multi-axis system that can be positioned the tem is recommended for ambulances, vascular
a sealed surface made from quality-engineered way you want. What‘s more, it can be con- and cardiology centers, departments of oncolo-
thermoplastic for fast, effective cleanup. trolled with far greater ease and precision than gy, cardiology and neurology of multifunctional
Email: [email protected] a traditional floor- or ceiling-mounted system. hospitals.
Email: [email protected] Email: [email protected]

JUN-AIR Dental Compressor System Low Turbulence Ventilation System Cam Cleaner 2000 Air Purifier
(Keystone) (Marchhar t) (Camfill)

JUN-AIR Dental Systems are designed to deliver The low turbulence ventilation system with The CamCleaner 2000 air purifier for dusty
continuous high flow operation, producing the laminar displacement flow contributes to pro- environments and indoor premises such as
quickest duty on demand and system recovery tect against contamination caused by airborne warehouses, pharmaceutical facilities, food
times. Compressor and vacuum model systems particles and germs, and it reduces the risk of factories, heavy industry, paper mills, welding
are available to meet the requirements for 3, 5, post-operative infections. workshops, construction sites, laundries, tim-
& 7 user stations. With built in sound reduction Email: [email protected] ber facilities, bakeries, packaging production,
and industry leading performance, JUN-AIR printing facilities, stables, processing industry
Dental Systems lay the foundation for reliable and supermarkets. Also suitable in connection
worry free operation, bringing a smile to dental with construction, demolition and coating op-
professional and patients alike.Contact: erations. Carbon filter system available as op-
Email: [email protected] tional accessory.
Email: [email protected]

Artis Zee Biplane System LS-3E Lens Blocker Power Plus Behind-the-Ear
(Siemens) (Dia Optical) Hearing Aids (Starkey)

The Artis zee biplane system with mixed The LS-3E Lens Blocker is upgraged with bat- The Power Plus Behind-the-Ear hearing aids
detectors (30x40 and 20x20) provides tery-powered LED light source. It has twin-arm reliable, high-performance hearing aids are
increased coverage ideally suited for imaging of type for both blocking and marking lenses as designed to make people come in clearer and
structural heart diseases. well as single-arm type only for blocking lenses. every environment sound better.
Email: [email protected] Email: [email protected] Email: [email protected]
14 Medical Tourism Jan - Mar 2017

A Complete Magazine on Healthcare in Asia 15

Medical Tourism
interview

AAA Healthcare is one of the leading Medical Tourism

Facilitators in India.

The Company’s Founder & Chief Executive Officer Dr. Ahmad S Mecklai,

in an exclusive interview with Medical Tourism, talks about the industry and its
prospects

What factors made you choose Medical Tourism as a our business processes. We have brought in concepts like
career? What are its prospects in this part of the world? Second Opinion and Decision Support Panel.
I have been associated with this industry for the past 20
years now. Eventually when I started my own company - What are the advantages of receiving medical treat-
AAA HealthCare Consultancy - I resolved to address the ment in India? How is India going to make significant
challenges of this industry through transparency and qual- progress in Medical Tourism in the coming years?
ity compliance. In line with my resolution, we are FIRST
NABH Certified Medical Value Travel Facilitator in the India offers an unmatched cost competence for a world-
world. India has grown into a global health destination, class clinical expertise. Also there are no wait-lists for high
with the medical value travel industry showing nearly 30% quality treatment with World class facilities by access to
YoY growth. Research shows that at this rate, the Indian latest technology.
Medical Value Travel market is poised to double by 2020
to become US$ 8 Billion industry. Our Doctors and Healthcare professionals are the USP of
our country
Which are the specialties / procedures most sought af-
ter from Asia? How does a Medical Tourist get informa- What are the major hurdles that Medical Tourists com-
tion on services available in other countries? ing to India have to face?
Language and touts are the two most important hurdles in
Oncology, Orthopedics, Cardiology, Transplants, Dentistry, effective care delivery. These factors can leave a sour after-
IVF, cosmetic and plastic surgery, obesity surgery, ophthal- taste of the whole medical tourism experience.
mology. Hip and knee replacement, face lift, and gastric Although the language is not a barrier with doctors, nurses
bypass are quite affordable in India and most of the times & attendees being fluent in English in most of the health-
these procedures are not covered by insurers. care setups, there is still dearth of other foreign language
Information is shared through word of mouth, online fo- translators.
rums, social media, and networking.
How would you prospect the year 2017 for Medical
What would be the approximate number of patients Tourism in India looking at the current scenario?
coming to India from other countries for treatment and
which cities are most popular among them? What are Currently our strengths lie in two areas
the tourists looking for specifically? Quality- Many Indian hospitals that cater to foreign tourists
meet the requirements of international standards like Food
Over a million patients travel to India across major cities and Drug Administration and Joint Commission Accredi-
like Delhi, Mumbai, Chennai, Kolkata, etc. tation for hospitals. We also leverage latest advances in
medical technology.
Do Insurance Companies cover such treatments? If yes, Alternative Medicine- India is home to many alternative
what are their criteria for claims? medicine techniques like Ayurveda, Sidha, Unani, Yoga,
Acupuncture and Homeopathy. Such treatment opportuni-
Yes. However, there is a set criteria for room tariff and ties give India the edge over its competitors like Thailand,
treatment coverage as per the policy allowance. Singapore, Malaysia, South Korea, and UAE.
With regard to what we expect for a prospective future the
Are Medial Tourists who come to India happy with the following issues need to be addressed:
services provided in our hospitals? a) Increase Infrastructure investment by the government.
b) Reducing barriers for visiting India for medical purposes
Yes, because of the cost benefit. through e-Visa, M-Visa etc.
However, more transparency needs to be brought in along c) Marketing of Indian health tourism in Western countries
with the better concierge services. by government bodies.
How has the feedback from them been and what are
your suggestions to make the services better?

The feedback has highlighted the unmet needs of patients,
based on which we built our IT platform and improved

16 Medical Tourism Jan - Mar 2017

A Complete Magazine on Healthcare in Asia 17

Medical Tourism Bangkok Hospital was established in 1972 as one of
HOSPITAL PROFILE the first private hospitals in Thailand. Over the past
44 years this hospital has expanded its operations
to become a tertiary care facility with dedicated
hospitals for cancer and cardiology. At Bangkok Hospital,
patients are offered with full complement of diagnosis,
treatment, and rehabilitation services, with specialists in
all major fields of healthcare, but what sets the hospital
apart from other hospitals is the dedication to specialised
Bangkok tertiary care. Services and treatment processes are inter-
nationally certified by the Joint Commission International,
one of the largest and most respected accreditation agen-
cies for healthcare.
Hospital: Thailand has long been a premier tourist destination. Its
world-renowned, exotic travel destinations and unique cul-
A class apart ture have contributed to a steady increase in the number
of annual visitors. At the same time, the demand for inter-
nationally accredited healthcare has also been continuous-
ly increasing. With this in mind Thailand has proven itself
to be a significant component of global healthcare.

A testament to Bangkok Hospitals’ commitment to quality
service for international patients, the hospital provides a
team of knowledgeable translators able to communicate
effectively in over 26 languages to ensure that there are
no issues with regards to communication when it comes to
healthcare. A network of 46 hospitals in home and abroad
enables Bangkok Hospital to provide initial support to the
patients at any corner of the country and provide super
tertiary level care those who need.

Bangkok Hospital aims to provide medical services in a
welcoming and convenient environment, complete with
top-notch accommodation and amenities to meet the
needs of patients and relatives. Furthermore, comprehen-
sive visa services, as well as limousine and shuttle bus ser-
vices are available to facilitate transportation to and from
the hospital.

Dedicated to excellence in healthcare and continuous
improvement through advanced technology and compas-
sionate care, visitors can expect to experience world-class
service and specialized tertiary care at Bangkok Hospital.

At Bangkok Hospital, patients are offered The philosophy “Bangkok Hospital is where advances in
with full complement of diagnosis, treat- medicine meet with compassion.” guides the hospital to
ment, and rehabilitation services, with the inspiration to serve the client with most advanced tech-
specialists in all major fields of healthcare, nology in Thailand. A lot of new technologies in Thailand
but what sets the hospital apart from oth- were first introduced by Bangkok Hospital and the trend
er hospitals is the dedication to specialised continues. The vision “Bangkok Hospital is a premier ter-
tertiary care tiary healthcare provider, dedicated to international quality,
customer focused care” clearly mentions the reason why
Bangkok Hospital is now the most sought for international
hospital in Thailand. Yearly a number of 223,000 medical
travellers/tourists aretaking medical services in this hos-
pital.
Considering the comfort of the international patients- Bang-
kok Hospital has established dedicated centers to deliver
one stop service to the non- medical needs while staying
in and around the hospital. Some specialised facilities as
bellows are the efforts to make the patient’s journey to the
hospital seamless as well as supporting any other kind of
needs.

18 Medical Tourism Jan - Mar 2017

• Bangkok Referral Center
• Multi-Cultural and Multi-Lingual Clinics and Wards
• Dedicated International 3rd Party Payers Services Team
• Concierge Services
• On-site Visa Extension Services
• Dedicated Airport Counter and Pick-Up Services
• Dedicated shopping area (Bangkok Plaza) with multi
cuisine restaurants, medical accessories shop, fruits and
gift shops, coffee corners, book shops, 3 bank branches
and others.
Technology, expert medical professionals and Thai Hospi-
tality can do a lot of differences in medical care support.
Having all these facilities – Bangkok Hospital is now con-
sidered to be most chosen Private Health Care Service pro-
vider in Thailand.

Bangkok Hospital

Address :2 Soi Soonvijai 7, New Petchburi Road., Huayk-
wang, Bangkok 10310 Thailand
Phone : (+66) 2310-3000 1719 (local mobile calls only)
Fax : (+66) 2318-1546 (+66) 2310-3327
Email :[email protected]
Website: www.bangkokhosptal.com

A Complete Magazine on Healthcare in Asia 19

Medical Tourism
REFLECTIONS

Hats off to the service,
make it cost-effective too

World- class amenities all right, but there can be better affordability to medical tourists
By O.J.George (Consulting Editor)

20 Medical Tourism Jan - Mar 2017

Surgical procedures have turned so sophisticated As per Asian standards, the cost of major surgeries like
that deft hands, precise tools and safe environs heart, liver, kidney transplants in the US and allied coun-
can enable a specialist surgeon do wonders with tries is unimaginable and prohibitive to ordinary mortals.
the human body, its systems and organs which It is in these circumstances that many Asian countries are
need upkeep and correction. providing succour to the incoming patients with equal fa-
Times may not be far off when we would have custom-made cilities existing elsewhere. Doctors who have gained expe-
bodies, ordered to size and specifications. rience and expertise in the US, UK etc and well-qualified
Body-lift, contouring, tummy tuck and similar procedures para-medical staff in these facilities offer excellent service
have already settled in, so much so that sculpted figures to the visiting crowd of patients.
may emerge from Homo sapiens, in addition to the reg- The nurses and para-medical staff members are generally
ular work of altering or replacing malfunctioning internal well-versed in English and many of them are fluent in Ar-
organs. abic conversation gained during their stint in West Asian
Scalpel manouevre, internal or external, has become some- countries.
thing of an architect’s job, building proper edifice of the It is settled custom that visiting patients from the Gulf
human body. countries would be comfortable explaining their difficulties
‘The spirit is willing but the flesh is weak’ is a proverb to staff members who are accustomed to their own lan-
which drums up the frailties of the human body, but mod- guage.
ern medical interventions appear to drive up the survival As of now there is no dearth of Arabic- fluent aides in the
spirit of the crown and glory of all creations. hospitals offering services to patients hailing from the Mid-
They would evolve and prosper in all circumstances, or our dle East.
medics would conjure up procedures that would uplift the Even as existing facilities which are spick and span in all
mortal figures. respects and are comparatively cost-effective abound, dis-
Think of the mopping up of the minutest details by sur- cussions in various echelons centre round ways to further
geons while transplanting heart, lung, kidney or any oth- reduce expenses to make treatment affordable in better
er organ for that matter. There are reports that a group manner. Discounts and reductions here and there would
of surgeons are preparing themselves to go in for a head work immensely in bringing down the expenses.
transplant as well. Moreover, at the government-level, Ministers and senior
CBS News has reported that an Italian neuro-scientist, officials making a beeline to the US and Europe for under-
Dr Sergio Canavero, has plans to perform the first human going treatment can be regulated in such a way that their
head transplant in 2017, recruiting Chinese surgeon Dr medical needs could be efficaciously met in facilities avail-
Xiaoping Ren to work with him and has already found a able in native regions or nearby Asian countries.
volunteer patient, a Russian by name Valery Spiridonov, for It would be worth mentioning that Dr Manmohan Singh
receiving a new head from a brain-dead person. had graciously undergone an open-heart surgery in the
The procedure has already been successfully tried in mice All-India Institute of Medical Sciences, New Delhi, during
which lifts up the morale of the doctor and his team of 80 his stint as Prime Minister of India.
surgeons as well as the wheel-chair-bound patient suffer- Earlier he had undergone two such procedures in the UK
ing from a rare disease that rendered him shriveled and and the third one could have required meticulous planning
dried up, who would then be surgically ‘decapitated’ and and execution for which he had no qualms about being
provided with a refit of another head. admitted to the AIIMS where most-modern facilities and
Intricate procedures are involved in an attempt to make expert doctors in fact catered to his needs perfectly well.
the effort successful, even as there are virulent critics con- An irritant about getting admitted anywhere is the fear
demning the action on ethical grounds. about nosocomial issues which are nothing but hospi-
Forget about all the hair-splitting arguments, but the in- tal-acquired infections, be they bacterial, fungal or viral.
thing is nothing but the giant strides made by the medical Definitely, the medical facilities have worked to minimise
fraternity in sustaining the human race from frailties of the such dangers that patients can safely accommodate them-
body which are congenital or acquired. selves for various procedures.
The crucial aspect relating to stunning achievements in As an example of the Asian nations making it big in the
medical and surgical procedures whittles down to the fact business of medicare, the annual Arab Health exhibition
that the new-found accomplishments are not limited to de- being held in Dubai from January 30 to February 2 this
veloped nations like the US, UK and the European bound- year should be highlighted.
aries. During the four-day event, close to 4000 exhibitors would
Sophisticated hospitals and facilities with ultra-modern lay bare their wares taking care of the A to Z of various
machinery and equipment have come up in the Asian con- aspects of healthcare, technology, equipment, and discus-
tinent, including in India, Malaysia, Thailand, Singapore, sions that would further enrich the clientele involved.
the UAE and elsewhere. Hats off to regional achievements, taking a cue from
No doubt, the expenses of patients undergoing various in- well-established entities elsewhere affirming that we have
tricate procedures in these countries are a fraction of the come up in a big way.
sum they would be incurring in their own native developed
nations, if they venture out as medical tourists to specified ([email protected])
destinations offering treatment in salubrious climes.

A Complete Magazine on Healthcare in Asia 21











ing the upper extremities. This specialty includes the per- struction, management of maxillofacial trauma, soft tissue
formance of microvascular surgery, which is necessary for repair and neural surgery.
reattachment of amputated fingers or limbs.
Otolaryngology – head and neck Surgery Plastic surgery
An otolaryngologist—head and neck surgeon—provides
medical and surgical care for patients with diseases and Plastic surgeons specialise in the care of patients requiring
disorders that affect the ears, nose, throat, the respiratory repair, replacement, and reconstruction of defects of the
and upper alimentary systems, and related structures of form and function of the body covering and its underlying
the head and neck. They diagnose and provide medical musculoskeletal system, with emphasis on the craniofacial
and surgical treatment of diseases and have skills and structures, the oropharynx, the upper and lower limbs, the
knowledge in audiology and speech-language pathology; breast, and the external genitalia. This surgical specialty
the chemical senses; allergy, endocrinology, and neurology also focuses on the aesthetic surgery of structures with un-
desirable form. Special knowledge and skill in the design
as they relate to the head and neck. Operations are per- and transfer of skin flaps, in the transplantation of tissues,
formed on the head and neck, and face. Head and neck and in the replantation of structures are vital to the perfor-
oncology, facial plastic and reconstructive procedures, and mance of plastic surgery.
the treatment of disorders of hearing and voice are funda-
mental areas of expertise for the otolaryngologist. Surgery of the Hand
Neurotology
A neurotologist is an otolaryngologist—head and neck sur- This specialty focuses on the investigation and treatment
geon—who treats patients with diseases of the ear and of patients with diseases, injuries, or abnormalities af-
temporal bone, including disorders of hearing and balance. fecting the upper extremities. This specialty includes the
Paediatric otolaryngology performance of microvascular surgery, which is necessary
An otolaryngologist—head and neck surgeon— has com- for reattachment of amputated fingers or limbs. All hand
pleted specialty training in the management of infants and surgeons are certified in plastic surgery and then complete
children with congenital or acquired disorders of the head additional training and testing in hand surgery.
and neck, nose, paranasal sinuses, ear, and aerodigestive
tract. Plastic surgery within the head and neck
Plastic surgery within the head and neck
An otolaryngologist—head and neck surgeon—has com- A surgeon with this specialty is a plastic surgeon with ad-
pleted additional training in plastic cosmetic and recon- ditional training in cosmetic and reconstructive procedures
structive procedures within the head, face, and neck. This within the head, face, and neck. This area includes skin,
area includes skin, head and neck oncology and recon- head and neck oncology and reconstruction, management
of maxillofacial trauma, soft tissue repair, and neural sur-
gery.

Thoracic and cardiovascular surgery

Thoracic surgeons specialize in management of patients
with conditions of the chest and heart. This specialty in-
cludes providing surgical care of patients for coronary ar-
tery disease; cancers of the lung, esophagus, and chest
wall; abnormalities of the heart, great vessels and heart
valves; congenital anomalies; tumors of the mediastinum;
and diseases of the diaphragm. The management of the
airway and injuries to the chest are also areas of surgical
practice for the thoracic surgeon. They have specialized
knowledge of cardiorespiratory physiology and oncology,
as well as capability in the use of extracorporeal circula-
tion, cardiac assist devices, management of cardiac dys-
rhythmias, pleural drainage, respiratory support systems,
endoscopy, and other invasive and noninvasive diagnostic
technique.

Urology surgeon

A surgeon who specialises in urology manages patients
with benign and malignant (cancerous) medical and surgi-
cal disorders of the adrenal gland and of the genitourinary
system. Urologists have comprehensive knowledge of, and
skills in, endoscopic, percutaneous, and open surgery of
congenital and acquired conditions of the reproductive and
urinary systems.

Source:

MedlinePlus and National Institute of Health (US)

A Complete Magazine on Healthcare in Asia 27

Medical Tourism
COVER STORY

weird and
wonderful
surgical

5procedures

28 Medical Tourism Jan - Mar 2017

In 1967, the first human heart transplant was performed. Almost half a
century on, the procedure saves the lives of around 5,000 people across
the globe every year. This is just one example of the thousands of surgical
procedures that are transforming people’s lives every day..

According to the World Health Organization (WHO), there were approxi-
mately 312.9 million operations carried out worldwide in 2012, increasing
from 226.4 million in 2004.

In the United States, the most common surgical procedures include appen-
dectomy, cesarean section, cataract surgery, mastectomy, and coronary artery
bypass.

It goes without saying that each and every one of these surgeries can improve
or save a person’s life, but there are some procedures that are so complex and
unusual that they really bring home just how much surgery has progressed
since the first heart transplant.

A look at five of the most bizarre and incredible surgical procedures

1) Rotationplasty: Turning an ankle into a knee

Rotationplasty is an extraordinary form of reconstructive surgery that enables
the ankle to be used as a knee joint.

The procedure involves the surgical removal of the bottom of the femur, the
knee, and the upper tibia. The lower part of the leg is then rotated 180 degrees
and attached to the thigh.

Put simply, the foot is attached to the knee backward. Once a prosthesis is
fitted, the ankle of the foot functions as a knee.

Rotationplasty is most commonly performed in children who have malignant
bone tumours - such as osteosarcoma or Ewing sarcoma - near the knee that
have not responded to other treatments.

The main aim of rotationplasty is to fully remove the tumour, but in a way that
allows a child to have an active lifestyle, which would not be possible with
complete amputation.

2) Osteo-odonto-keratoprosthesis: Restoring sight with a
tooth

Often referred to as “tooth-in-eye” surgery, osteo-odonto-keratoprosthesis
(OOKP) is just that - using a tooth to restore a patient’s sight.

First described in the early 1960s by Prof. Benedetto Strampelli, of San Camillo
Hospital in Italy, OOKP may be used for patients whose blindness is caused by
irreversible damage to the cornea - the outer layer of the eye - and for whom
other treatment methods have failed.

The procedure involves the removal of a patient’s canine or premolar tooth and
the surrounding bone; the technique uses the patient’s own tooth as the body
is unlikely to reject it. A hole is then drilled in the tooth and a plastic lens is
inserted.

The lens-tooth structure is then implanted into the patient’s cheek, where it
grows new blood vessels over a few months. The structure is then removed from
the cheek and implanted into the eye. Light is able to travel through the lens,
restoring the patient’s vision.

In 2013,The Telgraph reported on a British man who regained his vision after
undergoing OOKP.

In 1999, Ian Tibbetts lost his sight completely through eye problems first trig-
gered by an accident at work, whereby a piece of scrap metal struck his right
eye and damaged his cornea.

In December 2012, Ian underwent OOKP at the Sussex Eye Hospital - the only
hospital in the United Kingdom that performs the procedure - and was able to
see his children clearly for the first time.

A Complete Magazine on Healthcare in Asia 29

“I have my independence back now and I can start looking Patients who undergo hemispherectomy will have some
after the kids while my wife is out at work. Before, the kids paralysis on the side of their body opposite to their re-
were just shapes. I couldn’t make them out,” Ian told The moved hemisphere, and they normally lose sensation or
Telegraph. “I had a picture in my head of what they looked function in the hands and fingers.
like but they were better. I gave them a big hug and a kiss.”
However, in many cases, the benefits of the surgery out-
3) Hemispherectomy: Removing half of the weigh the risks and side effects.
brain to treat seizures
One example of a successful hemispherectomy involves a
The brain is the most complex organ of the human body, 17-year-old girl called Karley Miller from Australia, who
containing billions of nerve cells that act as the command underwent the procedure to stop daily seizures caused by
center for physical and psychological functions. epilepsy. Her decision to have the radical operation was
prompted by one seizure that lasted 9 ½ hours.
With this in mind, it seems beyond belief that removing
half of the brain can be a feasible, effective surgical proce- “I couldn’t go anywhere without mum being a few steps
dure for certain neurological conditions, but in some cases, behind, I couldn’t even have a shower with the door locked
it is. Such a procedure is known as hemispherectomy. in case I had a seizure and no-one could get to me,” Karley
told The Daily Mail earlier last year.
Hemispherectomy involves the partial or total removal or
disconnection of one of the two hemispheres of the brain. While Karley did experience some side effects from hemi-
It is considered a radical procedure, which can take as long spherectomy, she no longer has seizures and is living a
as 12 hours to complete. more happy, fulfilling life.

The procedure is usually performed on individuals who 4) Heterotopic heart transplant: Two hearts
have neurological disorders that cause seizures on one side may be better than one
of the brain.
Traditionally, a heart transplant involves removing a pa-
Such disorders include severe epilepsy, perinatal stroke, tient’s damaged heart and replacing it with a healthy donor
hemimegalencephaly (where one side of the brain is larger heart. This valuable procedure saves around 2,000 lives in
than the other), Sturge-Weber-Dimitri disease (character- the U.S. every year.
ized by facial birthmarks, glaucoma, and seizures), and
Rasmussen’s encephalitis (inflammation of the cerebral But what if a recipient’s body is likely to reject a donor
cortex). heart, or the donor heart is unable to function alone? This
is where heterotopic heart transplantation may come in.
According to The Hemispherectomy Foundation, hemi-
spherectomy is most effective among children, as the re- Heterotopic heart transplantation - also known as “piggy-
maining half of their brain can compensate for the some of back” heart transplantation - involves implanting a healthy
the functions lost by removal of the other half. donor heart on the right side of the recipient’s damaged

30 Medical Tourism Jan - Mar 2017

heart. Both hearts are surgically attached, allowing blood All in all, the operation is expected to take around 36 hours
from the damaged heart to flow into the new heart. The and $11 million to complete, and it will require the skills of
new heart can then pump blood around the body. around 150 surgeons and nurses.

In 2011, researchers from the University of California-San After the procedure is complete, the recipient will be kept
Diego reported performing this rare surgical procedure on in a coma for 3-4 weeks, in order to minimize movement
a man named Tyson Smith, who had advanced heart fail- and ensure the nerve connections between the neck and
ure.. the spine have time to fuse together.

“Even though Mr. Smith was facing death, he could not While this extreme procedure might sound like the makings
have a standard heart transplant,” explains Dr. Michael of science fiction, it is set to become a reality. In October
Madani, of the University of California-San Diego Sulpizio last year, Dr. Canavero told Medical News Today that the
Cardiovascular Center. first human head transplant will be performed in December
2017. .
“Removing the old heart and replacing it with a new heart
would have caused the new heart to fail, because resis- A number of individuals have already volunteered to have
tance to flow in his lungs - called pulmonary hypertension the procedure, including Valery Spiridonov, a 31-year-old
- was so high. But together, the two hearts share the work man from Russia who has a muscle-wasting condition
and get the job done,” he added. called Werdnig-Hoffman disease, which has left him para-
lyzed from the neck down.
5) Head transplant: A possible cure for pa-
ralysis Unsurprisingly, the prospect of the first human head trans-
plant has been met with much criticism, but Dr. Canavero
In 2013, Italian neurosurgeon Dr. Sergio Canavero an- is confident the procedure will be a triumph.
nounced proposals to perform the world’s first ever hu-
man head transplant - a procedure he believes has the “It will be a success,” he told Medical News Today . “There
potential to treat paralysis caused by neurological or mus- is a detailed plan - we are not just concocting this in some
cle-wasting diseases. secret Frankenstein lab. We are way ahead now into the
project, everything is moving - it is no longer science fic-
The procedure - named HEAVEN-GEMINI - will involve tion.” Story Source: Medical News Today
removing the heads of the recipient and a healthy donor
using an “ultra-sharp blade,” in order to avoid spinal cord
damage.

The recipient’s head and the donor body will then be
placed into deep hypothermia for around 45 minutes to
reduce nerve damage. The recipient’s head will then be
attached to the donor body using spinal cord fusion.

A Complete Magazine on Healthcare in Asia 31

Medical Tourism
COVER STORY

Magical healing
possible through

modern

Neurosurgery

With the advent of modern technology and ad- If someone asks which is the most complex organ in the
vances in surgical techniques and skills results of human body the answer will be almost unanimously –The
Neurosurgery are excellent.. Many complicated Brain and spinal cord.. Naturally the field of medicine
and near death brain and spine problems can dealing with surgical problems of the brain and spine will
be cured now by the magic of modern micro- be the most challenging, Intricate and unnerving… Neu-
neurosurgery, writes renowned Neurosurgeon rosurgery has over the years evolved to become a really
Dr. ARUN OOMMEN challenging medical field of practice but thanks to exten-
sive research, publications, vast advances in surgical tech-
niques and instrumentations the results have tremendously
improved over the years

There was not much advancement in neurosurgery until
late 19th early 20th century,

In 1879 after locating it via neurological signs alone, Scot-
tish surgeon William Macewen (1848-1924) performed
the first successful brain tumor removal. On November 25,
1884 English surgeon Rickman Godlee (1849-1925) per-
formed the first primary brain tumor removal, via treph-
ination. On March 16, 1907 Austrian surgeon Hermann
Schloffer became the first to successfully remove a pitu-
itary tumor.

While all physicians work to heal people, neurosurgeons
often have especially gratifying outcomes from success-
ful surgeries in which patients are freed from severe pain,
physical disabilities or impending death. Neurosurgeons
can also participate in cutting-edge research, helping in-
crease medical knowledge of illnesses for which there is
currently no cure.

Surgery on the brain and spinal cord requires the greatest

32 Medical Tourism Jan - Mar 2017

of skills, surgical knowledge, perseverance and physical very widely being done and are producing excellent results.
endurance. Neurosurgeons work long hours on complex A wide spectrum of tumours and cancers can involve the
tasks. An average Neurosurgery can take around 4-6 hours brain and spinal cord. With the advent of modern technol-
to complete. In addition to neurosurgeons, neurosurgical ogy, much improvement in surgical techniques and better
patients has round the clock care of neuro anaesthetists, understanding of different types of tumours and cancers,
neuro intensivists, neurologist, neuro radiologists, Neu- many types of tumours like Meningiomas, Low grade gli-
ropsychiatrist, trained Neuro Nurses, Neuro physiothera- omas, pituitary tumours, germ cell tumours, scwanom-
pists, Nutritional therapists and other allied specialists. mas, etc have entered the group of completely treatable
tumours. Many of the most complex brain tumours can
Some of the modalities that revolutionized Neurosurgery be removed surgically now. Extensive research and studies
and has significantly improved the outcome include a are going on and more and more treatment modalities are
fully equipped theatre with sophisticated operating mi- being tried to fight this dreaded disease. Immunotherapy/
croscopes, neuro navigation system, Cavitron ultrasonic biological response modifier (BRM) therapy, Oncolytic virus
surgical aspirator (CUSA), Neuro monitoring system, Intra therapy. Targeted therapy of faulty genes or proteins, Gene
operative MRI, endoscopic and minimally invasive surger- therapy, Hormonal therapy, photodynamic therapy and
ies, sophisticated implants etc Electric field therapy are some of the treatment modalities
that may bring hope in the future.
Neurosurgery carters to a wide spectrum of diseases or Neck pain and back pain is increasing many fold and prob-
anomalies pertaining to Brain and spinal cord. Head injury lems secondary to disc prolapsed are increasing. With the
secondary to road traffic accidents, falls, assault etc are advent of minimally invasive surgeries and better under-
managed by a Neurosurgeon. They perform a large num- standing of the anatomy dics surgeries are now very safe
ber of complicated procedures like removing clots from and produce very good results.
brain following accident induced head injuries repairing Also removing damaged areas of the brain associated with
skull fractures and spine fractures. With ever increasing re- epilepsy is also being done in many centres. Brain and
search and understanding of head trauma the success rate spine related congenital anomalies and also very complex
of treatment is increasing and is almost 95% in our cen- and are dealt by neurosurgeons.
tre. Also massive clots formed following other spontaneous The learning curve for becoming a trained Neurosurgeon
bleeding, like hypertensive bleeds, abnormal vessel bleeds is steep ..What it takes to become a Qualified Neurosur-
etc are also tackled by neurosurgeons. Minimally invasive geon in India. After the 6 years of basic Medical Training
Interventional therapies like coiling, embolisation, etc are and intership, there is a 3 year Masters degree Training
in surgery followed by 3 years superspeciality training in
Neurosurgery Proper. This tolls to around 12-14 years of
extensive education, Intense Training, surgical learning and
research.. Following which a Neurosurgeon can opt for his
field of subspeciality like Neuro Oncology, Neuroendocopy
, Vascular neurosurgery, Paediatric neurosurgery, spine,
Trauma, Functional Neurosurgery etc which requires fur-
ther 1-2 years of fellowship training.
Many of the neurosurgical patients are critically ill and re-
quired prolonged period of medical care and is a journey
from near death to life which naturally increases the bond
between the doctor and patient and may even last a life
time.

Dr. Arun Oommen

MBBS, MS (Gen Surgery), Mch( Neurosurgery),
MRCS Ed, MBA
Consultant Neurosurgeon
VPS LAKESHORE HOSPITAL, KOCHI

www.arunoommen.com

A Complete Magazine on Healthcare in Asia 33













Medical Tourism
DISEASE

Alcohol &
Asthma:

What’s the connection?

Asthma is a condition that causes a person’s airways to be- • Chest tightness
come narrower, which affects breathing. For some people,
this effect is temporary. When asthma occurs long-term, • Coughing that occurs at a certain time during the day
the airways can become inflamed and tightened.
• Trouble catching a person’s breath
Asthma most commonly starts in childhood. According to
the National Heart, Lung, and Blood Institute, an estimat- • Wheezing
ed 25 million people in the United States have asthma.
Asthma is a chronic condition, so it doesn’t go away even
Asthma symptoms can range from mild to severe, where with treatment. Children often grow out of asthma and may
a person requires emergency medical treatment to start not have any symptoms or need for medications as adults.
breathing again.
How does alcohol use affect asthma?
Although there are medications a person can take to man-
age asthma, a cure for the condition doesn’t exist. That’s Alcohol has often been suggested as a contributor to and
why it’s important that people who have asthma take steps trigger for asthma. However, researchers haven’t conduct-
to prevent an asthma attack. ed a significant amount of research as to the specifics of
alcohol and asthma.
What causes asthma?
One of the biggest research studies on the topic was pub-
A number of triggers can potentially cause an asthma at- lished in 2000 in The Journal of Allergy and Clinixal Im-
tack. When a person is exposed to their particular trigger, munology . The study from Australia asked more than 350
the airways react by getting tighter. This causes asthma adults to fill out a questionnaire on their allergy triggers
symptoms. A person can have several asthma triggers or related to alcohol. The study’s findings included:
just one.
• 33 per cent said that alcohol had triggered an asthma
Common asthma triggers include: attack on at least two occasions

• Air irritants, such as air pollution, chemicals, and smoke • Wine was associated with being particularly allergenic

• Common allergens, such as dust mites, cockroaches, • The onset of most alcohol-related asthma symptoms oc-
molds, and pet danders curred within 1 hour of drinking alcohol

• Exercise • Most asthma symptoms reported were mild to moderate
in severity
• Medications, including over-the-counter medicines such
as aspirin The researchers highlighted two components of some alco-
holic beverages that appeared to be particularly allergenic
• Stress and could contribute to an asthma attack: sulfites and his-
tamines.
• Weather extremes, such as very hot or cold days
Sulfites are a preservative that is commonly used in mak-
Doctors will often recommend a person keep an “asthma ing wine and beer, but also may be added to other food
journal.” In these journals, people track their symptoms types. People with asthma are often especially sensitive to
and what they were doing, eating, or drinking when an the effects of sulfites.
asthma attack occurred.
Another potentially allergy-causing substance in alcohol is
Symptoms of asthma called histamine. This compound is created when alcohol
is fermented. Histamine is present in all alcohol types, in-
Asthma can cause acute symptoms, known as an asth- cluding liquor, beer, and wine.
ma attack, or can cause less-obvious symptoms, such as
a chronic cough at night. Examples of asthma symptoms Histamines are common causes of allergic reactions - this
include: is why some types of allergy medications are called anti-
histamines.

40 Medical Tourism Jan - Mar 2017

Complications of asthma and alcohol intake

Alcohol could also indirectly contribute to asthma symptoms. Stress
is a known contributor to asthma symptoms. Some people may feel
sad or stressed and turn to alcohol as a means of escape. However,
excess alcohol can worsen feelings of stress and also take a toll on a
person’s body and health.

Asthma can have several complications on a person’s health. It can
affect their ability to sleep, engage in exercise, and attend work or
school. If alcohol makes these symptoms worse, the complications
and effects of asthma can be worsened.

Are any alcoholic drinks safer than others for
people with asthma?

If a person with asthma does have alcohol-related triggers, it’s import-
ant to be aware of what alcoholic drink types trigger the symptoms.

According to the study mentioned above, wine is seemingly the most
allergenic alcoholic beverage. Organic wines that do not have preser-
vatives added to them may be lower in sulfites. Beer also contains
sulfites that could potentially trigger asthma symptoms.

To limit the effects of alcohol on asthma, a person should keep their
alcoholic beverage intake to a certain type of alcohol for the night. If
it causes symptoms, a person should avoid it. If it does not, it may be
a less asthma-inducing drink type.

The volume of alcohol may also contribute to worsening asthma symp-
toms. While a glass of wine may not cause symptoms, drinking three
glasses could have enough sulfites or histamines to trigger a reaction.

It’s also possible that a person cannot drink any alcohol type without
having an asthmatic reaction. In this case, a person must weigh the
importance of their health and severity of symptoms with their desire
to drink alcohol.

Treatments for asthma

Asthma treatments involve avoiding asthma triggers and taking med-
icines that can reduce asthma symptoms. People can also have their
own unique personal triggers for asthma, including alcohol.

A doctor may also prescribe medications to help people control and
treat their asthma. These medications are usually divided into short-
and long-acting options.

Short-acting medicines are used to provide immediate relief during an
acute asthma attack. These medications open up the airways, making
it easier for a person to breathe. Examples include short-acting beta-2
agonists, such as albuterol.

Long-acting medications are intended to reduce inflammation that
can lead to an asthma attack. Examples of these medications include:

• Antileukotrienes
• Cromolyn sodium
• Immunomodulators
• Inhaled corticosteroids
• Long-acting inhaled beta-2 agonists
• Methylxanthines
• Oral corticosteroids
Finding the right combination of medications to treat asthma can re-
quire some trial and error. As a general rule, if a person must use
short-acting medications more than twice a week, their asthma could
be better controlled. Story Source: Medical News Today

A Complete Magazine on Healthcare in Asia 41

Medical Tourism
WOMEN'S HEALTH

Healthy lifestyle
can lower

Breast
Cancer risk

Breast cancer affects 1 in 8 women during their lives, and many of
us know someone — a mother, sister, friend — who has had it. It
is the second-leading cancer killer of women in the United States,
next to lung cancer. Thanks to screening, breast cancer often can be
found early, when the chance of successful treatment is best. In fact,
many women are even cured of the disease. A look at the basics,
symptoms , risk factors and prevention:

42 Medical Tourism Jan - Mar 2017

cancer.) They may also invade nearby tissue and spread to
lymph nodes and other parts of the body. The most com-
mon types of breast cancer are:

• Ductal carcinoma – Cancer that begins in the ducts and
grows into surrounding tissues. About 8 in 10 breast can-
cers are this type.

• Lobular carcinoma (LAH-byuh-luhr KAR-sih-NOH-muh)
– Cancer that begins in lobules and grows into surrounding
tissues. About 1 in 10 breast cancers are this type.

With routine screening, breast cancer often can be found at
an early stage, before the cancer has spread.

Symptoms

Thanks to screening, breast cancer often is found before a
woman has any physical symptoms. Yet a woman should
know how her breasts normally look and feel so that she
can report any unusual changes to her doctor. Reasons to
call your doctor include:

• A lump in or near your breast or under your arm

• Thick or firm tissue in or near your breast or under your
arm

• A change in the size or shape of your breast

• Nipple discharge (fluid that is not breast milk)

• Nipple changes, such as a nipple that turns inward
(inverted) into the breast

• Changes to your breast skin, areola, or nipple, such as
itching, redness, scaling, dimpling, or puckering

Keep in mind that most breast changes are not cancer. For
instance, nipple discharge can be caused by birth control
pills, some medicines, and infections. Or, a breast lump

Breast basics

A woman’s breast is made of glandular tissue, connective tis-
sue, fatty tissue, blood vessels, lymph tissue, and nerves. Each
breast contains up to 20 sections of glandular tissue called lobes.
Each lobe has many smaller sections called lobules, where milk
is made. Milk flows from the lobules through thin tubes called
ducts to the nipple. The nipple is the small, raised area at the tip
of the breast. The areola is the area of darker-colored skin around
the nipple.

Each breast also contains lymph vessels. These are thin tubes
that carry lymph to small, bean-shaped glands called lymph
nodes. Lymph nodes are found near the breast, under the arm,
and throughout the body. Lymph nodes and lymph vessels are
part of the lymph system, which helps your body fight disease and
infection. The chest muscle and chest wall are behind the breasts.

What is Breast cancer

Cancer is a disease in which cells become abnormal and form
more cells in an uncontrolled way. With breast cancer, the can-
cer begins in the tissues that make up the breasts. The cancer
cells may form a mass called a tumor. (Note: Not all tumours are

A Complete Magazine on Healthcare in Asia 43

could be a cyst, which is a fluid-filled lump that is not can-
cer. Early breast cancer usually does not cause pain. Still, if
you notice a change in your breast or pain, call your doctor
and schedule a visit. Don’t wait until your next checkup.

Risk factors and prevention

“What’s my risk of breast cancer?” is a question many wom-
en ask their doctors. Doctors have tools to help estimate a
woman’s personal risk. Some women who get breast can-
cer have no known risk factors besides age. Many women
with one or more risk factors never get breast cancer. So
it’s impossible to know who will actually get breast cancer.

Factors that affect a woman’s risk of breast cancer include:

• Age. The strongest risk factor is age. Risk goes up as a
woman gets older. Most women who get breast cancer are
older than 50.

• Personal history of breast cancer. Women who have had
breast cancer in one breast are more likely to get it in the
other breast.

• Family history. Having a mother, sister, or daughter who
has had breast cancer increases a woman’s risk. The risk
is higher if her family member got breast cancer before
age 40. A woman’s risk also is increased if more than one
family member on either her mother’s or father’s side of
the family has had breast cancer.

• Inheriting certain harmful gene mutations. Here are
some key points about genes and breast cancer:

o Inheriting changes to certain genes, such as BRCA1 and
BRCA2, greatly increases the risk of breast cancer.

o Inherited genetic changes account for about 10 percent
of all breast cancers.

o If you have a relative who has a harmful gene mutation,
you may want to talk to a genetic counselor to learn more
about your personal risk. You may also want to seek ge-
netic counseling if your family history of cancer suggests a
gene mutation.

o A woman known to carry a harmful gene mutation
should talk to her doctor about ways to try to lower her
breast cancer risk or find breast cancer early.

• Certain breast changes that are not cancer. Women who
have certain types of abnormal breast changes, such as
atypical hyperplasia, ductal carcinoma in situ, and lobular
carcinoma in situ, have a higher risk. These changes are
found during a breast biopsy.

• Breast tissue that is dense on mammogram. Women
whose breasts have more dense tissue relative to fatty tis-
sue have a higher risk than women of about the same age
who have little or no dense breast tissue.

• Menstrual and reproductive history. Getting your first
menstrual period before age 12 increases breast cancer
risk. Reaching menopause after age 55 increases breast
cancer risk. Never having children or having children after
age 30 also increases risk. Women who have a first baby
before age 20 have a lower risk.

44 Medical Tourism Jan - Mar 2017

• Taking the hormones estrogen and progestin. Using • Breastfeeding. Women who breastfeed have a lower risk
menopausal hormone therapy containing both estrogen of breast cancer.
and progestin for more than five years increases breast
cancer risk. It’s not clear whether estrogen-only therapy af- • Race. In the United States, white women have the high-
fects risk. Using birth control pills may slightly increase the est breast cancer rates. Yet women of all races get breast
risk of breast cancer in current users, but this risk returns cancer. African-American women are more likely to die
to normal over time. from breast cancer than white women. One reason is that
cancer is often found in African-American women at a later,
• Radiation therapy to the chest. Radiation therapy to the more advanced stage, when it may be harder to treat.
chest for the treatment of cancer increases breast cancer
risk. Risk depends on the dose of radiation and age of Researchers continue to look for other factors that might
treatment. The risk is highest for radiation treatment used affect a woman’s risk of getting breast cancer. Factors that
during puberty. do not appear to affect a woman’s breast cancer risk in-
clude:
• Body weight. The chance of getting breast cancer af-
ter menopause is higher in women who are overweight or • Breast implants
obese.
• Miscarriage or abortion
• Drinking alcohol. The more alcohol a woman drinks, the
greater her risk of breast cancer. • Underarm deodorant and antiperspirants

• Taking DES. The drug DES, or diethylstilbestrol (dye- • Smoking – Although neither smoking nor secondhand
ETH-uhl-stil-BES-trol), was given to some pregnant wom- smoke has been shown to increase the risk of breast can-
en in the United States between about 1940 and 1971 cer, they do have other cancer-causing effects. Smoking is
to prevent miscarriage. (It is no longer given to pregnant the number one risk factor for lung cancer.
women.) Women who took DES during pregnancy may
have a slightly increased risk of breast cancer. If you’re looking for ways to lower your breast cancer risk,
focus your efforts on a healthy lifestyle. Wholesome and
• Physical activity. Women who are not physically active well-balanced meals and regular physical activity can help
throughout life may have an increased risk of breast cancer. you to maintain a healthy weight. Limit alcohol to no more
Strenuous exercise for more than four hours per week may than one drink a day. Whether these steps will protect you
help lower breast cancer risk. Also, being active can help from breast cancer is not certain. But living a healthy life-
women prevent overweight and obesity, which are known style is a cornerstone of disease prevention.
risk factors for breast cancer in women who have reached
menopause.

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46 Medical Tourism Jan - Mar 2017

Diagnosing breast cancer Screening and diagnosis: Mammogram, clinical breast exam,
Screening tests look for signs of cancer. If a and other tests
screening mammogram or CBE shows a breast Breast cancer screening looks for signs of cancer before a
change that could be cancer, additional tests are woman has symptoms. Screening can help find breast cancer
needed to learn more. These tests might include: early, when the chance of successful treatment is best. Two
• Diagnostic mammogram. This type of mammo- tests are commonly used to screen for breast cancer:
gram uses x-rays to take more detailed images of • Mammogram. A low-dose x-ray exam of the breasts to look
areas that look abnormal on a screening mammo- for changes that are not normal. Check the womenshealth.
gram. gov screening charts (PDF, 132KB) to see when you should
• Ultrasound exam. Sound waves help your doctor get a mammogram.
see if a lump is solid (could be cancer) or filled • Clinical breast exam (CBE). The doctor looks at and feels
with fluid (a fluid-filled sac that is not cancer). the breasts and under the arms for lumps or anything else
• Magnetic resonance imaging (MRI). Radio waves that seems unusual. Ask your doctor if you need a CBE.
and a powerful magnet linked to a computer are Some women have not gotten regular mammograms in the
used to create detailed pictures of areas inside the past because of cost and lack of insurance. But insurance
breast. MRI may be used if enlarged lymph nodes companies are now required to cover mammograms every 1
or lumps are found during a clinical breast exam to 2 years for women over 40 at no cost to the patient be-
that are not seen on a mammogram or ultrasound. cause of the Affordable Care Act.
• Breast biopsy. Fluid or tissue is removed from Depending on factors such as family history and your general
the breast and checked for cancer cells. There are health, your doctor may recommend a mammogram before
many types of biopsy. A biopsy is the only test to age 40 or more often.
find out if cells are cancer. Regular screening is the best way to find breast cancer early
Not all women who have abnormal screening test in most women. If you are at higher risk of breast cancer, your
results need to have a biopsy. Sometimes, doctors doctor might want to use other tests too, such as a different
can rule out cancer based on the results of fol- type of mammogram or magnetic resonance imaging (MRI).
low-up tests without biopsy. It is important to let your doctor know if you find any changes
Finding out about “abnormal” breast changes can in your breast, such as a lump or dimpling or puckering of
be scary. Talk to your doctor about what tests you the skin. Although research results do not support an official
might need and what the test results mean. If you recommendation that all women conduct breast self-exams,
learn that you have cancer, your doctor will help knowing your body is key to pointing out any concerns to your
you move forward and begin treatment. doctor.

Breast cancer in men is rare. It happens most often to men
who are older than 60. Factors that can increase a man’s risk
of breast cancer include:
• Exposure to radiation, such as from prior cancer treatment
• Having a harmful gene mutation or several female family
members who have had breast cancer
• Having high estrogen levels, such as from disease or a ge-
netic disorder
Men with breast cancer usually have lumps that can be felt.
Treatment can help men with breast cancer, and survival
rates for men and women are similar. Yet breast cancer in
men often is diagnosed at a later stage, when the cancer may
be harder to treat. Men who find a lump should see a doctor
right away.

Information courtesy: Womens health.gov

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