Everything You Want to Know About Comorbidities and COVID-19

Probably the biggest fear to come out of the COVID-19 pandemic is the fear of the unknown. This is understandable since we are dealing with a virus that is largely alien to humans.

But as the virus has spread around the globe, so scientists have started finding answers to their questions, one of which has become an absolute certainty:

If you have a chronic or underlying disease that has compromised your immune system, you are at a higher risk of developing severe symptoms or complications if you become infected with COVID-19.

In this article we address the questions people often ask about the link between chronic diseases (comorbidities) and COVID-19. We focus on the most common comorbidities that people need to be aware of. But the principles apply to any person who is living with a chronic disease, whether it is a rare or common one. Similarly, all elderly people are more vulnerable, because typically the immune system does not function as well when you grow old.

1. What is a comorbidity?

Comorbidity is the presence of one or more additional medical conditions often co-occurring or co-existing with a primary condition. In the context of COVID-19 it refers to existing chronic diseases that could put people at a higher risk of developing complications if they are infected with the Coronavirus.

People across all ages with existing comorbidities like diabetes and hypertension – which seem to be the most prevalent – are more at risk of becoming severely ill if they get COVID-19. This is why the Health Department is urging all South Africans to play their part in protecting the more vulnerable members of society – people with comorbidities at any age and people aged 59 and older with or without comorbidities – from becoming infected with the virus.

2. What comorbidities put people at a higher risk of contracting severe symptoms of COVID-19?

According to the Centre for Disease Control and Prevention (CDC), the top five comorbidities are hypertensionobesitychronic lung conditions like TB, COPD (chronic obstructive pulmonary disease), asthma and cystic fibrosis,  diabetes, and cardiovascular conditions like coronary heart disease, congenital heart disease and heart failure.

Other individuals at risk are older adults, aged 59 and over, people with autoimmune illnesses as well as compromised or suppressed immune systems due to cancer treatments or steroids. Pregnant women are also at a slightly higher risk.

COVID-19 severe symptoms mean your oxygen levels are below 93% and you require hospitalisation. If you are a person at higher risk, don’t panic because it also depends on how your comorbidities are being managed, the strength of your immune system and how much of a viral load you get exposed to, which will affect the risk factor even more. In other words, it is usually a combination of issues which lead to you getting severe symptoms.

3. If I have a comorbidity like hypertension, diabetes, asthma or heart disease but my immunity is usually very strong at fighting regular illnesses like colds and flu, does this put me at high risk of contracting COVID-19?

The presence of comorbidities does not necessarily put you at higher risk for contracting COVID-19, as everyone is equally at risk of becoming infected. Which is why we must all take precautions to prevent infection, including practicing social distancing and good hygiene (hand washing, sanitising and wearing a mask).

However, should you get infected and also have a comorbidity, you have a higher risk of getting it more severely. The severity of your symptoms will depend on how well you are taking care of yourself and managing your pre-existing condition.

4. If I have comorbidity, how can I give myself the best chance of recovery, in the event of contracting COVID-19?

The most important ways to protect yourself against the severity of the disease are :

  • Boost your immune system with the supplements Vitamin C, Vitamin D and Zinc
  • Maintain a healthy lifestyle and eating habits and exercise regularly
  • Continue with your usual treatment – make sure you never miss out on even a day of medication
  • Monitor and control your blood pressure if you suffer from hypertension
  • Monitor and control your glucose levels if you have diabetes
  • If you suffer from obesity, make every effort to lose weight
  • Make sure you have an adequate supply of medicine
  • Reduce exposure to tobacco smoke
  • Get seven to eight hours of sleep
  • Keep well hydrated, preferably by drinking water
  • Take care of your mental health by remaining calm and positive – try not get caught up in a cycle of stress

5. If you are younger than 59 with a comorbidity are you still at a high risk?

Certain underlying medical conditions may increase risk of serious COVID-19 disease for individuals OF ANY AGE. These include, but are not limited to, cancers, chronic lung disease including asthma, chronic bronchitis or emphysema, diabetes, chronic kidney, lung or heart disease. You must take steps to lower your risk of getting infected in the first place. In addition, do your best to keep your chronic conditions well controlled

6. One of the members in my household is being treated for cancer; how do we keep her safe from getting COVID-19?

Cancer patients on treatment are immunosuppressed and at a higher risk of developing severe symptoms if they become infected. The first course of action is to minimise their risk of potential infection.

Here are some good prevention tips for cancer patients:

  • Stay at home
  • Follow strict social distancing rules when out in public
  • Never shake hands or hug
  • Practice diligent hand washing with soap and water or apply sanitiser to hands after contact with surfaces inside and outside your home
  • Wear a face mask in public, crowded or small and enclosed places
  • Eat well and get plenty of sleep, which helps keep your immune system healthy

7. Why are people with rheumatologic (autoimmune) disease at a high risk?

Rheumatologic or autoimmune disease is characterised by inflammation that affects the connecting or supporting structures of the body – most commonly the joints but also, tendons, ligaments, bones and muscle. Some rheumatic diseases can affect the organs of the body.

People with rheumatic diseases are at increased risk of developing severe symptoms should they become infected with COVID-19.  This is due both to the disease itself and to the immunosuppressant medication used to treat these diseases. This vulnerability can affect people living with rheumatic conditions such as lupus, myositis, rheumatoid arthritis, scleroderma and many others.

8. Why are people with diabetes at high risk?

People with diabetes are at increased risk of developing severe symptoms and related complications from COVID-19. Diabetes patients have impaired immune response to infection. Poor glycaemic control impairs several aspects of the immune response to viral infection and also to potential secondary bacterial infection in the lungs.

Many patients with type-2 diabetes are obese, and obesity is also a risk factor for severe infection. Diabetes complications such as kidney disease and cardiac disease increases the severity of COVID-19 infection.

People with type-1 diabetes who have their blood sugar well controlled are at less risk of infection and getting severe COVID-19.

9. Why are people with hypertension at a high risk?

Hypertension, or high blood pressure, is the most common comorbidity globally. For older South Africans this poses a concern because it is quite common for people over the age of 60 to develop higher than normal blood pressure (according to StatsSA).

In fact, hypertension frequently co-exists with other underlying conditions such as diabetes, obesity and cardiovascular complications.

In patients with COVID-19, untreated hypertension is associated with approximately twofold increase in mortality, compared with treated hypertension. Doctors are therefore cautioning patients with high blood pressure to keep taking their medication and individuals older than 59 should have their blood pressure checked.

10. Why are people with cardiovascular diseases at a high risk?

Cardiovascular disease, involving disorders of the heart and blood vessels, is the third-biggest killer in South Africa after TB and diabetes. It is often linked to obesity, uncontrolled high blood pressure, smoking, diabetes and high cholesterol.

When blockages stop the blood flow from the arteries to the heart or brain, you can have a heart attack or stroke. Severe COVID-19 can damage your lungs which then causes your blood oxygen level to drop. It can also bring about inflammation which is more likely to make blood clots as well as cause your blood pressure to drop. When this happens, your heart has to pump faster and harder to circulate oxygen, and can strain a weak heart.

11. Why are people with obesity at high risk?

Did you know that at least 70% of South African women and something like a third of the country’s men are unhealthily overweight or obese? This means that more than eight million people live with obesity. This figure is higher than the number of South Africans living with HIV. One of the biggest reasons so many people suffer from obesity is a poor diet high in sugar.

People living with obesity are at higher risk of experiencing severe symptoms if they contract COVID-19. Obesity can also cause a chronic inflammatory state which affects immunity, which means that people who are overweight are more likely to get infections.

Multiple comorbidities are also common with obesity, such as type 2 diabetes and asthma, which affect the severity of the disease.

12. If my young child has asthma or diabetes, does this put him or her in the high-risk category?

Most children experience mild symptoms of COVID-19 if they become infected. They may even remain asymptomatic, but they can still be carriers and spread the virus.

However, children with certain underlying medical disorders may experience severe symptoms if they become infected. The types of disorders are asthma, diabetes and chronic kidney, lung, liver or heart disease.

Your child should continue to take his or her chronic medication to lower the risk of getting severely ill with COVID-19. Oral steroids and aerosol measures to control asthma should be continued to reduce the risk of complications.

13. Are there any medications for comorbidities that may put you at higher risk of experiencing severe COVID-19 symptoms?

Medications that suppress your immune system, like chemotherapy, may increase your chances of becoming severely ill if you are infected by COVID-19. However, it has not been proven that certain chronic medications, such as those used for hypertension and anti-inflammatories for pain and arthritis, might put you at greater risk.

How you respond to infection depends on many factors, medication being only one of them. It would be best to consult with your doctor first before changing your medication or stopping it altogether because this could make your underlying condition worse.

Medication compliance is essential in all chronic conditions and should only change if your doctor says so. Except for oral steroids (such as Prednisolone, Dexamethasone or Hydrocortisone) using prescribed medication should continue as normal during the COVID-19 pandemic. Do not take experimental and hypothetical drugs which you hear about without consulting with a specialist first.

14. I am taking my treatment for TB; what do you suggest I do if I become infected with COVID 19?

If you are experiencing mild symptoms, which may or may not be COVID-19 related, it is important to carry on taking your TB treatment to completely cure your TB. Also, inform your TB treatment provider and find out how to access COVID-19 diagnostic services it if you need to. There is no evidence currently that TB medications increase your risk of developing severe COVID-19 symptoms.

If you are diagnosed with COVID-19, let the healthcare provider know that you are on TB treatment. If you have been started on any treatment for COVID-19, your care provider can make sure there are no drug-to-drug interactions with other medications. This is particularly important if you are on treatment for drug-resistant TB as you are on more medications and you may be at more risk of drug-to-drug interactions.

As the impact of COVID-19 on people with TB and on treatment is unknown, you should, if possible, practice strict social distancing, wear a mask at all times around people and control infections to minimise your risk of getting infected.

15. Since the symptoms for TB are quite similar to COVID-19, what should a person look out for to know whether they have one or the other illness?

The symptoms of COVID-19 can be similar to those of TB, such as fever, cough and shortness of breath, but there is usually a difference in the speed that the symptoms start. COVID-19 symptoms are likely to come on much more quickly.

If you come into contact with someone known to have either TB or COVID-19, that increases your chance of contracting these diseases. If you are unwell and are showing the above symptoms and have been in contact with someone with either TB or COVID-19, it is important that you are tested for both. When you visit the healthcare facility, let them know your symptoms and any risk factors you may have for either TB or COVID-19 so they can ensure the appropriate infection prevention and control measures can be implemented while you wait for your diagnosis.

16. I have recovered from TB, does this still make me vulnerable to getting severe COVID-19 disease or becoming infected at all?

As COVID-19 is so new, there are no data currently on whether those who have TB or who have a previous history of TB are more at risk of worse outcomes. However, COVID-19 affects the lungs and, as we know, there is usually some left-over damage in the lungs following TB disease, which may put you at increased risk of developing more severe COVID-19 symptoms.

People who have had TB, particularly those who have had lung surgery or were diagnosed with post-TB lung disease, should consider avoiding exposure to high risk situations.

In addition to the advice regarding regular handwashing, regular cleaning of surfaces, wearing of masks in public, and practicing social distancing measures, some of the ways to protect yourself include keeping in good general health and not smoking.

Source Credit: lenmed

Stroke Signs and Symptoms

During a stroke, every minute counts! Fast treatment can lessen the brain damage that stroke can cause.

By knowing the signs and symptoms of stroke, you can take quick action and perhaps save a life—maybe even your own.

Signs of Stroke in Men and Women

  • Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking, or difficulty understanding speech.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
  • Sudden severe headache with no known cause.

Call 9-1-1 right away if you or someone else has any of these symptoms.

Acting F.A.S.T. Is Key for Stroke

Acting F.A.S.T. can help stroke patients get the treatments they desperately need. The stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for these if they don’t arrive at the hospital in time.

If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:

F—Face: Ask the person to smile. Does one side of the face droop?

A—Arms: Ask the person to raise both arms. Does one arm drift downward?

S—Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?

T—Time: If you see any of these signs, call 9-1-1 right away.

Note the time when any symptoms first appear. This information helps health care providers determine the best treatment for each person. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Treating a Transient Ischemic Attack

If your symptoms go away after a few minutes, you may have had a transient ischemic attack (TIA). Although brief, a TIA is a sign of a serious condition that will not go away without medical help.

Unfortunately, because TIAs clear up, many people ignore them. But paying attention to a TIA can save your life. Tell your health care team about your symptoms right away.

Polycystic Ovarian Syndrome (PCOS) and Obesity

This month we take a look at the link between PCOS and obesity in women.

Image Credit: Alena Menshikova/Shutterstock.com

Polycystic Ovarian Syndrome is often a sensitive topic. Most individuals are familiar with the common health risks linked to obesity, including type 2 diabetes, sleep apnea, coronary artery disease (CAD), high blood pressure and cancer; however, fewer know that women affected by obesity are also more likely to face reproductive problems like polycystic ovarian syndrome (PCOS).

What is PCOS?

PCOS is one of the most common hormonal disorders in women of reproductive age, affecting 5 to 10 percent. Women with PCOS have irregular menstrual bleeding and often have difficulty getting pregnant. The syndrome occurs when levels of hormones are abnormal. The name “polycystic ovarian syndrome” refers to the appearance of small cysts along the outer edge of the enlarged ovaries of women with this condition.

What Causes PCOS?

The exact cause of PCOS is unknown, but experts believe it is related to the production of an excess amount of androgens, a group of male sex hormones. Although all women produce some androgens, too much of this type of hormone prevents ovulation. Excess androgens also disrupt the normal menstrual cycle. They may cause infertility, acne and abnormal hair growth, such as excess facial hair or male pattern baldness. But, what causes a woman to produce excess androgens?

Many factors may play a role in the production of androgens, and thus the development of PCOS. For instance, excess insulin (the hormone that allows cells to use sugar) may be a factor in developing PCOS. Excess insulin leads to insulin resistance, which in turn decreases your ability to use insulin effectively. When the body cannot use insulin properly, it secretes more insulin to make glucose available to cells. The resulting excess insulin is thought to additionally boost androgen production by the ovaries.

Low-grade inflammation is another potential factor leading to PCOS. Research has shown that women with this condition often have low-grade inflammation. Heredity is also a factor. If your mother or sister has PCOS, you may have a greater chance of having PCOS.

Finally, even conditions before birth in the mother’s womb can be a factor contributing to PCOS. Excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working normally. These androgens can promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Because many factors can lead to the development of excess androgens, which is related to the development of PCOS, it is impossible to name a single, exact cause of this condition.

Does being Overweight Cause PCOS or Does PCOS Result in Obesity?

Both are possible. The link between PCOS and obesity is complicated. Signs and symptoms of polycystic ovarian syndrome begin for some females soon after they start having periods. Women with PCOS produce too much insulin, or the insulin they produce does not work as it should. The inability of insulin to function normally is one reason why women with PCOS tend to gain weight or have a hard time losing weight. For others, PCOS develops later on, following substantial weight gain. What is clear is that women affected by obesity have a greater risk for PCOS and women with PCOS have a greater risk for obesity.

What are the Symptoms of PCOS?

Although the symptoms vary from individual to individual, a diagnosis is usually made after two of the three following symptoms are found: menstrual irregularity, excess androgen and polycystic ovaries. Since there is no definitive test for PCOS, a doctor diagnoses this condition by ruling out other possible disorders. The physician’s diagnosis is based on findings from your medical history, physical and pelvic exam and pelvic ultrasound. Women diagnosed for PCOS also undergo blood tests that measure levels of several hormones in order to exclude potential causes of menstrual abnormalities or androgen excess.

Addressing Your Overall Health as Part of the Treatment for PCOS

Quitting smoking is generally the most positive action you can take to improve your health, and related to PCOS, it may lower the higher levels of androgens. Birth control pills and androgen reducing therapies can address the symptoms of PCOS, such as menstrual cycle problems, male-type hair loss and hair growth and acne. For women who wish to get pregnant, fertility drug treatment may also help start ovulation. For some women, a doctor might also prescribe the anti-diabetic drug metformin, or the fertility drug gonadotropins, to address insulin resistance.

And importantly, even modest weight-loss of 5 to 7 percent of body weight throughout six months can lower your insulin and androgen levels. Such a reduction, according to Dr. Huang and associates in the 2007 edition of Berek and Novak’s Gynecology, restores ovulation and fertility in more than 75 percent of women with PCOS.

Why is Early Diagnosis and Treatment of PCOS Important?

As with any chronic disease, finding it early helps a lot. That’s because PCOS makes a number of other diseases more likely. These include high blood pressure, type 2 diabetes, sleep apnea, abnormal uterine bleeding, cholesterol abnormalities, metabolic syndrome, heart disease, cancer of the uterus and complicated pregnancies. With early diagnosis and treatment of PCOS, doctors can reduce risk of these long-term complications.

What Treatments Can Help with PCOS?

No simple cure for PCOS exists. Fortunately, it can be controlled, decreasing the risk of long-term complications. Engaging in regular exercise, keeping a healthy diet, losing excess weight, quitting smoking and using medications to control hormones are all important parts of treatment for PCOS.

Daily exercise improves the body’s use of insulin, and many of the symptoms of PCOS may improve with at least 30 minutes of exercise a day. Furthermore, it is important to fuel your body with a healthy diet – one that includes many complex carbohydrates and is low in animal fats. The more fiber in a food, the slower it is digested, which has the advantage of causing your blood sugar levels to rise slower. Examples of high-fiber complex carbohydrates include whole-grain breads and cereals, whole-wheat pasta, brown rice, barley and beans.

Conclusion

PCOS is a common hormonal disorder that affects women of reproductive age. PCOS challenges the quality of life of the women who suffer from it. Yet with proper treatment, PCOS can be managed and symptoms can be relieved. In addition, early diagnosis and treatment of PCOS can help reduce the risk of long-term complications such as type 2 diabetes, heart disease and stroke. For more information on PCOS, visit the Polysystic Ovarian Support Association at www.pcosupport.org.

Source Credit: https://www.obesityaction.org/community/article-library/polycystic-ovarian-syndrome-pcos-and-obesity/

further references for reading: https://www.news-medical.net/news/20200720/Developing-a-Better-Understanding-of-Polycystic-Ovary-Syndrome-(PCOS).aspx

Covid 19 and the current situation with surgery

With the reported increase in the number of COVID-19 cases in South Africa at the moment, elective surgery may have to take a backseat for a second time this year since a nationwide lock-down was introduced in March 2020.

The following is an extract from The Federation of Surgeons of South Africa consensus document detailing the various surgical categories and their classification in terms of treatment under lock-down regulations:

With the requirement for our profession to provide critical care services and the possibility
that our operating theatres may be converted into Intensive Care Units, it becomes our
collective responsibility to take appropriate steps to support measures that will “flatten the
curve”. This is a dynamic document with it’s recommendation being effective at the time of
issue and may be updated or changed at any time.


At this stage we do not propose a list of surgical procedures, but rather categories into which
we encourage surgical/ procedural teams classify their patients into. For the purposes of this
document we define elective and other surgery/procedures as follows:


Discretionary elective and Essential surgery is surgery that is scheduled in advance and
where postponement of the surgery/ procedure will not result in the patient’s outcome or
quality of life being significantly altered with a 3 month delay.


Essential surgery is a surgery that is scheduled in advance and where postponement of the
surgery will result in the patient’s outcome or quality of life being significantly altered if
extended past 2 weeks to 3 months.


Urgent, essential surgery is surgery that must be performed in order to preserve the patient’s
life or limb or prevent longer term systemic morbidity, but does not need to be performed
immediately and should be generally performed within 2 weeks.


Emergency surgery is one that must be performed without delay or until the patient is
medically stable; the patient has no choice other than to undergo immediate surgery if
permanent disability or death is to be avoided.


It is impossible to define the medical urgency of a case solely on whether a case is on an
elective surgery schedule. While some cases may be postponed indefinitely, the majority of
cases performed are associated with progressive diseases which by their nature will continue
to progress at variable, disease specific rates. Hence the judgement as to whether or not a
surgical intervention should take place can only be decided once numerous considerations
have been observed.

Given the uncertainties regarding the impact of COVID –19, delaying
some cases risks having them reappear as emergencies at a time when they will be less easy
to manage. FOSAS strongly urges communication and collaboration between hospital
clinicians and their administrative staff to consider the following recommendations:

  1. Hospitals and surgical teams should consider both their patient’s medical needs and
    their logistical capacity to meet those needs in an appropriate time frame.
  2. The medical need for a given procedure should be established by a surgeon with
    direct expertise in the relevant surgical speciality to determine which medical risks
    will be incurred by a delay.
  3. Logistical feasibility for a specific procedure should be determined by management
    personnel with an understanding of hospital and community limitations. This includes
    facility resources (eg. beds, staff, equipment etc.) as well as the safety and well-being
    of care providers and local community.
  4. Case conduct should be determined based on knowledge of national, regional and
    local evolving conditions, recognizing that marked regional variation may lead to
    significant differences in regional decision making.
  5. The risk to the patient should include an aggregate assessment of the real risk of
    proceeding and the real risk of delay, including the expectation that a delay of
    several weeks (or months) may be required to emerge from to an environment where
    COVID – 19 is less prevalent.
    In general, a day by day, evidence driven assessment of the changing risk-benefit
    analysis will need to influence clinical care decisions and delivery for the foreseeable
    future. Plans for case triage should avoid blanket policies and instead rely on data and
    expert opinion from qualified (and well informed) clinicians and management teams
    understanding all COVID–19 issues in play. Although COVID–19 is a clear risk to all,
    it is but one of many competing risks for patients requiring surgical care. Thus, surgical
    procedures should be considered not based solely on COVID–19 associated risks, but
    rather on an assimilation of all available medical and logistical information.

Source Credit: http://www.surgeon.co.za/wp-content/uploads/2020/05/FOSAS-Consensus-Document-on-Resumption-of-Elective-Surgery.pdf

Laparotomy: Everything you need to know

Laparotomy is a type of open surgery of the abdomen to examine the abdominal organs.

Surgeons may use this surgery to diagnose and treat a variety of abdominal conditions.

Here, we look at the types and uses of laparotomy, as well as what people can expect during and after laparotomy surgery.

What is it?

surgeons performing a Laparotomy
A laparotomy may help doctors diagnose certain abdominal conditions.

Laparotomy is a surgical procedure that involves a surgeon making one large incision in the abdomen.

Doctors use laparotomy to look inside the abdominal cavity to diagnose or treat abdominal health conditions.

Uses

Doctors may use laparotomy for a variety of reasons. It can help them diagnose or treat abdominal conditions, such as:

  • abdominal pain
  • abdominal trauma
  • peritonitis, which is an inflammation of the inner lining of the abdomen
  • a perforated organ in the abdomen
  • infection in the abdomen
  • internal bleeding
  • the spread of conditions such as cancer or endometriosis

Females may have a laparotomy for a hysterectomy, which is the removal of the uterus, or for the removal of the ovaries or fallopian tubes.

Types

There are different types of incisions for laparotomy:

  • Midline: This incision runs down the middle of the abdomen. It is the standard incision for laparotomy. If people only need surgery for their upper abdomen, the incision will not run the whole length of the abdomen.
  • Paramedian: A paramedian incision is a vertical cut that runs to one side of the midline. It allows a surgeon to access the kidneys and adrenal glands.
  • Transverse: A transverse incision is a horizontal cut. Surgeons may choose to use this approach because it can cause less damage to the nerves supplying the abdominal muscle, and it heals well.
  • Pfannenstiel: Surgeons may use a Pfannenstiel incision to access the pelvic region, such as in the case of an emergency cesarean delivery.
  • Subcostal: A subcostal incision is a diagonal cut across one side of the upper abdomen. A surgeon may use a subcostal incision to access the gallbladder or liver on the right side or the spleen on the left side.
  • Rooftop (chevron): If the surgeon makes a subcostal incision on each side of the body, the incisions may meet in the middle to make a rooftop incision.

What to expect

Before the operation, a person can expect the following:

  • a doctor will ask them not to eat for a certain number of hours before the operation
  • a doctor may give them an enema beforehand, which empties the bowels
  • the person may shower first with a surgical lotion, before putting on a theater gown
  • a healthcare professional will shave any hair in the abdominal area
  • an anesthetist will ensure that everything is ready for the operation and note any allergies that the person may have

During the operation, people will be under general anesthetic. A surgeon will make one incision to cut through the abdominal skin and muscle to reveal the organs in the abdomen.

They will then examine the organs to diagnose any issues. If they can make a diagnosis, surgeons may be able to treat the condition straight away.

For conditions that surgeons cannot immediately treat, people may require repeat surgery.

After the diagnosis and the completion of any possible treatment, the surgeon will sew up, or suture, the incision.

Following the operation, the person will slowly wake up from the anesthetic. They will remain in the hospital for immediate aftercare.

This aftercare may include:

  • careful monitoring of temperature, pulse, breathing, and blood pressure
  • assessment of the wound site and wound care, possibly including drainage
  • a tube through the nose into the stomach to drain the stomach for a day or two, if necessary, to help the digestive tract recover
  • the insertion of a urinary catheter to drain urine, if necessary
  • intravenous fluids, as people may have to avoid eating and drinking for a few days
  • regular pain relief medication to ease discomfort
  • deep breathing, leg exercises, and walking the day after the operation to help reduce the risk of chest infections and blood clots

Some people feel nauseated after receiving an anesthetic. A doctor may be able to provide medication to relieve nausea.

Once the person is well enough to leave the hospital, a doctor will provide details of how to care for the abdominal wound at home.

The doctor will also provide any necessary medication and advice on how to rest and recover.

Recovery

As people can undergo a laparotomy for a wide range of reasons, the recovery time can vary significantly among individuals. Many other factors, including the person’s age and overall health, will also determine how long it takes them to feel better.

People can take steps at home to rest and allow their body to recover. These include:

  • resting as much as possible for days to weeks, depending on the doctor’s recommendation
  • continuing to move around and do any exercises that a doctor has set
  • getting other people to help around the home and with daily tasks, where possible
  • following all dietary guidelines from a doctor
  • taking medication as a doctor prescribes
  • avoiding all heavy lifting, including pulling or pushing items, sexual activity, and swimming for 6 weeks

It is usual to feel tired with low energy during recovery, as the body is healing. It is also quite common to experience a wide range of emotions and have difficulty sleeping.

People may be unable to drive during recovery, either because they are allowing their body to heal or due to the medications that they are taking. A person can check with their doctor and inform their insurance company if this is the case.

It is important to contact a doctor as soon as possible if any signs or symptoms of infection appear around the wound site. These may include:

  • increased pain or tenderness
  • redness
  • swelling
  • discharge from the wound site
  • fever or chills
  • vomiting or nausea

People should also seek medical help straight away if they have any symptoms of a blood clot, including:

  • difficulty breathing
  • chest pain
  • severe leg pain

People can carefully follow the doctor’s instructions and ensure that they have a final checkup at the end of their recovery period.

Source Credit: https://www.medicalnewstoday.com/articles/laparotomy#recovery

146 000 elective surgeries in SA could be cancelled due to Covid-19

As South Africa continues to focus on ploughing health, financial and human resources into the national response against the Covid-19 coronavirus, there is collateral damage in hospitals.

The Covid-19 pandemic has disrupted routine hospital services globally, and a new study estimates that 146 000 elective surgeries in this country could be cancelled as a result of the crisis (iStock)

The pandemic has disrupted routine hospital services globally, and a new study estimates that 146 000 elective surgeries in this country could be cancelled as a result of the crisis – leading to patients facing a lengthy wait for their health issues to be resolved.

Worldwide, the CovidSurg Collaborative, a research network of 5 000 surgeons from 120 countries, has projected that based on a 12-week period of peak distribution to hospital services due to Covid-19, 28.4 million elective surgeries will be cancelled or postponed this year.

The modelling study, published in the British Journal of Surgery this week, shows that each additional week of disruption to hospital services will result in a further 2.4 million cancellations.

Led by researchers from the University of Birmingham, UK and the University of Cape Town (UCT), they collected detailed information from surgeons in 359 hospitals across 71 countries on plans for the cancellation of elective surgery.

This data was then statistically modelled to estimate the total number of cancelled surgeries across 190 countries.

The researchers projected that worldwide 72.3% of planned surgeries will be cancelled during the peak period of Covid-19 related disruption.

Most cancelled surgeries will be for non-cancer conditions. Orthopaedic procedures will be cancelled most frequently, with 6.3 million orthopaedic surgeries cancelled worldwide over a 12-week period. It is also projected that globally 2.3 million cancer surgeries will be cancelled or postponed.

In South Africa, more than 146 000 operations will be cancelled, including 12 000 cancer procedures. These cancellations will create a backlog that will need to be cleared after the Covid-19 disruption ends.

Professor Bruce Biccard, second chairperson in the department of anaesthesia and perioperative medicine at UCT, said: “Each additional week of disruption to hospital services results in an additional 12 000 surgeries being cancelled. Following the surge in the epidemic, we are going to need a continuous assessment of the situation, so that we can plan a safe resumption of elective surgery at the earliest opportunity.

DURING THE COVID-19 PANDEMIC ELECTIVE SURGERIES HAVE BEEN CANCELLED TO REDUCE THE RISK OF PATIENTS BEING EXPOSED TO THE VIRUS IN HOSPITAL

Aneel Bhangu, consultant surgeon and senior lecturer at the National Institute for Health Research

“Clearing the backlog of elective surgeries created by Covid-19 is going to result in a significant additional cost for the national health department. Government will have to ensure that the department is provided with additional funding and resources to ramp up elective surgeries to clear the backlog.”

Aneel Bhangu, consultant surgeon and senior lecturer at the National Institute for Health Research unit on global surgery at the University of Birmingham, said: “During the Covid-19 pandemic elective surgeries have been cancelled to reduce the risk of patients being exposed to the virus in hospital, and to support the wider hospital response, for example by converting operating theatres into intensive care units.

“Although essential, cancellations place a heavy burden on patients and society. Patients’ conditions may deteriorate, worsening their quality of life as they wait for rescheduled surgery. In some cases, for example cancer, delayed surgeries may lead to a number of unnecessary deaths.

Source Credit: https://city-press.news24.com/News/146-000-elective-surgeries-in-sa-could-be-cancelled-due-to-covid-19-20200515

Elective surgery during the COVID-19 pandemic may increase complications — small China study

Image Credit: Shutterstock

A study in Wuhan, China’s COVID-19 epicentre suggests that having surgery during the coronavirus incubation period is likely to complicate or prolong your hospital stay. Researchers behind the first study of the effects of surgery on COVID-19 progression said that surgery might accelerate and worsen the disease.

Researchers from Renmin Hospital at Wuhan University and the University of Hong Kong found that 34 surgical patients who were later treated for COVID-19 complications had a 21% mortality rate, versus 2% for nonsurgical COVID-19 patients. Surgical patients also developed symptoms within two days of surgery compared to between five and eight days for the others.

“Surgery may not only cause immediate impairment of immune function but also induce an early systemic inflammatory response,” said lead researcher Shaoqing Lei.

The Times reports that says many hospitals in South Africa have postponed elective surgery, but authorities showed mixed reactions to the Chinese study. Mark van der Heever, spokesperson for the Western Cape Health Department, said the study sample was small and the patients involved had serious cancer procedures and even kidney transplants. “It is not relevant to our population or to any routine elective surgery,” he said.
However, “the department issued a public notice informing clients that … elective surgery will be cancelled”.

Netcare group medical director Anchen Laubscher said the hospital group is postponing all elective surgery, “provided that this will not result in the patient’s outcome or quality of life being significantly altered”.

Abstract
Background: The outbreak of 2019 novel coronavirus disease (COVID-19) in Wuhan, China, has spread rapidly worldwide. In the early stage, we encountered a small but meaningful number of patients who were unintentionally scheduled for elective surgeries during the incubation period of COVID-19. We intended to describe their clinical characteristics and outcomes.
Methods: We retrospectively analyzed the clinical data of 34 patients underwent elective surgeries during the incubation period of COVID-19 at Renmin Hospital, Zhongnan Hospital, Tongji Hospital and Central Hospital in Wuhan, from January 1 to February 5, 2020.

Findings: Of the 34 operative patients, the median age was 55 years (IQR, 43–63), and 20 (58·8%) patients were women. All patients developed COVID-19 pneumonia shortly after surgery with abnormal findings on chest computed tomographic scans. Common symptoms included fever (31 [91·2%]), fatigue (25 [73·5%]) and dry cough (18 [52·9%]). 15 (44·1%) patients required admission to intensive care unit (ICU) during disease progression, and 7 patients (20·5%) died after admission to ICU. Compared with non-ICU patients, ICU patients were older, were more likely to have underlying comorbidities, underwent more difficult surgeries, as well as more severe laboratory abnormalities (eg, hyperleukocytemia, lymphopenia). The most common complications in non-survivors included ARDS, shock, arrhythmia and acute cardiac injury.
Interpretation: In this retrospective cohort study of 34 operative patients with confirmed COVID-19, 15 (44·1%) patients needed ICU care, and the mortality rate was 20·5%.
Funding: National Natural Science Foundation of China.

Authors
Shaoqing Lei, Fang Jiang, Wating Su, Chang Chen, Jingli Chen, Wei Mei, Li-Ying Zhan, Yifan Jia, Liangqing Zhang, Danyong Liu, Zhong-Yuan Xia, Zhengyuan Xia
Full report in The TimeseClinical Medicine abstract

We Are Open

Due to the fact that the Department of Health has closed St Augustine’s hospital for any new patients, our practice has been forced to base ourselves at Umhlanga Hospital.   This will enable us to treat relatively urgent cases, usually requiring admission (complying with DOH health care risk guidelines).  All elective procedures have been curtailed at ALL hospitals.

We are available to assist referring practitioners with consultations for their patients.  Urgent cases should be discussed with the receiving doctor directly.

The more elective consultations will involve a 3 step process, ie: an initial screening by the receptionist followed by a telephonic consultation with one of the accepting doctors and if the need then arises, a patient will be seen in person at the rooms or in hospital.

We remain at your service in these difficult and uncertain times.

COVID-19 alert

Stay at home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority. Source: World Health Organisation

What Does COVID-19 Do to Your Lungs?

COVID-19 was first identified late last year as a cluster of pneumonia cases caused by a new coronavirus. Doctors have since learned that it’s a respiratory disease, one that especially reaches into your respiratory tract, which includes your lungs.

COVID-19 can cause a range of breathing problems, from mild to critical. Older adults and people who have other health conditions like heart diseasecancer, and diabetes may have more serious symptoms.

Here’s what the new coronavirus does to your lungs.

Coronavirus and Your Lungs

SARS-CoV-2, the virus that causes COVID-19, is part of the coronavirus family.

When the virus gets in your body, it comes into contact with the mucous membranes that line your nose, mouth, and eyes. The virus enters a healthy cell and uses the cell to make new virus parts. It multiplies, and the new viruses infect nearby cells.CONTINUE READING BELOW

Think of your respiratory tract as an upside-down tree. The trunk is your trachea, or windpipe. It splits into smaller and smaller branches in your lungs. At the end of each branch are tiny air sacs called alveoli. This is where oxygen goes into your blood and carbon dioxide comes out.

The new coronavirus can infect the upper or lower part of your respiratory tract. It travels down your airways. The lining can become irritated and inflamed. In some cases, the infection can reach all the way down into your alveoli.

COVID-19 is a new condition, and scientists are learning more every day about what it can do to your lungs. They believe that the effects on your body are similar to those of two other coronavirus diseases, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

Mild and Moderate Cases

As the infection travels your respiratory tract, your immune system fights back. Your lungs and airways swell and become inflamed. This can start in one part of your lung and spread.

About 80% of people who have COVID-19 get mild to moderate symptoms. You may have a dry cough or a sore throat. Some people have pneumonia, a lung infection in which the alveoli are inflamed.

Doctors can see signs of respiratory inflammation on a chest X-ray or CT scan. On a chest CT, they may see something they call “ground-glass opacity” because it looks like the frosted glass on a shower door.

Severe Cases

About 14% of COVID-19 cases are severe, with an infection that affects both lungs. As the swelling gets worse, your lungs fill with fluid and debris.

You might also have more serious pneumonia. The air sacs fill with mucus, fluid, and other cells that are trying to fight the infection. This can make it harder for your body to take in oxygen. You may have trouble breathing or feel short of breath. You may also breathe faster.

If your doctor takes a CT scan of your chest, the opaque spots in your lungs look like they start to connect to each other.

Critical Cases

In critical COVID-19 — about 5% of total cases — the infection can damage the walls and linings of the air sacs in your lungs. As your body tries to fight it, your lungs become more inflamed and fill with fluid. This can make it harder for them to swap oxygen and carbon dioxide.

You might have severe pneumonia or acute respiratory distress syndrome (ARDS). In the most critical cases, your lungs need help from a machine called a ventilator to do their job.

COVID-19 Complications

It can take time to feel better after you have pneumonia. You may feel more tired than usual for a while. You might also find that you can’t exercise like you used to.

Some people had a cough even after they recovered from COVID-19. Others had scarring in their lungs. Doctors are still studying whether these effects are permanent or might heal over time.

Source Credit: webMD Medical Reference Reviewed by Neha Pathak, MD on March 25, 2020 https://www.webmd.com/lung/what-does-covid-do-to-your-lungs#1

Cholesterol Disorders

Cholesterol Disorders

Alternative names: Hyperlipidemia, Hyperlipoproteinemia, Hypolipidemia, Hypolipoproteinemia

What are cholesterol disorders?
What are the signs of cholesterol disorders?
What causes cholesterol disorders?
How does my doctor tell if I have a cholesterol disorder?
How are cholesterol disorders treated?

What are cholesterol disorders?

Cholesterol is essential for life, and is found in the body cells of all animals, including humans. Your body needs cholesterol to work properly. Two cholesterol disorders are hyperlipidemia, and hypolipidemia.

Hyperlipidemia means you have an unusually high level of fat (lipids) in your blood. This puts you at risk for many health problems, including heart attack and stroke. It is sometimes called high blood cholesterol.

Hypolipidemia means you have an unusually low level of fat in your blood. It is sometimes called low blood cholesterol.

What are the signs of cholesterol disorders?

There are two basic kinds of cholesterol: LDL (low-density lipoprotein, or “bad cholesterol,”) and HDL (high-density lipoprotein, or “good cholesterol”).

In a patient with high blood cholesterol, LDL cholesterol builds up in the inner walls of the arteries that carry blood to the heart and brain. Although many people with high cholesterol levels have no symptoms, this narrowing of the arteries (arteriosclerosis) can cause angina (chest pain), heart attack, and stroke.

Low blood cholesterol rarely causes symptoms, but it may indicate the presence of another disorder.

What causes cholesterol disorders?

High blood cholesterol

When you eat meat, eggs, and dairy products – any food that comes from an animal – you are adding cholesterol to your blood. A diet high in saturated fat and cholesterol is just one thing that may cause high blood cholesterol. Other factors include:

  • Being overweight
  • Not exercising regularly
  • Overuse of alcohol
  • Family history. High blood cholesterol can be an inherited condition.
  • Age and sex. As you age, your LDL (“bad cholesterol”) level rises. After age 55, women have higher LDL levels than men.
  • Diseases like diabetes, hypothyroidismCushing’s syndrome, and kidney failure
  • Medications like birth control pills, beta-blockers, estrogen, corticosteroids, and certain diuretics

Low blood cholesterol

Hypolipidemia can be caused by several things:

  • Hypothyroidism
  • Anemia (a low amount of red blood cells)
  • Malnutrition, or a lack of food
  • Liver disease
  • The body being unable to absorb food (malabsorption)
  • Rare genetic conditions, such as hypobetalipoproteinemia and abetalipoproteinemia
  • Tangier disease

How does my doctor tell if I have a cholesterol disorder?

Blood cholesterol tests tell how much fat is in your blood. A total cholesterol level test measures both your LDL (low-density lipoprotein, or “bad cholesterol,”) and HDL (high-density lipoprotein, or “good cholesterol”) levels in milligrams per deciliter (mg/dL).

Normal total cholesterol levels are below 200 mg/dL. HDL levels should be above 40 mg/dL. Triglyceride levels also should be below 200 mg/dL.

How are cholesterol disorders treated?

High blood cholesterol

Lifestyle

  • Follow a healthful diet, eating foods low in total fat and saturated fat
  • Maintain a healthful weight
  • Exercise at least three times a week, for 30 minutes at a stretch
  • Have your total cholesterol rechecked in one to two years if:
    • Your cholesterol reading was above 240 mg/dL
    • You have other risk factors for heart disease, such as high blood pressure, diabetes, or being overweight

Medications

  • Statins lower LDL (“bad cholesterol”) levels
  • Bile Acid Sequestrants (seh-KWES-trants) are sometimes prescribed with statins, and help lower LDL cholesterol levels
  • Nicotinic (Nick-o-tin-ick) Acid lowers LDL cholesterol and triglycerides, and raises HDL (“good” cholesterol) levels
  • Fibrates lower triglyceride levels, and may increase HDL levels
  • Ezetimibe blocks cholesterol absorption, and lowers LDL cholesterol

Low blood cholesterol

Treatment focuses on the root causes of hypolipidemia

Side note:  Gastric bypass surgery can help lower cholesterol and improve the ratio of total cholesterol to HDL (good) cholesterol (Surgery to Treat High Cholesterol?)

Source Credit: https://www.dartmouth-hitchcock.org/endo/cholesterol_disorders.html