Medical News

How do you stop snoring?

Snoring occurs when a person’s upper airway tissue vibrates, making them breathe noisily as they sleep. It is a common issue that affects most people at some time during their lives.

Snoring is often not thought to be a serious health concern, and home remedies may reduce it. If these do not work, medical treatment may be available.

Sometimes snoring indicates a more serious health problem. If it becomes disruptive or a person has other symptoms, it is best to see a doctor.

Causes

During waking hours, the tissues in the throat and upper airway are open, and air enters the lungs easily for most people.

During sleep, the soft tissues and tongue relax. This can partially block the airway. If the air coming in and out of the airway meets resistance, vibration can occur, causing snoring.

Factors that can lead to snoring include:

• smoking
• drinking alcohol
• using depressants or other muscle relaxants
• sleeping on your back
• congestion from a cold or allergy
• a deviated septum or other structural features
• being middle-aged
• being male
• pregnancy
• genetic characteristics that affect the structure of the mouth and throat

According to the American Academy of Sleep Medicine, around 40% of adult males and 24% of adult females snore regularly.

Snoring is more common during middle age, while males aged over 70 years are less likely to snore than younger males.

Research also suggests that people who snore are more likely to have:

• obesity
• stress
• low levels of high-density lipoprotein, or “good” cholesterol

These factors all increase the risk of cardiovascular disease. However, experts do not know what exact role snoring plays in these conditions or whether they are a cause or an effect.

Learn here about sleeping positions for good health.

Sleep apnea

Snoring is a symptom of sleep apnea. A person who experiences this condition may appear to stop breathing for a while as they sleep, then make choking or gasping sounds.

There are two types:

• Obstructive sleep apnea involves a structural blockage. This type of sleep apnea often has links with snoring.
• Central sleep apnea is due to a problem with the central nervous system that controls breathing. This type of sleep apnea is not associated with snoring.

Apart from loud snoring, a person with sleep apnea may also experience:

• daytime sleepiness
• insomnia
• morning headaches
• difficulty concentrating or remembering things
• irritability
• low libido, or sex drive

Sleep apnea has links with other conditions, such as hypertension, congestive heart failure, hypothyroidism, or problems relating to the nervous system.

Some research suggests that approximately 50% of people with hypertension may have sleep apnea. Experts also believe that sleep apnea contributes to high blood pressure.

Home remedies

Several home remedies may help with snoring.

Avoiding alcohol and sedating medications

Drugs that act as depressants or sedatives aim to relax muscles, which can lead to snoring. Alcohol also acts as a depressant.

People should only use prescription or over-the-counter sleep aids under the guidance of a doctor.

Relieving nasal obstruction

Nasal congestion is often due to inflammation. Medicines and other techniques can help reduce congestion and inflammation.

They include:

• nasal strips
• corticosteroid and moisturizing nasal sprays
• antihistamines
• a room humidifier

Changing sleep positions

Sleeping position may affect snoring. A person who sleeps on their back can cause their tongue to relax and block the airway.

Alternative sleeping positions and methods to try include:

• sleeping on your side
• raising the head of the bed by a few inches
• using an anti-snore pillow to improve neck position

Another tip is to sew a tennis ball or other soft object in the back of a person’s sleep shirt. This might help prevent rolling over to the back sleeping position. There are also positional sleepers available online to help a person avoid sleeping on their back.

Weight management

In a person with obesity, fat tissue can surround and narrow the airway, obstructing the airflow, which can lead to snoring.

Maintaining a moderate weight may reduce the risk of snoring.

Oral appliances

A custom-fitted oral appliance, similar to a retainer or mouth guard, may help keep the airway open by moving the tongue and jaw slightly forward.

A specially trained dentist can design this device for a person.

Throat exercises

Research suggests that throat exercises may help strengthen throat muscles and prevent them from collapsing during sleep in some people. However, the study results are mild and inconsistent, while practitioners cannot agree on what these standardized exercises should be.

Here are examples of exercises that some experts recommend:

• Repeating each vowel (“a, e, i, o, u”) out loud several times a day for 3 minutes.
• Closing your mouth and pursing your lips, and holding this for 30 seconds.
• Opening your mouth and tightening the muscle at the back of the throat for 30 seconds. Repeat several times.
• Making a vowel sound intermittently and then continuously for 3 minutes each day.
• Putting the tip of the tongue behind the top front teeth, and then sliding the tongue backward. Do this for 3 minutes every day.
• Pushing the tongue against the roof of the mouth for 3 minutes each day.
• Pressing the tongue into the bottom of the mouth while keeping the tip against the front teeth for 3 minutes a day.
• Opening the mouth and moving the jaw to one side. Hold for 30 seconds, then repeat on the other side.

A person will need to practice these exercises consistently and regularly to see results.

Quitting smoking

Tobacco smoke is an irritant that can result in tissue inflammation. The upper airway is a narrow passage, so even small amounts of inflammation can restrict airflow.

Quitting smoking can help reduce this risk and lower the likelihood of other diseases and conditions.

Following good sleep hygiene practices

Develop a good sleep hygiene program by getting consistent sleep on a comfortable bed, in a dark, cool room. Experts link inadequate sleep with weight gain, which can lead to snoring.

Where possible, follow these tips for getting a good night’s sleep:

• ensuring the bed is comfortable
• making sure the room is cool and quiet
• using blinds or heavy curtains to restrict outside light
• sticking to a regular sleeping and waking schedule, even on weekends
• avoiding screen time before sleeping
• avoiding eating large meals and drinking fluids close to bedtime
• taking part in exercise, but not within 2–3 hours of bedtime
• avoiding caffeine and nicotine
• keeping smartphones and other devices outside the room

Medical treatments

If a person’s snoring or sleep apnea is severe, a doctor may suggest treatment alongside lifestyle measures.

Continuous positive airway pressure (CPAP)

This is the first-line treatment for people with obstructive sleep apnea. A person wears a specialized mask during sleep that delivers pressurized air.

Surgery

In some cases, surgery may help resolve severe snoring. Several options are available for people with snoring or sleep apnea, but results are often difficult to predict and less robust than CPAP.

They include:

• Palatal implants, which involve inserting small fiber rods into the soft palate to stiffen loose tissue.
• Septoplasty can help straighten a deviated nasal septum.
• Uvulopalatopharyngoplasty removes excess tissue from the soft palate and uvula.
• Radiofrequency stiffens loose tissue in and around the throat and tongue.
• Genioglossus advancement involves moving the tongue attachment forward to allow for more breathing space.

There are risks with all types of surgery, so it should be a last resort.

When to speak with a doctor

Heavy snoring and sleep apnea can disrupt sleep, leading to fatigue and difficulty concentrating. A lack of sleep can also increase the risk of some mental health issues.

If a person experiences severe snoring, especially with other symptoms, they may wish to seek medical advice.

A medical professional or dental specialist can help determine any underlying causes, and they may suggest ways of stopping or reducing snoring.

Summary

Snoring occurs due to the airway tissues vibrating during sleep. It can occur for various reasons.

Snoring may indicate a medical condition. It can also lead to embarrassment and can disrupt the sleep of the person and other nearby partners or people.

A doctor may advise a person on how to reduce their snoring.

Source Credit: https://www.medicalnewstoday.com/articles/303834

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 hypertension, obesity, chronic 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.

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?

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

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

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 XiaFull 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