Rajeev is a fitness coach living the fast-paced metropolitan life! He is a bachelor in his late thirties, and has a great track record of helping his clients reach their fitness objectives.Even though he’s excellent at training others, he constantly neglects taking care of himself, ignoring persistent problems such as sweating profusely and experiencing shortness of breath when engaging in certain physical activities like walking fast for a short period or climbing a flight of stairs.One day, while climbing the stairs to his apartment, Rajeev began experiencing immense pain in his chest and consequently collapsed on the spot. Luckily, his neighbour found him and immediately called Apollo Hospitals.  Rajeev was rushed to the hospital without delay and was referred to Apollo’s cardiology team. His doctor ran an angiogram and found that he had a coronary artery disease that needed immediate surgery called Coronary Artery Bypass Graft (CABG).This diagnosis shocked Rajeev as he always thought his breathlessness was a symptom of ageing and perhaps exaggerated due to lack of exercise. He never imagined in his wildest dreams that it was a symptom of an underlying heart condition – especially given the fact that he was not visibly obese and thought he  led a fit and healthy  lifestyleRajeev’s cardiologist at Apollo Heart Institute explained that early symptoms of coronary artery disease tend to go unnoticed, and the condition will worsen till there is enough arterial blockage to cause major symptoms and complications. Rajeev had a heart attack because the blood supply to his heart muscle had continued to deteriorate as a result of increased blockage of a coronary artery. The tissue was dying as blood flow to the afflicted portion of the heart muscle could not  be restored naturally.His cardiologist reassured him and asked him not to worry. He expressed confidence, given 10,000+ hours of combined experience in cardiovascular care possessed by Apollo, that they would  be able to treat Rajeev’s condition successfully and enrol him into a special post-operative recovery plan that would be highly effective in avoiding future complications and quickly achieving normalcy, the Apollo Healthy Heart program.What is the Apollo Healthy Heart Program?Introduced by the Apollo Heart Institute, Apollo Healthy Heart Program is India’s first-ever heart disease prevention and reversal program. This program is tailored to promote a healthy heart and reduce the risk of:heart diseasesstroke and heart attacksreversing the recovery from heart diseaseThis program is designed to keep patients informed about preventing and managing cardiovascular diseases through education and exercise. The Healthy Heart Program includes education and support on a variety of risk factors that can affect heart health, including diet, activity, cholesterol, and diabetes.The program’s goal is to help patients live well by lowering their risk of heart and blood vessel illness, as well as preserving and improving their heart health.But before joining this program, an emergency CABG surgery had to be performed  on Rajeev. Before we learn more on how Rajeev responded to the CABG surgery and the Healthy Heart program, let’s quickly look at what  coronary artery disease and CABG is.What is coronary artery disease and CABG?Coronary artery disease is a medical condition in which the coronary arteries, which supply oxygen to the heart ,  are blocked or become narrow due to the accumulation of plaque. Plaque creates a constriction or blockage in the arteries, leading to a heart attack. Chest pain or discomfort, as well as shortness of breath, are common symptoms.A Coronary Artery Bypass Graft, or CABG, is a surgical procedure performed for the treatment of coronary artery disease. It helps restore blood flow and oxygen supply to the heart by diverting blood around blocked or congested portions of the major arteries.What happened to Rajeev once the CABG was performed?Rajeev’s surgeon advised him to get the surgery as fast as possible, and eliminate the risk of heart attacks in the near future. He also explained that when this procedure was combined with a preventive healthcare program, the Apollo Healthy Heart programme , there wouldn’t need to be any more worries about this condition recurring.  The CABG procedure usually takes around 3 to 6 hours to complete, which in Rajeev’s case was close to 4 hours, and it was performed under general anesthesia.Post-surgery, Rajeev was advised to stay in the hospital for close to 7 days. During his recovery, his cardiologist took him through the Apollo Healthy Heart program and educated him on why this program was essential for him, going forward.What benefits did Rajeev gain by joining the program?On joining Apollo Healthy Heart program, Rajeev was educated on various healthy lifestyle practices and was able to assimilate  the following information, tips and health-linked regimens:His ability to exercise and carry out activities was checkedHis blood cholesterol was checkedHis risk of heart disease was checkedHe received education about his heart healthHe received counseling regarding his dietHe received an exercise regimenHe received sessions on yoga and meditationHe received education from a social worker on smoking cessation,  depression and stress managementApollo Healthy Heart program also offered Rajeev the following additional benefits:Quarterly Healthy heart doctor consultationQuarterly cardiologist consultationQuarterly dietary consultationQuarterly physiotherapist consultationQuarterly social worker consultation for patient educationQuarterly yoga and meditation consultationWeekly and monthly calls by a Healthy Heart doctor to ensure compliance with the programApollo Healthy Heart Program helped Rajeev get back on track!Rajeev had to undergo coronary artery bypass graft surgery (CABG) to restore blood flow to his heart muscle after a blockage of one of his coronary arteries. While the surgery was highly effective, Rajeev understood the importance of maintaining a clean, healthy lifestyle; and Apollo Healthy Heart program was the right platform to get him started on this journey.We must keep in mind that Rajeev’s case is not unique. With many working professionals completely dedicating their time and energy to their jobs, the prevalence of heart diseases is at an all-time high. People, especially working professionals, need to be educated on the importance of putting health first, and building a healthy and sustainable lifestyle around it. That’s why it’s highly recommended to join Apollo Healthy Heart program to gain complete control of your heart’s health and avoid life-threatening situations (like heart attacks) from happening in the future.

Balaji is a businessman who owns a garment shop in one of the busiest streets in Chennai. He travels to his shop on his two-wheeler, threading through heavy and chaotic traffic every day. His job requires him to sit for long hours overseeing his staff and to wait on clients, and he smokes on occasion, primarily to while away time, waiting for potential customers. There are numerous eateries, bakeries and street vendors selling various food items in the vicinity of his shop, and as a result, Balaji finds himself snacking frequently.On one unremarkable Wednesday evening, Balaji received a WhatsApp forward [AJS1] from his relative for Apollo’s ‘AICVD program’. Little did he know that this was going to change his life! AICVD is an AI-driven diagnostic program introduced by Apollo Hospitals that can predict the onset of cardiovascular problems.Intrigued, Balaji decided to enrol in the program. Also, quite a few years had passed since his last checkup, and he felt it was about time he got a health check done as well. He was also eager to see the kind of analysis an AI system would generate.On the day of the AICVD test, Balaji was feeling extremely confident that his results would come back normal. At this point, Balaji was more interested in finding out how well an AI could predict possible medical conditions or whether it was just another marketing gimmick.When Balaji walked into Apollo Hospitals for his test, he was greeted by an Apollo expert who guided him through the program and explained how it worked. After the test was administered, he was asked to wait for the results. Balaji waited patiently, not expecting anything out of the ordinary.However, to his dismay, when the results arrived, he was diagnosed with ‘high risk’  category for developing cardiovascular diseases! Using AI to save lives!The test results were a little hard to digest for Balaji, and as expected, he had a lot of queries for his Apollo expert. Balaji was beginning to feel a little anxious and agitated after the results. Noticing this, the Apollo team of experts reassured him and asked him not to be alarmed. They told Balaji that this test was the first step in preventing any major cardiovascular incident, and he should be glad that he got the test done in time before he suffered any major issue.The Apollo expert also explained the fact that more than 60% of morbidity and mortality in India is due to Non-Communicable Diseases, such as cardiovascular diseases. The Apollo expert further explained that the best way to beat cardiovascular diseases is to prevent them, and the first important step in any prevention program is risk assessment. [AJS2] Therefore, to develop a strong prevention care built on accurate risk assessment, Apollo Hospitals, in collaboration with Microsoft India, developed the ‘first-ever’ Artificial Intelligence-based cardiovascular diseases (CVD) Risk Score API (Application Program Interface) called the AICVD. The AICVD program is designed to predict the risk of developing cardiovascular diseases in the Indian population. This program has been validated by Maastricht University, Netherlands and King George Medical University, Lucknow. About the AICVD program  The Apollo expert guiding Balaji explained how the AICVD program is found to be more accurate and effective than other routine body check-up programs, and the fact that it aims to reduce healthcare costs for patients by promoting preventive healthcare. The key objective of AI-powered Risk Score program is to develop a more accurate risk prediction model to avert cardiovascular diseases in high-risk groups.AI provides a more accurate risk scoreThe Apollo expert explained that the Cardiovascular Risk Score algorithm was built using more than 500,000 patient records from Apollo Hospitals. This AI-based program predicts the 10-year risk of a person having a potential cardiovascular problem such as a heart attack or a stroke, with almost 90% accuracy.The risk estimate considers factors such as age, gender, blood pressure, cholesterol levels, medication use, and diabetic status. The scoring also considers other risk contributors including lifestyle attributes such as diet, tobacco and smoking preferences and physical activity. The other clinical parameters factored in the assessment include psychological stress and anxiety as reflected via the rate of respiration, hypertension, and systolic and diastolic blood pressure. These factors are shown in the table below:Patient ParametersMedical HistoryLifestyle     Heart Health AttributesAge HypertensionDiet Heart SymptomGenderDiabetesAlcoholHeart rateHeight DyslipidaemiaSmokingSystolic BPWeightHistory of Heart DiseasePhysical activityDiastolic BPBMIFamily History of Heart Disease Pulse Rhythm   Respiration RateThe combination of AI, along with the expertise in cardiovascular care offered by top specialists at Apollo Hospitals, helps prevent heart diseases, saves lives and ensures that  those with existing or potential heart diseases can make informed choices about their health. Benefits of AICVDConvinced about the AICVD program, Balaji wanted to know how AI helps Apollo Hospitals provide better predictive outcomes for serious health conditions like heart-linked diseases. The health expert told Balaji that the AI-driven approach is being used extensively at Apollo Health Check centers to provide personalized insights for high-risk patients, including  a study involving a selected cohort of thirty-three thousand patients. Importantly, this is also the first time an AI-based cardiovascular risk score has been generated after analyzing India-specific data, tailored for the Indian population. The entire data generation, analytics, and clinical decision support system is integrated into the organization’s Electronic Medical Record (EMR), making it easier for activities such as patient follow-ups and eventually lowering their risk profiles. The Clinical Decision Support System provides a mechanism for the physician to prospectively identify relevant risk factors and advice patients on how to reduce identified risks.The AICVD Risk Score empowers physicians to look at patients with risk more holistically and provide insights to patients for lifestyle modification and timely interventions. The program benefits both patients and physicians in helping them decide on treatment modalities, prevention, lifestyle modification, education, overall prediction of the outcome of cardiovascular conditions and risk for further events.Balaji peeked into the future and felt he needed to make changes  On assessing the results of the program, and getting them validated by his Apollo expert, Balaji decided to make calculated changes to his lifestyle to prevent the possibility of developing heart conditions in the future. He also understood the vast advantage that AI brings in vis-à-vis preventive healthcare by providing accurate results for patients, and as a result, he got his family members to enroll in the program as well. Guided by the results, he decided to quit smoking, walk, or cycle to his shop at least thrice a week, and consciously avoided fried items and snacks while working at his shop. All of these steps have led to positive changes for Balaji and he is now leading a more fulfilling and healthier life.

Anil, a 53-year-old businessman, was driving to a shopping mall with his family one fine Saturday evening. This was the second mall they were visiting this day. It was the middle of the festive season, and Anil had been tied up with work calls all afternoon. And now, he was in the middle of snarling traffic heading towards another packed mall.With all the work stress,  coupled with constant travel and carrying around heavy shopping bags, Anil began to feel a little overwhelmed. He noticed he was also experiencing tiredness and sudden shortness of breath. He thought this could be because of his overweight frame and all the walking and stress that was getting to him, maybe making him feel more tired than usual. Or it could be diabetes-induced fatigue as he was diabetic as well. After a short rest, Anil continued as if everything was normal. After close to an hour, as Anil was parking his car in the mall, he started feeling a tightness in his chest and a tingling sensation running up his arms. Anil knew something was wrong, and he immediately told his wife, who called Apollo Hospitals without delay. Anil was swiftly taken to the hospital and admitted to the emergency room. Anil suspected he was experiencing a heart attack, and what worried him the most was how his diabetic condition might complicate the treatment.What did Anil and his family do right?Anil’s wife made the right decision by admitting him to Apollo Heart Institute. With more than 500 cardiologists and 200 cardiothoracic surgeons working across the country, Apollo Heart Institute has the largest Cardiovascular team in the world with a combined experience of more than 10,000 years! Anil’s wife instinctively knew that a hospital like Apollo would have more experience treating patients with existing ailments like diabetes and hypertension. Armed with the latest in heart care, such as the robot-assisted Minimally Invasive Cardiac Surgery (MICS), Apollo Hospitals represented the best chance for Anil to make a full recovery and resume a normal life with his family. Having advanced facilities, including all the necessary experience and expertise, Anil’s family made the right choice for him – giving him the best shot at getting through this crisis by bringing him to Apollo Heart Institute.What is MICS?As the name suggests, Minimally Invasive Cardiac Surgery (MICS) is a surgical procedure that involves making small keyhole incisions and inserting a tiny tube with a camera attached at the tip, rather than cutting through the breastbone, as is done in traditional open-heart surgery.  Primarily used to avoid traditional open-heart surgeries, MICS is also known as ‘Keyhole surgery’ due to the keyhole size of the incisions made, through which the surgical procedure is performed. The advantages of MICS over traditional open-heart surgeries are:High precision for surgeons, with robotic assistance enabledBetter view of the heart through the cameraMinimal blood lossFaster recovery timeLess risk of injury to internal tissues and organsSubstantially lower risk of infectionLower pain and decreased chances of traumaBook An AppointmentHow did Anil prepare for his MICS treatment?After conducting an angiogram (a diagnostic procedure used to detect blockages in arteries and veins), Anil’s doctor found that Anil had plaque built up in his artery, which was causing him chest discomfort (pain) and shortness of breath. The Cardiologists at Apollo Hospital’s renowned Cardiology department, in turn suggested performing a MICS procedure at the earliest. Anil was wary of surgery due to his pre-existing diabetes. He knew that the chances of complications in diabetic patients were higher from the various sources that he had referred to online. He voiced his concerns to his surgeon, and he was relieved that the procedure which was to be performed upon him had significantly lesser complications caused by existing medical conditions due to the non-invasive nature of the procedure. Anil’s surgeon also told him that this surgery would be assisted by a robotic arm, which completely vastly reduces the chances of human error and substantially improves precision and surgical performance. On hearing this, Anil felt much better and significantly more confident about undertaking the surgery. How did the robotic-assisted procedure help Anil’s surgeon treat his heart condition?Before prepping for the procedure, Anil’s surgeon explained how the procedure would be performed and how  robotic assistance would help during the surgery.A robot-assisted heart surgery involves the surgeon using robotic arms, rather than his/her hands, to perform the exact surgical manoeuvres that’s used in traditional open-heart surgery. During this procedure, the surgeon works at a remote console and views the patient’s heart through a magnified high-definition 3D view on a video monitor. From the console, the surgeon’s hand movements translate precisely to the robotic arms at the operating table, which operates identically to the human wrist.A second surgeon and surgical team assists at the operating table, changing surgical instruments attached to the robotic arms.With Apollo’s robotic assisted MICS, cardiologists at the Institute were able to:Substantially decrease the chances of complications that develops during the surgeryMinimize blood lossRecover quickly from the surgeryAvoid the risk of infection at the incision site due to small scars left behind the surgeryHow did Anil find his post-operative recovery after MICS?After the surgery, Anil was taken to the ICU, where the surgical team kept him under observation. Due to the non-invasive nature of the procedure, Anil was able to recover quickly and was moved to a regular hospital room within a day itself. In the hospital room, Anil was able to meet his family and relatives, and he told them about how the surgery went and was relieved that his diabetes did not cause any issues with the procedure. In sheer excitement, he explained how robotic assistance benefited his surgeon greatly in performing the procedure, and at no point in time of the procedure, was he scared. After one more day in the hospital room, Anil was discharged from the hospital and was able to return to his home with his family. His surgeon prescribed medication to help Anil fully recover from the surgery and suggested subscribing to the Apollo ProHealth program so that he and his family could avoid such health scares in the future and take effective preventive steps.Innovative technologies can help save people’s lives!At Apollo Hospitals, we believe cutting-edge technology can help us save people’s lives, and with robotic-assisted surgery, patients like Anil have a better chance at living a normal, fulfilling life with their families, and at the same time minimize the risk of any life-threatening conditions after major surgery. In this instance, Anil benefitted from a MICS procedure that was handled by a surgeon but surgically performed by a robot. 

Ms. Reddy, vice-chairperson, Apollo Hospitals, in an interview with The Hindu, says the group has been working closely with the States and Central government and has initiated a comprehensive response plan to tackle the COVID-19 pandemic

A sick baby gets a liver transplant overcoming multiple hurdles during emerging covid timesHow soon after transfer can you do the liver transplant? Thus, came the query from the treating hepatologist of baby N from Malaysia. Within 24 hours in an emergency, perhaps a little longer for international patients depending on the paperwork and permissions from the embassy, was our prompt assurance.Baby N had been jaundiced since her early neonatal period and when it didn’t resolve over the next few weeks, detailed evaluations led to a diagnosis of biliary atresia. She had the most severe syndromic form with dextrocardia, heterotaxy with midline liver, malrotation and polysplenia. A Kasai portoenterostomy was performed on day 55 of life along with corrective surgery for the malrotation. Despite the timely Kasai procedure that entails a hepaticojejunostomy with the aim to establish biliary drainage, her disease continued to progress rapidly and she had decompensated liver disease by the time she was 6 months of age and had an episode of upper GI bleed due to advanced portal hypertension. She needed a liver transplant, the only definitive curative treatment for her condition that remains the leading indication for pediatric liver transplant in most parts of the world.We were sent the clinical details and with a donor identified, by end February all preparations to travel to us had been made by the family. Tickets booked and ready to fly but baby N’s route was on a different tangent. She developed severe pneumonia and encephalopathy landing her into intensive care. Sir Henri Bismuth, one of the pioneers of liver transplant had very poignantly and precisely said “The worst complication of liver transplant is to die without receiving liver transplant”. Every life deserves a chance that innumerable babies who die in similar situations never get. As though refusing the flight to Heaven, baby N improved and once stabilized was put on a flight to India only after the precondition of an urgent transplant was accepted by the receiving team.The covid pandemic had erupted and was increasingly engulfing the world when baby N reached India in the second week of March. Travel restrictions were not yet in place but quarantine requirements for selected nationals were mandatory. Malaysia was not amongst them. The dawn after the night they landed was to throw all plans haywire with the advisory coming from the Govt of India to quarantine for 2 weeks all travelers from Malaysia as well,  as quite a few coronavirus cases had been reported  in the country.    The family was devastated, the medical team in deep dilemma. Baby N was presently stable but could deteriorate any time considering her end stage liver failure. To deny a life saving surgery for fear of an infection that she may never be carrying in the first place, how ethical was that? Nevertheless, she could very well be in the incubation period and what outcome could be expected if she received a transplant and then manifested covid disease? How could her donor, her mother, a healthy beautiful young woman be subjected to a surgery that would place her at grave risk if she was infected? How could the medical staff be exposed to the risk? Covid testing was under government regulation and not yet available in private hospitals. It was only offered to symptomatic individuals in select government hospitals as testing kits were limited. Request for covid testing for baby N and her parents was denied by the requisite authorities as most surgeries had been put on hold. Also, a negative test would still not forego the mandated quarantine. The disease was very new to India, very little was known of the virus and treatments were just being researched. Fears were high, the thin line between being brave and being reckless was obscure. The transplant would have to wait. Would baby N be a covid mortality regardless of her covid status? The time bought was used as an opportunity to build her nutritional status and she inched closer to her new life as she continued to remain stable and gain weight with each passing day despite her alarmingly high bilirubin levels of about 45 mg/dl.  As she neared the end of 2 weeks, covid testing also became available to us and both mother and daughter tested negative. Her transplant was finally scheduled to happen, or was it? Exactly 14 days after her arrival, the effect of the dangerously high bilirubin levels on the SA node of a dextrocardiac heart led her to develop heart block. With heart rates between 40-45/minute, she was again in intensive care with medical therapies instituted for the heart block. Doses were hiked and titrated with no response. Would a plasmapheresis to reduce the bilirubin help? With its attendant risks in this scenario, the option was not chosen. She would require a pacemaker. Temporary pacing was started before she was taken up for the complicated transplant surgery considering her abnormal anatomy. Perhaps as a concession for all her trials and tribulations, the transplant surgery was accomplished without any major intraoperative and postoperative complications. Death had in fact chosen to quarantine itself from baby N and let her bloom into a lovely radiant little girl, a marvel of human resilience, modern medicine and divine grace.

Enrapturing victory, success and joy…his name “Nihaal” embodies all that he stands for. His journey is a miracle that truly enraptures our heart and soul, leaving even the hardest nonbelievers with a faith that says there stands a power far greater than you and I are.Second year into their marriage, Nihaal’s parents were worried. They were hoping for a baby. The elders in the family like most ones in Indian families had started enquiring for the “good news”. A series of tests and visits to the gynecologist shattered their dreams. Nihaal’s mom, Navnita had severe tubal blocks in both tubes, surgical correction was tried but a spontaneous conception would be “impossible”, they were told. A natural pregnancy without assisted reproduction techniques would be a “miracle”.We have all heard fairytales and fables about miracles. Do they really happen? Aren’t they just figments of imagination handed down generations to reinforce a belief in a higher force? Here were miracles, not one but one after another that were to unfold in their lives. The first was Nihaal’s natural conception.Navnita’s happiness knew no bounds when she realized she was expecting her first baby, the ‘impossible” had happened. Nihaal came into this world bringing joy and ecstasy into their dejected hearts. A few weeks of blissful parenting and their joys were replaced by fears. Soon after birth Nihaal developed jaundice that refused to go away. Detailed evaluations in the 3rd month of his life revealed he had biliary atresia wherein the biliary system, a network of channels that drains bile produced in the liver to the gall bladder has blockages causing liver damage due to bile stasis.Over the next few months he developed progressive liver failure and was practically in and out of hospital. They were referred for a liver transplant, without one he didn’t stand a chance. His parents were devastated. They had thanked their stars for his birth, wondered what past good deeds had manifest this miracle into their lives. Was their faith in the Divine being tested? They couldn’t afford a liver transplant, they couldn’t afford to lose Nihaal either. Nihaal was too precious to be lost, their hearts bled at their predicament.Nihaal was too precious to this universe as well. Another miracle was about to unfold, a person unknown and unrelated to them was about to become his guardian angel. The transplant team had put in an appeal on national television seeking financial help. Herein, stepped in a person with a heart of gold, one who is revered by his fans for his cricketing skills, his wit and his down to earth persona. Navjot Singh Sidhu put in 18 lacs to cover for his surgery and the recurring lifetime cost of his medications without letting out a word for publicity. To give is great, to give silently is divine. The only bank that can never go bankrupt is the bank of selfless love.The hospital chose not to charge for the transplant apart from the six lacs to be spent on the consumables. The remaining twelve would be put into a fixed deposit and the interest pay for the monthly immunosuppression medications. Does this bring us to the end of the story? All hurdles sorted, successful surgery and happily ever after? Man proposes, God disposes. There was another miracle waiting to happen, one that would jeopardize all their plans, that seemed more of a setback than a blessing.All pretransplant assessments for Nihaal were complete. Navnita, his mother, being the same blood group as Nihaal was to be the liver donor. Her ultrasound abdomen done as part of assessment before surgery left her flabbergasted. She was in the 3rd month of another pregnancy, one that she was totally unaware of. She had been declared infertile at one point of time, and here she was with another pregnancy!She wept her heart out and steeled herself. She had to save Nihaal, and she contemplated an abortion. She asked to confirm how soon after an abortion could she go in for the donor surgery. Today, she credits the life of both her children to our team. We put our foot down, no abortion. She would not be the donor. There was no guarantee Nihaal would survive the liver transplant, was she prepared to live with the loss of both her children if Nihaal didn’t make it?As if the whole universe had conspired to bless them with a happy family, Nihaal had another guardian angel up his little sleeve. An aunt with Nihaal’s blood group showed great magnanimity and came forward to donate a part of her liver. After all these miracles, how could the miracle surgery that has revolutionized the course of this disease ever go wrong? All went well. Both Nihaal and his aunt recovered very well after their surgeries.Today, more than a decade after Nihaal’s transplant, with his younger brother in tow, they constitute one  blissful family. They have been truly blessed beyond their fondest dreams. They live in gratitude for providence has brought them their highest good for their greatest joy.Clinical perspectiveNihaal has had a miracle run in the clinical context as well. He had a smooth surgery and postoperative course. On follow up, he has done remarkably well with no late post transplant complications.

Lord Ram’s banishment to the woods had ended in 14 years, imprisonment sentences for even the severest of crimes end in 10 to 14 years. What had she done to deserve such a punishment? Samreen’s mother wondered. She had been married for almost 17 years and was yet to beget a child of her own. It is said that motherhood completes a woman and brings out the best in her. Would she ever experience it? She had suffered repeated miscarriages that had completely drained her body and soul. Pregnant again, she prayed fervently for the successful outcome of this pregnancy. But she had been praying for years and years, she had begun to ask herself – was there a God?The cry of her newborn baby seemed like a call from the heavens above to uphold her faith. She had never been happier! No sound sweeter! Her husband wept like a baby. They had finally become proud parents to a baby girl. They named their new born jewel, Samreen.Sadly, their joy was short lived. They had not even settled into their newfound roles, not even learnt to change the diapers properly that their visits to the hospitals began. Samreen had jaundice, and then began visits from one doctor to the other. At 5 months of age, she vomited blood and was hospitalized at Islamabad.  She was detected to have progressive familial intrahepatic cholestasis, a condition in which liver cells are less able to secrete a digestive fluid called bile. Build up of bile in the liver cells leads to liver failure.She would require regular medications, but there was no way to prevent her liver disease from progressing. She had developed portal hypertension and had repeated episodes of bleeding from her gut necessitating blood transfusions and endoscopies. Every bleeding episode was a potential threat to her life.Her parents were devastated. It seemed like a sword always dangled over their head. Her mother would go paranoid thinking she would bleed again. She was all but 3 years in age, what years of prayers had brought seemed to be slipping out of her hands. Questions plagued her mind, had she asked for something that was not meant for her? Was the joy of motherhood not destined for her? Is that why they were suffering? Could God be so ruthless?  She would go crazy with grief. Was a gift, a gift at all if it was to be snatched away so soon?  But Samreen was destiny’s child. She was meant to live. Her doctors in Pakistan advised her for a liver transplant. It was the her only hope. Her parents were terrified of such a major high risk surgery. They chose to put their trust in the Divine and came to India for a liver transplant.The surgery was a success and she recovered wonderfully. She did have postoperative infections that were treated well. She went home after about 5 weeks in hospital. Finally, life for Samreen and her parents had begun.The Clinical Perspective Post transplant Samreen developed chickenpox. She did receive prophylaxis but still suffered the infection. As all post transplant patients are on medications to suppress their immunity and chickenpox is highly contagious, an outbreak in the postsurgical unit would have been devastating. She was immediately isolated and all precautions taken.

“Ayubowan” – May you have the gift of long life! With this traditional Sri Lankan greeting Dhanundhara was welcomed to his place of birth by his grandparents. Just as this tear shaped island country is the sparkling jewel of the Indian Ocean, so was Dhanundhara the jewel of his family, doted by one and all.All of 3 years, he was too small to express in poetic language the natural beauty of his country. The magnificent coastline along azure seas lined with palm trees, sun drenched beaches, lush green jungles, cool refreshing hills had a magical effect on him – transforming him from the quiet reserved child that he was, to a chirpy kid squealing with joy at every new experience.His parents had migrated to UAE and it was his skin condition that had brought them on this trip. Dhanundhara suffered from vitiligo, a skin disease that causes white patches on the body. Full of its traditional heritage as their country was, they banked on an alternative medicine therapist to try and heal him with herbal medication. Sadly, it became the source of their nightmare.He had been on his herbal medications for a few weeks when he began to have fever and then vomitings and jaundice.  He had developed hepatitis, ie inflammation of the liver. His parents took him to back to Abu Dhabi for medical care but his condition progressively deteriorated. He had developed acute liver failure and was susceptible to life threatening bleeding or coma if his liver function continued to deteriorate any further. He needed an urgent liver transplant.Emergency contact with the team of liver specialists at Indraprastha Apollo Hospitals was made and he was flown to India. It was inferred from his clinical course and diagnostic workup that he had developed liver failure due to the herbal medications as all tests for an infective cause or underlying silent chronic liver disease were negative.Preparations were started and he was admitted to the intensive care unit. It was a herculean task to care for him. He would speak little and would resist blood tests with all his might. His long dark curly hair made the staff mistake him time and again for a girl, causing him to sulk further. Only his mother could understand his agitated state of mind behind his quiet persona that gave a false perception of tranquility. She was his magic charm and became his donor, giving him life twice.The transplant surgery was a success and he was off the ventilator within a few days. When all seemed fine, arose another problem. He would not accept his oral medicines. He hated them. He had always been averse to taking medicines, said his mother. He would just shut his mouth and require coercing for hours together, becoming agitated when forced. After undergoing a transplant one needs to take regular medications, to prevent the body from rejecting the new liver.  Am I going to struggle daily to administer them, wondered his mother. For a few days, his oral feeding tube was not removed after surgery so that he could be given his medications. The magic charm that his mother was, she gradually and loving brought him around and he slowly overcame his strong aversion to medicines.By the time of discharge, his syrups didn’t anger him, the needles and syringes didn’t terrify him. All he wanted was to go home to live the life he had been blessed with.The Clinical Perspective Acute liver failure is a grave medical emergency as the mortality risk is very high. An urgent liver transplant has to be arranged before the patient develops complications involving the brain, kidneys and other organs that would render a transplant unfeasible and/or futile. Dhanundhra had to be airlifted to our hospital from UAE at a very short notice. Meticulous preparations ensured he underwent a timely transplant.

The hospital cot was her cradle, the beeps of the monitors her rattle sounds, stethoscopes her toys, the doctors and nurses her family. For Vani, the hospital was her home. Her parents had forgotten the joys of youth, the gay abandon their age would warrant.  They had suddenly grown up, sobered and quietened by the burden and enormity of Vani’s illness. Nothing could have prepared them for the suffering they would go through together.Like all new parents, they had been overjoyed by Vani’s birth, she was God’s gift to them. Full of dreams to raise her as their princess, buying her frilly frocks and fancy pink clips, they brought her home. But only if yellow would give pink a chance….A few days after her birth, they noticed that she had yellow eyes and urine. Her stools were clay white. The idea of routine newborn jaundice that resolves in a few days was reassuring,  but they began to worry when she was still jaundiced well into her second month of life. Medical tests confirmed that she had biliary atresia. She needed urgent surgery and was operated at 57 days of life. Thus began her war with the disease.The cure that had been anticipated with her surgery was never to be. It only left her worse with repeated episodes of infection in her gut as it had been connected to her liver. She received multiple courses of antibiotics for the next few months. She would get a little better and be discharged from hospital, only to be back again in a week or so. This happened half a dozen times. Finally she was then brought to Indraprastha Apollo Hospital, Delhi, frail, emaciated and struggling for her life.She was put on ventilatory support as her blood grew deadly bacteria for which she was treated with heavy antibiotics. Thankfully, she responded well and her infection was controlled. But her doctors knew that her only chance for survival was to have a liver transplant. However, she weighed just 6 kgs, had been ill for what seemed forever, her liver had failed and infection would return any time.  They could not wait for her to gain weight and grow stronger for the surgery. This was the only window of opportunity. She was on top of her infection and a very high risk liver transplant was performed.Out went her diseased liver with all its hidden foci of infection and along with it her misfortune. Worst fears of her not coming out alive from the surgery were allayed when she was wheeled out of the operation theatre after the 12 daunting hours of surgery.  She was a fighter, she looked better as each day passed and the real Vani surfaced. Vani with white eyes, soft belly with no distension, kicking her way to good health. Within 3 weeks she was home, never to be hospitalised again in the 7 years that have elapsed after her transplant.Life had triumphed, had given her the joy of childhood in her parental home, with many more to grow up for. A pink wedding dress, perhaps?The Clinical Perspective Vani had been ill for too long, was very weak due to her chronic liver disease, repeated infections and prolonged hospitalization. This made her transplant very high risk and early complications like flare up of infection and vessel thrombosis were feared. However, she had a dramatic recovery after receiving the new healthy liver.

An unemployed alcoholic gives up drinking to become a liver donor for his son who in addition to a new liver gets back a responsible loving dad saved from doom that alcohol had led him to  The doctors measuring tape doubled up as a tailor’s tape for taking measurements for Vinay’s clothes. He was being discharged and his doctors, along with giving him a new liver, wanted to dress him up in new clothes. “Please don’t bring anything in red”, he whispered in his mother’s ear to convey to his doctor who was now off from the ward round to proceed for the mall round shopping for Vinay.Some people evoke sympathy, others evoke empathy. Vinay was one who evoked pure love and deep affection. He was too blessed to be sympathized with.  Despite his illness, there was never a moment where you could catch him awake without a smile on his face. Ever radiant, ever beaming, ever content, the gleam in his eyes never gave away his tale of suffering.All of 11 years, he had been in and out of hospitals multiple times over in the last 4 years. The first episode had occurred when he was barely 3 years of age. These repeated episodes of fever, jaundice, pain abdomen and vomitings brought him from a small village near Jalandhar to Ludhaina and then to the Post Graduate Institute of Medical Education and Research(PGIMER), Chandigarh in his quest for a cure. A diagnosis  of primary  sclerosing cholangitis was arrived at, a condition in which the draining channels for bile become beaded and narrowed leading to bile accumulation in the liver and subsequent tissue damage. With the non complaining temperament that he had, Vinay patiently endured 7  endoscopic attempts by his doctors to put in a stent across his main blockage. As a last resort, an external diversion was created that drained his bile into a bag attached with a tubing to his gall bladder.To live with a bag attached, liver already damaged and shrunken, no school, no play – was this to be Vinay’s fate? He deserved better and the universe ensured he got his due.He needed a liver transplant, that was his only chance of a life worth living. An alcoholic out of work father, 2 elder school going sisters, a mother who supported the family with her peon’s salary that barely made both ends meet…. Where were the means to salvage Vinay?His doctors needn’t have despaired. The entire universe had conspired to help Vinay. The liver transplant team at Indraprastha Apollo Hospital offered a free transplant in which the bed charges and fees would be waived off with the patient needing to pay only for medicines and consumables. That would cut the cost to about half (6 lacs), but that too was beyond their means. In true community spirit, his village was like an extended family and the panchayat took on the challenge to raise money. A public appeal was issued, several rounds of Kabaddi matches were organized to raise funds and sanctions were obtained from the Punjab Chief Minister’s relief fund. Rupees one lac each were donated by the kind parents of 2 patients.  Soon the required sum was in the kitty.With the funds arranged, evaluation of the mother as a donor was started. After all the positivity, no one was prepared for this setback – even though she had no symptoms, her main vessel supplying the liver was found to be blocked making her unfit to donate. Both the sisters were not yet adults. Tears rolled down her eyes as she foresaw all her efforts go down the drain.Little did she realize, God had grander plans for her. A new life awaited not only her son but also her husband whom this challenge reformed completely. To be able to donate a part of his liver, he would have to abstain from alcohol for at least 3 months. Post donor surgery, if that happened, alcohol would be taboo as it would harm his regenerating liver. Love for his son proved stronger than the love for alcohol. What years of coercing and pleading by his wife and children could not achieve, the desire to see his son live did. Not a drop of alcohol went down his throat in the next 3 months and he was then cleared as a donor by his surgeons.What could go wrong with Vinay after having surmounted odds of such gravity? All went well, Vinay went home looking dapper in his new clothes. He now goes to school, his father – now a teetotaler earns reasonably as a carpenter, his mother and sisters have never been happier and the village panchayat never felt prouder. From the greatest adversities emerge the greatest success stories, such are life’s ways!   Clinical perspective:Vinay and his family had suffered for almost 8 years due to his illness. Recurring at progressively decreasing intervals ever since he was three, for the last 4 years he had been ill every 2-3 months. By the time he was diagnosed, he already had portal hypertension. As stenting had failed despite repeated attempts, a cholecystostomy had been done that was an open channel for infection and also tended to block.Vinay’s liver transplant was a success- medically and socially. He became a model for other patients from the economically deprived strata of society, bridging them from despair to hope.

A child born of a precious pregnancy undergoes renal transplant due to kidney failure 2 years after a liver transplantDoctor! doctor! See! Sroy is dancing! He is hiding and peeping from behind the curtains! Look at him!…The sister was beaming with joy as she ran through the ward corridor to share the news. He was quick to capture the moment in a video on his mobile and the mother was in tears, this time, of happiness.Countless tears had she shed on countless occasions as she had struggled to save her only living child. Four miscarriages, a child lost in infancy to an undiagnosed illness, a broken marriage, all alone in a foreign land with a child ill from birth……the strongest of humans would break in such a predicament, but not this lady. Not this lady, for she had the strength that comes from love. One of the biggest joys in life is to love and be loved. Sroy was the  one to love her back and she would do all in her power to have him live.She first come to India from Cambodia when Sroy was about a year and a half. He had biliary atresia. Sroy had a corrective surgery at 2 months of age at Singapore but his liver functions continued to deteriorate. He had repeated episodes of jaundice with fever and when he began to vomit blood, he was advised for an urgent liver transplant. Fortunately, funds were not an issue. The family chose to come to Delhi.Sroy underwent a liver transplant and was discharged within 3 weeks. His liver functions improved rapidly and we sent home this little bundle of joy, his eyes sparkling with the hint of mischief, his laughter so infectious that the hospital gloom would be uplifted within seconds of being with him.But the troubles he was born with didn’t go away with his liver. After remaining well for about 20 months, Sroy developed swelling all over his body and was detected to have kidney dysfunction. He was back with us, his blood pressure was high and is normally cheery nature was drowned in his restlessness.Anxiety was writ large on the faces of the transplant team. Their worst fears were confirmed with the medical and kidney biopsy reports… Sroy had developed chronic renal disease due due to transplant associated thrombotic microangiopathy, a condition where the small blood vessels get occluded due to damage to their inner lining. This is a very rare but devastating complication of transplantation with mortality ranging from 60-90%.Medications were changed, treatments instituted but to no avail. Sroy’s kidney function continued to deteriorate and soon he was on hemodialysis with no option but to undergo a renal transplant. One of his maternal uncles came forward to donate his kidney and the mother steeled herself to consent for his high risk surgery that fortunately, went off well. But Sroy’s troubles were far from over. He continued to have renal dysfunction and had multiple sessions of plasma exchange, intravenous steroids and high end novel therapies were instituted to save the new kidney. He picked up a urine infection, developed spiking high fevers requiring prolonged antibiotics. He was in the intensive care unit on his birthday, had fever when he cut the cake, yet was happy playing with the toy car his doctors had bought him. The injections, the monitors, the nurses had somehow integrated into his life and the pain couldn’t subdue his joyous spirit. That was what triumphed ultimately when his new kidney worked well, his complications controlled, he danced in his room, his pranks were back and so was the long lost smile on his mother’s face. He had won, a mother’s resilience had paid off and he went home after a 4 month long hospital stay, all hale and hearty.The Clinical Perspective Thrombotic microangiopathy has been reported frequently after stem cell and bone marrow transplants but is exceedingly rare after liver transplantation. After one organ transplant, he needed another – a nightmare for any family and treating unit. He needed strategizing on multiple therapies to control the angiopathy and make the kidney transplant feasible and successful whilst also protecting the grafted liver.  The situation was very challenging and we really feared losing Sroy.

An NRI woman travels all alone with her son for his liver transplant in her homeland“Maanvan, thandian chaavan” goes a popular saying in Punjabi that describes a mother as a shade that cools and protects from the sweltering heat. Search for this solace was perhaps what brought this young lady, hardly in her mid-twenties, to her homeland India. Born and brought up in South Africa, she was of Gujarati lineage. Her parents had migrated before she was born but distances only bring hearts closer. As she landed in India, uncles and aunts,  gathered around her to cuddle her infant son, Hamza.Hamza was a happy baby, his large round eyes lit up as he was showered with gifts, his “shagun”. His mother’s eyes, however, were sad as she looked at him- he was perfect but only for his deeply yellow eyes….Hamza had jaundice since a few days after birth as he suffered from biliary atresia that had caused his liver failure. Why a child develops biliary atresia soon after birth, medical science has yet to fathom. All we know is that it’s universally fatal unless a partially corrective surgery is done within 2 months of life. The success rate for this surgery varies and liver transplant has over the last few decades revolutionalised the management of this otherwise dismal disease by providing the only definitive cure. Hamza’s corrective surgery had failed and his mother had come to her motherland seeking life for her son from the land that gave her hers.Her husband had stayed back to look after their other 2 children and her relatives from Gujarat were her pillar of support here. If God had given her this challenge, he had also bestowed her with tremendous support. She was fortunate to have a family that was so closely knit, it was her sister’s husband who came forward to donate a part of his liver as she and her husband had been rejected as potential donors on medical grounds.Moving from one hospital corridor to the other, she held his hand tightly as Hamza went through the tests and assessments.  Her soft voice and calm eyes spoke volumes for her inner strength as she watched her son being wheeled in for the transplant. Her usually difficult to restrain little one was engulfed in tubings, deep asleep under the effect of anesthesia when he returned after the 10 hour surgery. But he would soon return to his naughty self as his anesthesia effect wore off. He was off the ventilator within a few hours, smiling reassuringly at his mother. It was as if he could sense the turmoil in her heart that she concealed from the outer world. Like mother, like son. Hamza was a brave little lad and would cry briefly when pricked for blood samples and then return to his calm demeanor. Only hunger would unsettle him and he was cheerful once feeds were started 3 days after the surgery. He became the darling of the nurses who wouldn’t tire of playing with him.The Gods favor the humble and Hamza recovered well. He was discharged in 3 weeks time, his eyes perfectly pearly white, carrying only the surgical scar on his tummy as a momento of the terrible illness he was born with and conquered in his native land.The Clinical Perspective Hamza thankfully did not develop any major complications. He had intermittently high potassium levels for which he required a potassium binder. Hamza easily drank the medication mixed with his feeds and was an exceptionally co-operative and easy to manage baby.