Welcome

Hello.

Welcome to the heralding of a new version of www.irineupereira.com shortly.

The upcoming version has been designed by our website guests like you. The suggestions, reservations and opinions expressed by guests like you have been instrumental in the content of the upcoming website in particular. We look forward to your continued feedback and suggestions on our website and more importantly our services.

Our satellite clinic in Margao is now fully operational on Tuesdays and Fridays at Pereira Plaza, Opposite Hospicio, Margao while the Good Shepherd Healthcare Clinics at Ambrosia, Patto Plaza, Panaji;  are functional throughout the week minus the Sundays.

Thank you for your support and encouragement. It means something very special to us.

God Bless.

 

Dr.Irineu A.Pereira

 

Posted in Issues

3 Steps to Simplified Management of Varicose Veins

Varicose Veins affect nearly a fourth of the world population. Under-Diagnosed and hence Under-Treated, they account for untold suffering and complications on the presumption that they are only an issue of cosmesis or the “looks”.

Varicose veins are a disease !. Watch the slideshare presentation to know the present day reality in its practice. With a pun and fun element as well !

Posted in Issues

Thanks to the South Goan Seafarers , 1470 nm Endovenous Radial Laser for Varicose Veins comes to Margao.

 

Ceralas_E_30_Laser    EVLT 1   EVLT 2

Varicose Veins are a relatively common problem in Goa and in my ten-odd years in Goa, I can fairly confidently say that South Goa – especially Salcette ; has a higher prevalence of varicose veins in the middle-aged males as well as females.

On an average, we have done approximately 200- seafarers’ legs every year in Goa. The prolonged standing at work aboard the ships – cargo or passenger alike ; has had an adverse effect on the vein valves resulting in the incompetence of the vein valves and varicose veins. However after having the problem resolved, they are able to resume their duties in an average two-odd weeks.

The early return to their regular jobs has been facilitated by the “Minimally-Invasive Surgical Techniques” employed as well as the extensive use of the Biolitec 1470nm Endovenous Radial Fibre Laser System as well as the use of Foam Sclerotherapy.

The joy of returning home after a morning in the hospital, is a blessing indeed. And on their vacations in Goa – the taste of home-cooked food  - Fish Curry Rice, Xacuti, Cafreal, et cetera ; is an offer too hard to resist.

“Walk-In” the hospital in the morning, have a vein laser or minimally-invasive surgery in the afternoon and “Walk-Out” of the hospital in the evening ; have become a routine for most of the varicose vein surgery patients.

An alert patient with the advantage of being able to stand on one’s own feet within an hour after surgery, is  a matter of great relief for the patient and his or her family.

These minimally-invasive procedures have the added value of our cost-effective and compassionate care making them a truly satisfying experience.

We have until the present, restricted Endovenous Laser Procedures to Mapusa, but come 15th October 2015 ; Margao shall be on our Laser Map too at Royal Hospital, Margao-Goa. This is as a mark of gratitude to the people of  Salcette and  South Goa who have always shared a special bond with us.

Posted in Issues

Endovenous Laser and Varicose Vein Day-Care Procedures

Ceralas_E_30_Laser    EVLT 1   EVLT 2

Everyone loves the comfort of their own bed for a goodnight’s rest- even if they have had a surgery that very morning. Welcome to the era of Day-Care and Laser Varicose Vein Surgery.

A night in a hospital itself can send shivers down the spine of a patient. It is here that the concept of “Day-Care Surgery” took off in the western world and slowly but surely is coming to India in a big way.

There is another fear ! An Anesthetic Injection in the spine, either a spinal or an epidural – though safe today; is still a subject of great anxiety for many patients. These may be secondary to a bad past experience or just as a concept. Patients do not want to be aware of just anything ! But does it always mean a General Anesthetic ? Not necessarily ! Not anymore !

Varicose Veins have been handled in various ways. Surgery, Lasers, Sclerotherapy, Ultrasound and Radiofrequency Ablation.

Surgery itself  has undergone a lot of evolution over the years from minimising surgical incisions to decreasing anesthetic invasion.

MIVAS ( Minimally Invasive Venous Ambulatory Surgery) is the latest standard in Varicose Vein management. We had over the last two years done 400-odd legs using this technique with good results.

Ligation of all the Tributaries, Stripping of the Long Saphenous Vein, Sub-Fascial Ligation of Incompetent Perforator Veins and Excision of Varicose Veins can be achieved by MIVAS.

“Walk-In” the hospital in the morning, have a surgery in the afternoon and “Walk-Out” of the hospital in the evening ; have become a routine for most of the varicose vein surgery patients.

We have now included in our Varicose Vein Day-Care  Surgery Treatment Program,  Thermal Ablation involving Endovenous Laser Therapy (EVLT) employing the BIOLITEC Caselas 1470nm Radial Laser Fibre Technology from Germany as well as Chemical Ablation or Sclerotherapy. These procedures are also offered as stand-alone procedures in selectively indicated patients. Six months after the additions, we have already completed a 100-procedures.

An alert patient with the advantage of being able to stand on one’s own feet within an hour after surgery, is  a matter of great relief for the patient and his or her family.

These minimally-invasive procedures have the added value of our cost-effective and compassionate care making them a truly satisfying experience

 

Posted in Issues Tagged with: , , , , , , ,

Cross-Over Autologous Vein Bypass : The “KISS Approach”

John Gonsalves, 62 , diabetic and hypertensive from Goa Velha, found himself with a pulsating swelling in the right groin with pain in his right leg. An evaluation showed the swelling to be an Aneurysm (Ballooning) of the Right External Iliac Artery – the main artery supplying blood to his right leg, with thrombosis or “Block” in its forward course to the leg.

Untreated it would lead to gangrene of his right leg and an amputation above the level of the knee. A horrifying prospect indeed. Read more ›

Posted in Interesting Cases Tagged with: , , ,

A Giant Hydatid ; Delivered !

Jamila Bi, 62, is a relieved woman. A giant sized “hydatid cyst” with thousands of worm eggs from her right lung has been delivered. A startling size and rare condition in India, the Ponda-based Jamila, a housewife, might have been living in this condition since her teens.

The fact of the matter was that this lady had been suffering from repeated attacks of breathlessness. She was being treated as a case of Bronchial Asthma for many years. However, this time around – probably the large size of the Hydatid, compressed on her right lung too significantly  within the chest cavity to render it not to be of any function.

Her condition was complicated by the fear of a rupture of the cyst and its resultant bad anaphylactic reaction and high death rate. Also she was detected to be a case of alarge Thyroid Swelling with Thyrotoxicosis. She was urgently stabilised and taken up for semi-elective surgery.l

Jamila underwent an uncomplicated three-hour surgery and was discharged from the hospital on the 5th post-operative day.

Posted in Case of the Month, Interesting Cases Tagged with: , , ,

From Russia with Love : A case of Diaphragmatic Rupture

A massive head-on road traffic accident left 24 year old,Mr.Timo (abbreviated for privacy), a foreign national on a holiday to Goa; unconscious and struggling for breath.

He had Bilateral Brain contusions and ten ribs fractured on the left side of his chest with a lung contusion and a resultant air-leak and bleeding inside his left chest – a hemopneumothorax. He had a left sided chest drain inserted for drainage of the air and blood by the Intensivist at the hospital. He was put on Mechanical Ventilatory Support while he was further resuscitated and evaluated.

Then a mystery unfolded as I was called in to see the case. Chest X-ray reviews serially  revealed that the feeding tube was seen in the stomach which had migrated into the chest and then the transverse colon with the splenic flexure was lying in the chest too. A CT Scan of the Chest confirmed the findings of the stomach, spleen, colon and even the left kidney holidaying in the chest.

Mr.Timo had a Left Thoracotomy and Repair of a Complete Tear in the tendinous portion of the Left Hemi-diaphragm (partition between the chest and the abdomen) after returning the stomach, spleen, the colon and the left Kidney to their normal location – in the abdomen.

The recovery has been good after a very satisfying clinical and operative experience.

Posted in Case of the Month, Interesting Cases Tagged with: , ,

One cannot eat a Goan Fish Curry at a Punjabhi Dhabha

The world-famous Goan Fish Curry tastes different in Goa than in any other part of the world. It has got to do with all the ingredients including the water, they say. There are many who can and who will testify to this fact. I personally have had the displeasure of having tasted it in five different states in India other than in Goa ; and it tasted just like any Fish Masala. I can draw a corollary between the Fish Curry/Masala and listening discomfort of some remixed present day music of the the olden days.

But why am I blogging about Food on my Medical Blog ? Agreed that our food habits have got a lot to do with our present day ailments ; but the reason is that the above discomfort also happens when certain treatments take place through a combination of a wrong pair of hands and mind.

Mr.Sudesh, had been suffering from a collection of pus in his chest cavity, a condition known as “Empyema Thoracis”. Undrained and untreated, the pus tends to track through the rib cage and under the skin to give rise to a condition called “Empyema Necessitatis”. Left alone, it bursts out of the skin and the pus drains out.

Pre-Operative Clinical Photograph shows the partially healed but draining multiple incisions/sinuses.

Pre-Operative Clinical Photograph shows the partially healed but draining multiple incisions/sinuses.

Pre-Operative Chest XRay showing the loculated collection at the left lower zone

Pre-Operative Chest XRay showing the loculated collection at the left lower zone

So when Sudesh presented to the doctor at the “Empyema Necessitatis” stage, the doctor just drained the pus by multiple incisions. The cuts healed partially but continued draining. They continued draining for 18-odd months across two metro cities as well, until Sudesh was terminated from his BPO job and his uncle in Goa decided to intervene.

CT Scan of the Chest showing the large collection in the chest cavity. Compare with the Chest Xray to appreciate the difference in imaging capacity.

CT Scan of the Chest showing the large collection in the chest cavity. Compare with the Chest Xray to appreciate the difference in imaging capacity.

A CT Scan of the Chest showed what was always expected. A collection within the chest. He had a Mini-Thoracotomy and Decortication of the lung. The rest as they say, was history.

Post-Op Chest XRay.

Post-Op Chest XRay.

Posted in Interesting Cases, Issues Tagged with: , , , , , , ,

Its better to pay with Patience than your Leg.

When it comes to leg ulcers, it is not that an intervention or a surgery is always the answer. Similarly, when it comes to a gangrene of the toes/foot, that a radical amputation is the only solution.

An Amputation is necessary to be done when the tissue is dead or deadly. In some instances, gross infection puts the life of the patient at risk because of failing kidney and other organs. In such cases, an amputation is advisable. Conservative amputations in combination with other aggressive medical line of management can salvage most – if not, all of the limb. The result is that the patient is independently mobile –  no artificial limbs. crutches or wheelchairs.

Posted in Issues

The Chest Clinics @ 77 44 88 00 22


“All Chest Pain is not Angina (because of a blockage to the blood supply of the heart) and all Breathlessness is not Bronchial Asthma.”

    1. Chest Pain,
    2. Breathlessness,
    3. Chronic Cough,
    4. Chronic Expectoration,
    5. Coughing of Blood,
    6. Difficulty  in Swallowing,
    7. Hoarseness of Voice,  are just symptoms of chest diseases.

These can be caused by disease in any organ in the chest of which the heart is not the only one.

These diseases  may range from Hyperacidity to Cancer, from a Common Cold to Tuberculosis. Thus they cannot be ignored. If these symptoms persist, then they have to be thoroughly assessed and treated.

The Heart is only one of the many organs in the chest. It is not the only one there.

The Heart is only one of the many organs in the chest. It is not the only one there.

There are the two lungs, its covering envelope – the pleura, the wind-pipe and its branches, the food-pipe, the heart with its containing bag – the pericardium placed in a a fold called as mediastinum and one cannot forget the chest wall with the ribs and enveloping muscles and much more.

The Heart, at best is responsible for 5 percent of  cases of chest pain.  It is not that only the Heart can be a killer, diseases principally cancer of the other organs in the chest can be very dangerous “Silent Killers”. Silent because cancer is painless to begin with and therefore can be missed in its early course.

A Chest X-ray is usually the only test that  needs to be done for persistent symptoms  in most of the patients. A CT Scan of the Chest and/or other tests may be necessary in another 10 percent of the cases. An intervention or surgery, is needed in only around 5 percent of the chest disease patient.

“Early treatments give the best results and require very simple endoscopic treatments. The recovery of the patient is prompt, but a prompt recovery needs a prompt diagnosis.”

The causes of the delayed or late presentations are many, but are mostly concerns  about availability and affordability of treatments. It is to remove these concerns that there was a need to ensure that people especially those who are financially compromised could have access first and foremost to an early super-specialist consultation and then proceed with the required treatment .

The  Chest Clinics offers Consultations , Pulmonary Interventions, Chest Video Endoscopy and Chest Surgery.

The treatments principally focus on employing Minimal-Access Chest Surgery and Endoscopic Surgery techniques.

The service is available presently in Margao, Panaji and Mapusa. Appointments on 77 44 88 00 22.

 


Posted in Issues Tagged with: , , , , , ,

Chest Diseases

All Chest pain is not because of the heart nor all cough is due to a respiratory infection. Chest Pain, Chronic Cough, Breathlessness amongst others are only symptoms of a chest disease.
Read More...

Vascular Diseases

Pain in the legs on walking or at night , Non- Healing Leg Wound / Ulcer or Pigmentation and Varicose Veins are only symptoms of an arterial or venous disease.
Read More...

Varicose Veins

Varicose Veins affects nearly 10 - 15 percent of the adult world population by conservative estimates. When prominent surgery may be indicated.
Read More...