Patients and their families undergo a great deal of suffering when diagnosed with a life-threatening disease such as COVID-19. Unlike other chronic diseases, dealing with COVID-19 patients was different and difficult because the disease was unknown to us and we did not have answers to the patients’ questions. The uncertainty of the disease, the fear of illness and death, the stigma, and socioeconomic hardships all made it even more difficult to deal with the situations in the hospital.

At the end-of-life department, we look after patients with advanced, progressive, incurable or life-limiting diseases so that they can live the final few days with their loved ones and make a few extra memories with their families before they die. The process of care and counselling is not limited to the person who is dying but extends to their families, friends, and caregivers as well. Working at the end-of-life department is quite overwhelming. Watching people lose their loved ones is difficult, and it becomes all the more emotionally challenging when it is a COVID-19 patient as no one is allowed near the patient, they are to be isolated and stay alone.

Suffering from a life-threatening disease and being isolated while fighting the battle alone can take a toll on you emotionally and psychologically. Many times, the patients would scream and yell in agony and fear, would abuse the nurses just to vent out. The disappointed nurses would then come to me and tell me how they did not wish to continue working in the COVID wards. In times as such, I would counsel my team members and tell them how the patient is in pain and struggling for life; there isn’t any grudge against the nurses or the authorities, but the fear of losing their lives and leaving their families alone. It was overwhelming for the nurses in the initial months, but now everybody is well acquainted with the situations and knows how to handle things. 

When the pandemic was at its peak and the hospital was full of COVID-19 patients, nurses had to provide care in extreme situations, even in critical care units which were outside the area of their usual practice. None of my nurses backed off from such additional responsibilities. In fact, they spent extra time learning the right ways of doing things to help the patients and their team members, and I am extremely proud of my team.

However, offering clear, accurate and consistent communication to the patients and their families during end-of-life care, in this situation, was challenging. Having access to equipment to provide supportive end-of-life care, was increasingly difficult as demand for supplies increased day-by-day while we approach the height of the pandemic. Creative care planning helped us mitigate some of these challenges along with the determination and diligence of my team.

The initial months, where we had minimal information about the disease, were extremely difficult. We did not have enough PPE kits so we had to use raincoats to protect ourselves. Many of our teammates had contracted the virus and were struggling for life. Doctors had lost hopes with one of them, said she may not recover. This incident was very tough for us to deal with, but thankfully she recovered and has rejoined the team to serve the patients. 

One very disturbing challenge that we had to face during the times of the pandemic peak was the process of disposing of the bodies of those who lost their lives. Normally, when a patient died, the family would be informed and they would take their patient home to do the final rites. But during the pandemic, many patients were abandoned by their families, and in such cases, we had to dispose of the bodies with the help of municipal authorities. In such cases, we would dress the body in a fresh hospital gown, wrap it in a blanket, then cover it with a dead-body bag and hand it to the municipal authorities with utmost dignity.

In cases where the families we not allowed near the patients due to the restrictions, we tried to do some of their final rituals because we understand how difficult it must be for the family to not be able to see their loved ones for the one last time. I along with my team made sure that none of our patients or their families feel they are alone in this or that the patients are being discriminated against because they may not survive. The end-of-life care department is dedicated to support and care for patients, and their families, in their final, most vulnerable times.   

By Prameela Korampalli
Chief Nursing Officer

With the COVID-19 pandemic, we are living through a world crisis that we have never seen in nearly a hundred years.

The enormous scale of the crisis and the impact it has created had already caused a lot of fear, uncertainty and anxiety across the globe. The frontline workers were always at the risk of contracting the virus, despite which they have served us and took care of millions worldwide. When the pandemic started no one knew about it precisely and we were in the same boat too. All the employees and nurses were timorous and terrified but when we gathered them with respective managers and conducted meetings to explain their duty, they came forward. We had taken the initiatives to train them and counsel them about how they have to take care of the patients in the given scenario.

The acceptance of a situation where we had to stand for one another was the utmost priority which the nurses developed. Those times were so hard as there was no transportation for anyone to go to their homes respectively which was a matter of concern. But, we being nurses were only concerned about our duty and responsibility.

Generally, the ICU care unit had always seen the hardest goodbyes and warmest welcomes, but Covid-19 ICU care units were no less of a greater chore. We were running aisles to get the patients what they needed on time each moment. This reminds me of the most challenging day in the covid ICU critical care unit. This was the time when covid cases peaked up, we were accommodating 40-45 patients all at once. Suddenly, we received a call from the emergency room that there were three patients that had to be admitted as early as possible. We panicked as soon as this news was received. They were on mobile ventilators and they had to come all the way to the hospital.

We had assigned two nurses who took care of these covid patients, as our first priority were always them, we were making arrangements for them for a hassle-free admittance. We received the call about their arrival post at 5 pm in the evening and these critical patients arrived at 7 pm. They were in miserable conditions, one patient was unconscious and the other two had major respiratory problems. I remember how their saturation levels were at 80 and it was terrifying to see three patients at once with such ailments.

The doctors along with nurses were on the duty trying to do whatever we could to bring them to normalcy. As the three of them had different conditions, looking after them was a challenge. The frontline leaders faced great difficulty to get the nurses from normal ICU to covid care unit. Arranging manpower was a task for the assistant nursing superintendent. Even though there were such circumstances the nurses always came front to help the patients which were overwhelming.

Nurses are known for their patience levels and self-composed nature, needless to say, that day we experienced it. The nurses were so composed and patient with those patients who happened to recover in later stages. There was less equipment for them so, we immediately contacted the biomedical engineers to provide us with the necessary equipment. They did a very commendable job in coordinating with us at such times.

There is an on-call list for emergencies where the nurses wait at their respective hostels. If there is any need, they attend as soon as possible. Such arrangements play a major role at times where it is the matter of life and death. Post that day, we have taken good care of the mentioned patients and they recovered pretty well.

This experience has been great learning for the nurses as they have dealt with such situations, they are now ready for anything. They have no fear of treating any patient with any kind of ailments. Currently, we have 12 covid patients admitted and the nursing staff is dealing with them extremely responsibly. As they are competent to handle patients, the nurses are getting opportunities in other countries mainly, the Gulf countries and the UK where they are looking for such skilled manforce.

I am very much proud that after such experiences, our nurses are getting the opportunity to excel in their careers. After the patients recovered, their smiles are what we look up to and feel proud of. Even though time has passed such memories stay with us impacting and leave us with great learnings.

I believe that a pandemic had to come to make the world realise what nurses are capable of doing anything and 2020 was the year for nurses. As the patients struggle for their life, we can handle any situation now as we demonstrate care, team spirit and utmost unity. The most challenging day had been the most memorable one too in the times of covid.

Nursing is called a noble profession for a reason, it is not just about treating a patient, but also giving them comprehensive care and family-like support throughout their recovery process. It is about ensuring that the patients know there’s someone to look after them, a caring professional who will be there to help them throughout. It takes a great deal of perseverance, dedication and commitment to serve as a nurse with the complexity of disease conditions and technological advancements. Earlier what was considered to be an occupation that only involved caring has now changed to become a profession that involves caring as well as curing.  

Nurses have time and again, proved that they are an extremely important fraction of the health sector and full partners to medical professionals. The COVID-19 pandemic was one such chaotic crisis where the nurses shouldered equal responsibilities with doctors playing an extended role and were involved in care-efficient and cost-efficient services. I can vouch that without nurses, the conditions would have been extremely difficult to handle. The abilities of the nurse to carry out various jobs, learn new skills, and adapt to a different environment were the driving forces that kept the hospitals functioning during the pandemic. The pandemic did not only showcase the competency of the nurses but also the importance of them.  

My team of nurses at Gleneagles Hospitals Group worked day in and day out to serve our patients suffering from COVID-19. Within a few days, they were able to learn about the virus and nursing management of patients with COVID-19. They were the most preferred team members for the doctors in planning, diagnosing, treating and evaluating patients’ progress.  They helped several patients recover without any severe complications and lessened the economic burdens on the family and the payors.  Nurses went beyond caring, predicted early warning signs and collaborated with doctors in making the right clinical decision. They followed best practices of care to hasten recovery, and early discharge and prevented readmission by their education and guidance to the patients they cared for. My nurses never missed wearing pleasant smiles behind masks, gentle gestures in a COVID suit, warm touch with gloved hands, and empathetic words heard beyond N95 mask and face shiels. They stood tall in their heroic expression when they assisted patients in non-invasive ventilation, collected samples for COVID test, stood close to the patients while performing aerosol-generating procedures, met the nutritional, hygienic and elimination needs of the patient and assisted in birth and end-of-life care. The nurse was the family of the patient when the visitors were restricted in the COVID ICU and wards. Nurses used all their talents such as singing, praying, reading stories and spiritual books to patients, using humour, motivational small talks and connecting with their loved ones through WhatsApp and online modes to delight patients with COVID-19.  

If you ask me what has led to such drastic and positive changes in the field of nursing, I would say it is the improved standard of education and training, nursing philosophy, vision, mission, values, code of ethics and technological advancements. With improved education, the foundation of knowledge is strengthened making nurses who are capable of learning and adapting new skills without facing any issues. An improved code of ethics gives a sense of security to those entering the profession and attracts more individuals to it. And lastly, technological advancements have made it possible and easier for nurses to help their patients more efficiently and accurately. With all these positive changes I see the future of nursing in India to be bright and progressive. Nursing centres of excellence, global nursing education system, collaborative care, nurse clinicians, robotic nursing, specialization and super specialization in nursing, telenursing, Young Nursing leadership development, nursing research and collaboration, nursing informatics, preventive care and nurses as business leaders are the way forward.  However, there are still certain concerns that need to be addressed.  

There is a massive shortage of nurses in India and the major reason being, the migration of nurses to foreign countries. Indian nurses are highly competent, dedicated and committed and therefore are valued in foreign countries. Nurses from India migrate to a foreign land where they get a higher education, career advancement, lateral entry to medicine, evolve as nurse practitioners, and earn more respect and better compensation than they could in India. Adding to the shortage of nurses is the fact that we Indians think of nursing to be a secondary or inferior profession to medicine. We fail to understand that nursing walks alongside medicine and surgery and that nurses too are highly educated and capable. Behind every successful treatment and surgery, there are a team of nurses whose untiring efforts result in cost-effective and care-efficient services.  For India to become a global leader in the healthcare and medical field, we must appreciate and value our nurses and give them the respect they deserve because, without them, the system will fall apart.  

Lastly, I have a message for all the nurses, the future of nursing in the nation will be bright if only the future of the nation is bright. We are well aware of the equipment we use and the impact them on nature. Syringes, tubes, drains, disposables, PPE kits, surgical masks, etc. When they are disposed of carelessly, can cause severe harm to the environment. Although we cannot stop using them, we can ensure that they are disposed of properly so that no major harm is caused to the environment. Nurse innovators who are interested in product designing are to be encouraged so that they can contribute towards building Greener Healthcare by minimizing Biomedical waste generation, thereby protecting the soil, air and water.  Together, we can make healthcare green and sustainable to give our nation a healthier future. Nurses can make a difference and impact if recognized, respected and rewarded for being a care hero at the bedside and a business hero at the boardroom.  

By Dr Jothi Clara. J. Micheal

Director of Nursing, India Operations Division, IHH Healthcare India (Gleneagles Hospitals Group)

The COVID-19 pandemic has not only changed the lives of those affected by it, but has, in the literal sense, changed the lives of everybody. The way we socialize, the way we see our health, the way we perceive life, has all changed, and perhaps, this change is permanent. It also changed our entire education system. There were no more classrooms anymore where we could interact with our professors and peers to learn. It was all online. The pandemic forced us all to fetch our electronic devices to learn about the virus and how to look after the patients while taking care of ourselves. 

Regular classes were necessary as we knew absolutely nothing about the disease. We had to upgrade our knowledge in order to treat our patients and protect ourselves from contracting the virus. We had to attend several online classes and webinars, and it was difficult to manage time as the nurses had to look after patients too. Therefore, we divided the staff into groups, the on-duty group will look after the patients in their respective shifts and the off-duty group will attend the classes in the meanwhile.

The classes taught us everything. Right from the effects of the virus and how it spreads, to the safety protocols, PPE donning and doffing, and its sequences as per HIC policy to prevent the spread of infection. We were also taught the importance of hand hygiene, the sequence and the right way of doing it, and isolation techniques. It was exciting to learn new information, as we knew with this knowledge we could help thousands of patients and save their lives.  

With the introduction of telenursing, our nurses were connected with patients in the isolation wards where they addressed their concerns, answered their questions, and took updates on their health regularly without having the need to expose themselves to the contaminated wards unless extremely necessary. 

If I were to pinpoint a challenge that we faced with the entire online learning and telenursing approach, it was the rare connectivity and internet inconvenience that we had. And there were a few instances in which some of the team members had difficulties using the video conference applications or login problems. Apart from that, it was all smooth and effective. The ease of having access to a smartphone and such advanced technology, was extremely helpful in managing the whole pandemic situation and keeping the entire staff updated with the latest information about the virus.

To ensure the health of our nurses, we made regular announcements to remind the staff to wash their hands. We also had all the arrangements made to ensure that the nutritional needs of the staff are met. We provided them with good food, protein bars, healthy snacks, energy drinks and everything else they needed to remain active throughout their shifts.

The e-learning approach is extremely different from the traditional classroom-learning approach. However, it is equally effective and came as a savior during the pandemic when group gatherings were prohibited as an attempt to contain the virus. The experience with online learning was different, perceiving information was a little difficult given the unpredictable technical glitches, but with the dedication of our staff-member and their will to spend extra hours in learning along with working full-time shifts, it was all possible. The nurses worked day in and day out to serve the patients along with that, they honed their skills to help those suffering in a better, more efficient way. The hard work and diligence of my team were commendable and I can say that I am extremely proud of each one of them.

By Felicita Franklin

Chief Nursing Officer

Gleneagles Hospital

The preconceived notion of nursing being a women’s only field is something that I have always found to be inappropriate. To my belief, there is a need for male nurses as they make important contributions to the team, profession and organization as well. They not only help with laborious tasks but also support the team beyond work. I say this because I have seen how helpful male nurses can be, especially during times of crisis. In 2018 when the entire state was hit by the historical Chennai floods and the hospital was submerged 5 feet underwater inside and 8 feet around the hospital. There was no electricity to keep the machines and instruments running. It was crucial to evacuate the patients from the hospital to a safer place. At that time, it was the male nurses who came forward and gave confidence to me as a Director Of Nursing to lead the evacuation. They played a herculean task to ensure safe transportation of patients from the hospital and evacuated them on boats to ensure that they reached a safer place. Only because of the help of male nurses, we could ensure that there were no casualties. The presence of mind of one of our nurses in evacuating a patient saved his life on the boat. If it were someone else, any rescue team, we may have lost the patient on the commute, but because there was a nurse, he could save him. 

Having male nurses in the team has always been seen as a strength. They not only help the female nurses with work but also offer them emotional support and assistance when anybody misbehaves with them. The concerns of my male team members are not just limited to the hospital. They ensure their female teammates’ safety beyond work as well. They always offer to drop them home after late shifts, just to be sure that all the women in the team have reached their homes safely.

I have been in the industry for over 3 decades and I do not consider internal bias or discrimination to be the reason for men not wanting to be a part of the field. As I mentioned earlier, there is no bias within the team but the prejudice of the society. There are no nursing colleges in India that offer an equal or a high number of seats to men. Most colleges do not admit men for nursing at all. This is, perhaps, the biggest reason why men do not enter the field because there is no source of knowledge, to begin with. Apart from that, the assumption of this being a women-dominated field, based on the fact that modern nursing was founded by Florence Nightingale, a woman, is also a contributing factor. In addition, the assumptions of low pay and almost no recognition are also certain crucial factors that stop men from entering the nursing niche. But the biggest reason why India suffers from a deficiency of male nurses is the perception of society, relatives and the people around them, towards nursing. Since nursing is struggling to be accepted to be a reputable, gender-unbiased career, it is difficult for men to be a part of it, although there is a great demand and opportunity for growth for men in the field. 

Many of you must think about how nursing a field so intimately related to medicine, became a women-dominated profession when women were not allowed to have an education just a few decades ago. The answer is quite interesting. During the wars, it was the men who nursed the injured soldiers, mostly without any formal training in medicine, and women were restricted to playing the roles of midwives and child-birthing processes. With time, the demand for men increased in the army and other sectors that needed manpower and muscular strength. Therefore, the role of caring for the sick came down to most women. In addition, the founder of modern nursing, Florence Nightingale, became the role model for most women to get into nursing and pursue it as a career. Since initially, nursing meant to just take care of the patients and tend to their needs, it did not need high education, unlike today. Therefore, women did not face much resistance and slowly, nursing grew to become a sector that had way more women than men.

Today, nursing is not just meant for caring but also curing and it runs parallel to the medical field and partners in delivering the business goals of the organization. Nurses need to be highly educated and trained to provide good care and plan treatment with a multi-disciplinary team. It is also the first line of care, especially in cases of trauma and accidents, as nurses need to go to the accident site and bring the patient to the hospital in an ambulance. Therefore, we need more men in nursing as it requires a lot of strength to transfer patients, lift them and do other laborious tasks.

According to me, the way to put an end to this bias in the eyes of society is by providing equal opportunities to both men to women who desire to enter the field of nursing. Colleges and universities should have an equal number of seats for male aspirants. Hospitals must make it a point to include nurses in governance and development teams, make them a part of hospital planning, include their views in developing policies, etc., it will not only help the hospital run better but will also help society understand how nursing is not a female dominant career anymore, it is way more than just helping the doctors. When given importance respect, and value will surely attract more men to the field. The nursing profession needs heterogeneity to run smoothly which creates a huge demand for men in the field. It also provides growth opportunities and is a stable career as nursing is not only limited to hospitals any more but even to flight nursing, submarine nursing, military nursing, robotic nursing, telenursing, space nursing, school health nursing industrial nursing etc... Other reasons why I say there is a great demand is that even the male patients are more comfortable when male nurses render personalized care for them, especially when it involves caring for patients with andrological, urological and support activities of daily living. This also protects the rights of female nurses who have been historically subjected to meeting the personal hygienic needs of male patients.

Nursing is a noble profession and equal opportunities should be provided to both men to women. There should be a gender-sensitive approach including equal opportunities and respect.  It must be open to all genders and not be limited to a specific gender. The profession requires a great deal of empathy, and according to me, any human being capable of being empathetic towards the pain of others and who is committed to helping others can and should be given the chance to pursue nursing everywhere in this country. Let us bring a new norm of bringing more male nurses into nursing and consider involving transgender.  It’s high time we see people as humans first, see their calibre and not judge them or snatch an opportunity away from them just because they were born a certain way. There should be a need to let people grow based on the given opportunities. Let’s make inclusion our mantra and use the strengths of every human being to make this nation a superpower.

By Dr Jothi Clara. J. Micheal

Director of Nursing, India Operations Division, IHH Healthcare India (Gleneagles Hospitals Group)

Motherhood sparks joy in a woman’s heart as nothing else can. Your baby completes you emotionally and it is, without a doubt, your most valued possession. If you are a mother, you may agree that keeping your baby out of sight for even a fraction of a second feels like a task, let alone for hours and days. Today I submit to you my experience of working with some incredible, selfless mothers who put their duties as nurses and frontline warriors before their desire of being with their children and families.

The year 2020 brought the world down to its knees with a rapidly spreading pandemic virus. It wreaked havoc and claimed millions of lives in a few months. Everybody was confined to the limits of their homes to shield them from contracting the virus. But doctors, nurses and other healthcare workers bid adieu to their comfort and marched into the environment that exposed them to the virus, just so they could find a cure and look after those affected. A large fraction of this selfless group included mothers of young children who not only put their families second to their call of duty but also put their own lives in line.

It wouldn’t be an overstatement to say that the year extremely difficult for nurses with young children. Not being there for their babies and the perpetual fear of their health while putting their own lives at risk, took a toll on their psychological health and mental wellbeing. The oath of taking care of their patients, the responsibilities to look after their children and the fear of infecting them was extremely overwhelming and truly a lot for our staff members to handle. In addition, witnessing so many patients losing their lives and them being unable to help these patients in pain added to their trauma.

 Many staff members lost their parents and loved ones to the pandemic which made it almost impossible for them to work in the COVID-19 and ICU wards, as it reminded them of their deceased loved one. It was simply overwhelming to see my team lose hope and work with such mental stress in a completely different and challenging environment.

We came up with certain plans of action to boost staff morale and ensure their physical and mental wellbeing. We asked lactating women to take leaves as posting them in the COVID-19 wards would have been a massive threat to the health of their babies. Most lactating and pregnant nurses still wished to work, so we posted them in other safer wards. My heart was filled with pride to see my teamwork with such dedication. However, it was my responsibility to ensure that they still get enough time with their young babies, as being a woman myself, I understand what it felt like being away from your children. So, we assigned nurses with young children 6-hour duty instead of 8 hours and gave them seven days of quarantine off for every 7 of working. Their shifts were managed based on their family needs so they did not have to face any issues or resistance.

For those who missed their families and could not visit, arrangements were made to accommodate their families in the nearby hotel for them to spend some quality time together. 

To deal with the fear, anxiety and symptoms of depression in some, regular counselling sessions were hosted. I personally called each of my team member in-between shifts to see if they are doing fine, if they had any symptoms or if they needed any assistance.

 Spending hours in the PPE kit was one of the toughest challenges that we had to overcome. It was difficult to breathe, frequent toilet breaks were impossible, many felt dizzy and nauseated in the suits. Therefore, we came up with a creative solution. After spending a certain period in the suit, if the nurses needed a break, a reliever was sent to cover their shifts.

There were times when my team members came to me crying and without hope, feeling helpless, exhausted and lifeless after hours and hours of working. It was physically impossible for them to work, yet they did; to honour the oath they took, to help those in need, to do the duties and to serve their nation. I can say that I am proud of my team and especially the extraordinary women who impeccably managed their work along with the responsibilities of their children and their families. It’s such strong and dedicated women and mothers who make a nation great.

By

Ms. Joice Inbarani

Chief Nursing Officer, BGS Gleneagles Hospital, Bengaluru

The initial months of the COVID-19 pandemic, when we were unaware of the threats that surrounded us, were extremely challenging. The uncertainty of the disease and the lack of information together made an appalling combination that the healthcare professionals had to deal with. The peak of the pandemic was like a nightmare, we did not have enough manpower, information, PPE kits, essential equipment, and other resources to treat the patients and look after them.

At this point, we needed to come up with innovative and creative solutions to treat patients given the complexities of the pandemic. In those tough times, telenursing came as a saviour. It emerged as a critical tool in the fight against COVID-19, helping to ease the burden on healthcare providers by encouraging patients with relatively mild or moderate ailments to get care through telecommunication, from their homes.

Telenursing uses technology to provide nursing care to individuals who are geographically distant from healthcare providers. This was especially beneficial during the peak of the pandemic as the hospitals were crowded with patients who needed serious care. When the concept was introduced to us, most of my team members were excited to learn the new skill of nursing patients digitally. It was truly helpful and saved several patients from unnecessarily visiting the hospital and being exposed to the virus.

When the nurses interact with the patients digitally to figure out if they need to visit the hospital, they ask the patients certain questions about their health. Based on the answers that the patients give, the nurses put them into red, amber, and green groups. Those who fall under the red group need instant medical attention and are asked to visit the hospital, those in the amber group could be assisted by doctors digitally and improve their health, and those in the green group needed no medical assistance and are fine. All the nurses were vigorously trained to assist the patients and take the right call while segregating them into these three groups.

It truly did help in easing the burden on healthcare providers by encouraging patients with mild or moderate symptoms to get digital care. There were more pros than cons and challenges while providing telenursing. If I had to mention some challenges, it would be the few instances where we had connectivity issues and the times when the patients could not use their digital devices well. Other than that, all our nurses are technology-driven and can use telenursing to their best advantage.

Our nurses recognize the value of tele-home care as essential components of telenursing that give patients easy access to high-quality care and eliminate costs and difficulties associated with travel to healthcare facilities. They monitor the patients closely using technology and try to identify the warning signs early, to ensure good health and quality of life for the patient.

Telenursing continues to grow as a valuable method for providing nursing, especially in India. The trend is breaking the tradition for good. According to me, integrating telenursing with POC devices and healthcare mobility solutions will enable healthcare professionals to help more and more patients. Creating a telenursing portal for disease conditions like pre and post-transplant, chronic disease detection and management, long duration of tubed and drains and other rehabilitative services can also be extremely beneficial. Telenursing is cost-effective and time-saving. The COVID-19 pandemic has unfolded this opportunity to us and we should make the best out of it. It has expanded at lightning speed and will continue to grow. The time is not far when telenursing will become a norm and will also be included in the regular curriculum for good.

Nephrological Diseases

The kidneys, each about the size of a fist, play three major roles:

• Removing waste products from the body
• Producing hormones that control other body functions, such as regulating blood pressure and producing red blood cells
• Regulating the levels of minerals or electrolytes (e.g. sodium, calcium, & potassium) and fluid in the body

Different types of Kidney diseases

• Acute Kidney Injury
• Chronic Kidney Disease
• End-stage Renal Disease

Symptoms

Mild to moderate kidney disease often does not have any symptoms. However, in End-Stage Renal Disease or Uremia, when the toxins accumulate in a person's blood, symptoms may include:

• Puffy eyes, hands, and feet(called edema)
• Bad taste in the mouth or bad breath
• High blood pressure
• Weight loss
• Fatigue
• Generalized, persistent itchy skin
• Shortness of breath
• Muscle twitching or cramping
• Loss of appetite
• A yellowish-brown tint to the skin
• Nausea and vomating
• Thirst
• Urine that is cloudy or tea-coloured

Kidney disease usually does not cause pain, but in some cases pain may occur. A kidney stone in the ureter can cause severe cramping pain that spreads from the lower back into the groin.

Causes

• Infection such as Urinary Tract Infection (UTI)
• Obstruction due to Kidney stones
• Lifestyle factors like Obesity
• Heredity such as Polycystic kidney disease
• Diuretics or medications may lead to excessive urination or incontinence
• Food like alcohol and caffeine may also act as diuretics

Diagnosis

• Physical examination (Edema, high blood pressure, Anaemia)
• MR angiography
• Renal biopsy
• Blood tests
• Intravenous urography (IVU)
• Urine analysis
• Scintigraphy
• Gomerular Filtration Rate (GFR)
• Renal Arteriography
• Ultrasound scanning

Treatment

Depending on the underlying cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure.

Five things people with kidney disease should follow

• Lower your blood pressure
• Keep blood-sugar levels under control, if diabetic
• Reduce salt intake
• Avoid Nonsteroidal anti-inflammatory drugs (NSAIDS), a type of painkillers
• Moderate protein consumption

If you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant:

• Dialysis: Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood. In peritoneal dialysis, a thin tube (catheter) inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a period of time, the dialysis solution drains from your body, carrying the waste with it.
• Kidney transplant: A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. You will need to take medications for the rest of your life to keep your body from rejecting the new organ. You don't need to be on dialysis to have a kidney transplant.

A heart transplant is a surgical procedure in which a diseased or failing heart of a patient is replaced with a healthy donor heart. The treatment is often considered for patients with end-stage heart diseases who have not been responding well to medications and other treatments.

When Is A Heart Transplant Performed?

When a patient with end-stage heart disease is not showing any progress under the current treatment program, a heart transplant can be considered. Some common heart diseases that can benefit from heart transplant include:

• Advanced heart failure
• Arrhythmia
• Cardiomyopathy
• Congenital heart disease
• Coronary artery disease
• Heart valve diseases

Risks

Heart transplant is a complex medical procedure with potential risks such as:

• Infections
• Excessive blood loss or bleeding during or after the surgery
• Blood clots leading to heart attacks or strokes
• Breathing problems
• Rejections of the donor's heart
• Failure of the donor's heart
• Cancer
• Sever side effects of medicines

How Can You Prepare?

Preparing for the transplant is a crucial task and often takes months. Once you have consulted your doctor and decided to undergo a transplant, it’s time to look for a transplantation center. Ensure that you meet all their criteria to be considered for the transplant. You may have to take certain tests to ensure that your body can take the surgery and respond positively.

After all this, your next step will be to wait for a potential donor.

What Happens Before The Procedure?

The transplantation procedure needs to take place within four hours after the organ has been removed from the donor’s body. Once you’re notified, you will have to reach the transplantation center immediately where the surgeons will perform a few tests on you to determine if your body is ready for the transplant and if it will accept the donor’s heart.

What Happens During The Procedure?

During the procedure, you will be given anesthesia. The surgeon will then make an incision or a cut through the breastbone to remove the dysfunctioning heart and replace it with a healthy heart. A machine called the heart-lung bypass machine keeps pumping the blood throughout the body while the surgery is being performed. After the new heart is attached, the machine is stopped, and the transplanted heart takes over.

During the procedure, the lungs too stop functioning, therefore, tubes are inserted in the chest to drain blood, air, and fluids from the body till the lungs fully re-expand are start functioning normally.

What Happens After The Procedure?

Post-surgery, you will have to spend a few days in the ICU where the doctors will monitor your health closely to determine if the transplant was successful and/or if you have any complications.

After you leave the hospital, your health will be monitored by your transplant team to look for signs of any complications or organ rejection. You will also have to visit your doctor every few months to undergo certain tests to ensure that the new heart is functioning well.

Why BGS Gleneagles Hospital For Heart Transplant?

BGS Gleneagles  Hospital is one of the best hospitals for heart transplantation in Bangalore as it is well-equipped with advanced technology, modern instruments, state-of-the-art infrastructure, and supremely skilled surgeons.

Chest pain can be a worrying symptom because of its association with heart attacks. At the same time, keep in mind that pain or heaviness in the chest can also be indicative of digestive, musculoskeletal, respiratory, or other physical and mental health ailments. Because of its association with heart attacks, chest pain should never be ignored. However, chest pain isn’t always a cause for panic as there are ways to tell if it is an emergency that requires quick medical attention.

Signs Of A Medical Emergency

Although heart attacks don’t always present with chest pain, it should be treated as such if you notice other symptoms including:

• Breathlessness or heaviness in the chest
• Nausea or lightheadedness
• Cold sweats
• Pain that radiates to the shoulder, arm, neck, or jaw

In the event that such symptoms persist for 5 minutes or more, seek immediate medical care.

Causes Of Chest Pain

Aside from heart problems like coronary artery disease, myocarditis, or a heart attack, chest pain can also have other causes. Some of these can include:

• Respiratory problems like pneumonia, Chronic obstructive lung disease (COPD), asthma, pleurisy, or pulmonary embolism, among others.
• Gastrointestinal problems like gastroesophageal reflux disease (GERD), Esophageal hypersensitivity, peptic ulcers, gallbladder disease, and so on.
• Musculoskeletal and nerve problems like muscle strain, shingles, and rib problems.
• Anxiety and stress disorders that cause panic attacks.

Heart Related Causes

Common heart related chest pain causes include:

Coronary artery disease (CAD)–

A condition of narrowing or blockage of blood vessels, impairing blood and oxygen flow to the heart muscles. The chest pain may radiate to the shoulder, back, arm, neck, or jaw.

Heart attack –

The condition in which reduced blood flow to the heart causes damage or death of heart muscle cells. This is characterized by crushing pain in the centre of the chest or right chest pain.

Myocarditis –

A condition of heart muscle inflammation that can cause similar symptoms to those of a heart attack although there is no blockage.

Pericarditis –

This describes inflammation or infection of the pericardium, which is a protective sac around the heart. It can cause sharp pain in the left chest that can also radiate to the neck and shoulder.

Other heart related causes of chest pain include hypertrophic cardiomyopathy, mitral valve prolapse, and coronary artery dissection.

Respiratory Causes

Chest pain associated with respiratory causes is usually a result of lung injury or impairment of airflow because of problems with the airways. Respiratory conditions that can cause pain in the middle of the chest or stabbing pain in the chest include pneumonia, asthma, COPD, collapsed lung, pulmonary embolism, pleurisy, pulmonary hypertension, and lung cancer.

Chest pain that is caused by a respiratory condition will typically worsen with any kind of exertion or heavy breathing, while it is relieved with rest and slow breathing.

Gastrointestinal Causes

Chest pain linked to digestive disorders is usually connected to problems that affect the esophagus. The esophageal tube connects the throat to the stomach to carry food or liquid that you consume. Conditions like acid reflux or GERD are known to cause heartburn, which is characterized by a sharp pain in the chest. It is often confused with heart attacks. Conditions like esophageal contraction disorders, esophageal hypersensitivity, peptic ulcers, and gallbladder disease can also cause chest pain.

Chest problems and pain linked to gastrointestinal problems are usually relieved with exercise and exacerbated with lying down, as opposed to chest pain caused by heart and lung disease.

Other Causes Of Chest Pain

In addition to heart, respiratory, or gastrointestinal disease, chest pain can also be caused by musculoskeletal problems or nerve disorders, such as muscle strain, a rib injury, shingles, or stress and anxiety disorders that cause panic attacks.

When To See A Doctor?

Chest pain that is accompanied by other symptoms associated with a heart attack should always be treated as a medical emergency. However, chest pain that develops suddenly and does not improve with anti-inflammatory medications and dietary changes should also be brought to the attention of your doctor.