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The Complete Medical Tourist
Your Guide to Inexpensive Dental Cosmetic and Medical Surgery Abroad
By David Hancock
John Blake Publishing LtdCopyright © 2006 David Hancock
All rights reserved.
Coronary heart disease claimed the lives of 233,000 people in the UK in 2003, according to the British Heart Foundation. More than 1.4 million people suffer from angina and 260,000 people had a heart attack in the UK in 2003. These are astonishing statistics, making coronary heart disease the biggest killer in the country.
In order to work properly the heart needs a constant supply of oxygen, which is carried in the blood and flows through the heart's blood vessels. When the supply is blocked or interrupted due to a build-up of fatty substances in the arteries, heart disease occurs. A partial blocking can lead to angina, the symptoms of which are chest pains. A complete blockage leads to a heart attack.
A combination of regular exercise with a change to a low-fat diet with a lower salt intake and more fresh fruit, oily fish, vegetables and cereals can help the prevention of heart disease by increasing the level of HDL cholesterol (the good cholesterol). Needless to say, smokers should stop smoking, as it hardens the arteries and causes the majority of cases of coronary thrombosis in people under the age of 50.
The most effective form of treatment for people with hardened and narrowed arteries is the heart bypass, although contrary to popular opinion it is best in those who have not had a heart attack and whose heart is not enlarged.
The two coronary arteries come off the main artery of the body, the aorta. The left coronary artery immediately divides into two, so there are three main coronary branches. If necessary, a bypass can be done on all three. This is called a triple bypass. Veins stripped from the leg were almost always used to make the bypass. They were connected to the coronary arteries beyond the narrowed areas and then linked to the aorta, just above the heart. But in recent years surgeons have been preferring to connect an internal artery of the chest wall to the diseased coronary artery. This means that the surgeon can use keyhole surgery, which is minimally invasive, and the heart does not have to be stopped during the operation. Small plastic devices, known as stents, are used to keep the arteries open.
Bypass surgery, performed under general anaesthetic, takes between three and six hours after which there is a period in an intensive care unit. Within two days of surgery, you should be able to sit out of bed and, if you have an office job, be able to return to it within six weeks. More demanding manual work may mean three months off, and patients are advised not to drive for at least a month after the surgery.
Although heart-bypass surgery is major, it is very common and quite safe with less than a 2 per cent risk to life. Most patients get another 10 years free of heart symptoms but they need to change their lifestyle as well. Regular exercise, stopping smoking and a healthier diet are all good advice.
UK cost(approx): £12,000–15,000
See Section Two: Belgium; Germany; India; Malaysia;
The mitral valve is the inflow valve for the left-hand side of the heart, allowing blood to flow into the heart's main pumping chamber, and closing to prevent the blood from going back into the lungs before it has been pumped around the body. As we age, the mitral valve can degenerate, or it may be damaged by infection or rheumatic fever. They can also be affected by heart attacks or congenitally. Sometimes the mitral valve has to be replaced, but it can often be repaired.
In replacement surgery, the valve is made usually from titanium; this lasts forever but the patient has to be given blood thinners for the remainder of his or her life. A valve can also be made from a cow or pig's heart; the patient doesn't need anticoagulation treatment, but these valves do wear out after about 12 to 15 years.
During the operation, under general anaesthetic, the patient is connected to a heart and lung machine, which takes over from the patient's real heart and lungs while the surgeon opens up the heart to see whether the mitral valve is damaged and can be repaired or whether it has to be replaced. After the operation, patients are transferred to a special unit for open-heart cases before draining catheters are taken out and they can return to a normal hospital room. Hospitalisation usually takes about seven days.
The future of mitral-valve operations is with minimally invasive videoscopic and robotic techniques, where the only incision needed is merely two-and-a-half inches long.
Heart-valve-repair operations take between three and five hours and full recovery can take a few months. An exercise programme is often recommended along with a lifestyle change of diet, and an awareness that valves sometimes have to be replaced.
UK cost (approx): £10,000+
See Section Two: Belgium; Germany; India; South
Doctors can tell how well blood moves through the vessels of your body by taking an angiogram, which is really an X-ray examination of those blood vessels. A coronary angiogram is done by inserting a small tube through the skin into the artery, guiding it to the opening of the coronary arteries and injecting a dye (usually a solution of iodine) which can be traced by X-ray pictures. The images are called the angiogram and can reveal the extent and severity of any artery blockages or narrowing.
The procedure – performed with local anaesthetic – usually takes about 30 minutes and is not terribly uncomfortable; the insertion is either through the arm or the groin.
UK cost (approx): £1,000–3,160
See Section Two: Belgium; Germany; India;
Fat and cholesterol that has formed on the inside of arteries is known as plaque. If the narrowing or blocking of the arteries due to plaque is not too severe, then the artery can be opened using a balloon catheter as an alternative to bypass surgery. The inflated balloon widens the blocked vessel and restores adequate blood supply. The artery is kept open by placing a stent at the site of the blockage and the whole procedure is known as an angioplasty.
Although this procedure treats the condition, it does not cure the cause and narrowing may or may not reoccur. Patients are often post-operatively treated with blood thinners as well as statins to lower cholesterol, and advised to change their lifestyle patterns with a healthier diet, exercise and stopping smoking.
The average hospital stay for the procedure is two days and complete recovery takes a week or less, with patients able to walk within six hours of the operation.
UK cost (approx): £11,600–15,000
See Section Two: Belgium; Germany; India;
More and more people are deciding to change the way they look by having cosmetic surgery. And, in line with the increase in demand, there have been major advances in these kinds of elective procedures. It is no longer just the rich or the celebrity-conscious who are having their bodies resculptured; prices have now become so affordable that anyone who can take a holiday can afford a little nip and tuck.
In the age group of 18 or younger, the dominant procedure is ear surgery; breast augmentation is popular with women aged 19–35, while the over-50s go for eyelid surgery or facelifts.
For many years, it was assumed that only women took advantage of cosmetic surgery, but that has all changed. Today, more men than ever are aware of the way they look, and just as a whole industry of male facial creams, scrubs, lotions and other cosmetics has built up, so has the desire in men to change their appearance. For many, it is a greater awareness of health issues as mirrored in the growth of men's magazines. For others, it is the intense competition in the business world. The perception, correct or not, is that an older man is less up-to-date and efficient. So in an effort to remain looking young many men are turning to cosmetic surgery. And there are some operations that are peculiar only to men, such as treatment for gynaecomastia (large breasts), penile surgery and hair transplants.
But, male or female, before embarking on any form of cosmetic enhancement read as much as you can about your chosen procedure or treatment. This will help you to make sure it is right for you and you are aware of the pros and cons of the treatment. Be clear about what you want to achieve. Find out all you can about the doctor who will be performing the surgery and, at an initial consultation, don't be afraid to ask the surgeon about his or her qualifications and expertise in the procedure. Ask how many times they have performed the operation and whether complications have ever occurred. Choose the clinic or hospital carefully by reading as much literature as possible so you can compare prices and services. Don't ignore the risks – all surgery can have risks.
This guide is an excellent starting point for that research.
Breast size is determined by genes, hormones, weight and body frame and for most women the breast size is in proportion to their frame. But when it is not it can cause both psychological distress and physical discomfort. For some women, large breasts can develop in adolescence because of the hormone oestrogen, and for others it may happen later in life following the menopause or use of Hormone Replacement Therapy. Either way, it can be distressing for women, leaving them with an overbearing feeling of self-consciousness. Some women may even have breasts of a different size or shape and in these circumstances surgery may be undertaken to reduce the larger one. But it must be emphasised that breast reduction is not vital for one's health and so for this reason it is classified as cosmetic surgery, even though there is some evidence that breast reduction may decrease the chances of developing breast cancer (according to Bandolier, 2001).
Although excessively large breasts, known medically as mammary hypertrophy, may not be life-threatening, they can cause distressing problems like back and neck strain, poor posture and shortness of breath, and can be both socially and sexually embarrassing. Women with pendulous breasts may also find difficulty in buying clothes due to the disproportion, and many become so self-conscious that they try to camouflage their body shape by wearing baggy clothing, avoiding recreational activities and in extreme cases become introverted, reclusive and depressed.
Normally, a female breast reduction will take a surgeon about three hours and will be carried out under general anaesthetic. The patient will be expected to stay in hospital overnight. The operation involves reducing and uplifting the breast tissue at the same time. Techniques vary but usually involve an anchor-shaped incision that circles the areola, extends downwards and follows the natural curve of the crease beneath the breast. Excess glandular tissue, fat and skin are removed and the nipple and areola moved into their new position. The movement of the nipple carries with it the risk that the woman may not be able to breastfeed after surgery.
Modern surgical techniques, especially using liposuction, mean breast reduction can leave minimal scarring. After surgery, the breasts are wrapped in an elastic bandage or surgical bra over gauze dressings, and pain may be experienced for the first few days. The first menstruation following surgery may also cause the breasts to swell and hurt.
Patients are advised to take things easy and not return to work for at least two weeks after surgery. As a medical tourist, it is the time to relax and enjoy being pampered. Although the swelling and bruising will disappear before it is time to return home, it may take six months to a year before the breasts settle into their new shape, so patience is required.
No surgery is without risks, although these can be greatly lessened by taking the advice of the surgeon to make sure the patient is in good health before the operation. Side-effects specific to breast reduction may include losing sensation in the nipple and experiencing scarring, which usually takes quite some time to fade. The new breasts may also feel tender and lumpy for some weeks or even months after the procedure.
UK cost (approx): £4,550–5,600
See Section Two: Argentina; Belgium; Czech
Republic; Egypt; Germany; Greece;
Hungary; India; Mexico; Poland;
South Africa; Spain; Thailand;
For obvious reasons, men with abnormally large breasts can be left with feelings of shame and embarrassment, and it can leave sufferers with deeper psychological issues to deal with than those of women with large breasts. A man or boy with gynaecomastia struggles with anxiety over such simple acts as taking off his shirt at the beach. The condition is relatively common in adolescent boys, and 90 per cent of the time symptoms disappear in a matter of months or, as adolescence wanes, a few years later. But the remaining 10 per cent are burdened with a social handicap that causes a deep and complex shame, and puts one's relationship with one's body at risk.
There are many reasons for the development of gynaecomastia, from a genetic disorder which occurs at conception known as Klinefelter Syndrome, in which the chromosomes in the sex line have at least one extra 'X', to the abuse of steroids by bodybuilders, often known as 'bitch tits'. The ageing process itself in men can also cause gynaecomastia. But the men who suffer the greatest problems are those who have been aware of the condition since adolescence and have tried to hide it.
Surgery can help, though it is not the preferred option and is discouraged in men who are overweight and have not attempted to correct the problem with exercise and weight loss. Excess breast tissue is removed through an incision around the nipple and the procedure can be done in two hours under general anaesthetic, requiring no overnight stay in hospital. After surgery, the patient is fitted with a compression garment or ace bandages to support the breasts while they heal.
Considering the amount of emotional damage that gynaecomastia can cause to a sufferer, a surgical solution is relatively quick and patients can be back to work within seven days, although bruising, numbness and soreness will last longer. Any complications usually only stem from surgeon error or the patient trying to do too much after the operation.
UK cost (approx): £1,800–4,750
See Section Two: Argentina; Belgium; Egypt; Greece;
India; Mexico; Poland; South
Africa; Spain; Thailand; Tunisia;
Contrary to popular belief, very obese people are not really suitable for liposuction, which is the removal of excess fatty tissue to reshape the body. Instead, they should diet and exercise first. Liposuction is aimed at getting rid of the stubborn fat left after diet and exercise. In women, the most frequently treated areas are the abdomen, hips, thighs and knees, and in men it is love handles, abdomen, arms, neck and face. Sweat glands in the underarm can also be removed by liposuction without it affecting the body's ability to cool itself.
Liposuction was invented in Rome as far back as 1974 by Dr Giorgio Fischer. It has been constantly developed and refined, and now there are different methods employed – from the tumescent technique, which uses large volumes of lightly salted water solution, to standard liposuction methods, which require a general anaesthetic. A more modern technique uses ultrasonic energy to explode the walls of fat cells.
With standard liposuction, the patient is given a general anaesthetic and the surgeon uses a hand-held instrument called a cannula, which might be partly or completely made of metal or plastic, to suck out the fat. The fat is pulled out into a suction machine. In order for the liposuction treatment to be long lasting, the patient must stick to a proper diet and exercise plan after the operation.
The method of liposuction used depends on patient and surgeon preference, and anyone considering undergoing the treatment is advised to find out about all types, and which methods certain surgeons use. It is claimed by some specialists that recovery and return to work and daily functions are faster following tumescent liposuction as opposed to traditional/standard liposuction, with significant numbing lasting only 18 hours in the suctioned areas. The post-operative recovery period is also claimed to be only one or two days, allowing for a longer holiday while abroad.
However, like any surgery, it carries risks, which include infection, blood clots, nerve damage and numbness.
Side-effects in all methods of liposuction include bruising, soreness and swelling, but these should disappear completely within a few weeks.
Excerpted from The Complete Medical Tourist by David Hancock. Copyright © 2006 David Hancock. Excerpted by permission of John Blake Publishing Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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