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V.N. Bhattacharya

Dear Dr. Patil,

I hasten to add I am improving each day. Gaining strength, confidence, and achieving slightly greater range of movements every day.

I wish to convey how impressed I am by the organisation and ethos of your hospital. I found everyone - from housekeeping staff to nurses, and doctors - cheerful, helpful, and attentive.

Rajesh and Lakshmi (housekeeping) went beyond their call to be available and to assist quickly and happily. Maya, and Prema stood out with their competence, quick response and attention. They were ably assisted by their team of nursing staff. And of course your doctors, especially Dr. Shashikanth, were knowledgeable and helped with interventions when needed. I am a student of management. Ms. Shetty was always available to help iron out any wrinkles and assist with information and advice. Always prompt and caring.

I cannot help but marvel at the effective and compassionate organisation you have built.

Please accept my gratitude for the skill and care with which you treated my condition. I deeply appreciate that you managed my expectations with realism and a conservative approach. Your philosophy helped me opt for Sparsh among a number of options I had carefully explored.

Thank you very much.

V.N. Bhattacharya

Lakshmi – the eight limbed girl child

About Lakshmi……

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Two-year old Lakshmi – named after the Hindu goddess she somewhat resembles with her four arms and four legs – comes from a small village in the district of Araria, located on the border of Nepal, in Bihar.

Lakshmi is an Ischiopagus conjoined twin. Ischio stands for pelvic bone and pagus means fused. Therefore, Lakshmi is actually two bodies united at the pelvis. Only one of the twins has a head and the other is a parasite. Two pairs of arms and legs have formed at either end of the two adjoining torsos, creating a child with 8 limbs. The incidence of conjoined twins is 1 in 50,000 Lakshmi’s kind of twin forms only 3% of all types of conjoined babies.

Poonam gave birth to Lakshmi in her mother’s home village without any form of medical supervision, and neither did she receive any antenatal care during her pregnancy. When Lakshmi was born, it invoked tremendous curiosity in the village. Hordes of people started turning up from the neighbouring areas to see the incredible Lakshmi.

Lakshmi comes from a very impoverished background. Since Lakshmi’s birth, her parents, Shambu and Poonam, have faced innumerable ordeals – socially, medically and mentally – in trying to raise her. She is the younger of the two siblings – her brother Mithilesh is 6 years old.

Lakshmi at SPARSH…….

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She was admitted to SPARSH Hospital at the beginning of October 2007 – the first time that she and her family have travelled so far away from home. On arrival, immediate tests revealed that she was extremely mal-nourished, and had haemoglobin of 5.4 gram percent as opposed to 12 gram percent in normal children. She was suffering from an infected pressure sore on the dorsum of the parasitic twin measuring almost 6 inches in diameter – causing her to run a constant fever. She also had a parasitic helminthic infestation of her bowels.

It became imperative to improve Lakshmi’s nutritional status and general wellbeing which was done by de-worming her and putting her on a high-protein calorie diet. Simultaneously, a battery of blood and urine investigations were carried out including ultrasound tests, whole-body MRI scans and a 64 slice CT scan. All the data from the tests has been thoroughly examined and discussed.

Now with an improved nutritional status and an increased haemoglobin of 11 gram percent, surgery has been scheduled to begin at 0700 hrs on November 6th 2007. The operation is expected to go on day and night, and likely to take up to 40 hours to complete. The medical team, supported by paramedical staff, will number a total of approximately 36 members.

 

Lakshmi Tatma:

The 40-hour Countdown

A sleepy little Lakshmi was wheeled into the operating theatre at 0700 hrs in the morning of November 6th 2007. She was anaesthetized and all monitoring equipment was placed, before – following careful preparation – the surgeons began to work. The child was carefully monitored throughout the long surgery and all necessary corrections were carried out immediately throughout the operation.

The paediatric surgery team operated on her first and carefully dissected out vital organs so that they could be preserved during removal of the parasite. Lakshmi’s internal structures were not exactly as they had appeared on the scans, but the surgeons were able to negotiate these difficulties. As Lakshmi herself had only one kidney, a second kidney from the parasite was successfully isolated and moved into Lakshmi’s body.

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Then the neurosurgeons began the delicate process of separating the Lakshmi’s spine from the spine of the parasite. This was accomplished without any major complications.

Next the orthopaedic team led by Dr Sharan Shivaraj Patil went in to perform the crucial part of the surgery – "the pelvic osteotomy". The bones in Lakshmi’s pelvis were split apart in order that they could be moved closer to each other to form a ring, thus supporting Lakshmi’s internal organs above. The lack of space caused by the proximity of the parasitic body, and the continuing discovery of unforeseen internal structures, made this a difficult part of the operation. It was also very important that the ring of Lakshmi’s pelvis could be closed as tightly as possible in order to give her the best chance of walking in later life. In a daring move, Dr Patil used some of the pelvic bone from the parasitic twin to reconstruct Lakshmi’s pelvis into a rounder and more successful shape than had been expected – giving her a very good chance of a normal walking gait later in life.

The climax of the operation at 12.30 am on November 7th. It was a spectacular moment when the legs, arms, and remainder of the parasitic twin were removed from Lakshmi and held in the hands of the Dr Sharan Patil. The Plastic and Micro vascular surgery team then stepped in to perform the soft tissue reconstruction and close the open wound. The whole surgery was completed at 10 am in the morning.

On completion of the surgery, there was a great sense of elation for having achieved everything that the entire team had set out to do. Lakshmi was shifted out to ICU were she is being monitored round the clock. Her condition is stable. But the next 48 to 72 hours are critical. And the whole team is constantly monitoring her in order to ensure that her vital signs remain normal and so that her recovery continues as quickly as possible.

SPARSH Hospital wants to thank the Indian public and people from around the world for their prayers and support without which this landmark surgery would not have been possible. With you we will hope and pray that Lakshmi will continue to make great progress in days and weeks ahead.

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Lakshmi Tatma is going home today

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Lakshmi Tatma is going home today (15.12.2007) from SPARSH hospital. As you all know Lakshmi with her family i.e. Shambu, Poonam and mitilesh arrived at our hospital on the 3rd Oct 2007.

After over a month of building up of Lakshmi’s general condition & planning the surgery itself was undertaken on 6th of Nov 2007. after the 27 hrs of surgery. She was kept in ventilator for the next 72 hrs.

We had a steady progress in her conditions & all the organ functions are normal

On 13th Nov she was shifted out of the ICU

Further her wound healed satisfactorily a physio rehabilitation was carried out. The plaster casts on her limbs were removed and splints applied. She has started accepting her new body condition & showing great signs of catching up of her milestones.

We are satisfied with the progress Lakshmi has made.

The Parents are keen to go home at this point -Missing home. Medically we do not have an objection to this.
However we have 3 to 4 issues to sort out in the future.

She has condition called tethered cord syndrome which needs to be surgically released.

She has small segment of the sacrum of the parasitic twin remaining in the pelvis of Lakshmi which needs to be excised.

Depending on the tissue shrinkage we may need to further reconstruct her pelvic bones and further align the genital-urinary and excretory system.

Bilateral club foot which will requires surgical correction.
We do not consider any of the above surgeries are immediately necessary.
The parents intend to return for the procedure immediately after holi.

We are indeed grateful to all the people who have wished welfare Lakshmi & team at SPARSH Hospital. The media who have covered this human story in such a sensitive manner.

Dr Sharan S Patil from the SPARSH Hospital, Narayana Health City, Bangalore

15.12.2007

 

Lakshmi Tatma: Post-Op Update

9th November 2007 at 1600 hours

Lakshmi Tatma has now been in ICU for approximately 54 hours. Her condition has continued to remain stable during this time. Lakshmi opened her eyes for the first time yesterday. In addition, she managed to move her fingers and toes. She continued to be ventilated overnight.

Shambu and Poonam Tatma visited their daughter in the ICU. They spent about 15 minutes at her bedside.

This morning, all of Lakshmi’s blood parameters were within normal limits. We started weaning her off the ventilator around 0800 hrs, and were able to take her off the ventilator completely within a few hours. She has been off the ventilator since that time, with all parameters continuing to remain stable.

Shambu and Poonam Tatma revisited Lakshmi again today at 1600 hrs.

Dr Sharan S Patil from the SPARSH Hospital, Narayana Health City, Bangalore
09.11.2007

10th November 2007 at 1600 hours – Day 4
Mother and daughter – Lakshmi and Poonam, today, spent a good 2 hours together. Lakshmi responded to her mother’s touch positively.

For the first time following the surgery, Lakshmi is able to tolerate oral liquid feeds. Her clinical and biochemical parameters continue to be within the normal limits.

Overall, she has made significant progress in the last 24 hours.

Dr Sharan S Patil and Dr Sharanu Patil from the SPARSH Hospital, Narayana Health City, Bangalore
10.11.2007

12th November 2007 at 1600 hours – Day 5/6
The entire Tatma family – Poonam, Shambu and Mithelesh – has been spending a lot of time with Lakshmi over the last couple of days. And Lakshmi has been responding well to this interaction.

Lakshmi is now able to tolerate oral semi-solid feeds. Her clinical and biochemical parameters continue to be within the normal limits. Her invasive monitoring has been removed.

Overall, she has made significant progress in the last 48 hours and is looking cheerful.

Dr Sharan S Patil & Dr John from the SPARSH Hospital, Narayana Health City, Bangalore
12.11.2007

13th November 2007 at 1600 hours – Day 7
Lakshmi Tatma is on her sixth postoperative day. She continues to make good progress. and has maintained all her vital parameters.

Poonam and Shambu Tatma along with their son Mitilesh have spent a few hours with her. Poonam has been able to take part in all of Lakshmi’s feeds as well. Lakshmi has had milk, bread and eggs today. She also made a brief appearance along with her parents and brother at about 4pm today.

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Dr Sharan S Patil from the SPARSH Hospital, Narayana Health City, Bangalore
13.11.2007

03rd Dec 2007 at 1600 hours – Day 26
Lakshmi Tatma an Ischiopagus parasitic type conjoined was operated at SPARSH Hospital on 6th & 7th Nov 2007.

Lakshmi has made significant progress, her wounds are healing well, her plaster cast remains off, custom made splints have been applied and her rehabilitation process is progressing satisfactorily.

She will require further evaluation before any more surgery is planned. She has been eating and drinking well. All her organ system are functioning normally. She is in good cheer and playful. She is able to sit up on her own and is attempting to crawl. She is happy while being carried around the hospital.

Dr Sharan S Patil from the SPARSH Hospital, Narayana Health City, Bangalore

03.12.2007

 

15 year old Govind takes his first step

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Govind(name changed to respect privacy)is a 15 year old boy from Bengal born with a congenital cardiac problem. In addition to this problem, Govind also had a congenital kyphoscoliosis (bent spine). He received treatment for his cardiac problem and at the age of 10 was operated for his spine problem. While it appeared that he had been treated the deformity of the spine continued in spite of the surgery. It was at this stage that he came to hear about SPARSH Hospital.

He came to SPARSH Hospital when he turned 15. The spinal problem had aggravated over the 5 years since his operation. He now had a severe deformity with a resultant persistent pain in the back. He was bent forward and had been that way for the past 4 years. Sadly he lost out on his childhood as he could not even engage in simple play with other kids. Dr Gowrishankar and his team operated on him hopeful that in some way they could give him at least a productive adulthood. There was differential uneven growth of the spine due to the congenital problem impairing the normal development of the spine. This manifested itself in the form of a bent spine. The doctors had to remove a portion of the vertebral body to correct the bent spine and then fuse the spine, accurately, in the corrected position and hold it together with implants. Post surgery Govind took his first hesitant steps. With an external spinal brace support, he made his first few steps with an erect spine. Over time he made rapid progress. There was elation in the ward as he stood on his own in a week’s time. His life went back to normal and he returned to school . He is now in the process of making up for the lost time.

 

Sita’s life changing decision

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Sita (name changed to respect privacy) is a 40 year old housewife. She had rheumatoid arthritis and took a lot of medication to control the pain. After visiting a string of hospitals, she underwent several surgeries. Everyone she was close to discouraged her from taking further medical intervention. But the pain was agonising. Eventually she became bed ridden. She developed deformities not only in her knees but also in her shoulders, fingers and feet. People told her any further surgery will be useless and that her body will not be able to handle it. She lost all hope and thought that she will never walk again. Unable to see her like this some of her relatives went to her and insisted that she comes to SPARSH Hospital for a consultation. She came in on a wheelchair. She couldn’t even manage a single step. She was admitted for a bilateral single stage total knee joint replacement surgery. Under epidural anaesthesia she went through a painless procedure. With a low haemoglobin level she had to receive blood transfusions. Post operation the change was dramatic. She couldn’t believe that she was walking three days after the surgery. It was an emotional moment for her family as along with her, they too had lost hope that she would never walk again. She was discharged 10 days post the surgery. Seven months later she remains elated at the life changing decision that she took and the happiness and freedom that came with it.

 

Prakash Rao

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Prakash Rao, aged 62 years had an accident in 2001. The Doctors removed his left knee cap. Till 2007 he was able to walk and then his problem started wherein he started finding it difficult to move around. His doctor at other hospital suggested SPARSH.

In January 2010 he came to SPARSH and underwent a Joint Replacement Knee Surgery (Left Knee). His surgery was successful and the treatment is over. He is able to walk properly now and is very happy with his experience at SPARSH.

Prakash Rao/62/M/Bangalore

 

Giriyappa

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Giriyappa, aged 72 years, lives in Chitradurga. He had swellings on both the knees and was finding it very difficult to walk for even a small distance. He consulted some doctors at Chitradurga but his condition didn’t show much improvement. His daughter and son in law are both doctors, and they asked him to go to SPARSH Hospital. He came to SPARSH one and a half years ago, and then underwent a surgery on both knees for joint replacement. He was in the hospital for 10 days. His surgery was successful and now he is able to walk with a stick or by holding someone. He is very happy with his experience at SPARSH and said “Dr Chandrasekar is a very good doctor and has given me very good health.” “SPARSH has well experienced doctors and we can get efficient treatment. Has has now recovered completely and does not have to go to SPARSH even for a check-up.