How to choose the right hospitals for your treatment

Now a days the choosing the right hospitals is the big headache , everyone giving priority for the best treatment services , hygiene and affordable prices .

Cardiac diseases are one of the most deadly diseases in Malaysia. According to researches, currently the total number of deaths in the country due to heart disease is about 30,000. At the current rate, this number will double itself by 2017. The main reason behind this increasing rate of heart diseases is due to the stressful environment of everyday life and unhealthy lifestyle. Thus, it is very important to monitor the health of the heart on a regular basis.

It must be noted that a proper diet programme and regular consultation with the cardiologist heart diseases can be prevented.

Manipal Hospitals in Malaysia has the best cardiac and other health services in Malaysia. With comprehensive cardiac health check packages available with Manipal Hospitals in Malaysia, one can take a better view of the health of the heart and plan a healthy lifestyle which may not lead to any heart disease.

Manipal Hospitals in Malaysia also has the most advanced technologies for the diagnosis and treatment of all cardiac problems. The focus at Manipal Hospitals is to develop an affordable tertiary healthcare structure to completely eliminate the disease from the country. To know more about the facilities and treatments which are available with Manipal Hospitals in Malaysia, Visit the website: http://manipalhospitals.com.my/

Understanding Breast Cancer – Treatments

Breast cancer can be treated:

In our last blog, we understood about breast cancer, its risk factors and how methods of early detection can help in lowering the risk involved and assist in a successful treatment for the cure.

Certainly, there are several treatment options for women diagnosed with breast cancer that include surgery, chemotherapy, radiation therapy, hormonal therapy and targeted therapies.

But only after consideration of the optimal treatment available for the stage and biological characteristics of the cancer, the patient’s age and preferences, and the risks and benefits associated with each treatment protocol, the treatment decisions are made by the physician. To be more precise, the most appropriate treatment depends on the woman’s risk profile and stage of disease, which can range from I-IV and is based on the tumor size, location, and involvement of lymph nodes and whether or not tumor has spread to surrounding tissue or distant organs.

Most women with breast cancer will have some type of surgery. Surgery is often combined with other treatments mentioned above.  The treatment options for breast cancer are as follows:

Surgery:The primary goals of breast cancer surgery are to remove the cancer from the breast and to assess the stage of disease. There are three methods to do that. First is lumpectomy where cancerous tissue plus a rim of normal tissue is removed, also known as breast-conserving surgery.

The second is mastectomy where all the breast tissues are removed, although muscles underneath breast are no longer removed.

The third option includes lymph node removal (or axillary lymph node dissection) which takes place during time of lumpectomy or mastectomy if biopsy shows that breast cancer has spread. Other options include preventive surgeries such as prophylactic mastectomy for women at high-risk and prophylactic ovary removal to lower estrogen production in the body.

Radiation therapy:Radiation is given after surgery to destroy cancer cells remaining in the breast, chest wall, or underarm area after breast-conserving surgery. Radiation may also be needed after mastectomy in patients with either a cancer that is larger than 5 cm in size or when cancer is found in the lymph nodes.

There are two types of radiation therapy. It includes external beam and internal (implantation of radioactive seeds) radiation therapy. While the former is a well-tested, long-standing treatment option, the latter has recently being developed and is still being studied for its efficacy.

External beam radia­tion is the usual type of radiation for women with breast cancer. Radiation is focused from a machine outside the body on the area affected by cancer. Internal radiation therapy, known as brachytherapy, uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Some patients are treated with both internal and external radiation therapies in combination.

Chemotherapy:It is a systemic therapy that can be administered either before surgery, to shrink the tumor or afterwards, to reduce the risk of recurrence. For early-stage disease, it is usually administered to help remove cancer cells from the body and to reduce the risk of recurrence. For advanced-stage disease, it is given to destroy as many cancer cells as possible. The benefit of chemotherapy is dependent on multiple factors, including the size of the cancer, the number of lymph nodes involved, the presence of estrogen or progesterone receptors, and the amount of HER2/neu protein made by the cancer cells. Chemotherapy is most effective when the full dose and cycle of drugs is completed in a timely manner.

Hormonal therapy:It is a treatment option for hormone receptor-positive cancers. It can be given for early-stage disease to either reduce the amount of estrogen or block its action to reduce the risk of recurrence. It can also be given for advanced-stage or metastatic disease to shrink or slow the growth of existing tumors. Hormone therapy includes aromatase inhibitors (AIs), selective estrogen receptor modulators and estrogen receptor down regulators as well as surgical treatments such as removal of ovaries and fallopian tubes.

Targeted therapy:It targets cancer cell properties specifically as opposed to chemotherapy which also destroys normal, healthy cells. It includes treatments such as herceptin and tykerb, both block cancer cell growth in HER2-positive breast cancers, and avastin, which blocks growth of new blood vessels depending for cancer cell growth.

There are several treatments for curing breast cancer but it is always advisable to stay well by taking steps to reduce the risk of breast cancer or detect it early.

Manipal Comprehensive Cancer Care Centre

Breast cancer

It’s a fear that every woman across the realm has faced sometime or the other. Breast cancer is responsible for an estimated 232,670 new cases in the US (2014). It is by far the most common type of cancer sighted in women and the second most common cause of death in women.

Breast cancer is often started off by the presence of an unusual lump in the breast or even the areas surrounding it. If untreated, breast cancers can grow bigger, taking over more surrounding breast tissue. A variety of diagnostic procedures are carried out to detect the presence and the stage at which the tumor is. Mammography is superior for less dense breasts and is almost invariably performed. Ultrasound is very effective especially in younger women. MRI is performed in difficult cases such as dense breast tissue, especially in young women.

The treatment in most women with breast cancer includes some type of surgery. Surgery is often needed to remove a breast tumor. Options for this include breast-conserving surgery and mastectomy. The breast can be reconstructed at the same time as surgery or later on.

One always wonders on how breast cancer can be prevented. Here are a few simple tips:
• Avoid becoming overweight.
• Eat healthy to avoid tipping the scale
• Keep physically active.
• Drink little or no alcohol
• Don’t smoke.
• If you bear children, breast-feed your babies for as long as possible.
• Avoid hormone replacement therapy
• Get regular breast cancer screenings.

ENT surgery

Our in-house Audiology Department has facilities for Pure Tone Audiometry and Impedance Audiometry. The audiologist is also trained in speech therapy. The Neonatal Screening Unit in the department has Otoacoustic Emission (OAE) Screening Machine and Brainstem Evoked Response Audiometry (BERA) equipments which are handled by the paediatric audiologist. The Seminar Room is equipped with a LCD projector and overhead projector facilities. 

The Operation Theatre of the department handles Ear, Nose, Throat and Head and Neck surgeries. There is a high end microscope for Ear and Laryngeal procedures. The CO2 Laser with Micromanipulator facility is being used for ears and larynx. For nasal surgeries, the department is equipped with the Nasal Endoscopes and Microdebrider and also facilities for Balloon Sinoplasty. The Radio Frequency equipment is also used for nasal and oral surgeries. Diode Laser and Harmonic Scalpel are available for use. The Skeeter Drill is the latest addition to the department’s state-of-art equipment bay. Surgical procedures requiring team effort of multiple specialties such as Cochlear Implantation, Skull Base Procedures and Airway Reconstruction are also carried out.

arthritis

For most age, old age rather itself does turn out to be a form of illness. Despite being conscious of health hazards and taking all the care in the world so as to be able to fight of diseases, one might simply catch up on the symptoms of an aging body in a way or two. When age sets in the body begins to show off its own agenda and one might often  have to encounter its ill effects whether or not one has taken care to shake off immediate threats or has seldom over a lifetime throw caution to the air.

Arthritis is one such ailment which often gets the better of an aging individual and makes his/her life a long drawn yarn of pinches and pain. The word arthritis (plural: arthritides) comes from the Greek word arthron which literally means “joint” and the Latin word itis, meaning “inflammation“.  Therefore in layman’s terms, arthritis simply means the routine inflammation of the joints. Technically, arthritis affects the musculoskeletal system, specifically the joints and it is the main cause of disability generally among people who are over fifty-five years of age around the world.

If one is diagnosed as a case of arthritis it fundamentally means that something has gone wrong with the joint(s). What indeed has gone wrong depends on what type of arthritis one has. In almost all the cases it could be either of the following: 

• The wear and tear of the cartilage about the joint(s)
• The lack of lubricating fluids
• Autoimmunity which entails the self assault of one’s own body
• Infection
• Combination of one or more factors

The main symptoms of arthritis are pain and stiffness at the joints, which characteristically worsen with age. The two most common types of arthritis are Osteoarthritis and Rheumatoid arthritis.

Osteoarthritis: In this case of arthritis the cartilage loses its elasticity and once it becomes stiff it becomes more prone to breakage. The cartilage whose major function is to act as a shock absorber will, therefore, wear away in certain areas which will then result in the stretching of the tendons and ligaments thus causing thorough pain and once the cartilage wears off to a large extent the subsequent bones in a joint begin to rub against each other which further increases the multitude of pain.

Rheumatoid arthritis: This is the inflammatory form of arthritis. The synovial membrane (the membrane that houses the synovial fluid, which is the lubricating fluid in a joint) is attacked, resulting in swelling and pain. If left untreated this type of arthritis can lead to deformity. Rheumatoid arthritis is significantly more common in women than men and generally strikes when the patient is aged between 40 and 60. However, children and much older people may also be affected.

Even though medications are an important part of managing arthritis symptoms medication alone may not be enough.  All medical manuals and guidelines suggest taking an active approach that includes medication as well as lifestyle changes such as routine exercise, dietary plans, keeping track of one’s own condition and the latest information regarding the illness and adaptation and adjustment to products of daily use which are more suited to the diseased  assist  more effectively manage arthritis symptoms.

look beautiful naturally

Every woman wants to look and feel beautiful. There are many ways that can make you look beautiful but acquiring beauty through artificial means while not expensive can be harmful to your skin in long run. Looking beautiful naturally is the way to go. Though this might require an added effort from you but not only is this inexpensive but can actually make you confident about your appearance, always.

To look beautiful naturallylook beautiful naturally is actually a matter of changes to your lifestyle which includes diet, exercise and many other things. The following are a few steps to look naturally beautiful and young -

1) Eat healthy

Eating healthier foods like fresh fruits and vegetables including fish and eggs give a balance to your diet. A balanced diet is an essential prescription for healthy and vibrant skin. You can still eat other foods but lower on the intake of fat, sugar, and calories. Some foods have empty calories. Avoid them as much as possible. Try not to eat too much junk food such as potato chips, pizza, cookies, cakes, etc. Foods that happen to be good for your skin are also good for your overall health.

While genetics largely determine the ageing of your skin, environmental damage and lifestyle choices can accelerate this process. Skin damage occurs as a result of oxidation, a chemical process in which unstable molecules called free radicals steal electrons from healthy cells. The most damaging oxidative stressors that we expose ourselves to are smoking and sunlight.

2) Use Homemade Moisturizers

This will keep your skin soft and beautiful as you get older. Homemade Moisturizers are not only inexpensive but are an excellent option for improving your skin condition.

Skip the foundation unless you really, really need it. Heavy makeup hides true beauty! Work on your skin instead. Applying coconut oil to your face before you turn in for the night will smoothen and clear your skin tones, plus it treats acne.

3) Consume healthy fluids

Make sure to take in plenty, i.e. 4-5 liters, of cool water. It flushes away the toxins and gives your skin that glows naturally. Avoid drinking caffeinated drinks.

4) Tone up

Exercising regularly will not only make your physique look better, it’ll also boost your confidence and your endorphins. Try to set aside time to exercise for at least 30 minutes, three or four times per week, or get involved in an athletic sport.

Try Yoga. Yoga will help you improve flexibility as well as correct posture preserving your younger looks. It will help detoxify your skin and body of the possible toxins, while providing proper nutrition at the cellular level. Beauty through yoga will only take place with the right balance of diet and exercise.

5) Get plenty of sleep

Lack of sleep gives you red, baggy eyes and a lackluster physical presence. Studies have also shown that sleeping too little causes overeating and weakens your immune system.

Skin care Tips:

For normal skin: Take 4 tbsp of aloe vera gel and 1 tsbp of essential almond oil.  Mix it well and use it as a regular moisturizer for normal skin.For combination skin: Take 4 tbsp of aloe vera gel, 3 drops of tea pine oil and 1 tbsp of essential oil. Mix it well and use it as a moisturizer for combination skin.For dry skin: Take 4 tbsp of aloe vera gel, few drops of rose oil, 1 tbsp of essential almond oil, 1 tbsp of essential olive  oil. Mix all the ingredients well and use it as a moisturizer for dry skin. Body Moisturizer: Take 1/3 cup of milk, 2 tbsp of lime juice and 1 tbsp of olive oil. Mix all the ingredients well and store it in the refrigerator. You can use this mixture as a body moisturizer on a daily basis. Moisturizer for Face: Take 1 tbsp of extra virgin coconut oil, 1 tsp honey and 1 tsp lemon juice. Mix it well, and store it in the refrigerator for longer shelf life.

Infant Care

Infant Care: Neonatology is the medical practice of rendering special care and treatment to the critically ill, premature or newly born infants with poor health. To facilitate this special treatment for infants, Neonatal Intensive Care Units (NICU) is maintained in hospitals dealing with woman and child care services. NICU is equipped with specialized health care professionals and the best and advance technologies of instruments and devices to meet the slightest need of the newborns.

Common diagnosis at NICUs includes Anemia, Bradycardia, Sepsis, Jaundice, Hydrocephalus, Bronchopulmonary Dysplasia (BPD), Intraventricular Hemorrhage (IVH), Necrotizing Enterocolitis (NEC), Patent ductus Arteriosus (PDA), Periventricular Leukomalacia (PVL), Infant Respiratory Distress Syndrome (RDS), Retinopathy of Prematurity (ROP), Transient Tachypnea of the Newborn (TTN), etc.

NICUs in India are carried under a 3-tier system based on weight and gestational age of neonate.

Level I care: For Neonates weighing more than 1800 grams or having gestational maturity of 34 weeks or more. This level of care includes providing basic care at birth such as provision of warmth, maintaining asepsis and promotion of breastfeeding. It can be given at home, sub-centre and primary health centre.

Level II care: For Neonates weighing 1200-1800 grams or having gestational maturity of 30–34 weeks. This level of care handled by trained nurses and paediatricians includes equipment for resuscitation, maintenance of thermoneutral environment, intravenous infusion, gavage feeding, phototherapy and exchange blood transfusion. It can be given at first referral units, district hospitals, teaching institutions and nursing homes.

Level III care: For Neonates weighing less than 1200 grams or having gestational maturity of less than 30 weeks. This level of care is handled by skilled nurses and neonatologists. It includes equipments such as centralized oxygen and suction facilities, servo-controlled incubators, vital signs monitors, transcutaneous monitors, ventilators, infusion pumps etc

There exist plenty of Hospitals with NICU in Malaysia but not all of them offers the desired services nor are equipped with the best equipments. A lot of hospitals among the hundreds still lack the quality delivery in services, maintenance and hospitality. Before rushing into any hospital in such emergency cases of child birth one must at least be aware of the basic information about the hospital and the services and facilities it offers.

There accommodates a total of 30 beds at the NICU at Manipal Hospital, Malaysia. One of the premium services the hospital offers is the transport incubators which facilitate movement of the newborn patient by road or air. The team of doctors, nurses and other concerned staffs at the NICU in Manipal Hospitals can be considered as one of the best children’s doctor in Malaysia as they consist of highly experienced and specially trained officials only. The team has acquired an outstanding reputation in the past two decades for quality clinical care, academics and research.

The other notable services provided by the NICU Manipal Hospital include:

• Conventional Ventilation for Sick Neonates
• Patient Triggered and Synchronised Ventilation
• Volume Cycle Ventilation
• High Frequency Oscillatory Ventilation
• Surfactant Replacement Therapy
• Total Parental Nutrition
• CPAP
• Non-invasive Ventilation
• Nitric Oxide Therapy System

Neonatal mortality accounts for most infant mortality in India. So, it is essential for the parents giving birth of a child to precisely comprehend the basic precautions and provisions for facing the proceeding. Plus, admitting to the hospital with the finest NICU facilities is mandatory for the parents to secure the best health results of the newborn.

Healthy habits during Pregnancy

There is great joy that fills the air every time the good news that a baby is due reaches our ears. It is not just a moment for the couple but the entire community that surrounds. A newborn brings a lot of new hope into the people; it becomes a bundle of joy to the world around. However, cautious measures have to be taken to give the child good health, even while in the womb, else it could be a disaster for the mother and the child. Wrong habits and insufficient care can increase the trouble for the pregnant women and the baby within her. Therefore, the need to ensure that the best care is always present, for the infant, is very important.

Here the joy and responsibility of the couple is multiplied twice. Therefore, the famous statement of Spider-Man can be brought to mind once again – “With Great Power comes Great Responsibility”. Here the power is in terms of the control that the parents exercise over the infant. However, let us focus on responsibility part of it for now.

Here are some of the tips that would surely enable a healthier living, during your pregnancy:

Craving for Food: This is a phenomenon that practically every single one of the women going through pregnancy would have to face. Most often women also take this as an opportunity to swim in chocolates and ice-creams. However, a careful examination of the amount of food one consumes has to be kept a watch on. It is said that a roughly an additional 300 calories (close to 600 gms of Apple) of food per day would be nutritious enough for the child and mother.

Weight gain: This is more in relation to the previous topic. However, this is very important too. It is suggested that if you are very hungry during pregnancy. It is better to eat short meals throughout the day rather than having 3 heavy meals. It is also essential that all foods have to be scrutinized before consumption.

The no nos: There are a lot of elements that have to be clearly avoided during pregnancy. Caffeine, alcohol, tobacco, illicit drugs and over the counter medications will have to be clearly avoided. Further, always ensure that you go to hospitals where best patient care services are provided; because ensuring that the right medication is taken is that important for the health of the mother and the child. Avoid hot tubs, as high internal body temperature can cause birth defects, in the first trimester.

Physical Activity: There is a necessary to stay active; you will feel better and have more energy. More importantly you will have the muscle tone for labour and birth. Routine activities like keeping up the climbing the stairs, cleaning the house, gardening can be continued. However, physical activities involving excessive strain like horseback riding should be strictly avoided.

General: Ensure that you get the best prenatal services, because it of top priority. While in confusion to choose your doctor ensure that you go to hospitals that consistently deliver the best patient care services. Also keep in mind that the any chemical intake could harm the mother and child. Oral Care is another essential as bacterial activity in the mouth is very high during pregnancy.

Ultimately, all the efforts and pain undertaken boils down to a sole joy, that of finding a new infant in a new world, with the best health he/she could have.

ENT Surgery

ENT surgery at Manipal Hospital deals with treatment of ear,nose & throat problems. Our top ENT specialists in Malaysia, Klang are expertise in diagnosing hearing disorders,Head and Neck surgeries.

The ENT Department at Manipal Hospitals is renowned across the country for its ultra-modern facilities, amenities and the expert team of ENT surgeons, audiologists and therapists. The department is well equipped with the latest operating microscopes, diagnostic video endoscopes and an up-to-date audiology lab. Advanced procedures in ENT, head and neck surgery such as Cochlear Implantation, various kinds of Endoscopic Surgeries and Paediatric Airway Surgery are conducted here on a regular basis. The department holds the distinction of being the first of its kind in South India to introduce Radio Frequency Surgery for Somnoplasty (snoring) and Turbinoplasty (nasal obstruction).

Many a times, children and infants face life threatening crises due to obstructions in the nasal and airway passage. Immediate and accurate medical help in such situations can make all the difference between life and death. The ENT Department of Manipal Hospitals has advanced facilities for critical care and round-the-clock visits by doctors to resolve such sensitive issues. The department also conducts neonatal screening to detect hearing loss in newborns. Many children and infants from India and the neighbouring countries have benefited from the diverse diagnostic, surgical and therapeutic audiological procedures available here

Orthopaedic Hospital

Manipal Hospital gives the best treatment & advanced replacement surgery for bones, knee, hip, joints, shoulder, elbow. Visit the best orthopaedic hospital in Klang for top surgeons assistance.

Manipal hospital, established in 1991 has all specialties under one roof which allows comprehensive multidisciplinary care of polytrauma patients. The departments of Emergency Services & Intensive Care units are well equipped to receive poly trauma patients.

Manipal Hospital's Joint Replacement Center performs hundreds of joint replacements each year and earns high praise from patients and their families. We offer a comprehensive program with personalized care, excellent outcomes, and superior satisfaction.

Working in collaboration with national joint care experts and area orthopedic specialists, Manipal Hospital is renowned for Joint replacement surgeries across India and overseas. The infrastructure and facilities are world-class within the joint replacement surgery centre.

The foot itself contains 26 bones and the ankle joint actually involves three bones. A broken ankle can involve one or more bones, as well as injuring the surrounding connecting tissues such as ligaments and capsule.

The foot itself contains 26 bones and the ankle joint actually involves three bones. A broken ankle can involve one or more bones, as well as injuring the surrounding connecting tissues such as ligaments and capsule.

Skin Specialist

Get best diagnosis for all skin related diseases by our top skin doctors & dermatologists at Manipal Dermatology Hospital, Malaysia. Our skin specialists in Klang are highly trained in treating Psoriasis, Vitiligo and other chronic skin conditions.

The Department of Dermatology at Manipal Hospitals was set up in the year 1990 and has since evolved manifold to provide an extensive range of treatments for all kinds of skin, hair and nail problems. Diagnosis and treatment is provided for a wide range of skin disorders and the facility is equipped with the latest USFDA (United States Food & Drug Administration) approved technologies. Treatments like photo therapy, cryotherapy, laser surgery and allergic testing are routine. Combined with other specialities available at Manipal Hospitals, advanced treatments like cranio maxillo facial surgery, micro surgery and reconstructive surgery are handled  successfully by the immensely talented team of dermatologists and surgeons. Everything from common acne, laser hair removal, skin allergies to more complex problems like skin cancers, dermatitis, psoriasis and immune related skin diseases are dealt with care, compassion and consummate skill here. Along with a new found confidence, thousands of patients from around the world have found long lasting solutions to their varied dermatological problems at Manipal Hospitals

Paediatric Specialist

Manipal Hospitals in Malaysia has a team of highly skilled top paediatricians in Klang, who deals with health of newborns,infants,teens. Contact the best childrens doctor to avail health care services for your child.

We have a team of highly skilled, academically qualified and experienced paediatricians, besides a group of other specialists to deliver top class health care to children. Our medical facilities and specialty care are of international standards, so we are able to translate the emerging technologies into highly advanced therapies in an adept manner.

Paediatrics, deals with the health and well being of newborn, infant, school age, and teens. Our health care in this space includes a range of services like determination of an existing illness, anticipatory guidance, treatment, preventive measures, and so on - depending on the age of the child

Pregnancy Care

Manipal Hospitals Malaysia has the best gynaecologists & obstetricians in Klang, who are expertise in pregnancy, infertility department. This makes Manipal,the top maternity hospital with best womancare services.

The Woman and Child care services at Manipal Hospitals wishes to provide complete care to the needs of women from their puberty and adolescence, through their pregnancy to menopause and beyond like menstruation, contraception, reproductive disorders and hormonal. We are focused on providing the best patient care services, and meeting the needs of women and mothers.

Best Doctors in Malaysia

Manipal Hospital provides the best doctors in Malaysia who are expertise in various specialties. Contact Manipal Hospitals for top consultants, gyanecologists, paediatricians, skin specialists, ent doctors for the best treatment.

Manipal Hospitals Malaysia

Manipal Hospitals Malaysia is a multispeciality hospital that delivers best healthcare services internationally. Ranks the top private hospital in Klang with world class doctors, modern infrastructure, advanced surgical technologies, international standards, major specialities

Manipal Hospitals Malaysia is a multispeciality hospital that is focused on delivering exceptional service on par with the international standards. Our facilities and doctors are focused on providing on that one essential element most necessary for any hospital – complete care.

Manipal Hospital Malaysia derives its ethos from Manipal Hospitals, which has placed its belief in the credo "Clinical Excellence, Patient Centricity and Ethical Practices". Therefore, every effort has its essence derived from the above philosophy.

Our expertise is derived from the World-class doctors who have specialized in their particular fields for the rapid diagnosis and treatment of our patients. This coupled with the modern infrastructure has lead us to be extraordinary in our segment. We measure ourselves by the medical outcomes, patient satisfaction, doctor satisfaction and staff satisfaction. This has enabled us to deliver the best at every stride in our journey.

Best Hospital in Malaysia

Manipal Hospital,the best multi speciality private hospital in Malaysia ranks first in delivering world class quality healthcare treatment in all major departments like Emergency, Trauma & Critical Care, Maternity, Orthopaedics,Skin,Spine. Has highly experienced surgeons giving quintessential treatment for all major surgeries.