As a cardiologist, I've had many cases, but few that impacted me as powerfully as that of Mrs. Bhanbai Gala, a 94-year-old woman from Mumbai in India, who survived with determination to attend her great-grandson's wedding after accepting to go under the revolutionary Transcatheter Aortic Valve Replacement (TAVR) surgery.

Mrs. Gala, thin and only 36 kg in weight, had been having severe aortic stenosis, which made her aortic valve narrow and limited blood passage. She complained of chronic chest heaviness and shortness of breath, precluding her from walking more than a few meters. Due to her bypass operation history in 2010 and her poor state, she was highly susceptible to open-heart surgery. Her family, particularly her granddaughter, Dr. Mita Gala—a general practitioner—was much concerned with her health condition.

Mrs. Gala did have a wish though: she desired to attend the wedding of her great-grandson. This tender aspiration pushed her family towards attempting medical remedies for her illness even with the attendant risks.

Following careful consideration, I advised TAVR, a minimally invasive procedure to replace the stenosed aortic valve without open-heart surgery. Due to her advanced age, history of cardiac disease, and petite stature, the procedure was fraught with risk. Nevertheless, with careful planning and precise execution, we believed that we could provide her with a new quality of life.

The operation was done under local anesthetic. Using a catheter placed through the femoral artery, we replaced her failing aortic valve within an hour. In spite of her complicated anatomy and pre-existing trifascicular AV block, the new valve worked immediately, enabling her to breathe more comfortably during the night.

Within 48 hours, Mrs. Gala was discharged from the hospital. At her one-month follow-up, she was doing amazingly well—she was walking comfortably, going about her household activities, and even making her favorite dessert, Khajur Pak. Her turnaround was nothing short of inspiring.

Her family, initially hesitant about the procedure, was flooded with joy. Dr. Mita Gala, who too had her reservations as a doctor, was extremely thankful. "As a physician, I was unsure of the safety of TAVR for my grandmother, but Dr. Rao's knowledge and continuous guidance put our minds at rest," she stated. "Watching her experience the wedding traditions with such zest was a blessing indeed."

Mrs. Gala's story is a testament to the remarkable progress in interventional cardiology. TAVR has been a game-saver for patients with severe aortic stenosis, providing a safe and effective option, even for high-risk procedures. With each passing year, our experience with the procedure has enabled us to customize therapies to fit complicated anatomical and physiologic states, providing the optimal results.

Though long considered for patients who are not candidates for open-heart surgery, TAVR is increasingly being offered to younger, low-risk patients in their 60s if the valve can be replaced through the femoral artery. The success of these cases adds to the increased use of the procedure globally.

Since it was first applied in India in 2011, the TAVR procedure has been on the rise. With an estimated prevalence of 7.3% for isolated aortic stenosis alone, it's estimated that close to 300,000 individuals in India may be eligible for TAVR. The potential to deliver a life-enhancing therapy to an elderly patient such as Mrs. Gala is a reflection of the advancement of cardiology and the life-altering power of medical innovation.

Known for her iconic role as Claire in the Modern Family, Julie Bowen who is a versatile American actress, recently spoke about the rare heart condition she's was diagnosed with at 29.

Speaking about it on the first episode of 'Inside of You' with host Micheal Rosenbaum, Julie revealed her condition 'shy sinus syndrome' that caused her to have a low resting heart rate. She also explained how, due to the condition, she also has had a pacemaker put in place.

Lifelong Low Heart Rate and a Surprising Diagnosis

Bowen explained that she has always had a remarkably low resting heart rate, even around 30 beats per minute at times, a significant deviation from the normal range of 60 to 100 beats per minute for women. This was due to sick sinus syndrome, a heart rhythm disorder exacerbated in her case by hypervagotonia, an overactive vagus nerve. Despite being a competitive runner, her low heart rate was a constant, though initially unexplained, characteristic.

The John Hopkins Medicine explains that sick sinus syndrome (SSS) occurs when your heart's natural pacemaker, the sinoatrial (SA) node in the upper right chamber, becomes damaged and can no longer regulate your heartbeat properly. This damage can result from underlying medical conditions or certain medications, leading to heartbeats that are too slow, too fast, or fluctuate between both extremes.

Recognizing the Symptoms

You might have SSS with no symptoms at all, or only mild ones. However, if symptoms do appear, they can include:

• Dizziness
• Fainting (syncope)
• Shortness of breath, especially with physical activity
• Heart palpitations (a fluttering or pounding sensation in your chest)
• Chest pain

How Is Sick Sinus Syndrome Diagnosed?

The turning point for Julie came thanks to her sister, Annie Luetkemeyer, who had just graduated from medical school. During a family vacation, her sister, still in the habit of carrying a stethoscope, insisted on listening to Bowen's heart. "That is not what they've been telling you, and it's not runner's heart or whatever. That means you need to go to a cardiologist," her sister declared, refusing to let the issue drop

Your healthcare provider might suspect SSS based on your symptoms, but these symptoms can be common to many other conditions. To confirm a diagnosis, your provider will likely perform an electrocardiogram (ECG), which records your heart's electrical activity, rate, and rhythm. If you're not experiencing symptoms during the ECG, the results may appear normal. Other diagnostic tests that may be used include:

Stress test: An ECG performed while you exercise on a treadmill.

Holter monitor: A portable device you wear for over 24 hours to continuously record your heart's electrical activity.

Event recorder: A device worn for several days that records your heart rate only when symptoms occur.

Electrophysiologic testing: A hospital procedure where catheters are threaded into your heart through a vein in your thigh to study its electrical system.

Echocardiogram: An ultrasound of your heart to check for structural problems.

Treatment Options For SSS

About a month after her sister's crucial warning, Bowen was filming the pilot for "Ed" when she was faced with the reality of needing a pacemaker. Initially, the news was daunting. "I was like, 'Oh my God. My life is over. This is so weird. I'm gonna die,'" she recalled. However, doctors explained that while the condition wasn't immediately fatal, it would lead to her frequently passing out.

Bowen described a sensation of lightheadedness, particularly when she was relaxed, feeling "like I'd been holding my breath for a while." The critical warning that solidified her decision was the risk of passing out while driving and potentially harming someone. "Oh, well, then give me the Goddamn pacemaker," she decided.

Her pacemaker is now set to ensure her heart rate doesn't drop below 45 beats per minute. She shared that the surgical insertion was done discreetly through her armpit, leaving no visible scar. While she's had to have the batteries replaced three times, she largely forgets about it now, a testament to how seamlessly it has integrated into her life.

While this is one way to treat her condition, here are some other ways your doctor may choose to go about your treatment,

Medication adjustment

If certain medications are contributing to your SSS, your healthcare provider may change your prescription.

Blood thinners

Because SSS can increase the risk of blood clots forming in the heart and leading to a stroke, you may be prescribed blood thinners as a preventive measure.

Alpha-gal syndrome (AGS) is a potentially life-threatening allergy to red meat and other products derived from mammals. Unlike typical food allergies that cause immediate reactions, AGS symptoms can appear several hours after consumption. These range from hives and nausea to anaphylaxis and, in rare cases, heart attacks. The syndrome is triggered by a sugar molecule called galactose-α-1,3-galactose (or alpha-gal), which is introduced into the human body through the bite of a lone star tick.

Why are lone star ticks spreading?

Lone star ticks, named for the white dot found on the backs of females, have long been native to the southeastern United States. But in recent years, their range has expanded dramatically — now reaching as far north as Maine and westwards toward the central US. Experts say this is largely due to the warming climate, which has made previously inhospitable regions more suitable for tick survival and reproduction.

This spread is also helped by other factors such as:

• Increased deer populations (which host ticks)
• Urban development that pushes human dwellings closer to wild habitats
• Lack of natural barriers, such as mountain ranges, in some regions

How common is AGS?

The true number of alpha-gal syndrome cases is difficult to determine due to inconsistent data collection and lack of awareness. The Centers for Disease Control and Prevention (CDC) has documented about 110,000 cases since 2010, but estimates suggest the actual number could be as high as 450,000. Many people may never realise their allergic reactions are linked to a tick bite.

What makes these ticks dangerous?

Lone star ticks are notoriously aggressive. They are capable of detecting humans by sensing heat and carbon dioxide and will actively pursue a host. They can even move quickly over short distances, increasing the chances of biting.

The concept of a “tick bomb” — a cluster of tiny juvenile ticks that swarm over anything they encounter — adds another terrifying element to their behavior.

Living with alpha-gal

For those diagnosed with AGS, life can change dramatically. Aside from cutting out red meat (beef, pork, lamb), many patients also have to avoid dairy, gelatin, and even some medications, toothpaste, and medical products derived from mammals. Food choices become limited and dining out risky. In severe cases, even airborne particles from cooking meat can trigger a reaction.

Support groups are growing rapidly, especially in affected regions like Virginia, where community members share coping strategies and advocate for clearer food labelling.

What’s next?

As the climate warms and tick populations expand, AGS may affect millions more. Other tick-borne illnesses like Lyme disease, Babesia, and the deadly Powassan virus are also on the rise.

Yet, despite this growing threat, researchers warn that US funding for tick-borne disease research is shrinking. Experts stress the urgent need for better surveillance, education, and treatment options to confront what could become a nationwide health crisis.

The choice of quitting oral contraceptives is a personal one, usually related to shifting life priorities—whether it's switching to another type of birth control, getting pregnant, or just needing a break from hormone synthetics. But for many women, going off the pill isn't only about changing periods. For some, it can also mean the return of unwanted acne—sometimes more stubborn and long-lasting than the breakouts of your teenage years.

If you assumed your days of fighting breakouts were over, stopping the pill can be a rude shock. Why does this occur, and how can you prevent it? As a health editor to a worldwide audience, I've spoken to dermatologists and sifted through the most recent evidence to give you an in-depth guide to managing post-pill acne.

Why Does Acne Suddenly Break Out After Stopping the Pill?

The birth-control pill is not only a pregnancy-prevention tool—it's also a hormone controller that has a major impact on skin health. Some women are put on the pill simply to manage acne due to its effect of inhibiting androgens (male hormones) and sebum (skin oil) production. When you discontinue the pill, your body needs to re-balance its hormones, which often means a short spike in androgens. This hormonal storm can put the oil glands in your skin into overdrive, producing clogged pores and breakouts.

The transition phase has been likened to "hormonal chaos." Your ovaries, which had been maintained with artificial estrogen and progesterone, suddenly take over their natural role, sometimes compensating by producing more androgens than previously. This rush of oil production sets the stage for the acne-causing bacteria to thrive.

The birth control pill, particularly combination pills containing estrogen and progestin, inhibits this androgen activity. When the pill is discontinued, the body's natural hormonal cycles return, including the production of androgens, which can overburden the skin's oil-controlling systems—especially if your body is genetically predisposed to be sensitive to these hormones.

Not necessarily. How your skin reacts after coming off the pill depends heavily on your genetics and any underlying hormonal imbalances. For instance, some women start the pill in their teens before acne ever truly develops. In these cases, the pill may be silently suppressing a genetic predisposition to acne, which becomes apparent only after discontinuation.

In some women, the recurrence of acne can indicate a pre-existing covered-up hormonal issue, such as polycystic ovary syndrome (PCOS)—a prevalent endocrine disorder that involves high levels of androgens. In these women, the pill corrects PCOS's evident signs, but when it is withdrawn, the underlying imbalance reappears.

Where and How Does Post-Pill Acne Appear?

Hormonal acne tends to appear in the lower third of the face—jowl, chin, neck—and sometimes the shoulders, chest, or back. It tends to be made up of cysts or inflamed, painful pimples that are deep, not blackheads or whiteheads you may have experienced in puberty.

This pattern is related to sites of increased androgen receptor concentration and oil gland function. But everyone's experience is different: some people have solo flare-ups, others experience more widespread outbreaks.

Women with a history of acne in their families or those with naturally higher androgen levels are at increased risk. Stress, food intake, and even gut health can also determine the intensity and longevity of post-pill breakouts.

What Does Post-Pill Acne Look Like?

Hormonal acne tends to appear on the lower third of the face—chinion and jawline, basically—but can crop up on the chest, shoulders, or back. The eruptions can be as mild as blackheads and whiteheads, or as severe and painful as cystic acne. For some, the flare-up fades in a few months; for others, it can last for a year or more, particularly if there are strong genetic components involved.

The timeline is different. Most women see their acne flaring two to six months after stopping the pill. In some, it could improve a few months later as the hormones balance out. But for others—particularly those with a strong genetic inclination toward acne—it might continue for up to a year or even longer.

In the opinion of dermatologists, your acne's severity and duration will usually reflect your body's sensitivity to hormones. If your body responds strongly to even minor hormonal changes, post-pill acne can be more serious and persist for a longer period.

Can Skincare Alone Treat It?

Here's the bad news: skincare can't change your hormones or your genetic sensitivity to androgens. Although regular skincare can help maintain healthy skin, prevent breakouts, and downsize inflammation, in most cases, it is seldom sufficient to treat post-pill acne in moderate to severe forms.

Over-the-counter remedies such as salicylic acid, benzoyl peroxide, and retinoids might provide relief. But dermatologists sometimes prescribe stronger medications, such as:

• Topical antibiotics or retinoids to decrease bacteria and inflammation
• Oral antibiotics in moderate to severe cases
• Hormonal treatments such as spironolactone, which blocks androgen receptors
• Isotretinoin (Accutane) for severe, cystic acne that is nonresponsive to other treatment

Could This Be a Sign of a Bigger Hormonal Imbalance?

Yes. In many cases, post-pill acne acts as a window into your natural hormonal landscape. If your acne is accompanied by other symptoms—like irregular periods, excess facial hair, or unexplained weight gain—it might be worth exploring conditions like PCOS or insulin resistance with your healthcare provider.

Coming off the pill can reveal long-standing imbalances that were previously being managed rather than resolved.

When to See a Dermatologist?

If your acne is bad, ongoing, or emotionally distressing, see a dermatologist. They can diagnose underlying hormonal imbalances, provide effective treatments, and offer advice specific to your needs. Women with symptoms of PCOS—irregular menstruation, excessive hair, or weight gain—may need a referral to an endocrinologist.

Post-pill acne isn't your fault, and it's not permanent. Although it can be an infuriating obstacle, particularly if you thought you could put acne behind you after adolescence, it's also a chance to learn more about your body's individual hormonal map.

If you’re thinking of coming off the pill, talk to your healthcare provider about what to expect and how to prepare. Remember, you’re not alone—and with the right support, clearer skin is within reach.