My name is Dr. Tulip. I am a Bariatric and Laparoscopic Surgeon practicing at Doctor Tulips Hospital, 4th block, Koramangala.
Why do we need to go on to a diabetic surgery? Because diabetes even though under control with medications over years cause a lot of complications like all of us know. Complications for the heart, complications for the kidney, for the eyes and so on. And India being the diabetic capital, you will find many diabetics , they may not be obese but the diabetics. And the severity of diabetes is higher in our population which means we get complications at very early age after a few years of diabetes.
So, if you undergo this metabolic surgery, you are out of diabetes and you can protect yourself from the complications of diabetes.read more
This is Dr. Tulip. I am a Bariatric and Laparoscopic Surgeon practicing at Dr. Tulip Hospital, 4th block, Koramangala.
We all know that once a diabetic , always a diabetic. But now we have something called as metabolic surgery by which one can be totally free from Diabetes. I mean you can stop your diabetic medications and still your sugar can be in normal limits. You don't need to take any oral diabetic medications and you need not take any insulin. But is this surgery helpful for all types of diabetics? No, we need to be a little careful and a little choosy about this. This surgery is good for, it helps Type 2 diabetics.
Type 2 Diabetics are those people who develop diabetes after the age of 30. They don't have a family history like their parents, grandparents would have had diabetes but those people who develop diabetes in childhood or in their teens less than 30 years are most likely to be Type 1 diabetics wherein the body is not secreting any insulin, the pancreas is not having any insulin to secrete, wherein the surgery the metabolic surgery will not help. Now, is every type 2 diabetic eligible for this surgery? Yes , but we also need to see the amount of pancreatic reserve that is present in that patient. For example, if the patient is suffering from diabetes for 4 to 5 years, the reserve will be much better.
But if they're suffering from diabetes from 15 to 25 years, then the reserve will be a little less and hence the results may not be very good. But all said and done, the results will definitely better. Now, how do we check the pancreatic reserve? There is a blood test which is called as the C-peptide. When we assess this value, if it is more than one, that means the pancreas has a good reserve and the results would be very good. Now how early do we expect the person to be free from diabetes after the surgery?
Even as early as 24 hours after the surgery, the person can be free from diabetes. Now, in some cases where the pancreatic Reserve is not very good then the patient might have to take one tablet, one oral hypoglycemic, maybe for a month or two and then the person can get totally out of diabetes.read more
This is Dr. Tulip. I am a Bariatric and Laparoscopic Surgeon practicing at Dr. Tulip Hospital, 4th block, Koramangala.
Now this surgery for diabetes is called the metabolic surgery. This is done through tiny holes over the tummy so we need not cut open that tummy and what is done if we operate on the stomach and the small intestine. It is called the gastric bypass. So what is happening in the surgery? We divide the stomach into small portions and this small portion, a small pouch, is attached to the small intestine. Which means we are diverting the food directly from the small gastric pouch into the small intestine.
So majority part of the stomach and small intestine , who doesn't enter. How does this help us? Because we are by passing that second part of the deodenum the second part of the deodenum, the harmful factor, the deodenum factor is not released because this is released only when the food touches that part of the stomach of the intestine. Other thing is what we achieved by these bypass is, the food touches, reaches rather, this lower part of the small intestine which is called the idiom which is very early compared to normal and this causes release of the glp 1 hormone normally in three times more than normal.
Now, what happens by this? This hormone is very good for the pancreas it stimulates the pancreas and does define class starts working in a much better way and more insulin sensitization occurs. Normally in type 2 Diabetics we have insulin resistance. So by doing this bariatric surgery when we do the manipulation the hormones, Dipankar starts working better and the person gets out of insulin resistance. So much so that the very next day of surgery, the patient is totally out of diabetes. This is nearly like a wonderful but we do need to take care, we need to make sure the patient of the type 2 diabetic as good pancreatic reserve and is not underweight. We don't do the surgery for underweight people. The person should be either overweight and obese.read more
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Weight Loss Treatment
Prevention & Treatment of Diabetes
Treatment of Hypertension
Treatment of Gynecomastia
Sleeve Gastrectomy Treatment
Treatment of Osteoarthritis of the Knee
Management of Obesity and related Disorders
Weight Loss Diet Counseling
Treatment of Stroke
Fat Removal Technique/Liposuction
Gastric Bypass Surgery
Type 2 Diabetes Treatment
Treatment of Gallbladder Disease
Treatment of Metabolic Disorders
Treatment of Sagging Thighs
Treatment of Heart And Blood Vessel Disorder
Lap Gastric Band
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I found the answers provided by the Dr. Tulip Chamany to be very helpful, knowledgeable, caring, practical and helped me improve my health. Answered my all queries thoroughly. Best doctor I have seen for consultation. Though taken text consultation but felt like a benefit of personal consultation at hospital. Detailed and thorough explanation to all me anxiety regarding my health problem. Thanks a lot Doctor....
Dr. Tulip's Hospital has polite staff, and the consultation with Dr. Tulip went very well. She not only gave information about liposuction, she gave other options and in-depth detail about Bariatric Surgery as well. Would be visiting her again for a follow-up to decide on best suited solution for me. The doctor was understanding and patiently explained everything.
Got the treatment done, now I am following the advices. Felt so happy for the care above treatment.
I found the answers provided by the Dr. Tulip Chamany to be very helpful. Nice that's good doctor
I am 22 years I have ovarian cyst in my right ovary size 3 cm, I also complain from heavy menstrual cycle, weight gain and urine incontinence for along time I am also have anemia can the cyst cause these symptoms?
Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.
As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.
The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.
Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.
Sometimes, problems that may be faced are:-
Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.
Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.
Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.
Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.
Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.
Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.
Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.
Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to 2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.
Losing weight is a daunting task. This becomes all the more difficult for obese people. In many cases, the patient may be advised to undergo bariatric surgery. There are many types of bariatric surgery. Some surgeries address both the stomach and the small intestines while others address only the stomach. A gastric band surgery is one such procedure.
For this procedure, an adjustable band is placed around the upper half of the stomach. This creates a small pouch that can hold a limited amount of food. The band is connected through a plastic tube to a small device placed under the abdominal skin. Sterile fluid may be injected or removed from the band through this device. By injecting saline, the band is made tighter and by removing the liquid the band is loosened. This allows the band to be customized to improve weight loss.
The result of a gastric band surgery may vary from person to person. Band adjustment starts after the third week of surgery. Because the size of the stomach is reduced, the person will feel full faster and hence eat less. In most cases, a person can expect to lose 60 to 75 % of their excess body weight. This should not be confused with a person’s total weight. The procedure can be reversed at a later date if need be.
Some people may develop side effects like nausea and vomiting after the procedure. But why this procedure has not gained acceptance compared to other bariatric procedures like gastric bypass and sleeve gastrectomy is because, the compliance with the band is not very good and complications like band erosion, band slippage, band migration are very high. Another dreaded complication following the band surgery in non-compliant patients who eat large quantities and overstretch the small gastric pouch above the band is severe GERD.
In severe cases, rarely, grains of undigested food is seen in the mouth on waking up in the morning. This could be life-threatening. Vitamin deficiencies are rare provided supplements are taken regularly during the weight loss period.
Gradual band adjustment is required and regular follow up with the bariatric surgeon will yield good results. Over adjustment is not good at all and could lead to higher chances of complications like band erosion. However, proper dietary compliance can make the results of a band better. Ideally, a patient should get follow up checks every month after such a surgery.
All said and done, the percentage of excess weight loss in the gastric bypass and sleeve gastrectomy are far superior to the adjustable gastric banding. Even the compliance, and maintenance of weight loss over years is better in the other bariatric procedures compared to the band.
I am a 39 years old male person. I am suffering from hypertension and diabetes from last two years. I am regularly taking cortel H 40 (telmisartan). And stamlo beta, Rozucor F10, Semitrigem 2 and tendia M tablets. Now from last two months. I am suffering from acidity and gases. Even after using Pan D tablet the acidity remains and increases my anxiety. What to do.
When dieting and exercising fail to help an obese person in managing his/her weight, bariatric surgery may be suggested. One of the most popular types of bariatric surgery is a gastric sleeve surgery or sleeve gastrectomy. The main aim of this surgery is to reduce the amount of food that can be consumed in one sitting. It does not affect the amount of nutrients and fats absorbed from the food that has been eaten. A majority of the weight loss resulting from this surgery happens within the first 6 months following which there is a slower weight loss over the next 6 months.
A gastric sleeve surgery is a relatively safe and short duration surgery. Prior to the surgery, you would have been given a special diet to be followed, the duration varies between one week to two weeks. It is essential to follow this diet strictly. This surgery may be performed laparoscopically, through tiny keyholes. More than half the outer side of the stomach is removed. The remaining part of the stomach takes the form of a tube. This surgery is not reversible.
Recovery from a gastric sleeve surgery is quite smooth and varies from person to person. A certain amount of pain and discomfort is normal for the first and second day following the surgery. The patient is put on clear liquids for the first 2 weeks following surgery. Soft foods are introduced in week 3 and 4. You can get back to small amounts of your normal food in week 5. You will notice that you feel fuller much faster and are able to consume a very limited portion of your normal food intake. In some rare cases, your food may also be emptied into the small intestines at a very fast rate. This is known as dumping syndrome. This may cause diarrhea and nausea and leave you feeling weak. It is essential to drink plenty of water to allow for smooth bowel movements and to prevent constipation.
On an average, this surgery can help people lose between 60 to 90% of their excess body weight. However, this requires control over your diet and the amount of exercise you do. At some point in time, your weight loss may plateau. This is normal to overcome this, you must make a change to your diet or exercise schedule. A dietician can also help you address the right number of meals needed by your body. It is very important not to fall back to your earlier unhealthy lifestyle and to maintain a positive attitude.
Obesity in childhood is on the increase because of the change in lifestyle adapted by us in our day to day life.
We do not realize that our children are observing every thing we do. They look up to us, their parents as thier idols, role models.They tend to imitate us to the T. One wrong move on our side and you will find them following suit.
It is high time that we as parents adapt to healthy life style changes -be it a daily walk or exercise and a well planned diet including all nutritious food. We should be able to take some time off our busy schedules and try to change the trend of enterainment which our children are now following-
EVERTHING on the Computer,Be it studies, be it entertainment. This should hange and we should take an active part in bringing about this change. However we can cheat once a week.
Our motto as parents should be "Practice what you preach". We will also remain healthy and so will are children be.