Dialysis is a very important and life-saving procedure. It is performed to replace kidney function in case of renal failure. Wastes and extra fluids in the blood are filtered out during this process. To be able to perform Dialysis, the connection between the patient s bloodstream and the equipment for performing Dialysis (dialyzer) outside the body is established. This connection is created through Dialysis Access Surgery. It is a type of Vascular Surgery which forms the vascular opening for access during Dialysis. Thus, Dialysis Access Surgery is the lifeline for the survival of the patient.

Types of Vascular Access for Dialysis- 
There are three types of Vascular Access for Dialysis: Arteriovenous (AV) Fistula, Arteriovenous (AV) Graft, and Venous Catheter.

  Arteriovenous (AV) fistula is a surgical connection of an artery to a vein. An AV fistula is usually placed in the upper arm or in the forearm. It causes extra blood to flow into vein making it grow large. A larger vein hence provides easy access to blood vessels. An AV fistula is preferred over other methods as it lasts longer than other methods of access and provides a good flow of blood. Moreover, it is less prone to infection and blood clots than other methods. Before an AV Surgery, a Vessel Mapping Test is sometimes performed for assessing the blood vessels most suitable for Dialysis. An AV fistula is performed under local anaesthesia and requires two to three months for maturation before hemodialysis. If it fails to mature, the procedure is repeated.

  Arteriovenous (AV) graft is performed when AV fistula fails to mature. It is hence the second most preferred choice for long-lasting access to vascular tissues for Dialysis. An AV graft is a looped plastic tube which establishes a connection between an artery and a vein. Like AV fistula, AV graft is also performed under local anaesthesia. It is slightly more difficult to maintain than an AV fistula.

  A venous catheter is used for short- term hemodialysis. It is a tube which is inserted into chest, neck, leg, or near groin for vascular access. After exiting the body, the tube splits into two halves. In the case where a renal disease has made quick progression leaving little or no time for the AV fistula or AV graft to mature, a venous catheter is used to establish the required vascular connection. This procedure is also performed under local anaesthesia. It is a tool for emergencies but is not suited for long- term use. It can cause narrow vein due to an infection,
scarring, or blood clot. If long- term venous catheter is used, it is tunnelled under the skin which has fewer problems associated with it and is more comfortable. 

How to Care for a Vascular Access?
  Get checked for infections and other problems before each hemodialysis session;
  Use the operated site for access only for the intended use;
  Always keep the access clean;
  Prevent cutting or bumping the access;
  Check for thrill/ vibration in the access and inform the doctor if any;
  Do not put pressure on the access site;
  Do not put blood pressure cuff around the access arm;
  Do not wear jewellery or tight-fitting garments over the site;
  Do not lift a weight.

Take Away-
Vascular Surgery for Dialysis is performed to provide vascular access for the procedure. AV fistula is the most preferred type followed by an AV graft. A venous catheter is recommended to be used only in case of an emergency when there is not much time left for the other two options to mature.

Vascular Surgery - Can It Help For Dialysis?

Carotid artery disease occurs when an oily, waxy substance called plaque builds up inside the carotid arteries. These are arteries that supply oxygenated blood to your brain, face, scalp, and neck.
Carotid artery disease is very serious as it can cause a brain stroke. It, in fact, starts with damage to the inner layer of the carotid artery. To stem this damage your body starts a healing process and this leads to a build up of plaque at the point where the artery is damaged.

When this plaque ruptures, platelets are rushed in and these create an obstruction to the flow of blood to the brain. When the blood supply to the brain is cut off, which happens in carotid disease, the brain cells begin to die causing a stroke. This neural death impairs the parts of the body that these brain cells control. So, you can get paralyzed, become speech or vision impaired, have long  term effects like paralysis or even die due to a stroke.

Causes of carotid disease

Smoking
High cholesterol levels
High blood pressure
High levels of sugar in the blood due to diabetes
What s even more worrisome is that carotid artery disease may not cause any signs or symptoms until the carotid arteries are severely narrowed or blocked. And what usually happens is that a stroke becomes the first sign of the disease.

How scary is that?
So, the next question that comes to the mind is - Can this condition be cured? Let s learn more about management and prevention of the same-

Prevention
Lifestyle changes are key. Since hypertension, uncontrolled diabetes, sedentary lifestyles and imbibing too much fat are all risk factors, taking care of them minimizes the risk of carotid disease and strokes. Heart healthy lifestyle changes that include moderate exercise are a great way to prevent carotid disease.

Treatments
Treatments for carotid artery disease include:

Medicines: Sometimes lifestyle changes do not stem the rot. You need medicinal help. Doctors usually prescribe statin medications to control your cholesterol levels. These lower the bad cholesterol that can narrow your carotid arteries and cause brain strokes and damage. Statins are usually prescribed for people who have:

Heart disease
Those who ve had a stroke
Diabetes
High LDL or bad cholesterol levels
Medicines like Aspirin and Clopidogrel to prevent blood clots are the mainstay treatment if you suffer from carotid disease. They prevent platelets from clumping together inside your carotid arteries and forming blood clots. Apart from these, your doctor may also medicate you for conditions that can damage your carotid arteries and cause strokes. These medicines are for lowering your BP, blood sugar levels, preventing the formation of blood clots anywhere in your body including inside your heart, and preventing and reducing inflammation.

Medical Procedures
These are used to open narrowed or blocked carotid arteries.
The two common procedures are:
Carotid endarterectomy: It s mainly for people whose carotid arteries are blocked 50 percent or more. In this, the inner lining of the carotid artery that is blocking blood flow is removed.
Carotid artery angioplasty and stenting: Here, doctors use a procedure called angioplasty to widen the blocked carotid arteries and restore blood flow to the brain. A stent is inserted into your carotid artery to broaden the lumen. 

High Cholesterol Level - Can It Cause Carotid Disease?

What Happens When the Electrical Activity of Your Heart Changes?

The heart's electrical conduction system plays a very important role in cardiovascular functioning. Also known as the atrioventricular (AV) conduction system, it regulates and controls the timing of the heartbeat.

How does the heart's electrical conduction system work?

There is a collection of electrical cells in the upper right atrium of the heart known as the sinoatrial (SA) node which acts as a natural pacemaker and generates electrical signals. These signals travel through specialized electrical pathways and stimulate the muscular walls of the heart to contract in a rhythmic manner. This gives rise to the heartbeat that pulses at a specific frequency every minute.

What is the effect of fluctuations in electrical activity on the heart?

The standard heart rate in human being ranges from 60 to 100 beats per minute. It slows down when a person sleeps and speeds up when one experiences physical or emotional heightening. These fluctuations are triggered by the brain or other systems of the body and signal the SA node to generate charges more rapidly or slowly. This leads to spikes and drops in the heart rate, depending on the nature of the situation.

What happens when there is dysfunction in the heart's electrical activity?

When the heart's electrical conduction system does not function properly, it leads to the occurrence of a condition known as arrhythmia or abnormal heart rhythm. This happens when electrical impulses are generated in an irregular manner and causes tachycardia (rapid heartbeats) or bradycardia (slow heartbeats) which takes place in jarring infrequent tempos.

What causes fluctuations in the heart's electrical activity?

There are various kinds of triggers that cause the heart rate to fluctuate. The exact nature of fluctuation also depends on the type of trigger. A few everyday examples of these causes are as follows:
- Exercise and strenuous physical activity increases electrical activity as the heart is required to beat faster so as to increase the supply of blood and oxygen to the muscles.
- Sleep and rest reduce heart rate as the body is not needed to exert itself.
- Release of adrenaline into the bloodstream causes the heart rate to spike up.



What Happens When the Electrical Activity of Your Heart Changes?

Cholesterol is either ingested in the food (about 25% ) we eat and some of it is produced by our body (remaining 75%). Cholesterol is needed by the body to produce steroid hormones and bile acids. It is an aspect that is required by the body and if in too much quantity, the same can cause havoc in the body. The best is to maintain the right balance of cholesterol in our diet. The same requires life style and dietary modifications.

The first step in creating your low cholesterol diet plan is to eliminate foods high in saturated fat and bad cholesterol.

Low cholesterol foods diet mainly includes:

High-Fiber Diet- Soluble fiber reduces bad cholesterol. Good food sources are oatmeal, fruits and vegetables.

Cooking oil- Fats makes about 30 % of your days in take. A combination of oils work the best. Foods rich in saturated fats are butter, ghee, cream, and cheese. These need to be taken in moderation or avoided. Avoid fried foods. Not more than 10% of total calories should be from Polyunsaturated Fatty Acids (PUFA) and the remaining should be from Monounsaturated Fatty Acids (MUFA). The best sources of PUFA are plant based oils , sunflower, corn, soybean, cottonseed and safflower. MUFA are found in the largest amounts in olive, canola, mustard, almond and peanut oils.

Avoid Trans fats- Read labels carefully and do not re use oil used for frying.

Go lean- Choose lean meat and fish. Fish is a good source of omega-3 fatty acids. Foods high in omega 3 help you lower down the risk of cardio-vascular disease. Tuna and salmon are a good source of omega-3 to name a few.

Eat a wide range of fruits and vegetables- This will help ensure that your body meets all the vitamins and nutrient requirement. Fruits and vegetables are relatively low in calories. Apples and pears are known for soluble fiber, which reduces bad cholesterol levels. It is best that you eat good quantities of the same.

Include low fat dairy products-Avoid ghee, cheese, cream, paneer and butter. Opt for lighter and healthier options.

Exercise well - Exercise at least 30 mins per day. Workout will help you burn extra fat resulting in lowering cholesterol levels.

How Can I Avoid Cholesterol In My Diet?

Heart Care Tips For a Heart Patient

A heart patient has to always live with caution. This World Heart Day, let us understand what it takes to keep our heart in good health. In fact, by following certain rules, one can lead a smooth life despite being a heart patient.
The major risk factors of heart diseases are smoking, high blood pressure, diabetes, physical inactivity, obesity, and high cholesterol. In addition to these, there are factors which add to the heart condition. They are stress, alcohol, sleep apnea and C - reactive protein.

Food and exercise play a major role in the well-being of a heart patient. It is important to engage in exercises as prescribed by your heart specialist. Follow these dos and don’ts with respect to food.

Say YES To:

1. Poultry and fish for the requirement Omega 3 and Protein
2. Raw nuts, flax seeds, avocados, olive oil, fish oils etc which make up the body's need of healthy fats.
3. Fruits and vegetables for the body's nutrient needs.
4. Whole grains and legumes which provide energy and fiber to the body.
5. Protein and calcium which come from unsweetened yoghurt, egg whites, low-fat/non-fat cheese and skimmed or double toned milk.

Say NO To:

1. Fried foods, cakes and pastries, since they have trans-fats or other harmful fats.
2. Foods high in sodium and sugar, especially packaged goods.
3. Rice, pasta, white breads, sugary foods.
4. Sausage, bacon and red meat.
5. Full cream milk, whole milk cheese and sweetened yoghurt.

If you would like to consult with me privately, please click on 'Consult'.

 Heart Care In Your Hands: World Heart Day Special Tips

Some foods punch well above their weight in helping to reduce cholesterol levels, we call them'cholesterol busters. Choosing a healthy diet, low in saturated fat is important in helping to keep your cholesterol low but you can reduce your cholesterol levels further by including these super six foods in your everyday diet.

Super food 1 - soya foods
Being naturally low in saturated fat, soya foods help lower cholesterol. The special proteins in soya also appear to influence how the body regulates cholesterol too. Studies show you can lower your cholesterol by around 6% by including as little as 15g soya protein per day.

Choose from: soya alternatives to milk and yogurt, soya desserts, soya meat alternatives, soya nuts, edamame beans and tofu.

Super food 2 - nuts
All nuts are rich in vegetable protein, fibre, heart healthy unsaturated fats, vitamin e, magnesium, potassium, natural plant sterols and a host of beneficial plant nutrients. 30-35g a day of nuts (a handful) has the potential to lower cholesterol by an average of 5%.

Super food 3 - oats and barley
Both oats and barley are rich in a form of soluble fibre called beta glucan. Once eaten beta glucan forms a gel which helps bind cholesterol in the intestines and prevent it from being absorbed. It is recommended that we eat about 3g of beta glucan per day. Foods which contain 1g or more of beta glucan can carry a cholesterol lowering claim.

Super food 4 -foods fortified with plant sterols and stanols
Plant sterols are structurally similar to cholesterol and can be divided into sterols and stanols. Their cholesterol lowering effects have been known for some time.

Plant sterols/stanols are naturally found in a wide range of foods such as vegetable oils, nuts, seeds, whole grains, fruits and vegetables. However, for most people, it is not possible to achieve the optimum intake from ordinary foods.

Super food 5 - fruits and vegetables
All fruits and vegetables are low in saturated fat so eating more helps to keep saturated fat intake low. Fruit and vegetables are also a valuable source of cholesterol lowering soluble fibres. Try to include at least one pulse (beans, peas, lentils) everyday. Other rich sources of soluble fibre include sweet potato, aubergene, okra (ladies finger), broccoli, apples, strawberry and prunes.

Super food 6 - foods rich in unsaturated fats
Keeping our daily saturated fat intake below 20g (women) and 30g (men) is vital for cholesterol lowering, but it is equally important to replace this saturated fat with modest amounts of unsaturated fats such as those found in olive, sunflower, corn, rapeseed and other vegetable, nut and seed oils. Other foods rich in unsaturated fats include vegetable spreads, avocado, oily fish and nuts. Avoid coconut and palm oil as, unlike other these vegetable oils, they are rich in saturated fats.

6 Super Foods That Actively Help Lower Cholesterol

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