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?

On an average a person consumes nearly 800 calories daily from added sugar. This does not just include natural sugar found in fruits or milk but the processed sweet sugar as well, that is added to cakes, tea, coffee, confectionery and even pasta sauce and salad dressing. However, it is possible that you can limit your sugar intake or even quit it to get some truly amazing benefits.

When you take this hard decision, you may experience withdrawal symptoms such as mild depression, anxiety or restlessness. But if you remain adamant and continue with your decision, your body will soon show some incredible results that you couldn't have imagined.

Here are a few of them:

1.&nbsp;Your heart will beat happily

Sugar raises insulin levels that activate the responses of sympathetic nervous system thereby elevating your bp and heart rate. When you cut down on sugar, your ldl cholesterol will decrease by 10% and triglycerides will reduce by 20-30%. And your risk of heart attack will reduce manifold.

2.&nbsp;Your weight fluctuations will be gone

With the exception of fruits, sugar is mostly present in processed or high-carb foods that contain loads of other unwanted constituents like fat etc.

So when you quit sugar, your body has to no longer worry about those unwelcome calories and your weight will stop moving right and left across the scale.

3.&nbsp;Digestion will become efficient

When you quit sugar, the digestive system becomes more efficient. Since your stomach and intestines have to no longer worry about those difficult to digest processed foods, their abilities and functioning improves. Even your colon begins to work better, may be you take more trips to the restroom, so things get even more on track.

4.&nbsp;No more acne troubles

Sugar triggers acne troubles. When you cut it down, you will no longer be troubled by those zits that dampen your looks. Your skin will actually clear up, cracks will disappear and you will get a healthier skin.

5.&nbsp;You will no longer have sweet craving

With sugar, there is a huge negative, as you enjoy sweets, you crave for more sweets. But if you quit sugar, slowly you will begin to avoid foods that contain sugar and as a result, whenever you will eat anything that has sugar, it will taste over sweet and you will not be able to have large portions. This means no more cravings for sugar!

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

5 Wonderful Things That Happen to Your Body When You Quit Sugar!

Ways to identify and treat Angina pain

Angina or angina pectoris is the pain, discomfort or tightness in the chest that occurs when the blood flow to the heart muscle cells is not enough to meet its energy needs. It is not a disease itself but rather a symptom of the coronary heart disease.

What are the different types of angina?

1. Stable angina: It is the commonest form of angina. It can be triggered by stress or physical activity and usually only lasts a few minutes.

2. Unstable angina: It happens when you're resting or aren't very active. The pain is strong and long lasting, and may keep recurring. It may be a signal of an impending heart attack.

3. Variant angina: This might take place when you're asleep or at rest. This sudden tightening or narrowing of the heart's arteries causes a lot of pain.

How u know what your are experiencing is an angina pain?

You might be having angina pain if you suffer from one or more of these symptoms:

- Chest pain
- Heartburn
- Breathlessness
- Nausea
- Dizziness
- Restlessness
- Fatigue
- Pain in your arm, neck, jaw and back
- Numbness or loss of feeling in your arms, shoulders or wrists

Immediate Relief from Angina

If previously advised by a certified doctor, patients can take antiplatelet medicines which are blood thinners and prevent unstable angina. Final treatments include angioplasty (repair of a blocked blood vessel through surgery), insertion of a coronary artery stent (a tube that is used to treat weakened arteries) or a heart bypass surgery for serious complications.



Ways to Identify and Treat ANGINA PAIN?

The heart is a muscular organ that pumps blood to the entire body through a network of arteries and veins. This network contains big vessels which branch out further to supply blood to the distant organs. There is, therefore, some pressure that the heart and thereby the vessels need to exert to push the blood through these vessels. This is known as blood pressure, and normal pressure levels range from 90-140(systolic)/60-90(diastolic) mm of Hg. However, due to various reasons, this pressure could be more, which is one of the first signs of heart disease. 

Causes of increased blood pressure: 

Thickening of the blood vessels. With age, the elastic blood vessels naturally turn rigid and less elastic, so there is more pressure required to push blood. It is natural for people over 55 years of age to have higher readings of blood pressure. This is known as primary hypertension (HTN) 
Narrowed blood vessels. This happens due to cholesterol accumulation along the walls of the blood vessels. Faulty dietary habits along with sedentary lifestyle have increased the incidence of hypertension due to this condition, known as atherosclerosis. Critical atherosclerotic narrowing of renal arteries lead to renovascular HTN that is one of the commonest of secondary HTN. 
Other Causes of secondary hypertension are: 

Kidney problems 
Thyroid hormone disorders 
Congenital heart defects 
Chronic alcohol abuse 
Adrenal gland tumours 
Chronic use of medications like birth control pills, pain killers, etc. 
Unidentified and uncontrolled hypertension can be silent and can lead to more severe conditions like heart attack and stroke. India is fast becoming the new hypertension capital of the world. Some of the common risk factors are: 

Age 
Family history 
Being obese or overweight 
Sedentary lifestyle 
Smoking 
Alcohol consumption 
Excessive salt intake 
Stress levels 
Ethnic background 
Symptoms: 

Hypertension can go undetected for years together, but if there are risk factors like diabetes and high cholesterol, it is advisable to periodically monitor blood pressure. 
Headaches, nosebleeds, and shortness of breath should not be ignored. These can be the first warning signs of hypertension, and if detected early, preventive measures can be taken. 
If there are co-morbid risk factors, it is advisable to constantly keep a check on BP readings. 
Management: 

This includes a combination of diet and lifestyle modifications. 

Quit smoking and alcohol: Of the many wonders quitting smoking can do, reducing BP readings is just one. The improvement would be almost instantaneous. Quit or else reduce alcohol and see dramatic improvements. 
Weight management: Through a combination of diet and exercise, ensure that weight is brought under control. Set a target BMI (Below 26 kg/m2) and work towards it religiously. 
Diet: Reduce salt, increase potassium, increase vitamin D, eat a heart-healthy diet, and see the hypertension readings improve. Please find attached and reviewed copy for health tip for posting

High Blood Pressure - All You Need To Know About It!

The heart pumps pure blood to all parts of the body through a network of arteries. These are thicker in the beginning and become finer and thinner as they reach the various organs. These arteries are lined by a layer of epithelial tissues and as blood flows through them, the heavier cholesterol / fat molecules settle down along the walls. 


This attracts more and more fat molecules to settle down.  This is known as atherosclerosis (hardening of the arteries). Over a period of time, the vessels circumference reduces and the blood supply to the target organ reduces. This impacts proper functioning of these organs and when this happens to the major organs like the heart, kidney or the brain, conditions like stroke or thrombosis or heart attack can occur.


This condition, known as coronary artery disease, is becoming a major cause of deaths.  While that is the bad news, the good news is that it is largely lifestyle dependent, and if steps are taken, it can be prevented, and in the early stages, the damage completely reversed.


Preventive measures: 
1. Diet: A low-fat, high-fiber, heart-healthy diet consisting of Omega-3 fatty acids is recommended by doctors, especially to people who are prone to develop heart disease.  This also requires reduced salt, increased unsaturated fats, reduced triglycerides and reduced sugar.  Include loads of fresh fruits and vegetables, whole grains, nuts and seeds and fish oils. Include multivitamins or other supplements after checking with your doctor.


2. Exercise:  Regular exercise in any form increases the efficiency of the circulatory system, keeps the cholesterol levels in check and helps in blood pressure management.  Exercise in any form is advisable, based on individual preference. A moderate physical activity of 30 to 45 minutes per day is advisable.


3. Smoking: This is one of the major risk factors for smoking, and quitting or controlling smoking is one of the best methods to prevent coronary artery disease.


4. Alcohol consumption:  While moderate alcohol consumption is believed to be healthy for the heart, excessive alcohol consumption is a strict no-no.  Binge drinking especially is shown to cause heart attacks.


5. Weight management: Check with your doctor on what is ideal BMI for you and work out a plan to keep your weight under check.


6. Regular medications: If you are on blood pressure or diabetes medications, ensure you do not miss them.  Keep a constant check to ensure your readings are managed well. 


7. Watch out:  Ask your doctor if there are specific symptoms that you need to watch out and seek medical support if you see any of them.


Coronary disease is not treatable fully, but can be prevented and managed effectively to improve the overall quality of life.

Coronary Artery Disease - 7 Ways You Can Prevent it 

Know Your Cholesterol 

Cholesterol is a waxy, fat-like substance that’s found in all cells of the body. The term cholesterol is often directly related to a heart condition. But the truth is that not all types of cholesterols are harmful for your body. It is important that one knows about the different types of cholesterol, having healthy levels of both types of lipoproteins is important, deal with them appropriately and lower the chances of having a stroke or getting a heart disease. Bad cholesterol levels can be high in people irrespective of them being thin, if it is genetic or if they are smokers.

Types of Cholesterol.

The Bad One:

LDL cholesterol sometimes is called “bad” cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. Lowering your cholesterol may slow down, reduce, or even stop the buildup of plaque in your arteries. It also may reduce the risk of plaque rupturing and causing dangerous blood clots.

The Good One:

HDL cholesterol sometimes is called “good” cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. Your liver removes the cholesterol from your body and  is important for the body as it reduces the risk of heart attack, disease and strokes.

Cholesterol count of the body is counted by adding the two types of cholesterols (LDL and  HDL) along with body's triglyceride level. Triglycerides are a type of fat found in your blood. Too much of this type of fat may raise the risk of coronary artery disease.

The level of your cholesterol shows the level of risk your body is in, to have a stroke or a heart condition. Other factors which determine the risk are whether the person is a smoker, diabetic, has high blood pressure along with their age, sex and race.

Cholesterol levels are affected by:

1. Genetics: Genetics have a direct effect on your cholesterol level. If the levels have been high in the previous generations, you are automatically at higher risk of this condition.An inherited condition called familial hypercholesterolemia causes very high LDL cholesterol.

2. Age and Weight: Once we cross the age of 20, our cholesterol level starts to rise. Being overweight however is also a high risk factor of increased levels of bad cholesterol in the body as well as developing heart disease.

3. Lifestyle: Less or no exercise is another reason which reduces the good cholesterol in the body, as does being overweight. Regular exercise however reduces LDL and increases HDL in the body. Also a diet rich in saturated fats makes your LDL levels shoot up and puts you to higher risk.

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


 Know Your Cholesterol: Good Vs Bad

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