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?

The coronary arteries supply the heart with oxygen-enriched blood and nutrients. If these arteries become damaged or diseased; they could cause Coronary artery disease or CAD. Plaque deposits on the walls of the arteries are the most common cause of this disease. This plaque is usually the result of high cholesterol levels. As the plaque builds up, the passage of blood flow is reduced. This reduces the amount of blood that reaches the heart. In cases of a complete blockage, CAD can even cause a heart attack. Because of its slow progression, this disease is often not diagnosed until it reaches a dangerous stage. However, it can be prevented and treated if diagnosed in time.

In the early stages of CAD, symptoms are not very noticeable. Symptoms become visible only when blood flow to the heart reduces and the heart has to pump harder than normal. The most common symptoms experienced include:

Chest Pain: This is also referred to as angina. It may feel like a tightening of the chest or pressure on the chest as though someone is pressing against it. This type of chest pain may be triggered by emotional or physical stress. It is usually relieved within a few minutes of stopping the activity. Women may experience this pain as a sharp, fleeting pain in the back, arm or neck.
Breathlessness: When the heart does not receive enough blood, it has to work harder to pump blood through the body. This may be translated to breathlessness of shortness of breath when performing any type of physical activity. It can also cause extreme fatigue.
Heart Attack: A heart attack is the most severe symptom of coronary artery disease. This is caused by the complete blockage of a coronary artery. A heart attack can occur without any symptoms or be preceded by slight symptoms. The signs of an impending heart attack include pain in the chest and shoulder, shortness of breath and extreme sweating. The chest pain may also travel to the lower jaw. These symptoms are more pronounced in men as compared to women. Women have a higher tendency of experiencing atypical signs such as extreme fatigue.
Other symptoms that might indicate coronary artery disease are dizziness, nausea and an irregular heartbeat. The good news is that this disease can be prevented. Staying physically active, maintaining a healthy weight, reducing stress and eating a low fat and low salt diet can help reduce the risk of CAD.

Coronary Artery Disease (CAD) - What Are The Symptoms?

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!

A heart attack does not always have obvious symptoms, such as pain in your chest, shortness of breath and cold sweats. In fact, a heart attack can actually happen without a person knowing it. This condition is known as a  silent heart attack , medically known as  silent ischemia , occurring due to the shortage of oxygen supply to the heart muscle. The causes of a silent heart attack are similar to that of a heart attack. 

They include- 

Conditions like: 
Obesity or excess weight 
Diabetes 
High Blood pressure 
High cholesterol 
Heart Diseases 
Lack of exercise 
Age, usually above 65 
Consumption of tobacco or smoking 
High consumption of alcohol 
A silent cardiac arrest makes one more vulnerable to another heart attack that could be fatal. Diagnosis: The only method to diagnose if you had a silent heart attack is through imaging tests, such as echocardiogram, electrocardiogram, Holter Monitoring or others. These tests can show certain changes which might be indicative of a heart attack. An analysis of one s overall health and the symptoms can aid in deciding whether few more tests are required. 

How would you prevent a silent heart attack? 
1.   Get your cholesterol and blood pressure count tested regularly. 
2.   Refrain from smoking. 
3.   Get your VO2 max checked regularly. 
4.   Live a healthy lifestyle: Refrain from smoking and excessive alcohol consumption; exercise daily, eat healthy. 
5.   Control high blood pressure, cholesterol, and diabetes 
6.   Be aware of your body and call on a doctor if you feel there s anything which is bothering you. 

If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

Know Everything About Silent Heart Attacks

Causes and Symptoms of Renal Hypertension

High blood pressure is characterized by an increased force that the blood exerts on the blood vessels when it moves through the body. Renal hypertension is a blood pressure disorder where the arteries that carry blood to the kidneys become narrow, as a result of which the blood pressure through these vessels increases.

Causes

It is caused when the arteries that supply blood to the kidney get narrow or get blocked. This can cause the kidney to release specific hormones that signal the body to retain water and sodium. This can put additional pressure on the blood vessels which leads to increased blood pressure. It can also be caused by atherosclerosis which is characterized by hardening of the arteries. Improper development of the arteries can also lead to renal hypertension.

Symptoms

The symptoms of renal hypertension are:

Feeling confused
Blurred vision
Regular headaches
Bleeding from the nose
Gradual decline in kidney function
Possible long-term damage to the kidney
Feeling lethargic and drowsy
Loss of appetite
Dryness in skin
Muscle cramps
Breathing difficulties

Treatments

The diagnostic procedure for this disorder consists of blood, urine, doppler ultrasound and CT angiography or MR angiography tests. Treatments for this disorder usually include medications to ease blood pressure. Preventive measures include modifications in lifestyle such as following a proper diet, limiting smoking, restricting sodium or salt in the diet and following an exercise regimen. Steps should also be taken to reduce stress. Yoga and meditation are highly beneficial to control the condition. Sometimes intervention is needed in the form of PTRA and stenting.

High Blood Pressure and Kidney Disease - Causes and Symptoms!

Performing physical activities on a daily basis always have its benefits, but doing exercise in a well-planned manner is essential for those people who suffer from either type-1 or type-2 diabetes. Becoming more active helps lower blood sugar levels and keep diabetes under control.

Relation between exercise and sugar levels
The food we consume contains sugars which are stored in our blood in the form of glucose. This glucose is absorbed by the muscles in our body, but body fat is the enemy of this absorption process. An obese person is prone to type-2 diabetes since excessive amounts of fat are present in the body which does not allow the muscles to absorb the glucose from the blood. This results in more glucose or sugar level in the blood which leads to diabetes.

By regularly exercising, a person not only burns his/her excessive body fat, but also makes use of the muscles in his body thus allowing the muscles to absorb the glucose present in the blood readily. This helps reduce the sugar level in the blood. Moreover, doing exercise on a regular basis helps increase insulin sensitivity. It helps cells to use available insulin in taking up glucose during and after physical activity.

Understanding blood glucose reaction
The duration for which you perform physical activities will determine your blood glucose level. Physical activity has its effect on your blood glucose level and can keep it in check for up to 24 hours by increasing your body s insulin sensitivity. Every individual needs to monitor how his body responds to physical exercise by regularly monitoring the blood sugar level before and after exercise or as advised by the doctor.
Once you are familiar with the results you achieve with respect to duration and types of exercises you perform you shall be able to control your blood sugar levels more effectively and prevent your sugar levels from going either too high or too low.

Hypoglycemia and physical activity
People who have diabetes should be prepared to treat hypoglycemia or low blood sugar level. Hypoglycemia is more common in people with type-1 diabetes, and people with type-2 diabetes are at lesser risk unless they are on insulin. Individuals who experience Hypoglycemia during or after exercise should consult a doctor immediately.

If you choose to resume your exercise routine, make sure you take a break and treat your low blood sugar level. Once your sugar level gets normal, you can begin your physical activity. What you need to know is that a drop, in sugar level, can occur just after exercise or even long after exercise.

Chances of a drop, in sugar level, occur in those diabetic people who either take insulin, skip meals, or exercise for too long or too hard. If you are finding it hard to keep your sugar level in check, consult a doctor immediately and follow his advice diligently.

In order to avoid hypoglycaemia, you can eat a fruit or nuts before exercise. It is also very important to hydrate yourself during the exercise. Ideally, take a fruit half hour before exercising. Keep yourself hydrated during the workout. Avoid energy drinks.

Why Exercising Is Important In Reducing Sugar Level In Blood?

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