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?

Diabetes is something which has become so common over the past few decades and this is said to be a cause of worry as most people don't understand how to prevent and manage it. This has led to some myths, gaining more than their fair share of popularity. So, wouldn t it be a good idea to get to know a little more so as to separate the myths from the facts?

Weight & watch: One of the most common myths when it comes to diabetes is the belief that a person is going to have his or her life adversely affected if he or she is overweight. While it is true that being overweight happens to be one of the risk factors related to diabetes, it is important to keep in mind the fact that there are other risk factors which are responsible, as well. Some of these factors are age and family history, as well as the ethnicity of the person. Taking this into account, it should not come as too much of a surprise to know that there are quite a few people who are not overweight, but are still fighting diabetes.
Packaged tricks: Considering the rise in the number of people who are suffering from diabetes, this has led to food being marketed specifically for their consumption. However, in reality, whatever represents a healthy diet is sufficient for a person who is diabetic. So a diet which does not have a high amount of saturated fats and trans fats and does not go overboard with starch and sugar, but features a fair amount of lean protein works well too. All the fancy diabetic food, which a person buys, is only likely to drive a great hole in the wallet and not have any additional health benefits. Therefore, the extra spending is nowhere close to being worthwhile and should be avoided.
Fruits punch: Many people are of the opinion that it is the processed and sugary food items, which cause diabetes and this is true to a significant extent. However, some people are of the view that since fruit is natural, diabetics can eat as much of it as they like. This is where the thinking gets dangerous. Some fruits are rich in carbohydrates and so it should be consumed in a reasonable quantity, as part of the daily meal plan. After all, too much of any good thing is bad!

Diabetes - 3 Myths Decoded!

There was an era where we had deadly infections like plague and polio causing death of thousands of people. We still have occasional outbreak of swine flu, but by and large, infections are quite controlled. The new killer diseases are caused because of the lifestyle we have adapted and the damage we have done to the environment. High intake of processed foods, artificial chemicals in our foods, sedentary lifestyle with very minimal to no physical activity, couching over the computers; the list is quite long. All these have led to diseases like diabetes and cancer that were not so common about say few decades ago.

Detailed observation has revealed that both these new epidemiologic diseases have a close correlation. There are factors, which induce diabetes and diabetes in turn and in some cases, diabetes inducing agents, can cause cancer also. It has also been observed that mortality is severely increased if diabetic patients are diagnosed with cancer. There are two types of diabetes. While type 1 is mostly hereditary, type 2 is lifestyle induced and the age at which this is being diagnosed is taking a severe plunge. Adolescents and teenagers are being diagnosed for diabetes. Cancer, on the other hand, is of various types (leukaemia, melanoma, etc.) and can affect various organs (lung, breast, prostate, stomach, liver, etc.).

The medical community is yet to decipher the disease pattern of both these conditions. While there is no definite correlation between diabetes and all types of cancer, some types of cancer are definitely correlated with a definite reason identified, pancreatic and liver cancer for instance. The high amounts of insulin that diabetic patients are exposed to causes changes in liver and pancreas including fatty liver and cirrhosis, here the incidence of cancer is higher. The linkage is not very clear in lung and intestinal cancers and also there is no link between prostate cancer and diabetes.

Diabetes is considered as a state of chronic inflammation and leads to conditions like hyperinsulinemia (higher levels of insulin in the blood) hyperglycemia (higher levels of sugar in the blood). These are believed to aggravate the neoplastic process of cancer formation, thereby inducing cancer at a greater pace and also increasing the mortality rates.

The following are risk factors that are applicable to both age, physical activity, diet, obesity, drinking and smoking. It is also possible that onset of one can be followed by the other. As noted earlier, more detailed research is awaited to establish a definite linkage, but the correlation cannot be ignored at all.

Both these new epidemics are here to stay and since they have a common set of factors, we need to work on ways to contain them.

Diabetes and Cancer: The New Epidemic?

Surgery to remove abnormal growths of the brain, peripheral nervous system or the spine or any disorder can be tricky because the brain and the skull that shields it are complex areas. In the old days, open surgery was the only way to access the brain or spinal cord. But, with the invention of laparoscopy, keyhole surgery to treat neurological issues is gaining ground.

What is Neuroendoscopy? 
Neuroendoscopy is a surgical procedure that is favoured by doctors and patients alike because it is minimally invasive.
Before the surgery, you will be administered general anaesthesia so that you will be unconscious during the entire duration. During the surgery, the surgeon will drill a minute hole into your skull just above the eyebrows. You skull also has two natural openings. That is why the surgeon may make use of the nose or the mouth to access the region that needs to be operated upon.

Neuroendoscopy is useful because -

  It lets the surgeon reach regions that are not accessible with open surgery
  The tumour can be removed without any damage being done to surrounding tissues

An endoscope is a delicate device with a high-resolution camera mounted on it. There is an eyepiece on the other end. The device is also fitted with a light. When it is inserted into the brain, it lights up the passage and the eyepiece allows the surgeon to take a look inside. The camera sends a live feed of the path it is traversing and this guides the surgeon. When the tumour is reached, it is gently removed with other surgical instruments that too were inserted through the cavities or the drilled hole.

Benefits of Neuroscopy -
There are several advantages of relying on laparoscopy -

  The patient endures less pain
  Fewer chances of infection
  Faster recovery
  Very little scarring of tissues

Which Disorders call for Neuroendoscopy?
Any of the following disorders can be put to rights with a neuroendoscopic surgery -

  Pituitary tumours
  Rathke s cleft cysts
  Pineal area tumours
  Ventricular tumours
  Skull base tumours
  Brain inflammation triggered by an infection
  Chordomas
  Cerebrospinal fluid fistulas
  Trigeminal neuralgia
  Cerebral aneurysm

After Surgery-
Once you undergo the neuroendoscopic surgery, you will have to be rehabilitated so that your condition can be monitored round the clock. Neuroendoscopy is a state of the art clean and efficient surgery that is beneficial to both surgeons as well as the patients.

Know More About Neuroendoscopy And Its Uses!

Diabetes is growing to be the epidemic of modern days. The challenge here is it is not just about managing your sugar levels, but the whole lot of symptoms that diabetes brings with it. From bones to teeth to kidneys to wounds, diabetes affects all body systems. It is therefore very essential to watch out for symptoms of diabetes and curb it in its early stages. This will help control diabetes significantly along with its effects on the whole body.

Diabetes Complications-

Long-term complications of diabetes develop gradually. The longer you have diabetes   and the less controlled your blood sugar   the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.
Nerve damage. Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain. Left untreated, you could lose all sense of feeling in the affected limbs. 
Kidney damage. The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. 
Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. These infections may ultimately require toe, foot or leg amputation.
Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
Hearing impairment. Hearing problems are more common in people with diabetes.
Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. 
The following are some of the basic must do's if you have diabetes. These can go a long way in preventing adverse diabetic side effects.

Diet: Whether diabetic or not, it is always important to watch your diet. You are what you eat. Eat what your body needs, reduce refined foods, processed foods and increase the amount of whole grains and fruits and vegetables. Eating small frequent meals goes a long way in managing sugar levels than binging at one meal and starving the rest of the day. Reduce intake of saturated fats; include more lean meats. Choose grilling and steaming over frying and roasting. Diet is very important in diabetes. Recommended foods - Healthy carbohydrates, Fiber-rich foods, Heart-healthy fish and Good fats. Foods to avoid - Saturated fats, Trans fats, Cholesterol and Sodium
Exercise: Every week, make sure about 2 hours is dedicated to physical activity. This could include any exercise of your choice, brisk walking, swimming, cycling, aerobics, hiking, jogging, skipping, gymnastics, or playing games like football or basketball. While in most cases, the person can do these on their own, in some people, supervision may be required.
Watch your weight: For a diabetic person, controlling weight to a desirable level of BMI of 18 and 23 is very important. Obesity is one of the predisposing factors for diabetes, and reducing weight controls the onset of diabetes and helps the progression of symptoms in diabetics.
Smoking: Another risk factor for diabetes onset, quitting is the best option. If not feasible, reducing smoking and gradually quitting should be aimed at. Not just diabetes, the effects on overall health will be evident almost immediately after quitting.
Stress management: One of the main risk factors for diabetes, there is no getting away from stress. Everybody has their stresses but the trick is to manage it well. Whether it is music or meditation or medication or counselling, make sure stress levels are managed. This also helps prevent diabetic complications like heart disease and stroke and promotes well-being.
Constant Checkups: Periodic check-up of blood sugar levels, cholesterol levels, eye exam, dental checkup, foot checkup to test for nerve damage are all extremely important. Take your medications regularly without fail.
Diabetes requires a change in lifestyle, which may seem tedious initially. But after a while, it will become the norm and then diabetic control does not feel like something additional that is to be done.

Diabetes - 6 Ways You Can Prevent it

Many people know that smoking causes several problems including cancer, heart disease, and respiratory disease. However, there are other diseases occur because of smoking and chewing tobacco. Buerger's Disease is one such disease in which the blood vessels in legs and arms get blocked. This blockage will interfere in blood flow and results in forming blood clots. These clots will affect both legs and
hands.
Buerger's Disease is also known as Thromboangitis Obliterans. It is a type of vasculitis which causes inflammation in the blood vessels including thickening, narrowing, weakening, or scarring.
Buerger's Disease cannot be cured easily. However, by quitting the use of tobacco and smoking, one can limit the symptoms from getting worse. If a person is not able to quit smoking, he/she might end up
suffering from severe tissue damage. One can also even lose toes, fingers, or other parts of the limbs. This is why quitting all type of tobacco or smoking is the only way to treat Buerger's Disease.

What Causes Buerger's Disease?
As discussed earlier, smoking cigarettes or cigars and chewing any form of tobacco is one of the main causes of Buerger's Disease. Still, the exact cause of this disease is unknown, but in most cases of Buerger's Disease, the sufferer has consumed tobacco products. It is an assumption that chemicals present in tobacco, cigarettes, and cigars may affect the lining of blood vessels, causing them to swell. According to experts, the genes in the body may also cause this disease. It is suspected that this disease is caused by an autoimmune response in which the immune system of the body attacks healthy tissues mistakenly. According to this theory, some people are prone to this disease.

Symptoms of Buerger's Disease-
Some of the most common symptoms of Buerger's Disease are:
  Pain in the hands and feet while exercising
  Stiffness due to reduced blood flow
  Pain at Rest
  Skin ulcerations
  Gangrene of the fingers and toes in severe cases
  Numbness, coldness, or tingling of the feet and hand
  Pale, reddish, or blue-tinted hands or feet.

Diagnosis of Buerger s Disease-
There is a set of tests that can diagnose Buerger s disease. Doctors first ask a person about his/her lifestyle, use of tobacco, and symptoms. After seeing a few symptoms, doctors may perform a test to check the blood flow. He may also look for other diseases that cause similar symptoms. Some of the common test to diagnose Buerger s Disease are:


  Allen Test: The Allen test is a blood flow test. In this type of test, patients squeeze their hand into a firm fist, which pushes out blood from hand. The doctor presses the arteries to slow down the
blood flow of the hand. At this stage, the normal color of the skin gets pale. After that, patients open his/her hand and doctors release the pressure from both sides of the wrist one by one. If it takes a longer time to go back to the normal skin color, it may be an indication of Buerger s disease

  Angiogram: It is a type of X-ray that will help to check the blockage of the blood vessels in the legs and arms. In this test, doctor place catheter (thin tube) into an artery to pump the dye. After
that, he takes X-ray images. Doctors may also perform tomography (CT) or MRI scan for clear results.

  Blood Tests: The blood tests will help the doctor to check if there is any other disease that causes the same symptoms as most of the vascular diseases mimics the symptoms of Buerger s
Disease. The doctor may also perform tests to check for diseases like lupus, diabetes, and those that cause blood clots.

Treatment of Buerger' Disease-
Quitting smoking and use of tobacco will help a person to lower the symptoms of this disease. Doctors may also prescribe for pain killers or antibiotics to get rid of the pain in affected areas. If a person finds it difficult to quit smoking, doctors help him/her with the right program and rehabilitation techniques.

Take Away-
Buerger's Disease is one of the rare illness caused by intake of tobacco products, this is why quitting smoking is most important to treat this disease. It is also advisable to consult a doctor as soon as a person identify any of the above symptoms.

All You Need To Know About Peripheral Vascular Injuries!

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