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?

What complications are associated with diabetes?

Diabetes is a serious disorder which happens when your body has an unreasonably high level of blood sugar, which further leads to harmful effects. Diabetes has a wide variety of complications associated with it, and they start to build up slowly and gradually. Some of the common complications are:

Retinopathy

In simple words, diabetes leads to eye damage by making the eye exposed and prone to severe eye disorders like cataracts and glaucoma. If you have retinopathy, then you may also have face the consequence loss of vision or permanent blindness.

Skin conditions

During diabetes, your skin health is bound to degrade to a large extent. Your skin will become thin in texture and more prone to cuts and breakages due to internal skin cell damage. Thus, the skin gets more exposed to the bacterial and viral infections and its healing process also slows down as the cell division takes longer than usual.

Nephropathy

Nephropathy refers to kidney damage which is caused due to diabetes. The kidneys act as a filter system to the body and they filter out waste materials from the blood. Diabetes causes damage to the blood vessels of the kidneys which may further result in serious kidney disorders and may increase the risks of a sudden kidney failure.

Cardiovascular diseases

This means that if you are having excessive diabetes, then you are at a risk of having a major heart attack or a heart stroke. Additionally, increased blood sugar levels also lead to other heart-related diseases like chest pain, narrowing of arteries etc.

Neuropathy

It is a complication related to the nervous system of your body. The complication generally occurs in the legs as there is a numbness, burning or tingling sensation in the legs. This happens due to the extra sugar in the body, which damages the walls of the blood vessels. In the worst case scenario, you can lose sensation in the legs.

However, it is always desirable that you go and visit a doctor if the conditions persist for a longer time. Additionally, you can also depend upon some domestic care measures to bring your blood sugar levels under control.



What complications are associated with diabetes?

Diabetes is a metabolic disorder, chiefly caused by insulin fluctuation in the body. A study shows that, 1 out of 3 people suffering from diabetes are likely to develop a skin condition sooner or later; and in some cases, these skin problems serve as symptoms of diabetes. Although these skin problems can be cured easily if treated early, proper care must be administered at all times. Here are 7 skin conditions that affect diabetics:

1. Bacterial infection

Although anyone can get a bacterial infection, people suffering from diabetes are likelier to contract them. Usual bacterial skin problems that tend to trouble diabetics are boils, lumps near the eyelids, nail infections and carbuncles. Diabetics are also prone to infections deep in the skin and of the underlying tissues. The affected area is usually warm, red and swollen.

2. Fungal infections

People who have diabetes have an increased risk of contracting the fungal infection, especially the one known as candida Albicans. The fungus tends to create a red, itchy rash, which is surrounded by blisters and scales. These are usually found in warm places of the body like the armpits, or between the fingers of the hand or perhaps even the toes. Common fungal infections in diabetic people include athlete's foot, jock itch and ringworm.

3. Tingling and itching

Among the many causes of itching, diabetes is one. Yeast infection, dry skin and poor circulation are the primary causes of itching among patients of diabetes. Usually, the lower part of the leg tends to itch the most, if poor circulation is to be blamed.

4. Skin problems related to neuropathy

Diabetes can be the cause of nerve damage in some cases; and neuropathy is a common symptom of diabetes. This type of damage can cause a loss of sensation in a part of the body. On event of an injury, one may not be able to feel it. As a result, an open sore or wound, if left unattended, can develop into an infection.

5. Digital sclerosis

Digital sclerosis, a condition marked by tight, waxy, thick skin that develops on the back of the hand, is common among people who have type 1 diabetes. In this condition, the joints of the fingers get stiff and, thus, lose their mobility and elasticity. Skin of the toes, forehead and knees may also get affected.

6) xerosis

Xerosis is another common skin condition that accompanies diabetes. In this condition, the skin becomes very dry and itchy.

7) acanthosis nigricans

Acanthosis nigricans is the condition where diabetics get darkening of skin leading to skin tags around neck and armpits.

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Related Tip: Does Hormonal Imbalance Hint the Risk of Diabetes?
 

7 Skin Problems Diabetes Gives You

Diabetes is a condition where the blood sugar level rises in your body either due to less insulin level in the body or reduced sensitivity of the body to insulin. The foods you eat have a major role in controlling your blood sugar levels. You need to pick your foods wisely to prevent your blood sugar levels from spiking.


The various foods that you should be eating if you have diabetes are:

1. Dark chocolate: chocolate contains good amounts of flavonoids that help in improving insulin sensitivity and limits food cravings. It also reduces your chances of heart attack.

2. Blueberries: blueberries are rich in fiber that helps you in managing your blood sugar levels. They also contain anthocyanins that assist in regulating your blood sugar levels.

3. Fish: fish is rich in omega 3 fatty acids that reduce inflammation in the body, thus reducing your chances of heart problems. Fish is also a good source of protein that helps you in feeling fuller.

4. Olive oil: olive oil is rich in antioxidants that help in reducing your chances of heart diseases and diabetes.

5. Oranges: make sure you eat plenty of oranges as they are rich in vitamin c and they reduce the risk of diabetes. You may also opt for broccoli or strawberries.

The various foods you should avoid are:

1. White rice: white rice is a refined grain which, when consumed, tends to spike your blood sugar levels. You can instead opt for brown rice.

2. Bananas: banana may contain vitamins and minerals, but are also rich in carbohydrates. Instead, opt for fruits like berries that are not only rich in fiber and antioxidants, but also have a low glycemic index.

3. Sugary foods: the term sugary foods is used to describe foods such as pastries, cakes, and cookies. These foods are carbohydrate rich and do not contribute much in making the body healthy. Instead, replace them with natural foods such as chickpeas and peanuts.

4. Dried fruit: various dried fruits contain a high concentration of sugar, which happens due to the dehydration process by which they are formed. So replace them with fresh fruits such as guava and peaches to control your blood sugar levels.

Amongst all other dry fruits, almonds and walnuts can be had in moderation as they contain essential fatty acids and do not affect blood sugars.

Foods to Eat and Avoid When You Have Diabetes

Top 5 things all diabetics must do

As you are aware, diabetes is an increasingly common problem not only in adults but with children and young people too. Preventing or delaying diabetes is possible with a few lifestyle changes. And for those who have been diagnosed with type-2 diabetes, changes in lifestyle can prove beneficial to keep it under control. This is important and should not be taken lightly as diabetes can lead to other serious health complications. There are few simple things which if done regularly can keep you safe and absolutely fine.

5 ways to combat diabetes.

1) exercise - do minimum 45 to 30 minutes of exercise like brisk walking (for people with heart ailments make sure that you have done stress test/tmt). Keep yourself physically active all the time this will help you in losing weight, controlling blood sugar, blood pressure, cholesterol. It will also improve insulin sensitivity in your body. 
2) high fiber diet - include high fiber foods like fruits, vegetables, leafy vegetables, beans, nuts, seeds, and whole grains, cinnamon, green tea in your diet. This will improve your blood sugar level and also reduce your risk of developing diabetes and helps you to lose weight. Do not get into fad diets and tv commercials as they are often misleading.
3) reduce stress - tension and worry releases certain chemicals (stress hormones) which can increase your blood sugar level. Try relaxation therapy like meditation, yoga, music and soundful sleep.
4) restrict intake of alcohol - alcohol increases body weight, triglyceride (cholesterol) level and blood pressure. They may make you unaware of symptoms of hypoglycemia (low blood sugar which may be dangerous). They are empty calorie with no nutritional value. Permissible limit is 2 drinks (60ml) a day for men and 1 drink (60ml) for women, it is also not advisable to smoke.
5) regular check-ups - make sure that you regularly check your blood sugar levels and modify treatment from your diabetologist doctor (if required.) your body and your friend/ relative / colleague's body are different, so is your need of medicine for diabetes as well. What works best for them may not be right for you. So it is my sincere request is to avoid any self medication as it can be dangerous. Regularly undergo screening for early detection of diabetes complications like eye, nerve, heart, foot, kidney.

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Top 5 Things All Diabetics Must Do

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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