Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.

As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.

The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.

Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.

Sometimes, problems that may be faced are:- 

Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.

Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.

Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.

Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.  

Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.

Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.

Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.

Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to  2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.

Bariatric Surgery - Know Problems Of It!

Most may not be aware of the fact that the human body requires cholesterol for normal functioning. Though normal levels of cholesterol are essential for proper functioning, any fluctuations in these levels can lead to disorders like hyperlipidemia and hypolipidemia.

Cholesterol, a soft, fat-like substance helps in building new cells and secreting hormones. While 80% of the cholesterol is produced by the liver, 20% is obtained from the food you eat. The cholesterol sticks to a protein called the lipoprotein and along with it travels through the bloodstream. Among these lipoproteins, HDL (High-Density Lipoprotein) is good for the body, and the other four namely LDL (Low-Density Lipoprotein), VLDL (Very Low-Density Lipoprotein), and Triglycerides are bad for your body.

Complications
While high blood cholesterol can lead to complications such as heart attack or stroke, low blood cholesterol would indicate the presence of an underlying condition and in either case, proper treatment and management are essential.

Managing high cholesterol

Diet and exercise: The first line of treatment begins with an active lifestyle and a healthy diet. Choosing healthier fats, avoiding trans fats, limiting dietary cholesterol, including whole grains, vegetables, and fruits, and limiting alcohol consumption along with adequate exercise should reduce the levels without medication.
Medication: If the cholesterol levels do not reduce despite m lifestyle changes, the physician will prescribe a combination of medications, considering several factors such as the individual s age, present health condition, and the side effects of the medication. The common drugs used to reduce high cholesterol are statins, bile-acid-binding resins, cholesterol absorption inhibitors, and injectable medications.
Managing low cholesterol: In the case of being diagnosed with low cholesterol, the treatment focus would be handling the underlying condition. 
Irrespective of the type of cholesterol disorder, it is essential to follow the doctor s advice in both cases to avoid the risk associated and lead a healthy life.

Dealing with Cholesterol Disorders

What is adrenal gland tumour? Let's answer this question by first knowing the meaning of what a tumour is.

When many tissues grow in the body, some tissues start to grow abnormally and it forms a clot thing in the blood. These clots do not allow the body to function properly and hence, it is called a tumour.

Adrenal gland tumour is the type of tumour when some tissues join together and grow abnormally in the adrenal parts of the endocrine system. It forms a cyst there hence resulting in the swelling of that body part and is called as adrenal gland tumour. This tumour can be cancerous or maybe non-cancerous, depending on the functioning of the cells.

Adrenal glands are an important part of the body. These glands are present on the top of our kidney and are in triangular shape. It releases all kinds of hormones which are important for the metabolism of the human body. These hormones help the human body in many ways.

Causes of Adrenal Gland Tumour:

One of the main causes of adrenal gland tumour is the normal behaviour of any tumour. The tumour grows in the body and does not allow other organs to work properly, which results in many problems inside the body.

The tumour grows and grows and becomes a regular part of metabolism. It suppresses the other glands by not letting them do their work and obviously forming a cyst.

The other reason of these kinds of tumours can be that they release hormones which affect the body and may also result in cancer. These hormones are generally the androgens and estrogens which result in the early growth of many people.

Symptoms of Adrenal Gland Tumour:

People experience many symptoms before they get diagnosed with this tumour. These symptoms are clearly visible and one should take care of all the symptoms. If a person notices any of the symptoms, they should be directly admitted to the hospital.

The symptoms which are visible in a person having adrenal gland tumour are:

They might experience high blood pressure with a low potassium level.

They may experience heart palpitations, anxiety, or panic attacks.

The major signs are that they may experience abdominal pain, weakness, weight loss, or weight gain.

Other symptoms include abdominal stretch marks, excessive hair growth, changes in their genitalia, unusual acne, and also changes in libido.

Treatment for Adrenal Gland Tumour:

The adrenal gland tumour is mainly treated by surgery. The surgery is done by a specialist called endocrine surgeons. The surgery not only consists of many steps performed together by multidisciplinary team. They do the surgery and remove the cyst out of the body and also ensure that it does not return.

The surgery is known as Adrenalectomy, which removes a tumour from the adrenal gland. There is a team of endocrine surgeons who have come together to clear this tumour from the body.

Conclusion:

The adrenal gland tumour should be detected at an early stage so that it can be treated properly and cured at the right time. However, it is always advisable to consult the doctor or specialist before opting for any treatment or medicines.

Adrenal Gland Tumour - What Should You Know?

Obesity can make life miserable. From unhealthy eating habits to unhealthy lifestyles and medical conditions, obesity can be an amalgamation of many factors. Obese people are a greater risk of suffering from many serious health complications like type-2 diabetes, mood swings, and depression, cardiac problems, high blood pressure and high cholesterol, to name a few. It does not stop there. More alarming is the fact that obese people are an increased risk of suffering from different types of cancer.

Bariatric surgery comes as a saviour for highly obese people (with a BMI over 40), who have tried every possible treatment under the sun to lose weight without any success. Bariatric surgery has helped many severely obese people attain a healthy weight. Bariatric surgery can be of three types;

Gastric bypass surgery (Roux-en-Y): This is one of the most common types of weight-loss surgery practised worldwide. The procedure involves rearranging (dividing) the stomach into a smaller upper pouch and a larger lower part. The smaller pouch is then connected to the small intestine. The food consumed will pass into the small intestine through the pouch. The idea is to rearrange the stomach in such a way that a person consumes a lesser quantity of food.
Gastric banding (Laparoscopic Adjustable Gastric Band): In this procedure, the surgeon creates a small pouch at the upper part of the stomach by placing a band (lap band or A-band) around it. The pouch, true to its name, is used to hold the food consumed. The purpose of placing a band around the stomach (upper part) is to reduce the intake of food.
Sleeve Gastrectomy (Gastric Sleeve surgery): In Sleeve Gastrectomy, surgeons remove a large portion of the stomach, leaving behind only a small sleeve-like pouch (hence the name). Like the other two surgeries, sleeve gastrectomy also aids in limiting the consumption of food.
Duodenal switch: The fourth type of bariatric surgery, Duodenal switch with biliopancreatic diversion, is not very commonly used. Bariatric surgery has several health benefits. In addition to the weight loss, it plays a pivotal role in lowering the incidences of Type-2 Diabetes, depression, anxiety, coronary artery problems, sleep apnea cardiovascular diseases.
Research also suggest that bariatric surgery has been instrumental in reducing the chances of cancer (especially colon and breast cancer) by as much as 60%. The correlation between weight loss and reduced cancer instances is still a debatable topic. Some researchers and oncologists believe that the weight loss (bariatric surgery) brings about a hormonal modification which prevents the growth of tumour cells. Another study links obesity with an increased inflammation. In many cases, inflammation acts as a catalyst, accelerating the growth of cancer cells. Research is still going on to understand this correlation (obesity and reduced cancer rates) better.

Bariatric surgery has its share of risks and demerits. Consult your physician and get yourself thoroughly examined before opting for the surgery.

Does Bariatric Surgery Reduces The Risk Of Cancer?

Chronic kidney disease or CKD is the decreased function of the function of the kidney for a minimum of three months or more. In this the end stage renal disease usually refers to the end of the kidney function where the kidneys work for less than 15% of what they are supposed to. The kidneys play a vital role in the human body and if they do not function properly then a person can die. The functioning of many organs depends on the kidneys. However, the main function of the kidneys is to remove the products and regulate blood and water, control blood pressure, promote healthy and strong bones, and produce hormones.

Here are 5 facts about kidney disease you should know about:

1. Causes of the kidney disease: There are two main common causes of the end-stage kidney disease. These are preventable causes. These are diabetes and high blood pressure, but then kidney disease can be caused by other inherited diseases such as infection, trauma or polycystic kidney disease.

2. Serious Stages: The kidney disease has five stages and stage 5 is known as the end stage renal disease; this is the point where patients usually need dialysis or kidney transplant to lead a sane life. The stages of kidney disease are:

Stage 1   Slight kidney disease
Stage 2   Mild decrease in kidney function
Stage 3   Moderate decrease in kidney function
Stage 4   Severe decrease in kidney function
Stage 5   End stage renal disease

3. Detection of the disease: Kidney disease is usually difficult to detect because of the presence of very few symptoms. Age, gender along with the blood test is one way to determine information regarding kidney function. The people who are at a risk of getting kidney disease are:

    Over the age of 55 years
    People who suffer from hypertension and diabetes
    Ethnic groups such as Asians, Africans, Americans, Pacific Islanders and Hispanics

4. Signs and Symptoms: CKD is usually considered to be a silent disease and many people don t know that they are suffering from the disease. The signs and symptoms of the disease are:

    Fatigue and weakness
    Nausea, vomiting and loss of appetite
    Dizziness
    Numbness and headaches in hand and feet
    Frequent urination

5. Renal Replacement Treatment: This is the treatment for the end stage of the kidney disease. Dialysis involves the replacement of some part of the lost function of the kidneys and is usually continued throughout life. There are 2 types of dialysis:

    Hemodialysis: This cleans the blood via an artificial kidney which is hooked to the machine
    Peritoneal Dialysis: This removes the excess water and waste products and cleans the blood of the body by using the peritoneal cavity as a filter. 

5 Facts About Kidney Disease You Should Know

How Do You Recognise a Stroke?

Strokes occur when blood to the brain gets interrupted or reduced. When this occurs, brain cells begin to die as they don't get enough nutrients and oxygen. Such life-threatening episodes can strike you anytime.

There are certain signs that can help you to clearly recognise an occurrence of stroke:

Face drooping on one side
Weakness or numbness on one side of the body, usually a leg or an arm
You're unable to think or say anything clearly
You experience slurred speech
Difficulty in moving your tongue
You get a sudden and severe headache

What Tests can be Done to Identify the Stroke?

There are certain tests that you can do to identify these warning signs.

To identify facial weakness, the smile test is used wherein you're simply asked to show your teeth to check for any changes in this facial expression - a lopsided smile.

To check for weakness in the body, the arm test is performed in which you raise both your arms to the same height. In case you're unable to do so, you may be experiencing arm weakness, a sign of stroke.

For slurring of speech, you may be asked to repeat sentences such as 'Don't cry over spilt milk' or 'The pen is mightier than the sword'.

Stroke can also be identified through the walk test wherein with the help of another person, you walk across the room to check for changes in your step.

If not treated in time, strokes can cause permanent brain damage. More importantly, unlike heart attacks, anxiety may not always be the cause of your stroke symptoms. That's why, being aware of these symptoms and recognising them on time can help you to quickly seek medical assistance.

How To Recognise a STROKE, Before it's Too Late!

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