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!

What is a hysterectomy? This is a surgery that is used to remove the ovaries or even the uterus. This surgery is usually conducted in order to deal with the extreme conditions that may be caused by the severe onset of various conditions related to the reproductive system of women. Read on to find out why this surgery carried out and what are the after effects?

Causes: This surgery can be carried out for a variety of reasons. One of the main reason is the manifestation of uterine fibroids that can cause severe pain and bleeding. These fibroids will have to be removed surgically and in case they have spread, the uterus will have to be removed entirely. Also, if the condition has spread to the ovaries, it may be imperative to remove the ovaries as well. Furthermore, if the patient is suffering from endometriosis, where the tissue has spread too much and cannot be contained merely by medication or other forms of treatment, then the doctor will have to conduct a hysterectomy surgery in order to remove the affected areas of the reproductive area. Also, other conditions for which this surgery may be required include adenomyosis, chronic pain in the pelvic area, cancer of the uterus, cervical cancer and uterine prolapse.

Procedure: A hysterectomy is performed under anesthesia, and the doctor makes a five to seven inch incision in the abdomen for an open surgery. The doctor will then continue to remove the uterus through this incision. Also, usually, the patient will have to spend about three to four days in the hospital following this surgery. A vaginal hysterectomy may also be conducted for certain cases, depending on the type and severity of the condition that has led to this form of treatment. For this kind of surgery, the incisions will be made in the vaginal area.

After effects: Starting from hormonal imbalances to early menopause, this surgery can leave significant after effects in its trail. The patients who have been through this surgery will be asked to abstain from heavy physical work that involves lifting heavy objects and bending. Also, the doctor will recommend abstinence from sex. One will have to avoid these things for a period of at least six weeks after the surgery. In many cases, the patient may also go through heavy menstrual bleeding.

Doctor visits: In case the bleeding and hot flashes are excessive, then the patient will have to see a doctor and take further appointments so that the condition may not reoccur. Also, the doctor will usually prescribe supplements like vitamins, which must be taken on a regular basis after the surgery to avoid any complications at a later date.

Hysterectomy Surgery - Know the After Affects!

GERD or acid reflux is caused by the regurgitation of acidic liquid stomach contents back up into the esophagus. It is a long-term condition where stomach contents come back upwards from the gastro-intestinal tract resulting in either symptoms or complications. It is a commonly occurring digestion condition. A burning sensation in the chest is usually caused by acid reflux which radiates up from the stomach to the mid-chest or throat. This condition is also known as the heartburn. A sour taste in the back of the mouth is a common experience amongst the patients. Long term reflux of gastric contents causes the condition to become chronic which can lead to difficulty in swallowing. In some cases the erosion of the tract lining can also cause breathing problems.

Symptoms:

Heartburn is a burning sensation felt in the retrosternal area. Most commonly it occurs post-prandial or nocturnally. Consumption of fatty foods, spicy foods, acidic foods aggravates the condition. Burning sensation is relieved with antacids, water or milk.
Perception of gastric content reflux in the mouth or hypopharynx is termed as acid regurgitation. It is also known as water brash. A bitter or acidic taste is felt in the mouth.
Other symptoms include dysphagia, odynophagia, nausea, chest pain, dyspepsia, epigastric fullness, bloating, frequent belching
Extra-esophageal symptoms like chronic cough, hoarseness, laryngitis, dysfunction of the vocal cords, bronchospasm can also be observed.
Complications:

Peptic stricture
Ulcers of the esophagus
Metaplastic disease (Barrett s esophagus)
Dysplastic disease (Adenocarcinoma)
Laryngitis or bronchitis
Pulmonary disease
Fluid in the sinuses and the middle ear
Diagnosis:
The diagnosis of GERD is made by its most commonly presenting symptom- heartburn. To confirm the diagnosis of GERD, the physicians treat patients with medications for suppression of the production of acid by stomach. If heartburn diminishes to a large extent by the medications, diagnosis of GERD is considered confirmed.

Conditions like an ulcer caused by bacterial infection, mimic the symptoms of GERD. To get a clearer diagnosis, an endoscopy is then performed. The common diagnostic modality for GERD is Upper intestinal gastro-endoscopy. A tube containing an optical system for visualization is swallowed, the tube progresses down the gastrointestinal tract, and then the lining of the esophagus, stomach, and duodenum can be examined. A normal esophagus is observed in most patients with symptoms of reflux. 

However, sometimes the lining of the esophagus appears inflamed. If erosions (superficial breaks in the esophageal lining) or ulcers (deeper breaks in the lining) are seen, a diagnosis of GERD can be made definitely. Other complications of GERD like ulcers, strictures, and Barrett's esophagus are also identified. Biopsies also may be obtained. Other common problems that may be causing GERD like symptoms can be diagnosed (for example ulcers, inflammation, or cancers of the stomach or duodenum) with EGD. Previously, barium meal x-ray was undertaken to diagnose GERD. It is now discontinued.

Other tests that are carried out are esophageal acid testing, esophageal motility testing, gastric emptying studies and acid perfusion test.

Treatment:

Lifestyle modifications   Avoiding acidic foods, quitting smoking, weight loss, abstaining from alcohol consumption improves symptoms in people with GERD.
Medications   Proton pump inhibitors (Pantoprazole, Omeprazole, Rabeprazole), H2 receptor blockers (Ranitidine, Cimetidine) and antacids.
Surgery   In cases where the proton pump inhibitors are unsuccessful in relieving symptoms of GERD, a surgical procedure called Nissen fundo-plication is done.

GERD - Complications Associated With It!

Rectal bleeding is the collective name associated with all the conditions that cause blood to pass into the stool. Blood may appear in the form of small flecks in the stool, or clots, or a lot of liquid mass. It can also appear on the toilet paper, instead of in the pot. The blood may be coming from the anus, colon, or rectum itself.

Causes of Rectal Bleeding

The causes are multiple, and they include-

  Swelling and irritation of the anal veins, a condition known as haemorrhoids. Piles are the more common name for this phenomenon.
  Constipation (inadequate and painful passing of stools)
  Tears or scratches in the anus (fissures), sometimes as a side effect of constipation.
  Anal cancer
  Colon cancer
  Rectal cancer
  Diarrhoea
  As a side effect of radiation therapy, used in the treatment of diseases like cancer

Ayurveda believes that such a condition occurs due to the imbalance of the three doshas - fire (Pitta), water (Kapha) and air (Vata). Therefore, the aim of Ayurveda is to restore the dosha balance in your body and improve the condition. The help of a medical professional must be sought immediately after you notice this phenomenon occurring with you.

Treatment of rectal bleeding: Why Ayurveda is your best resort?

Ayurvedic treatment is the best possible alternative at your disposal. Besides being tailor-made to cater to your medical history, it is the only form of treatment that has negligible side effects. Hence, you might want to talk to an Ayurveda medicine specialist in the first place.

Rectal bleeding has a whole host of possible solutions within the fold of Ayurveda treatment. They are-

  Use laxatives, but natural ones. Laxatives are compounds that make stool less hard and easier to pass. The substances that can act as natural laxatives are coconut water, chia seeds, spinach, flaxseeds and prune juice.

  Foods that are rich in fibre should comprise a major chunk of your dietary intake during treatment. These foods include the peels of fruits and vegetables, and figs, beans and prunes.

  There are certain items you should not consume as well according to Ayurveda, like alcohol or fried foods. Also, to not further irritate haemorrhoids and exacerbate your condition, avoid hot and spicy foods like those flavoured with green chillies.

  Reduce time spent on sitting on the toilet seat, as this puts a strain on the muscles around that region.

Rectal bleeding is a common medical phenomenon that may require critical attention. While some of the reasons behind it may be easily treatable, there are some conditions with deep complications underlying it, like rectal cancer. You should get yourself checked immediately if you are experiencing rectal bleeding. After getting a primary diagnosis, you should try Ayurvedic remedies for the best results.

Rectal Bleeding - Causes & Treatments Of The Problem!

Over the past several years, the prevalence of GERD (Gastro-oesophageal reflux disease) has increased in our communities due to unhealthy lifestyle and that can potentially lead to serious medical complications if left untreated. 

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach and occurs when the lower esophageal sphincter (LES) does not seal off the esophagus from the stomach.

The two most frequently reported symptoms of GERD are heartburn, which can be described as a burning discomfort that begins behind the breastbone and radiates to the neck and throat, and acid regurgitation, which is characterized as a bitter, sour tasting fluid. One out of five people experience heartburn or acid regurgitation on a weekly basis and two out of five people experience heartburn or acid regurgitation at least once a month.

However, some patients may present with atypical symptoms such as a cough, asthma, laryngitis, or chest pain, and other patients with GERD experience no symptoms at all. 

Causes

1) Eating food while not feeling hungry
2) Eating in haste and in indigestion
3) Eating stale food
4) Eating spicy, hot  & tangy, fermented, stale food on a regular basis.
5) Excess consumption of tea, coffee
6) Sleeping immediately after meals
7) Drinking alcohol & smoking in excess
8) Mental stress
9) Staying awake at night, disturbed
sleep
10) Eating late at night.

Signs and symptoms:

Difficulty in swallowing
Regurgitation of food
Belching
Bitter taste in mouth
Discomfort or pain in upper abdomen
Dry cough
Anorexia ( loss of appetite )
Excessive thirst
Heartburn especially after meals and at night
Loss of taste
Nausea & vomitting
Bloating
Giddiness
Treatment in Ayurveda focuses on:

1) Improving appetite
2) Help nourishment of body
3) Regulating the acid metabolism in the body
4) Improve the ability of digestion & absorption
5) Treat inflammation and cause healing of the digestive tracts
6) Protecting the intestinal layers from ill effects of acid 

Do's & Don'ts for GERD:

Do's

1) Eat light to digest food
2) Eat only when one is hungry
3) Gap between two meals should not be more than 6 hrs
4) Eat fruits  daily 
5) Food good for GERD - Old caged rice, Jowar roti, Moongdal, Bittergourd, pumpkin, dates, pomegranate, Indian gooseberry,  Lemon, mint, mangosteen, turmeric, coriander, cumin, asafoetida, coconut, cowghee, cow milk, fresh buttermilk .
6) Drink lukewarm water half hour after meals
7) Walk after every meal
8) Daily exercise for atleast 45 min

Dont's
1) Very spicy & hot, excessive consumption of chillies & curd
2) Excess tea, coffee & fermented food
3) Excess stress & negative thinking
4) Sedentary lifestyle
5) Excess smoking & drinking
6) Drinking excessive water 
7) Sleeping immediately after meals
8) Sleeping in the afternoon
9) Staying awake late night

Symptoms of GERD are very commonly found in the population. If it is not taken care of, it can lead to complications like Barrett's oesophagus, oesophagitis, ulcers, Ca oesophagus, bleeding, scarring and difficulty in swallowing. Ayurveda has a complete holistic approach in treating GERD. Treating on time helps in avoiding complications in future.

Gastroesophageal Reflux Disease And Ayurveda!

A polyp is a cauliflower-like growth on the skin or the mucosal surface. Colon is the medical term for the larger intestine and the rectum. A growth on the mucosal surface of this part of the intestine is known as a colon polyp. Although not visible, colon polyps is present with symptoms, which can lead to their diagnosis. The main cause for concern is that some colon polyps can turn into colorectal cancer, which is the third largest cancer in America.

Types: There are two main types of polyps

Hyperplastic or inflammatory: These are benign growths and do not carry the risk of developing into cancer.
Adenomas: These carry the risk of turning into cancer, and so early detection and intervention is essential.
Though not all polyps develop into tumors, yet all tumors develop from a polyp. There is a strong genetic component, which makes it worse. Someone with inflammatory bowel disease or Crohn s disease is also at a higher risk of mucosal inflammation, which can induce dysplasia and then polyps.

Risk factors:

Family history
Inflammatory bowel disease
Obesity
Diet rich in processed meat and red meat
Smoking
Lack of physical activity
Type 2 diabetes
Being male, being African American
Symptoms: Though often silent, some symptoms which also appear only after the polyp has grown considerably include:

Bleeding with stools   often small amounts intermittently, which is occult bleeding, not visible though
Altered bowel habits (constipation, diarrhea)
Abdominal pain and discomfort
Unexplained weight loss
Anemia (due to blood loss)
Diagnosis: If a person is at risk from medical history and has the above symptoms, then the following are done:

Sigmoidoscopy Viewing the colon and rectum to see if there are any polyps. A biopsy may also be taken to confirm cancerous growth.
Colonoscopy The entire colon is viewed to rule out polyps in other areas of the colon.
CT scan of the abdomen which is non-invasive and can be used as the first step.
Treatment:

If a polyp is diagnosed, then it needs to be removed.
If it turns out cancerous, then detailed evaluation should be done to rule out spread to other areas. Additionally, chemotherapy and radiotherapy may be required to completely eliminate the tumor and contain it.
The surgical removal of the tumor would be planned depending on the stage of the tumor.
Adapting a healthy lifestyle is very essential to managing polyps and preventing cancer. Quitting smoking, managing weight, eating healthy, and being physically active are some ways to prevent colorectal cancer.
Repeat colonoscopy needs to be done to ensure these are not recurrent.

Colon Polyps - What Are The Available Treatment Options?

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