The  Roux en Y Gastric Bypass  surgery was first performed by Professor Mason in 1966. Being done in the conventional way (i.e by open surgery) earlier and later laparoscopically, the Gastric Bypass has stood the test of time over the last 52 years.

Over 50 years the Gastric bypass surgery is being performed across the globe. It has given excellent results in terms of significant and long-standing weight loss in the morbidly obese, as well as remission of Type 2 diabetes in properly selected patients. Selection of the patient to undergo this procedure is paramount. 50 years of successful results are enough to term this procedure as the GOLD Standard.

Obesity and Diabetes have been a menace over the last 2 decades world over. In India obesity is growing in such a rampant way that we can equate it to an epidemic.

As we all know, India is considered to be the Diabetic Capital of the world. Type 2 diabetes contributes to the major chunk of diabetes affected population. We Indians get affected by diabetes at very early ages and hence complications are seen at very early ages among us. Strikingly important to notice is that Diabetes is seen not only in the obese category of people but also in the normal weight people.

Diabetes is feared of only because of the complications it is capable of causing affecting the vital organs like the brain, heart, eyes, kidneys.

Intermittent or elevated surges in the blood sugars levels during the course of the day are responsible for causing microangiopathies ( damage to the small vessels supplying blood to the vital organs).

We have seen that diabetes is accompanied by high blood pressure and dyslipidemia in most of the cases. So, when a person has diabetes, high blood pressure and dyslipidemia, we label them as having the metabolic syndrome.

Oral hypoglycemic agents (OHA) and insulin form the mainstay of treatment in getting sugars under control. But these are not able to avoid these surges in high sugar levels. This does not mean that OHA s and Insulin are not the right way to treat diabetes- they indeed are.

We are going a step higher, in an attempt to get control of diabetes without OHA and insulin. Not only this, we are trying to tackle not just diabetes, but the metabolic syndrome on the whole i.e one procedure that will take care of diabetes, dyslipidemia and hypertension. This procedure is popularly known and referred to as the  Gastric Bypass  or the  Roux en Y Gastric Bypass . Thus, In short, the gastric bypass surgery offers ICE BURG treatment.

Now, the first question is that  Is this possible . The answer is YES. The second question is that is this procedure applicable for all diabetics. The answer is NO. Only Type 2 diabetics are the beneficiaries of this procedure where insulin resistance has a major role to play. (This procedure does not benefit Type 1 diabetics) Reasons for this will be explained later. The third and important question is that,  Is the Gastric bypass going to give remission of diabetes in all type 2 diabetics?  The answer is NO.

There is strict selection criterion or eligibility criteria to select a patient for The Roux en Y Gastric Bypass surgery. Best results of the Gastric Bypass surgery are seen when it is confirmed that the person is suffering from Type 2 diabetes, duration of diabetes is less than 5 years, the pancreatic reserve is good and showing good levels of C -peptide in the blood, the person has a family history of diabetes, Insulin was not required to control sugar levels within the first 5 years of onset of diabetes and person should not be underweight( BMI > 27.5 preferred).

Losing weight is not easy and even if we lose weight, weight regain is very common. Most of us would have already experienced it. When we are tackling just the weight issue, we are talking into consideration only the morbidly obese people who have a BMI > 37.5. In the morbidly obese, at first, it is very difficult to lose significant weight by the normal method of diet and exercise. Even if weight loss does occur, weight regains or bouncing back is sure.

Here we bring in the trump card   The  Roux en Y Gastric Bypass  that helps the :

 Morbidly Obese  (BMI >37.5) to lose significant weight and reach their ideal weight.
 Obese  (BMI >32.5) who also have comorbidities (like diabetes, hypertension, dyslipidemia, sleep apnea, obesity-induced infertility) not only to lose significant weight and reach their ideal weight but also to get control of the associated comorbidities.
 Type 2 Diabetics  (BMI > 27.5) to get Remission from type 2 Diabetes.
 Metabolic Syndrome  (BMI > 27.5) to get remission from type 2 diabetes, dyslipidemia and Most cases hypertension.
Type 2 diabetics can be offered this procedure even if they are not morbidly obese, is what I would like to bring it to notice.

Exposure to Type 2 diabetes for long years can lead to potential complications like coronary heart disease, chronic kidney failure, brain stroke, gangrene of the lower limbs.

In some, in spite of talking OHA s, Insulin, sugars are not under control. In these cases, the gastric bypass can be offered to those who fulfil the eligibility criteria.

Remission of diabetes after the gastric bypass procedure is very quick, ranging from a week to a month in most of the cases. However, in some, The sugar levels come to normal the very next day after the surgery in some without the OHA and /or insulin.

Gastric bypass is done through laparoscopy i.e through tiny holes over the tummy, requiring 3 days hospital stay. Supplements need to be taken following the procedure on a daily basis. Following the procedure, intake is reduced to a great extent which increases over few months as the gastric pouch stretches.

Gastric Bypass - Be It Bariatric Or Metabolic Surgery, Get Amazing Results!

Even though Prostate cancer is one of the most common types of cancer among men and a lot of research has been conducted towards its understanding, it still remains one of the least talked about forms of cancer. This can lead to a lot of confusion and misinformation that gives rise to a number of myths associated with the disease. Some of the most common myths about prostate cancer are:

1. It occurs only in old men

Although the risk of developing prostate cancer does increase with age, especially after 60-65 years of age, it can develop at any age in a man s life. Ageing cells are more susceptible to mutations and hence more susceptible to cancer but other factors such as genetics, geographic location, overall health, lifestyle, etc. can play a major role in whether someone stands a chance to get prostate cancer.

2. It is a slow-growing cancer

Research has discovered 29 different types of prostate cancers, each of which behaves a little differently from others   some are very fast growing and aggressive while others are slower in developing. Prostate cancer also tends to be more aggressive in younger men than older men; aggressive cancers metastasize faster, i.e. spread to other parts of the body quicker and progress rapidly. Therefore, it is important not to ignore any initial symptoms and consult a doctor as quickly as possible to have the best shot at successful treatment.

3. You can t get prostate cancer if no one in your family had it

While having a family history of prostate cancer does significantly increase the risk of a man developing prostate cancer himself, it can also be diagnosed in men who have no genetic history or predisposition. It depends not only on genetics but also on a number of other factors which can contribute to prostate cancer.

4. If you don t have any symptoms, you don t have cancer

Prostate cancer is known to be one of the most asymptomatic forms of cancer and even when symptoms are present, they are very often misinterpreted as something else. The most common symptoms are: needing to urinate frequently, difficulty in urinating, blood in urine or semen, erectile dysfunction and pain in the pelvic area. Although all of these symptoms don t always mean cancer, it is best to go to the doctor in case you experience these symptoms.

5. Prostate cancer is inevitable   you can t prevent it

It is true that genetics, ethnicity and age do increase the risk of prostate cancer in men. However, research has shown that lifestyle changes such as avoiding red meat in your diet, regular exercise and preventing stress, do have an effect on the genes that regulate growth of tumours.

Hence, you should stop believing everything you hear or read on the internet, they may not always be true. Any symptoms out of the ordinary should be immediately checked out by your doctor. Do not ignore unusual symptoms   they might prove to be very costly later in life.

Prostate Cancer - 5 Most Prevalent Myths About It! 

5 Ways to protect your skin this summer

Staying out in the sun too long can cause you to suffer from a host of skin problems such as age spots, wrinkles and even increase your risk of developing skin cancer. During the summer months, you need to take extra care of yourself as the sun is at its peak at that time. Here's what you can do in this summer to ensure that your skin remains protected:

1. Avoid the rays of the sun between 10 am and 2 pm

The strength of the UV rays depends on a number of factors such as reflective surfaces, height, and time of day. The sun's UV rays are at their strongest between 10 am and 2 pm. If you're outdoors, seek a cool area to protect yourself from the damaging rays of the sun. You could stand under a tree or use an umbrella to shield yourself from its ultraviolet rays.

2. Don't use tanning beds

Several studies reveal that tanning beds can cause skin cancer. According to these studies, individuals under 30 who use tanning beds increase their risk of melanoma (the most deadly of all skin cancers) by about 75%.

3. Increase your fluid intake

One of the ways in which you can beat the sun and protect your skin is by increasing your fluid intake during this time. On an average, one should have about 3 liters of fluids every day, which is about 1.5-2 liters of water and 1 liter of fluid from solid foods. From summer foods like watermelon and berries to beverages like fruit juice, milk, etc and liquid-based meals - all these avenues should be considered.

4. Have a proper cleansing regimen

To help your skin look fresh even during the summer months, you should exfoliate regularly. When you do this, all the dead skin cells are removed, giving your face a youthful and fresh appeal.

5. Use a sunscreen all the time

To protect yourself from the damaging ultraviolet rays of the sun, you should never forget to apply sunscreen when going out. Ideally, a sunscreen that has an SPF of 30 should be applied thoroughly to your skin 30 minutes before leaving your house. More importantly, it should be applied again every 2 hours.



5 Ways to protect your skin this summer

The kidneys are primarily responsible for filtering blood and removing waste from the body. They also regulate the fluid and electrolyte balance. If the kidneys stop functioning, a patient may need to undergo dialysis or have a renal transplant. Many patients prefer undergoing a transplant as it offers a better quality of life in the long run.

A kidney transplant can be described as a procedure to replace one s own kidneys with a donor's kidney. In case of kidney transplant, there are two types of donors. The human body can function with one healthy kidney and hence family members and friends of the patient may choose to donate a kidney. Else, a kidney may be sourced from recently deceased donors who have chosen to donate their organs after death. In both cases, it is important that the donor kidney match the patient s blood and tissue type.

A renal transplant surgery usually takes about 3 hours. The donor kidney is placed in the abdominal cavity and connected to the patient s arteries, veins and bladder. Usually, the donor kidney begins functioning immediately. The patient s own damaged or diseased kidneys may not be removed unless there is a severe infection, cancer or a diagnosis of large polycystic kidneys.

The patient will need to be hospitalized for a few days after the surgery. In some cases, dialysis may be needed if the kidneys are unable to produce urine. In addition diuretics and other medication may be needed to remove excess water and salt from the body. Medication will also be prescribed to suppress the immune system so that the patient s body does not reject the donor kidney. These medications typically need to be taken for the rest of the patient s life.

A renal transplant is considered a relatively safe procedure. Less than 20 out of 100 people reject a donor kidney. However, there are a few other risks involved. These include:
  Bleeding
  Severe infection
  Failure of the donor kidney
  Reaction to anesthesia
  Increased risk of infections due to suppressed immune system

Kidney transplant is not advised for people suffering from diseases such as cancer or any significant lung or heart disease. If the patient is suffering from an infection, he or she may be advised to wait until the infection subsides before undergoing a renal transplant. A renal transplant may seem to be an expensive procedure but in the long run, this can work out to be more budget friendly than dialysis.

Renal Transplant - What Should You Know About It?

While you cannot cure breast diseases, family history and maturing, but there are some hazards or risks that you can control. Keeping in mind the fact that there is no certain approach to forestall breast cancer, there are things you can do that may bring down the hazard. Here are five approaches to ensure your breast's well-being:

Watch your weight: Being overweight or hefty expands breast cancer chances. This is particularly true after menopause and for women who have put on weight as grown-ups. After menopause, the vast majority of your estrogen originates from fat tissue. Having more fat tissue can heighten your chances of getting breast cancer by raising the estrogen levels. Additionally, women who are overweight have a tendency to have more elevated amounts of insulin, than other hormones. Higher insulin levels have been associated with a few tumors, including breast cancer.
Exercise routinely: Many reviews have found that exercise is the sign of having a healthy breast. Studies show that one to two hours of energetic walking each week, lessened a woman s cancer risk by eighteen percent. Walking ten hours seven days decreased the hazard all the more.
Constrain liquor: Women who have two to five mixed beverages every day have a higher danger of breast cancer than women who have just one drink a day or none . As much as three to six glasses of wine seven days have been found to somewhat increase breast cancer chances. It is not clear how or why liquor raises the hazard. In any case, constraining liquor is particularly essential for women who have other hazard variables for breast cancer, like, breast cancer running in their families.
Restrain time spent sitting: Research has shown that sitting time, regardless of how much exercise you get when you are not sitting, increases the probability of growing cancer, particularly for women. Women who sit six hours or more a day outside of work have a ten percent more serious risk for breast cancer compared to the ladies who sit under three hours a day, and an increased hazard for other cancer types as well.
Stay away from or confine hormone substitution treatment: Hormone Replacement Treatment (HRT) was utilized frequently in the past to control night sweats, hot flashes, and other troublesome manifestations of menopause. In any case, specialists now realize that postmenopausal ladies who take a blend of estrogen and progestin might probably create breast tumors or cancer. Breast cancer disease seems to come back within five years in the wake of ceasing the blend of hormones. Therefore, get a breast cancer test even if you feel a small lump.

5 Ways to Decrease The Chance of Breast Cancer 

Hernia are bulges protruding form a weak point on belly (abdomen) through which intestine and abdominal fat comes out to lie just below the skin. It can also be found in groin, upper thigh and chest. There are several types of hernia like inguinal hernia (direct and indirect), femoral hernia, umbilical hernia, umbilical hernia, epigastria hernia and incision hernia.

Who get hernia?

Conditions that lead to increased abdominal pressure are at more risk of developing hernia  

o Persistent cough

o Being overweight or pregnant

o Lifting, carrying or pushing heavy loads

o Straining on the toilet

What are the symptoms of hernia?

o Mostly they are asymptomatic/ no symptoms.

o People just notice a swelling or bulge which gets bigger while standing or straining and disappear while lying down/sleeping.

o Some might feel a dragging/aching sensation.

o The swelling tends to get bigger with time.

o Symptoms develop when there is a complication like strangulation. This happens when the content of abdomen (intestine) come out and can not go back. There will be severe pain in the region and vomiting. Overlying skin will become red. Urgent surgery is needed in this situation otherwise the blood supply to intestine gets cut-off and the intestine in hernia might die (gangrene).

How are hernia treated?

Surgery is the only treatment for hernia. Now a days, most of the hernias are operated laparoscopically (key hole or minimally access technique)

Minimally Invasive Hernia Repair - The surgery is done with a laparoscope which has a small tiny camera, hernia mesh and small tool with it. So the patient can return back to their normal routine earlier as the incision made is smaller.

Advantages of Laparoscopy:

Laparoscopy has clear advantage over open repair in the way of less pain, less complications like wound infection, small and more cosmetic scar, shorter hospital stay, early return to work and daily activities and less chance of recurrence (repeat formation of hernia after surgery).

Before undergoing hernia surgery:

* One week before surgery it is much essential to stop taking drugs that are causing the thinning of the blood. Drugs like Clpodogrel and Acitrome or Warfarin should be stopped with the doctor s advice. 
* Stop herbal supplements and check the fitness of your cardio and diabetes. 
* Gain adequate knowledge about surgery and be prepared for post surgical care.

After hernia surgery:

* Avoid heavy weight lifting, exercises, and physical works with excessive strain a few weeks after surgery 
* Cough or laugh loud only with support to the surgical site until one week after surgery

DO s & DON T s in patients of Hernia:

DO s:

1. Increased intake of fibers in diet. ( Fruits, vegetables and grains)

2. Drink plenty of water and other fluid to prevent constipation.

3. Exercise regularly: sweat and loose excess weight and toxins.

4. Eat small meals more frequently in place of one or two large meals

DON T s:

1. Stop smoking and drinking

2. Don t reduce the amount of food you eat

3. Avoid lying down or bending after meal

4. Avoid wearing tight clothes

5. Avoid food difficult to digest

6. Avoid strenuous activities like heavy weight lifting

Types of Hernias:

Incisional hernia:

This happens at the site of previous surgery. This occurs as a result of poor wound healing at the time of previous surgery or as a result of complications like in infection. It is rare after laparoscopic or key hole surgery.

Umbilical hernia:

This occurs through or around belly button (umbilicus). It can be present at the time of birth and needs no repair as most of them resolve by the end of one year. If it persists or appears after 5 years of age then operation is required.

Inguinal hernia:

These are most common hernias and occur in groin region. They are more common in men.

All You Need To Know About Hernia!

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