Tuesday, 12 September 2017

Dilemma of a patient with Heartburn: How long to suffer? When to seek a permanent solution?

Acid reflux causing ulcers and damage to the foodpipe
I will briefly talk about a patient with severe
heartburn, suffering for the past 7 years. I saw him a year back with his latest endoscopy report showing Grade A esophagitis that is a mild form of damage to the foodpipe due to acid coming back into the foodpipe from the stomach. But his was despite high dose of acid suppressing medications he was having since past few years.

24 hr pH with Impedance study
He was unable to stop them due to severe heartburn giving him sleepless nights and a affecting his daily work. Significantly affecting his
quality of life. I suggested him to undergo a 24 hr pH with Impedance study and undergo surgery for a permanent solution. The pH with impedance study showed severe reflux and also suggested that all his symptoms are due to reflux (good symptom reflux correlation by high Symptom association probability or SAP). All this point to surgery as a permanent solution. Surgery is laparoscopic with very quick recovery.

But like all humans he being scared of surgery, differed it. Took opinion of multiple doctors physicians, gastrophysicians, surgeons and G I surgeons. All having their own opinion further confusing him. After a year that showed further worsening of his symptoms he is finally planned for surgery in a couple of days.

While I am sure of giving him a permanent solution to his problems with a Laparoscopic Fundoplication surgery, the question is when a patient should say enough is enough? Many doctors not used to see the outcomes of these surgeries may not be confidant in suggesting surgery for your problems. Again in our society sleepless nights and a poor quality of life is considered acceptable. But in doing so we just deffer the inevitable to a later date rather than able to prevent it completely. In  doing so we just push the patient to have a few more years with a poor quality of life.

To know more about acid reflux and its surgery watch our patient information video by clicking this link https://www.youtube.com/watch?v=jbI3o4K_7xM&t=52s
Disclaimer: The same article has been published by me on practo health feed with the link

Sunday, 3 September 2017

Obesity: Why is surgery necessary? Why just surgery is not enough?

                                                                                                                                                                                            Obesity is a complex disease. Complex to understand, occurs due to a complex interplay of multiple causes, it causes a complex set of end organ damage and complex in its treatment. I would like to remind you that I am talking about obesity and not overweight. To make it clear overweight is the situation where your weight is above the ideal range but not too high. More objectively overweight individuals have BMI from 23 to 27.5. BMI > 27.5 is obesity for all individuals of Asian origin. Surgery is not mandatory for all obese individuals, but weight loss is very much necessary for all of them.                                                                                                                            
           Surgery is necessary because only Bariatric surgery has till date shown a significant and sustained weight loss required to get improvement in obesity related diseases. Obese individuals need to shed a large number of kilos to get significant benefit. Diet and exercise has failed to achieve these goals even in dedicated and committed individuals. The problem increases if you have knee or spine problems or you have heart or lung condition further limiting your exercise capacity. A few individuals who somehow manage to lose weight are unable to maintain it, gaining back all those kilos in few months. These individuals do not get the health benefits of weight loss.      
            Surgery is the ideal option for those whose BMI is more than 37.5 even if they do not have any other medical problems. Surgery is also the treatment of choice for individuals having BMI>32.5 and Obesity related comorbidity. Obesity related comorbidites, that is disease caused by Obesity include Diabetes, Hypertension, Cardiac problems, Acid reflux disease, NASH (Non alcoholic Steatohepatitis or Fatty Liver), Sleep apnoea and Asthma, Knee and spine problems, Infertility etc. I know the list is long, but this is a fact. Surgery is also very helpful for lower BMI obese individuals (BMI 27.5 to 32.5) with diabetes, especially if the diabetes is not well controlled with medical treatment.   

          Bariatric surgery helps you to achieve what you are unable to achieve with diet and weight loss, a significant and sustained weight loss. It thus brings you back to normalcy where you would again be able to control your food and activity and lead a healthy life.  What people fails to understand is that just like any individual can put up weight if they don’t care about their diet  and lifestyle, all those who have lost weight by bariatric surgery can also regain weight. Hence changing your lifestyle including your diet and activity level is mandatory irrespective of what treatment you undergo. There is no alternative for that. Unfortunately the idea of improving your healthy by doing nothing is so strongly promoted by a lot of quacks in the name of a lot of products. And sadly this idea is bought by a lot of people.  However harsh it may seem, it is a fact that if you don't want to do anything about your weight and health nobody and nothing is going to help you. Bariatric surgery is a great tool that has transformed a lot of lives but it is no magic.