Being committed and responsible for your own health is the
most important determinant for lifelong maintenance of weight loss and good
health.
We have seen that those who follow up regularly and
religiously maintain their weight loss and health. Those who do not come for
follow up even when it is free, is possible on phone or video call even after
reminders from the clinic, show that they are very casual about their health.
It shows that health is not at all a priority for them, and these are the
patients who either regain weight or land up with nutritional deficiencies.
It is not uncommon to see patients missing their follow up
visits or postponing it for trivial and insignificant reasons, let’s call them
excuses. I strongly urge all my patients to be very religious and punctual
about the follow ups.
Finally a healthy way of living is the most crucial
determinant. How can a surgery be an alternative to a healthy lifestyle?
Bariatric surgery treats your obesity and related problems and brings you back
as close to normal health as possible. But to maintain that you have to share
the responsibility with your bariatric surgeon. Your job is to follow the
healthy lifestyle and your surgeon’s job is to guide you, motivate you and
remind you to do so. Discussion regarding different aspects of healthy
lifestyle is an important aspect of follow up visits and hence they are very
important.
Hernia is a very common problem and its surgery is available
at every nook and corner. Most of the times, neither hernia nor its surgery is life threatening. This makes the case for ignoring the need for perfection in
surgery by a specialist.
Most of the people including many doctors fail to understand, that the abdominal wall (the wall of your tummy with its different muscles) is
an organ in itself, with its special functions. The muscles of the wall of your
tummy along with the muscles of your back are needed to function optimally, for
the core functions of your body. These core functions are breathing, coughing,
sneezing, passing motion and urine. And many other activities like sports, running,
swimming and other strenuous work are dependent on the efficiency of your
breathing.
Thus, hernia which is a defect in the muscles of your tummy, impacts many of your activities and your core body functions. Hence, surgery for
hernia is not done just to stop the intestines from coming out of your tummy
and create an emergency, but also to normalise your activity level to best
possible. Anything less than the best possible in your case, depending on
your hernia type, other medical problems and age, will not serve the purpose of
restoring the function of the wall of your tummy. Type of surgery, type of
anaesthesia, type of mesh and sutures and precision of surgery, each play a crucial
role in the outcome and none can be ignored.
In
a nutshell, all the hernia surgeries are not the same, but each type is suited to a particular kind of hernia and patient. And overall, the aim is not just to cure hernia
but to optimise your tummy wall function, so that you can live your life as
actively as possible.
Acid reflux is a problem that troubles a large number of people. Many of them are very young, and find themselves in a state of inefficiency at work due to this problem. Is surgery an ideal solution to there problem or it is just a gimmick? Lets discuss.
I encounter a large number of these patients, taking medications for years for heartburn and acid reflux. Still not feeling completely normal. On and off have a bad day due to heartburn and either have to skip work or continue suffering at work place. Missing medication for a day brings very harsh punishment for these people. Thus starts their search for an effective solution to their problems.
The problem of acid reflux, if it has been very convincingly confirmed with endoscopy and pH study, certainly gets cured by a laparoscopic surgery. The problem is many a times people have additional digestive issues like constiaption and IBS (Irritable bowel syndorme) along with acid reflux. The person may require medications for these conditions even after surgery. If these conditions are not recognised before surgery and explained to the patient, they are likely remain dissatisfied with the surgery.
Even larger is the problem of misdiagnosis. If someone having IBS or constipation or functional problems are wrongly diagnosed as acid reflux (which is quite possible even with experienced doctor if complete evaluation is not done) and a surgery is considered, then they are not likely to benefit from the surgery. And hence we always recommend to get a complete work up including an endoscopy, esophageal manometry and 24 hr pH study before surgery. So that we can pick the patient who is unlikely to get benefited from surgery and avoid the surgery.
All in all, those finding themselves stuck in this situation, should not feel hopeless. Should get themselves thoroughly evaluated. If these tests confirm the diagnosis of acid reflux, then should consider laparoscopic surgery with the confidence of leading a normal life after that.
Watch some of our videos to understand these problem and solution in a way that you would understand better. Directly form the ones who have faced it.
Hello friends, am writing this because it is a very common practice to ignore
Obesity and acid reflux as the primary cause of cough and breathing problems. I
am not saying your doctor is not aware of this possibility. But it is commonly
seen that patients and their primary physicians both many a times don't give
Obesity and Acid reflux its due importance. And the treatment and evaluation is
focused on lung problems. The reason for such a casual approach to these
conditions is our human nature. Obesity and Acid reflux do not pose any
immediate threat to one’s life, so it is taken casually by all of us.
But the problem is, if not addressed in a
proper way these conditions, Obesity and Acid reflux affects your quality of
life in a major way. Without treating obesity and acid reflux, complete relief
form cough and breathing problems is not achieved even with aggressive lung
treatments. I see a lot of patients who have a very compromised quality of life,
they have to take frequent leave form work, don’t get a good sleep, can’t
concentrate on work, the personal life is affected, are forced to stop physical
activity and exercise. I have also seen patients who have eventually developed
psychological problems due to years of poor health.
And it feels terrible when you see life being lost
because of a preventable and treatable condition. And it is never a single life
that is affected; just think the life of a spouse or children or parents of
these patients. They all suffer along with the one who is having this disease.
So my appeal is “If you are suffering from a long
term cough and breathing problem, do ask your chest physician if Obesity or
GERD could be a reason for this. If you are obese, then reducing weight by any
means will be the primary treatment that you need. Recall if you had in past or
are now having heartburn and feeling of food coming back after eating. If yes,
than you should see a Gastro-surgeon and get evaluated by an endoscopy and pH
study."
Studies show that when a pH study is done on all the patients with chronic cough
and breathing problems, 32-50 % had acid
reflux even if they had no acid reflux symptoms. This percentage goes up
to 50-82 % for those who had acid reflux
problems.
So apart from obesity if you have even a mild problem of acid reflux, you should get yourself evaluated by a 24 hr pH study. This may change your
line of treatment and improve you cough and breathing problems like never
before.
World is progressing very fast. Centuries back the treatment was primarily aimed at relieving pain and other symptoms. At the time there was lack of the understanding of what is going on inside, so the treatment was not aimed to cure the diseases but relieve the pain. Then gradually medical science developed and developed. The understanding for the underlying disease improved, various ways of detecting the disease in detail improved along with the various ways of treatment aimed at cure of the underlying disease. The negative thing about these developments brought along was a tendency to partially ignore the symptoms due to a deep focus of the disease itself. There was no lack of good intent for the patient. But the thinking was "We are doing the right treatment for the cure of the disease. Even if the patient is bit in pain now, he will be cured in coming time". This thinking led to the scenarios where you can see patients in agony and pain after an excellent surgery by a doctor. There was apathy towards the pain of patients by doctors and the healthcare workers. And patients would eventually be doing great in the coming weeks being cured of the disease." Partly this was because of the belief that this is what we can do with all our effort. Cure him of the disease by a surgery and in doing so he will have to bear some pain. I am sure any surgeon who undergoes a surgery would surely think of developing ways of decreasing this pain. And due to thoughts of such doctors medical science have further improved to level where not just curing the disease, we are able to significantly reduce the pain and discomfort of a surgery. Thanks to development of minimal invasive surgical techniques like laparoscopy and thoracoscopy, and also the development of many pain relieving therapies like nerve blocks. Apart from the pain killers that are given after surgery, a lot of surgeons now make the maximum use of a local anaesthetic agent to block the pain sensitive nerves at the site of operation. Hence the patient wakes up after surgery with very minimal pain and is ready to get up in few hours. The improved understanding of the futility of many procedures like putting a tube through the nose and a urinary catheter in many surgeries have decreased the patient discomfort. Years back we used to do that in many more surgeries than we do now, just because that was thought necessary. Now our patients wake up after surgery without any tube coming out of their nose or private parts. There are in very minimal pain, walk around in few hours, go to washroom. Most of the cases they drink and eat on the same day and go home on the same day or next. I would like to share a few videos of our patients taken on the same day or next day of surgery. Some had a bit complex surgeries done laparoscopically but you can yourself make out their comfort level. To watch click the links below
Laparoscopic surgery is not a new
word for most of us. People in general are quite aware of this mode of surgical
treatment, that it is better than formal open surgery in terms of recovery. And
it is not uncommon for patients to demand laparoscopic surgery for various
surgical treatment they need. It is really good that people are aware of their
options and are asking for it.
Today I feel like talking about aspects of this modality of
surgical treatment that people are not much aware about. Laparoscopy means
Lapro that is your tummy and scopy means a telescopic camera, thus any surgery
of abdomen that is done by a minimal invasive method using a telescope is
called Laparoscopic surgery. Similar modality used for any surgery of your
chest is called Thoracoscopic surgery. Thus a surgery is performed by making
very small incision (cuts) in your tummy and inserting instruments and a telescopic
camera through it and performing surgery. Whatever is done in your tummy
is seen on the monitor in the operation theater and thus a big cut in your
tummy is avoided.
The general perception is that the faster
recovery is due to the small cut on the skin. My patients commonly ask me
" Sir how many stitches I will get?" , and I always say it does not
matter. What people don't know is that, the wall of your tummy is itself an
organ. Just like your leg and hands, and it is not just skin but multiple layer
of muscles, fat and skin. It has many important function also, like they are
the key muscles in your basic body function like breathing, coughing, passing
stool and urine. They are also very important for different body movements like
bending, lying and getting up. Any decrease is the health of the wall of your
tummy affects you in multiple ways. And laparoscopic surgery does not just
reduce the length of scar on the skin but also on the whole wall of your tummy.
Hence it helps to maintain the natural strength of your tummy, causes faster
recovery, less breathing problems after surgery and decreases the chances of
hernia through the operation site.
It is a technically demanding skill, and also needs
very specialized equipment. Fortunately with time there has been significant
advances in the instruments and skills of surgeons. So the technique which was
previously used for some basic surgeries like gallbladder and appendicectomy is
now widely used for even very complex surgeries like cancer, weight loss and
other major surgeries of your tummy and chest. For a lot of medical conditions,
surgery was previously avoided due to the complications and poor recovery with
open surgery and patents used to suffer, with no option of an effective
treatment with low complication rate. But with laparoscopy, the recovery being
faster and complications less, many of these diseases are very effectively
treated with laparoscopic surgery with acceptable rate of complications. The
patients are being able to walk within hours of surgery, can take liquids and
diet very early depending on the type of surgery and are being discharged very
early due to laparoscopy.
Thus I would like to again reaffirm that " There is
much more to Laparoscopic surgery than mere small scar and your tummy wall is
not just skin but an active organ of your body".
Disclaimer: The same article has been published by me on practo.com
A lot of doctors get irked by the patients
who come to their clinic with a self made diagnosis by reading a lot of things
on Google. Sounds fair to some extent, because they come with the wrong facts
firmly embedded in their head. This makes it difficult to treat them, as they
are not convinced easily by the genuine advice that is given by doctors. The
doctors have to spend more time to convince them and prevent them from making
wrong decisions, which may harm them rather than being of any help.
What we doctors fail to understand is, the
problem is not Google or the patients who search Google for their problems, and
even if it is the fact is this is going persist. The problem is the false and
confusing or wrong information that is there and the way to counter it is to
provide the people in general with more and more genuine and authentic
information. So that it helps them in making proper choices for their problems,
especially when they are being advised different treatment options by different
set of doctors. If we see from their perspective, they feel totally confused and clueless what to do when different qualified and expert doctors give a
different opinion about their treatment.
To believe that someone is not capable of
understanding the problems they are facing, and not capable of taking an
informed decision is big mistake. So we as doctors should strive to get as much
information about different problems as possible, in a language that is easily
understood by a non medical person. This will not only help them take better
decision, this will improve the compliance of patient to the advice of doctor
as they will understand the reason behind the advice.
But with this the responsibility of the
patient also increases, as they are now the active partner in their own
treatment. They need to learn the art of understanding what is genuine and what
is fake.
A lot of patient’s complaint that some doctors misguided them to
a wrong treatment. From my experience I can say, all such patients had opinion
of multiple doctors and among these doctors were also those gave them proper
guidance. But they chose to follow the one who gave the wrong advice,
either deliberately or out of their poor knowledge. Not going into the
discussion who is to blame, it is very clear that only the patients are at an immediate loss. But it the responsibility of both the public and the doctors both to
make sure that people in need of guidance should get a correct one. We are in a
new age and literacy is no more just the ability to read and write. Literacy in
today’s time is ability to read between the lines, and the ability to send a true
message in a stronger way such that it is louder the wrong ones. The onus is on
all of us, and surely we will achieve that mark. Disclaimer; The same article had been published by me on practo health feed with the below link https://fit.practo.com/#!/content/29965
