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
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.
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.
The above mentioned problems are quite common in their occurrence and many a times can be seen in clusters. This is because some of the underlying causes are the same. The good thing about it is that most of the times they are functional, meaning there is no serious underlying organic disease. This also means that they are due to deviation in the normal function of any of the digestive organs. The root cause of most of these functional problems is our lifestyle. The Lifestyle includes our eating habits, substance abuse i:e smoking or alcohol, our work habits, our sleep pattern, our physical activity and our mental health i:e our stress levels. So people with these problems need to go deeper to find out whats wrong in their lifestyle and correct it. The worrying thing with these symptoms is that it could be due to disease of the digestive organs, sometimes grave problems like cancer also, and it is not possible to rule this out without thorough investigations. To add to these problems, many of the different disease of many of different digestive organs present with these similar complaints. Hence many a times to rule out that nothing is wrong or to find out what is wrong, multiple tests are needed. Let me give you an example, bloating and heartburn can be due to no so serious problem like deviation in your digestive process and can get better with change in lifestyle and some simple medications. But occasionally, very rarely it can be due to acid reflux disease, achalasia cardia, peptic ulcer disease, gallbladder stone disease, or worse cancer of either stomach, esophagus, gallbladder or pancreas. It also can be due to chronic pancreatitis.
So what should be done? Should we panic with the occurrence any of the above symptoms and get all the investigations done? No the answer is no. First we should look into the root causes i;e lifestyle changes and seek the opinion of a doctor, who will most probably give simple medications and things should be fine. But it the problems persists after these measures then you need a thorough investigation. The problem is we don't seek medical attention even if the symptoms are there for years altogether. There is our general tendency to not get alarmed by the problems that are there for quiet some time, we learn to live with it, and that is really dangerous. Also there are some red flag symptoms that should make your doctor suggest investigation at an early stage before starting medications. These red flag symptoms are blood in stool,
blood in vomit, anemia, jaundice, weight loss, difficulty in swallowing or if any of your close family member had any abdominal organ cancer at an early age. If any of these red flag symptoms are there then as a precautionary measure further investigations should be done. You need to understand that there are different investigation for different disease of different organs, so multiple tests may be needed. Which tests should be done is upto your doctor to decide depending on the whole presentation. Many a times a doctor needs to advise more investigation depending on the reports of the previous investigations. Many a times this is taken as a lack of doctors knowledge or understanding about your problem but most of the times it is not so. Always some primary or simple investigations like blood test and ultrasound are advised first and further investigations are advised based on the findings in these tests. This is done in good faith to avoid unnecessary tests or to get the best possible information by selecting the most appropriate test from the many available investigations. Many a times its a test of your patience and your faith in your doctor. We also need to understand the fact that a large portion of these test would be normal and only a few patients from all those who are subjected to investigations will have disease. This is so because to diagnose the disease in early stage we need to keep a low threshold for getting the investigations done. We also need to be humble to understand that we including all the doctors and today's technology and medical science are not above nature, so even with all that we do we may still miss a disease which would be detected at a later stage where outcomes many not be very promising. Disclaimer: The same article has been published by myself on the Practo health feed page. The link to that page is https://fit.practo.com/#!/content/29376
Diabetes currently affects more than 150 million people worldwide and that number is
expected to quickly increase. Over 90% of people with the disease have the Type 2 form, which
is associated with obesity and overweight, lack of physical activity, family history and older age.
Unlike Type 1 diabetes in which the pancreas fails to produce sufficient insulin, the pancreas in
patients with Type 2 diabetes produces enough insulin, but for unknown reasons, the body is
unable to use the insulin. Diabetes can lead to blindness, heart and blood vessel disease, strokes,
kidney failure, amputations, and nerve damage. Current therapies, which include diet, exercise,
oral antidiabetic drugs and insulin, do not always cure the disease.
TRADITIONAL THERAPY FOR DIABETES
The goal of treatment is to improve the symptoms of diabetes through normalizing blood
glucose levels. The ongoing goals are to prevent long-term complications like eye and kidney
disease, damage of nerves and blood vessels. Strict control of blood glucose reduces risk of death,
stroke, heart failure, and other complications. Glycosylated hemoglobin (HbA1C) is a test that
determines risk for long-term complications. It measures how much glucose has been sticking to
red blood cells and other cells.
The first-line treatment for type 2 diabetes is weight lost, diet and exercise. Appropriate
meal planning includes choosing healthy foods and eating the right amount of food. Exercise is
important for effective treatment of diabetes. Regular exercising helps burning excess calories,
managing weight thus improves control of the glucose amount in the blood.
2
When diet and exercise are not sufficient to maintain normal blood glucose levels,
medications may be needed. They work through triggering the pancreas to make more insulin,
helping insulin work better, decreasing the absorption of carbohydrates from the gut or decreasing
glucose production in the liver. Poor blood glucose control despite lifestyle changes and taking
medications means insulin should be injected.
ROLE OF SURGERY
Despite continuing advances in diabetes pharmacotherapy, fewer than half of adults with type 2 diabetes mellitus (T2D) attain therapeutic goals designed to reduce long-term risks of complications, especially for glycemic control, and lifestyle interventions are disappointing in the long term.Metabolic surgery, on the other hand, has been shown to improve glucose homeostasis more effectively than any known pharmaceutical or behavioral approach.
For the patients having diabetes for les than 5 years there is a high lifelihood of achieving normal blood sugar levels wihout any medications. If the person is obese and not yet requiring Insulin his chances of compelte stopage of medication and still acheiving normal sugar levels are very high. If they are having very poorly controlled diabetes , are on high dose of insulin and are having diabetes for a very long time, surgery helps in acheiving normal sugar levels with decresed requirements of Insulin and medications. Such patients may still need medications but they can achieve good glycemic control leading to prevention of diabetes related complications
While Metabolic surgery( Surgery for Diabetes) certainly has some risk, the long-term risk of continued diabetes (which is often inadequately treated with medication) typically outweighs the risk of a surgical procedure for most patients. Each patient’s individual risks for surgery, though, should be evaluated in the context of the duration and severity of their diabetes as well as their other obesity-related health problems.
THE EARLIER THE SURGERY, THE BETTER THE OUTCOME
A key finding of many studies is that the shorter the history of diabetes, the greater the
likelihood of complete remission. Glucose toxicity, particularly in poorly controlled diabetes,
accelerates B-cell failure. B-cells are located in the pancreas and produce and secrete insulin.
Weight loss can improve B-cell responsiveness to glucose. If the bariatric surgical procedure is
performed before irreversible B-cell failure has occurred, durable weight loss will be
accompanied by a high likelihood of long-term remission.
Do not
Ignore your Obesity- There is a solutionto all your problems
There has
been a significant rise in obesity in the last decade, but obesity has been a
part of our society since long. It was not considered seriously due to lack of surgery for it and a degree of
hopelessness in finding its solution. Excuses, denials and turning their face
from the truth was a normal thing for all obese persons. It was also quite
common for the society to consider obese persons less active and helpful and to
a certain extent, a burden to the society. The attitude of society was one
which made more problems for them than helping them. Their lack of control for
eating and inability to do physical
activity was considered very negatively by society making their condition
worse. This increased their psychologicalproblems as well as their non acceptance
of obesity and decreased their efforts to reduce weight.
There is
still an argument by normal nonobese persons regarding bariatric surgery- that why
a surgery for a condition like obesity which can be cured by diet and exercise?
They all feel that it is a lack of effort and commitment from the obese person
if they are not able to loose weight. It is certainly not true. Only an obese
person can understand that with significant obesity loosing adequate amount of
weight and maintaining it is almost impossible even with all effort and
commitment.
Obesity
related health hazard is also not new with India being one of the leading
countries in no of diabetes, knee osteoarthritis and heart problem patients.
But now
things have changed to a great extent. With the availability and a great amount
of experience with bariatric surgery there is a ray of hope for obese persons.
Those who are on a higher side of their weight, have failed in multiple attempts of weight
loss with diet and excercise, have diabetes, breathing problems, have knee
problems limiting their mobility severly have still hope in bariatric surgery
that can lead them back to a normal life led by all other people surrounding
them.
This has
lead to greater confidence in accepting that they are obese, that they have a
problem and they want to solve it. A positive attitude is seen in their attempt
to loose weight with diet modification and exercise. A confidence in demanding
surgery to regain back their health is seen. Obese people have started becoming
proactive in loosing weight and leading a normal healthy and active life. And
miracles happen after bariatric surgery and weight loss. All our patients feel
they are living a totally different life. Their relatives and friends see a
different person in them. With freedom from lot many medical problems like
diabetes, breathing problems, knee problems and with a increase in their
mobility in general, they feel a new enthusiasm, a new zest for life. Patients
themselves and all surrounding them see a very active and enthusiastic person in
them. Its like a rebirth of that person.
