When to consider Surgery for Diabetes?

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Good question? Obviously, one is not asking all diabetics to be subjected to surgery. Instead it is proposed as an option for some of them. And that too, for those who are eligible as is ascertained by some tests.
Lets start by finding out who needs to look for options other than medicines and insulin for controlling the blood sugar.
Well, there may be different scenarios. First, a diabetic well controlled on medicines and lifestyle changes with no evidence of diabetic complications. Would this subject be a good candidate for surgery? An argument might be – why not? After all, surgery offers permanent cure whereas medicines do not. And he or she might get worse with time and develop complications (kidney failure, high blood pressure, heart ailments, eye complications, infections, etc). Then what? Is it not a good idea to offer surgical cure to all eligible?
All true, but what if this patient was to have a complication from the surgery? What about the commitments required in terms of follow up after surgery? If a person is doing well with medicines, is it not a good idea to leave him or her alone. Maybe. Sounds fair.
Unless, the patient is adequately informed and has decided for himself or herself to undergo surgery for a long lasting freedom of diabetes knowing fully well the risks and consequences of surgery.
Well, the argument can continue.

Let us examine other scenarios. A young person with lots of productive years left in life having diabetes uncontrolled on pills and insulin. Or, consider a diabetic who is rapidly developing its complications. What about these people? If a cure is possible, is it not right to offer them a choice? Is it not fair to let them have the option of diabetes surgery? Let them decide if they are willing to take the small risk associated with surgery and the necessary follow up. After all, a life free of medicines, insulin and complications is something every diabetic is looking for.

There is a lot of evidence from scientific research in recent years that has clearly demonstrated the benefits of bariatric surgery on diabetes. Way back in 1995, Dr Pories shocked the world by reporting that bariatric surgery corrects diabetes within days after surgery much before significant weight loss has taken place. The claim challenged the established conventional belief that diabetes is a chronic non-remitting illness necessitating lifelong treatment with pills and insulin. Subsequent scientific research in this area established the role of small intestine as an important cause of type 2 diabetes. It also demonstrated the role of realignment of intestinal flow done in bariatric surgery as the mechanism for resolution of diabetes.
A consensus summit in Rome in 2009 attended by most respected bodies in the world has recommended strongly the use of bariatric surgery for diabetes under stipulated guidelines. In a huge meta-analysis comprising of 135,246 patients by Henry Buchwald et al, 78.1% of diabetic patients showed complete resolution and 86.6% showed improvement.
There is an increasing burden of diabetes in the world today. India is unfortunately the place where this disease is going to strike maximally. We, as humans will be better prepared to combat this problem if we incorporate this effective solution as part of diabetes management. After all, surgery is now offering cure for a disease, which was so long considered incurable.

THE DEMERITS OF ALCOHOL

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Alcohol has been in the center of a lot of research in the past few decades for a lot of reasons. While nobody with a sane sense of mind questions the vices of smoking, the sensible drinkers have hotly contested the alcohol debate.
Let us analyze whether there is any wisdom in alcohol drinking.
So why do people drink? Most drink in the hope of havinga good time. Alcohol removes inhibitions of an individual making the person loosen up and be more talkative. Many people use alcohol to escape from their problems, or to change their personalities. But are all these desirable? Do we want to loosen up in front of friends and family and at times strangers and behave weirdly or even misbehave? Is there any way to deal with problems but to face them? Would escape help? Obviously no.

After years of consumption- and this is the dangerous part- manyareunable to control their drinkingand may suffer problems at work or in school. This loss of control over drinking is perhaps one of the greatest social menace especially for children of an alcoholic parent. It is estimated that 6.6 million children under the age of 18 live in households with at least one alcoholic parent.

Medically speaking, alcohol causes damage to the liver and kidneys. Even a small amount starts the problem. The system considers alcohol as a poison and works really hard to remove it from the vicinity. This overworks the liver and kidneys and prevents them from doing their primary job of metabolizing food. This is one of the major reasons how alcohol causes obesity.

Alcohol causes health hazards when some medicines are taken. For instance a combination of aspirin and alcohol can provoke bleeding from the stomach. Taken with long usage of analgesics, it can damage the liver.

Imbibing alcoholic beverages may get you in trouble with the law. Some people become mean and unreasonable. All they want to do after taking a drink is fight.

Alcohol consumption is a major factor promoting obesity as explained above. In fact we at BMI- our one stop center for Obesity Management at Belle Vue Clinic- we discourage patients to have alcohol especially if they are to undergo Bariatric surgery (surgery for severe obesity). Eating high calorie snacks, little activity and smoking often go together with a drinking session, which compounds the problem as each on their own have been linked to weight increase. 


If the family and friends of an alcoholic are concerned about the problem, the alcoholic should be too. Sadly most of the times, the alcoholic does not even realize he or she has a problem. That makes remedial measures even more difficult

To the proponents of sensible drinking, I have to say that alcohol consumption is analogous to the proverbial

Cancers in the Abdomen- Let us not close our eyes to it

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Nobody wants to listen to bad news. That is why, we do not want to accept any deadly diagnosis such as cancer (a term which should be replaced by ”tumor” so as not to scare people). We also want to believe anybody who gives us a hope of treatment by easy methods even if they are unscientific and irrational.
Let us look at the example of MrAgarwal (name changed), who had been having bleeding in his stools for the last 4 months. He had been to a doctor who advised him a colonoscopy, a test where a pipe with a camera at the tip, is inserted through the anus and examines the last one-meter of the foodpipe. He did not follow the advice, which he found too indignified. Instead he went to a local quack who advised him to take some pills. When he did not receive any benefit in the next two months, he underwent colonoscopy reluctantly. To his dismay, there was a tumor in his foodpipe a foot from his anus. He came to us and was promptly operated. The biopsy proved it to be an advanced tumor. Sadly, if he had been detected and operated earlier, he might have been cured.
Take the example of MrsJaiswal (name changed),who was suffering from jaundice for the past one month. She was investigated in our clinic and found to be having a pancreatic tumor. We put in a temporary pipe in her bile duct for temporary reduction of her jaundice and advised her for surgery 1 week later. When this was communicated to her and her family, they refused to believe it. They were made to believe that a herbal medicine could cure her in three months time. They were of the opinion that if that failed, then only they would subject her to undergo surgery. All our appeals for early surgery fell on deaf ears. When she was subjected to a CT scan three months later her tumor had spread to the liver. Nothing could be done to save her from the clutches of death 3 months later.
These are very common occurences in practice. The main reason behind this is fear. The fear of disease and death makes us irrational. The term “cancer” plays havoc in our minds. It spells doom. Nobody is ready to accept that it can happen to anyone. It is an unfortunate incident in anyone’s life. But isn’t the tsunami in Japan unfortunate too? Don’t we accept it? Turning away from the problem (any problem in life for that matter) does not make the problem disappear. It allows it to grow.
The other major fear is the fear of pain and discomfort from surgery, chemotherapy and radiotherapy. The last two decades have seen a mammoth progress in the field of cancer treatment. Many of the operations for tumors of the abdomen can be done by laparoscopy (operation through holes eliminating the need of cutting the abdomen). This means less pain, more comfort and early return to work. A good center would also provide pain specialists to minimize the pain in the postoperative period in case of open surgeries. The complication rates have been brought down largely with usage of modern technology. For instance, after excising the diseased segment of foodpipe, the joining of two ends can be done with staplers that reduce the incidence of wound infection. Modern gadgets to cut liver can reduce blood loss avoiding blood transfusion, a potentially hazardous affair.
A good counseling by your doctor is of immense importance. Ask your doctor regarding the disease, its prognosis, and treatment options. Learn more about the tumor to have a realistic expectation. Also, be aware of the treatment options and find out if your center has the facilities.
Knowledge and awareness of tumor treatment should bring a change in the way society looks at cancers, or should we say” tumors”. Accepting and facing it scientifically and staying away from the unscientific remedies are the first steps in the right direction.

Bariatric Surgery can help the Obese Infertile

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Infertility in females is a growing problem. Statistics show that one in six couples are infertile. Forty percent of the problem lies in the females. One of the major influence or contributor to this problem is obesity. If you look around or visit a fertility center, one would know that many of the patients are overweight or obese. It comes as no surprise as obesity is now fast becoming the number one problem in the world.
So why is obesity so important in fertility?
Body fat is nowadays considered an endocrine organ responsible for producing various hormones. Some of these hormones work like birth control pills. Hence the eggs production and release are impaired and results in infertility. This phenomenon is also seen in a condition called PCOD (polycystic ovarian disease), a major cause of infertility.
Another important and interesting observation seen in obese individuals is that some of the severely obese individuals are unable to perform a normal sexual act because of the sea of fat whichhides the external genitalia.
It is also evident from medical research that assisted reproduction (fertility treatment) is less likely to succeed in obese individuals.
So how does one help these infertile ladies with obesity?
Since obesity is the root cause of such infertility, it would be natural to consider that weight loss would logically improve the chances of fertility in these subjects. As a matter of fact this does happen in clinical practice. Medical literatures and researches are showing that weight loss is associated with improved chances of fertility either naturally or by assisted reproduction.
What is the role of Bariatric Surgery in infertility?
Weight loss achieved either by adoption of diet and lifestyle or by weight loss surgery (Bariatric Surgery) in cases of severe obesity have both shown favorable outcome. A new study of morbidly obese women suggests that Bariatric surgery may effectively treat one of the most common causes of infertility i.e. PCOD. It is noted that 50% of infertile women conceived within 2 years of their Bariatric surgery. Even the increased risk of miscarriage in obese women may decline after Bariatric surgery. Additionally, the risks of complications during pregnancy such as diabetes, hypertension are also diminished.

BLOOD IN STOOLS- KNOW THE FACTS

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It is interesting to ask ourselves that if the great Napolean did not have piles , would he have won more battles. Although it is difficult to answer this question but it is easy to address the more common queries that laymen have regarding piles. Let us see what science has to say regarding these.

Question 1.
Are all bleeding in stools due to piles?
No. Most bleeding in stools are due to piles but there are many other important cases of bleeding. Bleeding in stools can be due to anal fissure, dysentery, cancers, ulcerative colitis, etc.

Question 2.
When should I see a doctor?
If you have been bleeding for two to three times in a year and it is painless then you may not see a doctor. However if you bleed more, it is painful, there is associated alteration of bowel habits, stools are not yellow or if stool is mixed with blood then you definitely need to see a doctor. These symptoms mean that one may be harboring a bad disease requiring urgent attention. Colonoscopy (examination of the foodpipe through anus) would be mandatory in these cases. Many people deny themselves this test because they feel it is indignified. This is a grave mistake and must be avoided.

Question 3.
Would piles always require surgery?
It is possible to manage piles medically in most patients. Only in some cases when the bleeding is excessive, piles become painful, and the anus starts coming out (prolapse), it becomes necessary to operate.

Question 4.
Is piles surgery painful?
Traditional surgery for piles results in a painful wound at the anal opening necessitating daily dressings for weeks. This means increased hospital stay and delayed return to normal activities and work. This has become unacceptable in the modern world and leads patients to look for alternative treatments such as magic herbs, ointments, strange diets, etc. Look around and you will see excessive proliferation of these “piles shops” promising immediate cure. The sad part is common people usually fall prey to these false promises. Such unscientific remedies however do not give lasting benefits and leaves the patient frustrated in most instances.
Modern surgery for piles (stapler surgery) is a painless procedure where the patient can go home the same day. The patient can join work the very next day and can return to normal activities immediately.

Question 5?
If my bleeding in stools are due to cancer can I be cured and still pass my stools from my anus?
If the patient reports early, it is possible to cure cancers of foodpipe. It is also possible to preserve anus and do these surgery by laparoscopy in most cases in good centers.

What you need to know about Hernias?

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Hernias are bulges in the belly where intestines and abdominal fat come out under the skin through an abnormal opening. The abnormal opening may be a defect in a scar from a previous operation or a naturally present gap in the abdomen. Hence the common sites for hernias are the groin, navel or a previous operation site. A very common scenario is an elderly gentleman having a groin hernia or a middle-aged lady having hernia through a previous operative scar such as following a previous pelvic surgery.
Hernias may be totally innocent not causing any problems or may produce pain, ugly bulges or may at times be a source of great danger to health when their blood supply gets impaired.
A patient usually ignores an asymptomatic hernia in the hope that it will go away. Unfortunately this isn’t going to happen. An untreated hernia will increase in size over a period of time, during which it will also become more uncomfortable as well. A visit to the doctor makes it worse when he talks about surgery to correct the problem. Now imagine someone who has had a previous surgery and now has developed hernia through it. The thought of having to undergo one more cut in the belly is traumatic. As it is, the female patients are embarrassed to wear saris lest their scar should show. Surely, another scar is unacceptable. To add to it, the fear of recurrence (having a hernia again) is always there. Hence, it is understandable that many patients avoid surgery, the only cure for such a condition and fall prey to unscientific methods.
In recent years, laparoscopic repair of hernias has emerged as an increasingly popular option. The very concerns of the patients such as more scars, fear of pain and failure are addressed by this procedure. Laparoscopic repair of hernias are done by making small holes in the belly instead of a large incision. This makes the procedure painless, stitchless and bloodless. There is almost no chance of wound infections, something that is seen more commonly in conventional surgeries. It also allows the patient to go back home in 1-2 days and resume normal activities. This is unprecedented in conventional surgery where the patients are hospitalized for many days with usually a tube sticking out of the abdomen. And they are not allowed to return to normal activities for few weeks.
In the laparoscopic procedure, the mesh (an artificial sheet made of synthetic materials) is placed from inside the abdomen to reinforce the defect unlike what is done in open surgery where it is placed just below the skin (this leads to more discomfort). According to research, this is responsible for the decreased failure rates seen with this method.
In recent times lots of development has taken place in improving the quality of meshes and the way they are fixed. This makes it more comfortable for the patient.
However just like all good things in life, this method of treatment too does not come cheap. The mesh costs a lot of money. As does the fixation devices. But for patients who love their body and are conscious for the comfort and results, the expense is worth it.

Scarless Surgery for Gallbladder, Hernia, Appendix and Severe Obesity- Glimpse into the future or Reality

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Scars on the body make an ugly sight. Some do not mind, some may accept it but some just refuse to stomach it. Somewhere down the line each one of us would prefer to have a scarless body. I am sure everyone knows how acnes and their subsequent scars are a constant source of irritation to a teenager. Oh! How they would love to have a magic cure. Any cream, any pills are welcome. If you talk to them about cost , they would say “ forget cost”. Although our beauty conscious soul is most sensitive to our face, make no mistake, a metro sexual is almost equally concerned of not having scars anywhere in the body.
The popularity of Scarless Surgery is precisely riding on this sentiment. The industry is hoping that surgeons are going to learn this new novel technique. Surgeons of course are tired of coping with the rapid progress in surgery. As if laparoscopic surgery was not enough, there are scarless surgery and robotics at the horizon already. All this learning is a source of great stress to the surgeons. What is the incentive in learning this new science of scarless surgery? Cosmesis. The question is, is improved cosmesis enough of an incentive for surgeons to switch from laparoscopic surgery to scarless surgery, or will increased costs and complex training dampen enthusiasm? Is it worth to invest time, money and effort into this space? The answer is simple. In the end, many believe consumer demand will be the biggest market driver for scarless surgery—one that could eventually overcome any resistance by the physicians to the technique.
Numerous movies and television shows have glimpsed a future where surgeries are performed with a slender instrument, which is certainly not a scalpel. For example, fans of the original Star Trek series remember Leonard “Bones” McCoy, the resident starship physician who was able to perform a wide range of complicated procedures on patients while leaving no scars whatsoever. Although such a utopian vision of the future still exists only in the realm of science fiction, the concept of scarless surgery is no longer a mere fantasy but a reality, thanks to the rapidly advancing technology.

On a practical level, scarless surgery is now available for those who want it. It is possible to perform cholecystectomy, appendicectomy, hernia repair and bariatric surgery amongst a long list of procedures with this technique. The extra technology translates into extra cost but then when we want all the comfort for ourselves, cost becomes a very secondary issue.
Already awareness is building up regarding this technique thanks to our great friend called “Google”. Earlier we were providing the options to patients between laparoscopic surgery and scarless surgery mostly to the body-conscious people such as actors, models and even doctors. Nowadays many patients walk in the clinic to enquire and even order regarding the procedure. We understand that more than anything this consumer demand is going to push the horizon of this Scarless Surgery even further. The patient ultimately has everything to gain.

Welcome to Digestive Surgery Clinic, Kolkata

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DSC (Digestive Surgery Clinic) is a body of dedicated doctors, who are passionate in the field of gastrointestinal surgery. More than sixty percent of the diseases in the human body originate from the gut, some of which require medical or endoscopic treatment and some necessitating surgery. Yet there are few centers in the country that provide comprehensive medical, endoscopic and surgical treatment of gastrointestinal diseases. With this in mind, this Clinic has been established to provide excellence in the field of care for gastrointestinal diseases.
The Clinic provides safe, ethical and rational treatment based on evidence and sound scientific principles. To ensure the same, there is a body of committed doctors, nurses, paramedical staff, stoma nurse and secretarial services.
For those who require surgery, open or laparoscopic, a lot of stress has been put on safety and comfort of the patient. To achieve this, we have well trained surgeons, an excellent infrastructure with modern technology, dedicated paramedics and reliable ancillary departments (pathology, radiology, intensive care, etc.).
With GI surgery advancing at a rapid pace, we make all efforts to be updated and with the times. We have done all advanced and complex procedures laparoscopically safely. Our series of more than five thousand laparoscopic cholecystectomy (removal of gall bladder) has a complication rate of less than 0.1%, an enviable feat in itself.
Resections of GI cancers is our specialty. Standard procedures are followed and safety kept as priority. Technically challenging procedures like Whipples operation, considered to be one of the most formidable surgeries is done now as a routine with low complication rates. Some cancers like those of stomach, colon and rectum are resected laparoscopically, probably the only center in Eastern India to do so.
Surgery for obesity and diabetes (bariatric surgery) is done in our center regularly.
We realize that surgery causes a lot of stress for the patients and their relatives; hence every care is taken to create an environment thatis friendly and caring.
Communication regarding the disease and treatment is maintained in a dynamic way to have a clear expectation of treatment outcome.
We at DSC understand that excellence is a dynamic process and so is its achievement. With us we expect you to expect a lot from us. We at DSC promise to deliver.