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PCOS with obesity

Infertility has become a bane of modern living and PCOS is one of the major causes of infertility.

Polycystic Ovarian Syndrome commonly called PCOS condition is a very common endocrine condition in reproductive-aged women often leading to difficulty in conceiving. Women diagnosed with PCOS can experience irregular periods, abnormal hair growth, acne, and can have ovaries containing multiple small cysts.

PCOS has a negative effect on fertility since such women are not able to ovulate or release an egg, each month due to an overproduction of estrogen. This subsequently leads to irregular periods and increased levels of hormones such as testosterone that can affect oocyte quality, inhibit ovulation, lead to insulin resistance, and increase the risk disorders such as gestational diabetes.

The relation between PCOS and obesity can be termed as complicated. Signs and symptoms of PCOS begin for some females soon after they start having periods. Women with PCOS produce too much insulin, or the insulin they produce does not function normally which leads to weight gain. Women diagnosed with PCOS may also find it difficult to lose weight. For some others substantial weight gain is followed by PCOS. However, it is certain that women suffering from obesity have a greater risk for PCOS and women with PCOS have a greater risk for obesity.

Many PCOS women with obesity may also develop coronary artery disease and glucose abnormalities at a very young age. Bariatric surgery can be a significant procedure to fight against all these abnormalities and a solution for all such irregularities. According to a study, in the state of Gujarat itself 18% females and 14 % of Males are over-weight.

If the prevailing PCOS condition is due to obesity, the chances of cure are almost close to 100% particularly young females with such condition. There are few types of surgeries and procedures for such condition, but your surgeon will likely have a recommendation as to which will be most effective for PCOS. The proven methods are Laparoscopic Sleeve Gastrectomy (LSG) and Endoscopic Sleeve Gastroplasty (ESG).

The Laparoscopic Sleeve Gastrectomy (LSG) generates weight loss solely through gastric restriction (reduced stomach volume). In LSG approximately 2/3rd of the stomach is stapled off roughly the size and shape of a Banana or Sleeve. This operation does not involve any ‘rerouting’ or reconnecting of the intestines. Hence it is technically as simpler operation than the gastric bypass.

Endoscopic Sleeve Gastroplasty (ESG) is one of the latest advancements in Medical Science. Endoscopic Bariatric Procedure does not require any hole or incision to put on any part of the body but a special Endoscopic instrument is inserted through an oral route to reach the stomach. Then the size of the stomach is reduced using stitches. On the same day after 4-6 hours of the procedure, a patient can go home. Moreover, as the procedure involves zero blood-loss, there is no need for blood transfusion and chances of infections are also almost nil.


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Written By : Dr. Apurva Vyas

Obesity surgery for diabetes

Diabetes is one of the most common medical conditions which affect more than 150 million people worldwide. Owing to the dynamic lifestyles of people nowadays, at least 90% of the people have Diabetes type 2 which is related to Obesity, overweight, family history, insufficient physical activity or old age.

Obesity is a medical condition that is related to diabetes and occurs when a person carries excess weight or body fat, so as affecting the person’s health. A medical expert would say a person with high Body Mass Index is Obese.

Types of Diabetes:

  1. Diabetes Type 1- it is believed to be an autoimmune condition.
  2. Diabetes Type 2- your body can’t use insulin efficiently.
  3. Gestational- occurs only during pregnancy

Generally, metformin is the medication prescribed for type 2 diabetes. It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively.

The most common amongst all is diabetes type 2. Risk factors for type 2 diabetes include:

  • having a sedentary lifestyle
  • being overweight
  • having had gestational diabetes or prediabetes

Although diabetes is traditionally viewed as a chronic, relentless disease in which delay of end-organ complications is the major treatment goal, bariatric surgery offers a novel endpoint: major improvement or even complete disease remission. For obesity, it is one of the most popular and safe methods. Evidence suggests that bariatric or metabolic surgery for obesity may lower death rates for severely obese patients, especially when coupled with healthy eating and lifestyle changes after surgery.

Though bariatric surgery for obesity or weight loss surgery includes a variety of procedures performed on people who are obese, the basic principle of weight loss is achieved by the following methods:

  1. Sleeve Gastrectomy: Reducing the size of the stomach through removal of a portion of the stomach. This approach resulted in reduced surgical morbidity and mortality compared with the traditional one-stage approach highly obese patients. Unexpectedly, patients achieved remarkable weight loss after the first stage and SG.
  2. RYGBP: This is the most common amongst all. By resecting and re-routing the small intestines to a small stomach pouch. After RYGBP, ingested food bypasses most of the stomach and the first part of the small intestine. (gastric bypass surgery)
  3. Restricting food intake and decreasing the absorption of food in the stomach and intestines.

Results:

  • Average 77 % of excess body weight is lost in one year after surgery
  • A study shows that after 10 to 14 years, patients have maintained 60 % of excess body weight loss. A study of 500 patients showed that 96 % of physical problems were improved and resolved in some cases which mainly includes back pain, sleep apnea, high blood pressure, type 2 diabetes and depression.
  • In most cases, patients report an early sense of fullness even by taking little food so that there will be no desire to take more food

Bariatric surgery can help in prevention of diabetes and helps weight loss through gastric bypass in obese patients. Also, non-diabetic patients can decrease their likelihood of developing diabetes by 60 percent.

One long-term study tracked 400 people with type 2 diabetes. Six years after bariatric surgery, 62% showed no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels.

In a recent study, over 20,000 patients were examined. It revealed that 84% who underwent obesity surgery for diabetes experienced complete reversal of their type 2 diabetes.

Rapid improvement in blood sugars and reduction or elimination of diabetic medications is often seen within the immediate period following bariatric surgery for diabetes type 2.

 

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Sleep Apnea

Have you ever heard about the medical term called “Sleep Apnea”? If not, you should. Now, why you should know all about Sleep Apnea because there are certain signs that you might come across in your daily routine during the morning or a whole day and in the absence of the awareness about the disease, you may overlook the signs or symptoms which can become life-threatening if not attended and treated in time.

So, let’s begin to learn something about the disease and throw lights on the symptoms, causes, precautions, treatment and care.

Let’s first look at to the common symptoms of Sleep Apnea disease

  • Loud snoring
  • Episodes in which you stop breathing during sleep — which would be reported by another person
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • A morning headache
  • Difficulty staying asleep (insomnia)
  • Excessive daytime sleepiness (hypersomnia)
  • Difficulty paying attention while awake
  • Irritability

The majority of the above symptoms suggest that you might have Sleep Apnea and you should seek the advice of your Doctor and rule out the disease as this will help you out to avoid the risk of heart problems and other associated complications.

There are three types of Sleep Apnea classified following the symptoms and health condition of a person.

  • Obstructive sleep apnea, the more common form that occurs when throat muscles relax
  • Central sleep apnea, which occurs when your brain doesn’t send proper signals to the muscles that control breathing
  • Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea

Now, let’s bring more understanding to the common cause Obstructive sleep apnea.

While you sleep, the muscles in the back of your throat relax and results in narrowing the airway you breathe in from. In this condition, you cannot get enough air and subsequently it lowers the level of oxygen in your blood. Your brain senses this inability to breathe and rouses you from sleep to reopen your airway. Generally, you don’t remember it at all during the night. However, the deprived sleep symptoms come out during the daytime. Along with a morning headache and irritability, there are incidences reported of road accidents where such person slept during driving.

Now, after knowing all above, it is mandatory for you to know the risk factors which are responsible for the disease called Sleep Apnea. Apart from Nasal congestion, smoking, use of alcohol or sedatives, or family history, there is a common risk factor ‘excess of weight’ is becoming the lead risk factor nowadays.

More than half of people with obstructive sleep apnea are either overweight or obese, which is defined as a body mass index (BMI) of 25-29.9 or 30.0 or above. Each unit increase in BMI is associated with a 14% increased risk of developing sleep apnea, and a 10% weight gain increases the odds of developing moderate or severe obstructive sleep apnea by six times. Compared to normal-weight adults, those who are obese have a sevenfold increased risk of developing obstructive sleep apnea. However, the impact of BMI on obstructive sleep apnea becomes less significant after age 60.

BMI isn’t the sole marker of obesity that’s important. Men with a neck circumference above 17 inches (43 centimetres) and women with a neck circumference above 15 inches (38 centimetres) also have a significantly increased risk of developing obstructive sleep apnea.

So going by the above information, if you know that you are at risk of sleep apnea, immediately consult your doctor. Depending upon the stage, condition and type of sleep apnea, your doctor may suggest lifestyle changes if it is mild or may recommend you the proper therapy or treatment if above mild or severe. Even in the worst cases, your doctor may suggest you to go for Surgery to remove enlarged tonsils or adenoids or weight-loss (Bariatric) Surgery also.

 

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Endoscopic Sleeve Gastroplasty

Endoscopic sleeve gastroplasty is a newer type of weight-loss procedure. Endoscopic sleeve gastroplasty reduces the size of your stomach using an endoscopic suturing device without the need for surgery. This procedure may be an option if you’re significantly overweight — a body mass index of 30 or more — and diet and exercise haven’t worked for you.

Endoscopic sleeve gastroplasty leads to significant weight loss. It helps you lose weight by limiting how much you can eat And the procedure is minimally invasive, reducing the risk of operative complications.

Like other weight-loss procedures, endoscopic sleeve gastroplasty requires the commitment to a healthier lifestyle. You need to make permanent healthy changes to your diet and get regular exercise to help ensure the long-term success of endoscopic sleeve gastroplasty.

Why it’s done

Endoscopic sleeve gastroplasty is performed to help you lose weight and potentially lower your risk of serious weight-related health problems, including:

  • Gastroesophageal reflux disease
  • Heart disease and stroke
  • High blood pressure
  • Sleep apnea
  • Type 2 diabetes

Endoscopic sleeve gastroplasty and other weight-loss procedures or surgeries are typically done only after you’ve tried to lose weight by improving your diet and exercise habits. Endoscopic sleeve gastroplasty is less invasive than other forms of bariatric surgery.

Who it’s for

Endoscopic sleeve gastroplasty is often an option for people who aren’t candidates for other bariatric surgeries. The procedure is available to people whose body mass index (BMI) is above 29 who haven’t been successful maintaining weight loss with other methods.

Results

Endoscopic sleeve gastroplasty can lead to significant weight loss. The amount of weight you lose also depends on how much you can change your lifestyle habits.

When weight-loss surgery doesn’t work

It’s possible to not lose enough weight or to regain weight after any type of weight-loss procedure, even if the procedure itself works correctly. This weight gain can happen if you don’t follow the recommended lifestyle changes. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise.

 

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The Diverse Categories of Bariatric Surgery

Written By : Dr. Apurva Vyas

Bariatric Surgery

Overeating is a kind of addiction which is similar to smoking or alcoholism being a thorny psychological habit to shatter. The weight loss accomplishment after Bariatric Surgery may appeal the patients to gradually pamper in overeating, making them consider that a small further portion of an ice cream or a bar of chocolate is not going to effect after the surgery. However, it does matter in both longer and shorter run.

So, patients even themselves have to play a vital role in getting better on their eating and food habits after the surgery to keep hold of their preliminary success for a lifetime after the surgery.

Here are some of the top tips when followed on a daily basis, will lend a hand to you for avoiding weight regain even after a long time of surgery.

      1. Take smaller food bites

After your operation, when your stomach space has been surgically made compact to put a ceiling on overeating, a few bites of the healthy part of food will fill you up. So take bites as smaller as possible.

      2. Eat gradually

You need to take time to chew and get pleasure from food. This is applicable to each and every person being operated or not.

      3. Don’t drink while you are eating

It is better not to take drinks with food no matter which meals you take. Having a glass of water previous to an hour of your meal is good for health. You can take another glass after an hour of your food.

      4. Use a smaller food plate

You need to use plates that hold less amount of food which is a good way to avoid subliminal overeating routine from taking over devoid of your sense.

     5. Order less food in restaurants

You should order a lesser amount of food when you go to restaurants, order little portions or from the children menu as the fewer food you order, the fewer food you are liable to eat.

    6. Stop eating when you feel occupied

While eating food even if you have just one bite left out in your plate, don’t eat it as your body is not a waste bin. It is like a temple that you require to take care of else you would need to face the consequences. So admire contentment signals from your stomach and not give in to the childhood sessions of “clean your entire plate” as advised from the elders.

Conclusion

At Radiance Hospital, we have operated and cured thousands of patients with Bariatric Surgery and we make possible India’s prevalent active post surgery support groups. A big percentage of our patients fruitfully maintain weight-loss even subsequent to years of surgery following suggested healthy lifestyle and diet plans from our medical experts. Also, our lifetime follows up programs are open to all our patients and those treated by other doctors or surgeons.

For more information about our post bariatric surgery diet, you can any time contact us and set up a swift appointment with our trained dieticians or be present at one of our support group discussions or meetings.

Written By : Dr. Apurva Vyas