A bariatric surgical procedure results in weight loss by making changes to an individual’s digestive system. Such a procedure restricts the amount of food held by the stomach, causing malabsorption of nutrients. Often, these surgeries also cause hormonal changes in the individual. Typically, this surgery is performed when diet and exercise have failed to yield results or when obesity poses serious health problems.
As opposed to dietary weight loss plans which can often lead to regaining weight, bariatric surgery affects hormone production such that long-term and sustainable weight loss is achieved.
What is bariatric surgery?
Bariatric surgery is a term used to refer collectively to several types of weight loss surgeries that either limit the amount of food intake or reduce the body’s ability to absorb nutrients, or both.
This type of surgery is performed to help lose excess weight and reduce the risk of life-threatening conditions such as high blood pressure, heart disease, diabetes, etc. Typically, this surgery is done only after an individual has tried to lose weight through diet and exercise.
Generally, bariatric surgery is an option for obese individuals with a body mass index (BMI) of higher than 40 or those that have serious weight-related health problems. However, bariatric surgery isn’t meant for everyone who is overweight. You must meet certain medical guidelines to qualify for the surgery. Additionally, you may be asked to participate in long-term follow-up programs that involve the monitoring of nutrition, lifestyle, and medical conditions.
Types of bariatric surgery
The following are some of the most common types of bariatric surgery –
- Roux-en-Y Gastric Bypass: This is an irreversible surgery that works by decreasing the amount of food intake by the stomach and the absorption of nutrients in the body. In this procedure, the surgeon cuts a part from the top of the stomach, making a sealed off pouch that can hold just about an ounce of food. This pouch is then sewn directly into the small intestine. Food, once swallowed, passes from the small pouch to the small intestine, bypassing the rest of the stomach.
- Sleeve Gastrectomy: In this procedure, multiple incisions are made on the upper stomach, thus effectively reducing 80% of the entire stomach. A long, tube-shaped pouch is left behind, which doesn’t hold much food. Additionally, hormonal changes are also induced that further aid weight loss by reducing appetite.
- Biliopancreatic Diversion with Duodenal Switch: In this two-part and less common surgery, a procedure similar to a sleeve gastrectomy is performed first. Then, the end portion of the intestine is connected to the duodenum, bypassing the majority of the intestine. This procedure both limits food intake and reduces nutrient absorption. While it is very effective, it has greater risks such as malnutrition and vitamin deficiencies. Thus, it is typically recommended to individuals with a BMI of more than 50.
The best weight-loss surgery for you will depend on many factors – dietary habits, BMI, health issues, and the risks involved in each procedure.
How bariatric surgery results in weight loss
To put it simply, bariatric surgery causes weight loss in two primary ways –
- Restriction – Physically limiting the amount of food the stomach can hold
- Malabsorption – Bypassing or shortening part of the small intestine to reduce the body’s calorie and nutrient absorption
Combined with a comprehensive treatment plan, this procedure can be an excellent tool to facilitate long-term weight loss and boost the patient’s health. Moreover, bariatric surgery has been proven to help improve many obesity-related conditions such as type 2 diabetes, cardiovascular conditions, high blood pressure, etc.
Bariatric surgery works by changing the anatomy of the gastrointestinal tract – the stomach and digestive system – and/or causing different hormonal changes in the body. By changing the anatomy, bariatric procedures modify the production of some intestinal hormones such that and appetite is reduced and the patient experiences a feeling of “fullness” with less food intake.
When significant weight loss occurs, other changes in the body take effect, that further reduce defects in fat metabolism. The patient is likely to find themselves engaging in more physical activity, which improves the body’s ability to burn fat. Massive weight loss also reduces hormones such as insulin and cortisol, reducing the uptake and storage of fat in the body.
In addition to improvements in health, surgical weight-loss improves an individual’s quality of life by positively affecting self-esteem, mobility, social interactions, psychological conditions, and sexual functions. Thus, bariatric surgery can prove to be a useful tool to break the vicious cycle of weight gain and achieve long-term weight loss.
What to expect after bariatric surgery
After bariatric surgery, patients are typically not allowed to eat for a couple of days to allow the digestive system time to heal. After this, they are put on a specific (mostly liquid and puree) diet for some weeks. Patients must also get frequent medical checkups to monitor their health in the initial months.
For patients with a brain tumour, a surgery is one of the most common treatments. Depending on the size and position of a tumour, the operation is performed by highly specialised surgeons. When a tumour is in a place that is difficult to reach or if the risk of damaging the vital parts of the brain is high with a surgery, the tumour is called inoperable. In such an event, the doctor will recommend other treatments.
What is a surgery for brain tumour?
A surgery is the process of removing a tumour and its surrounding tissue. Especially for low-grade brain tumours and those that can be removed without causing damage, this is the only treatment required. Performed by a neurosurgeon, a brain tumour surgery can help in improving neurological symptoms, improve the patient’s prognosis, and provide tissue for diagnosis.
Different types of surgeries and techniques are practised. A patient’s individual circumstances and history will determine the kind of approach taken by doctors.
When is a surgery done?
A brain surgery is performed for the following reasons -:
- To remove the entire tumour
- To remove some part of the tumour, as much is safe, to slow its growth
- In assistance with other treatments like chemotherapy
- To take a sample of the tumour for accurate diagnosis of its type
Many non-cancerous tumours are treated only with surgery. However, the majority of cancerous ones will require treatment in addition to the surgery, such as chemotherapy, radiation therapy, etc.
While a brain surgery is a serious procedure, it is quite safe, and is only carried out by highly skilled doctors. Even if the entire tumour cannot be removed, the neurosurgeon will try to remove as much as possible to slow its growth and curtail symptoms.
Types of surgery
There are two primary types of brain tumour surgery – Craniotomy and Neuroendoscopy.
Craniotomy (Open Brain Surgery)
This is the most common type of brain tumour surgery, where the patient is given a general anaesthetic and is asleep. In this procedure, the neurosurgeon cuts out some area of bone from the skull, using the opening to operate on the brain. In preparation for the surgery, a portion of the scalp is typically shaved. When the outermost layer of the brain tissue is exposed, the tumour is located and removed. Then, the scalp is stitched back shut. Since a part of the cranium is removed, this surgery is called craniotomy.
Neuroendoscopy (Keyhole Brain Surgery)
In a neuroendoscopy, all or part of a tumour in the fluid-filled areas of the brain is removed. The procedure uses an endoscope, an instrument shaped like a long tube that has a camera attached to a monitor and an eyepiece. A small hole is made into the skull, through which the endoscope is inserted. With the eyepiece, the surgeon can see what lies at the tip of the endoscope. There are tiny forceps and scissors at the end, using which the surgeon removes the tumour.
Can complications develop?
Brain surgery, much like any other invasive procedure, comes with a few risks despite the advances medical science has made in safety and precision. Some complications that can arise after a surgery are –
- Bleeding in the brain region
- Allergic reactions
- Blood clots
- Swelling due to trauma or fluid build-up
- Infection that can cause swelling
- Impairment of bodily functions
Preparing for a brain surgery
Before an actual surgery is carried out, doctors perform a series of assessments to test the patient’s suitability and fitness for a brain surgery. Several tests are done – blood tests to check for hormonal imbalance, an electro echocardiogram to check heart function, X-rays, MRI scans, etc. Typically, these assessments happen over 1-3 weeks before the surgery. Only after this happens do doctors decide which procedure is most suitable for the patient.
Doctors will also discuss drug and food allergies to decide the diet and post-operative medication. During such consultations, the patient’s medical history and family history are taken into account.
Some patients are also prescribed steroids before the surgery to help reduce the swelling caused by the tumour.
Recovering from brain surgery
Recovery from a brain surgery can take a couple of months, sometimes even more. The team performing the surgery typically creates a recovery plan. Usually, after the procedure, a patient is kept in the hospital for a few days, during which doctors monitor overall patient health and risk of complications.
Some patients have drips and tubes in place when they wake up; these are for providing fluid and drugs to the body, or draining them out. Some patients have a headache on waking up from the operation, which is treatable with painkillers.
After a surgery, some lifestyle changes are in order – less stress, reducing alcohol intake, frequent check-ups to monitor symptoms, etc. Because brain surgery causes exhaustion in the patient, it is crucial for the body to get adequate rest.
It is a universally acknowledged fact that “Prevention is better than cure”. It’s an adage going around from time immemorial and there won’t be one doctor that would argue against this.
A preventive health check-up is of utmost importance for maintaining good health. Especially in a post COVID-19 world where health check-ups will be paramount for every country and citizen.
Regular health check-ups should be part of one’s fitness routine. It helps you keep track of your health and fitness. It is important for people who have a weak immune system or those who have a lifestyle that makes you prone to health risks.
As a new-born, your parents would probably rush down to the doctor even with the slightest cold, right? That is because babies have weak immune systems and as we grow old, our immune systems also grow weaker. That is why these health check-ups can be handy and give a good insight about our health.
The pros of health check-ups
It is important for us to keep track of our health to lead a healthy and happy life.
Regular health check-ups can benefit us in the long run in various aspects of our lives. For example:
- Medical Expenditure:
Medical bills can eat up your life savings to say the least. Regular health check-ups can help you save in the long run as regular health screening and tests can prevent you from an expensive surgery or therapy later. These screenings are far more cost-effective as hospital medical bills. Yes, there is health insurance, but those also come with plenty of terms and conditions.
- Helps in early detection of diseases:
Preventive health check-ups enable you to catch the disease in its primary stage. For example, a cancer or tumour is curable in the early stages. These can help your doctor to prepare a proactive approach rather than a reactive plan to your diagnosis. These tests are also done on the basis of gender, age, family history and lifestyle choices. These results can show your doctor as to hoe prone are you to certain diseases and how to take corrective measures at the earliest.
Regular blood tests:
Regular blood tests can help you keep track of various infections in your blood like HIV/AIDS, diabetes, cholesterol, coronary artery disease, cancer, high blood pressure, anaemia and cancer. It also helps in monitoring your organs like liver, kidney, heart and the thyroid gland. Based on the status of your reports, the doctor can prescribe you certain medications in order for your body to fight the disease.
Helps in identification of stress related diseases/illness:
In today’s fast-moving world people often forget to take care of their mental health which has led to an increase in the number of stress and anxiety related diseases. Some of the physical and psychological illnesses, which are directly related to anxiety are high blood pressure, hypertension, mental disorders, depression, Alzheimer’s, asthma and gastrointestinal diseases.
- Keeps you up to date with your body:
The reports of these screening will keep your doctor aware of your body’s health and needs. The doctor will act and guide you accordingly.
Some essential tests and screenings include:-
- High blood pressure
- Body Mass Index
- Breast and cervical cancer early detection for women
- Prostate cancer for men
- Dental check ups for adults
- Skin cancer
- Viral hepatitis
- Sexually transmitted disease screening for adults
- Colon cancer screening
- Lung cancer for people who live in polluted areas or smoke
- Immunization schedules for both children and adults.
How often do we need a health check-up?
The need for routine check-ups depends mostly on people’s age and in some cases their lifestyle in general.
For healthy people under 30: once every two years is sufficient. A healthy person indicates a non-smoker and a person who does not suffer from any major disease. Their BMI should be between 18.5 to 24.9.
If you are between 30-50 years and smoke, drink and are overweight, you should opt for a complete screening every year. If not, then once every 2 years is okay.
People over 50 years of age should consider a routine health check up every year or every six months as they are more prone to various health risks.
Accidents and trauma on the rise
Trauma has been a leading cause of death and deficits throughout the world in almost all age groups. WHO (World Health Organization) has declared 2011-2020, the Decade of Action for Road Safety. The aim of this step is to reduce the number of deaths caused by road accidents. Road accidents can lead to permanent injuries, disability or psychological trauma to the patient. That is why, it is important that the victim or victims get all the psychological, physical, financial and legal assistance they need.
Road traffic injuries kill more than 1.5 million people every year. It is also the number one cause of death among 15 to 29 year olds. In non-fatal cases, the victims are often left permanently incapacitated, which causes a huge financial burden on the victim’s family.
Among the five pillars of the Action for Road Safety agenda, the fifth pillar focuses on elements of post-crash response. From properly trained medical responders to providing psychological and legal support to the families.
The golden hour of trauma
In many countries including India, the golden hour is the most important hour for a trauma patient. It is described as the first hour after the event of a trauma. During this period if timely first aid is offered; the life expectancy can increase by a significant percentage. Prompt action can reduce the severity of injuries. It is a commonly accepted that blood loss is the leading cause of death for accident victims. That is actually a myth. It is actually the loss of oxygen supply that puts the patient at more risk.
What is trauma care?
Trauma care demands provisions for appropriate medical equipment and personnel to deal with road accident victims. It is an organised and coordinated effort to deliver a full spectrum of care to an injured person. From injury through transport and post-hospital care, this system consists of three major steps, which are:
- Pre- hospital
- Acute care and
Pre-hospital care includes quick assessment of the person’s injury and triage by medically approved protocols. Acute care deals with diagnosing and treating the injuries at a deeper level. The key however lies in taking the injured person to a dedicated trauma centre approved by the government healthcare department. Doing so will give the person the best possible prognosis. Rehabilitation includes physical therapy and providing them with professionals who will help them settle back into their pre-accident life as comfortably as possible.
What to do in case you witness an accident?
- The first and foremost step should be contacting the emergency services as soon as possible if you have just witnessed an accident.
- As soon as you have contacted the EMS, it is important for you to remain calm so that you can help the crash victims.
- If the person involved in the crash is responsive, make sure you help them keep calm and check for ventilation. Make sure they are breathing and frequently check their pulse till the professionals arrive.
- Remember that only a few things can be fixed on the scene, the rest needs a trauma centre. Interventions on the scene include a quick head to toe exam for penetrating injuries, checking for proper ventilation and controlling excessive external bleeding. Unless the person is trapped under the crash debris, most of these exams are done on the way to the centre.
- Apply pressure to stop external bleeding. External hemorrhage is controlled by applying pressure to the wound with a dressing. Hold the dressing firmly on the wounded blood vessel/injury.
The needs of an injured person are divided into three broad aspects by the WHO guidelines as:
- Life threatening injuries should be treated promptly in order to maximize the likelihood of survival.
- Disabling injuries should be treated appropriately so as to minimize functional impairment.
- Pain and psychological suffering are minimized.
Special considerations for children:
- For airway management the paramedics should be equipped with paediatric sizes for nasal and oral cannulas as well as they should know the difference between the anatomy of an adult to that of a child.
- Management of shock needs proper knowledge in baseline vital for different ages and varying physiological signs of blood loss and shock. The paediatric doses for baseline fluids for treatment of shock.
- In case of spinal injuries, the personnel should be well versed with varying anatomy of a child’s spine. C-collars in paediatric sizes should be at hand ready for use.
- For burns the percentage of body surface area affected should be taken in consideration and should be closely monitored.
- Pain medication should be well monitored by the paediatrician to ensure proper administration of the medicines and its side effects.
- For rehabilitation in children, the physical therapist should ensure milestones are met as closely as despite the impairment.
Trauma care is a matter of life and death. Knowing the basics of trauma care management and emergency response can help save lives.