Tricks to manage pain

Rhythmically tapping a part of the body that is away from the area of the pain confuses the brain.

There is a myth that we use only 10 per cent of our brain, but actually we use most of our brain almost all the time. It functions tirelessly, 24 hours a day, whether we are awake or asleep. It performs complicated sequential actions, some physical (those performed by an expert juggler), some mental (complex mathematics) and coordinates thinking and movement. All activities, conscious and subconscious, performed by humans are under the centralised control of the brain.

With advancing age, brain cells die, leading to loss of function, physical prowess and memory. The good news is that neurogenesis — the formation of new neurons — also occurs. It occurs naturally rapidly in children but reduces in adult life.

It really slows down in older people unless active efforts are made to form and maintain new connections. This can be done by learning new skills — such as dancing, a different language or a musical instrument.

Adults tend to accelerate the rate of destruction of brain cells with inappropriate lifestyle habits such as smoking, uncontrolled diabetes or hypertension, or working with volatile aromatic compounds such as glue. Of all the lifestyle poisons, controlled alcohol consumption — not more than one “small” drink a day for women and two for men — is the least harmful.

Incidentally, it is possible to control some subconscious brain functions, such as the perception of pain, by tricking the neurons. All of us feel pain at some point of time. If it is an episode of acute pain, it can be tackled with medication but chronic pain is a different story. Arthritis and other painful diseases can take over our lives, preventing efficient functioning. Although pain arises in specific areas of the body, it is processed and felt in the brain. And it is possible to trick the brain into thinking that the pain has disappeared or lessened.

Here’s how:

Apply ice for 5-10 minutes to the area of pain. Then rhythmically tap a part of the body that is on the side opposite or away from the area of the pain. The conflicting signals confuse the brain and there is an “override”. The pain reduces in intensity. The dose of painkillers can also gradually be reduced.

Listening to music lessens the perception of pain as the auditory sensory signals override that generated by the pain. Meditation and repeating mantras also helps.

People sometimes have an uncontrollable itch in a part of the body. If there is no discolouration or swelling, it may be a kind of neurogenic itch . That too responds to ice packs, followed by rubbing the opposite side of the body. This manoeuvre is even more efficient if it is done seated in front of a mirror.

Insomnia — the inability to fall asleep and stay asleep — is the plague of the 21st century. It aggravates a plethora of diseases, such as diabetes and hypertension, and contributes to weight gain. In addition to exercising in the evening (only until 7pm), going to bed at the same time every day in a darkened room with no plugged-in electronic devices and drinking a glass of warm milk before bed, you could try the 4-7-8 method.

Place the tip of the tongue behind the two front teeth, exhale completely through the mouth while making a sound for a count of eight. Inhale through the nose for a count of four and then hold your breath for a count of seven.Repeat three times. This works miracles, without the aid of addictive sleeping medication. Sweet dreams!

Sources: The Telegraph (Kolkata India)

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Neuroblastoma

Description:
Neuroblastoma is a cancer that develops from immature nerve cells found in several areas of the body.

Neuroblastoma most commonly arises in and around the adrenal glands, which have similar origins to nerve cells and sit atop the kidneys. However, neuroblastoma can also develop in other areas of the abdomen and in the chest, neck and near the spine, where groups of nerve cells exist.

Neuroblastoma most commonly affects children age 5 or younger, though it may rarely occur in older children.

Some forms of neuroblastoma go away on their own, while others may require multiple treatments. Your child’s neuroblastoma treatment options will depend on several factors.

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Symptoms:

Signs and symptoms of neuroblastoma vary depending on what part of the body is affected.

Neuroblastoma in the abdomen — the most common form — may cause signs and symptoms such as:

  • Abdominal pain
  • A mass under the skin that isn’t tender when touched
  • Changes in bowel habits, such as diarrhea or constipation

Neuroblastoma in the chest may cause signs and symptoms such as:

  • Wheezing
  • Chest pain
  • Changes to the eyes, including drooping eyelids and unequal pupil size

Other signs and symptoms that may indicate neuroblastoma include:

  • Lumps of tissue under the skin
  • Eyeballs that seem to protrude from the sockets (proptosis)
  • Dark circles, similar to bruises, around the eyes
  • Back pain
  • Fever
  • Unexplained weight loss
  • Bone pain

Causes:
The cause of neuroblastoma is not well understood. The great majority of cases are sporadic and nonfamilial. About 1–2% of cases run in families and have been linked to specific gene mutations.

Occasionally, neuroblastoma may be due to a mutation inherited from a person’s parents. Environmental factors have not been found to be involved. Diagnosis is based on a tissue biopsy. Occasionally it may be found in a baby by ultrasound during pregnancy. At diagnosis, the cancer has usually already spread. The cancer is divided into low-, intermediate-, and high-risk groups based on a child’s age, cancer stage, and what the cancer looks like.

Cancer cells grow and multiply out of control. The accumulating abnormal cells form a mass (tumor).

Neuroblastoma begins in neuroblasts — immature nerve cells that a fetus makes as part of its development process.

As the fetus matures, neuroblasts eventually turn into nerve cells and fibers and the cells that make up the adrenal glands. Most neuroblasts mature by birth, though a small number of immature neuroblasts can be found in newborns. In most cases, these neuroblasts mature or disappear. Others, however, form a tumor — a neuroblastoma.

It isn’t clear what causes the initial genetic mutation that leads to neuroblastoma.

Risk factors:

Children with a family history of neuroblastoma may be more likely to develop the disease. Yet, familial neuroblastoma is thought to comprise a very small number of neuroblastoma cases. In most cases of neuroblastoma, a cause is never identified.

Diagnosis:

Tests and procedures used to diagnose neuroblastoma include:

Physical exam. Your child’s doctor conducts a physical exam to check out any signs and symptoms. The doctor will ask you questions about your child’s habits and behaviors.

  • Urine and blood tests. These may indicate the cause of any signs and symptoms your child is experiencing. Urine tests may be used to check for high levels of certain chemicals that result from the neuroblastoma cells producing excess catecholamines.
  • Imaging tests. Imaging tests may reveal a mass that can indicate a tumor. Imaging tests may include an X-ray, ultrasound, computerized tomography (CT) scan, metaiodobenzylguanidine (MIBG) scan and magnetic resonance imaging (MRI), among others.
  • Removing a sample of tissue for testing. If a mass is found, your child’s doctor may want to remove a sample of the tissue for laboratory testing (biopsy). Specialized tests on the tissue sample can reveal what types of cells are involved in the tumor and specific genetic characteristics of the cancer cells. This information helps your child’s doctor devise an individualized treatment plan.
  • Removing a sample of bone marrow for testing. Your child may also undergo bone marrow biopsy and bone marrow aspiration procedures to see if neuroblastoma has spread to the bone marrow — the spongy material inside the largest bones where blood cells are formed. In order to remove bone marrow for testing, a needle is inserted into your child’s hipbone or lower back to draw out the marrow.

Staging:

Once neuroblastoma is diagnosed, your child’s doctor may order further testing to determine the extent of the cancer and whether it has spread to distant organs — a process called staging. Knowing the cancer’s stage helps the doctor decide what treatment is most appropriate.

Imaging tests used to stage cancer include X-rays, bone scans, and CT, MRI and MIBG scans, among others.

The stages of neuroblastoma are indicated by Roman numerals that range from 0 to IV, with the lowest stages indicating cancer that is limited to one area. By stage IV, the cancer is considered advanced and has spread to other areas of the body.

Treatment:

When the lesion is localized, it is generally curable. However, long-term survival for children with advanced disease older than 18 months of age is poor despite aggressive multimodal therapy (intensive chemotherapy, surgery, radiation therapy, stem cell transplant, differentiation agent isotretinoin also called 13-cis-retinoic acid, and frequently immunotherapy with anti-GD2 monoclonal antibody therapy).

Biologic and genetic characteristics have been identified, which, when added to classic clinical staging, has allowed patient assignment to risk groups for planning treatment intensity. These criteria include the age of the patient, extent of disease spread, microscopic appearance, and genetic features including DNA ploidy and N-myc oncogene amplification (N-myc regulates microRNAs , into low, intermediate, and high risk disease. A recent biology study (COG ANBL00B1) analyzed 2687 neuroblastoma patients and the spectrum of risk assignment was determined: 37% of neuroblastoma cases are low risk, 18% are intermediate risk, and 45% are high risk. (There is some evidence that the high- and low-risk types are caused by different mechanisms, and are not merely two different degrees of expression of the same mechanism.)

The therapies for these different risk categories are very different.

  • Low-risk disease can frequently be observed without any treatment at all or cured with surgery alone.
  • Intermediate-risk disease is treated with surgery and chemotherapy.
  • High-risk neuroblastoma is treated with intensive chemotherapy, surgery, radiation therapy, bone marrow / hematopoietic stem cell transplantation, biological-based therapy with 13-cis-retinoic acid (isotretinoin or Accutane) and antibody therapy usually administered with the cytokines GM-CSF and IL-2.

With current treatments, patients with low and intermediate risk disease have an excellent prognosis with cure rates above 90% for low risk and 70–90% for intermediate risk. In contrast, therapy for high-risk neuroblastoma the past two decades resulted in cures only about 30% of the time. The addition of antibody therapy has raised survival rates for high-risk disease significantly. In March 2009 an early analysis of a Children’s Oncology Group (COG) study with 226 high-risk patients showed that two years after stem cell transplant 66% of the group randomized to receive ch14.18 antibody with GM-CSF and IL-2 were alive and disease-free compared to only 46% in the group that did not receive the antibody. The randomization was stopped so all patients enrolling on the trial will receive the antibody therapy.

Chemotherapy agents used in combination have been found to be effective against neuroblastoma. Agents commonly used in induction and for stem cell transplant conditioning are platinum compounds (cisplatin, carboplatin), alkylating agents (cyclophosphamide, ifosfamide, melphalan), topoisomerase II inhibitor (etoposide), anthracycline antibiotics (doxorubicin) and vinca alkaloids (vincristine). Some newer regimens include topoisomerase I inhibitors (topotecan and irinotecan) in induction which have been found to be effective against recurrent disease.

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Effective Treatment for Neuroblastoma

NEW HOPE FOR CHILDREN WITH HIGH-RISK NEUROBLASTOMA

Child’s Neuroblastoma Cancer Responds to Nutrition

Prognosis:
Between 20% and 50% of high-risk cases do not respond adequately to induction high-dose chemotherapy and are progressive or refractory. Relapse after completion of frontline therapy is also common. Further treatment is available in phase I and phase II clinical trials that test new agents and combinations of agents against neuroblastoma, but the outcome remains very poor for relapsed high-risk disease.

Most long-term survivors alive today had low or intermediate risk disease and milder courses of treatment compared to high-risk disease. The majority of survivors have long-term effects from the treatment. Survivors of intermediate and high-risk treatment often experience hearing loss. Growth reduction, thyroid function disorders, learning difficulties, and greater risk of secondary cancers affect survivors of high-risk disease. An estimated two of three survivors of childhood cancer will ultimately develop at least one chronic and sometimes life-threatening health problem within 20 to 30 years after the cancer diagnosis.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Neuroblastoma
https://www.mayoclinic.org/diseases-conditions/neuroblastoma/symptoms-causes/syc-20351017

Mastectomy

Description:
A mastectomy is surgery to remove all breast tissue from a breast as a way to treat or prevent breast cancer.

For those with early-stage breast cancer, a mastectomy may be one treatment option. Breast-conserving surgery (lumpectomy), in which only the tumor is removed from the breast, may be another option.

Deciding between a mastectomy and lumpectomy can be difficult. Both procedures are equally effective for preventing a recurrence of breast cancer. But a lumpectomy isn’t an option for everyone with breast cancer, and others prefer to undergo a mastectomy.

Both mastectomy and lumpectomy are referred to as “local therapies” for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.

Traditionally, in the case of breast cancer, the whole breast was removed. Currently, the decision to do the mastectomy is based on various factors, including breast size, the number of lesions, biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of tumor recurrences after lumpectomy and radiation. Outcome studies comparing mastectomy to lumpectomy with radiation have suggested that routine radical mastectomy surgeries will not always prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis, and operation.

Newer mastectomy techniques can preserve breast skin and allow for a more natural breast appearance following the procedure. This is also known as skin-sparing mastectomy.

Surgery to restore shape to your breast — called breast reconstruction — may be done at the same time as your mastectomy or during a second operation at a later date.

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Types:
Currently, there are several surgical approaches to mastectomy, and the type that a person decides to undergo (or whether she or he will decide instead to have a lumpectomy) depends on factors such as the size, location, and behavior of the tumor (if one is present), whether or not the surgery is prophylactic, and whether the person intends to undergo reconstructive surgery.

* Simple mastectomy (or “total mastectomy”): In this procedure, the entire breast tissue is removed, but axillary contents are undisturbed. Sometimes the “sentinel lymph node”—that is, the first axillary lymph node that the metastasizing cancer cells would be expected to drain into—is removed.

* Modified radical mastectomy: The entire breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). In contrast to a radical mastectomy, the pectoral muscles are spared. This type of mastectomy is used to examine the lymph nodes because this helps to identify whether the cancer cells have spread beyond the breasts.

* Radical mastectomy (or “Halsted mastectomy”): First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoralis major and minor muscles behind the breast.

* Skin-sparing mastectomy: In this surgery, the breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple).

* Nipple-sparing/subcutaneous mastectomy: Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with mastectomy for the benign disease over the fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position.

* Extended Radical Mastectomy: Radical mastectomy with intrapleural en bloc resection of internal mammary lymph node by sternal splitting.

* Prophylactic mastectomy: This procedure is used as a preventative measure against breast cancer. The surgery is aimed to remove all breast tissue that could potentially develop into breast cancer.

Risks Factors:

Risks of a mastectomy include:

* Bleeding
* Infection
* Pain
* Swelling (lymphedema) in your arm if you have an axillary node dissection
* Formation of hard scar tissue at the surgical site
* Shoulder pain and stiffness
* Numbness, particularly under your arm, from lymph node removal
Buildup of blood in the surgical site (hematoma)

Before surgery:
Before the operation, everyone will meet with the surgeon a few days before the surgery or even the day before, however, a much longer period is very beneficial since it allows the patient for a more objective weighing of the options. Although there is some urgency in timing the surgery, the patient needs some time after the initial shock of hearing the cancer verdict; otherwise, she may later regret her decision. The extent and specific details regarding the mastectomy will be discussed along with the person’s medical history.

Of extreme importance will be the woman’s decision whether the entire breast is to be removed, or only a part of it – and that is usually much more a personal choice than a medical assessment. The medical viewpoint stresses the statistical fact of much stronger chances for cure and survival when the breast is removed completely, even when the size of the cancer is small. From the personal viewpoint, the perspective of not having the breast is very painful and difficult to accept. At this point the support of the family and of good friends can make the difference between life and death, since it is easier for friends to present the after-the-surgery future in the “matter of fact” way, thus facilitating the reasonable decision. The dilemma of the vital importance will be weighing the aesthetics and pride, against the chances of curing and surviving, which are much better when the breast is removed 100% completely. During these considerations, very painful indeed, one needs to realize that a woman’s flat chest without breasts, even without nipples, does not look bad at all, nothing to feel embarrassed of, or to be ashamed by; it looks just neutral – much better than a partly removed, disfigured breast. Since the surgery is unavoidable, for people open to see the problem in this way, the choice becomes easier.

Before the surgery the person will have time to ask any questions regarding the procedure at this time and after everything is addressed a consent form is signed. Information about not eating or drinking anything beforehand will be gone over as well. The person will also meet with the anesthesiologist or the health professional who is going to be giving the anesthesia the day of the operation.[2][citation needed]

Recent research has indicated that mammograms should not be done with any increased frequency than normal procedure in people undergoing breast surgery, including breast augmentation, mastopexy, and breast reduction.[12]

During surgery:
The day of the operation the person will have an IV line started, which will be used to give medicine. Since this is an extensive procedure the person will be hooked up to an EKG machine and also have a blood pressure cuff to monitor vitals and the heart rhythm throughout the whole surgery. The anesthesia will be given, which will result in the person going to sleep. The timing of the surgery all depends on the extent and what type of mastectomy the person will be having.

After surgery:
When the procedure is complete the patient will be taken to a recovery room where they are monitored until they wake up and their vital signs remain stable. It is normal for people that have mastectomies to remain in the hospitals for 1 to 2 nights and they are released to go home if they are doing well. The decision for discharge should be made by the doctor based on the person’s overall health at the time. The person is dressed with a bandage over the surgery site that is wrapped around the chest snugly. It is common to have drains coming from the incision site to help remove blood and lymph to initiate the healing process. Patients may have to be taught to empty, care, and measure the fluid from the drains. Measuring the fluids will help identify any problems the doctors need to be aware of. Patients should be taught the effects of the surgery, such as regular activity may be altered. There is a possibility that pain, numbness, or tingling in the chest and arm could continue long after the surgery has been done. It is recommended that patients see their surgeon 7–14 days after the surgery, during this time the doctor will explain the results and talk about further treatment if needed such as radiation and chemotherapy. The doctor might refer the patient to a plastic surgeon if she showed interest in breast reconstruction surgery.

Resources:
https://en.wikipedia.org/wiki/Mastectomy
https://www.mayoclinic.org/tests-procedures/mastectomy/about/pac-20394670

Health Problems & Solutions

Q. I get frequent headaches at work. I got my eyes checked. I don’t need glasses.

Ans: A headache may be due to the air conditioning in the office causing blocked sinuses, room fresheners causing allergies or lack of ventilation. It can also be because of dehydration or hunger, especially if you are so involved with your work that you forget to eat and drink. Take steam inhalations before leaving for work and after reaching home. Keep a bottle of water and a fruit or two as a snack at your desk. (Samosas, biscuits and other high-calorie foods are not a good idea as they lead to weight gain.)

Q: I am very scared because my neighbour developed flu, had to be admitted in the ICU and died.

Ans:You can take a flu vaccine to prevent the disease. And if you get the flu despite immunisation, the attack is usually mild. The vaccine has to be taken every year, preferably from October to March (the flu season). It needs to be administered to all children and older adults, especially those with diabetes or other chronic illnesses. Frequent handwashing decreases the likelihood of contracting the flu as does taking steam inhalations once a day and gargling with warm, salted water.

Q: I was told that I need to breastfeed my baby for only six months as she would get all the immunity she requires in that time. I was also told that the newer milk formulas are equally effective, if not superior, as they contain trace elements and essential amino acids. Is this true?

Ans: Breastfeeding protects the baby from infectious diseases and provides easily digestible food. It offers a wealth of benefits for the mother too. It protects against breast and ovarian cancer, delays the onset of type 2 diabetes as well as some forms of arthritis. If possible, a baby should be breastfed for at least a year.

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India.

Source: The Telegraph, Kolkata (India)

Bariatric Surgery to reduce obesity


Description:
Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery).

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Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a mortality reduction from 40% to 23%. The U.S. National Institutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI of at least 35 and serious coexisting medical conditions such as diabetes. However, research is emerging that suggests bariatric surgery could be appropriate for those with a BMI of 35 to 40 with no comorbidities or a BMI of 30 to 35 with significant comorbidities. The most recent American Society for Metabolic & Bariatric Surgery guidelines suggest the position statement on consensus for BMI as an indication for bariatric surgery. The recent guidelines suggest that any patient with a BMI of more than 30 with comorbidities is a candidate for bariatric surgery.

A National Institute of Health symposium held in 2013 that summarized available evidence found a 29% mortality reduction, a 10-year remission rate of Type 2 Diabetes of 36%, fewer cardiovascular events, and a lower rate of diabetes-related complications in a long-term, non-randomized, matched intervention 15-20 year follow-up study, the Swedish Obese Subjects Study. The symposium also found similar results from a Utah study using more modern gastric bypass techniques, though the follow-up periods of the Utah studies are only up to 7 years. While randomized controlled trials of bariatric surgery exist, they are limited by short follow-up periods.

Types:
Procedures can be grouped in three main categories: blocking, restricting, and mixed. Standard of care in the United States and most of the industrialized world in 2009 is for laparoscopic as opposed to open procedures. Future trends are attempting to achieve similar or better results via endoscopic procedures.

Blocking procedures:
Some procedures block absorption of food, although they also reduce stomach size.

Biliopancreatic diversion:
This operation is termed biliopancreatic diversion (BPD) or the Scopinaro procedure. The original form of this procedure is now rarely performed because of problems with. It has been replaced with a modification known as duodenal switch (BPD/DS). Part of the stomach is resected, creating a smaller stomach (however the patient can eat a free diet as there is no restrictive component). The distal part of the small intestine is then connected to the pouch, bypassing the duodenum and jejunum.

In around 2% of patients there is severe malabsorption and nutritional deficiency that requires restoration of the normal absorption. The malabsorptive effect of BPD is so potent that, as in most restrictive procedures, those who undergo the procedure must take vitamin and dietary minerals above and beyond that of the normal population. Without these supplements, there is risk of serious deficiency diseases such as anemia and osteoporosis.

Because gallstones are a common complication of the rapid weight loss following any type of bariatric surgery, some surgeons remove the gallbladder as a preventive measure during BPD. Others prefer to prescribe medications to reduce the risk of post-operative gallstones.

Far fewer surgeons perform BPD compared to other weight loss surgeries, in part because of the need for long-term nutritional follow-up and monitoring of BPD patients.

Jejunoileal bypass:
This procedure is no longer performed. It was a surgical weight-loss procedure performed for the relief of morbid obesity from the 1950s through the 1970s in which all but 30 cm (12 in) to 45 cm (18 in) of the small bowel was detached and set to the side.

Endoluminal sleeve:
A study on humans was done in Chile using the same technique however the results were not conclusive and the device had issues with migration and slipping. A study recently done in the Netherlands found a decrease of 5.5 BMI points in 3 months with an endoluminal sleeve.

Restrictive procedures:
Procedures that are restrictive shrink the size of the stomach or take up space inside the stomach, making people feel more full when they eat less.

Vertical banded gastroplasty:
In the vertical banded gastroplasty, also called the Mason procedure or stomach stapling, a part of the stomach is permanently stapled to create a smaller pre-stomach pouch, which serves as the new stomach.

Adjustable gastric band:
The restriction of the stomach also can be created using a silicone band, which can be adjusted by addition or removal of saline through a port placed just under the skin. This operation can be performed laparoscopically, and is commonly referred to as a “lap band”. Weight loss is predominantly due to the restriction of nutrient intake that is created by the small gastric pouch and the narrow outlet. It is considered one of the safest procedures performed today with a mortality rate of 0.05%.

Sleeve gastrectomy:
Sleeve gastrectomy, or gastric sleeve, is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (typically with surgical staples, sutures, or both) to leave the stomach shaped more like a tube, or a sleeve, with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible. It has been found to be comparable in effectiveness to Roux-en-Y gastric bypass.

Intragastric balloon:
Intragastric balloon involves placing a deflated balloon into the stomach, and then filling it to decrease the amount of gastric space. The balloon can be left in the stomach for a maximum of 6 months and results in an average weight loss of 5–9 BMI over half a year. The intragastric balloon is approved in Australia, Canada, Mexico, India, United States (received FDA approval in 2015) and several European and South American countries. The intragastric balloon may be used prior to another bariatric surgery in order to assist the patient to reach a weight which is suitable for surgery, further it can also be used on several occasions if necessary.

Stomach folding:
Basically, the procedure can best be understood as a version of the more popular gastric sleeve or gastrectomy surgery where a sleeve is created by suturing rather than removing stomach tissue thus preserving its natural nutrient absorption capabilities. Gastric plication significantly reduces the volume of the patient’s stomach, so smaller amounts of food provide a feeling of satiety. The procedure is producing some significant results that were published in a recent study in Bariatric Times and are based on post-operative outcomes for 66 patients (44 female) who had the gastric sleeve plication procedure between January 2007 and March 2010. Mean patient age was 34, with a mean BMI of 35. Follow-up visits for the assessment of safety and weight loss were scheduled at regular intervals in the postoperative period. No major complications were reported among the 66 patients. Weight loss outcomes are comparable to gastric bypass.

Mixed procedures:       Mixed procedures apply block and restrict at the same time.

Gastric bypass surgery:
A common form of gastric bypass surgery is the Roux-en-Y gastric bypass, designed to reduce the amount of food a person is able to eat by cutting away a part of the stomach. Gastric bypass is a permanent procedure that helps patients by changing how the stomach and small intestine handle the food that is eaten to achieve and maintain weight loss goals. After the surgery, the stomach will be smaller. A patient will feel full with less food.

A factor in the success of any bariatric surgery is strict post-surgical adherence to a healthy pattern of eating.

There are certain patients who cannot tolerate the malabsorption and dumping syndrome associated with gastric bypass. In such patients, although earlier considered to be an irreversible procedure, there are instances where gastric bypass procedure can be partially reversed.

Sleeve gastrectomy with duodenal switch:
A variation of the biliopancreatic diversion includes a duodenal switch. The part of the stomach along its greater curve is resected. The stomach is “tubulized” with a residual volume of about 150 ml. This volume reduction provides the food intake restriction component of this operation. This type of gastric resection is anatomically and functionally irreversible. The stomach is then disconnected from the duodenum and connected to the distal part of the small intestine. The duodenum and the upper part of the small intestine are reattached to the rest at about 75–100 cm from the colon.

Implantable gastric stimulation:
This procedure where a device similar to a heart pacemaker is implanted by a surgeon, with the electrical leads stimulating the external surface of the stomach, is being studied in the USA. Electrical stimulation is thought to modify the activity of the enteric nervous system of the stomach, which is interpreted by the brain to give a sense of satiety, or fullness. Early evidence suggests that it is less effective than other forms of bariatric surgery.

Eating after bariatric surgery:
Immediately after bariatric surgery, the patient is restricted to a clear liquid diet, which includes foods such as clear broth, diluted fruit juices or sugar-free drinks and gelatin desserts. This diet is continued until the gastrointestinal tract has recovered somewhat from the surgery. The next stage provides a blended or pureed sugar-free diet for at least two weeks. This may consist of high protein, liquid or soft foods such as protein shakes, soft meats, and dairy products. Foods high in carbohydrates are usually avoided when possible during the initial weight loss period.

Post-surgery, overeating is curbed because exceeding the capacity of the stomach causes nausea and vomiting. Diet restrictions after recovery from surgery depend in part on the type of surgery. Many patients will need to take a daily multivitamin pill for life to compensate for reduced absorption of essential nutrients. Because patients cannot eat a large quantity of food, physicians typically recommend a diet that is relatively high in protein and low in fats and alcohol.

Benefits of Bariatric Surgery:
Gastric bypass surgery is done to help you lose excess weight and reduce your risk of potentially life-threatening weight-related health problems, including:

* Gastroesophageal reflux disease

* Heart disease

* High blood pressure

* Severe sleep apnea

* Type 2 diabetes

* Stroke

Gastric bypass and other weight-loss surgeries are typically done only after you’ve tried to lose weight by improving your diet and exercise habits.

Risk Factors:
As with any major surgery, gastric bypass and other weight-loss surgeries pose potential health risks, both in the short term and long term.

Risks associated with the surgical procedure can include:

* Excessive bleeding

* Infection

* Adverse reactions to anesthesia

* Blood clots

* Lung or breathing problems

* Leaks in your gastrointestinal system

* Death (rare)

Longer term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:

* Bowel obstruction

* Dumping syndrome, causing diarrhea, nausea or vomiting

* Gallstones

* Hernias

* Low blood sugar (hypoglycemia)

* Malnutrition

* Stomach perforation

* Ulcers

* Vomiting

* Death (rare)

When weight-loss surgery doesn’t work:

Gastric bypass and other weight-loss surgeries don’t always work as well as you might have hoped. For one thing, although rare, something during or after the procedure itself may go wrong. For instance, the adjustable band may fail to work properly. If a weight-loss procedure doesn’t work right or stops working, you may not lose weight and you may develop serious health problems. Keep all of your scheduled follow-up appointments after weight-loss surgery. If you notice that you aren’t losing weight or you develop complications, see your doctor immediately. Your weight loss can be monitored and factors potentially contributing to your lack of weight loss evaluated.

It’s also possible to not lose enough weight or to regain weight after any type of weight-loss surgery, 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. If you frequently snack on high-calorie foods, for instance, you may have inadequate weight loss.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Bariatric_surgery
https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258