Bypass surgery: All your questions answered

Bypass, this word starts ringing in the most villainous terms in the ears, and the most hardened person in the world also starts thinking of the so-called alternative medicine.

Sitting in the hospital of a metro city in India with all the medical paraphernalia to guard one, and take care in this difficult situation, many patients and relatives suddenly feel insecure and helpless. A Consultant-cardio vascular thoracic surgery, answers a few common questions regarding the bypass surgery.

Q: Doctor, are you sure? Is there any other better and safer way?
A: Yes, CABG or bypass has been performed since 40-50 years, and daily addition of medical and scientific knowledge has transformed into around 1.5 to 2 lakhs heart surgery numbers in India, alone. Many clinical trials and research papers have reemphasized the benefits and efficacy in saving multiple lives and maintaining smiles on the faces of the patients and most importantly, given them an opportunity to lead a second inning.

Q: Will one be able to walk or work? How many months of bed rest?
A: Surgery is like a speed breaker. You must go over it and then accelerate. Most of the patients are walking 500 meters, and climbing a flight of stairs within 7 days of the operation. A patient is back to a desk job in 4 weeks and behind the steering wheel in 3 months (obviously with a seat belt).

Q: But Doctor, isn’t it too painful?
A: Surprisingly, the surgery pain is very less after the first two or three days, and patients do manage with only a tablet of crocin. Some patients have some dull sense of tightness in the chest for a few days which is improved by physiotherapy. The resistance to one of the safest and well documented open-heart procedures is mind-boggling. Even in presence of medical conditions like Diabetes, blood pressure, mild kidney issues, heart dysfunction; Bypass can be performed with relative safety and efficacy, and good recovery in 98 to 99 per cent of patients. The remaining one or two patients have issues due to the previous delay in treatment or severe dysfunction and emergency conditions.

Especially in patients with diabetes, CABG (bypass) has shown to be most effective and long-lasting treatment option in the presence of 3-4 significant blocks. Many scientific studies have pointed to a massive reduction of heart attack events, readmission events and improved life span in almost 95 per cent of patients. More so, this effect stays on for around 10-15 years adding significant value in the family and personal life of an individual. Restitution of normal heart function gets the patient back on the productive earnings track adding significant value to the family and society with reduced 
dependence on accumulated savings. Simple techniques of keeping diabetes under control are more than sufficient to prevent the dreaded complications of infection at bay.

In a price-sensitive developing country like India, prevention of readmission and reintervention itself adds up to a lot of savings in the long run. And obviously, no amount of money can ever get you back the vitality and heart function once it is lost. A timely procedure can set you right for a long time with the least possible discomfort.
Keep these few things in mind

• Early detection and procedure, if needed
• Lifestyle changes as per advice like quitting smoking and tobacco
• Adequate control of blood pressure and diabetes
• Exercise like walking 5kms a day within 3 months of surgery
• Weight loss of around 5-10kg (as per case) and same weight throughout the lifetime
• Early resumption of work
• Stress-free atmosphere and relaxation

These few things will help the patient, and family get back right into the act after the surgery.
Everything you need to know about minimally invasive bypass surgery

A recent new option of the minimally invasive bypass with a small incision of around 6-7 cm to the left chest has shown to be beneficial to most patients. This not only reduces the pain and blood loss but also has faster recovery times and near-zero risks of infection. The patient is usually discharged by 6 days after the operation.

Take-away message: A damaged heart is never possible to be restored back to its original function. Risk is the only increasing outcome of a procrastinated decision.

this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.   
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New approach to manage post surgical pain with less opioids

A new study has reported that the post-surgical pain can be effectively managed with minimal or no opioids.

The study revealed that the number of opioid medications prescribed after surgery can be drastically reduced without negatively affecting pain scores, postoperative complications or patient requests for additional opioids, demonstrating that alternative approaches to pain management can be both safe and highly effective.

Researchers conducted a case control cohort study evaluating whether , after hospital discharge, post surgical acute pain can be effectively managed with a markedly reduced number of opioid doses.

The cohort study included 1231 patients undergoing gynecologic oncology surgery. Patients undergoing ambulatory or minimally invasive surgery ( laparoscopic or robotic approach), were not prescribed opioids at discharge unless they required more than 5 doses of oral or intravenous opioids while in the hospital. Patients who underwent laparotomy were provided with a 3 day opioid pain medication at discharge.

The study found that during its first year alone,  the restrictive protocol eliminated the circulation of 16,374 opioid tablets ( 5 mg oxycodone equivalent) significantly reducing the volume of opioids that could be misused or diverted. The results of the full 2 year study of 1231 patients demonstrated that because postoperative pain can be managed effectively without opioids for minor or minimally invasive surgical procedures or with only 3-day supply for major surgery, the risks of chronic opioid misuse can be managed by reducing or eliminating opioid prescription in the first place.

Using ultra-restrictive opioid prescription protocol (UROPP) to manage post-surgical pain after discharge did not result in any negative health consequences and we advocate for adopting radical opioid sparing approaches for managing postoperative pain nationwide, writes the authors.

The study concluded that the implementation of  UROPP in a large surgical service is feasible and safe and was associated with a significantly decreased number of opioids dispensed during the perioperative period , particularly among opioid naive patients.

Opioids are routinely prescribed for postoperative pain management for most patients with limited evidence of the amount needed to be dispensed. Opioid based treatment often adversely affects recovery. Prescribed opioids increase the risk of chronic opioid use, and diversion and contribute to the current opioid epidemic.

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Read more at Speciality Medical Dialogues: Study finds new approach to manage post surgical pain with less opioids https://speciality.medicaldialogues.in/study-finds-new-approach-to-manage-post-surgical-pain-with-less-opioids/

Read more at Speciality Medical Dialogues: Study finds new approach to manage post surgical pain with less opioids https://speciality.medicaldialogues.in/study-finds-new-approach-to-manage-post-surgical-pain-with-less-opioids/

Read more at Speciality Medical Dialogues: Study finds new approach to manage post surgical pain with less opioids https://speciality.medicaldialogues.in/study-finds-new-approach-to-manage-post-surgical-pain-with-less-opioids/

Woman with type 1 diabetes still off insulin one year after cell transplant

Scientists report a step forward in the plan to create a truly artificial pancreas, offering new hope to people with type 1 diabetes.

A 43-year-old single mother with dangerously difficult-to-control diabetes had insulin-producing islet cells transplanted into her omentum -- a fatty membrane in the belly.

The cells began producing insulin faster than expected, and after one year she is doing well and doesn't need insulin injections, the University of Miami researchers said.

"We're exploring a way to optimize islet cell therapy to a larger population. This study gives us hope for a different transplant approach," said the study's lead author, Dr. David Baidal. He's an assistant professor in the university's Diabetes Research Institute.

Others voiced optimism as well. "This study was a good start at evaluating a novel site for transplant," said Julia Greenstein, vice president of discovery research for JDRF (formerly the Juvenile Diabetes Research Foundation).

Type 1 diabetes is an autoimmune disease. That means the body's immune system mistakenly damages healthy cells -- in this case, the islet cells found in the pancreas. This leaves people with type 1 diabetes without enough insulin to convert sugars from foods into energy for the body.

As a result, they must take multiple daily insulin injections, or use a pump that delivers insulin via a tube inserted under the skin that must be changed every few days.

Currently, islet cells from deceased donors are transplanted into the liver, but that's not an ideal option.

This new research was a proof-of-concept study expected to be the first step on a path toward developing a mini-organ called the BioHub.

In its final stages, the BioHub would mimic a pancreas and act as a home for transplanted islet cells, providing them with oxygen until they could establish their own blood supply.

FDA approves first " artificial pancreas" for type 1 diabetes
2 types of diabetes on the rise in children

The hope is that the BioHub also would attempt to tackle the autoimmune attack that causes type 1 diabetes.

But, the first step in developing the BioHub was to find a suitable location in the body. When the liver is used for islet cell transplants, only a limited amount of islet cells can be transplanted. There's also a risk of bleeding when the transplant is done and the possibility of other complications, the researchers said.

"For most people, the liver isn't a problem. It's a great source of blood. It's a good place for insulin to be made. But, there are rare complications that can occur and we want to be able to explant [take the cells out] in case something does happen," said Greenstein, adding that you can't take the cells out of the liver.

Also, with islet cell transplants in the liver, the underlying autoimmune condition is still there. And, if people didn't take immune-suppressing medication, the new islet cells would likely be destroyed.

Because of these and other issues, islet cell transplantation is generally reserved for people whose diabetes is very difficult to control or who no longer have an awareness of potentially dangerous low blood-sugar levels (hypoglycemia unawareness).

The woman in the current study had a 25-year history of type 1 diabetes. She also had severe hypoglycemia unawareness.

"Her quality of life was severely impacted. She had to move in with her parents. And, if she traveled, she had to travel with her father" in case her blood sugar levels dropped dangerously low, Baidal explained.

The surgery was minimally invasive, and the islet cells were placed on a "scaffold" that eventually dissolved. There were no complications, the researchers said.

"We were happily surprised when her glucose [ blood sugar] profile improved quite dramatically," Baidal said.

Normally, after a transplant, doctors wait a while before stopping insulin to give the new islet cells a chance to rest. But the new islet cells worked so well that the injected insulin was causing low blood sugar levels.

"We were able to discontinue insulin sooner than we thought we would. And, the glucose control was very stable," Baidal said.

Baidal said the study results need to be replicated in other patients, and the researchers want to see what happens post-treatment over a longer time. The researchers plan to test the omentum as a site in five more patients.

Greenstein said a big clinical trial isn't necessary because "either the transplant works or it doesn't work," so only a small number of people is needed.

The study's findings were published online May 10 in the New England Journal of Medicine.

 this is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.   
https://gscrochetdesigns.blogspot.com. one can see my crochet creations 
https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes    
https://kneereplacement-stickclub.blogspot.com. for info on knee replacement