Currae Specialty Hospital ( On Call)

Hi,

I am Dr. Aparna Govil Bhasker, Bariatrician with an experience of about 13 years practicing in Mumbai. I deal with patients who are suffering from obesity. First thing I would like to share that obesity is a disease. Whenever we see the patient we see that somewhere they are also responsible for the weight that they are carrying. So, the first thing we need to realize that obesity is a disease like any other chronic disease. It is very similar to diabetes or heart disease and the progression is very similar to various stages. Today we define the stages on the basis of body mass index. That is the parameter that we use. So, if the BMI is between 23.5-27.5 then these patients are considered to be overweight. People between 27.5-32.5 suffers from grade 1 obesity. Any person with BMI more than 32.5-37.5 suffering from grade 2 obesity. Any person whose BMI is more than 37.5 suffering from grade 3 obesity.

When we talk about bariatric surgery, it is actually a treatment option for grade 3 obesity. And sometimes, for grade 2 obesity with 2 associated diseases like diabetes, hypertension, sleep apnea or say any other problem which is associated with obesity. The treatment will depend upon the grade of obesity. Now when we talk about bariatric surgery, it is basically a laparoscopic surgery, gastrointestinal surgery where we actually reduce the size of the stomach and some kind of surgeries where we re-route the intestines and join it to the stomach. There are 2 types of surgeries which are commonly performed in India: Laparoscopic sleeve gastrectomy. In this, we divide the stomach vertically. We create a small tube of the stomach. In this 65% of the stomach is removed out of the body. So, a small tube of the stomach remains inside the body. So, the amount of food gets reduced and they feel full early.

Another advantage, the person doesn't feel hungry much after the surgery. The other surgery is called a laparoscopic gastric bypass. This is one of the common and oldest surgery. It has one of the best results. In this small pouch of the stomach is created. So, here we are not removing any part of the stomach, we actually re-route the intestine to reduce the size of the stomach. This also has similar effects. The person is able to eat less. They don't absorb all the calories from the food. Now, it totally depends upon the patient's clinical profile. After a thorough evaluation, we see what surgery will be comfortable. All surgeries will lead to 65-75% of excess weight. Bariatric surgery also leads to very significant results and improves the quality of life. Associated diseases like diabetes, high blood pressures, sleep apnea, liver disease, lung disease, all these leads to a lot of improvement after bariatric surgery and overall health of the patient improves.

Weight loss happens over a period of about a year-year and a half. Most patients are able to maintain their weight. For the long term of weight maintained, a little bit of work is required from the patient's end as well. We do some degree of lifestyle and behavioral modification. Follow-up is a very important part of the whole program. Because good follow-up and great attendance keep the patient motivated. So, bariatric surgery is safe. In the end, I would like to say that when you are suffering from obesity, if you do not get treated properly, there are repercussions for that. And that can actually lead to a life-threatening problem. Doing surgery is always a risk and patients always think twice about it. But doing bariatric surgery for obese patients is much better than going into further risk. If you have any query regarding weight loss or bariatric surgery, you can contact me through Lybrate.

Thank You!

Hello,

 I am Dr. Shailendra Patil, consultant joint replacement and arthroscopic surgeon. Today we are going to talk about the new technology in joint replacement called as Partial Knee Replacement. As you know, nowadays arthritis is seen more and more in young population say like 40 to 50 years of patients. Coming to the partial knee replacement we need to understand about the pattern of arthritis. How does arthritis occur? Looking at this model the knee is composed of three compartments, the inner also called as the median, the outer also called as the lateral and the kneecap compartment also known as the Patella-Humoral compartment. In early stages, arthritis starts in either of these compartments and then it starts spreading to the other compartments.

Usually 80 to 90% of the cases it starts on the medial that is inner compartment. If we tackle the same patient at early stages so the patient can get away with partial knee replacement. As you can see in this diagram only the inner that is the medial compartment is affected in the patient so it make sense to change the only the affected compartment rather than changing the hole knee. So that is called as the partial knee replacement. What we do in this case- we just change the cap above, the cap below and a polyethylene white structure in between. In the partial knee replacement if you see, out of 100% we have changed only 30% and 70% remains as it is. That is God given knee remains as it is. So compared to the total knee replacement where we change everything, in partial knee replacement there is no need of changing the whole knee rather we can change the affected area. The advantage of partial knee replacement is that the naturalness of the knee remains, patient feels there as natural knee or their own knee. The activity level, the rehabilitation is much much faster as compared to the total knee replacement. It is as good as 3 times faster than the total knee replacement. The proscription is very very good. The patient like the partial knee replacement after the surgery as compared to the total knee replacement.

Thank you

Hello,

I am Dr. Shailendra Patil, Orthopedist, practicing in Mulund, Thane and Navi Mumbai. I do knee replacement surgery. I take a special precaution is not to cut the thigh muscles. Even after the surgery patient gets the very less pain because of no cut and stitching in the muscle. injections are given to get rid of pain. After 3-4 hours of this surgery, patient starts walking. Patient is ready for discharge even on 2nd or 3rd day. Patient requires physiotherapy and medications after the surgery for few time. Another specialization of mine is in hip replacement surgery. With this surgery, we can save maximum natural bones. Even after the total hi replacement, patient can enjoy all his activities.

There are very minimal chances of hip dislocation after the surgery. A partial knee replacement surgery. A knee has 3 compartments. Inner, outer, knee cap compartment. Arthritis starts from any one of the compartment. In knee replacement 70% of the knee remains natural. Only 30% is treated. Patient feels a natural knee after the surgery. Patient can perform all his activities after the surgery which he was doing prior to it. Like sitting on floor, cross leg sitting, use of Indian toilets and stair climbing. Arthroscopic surgery is my another speciality also known as keyhole surgery. It fixes the problem of ligament injuries, ACL injuries or usually know as sports injuries. We make the small hole in front of the joint and try to fix the problem. To know more about it, you can consult me through lybrate.com.

Thank You!