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OBESITY& DIABETES
CARE CENTRE
“Where move to life”
P.B. No. 31, Ootty Road, Perinthalmanna. Pin - 679 322, Malappuram District, Kerala.Ph: 04933 - 300600, 228511, 09447128511
Email: [email protected], [email protected]. Web: www.obesitycureindia.com, www.moulanahospital.com
Hospital An ISO 9001 : 2008
ENDOSURGENDOSURGVol - 3, Dec. 2012
Happy New Year
Dears,
"Wishing you and your family a very happy, healthy and prosperous
new year."
The transformation in the healthcare that brought about great
strides in surgical technology is tremendous indeed. The newer advances in
Gastrointestinal surgery are the best example. Almost all abdominal
surgeries can now be done through key-hole incisions with more precision,
accuracy and safety. In this context I now recollect the initial objections,
oppositions and criticisms on starting key-hole surgeries during the early
years of my carrier. For, the technique has today won all-round and universal
approval.
Obesity and Diabetes are two great challenging faces today in
health care; the two, like two sides of a coin, devitalize the afflicted physically,
mentally and takes away a major share of the expenditure of healthcare.
Bariatric surgery, aimed at combating obesity has won world-wide
acclaim and removed much of the anxieties among the professionals and the
public. But the ignorance about this remains a matter of concern. Bariatric
surgery to control diabetes has been named as the top medical innovation for
2013 at the Cleveland Clinic's Annual Medical Innovation Summit.
A panel of doctors and scientists cited the results of the
STAMPEDE study, which found that patients who underwent surgery were far
more likely to be free of diabetes than those on medication and counseling
alone, in naming the procedure as the top medical innovation.
The study results, published in the New England Journal of
Medicine in 2012, astounded the medical world, reads the announcement,
In our center we have performed more than 500 Bariatric surgeries
and around 50 Diabetes Surgeries so far with excellent results. It would surely
bestow new life and hope to such diabetics, distraught in mind and enslaved
to medicines. Please feel free to call us in 9447128511, 9020444141 for any
clarifications or assistance.
With regards,
In a
process that received more than 100 different nominations for medical
innovations from 110 medical experts, Bariatric surgery was chosen because
of its "astounding" ability to remedy the symptoms of type 2 diabetes.
" A cure for type 2 diabetes ? Perhaps ."
Dr. Mohamed Ismail, MS, FICS, FMASChief Bariatric & Metabolic Surgeon
OBESITY& DIABETES
CARE CENTRE
Where move to life
Overweight / Obesity
Reasons
Obesity, a malady of the twenty first century, is accumulation of fat in the body to the extend of endangering health. There has been an alarming increase in the number of obese people all over the world, especially in the developed countries. Many countries have initiated measures against obesity considering it as a public health issue.
Obesity can be familial in 25% 30% of people. But the main villain is the change in life-style of the people. Excessive food intake and lack of physical exercise contributes to Obesity. The new fast-food culture speeded it up. Obesity is thus the reward to those who gulp down food, in greater quantity than is needed. Certain diseases and mental ailments also can be associated with obesity.
How to detect Obesity?
How to Calculate the BMI?
There is a desired weight which is normal or proportional to the height of the body. Obesity is determined by noting the changes in this ratio, the Body Mass Index (BMI).
BMI (Body Mass Index) is the fraction found out by dividing the body weight in Kilogrammes by the square of the height in Meters.
3
SURGERY FOR
OVERWEIGHT
Obesity and related diseases
OBESITY& DIABETES
CARE CENTRE
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The health-related problems posed by obesity are many. Diabetes mellitus, hyperlipidemia, increased incidence of various cancers, stroke, varicose veins and asthma are some diseases in the causation of which obesity of BMI greater than 35 may play a role. Besides, the desire to stay away secluded from social assemblies could
create mental stress and depression.
The first-line measures are, doubtless, to control the intake of food and orderly exercises. Still, the long term
What are the Modalities of Treatment?
effects of these conservative methods are at best only 2 -20%. Orlistat is a medicine widely used for obesity that could help reduce weight by 5-10 Kgms. But it is not safe for those with gastrointestinal or renal disorders.
Bariatric surgery is the only permanent remedy to reduce obesity and promises long-term alleviation and relief from obesity related diseases. It has been proved that obesity can be fully treated with modern laparoscopic surgical techniques which are mainly three: Lap Banding, Lap Sleeve Gastrectomy and Gastric Bypass. Obese people almost always need extra food and consequently their stomach could
also be larger in size. Their hunger will be satiated only if stomach is fully distended with food and thus the pressure exerted by the stretched stomach wall sends the satiety signals to the brain. Of this intake, whatever exceeds the actual need of the body is directly converted to fat,
4
BMI =
Normal Weight
Obesity Grade I
Obesity Grade IIObesity Grade III
Obesity Grade IV
Obesity Grade V
218.0 - 23 kg/m223.0 - 30 kg/m230.0 - 40 kg/m240.0 - 50 kg/m250.0 - 60 kg/m
2 > 60 kg/m
Weight of the person in Kgms.
2 (Height of the person in Meter)
Laparoscopic Sleeve Gastrectomy Laparoscopic Gastric BypassLaparoscopic Banding
OBESITY& DIABETES
CARE CENTRE
Where move to life
accumulation of which in several parts of the body leads to diseases. Bariatric Surgeon can limit the amount of food that the stomach can accommodate by reducing its size. Surgeon, endocrinologist, physician, dietician, physiotherapist, p h y s i a t r i s t a n d t h e psychologist all team up for the necessary evaluation and treatment. Hospital stay need be only for a maximum of five days after which the person can follow his routine jobs and chores.
The post-surgical dietary regimen is divided into three stages :
After the first or second day, liquid diet can be taken beginning with boiled and cooled water slowly changing over to fruit juices, but not more than
First Stage, Liquid Diet:
half a cup at a time. Carbonated and high calorie drinks are better avoided. This stage will be for three weeks after surgery.
After getting adjusted so with stage 1 diet, skimmed milk, soya milk, mixie-ground gruel (kanji), oats etc. can be taken, from ½ to ¾ of a cup at a time. This stage will be for three to six weeks.
Solid diet can be allowed after six weeks. From now onwards, fat-free food can be taken at frequent intervals.
Second Stage, Semi-solid diet:
Third Stage, Solid Diet:
5
OBESITY& DIABETES
CARE CENTRE
Where move to life
6
Subsequent Dietary Regimen
1. Make meals small in quantity. Excess food can cause pain, dizziness and vomiting and extra increments in calorie intake. The meal is to be stopped before the actual sensation of fullness.
2. Eat slowly. Drink water, also slowly.
3. Drink water at frequent intervals and avoid drinking in between meals.
4. Chew the food well; it will help in digestion.
5. Do not gulp down food, since solid mass of food could block the n a r r o w e d p o s t - o p e r a t i v e gastrointestinal passage and can cause severe abdominal pain.
6. It will take time for the GIT to adapt to absorbtion of nutrients since part of the stomach and small intestine has been bypassed. So, supplements of vitamins and minerals as advised by the doctor should, therefore, be taken.
7. Foods containing multivitamins and minerals, calcium, iron, Vitamin B-12
and Vitamin are the ones to be Supplemented.
Protein-containing food is necessary to help healing of the surgical wound, strengthen muscles and to reduce fat. The day's food should contain 60 Gms. of protein. The directions are:Ø Start the day with protein foodØ Use skimmed milk or soya milkØ Include protein powdersØ Avoid sugar and fat-rich food.Ø Reduce the intake of food to one cup.
1. Control or eliminate sugar and fat-rich food.
2. Compulsorily avoid untimely food.3. Do daily exercises at the appointed
time.4. Consult the doctor as scheduled and
follow instructions.5. Desist from liquor.
Need for Protein:
Follow the following health commands to reduce weight:
OBESITY& DIABETES
CARE CENTRE
Where move to life
7
EXPERIENCES
'I was a man who saw death in the face due to obesity and associated diseases. And then I happened to meet a friend's brother who had undergone bariatric surgery. The changes in him as a result really astonished me. I was against beauty enhancing artificial means. On studying about this surgery through the internet, I could learn one thing: that bariatric surgery is not a cosmetic one. Instead it is a life-saving one. Thus I too underwent this surgery at Moulana Hospital. I don't have any difficulty after the surgery. And I am very happy too.'
'It's hell to live with obesity. This I felt on shedding a weight of 75 Kgms. after the surgery. I am thankful to the surgical team of Moulana Hospital, especially Dr. Mohamed Ismail for completely transforming my life from drudgery to a new enthusiasm.'
-
'The surgical expertise and service I got on undergoing surgery to reduce weight at Moulana Hospital gladden me. I recommend this surgery to those who need it, because I do not have any problem after the surgery. I am very happy that I was very well looked after and treated.'
'It was in an ill state that my parents took me to the Bariatric Surgery Department of Moulana Hospital in August 2010. I was under great stress, but encouraged by the friendly
thatmosphere there. I became free on August 15 , from obesity through surgery. Now I am very happy. My special congratulations are due to Dr. Ismail and his team who gave me new life.'
Anu John (34)
NagercoilPhone: 0465 2227240
Jose Binu (33)Kochi
Ph: 00971505547958
Aftab Ahmed (40)
London
Ph: +7973900034
Barry Stephen (31)Thiruvananthapuram
Ph: 9846023332
Diabetes Surgery for
DIABETES
Diabetes and its complications in
different organs in the body pose a great
health problem to the
world today. Diabetes
is on the rise in
incidence and its fatal
complications are as
severe if not more as
those caused by AIDS
in 19980s. According
to latest estimates,
300 million people
a r e a f f e c t e d b y
diabetes all over the
world and it is projected to double by the
year 2030. India has, on its part, become the
capital city in the world as far as incidence of
diabetes is concerned.
The first thing to
be considered, if an
analysis is made as to the
reasons for the above, is
the total change in life
style and food habits
that have taken place
during the last 10 to 15
years. Lack of exercise,
fast-food usage in excess, stress and obesity
lead to diabetes. Diabetes has genetic basis
too.
D i a b e t e s i s o f
different kinds. Type-
1 seen in childhood,
type-2 seen mostly in
adults and Gestational
diabetes in pregnant
women are examples.
Medical science has
recorded a great leap
f o r w a r d i n t h e
scientific analysis of
them. Initially the
only fault in diabetes was thought to be with
the Pancreas as an organ. But later it was
shown that the stomach, small intestine and
even the fat deposited in the body all over
has roles in regulating the sugar levels in the
blood and this led to the
discovery that not merely
medicines but surgery can
also play a role in treating
diabetes. The notion that,
once a person becomes
d i a b e t i c , l i f e - l o n g
medications with oral
tablets or injectable insulin
8
Act on DiabetesNow
"Sweet Life"
OBESITY& DIABETES
CARE CENTRE
Where move to life
would be necessary thus had to be given up.
This new concept was drawn from the fact
that diabetes was permanently cured in
those who underwent bariatric surgery.
Current studies
shows that surgery
i s e f fe c t i v e i n
curing diabetes
even in the non-
obese. It was Dr.
Francesco Rubino,
an American surgeon
who conducted
experiments in rats
along these lines.
The largest
functioning system
in the body is the Gastrointestinal tract which
produces large number of hormones. Some
of them have a great role in regulating the
blood glucose levels. Incretins, certain
hormones produced in terminal ileum
increase levels of insulin and its efficacy. It is
the passage of food through this part that
stimulates release of these hormones.
.
Grhelin,a peptide
hormone produced
from the fundus of
stomach induces
satiation and raises
d e s i r e f o r h i g h
c a l o r i e f o o d .
D u o d e n u m a n d
Jejunum secrete, on
the other hand, anti-
incretins that reduce
the levels of insulin
and thus raise the
blood glucose levels
(Hindgut Theory)
(Foregut Theory).
These hormones are releases only when
food is passing through respective parts of
G.I.T.
9
LAPAROSCOPIC SG+ DUODENO JEJUNAL BYPASS
LAPAROSCOPIC SG+ STANDARD ILEALINTERPOSITION
LAPAROSCOPIC SG+DIVERTED ILEAL INTERPOSITION
Initially the only fault in diabetes was thought to be with the Pancreas as an organ. But later it was shown that the stomach, small intestine and even the fat deposited in the body all over have roles in regulating the sugar levels in the blood and this led to the discovery that not merely medicines but surgery can also play a role in treating diabetes.
OBESITY& DIABETES
CARE CENTRE
Where move to life
10
Thus three kinds of surgeries were devised
based on these two theories :
1. Laparoscopic SG + Duodenojejunal
Bypass: By bypassing the passage of food
away from the first part of the small
intestine, the secretion of anti-incretins is
reduced and blood levels of blood sugar
also are kept low.
2. Laparoscopic S.G. + Standard Ileal
Interposition: By anastomosing the
terminal parts of ileum to the first parts
of the small intestine. Levels of incretin
can be increased.
3. Laparoscopic S.G. + Diverted ileal
interposition: This procedure is a
combination of the above two and is
done for severe diabetes mellitus.
The volume of the stomach is reduced
in all these three techniques by Sleeve
Gastrectomy, in order to speed up the transit
of food from the stomach to the small
intestine and to eliminate the hormone
Grhelin.
The type of surgery is decided by taking
into account such factors as BMI and the
severity and type of diabetes.
It is doubtless that diabetes can be
completely cured thus in those with BMI
greater than 35. Studies abroad have proved
and recognized that those with BMI
between 30 and 35 do benefit from the
surgery. But, for those with a BMI of below
30, the surgery is still at an experimental
stage in India.
is one of the five
centres recognized for these studies in India
(ICMR: Reg. No. CRTI/2010/091/002938)
Only Type-2 diabetics can benefit
from this kind of surgery; hence many blood
tests may have to precede selection of
patients. These tests are:
Since all the above surgeries can be done through key-hole, the patient can quickly, after 5-7 days of hospital stay, return to his normal work.
Dr. Aurio De Paula, a Brazilian surgeon, has done 600 such surgeries during the last 7 years, of which 90% were completely liberated from diabetes and in 10%, the amount of drugs could be
drastically reduced. It might take 4-5 weeks for the full results to be known. More than 150 patients have undergone such surgeries in all the five centres in India, including the 50 done by Dr. Mohamed Ismail in Moulana Hospital. Initial results are encouraging. Revolutionary changes in the treatment of diabetes are to be inaugurated with more research findings coming out in this field.
Moulana Obesity and
Diabetes Care Centre
HbA C1
Serum C-PeptideSerum InsulinSerum anti - GADA antibodySerum anti - ICA antibody
OBESITY& DIABETES
CARE CENTRE
Where move to life
11
EXPERIENCES
'I had been a diabetic, difficult to control even with 40 units of insulin per day. And then, I got a chance to attend a seminar on bariatric surgery in Moulana Hospital. After learning about it further, I underwent it on 07-09-2010, after which, for about six months, I could have diabetes control with oral tablets alone. Slowly the tablets also could be completely stopped and now I am totally free of diabetes. I feel much more enthusiastic and energetic than before. Surprisingly even slight indiscretion with sweets does not increase blood sugar. Taking cue from my experience, my husband, who has been taking 60 units of insulin every day for the last nine years, underwent the same surgery on 17-02-2011 and he too is totally satisfied with the results, as he needs only minimal oral medicines for diabetic control. We are indebted to Dr. Mohamed Ismail for this happiness.'
I had been diabetic for ten years and had to take 16 units of Insulin apart from tablets. The ever felt tiredness and sleepiness even started to affect my business. It was when, out of desperation, I was thinking of even selling my shop that I came to know that Dr. Ismail was doing surgeries for control of diabetes. I did undergo the surgery on 27-09-2011 and am now totally healthy and happy. Diabetes is now fully under control, not having to take any medicine. I don't feel tired even after doing work up to 9.30 at night. I owe this happiness to Dr. Ismail and Moulana Hospital.
˛Shirley Anil Kumar (49)Kottarakkara
Ph: 9947836533
-Prakash (42)PathanamathittaPh: 9495112318
-Sali. P.K. (56)Ernakulam
Ph: 9846150041
'I had been diabetic for 12 years. At first, had been taking only tablets. Slowly the severity of the disease increased, and reached a state when I had to take 70 Units of Insulin also apart from the tablets. Besides high cholesterol levels and high blood pressure also caught me on. It was then I had occasion to see a television interview in which Dr. Ismail disclosed a surgery to control diabetes. Though unbelievable at first, further enquiries about it were being made and, quite accidentally, I happened to see a relative of mine, who had undergone the surgery and as a result, she could stop all anti-diabetic medicines. I too, thus, underwent the surgery on 27-10-2011. Now I am fully healthy and energetic, much better than before the operation. The high levels of blood pressure and cholesterol and diabetes, all the three, are now under control. Now, I am not taking any medicine for diabetes. I am indebted to Dr. Mohamed Ismail and his team.
TEAM OF CONSULTANTS
= Performed more than 60,000 Laparoscopic surgeries = Performed more than 6500
Endoscopic Hernia repairs = First centre in Kerala to start Laparoscopic oncosurgery
= Performed more than 300 Bariatric surgeries = One of the few centres in India performing
metabolic surgery for the surgical control of diabetes = Performed more than 30 metabolic
surgeries for patients with BMI less than 35 = More than 3000 Stapler hemorrhoidectomies,
largest number in the country = More than 3000 varicose vein surgeries (Now Radiofrequency
ablation also) = Centre for the early detection and surgical treatment of carcinoma breast
= More than 1000 thyroidectomies = Centre of excellence in all kinds of minimally invasive
surgical procedures
Dr. Zacharia MD, DMEndocrinologist
Dr. Ajay. K. Gopal MD, DM, MRCPInterventional Cardiologist
Dr. Markose MD, DMInterventional Cardiologist
Dr. Sunil Sivadas MD, DMInterventional Cardiologist
Dr. Muhammed Muneef MD, DTCD, FCCPInterventional Pulmonologist
Dr. Sasidharan DAAnesthesiologist
Dr. Sudhakaran DAAnesthesiologist
Dr. Sherin Rajiv DA, DNBAnesthesiologist
Dr. Firdhouse DAAnesthesiologist
DEPT. OF GEN. SURGERY, G.I. ENDOSURGERY, BARIATRIC & METABOLIC SURGERY
Published by: Dept. of Gen. Surgery, G.I. Endosurgery, Bariatric & Metabolic Surgery, Moulana Hospital, Perintalmanna
For private circulation only
Dr. Mohamed Ismail MS, FICS, FMAS
Chief Bariatric & Metabolic Surgeon
Dr. Mahesh Rajagopal MS, FICS, FMAS
Dr. Muhammed Shereef MS, FMAS
Dr. Sreejith Nair MS, FMAS
Dr. S.V. Krishnankutty BAMS, MDPhysician
Dr. Pradeep MDPhysician
Dr. Sujith. S DCH, MDPhysician
Dr. Anoop MBBS, DNB (Psych)Psychiatrist
Dr. Febina Seethi MD, DPMRPhysiatrist
Mrs. Liji MScDietician
Ms. Sayana MScDiabetic Educator
Mrs. ShakeelaCo-ordinator
Mrs. Vinitha Co-ordinator
Dr. Hafiz Ansari DNB
CONSULTANT SURGEONS
