Fear of Surgery

Fear is one of the most common reactions from patients when they are offered Metabolic Surgery.
This is understandable. The layman's view of surgery is always associated with pain, complications, disability and even death.

What they don't realise is that surgery has completely changed over the last twenty years. Nowadays it is high tech and minimally invasive. The equipment we have now is beyond the imagination of surgeons 20 yeats ago. We can cut without bleeding, we can seal without stitching, we can do amazing things through the tinniest holes.

Patients today can get up and walk around immediately after surgery. They can drink. They can go to toilet. Much surgery today is day surgery or only one night stay in hospital. The risk is very very much reduced. The pain and disability is minimal.

Surgeons paid a very high price to achieve this revolution.

On the other hand living with Diabetes and Obesity detracts so uch from life. Both longevity and quality are seriously compromised. The complications from Diabetes are horrible. They include blindness, kidney failure, amputation, heart disease, stroke and many more.

Why not give yourself a chance to have a normal and healthy life once again.

There is a raging debate over the internet about which way minimally invasive surgery should go. The contenders are 1. NOTES which is natural orifice surgery, 2. Singapore port surgery where evrything is done through the umbilicus and 3.Mini or neeldescopic surgery.

The issues are, which has less pain, which gives the best scarring and which is the safest. The Jury is still out on this debate.

My own preference stays with the mini or neeldescopic technique using 2 and 3 mm instruments. As you can see in this picture, the puncture wounds are hardly visible after some months. I think it also wins hands down on safety. As for pain, the differences are probably minimal between the 3 approaches and statistically significant differences will be difficult to show.

Mini or neeldescopic technique is ideal for operations like gall bladder removal, hernia repair, appendicectomy and perhaps even funduplication in slim individuals.

http://gallbladdercancer.wordpress.com/2009/09/16/ca-19-9/

Today I learnt something new about CA 19-9 the Cancer antigen. I have a 70 year old lady who had a markedly raised CA 19-9. We investigate very thoroughly to look for a malignancy,

I read the website above and found this:

CA 19-9 is elevated in most patients with advanced pancreatic cancer, but it may also be elevated in other cancers, conditions, and diseases such as colorectal cancer, lung cancer, gall bladder cancer, gall stones, pancreatitis, cystic fibrosis, and liver disease. Other causes of bile duct obstruction may also cause very high CA 19-9 levels, which fall when the blockage is cleared. It is often a good idea, if the bile ducts are blocked, to wait a week or two after the blockage is removed or treated to check CA 19-9 levels

CT scan did not reveal any pancreatic cancer in this case but she had multiple gallstones and thickened gall bladder wall.  One of the stones must have dropped into the bile duct and temporarily caused a rise in CA 19-9.

The lady agreed to have neeldescopic cholecystectomy.

It's strange how history repeats itself. Once more I may be operating once again in Deutschland. Professor Stefan Saad is a brilliant German surgeon whom I used to  work with in Cologne at the Krankenhaus in Merheim. He is now Chefartz at the Hospital in Gummersbach.

We have now organized to work together on bariatric surgery. Patients who prefer to be operated in Germany may have their sleeve resections and bypass operations done at this hospital. It has excellent fascilities and prices are very reasonable even by Singapore standards.

Had a really productive week in Doha. This time we completed 32 operations in one week. On the first day alone we did 9 cases and 7 operations were done just the day of my departure. The rest of the days we were plaqued by unavailability of operating rooms. Nevertheless it was a good result from a weeks visit.
The picture shows a happy Palestinian patient and her 2 lovely daughters. Many of the patients have had gastric banding and were being converted to sleeve resection. One patient had a migrated band which we removed endoscopically through the stomach.
There is still a 2600 waiting list and every clinic at least 10 new patients added to it. It will take at least 2 years to get to any patient registering now.

Tomorrow I head out for Doha again. Not for another round of Doha talks but to slowly chip at their enormous obesity and Diabetes case load. Before I leave I want to leave you all with this paper that shows great results with the Laparoscopic Sleeve resection and for the treatment of Type II Diabetes.

http://www.medscape.org/viewarticle/763098

There are now critics from the medical community who do not see surgery as the mainline treatment for obese diabetics. They are concerned about the high cost and they claim that lifestyle change and weight loss is the key.

We have know this for a century but we should now realise that solutions based on behavorial control are almost impossible to achieve or take a long time. Meantime the terrible compications of Diabetes will take its toll. The critics do not take into account the Billions of dollars spent every year on doctor's visit, medications, and the treatment of complications and coutless investigations.

When we have a one shot solution we should take it.

Toxic Fat

Fat around the waist is nothing but trouble. It is well worth getting rid of. More harm is done by the fat inside the abdominal cavity than the fat just under the skin. Both contribute to the "pot-belly" and the apple configuration. It is one of the features of the Metabolic Syndrome.

Strange sex fact 10: Orgasms can prolong your life
Good news at last! Something pleasurable is actually good for us. In 1997, the British Medical Journal noticed a strong correlation between orgasms and mortality rates, pointing out that those who orgasm two times a week or more can add up to eight years on to their life. Doing the deed adds a bit of ‘oomph’ to the immune system, improves hearth health, boosts brain power and much more. We can’t think of a better excuse to get it on!

This Video shows how more Diabetics are now opting for surgery to gat rid of their Diabtes once and for all. An even simpler operation, Laparoscopic Gastric Sleeve Resection obtains almost the same effect on Diabetes as the Bypass operation.

Cleveland Clinic Report.
Diabetes is now best treated by Surgery.
Cure is possible.

http://www.youtube.com/watch?v=IBfvTBFAByA

Check out this Video Clip.

Cancer and Obesity

One study, using NCI Surveillance, Epidemiology, and End Results (SEER) data, estimated that in 2007 in the United States, about 34,000 new cases of cancer in men (4 percent) and 50,500 in women (7 percent) were due to obesity. Recent studies indicate that obesity and being overweight may increase the risk of death from many cancers, accounting for up to 14 percent of cancer deaths in men and 20 percent of cancer deaths in women. NCI:Fact Sheet:Obesity

According to the Annual Report to the Nation on the Status of Cancer:

• Considerable evidence suggests that excess weight may be associated with increased risk of other cancers, including gallbladder, liver, thyroid, and hematopoietic cancers.
• Lack of physical activity is associated with increased risk of colon, endometrial and postmenopausal and maybe premenopausal breast cancer.
• Excess weight is associated with poorer survival among patients with breast cancer and colorectal cancer.” Eheman C, et al Annual Report to the Nation on the Status of Cancer, 1975-2008, Cancer 2012 May 1;118(9):2338-66

The connection between obesity and cancer have been attributed to:
Hormones, growth factor and inflammation.

Patients who are overweight should go for cancer screening regularly. This should include blood tests and endosopy foe men and women and additionally mammogra/ultrasound of breast and Pap smear for women.

 

Cost of Bariatric and Metabolic Surgery

The main constraint to the uptake of bariatric and metabolic surgery in the Singapore context is the cost of the procedure. The main cost is however not the Surgeon's fee. Two major components are the fascility fee charged by the hospital and the cost of the disposable staplers used to perfom the surgery.

Patients now have the hope of reducing these two components. Some of the simpler procedures can now be done as day surgery. Yes, it has now become that safe and routine. The Fascility fee can now be cut to around one third. A good surgeon can also minimize the number of staplers used thus saving some cost.

The operations are now far more affordable.
http://www.facebook.com/#!/groups/326209247474320/

For information : advancesg@gmail.com

How Obesity shortens your life.
At the end of every chromosome is a sequence of DNA called a telomere. They are repeating sequences and in humans it is thousands of base pairs long. On the average, as we age we lose 50 base pairs every year. Despite this if we live to 100 years our telomeres are just 50% reduced. Fat people lose 250 base pairs per year and thus age 5 times faster. In order to slow down aging we must remain slim.

It has been shown that every 1Kg of excess weight reduces your life expectancy by 2%.

 

Recently I have been doing bariatric and metabolic surgery in Doha in Qatar. There is a big problem with obesity and Type II Diabetes in the country. There are about 2600 patients on the waiting list for surgery. The main operation done there is the laparosocpic sleeve resection which takes care of bothe the obesity and Diabetes in short order. What is more hypertension and lipid disorders are often corrected as well.
The team there is really expert and the surgery usually takes just over an hour. Patients are mobile the day after surgery.
The program is doin a lot to help the people in the country control this huge problem.
Contact : advancesg@gmail.com for information.
I think the problem with Obesity and Diabetes is endemic in many other countries in the Asian region.

This procedure is called the Laparoscopic Gastric sleeve resection. 70% of the stomach is removed using specially designed laparoscopic staplers which resect and seal very safely. The procedure has both weight loss and anti diabetic effects. There are 2600 case on the waiting list at the hospital in Doha, Qatar.

Go to this facebook site to learn more:
http://www.facebook.com/#!/groups/326209247474320/

Back in action 

I have decided to reactivate this blog as there have been real new developments in the field of obesity and the management of Diabetes Type II. Dr. Michel Gagner from Canada developed the operation of laparoscopic gastric sleeve resection and suddenly there is a potent weapon for getting rid of both diabetes and obesity with one quick procedire lasting less than 90 minutes.

This development is so important I decided to start a new facebook group to let people know all about it.
For daily updates, go to : Obesity and Diabetes on facebook
The link is : http://www.facebook.com/groups/326209247474320/

Great to be back.

Peter Goh