Kidney stones occur due to known aetiology. If the aetiology is taken care of, then the stones do not reoccur. Aetiology can be as simple as a person not consuming enough fluids while working in the heat. If a person takes care of such of avoiding the aetiology, he/she may not suffer from reoccurring stones. However, in some patients, stones may keep reoccurring due to abnormal tracts. Kidney transplant if detected early, has a good prognosis without any damage to the kidney.

Symptoms of kidney stones

• Frequent urination especially at night
• Recurrent abdominal pain with high severity
• Change in colour of urine
• Vomiting
• Nausea
• Fever
• Chills

Treatment of kidney stones

If the patient is predisposed to kidney stones, they are advised to consume 3 to 5 litres of water, avoid high protein diet, rough meat meaning fibrous meat, high oxalate foodstuff like cake, coffee, etc. Other treatment options are:

• Lithotripsy: An ultrasound sound wave is projected on the stones to break it into small pieces which can be easily passed out through urine.
• PCNL(Percutaneous Nephrolithotomy): When the stone is very large to be passed through urine, it is removed through a small incision in the back.
• Ureteroscopy: If a stone is stuck in a ureter, a small wire-like tool called ureteroscope is used to remove it.

REASONS FOR KIDNEY FAILURE

There are various reasons for kidney failure which are as follows:

• In case of acute diabetes the kidneys fail to filter out the blood normally.
• Formation of cysts in the kidneys. This could be hereditary too.
• Hypertension causes the arteries in and around the kidney to narrow and eventually fail to function.
• Glomeruli where the kidneys get inflamed affecting the walls of the fibrous filters.
• Injury to kidney due to a major accident.

HEMODIALYSIS VS KIDNEY TRANSPLANT

Hemodialysis is a process where an external machine known as a dialyzer is attached to the patient with a graft. This blood from the patient is transferred to the dialyzer where it filters the blood just like an artificial kidney and then transfers the filtered blood into the body through tubes. This has to be done either thrice a week or almost everyday depending upon the patient’s body.

The patient is suggested for hemodialysis until the next kidney transplant.  A kidney transplant is suggested over hemodialysis because of a few reasons which are as follows:

1. Process of hemodialysis could be slightly painful at times.
2. Requires an external machine every time to filter blood.
3. May require to come to hospital on a frequent basis to perform dialysis.
4. Life expectancy of a person with a transplanted kidney is much more than the one under dialysis.
5. Kidney transplant is a one time process with less frequent visits to hospital for general checkup.

A kidney transplant is suggested when both the kidneys have totally stopped functioning.

Note: Everyone can afford a kidney transplant as dialysis costs a few thousands per session whereas a kidney transplant costs about a few lakhs, depending upon the hospital. Secondly a right match of a donor should be available for the transplant.

IS IT LEGAL TO TRANSPLANT A KIDNEY?

Yes, since 1994 according to the Transplantation of Human Organs ACT, which was passed by the Government of India it is absolutely legal to transplant a kidney through a donor who may or may not be deceased for therapeutic purposes only and not for commercial purposes.

PROCESS OF KIDNEY TRANSPLANT 

The patient would be on a waiting list waiting for a deceased donor’s kidney to be transplanted or the patient’s surgery could also be performed at the earliest if any family member or a friend is ready to be a donor:

• After the consent from the donor is taken, the donor is ready to donate the kidney. Few medical examinations and medical history might be taken so that the kidney matches to that of the patient.
• Once everything is done, the patient and donor both are given anesthesia as both the bodies would be operated at the same time.
• Post the effect of anesthesia, the surgeon makes an incision and removes the kidney known as Nephrectomy.
• Another surgeon does the required preparations on the patient’s body so that it is compatible for a new kidney placement.
• Donated kidney is placed in the patient while the originally non functioning kidneys remain in their relevant position.
• The surgical incisions on both the donor and patient are closed.
• The patient is kept under observation and few other tests would be done based upon the doctor’s advi.
• Post observation both the donor and patient are discharged.

POST SURGERY: 

• A timely follow up with the nephrologist is to be done by the patient until a year.
• Various medications are to be followed without fail to keep up with a healthy immunity and so that the body does not reject the new kidney.
• Additional drugs to reduce the risk of various infections and complications are given which are to be taken on timely basis.
• A healthy lifestyle  and utmost hygiene is to be maintained for a healthy functioning of the heart.

FACTS REGARDING KIDNEY DONATION: 

• A person can survive with just 1 kidney. Hence donors can still live a healthy and active lifestyle as always.
• Donating kidney is legal but selling of kidney is not.

When Is Dialysis Performed?

Dialysis is performed commonly under two scenarios i.e

1. Total renal damage / permanent kidney failure
2. To filter/ flush out drugs, poisons and toxins from the body.

Types Of Dialysis 

There are two types of dialysis i.e

1. Hemodialysis – Here, an external machine known as a dialyzer is used for the filtration of blood by connecting 2 needles into the fistula or a graft i.e a connection between an artery and vein is made. The dialyzer, which contains many fibers and a dialysate, filters out the waste and  sends the filtered blood into the patient’s body through the second needle. Post the session the needles/ tubes are safely removed and the patient is discharged.

In case of an emergency dialysis a central venous catheter is inserted into the large vein of the groin or neck surface. The catheter (narrow flexible tubular structure) is later safely removed post the process of dialysis

1. Peritoneal Dialysis – Here, the peritoneal lining of the abdomen acts as a vital role for the filtration as the blood is not transferred to any external source of machine. A catheter is inserted in the abdomen through the area around the belly button through which the dialysate can go through the abdomen. The abdomen is then filled with a special fluid called dialysate. Eventually, all the toxins, and other waste material in the blood is drawn out into the dialysate. This then is collected and disposed of in a specific bag attached to the other end.

Reasons For Kidney Failure  

Generally kidney failure would not occur all of a sudden but rather by the gradual depletion of the kidney’s efficiency. This could happen not only by one factor but various factors together also. The factors are as follows

1. Hypertension
2. High blood glucose levels
3. Inflammation in the kidneys which is medically termed as glomerulonephritis
4. Formation of cysts inside the kidneys (PKD) or polycystic kidney disease
5. Inflammation of blood vessels
6. Accident/ Injury on the kidneys
7. Heart Attack

How often is Dialysis performed? 

• Dialysis is performed depending upon the patient’s severity of illness. Only the doctor diagnosing would best suggest the frequency of the dialysis sessions to be done in its respective period.
• On a general note most people get dialysis done thrice a week, known as In-Centre Hemodialysis. Per session would last anywhere from 3 to 5 hours.
• For patients in critical conditions, dialysis would be done almost everyday but for a shorter duration of time. This is done at home where each session would last about 2 to 3 hours.

Chronic Kidney Disease (CKD) and End-Stage Kidney Disease (ESKD)

It is the most common kidney disease. In case of a progressive decline in a kidney function over a period of 3 months, then the patient is said to have chronic kidney disease. The incidences of this disease have risen rampantly in the last decade. In India, around 7.85 million people suffer from various stages of chronic kidney disease. Around 35 million which is 1/10th of the American population is affected by the disease. This increase in a number of people suffering from the disease is largely owing to the rise in diabetes and hypertension.

Symptoms of CKD  and End-Stage Kidney Disease (ESKD)

The symptoms of a kidney disease are not noticeable in the early stages, therefore there is a high chance of the disease being detected in later stages which can be detrimental to the patient.

The symptoms of CKD are as follows:

• Swelling of hands, face and legs
• Difficulty in breathing
• Loss of appetite
• Vomiting
• Itching
• Non-specific body pain.

Some patients may also complain about frequent urination in the night. After observing the symptoms further investigations are conducted on the patient. Serum creatinine is normally excreted through kidneys, when there is an impairment to the kidneys, there is a rise in the accumulation of creatinine in the blood. So this is an important marker used to quantify/ diagnose the disease or understand the extent of disease. Urine examination is conducted to determine if the protein is being excreted out in urine. Ultrasound is used to understand the morphology of kidneys. Normal kidney size is 9 to 11 cm in length and 3 to 5 cms of width. If the size of kidney changes beyond these sizes, a person is said to be suffering from kidney disease.

What is the course of treatment for CKD  and End-Stage Kidney Disease (ESKD)?

Initially, the categorization of the disease is done into 1 to 5 stages on the basis of eGFR (estimated glomerular filtration rate) which is the filtration capacity of the kidney. The following are stages depending on eGFR:

The history of the patient is investigated to understand the status of pre-existing conditions like diabetes and hypertension if any. The pre-existing conditions are monitored and efforts are taken to bring them in control. Following suggestions are made to the patients to bring CKD in control:

• Exercise regularly.
• Quit alcohol consumption.
• Quit smoking.
• Avoid over-the-counter medicines like painkillers.
• Diet should have low potassium and phosphorus levels.

When the patient reaches Stage V of CKD, they require renal replacement therapy along with other general care. The two renal replacement therapies available are dialysis and renal transplantation.

Treatment

Our Nephrologists have experience in handling the most complicated kidney transplants. We have performed different types of kidney transplants such as Cadaver-donor kidney transplantation, Laparoscopic donor Nephrectomy, Cadaveric renal transplantation, and Living donor kidney transplantation. We also offer dialysis, Hemodialysis, and Peritoneal Dialysis. We manage all kinds of illnesses affecting the urethra, bladder, prostate, kidney, and male genitalia in all age groups.

We also offer urology-related treatments for diseases such as Interstitial Cystitis, Constipation, Urinary Tract Observation, High Blood pressure, Kidney stones, Prostate cancer, Chronic Kidney Diseases, Kidney Filtering Disorder, Benign Prostatic hyperplasia, etc. We also perform major endoscopic surgeries for issues such as Laparoscopic Ureterolithotomy, Urodynamic evaluation, Urinary stones, Neurogenic bladders, Prostatectomy, Radical Cystectomy, and urinary incontinence. We are always available for all urological emergencies. 

Diagnosis Services

1. Urolithiasis and prevention clinic.
2. Impotence and andrology clinic.
3. Microscopic varicocelectomy .
4. Urinary stones.
5. Uro dynamic evaluation.
6. Penile doppler.
7. Radical cystectomy and prostatectomy.
8. Vaso-epididymal anastomosis.
9. Laparoscopic urological surgeries.
10. Laparoscopic nephrectomy.
11. Adrenalectomy.
12. Neurogenic bladders and urinary incontinence.
13. Laparoscopic ureterolithotomy.
14. Laparoscopic pyeloplasty.
15. Orchiopexy.
16. Radical prostatectomy.
17. VVF repair (vesicovaginal fistula).
18. Management of CAPD (Continuous Ambulatory Peritoneal Dialysis).
19. Stress urinary incontinence (TVI) surgery.
20. Artificial sphincter placement surgery.
21. Diabetes mellitus.
22. hereditary illnesses.
23. Hypertension.
24. Infections.
25. Stone disease. 
26. Poisons.

Our Clinical Team

• Dr. J.N. Srinivasulu
• Dr. B. Sreenivas Rao
• Dr. M. Prasada Rao
• Dr. Ravinder Reddy
• Dr. K. G. Govinda Reddy
• Dr. Seshadar
• Dr. Santhosh Bukya

Testimonials

• Omni Hospitals has always been offering patients with the best diagnosis and treatment. Their entire team of doctors and nurses always strive to make patients comfortable. Thank you for being the best.
• Doctors at Omni have made me comfortable right from the first consultation. They have provided me the comfort needed and also were patient when explaining the surgery procedures.
• Great team! You guys are the absolute best in making the patient comfortable. Thank you for being patient and taking the best care of me at odd hours. 
• I have visited many specialists regarding my kidney issues but there was no permanent solution. But at Omni, they have provided me with a course of treatment that is nursing me back to my health. 
• I had an excellent experience at Omni. I was suffering from prostate issues and right from the get-go the doctor was extremely cooperative and made me feel comfortable. 
• Thank you to the whole team of Omni hospitals for taking excellent care of me.
• When I was diagnosed with Bladder issues and Kidney stones, I really did not know how to take care of myself and was worried if I would be able to go back to my daily life. But doctors at Omni have been a constant support and helped throughout my healing process. Thank you for your service.
• Omni Hospitals is the best in patient care.
•  Ref- Apollo, WebMD, Max cure

Foot and lower leg ulcers are one of the many problems caused by poorly controlled diabetes. Ulcers that do not heal can lead to amputations of toes, parts of the foot, or the lower leg. Diabetes damages blood vessels throughout the body.

Calluses, blisters, cuts, burns, and ingrown toenails can all lead to diabetic foot ulcers. A patient may not be aware of these minor injuries due to peripheral neuropathy, so ulcers may develop and enlarge before they are noticed. Daily foot inspection is an important part of diabetes management and can help prevent foot ulcers.

Here is an excerpt from a video interview of Dr M Raja, Consultant General and Laparoscopic Surgeon at OMNI Hospitals, Visakhapatnam on Diabetic Foot Care - causes, prevention and treatment.

Q. What are diabetic ulcers?

A. Diabetic foot ulcers form as a result of a loss of peripheral sensation and are typically seen in individuals with diabetes. Local paresthesias, or lack of sensation, over pressure points on the foot leads to extended microtrauma, breakdown of overlying tissue, and eventual ulceration.

Q. What are the symptoms of diabetic ulcers?

A. The appearance of diabetic foot ulcers will vary based on the location and patient’s circulation and can appear as calloused blisters to open sores that are reddish to brown/black. 

The wound margins are usually undermined or macerated, and the surrounding skin will often be calloused, with the depth of the wound depending on the amount of trauma the skin has been subjected to.

Q. What are the causes of diabetic ulcers?

A. Both type 1 and type 2 diabetes cause damage to blood vessels and peripheral nerves that can result in problems in the legs and feet. 

Two main conditions, Peripheral artery disease (PAD) and Peripheral Neuropathy are responsible for the increased risk of foot problems in people with diabetes.

- In people suffering from Peripheral Artery Disease, there is a decreased delivery of oxygen to the lower legs and feet. In severe cases, the lack of oxygen delivery to tissues results in ulcers and even gangrene (tissue death)

- In people suffering from Peripheral Neuropathy, there is damage to the peripheral nerves directly as a result of diabetes. Peripheral Neuropathy decreases sensation in the nerves of the legs and feet, making it difficult to perceive injuries due to lack of feeling. It can also cause the muscles of the feet to work improperly, leading to misalignment of the foot that can put pressure on certain areas of the foot

Q. What are the three main complications that arise due to lack of sensitivity?

A. Three complications arise from lack of sensitivity:

- Constant pressure for several hours leads to local ischemic necrosis (e.g., in the absence of pain when wearing tight footwear).

- High pressure over a short period of time leads to immediate injuries. Objects with a small surface such as nails, needles, and sharp stones etc. cause direct mechanical damage.

- Repetitive moderate pressure causes inflammatory autolysis of tissue. Ongoing pressure on already inflamed or structurally affected tissue additionally promotes the development of ulcerations. Furthermore, gangrene develops from burns with hot items such as hot-water bottles and heating blankets, excessive sunbathing, acid burn (“corn plaster”) as well as improper use of disinfection products.

Q. How is a diabetic foot ulcer physically examined?

A. A physical examination includes inspection of the stature, gait, foot (the integrity of skin, muscular condition and bone structure, deformities of the feet such as claw toe, hallux valgus, hollow foot, skew foot and flat foot) and footwear. Prominent features are dry and fissured skin with hyperkeratosis as a sign of polyneuropathy.

Q. What are the stages involved in diabetic foot ulcers?

A. There are two main systems to classify the stages involved in diabetic foot ulcers.

The Wagner diabetic foot ulcer classification system assesses ulcer depth and the presence of osteomyelitis or gangrene by using the following grades:

Grade 0 – intact Skin

Grade 1 – superficial ulcer of the skin or subcutaneous tissue

Grade 2 – ulcers extend into tendon, bone, or capsule

Grade 3 – deep ulcer with osteomyelitis, or abscess

Grade 4 – partial foot gangrene

Grade 5 – whole foot gangrene

The University of Texas system grades diabetic foot ulcers by the depth and then stages them by the presence or absence of infection and ischemia:

Grade 0 – pre or post ulcerative site that has healed

Grade 1 – superficial wound not involving the tendon, capsule, or bone

Grade 2 – wound penetrating to tendon or capsule

Grade 3 – wound penetrating bone or joint

Within each wound grade there are four stages:

Stage A – clean wounds

Stage B – non-ischemic infected wounds

Stage C – ischemic non infected wounds

Stage D – ischemic infected wounds

Regardless of which classification system is used, it is essential that the system is used consistently across the healthcare team and be recorded appropriately in the patient’s records.

Q. What are the treatment options available for diabetic foot ulcers?

A. The two main treatment options are,

Conservation therapy: 

The main objective is to stop progression to prevent further deformities of the feet resulting in ulcers. Disease activity is measured by the degree of swelling, erythema and especially skin temperature. The difference in temperature should be at least 2 °C compared to the unaffected side. The basic therapeutic principle is a quick and consistent pressure relief by means of temporary immobilisation, wearing of a protective cast (Total Contact Cast) or orthosis until the acute phase has subsided. Patience is needed from both the patient and diabetes team as this process can take months.

Surgical therapy:

It becomes necessary in cases whereby plantigrade foot position and resilience of the foot cannot be gained by conservative approaches. Once the healing of ulcers is fully complete, local exostoses should undergo resection. Resection of exostoses by elliptical circumcision of ulcerations may be an alternative for plantar ulcers and exostoses. For serious Charcot deformities of the feet and instabilities, arthrodesis measures should be employed. The most important objective of treatment is then the resilience of foot, plantigrade foot position and adequate shoe or orthosis provision.

Q. What are other complications that can arise due to diabetic foot ulcers?

A. Complications like renal disorders, arthritis, weakness, ingrown toenails, athlete’s foot and corns can arise due to diabetic foot ulcers.

Q. Is it recommended to wear sports shoes continuously for 10 hours?

A. It is usually recommended to not wear any shoe for more than 4 hours, although in a healthy condition, it doesn’t matter much.

Q. Which specialist should be consulted for diabetic foot ulcers?

A. Diabetic foot ulcers are generally taken care of by multiple specialists that include a physician, general surgeon, plastic surgeon, orthopaedic surgeon and more.

Q. What is the pathogenesis of diabetic foot ulcers?

A. Most cross-sectional studies have revealed that chronic ulcerations are most often preceded by minor trauma.

About 50% of patients with diabetes mellitus develop symptomatic peripheral neuropathy within 25 years of disease onset. Patient age, disease duration and quality of diabetes control are strong influencers of the disease. Signs of autonomic neuropathy can be found in 20% of cases, again in strong correlation with age and disease duration as well as microangiopathy.

Q. In this condition, when is limb amputation indicated?

A. If the patient is diagnosed in later stages of the ulcer, limb amputation is indicated.

Q. Are diabetic ulcers and diabetic foot ulcers different?

A. There is no difference.

Q. Does family history play a role in diabetic foot ulcers?

A. Yes as family history plays a role in diabetes, it also plays a role in diabetic foot ulcers.

Q. Does diabetic ulcer occur only in the foot?

A. It occurs mainly in the foot and sometimes in other places. 

Q. How often is a review necessary for people with diabetic foot ulcers?

A. A weekly review is required for people with diabetic foot ulcers.

Q. What is cellular dysfunction of wound healing?

A. Diabetic foot lesions cause a complex dysfunction of cellular wound healing. In addition to general impairing factors of wound healing such as age, fluid and nutritional status as well as hyperglycaemia, the system character of diabetic disease causes alterations at the cellular level. These include disturbed microcirculation, reduced inflammatory reaction, reduced fibroblast proliferation, and an altered cytokine-protease profile.

Q. What is the treatment for diabetic foot ulcers?

A. The first step in the treatment of diabetic foot ulcers is to remove necrotic wound tissue from the wound. It is essential that the method of debridement utilized does not damage the nerves, tendons, and blood vessels. Since many people with diabetes don't feel pain from the wound site, health care practitioners can't rely on the patient to let them know when sensitive areas are being examined. The debridement will:

- Reduce pressure on the ulcer.

- Stimulate wound healing.

- Allow the healthy underlying tissue to be examined.

- Help the wound to drain.

- Optimize the effectiveness of the wound dressing.

Q. What is infection prevention?

A. Aggressive infection control is necessary to prevent infection. High morbidity and mortality rates are associated with diabetic foot ulcers which means oral and topical antibiotics are recommended if there is any sign of infection. Typically, wound dressings impregnated with antimicrobial agents are used. Simple gauze may actually damage the skin. Alginate and foam dressings provide high absorbency for moderate to heavy exudate. For a diabetic foot ulcer with dying tissue, hydrogels or dressings with collagen and silver are most effective. Most important is matching the absorptive ability of the wound dressing to the amount of wound drainage.

Q. What are advanced foot therapies for diabetic foot ulcers?

A. Physicians of individuals with diabetic foot ulcers may have difficult decisions to make if wounds don't heal. Many of these patients have a significant cardiac risk and health care practitioners need to make complicated decisions about whether to perform invasive procedures like angiography. Other options can be:

- Covering the wound with cultured human cells.

- Heterogenetic dressings or grafts with recombinant growth factors.

- Hyperbaric oxygen therapy.

Q. How can one prevent a diabetic foot ulcer?

A. Individuals with diabetes should be instructed to:

- Examine their feet daily with a mirror and to look carefully for fungal infections or any abnormality.

- Wash and dry feet at least once a day in lukewarm water (tested with elbow), paying special attention to dry between the toes.

- Not use heating pads or put feet close to heaters.

- Always use footwear inside and outdoors.

- Use close-toed shoes if they can't feel their feet.

- Always use socks and change them daily.

- Treat dry feet with lubricants containing urea or salicylates.

India is cited as Global Capital of Diabetes owing to the astounding figure of 70 million diabetics. World Health Organisation estimates that this figure will increase by almost 45% to 101 million by 2030.

The sedentary lifestyle of the corporate employees in a cubicle with easy access to food that is canned and beverages which add to carbohydrates but with little fibre content, the stress to compete and win and abnormal sleeping patterns all culminate in an individual with high risk for obesity, lipid abnormalities, hypertension and diabetes. About 25% of people with diabetes eventually develop kidney disease. This figure is higher if family history of diabetic kidney disease is present.

Here is an excerpt by Dr Sreedhar Sharma Medavaram, Consultant Nephrologist, OMNI Hospitals, Kurnool about taking care of your kidneys in the global capital of diabetes.

Q. How does diabetes affect kidney?

A.  Apart from the widely known fact about diabetes that the glucose levels are increased, the lining layer of the blood vessels (endothelium) is at fault. This lining is important in preventing the leak of proteins into the space around the vessels and it is vital in preventing the blood from clotting. An injured endothelium attracts platelets and blood clotting factors, thus predisposing to blood clots there by blocking circulation.

In diabetes owing to the endothelial dysfunction, the proteins from filtering units of kidney (glomerulus) leak into the urine. This leaked protein causes damage to the tubules thus worsening the kidney function.

Also the protein lost in urine causes the blood proteins to be low. This low protein in the blood is the cause of leg swelling and puffiness around the eyes we see in diabetic kidney disease patients. The leak of proteins is exacerbated by hypertension. The cornerstone of treatment of diabetic kidney disease lies in strict sugar control, drugs that decrease protein leak and also drugs that control hypertension.

Good news is that diabetic kidney disease can be prevented by several steps:

• Regular exercise (at least 30 minutes aday)
• Quit smoking
• Avoidingalcohol
• Maintaining healthy bodyweight
• Being vigilant and taking medical advice early in case of urinary tract infections
• Avoiding over the counter pain killer medicationsand drugs that cause kidney damage

Diabetic kidney disease is a slowly progressive disease over a period of three decades from onset to dialysis dependant renal failure. The pace of deterioration of renal function varies from person to person.

Follow your doctor’s advice. Taking blood pressure medications on time as blood pressure control is the cornerstone of management of diabetic kidney disease. Eating wisely keeping in view of the blood glucose levels. Certain kind of pills used to control blood sugars may become less effective or may require dose modification as the diabetic kidney disease progresses. Certain medications (e.g. Metformin) may have to be totally stopped when renal function declines. Periodic checking of serum creatinine levels (an indicator of renal function) helps in avoiding these problems. Cholesterol-lowering medications and medications to decrease protein leak from kidneys have been shown to retard the progression of kidney damage.

Frequent episodes of low glucose and requirement of lesser doses of insulin for glucose control indicate deteriorating renal function. AV fistula creation over non-dominant arm can provide access to future haemodialysis (HD), if renal function deteriorated and necessity for HD is anticipated.

Continuous Ambulatory Peritoneal Dialysis (CAPD) and Renal transplantation are other options available when End- stage kidney disease has set in requiring dialytic support.

Keeping stress at lower side by planning, meditating, keeping reasonable targets and being kind to yourself and learning to let go will make you the winner.

Q. What is Daycare Surgery?

Q. When did the Daycare Surgery concept originally evolved?

Q. What facilities are required to set up a Daycare Surgery?

• Surgeon
• Anesthetist
• Floor Managers
• Operational Managers
• Nursing Staff

Q. What is a day surgery cycle?

Q. What factors are considered for the daycare surgery process?

Good Caretaker

Emergency Conditions

Contact Numbers

Environmental Conditions

Medical factor

Obesity

Smoking

Q. What investigations are required for daycare surgeries?

Q. What should be the ideal condition of the patient for a daycare surgery?

Q. What are the most common daycare surgeries?

Q. What is the role of the Anesthetist in daycare surgery?

Q. What kind of anesthesia is preferred?

Q. What are the benefits of daycare surgery over traditional surgery?

• In the case of traditional surgery, the patient has to stay in the hospital for a few days or weeks. Moreover, the patient may get infections for remaining in a room for more than a week. The charges for staying in the hospital also increases in traditional surgeries.
• Early mobilization i.e., ability to walk around is one of the greater advantages of daycare surgery.
• The patient may feel less pain in the location of the surgery as it involves minimally invasive surgical techniques. The patient can be discharged from the hospital on the same day of the surgery.

Q. What kind of role does nursing staff play during a daycare surgery?

Q. What is the recovery process followed in daycare surgery?

Q. What are the post-operative instructions given to the patient at the time of discharge?

Q. What kind of post-operative complications are expected in a daycare surgery?

Q. What are the advantages of daycare surgery?

• Faster Recovery
• Lesser Hospitalization course
• Peacefulness to the patient
• Not prone to hospital infections i.e., nosocomial infections

Q. What are the contraindications for a daycare surgery?

In the current epoch, Diabetes has become the most common health problem in the maximum number of people globally. Diabetes is actually caused when blood glucose or blood sugar levels in the body increase. Due to increased sugar levels in the blood, most of the people get Diabetes. However, there are different types of Diabetes.

Some of them may get a type of Diabetes that is very complicated. In some people, the Diabetes type may not be critical and it is possible to manage it through a few lifestyle changes. Through this blog, our readers will be able to understand more about Diabetes, its cardinal symptoms, treatment options and a lot more.

Here is an excerpt from a video interview with Dr. L. Venkatesh, Director and Chief Consultant Physician at Omni Hospitals, Vizag on the topic Diabetes, types of Diabetes, its causes, symptoms, how to diagnose, complications of Diabetes and more. Get answers to all your queries about Diabetes and its complications in children, adults and pregnant women.

Q. What is Diabetes?

A. Diabetes is a metabolic disorder that occurs due to increased blood sugar levels. It is actually caused due to insulin secretion deficiency or insulin resistance. In fact, blood glucose is the cardinal energy source and produces from the food that we eat in our day to day lives.
Insulin is a hormone that helps in transforming glucose from food into the cells for energy. Whenever a human body doesn't produce adequate insulin, glucose remains in the blood and doesn't reach cells. As a result, over time, glucose levels in the blood increases eventually causing Diabetes.

Q. What are the types of Diabetes?

A. There are different types of Diabetes. The most common types of Diabetes include:

• Type 1 Diabetes
• Type 2 Diabetes
• Gestational Diabetes

These three are the most common types of Diabetes that we usually come across in the maximum percentage of people. Besides these types, there are a few less common types.

Q. What is Type 1 Diabetes?

A. Type 1 Diabetes is an auto-immune disorder, which is seen in some people below 30 years of age and is also witnessed in children. In this Type 1 Diabetes disorder, we can confront the symptoms at an early stage. Some of the symptoms that appear all of a sudden include rapid weight loss, lack of insulin levels in the body and more. If these symptoms are seen in children then, such kids must depend on insulin for a lifetime.

Q. Explain Type 2 Diabetes?

A. Type 2 Diabetes is another most common type of health disorder that is usually witnessed in adults between 30 to 40 years of age. In this type of Diabetes, people witness mild symptoms. In such adults, the production of insulin will be in a normal amount. But, due to insulin resistance, the functioning may not be proper. People with Type 2 Diabetes may have complications during diagnosis.

Q. What is Gestational Diabetes?

A.Gestational Diabetes is a type of diabetes that occurs in women during pregnancy.In such pregnant women, there will be increased health risks both for mother and baby. Women with gestational diabetes during pregnancy can manage this type of diabetes through insulin injections.

Q. What are the complications of Diabetes?

A.There are two types of complications in people with Diabetes. It includes acute complications and chronic complications.

Acute Complications

• Diabetic ketoacidosis
• Hyperosmolar Diabetic coma

When the patient lands in critical conditions due to increased blood sugar levels, they may go into a coma. Such patients must be treated in the ICU [Intensive Care Unit].

Chronic Complications

Some of the most common chronic complications include:

Neuropathy:

It is the most common chronic complication of Diabetes. It causes nerve damage in patients with Diabetes in the chronic stage.

Retinopathy:

It is another complication in which the patient may end up causing eye damage.

Nephropathy:

It is the involvement of kidneys wherein the patient's kidney may get damaged due to Diabetes. Nephropathy is another common chronic complication of Diabetes.

Cardiovascular Diseases:

These diseases are related to the heart. Some of the chronic complications of Diabetes include Heart Attack, Brain strokes, heart strokes and more.

Amputations:

People with Diabetes may have the risk of amputations. It means, when Diabetic patients get ulcers or wounds, they won't heal like the way it heals in normal people. It is another chronic complications that we come across in diabetic patients.

Q. What are the cardinal [primary] symptoms of Diabetes?

A. Some of the cardinal or the major symptoms of Diabetes include:

1. Polyuria

It is very common that most of the diabetic patients frequently pass urine. There is a reason behind it. This type of symptom is called Polyuria. Polyuria is the need to urinate on a frequent basis. When the blood sugar levels are abnormal i.e., increased sugar levels, it excretes through the kidneys in the form of urine automatically.
Glucose is the high-density molecule present in the body. During the excretion process, glucose brings out more water alongside during urination. As a result, most of the diabetic patients complain about the increased frequency of urine.

2. Polydipsia

Polydipsia is another symptom in diabetic patients wherein they feel increased thirst. Due to the heavy loss of water in the body, the diabetic patient reaches the dehydration state. In such a situation, the patient feels more thirsty. So, the patient often has a thirsty feeling and ends up drinking more water. This particular symptom is known as Polydipsia.

3. Polyphagia

Polyphagia is related to increased appetite. It is another cardinal symptom of Diabetes. In such a case, the patient intakes food repeatedly. Usually, glucose present in the blood produces energy when sugar molecules in the blood enter into the cell wherein it burns and releases calories.

In Diabetic patients, the glucose molecule may not enter into the cell due to the lack of insulin. Eventually, the production of calories in the body reduces. As a result, the patient feels more hungry due to the limited production of calories. This symptom is called as Polyphagia.

Whenever a person complains about having the aforementioned cardinal symptoms then, they are said to have Diabetes. However, such people must consult a doctor and get a Diabetic test for confirmation.

Q. How to Diagnose Diabetes?

A. There are some procedures to diagnose Diabetes in people. People who suspect Diabetes after witnessing some of the aforementioned symptoms can diagnose diabetes through a few blood sugar tests. Some of them include:

Fasting Blood Sugar:

The normal range in fasting blood sugar is below 100mg/dl. If FPS levels are more than 125mg/dl then, they are said to have Diabetes.

Post-Prandial Blood Sugar:

The normal range in post-prandial blood sugar is below 140mg/dl. If the patient is diabetic then, they will have more than 200mg/dl.

Random Blood Sugar:

Random Blood Sugar is sometimes referred to as RBS. The normal range is below 200mg/dl. If the patient’s random blood sugar level is more than 200mg/dl alongside few cardinal symptoms of diabetes then, they are said to have diabetes.

Q. What is HbA1c?

A. HbA1c means Glycosylated Hemoglobin. In general, sugars are attached to the RBC molecule. The lifespan of the RBC molecule is 120 milligrams. By estimating the HbA1c level, it gives an approximate idea of the sugar levels in people for the last 3 months. Usually, this particular test is performed to monitor long-term control of Diabetes.

Q. How can we manage Diabetes?

A. The management of Diabetes includes multitasking. People who are planning to manage their blood sugar levels must and should make certain modifications in lifestyle. Some of the lifestyle changes include doing exercise, intake of insulin, taking proper drugs such as oral hypoglycemic drugs.

Q. What lifestyle precautions are necessary to Manage Diabetes?

A. Patients with diabetes must follow a specific diet and make various lifestyle changes to manage diabetes. They should evade or reduce the intake of carbohydrates, fatty foods and more.

• Reducing the consumption of high glycemic index substances
• Avoid intake of carbohydrates
• Maintain proper protein diet
• Intake of fresh fruits and vegetables
• Doing any type of exercise like aerobic exercise for about 30 minutes a day. They must practice doing exercise at least 5 days a week.

Q. What is Hypoglycemia?

A. Hypoglycemia is a significant complication of diabetes. It is most commonly seen in patients who are surviving on insulin. If the patient is only on oral diabetic drugs and doesn’t follow a proper diet then, they are prone to hypoglycemia. If the blood sugar levels are less than 70mg/dl then, such patients are said to have hypoglycemia.

Q. What are the Symptoms of Hypoglycemia?

A. Some of the symptoms of Hypoglycemia include:

• Headache
• Dizziness
• Confusion state
• Drowsiness
• Blurred vision
• Weak and feeling irritable
• Profused sweats
• An increased or faster heartbeat

If any diabetic patient complains of having the aforementioned symptoms then, they are said to have Hypoglycemia.

Q. How to manage Hypoglycemia instantly?

A. There is an instant solution to manage Hypoglycemia. They must immediately take any chocolate, candy, sugar or milk mixed with sugar. Soon, the patients will recover from hypoglycemia.

Q. Are artificial sweeteners safe to use?

A. Yes, it is safe to use artificial sweeteners. There is no objection in using artificial sweeteners for diabetic patients.

Dr L. Venkatesh

Director - Chief Consultant Physician

OMNI Hospital, Vizag

Q. What is Chronic Kidney Disease?

Q. What are the Symptoms of Chronic Kidney Disease in a Person?

• Bilateral swelling of legs and face
• Difficulty in breathing
• Severe Abdominal pain
• Loss of Appetite
• Itching
• Non-specific body pains
• Increased urination during the night
• Vomitings

Q. How to Diagnose Chronic Kidney Disease?

• Blood Chemistry
• Blood Urea

Q. How the patients with CKD are treated?

Q. How to treat patients with CKD?

• Avoid Alcohol
• Control Sugar Level
• Regular Exercise
• Stop Smoking
• Control of Hypertension
• Avoid the usage of over the counter medications or drugs

• Include Foods with low phosphorous and low potassium in your diet
• Avoid Non-Vegetarian food
• Avoid fruits which have high potassium
• Stop eating cakes, egg yolk that has high phosphorous

Q. What happens if the patient has stage 5 or end-stage CKD?

Q. What are the common therapies to treat stage 5 CKD?

Hemodialysis

Peritoneal Dialysis

Renal Transplantation

Q. What are the common causes of Kidney disease?

Q. What are the common myths and facts about Kidney diseases?

Q. Is Dialysis better than a kidney transplant?

Q. Will the patient with Kidney problems need to urinate frequently?

Q. What is the follow up for kidney stones?

Q. Is it possible to cure Kidney Stone Prognosis?

Q. Is renal disease hereditary?

Q. Are there any risk factors in patients with CKD?

Q. Will kids get kidney stones?

Q. What are the causes of kidney stones?

Q. How to prevent people from getting kidney diseases?

• Follow a healthy lifestyle
• Regular Exercise [30 minutes walk daily]
• Avoid smoking and alcohol
• Control of Hypertension
• Intake of 3 to 4 liters of water on a daily basis
• Controlling blood sugar levels once diagnosed with Diabetes
• Avoid over counter medications

Q. What are the preventive measures to cure Congenital Diseases or Hereditary Kidney Diseases?

Q. How to prevent kidney stones?

• Intake of adequate fluids
• Avoid Red meat
• Evade Cocoa related products like coffee

Q. What is the normal range of passing urine daily?

Q. Will the ideal amount of water differs from person to person?

Q. What kind of diet a person on dialysis should follow?

• High protein diet
• High-Calorie Diet
• Multivitamins Supplements

Q. Can a person without pain have a kidney problem?