WHY WOULDN’T I QUALIFY FOR BARIATRIC SURGERY?

When patients finally arrive in our office ready to commit to the life change that is bariatric surgery, they are often eager to go and want to have surgery as soon as possible. Years of dieting, exercising, weight loss programs and more are so exasperating that surgery feels like a breath of fresh air and excitement. So, when the news comes back that there may be a hiccup in their qualification for bariatric surgery, it can be downright depressing. But why might a patient not qualify for bariatric surgery?

BMI: First and most obviously, they simply may not have a BMI that is high enough. A BMI of 35 or more with one or more obesity related conditions or BMI of 40 or greater regardless of obesity related conditions is required to have surgery. This is a fixed rule ensuring the patient truly does need bariatric surgery and cannot benefit from other interventions.

Health Concerns: Surgery puts significant strain on the body. Both the surgical intervention and anaesthesia come with risks, and patients in poor general health increase those risks dramatically. That is why we perform several pre-operative tests to ensure this risk is as low as possible.

Smoking: Smoking is a recipe for complications during and after surgery. Patients must be able to quit smoking at least six weeks before the procedure.

Payment arrangements: Not all insurance plans cover bariatric surgery. Further, getting a pre-authorization for surgery is not always successful. While some patients may be denied coverage due to a clerical error or a technicality which can be overturned, other patients may not be deemed candidates for bariatric surgery by their insurance company and therefore not have coverage. Some insurance plans specifically exclude bariatric surgery, but of course, there are always financing, and cash pay options as well.

Other Reasons: There are also some intangible reasons why a patient may not be suitable for bariatric surgery the greatest of which is simply not being ready psychologically and emotionally. This is something that our surgeons take very seriously and will discuss with every patient in detail. Some patients will also need to have a psychological evaluation that is less about mental health and more about emotional suitability for the trials and changes that will undoubtedly occur after surgery.

Of course, while being denied the opportunity to undergo bariatric surgery is difficult to hear, it is done for good reason. The most important focus is on the safety and effectiveness of the procedure. Without that, bariatric surgery becomes less effective and safe. With that being said, we will always work with you to understand what it takes to have surgery. We will have a frank and honest discussion with you about your suitability and whether bariatric surgery makes sense or if non-surgical weight loss may be a better option for you.

To find out if you are a candidate for bariatric surgery, please send an email to dutfun@gmail.com with the heading CONSULTATION WITH DR IVOR FUNNEL.

Source Credit: https://sampadocs.com/2021/01/04/why-wouldnt-i-qualify-for-bariatric-surgery/

Common Vascular Procedures and Treatments

Angioplasty, Atherectomy and Stenting

Arteries, blood vessels that carry oxygen-rich blood to all the parts of the body, are normally flexible and smooth on the inner side, but deposits of cholesterol, calcium, and fibrous tissue (plaque) can build up on the inner walls of the arteries, making them hard, stiff, and narrow.

Arteriovenous Fistula Creation for Dialysis Access

Haemodialysis is a procedure performed to manage patients suffering from kidney failure. A dialysis machine takes over the function of the diseased kidneys by filtering the blood of wastes. During dialysis, you will be attached to a machine called a dialyser through a thin tube.

Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure performed to remove plaque (deposits of fat) from the carotid arteries of the neck; the main blood vessels that supply blood to the brain.

Carotid Stenting

Carotid artery stenting is a minimally invasive procedure to open or clear the blocked carotid artery. It is performed along with carotid angiography, which uses X-ray images to check for the blocked carotid arteries.

Chronic/Non-healing Wound Management

Chronic non-healing wounds are the wounds that do not heal even after a few months or years, secondary to an underlying disease which may interfere with the normal healing process. Chronic wounds can be painful and can adversely affect the quality of life of the patient. Chronic wounds may lead to life threatening complications.

Dialysis Access

Dialysis is an artificial method of purifying the blood in individuals with kidney failure. It helps in removing the impurities and waste products from the blood. Dialysis access is a method of gaining access into the bloodstream through blood vessels for dialysis.

Endarterectomy

Normally, the arteries have a smooth surface inside to promote unobstructed flow of blood. With advancing age, a sticky plaque made up of cholesterol, calcium or fibrous tissue starts accumulating on the inner walls of your arteries.

Endovascular Stent Graft

Arteries are the blood vessels that carry oxygen-rich blood from the heart to all parts of the body. An aneurysm is a balloon like bulging or swelling in a weak area along the wall of an artery.

Renal Transplant & Vascular Access

A renal or kidney transplant is a procedure in which a healthy kidney is transplanted into your body to treat kidney failure. The procedure involves precisely suturing the blood vessels of the donor kidney to the recipient’s blood supply.

Surgical Aneurysm Repair

An aneurysm is a balloon like enlarged and weakened area (caused due to blood pressure) on the wall of an artery. An aneurysm can cause serious complications when it increases in size and ruptures or when blood clots block the blood flow.

Surgical Bypass

Normally, the arteries have a smooth surface inside to promote unobstructed flow of blood. A sticky plaque made up of cholesterol, calcium or fibrous tissue starts building up on the inner walls of your artery, as you age.

                          Thoracic Outlet Surgery

The thoracic outlet is a small passageway leading from the base of the neck to the armpit and arm. This small area contains many blood vessels, nerves, and muscle. When this passageway becomes compressed, the condition is termed as thoracic outlet syndrome.

Thrombolytic Therapy

The normal process of blood clotting or coagulation occurs when platelets clump with other blood components to form a gel. Generally, clotting after an injury avoids excessive bleeding, but clots formed in the blood vessels of the body may block the blood flow in vital organs such as the lungs, heart or brain creating a life-threatening situation which requires emergency management.

Source Credit: https://www.sydneyvascularsurgery.com.au/common-vascular-procedures-treatments.html

Understanding Trauma and How It’s Treated

Trauma surgery is the branch of surgical medicine that deals with treating injuries caused by an impact. For example, a trauma surgeon may be called to the emergency room to evaluate a patient who is a victim of a car crash.

Surgeons performing surgery in operating room
Morsa Images / DigitalVision / Getty Images

Trauma Explained

Trauma is the injuries suffered when a person experiences a blunt force or a penetrating trauma.1You may also hear trauma referred to as “major trauma.” Many trauma patients are the victims of car crashes, stabbings, and gunshot wounds. Trauma can also be caused by falls, crush type injuries, and pedestrians being struck by a car.1

Traumatic injuries can affect internal organs, bones, the brain, and the other soft tissues of the body. No area of the body is immune to trauma, but trauma can range from minor (hitting your finger with a hammer) to major (being hit by a car traveling at a high rate of speed or falling off of a building).

Who Performs Trauma Surgery

In the case of severe trauma, such as a catastrophic car crash, the trauma surgeon may be one part of a surgical team that includes general surgeons (to repair internal abdominal injuries), vascular surgeons (to repair damage to blood vessels), orthopedic surgeons (to repair broken bones), and other surgeons as needed.2

The trauma team will include not only one or more surgeons, but also the paramedics who stabilize and transport the patient, nurses, anesthetist, respiratory therapist, radiographer, and the support of the medical laboratory scientists, including the blood bank.

For surgeons, extensive education is required in order to practice in their chosen field. As with all physicians, they first graduate from college with a bachelor’s degree and enter medical school for four years. For general surgeons, five years of surgical training as a residency is required. For surgeons who want to specialize, the same five-year residency is completed, followed by additional years of training in the area of specialization.3 Trauma surgery fellowships are usually one to two years long. Trauma surgeons often also serve a critical care fellowship. They take their boards for a certification in Surgical Critical Care.4

From the Emergency Room to Surgery

A trauma surgeon has a different set of skills and functions from an emergency room doctor.5 When you arrive in the emergency room for any complaint, the ER doctor will see you, stabilize your condition, examine you, and order tests and imaging studies. She will alert the specialists needed, which may include the trauma surgeon. The ER doctor’s function includes referring you for admission or discharging you with appropriate treatment and follow-up referrals.

If your condition requires trauma surgery, you will be handed off to the trauma surgeon, who will become your provider. She will not only perform the surgery, but you will also be followed by her and her team through recovery, rehabilitation, and discharge.5 When you need emergency surgery, you may be treated at the facility where you arrived, or you may be transported to a facility that has the specialists needed for your condition. The trauma surgeon may not be available to examine you until you arrive at her facility.

The trauma surgeon is often the person responsible for prioritizing which of your injuries will be treated first and determining the order of the diagnostic and operative procedures needed.

Source Credit: https://www.verywellhealth.com/trauma-surgery-defined-3157175

Obesity Is Linked With Cancer – Now We Finally Know Why

Cancer is caused by genetic changes

Brain Obesity Weight Loss

Cancer is caused by genetic changes that break down normal constraints on cell growth. It is known that obesity and overweight increases the risk of developing cancer, but the question until now has been why? Now, researchers at University of Bergen have demonstrated that lipids associated with obesity make cancer cells more aggressive and likely to form actual tumors.

Nils Halberg

Associate professor Nils Halberg. Credit: Melanie Burford

The researchers have discovered that the changed environment surrounding the cancerous cell, from a normal weight body to an overweight or obese body, pushes the cancer cell to adapt. This allows the malignant cells to form a tumor.

“This means that even in the absence of new gene mutations, obesity increases the risk that tumors will form,” says associate professor Nils Halberg.
Obesity is the cause of approximately 500 000 new cancer cases each year – a number that is expected to grow as obesity rates continue to increase.

“To scientifically dissect how these two complicated diseases interact has been extremely interesting and rewarding. Especially as this new understanding will enable researchers to design improved treatments for obese cancer patients,” Halberg adds

Reference: “C/EBPB-dependent adaptation to palmitic acid promotes tumor formation in hormone receptor negative breast cancer” by Xiao-Zheng Liu, Anastasiia Rulina, Man Hung Choi, Line Pedersen, Johanna Lepland, Sina T. Takle, Noelly Madeleine, Stacey D’mello Peters, Cara Ellen Wogsland, Sturla Magnus Grøndal, James B. Lorens, Hani Goodarzi, Per E. Lønning, Stian Knappskog, Anders Molven and Nils Halberg, 10 January 2022, Nature Communications.
DOI: 10.1038/s41467-021-27734-2

Source Credit: https://scitechdaily.com/obesity-is-linked-with-cancer-now-we-finally-know-why/

Endocrine Surgery

Surgery performed with its focus on one or more of the endocrine organs is referred to as endocrine surgery. The endocrine organs are glands located throughout the body, which secrete hormones that are vital for maintaining homeostasis (i.e. a constant internal environment) and metabolism into the bloodstream.

These glands together make up what is known as the endocrine system, whose control and command centers are the pituitary gland and hypothalamus. Other endocrine glands are the endocrine pancreas, pineal, adrenal, thyroid, and parathyroid glands. Specialists who conduct surgery on these glands are called endocrine surgeons.

Endocrine organs

Hypothalamus and pituitary gland

Hamartomas, although rare, are non-neoplastic tumors that arise in the hypothalamus and cause devastating consequences, such as seizures, cognitive impairment, behavioural and emotional troubles, hormonal imbalances and early puberty. Surgical removal of the tumor is required, and surgeons take advantage of the physiological gap between the hemispheres of the brain to gain access to the tumor and remove it.

Another less invasive approach is the use of stereotactic radiosurgery (gamma knife), which uses light energy to destroy the tumor and surrounding damaged tissue. It is a more focused form of standard external beam radiotherapy that targets the tumor more precisely.

The pituitary gland, located at the base of the brain, is the size of a kidney bean, yet is responsible for growth and development, and the function of all endocrine glands. Tumors of the pituitary gland are mostly benign adenomas that remain within the pituitary gland and do not metastasize. However, some tumors produce excess hormone, which is responsible for the symptoms.

Others produce symptoms because of the mass effect of the tumor itself. Most pituitary gland tumors may not require treatment, but if the tumor is compressing the optic nerve, then emergency surgery is necessary. There are two main surgical approaches: an endoscopic trans-nasal trans-sphenoidal (ETNTS) method and a trans-cranial technique.

With the ETNTS approach, surgeons remove the pituitary tumor through the sphenoidal sinuses and the nose. There is no need for an external incision. Moreover, there is no effect on other parts of the brain, and just as importantly, there are no surgical scars producing a better aesthetic effect.

Large tumors, however, may be much more difficult to remove via this method. Therefore, a trans-cranial approach or craniotomy may be done. An incision is made through the upper part of the scalp and the tumor is removed.

Endocrine pancreas and neuroendocrine glands

In contrast to the exocrine pancreas, which produces enzymes for digestion, the endocrine pancreas secretes hormones, such as glucagon, insulin and gastrin. These are produced with the help of specialized cells called “islet cells” that are found scattered throughout the pancreas, which is itself located deep within the abdominal cavity.

Tumors may arise in the endocrine pancreas that warrant surgical removal. These tumors can cause local symptoms due to the mass of tumor compressing adjacent structures, or they may be responsible for clinical syndromes due to the overproduction of hormones.

Cells of neural crest embryological origin can develop into neuroendocrine tumors. These are commonly found in the lungs and gastrointestinal tract, and cause symptoms due to hormone production. Since endocrine pancreatic tumors as well as neuroendocrine gland tumors are found deep within the abdominal cavity, surgery is done under general anesthesia. It may be necessary in some cases to remove parts of the intestine and/ or pancreas.

Pineal gland

The pineal gland is the location of the internal biological clock in humans. It is a small gland located posteriorly within the diencephalon in the center of the brain. In the absence of light, and at night, it secretes melatonin, a hormone that plays a pivotal role in regulating circadian and seasonal rhythms.

Although extremely rare, tumors may arise in the pineal gland. These will necessitate surgery to remove the tumor, which can cause serious complications, such as visual impairment, seizures, and memory disturbances. Surgical removal is usually curative.

Adrenal glands

The adrenal glands, like other endocrine glands, are also susceptible to the formation of tumors, both benign and malignant, that can cause a wide range of symptoms. Most of these tumors can be surgically removed and are usually amenable to laparoscopy. In some patients, however, an open adrenalectomy may be required. Associated risks include infection, bleeding, and extreme changes in blood pressure. These risks are outweighed by the medical benefits of the surgery.

Thyroid and parathyroid glands

Thyroid gland removal, also referred to as thyroidectomy, may be indicated for benign and malignant thyroid lesions, as well as an overactive thyroid gland. The amount of the gland removed depends on the indication for the surgery. Partial removal is warranted in some cases, allowing the remaining parts to function normally after the operation.

In contrast, total removal means that the patient will need lifelong thyroid hormone supplementation, as is the case when other endocrine glands are completely removed. It is a safe procedure, but may have associated risks, such as bleeding, infection and inadvertent injury to the laryngeal nerve, or the parathyroid glands.

Thyroidectomies may be done by one of three approaches. In the first, which is the conventional approach, an incision is made down the center of the neck to access the gland directly. In the second approach, the gland is removed endoscopically with smaller neck incisions. The third approach is called the robotic method. Here incisions are made in the chest or armpit, circumventing the need for incisions in the center of the neck.

Parathyroid surgeries may also be required for similar indications as a thyroid surgery and the diseased parathyroid gland is surgically removed via neck incisions in a similar fashion.

Source Credit: https://www.news-medical.net/health/Endocrine-Surgery.aspx

Hernia

A hernia happens when an internal organ pushes through a weak spot in your muscle or tissue. There are several types of hernia that you can experience including, inguinal hernias, femoral hernias, umbilical hernias, and hiatal hernias. If you have a hernia, it’s important to treat it quickly.

What is a hernia?

A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that normally contains it. Most hernias occur within the abdominal cavity, between the chest and the hips.

The most common forms of hernia are:

  • Inguinal hernia: In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. In an inguinal hernia, fatty tissue, or a part of the intestine pokes into the groin at the top of the inner thigh. This is the most common type of hernia and affects men more often than women.
  • Femoral hernia: Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias are much less common than inguinal hernias and affect older women.
  • Umbilical hernia: Fatty tissue or part of the intestine pushes through the abdomen near the navel (belly button).
  • Hiatal (hiatus) hernia: Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).

Other types of hernias include:

  • Incisional hernia: Tissue protrudes through the site of an abdominal scar from a remote abdominal or pelvic operation.
  • Epigastric hernia: Fatty tissue protrudes through the abdominal area between the navel and lower part of the sternum (breastbone).
  • Spigelian hernia: The intestine pushes through the abdomen at the side of the abdominal muscle, below the navel.
  • Diaphragmatic hernia: Organs in the abdomen move into the chest through an opening in the diaphragm.

How common are hernias?

Of all hernias that occur:

  • 75 to 80% are inguinal or femoral.
  • 2% are incisional or ventral.
  • 3 to 10% are umbilical, affecting 10 to 20% of newborns; most close by themselves by 5 years of age.
  • 1 to 3% are other types.

SYMPTOMS AND CAUSES

What causes a hernia?

Inguinal and femoral hernias are due to weakened muscles that may have been present since birth or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation.

Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth.

The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.

What are the symptoms of a hernia?

A hernia in the abdomen or groin can produce a noticeable lump or bulge that can be pushed back in, or that can disappear when lying down. Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear after it has been pushed in. More symptoms of a hernia include:

  • Swelling or bulge in the groin or scrotum (the pouch that contains the testicles).
  • Increased pain at the site of the bulge.
  • Pain while lifting.
  • Increase in the bulge size over time.
  • A dull aching sensation.
  • A sense of feeling full or signs of bowel obstruction.

In the case of hiatal hernias there are no bulges on the outside of the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, frequent regurgitation (bringing food back up) and chest pain.

DIAGNOSIS AND TESTS

How is a hernia diagnosed?

It is usually possible to see or feel a bulge in the area where a hernia has occurred by physical exam. As part of a male’s typical physical exam for inguinal hernias, the doctor feels the area around the testicles and groin while the patient is asked to cough. In some cases, soft-tissue imaging like a CT scan will accurately diagnose the condition.

MANAGEMENT AND TREATMENT

What kind of doctor do you see for a hernia?

When you have a hernia, treatment will start with your primary care provider. If you need surgery to repair the hernia, you’ll be referred to a general surgeon. In fact, ventral hernia repairs are one of the most common operations U.S. general surgeons perform.

If you think you have a hernia, don’t wait to seek help. A neglected hernia can grow larger and more painful — this can lead to complications and possibly emergency surgery. Early repair is more successful, less risky and offers a better recovery and outcome.

How is a hernia treated?

Hernias usually do not get better on their own, and surgery may be the only way to repair them. However, your doctor will recommend the best therapy to address your hernia and may refer you to a surgeon. If the surgeon thinks it is necessary to repair your hernia, then the surgeon will tailor the method of repair that best meets your needs.

In the case of an umbilical hernia in a child, surgery may be recommended if the hernia is large or if it has not healed by the age of 4 to 5 years old. By this age, a child can usually avoid surgical complications.

If an adult has an umbilical hernia, surgery is usually recommended because the condition will not likely improve on its own and the risk of complications is higher.

One of three types of hernia surgery can be performed:

  • Open surgery, in which a cut is made into the body at the location of the hernia. The protruding tissue is set back in place and the weakened muscle wall is stitched back together. Sometimes a type of mesh is implanted in the area to provide extra support.
  • Laparoscopic surgery involves the same type of repairs. However, instead of a cut to the outside of the abdomen or groin, tiny incisions are made to allow for the insertion of surgical tools to complete the procedure.
  • Robotic hernia repair, like laparoscopic surgery, uses a laparoscope, and is performed with small incisions. With robotic surgery, the surgeon is seated at a console in the operating room and handles the surgical instruments from the console. While robotic surgery can be used for some smaller hernias, or weak areas, it can now also be used to reconstruct the abdominal wall.

Each type of surgery has its advantages and disadvantages. The patient’s surgeon will decide the best approach.

What can happen if a hernia is not treated?

Other than umbilical hernias in babies, hernias will not disappear on their own. Over time, a hernia can grow larger and more painful or can develop complications.

Complications of an untreated inguinal or femoral hernia may include:

  • Obstruction (incarceration): Part of the intestine becomes stuck in the inguinal canal, causing nausea, vomiting, stomach pain, and a painful lump in the groin.
  • Strangulation: Part of the intestine is trapped in a way that cuts off its blood supply. In such cases, emergency surgery (within hours of occurring) is necessary to prevent tissue death.

PREVENTION

How can a hernia be prevented?

  • Maintain ideal body weight by eating a healthy diet and exercising.
  • Eat enough fruits, vegetables, and whole grains to avoid constipation.
  • Use correct form when lifting weights or heavy objects. Avoid lifting anything that is beyond your ability.
  • See a doctor when you are ill with persistent coughs or sneezing.
  • Don’t smoke, as the habit can lead to coughing that triggers a hernia.

OUTLOOK / PROGNOSIS

What can be expected following surgical treatment for a hernia?

After surgery, you will be given instructions. These include what diet to follow, how to care for the incision site, and how to take care to avoid physical strain. Hernias may recur regardless of the repair operations. This is sometimes caused by inherent tissue weakness or protracted healing. Smoking and obesity are also major risk factors for hernia recurrence.

Source Credit: https://my.clevelandclinic.org/health/diseases/15757-hernia

Durban metabolic surgery center joins ranks of the few in SA accredited to perform a specialized procedure

The Durban Metabolic Surgery Centre, run by well-known surgeons Dr Gert du Toit and Dr Ivor Funnell, has been accredited by the South African Society for Surgery, Obesity and Metabolism (SASSO) to perform the highly advanced Biliopancreatic Diversion with Duodenal Switch (BPD-DS) surgery. Performing procedures at Netcare St Augustine’s and Netcare uMhlanga hospitals, Drs Du Toit and Funnell started performing laparoscopic gastric bypass surgery – the preferred procedure for morbid obesity and associated illnesses including type 2 diabetes – in 2006. Since then the team has completed approximately 660 procedures, which have achieved some life-changing results for patients. Read more:

Your gut senses the difference between real sugar and artificial sweetener

Sugar preference isn’t just a matter of taste – it’s deeper than that

Date: January 13, 2022 Source: Duke University Summary: Why do mice without taste buds still prefer real sugar to fake stuff? ‘We’ve identified the cells that make us eat sugar, and they are in the gut,’ said one of the researchers. Specialized cells in the upper gut send different signals to the brain for sugar and sugar substitutes.

Your taste buds may or may not be able to tell real sugar from a sugar substitute, but there are cells in your intestines that can and do distinguish between the two sweet solutions. And they can communicate the difference to your brain in milliseconds.

Not long after the sweet taste receptor was identified in the mouths of mice 20 years ago, scientists attempted to knock those taste buds out. But they were surprised to find that mice could still somehow discern and prefer natural sugar to artificial sweeteners, even without a sense of taste.

The answer to this riddle lies much further down in the digestive tract, at the upper end of the gut just after the stomach, according to research led by Diego Bohórquez, an associate professor of medicine and neurobiology in the Duke University School of Medicine.

In a paper appearing Jan. 13 in Nature Neuroscience, “we’ve identified the cells that make us eat sugar, and they are in the gut,” Bohórquez said. Infusing sugar directly into the lower intestine or colon does not have the same effect. The sensing cells are in the upper reaches of the gut, he said.

Having discovered a gut cell called the neuropod cell, Bohórquez with his research team has been pursuing this cell’s critical role as a connection between what’s inside the gut and its influence in the brain. The gut, he argues, talks directly to the brain, changing our eating behavior. And in the long run, these findings may lead to entirely new ways of treating diseases.

Originally termed enteroendocrine cells because of their ability to secrete hormones, specialized neuropod cells can communicate with neurons via rapid synaptic connections and are distributed throughout the lining of the upper gut. In addition to producing relatively slow-acting hormone signals, the Bohórquez research team has shown that these cells also produce fast-acting neurotransmitter signals that reach the vagus nerve and then the brain within milliseconds.

Bohórquez said his group’s latest findings further show that neuropods are sensory cells of the nervous system just like taste buds in the tongue or the retinal cone cells in the eye that help us see colors.

“These cells work just like the retinal cone cells that that are able to sense the wavelength of light,” Bohórquez said. “They sense traces of sugar versus sweetener and then they release different neurotransmitters that go into different cells in the vagus nerve, and ultimately, the animal knows ‘this is sugar’ or ‘this is a sweetener.'”

Using lab-grown organoids from mouse and human cells to represent the small intestine and duodenum (upper gut), the researchers showed in a small experiment that real sugar stimulated individual neuropod cells to release glutamate as a neurotransmitter. Artificial sugar triggered the release of a different neurotransmitter, ATP.

Using a technique called optogenetics, the scientists were then able to turn the neuropod cells on and off in the gut of a living mouse to show whether the animal’s preference for real sugar was being driven by signals from the gut. The key enabling technology for the optogenetic work was a new flexible waveguide fiber developed by MIT scientists. This flexible fiber delivers light throughout the gut in a living animal to trigger a genetic response that silenced the neuropod cells. With their neuropod cells switched off, the animal no longer showed a clear preference for real sugar.

“We trust our gut with the food we eat,” Bohórquez said. “Sugar has both taste and nutritive value and the gut is able to identify both.”

“Many people struggle with sugar cravings, and now we have a better understanding of how the gut senses sugars (and why artificial sweeteners don’t curb those cravings),” said co-first author Kelly Buchanan, a former Duke University School of Medicine student who is now an Internal Medicine resident at Massachusetts General Hospital. “We hope to target this circuit to treat diseases we see every day in the clinic.”

In future work, Bohórquez said he will be showing how these cells also recognize other macronutrients. “We always talk about a gut sense,’ and say things like ‘trust your gut,’ well, there’s something to this,” Bohórquez said.

“We can change a mouse’s behavior from the gut,” Bohórquez said, which gives him great hope for new therapies targeting the gut.

Source Credit: Duke University. “Your gut senses the difference between real sugar and artificial sweetener: Sugar preference isn’t just a matter of taste – it’s deeper than that.” ScienceDaily. ScienceDaily, 13 January 2022. www.sciencedaily.com/releases/2022/01/220113111410.htm

Bowel habits written in the DNA: New clues for irritable bowel syndrome

Credit: bowel-pixabay-cco-public-domain

In a large-scale study published in Cell Genomics, researchers studied the DNA of more than 160,000 people who provided information on the frequency of their bowel movements. Genetic profiles and specific genes were identified, which influence bowel habits and susceptibility to irritable bowel syndrome, the most common gastrointestinal disorder.

How often people move the bowels is important for wellbeing and reflects the correct functioning of the gastrointestinal (GI) tract in digesting and absorbing nutrients while excreting waste products of digestion and toxic substances. Irregular bowel habits and altered gut motility, including constipation and diarrhea, are often observed in common gastrointestinal conditions like irritable bowel syndrome (IBS), a disorder that affects up to 10% of the population worldwide. The precise mechanisms regulating peristalsis (the action of intestinal muscles pushing food and feces along the GI tract), as well as the reasons why this is often altered in IBS, are unknown. They may be hidden in our genome, it turns out.

An international team coordinated by Mauro D’Amato, Ikerbasque Research Professor at CIC bioGUNE in Spain, in a research article published online in the journal Cell Genomics, have demonstrated for the first time that the frequency of defecation is a heritable character in humans, and that specific genetic profiles influence bowel habits as well as predisposition to IBS. They studied 167,875 individuals from population-based cohorts in the UK (UK Biobank), the Netherlands (LifeLines-Deep), Belgium (Flemish Gut Flora Project), Sweden (PopCol), and U.S. (Genes for Good), and correlated their genetic makeup with questionnaire data, mostly in relation to a simple query about the number of times one opens the bowels every day (the “stool frequency,” as they called it in the study).

They discovered that among people with higher (or lower) stool frequency, specific DNA changes were more common than in the rest of the population. These changes, found in 14 regions of the human genome, involved several genes that were studied more in detail: “We were surprised how much sense these new findings make, highlighting multiple molecules whose role in gut motility was already known from clinical studies, including the communication between the brain and the gut,” says Ferdinando Bonfiglio, first author of the study. Some of the genes reported in the study produce neurotransmitters, hormones, and other molecules especially active in the brain and nerve cells involved in the control of intestinal peristalsis, and even targeted pharmaceutically to induce bowel movements in previous studies (like BDNF). “These results are very exciting and warrant follow-up studies: once more stool frequency genes are unequivocally identified, we may have a battery of new drug targets to be exploited for the treatment of constipation, diarrhea and common dysmotility syndromes like IBS” explains the corresponding author Mauro D’Amato.

The team also reported evidence of a common genetic background for stool frequency and IBS, and that this information may be used to identify individuals at increased risk of disease. This was more informative for IBS predominantly characterized by diarrhea (IBS-D). The researchers translated genetic findings from their study into simple numerical values (called polygenic scores), to estimate the probability of having altered stool frequency in each individual. Using data from UK Biobank, they then showed that people with higher polygenic scores were up to five times more likely to suffer from IBS-D than the rest of the population.

“The genetic information and the polygenic scores obtained in this study can be refined and eventually contribute to the classification of patients into different treatment groups, hopefully leading to improved therapeutic precision when aiming to bring gut dysmotility and altered bowel habits back to normal. This would be a major step forward in IBS, a common condition for which there is currently no effective treatment that works for all,” concludes Mauro D’Amato.

Source:https://medicalxpress.com/news/2021-12-bowel-habits-written-dna-clues.html

Abdominal Hernia Repair: What to Expect at Home

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

Incisional Hernia text on top view isolated on white background. Healthcare/Medical concept

Your Recovery

After surgery to repair your hernia, you are likely to have pain for a few days. You may also feel tired and have less energy than normal. This is common.

You should feel better after a few days and will probably feel much better in 7 days.

For several weeks you may feel discomfort or pull in the hernia repair when you move. You may have some bruising around the area of the repair. This is normal.

How can you care for yourself at home?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • If your doctor gives you an abdominal binder to wear, use it as directed. This is an elastic bandage that wraps around your belly and upper hips. It helps support your belly muscles after surgery.
  • Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay.
  • Avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
  • Ask your doctor when you can drive again.
  • Most people are able to return to work within 1 to 2 weeks after surgery. But if your job requires that you do heavy lifting or strenuous activity, you may need to take 4 to 6 weeks off from work.
  • You may shower 24 to 48 hours after surgery, if your doctor okays it. Pat the cut (incision) dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
  • Ask your doctor when it is okay for you to have sex.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids (unless your doctor tells you not to).
  • You may notice that your bowel movements are not regular right after your surgery. This is common. Avoid constipation and straining with bowel movements. You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
  • If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do.
  • Be safe with medicines. Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.

Incision care

  • If you have strips of tape on the cut (incision) the doctor made, leave the tape on for a week or until it falls off. Or follow your doctor’s instructions for removing the tape.
  • If you have staples closing the cut, you will need to visit your doctor in 1 to 2 weeks to have them removed.
  • Wash the area daily with warm, soapy water, and pat it dry. Don’t use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.

Other instructions

  • Hold a pillow over your incision when you cough or take deep breaths. This will support your belly and decrease your pain.
  • Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
  • If you had laparoscopic surgery, you may also have pain in your shoulder. The pain usually lasts about a day or two.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

Call your doctor or nurse call line now or seek immediate medical care if:

  • You are sick to your stomach or cannot drink fluids.
  • You have signs of a blood clot in your leg (called a deep vein thrombosis), such as:
    • Pain in your calf, back of the knee, thigh, or groin.
    • Redness and swelling in your leg or groin.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incision.
    • Pus draining from the incision.
    • A fever.
  • You cannot pass stools or gas.
  • You have pain that does not get better after you take pain medicine.
  • You have loose stitches, or your incision comes open.
  • Bright red blood has soaked through the bandage over your incision.

Watch closely for changes in your health, and be sure to contact your doctor or nurse’s call line if you have any problems.

Source: Credit: https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=bo1696