Have you found your joystick?

I remember it was a cold morning in Hong Kong. The year was 1992 and I had just entered the big hall in Prince of Wales College, meant for the practical training session of basic laparoscopic surgery. As my instructor finished with the illustrations, I held the laparoscope with keen eyes and fearful fingers. It was a bit uneasy to absorb the concept of minimal invasive surgery being really hit the jackpot with its potential applications. The experience was very strong. As I was guided by my instructor, I started making use of laparoscope with my gaze fixed on the monitor. Seemed unreal, but it was happening. It took me some time to not to stare at my hands but to focus on the screen. Those 10 days taught me the most magical aspect of surgery, performing big procedures with small incisions. I think, it took me my share of time to become relatively adept at. But I enjoyed the process and my learning curve.

Days passed by and I started doing laparoscopic (minimal invasive) surgery at my hospital (Khetarpal Hospital started functioning from year 1992 itself) with overflowing vigil. I learnt with every procedure; to be honest it used to take a lot of time in finishing one procedure and most of the practice spanned in removing gall bladders. I was feeling good to have adapted relatively very new concept and technique of surgery in my own practice. Those were the days when very few organizations in India were performing laparoscopic surgeries. As some more water passed under the bridges, the words spread and I started getting more patients who were keen to be performed minimal access surgery. But one thing remained unchanged, the sight of laparoscope infusing the vigor in my inner self. I remember, I went to Muktasar (a small town in Punjab, India) with my team and performed 32 Gall bladder removal operations in a single day. It was such an absorbing and full of beans experience. Life has in its stores to teach you and to make you efficient, only if you know the real meaning of being efficient.

Even today, as I enter my OT (Operation Theatre), the very sight of display of scopes and other minimal invasive instrumentations, gives me a cause to reinvent myself. I love to perform surgeries; in fact I don’t think I could have done anything in my life with such quantity of interest and gusto. I owe a lot to the laparoscope; it is my joy stick, my pillar of strength, my pal.

COLLLABORATIVE APPROACH FOR OBESE PATIENTS

Managing a patient with bariatric issues requires high level of dedication and team-spirit approach. A person who has tried for achieving optimum body weight and has not been successful requires motivation, disease education and an inclusive approach by the team of attending clinicians. Every case has its own merit, while sometimes it may be possible to achieve the results quite fast the same may not be true for everyone. An in-depth analysis regarding dietary schedules, physical regimen, family history is important as many vital links can be obtained regarding future approach. Though Psychoanalysis remains a separate specialized stream of medical sciences, the chief attending clinician should be able to make out the emotional and psychological factors associated with the disease. Patient’s can provide unmatched compliance if the rapport is established well with the attending team. Obesity in patients poses a challenge to clinicians, especially if the person is unreceptive, but sometimes it is unexpectedly easy to break through hostility and gain patient trust. If I recall, most of the rapport establishing sessions have been a blend of bitter-sweet experience, then. But there was consolation in knowing I had learnt something useful and brought a little light into my patient’s life. I couldn’t ask for more than that as the road to health begins when mutual faith is born between doctor and patient.

The disease burden was known to be high in developed countries, however in past few years; it has silhouetted even developing nations in a big way. Escalating prevalence of obesity in children will lead to higher obesity rates in the adult population, resulting in a greater health burden caused by obesity-related metabolic and cardiovascular complications. In fact, obese children may already exhibit early signs of disorders such as hypertension, elevated cholesterol levels, and insulin resistance. A patient should always be made comfortable, giving attention to his / her small needs, and after establishing the rapport, treatment options should be narrated along with their merits and limitations. It is highly recommended if the patient could be shown animated videos of the bariatric surgery (if the person is required to undergo surgical intervention) with highlighting step by step approach in a nice way. It helps the patient to be mentally prepared and to be equipped with a lot of questions which in turn will help the outcomes, as the expectations turn to be more real. Clinician should always tend to involve the patient’s family support in the applicable capacities as post surgery the outcomes can radically differ if the optimum mental and physician care has been imparted and patient’s emotional solace is a very important factor.

Importance of keeping up sessions with obesity support group has been highlighted every now and then and I believe this is one of the best methods for the patient to understand the best postoperative measures which can help in achieving adequate weight loss. Acquiring bariatric surgery support is essential to letting the patient effectively navigating his / her own struggles after weight loss surgery. In order to get a decent jump start on exactly what to expect after weight loss treatment, the patient should join a support group meeting prior to having the procedure. Mentors, found usually in obesity support groups, can be a concrete rock in moments when the patient doesn’t seem to really want to move further on his / her quest to weight loss. There’s a wealth of answers that individuals will provide in a group environment and ground realities can be explored which mostly encourage the patient to undergo the procedure and follow the schedules thereafter.