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What do we know about chronic cough?

A chronic cough is defined as one lasting more than 8 weeks. This is a common and distressing condition. It particularly affects women between the ages of 45 and 55. Many report a persistent dry cough with a sensation of throat irritation, particularly after exposure to changes in temperature or irritant fumes. Talking and laughing can also trigger cough. The problem is caused by a heightened cough reflex.

Common causes include a side effect of blood pressure tablets (ACE inhibitors such as ramipril, lisinopril, captopril and perindropril), asthma, nasal disease and acid refluxing from the stomach to the gullet and throat. However, in up to 40% of patients none of these conditions are present and the cough is unexplained.

We are usually able to help patients with unexplained cough by reassuring them that they do not have a serious underlying lung condition and working with them to develop strategies to control the cough. We have an active research programme looking into the cause of chronic cough and we hope that better treatments will become available in the future. Reassuringly, the longer-term prognosis of all cough syndromes is good.

We have a step by step procedure through which our patients are investigated so nearly all of our patients will be asked to undergo a series of tests and procedures to investigate potential causes for their cough and exclude known triggers.  Our aim is to provide you with expert clinical care in order to treat your cough where an underlying cause is found.
 
Tests and procedures you may be asked to undergo include x-rays, blood tests, allergy tests, bronchoscopy, asthma tests and/or provide sputum (phlegm) samples.

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Difficulty breathing during sleep are classified as sleep related breathing disorders. Obstructive sleep apnea is the most common disorder of this type, however there are a number of variations of sleep apnea.

When a person goes to sleep, the muscles in the body relax, including the muscles that hold the airway open when awake. In some people, the airway is narrow enough that the suction from just normal breathing causes the relaxed muscles of the airway to vibrate and make noise during sleep.

Complications of sleep apnea can include daytime sleepiness and difficulty concentrating. The consequence of this is an increased risk of accidents and errors in daily activities. Studies have shown that people with severe OSA are more than twice as likely to be involved in a motor vehicle accident as people without these conditions. People with OSA are encouraged to discuss options for driving, working, and performing other high-risk tasks with a healthcare provider.
In addition, people with untreated OSA may have an increased risk of cardiovascular problems such as high blood pressure, heart attack, abnormal heart rhythms, or stroke. This risk may be due to changes in the heart rate and blood pressure that occur during sleep.

Overnight Pulse Oximetry
Performed at night, pulse oximetry is a simple overnight test that monitors a patient’s cardio-respiratory stability. This tool is used to check the oxygen level in a patient that is currently on Home Oxygen Therapy to provide their physician with current medical information on a patient's condition.

Overnight Pulse Oximetry can also be used to screen patients that may be suffering from sleep-disordered breathing or other respiratory disorders.

Interstitial lung diseases are characterized by persistent lung inflammation and scarring.

Al Zahra, Dubai Lung Disease Clinic provides state of the art clinical care, patient and physician education, and cutting edge research into the causes and treatments for this group of diseases.

We take care of patients with idiopathic pulmonary fibrosis and other forms of interstitial lung disease, such as autoimmune-associated ILD, bronchiolitis obliterans organizing pneumonia, hypersensitivity pneumonitis, and lymphocytic interstitial pneumonitis. The clinic provides initial evaluations, secondary consultations and follow-up care.


It brings together a unique multidisciplinary team of physicians - rheumatologists, pulmonologists, pathologists, and radiologists - to provide specialized care for patients with interstitial lung disease (ILD).


The causes of ILD are not always understood, and, therefore, it is often difficult to determine how the disease developed and how to treat it. Recognizing the challenges surrounding the disease and the benefits that could be gained through closer collaboration.


We have also established a Sarcoidosis and Granulomatous Disease Service within the ILD clinic.
The collaborative structure of the Clinic, combined with the expertise of our staff, enables us to provide a focused and thorough approach to diagnosing and treating our patients with ILD. Patients evaluated in the Clinic undergo a comprehensive consultations with a pulmonologist and a rheumatologist, our multidisciplinary team reviews diagnostic material, and treatment is applied according to evidence-based protocols developed from our own algorithm. This approach leads to not only highly informed diagnosis and treatment, but also a timely and well-organized plan - critical for patients with ILD.
For patients requiring surgical intervention, we in the ILD Clinic work closely with our thoracic surgery colleagues.

 

 

 

SLEEVE GASTRECTOMY

The sleeve gastrectomy has become the most popular bariatric weight loss procedure in the world. This is because it is highly effective at producing weight loss and people recover very fast from it. Many people will favour this procedure because it does not involve complicated looking bowel and stomach bypasses, it simply reduces the size of the stomach.

The surgery itself takes under one hour to perform under a safe general anaesthetic. During the operation the stomach is stapled so that its capacity is reduced from 2litres down to 200-300cc. The ¾ of the stomach that is removed contains the appetite controlling hormone, ghrelin, This is therefore decreased after surgery making sustained weight loss easy.

The procedure is performed laparoscopically (key-hole surgery) meaning that there are only small 1cm long incisions - and therefore minimal pain post-operatively. Most patients will be fully mobile again within hours of surgery and will go home the next day.

Recovery time is 1 week off work or normal activities.

The average weight loss would be 60-70% of excess weight. E.g. if you weigh 120kgs but your ideal weight is 70kgs then you are carrying 50kgs of excess weight. Within few months of surgery it is likely that you would have lost up to 35kgs - and maybe even more.

 

The sleeve gastrectomy procedure is safe but you must be aware that there is a small risk of complications occurring. These include bleeding or leakage from where the stomach is stapled and can occur in a small proportion of people - if a complication occurred it can be dealt with safely and effectively by your experienced surgical team.

As with all bariatric procedures for sustained weight loss we encourage patients to eat mostly home cooked fresh foods (vegetables, meat, fish and dairy products) and avoid regular processed foods or sweets - these should be reserved for treats or special occasions.


MINI-GASTRIC BYPASs (Single anastomosis BYPASs)

The mini-gastric bypass is becoming more and more popular as both surgeons and patients see the excellent weight loss and the improvement in other health conditions that it brings. Not only will it confer more weight loss that the sleeve gastrectomy, but it produces even more weight loss than the traditional gastric bypass.

The surgery itself takes about one & half hour to perform under a safe general anesthetic. During the operation, the stomach is stapled so that its capacity is reduced from 2litres down to 200-300cc. A loop of the small bowel is then attached to the stomach pouch so that the stomach and upper small bowel are bypassed by food. As with the sleeve operation this procedure produces dramatic changes in appetite and satiaty signalling to the brain - meaning that you are not as hungry, and feel fuller - even when you are losing weight.

The procedure is performed laparoscopically (key-hole surgery) meaning that there are only small 1cm long incisions - and therefore minimal pain post-operatively. Most patients will be fully mobile again within hours of surgery and will go home the next day.

Recovery time is 1 week off work or normal activities.

The average weight loss would be 70-80% of excess weight. E.g. if you weigh 120kgs but your ideal weight is 70kgs then you are carrying 50kgs of excess weight. Within few months of surgery it is likely that you would have lost up to 40kgs - and maybe even more.

 

The mini-gastric bypass procedure is safe but you must be aware that there is a small risk of complications occurring. These include bleeding or leakage from where the stomach is stapled and can occur in a small proportion of people - if a complication occurred it can be dealt with safely and effectively by your experienced surgical team.

As with all bariatric procedures for sustained weight loss we encourage patients to eat mostly home cooked fresh foods (vegetables, meat, fish and dairy products) and avoid regular processed foods or sweets - these should be reserved for treats or special occasions.

 

 

GASTRIC BYPASs (ROUX-EN Y)

 

The gastric bypass is a gold standard of Bariatric surgery practiced more than 40 Years with good long lasting results . 

The procedure is performed laparoscopically (key-hole surgery)  under a safe general anaesthetic. During the operation, the stomach is stapled so that its capacity is reduced from 2litres down to about 50 cc.

As with other weight loss operations, this procedure also produces dramatic changes in appetite and satiety signaling to the brain - meaning that you are not as hungry, and feel fuller - even when you are losing weight.

Recovery time is 1 week off work or normal activities.

The average weight loss is comparable to gastric mini BYPASs. For More Details Please refer to Dr. Girish Juneja / Dr. Andrew

 

 

GASTRIC BANDING

The gastric band is becoming less popular as we now realise that for weight loss the sleeve or the mini-gastric bypass are superior procedures. However, the gastric band is extremely safe and confers minimal risk of any serious complication occurring - it is for this reason that some patients still favour it.

The surgery itself takes about less than an hour to perform under a safe general anaesthetic. During the operation, a silastic (a type of plastic) band is placed around the top of the stomach. The band is attached to tubing that connects it to a ‘port’ that sits underneath the skin, usually just below the left ribcage. One you have recovered from the operation you will see your surgeon in clinic and he will be able to tighten the inner tube of the band by injecting fluid into the port. The band works by making it difficult to eat food fast - meaning that you have to chew foods for longer.

The procedure is performed laparoscopically (key-hole surgery) meaning that there are only small 1cm long incisions - and therefore minimal pain post-operatively. Most patients will be fully mobile again within hours of surgery and will go home the next day.

Recovery time is 1 week off work or normal activities.

The average weight loss would be 50% of excess weight. E.g. if you weigh 120kgs but your ideal weight is 70kgs then you are carrying 50kgs of excess weight. Within few months of surgery it is likely that you would have lost up to 25kgs - and maybe even more.

As with all bariatric procedures for sustained weight loss we encourage patients to eat mostly home cooked fresh foods (vegetables, meat, fish and dairy products) and avoid regular processed foods or sweets - these should be reserved for treats or special occasions.

 

 

 



(Reversible temporary or permanent procedures)


A. Reversible temporary procedures

Gastric Balloon Procedure

( 4 months To 1 Year depending on Type of gastric balloon)  

It is a procedure without surgery (endoscopically/swallowable pill) indicated for patients who are either obese/overweight or have failed dieting attempts or unfit for surgery. The balloon partially fills the stomach and limits food intake, it gives you a feeling of satiety, so it should be easier to change eating habits & as a consequence, lose weight. 

On average people lose between 20 and 30% of their excess weight with a gastric balloon but the amount of weight you lose and maintain will depend on how closely you follow your diet and adopt long-term lifestyle changes including regular exercise. However, the amount of weight lost by each patient will vary depending on an individual’s circumstance.

Elipse Balloon

Latest Technology in our Bariatrics Department!!

No Anaesthesia!!     No Endoscopy!!       No Removal!!  

  • The Elipse is the first liquid gastric balloon that can be inserted and removed without anesthesia or endoscopy.
  • This pill balloon can be swallowed with a glass of water under x-ray supervised by Dr. Girish and then inflated in the stomach (with saline), 4 months later it passes into the toilet by itself.
  • The Elipse Balloon empowers overweight and obese individuals (and their healthcare providers) to reclaim their health with a safe and effective weight loss tool.

 

Obalon Balloon

  • Swallowable pills
  • 2 -3 Gas Balloons
  • Endoscopically removed                      
  • 6 months duration

The Obalon Balloon System is designed to assist weight loss by partially filling the stomach. The System consists of up to 2-3 intragastric balloons placed during a 2-3-weeks period. The balloons are swallowable in that they are delivered via capsule. Each balloon is placed individually (one balloon every week). All balloons are removed 6 months after the first balloon was placed.

Advantages of Elipse & Obalon

• A brisk methodology of 10-15 minutes.

• No downtime required after the system and the patient can proceed to his/her normal working.

• Minimal or no reactions and no critical recuperation time.

 

Reshape Balloon 

Non Surgical, Non anatomy altering gastric balloon

It is double balloon for extra safety, in case one ballon ruptures the other balloon does not allow it to go down in the intestine. Two balloons connected to each other so volume filled can be more, one of its kind & with personalized attention leads to maximum weight reduction.

 

Orbera Balloon

  • Endoscopically inserted & removed      
  • Liquid Balloon                
  • 1 Year duration

The unfilled gastric balloon is inserted into the stomach through the mouth and esophagus with the aid of an endoscopic camera. The procedure will be conducted under IV sedation. Using a fluid supply tube, the gastric balloon is then filled according to the size of the stomach (400-700cc) and the tube removed. The insertion of the gastric balloon takes between 10 to 15 minutes. You will be able to return home the same day after an appropriate period of recovery (2-4 hours approximately).

After 1 Year, an endoscopic camera is once again introduced into the stomach through the esophagus, the gastric balloon is then punctured, deflated, grasped with forceps and removed via mouth.

 

 Gastric Balloon Surgery in Dubai

 

 

Spatz Balloon

  • Endoscopically placed and removed                      
  • 1 year duration
  • Re-adjustable gastric balloon _ the size of balloon can be increased or decreased  endoscopically as per requirement

one year duration is long enough to help you to change and maintain your life style changes including regular exercise and healthy eating.

 

 

ENDOSCOPIC GASTRIC BOTOX

(Temporary 3-4 months)

The simple procedure in which injection of Botox is done into stomach muscles via the endoscope (through the mouth)which leads to longer time for stomach emptying  more details, therefore, reduction in food intake & weight loss 

B-  Permanent weight loss procedures

POSE (primary obesity surgery endoscopically)

Primary Obesity Surgery Endoluminal, or POSE procedure, is a type of weight loss surgery that restricts eating and reduces hunger by reducing the size and capacity of the stomach by folding and anchoring the stomach tissue. The multiple folds of stomach tissue created by the POSE procedure effectively reduce the size and capacity of the stomach to limit food intake and diminish hunger cravings.

  • No external cuts or incisions leaves no visible scars
  • Quick procedure (45 minutes)
  • Quick recovery time, resume normal activities within 2-3 days
  • Overall risks much lower than with open or laparoscopic surgery
  • The majority of POSE patients are able to leave the hospital the same day that the procedure is performed. 

It is performed endoscopically (via the mouth) and does not require cuts or incisions through the abdomen to reach the stomach. This speeds healing time minimizes surgical pain and discomfort and leaves no visible scars.

It does not involve any cutting, removal, or rerouting of either the stomach or intestines as with gastric bypass surgery or sleeve gastrectomy and does not involve placing a medical implant into the body or need adjustments as with laparoscopic adjustable gastric banding.

For about nonsurgical weight management solutions, please consult Dr. Girish Juneja –best weight loss surgeon, Director bariatric (weight loss) center, Al Zahra hospital, he is a veteran for the weight loss procedure like Gastric Balloon, Sleeve surgery, Gastric Bypass, Gastric Band and other Weight loss surgeries or Revisional weight loss surgery including gastric band removal.

 



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