A team headed by Dr. Aparna Govil Bhasker, consultant bariatric surgeon in Mumbai, successfully treated a 40 years old businessman man weighing 122 kgs and a body mass index (BMI) of 42.2 Kg/m2. The patient had undergone right leg amputation in a road traffic accident during childhood. Over the years, he gradually gained weight. He also suffered from severe covid-19 infection 2 years back and was treated with steroids. This led to steroid-induced avascular necrosis of both hip joints which added to his problems and hampered his mobility. 9 months back, he underwent laparoscopic sleeve gastrectomy for the treatment of obesity and has lost 43 kgs. Now, at 79 kgs, he feels much lighter. His pain is reduced significantly and he is much more mobile now. He has resumed his business and is doing very well.
Nilesh Ramyash Tiwari was just 13 years old when he met with a tragic road accident and had to undergo amputation of his right leg. It was physically and emotionally very challenging for him, but he found support in his elder brothers and father who helped him to cope. Despite the physical challenges, he found a successful career in being a surgical device supplier. This involved a lot of traveling and long hours of standing and was managed with the help of a prosthetic leg. With advancing age, his weight started increasing and he crossed 100 kgs when he was about 27 years old. He was constantly aware of keeping obesity away. A person of great willpower and inner strength, he managed to lose 25 kgs in 2014, by following a self-supervised diet and exercise regime. However, due to his busy schedule and less physical activity he was unable to sustain this weight loss. He started regaining weight gradually and reached 112 kg. In the next few years, he made multiple efforts to lose weight by doing many diets and even going to the gym. However, every time there would be a slump in his lifestyle, the weight would come rushing back.
In July 2020, Covid hit him hard and he was admitted to a hospital for more than 3 weeks with breathing difficulties and lung involvement. He had to be admitted for almost 3 weeks out of which he was in the ICU for 10 days and was treated with NIV support, anti-viral medications, and steroids. He recovered from Covid but soon started experiencing severe pain in both hip joints. He also gained more weight during this period and this adversely impacted his daily activities and mobility. He was not able to travel and this affected his work. He met an orthopedic surgeon, Dr. Saifuddin Nadvi, who diagnosed him with steroid-induced avascular necrosis of both hip joints and advised him to lose weight at the earliest in order to help the pain in the hip joints. Mr. Tiwari then consulted Dr. Aparna Govil Bhasker at Apollo Spectra Hospital.
Dr Aparna Govil Bhasker, a consultant bariatric surgeon, said, “At the time of surgery, Mr. Tiwari’s weight was 122 kg and body mass index was 42.2 Kg/m2. There are multiple types of bariatric surgeries like the Roux en y gastric bypass, single anastomosis gastric bypass, and sleeve gastrectomy. He underwent bariatric surgery for weight loss in the form of laparoscopic sleeve gastrectomy in August 2021. Bariatric surgery is the only effective method for sustained weight loss in patients with severe obesity (when BMI >35 Kg/m2). In a gastric sleeve operation, the stomach is divided vertically using surgical staplers and a sleeve-like pouch is created. This restricts the quantity of food intake, leads to early satiety, reduces appetite, and causes many hormonal changes, which lead to weight loss.”
Bariatric nutritionist Ms. Mariam Lakdawala adds, that “it is very important to focus on nutrition after bariatric surgery. Patients who embrace lifestyle modification tend to be much better in the long term.” She helps post-bariatric surgery patients to improve the quality of their diet and make them more nutrient-rich. A good diet, regular supplementation, and moderate physical activity help patients to lose weight in a healthy manner after surgery.
Dr. Bhasker added, “Mr. Tiwari lost 43 kgs in the last 9 months. Today he feels a lot more energetic and the pain in his hip joints has decreased significantly. There are numerous reports that have linked obesity as a risk factor for developing more severe illnesses of COVID-19 as in this patient’s case. Post- Covid recovery in patients with obesity is also challenging. The use of steroids in his case led to avascular necrosis of hip joints which is the death of bone tissue due to a lack of blood supply. This further reduced his mobility which in turn led to more weight gain, thus forming a vicious cycle. Bariatric surgery is a boon in patients like him for whom there are no other avenues for weight loss due to their multiple medical conditions.”
“After my accident, I was devastated. However, with the help of my family, I coped up and stood on my feet. Obesity was a very big roadblock for me. It got worse when I had Covid at the weight of 122 kgs. I was in the ICU for 10 days and had to be treated with steroids. My problems continued when I was diagnosed with steroid-induced avascular necrosis of both hip joints. My health deteriorated and I couldn’t even do my daily chores with ease. I had severe pain even while lying down. I am fortunate to be able to get timely intervention with the help of Dr. Aparna Bhasker and Ms. Mariam Lakdawala. I am thankful to them for giving me my life back. I have got a second lease of life after bariatric surgery and lost 43 kgs. I am looking forward to losing some more weight in the coming months. At 79 kgs, I travel across Mumbai for my business and the hip pain has also settled down,” concluded the elated patient Mr. Tiwari.