The “opportunity” Brexit brings to UK Health care.

Hello to all who reads this!

I recently attended a royal society of medicine event which alerted me of the crisis called Brexit that is to hit us, but used the word  “opportunity” as a euphemism.  I wanted to share some of the topics discussed in terms of the areas that will be affected and the potential solutions to the issues that Brexit brings.

The first speaker was Youssef El Gingihy, a GP working in Tower Hamlets who spoke about the NHS 5 year forward view, which is a 60 page document which outlines the seven new models of care in the NHS, over the next 5 years. It focusses on workforce investment, care redesign and practise infrastructure.

Chapter 1 proposes an increase the funding for primary care which is said to rise to 2.5 billion annually by 2020. This funding will come with resilience programmes which sets out to decrease the burnouts of employees due to stress, and works on reducing sickness absence in the workplace. Dr Youssef next spoke about the 5 year forward view promising 5000 extra GP’s, 1000 extra Physician associate & 5000 non med staff which will be cheaper than international recruitment. He mentioned the 5 year forward view mentions reducing the number of GP appointments by 1/3 , by having a wider use of the primary care staff and not solely going to GP’s for all issues.

He mentioned having social prescribing being introduced more often. Social prescribing is a mechanism for giving patients non-medical sources of support within the community. This would include the chance to learn new skills, opportunities for arts and creativity, physical activity, volunteering, self help etc as well as support with e.g. employment, benefits, housing, debt etc. This would be directed to patients by GP’s.

He spoke about the issue of high quality healthcare being substituted for efficiency savings. E.g. with digital models such as NEXUS health group substituting the knowledge of a family doctor. With the direction of travel we’ve seen over the last few decades, there is the risk of taking the private health care route and having to charge patients for their treatments.

Professor Martin McKee, mentioned the implications to public health being;
No money–> £290 million per week will be lost, the money will not be going to the NHS.
No staff –> People will be leaving as they European staff have lost their rights in the UK.
Starvation –> As there will be this risk of a lower supply of food, from a public health point of view. Due to the UK not being able to grow enough in the UK, without EU migrant workers. The rise of food banks in the UK can suggest a supply/demand failure meaning increasing reliance on food banks.
Government failure –> Parliament can’t cope with a “legislative tsunami”.
Civil disorder –> In the north east of England the terrorist force  spent 50% of their time on right wing neo Nazi, and 50% on Islamic fundamentalists.

Professor Tamara Harvey spoke about the legal impacts of brexit affecting healthcare. Medicines regulations, workers rights and many more will be affected when abolishing international legal frameworks, which will happen once the UK leaves the EU, which loses the efficiency of the system.

Professor Michael Manns’ spoke about the effects of funding to research companies and big drug companies in the UK. The UK receives a lot of grants across the board for research in contrast to other EU countries. Therefore due to Brexit, pharmaceutical companies will have to leave the UK, due to the complexity of having to conduct clinical trials once the EU regulations have been abolished. However, companies like GSK and other private industries who have saved the funding  will not need to leave the UK. The new EU regulations make it much easier for EU countries to test pioneering new treatments in other EU countries. If the UK now leaves the EU, which is set to happen, it’ll be harder with our population being 60 mill, in comparison to 500 mil being that of all the EU countries, to run trials in the UK.

Mark Dayan 
The main healthcare professionals that is suffering the most are Nurses. with 1 in 5 vacancies unfilled in every hospital and approximately 24,000 unfilled nursing vacancies. Social care staff are also unskilled and there is a high demand of social care stuff which the small supply doesn’t meet. Overall there are severe staffing challenges, with an increasing population the needs are not being met.

Potential solutions:
Keep freedom of movement like Norway and Switzerland but the problem is politics and optics
Look for a loophole such as the NHS being exempted from the migration system however there are two problems with that –
1) families may need to be brought over
2) social care workers are hard to be exempted as they are deemed unskilled and unsure with what job they want to do
Raise the pay in order to raise the value of working relative to other things i.e. those who are part time or just retired. However, the NHS and social care are financially strained and at their limits.
Changing the working time directive back to a shift where doctors were on call to 100 hours a week rather than 48 now as will fill gaps but the problems with this;

1) only applies to doctors and are only 10% of staff and are not the ones who are in shortage

2) will not solve workforce issues that Brexit brings

3) Extremely dangerous to over work Doctor as this puts patients’ at risk.

Disruptions to the EU working time directive

·   Post Brexit, the EU working time directive which protects workers rights, entitling them to breaks will no longer be applicable to the UK. This could be dangerous to the rights of workers in the UK, as the hours worked without a break could increase to get rid of the issue of the NHS staff shortages. Trainee’s are overworked and this recruitment and retention issues and widespread rota gaps.

·   The long hours worked by Foundation year 2 doctors have caused a 50% drop out.

·   There has been an increase in road traffic accidents due to doctors coming home after a long shift with extreme exhaustion and, this exhaustion is  equally to patients’, civilian’s as well as the Doctors’ themselves.

·   By diluting safeguards is sacrificing safety for efficiency savings

Mutual recognition of  professional qualifications;

·   A UK system of recognition isn’t required until the government specifically chooses to amend the medical act 1983.

·   A GMC survey showed that 60% of doctors are considering leaving the UK. This is because the current existing European framework (MPRQ) allows for automatic recognition of qualifications from EEA applicants allowing fast entry into the UK medical register. This would benefit the NHS and EEA applicants, however this can be changed due to Brexit.

The Medical Licensing Assessment (MLA) would allow for UK university fees to be abolished for UK applicants but have a fee for overseas applicants, this will be implemented from 2022.The MLA would also provide a core for UK university assessments.

So this was my overview of the effects of leaving the European union as learnt from the #RSMdebatesBREXIT conference. The costs outweigh the benefits by a milestone and the effects will hit us harder depending on which type of Brexit is implemented (hard/soft).


Rare condition: Sarcoidosis

So today I wanted to go over some of the less common diseases that I picked up on from my work experience in the summer where I was fortunate enough to shadow many knowledgeable consultants.

“Sarcoidosis is a rare condition that causes small patches of red and swollen tissue, called granulomas, to develop in the organs of the body. It usually affects the lungs and skin.The evidence that a patient is a sufferer of this condition would be from observations on a CT scan of the trachea and the aorta but most of the damage would be done to the lymph nodes.The lungs are affected in about 90% of people with sarcoidosis and the two main symptoms are shortness of breath and a persistent dry cough. Some people with pulmonary sarcoidosis experience pain and discomfort in their chest, but this is uncommon. There has also been a correlation of  lymphoma sufferer also having choroidal metastasis.This is secondary malignant growth of a tumour from a primary site and from in the eye. Cancer metastasis that appear in and around the eye are usually from a breast and lung cancer; less common sites of origin include the prostate, the kidney, the thyroid, and gastrointestinal tract. Blood cell cancer types; lymphoma and leukemia can also metastasize to the eye and orbit.In those rare cases where the metastasis spreads to the iris, patients can develop severe glaucoma and may lose their eye.

Malignant pleural effusion

is a condition in which cancer causes an abnormal amount of fluid to collect between the thin layers of tissue (pleura) lining the outside of the lung and the wall of the chest cavity.This causes nodular plural thickening.The pleural Cavity is filled with a small amount of serous fluid which forms a thin film of liquid between the pleural layers. in the lungs This is vital in that it prevents separation of the two pleural layers and lubricates the surface, so the lungs can move easily within the thoracic.

From observing a conference between the ophthalmologist’s in St Thomas’s, I learnt that although the consultants specialised in ophthalmology,there were many links to other diseases.These other diseases and issue may have led to the development of retinal dettachment or even be caused because of it, which was amazing to discover.




Mental disorder awareness:Depression

Today I wanted to go a bit more off topic and talk about mental disorders as the stigma toward mental disorders in certain ethnicities and cultures of being weak and not praying enough as a sufferer, prevent us from developing a good understanding into different disorders and accepting that we may have a mental disorder.What concerns me is the portrayal of mental disorders to be something negative and absurd and people are almost unsympathetic and view people with mental disorders as abnormal. Just as a broken leg( which  can be seen) is sympathised for, so should mental disorders despite their lack of physical presence.By spreading awareness, more can be done to investigate into more effective research as mental health is just as crucial as physical health as the mind has a strong association with the body.I will talk specifically about depression today ,its causes & the  possible treatments.

Unipolar depression is a treatable illness involving an imbalance of brain chemicals called neurotransmitters. The sole cause of depression is unknown as there is no single cause; many factors contribute to the likelihood of developing depression. This could be resulted from traumatic/stressful life experiences e.g. a divorce, certain personality traits, long term illnesses which may leave you in a feeling of melancholy and hopelessness e. g cancer, giving birth, family history etc.

The symptoms of unipolar depression can be persistent sadness, pessimism, difficulty in concentrating, remembering details, overeating/appetite loss, Insomnia etc.Any previous pains  may worsen, e.g. your daily mild headaches may beocome severe. Someone experiencing depression would suffer from a consistently low mood. If the severity of depression increases, the symptoms can hinder every day activities e.g. eating, taking a shower etc. Depression can also affect your level of exhaustion and can affect your sleeping pattern. It varies from both ends of the spectrum; you can either receive very little sleep, or feel a constant urge to sleep. There can be noticeable changes to your weight, with either appetite loss or gain. You may feel light headed at times. You can also suffer with digestion and bowel issues, either constipation or diarrhea.                                                Causes?

  •  The serotonin transporter gene which produces serotonin is an important gene in the susceptibility of an individual for suffering from depression. People with the short version of the gene have insufficient serotonin production and are more susceptible to depression. Barry Jacobs, a neuroscientist in Princeton believes that the stress of containment and suppression of new brain cells has a big effect on depression and serotonin is believed to mediate this process.
  • Becks cognitive theory of depression (1976), states that the relationship between the severity of ones negative thoughts and the severity of their depression is directly proportional. Therefore the more negative thoughts one experiences the more depressed on would be. The negative cognitive triad states that there are the three main dysfunctional beliefs that would be governing in someone with depression.
  • I am defective or inadequate
  • All of my experiences result in defeats or failures
  • The future is hopeless


 Mild depression can be treated  through exercising which would help to stimulate chemicals that would make you feel good and satisfy you, e.g. dopamine. It also reduces the production of chemicals in the immune system that would worsen the depression, e.g. neurotoxic chemicals.

Severe clinical depression can be treated through the use of antidepressants. There are different types of antidepressants which alter different chemical levels in the brain .

  • Selective serotonin reuptake inhibitors (SSRIs) e.g Prozac. These stop serotonin being reabsorbed and broken down after crossing the synapse and therefore increase the levels in the brain.
  • Noradrenaline reuptake inhibitors prevent noradrenaline from being reabsorbed after it has crossed the synapse and so increase the levels in the brain.  NRIs are particularly useful for motivating depressed patients who have become very inactive.
  • Tricyclics prevent serotonin and noradrenaline being reabsorbed after it has crossed the synapse. This increases levels.  These are effective but now considered old fashioned.  They can have serious side effects such as drowsiness, dry mouth and constipation.
  • Cognitive behavioural therapy is also used to help change and reduce an individuals negativity and change their thought patterns which would be the tendency to pay attention to the negative and blame themselves for everything that goes wrong.

Depression can affect anyone at any time in their life and it affects females more than males, but it can also be effectively treated.If you feel you are suffering from depresssion, from having quite alot of symptoms,go and see your doctor as there is no shame in doing so.Here’s a depression self-assesment link  for you to click on if you feel you may be suffering from depression which may prompt you to go to the doctors.

Here’s a link to the NHS website for more on depression

Keep smiling 🙂

Are smart drugs a not so smart idea?

Nootropics aka ‘smart drugs’ have recently been used popularly by students due to its  abilities to act as memory enhancers, neuro enhancers, cognitive enhancers, and intelligence enhancers.They improve many areas of mental function and increase concentration and alertness which can be very desirable to night shift workers, students and anyone who needs to stay active for long periods of time! Modafinil was originally used as a drug aimed at people suffering with narcolepsy which is when an individual would have extreme tendency to fall asleep whenever in relaxing surroundings.

So what’s the problem with these Modafinil pills made form heaven or so it seems? Initially it was painted as a perfect picture to people as it was classed as the world’s first safe smart drug” by researchers at Harvard and Oxford universities who suggested its effects were “low risk” when taken in the short term.However the side effects can include insomnia, headaches and potentially dangerous skin rashes, and there is a lack of long-term data.

Recently sudents have wrote about and shared their experiences of taking modafinil.In particular a student called ‘Zand’.When initially taking the drug and comparing his cognitive ability in taking the same test twice with and without Modafinil, his results which tested visual sustained attention, spatial working memory, executive function and episodic memory had increased from 80-85% to 90-95% which was incredible. Unfortunately after an amazing first few hours of staying focused, being less agitated he experienced frequent headaches, insomnia and skin rashes.He had claimed that the drug kicked in late around the evening when he didn’t want them to but it increased his focus on video games on his smartphone more than when trying to study.

Although Modafinil can only be a prescription only purchase in the UK or illegal otherwise it is not illegal to buy form other countries e.g. India but the UK’s Medicines and Healthcare Products Regulatory Agency warn this can be unsafe.

So the long term effects of these smart drugs aren’t fully known but they have been revealed to a few testing the product and it seems as if the benefits of increased attention doesn’t necessarily outweigh the costs.Would you take Modafinil? What do you think of the symptoms and are they worth increased attention span?


The NHS 5 year forward view.

The NHS 5 year forward view is a 60 page document which outlines the changes that are set to be made by the year 2020, and what the NHS will strive towards achieving. I thought I’d share the most important snippets I found from the document.Fortunately, there is now quite a big agreement on what a better future should be. The Five Year Forward View sets out a clear direction for the NHS – showing why change is needed and what it will look like.

Changes to be expected to implanted by 2020;

  • New option to let groups of GP’s join with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of-hospital care – the Multispecialty Community Provider. In order to see if this works well, this idea is being trialled and we will learn what works and what can be improved.
  • Another option will be the joined hospital and primary care provider – Primary and Acute Care Systems – bringing together for the first time general practice and hospital services.
  • The NHS will support hard-hitting national action on obesity, smoking, alcohol and other major health risks. We will help develop and support new ideas in the workplace to help employees’ health and cut sickness-related unemployment, with resilience programmes.
  • Try for stronger public health-related powers for local government and elected mayors.
  • When people do need health services, patients will gain far greater control of their own care.
  • More intergration between family doctor and hospital, less differences between how we care for physical and mental illnesses.
  • More money given to GP led care commissioning groups
  • Urgent and emergency care services will be reformed to join A&E departments, GP out-of-hours services, urgent care centres, NHS 111 and ambulance services together.
  • Smaller hospitals will have new options to improve them and make them more beneficial as well as make them stay workable, including making partnerships with other hospitals further away, and partnering with specialist hospitals to provide more local services.


Proffessor Lindahl and the grand Excision repair discovery

Dna damage links to a change in the chemical structure of DNA, e.g. a base missing from the backbone of DNA, a chemically changed base or a break in the strand of DNA as apposed to a mutation which refers to a change in the sequence of base pairs ,be it an addition removal or change in a base pair.This can most definitely cause serious damage especially in cancerous cells when cell proliferation is so high.

UV radiation and  free radical molecules can cause a lot of damage.and this can be detected during cell division when the DNA is copied a frequent process in our bodies.”Cigarette smoke contains small reactive chemicals, which bind to the DNA and prevent it from being replicated properly – so they are mutagens. And once there is damage in the DNA this can cause diseases including cancer.“Prof Lindahl one of the Nobel chemistry award winners of 2015 who now partakes in cancer research.Prof Lindahl also showed the rate at which DNA decays disproving the scientists theory in the 70’s which stated that DNA was a fairly stable molecule.He discovered the base excision repair mechanism which fixes the degradation of DNA.

Excision repair fixes most forms of spontaneous hydrolytic decay products in DNA and modifications to bases or the sugar phosphate backbone. The repair response involves five main enzymatic steps that work to remove the initial DNA lesion and restore the genetic material back to its original state:

  1.  removal of a damaged or incorrect base,
  2. addition of the phosphodiester backbone at the resulting abasic site (loss of pyrimidine sites in DNA resulting in a chemical reaction ; depurination  in which the β-N- glycosidic is hydrolytically split releasing a nucleic base, adenine or guanine.The second product of depurination of deoxyribonucleosides is sugar)
  3. clean-up to allow repair synthesis
  4.  gap-filling to replace the removed nucleotide,
  5. Sealing of the final, remaining DNA.

This was a break through for science and chemistry and is also another example of the unbelievably beneficial mechanisms performed in the body.Without this synthesis there would  be an increase in mutation rates and a decrease in cell survival.The many enzymes used in this process (glycosylases, apurinic/apyrimidinic endonucleases, phosphatases) are to thank! What do you feel about this discovery, and which part of this fascinates you the most?Well doneto Professor Lindahl for accomplishing such an achievement that opens up even more doors in the reals of the scientific field and the biochemistry area!

5000% increase in price to save your life?

It may not be thought of as a tricky thing just something on a label you may accept and not look into further but agreeing prices for drugs take quite some planning and deciding.

You have to consider the price of manufacturing the drug distributing it and creating the drug against the affordability of a drug because who wants something that they cant pay for!

The system for settling in a price in the UK works through a voluntary scheme between manufacturers and the government, who try to settle on a price which implements the perfect balance of generating profit for the manufacturers and selling to the patients.However prices are capped to stop the prices shooting up.The NHS would be the top buyer from the pharmaceutical companies so this is why the government negotiates in order for everyone to have access to affordable healthcare.

However in the US it is a totally different story. On top of the government, there are private insurance companies who buy through the medicare and medicaid system.This market is dependent on the prices the people  will pay.This can be a downfall as nowadays the essential and significant drugs that are created for rare diseases aren’t favored over drugs such as viagra.Therefore now companies are rethinking what they are investing in,The rare diseases  are a rare because only such a small amount of people have it but it is it fair that these medications won’t be  manufactured so willingly or the prices will go shooting because they wont generate such a profit?.An example of this is Daraprim – this drug is used to treat a rare and sometimes deadly infection called toxoplasmosis.The prices have been increased from an acceptable $13 to an outrageous $750 a 5000% increase.

The decision was made by Martin Shkreli the founder and chief executer of ‘Turing’ a pharmaceutical company. His reason for this is that this raise in price may influence the pharmaceutical industries to search for new treatments for rare diseases.He also says he will provide opportunities for sufferers of toxoplasmosis to use the drug for free and that the some of the profit generated from this increase in price will be invested in new treatment involving enhanced better developed drugs.Whats worse is that the cost of this drug excluding distribution costs $1!

In the UK the same drug can be sold for£13 for 30 tablets.What are your views on this inexcusable price jump?.Do you think it is fair and the decisions behind it are justifiable?

Read the full BBC news article on this here!

The robotic exoskeleton vs parlysis

As a human you are extraordinary and the human body the trillions of cells and the specialised organs we inhabit make us an incredible race.But a paralysis of any form restricts the parts of your body which are supposed to be free and mobile.

The definition of paralysis is ‘the loss of the ability to move (and sometimes to feel anything) in part or most of the body, typically as a result of illness, poison, or injury.’This could occur at any point in life, you could suffer from birth paralysis, or be involved in a serious car accident which then leads to a for of paralysis.Although you do feel restricted,having paralysis does not determine the way your life will plan out.Sophie Morgan ;TV presenter is doing great although she does speak of the problems that come with being paralysed.She says its harder to manage as she had experienced full mobility before her acicident so the comparisons being drawed do bring frusrations from not being as independent as she’d like to  be as well as the stigma that comes with being in a wheelchair.

However,the amazing field of science may be able to do the unexpected and help people like Sophie.The wearable robotic suit has been invented by applications of science and putting together different research from regenerative medicines and stem cells  and nerve stimulation supports and helps the body move by automatically balancing itself and detecting shifts in weight and putting them into mechanical movements .

The newest research may be even more beneficial to people with upper body paralysis with neural interfaces to allow you to control your movements Neural interfaces ares systems which work at intersections between the nervous system and a device which can be internal or external.Prosthetics is a form of a neural interface which are artifical extensions to the body which help to revive or stimulate function of the CNS which can  be lost  leading to paralysis.This can allow people who are paralysed to control their bodies.A break through for science once again!

Similar to this,scientists are working on  brain controlled interfaces.This involves specialised headgear or implants which allows you to use complex devices  and use technology to function without requiring any movement.The brain controlled interface work through detecting electrical impulses that are initiated in the brain.

Shadowing at St Bart’s Diabetes and obesity clinic.

Last week, I had the great pleasure of being able to shadow consultant.Dr E completed his training in Diabetes and Endocrinology and his PhD in Obesity at UCL. I went to St Bartholomew’s hospital which is one of the oldest Hospitals in Britain! I had the pleasure of shadowing Dr Emmanuel at the diabetes and obesity clinic for the day.I managed to see the clear link between obesity and diabetes.A quick overview of diabetes;

This is a metabolic disorder where the body cannot make use of the glucose so it builds  up in the blood, therefore giving you a high blood glucose concentration.With type 1 diabetes, there is no insulin or very little insulin present to unlock cells.The treatment of type 1 diabetes usually would consist of frequent insulin injections/ using an insulin pump.This would ensure that there would be insulin present for the correct blood glucose levels to be achieved by being able to break down the glucose.The insulin pump would allow the correct level of insulin to remain in your blood stream without you having to inject yourself on a timely basis.

Type 2 diabetes is much more common and usually develops later on in life.Type 2 diabetes means one who suffers from this would produce no insulin at all as your body looses the ability to respond to insulin. Obesity has a very strong link to diabetes and is common in most type 2 diabetes patients.The medication Dr E mentioned to help with diabetes; Furosemide, metformin

Talking to Dr Emmanuel I was able to understand with more detail the link between diabetes and obesity and seeing as the clinic was for both diseases, and the patients who were obese did have diabetes I understood that obesity  increased your chance of developing type 2 diabetes.Dr Emmanuel explained that people who are obese, tend to produce less and less of insulin as their BMI increases.Therefore the pancreas has to make up for the little insulin produced and therefore is under a lot of stress,Essentially the pancreas runs out of steam and therefore destructs itself,leading to diabetes. In response to accumulation of unfolded/misfolded proteins, cells adapt themselves to the stress condition via the unfolded protein response then ER homeostasis is disrupted, the ER generates adaptive signaling pathways, called the unfolded protein response to maintain homeostasis of this organelle. However, if homeostasis fails to be restored, the ER initiates death signaling pathways.Some new research and observations suggest that both chronic hyperglycemia and hyperlipidemia, known as important causative factors of type 2 diabetes (T2D), disrupts ER homeostasis leading to insulin producing β-cell death.Hyperglycemia is when there’s an excess of glucose in the blood stream, hyperlipidemia is where there are high lipid levels.Both of these can come from the diet of someone who is obese and therefore can lead to diabetes.

I also was curious to learn more about the relations between blindness and Diabetes.Dr Emmanuel spoke about small blood vessels sustaining tissues and supplying blood to the retina so the retinal electrons and epithelia are maintained.This allows the retina to function well and to convert light into electrical signals.New blood vessels form in the retina and a high blood sugar level can lead the blood vessels to leak blood and narrow.In order to correct this ophthalmologists will perform surgery and try to prevent the bleeding, this should prevent the blindness as you only require a small part of the retina to see.

When sitting in on the appointments between patients I learnt vital information about the speacialty and in general rules as a doctor.The first patient was a new patient and therefore had the longest consultation meeting.This was due to the fact the consultant had to receive an in depth patient family history as well as his current lifestyle and eating patterns etc.This consultation highlighted the strong heritable nature of diabetes as many of the patients family, also had diabetes.Dr Emmanuel asked about each side of the family and their health conditions if any.He then went and asked about the frequency of exercise the patient undergoes and his meals,whether he smoked,how much he could walk without becoming breathless etc.

The vitality of lifestyle also become very apparent to me as the patient would have one very heavy dish  in the late afternoon and sleep during the day.As he worked night shifts he would also eat late at night and have to stay up.This also affects how much calories you burn as  eating and sleeping straight after can cause much more weight gain.Over the next few consultations, I picked up on the set areas the consultant would ask questions around.He would check for symptoms of Sleep apnea,mood levels,any cardiac issues as this would tie in with obesity.The main goal for the patients who were very obese,(obese being a BMI of 30) was to have surgery done.Either sleeve gastrectomy or gastric bypass.

Dr E would try and set goals for the patient by discussing their abilities in performing the tasks he would set, for example he would ask each patient how far they could walk comfortably without feeling too restless. The solution would then be to ensure they were getting their exercise, be it by walking the last 3 bus stops of your journey, participating in a sport the patient enjoys etc.He would then refer them to a psychologist if needs be to help tackle any issues in their mood and help them to become more positive and happy people.This is because after surgery, for around 2 months the patients who’d undergone sleeve gastrectomy would be having liquids and soft textured food for 2 months.As food can be very comforting and these patients particularly gain comfort from food, it would be a struggle for them nd this may indeed affect their mood after surgery.It would take around 6 months for the effect of surgery to no longer have an  affect in the patients lives for various reasons.It would be important for the patients to be able to hopefully be mentally prepared for the stress of surgery and not become overwhelmed by it all and let it bring them down.The consultant also requested a test of the heart for stress, and lungs for the patients.He checked for fluid in the foot as this is common if you’re overweight,

This experience was extremely useful in allowing me to gain better knowledge with  obesity and diabetes and the ways to tackle it.