Average weight regain after 5 years from Bariatric Surgery ranges from 0 to 10%, depending on on two key factors: 1) The procedure chosen and 2) Patient behavior.
However, several non-surgical measures exist to prevent or reverse weight regain.
First lets see which procedures cause how much long-term weight loss and average weight regain from our Center’s experience and various studies published in medical journals:
Highest long-term weight loss with little to no weight regain:
Duodenal switch: 70%+ excess weight loss (EWL) after 3 years with little or no weight-gain
Duodenal switch is a procedure where the first part of our small intestine called Duodenum is partially removed and replaced with a graft of the last part of our small intestine called Ileum.
We are the most experienced Center in India in Duodenal Switch Surgery which can also be used in non-obese type 2 diabetes patients for permanently resolving Diabetes. In fact we were the first in India to offer Duodenal Switch Surgery since 2010.
High long-term weight loss, with 8 to 10% weight regain:
Gastric sleeve: 60% EWL after 3 years
Gastric bypass: 60% EWL after 3 years
Lap-Band: 55% EWL after 3 years, but highly variable from patient to patient
Moderate short-term weight loss, with 100% weight regain possibility if a secondary procedure is not done:
Gastric balloon: 30% EWL in 6 months, then must be removed. If the patient does not receive another gastric balloon after their first one is removed or does not undergo one of the more interventional procedures listed above, 100% weight regain is likely.
The key to preventing weight regain after Bariatric surgery depends on these 4 actions:
- Lose as much weight as possible before Surgery:
Studies show that your BMI before surgery directly correlates to how much weight you will lose and keep off after surgery. Hence we put patients on a liquid diet two weeks before surgery so that much weight is gone as you get operated, and the procedure would accelerate loss of remaining excess weight.
- Follow Bariatric Diet:
The right bariatric diet addresses “What” to eat. It includes:
- High-protein, low-carb diet, and no cheating before surgery
- Slow transition from clear liquids to solid foods after surgery
- Healthy foods, proteins first
- Lots of sugar-free liquids, but never around meals
- Minimal snacking
- Small portion sizes, chew thoroughly
- Adhering to prescribed vitamin regimen
- Avoiding “trigger” foods and alcohol
Our Center has well experienced Dietician to help you with this part.
- Bariatric Eating:
The right bariatric eating is about “How” to eat what you have chosen to eat.
These techniques help prevent complications, weight regain, and malnutrition. They include:
- Preparing your food properly
- Controlling portion sizes
- Eating slowly and chewing thoroughly
- No drinking before, during, or after meals
- Being mindful of warning signs
We guide all our patients through this process in detail.
- Moderate Exercise
A reputed study by UCLA (University of California, Los Angeles) in the US reveals that those who moderately exercised after Bariatric Surgery had 4.2% lower BMI than those who didn’t exercise.
Another study from University of Virginia found that patients who maintained 2 ½ hours per week exercise routine showed significantly greater long-term weight loss vs patients who didn’t exercise.
2 ½ hours as you realise is just 30 minutes exercise for 5 days a week.
I am sure you can find this much time and motivation however busy or uncharacteristic of physical activities you are.
Why does moderate exercise matter so much for long term weight-loss success?
The reason is counter-intuitive.
Moderate exercise by itself may burn as little as 200 calories per session. These many calories can be gained back in 5 minutes by eating two gulab jamuns or a small piece of black forest cake.
The more important reason a 30 minute moderate exercise works is by boosting your metabolism, which is especially important considering your body’s natural tendency to slow down your metabolism as you lose weight.
A higher basal metabolic rate means that your body will automatically burn calories at a faster rate even while you are resting, thus leading to additional weight loss.
Key is to start slowly and build endurance at your pace.
The best exercise for bariatric surgery patients achieves a balance of Flexibility, Strength and Endurance.
For more details on exercise plans, please do connect with us for a detailed discussions. If you have any chronic pain, our highly experienced physiotherapists will be able to help.
If you wish to learn more about any of the points shared above, please feel free to call us at +91 22 2888 6666 for an appointment with Dr Abhay Agrawal or his Dietician or Physiotherapist.
Dr Abhay Agrawal is also available at Apollo Spectra Hospital Tardeo, Seven Hills Hospital Andheri East and Thunga Hospital Malad West on prior appointment so that you can meet him at a convenient location to you.
Freedom at Midnight!
The Birds dispersed after the secret meeting at midnight. Their plan to escape the zoo was taking shape. Owl had planned every detail. Freedom was a month away.
‘Party-time!’ quaked Duck, digging into some chips and chocolate.
‘What is this?’ asked Kingfisher, peering into the packet of chips. ‘I haven’t seen anything like this before!’
‘Chips!’ smiled Duck, slurping some Cola. ‘You don’t know what you’re missing!’
‘That doesn’t look like food to me!’ shrieked Parrot. ‘Why not celebrate with nuts?’ she asked, offering some she had stashed away.
‘I have some delicious fish!’ Kingfisher announced.
‘Trr Trr’ Babbler flew in. ‘Here…some chana from the little boy who visits daily.’
‘Yuck!’ shrieked Duck. ‘You can eat your boring chana! And nuts and fish! I have more exciting things to eat!’ she said, pushing away their offerings.
The Birds enjoyed their midnight feast, dreaming of their flight into freedom.
A month passed and the day of escape arrived. The sun set and the last visitors exited the zoo. The zookeepers locked up the enclosures and made their way out. Signalling to them all, Owl led the forward march toward the southern wall where Owl and Kite, had worked very hard over several months, to tear a small hole into the wire-mesh wall.
One by one, the Birds emerged from the caged enclosure. Kingfisher Babbler Parrot and all. They flew out into freedom. Entering a whole new world where no cages bound them.
‘We’re free!’ they all danced, thanking Kite and Owl.
‘Wait! Duck isn’t out yet!’ hooted Owl, as he encouraged Duck to press himself through the little opening.
‘I’m too large for this!’ Duck rued, as he struggled to squeeze through.
‘I told you not to drink those colas and eat those chips!’ muttered Parrot. ‘Now look how huge you have become!’
Duck nodded. ‘I’m stuck now!’ he cried. ‘Please help me! I promise I will never have chips and colas again!’
The Birds felt sorry for Duck. ‘Wait! I have an idea!’ chirped Babbler. ‘Maybe that boy who feeds me chana everyday can help!’
The Birds flew to the home of the little boy across the street and created a din to wake him up. They led the boy to the wall of the enclosure and he understood the problem immediately. Tugging at the wire-mesh, the boy made more space for Duck to hop out.
A cheer went across as the Birds danced around Duck, as he hobbled out of the zoo, in relief.
Deeply grateful, Duck made a vow to eat nothing other than his food again. The sight of chips and cola reminded him only of the dreadful life he had left behind. A life trapped in a cage.
Eat Healthy. Not Junk.
Chips and Cola can trap you in a cage you cannot escape!
About Dr Abhay Agrawal:
Dr Abhay Agrawal is a world-class expert in all types of Bariatric and Diabetes surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery). He is highly skilled with vast experience in advanced laparoscopic surgery. One of the few in India to offer 3D laparoscopic Surgery.
Dr Agrawal is among World’s first and few to be certified as International Surgeon of Excellence from the non-profit accreditation organisation from USA, Surgical Review Corporation (SRC).
He has treated more than 4000 patients with Bariatric and Diabetes Surgeries. His Bariatric and Diabetes Surgery program is well known for consistent and high quality results in long term weight loss and permanent cure for Type 2 Diabetes. He personally treats every patient with out delegating it to juniors.
Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; Apollo Spectra Hospital Tardeo, at Mumbai; and once a month at Kalda Hospital Raipur, India.
For appointments: Call or What’s app on +91 98210 32169 or Email at drabhay@gmail.com
Dr Abhay Agrawal Moderates Diabetes Surgery Discussion National Meet of Surgeons
Dr Agrawal with Honorable Health Minister of TN
Dr Abhay Agrawal who is an international expert in Diabetes Surgery, that totally resolves Diabetes (Type 2) in Obese and Non Obese patients, was invited to moderate a panel discussion of renowned Surgeons at Laparofit National meet held at Coimbatore.
Dr Abhay Agrawal, who is one of the foremost Indian surgeons to offer the Ileal Transposition (Medical name for Diabetes Surgery) in the country and with vast experience in this procedure had the privilege of moderating the interactive session on how this surgery helps patient to totally stop diabetes medications as the sugar levels come back to normal permanently after surgery.
On the sidelines of this meeting, Dr Agrawal also had a meeting with Honorable Health Minister of Tamilnadu Mr Vijayabaskar who is instrumental in including Bariatric Surgery in state sponsored procedures.
Center for Obesity and Diabetes Control thanks Dr Praveen Raj who organized this high impact meeting for inviting Dr Abhay Agrawal and thanks Dr C Palanivelu, the doyen of laparoscopic surgery who graced the conference with his illuminating insights.
With Host Dr Praveen Raj
Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.
He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quality results in long term weight loss as he personally treats every patient.
Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai, India.
For appointments, call or what’s app on +91 98210 32169 or email at drabhay@gmail.com
Reema recounts 5 years of success since her Bariatric Surgery
‘I was constantly fatigued, feeling low, not able to go out. Unable to enjoy life like others my age,’ says Reema recollecting her misery.
But life has taken a 360 degree turn after the bariatric surgery she underwent five years ago with Dr. Abhay Agrawal. ‘I flew in from Nairobi in Kenya to Mumbai for the surgery. I was convinced it was the only solution and worth it,’ she reminisces.
Reema had been suffering from a condition called skin vitiligo and had been on steroids for its treatment. That had led to excessive weight gain. Exercise routines and diets had given short term benefits, which were quickly lost again. Reema realized she had to something more.
Reema lost 10 kilos in the first week after the surgery. She lost 26 kilos in nine months. She now weighs 64 kgs and feels fit and healthy.
‘The experience with Dr. Agrawal was fantastic,’ narrates Reema. ‘I was operated at his clinic. I found the staff very caring and supportive. The atmosphere is very homely.’
Reema is a Consultant and Regional Manager of a Company. She finds that the surgery and weight loss has improved her life greatly. ‘I have more energy and can get more work done in a day,’ she explains.
Obesity is a very different kind of health problem,’ says Reema. ‘People don’t seem to understand. They will tell you to exercise, think you are being lazy. But in reality, it is not so easy.’
Reema is convinced it was the best decision she made and says she is happy to talk to any patient who may need advice on navigating through the battle against obesity.
‘I would recommend this surgery to anybody in my situation,’ she advises. ‘Young or Old, it is important to be the master of your body and not vice-versa. Do not look at this as an easy way out of the problem. On the other hand, look at it as a process that makes your life easy and worthwhile.’
About Dr Abhay Agrawal:
Dr Abhay Agrawal is a world-class expert in all types of Bariatric surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery) with vast experience in advanced laparoscopic surgery.
Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.
He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quAlyty results in long term weight loss as he personally treats every patient.
Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai, India.
For appointments, call or what’s app on +91 98210 32169 or email at drabhay@gmail.com
Dr Abhay Agrawal’s Diabetes Surgery Lecture at National Conference of Laparoscopic Surgeons at Jaipur Well Received
It was like homecoming for Dr Agrawal whose roots are from Jaipur.
In a meeting of expert surgeons here last weekend, Dr Agrawal delivered a scientific lecture on why he favors Ileal Transposition Surgery to permanently resolve Type 2 Diabetes in Obese as well as Non-Obese patients.
This life-changing surgery alters how food is digested in patients suffering from Type-2 Diabetes. Rearranged metabolism(digestion) helps patients achieve normal sugar levels permanently with no help from diabetes tablets or insulin injections. In most cases, glucose levels become normal even before patients are discharged from the hospital.
Reversed diabetes in-turn reverses or prevents host of other complications of diabetes such as heart disease, kidney and eyesight losses, foot amputation due to gangrene etc.
Dr Agrawal is a National expert in Ileal Transposition or Diabetes Surgery and hence was invited to share his experience at this 10th annual congress of Society of Endo-Laparoscopic Surgeons of India (SELSI).
Dr Abhay Agrawal is a world-class expert in all types of Bariatric surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery) with vast experience in advanced laparoscopic surgery.
Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.
He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quality results in long term weight loss as he personally treats every patient.
Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai, India.
For appointments, call or what’s app on +91 98210 32169 or email at drabhay@gmail.com
Dr Abhay Agrawal Participates as Faculty at National Consensus Meet on Bariatric Surgery
Leading Bariatric Surgeons of India were invited to Delhi last weekend to discuss their experiences and outcomes in the Indian scenario.
Best practices on indications, choice of procedure, technique during surgery, post operative nutrition, dealing with complications etc topics were deliberated to minimize potential controversies, between different surgeons performing the same procedure, due to varied experiences.
Dr Agrawal took part in this panel discussions as National Expert in Mini Gastric Bypass which is a newer and hybrid Bariatric surgery to offer the best of two procedures- sleeve and gastric bypass- in one to the patients with excellent results. Dr Agrawal also shared his pioneering and large experience of Diabetes Surgery which can treat non-obese individuals too with permanent resolution of Type 2 diabetes.
About Dr Abhay Agrawal:
Dr Abhay Agrawal is a world-class expert in all types of Bariatric surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery) with vast experience in advanced laparoscopic surgery.
Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.
He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quality results in long term weight loss as he personally treats every patient.
Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai, India.
For appointments, call or what’s app on +91 98210 32169 or email at drabhay@gmail.com
A life-transforming journey of Aly from Kenya
In 2013, I weighed 194 kgs. Life was a struggle beyond words.
Today I weigh 85 kgs and the journey has been life-transforming.
I had hit an emotional low point. Day to day activities had become a challenge. The remarks and taunts from people hurt. Even something as basic as breathing had become difficult. There were many other problems. It was at this point that I was recommended to approach Dr. Abhay Agrawal for bariatric surgery and I agreed.
My family was extremely supportive of my decision and I flew down from Nairobi, Kenya to Mumbai, India for the surgery. When I went in for the surgery, my BMI was 58. The surgery went off well and Dr. Agrawal was very responsive to my every concern and question. I returned to Kenya two days after the surgery.
During the first few days after the procedure, one is put on a liquid / semi-solid diet as the body starts preparing itself for a controlled diet.
In the first two weeks after the surgery, I lost 15 to 18 kgs. In the first year, I was down by 45 kgs. In two years, I lost 111 kgs.
Things are much easier today and I am able to enjoy living a normal life. I still have an asthma problem but things have improved. Even today, I am required to take steroids in case of severe asthama but my weight is under control. It has been a long journey but a fulfilling one.
In my opinion, there is a tipping point in the weight loss and weight gain journey. Up until that point, exercise, diet, nutrition etc may be able to help in losing weight but once the weight is beyond that tipping point, natural weight loss is impossible. If one finds themselves in such a situation, it is better to consider surgical options like bariatric surgery as a means to resolve the problem of obesity.
Today, I am fit, I go to the gym regularly to exercise, I can enjoy going out like other people and receive complements for my looks. I feel confident and good about myself. I look back at the decision to go in for bariatric surgery as a turning point in my life.
About Dr Abhay Agrawal:
Dr Abhay Agrawal is a world-class expert in all types of Bariatric surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery) with vast experience in advanced laparoscopic surgery.
Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.
He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quality results in long term weight loss as he personally treats every patient.
Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai, India.
For appointments, call or what’s app on +91 98210 32169 or email at drabhay@gmail.com
Rwanda (East Africa) Government Invites Dr Abhay Agrawal
Rwanda Military Hospital hosted a discussion with Dr Abhay Agrawal for local Doctors on how could the healthcare services could be improved to serve patients better.
With average life expectancy of only 53 years, Rwanda on the other hand is a fast growing economy with focus on improving various services including healthcare.
Dr Agrawal emphasised on raising standards of care by elevating outcomes, infrastructure,wellness experience and service quality.
Rwanda Doctors had a very interactive session with Dr Agrawal that included shortlisting priorities and chalking out next steps.
Dr Agrawal also met Dr Ndahiro Military General of Rwanda during this visit.
Dr Ndahiro Military General Rwanda & Dr Agrawal
Rwanda Military Hospital
Another successful visit to Raipur
Dr Abhay Agrawal was at Raipur again last week as a part of strategic partnership between Dr Agrawal’s Center for Obesity and Diabetes Control Mumbai and Kalda Hospital Raipur to offer Bariatric Surgery Solutions for patients in Raipur and Chattisgarh.
A mini gastric bypass and a sleeve gastrectomy were performed this time by Dr Agrawal on two shortlisted patients.
Also the patient operated last time has lost significant weight and is feeling on top of the world.
Positives of Multi-Location Practice
Sometime people ask why do I practice from many locations. Am I hedging my risk?
No. Actual reasons might sound counter-intuitive.
First, our patients can choose a location they want for their consultation, surgery and post-operative care.
Second, it preserves our autonomy to take the best clinical decision every time. As surgeons we are outcome driven whereas hospitals are process driven. Being attached to many hospitals provides us with the flexibility to match a patient condition with the center that is best suited to achieve the outcome.
Whereas if we are tied full-time to one hospital, all our decisions will have to be within the boundaries and rules and regulations of that hospital.
There is a constraint too. Bariatric and other advanced Laparoscopic surgeries that we perform need advanced equipments, state-of-the art operating theaters and well trained staff. Hence we need to be selective about Hospitals that we operate at.
All these efforts are worthwhile because there is nothing more satisfying than to cure a patient by pooling the best of the facilities, people with our skills. Its the least we could do in return of the trust and faith our patients place in us.
——————————————————–
Dr Abhay Agrawal is a world-class expert in all types of Bariatric surgeries: Mini Gastric Bypass, Roux-en- y Gastric Bypass, Sleeve Gastrectomy and Ileal Transposition (Diabetes Surgery) with vast experience in advanced laparoscopic surgery.
Dr Agrawal is one of the few in world to be certified as International Surgeon of Excellence from the non-profit accreditation organisation Surgical Review Corporation (SRC) USA.
He has treated more than 4000 patients with Bariatric surgery and his Bariatric program is well known for consistent and high quality results in long term weight loss as he personally treats every patient.
Dr Agrawal is available for consultations and surgeries at his own Center for Obesity and Diabetes Control (CODC) Malad East; SevenHills Hospital Andheri East; and Apollo Spectra Hospital Tardeo, at Mumbai.
For appointments, call on +91 22 2888 6666
Weight Gain After Bariatric Surgery: Everything You Wanted to Know
Average weight regain after 5 years from Bariatric Surgery ranges from 0 to 10%, depending on on two key factors: 1) The procedure chosen and 2) Patient behavior.
However, several non-surgical measures exist to prevent or reverse weight regain.
First lets see which procedures cause how much long-term weight loss and average weight regain from our Center’s experience and various studies published in medical journals:
Highest long-term weight loss with little to no weight regain:
Duodenal switch: 70%+ excess weight loss (EWL) after 3 years with little or no weight-gain
Duodenal switch is a procedure where the first part of our small intestine called Duodenum is partially removed and replaced with a graft of the last part of our small intestine called Ileum.
We are the most experienced Center in India in Duodenal Switch Surgery which can also be used in non-obese type 2 diabetes patients for permanently resolving Diabetes. In fact we were the first in India to offer Duodenal Switch Surgery since 2010.
High long-term weight loss, with 8 to 10% weight regain:
Gastric sleeve: 60% EWL after 3 years
Gastric bypass: 60% EWL after 3 years
Lap-Band: 55% EWL after 3 years, but highly variable from patient to patient
Moderate short-term weight loss, with 100% weight regain possibility if a secondary procedure is not done:
Gastric balloon: 30% EWL in 6 months, then must be removed. If the patient does not receive another gastric balloon after their first one is removed or does not undergo one of the more interventional procedures listed above, 100% weight regain is likely.
The key to preventing weight regain after Bariatric surgery depends on these 4 actions:
Studies show that your BMI before surgery directly correlates to how much weight you will lose and keep off after surgery. Hence we put patients on a liquid diet two weeks before surgery so that much weight is gone as you get operated, and the procedure would accelerate loss of remaining excess weight.
The right bariatric diet addresses “What” to eat. It includes:
Our Center has well experienced Dietician to help you with this part.
The right bariatric eating is about “How” to eat what you have chosen to eat.
These techniques help prevent complications, weight regain, and malnutrition. They include:
We guide all our patients through this process in detail.
A reputed study by UCLA (University of California, Los Angeles) in the US reveals that those who moderately exercised after Bariatric Surgery had 4.2% lower BMI than those who didn’t exercise.
Another study from University of Virginia found that patients who maintained 2 ½ hours per week exercise routine showed significantly greater long-term weight loss vs patients who didn’t exercise.
2 ½ hours as you realise is just 30 minutes exercise for 5 days a week.
I am sure you can find this much time and motivation however busy or uncharacteristic of physical activities you are.
Why does moderate exercise matter so much for long term weight-loss success?
The reason is counter-intuitive.
Moderate exercise by itself may burn as little as 200 calories per session. These many calories can be gained back in 5 minutes by eating two gulab jamuns or a small piece of black forest cake.
The more important reason a 30 minute moderate exercise works is by boosting your metabolism, which is especially important considering your body’s natural tendency to slow down your metabolism as you lose weight.
A higher basal metabolic rate means that your body will automatically burn calories at a faster rate even while you are resting, thus leading to additional weight loss.
Key is to start slowly and build endurance at your pace.
The best exercise for bariatric surgery patients achieves a balance of Flexibility, Strength and Endurance.
For more details on exercise plans, please do connect with us for a detailed discussions. If you have any chronic pain, our highly experienced physiotherapists will be able to help.
If you wish to learn more about any of the points shared above, please feel free to call us at +91 22 2888 6666 for an appointment with Dr Abhay Agrawal or his Dietician or Physiotherapist.
Dr Abhay Agrawal is also available at Apollo Spectra Hospital Tardeo, Seven Hills Hospital Andheri East and Thunga Hospital Malad West on prior appointment so that you can meet him at a convenient location to you.