Single Anastomosis Duodenal Switch Abroad: Complete SADS Guide

Single Anastomosis Duodenal Switch (SADS) represents an important evolution in metabolic bariatric surgery, offering the powerful weight loss benefits of traditional duodenal switch with a simplified surgical approach. For patients seeking the most effective surgical weight loss option, SADS provides exceptional outcomes through a technique that reduces operative complexity while maintaining or improving upon established results. For more information, see our guide on weight loss surgery abroad. For more information, see our guide on duodenal switch surgery abroad.

Understanding SADS requires navigating some terminology complexity, as variations of simplified duodenal switch procedures have emerged under different names. This guide clarifies the distinctions, explains the procedure, and provides comprehensive information for patients considering SADS surgery abroad at specialized centers. For more information, see our guide on sadi-s surgery abroad.

What is Single Anastomosis Duodenal Switch (SADS)?#

Single Anastomosis Duodenal Switch, commonly abbreviated as SADS, is a bariatric surgical procedure that simplifies the traditional biliopancreatic diversion with duodenal switch (BPD-DS) by creating only one intestinal connection instead of two. The procedure combines a sleeve gastrectomy with a duodeno-ileal bypass, producing both restrictive and malabsorptive weight loss effects.

The position of SADS within the evolution of duodenal switch procedures reflects ongoing surgical innovation. The traditional duodenal switch, developed in the 1990s, proved highly effective but technically demanding. Surgeons sought simplifications that would maintain excellent outcomes while reducing operative complexity and complication rates.

Understanding the difference between SADS, SADI-S, and traditional DS requires attention to terminology nuances. SADS and SADI-S are often used interchangeably in clinical literature, though some surgeons distinguish between subtle technical variations. Both represent simplified single-anastomosis approaches to the duodenal switch concept. The traditional BPD-DS creates two anastomoses with a specific configuration of alimentary and biliopancreatic limbs.

SADS was developed to address several challenges with traditional duodenal switch. The simplification reduces operative time, decreases the number of potential complication sites, and may make the procedure accessible to more surgeons while maintaining the metabolic benefits that distinguish duodenal switch from less aggressive procedures.

Limited availability and research-phase status characterize SADS in many regions. The procedure is not universally available, and long-term outcome data continues to accumulate. Patients considering SADS should understand both its potential benefits and its emerging status.

Geographic distribution of SADS expertise concentrates in centers specializing in complex bariatric surgery. Spain, where much innovation in simplified DS techniques occurred, maintains significant expertise. Selected centers in Turkey, Mexico, and other bariatric tourism destinations have added SADS to their procedure offerings.

Surgeon training requirements for SADS exceed those for simpler bariatric procedures. Surgeons performing SADS should have comprehensive training in duodenal switch techniques and meaningful case volumes with simplified DS variants. The procedure's complexity demands specialized expertise.

SADS vs. Traditional Duodenal Switch: Key Differences#

Understanding how SADS differs from traditional duodenal switch helps patients appreciate the rationale for procedure selection and set appropriate expectations.

Anatomical Modifications

Single anastomosis vs. double anastomosis represents the fundamental difference between SADS and traditional DS. Traditional DS creates two connections: one at the duodeno-ileal junction (alimentary limb) and another further downstream where the biliopancreatic limb joins (common channel). SADS creates only one anastomosis, simplifying the surgical reconstruction.

Measurement and intestinal length calculations differ somewhat between approaches. In SADS, the single anastomosis is typically placed to create a common channel of 200-300cm from the ileocecal valve, similar to the common channel in traditional DS. The elimination of a separate alimentary limb simplifies the measurement process.

Valve reconstruction specifics in SADS preserve the pyloric valve at the stomach outlet, maintaining normal gastric emptying physiology. This preservation, shared with traditional DS, helps reduce dumping syndrome compared to gastric bypass.

Dietary flow through the digestive system following SADS is relatively straightforward: food passes from the sleeve stomach through a short segment of duodenum directly to the lower ileum. Digestive juices from the bypassed intestine mix with food primarily in the common channel, where most remaining absorption occurs.

Surgical Technique Comparison

Operative time for SADS is generally shorter than traditional DS. Eliminating one anastomosis saves approximately 30-60 minutes of operating time, reducing anesthesia exposure and potentially improving early recovery.

Technical complexity reduction makes SADS more accessible to surgeons who may not have extensive traditional DS experience. However, the procedure remains technically demanding and requires specific training.

Laparoscopic accessibility advantages are enhanced with SADS. The simplified reconstruction may reduce the technical challenges of minimally invasive approaches compared to traditional DS.

Complication profile differences favor SADS in most analyses. With only one anastomosis, there is one fewer potential site for leak, stricture, or other anastomotic complications.

Metabolic and Weight Loss Outcomes

Similar weight loss to traditional DS has been reported in comparative studies, with both procedures producing 60-70% excess weight loss. This represents the highest weight loss of any bariatric procedure category.

Protein absorption considerations exist with any DS variant due to the malabsorptive component. However, the single common channel configuration in SADS may provide somewhat better protein absorption in some patients compared to traditional DS.

Fat malabsorption parameters are significant with both procedures, contributing to their superior weight loss. The degree of malabsorption can be adjusted based on common channel length.

Long-term metabolic stability appears favorable with SADS based on available data, though very long-term outcomes are still being collected.

SADS vs. SADI-S Surgery: Understanding the Variations#

The terminology surrounding simplified duodenal switch procedures can be confusing, and understanding the distinctions helps patients navigate their options.

Nomenclature differences and confusion arise because different surgeons and institutions have developed slightly different approaches under varying names. SADS, SADI-S (Single Anastomosis Duodeno-Ileal Bypass with Sleeve), and loop duodenal switch all refer to related concepts in simplified DS technique.

SADI-S specifically describes a Single Anastomosis Duodeno-Ileal Bypass with Sleeve gastrectomy. The name explicitly indicates that the procedure includes both the sleeve stomach creation and the intestinal bypass with single anastomosis.

SADS as a duodenal switch variant may be used more broadly to describe any single-anastomosis approach to the duodenal switch concept, potentially including slight technical variations from SADI-S.

Anatomical similarities and key differences between SADS and SADI-S are often minimal or theoretical. In practice, many surgeons use the terms interchangeably to describe procedures with essentially identical anatomy.

Interchange ability of terminology in literature means that research findings for SADS and SADI-S are often comparable and applicable to both. When reviewing outcomes, the specific technical details of the procedure studied matter more than the name used.

Surgeon preference variations influence terminology use. Some surgeons prefer one term over another based on their training, institutional tradition, or philosophical approach to procedure description.

Outcomes comparison between SADS and SADI-S shows equivalent results in most analyses, consistent with their anatomical similarity. Patients should focus less on specific procedure naming and more on surgeon experience and individual surgical planning.

How the SADS Procedure Works#

Understanding the surgical process helps patients prepare for their SADS experience and set appropriate expectations.

Pre-operative imaging and planning establish baseline anatomy and guide surgical approach. Upper GI imaging, CT scans, and sometimes upper endoscopy provide information about stomach configuration and identify any anatomical factors that might affect surgery.

Sleeve gastrectomy creation forms the first component of SADS. The surgeon removes approximately 75-80% of the stomach, creating a narrow tubular sleeve with capacity of approximately 100-150ml. This provides the restrictive component of weight loss.

Duodenal and intestinal measurement determines where the bypass anastomosis will be created. The surgeon measures from the ileocecal valve (where the small intestine meets the large intestine) to determine the appropriate location for the connection.

Single anastomosis construction connects the duodenum to the ileum. The duodenum is divided just beyond the pylorus, and the downstream portion is closed. The surgeon then creates a connection between the divided duodenum and the measured point in the ileum.

Intestinal configuration for optimal results creates a common channel of approximately 200-300cm where food and digestive juices mix and absorption occurs. The bypassed intestinal segment carries digestive juices from the liver and pancreas.

Laparoscopic technique and equipment enable minimally invasive surgery through small incisions. Specialized instruments and cameras allow the surgeon to perform the procedure without large abdominal wounds.

Operative duration for SADS is typically 2.5-3.5 hours, depending on patient factors and surgeon experience. This is somewhat shorter than traditional DS but longer than simpler procedures like sleeve gastrectomy alone.

Hospital stay requirements following SADS typically range from 2-4 days, allowing for monitoring of recovery and ensuring patients can tolerate oral intake before discharge.

Benefits of SADS for Weight Loss#

SADS offers significant benefits for patients with severe obesity, particularly those with metabolic disease.

Significant weight loss with SADS typically reaches 60-70% of excess body weight, among the highest of any bariatric procedure. This substantial loss produces meaningful improvement in health and quality of life.

Type 2 diabetes remission rates are exceptional with SADS, approaching 80-90% in many series. The combination of weight loss and metabolic changes from intestinal bypass produces rapid and sustained improvement in blood sugar control. Many patients reduce or eliminate diabetes medications permanently.

Hypertension improvement occurs in approximately 70-80% of patients, with many achieving normal blood pressure without medication.

Sleep apnea resolution commonly follows significant weight loss, with many patients no longer requiring CPAP therapy.

Joint pain relief and mobility improvement result from reduced mechanical stress on joints and reduced inflammation associated with obesity.

Psychological and emotional benefits accompany physical improvements. Patients frequently report enhanced self-esteem, reduced depression and anxiety, and improved quality of life.

Quality of life enhancement encompasses multiple dimensions of improved physical function, social engagement, and overall wellbeing.

Long-term weight maintenance advantages stem from the permanent anatomical changes and metabolic effects of the procedure. While some weight regain may occur over years, the majority of patients maintain significant weight loss long-term.

SADS Availability: Where to Get Surgery#

SADS is not universally available, requiring patients to seek specialized centers with appropriate expertise.

Limited global availability reflects the emerging nature of SADS. The procedure requires specific training beyond standard bariatric surgery, and not all centers offer it. This limited availability is a key consideration in planning treatment.

Spain stands at the forefront of SADS development, with Spanish surgeons having contributed significantly to technique development and refinement. Barcelona and Madrid host innovation centers where simplified DS techniques continue to advance.

Turkey offers SADS at selected high-volume bariatric centers, particularly in Istanbul. Some Turkish surgeons have trained specifically in DS variants and maintain meaningful case volumes.

Mexico provides SADS options at established bariatric centers, with experienced surgeons in locations including Tijuana and Guadalajara. Many have trained at leading US or European institutions.

Europe broadly offers pockets of SADS expertise, with centers in Germany, Belgium, and other countries providing the procedure to select patients.

Surgeon credentials and specialization are essential considerations. Verify that surgeons have specific training in duodenal switch procedures, have performed meaningful numbers of SADS cases, and maintain appropriate professional affiliations.

Multi-surgeon consultation is recommended for patients considering SADS. Given the procedure's complexity and limited availability, consulting multiple surgeons helps ensure appropriate patient selection and optimal surgical planning.

Travel planning for specialized centers requires more advance consideration than for common procedures. The limited number of qualified SADS surgeons means patients may need to travel farther or wait longer than for more widely available procedures.

Cost of SADS Surgery Abroad#

Understanding the financial aspects of SADS abroad helps patients plan appropriately.

Total cost range for SADS abroad typically falls between £4,000 and £5,500 at reputable centers, depending on destination and specific facility. This represents all-inclusive package pricing at most facilities.

Regional price variations exist, with Turkey and Mexico generally at the lower end and European destinations at the higher end of the range.

Package inclusions at reputable centers typically cover pre-operative consultations and assessments, the surgical procedure including surgeon fees, anesthesia, and operating room, hospital stay and post-operative care, initial follow-up appointments before departure, and local transportation.

Pre-operative consultation costs may be separate or included in the surgical package. Clarify this during your initial inquiries.

Travel and accommodation expenses add to the total investment. International flights vary significantly based on origin. Accommodation needs typically span 10-14 days total.

Post-operative follow-up in home country should be arranged before traveling. While virtual consultations with your surgical team are typically available, local support for ongoing care is important.

Financing options are available through many clinics and medical tourism financing companies. The significant cost of SADS, while less than domestic alternatives, may require financial planning.

Cost-benefit comparison with traditional DS shows similar pricing for both procedures at most centers, with SADS offering potential advantages in recovery time and complication rates.

Pre-Surgery Evaluation and Requirements#

Thorough evaluation ensures appropriate patient selection and optimal outcomes.

Medical Assessments

Comprehensive physical examination establishes baseline health status and identifies conditions requiring attention before surgery.

Complete blood work and lab tests provide essential information about organ function and nutritional status. Standard panels include comprehensive metabolic panel, liver function, thyroid function, and nutritional markers.

Imaging studies including CT scans or barium studies may be requested to evaluate abdominal anatomy and identify any factors affecting surgical approach.

Cardiac and pulmonary clearance ensure safe anesthesia for patients with cardiovascular or respiratory risk factors.

Nutritional status assessment establishes baseline vitamin and mineral levels for post-operative comparison. Pre-existing deficiencies should be corrected before surgery.

Liver function evaluation assesses for fatty liver disease, common in obesity. Severe fatty liver may require pre-operative dietary intervention.

Psychological Evaluation

Mental health assessment ensures patients have appropriate psychological resources for the surgical journey.

Eating disorder screening identifies conditions requiring treatment before or alongside surgery.

Realistic expectations confirmation ensures patients understand what SADS can and cannot accomplish.

Support system evaluation examines available social support during recovery and long-term.

Commitment to lifestyle changes assessment confirms readiness for the permanent dietary and behavioral modifications required for success.

Consultation Process

Virtual or in-person initial consultation allows detailed discussion of medical history, goals, and surgical options.

Surgical plan personalization tailors the procedure to individual patient characteristics. Common channel length and other parameters may be adjusted.

Detailed expectation discussion establishes realistic understanding of outcomes, recovery, and long-term requirements.

Question and concern addressing ensures patients have complete information for informed decision-making.

The SADS Surgery Journey: Step-by-Step#

Understanding each phase of the surgical experience helps patients prepare.

Before Surgery

Pre-operative diet and preparation typically includes a period of caloric restriction to reduce liver size and facilitate surgical access. Following these protocols precisely improves surgical safety.

Medication adjustments may be necessary for certain medications. Provide a complete list to your surgical team for guidance.

Travel arrangements and timing should allow arrival 1-2 days before scheduled surgery for final assessments and rest after travel.

Accommodation near hospital selection should prioritize proximity and appropriate amenities for post-discharge recovery.

Surgery Day

Hospital arrival and check-in occurs 1-2 hours before scheduled surgery time for administrative processes and final preparations.

Pre-operative briefing includes meeting your surgical team and anesthesiologist, reviewing the plan, and signing consent documents.

Anesthesia and operating room experience involves general anesthesia. You will be unconscious throughout the procedure.

Procedure duration and monitoring spans 2.5-3.5 hours typically. The surgical team monitors all vital functions throughout.

Recovery room and immediate post-op involves close monitoring as anesthesia wears off. Pain management begins immediately.

Post-Surgery Stay

Hospital stay duration of 2-4 days allows monitoring of recovery and ensures adequate oral intake before discharge.

Pain management uses a combination of medications to keep discomfort manageable.

Diet progression protocols begin with clear liquids, advancing as tolerated.

Discharge criteria and instructions ensure patients are safe for recovery outside the hospital. Clear guidance is provided for the recovery period.

Recovery Timeline After SADS#

Recovery from SADS progresses through predictable phases.

First week involves managing surgical discomfort, taking prescribed medications, and beginning liquid diet. Activity is limited but walking is encouraged. Contact your surgeon with any concerning symptoms.

Weeks 2-4 see activity gradually increasing. Pain diminishes significantly. Diet advances through pureed and soft food stages. Light walking increases.

Month 1-3 features return to work and most normal activities. Diet continues progressing toward regular foods in small portions. Weight loss becomes clearly evident.

Months 3-6 represent the rapid weight loss phase. Energy typically improves substantially. Exercise can gradually increase.

Months 6-12 show continued weight loss at a slower pace. Nutritional stability is established with appropriate supplementation.

Wound healing and scar development continue throughout recovery. Laparoscopic incisions typically heal well, leaving small scars.

When to contact your surgeon with concerns includes fever, severe or worsening pain, persistent vomiting, signs of infection, or any other worrying symptoms.

Emergency protocols for complications should be understood before surgery. Know what symptoms require immediate attention and how to access emergency care.

Nutritional Requirements and Supplementation#

SADS creates permanent changes requiring lifelong nutritional management.

Lifelong supplementation necessity stems from the malabsorptive component of SADS. Bypassing significant small intestine reduces absorption of many nutrients.

Protein requirements and timing are substantial after SADS. Aim for 60-80 grams daily, prioritizing protein at each meal. Protein supplements may be necessary, especially early after surgery.

Fat-soluble vitamins (A, D, E, K) require supplementation due to fat malabsorption. These vitamins are absorbed with dietary fat, and reduced fat absorption affects their uptake.

Mineral supplementation includes calcium citrate (better absorbed than carbonate), iron, magnesium, and zinc. Specific doses depend on blood test results.

Vitamin B12 injection schedule is typically monthly, as oral B12 absorption is significantly reduced after DS procedures.

Lab work frequency for monitoring follows a standard schedule: 3 months, 6 months, and 12 months post-surgery, then annually. More frequent testing if deficiencies are identified.

Dietary counseling resources from bariatric-specialized dietitians help navigate the significant dietary changes required.

Supplementation brands and sourcing vary in quality and bioavailability. Your medical team can recommend appropriate products.

Is SADS Surgery Right for You?#

Determining appropriateness for SADS requires considering multiple factors.

Ideal candidate profile and criteria typically includes BMI of 40 or higher, or BMI 35 or higher with significant obesity-related comorbidities. Patients with type 2 diabetes may particularly benefit from SADS given its exceptional metabolic effects.

BMI and health condition requirements vary somewhat between surgeons. SADS is often recommended for patients with higher BMIs or metabolic disease who would benefit from the most aggressive intervention available.

Commitment level and lifestyle readiness must be substantial. Lifelong supplementation, regular monitoring, and permanent dietary changes are non-negotiable for success.

Realistic expectations confirmation ensures understanding that even excellent outcomes require ongoing effort and that complications, while uncommon, can occur.

Comparison with alternative procedures should inform decision-making. Gastric sleeve offers simpler surgery with less malabsorption but less weight loss. Gastric bypass provides excellent results with less malabsorption than DS variants. Traditional DS offers similar outcomes to SADS with potentially more surgeon expertise available.

Important questions for your surgeon include specific SADS experience and outcomes, complication rates, approach to nutritional management, and handling of problems if they arise.

Decision-making and next steps involve weighing potential benefits against risks, evaluating ability to comply with requirements, and assessing practical aspects of pursuing surgery.

Frequently Asked Questions About SADS#

Is SADS surgery better than traditional duodenal switch?

SADS offers several potential advantages over traditional DS while producing similar weight loss outcomes. The single anastomosis reduces operative time and eliminates one potential complication site, potentially improving the safety profile. Weight loss of 60-70% excess body weight is comparable between procedures. However, traditional DS has a longer track record with more established long-term data. Some surgeons have more extensive experience with traditional DS. The choice between procedures depends on individual factors, surgeon expertise, and patient preferences. SADS may be preferable when seeking the benefits of DS with potentially reduced complexity, while traditional DS may be preferred when surgeon experience strongly favors that approach.

Why is SADS not more widely available?

Several factors limit SADS availability. As a newer procedure, surgeon training in SADS is less widespread than for established procedures. The technical demands of DS variants require specific expertise beyond general bariatric surgery training. Limited published long-term outcome data makes some surgeons and institutions cautious about adopting the procedure. Regulatory considerations in some countries may restrict which procedures can be offered. The relatively smaller patient population appropriate for DS-type procedures reduces the incentive for widespread training. Finding qualified SADS surgeons may require patients to travel to specialized centers.

How much weight loss should I expect with SADS?

SADS typically produces among the highest weight loss of any bariatric procedure. Average results show 60-70% excess body weight loss within 18-24 months of surgery. For example, a patient 150 pounds over ideal weight might expect to lose 90-105 pounds. Some patients achieve even higher percentages, while others fall somewhat below average. Individual results depend significantly on adherence to dietary guidelines, physical activity levels, metabolic factors, and starting weight. The timeline for weight loss extends through 18-24 months, with most rapid loss in the first 6-12 months. Commitment to recommended lifestyle changes is essential for achieving results at the higher end of the expected range.

What complications can occur after SADS?

SADS carries surgical risks common to major abdominal procedures. Blood clots can form in leg veins, potentially traveling to the lungs. Infection can occur at incision sites or internally. Anastomotic leak, though uncommon at approximately 1-2%, is a serious complication requiring prompt treatment. Nutritional deficiencies are expected consequences of the malabsorptive procedure, requiring lifelong supplementation and monitoring. Dumping syndrome can occur with sugar or fat consumption. Protein malnutrition can develop if intake is inadequate. The complication rate with SADS is generally comparable to or lower than traditional DS. Selecting experienced surgeons and following post-operative guidelines carefully minimizes risks.

Can I have a baby after SADS surgery?

Pregnancy after SADS is possible but requires careful planning and management. Most surgeons recommend waiting 18-24 months after surgery before becoming pregnant, allowing weight to stabilize and nutritional status to normalize. During pregnancy, nutritional demands increase while malabsorption from SADS continues, requiring intensive monitoring and supplementation adjustment. Blood tests for vitamins and minerals should be performed more frequently during pregnancy. Coordination between your bariatric team and obstetric team is essential. With appropriate planning and monitoring, many women have successful pregnancies after SADS or similar procedures. Discuss family planning goals with your surgical team before and after surgery.

How often do I need nutritional monitoring?

Nutritional monitoring after SADS is essential and continues lifelong. In the first year, blood tests are typically performed at 3 months, 6 months, and 12 months post-surgery. After the first year, annual comprehensive lab panels are standard. More frequent testing may be needed if deficiencies are identified or symptoms suggest nutritional problems. Typical tests include complete blood count, comprehensive metabolic panel, iron studies, vitamin B12, vitamin D, calcium, and fat-soluble vitamins. Additional tests may be ordered based on symptoms or individual risk factors. Virtual consultations with your surgical team can review results and adjust supplementation.

What happens if I regain weight after SADS?

Weight regain after SADS, while less common than after less malabsorptive procedures, can occur. Contributing factors include dietary indiscretion (returning to high-calorie eating patterns), reduced physical activity, anatomical adaptation over time, and metabolic factors. If weight regain occurs, the first approach is recommitting to lifestyle modifications with support from bariatric professionals. Revision surgery options after SADS are limited due to the already significant anatomical changes. Additional procedures may address specific issues if identified. Psychological support helps address emotional and behavioral factors contributing to regain. Prevention through ongoing engagement with recommended lifestyle modifications is more effective than treating significant regain.

How do I choose between SADS, SADI-S, and traditional DS?

Choosing among DS variants requires balancing multiple factors. First, identify surgeons with genuine expertise in whichever procedure you are considering. Surgeon experience and skill often matter more than subtle procedural differences. Consider the track record of data: traditional DS has the longest follow-up, while SADS/SADI-S have shorter but growing evidence bases. Evaluate your own preferences regarding operative complexity, recovery expectations, and risk tolerance. Discuss the specifics with potential surgeons, asking about their personal experience and outcomes with each option. For most patients, the distinctions between SADS and SADI-S are minimal, and the choice may depend more on surgeon terminology preferences than meaningful procedural differences.

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Medical Disclaimer#

This article is provided for informational purposes only and does not constitute medical advice. The information presented should not be used as a substitute for professional medical consultation, diagnosis, or treatment. Single Anastomosis Duodenal Switch is a significant surgical procedure with inherent risks that vary based on individual health status and circumstances.

SADS is an emerging procedure with limited availability and continuing accumulation of long-term outcome data. While published results are promising, patients should understand that some aspects of very long-term outcomes remain under study. The procedure is not available at all bariatric surgery centers and requires specialized surgeon expertise.

Before considering SADS surgery abroad or domestically, consult with qualified healthcare professionals who can evaluate your specific situation. All surgical procedures carry risks including but not limited to infection, bleeding, anastomotic leak, adverse reactions to anesthesia, and other complications. The malabsorptive nature of SADS creates specific nutritional requirements that must be followed lifelong.

Individual results vary significantly and cannot be guaranteed. Success depends on many factors including patient adherence to post-operative guidelines, underlying health conditions, and individual metabolic factors. Not all patients are appropriate candidates for SADS.

The cost information provided represents general estimates and may not reflect current pricing. Actual costs vary by facility, surgeon, and geographic location. Insurance coverage for bariatric surgery abroad is generally not available through standard health insurance policies.

Terminology surrounding simplified duodenal switch procedures (SADS, SADI-S, loop DS) varies in medical literature and clinical practice. This guide attempts to clarify these distinctions but cannot account for all variations in how these terms are used by different practitioners.

By reading this article, you acknowledge that the authors and publishers are not responsible for any decisions made based on this information. Always seek personalized medical advice from qualified healthcare providers before making decisions about your health.