Endometriosis

Not writing just for the sake of writing,but one more severe case endometriosis in a young unmarried female with multiple health issues and I really feel low and helpless.If I go operate with the intention of preserving her fertility ,this would be her 5th surgery(4 other done for various reasons).And then she is bound to have a removal of uterus and ovary sooner or later.Sometimes I do wonder,God could have been a little more kind on human beings.

Fibroids and Endometriosis

Come across so many youn patients in their late twenties and early thirties with Fibroid uterus and Endometrosis.Just in last 1 week performed operative laparoscopy with severe endometriosis in 2 young females.My heart went for them.Yet to complete family and both the ovaries converted into big cysts(endometriomas)with gut stuck wickedly to the uterus.
a very tough decision to make as a surgeon.You know you are leaving the ovary behind,as they haven't completed the family yet for another round of surgery later few years down the lane.........

Chicken pox in Pregnancy

Hi Mini,
So to address your concern regarding exposure to a person affected with chickenpox while you are Pregnannt,As I told you we need to get the level of your immunity checked before deciding on further line of treatment.the sooner we get the result better it would be.if you have low or no immunity for this condition you need to take Immunoglobulin injections within 10 days of exposure.
you can find further information on this topic.Please follow the link

http://www.rcog.org.uk/womens-health/clinical-guidance/chickenpox-pregnancy-what-you-need-know

Sex during Pregnancy

In my OPD almost 100% sheepish couple ask me this question very hesitantly if they can have sex safely during pregnancy and till when?the answer is yes,very much,you can have sex safely till the very end of Pregnancy.
For further details please visit this website.
"http://www.myhealthguardian.com/health-concerns/sexual-health/can-we-go-ahead"

http://indiagynaecology.blogspot.com/pregancny/my-post-on-pregnancy)

The commonest cause of mental retardation in children is downs Syndrome.1 in 700 women runs the risk of having a Downs baby.The associated risk factors are increasing maternal age,a family history of Downs syndrome,a previous child with Downs syndrome.Having said that it doesn't mean that a Lady of 40 will for sure have a Downs baby and Lady of 20 won't have one.So now WHO recommends 'screening tests,'(a test which tells the risk but doesn't confirm the condition).A blood test double marker which can be between 11 to 13 weeks or triple marker between 16 to 18 weeks.One doesn't need both the tests.The other mandatory test is level 1 Ultrasound Scan,which measures the thickness of baby's nape of neck and nasal bone thickness.If unfortunately one is high risk in the screening test one has the option to go for confirmatory CVS and amniocentesis.

http://indiagynaecology.blogspot.com/pregancny/my-post-on-pregnancy)

Diabetes in Pregnancy is a common condition in Asian Pregnant women.When a lady is pregnant body is producing lots of hormones which make a lady prone to develop this condition.Altered blood sugar level which usually gets back to normal once baby is delivered.Our Asian genes make us more prone to this condition.with ladies opting for Pregnancies at later age,this condition becomes more common.Ladies those who have PCOD are even more Prone to it.
A GTT around 24 to 26 weeks of Pregnancy is called for.A family history of DM is a strong risk factor.
And if you do develop GDM,don't panic.Exercise,diet control,metformin and insulin can be used to prevent the complications of this condition.

Dr Please.....need your personal attention

I was just thinking of a rather common issue as I got a text early morning from an admitted patient's husband."Doctor when can we get your Personal attention'?The lady got admitted with some problem at 4 in the morning today.Her management which was anyways conservative was arranged and coordinated by me telephonically with a trained registrar to look after her care and only on being sure that she is fine I slept back.And this message left me little disappointed.
Then from the perspective of the patients husband,I thought and disappointment was little less.For an anxious attendant who has no knowledge of medical science any condition can look serious,for me which is not. They feel so helpless and gain the confidence to see their doctor WITH them physically.I would love to do that i.e to be present all the time with my patients to give them the much needed mental support,but God that is not humanly possible..............

Happy Diwali

Wishing all my Patients and their families a very HAPPY DIWALI.

Fast in Pregnancy

Since yesterday I got anxious calls from many would be moms whether to keep a KARWA CHAUTH FAST or not.Well Hinduism as well as Islam both are lenient towards pregnant women and a fast isn't mandatory.
Short duration fast like that of Karva Chauth should not affect the baby ,though if it is a prolonged fast like during Ramadan,baby and mother both can be affected.Even during Karva Chauth it would be advisable to have water,juices and other eatables which are approved as food ment to be eaten during the fast.Hope this helps...........And if one wishes to go ahead without water too,then one has to see how the day progresses and if feel too dehydrated or exhausted can have water.I am sure God would forgive you,coz even he won't like your little baby who is still inside the womb and dependant on you for nourishment to have a forced fast

Vomiting in pregnancy

Never thought VOMITING IN PREGNANCY(HYPEREMESIS) can be such a big problem to make a person loose all her self confidence an contemplate termination of pregnancy.Even my all time faithful,Prednisolone isn't helping her.In fact she is the first case in which prednisolone hasn't worked.Feel so helpless......... Anyone has a better solution???And no,she isn't ready to get admitted for injectables or i.v. fluids.

HPV VACCINE

HPV vaccine.sounds good.......................uhhh........but what is it?why?Let us talk about cervical cancer a bit,(cancer of mouth of the womb),Commonest killer cancer amongst Indian women.Out of 5 lac cases detected annually globally,India has 1 lac of them,Scary isn't it???That too a cancer which is preventable.
A routine check called 'Pap Smear' should be done every 3 years from the age of 24 to 50 and then at 5 yrly interval between 50 to 64.After that you don't need it.
Now HPV vaccine sounds wonderful but for the cost,lack of awareness and a little stigma attached with HPV of it being transmitted sexually in majority of the case.
But anyways it might turn out useful in long run,when it is cheaper than the current Rs 9000/.
The recommended age is between 9 yrs to 26 years.And still one needs regular pap smears.
http://www.cancerscreening.nhs.uk/cervical/
www.myhealthguardian.com/Combat-cancer.asp

New to India and looking Options for Antenatal care?

New to India and looking Options for Antenatal care?
Well yes ..................can appreciate if you are a foreigner living or working in India and your health care system is different than Ours,you might be pretty confused.Where to go?
Recently One such mom delivered under my care.A cool couple.Very chilled about the things but still there was an apprehension.Not with me,not with hospital but just as it is a country which is not as familiar to them.They made a very sensible birth plan which looked so very exhaustive to our team members,but in fact it wasn't.They were just too prepared for the whole experience of pregnancy and childbirth.A birth plan given in advance helped us in giving them a good quality care.And yes! it felt really good when they left the hospital on a very positive note,happy with the whole team.So if you are new to India,little apprehensive and wish to know where to go for health care,I would certainly suggest give yourself as well Us(i.e ,MAX Gurgaon) a chance to make your health care experience in India a memorable one.

http://www.maxhealthcare.in/international_patient/index.html

PROGESTERONE SUPPLEMENTATION FOR MISCARRIAGE

This is one issue which leaves me quite confused.It is a common Practice to prescribe Progesterone supplement by the physiscians in India.There is evidence that it can cause structural defects in babies.But there are studies also that they are useful.I don't know the real answer to it.So very confused I don't supplement unless patient's demamnd for it.Has anyone got any evidence based answer...............................?????????
http://www.rcog.org.uk/womens-health/clinical-guidance/couples-recurrent-miscarriage-what-rcog-guideline-means-you
http://globalrph.mediwire.com/main/Default.aspx?P=Content&ArticleID=114962

Miscarriage

Miscarriage.A difficult situation for patient and doctor both.Why me.............?Did I do something wrong?Will I have a repeat in next pregnancy.Was my doctor at fault?Did she/he missed to instruct me something,which could have prevented the miscarriage.Pregnancy is a wasteful process with 25%of pregnancies ending in miscarriage.No you are not alone and neither is it going to repeat itself in next pregnancy.Progesterone,HCG injections and bed rest are not of any confirmed value but it gives both the concerened sides i.e doctor and the patient the feeling that something is being done.Its a traumatic condition emotionally.If you are one of such would be moms who has undergone any such experience.Don't loose heart.Its not an end..........
http://www.rcog.org.uk/womens-health/clinical-guidance/early-miscarriage-information-you

Basic surgical skills

1.10 in the night.......3 days of gruelling course at jhonson and jhonson centre at kirti nagar.It was fun to train fellow gynaecologists.It was RCOG's basic surgical skills course and was well attended by able gynaecologists from India.Got the opportunity to practice so many mock drills while teaching them.Hope all the trainees went home back feeling it a ,worthwhile, course.First time it is out of UK and it is being conducted at a much cheaper rate as compared to UK with the same quality of training.
http://www.rcog.org.uk/event/rcog-basic-practical-skills-courses

Mentorship

It is a topic not related to women health directly but indirectly definitely and it has a huge positive effect in growth of doctors as professionals and clinicians which ultimately leads to better patient care.To be a mentor a senior consultant needs to be magnanimous,has to find enjoyment and satisfaction in one's disciples good work.Unfortunately in gynaecology ,particularly in Indian corporate system there are very few actual mentors.Competition and jealousy is basic human nature but my personal opinion is when we are in a noble profession like we are in the interest of oneself,juniors and patients overcoming these petty human emotion is a must.My consultant,Mr P tivy Jones said at Ysbyty Gwynedd said while teaching me operative laparoscopy ' learn one,do one and teach one' and I do believe that is the way one can grow and be a true professional.

Endometriosis

It is already past midnight of Friday.Time just flew this week since I wrote a post.It was maddeningly busy at work place.Not that I mind.Some exciting surgeries,lots of action,drama at work place and what not..........Life looks like straight out of the soap operas running at our Indian Television.But all in all,with the able help of my surgeon colleague,did a very good case.Aha and how can I forget to thanks my team mates and jounior friends Asha and Deepa for a beautiful assistance.Grade 4 endometriosis(sorry we realised it only on table that the case was so complicated after putting the laparoscope in) with everything stuck up inside the abdomen including the gut and ureter.Beautiful laparoscopic hysterectomy.And that's the beauty of key hole surgery,within 48 hrs of surgery patient is back home,feeling fit and fine.Around mid 30s and 40s a very painful,heavy period might be indicative of 'endometriosis'.A condition when menstural blood goes inside the abdominal cavity as well and makes all the organs to get stuck up.A frustrating condition for both patient and the doctor alike,particularly in case of patients yet to complete family.
http://www.rcog.org.uk/womens-health/clinical-guidance/endometriosis-what-you-need-know

Oh Please......Its sunday

I appreciate the problems of working couple where the husband is free only on Sunday's and who are keen that I would be available on Sundays for consultation(which anyways I am available for 2 hrs on alternate sun days) but at the same time I do feel at times please do realise a doctor is a human being too who is working 24/7,365 days a year for emergencies but needs some time for her or his family and oneself.I have disappointed a few patients already but Oh Please..............Its Sunday

Rising caesarean section rate

Doc,please do something.please,I want a c-section.I can't tolerate labour pains............
your baby's heart rate is going down,you need a c-section.
you haven't progressed well in labour can't deliver vaginally.need to do a c-section.
baby is upside down(Breech) need to do a c-section.
Your baby has passed stool inside the womb.
List is unending for why we end up with a c-section.
WHO recommends a c-section rate of no more than 15%;for an optimal care for both mother and baby.But are we maintaing that rate?I do remember how it used to be a Panic situation at my hospital in UK the moment we crossed 20% of the deliveries as C-section.And it used to be an exhausting exercise for Mr Banfield,our Labour Room in charge to go through all the c-section files.And most often then not, we were able to maintain the c-section rate within 20% despite the fact we were a referral centre with high risk cases.And no,we didn't gave compromised babies in return.
Today ,when I look back,I do feel thankful to all my bosses at NHS,who made me realise that conducting delivery is more of an art than skill.Taught me the nuances of instrumental delivery.Thanks my dear teachers,you have helped me in a big way in maintaing my c section rate still within the WHO approved rate.I know it means spending a little more time with the patient,being little more patient but at the end of a vaginal delivery(be it normal or instrumental)I feel on the top of the world and believe me I thank you all,every time................

A link below which is related and I found it interesting
http://www.childbirthconnection.org/article.asp?ck=10456

haemorrhage in Pregnancy

I was enjoying my surgeon collegue performing a beautiful rectopexy for rectal prolase and suddenly came to know a lady with pregnancy and severe bleed was being taken in next OT for Caesarean.
Torrential bleeding in pregnancy still remains the commonest cause of maternal deaths in our country.It is a real emergency when the delegated team of doctors,nurses,porters ,lab staff and blood bank need to work in a systematic and coordinated manner.The anxious relatives need to be kept informed of the proceedings.

I feel if we have a protocol in place ,where every concerened health professional knows what to do when in such emergencies and things run very smoothly with better patient care.I love the mock drills we used to have at our hospital in UK.As I am finishing today's note,just wish that the said patient and her baby are fine.

Instrumental delivery

While at a discussion with other consultants at hospital,realised instrumental delivery is a dwindling art.Reasons might be any but due to increased c-section rate in general the new trainees would get lesser and lesser training in ventouse,forceps and oh so beautiful rotational forceps delivery.Its sad,as I truly believe a nicely accomplished instrumental delivery just leaves one with one expression...........wow!!Baby delivered safely and one c section prevented.

Emergency Contraception

http://www.maxhealthcare.in/aboutus/news/images/sep09/sept13_drkaushikee.pdf
After a long day time to relax.....And what could be more interesting than returning to my brand new blog.Again today came across 3 cases of PCOD.God,Suddenly how come so many women are having PCOD???
Another thing which I wish to write about is the emergency contraceptive 'misuse'.They way it is misused it takes me by surprise .After T.V. commercials couples are using these pills as indiscriminately as candies.But it isn't so safe.one should ideally use it only once a month.It leads high rate of failure.Increased risk of ectopic pregnancy(pregnancy outside uterus).It makes the periods go haywire.One needs to have a regular method of contraception.Restrict the use of these pills to only real emergencies like a condom rupture.
And a fact which is not so popularly known,CuT,Multiload etc can be used as a more reliable method of contraception and it is effective up to 5 days of unprotected act unlike 72 hrs for these pills.

PCOD

I am very much surprised by the sudden increase in the number of cases of PCOD that I encounter in my OPD.Was just wondering ,is it due to changed Lifestyle or increased awareness level of both Patients and doctors.Most of the ladies who are told they have PCOD,they are quite shocked,I intend to tell them 'you are not alone'.Its as common as every 5th woman has this condition.And though it can't be cured,the symptoms can be taken care of with simple lifestyle changes like exercise,health diet and stress management.Ofcourse your gynaecologist can help you with Metformin and Oral contraceptive pills .

en.wikipedia.org/wiki/Polycystic_ovary_syndrome
http://www.medicinenet.com/polycystic_ovary/article.htm