Do I have the liberty to admit my mistakes??

On Shalabh's insistence I started reading this book Complications by Atul  Gawande , an American doctor of India origin.Shalabh said ,you will find a lot of us in the book.OK.....So I started with the introduction.

Dr Atul wishes to write not just about the things which go right but also when things go wrong.Oh Dear So do I.So many times I have almost typed a post when things went wrong but at the preview stage have dropped the Idea.

Reason Dr Gawande has been lucky to have a Supportive Dr Michael Zinner,his hospital's Chairman of surgery.I dare not think how much flak would I get from my employers,colleagues,friends and foes and above all my own patients.

But I am determined,some day I will write an anonymous Blog which will reflect a balanced view of our job,science,art....whatever you would like to call it.

Doctors are human too!!!!!!

It was a lazy cold and foggy morning today and I was trying to get some sleep following two back to back 3.20 am and 3.55am deliveries which I had dutifully attended bearing the fog and cold of shivery 30th Dec 2010.
At 7 am in the morning my mobile started singing 'never say never....' echoing my sentiments(though now I have started to feel 'I have had enough').
ammm,yawn.......may be another emergency .......'Doctor I have got my periods .Do I still need to go for Ultrasound Scan'?I muttered 'Bloody hell'!!May I know who is online please??
XYZ   .You suggested me an ultrasound to rule out PCOD about 15 days back when I had missed my periods by 10 days.I didn't get it  done then.Do I still need to get it done even if I have got my Periods?Will it be a TVS or will be an abdominal Ultrasound? (I mumbled to myself...So if you could wait for 15 days why this early morning rush?)
I understand that this XYZ was ecstatic to see blood in the pan when she got up from bed and went to pee.She presumed she doesn't have a suspected hormonal imbalance.Great.....BUT FOR GOD'S SAKE PLEASE TRY TO UNDERSTAND THE PLIGHT OF YOUR POOR DOCTOR WHO IS STILL HALF SLEEP AFTER a day and  a night of hard work.
Day before there was an early morning call from another desperate patient who keeps on fiddling with hormones to prepon and postpon her periods as per occasions like outings,Christmas,New Year,Diwali etc etc.Doctor While peeing I noticed I had started to spot and I wish to get my periods delayed on Occasion of new year,what do I do? ''For God's sake do anything but don't disturb my sleep''!!
I am sure most of you would understand and agree,it is not an emergency and a call can wait till a more official hour.
I am seriously planning to get my calls charged between 9 pm to 9 am in the morning to avoid such 'emergencies'.I might be labeled a money minded doctors after that,I know.But tell me ,do I have an Option?

Selection of foetal gender.........Who is responsible??????

About 6 months back a lady who is my old patient walked in to my OPD with 'Delhi Times' folded and  very tightly held in her hands .She was undergoing treatment  for secondary infertility and at the same time was under tremendous pressure from her family to produce a heir(male child) for the family.She opened the folded news paper in front of me and asked 'Is this Possible,Doctor'?Delhi Times had reported that many Indian celebrities are going to Thailand for gender selection of their babies through Assisted reproductive Technology.She was very keen to go for it if that was possible.Though it was possible but to her pleasure mixed disappointment she tested positive for pregnancy in her that very visit and thus that gender selection never took place.But I did realize the power of MEDIA.I realized inadvertently they have opened a Pandora's box.

Yesterday,main TOI reported lot many Indian Couples are visiting Thailand to adopt the same technology to have baby boys.
DO THESE MEDIA PEOPLE REALIZE THAT THEY IN SOME WAY ARE RESPONSIBLE FOR NOT SO RESPONSIBLE BEHAVIOUR OF THESE DESPERATE INDIAN COUPLES????????

Dermoid Cyst

Dermoids are Ovarian cysts which are mostly non cancerous in origin.At times it can be boderline cancerous as well and then called immature teratoma,


Though mostly non Cancerous,once a diagnosis of Dermoid Cyst is made by Ultrasound or MRI,it should be operated.The procedure is called laparoscopic ovarian Cystectomy ,which simply means that the cyst is remove preserving the ovarian tissue.These cysts can't be treated medically and if left unoperated can lead to various coplications like torsion,severe pain,increase in size compromising the ovarian tissue and one might end up loosing complete ovary rather than just removal of the cyst.Dermoid cysts are filled with tufts of hair,tooth,bone pieces and very thick cheesy fluid which if bursts inside the abdomen can lead to severe pain and adhesions.



15 to 20% of the times they can affect both ovaries simultaneously.No one can predict a recurrence.



Once operated usually the patients are discharged within 24 hours and eating and drinking normally.

New Websites

Hi Friends,

My new website on Gynecology and laparoscopy is now available online.Would request you all to go through it and leave your feedbacks.

http://www.gynelaparoscopy.co.in/
http://www.gynelaproscopy.com/

Menopause

Menopause just like pregnancy is a condition unique to women.Have seen most of the women over 40 waiting with apprehension for menopause.Even doctor colleagues;after 40 start having the sudden middle age crisis.They start complaining even an iota of weight gain,a day here and there in period triggers a panic attack.Am I approaching IT.Periods are a 'symbol' of a females youth,fertility and femininity.And the sudden fear of loosing it makes women irritable even before menopause has actually set in.
Relax!!!!Just like your 1st period,like your first sexual experience,like your pregnancy......it is one more stage of your life which has to set in.Its not the end of your femininity but yes accept it gracefully it is end of your fertile period.Time to move on from procreation to better things in life.
It is the time in a woman's life when her period stops. It usually occurs naturally, most often after age 45. Menopause happens because the woman's ovary stops producing the hormones estrogen and progesterone.

A woman has reached menopause when she has not had a period for one year. Changes and symptoms can start several years earlier. They include
•A change in periods - shorter or longer, lighter or heavier, with more or less time in between

•Hot flashes and/or night sweats

•Trouble sleeping

•Vaginal dryness

•Mood swings

•Trouble focusing

•Less hair on head, more on face

Some symptoms require treatment. Talk to your doctor about how to best manage menopause. Make sure the doctor knows your medical history and your family medical history. This includes whether you are at risk for heart disease, osteoporosis, or breast cancer.Exercise: It strengthens your bone as well as heart.HRT is best avoided.If need be you can be prescribed herbal supplements.A supportive partner is very important.
And don't forget age is just a number.You are as young or old as you feel :)

A salute to Riddhi Purohit

About 2 months back this girl Riddhi came to my OPD along with her loving mom and dad.She seemed very quite,apprensenive and with lots of anxiety in her eyes.
Then suddenly I realised a tracheostomy scar in her throat .She was around 32 weeks Pregnant.And put down a bundle of papaers in front of me.Then she with the help of her parents completed the story of her grit,determination and efficient medical staff at saudi Arabia.She had been on ventilator for 45 days,had suffered respiratory faliure  with swine flu(H1N1 Virus)and had fought back death to be there with me.
Yesterday I had to induce her for an increasing blood pressure.In today's time when it is a difficult job to convince patients for a normal delivery(They are so afraid of pain despite an open offer of epidural analgesia),this girl went through 12 hrs of labour pain very quietly and with confidence,asked for an epidural when required and finallydelivered a healthy  bony baby girl tonight at 1 am..
What motivated me to mention Riddhi in my blog is not her medical history but her positive attitude,the willingness to fight with odds and to come out victorious of it.I salute her spirit and ofcourse her supportive family.

Total Laparoscopic hysterectomy

Mrs Ruhi,24 hours post Total laproscopic Hysterectomy.She was discharged the next day of her operation.

Bilateral endometrioma with adhesiolysis

Post Total Laparoscopic hysterectomy patient

My Sincere thanks to Mrs Soma Sinha for sharing her experience post total laparoscopic hysterectomy of a Uterus as big as 5 months of Pregnancy with multiple fibroids and weighing 700 gms

ECTOPIC PREGNANCY

This patient had lots of dense omental adhesions,left sided simple ovarian cyst and right sided ectopic pregnancy

Paratubal Cystectomy

Asherman's syndrome

Patient Presented with absence of periods since 2 months.USG was suggestive of intrauterine Adhesions.Hysteroscopic Adhesiolysis with return of periods after a course of supplemented estrogen

European congress of gynaecological endoscopist,Barcelona

.

Recently I had a short trip to Barcelona for a paper presentation on laparoscopy.My paper was selected for Oral presentation at the 19th ESGE conference and it was amonst the top ten papers.Only one from Indian subcontinent.There were 2 more Asian presentations,one from China and the second one from Japan.It was a great learning experience.

Is the effort worth it?

It was a very busy September for me.Lots of deliveries.I try to manage my labour patients  in a logical manner.To try for a vaginal delivery unless there is an Obstetric indication for a Cesarean or unless the mother demands a Cesarean section.
As per my training in UK ,a trial of instrumental delivery is an accepted method where you know that there is a chance of faliure of instumental delivery but still it is worth trying.One succeeds mostly but some time it might fail and the patient ends with a Cesarean section.Its a pity that in India even doctors are unaware of correct protocols and would like to go for a C/S as a part of defensive practice.
Recently I was appalled to hear from a doctor colleagues that I should leave my' passion' for vaginal delivery  .I am not passionate about a vaginal delivery,but just wish to treat my patient the way I would like myself to be treated.It might mean little inconvenience to me or to my colleagues as Vaginal delivery NEEDS PATIENCE.It needs one to attend patient at anti social hours( any time of day or night).But can that be a reason for CS.Just thinking????Am I actually doing something wrong by trying to give fair and safe trial of labour to patients who actually want a vaginal delivery if possible. Any answers??????????

Intrauterine Death of one twin

Am handling one such case these days.The couple and her family came to me with lots of hope.It isn't an easy situation to handle.The trauma of loosing a twin is a great shock to parents.And then the risk to surviving twin and mother is no less.Thankfully it is a diamniotic diachorionic twin where the prognosis is slightly better.
With Monochorionic twin the prognosis is quite bad with risk of brain damage to surviving baby.
Am intending to take her Pregnancy up to 34 weeks which is almost 11 weeks away.
Just hoping the best for mom and her baby who have come all the way from Gujarat with lots of faith!!

Post Partum haemorrhage:Obstetricians worst nightmare

I am back to my blog after many days.lots to share.On 21st sept had one of the worst professional nightmare,which almost every busy Obstetrician must have encountered sometime in their life.
A patient of mine who had a previous LSCS had a very smooth vaginal delivery under my care.I was happy after a VBAC.her family was rejoicing after a smooth labour and delivery .In dead of night 2 hours after her delivery I got a call from worried Registrar'Madame ,She is in pool of blood  I rushed realizing Post partum hemorrhage is the commonest cause of maternal death in our country.
After that started the nightmare.There was too much to handle.Take quick actions,break the news to a rejoicing family that all wasn't well any longer,arrange for blood.nothing seemed to be working.Performed an Internal iliac artery ligation which was partially effective,Ended with a relaparotomy and removal of uterus to save her life.It was a difficult time.Its not at all easy to take quick clinical decisions,keep the Families faith intact in you,keeping them informed of each and every step,procedure,progress.Console them .
Today I saw  her in my OPD.She coped well with the whole situation.Her family after an initial dilemma trusted me enough not to transfer her to any'bigger' centre.
I am thankful to all my team mates including my assistants,anaesthetist colleagues,Nurses,ICU staff because of whom she is alive today.

Dengue in Pregnancy

Its the peak of Dengue cases and Pregnant ladies are also at risk.

Effect of Dengue on Pregnancy : Due to high grade tempeatue there is increased risk of miscarriage but to structural defect is noted in the babies.Babies born immediately after or during dengue fever in a pregnant lady can have neonatal dengue.Once the acute phase is over Pregnancy is uneventful.

Effect of Pregnancy on Dengue:A Dengue affected pregnant lady is no more at risk than any other person.

The overall managment remain the same as for Dengue i.e antipyretics,fluids and Platelets if counts fall down to the recommended range or if there is associated bleeding

The new Clinic

Dear Friends,
Am back after a long long time.sorry for being away.Missed you all.Work kept me too busy and I was in the process of shifting.Now to make life easier for myself and my patients,I am available for consultation at my residence cum clinic at

Tower 18,Flat001
The Close (South)
Nirvana country
South City 2
Gurgaon.

HI

Dear Friends,

Am back from a great vacation to koh Samui the same place I visited 6 months back for my honeymoon,It was great but missed all of you.Would be back with you in a day or two with clinical as well as non clinical experiences

On leave

Dear Friends,

I am unable to take your calls.As I don't have email ids of all my patients can't inform all of you separately.
I am away from India from 16th to 23rd may 2010 and won't be able to take your calls.If you leave me a mail on my email id which you all know if you have been my patients,I would surely respond back.
See you all on 24th may.Till then if you have any queries please contact my team mate Dr Deepa Maheshwari (+919871199511)

Pudendal neuralgia

Its a not so common but easily overlooked condition where females as well as males can have pelvic and genital pain , hyper arousal particularly after sitting for prolonged period.Mainly it is pain in the organs innervated by pudendal nerve.
Later this month I shall be leaving for France to learn the nuances of its surgical and medical management from expert Dr Eric Boutrant.
Once I am back and more enlightened about the condition will share the same with you.With the help of Dr Boutrant we might be able to start the Indian society of pudendal info.

"I'll Never Let You Go" by The Jammies - Congenital Diaphragmatic Hernia...

Diaphragmatic hernia

This blog is for women health and I am talking about a congenital condition found in children.Well a women health blog is incomplete if we don't talk about those 1% of pregnancies where babies have congenital ( since birth) structural defect.
Today I got a frantic call from a very anxious father to be refered to me by a patient of mine.His wife has been diagnosed in advanced stage of pregnancy with Diaphragmatic hernia.
What is diaphragmatic hernia?

 A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm, the muscle that helps you breathe. The opening allows part of the organs from the belly (stomach, spleen, liver, and intestines) to go up into the chest cavity near the lungs.

Symptoms

Severe breathing difficulty usually develops shortly after the baby is born, because of ineffective movement of the diaphragm and crowding of the lung tissue, which causes collapse. The reason why this occurs is not known.

Treatment

A diaphragmatic hernia is an emergency that requires surgery. Surgery is done to place the abdominal organs into the proper position and repair the opening in the diaphragm.Baby needs ventilator soon after birth and thus good Obstetrician,Neonatology department and Paeds surgeon.



http://www.nlm.nih.gov/medlineplus/ency/article/002936.htm

Prognosis

With advances in neonatal and surgical care, survival is now greater than 80%.

I was happy that though I can't guaranty a full recovery for this unborn child but with a good team of doctors and a good nursery at our Hospital I could give some hope to a distraught father.

My teachers

One keeps on learning throughout one's life
One comes across teachers who have a large contribution to what you are today.In my life I can think of many such names. I wish to dedicate few posts of my blog to some of these great teachers.To begin with the two names which come to my mind are Mr Philip Banfield and Mr Aled Plemming.One a great academician and obstetrician another an all in one package.we used to joke that if Mr Plemming could have his way he would even deliver the babies using laparoscope.He is that good.Both of them instilled so much confidence in me by teaching and appreciating my work and by also standing behind me at difficult times that now all my Juniors in India know their name without even ever meeting them.

I admit I miss them.I miss teachers like them in this cut throat world of corporate practice.

Twin Pregnancy

Sorry folks it took me a while to keep my promise to write the differences between multiple and Singleton pregnancy.BTW I have created a website cum blog http://www.gurgaongynaecology.wordpress.com/ and was quite impressed by my tech savviness :)))
There are a numbers of differences but to name a few important ones

• The morning sickness in twin pregnancy is much more than Singleton pregnancy.
• The risk is more if both the twins are sharing the same 'kitchen '(Placenta) and same' living room'(sac) in comparison to when they have separate placenta and sac.
• One twin can outgrow the other and can even become a parasite on another twin,so more frequent Ultrasounds(called serial ultrasound scans) are required in comparison to uncomplicated Singleton pregnancy
• Weight which one is carrying during pregnancy is also of two baby's rather than one.
• There is increased risk of Diabetes of Pregnancy as well as hypertension of pregnancy
• There is a possibility of preterm labour pains
• The rate of Cesarean section is more in twin pregnancy than Singleton pregnancy

Multiple Births (Pregnancy Considerations #4)

Twin Pregnancy

Last saturday a young couple walked in to my chamber at Max Hospital.They looked visibly excited and happy.And I think they had all the reasons to be so.After an IVF treatment they had been blessed with twin pregnancy.They had come to me on recommendation of a fellow doctor(I am happy now after almost 3 years of practice in India my fellow collegues have started showing their confidence in me).The lady asked me a question which brought a smile to my face.Similar question 10 years back by a senior consultant at Lady hardinge medical college,where I worked as a senior resident for 15 days made me leave the institution.The question was doctor 'Do you have enough experience to handle twin Pregnancy?'This time I could understand the apprehensions of a would be mom but 10 years back just out of my college after postgraduation,I was offended.My answer was:It's a simple case,I have even performed difficult caseareans of twins  since I was second year PG student'.And I made a quick decision ,not necessarily right to leave the institution where a senior resident is thought incapable of handling something so very basic.It was my Good fortune to be trained in Gujarat where I have to accept that training is very good and systematic.
I promised this new patient of mine to write my next blog on twin pregnancy.This is just a prelude to my actual blog on multiple pregnancy which would be dealing with 'How is it different from a singelton Pregnancy'?It is surely high risk Pregnancy but not something over which one should loose one's sleep.So wait for my next post........Goodnight and take care.

Premature Ovarian faliure

This is one condition where the ovaries stop functioning Prematurely(by definition before the age of
40 years).Not a very rare condition and I have come across such patients in past as well.But yesterday I could feel how traumatic it must be.A dear friend who married late  was diagnosed with POF.She didn't express as much grief as she is a fighter but I was horrified.She is yet to start her family.
Of course for her or anybody who hasn't completed ones family the option is ovum donation and assisted reproduction.But that is not the only issue.It means an early menopause with all it's manifestations like hot flushes,brittle bone disease(osteoporosis and of course an emotional trauma).A person with POFmight need Hormone replacment therapy( not widely recommended though due to associated side effects),calcium supplementation and exercise.

PART 1 - Medical care during pregnancy in late 30s

PART 2 - Medical care during pregnancy in late 30s

PART 3 - Medical care during pregnancy in late 30s

Pregnancy after 35

More and more ladies are planning their family in mid and late thirties.They have many questions and apprehensions preconceptionally and during pregnancy too.Hope you will find these Videos helpful if you are one such mom.


http://www.youtube.com/watch?v=tURBmzPla_s

http://www.youtube.com/watch?v=8VIFgo4euSg

http://www.youtube.com/watch?v=IVXS2jhlwNg

Maternity dresses in Gurgaon

Quite a lot of my pregnant patients wish me to help them by suggesting shops which sell good maternity clothes.Now honestly I don't have much clue.I think there is a shop in DT Mega mall next to the toy shop which I frequent due to my son.I was doing a google search and came across a site the link of which I will share with you gals.This site seems to be a blog devoted to Gurgaon and living in Gurgaon.And as I was browsing through the site I was happy to see some good comments by my patients.Thanks a lot Sashi and G.Good to know you feel comfortable with me.Click here Gurgaon watch for the nice research done by blog master on stores keeping maternity dresses.Happy Shopping :))))

Interactive blog

I always wished it to be an interactive blog.I would be happy if my patients who are visiting my blog have questions to ask or ideas to share which can be used by others facing similar situation as yours.I know many of you do visit the blog and it would be lot more fun if we could chat outside the confines of my OPD where actually at times I might not be able to give personalised answer to all your queries.

Pain relief in labour

Labour is painful so it’s worth considering what options are available to help you out
• A TENS or Transcutaneous Electrical Nerve Stimulation machine delivers small electrical pulses to the body through pads on the back, these block pain signals and encourage your body to produce endorphins, which are natural painkillers. They are not very effective though.
• Gas and air or entonox is inhaled through a facemask or mouthpiece and works by anaesthetising the pain.Good pain killer but not available in majority of birthing centres in India.But you can always ask your obstetrician to confirm,just in case it is available.
• An epidural is a powerful local anaesthetic that is injected into the spine, it still allows you to move around and feel the pushing sensations. Side effects can include a fall in blood pressure and headaches(incidence is not very frequent).
• There are other painkilling medication available, such as pethidine, but these can cause side sleepy mother and baby.
• There are pros and cons to each of these options, by going through them with your doctor in your third trimester you should be able to determine, which will work best for you.

Medical terms explained

As I was eye balling through my college website,I came across this very interesting link which explains the medical terms in simple English.I hope it is useful for the readers.That's the reason why RCOG website is my favourite.It is full of knowledge for doctors and patients alike.
http://www.rcog.org.uk/womens-health/patient-information/medical-terms-explained

A dedicated floor for Women health in Max Gurgaon

Now there is some good news for those patients who always wished to have that feel of a 5 star delivery with big rooms,a LCD screen and all the designer stuff to make their child birth memorable in' Cradle style 'as Max Gurgaon is converting it's 3 rd floor entirely into delivery suites.So now you have a twin benefit of competent doctors with a multidisciplinary backup in a luxurious ambiance.

Are you HPV POSITIVE?

Advances in medicine are good,but new tests also run the risk of over treatment if not used judiciously.Here I am taking about the latest health fad to grip Indian urban ladies and gynaecologists alike.HPV,HPV vaccine....It is good,i.e the awareness regarding HPV and cervical cancer but there shouldn't be any unnecessary panic.
Your gynaecologist tests you for a pap smear and HPV .You turn out to be HPV Positive.What next????
Certain facts
80% of ladies are infected by HPV and 90% of it clears without any treatment.
As per the UK cervical screening guidelines your further treatment would be

Inflammatory cells in pap smear-repeat pap smear and HPV after 6 months.No Colposcopy needed
Mild dysplasia-same as above
Moderate dysplasia and severe dysplasia-Colposcopy,biopsy,LEEP.You don't need removal of uterus unless it has cancerous cells.So relax!!!!

Gurgaon the hub of Medical tourism in India

India has become and has a vast potential for medical tourism.All the international patients coming in search of good and cheap healthcare can get a good deal if they land up at right hospitals directly or to Medical tourism agencies.I would advice all Foreigners who are coming through small time touts,please avoid it.You end up getting investigated for more than you are required as your tout as got a referral fees for every thing you get done.(I am sorry,am making a lot of unnecessary enemies,but medical profession can't be just buisness)
There are many gynaecological procedures which one can get done in India by internationally trained professionals.These procedures can range from
Hymenoplasty
laparoscopic or key hole Hysterectomies
Removal of Ovarian cysts
Operation for severe endometriosis

Hospitals encouraging c-section

I often get this query from my patients that doctor we know that you are pro vaginal delivery, but we also know that you are compelled by your hospital to do Cesarean section.How will you go against them?
Well.....I do agree that medicine is a pure business now and hospitals are money making organizations.There is nothing charitable about these new age hospitals,but still it is a myth that hospitals force clinicians for cesareans.They don't want a bad name for them as money gained by Cesarean in comparison to vaginal delivery is very nominal but does get bad name for them.It is true that they are not stringent about the Cesarean section rates of their hospital as long as doctors and patients are fine with it but for sure they don't force any doctor for the same.
The rise in rate of c-section is multi factorial.It can be patients demand.An easy way out.Defensive practice by doctors.A tired doctor wishing to rush back home after a long day........but for sure not due to hospital pressure.

give me some sunshine

Corporate hospital politics makes me say

Saari umar hum
Mar mar ke jee liye
Ek pal to ab humein jeene do
Jeene do

HPV Vaccine

There has been a lot of interest amongst the doctors as well as Indian Urban women off late regarding HPV vaccine,particularily after recent media campaign by Glaxo and Merck(The pharmaceutical giants behind these vaccines).And any new product causes a lot of speculation.Often one is left wondering as to what is fact and what is a myth?
It is a good product and seems to hold a lot of promise.Ideally females who haven't yet initiated sexual activity are the one who will get maximum benefit out of it but still it can be given to sexually active women as it prevents reinfection with HPV to which almost 80% of the women would be exposed at some point in their life.90% of times body clears itself these infection with its own immunity.There are no major side effects but fainting has been reported after it's administration.3 doses of the vaccine are needed.As of now we don't know whether a booster dose would be needed or not.It should be avoided during pregnancy.It does't prevent 100% cases of cervical cancer,thus associated Pap smear or cervical smear is needed at 3 yearly interval.

Don't Salnder your doctor

Well after a long long day at OT ,I reached my OPD dead tired.There walked in a female 34 years old 'SP'(trying to maintain patient's confidentiality) Who wished to terminate her pregnancy.I advised her an Ultrasound to rule out ectopic pregnancy(pregnancy outside the womb) because it can be a deadly condition.
Now this female doesn't want to get that done for whatever reason,says its her choice and I have to do her termination of pregnancy as she has made a Rs500 invoice.
Now she sits and understands the pros and cons of both medical and surgical termination of pregnancy.Takes well over 25 minutes of my time.Says she wishes to get her money back as she is indecisive about the Ultrasound as my website never said I will ask for an ultrasound.And she leaves my OPD THREATENING ME THAT SHE IS 'MEDIA' AND WILL WRITE BAD THINGS ABOUT ME ONLINE AS TESTIMONIALS.WILL DESTROY
ME:( .I am not afraid of any online bad testimonials but it hurts when people(thankfully there aren't many) who try to act smart,harm themselves and believe that by paying 500 bucks have purchased a doctor and her ethics.

Webcast on PCOS

I found this webcast quite informative and would like to share with myonline friends.

http://www.rcog.org.uk/consumers-forum-public-lecture-living-with-pcos-webcast

Post Natal Blues

Now you’ve finally met your baby face-to-face, you’re likely to feel great. Many new mums even say they’re on a high for the first 24 hours after the event. But some come down to earth with a bump. About 10 per cent of new mothers get some form of postnatal depression (PND) and if you include mild forms of depression, up to one mum in six is affected. PND peaks in the first few weeks after birth but it can start any time – even six or more months later when most people assume you’re taking motherhood in your stride.

Feeling low
Most new mums feel low and tearful about the third day after delivery, roughly when milk production starts. This is the so-called “baby blues” and is probably due to fluctuating hormone levels. These symptoms only last three days at most.
PND is more severe, starts later and lasts much longer. If left untreated, it can take a huge toll on your health and how you relate to your baby.
For a condition this common, it’s strange that no one is certain about the cause. Some think hormones are the key, but research has not proved this. Besides, PND affects fathers too.
Factors that increase the risk include:
• Previous history of depression
• Unsupportive partner
• Premature or sickly baby
• Recent stresses (eg death in family)
Does PND recur?
Mums who’ve had depression often worry that it may recur if they have another baby. There is a small chance it might but it’s hard to put a figure on the risk. If you get pregnant again, try not to worry but do get help sooner rather than later. Make sure your doctor and midwife both know about your previous history. With extra support during the pregnancy and afterwards, it’s more likely you’ll prevent a recurrence, enabling you to enjoy life as a new mum.
What to look out for
Someone with PND may feel low, exhausted, irritable and unable to cope with life. Despite being tired, they may be unable to sleep. Losing interest in sex is typical of new motherhood but with PND it’s more persistent.
A depressed mum may lose interest in food or eat for comfort. Anxiety, guilt and feeling useless are common. She may feel she can’t look after her baby properly and become obsessed with the baby’s health or her own. Some mums fear they may harm their baby, though very few ever do. If you suffer from PND you feel unable to enjoy things – although there may be enough good days to convince you there’s nothing wrong beyond a lack of parenting skills. But PND isn’t anyone’s fault and you can’t just pull yourself out of it at will.

My new clinic

Within a day or two I shall be consulting in my Private and exclusive OPD at JAP Health care ,Gurgaon between 10AM to 12 PM every day except Sunday.I love the ambiance myself

Lamaze ( Fact or Placebo?)

It might sound little ironical.A gynaecologist asking patients to educate.But yes ,I don't have all the answers.For doctors patients are the best teachers.I am not very sure about whether Lamaze exercises help or they don't help during pregnancy and labour.Comments are welcome from those readers who had Lamaze experience and found it useful.I will share your experiences with my patients.

Pre menstrual Syndrome (PMS)

Premenstrual syndrome or PMS is the name given to a collection of physical and emotional symptoms that can occur in the two weeks before you have your period. These symptoms usually get better once your period starts and often disappear by the end of your period.

Nearly all women have some premenstrual symptoms. Each woman’s symptoms are different but the most common symptoms include:

•mood swings
•feeling depressed, irritable or bad-tempered
•feeling upset, anxious or emotional
•tiredness or trouble sleeping
•headaches
•changes in appetite and food cravings
•feeling clumsy, possibly leading to increased accidents
•fluid retention and feeling bloated
•changes to skin or hair
•having sore or tender breasts.
Most women do not have all these symptoms, only certain ones. Sometimes the symptoms are the same each month and sometimes they are different. The symptoms form a pattern over time.

Between one and two in 20 (5–10%) women get PMS which is severe enough to prevent them from getting on with their daily lives. PMS usually improves after the menopause. A very small number of women get a more intense form of PMS, known as premenstrual dysphoric disorder (PMDD).

Tomorrow I shall be talking about how to cope with it.If you are also amongst the majority of women who have PMS ,RELAX!! You are not the only one :)

What do you Prefer :competence or age????

Though I take it as a complement but at times it does bother me.Doctor is very young........would she be able to manage my case?Unfortunately medicine is one field where you do get advantage if you have few crow feet's and gray strands of hair to flaunt.Being cuddly adds to your years and that is also an advantage.
Medical skills have nothing to do with age.Its more about how quickly you achieve the competence required to perform any surgery.Its about your basic aptitude for the subject.
And yes I have decided,even if some patients would prefer a old matronly looking strict gynaecologist,I am fine being a young and friendly soul.:)

Cord blood banking,

•Cord blood is the baby's blood that remains in the placenta and umbilical cord after birth.
•Cord blood contains stem cells.
•Blood stem cells from cord blood can be used for transplants for children and young adults. This is known as a cord blood or stem cell transplant.
•A cord blood transplant can treat many blood diseases, immune diseases and metabolic diseases.
•It is not yet known if stem cells from cord blood can be used to treat other conditions.
•Stem cells from cord blood can be collected and stored for future use.
•Cord blood is not usually collected as a routine.
•Cord blood must be collected safely and in a way that minimises contamination and infection.
•It is best if a trained technician who is not involved in the care of a woman or her baby collects cord blood.
•There are two types of cord blood bank:

1.private (commercial) banks
2.public banks.
•Private banks are generally for-profit organisations which store cord blood for possible future use by an individual's own family for a fee.
•Each hospital should have its own policy on private banking and make this policy available to prospective parents.
•A public bank, such as the NHS cord blood bank, stores donated cord blood for use by patients anywhere in the world who need a transplant.
•A public bank may also store cord blood for families with a known genetic or other disease.
•The Royal College of Obstetricians and Gynaecologists (RCOG) supports public banking and donation to the NHS cord blood bank.

Happy New Year

Wishing a very happy and Prosperous New Year to all those who visit my blog