Thanks Neha and Rohit

I did what was my duty but for sure It feels good to know that it made you happy!!

Your cancer can be in your head

A strange title for a blog.Wanted to make the title sound catchy.
I had a dull aching pain in my right side of abdomen exactly where the liver is since last 3 months now.No other symptoms at all.And I Ignored it for a while.Was simply afraid if I get an ultrasound scan done and it suggests a problem then what?But since  1st week of march it was aching badly.I palpated very hard on the side to feel if I could feel a lump .And I did feel something.It horrified me.What could it be?
A liver cancer.Or  may be a spread from intestine to liver.But then It I don't have any other symptom.But then who said cancer has to have symptoms before it is already spread.I asked my Surgeon husband to feel for that lump and even he confirmed in an affirmative.Time to go........Or beginning of a very painful period of chemotherapy etc.Could it be big gall stones only.God I will thank you if it is just gall stones.It would mean just a laproscopic removal of gall bladder.What if my Common bile duct gets injured?But then I would still be live.Was it an adrenal tumor or a renal cell carcinoma.I started taking antibiotic just in case there was some infection.
Shalabh said,'Get an ultrasound scan 'and got busy with his day to day work.I preferred not to tell it to my mom and brother.My son had heard my conversation with Shalabh and was asking all the sign symptoms of cancer on and off and I was reassuring him I don't have one.see I want to loose weight still I can't.can't have cancer.
After 10 to 11 days of feeling this lump one night my pain got really bad.It was radiating to my back.it was horrible.May be it was pancreatitis.I decided no matter what I will get a scan done in the morning.
Took an appointment with Dr Girish pandit.He was kind enough to adjust me at such a short notice.
i requested him,if you find any secondaries please tell me so clearly.I am prepared!!After a prolonged scan he announced,Doc your scan is very boring.Everything is so normal.I took a sigh of relief.
That day my pain was about 50% better.I stopped prodding that area of mine .After 5 days later, today my pain is totally gone.No medicines needed.
The cancer was all in my head.And I am being honest when I say I have a very high pain tolerance level but the night before my scan I was in tears because of pain.It was all in my head and I once again realised the power of brain.May be that is what is used by yogi's in Hatth yog to bend the iron bars by just looking at it.And yes a lot of our problems are mainly psychological..........

Russsssssh for caesarean .........Baby has passed stool!!

In current day Indian Obstetric practice,there are couple of situations (out of many) which lead to an immediate Cesarean section. Both of them are controversial indications.

A Pregnant lady goes for a routine ultrasound scan.Ultrasonologists after looking at the doppler declare there are two loops of cord around the baby's neck!!!''Aaap ka baccha neta hai,mala pahen kar hi paeda ho raha hai.So it calls for a Cesarean section.Baby's cord will get strangulated and there is a high risk that baby will get choked.'' So speaks the Ultrasonologist and then a concerned gynaecologist.They sincerely believe that,CS is the only safe way out.But is really so??Evidences are to the contrary.In my practice I do find it a challenge these days to motivate would be parents for trial of labour if a loop of cord is reported,as nearly every one tells a story of how their friend had a c-section for the same indication.Most of the times they do get convinced,after a lot of counselling and perhaps seeing a non buzzing attitude on my face and achieve vaginal deliveries as well and that too without any problem.And what for are the modern day Foetal heart rate monitoring machines?If it shows a foetal compromise a crash Cesarean section can be done immediately .

Now comes other one.Baby passing stool inside the womb.This stool is called meconium.Now this thin meconium again isn't an indication for Cesarean section but here comes a big handicap if one doesn't have acess to Foetal blood sampling (like I don't have and neither I know of any other Indian hospital which has)facility.One can try to be little brave as a doctor to try for a vaginal delivery if baby has passed stool but can't keep on waiting for n number of hours without knowing if baby is alright or getting acedotic.So,no wonder passage of stool inside the womb leads to a much higher number of cesareans in India than required. Few days back did one such cesarean where I did wait for 6 hours post detection of meconium but then got scared to try further,because if things went well.....No big deal,that's my job.But if baby aspirates meconium and has a meconium aspiration syndrome,onus would be totally mine.Baby was fine at delivery .May be if I had a FBS facility,may be could have given a different outcome!!Just Wondering!!

'Sexy 'India

Things are in transition in our new 'sexy India'.Few days back a young couple visited my OPD.To my usual question of Ms XYZ ,how can I help you,came the answer from the young man.My girlfriend(thank God not the cliche' fiancee') has very painful periods.She isn't seeking any medical help and I had to pull her out to come to you.After few questions later I realized the girl was a small town girl and my UK acquired way of asking needed a constant translation from her boyfriend.I switched to my chaste Hindi.I addressed her clinical concerns...Primary dysmenorrhoea,mild pelvic infection.OK ........I hope these things will settle down with medicine.Period pain might be better after 1st delivery.And then came a googly,which left me beaten for a second.Realised India was changing but really so??
The man told me,there is a 50 - 50 chance that they will get married as they belonged to different castes.So could I fix her virginity?He really love her and didn't wish her to suffer in future because of the act they did.I said,get married if you love her!!No,her mother etc are from rural background and then he mentioned the name of a place know for being notorious.I asked light heartedly....do you anticipate an honour killing?Inform the police and proceed.He came back to say ,no they won't kill her but might kill me.Girl showing all her concerns for her BF said no-no they won't.
I talked of hmenoplasty.But since last  few days am thinking of paradox of our sexy India where the youth are liberated,have a new found financial Independence ,are living alone in big metros.enjoying their life but still a person who loves his girl friend thinks of getting her hymen 'mended' for her better future.

100th post

This is my 100th post in this blog.So has to be something close to my heart.Something which touched me and changed me,made me and improved me.

Today I watched the an Indian flick 'Patiala House'! A light harted movie about 'the then racism in Uk',the Patriotism of a Sikh patriarch who would live in South hall but won't allow his son to play cricket for 'enemies'ANGRAZ and the son's revolt and how he was considered a national Hero by Brits.

I got a little emotional today while watching the movie.2 drops of tears came from both my eyes.There was a sudden surge of emotion and I felt for a second I missed Mr Banfield,Dr Lesely Bolton,Mr Aled plemming,Dr Chris Clark,Mr Nigel Bickerton,Mr Simon Leeson and my all other consultants.I owe a big part to what I am today as a clinician to them.I knew my basics but they tought me the art of Obstetrics,the science of paper writing,the importance of credibility,art of playing with the words so that the patients are neither offended nor get a sugar coated version of their condition but know the truth and only truth in an evidence based manner.
These were the people who groomed me.Never differentiated between me and a white local doctor.I never got a mentor in India.There I had so many.

My experiences of life have made me like the Brits if not love them atleast, coz  I won't been myself but for all my British teachers.When I perform all my complex laparoscopic surgeries I always remember Mr Plemming who let me do first laparoscopic surgery with an endoloop for a tubal ectopic.In our unit there in UK we didn't have a harmonic then .Have surely moved a lot ahead since then but then it were they who showed me the 'yellow brick road'!!

Medical termination of Pregnancy

I miss NHS for many reasons.One of them is the freedom to choose whether you as a clinician wish to be a part of Medical termination of pregnancy or not.I have an ethical issue with termination of pregnancy and NHS gave me the freedom to say a no and all throughout my working in UK ,I was not a part of even single TOP accept if it was for a congenitally malformed baby or any such medical indication.
In Indian Practice one can choose not to do a MTP/TOP(Termination of pregnancy) ,but then that can affect your practice,as these couples come to you for a termination first and may be an year later come back for an Antenatal check up of pregnancy.So,I do perform 1st trimester terminations in India and feel guilty every time I do so.
I feel less guilty when it is a medical ( with pills) as I just prescribe the medicines.I know,still the involvement is there and am responsible for it.Medical TOP has good 30 % chance of being a faliure.There is a very clear RCOG guideline on of these 30% who would need surgical intervention ( Suction and evacuation).Those who have an endometrial thickness grater than 15 mm or the retained product of conception is approx 15 mm. There is no recommendation to prescribe a second dose of misoprost.I am very cautious in explaining the risk of failure to my patients and the aftermath but have realized that after a failure they insist on a second dose of misoprost as the 'radiologist' suggested so.That is 'quackery'.Practice of medicine without evidence is quackery and shouldn't be practiced.
So,please listen to your doctor properly during the consult,if you don't understand ,ask,ask,ask and ask before you decide any particular process.But once taken a decision don't try to influence a doctors treatment.Agreed you have a right to make a choice but the doctor has the right to say No to treat you.

Emergency

In my previous post I talked of an emergency.Let's talk about that.
I am on call on Wednesdays.At 00.15 ,got a call from my attending consultant Dr Veenu Agarwal.There was young lady,all of 21 years in the triage,pouring blood vaginally.She was escorted by her boyfriend and friends of her boyfriend.They were all students of a very prestigious university of Delhi.
Apparently this girl got pregnant.Consulted some doctor at some Sharda Hospital for Termination of pregnancy.No ultrasound was conducted there to ascertain weeks of pregnancy,though her history was suggestive of about 12 weeks of pregnancy.seemed like she was advised to take the pills also in wrong manner.Who knows she had been to a local chemist and self medicated her(Very common in India).

This girl was slowly sinking with a rising pulse and dropping blood pressure.We were running short of time lest she goes in shock and DIC.Dr veenu very efficiently shifted the young lady to OR and directed the radiologist to come directly there to confirm the weeks of pregnancy.
It was a big uterus with incomplete miscarriage.She was bleeding.......It resembled spirts coming out of a fountain.
A suction and evacuation was done and as expected bleeding stopped immediately.
Her Hb had dropped to 7 gm%.But being a young patient recovery was quick.
Next day before her discharge I gave her an option of OCP and other contraceptives too.She declined flatly.
By this blog I wish to convey all young girls who behave in similar manner:please don't self medicate yourself.It might turn out to be a life threatening situation.
Secondly.......be responsible and use a regular contraceptive