My new website

Dear Blog Readers,

I have updated my website www.drkaushikidwivedee.com  and would request you to visit the site to know the changes that would be there in my practice timings and places.

• My personal clinic at Nirvana Courtyard (CLINIC NIRVANA) would become functional latest by 3rd week of this month.I hope that will help in streamlining my appointments as most of you have complained of unavalibility of slots at Max Gurgaon.
• I intend to spend my OPD timings equally between the two places i.e Max Hospital Gurgaon and Clinic Nirvana.
• For appointments please call 9899559807.
• For clinical queries you can use my personal mobile number and would prefer a text to a call.I find it more convenient.

                                                                                     

                                                                                               Love

                                                                                              Kaushiki

                                                    

What are Leaders made of ?

On 6th of October there was an offsite organized by Max healthcare which was called clinical leader offsite.It was my good luck to be a part of it . Not because I was 'chosen' as one of the 'clinical leader'but because I could meet and see and observe some such great leaders closely.
       
          This is a general human tendency to dismiss a successful Industrialist or a politician or writer,as being 'you know it was because he/she was born with a golden spoon.His kismat was very good.He is cunning .He is corrupt...so on and so forth.

           It is not just Kismat or corruption.One has to be different from the crowd...... from the rest of us to be great.They are different.Working in the organisation since last 5 years I met Mr Analjeet Singh for the first time and heard him speak for the first time.It was an extempore speech which were basically answers to the questions put by the audience.I heard him and boy I was impressed.During 99 % of the speeches I fall asleep but I was mesmerized. He doesn't need my acknowledgement to be considered for what he is or who he is,but I think I gained a lot listening to him.Successful people are clear in their vision and thought and they are able to express it plain and simple to the audience.They dare to think different and they work hard,up to 16 to 18 hours a day and they have the capacity to convince you of their thoughts..

         Then it was the turn of Max MD Mr Rahul Khosla .He spoke two or three lines.And again ,you knew what he wanted to convey and he conveyed clearly in not many words.Here was a leader .....you knew.

        I am impressed......I wish to learn from people who are Leaders with their pluses and their minuses.Just searching for a person around my working place who is a leader and from whom I can imbibe some tips.........

But then I think such leaders are born and not made :-)

Intra uterine foetal Death ( IUFD)

Intra uterine foetal death is a morbid topic to talk.But it is a fact of life and pregnancy.No gynaecologist can escape it and neither could have I.
Yesterday I was revising my RCOG Guidelines on IUFD.It is always good to study.Keeps you up to date and makes you a confident doctor.You know what your talking or dealing with.
And slowly as I was reading my mind wandered to all those IUFDs which (Late Pregnancy losses inside the womb) my patients had in my last 5 years of private Practice as senior Consultant at Max Gurgaon.I could recollect 3 of them very vividly.
First one was in the very first year of my practice.I am not sure wether it was IUFD or fresh still birth which happened after the admission .That is an enigma to me still.There was this lady who had PCOD,had conceived under my treatment for PCOD.Her scans till level 2 scan were reportedly fine.She was obese and was gaining constant weight as pregnancy advanced.It looked like an avg size baby.She was gaining 1,5 to 2 kgs every month.And then she came in labour at terh.I as well as my registrar put a CTG machine and thought there was the foetal heart beat which vanished suddenly.Asked for scan.Showed a loss of heart beat.Baby was growth retarded.I had failed to pick the growth retardation it seemed due to belly fat.The liquor around the baby was hardly any.Baby had potters syndrome.The ultrasonologist had missed it.So I delivered a dead baby.I don't know whether the baby was live on arrival and died after the CTG machine was put in or actually we mistook the MOTHER'S PULSE FOR BABY'S HEART BEAT,
 The baby's father then mentioned that ultrasonologist suspected some problem with bladder filling but she never mentioned it on paper.The HOD radiology came to the defence of his team witha book which suggested that for bladder problem a repeat scan at 24 to 26 weeks was needed.So if I didn't ask for it ,it wan't  his team who was at fault.My HOD tried to 'save' me by saying the baby had died before the mother came to the hospital.I like a stupid fool kept on insisting....I did hear the heart beat on admission.Any ways the parents wished to sue the radiology team.I insisted'the fault was mine if I took body fat for baby's growth'.Sue me if you have to.And despite their grief they said a big NO.Doctor.......you can't be wrong.I felt their pain.And then for a short while till they left the town they always came back to me for any gynaecological advice.I was the blessed one.My patient's trusted me.Atleast they trusted my intentions.
Second one was even more sudden.A on going healthy pregnancy.C/o sudden loss of foetal movement at 32 weeks.She kept on waiting for 24 hours of loss of foetal movements.Primigravida.Usg later.....No heart beat.Was actually difficult to break the news.I cried and they cried.It was bad.Anyways....terminated the pregnancy.6 weeks later showed antiphospholiid antibody positive.I had a reason and a treatment to offer.They never returned back to me for their second pregnancy.But it was painful.
Third one had a happy ending.There was this too well read a lady with PCOD with GDM who had big fights with her husband and her in laws.In my opinion all of them were contributing to the fight.At 34 weeks,reported to Max emergency with no foetal moveents.USG.IUFD.Counselling wasn't too difficult.She was prepaired for the worse due to loss of foetal movements and being a well read person as she was.Her in laws thought me to be an unlcky doctor for her,suggested change of doctor and suggested me to do a hysteroromy.Challenged their daughter in law if her doctor would be able to deliver the baby vaginally.Anyways she did deliver vaginally.Even I thought she was someway responsible for foetal death due self induced hypoglycemias with insulin leading  to foetal hypoglycemia.But baby was born it had 5 to 6 tight loops of cord around the neck.I felt ashamed to have been judgemental.Anyways despite her family's objection she returned back to the doctor i.e me whom her family had declared unlucky.She had her whole pregnancy on insulin.At 38 weeks I induced her and she had a bonny baby girl.
It was a roller coaster ride for me all the three times.
Usually following an IUFD the doctor is considered unlucky whether actually contributing to it or not.It was good that my patiets showed faith and returned back to give themselves and me a second chance.

Believe me IUFDS are no less traumatic for a doctor.....

Back from Germany

First of all ,sorry to all my patients who had any trouble due to my being out of Gurgaon for 5 days.Though I try to insure that none of my patient is left unattended in my absence.I have a team headed by Dr Veenu Agarwal which insures that you are managed in my absence as per the same protocol as created by me after research of evidence based Management.So whether I am in town or not under the care of my team your management will still be the same.

Now that isn't what the post was about.It was about my Germany Visit.This Visit was for a specific reason.Those who have been following my blog must be aware about my passion to follow urogynaecology and to treat patients of Urinary incontinence who keep on suffering in silence for long years.Are scared even to sit on a sofa at their home lest they might wet them.

At Max Hospital with the support of our CEO and GM Operations I intend to start a full fledged Urogynaecology department.My visit was related to it only.It was a masters workshop at Ehingen City,Germany.The idea was to see what other masters are doing and whether you should do things differently.

It was a highly successful trip and I came satisfied that we won't be providing a care an less than the best of urogynaecology centres in the world to such patients.Follow my blog to get an update soon.In the meantime if you or any one of your family member has an incontinence issue......don't shy.Help is very near. 

How reliable are online feed backs?

Have you ever been a part of any matrimonial or dating site?May be yes.Have you ever come across a fake profile?Looks to kill,job profile which few can match ,family background .....you don't have words to compare.And finally you realize it is a 100% fake profile created for a time pass or if not fake a lot of information is morphed.

Now coming to online reviews of doctors.......are they to be 100% believed or should you disbelieve it or take it with a pinch of salt?There is this one site where the blog master has very painstakingly tried to give an overview and published reviews of various people about different aspects of Gurgaon.And in my opinion he is doing a good job.There is one section there on Gurgaon Gynaecologists as well.Recently there was one Lady who shared her concern if what is shared in the blog are actual reviews or just promoted a few gynaecologists.There are a few positive reviews about me too on that site and thus I feel my moral obligation to answer this question.And people do come to me reading those reviews.

I personally don't know the blog owner .His favoured gynaecologist is someone else and not me and even at the cost of irking him I would say that he surely has a biased attitude for her but the reason is simple.....he is satisfied by his wife's Gynaecologist.Just like anyone of you he is entitled to his opinions and feed backs and it might be so that he might slightly favour her by deleting not so favourable feed backs about her.Coming to me....as my online presence is quite significant due to multiple reasons.....one I like to be online and communicate with my patients.Secondly in Gurgaon it is a very good marketing option due to huge number of net savvy people.Thus my patients are also quite net savvy and I do have an advantage that they are their to give their feed backs.Of course it has it's disadvantages too....if someone is dissatisfied there is a good chance that I would get bad reviews online as again, a vocal online person will give a negative feedback too.

Now the question is whether to trust these feed backs or not?Please take it with a pinch of salt.These online reviews are just one way of finding required information.Try to find people in real world and not virtual world only who can give you feed backs.Try to ask the concerned hospitals.Try to find the educational qualification and experience of your doctor.There might be actually many good doctors who don't have a good online presence.

If I wish to give false and fake reviews I can do so.No blog master can stop me despite his /her best efforts to keep me from giving fake reviews even if he/she wants to publish only genuine reviews.I can ask 10 different friends and relatives to use 10 different ids/IP addresses/computers and write  reviews sitting at 10 different parts of the world.Where ever I travel I can myself use different Ids at different cities to write it all myself.Who needs even friends or relatives for that.It is still much cost effective than spending Lakhs on marketing.Do you think that blog master would be able to say for sure whether it is a genuine review or one prompted by me???Same goes for anyone..........

HAPPY SURFING :-) :-)   

Pregnancy in a Post Bariatric surgery Patient

Obesity is on rise and so are post bariatric surgery patients.I am not sure whether about the whole concept of loosing weight by such drastic surgical means.Being married to a expert bariatric surgeon Dr Shalabh Mohan......I do have a fair amount of knowledge about the physiology,emotional and physical issues faced by these patients both pre op and post op.According to him and the evidences which he has showed me it is a extreme step towards loosing weight but then probably these are the people who if hadn't gone for these surgery would have never lost the weight themselves once morbidly obese, had a miserable social life and would have had their life shortened by diseases like Diabetes,raised blood pressure,heart disease etc..

Now I have started getting women who are pregnant and had Baratric surgery.Two of them have already delivered under my care and few others are currently pregnant.They are quite apprehensive ladies.The clinicians who were taking care of them before me also seemed little panicky in their management of these women.Do we really need to panic?What are the special precautions needed by these women during Pregnancy?Let me summarize it .

Which Procedure ? A Lady desirous of having a pregnancy and opt for Gastric sleeve or bypass.Once it was considered that bypass was a big no no for lady who have yet to conceive as the deficiency of nutrition was considered to be more in bypass.It is a fact but the deficiency is marginally more and not of significance.In bargain the weight loss is more with bypass ( again whether all this is healthy or not I am not commenting on that.It is for you to decide and the Bariatric surgeon to counsel you)

When to conceive? Ideally once the weight loss has has stablized.Mostly the recommended timeframe is 18 to 24 months.Till then Oral contraceptive pills shouldn't be used for contraception as the faliure rate is high due to lesser absorption of the medicine.

Preconceptional Planning? Meet a gynaecologist as well as Bariatric surgeon.These women should be tested of their micronutient levels preconceptionally and then in each trimester.These micronutrients are Iron,ferritin,folate,Vit D,Vit B 12 and serum Protein.
These women should be supplemented with multivitamins,iron,calcium and if deficient in protein on high protein diet.

Diet during Pregnancy? Diet should be same as pre pregnacy diet.If someone has a difficulty in swallowing high fibre diet like green vegetables it can be made semisolid by pureeing in a mixer.

Very sweet food should be avoided just like in prepregnancy food as it can lead to dumping.....sensation of abdominal pain,nausea and vomiting.As one can get abdominal pain,nausea and vomiting as symptom of pregnancy as well a bariatric surgeon should be consulted to rule out dumping as the reason of these symptoms.To compensate for the 300 kcal required extra during pregnancy these women should have frequent small meals.There is a small probabilty that these women can have small for date babies and serial growth ultrasound scan is recommended on a monthly basis.Micronutrients should be supplemented during the pregnancy.In nutshell it isn't much different from a routine pregnancy.

Delivery? Caesarean section is recommended for only obstetric reasons.

Bariatric patients have a lot of preop as well as post major emotional issues and are advised to be in touch with a good bariatric surgeon who can be their counsler and can provide them the much needed support.It will also be a good idea to join a post bariatric surgery support group sessions.
 

Doctors don't always write investigations to make money

On Monday I shall be doing a completion  cancer surgery on a woman on whomn I did a surgery 10 days back.I have mentioned about this Lady in my earlier post as well.
52 years old lady,detected with both sided Ovarian cyst with normal tumor markers.....declined Frozen section.Frozen section tells about any organ being cancerous or not so that one can proceed for the extensive cancer surgery.
But that this lady didn't distrust me but thought why to spend on frozen section and if in case it is a cancer the money on cancer surgery.I opted to reduce my surgical fees........which was actually peanuts in comparison to he whole estimated bill at hospital.So she ended with a TAH +BSO ( removal of uterus and ovary)Despite bad adhesions I managed to take the cysts out with capsules intact......just in case.And it turned out to be a cancer.
Then I sent her to Medanta to a very well known medical oncologist for a second opinion regarding a need for completion surgery or a direct chemotherapy.
The Medanta oncologist asked her to get operated at his place.
Anyways she has returned back to me and on monday we are planning an extensive staging Laparotomy.
If only she had trusted that doctor would suggest a test only if needed she would have been saved of great amount of money and post op discomfort.
This is just and example..........there are many such.Will keep on updating on the blog .............not to justify the doctors or myself but to let you understand that health is a serious issue take it seriously!!
And yes........please all of you get your health insurances done.Treatment at quality hospital by quality doctors in India is quite costly.