Channel Introduction

Satisfaction???

God gives different personalities to different people.
He has made me ambitious,restless and perhaps a go getter.So it transpires into diabetes,Hypertension and heart attacks in long run.Before I have sorted one agenda ,I am ready with a new target.A challenge for myself.A lack of patience makes me a figidity person while I am waiting for the target to be achieved.
So today my brother declared ,you have stagnated.Either be happy with the tag of a good doctor with nice practice or if you wish to reach a higher level become an educationist.God,,,,,that is difficult....For a doctor who has no support in GGN /Delhi.Did all the schooling.college and PG outside Delhi/NCR and has no standing amongst the local educationists, how do you intend to make that person an educationist?Go...Present in conferences.And my answer was....they won't let me deliver a guest lecture unless I know someone from the organising committee.You know that my networking skills are zero.Other option was to do real research have few publications on some topic and then no one can stop you from a guest lecture.And it all started with the Afghan president's wife delivering at another Gurgaon hospital and not under me despite me being a better Obstetrician an knowing my subject better than that person( I know it is a rather bold statement to make).I lacked the name of being an ex professor.As of now I am feeling very low at my self esteem.
I was told,I will be a good practitioner of average masses but should not think being a stalwart.Nothing wrong in that too,But then no doubt I need to spend time on research and academics.Soon my patients will me find out of GGN  for a conference outside.Which is the next one BTW??
All said and done whether I manage to become a stalwart amongst doctors or not.......academics and research is what I am lacking in as I am too busy just doing my private practice,trying to just appease my patients by being present when they are delivering with no time for my personal growth and development.Dilemma!!

Endometriosis

Have written so many times about this condition.One of the bad ones to have and the number of women coming with endometriosis is just increasing in leaps and bounds.
Endometriosis is a condition where there is spillage of blood in the abdominal cavity during periods.And over the period of time it becomes a painful condition with painful period,painful sex,heavy periods sometime even painful passage of stool.It compromises even the fertility.
               The treatment of endometriosis is unsatisfactory or drastic.There is nothing in between.Removal of cysts or removal of adhesion means that 75% of the women will have the symptoms back in 5 years unless the ovaries as well as uterus is removed along with.
                 Medical management can be in the form of Oral contraceptive pills,Injections called Zoladex, Mirena etc All these agents either stop the periods temporarily or lighten it,But once stopped there is bound to be recurrence.
                 The surgery for endometriosis needs special skills and should be performed by expert laparoscopic surgeon as there is a possibility of a bowel or bladder injury if they are badly stuck.

Scar Endometrioma

Endometriosis is not an uncommon condition,where the inner linning of the uterus endometrium is implanted inside the abdomen at various sites due to back flow of period blood through the fallopian tube.It causes painful and heavy periods as well as painful sex,painful passage of stool etc.
It can be treated by certain medicines but primarily surgery.The treatment is unsatisfactory at best unless the Lady gets menopause or uterus and ovaries both are removed.
But today I wish to write about something much rarer SCAR EDOMETRIOMA.It is a condition when during any surgery involving uterus endometrium is imbedded in various layers of abdomen leading to tumor or swelling which increases in size prior to the period and during period and the lump is painful as well.It decreases in size after periods.The incidence of scar endometrioma after a caesarean is 0.1 % to0.01 %.The treatment of such a condition is to excise the lump with at least 1 cm of free margin as well to prevent such recurrence of the lump.
Recently I came acoss such patient who had a caesarean delivery about 6 years back and was having a lump at her caesarean scar since then.
My surgeon husband felt strongly that a surgeon rather than Gynaecologist should treat it as in past Gynaecologists have referred such cases to him rather than correct it themselves.But there is nothing so complicated about treating it and any surgeon i.e, Gynaecologist or surgeon who can repair and stitch anterior abdominal wall can operate it,which I did.
The idea of shairing is this fact is both for the Gynaecologists who transfer it to a surgeon and also for the patinet's to know the correct specialist for their treatment.
The dianosis of this condition can be confusing at times being confused with cancers or desmoid tumours ,infected scar etc.It can be confirmed finally with histopathology but prior to that ultrasound and if still confusion persists MRI can be used to come to a preoperative diagnosis.
Also while performing caesarean tissue handling should be kept to minimum( which is correct for any surgery)by the Gynaecologists.Despite careful tissue handling this is still a possibilty but every little bit of surgical technique counts in prevent such non serious but nagging post operative problems.

scar endometrioma

Decaying Patient - Doctor relationship

Of Late I find myself mostly writing about patient doctor relationship.Am I getting Obsessive or actually there is a decay in the patient doctor relationship?Is it only me or is the world actually changing fast?Last week I took off from my max OPD as I was unable to handle the stress.Stress of dealing with the patients.No ,the issues weren't clinical.The issues were everything but clinical.

A young man comes to my clinic with his 'wife'.Claims to be an Army officer who can't tell where he is posted as he is in ínterrogation'.Doesn't want to take his wife to Army hospital as they admit for the smallest possible reason.Wishes to get termination of Pregnancy done.I advise them to come back to me with an ultrasound scan.Then after few days ,that Ármy officer'calls me that his wife is having severe abdominal pain post termination of Pregnancy with pills,which was conducted under my guidance.That left me surprised.Under my guidance? When was that?No we came to you but took the medicine ourselves.Great!! so how do I help you? He told me,''my wife is having severe abdominal pain'.What should I do? The natural answer was to bring her to the hospital emergency as obviously I can't do any operation at the clinic.So he lands up there with another couple.Now we know that she isn't wife but 'Fiancee'.Now this 'Fiancee'word has been so badly used misused by Gurgaon singles.If you copy the western ways of social values then why don't you have the guts to say the truth like they have.Anyways so after an Ultrasound to confirm the abortion and after first aid when the guy was asked to pay the bill,both the Army officer and his wife cum Fiancee had a strong urge for fag and they both wished to leave the hospital campus together.When asked by the Guard to go one by one to smoke this Army man calls me to tell me the 'misbehaviour' of the security department.When I told him that I can't sort this issue,he told me that he came to the hospital because of me so it was my moral responsibility to get the things done free for him.Why on earth? I can take care of your health issue but of course not of your social and financial issues.So,he tells me that in that case he will hang the phone.That left me speechless.Anyways.....I can't sort your bill.

There are many such stories..........A presumption amongst the youngsters that they can get away with anything and everything.Will bad mouth,leave a bad review on social networking site for the doctor.Sue the doctor.Say that corporate hospitals are looting them.........Then why do you come to these corporate doctors?Will that scare the doctor and hospital.actually when anything is misused it looses it's effect.No longer does these tantrums make any effect to us.But yes.....the trust is decaying.A patient should have full trust on his/her doctor and treating doctor should feel comfortable treating the patient.Suddenly it looks as if we are not on the same side of the table but as if we are opponents...........one ready to find fault and cry for a discount and another ready to get attacked and sued........Where will it take the health care system.very recently I saw a patient, who needed an opinion from haematologist and gynaecologist.And no one and I mean no one including me was ready to take a decision for her treatment.....we all were scared.The case was slightly complicated,the patient too confused and the doctors too scared.....we all told him to take her own decision.so who is the sufferer in the end......YOU!!

Gurgaon Stab Victims

Recently there were two incidents of stabbing where four robbers entered inside the houses of a Lawyer and an Architect.The Architect's wife is also a Lawyer.Both the incidents were unfortunate and should be condemned.Fortunately no lives were lost.

So in the second incident the robbers entered the house,didn't find much at home  and that infuriated them further which lead to insensible stabbing of the Architect's family........his lawyer wife and his mom and dad.

Now the Architect wasn't stabbed and brought his family to a private hospital for treatment.They did get timely treatment.All the three underwent major surgeries and the Surgeon saved all the three after operating continuously for many hours. Just after two days of the incident the Lawyer( wife of the Architect) has been discharged today.

So now the question is that why am I mentioning it on a health blog.It should be on a crime blog.Actually it should be there.But unless I mention the rest of the story ,no one would no the complete story.

Today when the Lady was being discharged,a group of lawyers entered the hospital.Demanded some discount ...........When it was told to them that as it wasn't a government hospital but a private hospital which the victims knew from the beginning,the mob threatened to burn the hospital.A group of well educated Lawyers.So they did manage to get discount.But is there any difference between the behaviour of the robbers and a mob who threatens to burn a hospital if the bill wasn't discounted?

This crime is no heinous than what the robbers did.Trying to burn a hospital full of patients to get a petty discount that too by Lawyers :-)

But doctor you said it was NORMAL

This post is for all my present,past and future expectant couples.
After 5 years of MBBS ,I spent 3 years getting trained to be a Specialist and then again went to UK and trained further and now am aiming to get further trained in Australia sometime  in coming times. Have you ever wondered why and what?Pregnancy is after all so simple.You have sex,conceive,visit the doctor on monthly basis or as called get the investigations done as advised and comes term.Labour starts and epidural comes Handy and unable to push....doctor will pull the baby out.So simple.
But no it is not as simple. In these years we learn the NORMAL as well as the abnormal of the Pregnancy as well as other Gynaecological problem.
Have you ever wondered after labelling your pregnancy as low risk pregnancy why do I call you on regular basis to meet me,ask you to get investigated for various conditions as recommended by interntional guidelines for pregnancy care?Because a NORMAL Pregnancy has the potential to turn into abnormal anytime of the 40 weeks of pregnancy.And a regular visit is advised either to catch such a complication ASAP and correct it if possible and if Uncorrectable to terminate the pregnancy ASAP.
Why am I writing this post?I don't wish all of you to live the 40 weeks under fear of something bad striking your pregnancy but at the same .time a complication should neither be taken as self fault or doctor's negligence .Not all pregnancies are perfect and we have to accept it.

Just Last month I had 3 such incidents

Hydrops Foetalis of previous post I have already mentioned and the husband of the lady is still trying to find out some negligence and malpractice at my end.

Another couple had gone for a routine 20 weeks scan and found an Intrauterine death with Hydrops foetalis.They were much more reasonable and took it the way it should be taken i.e in right spirit,faced it bravely and now we are trying to find the reason so that it can be prevented in next pregnancy if possible.

3rd is the saddest of all story but bravest as well. An uncomplicated pregnancy till 40 weeks,all the necessary scans,caesarean delivery as demanded by the patient and a baby with an undeveloped left heart almost incompatible with child's survival.So they decided to let the child go without any unnecessary torture of ventilator etc. No venting involved.....they simply said even if the ultrasonologist had detected it during pregnancy the outcome would have been no different. But it is not so easy to take such a tragedy so calmly.

BUT AT THE END ONE HAS TO AGREE THAT NOT ALL PREGNANCIES HAVE A HAPPY OUTCOME,THINGS DO TURN FOR WORSE FROM LOW RISK PREGNANCY TO NORMAL FINDINGS.AND IT IS IMPOSSIBLE TO GET ALL THE PREGNANT WOMEN INVESTIGATED FOR ALL THE POSSIBLE COMPLICATIONS OF THE PREGNANCY.

So,trust GOD.....whatever the outcome,he has thought something better for you.

BTW all was well with Sunanda Pushkar till yesterday except for her tweets and today she is gone :-(
So normal does turn to abnormal.Ek pal hai Zindgi,ek pal kuch bhi nahi,kahe ka gum kaise khushi?