Complex Ovarian cyst in Postmenopausal women

Within a span of 15 days I got to operate on two women ,both of whom were menopausal and had complex Ovarian cyst.Both had otherwise a normal ca 125 levels and normal CT scan apart from the cysts.
I have the standard option of frozen section to both these Ladies.Frozen section is the pathology report which pathologist provides as an intereim report based on which it is decided whether it is a cancerous or non cancerous growth.If Cancerous, one needs staging operation.
Both these ladies declined to get the frozen section done.The first family was so scared that they didn't wish to even know that it was cancerous.They were lucky and that lady had just a fibroma of ovary.
second one who choose not to go for frozen section in want of funds,wasn't so lucky.In her case it turned out to be clear cell carcinoma.Now starts her PET scan ,MAYBE COMPLETION SURGERYetc and chemotherapy.I hope she has the money to get herself treated.

TAKE HOME MESSAGE GET FROZEN SECTION DONE IF INDICATED.DON'T DISMISS IT AS JUST ANOTHER TEST FROM THE DOCTOR.

Musical chairs at Gurgaon

Returning back after some gap.Lots of things to keep me away from you.Some personal and some professional.
With opening of yet another corporate hospital in the vicinity,the doctors in Gynaecology are playing musical chairs.
Someone is moving from sector 14 to HUDA City Center.Some one moving from HUDA city center to HUDA City Center.Someone has decided to move from one part of sushant Lok  to another part of shushant Lok .Others yet deciding.And how can I forget docs from all over the Delhi are also joining the game. I also got few invitations to play this game of musical chairs.For a while I thought of it and then the question was after all why?
I am a satisfactory doctor with a busy schedule.My Hospital by and large is good to me.They might not think me yet old enough to be the HOD but they don't deny that I do my job well and are appreciative of it.
Anyways ,just to let the readers know that in near future for a while you might not be able to find your gynaecologists at their usual hospital but don't loose hope and keep on searching.You will find them near by in one or another hospital playing Musical Chairs ;-)
Can't be more candid or I run the risk of being boycotted by all these hospitals.Lol.

Three unrelated tweets!!

Today I feel like sharing three incidences,all very different,unrelated and even not even related to women health.

first one happened yesterday night.A patient of mine delivered during the day and as per protocol I asked the nurse to take off her IV Cannula.Following an uneventful vaginal delivery,no rationale to have a foreign body in anyones body.The nurse insisted that it was a medical policy and she can't take it out till the patient was discharged.I lost my control.She was really reluctant to take it out but ultimately took it out.When we came out of the room,she told me that we nurses have decided to put a cannula in a patients hand till patient is discharged as when they have a cannula in ,it will work like an identity tag and patient can't run away without payment.Poor thing what she didn't underdstand was that a person who has to run away can also take out the cannula himself/herself.

second one....I took an off from my OPD as was feeling really tired.But in morning had 2 deliveries and a minor surgery to perform.Was free by 12 noon and while awaiting at the reception for my driver I heard a conversation between a patient and front desk staff .I wish to show my son to a orthopaedician.The help desk Lady informed that the consultant was on leave due to janamasthami.That gentle man responded.....doctor on leave?How can they be on leave?.As I was standing near by,I smiled and told him that as doctors are also human they can celebrate Janamasthami if they wish to.To which he smiled back,but then he for sure had made the front desk staff feel guilty.You can certainly show to the doctor in emergency who is providing ortho emergency cover.

Lastly.....feeling really tired and drained I went to a spa at DT Mega mall.While returning back near Sikanderpur circle found two hatta katta, jaat boys in their twentees were kicking and beating a sardarji in his late fourties or early fifties.Didn't seem like a car accident.Both of them had small cars.One of the jaat boy had a big Tatto like Saif ali khan on his hand.They were beating the other man mercilessley.He was requesting them to leave him and was crying for help.No one came in the front.My driver stopped me but I went to them to request them to leave the poor fellow.They pretended as if they have not even seen me while constantly they were abusing those who even requested them to stop this nonsense.Ultimately I moved from there and dialled 100.Don't know whether they arrived on time or not??

Private hospitals fuel C-section epidemic

Private hospitals fuel C-section epidemic

Do they really? I think I can answer this question better.

Let me talk about myself first.I have on an average 20 deliveries a month at a corporate hospital like Max.Less than 20% of them end up in a caesarean section.I do take pride in these figures.And yes MY  PATIENTS DO HAVE MAXIMUM NUMBER OF VAGINAL DELIVERIES IN COMPARISON TO OTHER CONSULTANTS.All of these are facts which can be verified from our hospital records......any media ,any SMJ team,anyone else who is interested can check the records.

Now why do I try for vaginal delivery?I do so because that is what has been trained as the optimal method of delivery unless there is a maternal and foetal indication for performing Caesarean.At my Hospital I am paid the same amount of money as my surgical fees which is around13 k in a single room patient,whether it is a simple 15 minutes caesarean section or 36 hours spent with a patient to help her have a vaginal delivery.Do you think this is fair?I strongly feel that surgical charge for vaginal delivery is very less in comparison to what it should be.It should be for sure one and a half times more than caesarean section,considering the hard work,patience and skills required for a safe vaginal delivery.It will be good for patient and doctor both.
For patients if they think ___ Money is the reason for caesarean section then if she is paying less for caesarean section in comparison to vaginal delivery she would know that the money wasn't the reason.If doctors work only for money then naturally they will start conducting more of vaginal delivery.

In my opinion money isn't the only reason for increased caesarean section rate.Some doctors and patients also feel that caesarean is the safest method and easiest method of child birth.So if they are paid less for a caesarean section,they also know that they wished the work done easy way out and thus less surgical fees.

Finally,if doctor earns money in correct way_________Don't be jealous.They have slogged hard to be where they are.
PS : When you make payment at private hospital for a caesarean do you think all goes to the doctor's kitty? You are mistaken.Of the total bill of 75 K + ,a Gynaecologist will not get  more than 13000.

If anyone of you have any question to ask me on this topic please leave your comments.

Removal of Ovary for Ca Breast

Today I performed a Laparoscopic removal of both ovaries in a 40 years old lady.And as I had to remove the ovaries I had to remove her uterus as well.Ovaries weren't diseased.Then what was the reason for this unindicated removal of ovaries ? Well about 8 months back she was diagnosed with Ca breast and had Mastectomy followed by chemotherapy.But it is a known fact that Breast cancers can be estrogen and progesterone dependent.So for a better effect of chemotheraputic agent,tamoxifen and to reduce the recurrence of Ca Breast ,it is advised to get the ovaries removed. So if a breast cancer sufferer has completed her family or has a high chance of recurrence this rather drastic surgery can actually improve the long term prognosis of the patient. I hope it works well for her and she has many more years of her life to enjoy.

Fenton's Procedure

Fenton's procedure is an easy but not very commonly done procedure for superficial dysperunia (painful sex) due to scar tissue at the mouth of the introitus i.e at the mouth of the vagina.It can happen due to infected and badly scarred episiotomy wound,following labial adhesions,lichen sclerosis and Lichen Planus.I was amazed not to find a single video or picture of this operation on the whole of net.Sharing with you pictures of one of my patients who was operated about 3 years back.She attributes Fenton's surgery as her life changing surgery.

FG: Gurgaon Healing

FG: Gurgaon Healing