God.....the indirect evidence

This post is not about health,Not about women.But I still feel an urge to share it with you.Yesterday night at around 2 am I returned home after finishing an emergency surgery.Tried to sleep but couldn't .Was feeling thirsty.I had a bottle of water just next to my bed.But then I thought I will walk down to the fridge to have some chilled water.And I walked down towards the kitchen.From the light which came out of the aquarium tube light I could see something on the ground.I was groggy.....half asleep.Still I put the light on in the living area.I thought I saw a rubber toy,shaped like a big Fish.With a new puppy at home ,I thought may be my mom has got him a soft toy to chew.And then i thought I was hallucinating.Looked like the mouth of the rubber fish was opening and closing very gently.In those few seconds I thought too much and too fast.I looked at the aquarium where the fishes were moving in.And then I realised that it wasn't hallucination.....the mouth of the toy was moving.....like shallow gasps before one is dying.But this fish was at least 4 feet away from the aquarium.God.....it was the fish who had jumped out of the aquarium and was having her last few breaths.Being a pucca vegetarian it was difficult for me to hold the fish,but if I didn't put it to water it had no chance at all.And I held it on a news paper and just threw inside the tank.It moved and then sank to the bottom of the aquarium.It started to breathe.......very hard and very strained.It's fins looked all dried and shrivelled up.I thought it won't make it.I thought it was a dream.Called my husband to confirm what I had just seen and done.
In the morning when I got up I expected it to be dead.But no.........it looked better.Definitely unwell but not dead.Slowly over the day it improved and is almost 50 to 60 % of it's normal.
Do you have an explanation.......how the fish came out of aquarium.........What made me have the urge to have cold water from fridge while mostly I don't bother in night.How I reached just when the fish was having it's last few breathes and the body was not at all moving?What stopped the puppy to follow me(who otherwise would not have left the fish)at the point of time.Just like Life of pi I got an indirect evidence of God..........We are nothing.It is he who decides who will we were doing what and also the outcome.The fish could have died even after being put in the aquarium.But he choose to make it live.Amazing.......though a small incident,it has touched me from deep within.

Stem Cell banking- to go for it or not?

Lot many parents are interested in getting stem cell collected for their Kids as apart of 'future Investment'.There is an emotional angle and it leaves parent feel guilty if it haven't got the banking done.Yesterday I attended a CME on stem cell and it made me think that how less do the counsellors and even the doctors who advise you to go for it or don't go for it know about the stem cell banking.
Stem cell is a bright concept with a huge potential to treat many medical conditions.That we are talking about Public banks,where just like public blood banks umblical cord cells are donated and stored as stem cells.The stem cell is released at a price when a person needs it for therapy .
Now coming to the Private stem cells,the idea again is good but then there are few aspects which you need to know before you take any such decision.

1. If your baby has Metabolic disorder ,he can't be treated by his own blood.Reason being even the stem cells are having the same disorder.
2. Leukemia can't be treated in the child by the stem cell,as it has been found that these stem cells have the potential to get transformed to cells having leukemic antigens.Moreover when donor cells are given there is a preventive Graft VS tumor reaction,which is beneficial and can fight with the cancer cells.When the child's own sample is used this protective graft vs tumour reaction is absent.
3. For a good unit of stem cell at least 60 mls of umblical cord blood is needed.Below which the cells retrieved would be less and thus useless.
4. When needed this 60 mls is sufficient for only one transfusion of the child.For adults this one unit won't be sufficient.Ask you blood bank ,God forbid if you need it tomorrow........how will you get more units?
5. Umbilical cord blood should not be collected in woman who are less than 34 weeks pregnant as the cell retrieval will be very less due to small size of placenta.IN a twin pregnancy the collected sample should be checked for cross contamination.If Lady has uterine infection then sample should be discarded .Goes without saying if mother has HIV or any other blood borne Infection,,,,,collection shouldn't be done.

In India as of now we don't have a full fledged public stem cell bank and till than private banks are better than nothing.
All the Hospitals and Gynaecologists worldwide are paid some collection charges for stem cell, from all of these companies and that is ethical and doesn't come into the category of unethical cuts.

NIFTY(Non invasive foetal Trisomy Test)

I am excited to share some recent advancement in the management of Pregnant Ladies,particularly those who wish to become mother at a later age.
The biggest fear of these mothers are 'I hope my baby doesn't have Down Syndrome'.
Till now the options available were screening tests ( Level 1 scan and Double Marker and quadruple Marker).A serum integrated test was considered the best screening test.But it has it's pit falls.There is a possibility of false negative as well as positive.
So the confirmatory test used to be invasive Chorionic Villi Sampling or amniocentesis which was a major cause of concern of these Ladies as these procedures can lead to miscarriage or infection.
NIFTY (Non Invasive Foetal Trisomy test) a new test and still under trial seems to be coming up as a very good,practical and safe solution for confirming the Downs syndrome.It has a false positive value of less than 1 %.It can be done from 2mls of mothers blood.The test works on the basis of identifying foetal cell in the maternal blood and process it.
At the moment the test can be done in Hongkong,Dubai and Germany.But if you are an Indian who unfortunately needs this test,the sample can be sent to Hong Kong.

A New begining

More than three months of dilemma and I realise I lack the quality to be cut throat required to reach the top.I will never reach the top of a corporate ladder and I am a mere clinician .But then I think that is what I was trained to be .
To all my friends whom I told that I am moving to another hospital as the departmental Head,I am not.I am very much at Max Hospital Gurgaon.It has been a stressful 4 to 5 weeks of thinking and rethinking and logic and counter logic and ultimately it was my emotions which got  better of any logic.There were people at Max Hospital who I value more than my gains.............. It is perhaps stupidity.And as few of you thought I had a counter offer.No there was none.I am still the unit head with no financial gains as one would like to believe.I know in bargain I have made a few people unhappy.Have not been at my best possible behaviour with few friends.But then you can't keep everyone happy. .
The decision to leave one hospital from another would be so difficult,I never thought so.I wonder how doctors switch over so fast from one institution to another and with so much of ease.Maybe I made a mountain of a mole hill.Anyways I am still where I was.......at clinic Nirvana and Max Hospital ,Gurgaon.

What makes them special?

Just last month there was some meeting going on where I heard people commenting about slowly older doctors become redundant and how new talents are brought to take them over.It was little ruthless but yes a fact of life none the less.
And then I talked of my aunt Dr Shakti Bhan Khanna that how despite her age is still not redundant and Apollo hospital doesn't have her replacement.
And then as usual I mind wandered in between the meeting to think of Amitabh Bachchan.A person who has changed himself so much with the changing time.He is still so very relevant.I was his fan since I was infant.Watching his movies during school days used to be a treat.And then came his phase of transition.Lal Badshah and Jadugar etc.It looked like the end of a brilliant Carrer.Those movies were horrible.But that man.......he rediscovered himself.Not just acting if you follow his blog or follow him on FB or on twitter.......you can see the difference between him and a routine 70 years old.He keeps it interesting with rare pics,stories and messages which are socially relevant.for a person who had multiple abdominal surgery ,it is quite commendable how he still dances and does his stunts.He takes that special extra effort to look stylish.I know he or my masi are different.They are the 10 % who never become redundant.Pray to God to keep me in a good health till that age that I am able to emulate my idols.

Cute baby of Gurgaon

Dear Friends,

Time to have some fun.I am sure all the new moms and not so new moms like taking pics of their babies and post it on Facebook.I invite all the Gurgaon Moms to post the pics on the following link on my Facebook Page.Let you and your friends decide the cute baby of Gurgaon.We have started the event from 18th March and will continue to receive the pictures till 18th April.
Winning the title is very simple.The baby with Maximum number of likes gets the gift hamper.There are three prizes.On 19th April I will declare the result and then at clinic Nirvana ,all the participants shall meet to have lots of fun ,frolic and Masti.

https://www.facebook.com/KaushikiDwivedee?ref=hl#!/events/153445884817750/

When a doctor tells you to come to the emergency......

I was reading an online review of a doctor from a different hospital from a different speciality.The parents of a child thought the doctor to be inconsiderate and inhuman not to call them immediately to the place she was in night(I presume she was at her home as it says that she was trying to make her child sleep) rather than asked them to come to the emergency of the hospital she is affiliated to.To a parent whose child has been hurt it is the emergency of worst sort where emotion overpowers the emotion.
I guess you can relate to doctors in one aspect that they are human beings just like you and also get exhausted,tired,unwell,emotionally disturbed,have to take care of their household.Let me tell you my schedule and then you can may be understand why a doctor calls you to an emergency rather than attend all the emergency oneself.

My OPD at Hospital starts at 10 am and ends at 2pm i.e, 4 hours.In these 4 hours I have to see an average of 20 patients.And this involves a lot of talking and answering......and it isn't blabbering .It involves application of mind to understand your problem and find solutions for it. My one mistake can be quite crucial for you.Now this 2 pm is never 2 pm and gets extended to 3 pm or 3.30 pm.So that is when I am free to take my lunch.Now starts my OPD at my clinic from 5 to 8 pm where I see about 10 patients on an avg.Again a lot of talking.At anyone point of time there are on an average 3 patients in labour........which means calls at regular intervals from hospital regarding their management including in night time.Which also means that if Ladies deliver in night I will be in the hospital with each one of them.And being a gynaecologist I have elective surgery list for fibroids,endometriosis and other common Gynaecological problem.This is no exaggeration.
So now tell me if the doctor attends  and calls all the emergencies at home too, were there is no health care support available,do you think your doctor will be safe enough to take your or your child's care?

Everyday I get call from my call centre to inform me that there are patients who haven't got my appointment for that day and they would like to come in as walk in.Do you think after talking constantly for so many hours I would be able to do any justice to you if you walk in?Even I say if it is an emergency please walk in to the emergency and if it can wait then please take appointment on the next available day.I am working for you and not against you.

Now when you come in emergency of any hospital there is a system in place.The in house junior consultant who works in shift examines you and informs the concerned consultant.Your treatment and investigations are started on an emergency basis and based on the severity of emergency your consultant prioritises that how soon should she/he be present with you.If in case there are two emergencies who should be taken care first and who should get second priority.And believe me that is also the safe option for you.

I hope I have been able to give you a sneak preview of a doctors life and you can understand now that why doctor calls you to an emergency in case of an emergency!!

And before anyone just doubts if it is me writing such a long post.......yes it is me.Today I don't have a single patient in labour and not that I mind :-)