Thursday, August 24, 2017

Swine flu vaccine in pregnancy

Wednesday, August 23, 2017

Laser for fibroid removal

LASER sound fascinating .A laser surgery sounds so exotic and as a MBBS students mention of LASER in the surgery mage it sound really impressive to my ears too.

Recently,my husband Dr Shalabh Mohan started LASER surgery for Piles and fissure and whole lot of general surgical conditions.And that made me curious as usual.Can I use it for my patients in any possible way to make the treatment better?I know vulval warts and skin tags can be removed -but I can it be for something more?

And then came A lady from Punjab.Rather her son got her to me.She had visited PGI Chandigarh and was advised removal of uterus.On examination I found a big cervical fibroid.Question was - Doctor can I avoid Hysterectomy?

I said probably yes with a cervical Myomectomy but with this big Fibroid the bleeding can be quite heavy and suddenly I remembered the friendly Diode Laser sitting next to the study table at home.Oh yes - we can.We surely can.Laser minimises the bleeding and the fibres can reach those nooks and crannies which isn't possible otherwise.So that what she wanted - a laser surgery.Getting an approval from her insurance company was a hassle.Insurance company wasn't willing to pay extra even if it meant less blood loss and early recovery.But still she wished to get the surgery done and I did perform.

With the ease of the LASER the 6cms fibroid was out and away in 1
5 to 20 minutes.The blood loss wasn't even 50 mls and the Lady had left for her home in 4 days.
How did I feel - surely was a job well done.

IVF and the stimulation story

I was trying to explain a very old loyal patient of mine today.For an IUI I can't give you FSH in a dose which hyper stimulates you.And she said why?I said - see that can triplets or quadruplets which can complicate the pregnancy besides Ovarian hyper stimulation which can be dangerous for your life.And her response was -whats the harm in having triplets.In my current state I am willing to take all these possible risks.Well....her current state is a secondary sub fertility.Has a cute little child already.

So what it means is that sub fertility a 'disease' which leaves a couple so vulnerable and desperate that one is willing to take all the risks.

I have another lady under my care.Pregnant with an IVF conception.The dose at which she was stimulated was unheard of.And I had asked -so didn't you get OHSS? She said-yes I did.Was even admitted in ICU for few days,but she still had a sense of satisfaction on her face,as if to say,'' doesn't matter ,it was a small price to have baby'.

It becomes a dilemma as an infertility specialist.What is justified?Infertility treatment is nerve wrecking and costly-an emotional roller coaster too.Low dose stimulation means less eggs but then how can one be oblivious to the mothers health and life.But at the same time a low harvesting of egg means a possibility of repetition .

The evidence based and safe answer is still mild stimulation but I just wonder to a couple badly desirous of conception does this makes any sense?

Probably not for most Indian couples.

Friday, June 23, 2017

I am scared Doc!!

Not uncommonly ,couples visit me with a particular complaint after many years of suffering in silence.Health is a state of physical,mental and emotional well being.And unfortunately these co uples though physically healthy have severe emotional issues.

A typical history is where the male is a considerate person and the woman has a fear of painful sex and they are unable to consummate the marriage despite being in relationship for many years.
Most of the time the Lady doesn't have any problem locally but it is the 'fear' .

If you have tried every possible conservative method in the world and still are unable to overcome the fear,visit a Gynaecologist who has some knowledge of urogynaecology. After examination it can be ruled out if there is a local problem and that can be fixed.If there isn't any anatomical problem,then a vaginal dilatation can be performed under anaesthesia.It works as the lady knows that now the dilation has been performed and that helps them overcome the fear.

Lot many time if there is a local scarring an operation called fentons operation which widens the vagina is useful.It is a kind of vaginal reconstructive surgery .

Those who have never faced this issue might find this post surprising but for those it is a real concern,their life is muddled with a problem which they find difficult to share with anyone easily and keep on suffering.

Wednesday, June 7, 2017

Chronic Vaginitis

Nothing can be more frustrating that a constantly itchy vagina with a fungal or bacterial infection.What increases the frustration further is one has already visited the best of gynaecologist in the town,has had many courses of anti fungals,antibiotics,many pessaries,potassium permegnate solution and all sort of ph maintaining washes.

By now many sufferers start thinking that their martial life has gone for a toss or they themselves are mentally ill.
Is there anything which still remains to be tried?As a hope of relief comes Boric acid capsules which can be used vaginally for 14 days to get rid to resistant fungal of bacterial infection.Next time you have a similar condition under your Gynaecologist's supervision do try .It should be used as 600 mgs pessary.In India it isn't easily available ,so you can try this product from Amazon which I recently searched online for one of my patients.

Book to read while Pregnant

Many a times Pregnant women ask we the book or books they should read while pregnant.Those who have been my patients know that I give an elaborate handbook ( What to expect when expecting)to all the moms under my care which answers most of the FAQs.Still if you wish to read further you can read this book available on Amazon.This book is good.Also covers lots of Pregnancy complications which many a pregnant women tend to imagine themselves with all possible complication while reading this book.Avoid that and then it is a nice book to read and understand pregnancy.

Monday, May 29, 2017

Stressed ???

Stress - It isn't uncommon word or rather it is an extremely common word.
Atleast 50 % of my patients are stressed.It leads to whole load of health problems.It has contribution in infertility,metabolic syndromes like PCOD,irregularity of periods,discordance in sexual and marital life and so on and so forth.

But why are we stressed? Who is responsible?Is it us?Is it our surrounding?Is it multifactorial?
Who can help us?How can one help oneself?

I am writing this post for two reasons.One -this is a very commonly asked question.Second-I think ,I am qualified to write it now.A stage in life where I can say I have learnt to handle situations in life in a way which has reduced the stress levels to a minimum.

Not long back I was a typical type A personality who was driven on adrenaline.Even today I am a type a Personality but I have learnt to tame that type A person in me.I let it be awake when I need it but at other times I make it have good rest.Yes....thats correct you need to take good rest,detach yourself from the mad rush around you to perform more effectively and more productively .

After so many years in my profession and also my life,I realize,events are predestined.Though one should give one's best in whatever one does,nothing is in one's hand.Once I could feel this and make myself believe in this theory 70 % of my stress was relieved.Secondly ,the definition of success has changed for me.It no longer means the biggest player in the market ( number wise).I enjoy what I do.But excess of anything is bad,including enjoyment.The moment one increases one's work load beyond a certain limit the performance and productivity falls down.Recently there was a Lady admitted under surgeons for some general surgery related problem.She had an incidental ovarian cyst as well which she wished to get removed in the same sitting.Now due to whatever reason,it was convenient for the surgeon to operate the Lady late in night around 10 pm.In my opinion elective surgeries are best done in elective hours for best outcome.So what I did was I refused to operate .That lady had not come for me.For her it didn't matter who the treating gynaecologist was and thus I requested the surgeons to call some one else,which they did.

I saved myself from a stressful situation.Previously I would have operated her even at 10 pm in the night against my own wishes and belief and a tired body and mind.It would have given me 12 - 13 k but I would have lost my health and sleep and of course would have been an unsafe tired surgeon.

It is just an example .The situations are varied and you will have to find your ways to minimize your stress levels.

Another change - now when in theatre I am not worried of the waiting list in OPD.Things need to be prioritized.An emergency or on going active surgery takes priority over an OPD patient.If unhappy to wait,there are other consultants available around and am sure they can be taken care of.There is no point trying to be omnipresent. 1300 OPD fees ,isn't worth a complication in OT or a law suit in court.

Now my own health is my priority.I insure to take 2 to 3 hours out for me in my 24 hours for my health and exercise.All the joys and pleasures in the world can be felt only till we have a healthy body and mind for which it should be treated as a temple and should be worshipped.

Lastly ,now i don't think any loss is irreparable accept the loss of life .So ,I don't fear the future.There is no question as what next?

These are few of the changes ,which I think has helped me immensely.Try to incorporate in your life and see if that helps an irregular period or a failing marriage or dry sex or endometriosis or makes you conceive .