Thursday, March 31, 2011

Strange are the ways of nature!!

A female has one uterus,a pair of ovaries and tubes.How must it be to be told either you have 2 uteri,or 1 uterus and another half uterus ?You have one ovary and tube and nothing on other side?Strange are the ways of nature!!!But at times the tissues from which uterus ,tubes and ovaries behave differently during developmental stage leading to various combinations of conditions called mullerian anomaly.The' difference' might vary from minimal deviation from normal to quite a significant one.The incidence varies from 0.1% to 0.5 %. Patients with müllerian duct anomalies are known to have a higher incidence of infertility, repeated first-trimester spontaneous abortions, fetal intrauterine growth retardation, fetal malposition, preterm labor, and retained placenta.
These patients are also at increased risk of developing endometriosis and kidney abnormalities.Recently came across one  such case where the ultrasound picture was completely different from what we found inside..

This is picture of another lady who was operated by me some 3 years back has only one sided ovarian tissue.A strip of uterine tissue.A 4 cm long blind vagina.She had presented to me with recurrent urinary infections and history of absence of periods.

Monday, March 28, 2011

A message for my Albenian hacker frnds

Dear Friend,

You have hacked my site twice.Kudos for that.You have visited my blog as well the day you hacked my site.
Great job so far.But what do you wish to prove??A game of one upmanship?Do you wish show that you are 'superior' to my service provider?Or you hate me for some reason.
If you are a genius.......then use it for some good purpose.
I am sure you will read this post and this is my only way of reaching to you.Put your know how to some good use!!!!!!!

Thanks Neha and Rohit

I did what was my duty but for sure It feels good to know that it made you happy!!

Tuesday, March 22, 2011

Your cancer can be in your head

A strange title for a blog.Wanted to make the title sound catchy.
I had a dull aching pain in my right side of abdomen exactly where the liver is since last 3 months now.No other symptoms at all.And I Ignored it for a while.Was simply afraid if I get an ultrasound scan done and it suggests a problem then what?But since  1st week of march it was aching badly.I palpated very hard on the side to feel if I could feel a lump .And I did feel something.It horrified me.What could it be?
A liver cancer.Or  may be a spread from intestine to liver.But then It I don't have any other symptom.But then who said cancer has to have symptoms before it is already spread.I asked my Surgeon husband to feel for that lump and even he confirmed in an affirmative.Time to go........Or beginning of a very painful period of chemotherapy etc.Could it be big gall stones only.God I will thank you if it is just gall stones.It would mean just a laproscopic removal of gall bladder.What if my Common bile duct gets injured?But then I would still be live.Was it an adrenal tumor or a renal cell carcinoma.I started taking antibiotic just in case there was some infection.
Shalabh said,'Get an ultrasound scan 'and got busy with his day to day work.I preferred not to tell it to my mom and brother.My son had heard my conversation with Shalabh and was asking all the sign symptoms of cancer on and off and I was reassuring him I don't have one.see I want to loose weight still I can't.can't have cancer.
After 10 to 11 days of feeling this lump one night my pain got really bad.It was radiating to my was horrible.May be it was pancreatitis.I decided no matter what I will get a scan done in the morning.
Took an appointment with Dr Girish pandit.He was kind enough to adjust me at such a short notice.
i requested him,if you find any secondaries please tell me so clearly.I am prepared!!After a prolonged scan he announced,Doc your scan is very boring.Everything is so normal.I took a sigh of relief.
That day my pain was about 50% better.I stopped prodding that area of mine .After 5 days later, today my pain is totally gone.No medicines needed.
The cancer was all in my head.And I am being honest when I say I have a very high pain tolerance level but the night before my scan I was in tears because of pain.It was all in my head and I once again realised the power of brain.May be that is what is used by yogi's in Hatth yog to bend the iron bars by just looking at it.And yes a lot of our problems are mainly psychological..........

Sunday, March 13, 2011

Russsssssh for caesarean .........Baby has passed stool!!

In current day Indian Obstetric practice,there are couple of situations (out of many) which lead to an immediate Cesarean section. Both of them are controversial indications.

A Pregnant lady goes for a routine ultrasound scan.Ultrasonologists after looking at the doppler declare there are two loops of cord around the baby's neck!!!''Aaap ka baccha neta hai,mala pahen kar hi paeda ho raha hai.So it calls for a Cesarean section.Baby's cord will get strangulated and there is a high risk that baby will get choked.'' So speaks the Ultrasonologist and then a concerned gynaecologist.They sincerely believe that,CS is the only safe way out.But is really so??Evidences are to the contrary.In my practice I do find it a challenge these days to motivate would be parents for trial of labour if a loop of cord is reported,as nearly every one tells a story of how their friend had a c-section for the same indication.Most of the times they do get convinced,after a lot of counselling and perhaps seeing a non buzzing attitude on my face and achieve vaginal deliveries as well and that too without any problem.And what for are the modern day Foetal heart rate monitoring machines?If it shows a foetal compromise a crash Cesarean section can be done immediately .

Now comes other one.Baby passing stool inside the womb.This stool is called meconium.Now this thin meconium again isn't an indication for Cesarean section but here comes a big handicap if one doesn't have acess to Foetal blood sampling (like I don't have and neither I know of any other Indian hospital which has)facility.One can try to be little brave as a doctor to try for a vaginal delivery if baby has passed stool but can't keep on waiting for n number of hours without knowing if baby is alright or getting acedotic.So,no wonder passage of stool inside the womb leads to a much higher number of cesareans in India than required. Few days back did one such cesarean where I did wait for 6 hours post detection of meconium but then got scared to try further,because if things went well.....No big deal,that's my job.But if baby aspirates meconium and has a meconium aspiration syndrome,onus would be totally mine.Baby was fine at delivery .May be if I had a FBS facility,may be could have given a different outcome!!Just Wondering!!

Wednesday, March 9, 2011

'Sexy 'India

Things are in transition in our new 'sexy India'.Few days back a young couple visited my OPD.To my usual question of Ms XYZ ,how can I help you,came the answer from the young man.My girlfriend(thank God not the cliche' fiancee') has very painful periods.She isn't seeking any medical help and I had to pull her out to come to you.After few questions later I realized the girl was a small town girl and my UK acquired way of asking needed a constant translation from her boyfriend.I switched to my chaste Hindi.I addressed her clinical concerns...Primary dysmenorrhoea,mild pelvic infection.OK ........I hope these things will settle down with medicine.Period pain might be better after 1st delivery.And then came a googly,which left me beaten for a second.Realised India was changing but really so??
The man told me,there is a 50 - 50 chance that they will get married as they belonged to different castes.So could I fix her virginity?He really love her and didn't wish her to suffer in future because of the act they did.I said,get married if you love her!!No,her mother etc are from rural background and then he mentioned the name of a place know for being notorious.I asked light you anticipate an honour killing?Inform the police and proceed.He came back to say ,no they won't kill her but might kill me.Girl showing all her concerns for her BF said no-no they won't.
I talked of hmenoplasty.But since last  few days am thinking of paradox of our sexy India where the youth are liberated,have a new found financial Independence ,are living alone in big metros.enjoying their life but still a person who loves his girl friend thinks of getting her hymen 'mended' for her better future.

Tuesday, March 8, 2011

100th post

This is my 100th post in this blog.So has to be something close to my heart.Something which touched me and changed me,made me and improved me.

Today I watched the an Indian flick 'Patiala House'! A light harted movie about 'the then racism in Uk',the Patriotism of a Sikh patriarch who would live in South hall but won't allow his son to play cricket for 'enemies'ANGRAZ and the son's revolt and how he was considered a national Hero by Brits.

I got a little emotional today while watching the movie.2 drops of tears came from both my eyes.There was a sudden surge of emotion and I felt for a second I missed Mr Banfield,Dr Lesely Bolton,Mr Aled plemming,Dr Chris Clark,Mr Nigel Bickerton,Mr Simon Leeson and my all other consultants.I owe a big part to what I am today as a clinician to them.I knew my basics but they tought me the art of Obstetrics,the science of paper writing,the importance of credibility,art of playing with the words so that the patients are neither offended nor get a sugar coated version of their condition but know the truth and only truth in an evidence based manner.
These were the people who groomed me.Never differentiated between me and a white local doctor.I never got a mentor in India.There I had so many.

My experiences of life have made me like the Brits if not love them atleast, coz  I won't been myself but for all my British teachers.When I perform all my complex laparoscopic surgeries I always remember Mr Plemming who let me do first laparoscopic surgery with an endoloop for a tubal ectopic.In our unit there in UK we didn't have a harmonic then .Have surely moved a lot ahead since then but then it were they who showed me the 'yellow brick road'!!