Friday, August 31, 2012

Weight Watch

Our Lifestyle has changed.As I child I think months used to pass by without going to any outside food joint.My dad was a foody but a foody of different sorts.He used to invent variety of healthy dishes like all sorts of chillas,mixed rotis and quite a lot of such food stuff which finds it's place in a dietician's chart.He never used to cook but had trained my mom to do that who hated cooking as much as I do.Anyways what I mean to say that eating out wasn't a frequent option and there were lots of variety at home but all of them were healthy food stuff.
Today what I find is that my son wishes to eat out every weekend i.e is a  different question whether I oblige him or not.There are kids in family who loose appetite at the mention of home food but can finish tubs of chickens at KFC or full paneer plate at Bauji ka dhaba.
So what are we heading for? A generation with high probability of obesity,early age of periods,Precocious puberty,cancer.....they loath vegetables and fruits the main antioxidants.When alcoholism has become a part of our generation our kids would surely follow the path shown by us.There are kids who have tasted Breezer and are so cool about it and parents just laugh it off.A child in family wishes to have water only from beer can.Amazing!!Jai ho........
Now as we do expect obesity affecting people in big way let me share a very informative patient information leaflet of RCOG ( London).Hope it is of some use to all of us.Happy reading ;-)

Here follows the guideline on obesity...........

Most women who are overweight have a straightforward pregnancy and birth and
deliver healthy babies. However being overweight does increase the risk of
complications to both you and your baby. This information is about the extra care
you will be offered during your pregnancy and how you can minimise the risks to
you and your baby in this pregnancy and in a future pregnancy. Your healthcare
professionals will not judge you for being overweight and will give you all the
support that you need.
What is BMI?
BMI is your body mass index which is a measure of your weight in relation to your
height. A healthy BMI is above 18.5 and less than 25. A person is considered to
be overweight if their BMI is between 25 and 29.9 or obese if they have a BMI of
30 or above. Almost one in five (20%) pregnant women have a BMI of 30 or above
at the beginning of their pregnancy.
When should my BMI be calculated?
You should have your BMI calculated at your first antenatal booking appointment. If
you have a BMI of 30 or above, your midwife should give you information about the
additional risks as well as how these can be minimised and about any additional
care you may need. If you have any questions or concerns about your BMI or your
care, now is a good time to discuss these.
You may be weighed again later in your pregnancy.
What are the risks of a raised BMI during pregnancy?
Being overweight (with a BMI above 25) increases the risk of complications for
pregnant women and their babies. With increasing BMI, the additional risks
become gradually more likely, the risks being much higher for women with a BMI
of 40 or above. The higher your BMI, the higher the risks.
Why your weight matters
during pregnancy and
after birth
Information for you
Published in November 2011
If your BMI is less than 35 and you have no other problems you may still be able to
remain under midwifery led care. However if your BMI is more than 35, the risks to
you and your baby are higher and you will need to be under the care of a
Risks for you associated with a raised BMI include:
Thrombosis is a blood clot in your legs (venous thrombosis) or in your lungs
(pulmonary embolism). Pregnant women have a higher risk of developing blood
clots compared with women who are not pregnant. If your BMI is 30 or above, the
risk of developing blood clots in your legs is additionally increased. For further
information see RCOG Patient Information: Treatment of venous thrombosis during
pregnancy and after birth.
Gestational diabetes
Diabetes which is first diagnosed in pregnancy is known as gestational diabetes. If
your BMI is 30 or above, you are three times more likely to develop gestational
diabetes than women whose BMI is below 30.
High blood pressure and pre-eclampsia
A BMI of 30 or above increases your risk of developing high blood pressure. Preeclampsia
is a condition in pregnancy which is associated with high blood pressure
(hypertension) and protein in your urine (proteinuria). If you have a BMI of 35 or
above at the beginning of your pregnancy, your risk of pre-eclampsia is doubled
compared with women who have a BMI under 25. For further information see
RCOG patient information: Pre-eclampsia: what you need to know.
Risks for your baby associated with a raised BMI include:
● If you have a BMI of 30 or above before pregnancy or in early pregnancy,
this can affect the way the baby develops in the uterus (womb). Neural
tube defects (problems with the development of the baby’s brain and spine)
are uncommon. Overall around 1 in 1000 babies are born with neural tube
defects in the UK but if your BMI is over 40, your risk is three times that of
a woman with a BMI below 30.
● Miscarriage - the overall risk of a miscarriage under 12 weeks is 1 in 5
(20%), but if you have a BMI over 30, your risk increases to 1 in 4 (25%).
● You are more likely to have a baby weighing more than 4 kg (8 lb and 14
ounces). If your BMI is over 30, your risk is doubled from 7 in 100 (7%) to
14 in 100 (14%) compared to women with a BMI of between 20 and 30.
● Stillbirth - the overall risk of stillbirth in the UK is 1 in 200 (0.5%), but if you
have a BMI over 30, your risk is doubled to 1 in 100 (1%).
● If you are overweight, your baby will have an increased risk of obesity and
diabetes in later life.
What are the risks of a raised BMI during labour and birth?
There is an increased risk of complications during labour and birth, particularly if
you have a BMI of more than 40. These include:
● your baby being born early (before 37 weeks)
● a long labour
● the baby’s shoulder becoming ‘stuck’ during birth. For further information
see RCOG Patient Information: A difficult birth: what is shoulder dystocia?
● an emergency caesarean birth
● a more difficult operation if you need a caesarean section and a higher risk
of complications afterward, for example your wound becoming infected
● anaesthetic complications, especially with general anaesthesia
● heavy bleeding after birth (postpartum haemorrhage) or at the time of
caesarean section.
How can the risks during pregnancy be reduced?
By working together with your healthcare professionals, the risks to you and your
baby can be reduced by:
Healthy eating
The amount of weight women may gain during pregnancy can vary greatly. A
healthy diet will benefit both you and your baby during pregnancy. It will also help
you to maintain a healthy weight after you have had your baby. You may be referred
to a dietician for specialist advice about healthy eating. You should aim to:
● Base your meals on starchy foods such as potatoes, bread, rice and pasta,
choosing wholegrain where possible.
● Watch the portion size of your meals and snacks and how often you eat.
Do not ‘eat for two’.
● Eat a low-fat diet. Avoid increasing your fat and/or calorie intake. Eat as
little as possible of the following: fried food, drinks and confectionary high
in added sugars, and other foods high in fat and sugar.
● Eat fibre-rich foods such as oats, beans, lentils, grains, seeds, fruit and
vegetables as well as wholegrain bread, brown rice and pasta.
● Eat at least five portions of a variety of fruit and vegetables each day, in
place of foods higher in fat and calories.
● Always eat breakfast.
In general you do not need extra calories for the first two-thirds of pregnancy and it
is only in the last 12 weeks that women need an extra 200 kilocalories a day.
Trying to lose weight by dieting during pregnancy is not recommended even if you
are obese, as it may harm the health of your unborn baby. However, by making
healthy changes to your diet you may not gain any weight during pregnancy and
you may even lose a small amount. This is not harmful.
Your midwife should ask you about how physically active you are. You may be
given information and advice about being physically active as this will be a benefit
to your unborn child.
● Make activities such as walking, cycling, swimming, low impact aerobics
and gardening part of everyday life and build activity into daily life by taking
the stairs instead of the lift or going for a walk at lunchtime.
● Minimise sedentary activities, such as sitting for long periods watching
television or at a computer.
● Physical activity will not harm you or your unborn baby. However, if you
have not exercised routinely you should begin with no more than 15
minutes of continuous exercise, three times per week, increasing gradually
to 30 minute sessions every day. A good guide that you are not overdoing it
is that you should still be able to have a conversation while exercising.
An increased dose of folic acid
Folic acid helps to reduce the risks of your baby having a neural tube defect. If
your BMI is 30 or above you should take a daily dose of 5 mg of folic acid. This is
a higher dose than the usual pregnancy dose, and it needs to be prescribed by a
doctor. Ideally you should start taking this a month before you conceive and
continue to take it until you reach your 13th week of pregnancy. However, if you
have not started taking it early, there is still a benefit from taking it when you realise
you are pregnant.
Vitamin D supplements
All pregnant women are advised to take a daily dose of 10 micrograms of vitamin D
supplements. However, this is particularly important if you are obese as you are at
increased risk of vitamin D deficiency.
Venous thrombosis
Your risk for thrombosis (blood clots in your legs or lungs) should be assessed at
your first antenatal appointment and monitored during your pregnancy. You may
need to have injections of low molecular weight heparin to reduce your risk of
blood clots. This is safe to take during pregnancy. For more information, see
RCOG Patient Information: Reducing the risk of venous thrombosis in pregnancy
and after birth.
Gestational diabetes
You should be tested for gestational diabetes between 24 and 28 weeks. If your
BMI is more than 40 you may also have the test earlier in pregnancy. If the test
indicates you have gestational diabetes, you will be referred to a specialist to
discuss this further.
Monitoring for pre-eclampsia
Your blood pressure will be monitored at each of your appointments. Your risk of
pre-eclampsia may be additionally increased if you are over 40 years old, if you had
pre-eclampsia in a previous pregnancy or if your blood pressure is high before
If you have these or other risk factors, you may need to attend hospital for your
appointments and your doctor may recommend a low dose of aspirin to reduce the
risk of developing high blood pressure.
Additional ultrasound scanning
Having a BMI of more than 30 can affect the way the baby develops in the uterus
(womb) so you may need additional ultrasound scans. You may also need further
scans because it can be more difficult to check that your baby is growing properly
or feel which way round your baby is.
Planning for labour and birth
Because of these possible complications, you should have a discussion with your
obstetrician and/or midwife about the safest way and place for you to give birth. If
you have a BMI of 40 or more, arrangements should be made for you to see an
anaesthetist to discuss a specific plan for pain relief during labour and birth.
These discussions may include:
Where you give birth
There is an increased chance of your baby needing to be cared for in a special
care baby unit (SCBU) after birth. If your BMI is 35 or above, you will be
recommended to give birth in a consultant-led obstetric unit with a SCBU. If your
BMI is between 30 and 35, your healthcare professional will discuss with you the
safest place for you to give birth depending on your specific health needs.
What happens in early labour
If your BMI is over 40, it may be more difficult for your doctors to insert a cannula
(a fine plastic tube which is inserted into the vein to allow drugs and/or fluid to be
given directly into your blood stream) into your arm. Your doctors will usually insert
this early in labour in case it is needed in an emergency situation.
Pain relief
All types of pain relief are available to you. However, having an epidural (a regional
anaesthetic injection given into the space around the nerves in your back to numb
the lower body) can be more difficult if you have a BMI over 30. Your anaesthetist
should have a discussion with you about the anticipated difficulties. He or she may
recommend that you have an epidural early in the course of labour.
Delivering the placenta (afterbirth)
An injection is normally recommended to help with the delivery of the placenta
(afterbirth) to reduce the risk of postpartum haemorrhage (heavy bleeding).
What happens after birth?
After birth some of your risks continue. By working together with your healthcare
professionals, you can minimise the risks in the following ways:
Monitoring blood pressure
You are at increased risk of high blood pressure for a few weeks after the birth of
your baby and this will be monitored.
Prevention of thrombosis
You are at increased risk of thrombosis for a few weeks after the birth of your
baby. Your risk will be re-assessed. To reduce the risk of a blood clot developing
after your baby is born:
● Try to be active – avoid sitting still for long periods.
● Wear special compression stockings, if you have been advised you need
● If you have a BMI of 40 or above, you should have low molecular weight
heparin treatment for at least a week after the birth of your baby -
regardless of whether you deliver vaginally or by caesarean section. It may
be necessary to continue taking this for 6 weeks.
Test for diabetes
For many women who have had gestational diabetes, blood sugar levels return to
normal after birth and medication is no longer required, but you should be re-tested
for diabetes about 6 weeks after giving birth. Your risk of developing diabetes in
later years is increased if you have had gestational diabetes. You should be tested
for diabetes by your GP once a year.
Information and support about breastfeeding
Breastfeeding is best for your baby. It is possible to breastfeed successfully if you
have a BMI of 30 or above. Extra help should be available if you need it.
Vitamin D supplements
You should continue to take vitamin D supplements whilst you are breastfeeding.
Healthy eating and exercise
Continue to follow the advice on healthy eating and exercise. If you want to lose
weight once you have had your baby, you can discuss this with your GP.
Planning for a future pregnancy
Reducing your weight to reach the healthy range
If you have a BMI of 30 or above, whether you are planning your first pregnancy or
are between pregnancies, it is advisable to lose weight. If you lose weight, you:
● increase your ability to conceive and have a healthy pregnancy
● reduce the additional risks to you and your baby during pregnancy
● reduce your risk of developing diabetes in further pregnancies and in later life.
If you have fertility problems it is also advisable to lose weight, since having a BMI of
more than 30 may mean you would not be eligible for fertility treatments such as IVF.
Your healthcare professional should offer you a structured weight loss programme.
You should aim to lose weight gradually (up to about 1 kg or about 1 to 2 lbs a
week). Crash dieting is not good for your health. Remember even a small weight
loss can give you significant benefits.
You may be offered a referral to a dietician or an appropriately trained health
professional. If you are not yet ready to lose weight, you should be given contact
details for support for when you are ready.
An increased dose of folic acid
If you have a BMI of 30 or above, remember to start taking 5 mg of folic acid at
least a month before you start trying to conceive. Continue taking this until you
reach your 13th week of pregnancy.

Thursday, August 30, 2012

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.

Wednesday, August 29, 2012

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.

Saturday, August 11, 2012

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 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??

Tuesday, August 7, 2012

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.

Saturday, August 4, 2012

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.