Tuesday, December 17, 2013

Breast Cancer in Pregnancy

When I read the green top guideline on Breast cancer in pregnancy few years back,I read it as it is my habit to read any new green top guideline.Never thought that will need to use it ever in life.May be I was trying to be too optimistic.
Without going in the details of the patient and her condition,wish to write this blogpost for gynaecologist if anyone of you are reading this post.The RCOG guideline is very good.Read it.It will help you in managing such a complicated pregnancy better.
There is no need to deliver the foetus immediately if in late second or early third trimester.Let the surgeons proceed with Lumpectomy or Mastectomy as they consider appropriate.Then wait the foetus to reach upto atleast 34 weeks and if possible even 37 weeks if tumour isn't very malignant.Chemotherapy and radiotherapy can follow later,after the baby has been delivered. In my patient's case it is quite a malignant variety and I am aming to reach 34 weeks only.
Scary!!Her malignancy was diagnosed just by chance at 35years,first pregnancy!!Not fair at all.

Monday, December 16, 2013

LGBT issues

As chance would have been a patient turned friend recently started fighting with me for LGBT rights and within two days supreme court came out with it's ruling.I am no way ashamed to say that I am not a LGBT supporter,though I am against the discrimination they face because of their choices.
Now few thought provoking questions ( I know I am touching a sensitive issue)
IS it crime?My answer is ,I don't know but it is different from the normal,
Should it be encouraged? Again I don't know.If tomorrow my son turns out to be a gayI would be ashamed.I will feel unwell and no amount of justification will make me feel good that his chemicals are making him do it.Then what is the difference between human being and animals?
Tomorrow then bestiality,pedophilia and incest would be legalised as the involved people can always blame it on their chemicals.
To say bestiality is wrong as the animal can't give consent.What if it is found the animal is enjoying the act.Will it be legalised?
Fraser law gives alot of freedom to juveniles to indulge is sex,ask for OCPs,right of confidentiality etc.So tomorrow if we find Pedophiles are also guided by their hormones and aren't criminals,will it be legalised.
May be it will happen in future.
Few facts

Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations.


American Foundation for Suicide Prevention, New York, New York 10005, USA. ahaas@afsp.org


Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice

2011;30(4):393-401. doi: 10.1080/02763869.2011.608971.

Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources.


Texas A&M University Medical Sciences Library, College Station, USA. rlmckay@library.tamu.edu


Lesbian, gay, bisexual, and transgender (LGBT) persons, while widely diverse in many ways, share health disparities related to the stigma and discrimination they experience, including disproportionate rates of psychiatric disorders, substance abuse, and suicide. Lesbians, gay men, bisexuals, and the transgender communities have additional health concerns and disparities unique to each population. This paper highlights the national recognition of these health issues and disparities and presents web-based information resources about them and their mitigation

American Academy of Pediatrics stated in Pediatrics in 2004:
Sexual orientation probably is not determined by any one factor but by a combination of genetic, hormonal, and environmental influences. In recent decades, biologically based theories have been favored by experts. [...] Although there continues to be controversy and uncertainty as to the genesis of the variety of human sexual orientations, there is no scientific evidence that abnormal parenting, sexual abuse, or other adverse life events influence sexual orientation. Current knowledge suggests that sexual orientation is usually established during early childhood.[

Now this is my belief.If you feel differently then please feel free to express.

Big Boss

So like many of you I am a big fan of big boss.Certain people call it third rate show.My sister in law Aditi Mohan is one such person,who finds me a'cheapda' for the same.And strangely this is the only show which I watch on television.
Why do I like it,I don't know.May be it is a teacher.If you look at the show closely there is myriad of human emotions........some fake and some genuine.You also see the best of sacrifices and the worst of bitching.People lie to each other as if water flowing out from a running tap.
All of us develop sympathy for certain contestsnts.Have you noticed usually who are they?
Either bitchy but strong human beings or some one benign.
In the current show I think Sangram singh should be the winner.Reasons are many.
He has stayed away from most of the fights.
He most of the time tries to fire fight.
On occasions where Arman Kohli fought with him,he was still so controlled.
Not just that he rarely bad mouths other contestants unless /until provoked.
He is busy in his yoga.
He has been a true friend to his friend Andy.
Also I have learnt a few lessons from him.On very rare occasions I have bad mouthed a couple of doctors in front of my patient.it was wrong and unethical.Mostly I try not to talk bad of my colleagues.(though my colleagues are free to bad mouth me as much a they want :-)
Secondly at times I become catty while chatting  with friends of different speciality I do make fun of my other department mates.After Sangram singh.A Big No to it too.

Sunday, December 15, 2013

THe Feedback that moved me

I have got many positive  as well as negative feedbacks in past.But I have to say that this is the most honest feedback I have received so far which has moved me.The gentleman promised that it will be a 4 page feedback and I am amazed that he did take that time out despite being a father of a new born baby where you hardly get anytime to write so indepth and heartfelt write up.Thanks and I promise I will try to smile more often.

Hi all,


I became a dad on 1st Dec 2013 to a lovely girl child… Thanks to Dr Kaushiki, both mom and baby are doing well….. Let me rewind 9 months ….


This was the first time we attempted and also conceived, we would be first time parents…. We didn’t know ABC of handling pregnancy… Like most people I started searching the internet on who is the best doctor etc… I must say that I too believed that any doc who can perform a normal delivery is a better doc… let me say that’s not true ( btw Dr Kaushiki helped us delivery via Vag Delivery !  ) .. There are many reasons for which many doctors perform a C-sec , most of the times the reason can be the money involved for the institution where they are employed… I understand that .. most big hospitals are run like corporations with strict P/L statements driving the underlying behavior, I don’t think its completely wrong way of functioning after all its not like they are running a charity. Everything comes at a cost …



As I said at the beginning I didn’t know much .. I think most people think this way that a doc is good if its vag delivery and a cheat if it’s a C-Sec ….. I read up lot of reviews ( women ) talking good about Dr Kaushiki, I did more research online….. and decided to make Dr Kaushiki my doc for my first baby… my wife didn’t have any opinion on this.. she had left the decision upto me… I learned of the pros and cons of C sec v/s Normal Delivery … … but my take was always… that “Doc !! Pls do what is best for the child/mother given the situation at hand “, it doesn’t matter if it’s a normal delivery or a c-sec. But since I read that Dr Kaushiki has a high rate of normal deliveries I approached her as my best case scenario. Its absurd to demand a normal delivery at any stage of the pregnancy and especially at the beginning, there are a million changes that are going to happen before you reach week 40 how can any one or any doc gurantee you that it will be a normal delivery ?


My first day at her clinic, she opened a big folder with lot of paper in it….. and I was like what is this… that big folder had “My Pregnancy Book” written on it…LifeCell had apparently created the binder .. which later changed to Cordlife… but that’s fine everyone does their branding… and Dr Kaushiki never recommended me that I should go with this cordbank or the other…( that’s what I love about her, she doesn’t dole out unnecessary suggestions which may potentially make you think she has vested interest in those deals )


 I liked it , Dr Kaushiki meticulously recorded each and every thing which was required to create a background of the pregnancy and try to zero in if it’s a high risk or low risk pregnancy…. In that first meeting I would say she came across a bit cold / professional ( may be she was not having a great day or I was expecting some one very jovial or happy or equally excited as we were that hurray we will be parents J ) but then it was the first meeting… and I would say its not a small fee to see Dr Kaushiki , it was 800 Rs then ( Apr 2013) for those 15 minutes..


The reason I approached Dr Kaushiki ( which I later also told Dr Kaushiki herself ) is I feel that she has “arrived” in her life… now I know all of us have different versions of being “arrived” and may be Dr Kaushiki has not yet “arrived” in her professional life.. and she may have many more personal milestones but I strongly felt that she would just not do a C-Sec to make dirty money for the hospital she may be working for… as at this point of her career she would definitely give much more importance to the quality of her practice and her Name than to some cheap money made by performing unnecessary operations……



Also Dr Kaushiki has vast experience of workin in NHS in UK, you should read up a bit if you are not aware of the healthcare system in the western world, I lived in US for few years and I often saw comparisons drawn up between the US and UK healthcare system. Working at NHS means that the focus is on the outcome and the compensation of the doctor will not change if it’s a csec or normal delivery, doctors get trained and habituated to do what is in the best interest of the mother/baby. So as Dr Kaushiki also shared I guess that has ingrained in her way of working as those might be her formative years…. So Patient first comes naturally to her.. and because of that attitude fame/money automatically follows… so that’s another plus for Dr Kaushiki.




When I reached home after that first visit I poured over the entire book she had prepared… there are some 250 plus questions she has answered… more importantly I liked the two page basic description of her practice at the beginning was something which made me believe I did the right thing by going to this doc…. In brief she said…..

-       My way of working will be based on scientific evidence

-       I will not recommend any ultrasound clinic or any other test/clinic 

-       I will not pamper you

-       I am not always reachable on phone, you may have to sms and wait for response or email me

-       Be prepared to be late while sitting out in the waiting room for your appointments, because If my patients ask questions I answer them and it may take 15 min to 1 hour.. you will have to be patient.

-       With all this said if you want to be my patient , then welcome lets start this journey.

These two pages sold me…. But I would not say that all this came our very professional and a bit cold but then again I consoled myself that its ok, atleast I am getting a honest doc who talks straight and calls it as it is…


In the age of internet every adult who can search in google thinks of himself as an expert…. This is a big mistake… what I have learnt is that google will give you what you are looking for…. It will corroborate your original belief.. for example if you type “Is Dr kaushiki bad”, it will give you results corresponding to your search and if you type “is Dr kaushiki good” you will get those good results…. Same goes for when you try to find out any specific things about pregnancy… Understand and accept the fact that if you are not a doctor you are not going to become one in 9 months and don’t even try to become one for that matter… dr kaushiki understands that we have lot of questions and hence she has put out answers to so many popular questions which would be parents have… I would say if you do want to learn , go to babycenter.com a trusted resource which will have researched material.. or the other best option ask your doctor.. email her if it’s a long question or set of questions..


Dr Kaushiki has a plan and she sticks to it…. I think she works in a venn diagram mode J which is very good… in the beginning itself she made it clear on when and why would she need ultrasound reports .. earlier I was skeptical of too many ultrasounds but that was one of my mistakes.. ultrasound is completely safe get it done as many times your doctor asks …


Our pregnancy continued uneventful for most of the period, my wife stuck to the diet prescribed and did what ever was asked of her…  all the meetings with Dr Kaushiki were brief and to the point not one meeting going over 15 mins.. we usually had our questions before hand and she always answered them promptly. I must say she didn’t recommend a ultrasonologist until we really forced her and that too she gave multiple options.. but were ok, we just wanted to go to Ultrasonologist whos work Dr Kaushiki was familiar with as this aspect is very critical, Your doctors decisions depend on the progress shown by the ultrasound reports…


During this time upto  34 weeks I never went for a second opinion or to another doctor… I am of the opinion that unless you really don’t trust your doctor, why go for a second opinion , this is not a movie you are going to watch over weekend.. say your second doctor says something completely opposite to your first doctor what would you do… whose opinion you would take.. would you take the opinion which you like ? does that mean your medical condition is being treated on what you “like” are you a doctor .. or are you a qualified person to even judge what is good for you and what is not ? Hence I would say try to put lot of thought in picking a doctor, then trusting them… otherwise you would keep on taking multiple second opinions…


I also used to keep going back to Dr Kaushikis blog, even though she is a proponent of Vag delivery , she says on the table its mostly the mother who asks for a C-Sec as these days women cannot / do not want to go through the actual pains of delivering normally , that was a revelation and I concur with that fact, some of my friends told me that doing a C-Sec was their wives first and only choice… so don’t go and paint all doctors in the same color, if some of them are doing C-Sec , they may be requested by the parents themselves… In one instance infact on the same day when my wife was to deliver I saw a would be father and his mother seeing off the would be mother into OT and the father shouting from behind 10:20 AM se pehle karna . 10:20 AM se pehle karna… ( Deliver before 10:20 AM ), so there you go another reason to have CSec so you can have the perfect kid based on planetary positions J, its not the doctors fault if they do CSec ….


Our case was getting complicated as it neared its term… Dr Kaushiki asked us to take a call on a matter and also gave her opinion on it…. at this point I took second opinion ( which I didn’t want to but was forced to ) those second opinions were not good at all in the sense of the clarity of thought… they just said continue as it is…. ? but why ? what are the repercussions to continue or induce labour, and all of them said it will be a CSec, which was not a concern to me as what I read up on the subject at times the baby is not strong enough to take the strain of a Vag Delivery and the doctor may take a call to do a CSec to protect the baby…. On this too Dr Kaushiki didn’t say that it will be normal delivery or a Csec, which was fair, I again iterated to Dr Kaushiki that the reason I came to her was that she will do the right thing , so I was convinced that if it has to be a Csec there will be good grounds for it.. and in the end Dr Kaushiki told me that don’t worry if anywhere in the world your baby can be delivered normally it will be delivered here… J I went with Dr Kaushikis opinion and moved my wife to the hospital…within 18 hours Dr Kaushiki helped us deliver the kid normally … it was just excellent… there was so much support in the labor room , everything went like clock work…. It was just another day for Dr Kaushiki in office but life changing event for us….


I am so proud , not just because Dr Kaushiki took care of us during the 9 months , not just because her advice was based on scientific evidence, not just because she helped us Vag Deliver the baby.. but because she definitely upheld my belief in doctors that not all doctors are alike…. And some of them are honest….


Max Hospitals – if you are reading this.. feel lucky and be proud that you have Dr Kaushiki working for you.. kindly don’t put any kind of “assurance” schemes on Dr Kaushiki and let her be… she is the queen of your chess board and a queen works best when she is allowed the freedom to move anywhere anytime…. Please note she is one of those doctors which brings credibility and good will to your institution. If I were you , I would have held biweekly calls with Dr Kaushiki just to know if there is something that Max Administration can do for her to help her see patients , deliver babies better.


Other Gyne Doctors – When I took second opinion, I spoke on phone with few of them, I must say no matter how good a doctor you are , but when you ask my Gyne’s name and then smile/laugh first and then talk.. you have already lost me… Please be professional and respect your peers, even if you don’t have a high opinion of any doctor kindly don’t let that be known in no uncertain matter to your patients, the patients anyways are under lot of stress, you smiling laughing and doing a “know all” attitude and making the patient feel that they are in wrong hands is not winning you any brownie points…. Its then I realized that the curt behavior of Dr Kaushiki is better where only professional inputs are given to qualified questions… no drama.

Most importantly please try to have an honest practice like Dr Kaushiki has, even Sachin Tendulkar has said in his farewell speech "Fame and Fortune will automatically come to you if you pursue Excellence" , and try to be humble, you will get more respect.


Dr Kaushiki – cannot thank you enough for you are reinstalling the belief patients carry in doctors, which is being steadily eroded by some doctors by not being honest … also you have a great smile, flash it often… I know you don’t want to pamper the would be mother J , but a reassuring smile always works J



A Few things I learnt from my experience…..


-       Try to get a doctor who works close to your home/office , it will convenient esp In the later months as last thing you want is to deal with traffic while commuting to then frequent trips to ultrasound clinics and doctor visits.

-       Put a seat belt on your pregnant wife no matter how slow the car is going.

-       Massage your wifes feet every alternate day in upward motion , it will relieve her off the swelling and pain.

-       Would be mothers – all through the pregnancy keep massaging olive oil or any other good massage oil all over your belly and back area if you want to minimize the damage done by stretch marks.

-       Would be mothers – don’t skip any meal, most of you have smart phones, make an account in caloriecount.com and ensure you eat right… you don’t have to eat fatty stuff but just eat enough quality stuff.

-       Read up and follow babycenter.com , the smart phone app version of the website is very nice, it only brings up those things ( changes in your body ) which come at the right time ( week wise ) so you are aware of what is happening with your body and you will not panic or worry.

-       Get a juicer / blender and whip up fresh juices off mausmi etc , avoid canned food/juices.

-       Avoid Cut fruits at any cost… ie don’t cut an apple and keep in refrigerator.. consume the food immediately.

-       Do go for cordblood banking, which company , I will leave it upto you.. but do go for it, its not costly and it’s the only opportunity to save the cord blood and cord tissue , once in a life opportunity it will never come back, and who knows in next 20 years how much would science progress, god forbid should you never need to use it , but its like an insurance. Companys have EMI options and as little as 2500 rs per month for 2 years you can get this service done.

-       Try to get a Ultrasonologist who your doctor trusts…. Believe me there is +-15% variation in every reading they give.

-       If you are a smart phone user, keep a todo app handy, I regularly use Wunderlist app on iphone and I used to jot down any doubt / question that I may have for the doctor , I used to bring up the list of questions when I used to visit my doc. Make your appointments count and try to get your questions doubts answered….

-       Its very important that you trust your doctor, if you don’t trust your doctor and feel he/she is inept or taking you for a ride , leave immediately , you are wasting your and the doctors time.

-       Having a single or double loose loops around the babys neck is not the qualifying condition to do a C-Sec, if your doctor is saying that’s the case then do take a second opinion. Its time that patients are not scared into CSec by doctors..

-       (For Guys) Leave the decision of Csec or Vag Delivery to your doctor and your wife.. don’t force your opinion on what is right or wrong.. you are not the one who is going to deliver and you cannot even imagine the pain a woman goes through. Also understand there may be many situations where a CSec is better for your wife and baby than a normal delivery, like I said since you and I are not doctors , find a good doc and trust her.

-       Be patient while waiting in the waiting room for the doc, because if you are not patient or irritated that its taking so long to see the doc, one you are going in with a bad mood to see the doctor, two you are taking unnecessary stress. Please understand if a couple is taking time, it must be important , you could be that couple..

Monday, December 2, 2013

Rahagiri needs to be better organised

It looks so nice.On a balmy Sunday morning ,Moms , dads, children , dogs , Grandparents  and Girl Friends and boyfriends can roam around safely on the Gurgaon Roads.They can ride their cycle and show few tricks as well.Skateboard skills look good too.What to say of Zumba on road.It is so colourful and we already have mimicked the European concept of walking and cycling and enjoying the physical activity for a healthy us and better environment control.

So where is the problem? The blocked roads near emergency services like Hospitals.Not acceptable at all.There is no sign post to say that the road has been blocked.there is no sign post to suggest the alternative road.

Yesterday I was stuck in this whole 'Tamasha' near park plaza hotel and my patient was fully dilated and pushing.It was just God's grace that Dr Deepa Maheshwari was there to attend to her delivery ,but I couldn't make it in time.It can be unsafe.In just my last post I mentioned of Shoulder Dystocia.What if something like that had happened and I was stuck for 20 to 30 minutes just because of ill organised Rahagiri.


  • Don't block roads near emergency services
  • Please think the repercussions of your actions
  • Please handle the traffic properly as all Rahgirs reach the venue in their cars and thus adds to chaos .
  • People who load their cars with bicycles ,please see that it is safely chained and not going to affect other people on road and also that it doesn't cover your number plates.Traffic police should Chalan such drivers.
Finally ,make separate cycle tracks and bus tracks.Separate paved area for people who wish to walk.Please don't block the existing roads which anyways are in pathetic situation.
I am not trying to be spoilt sport,but fact is fact........even if harsh