Sunday, February 9, 2014

Scar Endometrioma

Endometriosis is not an uncommon condition,where the inner linning of the uterus endometrium is implanted inside the abdomen at various sites due to back flow of period blood through the fallopian tube.It causes painful and heavy periods as well as painful sex,painful passage of stool etc.
It can be treated by certain medicines but primarily surgery.The treatment is unsatisfactory at best unless the Lady gets menopause or uterus and ovaries both are removed.
But today I wish to write about something much rarer SCAR EDOMETRIOMA.It is a condition when during any surgery involving uterus endometrium is imbedded in various layers of abdomen leading to tumor or swelling which increases in size prior to the period and during period and the lump is painful as well.It decreases in size after periods.The incidence of scar endometrioma after a caesarean is 0.1 % to0.01 %.The treatment of such a condition is to excise the lump with at least 1 cm of free margin as well to prevent such recurrence of the lump.
Recently I came acoss such patient who had a caesarean delivery about 6 years back and was having a lump at her caesarean scar since then.
My surgeon husband felt strongly that a surgeon rather than Gynaecologist should treat it as in past Gynaecologists have referred such cases to him rather than correct it themselves.But there is nothing so complicated about treating it and any surgeon i.e, Gynaecologist or surgeon who can repair and stitch anterior abdominal wall can operate it,which I did.
The idea of shairing is this fact is both for the Gynaecologists who transfer it to a surgeon and also for the patinet's to know the correct specialist for their treatment.
The dianosis of this condition can be confusing at times being confused with cancers or desmoid tumours ,infected scar etc.It can be confirmed finally with histopathology but prior to that ultrasound and if still confusion persists MRI can be used to come to a preoperative diagnosis.
Also while performing caesarean tissue handling should be kept to minimum( which is correct for any surgery)by the Gynaecologists.Despite careful tissue handling this is still a possibilty but every little bit of surgical technique counts in prevent such non serious but nagging post operative problems.

scar endometrioma



Sunday, February 2, 2014

Decaying Patient - Doctor relationship

Of Late I find myself mostly writing about patient doctor relationship.Am I getting Obsessive or actually there is a decay in the patient doctor relationship?Is it only me or is the world actually changing fast?Last week I took off from my max OPD as I was unable to handle the stress.Stress of dealing with the patients.No ,the issues weren't clinical.The issues were everything but clinical.

A young man comes to my clinic with his 'wife'.Claims to be an Army officer who can't tell where he is posted as he is in √≠nterrogation'.Doesn't want to take his wife to Army hospital as they admit for the smallest possible reason.Wishes to get termination of Pregnancy done.I advise them to come back to me with an ultrasound scan.Then after few days ,that √Ārmy officer'calls me that his wife is having severe abdominal pain post termination of Pregnancy with pills,which was conducted under my guidance.That left me surprised.Under my guidance? When was that?No we came to you but took the medicine ourselves.Great!! so how do I help you? He told me,''my wife is having severe abdominal pain'.What should I do? The natural answer was to bring her to the hospital emergency as obviously I can't do any operation at the clinic.So he lands up there with another couple.Now we know that she isn't wife but 'Fiancee'.Now this 'Fiancee'word has been so badly used misused by Gurgaon singles.If you copy the western ways of social values then why don't you have the guts to say the truth like they have.Anyways so after an Ultrasound to confirm the abortion and after first aid when the guy was asked to pay the bill,both the Army officer and his wife cum Fiancee had a strong urge for fag and they both wished to leave the hospital campus together.When asked by the Guard to go one by one to smoke this Army man calls me to tell me the 'misbehaviour' of the security department.When I told him that I can't sort this issue,he told me that he came to the hospital because of me so it was my moral responsibility to get the things done free for him.Why on earth? I can take care of your health issue but of course not of your social and financial issues.So,he tells me that in that case he will hang the phone.That left me speechless.Anyways.....I can't sort your bill.

There are many such stories..........A presumption amongst the youngsters that they can get away with anything and everything.Will bad mouth,leave a bad review on social networking site for the doctor.Sue the doctor.Say that corporate hospitals are looting them.........Then why do you come to these corporate doctors?Will that scare the doctor and hospital.actually when anything is misused it looses it's effect.No longer does these tantrums make any effect to us.But yes.....the trust is decaying.A patient should have full trust on his/her doctor and treating doctor should feel comfortable treating the patient.Suddenly it looks as if we are not on the same side of the table but as if we are opponents...........one ready to find fault and cry for a discount and another ready to get attacked and sued........Where will it take the health care system.very recently I saw a patient, who needed an opinion from haematologist and gynaecologist.And no one and I mean no one including me was ready to take a decision for her treatment.....we all were scared.The case was slightly complicated,the patient too confused and the doctors too scared.....we all told him to take her own decision.so who is the sufferer in the end......YOU!!

Gurgaon Stab Victims

Recently there were two incidents of stabbing where four robbers entered inside the houses of a Lawyer and an Architect.The Architect's wife is also a Lawyer.Both the incidents were unfortunate and should be condemned.Fortunately no lives were lost.

So in the second incident the robbers entered the house,didn't find much at home  and that infuriated them further which lead to insensible stabbing of the Architect's family........his lawyer wife and his mom and dad.

Now the Architect wasn't stabbed and brought his family to a private hospital for treatment.They did get timely treatment.All the three underwent major surgeries and the Surgeon saved all the three after operating continuously for many hours. Just after two days of the incident the Lawyer( wife of the Architect) has been discharged today.

So now the question is that why am I mentioning it on a health blog.It should be on a crime blog.Actually it should be there.But unless I mention the rest of the story ,no one would no the complete story.

Today when the Lady was being discharged,a group of lawyers entered the hospital.Demanded some discount ...........When it was told to them that as it wasn't a government hospital but a private hospital which the victims knew from the beginning,the mob threatened to burn the hospital.A group of well educated Lawyers.So they did manage to get discount.But is there any difference between the behaviour of the robbers and a mob who threatens to burn a hospital if the bill wasn't discounted?

This crime is no heinous than what the robbers did.Trying to burn a hospital full of patients to get a petty discount that too by Lawyers :-)

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