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 .

Tuesday, May 16, 2017

I have got thyroid dddd !!!!!

Are you also worried ,you have got thyroid'? If the answer is yes then we need to know a bit more about thyroid.And what do you mean when you reach the doctor to tell'you have got a thyroid"
Thyroid is intact a gland in neck region of all of us unless surgically removed.It is present since birth.Due to various reasons it can under function when Pituitary gland ,a gland in brain starts producing more TSH and you suffer from Hypothyroidism.

On the contrary if Thyroid is overactive and produces more thyroxine,less of TSH is needed and produced by the pituitary.That is called Hyperthyroidism which is less common but more serious issue then Hypothyroidism.

In Pregnancy the cut off for TSH is 2.5 If the concerned Lady has anti thyroid antibody and TSH level is between 2.5 to 10 mu,even then thyroxine supplement is needed to prevent potential complications like mental retardation ,miscarriage ,if Anti thyroid antibody is negative,no supplement is needed between TSH values 2.5 to 10.Any value measuring 10 and above needs thyroxine supplement.

( Based on American Thyroid society guidelines 2017)

Monday, May 1, 2017

Normal Delivery or caesarean ??

You are Pregnant.Are you ?Most likely you are if you are reading my post or are planning it real soon.Or may be you are not.Pregnancy and delivery are facts of life which most of the women go through with great apprehension,enjoyment ,doubts and at times confusion.

It is a quite frequent question - Doctor ,which one is better -normal or Caesarean section ?Well well,may be few years back my answer would have been 'of course vaginal delivery if you can manage it safely'.Still my answer is more or less the same but my attitude to it has changed slightly.I don't know whether it is right or wrong but it is changed for sure.I will share my thoughts and the reason behind it.

Before I write what I feel,let me tell my interpretation of high Caesarean section rate in corporate hospitals.It isn't certainly not for money making.No doctor is paid more for doing Caesarean vs normal delivery.Hospital probably gains marginally from caesarean section but atlas I haven't been told my anyone and I mean no one in either of the the two hospitals I have worked to perform a single un indicated surgery.The most common reason is a scared doctor,scared of things going wrong during the long process of labour and at times not to wait the long hours of labour and get tied leaving rest of the chores and social life and responsibilities and at times a busy OPD.

Now coming back on track,Vaginal delivery is good.Caesarean is good too.Vaginal birth after caesarean section is no less good.But what is bad then ?Bad is when a procedure is done against the wishes of the Lady and if it is unindicated. Now a caesarean on demand of a lady without any Obstetric indication isn't unindicated. The Lady needs to know pros and cons of all the three methods and after that whatever she decides is a correct decision.

Not many of us give a unbiased we including me.Vaginal delivery is the normal process which nature wanted.But has caesarean got certain advantages over it ? Probably yes.With vaginal delivery there is for sure more chances of weakness of the pelvic floor in long run with an increased chances of urinary leakage,pelvic organ prolapse.It is not to be mistaken with me saying ,women who delivered by caesarean won't or can't have these problems.If the baby size is too big and if it is a traumatic delivery it can have long lasting impact on your pelvic wall as well as the baby.Again i am not saying ,it is rule of thumb but it can happen.

Now caesarean - well it has many disadvantages too.Recovery is longer than vaginal delivery for sure but it isn't a long long process but there is increased risk of adhesions,injury to bowel and bladder,infection,ectopic pregnancy,placenta praaevia and increased possibility of caesarean section in future pregnancy.

Vaginal birth after caesarean section can be achieved in 60 to 80 % of women who had previous caesarean section.But if any female decides an elective caesarean after a previous caesarean is also not an insane decision.VBAC has a risk (1%) of previous scar giving way during labour and that risk increases if we need to use any drip -syntocinon or Prostaglandin gel either for induction or augmentation.The lady needs to take an informed decision whether is wishes to take the risk of repeat major surgery or the scar giving way.

Now you know,when I see dispassionately which I wasn't able to do before due to my NHS training which  then recommended -Normal delivery rate of 80%,I don't think either of the mode of delivery is bad.It is all about choices.But what I do disapprove is ,if the woman wants a vaginal delivery and can achieve one safely to convert it into a caesarean.

If any one of you wish me to write any further posts on this issue or any other please do write back .