Thursday, August 24, 2017

Swine flu vaccine in pregnancy

Wednesday, August 23, 2017

Laser for fibroid removal

LASER sound fascinating .A laser surgery sounds so exotic and as a MBBS students mention of LASER in the surgery mage it sound really impressive to my ears too.

Recently,my husband Dr Shalabh Mohan started LASER surgery for Piles and fissure and whole lot of general surgical conditions.And that made me curious as usual.Can I use it for my patients in any possible way to make the treatment better?I know vulval warts and skin tags can be removed -but I can it be for something more?

And then came A lady from Punjab.Rather her son got her to me.She had visited PGI Chandigarh and was advised removal of uterus.On examination I found a big cervical fibroid.Question was - Doctor can I avoid Hysterectomy?

I said probably yes with a cervical Myomectomy but with this big Fibroid the bleeding can be quite heavy and suddenly I remembered the friendly Diode Laser sitting next to the study table at home.Oh yes - we can.We surely can.Laser minimises the bleeding and the fibres can reach those nooks and crannies which isn't possible otherwise.So that what she wanted - a laser surgery.Getting an approval from her insurance company was a hassle.Insurance company wasn't willing to pay extra even if it meant less blood loss and early recovery.But still she wished to get the surgery done and I did perform.

With the ease of the LASER the 6cms fibroid was out and away in 1
5 to 20 minutes.The blood loss wasn't even 50 mls and the Lady had left for her home in 4 days.
How did I feel - surely was a job well done.

IVF and the stimulation story

I was trying to explain a very old loyal patient of mine today.For an IUI I can't give you FSH in a dose which hyper stimulates you.And she said why?I said - see that can triplets or quadruplets which can complicate the pregnancy besides Ovarian hyper stimulation which can be dangerous for your life.And her response was -whats the harm in having triplets.In my current state I am willing to take all these possible risks.Well....her current state is a secondary sub fertility.Has a cute little child already.

So what it means is that sub fertility a 'disease' which leaves a couple so vulnerable and desperate that one is willing to take all the risks.

I have another lady under my care.Pregnant with an IVF conception.The dose at which she was stimulated was unheard of.And I had asked -so didn't you get OHSS? She said-yes I did.Was even admitted in ICU for few days,but she still had a sense of satisfaction on her face,as if to say,'' doesn't matter ,it was a small price to have baby'.

It becomes a dilemma as an infertility specialist.What is justified?Infertility treatment is nerve wrecking and costly-an emotional roller coaster too.Low dose stimulation means less eggs but then how can one be oblivious to the mothers health and life.But at the same time a low harvesting of egg means a possibility of repetition .

The evidence based and safe answer is still mild stimulation but I just wonder to a couple badly desirous of conception does this makes any sense?

Probably not for most Indian couples.