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 .

Saturday, April 29, 2017

Genital Warts

Genital warts aren't uncommon.I am frequented by Ladies who have developed warts and aren't sure what it is or they have done so much internet surfing that the are too stressed by the time they visit a specialist.
Genital warts are caused by Human Papilloma Virus,the same virus type which causes cervical cancer but having said that Vulvar warts aren't equal to cervical cancer and thus detection of a wart shouldn't be a cause of panic.It is one of the sexually transmitted disease but it doesn't mean that your partner is cheating on you.Actually most of the women develop these warts many months or years after acquiring the HPV infection.HPV can be transmitted by skin to skin contact and need not be through penetrative sex.Condoms are the most effective way of preventing HPV transmission but condoms don't give 100% protection.Even for oral sex it is advisable to put condom over the penis and sharing of sex toys should be avoided.
Warts in general don't cause massive symptoms or cause major damage.They can look unsightly and if not removed can be a source of spreading the infection to your partner.For very small warts some chemicals can be used but it takes a lot of time for them to get cleared with the chemicals .
Surgically it can be removed using electrocautery or laser.It is important to seek specialist help.HPV infection and warts can get cleared off the body completely or it can be recurrent.There is no medicine to prevent the recurrence and depends on the immunity of the lady.If smoker,stopping smoking can be helpful in making the treatment more effective.

Saturday, April 22, 2017

Vaginal reconstruction,Vaginal rejuvenation,tightening of Vagina

Does these name vaginal rejuvenation,Vaginal reconstruction,Vaginal resurfacing,Hymen repair sound familiar.have you heard it recently more often than before

With changing society the current day health requirements are not just about how one feels but also how one looks inside out,top to bottom( literally)

A lot of attention is paid to the genitalia by females as well as males to get aesthetic surgery for private parts.

Though I don't see a compulsion when a lady about to get married comes to me to repair the hymen,but I do understand her judgement and that needs to be respected.A neo hymen needs to be made and yes,it is refreshed and made.

Then comes a Lady with multiple Vaginal births with a vagina and perineum which has naturally gone lax.She feels embarrassed while her husband feels unsatisfied.A minor issue but a major one for the Lady and her husband.Can the vagina be tightened,refreshed where the couple can get for pleasure out of sex to keep a harmonious marital life.Yes surely it can be done. If you feel the need to visit our centre at Clinic nirvana ,I would feel happy to explain you the procedure and how simply it can be done.

At time women have body dimorphism and the go for aesthetic surgeries and private part is no different and have seen many young ladies who didn't like their Labial size or shape.Can we help them.Sure we can

Urinary Leakage ...well mesh surgery as well as  minimal incontinence can be dealt with laser surgery too.

Menopausal lady whose vagina is hormone depleted,gone dry and thinned out and has uneasy buning sensation,she can be helped with laser surgery too by generating new collagen

With many years of  experience in urogynaecology,I find aesthetic gynaecology an interesting part of health care.With new techniques and modalities it is possible to give as much efficacy in vaginal tightening or rejuvenation as one would do after a big surgery  by just a half day or maximum 24 hours or at times 45 minutes of non knife surgery.-Lasers to be precise.

Considering that anything to do with aesthetic surgery or repairs,doesn't come cheap including the Laser machines used.

We also perform hymenectomy in couples who have not been able to consummate marriage due to any reason.

Friday, January 27, 2017

Cervical Cancer and Pap smear

So, January being cervical cancer awareness month,I thought of getting repetitive  and talk about Pap smears and vaccines once again.

Cervical cancer - Cervical cancer is the cancer of mouth of the womb and is the commonest cancer in Indian women.Unlike other cancers cervical cancer doesn't surprise you by it's sudden occurrence.It goes through various stages of cell abnormality before getting pre cancerous or even cancerous.

High Risk Factors-Promiscus behaviour and multiple sexual partners,usage of Oral contraceptive pills,smoking,multiple child birth to mention a few.It is caused by a virus called Human papilloma virus,which is mostly transferred during sexual encounter.

Screening- Pap smear is a preventive test which doesn't  take more than 5-7minutes to perform.A brush is used to gently take the cells from the cervix.At worst this test can be called mildly uncomfortable but not painful.A laboratory examination screens out any abnormal cells.

Pap smear should be done every 1 to 3 years till the age of 64years.

What if Pap smear is abnormal-Incase of an abnormal report,another test colposcopy is done where the cervix is visualised under a magnifying lens after applying a vinegar like solution or iodine or both and if any area looks suspicious,small piece s taken and sent for pathological confirmation.Again,this procedure can be done without Anaesthesia.

What if Biopsy also comes abnormal.If it is till precancerous stage,a procedure called LETTZ is performed where the abnormal area of cervix is 'shaved of' using electric current.A cancer obviously would need removing major chunk of cervix if family isn't complete or a hysterectomy if the family is complete.

HPV vaccine- It covers only 4 out of 100 strains of HPV and thus the maximal protection offered is 72 % and not 100 percent.Maximal benefit derived is before the girl became sexually active.Recommended age group is 9 years to 26 years.After that one would get some protection but difficult to say how much protection.

So a few minutes spared every year can save many lives.If you haven't had a screening so far,it is never too late to begin something as beneficial as this.

Thursday, December 29, 2016

let it go to the dogs !!

It is a doggy story from beginning to end.Nothing about women or health or infertility.
Due to multifactorial reasons I got enrolled for my first 10 kms run scheduled for september 2016-Pinkathon ,Delhi.
The person who initially in 2015 had suggested me to try running,by that time had changed priorities.I had thought he would guide me so called training for long runs,never being an athlete or sports person.I was left with the option of trying it myself or run with the local running group,the timing of which was too early for my comfort.Being a late sleeper ,I needed my 8 hours of sleep an 5 am runs were not healthy at all for me.Other option was to quit that 10 kms.By God's grace I haven't quit anything which needed my solo participation.
I started with walks and to my amazement I had run my first 10 Kms in not too bad timings.But that run is a different story all together.I used to train and practice in my condominium myself,all by myself and You tube videos to guide.4 stray Indian dogs have been adopted by our condominium mates and they mutually co exist with us.
When I used to run,mid way around half the circle,4 of these dogs used to come along with me,join ,lick and pounce and play and do all what they could do to show their affection.It was annoying at first and slowly i got used to it.It became the daily routine.Why they liked me,I still don't know as not even once have I played with them or given anything to eat.
And then 20th November was Airtel delhi Half Marathon.My first 21 kms.Again I was alone to train.My friend has his own priorities,other friends who needed help and moral support and training.Anyways again these four guys followed me everyday at the same pace as mine.If I used to run they used to run .My walks made them slow down their pace.They had become my friends ,who derived pleasure of my company.For them no other gain from me mattered and neither I was of any use to them except occasional chats we would have on the running tract.
Now I have a pedigreed Beagle at home.Son of parents who have been show dogs and prize winners-Buddy.A nice little content four years old.Suddenly I was finding a change in his behaviour.He was ignoring me.What was the reason?And then we realised that all the family members used to give him some prize food as soon as they entered the home while I didn't as the deal was not to over feed him to improve his longevity.I felt bad.You can interpret me as a mean person who feels bad of a dog's behaviour or you can classify me as a person who is sensitive enough to feel bad even of a dog's behaviour.And I did rebuke him.
When I came down to run that  day,for the first time I realised the unconditionality of the love these stray dogs had for me.Why?I don't know but their friendship had nothing to do except for being with me for those hours as we were together.I was touched and now we are friends.I look forward to meet them when I go running and in their company I did my first 21 kms.I have patched up with the pedigreed Buddy by offering him his goodies off and on but what I value more is the friendship of street dogs ,who made a runner out of me.

Monday, December 12, 2016

Power of Positivity

My biggest handicap while writing this blog is my limited Vocabulary ,having studied in a non english medium school and have little what so ever liking or time for non medical books.(Inspirational ones are the only exception)

How many of you trust,what you do gets back to you like a boomerang?All,many or nobody?

Well,I do believe in it.As after all whatever you  will sow,you will reap.I have many personal reasons to believe it and I will share with you guys in due course of time.

I reached my OPD Chamber and there was a middle aged couple chatting with my Assistant Ankita.Ankita told in her typical way the medical history where she weighs every word she speaks carefully, weighing each and every word . After all I am the boss.Ok so this 46 years old Lady wanted a Hysterectomy today.Period!!We will call this lady K hence forth for the sake of convenience.

K is a govt teacher ,travels everyday 128 kms towards Rajasthan and comes back.She had not taken a single leave in her career of many years ,she told me proudly.I was impressed ,no doubt.For her 46 years ,she looked younger.It would have been easier to accept her asA 35 year old.A chatty female,who was in rush not just to get a surgery done but also to tell a lot of related stories.Her husband was the scared  and quite one.Scared ,if he would be able to run this show all by himself i.e getting his wife operated and manage the home too.

K had been diagnosed with a big fibroid which in my opinion she could have lived further.But she was determined...surgery,surgery and surgery as that too ASAP.Advised to get endometrial biopsy done preoperatively and she said 'no'.Okay so the next day she was taken for removal of uterus and we decided ( what me...all decisions were of K and I was just executing it)to preserve the ovaries as everyone in her family gets menopause after 60 years of age only.

Do You know me or my professional profile?No came the answer pat.And you are in urgency to get a major surgery from me?Doctor,a neighbour told go to Artemis and in Artemis we liked your name best .I do loved my name before,and I love it more now.Thanks Mom and Dad for the same.I thanked her but said my name kind be the only thing.She said,it gives me positivity.Then came the bouncer.

She said,'Even God has to show his face to us and not just vice versa) .As I have not harmed /hurt or professionally did any misdeed/I don't think a reason to be in  wrong hands.What face will he show to me?Her word were even re assuring for me.It always helps the doctor to treat her patient better if the patient shows so much confidence in the doctor.
It was a complicated case with adherent bowl and bladder due to previous multiple abdomen Surgeries.The surgery went well and uneventful.She visited me again in OPD.So full of praises for all of us but mostly her husband who according to her had graduated to being husband rather than a scared companion of past.

While leaving she again said.God had to show his face to me.That's why I met your team.I didn't do any online search and once I had talked to you the vibes told me-Go for it under her and no where else.

The theory of The secret says,what ever you you wish with full heart the universe conspires to make it happen.I have seen it happens.You are guided rightly by your circumstances.A believer is better than someone who has done mega research on the doctor on internet and still isn't able to trust the person in whose hands has put her life.

Being working in a ECS empanelled hospital,I do get wives of senior level Army officers off and on.It is a huge concession for them.Now this lady , say R,needed a surgery which went smooth again.She came in follow up and just notice the difference in K and R's behaviour.She is a non believer,it sounded.She said doctor I have to say everything went well.I am not even sure you did any surgery on me,as I feel really comfortable.And yes...this is exactly she meant.
In my personal life I have seen power of positivity.It works.In each and every sphere of life.Only-Trust,believe and when things go against you still have Gratitude for a while.And you will realise....everything is back on tract once again.Usko bhi to much dekhana hai !! :) :)