Wednesday, November 28, 2012

Epidural analgesia in labour-Facts and fictions

Epidural analgesia......whether it is good or bad?I think it is good as labour pains are really bad pain.But in this post I  don't wish to talk about my view point on epidural analgesia.It is all evidence based medicine.As chance would have been in last few days there have been many incidents involving me, ladies in Labour,expectant mothers ,other obstetricians and labour room nurses and anaesthetists.....and common factor was epidural and some associated myth about epidural analgesia.I realized that my years in UK have helped me understand epidural analgesia better.Would like to share the answers of some common queries:

Is epidural safe?What are the side effects?

It is !! But there  can be associated complications just like any other intervention and would depend on the competence of the anaesthetist. Accidental puncture of meningeal membrane can lead to dural tap with leakage of spinal fluid.It can lead to severe headaches .the definitive treatment is blood patch injected in the epidural space.It is recommended to deliver the baby by vaccum rather than allow the lady to strain to deliver the baby.

At times if the dose of local anaesthetic medicine becomes more it can impair diaphragmatic innervation and thus arrest of respiration.This is called total spinal.

Some ladies can be allergic to the local anaesthetic agent which is used.

Epidural at times can cause lowering of blood pressure typically after administration of bolus dose of medicine.It can lead to lowered pulse rate of the foetus and is corrected by putting the Lady in left lateral position and hydrating the lady.

It is a known fact that epidural increases the length of 1st and 2nd stage of labour and there is increased used of instrumental delivery.Anaesthetist at times are touchy about this fact and would not like use of a vaccum for delivering a lady who has been given epidural analgesia as this confirms the age old fact that epidural administration is associated with increased used of instrumental delivery.I have found my patients quite cool of the fact that a vaccum will be used if they are unable to push. I think most of them are well read people and they talk to me to clear their doubts. Few Gynaecologists like to push the fundus of the lady to deliver the baby if she is not able to push.This is perhaps not recommended in modern day obstetrics.Though technically a normal delivery and not a instrumental delivery it is much dangerous with a possibility of injury to spleen,liver,ribs etc. (Again if I had not been to UK even I  would be pushing the uterus hard.There they would have struck my name from the GMC register for something as dangerous as this)

When can epidural analgesia be given?

There is no arbitrary dilatation based on which the administration of epidural should be stopped.

Should the Epidural be stopped at the time of bearing down?

Many Gynaecologists stongly believe that epidural should be stopped when the ladies pain is at it's peak and when she is bearing down to help in getting her motor impulses back.Fact of the matter remains that once epidural has been administered it should be stopped only after 1st,2nd,3rd stage of labour as well as perineal repair if needed is all complete.There is no role of stopping the epidural intermittentely.

So , epidural will cause me life long back ache? won't.There is no evidence to the same effect.

Should I go for it or not?

If I had a competent Gynaecologist who can perform safe instrumental delivery and an anaesthetist who could give me epidural without a dural tap,I would have surely gone for it myself.

Dear patients of mine, anyone of you who would like to share their good,bad or ugly experiences about epidural are most welcome at my blog.

Tuesday, November 27, 2012

Free Health camp at Max Hospital ,Gurgaon

I shall be conducting free consultations on every aspect of gynaecological disorder from 3rd to 8th dec between 6 pm to 8 pm at Max hospital Gurgaon.There would be discounts on Pap smear and mammogram.If any one gets registered for any kind of gynaecological surgery (including all the major cases) would be entitled to a discount of 10% of the total bill if the surgery is performed within 30 days.There would be special emphasis on Urine incontinence surgeries and on advanced laparoscopic surgeries. 

Saturday, November 10, 2012

Property' Pachda'

Of late I haven't got any inspiration to write a new post.To write a post I need to be inspired either with a positive experience or a negative one.These days I have become numb as well as dumb.Reason being a poor doctor trying to buy a property to live in.In the process I realized Arranging finances isn't the biggest problem.There are many more battles to be conquered.So , with sky rocketing prices of property in Gurgaon I thought of purchasing a property sold by a friend in order to save some money.So that left me with no broker.Now imagine working at hospital,running an OPD,operating,delivering,doing caesareans,I have so much to handle.
A call from the bank......God a never ending list of paper work.Call from Gaurav ,the bank rep.Fixing time with managers was a big problem.I am free only in anti social hours.After 9.30 or 10.Imagine.....the trouble of meeting the managers so late in the night.It is still going on.Am yet not over with it.
Now I have to sell a property to purchase this property.So just imagine the number of people involved.My buyer has to arrange loans and thus to complete my deal I am dependent on him.If he is stuck which he is at the moment currently....then I will also find me breaking my commitment to my seller.
My seller and his wife live out of even signing an ATS isn't so easy....needs coordination of presence of me,mom,seller and his wife.God save again after I meet you guys in OPD I try to fulfill these commitments in night after 10 pm.
A visit to deed Writer.Purchasing stamp paper for registry  .........carrying cash in Gurgaon.......I DIDN'T FEEL COMFORTABLE.Waiting list at SBI.Gurgaon civil court.Nexus of Property dealers.Cheque and cash etc and etc.
You are also numb ,I now I know.So that is what is happening I see you guys at the hospital,operate and then keep on coordinating with bankers,writers,property dealers,buyers and sellers......and that just finishes the day.
just praying that it gets over soon so that I am back to be the clinician I was before I started with this Property Pachda.....Waiting for the time when I will get time again to teach my son.To relax on sundays.

Tuesday, November 6, 2012

My OPD slots and waiting

Tody once again a Patient wished me to increase my OPD slot duration to 25 minutes per patient instead of 15 minutes to decrease the waiting time.Less appointments and thus less waiting.

Dear friends that is not possible at any cost because I can't sit for 2 hours in OPD and see only 4 patients.It isn't financially viable option either for me or the hospital.

There are few ways in which you yourself can help each other and help me in decreasing the waiting time.Better time management by all of us.

You realize that that your consultation time is 15 minutes please come prepared with your queries.If you wish to save time ,Please don't expect me to answer all the myths that are generated in your mind  by your google search or your mom or mom in law or your friend if you wish the appointments not to run late.At the moment I do answer even your  smallest query which can take up to many minutes .

Don't ask me such irrelevant questions like 'how much is the rate of baby's heart beat when I have already told you that it is normal.

Please come on time.

When asking questions Please don't keep on beating around the bush.Respect my time and automatically the schedule will run on time and thus your time will be respected too.

Other option is to let it continue the way it keep on asking the questions to your heart's content and me answering them......I don't have any problem when your 15 minute appointment runs to 45 minutes because I feel you need to understand the treatment and your condition to take care of yourself better.But if the waiting time bothers you,let us all try to do our bit to stick to the 15 minute schedule.Don't yell or shout at the duty Manager.He/she isn't at fault.Don't complain against the front desk staff for my waiting time.It won't help as they are not the ones responsible for it.It is You and me.You because you have taken more than your stipulated 15 minutes and me because I have obliged you.Do you realize that in this process my opd supposed to get over by 8 pm ends by 10 pm.Do you realize that at the end I have waited along with you????Next time think over it while waiting........And also at times there can be patients whose medical history is so complex that they need to give me a detailed history and I do need to give them time genuinely as well.

Some one also told me that with increasing competition ( I think she meant a Hospital coming across the road).......if the appointments are delayed it will be a bad name for the Max Hospital. :-)) I find this comment really funny.And fortunately her husband also found it funny too.Pleaded her to keep quiet,reminding her that in this whole process she had already spent 25 minutes with me instead of her allocated 15 minutes.Reminded that she had to wait for hours for the doctor in South Africa too .