Experiences of a doctor in covid times

It came as a slow threat in early March 2020 when we were asked to wash hand, use mask & follow social distancing. Before we could adjust to this new lifestyle it became a full fledged enemy hitting us left and right.
Government declared total lockdown, administration started defining zones, hospital administration started arranging beds, PPE kits and society glued itself to television, staying indoors throughout. CORONA HAD ARRIVED.

Doctors were caught in a battle between ethics, social responsibility, safety of the family and fear of being infected, in the same order. The last one “fear of own life” could sneak in only in those few minutes in the elevator while returning from hospital and before entering the house. There was no time to think about our own life.

We felt rude to tell our patients to stay away, reminding them intermittently to cover the mouth & nose with mask, which as a habit they would keep on dropping. We lost a sense of touch which is so important for both of us. Anaemia became a laboratory diagnosis, which was otherwise identified by checking the patient’s eyes, tongue and palm which were now kept covered.

Teleconsultation became a norm. It was initially difficult to find a quite corner in the house. For a more professional feel kids & pets were kept away, pressure cookers were not allowed to whistle during teleconsultation sessions. Becoming savy with videoconferencing, scanning, payment gateways became a necessity even for the camera shy. Webinars were held back to back to guide us about new guidelines on managing covid, which also kept on changing every week.

Patients who were pregnant had to be attended throughout, even in the darkest of times. Many patients came without knowing their covid status & we had to equip ourselves in PPE kits to deliver them. Every patient had to be handeled as corona positive, until proven otherwise.
We kept trying to give our best professional service sweating inside the safety gadgets and seeing through fogging specks & face shields.

Challenge was entering the house with a minimal touch technique, taking a bath every time after returning from hospital followed by steaming, be it 3 am or 1 pm. We started popping in every possible immunity boosting food, drinking ginger, tulsi extracts and supplements. To keep immunewe would try to catch up with sleep as much as possible, which was otherwise a rare commodity for us. Health of elders was a concern and hence we kept away from them and managed with video calls.

There was a bright side of covid too. For the first time, we found time in hand. We could lie down on a couch and do channel surfing which was an ultimate relaxing act for few. Old cookery notebooks, diaries, albums with a yellow tinge on pages came out from the trunks. We could spend more time with our spouse, kids. Pets were the happiest creatures in the house with everyone ready to play with them, all the time.

Now life is returning to near normal. We lost many colleagues from medical fraternity. My heart goes out totheir family. They were true heroes, who gave up their lives.
Lucky those who are alive will keep on giving their best service to the society, as our Hippocratic oath taken at the end of MBBS, teaches us to always keep patient first. Long live doctors & patients!

Pregnancy in the time of Corona virus

Coronavirus risk: Is it safe for pregnant women to travel? Doctor ...

Pregnancy in the time of Corona virus

While leading a normal life, one fine day, the whole world is caught in the grip of corona virus. Women who were planning to have a baby, those who are already pregnant & those who are about to deliver, are all utterly confused & fearful about what corona holds for them.

The question which comes to one’s mind is how is corona going to affect the pregnant woman & her unborn child. As it is a beginning of the pandemic, it is a learning time for medical fraternity also. But with the cases seen so far, all over the world there seems to be no major effect of corona virus on the pregnant woman and her unborn child.

As a precaution, you should follow government advice about social distancing, stay away from public places and avoid anyone who has symptoms suggestive of coronavirus. Follow frequent hand washing with soap & water, avoid touching your face. If the baby is moving well and there is no other high risk factor, then you postpone your hospital visits by few weeks. Those nearing term or> 34 weeks must continue their regular checkup visits to the doctor, with all due precautions.

Too much of news inputs will disturb your mind. This is the time for staying calm a7 happy. Pursue your hobbies, turn over the long forgotten albums, story books. Being pregnant you must continue to exercise & meditate atleast twice a day.

If you develop fever with dry cough, isolate yourself and contact a physician urgently. You may be  asked to undergo corona testing. It is a simple swab test being done only at government approved labs. Once detected in time, most patients are quarantined and treated by various drug combinations. So don’t worry, together we will win the battle against corona virus, very soon.

How an Email Made Our Day

A doctor’s life is a hectic one with hardly any time to breathe but one which requires you to be alert and on your toes all through the day and sometimes night as well! Despite all this, a case well handled, a surgery gone well, and in the case of gynaecologists, the happiness of a successful delivery, makes all the beads of perspiration vanish and smoothens the creases on the forehead.

 

The birth of a baby brings a smile not only on the mother’s face but also on us doctor’s. And, the smile only gets broader if we were to get an email from a patient who crossed a number of hurdles and eventually experienced the biggest joy in a woman’s life – that of holding a bundle of joy in her hands. Here’s one email that definitely made our day!

 

“My sincere apologies to you for not being able to send the email earlier. I just want to thank you wholeheartedly for giving me the most precious gift of my life in form of my son. I have seen other doctors also before meeting you, but the empathy, guidance and the personal care I received from you and all other staff at Blossom’s Women Clinic was simply amazing. I am extremely thankful to you for helping me through the most difficult phase of my life, encouraging me to face the challenge and finally making it a success. THANK YOU very much for all your help, support and guidance. I wish all success to you and all others in the clinic.”

Warm Regards,
Barnali Chaudhuri

 

We’re glad we were able to make a difference in your life, Barnali!

 

Infertility – Opening the blocks………..

Laparoscopy

Laparoscopy

Infertility – Opening the blocks

Pregnancy is a dream of every woman, but getting pregnant may not be an easy task for all. To simplify the mechanism of pregnancy, female produces one egg every month which is released from the ovary & enters the Fallopian tube. Male sperms enter through the vagina and reach the tube, where final meeting of sperm & egg (fertilization) takes place. Hence any blocks in the Fallopian tube will lead to failure of fertilization & infertility.

What causes block in the tubes?

Pelvic infections such as tuberculosis & previous surgeries are common causes of tubal block. These blocks are often first diagnosed on HSG or SSG during a fertility workup.

Treatment

Blocked tubes leave a woman with two choices – IVF or surgery to open the tubes.

Opening blocked tubes is a simple procedure through minimal access technique/endoscopy/ keyhole surgery. For blocks close to the uterus (cornual blocks), hysteroscopic tubal cannulation is the method of choice. Procedure involves passing a very thin guidewire through the blocked segments, under vision with a hysteroscope.

Blocks away from the uterus (ampullary/ isthmic/ fimbrial), are opened by laparoscopy. Use of high magnification, fine instruments causes minimum tissue trauma & gives better results.

Previous sterilization (family planning/ tubal ligation) operation may need to be opened after untimely death of children. This is also best done with laparoscopy. Tubal recanalization involves cutting the blocked part & stitching the fresh ends with very fine sutures. Large hydrosalpinx, where the tube is ballooned up, may necessitate removal of the tube.

All tubal surgeries need extreme expertise of the surgeon. Unlike IVF, which is an expensive technique & needs to be repeated everytime, tubal surgery If done well, gives the patient a chance to become pregnant naturally, not just once, but as many times as she wants.

“Babies for all” – Your fertility options

“Babies for all” – Your fertility options

 If you are one of those who has not yet seen the joy of parenthood, this article is for you. With advances in medical science, even for extreme cases, there are multiple options available.

Initial treatment consists of history, examination, blood tests & specific workup of a couple. If simple
drugs, intrauterine insemination (IUI), etc. do not work, then a more advanced therapy is needed.

Let us begin with a man whose sperm count is zero; the world seems to be coming to an end. But wait, few hormone tests & a biopsy may reveal if the body is making sperms and if there is just an obstruction on the way. If this is the case, then with the help of surgery to remove the block or with in vitro fertilization (IVF) with needle aspiration of testicular tissue (TESA), you may have your own genetic child. For those whose body is not producing any sperms, one of the options is donor sperm IUI.
Baby image 3.jpA large number of drugs & injections can help women, produce eggs. If not, there are always donor eggs. Donor eggs are also used when due to advanced age, a woman has stopped producing her own eggs.

If a woman is born without a normal uterus or has lost it to disease, then surrogacy is the answer. Surrogacy is often called “hiring a womb”, where another woman provides her uterus just as a room to grow the baby for nine months. Also various medical disorders, which do not allow a woman to carry a pregnancy surrogacy, may be used.

Fibroids – Better Ways To Deal With !

You just went for a routine ultrasound & there came the news of you carrying fibroids in your uterus. Don’t panic, fibroids are not an end to life. They are non cancerous growths arising from the muscle of uterus & most of them lie silently, without causing any ill effects.

Depending on their size & location, they may give rise to heavy menstrual flow, irregular menses, painful periods, difficulty in conceiving, repeated miscarriages, pregnancy complications, anaemia, heaviness in lower abdomen, etc. Fibroids are easily diagnosed on ultrasound.

This fibroid may not require urgent treatment.

This fibroid may not require urgent treatment

Various treatments options include simple reassurance to the patient, if symptoms are not many & patient is nearing menopause, as most fibroids tend to shrink after menopause.

Most large fibroids & those distorting the inner lining of the uterus will need treatment. Injections & several medicines can temporarily shrink the fibroids.

Hysteroscopy involves insertion of a narrow telescope through the vagina & removal of submucous variety of fibroids. Laparoscopy through very fine cuts, may be surgery of choice in a selected group of patients. Hysteroscopy & Laparoscopy are forms of minimally invasive procedures, which allow quick, pain free recovery, 1-2 days hospital stay & minimal blood loss. Other treatment options are embolization of uterine artery, Mrgfus.

Remember, you are not the only one living with fibroids. Leave the management to the doctor, there is more to life then worrying about fibroids.

Endometriosis – Laparoscopic Treatment

Endometriosis – an enigma….often compared to cancer, can debilitate a woman with severe pain during menses or infertility. Different modalities of treatment include medicines, surgery & alternative medicines. Surgical removal is indicated when there are large ovarian endometriomas (chocolate cysts). To prevent recurrence, disease needs to be completely excised & this depends on the expertise of the surgeon. This video shows laparoscopic surgery for endometriosis.

Painful menses

Pain is an unpleasent sensation that none of us would want to expetience. Yet, many young girls have to tragically go through this month after month. This takes a toll on them not only  physically & emotionally , but also reduces their efficiency in the most productive & demanding years resulting in an overall poor quality of life.

As the age old saying goes, all women must go through some pain, let us understand what is normal & when should you start getting alarmed.

Slight pain on first or second day of menses is considered to be natural. It can be easily managed with rest, hot water bags locally & occasionally some pain killers.

You need to see a doctor when pain is of severe intensity, lasts longer or appears later in life after many years of painless menses. You may be asked to do an ultrasound & blood test, which most of the time will be normal. This will reassure you.

Sometimes there could be pelvic infections, endometriosis or ovarian cysts. A short therapy with antibiotics or hormones will help most patients, except a few who may need surgery. Minimal Access surgery (also called Keyhole or Laparoscopic Surgery) benefits such patients with very fine, small scars, minimal pain, very short hospital stay & fast recovery, with complete cure of the disease within.

Race between age & decreasing fertility in women

Are you in your mid thirtees, busy with job commitments, working overtime for the next promotion? Or are you still looking for Mr. Right, somebody who will be commited to you & your child.

Ladies, please pause for a moment!  Your biological clock is ticking fast. The number & quality of female eggs starts dropping after the age of 35. You may be having regular monthly bleeding  with normal flow, but still the fertilizing capacity of your eggs keeps going down. The chances of getting pregnant also keep reducing  from the age of 35, drastically after 40 & there is a very remote possibility of becoming a mother naturally after 45 years of age.

There are few tests to assess the fertilizing capability of eggs, namely AFC & AMH. AFC (Antral Follicle Count) is an ultrasound study to count the number of resting follicles, which will eventually become eggs.

AMH (Anti Mullerian Hormone) is a blood test to again assess your chances of getting pregnant.  The test results have to be interpreted carefully, considering multiple factors. The treatment options, even if it is IVF, become less with increasing age & you may have to take the help of donor eggs, if the time has run out.