Author: mygynaec

Mrs. Saluja is a professor of bio technology. Her gynaecologist has advised her a surgery for removal of uterus (hysterectomy) and the same was scheduled the next day. Her close relative had almost dragged her to me, insisting that I should see her once and opine. Mrs. Saluja seemed very sure and clear about everything. When I asked her these questions she looked puzzled. She did not know the answers and had not asked these questions to her doctor too.

Here I share are those eleven things you must know before undergoing hysterectomy

1. What is Hysterectomy? : It is surgical removal of uterus. It is a common surgery that women undergo during their life time.
2. Are ovaries going to be removed? : Ovaries are power house of the hormones. Removal of ovaries will lead to sudden deficiency of hormones. This will lead to symptoms of menopause. The skin may go dry, hair brittle, hot flushes etc. If you have already attained the menopause or on the verge of attaining it, it is fair to remove the ovaries; but not otherwise. Of course if the ovaries are diseased doctor may consider removal of the ovaries.
3. Are there any alternative treatments available? : It is true that removal of uterus might be the ultimate solution to many of the problems. But there can be many other alternatives. These alternatives depend on what is the basic gynaecological condition that you have. You should discuss with your doctor about the options
4. Is the removal of uterus possible through the natural orifice of vagina?  : The surgery can be done by three ways: Open surgery on abdomen, laparoscopy and vaginal surgery. Endoscopic surgery or laparoscopy is definitely better option as compared to open surgery. However even better option is to go for surgery through natural orifice that means vaginal surgery. Some doctors are able to do this surgery through vaginal route even if the uterus is large or has fibroids. Check with your doctor on this.
5. What are the common complications? : Every surgery has its share of complications. The uterus has to be separated from the adjoining structures that is the urinary bladder and the intestines. Excessive bleeding, wound infection are two other common problems that can occur.
6. How fast will you be able to resume work/ exercise? : It is important to know how early you can resume your work. One does not need weeks and months of rest after the surgery. Vaginal surgery leads to quickest recovery followed by laparoscopic one. One may have to resort to abdominal surgery if the uterus is too big or has large fibroids.
7. Is there a suspicion of cancer? : It is important to understand why are you undergoing the surgery. If there is a suspicion of cancer, you must know what investigations are needed further.
8. What is the cost? : Do not forget to ask the cost of the surgery before you go ahead.
9. Are you sure about preparation before surgery? : Has your doctor adequately investigated you before surgery? Are you aware of when should you eat or drink last? Have you got clear instructions on preparation before surgery? Do you take any medicines that need to be stopped prior to surgery? Ask these questions to your doctor.
10. Have you disclosed all the details about yourself? : Do not forget to disclose all the details about yourself. If you are suffering from common problems such as high blood pressure or diabetes or thyroid you must disclose it. Are you allergic to any medicines? Have you undergone a surgery in the past? Do share this information with the doctor.
11. What anaesthesia is going to be used? : There are two broad categories. General anaesthesia where you are completely anaesthetised and regional anaesthesia in which only certain part… in this case only part below the belly button is anaesthetised. Anaesthesia depends upon the nature of surgery, medical conditions, patient’s choice and doctor’s choice.

Sneha and Arun walked into my cabin. The couple was excited about the first baby. It was just third month of pregnancy and second visit to me. This time the mother was also accompanying the couple. The mother looked happy and watchful too. After the consultation we had a quick chat and then they got up to leave. This time Arun allowed the mother to exit first and turned back with a shy smile. Sneha looked in two minds… Whether to ask or not to ask? And I knew the question that was coming my way. As expected the question was about whether they could have sex or no?

Most Indian couples do not discuss this with anyone. They rely on myths and beliefs or lay literature. This adds further confusion! Like the famous Shake sphere’s quote “To do or not to do, that is the real (unanswered) question” for the young couples. Commonly people believe that sex during pregnancy is a big NO- NO. People believe that intercourse can harm the pregnancy. Surprisingly many doctors also advice the same to their patients! While few advice not to have sex in first three months and some advice not to have sex when the bump grows bigger!! So what does the evidence say?

Well, there is a clear scientific evidence that sex during pregnancy can NOT harm the baby per say. However there are few conditions such as placenta praevia (placenta is low placed), repeated miscarriages, opened up or short cervix, previous premature deliveries or if there is bleeding or leaking most doctors will advise against intercourse. It is important to understand that the baby is inside a balloon of water which is inside the uterus. The lower end of the uterus called cervix is closed and plugged with a mucus plug which does not allow entry of even germs (microorganisms) upwards.

The baby inside the balloon of water in the uterus which has closed cervix

However it is also important to understand that although the baby is protected the woman can contact infections from her male partner. These infections could be simple fungal infection, bacterial, viral infection too. In order to prevent such infections it is better to use a condom (or barrier contraceptive). During the pregnancy the hormones in the body surge making the tissues softer and congested. So a pregnant woman may rarely experience few drops of bleeding after intercourse.

So here are few tips for the young couples:

In first three months pregnant woman may feel exhausted due to nausea, vomiting and may not feel interested in sex. The partner must understand her problem and support her.

In second trimester and third trimester, the increasing bump needs to be taken into consideration. Change of position may help. Many women find “side to side” or “woman on top” position more comfortable.

Especially after six months most women may find it more and more uncomfortable. Some may feel minimal uterine contractions which are “innocent”. Intimacy does not necessarily mean penetrative sexual intercourse. The couple can make love without penetrative intercourse too.

In this delicate period of pregnancy, women undergo a complete emotional and physical turmoil. The partner must encourage her, caress her, support her. Sexual intercourse is perfectly fine if the woman is comfortable. Expression of love is important and being intimate is a necessity!

By Dr Nikhil Datar
MD DNB FCPS FICOG DGO DHA LLB
Consultant Gynaecologist & Medical Director Cloudnine Hospital
Consultant Gynaecologist Lifewave Hospital & Yashada Hospital
www.mygynaec.com

Anemia is a common health problem amongst women in India. Iron tablets is the most common medicine prescribed medicine for this. All pregnant women are given a tablet of iron.
Iron tablets can be very effective but only if they are taken correctly.

Here are ten things you must know about iron intake.

1.  Iron is best absorbed when taken on empty stomach. But it can cause cramps, acidity, vomiting when taken on empty stomach. That is why we advice to take iron tablet be taken after small quantity of food especially when they are not tolerated on empty stomach.
2. Indian meal is full of phytates and phosphates. These ingredients hamper iron absorption. So never take iron immediately food. You may take it after some time.
3. It is a common practice in India to take medicines with milk. This is a big “NO- NO”. It does not allow iron absorption.
4. Conventional iron tablets should not be taken with calcium as this may reduce the absorption. However there are few iron salts which can be taken with calcium.
5. Vitamin C improves iron absorption. It is a good idea to take iron with lime juice or orange juice.
6. Common side effects of iron are constipation, dark stools, diarrhoea, nausea.
7. It is commonly believed that beet root, carrot are best sources of iron. This is not true. Green leafy vegetables, walnuts, black grapes, dates are good vegetarian sources of iron.
8. Haem Iron, the iron from Non vegetarian source is better absorbed in the body as compared to vegetarian sources.
9. iron syrups may stain the teeth dark.
10. Iron comes in the form of various salts. If you do not tolerate one type of salt discuss with your doctor and get it changed. But take the iron tablet and prevent anemia. Be healthy!

By Dr Nikhil Datar
MD DNB FCPS FICOG DGO DHA LLB
Consultant Gynaecologist & Medical Director Cloudnine Hospital
Consultant Gynaecologist Lifewave Hospital & Yashada Hospital
www.mygynaec.com

Social media and mobile have become an integral part of our life. We are connected to our family, friends and to market places by internet and social media all the time. Doctor is a crucial person in every one’s life. Being connected with the doctor makes everyone feel secure and safe. Naturally patients use social media like WhatsApp or mobile for quick advice when in need. The two commonest questions that are asked are “Is this worrisome?” “Can you suggest some medicine on phone?”
Here I share a real life story. A nine month pregnant patient’s mother called me on a Sunday afternoon stating that her daughter has slight bleeding but no pain and indicated that she may bring her to the hospital if pain increases. She wanted my nod to the plan. On the face of it the symptoms seemed “No worries” type… However knowing the case I simply told her to come to the hospital. No sooner she reached the hospital we diagnosed that it was a serious problem called “Abruption”. A life was saved only because we could examine the patient and not rely on the mother’s version.
Here are some fundamental problems with telephonic consultations.
• Detailed history, verbal and non-verbal clues which are picked up during face to face consultation and examination are necessary for accurate diagnosis. Had that been untrue, software could have diagnosed medical conditions! Just key in the complaints or symptoms and software gives you the diagnosis. Thus telephonic consultations to “quick fix” the problem can go miserably wrong some times.
• A doctor may or may not recollect the complete and minute details of the history (Say history of allergy to a particular drug) while on phone.
• While attending to some other important work and simultaneously speaking on phone there may be lack of attention.
• Both parties may not hear correctly on phone.
• Name of medications can go completely wrong when taken down on the phone. Even today while I write this article I saw a patient who had taken down a wrong spelling of a medicine during telephonic conversation.
Social media or phones are not basically meant for a serious professional conversation ( exception: pre decided conference call or pre-decided telephonic consultation). So what is the solution? How to seek help in emergency? How to stay connected with the healthcare provider without compromising on safety?
Here are some tips:
1 Ask your doctor what is the preferred mode of communication. In my experience I have found email to be the best. They are usually written and read by certain degree of seriousness.
2 You must have all the contact details of the hospital. You must know how the hospital has organised emergency medical service or “out of hour” service.
3 In case you call the doctor, keep your medical papers handy. Keep a pen and paper ready so that you can quickly write down.
4 You may remember this simple acronym “N-C-C-Q” and give the details accordingly .This can make the conversation productive and safe.
• Name: Full name
Resist conversations such as “Hi Doctor! Recognised me? I am Shilpa” You are not calling the doctor to test his/her memory. Are you?
• Case details:
Resist Conversation such as “Last time you gave me red coloured tablet…”
Instead say important things like you are pregnant, six months pregnant or not pregnant. You had visited for XYZ symptoms or was diagnosed as “ABC”. You have diabetes or blood pressure etc.
• Current problem:
Explain the current problem. Say “ I have got cough since two days.”
• Question
Do not ask vague question like “ Is this worrisome? ???? ???? ?? ?????” Instead ask specific questions like “What should I do next?” It is preferable not to ask for medications on the phone. The medical council guidelines prohibit telephonic advice on medications.( Over the counter products are exception)
You have to understand the limitations of the doctor and not expect a very detailed advice. Doctor can at the most give some temporary solution.
When in doubt it is always better to go to the hospital, Even if your doctor is not available, there will be medical personnel, doctor or a nurse who can make basic assessment and inform your doctor so that your doctor get the correct picture to help you out.
In conclusion, telephonic advice is not the best advice. Don’t underestimate your concerns by casual talks on phone, they need serious attention!