Monday, May 2, 2016

A 'ma' speaks about 'Asthma'

Today I am known all around for my skills with children suffering with asthma...

The story had a personal beginning.

Ekalavya, my son, now 30, would come down with recurrent episodes of cold and cough taking long to settle as an infant. I was then in my mid-twenties, a young captain in the Army Medical Corps. I would often wonder that why does he suffer as his sibling a year older did not get afflicted. It was probably not an infective etiology then. Since the episodes were not very severe and settled down easily, I stopped worrying.

Around the time he was 18 months old I was posted to Base Hospital Barrackpore, in the outskirts of Kolkata. I was a single parent, my husband was pursuing higher studies overseas. There were floods in Bengal and an officer had to be sent on special duties to help the locals and the troops. As I spoke Bengali, I was given the orders to go. Not one to shirk duties, I accepted the orders but made a request to be allowed to take my children and their nanny with me. I was given the permission to do so.
The duty was gratifying but the surroundings damp and mouldy. One night I heard loud wheezing in the room at night .There were my two children and me in the room. I knew the sound came from one of them .Little Ekalavya was breathing heavily and distressed. With a torchlight, I skipped over puddles of water to bring him some medicines. I knew none of this would work in a hurry .Those days asthma care was primitive. I had to give him a shot of adrenaline. He settled.In a few days time we returned back to the base as my duties were over. I knew then that Ekalavya had asthma, he had strong genetic propensity from both sides of families.

In a few month’s time I completed my commission with the Indian Army. We joined my husband at UK. I chose to work as an observer in the Respiratory Unit of a tertiary care Paediatric Hospital. I got home what was the best available treatment for Ekalavya and he did very well.

On return to India we discontinued treatment. But one Diwali when the house was buzzing with friends who had dropped by to wish us, I saw Ekalavya was not in the room. He had been coughing the past few days. I found him lying in bed breathless, answering me in monosyllables. My husband ,not from the same profession did not understand the gravity of situation. But one of my childhood friends was there. We got onto his scooter, me clutching onto a breathless child, who was beginning to grunt. We raced to the hospital Emergency Room, it helped that I was the senior Paediatric resident. Ekalavya settled. But many don't...

Thus started my crusade for the asthmatic child.

I make their lungs the heart of my practice.

editors note: Thank you Dr Barnali Bhattacharya for your heart felt message. it is said that to be a good doctor we must empathise. but beyond Empathy is 'kinship'. where empathy says ; i know how you feel...kinship says; i have felt what you are feeling. 
This kinship with your patients parents , makes you a better doctor, and thus a renowned name in Asthma counselling and treatment.

Friday, January 29, 2016

to eat or not to eat

As an obstetrician , I have been asked this question thousands of times – what do I eat in pregnancy? Can  I eat papaya? Can I eat pineapple? Should I avoid meat? Is eating egg harmful? And the alltime favorite – should I eat ‘garam’foods or ‘thanda’food? Not hot or cold in terms of temperature but in terms of whether it increases body heat or not. Don’t ask me , I don’t know how?! As a practitioner of Allopathy , I am clueless about these concepts , which are probably derived from Ayurveda.

 As students in medical college , we were not taught to answer such questions, so ,when faced with such queries , I advice them on calorie & protein intake and the need to avoid unhealthy junk food.

The tables turned though when I was expecting

No one asked me anything , everyone turned advisor instead." Do not eat methi", said my cousin. "Do not eat nachni , it is garam " - my neighbor said. My rational scientific mind rebelled against this – to no avail. Everyone assumed they knew better- I was only a gynaec whereas they were already mothers!

 It only got worse post delivery. Most communities in India have their own brand of post partum foods. In Maharashtra , the new mother is fed laddoos of methi (yuck!) , and also raisin- all made with lots of ghee (which I don’t like) . In Tamilian Brahmins , there is something called ‘pathiya samayal’. This excludes all pulses except moong , all tubers, vegetables like brinjal and okra and even green and red chillies.

 Unfortunately , having a Tam-bram mom and a Marathi mum -in-law , I was ‘forced’ to follow both traditions!

There are also a whole lot of myths associated with pregnancy and delivery – my mallish wali bai scolded me for not stuffing my ears with cotton lest the ‘hawa/air’ leads to abdominal bloating , my maid asked me not to eat rice so that my scar heals well, ‘well wishers’ adviced that tying a tight cloth around my waist will make me all slim and trim again!

  The whole experience made me  realize that pregnancy and delivery is a social event in our country , with everyone and their aunt chipping in with well intentioned and conflicting advice. 

The new mother is generally left confused, not knowing whose advice to follow – the obstetrician does not even figure in her scheme of things!

I think my whole pregnancy experience changed the way I practice gynecology and obstetrics. Earlier , I believed educating patients was the key to good nutrition and healthy pregnancy. Now , I counsel mothers and mothers- in –law  instead as they have the final say!

Editor's note: Thank you Dr Lakshmi on the true tale of unsolicited advice in Indian scenerio. I do wish our medical textbooks had armed us better with the cultural and social aspects of pregnancy and motherhood. Food fads especially are an intrinsic part of pregnancy, and what I noticed is that what was bad for you in pregnancy becomes good for you in early motherhood. I guess it depends on their 'claimed effects on uterine contractility'. I am sure they have a kernel of truth in them especially in the time of yore, but they have been blown right out of proportion. unsolicited advice is common in every society, but most parenting guides will tell you to "go right ahead and follow your maternal instinct." in Indian joint family scenerio, the new moms instincts are not given much importance when there are other 'veteran moms' such as grand moms and great grandmoms, and aunts and dais. I think you might have a point there on educating the family tree.




Thursday, January 21, 2016

A mother helps her child see

 I am DR. Samyukta, practicing anesthiologist from Chennai. Though I had read of nystagmus and its types in 3rd year of MBBS, I had nott seen a case of nystagmus  during the course.when I noticed it at 9 months of age in my daughter, I was thinking that it will settle down with age as congenital squint.

Even at that time I did not know that "shaking of black ball is “nystagmus".This shows the  importance of practical knowledge /clinicals in our profession.

  After 6 months , ie when she was  about 1.5yrs I took her to opthamalogist for squint, even at that time the shaking was not observed by doctor, after 2 weeks I myself presented with the complaint of shaking  and it was the first time I came to know it as "NYSTAGMUS". I was shocked, felt bad about it. The doctor had referred to a paediatric ophthalmologist who is experienced in squint and nystagmus surgeries.
                                       
Without reading   much of it, we went to for consultation where he said observee for null point direction and we would operate and it should be within 4 yrs for best results, it was the first time when she had eye drops. being in medical field , that too anesthiology I know the risks, complications,  psychological trauma , mishaps  that can take place during surgery. Thinking we can get operated in UK we continues with our plans for travel.Though scared by the surgery, till then we had a positive hope things will settle down and her eyes will be normal after it.
            
  But things have changed after the consultation in UK. We did ERG  and MRI, we came to know she is having cone dysfunction with nystagmus being defect in afferent system nothing can be done.

He explained the most important points, how nystagmus eyes see the world.

As all are aware, consultation in UK is a process of 5- 6 months, before we understood how her eyes see the world, we troubled her a lot. I  used force her to sit away from TV, to look straight and talk , poor girl she even tried to see straight, whenever  that flashes in my mind I hate myself.I searched   what might be the causes of cone dysfunction, and I found in one of researches that  when foetus gets exposed to bright light , it damages its retina. I hated myself more because I was working in operation theatres until 9 months and even I did CPR at 8 months of pregnancy. Even today I feel my profession is a curse for my little one.

What really helped me was not medical books but internet  and blogs.

When we hear the word  ‘cone’ one first thing which comes to our mind is colour blindness.Intial she use to even get confused with green and red. Everyday I used show apple to tell her it is red color and leaf for green color, slowly she started to identify them correctly.Now her identification, colouring everything is perfect.All these things are shared by other parents

I have joined the nystagmus network UK, which taught me how parents should support the kids. I am most thankful to it.With idea to help other parents of nystagmus kids in india I have started Nystagmus Group India.

The main reason for starting this group to prove to my kid that she is not the only person with this problem, there are many persons like her and how they cope up in Indian scenario.the feeling that someone is there with similar problem like me, itself  boosts their self confidence.
IF we really know what is the problem , we can come up the solutions, but for it we should understand the problem thoroughly.This is the most difficult part in nystagmus.Even myself being in medical field took nearly 2 years to understand it, what would  be the postion of non medical person??? Commom man???At present I am working on this aspect,this should stop with face book, it should reach all kids and hope I can reach this in couple of years.


                EDITORS NOTE: Thank you Dr Samyukta for your words. You are so right, knowledge is power. And in todAys age knowledge is at our finger tips. But as a paediatric ophthalmologist I have realised that with knowledge, patients and parents need empathy,need support; and that is where support groups come into play. I have learnt a lot about handling nystagmus patients from the facebook support groups, especially from our own Indian group. you have taught me from your own examples, how you make your daughter brush her teeth, help in her homework, spread the message in her class rooms, these were issues which I earlier did not address as a paediatric ophthalmologist. today one of my questions to my patients is "do you have facebook? or internet access" so that they can get in touch with other parents/patients with nystagmus.

other than that this story deals with a universal topic- of a mothers guilt. There is no escaping that, as mothers we are wired to blame ourselves. child crying at night, child not eating well, child having a temper tantrum, and in India they go a step further and blame mothers for having a female child. As a paeditric ophthalmologist I assure you, you did not cause this to your baby, and as a mother I applaud your quest to provide the best to your child, as well as understand her physical handicaps so as to better help her adjust. 

another important lesson here is acceptance. As Dr Samyukta says, until you accept your child has a problem, you will not be able to help her, or find solutions. like in Nystagmus, trying to make your child look straight (when she CAN'T, or making her soit further from the TV or board (WHEN SHE CAN;T SEE) arte classical examples where parent refuse to accept that their child has a problem. Acceptance is the first step to solutions, not cure in many cases, but solutions nevertheless.

to join the nystagmus group click here

to read more stories by doctor parents :click  here


Wednesday, January 13, 2016

The balancing act

A recent headlines in the Times of India caught my eye , it read “More women study medicine ,but few practise.” The article essentially spoke of how women are unable to balance work and home and many choose to forfeit their medical degree for their marital duties.

The article speaks of how 50.6% of admissions into a medical college are women, but only 17% of allopathic doctors were women. to read the whole article press here.

As a new mom and currently on a sabattical from work, I can in a way identify with the herculean task of balancing work and family.


Early into my pregnancy, or rather even before I conceived, I was well aware that I stood at a disadvantage to my non-doctor friends. First, as a doctor in a private hospital, I did not get paid maternity leave. Unlike government positions, a doctor working in a private hospital is not always paid for the 3 to 6 months that she takes to raise her new born. Doctors, especially those who have their own practices, or are freelancing in multiple hospitals, are essentially ‘daily wage earners’; they earn as much as they work, and for as many days.



This early realisation that I was more akin to my local bhajiwali, who got paid depending on the wares she sold, and whom I wouldn’t dream of paying if she decided to go on a maternity leave, made me feel more kindly towards her. I stopped bargaining for the extra 5 rupees, I even paid my cleaning woman her bonus, knowing fully well that these ‘working women’ were trying to balance a home and work, without the benefits of a government plan to safe guard our interests as we brought up the next generation of Indians.
The slogan says “beti bachao, beti padhao’ no where does it say, ‘beti ko job dilao’!

My friends working with multinationals and corporates spoke of their ‘maternity leave packages’ and ‘work from home’ plans, and ‘in house crèches and daycares’ within their companies. True, these were non-government jobs, and many of them financed by foreign investments, and yet, they seemed to care about the ‘working Indian woman’ more than many ‘indian companies’ did.

I did finally come to terms with my not getting any ‘paid maternity leave’, and then contemplated about my medical insurance.
It’s an honest declaration that doctors are extremely poor with understanding investments and finances. Maybe it is our inherent dislike for numbers, or the fact that we start earning much later than our counterparts in any other profession.  And medical insurance is something we doctors take extremely lightly, especially so early in life. All the minor ailments are easily solved by a quick call to another doctor friend, most doctors (atleast the ones that I have met) don’t charge other doctors any consultation fees as part of the unspoken ethical code we follow.
If being ‘jobless’ was scary enough for me, the fact that no health insurance covered pregnancy/delivery/newborn care was another new revelation.

We were going from a double income family of two, to a single earning member of a family of three! With the loss of around six months of pay as well as the added costs of hospitals, as well as a full time baby care if I ever wanted to join back work, the financial dilemma was obvious.

For doctors there is also the question of ‘losing our practice’. Our patients would need to see other doctors in our absence, and what are the chances that they would return once I resumed work?

I don’t know about the 50.6% of female doctors who decided to take up the medical studies, but I always planned on practicing my knowledge and not  just because I wanted to gain degrees.
Yes, it’s true some parents hope that a degree will help their daughters marry a better prospective husband, and they never intended to use their medical degree for any other reason, but if a degree is all that one is after,I can think of less gruelling courses to apply for.

Is it not sad then, that after excelling in competitive exams, burning the midnight oil, many female medical graduates have the coveted Dr. in front of their name, but are essentially homemakers?
Don’t get me wrong, being a home maker is bloody hard work!

If the last couple of months have taught me anything, then it is that staying up feeding, burping and rocking to sleep a baby, is as tough as any night duties I did as a doctor (maybe even tougher on some nights). The physical tolls of motherhood, the continuous undivided attention that a baby demands is more than the most demanding bosses in any profession.


It’s like an alarm without the snooze button, which can ring at any given time day or night. You are never on a coffee break, and you can never call in sick, neither are there any furloughs as a mother. I have done it only for 5 months and I can only imagine, how many women volunteer to do it all their life. Being a stay at home mom is a demanding job, more demanding than maybe even being a doctor, and yet I want to be able to practice my profession.

Why is it so difficult for doctors? First, there is no concept of ‘working from home’ doctors. Maybe in years to come we will have online consultations and doctors working in atleast a few fields will be able to work from home, but all in all medicine is a field where we need to palpate, percuss, auscultate and do various hands on tests on a patient. Secondly, many medical fields have emergencies and do not have flexible timings, say an anaesthetist who is dependent on the surgeons hours, or a gynaecologist who can hardly decide when her patients go into labour.

 Nuclear families have made the need for caretakers a necessity, and unlike multinationals which have in-house crèches, very few hospitals have such facilities for their doctors. As one hospital administrator once told me ‘Hospitals don’t owe doctors anything’. In an age where we are well into second generation working moms, and where even grandmothers are working women , we can hardly hope for ‘grandmaternity leave’ where we expect working grandmothers to leave their jobs and look after the grandchildren. (to read my article on caretakers and nannies read ..  here)


India is going through ‘growing pains’ where we want our women to work, but we want them to look after home and hearth as well. Doctor- moms, who always kept their patients first, find their priorities changing once they have children and they become mom-doctors where they are moms first.


As I inch towards the arbitrary 6 months period , after which it is generally considered that women who hope to have a professional life start to resume the role of a ‘working mother’ rather than just a ‘mother’, I will soon be lifting the balancing scales. Sometimes they will tip in favour of being a mom, and I will be judged as not being professional enough, and sometimes they will tip towards my work and again I will be criticised for neglecting my child. I realise that the balance will continue to swing up and down and I may very well never have the perfect balance. But, I hope that I am part of the 17 % women doctors who are practicing doctors, for then I will know that I have beaten the odds. And even if I meet a doctor mother who chose to not practice, I will not judge her by saying that she let her weighing scale fall or that she lost her balance, it’s just that she decided to weigh her life on a different scale.