Sunday, September 16, 2012

Quit Smoking

Today I was  talking to a patient who was operated for carcinoma(or Cancer) of urinary bladder about a year back but required to be operated again for a complication (strangulated parasternal hernia). He had a bad chest infection which was contributed by smoking. Smoking is one of the cause of bladder cancer and I clearly remember telling him to stop. I was upset and asked him the reason for continuing to smoke. To this he replied that as the cancer is removed by operation so he thought he can smoke again. I was amused by his answer. 
One is so addicted to nicotine that one is ready to suffer the consequences rather than leave smoking.

As a Doctor and surgeon I come across  many patients whom I advice to stop smoking. Only few really do. Smokers are in a denial mode. Quite a few of them will say that they have quit smoking. When one ask them for how long, then for many the answer will be for only a few days. Smoking increases the risk during operation and we advice them to avoid smoking atleast a week before surgery. I have cancelled surgery for quite a number of patients on finding them smoking in corridors of the hospital.
One of my Professors used to get very upset about tobacco. Significant disfigurement is caused in operation for oral cancer. When patient raise their concerns regarding that he used to put the blame in straight words on them for consuming tobacoo.
Smokers should pray that if they are to have problem then it's better be a heart attack. Atleast they would not suffer. Cancers, ischemia of limb are far worse. These cause prolonged sufferings.

Better quit tobacco!!

Friday, June 22, 2012

Plight of paitents with chronic renal failure

Chronic Renal Failure is the condition where kidneys stop functioning because of a variety of conditions. At some stage these patients require to undergo dialysis which is a procedure where the blood is purified of the wastes products. Simply put, the job of the kidney is to be done by some artificial means, which is known as dialysis. Haemodialysis is a form  of dialysis where blood is purified by machines. In order to do this, one requires to take the blood out of the arteries, which goes to the dialysis machine, purified and sent back to the body via veins. With the repeated puncture of veins for dialysis, blood clot forms in the vein (thrombosis) and vein becomes unsuitable for further procedures. Due to this, before commencing on dialysis, one makes an arterio venous (AV) fistule(connecting the artery with the vein), which increases the flow in the vein and makes it amenable  to be repeatedly used for dialysis without formation of clots.

                         photograph - AV fistula performed by me

Very few government hospitals in Delhi provide this facility for making AV fistule.  Many of the lower socio economic strata patients cannot afford to get the same procedure done at private hospitals, costing around  Rs. 15, 000 to 20,000.  Around 2 years ago, I started providing this facility at my hospital for such patients. In the last one year, I have made AV fistule for 70 odd patients and it has been a successful endeavor. My idea behind this attempt is to provide some kind of relief to the patients and their families undergoing dialysis. 
For the patients with chronic renal failure, dialysis has to be done at given intervals which can range from one to three times in a week. Patient has to be accompanied by atleast one relative to the hospital for such sessions. So, both the patient and his/her relative lose valuable time in each visit. Government hospitals in Delhi cannot accommodate all the patients for routine dialysis as the patient load is enormous. Hence after the stabilization of the condition of the patient, they are asked to get it done at private hospitals where each session costs 2000- 5000 Rs. Its results in financial strain to the entire family of the patient, with some patients telling me that they have sold their property, land and even sometimes cattle (for rural patients) for getting dialysis at private hospitals.
The only other solution for renal failure is transplant, which requires a donor (hard to find a match and costly). Plus there is also recurring cost of Rs. 10,000 per month for medicines post transplant.
On my part, I do this with the thought that I may be alleviating some of these patients’ agony and contribute to lowering their financial strain, since this procedure is free of cost my hospital.