[falconion]

Originally Posted by petrolhead_chn

Doctors are pure professionals. They work for money or rather incentives too. But having said that it is their least responsibility to explain in simple terms. Agreed they may have seen umpteen number of patients with same cases. But that is what doctors do with all due respect.

Just to update: The diabetologist has recommended two types of insulin now. One in the morning and totally another one in the night. We are taking a viability scan on Saturday based on which the course might change and all I can do is pray.

I am sorry for your loss. Its never easy loosing a child, specially due to someones negligence.

I am glad you got in touch with a diabetologist. It is important to monitor Diabetes during and prior to pregnancy. It adversely affects the fetal development in a number of ways.

Yes the surgery could have been done earlier, but if the child is healthy doctors do prefer to delay as much as needed to ensure the fetal lungs are well developed (usually around 36 weeks). At the same time the mother is asked to monitor fetal movements, so that in case there is any decrease in fetal movement or no movement it constitutes as an emergency due to fetal distress. The closer the child born to term the lesser the chances of complications in the child. Yes you can give steroids to help mature the fetal lungs etc, but in all honesty you cannot predict what will happen to the fetus if you had delivered earlier or late.

An Autopsy would not have helped much. It would have been a trauma on you and your wife by itself having the childs body put through that. The cause was diabetes and the autopsy would have said the same.

There are children born healthy and die within a day or two. Cant be explained sometimes. And its never easy.

I had a privilege of seeing a patient during my training days who had 4 miscarriages. She was put in the hospital for 2 weeks before her actual surgery with complete bed rest to make sure she was taken care of immediately. I was amazed at how well she was handling it. Trying for pregnancy year after year. It was not easy for her but she knew there was little she could have done at that time. She found the right doctor who managed her condition well.

My mentor always said to the patient, "If you want me to treat you, you have to do as I say. If you cant follow my instructions, I dont want you as my patient."

And that statement was about compliance. Patients have a hard time complying with treatment. No matter how good a doctor is, if the patient does not comply with treatment he cant do much to help them either.

And yes Pregnancy is a very complicated state. There are a number of things that can go wrong despite everything being right. Its all in Gods hands. The best you can do is find a hospital that has all the required facilities. The hospital should have a 24 hour labour and emergency service along with neonatal ICU facility. This setup ensures the mother and child are looked after in cases of emergency and complicated high risk pregnancies.

Above all patients compliance is essential to reduce any risk to the fetus.
Being positive and not blaming anyone is important.
You are under stress and so is your wife, which again is unhealthy.

It is never easy and it wont be. The best you can do is be there for your wife no matter the outcome. Try to control the diabetes and be positive. Do not stress about the future or the outcome. I am saying this because if she has diabetes then hypertension is not far off if she takes stress and cant control her diabetes.

Wish you all the best!!

[petrolhead_chn]

Originally Posted by falconion

I am glad you got in touch with a diabetologist. It is important to monitor Diabetes during and prior to pregnancy. It adversely affects the fetal development in a number of ways.

First, I appreciate your empathy. Thank you very much falconion.

Going by few words in your response, "my training days" and "my mentor", out of curiosity, may I ask if you are a doctor?
If yes, I would like to ask about organogenesis and if it does have any adverse impact with diabetes in the early stages. I am unable to get an exact response on the web.
In fact I wanted to ask the question in an elaborated manner but I do not want to take advantage of your time and knowledge. Thank you in advance and for understanding.

[blacksport]

Originally Posted by Chetan_Rao

I spoke from personal experience in the family, my sister suffered for years because some of the best doctors in the country couldn't figure out what exactly was wrong with her; not for a lack of time, money, patience or faith from us.

I have been suffering from a neurological condition for a decade, which none of the docs I visited are able to diagnose. A 5 minute evaluation and a few pills to take care of the symptoms is all they have to offer. Can't blame them, as the queue outside is always large. What baffles me is that there is a lack of inquisitiveness. Maybe somebody could discover a new disease name it after him or even collect his nobel. No ambition, I'd say.

[bravo82in]

Originally Posted by Chetan_Rao

I'm not sure if you're being intentionally obtuse, or I'm unable to explain myself clearly.

Sir I chose not to comment on something that happened years ago. Medicine is an ever-changing branch. Do you mind sharing the patient’s diagnosis so that I am in a better position to comment?

Originally Posted by petrolhead_chn

1. The gyn should have referred us to a diabetologiest immediately upon noticing high sugars.

I am sorry for your loss and understand your frustration and anguish over the same.

Please read these lines from a standard medical journal.

“Pregnancy loss is significantly higher among women with diabetes compared to the nondiabetic population. Recently, a population-based cohort study conducted in the UK by Casson et al. has shown that women with type 1 diabetes have a higher risk of late fetal loss, presenting a four- to five-fold increase in perinatal death, and a four- to six-fold in stillbirth compared to the general population. Neonatal mortality is also higher among infants of diabetic mothers in approximately 15-fold when compared to the general population”

Please understand that diabetic pregnancy is very complicated and risk of losing the fetus is 400 to 600% in countries like UK, which have the best of facilities. It’s a fact that one must accept before blaming someone for the fetal loss.

[Piyadassi]

My daughter has been asthmatic since the age of 8/9. She has been regularly taking puffs and her condition usually deteriorated at the time of change of seasons. However, after a change of doctor and a change of prescription, which meant new medicine for few months, he advised us to altogether stop the puff. It has been almost three months now—a time period that not only saw a season change but also one of the most polluting months in Delhi—and she has carried on without any hitch. She is 13 now.

Now the issue. She likes running (amateur type). She would do it when she was on the puff. How do we initiate her? We had deliberately kept her off it but now with weather stabilizing we want her to take it up. The doctors, except for warning us of consequences, have drawn blank. But we know that people suffering from asthma have successfully taken to sports, besides it will also do her lungs good.

Could someone guide us? Thanks.

[Chetan_Rao]

Originally Posted by bravo82in

Sir I chose not to comment on something that happened years ago. Medicine is an ever-changing branch. Do you mind sharing the patient’s diagnosis so that I am in a better position to comment?.....

I wasn't expecting you to comment on specifics of a case I didn't mention in public, and I'll leave it at saying the final diagnosis surprised a lot of the 'experts' we'd consulted earlier (and informed post-diagnosis/treatment), and it would've been pretty obvious to someone willing to dig a bit deeper than overt symptoms and test results. A couple of them actually had the good grace to admit as much, though sheepishly.

My intent isn't to tarnish an entire fraternity that delivers life-saving services with a broad brush of inefficiency/incompetence, but there's a large chunk out there (in every profession and not just medicine, to be fair) that's willing to take short cuts that lead to often unintended consequences, to put it mildly.

I prefer a certain kind of interactive relationship with someone I'm entrusting my health and well-being to, everyone else is obviously free to make their own choices.

[fine69]

I'm looking for an electric toothbrush for my wife. Budget is around 5k but can stretch to, say 10k, if the benefits really outweigh the cost. She doesn't have totally symmetrical teeth and has had 3 wisdom teeth pulled out on the past because they were cutting her cheeks.

I'm looking at the best toothbrush for her in the 5-10k budget with relatively affordable brush heads. I read that Philips is the best when it comes to toothbrushes but not very sure which model to go for, any tips?

[centaur]

Hello Doctors,

Looking for some advice on my disc prolapse. Long story short, in 20102 I was taken to the hospital in an ambulance because of severe pain bouts in my lower back and was there for a week in which I was administered a root block because the MRI said disc prolapse at L4-L5. Last year was detected with extremely low levels of Vitamin B12 and D and was administered injections as well

Its been 4 years now and I have been doing well (touchwood no pain since then) because of but sometimes I do feel some sensations in my lower back or right buttock or thigh or my toe but none of these all at once. Just had 2 questions-

1. Is it necessary that in case of a disc prolapse, the pain/sensation gradually radiates from the back to the toe or it can happen in any isolated part of the nerve being impinged from the back to the toe e.g. no pain/sensation in lower back but sensation in say buttock or toe?

2. Can I do planks?

[VIKINGTILLDEATH]

Originally Posted by Piyadassi

My daughter has been asthmatic since the age of 8/9. She has been regularly taking puffs and her condition usually deteriorated at the time of change of seasons. However, after a change of doctor and a change of prescription, which meant new medicine for few months, he advised us to altogether stop the puff. It has been almost three months now—a time period that not only saw a season change but also one of the most polluting months in Delhi—and she has carried on without any hitch. She is 13 now.



Now the issue. She likes running (amateur type). She would do it when she was on the puff. How do we initiate her? We had deliberately kept her off it but now with weather stabilizing we want her to take it up. The doctors, except for warning us of consequences, have drawn blank. But we know that people suffering from asthma have successfully taken to sports, besides it will also do her lungs good.



Could someone guide us? Thanks.

Bronchial Asthma has varied course in different people. Sometimes the natural course of disease is such that it wanes off as child grows. So the benefit which your daughter is having may be due to change in prescription or natural course. Also sometimes Asthma can be exercise induced. All these doesnt mean your daughter should not start running. Infact aerobic exercise will be good for her as it will increase her respiratory reserve. You can intiate her to run with supervision in the beginning and also can have salbutamol puffs so that if she starts having bronchospasm it will be handy. Discuss this in detail with your Paeds and he will be able to guide you. If your Paeds does not have time then find someone who is at the beginning of his career. Being a Doctor doesnot require Einstein genius. Most of the times there are set guidelines. What matters is he should be able to give you time. Again would like to insist that dont refrain your daughter from running. Just plan it properly.

[petrolhead_chn]

Originally Posted by bravo82in

Please understand that diabetic pregnancy is very complicated and risk of losing the fetus is 400 to 600% in countries like UK, which have the best of facilities. It’s a fact that one must accept before blaming someone for the fetal loss.

Really? You should review the culture and lifestyle of women in western countries against women in India before bringing in the facts.
And what you are saying is that the doctor and patient must continue the course with the thought that the fetus would not anyways survive because of complicated diabetes?

[Tejas@perioimpl]

Originally Posted by petrolhead_chn

Really? You should review the culture and lifestyle of women in western countries against women in India before bringing in the facts.
And what you are saying is that the doctor and patient must continue the course with the thought that the fetus would not anyways survive because of complicated diabetes?

So women in UK and USA don't take care of themselves while in pregnancy is what you are implying? The days of smoking and drinking oneself silly during pregnancy are gone once the statistics came out.

[petrolhead_chn]

Originally Posted by Tejas@perioimpl

So women in UK and USA don't take care of themselves while in pregnancy is what you are implying? The days of smoking and drinking oneself silly during pregnancy are gone once the statistics came out.

I am neither implying anything here not did I bring in any statistics for explanation/comparison. Please read the earlier comments for how my post has taken route.

I'd like to come out of this particular topic by thanking all who responded and especially @falconion for those words of caution and advice which certainly helped us

[bravo82in]

Originally Posted by centaur

1. Is it necessary that in case of a disc prolapse, the pain/sensation gradually radiates from the back to the toe or it can happen in any isolated part of the nerve being impinged from the back to the toe e.g. no pain/sensation in lower back but sensation in say buttock or toe?

2. Can I do planks?

1. Yes, Low back ache may not be there. Only Radiculopathy may be present
2. Better to avoid. It may aggravate your problem

Originally Posted by petrolhead_chn

Really? You should review the culture and lifestyle of women in western countries against women in India before bringing in the facts.
And what you are saying is that the doctor and patient must continue the course with the thought that the fetus would not anyways survive because of complicated diabetes?

Scenario in India is even worse. And to add to it the Indian patients never follow their Doctor's advice religiously when it comes to investigations, treatment and follow-ups which is not the case in UK or Europe.
One should always be hopeful, though results in diabetic pregnancy are unpredictable. Accepting the bare fact or not is your choice.

[audioholic]

These days I am getting cramps in my back muscles and arm muscles if I stretch them in some directions. Why does this happen? I am currently in Germany, with low temperatures <10deg C. Does the cold have to do anything? My diet is mixed vegetarian and some eggs and chicken. What can I do to solve this problem?

[Mortis]

Originally Posted by fine69

I'm looking for an electric toothbrush for my wife. Budget is around 5k but can stretch to, say 10k, if the benefits really outweigh the cost. She doesn't have totally symmetrical teeth and has had 3 wisdom teeth pulled out on the past because they were cutting her cheeks.

I'm looking at the best toothbrush for her in the 5-10k budget with relatively affordable brush heads. I read that Philips is the best when it comes to toothbrushes but not very sure which model to go for, any tips?

Oral B electric toothbrushes have become quite common in the supermarkets in Mumbai (imported). Ive been using one for around 2 years now. It costs 4-500 bucks and heads are 250 for 2. Go for it, its a good buy and definitely better than conventional toothbrushes. If you want something more to improve oral hygiene then get a water flosser. Either Waterpik or Philips Sonicare are good options.