Sunday, April 20, 2014

Choosing Wisely - A Guide for Patients Five Medical Facts You Need to Know About Hormone ( Endocrine) Disorders

We are seeing  a major epidemic of avoidable care today. Unnecessary tests and expensive treatments have become a major health hazard. What can  you do to protect yourself ?

An initiative of the ABIM Foundation, Choosing Wisely is focused on encouraging physicians and patients to talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.

Adapted from the Endocrine Society and American Association of Clinical Endocrinologists ( and

1. Adults with Type 2 diabetes do not need to perform multiple daily self-glucose checks . Once target blood sugar control has been achieved, there is little to be gained from repeated daily testing . Self-monitoring is beneficial only when you are learning and adjusting to a new form of therapy.

2. Doctors sometimes over-order a vitamin D (1,25-hydroxyvitamin D) blood test. It should not be done unless your doctor finds you have a high level of calcium (hypercalcemia) or decreased kidney function.

3. Another test doctors commonly over order is thyroid ultrasound. If there are no signs and symptoms of thyroid gland abnormality, thyroid ultrasound is a costly procedure and should not form part of a routine evaluation.

4. Thyroid profiling (a panel of blood tests, including total and free T3 levels, ordered to help diagnose thyroid disorders ), is not needed for prescribing the correct dose of levothyroxine ( T4) in hypothyroid patients . In most of these patients, a normal TSH ( Thyroid-Stimulating Hormone ) level is enough to confirm the correct dose of T4.

5. Don’t go for testosterone (male hormone) therapy unless there is evidence of testosterone deficiency in your body. Testosterone therapy has the potential to cause serious side effects. It is important to confirm the diagnosis of hormonal deficiency (hypogonadism) by doing blood tests before going in for hormonal replacement therapy.

Saturday, April 19, 2014

Our IVF success story

My husband and I have turned 30 now and have been married for 5 years. As we stay in a joint family there was lots of pressure for having a baby since second year . As we tried naturally 2 years but things did not turned out as we had planned . Then we decided to consult doctors for our
problem . We went couple of big doctors in Mumbai and undergone many test but didn’t find any good chemistry with any of them . As one of our family members had been treated in Dr Malpani clinic successfully , we decided to consult Dr Malpani. We read the reviews about Dr Malpani and were very impressed with the amount of information on their website at

After meeting Dr Malpani , all my negative vibes about doctors turned positive . Dr Malpani explained and treated us so well that we never expected doctors could be so calm and patient and give so much time and answer all the questions. He cleared all the confusion and doubts and made us believe that we could also have a baby.

                I started with my cycle in Jan 2013 and with my first IUI got a positive beta HCG . We were very happy as the first cycle itself succeeded . However, I miscarried and I was shattered . I gathered my courage and went back to Dr. Malpani after 3 months. Dr. Malpani was kind and understood what state I was going through and made me win my confidence in myself again. After that, two IUI failed. Then he suggested me to step ahead and do IVF. I started my IVF in Jan 2014. The injections are no fun, but every time I met Dr. Malpani , he destressed me and helped me to accept whatever is happening  positively.

        The best part of Dr. Malpani is that he himself monitors and takes efforts for the patients . He ( and Dr Anjali ) do the scanning themselves. They understand the patient deeply and do not rely on reports of another doctor. He takes care and checks that  all the proper medicines and injections are taken and explains the whole procedure very gently and clears all doubts. I got pregnant in the very first IVF cycle done in Malpani Clinic. Now I'm 13 weeks pregnant and am very thankful & grateful to Dr. Aniruddha & Dr. Anjali Malpani, and their whole staff , who every time gave us blessings & well wishes. All the staff & nurses were very supportive during all the treatments & procedures.

        We are very glad that we took very wise decision and went to Dr.Malpani and followed his treatment. 

Deepak and Shweta Soniminde

Thursday, April 17, 2014

Five Medical Facts You Need to Know About Allergic Reactions - Choosing Wisely – A Guide for Patients

We are seeing  a major epidemic of avoidable care today. Unnecessary tests and expensive treatments have become a major health hazard. What can  you do to protect yourself ?

An initiative of the ABIM Foundation, Choosing Wisely is focused on encouraging physicians and patients to talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.

These are Five Medical Facts You Need to Know About Allergic Reactions, as adapted from the guidelines by the
American Academy of Allergy, Asthma and Immunology (

1. Blood tests which check for antibodies (ImmunoglobulinG (IgG) and immunoglobulin E (IgE)) are of questionable value in diagnosing the source of an allergic reaction. They just add to your cost and may even lead to inappropriate diagnosis and treatment.

2. If you develop a sudden onset of sinusitis (acute sinusitis), CT scans are of little help because the condition is caused by a viral infection which usually resolves on its own in two weeks. Antibiotics are not needed to treat uncomplicated acute sinusitis because less than two percent of acute sinusitis is caused by bacterial infections.

3. If you have chronic urticaria, also known as hives, ( where an itchy rash appears for a week or more) diagnostic tests are not usually helpful as a definite cause will often not be found in most patients.

4. If you have recurrent infections, unless you do not respond to vaccines, replacement immunoglobulin therapy is of little use.

5. If you have asthma, you need to perform spirometry, which is a simple lung function (breathing) test. Doctors sometimes don’t bother to order this test, and often rely solely upon symptoms when diagnosing and managing asthma, but symptoms may be misleading. Spirometry is essential to confirm diagnosis, identifying disease severity and monitoring control, so please ask for this.

Wednesday, April 16, 2014

Why are doctors scared of internet positive patients ?

The Mumbai Mirror had an article, which talks about a survey, conducted across 27 cities including Mumbai, Pune, Delhi, Kolkata, Chennai, Bangalore, Hyderabad and Ahmedabad by Ipsos Healthcare and Ruder Finn, which revealed that " doctors have been struggling to deal with patients who use the internet to find out what ails them.

Making matters worse are hundreds of thousands of online forums where people discuss their ailments and symptoms, which often result in patients indulging in self-medication, and also end up arguing with doctors upon being told that their ailment is not even close to the worse diseases they had imagined, said majority of the 650 doctors who participated in the survey.

The doctors, including specialists and super specialists, termed people's increasing dependence on the internet to find medical cures and search for symptoms as a "major strain on the doctor-patient relationship".

This is a completely archaic attitude in  my opinion.

My take is completely different ! Most good doctors are very happy to talk to internet positive patients , because they are well-informed and have realistic expectations . Patients who have done their homework actually have a better doctor-patient relationship, because the doctor has to treat them an intelligent adults, who have an opinion about their own health and would like to decide their own treatment options, in partnership with their doctor !

We believe that patients are the largest untapped healthcare resource – and that Information Therapy – the right information at the right time for the right person – can be powerful medicine !

Information Therapy helps patients get better medical care by
Promoting SelfCare , and helping them to do as much for themselves as they can
Helping them with Evidence-Based Guidelines , so that they can ask for the right medical treatment that they need – no more and no less
Helping them with Veto Power, so they can say No to medical care they don’t need, thus preventing overtesting and unnecessary surgery .

How can we use technology to empower patients with Information Therapy , so that they can become expert and engaged patients ? This is a challenge and an opportunity for doctors. Doctors who learn to put patients first will thrive as healthcare evolves and becomes more patient-centric !

Rather than force patients to get information from unreliable websites, doctors need to learn to put up their own websites, where they can empower their patients with reliable information. Websites are a great way of educating patients, and doctors who do so will earn their patient's trust !

Pushing patients into doing expensive IVF treatments

I received an interesting e-mail from a patient .

She wrote., “ I am currently pursuing IVF/ICSI/PGD/PGS eSET. Doctor performed one 'Endometrial Function Test' which determined 'Exteme Glandular Developmental Arrest' (aka 'Glandular Stromal Dyssynchrony') Treatment consisted of 3 consecutive months of 3.75 mg Depot Lupron, inducing menopause. After first failed eSET FET, my doctor is now pushing for gestational surrogacy, citing the 'GDA' as the primary reason why I will never carry to term. I am suspicious.”

As you can see , this is obviously a sophisticated , well-informed patient , who's done her homework . She is taking treatment at a modern, sophisticated , well-equipped , world-famous, " brand name"  IVF clinic in the USA , where her doctor has advised her that she needs surrogacy in order to have a baby. Fortunately, this patient is smart enough to realize that this is not good advice , which is why she asked me for a second opinion .

I can imagine how many other patients this particular IVF clinic must be taking for a ride, by coining all sorts of unscientific terms using pseudoscientific tests, in order to scare the patient and upselling them into doing expensive treatments.

While we talk about “ endometrial function tests”, the truth is that the endometrium is an extremely dynamic organ . We can easily can help the endometrium to grow properly , and “ treat the dyssynchrony “ by using estrogens. However by using medical jargon , such as “ glandular developmental arrest “ ( terms which even I find hard to spell and pronounce ), any patient is going to get intimidated . The doctor has folled her into believing that she has an intractable problem,  and would therefore be willing to do whatever the doctor advises.

The tragedy is that most patients are not sophisticated enough to understand what the doctor is saying. Many doctors take undue advantage of this information asymmetry and push patients into doing inappropriate treatment , because it is financially much more profitable for them .

By advising surrogacy , the doctor can make four times as much money as he would by doing an IVF cycle . Patients are often desperate and are happy to do what the doctor suggests. Similarly , lots of doctors suggest that patients use donor eggs , rather than try to do IVF with their own eggs, using alternative options such as aggressive superovulation or natural cycle IVF . While it’s true that using donor eggs does have a higher pregnancy, it’s also equally true that this option is much more profitable for the doctor. Most patients would much rather try at least once with their own eggs, rather than be pushed into using donor eggs.

It's sad that IVF clinics are not willing to put patient's interests first , and by coining all of these fancy medical terms and using all of these unproven experimental treatment, they push patients into doing treatment which may not be right for them .

The only solution to this distressing problem  is Information Therapy . Patients need to do their own research and then decide whether what the doctor is saying makes sense or not .

Not sure if your doctor’s advise is in your best interests or not ? Please send me your medical details by filling in the form at so that I can guide you better !

Tuesday, April 15, 2014

My IVF success story

Motherhood is is something every women aspires for.. Not all are fortunate to have babies naturally. Thanks to the advanced technology which makes the impossible "Possible".
But, it's just not that, we need skillful doctors to complete the process .

This is where Dr. Aniruddha Malpani and Dr. Anjali Malpani fit the most. They are not only good doctors but also one who can connect with the patients, educate them as well.

Before I met Dr. Aniruddha Malpani, I have had terrible experiences with a couple of hospitals in Bangalore and Mysore . Thank God that I did the right thing of not getting into the trap. Doctors were so arrogant, environment was such that ,you would feel like not having a baby at all. It took me a year to rebuild the courage and explore again.. That was when I was referred to Dr. Malpani by my friend. I got to read more about the complete IVF procedure on their website along with charges.. Everything is very much clear.

Once you enter the Malpani clinic, it's not just the ambience, but, you feel the positive energy around you which is very important . Dr. Aniruddha Malpani is very humble, well informed and full of positive vibes..and most of all very down to earth. No arrogance AT ALL.
He does make sure that he explains the entire procedure , wants his patients to be informed about the minute things .. No doctor takes that pain to educate or spends time with their patients and motivate them.. Only Dr. Aniruddha Malpani can do that. He is a blessing to the world.

They have a very good team. I would like to take this opportunity and thank the entire team..
Ms. Shonali and Ms. Rashmi at the front desk are very polite and make sure that the visitor (patient)is comfortable. Sister Lizzy , sister Neeta , Vinayak and Sister Pramodini are very good nurse practitioners who take care of the patients very well. Dr. Sai the embryologist is also excellent . And also the anesthetist . All know their job well and execute it too. Accounts department is also very transparent .. No hidden charges.. Everything is at actuals..
It's always one to one in Dr. Aniruddha Malpani's clinic. Unlike other places where nobody has any clue of what's going on.

Thanks to Dr. Anirudda Malpani and Dr. Anjali Malpani who have made my dream come true. Am 8+ weeks pregnant and in cloud 10 :).. Very excited...And hope to continue the pregnancy till the very end and become a mom :-)

In all , I should say that I have had an EXCELLENT experience at Dr. Malpani's clinic..
I would highly recommend couples exploring IVF option  to visit Dr. Malpani's. You would never go wrong with them. You could trust them with eyes shut..

By the way ,I still write to him with the reports asking for advise and he is so very humble that he does write back to me with the right and timely advise. This is a free service he is been doing.. I have never seen such a dedicated Doctor. :-)

It's indeed the Best Place to Complete the family.


Monday, April 14, 2014

What is the best way to communicate with the referring doctor?

A family physician recently referred a patient to me for IVF treatment. She was well educated and wanted to be an active participant in every aspect of the treatment procedure. I explained to her the details of the IVF treatment, and her treatment options.

At the end of the consultation, she requested me to explain the same information to her general practitioner , who had referred her to me.  Although I am not against communicating with other doctors, I don't do this too often. I believe when two doctors discuss medical treatment; the patient is often left out of the discussion. Patients are never a part of the medical discussion , and thus often end up having incomplete information regarding their own treatment.

I prefer an alternate way of explaining things to the referring doctor , by keeping the patient in the loop. I document the entire discussion that I have with the patient, and send the complete consultation note to the general practitioner with the patient. This method has many benefits. The referring doctor understands my plan of action regarding the patient’s infertility. He has full information about the IVF procedure and what I am planning to do .  More importantly, he can also check the patient's understanding, so he can ensure she has realistic expectations of my treatment. This helps me to audit my consultation, and ensures that I have done a good job with clearing the patient's doubts. At the same time the patient becomes the central part of the discussion. She is not left out from any information transfer. The referring doctor also gains confidence in the treatment offered at Malpani Infertility clinic. Since all the parties involved receive the same level of information , there is no room for misconceptions.

Saturday, April 12, 2014

The Top Ten Es of an Excellent Doctor - the AMC Medical Mentorship Program

Dr Sangeeta Pikale, President of the Association of Medical Consultants, kindly invited me to give a presentation at the " Mentorship for Medical Students and Residents" program she launched recently. This is an exciting initiative , which should help junior doctors to cope better with the stresses and strains of real life !

The unconsummated marriage

The unconsummated marriage is a surprisingly common course of childlessness . If you notice , I did not say infertility , because infertility refers only to couples who have failed to conceive after having regular intercourse for at .least one year.

So why are couples unable to achieve vaginal intercourse  ?

While the fact that this is a common problem comes as a surprise to many of these couples ( who feel they are incompetent freaks , because they cannot even manage to perform such a natural biological activity) , what’s even more surprising is how often the diagnosis is missed by their doctors.

Most doctors naively assume that in this day of sexual permissiveness , all couples know how to have intercourse . They blithely assume that the couple is having normal intercourse , and have come to them for resolving their fertility issues . These couples are often very reluctant to volunteer the fact that they have not been able to achieve intravaginal ejaculation, because this is something they are ashamed of.

This is a tricky situation, and doctors need to be extremely patient , if they want to make the right diagnosis . This is not something which can be diagnosed by ultrasound scans or blood tests ! It’s hard to get to the truth in the first few minutes of a hurried consultation , and requires a lot of gentle and careful probing. Patients need to be able to be trust the doctor, before they are willing to volunteer such sensitive information.

An unconsummated marriage could occur because of many reasons . Often it's because of erectile dysfunction or because of vaginismus. Sometimes it’s because of plain ignorance - if both partners are virgins, they may not have an idea as to how to have sex.  The only way they can get this information is from the net, but a lot of this sexual information  comes from unreliable pornographic sites, which often end up confusing the couple even more.

The good thing is that this is a relatively easy problem to solve, because it doesn't require much medical intervention . Of course, this makes it harder to treat for some doctors, who prefer writing a prescription rather than sitting down and educating to the patient what they need to do to consummate the marriage.

Not only does it require a lot of counseling , it also requires an empathetic doctor, so that patients know that they are not being judges as incompetent nincompoops, who do not even know how to have sex !

Some doctors will make a bad situation worse by coming to the “ diagnosis “ that the reason for the failed penetration is a very tight vagina, which can be treated by a primitive operation called a Fenton’s where the vagina is cut in order to make it bigger ! Others will fob off the patient to a psychiatrist, as they aren’t interested in handling these “mental” problems.

Doctors can prescribe information therapy, by encouraging these couples to buy books, so they can educate themselves as to how intercourse is normally performed . This can go a long way towards helping them to resolve their issues. Couples should be encouraged to explore their own sexuality , by performing mutual masturbation ; and using sexual toys such as vibrators and liquid paraffin . Once they are comfortable with their own sexuality , many of these couples are able to get pregnant in their own bedroom, without any further assistance from the doctor.

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