Saturday, December 31, 2011

Why iPills are more important than iPads in healthcare

Ipads are the cool new toys for doctors and patients to play with ! They are flashy and fun to use, easy to carry, make a fashion statement - and all the clever medical apps on ipads make them useful too.

However, ipads are costly - and not easily available either.

Far more important - and much less expensive than iPads for fixing healthcare are iPills - prescriptions for information therapy ! These are easy to prescribe - and easy to dispense as well !

Not only should doctors routinely prescribe iPills at the end of each consultation, patients should insist that their doctors give them iPills as well !
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Friday, December 30, 2011

Take an iPill and call me in the morning

As all good family physician's wives know, most complaints are self-limited and most patients will get better in the morning on their own. This is why " Take 2 aspirin and call me in the morning" is still extremely good medical advise

Tincture of time is often the best healer; and if things aren't better by morning , then the doctor can start a more detailed evaluation.

Today, instead of advising patients to take 2 aspirins, I advise them to take an iPill. An iPill is an information therapy prescription and has an equally useful role to play ! It helps to reassure patients that their symptoms are unlikely to be serious; and helps them to make better decisions.

At the end of each consultation, along with giving them pills, doctors need to give iPills as well - personalised information therapy prescriptions !

There are many ways of prescribing this - and digital tools are often the best way of delivering these.

Thursday, December 29, 2011

Review of the book, Using Information Therapy to Put Patients First

My teacher, Dr Bhandarkar, kindly reviewed my book, and had some very nice things to say about it !

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It was a privilege to be asked to review Dr. Aniruddha Malpani’s book ‘ Using Information Therapy to Put Patients First ’. Dr. Malpani was my student at KEM Hospital and is now a practicing gynecologist and an ‘ IVF doctor’. But, his mastery over modern Information Technology is amazing. He has ably married his knowledge of both his specialties and produced this book. It is written in simple language and uses jargon only when absolutely necessary. This has made it a highly readable book. I enjoyed reading the book and learned a lot from it. While reading it, I was continually reminded of one the finest books of the same size as the present book that I have read 25 years ago viz. ‘ Statistics In Small Doses ’ by Winifred Castle. The similarity between the two books is uncanny: both have many small chapters, each dealing with one facet of the subject of the book, and are structured superbly with progressive increase in details of information. The chapters are independent of each other, and yet linked by the common theme, Information Therapy, for the empowerment of patients .

Dr. Malpani defines Information Therapy as the “ prescription of the right information, to the right person, at the right time to help him to make the right decisions ”. In this book he has discussed how not only patients but also doctors, hospitals, pharmaceutical companies insurance companies benefit from Information Therapy, medically and financially, the latter without the vulgarity of greed. It is a ‘ win-win situation ’ for every one in the health care world. For the doctors, whenever a patient asks questions about his ailment and its treatment, it should not be looked upon as a burden but as an opportunity to learn. In fact, in life ‘ No questions, No learning ’. Proactive Information Therapy does even better; for, teaching is the best method of learning.

The first eleven chapters describe in detail what the individual doctor can do for his patients and how he can do it. This part of the book resembles ‘ Good Medical Practice ’, a publication of the General Medical Council of Great Britain, in its philosophy. He rightly advocates ‘ ONLINE ’ technology for this purpose, and defends it with the skill of an advocate. He strongly favours each doctor having his own website to make it possible for the patient to learn about his ailment and its treatment at his home and at his own time. The book is full of URLs for a patient to use for learning more about what is prescribed, especially the drugs and their side effects, and to get answers to their questions on 24/7 basis. With the spread of computer literacy in India, and the availability of affordable computers this should be possible, at least for upper middle class and affluent patients. However, this method is time- and funds- intensive and is only possible for doctors who are willing to learn online technology, and are willing to spend the time and money needed, particularly in the initially stages. The online method of patient education also makes it possible for the patient to interact with the doctor via email, without having to visit him at his clinic, and even without using the telephone. Finally, the doctor can learn about the patient’s perception of the treatment which helps the doctor to fine-tune the treatment to suit the patient’s preferences It also facilitates the formation of online patient support groups.

This is followed by chapters on how it makes sense for hospitals, pharma companies and the health insurance companies to participate in generating and transmitting material for Information Therapy. Such an effort on their part gives them more visibility, more credibility, more goodwill and happiness on the part of the users of these services. It lowers their cost of doing business , making them more profitable.

The ready to use and easily accessible Information Therapy material on the internet; and that generated by the doctors for their own patients are the back bone of this effort by various health service providers. If the data generated by this effort is used to build centralized data banks, they will facilitate trans-physician, instant access to patients’ medical records, and therefore continuity and improvement in patient care. Such service has been made possible by the availability of smart-phones and tablets with increasingly powerful processing and transmitting facilities in them.

The author then stresses the importance of medical librarians, who are professionals specially trained in searching information from books, CDs as well as on the internet, and make it availability to practicing doctors, their patients and to the research workers. To do this successfully, they must be respected and given their proper status in the complex hierarchy of the healthcare world.

The author then takes to task the half-baked, circulation-oriented and. therefore, hurried, inaccurate and misguiding medical reporting on the ‘ latest medical advances ’ in the newspapers. He makes a plea that medical reporting in newspapers must be entrusted to a team of full-time devoted news reporter doing exclusively medical reporting.

Information Therapy makes for a more transparent and therefore more trustworthy doctor-patient relationship. It must be recognized that the patients also have ‘ The Right to Information ( RT I ) ’ and this right must be respected by all concerned. It now has received the judicial seal, and it is in the doctors’ interest to embed this in their day to day medical practice.

While doing all this, we will do well to learn from the experience of other countries such as the U S which have such services in place in an advanced form; and then modulate them to suit the ethos in this country.

All in all, this is a comprehensive, easily readable and informative book, and it is worthwhile for every doctor to possess his own copy. Now that the new medical syllabus in India includes an exclusive, 2 ½ month term for a Foundation Course immediately on admission to a medical college, this book should be recommended reading for every new entrant to the medical college. That is the best time to read this book. For the citizens, it can be a Right to Health Information adviser.

It will be helpful if the future editions include a summary appendix , listing all the URLs mentioned in the book and the type of information offered in each of them.

Great going, Aniruddha !

Dr S. D. Bhandarkar, M.D., F.R.C.P. (Edin.), F.R.C.P. (Glasgow)
Retd Hon. Professor & Head, Dept. of Endocrinology & Associate in Clinical Pharmacology
Seth G S Medical College & K E M Hospital, Mumbai



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Wednesday, December 28, 2011

The first trimester of an IVF pregnancy

This is a guest post from our patient.

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The first trimester can be the most exciting time in your life as well as the most nerve-racking. The initial news of your pregnancy comes with great joy!

For those that have gone through infertility treatments, getting through the first trimester may be a very trying time. The average fertile couple trying to conceive will typically get a positive pregnancy test shortly after a missed period and will be seen by an OB-GYN a few weeks later. For the infertile couple, the first pregnancy test will come just two weeks after conception; it will be followed by at least one more blood pregnancy test 48 hours later. If the numbers rise correctly, an ultrasound will be scheduled for the patient to determine the number of embryos implanted and if there is a fetal pole and yolk sac. As you can imagine, each step in this process creates great anticipation for the couple. Once the initial ultrasound confirms everything is developing correctly another ultrasound may be scheduled a few weeks later. On my first ultrasound I was very nervous , came to know that I am pregnant with singleton , it was very assuring I got to hear my baby’s heart beat on the second ultrasound which was scheduled just after 2 weeks , that was very exciting moment ! Most infertility patients do not return to their regular OB-GYN until at least 8 weeks in pregnancy. So did I consult with local OB-GYN after 8 weeks. As I was already on hormone regime and folic tablets, I was advised to continue the same by my local GYNE.

For us, the initial news of our pregnancy was surprising and exciting. It was hard to believe that I was actually carrying another life. In the very beginning, I didn’t experience too many early symptoms, which often made me question if I indeed was pregnant. When an ultrasound scan shows everything is fine , this is very reassuring, Since I was on a progesterone regime, I was required to insert a gel compound vaginally thrice a day for the first 12 weeks. I did have brown discharge couple of times which made us worried and increased my anxiety level, later I read articles and wrote to Dr. Malpani and came to know it might have been “old blood” from implantation bleeding. I remember searching endlessly on the Internet for early pregnancy symptoms wondering if I really was experiencing anything super early on, or possibly it was simply wishful thinking. I did not had morning sickness but I would feel very tired and had many exciting emotional roller coaster rides. Many times I used to feel like crying with no reason , I was too fragile . Mostly I was able to do my work day comfortably . However, I do suffer from a nasty nose blockage due to Pregnancy Rhinitis, which causes me to get up at the middle of the night and sometimes leaves me exhausted during the day. I resisted taking any medicine since when were doing IVF, and have treated this with saline water irrigation, steaming, and gargling regularly . Breathe Right strips are helping a lot for coping up with nose block. I was never “so sick” that I couldn’t do my chores at work and was able to take care of home too. I have had very dry skin problem, my skin is too sensitive and it is becoming so dry that I put Vaseline ointment thrice a day, do not know if it is related to pregnancy . I am hoping my skin begins to look better in the weeks to come.

All members in the family are taking very good care of me, specially my husband . The poor guy has to cope with my mood swing all the time . I read a lot on the internet and found Dr. Malpani’s site and www.babycenter.com very good. I never hesitated to write to Dr. Malpani about my worries and sincerely thank him for writing me back in very assuring manner.

I surely feel that the concerns and worries of the naturally pregnant women and women who get pregnant with medical help are very different. My friend is also pregnant at the same time. She is blessed with a natural pregnancy, and as compared to her, I get worried about trifles and my anxiety level is very high .There are many things that she does not even bother about or does not even know ! I worry about every little thing!

I am trying to go easy and not to push myself for anything and she does not hesitate to go for parties and for out station trips too.

I am trying to eat healthy , taking milk regularly , and whenever we go to eat out , I try to make sure I eat fresh food. I am restricting myself with road trips , sometimes my husband says - take it easy .

After first trimester, we had an ultrasound, in which I took my husband with me, and now he feels more connected with the baby .

All in all, my first trimester has been great. Of course there were the evenings and days of worries and anxiety, but I know it could be worse. I’d gladly take all of the terrible symptoms in order to be pregnant; I’d go through anything! My first trimester is nearly over and I am feeling better and better each day. I am really looking forward to the renewed energy that I keep hearing about in the second trimester and hoping that a little “baby-bump” pops out soon.





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Saturday, December 24, 2011

Embryo transfer vs implantation

Lots of IVF patients are not very clear about the medical details of their IVF cycle. This sometimes causes them to use medical terms inappropriately. Many are confused about the difference between embryo transfer and embryo implantation and will sometimes use these terms inter-changeably.

There's actually a world of a difference between the two !

Embryo transfer is a simple clinical procedure where the doctor transfers your embryos into your uterus, using a plastic tube called an embryo transfer catheter. This is a mechanical step, which involves transferring the uterus from the petri dish in the incubator to your uterus.

Implantation , on the other hand, is a complex biological process which occurs within the uterus.

How are the two connected ?

When the doctor transfers your embryos on Day 3, they are about 8-cells. They continue to divide in utero , if all goes well , until they form blastocysts. This hatches, and the cells of the embryo embed themselves into the wall of the uterus . This is usually on Day 6 or Day 7 after the egg collection.

Implantation is a silent process over which we have no control. It involves 3 phases - apposition; adhesion ; and invasion, based on an interchange of a beautifully synchronised exchange of molecular signals between the endometrium and the embryo. All the steps are equally important, and need to occur sequentially. There is no special day or time which is more important than another ! We are not able to track or monitor implantation ; and we cannot influence it either. We do give you estrogen and progesterone to prepare your uterine lining for the implantation, but whether or not your embryos will implant; and how many will implant , is not something we can influence or predict.

This is hardly surprising. After all, the embryo is just a microscopic ball of cells - how can we track what it's doing after we have transferred it into your uterus ?

So why don't all transferred embryos implant ? This is simply because human reproduction is notoriously inefficient - after all, not every fertile couple gets pregnant every time they have unprotected sex during their fertile period ! The commonest reason for failed implantation is a genetic abnormality in the embryos , and this is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for.




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Friday, December 23, 2011

Menstrual cycles and infertility

There is lots of variation in menstrual periods even in normal fertile women. Sometimes the period maybe heavy; sometimes it maybe light; sometimes there may be clots or spotting ; and sometimes there maybe more cramping than usual. These are common variants, and most fertile women don't even notice them.

Infertile women, on the other hand, obsess over every minor variation. Was the period too heavy ? Was there clotting ? Could that have been an early pregnancy which miscarried early because I lifted a heavy bucket ?

If my period has become very light , does this mean my uterine lining is too thin ? Does this mean that the embryo will not be able to implant ?

My periods are due in 2- 3days, but my breast fullness and tenderness is much more this time. Is it just PMS ? or does it suggest an early pregnancy ?

Is the spotting I get before my flow mean that I have endometriosis ?

The mind plays all kinds of games in infertile women , and since you cannot see the eggs and the sperm and the uterine lining, you worry about the only thing which you can see - your menstrual flow. You try to correlate every variation in your periods to your inability to get pregnant.

The truth is that there is little correlation between your menstrual cycle and your fertility , as long as your cycles are regular.

In any case, rather than worrying needlessly about this, the best option is to get a basic medical evaluation, to reassure yourself that all is well !


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Thursday, December 22, 2011

IVF or IUI - should I let the patient decide ?

I just saw a 28 year old woman with unexplained infertility. I am a conservative doctor and suggested that the logical treatment option for her would be intrauterine insemination ( IUI).

However, she was quite adamant that she wanted to do IVF. She had done her homework and knew that IVF had a much better success rate than IUI. Since it did not involve surgery or have any medical risks, she was sure IVF would be better for her, because she did not want to waste time.

" Why should I do a treatment which has a success rate of only 10% when I can go in for a treatment which has a success rate of 46 % ? I am paying for this myself, and my time is at a premium. I have only one life, and want to enjoy being a mom when I am young and have lots of energy. Both IUI and IVF involve coming to the clinic 6-7 times each month, and I'd rather select an option which would have a higher yield. I am the kind of person who flies first class - and IVF would actually be more cost effective for me !"

This was a woman who knew her own mind, and it was hard to argue with her logic. Money was not an issue for her; and she was well-read and well-informed.

This is a good example of IVF being done for patient reasons, and not medical reasons. I believe we should respect patient autonomy , and allow the patient to decide.

Will this lead to overtreatment ? Yes, but there are lots of advantages to this approach.

It saves the patient valuable time , because she'd rather focus on bring up her baby and moving on with her life, rather than making multiple trips to the infertility clinic !

This approach is quite ethical, because it put patients in charge of their treatment ( respects their autonomy) ; provides them the benefit of a higher success rate ( beneficence) ; and also has no risks or downsides ( non-maleficence) .

Is it ethical for me to refuse her request ?
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Wednesday, December 21, 2011

What is Information Therapy?

Every doctor is supposed to educate and inform his patients; do we really need a buzzword for such a basic concept? The tragedy is that this fairly simple and obvious notion is not implemented routinely in today’s world.

Information Therapy can be defined as the prescription of the right information, to the right person, at the right time to help make a better health decision. But this is not free-floating generic information by simply Googling it. In fact, the problem is that there is too much information available online today –of which a major chunk is unreliable and misleading. In fact, easy access to so much information at the click of a button has made both doctors and patients skeptical of using this information in the real world. An overload of information has resulted an in information smog , which often leads to further confusion and uncertainty.

Information Therapy refers to prescription-strength information, tailored to your needs. Ideally, this information is best dispensed by your own physician – the one person whom you trust, and who knows you and your medical problems intimately. Equally importantly, Information Therapy must result in a tangible good – it should help you make better decisions. The key question is- what is the ‘right’ information? Who decides what is right and what is wrong?

The right information needs to be accurate because it is evidence-based; approved by experts; up to date; easy to read and understand; available in many different formats ( local languages and audiovisual formats); and referenced. Producing such high-quality information is not easy and we underestimate the cost and complexity involved in doing so. This is one of the reasons why there’s such little quality information available in Indian regional languages – no one has invested the time and the trouble to create this as yet, since they still do not see the value in doing so.

The right person means that this information needs to be delivered to you (and your caregivers), so you can make (or help in making) the decision (or behavior change). The right time means it should be provided when you need it – “ just in time “ to help you make a better medical decision .
There are many ways of delivering this powerful tool. Information Therapy can be clinician-prescribed, system-prescribed, or consumer-prescribed. At present, most patients get information through their own research. However, they are often not knowledgeable enough to conduct searches that provide valuable results. Ideally, the information should be prescribed by doctors – but this is likely to happen regularly only when they get paid for this! The good news is that hospitals and health insurance companies that systematically implement information therapy applications will be in a better position to gain market share, profitability, and prestige over those that do not. They will hopefully start doing so routinely because it makes business sense for them!

Healthcare is rapidly evolving globally. It may take some time for India to catch up, but the current US scenario should serve as both a warning and learning tool. We have empowered consumers (who demand time, information, control, and service) and embattled doctors (who are more respectful of the patient, but are burnt out and resentful because they are starved of time and poorly compensated). We have a new focus on quality (which promotes safer medical care and a move towards pay for performance); and a new way of validating what works and what does not in medicine (the science of evidence-based medicine). We are also equipped with new technology to reach out to consumers – thanks to the internet, which connects anyone, anywhere to top-quality information 24x7. These drivers create a compelling case for information therapy — a new approach to healthcare that revolves around an expanded patient role.

As healthcare evolves :
• Every clinic visit, medical test and surgery will be preceded or followed by Information Therapy prescriptions.
• Information prescriptions sent between in-person visits will extend the continuity of care.
• Patients will play an active role in shaping how they want the information to be delivered to them

Information Therapy is a very cost-effective solution that allows your doctor to put you at the heart of the care he provides you. As Kahlil Gibran said, ‘Progress lies not in enhancing what is, but in advancing toward what will be.’ Information Therapy is the future – and in India, using our medical and IT expertise, we can outdo the rest of the world and become leaders in this space. You can start by requesting your doctor to prescribe information every time you see him.

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Malpani Clinic in the DNA newspaper

Tuesday, December 20, 2011

IVF sucess story for couple from Sri Lanka


We, Thushara and Medha being Sri Lankans, living in Colombo, are pleased to make few words regarding our success story with many thanks to Dr. Aniruddha and Anjali Malpani and their staff at the Malpani Fertility Clinic at Colaba, Mumbai, India. We had to pass a long way to reach this destiny, it was more than 11 years, from the date of our marriage. During this period we visited to many doctors in Sri Lanka and abroad even followed western and eastern medical prescriptions, without any interval. We were really fed up with the matter and that feeling created more and more negative impact with regard to the possibility of having a baby. All the doctors said that we haven’t any serious problem rather that some hormone imbalances, but the result was so far from us until we met Dr. Malpani.

We came to know about the clinic of Dr. Malpani during our thoroughly search for a doctor in India, by that time I also had an opportunity to work in Mumbai for some times. It was a silver line in the dark cloud . We came to Mumbai and met Dr. Malpani. The first impression was very encouraging and it defeated all of our negative attitudes regarding another circle of treatment. He spoke to our broken heart and healed the wounds in our heart and the mined, that was a spiritual treatment we got for the first time. We met several best doctors with whom even we can’t talk properly or ask any question regarding the gray areas in the fertility process. Sometimes Dr.Malpani was a teacher to teach us the steps and the process in depth and resolved all the questioned we had regarding the treatment. This approach we haven’t experienced at any other places in Sri Lanka or abroad. He took his own time for the explanation and encouraging to keep our moral fitness and mental balance for the purpose. It was a psychological therapy before the treatment. We were surprised to see the a doctor spent such a time for the wellbeing of the patient. Kindness and the friendly relations of both Dr. Aniruddha and Anjali Malpani and the service of their dedicated staff was a blessing for our burning soul. The entire environment of the clinic was a very pleasant place for us.

When we came to know that Our first IVF was positive we enjoyed a lot. it was a spiritual happiness and it was like a shower after a long drought. But we were devastated from the message that the pregnancy had some defect due to its genetic problem. However , this time too, Dr. Malpani gave us full moral impetus to keep the balance to go for the next round of the IVF treatment. With his immense motivation and consultations we did the 2nd treatment. It was very successful, keeping us waiting for another 10 months for the result. We got a lovely and healthy baby girl!

Baby gave us a rebirth and a new life, even I am in 40 years and wife is in 38 years. We had more confidence on the success rate of IVF treatment of the Malpani clinic, we had an opportunity to share the information with other IVF patients who came to the clinic from across the world and they also had the success stories with more babies.

We extend our sincere thanks and gratitude to the divine hands of Dr. Anirudha and Anjali Malpani and their divine look at the patients which you can’t find anywhere in the world other than at the Malpani Clinic in Mumbai , India. As Buddhists we have a spiritual bond with India ,since it is the birth place of Lord Buddha. Now we have the second reason to further strengthen that bond with the Bharat, since it is the Birth place of our lovely daughter. The names of Aniruddha and Anjali have been embodied to us and will live with us forever.

We highly recommend to any couple who are searching a right place for their IVF treatment, don’t miss the Malpani clinic in Colaba, Mumbai, India. You will have a better understanding and the confidence once you visit the clinic. If someone wishes to know any specific information through our experience with Malpani , we are pleased to keep you updated, Don’t waste your time and money. Don’t delay your parenthood; don’t delay of writing your success story in this column.

You may contact us through – medha1118@yahoo.com at your convenience.
Thushara/Medha








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Monday, December 19, 2011

Does your IVF clinic have a full time embryologist ?

There are many IVF centers sprouting up in India today. This is because there is a huge demand for treating infertile couples. This is hardly surprising, given the fact that over 10 million couples get married every year- and that 10% of these are going to be infertile.

It's also considered to be a highly lucrative field; and all gynecologists today want to start IVF clinics. They have the space and the money; and are happy to invest in starting an IVF lab because they think this will be highly profitable.

The trouble is that they forget that the IVF lab is only as good as the person who runs it. This scientist is called an embryologist - and the tragedy is that there just aren't enough embryologists in India right now. This is one of IVF's dirty little secrets - embryologists in India are in very short supply.

Since it takes 2-3 years of full time experience to become an expert embryologist, many IVF clinics today rely on traveling embryologists to treat their patients. These embryologists are very skilled; but they are also very busy, because they have to serve many clinics all over the country. This means that they can spend only 1-2 days at each clinic

This is why the doctors are forced to do " batch IVF". They group over 20-40 patients together, and treat them all in this 1-2 day window period

While this works well for young patients, the results are terrible for older women , because the doctor cannot tailor make or customise the treatment protocol for patients with poor ovarian reserve - they are forced to use a "one size fits all " approach.

The major benefit of this approach is that it's much more convenient and less expensive for the patients, because the do not need to travel out of town.

However, these clinics typically have a lower success rate because the embryologist cannot spend enough time on the " difficult " patients. He may have to do over 10 ICSI cycles in one day - and injecting over 100 eggs in a few hours can be fatiguing and stressful. Also, it's not possible to do justice to difficult and complex procedures such as TESE for patients with non-obstructive azoospermia.

Also, since they have to leave in 2 days, they cannot freeze the spare embryos - these are often "donated" to other patients or discarded

The documentation in these clinics is also poor, because the embryologist doesn't have the time to take photos of the embryos

Finally, the quality control leaves a lot to be desired . The embryologist needs to depend upon a technician to maintain the incubators and the IVF lab equipment - and when these are used only an episodic basis, they are often not in optimal working condition.

Please ask ! If your clinic does not have a full time embryologist, you might be better of finding one which does !





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Saturday, December 17, 2011

When bad things happen in the IVF lab

Most patients are pretty clueless about what goes on in the IVF lab.

Sadly, many doctors are equally clueless too and they leave everything upto the embryologist. While this works very well when you have a full time experienced expert embryologist, the sad truth is that not all IVF labs and IVF embryologists are upto the mark. While many are extremely hard working , talented scientists, others are poorly trained

Thus, some will use shortcuts, such as using donor sperm because they do not know how to handle TESE sperm

Others are not very careful about quality control , and will not bother to check that their equipment is working well

Some are not very honest with the patient and do not give the patients photos of their embryos - they just tell the patient that their embryos are of "good quality" ( even when they are not), thus taking advantage of the patient's ignorance.

Other will use one patient's eggs for another without her consent. They justify this by calling it
egg sharing , but really this is egg stealing.

Documentation is often poor and records are poorly kept. If there are accidents or mixups in the the lab , these are covered up and not reported

Thus, when the incubator malfunctions and the embryos die, they are not forthright with the patient. They explain that the problem is because of poor egg quality, and tell them to use donor eggs for the next cycle !

Sadly, it's easy to exploit poorly informed patients. Smart patients make sure they have done their homework, so they can arm themselves with Information Therapy !



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Friday, December 16, 2011

Side effects of Information Therapy

I am a big believer in Information Therapy. I feel that the more patients know about their medical problems, the better for them - and the better for their doctor as well !

I recently had an interesting conversation with a senior doctor, who was quite skeptical about the value of empowering patients with information. He felt this was just a new fad, and would just create more problems.

He believed that medicine was a complex subject – after all , it takes 8 years of full time training to become a surgeon ! How can one expect patients to understand the nuances of their medical problems in a few minutes ? Isn't it far better for them to trust their doctor, who is the true expert, and who can help them heal quickly ?

He was very critical of patients who came with pages and pages of internet printouts about their medical illness. They were often very confused ; and ended wasting a lot of their time ( and his ! ) wanting to discuss options and alternatives which did not make any sense at all. He felt that all this second guessing the doctor just caused patients to doubt their doctor – and this loss of faith and trust in the doctor would end up harming patients - and doctors as well.

Hypochondriacs have a field day googling their symptoms. They end up with “medical student “ syndrome, convinced they have all possible medical diseases, ranging from asbestosis to
zoonoses !

He was quite dismissive about “well-informed patients” who felt they had become “half-doctors” by reading and researching their medical problem online. A little knowledge can be dangerous – and patients who thought they know a lot about their disease often created more problems they solved, by challenging their doctor’s decisions. Doctors are not used to having patients disagree with them – and often ended up getting upset and angry. This just damaged the doctor-patient relationship, making this confrontational, rather than cooperative.

Everything he said was true – but this does not mean that there’s anything wrong with the idea of Information Therapy. Like anything else, information can be used properly – or misused and abused. The key is that the information we need to provide patients needs to be reliable, updated ; evidence based – and tailored to the patient’s needs. Rather than force the patient to search for this information himself, if the doctor prescribed information himself, this would create a win-win situation. The patient would trust this information, since it was coming from his doctor and not have to waste his time wading through pages of rubbish. The doctor would also be more confident that the patient was well-informed and had realistic expectations from his medical treatment.

The word doctor is derived from the word, docere, which means “ to teach”. When doctors don’t do so, we are abdicating our responsibility and forsaking our patients. They feel lost and are then forced to fend for themselves – thus wasting their time , and their doctors’ time as well , because they need to clear up their patient’s confusion and doubts.

The solution is simple . Doctors need to guide their patients and prescribing information therapy is a simple way of doing so ! This needs to be curated, reliable information, which both doctors and patients can trust, thus ensuring they are on the same page, and are active partners in a healing relationship.

There is a difference between information, knowledge and wisdom ! If doctors prescribe information intelligently , they can trust their patients will become knowledgeable, and together they can create a wise path to help their patients navigate their illness.

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Thursday, December 15, 2011

Egg sharing - or egg stealing ?

In many IVF clinics in India , doctors will often use one patient's eggs for another without her consent. They call this egg sharing - but really this is egg stealing. They do not bother to inform the patient that her eggs are being used for someone else !

For example, when they retrieve 10 eggs, they use only 6 for the patient, and borrow 4 to give to someone else

This is why there are so many patients who have 12 mature follicles on the ultrasound scan, but the doctor gets only 6 eggs !

This kind of lack transparency will end up giving all IVF clinics in India a bad reputation !

As a patient, you need to be well-informed about your treatment, so take an active interest in what is happening . You can always ask the doctor to show you the ultrasound screen during the scans, so you can track your follicles; and ask for prints of the scans as well.

Ask questions and speak up !


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Poor quality treatment - patient ? doctor ?

When the IVF cycle fails, patients often blame their doctor for not doing a good job. However, this blame game does not help at all ! It just creates anger and resentment, as a result of which patients become bitter and lose confidence in all doctors.

When things don't go according to plan, I always tell the patient that you need to take a proactive role in your treatment, before your treatment starts, s you know exactly what to expect. This way, if things are not going as expected, you know this before the problems get worse.

This does not mean that you need to become a medical expert - but it does mean you need to become an expert patient !

For one thing, there's little point in blaming someone else for problems. Even if these do occur because the doctor goofed, obsessing over this just makes a bad situation worse, because you them end up playing the "woulda, coulda, shoulda" game.

In any case, you can never change someone else's behaviour - you can only change your own !

Many patients complain that doctors don't give them their medical records. While it's true that
good clinics will do this routinely, part of the problem is patients don't bother to ask for them either ! If you request the doctor to give you a copy of your records in writing, no one will refuse to do so. You do have a legal right to your records , but you need to assert this.

The important thing is not to treat yourself as a helpless victim. Take active responsibility for your medical care - and learn from your mistakes, so you don't repeat them again !

Be charitable - and never attribute to malice which is a result of stupidity - everyone is allowed to make mistakes once !

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Wednesday, December 14, 2011

Pelvic pain and infertility

Lots of infertile patients also have pelvic pain . Both pelvic pain and infertility are common complaints amongst women in the reproductive age group, which is why the coexistence of pain and infertility is extremely common. Sometimes the pain is just garden-variety dysmenorrhea ; and sometimes its pain because of endometriosis, which causes both pelvic pain as well as infertility. Sometimes it's pelvic congestion syndrome and often we don't have a very good answer for why there is pelvic pain.

Read more at http://www.drmalpani.com/pain-infertility.htm

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Tuesday, December 13, 2011

Treating shadows in infertile couples

Modern medicine involves a lot of testing. While some is useful, overtesting leads to unnecessary overtreatment for many infertile couples. Here's how you can protect yourself, to make sure your doctor does not waste time treating shadows !
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The one thing Malpani Infertility Clinic does not have

Most IVF clinics take pride in using "state of the art" technology and often tom-tom the fact that they use the latest equipment.

There's one thing which our clinic does not have - unlike all other IVF clinics - and we take pride in this.

We don't have any assistants !

This means that every time you come to Malpani Clinic, you get to see either Dr Anjali or me , because there are no assistants !

So if you want hands-on personalised care, with treatment protocols tailored to your clinical situation, please come to us !

However, if you are happy being another number in a large impersonalised clinic, when you are never sure if you will ever see the "main doctor" again, then we are not the right choice for you.
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Saturday, December 10, 2011

Aphorism for surgeons

A surgeon takes 10 years to learn how to operate - and another 10 years to learn when not to operate !

Friday, December 09, 2011

Is doing IVF for women with high FSH levels futile treatment ?

I recently saw a patient who begged me to do IVF for her. She had an extremely high FSH level of over 40 mIU/ml which clearly meant that she had ovarian failure. The chances of her being able to produce viable eggs which we would be able to use for IVF were extremely low. She was a thoughtful intelligent patient who had a clear understanding of her medical problem and also understood that her treatment options were extremely limited. She was very sure that she did not want to use donor eggs and was wondering if I would be willing to do an IVF cycle for her. She was quite hesitant about making this request because she had been refused by many IVF specialists in the past. She felt that I would also refuse her request, which is why she made this very tentatively.

I sat down and explained to her that as long she had realistic expectations from me and the treatment I could offer her , I would be happy to take her on as the patient. Read more to find out why.
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Thursday, December 08, 2011

Failed IVF - is is the uterus ? or the embryos ?

Most IVF cycles result in the formation of good looking embryos ; and most patients naturally expect these embryos to become babies after the transfer. Now that all the in vitro lab work has been completed, nature will take over and make sure the embryos will become babies. Sadly, most IVF cycles still fail, and when good looking embryos fail to implant, the natural tendency is to blame the uterus , but this is usually not true !

Read more
to find out why.

Wednesday, December 07, 2011

Why do frozen embryos have a higher success rate than fresh embryos ?

A few years ago, everyone believed that fresh embryos were better than frozen embryos . We felt that they had a better chance of becoming a baby ( in scientific jargon, that they had a higher implantation rate.)

However, we are now starting to realise that this is no longer true; and that thanks to vitrification, the success rate with frozen embryos is better ! This may seem counterintutive - but here's why transferring frozen embryos has a higher success rate than transferring fresh embryos.


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Tuesday, December 06, 2011

IVF treatment - Chance, choice and destiny !

While the IVF treatment process itself is well-defined, the outcome of an individual cycle is always uncertain - something which seems to be true for most complex biological systems. While we are very good at making embryos in the IVF lab, after we transfer them into the uterus, we have no control over whether or not they will implant.

So what affects the outcome of the IVF cycle ? Is it chance ? choice ? or destiny ? And what intelligent choices can you make to improve your chances ?



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Monday, December 05, 2011

IVF Surrogacy and Aamir Khan


Now that Aamir Khan has publicly acknowledged that he has had a baby using IVF surrogacy, surrogacy has become a hot topic once again in the news . As with every story, this will have a mixed impact - some good, and some bad.

The good impact is that surrogacy will now become much more acceptable as a method of family building. Celebs play a big role in influencing societal attitudes and the fact that Aamir Khan has used surrogacy to have a baby and has issued a press release stating this publicly means that many other infertile couples will want to learn more about this option.

The bad impact is that surrogacy will now become much more acceptable as a method of family building. Most infertile couples are pretty clueless about when surrogacy is an acceptable treatment option - and the danger is that since Aamir Khan has endorsed this option, many other infertile couples will follow blindly in his footsteps. The truth is that surrogacy is often misused, overused and abused. Using it for treating women who have had repeated IVF failures or miscarriages , even when their uterus is completely normal, is not good medical practise, in my opinion. However, it's much more lucrative for doctors, and now that Aamir Khan has given the practise his stamp of approval by using it personally, the overuse will multiply manifold.
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Why do doctors charge so little ?

If this question causes you to raise your eyebrows, let me rephrase this.

Why do lawyers charge far more than doctors do ? Both medicine and law are learned professions which have been around for centuries. It takes years of education to qualify as a doctor or a lawyer; and both are service professions.

However, lawyers charge disproportionately more than doctors do. Many lawyers charge as much as Rs 1 lakhs just to appear in court, whether or not they actually argue the case . Moreover, they have a much cushier lifestyle, with very little risk. They work fixed hours and do not have to deal with emergencies. The only skills they need are to draft and to argue, unlike doctors who have to learn how to operate as well !

Even though doctors slog much harder, they still charge much less than lawyers do. Their training is far more grueling and takes much longer. They have to be available at all hours - and are at high risk for being sued , in case something goes wrong ( even if it's not in their control).
Even though they perform a far more useful function than lawyers ( just think - if you were stranded on a desert island, would you rather have a doctor as a companion, or a lawyer ?) , they get paid a pittance. To add insult to injury, patients are always unhappy when paying the doctor and they pay his fees very grudgingly. However, when they need to pay their lawyer, most clients may much larger amounts, without complaining !

Why is this so ? Do we expect doctors to be superhumans , who are meant to slave for their patients without expecting any tangible financial returns ?

I think the reasons are primarily because of the differences in the training doctors and lawyers receive. Lawyers start of by fighting cases at which millions of rupees are at stake. They are used to dealing with large sums of monies - and are quite happy to charge a sizable chunk of this as their fee. After all, if they will millions for their client, why should their client mind giving them a small percentage of this as their fee ? Also, clients who win cases don't mind paying their lawyers, since he has earned so much money for them.

Doctors, on the other hand, are never taught how to handle money or to collect their fees. They are used to working for free during their residency , and never learn to charge what the worth of their services really is ! After all, if doctor saves your life, how do you put a monetary value on the service he has provided ? If I give an infertile couple an IVF baby , whatever they pay me will always be a small fraction of the real worth of the service I have provided them with !

Sadly, many doctors still feel that their ethical standards demand that they should be able to rise "above" the filthy lucre of money. I think this is incorrect. People only value what they have to pay for - and the more they pay, the more they value the service ! Today, doctors take on all the risk of treating patients, without being adequately compensated for their time, expertise and effort.

This is not a sustainable system. People respond to economic incentives; and the next generation of smart students will no longer want to become doctors - they will all become lawyers ! Serves us right !

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Wednesday, November 30, 2011

We treat patients - not numbers !

Patients ( and IVF doctors ) need to remember that we treat patients - not just abnormal lab reports !

How do we sort out the significant abnormalities from the red herrings ? How do we prevent overdiagnosis and overtreatment ?

Saturday, November 26, 2011

Doctor vs Doctor

It's true that doctors often disagree. This means that patients get confused and frustrated, because they don't know what to do ! After all, if experts cannot agree, what's the poor patient to do ?

We need to remember that medicine is not an exact science - it's evolving rapidly, and recent advances can mean that there may be newer ( and better) options to solve a problem.

However, the bigger problems is that doctors have large egos - and are very fond of making up their own mind - and then closing it ! Many doctors will trust only their own "personal judgment" based on their "personal experience" - which means it's hard for them to accept alternatives. Some treat dissent as a personal insult - and will refuse to discuss options - it's "my way" or go away !

This is especially true when infertile couples seek medical help.

Gynec vs Gynec

The point of first contact for most infertile couples is their gynecologists. While most older ones are quite conservative, the young ones are more interventionist, and will often advise a laparoscopy as a preliminary investigation - even though most infertile women do not need one at all !


Gynec vs Gynec Endoscopist

Now that gynecologists have superspecialised, we now have a breed of gynecological endoscopists who will not accept the laparoscopy report of an ordinary gynecologist, and will insist on repeating this again. Even worse, they will make it a point to "diagnose" an abnormality which the earlier doctor missed, thus proving that they are better doctors ! Sadly, most of these "abnormalities" are just red herrings, which are of no clinical importance. This is especially true for those unfortunate infertile women who have endometriosis, for example.

Gynec vs IVF specialist

Most gynecologists are very reluctant to refer their patients to an IVF specialist, because they do not want to "lose" their patient. They will repeat IUI treatment cycles ad nauseum - till the patient gets fed up and frustrated.

While some of these differences are a result of maximising personal income, it's also fair to point out that it's not just pecuniary gains or vested interests which cause these differences in opinion. Many doctors have different world views, just because they see completely different patient populations !

Thus, older gynecologists who also practise obstetrics ( OB) are likely to see lots of older women who have got pregnant in their own bedroom. They are therefore much more likely to allow nature to take its own course and treat all 35 year olds as having normal fertility ! IVF
specialists , on the other hand, usually see only the ones who have problems - which is why they are much more worried about the biological clock , ovarian reserve and time !

We all have our biases - and this is completely natural . We tend to remember our successes and conveniently forget our failures.

IVF specialist vs IVF specialist


In fact, even IVF specialists differ amongst themselves ! Thus, many will remove a small hydrosalpinx prior to IVF; while others will routinely do a hysetroscopic metroplasty to "improve uterine receptivity" and facilitate embryo implantation !

Western medicine vs Alternative Medicine

This is also why IVF doctors have such a poor opinion of alternative medicine . They see lots of infertile women who have done a lot of alternative medicine and failed, which is why they then turn to IVF as their last resort. Because IVF specialists see only the alternative medicine failures, they start believing that alternative medicine is all rubbish and does not work.
Conversely, they have lots of faith in their modern technology - after all, they see embryos which they have created in their labs daily, and this can be quite awe - inspiring !

Alternative medicine doctors, on the other hand, have a completely different perspective ! They see lots of patients, many of whom have unexplained infertility , and who quickly get pregnant after they "treat them". Now whether the pregnancy was a result of the treatment, or inspite of it, is something we'll never be able to find out ! However, like all doctors, they are quick to take the credit for their successes - and their patients are more than happy to give them what they think is their fair due. This is how their reputation and practise grows !

I think the truth lies somewhere in the middle. Everything works, when used intelligently - the secret is to select patients carefully !

So what is the poor patient to do ? There's only one solution - you need to do your own homework, and the more you know, the easier it will be for you to make the decision which is right for you. It will be easier for your doctor as well !

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Friday, November 25, 2011

Beyond Organic Farming - a textbook in Hindi



This has been published by Deepak Suchde , who runs the organic farm in MP set up by the Narayan Chandra Trust , which my parents started , to help make Indian farmers self-sufficient

Why do doctors give cuts ?

Most doctors are like most of us - honest, ethical and happy to earn a comfortable living. Most doctors would rather not give cuts if they have a choice - after all, who likes doing something which is dishonest and underhand ? And I am sure no one wants to give away their hard-earned money in the form of a kickback !

Yet doctors in Mumbai do this all the time, routinely. How do they justify it ?

The truth is that the brain is wired in such a fashion that it's possible to justify practically anything and everything. The commonest excuses are:

I need patients and cannot survive if I do not give kickbacks
Everyone else does it, so why shouldn't I ?
What's wrong with being corrupt ? This is a corrupt society, so why should doctors be held to a higher standard than everyone else ? Why should I be expected to be God ?

The truth is that doctors give cuts against their better judgment. They do this because they feel they don't have a choice.

In reality, there is a better alternative - a solution which is good for both patients and doctors !

Remember that the only reason doctors give cuts is so that they can get patients - and this is the role which the "middleman" serves. This middleman could be :
the referring family physician;
the medical tourism company;
the taxi driver or tout;
the insurance company; or
the corporate hospital .

The trick to stop giving cuts is to cut out the middleman , so that doctors can get patients directly.

The only way to do this is to go to where the patients are - the internet !
This is why it's so important for doctors to have their own websites. It keeps doctors honest, open and transparent - and this is best for doctors and their patients as well !

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Thursday, November 24, 2011

How can we clean up the corruption in the medical profession ?

The Hindustan Times has run a great series of articles which document the unethical practise of giving cuts and kickbacks within the medical profession which is rampant in Mumbai today.

I am happy they have documented this practise. This was an open secret, which everyone was aware of, but preferred to sweep under the carpet. I am glad they have create awareness about how harmful this can be . We can no longer ignore this elephant in the room, and this is the first step is tackling this pernicious problem - talking about it, rather then pretending it does not exist.

However, the problem with such articles is that they sow the seeds of mistrust in the doctor. Patients are now likely to treat their doctor with suspicion. Is he advising surgery in my best interests ? or his own ?

My major criticism about these articles is that they do not provide solutions - and often end up up making a bad situation worse. Patients feel helpless and powerless - and start treating all doctors as crooks. Doctors start getting defensive - and if you treat someone as a crook, he will soon start behaving like one ! Is this the kind of self-fulfilling prophecy we want to achieve ?

Sadly, patients cannot differentiate good advise from bad advise - and some of them may end up saying no to surgery which they really need - causing a lot of unnecessary harm and suffering. Also, these articles end up making the doctor's life more difficult as well. Trust is an integral part of the doctor-patient relationship - and if this eroded, it's very hard to repair.

What's even worse is the fact that the silence from our medical associations is deafening. Where are the leaders in the medical profession who should be standing up for the doctor - there don't seem to be any left !

The truth is that patients are not powerless ! They can learn what is appropriate medical advise and what is not. It's important for them to trust their doctor - but the doctor needs to earn this trust - and patients need to verify that their doctor's advise is sound.

I feel a simple solution to help clean the Augean stables would be to make sure every doctor has their own website. Websites will force doctors to be transparent. They can publish their fees openly, so patients are confident they are not being overcharged or taken for a ride. These websites will allow patients to comparison shop - so they can make the right choice for themselves.

The truth is that patients doctor shop all the time - why not help them to do so intelligently ?


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Wednesday, November 23, 2011

Dr Anjali Malpani's presentation about IVF and alternative medicine at COGI, Paris


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Making sense of your IVF medications

Are you confused with the medications your doctor uses for your IVF treatment ? What's an agonist ? An antagonist ? Why do I need so many shots ? Will I run out of eggs because of all these hormones ?

One of the reason for the confusions is that there are so many different medications available - and so many different treatment protocols !

Why are there so many protocols ? Is one better than the other ? Did my online buddy grow more eggs than I did because her doctor started her meds before Day 1 ? Should I ask my doctor to also start my meds before Day 1 ? Or should I change my doctor ?

If you need help in making sense of your IVF treatment protocol, please
go to http://www.drmalpani.com/ivfmeds.htm
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Thursday, November 17, 2011

I am going to be speaking at the Health 2.0 India conference

I am very excited to be talking at the Health 2.0 India conference to be held in Delhi on 30 Jan 2012.

There are some very interesting speakers I look forward to listening to; and many demos of clever products I want to check out. It's going to be a packed day !

This space is hotting up - and I am very pleased to be participating.

Success story for a man with azoospermia

We got married in 2000. After waiting for two years as my wife could not conceive we consulted a gynecologist in Nasik. He advised us for some blood test for my wife and semen analysis. To my surprise I was diagnosed with “Azoospermia”. Then I consulted Urologist he suggested Biopsy which took me another year. After Biopsy, my urologist confirmed I had obstructive Azoospermia. On one side we started feeling pain of not having baby ; and our life became miserable by lots of suggestions from relatives and friends. We started avoiding social meets and functions.

Our parents took us to many religious places, some of them were baba’s . We had many bad experiences , travelling long distance to cites in Guj, Mah and some in Konkan.

Then we again went to the same gynecologist in Nasik . He suggested us IVF treatment with TESA, we invested all our savings in the treatment but it didn’t worked.

Somebody suggested Ayurvedic medicine from Kerala, no result I was only gaining weight day by day. I tried acupuncture, Homeopathy and many more options.

We lost all our hope and didn’t even have enough money to go for next IVF and take risk and 2007 we left everything in God's hand and were waiting every month for a miracle which never happened. In 2007 somebody from Nasik suggested we try treatment in Mumbai as the doctors in Mumbai are well equipped . I started searching for Job in Mumbai and finally I got one in Dombivali. Without wasting a single day we started treatment at Dombivali but it didn’t work. We lost all hopes and started thinking on adoption , which we found out was not at all easy.

One day while surfing on internet , I found information on Malpani Clinic which seem to be very genuine and informative. We we both decided to visit the clinic and went first in 2008. Doctor was very informative , friendly and the environment I found in the clinic was wonderful. I decided to get the treatment done at Malpani Clinic but again my finances were not enough to immediately start the treatment. So, I made my wife to join art & painting college.

We arranged finances in 2011 and started our TESE-ICSI treatment in Malpani clinic . The staff and doctors are wonderful, they made us so comfortable that we never felt we are in a Clinic. At Malpani clinic , all the treatment procedures were clearly explained, everything is documented and transparent. All the possibilities were told . This place was a hope and home for us during this period. The Malpani staff trained me on giving injections at home, they were very cooperative.

Our first cycle didn’t work but our Doctor supported us morally, and we were ready for second cycle , which worked ! We were lucky that we were in right hands.

We are very thankful to Dr. Aniruddha Malpani, Dr. Anjali Malpani. and entire Malpani staff for supporting us throughout our treatment, they all are Angels on Earth.

May God Bless Them All!!!!

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Wednesday, November 16, 2011

Make the patients do all the work !

Doctors are always complaining about how busy they are and about how many patients they have to see every day.

Here's a simple solution - make patients do more work !

Patients can be very smart - and they can often do a better job at educating other patients, for example. Not only are their concepts clearer , they are much more patient-centric and use language which is easier to understand, because it is not burdened with medical jargon.

Patients can develop many clever tools, which we can then use to treat other patients !

For example, when I give patients their IVF treatment plan, I write this down - and then ask them to email me what they will do , in their own words , so I am sure they have understood it properly. One patient created a very clever spreadsheet for herself. I requested her to adapt this, and we now use this for all our patients ! They just have to enter their LMP and they get a customised daily treatment plan which spells out what's going to happen on each day. This helps them become better organised ; saves me time; and reduces errors and confusion.

If you are a busy doctor and have lots of patients , please learn to make good use of them ! They are a very inexpensive resource ! For example, they can help you search the internet; or help you design patient education brochures in their local language.

Remember, patients are not just consumers - they are the largest untapped pool of healthcare providers. They act as primary healthcare providers for themselves - why not tap into their intelligence to help them provide better health care tools for other patients as well ?

Doctors as a healthcare tool

Most people ( including doctors themselves) have an excessively inflated opinion as to how important doctors are in improving the health of their patients . I think this self-importance is completely uncalled for.

We need to remember that doctors are primarily illness experts , and they are good
( sometimes, but not always ) at fixing problems when you fall sick. However, the most important person for ensuring you remain healthy is - you !

Sadly, when we give too much importance to doctors, we create lots of problems.

I think doctors are simply one of the many healthcare tools we can use to remain well. Many other tools ( such as a healthy diet; money; safe drinking water; regular exercise; information therapy; and plain common sense !) are often much more important !

It's because we've handed over control of the healthcare system to doctors, that they progressively demand ever increasing importance. This is perfectly logical ( from the viewpoint of the medical profession), but is likely to hurt the common man.

Just like any other tool, the doctor can be used well. However , they can also be used badly - and because they often make the rules as to what patients are allow to do ( and not allowed to do), they are often overused and misused.

Like CT scans and MRI scanners, doctors are very expensive tools - and it's important that patients learn how to use them intelligently ! Just like you need to learn when to go to a doctor, it's equally important to learn when you are better off not going to one !

The trouble is that they command a lot of prestige and respect - and it is hard not to get blinded by their halo !

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Tuesday, November 15, 2011

A great series for infertile couples - None in the Oven !



Being infertile is hard - and often the rest of the world makes it much worse !

Here's a great video series, full of humor and empathy, which will help you realise that you are not going crazy ! Other couples have dealt with infertility successfully - and so can you !
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Monday, November 14, 2011

Launch of the Continua Health Alliance in India !
















The Continua Health Alliance was launched in India at the recent Telemedicon 2011. This was a very well organised affair, and Rajendra Gupta gets full marks for doing such a great job !

I am very pleased that Continua is now focusing its efforts on India. This reinforces the fact that India is a huge market - and that healthcare entrepreneurs who develop clever products to improve personal health care now have a global opportunity they can tap into !

I also suggested to the Continua Chairman that they need to have an e-Patient working group. After all, if they are designing products for patients, they need to actively solicit patient input from Day 1 !

Sunday, November 13, 2011

Aneesh Chopra, CTO at Telemedicon 2011


I had the pleasure of listening to Aneesh Chopra, Chief Technology Officer, The White House, USA at Telemedicon 2011.

He is a very inspiring speaker - full of energy and bounce. Reminds me of Tony Robbins !

I was impressed by how sharp he is; and how he is using technology to tap into the expertise of ordinary citizens. He kept us glued to our chairs for 60 minutes - and shared lots of great ideas.

It's very heartening to see government led efforts which tap into crowd sourcing to come up with innovative cost effective solutions to improve healthcare. There's a lot the Indian government could learn from this exercise - we have lots of smart Indians !

Wednesday, November 09, 2011

I'll be speaking at the International Telemedicine Congress 2011 !

I'll be presenting the patient's point of view at the forthcoming Telemedicon 2011.

This promises to be a very interesting conference. Rajendra Gupta has done a stupendous job in getting together a galaxy of speakers from all over the world !

Since we cannot clone doctors, the best way of ensuring doctors can reach out to more patients is by using technology ! Telemedicine is a very cost effective way of doing so. However, while it can help the doctor to improve his efficiency, most patients still want to talk to their doctor face to face ! And how can telemedicine replace the human touch we all crave for ?

I'll be discussing some of these issues in my presentation !
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Busting myths about sperm and fertility !


This article appeared recently in Mumbai Mirror, one of Mumbai's leading newspapers.

Monday, November 07, 2011

What every infertile couple needs to know about DPO !

DPO stands for Day Post Ovulation, and is a key term every woman needs to be aware of. We all know that ovulation is the central event in a woman's reproductive cycle. Unfortunately, because ovulation is a silent internal event, most women are not sure when this occurs. This is why most of them use their last menstrual period ( LMP ) as their key reference timing milestone . This creates a lot of confusion .

Read more at http://www.drmalpani.com/dpo.htm

Saturday, November 05, 2011

One more Malpani IVF Clinic success story !

When we first came to the Malpani’s clinic, we are a bit nervous. After reaching there and talking to him we came to understand why Dr. Malpani emphasises that the patients should be VIPs (very informed patients). If patients are informed well then, they will understand better and ask pertinent questions to get the best out of the treatment. Dr. Malpani has done a yeoman service of educating the infertile couples with his site and HELP organization. Kudos to him on such a noble dedicated venture.

We had been married for more than 3 years, when we started thinking seriously of starting a family. We went to the normal gynecology doctor who did the normal tests and then the journey began with the all the up and downs of varied nature. When we reached Malpanis we had already undergone one cycle of treatment which ended in failure. We had our second round of treatment with the Malpanis. The biggest differentiating factor of Malpanis with others is that once reach his clinic you leave your worries and transfer your worries onto them. They and their staff take adequate care of the worries and pains associated with the infertility treatment at their clinic.We had high hopes and expectations from this treatment. Anjali extracted eight eggs and six of them fertilised. The embryos were transferred two days after the extraction. Then the longest wait began. The next fortnight was seemingly too long. It was as if the Time has slowed down. Somehow we spent those two weeks and the D-day came for the beta Hcg test. By the evening hopes were dashed to the ground. The report was negative and we were dejected and exhausted mentally and physically.

But life has to go on. We mustered courage and visited Malpanis after some time and there was only one question before him-“what next?’’. He advised us suitably and counselled us to give it another try. We need to remember in this treatment that day by day we are aging and postponing the treatment only compounds the problem and more so for them who are on the wrong side of the 30s. We decided to give it one more try after taking a short break. The break period we utilised for the alternate therapies like acupuncture and some naturopath to enhance the chances of conception. We again went for another round of treatment under the Malpanis. We were still positive and thought that these therapies would do some miracle but the wheel of fate has many unexpected revolutions. This time also we were back to square one. This round also failed and we were thoroughly dejected. Again the same unanswered question-“what next?’’. But we never lost faith on GOD and the doctor. Probably time was not on our side.

One of the suggestions was to go in for adoption but that also takes a lot of time and procedure is still cumbersome in India. We again came to the Malpanis and he suggested exploring the option of embryo adoption which we liked very much. We went ahead with it. He transferred four beautiful embryos. Again the two weeks of prayer, suspense, anxiety et al. After the two weeks the result was again negative. We were totally wrecked and kind of given hope of becoming parents. We took our time and reconciled to the situation. For some time it was alright but when the fun is over and loneliness takes over, pain starts mounting at all levels. Again, we called the Malpanis and consulted him regarding the final attempt for the procedure.

We went under the procedure and hoped for the best. Throughout the treatment Malpanis have been a pillar of strength. Their professional treatment and dedication is par excellence. After 2 weeks of the resting phase and the blood test, the clinic informed over phone that the result is negative. We were devastated. Next day when we saw the report there was a surprise in store. The result was showing “In Range”. We again contacted Malpanis and he confirmed that the news was good and he again took care of the resultant weeks to see that the initial pregnancy develops well.

This time GOD has been kind to us and we are now awaiting our first child. The first trimester was having a lot of ups and down. We would every time contact him over phone and e-mail and he would respond at the earliest. Most of the times I found find solace in his advice rather than of the regular gynaecology doctor. Whenever I have doubt, I would mail him and his response would be there within 24 hours. We are thankful to the entire team of MALPANIS. Their co-operation and dedication is deeply appreciated from the bottom of our heart. May GOD bless Malpanis in their great work of bringing smiles to the childless couples from across the world.

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Friday, November 04, 2011

Ashok Jain on why it makes business sense for entrepreneurs to promote information therapy in India



Mr Ashok Jain is a very successful healthcare entrepreneur and CEO of OxygenHealth. He talks about how he uses Information Therapy to help his company to flourish by keeping patients healthy !

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Thursday, November 03, 2011

Dr Nikhil Datar on How Information Therapy can be used to promote patient safety



Dr Nikhil Datar champions the cause of Patient Safety in India ! He talks about how Information Therapy can help to make healthcare safer for patients.

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Wednesday, November 02, 2011

Promoting Information Therapy in India - Dr Aniruddha Malpani



Patients are the largest untapped healthcare resource ! Here's how we can mobilise the bottom of the pyramid in India.

I presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Tuesday, November 01, 2011

Successful donor egg IVF pregnancy at Malpani Infertilty Clinic

When we got married we decided to plan our family after 6 months. I used to have serious pain during my periods and that used to get worse, that I used to unable to move .After ultrasound doctor found a chocolate cyst near my ovary and assured me nothing to worry it can be removed easily , soon after I found that my both tubes were blocked and I am having endometriosis, as I have endometriosis and my both tubes were blocked I was advised to have laparoscopy followed by IUI after 3 months by many doctors. These all test and making decision for surgery took 1.5 year , I finally got done laparoscopy , which showed I was having Stage - 4 Endometriosis , this laparoscopy opened my fallopian tubes and I was advised to go for IUI , I was given hormone injection but there was NO significant follicular development found, the FSH value was very HIGH , endometriosis has destroyed my ovarian tissues and I was detected with premature ovarian failure , I was advised to consider IVF with donor help. This all happened so fast that I could not believe that this had happened with us , just after this we had to move to US for work and our IVF decision got side tracked for couple of years .

In these couple of years I tried with clomid with no result, I looked at internet and made decision to go with Dr. Malpani, I wrote him for second opinion and immediately I got his response and after going thru with my history he also suggested to opt Donor egg but I really wanted to try at least once with my own egg , I am thankful to Dr. Malpani that he gave me opportunity to try my luck, without worrying about his numbers of successful cases. But I was not lucky enough, I did not respond well with the hormone medication and my cycle got cancelled, The IVF process was filled with so much hope and prayer that its failure was unbearable. Dr Malpani and Anjali Malpani took time to explain me things and he said nothing wrong that - you tried; it was worth of trying to rule out the option and for your own peace of mind, now you have more options to explore and suggested me to try with donor egg .He explained in detail about the donor egg option. He himself does screen their donors for their health and for infectious diseases and match their physical traits with us. Also, he explained that we should focus only that egg should come from healthy woman, which he ensures.

I was really touched by his behavior as in all these years of meeting doctors I had come across with so many rude doctors who treats their patients like their slaves, in spite of paying their high consultation fees.

We again planned to go for IVF this time with donor egg and emailed him about our plans, again he responded very promptly and precisely , due to some family emergency I had to travel to India immediately , he understood our situation and planned everything over email , Everything was well arranged when we reached to Mumbai. He assured me to take care of my chores well and he will take care everything regarding our treatment. I was well taken care by Dr Anirudh and Dr Anjali , On the day of egg transfer I was very nervous , after reaching to the clinic I was taken care by his staff , I would say whole staff is very friendly and always smiling, before going to operation theatre I got chance to look at our embryos , at the OT , Dr Malpani was very friendly as always , he was talking to me for whole time to get me on ease .While talking he cleared many of my doubts regarding what should I do or not do after embryo transfer , he cleared all the myths which really set me on ease. I was transferred 4 beautiful embryos.

My decision of choosing Dr. Malpani was very easy , as back in mid eighties, there was big news in India Today magazine, for Doctor couple, “Young Achievers Dr Anirudh Malpani and Dr Anjali Malpani, a gift to infertile couples”, I was very inspired by them ,I never thought at that time that I will meet them and with their help I will be able to build my family. I am now 8 weeks pregnant and very thankful to Dr Malpani and his clinic and also have deep gratitude to my donor.

I found his web site extremely helpful , whenever I used to be in doubt and think what should I do , I just go to his web site and read the relevant topic and while reading I feel that I am talking to him in front of me. I used to get accurate information on his web site which clears all my doubts. I thank him for his contribution to the society for creating such informative resource. Also, I get very prompt and sincere reply for each of my email from Dr. Anirudh Malpani , no matter what the question is .

I understand that the journey of having baby for couple like us is very difficult , I will be happy if I could be of any help to my friends in making their decision, please email me at contactmg14@gmail.com.


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