The type 1 Diabetic I mentioned in A Strange Interview married that guy.I was specially invited for that marriage. It was on a working day and I excused myself.Send a greetings instead. I had 2 reasons for not attending the marriage. The obvious reason is I was busy as all doctors are. The other reason which I thought is some thing entirely different.I am not sure it is correct. Going to a gathering where I am invited because I am the doc treating the bride's illness may highlight the fact of her illness among even those who do not know it. I did not want that.
The marriage was almost a year ago. 10 days ago she called saying her blood sugars are unusually high.I asked her to come and see me. There was nothing wrong on examination.Then I asked her about her menstrual periods. She is late by few days.As her periods were irregular how late she did not know. I asked for a Urine Pregnancy test. It was positive.Yes she was Pregnant. I was happy but also worried that from now onwards extra care have to be taken to ensure a normal pregnancy and delivery. Her HbA1c was 6.9, which is fairly good.I am hoping for an uneventful pregnancy.
Friday, September 5, 2008
Thursday, September 4, 2008
Fasting Season
During the last week of August my out patients were mainly Muslims getting ready for traditional fasting during the month of Ramadan.As I was out of station also for some days my hands were full with patients.
Most of them are regular patients who wanted my guidance and approval before starting fasting. They want their blood sugar,Cholesterol and Blood pressure checked. They wanted my advise regarding timing of medication. As they fast from day break to Sunset medicines have to be taken late evening and early morning. Most of them are happy when I tell them they can fast. Some sick old people who may not be able to with stand fasting have to be told no. Some times they insist and then I will say try for few days, and if you feel sick stop.
Some patients I see only just before fasting season. They will be Diabetic or having high blood pressure. They never come for follow up visits even though they are taking medicines. They come during this time because they also want a reassurance that they can fast.Their face will show guilt as I ask where were you all this time. After hearing my lecture regarding the importance of frequent blood testing and follow up visits some may change their habits. But many in this group I am sure will come only next year.
From the experience of last 10 years I know that I cant change everybody.
Most of them are regular patients who wanted my guidance and approval before starting fasting. They want their blood sugar,Cholesterol and Blood pressure checked. They wanted my advise regarding timing of medication. As they fast from day break to Sunset medicines have to be taken late evening and early morning. Most of them are happy when I tell them they can fast. Some sick old people who may not be able to with stand fasting have to be told no. Some times they insist and then I will say try for few days, and if you feel sick stop.
Some patients I see only just before fasting season. They will be Diabetic or having high blood pressure. They never come for follow up visits even though they are taking medicines. They come during this time because they also want a reassurance that they can fast.Their face will show guilt as I ask where were you all this time. After hearing my lecture regarding the importance of frequent blood testing and follow up visits some may change their habits. But many in this group I am sure will come only next year.
From the experience of last 10 years I know that I cant change everybody.
Monday, September 1, 2008
A mood elevating patient
It was Monday,the beginning of a busy week. My mood as I entered my consulting room was not good.May be the morning blues.Or depressed thinking about a week full of work ahead.
First 2 patients came in and went out.My mood remained the same.
Then walked in[or literally carried in by his son] a retired school teacher.He is above 80. He is a regular patient of mine for last 4 years.He is suffering from Type 2 Diabetes,Benign prostatic enlargement,Osteoarthritis etc etc. Regularly he becomes sick when I am out of station. This time it happened again. He tried to contact me for a trivial cold. He could not as I was away for a week.This made him restless.His sleep was reduced.Then he started running a temperature.The son took him to another doc the next day. Medicines were prescribed.The symptoms were reduced but he was not satisfied.
He held my hand and told me he is so happy seeing me. He said he do not feel good.There is no appetite or sleep. He was afraid he will die before I came back.The son remarked that the illness actually started when his Dad heard I am out of station and now he will become all right soon.
I examined him and then reassured him that he is only having a mild cold.I also told him I won't go anywhere next 2 months. He did not leave my hand for a long time.
The faith and love that the old man had for me made me happy and I began smiling again.My blues were forgotten.
First 2 patients came in and went out.My mood remained the same.
Then walked in[or literally carried in by his son] a retired school teacher.He is above 80. He is a regular patient of mine for last 4 years.He is suffering from Type 2 Diabetes,Benign prostatic enlargement,Osteoarthritis etc etc. Regularly he becomes sick when I am out of station. This time it happened again. He tried to contact me for a trivial cold. He could not as I was away for a week.This made him restless.His sleep was reduced.Then he started running a temperature.The son took him to another doc the next day. Medicines were prescribed.The symptoms were reduced but he was not satisfied.
He held my hand and told me he is so happy seeing me. He said he do not feel good.There is no appetite or sleep. He was afraid he will die before I came back.The son remarked that the illness actually started when his Dad heard I am out of station and now he will become all right soon.
I examined him and then reassured him that he is only having a mild cold.I also told him I won't go anywhere next 2 months. He did not leave my hand for a long time.
The faith and love that the old man had for me made me happy and I began smiling again.My blues were forgotten.
Saturday, August 30, 2008
A strange interview
It happened some time ago. She is a 31 yr old Type 1 Diabetic patient of mine. She called me up one day saying a guy will come to see me asking about her health condition. He is her prospective bride groom. The families contacted through a matrimonial ad. He had met her and her family. Now he wants to know how healthy she is.
In India most of the time it is the family/parents who search and find partners for their sons and daughters.[Things are changing but slowly] The parents of my Type 1 patient were in search of a bridegroom for some years now. She had called me before also, saying a guy or his parents may come and ask about her. But nobody had come to me yet.She had a stable and well paying Govt job and this had attracted many suitors.Still her T1 status might have dissuaded her prospective grooms. As far as I know she had said no to one or two suitors too.
He called me 2 or 3 times on phone before fixing a suitable time to see me. He was a serious looking guy, little bald may be around 35 years. He introduced himself and mentioned the name of my patient[his proposed bride].
We were silent for sometime.Then I started interviewing him.He is only having a temporary job in a Company,but his family had some agricultural land and according to him are financially stable.
He did not knew how to start his questions.I helped him by asking what he want to know.
How serious is her Diabetes?
Will she need Insulin through out her life?
Can she become pregnant and deliver children?
Will the children inherit her Diabetes?
Some how I thought this Guy is nice and dependable. I wanted my patient to get a good partner.So the picture of her health status that I presented to him was very positive.
Yes, she needs Insulin through out her life.Her body is not producing Insulin,a hormone essential for Sugar metabolism. We are injecting it so that she can live normally.
She have no other defect.
She can become and pregnant deliver normal children.
Finally I also added that she is having the best blood sugar control among my Type 1 patients.
I had a feeling that he was satisfied and happy. She came the next day and wanted to know everything.I told her in detail.Then she asked me 'How you feel about him?' I said I felt he is nice and dependable. She looked at my face intently and I gave her a reassuring smile.
In India most of the time it is the family/parents who search and find partners for their sons and daughters.[Things are changing but slowly] The parents of my Type 1 patient were in search of a bridegroom for some years now. She had called me before also, saying a guy or his parents may come and ask about her. But nobody had come to me yet.She had a stable and well paying Govt job and this had attracted many suitors.Still her T1 status might have dissuaded her prospective grooms. As far as I know she had said no to one or two suitors too.
He called me 2 or 3 times on phone before fixing a suitable time to see me. He was a serious looking guy, little bald may be around 35 years. He introduced himself and mentioned the name of my patient[his proposed bride].
We were silent for sometime.Then I started interviewing him.He is only having a temporary job in a Company,but his family had some agricultural land and according to him are financially stable.
He did not knew how to start his questions.I helped him by asking what he want to know.
How serious is her Diabetes?
Will she need Insulin through out her life?
Can she become pregnant and deliver children?
Will the children inherit her Diabetes?
Some how I thought this Guy is nice and dependable. I wanted my patient to get a good partner.So the picture of her health status that I presented to him was very positive.
Yes, she needs Insulin through out her life.Her body is not producing Insulin,a hormone essential for Sugar metabolism. We are injecting it so that she can live normally.
She have no other defect.
She can become and pregnant deliver normal children.
Finally I also added that she is having the best blood sugar control among my Type 1 patients.
I had a feeling that he was satisfied and happy. She came the next day and wanted to know everything.I told her in detail.Then she asked me 'How you feel about him?' I said I felt he is nice and dependable. She looked at my face intently and I gave her a reassuring smile.
Friday, August 29, 2008
Who profits from illness?
The other day I was travelling with an Indian guy settled in US.He is a retired person aged about 60 years.He has been in US for last 35 years. He had come to India for attending a marriage of one his nephews.After the customary lamentations about the 'dismal' situation in India our chat turned to the subject of health care in USA.
He said recently he had to do an emergency surgery for Piles in USA and it cost him about 20000 US dollars. I first thought I heard him wrongly.In India for 20000$ a person can replace both his knees and do a coronary bypass surgery.I asked him again and he said Yes the bill was for twenty thousand dollars.He also added that his Insurance Company payed only 6000$.He is paying the rest from his pocket in instalments.
Then I said the doctors in US must be having handsome earnings as the patients have to pay so much. He said only a few docs have good savings. He revealed that his son is a Doctor and is still paying off his debts incurred while studying even though he passed out 5 years ago.
So who profits from the illness among common people? May be Insurance companies,Drug Companies,Corporate Hospitals etc. Is there any way out so that quality health care is easily affordable to all?
He said recently he had to do an emergency surgery for Piles in USA and it cost him about 20000 US dollars. I first thought I heard him wrongly.In India for 20000$ a person can replace both his knees and do a coronary bypass surgery.I asked him again and he said Yes the bill was for twenty thousand dollars.He also added that his Insurance Company payed only 6000$.He is paying the rest from his pocket in instalments.
Then I said the doctors in US must be having handsome earnings as the patients have to pay so much. He said only a few docs have good savings. He revealed that his son is a Doctor and is still paying off his debts incurred while studying even though he passed out 5 years ago.
So who profits from the illness among common people? May be Insurance companies,Drug Companies,Corporate Hospitals etc. Is there any way out so that quality health care is easily affordable to all?
Friday, August 22, 2008
Type 2 or Type 1 Diabetes? Not sure yet
The 12 yr old girl with Diabetes about whom I posted few days ago came with her lab reports. The C peptide level was in the upper range of normal.It means considerable amount of Insulin is being secreted from her Pancreas.
Does it mean she is having Type 2 Diabetes? We cannot be sure yet. There is something called 'honey moon' period in Type 1 Diabetes where the patient's requirement of Insulin injections will be less or even nil. That does not mean the patient is not suffering Type 1 Diabetes. After such honey moon period which lasts for few months the Insulin requirement will increase and the patient will show all features of Type 1 Diabetes.
Let us hope it is not Type 1 Diabetes but only time will tell.Meanwhile I have started her on Oral tablets in addition to Insulin.Let us see the response.
Does it mean she is having Type 2 Diabetes? We cannot be sure yet. There is something called 'honey moon' period in Type 1 Diabetes where the patient's requirement of Insulin injections will be less or even nil. That does not mean the patient is not suffering Type 1 Diabetes. After such honey moon period which lasts for few months the Insulin requirement will increase and the patient will show all features of Type 1 Diabetes.
Let us hope it is not Type 1 Diabetes but only time will tell.Meanwhile I have started her on Oral tablets in addition to Insulin.Let us see the response.
Friday, August 15, 2008
Patient loyalty
Some patients are very loyal to their doctor. They hate seeing another doctor. They will believe only if their favourite doctor tells them, but their loyalty land them into trouble sometimes.
A patient of mine, a 50-year-old diabetic, developed sweating and mild chest pain. As I was away for a day, he consulted another doctor. An Electrocardiogram (ECG/EKG) was done and the doctor found some changes suggestive of early heart attack. The patient was asked to get admitted in an Intensive care Unit. Not believing the doctor, the patient waited for a day to see me. That night the patient became worse and he died on way to Hospital.
Being a one man practise, many a time it is difficult for me to arrange substitute medical care when I am out of station. Though I tell them to see the nearest available doctor in case of emergency, many are reluctant. When I come back from a break of few days many of these loyal patients accuse me of orphaning them. Their affection make me feel good ,but at the same time the accusation make me feel guilty.
A patient of mine, a 50-year-old diabetic, developed sweating and mild chest pain. As I was away for a day, he consulted another doctor. An Electrocardiogram (ECG/EKG) was done and the doctor found some changes suggestive of early heart attack. The patient was asked to get admitted in an Intensive care Unit. Not believing the doctor, the patient waited for a day to see me. That night the patient became worse and he died on way to Hospital.
Being a one man practise, many a time it is difficult for me to arrange substitute medical care when I am out of station. Though I tell them to see the nearest available doctor in case of emergency, many are reluctant. When I come back from a break of few days many of these loyal patients accuse me of orphaning them. Their affection make me feel good ,but at the same time the accusation make me feel guilty.
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