Newsletter 5

KHETARPAL HOSPITAL

Newsletter VOL 02 NO. 02

JUNE 2009

LETTER FROM THE E D I T O R Let Your Self Belief Strengthen Every Day By Dr Anil Khetarpal, MS, FAIS, FACS, FICS, FIMSA There have been innumerable uncertainities at various junctures of our lives and we, somehow, manage to find a road ahead. Everyone experiences self-doubt at some point in our lives. For many people, self-doubt can be pervasive, even crippling. It can impact your relationships and may even destroy confidence. It causes procrastination or lack of effort. It can be extremely frustrating to live with the reverberating voice in your head telling you you're not good enough to do or have whatever you might want. Every day throughout the day, doubts creep in. You question everything from your worthiness and deservingness to your abilities. "Can I really do it? Will I be successful?" The day ends hoping for a reprieve only to have these same thoughts repeat tomorrow and the next day and the next.These thoughts have become habits and you have become their slave. This sounds ominous and it really is! It is very sad that for some reason we do this to ourselves. Much of what we say in the privacy of our minds we would never say to another human being. So what gives us the right to entertain these thoughts? There is no benefit to doubting yourself and questioning your ability to the point of not pursuing your dreams. Its only impact is to stop you from living bigger than you are. There is a huge cost to both the individual and to society at large for these negative remarks in your mind.You lose because you don't take risks, you're not as productive as you can be (all of those thoughts carrying negative inertia slow you down), and you are unhappy because deep down inside you know you can do more, be more, and contribute more to the surroundings. Your relationships are not as gratifying because you hide the best of YOU behind your wall of self-doubt, which has you questioning your desirability, your looks, your personality, your deservingness. Society loses because we don't reap the benefits from your talents and skills and abilities that you hide behind your wall of fear and doubt. Sometimes doubt can be beneficial when it causes us to question our direction : Can you really pull this off? Do you have the ability, the skills, and the capacity to complete the task? But doubt just because you lack faith in yourself won't nurture your success. If you are in your own way, learn ways to get out of your way so you can stop making excuses for not living your life the way you really want. Self-doubt is submerged in the cocoon of fear fear of your own greatness, fear of your own rejection or failure, fear of success. Learn to trust yourself again (or for the first time!). If you don't trust you, who will? If you cannot trust yourself, you will have difficulty trusting others, and others will have difficulty trusting you. Start doing little things to build your self-trust like following through with anything you commit to which means, you need to take your commitments seriously and honor your word. You will want to make good choices about what you commit to doing making sure you have the energy, resources, and time to do it.You might ask yourself "why" you are choosing this commitment. Is it out of fear of not being liked, being unable to say "no", or concern over what other people think? Or is it something you really want to do? By taking care in your sepchoices of how you use your time and then doing what you say, you start to have faith in you. Pay attention to your thoughts, as it is the great remedy. Over the course of many years, you have learned to doubt who you are and the choices you make.You may have learned these thoughts as a child or when you were involved in an old relationship or had a bad boss. Listen to the messages being played in your head. If the messages in your head are saying things to you that you would never say to another human being, then don't entertain them. You are a human being too! Without you what do you have? Become your own biggest fan! Be curious about how you think and your beliefs.What DO you value the most? And are you living in congruence with those values? Often we run on autopilot and the thoughts that drive our actions are based on what we have been taught to think or value, not what we choose to believe or value. By taking the time to consider what you value most and what you want to believe, you can observe your thoughts to see if they support your chosen beliefs and values or sabotage them and then you can choose new and better thoughts. Never, ever put yourself down, not even in the privacy of your own mind.Your negative thoughts are not serving you; they are hurting you.They serve no purpose except to keep you small and wishing for more in your life.You are a part of the universe, no less than the trees and the stars.You have a right to be here and you are amazing! Being human means that you will make mistakes. They are pointing you in the direction of the work you need to do, the things you didn't know you need to know, and teaching you humility.You have strengths and great assets and you have things that you're not so great at. Spend more time mastering the things you love and the things you are good at and your life will be easier and more fulfilled. When you take a wrong turn and you will learn from it, forgive yourself, and move on. By not forgiving yourself, you are abusing yourself by reliving the error over and over again.Thoughts of your past wrongdoing waste precious moments of today. Let go of your pain.There is no reason to hold onto it unless you enjoy the self-torture. Overcoming self-doubt means that you feel confident, comfortable in your own attire, and focussed in your future-proofvision. There is less to fear because you know that you're okay and that no matter what, you will make the right choice for you and if you don't, you learn to admit and overcome your mistake in sheer positivism.There are no mistakes really. When you stop doubting yourself at every turn, you let yourself off the hook from pretending to be something you're not. It feels good to feel okay being YOU.

Health Quotations

a piano, and "The body is like music. happiness is like ve the ha o t l dfu ee It is n order. od go in t instrumen ---------Beeche

proach so "In nothing do men ap in giving as s, d Go e th o t nearly ." health to men ----------Cicero

GUEST ARTICLE : CAN A DOCTOR REFUSE TO IMPART TREATMENT TO A PATIENT? Dr Manju Singh, MD (Medical Superintendent, Khetarpal Hospital) In this highly evolved and developed world of scientific innovations and increasing awareness regarding rights and duties of individuals everywhere, debates are organized concerning human rights with special reference to rights of the accused, rights of the victims, rights of the women, rights of the children, rights of prisoners and so on. With consumer cases against doctors on the rise, it is time to emphasize that medical professionals who perform their duties with devotion and sincerity too have their rights. Does a doctor has the right to decline treatment to patients? Yes, a doctor can express his denial or inability to impart treatment under following circumstances a) If the doctor himself is not keeping well or free. b) Doctor may refuse to give fresh treatment to a patient if he has had a bad experience in the past. c) He cannot be compelled to treat a patient in odd hours. That is at hours other than those ear-marked by him for his profession. d) There is no legal obligation to answer a call to visit the patient at his or her place of residence. e) Doctor treats a patient in emergency on ethical grounds.. It does not mean that he has accepted the patient. He may advise that patient to go to some hospital or a specialist for further treatment. f) If a patient does not agree with the method of treatment or fee asked, doctor may refuse to treat the patient. g) In his honest opinion, if a doctor feels that he is not in a position to treat a patient because of non availability of certain facilities, instruments, medicines, staff etc. he may refer the patient to a suitable place.

RECENT OUTCOMES IN PROSTATE CANCER STUDY Two Mayo Clinic patients whose prostate cancer had been considered inoperable are now cancer free thanks in part to an experimental drug therapy that was used in combination with standardized hormone treatment and radiation therapy. The men were participating in a clinical trial of an immunotherapeutic agent called MDX-010 or ipilimumab. In these two cases, physicians say the approach initiated the death of a majority of cancer cells and caused the tumors to shrink dramatically, allowing surgery. In both cases, the aggressive tumors had grown well beyond the prostate into the abdominal areas. "The goal of the study was to see if we could modestly improve upon current treatments for advanced prostate cancer," says Eugene Kwon, M.D., Mayo Clinic urologist and leader of the clinical trial. "The candidates for this study were people who didn't have a lot of other options. However, we were startled to see responses that far exceeded any of our expectations." The patients first received a type of hormone therapy called androgen ablation, which removes testosterone and usually causes some initial reduction in tumor size. Researchers then introduced a single dose of ipilimumab, an antibody, which builds on the anti-tumor action of the hormone and causes a much larger immune response, resulting in massive death of the tumor cells. Both men experienced consistent drops in their prostate specific antigen (PSA) counts over the following weeks until both were deemed eligible for surgery. Then, during surgery, came a greater surprise. "The tumors had shrunk dramatically," says Michael Blute, M.D., Mayo urologist, coinvestigator and surgeon, who operated on both men. "I had never seen anything like this before. I had a hard time finding the cancer. At one point the pathologist (who was working during surgery) asked if we were sending him samples from the same patient." One patient underwent radiation therapy after surgery; both have resumed their regular lives. Further research is being planned to understand more about the mechanisms of the antibody and how best to use the approach in practice. The researchers, however, note the significance of their findings. The research was supported by the Department of Defense, The Richard M. Schulze Family Foundation, the Mayo Clinic Cancer Center and the Mayo Clinic Center for Translational Science Activities. Medarex, Inc. provided the study drug free of charge and supported safety monitoring during the protocol. Source: Mayo Clinic

NEWER TESTS FOR EARLY DIAGNOSIS OF GASTROENTERITIS CAUSES Oxoid, a world leading microbiology brand, is pleased to announce that the ProSpecT™ range of qualitative enzyme immunoassays has recently been extended to include test kits for Adenovirus, Astrovirus, Clostridium difficile, Campylobacter, Cryptosporidium, Entamoeba histolytica, Giardia, Giardia/Cryptosporidium, Rotavirus, Shiga Toxin Escherichia coli. These easy-to-use, diagnostic tests for enteric infectious disease (gastroenteritis), caused by bacteria, viruses and parasites, require minimal hands-on time, are suitable for automated protocols (DSX™ and Triturus®) and provide results in less than 2 hours. The test kits have common substrate, wash buffer and stop solution, plus colour-coded kit-specific components for ease of handling. Gastroenteritis is an inflammation of the stomach and intestines. The main symptom is diarrhoea, with other symptoms, such as abdominal pain, cramping, nausea and vomiting, also seen. The diarrhoea and vomiting can lead to patients, particularly young children and the elderly, rapidly becoming dehydrated. Although many cases do not require hospitalisation, it is estimated that gastroenteritis causes 5-10 million deaths per year worldwide1. Gastroenteritis may be caused by viral, bacterial or parasitic infections, with the most common routes of infection being food, contaminated water or contact with an infected person. Although anyone may become infected, people at a higher risk include young children, the elderly, immunocompromised people and travellers. Rapid, differential diagnosis of the cause of infection is important, both for patient treatment and appropriate infection control measures. ProSpecT tests are quick and easy to perform, giving sensitive and specific results for the majority of causes of gastroenteritis. Oxoid is part of Thermo Fisher Scientific Inc., the world leader in serving science.

Source Thermo Fisher Scientific

Hospital News Plan to get ISO 14001 and OHSAS Certifications in near future along with NABH accreditation

Case Report

Laparoscopic Sigmoid Resection for Well Differentiated Adenocarcinoma

A 36 year old man presented to this hospital in June 2009 with presenting concerns of pain abdomen (vague in nature with no radiation and poorly localized. Mostly towards lower abdomen and required moderate dosages of analgesics to show a transient relief), constipation, spurious diarrhoea for 1 month. No bleeding by the passage of rectum, no significant weight loss, unexplained lumps, loss of appetite, prolonged fever. No H/O Hypertension, Diabetes mellitus, Chronic obstructive airway disease, Pulmonary Koch’s, Seizure disorder. H/o Coronary artery disease/ Unstable angina/ Old Myocardial infarctioni (Anterior wall)/ PTCA to LAD in 2006, Coronary angiography done in June 08 (Post PTCA stented LAD, artery non critical in stent stenosis, Right coronary artery and Left Circumflex artery normal) Mixed in dietary preferences and leading an active life style with good exercise tolerance. General examination revealed patient to be conscious, co-operative and oriented with pleasing personality. Pallor present. No icterus, clubbing, cyanosis, pedal oedema, lymphadenopathy. JVP not raised. Vital parameters within normal limits. Systemic examination revealed normal findings for cardiovascular examination, respiratory examination, neurological examination. Abdominal examination revealed Mild tenderness and presence of an ill-defined vague lump over left lumbar region with firm to hard consistency and irregular margins. Ultrasonogram (Abdomen) done which suggested presence of thickened bowel loops, following which Contrast enhanced CT Scan done which showed 6 cm long circumferential thickening of sigmoid colon with luminal narrowing with stranding of pericolic fat with 2-3 subcentimetric lymphadenopathy. Sigmoidoscopy carried out which revealed growth from 30 cm of anal verge (ulcerated, fungating, circumferential, compromising the lumen) with hemorrhoids. Biopsy from the growth taken and histopathological examination showed it to be well differentiated adenocarcinoma. Routine hematological parameters showed presence of anemia (microcytic, hypochromic type) with Hb, 6.7 mg/dl. Rest of the parameters including TLC, DLC, LFT, KFT, Coagulation Profile were within normal limits. Patient was decided to be put under surgical intervention to carry out resection of the affected region of sigmoid colon. Patient and relatives well interpreted the need and mode of definitive treatment modality and informed consent obtained. 2D Echocardiogram done which revealed Left ventricular ejection fraction to be 45% and ECG showed changes pertaining to old anterior wall MI with no fresh deterioration. Pre anesthetic check up done in terms of neecssary diagnostic tests and detailed physical examination and patient considered to be fit for surgery. TNM Staging was T3N1M0 making it to Stage 3. Under general anesthesia, laparoscopic resection of carcinoma sigmoid with anastomosis done successfully using double port technique and a modified incision. Post opertaively, patient kept in ICU for a close watch and optimum monitoring. Calculated dosages of intravenous fluids given with a combination of broad spectrum antibiotics covering gram negative and positive bacteria with anerobic organisms were imparted under strict vigilaance of battery of intensivists and physicians. Patient’s recovery was remarkable and ryle’s tube taken out 3rd post operative day. Patient maintained adequate hydration and urinary output was satisfactory. There were no systemic or cardiac complications (early or intermediate) and orally liquids were commenced soon after, which was tolerated well. Patient discharged in stable and improved general condition on 7th post operative day with instructions regarding keeping up future follow up sessions, chemotherapy schedule and other necessary instructions. *In 1991, Fowler and White performed one of the earliest laparoscopic sigmoid resections (LSRs). Laparoscopic resection in patients with sigmoid carcinoma is safe, with faster recovery and shorter hospital stay compared with conventional open surgery. Operative time for laparoscopic sigmoid colectomy is decreasing as surgeons gain more experience. Laparoscopic Colectomy for colon carcinoma results in less estimated blood loss, shorter time to first bowel movement and less postoperative complications. Laparoscopic colectomy also found to be cost-effective means of electively managing sigmoid colon carcinoma. This operative approach is important in an era of increasing constraints on hospital occupancy rates and access to nursing services in many regions of the country. In a outcomes comparison based on large nationwide databases, laparoscopic sigmoid resection in patients with sigmoid carcinoma disease has statistically and clinically significant advantages over open sigmoid resection with respect to the length of hospital stay, rate of routine hospital discharge, and postoperative in-hospital morbidity.

In a Lighter Vein :

In a Lighter Vein :

A patient complained to his doctor, "I've been to three other doctors and none of them agreed with your diagnosis." The doctor calmly replied, "Just wait until the autopsy, then they'll see that I was right."

IN A LIGHTER MODE

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CONTRIBUTORS Editor In Chief Dr Anil Khetarpal Assistant Editors Dr Manju Singh Dr Darshana Associate Editor Dr Smita Khetarpal Co Ordinator Dr Kamal Singh Editorial Advisory Board Dr S P Bajaj Dr S K Jain Dr Rakesh Nathani Dr Manoj Sareen Production Director Mrs Renu Khetarpal Design Head Mr Fazal

A man wakes up in a hospital bed after a terrible accident and cries "DOC, DOC...I can't feel my legs, I can't feel my legs!!! "Well of course you can't silly!", replies the Doc... "I've cut off both of your arms."

The Hippocratic Oath (Modern Version) I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation. TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient. WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life. WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient. WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret. WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot. Minimal Access General Surgery . Laparoscopic Hernia Repair . Laparoscopic Assisted Vaginal Hysterectomy . Total Laparoscopic Hysterectomy . Laparoscopy For Gall Bladder Stone . Laparoscopic Removal Of Ovarian Cyst . Laparoscopic Bariatric Surgery . Diagnostic Laparoscopy . PCNL . URS . Extra Corporeal Shockwave Lithotripsy . Flexible Ureteroscopy . Laparoscopic Splenectomy . Laparoscopic Appendectomy . Minimally Invasive Procedure For Piles . Endoscopic Spine Surgery . Malignancy Surgeries . Specialities . Anesthesia and Pain Clinic . Andrology . Psychiatry and Deaddiction . Neurology . Gastroenterology . Endocrinology . General Medicine . Cardiology . Opthalmology . Pulmonology . Paediatrics . Maternal and Child Health .Nephrology . Immunology . Rheumatology .Oncology . Geriatrics . Dermatology and Venereal Diseases . Bone and Joint Relacement . Arthroscopy . Cardiothoracic and Vascular Surgery . Neurosurgery . Endocrine Surgery . ENT Surgery . Cosmetic and Aesthetic S u r g e r y . I n f e r t i l i t y C l i n i c . S t r o k e C l i n i c . U r o g y n a e c o l o g y

KHETARPAL HOSPITAL

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Multi Disciplinary Super Specialty Hospital

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Center of Excellence for all Laparoscopic, Endoscopic and Bariatric Surgeries F-95,Bali Nagar,Najafgarh Road,New Delhi

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An emblem of excellence, driven by ethical values WEBSITES infused with competency of highest standards to www.khetarpalhospital.com impart dedicated patient care. Founded in 1992 with a vision to provide world class care to www.delhiobesitycenter.com E MAIL everyone, Khetarpal Hospital has continually [email protected] escalated its stature by adapting and innovating newer technologies and adding dimensions to [email protected] absolute patient care with inimitable outcomes.