May 17  2015, Sunday
editorial
Beware of Synthetic Milk
Dr KK Aggarwal
  • It is not milk.
  • It is made up of urea, caustic soda, refined oil (cheap cooking oil) and common detergents.
  • Detergents are used as they emulsify and dissolve the oil in water giving the frothy solution, the characteristic white colour of milk. Refined oil is used as a substitute for milk fat. Caustic soda is added to the blended milk to neutralize the acidity and preventing it from turning sour during transport. Urea/sugar are added for solid–not–fat (SNF), to provide whiteness in milk and natural milk taste.
  • It looks like natural milk, except in taste and nutritional qualities.
  • It is normally mixed with milk and then sold in the market.
  • It is carcinogenic in humans.
  • Urea and caustic soda can harm liver and kidneys.
  • Caustic soda with high sodium content is harmful for patients with high blood pressure.
  • Caustic soda also deprives the body from utilizing lysine, an essential amino acid in milk, which is required by growing babies.
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Heart Care Foundation of India, a leading national non-profit organization celebrated World Earth Day jointly with Indian Medical Association, the Ministry of Earth Sciences, Govt. of India
News
  • The North Corporation has threatened to invoke the Essential Services Maintenance Act against doctors and class-4 employees who have decided to go on mass casual leave (Deccan Herald).
  • Injectable testosterone is associated with a higher short-term risk of cardiovascular events compared with testosterone gel or patch formulations. The study is published online May 11 in JAMA Internal Medicine.
  • Psychiatrists from around the world will head to the Great White North (aka Canada) this weekend to attend the American Psychiatric Association (APA) 168th Annual Meeting in Toronto.
  • New European and Latin American guidelines on the use of noninvasive tests for liver evaluation are the first to specifically address an approach that has become the standard in much of the developed world, but has been slower to take hold in the United States.
  • New guidelines from the American Thoracic Society address crucial decision-making regarding the care of patients with critical illness. The policy statement aims to prevent conflicts and ensure cooperation between medical staff and family caregivers. The guidelines are published in the June 1 issue of the American Journal of Respiratory Research and Critical Care Medicine.
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Dr KK Spiritual Blog
How to Finish your Pending Work?
  1. This involves principles of time management including some Vedic principles.
  2. The first thing to do is to make a checklist of all the pending work by writing it down and re–categorizing them depending upon the urgency and importance.
  3. Pending work can be classified under following four sections:
    • Urgent and important: Should be done immediately.
    • Important but not urgent: Should be scheduled as per the time available
    • Urgent but not important: This work should be delegated to others
    • Not important and not urgent: One should learn to say no and dump it
  4. Urgency of the work is decided by the deadlines available.
  5. The importance of the work is decided by directing the result of the work to the mind, body or the soul. One should see whether the result of the work gives pleasure to the body, mind or the soul. The one that gives pleasure to the soul will be free of fear or guilt.
  6. When choosing between simple or difficult tasks, choose the difficult first so that you do not carry them back home in the mind. In terms of importance, difficult files are more important than simple files.
  7. When choosing right versus convenient action, give priority to the right action and not the convenient action.
  8. Delegation of work: Team work is very important.
  9. When deadlines are available, it is always better not to keep the work just near the deadlines.
  10. Anticipate delay and keep time for unforeseen movements.
  11. Work is work and not something personal.
  12. Always remember the spiritual principle that you get what you deserve and not what you desire. So never associate yourself to the results of your actions.
  13. Yoga, pranayama, afternoon naps and meditation help to prioritize your work.
  14. Follow the principles of creativity and learn to take breaks in between the work so that the mind is relaxed and can take soul boosting decisions.
  15. Remember, Yudhishthir never kept anything pending for tomorrow. This way you can have a fearless, undisturbed sleep.
  16. Organizing your pending list always helps.
  17. Do not waste time on learning material on which you are already an expert.
  18. Take advantage of down time. If you find free time in your ro utine, then convert it into a creative time so that you can plan strategies or do something new.
  19. Always get up at the same time and never disturb your sleep time.
Cardiology eMedinewS
  • For years and years, physicians have told patients with atrial and ventricular arrhythmia to forgo the pleasures of chocolate and coffee. A study presented during a featured poster session at the Heart Rhythm Society 2015 Scientific Sessions suggests otherwise. Consumption of healthy caffeinated products like coffee, tea, and chocolate consumption were not associated with PAC or PVC frequency.
  • According to a new study in the journal Circulation: Cardiovascular Interventions, patients who quit smoking at the time of undergoing angioplasty may benefit much more from the procedure than those who continue to smoke.
Pediatrics eMedinewS
  • A new study led by McGill University in Canada suggests that babies prefer listening to other babies rather than adults as they get ready to produce their own speech sounds. In the study, published in the journal Developmental Science, researchers observed that when the vowel sounds the babies listened to sounded more baby-like (for instance, higher pitch), the infants aged from 4-6 months paid attention longer than when the sounds had more adult-like vocal properties.
  • Having a regular bedtime routine is associated with better sleep in young children up to 6 years of age, and the positive impact on sleep increases with the consistency of the nightly routine. Results of this multicenter study are published in the May issue of the journal Sleep.
Make Sure
Situation: A patient of dengue with pulse pressure of 20 died
Reaction: Oh my God! Why was fluid resuscitation not given in time?
Lesson: Make sure to remember that dengue patients need fluid resuscitation and not platelet resuscitation.
Dr Good Dr Bad
Situation: A patient with dengue was found to be malaria positive

Dr Bad: This diagnosis is incorrect

Dr Good: The diagnosis is correct

Lesson: Malaria and dengue coinfection can occur.

(Copyright IJCP)
Inspirational Story
If and When

IF and WHEN were friends. Every week they met and had lunch. Their conversation usually centered on all the things they were going to achieve. They both had many dreams and they loved to talk about them.

This particular Saturday when they met, WHEN sensed that IF was not in a great mood. As usual they sat at the table reserved for them and ordered their lunch. Once they placed their order, WHEN questioned IF. "IF what is wrong with you? You don’t seem your usual cheery self?"

IF looked at WHEN and replied, "I’m not sure; I just don’t feel like I am making any progress. This last week I saw a course I wanted to take if only I had the time to take it."

WHEN knew exactly how IF felt. "Yeah," replied WHEN, "I too saw a course and I am going to register when I get enough money together." WHEN then said, "Well what about that new job you were going to apply for. You were so excited about it last week, did you apply?"

IF responded, "If my computer didn’t break down last week, I would have applied. But, my computer is not working, so I could not type my resume."

"Don’t worry about it IF, when you are ready another job will come through. I have been thinking about looking for another job also, but I will wait and when the weather gets nicer I will look then." WHEN then went on to tell IF about his week, hoping that it would cheer him up a bit.

The man at the next table couldn’t help overhear WHEN and IF. They both were talking about when this and if that, finally he couldn’t take it anymore.

"Excuse me gentlemen," the man said. IF and WHEN both looked at the man and wondered what he wanted? The man continued, "I’m sorry, but I couldn't help hearing your conversation. I think I know how you could solve your problems."

IF smiled and thought, how could a complete stranger know how to solve all of their problems? If only he knew. When he realized the challenges they faced there was no way he could solve their problems! Curious, IF asked the gentleman, "How do you think you can solve our problems?"

The gentleman smiled and said, "You only need listen to yourselves. It reminds me of an old proverb: ‘If and When were planted, and Nothing grew’."

IF and WHEN looked puzzled. The gentleman smiled and said, "Start counting how many times you use the words ‘if’ and ‘when’. Rather than thinking ‘if and when’, start doing, take action, stop talking about ‘if and when’."

IF and WHEN both looked surprised, and suddenly realized that what the gentleman had said was so true. Both of them were guilty of thinking, acting and living their life for the "ifs and when’s".

The gentleman left and IF and WHEN’s conversation changed. They made a pact that when they met for lunch next week, there would be no "ifs and when’s"; they would only talk about what they accomplished!
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Wellness Blog
Plate Your Food Now

A ‘Food Plate’ symbol has replaced the traditionally recommended ‘Food Pyramid’ of the USDA. These guidelines break down a healthy diet into 4 main quadrants on a plate: red for fruits, green for vegetables, orange for grains and purple for protein. A small blue circle attached to the plate signifies dairy products.

Fruits and vegetables occupy half of the plate space, with the vegetable portion being a little bigger than the fruit section. Eating more fruits and vegetables means consumption of fewer calories on the whole, which helps to maintain a healthy body weight. Fruits and vegetables are also a rich source of fiber along with vitamins and minerals.

The other half is divided between grains and proteins. Grains, with emphasis on whole grains make up one quarter of the plate. Protein is a smaller quarter of the plate. The recommendation is to aim to eat different kinds of protein in every meal.

In a major shift from the food pyramid, the Plate does not mention the number of servings for any food group or portion size. Nor does it mention fats and oils.

Remember the following tips for a healthy meal:
  • Eat less and enjoy your food by eating slowly
  • Fill half your plate with fruit and vegetables.
  • Avoid oversized portions which can cause weight gain.
  • At least half of your grains should be whole grains.
  • Reduce intake of foods high in solid fats and/or added sugar.
  • Use fat–free or low fat milk and/or dairy products.
  • Drink plenty of water. Avoid sugary drinks.
  • Avoid foods that have high sodium levels such as snacks, processed foods.
  • Above all, balance your food choices with your activity level.
eMedi Quiz
You’ve had yeast infections before, but in the past year they haven’t really gone away. This could be a sign of:

A. Diabetes
B. Emphysema
C. Stomach ulcers
D. Depression
E. Food allergies

Yesterday’s Mind Teaser: Which of the following is not fermented by colonic bacteria?

a) Lignin
b) Pectin
c) Cellulose
d) None of above

Answer for yesterday’s Mind Teaser: a) Lignin
Correct Answers received from: Dr Poonam Chablani, Tukaram Pagad, Dr Avtar Krishan.
Answer for 15th May Mind Teaser: B. Heart disease.
Correct Answers received: Dr.K.V.Sarma, Daivadheenam Jella, Dr Prabodh K Gupta, Dr Avtar Krishan, Dr Madhusudhan G.
eMedinewS Humor
If a lion is chasing you

Teacher: If a lion is chasing you, what would you do?

Student: I'd climb a tree. Teacher: if the lion climbs a tree?

Student: I will jump in the lake and swim.

Teacher: if the lion also jumps in the water and swims after you?

Student: Teacher, are you on my side or on the lion’s?
Quote of the Day
Once you start a working on something, don't be afraid of failure and don't abandon it. People who work sincerely are the happiest. Chanakya
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Rabies News (Dr A K Gupta)
Do antibodies from rabies vaccination cross an intact blood–brain barrier?

No. Antibodies from vaccination do not cross an intact blood–brain barrier.
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CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF
eIMA News
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Mission Clean India initiative by Alkem & IMA
IMA HQ is supporting the National Clean India movement by Alkem Chronic taking place across 135 cities on Saturday, May 23rd, 2015.

Over 20,000 doctors and 3 lakh patients to join Clean India movement Alkem Chronic & IMA in 135 cities.

A clean India will deliver a healthy India; join the mass cleanliness drive in your city on Sat, May 23 from 9:30 – 11 am.

To know about the assembly points for the Mission Clean India initiative by Alkem & IMA please visit:

http://module.ima-india.org/ima
IMA Swatch Bharat Swasthya Bharat Campaign: Safe water hygiene
Patients on hemodialysis patients are especially vulnerable to contaminants in the water used to prepare concentrate and dialysis fluid.

No municipal water can be considered safe for direct use in hemodialysis applications. All dialysis facilities therefore require a properly designed and maintained water treatment system to safeguard patients.

Reverse osmosis is the most commonly used process to minimize risk of chemical contaminantion to the dialysis patient.

Reverse osmosis

In reverse osmosis, water is forced across a semipermeable membrane by high pressure (200 to 250 pounds per square inch (PSI)). Reverse osmosis alone or in combination with deionization is used in around 98% of water treatment systems used for hemodialysis applications.

Although the capital cost is relatively high, reverse osmosis offers the following advantages:
  • Low operating costs
  • Essentially unlimited capacity for contaminant removal
  • Effective removal of a wide range of inorganic and organic contaminants
Reverse osmosis membranes filter out dissolved inorganic elements, such as ions of metals, salts, and chemicals, and organic elements, including bacteria, endotoxins and viruses. The most commonly used reverse osmosis membrane for hemodialysis applications is made of polyamide.

The effectiveness with which reverse osmosis membranes filter out water contaminants depends upon characteristics of the contaminant, including particle charge and size.

Reverse osmosis does not remove chlorine or monochloramine (which are added to municipal water supplies and are thus common contaminants of dialysis water supplies).

Ionic contaminants are more effectively filtered, compared with neutrally charged particles.

Approximately 95 to 99 percent of charged ionic particles are filtered out by the reverse osmosis membrane.

Polyvalent ions are more readily rejected by the membrane than monovalent ions. The removal of organic contaminants by the reverse osmosis membrane is largely based on size; organic contaminants with molecular weight >200 kDa are effectively filtered out.

Exposure to contaminants such as chlorine and chloramine or to high concentrations (>1 percent) of peracetic acid, if used as a disinfectant can cause oxidation and degradation of the reverse osmosis membrane, which should be prevented. Carbon beds are usually installed in series before a reverse osmosis unit in order to remove chloramines.

Reverse osmosis systems are operated in a cross-flow mode, meaning that the feed-water stream flows parallel to the membrane.

The high transmembrane pressure gradient forces water across the membrane to form product water (i.e., permeate).

The remaining feed water carries the concentrated contaminants to the drain in the reject water. Typically, in a single-pass system, the product-water flow is approximately 30 to 50 percent of the feed-water flow and is highly dependent upon the feed-water temperature.

Double-pass reverse osmosis involves reprocessing the permeate from the first-stage membrane through a second membrane stage and offers enhanced permeate production and minimizes water usage.

(Source: Uptodate)
Specialist Doctors/Primary Care Physicians for humanitarian help to earthquake affected Nepal
Dear Sir The IMA (HQs) representing medical professionals across the country and its members are deeply concerned about the loss of human life and despair following the natural calamity that took place in Nepal. Several hundreds have died and thousands have been injured. The President, the Honorary Secretary General of Indian Medical Association (HQs) and the Disaster Management Cell of the Indian Medical Association (HQs), deputed a team of Specialist Doctors / Primary Care Physicians to treat the injured and save the life of affected. The pilot team was led by Padma Shri Awardee Dr Ashok Gupta along with a group of dedicated Specialist Doctors / Primary Care Physicians. Tremors and aftershocks have remained the most dreadful episodes happening every day. Life is gradually returning to normal, but some of the most affected areas are still cut off and inaccessible. While travelling around the city and the remote areas, we saw that every corner / part of the city is still painted with the memories of the devastation. Please find the detailed progress report.
  • Apply the product to the palm of one hand (read the label to learn the correct amount).
  • Rub your hands together.
  • Rub the product over all surfaces of your hands and fingers until your hands are dry
Day 1: 30th April, 2015
  • Arrival at Kathmandu International Airport
  • Informal introduction of the members of the Team
  • Visit to the Office of the Director, Ministry of Health and Population, Government of the Nepal
  • Discussions with the Officials of the concerned sections of the Ministry of Health and Population / WHO for registration of Foreign Medical Teams, planning to respond to 2015 Kathmandu Valley Earthquake.
  • Visit to the related Hospitals as suggested by the Director, Ministry of Health and Population, Government of the Nepal.
  • Formal meeting and briefing of the action plans for the following days
  • To complete the formalities as well as to submit the self-attested documents for issue of the Authority Letter / ID for members of the Foreign Medical Teams
  • Discussion with the Host for the IMA Team at Kathmandu
Day 2: 1st May, 2015

Dr. Ashok Gupta paid a visit to the Tribhuvan University Teaching Hospital, the largest post graduate teaching hospital of Nepal and met the Executive Director Prof. Dr. Deepak Prakash Mahara, through the courtesy of Prof. Dr. Ishwar Lohani, Ex Director of the Hospital and the Head of the Department of Plastic Surgery. Professor of Anaesthesiology also joined in the discussions:
  • IMA (HQs) is keen to support the specialized treatment for patients affected by the earthquake either at Nepal or at India
  • IMA can provide the necessary technical support, manpower as well the supplies needed for such specialized treatment.
  • IMA will be happy to support the advanced specialized treatment at select hospitals in India for the victims of the earthquake.
Prof. Dr. Deepak Prakash Mahara, Prof. Dr. Ishwar Lohani and Professor of Anaesthesiology were very appreciative of the gesture of the IMA and did mention that although they had successfully tackled all the injured persons at the hospital, but definitely need help / expertise, when additional load of patients arrive at the hospital. They have suggested to form a sub-committee to assess the patients needing advanced specialized treatment in India, and on the recommendations of the sub-committee, would be sending the details to the IMA (HQs).

Prof. Dr. Ishwar Lohani then showed me some of the patients of earthquake being treated at the Dept. of Plastic Surgery, wherein microsurgical free flap transfer, replantation, cranio facial surgery etc. were carried out. I was further introduced to Post Graduate students in the department and other members of the teaching staff. Then I arrived at the Vayodha Hospital for further work.

Team B led by Dr. Kanchan Gupta
  • Proceeded to a distant Medical Relief Site at Ranipur in association with the Designate Hospital
  • Temporary Medical Centre was established and OPD started.
  • Volunteers from the Designate Hospital and the region made several rounds in the region and made announcements using PAC
  • Over 340 patients of different age groups attended the OPD and were duly accorded medical / surgical help
Dr. Ashok Gupta, advised all the members of the team to fill up the Ministry of Health Form for FMT along with the auto attested copies of State Medical Council Registration and the University degree certificate + Photo ID, to be submitted to MOH / Nepal Medical Council.

Team A, led by Dr. Ashok Gupta, reviewed the hospital infrastructure, OT set up, ICU back up and interacted with the Authorities at the Designate Hospital
  • Visit and assessment of the patients admitted in the hospital following the major earthquake and needing specialized treatment
  • Over 34 patients of different age group were admitted in the hospital and were attended immediately by the in house staff of the hospital.
  • About 4 patients of major polytrauma needed further immediate surgical intervention and were attended by respective specialists.
It has fully equipped OTs, ICU, ICCU, Cath Lab and a list of In House / On call Visiting Specialists to attend to needs of the patients. The Hospital has Operating Microscope, C T Scan and other state of the art facilities.

In collaborations with the hospital staff and the Ministry of Health, Indian Embassy, the Team extended all the technical support. There were over 4 patients, needing immediate surgical intervention and posted for joint discussions and planning.
  • One patient had # both bones lower limb (R + L) with blunt injury chest / abdomen / cerebral contusion + distal vascular compromise + ??gas gangrene. External Fixation was applied on both sides to stabilize the #
In association with the treating Orthopaedic Surgeon, Dr. Shashank Shringarpure (Consultant Plastic Surgeon) and Dr. Adsul (Anaesthesiologist) helped in extensive wound debridement and removal of all the doubtful areas of skin + soft tissue. The patient was followed up by bedside change of dressings on following days. The patient would need repeated debridement and a free flap reconstruction. The Hospital is fully equipped and has a consultant Plastic Surgeon as well, capable of undertaking microsurgical reconstruction.

Through the office of the Indian Embassy, Dr. Thakur, Health Attaché / In-charge of Shortlisting seriously injured patients to be air lifted to India, visited the hospital along with Dr. Ashok Gupta and after discussions with the hospital authorities and the patients relatives, it was left to the patient to choose the options of further treatment either at the same Hospital in Kathmandu or come to India. I had suggested that 10-15 days course of hyperbaric oxygen therapy would be of a great help in final outcome and as the treatment options of hyperbaric oxygen therapy is available at Mumbai, she is welcome to come to the Bombay Hospital. As per the advice of the Medical Director, Bombay Hospital & Medical Research Centre, she would be extended all the support at the Hospital.

There were several other patients requiring specialized / critical treatment and were being well looked after at the hospital.

Dr. Ashok Gupta
IMA Team Leader
Nepal Disaster Relief Team
Letter to Editor
Ref: "We have received an advisory from the MCI. We have already sent circulars to over 2.5 lakh doctors asking them to start billing the state government in cases where emergency patients fail to pay their bills," said IMA Hony. Secretary General Dr KK Aggarwal.

The advisory by MCI's ethical committee stated that "in case of emergency situations, doctors should attend to the patients and treat them with proper care. With regard to the financial aspect, the state should develop a mechanism to reimburse hospitals as per rates."

The advisory also states if doctors fail to deliver proper treatment immediately to such patients, action will be taken against them by the state medical council and/or the MCI under provisions of the Indian Medical Council (Professional Conduct Etiquette and Ethics) Regulations, 2002.”

****************
  1. There is an old saying—Better late than never. However, one must say that a delay of 26 years is a bit too much. What should have been asked from the SC itself in 1989 by IMA and MCI in Pt. Parmanand Katara Vs Union of India and Others, Supreme Court, decided on 28.08.1989, 1989 AIR 2039, 1989 SCR (3) 997, is being done now in a rather uncertain and oblique manner. Anyhow, the wind has at least started blowing in the right direction.
  2. It is unfortunate that the IMA and MCI were parties to the case but none of them represented to the court that the government must make provisions for compensating doctors for providing medical services to the injured which, as observed by the SC, was a responsibility of the state under Article 21.
  3. Let those rendering free emergency services send a proper bill to the health authorities in the state for reimbursement with copy to state IMA. The path will not be quick or easy but will certainly lead to success. Since I don’t envisage quick payment by the state and even apprehend that the state will protest, it is better that the demand letter and the bill etc. should be legally drafted so that, in case the state does not act, a WP in the HC may be filed successfully.
  4. I congratulate the HSG for his initiative in this matter.
--M C Gupta
16-5-2015
Sonal Namaste
How do you use hand sanitizers?
  • Apply the product to the palm of one hand (read the label to learn the correct amount).
  • Rub your hands together.
  • Rub the product over all surfaces of your hands and fingers until your hands are dry
On-strike doctors seek IMA support
TNN | May 16, 2015, 04.07 AM IST

Ludhiana: As the ultimatum given by Punjab Civil Medical Services (PCMS) specialist doctors' association ends on May 16, they have now sought the support of the Punjab chapter of Indian Medical Association.

On Friday, Dr Kashmir Singh Sohal, after a meeting in Chandigarh with senior officials, said, "We request office-bearers of all branches of IMA in Punjab to call a meeting of all IMA doctors to extend support to our strike."

The IMA has called an emergency general body meeting on Saturday. Dr Ajit Singh Chawla, president of IMA Ludhiana, said, "We have called the meeting on Saturday. We will support their demands but not the strike. They are specialist doctors and if they have invested in giving specialized services to all classes of people, they should be paid accurately."

Friday was the 14th day of doctors' strike which has affected the patients' flow at all government hospitals in the state.

At Ludhiana civil hospital on Friday, 226 OPD patients were recorded, which on any other day are 700. Indoor patients were 130. Eleven new patients were admitted, while 26 were discharged. X-rays too have reduced to 85, which are usually 125 in a day. Total gynecology department admissions were 43, 76 lab tests, three refractions and six ECGs were performed.

A state-level meeting has been called on Sunday by the association doctors to decide on total shutdown of government hospitals if demands were not met by 2pm on Sunday. They had started the strike on May 2.

Dr Avinash Jindal, district president, Ludhiana, said, "We are planning a complete shutdown of services if our demands are not met. All other works will be stopped which we have been performing even during the strike."
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Reader Response
Dear Dr K K Aggarwal, suggestions for clinical establishment act are praiseworthy, thanks. We all know medical services cannot be run by vanishing individual practicing doctors. They on the contrary need to be strengthened with better skills. Dr Sunil Dargar.
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Press Release
Insurance cover to Breast Reconstruction Surgery

IMA has raised an issue with the Insurance Regulatory & Development Authority (IRDA) regarding Insurance Companies not covering the cost of Breast Reconstruction Surgery after a patient has undergone removal of breast due to the breast cancer.

Claims have been denied on the ground that Breast Reconstruction Surgery falls in the category of cosmetic surgery.

“Breast Reconstruction Surgery in patients with breast cancer is not a cosmetic surgery but a medically indicated part of the Breast Reconstruction Surgery said Padma Shri Awardee Dr. (Prof.) M.Marthanda Pillai, National President and Padma Shri Awardee Dr K K Aggarwal, Hony. Secretary General, IMA”

In a letter dated 31st March, 2015, Joint Director, IRDA has clarified that though the Authority does not interfere into the design of the products of the Insurance Companies, “however, surgeries of this nature that are medically necessary are not excluded.”

Breast Cancer Surgery is a staged surgical procedure. In stage I breast is removed and in the second stage, removed breast space is reconstructed.

IMA has written to all its members to specifically mention this in claim form as “stage one radical mastectomy followed by State 2 breast Reconstruction surgery.”

IMA has also written to its members that if the Insurance Companies fail to pass the claim they must approach IMA Hqrs so that this issue can be taken up by IRDA again.