medical moments 3--radiology

                                                                  Always when you look back you will realise the true importance of things . As i have blogged earlier radiology is quite different from the typical doctor . So many differences starting with the cumpulsory airconditioned environment (its for our costly machines not for us :) )  , the distance from the disease , etc etc . But frankly compared to a "typical " doctor the experiences are less . The average radiologist who is more technically inclined and interested in more fixed hours is less bothered by it but it remains a truth .

But still though daily used to be a tailor measuring fetuses and checking their growth in antenatal ultrasound and checking whether the follicles are growing in women treated for infertility i still remember the day when i scanned the patient ten years back .  She came for "infertility  "   .. No children . The social implications , the cost of treatment and the varying results of infertility is known but it was one of my most satisfying scans .
Inside the uterus there was a white structure . Easy to diagnose but the implications were terrific .  It was an intrauterine contraceptive device .  Put many years back all had forgotten about it including the patient and many years back she had come for infertility . Probably she would have conceived and her children would be running around now  ...

Head injuries are common and CT scans especially of the head is the bread and butter of the radiologist . From the "coconut falling on head "  to head on head collisions CT is a highly accurate modality for diagnosing head injury  . And even for a fresh tutor who has joined in a busy teaching hospital head injury is easy to diagnose . But my first case was a kick in the abdomen . Though for an experienced radiologist abdominal injury is easy for a fresher especially when i found one kidney missing things were not easy  ...
(this was before the kidney scam era when any missing kidney was attributed to surgical removal )  ..
I still cant figure out how the person managed to kick the only kidney the patient had albeit whose only kidney was having a fusion abnormality from birth  .   Anyway "my first patient " though his abnormally fused kidney had an injury recovered completely though the grading  of injury  as well as the fused kidney status revealed by CT scan significantly altered the treatment  ..

Doing carotid doppler on one of my favourite singers as well as seeing the maskara artifact in MRI of popular film actress i would say the bonus of the profession .  And yes both studies were normal (but cant reveal their identities :))

hobby biography reading

I dont bungee jump .. frankly i am scared  ..But i have tried a range of hobbies from aeromodelling to salsa dancing and found most of them quite enjoyable . And one hobby which stands out is biography reading of famous people . And not only their achievements , the reading helps to understand what motivated them , their private life (in that sense i am vouyeristic :)  )  , what was like in the soceity at that time etc  ..

I am not a connoisseur of classical music generally  but am fond of two pieces of music of Mozart and Beethoven . And that is more than reason enough to wikipedia them both and in half an hour knew more about them which is inspiring in so many ways  .  The sequential progression of Beethovens deafness and still he composed music and retained his humour . Also his love life which was always with the nobility and failed due to class difference couldnt help me think . The music he made didnt have any caste or religion but his love wasnt allowed due to class .  ( this was 200 years back )  .

Coming back to my hobby i also referred wikipedia about two heroes of my childhood amar chitra katha . Raja Ram mohan Roy and Dayananand Saraswathi (refer wikipedia )  . We all know the former as he stopped the practice of women jumping into husbands funeral pyre .(which we now know totally illogical ) . But reading through the practices which he were against brought a chill along my spine . And reading Dayananand Saraswathi and his great social reform (both 200 + years back )  brought another chill .
Written in black and white were so many social evils which they were against at that time (two centuries ago )  with clearcut reasons .

Why these have relevance to me is two fold . ? Each great persons life teaches me something new about the human spirit  and i find more similarities than differences in their great lives  . Their philanthropism , their logical thinking , their lack of hypocrisy etc  .  And thanks to internet its so easy these days to read about them by just two clicks  ..

But more reading also has a sideeffect  ... its not 10 or 20 years has passed but close to 200 + years ... We have communication methods which will make people like Ram mohan Roy get shocked , medical treatments which make Beethoven stop his composition ( at his era tuberculosis etc were deadly )  . But culturally have we progressed or regressed . Read wikipedia on Raja Ram Mohan Roy and Dayanand Saraswathi and objectively tell me the answer .   

medical moments 2--- surgery

                                                                    Studying in a major government teaching hospital during MBBS is good in many ways and bad in many ways how you look at it  .. For example my visiting relative found a running rat in the department while i didnt "notice " it  because i was engrossed in other things .   But other than learning how to treat (not rats of course:)   )  this living lab gives you the experiences which makes you realise what "being human " is all about  ..

Being a studious student and hardly bunked classes there was one place i used to bunk as much as reasonably possible . That was the operation theatre .  As  often was feasible i used to put on the surgical gown and then spend a half an hour seeing some surgery then bunking into the coffee shop inside the theatre . For one thing watching something without a commentary and that too competing with a large group peering into an incision of 4x 5 cm is not my idea of learning  . And i had decided anyway that i am not interested in becoming a surgeon .  Inspite of my great respect of surgeons , i was very clear that i am more interested in non surgical things  .

But inspite of this i was filled with awe seeing the heart lying still in the cardiothoracic surgery theatre . The organ which beats from the moment even before you are born to the moment you die whoever you are (in that humans are similar )  was seen in a bloodless field still while surgeons were repairing it .  The hearts function meanwhile was taken up by the heart lung machine .  And it was nice to watch the team coordination in making this medical miracle happen .

Next stop was the neurosurgery theatre .  Again silent ...except for the constant bleeps . Being the most complex organ and if any smallest mistake is irreparable the surgery takes 8-12 hrs slowly  . But for me that slowness and their patience filled me with awe at the great work they do  .  But again it was very clear it was not for me because my strengths lay at different things ( not coffee drinking of course )  .  Even with major radiological advances which can even see the tracts near the tumor in colour neurosurgery is still a highly complicated surgery because the room for error is not there because we still dont know how to repair neurons .

Inspite of all the bunking i was favorite of one of the general surgeons and he gave me the opportunity to tie the purse string suture of appendicitis repair  . My hands were steady and having done many sutures for patients in surgical casualty (for common injuries )  under his guidance i did that suture for appendicitis  .  That was my first and last suture in a major surgery.  (that was a successful surgery  ....)

I admire  good surgeons . And its clear that some people are cut out for it .And since there are 20 + specialties in the profession and the long years to be put in establishing in a surgical career only those who like it should go for it  ..(this applies to anything ).

A good surgeon has an eagle’s eye, a lion’s heart, and a lady’s hand

I have a leopards heart :)

why i wont buy a bmw

Recently had an opportunity to travel on the road in kerala literally almost the length of kerala .  I love road travel because not only the changing landscape is very palpable which you never get the feel in rail or air travel .  I enjoyed the travel thanks to the company of two people i like very much my cousin and his dad .  And of course travelling in a high end SUV was quite comfortable .  Part of the journey was done in a small hatchback .

Its said all blogs should start in an optimistic note but when the road is filled with gutters (its a highway ) and though its my uncles cars suspension at stake i looked at the beautiful coconut tree laden landscape to be filled with optimism  .  But in between i couldnt help but look at the roads and wonder how inspite of being the most literate state and quarrelling for the silliest reasons with each other  kerala has one of the worst roads in india  . Its a paradox because countless amounts of media space and waking hour discussions is spend on this "road " topic but still roads are as bad as 10 years back . This would have been ok but at least two of our favorite filmstars had their lives ended in tragedy not because of "accident " but poor road state  .  And these are the same roads through which most malayalis kin drive to reach their loved ones and also when they drive to the nearest hospital in an emergency  .  Sorry ,  i wanted to be optimistic  ...

Anyway after a brief shopping spree at kochi we travelled through a wonderful stretch of road to trichur one of the few well maintained roads in kerala . Having used to roads in other states even the highways in mumbai city i loved this stretch . What used to take double the time previously has been cut in half by this nice stretch of road . Further north the roads were not as tragic as the south of kochi stretch but head on collisions was always a possibility as though a highway overtaking was always a risk due to the narrowness and poor road manners .  The saving grace was the changing landscapes each area showing the local culture with trichur , calicut , mahe , thalassery and kannur enroute  ..The high end SUV trimmed out the uneven stretches of the road and in kerala the big size and formidableness of the SUV helped to some extent in getting some clearing in the road chaos .

The return trip at night through thin traffic was much better . Here too my uncle was wondering why tolls were being collected at numerous points especially when roads were horrible just metres from the toll booth .  In kerala where people are more interested in what an undertrial eats in central jail (solar scam : sarita , shalu menon etc filling the news for the third week now )  i told my uncle please relax this is Gods own country  .......In heaven there are no roads  ....And yes .. i wont buy a BMW here because a BMW is not a boat  :)

PS : Next time anyone of the people we know dies in an accident due to poor road conditions it would be good if a public interest litigation is filed in high court  .  Because even in Bihar (yes they are "supposed" to be less literate  )  they were thinking of sueing their chief minister for pesticide tragedy of kids  ...(vicarious liability  )  .

First blood movie review

Having seen both First blood and terminator series i like the former better because i feel it has got a better storyline and more realistic .
A dialogue from the first blood movie  : "
;Rambo :  I could have killed 'em all, I could've killed you. In town you're the law, out here it's me. Don't push it! Don't push it or I'll give you a war you won't believe. Let it go. Let it go!

It amazes me the movie buff i am misses so many things in movies and i have to see it many times to get the full message .  As an action movie buff i always liked the movie first blood where the character Rambo played by sylvester stallone fights singlehandedly against an entire section of armed men . The guerilla warfare and the techniques employed are simply superb .  Even the fighting technique where he uses sharpened sticks to severely injure armed men and improvising traps etc is too good . And the M60 machine gun is one of the few machine guns which can be hand carried and fired at 600 rounds per minute

;It is only in second round of movie watching that i understand stallones dialogues especially since he is known to swallow half his dialogues with his style of speech  ..For an action movie the dialogue delivery is good , forceful and tells why he did what he does in the movie

Though we see all this in the first view actually the movie is about PTSD or Post traumatic stress disorder  . (wikipedia )  .. As he himself puts it  towards the end the entire action sequence was because as a returning war veteran he couldnt adjust to civilian life  and in addition to that the innocent civilians triggered him by a wrongful arrest and a little torture in police custody ;Towards the end he summarises why he went into the carnage which blew up half the town . In the  words of Rambo  "Calling me baby killer and all kinds of vile crap! Who are they to protest me? Who are they? Unless they've been me and been there and know what the hell they're yelling about!"   Those who have read about the problems of returning vietnam war veterans will know what he means though Rambo is a fictional character  .

And lastly seeing First blood i cannot help but think whether campus shootings in united states which occur every year with a regularity has something to do with bullying on the campus  .Just like Rambo was a troubled man who was pushed too much , many of the campus shooters were bullied before they went into a killing spree .  I have blogged on this before .. But as Rambo says in the movie : Sir , it was not I but they who drew the first blood ..

My rating for this movie is Must watch ..

Malala , Mahatma Gandhi and Bhagat Singh

                                                         I was a kid then . I saw Gandhi film and still remember like yesterday the scene  when he is pushed out from the first class compartment of the train where he stares at the oppressor in that initial scene . Lets be honest most of us would have just brushed our coat and would have walked home with bruised mind . Because the enemy against this man was not one person but a mighty nation where sun never sets .But he never gave up and the end result is the free india

Years passed by and though his methods was different an angry young man in punjab also revolted against this tyrannical rule with a handful of his friends . He too was not fearful in taking on an enemy the size of which was unfathomable . He was Bhagat singh and if you think you know him really well read wikipedia and google really well . He was a real " man " in every sense even in the days before he was hanged .  He was 23 only  .

And in this day and age where we are cosmopolitan and where none of us have fear ( i am sarcastic here ) many social evils prevail . Oppressors have changed their form and colour , These days we know clearly what is oppression and how it can be tackled . Because the greatest thing which sustains oppression is not the handful of oppressors but the "silent " majority who minds their business .  It is in these circumstances people like Malala have a bigger question mark in front of the people .

http://www.guardian.co.uk/world/2013/jul/12/malala-idol-un-speech-pupils

Shes only 16 years and  a girl  . And that tells a lot .  At that tender age and being a girl ( i am being sexist here )  she has dared to stand up for her rights . And the question comes where is all the mature men and women of her country ? What are they doing ?  And her speech "after "  her injuries show the undying spirit that just like "hope " the " fighting against odds " is an inherent human trait . Only thing is its ingrained in a few and as the " silent " majority at least lets support them .

Whenever we say big words (me included ) against corruption , against crimes against women ,religious fundamentalism etc etc lets ask ourselves how silent we are and whether we can do something about it .. Think about it  ...

Side effect

These days in kerala (  no exaggeration at all ) if you see a long queue it is 99 percent chance that it is in front of a liquor shop  .  Probably the literacy rate and alcohol consumption are related .

But when i was studying for MBBS once there was a long queue in trivandrum . As a budding medical student many of the educated laymen even asked me opinion on the new treatment . The new treatment was for an age old problem called baldness . Apparently a person has discovered a new medicine for baldness in alternate system of medicine , word of mouth has publicised it and there were daily queues to get it .The person who discovered it got rich fast at the expense of educated malayalis who usually argue and counterargue everything on earth especially medicines.  That incident was forgotten but whenever i see the androgenic alopecia (baldness male pattern ) in many i cant but laugh inside at the long queues and the vehement arguments including against this poor me when i talked against this miracle cure .  I am not against alternate systems but fights should be fair and when modern medicines are subjected to extensive trials ( refer wikipedia ) and still have problems its surprising how alternate system medicines are gulped without any forethought just because they are marketed even better .  I think i blogged about the cancer patient who ate the ash and then died and also about the person who got liver failure taking alternate medicine with heavy metals  .

Sorry to be off topic  .  But the point is as a doctor i find it funny when even very intelligent and educated people speak about sideeffects of modern medicines . Its a known fact that modern medicines do have side effects .  But as in life for a large gain you always have to compromise on small things side effects are a realistic part of treatment . And the knowledgeable patient neither underestimates or overestimates it .
How many of us (including  me ) had fever ? How many of you had paracetamol for fever ?  What side effect you got with it  ? I till this moment got none . But  if you read the possible side effects of paracetamol the list goes in hundreds including death due to many causes . http://www.drugs.com/sfx/paracetamol-side-effects.html    . The fact remains that most side effects are rare .

On the other extreme are chemotherapy cancer drugs some of which eg: methotrexate gives near 100 percent cure for certain cancers . But there side effects are more common and severe but still the benefit outweighs the risk and since there is no choice the intelligent person takes an informed decision and choice .
The saddest part of my MBBS experience is when early cancer patients skip the treatment fearing the "side effects" go to alternate systems and come back in stage 4 disease ( the final stage ).

Allergic reaction to pencillin can kill . Its a rare but known risk . But the lakhs of people saved in world war 2 was due to the newer antibiotic while in previous wars lakhs due to die not due to war but due to infection .  I dont think the " sideeffect " of pencillin and the "negligence " was a major issue in world war era . But even Alexander Fleming will have second thoughts why he didnt throw away that petri dish when  the wonderful medicine he discovered and scores of others are seen with suspicion in modern times ..Is it that a little knowledge is a dangerous thing .. I dont  know .