Much hyped semifinal between India and Pakistan was finally over yesterday with India winning. The celebrations across the country made me wonder what was the achievement? They still have to win the finals on saturday against Sri Lanka.
Be that may, for many Indians and Pakis winning means a great boost to their national pride and honor. Ridiculous but true.
I have often felt Muslims in India are lucky. They are better off in a tolerant corrupt India than a begoted [honest]islamic country. It is reminder for all Indians that two of the last three crucial overs were bowled by two Indian Muslim boys, Munaf Patel and Zahir Khan.
Democracy in action for all to see!
Thursday, March 31, 2011
Sunday, March 27, 2011
Earth [H] Our
Sent to me by my friend and one of the few young men who is doing his bit to keep the earth green. It is worth reading.
Earth (H)Our
At 8.30 pm on March 26th, as we turn off all electrical points in our homes for an hour, we could consider this an atonement, albiet a token one, for the economic runway that we have laid out for ourselves, riding on a blasphemous belief that energy – as much energy as we need - is a birthright.
Most people I know will switch off a light when they leave the room, yet this is hardly conservation; this is decency, protocol, the done thing, just as most people I know would say ‘Thank you’ when they were gifted a present. Conservation begins by questioning what could be done to change a lifestyle that is energy intensive and getting worse by the day.
A few months ago, a young journalist, Namrata Nandakumar, did a short study on electricity consumption in two urban spaces in Bangalore city. She first chose a slum which had ‘authorised’ access to electricity, a slum of three and a half thousand homes called Ullalu Upanagara, that houses about five times that number of people, during a post-monsoon month when there was no significant power cut. The monthly electricity bill for the entire colony was Rs. 2.38 lakhs. In contrast, Bangalore’s most popular mall, The Forum Mall, with a sanctioned load of 4 megawatts of electricity, had a monthly bill of about Rs. 85-90 lakhs (which included its expenditure on diesel for generators) for the energy it used with abandon, including the cooling of an enormous common areas around the day.
Recognise the sobering reality that energy is a finite resource currently in acute short supply in India. As the country’s GDP trots along, much more of it will be needed to supply basic energy needs to millions of our people as well as to meet the consumptive lifestyle of urban India. Energy comes at a cost, a cost well hidden from most of us who live in protected urban India and take planes when we travel : the costs, ecological, psychological, financial and otherwise, of displacement of people, damming of rivers, submergence of land and forests, pollution from thermal plants and carbon dioxide emissions and huge consumption of natural resources. Recognise that this is not a historical cost but a running one - for instance, the origins of the Maoist problem and the slums of urban India can be traced to our energy projects - and the true impact of the Mall’s consumption begins to emerge. Recognise, in addition, that the production of every litre of diesel needs 9,200 litres of water and 2-3% of the diesel that is imported into India is consumed in its own transportation to the consumer.
Yet, none of us would seem particularly perturbed with these numbers, ascribing them to a convenient rung on the ladder of development, for we empathise, not with the slum, but with the mall. It is a lifestyle that, though recent and foreign, is not negotiable. The biggest issue, of course, is that we – literate, well-read, well-meaning, intelligent as we are - do not connect the dots. We cannot, often do not, wish to see the impact of our actions on others. Let us then not blame the Americans for the climate mess we are in. Given an option, we have grabbed the ‘pollute’ lever ourselves for the short term gains that accrue from glamorous living.
I have in front of me, two recent articles that are very recent, yet hardly new in content. The first speaks of the protests last month against the East Coast Energy coal-fired power plant in Srikakulam district in Andhra, during which two people lost their lives, lives that were worth much more than any power plant could possibly match. This plant coming up next to a ecologically fragile wetland has, over the last couple of years, damaged the area and put many fishermen and farmers’ livelihoods in peril as the wetland is excavated and filled up in haste. The police were there, of course, to help push this private project through. This incident was merely a repeat: on July 14, 2010, in Sompeta, where the Nagarjuna Construction Company is building a thermal plant on a wetland, three persons were killed in clashes with the police.
The second article concerns a different source of energy that threatens a different species. If you make your way into the Athirapilly-Vazhachal forests of Kerala, as I have done – dense, wet deciduous forests of breathtaking beauty and surprise – you occasionally hear a loud, pitched call, a distinctive ‘tock-tock-tock’ , or sometimes a heavy whooshing sound. Look up or around (if you are by a ridge) and you might see the Great Indian Hornbill take to the air, the most beautiful, graceful, charismatic, even-tempered bird that has ever been. It is a bird that might see its habitat destroyed with a hydroelectric project proposed by the Kerala State Electricity Board that will generate a measly 160 megawatts, for the forty Forum-Mall-look-alikes that will dot the state to sell the resident Malayalee’s sole fetish: gold. The Hornbill, stunning as it is, is merely a representative species of the priceless biodiversity we stand to lose at Athirapilly, a portion of which is not even known to science as more discoveries enhance our sense of wonder at the mechanics of creation.
To set the record straight, the KSEB is hardly the first State Electricity Board to consider habitat of little use except for submergence, yet it was a pioneer in the destruction effort, with a plan made forty years ago to submerge the Silent Valley. It required the determined effort of Dr. Salim Ali and Mrs. Indira Gandhi to scuttle the project.
The destruction of forests, and the biodiversity within it, is a horrendous cost to pay for our lifestyle, yet it is a cost that few of us understand, even as the decision makers do the hypocritical act of planting the odd sapling to mark an Earth Day or a Wildlife Week. Much before additional power plants of any kind – thermal, nuclear or hydro – are planned, there is need, indeed a pressing, vital need, to use a system of incentives and disincentives to get the energy addicts (that’s us) to reduce our need for the fix. Yet, I have little faith in the Government’s ability to promote a culture of reduction and thrift and a lot more conviction in your ability to reason and conclude.
In my few years in conservation, never have I felt this alarmed at the speed of the consumption gravy-train. On March 26th, therefore, I have a request to make : please switch your lights, air coolers, water heaters and all else off, for just an hour. This, by itself, will make little difference, yet it will hopefully provide the darkness needed for a few moments of solitude.
In those moments, do think of just how you could become part of the solution, just how you could change the way you live your life to reduce, dramatically lessen, the need for energy. I repeat, target, not a 5% drop in consumption but, a 50% reduction in your energy demand. …for unless we press the brake now, the energy gravy train will run over the person on the railway track.
That person is you. And the time to heal the Earth is Now.
Warm regards,
Gopakumar
www.gopakumar-rootcause.blogspot.com
Earth (H)Our
At 8.30 pm on March 26th, as we turn off all electrical points in our homes for an hour, we could consider this an atonement, albiet a token one, for the economic runway that we have laid out for ourselves, riding on a blasphemous belief that energy – as much energy as we need - is a birthright.
Most people I know will switch off a light when they leave the room, yet this is hardly conservation; this is decency, protocol, the done thing, just as most people I know would say ‘Thank you’ when they were gifted a present. Conservation begins by questioning what could be done to change a lifestyle that is energy intensive and getting worse by the day.
A few months ago, a young journalist, Namrata Nandakumar, did a short study on electricity consumption in two urban spaces in Bangalore city. She first chose a slum which had ‘authorised’ access to electricity, a slum of three and a half thousand homes called Ullalu Upanagara, that houses about five times that number of people, during a post-monsoon month when there was no significant power cut. The monthly electricity bill for the entire colony was Rs. 2.38 lakhs. In contrast, Bangalore’s most popular mall, The Forum Mall, with a sanctioned load of 4 megawatts of electricity, had a monthly bill of about Rs. 85-90 lakhs (which included its expenditure on diesel for generators) for the energy it used with abandon, including the cooling of an enormous common areas around the day.
Recognise the sobering reality that energy is a finite resource currently in acute short supply in India. As the country’s GDP trots along, much more of it will be needed to supply basic energy needs to millions of our people as well as to meet the consumptive lifestyle of urban India. Energy comes at a cost, a cost well hidden from most of us who live in protected urban India and take planes when we travel : the costs, ecological, psychological, financial and otherwise, of displacement of people, damming of rivers, submergence of land and forests, pollution from thermal plants and carbon dioxide emissions and huge consumption of natural resources. Recognise that this is not a historical cost but a running one - for instance, the origins of the Maoist problem and the slums of urban India can be traced to our energy projects - and the true impact of the Mall’s consumption begins to emerge. Recognise, in addition, that the production of every litre of diesel needs 9,200 litres of water and 2-3% of the diesel that is imported into India is consumed in its own transportation to the consumer.
Yet, none of us would seem particularly perturbed with these numbers, ascribing them to a convenient rung on the ladder of development, for we empathise, not with the slum, but with the mall. It is a lifestyle that, though recent and foreign, is not negotiable. The biggest issue, of course, is that we – literate, well-read, well-meaning, intelligent as we are - do not connect the dots. We cannot, often do not, wish to see the impact of our actions on others. Let us then not blame the Americans for the climate mess we are in. Given an option, we have grabbed the ‘pollute’ lever ourselves for the short term gains that accrue from glamorous living.
I have in front of me, two recent articles that are very recent, yet hardly new in content. The first speaks of the protests last month against the East Coast Energy coal-fired power plant in Srikakulam district in Andhra, during which two people lost their lives, lives that were worth much more than any power plant could possibly match. This plant coming up next to a ecologically fragile wetland has, over the last couple of years, damaged the area and put many fishermen and farmers’ livelihoods in peril as the wetland is excavated and filled up in haste. The police were there, of course, to help push this private project through. This incident was merely a repeat: on July 14, 2010, in Sompeta, where the Nagarjuna Construction Company is building a thermal plant on a wetland, three persons were killed in clashes with the police.
The second article concerns a different source of energy that threatens a different species. If you make your way into the Athirapilly-Vazhachal forests of Kerala, as I have done – dense, wet deciduous forests of breathtaking beauty and surprise – you occasionally hear a loud, pitched call, a distinctive ‘tock-tock-tock’ , or sometimes a heavy whooshing sound. Look up or around (if you are by a ridge) and you might see the Great Indian Hornbill take to the air, the most beautiful, graceful, charismatic, even-tempered bird that has ever been. It is a bird that might see its habitat destroyed with a hydroelectric project proposed by the Kerala State Electricity Board that will generate a measly 160 megawatts, for the forty Forum-Mall-look-alikes that will dot the state to sell the resident Malayalee’s sole fetish: gold. The Hornbill, stunning as it is, is merely a representative species of the priceless biodiversity we stand to lose at Athirapilly, a portion of which is not even known to science as more discoveries enhance our sense of wonder at the mechanics of creation.
To set the record straight, the KSEB is hardly the first State Electricity Board to consider habitat of little use except for submergence, yet it was a pioneer in the destruction effort, with a plan made forty years ago to submerge the Silent Valley. It required the determined effort of Dr. Salim Ali and Mrs. Indira Gandhi to scuttle the project.
The destruction of forests, and the biodiversity within it, is a horrendous cost to pay for our lifestyle, yet it is a cost that few of us understand, even as the decision makers do the hypocritical act of planting the odd sapling to mark an Earth Day or a Wildlife Week. Much before additional power plants of any kind – thermal, nuclear or hydro – are planned, there is need, indeed a pressing, vital need, to use a system of incentives and disincentives to get the energy addicts (that’s us) to reduce our need for the fix. Yet, I have little faith in the Government’s ability to promote a culture of reduction and thrift and a lot more conviction in your ability to reason and conclude.
In my few years in conservation, never have I felt this alarmed at the speed of the consumption gravy-train. On March 26th, therefore, I have a request to make : please switch your lights, air coolers, water heaters and all else off, for just an hour. This, by itself, will make little difference, yet it will hopefully provide the darkness needed for a few moments of solitude.
In those moments, do think of just how you could become part of the solution, just how you could change the way you live your life to reduce, dramatically lessen, the need for energy. I repeat, target, not a 5% drop in consumption but, a 50% reduction in your energy demand. …for unless we press the brake now, the energy gravy train will run over the person on the railway track.
That person is you. And the time to heal the Earth is Now.
Warm regards,
Gopakumar
www.gopakumar-rootcause.blogspot.com
Earth hour
I was out driving a friend home during the earth hour. I had to despite the fact using the vehicle too is against the green movement. I was pleasantly surprised with the response from the citizens of the city.
Most had switched off the lights and the vehicles were less on the roads. This awareness should be there all the time and at all levels. More importantly at the levels of politicians and beurocrats as these are the decision makers.
My city is being slowly and steadily being destroyed in the name of development.More roads are being built or widenied and more vehicles are allowed on the roads. Many busy roads have no place for the pedestrian and the cyclist. Moving from one part of the city to another has become a night mare. More and more trees are felled to make way for roads in the name of development. Once, the city had hundreds of lakes which were interconnected and water flowed from west to east.Now many of these are filled up and developed. What is this development? Building more and more apartments and housing colonies.
The city's population has quadrypled in less than 15 years. The water needs of the city are met with the crazy scheme of pumping water up a gradient of 2000 ft from a distance of 100kms.Where is the power coming from? build more hidel and nuclear powerplants, inundate verdat forest and agri land and invite disaster?
Gandhi, nearly a century ago had anticipated all this. He advocated minimum consumption of resources as the key to life. Is any one listening? Today's developers are taking away resources of tomorrow's generation. Who is worried?
Mr Gandhi must be turning in his grave!
Most had switched off the lights and the vehicles were less on the roads. This awareness should be there all the time and at all levels. More importantly at the levels of politicians and beurocrats as these are the decision makers.
My city is being slowly and steadily being destroyed in the name of development.More roads are being built or widenied and more vehicles are allowed on the roads. Many busy roads have no place for the pedestrian and the cyclist. Moving from one part of the city to another has become a night mare. More and more trees are felled to make way for roads in the name of development. Once, the city had hundreds of lakes which were interconnected and water flowed from west to east.Now many of these are filled up and developed. What is this development? Building more and more apartments and housing colonies.
The city's population has quadrypled in less than 15 years. The water needs of the city are met with the crazy scheme of pumping water up a gradient of 2000 ft from a distance of 100kms.Where is the power coming from? build more hidel and nuclear powerplants, inundate verdat forest and agri land and invite disaster?
Gandhi, nearly a century ago had anticipated all this. He advocated minimum consumption of resources as the key to life. Is any one listening? Today's developers are taking away resources of tomorrow's generation. Who is worried?
Mr Gandhi must be turning in his grave!
Saturday, March 26, 2011
Chasing the ESR
We doctors order investigations when we are stumped as to what is wrong with the patient or some times to know the effect of treatment. Added to these, we also order teats to assess fitness levels. This last phenomenon which was exceptional when I began my career has now become routine. So common it is that patients themselves go to the lab and get tests done and then see us. Most often it is a sheer waste of money but occasionally it results in early diagnosis and effective management.
When tests are ordered a common one among them is called the ESR. This stands for erythrocyte sedimentation rate. In simple language it means speed with which the red cells of the blood drop when a column of blood is suspended in a glass tube. This simple screening test is very nonspecific. It tells us that there is something wrong but does not tell us where and what is wrong. A friend of mine once said you sneeze hard couple of times and then measure the ESR and sure it will be up.
Red cells are in large numbers compared to white cells. Their main purpose is to carry oxygen to the tissues and normally they circulate without clumping and when suspended they drop down ever so slowly. In disease conditions the rate of this fall is rapid. The higher the fall more serious is the disease. We accumulate willy nilly, lot of unwanted material in the blood during the course of our lives. These include among others bacterial and viral antigens against which the immune system produces antibodies, particulate materials which freely flow in our blood much in excess of the ability of our innate cleaning systems to scavenge. Some of these stick to the surface of the cells and make them not only heavy but also get them to stick to one another. Thus the cells which were once clean now become dirt laden and heavy and thus fall faster in suspension and the ESR goes up. In acute infections and in malignancies, the phenomenon is marked. And very high ESR levels are always worrying to the attending doctor.
Mrs. Y is a sixty year old woman and a true party animal. When she was with a group of friends, one of them told her that she was looking pale. Everyone looks pale in the artificial light and Mrs. Y did not attach any importance to the remark. Few days later at another party another friend remarked,’ what is the matter with you? You are looking very pale’. Remarks of similar nature on two successive days had her worried.
She took the decision to do the tests. Had she come to me I probably would have examined her and may and more likely not have got any tests done. She went to a well known lab and told at the reception to tests for her looking pale. Most labs are privately owned and clients like Mrs. Y are like a new lode of gold for them. All tests including the scans of her chest and abdomen were done. Here is something interesting. It is not difficult to find some trivial abnormality in most people and as they say half in jest, when you see a tail sticking out of a hole it is sometimes best not to pull it out, you don’t know whether you pull out a cat or leopard. The labs too have a funny way of reporting here. They put an asterisk against the slightest abnormality that is found or a value which even slightly abnormal. In madam Y’s case there were many such asterisks!
Thoroughly frightened, Mrs. Y landed in my clinic with a whole wad of papers. ‘I am very sick’ she said by the way of opening remark. She looked very fit and I said so. ‘No, no, you see these reports and then you will change your opinion’ she said. If she is insisting to be very sick, I felt I should first examine her before going through her papers. She agreed and a ten minutes physical found her in a fit condition with her basic parameters being normal. Now came the time to see her lab reports and scan reports and I could see her becoming visibly anxious. Almost all her reports including the ones marked with an asterisk were normal. There was however one major abnormality. Her ESR was very high. Normally in her age group it should not exceed 20mm of fall in an hour and in her it was 80.
This was indeed a surprise and a cause for worry. Surprise because she was fit and I found nothing which would explain this high ESR. In the absence of infection the only other cause would be occult [hidden cancer]. In women the most likely place is the breast where small tumors could easily missed. I felt her breasts once again. I could find no mass small or big. I found among her papers recent tests to exclude cervical [uterus] and ovarian cancer. Then where is it? Could this be in her blood forming bone marrow? Could this be in her colon? Lungs?
I had no option but to get a whole lot of expensive tests done. May be a better option would be to send her to an institution [an unsettling thought]. My brain was buzzing with all sorts of thoughts and idly I was sheafing through her papers and saw her liver function tests. There was a marginal increase in the globulin fraction of her blood protein. Globulins are very important componets of our immune system and special cells called plasma cells make these.
Here was a possible clue. Without telling her what I was thinking but all the same reassuring her, I ordered a test called serum protein electrophoresis in which the various fractions of blood proteins are studied, a non invasive test. She came back two days later with the report. She had a raised level of one particular fraction of her gamma globulin. I, at last, had the diagnosis. She has monoclonal gammopathy of uncertain cause. This condition is due to excessive production of gamma globulin of one variety by one clone of cells. This excess protein adheres to the surface of the red cells and thus making them heavy and drop faster in suspension. Monoclonal gammopathy is premalignant condition and in time a percentage of them go into a type of cancer called multiple myeloma. No one knows who will develop into this serious condition and who will not. I have had several patients who have carried MGUS [monoclonal gammopathy of uncertain significance] to their grave without suffering Multiple Myeloma.
I painted the picture highlighting the positive aspects. That was ten years ago. She is now seventy. The other day she had come for the usual follow up with her reports. They were all normal and she too will hopefully carry this to her grave without going into cancer when ever her time comes to go.
When tests are ordered a common one among them is called the ESR. This stands for erythrocyte sedimentation rate. In simple language it means speed with which the red cells of the blood drop when a column of blood is suspended in a glass tube. This simple screening test is very nonspecific. It tells us that there is something wrong but does not tell us where and what is wrong. A friend of mine once said you sneeze hard couple of times and then measure the ESR and sure it will be up.
Red cells are in large numbers compared to white cells. Their main purpose is to carry oxygen to the tissues and normally they circulate without clumping and when suspended they drop down ever so slowly. In disease conditions the rate of this fall is rapid. The higher the fall more serious is the disease. We accumulate willy nilly, lot of unwanted material in the blood during the course of our lives. These include among others bacterial and viral antigens against which the immune system produces antibodies, particulate materials which freely flow in our blood much in excess of the ability of our innate cleaning systems to scavenge. Some of these stick to the surface of the cells and make them not only heavy but also get them to stick to one another. Thus the cells which were once clean now become dirt laden and heavy and thus fall faster in suspension and the ESR goes up. In acute infections and in malignancies, the phenomenon is marked. And very high ESR levels are always worrying to the attending doctor.
Mrs. Y is a sixty year old woman and a true party animal. When she was with a group of friends, one of them told her that she was looking pale. Everyone looks pale in the artificial light and Mrs. Y did not attach any importance to the remark. Few days later at another party another friend remarked,’ what is the matter with you? You are looking very pale’. Remarks of similar nature on two successive days had her worried.
She took the decision to do the tests. Had she come to me I probably would have examined her and may and more likely not have got any tests done. She went to a well known lab and told at the reception to tests for her looking pale. Most labs are privately owned and clients like Mrs. Y are like a new lode of gold for them. All tests including the scans of her chest and abdomen were done. Here is something interesting. It is not difficult to find some trivial abnormality in most people and as they say half in jest, when you see a tail sticking out of a hole it is sometimes best not to pull it out, you don’t know whether you pull out a cat or leopard. The labs too have a funny way of reporting here. They put an asterisk against the slightest abnormality that is found or a value which even slightly abnormal. In madam Y’s case there were many such asterisks!
Thoroughly frightened, Mrs. Y landed in my clinic with a whole wad of papers. ‘I am very sick’ she said by the way of opening remark. She looked very fit and I said so. ‘No, no, you see these reports and then you will change your opinion’ she said. If she is insisting to be very sick, I felt I should first examine her before going through her papers. She agreed and a ten minutes physical found her in a fit condition with her basic parameters being normal. Now came the time to see her lab reports and scan reports and I could see her becoming visibly anxious. Almost all her reports including the ones marked with an asterisk were normal. There was however one major abnormality. Her ESR was very high. Normally in her age group it should not exceed 20mm of fall in an hour and in her it was 80.
This was indeed a surprise and a cause for worry. Surprise because she was fit and I found nothing which would explain this high ESR. In the absence of infection the only other cause would be occult [hidden cancer]. In women the most likely place is the breast where small tumors could easily missed. I felt her breasts once again. I could find no mass small or big. I found among her papers recent tests to exclude cervical [uterus] and ovarian cancer. Then where is it? Could this be in her blood forming bone marrow? Could this be in her colon? Lungs?
I had no option but to get a whole lot of expensive tests done. May be a better option would be to send her to an institution [an unsettling thought]. My brain was buzzing with all sorts of thoughts and idly I was sheafing through her papers and saw her liver function tests. There was a marginal increase in the globulin fraction of her blood protein. Globulins are very important componets of our immune system and special cells called plasma cells make these.
Here was a possible clue. Without telling her what I was thinking but all the same reassuring her, I ordered a test called serum protein electrophoresis in which the various fractions of blood proteins are studied, a non invasive test. She came back two days later with the report. She had a raised level of one particular fraction of her gamma globulin. I, at last, had the diagnosis. She has monoclonal gammopathy of uncertain cause. This condition is due to excessive production of gamma globulin of one variety by one clone of cells. This excess protein adheres to the surface of the red cells and thus making them heavy and drop faster in suspension. Monoclonal gammopathy is premalignant condition and in time a percentage of them go into a type of cancer called multiple myeloma. No one knows who will develop into this serious condition and who will not. I have had several patients who have carried MGUS [monoclonal gammopathy of uncertain significance] to their grave without suffering Multiple Myeloma.
I painted the picture highlighting the positive aspects. That was ten years ago. She is now seventy. The other day she had come for the usual follow up with her reports. They were all normal and she too will hopefully carry this to her grave without going into cancer when ever her time comes to go.
Wednesday, March 23, 2011
In search of the stink
They first noticed the foul smell two weeks ago while watching television more or less at the same time, the wife first and then the husband. They thought the smell is because of a dead mouse that was seen inside the home couple of days back. They took the house apart looking for the dead mouse but to no avail. Then couple of days later the husband told the wife that he noticed the same smell in his office. They thought justifiably that he was imagining the smell!
Next day too he said the same and confirmed that it was no imagination as his secretary too smelt the stinky waft. How can the same smell be both in the office as well as home?
Realization came at last. The smell was coming from the body of the man! Wife found that it was from his navel and on close inspection she found a whitish substance in the depth of his belly button. She made him wash it thoroughly; still the smell remained though the whitish material was no longer there.
This was the time they thought it to be serious enough to seek medical advice and came to see me.
The stink was obvious even before she told me its origin. He had a navel which was deep and well hidden in the fat fold of his paunch. I could with difficulty, [I used an old fashioned nasal speculum] to separate the overhanging skin folds. There I could see something glistening! It was quite easy to pull it out with a forceps. An inch and a half of cone shaped hard rubbish was pulled out. The cavity was washed and sterilized with iodine.
That was the end of foul smell. The cone contained debris, shed skin, secretions all of which had joined together to produce this foul cone!
I asked the couple if they wanted to take it home as a memorable memento. They vehemently refused!
I then dumped it in the toilet bowl and flushed it to make sure it went for ever.
Next day too he said the same and confirmed that it was no imagination as his secretary too smelt the stinky waft. How can the same smell be both in the office as well as home?
Realization came at last. The smell was coming from the body of the man! Wife found that it was from his navel and on close inspection she found a whitish substance in the depth of his belly button. She made him wash it thoroughly; still the smell remained though the whitish material was no longer there.
This was the time they thought it to be serious enough to seek medical advice and came to see me.
The stink was obvious even before she told me its origin. He had a navel which was deep and well hidden in the fat fold of his paunch. I could with difficulty, [I used an old fashioned nasal speculum] to separate the overhanging skin folds. There I could see something glistening! It was quite easy to pull it out with a forceps. An inch and a half of cone shaped hard rubbish was pulled out. The cavity was washed and sterilized with iodine.
That was the end of foul smell. The cone contained debris, shed skin, secretions all of which had joined together to produce this foul cone!
I asked the couple if they wanted to take it home as a memorable memento. They vehemently refused!
I then dumped it in the toilet bowl and flushed it to make sure it went for ever.
Monday, February 14, 2011
Cricket Crazy
The game of cricket is confined to Britain and its erstwhile colonies. The one legacy the colonies bear cheerfully but have also excelled in. For many decades it was Australia. Australians were virtually unbeatable in playing cricket and in the art of sledging. Sledging is a term referred to acts designed to irritate and do things to get the batsman of the opposing side to lose concentration and throw away his wicket. This is a specialty of close in fielders especially the wicket keeper. Sledging identified, as some wit put it, the hallmark of progeny of erstwhile prisoners who colonized Australia! Words like,’ you want to sleep, there are better places’, when the batsmen went run less, or ‘now you can think’ when the ball thrown at the batsman hits the head [though covered with helmet]can disturb any batsman and sensitive Indians were particularly prone to this some decades back. Now I believe they too have become experts and have taken to saying so in Hindi which the hapless Australians don’t understand and worse likely to misunderstand as it happened between two volatile players, the Australian Symmonds and Harbhajan Singh the Indian. What Harbhajan said to Symmonds in Hindi was ‘Theri Maaki……’ [Your mother’s]. Symmonds heard it as you are a monkey! The two came to blows and the umpires had to intervene. The Sardar [Harbhajan is a Sikh] is not by any means a handsome fellow but Symmonds has some simian features which added color to the misunderstood ‘theri maaki!’ Good it was misunderstood as the Hindi curse has worse connotations. In the enquiry that followed, the venerable and much respected Tendulkar who heard the altercation was hard put to explain the meaning! I believe our own skipper M.S.Dhoni is a sort of expert sledger behind the wickets.
Every three years a cricket extravaganza is held and it goes by the name World cup. Over the years India has taken over as the prime promoter and Indian companies spend mind boggling amount of money on promotion. The centre of cricket and the power is slowly and steadily moving Indiawards. Going by the record crowds that attended the first match yesterday, which was a practice match and therefore does not really count, we are in for a crazy period of six weeks. Incidentally India won! 30.000 cricket fans paid through their nose for the privilege of seeing the two sides fling a ball 600 times at each other! [It is not as simple as that]
When the Britishers left India it was a complete severance. Unlike in other countries where many stayed back, In India and Pakistan none stayed. This is indeed a surprise, so alienated were they from the locals, that they had no options but to leave. The first Englishman who opted for Indian citizen was a defrocked priest called father Vernier [read the famous and well written and researched biography on father Vernier by Ramachandra Guha]. But many of their habits and institutions survived. The game of Cricket is one such. The other is our clubs. In most of urban India there are these bodies where in friends [members] gather mostly to drink in private [not really wholly true]. These clubs have their own archaic rules. Till recently one of these in Bangalore, did not allow women to become members! Even now you cannot enter some clubs in comfortable Kurta and Pajama’s. If you go in a Lungi, it is possible that an elderly member clad in suit will suffer a heart attack.
Cricket caught on like wild fire. It suited us very well. We are an over populated country with a large number of partially or fully unemployed. These found it great to spend time five days watching this game. Those days there were no limited overs cricket which ended in six hours. They could sit back relax, sleep and do nothing in keeping with our national character.
With money and new found affluence this pastime has become a monstrous obsession and addiction and the newly rich cash cows are hell bent on making all of us slaves to this game.
Sadly it includes your truly!
Every three years a cricket extravaganza is held and it goes by the name World cup. Over the years India has taken over as the prime promoter and Indian companies spend mind boggling amount of money on promotion. The centre of cricket and the power is slowly and steadily moving Indiawards. Going by the record crowds that attended the first match yesterday, which was a practice match and therefore does not really count, we are in for a crazy period of six weeks. Incidentally India won! 30.000 cricket fans paid through their nose for the privilege of seeing the two sides fling a ball 600 times at each other! [It is not as simple as that]
When the Britishers left India it was a complete severance. Unlike in other countries where many stayed back, In India and Pakistan none stayed. This is indeed a surprise, so alienated were they from the locals, that they had no options but to leave. The first Englishman who opted for Indian citizen was a defrocked priest called father Vernier [read the famous and well written and researched biography on father Vernier by Ramachandra Guha]. But many of their habits and institutions survived. The game of Cricket is one such. The other is our clubs. In most of urban India there are these bodies where in friends [members] gather mostly to drink in private [not really wholly true]. These clubs have their own archaic rules. Till recently one of these in Bangalore, did not allow women to become members! Even now you cannot enter some clubs in comfortable Kurta and Pajama’s. If you go in a Lungi, it is possible that an elderly member clad in suit will suffer a heart attack.
Cricket caught on like wild fire. It suited us very well. We are an over populated country with a large number of partially or fully unemployed. These found it great to spend time five days watching this game. Those days there were no limited overs cricket which ended in six hours. They could sit back relax, sleep and do nothing in keeping with our national character.
With money and new found affluence this pastime has become a monstrous obsession and addiction and the newly rich cash cows are hell bent on making all of us slaves to this game.
Sadly it includes your truly!
Thursday, February 3, 2011
Drugs Doctors and Patients
How did L. Leela get tablets of Colchicine without prescription? If you are a non Indian reader of my blog you are justified in wondering. If you are a reader from India then you know how and it will be of no surprise to you.
I will tell this sordid story of easy availability of drugs and the damage that this is causing to people with a real life story and follow it up with another later.
Mr C has been my patient for over twenty years, that is, when he is in Bangalore. A senior executive, he is often posted out of Bangalore and seeks attention with other doctors or self medicates. He suffers from high blood pressure and diabetes for which he takes medication and consults doctors when there is trouble. When living in New Delhi he developed pain In his back for which initially he saw an orthopedic surgeon who prescribed him a drug which belongs to a class called NSAIDS [non steroidal anti inflammatory drugs].The commonly prescribed drugs such as diclophenac, Ibuprofen, Indomethacin, paracetamol, aspirin etc belong to this class. He was asked to take one of these for five days when the pain was acute and was asked to report back. He never did go back. Instead whenever he had some back pain he took these drugs and got pain relief. Few months ago he went for his annual medical and he was found to have elevated levels of creatinine in the blood, a sure sign of renal disease. His creatinine levels were near normal when the test was done a year ago. Indiscriminate use of the pain killer had irreversibly damaged his already fragile kidneys [due to high blood pressure and diabetes] and he is now in end stage kidney disease and on three times a week dialysis. This means spending the rest of his life hooked on to a machine for over six hours, three times a week. If the drugs were not available to him and he was forced to go to the doctor this misery, possibly, would not have happened.
How then did Mr C get his Ibuprofen?
n India pharmacies are run by businessmen. The license to run a pharmacy is obtained in the name of a qualified pharmacist who is usually not the owner. Even if he is one, he would be reluctant to let go an easy custom for want of a prescription. Many of them are located near the patient and those who work in the pharmacy are friends of the patient and are unlikely to refuse a request. Old prescriptions are used with impunity and doctors too are to be blamed for indiscriminate prescriptions.
Let me tell you all another ongoing problem a patient of mine is facing. She is a seventy four year old lady who is a severe diabetic with complications and who has chronic urinary tract infection caused by a versatile organism called E.Coli. This one belongs to a class of germs who are called ESBL producing organisms. Meaning there by, that they are clever enough to survive the onslaught of most of the available antibiotics. How did this happen? We doctors to a great extent, and patients to some extent, are responsible. How did she manage to acquire this dreaded multidrug resistant strain? Please go to the website given below and read the article by Dr Chatterjee. How is she being managed? An ongoing struggle for both of us.
On many an occasion the illness especially the one caused by virus is self limiting and no drug is required. Rare is a doctor [of any variety] who says so to the patient. Almost always a drug is prescribed. This is especially so with painkillers and antibiotics. To learn more about the havoc we doctors have caused I draw your attention to an article by Dr Biswaroop Chatterjee [Turmoil over New Delhi Metallo-Beta Lactamase-1: a tale of ersatz patriotism] which has appeared in the recent issue of Indian Journal of Medical Ethics [www.ijme.in]
Have we, both doctors and patients learnt our lessons? Sadly, the answer is no and the sordid tale is continuing and I shudder to think of the future scene of resistant infections. Probably we will be back into 1930s [pre antibiotic days] very soon.
Scary isn’t it?
I will tell this sordid story of easy availability of drugs and the damage that this is causing to people with a real life story and follow it up with another later.
Mr C has been my patient for over twenty years, that is, when he is in Bangalore. A senior executive, he is often posted out of Bangalore and seeks attention with other doctors or self medicates. He suffers from high blood pressure and diabetes for which he takes medication and consults doctors when there is trouble. When living in New Delhi he developed pain In his back for which initially he saw an orthopedic surgeon who prescribed him a drug which belongs to a class called NSAIDS [non steroidal anti inflammatory drugs].The commonly prescribed drugs such as diclophenac, Ibuprofen, Indomethacin, paracetamol, aspirin etc belong to this class. He was asked to take one of these for five days when the pain was acute and was asked to report back. He never did go back. Instead whenever he had some back pain he took these drugs and got pain relief. Few months ago he went for his annual medical and he was found to have elevated levels of creatinine in the blood, a sure sign of renal disease. His creatinine levels were near normal when the test was done a year ago. Indiscriminate use of the pain killer had irreversibly damaged his already fragile kidneys [due to high blood pressure and diabetes] and he is now in end stage kidney disease and on three times a week dialysis. This means spending the rest of his life hooked on to a machine for over six hours, three times a week. If the drugs were not available to him and he was forced to go to the doctor this misery, possibly, would not have happened.
How then did Mr C get his Ibuprofen?
n India pharmacies are run by businessmen. The license to run a pharmacy is obtained in the name of a qualified pharmacist who is usually not the owner. Even if he is one, he would be reluctant to let go an easy custom for want of a prescription. Many of them are located near the patient and those who work in the pharmacy are friends of the patient and are unlikely to refuse a request. Old prescriptions are used with impunity and doctors too are to be blamed for indiscriminate prescriptions.
Let me tell you all another ongoing problem a patient of mine is facing. She is a seventy four year old lady who is a severe diabetic with complications and who has chronic urinary tract infection caused by a versatile organism called E.Coli. This one belongs to a class of germs who are called ESBL producing organisms. Meaning there by, that they are clever enough to survive the onslaught of most of the available antibiotics. How did this happen? We doctors to a great extent, and patients to some extent, are responsible. How did she manage to acquire this dreaded multidrug resistant strain? Please go to the website given below and read the article by Dr Chatterjee. How is she being managed? An ongoing struggle for both of us.
On many an occasion the illness especially the one caused by virus is self limiting and no drug is required. Rare is a doctor [of any variety] who says so to the patient. Almost always a drug is prescribed. This is especially so with painkillers and antibiotics. To learn more about the havoc we doctors have caused I draw your attention to an article by Dr Biswaroop Chatterjee [Turmoil over New Delhi Metallo-Beta Lactamase-1: a tale of ersatz patriotism] which has appeared in the recent issue of Indian Journal of Medical Ethics [www.ijme.in]
Have we, both doctors and patients learnt our lessons? Sadly, the answer is no and the sordid tale is continuing and I shudder to think of the future scene of resistant infections. Probably we will be back into 1930s [pre antibiotic days] very soon.
Scary isn’t it?
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