Sunday, February 26, 2012


    According to the Big Bang theory the universe was formed  from almost very tiny , extremely compacted matter. Almost a singularity. Also it is known from the observations of the various galaxies that the universe is expanding . When scientist Hubble looked at various galaxies through telescope , he realised that the galaxies that were  200 light years away from us  were moving at double the speed of the galaxies that were 100 light years away from us . this could be explained by the possibility that the universe was expanding. To understand this  one can look at the muffin with resins in it when it is in the Owen , how resins go apart . one can also put dots of ink on the balloon and then inflate the balloon and observe the dots go apart.  The dots that are one inch apart will move at half the speed of the dots that are 2 inch apart. It is thought that this expansion will go to it's maximum (?) expansion and then will --may be --start shrinking , finally to tiniest , dense. compact universe , where we started..
     Now if we look at the Hindu concept of the origin of the universe, it is about the same . The only difference is that in Hindu concept , this cycle of the expansion and shrinking has occurred in the past for infinite times and it will continue for infinite times. So at the End of one cycle every thing gets dissolved in to Singularity. and it is at peace . Then  at the time new universe is to form , there is a '"  Disturbance" in it , called GUNSHOBHINI").
All the 3 " GUNAS "- qualities, all the 5 " PRANAS" , 5 " PANCHMAHABHUTAS ", and rest of the things that go in making the universe start  coming   out..First creation is "AAKASH " " --the space , then comes "  "WAAU "--air or the wind , then comes the " TEJA", ---energy or the light , then"  AAP" -water or the liquid then lastly the " PRITHWI "---the earth or the solids.If we compaire  this with the origin of the universe according to the astrophysics , space is created( the Big Bang has to occur in the space ). Then there was gaseous form , then hydrogen molecules got together and helium was formed and the energy furnace was formed . Then compound s started forming --the liquid or the water, then came the solid or the earth.

Thursday, February 23, 2012


      It was my last patient . As usual I was late . This one was of 'double booking patient' at 4-15 pm that I was seeing at 4-40pm. She had bronchial asthma, and was not feeling good. She had seen her primary care doctor and was not happy as was not any better. I could see that she was quite frustrated . I examined her . She was wheezing .I talked to her about the change in treatment. I  decided to increase .her inhaler strength, ( advair250/50 to 500/50) and added and antibiotic , and gave her the sample of the antibiotics, and gave her prescriptions for steroids. I gave all the samples and gave her one prescription for prednisone -steroid.. She was not thrilled about the prescription .I can not afford this expensive  prescription, she told me . i told her that it would cost only $4. She told me that she can not spend even $4. " I have only $2. for now " i was stunned . Did not know what to say as I had given hes enough samples. I opened my wallet and took out $2 and gave her $2. She took them , thanked me for seeing today and told me that she will give me my money as soon as she gets her pay check. next  week.
     I had forgotten about this incidence . A week went by and I did not hear from her . It was Wednesday and I had morning office. It is suppose to end by 11-30 , but it never does Usually goes till 1pm . As I was about to leave my secretory gave me an envelop , it was given to her by patient. I  opened it . It contained $2 and a thank you note.  I took it with me and left the office . As I got in the car I left the envelop on the front passenger seat of the car . When I go to the hospital I take a short cut through one of the plaza . So I have to slow down . As I was passing through , I saw a man waving at me . I stopped and opened the passenger side window . He came closer and said , "Excuse me Sir, I need to get a bus and I am short by 2 dollars Can you please give me 2 dollars?" I did not say a word . I picked up the envelop that  I  got earlier and gave it to him .

Friday, February 17, 2012


  And this is an another story on  Unusual POA , power of attorney, for the medical decisions. I had known Sheila for few years. She had bronchial asthma and was doing very well . My office follow up was every 4 to 6 months as her asthma was fairly stable. But this time when I saw her she did not look happy. She told me that she was not feeling well. She was waking up at night and could not fall asleep again. She was not short of breath, but fell tired and had no desire to do any thing. On physical examination her blood pressure was normal and her lungs sounded clear, So I was not sure as to the reason for her complains . As I started to ask her further , she suddenly started crying. On further asking I came to know the whole story.
   She was living with her boy friend for the last 18 years. Never got married or thought . This was partly due to her bad experience with first marriage. She was 49 years old and he was 55 years .He had cardiac arrest and collapsed . She called 911. and the paramedics came in He was admitted to Intensive Care Unit . Unfortunately he was in the coma and in spite of being supported on respirator he was found to be all most brain dead . The decision was made to consider withdrawal of life support , so called 'pull the plug ' Per the state laws if patient can not make the decision then the spouse has the   right to make the decision . If there is no spouse then the children are allowed to make the decision . If there are no children then the parents are in the line , and if they are not there then is the turn of siblings . This all can be avoided if patients makes his wishes known , and appoints some one , relative or friend or any one .
    In this case my patient had no relationship with other relatives, and in fact had some strained relations with the brother. Unfortunately since Sheila and her live in friend were not married and had made no written appointment , she was ' no one ' and her opinion was not to be taken in to account. The decision was made by the  brother r and she was not asked any opinion . This had caused the mental anguish and distress and had made her feel bad !

Wednesday, February 15, 2012


5 Kosha  5 Coverings of the body.                                                                                                                      
               1. Annamaya kosha
               2. Pranamay kosha
               3. Manomay kosha
               4 Dnyanamay kosha
               5.Anannadmay kosha
4Wacha.  Languages
                1  Para
                2. Pashshanti
                3. Madhyama
                4. Vaikhari
4 Levels of existence.
                1. Stone
                2. Plant
                3. Animal
                4.Human beings

3 Universes.
                1. Physical
                2. Astral
5 Karmendriye  ..5organs of the action
                2. Legs
                4 Procreation
5Dnyanendriye . 5 sense organs with which we perceive
                1 Ears-Hearing
                2. Eyes vision
                3.Skin  Touch

Saturday, February 11, 2012


     This story is not my personal patient. But it is very interesting and show es how sometimes human mind works.
    This was a 68 years old man who had extensive  cardiac history, had open heart surgery done for bypass.. had decrease cardiac function in spite of surgery . So he was short of breath all the time , but was doing OK with day to day activity. His congestive heart failure would flair up at times and then he would need fine tuning in his medicines and at times would need to be admitted . Since his heart was quite weak and his ejection fraction  i. e. pumping ability of heart had dropped to about 10 or 15 %. His cardiologist had mentioned to him about his deteriorating heart function and had asked him to think about  'code' status, DNR-Do not resuscitate . Normally we ask patient to do ' Living will' -which states patient's desire about aggressive and artificial medical means including feeding, . We also ask them to assign someone , in case they can not make own decision about the care ,. Most of the time it is spouse who takes over when patient can not . Sometimes if spouse is also too old or has dementia the one of the children will be assigned.
   One of these days he was admitted to hospital , with gastro intestinal bleeding . He was on many medicines which could contribute to the bleeding, aspirin , plavix and coumadine due cardiac arrhythmia . He was quite sick, and was in ICU. He needed several different consultants to see him  and needed many procedures . He needed ' central line ' to have access to give blood and fluids , needed endoscopy  to find source of bleeding . Overall he was not doing well. The cardiologist was talking to the wife and the children on daily basis to tell them the poor condition and the chance that he may not survive. The cardiologist was getting calls from hospital nurses any time there was new test was ordered or needed especially when it was invasive and they always got his OK to proceed .
    One day his blood pressure dropped . and in spite of medicines to bring it up it was not doing very well. When the hospital nurse called the cardiologist to update of his poor condition he made a comment that this patient should be DNR and family needs to make that decision soon . The nurse told the cardiologist that he was the one who is suppose to make that decision . The cardiologist did not understands , He stated that he has all ready told the family that the prognosis was very poor .and they need to make the decision . Then the nurse told him that He is the one who has to make that decision as He was the one  " who was assigned by the patient to make the decision ". He could not understand how he was  the one . When he came to the hospital , the nurse showed him the papers that stated that final decision will be made by this cardiologist AND NOT BY HIS FAMILY . This doctor was not only surprised but had big problem as the family though not ALLOWED to make decision were still involved in the care
     It appeared that the patient did not trust the spouse to make independent decision without being influenced and pressured by the children and so he assigned the cardiologist to make the medical decision .
     After talking to the family he did make him DNR and the patient passed away .

Friday, February 10, 2012


We need to know certain words to understand how the universe  and we as human beings are born from it as well as how The God created this  universe and beyond .
So let us understand the different words used in the explanation of this birth of the universe and beyond.
 1) Three bodies of human beings ,physical body , the one that we see , the astral body   , the body that we can not see but exact replica of the physical body, and the causal body , the one which is the cause of the all the  bodies or the existence.These are called ' STHUL SHARIR ' SUKSHMA SHARIR ' AND 'KARAN  SHRIR'  respectively.
 2)Three qualities, namely Tamasic , Rajasic and Satwik.Due to these qualities we 'act ', do different activities.
 3)Panch Pran. there are 5 pranas. These are 5 forces of energy or life , but not exactly. These are Apaan  Vyan .  Udaan Samaan and Praan  . When they are in relation to our body they are digestion assimilation , circulation excretion and the pran the life energy  itself.
 4)Panchamahabhute.  The 5 great elements. These are not the elements in physics , but these sre the one in the universe and they make the universe and our physical body .They are 'Akash ' --the ether or the space, The vayu-the air, the Tej--the energy , Aapa,--water,and the Pruthwi ---the earth. The air is all the  gases   , the water is all  liquids and the earth is all solids.

Friday, February 3, 2012


    It was more then 30 years ago, but I still remember it like it was yesterday.I was in my  1st year of residency in India, in medicine.We had this 14 years old patient named Ramila. She had intestinal tuberculosis. This occurs in countries where milk is not routinely pasteurised . So when one has milk contaminated with TB bacteria it settees in intestine rather than in lungs as commonly occurs in most of the patients. It causes nausea , vomiting and gastrointestinal symptoms.  She was 14 and weighed may 65lbs.She could not eat much and we used to force her to eat and drink milk, which was provided by the hospital. In those days the treatment for TB was to give intramuscular injection of streptomycin and pills of two other drugs. One of the medicine --pas was so high that even normal person would get nausea. She had no 'meat' to give injection in 'butt' After being in the hospital for almost 2 months we decided to to discharge her home . She came from a village near by. Her father was not very happy taking her home for several reasons . She was still not eating well , not gained weight, and she could not do anything to help him at home. But I had to.
       We did not hear from her for next 2 weeks . We had set up follow up with TB clinic. I was sitting in out patient clinic .Our clinic is usually very busy , we did not have any time do anything other than going from one patient to other . We had quota system for x-ray , and we could not order x-ray freely. So we used to do  lot of   fluroscopy.  We used to 'collect 8 or 10 patients to do it and one of us would go and do it . It was 11 am and our outpatient ended at 12 noon .And I saw Ramila   with her father . H e came to my table and said , ' I Will not take her home , you have to take care of her , she is  all yours, treat her as your sister. . I am not going to take her home today .' Ramila was still not eating was unable to keep much down . I did not know what to do . He also wanted to me to do fluroscopy . This was very common , all general public wanted it . So I decided to honor his request. I thought it may help him to understand that there was not much that I could change .
        In next 20  mins. we had our last group of patients to do the screening. When I did  the screening  of Ramila I was shocked. She had what we call air-fluid levels , suggesting that her intestines were blocked, intestinal obstruction . I called the surgical resident and she was admitted to surgery ward. I  explained  to the father that she may need surgery to relieve the obstruction. The day was too busy , so I did not have much time to check on her . But next day in the afternoon when I had time to think I decided to go to the surgical ward. I was expecting Ramila to be operated , but instead I was told that the father refused the surgery. I could not believe it . I told the ward boy es to look for him  around the the hospital so I could talk to him and convince him to agree for the surgery  I could not find him Next day he came to the daughter and the surgical resident called me . I had extended discussion with him and finally he agreed for the surgery . Ramila was not in the best shape for the surgery , and did not make it , she died shortly  after  the surgery .