Thursday, May 31, 2012


The difficulties that we used to  face in treating TB were stories in the past if we get patients in our office. We still continue to have problems when we treat patients with TB who are homeless or alcoholic or unreliable. But the case that I am going to describe is difficult due to other reasons.
    I saw this young lady , may be about 40 years old . She was referred to me due to the x-ray findings . She had history  of positive skin test for the TB called PPD . The positive test means that some one was exposed to TB and that caused skin test for the TB to be positive. The test does not mean that patient has active TB .Her x- ray showed the upper lobe abnormality , which was consistent with 'old TB '. She worked in a extended care facility where she worked as physical therapist. So it was essential to rule out active infection with TB . So I did a bronchoscopy and send the samples for the culture of the TB.The cultures came negative --no TB . She was cleared to work in the facility.
   I continued to see her . I had to clear her every year. So I continued to do yearly x-ray and see her every 6 monthly in the beginning and then yearly.
   It must be 3rd or 4th year that we did chest x-ray and it showed some change in the upper lobe , same place where she had scars in the past suggestive of old TB . When she came for the follow up , I asked for any symptoms of the TB , like weight loss or night sweats or low grade fever etc . She had no symptoms. I was still not happy . So I decided to do again a bronchoscopy . The bronchoscopy was done and about 2 weeks down the road I get a call from the microbiology lab . that the bronchoscopy washings were growing TB. I did the bronchoscopy to rule out TB , I was still  stunned. I asked the lady if this was reported to the  the health department . She said 'yes and that it is automatic.I was going to call patient. It was 4-15pm and I had to clear messages . But it was very important to call the patient and the health department. I called the patient and there was answering machine. I left brief message to have her call me . Then I called the health department and I again got the message . I again left the message . I was trying to return my other messages , when I got the call from the patient . I explained her the situation and told her to come to office in the morning to get the prescriptions. She was not alarmed , but was concerned . I also told her about checking the family members . She had a young daughter and husband . They both will be needed to be tested . I also told her to expect a call from the health department . I told her that they will check her out as well as treat her and the family , if needed. They will also monitor them . then I got second call . This one was from the health department and she took down all the information and told me that they will contact the patient and the family in the am and 'take care of this .'
    Up till now this was all expected . But next call was not anticipated. I knew that she worked in the nursing , but had forgotten about it . My next call was from the nursing home director . The patient had informed them about the diagnosis and told them that she will not be in position to work till was on treatment for 2-3 weeks . The director wanted to know about the patients that she was treating and if they should be tested. and what was the 'risk' of transmitting the TB . I tried to explain her the risk but was not able to tell her enough to calm her down . So I gave her the telephone number of the Health Department and told her to contact them in the morning  as  they will be  doing all the testing of the contacts'
    The good news as it turned out , was that the patent's husband , the daughter were all negative  , and the nursing home contacts were also negative . I have since done follow up on her , she is off the treatment and she is fine and the x-ray is good too .

Wednesday, May 30, 2012


     We all have different priorities. We value things differently. I am never going to buy shirt for $100. But I will not hesitate to spend as much as it takes for the education of my kids. I see this in medical practice all the times . Patients will have no problem spending $10 for smoking or $100 for name brand shoes, but they will have problem with co pay of $40 for buying an inhaler. So it does not surprise me when I see priorities which are different than mine . But sometimes I am also amazed.
    I was called from ER on one weekend . There was a 31 years old female who came to ER for the shortness of breath. She had breast augmentation done a day before . Her X -ray showed  partial collapse.of the lung. She was not in any distress but the collapse of the lung was significant and which meant that she would need chest tube to re-expand the collapsed lung. When I went to see her and examined her I realised that her recent breast augmentation was saline implant  and it was not yet 'localised' and was quite spread . I was not sure about the  extent of the implant . I was afraid that if I happen to make 'cut' to close to it or puncture it bu accident it would rupture and I would have more problem than the collapse of the lung.
    I decided to to call a chest surgeon. The chest tube was put in with no problem and she did fine.
    When I looked at the health insurance information I was not too surprised to know that she had no health insurance and so no doctor would get paid for his or her services. So the question was who paid for the breast augmentation?I asked her that question . The answer was some what surprising . This patient was a strip club dancer and one of the 'patron ' of the club was very 'happy ' with her and had paid for the surgery. So the breast augmentation was the 'priority ' for her and him and not getting ahead in life or get health insurance.

Saturday, May 19, 2012


      In life one has to be at right time at right place. Sometimes we are a wrong time at wrong place . This one is story of a patient who found himself to be at right place but at wrong time. or me be at wrong place at wrong time. I will explain at the end .
      One my my friend is  an internist. Lot of doctors have their DEA number printed on their  prescription pads . I tend to wright it , only when I write prescription for the 'controll'  substance, narcotics, (pain medicines ,sleep aids etc. )So this friend had a patient who was a drug addict . In my office the prescription pads are not in the examination rooms , but write the prescription  in the room and then they are left in my room . This patient stole the prescription from this doctor.He wrote the the prescription on it for the narcotics and signed  the doctor's signature. The DEA number was printed on it, so he did not have to know it . He took the prescription to the local  pharmacy. he was sure that he would come out with the narcotics . Unfortunately for him , the pharmacist on duty was the wife of the Internist whose signature he had forged. When she saw the signature, she knew that it was not her husband's signature. She called him to confirm it and then called the cops.
     The patient got suspicious , when saw the expressions and the commotion and ran out. So if he would have come there at other time or had gone to other pharmacist, there would have been no problem . So he was at either at wrong place or at wrong time . 

Monday, May 14, 2012


     There are many incidences that occur in our life . This is especially true in medicine.But this story that occurred several years ago is quite unusual. and may be that is why I remember it as if it occurred yesterday .
     It was Saturday and I was going to start my weekend hospital rounds. On the weekends the rounds are shorter, as usually there are no procedures and there is no office, so I am done in 3 hrs. And then the phone rang. I answered it . There was a male voice, " is this  xxxx's residence ?" I said 'yes'. o then he told me his name and told me that he was visiting from out of state and had come for some work. He had a meeting that afternoon and had some 'free ' time , so thought of meeting me . I was not too sure as to who he was , but then came to know that he had known that I lived here and he looked up in the telephone book and found out my telephone number and was calling me to see if I had free time . I told to come in the afternoon as I was going out for my work .I gave the directions to my home .
     He came to my home that afternoon . We were fasting on that day , so the 'Fsting food ' (this is the paradox ---fasting food ) is great and most of the people love it. He was no exception . We had  nice  talk . He owned a company that he had started and developed and the sold it to a bigger company and now was a 'consultent ' for that company . He was married and had 2 sons and both were married . His company had a small office in our area and  he had come to talk to the manager. we had a nice talk.When he was leaving my home he asked me for the directions to his manager's place .It appeared from the address that he lived very near our place.
     On the Sunday night I got a call from the hospital. There was a new patient who had a cardiac arrest and was put on respirator. I had to go to see the patient . When I went ti ICU I was surprised . She was a 23 years old female who was with her boy friend  and friends , and had the collapsed. The paramedics were called in and the she was resuscitated and was transferred to the hospital. Usually in these situation it is related to drug overdose. and then when something like cardiac arrest occurred the boy friend is never to be found. This was though not usual. Te boy friend was there and so were the parents . and to mu surprise the 'drug screen '  was negative . So she had not taken any drugs ! When I looked at the x-ray I was little more surprised . Usually the x-ray is normal , unless patient had vomited and aspirated ,food or the stomach content go in to the lungs.There was no alcohol involved , so there was less of a chance of aspiration. I was not too sure , it could be a pneumonia and then she had respiratory difficulty and had drop in the oxygen and than the cardiac arrest.
    I talked to the family and started her on antibiotics and then told the family that we will 'support ' her on respirator and allow the 'time' to have brain recovery. There may be a chance that the brain may not recover. So we have to wait and see.
    Next morning I had ordered the ultrasound of the heart as a routine as she had the cardiac arrest. It was shock to me when the  ultrasound was done . It showed that her heart function was reduced to 10 % or less . This was a shock , but it explain the cardiac arrest and the x-ray findings and it became easier to explain to the family . I still had no idea why she had the weak heart .It could be that she had viral infection , that caused the inflammation of the heart muscles that made it weak .
     As time passed this became a mute point as she had not improved and she continued to be in coma . When we did brain wave recordings it was abnormal, but very abnormal . We continued for the couple of days, though we had no hope . Then I talked to the family . I wanted to discontinue every thing ---so called "withdrawal of the life support ". The father was quite open and had accepted the fact that his daughter was not going to wake up .But it was still quite difficult.
      It is never easy to loose some one close to you, and here it was 23 years -young daughter. I do tell patients some philosophy, especially Indian thinking of death and dying . So I told him about Indian thinking that the soul  is permanent and  like we change clothes it changes the body . i.e the concept of reincarnation  'clothes'.
    The father asked me if I was Indian -Hindu , when I said yes , he told me that his 'boss' was also Indian . I knew quite many Indians in our town , so I asked his name . He said , ' you would not know as he is from out of town '. I told him that I knew him . AND HIM IF HIS NAME WAS MR. XXXX, (THE GUY WHO HAD SEEN ME ION THE SATURDAY ) The answer was YES.

Sunday, May 13, 2012


     I was going over the last blog and realised that some confusion may arise.This is related to the last segment. Did we come from the animals ? I wanted to clarify something. When I say that we did come from the animals , it does not mean that we 'evolved ' from the animal. When the Hindu religion talks about the evolution , it talks about the evolution of the soul, and not the physical evolution that Darwin talked about. We did evolved from the animals , as the improvement in our understanding and devotion . We will regress to the animal level , if we do things that are not repayable in our human existence. So ideally once we get to the Human level , where the 'food covering ' the 'life covering ' , the 'mind covering ' and  the intellect covering ' ,   are all evolved and so we can continue to 'progress' to get 'bliss covering ' evolved.
   As per law of karma, we will have to 'pay' for every bad deed that we do .If one continues to do bad deeds , then he will accumulate lot of bad karma seeds, that need to come to fruition . The may come in this life (some one stealing or killing some one and getting caught, will go to prison and this is the effect of bad deed that he did in this life  coming to fruition in this life . )or next life or next one. But if one has so many bad deeds that no matter how many lives he lives , he can not repay .(This is because when we are born, we continue to create more karma and if we are not good to start with , we are likely to do more bad deeds and continue to  have more bad karma accumulated ) So in short he will have no 'hope ' of getting rid of bad karma .and no hope of stopping the cycle of life and birth . This is not 'fare ' So in this case this particular individual will regress to animal kingdom , where not only the law of karma does not apply , most of the time , but because the animals act on the instinct , they will he will have chance to 'exhaust the bad vasanas. So in this case we do go back to being animal again.
   This situation as described above could be compared to the situation that some face , when they run a debt which is so high that there is no way that they can pay it off. The day to expense continues to mount and the debt goes up . So the only way this cycle can be broken down is to declare bankruptcy. Now the creditors can not demand and  then they can start 'new ' life and there is some hope that the debt can be repaid .

Saturday, May 12, 2012


    I was asked some questions about the reincarnation , and as such these  questions would come to any body's  mind if he  or she would think about the concept of the reincarnation . I Will try to address them and I am sure that there are more questions that will come out of the answers . This will make me think and look for the answers.
    1 . If our life is determined by what we did in last life , what about the 1st life? How was the course of the first life determined.?This question is quite common , and the then it becomes like  a question , 'what was first , the chicken or the egg'. But it is little better here . The cycle of the birth and death continues for the 'jive', from the beginning of the universe till the end . At the end of the universe, all the things go back in to unity. This includes the consciousness, all 3 Gunas -the qualities,  the 5 Mahabhuta-the elements and all the Jivas. So there is no real end and no  real beginning .These cycles of the beginning and the end of the universe has continued for EVER. So in reality there is no first life . If one remembers the video games , there is no 'end' to the screen , something like that is to the universe or same can be said about the Time . I will come back to the first life again in latter question.
    2 . If we were 'here ' and had 'interaction ' with the same people in our last lives, then how come we don't remember any of this life or the relationships etc. The answer is very simple. We do  carry forward the 'impressions' from one life to other , but these are in an abstract form . That is they are impressions, but not like we carry in present life . In all probability in this life , we will never forget our parents or our children or our spouse., unless of course our contact was too brief,or we become demented. But the impressions are carried as an abstract and  'give' and 'take' type of relationships .So we carry forward the debt and the balance related to one another without remembering exactly what this debt is due to or the balance is for . Let us say that I have helped some one with physical , or monitory or emotional help . This will have lasting impression in this life and if he in turn helps me , some of the debt will be repaid . But whatever is not repaid is carried to the next life as debt without knowing as what it is for. The actual incidence which created is not going to be remembered, as it is stored in 'physical brain ' exactly as it occurred, but stored in astral brain in abstract form . In other words, if I am keeping bookkeeping records of my expenses, I will be writing $50 for the dinner , $ 300 for the air line ticket or $1000 loaned to some one . This is the way in which it is stored in physical brain , but in astral brain it will be stored 'plus or  'minus ' . Since we do not carry our physical body from one life to other we do not remember these incidences.
    3. If our every action has reaction and every deed  has the effect of  'creating ' karma., then does a thought , either good or bad , especially bad , creates any 'karma '?This is a great question and the answer is same as in our present life . Let us say I went to LA once and I was trying to find way to a place . I never go to LA again and never went to that place . What is the chance that after 10 years I would remember it or better after 50 years  would I remember it ?  There is good chance that I would remember nothing. This is same as a 'thought'. If I think about  something -either good or bad- if it is only once , it will not have much long lasting impression and it will not 'creat' karma . i.e. I  have a  thought of  killing some one or a lust for some one  and I continue to have it repeatedly, then it will create lasting effect and will be a karma carried to next life . So the thought will create karma only if repeated .
    4.Did we come from the Animals? This one is interesting and and don't have all the answers . But as I understand we did come from animals and 'evolved' from the animal kingdom to Human beings. But this 'evolution ' is different than the Darwinian evolution. As you recollect there are 4 different types of existence in this world ,i.e. stone , plant, animal and human beings .The stone and plant kingdom have not much of intellect and no conscious and no bliss.But at the level of animal level some intellect is there , but most of the time they work at the level of 'instict' . The GOD put us through animal life to exhaust our 'wasanas ' --desires. If one observes the various animals , we realise that each one has different qualities. i.e. dogs are 'loyal ' fox is 'cunning ' the pig is 'dirty' etc. So we go through these 840000 different animal lives to get rid of all these desires . And then we come to the Human stage . In this one we are suppose to work on these  remaining desires to get rid of them .and one with the GOD . So we did go through animal kingdom .

Thursday, May 10, 2012


     I am often asked if the incidence of TB is on rise ? I think it is  on the rise and there are more cases of TB which are drug resistant, TB bug has become more resistant to the 'usual ' medicines that we use. This has to do with the immigration of people to US from the countries that have higher incidence of the TB and so the TB bug from those countries have been 'exposed ' to these anti TB medicines and so have developed the Resistance. But the difficulties that I am talking about are different. So I am going to describe 2 cases here that are interesting.
     I saw this young lady , for the chronic cough. She was 28 years old and had the cough for about 2 months . She saw her primary care physician in the office , who did some blood work and did x-ray and gave her an antibiotic . She was told that she had bronchitis .When she continued to complain of the cough, she was given an another antibiotic .The cough continued , so she was refereed to me .
    She was not short of breath, had no fever and no other complaints . She sounded clear . i.e. lungs were clear . There was some history of cough getting worse with laughing. She was told that x-ray was OK and so I did not repeat it . I ordered pulmonary function studies and started her on bronchodialator. She felt better but still had cough. I had requested the x-ray report but never got it ,So I finally asked her to get the actual films. As the cough continued  I decided to do the bronchoscopy . Her blood tests for allergies were negative . On the day of the bronchoscopy I got the x-ray films . THEY WERE NOT NORMAL , they showed mild 'infiltrate' ( congestion ) in right upper lobe . I thought that she may have had pneumonia and decided to repeat it after the bronchoscopy. and if needed to do the CT scan. . She had the bronchoscopy and it essentially OK . I told the patient the plan to repeat the x-ray and if need  to do the CT scan . And then it happened . I got a call from the micro. lab. that the bronchoscopy washings were growing TB bacteria. .Normally this triggers a call to the patient,then I talk to the patient , start them on medicines and do office follow up in less than 7 days . I also  get the family checked out from the health department. This is not that difficulty.and normally the patient is treated well . Unfortunately in this case there were complications.
     The next day I got 3 phone calls . 2 were from two different lawyers. One was this patient 's employer . He was quite concerned about the exposure of the other coworkers to this patient with TB and what is the risk, what can be done , when can patient return to work , and how sure I was that she will not be spreading the TB.
    The second phone call that I got was from the patient, she was upset and and was mad too . Her soon to be ex-husband and his lawyer were accusing her of  of purposely trying to spread TB to her daughter. I was not too sure as to what this exactly meant, and what was my 'role 'in these accusations . When I got the call from her lawyer it became clear . My patient did not know about the diagnosis of the TB which was in the 'infectious ' sate , and so she still had a close contact with her daughter. So the 'claim ' was that she was hugging her and kissing her with the 'intention ' of spreading the TB and was not 'fit ' yo be the mother and so the husband should get the custody .
    I had hard time trying to sort this out and deal with 3 lawyers and emotionally upset patient . However everything worked out . I told the her employer lawyer that she was 'infectios' for the period of 2 weeks after the treatment was started and was infectious before that too , though 'causual 'contact at work should not cause spread the TB , but testing the close contact workers was the best idea and was recommended.I told the husband's lawyer that she was not aware of the diagnosis of active TB and her daughter was exposed anyway and need to be tested and or treated . This was mandatory as all the family members must be tested . I assured the patient and her lawyer that the husband can not 'use ' TB diagnosis against her .and I will help them if they try to use it .
      The patient was started on the treatment, and was followed by the health department and good news was that she did not have 'drug resistent' TB and her daughter was negative for TB on further testing and her co-workers had no problems as far as I know.


Tuesday, May 8, 2012


      I often get consultations for the abnormal x-ray . Sometimes it is 'nothing ' , sometimes it is a cancer.and sometimes we need to do tests to find out what we are dealing with . Sometimes we have to do things to 'prove ' that there is nothing. or at least nothing sincere.
      I saw this patient in the office for the abnormal x-ray. He was 28 years old Vietnamese male who was seen by his primary care physician. He was complaining of the cough. So the physician did chest x-ray,and it was abnormal . It showed the 'congestion 'and so he gave him an antibiotic. Patient did not have fever, and did not get any better. So the MD did follow up x-ray, It continued to show the congestion . . So now he ordered a CT scan of the chest and send him to a cardiologist. The CT scan showed significant congestion in both the lungs . The cardiologist did an echo cardiogram --an ultrasound of the heart. He told the family that the heart was  OK and he needed to see a lung specialist. So now he came to me . He had Down's syndrome and was quite a bit mentally challenged. He physically looked OK , but was not educated and was not working and had significantly reduced IQ. So I was talking to the brother , with whom he lived .
     I examined him  . The over all examination was normal, except that he had a murmur . He was also having some cough and had very small sputum .  I looked at the x-ray and looked the CT scan . Though it was abnormal, I did not think it was showing 'pneumonia ' . I thought that it was consistent with 'congestive heart failure ' . When the heart does not pump out enough , then it 'backs' up in the lungs and x-ray will show increased congestion in the lungs . This time my thought was little different. With his Down's syndrome In which congenital heart defects are common , I was thinking of 'hole in the septum ' that separates the right and the left sided chambers. It either could be between upper chambers (called ASD ) or lower chambers (called VSD ) . When I  told the brother the possibility of this diagnosis, he said that cardiologist  told them that there was nothing wrong with his heart . I told him to go to a pediatric cardiologist, even though he was not a child.
     He agreed , did go to the pediatric cardiologist, who did again a echo cardiogram. IT was positive for the ASD and he did a cardiac catheterizing and it did confirm the diagnosis of ASD .
    He was referred to a pediatric cardiac surgeon. Unfortunately patient's father refused the surgery as he felt that there was no reason to 'prolong '.

Sunday, May 6, 2012


      It was my first patient. Normally I start at 1 pm . We however see new patients at 12-30  pm if they happened to be sick enough that they can't wait ,  but not sick enough to need to go to the emergency room . These are the patients that I 'squeeze' in at 12-30pm .
     She was 54 years old white female , who had or was in process of moving from other state. Her husband had moved here due to change in job and now she was trying to move after taking care of the 'stuff ' in her previous state. .When she was 'home ' she was driving on a highway and got chest pain and then developed a dry cough. She was also little short of breath. So she went to an emergency room . She was evaluated by the physician and had x-ray done , blood tests done and an EKG was also done . There was no 'heart attack ' , which was her concern as her father had died of heart attack, at very early age . The chest x-ray showed 'pneumonia ' So the emergency room physician gave her antibiotics and cough medicine and she was told to do the follow up with her private MD.
     She was quite busy, as her husband had moved , and she was trying to sell her house and so could not sees her own MD, but did manage to go to a 'walk in clinic ' . She still had the dry cough and still felt short of breath. She had no fever. The MD at the walk in clinic did again the blood tests , did another x-x-ray and told her that her 'pneumonia ' was still there and gave her different antibiotic and told her to do the follow up with her own MD.
     She was now in our state and city and was more short of breath and still had the cough . She now also had some sputum, which was clear and had no fever. She could not sleep well due to the cough and the shortness of  breath . She ended up in a walk in clinic and the doctor did another x-ray told her that her pneumonia was not clear , gave her yet a another antibiotic and told her to see a lung specialist.He gave her my name . Now she was in our office.and so due to such a long history we gave the 12-30 appointment. Today she was so short  of breath that she had to sit down for 5 minutes after taking the shower . She had brought with her the x-ray film and the blood tests.
    She looked quite comfortable , did not look short of the breath and did not look 'sick' . Her blood pressure was low normal , her oxygen saturation was 96 % and she all most sounded clear on the examination of the lungs except for mild crackles at the bases of the lungs. She did have a  murmur . When I asked her about it , she told me that she had a murmur and was told to have a prolapse mitral valve. I looked at her x-ray and told her that she did not have pneumonia . I also told her that I was concerned about the heart, and she may have a leaky valve, that may need urgent attention .I also told her that if this was not the case , then I would admit her to the hospital , do lung biopsy and start her on intravenous antibiotics. I was quite concerned about her overall status . Her 'pneumonia ' was going on for last 6 weeks . and she had not improved .
     She did not have the car and had come to my office in a cab . I called a cardiologist, who is my friend too . I told him the story and told him to see her ASAP. He agreed. I was so concerned that I told my office manager to drive her to his office .
    He called me in an hour , with the news that she had severely leaky mitral valve had needed to be admitted . She was stabilised , had a heart catheterizing and then was operated for the 'repair ' of the valve.
    So the so called pneumonia turned  out to not the unresolved pneumonia, but  congestive heart failure,. As her valve became leaky  the  blood instead of being pumped out , was going wrong way , causing congestion in the lungs . So the lungs which are like dry sponge, normally , were now like wet sponge and so she was short of breath .

Saturday, May 5, 2012


     So is there a Heaven ? When I ask this question , I use the term Heaven in a very specific way or the meaning. The current concept is that it is most 'desirable '  and place for all the pleasures and no pain and sufferings , etc . I am not so sure . If we do not have physical body in the heaven , can we 'enjoy ' the pleasures that we tend to attribute to the bodily experiences.?. If we 'can ' , then question is 'How ' and what is the vehicle of these experiences ? If we 'can not ' then how can this be a heaven  ?.
      To try to get an answer to this question , we need to ask a question . What is the source of the pleasure and what is it that experiences the pleasure ?. Let us take an example, If one likes pizza and he eats it , he gets the pleasure with the act of eating pizza. So he feels that the pleasure comes from the 'pizza' , i.e pizza is the source of the pleasure. The same will be with 'listening ' to music or having 'sex'. We tend to attribute sense of pleasure to the external source . But this may not be accurate. The 1st slice of pizza gives you more pleasure than 3rd or 4th and 10th slice will give to not give pleasure but will give pain or sense of vomiting . same with the music . If the pleasure comes from the music then 'everybody ' should 'enjoy' the rap music or the rock or classical music or the opera . But in practice it is not true . If the act of sex or the intercourse is the origin of happiness then the act of 'rape ' should be pleasant too . So from these example it is clear that pleasure is not in the 'act ' or the external 'source' , but it is in OUR MIND . So some people may like and get pleasure with classical music but others may enjoy hard rock . Because the pleasure is in the MIND .
     So when we die and there is no physical body we may still 'enjoy ' but it will be different type of the enjoyment as we do not have the 5 organs of perception . i.e. smell touch here see and taste . As I understand , in the astral world, every thing is astral. Which means it is without physical dimensions.So we may 'feel '  the pleasure but only in the dimensions that we have 'experienced ' it in the past.The past experiences leave us with 'pleasure ' or 'sorrow' and that in turn leads us to act in our physical life . Since we do not have physical body , we can not get or accumulate any new experiences, but those fro the past experiences, which have left us with the impressions in abstract form  , can be re realised.  As I understand there are 7 levels of astral world and according to our 'level ' of the 'achievement ' we will be in one of them . Lower the achievement, lower is the astral level . The criminals and the murderers will be in lowest levels.(If the sins that are done by such human beings are so bad that they could never 'repay it ' according to the law of the karma , then they may 'regress ' to the animal kingdom as the animals mostly act on instinct and law of the karma is applied to minimal or not at all,. in case of the animals. ) The highest levels are achieved by those that have no 'attachments' left with mortal world  which in actuality 'physica; ' world , but still want to 'help' others and or still feel 'Duality' with the God and are not 'one ' with 'Him ' . In the astral world we can not do physical acts, so we can not accumulate any more karma. but we can not 'pay ' for it too. So there is no change in our karmic balance .
    So in my view there is astral world and the higher levels of the astral world will give us more closeness to the GOD and that 'pleasure ' is the highest and the most desirable. So this could be considered the heaven . But when we have not detached our self  from the physical body and continue to feel duality with God and have not 'paid ' for all our karma, we will be reborn. When there is conception on the earth, based on the 'karma' of the parents and our karma match we are attracted to it (fertilised ovum ) and we enter it and the new life begins. As the karmic impressions are stored in an abstract form, we do not remember our past lives. But we do have the impressions from those lives and part of our 'personality ' comes from these impressions .
    The other concept, like hell and Satan  will be discussed some other time.

Thursday, May 3, 2012


      The concept of the heaven is in every religion . If one looks at the various religions , we find that there are 3 parts to each religion .
      1 Does and The Don'ts .These are present in every religion and they are similer  .e.g. Do not lie, Do not kill, Do not steel etc . No one teaches to kill the neighbour or steel from your neighbour etc. These are ' universal ' and they are 'common ' to all the religions .
      2 There are things in each religion that really does not make any sense. It may have some valid reason in the past , but now it is of no 'use' or there is no real explanation that would satisfy us . In Hinduism ,Hindus do not eat beef. The Jewish will not eat pork , same as Muslim and Christen avoid meat on Friday. This has no 'religious' explanation. But if we think about it , we can come with  plausible explanation.Many years ago  farming was  very important and we needed bulls  for  farming and cows were needed for milk So loosing bulls and cows would be major problem . If people were told the real reason and were told to not kill the cows , no one would listen . So some one must have come out with making it religiously not right . to eat beef. Otherwise it does not make sense for a religion that believes that every living thing has a soul , to allow to kill chickens or goates and not the cows . The same is true of the restriction on not eating pork . A parasite is transmitted by eating pork , so the religious restriction came in picture . ( The exact cause of the disease  caused  by the parasite may be not known , but people still recognised the sickness it caused. )
     3. The third part of the religion is the 'philosophical ' We in Sanskrit language call 'anushawic'--the one we have heard about , but not experienced it . This the concept of Heaven or the hell or Satan etc. So is there a Heaven , if yes then what is it and there are many other questions. We tend to use word heaven quite loosely. But we all mean the same . The heaven is a place where everything is great, pleasurable and there are no woes , worries or problems , pain etc . One will get anything and everything and will have no problems. I often ask a question , when I listen to this explanation of the heaven.So if one wants to eat juicy steak every day , he or she does not have to worry about the heart disease that it can cause or the cholesterol etc . But then what about the 'cow ' that has to 'die ' to get you the beef , is it not a heaven for 'her '? or there are different heavens for different people? ( forget about the fact that there is no physical body to eat the steak . ) Let us say one wants to be the best basketball player , wants to be the no 1 . So he will be the no. 1 . But then if there are other kids who want to be no 1 , then all of them will be no 1 . So now my question is ,if all the kids are no 1  , and there is no no 2 or no. 3 etc , what good is that no. 1. There is importance to no. 1 only because, there is no. 2 and no. 3 and the last number. So the pleasure of being no.1 is gone . So is it still heaven?
     So the question still remains , is there a heaven?  

Wednesday, May 2, 2012


   Sometimes doing nothing is the best approach, But in today's medicine practice, which is 'procedure ' oriented or because it is more to 'do things ', or the primary care physicians expect   consultants  to do things , whatever may be the reason , everybody tends to do  more procedures than do the thinking to see what may be the reason for the problem . This very similer to writing a script than to listen to the patients and do the proper advice.. This is more obvious to me in cases of pleural effusion or the fluid around the lungs . I have seen many patients with the pleural effusion and elected to do nothing or at least not do the procedure to take out the fluid.
    I saw this young lady, about 33 years old , for abnormal x-ray. She was diagnosed to have a 'Lymphoma ' --a malignancy of the lymph nodes , about 2 years and got the chemotherapy. She did very well and was in remission . She felt good and had no fever or cough . Her appetite was good and she had gained some weight since being off the chemotherapy. As a routine she had PET scan and then a chest CT scan. The pet was OK but the CT scan showed pleural effusion , fluid around the lung . She was not much short of breath, but did find some shortness of the breath an exertion. She was referred to me to see  if she needed to take out fluid. The oncologist was concerned about the recurrence of the lymphoma.
    When I saw her I was concerned too, but things did not look like she had lymphoma again. She did not 'look ' sick ', did not have fever, weight loss, her appetite was good and more than this her PET scan was 'good '. Even though PET scans are not 100 % they are quite reliable , may be 90% accurate in picking up malignancies.. But then there was this pleural effusion. I still had no idea , why she had the fluid . I   looked at the CT scan again . And it struck me . She had a port put in for the chemotherapy. When patients need chemotherapy , it causes sclerosis of the veins and even drawing blood is also very difficult. So we put in a semipermenant intravenous line which is called a port, This is put under the  clavicle bone in a vein called subclavian vein . So she did have a port. My thinking was that the port had caused the 'narrowing ' of this vein .  The veins drain back the blood , which goes to various organs by arteries. So if one has partial blockage of the returning fluid or the venous drainage the pressure would go up and the fluid will 'go out ' of the circulation and this could cause the pleural fluid .
    I told her my theory and told her that I  was going to schedule for a test to confirm my theory and then have radiologist put in a 'stent' to open up the blockage . Off course the port has to come out . This will help and 'cure ' the pleural effusion .
   I am glad to let you know that my  hunch was  correct and she had the venogram that confirmed the narrowing of the veins. The radiologist did put in a stent and that solved the proble. The pleural fluid disappeared and she did not need me to drain the pleural fluid .

Tuesday, May 1, 2012


     There is a story in the Indian literature.  There was a king and he had a very smart guy who was his adviser . Once upon a time the king had a visitor who spoke several languages very fluently. He was so good at speaking these language that no one could find out which one was his mother tongue. The visitor challenged the king , stating that he had heard that the king had several smart people at his disposal and asked him to tell the mother tongue. The king was not sure as to how to tell the mother tongue. So the king asked the adviser . He told the king that 'give me one day and I will tell you tomorrow ' . As the  visitor  went to sleep , this adviser went in his bed room and when he was asleep , poured some water on his face . The visitor was startered and woke up speaking in a particular language . The adviser apologised and left the bedroom . The next morning in the palace when the visitor arrived , and asked the king , if he dot the answer, the adviser answered that it was the language (that he spoke on suddenly waking up  from the sleep ). I had similer situation in my practice.
     I was in a gym one evening.  I have been going to this gym for few years. When I walked in , I saw the paramedics and all the members gathered at one place . On further inquiry I came to know that one of the members had cardiac arrest and then the paramedics were called in . The guy was really lucky as there were 2 doctors in the gym at that time . They knew and did CPR and then the paramedics came in , intubated the patient and started IV and then transferred him to the hospital.
    I was quite curious as to what happened to him at the hospital, so I called the hospital . As I called , I was told that He was on the respirator and I was consulted. So when I went to the hospital .
     He was a 45 years old Indian from Africa. He had sudden cardiac death , and was in coma . He was not breathing on own , being supported by the respirator. There was not much to do for me . The cardiologist was also seeing him , and I was going to support him on the respirator , as long as he was not awake( and hoping that he would wake up . ) I did speak to his wife , who happened to be white American . She was at his bed side almost all the time . He continued to be in coma for more than 48 hrs. I had call from his brother , who was a cardiologist and he flew in . On the 3rd day he was waking up very little . When I went in the wife was in the room . She was holding his hand and saying some thing like ,' honey wake up , this is ------, look at me ,  open your eyes, kids are waiting for you. ' And then his brother came in . He stood on the other side of the bed and spoke to him in 'his' mother tongue. I could not understand a word of it , but was very curious to know if he would 'respond ' to her ( wife ) or his question , which was in his mother tongue. I was not too sure what would happen , if he would answer to his brother who spoke in his mother tongue or to his wife . And what would she feel , if he did not respond to her and did to his brother.
     Fortunately he did not respond to either.
     He did wake up in next 24hrs and was off the respirator and did go home.