Saturday, June 30, 2012


    I often wonder, if medical doctors or their medical professional colleagues become insensitive to the problems or not . I was quite upset and sad when my own dad was sick and then passed away at age of 88 years. But I do not feel same sadness when I see 88 years old patient . I do however feel very sad and emotionally upset when I know the patient for a while . The age does make a difference, but more often it is the closeness that one develops that make us sad or indifferent . So I don't think we as healthcare professional have become indifferent to the problems of the patients as we face them daily , on the contrary as we see it daily , we develop 'insight' in to it . This story is of a patient where sometimes we did show insensitiveness.

    It was almost 5 pm on a weekday, when I was called by the nurse . One of the patients that I had seen in the morning had abnormal x-ray. I saw him in the morning this 78 years old  patient , who had a stroke . He was OK but was mildly short of breath. His swallowing was not normal and so I had ordered a swallow study and and X-ray . He was quite weak and could not clear his own secretions. The nurse called me at 5 pm , telling me that the x-ray showed that his entire left lung was collapsed. This can sometimes occur due to inability to clear the secretions. We give them what is called ' pulmonary toilet '. This helps in most of the cases. This time however his entire lung was filled with mucous and with his stroke and the advanced age , he was unable to clear it and was not likely to clear it without the help . We do a procedure called bronchoscopy , in which we put in a tube into lung through nose and suction out the secretions . Once this is done most of the patients can 'maintain ' the patency of the airway. So even though it was 5 pm I had to go to do the bronchoscopy . I told the nurse to get the consent for the procedure from the wife and called the endoscopy nurse on call to come in .I was hoping to do the procedure by 5 -30 pm .The nurse called me right away. She was already called by another doctor to an endoscopy. So she told me that I can do it when he was done. The procedure that he was going to do, normally takes 10-15 mins. only. So I decided to go to the hospital.

    When I reached the hospital , I went to ICU, hoping that the nurse would be there . She was not there. She was still busy with other doctor . His patient was in ER . So I decided to go to ER,as I knew that this doctor was easy going and takes his own time , unless pushed .

    When went to ER the gastroenterologist was there , the nurse was there . The patient was a30 years old female, who had swallowed needles . On the X-ray box there were 2 X-ray . One showed 2 needles and one had only one needle . So I asked the nurse if the gastroenterologist had removed one needle. She answered, "No, the 1st X-ray is from last admission, when shw swallowed 2 needles, the second one is from now . This time she has swallowed only one needle. ITHINK SHE IS IMPROVING!

I did laugh. Have I become too insensitive?


I talked about the 'Eight Fold Path ' for the achieving the Samadhi. I wanted to tell more about Ahinsa. The ahinsa is not only limited to action , but also should be related to thought and behavior. By the way all these things are to help keep our mind quite and to achieve Samadhi . Think about it . If we are indulging in various things, then we will be not be in position to calm our mind. I will get in to this latter on. But our action can also cause 'Hinsa '. We hurt someone by our talk or our action leads to problems for others, and then it is violence. This is in reference to people who fast, who do chanting and other family members have to suffer . This is not acceptable behavior. This is important as when we do any action, we are doing Karma and according to the law of Karma if we do bad karma, we will have pay for it . So if we ' hurt ' someone we will have to ' repay ' for it.
Now about the 'satya' Not much needs to be said about this one as all of us know it. Someone may ask, so what is truth? The answer is simple. When you say something knowing well that it is not true, then it is a lie. It does not have to be true. When in past people thought that the earth was flat and the sun moved around the earth, they were not lying, as they did not know that the truth was that the earth was round and it was moving around the sun can we lie if it is for the benefit of larger good? According to me the answer is yes. If I have to 'lie' to save a life or a good person, then it is OK. This is more of a common sense. This is little complicated and I am not sure I could answer it. In past the churches did hide people who were running from Nazi, and were lying about their where about. So they did take sided in the conflict and decided who was good and who was bad .But we don't have these kinds of conflicts occurring in our lives , certainty not daily , and so in the most or all the situations we know what is truth .


Thursday, June 28, 2012


    There are times when we get a question ,'Doc , How long do you think I have or he has or she has ? ' We tend to avoid it , if not completely , at least partly . We truly work on stastics and it may be true in many cases but not in all the cases. ( I often make fun of stastics by saying that ,if you put your one hand in boiling hot water and other in ice cold water, then statisticaly you are at comfort! ).But this 'wisdom ' of not telling the truith or so called truith, does not come till you are proved to be wrong . This story is one from my earlier years of practice .
    I was called to see a patient , who was caughing up blood . He was 75 years old white male , who was a retired priest . He was married ,and had never smoked or drank alcohol. He had developed memory loss , and further work up revealed that he had pressure build up in the brain , which has caused damage to the brain and has caused memory loss . This is called 'hydrocephalus ' . This also caused weakness in both lower extremity and urinary incontenance. Now he was wheel chair bound and had to were diper and was not thinking right . He also had history of skin cancer , called melanoma . This type of skin cancer is notorious in relapsing , sometimes after many years . So when I saw him I was worried about CANCER.
      I spoke to his wife and did CT scan anad then decided to do Broncoscopy i.e. to see inside the bronchial tubes to find out cause of bleeding and to find out if there was a cancer and then decide on the treatment. She agreed .
      The CT scan showed that there may be a tumour in the trachea--the main wind pipe. I proceeded to the bronchoscopy . As I expected , it did show the tumour in the trachea. I did biopsy it . I explained to the wife that there was a tumour in his maain wind pipe and it was most likely a cancer . The next day I got the biopsy report and it did confirm the diagnosis of cancer . I told the wife that it was cancer and the only treatment that can be done was the radition treatment . With his condition I would not consider chemotherapy. and the surgery was out of question due to the location . She seemed agreeable for the radiation treatment , but asked me the age old question . 'How long does he hace ? '.I told her that the location of the cancer was bad and even if does well with the radiation , it is likely to grow and and it may bleed or compromise the breathing . So the life expectency was not great .. But she wanted more specific answer. I gave it . I told her may be 6 months or 9 months . The tumour was quite large and was bleeding .
       There was no way for her to bring him to my office as he was parplegic , demented and was quite heavy . 6 months passed . I had forgotten about him . Then I got a call from his wife . She wanted to talk to me . I thought for sure he must be short of breathor caughing up blood . So when I called her she said , "Doc, It is allmost 7 months and he has not died yet , whit do you want to do ? "
    I had no answer. I did do another CT scan and di another bronchoscopy . The cancer was still there , but it was very small and was not compromising his air way at all ! 

Monday, June 25, 2012


    I often make a comment as a joke , that there are 3 causes of problem in this world. one Money , two Sex and three. In laws. Most of the people that I meet , they laugh when I make this comment.This story is one where the in laws did cause the problem .
    I was called in on a consult for a 60 years old male with the pulmonary embolism . The patient was quite active , physically , had not travelled any long distance . So the cause of his lungs was not clear . When I saw him he was quite comfortable . Only history that he had was that of high blood pressure . This was well controlled with the medicine . His lungs were clear, heart was OK and except some tenderness in both legs there was no positive finding on his examination .
    He had CT scan scan which had shown the clots .His Doppler examination of the legs showed that he had clots in both legs . Normally patients get clot in legs due to immobilization of the legs . This could be due to fracture , post surgery period and long distance travel etc. Females who take birth control pills also are at higher risk for these clots . My patient had none of these 'risk ' factors . So why did he get it . ?I was not too sure . We also do work up to make sure that patient does not have cancer . We also do work up to make sure that patient does not have blood disorder that causes blood to clot too quickly. We had ordered these tests .
      On the third day when most of the work up was found to be negative , the mystery was solved . I was also surprised that he had clots in both legs and that too in the thigh .  I was asking him what he had done the day before this embolism . Then he told me  and the the puzzle got the answer .
       His mother in law had moved with him , when the father in law had died . He set up a room fof her . They had a old TV in one of the bed rooms and he decided to to take it to her new room . He lifted it and started to take it from one bedroom to the other  The TV was quite heavy and he got tired . He had to sit in the living room . He sat in one of the chairs keeping the big , heavy TV resting on his thighs . When he caught the breath , he stood and took the TV to his mother in law's room . This heavy load on the thigh , caused the circulation , the venous return to be compromised. THIS CAUSED THE CLOT IN THE LEGS  and then it traveled to lungs and that caused the breathing difficulties . So the cause of the clot was the Mother in .(moving in with him ).

Saturday, June 23, 2012


     We did talk about the technique for the meditation. This must be done on daily basis . However the the Vedic religion is 'way of life ' One can not expect to achieve highest levels , without 'practicing ' the way in which we live. So the Patanjali sutra Yoga tells us to follow 8 fold path . I am going to try to explain this .
    The eight things that are described in this path are as followes. These are called --      1. Yama 2 Niyama 3 Aasan 4 Pranayam 5 Pratyahar 6 Dharana 7 Dhyan 8 Samadhi .
     These are , ' Don'ts ', Does ', 'proper posture ','proper breathing technique ', ' the withdrawal of consciousness from the senses ', the remaining 3 are part of the meditation that we mentioned before.
     The Yama, which is 'Don'ts ', are 5 different behavioral rules. These are , --1 Ahinsa,( non violence ), 2 Satya (do not lie, tell the truth)3 Astyey (Do not steal ),4 Brahmachary,(Do not have indiscriminate sex -celibacy ),5 Aparigraha (Do not hoard or collect things that you don't need and give sense pleasure ).
      There are 5 Niyama or 'Does '. I will write on them latter .
      The nonviolence or Ahinsa is to be follow all the time . This is not only related to our action , but also to 'speech ' and even 'thought '. ( may be that is why the speech is organ of 'action '.) Everybody understands that killing is violence . But there are different ' shades 'of it . I can kill a roach . I can kill a chicken or fish or goat or cow . One can even murder a human being . This is 'direct ' violence . All of us understand this . But the question may arise , 'Is killing a snake or a roach  also a violence or not ?'The answer is  "any killing is violence " . When one starts thinking about this , he will avoid the situation when he has to act . We will try to maintain our house such that there may not be roaches , or if we see snake , we will let it go his way , if possible . This violence could be indirect . We may be eating meat . We ourselves do not go and kill a goat or chicken . So are we still liable ? or The one may not eat the meat , nor does he kill , but cooks it . So is he still responsible ? Again the degree may be less or more , but it is still killing . The person who sells the chicken , the one who actually kills it , one who buyes it , the one who cooks it and one who eats it, --all are responsible for the killing , either 'directly ' or 'indirectly '. So they all are responsible.

Friday, June 22, 2012


     Now a days we have 'computer oriented medicine '. The orders are given based on the patients complaints, rather than 'examonining ' patient or 'thinking ' about the patient and then investigating . We also have medicine which is determined by 'standerd of care ' . i.e. what is acceptable way of doing work up or treatment of particular complaint or diagnosis. I often feel that this good foe may be 90 % of the patients, but one has to still think out of the box . Most of the people are afraid  to do so . I feel that we should 'think ' and treat each situation on case by case basis .
     This one a story , which is unusual , as we thought out of the box . I saw this young lady about 55 years old with abnormal x-ray . She had some cough and so the primary care physician ordered the x-ray. It came abnormal, so then CT scan was ordered . It showed that patient had two nodules , one in right lung and the other one in left lung . She came to me , She was  a smoker and had cut down to few cigarettes, and had some shortness of breath on exertion . She had some cough , which she had originally attributed to her smoking . Her examination was normal .I reviewed the CT scan and discussed with her. I told her that we have to answer 3 questions , 1. Is it cancer 2 Has it spread and 3 What can we do about it i.e treatment options --surgery, radiation and chemotherapy .Even today the best and only 100% 'curable ' option is surgery . Even with surgery some patients will relapse. I ordered a PET scan . PET scan shows the metabolic activity as glucose tagged with nuclear material is injected . As every cell needs glucose and the pick up of the glucose is dependent upon the metabolic activity, the cancer cells will get more glucose and then activity is high against the background. This has accuracy of may be 88 to 90 %.The inflammation or infection can also can have more activity than normal tissue/organs. So this is not 100 % but quite good .
      The PET scan was positive.But it was positive in both the nodules .It was also positive in one of the lymph nodes . I did do a bronchoscopy and it did not not show any abnormality. I ordered a needle biopsy . I spoke to the radiologist and decided to do biopsy of one of the nodule . The radiologist did biopsy of the  right nodule .It did confirm the diagnosis of the cancer . But now was the main question . By the data that we had , with  twe nodules, both positive on PET scan and one of them positive on biopsy, she was inoperable .Normally one nodule is likely to be the 'spread ' from the other nodule , and since the spread from one lung to other lung can occur only via blood , there is potential of the Cancer having spread to other organs .  I had refereed her to other MD, namely a radiation oncologist and and medical oncologists . Both of them felt that she was 'inoperable ' I spoke to a chest surgeon . I may be having wishful thinking as I wanted her to be a surgical candidate. I talked to him and also talked to patient and her husband . I told my thought process . Since the nodules were small we could 'take them out ' ,( which meant 2 chest surgeries ) , and then give chemotherapy and or radiation therapy . This was not what was conventional . She was inoperable and 'best ' option ' was chemo and radiation .
     She agreed to our plan . She did undergo left sided surgery and to our surprise , she had 'similer ' cancer as we had gotten from last needle biopsy , but it was different as far as tumor markers are concerned . She did have second surgery and right cancer was also removed . She did have some stormy course after second surgery as she had reduced lung capacity with loss of part or her left lung with first surgery , She is doing quite well . So far there is no evidence of CANCER.
    We are keeping a watch and hope that she will not get the recurrence. So far our 'out of box ' thinking has paid off.

Tuesday, June 19, 2012


I went for a wedding last weekend.  One of my friend's daughter got married . She is Indian and her husband is American .So this was inter faith wedding . She was Hindu and the husband was Christen .So they has two different weddings ,one was Hindu and the other was Christen . In the Christen wedding the priest was performing the ceremony.He said ,"Do you, xxxx, take  xxxx to be your lawfully wedded husband, in sickness and in health, in sorrow and in happiness etc " There was nothing new .
      But then week after that one of my friends came to our house . He had a business assignment in Switzerland .It was short trip, about 3or 4 days .So his wife did not go . This friend of mine had chronic back pain and needed physical therapy and can not sit for long time without back support. So when he went to the hotel in Switzerland, he was very happy to know that the hotel had Sauna and heated spa. After the day's work he decided to go to the spa. He wears glasses, but due to they getting foggy , in heated spa, he decided to not take them with him . When he went there ,he had pleasant surprise. The spa was nude and  was same for men and women .He made a statement ,  The bad part was that  , I did not have my glasses, so I could not see much , ".The wife commented , "That was good that you did not have your glasses. "
      I was thinking to myself , what was good and happiness for 'him' was not 'happiness' for her . So then how do you define happiness?

Sunday, June 17, 2012


     Do you believe in faith healing ?. Do prayers work ? Is it that prayers work or whatever is going to happens and we give credit to ' medicines ' ( where most of the people will have no problem giving credit )or prayers or some other things . This story is such that though not common , I have seen it happen , and though not impossible , certainly it is not common .
     I was called to see a patient in the middle of the night . It was Saturday night . I had a call from ICU .  It was a case of post cardiac arrest patient in a 38 years old male . In these cases at that one can not do much , but I still go to see patient .
     I went to ICU. It was 2 or 3 am of Sunday morning . He was a 38 years old male , who was on respirator, unconscious . The story was that he was businessman who had a pyramidal scheme in selling vitamins and many other products . He was quite successful and just build a 7000sq. feet house . He had house warming party and the when almost everyone had left , he and his associate did cocaine . He had a cardiac arrest . With his good luck his friend did the CPR and the paramedics were called . HE was intubated and resuscitated and put on respirator and was admitted to ICU and I was seeing him at 3am .
    His x-ray was normal and most of the blood work was also normal . His drug screen was positive for cocaine and pot . He was unresponsive . The CT scan of the brain was normal . So in short he had what will be called " hypoxic Encephalopathy  " , which means when he used drug, he had cardiac arrest . So then during that short time in between his heart stoppage and restarting , his brain did not get oxygen . This causes brain injury. The extent of the damage can not be estimated by CT scan and one has to wait and allow the time to see if he is going to wake up and how functional he is going to be .
     His wife and his daughter was present bedside. so was his business partner . They were all shaken up . I explained them the situation  and told them that we will have to wait for few days and see how he does. I also consulted a neurologist, who was not going to do much , but he can add to the mix and do brain wave recording and see how the brain doing .
    The next day , when I came in all the people were there and there was no change in his neurological condition . So there was nothing to do . The neurologist had seen him and did order EEG -brain wave recordings .
     The days went by and he had no improvement in his status .When it was 8 days and there was no change , I had to talk to them about tracheotomy and 'chance ' of improvement , which reduces , as time goes on . He was young and chance of 'waking up ' was there . The neurologist was not that optimistic and was little blunt. he business associate was mad and wanted second opinion . There was a constant tape going on next to his bed with his daughter's voice, 'Daddy , this is Lauren , I love you '. I had developed good relationship with the family and the friend .We also decided to do trach. by 14th day . At that time he asked me if it would be OK if he could get some 'Faith healers . ' I told him that it will be OK as long as they follow ICU rules and don't disturb other patients .
     The next day the faith healers came in . I was not there . He also had asked for the 'aroma therapy' This was also done He had trach done . He was still unresponsive by 18th day . But the fried had told me that the 'faith healer s' had seen the 'angels ' and that means he was 'protected ' will survive . I was not that sure .
     We had no special plan . The plan that I had talked to the family and the case management was to get him in to a special care unit , a sort of nursing home which can take patient with respirator and try to wean them off . I was not too sure when this could be done without causing much resistance or commotion. Due to his insurance issues we had to transfer him to another hospital .
    There was nothing happening , he was being weaned off the respirator and was being fed via feeding tube . AND IT HAPPENED . When I went to see him he was opening eyes and was following minimally . In next 3 dayes he was more awake and was off the respirator. It was almost 4 weeks . He was not oriented, nor was he normal , but he was awake and was following some commands .
     He was discharge to a nursing home for rehabilitation I had taken out trach and feeding tube was left in , though he was eating on his own .
    SO did aroma therapy work ? Was the faith healer prediction and seeing Angels correct? Or it was just a CHANCE?

Last note ----he did come to my office in about 4 months. with his wife and the daughter. Had some memory loss , but was fully functional in day to day life and had started getting back in the business .  

Saturday, June 16, 2012


  As I mentioned before, the real meaning of these shlokas is different than what it appears to be on surface . So now to be specific about , we need to remember about various ' chakras ' and their connection to various ' great elements '. As mentioned before 5 Pandawas represent 5 ' chakras ' .
     Sahadev represents Muladhar Chakra and when devotee concentrate on it , it is concentrating on 'gross element ' and on a successful  concentration what we achieve is called 'savitark ' samadhi . So when this happens we hear a sound of drone of bees . The conch that Sahadev blew is called Manipushpaka, which means, ' to unfold 'or 'to sound '. This at the level of 'mind'
     Nakula represents Swadhisthan  chakra, and when we concentrate on it and achieve it , it is called 'sawichar'. Here we concentrate on subtle element and when we get at this level we may hear sound of 'flute '. The conch that he blew is called 'sughosh ' which means ' sounds clearly or sweetly .  This is at the level of intellect.
        Arjuna blew his conch , called Devadatta . It represents Manipur  chakra . When we achieve this level it is called ' sanand ' samadhi and we hear sound of harp or 'veena'. Devadatta means 'God given or gift of God ' i.e. that of joy or 'anand '. This is at the level of 'chitta '
        Bhima represents 'Anahat chakra ' His conch is Paundra which means ' disintegrates ' When we concentrate on it and achieve the level we hear sound of bells . At this level it is called ' sasmit ' and we work with intuition .Here all doubts are destroyed or disintegrate .
        The next one is Yudhisthira, who blew his conch called ' Anant Vijay ' which means conquering infinity .  Yudhisthira represents the Vishuddha chakra . When we achieve this level we hear sound of distant ocean . Here there is no separation between what we concentrate upon --the GOD - and us , so this called Nirwikalp samadhi or also called samprdyat samadhi .

I want to summarise  this as followes'
      Coccyx -Muladhar chakra -Earth-flesh-smell-Sahadev-mind-gross element -savitarka-bees sound.
       Sacral-Swadhishan  chakra-water element liquid part like blood -taste-Nakula--intellect-subtle element -Savichar-flute.
        Lumbar -Manipur chakra-fire element-life glow or the body heat-sight-Arjuna-chitta-sanand -sound of veena or harp. 
        Thoracic -Anahat chakra-Air element-life energy or Prana-touch-Bhima-intuition-sasmita-bells ringing.
         Cervical-Vishuddh chakra-space or ether element- Yudhisthira-oneness with God -sound of ocean .
 One note of caution --Do not try to hear these sounds , if you hear them well and good , if not continue the mwditation .

Friday, June 15, 2012


     Some of us believe in psychic ability , while others feel that it is nothing more than a 'chance '. As far as I am concerned I believe there are people who have psychic ability, but many a times it is fake . The incidence that I am going to tell is real one and you can draw your own conclusions.
     It was Saturday. I went to the hospital in the morning . In that hospital on the medical floor there was a nurses aid who had an Indian name . I had talked to her in the past . Having Indian heritage , we had common things to talk . As I went to the floor I started looking at my patients. I usually see patients and then sit at the desk, computer and write my notes and enter orders. As I sat at the desk , I saw the lady , the nurses aid . Usually she would come and talk. Today she did see me but did not come . I signed in the computer, and went to grab a up of a coffee.In the coffee room I saw her and said hi to her . She did acknowledge me , but did not say anymore . I asked her if every thing was was OK . She looked at me ,and said ,"did you read today's news paper ?" I said ,' no '. She gave me the paper . I saw the front page of our local paper. The head line was that of a murder . One young white female got off her duty at 11 pm , did some shopping in a grocery store and went home .  It was midnight . There were 3 men who followed her home and as she got out of the car at her home hit her with a gun and then ran over her with her own car . Then they ran away in her car . She died . They were caught. They were 18years, 24 years and 27 years old male of Guinness descent .. I was shocked . This can happen in out city was not very comforting.When I looked up, she said to me , " the 18 years old is my son . " I was speechless. She told me that he is not a bad kid ,had descent grades and according to her ( like every other mother ) she never thought he could ever do this . this must be due to ' bad ' company. I just tapped her on shoulder and left .
       As days passed , the news became old and most of the people forgot about it . I continued to see her . She had asked a priest to pray for her had done some religious ceremonies. She told me that the ' stars are not good for her son .'
       I was involved in trying to read horoscope. and was quite interested in the ' stars '. I asked to give me her son's date of birth and place of birth, so I could get some 'readings ' on his horoscope, the natal chart.
        Six months had passed by . There was nothing in the news about this case . I was in my office . One of the patient whom I had seen in the hospital for asthma . She was doing fine and had cur her medicines on her own and still felt good . While I was writing my note , she noticed my ring . I were a ring in my index finger . She asked me 'how come you were ring in the index finger rather than ring finger ? ' I told her that " it is a ring with a stone of Planet  JJupiter and at the base of the index finger is a mount of Jupiter. The stone touches my skin as bottom of the stone holder is made hollow . ' She looked at me and asked , ' do you really believe in all this stuff ,' I said , " Yes absolutely . In fact one of my friend's son is is having some issues and he asked me to help him . So I sent his horoscope to India to know , what is in the future of this son ".
She looked at me and said , 'I normally don't tell anybody this , but since you believe in such things I  will tell you this. I am psychic .' I did not not know what to say . I already had said a lot . We continued to talk about her asthma . I adjusted her medicines and told her that I will schedule her for breathing test to asses her asthma .
    As she was getting up from her chair, she said to me ."tell your friend that his son is in bad company and the judge will find leniency ".
    Two years or so went by . The nurses aid had left our hospital. I never got any response from India on the horoscope . The case went before jury . The 18 years old became 'wittness for the prosecution ' and got 8 years of jail time or so .

Sunday, June 10, 2012


   I did mention before the  chapter one and earlier shlokas and their real meaning . This is continuation of the same theme . The real meaning of the shlokas in chapter 14 to 18 is much different than what is conventionally stated. I Will try to explain .
    I will tell the literal meaning and then try to tell what it really means.
    14 -Then the Madhawa and and Pandawa who were seated in the chariot with white horses blew their celestial shells.
     15-Hrishikesh blew Panchajanya, Dhanajaya his Devendra, Vrikodara of terrible deeds, blew great conch Paundra.
     16-King Yudhisthira, kunti's son, blew his Anantvijay, Nakula blew Sughosh and Sahadeo blew Manipushpaka.
     17- 18 -The king of Kashi, Shikhandi, Dhrishtadyumna , Virat and Satyaki(great warrior , archer, invincible ),Drupada, Draupadi's sons , Subhadra's son all blew their conchs.
      This is not just blowing of the conchs ,but much deeper  and is related to the various vibratory sounds that one can hear when one goes in to the higher levels of the meditation and deeper levels of the samadhi.As we talked before when we talk or say a '  ' mantra ' we Crete vibrations . When one sayes various prayers, "shree Ram jayaram jay jay Ram " or " Namo Bhagavate Vasudeway " or " OM  Namo Shiway " , we are crating vibrations . The same things happens, when we meditate . Since our 'perceptions ' are based on organs of perception, we always  'see ' or 'smell ' or  'hear ' things when we reached certain levels . These shlokas are references to the various centers and the structure of the spinal cord that we talked about .
   The previous shloka mentions that Bhishma blew his conch . As we saw Bhishma is Universal ego . So when we try to meditate the ego which is soul mistakenly bound to the physical body,disturbs the concentration . (which is what Bhishma blowing his conch means ). So now as we try to concentrate with help of 'Krishna consciousness ' we here the breathing or our heart beating.etc . but then we get help from Krishna , the God and that is what the Lord Krishna blowing his conch in shloka 14 means . The grand chariot is the body . Now about the stages of Samadhi or the meditation .
    In the earlier stages of meditation , we are separate from 'HIM '.So when we concentrate it is called "sawitark "  In this state we have doubt in the mind . Then is the " sawichar " , which discriminating intellect is involved . Then is the  "sanand " where we do experience some joy. and lastly is  , "sasmita " where I-ness is the only thing left. These 4 stages are part of what is called 'Sampradyat ' samadhi. In the highest level of the Samadhi , which is called "Asampradyat " where we are one with  him and feel that there is no difference
     We will talk about various sounds that we may hear and their relationship with various conch , that are mentioned next time . .


      I see many patients with abnormal x-ray. Fortunately many of them turn out to be nothing . , at least not cancer . Most of the times patients have same question, is it cancer . It all most common for patients to use term 'cancer ' interchangeably with ' tumour'.I try not to correct it till I know that it is cancer or not .  So this is a case when we suspected a cancer when we saw the x-ray.
       I saw this 65 years old white male in the hospital for the pneumonia . I had known him from before .He was followed by me in the office. He was a smoker and had continued to smoke in spite of the diagnosis of COPD, chronic lung disease. He was quite obese, and had many other health issues . He was disabled from it. HE had fever and had significant cough, and had coughed up blood. His x-ray showed pneumonia in the middle and lower part of the right lung. We started him on the antibiotics and did CAT scan . The CAT scan showed 'obstructing lesion 'i.e. cancer, per radiologist. So I did a bronchoscopy . During the bronchoscopy , he was quite short of breath and I did see the tumour in the middle lobe of the right lung . I did the biopsy, though they were not great as he was quite short of breath and issues with the oxygen saturation . So I did not want to prolong the procedure too long . The biopsy came back 'no cancer '. I knew what I had seen , i.e. blocking tumour , quite red and some bleeding . So I allowed him to get better on his wheezing and fever to come down . His x-ray was nor better. After about 3 days I did another bronchoscopy and saw again the same tumour, did again the biopsy . This time he was better and I was quite satisfied in the procedure and thought that I will get the diagnosis . Again the biopsy came , no cancer .' With his history , CAT scan findings and my bronchoscopy findings I was quite sure that he had cancer , but I was not getting the diagnosis.  So I decided to ask a chest surgeon to see him and do biopsy through a bronchoscopy under anesthesia . The idea was that with control conditions if he has bleeding or any other problems it could be better handled .
       The surgeon did the bronchoscopy and found the same finding of obstruction, but it was not because of cancer , but it was apiece of 'PEACH ' that was obstructing the middle lobe bronchus , giving rise to the appearance of the tumour. Patient had sleep apnea and also had obesity hypo ventilation syndrome , in which patients do fall asleep watching TV or reading or sometimes even during conversation . He must have fallen asleep during eating and aspirated, --the piece of peach went in the lung. The redness fooled me and it was not cancer so no wonder my biopsies came negative twice.
        He still comes to me , has lost 40 lbs on plant based diet , has cut down on smoking and has no cancer.

Wednesday, June 6, 2012


I was called in to see a patient. This one was unusual. I had seen him past . He was 78 years old white patient , that I had seen him in past . He was getting weaker and had pneumonia and was admitted to the hospital . I did the work up and while doing this he continued to get worse and I had to put him on respirator. Before that we had done the swallow study to see if he was aspirating, food and liquid going wrong way . So instead of going in the stomach , it would go in the lungs. Here it would cause inflammation and pneumonia. So we had to do feeding tube . His son was not very happy , but did accept it . When I did further work up , we found put that he had a myopathy. i.e. gradually weakening and wasting muscles , that added to the problem . I did not think he had a great prognosis and I tried to to talk to the son and make him DNR--he was all ready on the respirator , but not to do CPR or 'shock ' him , if the heart would stop. The son was not agreeable. So he was transferred to the nursing home . As expected he was re admitted with pneumonia. ,and I was consulted .
      I saw him in ICU There was not much to see or do . He was supported on the respirator , the blood pressure was OK , mildly elevated temperature. The x-ray showed the pneumonia. The only unusual thing was that he looked 'GREEN'. When I talked to the nurse, she agreed with my observation . On f further examination , we noticed that his secretions suctioned from the trach. were also green , even the tears were green . We have seen jaundiced patients when every thing is yellow, but never saw GREEN patient and green secretions.
    We had done cultures of the sputum and it had grown a bacteria called pseudomonas aerogenosa. ( I am not sure why the names of these bacteria are so difficult ).I called CDC to see if the infection with this bacteria caused this green colour . In between the news that we have green patient spread . No one had seen green patient . and so everyone came to see him . As  a record we did take the picture too . The son was extremely upset . I was not sure as to the cause of  green patient . The son was convinced that it was due to the infection that the nursing home had 'missed '. After talking to several people I found out the cause of his green secretions . He was getting tube feedings. The tube feeding nutrition liquid can be go wrong way and to detect it they added green color to it . This got absorbed and caused the green color to the patient and even the secretions . Now a days no one adds any color to the tube feedings . The mystery was solved .
      The only good thing that came out of this hospitalisation was that after extensive discussion with the son I made him DNR  and once the pneumonia was better we transferred him to the nursing home .

Tuesday, June 5, 2012


     As a pulmonary -lung specialist , I see patients in ICU who are very sick. We also come across patients that are on life support and the time comes when further medical treatment may be futile. So I tend to talk to the families about the futile care and withdrawal of the life support. Sometimes it is clear cut and easy , and other times it is very difficult. When there is diagnosis of cancer or patient is unconscious then it is easy , but when the patient is awake and can communicate , then it is very hard on me as well as families. This one belongs to the latter type.
      I was called in on a consult for a patient , who was admitted to the hospital with pneumonia . He was 55 years old White male , who had history of high blood pressure. Four months ago he had severe headache and was admitted with stroke and altered mental status . Further work up showed that he had bleeding in the brain . So the neurologist and the neurosurgeon operated upon him and drained the blood . He did survive, but the bleeding left him with severely impaired status . They could not wean him off the respirator and as he could not eat , he had to have feeding tube . (PEG ), He was otherwise stable , so was transferred to nursing home , on the respirator . In the respirator he developed pneumonia and so was transferred to the hospital in ICU and I was consulted .
      I saw him in the ICU. There was not much to examine . He was 55 years old , who was significantly impaired due to the stroke . The respirator was doing the job of supporting the breathing. The x-ray did show the pneumonia . He was started on the antibiotic. He could not move both legs and right arm . He could  move left arm , though not well coordinated. He could not open both eyes, only one eye , he could open . He was on respirator with the tracheotomy and was being fed via gastric feeding tube .
      Next day when I entered the ICU , I heard the banging noise coming from his room . As I entered the room I saw him banging his left arm on the side rail. I rushed in and held his hand . He could understand everything , though could not speak. I asked him, 'are you mad ? ' He answered , yes ,So I asked him 'is it because  the nurse could did not come quickly?'  He answered , no . I looked in his eyes , I knew the answer . I said to him , 'You are mad because you are here in this situation , bedridden, on the breathing machine, can't do anything, can't talk , eat . 'He  in his own way answered ,Yes.  I told him that we stop this , but I also told him  that if I would stop the breathing machine , he may die . He was willing to do it . I was not sure how I could go about it . But he was determined . I called his family . I also called the hospital 'risk management ' The patient was quite oriented ,So ideally if he did not want to continue life support , he could make that decision .But sometimes we can have medico legal problems or the families may not be agreeable or happy with the decision .
       I called his 2 sons . Both of them agreed to do whatever the father wants. I asked him to come in the town and sign papers. He agreed to come on the Friday. The other son was far away and told me that he would sign papers and fax them .
       The Friday came . I talked to the patient and the son . They both agreed and the son signed the papers . I signed the papers. and we did the withdrawal of the ventilator. He continued to breath on own and did not die . So we decided to transfer him back to the nursing home .
      He was transferred with one eye open , one hand barely moving  , with trachostomy , not able to speak or eat and with feeding tube . The only difference was that he was off the breathing machine.

Saturday, June 2, 2012


   Since we talked about the structure of the human body, and how it is formed from the formless at the beginning of the universe, now is the time to know how to go back to where we came from .This is the purpose of the meditation and achieving the samadhi. I will summarise briefly the constitution of the body . There are 5 breaths(pranas ), 5 great elements,(mahabhute ),5orgens of perception(dnyanendriye ), 5 organs of actions (karmendriye ), 5 (or may be 7 ) chakras or spinal centers.There are 3 bodies and they are connected to each other at the 5 centers , which also represent 5 great elements . The connection between the physical, astral and the causal bodies accrues at the lumber spine , and at this place we can change the direction of the energy or the current. Normally if I hold something in my hand , the nerves will carry the sensation to the spinal center., it goes up the spinal cord to the appropriate brain center.So the entire course is in the physical boby . We need to change the course and go in to the astral and causal spine and rise to 'fanal' center--Sahastrahar , 1000, petals center and  experience the Bliss, of being one with HIM.
      I have some method for achieving this goal. (I will be the first to admit that I have not achieved the goal nor do I know personally know anyone who has done it , though I know it can be done.)
       So let me start. The practice of the meditation should be done daily at least once , preferably twice a day .It must be done at least 20-30 minutes at each time . The best time is early in the morning , may be 4 or 5 am . There are reasons for this time  zone . One at this time of the day , every one else is asleep , so the disturbances from outside noise is less likely. Secondly this is a time when the REM stage of the sleep dominates and the REM is an active sleep . We are not tired from the entire day's work , so less likely to fall asleep from the tiredness. The meditation should be done in a place where it is quite and and not too much 'emoyions ' have played a role . We believe that the the previously occurred will be still there and will 'diturb ' our mind and not allow the concentration to occur. One must take shower after waking up , pray to one's personal God ( kuladewata ). and then start the meditation . As we perceive with our 5 sense organs we must keep them occupied with pleasant things. So one can have minimal light, soft music , burn scented stick.and so on . Try to face east ow west and avoid facing south or north. Do not sit directly on the floor . But one does not have to sit on ground. One can sit on the couch or in a chair. Support the lumbar spine by putting a small pillow and then pushing backward, so as to straiten the lower spine . Lotus position is good , but not mandatory . Have something that you believe in , trust , have conversation with (when in trouble ) or thank , when something good happens . This could be a statue or a picture of the 'favorite god ' ( for Hindu ) or could be a cross or statue of Jesus or Mary for the christens. One must select some thing that he or she believes in strongly . Start with thinking about your Guru - teacher in you have one , ask for the blessing from the Guru and then start the meditation . Keep spine straight , breath slowly , concentrating on at , at the same time concentrating on the statue . Your  eyes should be closed, and the angle of the vision should be slightly upward, as if you are looking at the location of the spiritual eye or the tip of the nose or so . Your eyelids should be closed , but your eyes should be open . I can not explain this paradoxical statement, but try it , it is possible to do this . So now all your sense organs are engage, and now the mind needs to be engaged . Decide on a short Mantra. and chant it in the mind not loudly . One can start with whispering and as the practice gets better then doing it completely in the mind . Think of the Lord -the GOD . The thoughts will come and go . DO NOT GET CARRIED  AWAY  WITH THEM . Do not allow one thought to be the mother of the other thought. Try to go back to the thought of the God and try to concentrate on the Mantra. e.g.if a thought comes about your son or the daughter as to what she or he may be doing , then don't do to the next one , today is Wednesday, today is exam day , hope the test is good and she does better and will get medical school , then where , then fellowship etc . Stop the thought as soon as first one comes .
   How to get through different levels of this process and how one knows that he or she is doing better, what are the signs of this progression , will be stated at a latter time .