Sunday, August 26, 2012


     In July 2012 the scientists found out the so called God particle . They have thought about it for many years and were unable to prove it . In the particle colider they did confirm the presence of this God particle and now we "know ' how every particle gets it's mass . The scientists were not sure how the subatomic particles get mass . or why do they have mass . The similar questions have been  asked about the Dark matter and the dark energy . So I thought about it and see if we can get any understanding of these new things in  the universe  and understand it by looking at the scripture .
    Since we started looking at the sky we have always thought about the nature and the origin of the universe . As the studies and the observation continued, scientist have recognised that there are 4 forces in the nature and each one has a particle.The field  'acts ' through it . As the work progressed there were several particles were recognised , in all there were 12 different particles , 6 being Quarts and 6 Leptons . All these particles have a mass . (photon does not have a mass ) . The question arose as to what gives rise to the specific mass to these particle ?. Many years  ago , more than 40 years ago Higgs suggested what came to be known as Higgs field . Since all 'fields' have a particle , this particle was called Higgs particle . No one was able to find this particle . The theory was that when a particle ( or for that matter anything ) moves through this Higgs field , there is a 'interaction ' or the 'resistance '  to the movement. Depending upon the resistance the 'mass' of the particle is determined . If the resistance or the interaction is more then the mass is higher , if it is low then the mass is low . The qualities of the Higgs particle and the field caught my eye . The Higgs field is 'nonzero' , this is in contrast to the other fields. As we know as one goes away from the magnet or an object the strength of the field reduces . (The gravitational pull is not same when we are close to the earth verses we are miles away from the earth )But the Higgs field is nonzero strength, which means there is no place where there will be no Higgs field influence . The particles in every other case have a 'spin' and a charge ' . The so called God particle has no spin or the charge .
    So in short the Higgs field is ' everywhere ' . it 'interacts ' with almost 'everything and gives them the mass . there is 'no reduction ' in the field strength , and the particle involved in it has no 'spin ' or 'charge '.
     Does this sound like  'CHAITANYYA ' OR so called  'UNVERSAL CONSCIOUSNESS '? The universal consciousness pervades 'everything '  and is 'everywhere ',It is not localised to one or other area of the space , it does not 'move ' or 'vibrate ' . It does not have any 'charge '. ( As you may remember according to the scriptures at the beginning of the universe the GOD split in to 'purush ' (spirit ) and the Prakruti (nature ).
  So then if this the God particle , then The God is not too far , and we don't have to do anything . I am sure this the feeling of many atheist. I have some other thoughts.I feel that even though this particle has all the above mentioned qualities it is neither God nor it is God particle . (All the particles are made or came from the God , so in that way all are God particles. )Even though  the Higgs particle and the Higgs field are close to the qualities of universal conscious, they fall short . To understand this we need to look at the origin of the universe . As I mentioned , in the beginning w hen.' everything ' was "unity" and was without any disturbance .Then there was a disturbance called  "GUNAKSHOBHINI ". Before this occurred all the 3 qualities called 'Gunas ' were merged in with everything else . Now they started appearing . Every thing in the universe has all 3 qualities , more or less . Each of these gunas have a quality and a function . The Tamasic quality reduces action or activity . The perfect example would be a stone . It has almost 100 %  Tamasic quality . So unless someone moves it , it will not move , unless someone changes it, it will not change the size or position or anything . This is pure Tamasic quality . The consciousness is still pervading in it , but due to overpowering Tamasic quality, it is masked . The Rajasic quality is main cause of all the activity .  The growth of trees or human being is due to Rajasic quality . The balance between the Tamasic and Rajasic Gunas the trees don't continue to grow, but after certain amount of the growth the growth stops or slowes down .The last one the Satwick  Guna is the purest of all . Everyone has all three qualities.I feel that the mass that Higgs particle has is due to the Tamasic quality and it's interaction and the activity is due to the Rajasic quality . So the Higgs particle is not God's particle , but a particle that has pervading consciousness plus 3 Gunas .

Friday, August 24, 2012


     I was watching the NEWS , yesterday . The  student who shot several people in the movie theater , had told some psychiatrist about desire to kill many people . I am sure this will bring in several law suits , off course against the university. This reminded me of one my old patients .When think about him , I still think about how the future is unpredictable.
      I knew him for a long time as he was a doctor  .and I had seen his patients many times . I also had seen him on occasions for lung issues and his wife was also my patient . I used to see her more often as she had sever asthma and she had many other problems . Her treatment was more complicated due to her intolerance to medicines, due to poor gastrointestinal tolerance .So I had to adjust her medicines on many occasions . She also poor appetite and had lost lot of weight . The medicine that she was given and was helping her was pulled off the market . I did give her a telephone no. of Canadian pharmacy. I did tell them about protein powder and even the fat and calorie loaded fast food stuff. He had not heard of 'chalupa ' . She was not doing well , but was not bad . He was fine . He was about 68 yrs old and was thinking of semi retiring . He had invested significant money in a real estate and had gotten great return . He was going to do a part time job as a physician . No calls , No hospital , No worries .
     He had sold his practice to a hospital few years ago and had also sold the office -the real estate for 'profit ' He had told the hospital about his retirement plans and they had brought in new doctor for last 3 or 4 months . So he was going to leave the 'practice ' after may be 30 plus years . I had known him for many years and I was not only a college but if not a friend , at least more than just a patient or acquittance .
    We were going to go for a lunch with the new doctor that was taking his place .On Thursday. he came to my office at 1 pm . I saw him at the window , where the patients check in . So I called him in and asked him as to why he had come . He asked me if I could write a letter for his wife to state that she was disabled . He was leaving the hospital employment and will be on new insurance . So he wanted the letter . I said OK . But he wanted it 'today'. It was a simple letter and I had no problem with such short letter . I told him I will do it and told him to pick it up at 4 pm .
    On next Monday I was seeing a patient , who asked me if I had heard the news . I said what news . So she asked me if I had heard of 'him ' committing suicide. I was shocked . She did not know much but knew that he had died . I called his wife at 4-30 pm and came to know the whole story.
    She had gone for a play . on Saturday . He did not want to go . So she went with her friend . When she returned home , he was not in the bed . But his car was there. So she thought that he slept in other room as he did not want to be disturbed , when she came home .When she woke up next morning , she did not see him in kitchen , where he always did the coffee and did the breakfast . So she went through all the bedrooms . She did not find him . The car was still there . So she went through all the rooms again and did find him .HE HAD SHOT HIMSELF IN THE BATH TUB!!.
   I did not know what to say . I had not have any idea . I did not know that he was depressed or had bipolar disorder and was on medicines . I did not know that he was gun nor did I know that he was capable of shooting himself . I definitely had NO IDEA THAT HE WAS GOING TO SHOOT HIMSELF.

Friday, August 17, 2012


     I often see patients that defy the medical expectations . At times we see patients that don't do as well as we thought and at times some get worse when we expect them to do well . I feel that everything has it's own way of response , good or the bad . Everybody is 'born ' with a so called 'timer ' .When the timer runs out of the time , the person dies . When the spring unwinds , then the time ends . Philosophically , when the karma that are going to come to fruition in this life have come to fruition , then the life ends . As seen in annual plants  when the have given the flowers , they are done .. We can not predict when someone is going to be born and we can not state with certainty when someone is going to go . The story that I am going to tell is one such case . As in all my stories names are not true names and certain things are changed to hide identity.
     I had known this 80  years old lady , with asthma  for some times . Most of the time when she would call , she was in trouble . Usually she was OK , but at times  needed antibiotics or steroids to control her symptoms . She also had rheumatoid  arthrttis  and did see a rheumatologist . She did have a primary care physician , but for all practical purpose I was her primary care doctor. Her husband had died and she lived with her son and the daughter in law . They usually brought her to me . This time when she was brought to me , she quite sick . She had fever and in spite of out patient antibiotics , she was still having fever , She was also short of breath. So with age , and her shortness of breath , I admitted her .She was started on intravenous fluids and antibiotics  and steroids . She got little better but her fever persisted .So I did CT scan . The CT scan showed the pneumonia , but also showed fluid around the lung . Normally I drain the fluid from the around the lung by doing the ultrasound of the chest and finding the right spot to insert the needle and the catheter to drain the fluid . This one on CT scan looked difficult . It was not possible to drain the fluid with the needle as it was not 'free' . It had formed pockets  . So I called the chest surgeon. This a story which occurred several years , In those days small incision chest surgery was not done . (Today we do a procedure called VAT , where a very small incision is done and a scope is inserted and with the help of video the surgery is done . Due to small incision the recovery is rapid . )Due to her age and other medical problems the surgeon decided to put in a chest tube . This is done bedside , under local anesthesia . This is done quite frequently without any major problems . I was not in the hospital at that time . The plan was to see if we can drain the fluid , (which was thought to be infected , causing the persistent fever . ) and hope to avoid a major surgery .
      As it happened , when the chest tube was inserted ,  the patient became short of breath and started coughing up blood . Her blood pressure dropped and so a code was called in . She was intubated and resuscitated . She continued to have blood coming to come out of her wind pipe and the chest tube . The surgeon took her to the surgery in next 10 minutes . She was operated upon and made it . She was transferred to intensive care unit and over period of time she recovered . She was discharged and continued to do follow up with me for next 7 or 8 years .
     What happened at that time ? . She had developed the adhesion in the chest , most likely due to infection and inflammation . Normally the chest cavity and it's covering are like a pillow and a pillow cover . So when the fluid accumulates between the lung ( pillow ) and the covering (the pillow cover ) we can put a needle or a tube and drain it . In this case , due to adhesions , the lung was stuck to the chest wall at one point . When the surgeon put in the chest tube , he did not go in the space but ended up tearing the lung which was attached to the chest wall . This caused the the shock , the bleeding from the lung etc . She would not have made it if the surgery was delayed for even short time , But with her luck , the surgeon was right there and he took her to operating room and she did well !
      So the time had not come yet !

Wednesday, August 15, 2012


     I have been board certified in Internal medicine , pulmonary Medicine and also in Sleep Medicine . I have taken no. of examinations . When I was in training , I was told to always check nurse's notes . There were no. of other things that I have learned to look at  , when assessing the patient . Most of the doctors are not used to doing this . But I find it quite helpful  in diagnosing the problem . The story that I am going to tell occurred may be 28 years ago .
     I had stated practice  and I had new patient . She was 72 years old female, who had moved to our area few months ago . She had moved to live with her daughter. She was 'getting old ' had problem living alone . She was seen by and followed by no. of doctors from where she came from . She had history of high blood pressure and Had smoked for may be 10 or 15 years. She was not eating well and appeared depressed . So she was seen by a psychiatrist in her own place . Now that she had moved here , she was seeing all new doctors . She saw new , local psychiatrist and he asked her to see me . When I asked her as to what was her main complaint, she said my breasts are tender . I was not to sure as to what exactly she meant . But when I asked her again she said the same thing . Her psychiatrist note that she had brought, also said the same thing as reason for the referral . When I talked to the daughter , she said that the mother had that complaint and was worked up quite extensively . with X-ray , cardiac work up and even endoscopies , without any reason being found for her complains.. The daughter had brought in all the old work up . She had no . of tests done and all of them were normal . The x-ray , bronchoscopy , EGD, to look inside the stomach , cardiac ultrasound and stress  tests all were OK . I went through her doctor's note . There was nothing glaring in the notes . The only thing that I noticed that was striking was that SHE HAD POST 60 LBS. One would have missed it as she was still overweight . She was still over 200 lbs.
      I knew something was wrong . She may have lost weight due to being depressed and not eating , but according to the daughter she was eating well , at least for last 3 months , since she had moved here and had still lost the weight . I decided to do the work up . She had band like pain , starting from spine and going around the chest and coming to the front and she would feel her breasts being tender. . I decided to do the CT scan of the spine . It showed a tumor on the back side and penetrating in to her spine and causing irritation of the nerve , that caused the radiating pain . We did the biopsy and it was cancer . I had consulted the radiation doctor and she was treated with the radiation .
      If I had not noticed the weight loss , that was not obvious , unless one looks at each visit weight , I would have sent her back to the psychiatrist and would have missed the cancer .

Sunday, August 12, 2012


     I was visiting a friend's house yesterday and we started talking . The couple has a son who is quite intelligent . We started talking about the Hinduism ( in actuality Hinduism is not 'ISM' but it is a vedic religion , which is " a way of life ". So we don't go to temple once a week , but follow it in our life every minute or every second . )So the question came as to the reason or purpose or more than all these  the justification for doing the daily worship ,called Puja . I fully understand the question , especially since in our 'ususal practice ' of the religion we do these rituals more than anything else . The temples support them , may be because it may be the only way to attract people to the temple . or may be this is the only way to get people to donate money .So how do you justify the Puja ?
    My thinking is mixed . It may not be the perfect answer, but may be a start.We do Puja as we Hindus or for that matter we all human being , 'humanise' God . On one side we say that the God is merciful or kind or forgiving , and in the same breath we say that he is GOD. So then how can He have these human qualities ?. So doing Puja is humanising him .Our Puja is called 'shodasha ' , 16 steps worship. To me this is not essential . But for the people that are starting , in practice of the religion , this is first step . To achieve the highest level we have to start some where and take steps . If this is a ladder then these are first one or two rungs . We need to start at this level and then try to get higher and higher . Unfortunately , most of us get stuck at the level of rituals . But rituals are important . In the early part of the worship , it is impossible to imagine  'formless ' shapeless ' 'feelingless ' God . So when we do Puja we try to address him as a guest or a friend. So as when a friend is invited to our house , or if a guest comes to our house from a far out distance , then we ask him if he wants to take shower or wash hand and feet , offer him a drink , offer him food , and even after dinner drink or in India 'Paan ' or 'sopari- bittle nut '. There are other steps and we do it too . So we do these 16 step Puja when we invite God to our home .
     It is possible to do what is called " Manas Puja " , the so called mental worship . In this we pretend to do exactly the same thing that we do in real Puja , but there is no real water to bathe or there is no real food to offer etc . Can we do without Puja ? Yes , but we need to be more advanced  in or practice . By doing the rituals we get our mind to concentrate on the God and offer him our undivided attention . Once we are expert in this concentration , then we do not need it . ( I have not known anybody who is expert ).This daily worship is especially important in America . When one is living  in India , he does not have to make special efforts to 'know ' that today is some special day , say Ganesha chaturthi or Shiwaratri etc . He is exposed to it anyway . Since doing Puja is the first step on the road to the higher practice of meditation , if we do not do it on daily basis , then our children will nit be exposed and the they will never know pr practice the meditation . By way of doing the Puja , all the members of the family will come together , which in turn will form a deeper bond .
     The problem that is faced by Hindu parents , is more complex . We do not not have one scriptural book , we do not have one God to worship and we do not have one Pope or religious leader . So when the children ask questions , as to why do we have so many Gods or what is our standard, reference scripture , of why we do this or that , we find our self in trouble . and then we avoid the entire situation or the conversation . The best way is to find answers. I Will try some of these questions in the future , but for now answer only one or two. We do have many statues or Gods . (in fact some of us will not go to a place where there is absence of their God ----this is sad ). My answer to this question is that these are different aspect of the same God . To expand on this at a child's level , I will say that if my mother looks at me she will say I am her son , if my son looks at me he will say I am his father and if it is my wife then I am her husband , so on so for . I am still same person , but depending upon the relationship of different people , I am son or father or husband or boss etc. So if we want to appeal to the 'knowledge ' aspect of the God it will be different than if we want 'money ' or want 'strength '  etc . There will be regional differences in the exact 'look ' of these gods (I did not write God , I wrote god , as these are personal gods . The GOD is only one . ) One can look at them as kids having different hair or skin color dolls . One can relate to some one who looks life him or her than entirely different . The symbolism in some of these gods is out of reach of understanding of children and some adults , so it will not be discussed here . Some question next time .

Saturday, August 11, 2012


     We talked in past about the things or the rules of the things that we should not do . Now we will mention the things that we should do . As mentioned before these are 1. Saunch (cleanliness), 2. santosh (satisfaction ) 3. Tap(control on sense organs )4.Swadhyay (study of the scriptures).5. Ishwarpranidhan ( offering all these to the God ).
     It is easy to see , how all these changes in our behaviour will help us on controlling our thought s and help us to meditate. . Saunch , which means cleanliness . This does mean both the body and mind both . To take a bath and then not have 'clean ' thoughts is not going to help . If our body is not clean , we may catch infection or may have things that would take our attention away from the meditation . e.g . itching or stuffy nose or belching etc , these things will divert our attention . So will the bad or unclean thoughts . These may be related to out day to day conflicts or 'attachments ' or attraction etc . So we need to be careful . If we get too involved in politics or sports or anything else , we will be thinking about and it will divert our mind .So we need to be 'clean'
     Santosh or satisfaction with whatever we 'get ' or not get. If we think too much about money or lack of it and are not happy with what we got it will create agitation in our mind . It may be our health or job or house or car or any other things that we normally we feel are ' essential ' for living  , all of these can cause problem . This does not mean we should do no attempts to get better . But we should be happy or satisfied with what we get . We can continue to try , but not get attached to it to a point of being unhappy  , if we don't get it .
    Tap . or control over the sense organ satisfaction  .Again this is same as before ,i.e..  not to get attachment with these things . We tend to complain about too hot or too cold . We also tend to eat to satisfy and not to survive. Same with all the other sense organs . We need to have control on all these sense satisfying activities.
     Swadhyay or the study of the scriptures Then Ishwarpranidhan, which means offering all these to the God . These last 3 are together called 'kriya yaga'. The last one when we do 'every ' action for the God and offer him the fruits of it , it takes away the
"I -ness "away and this will set us free from the attachment and in turn freedom from the law of karma and ultimately from the cycle of death and birth .
 I just want to clarify one thing about the study of the scripture . This does not mean just reading , but it means understanding  and practicing the principles in these Scriptures .

Friday, August 10, 2012


    We often read news papers or magazines . There are some stories that touch us and then there are some which we read and forget . We tend to remember some stories where we know the characters.  Things that we find 'funny' ,may not be funny if they happened to us . So our personal knowledge of people make the stories ' good ' or '  ' funny ' or memorable . The story that I am going to tell is one such .
    It was about 11 am on Wednesday .I was done with the majority of the patients. For a change  I was on time . I had couple of more patients remaining. The patient that I was seeing was a 68 years old female . I always start with a line ,"so what's going on ?"The line does not mean anything except it is my way of saying hello. Martha , had been a smoker and had mild COPD , related to her smoking . I had diagnosed her with a lung cancer about 15 months ago . Fortunately she was in early stage and we could cut it out . She was in such an early stage that she did not need any additional treatment with radiation or chemotherapy. I had done  follow up CT scan and there was no evidence of cancer . So all the things were good . But as the conversation went on she did not look happy or in to the conversation . I was not sure as to why she was not usual happy person . So finally I asked her , 'so what is bothering you, you are not yourself today . ' She answered with a question. "Did you read news paper today?" I said no , why . When I left the home it was 6-45am and I had to see some patients in ICU before I started i the office . She said ," There is a story on the front page , about a murder . " and she told me the story . She lived  with her daughter . When she woke up at 5 am and came down from her bedroom , she found her daughter in her living room . The daughter had gone out and she did not know when the daughter came home and when was she murdered . She was fast asleep when some one murdered her daughter in her own living room . . I did not know what to say .
   We read stories about murders and don't pay much attention to them as  we don't know the people in the stories .But when we 'know ' them it suddenly hits home .

Sunday, August 5, 2012


     In Mahabharata epic there is character called Jaynadrath. As the story goes , the Hero of the Bhagawat Geeta , Arjuna vowed to kill him before the sunset . The Jayadrath hides and Arjuna is unable to find him . So then the lord Krishna sent his Sudarshan chakra to hide the Sun . Now as the chakra covers the Sun , there is darkness . Thinking that the sunset has occurred , the Jandrath comes out from his hiding place and then the lord Krishna takes out the chakra , there is the Sun and the light and so Arjuna kills him . Metaphorically the Jandrath stands for our attachment to 'live' or survive. This attachment is the strongest of all the attachments . One can quit smoking , or the alcohol or salt in the diet , but the desire ti 'live' will continue . I have seen this in my medical practice many times , sometimes with surprise , sometimes with irritation and anger and sometimes with pity. I  treat many patients with chronic , disabling conditions and many times we in medicine can not help any more . Many a times it may cancer or advanced emphysema . I had one such incidence recently , and that reminded me of the other stories.
      I was called in on a patient for the shortness of the breath  .Before  I saw the patient , I looked in the computer for some old records .I noticed that she was diagnosed with a lung cancer about a year ago and had received radiation and the chemotherapy. I also saw the name of the pulmonary specialist and his recent note. So I ended up calling up both the oncologist and the pulmonologist . I came to know that he the pulmonologist had told her that he could not do much and so she was asking for 'second opinion '. So I was called in . This was a 63 years old female patient who had smoked fir several years . She had quit smoking several years before the diagnosis of inoperable cancer was made . The chest surgeon had seen her and felt that she could not benefit from the surgery , so she was treated with radiation and chemotherapy . She did OK with the radiation treatment , though had some side effects . But had bad reaction to the chemotherapy . So the chemotherapy was stopped . The oncologist did offer other treatment , but she did not do well. So now she was on no treatment.When I saw her she was short oh breath and had needed oxygen . She also had wheezing , the bronchospasm . I started her on treatment with medicines to improve the wheezing . I know that the steroids sometimes can do wonders . So when I stared her on the steroids , she did feel better, and her need for the oxygen went down and now she needed it only with long distant walking or sleep .This was partly due to emphysema and partly due to cancer and the scaring that had occurred due to radiation . She did not want any chemotherapy and wanted to consider 'alternative ' treatment . As it happened she was discharged home and did go to see a homeopathic medicine doctor and started some treatment . She did continue to come to me and also go to the oncologist . Due to the treatment of the COPD , she was feeling little better, though the cancer was not getting any better . As it happened , she was admitted to the hospital with irregular and fast heart beats and I had to cut back on the medicines for the COPD , as all of them can cause the increase in the heart rate . She had heard about the side effects of the steroids and wanted to cut them off , but unfortunately  she would become very short of breath with the reduced dose of the steroids . I had several discussions with her and her line in boy friend , who also was her POA , the medical power of attorney. So she never was DNR.
     As the time went by she continued to get worse and was more short of breath . We continued to do follow up CT scans to check on the cancer and it was getting worse . It was at times difficult to separate the changes due to cancer and radiation treatment , it was my feeling that the cancer was getting worse. She had also some fluid around the lung . It did not appear to be large and I did not drain it out . This was because , in past when we did drain it , it came back in less than one day and it did not appear to be large .
     She continued to get worse and was more short of breath . So I decided to do some tests to find out what if any could be done . I did CT scan and noticed that the abnormality on her right lung was getting worse . The fluid was more and the collapse of the lung was more , so called 'increase in volume loss' on the scan . I knew that the cancer was getting worse , and not much could be done . I did a new scan to check on the amount of  blood going to the lung and the air going to the lungs . The tumour was in the center of the right lung and my suspicion was that it was pressing on the circulation and the bronchus .It showed that the right lung was not getting any blood and there was no air going in to the right lung .I knew this when I ordered the test .The blood vessel going to the right lung was blocked by the tumor and so no blood was going to it and same was true of the bronchus . The tumor was pressing the bronchus from outside and so no air was going in . This was not a good news . I told her about this and called the radiation therapy doctor . He looked at the scans and called me . HE could not do anything . The next morning she was admitted to the hospital .I saw her and went over the findings with the patient and the family . In spite of the findings and the poor prognosis , she wanted everything done. As I had thought she needed to be put on respirator . I did call the chest surgeon . He had nothing to add. I did call another oncologist at the request of the family . He told the same thing In between her blood pressure dropped and her urine out put had dropped . Her kidney function also got worse .So I called the kidney doctor . By then I was having the problem with the oxygenation. Now she was on 100 % oxygen and still did not have adequate oxygen .I was speaking to the family and they wanted everything done . That night I got the call . Her blood pressure was low . She was on the medicines for the the dropping blood pressure and still no urine output and oxygen was low . I spoke to the family . Told them that with the given situation there was high possibility of the brain damage .They had the long discussion and decided to make her DNR .

Saturday, August 4, 2012


      I often say that the  'base ' of any thing should be solid . If the base is not perfect then further knowledge will be difficult to understand and one may forget it . This so true of every subject , but more so when one is practicing medicine . I was fortunate enough to have some of the great teachers and that helps me even today . I practice pulmonary medicine , but I still come across the other medical issues that need general medical knowledge and invariably I come out to of help in getting to the bottom of the problem . The story that I am going to tell is one such incidence.
    I was taught by an endocrinologist  named Hyneman . I still remember what he said 30 years ago . He had told me that do not let urologist touch your patient with kidney stone,unless it is obstructing the urine flow .
    I saw this 37 years old male who had myopathy --progressive muscle weakness which had led him to be  a wheelchair bound .I saw him and talked to him about some help for his breathing on long term , with a machine and Tristam in future . He was not ready for either. The next time I saw him was in the hospital , when he was admitted  due an abscess. The surgeon wanted to drain it and needed respiratory help . I saw him and did some respiratory treatments and he did fine with surgery. At that time I came to know him and his wife more . We talked about his condition and why was he  ' suffering ' . She was somewhat familial with eastern philosophy and the 'law of  Karma '. She had accepted the situation , but enjoyed talking to me . He was musician in past and so we also talked about Indian classical music and how it is composed.
     After discharge from the hospital they did come for a follow up . It was routine follow up . He was found to have a kidney stone . The urologist was consulted and he was going to have 'blassting of the stone ' called lithotrypsy. From lungs standpoint I had nothing to add . But when I heard about the stone I could not keep quiet . I told him that the stones occur due to a " cause " and if we don't find the cause and treat it , the stone will recur. I also told him that in his case , due to immobility , the calcium from his bones could be taken out , which can increase the blood level of calcium and that could lead to kidney stones ,which will be calcium stones . So it was  important to analyse the stone and find out if he had calcium stone and if he did we could treat and prevent  it.
      I did not see them for a while . But then he came for the follow up . There was no new lung issue . But then the wife told me how they had followed my advice and gotten the stone analysed . It was a calcium stone . Further work up revealed that he had a parathyroid tumour. (The parathyroid glands are located next to the thyroid gland in the neck and are responsible for the calcium metabolism . A benign tumour called adenoma could lead to excessive secretion of the parathyroid hormone called PTH and this will increase the level of the blood calcium and can cause the kidney stone . ) He was referred to a local doctor who saw him and felt that he was too high risk to be operated . He was referred to a university centre . He was operated by a surgeon under local anesthesia and did great . The parathyroid adenoma was removed and the calcium was normal. The great part of the story was that I had not forgotten the teaching and when I told them about the possibility , they acted upon it and in spite of his disability , he had the surgery and had the ' cure ; of the  kidney stones .