Sunday, October 28, 2012


   I have a ring in my index finger. This is rather uncommon finger for having ring for Non Indians . Many of us know about the significance of this ring , but I do get questions asked about this . This story is one such story .
   I was seeing a patient in my office . I was seeing this patient , whom I had seen in the hospital for asthma. She was doing fine, and had come for the follow up after the discharge .After I talked to her and examined  her ,I told her to wean down the medicines that we had started in the hospital . As I was writing the note , she asked me about the ring in my index finger . I answered that it was a ring with a stone ,that was suppose to Planet Jupiter stone . Since the the mount of Jupiter is at the base of the index finger , the ring with the stone of Jupiter should be worn in Index finger. (This is based on palmistry .) So then she asked me if I believe in " these kind of things "I said yes , as otherwise I would not were the ring . I took out my ring and showed her how the stone touches my skin .
   Here I must explain you some other thing . Many months ago , may be 6 or 8 months ago , when I was making rounds at the local hospital , I noticed that one of the nurse's aid was awfully quite . She was Guinness lady and must be Indian by ancestry. She was also Hindu . So I asked her as to why she was quite . She asked me if I had read the news paper . It was Saturday and I had no time to read news paper before I could finish the rounds.So then she told me the story . There was a story about a women being killed early in the morning . The woman came home late at night from her job and as she was getting out of her car 3 people hit her with a gun and when she felt unconscious, they ran her over with her own car . They were caught soon and one of the 3 people was her 18 or 19 years old son . At that time I was trying to learn reading of horoscope or natal charts. So I got the boy's date of birth and place of the birth and sent it to some one in India to read the horoscope and tell me what was his 'fate '.
   So when this lady was asking me about my belief in horoscope , I thought that story . I had not gotten any response from India . I did not want to be too specific . So I just told her that one of my friend's son was not behaving  well and was in trouble with the laws, and I had sent his horoscope to   India to see what was his future. I did not tell her about the killing , nor did I tell her that he was in jail . The story was quite old and nothing was mentioned in the news papers .
    She looked at me and said ,"do you believe I am psychic ?" I did not know what to say . (may be she would read my mind without me saying anything ?). She continued , "Please tell your friend that his son is in bad company , but do not worry , the judge will find leniency. "I did not say anything .
    Another 6 or 8 months went by . The case was finally in the courts . The 18 tears old became the witness for the prosecution and had a deal . He was given 10 years . He would be free by the time he is 28 or may get less imprisonment for well behaviour .
    The patient who claimed to be psychic was right .

Saturday, October 20, 2012


     I was watching the major debates between the 2 parties ,since this the 'season 'for it , and I was struck by the fact that quite many people are not aware of the changes that have occurred in last few years. I was talking to a family member of one of the patients , who happen to be a lawyer and a Democrat. When I told him  certain  changes in the practice of the medicine , he said , 'it is not possible , you are making it too simple .' After listening to his comments and then listening to many of my friends , I was stunned by the misunderstanding that exists. So I decided to write this blog . I am sure that lot of people will find it difficult to believe , some will feel that I am totally wrong, and some will feel that I am ignorant, rich person with ' no heart '.
    Let me start by saying that I am in practice of medicine for very long time  and I 'understand ' it very well . An average doctor has 4 years of college , 4 years of medical school and the extra years depending upon the speciality . Family practice or Internal medicine doctor will have 3 more years. If one does Cardiology or pulmonary etc then they have additional 3 or more years of training . I feel that  a ' college graduate ' should get more salary than a 'high school graduate ,' and a person with doctorate should get more that person with simple graduation, if they are in same field . And normally we do see it in life . So my feeling that sub specialist , who has extra 3 or 4 years of training than a family doctor should get more reimbursement than the family doctor and a family doctor who has 3 years of extra training than a medical graduate should get more money is natural. In last 2or 3 years ago this got changed . Now a days a doctor who has done 6 or 7 years of training after medical school , gets same money as new graduate from medical school who has no extra training. Does this sound right?So spending these extra years has no 'value ' per our government .
     Let me tell some other changes . If I had seen a patient in November of 2009, and then he did not come to see me till October of 2012, I have to charge him as 'follow up' visit, even though I will have to get detail history as to what has happened in last 2 and 1/2 tears . I have to spend much more time than usual follow up patient. I can not understand the thinking behind this 3 year rule .
   In 2012, they decided that all the doctors who treat patients with medicaid will need to be 'finger printed '. The original rule was that this must be done every year , as if the finger prints change . I did my finger printing more than 6 months ago . I am still not approved, and I have been participating in medicaid , even though the reimbursement is very low , for last at least 25 years. So till I get approved I am not getting paid for seeing patients with medicaid.This is how government run managed programs work.
.     Per new ACA (Obama care ) one should be in position to find health insurance for 8% of their income . So for a secretary making $30,0000 the premium should be $2400 per year or $200 per month . Per our experience premium to get $500 deductible policy is $300 or more . So if I have to provide health care  for my employee,I would ask these employees to go to the government pool . NOW think about it . What kind of health insurance one can get for such low premium?. It would be such that the befits would be low , so low that no one would accept it and then many of these patients will have to go to ER. There will be longer wait and more expense as the ER doctors do not know the patients.
    I was told that if one put a frog in boiling water it would jump out . But if one puts a frog in water and slowly heat it , the frog would not jump, but will get cooked . I was also told that if you want to 'enjoy ' the food in a restaurant , then you should not go in the kitchen . This applies to our taxes and government spending . If  you are approached by some one that you know ,and ask you to 'give'money as he wants to buy a new car, would you give it ? I am not talking about a loan but just giving it as a gift . The answer is  going to be no . So if you would not 'give' a gift to some one you know , why would you give the gift to some one you never met ? But this is what exactly was the "cash for clunkers "program. The government took money from the tax payers and 'gave' to people who bought new cars . If one is spending money for himself, then he is very careful , if one is spending his own money for someone else ( buying gift ),he is less careful. and when one takes money from others and spends it for still some other persons then he is not careful at all . The government spending comes under this 3 rd category.So money is wasted and the programs are not efficient.
    There are ways to stimulate economy . I was asking this to one of my patients . Now a days one can buy a condo for $50000.  which was sold 3 or 4 years ago for $200000. But the banks are not giving loans due to significant rules . So only those people who have money can buy it . But these people have no 'tax incentives ' . When one buyes a real estate, there is realtor, closing agent ,title company etc, they all will get work and benefit . If the property needs fixing, then handy man , carpet company , and many others will find jobs . So if these (rich )people who can afford to buy these condoes,  are given tax incentives  they will buy it and many more will get the jobs . This the domino effect . There is no question that the person who buyes the condo will make profit.But at the same time many are benefited .
   There are solutions to health care too . I have written some of them in my blog on Health care .

Saturday, October 13, 2012


   Quite often we see bad things happen to good people. Many years ago my professor of preventive medicine , had heart attack. When I went to see him in the hospital , he asked me as to why he got the heart attack. He was not a smoker, did not drink alcohol, was vegetarian and did not have high blood pressure or diabetic. His cholesterol was normal and he did walking as exercise daily. So this professor of preventive medicine was asking me as to why "he " out of all the people got the heart attack. Now we know few more factors that predispose to heart attack.But the the medicine is like the story of 7 blind men and the elephant , each one of the blind men was touching the different part of the elephant and 'feeling ' that he knew how the elephant really looked like .So as we know more , there is more to know . So the question that my professor asked me is not uncommon . I get it for many diseases, and under many circumstances. When I am asked why do I have asthma , I ask if anybody knowes why people get high blood pressure or diabetes. WE DON'T KNOW WHY WE GET THESE DISEASES OR FOR THAT MATTER ANY OTHER DISEASE. Not only that we don't know why we get them (other than statistical data as to who is predisposed to them ),but we never 'cure' them , we only 'controll' them . That brings me to the today's story .
      I saw this young 28 years old male for pneumonia. He started with symptoms like cold . So he went to a walk in clinic . He had an X-ray and was told it was OK , He was given an antibiotic and cough medicine and was sent home . He did well for a day and then the fever came back and cough got worse . So he came to the emergency room .The new X-ray done showed pneumonia and small amount of fluid around the lung .He was admitted to the hospital.When I saw him he was quite stable. He needed
some oxygen .The fever had gone down .We had started him on antibiotics and he was doing better.
    We continued to watch him . On 3rd day we did a new X-xay . It showed that the fluid around the lung had increased . I did a CT scan . It confirmed the pneumonia and the fluid . So I decided to take out the fluid as it could be infected . The small amount of fluid is not uncommon with the pneumonia.But if it increases then it could be infected or just because of the amount of the fluid , might necessitate draining it .When I did try to take out fluid , it was pus. It was so foul smelling that smelling it might make one feel dizzy.I did drain some , but I knew that he would need surgery. We called the chest surgeon. He had surgery and did well . When I saw him next day , he was doing well. He asked me a question , "Why did I get it . I don't smoke and hardly drink, I don't do drugs . When I got sick , I did see a doctor. So why is it , that I not only got sick , but even needed chest surgery."
  I had no medical answer. But being firmly believing in the law  of karma ,I had to explain him the philosophically reason. So I started to explain him the karma and how it is stored, and how each karma has to come to fruition, and must come to fruition. Unfortunately, we don't know the 'deed ' that we did has caused the miseries of today.As I was explaining him ,his church priest came in . I continued to finish my thought.and left.

Wednesday, October 10, 2012


     We often have a debate about the cost of medicines and the cost of the health care . There are usual 'punching bags ' for some people, especially the politicians . "The bad doctors " or "The greedy doctors ". But more often it is Drug companies . When we analyse the cost of health care, we realise that the physician's cost is about 15%, the cost of hospitalization is 70 % and the 'evil' drug company contributes 15 %. So why are they vilified and the patients believe in it ? The answer is simple . The patients never see the cost of hospitalisation . The medicare or the insurance company pay es most of the expense. So even though at times it is outrageous , patients don't realise it . To take an example , an endoscopy --EGD, --to look inside the stomach , the doctor who does it and does biopsy and analyses the finding and treats the disease, makes about $150.The hospital charges are about $1500 to 2000 or more depending upon what anesthesia was used. The pharmacy cost known to patient as they pay it at the pharmacy and many pay it from their pocket . I am not defending cost of the medicines . I do believe that it is too high . The story that I am telling is one such case.

        I saw this 64 years old female who was seen by me for pneumonia and chronic cough . She was seen by another lung specialist , but her cough had continued and so she wanted a different MD.I saw her and saw her X-ray I did not like it . I ordered a CTscan . It showed a mass in the center of the left lung. It was somewhat hidden and not obvious on plain X-ray as it was close to the big blood vessels and the center. I did bronchoscopy and diagnosis of  the cancer was done .It was not surgically resectable . So I consulted the radiation doctor and an oncologist .The radiation doctor felt that she would be best treated by chemotherapy. The type of cancer was such that ideally is treated by chemotherapy and not by radiation . The tumour was pressing on the bronchus and the artery going to the lung, So I had called him . The patient was treated with the chemotherapy and had usual side effects , but was doing OK .After about 6 months of treatment she was doing fair, but was admitted in hospital with generalised weakness. She was found to have low salt in the blood .She was treated and got better . and was discharged . She was readmitted in 2 weeks and had low sodium again . This was due to the cancer , which secretes some chemicals that cause low sodium . She was treated and discharged again . After 3 or 4 hospitalisations , the kidney doctor gave her a prescription for a pill to help maintain sodium level . She called me when she went pharmacy to get it . The cost of one pill was $250, YES ONE PILL WAS FOR $250. There was no way she could buy it .
    I ended up talking to the radiation doctor and he agreed to give her radiation treatment to the tumour . My simple thought was that the amount of the chemical secreted by the cancer was directly proportional to the size of the cancer . So if we can reduce it , the chemical secretion would go down and the sodium would be better controlled.
   The idea worked. The radiation treatment did work . But I still can't fathom the idea of one pill could cost $250. ( If one drops the pill on the floor he could offer $50 to find it out .)

Saturday, October 6, 2012


     When we learned the pharmacology in college , one of my professors had said that if you write nausea, vomiting , diarrhea etc, you would be right . As I started practicing medicine , I realised , as to  which side effects are common and which are not that common , but can occur.I have often said that if aspirin would come out as new medicine today , FDA which approves or disapproves the new drugs, would not be approved .Aspirin is one of the miracle drugs, just like statins , and has many benefits, but due to reported side effects it may not be 'safe ' per FDA criteria . Some of the rare side effects we learned with experience. Today the computer raises 'red flag ' with all most any 2 drugs , and then we have to check out if the drug interaction is major or not.But to know if there is any drug side effect from the drug , one must know that what drugs patient is on .This may sound like an easy thing , but in practicality it is not . Many patients describe their medicines as "blood pressure pill " or that 'red color small pill 'or the" one that I got at CVS pharmacy " etc .There are patients who do come out with a computer print out of their history , list of medicines. This help a lot .
    But there are incidences when even if  we try , we either don't have full list of medicines that patient is on or patient forgets some of the chronic medicines . The story that I  am about to tell is one such .
     Mary was refereed to me for complains of cough , which had started about 4 or 6 weeks .Her primary care physician gave a course of an antibiotic, and a cough medicine. It did not help much ,So he did a blood count and a chest X-ray.The X-ray showed that she had 'pneumonia ' . So he gave her another course of antibiotics. The cough continued. Now she was short of breath . So now she was referred to me . I saw her in the office . She was 74 years old white female , who had history of high blood pressure . There was no other major medical history . She had had hysterectomy and some arthritis . Her examination showed that she was mildly short of breath with the walking and her respiratory rate was 20 , little higher . She had some rales on examination of the lungs and her oxygen saturation was slightly low at 93 %.I saw her X-ray. She had diffuse infiltrates in both lungs.I decided to do some blood tests. Her previous X-ray , which was 6 months old, had shown the lungs to be clear.I also decided to do the bronchoscopy . I did the bronchoscopy , My main concern was some 'unusual infection' But I was not sure why would she get it . ( She had no other history that could make more susceptible to infection ).
    The bronchoscopy did not show any unusual infection . The biopsy that I had done showed only "inflammation ". I had called her for the follow up . I still had no specific diagnosis . My options were limited . One was to do open lung biopsy, or the other was to take' chance ' and try steroids. She was very reluctant for the open lung biopsy, which was a major surgery. I was talking to her about trial of steroids . I went over with her the use of steroid , side effects etc .I again wanted to know her medicines , so I would know if there was any other 'risk ' of using the steroids in this elderly lady . They were same as I had noted in my first visit . Then the daughter said . " mom did you tell the new antibiotic that gynaecologist added 2 months ago . Are you not taking it ?I don't see it on your list. "Her answer was "I forgot ".I asked her the name of the antibiotic. The answer I got was the 'Answer ' that I was looking for . She was taking an antibiotic , called nitrofurentine . This is used to prevent recurrent urinary infection. This is given on long term , which means it is continued for months .This antibiotic can cause an 'allergic' reaction in lungs , which causes inflammation and can lead to scar tissues .
      I told her to stop it . and started her on steroids . I saw her in 10 days . She was 80 % improved . I did new X-ray in 3 weeks . It showed 'marked improvement'.So we were on right tract .
      If we had not known that she was on this nitrofurentine , and it was not stopped , she would have been worse.So sometimes we need little luck .

Tuesday, October 2, 2012


  We often say many stotras . It has happened to me that I learned some of them  by listening to them . So I often misunderstood them, said them incorrectly and did not understand the true meaning . One of the 'ARATI', that we Hindus do , is often said in a wrong way . It is not in English , so those who do not understand the language will have difficulty in understanding it . But I will state it for making a point . It is
 " sukhakarta dukhaharta,warta whighnachi,nurwi purwi prem krupa jayachi." I have written it in the way that we say it . The meaning from this is not accurate . The correct way of saying is "sukhkarta dukhharta ,warta whignachi na-urawi( nurawi ),purawi prem krupa jayachi."Now that one makes perfect sense .
     The Ganapati Atharwashirsh is one  which has a great meaning . It was written by sage Atharwan. Every one of these stotra start with OM. The OM has three letters, namely A, U ,M, which represent 3 deities ,the Creator Brahma, the sustainer Vishnu and the destroyer Shiva .So we start with the OM ..So now for the meaning
of the whole stotra.
     I bow down ( do namaskar ) in front of the GANAPATI--the lord or in charge of the GANAS the soldiers of the God.You are the Lord which we can see with our eyes . You are the creatore of the entire universe .You are the sustainer of the universe. You are the destroyer of the universe.You are the 'real' Brahma or the pervading consciousness. You are indestructible Atman.(not limited by body called Jiwatma but Universal Atman called Parmatma ).
   I will tell the Truth,(so) you protect me .Protect the one who is describing( your real description).Protect the one who is listening to this (description )Please protect the teacher who is giving this knowledge and one who is receiving or learning it (the Guru and the Shishya)Protect from east , protect from west , protect from north protect from south, protect from  top , and from bottom .Protect from all sides and from all things -dangers .
     You are the speech(one that is written and read ).You are the Knowledge. You are the Bliss, You are the Brahman.You are the Truth, the Knowledge and the Bliss.You are the One.You are full of the knowledge and you are full of any special knowledge .
(knowledge is in general or understanding of the God and specific knowledge is that what we want to know in our day to day life .)The entire universe has originated from you .You are the the reason why this universe continues to exist, and this universe will end in you. You are the 5 big elements , the earth , the water, the fire or energy, the wind and the space .You are the 4 different parts of the speech . (called Para, Pashyanti, Madhyama , and waikhari, The last one is what comes out as the speech . But there are 3 other stages that we go through before the actual words are pronounced called Waikhari . )You are beyond the 3 qualities(Gunas -Satwa, Rajas , and Tamas).You are beyond 3 bodies(physical, astral and causal called Sthool, Sukshna , and Karanmaya).You are beyond 3 Times --past , present and future.You reside in Chakra called MULADHAR .You are the 3 different energies or the powers, ( strength of desire, called Ichchashakti, the strength knowledge called dnyanshakti, and the strength of the action called Kriyashakti.)The sages are in trance of ( thinking about )you are the creater called BRAHMA ( different than Brahman), the sustainer Vishnu and the destroyer the Shiva., You are the Indra ( who is the king of personal gods and who enjoys the pleasures of the creation . )the Fire (that receives the sacrifice in the Yadnya ).You are the air (that is needed for survival of entire life -plant animal and human beings . )You are the SUN ( whose energy is needed for the world to continue to  be ),you are the Moon (which is needed for the plants to survive ),You are the reflection in all the living beings (called the Jiwatma ) and you are the pervading consciousness in entire universe called Parabrahma.
   Now there is description of what is called BIJ mantra . Bij means seed . So this mantra sows the seed for the prayer . Take G from the Gana (the army solders . The in charge of Gana is GANAPATI ), Add A to it , then ANUSWAR pronounced as m, then add OM . This OM GAMM IS THE BIJ MANTRA .This is repeated for the understanding and told that by saying this we will get to the lord Ganesha.Ganpati is the Knowledge and this the poetic way of saying it .(OM GAM )The 8 letter Ganesha mantra is OM GAM GANAPATAYE NAMAHA.The Gayatri mantra for the lord Ganesha is similar to every other Gayatri mantra ."We know the appearance of the Lord with one tooth, we think of the Lord with the Trunk ,so that lord should guide us, )
    One can not easily meditate on 'spirit' without specific appearence. So His appearence is described, for us human beings to contemplate upon .(Saguna vs Nirguna )