Thursday, December 25, 2014


    Often in life we make decisions based on our previous experience .This is called Intelligence. So if we deduct based on our previous experience , then that is actually anything special, but when we act based on his experience , we think we are intelligent. If I have been burned with fire (which looks red ) , next time when we see something similar to the fire that we had seen ,then we deduct that it is fire and do not touch it.But it may be one of those 'fake' fire , that is seen in fake fire places. So then we are wrong . But when this happens in our regular life it may not be that bad. But when that happens in medical field , it may not be that benign.But unfortunately there is no 100% in life or for that matter in medicines . That is the reason same blood pressure medicine works differently in two different patients . But this is not that bad . When we talk about Life and Death , then it it very very important that we are correct as much as close to 100% as possible. Recently I had a patient that this holds so true.
     I have been seeing this patient who is relatively young. He is may be mid 40es. He has some developmental problems and some other diseases, but the reason that he is seeing my is for the lung problems. He had pulmonary fibrosis .I saw him may be 4 years ago or so. He is also obese and had dry cough. I did the CT scan and the pulmonary function tests and check on oxygen . His condition was bad . He needed to be put on oxygen and I tried steroids.I also treated his cough. He was put on oxygen. I tried to refer him to transplant centers, but due to multiple reasons , he was not accepted.So I continued to treat.He also had elevated pressure in the lung circuit, called pulmonary hypertension. So I started treating him for that.He has been doing well till earlier part of the year.But then he started having problem. He was admitted to the hospital and had pneumonia. His oxygen need went up and it was high enough that can not be provided at the home . I spoke to his mother, who is his POA, and told her that she needs to consider DNR status. But no decision was made and he got better. I discharged him on 6L oxygen .He would drop oxygen level to a critical level in less than 10 seconds if oxygen was stopped.But he was better than in the hospital , when he needed 40 and 50 L oxygen. But he was better at home . In next month or so he was readmitted . This time he had to be in the ICU. I had hard time getting oxygen up. He needed to be on pressurised mask and when it was taken off he would bottom down on his oxygen.I was successful in cutting down on his pressurised mask to high flow oxygen . But over period of next 10 days I was not in position to cut it down much from 40 L.I spoke to him and his family . I told them that not much could be done In my (educated) mind , his scar tissues were getting worse and not much could be done .No decision on DR was made. I ended up getting him to a special facility as this high rate of oxygen flow can not be provided at home or rehab. centers or any other place  other than hospital like facility. He looked OK but I had seen this type of patients in the past , who look OK , but don't get better and either end up on respirator or die. So I was not very hopeful.
    But in a 4weeks or so I saw him in my office, I was surprised . He was on 8L oxygen and he was running low oxygen ,when he walked , but then he was OK with 6 L.I decided to start him one new drug. He came with his mother and I talked to her about poor prognosis,but no decision was made. He was readmitted and not as bad as before . He needed 10 L oxygen . I have continued to talk to them on the prognosis and he was discharged this time on 6L oxygen . So in my experience he should not have done well 6 months ago , but he did and he is OK for now . So sometimes there are exception to the rules and our 'intellegence' may not be the most correct thing.
    The mother knew about the poor prognosis and still had /has the hope . I was basing my decision on my experience and felt desperate, when no decisions were made . I think the jury is still out.   

Wednesday, December 17, 2014


    I did write about the cost of health care in the past.This is the time of the year to renew the health insurance policy.The medicare replacement policy or other insurance policies need to be renewed.So I had to go to my insurance agent. I had called him about a month ago and since the 'new' policies don't open up till this month, I had to wait till I could get the new policies to review. Year before last I had a group insurance . The cost since then went up by 45%.Since last year to this year it went up by 33%.So in short it has doubled since 2012. I knew that the cost of health care insurance was not going to go down.(In spite of the claims otherwise.)But I was more interested in trying to find out the reason for this cost increase.And there are several reasons .In my view it is important to try to find the reasons as otherwise it is not going to be possible to reduce the cost . (I am not hopeful that this will ever happen).
     1) I was talking to someone who has coverage for 4 people and the cost of their family coverage is less than 25% of my cost.(which is foe 2)Their insurance plan is not as good as mine , but they got 40 %discount. So if the question is ,who is paying for the difference? This the first reason for the cost increase.
     2)There were several new drugs released in last 4 or 5 weeks. The 2 of them are for treatment of scar tissues in the lungs. This is called IPF,Idiopathic Pulmonary Fibrosis.The cost of these new drugs is , are you ready, $85000 per year.I can think of many patients that would need it and be benefited by these drugs.So if some one is paying the insurance premium of $1000 per month, which is $12000 per year, how would the insurance company going to come with the difference of $73000? The answer is the second explanation for the cost increase.
   3)The medicine has become the game of cat and mouse . Every time a new test is avaibale that pays more than the older one (whose reimbursement was reduced now), doctors tend to do the new tests more often than older tests .This is the 3rd cause .
   4) The cost for hospital employed doctors get more reimbursement for the same test , same service.The cost is at times 25% to 50 % more . Every one is aware of it , but no one is doing anything about it . More and more physicians are joining hospitals and so the cost is going up even though the services provided are same .
     I know there are several factors that contributes to the health care cost , the sad part is NO ONE IS DOING ANYTHING ABOUT IT.!!

Saturday, December 13, 2014


     I have been quite interested in the Quantum theory. This may have to do with the fact that in the Quantum theory ,every thing is interrelated . Two particles, miles apart ,will act as if they are connected by some force or information. So if one particles course is altered, then the other particle will also change the behavior .This is similar to the thought that we are all some way related and nothing happens by 'accidant'.There have been books written on the relationships of this behavior and the Hindu or TAO philosophy. One that comes to my mind was written several years ago, written by physicist, CAPRA. (TAO OF PHYSICS).  The other unexplainable behaviour of the particles is they could be at two places at the same time!This sounds impossible to the logical thinking mind . But it has been proved that this really happens.But we never knew that this can happen at cellular level. So it is one thing to have nonliving particles to behave as if they are related and exchange information, millions of miles apart and for a particle to be at two palaces at one time, but it is never thought or confirmed that this can occur at the cellular level. So when I came across this I was surprised at first, but then I felt that it was natural. If my behaviour is related and can affect behaviour of some one who is not in direct contact with me
    So let me tell you the quantum behavior at cellular level . This was observed and inferred in the plant who do Photosynthesis with the help of chlorophyll  and seen in bacteria called E.Coli. To have energy produced at a very efficient level, the transfer of information must occur at shortest  and best pathway. So the the "trial run" of the transfer occurs at various pathways at the same time.And then the plant find out shortest pathway.So it does not occur one pathway trial at a time , but all of them are checked at the same time and that is how the energy production is at 95%. (It is like I am driving on I4 and 17-92 state Hwy, at the SAME TIME to find out which one has less crowded and then take one that I can go faster.)
    This was also seen in bacteria .called E.coli. If the bacteria are put in a lactose medium, which they are not able to use for nutrition, then mutation occurs .But it was noted that the rate of mutation occurs at much higher rate than can be explained on the basis of random mutation. So the bacteria select position of hydrogen atom, in both position that based on the medium that the bacteria are put in , the hydrogen settles down so the mutation occurs.I know this is too complicated , but in short the bacteria behave,in two different way at the same time.
     I know this is of not interesting to many and not the most interesting to many ,I thought of writing as it intrigued me .

Sunday, December 7, 2014


       I used to think that in this world nothing could surprise me any more.Every day something new pops up.I have seen the drug free urine being sold for 'helping' those who use drugs and don't want to get caught on random  drug testing.I have heard about a company 'providing' disabled person in a wheel chair,  to get ahead in the 'lines of the Florida theme parks.'And many other that I would have not thought off few years ago. I do know that artificial insemination is done in castles all the times get better quality cattle. But I was talking to one my patients and what he told me was surprising.
      I was seeing this patient for the follow up of sleep apnea. Most of these patients have no major issues and are doing fine . Only some have issues with the mask or the amount of pressure of the CPAP etc.But for the purpose of the continuation of the care I see them every 6 to 8 months. So this was a stable patient with sleep apnea. His wife is also my patient and her problems are different. So I was chatting with them.I used to have a dog , which was German Sheppard. I knew that he had gotten a Rottweiler. So when I asked him about it , the story got interesting. He bought this one with all the 'papers'.So he had decided to breed it. But what I did not know surprised me . When he bought the puppy, he signed a contracts . According to the contract that was written by a retired judge, who does this as business, he has to breed this puppy with sperms of a show dog. This has to be done artificially and the expense has to be paid by this patient of mine. When the new little is born, then the previous owner will get one pup.(which she will sell with the same contract to a new owner).So the the business of the money making by breeding continues. He had paid $3000 for the puppy and spent another $3000 for the artificial insemination. But he told me that he can sell each puppy for significant amount of money , so he can make money himself !!
      I often talk about the Law of Karma and the Soul in Astral world. So I am not sure what kind of KARMA is this and what kind of souls will be attracted to the souls of puppy.
     Well I will hopefully find out the answer in future.

Saturday, December 6, 2014


    I deal with life and death and the attachment to our own body.I am no exception to the rule . I often Say that the 'worst' or may the highest attachment that we all have is the attachment to the body. Smoking, alcohol drugs or sex are strong addictions or the attachments, but nothing compared to the attachment to the body.In fact when we talk about the 'sin' that we all did or ;inherited' from Adam,is the attachment to the body and 'thinking that we are the body and not the soul.Even though we know that the body is 'mortal', we still treat it as if it lives for ever and it continues to be there after death.
    When my father died,I wanted to cremate a picture or 'our family' with his body.I was adamant about it and would not back out. But then there were other people who felt otherwise. ;They' felt that it was not 'good' to burn the picture of live people. So ultimately I backed off. So I did not get the family picture creamed with the body.So I was thinking about the 'body' as the soul and the other who opposed it thought it in the same way. The picture is not me and nor is the body.The reason I am writing this today is due to a patient that I saw.
    He is a 71 years old male with history of bronchial asthma and sleep apnea.He came for the follow up. I have to write in my notes that the patient is using the CPAP and it is helping him.This is required to get the supplies for the CPAP. So I asked him if he is using it. His answer was ,Yes , daily. Then we were talking to him , he told me that he could not use it in the beginning, and when he would turn on side,it would bother her wife. So I asked as to how she is taking it now.He told me that she passed away few months away. But before she died ,they started sleeping in such a way that her feet were at the head side so the CPAP would not hit her head ,but the feet. That sounded good , and I thought telling other couples about this trick.Then he told me that she had died and he wanted himself to be buried next to "HER" IN THE SAME WAY. Her feet where his head would be .I can understand the emotions , just like I had , but thinking about this after few months , May be be it is LOVE , may be it is misunderstanding or may be it is ATTACHMENT to the body.