Saturday, March 28, 2015


     I was invited for a function and it happened to be the religious one where there was TH SATYANARAYAN KATHA. So this one is for those who have some idea about the Indian Pooja. I met some one there . The Satyanarayan Katha or the VRATA is done on many different occasions. But in this incidence , there was priest who did the narration of the Katha or the story and directed the host to perform the ritual. So this gentleman turns to me and says , 'this is good foe the priests , who can make money.' I could have kept quiet , but I did not. I just felt that he did not understand the real meaning of this VRATA or the pooja. So I did explain him some the points , but then I thought of writing this blog.I am going to try to explain the pooja as I understand it.
     So to begin , this is the ritual in which we worship the Lord Vishnu. We do the usual pooja and then we listen or read the 5 chapters of story telling about this ritual. As  in any Hindu ritual . we first invite Lord Ganesha.He is the deity who is worshiped first. There are many reasons as to why we do this . But the one that I like as explanation,is that the the Lord Ganesha removes all the obstacle ,when we want to do any thing. But more than that it is the controller deity of the first Chakra called  MULADHAR. So if we want to uplift our self in any way we need to start with the lowest Chakra and until we conquer it ,we can not go any higher. So we worship the Lord Ganesha.
     Then we invite the 9 planets and bless us . The Hindus believe that the planets and their positions control our lives. So this to some extent the environment that we can hope to have no outside obstacles. The worship that we do is called  Shodash pooja , which means it has 16 steps. Without going in to these steps. I would just say that we HUMANIZE the God . So as we would treat the guest that comes to our house ( or as we are suppose to treat) we treat the God . We offer him water to get washed up , then the bath then the various things which could be considered cosmetics in this world are offered . And then finally the food and then the 'after dinner' treat.
   We also worship various other things , commonly used in our worship and each is symbolic of deeper meaning. But today I am talking about the Satyanarayan Pooja. So then after worshiping the Lord Vishnu or Krishna, we then read the KATHA or the story. There are 5 chapters and each one has different stories. When one reds them it may not sound any different than any other Indian pooja. But the difference is what I am trying to tell.
     In the Satryanarayan Katha , there are several stories in which the main characters are different. But if one looks carefully, they belong to 4 typical classes of Indian Religion . Brahman, Kshatriya,Vaishya and then Shudra.So the message is that ANY class of person can do this pooja. (The classes are based on type of soul development and not which family one is borned.) If one looks at the stories carefully each class has own problem or the attitude. When the firewood seller, who belongs to the Shudra class, was told to do the pooja , he did not question, and followed the ritual as was told to him. But the Vaishya,did not do anything.Instead like any  businessman,he bargained with the God , (If I would get a child , then I will do the Pooja ).The king  has big ego and he refuses to worship the God ,. But then when he gets in trouble , he starts praying. Again this is indicative of different mental attitude of different souls and different Gunas .
    The third interference is that of reincarnation. All the main characters in these stories , are reincarnated in next life at a HIGHER level . (But not reached the Kaiwalya or the Nirvana).So the old, poor Brahman became close childhood friend of Lord Krishna >(though he continued to be poor), the firewood salesman become the guy who helped Lord Rama to cross the river. The one of the Kings became the father of the Lord Rama , called Dasharath, and so on .
     So the moral of the story is that , this worshiping can be done by any one needing any help from any priest, it showed the different attitude of different classes based on different Gunas, and it tells us the principle of reincarnation. 

Sunday, March 22, 2015


      Since I moved to Florida, I have witnessed the afternoon rains that many a times are 'norms' . The rain sometimes could be very heavy , heavy enough that at times one has to pull car on the shoulder if we are driving on a high way.I have though experienced the real meaning of this saying first hand on many occasions. Multi system failure in ICU patients is not uncommon .So in a sick patient one may start with pneumonia and then in turn it causes respiratory failure.And then nest day we find that the kidneys are not doing the job and the liver test comes back abnormal and then make it worse, the coagulation of the blood is affected due to sepsis. But I am talking about today is something different which brings me to today's story.
      I saw this patient in my office for shortness of the breath. She was a66years old female , who had smoked her entire life . She quit smoking about 4 years before I saw her . She may not have come to me except that she needed a hp surgery. The orthopedic surgeon wanted a pulmonary clearance. So the primary doctor send her to me. I did a chest X-ray and did the breathing test. The X-ray was normal and the breathing test though abnormal was acceptable for the taking the surgical risk. So I cleared her and told her to start some inhaler for the COPD. She must have had surgery and did well and did not come back for the follow up. Then about 8 or 9 months latter, she started cough and the family doctor treated her with antibiotics and then the cough medicines . She did improve , but the some cough continued and she noticed little blood in the sputum. So chest X-ray was done and it was abnormal.So CT scan was done and she was sent to me . The CT scan showed that her one of the segment or a 'lobe' of the lung was collapsed. This is highly suspicious for the tumor blocking the bronchus , so the secretions can not get out and the lobe gets collapsed. So I explained this to her and her and her family. She had just lost one daughter. So the word or the thought of cancer was unnerving.
    I did the bronchoscopy. As I expected I saw the tumor blocking the bronchus. It was quite friable and  there was necrotic material on it . I did the biopsy. I went to talk to the daughter. After I told her that most likely it was cancer, she started crying. I tried to console her ,telling her that this cancer may be operable .So we had some 'chance' of the cure. Then what she said caught me with surprised. She said,"I was just told that I have inoperable cancer ,I came to know only yesterday."
     She was not my patient , but I had to talk to her . She had noticed a lump in her neck and so the primary care sent her to a surgeon .She had a biopsy and it showed the cancer. (I might have done a needle biopsy instead of 'biopsy under anesthesia')She was given the copy of the report and was told to see a cancer doctor. I did not know what to say , I sat with her and told her that the biopsy report did not indicate as to the origin of the cancer and she would need further work up,like PET scan , and additional scans. She asked me as to what could I do.She had not called any cancer doctors and wanted to stay in the area that I had the office. I asked her if she wanted I could get her to some one soon . She agreed and I called an oncologist.He was gracious enough to see her same day.
   I don't want to go further as to what happened to my patient or her daughter. But think about the situation, 2 daughter and the mother having 'bad luck ',like having cancer in span of 2-3 months , that is what I call 'when it rains it pours!!!!"

Wednesday, March 18, 2015


       All of us know about the movie called the GOOD THE BAD AND THE UGLY. (May be all of us who are old enough to remember and not too old to forget).The words like good  and the bad are relative. When I diagnose the cancer of the lung and tell some one about the diagnosis, I often get a question , "Doctor , what stage is the cancer?" My answer is ,'Don't worry about the stage . It is only for treatment decision and the data collection. What I like to know is , is it operable and can be resected or can not be  resected."But sometimes I am lost for the words. That brings me to the today's story . I had seen this patient may be a year and half ago . She was admitted with the pneumonia and was quite short of breath. She was a smoker and had smoked for more than 5 years . She had some fever and cough .On couple of times she had noticed blood in the sputum . She neglected it , but when she started getting more shortness of the breath , she had to come to the hospital . She needed to be put on oxygen and we also started her on antibiotics . She also got steroids and number of medications. We did the CT scan and it showed the extensive pneumonia. But it also raised the suspicion of cancer . When she improved a little bit , I did a bronchoscopy. It showed a cancer which was blocking the main bronchus . The biopsy came back " highly suspicious for cancer , but not conclusive "So I had to do a needle biopsy of a lymph node above the collar bone and it gave the definite diagnosis of the cancer . She had 'inoperable cancer ' .It was inoperable due to multiple reasons , type of cancer , spread of the cancer to the number of lymph nodes and lastly her poor lung capacity . So she was started on chemotherapy.
        She actually did quite well and responded to the treatment . Her shortness of the breath got better , she was off oxygen for most of the time and she was not short of breath on usual activity. Then she had a mild heart attack. She also had one episode of irregular heart beats. But in spite of all this she did well . She had new scans and was doing OK . Then she had episode of the shortness of the breath and was admitted. This time she was very short of breath. I did do new CT scan and it showed that there was fluid around the lung .I decided to take the fluid out . So I took her to ultrasound department and did the procedure. When I put the catheter in I was surprised . The fluid was milky . I had not seen this kind of fluid in last 3 years!This was the fluid due to cancer clogging the lymph nodes and the drainage and that had caused the fluid . So the fluid did not show the cancer cells , Normally that would be a good news , But in this case the milky fluid itself in presence of cancer was bad news . I am not sure which one is BAD and which one is UGLY. But certainly NOTHING IS GOOD !(Though on surface when the family knew that the fluid was negative for cancer cells , they thought it was good news .)

Friday, March 13, 2015


       In medicine when we say Adam's apple, we talk about the area in the neck, where there is thyroid gland and the prominence moves when we swallow . It also gets more prominent in males with the onset of puberty.But today I am talking about the story of the Adam and Eve and the story of the Garden of Eden and the forbidden apple. As the story goes ( or as I understand it )the GOD had created the man in his image ,the 1st man called ADAM, then HE created Women .They were told not to eat the fruit or the apple in the 'center of the Garden of Eden '. Then the Adam committed the Sin of eating the apple. So now all of us are 'paying ' for the sin of Adam and Eve. I had hard time accepting the story. In first place why would the GOD forbid Adam from eating the apple. What is so special about the apple tree in the center of the Garden of Eden that one should not eat it ?Secondly why are we all including the new borne infant are paying for it now"?It just does not make sense.So when I looked at it from a different view to interpret  mystically written scripture,I was told a different interpretation. THIS IS NOT MY OWN IDEA.It goes like this . When the God created the man , and the women , he provided us with the various sensed to keep us alive . So we have hunger to eat and we do not die of starvation and eyes to see  and have touch to prevent burns or injuries. We were also provide with sex organs to procreate and not get extinct. So the God wanted us to use these senses only as 'needed 'and as' desired '.THE GARDEN OF EDEN IS OUR BODY and the tasting the apple in the center of the garden was doing the sex without need for the procreation , but just for the lust.Human beings are the only animal that engage in the act of sex at random. THIS WAS THE SIN AND WE ALL HAVE BEEN AFFLICTED WITH IT.I was reminded of this when I saw this patient .
     I see many patients who have significant compromise of the lung function Many of them are short of breath with little activity and even need oxygen .The question of engaging in sexual act often arise in younger patients and there is always some frustration with the act as shortness of breath interferes with the pleasure.But many of my patients are older and have many other issues and some of them to be on not only oxygen , but also on breathing machines . Some of my patients are so bad that their breathing has to be supported by breathing machine , which gives them the actual breath.I have few patients who are on such machines at night and even sometimes during day time to get relief from the shortness of the breath.I have one such patient , that has been on regular respirator one time and has been on similar machine to help his breathing at home Recently his wife called me stating that he was not doing that well and was sleeping more time even during and had no energy , I called a respiratory therapist and we ran some tests at home to check his oxygen and the carbon dioxide while at sleep on respirator. It showed that his lung were not doing the job of getting rid of the carbon dioxide. So the retention of the carbon dioxide caused him to sleep all the time . So I had to increase the support from the respirator.(to do the job that his lungs were not doing )My next visit with him and his wife scheduled and I explained them as to what we found and what I had done . He was feeling better with the change in the machine. But then he asked me to close the examination room and told me that he wanted to ask me a 'personal' question. So I did it and his question surprised me.He wanted to know what can he do about the sex life,as he was too short of breath and then had problem with the erection ,I was shocked .In this 'older' gentleman who needs to be on respirator during night and even during day time for 4 hours, I was not expecting this question.My answer is not important.But it reminded me of the story of Adam and Eve and the first SIN. We are still paying for the sin ,as we are still doing the sin (May be this is too harsh word for the simple act of sex , but it is the lust and the attachment and not the act itself.)

Tuesday, March 3, 2015


       I did write about the life and death and about the 'time' of death.(and the birth). But it kind of struck me as I was reading an old book written by Dr, Weiss, who has few books to his name and does lot of lectures now a days. He wrote this book several years ago called MANY LIVES,MANY MASTERS. He had 'regressed' one patient not only in this life , but in several previous lives.Then she starts talking about the previous life and then when she dies , she is in astral level and the Masters teach or give explanation.In this book it was stated that people in the astral level could decide to get 'rebirth' and the time of the death. I was not sure if one can determine the time of the Death . I often see patients that have such a horrendous disease that even though they 'want to live', they do not. Some of them are young and some have many reasons to live . This struck me as I saw this patient recently.
      I was called to see this 71 years old patient , who was admitted to the hospital for the diagnosis of pneumonia. He had quit smoking more than 15 years ago . He had some shortness of the breath and had cough and some fever though the fever was low grade. He had no elevation of the white cell count , as is the case in the infection like pneumonia. His chest X-ray showed the pneumonia and he also had a fluid around the lung. I spoke the wife , who happened to have worked in medical field and knew some medical terminology.I did the CT scan and it showed the pneumonia and the fluid .I was concerned and was worried that there may be something more than just the pneumonia.I did mention this to them and she was not very happy.May be she did not not want to hear the bad news. I decided to do the bronchoscopy to rule out cancer as the cause of the CT finding . It was OK . So I did do the procedure to take fluid. The fluid was positive for the cancer , cancer of the lung. So we called the oncologist and did additional work up . We did a bone scan as he was having lot of pain and I was worried about spread of the cancer to the bones.It was OK .So I was happy . Then we did PET scan . In pet scan one can pickup cancer anywhere in the body. The accuracy of the PET scan is as high as 88%, not 100% , but 88% is very good pick up . It was a shock to see the report. The PET scan showed the spread of the cancer to bones, ribs , spine and lungs all over. After knowing the PET scan finding the family and patient decided to do no further treatment except to consider radiation to the painful areas in spine . Due to the collection of the fluid we had to put a catheter. So one can drain the fluid periodically without having to stick a needle .
       He was discharged . He came back in less than 2 weeks and had more shortness of the breath  and some pain . The radiation therapy was almost completed and question was to consider a pill for the cancer . I tried to drain the fluid but there was none and it looked like use of steroids and antibiotics and morphine seemed to have worked . And then I got a call at about 8 pm . He was having severe pain and morphine has to be increased.I did new CT scan .IT SHOWED TUMOUR ENCASING THE ENTIRE RIGHT LUNG!I went to see him in the morning and told the family the findings . We increased the narcotics to make him comfortable. He died that evening. It was less than 6 weeks between the diagnosis of the cancer and his demise . This was the short story and I am not sure he wanted to die or may be he did want to !