Saturday, July 30, 2016


     I have been in medical practice for many years and sometimes I feel that nothing can surprise me . But many a times I come across patients that have a diagnosis that is not uncommon , but it surprises me or may be it touches the heart. Some one coming for pain in the belly and then finding out wide spread cancer, is one of them . I often wonder as to how come there were no other warning symptoms. So today I am going to tell a story of one such patient.
     I was asked to see this patient who had pneumonia. This older patient had history of bladder cancer and has seen by urologist several times . He had some surgeries and treatment with BCG. (I have never known as to how this BCG came out as the treatment for the bladder cancer . The BCG is TB vaccine . It was used in the past for the protection of TB and now we know that it does not do the job so we don't use it . But how could one might have thought to use the BCG - a TB vaccine to treat bladder cancer?) He came to the hospital with painful urination and difficulty with urination. So he had some urinary retention. But the routine chest X-ray showed some infiltrates or congestion in the lung. So he was started on treatment for the pneumonia and I was asked to see him . He had never smoked and had not much of respiratory related complaints. He had some cough and no fever and had some minimal shortness of breath. I did do the CT scan as there was fluid around the lung and he did not have typical history of the pneumonia . The CT scan showed same -pneumonia and the fluid . So I decided to take out the fluid . So with the ultrasound guidance I took out 1200ml fluid . I was quite concerned about this being due to cancer rather than due to pneumonia.
    He felt great after I took out fluid . (It is amazing to see how one can have that much fluid and have no major shortness of the breath). In between he was seen by the urologist and had some surgery to help the bladder issues and they told him that he will have to have urinary catheter left in for few weeks. So he was not very happy. I got the fluid report and there were NO CANCER cells. So he and his wife were happy and I was happy but surprised .So I called a chest surgeon to do additional biopsy from inside . He wanted to go home .So he wanted to wait  But there were other issues going on . So I did another chest X-ray. I knew what I was going to get . The fluid had recurred in less than 3 days! So now he agreed to do the additional biopsy that the surgeon had suggested .
     The biopsy is done by inserting a small scope through a small incision in the chest. It is called THORACOSCOPY. The biopsy showed the cancer , IT WAS A LUNG CANCER . He and his wife were not happy , neither was I . But I was happy that I had ordered the biopsy.
     He stayed in the hospital for another few days to get a port put in and then to start chemotherapy as out patient . We left a chest catheter in to drain the fluid periodically at home .
     I felt quite bad as he and his wife were quite depressed . He came with urinary problem and left with the diagnosis of inoperable lung cancer and 2 CATHETERS, which he was quite unhappy about! He asked me HOW CAN THIS HAPPEN?

Sunday, July 24, 2016


     So in last blog I told the literary meaning . And I also stated the story of BHISHMA. So haw can the time of death is more important than what we do in our entire life ?  The answer is in the real meaning of the word , night and day , and the fire or smoke and Uttarayan or Dakshinatan or Shukla paksh or Krushna Paksha .
     If we think about the  'war' as the war of disciple with oneself , then it becomes clearer . So when the Lord Krishna is  talking about the  fire , he is talking about the knowledge or the Kundalini power. The smoke covers the truth. When he states smoke , it means the mind is not clear and one has ignorance .So if one has never engaged in meditation or trying to arouse Kundalini Shakti , and lived in ignorance of thinking of the physical body as the reality and engaged in sense pleasure indulgence , he is not going to reach eternity. He will be reborn due to desires and the attachments to the physical body as none of the physical desires can be fulfilled without the physical body.
    The 'Light' and the ''Darkness' are also very easy to understand . The Light is the spiritual eye . When one is successful in the meditation , he will have the  experience of one with the God , and this when sustained with repeated practice , will lead to detachment from the physical body . When there is no attachment to the physical body or the sense indulgence , then there is no rebirth.
     The Daytime and night are similar. When the Day starts , we are' awake' and wake up from' Sleep'. So during  the sleep when we do not have any Knowledge of our surrounding, is compared to us sleeping in ignorance. This term is quite often used when we are told to 'Wake Up' by many politicians or religious leaders .
     The next one is waxing and waning of the Moon . The Lunar light is not it's own light . In the real world the Moon's light is the reflected light of the SUN. So if the Sun is the spiritual Eye and it sheds it's light on the Moon which is material world. (The moon is related to material worls where the energy comes from the Sun . So when the enlightenment 'increases' and our mind turns away from the material world , we will have MOKSHA, but when this light is reducing or getting dimmer , we will have the rebirth as then we are turning away from the Realization.
      Now the last one . When we watch the Sun rise in the East, we will notice that the sun moves Northward for 6 months and then southward for 6 months. In our body the upper part of body is north and the lower part is south. (Remember in case of DRONA in Mahabharata , when he defeated Drupada ,he gave him back the southern part of the kingdom. So it is little easier to have control over lower centers than upper centers)The six months are six centers and when one tries to meditate and get control over lower centers , procreation , excretion and hunger, he is moving NORTHWARD . So the SUN or the knowledge is moving northward . When we are paying attention to lower centers more and more , we are moving southwards. So if we continue to be more involved in these lower level activities, we have no chance of MOKSH.and 100% rebirth is guarantied ..


    I am not sure why all the scriptures are written in a mystic way , such that they become 'open' to interpretations or 'misinterpretation'. This is true of Hindu as well as Christen Bible. I have some explanations of the some of the verses of the Bible that are according to the Hindu belief. In revelation(4) it is stated that "I looked up and saw 24 elders sitting on a thrones" I think these are 24 principles that go in forming ASTRAL body. But if one reads the entire passage it is very likely that different people will come with different explanations, all of them could be valid. The translation of the 'words' is not the intended meaning.
         So today I thought of writing on GEETA ,chapter 8 ,verses 23 to 26. I have seen different explanations including on by  Swami  Chinmayanand. But the best one and what I like by Yoganand.
The word by word meaning is when the Lord Krishna is telling Arjuna the path which is taken at the time of death by different people. So He says that ,
"I will tell you the path taken by yogis that leads to 'freedom' and path that which leads to 'rebirth'.23

"Fire, Light, Daytime and Shukl Paksh ( bright half of Lunar month), Uttarayan (six months of Northward movement of the Sun),--following this path (at the time of death) men (or women) who 'know' God or Brahman will go to God or Brahman." 24

"Smoke , night time , Krushna Paksh, (dark half of Lunar month), and Dakshinayan (six months of Southward movement of the Sun)--following this path he will obtain Lunar light and will return to Earth."25

"These 2 paths -one of light and one of darkness are thought to be eternal. The path of Light leads to release,while the path of Darkness he returns".
      So if one takes the literally meaning of these verses , will have to conclude that the 'time of death ' is very important. So if one dies at 'wrong time ' then he will have rebirth . But if one dies at 'right time ' then he will get the MOHSHA . If you recollect the story of Bhishma in Mahabharata , he war injured and could have died except for his own control on the time of death. He was blessed with a boon from his father Shantanu that he and he only will decide the time of his own death. So when he is badly injured the 'time ' was not right ,it was DAKSHINAYAN -The Sun was moving southward . So he would not achieve the Moksha . So Bhishma decides to hold on to the physical body till the Sun starts moving Northward again. So it does not matter what one has done in entire life if one dies at 'wrong' time ! This does not make sense . So the real meaning is different . let me try to explain as I understand it .

Saturday, July 16, 2016


    Some one had defined 'specialist'(in medicine) as "someone who knows more and more about less and less!" I feel it is so true . A cardiologist does not know about Pulmonary or at least does not want to be bothered about it and a  kidney doctor does not look at anything else but kidneys. But the medicine is growing so fast that one can not keep up to date on every new development in every subject. But my story today is about something else . Sometimes in practise of medicine we have all sorts of experts and they also come out empty handed. The line that I had liked in past was ,'Medical knowledge is vast and incomplete.'
     So this is the story of one of my patients. I had known her for few years . She was mid fifties and was a smoker . She had shortness of breath and also CO PD. so she was tested and was put on oxygen and medicines and was told to quit smoking . She had some kidney issues and so had an ultrasound   of the abdomen done and it showed some fluid in the lungs. So she called me . I did a chest X-ray and it did show large amount of fluid around the right lung. She was little more short of breath and so I decided to admit her. She then had a CT scan of the chest and the fluid was confirmed . There was no other abnormality to explain the cause of the fluid . So I drained the fluid . I drained 1200 ml of the fluid and sent it for various tests to find out the cause of the fluid collection. There was no infection , TB or bacterial . But the fluid did show CANCER cells. So I consulted an oncologist -expert in cancers. He ordered some tests , but we did not know the origin of the cancer -where did it start. Now a days we do many tumor  markers. The cancer cells look different that their parent organ cells. But they still retain certain characteristics of the original cells.Easy to understand would be breast cells . They will have 'markers' for female hormone, estrogen . I also give example of interracial marriages , where the children would show some characters of both the parents. So one can do many markers now a days  There are so many of them that I can not keep up with them and I have to depend upon other experts and their knowledge . So after testing many of them we still came out empty handed . I had ordered a PET scan . This scan is done by injecting glucose which is tagged with radioactive material. The glucose is picked by every cell in the body . Since the cancer cells are metabolically more active than the normal cells , they pick up more glucose and the this pick up is measured and one can diagnose or stste high probability of cancer . No test is 100%. So the PET is may bbe 88%. The PET scan showed abnormality only in pleura , where we knew that there was cancer. The major differential was between lung cancer and the mesothelioma. All of us know that if one has lung cancer there is no monitory gain , the treatment is different and the prognosis id different. On the other hand if it was mesothelioma , which occurs with asbestos exposure , there is monitory gain and the treatment and the prognosis is different. So I consulted a chest surgeon . I asked him to do 'open biopsy'. So an open biopsy was done and then bigger sample was given to the pathologist and the final diagnosis was ------still same .It is cancer , burt unable to state where it started and not sure if it is mesothelioma. The sample was reviewed by 5 local pathologists and now is sent out for 'expert' opinion. So in spite of all the experts we still DON'T KNOW' . This is what I call inadequacy of medicine .  

Saturday, July 2, 2016


  I have been always intrigued by the Geeta's1st chapter. In many of the series of first shlokas it appears that there is not much about the religion . In short they appear 'wasted' if one considers the Geeta to be a religious discourse on the battlefield. On the other hand many believe that these shlokas are introduction to the REAL battle field story and so they are part of MAHABHARATA and so the appear to be appropriate in the beginning of the Geeta. I wrote about the first 8 shlokas in past and in this blog I want to write about the 9th one . Please understand that this is not MY KNOWLEDGE and I am simply stating what I gathered by READING.
     In shloka 9 it states that "and many other warriors are present, they are well trained and have weapons and are here for my sake and will lay down their lives. " When I look at this one , in continuity of other shlokas it does fit in to the introduction of the war . May be it sounds like the speech that many Hosts give at the time of wedding stating important names first and to avoid omitting others ,state that and' many others who have come to attend this function taking out time from their busy schedule .'
    So who are these 'many other warriors?'Yoganand feels that these are the 6 enemies of the human beings that are mentioned here . These are KAMA, KRODHA, LOBHA, MOHA , MADA AND MATSARA.--LUST, ANGER,GREED, DELUSION,PRIDE AND ENVY OR MATERIAL ATTACHMENT. So are these 6 enemies represented by the 6 warriors in the Kaurav army?
   Kama-Lust-Usually we think of Kama as Lust or sexual desire , but in broader sense lust is intense desire for many materialistic things and so the DURYODHAN is the best example . But if we think about the story of Mahabharata and the incidence of Pandawas loosing in gambling there were many who came forward to undress Draupadi . So these are the one that  represent KAMA.
   Krodha or Anger -We all know that when we are angry , we can not think properly and make proper decision. We are told by elders to calm down and make decision. So in the Mahabharata , Duryodhana's brother Dushshasana is the example of anger . In Sanskrit meaning of the word Dushasana is 'one which is difficult to control.'
    Lobha or Greed- The greed could be for food or sex or money . But how do we develop the greed . We 'act' and then 'experience' pleasure and then we develop the likes and dislikes . If I eat something and I enjoy it I am attached to it and I develop GREED FOR IT.So even if I am not hungry I will indulge in eating . This attachment to the things that we like and repulsion to the things we dislike are represented by Karna and Vikarna .
    Moha or Delusion-Sometimes we use word Moha as attraction. And indirectly it is attraction . But the attraction is due to Delusion or not knowing the truth . The ego has the bodily attachment and has delusion. The soul does not have the delusion . This ignorance is the cause of Moha.So if we knew the truth , we may not have the attraction. If we fall in love with someone as they are good looking but then when we know their nature or views or behavior the attraction is gone .The same thing could be said about the food , which is tasting good but not good for the good health. In Mahabharata this Moha or delusion is represented by SHAKUNI . He was the one that had asked the Pandawas to play with the dice that were tainted . This is when the Pandawas lost everything in gambling. The delusion was that they could win .
    Mada or Pride- We are proud of our name , family  or education or job or family members . But when this goes beyond certain level it is intoxicating or unwise or bad . In Mahabharata Shalya is representing this quality. In reality Shalya was maternal uncle of last 2 Pandawas namely Nakul and Sahadev. He was brother of Madri. So he should have been on the side of Pandawas ,but due to the Pride ,he decided to fight from side of Kaurawas.
    Matsara or envy-This one is easy to understand as we all have it and display it all the time . We are envious of someone who makes more money or has better and bigger house or whose kids are smarter than ours. In the Mahabharata this is represented by Kritvarma. Lord Krishna belonged to the clan of Yadawas . Kritvarma was a Yadawa, but he became envious when the lady that he wanted to marry  , got married to Lord Krishna. So he was envious of Krishna and so decided to join Kaurawas to fight against the Krishna supported Pandawas .
    I know that this is not perfect explanation . But I thought this is as close as I can understand and accept.