Sunday, August 27, 2017


   In physics there is uncertainty principle. But I think it applies to medicine more . We expect certain things and at the end of work we get something else . I recently saw some patients and in each of them I was surprised after I did the work up. We always know that when we start working up a patient with certain complaints or problem, we have some idea as to what may be the final diagnosis or the outcome . If we did not have the idea as to what is the likely diagnosis , then we would not have the direction in which to do the work up.This is called the differential diagnosis. In other science it is called hypothesis. But sometimes the out come is so different that even the physician who ordered the tests is surprised.

      This brings me to my first patient . I saw this 70 some years old male patient who moved in from other state. He was told to have pulmonary fibrosis or scars in the lungs . He had some chronic cough and so he was seen by a family doctor and then when the cough persisted , he was sent to a lung specialist. He did the CT scan and then he was told that he had pulmonary fibrosis . He was followed for may be 3 years and then he moved here . He had new family doctor and so with the diagnosis of the fibrosis , he was sent to me . He was fairly stable . He had some cough , but it was not worse and he had some shortness of the breath,but that was stable too. His lungs had some crackles ,which are typical of fibrosis . So they sound like the sound that one would hear when one rubs the hair in 2 fingers . When I asked him on the last CT scan , he was not sure , but certainly it was not done in at least1 year .  Same was about the lung functions. To assess the extent of the fibrosis and it's effect on the lung functions ,I ordered the CT scan and the breathing test.
      The CT scan report came and I was surprised . IT showed the fibrosis , but it also showed a mass in one of the segments of the lung . IT was about the size of a Quarter coin . I called him up and told him about the possibility of the cancer and ordered the PET scan . When the PET SCAN report came I was more surprised . The PET scan showed the lung mass to pick up glucose , suggesting that it most likely was cancer , but it also showed a mass and the pick up in colon. So now we had a question , Is it colon cancer which has spread to lung , or Does he have two separate cancers,one in lung and one in colon . My problem was that he had such a bad lungs due to scar tissues , that doing a needle biopsy would certainly cause collapse of the lung . And in patients with scars , it might not be well tolerated or if tolerated , it might take long time to heal the lung .
      So he is having colonoscopy and bronchoscopy . Then I will decide , based on breathing test as to the treatment options. Should we do resection of colon cancer and the lung cancer , if he has two cancers . Should we do resection of colon cancer and treat the lung cancer with radiation , or should we treat both conservatively  i.e. lung with radiation and colon with laser or something like that where the risk of surgery is avoided .

    The jury is still out .
     But to make my point , when I saw the patient , I did not anticipate all these problems that I was  or he was going to face . I thought I was doing routine work up for patient who had established diagnosis of pulmonary fibrosis. 

Sunday, August 20, 2017


    I often come across stories about my patients and their families . I t is impossible to know the details of the family relations and the dynamics in short visit which is for medical follow up and not for psychiatric evaluations . But I am amazes at the different 'fate' that all of us have . With my interests in mystic 'sciences' like horoscope , I wonder about the Destiny and law of Karma . Why do people who do adopt children with good intentions have bad out come or fate where the adopted children do not behave with love and responsibility.

    In Hindu beliefs we have some explanation , but when I look at other religions , I do not know any explanations offered. In fact sometimes many questions remain unanswered. The Christianity believes that the Christ dies for our SINS . But how can HE die for the sins that I a doing now? So the answer could be that the GOD knows what sins I am going to do . But if that is true , then it means that I can not decide my own destiny and the the destiny is predetermined or fixed . If that is the case , then it means that I do not have any FREE WILL and then I can not be held responsible got he actions or the sins that I commit. This does not go well with the concept of the GOD .
    In contrast to that when we talk about the Law of the Karma, we talk about WE determining our DESTINY and the  destiny is in future and the Karma - good or bad -precede the destiny. So it does not involve the GOD .So we have free will. Some people will differentiate between the destiny and the future.So what is happening in immediate future is Destiny and what will happen in future is future. But sometimes we can not explain the bad out come of apparently good deed . How do you explain that ?The answer lies in the concept of Hindu religion . We believe that the Time is endless , it does not have the beginning nor end . The Universe comes in existence and it goes down to Unity -something that the science believes how the universe came to today's state .  The only difference is that theses cycles are endless . In fact they have calculated the time of each cycle. and surprisingly, it comes quite close to the calculations done by the scientist . So in these multiple cycles , we have multiple births and we are reincarnated. So the physical body dies , but the 2 other bodies , namely Astral and the Causal bodies continue along with the mind and the intellect and the ego and all the impressions and the desires and the attachments from ALL THE PREVIOUS LIVES. These attachments and the desires make US SELECT our parents or the environment that is conducive for satisfying them and paying back the debt of the bad karma or the SINS . So again God does not DO anything to punish us or die for our SINS but the Laws that have been created determine our destiny or future . We have free will and we can use it to change our future.
      So the effects of our Karma are going to be seen in our future and when we have them , we create new Karma and attachments and desires and that decides the future life and future lives . No one can suffer for us nor no one can take credit for our good actions . We get what we deserve , even though at times the things appear to be unfair. There is a tug of war between the effects of our previous deeds or Karma and our present efforts which comes out of our free will. The effect of the two is proportional to the strength of each force . If our free will is stronger than the effects of the karma our life will go in the different direction , than if the free will is weak . The we will see the full effects of our Karma .