Friday, November 24, 2017


     IN our life we face the situations ,in which e know what to do , but can not Do it. I am sure no one is an exception to this rule..We know we should not indulge in too much food , but we do .Yesterday was Thanks Giving -so all can see what I mean by this. We know we should exercise , but we don't and there are many other situations where we know what is good and what is right and we still are unable to do it.But in medical practice we see this all the time too. I know and the patient knows that smoking is bad , but still continues to do it ,and the obesity-everyone knows that one must loose the weight , and it never happens. If one considers obesity is a disease, then the 'cure rate' is zero. Even for those who do loose weight, the 5 yer survival or the disease free interval-terms that we in medicine use for cancer- is also zero. In both these conditions,the addictive nature of smoking or eating is very strong and the fault does not always lies with patient. The surroundings -stress,habits of spouse and the environment do play role.But sometimes we can put blame on patient and patient only. I am telling a story of such a patient.
            I saw this patient -72 years old , who had sickle cell anemia. She had episodes of crisis many times . In sickle cell anemia the red cells , which carry oxygen and have hemoglobin in them , are not shaped normally. They look like sickle. And when such a cell tries to go through very tiny blood vessel , it gets stuck and then is destroyed and that causes the attacks of pain . The pain could be anywhere in the body and sometimes patients can get addicted to pain medicines. They do have low hemoglobin.. In some of these patients when these episodes happen frequently,-may be in blood vessels of the lungs , the pressure in lung circuit-pulmonary pressure increases.This is called pulmonary hypertension. This is similar to one that can happen in patients who get frequents clots in lung.So this needs treatment .So when I saw this lady , she had same problems that she was admitted for in past several times . She had several echo cardiograms done in past 2 or 3 years before I started seeing her . She had the usual problems , high blood pressure and the anemia and the pain and mild problem with kidney function. I did order new echo cardiogram as in past she had elevated pressures. The normal pressure is less than 30 . 2 years ago the pressure was high 30es and the increased to 48 and then mid fifties. So there was trend of worsening pressure in lung blood vessels. The new echo cardiogram showed the pressure to 67. Clearly she needed treatment. So I asked cardiologist to do the right heart catheterizing and check pressures directly. This required as the echo cardiogram is good but not 100% accurate and the drugs that are used to treat are very expensive --$40000 per year. So the catheterizing was done and it did confirm the elevated pressure. So I started her on medicines . One of the medicines is Viagra .(it is interesting how the drug companies change the name and the price , So the same VIAGRA when used for pulmonary hypertension id called REVATIO, and the cost is much higher too.).

      We need to do some tests to assess that progress of the disease as we can not do heart catheterizing frequently . So we do check the distance that one can walk in 6 mins,which is very simple and can give us the idea about the improvement . We also need to do other tests . I have seen this patient many times in hospital where she comes in for pain or sickle cell crisis . But SHE HAS NEVER COME TO MY OFFICE TO DO SOME OF THE TESTS  that are needed.. Her pressure continues to be elevated and she continues to be on 2 different drugs . But without certain tests and close monitoring of the blood tests and other things , I can not add more medicines . Every time I talk to her ,she promises me that she will come to office and we have scheduled her for the tests and she never shows up.She does have many more medical problems now than when I started seeing her . Sh has also seen other lung specialist in between. But not in their office . .   

Saturday, November 18, 2017


           We had several mass killings in recent past and I was thinking about it . At the same time , I was reading Hindu script , which was written several hundred years before Christ.The one that I was writing about stated that 'IF ONE CAN CONCENTRATE UPON THE IMPRESSIONS THAT ARE CREATED BY THE KARMAS (FROM ALL THE LIVES)THEN HE/SHE CAN KNOW THE TIME OF DEATH." So this blog is about the Karma and it's effects . I have written about it in past.In Bible also it states that 'Reap as you Sow' The difference though is that in Hinduism, the seeds of Karma continue with multiple births and deaths , and the impressions of Karma or effects can occur in any life. This is different than the Christian belief  in which the effects ENDS with present life . So on the day of judgment , decision is made based on ONE life and if you have done more good than bad , then you go  to heaven and if have done more bad than good , you go hail . So every body is judged on the same day.So I am not sure as what happens in between . In Hindu concept the process is recurring and the NEXT life is based on all PREVIOUS lives. So when we continue to do Karma , we continue to accumulate the effects and this POT, full of all the Karmas that we have done in past lives , is called SANCHIT Karma . When we are born , we come with certain seeds or Karma that are going to come to fruition in Present life.This is called PRARBDHA  KARMA. We do more Karma in the present life and some of them will come to fruition in Present life and some will be stored as SANCHIT Karma to come to fruition in next lives.The current life Karma is called KRIAMAN Karma .
       In this law of Karma ,the EFFECTS or the Fruits of Karma occur AFTER the Karma is done . But in CHRISTIANITY when it is said that the Jesus died for our SINS , the Fruits happened before we did any sins or Karma.
       So for the Hindu concept of the Karma , the Karma has to precede the effects or the fruits of Karma , the effects of Karma ,can not be transferred to someone else ,(I can not suffer for the sins of my parents or my kids), there is no GROUP Karma . So when a group of people miss behave, EACH one has to get the fruits of his or her Karma and there is no group suffering due to group action. So in mass shooting each one of the victims had some unknown Karma from previous lives,that brought them to SAME DESTINY. The effects of the Karma is Recurring, and there is no final Judgment day.
       This concept is closely tied to the concept of reincarnation. One more difference is that just the Grace the God is not enough for getting rid of the Karma. Every one has to go through the effects of their Karma , the Surrendering unconditionally to GOD will help ,but not eliminate the effects . If one looks at the lives of many Indian saints , they all had very hard live,e.g.DNYANESHWAR,TUKARAM,MIRABAI . This has to do with completely neutralizing the effects of Karma from last ALL the lives , so there is freedom from rebirth. The only way to stop the KRIYAMAN karma -one that occurs with our every day life is to not be ATTACHED to the fruits -DO THE ACTION ,WITHOUT EXPECTING THE FRUITS OF THE ACTION.