Sunday, March 31, 2019


   Recently i came across some cases in my friends  and colleagues where I can not explain how  and why . Let me tell you on these patients . We recently lost a physician who was very young and had never smoked . He ad lung cancer and that did spread to brain and he died  in spite of all the treatments that he could get at various centers. Then there is elderly friend our our family who also never smoked and had lung cancer diagnosed. She is lucky and it was detected early and so she had surgery and it is in early stages  and there is good chance (Why good chance  and not 100 % chance ?) that she will be cured . And there was another case of a  cancer in a another physician who was completely unselfish , devoted her life to God  and community and again never smoked or had alcohol . She also dies of cancer. We all see this  and experience this in our life  and fail to understand why this happens.Some people ask me as to why some one gets cancer . And certainly there are definite causes and risk factors like smoking and also chemicals  and pesticides. In absence of obvious causes how do you explain the cancer and suffering that it brings in . And then why a stage 1 cancer is cured in some  and not in others . We have technology that can tell us -sometimes- as to who may recur  and who may not , buy not always So what is the answer to all these questions ?
      But I may have some possible explanation based on my faith and Law of Karma  and reincarnation. I am sure this will not be acceptable to all  and also those who may accept the Reincarnation also may have difficulty to explain why would someone get CANCER and suffering .
The Law of Karma states that EVERY Karma has a fruit  and one will ave to accept it sometimes -in this life or next or next. We are reborn for several reasons .
 1 We must pay the debt that we have accumulated with other individuals .
2 We have to have to accept the fruits of our actions
3 We must fulfill our unfulfilled desires  and we not do that without PHYSICAL BODY .
4 We need PHYSICAL body if we want to UPLIFT  our self . (when we help someone which is Good Karma - most or all of then are related to helping physical body , e.g. food shelter, sickness,or any comfort .
    So we must have physical body and to have NEW physical body after death of old physical body there has to be Rebirth. But then the question arises as to who wants to suffer  and who will have Desire to suffer ?
    To answer this one must understand that the Karma is done every second with MIND and BODY . When the two come together then the Karma is complete . The intention behind the MENTAL or Physical Karma will determine the Effect or the fruit . If I have transient bad thought about some one  and O do not ACT on then it may not or will not have ant fruit . But if I continue to have a thought ALL the time -say lust or some other it will create enough impression that I will have to fulfill it in pr there will be fruit to the thought. If I have a physical action which happened but there was no Thought behind it -I kick some one by accident and I had no intention of the kicking - I will not have much fruit , but if I have intention of kicking someone and I act on it , then I will have Fruit to it .
    One more thing to remember is that our PRESENT life is sum of effects of many Karmas  and not one Karma . So there are many forces and effects that determine the final effects  and so the FINAL EFFECT  may not be such that we can RECOGNIZE THE ORIGINAL KARMA - as it is sum of many karmas .
     This may explain the things that happen to us that we can not explain easily based on our ACTIONS in this life or even if we believe in Reincarnation , can not TRACE to one isolated Karma , that could have caused it .

Saturday, March 9, 2019


    In  past I have always stated that there is a limitation in medicine. I was taught to do physical examination before ordering tests . But even before one could put his hand on patient to examine , we were suppose to take history.Now a days then things have changed  and most of the physicians that I see and meet  do reverse way . They sit at the computer and see the X- ray and the labs  and the 'other notes' and then go to see the patients. Some times there is not much of history or even physical examination . They depend upon  nurse practitioners or ER physicians who in tern depend upon their nurse practitioners .I am still old timer and do my OWN history and physical Examination. But I have realized that the history and physical examinations also has limitations  ans sometimes we get diagnosis with TESTS rather than history or examination .This brings me to today's patient

    I was asked to see this new patient in the hospital . She was 72 years old patient who was having dry cough and so she saw her PCP . he gave her some medicines  and then did chest X- ray and then told her that she has allergies  and she should take some over the counter medicines for allergies . She continued to feel poorly and did see PCP and there was no change in treatment . Then she saw cardiologist as she was  also having some swelling of the feet and shortness of the breath. He gave her some medicines  and was going to do some more tests . But then when she was checking out at front desk , she was noticed to have significant shortness of breath . So she was admitted and I was called in . She had some lung scan done to rule out clots  and that was OK. But she has some fluid around the right lung. So the CT scan was ordered.
   When I saw her she was having dry cough . This was going on for last 2 months . She was getting short of breath for 3-4 weeks . She had worsening edema in legs . She had never smoked  and she had lost some weight , When I asked her about that she told me that she feels 'full'  and so could not eat more . On examination she had reduced air entry on lower part of right lung and she had edema . When I examined her belly , it was obese  and I felt it was 'tight' or firm . I could not feel much  and I did note that in my note . The CT scan showed 2 spots on lungs one on each side  and fair amount of fluid on right side. I told her the possibility of cancer and decided to do the procedure where upon I take out fluid . I took out more than 1000ml of fluid  and I ordered PET scan . The PET SCAN picks up cancer in body . It is about 88 to may be 90 % . The PET scan is done where glucose is injected  and the glucose pick up by cells is recorder . The cancers have higher metabolic rate  and so the cancer cells pick up glucose at much higher rate than the background . Since it is metabolic or biological scan we do not see the structure or the anatomy . So it is accompanied by CT scan . The lung Marses were positive suggestive of cancer. But to my surprise there was big tumour in pelvis  and it was 14 cm  and it was positive . She also had some fluid in belly. She had told me that she had hysterectomy and her ovaries were taken out partially . So it was a shock to me that she had cancer in pelvis . The fluid came back positive for ovarian cancer,

      So in spite of taking adequate history and examination, I did not anticipate the diagnosis . So sometimes one needs to get diagnosis which was not suspected .