Friday, August 16, 2019


      We are always told to look at the Fine Print . The Dish Network  tell us to look at the Fine Print when we sign contract with cable company and now that the cable companies are in cell phone business, they are telling us to read the Fine Print. So we are always ask to see and read the Fine Print.But one may say what is there in medicine that we need to read Fine Print. When we see patients , many of have tendency to see what is important to our field or specialty. And many  and most physicians have PA or nurse practitioners and they do the notes and the consultants tend to get biased and don't do much on their own . Even the hospital doctors - the hospitalist have the same problem . They do not have their own patients  and the ER doctors or ER pa or nurse practitioners tell them the story and then they admit or their PA or nurse practitioners admit the patients I am not complaining  but just stating the facts . I  still do the same old way. See my own patients  and also read the Fine Print  and sometimes it takes more time but it is more satisfying  and rewarding.This brings me to the today's story.
           I was asked to see a patient who came to hospital for shortness of breath and some chest pain. He was a 51 years old male  and was quite heavy. He was never a smoker  and drank socially only.He had shortness of breath and he felt that started 4 weeks ago only . The ER physician did the work up .He had high blood pressure and he also had other work up done. He was admitted to ICU and hospital doctor saw the patient and then the cardiologist saw the patient . The patients that are admitted are seen by ICU doctors who in many case are lung specialist . So he also saw him . There was no reason to call another lung specialist.But his cousin was a physician and patient called him and he asked them to call me . Si I saw him . He had had clear lungs  and his lungs sounded clear  and his CT scan was OK . He had further cardiac work up and all the work up was negative .
     When I saw him I thought that he may have asthma  and so I started him on inhaler. But when I saw him and looked at the blood tests,I noticed couple of abnormalities. He had elevated proteins  and had one particular type of cells elevated. So I did mention it to them and then and did some additional blood tests .
    I saw him for 3 days more  and then when he was cleared for discharged by cardiologist , he was to be discharged. I had mentioned the need for work up in my notes  and also told the patient  and his wife. No further work up or  any mention of the abnormality or need for work up was done by hospital physician or cardiologist or ICU physician .Finally I ordered hematologist to see patient .
     He was discharged  and saw the hematologist as out patient and he has diagnosis of CLL chronic lymphocytic leukemia.So I read the Fine Print and that helped the diagnosis.

Wednesday, August 7, 2019


    I have mixed blog and I do write sometimes about the religion  and the practice of it . I do try to make a sense out of certain behavior or the practices which are done mainly in Hindu religion . But I also have certain opinions about the other religions too. This is my opinion and it has limited value. Just to give  an example , in Revelation, It states that i heard a sound  and i turned  and saw 7 golden candles . I interpret it as meditation and the 'sounds' that one perceives when in Samadhi status , and their relations to the 'chakra' that we have . Certainly one could have a different opinion. There are many other examples I can give . But that is not my purpose of this blog .I had an Email from someone about the old Blog that was related to Indian religious -POOJA , called Satyanarayan Pooja. So I thought that I will y try to explain not the Pooja but the thought process .
      The supreme being is nothing but SPIRIT or energy. It has no qualities  as it has no GUNAS. Unless one has GUNAS or qualities , one can not have Desires . I want to eat Pizza because I have desire . But the Supreme being has none . So HE can not have desire to create the universe.But then there is matter . The matter has Gunas  and  so has desire .But no SPIRIT or the energy and without the energy it can not start the process of creating universe.  So the process starts ONLY WHEN THE SPIRIT AND THE MATTER (PRAKRUTI ) come together , This is important to understand . The supreme GOD is not a GOD FATHER , So one can not kiss his hand  and get favors. But the creation when started has lower level gods  and they are more like positions that are controllers of the 3 inverses. So when we humanize the god - we praise the God , we offer him food we do in HINDUISM SHODASH POOJA - 16 elements of worship , , we are now making the God a human being. So if the God can be pleased, he can also get MAD or Punish for not doing right things . The interesting part about this is that we tend to apply our worlds principles  and then are not willing to accept the results .
      We our self do worship ,but sometimes we do it through priest or we also do it with CD rather than priest . We also pray for others when they are not praying for them self . how can that be effective?.
If one kills someone or kills someone through contractor is he not guilty in both cases ? Direct or Indirect , we are responsible for the action . we apply same rules to the worship .
   In ideal situation , our own KARMA  are responsible for the situations that we are facing and the degree of efforts that we put to change it will make or break it . We have to accept it . But at the same time god can intervene, but not the SPPREME GOD .  .  

Sunday, August 4, 2019


    Now a days we have significant talk about the drug use  and drug addiction. The problem is old  and there are are different shades  and what we used to see in New York in seventies  and eighties is not seen that often. WE ALL ARE RESPONSIBLE FOR THIS . We may not like this statement, but in my mind it is accurate. In hospitals there were surveys from patients about the satisfaction. So to get have higher'scores', the hospital pushed doctors -not directly but indirectly -to give -offer- pain medicines. When I had hernia surgery,after the surgery I took only Tylenol  and Advil. I had prescription for narcotics and i never filled it. I stooped the pain medicines in 3 days. But in the hospitals we offered much stronger medicines  and narcotics  and patients did take them  and some came in to get the medicines only . Taking them for short time is OK But over period of time patients got addicted . Some were addicted  and demanded pain medicines  and some came to hospital and would not give good reports unless got the pain medicines . This part is now corrected . But now we have pot being made 'legal'.So more people are doing it and that is step one. The pendulum has swung on the other side . The government has new regulations  and now I see some doctors doing pain management practice  as it is lucrative. But the problem is not solved . Some of these people that get medicines from these doctors sell it  add then the addicts buy them. This brings me to today/s story .
       I saw this young lady for diagnosis of pneumonia .I went to see her . She was a young lady and
did tell me that she did use drugs.She was a smoker and did not drink alcohol.But she was on pain medicines obtained on streets. But she was not taking them as pills even though they were suppose to be taken orally. She had some cough and fever and she had some right sided chest pain . She came to ER  and she had chest X- ray done  and that showed pneumonia. So she was admitted. When I saw her she was comfortable  and she she seems to be honest about the drug addiction. She was admitted few months ago with sepsis and MRSA infection. She denied using cocaine and did not drink alcohol,She did smoke sometimes , When I asked her on her drug addiction she stated that she used Dilaudil pills.SHE DID NOT HAVE THEM AS PRESCRIPTION but she bought them on streets. She would dissolve them in water and then inject them intravenously to get effect quickly.
      This form of abuse is very dangerous. The pills taken by mouth or drugs used by intravenously or smoking pot or use of cocaine are all risky behaviors. But the injecting pills is especially dangerous . The pills are meant to be taken orally  and so the pill contains talc or other substance that is particulate- has small particles of talc or chalk. This is not completely dissolved in water and when injected gets caught in lung blood vessels - causing pulmonary embolism -smilier to blood clots getting trapped in lungs . This in significant quantity can cause death . 

     I explained this to her  and she seemed to understand. She looked like honest drug addict  and looked like she will try to kick the habit . When I looked at the chart the drug testing was positive for number of other things that she had told me she did not use!