Thursday 29 December 2016

WHAT DO I GIVE YOU THIS NEW YEAR?





At this time of the year, I wish I was Santa Clause. The obese guy with a red cap and white beards, riding a reindeer driven vehicle despite the vociferously malignant animal rights enthusiasts, knows exactly what each person on this planet wishes and has for centuries never given a gift which has gone unappreciated. So, inspired by him, I am granting you a gift which I feel is most appropriate for you! In fact I am challenging Mr. Clause today and giving all my friends the same gift and yet expecting it to be genuinely cherished and appreciated.


I am not offering something you can touch, but something you can be touched by. I am sending you a reminder of one very special thing, one that may be the secret of living. I'd like to share this thought with you, because you're a beautiful combination of things that make you YOU - the one I treasure.


I ask you to think of all the people who live or have ever lived on our planet since the very beginning of time. None of them are like you. Do you realize what a miraculous thing it is to be you! Nobody has the same combination of talents, abilities, sorrows and opportunities. No one has the same friends, the same acquaintances. Nobody's finger prints are the same like you and no one has eyes like you. No one has the same sorrows and the same family jokes or No one has the same ambitions and the same concerns or the same goals as you. No one! You are unique. 


Nobody can speak your words. Nobody can smile your smile. No one can leave the same impact on another person as you do. Enjoy how unique you truly are, let it flow out and touch your family and friends, and all the people you meet.  


Accept and enjoy this uniqueness. You don't have to pretend to be more like others expect you to be. Be yourself unhesitatingly, be different. No one in the world has the same things going on in their mind, soul, or spirit as you have going on in yours.  It is a gift only to you. Treasure and share your uniqueness with us all. You have a unique gift for the rest of us. Don’t deprive us of our gift this festive season!


I wish you the strength to be inspired by the fact that you are UNIQUE. And don't you ever try to change that. Because you're perfect that way! You are a perfect you, and people will value you because you are YOU.


I am one of those countless people who are inspired by your uniqueness. Don’t change; I still have to take the best out of you, my friend!



Happy New Year!!

Friday 16 December 2016

FRIENDS – I LIKE THEM RICH AND INFLUENTIAL!





Who are the people whom you call friends? Do you have many? Do you have some? Do you have any? Do you use this term ‘friend’ very loosely in an all encompassing manner? Or are you very choosy when it comes to conferring this title? There are many with whom I interact day in and day out - they are my colleagues from work, my batch-mates from King George’s Medical College, my school-mates from Colvin, my neighbors, my acquaintances, my patients and their relatives but just because I know them by their first name they do not qualify for the coveted title of ‘friend’. Over the years I have put a very high price tag on this title!

So naturally, the next questions who can qualify to be my friend? I am of the opinion that when I take an interest in someone, I do to a certain extent like them to reflect the qualities, morals and values that I have in life, but that doesn't mean if one is lacking them, they have no chance of qualifying. That is because though I like myself, I do not like my prototypes. One me is enough, the second one will surely be intolerable! So what are the qualities I look for in a friend? There are only two in fact – rich and influential…….but with a twist

To qualify as my friend I look for richness in honesty, reliability and trustworthiness. The next three qualities which attract me are individuality, positivity and openness. And the last three are empathy, humor and passion. With these ‘navaratnas’ (nine jewels in Sanskrit and Hindi) I expect the person to have an everlasting influence and an indelible impression on me and constantly improve me as a human being. If I don’t strike a bargain, I can call the person every other name but not a 'friend'.

Friendship is a win-win relationship in which both friends end up winning and there are no losers. Honesty and trust go hand in hand. If someone can’t look into my eyes and be straight with me I suddenly switch off. I much prefer the truth, even if it is a little blunt at times - I have no time for lies. There is no litmus test for trust but generally I trust my instinct, I usually know who I can and cannot trust. My attitude is; trust them until they prove me wrong.

I enjoy the company of people who love being 'themselves' and are clearly comfortable with their life, who are happy with who they are and what they do for a living. They don’t always struggle to prove themselves right but enjoy everything that life brings in their way. If they promise me something, they go an extra mile to deliver and they don’t make excuses. I am not a saint at all times so I need friends with a certain amount of tolerance and understanding which I hope to reciprocate.

I like happy people! I like people who are full of life, dynamic and impulsive. Our attitude plays a vital role in our social interactions, how we view things makes us who we are - either effervescence of positivity and optimism or grave stone of negativity and pessimism. But if we learn to focus on the good and not waste time thinking about the things that bug us, we display a radiant and positive attitude which in turn is infectious. I need a friend who can laugh and love to see others laugh and live in the moment and for the moment. His/her company should mean instant joy and optimism all around!

Gossips and idle chit-chat is not my style, but to open closed books is not my hobby either. I admire people who are brave enough to share their thoughts with me and express an opinion of their own that may be absolutely contrary to mine. That does not mean that I tolerate cold hearted and mean spirited people, their opinions may differ and we may disagree at times but never be disagreeable. Their warmth, kindness, consideration and love cannot be linked to whether we see eye to eye.

I love people with a passion for life. When someone is passionate or enthusiastic about life, their energy and drive draws me in. Passion oozes out of them and I can't help but admire this.  Such people have a mission in life and are goal oriented and I feel inspired in their company. I like people to have morals and I like them live by their morals and not someone else's. Morals not only give their character structure and substance they also sets standards of decency.

When we step back and look at our mythology the two most outstanding examples of good friends were Karna and Krishna, but this where their similarities ended. Duryodhan broke all the rules of the prevailing caste system and gave Karna, the son of the charioteer, a status which his skill, talent and knowledge deserved. Karna in order to show his gratitude towards this unconditional friendship vowed to help and assist Duryodhan all through his life and in all conditions, good or bad. This is the reason why he did not side with Pandavas even when Lord Krishna exploded with the truth that he is one of the Pandava brothers and son of non other than Lord Surya himself. Krishna, on the other hand, was a friend to both, Sudama, the poor Brahmin and Arjuna, the Pandava archer prince but his friendship was not blind. He did not hesitate to suggest course correction to either of his friends when they were blinded by ‘moha’ or mirage of worldly bondages and to Arjun he offered the ultimate gift of friendship – the essence of Gita!


So let us decide once and for all, what sort of a friend we need – a Karna, who will be with us through thick and thin no matter how wrong we are or a Krishna who will guide our destiny and enrich our lives! The choice is yours!

Friday 9 December 2016

WHY IS BENGAL ALWAYS ANGRY?


The smartest thing that my parents did was they migrated out of West Bengal. They were sorry, they were lonely, they were homesick and they were miserable to move out of home, but they were determined to live a better life and give their children better opportunities, something that simply wasn't possible in Kolkata. My father would often lament that his home state is not progressing. We Bengalis spend too much time in intellectualising simple issues, debating on non-issues, and procrastinating instead of working towards a better life, he felt. While Bengal was on the forefront of our freedom struggle, after partition it just fell apart. Punjab too was divided and still by sheer determination and hard work it was soon on road to recovery but Bengal still holds the grudge of being wronged! 

The state is perpetually angry and violent and is obsessed with the idea that it is being punished and victimized. Since the last three decades it could never see eye to eye with the government in the centre, irrespective of which party was ruling in Kolkata or in New Delhi. People are always in protest mode and whoever holds the biggest protest in Brigade Parade Ground is considered the most popular and most powerful! Imagine the irony, the lady who singlehandedly shooed away Tata from Singoor and handed the Nano factory on a platter to Modi in Gujarat, was elected by the people to become their Chief Minister! A person who deprived the people of industry, opportunities and jobs was rewarded by the same people! What does it say about the political atmosphere prevailing in the state?
                                                                                                           
Today Bengal is in a stagnant corner while Odisha, Assam and smaller states are rapidly progressing. Even literature, cinema and football are all stagnating and we have not had the champions like Rabindranath Thakur, Satyajit Ray and P. K. Banerjee in recent years. Saurabh Ganguli is perhaps the only bright star in the horizon today. The Chief Minister is angry and foul mouthed, her supporters are angry and equally foul mouthed and her representatives in the  assembly and parliament are also the same. The saner and smarter ones, and there are plenty - both in and out of politics, are side lined and the angry and rabid ones hog the limelight. They are all obsessed with an intellectual halo, which sadly doesn't exist, and a sense of victimhood, which only they have to shed. 

Gopal Krishna Gokhle once said 'What Bengal thinks today, India thinks tomorrow '. I hope he is proven wrong. We in India aspire to be a bunch of achievers and not a group of angry, ever complaining men and women who feel that the world is conspiring against them. The Nation is waiting patiently for Bengal to rise and shine once again not only for the sake of all Bengalis but for the sake of all Indians. The cancer of discontent, anger, frustration and protest must be uprooted by Bengalis themselves. The Nation is hoping and praying for saner senses to prevail and prosper!

Thursday 8 December 2016

THE STORY OF CAESARIAN SECTION


I hope you remember my esteemed senior colleague from Thrissur, Prof. Hirji Adenwalla. He told us the story of Cortisone and Insulin. Now this is another gem from the master story teller!

It is difficult to comprehend today that up to the year 1867 if a woman survived a caesarian section it was considered a clinical curiosity and the hundreds of years before that you could count on the fingers of one hand the number of women who lived after a caesarian. A few of the babies thus delivered  survived, the majority died because these caesarians were conducted on an already dead or a dying mother as a last resort, and on the part of the surgeon it was considered as sheer surgical bravado. The Catholic Church had issued a diktat that no mother should be buried with a child in utero. The child should be removed, baptized and then the mother and child were to be buried. Can you imagine that this was one of the indications for a caesarian? Compare this depressing scenario with the mortality reported less than a hundred years later in 1949. The University of Zurich reported a mortality of 0.66 percent. Today in the 20th Century the mortality is almost infinitesimal and an obstetrician would hang his head in shame if he lost a mother after a caesarian.
          
 It is erroneously believed that Caesar was delivered by a caesarian section. The word caesarian is derived from the Latin “Caeso matris utero” which means “cutting of mother’s uterus”. All that Caesar had to do with it is that he passed a law legalising the performance of this operation. It figures in Greek mythology, Apollo is supposed to have cut Aesculapius, the Roman God of Medicine out of the womb of his mother Korina. Aesculapius lived but what happened to the mother we do not know. The written chronicles of many ages and peoples contain reference to “Birth by section”. The Rig-Veda of the Hindus, the Talmud of the Jews and the records of the Romans, the Persians and the Arabs contain reference to this operation. It was mentioned that the history of child birth has ever been filled with pain. Now what was the cause of the death of these unfortunate women? The onus is laid at the door of one Francois Rousset surgeon to the Duke of Savoy. His was considered a classic text book of obstetrics and he was the first to recommend a caesarian section in a living mother for obstructed labour. He laid down certain rules that were followed without question by generations of obstetricians. He dogmatically stated that the womb should never be sutured as the after pains would tear open the incision. Only the abdomen had to be closed. If the mother did not die due to severe bleeding from the un-sutured incision in the uterus, she would die of surgical sepsis which was rampant in the pre-Listerine era. However, it was later discovered that Rousset himself had never done a Caesarian section, he had probably never even witnessed one. But his book became the Bible for any surgeon who dared to undertake a caesarian. They followed him unquestioningly like dumb driven cattle, so women continued to die of severe haemorrhage  as a result.
           
Rousset’s original book was in French but was translated into Latin the language of science by a man called Gaspard Bauhin and he related a number of fantastic cases which he said inspired Rousset to write his book. One of the stories was about a Swiss Butcher named Jacob Sigerhausen who in the year 1500 performed a caesarian on his wife and saved both mother and child. The woman went on to bear five more children whom she delivered normally-a statement which casts grave doubts upon the veracity of his story. From the end of the 17th century there is only one documented case of a caesarian performed on the 21st of April 1610 by a German surgeon in Wittenburg. His name was Trautmann. The caesarian was performed on a Cooper’s (barrel makers) wife, Ursula Opitz. The child survived but the mother died. These inevitable fatal outcomes of caesarian sections gave it ill repute.  Yet no one, no one, asked why women who were operated on according to Rousset’s instructions always died. No one ever doubted the teaching of this death dealing theoretician. Why did nobody make an effort to suture the wound which was the natural thing to do?

The stage now shifts to the San Matteo Hospital in Pavia, Italy and the main actor in this dramatic story is a young 33 year old surgeon trained at the University of Pavia and now held the post of Professor of Obstetrics in the same University. He was a fervent Italian nationalist and had served under Garibaldi. He was a thin earnest man with a pale high forehead and a heavy black beard. His eyes shone with a natural kindness which endeared him to his patients whose suffering he found difficult to bear. His name was Eduardo Porro (1842-1902). It must be admitted that Porro’s concept was originally suggested by a Florentine surgeon named Joseph Cavallini who proved on dogs that the uterus was not essential to life and could be removed with impunity.
            
On April the 27th 1876 a 25 year old girl who had obviously suffered from congenital rickets entered the San Matteo in Pavia to deliver her first baby. The girl was badly stunted and deformed. Porro examined the girl, she was four weeks overdue, she had a severe rachitic pelvis, her diagonal conjugate was 7 cm and her true conjugate was 4 cm or even less. Besides this she had a spondylolisthesis  of the lumbar spine forming a roof over the pelvic inlet. Seeing the girl he was not surprised at these findings. He knew for sure that he could never deliver this baby through the normal passage. A caesarian was imperative to save the baby but the mother would surely die of either haemorrhage or surgical sepsis. This kindly man patted the mother on the shoulder and said, “don’t worry the baby is alive these things take time”. He then let his students examine her, they adjourned to an adjacent room and the case was thrown open to discussion. His students were well trained by him and they all gave him a grave prognosis. At the end of it all a student asked him, “What will you do sir?”, “I will perform a caesarian of course I know the woman will die but we might save the child”. At the back of Porro’s mind was the knowledge that in the last 10 years not a single mother had survived a caesarian section. Porro also knew that caesarians were performed on dead mothers to baptise the children one of the edicts of the Catholic Church. Porro had read about the work of Jean Rena Sigault who proposed expanding the constructed pelvic girdle by cutting open the symphysis pubis, his research told him that it did not work. Sammuel Merriman of England advocated precipitating premature labour when the baby was very small. All the babies died and so did most of the mothers. John Aitken a British gynecologist who died insane in an asylum in the year 1790 proposed that all infection came from the air and therefore, caesarians should be performed under water. Porro said to his students “Gentlemen each proposal is wilder and more desperate than the previous one”. “Gentlemen”, he said “we must put all this aside and listen to what the French surgeon Lebas has to say for he has the answer. Listen to that what he writes. “In all the autopsies that I have performed the incision in the uterus was not closed and did not close on its own as Rousset believed. It was from this highly vascular area of the uterus that the women bled to death and died of shock even before sepsis could carry them away. I have tried to close the wound in the uterus but I did not have the adequate suture material, the after pains caused the incision to open up again”. Of course all these were classical caesarian sections.
           
Porro traumatised  by the misery he saw all around him had turned all this over in his mind a thousand times and came to the conclusion that if he could not close the uterus he had only one option and that was to remove it. The choice was a grim and a mutilating one. But if the choice was between certain death and survival by mutilation. The choice was obvious. What made Porro ultimately make his decision in the case of Julie Covallini? Was it the look of suffering of a timid child in her eyes? Or was it the conscience of a brave man accusing himself of being a coward when he knew full well that the only chance he had of saving the woman was by removing the uterus.
           
On the morning of the 21st of May 1876 a nurse reported to Porro that the Covallini woman’s pains had begun. At 10 AM he was informed that her sac had burst. At 20 minutes to five that evening Porro made his incision under chloroform anesthesia, it is recorded that he undertook some half- hearted antiseptic precaution that was slowly creeping into the surgery of those days. There was hardly any bleeding when he opened the peritoneum. But when he made the vertical incision of a classical caesarian section and delivered the baby, he was in a deluge of blood. All the conventional methods of massaging the uterus to make it contract to stop the bleeding were tried, but it was to no avail. For a long moment Porro hesitated then he made his decision. After putting a tourniquet like instrument on the cervix called a “Cintrat serre- naeud” which controlled the haemorrhage and then with a few bold cuts he whipped out the uterus. By today’s standards if you go through the detailed description of the operation which he later wrote, it was crude surgery, but you could say that it was a sub-total Hysterectomy.
           
For days after surgery Julie Covallini hovered between life and death, and Porro hardly left her bedside. For days she remained febrile. Infection had set in, she was delirious and there were several ups and downs when Porro thought he had nearly lost her. However, on the 33rd day after surgery the temperature settled down and at noon the same day Porro found her out of bed for the first time. Both mother and child had survived. A couple of months later Porro published his historical paper titled “Della Amputazione utero-ovario come compliment dal Taglio cesareo”. (utero-ovarian extirpation as a complement to caesarian section). It was carefully written and with extreme restraint. Unlike Semmelweis’s work it created a tremendous stir in the Mecca of Medicine-Vienna.
          
Throughout Europe and America in a short time the operation became a routine procedure, of the first 134 caesarians recorded by Porro’s method, the survival rate was 44%. This was phenomenal success and pinpointed the cause of death to the inability of the surgeon to close the uterus which led to fatal haemorrhage. It also focused the attention of the surgical fraternity to the undeniable fact that if they wanted to avoid the mutilation of a hysterectomy they must find a way to suture the uterus. The blind spot that Francois Rosset had created in the minds of surgeons was for ever removed.
           
As techniques improved and stronger suture material evolved surgeons were able to close the classical vertical opening in the body of the uterus. The credit for first successfully closing the uterus goes to Max Sanger of the University of Giessen in the year 1881 and so Porro’s operation enjoyed centre stage for only six years. But during that time the lives of thousands of women were saved. Marion Sims further improved the technique of suturing the uterus.
           
It was Ferdinand Adolf Kehler of Guntersblum  also a German who first advocated the technique of opening the lower segment of the uterus. Kehler’s operation was first performed in the town of Mackesheim on a 26 year old woman on the 25th of September 1881. With the lower segment caesarian section the classical caesarian section went completely out of vogue, and complications and mortality were further reduced to infinitesimal proportions. This today is the operation of choice performed uniformly all over the world.
           
There is a lesson to learn from this story. The mistake of Francois Rousset and all the mistakes of other like minded  men who postulate without proof have delayed the progress of science and have cost the loss of millions of lives. It was Lord Moynihan who said “there is no greater impotency of mind than the passive acceptance of facts”.
           

What Rousset wrote in 1581 without proof was accepted for 300 years without question and women died by the thousands. No one questioned Rousset. Generations of surgeons were like dumb driven sheep jumping over a fence without a thought. Only one man, a French surgeon by the name of Lebas said that Rousset was wrong, terribly wrong. He said either suture the uterus or remove it otherwise your mothers will continue to die, and it required the courage of one man Eduardo Porro to do what he thought he had to do. Eduardo Porro would have been criticised and ostracised if Julie Covallini and her baby had died. But luck was on the side of this brave man and on the side of millions of women that are alive today after a caesarian section. After this, men like Pasteur, Koch and Joseph Lister marched on to eliminate surgical sepsis and through them a new dawn broke on the surgical horizon.

Monday 28 November 2016

BALDNESS – IT’S COOL BUT WORTH FIGHTING AGAINST





Curing baldness is the holly grail of medical research in the eyes of many men who have male pattern baldness. While there have been significant advances in the world of hair replacement, an actual cure is at this point, just a baldness researcher’s (and bald man’s) dream. But there is an alternative to seeking solace in minoxidil, finasteride, toupees or follicular unit hair replacement surgery: just be bald and be happy.

We live in a time when many men who are not even beginning to bald, voluntarily shave their heads because they think it makes them look better, or they think it makes them cool. And most of the time they’re right. Bald guys are cooler. Bald guys do look better.

Just think of all the cool, good-looking famous gentlemen we have around now: Michael Jordan, Bruce Willis, Patrick Stewart, Vin Diesel, Ving Rhames, Matthew McConaughey, Sanath Jaisurya, Zinadene Zidane, and back home Anupam Kher, Shetty, Kulbhushan Kharbanda, Veerendra Sehwag to name but a few. Not one of these guys would be helped by a full head of hair. In fact, they fall under the category of men about whom a person could say, “Wow, it would be a real tragedy if his hair ever grew back”. In truth though, while there is nothing to be ashamed of in trying the available methods to restore lost hair; the most secure, most confident and probably happy guy, is the one who doesn’t spend time fretting over losing his.

For this person, going bald is just another interesting aspect of life to experience, and like many others, offers the opportunity for internal growth and personal advancement. This gentleman is not overly concerned with what’s on his outside. He knows that his real worth and most of what he is, is inside. He doesn’t see how losing his hair will make any difference in his ability to accomplish the things that he wants to. He knows that while it’s nice to have a full head of hair, it’s not going to get a degree for him, or decide the quality of his relationships, or get him the career he wants or ultimately determine whether he is able to do the things he loves to. Nor will his lack of hair in any way detract from any aspect of any of these things. This guy gets a bit of a chuckle out of the lengths that others will go to in order to avoid or remedy being bald. He doesn’t see the point of the expense of topicals. He’s probably mildly embarrassed for those fellows with comb-overs. He doesn’t want others guessing whether or not he’s wearing a toupee. And he wouldn’t consider anything as drastic as hair replacement surgery. He doesn’t begrudge others these choices or ridicule them for the simple reason that they’re just not for him.

Of course, if a true cure for baldness ever materializes, some of these men will choose to use it. But there will probably be plenty of others who will choose not to. Because some of us simply look better without hair. I can not imagine if a few of our past teachers would ever have that Professorial look if they had a crown full of hairs! Hairlessness has given them that unique dignity, gravity and solemnity that is so hard to find in the hirsute. Hair Transplant surgeons are my friends, but let them hunt the less confident and the unhappy lot!

And besides, hair requires care and upkeep. It has to be shampooed and combed and brushed, and conditioned and cut. With bald, you just shave it. So there you have it. It’s cool, and virile, and sexy and hot to be bald. If you’re losing your hair or even if you’re just tired of taking care of it; give bald a try. You may like it so much that you’ll never go back to being hairy.

An online troll through some hair-loss forums led me to a few interesting underground “remedies,” including scalp tattooing (camouflage that bald spot!), caffeine-laced shampoos (make those follicles so jittery they have to produce something!), and various herbal concoctions containing capsaicin, the compound that makes peppers hot (flush out your scalp with fresh, oxygenating blood!). Then there are official hair growing drugs – minoxidil, finasteride, micronutrients etc. And then off course there is hair transplantation surgery! But the future of hair restoration on bald heads is an interesting one. Some answers in the realm of research are:

1. JAK Inhibitors: Healthy hair grows in cycles. A follicle produces a hair; the hair hangs out looking sexy for a while; then the hair falls out. The follicle goes temporarily dormant before sprouting anew. The number of cycles is supposed to be unlimited, but in balding men, the new hair grows back finer each time, until it’s like peach fuzz. The hair isn’t gone; it’s just imperceptible. JAK inhibitors are drugs which target inflammatory cell pathways, to stimulate follicles back into robust growth cycles. Whether it’ll work on real men remains to be seen.
Since the drugs are already FDA approved for other purposes, they have cleared major safety hurdles and could be in clinical trials for hair loss soon.

2. Stem Cells: For quite some time, researchers have been betting big on the potential for stem cells to grow human hair. But when hair-follicle stem cells are grown in the lab, they lose their capacity to induce new hair follicles when placed back into the scalp. Researchers have hit a roadblock here and are trying to find ways to restore their inductive properties. Researchers have grown new hair follicles by using a type of human skin cell derived from pluripotent stem cells in mice but human trials are awaited.

3. Fibroblast Growth Factor: Science says that we’re born with all the hair follicles we’ll ever have, and some of us are simply destined to go bald. However,a possible way to grow new follicles by wounding the scalp and treating it with a substance called Fgf9, or fibroblast growth factor 9 is being tried. This has succeeded in mice but the problem is that humans don’t have much Fgf9. The solution is a combo treatment that involves “micro-wounding” the scalp and then applying a drug with synthetic Fgf9.

4. Hair-Follicle Engineering: Hair transplant surgeries rather than creating new hair, merely move existing follicles from the back and sides of the head to the front of the scalp. But what if we could take just 100 follicles and clone them into 100,000—the number most men are born with on the scalp our job would be done! The Japanese have already done it and the field of regenerative medicine is rapidly advancing, so one might have the opportunity to become successful hair farmer soon.

5. Quorum Sensing: Researchers at the University of Southern California have discovered that removing about 200 individual hairs induced the regrowth of about 1,200 dormant hairs—again, only in mice. The science behind this has to do with a process called “quorum sensing,” where a group of stem cells responds to an injury afflicting its colleagues. The resulting inflammation signals the surviving stem cells to wake the hell up, get busy, and grow more hair. So be patient. Someday soon we may finally have a legitimate reason to go pluck ourselves. 

We however did not discuss the cause of baldness, to avoid embarrassing the baldies. Scientific research has shown that at around the 4th and 5th decade the hair follicles in the scalp convert all their pent up potential energy into kinetic energy and start drilling in – through the layers of the scalp, through the bony skull in search of grey matter. If they find it, they turn grey and if they don’t, they just fall off! 

Thursday 17 November 2016

FAREWELL TO GOD!


As the curtains came down on the career of the greatest gentleman of the Gentleman’s game not one throat was without a lump and not a single pair of eyes without tears! The 24 year long celebration of the game of cricket, which was truly 24 carets pure, came to an emotional end today at the Wankhede in Mumbai and left a billion Indians numb and shell
Another century! He has done this for 100 times!
shocked. Cricket without Sachin? How will that game look like? India is still trying to come to terms with this reality. The man who united India from Kashmir to Kanyakumari and from Somnath to Kamakhya, the man for whom devotees prayed everywhere from Jama Masjid to the Golden Temple and from Shravanbelgola to Basilica Bom Jesus was the pulse of the Nation and he throbbed in over a billion hearts!
But was it only his cricket that made him what he is today? He answered this question himself in his farewell speech, which was nothing short of epic. See it for yourself by clicking: https://www.youtube.com/watch?v=EYLF3qQCKM0
The man was simply flawless even on such an emotional occasion as he did not forget to thank even a single soul who helped him. Starting from Siddhi Vinayak to his departed father, his mother, and his elder brother who saw the spark in him and pushed him into cricket, to the Dronacharya – Sri Ramakant Achrekar, to his lovely wife Anjali, with whom he said he enjoyed the best partnership, to his children who have not been possessive but let him be there for India as well, to his seniors , captains, team-mates and opposition players in all types of cricket teams everywhere, to the cricket administrators grounds staff, to finally his over a billion fans the world over, he did not forget a single sole! This is exactly what makes him so special – his humility and his gratitude to the excellent support system.
Sachin and his mind boggling stats!
The fact that he has more ‘Man of the Match’ awards than the total number of games played by many so called greats of the game, tells us how simply incomparable he is! The fact that he has played the fiercely competitive game at its highest level for almost a quarter of a century speaks volumes about his work ethics and dedication! The fact that he was the target of the opposition all his life and yet not one player who played against him feels anything but privileged to be called his one time opponent tells us in how high esteem he is held by his peers! The fact that in 24 years he has been in the receiving end of some horrendous umpiring decisions and ugly yellow journalism and yet never lost his cool on or off the field exemplifies his upbringing as a man who was born to be the king! Cricket lovers of my generation all over the globe are blessed to be born in his era. This was the ‘Satyug’ of cricket, because God himself batted for India at No.4!
The government of the day today chose to confer on him the highest civilian honour, the ‘Bharat Ratna’, but the people had bestowed him with this honour long long ago. They have always considered him as the jewel in their crown, and when they endlessly chant his name Sachin-Sachin, their admiration and adulation is there in abundance for all to see.

I am still trying to find a reason to watch the forthcoming South Africa series. Cricket will never be the same again!

Monday 14 November 2016

DEV DEEPAVALI – A CELEBRATION WORTHY OF GODS!

Dev Deepavali or Gangaotsav in Varanasi

Dev Deepavali is a celestial happening in the holy banks of River Ganga in the oldest living city on earth, Banaras or Varanasi. Milions of illuminated earthen lamps dot the stairs of various Ghats and adjoining majestic palatial buildings with an equal number seen floating gingerly on the holy waters of the river. There is a strong aroma of incense and a crowd of unimaginable proportions. Sacred chanting of Mantras renders a religious fervor to the divine occasion. Varanasi celebrates this festival on the auspicious day of Kartik Poornima- fifteen days after Deepawali. It falls on the full moon of the Hindu month of Kartik (November - December). 
Ganga Aarti
The celebrations are as old as the city itself and have been recorded even by Ptolemy and Huang Tsang among others, when several million earthen lamps are lit at Sunset on the steps of the Ghats. However, the celebrations as we see today, the tradition of lighting the lamps on the steps of the ghats, the thousands of small and big temples ans on the river surface on the Dev Deepawali festival day was first started at the Panchganga Ghat in 1985.
If mythology is to be believed then this occasion is marked to celebrate the victory of Lord Shiva over the dreaded demon Tripurasur. That is the reason why in Varanasi the occasion is also called Tripurotsav. The main rituals performed by devotees consist of kartik snan (taking a holy bath in the Ganges during the month of Kartika) and deepdan (offering of oil lighted lamps) to Ganga in the evening. When the dusk sets the steps of the ghats, the riverfront of Ganga and all the temples in the banks of the holy river lit up with millions of earthen lamps or Diyas. Right from Ravidas Ghat at the southern end to Rajghat in the north,
The full moon of Kartik Poornima


Steps of the Ghats studded with earthen lamps




A traffic jam of boats in the banks of Ganges to watch the Ganga aarti


Ganga Aarti as seen from the boat

A divine sight during the aarti


million earthen lamps are lit in honour of the holy river, the Ganges, and its presiding goddess. The gods are believed to descend to Earth to bathe in the Ganges on this day!

A sea of humanity but all well organized
For an outsider it is an amazing site, but for the devout Indian it is a time to worship the Holy Ganges. Dev Deepawali is also the culmination of month long Kartik Mahotsava, which starts from the day of Sharad Poornima. This also coincides with the end of Ganga Mahotsva, which takes place at Rajendra Prasad Ghat and Dasaswamedh Ghat for the previous three days. Houses are decorated with oil lamps and colored designs called ‘alpana’ on their front doors. Firecrackers are burnt at night, processions of decorated deities are taken out into the streets of Varanasi, and oil lamps are set afloat on the river.

Besides a religious role, the festival is also the occasion when the martyrs are remembered at the ghats by worshipping Ganga and lighting lamps watching the aarti. This is organized by Ganga Seva Nidhi when wreaths are placed at Amar Jawan Jyoti at Dashashwamedh Ghat and also at the adjoining Rajendra Prasad Ghat by police officials of the Varanasi District, 39 Gorkha Training Centre, 95 CRPF battalion, 4 Air Force Selection Board and 7 UP battalion of NCC (Naval), and Benares Hindu University (BHU). The traditional last post is also performed by all the three armed forces (Army, Navy and Air force), followed by a closing ceremony, where sky lamps are lit. Patriotic songs, hymns, and bhajans are sung and the Bhagirath Shourya Samman awards are presented.

A long shot of the ghats from the banks
This is a very special River Festival of Varanasi and it is a must see for all visitors to the Holy City. The festival is best enjoyed by taking a leisurely boat ride on the Ganges from around 5.30 P.M. in the evening for 2-3 hours or by just walking on the banks of River Ganges. Boat rides along the riverfront in the evening are popular among tourists, when all the ghats are lit with lamps and aarti is being performed. Ganga Mahotsav, as it is often referred to, is a tourist-centric festival in Varanasi. The sight of a million lamps (both floating and fixed) lighting the ghats and river in vivid colors renders a breathtaking sight. On the night of the festival, thousands of devotees from the holy city of Varanasi, surrounding villages, and across the country gather in the evening on the ghats of the Ganges to watch the aarti. The local government makes several intensive security arrangements to ensure order during the festival. Extra trains and flights are arranged and the city is all prepared to welcome these annual guests!


If you are ever in this part of the world during this time don’t miss out on this out of the world experience!

Wednesday 9 November 2016

KNOWLEDGE AND TECHNOLOGY - AN UNENDING TUSSLE



S
URGICAL KNOWLEDGE  and SURGICAL TECHNOLOGY are two comets which we are trying to ride at the same time. They both are fast and we have no control over them. We are holding on, with great difficulty, to the tail of these two Comets, hoping that they will take us to the right place at the end of the ride. Sometimes we pray that we can hold on for the entire ride. Sometimes we find ourselves praying that the Almighty God will be merciful and just let us fall off. What we shudder to think is what will happen when next time the two Comets choose to move in opposite directions as they have undoubtedly done in the past.

While it is so true that we can not hold on to the older proven techniques and should continue to strive for excellence at all times, the reality is that all that is new and for offer is not invariably good and useful. There is a lot of market driven euphoria and baseless jingoism with quite a few so called new gadgets and hence our reluctance to succumb to them like nine pins. When confronted with a new machine / technology we should ask whether we the masters or the slaves of the technology ? Once we understand that we must be the master the rest is fairly simple. The ultimate purpose of any technology is to help its master to do his or her job better. Our job is to cure patients, improve the quality of recovery and patient’s well being and reduce the sufferings of those we can not cure. We also must make treatment efficient and cost effective. If a product of new technological boom does not meet these criteria we must ask “ Why are we doing this ?”

State of the art Technology  is no substitute for the State of the art Knowledge, in fact it is quite useless and on most occasions downright harmful without it. Technology has not always taken us to the crest of success every time. The moment we have allowed it to lead our Knowledge it has led us astray, or more correctly we have allowed technology to lead us astray.  Extracorporeal Shock Wave Lithotripsy ( E.S.W.L.) has broken millions of stones in the kidney, ureter and bladder.  Thinking it to be a stone breaking machine a few among us tried to crush stones in the Gall Bladder expecting them to disappear like magic.  We conveniently forgot to compare the anatomy and physiology of the two organs - in one clear urine washes down the debris through a straight ureter and in another thick viscid bile slowly finds its way down across a spiral course and through a valve. The result was a disaster of enormous proportion and all because we did not do our homework well. The marriage of Knowledge and Technology is a very turbulent one as both are highly ambitious and growing very fast. A postal delay in delivery of two Journal issues leaves one fairly behind in patient care and ignoring Seminars and Conferences makes one antique.

If necessity is the mother of invention, then strategy should be its father. Technology should not evolve spontaneously. Its evolution should be our responsibility.  Where do we go from here ? What technologies are on the horizon ? How do we open our minds without closing too many doors?  Surgeons are looking at technologies that could enormously improve patient care and even put them out of business; that can fix things without touching them,  and touch things without seeing them. These are weary times but also exiting!

The future very often arrives faster than expected. In 1996, a renowned biologist, Lee Silver of Princeton University, wrote that it is impossible to clone mammals via cell-nucleus transfer. His book had not even reached the bookshops that scientists of the Roslin Institute in Scotland announced that they had succeeded in cloning Dolly the sheep. The best way to predict the future is to invent it because the visions of the future created by research laboratories, think tanks, science fiction authors and other visionaries not only form a matrix for the social perception of tomorrow's world but also open up the associated opportunities. Such futuristic thoughts are known as memes which propagate in society like a cultural gene. The mass media dictate collective expectations of the society and hence, can analyze the memes. Cinema can project new technologies as being real even if they are in the developmental stage and society will accept it, at least in the subconscious mind. The most radical ideas from science and fiction may find solutions to problems which we face in real life. On the other hand, consumer expectations are also programmed in this way. Micro-vascular transplants of severed limbs were seen in comic strips half a century ago, today they are a reality in a general hospital near you! 

Human life might also become programmable. Families will be designed and children selected according to catalogs. The gender of children might be reversible during the course of pregnancy and the little brother will be a robot. (!!!!!) Thus, our notion of family happiness might get programmed and human beings would like to make the entire world a theme park where spectacular experience boosters are available. One minute holidays and artificial hibernation of unproductive times will become the order of the day.

In the healthcare sector of the future, less emphasis will be placed on curing illnesses than on prevention and well-being. Beings and machines will merge; body and consciousness will be rewired. The new combination of natural and artificial hardware and software will create mechanical humans and human machines. Death might become optional with artificial parts increasingly replacing diseased organs. The secret of self-healing will be decoded changing the treatment pattern in dentistry. But the human evolution will continue and result in new intelligent beings.


The future belongs to those who tell the best stories about the future; in other words, only creative thinkers will get an opportunity to contribute towards future professional needs. Plastic Surgery is generally considered as a skill-based specialty but we have begun to establish our knowledge base. As a knowledge-based specialty, adoption of new technology is a natural extension of our commitment to patient care and not to skill-based bravado. Many new technologies are adopted from other fields viz . nanotechnology, lasers etc. With a solid knowledge base, we will not be afraid of technological failures and adopt technology as early as possible. 

Many technologies are popularized by corporate investments which may not be inherently interested in patients but be more of business opportunities. The profession has to manage the pressures of the market without ignoring the science because ignoring them totally will be fatal to our future growth. Knowledge has to remain a step ahead of Technology and riding these two Comets, though not easy, has to be done throughout the active professional life of a Surgeon , or shall I say, any Professional 

Sunday 6 November 2016

FEEL SORRY FOR YOU GUYS!




One thing is for sure, you have to feel sorry for America! Imagine the choice they are left with for the post of President! This is what happens when you tweak the elections, manipulate the mandate and defeat a genuinely good and wise candidate, Al Gore. The ghost of Florida recount is revisiting America. Why should good and decent people want to join politics when they see the election stolen away from the deserving and the very best.


Democrat Albert Gore won the most votes, a half million more than his Republican opponent George W. Bush, but lost the presidency in the electoral college by a count of 271-267. Even this count was suspect, dependent on the tally in Florida, a state ruled by the younger Bush sibling, where many minority voters were denied the vote, ballots were confusing, and recounts were mishandled and manipulated. The choice of their leader came not from the citizens of the nation, but from lawyers battling for five weeks. The final decision was made not by 105 million voters, but by a 5-4 majority of the unelected U.S. Supreme Court, issuing a tainted and partisan verdict.


President George W. Bush entered the presidency without any mandate and with half of the nation questioning his legitimate title to the White House. He shared power with a Congress essentially evenly divided between the parties, and confronted the bitterness of disappointed Democrats. That partisan divide still continues till date. How can you unite a divided nation? By war…..and that is what Bush did.


You say India is a divided country, look at the U.S. In this very election we have seen it being divided into:
• the poor and the rich
• single and married people
• working women and homemakers
• gays and straights
• nonbelievers and frequent churchgoers
• Catholics and white Protestants
• Hispanics, Blacks, Asians
• Jews, white Christians and others
• other voters and the religious right
• residents of large cities and rural areas
• high school dropouts and college graduates
• union members and nonmembers
• pro and against gun control
• pro and against ‘black lives matter’
and they all intend to vote differently, considering what suits them best and not what is best for their country. When an election throws up two equally undeserving candidates it does not need Albert Einstein’s IQ to understand that whether it is the Republican or the Democratic party, there is no inner party democracy and the power brokers in Washington have won by manipulating their candidates to the two respective pedestals. The public is now more knowledgeable and more cynical about political maneuvering today than it was 16 years ago in 2000, but alas it is powerless because it has to choose between the stooges of two rival power camps! America, you are paying for your past sins! Hillary or Trump, you are in the dumps!!


Imagine, with an Al Gore presidency there would have been no Gulf War and America would have thrived with green energy, better environmental protection laws, infinitely better education policy and an affordable health plan. Bush on the other hand provided no clear policy direction and for governing a divided nation had to invent a phantom enemy. Now if that was a bad patch in history, can you imagine what is in store for them in future!


America’s social, political, economic and environmental systems all appear to be in acute crisis. At their heart is the growing inequality and sense of disenfranchisement among the population, socially, politically, economically, academically, health wise and environmentally. This election season has done nothing to inspire me with confidence that America will become more equal after November 8. Donald Trump has built his campaign on the exploitation of the social, economic, and racial anxieties of, predominantly, white men without a college degree. ‘I know what is good for you’ Hillary Clinton too knows that this inequality is a significant national concern, but she has no solutions for it. Instead, she keeps on telling that Donald is a novice and has not played the game and so will not be able to deliver!


Americans, both Republicans and Democrats have to stand up and be counted. In this election they should register their protest by voting for ‘none of the above’, if they have a provision for that and let their party know that they are not happy with the choice of the candidates

Friday 4 November 2016

WHAT MAKES ONE SUCCESSFUL?



There was an excellent programme on the television when NDTV celebrated its 25th. birthday. Twenty five living legends of Indian origin were honored by His Excellency, the President of our republic, Pronob Mukherjee. Now you can have your own list of another 25, and undoubtedly they too would be equally deserving, but barring a few glaring omissions like Lata Mangeshkar, A.P.J. Abdul Kalam, T.N. Seshan and Atal Bihari Vajpai, I am in full agreement with this list. But that is not what I intend to deliberate upon today; what caught my attention was when asked to share three secrets of their success, though these ladies and gentlemen were from diverse spheres of life, how remarkably common was their road to success, how uniquely same were their enemies and how outstandingly similar were their ammunition to fight these enemies and surmount their obstacles!


The most outstanding commonality which all these icons of success, in alphabetical order, right from Amaratya Sen to Zubin Mehta  possessed was their ferocious drive and hunger for success, their refusal to accept status quo and their child like inquisitiveness and eagerness to go where no one has ever gone before. They were, to start with, like any one of us, not succeeding at every step. They got lost, stumbled and failed many times, but unlike others who give up, they pulled themselves up and started afresh with new vigor! Mukesh Ambani summed it up beautifully – if we focus only on the goal, the obstacles will be of not much significance, but if we focus on the obstacles we will loose sight of our goals. 


Henry Ford’s first venture to build a motor car got dissolved in 18 months because his share holders lost confidence in him. Walt Disney - one of the greatest business leaders who created the global Disney Empire of film studios, theme parks and consumer products didn't start off successfully. Before the great success came a number of failures. Believe it or not, Walt was fired from an early job at the Kansas City Star Newspaper because he was not creative enough! Richard Branson dropped out from school at 16 and started a student magazine which flopped. He then set up a mail-order record business which did so well that he opened his own record shop called Virgin. Along the way to success came many other failed ventures including Virgin Cola, Virgin Vodka, Virgin Clothes, Virgin Vie, Virgin cards, Virgin Atlantic, Virgin Music and Virgin Active! Oprah Winfrey got fired from her job as a reporter because she was 'unfit for television', and J.K. Rowling, a divorced single mother, when she approached publishers with Harry Potter, received endless rejections from countless publishers. Many rejected her manuscript outright for reasons like 'it was far too long for a children's book' or because 'children books never make any money'. Steve Jobs got fired from Apple, the company he founded. Only to return a few years later to turn it into one of the most successful companies ever! But all these achievers had one thing in common – they had a clear vision of their goal, and they did not allow the obstacles to pull them back. 


What also came out very clearly this evening was the role a stable family had to play in the success of all these great achievers – inspiring parents, supportive and encouraging spouses and friends who were ready to travel that extra mile. Those who are successful set daily achievable goals, goals that are S.M.A.R.T. — smart, measurable, attainable, realistic, timely. Repeatedly it was stressed throughout the evening that we should not loose focus of our long-term goals and establish small daily goals to achieve our vision more easily. And once we are successful, it should be not only our duty but our religion to help the next generation to succeed, because there is no success without a successor! 

Believe in yourself and believe in India was one common massage from all these super achievers.