FINANCIAL PLANNING FOR ALL AGES

 

Financial success doesn't happen by accident—it requires purposeful planning that evolves as you move through life. Just as your priorities shift with age, your money management strategy should adapt to each new decade. What makes sense in your twenties might not work in your fifties, and retirement brings entirely new considerations. My father worked in Life Insurance Corporation of India and was extremely meticulous in budgeting for meeting the diverse needs of my mother and their three children. Very early in my life, I was told the value of financial planning by judicious and purposeful investments. I am trying to recollect the lessons learned three and a half decades back and share them with you.

This decade-by-decade financial roadmap offers tailored guidance for every life stage, helping you build wealth gradually while avoiding common pitfalls. Whether you're just starting out or nearing retirement, these age-appropriate financial strategies create a framework for making informed decisions that support your changing goals and circumstances.

 

Your 20s: Building the Foundation

Your twenties mark the beginning of financial independence - you're finishing your education, starting careers, and standing on your own two feet. This decade sets the tone for your financial future. Five essential money moves in your 20s:

1.      Start banking properly. If you haven't already, open a checking and savings account. Beyond the practical benefits of managing your money and paying bills, established bank accounts signal responsibility to potential landlords, employers, and lenders.

2.      Begin saving consistently. Develop the habit of setting aside money from each paycheck. Aim for enough savings to cover 3-6 months of expenses for emergencies. Setting up automatic transfers into a recurring deposit (RD)account or a Systemic Investment Plan (SIP) in a mutual fund makes this process painless and effective. This fund may turn out to be your best Health Insurance Plan in days to come!

3.      Think about retirement now. It may seem distant, but people who start retirement contributions in their twenties can retire earlier with much more money. Take advantage of any employer-sponsored provident fund scheme, especially if matching contributions are offered. Opt for the New Pension Plan(NPS) now.

4.      Create a realistic budget. Understand exactly what comes in and what goes out each month. Add up necessities like rent, food, loan payments and savings, then subtract from your income. Whatever remains covers discretionary spending. If nothing's left over (or worse, you're in the negative), it's time to cut expenses.

5.      Start building credit wisely. Your credit history affects many future opportunities. Begin with a low-limit credit card that you use responsibly and pay off monthly. If you already have debt, make a plan to pay it down systematically, prioritizing high-interest balances first. Make on-time student loan payments to establish good credit habits.

 

Your 30s: Growing Your Wealth

In your thirties, you've moved beyond basics and face new financial challenges. You might be thinking about home ownership, starting a family, or moving up in your career. Five key financial priorities for your 30s are:

1.      Expand your investment strategy. While your PPF, NPS and Mutual Fund investments should be growing steadily, now's the time to review their performance and possibly adjust your approach. Your age allows for somewhat aggressive investments. Talk to your retirement plan provider about aligning investments with your personal risk tolerance. It the market is favourable switch a part of your debt investments into equity. Make it a habit to make a regular annual investment in gold or gold bonds.

2.      Consider homeownership. Buying property can be a smart long-term move, but only if the timing is right for your finances. Financial experts recommend keeping your monthly mortgage payment below 25% of your income to maintain healthy finances. Real estate values hardly ever fall and the earlier you purchase your house, the cheaper it will be.

3.      Review your insurance needs. If you've married or had children, life insurance becomes important. It provides for your loved ones if something happens to you. Generally, younger people pay lower premiums, making early enrollment a money-saver.

4.      Put basic estate planning in place. Creating a will is essential, particularly if you have a spouse or children. This document addresses both family and financial matters that would arise after your death. Depending on your situation, you might use online resources or consult an estate planning attorney.

5.      Refine your budget regularly. Review your spending plan at least quarterly and adjust as needed. If expenses exceed income, tighten up your spending habits. Continue paying down non-mortgage debt while saving for future goals.

 

Your 40s: Assessing Your Progress

Your forties are the time to evaluate your financial plan and make sure you're on track. You've established many financial habits, and now you need to check if they're working as intended. Five financial tasks for your 40s should be:

1.      Attack remaining debt. With mounting responsibilities and expenses, many people in their forties carry credit cards and other debts. Make debt reduction a priority now. Determine a monthly payment you can manage, then tackle high-interest debts first.

2.      Evaluate retirement readiness. By now, you should have a clear picture of your retirement savings. Meet with a financial advisor to review your investment strategy, set specific targets, and confirm you're on pace to meet them. If not, adjust your approach. Make sure you're taking full advantage of employer matching in retirement plans and the prevailing market forces. Your investment in gold should continue, you are doing this for your spouse and children.

3.      Check life insurance coverage. Ensure your policy still matches your family's needs. Major life changes like having children or buying a home might mean you need to update your coverage amount or type.

4.      Update your beneficiaries. To protect your family, verify that the right people are named as beneficiaries on your will, life insurance, retirement accounts, and other financial assets.

5.      Consider additional protection. Beyond life insurance, look into whether disability coverage or long-term care insurance makes sense for your situation. During this decade, many people find themselves caring for both children and aging parents. Don't let these responsibilities cause you to neglect your own financial health.

 

Your 50s: Preparing for the Next Chapter

In your fifties, you're likely established in your career. Your children may be independent, and retirement is becoming a more concrete reality rather than a distant concept. Five financial goals for your 50s should be:

1.       Work toward zero debt. With careful money management, you should aim to eliminate debt during this period. As retirement approaches, focus not only on reducing existing debt but also on avoiding new financial obligations. Simply put: live within your means.

2.      Strengthen your emergency fund. Having fully funded emergency savings becomes even more critical now. Unexpected events can still happen, and you want to avoid tapping into retirement funds to handle them. The RD which you started in your twenties is now grown to become your health insurance fund, an insurance plan which will never disappoint you.

3.      Reassess retirement plans. If you're behind on savings goals, take advantage of catch-up provisions that allow higher contribution limits for PPF or Pension funds. If you're on track, maintain your current strategy.

4.      Adjust investment risk. With adequate retirement savings and a target retirement date in mind, consider reducing your investment risk. Use online planning tools or consult a financial advisor to determine the right level of risk for your portfolio. Depending upon your assets and liabilities adjust your investments, more towards debt rather than equities

5.      Update estate plans. Review your estate documents, will, and insurance policies. Make adjustments based on life changes and current laws. Confirm that executors, beneficiaries, and guardians still reflect your wishes.

 

Your 60s: Transitioning to Retirement

Your sixties mark the shift from earning to spending your retirement savings. This decade requires careful planning to make your money last. Five financial priorities for your 60s then are:

1.      Develop a retirement withdrawal plan. As you move into retirement, create a strategy for drawing from your various accounts. Experts recommend managing withdrawals carefully to extend the life of your savings.

2.      Maintain a realistic budget. With regular employment income ending, tracking spending becomes even more important. Adjust your budget to reflect your new financial reality where your money is now working to make money and you are not working so much.

3.      Identify your income sources. Know exactly where your retirement money is coming from. First ensure your essential needs are covered, then plan how to fund discretionary expenses like travel, home renovations, and special events.

4.      Review your estate plan. This is an excellent time to update or establish comprehensive estate planning documents to ensure your wishes and that of your spouse’s are carried out.

5.      Consider healthcare costs. If you have a regular medical insurance it will cover some, if not all expenses, but if you have that RD still running you are assured for supplemental coverage and potential long-term care expenses that Medicai Insurance doesn't cover.

​

Your 70s: Enjoying Your Golden Years

Your seventies offer a chance to enjoy retirement while still maintaining financial security. This decade balances prudent money management with quality of life. Five financial considerations for your 70s should be:

1.      Monitor spending carefully. Continue managing your expenses to ensure your retirement savings last. Regular budget reviews help prevent overspending as living costs change.

2.      Finalize estate planning. Ensure your will and other estate documents are current and reflect your wishes. Consider discussing these plans with spouse and trusted family members.

3.      Prioritize health management. Healthcare often becomes a larger expense now. Budget for medical costs alongside preventive care that keeps you active and engaged.

4.      Create "spending guardrails." Financial experts recommend establishing flexible spending boundaries that allow you to enjoy retirement while ensuring long-term security. These guidelines help forecast sustainable spending levels.

5.      Make the most of your "go-go years." If your health allows, this might be the perfect time to cross items off your bucket list. Balance adventure with financial responsibility.

 

Your 80s: Securing Your Legacy

In your eighties, financial planning shifts toward protection and legacy. This decade focuses on preserving assets and defining your lasting impact. Five financial goals for your 80s should be:

1.      Guard against financial fraud. Stay vigilant about potential scams, as seniors are frequent targets. Consider simplifying financial arrangements and involving trusted family members in monitoring accounts.

2.      Reassess your living situation. Evaluate whether your current home still meets your needs or if downsizing would improve your quality of life and financial and social security.

3.      Update your legacy plan. Review beneficiary designations, charitable intentions, and other elements of your estate plan to ensure they reflect your current wishes.

4.      Consider philanthropic goals. This is an ideal time to finalize plans for charitable giving that expresses your values and supports causes meaningful to you.

5.      Document your financial information. Make sure loved ones know where to find important documents and accounts. Consider creating a comprehensive guide to your finances for those who may need to assist you.

The idea is that you have to remain in charge of your life at all times. For this to happen, you have to take charge of both your health and your wealth. Wealth management, which involves accumulating, conserving and distributing wealth, should always be under your control. Estate Planning involves a comprehensive approach to manage this estate during a person's lifetime and determining how it should be distributed after their death to optimize tax benefits as well as smooth transfers. It goes beyond simply creating a Will and encompasses various legal and financial strategies to protect and transfer wealth according to the individual's wishes. I wrote a blog on wealth management some months ago. You can read it by clicking this hyperlink: https://surajitbrainwaves.blogspot.com/2024/11/wealth-management-and-inheritance.html

Candid conversations with Dr Surajit Bhattacharya

Recently I sat for a session of Beyond the Knife - Candid Conversations with Dr. Nikhil Panse. Over to Nikhil..........

In this  episode of Beyond the Knife – Candid Conversations, we sit down with the ever-inspiring Dr. Surajit Bhattacharya. A brilliant teacher, academician, writer, editor, blogger and a surgeon – he wears many hats with ease.
From tips on writing well and dealing with manuscript rejections, to what makes a great teacher and mentor in today’s changing world – this conversation is full of practical insights and honest reflections.
If you’re a student, teacher, researcher, or just curious about learning and growth in plastic surgery – this one’s a must-watch!
Grab a coffee or tune in while you’re travelling. You won’t want to miss this!

A CHARMING PERSONALITY

 

Personality is a person's enduring characteristics and behaviors that help them adjust to life. It includes their interests, drives, values, self-concept, abilities, and emotional patterns. The word "personality" comes from the Latin word persona, which means "mask". It is a product of both biology and environment, and it remains fairly consistent throughout life. Personality influences a person's environment, cognition, emotions, motivations, and behaviors in various situations. It also predicts how a person will react to other people, problems, and stress. One can gain insights into a person's personality by observing their communication styles, body language, and decision-making approaches.

Personality embraces moods, attitudes, and opinions and is most clearly expressed in interactions with other people. It includes behavioral characteristics, both inherent and acquired, that distinguish one person from another and that can be observed in people's relations to the environment and to the social group. If one is attracted towards a person then perhaps these are the traits, in various combinations and in various degrees, that make them attractive:

·        Courage.

·        Trustworthiness, including honesty, reliability, punctuality, and loyalty.

·        Integrity.

·        Respect and courtesy.

·        Responsibility, including accountability, diligence, perseverance, self-management skills, and self-control.

·        Fairness, including justice and freedom from prejudice.

 

Who wouldn’t want a capturing personality that enables us to lead, connect with others easily, convince anyone to support us, and resolve any quarrel with irresistible personal charm? I have, in the past, written quite a few blogs on personality development, the most pertinent one being: https://surajitbrainwaves.blogspot.com/2018/09/how-to-cultivate-good-personality.html

 

People with great personalities are more likely to succeed, so it's not surprising that many people try to improve themselves and their communication skills. Part of this improvement process focuses on developing or strengthening features that people can’t resist, and if you want to have a good influence on people, you just need to recognize and adopt them.

 

1. Confidence

People who are self-confident do not compare themselves to others all the time. They rely first and foremost on their own minds and abilities and do not blame their environment for their emotional state. Instead of losing themselves in relationships or workplaces, people who have high self-confidence build and maintain their relationships based on their own personal plans and dreams - they know what they want to achieve and make sure they do so. When you feel confident in your personality and in the decisions you make, those around you will be impressed by your management and decisiveness. These people never lament being victims of circumstances, instead they create the circumstances of success for both themselves and others.

 

2. Honesty

Honest people are not afraid to tell the truth. They are direct in their judgment and open to themselves just as they are exposed and true to their environment. People are happy to talk with honest people because they can be trusted, and relationships become simpler, clearer and safer when everything is on the table and there is nothing to hide. In addition, in a romantic relationship it is easier to trust honest people - and for a healthy relationship, trust is priceless. In business relations honesty is the best policy and with friends and family, honesty is the only policy.

 

3. Trustworthiness

Without trust, any relationship - whether in the workplace, romantic or platonic - will quickly disintegrate. It is therefore very important that you establish yourself as a reliable person whose words and actions can be trusted, from minor matters to the big and significant things. This is the only way to get people to be pulled to you and trust you with all their hearts. For big time success in business (Ratan Tata), politics (Narendra Modi), performing arts (Amitabh Bacchan), Sports (Roger Federrer) trustworthiness is simply non-negotiable.

 

4. Sensitivity 

Sensitivity is about being able to sense the swings and changes in other’s moods, as well as to being empathetic towards them. Sensitive relationships begin with the smallest things, such as noticing when your partner wakes up on the wrong side of the bed, and bigger things such as noticing when your partner feels jealous. For example, in order to attract others, you must be aware of their feelings. If, for instance, one of your colleagues seems different, preoccupied or looks down in the dumps, don’t hesitate to take interest and offer an empathetic ear. Doing this guarantees that you’ll be able to bring people closer to you and be seen in a positive light.

 

5. Be supportive  

 It's not enough to just recognize that someone is going through something. You also need to know how to support them. You should make others feel that you are "on their team" and that, together, you’ll be able to overcome anything, big or small. The confidence and support you provide them will encourage them to act, make them part of your team, and perhaps even bring others closer to you. Being supportive in moments of crisis gives you a reputation of being a reliable and sympathetic individual.

 

6. Express interest

In addition to being supportive in times of need, in order to become an irresistible person, you should adopt a curious and healthy interest in others. Reach out to people you haven’t heard from in a long time, whether by phone or social media. In this way, you’ll be able to regain friends you’ve lost along the way and even make some new ones. If your partner is prepared to go with you to the stadium to watch cricket she is showing interest in things you like. So make sure you accompany her in a music concert, which is of her interest.

 

7. Loyalty

Loyalty is one of the most important qualities, not only in romantic relationships but in any relationship. Knowing that you can wholeheartedly trust another person who won’t knowingly betray you or try to hurt you, even when tempted, is very important to everyone. But first of all, you have to adopt this attribute for yourself. Always be loyal to your beliefs, views, and path and this will show others that you can be loyal to them as well. The crisis of loyalty is most evident in politicians, who change loyalty with seasons, and that is why you don’t tend to respect most of them.

 

8. A sense of humor

Our sense of humor can help us easily overcome minor problems, resolve small conflicts and quarrels, and generally make life more enjoyable. When a person has a sense of humor, a touch of irony and self-awareness, they are often perceived as being easy to love and cherish. Therefore, even if you are not naturally funny, you may want to remember some jokes and funny stories to draw people closer to you. However, a forced sense of humor may also be petty repulsive, so don’t overdo it.

 

9. Patience

Patience and restraint can be expressed in everyday life in all kinds of ways: if you can wait in line without whining and trying to push your way past, if you stubbornly avoid falling into life’s many obstacles, and if you know how to strive steadily to achieve your goal - you have patience. People find this attribute very attractive. If you haven’t been blessed and your patience tends to be very short, it is highly recommended that you work on it.

 

10. Optimism

It’s always nicer to be around a joyous person who radiates happiness. In order to adopt infectious optimism, you have to start seeing the good in life and know how to enjoy the moment. An optimistic person helps others and encourages them not to give up and stick to their goals, and, in doing so, brings them closer. When you are in a relationship, this approach will help you and your partner see all the little problems and troubles as smaller than they seem at first, and this feeling can strengthen the relationship and make your partner stick with you for the long run. Like

 

11. Likeability 

When given the choice between a sulky, angry, and sarcastic person and a calm-headed, forgiving, and compromising person, all would choose the latter. Likeability is part of the vast majority of traits that we’ve talked about so far, but it is also a trait within itself. Even a small smile will make others feel warm and happy –so start spreading them around and no one will be able to resist your charm.

 

12. Politeness and respect

If you can remain polite and calm despite provocation it is a priceless gift. We may disagree with people, but we do not have to be disagreeable. Impolite words and deeds, disrespectful gestures and utterances burn the bridges, which you might have to cross again in future. Walking out of a controversy with your head held high after politely putting your point of view is an art worth cultivating.

I choose my friends very carefully with the selfish motive of learning something good from them. I do not find all the traits in all my friends, but they end up forming a very beautiful kaleidoscope of personalities and I try to imbibe the good bits from everyone, even without their knowledge. By simply listening and watching people we get the opportunity to learn and improve.

TARIFFS - TRADE TACTICS OR TRUMPIAN BLUNDER

 

 

At times it seems Trump doesn't know what he is up to? He is driving the bus of U.S economy through a dense fog, with nil visibility and absent GPS. If it tumbles into the ocean of recession no one will be surprised. Yes, he will succeed to bring a high Richter scale convulsion in the world economic order and decimate globalization once and for all. 

The mighty solitary pole of the unipolar world is travelling down an unsustainable path of large fiscal deficit, spending more than earning, high current account deficit, consuming more than producing and an ever increasing debt to GDP ratio. A course correction was long overdue. His plan is simple - correct current account deficit by imposing tariffs on imports, reduce fiscal deficit by Musk' DOGE hit on wasteful government spending and bring stability to the debt-GDP ratio through a sovereign wealth fund and a reevaluation of gold reserves. The ideas are Clinton's, but a lot more radical leading the U.S towards stagflation and the rest of the world towards recession. 

 

He said the countries of the world, allies and enemies alike, are all out to take advantage of America's goodness and are ripping off the U.S economy by high tariffs, currency manipulation and trade barriers. If I am to quote him he feels America is being "looted, pillaged, raped and plundered by nations near and far, both friends and foes alike". So, what was his answer? Reciprocal tariffs, which were country specific, the more the trade deficit U.S suffers the higher tariff the offending nation faces. 

 

But will that not increase the cost of virtually everything in the U.S market from toys to clothes to cell phones to cars. America has stopped manufacturing most of them since ages, so does Trump expect these factories to mushroom overnight?

 

Trump thinks that higher tariffs will incentivize foreign and domestic companies to establish factories in the U.S and create employment opportunities. This resonates well with Trump's core vote bank, the blue collared working class Americans that have seen thousands of factories close, and large part of their once industrialized states convert into rust belt with shuttered industries, dying towns and depleting population. However, even if car manufacturers and machine tool and cell phone makers set up factories in America, in the age of AI and robotics are the good old golden days of manufacturing expected to return with bountiful employment opportunities?

 

Another miscalculation which Trump plan has is the U.S will earn $600 billion in tariffs, which will reduce their national debt, which today stands at 123% of their GDP! Lowering imports, because of higher tariffs will also reduce the trade deficit with their trading partners, he argues. Someone should tell him that his ideas will surely lead to worldwide recession and trade wars and Americans will not remain insulated from this impending economic disaster. 

 

All along he was telling in his election rallies and even today he continues to believe that tariffs will cause momentary price hike but the rich will be harmed and the poor will be benefitted! His MAGA supporters have no reason to disbelieve him because the stock market has tumbled, the Wall Street is running for cover and the MAGA crowd is cheering, oblivious of the fact that their own cost of living has gone through the roof! If Wall Street experiences pain long enough, the Main Street will feel it soon. 

 

Trump's class warfare is against the Elite America and the Global Elites. The MAGA followers know it is accompanied by pain, higher costs, shortages and inflation. But, the price is worth paying, they feel. Short term pain is worth long term benefits - more employment and better life! MAGA now has a President who can screw the Wall Street and the Global Elite and stand with working class Joes! Excuse me, but who exactly are Trump and Elon Musk if not global elites?

 

Trump has repeatedly told the blue collared Americans that they are victims of bad trade deals, off-shoring of cheap labour, starving the homeland getting work done at slave wages in China. As if that was not enough, illegal immigrants from Mexico, Central America and Asia are picking up the farm and factory jobs in the mainland at much below mandatory minimum wages.

 

No one except Trump could understand the logic of his varied reciprocal tariffs - 125% on China, 49% on Cambodia, 48% on Laos, 46% on Vietnam, 44% on Sri Lanka, 37% on Bangladesh, 32% on Indonesia and 26% on India! His insanity is best seen when he imposes 10% tariff on Heard &McDonald Island which has only penguins and no human beings. Perhaps he is charging the island for using his first name!

But, hang on; is there a method in his madness? Why is this 90 day pause on imposing tariffs on every country except China? By announcing mega tariffs and then postponing them the US President is acting like the thresher shark which stuns the shoal of sardines with a tail slap, before gobbling them up. Now more than 50 countries are, according to him, ‘licking his ass’ to renegotiate trade deals!

 

The trade war has already started. China has imposed a 84% tit for tat tariff on U.S goods. It looks like the world's biggest buyer U.S, and the world's biggest seller China, who together account for 40% of world trade, do not want to do business with each other. How can this be good for the post globalization global supply chain which turns around these two important cogs?

 

Different countries will be differently affected and right now Canada and Mexico, the two immediate neighbours, whose economy are heavily dependent on American consumers, seem to be facing the worst case scenario. Europe requires U.S to provide it security guarantees that subsidizes its welfare state economies. As their sclerotic thought process will not allow them to have an imaginative understanding with Moscow and lower their defense spending, they will remain easy target of Trump’s blackmail. 

 

Every crisis is an opportunity waiting to be exploited. Brazil, which is only second to the U.S in agro-trade, has an opportunity to sell more beef, soybean, oil and iron ore to China and footwear to the U.S. How will India use this opportunity? Higher tariffs on our competitors in textile and garment industries (China and Bangladesh) and electronics and telecom (Vietnam and Thailand) are opening opportunities for us but pharmaceuticals, agro products,  diamonds and jewellery will require renegotiation. 

 

With top companies of the world, Apple, Nvidia, Meta, Google, Microsoft, Amazon,  Netflix and Tesla, the U.S already enjoys a privileged position in world trade, with the best business minds calling America home. The USD is world's reserve currency. This irresponsible trade behaviour raises serious questions about the reliability of the USD as a favoured currency for conducting international trade. By weaponizing the dollar in the form of Sanctions against its strategic enemies, the world is already looking for an alternative. China, Russia, India and a host of other countries, almost 45% of the world’s population can and are trading in alternative currencies. China-Asian bilateral trade is already over $900 billion and with higher tariffs in America these intra regional trade options will become more frequent. 

 

Trump wants to leave behind a spectacular legacy, but a long standing recession in the U.S and in the rest of the world will surely not be anything worth boasting. Goldman Sachs has raised the probability of U.S recession to 35% and J.P Morgan Chase has predicted a 60% chance of global recession this year. High inflation is a distinct possibility and if the Fed raises rates, economic slowdown may become unavoidable. Economist John Kenneth Galbraith once said "when all else fails, immortality can be assured through spectacular errors". We are unfortunately witnessing one, and I am afraid, we have not yet reached the climax of this story!

REMEMBERING PROF. V.S. DAVE BY HIS LECTURE ON PARESTHESIA IN THE EXTREMITIES

 

The Neurosurgery Department in King George’s Medical College was always amongst the best teaching units of our Ammeter. It was started by Prof. P.N. Tandon way back in 1961, when just a handful of Neurosurgery teaching units existed in India. Prof. P.N. Tandon later moved to All India Institute of Medical Sciences. As Neurosurgery was a part of the Department of Surgery, its Head of the Department Prof. S.C. Mishra then handpicked Prof. V.S. Dave from Mumbai to run the new Department in K.G.M.C. in 1967. Prof. Dave was the gentlest of souls I ever came across. He was so soft spoken that in my residency days, even in his rounds we, the resident team, could hardly hear him. Only when he had to discuss a finding on the Carotid Angiograms, which we residents used to perform on all head injury patients, could he be heard teaching his residents. He was invariably dressed in white and always wore a starched white apron and was extremely kind to patients and their relatives. Though Neurosurgery those days had very serious patients and was very busy, he and his 2^nd. In Command, Dr. D.K. Chabbra worked tirelessly without looking at watch. His dedication and his diligence were infectious and easily trickled down his team.

Prof. Dave and his team performed all kinds of Cranial and Spinal Surgery. Pitutary surgery, ICP Monitoring, Minimally Invasive Cranial and Spinal Neurosurgery, Brain Tumor Surgery, Spinal Tumor Surgery, Brain and Spinal Trauma Management, Surgery of CV Junction Anomalies, Neuro Vascular Surgery, Micro Neurosurgery, Pediatric Neurosurgery (Meningocele, Encephalocele, Hydrocephalus etc.) were all performed in the Neurosurgery Department. Skull base surgery was his speciality and he excelled in it. You have to appreciate that those were pre CT Scan and pre MRI days and a good clinical examination and a carotid angiogram were the only two means of arriving at a diagnosis.

Prof. Dave used to stay in Rana Pratap Marg near the Botanical Garden and could reach the sick patient’s bedside within 10 minutes of a telephone call. He was always available for everybody. Even when there was an anaesthetic accident in the Ophthalmology OR, a request from his Ophthalmology colleague was enough to find him by his side within minutes. Availability was his hallmark and he was accessible to the junior most member of the resident team. He had a special bond with Dr. D.K. Chabbra and the latter could interpret his gestures and facial expressions and do exactly as the Professor wished. I have introduced you to Prof. D.K. Chabbra in one of my previous blogs: https://surajitbrainwaves.blogspot.com/2020/06/remembering-prof-d-k-chabra-today.html

Prof. Dave’s son Ajay is an ophthalmologist of repute.

 

I have been able to salvage a lecture on Peripheral Neuropathy or Paresthesia in the extremities, which was delivered to our class by Prof. V.S. Dave. 

Paresthesia is the tingling sensation or numbness, or sensation similar to pins and needles, experienced in the extremities – arms and hands or thighs, legs and feet. Often, as pins and needles, it is simply a benign consequence of undue pressure being placed on the body parts in question, such as leaning on one arm or crossing your legs for a long time. It is resolved as quickly as it appears when you remove the offending pressure, causing only mild discomfort, but no pain.  

The very same sensation can occur without any obvious pressure being applied. This paresthesia may be severe, episodic or even chronic (never ending). If this happens and is coupled with other symptoms, like

·        Pain

·        Itchiness

·        Numbness

·        Muscle wasting

then the tingling might be an indication of nerve damage. Such damage is called peripheral neuropathy, affecting nerves that are far away from the brain and spinal cord, usually in the hands and feet.  There are three categories of causation.  

1. Diabetes

Many people who are diabetic, the elderly in particular, suffer from peripheral neuropathy. There are in excess of 100 different types of peripheral neuropathy. In time, the condition worsens when left untreated, resulting in reduced mobility and possibly even disability. The major cause of peripheral neuropathy, in around 30% of cases, is diabetes. Peripheral neuropathy is therefore considered to be the first sign of diabetes. 

Since peripheral neuropathy, the underlying cause of paresthesia, in 30% of cases is a sign of diabetes, it is very important that if your patient has a history of prolonged paresthesia monitor his/her blood sugar levels.   Some common Peripheral Neuropathies in Diabetes are;

·        Peripheral symmetric neuropathy: This affects the feet and hands and is the most common form of neuropathy.

·        Autonomic neuropathy: This affects the nerves that control involuntary functions of the body, such as digestion, urination, or heart rate.

·        Proximal neuropathy: This affects the muscles of the hips, thighs, or buttocks and is also known as diabetic amyotrophy.

·        Focal neuropathy: This affects a single nerve, usually in the head, torso, or leg.

 

2. Idiopathic Cause 

In another 30% of cases of peripheral neuropathy, where the cause is not diabetes, no cause can be found, and they are thus labeled ‘idiopathic’. This may be the case more commonly in over the age of 60, and it progresses slowly. Patients often resort to over-the-counter pain medication for mild pain, but for severe pain, judicious use of NSAIDs and anti-depressants are prescribed. Therapeutic footwears can also be acquired which reduce symptoms.   

3. Unrelated causes

The remaining 40% of cases besides diabetic and idiopathic causes of peripheral neuropathy contain a wide variety of unrelated causes. However, the disease is very well-researched, and most of the time it is possible to diagnose the root cause of  paresthesia efficiently.   Besides paresthesia​, other nerve related condition are:

1.      Neuralgia: This is a potent stabbing or burning pain that occurs right along the nerve that has become damaged. It has many possible causes, such as shingles, diabetes, or multiple sclerosis.

2.      Radiculopathy: this is a disease of the spinal nerve roots. It can produce pain, numbness, and weakness at the spine area. 

3.      Carpal Tunnel: a syndrome of the hand’s median nerve, which has become compressed. It is located on your palm.  I have discussed Carpal Tunnel Syndrome in one of my previous blogs: https://surajitbrainwaves.blogspot.com/2022/04/carpel-tunnel-syndrome.html

4.      Mini Stroke (transient ischemic attack): unlike a stroke, which kills brain cells, this ITA, mini-stroke, does not. It does, however, cause similar symptoms to a stroke, and is the result of blood flow to the brain stopping for a period of time. This is considered a medical emergency that may well require urgent attention. I have a blog on Stroke and Mini Stroke: https://surajitbrainwaves.blogspot.com/2022/01/stroke-killer-mini-stroke-warning.html

5.      Spinal Cord Injury: This is a very serious type of injury, which may drastically alter your patient’s life condition and quality. It too will require urgent medical attention.  

6.      Other common causes include, but are not limited, to:

·        Cervical Spondylitis

·        Stroke (urgent)

·        Ulnar Nerve Palsy 

·        Panic Disorder

·        Intracerebral Hemorrhage (urgent) 

·        Guillain-Barre Syndrome (urgent) 

·        Stenosis of spinal canal

·        Spinal Bone Fracture

·        Alcohol Abuse / Alcoholism

·        Frostbite (urgent)

·        Vitamin Deficiency

 

 

Diagnoses

History: In order to be absolutely thorough, you will require a complete medical history of how the paresthesia or neuralgia started. Since medication is often considered a cause of tingling, history of any such medications, or vaccinations would be important. A detailed history of any infections or injuries the patient might have sustained may be vital.  A habit of asking a set of questions may be of help to avoid missing the diagnosis:

·        Numbness or tingling with no obvious cause

·        A pain in the neck, forearm or fingers

·        Unusually frequent urination

·        Numbness in legs which worsens on walking

·        History of a rash

·        History of dizziness, a muscle spasm, or something else unusual.

·        Weakness in limbs interfering with normal mobility

·        History of recent head, neck or back injury

·        Inability to control arms or leg movement

·        Lost bladder or bowel control

·        Feel confused and have lost consciousness for a

·        Speech is slurring

·        Vision is affected

Physical examination: A detailed examination of the patient, not restricting oneself to the effected limb, is vital. Which spinal levels are involved or which peripheral nerve is compressed and where is important to document. Any scar in the anatomical line of a nerve or any local tenderness should ne documented.

Investigations: Blood tests CBC, electrolyte levels, thyroid functions, toxicology screening and nerve conduction studies are required to establish the diagnosis. Perhaps a lumbar puncture and CSF examination may be needed. X-rays and angiograms, may clinch the diagnosis.   

 

Treatment

Treatments will be related to the diagnosis made of the cause of your paresthesia. If the peripheral nerve cells have not died they will regenerate and the patient will return to normal. For diabetes, good blood sugar control can slow down and reduce the progression of diabetic neuropathy. Those who, for example, have a vitamin deficiency can have their diet supplemented with more balance, which will also correct their peripheral neuropathy.    Maintaining an optimal weight by adhering to a regimen of diet and exercises and drastically cutting down alcohol and tobacco consumption will help. .If the cause of tingling is surgical like cervical spondylitis, carpel tunnel syndrome or other compression neuropathies then prompt surgery is indicated before muscle wasting sets in.

 

Thus ended Prof. Dave’s lecture on Paresthesia in the extremities. He would gently smile and quietly walk out of the lecture theatre with his Senior Residents and continue with his morning patient rounds. No fuss, no fanfare, always gentle and always held in very high esteem, Prof. Dave was a true Georgian role model. He was the senior most professor of Surgery in our Department but he refused to become the Head of the Department as he felt that would interfere with his true passion of teaching and training Neurosurgery residents and treating Neurosurgery patients. With no CT Scans, no MRIs, no neuroendoscope and with very primitive operating microscope, the Professor could do wonders by his sheer dedication to Neurosurgery and devotion to his professional duties.