Sunday, August 9, 2015

An Irritation

Usually I try to accept this world as it comes. There are many things that I like and some that I don’t. But there is nothing much I can do about them. I try to appreciate and enjoy what I like and gloss over what I don’t. Some people, some attitudes, certain behaviours, some of the happenings irritate a bit more. I am sure that me and some of my actions are a source of irritation to many. We (I mean all of us in this society) usually share these likes and dislikes with those who have similar views and get it off our heart. I also put some of them down in this blog. They may not merit a mention anywhere but I feel better once I put it out of my head. This was one such irritation. Sorry for a grouchy post.

The referral letter said,

Dr Raghunandan,

Ref  Mr XYZ , with periosteal abscess for needful.  Treatment Given, Baycip TZ 1+1 and    
 Mahacef 200  1+1. 
Sd  Dr ABC

This letter was from one of my medical colleagues and was brought by a patient with a swollen face and tooth ache.

I have great regards and respect for all my medical colleagues.  It is a fact that they have a better qualification, a better understanding of the human body and its functions, and are much more capable in dealing with it.  At the same time it is also a fact that a majority of them hardly have any knowledge of dentistry.

(When I was in my final year BDS, there were a number of my higher secondary batch mates who were in final MBBS.  They were doing clinical rounds in various departments and they had a fifteen days posting in dental college. Usually the dental posting was considered a lean time during their grueling clinical schedule and it provided them with a chance to catch up on the morning shows in the ‘Apsara’ theatre next to our college.)

This patient reported to the doctor with tooth ache and swelling four days back. He was given Ciprofloxacin + Tinidazole. Patient returned after two days with increased swelling.  Cipro+TZ was discontinued and Cefixime started. Another two days and the patient came back with an even bigger swelling and unbearable pain. That was when he was shunted off to the dentist.

 It was an abscess alright but not periosteal abscess. We call it alveolar abscess. And evidently, both the antibiotics prescribed were not at all necessary and absolutely useless.

The patient spent four agonizing days and a considerable amount of money, which he could ill afford, on consultations and medications which were not at all required in the first place. A daily wage worker, he missed work and consequently the wages for all the four days.

I drained the abscess and I will have to extract the tooth sometime later. If I had seen the case first, I would have removed the tooth then and there and the patient would have been fine within a few hours and with two pain killers, if at all.

The doctor knew that this was a dental infection, did not have the required knowledge or skill to treat it but still attempted and persisted in treating it with medicines which were not at all indicated.

This is not a stray case. I am writing this after seeing many such cases in my clinic. I can understand a practitioner prescribing medications for immediate relief before referring the case to the right person. But I can't understand this persistance.

Why do they attempt/ feel compelled to treat these? It certainly is not ignorance. Is it the fear of losing a patient? Is it because they feel that it is a ‘mere dental infection’ and nothing beyond their capabilities? Is their ego coming in the way of referring the case to a dentist straight away? What is it?

Saturday, August 1, 2015

Nagesh Maharudra Temple at Nageshi, Ponda.

Our swimming pool is closed for maintenance since the last fifteen days and is expected to remain closed for another month or so. Some of us, the addicted ones, now infest the temple pond of Nageshi at Bandora, Ponda. I have visited Nageshi a number of times but the greenery of the rainy season, the overnight rain and the early morning fog had given a refreshing  new look to the temple and its surroundings. I was tempted to take some pictures and post them here.  

The washed road to Nageshi and greenery all around.
Early morning fog covers the hillocks surrounding the temple. The tower seen amidst greenery is the temple of Shantadurga. 

Abode of Nagesh Maharudra. The rainy season grass covers the courtyard, provides a wonderful contrast and adds to the beauty. 
The inviting waters of the picturesque temple pond.

The green surroundings and the fish in the pond provide a break for the pool users from the monotony of the blue ceramic tiles. It is a pleasure to watch the fish swimming under you. The bigger ones which are capable of biting your fingers off  remain stationary at the bottom and stay put till you stretch your hands.

And if you are lucky you may even find a colourful water snake keeping you company. They are supposed to be harmless and non poisonous. (Till they bite you!) My friend Triambak was the lucky one yesterday. 

Another view of the pond

Monday, July 27, 2015

Ashaadha Ekaadashi

One of my friends on FB wanted to know about the importance of Ashadha ekadashi .  I did not know either. I felt that whether I follow our religious practices or not, I should have some knowledge about them. Searched the net, used whatever brains I have and came up with the following information.

A day in the life of gods is a year for human life.  The ‘Uttaraayana’ and ‘Dakshinaayana’ which are of half a year duration for humans are the day and night for gods.  Dakshinaayana is the night part. It begins in the month of ‘Ashaadha’ of lunar calendar. That is the time when lord Vishnu goes to sleep or ‘Yoganidra’. He is in Yoganidra during the first four months of Dakshinaayana  which are collectively called ‘Chaaturmaasa’.

We have a goddess responsible for day and another for night. I believe the goddess of night was unhappy that no auspicious activities were taking place during her time and felt that there was no need for her to exist.  Her sentiments were conveyed to Lord Vishnu. Lord Vishnu felt bad about it and assuaged her feelings by declaring that the benefits obtained by worshipping him during chaaturmaasa would be in multiples of what one would get by worshipping him during other times.  
Since Ekaadashi is considered the most auspicious for worshipping Lord Vishnu, Ashadha ekaadashi, the beginning ekaadashi of chaaturmaasa acquires greater importance.

Wearing the symbols of Lord Vishnnu namely the Shankha and Chakra, called the ‘Mudras’ is a must during worshipping lord Vishnu. Hence the followers of Dwaita philosophy have these symbols put on their bodies from the heads of their respective religious organisations on ashaadha ekaadashi. This process of preparing for the worship is the ‘Mudraadharana’.

I got the information I wanted and should have kept quiet. Now what made me write this and torture you?

Out of a whim, I decided to fast on one Ekaadashi day few years back. (What is so great about fasting for a day? I can as well do it- feeling) I decided to fast for 24hrs, remained without food since morning and was miserable by evening. I could not think of anything other than food.  I gave up, had my food and slept. Then I took it as a challenge but did not have the guts or willpower to try another 24 hrs. So I decided to partially fast half a day. For the past few years I have been successfully following it. It is not a fast actually. Can call it disciplined eating.  I have a cup of coffee and two biscuits in the morning, Some snack at mid day and end it by 8 pm. But strictly no tit bits which I otherwise keep popping into the mouth the whole day. Still it is difficult. I can manage fairly well if I am totally occupied in the clinic or elsewhere. If I have nothing to do it gets worse.

It has been raining since two days and there are hardly any patients in the clinic. And today is ekaadashi. By writing this I could keep myself occupied for more than an hour.  Another half an hour and I am done.  What started as ‘ekaadashi’ has turned out to be ‘Roza’. 

Monday, July 13, 2015

Concern or Interference?

The little girl hesitatingly followed her mother into the clinic.
“She has tooth ache since three days”
I asked the child to sit on the chair and just as the girl attempted to climb on to it, her mother lifted her and placed her in the chair. I went closer and bent down to address her.

“What is your name?”
The child was shy and took time to answer.
“Tell me, what is your name?”
“Her name is Tanvi”  - The mother intervened.
I ignored the mother and addressed the child again.
“Which standard are you in?”
“She is in third standard” Mother.
“Which school do you go to?” I tried to engage the daughter in conversation once more
She began falteringly “ I … I….go to Vidya…” 
“She attends Vidya Vikaas High school” -  The mother

I asked the mother to allow the child to speak. “You tell me” I asked the child again “which school do you go to?”
“Vidyaa Vikaas primary section” came the correct answer.
“Does your tooth hurt?”
The child nodded her head in answer.
“Which tooth?”
Again, the girl took time to reply. The mother could not hold back “See, this tooth” She tried to pull open her daughter’s mouth to show me the tooth.

I called the mother aside.
“Madamme, I can understand your concern but please allow your daughter to interact with me. It is important if I have to treat her.”
“But I am afraid that she may not explain things properly. She doesn’t know what to tell you and forgets everything.”
“That is Ok. I will manage and if I need your help, I will certainly ask you.”

I addressed the child again. “Which is the tooth that is hurting”
The girl pointed to the offending tooth. 
“Does is hurt always? All through the day?”
Now she answered. “No. It hurts only when I eat something”.
“Shall I see the tooth? Please open your mouth”

I examined the child. Told her what I intend doing and asked her if she wants me to treat her.
She nodded again.
“I want you to say it aloud.”
“Yes” came the answer.

Then I fixed an appointment and noted it down in my diary.
Now I asked the mother. “Please give me your telephone number”
“Mobile or land line?”
“Whichever, Some number to contact you if required”
“8873…….  No, 88763……. I am sorry, 88673…….. ‘Che’, 98673……… one minute” she opened her bag and tried to find her mobile phone  “oh, I forgot to bring the phone also.”
The child pulled at the mother’s saree “Mummy it is 8867..”
“You keep quiet, don’t interrupt me now”
 “Forget it” I said.  “Note my number and call me from your phone. I will get your number. Give me the landline if you can.”
“Ok. 2314….. Sorry, 2334…… Oh god, we changed it recently and I .……”
A shrill voice rang out confidently and clearly from her side, “8867345342 and 2314563.”
I looked down. The child was beaming .
“Good” I exclaimed and looked at the mother. With an effort I held myself back from saying “See, she can do much better than you”

“I always forget the phone numbers” The mother tried to cover up, sheepishly, and walked out hurriedly pulling her daughter behind her. 

Saturday, July 11, 2015

The Chief Guest

One of the Ponda high schools decided to felicitate the students who did well in the recently concluded SSC exams. A friend of mine is the chairman of the parent- teacher association of the school and he had taken the task of finding a chief guest for the function. He had contacted few people of eminence but had not been successful roping in anyone. He said that he will have to compromise and will have to make do with any knick-knack who was available. And the very next moment he exclaimed “Hey, YOU can be our chief guest.  You are a doctor and you have grey hair. Enough. Shed your hanky-panky half pants and T shirt for a day. If you dress decently you may really look like a chief guest.” So, I was the chief guest for the felicitation programme.

I reported to the venue ten minutes before time as directed.  The peon was setting the stage and some students were arranging the chairs. One of the teachers saw me, took me to the HM’s chamber and locked me in, preventing attempts at an escape. I spent the next forty five minutes memorising - from various charts hanging on the wall - the names of the past presidents and secretaries of managing committee, number of boys and girls in each class, weekly timetable of all teachers and the school prayer and its meaning.

 When the number of people in the hall had reached a respectable figure, I was taken to the hall, made to sit on the stage and was handed over a bouquet. I had to sit still, listening to the usual welcome song, (surprisingly sung very nicely with accompaniment of the harmonium and ‘tabla’) welcome speech and the introduction of the guest. (going by the virtues attributed to the guest, the person about whom the gentleman was speaking was certainly not me). Then the list of students receiving the prizes was read out and I was asked to stand and handover prizes. This I did commendably, like a seasoned politician, facing the camera with a smile, balancing the certificate, trophy and the flower in one hand and shaking the hand of the student with the other. Soon afterwards I was asked to say a few words for the benefit of students.

I had spent sleepless nights preparing for this speech. But I had prepared well, lining up quotes and anecdotes and had taken trouble to plan and rehearse what I intended saying. After a minute or two of forgetting everything and stammering, I got back my nerves and spoke confidently - like a real chief guest. I even felt like one. By the time I finished, I was thinking that the school did the right thing inviting me and the students were lucky to hear a speech like that. I really thought that my speech must have been of some value to them. I finished with a flourish, to a loud applause.

My speech was appreciated, I was thanked, handed a memento, offered a cup of lukewarm and very sweet tea and discharged. I returned home walking on the clouds, carrying the bouquet and the memento. I was feeling great.

My father in law who was visiting us, was sitting in the armchair reading the news paper when I returned. He was surprised to see me ‘decently dressed’ and walking in carrying the bouquet and the gift.

He raised an eye brow. “What is special today?”
“I was the chief guest for a function in the school”
“You were what!!!???”
“The chief guest”  
“Ha, Ha, Haaaa and did you make a speech?”
“How long did you speak?”
 “About fifteen minutes”
“People sat through the speech?”
“Of course”
“And they gave you this?” He pointed at the things in my hand.

“They needn’t have taken the trouble. Sitting through the ordeal would have been kind enough.”

Sunday, June 28, 2015

Tamdi Surla Revisited

Starting point - The 13th century 'mahadev' temple built by the Kadambas, now being maintained by the archaeological survey of India.

The first few hundred meters are fine. Easy going path. Cool breeze. Chirping birds

Cool streams with clear water

And then the obstacles start - crawling underneath over grown shrubbery and catching leeches all over the body

Trying to step over fallen bamboo stems - trying our best to avoid cuts and scratches 
 Climbing  over when crawling below is not possible and learning that crawling and catching leeches was better  
and negotiating slippery rocks at the final stage

In spite of getting rid of leeches with salt, one stubborn leech remains gorging on my blood 

and then the falls!

Forgetting all the hardships and enjoying the chilly shower before filling the stomach and returning.

Points learnt from the latest trek,

The reception committee of chirping birds which you find at the beginning is nature's way of fooling you. The real committee consists of hungry leeches and mosquitoes.

Better add a tube of insect repellent, 'Koito' ( Scythe - this is  to cut the over growth coming in your way but will be handy if you try to kill a mosquito. If you see their size you would think twice before trying to kill them with bare hands), a rope and a stout stick to the list of things to carry.

The path climbs and dips putting considerable strain on your heart, lungs and joints. Service them before you start.

Streams which look six inches deep are always one and a half feet when you step into them.

The over grown branches which you carelessly try to  swipe aside with your hands always have thorns on them and those which you try to kick aside never fail to trip you.

Hanging  overgrowth which are in the way are always at the height of your eyes irrespective of your height!

Nature always has an upper hand, however clever you are.

Monday, June 22, 2015

Extraction Under GA - A Recent Experience

Mr Raikar had a difficulty. Due to a childhood injury he was unable to open his mouth completely. And it was painful to keep his mouth even half open for more than a few minutes. Obviously dental treatment was a nightmare. I am sure so it was for his dentist. Raikar ignored all dental treatment, avoided dentists and lived a blissful life.  

Blissful life till his half erupted (impacted) wisdom tooth got infected. But now the tooth had to be removed. Immaterial whether the mouth was open or closed. He had consulted a surgeon and had been advised removing the tooth under general anaesthesia by cutting through the skin and reaching the tooth from outside. Raikar was worried. He came to me for a second opinion.

I took a look and felt that it may be possible to remove the tooth in the normal way, but under general anaesthesia. I called my young friend and budding Oral surgeon Dr Saurabh in whose capabilities I have a lot of faith. Saurabh was confident and highly enthusiastic. “You don’t worry uncle. I certainly can do it intra oral (Through the mouth). But if necessary I can go extra-oral too.” Then he added as a reassurance “If it comes to that, I can even take the jaw out, remove the tooth and put the jaw back”. Removing the jaw would certainly have ended Raikar’s trouble of not being able to open his mouth. He would only have to bother about closing it. But I wished it would not come to that.

The anaesthetist was consulted. Though she had some reservations about introducing the tube (tracheal tube - required to deliver anaesthetics and oxygen) into the throat, she felt it could be done. We scheduled the case. I was the assistant.

Hosa Chiguru HaLeberu kooDiralu mara sobagu - (New leaves and old roots make a great tree) New leave and old root of Dentistree

As it turned out the anaesthetist had considerable difficulty putting the tube in, had to struggle a lot, change tubes, increase dosage of drugs, but she remained cool and calm all the time and ultimately placed the tube in successfully. We had Raikar under anaesthesia. His pulse and pressure were normal. My pulse and pressure were rising. Saurabh had difficulty at all stages. Keeping the mouth open(Raikar's I mean), reaching the site, cutting around and releasing the tooth, so on and so forth. He had to call for extra assistants, change positions and help himself when I fumbled. But he performed commendably. I was standing there tensed, holding the suction tube in one shaking hand and irrigating syringe in the other. Saurabh had to remind me repeatedly that I am required to use them and assist him.  

Raikar had come to me because of his faith in ME. I had entrusted him to my colleagues in whom I had confidence. They were capable and responsible. But I was answerable to Raikar.

I was almost a nervous wreck when Saurabh exclaimed “The tooth is out, Uncle.” He gave me a look which said “Didn’t I tell you I would do it?”. I sat down and took deep breaths. Sutures were placed, Raikar was wheeled into the ward and was sleeping peacefully. The anaesthetist and Saurabh wrote their report, gave instructions, confirmed that the patient was fine and left.

I went to see Raikar in the evening. He was awake and fine. “Thank you very much doctor. I was worried that you may have to cut from outside and remove the tooth.” 

“Oh, you needn’t have worried” I answered nonchalantly. “I was sure that we could remove the tooth easily” I raised my collar and went out.