CHRISTMAS 2015

Walking through the streets of Silva Nagar on Christmas morning you just can't help imbibing some Christmas spirit. I mean the figurative Christmas spirit. You can hear the shouting and laughter of the younger generation who have imbibed the real spirit and celebrating - after the midnight mass, at a distance in the adjoining football ground. It has become an annual ritual for me to change my walking course on 25th Dec to enjoy the festive look of the locality. And I try to capture some of the spirit  in my Sony and post it here. A bit early and it is too dark for the abilities of my camera, a bit late and the lights are switched off.  May be I was at the right time today. Got a bit of both. Here they are.

Before I write anything else, I declare that my knowledge of art is zero or less and that any feelings hurt due to the expression of my opinion here is unintended and deeply regretted. I am only expressing my ignorance  and what is written has nothing to do with the quality of art displayed in the Kala Academy, Panjim - Goa.

My wife had some work in Panaji and I drove her there this morning. It is the year end, a time when people go crazy over Goa for reasons best known to them. To top it Panaji is hosting the 46th IFFI followed by the feast of St Francis Xavier. Needless to say that the city is overflowing. All the roads are jammed and no place even to park your legs. I dropped her on the road in front of the place she intended reaching and drove around Panjim searching for a place to park the car. Found a place two kilometers away from the spot I had dropped my wife - at the Kala Academy, Panaji.  

Other than promoting art and culture the Kala Academy serves the humanity through two very useful ways. It has lot of parking space which is freely available for parking when there are no programmes in the academy and it has very decent toilets. Having parked my car in the parking lot, I walked in. The academy building was being 'done up' to host the forthcoming Film festival. I walked around watching the work going on, used the toilet and was walking towards the canteen  when I came up on some art work in metal which have been installed near the canteen. As mentioned earlier I can’t recognize a piece of art even when it is labeled and placed in front of me. Since these were placed at strategic locations in the Kala Academy building and had a brass plaque in front of them giving the name of the art and the artist I think they are valuable pieces of art. For my untrained eyes they look like random selections from a scrap yard welded together. But the trained eyes in the academy must have chosen them carefully, paid good money and installed them there. Here they are.

This is the first one placed near the entrance to the hall that attracted my attention. According to the plaque it is a 'Dancing girl'. To my eyes it does not look like a girl and if it is one certainly she is not dancing. By stretching whatever imagination I have at my disposal, I may call it a two legged being which has undergone some surgery to set right broken hands and the surgery has gone wrong. 

This is called 'Goat'. I would be happy if someone can explain to me why it is a goat and not a wolf, dog or a deer. I wouldn't suggest a cow because once you call it a cow, you can't dismantle and dispose it off. 

I did not find a plaque before this piece of art. May be I could not make out which was the front and which was the back and was looking for a plaque on the back side. 

I like this. This is called 'Adrift artifact.' Meaning things found adrift in a junk yard (?). I would have made it better by adding 'welded' to the name. A honest piece of art!

There were many  more but since I did not carry my camera and since my mobile phone is just that and not a good camera I did not take more pictures. 

After going through the art exhibition I must have walked in a daze for sometime and when I came to my senses I found myself at the boundary of Kala Academy, looking at this great piece of art. 

 I have a suggestion for the administration of Kala Academy. Sell the pieces as what they are - pieces of scrap, at Rs 20 a kilo.  Use a part of it to paint an arrow with the words “Art - This way” and lead the fluff headed art lovers like me to the boundary of Kala Academy from where we can witness a great art. The art of nature!

Taking one flight, Being twice foolish and passing through three security checks!

It is called the Swiss army officer’s knife or a swiss knife for short. It was a gift to me from my brother in law. He had brought it from Germany, when he went there for training thirty years back.  I had just then read about the knife in Reader’s Digest and was impressed with its quality and the effort that went into its making. If I remember right, every officer of the Swiss Army got one  knife at the time of his commissioning and it was part of his kit. So, when he asked me what I would like to have from Germany, I had asked him to get me a Swiss knife, if available and affordable. Incidentally the same evening he had seen a large scale working model of the knife in the window of a shop and he had purchased it with out looking at the price. I do not remember the price he paid for it but I know that he had to stretch his resources a bit to buy it. It has been with me ever since and has been a part of my luggage almost on every trip. Now, the red knife made by ‘Victorinox India’ is available on Flipkart in different forms to suit different budgets (Rs 250 to 5000) but it was not heard off then. This background is to explain the sentiment  attached to my Swiss knife. 

I make sure that I pack it in the check - in luggage when I take a flight but had made the mistake of  putting  it in my cabin luggage this time. So when the security officer at the Bengaluru air port called out “Sir, do you have a swiss knife in your bag?” I first said “no” and then a sheepish “yes”. My bag was handed over to me and I was asked to take the knife out.  Obviously, it was not allowed on the flight. I did not know what to do. I was in a fix and I was feeling stupid standing there holding the knife in my hand. Then the officer himself suggested that I put it in a bag that I may not need on the flight, go back to the check in counter and check the bag in. We had arrived at the airport early and we had plenty of time. We had about three hand bags with us.  I hastily selected one, took out some snacks that I had kept in it, put the knife in the bag, took it back to the check in counter and checked it in as an extra piece. I collected another boarding pass, came back, went through the security drill a second time, reached the boarding gate and sat there breathing deep.  I am always apprehensive when I go through the security check at the airports and this experience had shaken me.

I did not see my son and wife near the gate and I wanted to call them and find out where they were. Compulsion of carrying a mobile phone. It wouldn’t really matter to me where they were. They would come to the gate at boarding time. But when a phone is handy we call. It was then that I realised that my phone was not handy but was in the bag that I had checked in. And, it was not securely inside but was in the outside pouch! I had put it in the bag before passing through the security gate.  Immediately after that I also realised that I had kept my cash as well as the house keys in the same pouch just before going through the security check. All of them were now in the outer pouch of the bag which I had checked in and would freely flow out when the bag tumbled around on the luggage belt.  By then my son and wife joined me at the gate and I explained to them the foolish situation that I had put myself in. For once my wife remained calm. “Sit here and relax. If you really deserve to have the things that you have put in that bag, you will certainly get them”. My son said that since we now know that we can go back to the check in counter even after the security check, we may try to go back a second time and retrieve the phone, cash and keys.

I went back to the security area and feeling very foolish, explained my predicament to the officer there. He was very helpful. He said that I should go to the information counter, which is located in the boarding area, call the airline from there and see what they suggest. The information counter was unfortunately manned by an arrogant and adamant fellow who just tried to brush me aside saying it was too late to do anything now as the luggage would have been loaded onto the aircraft. I explained that my flight was due only after another hour and a half and that it had probably yet to land at Bangalore. I insisted that he call the airlines and allow me to talk. He grudgingly called Air Asia while I stood wondering what the response of the airlines would be.  When I got my chance, I apologetically explained the situation to the counter staff and was surprised to hear “No issues sir. You please remain wherever you are. Our staff will come and escort you back to check in counter. We will retrieve your luggage and you may take out your phone and keys. By the way, you have checked in three pieces. Which one would you like us to bring back?”  I described my bag and stood waiting.

A pleasant mannered girl arrived after ten minutes, confirmed that I was the fool who needed help and escorted me to the check in counter again. My bag was waiting on the table there. As I took out the phone, keys, loose cash and a cheque from the outer pouch of the bag they stood watching me possibly wondering how stupid one could get. I returned the almost empty bag containing my valuable knife to the counter staff, collected my third boarding pass, passed through the security check for the third time and returned to the gate beaming. 

It was an unusual experience and I wrote this to express my gratitude and appreciate the staff of Air Asia. Even though it was very foolish of me to do what I had done, they just behaved as if it was routine for people to leave their valuables in the check in luggage, unsecured, and return to the counter to retrieve them. This is also to inform anyone else who may be as stupid as I had been, that the check in, security and boarding gates are not one way (as I had thought) and that it is possible to retrace your way if necessary. You may look foolish but you can do it.

 

Audiometry

“ I have been speaking to you for the last two minutes and you are not responding at all. You have stopped hearing me’  -  this has been my wife’s complaint for over an year now.

“Oh, is it? I never heard anything. May be I am getting old”  -  My response.

“You are not getting old. You are just trying to be clever and it won’t work with me” -  My wife retorts.

This has been going on for sometime now.

Recently I had a bout of cold and fever and felt that my ear is blocked. I consulted the ENT surgeon. He did not find any block and he suggested that I undergo an audiometry test.  It was done today.

It says that there is some hearing loss but I hear better at low frequencies.

It is official now. I do not hear what my wife says and need not respond to her words. And if she is bent upon getting an answer she will have to stop shouting and speak gently (and lovingly) in a low tone!

I love Audiometry! 

Trip to Mantralayam

“GOD  for people who are not strong enough to cope with reality” said the post on face book with which I agree completely. I am one of the billions of unfortunates who can’t face reality and I depend up on GOD for strength or solace or whatever. I am not being sarcastic. That is a fact. And that is really what I feel about the concept of ‘GOD’.  I am happy that I am strong enough to stop at GOD and not weak enough to lean on GOD MEN too. But there is an exception. Sri Raghavendra swami of Mantralayam. I lean a lot on him and recently I felt an urge to visit him at Mantralayam.  We made the trip last week. Here are some of the pictures of the trip.  I now realise that ‘Rayaru’ is not there in any of them. For that matter nothing else other than our car the road and us. Anyway, I posted them and you may glance through if you feel like. 

We  started from Ponda at half past nine and drove almost non stop till lunch time. Took the car on to a side road somewhere between Belgaum and Bagalkot. We thought that we will have a picnic lunch in the cool shade but found that the shade was cool only from a distance!
   

The inside of the car was cooler than the shade and so preparing to have a 'darshini' type lunch.

The road was smooth and straight and the evening cool. Hardly any traffic. The driving would have been a pleasure if only the road was devoid of speed breakers. The sadistic government of Karnataka has built unmarked and hazardous speed breakers every few kilometers just to make your journey a torture. Here, we take a tea break. 

The driver poses with the critics who have counted fifteen near misses till now.

I did manage to drive 500 kilometers at a stretch and we did reach Mantralayam in spite of the final test. A great 45 km pot hole which is called the 'National Highway' between  Raichur and  Mantralayam.

On the way back Akshay decides to take over and try the Indian roads.

The back waters of the Alamatti dam

Cool evening, clean air, growing crops and the bullock cart. I don't mind the life if time to time rains, pest free crops and good price for the produce were assured. 

The Mudagal fort.

The journey is almost over. We are back near Belgaum as the sun sets on the second day.

Side benefits of the trip (The only benefits?) Pomegranates and Papaya from Bagalkot and Custard apple from Belgaum.  

"Copies of PAN card and Four Photograaphs Please"

We had a temporary power connection provided for our house in Bengaluru when the construction was in progress and I wanted it to be regularised. I approached BESCOM which takes care of power supply to Bengaluru, rather, power shutdowns in Bengaluru, with a request to that end.

“Submit the application along with  1.Two copies of saledeed  2. Two copies of ‘Khata’ certificate 3. Two copies of ‘Khata’ extract  4. Two copies of tax paid receipt  5. Two copies of plan sanction order and Four passport size photographs .”

I have all the requirements except for the passport sized photographs and will have to get another set. About two years back I had my picture taken and got twenty four prints. I was fifty eight then. I had retired from service, my practice was ten years old and set, my house in Goa had been constructed and occupied, children had completed their education and were employed, my LIC policies had matured, my car loan had been repaid, I had no intention of opening any more bank accounts or taking loan from any agency -  in short nothing that would require copies of ration cards, driving licence, PAN card, photographs so on and so forth. I thought there was no need for so many prints but got them done just because the difference in cost between eight prints and twenty four was almost nothing. I thought that those twenty four may remain with me forever.

They did not last even six months!

You go to buy vegetables in the market and the vendor will ask for your PAN card, voter ID and two copies of passport size photographs. You get into a bus, the conductor will ask for photo ID and photographs. Go to a hotel and at the check in counter you need to provide photo ID and photographs, I register for a conference and have to give the organisers my ID copy and two passport size........  . I have had my picture taken twice after the twenty four that I have mentioned above and right now I have not got a single print with me. If my wife asks for my Photo ID and two passport sized photographs before serving me dinner today, I will have to sleep on empty stomach. Good for health, they say, anyway.

My bank account is thirty years old. They already have my PAN card, voter ID, Adhar card, ration card and what not as part of their KYC programme. Still,  when I go to open a RD “Sir, PAN card and photographs”, I want my mobile number to be incorporated with my SB account “Sir, PAN card and photos”, I want facility of net banking “PAN card and copies of photograph, sir”. I have fought with the bank clerk any number of times and have ultimately capitulated. Me -  “You already have everything that you are asking for under your KYC programme” .  Clerk - “Yes sir, but that file is with the head office and the system does not accept if I don’t scan PAN card and photos”. You can’t beat the system.

Today I went to the sub registrar’s office to register a power of attorney and the sub registrar wanted copies of driving licence, PAN card and two photographs.

The demand for my photographs is never ending.

This time I will have forty eight prints made. I will keep four of them in the bank locker and enter it in my will - to be used only when the attendant at the crematorium says “Adhar card copy and four passport size photographs please.”

I don’t think anymore photographs would be required thereafter.

Rain, Rain gauge And Ganesha Chaturthi

When we put up a fabricated structure to cover a part of our compound space, the fabricator had to leave spaces here and there to allow the electric wires, telephone cables and TV cables to pass through.  Rain water was flowing through these gaps and to prevent that we did some ‘Jugaad’ and managed to close most of them.  Still, one spot remained open and drops of rain fell into our portico. I managed it with another simpler ‘Jugaad’, which, in this case, is a bucket placed to catch these leaking drops. This bucket is my rain gauge. I empty it every morning and from the amount of water collected in this bucket I can measure the rain fall on my house as accurately as the meteorological department.  For most of this rainy season the bucket remained dry.  A week back the weather department announced that the monsoon has retreated and that the rain fall this season is deficient 25%. Tomorrow is Ganesha Chaturthi and I have hardly seen a rain free ‘chaturthi’ here. I thought this may be one.

 

 

Ganesha chaturthi is the most widely celebrated festival in Goa. It is a big issue here. From all points of view - religious, social, commercial and political. The bazaar starts buzzing with ‘chouti’ related activities at least a week or two before the festival.  These activities peak two days preceding ‘chouthi.’ There is a tradition of decorating the ‘mantap’ (‘matoli’ as it is locally known) with locally grown vegetables as also wild fruits, flowers and leaves.  In Ponda, the main bazaar road is closed for traffic two days before ‘chouti’ and the street is fully occupied by people selling and buying these things. It is called the ‘matoli bazaar’.  The bazaar began yesterday and it has been raining without break since then.  My rain gauge has recorded 3 cms of rain since yesterday. I hear that people are having a tough time shopping for the festival. The rain, which should have been welcome, is being cursed.

Since I hardly have anything else to do, we have finished our purchases days ahead of ‘chaturthi’ and I am now sitting waiting for my wife to finish her preparations and begin the Gowri pooja. I am the officiating priest and am under strict orders not to leave the room before I finish my task. I am sitting  snug enjoying the rain and using the time to type whatever occurred to my mind.

Goa badly needed rain and I heard that some people performed a ‘Yagna’ at the ‘Brahma’ temple last week.
They should have prayed for rains to begin AFTER Ganesha Chaturthi.

  

Teaching Dentistry - My Patient Education Programme

Most of my patients think that the ‘gum’ is a block of flesh and the teeth remain stuck in it somehow or the other. A tooth starts paining when a cavity goes deeper and touches the ‘flesh’ below.  A ‘filling’ is something similar to what a mason does. The mason mixes some cement and plugs a hole in the wall and the dentist mixes some cement (many may even be thinking that it is the same cement) and plugs a hole in the tooth. A ‘fixed’ tooth is somehow glued to the gum or tied to other teeth using some wires.  All these may sound idiotic to a dentist but I understand. My knowledge of an electric transformer or a petrol engine or a TV tube would be equally bad if not worse.  I should be least bothered about what my patients think as long as they get the treatment done and pay my fee. But I have a defect. Rather, I have many defects and one of them is trying to make my patients understand what the treatment involves. I spend considerable time and use a variety of teaching aids - a skull and mandible, plaster of Paris working models, plastic exhibition models, extracted teeth and on the spot drawings to achieve my goal. I give detailed explanations about impactions, dentures, RCTs, bridges, braces and what not and at the end, usually receive a bored expression and a blank stare for my efforts. But I persist.

My teaching aids. Ever seen a roadside dentist? His spread on the footpath to advertise his profession is exactly like this.

Recently we had an unusual case in the clinic where in a boy came in for braces to correct his alignment and the x ray showed an impacted canine (unerupted eye tooth stuck in the jaw bone) in the upper jaw. Since it could give rise to complications later in life and since it was mandatory to get rid of it before proceeding with orthodontic treatment (Braces), we decided to remove it. It was a big tooth, and it would have left a big hole in the jaw after removal. It would have taken a long time to close up. Hence, our young surgeon Dr Saurabh suggested that we remove a piece of bone from the chin region (lower jaw) and pack it (graft) in the hole after removing the canine tooth in the upper jaw. The procedure which can be called “extraction of an impacted upper canine followed by autogenous bone graft” was planned.

This is an X Ray of all the teeth in the mouth, known as orthophantamograph. OPG for short. Tooth C is the central incisor, L is the lateral incisor M  is the milk tooth and Ca is the impacted canine. In the normal course this Ca should have pushed the milk tooth out and taken its place. But it changed course, came between the two incisors creating trouble and forcing extraction (removal)

This is a CBCT (Cone Beam Computed Tomography) of the area marked in the other x ray. Something like a CT scan. Gives much more information than an OPG and helps in accurately locating the structures - in this case the canine. Makes the job a little easy for the surgeon.

Opened up the place where the canine is expected to be hiding. The 'gum' is not a mass of flesh. It is a tissue layer about 2 mm thick and covers the jaw bone inside the mouth. Two cuts are made on either side of the operation area and the gum is peeled and pushed up exposing the jaw bone.

The jaw bone is scraped off with a surgical drill exposing the impacted tooth lying underneath. What is seen is about one third of the tooth called the crown. The root, which is two thirds, is not exposed and is inside the bone.

The exposed part, the crown, is cut, separated from the root and taken out

The root as seen after removing the crown.

Root is pulled down into the space crated after removing the crown and is taken out.

The hole in the jaw after the removal of the tooth





What you are seeing here is the cut made to reach the chin bone. The cut is behind the lower lip in front of the lower front teeth 

The rectangular 'window' seen above the retractor is the place from which fragments of bone are removed for grafting.

Bone fragments (graft) placed in the cavity earlier occupied by the tooth

The cut behind the lower lip is sutured.

The cut made for removal of the impacted canine is sutured.

As a surgery it is not something great but it was the first time that such a procedure was being done in my clinic. I was excited as well as apprehensive. Cutting open the upper jaw was compulsory. Cutting the lower jaw was optional. Patients get jittery the moment a knife comes into picture. We were suggesting an extra cut which was not a necessity though beneficial to the patient.  The parents seemed to understand.  Saurabh as usual was confident. We did the extraction and graft. It took two hours. The boy bore it bravely. The parents were scared to look at the procedure and spent the time worrying, watching TV and napping.  It is a week since we did the case and the boy is fine. I had taken pictures at different stages so that I could explain the procedure to his parents and since I had the pictures, thought of posting them here. There is no reason why anyone should be interested in the gory details of my profession but you don’t know. This is an era where people are interested in gory details of everything. Whatsapp brings you all the gory details of an accident or suicide and TOI is full of a murder which took place three years back. This is far better. If you happen to be one of the interested, and have gone through the post, please let me know if you could make out what was done. That would help me rate my capabilities as a teacher, and if so mandated, put an end to my stupidity of trying to teach dentistry to my patients.

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,

To,

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?

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