Wednesday, July 31, 2013

Post-Operative Differences and Wound Healing Dilemma’s

Post-Operative Differences and Wound Healing Dilemma’s

Continuing from where I left off in my last post, my mom’s had her surgery and she is in recovery. But I have a couple of issues with the choice of treatment for the post-operative period prescribed by her surgeon and hence I thought I would discuss my dilemmas in this post, with you. The first shock was when the nurses did an allergy test for penicillin allergy and I was flabbergasted (no other word to describe my reaction) on seeing the injection made with the test dose in the forearm to see if there is any reaction. I almost asked the nurse right out "Excuse me, in which century am I? Did I somehow slip back a hundred years or so in a time machine?”

For, as every child knows, penicillin was invented in the last century - even before the Second World War – by a guy called Alexander Fleming and it cured a lot of infections back then but it has been largely superseded by newer and better antibiotics over the years. Currently, we (any doctor who qualified after the millennium) prescribe antibiotic-cocktails based on genomic typing of the bacteria which does a targeted delivery of the lethal dose right into the bacteria's guts and hi-tech stuff like that. And here was a doctor who wanted to prescribe old school penicillin with its history of allergies and all. As everyone knows - any antibiotic or for that matter any medicine has the potential for being allergic to any individual ( we don’t know why but guess it’s genetic) but the safety margin is pretty high with the newer combinations which not only work better but are also far safer even when given in high doses.

And so I ended up having this big dilemma- should I step in and suggest a better (in my view) or newer antibiotic to my mom? And will it be considered an impertinence – by interfering in the work of another surgeon? Or should I silently wait till we got home and then discarding the penicillin shift my mom over to my choice of drugs? After agonizing over the decision like Hamlet, the prince of Denmark, I finally decided to let it go- that maybe giving penicillin was not such a bad trick after all, for just like us the bacteria's would not have seen it for an hundred years or so and hence the suckers wont realize what hit them when they get the penicillin- in rugby parlance- it’s called a hail mary pass or in our local chennai auto driver style- put indicator on left and turn vehicle to right and let’s see if the suckers can be caught unaware.

Besides all these antibiotics are given just for a day or two or three- the immediate post-operative period and only to prevent any infection- as a precaution to make sure that the bacteria don’t take advantage of the patients weakened body after the surgery. So any antibiotic including penicillin should be fine in that limited preventive role. With that thought in mind I decided to let my mom follow her doctor’s post-operative treatment plans and not interfere in it. Decision made- mind at peace.

My next dilemma arose when I realized that my mom’s doctor was not going to prescribe to her any supplements or nutrients for wound healing, as I personally prefer to do for my patients. I gather that the doctor has a personal preference of letting the wound heal naturally, waiting patiently for as long as it takes. But we of the modern generation prefer to give our post-surgery patients -vitamins like b-complex and vitamin c and other minerals like selenium, manganese and calcium which are needed by the body for wound healing. The old standby of giving sathukudi juice (sweet lime juice)/horlicks for wound healing is now only seen in films and television advertisements- not in real life.

There are even newer treatments being studied now - like platelet rich plasma and nano-drug spherules for wound healing, which promise faster wound healing by better nutrients delivery at the exact wound sites. These work on the simple premise that instead of wasting the nutrients in the entire blood stream it’s better to deliver it where actually needed- at the wound site where it will help in healing faster. 

As of now when we let natural wound healing take place, the cells in the superficial layer migrate over the gaping wound and close it in a matter of 5-7 days and that’s when the sutures- the threads which hold the two cut edges closely together are removed, because once the cells from the two sides join up in the middle to form a bridge over the wound there is no more need to artificially pull them close and hold them together tightly. 

But the bridge analogy still applies to the wound, for what might look completely healed to us (after one week) when we remove the bandages is actually only 20% healed -for the bridge is spanning over a wide abyss- and there is nothing underneath to support. The wound has just a small covering of cells closing it externally and underneath it there is still a big open wound and it takes anywhere from 21 days to 6 weeks for the entire wound to fill up with cells and heal completely and get its original strength back. It’s in order to assist this gap-fill and make it happen sooner -that the newer treatment modalities are trying.

The most popular wound healing research being conducted now is in the Platelet rich plasma technique. Our platelets - the 3rd type of cell in our blood other than the Red blood cells and White blood cells everyone knows about- are mainly responsible for wound healing and blood clotting. As such they contain lots of essential stuff for wound healing and hence a technique called platelet rich plasma is now being tried out in several labs which involves taking out our own blood out of our bodies and then filtering it to get the platelet cells alone and finally injecting them back into the wound area directly instead of waiting for them to travel through the entire body and reach the wound- which might take time. This treatment is still in the experimental stage as not many patients can stand the thought of their blood being taken out, filtered of its cells and injected back again into their bodies. 

So to come back to my mom, I have decided to add a vitamin b/c tablet to help the wound healing process along. Of course without asking her doctors permission to do so -which is wrong, I know, I know. But hey, it’s in a good cause right? And I believe every little bit matters when the intention is right. What do you think?

P.s. as my mom is getting discharged tomorrow from the hospital- my hospital series of posts is now at an end. Or maybe not - for I have one final post in mind about how corporate hospitals fleece unwary patients who don’t know any better. But writing it down…..won’t it be like biting the hand which feeds? Time to start my Hamlet Act again.

Monday, July 29, 2013

It Takes As Long As It Takes

It Takes As Long As It Takes

They say that doctors make the worst patients. But what they fail to add is that doctor’s relatives come a close second. Case in point is at my mom. A couple of days ago my mother had to be admitted to the hospital for a cholecystectomy, or in normal English, a gall bladder surgery to remove her gall bladder which had become blocked with gall stones. Like all patients my mom had plenty of questions and as the doctor we had chosen for her surgery being a hot-shot surgeon who didn’t communicate much to the patient’s I had to bear the brunt of the questioning. Here’s a sample:

Mom: Is this a good doctor?

Me : well, I guess so. I talked to some friends and colleagues and they recommend him as having the best success rate. 

Mom : so you guarantee he is good?

Me : well, you know, I cannot guarantee anything, even the best doctors have an off-day and things can be bizarre during the simplest surgeries but yours is pretty much a straightforward procedure, so we don’t have to worry much about the doctor.

Mom: don’t you know anything about this? Aren’t you a doctor too?

Me : of course I know a little about this – but only the theory part. And yes I am doctor too, but I am not this kind of doctor, my specialty is different. Not all doctors know everything.

Mom : aren’t all doctors supposed to know everything about diseases? Like for emergencies?

Me : yes of course – for emergencies, like there was  a plane crash in the Sahara desert and there is no other doctor for 3000 miles around, then I suppose I can do something about it. But right now we are in a big city in a big hospital with the best doctors treating you- so I will let the experts work on you and stay out of it.

Mom: will you be there? I mean watching inside?

Me : I would love to, but I would rather not. No surgeon will like it when someone else comes and stands beside them to observe them. especially if it’s a relative of the patient. They get nervous and we don’t want that do we? We want him relaxed and concentrating on your surgery alone and not on me. Besides each hospital has different policies and they usually never allow any stranger, including docs inside the operation theatre.

Mom: how long will this take? Is this a big surgery or a small one?

Me : it’s the smallest of surgeries. You should be done by an hour or so. But we don’t know what the doctor prefers – whether he prefers to work fast or slow. So depending on his technique the timing may change. We can’t say right now how long it will take- just make a guess.

Mom: ok how long will take for me to get well?

Me : the minute the thing is out of your body- you are getting well.

Mom : that’s not what I meant. Getting well from the surgery I mean.

Me : hmmm, like all wounds it takes about a week’s time after the surgery – for the wound to become strong enough to no longer need the stitches. But it might take a month to get back its full strength again. Why do you bother about that? Let it take as long as it takes. 

And on that note we ended our conversation. Sitting along with my mom in the hospital room while she rested - for my dad who is alternating with me, has gone home to change before coming back- I was bored out of my skull and thought I would write something for my blog to pass the time. It was either that or to play stick tennis again on my mobile phone and I am frankly getting fed up of the number of time that federer keeps beating me that I am sorely tempted to delete the game. And so arose this blog post composed of a view from the other side- the patients’ side. Watch out for more hospital updates in the coming days.

Tuesday, July 23, 2013

Chatting up Strangers

Chatting up Strangers – In the Triplicane Photo-Walk, July 2013.

 Yesterday I talked to a dozen strangers and a dog. I am not kidding, I really did. It being the third Sunday of the month I had gone to Triplicane- one of the oldest neighborhoods in old Madras as part of a monthly heritage walk where we walk the streets and take pictures of anything which catches our fancy. It’s an eclectic bunch who turn up for the photo-walk every month- a mixture of seasoned photographers, newbie’s with their first DSLR's, heritage lovers and historians and people who are just along for the exercise and to enjoy the early morning streets.

The photographers during the walk specialize in different things - some look for architecture-old heritage buildings and stuff, some specialize in taking portraits of people on the streets - walking about and doing their stuff, some interested in the busy early morning activities -the paper delivery kids or the tea masters, some in documenting the street names - which keep changing with every change of government and there is even one guy who shoots (with the camera of course) every stray dog he meets.

And people like I, who do a mix of all these things together because I don’t have a niche as such and just click whatever I fancy at the moment. But in my (admittedly brief) experience - the hardest hobby of all is shooting personal portraits as most people are either suspicious or shy or a combination of both when it comes to posing for photographs by strangers. Well, to be fair to them wouldn’t we hesitate too, if a random guy walks up to and asks to shoot our picture?

And that’s the reason it takes great skill to convince them that their photograph is being shot for a harmless purpose. And the best way to convince them and put them at ease would be to chat them up. But there's a catch in it. As we walk along as part of a large group and the group is in constant motion, the only way to stay in touch and not fall too far behind the group is to make sure that we chat up a stranger and convince them in a couple of minutes (all that we can afford) to share their life story with us and to pose happily for their photographs. And believe me it’s not an easy job.

Which is why I count my dozen men (and dog) as a well rounded figure of achievement. Especially when you consider that they include people as diverse as a fish-monger, a butcher , a milkman, a metal worker, a laundry worker, a carpenter, a sweet shop owner, a flower shop owner, assorted busy bodies who walk up to inquire what we are doing and even a man on a bike with a dog. When I chatted up the man he introduced to me his dog (named Dilson) a mastiff which he had taken to the nearby beach for its morning walk/run and was now taking home. And finally both, the owner Dilshad and the dog Dilson happily posed for their photographs to me.

And that’s what I meant by screwing up the courage to talk to random strangers on a whim. You can learn surprising things once you get past the initial awkwardness of starting a conversation. Like the fishmonger who explained to me that he used separate sharp knives’ for separate varieties of fish depending on their scale types. Like the butcher who carried on our entire conversation in good grammatical English and giving me his mobile phone number offered to home deliver choice cuts of meat to my house. Like the milkman who spent 100 seconds of our 120 second conversation decrying the modern habit of going in for packet milk which was slowly driving their tribe out of existence. Like the laundry owner who explained that his landlord was the Nawab of Arcot and had been so for the hundred years his laundry was functioning from the same premises. Interesting little tidbits like that is what I look for in such talks.

And here are some of the pictures of those who posed for me….

And that reminds me of an online conversation I was part of in a blogger group recently where some guys were talking about how difficult it was to approach and talk to a strange girl (in a public space like a train for instance) who was reading an interesting book they had read too. As I said there and repeat again here, I have never found such situations difficult because when I walk up to that girl the only thing my mind’s looking forward to, is having a long conversation and not a long relationship. As long as you are clear in your own mind about the topic on hand, you need not be nervous about chatting up anyone. Do I make sense?

Wednesday, July 17, 2013

Killing Kids With Free Food.....

Killing Kids With Free Food - The Bihar Food Poisoning Case.

It’s tough. Tough being an Indian. Especially tough being an Indian who reads the papers or sees the news. The news is uniformly bad. And what’s worse it is so depressing that you cannot watch for more than five minutes at a stretch. Right now, I admit that I am oscillating between being pissed-off and being depressed. I can’t, just can’t digest the news tonight- about the 22 children dead in the state of Bihar after eating the pesticide contaminated food served at their school as part of the free noon meal scheme for school going kids. 

I remember when the free noon meal scheme for schools was first introduced in my native town Madras by the then Chief Minister MG Ramachandran. I remember that there were a lot of nay-saying economists who predicted (wrongly) that it would not work. I also remember that the scheme turned out to be a fair bit of success. Kids were kept off the streets by the chance of a guaranteed hot noon meal at school. They may not have learnt much at school but at least the free meal got them off the streets. Be thankful for small mercies. 

And I have watched with great interest the scheme being introduced all over the nation, in state after state. There have been quite a few “accidents” in the implementation over the years- lizards falling in the food, dead rats found in the food etc. And every time we are told that it will not happen again. Never again. We have improved the system and we will catch it on time, is the excuse trotted out every single time. And we, the stupid common people of India believe those voices of authority and go about our routine, till we see in the news that yet again children have died somewhere poisoned by their free meals served at schools.

I work in a children’s hospital. I work with fine people who fight for every single child’s life. People who work their butts off night and day to send home happy even the hopeless cases. And that’s why it hits me so hard to learn of all these healthy children dying for no reason at all. For these are 100% preventable deaths. Deaths which would not have happened in possibly any other country. Deaths which occur due to the incredible negligence of smug people in charge who know that nothing will happen to them, no punishments in the offing, whatever they do. Deaths which will happen again and again, maybe even in the near future and nothing will change. 

Do I sound pessimistic and bitter? Yes of course, for I know my nation and its people and this is our lot in life.  For us it’s all about politics, about scoring brownie points and about using every single tragedy to achieve some Machiavellian political goal. If you have been following the news you might have noticed that both the central- ruling and opposition parties have maintained an ominous silence because they want to form an opportunistic political alliance with the party ruling the state. So the political class as a whole tries to show solidarity to the rulers’ than the victims.

And those shining stalwarts of our news media are putting their oars in, trying to make this into a class issue rather than a universal tragedy. The dead are all poor children who tempted by the offer of a square meal a day went to their own deaths cheerfully little dreaming that they were being fed poison instead of food. But that does not make this a class issue. Even rich kids are poisoned to death in India. Middle class kids are poisoned to death in India. Every single kid in India is imbibing some kind of polluted or poisoned food even as we speak. A pollution (or poison) which is not accidental- but deliberately added to the food we eat for more (and faster) profits. In every single item. Reflect on that- if you have the time.

Death in India is the ultimate class leveler – it spares no one, rich or poor, adult or child. We all routinely eat poisoned stuff, because unscrupulous traders are looking to make a fast profit and our regulatory authorities are incompetent. And even if they do catch the occasional miscreant, he or she always has a political godfather or two tucked up somewhere to bail him out with no stain. The truth is all of us- you, me and everyone are slowly being poisoned day by day, in a hundred myriad ways and there is nothing we can do about it. In the manner of true-born Indians we accept it fatalistically and go on with our daily lives.

To round off this rant, I have a single appeal. A single plea to our politicians. No one is asking you to feed the poor children. It’s the duty of their parents to do so.  If you can’t afford to feed them at least leave them alone. Don’t tempt them in the name of giving food and poison them to death. We accept that Death is everyone’s lot in life- just don’t be in a hurry to grant it to us, the common people, in the name of your compassion.

P.S. I hope regular readers of my blog will excuse this personal rant as it does not reflect the overall tenor of my blog. But I needed an outlet to let off steam and this seemed the place to do it. And it’s strictly a one-off, one time only thing. I promise to return again with a more cheerful (and humorous) post next time.