Category Archives: Doctor’s Diary

HealthWise: Tasty Wholesome Chana Masala

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Chana masala served with naan

Who hasn’t heard of Chana Masala (chickpea curry). It’s everyone’s favorite. We don’t fail to order it when we go to the Indian restaurant even though we can easily make it at home. It’s not just delicious but it is also healthy and Vegan! What else could you want?!

So we decided to make some chana masala at home. This is our own recipe. You can try it too. It’s easy!

Most of the ingredients are easily available– the spices are available in Indian stores. The quantities/measurements are essentially estimates. They can be varied depending on taste etc.

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HealthWise: On Call #1 A Young Woman with Fatigue and Shortness of Breath

 

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On Call is a series where I present some interesting cases I saw in the course of my practice. 

Case #1: A Young Woman with Fatigue and Shortness of breath

Mrs. S, is a very pleasant 35 yo young woman. She is married with two young children and is a school teacher by profession. She was referred to the hospital by her doctor for evaluation of new onset shortness of breath and concern of a serious heart condition. 

When I interviewed her she told me the shortness of breath has been now ongoing for about a month and steadily getting worse. In the beginning she noticed she was unusually exhausted when she reached home from school and didn’t find the energy to prepare dinner and play with her kids (something she really loved to do). She also notes headaches, irritability of mood, difficulty concentrating which has been affecting her work as well as dizziness. She is also very concerned that she is losing hair. She denies that she is under much stress and says her family has just returned from a two week holiday. Unfortunately, she couldn’t enjoy herself very much because of how exhausted she felt. 

Her symptoms have progressed to the extent that now she is out of breath when she walks up a short flight of stairs; she also notes a feeling of tightness across her chest. She also feels her heart racing and puffiness in her arms and legs. She is worried she has a serious heart condition especially since her father died of a heart attack in his 60s. 

When I examined her I was struck by the pallor of her skin. I also noticed her tongue was swollen and her nails were thin and brittle and there was definite swelling around her ankles.

Her heart rate was regular but fast– 90-100 beats/minute, she had a normal blood pressure and oxygen level. 

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HealthWise: Dementia- An Overview

The Self Portraits of William Utermohlen

The White Room

I lie on the bed

in the white room

They sit around me

These strangers with familiar voices

I think we are waiting for something

or someone.

These strangers, they look at me

They mutter words I don’t understand

A man in a white coat walks in

He stands next to my bed.

He speaks not to me,

but to these strangers

They are talking about me, I know.

About what, I don’t understand.

Irritated, I kick off the covers.

Mother! They chide me and pull them back.

About the poem: This is a poem about dementia, the hallmark of the disease being loss of memory. I write about a scene I came across during my rounds in the hospital—an elderly woman in the advanced stages of dementia is lying on the bed surrounded by her caring relatives. It’s difficult to know what’s going on in the poor woman’s mind because she has lost the ability to speak, even comprehend. Yet it’s apparent she’s unaware of her ailment. She doesn’t even know where she is or who she is with.

Dementia is a syndrome that results in gradual and progressive decline of previously acquired mental abilities that results in a loss of social and occupational functioning and ultimately to loss of independence. It is imperative to distinguish this from normal aging- normal aging never results in loss of independence.

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HealthWise: COVID 19 Overview

Coronavirus Disease 2019 Rotator Graphic for af.mil.

Disclaimer: This is a general overview of COVID 19. A lot of the information is evolving therefore kindly refer to the CDC or your country’s public health agency. 

I am a practising physician, an Internist and hospitalist working in the USA and this is my small attempt to raise awareness about this virus.

What is COVID 19 or SARs COV 2?

COVID 19 or SARs COV 2 is the virus (severe acute respiratory syndrome coronavirus 2)  which is responsible for the pandemic across the world. It originated from Wuhan, China. We first learned about it when a cluster of cases with severe pneumonia was reported around New Year’s Eve 2019. 

Some facts: As of today:–

World over 12.9 million cases and over 571 thousand deaths. 

Equally important! Over 7 million recoveries!

US: over 3.3 million cases; 137,000 deaths and over 980,000 recoveries. Curve going up again. 

India: over 878,000 cases. Over 23000 deaths 553,000 recovered- cases still rising

UK: 290, 000 cases. Over 44800 deaths. 

China 85,522 cases. Reported Deaths: below 5K 

Italy: 243,000 cases Deaths: 34,954 and 1.9 million recovered. Less than 300 cases are being reported everyday now. Lockdown worked!

Spain: 254,000 cases. Deaths 28,403. 150K recoveries. 

South Korea: 13,479 cases. 289 deaths. 12,204 recoveries. Over 90% recovery rate!

Japan: 21,500 cases.. Below 700 deaths.

Hongkong: 1522 cases. 8 deaths. 1217 recovered! 

One death is too many. Yet it is important to know that most people who get the infection recover. 

Overall death rate is probably less than 1% (as many cases are asymptomatic and undiagnosed). It’s also important to keep in mind that this rate is considerably higher in the at risk population. 

The mortality (death) rate in India is much lower than other countries – (why?- unaccounted deaths (doubt), underlying resistance/immunity which ‘protects’ against severe illness?)

Besides the above the cost of the infection has been much higher- people have lost their livelihoods, their jobs and businesses have been shut down- some permanently. It has also had a huge mental health cost– such as isolation, lack of contact with your loved ones and dying alone from the disease. 

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A Woman is to be Seen not Heard.

Bust of a woman by Picasso

It may sound cliched yet nothing could be truer. A girl who goes on to become a woman has always learned to lead an inferior life. She has learned to be a perennial serf, who lives in the shadows. Who is seen and not heard. If she speaks– it has to be in soft tones or whispers. She has to align her opinions with those of the society — she has to be uncontroversial, motherly, generous. She has to live for her family and the world at large. She is ‘weak’ thus needs to be protected, yet she is also taken advantage of. Hypocrisy much? 

If she rebels and asserts herself even in the slightest she at once surrounds herself with frowns and draws rebuke and criticism. How dare she? She is labelled a vixen, a mad woman and cast out or burnt at the stake.

Hence since the birth of time (with a few notable exceptions) she has learned to clip her wings, succumb to the pressures, curb her desires, even censor her thoughts. What a tragedy isn’t it?

Do read ‘The Awakening’by Kate Chopin.

Image is of a painting titled Bust of a Woman by Pablo Picasso– Oil with fixed black chalk on canvas. Displayed at Norton Simon Museum in Pasadena, California.

You Will Always be My Mother

 

Our bond transcends Time, Worlds and Space. 

Our relationship doesn’t need a ceremony, or an oath, or witnesses, or a piece of paper.

It doesn’t need a special day, a reminder, or a note on the calendar. 

It doesn’t need talk, work, gifts and or constant reassurances. 

It is there when I need it, and I know it’ll always be there.

I can count on it at any time, I can make demands of it.

I can ask you to lay down everything else for me and you will

Because

I will always be your daughter and you will always be my mother.

Thank you, Mom!

 

An Unprecedented Time

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Okay I get it. This is real. For a while I thought it was a farce; a dystopian narrative like in a movie or a book that are so popular nowadays. Unfortunately, I was wrong. 

I never thought I’d live through a time like this when everyday is worse than the day before and there’s no end in sight, at least not for the foreseeable future. My training never prepared me for this. But fortunately, I’m a rational being and I’m not scared easily. Plus, my work gives me succor because I feel I’m making a difference.

The very nature of my profession (I’m a physician) has taught me to be calm, and do my job. The problem though is the uncertainty. What was ‘the norm’ yesterday is taboo today and who knows what tomorrow will bring. This is a new disease and a new virus. There’s no actual cure though there are multiple potential cocktails being flaunted and used. They haven’t been diligently studied or tested but have brought vital hope. 

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Changes–Excerpt from ‘Under the Shade of the Banyan Tree’

As a physician working in acute care I’ve seen many things that few others have and which are perhaps beyond a lay person’s imagination. Among these are few encounters that are etched in my mind. They have moved me, exposed me to my vulnerability and changed me permanently. I’ve learned so much.

I share a few of those encounters in my upcoming book ‘Under the Shade of The Banyan Tree’. Here’s one of them :–

Changes

Yesterday I met a young man in the hospital. I had seen him before, maybe a few months ago. He had an odd name, a name you don’t expect to forget easily, but I did somehow. I must be getting old, I think.

His name didn’t strike a bell when the ER doc told me about him, but I remembered his face.

“He’s a nice guy;” the ER doc said. “He really is,” he reiterated.

That had me curious. We don’t speak like that often. We physicians are a cynical bunch, you see.

I recognized the young man right away, and it was a shock. He didn’t look at all like he had just a month or so ago. He had shrunk. Literally deflated by several pounds and he had grown a beard to disguise his gaunt face.

He had been a young man in the prime of his life. Big, muscular, strong. Still hopeful and smiling, even after a heart attack at thirty-two. Still hopeful and smoking.

He was still smiling now, but it was a different kind of smile. There was diffidence in it and fear and uncertainty. There was also hope, but it was fading fast. It’s astounding how clearly I perceived it without him having to say a word.

Instinctively, I clasped his hand. It was perhaps the most spontaneous thing I’ve done. It was the best way I could express myself other than crying for this man’s life. That’d be a terrible thing to do.

He had given up smoking after the surgery. Ever since they told him he had cancer. We talked some more. I explained why he was here. The spots in his lungs could be pneumonia.

“Maybe they are,” he said and smiled. He’d become adept at dealing with bad news. He had aged beyond his years in such a short time. My heart wept for him.

White Room

 

The Self Portraits of William Utermohlen

I lie on the bed

They sit around me

These strangers with familiar voices

In the white room

I think we are waiting for something

Or someone

These strangers, they look at me

They mutter words I don’t understand

A man wearing a white coat walks in

He stands next to my bed

He speaks not to me

But to these strangers

They are talking about me I know

But what I don’t understand

Irritated, I kick off the covers

Mother! They chide me and pull them back

 

About the poem: This is a poem about dementia, the hallmark of the disease being loss of memory. I write about a scene I came across during my rounds in the hospital–an elderly lady in the advanced stages of dementia is lying on the bed surrounded by her caring relatives.

About the image: These are a series of self portraits that William Utermohlen, an American artist embarked on after learning he had Alzheimer’s disease.