National MRI Musings

They taught us parts of the respiratory system in class six. And I had nothing but the greatest admiration for the poetic rhyming tendencies of the guy who decided to name the Larynx (voice box) and Pharynx (gullet/neck part of digestive tube).

The larynx engineering was a bit beyond me, but for many years after that , our family doctor always ended up hearing how my pharynx was inflamed, while ordinary folks cribbed to him about sore throats, and infections.

Then I found out that doctors have a different way of expressing things. Preferably in illegible style, and in desperate abbreviations, inspired , possibly from Latin, which , clearly, is not part of the medical curriculum.

I've mixed up FUO(fever of unidentified origin) with UFO(Unidentified flying object), and UID (Unique Identification numer) with IUD(Intrauterine device), and wondered why the nurse read something-something STAT and promptly gave me an immediate oral injection dose of vit D3, when I was kind of actually mobilizing to face a deep poke with a needle in the arm.

Having said that, I can see how one can apply these secret words in daily life.

Like, say, (possibly tongue in cheek, or , as they say, "glossal" movement in the "mala" ) a doctor mother , seeing off her doctor daughter on her first day of her first job might say :

Coffee ad lib , agit aq ft, cf b.i.d

B.M a.m

Wash e.m.p. ex aq, B.S.A, a.l., a.s., a.u., o.d, o.s., o.u., ft soap emuls., NPO, NTE 10 minutes, rep.

admov. pulv. makeup, ad lib.

If NKA, admov perfume nebul. prn., chewing gum p.o.(NTE 4) , admov.

gtts o.u.

si op. sit cash q.s., disp. U.d.

Sometimes s. a.


would mean :

Use coffee freely, mix in water, and make coffee, twice a day. A morning bowel movement recommended.

Wash as directed with water, body surface area, left ear, right ear, then both ears, left eye, right eye, both eyes, make a soap emulsion, nothing by mouth (don't swallow), not to exceed 10 minutes. Repeat.

Use powder makeup freely (as much as you want) . If no known allergies, apply a spray perfume , as needed. Chewing Gum, by mouth, not to exceed 4.

Apply drops in both ears.

If there is a need for cash, use sufficient quantity, dispense , as directed.

Sometimes use your judgement ! (Exclamations mine. I don't think doctors do exclamation marks)

If you thought that was difficult, wait till you see what an MRI report of a certain Mr Suresh Kalmadi indicated. He , the Chairman of the Commonwealth Games Org Committee, is currently in jail on corruption scam charges, and consequent to feeling dizzy after several tete a tete's with the chief jailor, was sent to hospital for an MRI scan of his brain, with several folks talking about Dementia.

Which is a very creative thing to do.

Earlier our politicians took recourse to chest pain, uneasiness, breathlessness, and got themselves admitted to ICCU's, complete with their security apparatus.

In these e-days, when a scam is not a scam unless it is in thousands of crores, it is in the fitness of things that we talk about MRI scans instead. That' s like a step up. ( You need to keep still and unmoving as the scan proceeds. I should know. I had one done and wrote a post, " MRI Rock, " about it . And possibly, if you move even a bit , the picture could be conveniently misleading).

His report says. :

......he is suffering from 'diffused cerebral atrophy with old ischemic changes in brain parenchyma with calcified granuloma in caudothalamic groove on left side (of his brain)'.....

This is like describing the Mumbai roads MRI scan and saying :

.... the road is suffering from diffused unidentified potholes, with old plumbing related age-related problems with the road body (parenchyma = tissue). Occasional tar and stone granulomas(inflamations) , have calicified (become pucca). About the caudothalamic grooves on the left side, its pointless to say anything because our roads have developed so may grooves everywhere. .....


Of course, one is an assesment of a person for dementia, which, not too surprisngly would include interesting abilities like the ability not to remember things, and cognitive difficulties. The other is the description of a real endless malaise affecting the Mumbai roads and therefore, its million hardworking citizens.

Luckily ,( for us, that is, ) Dementia is not based on MRI reports alone. There are many other check ups and evaluations involved, and these will be done. I guess one needs to have a massive road scam, for someone to take the Mumbai Roads MRI report seriously.

Today's paper, in addition to citing latest research from George Washington University about how our brains become smaller as we age , has also indicated some eminent opinions on Kalmadi's dementia question , also mentioning his diabetes, and hypertension , which could cause the above enunciated changes as in his MRI report.

I was beginning to get worried.

I mean Mr Kalmadi is just a bit older than me. I have one of the afflictions (not dementia) , that he has. If a walking,talking, scheming, shoe-dodging person can have such problems , what about me ? An ordinary woman, who still gets confused when asked how many zeros in a crore ?

But I digress. I now have hopes for the Mumbai roads. If they can solve Mr Kalmadi's problems, they can solve Mumbai's road problems.

After all the reports are so similar, na ?

Cell phone to the rescue

I was a late entrant into the world of cell phones. I used to think at first that only folks like doctors , emergency services like police, fire etc would benefit from these so they could respond faster.

Slowly, cell phones became a "required item" for everyone. It was de rigeur, to give folks minute to minute updates on your bus trips to and from work. It was de rigeur to do mass messaging of some stupid jokes. Amazingly, sometimes narcissism flowered unknowingly, as folks photographed themselves with their own cellphones, holding them in front, now that cameras had a become de rigeur on phones. And when all was done, you stuck two probes in your ears, wore wires like garlands, and walked around , looking, as if you were a lost case , and were talking and guffawing to yourself; all because you wanted to use what was called "hands-free".

Then I heard about the "missed call" system. Reams have been written about the innovative usage of these in India, from simply sending a preplanned message via a terminated call, to running an entire autorickshaw-on-request system, in Kakinada , at no cost to either consumer.

One birthday dinner at a well known Marathi traditional food place in Pune, saw a young girl photograph a wonderfully filled plate with all the goodies, and upload it on Facebook; her cousin in the US who was a FB friend was impressed , and immediately sent back a "like", and shared the photo with others, one of whom was actually celebrating the birthday at that moment in India, at the lunch !

I recently heard of a more serious use.

An old grandpa in Bengaluru had cataract surgery. He was so impressed with the results that he complimented the doctor profusely, and then decided to go on a special thanksgiving pilgrimage. Certain part of the pilgrimage was to be done barefoot. And by and by the family returned home. Except, grandpa was a diabetic for many years, and his foot had now caught some infection. Typically, the hurting foot was treated first with household remedies, wraps, massages, etc etc, without success. It was an angry reddish swollen sight, very painful, and mobility was getting affected. So it was finally decided to operate before the danger of gangrene manifested itself.

Grandpa's only son , X. , was there throughout , and everyone breathed a sigh of relief after grandpa recovered from the surgery and was brought into the hospital room. X was married to a girl whose mother was a doctor in Mumbai. The doctor from Mumbai had called earlier to find out how things were going. X took a photo on his cell phone , and sent it to his ma-in-law, so she could see for her self.

Soon it was evening, and a relieved family brought out their dabbas and had a dinner of sorts in the waiting area. Grandpa too, was allowed a meal. He was helped up , and he had some excellent home made food . The energy seemed to be returning back, and people stopped by to chit chat with grandpa. This went on for some time.


Sometime later, a cleaning staff member, on a routine visit to the room, suddenly looked aghast at grandpa's foot , and what he said threw everyone into a tizzy. The foot was slowly dripping blood, and a pool was forming on the floor. And no one had noticed, including grandpa.

It was sometime before the doctors would arrive, but X had in the meanwhile got alarmed, called his ma-in-law, and sent her the picture of the bleeding foot and its environs. She immediately realised that no one had informed the patient or his relatives about keeping the leg appropriately elevated, and not letting it hang down like this. She even uploaded the photo on her computer to see it in detail, and promptly told her son-in-law what was happening.

Grandpa needed to lie down, slightly elevating the leg. They needed to ensure that grandpa's loss of blood had not adversely affected his Hb levels, his blood pressure needed to be confirmed, and she stayed alert , as X , sent her photographs of the wound which was now being attended to by hospital staff, stitches being checked etc etc. When the duty doctor checked the BP and did blood tests , X informed her, so she could tell him if it was a cause for worry or no. The sight of wounds, blood, dressings, stuff dripping all over etc was so traumatic, that X also sent her pictures of the finished dressing , to confirm, if she thought it was OK. Naturally, given grandpa's age, and diabetes, loss of blood, surgery etc, she asked X to stay at the bedside the whole night and keep observing grandpa. Ensure that the leg was at a slight elevation, and not allowed to hang down . And contact the resident doctor immediately and then her, if he noticed certain signs.

The next day dawned , and grandpa had recovered well. The dressing on the foot looked a bit frightening. The wound and the blood was under control. X called his mother-in-law with the news (and latest closeups of the stuff), checked if he could leave for a short while and then left when some other family member took over.

Grandpa returned home after a couple of days and is now fine. This episode happened almost a couple of months ago.

It is a fact, that sometimes, health care entities do not educate the patient and the attending relatives on the things to be careful about , post surgery. Things like the post surgical normal position of the limb in question, whether the person can use a pillow, whether water can be given to a patient when demanded ; so many things. Even simple things like which pills must be given with food, and which ones when fasting. Sometimes patients hesitate to ask the doctors, sometimes overcome by the aura of the expertise. Some people hesitate to ask the doctor thinking he /she will get angry. I've seen folks going into huddled whispers when the doctor comes on a visit. When they should actually be listening carefully and asking questions related to the patients well being and perceived difficulties.

It's not as if grandpa in the above story, would have had problems , if X had not called someone who was a doctor in Mumbai and related too. But he was able to ensure that post bleeding, the blood pressure , haemoglobin was being checked and followed up, and was able to confirm with his Mumbai contact what the local doctor was saying. His ability to stay alert throughout the night checking up on grandpa, his sleep, alertness and movement of the leg, possibly also kept some local paramedical folks on their toes.

And there is something to be said, for a son, thanks to some reassuring advice, getting some peace of mind, after all that "bloody" excitement, as he sat by his father's bedside, the whole night, keeping the truant limb in sight.

Such a great use of a cell phone, for someone not familiar with medicine, surgery, and the likes. But very very familiar with what all the cell phone could do.

I just thought this was such an amazing use of the cell phone ....

Hello Hippocrates !

When I was in the 6th grade, I went to a school in Pune that subscribed to, what was then called "Senior Cambridge" school board. It was affiliated with something in England, the things we learned were slightly different than those prescribed by the local State board, and we had a favourite subject called Physiology and Hygiene, where we learnt lots of anatomy names.

I used to love this, and it so came to pass that one day, when my mother was on the phone with our family doctor consulting about my non healing sore throat, I told her in a hugely hoarse voice to say that I had an "inflammation of the pharynx". She got a bit alarmed and handed over the phone to me. Doctor Uncle was completely amused, and he continued to be immensely amused even many years later, when I took my children to him on my trips to see my parents.

It also helped that I went to school by the municipal city bus, and that my school was very close to Pune's well known B. J. Medical College. The bus would be full of lady medical students , in sarees, holding thick books , we became friends, and I absolutely enjoyed leafing through their Gray's Anatomy's, and marvelling at pictures of bones and skeletons, something we were learning in class too.

I actually did marginally better in Biology than in Maths in college, but the system then allowed us to choose one or the other, and it was more or less expected that I choose Maths. Which I did. I wont say the world missed out on a decent doctor, but since then, I have had an abiding sustained interest, in all things medical and anatomical, to the immense disgust , wonder and surprise of not just family, but also some doctors.


Fortunately or unfortunately (depends on who is thinking), I have had doctor friends from across the age spectrum. I recently lost one who was in her mid-eighties, another is almost my age, and never complains about being treated as an encyclopedia, and even being questioned . Another friend , is the above mentioned Doctor Uncle's grandson, who is my son's age, but did home visits for my (late) ailing father, every alternate day, simply because I requested it, and was bombarded by lots of troubled questions by me when I was witness to the marvellous fight back capacities of a body, when faced with a terminal slowing down.

Over the years, I have come to the conclusion, that the best doctors are those who explain things to you, don't glare in a superior manner when you ask questions, and appreciate the fact that you want to know, and possibly learn something. It's your body, so the attitude should not surprise anyone. I suspect , that those that brush away your questions rudely saying "how is it your concern", are actually insecure about their knowledge or about communicating it to a layman.

Many doctors of the old school love getting questions. A close family elder, who was diabetic had just had surgery, and I was posted in his room, while others went downstairs to attend some paperwork and stuff. A nurse suddenly appeared with an injection. I asked her what it was , and she told me it was a maintenance dose of insulin.

I got alarmed; I had been a close witness to this relative getting into an hypoglycemic (low sugar levels) coma once, because he didn't reduce his dose corresponding to his reduced food intake during a digestive infection. Prior to surgery his intake had been very light. I knew the signs of a coma first hand, and I appealed to her to give that injection only in the doctor's presence. An argument ensued, and went on till everyone returned with the doctor, a very respected senior name in the field, now no more today.

He heard me out, asked us to keep a banana ready along with some fruit juice, and the injection , as prescribed was given. Within moments, the words became slurred, eyes kind of unfocussed, and the doctor , who was holding the patients hand , noticed the signs even before me, and asked us to give him the juice. The patient was able to stand the insulin dose needed post surgery, and the great doctor, smiled, patted me on my shoulder, nodded at the nurse and left.

Many times it has been a skirmish for knowledge, in a dicey health situation. Skirmish, because , very clearly, some doctors don't like to be asked. It has become a habit to ask details about any medicines that someone recommends that I take. Sometimes one has read something about a particular medicine, and has some questions about safety.

Caretaking of elders of the willful type often needs a different interaction with the doctor. I once did this for someone who was the type who threatened to do what he liked after prostate surgery , like cycling , and lifting luggage up the stairs.

The urologist surgeon was totally amused to see me with a chart, listing out do's and dont's , contraindicated Yoga postures, and instructions for medications , all written in large letters for someone with a cataractic eye. I thanked him for his suggestions to my questions, requested him to sign at the bottom, and had the hospital office put a bunch of stamps there. This particular doctor had a lot of geriatric patients and he even asked me for a copy of the chart !

When the elder in question, lifted his bag on reaching home , and pooh-poohed my suggestion, I whipped out the chart. And no further words were required. Even the rickshawallah who transported us was amused.

This tendency of asking questions , has somehow seeped into the anatomy. I have had general anaesthesia given to me for various things in my lifetime, and the one noticeable feature has been that I always tend to come out of it before anyone expects me to.

While science sometimes says, that it has to do with the amount of fat in your body , that can absorb a particular type of anaesthesia, I think it's the tendency to question stuff that is embroidered in the DNA, so to speak, that keeps something ticking below all that anesthesia.

And so I can fully understand the irritation in the voice of the surgeon, who was helping to wheel me out into a recovery area after an investigative procedure, and had me suddenly asking him , from under heavily lidded but desperately trying-to-open eyes, as to "What he found ...".... I was politely told to rest .

While the Internet has been a gift from the Gods for someone like me, who likes to check out her own diagnoses with the doctor's, not many doctors are thrilled about answering questions, starting with "Why" . But some are amused.


The knees started to pain a couple of years after I had a fall that fractured the ribs in 2005. I poured over pictures of muscles, ligaments, tendons, and read related articles on the Net. Finally, I was convinced about the ligament (Anterior Cruciate ligament) that was not behaving itself. I went to my doctor friend, who was not surprised at all this, and possibly agreed with my discovery, but she advised X-rays, and a consultation with the more experienced Orthopaedic expert.

And so there I was lying on the examination table. My doctor friend had come along, as this was in the same hospital premises where she worked. The orthopaedic expert had me move my legs, bend them, and then did some twisting and turning of his own , eliciting some occasional painful exclamations fro me. He then turned to my friend , muttering, something-something of the Anterior Cruciate Ligament, and proceeded to write up something in my file.

To this day he cannot figure out why a bad injury should have brought a wide smile on my face, and why I barely stopped myself from hi-fiving my doctor friend, who was trying to hide a smile. He advised some knee caps and physiotherapy etc, which was duly followed.

But to this day , he always smiles when he sees me otherwise.

And then there was the time, I was waiting for the aforementioned investigative procedure, and suddenly the nurse turns up to ask about the next of kin. The husband had stepped out to make a call. It seems they needed his signature to say that it was OK to put me under anesthesia.

This was too much. I wasn't invalid,was in my complete senses (though some folks tend to disagree occasionally), this was my body they were discussing and if anyone was going to give permission to put me under, it would be me. The nurse looked stricken at hearing this. Such things were not done. They must have a finger to point at someone who signed and gave permission, in case something happened to me. She disappeared to return some time later with the doctor

The doctor came, took one look at me, shook his head, and allowed me to sign. If I was well enough to have a surgery, my vital signs were fine, and this was a minor procedure, then I should be qualified to sign . That's what I thought. The doctor actually just wanted to get over with it. :-) ....


This post came about after I read this blog post. About maintaining secrecy about the patients treatment file. About the nurse mentioning how the particular doctor did not like nurses to see it too.

I have always thought , that the file or chart for the patient that is maintained at the bedside , lists chronologically the treatment he/she has received, the recommendations of visiting experts, and instructions for modifying doses etc. I don't see why nurse cannot see the stuff. In fact, they must.

Not that it is legible or understandable, but It possibly makes sense to keep the stuff confidential from relatives who visit.


But just think of how the this problem can be solved, if the doctor could quietly explain the stuff to the attending relatives, in addition to writing it down. There would be more confidence , less doubts , about what was going on.


Its about your body. You need to ask questions, and demand answers.

And so, it hurts when one sees, those who spend enormous amounts of time getting technical about cars and cellphones, talk about taking "red pills", and "white pills", and "green capsules", without finding out what they do.

Maybe it's time for some senior citizen lady type to tap them on their shoulder, smile a toothy smile , and ask how their Anterior Cruciate Ligament is doing, or why their Bundle of His in their heart , is twitching so much .....

And enjoy the look on their faces......:-))

Getting things straight......

In this age of high mobility, faster career advancements and virtual travel, this is probably a stupid question to ask. But what kind of feeling or sense would you have developed if you lived in the same place, for say 60 years ? And more ? ......

You would know most of the people residing in your area, you would remember their families, and lets say, quirks and /or outstanding features of certain family members. You would know which parts of your area are more susceptible to seasonal variations and changes; you would certainly remember new constructions happening in places, now being considered important. There would be a sense of holding memories amidst the community that you lived in.

All this kind of "lit up" my mind , recently, when it occurred to me that the same would hold true for our bodies. I mean, just think. A large variety of useful organ members, residing and growing in the same area for , in my case, 60 years and counting. Some doing well physically, some undecided, some clearly on the way down, and some showing the sort of wear and tear that you see in crumbling walls, that still stand tall by sheer virtue of the goodwill coming from neighbors and the environment. This of course assumes that all these entities have a mind of their own.

And I was most delighted to discover that our body does not function autocratically under the dictatorship of the cranial brain . There is a sense of thinking, a sense of mind, a sense of "having its own mind" , in our abdomen. Its called the abdominal brain. Remember butterflies in the stomach, rushing to the loo in a stressful situation, losing appetite on hearing something terrible ?

In the highest traditions of management practices, there is delegation of work in our bodies, and there is more than one type nervous system in our body. The systems that allow brain messaging to enable us to recognize someone we have met before, are different from those that enable us to shout and instantly yank back our hands on unknowingly touching a hot griddle smeared with smoking oil. Lets not get carried away by names and titles of these things.

I have a firm belief , possibly yet to be investigated and ratified by, say, the NIH in Washington, that all our organs in the body are NOT just a chemical mass (like our potholed roads outside) , but have a mind, that listens, stores, reacts, and sometimes changes things.

In his late seventies, my father was diagnosed with a herniated disc/discs. At one point he couldn't even sit, and had to eat in a supine position, so painful was any movement. As a firm yoga practitioner since his childhood, he immediately rubbished things like surgery, and after initial analgesic doses of allopathy taken unwillingly, he started on a slow exercise regimen. He would often tell me, that one had to visualize in one's mind, that this situation would heal, that one would be active as before again, and he had a childlike adamant attitude about getting the best of this affliction , which he had to defeat. HE DID. Physiology is difficult to change at that age. The mind is not. And I think, somewhere, his spine and vertebrae sensed the strength of the thinking.

I have personal experience of suffering a particular problem which kept going from bad to worse over almost 25 years. All kinds of tests and pathological exams indicated no organic problem. Surgery and removal was a solution, but not something that appealed, because nothing was diseased, per se. Things reached epic proportions at a time when I was beset with many many difficult family responsibilities and it came to a point when energy, intense anemia, and movement became a worrisome issue. Ten years earlier, surgery had been a solution, I was younger, but I had refused, being a firm believer in the fact that if you had a worrisome child, you worked with him to improve, rather than give up on him and ignore him; and of course, each child was different, but got an equal chance.

I often visualized what was happening in the body, how surgery would traumatise the innards, what needed to happen etc. My doctor , who had advised me earlier and knew my family system, physiology and thinking, now convinced me to go in for surgery. I finally agreed and consulted the surgeon. She fixed a date , and asked me to get the preliminary checks up and stuff done. She then asked , since I had waited so long and tried so many meds, if I would be willing to try a specific regimen of a medicine which I had tried earlier, several times, but which was being newly marketed now. I agreed.

I couldn't believe it, when my problem , chronic over 25 years, simply disappeared , just like that, once I took that medicine as directed. One day it was there, and it simply disappeared. And has remained so 10 years down the line. Just like that. I like to think that certain parts of my physiology, were aware of my thinking, my empathy and respect for the anatomy, and the wild behaviour kind of ceased, when the body sensed that I had unimaginable stresses coming up, and this was the time to put their hand up, be counted, and help. The concerned organ probably had nightmares of being cut up in surgery ,and removed, and kind of gave up its willful behaviour. My doctor thinks this whole thing is amazing. But also believes in the power of "visualization".

I know folks who had intense intestinal digestive problems after some unavoidable treatments. An elderly gent has explained to me how he actually "conversed" with his intestines in his mind, cajoling them to be co-operative. He would do that several times a day, while carrying on with his meds and treatments. I guess his intestines listened. I mean we may be globalizing but his intestines behaved in traditional Indian style, listening and respecting elders.

20 years ago, two acquaintances, closely related to each other, both detected with cancer at the same time, in a chance check up. Both were in decent health, and in control of their bodies, as such. One of them insisted, he wouldn't agree to any surgery/chemo/treatments, because, he had a great belief in his health situation, and would face whatever, whenever. The other person, simply agreed to undergo radical surgery followed by assorted chemo and radiation treatment.

Both did fine for many years. Today, the one who did surgery, is no more after facing an uncontrolled spread of the Big C, and several drastic last minute treatments. The other person, continues to live, now afflicted , simply by intense old age. May be he had stronger thoughts throughout. Maybe he lived in resonance with his body. Maybe he infused his physiological set up with those thoughts. Which is not to run down proper cancer treatments. But it tells you the power of your mind.

In our childhood, we often heard folks shout at us, whenever we didn't appear to be sitting or standing straight. I remember being asked to stand against a wall, and remember the straightness of the spine, and to hold it that way. Particularly in the pubertal years, one often heard "Don't slouch", " Keep your spine straight", " Shoulders back"...... and someone would even poke you in the back if it looked like you were sliding into a slouch.

A few days ago, the potato basket in my kitchen accidentally overturned and the stuff went all over the floor. In an effort at stopping things from rolling under cupboards and stuff, I hastened to bend , probably in a completely unrecommended manner, particularly for people my age. I paid the price. Excruciating pain while straightening to stand up, inability to stand for a longish length of time, and wild applications of ointments resulting in aromas of methyl salicylate pervading in a season where sandalwood, camphor, and jasmines and roses would be the norm.

XRays happened. The doctors says that my spine, which should have been in a graceful "S" shape, has tended to straighten out.(!) Its more like a mathematical "integration" sign now. And the muscles of the back, are pushing themselves to the limit, trying to support the whole thing, causing my stiff and painful back. I hear words like Lordosis. Sounds royal. :-) And Kyphosis . Sounds terrible :-(.....

But I am convinced, that years of listening to folks shout at me about keeping my back straight, must have trained the vertebrae and the spine. Like me, they must be harking back to the old days. They probably remember . They also probably realize how incredibly stupid I have been in bending inappropriately for the potatoes. Those who don't listen are often taught a lesson.

I guess, I am getting mine now.....