Statutory Warning: Nonsense Lies Ahead.

Warning the scanty readers that this post shall make no sense whatsoever.

So today (rather, yesterday) was our End Posting Test in Ophthalmology and we had to present a case. Ours was a immature senile cortical cataract and we answered to some extent to get some sort of marks. It dawned upon me (rather late) that making mistakes is a very good thing. It leaves you with a memory that will last longer than the memory of having gotten it right. (The spank (or rap?) that maám gave me for not doing palpating the globe appropriately will (hopefully) last for a long time.. )  

Weekend getaway to Chikmangalur with Atthe and Maama. A short but memorable trip where we visited Mullayangiri (in the midst of the clouds, the howling winds, the gusty air that makes you sway and the freshness in the air that cannot be found elsewhere!) and Habbe Falls (hidden in the middle of a plantation, this falls is ensconced in the midst of lush greenery and the cool shallow waters falling gently from the height makes it an ideal waterfall to enjoy the beauty as well as indulge in it.

Last week, we'd been to this coaching institute that has opened up in Shimoga. Basically it's to provide help for cracking PG entrance exams. It was a demo class and gave us a brief idea regarding the kind of competition we are going to face, the importance given to each subject, the books that we're expected to read and a sampling of the kind of questions that are often asked. 

I have the knack of doing amazing things in life. For example, walking into a bakery and asking the people at the counter (4-5) if it was open. The looks on their faces clearly indicated that they were wondering if there was anything wrong with me! 

Like I often reiterate, change is essential; we all need to adapt and acclimatize in order to survive and one cannot remain stagnant. We all evolve over time, owing to the surroundings, the company we keep, the work we do and the responsibilities we shoulder. But what if.. the metamorphosis has left you virtually unrecognizable? What if you no longer identify who you were initially after all the multitude of changes you have undergone in order to adapt to your surroundings? You might say that if it's working out for you with all the changes, then it shouldn't matter. But what about your originality? Has it been sacrificed for the price of belonging?

Sometimes the lines between who we actually are and who we portray ourselves to be become blurred and what ensues is a state of turmoil between our thoughts and actions. The mind cautions against frankness but the heart does not heed to these commands and behaves with the hope that one shall be accepted for who they are. But the truth is, very few people actually accept us the way we are; with all our flaws, intricacies and  idiosyncrasies. It is important not to seek this acceptance from everyone. It is important to remember those who have this wonderful quality because you will never hesitate to be yourself in their company!! :D

As hard as it seems to accept, the reality of Life is that people change. People walk in and out of our lives. When people walk into our lives and brighten our day, we don't question them for being a part of our lives. Yet, when people begin to walk out without rhyme or reason, it raises questions within us. We start looking back if we made mistakes and if there was something we could have done better. But sometimes, it's got nothing to do with us! People gradually fade out of our lives before we even realize that there is a void and it might be due to reasons absolutely unrelated to us. Maturity lies in accepting these twists of Fate and letting go.

Drink It Up!

So yesterday V Sir spoke about Gastritis [and a lot of other things such as how women give themselves Peptic Ulcer by excessive use of NSAIDS when all they have is problems with their better half, MIL, FIL and kids whereas the Doctor who prescribed the NSAID (When there was no need for it) is not to blame because he (unlike women) has a LOT of things on his mind.] As usual, there were his jokes and regular insults “Jackasses!”

After discussing Gastritis (which is a histological diagnosis; you need to do a biopsy before you declare that the patient has gastritis), he showed us this picture of two men sharing a drink. *Neurons fire and connections are made*

Robin Warren and Barry Marshall after winning the Nobel Prize in 2005

Robin Warren and Barry Marshall are the two men who changed the history of Peptic Ulcers with their discovery that Helicobacter pylori can cause the ulcers. They were awarded the Nobel Prize for Medicine in 2005.

Since time immemorial, scientists considered that gastritis could be due to:

• ·         Heavy use of NSAIDS
• ·         Alcohol Overdose
• ·         Stress (Trauma, emotional, surgical)
• ·         Suicide Attempts
• ·         Uraemia
• ·         Heavy smoking
• ·         Nasogastric Intubation

But nobody considered the possibility of a bacterial infection causing the symptoms.

Why? Well, because how would the Bacteria survive under such high acidity?

I'd read about this when read micro:)

The treatment for this evolved from gastrectomy to vagotomy to several other variants but none of them provided a permanent distress-free solution because the procedures left the patients with many more difficulties.

At this point, Barry Marshall and Robin Warren began working together to study about the Peptic Ulcers in greater detail.

Merely isolating the bacteria cultured from the gastric contents was not indicative since they could always be contaminated species from the environment.In order to consider a species as the causative agent for a disease it must satisfy Koch’s Postulates:

Isolate the infectious agent from the individual. (blood, aspirated contents)

Culture the agent and inoculate them into a healthy individual.

There must be an infection when the agent was introduced in the healthy individual.

It must be possible to isolate the causative agent again from the second individual.

H.pylori doesn't grow in mice or pigs so it was essential to test the Postulates on humans. But this was declined for numerous reasons. The only ethically acceptable person for testing this crazy idea was Barry himself so he collected the fluid and swallowed the broth. Sure enough, the classical symptoms developed and he was sick for a week.10 days later a gastric biopsy confirmed the culprit and this made the gastroenterologists and pharmaceutical companies sit up and take note. Of course, surgeons weren’t happy with this discovery because it meant that they didn’t have to go around doing gastrectomy and other surgeries that claimed to cure Peptic Ulcers.. Slowly, things began to change and today, Peptic ulcers are almost never treated surgically but with antibiotics.

This is a great example of challenging the accepted what we all take for granted. Someone said that ulcers can’t be caused by bacteria so that thought persisted for decades. Progress comes when we question “Why?” at the end of every statement. In this age of cutting edge technology and advanced molecular biology it’s possible to test a lot of theories that we take for granted. Some of the answers to important questions lie right before us, it takes a trained mind to see.

As they say, The eyes cannot see what the mind does not know..

For more:

• http://discovermagazine.com/2010/mar/07-dr-drank-broth-gave-ulcer-solved-medical-mystery
• Wikipedia: To avoid the acidic environment of the interior of the stomach (lumen), H. pylori uses its flagella to burrow into the mucus lining of the stomach to reach the epithelial cells underneath, where the pH is more neutral. H. pylori is able to sense the pH gradient in the mucus and move towards the less acidic region (chemotaxis). This also keeps the bacteria from being swept away into the lumen with the bacteria’s mucus environment, which is constantly moving from its site of creation at the epithelium to its dissolution at the lumen interface.
  H. pylori is found in the mucus, on the inner surface of the epithelium, and occasionally inside the epithelial cells themselves. It adheres to the epithelial cells by producing adhesins, which bind to lipids and carbohydrates in the epithelial cell membrane. One such adhesion, BabA, binds to the Lewis b antigen displayed on the surface of stomach epithelial cells. Another such adhesion, SabA, binds to increased levels of sialyl-Lewis x antigen expressed on gastric mucosa.
  In addition to using chemotaxis to avoid areas of low pH, H. pylori also neutralizes the acid in its environment by producing large amounts of urease, which breaks down the urea present in the stomach to carbon dioxide and ammonia. The ammonia, which is basic, then neutralizes stomach acid.

Manufacturing Defect, Perhaps?

This is one of those times when I'm too overwhelmed to blog. Honestly don't have a clue where to begin. Let me get started with the usual update! :)

On Tuesday, I had Ophthalm OT and got to see 2 Small Incision Cataract Surgeries with 3 others. Ratnamma maám performed the surgeries and I must take this opportunity to talk about Ophthalmology postings.
Basically Ratnamma maám and Shamshad Begum maám are the two doctors in the department and there are the sisters who do the dilation and refraction testing of the patients. They take theory class for us for a while and then we take the case history of the patient. One of us (Today it was Mee! Yes, I did make a "patch" of myself but it was fun nonetheless. :) ) presents the case in front of them and they tell us where we've gone wrong (or in case of Begum maám where we've got it right, because everything appears wrong to her!) I'd missed the initial few classes so I didn't really have an idea what was going on thanks to all those complex sounding terms for every condition (Trichiasis [the eyelashes or cilia are misdirected] or Distichiasis [overgrowth of cilia]) and the specific method of History Taking. 

Ratnamma maám peformed the 2 surgeries in under 45 minutes and there was so much ease in the procedure {valvular sutureless incision} that it didn't seem like she is doing anything as complicated as making a frown incision, removing the cataractous lens, removing other fragments and then inserting the new lens (one of them via the sandwich method) and then closing up with the same clockwork precision and confidence. There was some music (old Rajkumar songs, Hindi songs) playing in the background while she explained the highlights of the procedure to us, the names of the instruments she was using and so on.. After the surgeries, we went back to the OPD and she joined us shortly and she sat down to see some more patients. The patients come here from far and near mainly because of her and they don't go back disappointed. She talks to the patients well, makes the comfortable, brings a smile on their face and sends them with the hope that they will soon see better. Yes, she does all of this at 62 years of age. Her knowledge is immense and she expects a lot from students since she puts in a lot of effort to share her knowledge. There's a lot to learn from this lady and we're indeed lucky to be her students. :)

So we'd been to Sana's sister's wedding reception in Arsikere. Adi booked an Innova and we (Abhi BP Nammu Likki Sandy Appy and Eeshna) started off after college. The journey was memorable and we sang songs for most part of the drive. We reached the venue, met Sana, wished the couple a happy married life, spent some time appreciating the arrangements and then proceeded to our favourite hobby: HOGGING!! After leaving the leaf literally clean and empty, we left from Arsikere and had a short stop at CCD (Choco Frappé) and then people slowly began to doze off.. The driver then insisted that we play some music lest he falls asleep so I sat there fighting sleep, changing songs and watching the passing scenery. We reached the college gates at 12.10AM (No questions asked) and tried to catch some sleep. All in all, an eventful day. :)

Abhi Me Nammu Sana Beepee Appy Sandy and Likki :D

Blurred but who cares? One for the memories :')

Now here's for the latest songs that I find myself addicted to:

• Find you, I won't let you go and Fight for you (from Divergent)
• Beating Heart (by Ellie Goulding)
• Shut Up and Dance (Contagiously Happy song! :D )
• Santa Barbara (Nick Jonas)
• All about you (Hilary Duff)
• Hero (from the movie Boyhood)
• See You Again (from Fast and Furious 7)
• Judaai (from the movie Badlapur)
• Jiya Lage Na (from the movie Talaash)
• Maaeri (this is a song I'd hear many years ago. It's from the album Euphoria)
• Teri Meri Kahaani (Title track of the movie)
• Hamaari Adhuri Kahaani (Title track of the movie)
• Looking for Love: Main Dhoodne (Arijit Singh)

^Whew, that seems like a long list! But these songs have got me hooked on to my earphones and helps me shut away from all the noise and chatter of the world. :P :D

And as for other matters, it shouldn't matter and yet it does. To save ourselves from unnecessary persecution and over-thinking, we tell ourselves that the things boring a hole in our brains don't really matter to us. But after a point, this too fails to act as a placebo to the pain gnawing through insidiously.

A few days ago, Nammu and I were blabbering as usual and she asked me if I was still the person I was two years ago. The immediate answer was yes, superficially I'm still the same person. But on further pondering (and some amount of overpondering) I felt that some things have changed. To give a stupid analogy just like the lens that accommodates itself for near and far vision because of the ciliary muscle contraction, we tend to adapt ourselves for the extremes of personalities that we deal with in our day to day lives. After 40, the eye loses its power of accommodation and we commonly develop Presbyopia (what is colloquially known as Chaalis) because the lens can no longer accommodate. At some point we stop this charade of to and fro alteration of ourselves to get along with others. After some point, we remain constant irrespective of the kind of people we come across. It's that point which I hope to reach; when it'll no longer matter how people behave with you, you remain as an oasis of calm. That point can be attained when we are confident of who we are, when we no longer look for validation from others, when we are happy showing who we truly are to others and not care about the outcome. 

All this soul-searching brings me to the question of a possible manufacturing defect. It is wrong to expect without giving, it is wrong to ask for acceptance when you remain closeted yourself. It is unfair to ask for anything when you give nothing. Thus, The Fault Lies Within. 

Anecdotes Of April..

Being irregular on the blogosphere has now become a habit so the less said about it, the better..

April was an eventful month and there's a LOT I'll need to write about but given the paucity of time I'll just stick to the basics.

• Preparation for DeMedcon 2015. Basically involved meeting Indhudhar Sir, Reading up on Tuberculosis from Robbins, Harrisons, Park, Tuli and any related content on the net, preparing the abstract (done by Sir), preparing the poster (done by Sir, again) and printing the poster (Done by Ma). Heyy, but "I" had to Present the poster and that forms the crux (ok, not really) of the matter!
• The travel from Shimoga to Bangalore via the Morning train with PPK is one I'll remember for a long time. I was travelling in the General Compartment after probably more than 12-13 years and it gave me ample opportunity to indulge in my favorite hobby: People Watching! We started at the crack of dawn and watched the scenery unfold while the rain drops on the railings descended downward. The fields looked fresh and green (it had rained heavily the previous night) and the weather was pleasant throughout. I finished re-reading The Class (Eric Segal) and spent the rest of the journey wondering about the population of our country.
• DeMedCon was between 23rd-25th April. Day 1 was CPCR (Cardio Pulmonary and Cerebral Resuscitation), Theatre of Oppressed and Movie Night (Now You See Me [I was too sleepy so PPK and I walked out midway]. Day 2 featured the Keynote Address by Devi Shetty, Plenary session on Bedside Manners by Malavika Kapur, CPC (Clinico Pathological Conference), Oral and Poster Presentations, Quiz prelims (in which PPK and VP participated and hence I was alone and ... *ahem* the rest they say is history and better as a mystery!) and a Talent Hunt involving contestants from the participating colleges as well as the host college. Day 3 began with the Finals of the Oral Presentations, CPC Finals, Quiz Finals and finally culminated with the Valedictory Function. Overall, it was a great experience and I'd say more only if time permitted but alas, it doesn't. There was a lot to learn and I'm glad I attended it.
• Highlights of Devi Shetty's speech were on the emerging trend of courts giving crores as compensation in alleged medical negligence cases, the Yeshaswini scheme, the existing vs. projected required number of specialists in our country and concluded with Save the Doctor campaign.

• Quiz questions will be mentioned in a separate post for interested candidates.
• 
  
• So basically, I presented a Poster of Tuberculosis of Navicular Bone which is a rare occurrence and this was an isolated case (i.e no history of pulmonary TB or any other extrapulmonary TB). Radiological picture suggested a lytic lesion and FNAC showed Giant cells. Finally, a C-arm guided Biopsy showed Langhans type of Giant cells as well as epithelioid cells which confirmed it as a case of Tuberculosis. There was no M. tuberculosis bacilli seen in the biopsy but this is not essential since it is a paucibacillary case. The patient was on the standard drug therapy (HREZ) and has been making steady recovery since then.
  
  
  
• After DeMedCon, I was back in Bangalore (after an interesting bus journey :P ) and the next day I was again off to Shimo. In the following week, we had 2 field visits as a part of our Community medicine postings:
• Nandini Milk Federation (where they pasteurize, process and package the milk, make peda, curd, buttermilk and other yummilicious products that we hogged afterwards.
• KR Water Treatment Plant (additional entrants include Akkamma and Abhii) where we saw how water was taken from the river and then led to different areas and finally filtered in the filter beds (which we saw thanks to our guide Ms. Mo)
• After running around from Department to Department haggling for attendance (which some declined to give Point Blank), studying for a Mycology test (which I ruined after forgetting to attempt a question altogether) and taking a long walk with Abhii (on a so-called lonely unsafe road for girls) where approx 325823658734605 people on the road stared at us for no particular reason other than the fact that we had XX chromosomes. (-_-) But We enjoyed the walk nonetheless but Abhii heaved a sigh of relief as we entered the safety of the campus. :P
  
  
  
  
• Solo Train Journey Time!! I set off for Bangalore (again) on Thursday night and had a pleasant experience. I even saw a familiar face in the station but alas, speech could not be established. It remains as a convergence of light rays for a fraction of seconds.
• Bangalore Diaries:
• BhopieShamieMe: My girl has grown up. But Sheepie remains the same. How I miss my mains. Oh the Pizzas were divine! The joy of hogging in Dominoes and then walking into Pizza Hut to hog some dessert cannot be experienced by all. :) Times change, people evolve and we begin to perceive the world differently but some essentials remain the same. There were some who could not make it for valid reasons, but I guess one has gotten used to that. 

• Pai Viceroy: Just like the old times, well almost. ;)
• Bheemiee Bonding. <3
• PingiKiGruhaps: Drove down to Pingi Ki New House (after following the directions they'd pasted on every other tree en route to their residence. Made a new friend and came back! :)
• PakkadManeKiGruhaps: a.k.a family selfie time.:P
• Shopping! <3
• Ajji Mane: (the shortest visit probably) Met AjjiBajji after a LOOOOONG time :)
• I bought BOOKS!!
• Medical
• Parasitology by Chatterjee
• Hematology by Ramdas Nayak
• Another book on Neuro
• Non Medical
• Stephen King: Mr. Mercedes
• RK Narayan: The Guide
• RK Narayan: The Bachelor of Arts
• Dad got me Eric Kandel. First Hand. OMG. I can't believe it. I've started. :P
• MaDiMe in Shimoga: Ma and Di came to Shimoga (after nearly 6 months). They had a view of my room and spent some time with my friends (Di and Deepu bonded big time [over Ninja Hatori, Chota Bheem and so many more things! :D ])
• Back2Square1: Revert to the old routine. Patho class in the first bench and Patho Lab were Vaibhav Sir enlightened us to the fact that we were first class fools. Ophthalmology postings for a month from now! :)

I've never really believed in this, but of late, I've begun to wonder: Does being a girl imply that you can have lesser adventures in life? Of course, the answer would be "No! Of course not. Today's women travel the world and explore all territories without any inhibitions and restrictions." but that's probably not entirely true. In the ideal situation, yes, it should seem as if to travel by ourselves shouldn't be a big deal, but when it comes to reality, the truth is rather bitter. As childish as it seems, it is difficult for me to digest that a harmless walk in the evening on a highway road is perceived as dangerous (by members of our own generation) and implies that "one is asking for trouble". Now, if we ourselves resign ourselves to such a fate, what change can we expect in the next generation?! 

I've been a grouchy git today and I'm rather happy with myself for the same reason. ^_^