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Showing posts from 2018

De Quervain's like Pain After CPR

Yesterday I was demonstrating CPR in a life support workshop. Today, I have pain in the left radial styloid process area. What could it be? Searching took me to two pages of interest. One is AAFP's page on diagnosis wrist pain . This page talks about many things including Finkelstein's test which is grasping the thumb with other fingers and then ulnar deviation of wrist. It was negative for me, and I definitely did not have De Quervain's tendonitis. But it could be the same tendons. What are the tendons involved in de Quervain's? The extensor policis brevis and the abductor policis longus which both go through the groove lateral to the radial styloid process. Maybe there was some microtrauma? The other article was about wrist injuries in emergency service providers . It does not look like I have a scapholunate ligament injury. So I decided to read more about de Quervain's. I found an article - Walsh and Miller: Pain about the Styloid Process - which beautifully

A Letter to the Disillusioned Intern (or Medical Student)

Disillusionment. It happens to the best among us. It has happened to you? Welcome to the club. After all, who wouldn't be disappointed? You could have become anyone - an architect, an engineer, a teacher, a scientist, a mathematician. Yet you chose to become a doctor. Of course it was your calculated choice. What a fantastic profession is it, after all? When a doctor talks to a patient, she is a teacher, an artist; when a doctor is diagnosing an illness, she is a detective, a scientist; when a doctor is communicating, she is a writer; when managing an emergency, she is a leader; in her career, she becomes an administrator, a guide, a policy analyst, a visionary. A doctor's profession is an incredible melting point of careers. Unique, interesting. And above all, serves humankind like nobody else. And what did it all come to? Running around like a dog completing errands passed down to you in the strictest hierarchy ever. (It is called dog work, did you know?) Maybe learning

Why Jacob Vadakkanchery's Arrest is the Best Thing for Naturopathy, AYUSH, and the State

There is a lot of context needed here. To begin with, Jacob Vadakkanchery is a self-proclaimed healer naturopathist from Kerala who goes around asking people to believe that modern medicine is harmful for health. His arguments are so basic and trying to respond to an argument he raised had me writing a 1200 word blog post in Malayalam explaining what science is and whether medicine is a science. He was arrested in the second week of September by Kerala police for asking people not to take Doxycycline prophylaxis (in the aftermath of the floods) under at least section 505 of IPC. Section 505 is one of those sections which exist owing to the "reasonable restrictions" over freedom of speech and expression in the interest of public order as per Article 19 of the Indian Constitution. It punishes people who spread rumors that are likely to disrupt the society unless they are based on reasonable grounds. I, am an HIV physician and general practitioner of modern medicine. I ha

Healthcare With Smartphones?

Imagine this. You are a 36 year old lady working as maid in two houses, not supported by an alcoholic husband, and mother of two school going children. Your husband had a wart on his genitals and now you have it too. It is not particularly bothersome, but you are not sure what you should do about it either. You think it would be a good idea to go to a hospital, but which hospital? Which doctor should you meet? Would they judge you? Do they charge too much money? Is it going to hurt? Whom do you even ask these questions? Enter our app. You will be asked a series of questions in your own language. The questions get more and more specific as you answer them. They will also be read out to you in case you can't read. By the time you have answered about 10 questions, the app knows what your problem is. The app has been fed with a well designed set of protocols/algorithms that need to be followed in each situation. It has a curated collection of resources (hospitals, clinics, labs, l

Reimagining Kinnars (Hijras) as Health Workers for Reproductive & Sexual Health

Supreme court struck down section 377 a couple of days back. India is moving forward in the right direction. There is still a lot of work left to do. We see kinnars (hijras) working on roads asking people for money. They are "strange" humans in other people's mind and when people look at them all that comes to their mind is their gender issues and sexual connotations of those. This strangeness might be the reason why people are unwilling to give them jobs. Could we turn this around? Reproductive and sexual health is a topic that is absolutely neglected in our education system. There is plenty of embarrassment in discussing topics related to sex as well. What if, then, we put them both together? What if we empower kinnars by giving them training and other resources required, to go into the community and work for reproductive and sexual health? Like ASHA workers they would promote health. They can even distribute interventions like condoms. This is a positive chan

Way Forward

On 30th of June, SVYM organized a one day session on careers after MBBS at Vivekananda Memorial Hospital. Interns and/or final year students from Mysore Medical College, Bangalore Medical College, Hassan Institute of Medical Sciences, JSS Medical College Mysore were among the ones who were in the audience. After the SVYM video, it began with introductory remarks by Dr Chaithanya Prasad, the director of VMH. Then Dr MA Balasubramanya talked about administrative careers after MBBS. The gist of it was that as doctors, we are already administrating. There is no running away from it. We should embrace that reality and go forward with it. Dr Kumaran K took the audience through the story of his life in research and thereby had them thinking about how to pursue a career in research. Dr Ravindranath motivated the audience to take up surgery as a career and showed various alternatives to the MS degree to become a surgeon - majorly about options in various other countries. Dr

First PEP - Days 7, 8, 9, 10, and so on...

Well, I lost count. I didn't miss a single tab. But I have, as usual, missed on writing the experience. There are indeed some highlights. First, a house surgeon and his friend from my college came all the way to Nugu and our hospital after reading my posts. I guess I put enough philosophy in his head that he comes back and joins here later. Then, I'm making good progress in my thesis work, interviewing patients about their perspectives on how they became sick. I have interviewed three patients till today. Each interview gave me a completely different story. I have even moved to Asha Kirana hospital asking permission to interview patients there. Also, Amazon made three deliveries. My favourite book - The Emperor of All Maladies , my favourite stethoscope Dr Morepen ST 01 , and Tripti Sharan's Chronicles of a Gynaecologist . (all affiliate links)  Finally got a hard copy. Horror stories one after the other. Chronicles of @triptisharan200

First PEP - Days 4, 5, 6

Days fly by as usual. It's already day 6 and I'm wondering what I did on day 5. (I slept all day). Day 4 - Monday, 30th April I had general OPD duty. In essence I was jobless almost the entire day. I sat in the injection room and saw some 10 patients. This morning I had tried to swallow the LPV/r without any water. It wasn't a very good idea as one of it got stuck to the throat and I almost had to do Heimlich on myself. It's the day we went to Nugu and savoured garlic bread and churmuri prepared by all the ladies. Busy kitchen at the ladies' place Not conspicuous: Ram struggling with pepper powder in his eyes On the way back Kishan & Suchitra ran out of petrol. So I had to empty a 1 litre bottle of water into my throat and fill petrol in it. Swathi and I went on a scooter ride after about an year today. Day 5: May day All I remember of this day is sleeping all day. I tried to get some useful work done after waking up in the evening. But ha

First PEP - Days 1, 2, 3

After having done the " Perfectly Messy Prefect " series and " Jog Journal " series, I have now gotten the opportunity to start a new series - on Post Exposure Prophylaxis. Let's start with the good news. I put a central line in a patient (that's my first time after MBBS and the first time I was confidently doing it on my own). This patient who's been admitted with Cryptococcal antigen showing 3+ in their CSF needed lots of amphotericin for two weeks. Putting amphotericin in a peripheral venous line is okay, but it can soon lead to thrombophlebitis and both patient and doctor will have a hard time managing it. So we decided that it must go through a central line. And it was imperative that this happened in the new emergency department that was inaugurated the same day. Dr Ram was around and his guidance is better than the ultrasound guidance he gives. I will put a better picture of the new ED in a future post First thing we settled was whet