scan man has moved his notes to a new domain….

http://catscanman.net/blog/

All the existing posts on this site will hopefully remain here as permanent archives.

This, sadly, shall be scan man's last post here at WordPress.com…

Since he likes it, scan man's new blog will continue to run on WordPress.

I've been blogging, intermittently, over three months now.

I started out with some vague ideas about doing 'something creative'.

Question: Does the full stop – period for the Americans – come before or after the quote?… I never would have thought of something like this if it were not for Umberto Eco and his 'Foucault's Pendulum' (pedants please refer page 51 of the Vintage 2001 edition paperback).

I don't think I have been too creative these past weeks. In fact I don't think I have even crawled out of the primordial swamp. The peaks of creativity are not even on my horizon.

But that has not deterred me from taking what with hindsight looks like an imprudent decision…I have taken the plunge…

….that was my not-so-direct way of trying to say that I have decided to move my blog to my own domain.

Fret not, Gentle Reader, you will probably have to wait till you edit your bookmarks. Of course, I'm assuming that there are some gentle readers out there..

I had some help from the resident computer geeks in the hospital in setting up a domain and uploading WordPress on it. So I now have an empty homepage with few pathetic typed lines and a blog page loaded with the WordPress Default Theme. The geeks have now abandoned me. They claim it is all easy-peasy after this. I feel marooned.

I spent most of last night pulling out what remains of my hair. Now I'm reduced to a blubbering wreck with bitten-down nails..

I don't have the faintest idea what to do next. Its a confusing alphabet soup of html, php, css, rss,…… out there.

I feel like the village idiot who has entered the Big City Hospital for the first time and is getting an earful from Big Consultant about what is wrong with him….

I admit. I was reckless. I just did it out of a misguided notion that I wanted a unique blog. I wanted it customizable. I wanted all the 'bells & whistles', to quote a friend. It also looks like I will have to retain this blog as a permanent archive. WordPress does not allow exports. Though I can import posts from Blogger or Movable Type, WP does not allow imports from an existing WP blog. How dumb can that be? Don't answer that. It was rhetorical. I guess I should ask myself the same..

Now I don't know what to do…

Any help on setting up and customizing a good WP theme will be gratefully acknowledged and appreciated.

Curtains come down on scan man, kneeling center stage, hands outstretched, pleading…..

We have a new blogger, a fellow dotor from Tamil Nadu.

OrthoDoc is an Orthopaedic Surgeon based in India.

He would still call himself a student. Learning is a process that continues throughout life for a student of Medicine. He hopes to express, discuss and learn more through this blog. His range of discussion will not be limited to ortho only. As the time slowly goes by, he hopes to discover …unearth more from the web.

He has been blogging for two weeks now. I highly recommend the following posts:

Language as a Barrier – where he explores the pros and cons of having English as the language of the Medical profession and higher studies in a multilingual society such as India.

Fall from Grace – where he laments the poor portrayal of the Medical Profession in popular media and worries if it is justified.

Mid-day Meal – where he writes about the Nutritious Noon Meal Scheme in which a free freshly cooked lunch is provided free for all school children in the Government-run schools of Tamil Nadu.

It feels good to have a fellow Tamilian on the medical blogosphere..

Do I have an alcohol problem?

A question that I have been afraid of even thinking out loud.

Because I believe, as does Dr. Crippen, that the very fact that I am asking myself the question is proof that I believe there is a problem.

Dr. Crippen goes on in this excellent, thought-provoking post

If you are asking yourself that question, you probably do have one. But if in doubt, ask yourself the four CAGE questions.

1. Have you ever felt you needed to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Two positives and you are in trouble.

Well, here are my answers

1. Yes.
2. Only my wife. I don’t think that counts as a full positive, because she also nags me about a lot of other stuff, like my weight, or the shape of my abdomen (I keep telling her that round is a good shape).
3. No. I wonder if it counts as more than one positive for this question if I have felt guilty about not drinking!
4. Never.

So…

One definite positive and a partial. I guess I don’t have a problem (yet).

Humour aside, I think Dr. Crippen’s post is great.

The question that bugs me is…

Just how big is the Silent Alcohol Abuse problem in the world?

Is it as big as the Obesity problem? or Bigger?

I am sure we would be shocked by the numbers if some epidemiologists collect the data from different countries just based on responses to the CAGE questions.

Bloglines alerted me to a new post by Dr. Hebert a few days ago. I read a few lines and thinking that it was about Jazz and Gospel Music, something that I don't know anything about, I quit.

I came across the post again in Grand Rounds (hosted by Dr. iBear at Doc Around the Clock) today…

Dr. Hebert of Michael Hebert's Medical Gumbo talks about apprenticeships in medical education and eloquently contrasts that with the gospel group the Zion Harmonizers in Med Ed and the Zion Harmonizers. Where is the future of medicine headed unless we take a little tip from the Zion Harmonizers?

Curiosity aroused, I went back and read through the entire post.

To echo Dr. Flea, I'm Speechless.

This is the best thing that I have read about medical education in the sixteen years that I have been a medical student and a doctor.

Dr. Hebert has quoted the Hippocratic oath to make a point about apprenticeship as a way to learn medicine..

It was not always thus. The history of medicine is rich with preceptor-apprentice relationships. At one time, this was the expected method of medical education. The Oath of Hippocrates, written 2,400 years ago, gives more than a passing nod to apprenticeship:

I swear . . . . To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.

If we look further east (and a few centuries earlier), we find an obvious parallel in the haloed Gurukul system of education in ancient India with its Guru-Shishya tradition.

Knowledge passed on thus to generations of students in the ancient Greek and Hindu civilizations are at the core of most modern science and philosophy. The reason why we still remember them and their methods.

Medical educaiton, which was essentially an apprenticeship until the nineteenth century, has become, over the past century, more 'scientific' and 'professional'.

I wonder if anyone will remember this 'information assembly line' system of 'education by committee' two thousand years hence when, presumably, the chief medical officer would be assisted by computers, robots, medical droids and holograms.

I am distressed.

There has been an ominous silence in Tamil Nadu's usually spirited medical student community.

Their brethren are being beaten up and water-cannoned by policemen in Mumbai, on hunger strike in Delhi and on protest marches in Mangalore and other cities.

The Mumbai and Delhi chapters of the Indian Medical Association have called for strikes on Monday.

Why isn't there any noise in Tamil Nadu?

By all rights, Tamilians should be in the forefront of any anti-reservation protest. We have been at the receiving end the longest, and we have been hit the hardest by caste-based reservations.

The students in the northerns states are protesting the newly proposed 27% hike in the reservations in premier medical institutions for students from the Socially & Educationally Backward Classes (SEBC – more commonly known as OBC – Other Backward Classes). They claim that in addition to the existing 22.5% reservation (for Scheduled Castes / Scheduled Tribes & SEBCs) this will bring caste-based reservations in educational institutions to 49.5% of the available seats.

Here are some of the common anti-reservation arguments put forward by the protesting students (in no particular order):

• Caste-based reservations have gone on for long enough. Are 60 years of reservations not enough for uplifting the down-trodden.
• Unacceptably high percentage of reservations in the limited seats that are available in premier educational institutions.
• Build more institutions. Don't increase reservations.
• What happens to equal opportunity? Are we creating a new elite based on the backward classes?
• The death of merit.
• The real socially and educationally backward classes are not benefited.
• Caste should not be basis of reservations.

There are I am certain, an equal number of counter arguments. This is a debate that is akin to the Great American Abortion Debate, arousing fierce passions in India.

As a staunch opponent of caste-based reservations, I do not want to list the pro-reservation arguments here.

Back to my initial question. Why the silence in the student fraternity in Tamil Nadu?

Is it because they do not agree with the students in the north?

I don't think so.

Ask any student in Tamil Nadu about the current spate of anti-reservation protests and I am sure, one would get a surprised look and an answer such as this: "I don't know what those guys are protesting against. 49.5% reservation is nothing. We would welcome it."

Indeed 49.5% reservation would be welcome in Tamil Nadu.

For a state which has been chained to a repressive 69% caste-based reservation quota for all levels of higher education and employment in Government services, 49.5% would indeed be welcome.

It would be a relief.

Over the years I have come around to accepting reservations at the undergraduate level.

But to have 69% reservations at the post-graduate level, especially in medical and engineering colleges is criminal. It is nothing but vote-bank politics.

I am sure this post will generate some adverse comments from the pro-reservationists.

So here are some facts:

I belong to a caste which is officially classified an SEBC. My family was neither socially nor economically backward. I could have, but I did not take advantage of the reservation system. I got my medical undergraduate degree in a private medical college. I earned my postgraduate degree on merit through a competetive exam.

I agree with the views of the Indian communist parties that private colleges act as reservations for the rich. Isn't it time to ask the question, how many rich kids from the backward classes are abusing the reservations system instead of joining private colleges?

For the record I am not a right-wing nationalist. I strongly believe that all Indians should be treated as equals regardless of religion, caste, or region of origin.

The system of affirmative action that Gandhi, Ambedkar, Nehru et al devised for our country has been raped and abused beyond all recognition for narrow political gains by our political classes in the years since Independence. Affirmative action if it needs to be effective should begin at the primary school level with sustained effort by the government to really uplift the backward classes.

I think caste-based reservations and caste-based politics should be banned. In my opinion caste-based agitations should be equated with religious fundamentalism and should be tackled with the same kind of zero tolerance approach.

Arjun Singh and the UPA government are shamelessly playing the caste card for political gains.

God save our country from its political class.

For those who read Part-I of my Close Encounters, this story is different. This is more in line with the usual kind of stuff that 'real doctors' write about Alternative Medicine.

It ought to be titled "Quactitioner Alert". I refrained from doing so out of deference to Dr. Crippen who coined the phrase.

This story starts with the ringing of my office intercom on a busy morning…

My Receptionist tells me that there's a doctor on line and she wants to talk to the Radiologist. I tell him to put her on….

Lady Doctor (in a demanding tone): Is this the Radiologist?

scan man (a little put off by the demanding tone): Good Morning. Yes, I am the Radiologist. I'm Dr. scan man. What can I do for you?

Lady Doctor: I want a scan done for one of my patients. I wanted to talk to you about it before I sent him over.

scan man: Ok. May I know who you are and what scan you want for your patient?

Lady Doctor: I'm Dr. G. I'm a Doctor of Naturopathy. I'm calling from Town-M. My patient needs a scan of his abdomen. I wanted to ask you what would be better, a CT scan or an ultrasound scan.

Something goes 'Quack, quack' in the back of my mind while I try to take some deep breaths and compose myself. I really hate it when someone introduces themselves or is introduced to me as a doctor and they turn out to be alternative medical 'practitioners'.

The Government, in its infinite wisdom, recognizes them and encourages the practice of calling them Doctors. In fact the Government even encourages the habit of calling physiotherapists doctors. I don't like it.

scan man (trying very hard to sound polite): That depends on what exactly you are looking for..

G: What do you mean, what I'm looking for! I want the scan done so that I can find out if anything is wrong…

scan man (exasperated): Madam, what I meant is that the choice of scan would depend on what your clinical suspicion is..

G: Ohh… Ok. The patient has had stomach pain (sic) and loose stools for a day..

I waited for her to continue….and realized that she was not going to say anything more…

I had a suspicion about the kind of answer that I would get for my next question.

scan man: Have you examined the patient or done any other tests?

G: No. I wanted a scan done first.

Ah hah.

Suspicion confirmed.

The QUACKs in the back of my mind have become louder and more frantic.

I need to be careful here. I'm entering a delicate part of the process…

scan man: That's fine Dr. G, I think I'll do an ultrasound scan on him…

G: Do you think that will tell us what is wrong with him?

Good. I think I've got her…

I can handle this..

All I have to do now is to forget that I am a qualified doctor and try to use Quack Logic.

scan man: I'm not very sure Dr. G, but as an ultrasound scan is cheaper, I think we should go with that first. If that shows a bowel-related abnormality like a segment of wall thickening or some mesenteric adenopathy, I may need to do a CT scan or even a Barium study…

G: That sounds good. Shall I send him over tomorrow morning..

Good. It seems to be working..

Now to get the patient to safety fast…

scan man: I don't think we should wait that long Dr. G. I'm sure I can fit him in this evening. Please ask him to be here by 4 PM.

G: Ok. I'll do that. Thanks for your help.

scan man: Glad to have been of service.

I did see the patient that evening, long enough to advise him to see our Internal Medicine guy.

He never had a scan done. I'm sure my colleague treated him for what sounded like infective diarrhoea.

And I'm pretty sure he got an earful about Quactitioners and how to avoid them.

The Tamil Nadu State election results were declared yesterday. The people have voted for a regime change. So we'll have a new chief minister in a few days.

I had entertained the possibility of opting not to vote for any of the contestants in my constituency. I was not too sure if I would be allowed to do that. The existence of such a provision in the Election Rules has only been talked about in websites and blogs among what the Indian media quaintly calls the 'chatteratti'. I did not think that it had percolated down to the lower bureaucracy. So I chose the lesser evils and voted for the non-communist candidate.

I am glad to say he won. But the alliance that his party was part of lost. The left-of-centre alliance which included the two communist parties won.

My skepticism re. the lower bureaucracy was proved true by news reports of people being refused to entertain their privilege not to vote by opting for Rule 49 (O).

We really do need electoral reforms.

Update: The guy I voted for won with a margin of just 14 votes (total votes polled 240,267).    

That is the question posed by John Naughton of The Observer. The problem is the continuing saga of delays that have plagued the launch of Windows Vista.

Why is this on my blog?

The difference between Microsoft and Apple can be largely explained by two factors. One is structural: Apple's OS X is based on Unix, which has a different architecture from Windows, and may be inherently easier to upgrade. The other is that Microsoft is a victim of its past monopolistic success: any new version of Windows has to be 'backwards compatible' with the thousands of programs and hardware devices built to work on earlier versions of the operating system. Apple has much less of a 'legacy' problem in this sense.

He also has good things to say about Linux and Open Source in general. Read the full article here.

This is the first of two stories based on two incidents that occurred last week.

I am not a fan of any of the systems of Alternative Medicine. My limited experience of the world of medical blogging tells me that I am not alone. For those of you who are familiar with what 'real doctors' write about Alternative Medicine and its practitioners / quactitioners, this is a different kind of story…

..that started with a referral for a Brain CT scan by a Siddha Medical Practitioner from a nearby small town.

The patient was sent to me with a letter which said:

To The Radiologist, Big Town Hospital.

Dear Doctor,

Please do a CT scan of the Brain for Mr. P, a 60-year-old man who is semiconscious and has left-sided hemiplegia. Please admit him in your hospital and do the needful.

signed Dr. Sidha Practioner, B.S.M.S., Small Town.

I was intrigued.

It is not unusual to come across referrals for 'western / allopathic' tests from practitioners of the many alternative medical systems that the Indian Government recognizes (Ayurveda, Siddha, Yoga, Unani, Homeopathy & Naturopathy).

As a Radiologist, I have come across several referrals by these practitioners for various imaging studies. The majority of such referrals have been for questionable indications and for inappropriate imaging studies. In most of those instances, an allopathic practitioner could have come to a reasonable diagnosis based on history, clinical exam and some lab tests.

This referral sounded almost like what I would get from one of my allopathic colleagues. My curiosity was aroused to the extent that I did something that I rarely do for a CT Brain referral. I got out of my comfortable chair and went over to see the patient.

The patient, lying on a stretcher, had a large bandage swathed around his head covering the right side of his face and jaw. He was not arousable. His ABCs were ok. His blood pressure was normal. I could not get any relevant history from the worried-looking rustic old lady who was with him. I assumed it was his wife. After a cursory examination – the only kind that I know – I concluded that he did have a left-sided hemiplegia. I told my nurse and techs to get him into the CT room and went back to my office.

I was worried about the bandage. Was there a history of injury?

I needed more information. So I pulled out the referral letter, checked the number and called Dr. Sidhha Practitioner. I introduced myself, thanked him for the referral and asked him for clinical details. This was his story…

Mr. P had come to see him about a few days ago with a painful swelling on the right side of his jaw. Dr. SP thought it could be a Parotid abscess. Knowing that he would not be able to do anything for it through Siddha, he referred Mr. P to the local Government Hospital. The surgeon there had done an I & D, prescribed some antibiotics and sent him home. His wife and some neighbours brought Mr.P back to Dr. SP today, saying that he had not been arousable in the morning. After examining him, Dr. SP concluded that Mr. P had a stroke, so he referred him to our hospital which he knew had a CT scan and a Neurology Department.

By this time the techs had completed the scan. It showed an acute infarct in the Right Middle Cerebral artery territory. The scan also showed signs of facial cellulitis on the right side and small air pockets in the right Parotid, consistent with a recently drained abscess.

I alerted the Neurologist and sent the patient to the Emergency Department. I saw him again two days later when he was sent for a repeat CT. The infarct had not progressed and his facial cellulitis was subsiding.

In the course of a few days, Dr. SP had correctly identified two different medical conditions in Mr. P, had recognized the need for proper care and had sent him to the appropriate places.

This is one Practitioner that I will not forget. May his tribe increase!