FINAL
The cruise was a wonderful experience overall. We watched shows, ate
plenty and got pulverized later. The off-shore excursions were
engaging, enthralling and enchanting. One of them was In Juneau, where
we chose a Zip-line tour. A group of nine were taken to Douglas island
and then in to the tropical forest.
When we reached the take-off point, the small hill that we climbed was
deceptively reassuring. When we looked down from the top, it was
at least 150-200 feet deep and we saw one measly wire connecting two
tree tops. It seemed as though, the economic meltdown had melted down
the wire. "We never had an accident in the last 3 years" said the
guide in a weak tone, I thought. I did not dare to ask if there were
any accidents at all. But our ebullient member was very quick to add
"there is always a first time for anything" an optimistically
pessimist. The impending adventure was intoxicating to the few and
peristalsis stimulating to the rest!
Children were excited, but, I felt I should have packed some
pampers."The wire can hold two thousand pounds", the guide words
echoed on top of the hill. Our ever ready crepehanger was quick to ask,
"how about the trees that hold these wires". This sent the guide in to
a thinking mode. If you lingered with this guy for a day, you would
need Divesh (gastroenterologist) for life. I was convinced that
pharmaceutical company had specially trained this gentleman to boost
the sales of their IBS (irritable bowel syndrome) drugs. The guide
explained that there would be someone at the other end to receive and
secure the persons. "If we reach the other end" was the swift reply
from our ever cynical skeptic. Everyone missed having a duck-tape
handy!
"Who would go first?", asked the exuberant guide, the whole group
enthusiastically mentally pushed this prophet of doom to the fore
front. Before the action could become a reality, Snigdha offered to go
first.
It was my turn, later. If you looked down, your confidence would
follow the suit. My palms were sweaty but I managed look stoic, but
before I could say my last prayer, I reached the other end. The
pessimist was perplexed. We did five more such transfers. It was
delightfully gratifying and satisfying.
It was a trip of a life time.
Pradeep
Monday, December 28, 2009
Sunday, December 27, 2009
ALASKA-Part 4
Part 4
After the magnificent peak experience, our excitement also descended to a sea level. My youngest wondered-will it be mountain calmness to motion sickness? There was a beeline for the cruise liner. Yet, check-in process was commendable. Ours was a royal suite with a living room, dining area and a master bedroom. A large veranda was awe inspiring. It was on 10th floor and close to Palm springs cafe, where Indian lunch was served every day.
Having acclimatized ourselves with the ship, I coaxed Radha to treat herself to various programs, which she had not had time to cherish till now, such as massage, Thalassotherapy, facial etc. Believe me, she chose a personal trainer with three half hour sessions. I commended her physical fitness bent even on vacation. Little did I realize that she enrolled me too in the program. I was confused; is this she was waiting for all these years- make me sweat! or she wanted company!
We proceeded to the fitness center to encounter a charming young lady. It wasn't that bad, I thought! As she greeted us, her expression was- wow, what a couple! Bald and Beautiful. She was an ex Olympian.I was under the notion that there should be no personal motion on the ocean. I was not prepared for anything more than "Run to Reach Nowhere" (treadmill), but she put us through several exercises. She was pretty and pitiless. It was a comprehensive customized program to turn my all-round body in to a pulp. I wondered if I made a right choice in giving Radha a choice. I asked her to treat herself, but instead she subjected me to a titillating triturator (pulverizer)! I needed a zalim Lotion on the Ocean.
To be continued.
After the magnificent peak experience, our excitement also descended to a sea level. My youngest wondered-will it be mountain calmness to motion sickness? There was a beeline for the cruise liner. Yet, check-in process was commendable. Ours was a royal suite with a living room, dining area and a master bedroom. A large veranda was awe inspiring. It was on 10th floor and close to Palm springs cafe, where Indian lunch was served every day.
Having acclimatized ourselves with the ship, I coaxed Radha to treat herself to various programs, which she had not had time to cherish till now, such as massage, Thalassotherapy, facial etc. Believe me, she chose a personal trainer with three half hour sessions. I commended her physical fitness bent even on vacation. Little did I realize that she enrolled me too in the program. I was confused; is this she was waiting for all these years- make me sweat! or she wanted company!
We proceeded to the fitness center to encounter a charming young lady. It wasn't that bad, I thought! As she greeted us, her expression was- wow, what a couple! Bald and Beautiful. She was an ex Olympian.I was under the notion that there should be no personal motion on the ocean. I was not prepared for anything more than "Run to Reach Nowhere" (treadmill), but she put us through several exercises. She was pretty and pitiless. It was a comprehensive customized program to turn my all-round body in to a pulp. I wondered if I made a right choice in giving Radha a choice. I asked her to treat herself, but instead she subjected me to a titillating triturator (pulverizer)! I needed a zalim Lotion on the Ocean.
To be continued.
Alaska- Part 3
PART3
That was not the end. It was just the beginning of the "woes of my wallet".
My fellow wallet wrencher noticed Benjamin Franklin on the currency and shouted-"Oh, you are from US, Happy July 4th". Everyone else joined in a chorus. I gently bowed to appreciate my audience, who later turned out to be my plight pullulaters. They all appreciated us coming to Vancouver as that also helps the local economy, which in turn helps them to get ready for winter Olympics.
In the mean time, coach attendants brought the souvenirs catalogue and I was forced to make some more purchases. Some vehemently suggested we take Peak to Peak tour as that gives a panoramic view of the mountains. They were right, it was a magnificent view. We took a cable car at a height of about 5000 feet and went from a peak to a peak to have a peek at the peak from the peak. It was nature's beauty at its best. We never felt like leaving that place. It was worth the expense, but at what expense!
The cables were suspended in midair without any supports for over a mile and that too at a phenomenal height. An ultimate trepidation for acrophobics! I am posting the link. http://picasaweb.google.com/mealur/Alaska1?feat=directlink
http://premidoc.blogspot.com/ for some videos
That was not the end. It was just the beginning of the "woes of my wallet".
My fellow wallet wrencher noticed Benjamin Franklin on the currency and shouted-"Oh, you are from US, Happy July 4th". Everyone else joined in a chorus. I gently bowed to appreciate my audience, who later turned out to be my plight pullulaters. They all appreciated us coming to Vancouver as that also helps the local economy, which in turn helps them to get ready for winter Olympics.
In the mean time, coach attendants brought the souvenirs catalogue and I was forced to make some more purchases. Some vehemently suggested we take Peak to Peak tour as that gives a panoramic view of the mountains. They were right, it was a magnificent view. We took a cable car at a height of about 5000 feet and went from a peak to a peak to have a peek at the peak from the peak. It was nature's beauty at its best. We never felt like leaving that place. It was worth the expense, but at what expense!
The cables were suspended in midair without any supports for over a mile and that too at a phenomenal height. An ultimate trepidation for acrophobics! I am posting the link. http://picasaweb.google.com/mealur/Alaska1?feat=directlink
http://premidoc.blogspot.com/ for some videos
Alaska-2
PART2
It could be that those guys were demanding a real aircraft or refusing to part with their beards. They finally left. Snigdha, who had previously travelled by this toy craft museum piece, assured us that it did a good job of transporting. As expected, we could not take any carryon. I was allotted number 1b seat. Basically right behind the captain's seat. No kidding! If I stretched my arms forward, I would be changing the gears. Believe me, there were no cockpit doors and a special announcement was made, not to panic if any alarms were heard, which was a normal navigational process.
No food was served, as a pilot had to do that. None of us preferred that pilot leave this archaeological wonder unmanned in midair! However, we landed safely in Toronto. Immigration was a breeze. We were cherishing our newly found permanent residency status. The flight to Vancouver was a real aircraft. Journey was long, but as I did not have a skeptical Madrasi mother or confused Pakistani mother-in-law (that was another story), I was left in peace and in one piece.
Vancouver is a great city. It is no joke, if I said, majority of the population was either Chinese or Sardarjis, I found were homeless! It appeared Asians migrated with their land as well. Next day was July 4th and we boarded Glacier Dome train, which is full of glass to reach Whistler Mountain, the venue for winter Olympics in 2010.
The train journey was very pleasant and the scenery was stunning. The waitresses were winsome. They engaged us in a delightful way and fed us to the extent that I would have put on at least a pound by the end of the journey. Being, enchanted, entertained and contented, I thought of gratifying them with a handsome tip. I was trying to build up a case to convince Radha as to how a generous $20 may be appropriate for the services they rendered. I was trying to ensure that she would not impart sinful significance to my unusual generosity.
Well! She looked at me scornfully and I felt I failed to convey my honest and truthful feelings and reasons. "You will never change" Radha said. I was preparing to ward off a possible brouhaha. "How could you be so stingy?" she continued and made an instantaneous recommendation for $50. I was awestruck dumbfounded. My magnanimity turned into instant parsimony. I finally settled for a $40 tip.
To be Continued..
It could be that those guys were demanding a real aircraft or refusing to part with their beards. They finally left. Snigdha, who had previously travelled by this toy craft museum piece, assured us that it did a good job of transporting. As expected, we could not take any carryon. I was allotted number 1b seat. Basically right behind the captain's seat. No kidding! If I stretched my arms forward, I would be changing the gears. Believe me, there were no cockpit doors and a special announcement was made, not to panic if any alarms were heard, which was a normal navigational process.
No food was served, as a pilot had to do that. None of us preferred that pilot leave this archaeological wonder unmanned in midair! However, we landed safely in Toronto. Immigration was a breeze. We were cherishing our newly found permanent residency status. The flight to Vancouver was a real aircraft. Journey was long, but as I did not have a skeptical Madrasi mother or confused Pakistani mother-in-law (that was another story), I was left in peace and in one piece.
Vancouver is a great city. It is no joke, if I said, majority of the population was either Chinese or Sardarjis, I found were homeless! It appeared Asians migrated with their land as well. Next day was July 4th and we boarded Glacier Dome train, which is full of glass to reach Whistler Mountain, the venue for winter Olympics in 2010.
The train journey was very pleasant and the scenery was stunning. The waitresses were winsome. They engaged us in a delightful way and fed us to the extent that I would have put on at least a pound by the end of the journey. Being, enchanted, entertained and contented, I thought of gratifying them with a handsome tip. I was trying to build up a case to convince Radha as to how a generous $20 may be appropriate for the services they rendered. I was trying to ensure that she would not impart sinful significance to my unusual generosity.
Well! She looked at me scornfully and I felt I failed to convey my honest and truthful feelings and reasons. "You will never change" Radha said. I was preparing to ward off a possible brouhaha. "How could you be so stingy?" she continued and made an instantaneous recommendation for $50. I was awestruck dumbfounded. My magnanimity turned into instant parsimony. I finally settled for a $40 tip.
To be Continued..
Saturday, December 26, 2009
ALASKA-A trip of a life time
It was an amazing trip of a life time for us!
We have been preparing for this cruise for about 5 months. The excitement was building up every day. As the departing date approached, we were very much tensed up and yet very optimistic to experience the sea sickness first-hand!
We bought binoculars and I got a new Panasonic DMC ZS3 camera(has 12 megapixels, 12x optical zoom, 25mm wide angle, HD video recording, stereo sound recording and zooming ability in video as well and it fits in a pocket!!), a gizmo, one should never leave without for a vacation. I also carried my 1080p Canon camcorder.
None of us could experience any sleep as we were experiencing the experience, we were going to experience already!
We drove to Harrisburg and parked and took all our 6 suitcases for a 10 day trip. the lady at the counter looked at us in bewilderment-"do you know how you are going!" expression on the face. I previously checked the luggage allowance and it was an international flight to Vancouver via Toronto and we were allowed two bags/person.
Her head swung side to side as if these people will never learn attitude! I didn't care as I was determined to enjoy every bit of my voyage. We whisked through the security and reached our gate for boarding. I saw the counter clerk arguing with two bearded guys and pointing to their beards. As I glanced through the glass, I noticed our aircraft!
It was the smallest aircraft we have ever flown international or even domestic. It looked like one of those old dilapidated herald cars, which needed to be pushed to start. You would wonder if that aircraft was held in one piece by Duck-Tape! No doubt, the lady at the baggage checking was wondering, how this aircraft would carry our entire luggage and people too.
It appeared the lady at the check-in gate was asking those bearded guys to shave to reduce the weight on the aircraft!
to be continued.
We have been preparing for this cruise for about 5 months. The excitement was building up every day. As the departing date approached, we were very much tensed up and yet very optimistic to experience the sea sickness first-hand!
We bought binoculars and I got a new Panasonic DMC ZS3 camera(has 12 megapixels, 12x optical zoom, 25mm wide angle, HD video recording, stereo sound recording and zooming ability in video as well and it fits in a pocket!!), a gizmo, one should never leave without for a vacation. I also carried my 1080p Canon camcorder.
None of us could experience any sleep as we were experiencing the experience, we were going to experience already!
We drove to Harrisburg and parked and took all our 6 suitcases for a 10 day trip. the lady at the counter looked at us in bewilderment-"do you know how you are going!" expression on the face. I previously checked the luggage allowance and it was an international flight to Vancouver via Toronto and we were allowed two bags/person.
Her head swung side to side as if these people will never learn attitude! I didn't care as I was determined to enjoy every bit of my voyage. We whisked through the security and reached our gate for boarding. I saw the counter clerk arguing with two bearded guys and pointing to their beards. As I glanced through the glass, I noticed our aircraft!
It was the smallest aircraft we have ever flown international or even domestic. It looked like one of those old dilapidated herald cars, which needed to be pushed to start. You would wonder if that aircraft was held in one piece by Duck-Tape! No doubt, the lady at the baggage checking was wondering, how this aircraft would carry our entire luggage and people too.
It appeared the lady at the check-in gate was asking those bearded guys to shave to reduce the weight on the aircraft!
to be continued.
Tuesday, December 8, 2009
Does ECHO help decide number of Indocin doses?
Early targeted approach of using indomethacin in the first 12 hours of life if the Echocardiogram showed a duct of >2mm. Then they were randomized to echo directed indocin or standard 2 more doses of indomethacin. No differences in any complications or surgery were reported. but, the authors talk about TREND. I am not sure how trend in the absence of statistical significance has any relevance. However, they mention about higher trend of IVH in ECHO directed group than in 3 dose group. What is NOT mentioned is-the higher trend for chronic lung disease in standard 3 dose group (15% vs 6%). I believe this finding is also very important as Dr. Bancalari mentioned on Nicuniversity CME that prophylactic indocin may increase chronic lung disease. Less indocin=less CLD and more IVH?
IV Sildenafil for PPHN?
The December issue of JPeds published a multicenter pilot study evaluating IV Sildenafil in 36 newborns. Adverse events were reported in 4 neonates. Overall good improvement was reported in oxygen index. We have to wait for larger studies to show consistent improvement and without major side effects.
Simple Dimple-What Imaging is needed?
Simple dimple is defined as one that is <5mm in size and less than 2.5cms from the anus. Many consider that no imaging is needed for this. Recent study published in December 2009 issue of The Journal of Pediatrics confirms the same. They evaluated 109 babies with ultrasound and found no tethered cord.
Wednesday, December 2, 2009
Technology in Medicine—How Much Do You Rely on it?
Technology in Medicine!!!!!
I think we all know how much medical technology exposure we had in medical school (three decades ago) and during house surgeon (an internship): Barely any!
My friend, Ramana, came to visit me in cardiology one evening when we were house surgeons. I was showing him a patient who had an amoebic liver abscess that burst in to his pericardium. He had pericardiocentesis and was put on a cardio-respiratory monitor. I was told to watch this guy closely as he might develop sudden cardiac arrest; however, I was not told what to do in such an event. Hence, I was well prepared!! :-(
I was showing Ramana around the unit and told him about this special patient he might have cardiac arrest. As I was finishing the sentence, the EKG tracing on the monitor went flat. I panicked! I called for help from the cardiac nurse who was supposedly watching all the patients through a cubby hole in another room. She was one uncompassionate, uncaring nurse and did not budge an inch. I rushed and started cardiac massage. I told Ramana to get the cardiologist, Dr. Sai, immediately. I silently cursed the nurse who was sitting with her chin on the table seemingly unconcerned about the life and death situation before her.
Nevertheless, the patient's life was important to me. I yelled, "Nurse get me epinephrine now." I saw some movement and she slowly got up and moved at snail’s pace to the bed as I continued the cardiac massage. . She did not bring the epinephrine! Heartless and inconsiderate I thought As I watched her tap on the patient's shoulder and ask him to sit up and lean back in the cardiac bed. The dead patient (for all practical purposes) obliged her promptly.
I was ecstatic that my first CPR was successful until I notice the nurse adjust the fallen cardiac leads, and lo and behold, the EKG tracing was back to normal. I was shocked and felt so sheepish and was about to faint from my foolish actions. When I thought about it, the oddest thing was that patient never objected to what I was doing. Dr. Sai Gopal arrived and inquired about the situation and asked me if I had checked the patient's pulse. I replied negatively. He advised me t never to rely on technology without first conducting a clinical exam. Sensing that I was half dead from shame already, he said I was better than the last house surgeon, who wanted to DC shock a patient based on flat EKG on the monitor even though the patient was vehemently protesting "no, no, no don't do that doc" as the house surgeon apparently was trying to convince the patient "Please listen, your heart has stopped and it needs electric shock".
I thought that I would share this to emphasize to the residents and students that technology is useful but cannot replace good clinical exam!
I think we all know how much medical technology exposure we had in medical school (three decades ago) and during house surgeon (an internship): Barely any!
My friend, Ramana, came to visit me in cardiology one evening when we were house surgeons. I was showing him a patient who had an amoebic liver abscess that burst in to his pericardium. He had pericardiocentesis and was put on a cardio-respiratory monitor. I was told to watch this guy closely as he might develop sudden cardiac arrest; however, I was not told what to do in such an event. Hence, I was well prepared!! :-(
I was showing Ramana around the unit and told him about this special patient he might have cardiac arrest. As I was finishing the sentence, the EKG tracing on the monitor went flat. I panicked! I called for help from the cardiac nurse who was supposedly watching all the patients through a cubby hole in another room. She was one uncompassionate, uncaring nurse and did not budge an inch. I rushed and started cardiac massage. I told Ramana to get the cardiologist, Dr. Sai, immediately. I silently cursed the nurse who was sitting with her chin on the table seemingly unconcerned about the life and death situation before her.
Nevertheless, the patient's life was important to me. I yelled, "Nurse get me epinephrine now." I saw some movement and she slowly got up and moved at snail’s pace to the bed as I continued the cardiac massage. . She did not bring the epinephrine! Heartless and inconsiderate I thought As I watched her tap on the patient's shoulder and ask him to sit up and lean back in the cardiac bed. The dead patient (for all practical purposes) obliged her promptly.
I was ecstatic that my first CPR was successful until I notice the nurse adjust the fallen cardiac leads, and lo and behold, the EKG tracing was back to normal. I was shocked and felt so sheepish and was about to faint from my foolish actions. When I thought about it, the oddest thing was that patient never objected to what I was doing. Dr. Sai Gopal arrived and inquired about the situation and asked me if I had checked the patient's pulse. I replied negatively. He advised me t never to rely on technology without first conducting a clinical exam. Sensing that I was half dead from shame already, he said I was better than the last house surgeon, who wanted to DC shock a patient based on flat EKG on the monitor even though the patient was vehemently protesting "no, no, no don't do that doc" as the house surgeon apparently was trying to convince the patient "Please listen, your heart has stopped and it needs electric shock".
I thought that I would share this to emphasize to the residents and students that technology is useful but cannot replace good clinical exam!
Subscribe to:
Posts (Atom)