Saturday, February 16, 2019

Closed System

Human body is a complex machine where the life blood moves into the arteries and the oxygen depleted blood return through veins from birth to death in a closed circulatory system. The pure blood pumped into the system by the heart reaches to all the parts of the body and return to it and after purification in the lungs, it is pumped through blood vessels of different size and thickness: the arteries, arterioles, capillaries, venules, and veins.

As we age, narrowing occurs in many capillaries and venules in peripheral, heart and brain, and with the death of cells the death of the organ starts and finally writes the death of the individual. Therefore, it is essential to keep this system clean to make the life longer.

LDL Cholesterols and Diabetes are the two major challenges before the present generation to overcome to maintain blood flow in all the cells upto the last mile of all the body parts from the head to the toes.

God is miraculous but is very wise. He made a heart pump in the creatures to supply pure blood to all the cells but kept the veins in our command to bring back the depleted blood for purification in lungs by movements. Therefore, all the creatures keep walking and moving. The calf muscles in human body are called peripheral heart. Unless they are moved regularly, good functioning of the veins can’t be maintained. Blocked veins may cause thrombosis and may lead into serious health problems.

Keep walking daily, it extends life.

Good morning 😊

Punamchand
16 February 2019

Saturday, February 9, 2019

Medicity Amdavad, a Ray of Hope

Medicity Amdavad, a Ray of Hope

Last Saturday at 7 AM on 2 February 2019, I received a call from Mr. MB Parmar (IAS Rtd). In worry some voice he explained the serious health condition of Mr. RB Dave (IAS Rtd) for a month and the stress of the family, who couldn’t sleep for a fortnight and reached to the dead end of losing the right limb of Mr. Dave after spending ₹10 lakh in a private hospital in Amdavad. Within half an hour Shri Dave’s wife and son came to our house and explained the problem. They are our family friend for 28 years from our Junagadh days. 

Either to cut the right limb or to lose life if infection spread over the body were the options given by the vascular surgeon and they were directed to take decision in 15 minutes. They somehow asked for the time to think and managed to run away to home to think peacefully and reached to our door. 

Either to shift him to the hospital or to call the doctors at home were the options before us. They were upset with the fear of spreading of infections if the wound was opened at home for inspection. And they were not confident of going to Civil Hospital in such serious condition, where common men are going. I realised the dilemma of the family and called a General Surgeon and a Plastic Surgeon from the Civil Hospital Amdavad with a support staff to do dressing after wound was opened for checking. His limb was badly damaged by cutting of the larger portion of the muscles by the vascular surgeon of the private hospital. The arteries of the lower limbs had no flow of fresh blood. Only one bypass artery was saving the limb for awhile. In want of pure blood, the limb was dying. His second right toe developed dry gangrene made the doctors to lose hope but we sustained the ray of hope if the vascular surgeon of UN Mehta Cardiology Institute succeeds in opening the blocked arteries of the thigh and open the blood flow in the lower limb. The family trusted in our words and by evening, the patient was moved to Civil Hospital Amdavad and was admitted. 


Diabetic 68 years old Mr. Dave had developed acute on chronic critical right lower limb ischaemia with acute tenderness, swelling and the discolouration of the affected limb almost a month back. He developed cellulitis on 15 January 2019 and went to a private hospital in Amdavad. Arterial Doppler was done and 17th Jan and CT angio was done on 22nd Jan. CT angiogram of the lower limb vessels revealed acute cut of right distal superficial femoral artery (chronic thrombotic occlusion)till the trifurcation and minimal collateral fillings of posterior tibial and part of peronieal artery only. It was suggestive of complete block of distal superficial femoral and entire popliteal seen. Filling of trifurcation seen. He was treated for cellulitis and fasciotomy was done of the anterolateral compartment on 25th Jan, and further debridement was done on 28th January and negative wound therapy given. His 2nd toe was showing signs of dry gangrene.

Patient was admitted to Civil Hospital/UNM on 2nd February 2019, with open wound and critical lower ischaemia with dry gangrene of the second right toe. Though medicines to control infection were given, but passing 3rd and 4th Feb in a room of Civil Hospital, the patient and his family were waiting for the start of some procedure on the dying limb. But his CRP level was high, therefore, the vascular surgeon was waiting for the infection and inflammation of the arteries to come down by the fall of CRP level. The family was worrying for losing the leg or the life. 

The doctors discussed Two plans: (1)- balloon angioplasty of the affected segment of the artery and to put a stent in the above knee arterialsegment only. (2)- if plan one fails then do upper SFA to posterior tibial artery after wound stabilisation.

Fortunately, his CRP level came down and patient was moved to UNM on 7/2/19 for the execution of the plan 1. Dr. Chirag Doshi, the Vascular Surgeon and his team were able to execute plan first successfully. They have done POBA and inserted a stent in distal SFA opening up 20 cm long block in the thigh artery. To the great luck of Mr. Dave, the arteries of the limb opened up and antegrade flow has been established. With the start of new blood flow, the hope of saving his limb revived. Having done that there are two to three percent chances of reclotting and worsening of the symptoms. The patient is relatively more stable with less pain and is symptomatically better but condition of the wound is precarious at best. 

He would now require plastic surgeon intervention for further management of the open wound either by flap/graft or by the wrap. Hopefully, the Plastic Surgeon Dr. Jayesh Sachade and the General Surgeon Dr. Gunvant Rathod of the Medicity will find out the right answer. Without the flow of fresh blood for long time, his limb nerves are damaged, therefore, it will take two-three months of treatment and physiotherapy for the healing of the nerves to bring them back near to the normal. 

After this traumatic experience of running from pillars to posts and finally reaching to the destination; where Dave family can heal, here are two clear takeaways as per them:

1) Prejudice: Many might have a prejudice for public amenities and particularly healthcare. However, we realized that we are on the path of recovery due to swift actions, proper medications and above all right diagnosis/treatment at Medicity Ahmedabad.

2) Economic: Spending more money does not bring our health on the right track but the proper treatment does. We observe the positive impact on our health due to care and treatment of Doctors of Civil Hospital, Ahmedabad and UN Mehta, Ahmedabad.

“All in One under One roof”, the Medicity Amdavad is going to be the single largest hospital campus of the world with a bed strength of 7100 with all specialities and super specialities, where the Code of Ethics for Doctors are followed the most. 

Punamchand 
9 February 2019
Medicity Amdavad 

Manikarnika

Manu-Manilarnika became Laxmibai after her marriage with the King of Jhansi Gangadhar Rao. She fought for her right over the throne of Jhansi. Her husband signed the doctrine of lapse, the policy introduced by the East India Company and widely executed by Lord Dalhousie. It was a major cause to ignite the fire of rebellion. Laxmibai’s real son died in infancy and the adopted son was not accepted by the EIC. There was a dispute of interpretation of the agreement that was obviously decided by the London Court in favour of the EIC. She was granted privy purse of ₹60000/annum but had to leave the palace and fort of Jhansi. [GoI Act of 1935 had provision of deed of accession to make Union of India, that was implemented by Sardar Patel (with VP Menon and Lord Mountbatten) after the GOI Act of 1947, by giving good amount of privy purse and right over their palace-land-Jwelleries-properties, and a place of “Rajpramukh” like Governor of the Province to the bigger players for building united India. Later, they all merge with the union with the merger deed]

What is important to note that she was a Brahmin Girl, married at the age of 14 to a 46 years old King of Jhansi Gangadhar Rao, who was very weak and died in 1853 at the age of 56Y. Laxmibai became widow at 24 but the brave lady fought for her right. Her appeal in London Court, after losing it, quitting the fort and palace, organising and preparing the villagers including the women and building the strength of weapons to fight for home rule and when EIC Officers were busy in managing the Mutiny of 1857, taking over the possession of the palace and the fort was a great great courageous act.

When British forces entered Jhansi on 4/4/1858 and massacre the civilian population, she used presence of mind, jumped from a good height of the palace-fort using her horse Badal (eventually the horse died) and managed the great escape by traveling 151 kms on horse and reached to the camp of Tatya Tope at Kalpi. Jhalkari Bai (the Kori lady) gave her a great cover and fought the war as her duplicate keeping the British force busy in confusion of her as Rani. She sacrificed her life for her queen so that British couldn’t chase Laxmibai.

Laxmibai then took over Gwalior fort without much of an oppose but in that hostile palace of Sindhia, instead of waiting inside, she took a decision to move out of the fort to fight out with British, but was encountered by the forces of the Hugh Rose and was killed at the dead end of the street of Gwalior on 14/6/1858. She couldn’t manage the escape like Jhansi because there was no cover of Jhalkaribai !

She was only 29 when was killed. Her acts of bravery for those 4 years (1953-58) after the death of her husband and the last part of her life of 71 days fighting war of Jhansi, great escape, capturing Gwalior and sacrificing her life in a battle field for her right, gave her an immortal place in the history of India, made her an inspiration of bravery and love for the motherland. Rani Laxmibai is immortal.

Hugh Rose, the EIC Major General who fought wars of Jhansi and Gwalior against Rani, commented that Rani Lakshmibai is "personable, clever and beautiful" and she is "the most dangerous of all Indian leaders". Colonel Malleson wrote in the History of the Indian Mutiny; vol. 3; London, 1878 'Whatever her faults in British eyes may have been, her countrymen will ever remember that she was driven by ill-treatment into rebellion, and that she lived and died for her country, We cannot forget her contribution for India.'

खूब लड़ी मर्दानी वह तो झाँसी वाली रानी थी।

Our salutes to the Rani🙏

Punamchand
8 February 2019
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