Re: Help! I am getting clubbed!

[Guest guest]

Dear Kishore,

Today,I've startted questioning myself whether to tell

my daughter to go for medicine or not........despite the fact that

she is only 31/2 yet!Can be very embarassing at times........i can

understand your plight!!

But don't get disheartened,just remember the golden

rule of medicine,whenever you are being clubbed,you have no rational

answers to explain,just say, " Idiopathic/Idiosyncratic " .And i'm sure

your son will be an expert at using these terms by the time he

graduates!...............

Now coming to the most popular theory(yes its only a

theory)of clubbing......... " hypoxia induces release of growth

factors from megakaryocytes which enter the systemic

circulation,where they keep wandering around.....until they get

trapped in the acral circulation,no escape route!Now these trapped

growth factors take their wrath on the local tissues leading to

stimulation of growth of the tisues in and around the nailbeds " in

other words they start clubbing the nailbeds(Like your son clubbed

you)-----thats called displacement,another theory of psychiatry,i

think Duggal/Amulya will agree with me.....

So,now,Kishore,go with your head held high up.......and

prove it to your son how scientifically rational we medicos

are!!........)))

Neeti'86

> Dear Physicians / Paediatricians /Anyone of MGIMS, I need your help

> desperately to prove my worth to my son. Today he asked me a simple

> question. " Why does clubbing occur in the nails? "

>

> I immediately pulled myself up and gathering what meagre knowledge

I

> still remembered, started expounding on Cyanotic Heart Disease and

> Lung Hypoxic conditions. My son interrupted me and said, " Daddy, I

> know all that stuff. What I want to know is why does clubbing

occur in

> the finger nails only? "

>

> I scratched my head and tried, " Ummm ... because the developing

cells

> at the nail bed hypertrophy due to lung hypoxia .. "

>

> My son turned his back on me and walked out.

>

> Will someone tell me a good and scientific reason why clubbing

occurs

> only at the finger nail bed and nowhere else? Help me salvage my

> pride. (I think more and more such incidents are going to occur in

the

> near future.)

>

> Kishore Shah 1974

[Guest guest]

Dear Kishore Sir,

I face similiar problems here. I am the only MBBS among my group of

friends here and immediate post-marriage family. I am called for

medical advice on a variety of small issues (though I cant practise

medicine until I clear the USMLE). Vahaan tak baat theek hai. But

when I first came to the US- my friends would look shocked at me -

when I didnt know what Tylenol (paracetamol) or Alka-seltzer

(Aspirin with antacid combination) was. The other day I got the

brand names of the drugs for GERD and for depression mixed up!! In

the midst of my software handling, medically aware friends- I got

looks that said " Pata nahi degree kaise mil gaya " type of thoughts.:-

)

Medical awareness in the U.S. seems so high, with even the lay man

almost a half-doctor, ads and articles on every medical condition in

popular magazines and TV shows and everyone having their own

opinions- I wonder how a doctor practising here gets his/her

patients to trust the decision/type of treatment advised by the

professional.

The other day- I had a shaking experience. On a weekend, I with my

husband and a friend had gone to a nearby space observatory located

on Mount Hamilton. The drive to the top of the mountain is winding

and quite narrow and steep in many parts.

As usual it is a favorite for the cyclist or as they call themselves-

'bikers' here. ( The cycle is pretty much always refered to as a

bike and a motorcycle as a motor bike.)They mostly have helmets/

knee and elbow guards on, along with headlights and fluorescent

markers on the bike and themselves. All this is supposed to reduce

the risk of any serious injury.

On our way back from the space observatory- we suddenly spotted this

biker standing by the side of the road looking dazed and carrying a

battered bike in two parts in both hands. When he saw us he motioned

to us and we too stopped. Then we noticed his head was bleeding. As

a matter of fact,he had just fallen down an incline and hadnt as yet

noticed his head was bleeding. As soon as we brought it to his

notice- he panicked. He started crying and moaning- " Im going to die!

Im going to die! " We decided to take him to the nearest hospital or

clinic and took him in the car and put his cycle in the boot. In the

meantime,I knew I wasnt legally allowed to dispense any medical

advice ( suing is a big hobby here) and didnt mean to go beyond

offering any first aid like any other lay man.

I gave him some tissue from the car and told him to hold it against

the wound till we got something better. To be on the safe side,

I " examined " the wound; it seemed to be a superficial gash on the

scalp and was naturally bleeding. I realised that as it was a head

injury it could probably get worse- but tried to reassure him that

he would soon be in good hands etc.

But what was most unsettling was the way he took it all. It might

have been funny if it hadnt been someone in pain and so obviously

scared. He kept digging the tissue in his scalp and every few

seconds brought his hand down & looked at the blood stain with

renewed fear. " Ive read abt all this!! I know I will die!! I am

bleeding!! " I was worried he would increase the bleeding with all

that probing- and tried to calm him-but no! He KNEW! He had READ all

abt it!

It was with great relief that we finally spotted a fire and

emergency station. The men there had everything from a detailed

questionnaire for head injury to gloves to tranquilisers. They

radioed a helicopter to come and pick up the guy.

(Its impressive that this country can afford so much protection for

its citizens.)

We continued on our way home and I carried with me a very unsettling

experience of an encounter with an Educated, Well read, Informed

American patient.

Gayatri

1997 Batch.

P.S. (Another long mail..hope thats ok)

[Guest guest]

Dear Kishore Sir,

I face similiar problems here. I am the only MBBS among my group of

friends here and immediate post-marriage family. I am called for

medical advice on a variety of small issues (though I cant practise

medicine until I clear the USMLE). Vahaan tak baat theek hai. But

when I first came to the US- my friends would look shocked at me -

when I didnt know what Tylenol (paracetamol) or Alka-seltzer

(Aspirin with antacid combination) was. The other day I got the

brand names of the drugs for GERD and for depression mixed up!! In

the midst of my software handling, medically aware friends- I got

looks that said " Pata nahi degree kaise mil gaya " type of thoughts.:-

)

Medical awareness in the U.S. seems so high, with even the lay man

almost a half-doctor, ads and articles on every medical condition in

popular magazines and TV shows and everyone having their own

opinions- I wonder how a doctor practising here gets his/her

patients to trust the decision/type of treatment advised by the

professional.

The other day- I had a shaking experience. On a weekend, I with my

husband and a friend had gone to a nearby space observatory located

on Mount Hamilton. The drive to the top of the mountain is winding

and quite narrow and steep in many parts.

As usual it is a favorite for the cyclist or as they call themselves-

'bikers' here. ( The cycle is pretty much always refered to as a

bike and a motorcycle as a motor bike.)They mostly have helmets/

knee and elbow guards on, along with headlights and fluorescent

markers on the bike and themselves. All this is supposed to reduce

the risk of any serious injury.

On our way back from the space observatory- we suddenly spotted this

biker standing by the side of the road looking dazed and carrying a

battered bike in two parts in both hands. When he saw us he motioned

to us and we too stopped. Then we noticed his head was bleeding. As

a matter of fact,he had just fallen down an incline and hadnt as yet

noticed his head was bleeding. As soon as we brought it to his

notice- he panicked. He started crying and moaning- " Im going to die!

Im going to die! " We decided to take him to the nearest hospital or

clinic and took him in the car and put his cycle in the boot. In the

meantime,I knew I wasnt legally allowed to dispense any medical

advice ( suing is a big hobby here) and didnt mean to go beyond

offering any first aid like any other lay man.

I gave him some tissue from the car and told him to hold it against

the wound till we got something better. To be on the safe side,

I " examined " the wound; it seemed to be a superficial gash on the

scalp and was naturally bleeding. I realised that as it was a head

injury it could probably get worse- but tried to reassure him that

he would soon be in good hands etc.

But what was most unsettling was the way he took it all. It might

have been funny if it hadnt been someone in pain and so obviously

scared. He kept digging the tissue in his scalp and every few

seconds brought his hand down & looked at the blood stain with

renewed fear. " Ive read abt all this!! I know I will die!! I am

bleeding!! " I was worried he would increase the bleeding with all

that probing- and tried to calm him-but no! He KNEW! He had READ all

abt it!

It was with great relief that we finally spotted a fire and

emergency station. The men there had everything from a detailed

questionnaire for head injury to gloves to tranquilisers. They

radioed a helicopter to come and pick up the guy.

(Its impressive that this country can afford so much protection for

its citizens.)

We continued on our way home and I carried with me a very unsettling

experience of an encounter with an Educated, Well read, Informed

American patient.

Gayatri

1997 Batch.

P.S. (Another long mail..hope thats ok)

[Guest guest]

interesting letter...I do believe the medical education we get back home

does not prepare us for the big, bad world. Our curriculum focuses a lot on

theory and not on practicals. Our exam system would give gold medals to

people who know the names of the rarest syndromes in D/D but may'nt be

capable of effective CPR. I realised this when I came here. I am not

belittling the training we received but almost all of it was didactic.

Training here is more interactive. Graduates here may not know all the

syndromes but would know basic stuff.

Any thoughts?

cheers Malini

With regards

Lakshmi Prasad (lp1960@...

)

Re: Help! I am getting clubbed!

Dear Kishore Sir,

I face similiar problems here. I am the only MBBS among my group of

friends here and immediate post-marriage family. I am called for

medical advice on a variety of small issues (though I cant practise

medicine until I clear the USMLE). Vahaan tak baat theek hai. But

when I first came to the US- my friends would look shocked at me -

when I didnt know what Tylenol (paracetamol) or Alka-seltzer

(Aspirin with antacid combination) was. The other day I got the

brand names of the drugs for GERD and for depression mixed up!! In

the midst of my software handling, medically aware friends- I got

looks that said " Pata nahi degree kaise mil gaya " type of thoughts.:-

)

Medical awareness in the U.S. seems so high, with even the lay man

almost a half-doctor, ads and articles on every medical condition in

popular magazines and TV shows and everyone having their own

opinions- I wonder how a doctor practising here gets his/her

patients to trust the decision/type of treatment advised by the

professional.

The other day- I had a shaking experience. On a weekend, I with my

husband and a friend had gone to a nearby space observatory located

on Mount Hamilton. The drive to the top of the mountain is winding

and quite narrow and steep in many parts.

As usual it is a favorite for the cyclist or as they call themselves-

'bikers' here. ( The cycle is pretty much always refered to as a

bike and a motorcycle as a motor bike.)They mostly have helmets/

knee and elbow guards on, along with headlights and fluorescent

markers on the bike and themselves. All this is supposed to reduce

the risk of any serious injury.

On our way back from the space observatory- we suddenly spotted this

biker standing by the side of the road looking dazed and carrying a

battered bike in two parts in both hands. When he saw us he motioned

to us and we too stopped. Then we noticed his head was bleeding. As

a matter of fact,he had just fallen down an incline and hadnt as yet

noticed his head was bleeding. As soon as we brought it to his

notice- he panicked. He started crying and moaning- " Im going to die!

Im going to die! " We decided to take him to the nearest hospital or

clinic and took him in the car and put his cycle in the boot. In the

meantime,I knew I wasnt legally allowed to dispense any medical

advice ( suing is a big hobby here) and didnt mean to go beyond

offering any first aid like any other lay man.

I gave him some tissue from the car and told him to hold it against

the wound till we got something better. To be on the safe side,

I " examined " the wound; it seemed to be a superficial gash on the

scalp and was naturally bleeding. I realised that as it was a head

injury it could probably get worse- but tried to reassure him that

he would soon be in good hands etc.

But what was most unsettling was the way he took it all. It might

have been funny if it hadnt been someone in pain and so obviously

scared. He kept digging the tissue in his scalp and every few

seconds brought his hand down & looked at the blood stain with

renewed fear. " Ive read abt all this!! I know I will die!! I am

bleeding!! " I was worried he would increase the bleeding with all

that probing- and tried to calm him-but no! He KNEW! He had READ all

abt it!

It was with great relief that we finally spotted a fire and

emergency station. The men there had everything from a detailed

questionnaire for head injury to gloves to tranquilisers. They

radioed a helicopter to come and pick up the guy.

(Its impressive that this country can afford so much protection for

its citizens.)

We continued on our way home and I carried with me a very unsettling

experience of an encounter with an Educated, Well read, Informed

American patient.

Gayatri

1997 Batch.

P.S. (Another long mail..hope thats ok)

------------------------------

Website: www.mgims.org

------------------------------

[Guest guest]

Ha!Forget about tylenol and alka-seltzer Gayatri,that

you can tell after reading the labels....)) Think about a 90 year

old grandmother who migrated 10 years ago,telling you what oil is

good for cooking coz'it doesn't contain polyunsaturated fatty acids

and also carries good amount of omega-3-fatty acids!Thats what

America does to a person who probably according to our standards(??)

is not even considered literate!!Have you ever heard a six year old

talking about lactose-intolerance?And knowing it ALL....!!Not to my

knowledge in India.......I read about it only in my final year MBBS

as a part of paediatric curriculum,that too a " short note " as they

say it,was enough for the exam purposes.But in USA,even a six year

old in the family could tell me a lot more than a short

note .........!What an irony ........and what about all those eight

years of my medical educational i spent burning midnight oil??

I think it all boils down to the public awareness,an

educated ,well-read,informed society which brings with it the

everchanging demands and the challenging pressures to be at your

best as a professional!And catering to the needs of such society is

a daunting task for a physician.But at the same time i think these

are the standards that give us medicos an edge over the

professionals elsewhere in the world!..............and thats where

America is overdeveloped,i must say......))

Neeti'86

> Dear Kishore Sir,

> I face similiar problems here. I am the only MBBS among my group of

> friends here and immediate post-marriage family. I am called for

> medical advice on a variety of small issues (though I cant practise

> medicine until I clear the USMLE). Vahaan tak baat theek hai. But

> when I first came to the US- my friends would look shocked at me -

> when I didnt know what Tylenol (paracetamol) or Alka-seltzer

> (Aspirin with antacid combination) was. The other day I got the

> brand names of the drugs for GERD and for depression mixed up!! In

> the midst of my software handling, medically aware friends- I got

> looks that said " Pata nahi degree kaise mil gaya " type of

thoughts.:-

> )

> Medical awareness in the U.S. seems so high, with even the lay man

> almost a half-doctor>

[Guest guest]

Dear Malini,

You are absolutely right... I have put up the same view some time back, but

there were no takers...

It's sad.

Ravin '82

Re: Help! I am getting clubbed!

>

>

> Dear Kishore Sir,

> I face similiar problems here. I am the only MBBS among my group of

> friends here and immediate post-marriage family. I am called for

> medical advice on a variety of small issues (though I cant practise

> medicine until I clear the USMLE). Vahaan tak baat theek hai. But

> when I first came to the US- my friends would look shocked at me -

> when I didnt know what Tylenol (paracetamol) or Alka-seltzer

> (Aspirin with antacid combination) was. The other day I got the

> brand names of the drugs for GERD and for depression mixed up!! In

> the midst of my software handling, medically aware friends- I got

> looks that said " Pata nahi degree kaise mil gaya " type of thoughts.:-

> )

> Medical awareness in the U.S. seems so high, with even the lay man

> almost a half-doctor, ads and articles on every medical condition in

> popular magazines and TV shows and everyone having their own

> opinions- I wonder how a doctor practising here gets his/her

> patients to trust the decision/type of treatment advised by the

> professional.

>

> The other day- I had a shaking experience. On a weekend, I with my

> husband and a friend had gone to a nearby space observatory located

> on Mount Hamilton. The drive to the top of the mountain is winding

> and quite narrow and steep in many parts.

> As usual it is a favorite for the cyclist or as they call themselves-

> 'bikers' here. ( The cycle is pretty much always refered to as a

> bike and a motorcycle as a motor bike.)They mostly have helmets/

> knee and elbow guards on, along with headlights and fluorescent

> markers on the bike and themselves. All this is supposed to reduce

> the risk of any serious injury.

> On our way back from the space observatory- we suddenly spotted this

> biker standing by the side of the road looking dazed and carrying a

> battered bike in two parts in both hands. When he saw us he motioned

> to us and we too stopped. Then we noticed his head was bleeding. As

> a matter of fact,he had just fallen down an incline and hadnt as yet

> noticed his head was bleeding. As soon as we brought it to his

> notice- he panicked. He started crying and moaning- " Im going to die!

> Im going to die! " We decided to take him to the nearest hospital or

> clinic and took him in the car and put his cycle in the boot. In the

> meantime,I knew I wasnt legally allowed to dispense any medical

> advice ( suing is a big hobby here) and didnt mean to go beyond

> offering any first aid like any other lay man.

> I gave him some tissue from the car and told him to hold it against

> the wound till we got something better. To be on the safe side,

> I " examined " the wound; it seemed to be a superficial gash on the

> scalp and was naturally bleeding. I realised that as it was a head

> injury it could probably get worse- but tried to reassure him that

> he would soon be in good hands etc.

> But what was most unsettling was the way he took it all. It might

> have been funny if it hadnt been someone in pain and so obviously

> scared. He kept digging the tissue in his scalp and every few

> seconds brought his hand down & looked at the blood stain with

> renewed fear. " Ive read abt all this!! I know I will die!! I am

> bleeding!! " I was worried he would increase the bleeding with all

> that probing- and tried to calm him-but no! He KNEW! He had READ all

> abt it!

> It was with great relief that we finally spotted a fire and

> emergency station. The men there had everything from a detailed

> questionnaire for head injury to gloves to tranquilisers. They

> radioed a helicopter to come and pick up the guy.

> (Its impressive that this country can afford so much protection for

> its citizens.)

> We continued on our way home and I carried with me a very unsettling

> experience of an encounter with an Educated, Well read, Informed

> American patient.

> Gayatri

> 1997 Batch.

> P.S. (Another long mail..hope thats ok)

>

>

>

>

>

> ------------------------------

> Website: www.mgims.org

> ------------------------------

>

[Guest guest]

Ravin,i still remember your letter and infact i was going to respond

to it too but then b/w so many responsibilities,somehow it slipped

through my mind but that doesn't make this topic any less

significant,though.I definitely agree with you and Malini........and

i'm sure there are many more like me.But my question is--Is there

anyone,who is ready to go a step further and do something about it

rather than just thinking/discussing it on the forum ?

Neeti'86

interesting letter...I do

believe the medical education we get back home does not prepare us

for the big, bad world. Our curriculum focuses a lot

on theory and not on practicals. Our exam system would give gold

medals to people who know the names of the rarest syndromes in D/D

but may'nt be capable of effective CPR. I realised this when I came

here. I am not belittling the training we received but almost all of

it was didactic. Training here is more interactive. Graduates here

may not know all the syndromes but would know basic stuff. Any

thoughts?cheers Malini>>>

[Guest guest]

Dear Neeti,

The best place to start anything is at home!

Hopefully one day we Indian-Indians can get off our backs and start doing

something about things that need something to be done about?

:-D

Maybe, the concerned authorities could do it!

Ravin '82

Re: Help! I am getting clubbed!

> Ravin,i still remember your letter and infact i was going to respond

> to it too but then b/w so many responsibilities,somehow it slipped

> through my mind but that doesn't make this topic any less

> significant,though.I definitely agree with you and Malini........and

> i'm sure there are many more like me.But my question is--Is there

> anyone,who is ready to go a step further and do something about it

> rather than just thinking/discussing it on the forum ?

>

> Neeti'86

[Guest guest]

Dear Neeti,

The best place to start anything is at home!

Hopefully one day we Indian-Indians can get off our backs and start doing

something about things that need something to be done about?

:-D

Maybe, the concerned authorities could do it!

Ravin '82

Re: Help! I am getting clubbed!

> Ravin,i still remember your letter and infact i was going to respond

> to it too but then b/w so many responsibilities,somehow it slipped

> through my mind but that doesn't make this topic any less

> significant,though.I definitely agree with you and Malini........and

> i'm sure there are many more like me.But my question is--Is there

> anyone,who is ready to go a step further and do something about it

> rather than just thinking/discussing it on the forum ?

>

> Neeti'86