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The clinician's thought block

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Peak summer, or   kathiri veyil  as we refer to it in Tamil, has passed. Some uncharacteristic mild rains have also started drizzling in Chennai. But the ambient temperature and humidity continue to be oppressive. On most clinic days, this becomes an important factor in governing the mood of the day. I have been feeling a lot more irritable the past few months, especially during the start of the clinic. Slowly the body gets used to the sweltering ambient conditions and things become better as the day progresses! This irritability manifests itself as long gaps in the flow of thought, or thought blocks. A middle aged woman came the other day with complaints of intense itching all over the body. There was no rash. She does not have diabetes or hypertension. On a pleasant day my mind would have gone through a whole list of differential diagnoses for itching without rashes - liver disease, kidney disease, anemia, worm infestation, thyroid dysfunction, or sometimes even cancers. But...
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Book Review: Sacred and cyclical: an extraordinary free verse on experiences and emotions of the menstrual cycle

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  Book Title: “It isn’t just 28 days. Period” Style: Free verse poetry Author: Dr. Prathibha K M Price: Rs. 229.00 Printed by: Periyar Books.com  Can be ordered at:  https://periyarbooks.com/products/it-isnt-just-28-days-period?srsltid=AfmBOop6vovn8Ap5JJDejw1o5vi-RyAxfYH1eX68vIzqXiHx_HXEa0ci   A young girl accompanied by her mother, with a tear-streaked face, forehead fully creased with the wrinkles of pain, holding her lower abdomen and walking with a stooped posture into the clinic is something I see frequently. The staff of the clinic know even without asking that it is the painful cramps of ‘that time of the month’. Immediately they make her lie down in the bed, give her a hot water bag, and some warm water to drink. They would call me to go and check on her. I cannot assume all abdominal pain in a young woman to be menstrual cramps and so I would very politely and softly ask a few questions to rule out something else causing the pain. I am probably the last pers...
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Restoring the pleasure in scholarly writing

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I identify as a writer. I write both for work and pleasure. I write scientific papers, research reports, research reviews, peer review reports for work and blogs, short stories and letters for pleasure. In both forms of writing, my process is the same, but there is so much happiness in writing for pleasure (obviously it is writing for pleasure) and so much discomfort and unpleasantness in writing for work. I have been wondering why the experience of writing for pleasure versus writing for work are so different. I decided to write for pleasure about writing for work!    Scientific writing is regulated by scholarly standards. I have been stuck inside this quagmire of ‘scholarly standards’ for more than 2 decades now. What are these scholarly standards in writing? Maintaining objectivity and neutrality is one of the benchmarks of scholarly writing. The scholar is expected to be detached and impersonal. There is no room for emotions and sentiments in scholarly writing. The scienti...
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Nutritional supplements: the snacks of the Pharma industry

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I had a very interesting journey to my clinic yesterday. I was accompanied by a gentleman who had a medical issue which he wanted to discuss with me.     I usually nap during this ride, but yesterday’s conversation was interesting. As part of the discussion about his health issue, I had the opportunity to look at his prescription. It was a long one with 7 medicines listed one below the other in an uncharacteristic clean and readable handwriting.     Of the 7, 3 were pertinent to his medical condition and the other four were nutritional supplements of various kinds. One was a multi vitamin, one contained various fatty acids including omega three, one contained some amino acids and Vitamin B12, and another one had some herbal supplements with whose names I am not familiar. When I see such prescriptions, I do not know what to say. I stay silent.     But the problem arises when the person asks me for my opinion on the tablets. This gentleman asked me that exact...
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Drained and defensive: the poignant crusade of a fatigued healer

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    I finished reading the book “The Liver Doctor” by Dr. Cyriac Abby Philip. The book title says it is a collection of stories of Love, Loss and Regeneration. The title is an interesting pun, because the liver is the only organ in the body which is capable of regeneration. If a large part of the liver is damaged and only a small part remains, it can actually grow back and regenerate fully. In fact when people’s liver gets damaged, they undergo liver transplantation. Someone else donates a small part of their liver. This donated liver is only a small bit, but then in the recipient’s body it regenerates and forms a full big liver.    To give you a little background, Dr. Cyriac Abby Philip is a hepatologist, a liver doctor. He specializes in diseases of the liver. He works in Kochi, Kerala. He is a very famous doctor as a social media celebrity. He is very active on X (Twitter) in which he posts incisive and sharp posts against Ayurveda and dietary supplements and herb...
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Renewing a friendship

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Imad (name changed) pushed open the door to my room and walked in with a broad smile on his face. I did not recognize him at first because he had grown into a young man of 15. The last I saw him was when he was a little boy, when his mother used to bring him for childhood asthma. Imad and his mother used to be frequent visitors to the clinic and so we had a friendly bond. I recognized Imad only after I saw his mother walking in quietly behind him.     “Good morning doctor. How are you?” Imad beamed at me. By now, I was grinning back at him ear to ear, having recognized him and feeling so happy to see him again. I welcomed his mother and asked them both to have their seat. There was a bruise on Imad’s face just above his right eye and adjacent to the bruise was a swelling which looked quite painful. I saw it and asked, “What happened? Sports injury?” Imad laughed when I asked this, but his mother was quite upset and she said, “No doctor, he got into a fight with some hooligans ...
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Defining ‘necessary’ in the ‘necessary injection’

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  “I know what works for me and what doesn’t. This is not your body it is mine. I am living and suffering the back pain every minute. So just give me the injection when I ask you for it. I don’t need your lecture. It is the injection that I need.”    - Mr. A   “Sir, I am suffering badly with the foot ulcer. The pain is unbearable. Most days I am unable to sleep because of the pain. I spend the entire day sitting and staring at the roof, crying silently and suffering in pain. Please….please…please give me the injection.” – Mr. S   The past week has been rough. We travelled into interior villages in our project area to interact with people. The heat was oppressive. I missed the intellectual companion with whom I used to travel these same villages to interact with people. The experience of sharing surprised looks when the community says things which are totally unexpected, the long discussions during the travel to and from the village talking about the “why?”, “how...
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