Category: Blogs by Dr. Nikhil Datar

I was dressing a wound of my patient in the clinic. She had undergone a major surgery.A few months back I was introduced to a new medicine that was made up from silver nano particles. I was using that medicine( ointment) for the dressing and wound was healing very fast.
We all know that every material is made up of particles. When the particles are further broken into super minute size they are called as nano particles. These nano particles have completely different properties than the original material. The nano particles of silver are supposed to have anti septic and anti bacterial properties. Thus when used in the wound they provide anti bacterial properties and help healing!
A metal like silver is considered as “heavy metal”. Ingestion or absorption of this metal in the body is considered as toxic. It blocks the kidneys and leads to failure of kidney function. In fact many Ayurvedic medicines contain heavy metals such as silver, gold, lead, mercury. For years together allopathic doctors have been warning patients against the use of Ayurvedic medicines for the same reason. I mean… medical students of allopathic stream have been taught in this way for years together. So this new formulation in allopathic medicine … containing silver seemed to be interesting…. perhaps more interesting. It raised a question: Is the science taking a complete U turn?
I called up few of my doctor -friends who are practicing Ayurvedic stream. I wanted to find out more about the ayurvedic medicines that contain these heavy metals. Dr Sanjay actually came down to my clinic to give me some insights. Dr Sanjay Talgaonkar and Dr Shailesh Vaidya both spoke passionately about it. They strongly claimed that they have been prescribing and consuming ayurvedic preparations made up from these “so called toxic metals”. One of them stated that he has been consuming one such preparation made up from mercury and sulphur for years together! This was baffling!!
Two diagonally opposite views of two “pathies”…. Then what is the truth? Dr Sanjay said “ Nasti yojakastatr durlabhah” It is the “yojak”, the man who prepares the medicine Thus do not blame the science , blame the practitioner, he said. He claimed that the making “Bhasm” out of the metals is not same as that of mere oxidization. The modern science wrongly understood it. In Ayurveda it is not just burning but treating the metal. in depth analysis of drug preparation is discussed in the science of “ Ras shastra”. He also added that when the correct procedure and quality control is not observed the results will be disastrous. I think in India this is a real fear about food or medicines.
One another interesting issue came up during discussion. It was claimed that the way these metals are “treated” is very peculiar. The metals were treated with herbs and spices apart from other procedures. It seems that the process converted the metals into nano particles! This came as a big surprise. It seems that there is a lot of research going on this topic in the world. May be it is true… May be that these nano particles, albeit derived from heavy metals have different properties. That is why these proved beneficial and not harmful to kidneys?
I think we will have to wait and see what results say. If this claim is proved beyond doubt then different sector of medicines will open up. The “pathies” may collate at some point of time in future. And ultimately it may benefit the mankind. The silver nano particles in allopathic ointment may only be the beginning of this revolution.

Hey Lord Ganesha, while I was driving back home from my clinic I saw a part of the road decorated. Some film music was being played at an ear blurring and mind numbing volume. Suddenly I heard “ Ganpati bappa moraya” and I realised that it is the Maghi Ganesh Jayanti. Hey Lord, your enthusiastic devotees celebrate this one also with equal vigour and zest nowadays. Thus I thought of writing this email to you as I want you to sort out few things at once.

Hey Lord, are you really Vighna harta? Let me share a real life incidence. On the night of Ganesh Visarjan this year ( immersion day) when the roads were jammed, people were on the streets and huge processions were on, I had a pregnant patient who came with torrential bleeding to my clinic. She was serious. She needed urgent blood transfusions and immediate surgery. Calling and waiting for an ambulance was probably impossible. I put her in my car to take her to my hospital… It was terrible. Your so called devotees… half of them drunk… were on the roads. The car was not moving even an inch. They made me feel that you are Vighna karta and not Vighna harta on that day. And not me, I routinely see ambulances carrying serious patients stuck in the traffic caused by your processions. I am sure many patients and relatives must be feeling the same.

Are you Sukha karta? on all those 14 days when you are here… your devotees play very high decibel music during the procession. The small children, elderly, ailing, all find it very annoying and troublesome. Even in front of hospitals having serious patients in the ICU or recuperating from surgeries the loud music goes on. And that is not sufficient… You also have fire crackers making noise as well as pollution. The unscrupulous pandals occupy the roads causing massive traffic jams. The electricity is wasted and pollution created. I think you are Sukh harta not Sukh karta.

Hey Lord,Are you Budhdi Data( one who gives wisdom)? If so do you give this kind of wisdom to you devotees? The wisdom that makes people behave in the most antisocial manner such as dancing on the road by officially ingesting alcohol. How can I call you Budhdhi data too?

Hey lord if you are really the Sukh Karta, Dukh harta and Budhdhi data then your devotees need to stop all this. Lokmanya Tilak started this festival with a purpose. He wanted to spread the freedom movement across the country. Now that purpose is over. Let your worship be done at home the way it used to be 200 years back.

You are the lord of the lords, the God of Gods. I humbly request you to please instruct the other Gods and Goddesses and deities of all other religions to follow the same rules. It is a sincere request Lord!

I searched from newspapers and TV channels for the people who can inspire me. Those people who can lead the  way. But I realized that most of the media is into news items which are best selling news items or “chatpata Masala”.I am sure you also must have had  the same experience. I never realized that there are many people around me who do many great things. They are actually unsung heros. They limit what they do to themselves. The acts that do are very simple and doable and there is nothing very sparkling or dazzling about it. May be that’s why they are not appreciated by many. I have a friend in lonavla. He is enjoying his retired life and is very active. One day while gardening and watering his plants, he started a conversation on how trees in lonavla are being cut unscrupulously. I have also observed this since last few years. A nice  green tree suddenly starts drying up and after few days stating that the tree is dried up and dead it is uprooted. Everyone knows why and how the tree has dried up. As we discussed this I lamented about the corruption, inaction of municipality as usual. But then came an interesting message. My friend said he goes into the hills for his morning walk. In this season he sees many seeds of the tress lying on the ground. He collects them and brings them home  and during the monsoon season, he just takes them along and throws them across. He says that even if the success rate is 1%, considering the  number of seeds he throws, it must be a descent contribution to the nature. Amazing! Something so simple and easily doable. No cost no frills. He is one of those unsung heros who silently keep on doing these small things. They even don’t know that these simple things are so important and that  the other people appreciate them so much.

I had two annoying experiences few days before the municipal elections that took place in Mumbai. The incidence depicted the apathy of the “so called” educated middle class who claim to be the “thinkers” in the  society.

This time when elections were round the corner I reminded every patien that came to me that they should  surely vote on the day of election. One very posh patient’s husband said ” Voting? I never go for voting? what is the point in wasting time?” I  Isaid ” If you don’t vote how can you get the right candidate who will do something for you.and then you have no reason to complain. He simply said “Who is complaining? I know that there is no point in complaining. I neither complain nor vote.” This was very annoying and disturbing. On one hand there is a movement for accountability and transparency so that good people should get elected and there should be good governance.In Anna’s movement many educated and middle class participated and even showed their anger towards the existing system. And when it comes to making a change, we shy away from it and don’t even bother to vote!

Another educated friend of mine said that she does not even know who is contesting the election. She said that she is going to vote for the best looking symbol! Although I understand that the educated middle class has lost faith in politicians,  such apathy and irresponsible behavior is painful.

On the other hand in this elections there was a group of school and college children who went door to door to mobilise voters to come down and vote. These yougsters have showed us the way. May be if we would have done this when wewere young, the picture would have been different today. Here is the picture of these young girls and boys

Just a day or two before the Children’s day a couple with nine year old school going girl walked into my clinic. I was stunned to hear the shattering incidence of child sex abuse. The nine year old child was sexually abused by three teachers from her school… repeatedly!

It was an incidence that makes one feel very sick and terrorized! Apart from treating the child, I ensured that parents are aware of the next legal steps. In fact I stood by them and ensured that things were done. Parents are usually  not keen on taking any  legal steps. They feel that fighting against the system is unfruitful exercise and shall only bring shame to the child and the family. I took extra time to explain to them that it is not true any more! The parents were not aware of the Prevention of sexual offences against children Act , commonly called as POSCO Act. I walked an extra mile with them making them aware of the child friendly provisions of the Act. I  told them that it was also important to report as they  will also be protecting other children from the perpetrators.

I realized that most of the people and even doctors are unaware of these important provisions of the Act. I think it is very crucial that all of us know the special provisions.

The POSCO Act provides for the establishment of Special Courts for trial of offences under the Act, keeping the best interest of the child as of paramount importance at every stage of the judicial process. The Act incorporates child friendly procedures for reporting, recording of evidence, investigation and trial of offences. These include:

• Recording the statement of the child at the residence of the child or at the place of his choice, preferably by a woman police officer not below the rank of sub-inspector
• No child to be detained in the police station in the night for any reason.
• Police officer to not be in uniform while recording the statement of the child
• The statement of the child to be recorded as spoken by the child
• Assistance of an interpreter or translator or an expert as per the need of the child
• Assistance of special educator or any person familiar with the manner of communication of the child in case child is disabled
• Medical examination of the child to be conducted in the presence of the parent of the child or any other person in whom the child has trust or confidence.
• In case the victim is a girl child, the medical examination shall be conducted by a woman doctor.
• Frequent breaks for the child during trial
• Child not to be called repeatedly to testify
• No aggressive questioning or character assassination of the child
• In-camera trial of cases
• The media has been barred from disclosing the identity of the child without the permission of the Special Court.
• For speedy trial, the Act provides for the evidence of the child to be recorded within a period of 30 days. Also, the Special Court is to complete the trial within a period of one year, as far as possible.
• The punishments are more harsh than the regular provisions of the law when children are the victims.

On the occasion of Children’s day let us share this information to as many people as possible and stand united against the child sex abuse!

Dear adults,

Thanks. You all have started celebrating World Prematurity day on 17th November. Me and others like me who are currently kicking from inside our Mom’s womb are witnessing what you guys are doing. Did you know that 15 million  of us will be born early. Early? How early? No no. not before the due date given by the doctor… Early means more than three weeks prior to the due date!

So what?  You adults have now realized that it is our premature birth that is causing us die or become impaired more often. And more premature we are born more will be problems faced by us. No. We dont want to trouble you. Nor do we want to be a burden on you. But what to do? We are so tiny, small, underweight. We can’t breathe well on our own, we can’t keep our selves warm enough. Nor can we suck and get our feed. In fact inside the mom’s womb it was good. No ” khit pit”Even the feeding was automatic through the cord. In your world out side  everything has to be done on your own! Thus we need to be kept in the nursery or Neonatal intensive care unit… tagged to machines, ventilators, IV lines.

You don’s like it! We don’t like it too!! We also know that some times coming out in the world early is inevitable. But 75% of times this can be prevented. So here are few messages from us to all the Moms and Dad’s to be.

• Go to the doctor regularly. High blood pressure, Diabetes and anemia can cause us coming out early.
• Take good nutrition and prevent low haemoglobin.
• Do not indulge is alcohol or smoking at least when we are in… ideally even after we are out!
• Take iron calcium regularly and ensure that weight gain is not too much or too less.
• No jumpy, jolty activity please. But do not forget… regular slow paced exercise is good.
• Do the necessary tests. And sonography  does not harm us. So please see us on that screen . Some times your doctor may be able to tell if we are likely to be born early. But it can be often unpredictable too.

Now some thing very crucial.

Please do not send us in that van called ambulance to some other place after we are born. Don’t you know our roads and the traffic? And we are so small and tiny. We like to be going with our mom  and staying close to our mom. I know that doctor uncle calls this as ” In utero transport.”It is best that  we are born at a place where our Mom’s can deliver and nursery or NICU is just adjecent. This is the best strategy after all. And more importantly we can see and meet our Moms more frequently too.

On this World prematurity day, help us , unborn babies to make you adults aware of prematurity and its problems. Try and give us the best possible place to be born so that we can face the world better! And whenever possible ( we know it is not always predictable) prevent prematurity and let us be inside our Mom’s womb. It is nice and warm here. Isn’t it?

With love

From

U N Borns.

While walking down the streets to reach the hospital on Sunday morning i saw some men and women cleaning the garbage and picking up plastic waste on the road. Initially i thought that this must be some political party’s drama. To my surprise found no placard or banner of any party! Soon i realised that it was not a school or college students activity also.
I only saw a placard which requested people not to throw plastic waste so it was only the pure motivation of cleaning. When i requested them for a pic they said “Take our photo while working and not posing with broom in the hand.”
Impressive.They become my Sunday heroz heros. By the way Modiji’s clean India seems to be working slowly though. St Catherine students from Banglore were right. Mr Rahul Gandhi.

On the occasion of the World prematurity day (celebrated on 17th November) I had posted a simple looking question for all my doctor friends. The question was ” Fill in  the blanks”. It said :” Premature birth is a birth from ___ weeks to 37 weeks of pregnancy.” As expected I got the answers ranging from 20 weeks to 30 weeks!

The true answer is ” NOK … No one knows”! Surprised and stunned! Yes I am right. There is no legal clarity on the subject in India. If we see the progression of intrauterine life … this is how it goes.
6-7 weeks: we can see the presence of life in form of beating heart on USG.
20 weeks: limit for termination of pregnancy.
24 to 28 weeks: Some where around this time the fetus becomes ” viable”… means “capable of independent survival”. Before this time the fetus is not considered to survive even after medical help. Thus technically it is the “viability” which makes one change the nomenclature from “miscarriage to preterm birth.” Thus the process of expulsion of fetus from the womb when happens before the age of viability is miscarriage and after it is birth.
Now let me come back to my original fill in the blanks. The answer to the question varies from country to country and depends upon the quality of premature baby care available. WHO and UK consider viability age as 24 weeks. In India very few centers such as Cloudnine group of hospitals and few others may be able to send the baby home intact at 24 weeks. Practically it will be 26 to 28 weeks in most of the Indian hospitals.
One may ask why am I discussing all this? How does it matter in our life? The truth is we may be wrongly portraying our health care parameters in bad light due to this.
Due of lack of clarity most doctors prefer to call it as “preterm birth ” after 20 weeks.
Effect: we are unnecessarily calling “miscarriages” as “births”. Thus we are wrongly reporting the data. Thus we are wrongly showcasing high neonatal mortality statistics. Neonatal mortality is a quality indicator of health care according to WHO. And we score very low on it … courtesy lack of clarity.

It is the time that Government clarifies the exact limit of viability in our country and answer the “fill in the gap” authoritatively. Is Government going to solve this problem? Are medical organizations such as IMA, FOGSI, IAP listening and interested?

This is a true story. While I was waiting  at the signal for it to turn green I noticed a fire engine overtaking me. It barged through the red signal to attend to the fire call. The hose pipe at the back of the vehicle was leaking water and oil. The fire vehicle spelt out some water and oil while it went ahead briskly. On my right side was a middle aged man on his bike waiting to take a right turn. As the signal turned green, the biker started moving and his bike skid on the freshly spilt water. The other bike behind him could not control itself and ran over the man’s hand. The man sustained severe  injuries.

He was a law abiding middle aged man wearing a helmet. Not even speeding, he was just waiting for the signal to turn green. For no mistake of his own, he sustained multiple  fractures. Many good Samaritans helped the injured man.

Following questions came to my mind:

• Is it a sheer accident? Does the story end where  the victim  curses his bad luck and get himself treated at his own cost?
• Is it an error of the fire personnel? Should he not have waited for green signal and follow the traffic rules. Probably It is justifiable that he hurriedly wanted to rush to  the site of fire and douse it. It  is a human error. Is it  “justifiable to be erroneous”?
• If the fire engine fellows would have taken “due care” of closing the valve properly the problem could have been easily averted. And the precaution expected was a simple one. So is it the negligence of the personnel manning the fire engine? Should he be made accountable for this act improperly executed?
• Is the action of the fire personnel “rash and negligent” that led to “grievous hurt” to the victim? Should he be arrested and put behind bars?

The victim suffered a fracture, needed hospital admission and surgery, and had to spend a lot of money from his pocket. He was off the job for two months. He had to go through a lot of suffering. Is it human right violation?

Friends, I find a lot of similarity between the above mentioned story and medical accidents. A health care provider who wants to actually help the patient actually lands up messing it up unintentionally and unknowingly.

Till now patients accepted these as accidents and cursed their own fate. Some  took the doctors to courts for compensation. Then we witnessed increasing trend of  filling criminal cases. I consider this to be the most  dangerous trend in the doctor patient relationship.

Now is it right that we start calling these Human rights violations? Is it fair on the part of  National human rights commission to hear these petitions ?

Waiting for your comments…