Sunday, October 30, 2011

Vacation cum Conference



Two days for a surgical conference in Mahabalipuram. The idea was attractive for many reasons- technique is relatively new and we did have a fair amount of experience with it, the town was a historical one and I did not have to travel far- only about 35 km from where I live in Chennai.

The accommodation was large and spacious. The verandah faced the beach and had wonderful rocking chairs. Such a welcome change from the routine grind with traffic jams in Chennai. So many trees and so much of greenery on the way to the sands. … Birds chirping in the morning awakening you reminded me of how much we miss out on nature in cities. Beach was without a single human being before sunrise. It was great to run on the beach at sunset for a long distance with not a single soul in sight, just the crabs for company! The sound of waves, the vastness of the ocean, the ceaseless activity of the water remind you constantly of the beauty and the strength of nature. Small fishing boats returning at dawn, made a pretty sight as they neared the shore. Weather was cloudy with intermittent showers. Gym was a good one.

Radisson Resort Temple Bay, Mahabalipuram deserves its reputation because of the high standard of food and service. The band at the dinner was great ; unlike most bands, they had a violin too and did some Latin numbers till the rain played spoilsport.

Surgical part was good too and the holiday was very refreshing. It was a time to catch up with old friends and make a few. On the whole, a well deserved break.

Saturday, September 17, 2011

HELPING THE PHYSICALLY CHALLENGED

“Kindness is a language which the deaf can hear and the and the blind can see”- Mark Twain.

I was leaving to do a clinic this weekend at my hometown and booked my travel by train. It was an obscure ’special’ Mangalore Express and its announcement was not even on the billboard at the railway station. It even arrived at an obscure platform 2A in Chennai!

The train arrived in Coimbatore at dawn- 6am. As I walked towards the exit , I saw a couple- a blind couple with the man holding a white tell tale stick. I slowed down when the man and woman were about 10 feet away; people walked around them clearing the space for them. The couple clearly did not know which way to go. The noisy platform did not help them either. The man rotated around himself as if to assess which way to go. The wife just held his hand and circled along with him.

I politely walked past but then out of curiosity turned around to look; no one wanted to help. My pick up was waiting and I wanted to go away; but was interested enough to see if anyone would help. Well, no one did. So I stopped and walked back to the man and asked if he wanted to go out of the station.

He said he wanted to go to the bus stand. Coimbatore station has 2 long flights of stairs and I walked holding up his hand, warning him of the steps and the pillars around. He was a bit slow at first and then picked up momentum, gathering enough confidence in me not to use his stick for tapping. I walked him and his wife to the bus stand and then rang up for my car pickup.Ten minutes of my time probably save one hour of his.

I suppose most people would be like me – knowing when some one needs help, and hoping that someone else would help them. I guess that is human enough. But then, when help is not coming , we should step up. A little bit of kindness in spirit and action goes a long way to help the physically challenged and the weak.

Mark Twain was not wrong.

Sunday, September 11, 2011

A Visit to ALMA MATER






On Visiting the Alma Mater

Prof Inian had told me I must attend a farewell few months ago and followed up with a few polite emails. So, just for a day, I visited my alma mater- Christian medical college hospital, Vellore on 10.9.11. The occasion was to attend the felicitations to my friend since 1970- a famous Professor of Surgery who later on became Principal of the college. Department of surgery held a series of lectures from 8 am to 5 pm for surgeons from all over in honor of the retiring surgeon , Prof George Mathew.

The hospital campus had changed over the decades. Concrete buildings had replaced the green gardens. So many tall new buildings! Ocean of people and numerous pedestrian paths had replaced the wide roads of the past. Large posters of the farewell festivities were everywhere. The buildings bore little resemblance to the institution I trained in.

In contrast, when I walked into the auditorium, I was taken back in time to the 70s. Many of my former professors and teachers were there. Some who trained with me are now professors and surgical unit chiefs there.

To my surprise, the program read that I was to chair the second session in the morning. When you are back with your teachers who have taught you how to hold the scalpel and how to take your first stich, after a lapse of so many years , one feels tongue tied and very self conscious .But it got easier after the session started and my two presentations on thoracoscopic(keyhole surgery of) esophageal cancer and laparoscopic achalasia( cardio spasm) went down well.

I met many of the surgical trainees. There was definitely something similar about all these guys, which has not changed over time. Apart everyone wearing half sleeved white or light blue shirts with no coats, there was also the polite demeanor, which surrounded them. Not once did I hear a cell phone ring; nor did anyone walk out after a lecture began. No loud conversation or backslapping! Polite applause after every lecture as it always was and will be! The new things were of course a lady surgeon who was the master of ceremonies and the gifts for the speakers. So after all, the changes had been only exterior and much of the traditional spirit was the same.

At five thirty pm sharp, the director of the medical college and hospital (my room mate from first year of medical school) and the medial superintendent walked in. Over the decades, punctuality and simplicity of the speeches were maintained. All the former professors were also on stage and they had some anecdotes of note to share about the retiring George. The George I knew in medical school was a quiet, simple guy with no airs, who went about his work with no nonsense. From the remarks of everyone, that is the way he had remained over the years. After taking over the post of principal of the medical school, he made his highest contribution by getting the medical council of India to make way for more medical graduates, post graduate programs in the most ethical way.

Sitaram Chief of liver surgery who had been close professionally and personally to George spoke of his contribution in surgery and research. George in his own way responded by attributing all his achievements to the co-operation of everyone. Over the years he had been to many of my conferences. His tone and content of the talk of naturally with his fully grey hair was professorial and he remained quiet even on his last day after 42 years of service.

At night, we the shifted out to another part of town to a poolside dinner. Much of the evening was spent in anecdotes by other departmental chiefs, songs from other surgeons and a slide presentation of George.

Speeches from the heart full of dedication to the profession and God, with no flashy superlative statements. That left me to wonder if I had missed out by not getting back to my alma mater. Had I missed all this out by not working in this ivory tower?

Then I mused of all my non CMC colleagues and junior doctors I had worked with in the mission and corporate hospitals. The experience of being with surgeons of various medical colleges had made me broadminded and I had friends all over India. And I have met some terrific, brilliant, dedicated doctors from all over the country and abroad during the course of my life. And in our own way, we had kept the CMC flag flying high. So working out of the ivory tower was not a bad move after all.

I had wanted to leave back by road by 6pm, but managed to quit only by 11 pm to reach Chennai by 1am. I had only a three hour gap to catch a flight by four am to Madurai for another surgical meet. But what does a little loss of sleep matter when you have just managed to meet so many of your friends who have laid a foundation in your life? This was yet another moment in time when I met so many, who had taught me so much, so many years ago!

Friday, September 9, 2011

On Drunken Driving

I never understand why people drink and drive.

Yet another call from the hospital last night – 9 people injured and 2 dead. Auto driver was taking his wife and son for a wedding. He collided head on with a car with some young men driven by a drunken man. Fate decided that the sober auto driver and his son had to die… to make things worse, wife of the auto driver suffered fracture of thigh bone.

Folks drink in parties. So why can ‘t they leave in a taxi after they drink?

Why do so many of us needless watch these accidents happen not taking enough steps to ensure the safety of people who are sober on the road?

First of all, awareness by the drivers who drink that they can kill themselves or those on the road is vital to avoid drunken driving.

Of secondary importance is the stronger punishment for the guilty will have a deterrent effect on drinking. But then often the drunken driver also dies and hence the first option of awareness is vital.

Every day, I see more and more of flashy adverts on tv on alcoholic beverages. Yet the horrors of drunken driving are not brought out to the public at large clearly.

Being maimed for life or being reduced to a mental or physical handicapped person due to a negligent drunken driver is one of the cruelest fates in life.

Monday, July 25, 2011

Familial Adenomatous Polyposis




Familial adenomatous polyposis (FAP) is a colonic cancer syndrome which runs in families. It presents as mutliple adenomas in the colon which will become cancer of colon unless the colon is removed surgically.Though the cancer will present in the thirties, we have seen this presenting even at an age of 9 or 10.This runs in families caused by adenomatous polyposis coli (APC) gene, located on chromosome 5q21.

Patients present with hundreds of adenomatous polyps in the colon and rectum usually in adolescent phase which become cancer of colon by the thirties. Thought the polyps are found throughout the colon, more are found on the left half of colon making then easily diagnosable.

The upper gastrointestinal tract too can have its share of duodenal polyps which can become cancerous. They are mostly around the ampulla of Vater found in the second part of the duodenum.Stomach too can have multiple polyps.

Gardener's syndrome is a condition characterized by gastrointestinal polyps , osteomas , desmoid tumors of skin and soft tissues and thyroid tumors.

Definitive treatment consists of subtotal colectomy with ileorectal anastomosis,total proctocolectomy with a continent ileostomy, or proctocolectomy with ileoanal pouch.
Out of all these methods, proctocolectomy with an ileal pouch–anal anastomosis
is surgical treatment of choice,.Here, there is complete resection of colorectal mucosa with preservation of anal defecation.After definitive surgery,endoscopic surveillance of the
ileoanal anastomosis is useful as chances of polyps exist in the subsequent years.

Medical treatment consists of Sulindac, a nonsteroidal antiinflammatory drug.Celecoxib decreases duodenal polyposis.

Endoscopic methods include polypectomy, thermal ablation using monopolar,bipolar cautery or argon plasma coagulation, and laser coagulation.

Genetic counselling is useful.

A technique of the surgery of total colectomy using laparoscopic technique is outlined as a single incision surgery at http://www.youtube.com/watch?v=Wq4FFIbNiPg

Dr John AC Thanakumar
www.lapsurge.org

Thursday, March 17, 2011


Obesity in India. 19.3.11


Obesity is the second commonest preventable cause of death in the world next to smoking. It has been definitely shown by studies that overweight state leads to an early death. If one is able to control the weight, then there is longevity of life as the complications of obesity do not occur .


Overweight status is increasing all over the world and India is no exception to this phenomenon.India's National Family Health Survey indicates that more than 20 percent of urban Indians are overweight or obese. And in the northwestern state of Punjab, nearly 40 percent of all women are overweight or obese. Morbid obesity in India has increased to 5% of the Indian population,


Every sixth diabetic in the world is an Indian - earning India the title "the world's diabetes capital." Indians store more body fat per kilogram than Europeans.Obesity increases the chances of getting diabetes in Indians .


Half a decade ago, obesity and diabetes were found among the middle and upper classes. Now obesity is increasing among the poor population as well. This may well be due to the inexpensive easily accessible fast food and oily snacks ever so popular in the slums.


Children too have an increasing incidence of obesity.The prevalence of overweight and obesity was higher in the high income group as compared children of the middle and low income groups.This may be largely due to the fact that the food is taken with much fatty contents and less of physical activity.


There exists a distinct possibility that with better patient education and community teaching, the factors causing the obesity in children and adults can be effectively dealt with and the associated diabetes and cardiac illness can be minimized and in many instances prevented.


Dr John AC Thanakumar

Senior Consultant

Minimal Access , Bariatric and Gastrointestinal Surgery

Global Hospital, Chennai.


Email: drjact @gmail.com

mobile:9443709158.

www.lapsurge.com