Longevity

Posted on October 21, 2020 by rajuwilk

I was going through various scientific journals, where they study longevity. Surprisingly exercise does not feature. The most important reason for longevity is genetics, independent of any adverse habits.

There are people who are over 100 who have smoked heavily for at least 40 years of their life.

Genetics play a major role in negating the adverse effects of a bad life style, from reducing the cholesterol, chances of heart disease, hypertension, diabetes or malignancy.

Paradoxically malignant cells demonstrate the ability for unlimited division which healthy aging cells lose due to a genetic make up which limits the number of divisions, hence aging. If genetic engineering is done to enable unlimited division in normal cells it would also increase the propensity of it to turn malignant.

Unlike what is commonly believed a vegetarian diet does not have a major role to play. Various diets like increased antioxidants, vegetarian and vegan have limited role.

Vegetarianism or more specifically veganism is a for a sustainable planet as we use more resources raising livestock and poultry and feeding them fodder than we use growing plants for our own consumption. The amount of land cultivated is greater when we are feeding our livestock, poultry and ourselves. Depleting natural cover for farmlands.

The diet which has some role is a calorie limited diet. Where reduced calories to extent of starvation is followed. This could be due to A reduced oxidative damage to the body by breaking down food and converting it into usable nutrients. However whether such diets can be followed lifelong is doubted.

A positive belief in an higher power is also instrumental in longevity. This helps alleviate anxiety and the feeling of helplessness. There is the comfort that there is someone above looking after you.

Exercise can increase your life span by only an average of 5 years.
But it’s always better to add life to years rather than adding years to life! We can survive to a ripe old age but be bedridden and demented.
What would be the quality of life?
It’s better to live limited years healthy and independent rather than limp to a 100, bedridden and dependent on care givers. Hence the importance of exercise.
A disclaimer, I have merely quoted research and none except the last sentence is my opinion.

Running a steeplechase on Indian roads

Posted on September 25, 2020 by rajuwilk

Running on the roads in our country is as good as running a steeplechase. Since the lockdown I have a fixed circuit starting from my house and looping back.

Initially it was peaceful but suddenly the authorities in their wisdom decided to cement-concrete a perfectly good road. So half of the road was closed to traffic.

I started running on the functioning half of the road but it was too nerve wracking with a narrow carriageway, to and fro traffic honking and narrowly missing me. So I started running on the closed side.

Initially I had to negotiate a mound of gravel placed to block off the road and then enter a dug up road. Once the cementing started, I was running on the sidewalk across encroached entrances of shops, narrowly missing customers.

Then they dug up the sidewalk and yesterday I was jumping between the freshly cemented road and the sidewalk. Then suddenly my left foot hit an object and the momentum brought my centre of gravity way forwards and trajectory towards the ground.

I took a couple of frenzied steps attempting to bring back my centre of gravity over my legs but gravity one and I was sprawled over the gravel. I my hands elbows and knees bore the brunt but thankfully besides my pride there was no serious damages.

Aging a choice!

Posted on September 13, 2020 by rajuwilk

Aging a choice!
We sometimes don’t appreciate the importance of fitness until we lose it with age.

Losing is a very gradual process almost imperceptible. Initially it maybe just walking a little slower. Acceptable for advancing age but acceptable only if you accept it! Then preference for using a lift rather than the stairs.

I have never been athletic in my youth but once I finished my MBBS, I looked around me and saw life style ailments in my patients. I also saw my own father who had prematurely aged.
He discovered he was hypertensive only when he developed a nose bleed.

He had only one of his original teeth left. He was born in a time where dental care was in a nascent stage in India, so the treatment for dental caries was extraction. My mother jokingly commented that getting his teeth extracted has become a hobby with him. She also recounted an incident where the dentist mistakenly extracted a healthy tooth.
In those days in Uttar Pradesh you had itinerant dentist, invariably of Chinese origin, who set up a roadside stall with a barbers chair for a dental chair. The diseased tooth was identified by tapping and eliciting pain. The extraction would be sans anesthetics. People of that era were more stoic and had a high threshold to pain.

There is a classical description of a tooth extraction in Mark Twain’s ‘Adventures of Huckleberry Finn. The boy would complain of toothache and the mother would identity the tooth and tie a string around it. Then she would tie the string to the foot end of the bed and take an embering log from the fire place and bring it near his face. Defensively he would move back and out would pop the tooth.

As a result of not having teeth his cheeks and lips caved in because the lack of support from the teeth. He used a full denture which he removed in the night.

Towards his last days he was never satisfied with his denture despite having it refitted numerous times. He felt it poked his gums or palate. His past time was to file the denture with a nail file to smoothen the protuberances.

He was also unable to sit astride as a pillion on my scooter and had to sit side saddle.
All this made me firm in my resolve to remain active and at least slow down aging if not arrest it.

First in my actions was to give up smoking and it’s been 36 years since I’ve touched a cigarette.

There was a fitness wave abroad and the media promoted at least half an hour of aerobic activity for cardiovascular health. I started with running followed by skipping, then swimming and finally gyming and running.

I may have had cardiovascular benefits from running, swimming and skipping but gyming and weight training made me realize the benefits of muscle training and flexibility.

We visited Manas National Park in Assam and went for an elephant safari. Unlike in other places where they balance a ‘hathi howdah’ on an elephant’s back and you can sit comfortably. They were more humane here and we had to sit astride on the elephant’s back. The elephant is extremely broad in the mid section and this meant doing almost a complete split! I realized how stiff I had become. The mahout was comfortably perched on the elephant’s shoulder and neck and did not have to perform such contortions. I recollected the difficulty my father had sitting astride on my scooter.

One of my classmates who visited the Great Wall of China, sent a photograph to the class group with a comment we should visit these places when we can. Implying physical disabilities later would impede us.
I have run two half marathons in Ladakh, hiked upto Tiger’s nest monastery in Bhutan. In Tawang, Arunachal Pradesh we went to the Bum La pass on the China border at an elevation of 15200 feet. Many from the group experienced altitude sickness. I guess I had got accustomed to altitudes.
Age is only a number and you are only as old as you feel. If I compare myself with my father I’m definitely in better shape. I recollect that how old my parents seemed to me when they were the same age as I am now. I go with the attitude that nothing is impossible if I set my mind to it.

Thoughts after completing the Ladakh Marathon in 2017

Posted on September 10, 2020 by rajuwilk

In 2017 on this very day I finished the Ladakh Marathon. I am reminiscing my feelings.

Facing early morning sun and running uphill in the ‘cold dessert’ terrain of Ladakh.

“After finishing 21 kms at an altitude of 11500 ft above sea level, it is but natural that there will be soreness and stiffness. One begins to wonder whether it’s worth propelling a 56 year old body or whether it is doing me any harm. I guess it is not accepting any limitations and believing you are only as old as you feel.

During these marathons you come across amputees, polio afflicted, blind and other differently abled people who are not willing to let their disabilities drag them down. In my case I had bad knees and was told 17 years ago I would require knee replacement in 5 years.

Every orthopedic surgeon worth his salt advised me to choose exercises which would not stress my knees. Initially I tried those exercises like swimming and water aerobics. But didn’t find any improvement in my knees. Then I took the decision 8 years ago that if knee replacement is inevitable then I might as well go out with a bang!

I joined a gym kept a personal trainer and never told him about the pain I was experiencing on doing exercises like squats because I knew then he would not make me do it. I also started running on the treadmill something which I never had done earlier. I discovered because of the pain we experience the movement at the knee joints get limited and along with it movement at other joints like hips. We are no longer able to sit cross legged or use an Indian style toilet. The muscles also undergo disuse atrophy. As the saying goes “if you don’t use it you lose it.”

Physiotherapy involves improving range of movement and strengthening muscles. I was ultimately doing physiotherapy on my knees albeit in an extreme form. I’ll warn anyone who plans to tread my path that things became worse before they improved. My knees would get swollen up, a synovial bursa ruptured, the shin would be extremely tender and the muscles especially the calves would be stiff and painful. Rather than having an athletic gait I had more of a gait of aged person.

Any consultation with an orthopedic surgeon and I would be given advice on how to go easy on the knees, use a lift instead of stairs and plan my work in such a way that I would not have to go up and down the stairs often. What I never told them is actually how much stress I was subjecting my knees to. It was kind of a stubbornness and a belief that I was doing the right thing.

Very slowly things began to fall into place. The range of movement on my knees improved and I could sit cross legged or in a squatting position. Then I decided to add a further stress to my knees, start running on the road and for distances. This must have been 3 years ago when I used to run a 1 km stretch and another discovery I made, along with the stiffness of the knees we also develop stiffness in the small joints of the foot. You tend to run flat footed with the entire foot slapping on the ground.

Gradually after working on my form I managed to achieve the desired forefoot then heel strike. Nothing comes easy and no pain no gain but the most important thing is to be consistent.
Now touch wood! My knees feel like new and recently got them checked up. The orthopedic surgeon was surprised when he reviewed the x-rays that how healthy my knees looked.

I discovered amongst the runners circle that there are many other people with similar stories like mine. Even scientific evidence also shows that running with the correct form improves the knees.”

Initiation titles Circa 1978

Posted on July 30, 2020 by rajuwilk

Dear Friends,
Though we are united by our common sojourn in CMC we may have different tastes and sensibilities. In Men’s Hostel profane humour was the norm as is in any Male Hostel. All of us are jaded adults who have heard it all and seen it all, so hopefully are not disturbed with profanities. However if you feel your sensibilities will be hurt, please do not read!

Our Batch of 1978 was unique because we were the last to have the traditional 3 day initiation of Men’s Hostel, the last Batch to have premedical subjects and the first to have the massive fee hike (from Rs800 to Rs3000 a princely sum in those days). This is the description of some of the events which took place during ragging. This was already posted for my classmates and I am sharing with you. I request all those who read it and like it to press the like button. Those who dislike it to post their comments and everyone else is also free to post their comments. I would also like to apologize to all my ‘Senior Doctor Sirs’ and ‘Lords and Masters’ for any transgression I may be willingly or unwillingly be committing.

Dear 78ers,
It was on 17th july 1978 that we joined CMC. I will never forget that day when after paying the fees at SBI Carmen block I met Agroo, Datta & Venky who were to be my room mates. We walked down the path to the ‘Mansion of Gods’, on the way we encountered seniors who seemed unusually friendly. The FAQ was anyone you know in the Womens Hostel?
On reaching the hostel we were told that we would have to be interviewed by the Psychiatrist, Hostel Sec & Chaplain. The Psychiatrist was Bhanu Pant, he asked couple of questions which I don’t remember and showed me a drawing. If my memory holds me good then the drawing resembled a ‘Phallus with fluid dripping into a whirlpool’ and ask my opinion on the drawing. I said “it seems like something erotic,” to which he again asked, “what do you define as erotic”. I was sent out with a provisional diagnosis of ‘castration complex’. If Men Hostel lore is to believed then in previous years a machete was suddenly swung by the psychiatrist perilously close to the family jewels and if self preservation instincts kicked in like protecting them with your hands then a definitive diagnosis of castration complex was given.
The interview with the Hostel Secretary was relatively straight forward, we were given a choice of rooms and the choice include attached bathroom and AC. I wisely chose a single room but it is rumoured that those who opted for attached bathroom with AC had to have a chamber pot tied around their waist a shower sprout above their head and an aerosol can inside their shirt for rest of the initiation (Attached bathroom & AC).

The chaplain interview I somehow don’t remember though the chaplain was Raj Dayal Singh possibly nothing out of the ordinary was said which is expected from a man of God.

Next we were all taken to the mess for dinner, all the tables were put together and we sat around with the seniors surrounding us. They were very nice and asked us individually whether we would like an egg an used their own coupon books to pay. Once the dinner was over each of us were told to stand on our chair and introduce ourselves. Each introduction was followed by loud cheering of the crowd. Everything seemed so hunky dory until the bugle blew Tara Taraa (it actually was not a bugle it was a trumpet played by Tricky Dick). Then immediately the mood of the crowd changed, “down on your knees” was what could be heard. We had to crawl up to the upper common room and if we dared look up our heads were pushed down. In the common room were had to assemble around a podium still on our knees and our head still bent while the Hostel Sec Sumant Khanna address us. Our Batch was collectively christened as the ‘Pseudopriapistic catamites’, whatever that mouthful meant! The speech went on and on, some excerpts are “you all have to carry a handkerchief neatly folded in your front pocket at all time so your Lord and Masters can blow their nose on it whenever required”. We all were alloted to Lords and Masters and each given a new name by which we were to answer to. This is a deep dark secret which was to be guarded by the Laws of the Mens Hostel ‘Omerta’. However now having almost reached the half century mark I will reveal the ‘ragging names’ of our batch.

Abraham Muthunayagam – Abhi Mooth Ayega (This was considered a classic name in those days and also prophetic as he is now a Urologist)
Alfred Job Daniel – Jobs daughter gave Alfred Haat Daniel (I think it was a reference to Dr. C.K. Job’s daughter ditching Alfred Edward whether true or false God alone Knows)
Amitava Biswas – Guava up my Arse (most probably referring to his constipated look)
Bipin Chandra Paul – Bitten on my Ball (most probably because of his meek look)
Chrishantha Binojan Vishwalingam – Crusted Rusted Twisted Lingam (beats me why that name was consided appropriate)
David Srinivasagam – David See-My-Arse-and-Cum (possibly due to his voyeuristic tendencies)
John(ny) Christo – Horny Cysto (had to do something with that name)
Murli Krishna – Merrily Kiss my Dongs (We still refer to him affectionately as ‘Dongs’)
Philip John Prakash – Fill-up-my-Arse (I think our seniors were still caught up in the Freudian ‘anal phase’)
Philipose John – Phimosed Horn (I don’t think that was true about him)
Praneeth Peter – Pet my Peter (Unfortunately he was not with us for long enough. R.I.P. )
Premal Das – Anal Mass (You will all agree that sometimes he tended to be a pain in the _)
Sajiv John – F.L.-torn-that’s-why-I-was born (for the uninitiated that stands for French Letters)
Satish Korah Kuruvilla – Satish Lawda Kudiwalla (A true hermphrodite both organ present )
Srideo Jha – Seedhe Jhaat (whenever I called him that he would say, “Seedhe Nahi Hain Dekh Le”. I never took him up to his challenge, may his soul rest in peace)
Sunil Agarwal – Screw-nil-Bugger-all (That is the reason why he is still know as Buggeroo)
Sunil Datta – Screw-nil Dartos (Once in a while we called him Dartos affectionately otherwise he was just Datta)
Sunil Thomas Chandy – Randy Chandy (He is always been known as Candy)
Suresh Daniel – Spaniel Daniel (During ragging he was frequently asked to bark and no his bark is not worse than his bite)
Valsan Philip Varghese – Vulva Well-Greased (No comments)
B. Venkatesh – V.D. Wank-at-ease (Venky, Kusoo, Tiru KKBJL Gopalan and now known in Australia as Bala looking forwards to seeing you)
Jones Kurian – Kudiyana from Pudiyana (referring to his recent visit to Ludhiana)

Will someone help regarding the names of M. Anthony David Swaroop Kumar, Alexander John, Babu George, John Mathew, Neelam Rajendra Charles, Prio Sada, B. Samson, Shashi Varma, Simon Rajaratnam and Tambi Abraham Cherian. Tee Seng Kiong was not given a name as he was already ragged the previous year.
So friends here ends this letter, if someone wants to bump me off that Calcutta is a good opportunity. I will continue this trip down memory lane as and when the spirit moves me. So take care, cheerio and khuda hafiz!
Raju

My journey in running!

Posted on July 26, 2020 by rajuwilk

I started running 10 years ago and since then the design of running shoes has been constantly evolving. Running shoes then were ‘over built’, with multiple layers on the sole, cushioning, inner arch support for comfort and even springs at various strategic points. All in the belief that it would give an additional propulsion.

One of the first running shoes I bought had a thick sole with large corrugations, imaginatively named ‘zig tac’. The arches of these corrugations theoretically bent backwards when the foot takes a forward step then spring back giving and extra propulsion forwards. This happened, at least in theory and supposedly tested by the company.

I remember reading long time ago a study on human feet and the conclusion they reached after the study was that people who walked barefooted had the healthiest feet. Even in running long distances, barefoot running is supposed to be 30% more efficient. The reason being that the feet can feel the ground while running and adapt it’s shape according to the terrain. All will remember that the legendary Milkha Singh ran barefooted, more because he could not afford shoes. Celebrity marathon runner Milind Soman also runs barefooted and only wears shoes in races, where it’s compulsory to wear shoes.

These days in marathons, I see a lot of people running barefooted. In the 2018, Tata Mumbai Marathon one young girl I noticed, ran so lightly on her bare feet. She overtook me effortlessly and she reminded me of a deer springing away.

My mother was extremely particular that our feet were shod, all the time. At home we wore chappals and outside of course shoes. So leave alone running I had never walked barefoot.

The human foot consist of 26 bones and 33 joints and is divided into the forefoot, mid foot and hind foot or heel. The bones in the mid foot form the medial, lateral and transverse arches of the foot. These arches are important during running to give a forward propulsion by expanding and retracting. I unfortunately suffer from pes planus or flat feet where the medial and the transverse arches have collapsed. I realized when I started running that the joints in my feet had stiffened, decreasing the flexibility of my foot. As a result when I ran, the entire surface of the foot would strike the ground, rather than the ideal forefoot and heel strike. That resulted in the force being directly transmitted to the knee. As apposed to forefoot heel strike where the force is dissipated over the forefoot and mid foot, lowering the impact on the knees.

Now the trend in running shoes is towards minimalistic, the extreme example is Vibram shoes which fit the foot like a glove and have spaces for the toes. These would next best to running bare footed. But there are shoes with thinner and more flexible soles. I recently bought a pair online which are lace less and have a stretchable knitted upper. It has to be worn like a sock. I was surprised that my pace improved and I found running easier. Maybe psychological!

Earlier I invested in shoes which were supposed to prevent over pronation of the foot or the foot turning inwards which people with flat feet tend to do. I also wore a silicone arch support in belief that it would improve my plantar fascitis. I have pain on the sole of my left foot and swelling on the medial side of the left ankle joint since the last 6 years. Neither non pronation nor the arch support seemed to have made a big difference. I’d be limping on getting up in the mornings. The solution came on youtube and my own common sense. Every night I soak my feet in warm water with Epsom’s salt or magnesium sulphate. Followed by icing with an ice bag and stretching of the fascia with a foot roller.

Surprisingly this regime has worked like a miracle and the symptoms are almost 90% less.

Teachings of the Buddha

Posted on June 30, 2020 by rajuwilk

The Buddha or the ‘Enlighten One’, has stated that the root cause for unhappiness is attachment. Attachment to people, possessions, property or power. The loss of these will make us unhappy, but detachment would make us indifferent.

Prince Siddhartha never saw unhappiness until he left his palace on a chariot ride where he saw the poor, the suffering and the dying. It was then he decided to give up all wordly possessions or in other words attachments and seek enlightenment. The goal was to free an individual from sadness not only in this birth but in subsequent births.

Nothing is constant but change and nobody is immortal. Therefore in our lives there will definitely be a time when we will lose possessions or people. Paraphrasing the Gita by saying that what is yours today belonged to someone else yesterday and will belong to another tomorrow so why feel sad losing it?

If the importance of money, wealth and power can be removed from our lives we would be definitely a little happier.
My personal musings.

Facing our own mortality in the pandemic panic

Posted on June 28, 2020 by rajuwilk

Are we living or are we dying?
Both are true! Same as a glass of water can be half full or half empty.
In an increasingly uncertain life, two things are certain, first is that we are born and second is that we will die. Events in between are uncertain.

We all have an expiry date written somewhere but luckily we don’t know where and we cannot decipher it!
Suppose we could decipher it and know our date with fate, everything would become pointless. Our attitude would change completely from the enthusiasm of living and planning for the future to a feeling of futility because the future does not exist post expiry date!

In Tamil Nadu and Kerala there is a form of astrology called Nadi. It is based on the belief that the past, present and future lives of all humans were foreseen by Dharma sages in ancient times. The first sage being Agastya. This was written on palm leaves and stored for reference in the Vaitheeswara Temple in Sirkazhi, Tamil Nadu. A person’s leaf could be retrieved by the astrologer based on the date and time of birth and it could accurately tell you the day of your demise. One of my friends recalls that his brother went to a Nadi astrologer, who accurately told him his parent’s name and other details then was just about to reveal his date of demise when he silenced the astrologer mid sentence. He wisely didn’t want to know! If he was told the date, that knowledge would hang over his head like the sword of Damocles. He would count the days, the hours, the minutes and finally the seconds to the day and then it may turn out to be a damp squib! An example is of the Mayan Calendar which experts said predicted the end of the world in December 2012, because the calendar ended on that date. Considering the world is still around in 2020, it was a total wrong presumption! However a lot of people spent anxious moments anticipating the end of the world.

Scientist say “whether the earth will end” is not the question, the question is when the earth will end?”. The end may come as a meteor hitting the earth or a large solar flare destroying the ionosphere and exposing us to cosmic radiation or eruption of a supervolcanoe causing an ash cloud to block sunlight or even the Halydron collider which is trying to recreate the ‘Big Bang’ in miniature exploding.

Quoting the Bard of Avon, William Shakespeare, “A coward dies a thousand times before his death, but the valiant taste of death but once. It seems to me most strange that men should fear, seeing that death, a necessary end, will come when it will come.”

As I gradually creep toward senior citizen status many of my contemporaries have abandoned me. Some due to disease and others due to accidents. The incident which really shook me to the core was the passing away of a MBBS classmate, room mate, friend, philosopher guide and teacher, Sunil Agarwal. He died in an unfortunate car accident, this February 2020 and just before embarking on the fatal last journey, he messaged me good morning and that he was going to a mission hospital for a camp and that he was looking forwards to the cool weather there. Little did I know that by evening I would hear about his demise.

An analogy of life is a train journey. You boarded when you were born and on the way lots of passengers boarded and shared a part of the journey with you, only to disembark at some point for a different destination or sometimes permanently like Sunil.

I try to empathize with the cancer survivors who have been operated, received chemotherapy and radiotherapy. Now they can only wait or better live. The disease may raise it’s ugly head again. All it requires is one single cancer cell remaining, which can multiply rapidly and overwhelm their body. They could be in an pessimistic frame of mind or an optimistic frame of mind. In former they are dying a thousand deaths, whereas in the latter they die only once.

Legend has it that the ancient Gauls who inhabited present day France only feared the sky falling on their heads. The SARS COV-2 pandemic, has brought us to a similar predicament. Shoving our own mortality, right into our face. Suddenly we are faced with the real possibility that we may be infected and our infection may be severe enough that we may die!
One question is on everyones mind, “मेरा number कब आएगा?” or “when will my time come” and this is not with hopeful anticipation but with dread.

The virus is highly infective and a zoonotic infection or one which has jumped from animals into man following a crucial mutation which allowed it to infect humans. There is the conspiracy theory that it was genetically engineered to make that jump, blaming our neighbours to the east. But we won’t go into that!
This is not the only virus which is zoonotic, earlier we had swine flu, chicken flu, MERS and SARS which also belong to the same family of Corona viruses, so called because they have a halo or crown or crown surrounding it. These did cause their share of deaths but are not as infective as the latest avatar of corona, SARS COV-2.

Then there is the famous human immunodeficiency virus, which causes the acquired immunodeficiency syndrome or AIDS. The virus belongs to a family of retroviruses and is also a zoonotic infection. It was supposed to have jumped from the African green monkey into humans.
Arthur Ashe, the African American tennis player who is the only black player to have won Wimbledon, American open and Australian open contacted AIDS from blood transfusion following heart surgery. One of his fans wrote him a letter and asked, “Why does God have to select you for such a bad disease?”
His answer was, “The world over — 50 million children start playing tennis, 5 million learn to play tennis,
500,000 learn professional tennis, 50,000 come to the circuit, 5000 reach the grand slam,
50 reach Wimbledon, 4 to semi final, 2 to the finals,
when I was holding a cup I never asked GOD ‘Why me?’.
And today in pain I should not be asking GOD ‘Why me?’ ”
Happiness keeps you Sweet,
Trials keep you Strong,
Sorrow keeps you Human,
Failure keeps you humble and Success keeps you glowing, but only Faith & Attitude Keeps you going.”

Quoting Oscar Wilde, “To live is the rarest thing in the world. Most people exist, that is all.”
I see lot of my colleagues hiding in their homes and avoiding contact with patients in fear that they will contract the disease. However how long can you hide! The virus is going nowhere and our redemption lies in herd immunity or invention of an effective vaccine. Herd immunity will only kick in when at least 60% of the population is infected and as for the vaccine, attempts to create a vaccine for the other corona viruses also yielded zilch. This was thanks to the virus’s penchant for mutations, making it difficult for the antibodies to recognize the mutated virus.
However recently I read that the virus in it’s current mutation causes a less severe disease. This is also a self preservation strategy of the virus. If it killed all it’s host rapidly, it would no longer be able to spread and infect new hosts. Simply put all the people infected with the severe form of the virus succumbed to the infection ending the life cycle of the virus with them. However it is the ones with less virulent strains, who remained asymptomatic or only had mild symptoms, who spread it to others. Therefore the milder versions of the virus get disseminated while the virulent die with their host.

It has been predicted by an epidemiologist that COVID-19 will kill at least 2 million people in India. Though the number sounds large, so is the population of India at 1.3 billion. If you do the simple mathematics, 2 million merely represents 0.15% of the population of India, reducing the probability of you being part of this statistic to lower than the chances of you winning a lottery ticket. Have any of you won a lottery?

Since our knowledge of this virus is merely 6 months old we are daily learning new facts about it. The chances of contacting it while touching inanimate objects or fomites is low. The highest incidence of transmission is through aerosol or tiny droplets of saliva and mucus which are emitted when we cough or sneeze. These droplets when inhaled can enter the respiratory system via the trachea then bronchi, bronchioles which finally end in a tiny sac like unit called the alveolus. The respiratory system brings air into the alveoli, the lining is rich in blood vessels and exchange of gases occur. Oxygen diffuses into the blood and carbon dioxide comes into the alveoli which is exhaled. But now with the air also comes the virus and causes an inflammation in the alveoli, affecting the gas exchange. It also causes what is famously known as the cytokine storm, an over reaction of the body’s immune system to the virus. This causes irreversible destruction to the alveoli giving rise to a reduced lung function. The destruction could be so extensive that no alveoli is left for gas exchange.

The use of ventilators in these patients is push oxygen with pressure into the lungs, inflating all the alveoli and improving gas exchange. However now with no functional lung tissue left, pushing oxygen serves no purpose. Only an Extracorporeal Membrane Oxygenation ECMO, will work. This is similar to the heart lung machine used during cardiac surgeries. The blood is diverted to the machine and it oxgenates it and pumps it back, giving the heart and lung rest. But for a completely destroyed lung only option is a lung transplant.

The strategies which are being used for treatment are transfusing the plasma of patients who have recovered from the infection. Their plasma is rich in antibodies against the virus and help in fighting the virus. Antiviral like Remdesivir show promise in fighting the virus. A steroid like Dexamethasone which suppresses the immune response of the body is helpful in reducing the damage caused by a cytokine storm.
There is a race to make a vaccine for this virus spurred both by concern and commercial considerations. However the vaccine may not be effective because the frequent mutations the virus makes.

The virus is here to stay and we have to learn to co-exist with it like we learnt with other viruses. We cannot hide away forever and have to resume a new normal life which include the necessary precautions.
Finally we have to live and not exist or die a thousand deaths.

The origin of Chicken Manchurian

Posted on June 21, 2020 by rajuwilk

It was in 1975 Mumbai restaurateur Nelson Wang, an Indian Chinese invented chicken manchurian , keeping in mind local preferences. He covered the chicken in corn flour, deep fried it, tossed in ginger garlic, soy sauce and some other condiments. What he got at the end could have been described as a spicy corn flour covered chicken pakoda. To give it a Chinese name he called it ‘chicken manchurian’ but it had nothing to do with the region of China called Manchuria.

Manchuria is a remote part of China inhabited by the Manchus. It is bordered by Mongolia and North Korea and the inhabitants where considered by majority Han Chinese as putting it politely ‘provincial’ or ‘junglee’. Since the dish was to spicy and hot to suit the taste of Chinese, Nelson Wang called it manchurian or junglee chicken.

The connection between the solar corona and coronavirus.

Posted on June 21, 2020 by rajuwilk

Those lucky enough to observe the solar eclipse note that when the eclipse is complete, the ‘corona’ of the sun is visible. This is a layer of glowing plasma surrounding the sun which normally due to the brightness of the sun is not visible. However when the sun is covered in a solar eclipse it is visible as an aura.

The word corona comes from the Latin word crown but these days it has a more ominous ring to it, the coronavirus or the SARS-CoV-2, a zoonotic RNA virus causing COVID-19 infection. Zoonotic because it jumped from animals to humans, RNA because it has a RNA core and it causes the severe acute respiratory syndrome (SARS) also called coronavirus disease 2019 or COVID-19.

The name refers to the characteristic appearance of virus under electron microscopy, a fringe of surface projections creating an image reminiscent of the solar corona. This appearance is created by the viral spike peplomers, which are proteins on the surface of the virus. These groups of viruses where informally given this name by June Almeida and David Tyrrell and appeared in an article in Nature magazine in 1968.

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Memories from a medical career