Santhosh's ramblings

It was yet another regular Monday morning in Duncan. I, walking about with the young and excellent consultants in Medicine, Anesthesia/Critical care and Pead’s, me, not doing much but just being around.  As we walked into casualty, there was this 50-year, obese male, in encephalopathy and taking very shallow breaths. A classic and clear patient with Obstructive airways disease and possibly an additional Obesity hypoventilation syndrome in respiratory failure. Some surgeon in a nearby nursing home had taken the risk of doing a cholecystectomy on such a high-risk patient and now he had come in with respiratory failure. His complex blood gases started of a series of conversations. Should we intubate and ventilate, if we ventilate, would he ever come out, or should we wait on NIV alone? If he does not come out of ventilation what would the next step be? Finally, after much consideration, the Anesthetist turned critical care specialist, dec ided for NIV only. We walked into t...

We see quite a bit a new Hansen’s Disease (Leprosy) at the hospital where we are. Three to four new cases a day, for a disease supposedly “eliminated” in India and across the world! We see new pauci-bacillary, many multi bacillary, and very many with severe reactions. We come across many partially treated, some possibly resistant ones too! For an old disease we hardly have any new answers. The same old treatment since a few decades. Well the purpose of this blog was not to complain about the “neglected tropical disease” but to make another point!   But I couldn’t control my habit of being a complainer when it comes to diseases of poverty! The most difficult decision which I find in treating leprosy is to decide, if the patient still needs treatment or is it a burnt-out case. People come after having taken treatment for a few months, with no bacteria detected in the smear, or broken bacteria seen – are we dealing with a partially treated case or a fully treated “burnt out” ca...