The Tata Nano

Bayer manager and the medical representative visited the clinic today. After their detailing was over, they requested me to see a surprise outside--instinctively I asked whether it was a car , which the rep or manager might have bought. They said it was a Nano and would like me to drive it. Bayer has been alloted 1 car and after another manager used it for a few days, he handed it over to this manager, who stays at Airoli and on his visits to Thane, has made it a point to make the first call at my clinic and then proceed to the others on his list. This was one of those days.

So I drove it from my clinic, giving smiles to all people staring at it, to the service road and took a u-turn at 3 haat naka and came back. Wheel turn is fabulous.

The height is good just like the Wagon R, which I have at present , wheels are small -- scooter or rick size, quite roomy in front, don't know about the rear seats, front seats are reclining, gear and hand brake same as wagon r . Dashboard is basic-- speedometer on top at windscreen level, below are the 2 AC outlets with the controls below it, single wiper , accelerator, brake and clutch placed comfortably as the Wagon R and not at an angle to accommodate the right front wheel hump inside like the Maruti 800 or the Santro. Steering though powered felt very stiff. It was also a bumpy ride -- could be comfortable if loaded. It has power windows.

This was the advanced model 186000/= on road. basic model 126000/= on road. He was telling me that one has to take good care in avoiding potholes. He had taken a ride on a climb near Nerul with total 4 people , but had to shift to 2nd and even 1st gear. Felt less power. Should be good in cities but with good roads.

Marigold for the Festival

We had gone to the market on Friday, a day before Diwali. There were heaps of marigold all around and one enterprising vendor had this novel idea of attending to customers from all directions by sitting in the center if the mound. Couldn't help clicking as we passed him .

Chokhi Dhani

I had an occasion to recently visit Chokhi Dhani, a resort showing the life in Rajasthan. Right from the welcome till the time we exited, we experienced the traditional warmth of Rajasthani culture. This place is on the Bhiwandi-Kalyan Road, off the National Highway going to Nashik and beyond.

A traditional welcome with aarti and to the beats of drums and a dancing ' horse '

Many stalls with folk music and dance.

The ladies are very graceful in their performance and balancing acts.

They also invite the guests to be part of the dance and it so relaxing to join them, watch their movements very closely and dance with them to the fascinating rhythm.

Also there was a performance by a flame thrower and fire eater. I knew that they use kerosene or petrol, but here I got no smell of either.

Was curious to know what he had used.

Next we visited a typical ' mahal ' , where we were treated to a delicious jowar roti with butter and jaggeri , a traditional mix.

On our way back we were fascinated with the ' champi malish ' stall. A professional masseur was attending to a visitor using traditional oils and methods to give him a nice massage.

We then did shopping, buying bangles made of sealing wax, in the traditional Rajasthani method and design. He would patiently attend to the clients, answering queries and remodeling the bangles to the desired shape and size, on hot charcoals.

The final attraction was the Rajasthani menu in the dinner, served sitting down and with the plate put on a small decorated stool. From afar we could not see anyone in the dining area, as all were sitting down and I was under the impression that the mess was yet to open.

Food was really tasty, but with lots of butter and oil and many sinfully heavy sweets.

We are not really used to eating this kind of stuff, but it is excused for a day to savor such items.

Returned home with memories of a good time spent on a weekend.

Ride to Lonavla

A great idea planned extempore . After a few months of hectic work in the clinic, I was on breaking point and desperately wanted a change.

We decided to drive to Lonavla on Sunday, 5th October and visit the beautiful Durgeshwari temple, just off the old highway on the road going to Karla caves, do a bit of exploring of Lonavla and revive memories and then return back. To get more information about this Karla Durgaparmeshwari Math , visit this site, http://www.karlamath.org/Durgaparameshwari.htm

We left at about 8 in the morning and after a breakfast of ' wada pav ' at the food mall reached the temple at about 10.45.

We spent sometime there and went to the Tungarli area for a nostalgic visit. The area has changed totally from the times we stayed there in the late sixties. We saw the Varsha bungalow where we stayed, then towards the Tungarli dam area. It used to be an open countryside and now it is full of bunglows with little greenery left. Next we turned back and on to the road going to my school Don Bosco, which now has so many buildings, and so many houses in front. I used to walk or cycle to and from the school and home.

We then came back to the old highway and to the east to buy chikki and farsan from the famous National Chikki. The taste has not changed over the years and one just cannot like any chikki other than National's, once you have a taste of this.

We then came back to the west for lunch at the famous Chandralok .

This hotel was a small place in those days on the road leading to the VPS high school and the level crossing. There used to be a book store, owned by a Parsi lady, next to Chandralok and she used to resemble Indira Gandhi a lot--looks wise. Our family Physician, Dr. Rashingkar, had his clinic next to this store.

The Chandralok Hotel has a new look but its hospitality and food has not changed. It has a big dining area and a big waiting lobby.

The menu is typical Gujju food , very tasty and piping hot. Waiters always on their toes to attend with a big smile on.

We were fortunate not to have typical big weekend crowds in Lonavla as probably the school exams were still on. I was surprised with the ease with which we crossed to the east and found ample parking places everywhere.

On the way back . a slight drizzle and thick fog greeted us near Khandala. We had put off the AC and opened the windows to let the freshness in.

We returned by 3.30pm refreshed and eager to go back to work for the next week. The feeling was of having come back from a big vacation.

Bandra Foot Overbridge

I had read about this foot over bridge, connecting Bandra east Kalanagar to Bandra west across the railway, crossing the Dharavi - Bandra road and the Western Express way, being thrown open for pedestrians. Often I have passed below it and talked about going over it, just to satisfy my curiosity of its route and extent.

One Sunday, Shami and I decided to make the trip. It was best to use public transport, so we hunted out the shortest route from Thane on the BEST website. We took a bus to Vikhroli depot and a connecting one to Kalanagar. We went across and saw the traffic below, a beautiful garden near the fly over. From above it looked like a well cared for garden, a rare sight in Mumbai.

The bridge is quite wide as it must be catering to the huge rush coming out of Bandra station towards the offices in Bandra-Kurla complex. It crosses the expressway, then curves along the offices to the west of the highway and on to the station.

Here it joins the old railway bridges. Now it is a problem for people like us , who just wanted to cross over without entering the platforms. We read a notice saying ' Do not enter without a valid ticket '. We took a chance and fortunately no TC came our way. There should be an independent bridge going across with connections to the old railway bridges going on to the platforms.

Another good thing seen on the bridge were a few benches with bucket seats kept at regular intervals for people to sit, if tired. These seats of plastic were in a very bad shape as most had their backs broken. This a problem seen everywhere---no funds for maintenance and a destructive mentality in the people. A public toilet is also available at the Kalanagar end though one dare not enter it !!

Sahara Star

A seminar was organized by Merck of USA, a pharmaceutical company, at Sahara Star Hotel, formerly, The Centaur, near the Santacruz Airport. I was very eager to see it as on many of my visits to the airport, I could see some renovation going on to the old Centaur, under huge blue colored sheets. It used to be an eyesore, seeing the mess right in the middle of the road.

The entrance is facing the airport and a very complicated drive way almost to the rear of the hotel takes you to the reception area. The look here is very deceptive, as it is small compared to other star hotels and then on entering the main door, the majestic view enfolds before the eyes.


It is circular with all room balconies facing the central part, which has a garden, waterfalls and a small lake. In the balconies we could see people relaxing in chairs and looking down on what must be a great sight. I have made plans to stay there sometime.

Our talk was on the first floor mezzanine and the buffet was laid on the open space facing the central garden. On either side of the walkway from the seminar area to the garden are the hotel's restaurants. It was a grand evening

Dr. R.K.Gadgil, our most affectionate Dean

Last week , I got a call from Dr. Pravin Gupte, a senior pathologist . ' Make yourself free this Sunday night as our Grant Medical College Alumni Club Thane is having a get together to felicitate Dr. Gadgil, our ex Dean ' he said.

Oh !! what a pleasant thing to hear. I was looking forward to the Sunday to see this 87 year old great person, who had won international awards for his pioneering research work in 1952 for human infection of schistosomiasis in the remote villages of south Konkan.

When I was admitted to the college, our Dean was Dr.Karandikar . After him, I think it was Dr. Gadgil and then Dr. Lele. At that time I was not aware of his great personal charm, as there was no chance of interacting with him as a student.

The speakers that day had interacted with him very often in respect of some college activity or some problems in the hostel or resident quarters. GMC is always full of problems and that creates the liveliness in the campus.

Dr. G.B.Kulkarni welcomed Dr.Gadgil, Mr.Ramesh Gadgil of Medreich SaiMirra, the sponsors of the evening, Dr.Gupte, the chief architect and convener of this function and the committee members of the club, to the dais.

On behalf of the sponsors Mr. Ramesh Gadgil of Medreich SaiMirra was asked to say a few words before the programme started.

He is a very popular figure amongst Thane doctors. He is always ready to come forward for any program organized, especially if it is in Thane.

Dr. Kolge welcomed the guest and Dr Gupte gave a brief introduction of him. It was great to have Dr. Vijay Panikar, my batch mate and a very close friend, amongst us that evening .

He had come all the way from Dadar, from his busy schedule He did not want to miss this function, being very closely associated with Sir, as Vijay was the CS at that time and had a lot to share in his address.

It was decided to have an interacting session involving doctors to narrate their experiences and asking Sir questions related to that incident. This turned out to be a great success than having only the guest to speak and then have a question answer session.

Dr.Gupte took us down memory lane to an era more than 30 years ago. We were junior students when he was a post grad in pathology and so associated more with Dr. Gadgil in addition to his cultural activities of Marathi Vangmay mandal. He told of how he saw the test matches at Brabourne stadium for the entire 5 days from Sir's residence balcony over cups of tea. He also made Sir tell in detail about the story of Joshua, a Malaysian student who was an addict and wanted to reform. Sir had taken him home to stay with his family, dine with them, study along with Sir's children and travel to and fro with Sir.

Another story was narrated by Dr. Chhaya. She had come home for a short break and when she returned to the hostel, she found her belongings thrown out by an arrogant room partner. She went to the Dean's office, which was always open to all, at all times. When she entered there were already two groups of people narrating their problems and so Chhaya stood there not knowing when to begin. Sir looked at her and asked ' What the problem '. She said ' All others are talking.' ' You also start ' Sir said, ' I can hear you all !!! ' Her problem got solved in sometime.

Dr. Benny narrated about the day of admission to the college.

Sir congratulated her on getting the admission and asked her ' Do you know any other meaning to your name Benedicta ? ' She said no , to which he replied it also stands for the Benedict Test for sugar --- sweet.

Next was the presentation of the Citation in the traditional ' Shawl and Sreephal ' way, by the Alumni Club Thane.

Dr. Pawar told about the rowdy parties that used to go in the next room and how his balcony and room was literally messed about as on one such party the boys had used it as a toilet, when he was out on duty. He went to Sir to narrate the incident.

He was given a sweeper to clean up the mess and had summoned the other students, who returned and profusely appologised to Dr.Pawar. Sir might have given them the dose of a lifetime in a typical GMCite way.

Dr. Tambe was the other speaker.

Dr. Sushil Shah of the famous Metropolis Chain of Laboratories, spoke about the casual remark that Sir had made to him, that has taken him to these heights.

' Do something different than a routine pathology work. Endocrine Pathology is the future .' This was a chance remark that has made Dr. Sushil so famous and successful.

After a vote of thanks the session ended with the ' always looked forward to ' coctails and dinner.

Polypill

Last night I attended the launch of a poly-pill for the treatment of cardiovascular diseases. The talk was organized by Cadilla Pharmaceuticals at Satkar residency and the speaker was the eminent cardiologist Dr. Dayanand Kumbla.

Most of the patients require multi drug therapy for the control of various problems and they get fed up of popping in many pills in a day. The concept of a poly-pill is to put together many drugs in a single pill for convenience. That is an advantage but I personally have reservations. It is fine for a patient taking these drugs in that particular doses in a fixed combination, but may be incorrect for a generalized thoughtless prescription. It may put an additional burden on a physician to think correctly at the very short time available of writing down a prescription in a busy schedule.

This pill known as Polycap contains Symvastatin 20mg, Ramipril 5mg, Atenolol 50mg, HCTZ 12.5mg, Aspirin 100mg.

Here comes the problem for me and may be for a few fellow practitioners.

Though many studies have been published on symvastatin, it is atorvastatin that has mostly been in use over the past few years. Now rosuvastatin is gaining popularity and will be the future popular statin.

Ramipril is mostly used post episode, more for secondary prevention than for a primary prevention. Ramipril with HCTZ will be beneficial for hypertension control in this polypill.

Atenolol has had its good time and is on retirement. Other beta blockers are more favoured in practice. Due to the side effects of impotency and adverse lipids highlighted during the promotion of Atenolol as a first line treatment for young hypertensives, I never used it for HT control in young people and preferred the other molecules instead. Role of B-blockers post episode is non debatable. Hence use will be mostly for secondary prevention

Aspirin 100mg is fine, but should be used with close monitoring.

All the molecules being in a fixed dose, there is no scope for titration. In a busy schedule, a larger than required dose may go to some patients. When each drug is written separately, we can give a thought to each doses. Secondly, if many companies come out with this concept, there should be a standard drug list in each polypill, or else there will be a great strain on a prescribing physician to remember what drug and in what doses the various pills contain and probability of error increases.

The only positive thing is a convenience for the patient, but a great responsibility on the doctor, hence the use will be very restricted.

Well, only time will tell about the success of a Polypill.

Missed call

Many of my friends and the medical sales professionals who visit my clinic have suggested topics for my blog. They have told me to write about my experiences of the different types of patients and their relatives. The other topic is my interaction with the various types of sales representatives that have visited me in these past 29 years.

I had not given a serious thought, though the topics were simply fantastic, as I have narrated such experiences to many. The only problem is compiling, which I think I should do separately and then compose it perfectly in my simple way to make it interesting. Yesterday there was an incident in my clinic which has prompted me to write on those topics, which I will eventually do. I must narrate that first.

Due to the rush this season, I have started a number system, wherein people can take their token and wait or go home or finish their other work instead, but come back in time for their turn. During my work today, my assistant handed me a note given by one of the patients, whom I know well. On the note was written his wife's name, dates from 24th to 26th August, a reason 'viral fever ' and on the reverse was a mobile number. The instructions given by that patient to my assistant was ' Give the chit to the doctor, ask him to issue a medical certificate for my wife for the dates mentioned and when he finishes give me a missed call, so that I can come and collect it '.

I was thoroughly amused at what people expect a doctor to do in addition to treating them. I narrated this to the next patients sitting in front. They too had a good laugh and said that they remembered seeing him rush in the clinic to meet my assistant, ask for a paper, hurriedly scribble something and barge out. After an hour or so, as my door opened to let the next patient in, I spotted him standing gesturing to me if I had finished with the certificate. I just called him in, wrote it and handed it over without losing my cool.

This incident has prompted me to now write about my varied experiences with patients and the Medical Representatives.

Ganapati Bappa Morya

Happy Ganapati festival to all !!!

As I am writing this post I realized that it is almost 2 months since I have visited my blog.

I thought that this post must go on air now before the ganapati visarjan [immersion] day arrives, which is on the 3rd September. I must show off my creativity of my annual Ganapati decoration . The theme was the Bandra Worli sea link. This time of the year is always stressful, monsoon being a season of sickness, this year particularly being more special in view of the H1N1 scare in addition to the other inevitable stresses of life.

This year we decided to be a bit more environment friendly and did away with the use of thermocol in the decoration.

We used a lot of card paper, water colors and color pencils. Shami was a big help in the painting.

She is good at painting and has a very steady hand when doing thin lines, as she makes greeting cards all by herself for different occasions for relatives and friends.


I have realized that this work is a great stress buster. I was on the verge of giving it up as it was difficult to find time and the right mood to apply my mind. Some inner strength pushes you to take up the paper, scale and pencil and the plan that is already made begins to unfold before your eyes. As the work progresses the mind is totally engrossed in what you are doing and when it is completed there is a great sense of achievement and you thank yourself that because of this assignment your mind was off things that were bothering you at least for that period.

Shami's note ---

A few days later we went over this link by chance. We had gone to the airport to see off Rahul for his 4.15 pm flight to Hyderabad. After dropping him off we reached the junction to the Western Express highway near Sahara Star Hotel. Ajit asked me and Supriya whether we should go via Andheri Powai or via Sion Dharavi as we had come. Both of felt we should go via Powai, but before we could answer, he had steered the car towards the left and we had to go towards Bandra. We were a tad disappointed to go back the same way.

But then Ajit said shall we go and have a look at the Bandra Worli sea link? We jumped up at that. Very eagerly we made our way over the rarely used (for us) Prabhodhankar Thackerey Flyover towards Mahim causeway and zoomed over the S.V.Road on to the otherside towards the sea link. We were very excited thinking back over the inauguration ceremony we had witnessed on the television barely a month ago. This is where the VIPs were sitting and so on when we came to the toll . We went past it and on to the link. Ajit took us very slowly so as to take in as much of it as we could and also to make the Rs.75/= return toll fully worth. We could see the various landmarks like Mahim causeway, Hindula Hospital building and Dadar choupatty as we travellled towards Worli.

In no time we were at the other end and then on our way back. This time the sea on our left.We returned to Thane feeling very happy, and proud that our engineers had made such a beautiful masterpiece for the country.

Manas Jain Mandir

Two years ago , on my return journey from an overnight stay for a seminar at Manas Resort Igatpuri , one of my doctor friends , Dr. Mohan Ahuja talked about this mandir . He was insisting on having a look as it was still under construction , though we were all keen on returning home . We took a detour off the highway on the right about a km in .

What a sight it was to see the beautiful Mandir on a small hillock , there was greenery all around, skies were overcast and a there was a drizzle to welcome us. We planned to come again and see in detail as we were not keen to spend more time there.

It was after two years that we made this trip on 13th June during Rahul and Jean's visit.Before we left , I checked up the exact location on Google maps as I was vaguely but wrongly remembering that the turn was immediately after coming down the Kasara Ghats . It was good that I checked up the location as the mandir is just before Shahapur , when going towards Nasik , near Asangaon station and the Kasara ghat is about 20 kms beyond. It is about an hours ride from Thane --50 kms .
[ The Main Entrance -- front view ]

[ The rear view of the Mandir ]

Lot of changes were noticed since my last visit. Work is still on but it seemed the major structures are done . I had read that it is the second largest Jain mandir in India .


[ The Kshetrapal of the Mandir ]

View of the Dharmashalas [ hostels ] for devotees



A sunset view of the Mauli Mountains --a favorite spot for trekkers -- in the background of the temple complex .