Today outpatient had at least 7 patients with #Diabetes presenting with various Ortho conditions .
I am listing some common Ortho conditions which present in diabetic patients . Some may present only as Ortho pathology & alert about possibility of underlying undetected diabetes 1. Trigger finger : the incidence is 3-4 times higher & also can involve multiple digits
2. Carpal tunnel syndrome : the incidence is ten times more , can involve both hands & depends on duration of diabetes too

3 most common deficiencies I see in Ortho patients are
Calcium, Vitamin D and Vitamin B12 , especially in vegetarians . I have listed some foods specifically for them .
These are by no means an exhaustive list but can be incorporated easily in your daily diet Calcium:
Ragi , spinach , curd , methi leaves , moong sprouts , peanuts , Rajma , paneer , milk , til seeds , orange, bindi, drumstick , almonds , soya

#LifeLessons learnt in the last two decades as a surgeon

1. People trust you blindly or they don’t .There is no half way there. It takes time for that totality to come but,it’s worth it . The sad part about trust is once broken it hardly gets mended.The cracks remain for life 2. Your ability to convince people on anything is purely based on what they want to hear . They have made up their mind most of the times . It’s a little push they are looking for either ways . Understand this nuance

#Alcohol and bones:

Everyone knows the effects of alcohol on major organs but very few might know the damage it causes to bones & joints

When young people come with damaged hip joints as shown on X-ray due to chronic alcohol consumption, the treatment options are limited Alcohol affects the bones with osteoporosis & hence fractures
In the joints, it reduces the blood supply leading to what is called as avascular necrosis. This in turn reduces nutrition to the cartilage & ultimately leads to arthritis .. classically seen in hip joints.

#MedTwitter
Reaching out to all med students to do something more in times when classes stop due to lockdown

Also to build up your resume & have an edge when you apply for programs abroad n widen your horizons in clinical knowledge n skills

#Thread on non core opportunities 1. #Coursera
It is the world premier learning platform for “MOOC”(Massive open online courses) which brings online educational contents from the best of universities. Online courses on clinical research,emergency care, bioinformatics,public health, data science etc are available

#ToolKit for #MedicalEmergency @ home

Sunday started as usual & I thought it would be a relaxing day .After the coffee (which I posted) ,I received a call from my brother in law that my mother is semi conscious & complaining of chest pain. The whole world stopped for a moment . I did a video call to see her & I saw my dad,sis ,BIL panicking. I really had to calm them down,ask my sis to check my mom’s BP n pulse , & give a sublingual nifedipine . I quickly had to find my cardiology friend ,check the nearest hospital he visits & finally take her there .

#orthoTwitter
Don’t massage an injured #Elbow

The elbow is a quirky joint & sensitive to injury/immobilisation/ insult & responds by throwing extra new bone called heterotopic ossification(where normally bone shudnt be present)There are many theories explaining why it happens One practice we see is patients approaching native bone setters for their injuries who massage the joint which leads to exuberant new bone & stiffness. Even at home people apply oil massage when there is injury which is not good for the joint

#orthotwitter
#Amputation is a life changing experience, especially involving thumb/fingers.Most important step is to transport the amputated part in a correct way in order to suture back(Replantation)
We get queries from local practitioners & remote places as to how to send it Often the part reaches in a bad state & is difficult to salvage it as the tiny blood vessels are not viable for restoring circulation.The most common mistake is dipping it in some solution (saline/ water/ Iodine) or putting it directly in ice which is to be avoided.
#medtwitter

Thread on #HumanBehaviour
When the couple entered my room in OPD, I could make out that she was agitated. She was trying to pull her mask down to speak to me, probably to show me her emotions. I asked her politely to wear the mask & tell me what happened. Her husband was operated in a outside hospital 3 months back for a fracture. He has been having pain since then, not able to get back to work which worried her. Her main query was whether the surgery was done correctly. Her husband kept telling her it was alright and not to worry

#uppittu ( Upma if you want to be stylish😀)

The magic of Rava ( Suji) transforming to uppittu before your eyes is magic ❤️

In my personal opinion, the satiety factor of uppittu is next only to rice for a South Indian🙂

My learnings for making this humble but royal dish are 1. Take time to roast the rava ( Bansi/ Bombay rava) to get a good texture
2. Give adequate time to roast each ingredient during initial seasoning ( mustard, dals, ginger, onion)
3. Light fry the onion till they become translucent only. Retain their juiciness. Don’t brown them

A #thread on paradigm shift in Indian medical education

How many of you doctors entered the hospital in the first week of joining MBBS, met clinicians, joined rounds or entered operation theatre or a clinic? It would have been at least a year & half before we did such things The new curriculum involves a foundation course which has a component called 'Clinical shadowing' in the first week of them joining the course. It is an interesting concept which none of us have experienced among the old school doctors or even the batches which did MBBS recently

4 types of learning
#MedicalEducation now teaches about learning from teachers,self directed learning,peer learning & lifelong learning.This has been explained beautifully in this shloka long ago

आचार्यात् पादमादत्ते पादं शिष्यः स्वमेधया ।
सब्रह्मचारिभ्यः पादं पादं कालक्रमेण च ॥ One fourth from the teacher, one fourth from own intelligence,
One fourth from classmates, and one fourth only with time...

Not necessarily that one fourth should come from each of these, but is based on any individual’s capacity to absorb from each of these sources

#SundayMusings
Parents left to Bangalore back today .. It’s a heavy heart for all . Few thoughts on parents in their old age , especially when you meet them after almost an year

Dad has definitely slowed down compared to Mom.. His walking, his reflexes etc. I realised how thin our patience is with elderly people. It took me couple of days to adjust myself to their speed & not become impatient , especially when we travelled out. We need to slow down for them n remember our own kids when they were tiny. Parents become kids again

It was 2.45 pm today when we finished lunch at Kamath restaurant at Murudeshwar on our way back from Goa. I had a splitting headache & badly needed a coffee. The waiter said no coffee at that hour. I came to pay the bill n saw this old man at the cash counter sipping coffee I just smiled n told him I was refused coffee n there he was having it . He gave a smile back n said they have just put the fresh decoction into the filter n it will take some time . I went to wash my hands n then returned to pay the bill.

#VIPsyndrome: A syndrome in medical field where something goes wrong somehow with "VIP" patients..

I am sure many of us have come across this phenomenon where some sort of complication of varying degree happens in patients who come with that tag /1 These can be of various categories
1. Real VIPs in your practice ( mostly hospital staff/celebrities/politicians)
2. Those who come with a heavy recommendation
3.Those who are closely known to you ( family/friends)
4. Medical tourism related /2

My perspectives on our #Indian #Postgraduate #education

Once upon a time was an era of multiple entrance exams, quota systems, paper leaks,obnoxious capitation fee etc which have been largely controlled with more transparent systems now. /1 I won’t deny that they don’t exist in their own mutant ways even now. But It’s much better than two decades ago.
Coming to the students per se, we know that internship has almost become a formality now except in few colleges./2