18 October 2019

From the quill of Purnam Allahabadi

(sung by Nusrat Fateh Ali Khan)

“Agar’che kisi baat par woh khafa hain

To achha yehi hai tum apni si kar lo

Woh maaney ya na manaey yeh marzi hai unki

Magar un ko purnam manaa kar to dekho”

Roughly translated (improvements welcome)

She seems to be upset about something
Perhaps it is best to just move on
It is up to her whether to accept me or not
But please try to convince her with all your passion

There is a clever play on the word “purnam” in the end. The last line can mean – try with your “full” force to convince OR try to convince her about “Purnam” – which was the name of the poet. In the old days in that part of the subcontinent, poets often embedded their names in their poems – in a form of copyright protection!

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14 October 2019

The toll that systole and diastole takes

A few weeks back, I had gone for my annual physicals. For some reason, I look forward to this trip. A great chance to meet all the nurses and doctors there that I get to see once a year, go thru all the tests to look at the progress over the years (I have been going to the Emory Executive Physicals for 12 years now – so there are a lot of graphs for me 🙂 ) but the best part is sitting down with the doctor and understand in details how our body works.

This year it was about blood pressure. Before I go any further, I want to add that I am no doctor and a lot of my knowledge is from reading up on the internet (mostly documents from Mayo clinic). So, take this as a neophyte’s journey into understanding how our body works.

That said, one of the challenges I have been facing is sudden change of blood pressure. I have had pre-hypertension for a few years and take a daily dose of the minimum amount Losartan (25mg) allowed. I have kept meticulous records of my blood pressure throughout the day. And you can see clear patterns. The swings are predictable and pretty wide. Initially, I had difficulty convincing the doctor that I had no issue with my machine or taking readings. Till he took the pressure himself this time. Within a matter of three hours, my pressure came down by over 40 points.

That is what got us to figure out a strategy to understand what is happening with the body. Given that I had readings that came down to well within normal limits, he could not prescribe a higher dose. We are trying out some strategies to understand what might be causing this but that discussion led to my inevitable question…

“All this time you told me that controlling sodium is the best way to keep blood pressure under control. I get that. I remember in eighth grade learning that sodium chloride is hygroscopic and every molecule attracts and hangs on to many molecules or water. That would increase the blood volume and put pressure on the vessels.”

“That is accurate”

“But, how is that volume varying so much so quickly for me?”

That is when he knew that we are going to have one more of the “sessions”. He stepped out (my guess is he cleared out his schedule for some time) and then came back and sat down on the computer taking me thru pictures and some literature.

So, what I gathered about blood pressure is fascinating!!

My starting question was “Are there known long term effects of any blood pressure medicine?” (I wanted to focus on that aspect and see if I could take steps to counter that).

“Yes,” he said.

“What?” I asked somewhat concerned.

“You live longer,” he deadpanned! Yes, this is why I look forward to my annual visits.

After about thirty minutes, this is what I understood. If you are an engineer, it will be very easy to understand. Think about the blood vessels as pipes. They are built to carry liquid at certain pressure. Of course, if you suddenly send fluid at an astronomical pressure – it will burst. But if it is slightly higher pressure than what it is built for, it will not burst immediately. Over a longer period of time, the smallest part of the pipes will burst though. And they tend to be in our kidneys, eyes and brain.

But how does medical science control blood pressure?

The easiest – and the first medicine I was prescribed – are of the category ACE inhibitors. To understand this, you have to go back to evolution. When we were hunter gatherers, the brain often had to control blood supply to different parts of the body to focus on immediate preys or a lurking danger. To do this, it would send signals to constrict certain part of the blood vessels. To achieve that, the kidney would release a hormone (called angiotensin) in the blood. The hormones would be the signals for the muscle layer covering the vessel (called white muscle) to constrict itself.

The ACE inhibitor simply inhibits the kidney from producing that hormone. This prevents blood vessel to be constricted and raise blood pressure.

When I started taking Lisinospril (the ACE inhibitor), I started coughing. It took some time to realize that they were connected. But moment that happened, we switched to the next category of medicine – ARBs. Which is short form of Angiotensin Receptor Blocker. Instead of telling the kidney anything, this medicine works by blocking the white muscles from acting on the hormones. As the name suggests, it blocks the receptor signals. That is what I have now (Losartan is the specific one I take).

“My friend Anusuya takes another medicine – which is a beta blocker. How does that work?”, I asked.

To understand that, we have to realize that the blood pressure is not just about the volume of blood or the width of the pipe. How fast the motor is sending the fluid thru is the third factor. If the motor is furiously pumping the fluid thru, it will obviously creating more pressure. And that is what the beta blockers do. They get the heart to slow down a trifle bit. Of course, if you overdo it, there will be other disastrous effects.

There was a fourth strategy medical science takes to deal with specific blood pressure case. I cannot remember that now.

But the fifth case he described was fascinating. This is used mostly by gynecologists. I did not understand the method very well, but the problem is easy to understand. Basically, you are dealing with two human bodies now – the baby and the mother. They have different systems but any medication you put in one is going to reach the other. So, there is a more intricate approach to dealing with high blood pressure expecting mothers. (e.g. you do not want to slow the heart down – it might have verynegative effects on the fetus, as an example).

Later I came back home and was thinking if the body had any natural ability to get rid of extra sodium. Of course, for a person like me who travels five days a week, I must be consuming a lot of sodium – just from the preservatives of food eaten outside. Turns out you can help your body. Caffeine is a diuretic. And that prompts the kidney to dump sodium and water from the body. Tea, ginger and other plants help too. For that matter so does coke. (Coke has other terrible effects).

Which is an irony. I gave up on coffee just six months back. Completely a tea-totaller now (not teetotaller though 🙂 ).

“You know doc, what I am going to do when I take the next year off?”

“Study medicine?”

“Yes”

“Let me know if you need a reco letter. I have had a student who started at the age of 50. She is practicing medicine now.” (My doc is also a prof in Emory).

“Well, I do not want to practice. I just want to learn.”

I came back home – somewhat excited and told Sharmila –

“I want to study medicine after I am done with this job. My doc thought it would be a great idea. I think I should have become a doctor.”

“Yeah! Right!! You would have gone around telling people how to build self driving cars then”.

I was this close to calling my doctor to increase my Losartan to 50 mg!

14 October 2019

Meeting Mr. and Mrs. Jain

This is the second time I met Mr. and Mrs. Jain. Strictly speaking, this is the first time I met Mrs. Jain – but I have seen her once before. It was December 10th, 1976 – a Friday. It was our report card day. We all got promoted to fifth grade that day. Mr. Jain had come to pick up my classmate – Nishi Jain. All I remember is that he had some kind words to say after looking at my report card.

Funny part is that I never went back to that school after that day. Between that day and next school opening day, my dad got me admitted to a different school. That pretty much took away any chance of meeting Mr. Jain again.

Mrs. Jain was a different story. Our school had two buses. One day one of those buses had a mechanical failure. So, the bus that picked me up had to proceed to do the second route – which was Nishi’s route. I remember the bus stopping to pick her up and Nishi turning back to one of the houses and waving. That is how I guessed that it was her house and the lady at the gate waving back at her was her mom. And then there was a very small girl – maybe three year old tops at that time – hanging on to the gate and waving too.

Like I said, these are well over 40 years back! Believe it or not, last week, I got a message from that small toddler that hung from that gate – Supriya – she now lives in Chicago – that her parents were visiting her. That toddler is in the picture below along with her parents!!

I had about an hour between business meetings downtown. That was enough to swing by to say Hi to Mr. and Mrs. Jain. Had a fantastic time reliving the days of the past. Was suitably impressed how both of them have kept themselves physically and mentally fit at their ages!

Looks like they are going to be around for a couple of more months. I have to find some time one of these evenings to spend more time with them!!

12 October 2019

Talking to strangers

Just finished up this book after seeing that Somshekhar recently did the same. Overall, like every other Malcolm Gladwell book, there are a few key points. Some very interesting side facts. And lots of real life stories told in a very gripping way. Devoid of those stories, the net net of his message is about 4 pages strong. If that.

The stories, while initially very absorbing (again, he has a great way of narrating them) eventually became fairly repetitive and a tad too drawn out for me.

The core messages that he wants to deliver are not as insightful as his other books. His basic points are that we are terrible in judging strangers – we let a person’s demeanor color our judgment of their truthfulness, we are too quick to judge others (but never ourselves) and so on. The fundamental issues we suffer from when we judge strangers according to him are:
(*) we default to truth – we believe not because we do not have doubts but because we do not have enough doubts
(*) the illusion of transparency – we overindex on behavior and information gathered from personal interaction
(*) we fail to take context into account (from the stranger’s point of view)

Then again, without these we will not have a functional society either. If we did not default to truth, for example, we will never get anything done. So, in some ways, you are left wondering what to do with what the author is saying.

Now for some interesting side facts:
a. There are tribes in many parts of the world that drink alcohol that is as high as 180 proof. That is near-pure alcohol. They suffer from no social pathology. Now, we understand that alcohol is not a disinhibitor. It merely creates myopia. Meaning we can’t see the long term effect of words or actions. Just the short term ones.

b. When London switched from town gas (other than giving energy at homes, this was also the most commonly used mode of suicide – inhaling the carbon monoxide) to natural gas, the suicide rates plummeted. And did not come back. Implying that suicidal people are NOT determined to commit suicide one way or the other. The tendency needs to be matched with a particular context.

c. Poets have the highest suicide rate (5 times) as much as the general population. They also have far lower life expectancy and much higher emotional disorders than others – even playwrights, novelists and nonfiction writers by a wide margin

Not a big thumbs up from me but you will not regret reading it, for sure.

7 October 2019

A quick puzzle

Two students independently come to the library every day after dinner between 7pm and 9pm. Each stays for exactly one hour and then leaves. At any night, what is the probability that they met? (meaning that both were in the library at the same time even if for a very short while)

6 October 2019

Quintessential Bengali Puja lunch

This diet is not for the faint of the heart.

Luchi mangsho bhaja-bhuji bnodey and pantooa

(Deep fried bread, chicken curry, fritters and other fried vegetables, two different sweet meats – both of which require deep frying)

Nothing has caught a Bengali’s eye that eventually did not land up getting fried. Bengali Puja lunches are nothing if not elaborate cholesterol doling our ceremonies.