Everyone is a Diabetic..!

Though I had to read extensively on Diabetes Mellitus as a part of my undergraduate curriculum, it wasn’t until my internship days that I understood it better. You may find diabetics in almost every ward in a hospital but surgical ward is where you find them perceptible. As I began the surgical dressing of a Diabetic Foot Ulcer, that had awfully occupied the entire heel, I wondered why the patient came to the hospital so late. I mean, such a humungous ulcer doesn’t develop overnight. Why could she not seek a medical attention when it was embryonic? She replied, “I was not aware of that!”

Diabetes, a disorder of the carbohydrate metabolism, is described by some authors as “poverty in excess!” because though the glucose levels are high in the blood, glucose cannot be taken up by the cells and used. Spare the insulin-independent organs like Brain and Red Blood Cells, all other organs are starved! So, you see the muscles getting atrophied, the person becoming too weak to fight a trivial injury and succumb to horrendous infections thereafter. Also the unused glucose undergoes an alternative metabolic pathway (non-enzymatic glycosylation) which yields toxic metabolites. Hence the retina gets damaged, the kidneys are affected and the nerves can no longer do their job (Diabetic Neuropathy).

There are sensory nerves collecting the information from every millimetre of your skin. So, you feel the touch, pressure, vibration, temperature and pain from every square mm area of your body even if you can’t see it with your eyes. The moment something hurts you, you are aware of that and you give your attention to that. That’s not the case with Diabetics. They aren’t aware of an ulcer developing in their foot (unseen area of the body) until it goes on to smell badly.

Awareness! That’s the word that churned my thoughts on this appalling disease process. Take a look at the emblem of Karnatak University. It says – "Arive Guru" - which means “Awareness is teacher.” Such is the importance of Awareness. Well, I pity these Diabetics who are not aware of the parts of their body. But they are far better than people who are not aware of themselves! Just like the sensory nerves that pain you but ultimately protect you from developing dreadful complications, awareness or conscience pricks you time and again, and guards you from getting vice.

“A mind which wanders following the objects of desire deludes the intellect of the person just as a strong wind that rips off a ship in the ocean” (Bhagavad Gita 2.67). They are people who are at the verge of their extermination. If at all one could take a photograph of the mental status of such people, I am sure it would be more outrageous than this Diabetic Foot Ulcer.

But why in the first place one loses his awareness? Well, just as diabetics develop neuropathy as a result of uncontrolled blood glucose levels, one loses his intellect as a result of uncontrolled debts of Karma. The disciplines of action as described in the Karma Yoga are very much similar to the mechanisms of Glucose Homeostasis of our body. And that is why the pathology of Diabetes closely resembles the moral instability as per the Karma Yoga.

The Glucose Homeostasis means maintaining the blood levels of glucose within the normal range. There are many mechanisms by which the body senses the decrease or increases in the levels of glucose in blood and tries to bring it back to the normal range. In other words, the body maintains a perfect balance between the “gain” and “expenditure” of glucose. Similarly, Karma Yoga mentions “accepting” and “giving”. It is our duty to sense the “gain” and try to bring the balance back to normal by “giving.”

This is what the Karma Yoga means by mentioning the "Debts" or "Runas." The five debts according to the Karma Yoga are -

1. Debts towards Inanimate Nature (Deva Runa)

2. Debts towards Other Animals and Plants (Bhoota Runa)

3. Debts towards Parents and Ancestors (Pitru Runa)

4. Debts towards Society (Manushya Runa)

5. Debts towards Teachers (Rishi Runa)


So, the “work” or “Karma” we do should be directed in these directions. The Karma Yoga stresses upon clearing these debts so that one becomes free and attains salvation. That goes on to say that we are already in “debts.” Only Yajna (fulfilling the five debts); Daana (contributing more than consuming) and Tapas (stretching the limits and self-improvisation) purify the men of wisdom. (Bhagavad Gita 18.5)

Just as a physically healthy man maintains his blood glucose levels within normal range irrespective of the type and quantity of food he eats or the stressful situations (infections, starvation etc…) he undergoes, the “Sthita Prajna” or the “Yogi” maintains his mental calmness irrespective of the situation he is into.

“Sufferings don’t perturb his mind, He does not cling on to pleasures, He is free from attachment, fear and anger, and He is called a Sage of Stable Wisdom.” (Bhagavad Gita 2.56)

I don’t think we are the “Sages of Stable Wisdom” but we can always strive to be so. That is why I said in the beginning “Everyone is a Diabetic!” Now, the choice is ours – we can either struggle to get our glucose back to normal or go on to lose the sensation sooner or later and develop Diabetic Foot Ulcers!

Funny bone

The kind of posts I am writing makes one wonder if I am totally a serious guy; which I am actually not. Humor is a part of my life - something that keeps me cheerful all the way. Recently, I laughed out more than usual because of a real life incident. Almost everyone bursted out into laughter as I shared the experience and a few felt I should blog it to reach more people. And that's why this one..

It was just another day and I was chatting with my brother who is in UK. Incidentally, one of our cousins came to see him and I said hello to him. He has a daughter aged 3, who has been to India just a couple of times and I had seldom met her. So, the first time we saw each other was on a WebCam.

Though Bhanavi is her name, she feels good when someone calls her "Naughty-Bhanavi"; and she just keeps on exploring ways to make people call her that way reflexly. It took some time for her to get acquainted to me, after which she fluently unfurled her pranks. She sang a few rhymes, played with crayons, danced a bit and showed me a few pictures of animals in her books. One of them was a Starfish. I asked her, "Where do you find a Star?"

She didn't have to think much. "Sky," she replied.

"Where do you find a Fish?"

"Water." She took much less time for this question.

"So, where do you find a Starfish?"

But for the earlier questions, she would have replied instantly. She took some time and replied confidently, "Water!"

I wanted to pull her legs. "If Star is in the Sky, Fish is in the Water, then, Starfish has to be in between - on the Land, isn't it?"

She didn't seem confused at all. She was confident with the answer she gave, yet, she could not convince me. She tried her best but I stuck to my question expressing my dissatisfaction to her answer.

She turned to her dad. "Papa, the person we are talking to... Does he really exist or is he only in the Computer?"

This time, her daddy and I found it hard to convince her!

Darwinism

It has been a long time since I saw a Kannada movie by name “Gouri Ganesha” but I keep recollecting certain sequences from the movie again and again. Not because it has some unparalleled comic scenes in it but because it gives a moral in the end. Those of you who have missed the moral or have not yet seen the movie, please go watch it, it’s worth it. If you aren’t familiar with Kannada language, I pray someone comes up with English subtitles or a remake of this more than 15 year old movie!

Let me brief up the story for you. The story revolves around an intelligent unemployed bachelor struggling to make his living in a metropolitan city. His cunning wit not only helps him cheat people and earn him that day’s living but also gets him caught time and again for his pranks. Next, he moves around the city in search of a new scapegoat only to get caught again. The story gets good momentum when he finds the diary of a deceased damsel in a mortuary and gets to know the intricate details of incidences in her life and persons behind her sorrows. She would have had escaped the clutches of three men in her life to remain chaste but ultimately would have failed to sum up the money required for the cardiac surgery for her illness which would have claimed her life. But the men are under the delusion that she isn’t chaste. The protagonist uses his resourceful wit to create a fictitious son for her and each of the three men believes themselves to be the biological father of that child and sends money to the protagonist assuming him to be the caretaker! The fixed monthly income solves the basic problem of the unemployed protagonist and things turn out to be favourable until a day when all the three men coincidently visit him to meet their sons. The movie reaches the climax when they all find out the truth and attack him. The protagonist confesses that he lied to them but he justifies it by saying he did it for his living. He then questions them, as to why is it that they believed him and sent him the money. They turn speechless. He ends the drama by saying; they were cheated because they had in them some weakness and their weakness was their lust. Also he urges the audience to correct their weaknesses, for as long as one has a weakness there are always guys like him to exploit it!

How meaningful it is! But the irony is that most people fail to take the moral of the movie and keep getting into troubles. You know how? Surf some Indian news channels at night (local time), and I am sure you will find some “Crime Stories” being aired. People watch them but they don’t learn anything from them. That is why most episodes have similar crime sequences! To illustrate a few, some stranger goes to a village and promises to double any amount of money given to him within just six months. He does so for a couple of months and sets the final trap. One fine day the stranger vanishes with a huge amount of money and people find the truth a hard pill to swallow. Viewers often tend to blame only the cheat and forget that it was the greed of the cheated that got them into the scandal. What’s worst is some people get cheated by the same person again and again. That reminds me of a proverb: “If you are cheated by the same person twice, then probably you deserve it!”

Well, if you observe closely, there are many incidents happening around us (or with us) that work on this “Weakness” principle. The stock market gives a huge return to some investors and that always comes at the cost of many people losing their investment. The gamble here is partly luck and partly intelligence. One who has the right information of the share market invests cautiously where as the ignorant erratically loses the gamble. This can very well illustrate that knowledge is strength and ignorance is weakness and wherever the weakness is exposed, it is exploited!

Now, who doesn’t have weakness? Well, in some way or the other, everyone has! I mean everyone. The rich? Yes. Richness is their weakness. Anytime, anything can happen in business and the equation may all of a sudden reverse, turning people from riches to rags. Same is the case with politicians. One defeat in the elections can push them to dark. Celebrities? Yes. A couple of flops in their endeavours can make the public forget them. That’s why you see those celebrities, politicians and business executives so very generous (?) when they visit Thirupati! The astrologers are intelligent enough to exploit their weakness!

If you read the Hindu Mythology, there are several instances where demons perform penance and get extraordinary boons from Gods and Goddesses and misuse the powers. The Gods then struggle to sketch a death plan to end their tyranny. For a moment, I wondered, why do the Gods grant them those boons? It is because, even God has weakness! Yes, goodness is God’s weakness and the demons exploit it!

Ah… when God himself has weakness, who else is spared? Practically none. Everyone has an element of either Greed or Lust or Anger or Jealousy or Ego or Pride. Sit back and reflect upon yourself. I am sure; you will discover your weaknesses. You need not feel bad about it. In fact, you should be happy that you ‘discovered’ it. Some weaknesses can be overcome. This is where a ‘Guru’ (teacher) or the company of good people can help you. And some weaknesses cannot be overcome. That is where you need to use your intelligence to hide them. Remember, there is a proverb, never show your enemy where you bleed.

As Charles Darwin puts it, there is struggle for existence at all the strata of life. One’s strength is another’s weakness. The lion’s power is the deer’s weakness. The deer’s amazing speed is the lion’s weakness. In the end, Darwinism says, “It is neither the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” Wow! Look at his prophecy! He just summarises the whole essence of life. The humans struggle against bacteria. The bacteria struggle against the human immune system. Humans through their intelligence found out antibiotics. If ‘intelligence’ alone were to be the criteria for the ‘survival of the fittest’, there should have been no harmful bacteria. But look at the nature. The bacteria are responsive to change! They develop alternative biochemical pathways once their niche changes and that’s what we now call “Antibiotic Resistance.”

So, whether you are mighty or weak, intelligent or dull, rich or poor, human or bacteria, you continue to struggle. As long as you struggle, you live. Therefore, as long as you live, you struggle!

A World without Cancer?

Shortly after I had that dream about Cancer, I was browsing for related details and one such thing worth mentioning was a video on Google videos by G. Edward Griffin “A World without Cancer.” Now, if you are a medical professional, student of medicine or biology, stop reading this, click on the link to see the video and you may directly go to the last paragraph. Griffin has got to tell you a lot. If this topic seems completely foreign and uncomfortable, then go on and read. I have tried to put Griffin’s words for you concisely.

Griffin has challenged the long stood belief of the medical fraternity that Cancer is either due to defects in Genes one carries or Carcinogens or due to both of them, each one contributing to the disease. He upholds Dr. Krebs belief that Cancer is a Nutritional Deficiency Disorder and can be totally cured if the missing nutrients are supplied. To illustrate, you may be familiar with simple iron deficiency anemia – you take dietary supplements of Iron for a few months and you will be cured of it. Dr. Krebs believes Cancer can also be cured by dietary modifications and vitamin supplements!

Griffin illustrates a few examples from history on how Scientists were condemned, ridiculed or executed for proposing theories that contradicted the then believed ones. He says he is also aware of the fact that the execution in the present day meant a ban on the license and practice of a physician (“professional death sentence” so to say) but in the interest of Humanity he claims he is propagating the idea.

Coming to the science of it, Dr. Krebs says cancer is a result of deficiency of a nutrient called Vitamin B-17 or Amygdalin or mendelonitrile beta -D-gentiobioside (natural product) or Laetrile (synthetic form of B-17). The dietary sources of Vitamin B-17 are the seeds of apple and apricot and to a reasonable extent millets and others.

The possible mechanism of its action is described by the Enzyme theory. Let me remind you once again that Enzymes are Biological Catalysts required to carry out almost all the biochemical reactions in a living being. Also, if you remember, Enzymes and their Substrates are very Specific in their interactions and they fit each other like a Lock and a Key (just to illustrate the specificity of their interactions). Now this Vitamin B-17 is believed to contain a Benzaldehyde and a Cyanide group in its chemical structure – both of which are highly toxic to human cells. All “normal” cells contain an Enzyme called ‘Rhodinase’ (protecting enzyme) which prevents the release of Benzaldehyde and Cyanide form B-17. However Cancerous cells lack this enzyme. What’s more, they contain another enzyme which the normal cells lack – ‘β-glucosidase’ (unlocking enzyme) which unlocks the Benzaldehyde and Cyanide groups from its structure. Together, they are more toxic to the cells than each of them present separately. Hence it is claimed that Vitamin B-17 is Potent, Specific and Safe.

To support the theory Griffin quotes the examples of animals which eat grass and other plant products rich in B-17, Tribal and other isolated populations which consume B-17 rich diet and it is observed that the incidence of Cancer in these populations is very nearly Zero! But they do not constitute a Matched Control to the urban population. You may say, let them breathe the same air we breathe, smoke the same cigarettes and use the same cosmetics we use, and then let’s see! Well, he says, it is observed that the incidence of Cancer among urban population which consumes B-17 rich diet is significantly lower than the other kind. He also correlates the increasing incidence of cancer with the Industrial revolution and changes in the diet of the people.

Then what about the much believed Carcinogens (substances known to cause cancer)? Griffin claims that these carcinogens may just define the site and type of cancer and may just be predisposing the individual but the actual damage is done by the deficiency of B-17! So, can B-17 cure cancer? Yes, he believes, unless it has gone into a hopelessly bad state! Yes, some nutritional disorders are like that. For example, deficiency of Vitamin A causes blindness. It is possible to cure it only if it is detected at early stages. Once total corneal opacity sets in, no amount of Vitamin A can restore your vision. Griffin illustrates the case of a gun shot wound. You may successfully remove the bullet from one’s body, but he may still die, if the Wound caused by the bullet is large! But he illustrates some cases in which B-17 was opted as a last resort, but surprisingly some of them were totally cured!

Explaining the toxic side effects of B-17, he believes that the side effects would occur only when it is taken in such a large dose that even Water or Oxygen would be toxic at such doses. He also compares the ratio between Therapeutic Dose and Lethal Dose (also called ‘Therapeutic Window’) of Vitamin B-17 and that of Chemotherapy. There is a statistically big difference. The cure rates, he claims, are far too high with B-17 than with Chemotherapy or Radiotherapy or Surgery (orthodox treatment).

The next question that comes to your mind is why such an Ideal drug is not popular? To put it in Griffin’s words, “with billions of dollars spent each year on research, with other billions taken in from sale of cancer related drugs and with vote-hungry politicians promising ever increasing government programs, we find that there are more people making a living from cancer than those dying from it! After all, the science of cancer is not as complicated as the politics of cancer!”

A commission was set up to test Dr. Krebs theory and it was reported that Vitamin B-17 was not at all a drug that could do something to cancer. Griffin refutes that the experiment that lead to the conclusion was not done correctly in the first place. The drug doses and selection of patients was incorrect and Griffin believes that the report was falsified and the members of the commission were frauds.

To conclude, Griffin acknowledges physicians worldwide who came forward to test his hypothesis and give their feedbacks. He ends saying, “just as we are amused today at the primitive medical practices of history, future generations will surely look back at our own era and cringe at the senseless cutting (surgery), burning (radiotherapy) and poisoning (chemotherapy) that now passes for medical science.”

Now let us interpret this theory with an unbiased mind. As Arthur Schopenhauer says, “All truths pass through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” It appears that the theory is in first or second stage. But are we so foolish that in the era of supercomputers and what not, we still are burying hardcore truths like B-17, just for some monetary gain? Well, being a student of science, it’s hard to believe that scientists like politicians can sacrifice humanity for selfish reasons! At least, we can once again put this theory to a Scientific test and interpret it in the light of advanced knowledge. We can subject those enzymes (Rhodinase and β-glucosidase) to extensive analysis using the latest molecular and genetic techniques and see if the claim is right. Well, let us say it is right. Now I am worried about the Drug Resistance! What if the cancerous cells mischievously undergo mutations to alter the affinity of the enzyme and thus escape Vitamin B-17? Or what if, by mistake, a mutation in normal cells can make them susceptible to killing by Vitamin B-17? Well, it is hard to predict all those things with the available data. Griffin may be right or Griffin may be wrong. But let us not behave like politicians; friends, we are scientists. Let us understand, experiment and discover the truth. Truth that benefits humanity – let only that truth prevail!

The night between 23rd September 2007 and 24th September 2007.

I had a weird dream on that night.

I was interning in the department of obstetrics and gynaecology. I had been late to the OT and to my bad luck our HOD had noticed that, lest I was prepared to give him a lame excuse. I cursed my stars and went ahead to the changing room of the Operation Theatre complex. My HOD scolded me and asked me not to enter the OT and that necessary action would be taken later that day. I was just sitting blank in the changing room when a professor entered. He appeared to be in his sixties and measured just three inches above five foot in height. His fingers had gross deformities and I assumed he must be having Rheumatoid Arthritis and wondered how he could perform gynaecological surgeries with such deformities. Strange! I cannot associate this character with any of my real life professors. Yet, he appeared to be very brainy.

As he changed, he asked me, “So, you are good at mathematics?”

I was hiding my ignominious face and so, I just nodded in silence and tried to avoid any eye contact with him. “Then, tell me, what is Cancer in terms of mathematics?”

I was surprised at his question and reflexly looked at him. “What? In terms of Mathematics?” I retorted interrogatively. He nodded and continued, “Yes. How do you explain the growth of cancerous cells and their ability to spread to different body parts, in terms of mathematics?”

“Hmmm… sir,” I appreciated his ability to bridge two entirely different subjects and continued unconsciously. “I think, you can compare it with … factorisation of an irrational number… I mean, just the way, it goes on endlessly…”

“Wow, very good thinking! Come on, change your dress and get into the OT,” he appreciated me and disappeared into one of the theatres, leaving me perplexed in the changing room!

I was even more perplexed when I woke up and tried to interpret it. I could associate only a few components of that dream with my daily events. Earlier that day, I was watching a documentary on Discovery Channel about ‘Greatest Discoveries in Chemistry.’ One of the discoveries that the documentary featured was, the chemical structure of Benzene and how Kekulé arrived at it by interpreting his dream of a serpent trying to catch its own tail. The incident had inspired me to take a rather different approach if I think of making a progress in therapeutic Oncology (that’s my long term career goal and I think about it very often). And later that evening, I was discussing with my brother the achievements of one of my friend. He had put up in his website the methods of factorising a number which is nearly 50 or 100 digits long!

Wow… but how can I associate these two things and subsequently both of them with my dream? It is there that I lost the link and hence decided to blog it and let you people do it for me. It has been more than six years since I last did some serious mathematics and now I don’t even remember what is an irrational number, let alone whether it can be factorised or not. It was actually my dream and I pardon myself even if the whole concept of factorisation of an irrational number is mathematically vulgar!