We Canadians

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Niraj Chandra

Photograph by: Pat Mcgrath, the Ottawa Citizen

I had a mini-stroke a few weeks back, followed by surgery to remove an artery blockage. Thanks to the wonderful staff at the Civic campus of The Ottawa Hospital, the entire procedure went very well.

However, sometimes I wonder if the mini-stroke I suffered could have been avoided if a simple diagnostic test had been performed well in advance.

I was prescribed this test — a Doppler ultrasound — after the stroke. It showed that a major artery in the neck was 80 per cent blocked, requiring surgical intervention. Later, other more advanced tests were also done on me to get a better picture of what was happening.

I would like to suggest that the Doppler ultrasound test should be used as a screening tool for early detection of artery blockage. Why wait till a stroke occurs? If blockage is detected early enough, lifestyle changes and medication may be enough to fix the problem. Surely, prevention costs far less than a cure.

Doppler screening may not be practicable for every one, as the costs would be prohibitive. However, it could be used for patients who are at a higher risk due to age, elevated blood pressure, high cholesterol or other medical conditions.

The Doppler test could also be a paid option not covered by the provincial health plan.

I personally would have gladly spent a couple of hundred dollars for this test two years ago. At that time, the blockage would have been less severe and could have been controlled with diet, exercise and medication, saving the health-care system thousands of dollars in future medical costs.

Niraj Chandra,

Ottawa

© Copyright (c) The Ottawa Citizen

In India, many dogs don’t eat meat. They either grow up in vegetarian households or they hang around temples where only vegetarian food  is available.

 However, it is said that of you take one of these dogs and give it meat for a week, it can never go back to  a vegeterian diet. Metaphorically speaking, this is what has happened to Sarah Palin.

She got her taste of meat (metaphorically speaking) when she was selected as the Republican candidate for Vice-President. Everything changed for her after that, as she herself admits. She just cannot go back to her “vegetarian” existence anymore as the governor of a remote US state.

The only real reason why she is resigning from her position is, I believe, to take a run for the presidency; nothing less would satisfy her, now that she has tasted “meat”. She knows it is a long shot but it is a risk worth taking. And strange things do happen in politics. Just a few years back, it was a very long shot for Barack Obama to get anywhere near the presidency but he did it anyway.

Pailin has convinced herself that she is presidential material even though most of the media doesnt think so. She has also convinced herself that the media was biased against her and that she can do  better next time.

There are, indeed, quite a few things in her favour. The Republicans are leaderless right now and Pailin has a high popularity rating within this group. She has a reasonable  chance of winning the presidential nomination for the Republican party. Then she will be up against Obama in his bid for a second term.

Right now, Obama seems to be a formidable opponent. His popularity rating is very high and with his indisputed charisma, many people think he can do wrong. I am personally a great supporter of Obama because deep down, he is a good man. He wants world peace and a peaceful resolution of disputes through dialogue.

This, however, doesn’t mean he will always be popular. He takes risks and if one or two of his policies fail, he could lose popularity very fast. He has to succeed in Afghanistan and he has to restore the economy without over-spending public money. At the same time, he has to protect his country.

If his popularity declines, the Republicans under Pailin’s leadership will be ready to pounce. It is still a very long shot but this could well lead to Pailin being the next president of the U.S.A.

Personally, I dont like this possibility at all but stranger things have happened in politics.

By Niraj Chandra

This is a first-hand account of what happens before, during and after Carotid surgery, written from a patient’s point of view.

There are plenty of web-sites that describe the procedure  but most of this material is  written from a medical perspective and doesnt really describe what a patient goes  through. This account, it  is hoped, will give some guidance to others who have to go through this procedure. But please do remember - each experience will be a little different.

I had some remarkable spiritual experiences during this  journey but I’d rather not discuss them in a public forum like this. Many readers would not believe them, anyway.

Before  surgery

I had a mini-stroke  one month before the surgery date. In retrospect, it was a  mild episode that could  have been much worse. I got up in the morning with a  headache and loss of awareness. I could hardly talk and  my  wife figured out it was something  serious. She called over my son, who lived nearby,  gave me an aspirin and sent me to the hospital in an ambulance. The aspirin could well have been a life-saver, as it thins the blood. I got medical attention within an hour of  the first symptoms. In such situations, every minute is critical. I was very lucky to have a  wife who took immediate care of me.

I spent half a day in the hospital, the trained emergency staff knew immediately what was wrong and one of the nurses even told me right there that my left carotid artery-which supplies blood to the left side of the brain- was probably blocked. I was discharged  and sent home. For the next few days, my speech remained  slurred; other symptoms gradually disappeared. I took  aspirin, cholesterol medication and blood pressure pills to reduce the chances of another stroke; apparently there is a high risk of another stroke in the days and weeks following the first episode.

I returned to the hospital a few days later for more tests and for an appointment with a nerve specialist. An ultrasonic test on the left carotid artery showed it was about 80% blocked.I was booked for more tests and then,  for an appointment  with a neuro-surgeon. I saw the neuro-surgeon at the first available date,  about twelve days after my mini-stroke. He confirmed the diagnosis of a blocked artery and recommended carotid surgery.

He explained the risks involved - a five percent risk of stroke occuring during surgery, since I already had a mini-stroke. There were also smaller risks of anesthetic failure and of cardiac arrest; however the risks of not doing surgery were  higher. Without surgery, I faced a 30% chance of having another, more devastating stroke within the next few years.  With these odds, it didnt take long to agree to sign the consent form. The neuro-surgeon then prescribed more tests including CAT scan using a dye injected into the bloodstream. This test was really cool - the dye felt nice and warm and I could feel it going through the blood circulation system in a matter of seconds.I also got an echo-cardiogram to see how my heart and surroundings were doing.

I got a date for surgery exactly one month after my mini-stroke. In a way, this delay was good - it gave me time to set  my affairs in order. But it was a long one month-I couldnt go to work, I couldnt drive, even watching TV was a bit of a strain. Reading wasnt much fun, either, with, literally, a “deadline” looming just a few weeks ahead. It was a good time for introspection and not much else. To prepare myself for surgery, I did gently stretching exercises every day. My wife and family took real good care of me, making sure I got the nutrients the body needed. A supportive family is the biggest blessing a person can have at at a time like this; I was very lucky that both my married children lived in the same city.

On the day before the surgery, I took a bath in the morning and evening using anti-bacterial soap. I had regular meals thoughout the day - in retrospect this was a big mistake. I should have eaten lighter.

The Surgery Day

The surgery was scheduled for early morning, so I reached the hospital at 6:30 a.m. with my wife and son. On arrival, I was quickly divested of all worldly attire and moved into hospital clothing. No jewellery was permitted -even the wedding ring came off. My family members stayed with me a few minutes and then they were asked to go home. The doctor called them after the operation to re-assure them that everything went well.

 A trolley took me to the brightly lit operation theatre; the operating surgeon met me and said a few words of encouragement. The scariest moment was when other members of the operating team also came over and wished me luck. 

The anasthetist did his stuff and I was knocked out within a couple of minutes. When I regained awareness, the operating staff was all around me. I carefully looked at them - they looked just like normal human beings in normal earthly attire.  This was a big relief; later, I learnt the operation had lasted about four hours.

I was taken to the observation area and kept there till the next morning.  This area was very brightly lit and there was  lots of activity as patients were wheeled in and out after various procedures. As my awareness increased, I noticed all kinds of tubes on my body. There was an intravenous (IV) tube and another for injections and such. There was also a catheter for automatic urination and there were all kinds of sensors attached to my body. The nurse on duty was very caring; she checked my vital signs every hour or so. She also checked muscle strength in my arms and feet. My feet were verycold after the surgery and I asked for a blanket; she put a warm, folded blanket on my feet and it felt like heavenl.  She put an ice pack around my neck; it felt good.

There was very  little pain - just an uneasiness in the neck area where the surgery had occured. I didnt even take a pain killer; there was really no need.

My family came to visit me in the evening; they were not allowed to visit before that and they could stay for  just a few minutes.

The Day After Surgery

Early next morning, I was transferred to my own room. I still could not move much and the  IV feed was kept on for a few more hours. A nurse came and checked my stomach with a stethoscope; when she detected rumbling noises she declared I could now eat. I was given a breakfast with the IV feed still in place; I could eat just a few bites  of the omelet and drink a little juice.

As the morning progressed, the tubes came off one by one - first the IV and then the catheter. The sensors for the electrocardiogram were also removed.

My wife and my son came to visit me; this time they were allowed to stay all day. Having the family around was very comforting. Around mid-day, the nurse assisted me helped me get out of bed. After this, I was allowed to move around a little but it was very difficult because the body was all cramped up from staying in one position. I ate a light lunch and a few bites from my dinner. By evening, the stomach felt very bloated; I asked for a bed-pan but I couldnt use it. Like many other people, I’m not very comfortable with bed-pans.

Throughout the day, I noticed strange sensations around my forehead. If I just closed my eyes, I would see a  red screen which kept getting darker. There would be strange patterns of light but the predominant colour was red. Sometimes, I would see beautiful paintings and landscapes.  If I opened my eyes, the images vanished but when the eyes were closed the images would start up again. This went on throughout the second day making it almost impossible to sleep.

We had a couple more visitors in the evening and it was hard to talk.  Perhaps, I tried too hard because by evening my blood pressure had shot up.

By late evening, the pressure on my stomach was also building up. I went to the toilet a couple of times but it didnt work. Then, late at night I went a third time and tried very hard. It worked, but there was an intense pain in the lower region and when I came out of the toilet I was dripping blood. The bleeding didnt stop and I called the nurse. He turned me on my side and did something; I immediately felt better and shortly afterwards, the bleeding stopped.

Hence my advice to anyone who goes for surgery - take very light meals tha day before, preferably only soups or broths. This will save a lot of pain afterwards.

The Second Day

The second day was  easier. My stomach was totally empty so made myself a cup of tea early in the morning, walking down very slowly to the kitchen area.I was hungry and ate everything that was offered for breakfast - egg, cereal, toast, jam and coffee. My joints were still very stiff but I tried simple execises to loosen them up-getting up from the chair ten times, rotating the legs and walking around the ward. Gradually, the stiffness disappeared. I also did breathing exercises - breathing in deep and breathing out slow, a kind of elementary Yoga pranayam.

The doctor saw me around mid-morning and pronounced me fit enough to go home- the sweetest words I  heard thoughout the hospital stay. He also changed the dressing on my wound and gave instructions on what to do at home.

A short 15 minute ride with my son, and I was home. For the first few hours at  home, I was  disoriented.  It seemed I had the same consciousness but a new body or, atleast, a new brain. The brain had funny sensations and my thought patterns had changed. It took several hours to get out of the hospital mode. I couldnt stand much noise or commotion but it felt really good to be home.

There was some difficulty in swallowing food and I had to take very small bites. Chewing was a bit of an effort and I became a slow eater. There was also some discomfort inside the throat.

I had a mild cough that evening  - just enough to keep me and my wife awake all night.

The Rest of the First  Week

Each day was a little better than the one before. The mild cough persisted for a couple of days and then it just disappeared. It was replaced by a soreness in the throat, around the vocal chords. There was also a  swelling in the throat area.

I was not allowed to shower - the wound area had to be kept dry. I used a bucket - with my wife’s help, this worked quite well.

Exactly one week after surgery, I visited the hospital, as planned, to get the staples removed. In the hands of the experts at the hospital, the process took just a few minutes and it was entirely painless. The wound was left open, so it could slowly dry up.

The Second Week After Surgery

This is where I am, right now. As I write this article, It is exactly ten days after surgery and I have resumed most normal activities at home, including mild exercise, walking, reading, writing, watching TV and even a bit of cooking that I enjoy. Of course, my wife does most of the real chores around the house - I cannot help with yard work, or with mowing the lawn.

Over the next week or so, I hope to get back to my normal working life.

By Niraj Chandra

I had a mini-stroke a few weeks back and, in retrospect, it was  entirely my  fault.

Nature had given me several warning signs over the years that I simply ignored. I did a little yoga from time to time and believed that it was enough to keep me out of serious trouble. Unfortunately, life doesn’t work that way.

The first warning sign was when I was in my early twenties, just starting my first job in Mumbai, India. I was enthusiastic about my work -perhaps, a bit too enthusiastic. I fell sick with a routine fever, took lots of medication, and kept on going to work. However, on the second day of the fever, I woke up late at night and fell unconscious while in the bathroom; I passed out for a few minutes. I was OK by morning time and there was no real damage.

I got the second warning sign about a decade later. Again, I passed out while using the washroom very late at night. This time, the incident was a bit more severe and we had to call a doctor in the morning. He did all the tests, including an  Electro-cardiogram, but he could find nothing wrong. I was fully recovered within a few hours. This was a high stress time in my life as I was contemplating a job change.

The third warning sign came after another decade or so, this time in the US. Again, I was thinking about a job change and there was definitely quite a bit of stress. I passed out late at night while using the washroom and I was unconscious for a few minutes. My wife took me to the hospital and the doctors ran a battery of tests. Nothing showed up in the tests and I was discharged after an hour or two.

The last warning came a few weeks back when I suffered the mini-stroke. This time, I had to spend half a day in the hospital, followed by more visits to specialists and endless tests. My speech was slurred for at  least a week and there were plenty of other serious symptoms.  I had suffered what the doctors call a Transient Isochemic Attack - a TIA. I also have blockage of an artery for which some surgery will be  required.

As I look back, I realize there are so many health mistakes that I have made over the years. I have high cholesterol but I did not take medication regularly, as I experienced  side effects such as muscle pain. I did not take Aspirin pills prescribed by the doctor - I just didnt want to take daily medication. I also avoided taking blood pressure medication; all of these factors contribute to the TIA.

As I review my lifestyle, I notice other risk factors that should have alerted me to the dangers. My lifestyle is sedentary; an engineer by profession, I do mostly desk work including a lot of reading and writing.  At home, I like to read and write and work on the computer, or just watchTV.  I’m not much into sports or physical activities or even  household chores. I like tasty food and there is a food court right below my office carrying all kinds of “goodies”. Over the years, the junk food has  built up as plaque in the arteries. My Body Mass Index is borderline high. About the only redeeming factor is my love of yoga, which I practise as frequently as I can. However, I now realize that yoga practice is not enough unless it is very vigorous and done on a sustained basis.  And even if you exercise regularly, you must watch the vital signs of your body, such as blood pressure and cholesterol.

I have just learned the biggest lesson of my life the   hard way - NEVER, EVER ignore the warning signs of your body.

It is early December and the tourist season should be in full swing but not much is happening in this village in Goa.

Everyone is heavily in debt. Lucky, a rich Russian tourist arrives at a local hotel in this village.

He asks for a room, puts a $20 note on the reception counter, takes a key and goes to inspect the room.

The hotel owner takes the banknote and immediately hands it over to his grocery supplier whom he owes $20.

The grocer rushers to the fish vendor and pays him for the fish he bought that week.

The fish vendor triumphantly gives the $20 to a local prostitute who gave him services on credit.

The prostitute goes quickly to the same hotel and pays for the amount she owed for the room she used to entertain her clients.

At that moment, the rich Russian tourist returns to the reception, informs the hotel owner that the hotel room is unsatisfactory, takes his $20 and leaves.

The Russian spent no money at the hotel but every one has been paid off and the village people look optimistically towards the future.

The Russian tourist could be the solution to the global financial crisis!

Contributed By:Samir Kelekar

Lord Buddha was sitting under a banyan tree. One day, a furious Brahmin came to him and started abusing him.

The Brahmin thought that Gautam Buddha would reciprocate in the same manner, but to his utter surprise, there was not the slightest change in the expression on Buddha’s face.

This made the Brahmin  more angry. He hurled more and more abuses at Buddha. However, Buddha was completely unmoved. Ultimately the Brahmin was tired of abusing him. He asked, “I have been abusing you like anything, but why are you not angry at all ?”

Buddha calmly replied, “My dear brother, I have not accepted a single abuse from you.”

“But you heard all of them, didn’t you?” The Brahmin argued half-heartedly.

Buddha said, “I do not need the abuses, so why should I even hear them?”

Now the Brahmin was even more puzzled. He could not understand the calm reply from Buddha.

Looking at his disturbed face, Buddha further explained, “All those abuses remain with you.”

“It cannot be possible. I have hurled all of them at you,” the Brahmin persisted.

Buddha calmly repeated his reply, “But I have not accepted even a single abuse from you ! Dear brother, suppose you give some coins to somebody, and if he does not accept them, with whom will those coins remain?”

The Brahmin replied, “If I have given the coins and they were not accepted by someone, they naturally they would remain with me.”

With a meaningful smile on his face, Buddha said, “Now you are right. The same has happened with your abuses.. You came here and hurled abuses at me, but I have not accepted a single abuse from you. Hence, all those abuses remain with you only. So there is no reason to be angry with you.”

The Brahmin was speechless. He was ashamed of his behavior and begged for Buddha’s forgiveness.

Contributed by: Yuvraj Bahadur