Category Archives: smoking


The title of this post could have been “What I have been up to to have stopped blogging for so long”. Since I wasn’t sure whether, in the title, I could put into two to’s together, I desisted.

Whew. Life has been hectic, lemme tell ya!

I have been operating a lot, including some pretty difficult cases. Some sad, like a thirty year old girl who had advanced rectal cancer. I knocked off her left colon and rectum along with her uterus. She’s not gonna live too long, though chemo would give her some years, hopefully. She glares at me so angrily (she has a temporary colostomy) that I asked her, “Do you hate me, or you just angry with me?” She burst into tears and wailed “I am so scared!” I felt like a narrow-minded rat. Peculiar, that. Rats would have narrow minds and hinds, too, wouldn’t they?

On top of work, I have changed my life quite a bit without any New Year resolutions.

*For one, I have totally quit smoking, like Shane Warne has totally quit cricket and SMS-sex. The girls who have visiting rights to my mouth say they wished they could move in permadently. If you can stomach this gummy and toothfool statement.

*I eat only one sweet a day, rather (inversely) like an IPO attracts one customer a day.

*I eat rakshashoid portions of veggies and fruits daily, rather similar to the reserves of love that one of the Thackerays has for the Biharis, Gujaratis and Madrasis of Mumbai city. See pic of subject’s breakfast, for example, weighing around two pounds.


*I do an hour-and-a-half solid gym workout six days a week. This is, I notice, the exact time the guys who kill chickens (cullers, not killers) must be spending a day doing their work. No wonder, West Bengal and its contained bloggers are protein-starved and liable to be renamed Beangalis. The punned plant product being the main source of amine nitrogen in our diet in these days of the H5N1 virus.

*I cooked a very elaborate Chinese dinner one evening, but the flavors fell flatter than my puns.

*I research a bit on what is happening to the stock markets, preparatory to investing a bit of money when the market is down. So far, I think I have invested more money than I ever knew I had earned. Which means about as much money as an Ambani’s driver makes in a month.

End of story. All of this would make it next morning already. 7am, and work starts again.

Net net (as the corporate and CNBC-types say so irritatingly): aforementioned blogdoc is lighter by 4 kilograms in two weeks, plenty of muscle fibers showing, belly flattening, preparatory to the development of the imaginary six-packs. Only my shaven head (another new development) prevents the chicks from accidentally falling on me, lips locked to mine.
I am, of course, poorer now, and very blogopenic (Greek penia=lack, poverty).

Do accept my genuine apologies for not blogging, and for not visiting. And for the ladies who are not falling for me now, I have this to say: “The weight will be worth it!” I think the Emaar-MGF (also called the Bimaar MGF) IPO-wallahs will be saying more or less the same thing, as they nurse sore backsides from the kicks of the non-paying public.

(Oh, this post is dedicated to Geetha for being so sweet!)


Indians, I have long worried, have a strong tendency to be against individual freedom. In the past, many assaults on liberties have taken place, some even enshrined in the Constitution.
Today I learned that Delhi University, including its Student Union, has banned smoking within its campus. Students will not be allowed to smoke in colleges, and on roads or anywhere else. Anyone caught smoking will be considered to be breaking the law, and fined. I suspect the laws also have imprisonment as one of the consequences for repeat offenders, but am not sure about that.


I was taken aback at the virulence on the faces of some of the students campaigning for the ban. It seemed that all of their life’s problems would be over once smoking got banned. There were hardly a couple of feeble voices crying out for individual liberty and freedom.

Of course, I have discussed the issue of non-smokers’ rights in the past, maintaining that only the owner of a private property can declare his area off-limits for smoking. Otherwise, in public places, there have to be designated areas for smokers.

In this case, students are going to learn early in life the importance of cheating, of concealing truth, and bribing as a way of ensuring their self-interest. The police will benefit financially, of course, as will the media, with new stories to cover.

I can only wail at yet another bastion of individual freedom falling to the continuous onslaught of the control freaks, the Nazis of Correctness. Smokers are the new Jews.

The use of force to implement what is construed as the public good characterises every stormtrooper of righteous intent.

(pic credit:


According to Science Daily (hot off the press):

An extraordinary new scientific study, which for the first time documents marked improvement in Alzheimer’s disease within minutes of administration of a therapeutic molecule, has just been published in the Journal of Neuroinflammation.

Scientists have hypothesized that an excess of a molecule called Tumor Necrosis Factor-alpha (TNF-∝) causes a disturbance in the normal brain functions that are mediated by this chemical. By injecting a substance that acts against TNF, they have dramatically reversed the symptoms of Alzheimer’s Disease within minutes in a patient.

This new study highlights the importance of certain soluble proteins, called cytokines, in Alzheimer’s disease. The study focuses on one of these cytokines, tumor necrosis factor-alpha(TNF), a critical component of the brain’s immune system. Normally, TNF finely regulates the transmission of neural impulses in the brain. The authors hypothesized that elevated levels of TNF in Alzheimer’s disease interfere with this regulation. To reduce elevated TNF, the authors gave patients an injection of an anti-TNF therapeutic called etanercept. Excess TNF-alpha has been documented in the cerebrospinal fluid of patients with Alzheimer’s.

The use of anti-TNF therapeutics as a new treatment choice for many diseases, such as rheumatoid arthritis and potentially even Alzheimer’s, was recently chosen as one of the top 10 health stories of 2007 by the Harvard Health Letter.

Though this paper reports an exciting development in the continued search for a weapon against the dementia that characterizes Alzheimer’s, one of the authors has a financial stake in the drug being used. However, in time to come, more studies will surely be done to confirm the true value of this agent in the management of the disease.

Alzheimer’s disease is a progressive, degenerative disease of the brain (cause unknown, though genetic factors may be at play) that affects normal brain functions like problem solving, memory, etc. The patient ultimately becomes a virtual vegetable.

While many other disorders of the brain (including some tumors) can cause the same symptoms, diagnosis can be established by careful neurological assessment and a special scan called a SPECT scan, among others. SPECT scan is now available in major Indian cities.

Many preventive methods have been recommended, including smoking, eating fresh fruits and vegetables, eating fish oils (with their omega-3 fatty acids), and intellectually stimulating activities like playing chess.

Alzheimer’s has claimed a large number of historical and modern figures. The ‘A’ list itself is exhaustive, including Aristotle, Aeschylus, Aga Khan, Paula Abdul, Neil and Louis Armstrong.
Among several American Presidents, the last victim was Ronald Reagan.



Erectile Dysfunction (ED), originally from the Latin Impotentia coeundi, is one of the major diseases of mankind, and can be loosely defined as an inability to achieve an erection for successful penetration.

In normal populations, the incidence of major Erectile Dysfunction (ED) is 5 to 20%. Even in the young, ED occurs in around 13%, according to a study on boys between 18 and 25 years. This is remarkable, because ED is known to be seen in older, not younger men, as a rule.

One of the most respected and cited studies on the epidemiology of erectile dysfunction is the Massachusetts Male Aging Study. The study showed that 52% of 1,290 men aged 40 to 70 years had some degree of dysfunction, and almost 10% had total absence of erectile function.


A new article in The International Journal of Impotence Research has some interesting things to say, based on a large study on the sexual habits of more than four thousand men, both gay and straight.

Most men in the prime of their sexual lives (18 to 44 years) use no drugs for sex, while some do it for recreational use, and fewer because they need to use them medically.

The recreational use of ED drugs is increasing, and seems to have a negative effect. The study says that, on surveying the participants’ perceptions and self assessments after taking ED drugs, their confidence and performance suffered unless they took drugs again.

As lack of confidence in one’s ability to gain and hold erections has been identified as an important psychogenic risk factor for ED, the findings have important implications. Recreational users of ED medications may be vulnerable to becoming psychologically dependent on pharmacologically induced erection.

Therefore, the young kids out for a trip on Viagra are rooting for trouble!


ED is now more than an andrologist’s way of making bread. It is now a sentinel for a variety of diseases. What are they?

* ED may be the first symptom of coronary heart disease in a young man. In fact, ED is now considered a strong indicator of heart disease, with strong correlation as to severity. In other words, the more severe the heart disease, the greater the liability to be having ED. Men who have less than expected degree of erection, or have it only to lose it midway (lazy erections) are likely to have a cardiovascular cause of ED.

* ED may present in an undetected diabetic.

* It is seen in long-standing smokers, alcoholics (whiskey dick or brewers’ droop), and those with lipid disorders, prostatic diseases, etc.

* Evidence has linked hypertension to ED.

* Drugs used in the treatment of various diseases can also cause ED.



India has been called the country of unconsummated marriages because of the phenomenon of ‘honeymoon impotence’, when ED manifests on the first attempt. Impotence in India is mainly psychogenic, unlike the rest of the world, where three-fourths of cases are said to be due to organic, not psychological causes. Of course, once a man becomes impotent, he suffers enormous loss of confidence and self-image, leading to further performance anxiety. So the psychological overlay (no pun intended, for once) is also visible here.


If you are a man facing ED, the sensible thing is not to hide it, but come out with it to a physician. Screening for hypertension, diabetes and heart disease will follow. Smoking should stop, as should excessive boozing.
Then what?
Based on what is wrong with the patient, the treatment is commenced.
Usually, drugs like Cialis (tadalafil) are the first line of treatment. Among the ED drugs, a lot has changed since Pfizer came out with Viagra. Leftist limpos: please note that Viagra was not invented by a Government pharma company.
Cialis (Tadalafil) is now a preferred drug for ED patients. It works for 36 hours, can be taken irrespective of food, and one does not need to time the drug intake with sex, thereby making for a better experience. In contrast, Viagra (sildenafil) works for only four hours and needs to be taken half an hour or so before sex.
In some cases, the doctor may advise the patient to inject a substance like papaverine or a prostaglandin (Alprostadil) into the penis just before sex. Rigidity is best achieved with injections.
In psychological cases (performance anxiety, depression, schizophrenia, etc.), counselling and appropriate treatment is advised.
Specific cases where the penis loses rigidity due to blood leaking from the veins respond well to vacuum suction devices.


In a small percentage of cases, where there is no response to any of the above, the andrologist might consider implants. These are devices that are implanted inside the penis (and partly in the scrotum). One device (essentially a semi-rigid rod of silicone with metal wires), called the AMS prosthesis, may lead to a permanent semi-erect state. In India, it costs around 60,000 rupees (around 1150 USD). A local version has been made by andrologist Rupin Shah and costs only Rs. 10,000 ($250). The better prostheses (e.g., the three-part inflatable AMS prosthesis) enable erection only during sex (on demand). A pump (implanted in the scrotum) needs to be activated to push in fluid inside an implant in the penis. The implant fills with water, and the penis becomes hard. This costs around Rs.220,000 ($5050).

One problem with the penile implant is that any infection is disastrous, leads to removal of the device, and permanent impotence. Hard luck!

It should also be remembered that any treatment of ED, like drugs or injections, may cause a persistent, painful, permanent state of erection, called priapism. This condition is an emergency.
Unless treated within four hours, it leads to permanent impotence.

To sum up, a man’s inability to achieve a satisfactory erection is not a laughing matter. It may be a sign of serious underlying disease which can eventually kill him.

Note: pictures are mine!


It is two hours past midnight, and you might wonder why I am not asleep like decent people with two brains and one kidney would be expected to. Did I get that right? Whatever.
Well, it’s a longish kind of story, intricate in its human situations. It needed a Tolstoy or somebody comparable to do justice to it, but please make do with me, okay? I will use my special editing and writing skull skill and make it just bearable.


Day before yesterday, I operated on an eighty year-old lady, Dadi, at a posh hospital (called Hippocratic Medical Center) in the grand old city called Unknown. The operation went smoothly, and I, the surgeon, modestly boasted to the two daughters of the lady that it couldn’t have been better done. Period. I am not known for beating about the bush with words. As the girls keep saying, “Give it to me straight and hard, baby!”

Yesterday, the old bird was smiling in delight. She apparently did not expect to survive my surgery. Not one to misunderstand such low expectations as a poor reflection on my reputation, I gave her a dazzling smile, and said she could go home the next morning. Which was today.


This morning, I started off early as usual, for I had a long operating list of seventeen cases, but at another hospital. Happily doing the chop-chop job that characterises the peculiar perversity of being a surgeon, I got a call around noon. It was the old lady’s son-in-law.

“Doc, she is feeling a lot of acid and is puking a fair bit.”
“Hmmn, that is not supposed to happen. Do one thing. Keep her in the Hospital for the day, for I don’t want you to take her home and then have problems. Later in the day, I will come in and look her up. In the meanwhile, let me send another physician to check her up”, I said.
“Okay, doctor.”

I tried calling the internist physician who had been treating the patient as part of my team. He was stuck in an angioplasty, and had loads of work. He couldn’t visit the patient right away, but promised to visit her later in the day.


Shila, the nurse looking after the patient, was a struggling young nurse. With an alcoholic gambler of a husband, she had to earn the bread for her little daughter, and save for her schooling as well. She had got this job of private nurse (where she gets paid for her hours of serving the patient in hospital) with great difficulty. For the few hours since morning that she had been with Dadi, she got paid for a full day. Now she was looking forward to another ‘case’ that would double her day’s income.

Shila did not have much trouble in reassuring the patient and her daughters to take the patient home. She said, “Everything will be alright. I have spoken to your doctor. I have given the anti-emetic as he has advised”.
She called me up and said, “Sir, the patient is feeling much better now. I have given her an injection for vomiting. Her discharge papers are all complete, and if you want to keep her today, she will have to be re-admitted, with extra costs. The relatives don’t want this. So shall I discharge her?”

I was operating while I got this call. I said “If this is what they want, then it is okay.”
Shila got paid twice today.

Back in the hotel (for the family was from another city), the patient continued to get sick, vomiting repeatedly. The family called me, and I assured them I would send my assistant at the earliest. However, with so many cases, he, too, would be able to come in only by late afternoon.


Around this time at noon, Dadi’s eldest son was shot dead. Dadi’s son was a rich businessman with no vices and an obsession to expand his business. In his hometown, he was the target of extortionists and kidnappers. Recently, Maoist guerillas had warned him to pay them three crores of rupees (around $800,000) or he would be killed. He had refused, and jacked up his security. Today, in spite of that, he was shot at from a hand shake’s distance and dropped, all life spurting out from his chest.


Dadi’s family of her daughters, sons and sons-in-law, needless to say, was shell-shocked. Not only was their beloved mother sick, but their own brother and family head had just died a brutal and unexpected death. Very few people live expecting death, very few. Immortality is an invisible stain inherent in human actions and thoughts.

The family privately held a conference, and decided not to inflict the sick old woman with the shock of her son’s death. They decided to leave one daughter-in-law with Dadi, and all of them left for their hometown.


My assistant, Parthiv, went to see her, and called me, giving me the picture of the patient. I ordered him to readmit the patient to Hippocratic Medical Center (HMC). Time: 7.00 pm.

I left my office, finishing off some consultations, and headed towards the hospital. Both Dadi and I reached around 7.30 pm. One immediate problem. The family had left for home in disarray. They had forgotten to keep any money for Dadi’s further treatment. The 40-ish daughter-in-law looked to be a housewife protected by her family from the vicissitudes of city life. I took the responsibility of the admission. My patient, after all.


I needed a set of x-rays, a few blood tests, and most importantly, a CT scan of the patient’s belly to find out what her problem was.

At HMC, the day technicians in charge of the blood and x-ray departments took off by 7 pm. The night duty staff came in only at 9 pm. This two hour gap could not be avoided at HMC because the trade union of the employees was very strong, and had strongly refused to extend their duty hours.

Therefore, I had to wait for two hours for the investigations to begin. I had already started an IV, put in the tubes and catheters that you don’t normally see in the hospital scenes in movies.
Work temporarily over and all alone, I wandered off into the narrow streets of Unknown city. I stopped at a corner tea shop, and had hot spiced tea served in an earthen mug (bhaanr). To keep busy, I bought and lit a smoke. I don’t generally smoke, but now seemed to be a good time. After an uneventful hour of this, I returned and waited for the tests to start.

After another hour or so, the CT scan was going to start now. A full two hours later, the cause has been found. Dadi has a temporary malfunction of her intestines. A couple or more days of treatment would likely see her through.


What struck me today was that I behaved the way I used to as a young resident doctor: taking risks for a patient, pushing the patient’s trolley, drinking tea and smoking (both without count), proffering a bowl to the retching patient, holding her shoulders and back to help her sit up, regularly asking how she was feeling and reassuring her that everything would be alright. She smiled sleepily at me, contented and relieved that she was not alone.

Today, I am reliving this feeling, this rewind of a life long past, and I can’t say I am not enjoying this. A consultant (at whatever humble level I practise) does not get his hands dirty. Today, I am not shy to say this, I had some of her puke on my hands. I must say that I have done far worse: shaved heads and pubes, pushed wheelchairs, got my dress mucked up with blood and pus, and removed thousands of maggots from the festering sores of drug addicts, beggars and alcoholics.

Thinking of all that, I can almost smell the old, smoky canteen of the medical college, and the anorexia which getting dirty used to generate. Today, I am not hungry. I have not eaten all day, and am going to be awake till morning. But I am not feeling dirty.


A new study from India has been published in the World Journal of Surgery. According to the article, eating chili after a piles operation causes burning and should be avoided.
Gosh, my grandmother should have been made an editor of the WJS! She used to say the same long, long before this seminal (no dirty puns in this article, okay?) truth was known to science just back of yesterday.
Ladies and laddas, hear, hear! Here’s ‘ere a frontier study with a lot of Indian charactors: let us all stoke the fire of nationalism from the depths of our bowels without emberassment.

In previous studies on the same lines, it was erroneously concluded that eating chilis did not affect the bum after surgery. Now, says the author, in those studies, there were no Indians involved, that is, the chili consumption was not of the level where smoke detectors go off spontaneously the moment you come out of the bathroom.
Now, after feeding his poor patients three grams (not milligrams!) of chilis every day after piles operation, the author has reached this end-point. After this one, he will sorely be a fumous surgeon Down Under, if not the World Wide Underworld. Imagine how a hero can be tortured, all trussed up to a pillar watching the villain feed chili, flake by flake, to the heroine. It would be such a hot hit!
I am now planning to tailback on this author : I will now do a study on patients who will undergo piles surgery, and, as if my operating on them is not enough of a pain in their asses, I will give five grams of chili each day to one group (the control group), and compare their recovery with the other group, who will be given chili plus olive oil and lemon (maybe give them just my searsome aglio e olio every day without the garlic, for the last would alter the study results). Alternatively, if I get paid enough, the control group could be assessed (remember, I said no dirty puns?) with chili plus Coke.
Here is how my abstract would look on PubMed:

Aims: To reduce the burning after chilirrhoidectomy
Methods: 100 patients underwent chilirrhoidectomy. In the control group, 50 patients were given Coke. Those patients (N=5) who preferred Coke Light were excluded from this study. Patients (N=2) who wanted Vanilla Coke were admitted for Electro Convulsive Therapy in our Psychiatry wing.
Results: All patients who were prescribed Coke had dramatic relief of symptoms.
Discussion: Coke, with its phosphoric acid, citric acid and DDT (among its 112778456 known ingredients free from natural products), can dissolve the capsaicin in the chili….

I, too, would become part of surgical history by proving that Coke, apart from being a toilet cleaning, stain-removing, pest-killing, tooth-dissolving wonder, is also soothing to the burning rectum.
Imagine how cinnamon Coke enemas will help all those patients! It seems incredible that such monstrassly creative ideas are being thrown into the internet for Coke to pick up free and then use for obscene commercial benefits. A bummer of a job, I tell you!
Think about it: a ‘Chillied can of Coke’ could take on a new meaning!

PS- if you need help for piles, chilli out, and read this article of mine.

Want to smoke? Go to hell!

India (and I mean the State) has now determined that tobacco is a vile evil that needs to be driven out of it. I am sure that Union Health Minister A Ramadoss has absolutely purely altruistic reasons for his decisions, and his getting awarded by the WHO for anti-tobacco activities has nothing to do with a desire for more of the same. Now the Minister wants 65% of his male population (the smokers) to come out on the roads, or go home, and smoke. If he had bothered asking the Public Works Minister he would have been warned that there are not that many roads and homes in India to accomodate these many guys. He wants the men to smoke at home, but only if the maidservant (as his employee) permits. Er, what happens if I defy your order, sir?
“All places of work in the country will be declared smoke -free and those found flouting the law will be strictly punished. This rule will apply wherever there are employees working”. Yeah, like how people wanting to smoke in trains walk till the coach where all the Railway Police chaps sit and smoke bidis.
Smoking in public is bad for others’ health, as science says. However, smoking within one’s private property has to be within one’s individual rights, and if there are others within one’s private space, their right to breathe clean air is secondary at that point of time to the right of the owner to allow smoking. The non-smokers have to put up with it, or go to a place which is smoke-free. It is a different thing in a public space. In other words, banning smoking in restaurants and pubs, which are the property of individuals, is violating their rights as individual property owners.
As always, smokers are milch cows for politicians, because women voters will support anti-smoking activities (at least in India, where ladies don’t normally smoke), and revenues from taxation will continue to pour in. It has been proposed to discriminate against smokers for elective surgery in Government hospitals under the NHS, which I have discussed in an article in The Telegraph.
I have no particular axe to grind for smokers, but I am opposed to social engineering by the State anywhere. This is now a holy cow the world over. I have a whacky thought: when man colonises the moon, will smoking be disallowed even in outer space? What about Hell? Hello??