Apothecary film review

Malayalam film Apothecary ( drug man ) is a take against corporate hospitals and their squeezing the gullible s .
It is just one bunch of stupid lies taken by someone clearly biased and not serious enough to take a good medical film .
Its about a poor young man who reaches a posh hospital to see the famous neurologist enacted by Suresh Gopi who is portrayed as a mechanical physician who never bothers about his patients finances and is only interested in the medical part of it... ,while his hospital has at its helm a couple of greedy investors who force the doctors to become masked thieves and cheat the patients and force them into clinical trials so that a famous multinational company can make loads of money from the poor patients ,how convenient for keralas philosophy of the poor downtrodden s
the trials are depicted as night mares in the imagination of the director who caters to the crowd in Kerala who throw stones or manhandle doctors whenever they get an opportunity ,
maybe he should have taken Aamir khan as the hero instead of Jayasurya for Aamir with his constant diatribe against doctors in his TV show would have done it from his sodden soul .
The director tries to make it convincing by making the poor patient suffer from Trigeminal neuralgia which incidentally is a face innervating nerve inflamed
this condition is no death knell and its pain though severe can be treated in any good clinic but our director adds a tumor to it to make it serious and Dr Suresh Gopi advises surgery at the hospital with its astronomical costs which the poor family manages to get
there are scenes with a shaved Jayasurya waiting for the surgery which would make his family lose all money
Another scenario injected is clinical trials in the hospital where patients who cannot afford the bills are made to take part against their will and they suffer pain and torture so much so one of the characters even hides in freezers !
what imagination
clinical trials cannot be done without going through ethical committees in all hospitals private or government and these boards have non medical people in it too it also requires due consents from patients and families ,
the director should know that clinical trials are not area committee meets with paruppu vada and black tea

again most of the hospitals in Kerala in Government sectors are capable of handling all major surgeries free of cost or @ to income of patient so why did our patient not go there
the malayalee who falls into all quick money schemes always hesitates to take medical insurance with a small premium
instead of encouraging people to take health insurance and impart good facts the director makes it a melodramatic horror film with the medical men in it depicted as blood sucking vampires !
unadulterated rubbish

Real life hero

It was in late seventies
My second visit to Bombay , todays Mumbai to my sisters house who was married 4 years back I think .
My bro in law was working in Special steels ltd and initially in East Borivilli a busy suburb , later he moved into their factory in Boisar 2 hrs away in Thane district .
The small town was near TAP or Tarapore Atomic Power station .it was picterisque .
I had got down at Dadar railway station .My brother in law Unniettan was in station to pick me up .
After having some food we moved platforms and got into a Gujurat bound express train for travelling to Boisar .
The train was crowded and as it was a distance of less than 100 km one could not reserve a berth .
Somehow as train moved we both got close to door .
This was good as expect for a small bag slung on my shoulder there was no luggage with us and being near door one was better off as one could get fresh breeze .
Slowly we managed to find a perch near step .with our feet dangling we were laughing away on jokes as train sped along the crowded suburbs .
most long distance trains rarely stop in city or suburban stations the next stop was another 45 minutes off and we expected to find a seat inside by then .
All was fine with the world
We really had fun chitchattering and guffawing .
We never expected a couple of teenage ruffians in the door out of the blue .
Most Mumbai trains have such characters who roam around jumping into train at last moment or hanging from it precariously and doing all sorts of juvenile antics .
These two had come from next compartment nimbly jumping in the speedy train holding window bars .
Now the step we were sitting blocked them so we gave them space to move in .
The elder one stared at us as he wanted us to get in and he wanted them to sit in our place which by now was found to be a cosy perch .
My brother in law told him in chaste hindi nothing of the kind would be done the boy started using strong language and threatened us we just ignored him .
Later he just left with his friend to next compartment and we thought all had ended .
We were wrong .
Those were days when Mumbai was gripped with Shiva sena activism and there was a lot of animosity against south Indians .
In the next station a couple of huge thug like men got in and stood around us
The two ruffian boys were with them too they pointed to us
Ye dono madrasi he
The gang leader started his diatribe about how south indians cannot afford to be arrogant in amchi mumbai
After grabbing thier jobs do we want thier seats in trains too he was gesticulating wildly
I was worried as I had heard of such things
We were helpless as the crowd in train would not interfere though they watched the drama .
I was quite as I did not know language and was also frightened
My bro in law too was quite but he was cool and there was no fear in his eyes he just stared back at the fuming fretting guy in front rantling on him .
He never reacted
I tried to whisper to him to apologise or get angry but he did neither but one could make out he was not afraid he was taller and bigger than the thugs but he was no filmi hero to show his prowess and if he had done anything we both would have been lynched by thier followers bound to come .
It was not that all Maharastrians were like this they were very cultured even many in shiv sena were patriotic and had no ill feelings against south indians but the party then did use it for some popularity and the baser elements used it to bully south indians for thier gains .
Sadly we unknowingly got into such a situation .
Things were getting worser as the main thug was getting angrier in the non reaction of his victims
he ignored me and focussed on my bro in law who though silent projected clearly that he was not frightened at all and stared at the fellow with disgust .
He asked my bro in law his surname and to talk in Marathi which my bro in law did with ease he then just removed my bro in laws specs and started twirling it as if throwing it out of door
He said I can throw you and your specs out
My bro in law just looked at him with that I pity you
You fool look in his eyes
He fumed shouted almost punched him
I was really worried for him but he just stared back almost challenging him lets see what you can do attitude
Many eyes were on us as drama unfolded but no one spoke out as all were afraid of such elements .
My bro in law was like a saint cooly looking at the fellow almost feeling sad for him
He tried so many tricks to provoke him to get some fear in his eyes but failed .
Finally he gave back the specs meekly
He then said sorry sir
He tried to shake his hands but uniettan never offered his
Again he apologised and with the others moved off the compartment
I was impressed
My bro in law gave me a benign smile
What a great lesson it was for me
never succumb to bullies
Unnietan today is no more he left all of us but his lessons stay with us still

Andhos cabinet

The cuticle was becoming difficult ,the curve that was needed was delicate and tiresome to achieve Antho was tired
It was raining outside ,no it was  pouring .
He remembered that  he never had lunch today  ,his wife had knocked a lot but he refused to budge from his work ,he stepped outside to light a beedi in the small garden outside the coconut trees and the sunshade above  gave him some cover so he did not become totally wet but still the spattering from the floor made his dhoti a bit muddy ,
he threw his beedi into the rain and  washed his feet in the pipe jutting in front of the door and walked back ,he had to start again he knew he was not satisfied with the curl of that cuticle and he aimed for nothing less than perfection in his work specially this one .

Antho was a well known carpenter known for his elegant furniture items ,
spank cars drove in from Ernakulum city searching for him so that he can make the exquisite and unique pieces he was known for  ,
but that was all in the past for the  last one year no one turned up as Andho rarely stepped out of his house and was stuck in that room with that abominable piece which filled it .
Neighbors had started whispering .
 Mathai the sanitary worker said he had seen a bird flying  out of Anthos  ears one day  !
and that was a sure sign of his becoming loony ,not that he had no reason to become so .

His wife Ely had enough of cajoling him ,
 She too had sat with him and wept for a long time but slowly the routine in life had crept in and she had enough in her hands but Andho never cried ,neither did he talk much these days ,his was just one obsession and he was at it with his hammer and knife most of the time .
 It still was just a hulk and they couldn't get an idea what he was making but it did fill the room more than the grief that poured from him did .

Andhos son the younger one Stanley who got married three years back was living with him in the house ,he had a small child and his wife Rosie was constantly behind the child either running behind his bare bottom  or feeding him mouthfuls of rice ,
Rosie was thin and very fair .
 Up in  the hills where she came from they were fairer not exposed to the harsher sun .
She was from Devikulam near Munnar and constantly complained about Kochis humidity which she found it difficult to cope with ,she was constantly sweaty and harassed and the rains was the only thing that brought a smile to her pinched face ,she hardly gave a thought to her father in law who seemed to be doing something in his room most of the time .A lot of things had happened since he had moved in , her husband Stanley was working as a line man in Kerala state electricity board , his job was on contract and he kept odd times and did some dangerous climbing up lamp posts .
He was never interested in carpentry and wanted to be an electrician but now he had become neither !

He was also upset by his father of late as Andho was not contributing to the family expenses which was mounting as they had to clear the debts from recent expenses  ,
Stanley dreaded to meet Nadar the fierce mustachioed local money lender and his thugs who kept threating him to part with the monthly interests in time .
" Ammachi what does appachan think ? "
 "how long is he planning to be like this he needs to start earning I cant continue lie this Nadar could kill me one day and you will have one more death in this house ,he just stares  at me when I talk to him  what happened to him  ? and your elder son that hen pecked sod  either he is drunk on his toddy or on his wife's bosom  he never bothers about us and how we live
this is unbearable ! "
Andho did hear all this but kept his gaze down on the floor
 the  small crack on the cement floor loomed large in his eyes , have to plaster this he thought suddenly not knowing why !
he again took his hammer to strike home into the mahogany .
how carefully he had selected that wood ,
Jobys shop was not new to him he knew every nook and corner of it and every log there.
 He also knew what he needed the finest of the fine mahogany ,
Indian Mahogany was a prized wood for furniture and one of the best
Joby looked at him
 "Andhochetta what happened to you ?  I know but its so long when do you  start working ?
 there were enquiries now all have come down
 you know times change now there is so much competition  with youngsters with all sort of fancy drills etc who just do things in a jiffy , I know those  just cannot be equal to what you can do with your hands but the market you know  it waits for none ,happy now you thought of working again so who is it for ? got a ready customer  and that too for one made of costly mahogany ?"
Andho just smiled
" Joby I will find the log and cut it but I cant give you the money now after I finish the job I shall "

" Andho chetta not fair , I too have some problems , I almost thought I will take a loan from that Nadar he keeps coming here asking if I want one he knows the banks have turned me down and for all you know it might be his job the wretched greed .
 Chetta you need to pay me at least 50 % what can I do  ?
,Andho just tok off his thin chain with a crucifx and handed it to Job
" Jobby please take this the  rest I shall pay ok ? "
" how can I tell no to you Andhochetta "

So he had pottered around the logs with Nasser and they finally pulled out the log from under a pile carried it to the cutting house and the whole day Andho had spent in cutting it into planks and pieces and   took the logs to his house in a small pick up van and  put it all in the room ,his family watched him happy that he had got some work again
he never answered their questions but started his work immediately concentration written on his face as he drew pencil lines on the wood and sorted them in place this was his job and something in which he excelled .
and so it began the labor of love when he hammered knocked scraped swathed cut made holes smoothened on whatever he made
 slowly bit by bit he proceeded
,he would close the door the moment his job was over as he did not want anyone to have a look at it till finished
 his son also stopped trying to peep as he had enough to think about and was a bit irritated with his fathers strange behavior
Andho would rarely talk to anyone having an occasional cup of kattan or black tea smoke his beedis and once in a day have some rice with fish if his wife insisited he had lost weight he would just grunt and continue his way .

In his mind he could already see how it would shape up ,like a sculptor who sees his creation the moment he sees the stone
Andho had seen the cabinet he planned in his wood when he bought it .

He focused on the filigrees and fine art works ,later he would join the pieces that would be the easy part of course but he took a lot of time on the intricate art work on the borders this is where his cabine would be different from the run of the mill cabinets ,his nimble fingers shaped them from the fine wood which came to life slowly figurines appeared dancing children nimble teens pirouetting their way prancing in happiness it was all in remembrance of the images he had deep in his mind slowly he joined the pieces drilling and nailing them and then cutting the grooves for the glass which he would buy later .
He wondered how as there was no money for that maybe he would just borrow it from Nadar he wasn't worried about anything these days as he only thought of his work and how he would finish it .

he went to Nadar and convinced him to part with some money he needed he knew the interest would be very heavy and was also a bit worried by the sly grin Nadar and his henchmen gave when they declared that they would come for the monthly interests in exactly one month as he counted the rupees .
Andho bought the glass and fixed them now smoothening and polishing was needed he had no plans to paint the wood as he wanted the natural veneer to continue
he also fixed the gold colored knobs and fevicolled some more filigrees into place ,his cabinet was slowly coming to shape like a beautiful model would after the make up
it was a matter of days and he finished striking the last nail and brushing his piece with a fine cloth covered it up ,
his son crept inside took the cloth off  and saw the cabinet
 He stared at it surprised .
" its amazing the best you have made so far whom did you do this for Appacha ? "
"this is not for sale !"
" what and you have spent so much money what will this do in this house and it fills the room too incidentally have you ever thought how you will take this out for you cant use this room if you don't as there is no space for even standing comfortably with this here "
 "why don't you want to sell it ? "
Hhe saw tears welling in Andhos eyes he knew why his dad had built this with so much care it was for his beloved daughter who had left them last year .
His sister had died of an unfortunate illness .
 it started as a simple fever but later she developed viral encephalitis and as she lay delirious in the hospital he had heard Andho whisper to  her in her death bed
 "molle I shall still make it for you and you will be married off in heaven I will make the cabinet for you yes I will  "

 "Appacha I understand ,but we have to be practical we are upto our neck in debts and Nadar has started getting funny ,we need to sell this if we have to survive
she will understand  "

Slowly Andho also knew this was needed and he agreed .
 he knew his daughters soul would be happy he made it for her by now Andho had started working again .

Finally he sold it to a doctor who practiced nearby .
 they managed to cut into pieces to take it out and rejoin it in the doctors dining hall ,

whenever he went to the doctors home he requested to see the cabinet in the pretext of seeing if polish was needed and he would longingly pat the cabinet then

( all names are imaginary the story too is partly imaginary including the photo  ,

the cabinet building after a daughters death and later selling it to me was the only truth here )

Himalayas my tribute

 

 

 

 

 

 

The Himalayas is a range of mountains very dear to the soul of India ,for it was here that noble ideals were nurtured by the innumerable spiritual giants who inhabited its virgin heights and forests ,its magnificence is unparalleled ,its vistas rise above the constraints of humanity soaring into spiritual peaks unsurpassed ,Its geographical vastness is mighty as it extends for vast distances and it peaks soar into heaven itself touching divinity .I have been lucky to visit some places in its heights over time and those experiences have enthralled me and awed me to humility !,be it in snowy Darjeeling with a chugging mountain train hopping along over the quaint Batala loop ,or the winding road along the Teesta river to green Sikkim with its esoteric Buddhist monasteries perched on doughty heights ,be it the frozen Chongo lake 16000 feet above Gangtok where we saw a shirtless swami walking on the icy lake or the Nathulla pass where Chinese soldiers give a friendly wave from their lofty posts ,be it the huge boulders that threaten to decimate ones puny presence along the the treacherous road leading to the Sela pass at 14500 feet or the Tawang valley that quaint little town one stays before pushing on the Madhuri lake where Shah Rukh had frolicked with Madhuri in koyla the film , one cannot forget the hardy trip up to the origin of the river Yamuna gurgling with ferocity as it rolled down the hills to water the plains

 

 

 

 

 

 

 

 

or the oxygen starved holy city of Kedarnath filled with ash covered Naga swamis for whom neither cold nor heat matters ,the enchanting environs of Bhadrinath peak with its steamy hot pools spewing from the fretful and perky Alagnanda river ,be the hidden ribbon of the much elusive river Saraswati flowing far below amongst the hidden rocks and travelling under the bowels of the earth and to effortlessly merge with the Triveni at Allahabad thousands of kilometers away in the plains ,be it the lakshman jhoola of Rishiskesh which gently sways in the freezing winds ,the bright arathis of dusk and flowing lamps on mother ganga in Haridwar ,be it the climbing steps of Vaishnodevi where devotees chant and climb and chant again , or the foggy peaks of Rohtang pass where the snow and ice gives one a bleary visual of the world at large ,be it the elite Doon school at Dehradoon or the snow filled Mussorie hill station where an elderly Ruskin bond thinks and writes ,be it the land of beauty the paradise on earth Kashmir valley the lazy ride in its shikaras in the Dal lake or the boulders in Pathankot over which water tumbles or the tea drunk in the heights of Gulmarg ,,be it the rainy Chirapunjee or the colonial club in Shillong ,be it the army officers mess in Udhampur where we slept like lambs in bliss ,be it the country cottage in the CRPF camp where a log of fire burnt to keep us warm at Patnitopor the temples in Srinagar town in Uttarkhand where we bought coloured stones from gypsies my love for the Himalayas will never die though I had been only to small parts of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 or the oxygen starved holy city of Kedarnath filled with ash covered Naga swamis for whom neither cold nor heat matters ,the enchanting environs of Bhadrinath peak with its steamy hot pools spewing from the fretful and perky Alagnanda river ,be the hidden ribbon of the much elusive river Saraswati flowing far below amongst the hidden rocks and travelling under the bowels of the earth and to effortlessly merge with the Triveni at Allahabad thousands of kilometers away in the plains ,be it the lakshman jhoola of Rishiskesh which gently sways in the freezing winds ,the bright arathis of dusk and flowing lamps on mother ganga in Haridwar ,be it the climbing steps of Vaishnodevi where devotees chant and climb and chant again , or the foggy peaks of Rohtang pass where the snow and ice gives one a bleary visual of the world at large ,be it the elite Doon school at Dehradoon or the snow filled Mussorie hill station where an elderly Ruskin bond thinks and writes ,be it the land of beauty the paradise on earth Kashmir valley the lazy ride in its shikaras in the Dal lake or the boulders in Pathankot over which water tumbles or the tea drunk in the heights of Gulmarg ,,be it the rainy Chirapunjee or the colonial club in Shillong ,be it the army officers mess in Udhampur where we slept like lambs in bliss ,be it the country cottage in the CRPF camp where a log of fire burnt to keep us warm at Patnitopor the temples in Srinagar town in Uttarkhand where we bought coloured stones from gypsies my love for the Himalayas will never die though I had been only to small parts of its great magnificence

Stem cell Transplantation

Iam writing an article on stem cell Donation as there is alot of confusion on this for potential donors
read on
Stem Cell Donation
The term transplant in medicine generally makes one think of organ transplants ,be it a kidney ,the heart ,the liver ,cornea or even hair .but for the last mentioned the rest are highly skilled surgical procedures and has some amount of morbidity ( difficulty )for the donor too .the heart and liver transplants are generally from brain dead individuals and cornea from just dead but the kidney transplant is from live donors and the donor has to live with a single kidney for the rest of his or her life which many of them do so .
As far as stem cell transplant is concerned it is different from all of this ,there is a lot of confusion and misunderstanding the concept of the stem cell transplant among the lay people hence this blog post to clear the air .
Generally stem cell transplants are for hematological or blood cancers and very rarely for solid tumors like childhood Germ cell tumors ,Neuroblastomas ,Ewings sarcomas where the principle is more of a high dose chemotherapy to wipe the tumor out .
Blood cancers like Acute Leukemia's which are refractory to conventional treatments or relapse after those are given the option of stem cell transplants ,the principle is the mutant stem cells of the patient in his bone marrow which continue to produce the Leukemic cells are replace by fresh donor stem cells which are not mutant and this gives a new lease but this is not as easy as it sounds because the transplant itself though not very cumbersome
( Iam talking on the patient only , about the donor I shall tell later so donors don't get worried this has nothing to do with you )
The post transplant period can be quite stormy with two things ,till the time the new stem cells get en grafted the patient literally has an Aplastic marrow ( no or little marrow ) as the high dose chemotherapy or total body irradiation given before the transplant wipes out the diseased marrow .
During this period the patient is ill equipped to fight pathogens that can infect him even normally occurring body pathogens called commensals at the time of no immunity become dangerously virile hence the post transplant period is one where a high level of antisepsis is needed and the patient is in a highly cocooned sterile atmosphere with the staff in protective suiting's and his food made sterile and he is on higher end antibiotics at any sign of infection ,there could be catastrophic bleeds as his platelts ( blood component needed for clotting and prevent bleeding ) also would be down and his hemoglobin levels could be alarmingly low .
Along with this starts the Graft versus host reaction which is the reaction between the patients immune system to the newly transplanted stem cells at times this can continue as chronic GVHD which makes a mess of the patients life though he is cured of his disease so the success rate of an Allotranplant too is only about 40 to 45 % in the best of the centers
The cost of a transplant too is prohibitive in many countries and I can proudly say that India offers the most economic Allogenic Transplants with equally good results compared to any other country in the world .,there are several reputed hospitals in the country that offer stem cell transplants .
Allogenic transplants are also useful in non malignant conditions which are refractory like Aplastic Anaemias ,Sickle cell anameias Thalasemias etc .
Another type of transplant is autologous which actually is different as it uses stem cells harvested from the patient himself to be re infused after he is given high dose chemotherapy ,there is no outside donor here and hence Iam not detailing on Autologous stem cell transplants here .
Stem cell to be transpplanted need to be HLA matched
HLA is human leucocyte antigen
HLA in stem cells of the donors and the patients is to be matched and the more perfect the match is the better the results are
The Best match would be from an identical twin and the next best would be from a sibling .one can see the English movie My sisters keeper where a second child is planned by the parents so that she can later give her stem cells to her elder sister a leukemia patient .
A compatible donor is found by doing HLA-testing from the blood of potential donors. The HLA genes fall in two categories (Type I and Type II). In general, mismatches of the Type-I genes (i.e. HLA-A, HLA-B, or HLA-C) increase the risk of graft rejection. A mismatch of an HLA Type II gene (i.e. HLA-DR, or HLA-DQB1) increases the risk of graft-versus-host disease. In addition a genetic mismatch as small as a single DNA base pair is significant so perfect matches require knowledge of the exact DNA sequence of these genes for both donor and recipient. Leading transplant centers currently perform testing for all five of these HLA genes before declaring that a donor and recipient are HLA-identical.

Generally unrelated donor matches are quite rare and are detected by bone marrow registries where a mucosal swab of potential donors is collected and later matched by computer aided methods
now I come to the main part of this post for this is meant as a post for potential donors
What do donors have to go through ?
is the stem cell collection painful and arduous ?
what side effects are there because of the procedure itself ?
how many days of hospitalization is needed for the procedure ?
what are the long term side effects of donating ones stem cells ?
would one lose ones immunity by stem cell donation ?
these are some of the common questions to be addressed
I will start with the procedure of stem cell collection otherwise called harvesting .
Earlier Bone marrow itself used to be the source of stem cells and it used to be a painful hardy process of bone marrow punctures and syringing out the marrow to extricate stem cells but today those methods are mostly obsolete
today stem cells are collected by a process called Apharesis
,the donor is attached to an Apharesis machine and his blood flows through the machine and his stem cells are separated by means of a technical process where the stem cells are identified and separated out and the amount needed is calculated and it is collected and is stored under maintained conditions .
During the time of stem cell collection there is no pain or discomfort all one needs to do is to relax one can drink a cup of coffee or play with a tablet or watch TV or chat with a friend .

Before collection for a few days the donor is given Granulocyte colony stimulating factor injections twice a day for increasing the Granulocytes and hence the stem cells which are stimulated to come out to the peripheral blood in huge numbers ,the injections are subcutaneous and are not very painful but can produce bone pain as the marrow is stimulated to churn out more stem cells by the GCSF
some may experience low grade fever or shivering which can be easily controlled
once the stem cells are donated the donor responsibility is over and can lead a normal life forever
The stem cell collected is later transfused like blood transfusion to the patient and the patient goes through a very stormy period with potential graft versus host reactions which can be immediate or later and has to be on medications for a long time
The increasing number of donors in a country like India with organisations like Dhatri has made me write this post as donors need to know what they face
i am willing to answer any doubts that might arise in stem cell transplants for donors through this blog or otherwise

hope it is useful
the pictures added are of a patient having Apahresis for his Autologous transplant