CASE -7-POWER OF COLOR DOPPLER

CASE-7-POWER OF COLOUR DOPPLER
Mr S ,age 56 years ,male ,presented with pain in Rt lewer limb for ½ hour only. He was not a known diabetic or hypertensive. He used to smoke 10 cig/day –for 30 years.
On examination –pulse-80/min regular,BP-180/100mm,systemic exm-NAD
All his pulses of RT lower limb were not palpable,SLR-negative.Limb was slightely cold than LLL.
CLUE-absent pulses in Rt Lower limb
KEY INVESTIGATION-COLOUR DOPPLER LOWER LIMBS
He had total blockage at RT Internal Ileac Artery
TREATMENT-IMMIDIATE INTERVENTION
Patient recovered completely without any loss.

CASE-6-POWER OF ECHOCARDIOGRAPHY

CASE-6-POWER OF ECHOCARDIOGRAPHY

Patient Mr R ,54 years,Male ,presented with breathlessness on exertion -5 years which has been worsening and has worsened to dyspnoea on rest for 10 days and patient unable to sleep for 5 days. He is not a known diabetic or hypertensive. Smoker with 20 biris /day for last 30 years.No h/o chest pain.

O/E-puse-100/min ,regular,BP-110/80mm ,JVP-raised,oedema-nil, Lungs-few crepts at base.

On investigation-Haemogram is uneventful,Blood sugar-pp-144mg%,BUN-16mg%,S Creatinine-0.9mg%.CXR-mild cardiomegaly,ECG-P pulmonale.

KEY INVESTIGATION-ECHOCARDIOGRAPHY

ECHOCARDIOGRAPHY shows large ASD of 27mm diameter with decompensated heart.

TREATMENT-SURGICAL REPAIR

FOOTNOTE-Patient came to me after surgery touched my feet and said that he could visit  his Fields after 5years and he was now fit as a fiddle.

DISTORTED THINKING

15 Styles of Distorted Thinking

1. Filtering: You take the negative details and magnify them, while filtering out all positive aspects of a situation. A single detail may be picked out, and the whole event becomes colored by this detail. When you pull negative things out of context, isolated from all the good experiences around you, you make them larger and more awful than they really are.

2. Polarized Thinking: The hallmark of this distortion is an insistence on dichotomous choices. Things are black or white, good or bad. You tend to perceive everything at the extremes, with very little room for a middle ground. The greatest danger in polarized thinking is its impact on how you judge yourself. For example-You have to be perfect or you're a failure.
3. Overgeneralization: You come to a general conclusion based on a single incident or piece of evidence. If something bad happens once, you expect it to happen over and over again. 'Always' and 'never' are cues that this style of thinking is being utilized. This distortion can lead to a restricted life, as you avoid future failures based on the single incident or event.
4. Mind Reading: Without their saying so, you know what people are feeling and why they act the way they do. In particular, you are able to divine how people are feeling toward you. Mind reading depends on a process called projection. You imagine that people feel the same way you do and react to things the same way you do. Therefore, you don't watch or listen carefully enough to notice that they are actually different. Mind readers jump to conclusions that are true for them, without checking whether they are true for the other person.
5. Catastrophizing: You expect disaster. You notice or hear about a problem and start "what if's." What if that happens to me? What if tragedy strikes? There are no limits to a really fertile catastrophic imagination. An underlying catalyst for this style of thinking is that you do not trust in yourself and your capacity to adapt to change.
6. Personalization: This is the tendency to relate everything around you to yourself. For example, thinking that everything people do or say is some kind of reaction to you. You also compare yourself to others, trying to determine who's smarter, better looking, etc. The underlying assumption is that your worth is in question. You are therefore continually forced to test your value as a person by measuring yourself against others. If you come out better, you get a moment's relief. If you come up short, you feel diminished. The basic thinking error is that you interpret each experience, each conversation, each look as a clue to your worth and value.
7. Control Fallacies: There are two ways you can distort your sense of power and control. If you feel externally controlled, you see yourself as helpless, a victim of fate. The fallacy of internal control has you responsible for the pain and happiness of everyone around you. Feeling externally controlled keeps you stuck. You don't believe you can really affect the basic shape of your life, let alone make any difference in the world. The truth of the matter is that we are constantly making decisions, and that every decision affects our lives. On the other hand, the fallacy of internal control leaves you exhausted as you attempt to fill the needs of everyone around you, and feel responsible in doing so (and guilty when you cannot).
8. Fallacy of Fairness: You feel resentful because you think you know what's fair, but other people won't agree with you. Fairness is so conveniently defined, so temptingly self-serving, that each person gets locked into his or her own point of view. It is tempting to make assumptions about how things would change if people were only fair or really valued you. But the other person hardly ever sees it that way, and you end up causing yourself a lot of pain and an ever-growing resentment.
9. Blaming: You hold other people responsible for your pain, or take the other tack and blame yourself for every problem. Blaming often involves making someone else responsible for choices and decisions that are actually our own responsibility. In blame systems, you deny your right (and responsibility) to assert your needs, say no, or go elsewhere for what you want.
10. Shoulds: You have a list of ironclad rules about how you and other people should act. People who break the rules anger you, and you feel guilty if you violate the rules. The rules are right and indisputable and, as a result, you are often in the position of judging and finding fault (in yourself and in others). Cue words indicating the presence of this distortion are should, ought, and must.
11. Emotional Reasoning: You believe that what you feel must be true-automatically. If you feel stupid or boring, then you must be stupid and boring. If you feel guilty, then you must have done something wrong. The problem with emotional reasoning is that our emotions interact and correlate with our thinking process. Therefore, if you have distorted thoughts and beliefs, your emotions will reflect these distortions.
12. Fallacy of Change: You expect that other people will change to suit you if you just pressure or cajole them enough. You need to change people because your hopes for happiness seem to depend entirely on them. The truth is the only person you can really control or have much hope of changing is yourself. The underlying assumption of this thinking style is that your happiness depends on the actions of others. Your happiness actually depends on the thousands of large and small choices you make in your life.
13. Global Labeling: You generalize one or two qualities (in yourself or others) into a negative global judgment. Global labeling ignores all contrary evidence, creating a view of the world that can be stereotyped and one-dimensional. Labeling yourself can have a negative and insidious impact upon your self-esteem; while labeling others can lead to snap-judgments, relationship problems, and prejudice.
14. Being Right: You feel continually on trial to prove that your opinions and actions are correct. Being wrong is unthinkable and you will go to any length to demonstrate your rightness. Having to be 'right' often makes you hard of hearing. You aren't interested in the possible veracity of a differing opinion, only in defending your own. Being right becomes more important than an honest and caring relationship.
15. Heaven's Reward Fallacy: You expect all your sacrifice and self-denial to pay off, as if there were someone keeping score. You fell bitter when the reward doesn't come as expected. The problem is that while you are always doing the 'right thing,' if your heart really isn't in it, you are physically and emotionally depleting yourself.

UNHEALTHY NATION

DECEPTIVE APPEARANCE

This is a true incidence narrated 2 me by my paediatrician friend.One day he saw a well built man in his waiting chamber on cctv ,whoo has come 2 show his child 2 him and was creating nuisance for early appoinment.He looked like local goon ,had a gun strapped on him and few chamchas/sidekicks accompanying him.My friend got slightely intimated with him and asked his staff 2 grant an early appoinment 2 him.This became an routine for some time.

One day the child came with his grandmother .My friend asked her about the absence of father of the child and why he has not come 2day.She answered that my son is afraid of UR clinic .I used 2 bring him here for vaccination when he was a child and he is still afraid of those pricks U gave him.He avoids coming here.

SO MUCH FOR APPEARNACES.

MONEY MINDED

There R persons who have only one thing on their mind –MONEY. There thought process is simple n open 2 all. In every topic their interest is only in money. If U bought a item ,gift or house .They R only interested in price. There parameter 2 judge a gift or dress or person is price tag or how much u earn. If U earn more U R big N they R interested in U. Whatever the talk their talk is centred around money. What U call these people –Money minded- Poor or Laksmi  Ke  pujari. They only pray Godess Laksmi-  Godess of MONEY.

The thoughts may become repetitive and a person is unable 2 remove them form mind. Saving money becomes an obcession  and person derives pleasure from saving money . One of my relative has immense wealth but he sleeps on floor .No bed in bedroom. The drawing room is not furnished and has little furniture. One of my relative cant spend a single paisa on his or wife health despite having enough money.

Disease becomes acute when he can destroy relations n friendship for money .I know a instance when father knew the disease in his son and had 2 leave money with somebody else  for expenditure in cremation and last rights for his own ,knowing prettywell  that the son will not spend money for the same.

TREATMENT- No known treatment in books.

  Behavior therapy may be tried in early stages. SSRI  may be tried as drug treatment.

HOW 2 MAKE LIFE SIMPLE

Life is not complex. We are complex. Life is simple,
and the simple thing is the right thing.- Oscar Wilde

1. Don’t try to read other people’s minds. Don’t make other people try to read yours. Communicate.

2. Be polite, but don’t try to be friends with everyone around you. Instead, spend time nurturing your relationships with the people who matter most to you.

3. Your health is your life, keep up with it. Get an annual physical check-up.

4. Live below your means. Don’t buy stuff you don’t need. Always sleep on big purchases. Create a budget and savings plan and stick to both of them.

5. Get enough sleep every night. An exhausted mind is rarely productive.

6. Get up 30 minutes earlier so you don’t have to rush around like a mad man. That 30 minutes will help you avoid speeding tickets, tardiness, and other unnecessary headaches.

7. Get off your high horse, talk it out, shake hands or hug, and move on.

8. Don’t waste your time on jealously. The only person you’re competing against is yourself.

9. Surround yourself with people who fill your gaps. Let them do the stuff they’re better at so you can do the stuff you’re better at.

10. Organize your living space and working space.

11. Get rid of stuff you don’t use.

12. Ask someone if you aren’t sure.

13. Spend a little time now learning a time-saving trick or shortcut that you can use over and over again in the future.

14. Don’t try to please everyone. Just do what you know is right.

15. Don’t drink alcohol or consume recreational drugs when you’re mad or sad. Take a jog instead.

16. Be sure to pay your bills on time.

17. Fill up your gas tank on the way home, not in the morning when you’re in a hurry.

18. Use technology to automate tasks.

19. Handle important two-minute tasks immediately.

20. Relocate closer to your place of employment.

21. Don’t steal.

22. Always be honest with yourself and others.

23. Say “I love you” to your loved ones as often as possible.

24. Single-task. Do one thing at a time and give it all you got.

25. Finish one project before you start another.

26. Be yourself.

27. When traveling, pack light. Don’t bring it unless you absolutely must.

28. Clean up after yourself. Don’t put it off until later.

29. Learn to cook, and cook.

30. Make a weekly (healthy) menu, and shop for only the items you need.

31. Consider buying and cooking food in bulk. If you make a large portion of something on Sunday, you can eat leftovers several times during the week without spending more time cooking.

32. Stay out of other people’s drama. And don’t needlessly create your own.

33. Buy things with cash.

34. Maintain your car, home, and other personal belongings you rely on.

35. Smile often, even to complete strangers.

36. If you hate doing it, stop it.

37. Treat everyone with the same level of respect you would give to your grandfather and the same level of patience you would have with your baby brother.

38. Apologize when you should.

39. Write things down.

40. Be curious. Don’t be scared to learn something new.

41. Explore new ideas and opportunities often.

42. Don’t be shy. Network with people. Meet new people.

43. Don’t worry too much about what other people think about you.

44. Spend time with nice people who are smart, driven, and likeminded.

45. Don’t text and drive. Don’t drink and drive.

46. Drink water when you’re thirsty.

47. Don’t eat when you’re bored. Eat when you’re hungry.

48. Exercise every day. Simply take a long, relaxing walk.

49. Let go of things you can’t change. Concentrate on things you can.

50. Find hard work you actually enjoy doing.

51. Realize that the harder you work, the luckier you will become.

52. Follow your heart. Don’t waste your life fulfilling someone else’s dreams and desires.

53. Set priorities for yourself and act accordingly.

54. Take it slow and add up all your small victories.

55. However good or bad a situation is now, it will change. Accept this simple fact.

56. Excel at what you do. Otherwise you’ll just frustrate yourself.

57. Mature, but don’t grow up too fast.

58. Realize that you’re never quite as right as you think you are.

59. Build something or do something that makes you proud.

60. Make mistakes, learn from them, laugh about them, and move along.

Oh, and enjoy life’s simple pleasures. They’re free and better than anything money can buy. ;-)