Jumuat-ul-Vida'a

This is the last Friday of this Ramadhan.
  Nothing special but we always consider it special
My main reason is that the first day of my Pakistan was last Friday of that blessed Ramadhan seventy one years ago that I remember so vividly and I was so very happy on that day in my village
 Yes we used to feel "celebration" om Jumuatulvida even before that and would sing parting songs for this month of blessings
 Today I do not feel as happy for my Pakistan did not turn out to be as good Islamic country as I had the vision of 71 years ago
 But I am thankful to Allah we have a country of our own



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Village Experiences of Childhood

  Living in Kotla during my 11- to-15 year age was full of observations that are still vivid in my memory
 I am stopping to write Urdu blog as I feel my followers have gradually dwindled along with infrequency of my writings (like I did for Hindi)
 Summer: 1) we would sleep in open on the roof (chhat-چھت) and sometimes the dust-storm will come and go, we will only cover up with bedsheet and in the morning wake up full of sand everywhere (Sandstorms are common in Punjab) If it is too strong and you want leave the roof you may go into a room but it is too hot in the closed room.
 2) Next I want o share my experience with growing chicks from being born up to fully grown chicken both Murgha (Cock) and Murghi (Hen). The beautiful feathering of  the cock is quite contrasting (and very attractive) from hen especially at the neck and then the crest on top of the head (کلغی) is a most remarkable part of the beauty and varies in different varieties ( and I remember all those) Then also the crowing of the cock, so funny when the young one starts learning how to go from some initial funny sounds to full-fledged Cock-a-doodle-do (Cukkdoon-kudooooon). Once we had a whole lot of these birds in our house for eggs etc. and yes I remember what a hen does before and after laying the eggs those cut cut sounds were so inviting for a curious child (me) The hen makes a declaration after laying the egg (loud Cutcut cutaack) So you can rush down to the place where she did it.
3) Many homes had one or more animals usually kept (bound to a peg or something) within the courtyard or just outside the house. For s we acquired a Buffalo (for milk and lassi etc) and she had a baby which was my favourite (I had also had similar playing experience with a goat) I was  supposed to take her out and let her graze in the fields but the little one would run around jump around like any other child and I would enjoy that but she had a bad habit sometimes she would follow anybody and start going with him/her. One day while I was busy playing with other kids she disappeared. O boy there was problem we had to send somebody to other nearby villages, thank God she was found a couple of miles away. I hope you al know that in villages all the poops of these animals are used for (thaappy- dried up dung) fire. On an average a panjabi buffalo may produce anywhere from 20-30 seers (Dont know gallons) of milk per day.



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Evolution of Brain/speech

This is a subject that needs a basic understanding of biology before you go on further
   We are all familiar with Darwin's theory (there was some similar thinking among some Muslim scientists of the "golden Islamic civilization"period but they did not have the acute observational opportunity of Darwin) of evolution how Humans have descended from Monkeys etc. but this theory is sorely lacking in one thing, the explanation of a speaking', criticizing, formulating, intelligent man, that almost "suddenly" comes up after the bipedal hominoids in evolutionary process
    Let me explain very briefly what I am trying to say:
 Following the principles of "survival of the fittest" and positive selection for developmental adaptation etc. scientists have traced how in the family "Hominidae" all the genera and species developed over millions of years. The study has given us from Homo Sapiens the hominoids starting from "homo erectus" and we are looking at "homo sapiens sapiens" (HSS) You go through the study of changes in the limbs and pelvis, for example, in the musculo-skeletal arrangements/changes in adapting to the bipedal locomotion.  Here I will concentrate on the changes (or better), adaptational alterations in the brain only.
 Data/knowledge collected from fossils (found in Africa and some in Europe) does not give us all the information to connect everything nicely in the phylogenetic scales but the information does give us a clue as to how changes in the brains of Chimpanzees and then up to HSS etc. right up the humans are developed. Here I will make some brief quotes from the late Sir John Eccles book, "Evolution of the BRAIN, Creation of the SELF" :
" With respect to auditory pathway up to primary and secondary Auditory areas of cortex, NO CHANGE has been reported in the evolutionary sequence from monkey to ape to human."
"Brains of HomoHabillis (Hominoids) there was not only fullness evident over the inferior frontal lobule (precursor of Brocas) but it was also evident in the inferior parietal lobule indicating that phylogenetic development of areas 39-40 (precursor of Wernicke) had already occured"
     Next note this:
( Geschwind), .....He also made suggestion  that area 39 (Angular Gyrus) has special function in speech since it developed at the meeting place of visual and tactile information. . . . . . .  it would thus be specially fitted for the identification and naming of objects observed both visually and tactually. "
  I will skip the evolutionary development of organs related to speech production (throat, tongue jaws etc.) and go to Evolution of the language process itself.
   "It is suggested then that Habilis had both the neural basis and anatomical capacity for speech albeit probably neither the structural nor the functional complex had attained the evolutionary advancement of today's people"
  OK< now the speech as  we know it has three aspects, The Lexicon, the Syntax, and the Semantics. That is the vocabulary and their synthesis with each other to make a sentence and then the meaningfulness of it.
"Colorless green ideas sleep furiously" (a sentence making no sense  without semantics)
 Near relative of Man, the apes, but "there was apparently a clear QUALITATIVE difference between human and ape languages. Four forms/levels of human language:
1. Expressive or symptomatic - like ability to make words
 2. Signaling function - like being able to send a signal to a receiver who can accept/understand it
  3.Descriptive function -  ability to describe which is the main human function of speech
   4. Argumentative function. - probably just extension of the above, the highest speech function
 Here we can see the first two (lower) levels animals like apes etc also have but  3 and 4  are limited to humans only. All kinds of experiments have been performed to teach (for example) Chimpanzee brain (a little female was literally brought up with humans only and taught language like a daughter) yet the expressions of human beings cannot be reproduced and Humanoids are not available Chimps are the closest to human brain and the sensory and motor areas are seen on the cortex and yet no speech like humans (that is remain limited to #  1 &2 and not progress to #3&4)
Now I wish for you to look at Norman Gecshwind's (very well-known expert neurologist on speech) words above and one can easily see  how the ability to see, feel and remember the names form the basis of "intelligence"
 That reminds us how Qur'an majeed describes the first human created by God who purposefully DEMONSTRATED THAT ABILITY OF MAN (ADAM) that he answered the question "Can you name these things?" and he told the (other creations (Angels and Jinns)  NAMES OF THINGS
  (Now I have just simplified everything in order to be brief)

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iDoc- Amnesia and Twins

Being a neurologist I have had my share of patients with post-traumatic (Cranial Trauma) amnesia both ante-grade and retrograde
  I recently read a novel by a well-known Urdu novelist - Razia Butt,  "Main kawn hun" (Who am I)
 She has deftly combined the post-traumatic amnesia and identical twins into her captivating story of suspense in which a small accident results in complete loss of identity and memory of (one twin) before the injury and sudden return of memory toward the end.
 Writers as well as movie-makers have utilized these two things many times  (both Hollywood and Bollywood). Some of you will remember ;
 Ram awr Shyam" beautifully played by Daleep Kumar the contrasting personalities of twin brothers.More recently Hollywood presented similar contrasting personality of sisters in "Pretty Things" (like the contrasting personalities of Razia Butt's story). Then for amnesia, I recall one old movie of  Ronald Coleman that I enjoyed, ''Random Harvest" in which the hero looses his memory and identity lasting for a longer time (to help the story).
 Something not picked up by writers/movie-makers is epileptic phenomenon (Temporal epilepsy to be more specific)
 Just for adding spice to the topic let me relate one patient story:
 I made a presentation of an epileptic during my residency (Visiting professor was Dr Rassmusen from Canada) a woman who during attack would undress herself (she was brought to our hospital as she had started undressing while riding in a local bus) Her husband would make love to her during such attack as she would ask for it but he could tell the difference of sex when she was not under attack. Of course we had lot of intriguing teaching stories and warnings from the professor on this subject (I do not remember them but there was one of a murder during attack)



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Number two, ME that is

     #2  makes not much impact on you my dear reader but this is a rather painful subject for me to narrate and you will realize as I start now

This is just my story. When I was little (number six in my sibship) my turn was not number one Like, my mom would first give the best piece of meat to  my father (not really complaining just giving example). Well you understand what I am saying
Then when I became father  the mom of my children would give the best to children saying they are growing. Traditions had changed to place me number two on the list again

Now let me tell you this latest  My grandson writing Khuda Hafiz at the time of leaving after visit Last line says  Dadi and Dada

See Dada is again number two, Tradiditions changing or just plain ignoring the poor dada? Just see how beautifully dadi is written and then see and and dada scribbled(O he loves me a lot, I have no doubt about it)

 Just recently some thing else happened, We have been filing taxes together and my name is main but for some technical reasons our Consultant suggested my wife's name as primary. Nothing unusual though(Not complaining )

 Because of the fact that for several years now; my wife contacts everybody as I cannot hear phone (I cannot hear/understand spoken words much due to my extreme loss of hearing ability)

Not my own fault yet it happens to be my "fault"

 In fact many times may people consider my wife 's name to be husband and vice versa

 Long ago when we were married my wife said it would be strange for her to be number two living with me as she had been number one all her life (So was I, I thought) and in the beginning she did make me feel she is bumber two butas soon as children came in 

well you can see my plight and why this #2 is hurting me so much

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Bullying in schools

Recent news of the 10 yr old girl posting her video on FB (one of the good reasons for FB) brings to mind my own experience. He was my classmate and friend so we would hang out together.
 High school in Pakistan was 9th and 10th grades
 He was from another village and our class positions were somewhat together (in exams/tests). So we had a lot in common and I had started smoking which he already did (but he was older by about 2-3 years). We had no desks only one table and chair for the teacher students would sit on the floor (Bricks) and would need cleaning everyday which was done by rotation by students.
 Then one day he said something to me which was not good and I showed my resentment mildly. That day on for the rest of my stay in the school he started bullying (a word that only recently learned by me) He would say derogatory things about me and we would not sit together any more. I used to take my own (like other students) mat (bori) to sit on in the class. He would during  some time get hold of it and throw it on top of the room which was difficult to get it back. I do not recall fully now but he did write a kind of apology letter to me before we parted after graduation (1948)
    When I joined the (Middle School) school in Kakrali in May of 1944, I was still not familiar with Panjabi language but within a month or so I had picked up enough to understand but to my horror I discovered some of my classmates were finding it amusing to use "unparliamentary" language (bad words including abusive) in front of me thinking that I do not understand. Well it did not last too long but I remained shy throughout my four year stay in the school where I only spoke Urdu and not Panjabi. I wrote something about my Urdu "ability" on my Urdu blog but just to recover here, something: The totally paindoo people would read --hansnay lagi-- (Started laughing) as hanasnay lagi. There was no concept of noon ghunna. So I had to correct. In fact even teachers who would want to confirm proper pronunciation would ask me to pronounce it (feel good) and actually yes some teachers called me Urdu ki dictionary




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iDoc - Awakenings

A recent visit to this ''movie' has awakened my desire to write about my own experience as neurologist and it is no less entertaining, I think
    It all started in 1954-55, my third year in MBBS. We had just started the clinical experiences, going to the wards/OPD (outpatient departments) in the hospital, knowing nothing of medicine. Two outpatient clinics were of interest that I remember, one: VOD (Venereal Outdoor) where  we learned intravenous injections (Arsenic IV to the Syphilitic patients) and the MOD (Medical out door) where some days Parkinsonian patients were brought by their relatives with tremors and drooling of saliva from one angle of mouth or the other. We would give intramuscular injections (Hyoscine Hydrobromide) for relief of salivation.(they were also on Artane orally I would learn later) As (in pharmacology) we were told about anticholinergic (antimuscarinic) drugs. The Neurotransmitters knowledge was very basic at that time. I learned later about Parkinsonism problems. Briefly there is deficiency of Dopamine (Loss of cells in Substantia Nigra that produce it).  Dopamine is formed from DOPA (Di HydroxyPhenyl Alanine) by the enzyme  (dopa)decarboxylase. DOPA is formed from Tyrosine (Tyrosine hydroxylase) which is formed from Phenyl Alanine (hydoxylase).
 In its turn Dopamine can be acted upon by Beta hydroxylase into NorEpinephrine which turns into Epinephrine (PEN-Methyl Transferase)
 In other parts of the brain AcetylCholine (AC)is formed and there Cholinesterase enzyme is seen. Making it simple under normal circumstances there is a remarkable balance of these ( and other) neurotransmitters in the brain but from our point of view regarding Parkinson's syndrome  it is our understanding that a strict balance exists between Dopamine and AcetylCholine to make smooth usual movements (muscular activity) of the body
 In Parkinson's, deficiency of Dopamine may result in overactivity of AC and the first drugs used for this disorder were anticholinergic drugs (see above)
 Next medicines were those that increase Dopamine availability and that is where 'Awakenings' comes in.
 I went to England where I tried, unsuccessfully, to get into Neurology training but saw lot of Parkinson's patients but as I flew in to USA in 1969 I ended up first into a chronic sick hospital where there were lot of Parkinsonian (and other severely disabled) patients. Some Parkinsonian patients may be physically disabled to the extent of being bed-ridden but mentally they may or may not be as much affected. There I had one of my patient's complaint that she wrote (typed) over a period of 3 days in which she expressed quite eloquently her disgust of some visitors who talked in front of her in uncomplimentary terms thinking she was not understanding them. that had both amusing and  teaching effects on me. Later I was to become more ethical in my practice. From 1969 to 1972 I rotated and also functioned as regular neurology resident in the university of Cincinnati hospitals. As you will recall from 'Awakenings' This was similar timing as of the doctor Sayer (Played strangely and wonderfully by Robin Williams) I also participated in  Post surgery evaluations of Demented patients and evaluation of L-DOPA for various Parkinson's patients. I way relate one of the examples as I experienced the dramatic effects of this drug on these disabled patients who I was so familiar with from my long experience.
 One fellow who was a BS as well as MA (well-educated) patient with advanced Parkinsonian Syndrome. Bed-ridden due to immobility with classical rigidity of muscles as well as marked Tremor. I would go with juniors and students into his room and as if the whole room was in tremor. He would be in his bed half propped up and I will declare Good morning Mr. So-and-so. Then we all observed  in the next few seconds tremor reduction to almost nil and then his speech come out slurred with "good morning doctor". Anyway this was before he was started on L-DOPA and as he improved, started walking with help etc. and speaking better he was discharged home to the care of his wife. Later as I was to record the impressions of our patients who had been treated. Now problem was that he had lost some intelligence also. (This was pre-CT scan time)
 So I asked his opinion, how effective this medication had been to you Mr. So-&-So.
 He turns round to his wife and says
 Honey has there been any beneficial effect of it?

 Robert de Niro did a very convincing job of patient like other patients shown in the movie  (with the usual exaggeration to enhance the desired effect on the audience)- but I thought  de Niro would have been better as doctor and Robin better as patient but that is my opinion


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A quote of somebody

"Friends are some people with whom we can be our true selves with whom we can fearlessly let our guards down"

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