Shoulders and Elbows and Shoulders and Elbows.....

This whole week in Sydney has been busy...busier than in Christchurch I should say. The last week conference was very eventful.Lots of learning, lots of great men talking, newer instruments and implants, meeting new people and dining too. This week Monday I had been to royal North shore private to observe Prof Sonnanbend and Jeff Hughes. Prof had two small cases - SADs. I saw Jeff doing an open OK procedure. It is a good surgery for big osteophytes around elbow with impingement pain. Afternoon clinics I was with Prof Sonnanbend. That was again a good experience. Tuesday morning Marter Hospital. List with prof. we had a reverse shoulder, one stabilisation and one ac joint debridement. The reverse was for cuff tear arthropathy. depuy reverse. Prof was magnanimous to allow me to scrub in the case. The case went on well. the critical thing is the exposure of glenoid for putting in the glenosphere. The nest day ...two lists one in public and one in private...Prof did a revision in which he did a reverse removing a hemi, and a latarjet. Jeff did two replacements, one zimmer reverse with bone graft and one smr total shoulder again with bone graft. then he did one capsular release of shoulder and two elbow scopies one synovectomy and one osteocapsulectomy.
Thursday i went to Prince of Wales to watch Jerome goldberg. He had eight cases on list. The re were two pec major repairs, two open cuffs in which one was subscap repair,one scopic cuff,two stabilisations and one massive cuff for which ad arthroscopic repair was done. the last case was done by John trantalis an upcoming shoulder surgeon trained in Canada. Jerome is a wonderful man and a great surgeon.I am taking hos trough repairs with me. Friday was a day in clinics with Ben and evening surgeries with Ben the highlight case being a malunited proximal humerus for which he did a tuberoplasty.
The week has been really good.

The five course meal

The venue was the Quay restaurant, acclaimed as the best restaurant in Australia. It was night, the harbour bridge illuminated by an arcade of lights and the magnificent Opera house with its brightened mystic sails making reflections in water. The restaurant overlooked the circular quay, the harbour bridge and Opera house in the background. We reached the place it was busy already. Tables had been arranged such that people can sit in small groups and chat through the whole dinner. I was reminded of our conference dinners in India. Food cooked and served in big containers, heaps of people queuing up with plates in their hands, the small fights sometimes on alcohol and meat, the quarrels with bartenders of some senior people after they come under influence, I should concede that a concept of a "dining experience" is not popular in India. the Indian instincts of competition and urge for survival shows up in every instance, be a conference dinner or crossing road.
We were a bit late so we found most of the tables were already full and people were busily engaged in talking to their mates on the table. We managed to find a place in one of the tables. The tables seemed cramped with lots of glasses . I sat down to take a closer look. There were five wine glasses all in different dimensions, five knives on the right side and five forks on my left. A piece of bread was kept on a small plate onto my left. There was butter on the table and only enough room to rest our forearms on the table after all that crockery display. The waiter dressed in black suit asks" Could we start with a glass of sparkling wine gentlemen?" We nodded in approval. Little did I know that five different types of wine are to follow after that. I started cutting the bread piece with a small knife kept along with it on the table. It was not very special but suited the wine nicely. One of the Indian Australians sitting next to us started talking. He talked about his training in Bombay and his mother telling about the lot of rules she had to follow in Sydney as compared to Mumbai. He said at the end of the day he missed something which he thought would be there if he was in Bombay. i felt a city life could be no different in any city. May be he 'll find driving little better in Melbourne where he lives, may be the power never goes off, may be he can drink tap water, but the rat race ids the same. Keeping pace with others in spending in one of the major drives for earning money in a city. You have to dine in a new and a bigger restaurant every weekend, you will have to switch to better cars, you will have to move to better areas and you will have to have a holiday home.These things keep you busy running behind money. we feel comfortable or feel happy transiently on achieving these goals but soon a bigger desire enters our minds and torments us, threatens us of failure and drives us to our extremes to attain it.
The waiter asked if we had any special dietary requirements and we answered in affirmative. Chethan would n't take pork or beef and Iwas a vegetarian. He said we would be getting eggplant fry for our main course as it contained meat.
I came to know that the dinner is called Degustation dinner. A suiting wine precedes every course of a meal. The servings went on till 11 30 pm ending with a coffee.
Sydney does teach me new things!

On Manly Beach and double decker Electric trains.....

Flying trans Tasman over the Pacific in the day is a good experience as you get to see the varied landscape of New Zealand starting from nicely organized cultivation fields to mountains with the rivers flowing in between, bending and stretching out along their course, the snow capped peaks come into view after some time the spongy looking milk white clouds hugging the shoulders of these magnificent mountains. To me, the mountains look as if they are alive and conscious. I look startled at the majesty and strength they display.
crossing the Land, we enter the endless ocean. Water, water everywhere....I doze off on my seat listening to Ilayaraja on my ipod as the flight heads towards Sydney. As we approach Sydney the beauty of nature grips you again. Sydney is a beautiful harbour city. Sea finds its way to the center of the city. The natural harbour is one of the great gifts to people here i suppose. The flight takes a turn on the sea and prepares landing and it looks as if we are landing on the sea when just just before touching ground the patch of land with runway comes into view.
After airport formalities I headed to the railway station. I was not expecting Sydney to be this big. I had always imagined cities outside India to be very thinly populated and slow and my imaginations were confirmed in Christchurch where you hardly find more than five passengers in a normal city bus and you could find no one on road after 9 pm.
I was taken aback to find a striking similarity of Sydney to our metros. People looked very busy, most of them had mobile phones in their hands seriously grazing through stuff even when they were getting into train. It looked as if everyone was in a race. I thought "oh! This is another mad city where people keep running not knowing where they are heading". I saw three storeyed metro trains full of people. this was the thing I was afrais of. Big cities! the run! the rush and competition! Ok...I reached Chethan's place...wonderful young couple who are taking care of me very well.
the conference (for which I had come) was in Manly. manly is a beach area and the hotel where the conference was happening overlooks the sea. I was captivated by the beauty of the sea and beach when I reached Manly the next day morning. The bus services are good and i again find it similar to Chennai. Buses are a lot lot better. But again, this is another city. City which adverises about call girls and escorts for two full pages in local newspapers, city where ferry is one of the public transport system to got to job everyday, city where i find more asian faces than white faces!
The first day of the conference was good..workshops from various companies...new devices good things! Met Mr.Hong and he is happy taking me for his fellowship in Hamilton. Let's see how it works out! I have this problem of getting up early coz at Christchurch we are two hours ahead!
tha's why i am writing this
may be i'll write more in the two weeks I am goin to stay here.
bye!

New Learning everyday...

Attended Bhagavatham class at ISKCON temple today morning. The class was at 7 am. I had gotten up, bathed and got ready for the class in my White long kurta and veshti...the dress I love the most!

Wearing the veshti itself connects you immediately to your rich culture and heritage and reminds you that you are the son of the greatest civilisation of the planet.

The class was well attended according to Christchurch standards...20 people in the morning cold...most in sarees and dhoties....wearing thirumann on their foreheads...mostly white...very few Indians.

The importance of faith in a spiritual master was the topic of discussion today.

Good points came out in the class. the constant eagerness to liberate oneself is the most important stimulus for oneself to seek God. In that seeking, one need not get frustrated at one's inability to overcome vices, one need not feel guilty, instead one should feel humble and surrender to god and allow him to take care and accompany in the journey.

One should have a strong conviction about doing his duties.

Hope I follow some of these in my daily life. I should probably have the japa mala in my pocket all time and whenever I feel there is spare time which I feel is getting wasted i can at least chant!

I read a book on Gandhi yesterday. It is a pity that I come to know so much of Post Gandhi Gandhian movement in India from a foreign author and from a library in a foreign nation.

The book introduced me to Vinobha Bhave and Jayaprakash Narayan and narayan dessai and Bhoodhan movement and other such very relevant stuff which are still burning problems in post independence India.

sadly enough, our history books stop with pre independence Indian history. Nobody had taken any pain to teach us post independence as sixty years of experience has already passed with India not reaching any better heights than its neighbor, more populated but definitely more advanced than us.

Youth of today have to be taught more about leadership and responsibility and about the recent mass leaders and how they stood strong in principles. I am strongly convinced that Gandhian way is the only way ahead to solve problems of disparity India is facing now. the villages becoming empty, rising urban poverty, failing agriculture...these are all parts of a vicious cycle...which can be disrupted only by proper planning and concentration on policies which will not give victory immediately but will definitely make a stronger India.

I am now reading a book on Jihad, the shade of swords...a compelling history of jihad and its present state written by a Indian Muslim author.

Will write when I read more.

Hari Aum Tat Sat.

Zumba!!!!

Attending a group fitness class at the city council fitness centers was one weekend activity I was expecting. I love to attend the classes because they are fun doing the exercises at the same time in a short time period you get to do a complete Set of stretches and strengthen according to the class. Today I woke up early and was eagerly waiting to attend the B.A.T and Zumba classes. BAT is a program where lower abdomen and thigh muscles are worked out with a Swiss ball. Now, this Swiss ball is really good to assist you in exercises.

BAT was little trying to me as my abdominal muscles aren't that strong. Zumba was fun but the instructor was too fast and she enjoyed dancing to herself than to teach other people. Now, Zumba is a spanish dance. The steps are just like dance steps and it's a good workout basically but I couldn't keep pace with the moves as they were really fast and changed frequently.

Did my regular lane swimming, lazed for some time in the steam room and sauna, had a shower and came home.

The gyms and pools are a real attraction to the city I would say. The city council tries hard to keep people active. The gyms get busy at 6 am in the morning and the pools too. Since they are all heated it is real good.

Let me see how much I can use these to "build" up my body

christchurch diaries

today,

2/2/10

am: OPD saw a patient of habitual dislocation of bilateral shoulders examined her found how recruiting the infraspinatus can help in reducing the dislocation rate. Kibler’s concept of core stability to have good shoulder stability was explained. The patient had a proprioception problem.

pm: observed a reverse total shoulder arthroplasty

3/2/2010

Am: Rooms: pt with subluxing extensor tendon of the middle finger; pt with complete tear of the rotator cuff rt shoulder with ac joint artrhitis:pt wanted surgery we’ve put him on inj in the shoulder

Gave b/l first cmc joint steroid injections

Pm: rooms at St George clinic

Saw say about 20 of Malone’s personal patients. Many were interesting. One valid point was if subscap tests are positive and you find normal subscap at USG, suspect ant capsulitis and go for steroid in the Gh joint. The other is the test for PLRI. Saw a patient of PLRI secondary to cubitus varus post traumatic. Met a patient with gr III Ac joint disloc who has been planned for Tightrope. Clinic got over by 9 pm....walked down to the hostel...reached at 9 45.

Things to read:

Subluxing extensor tendons

Ac arthritis

Reverse total shoulder

Habitual shoulder dislocation

PLRI

Morrey is a good book for elbow. Hope I get it from the library. I would love to read it. I would also send a paper for the Ediburgh shoulder meeeting in Sep 2010.

Got to go to southern cross at 8 in the morning. May be a half an hour walk. Should have to wake up at 6 30.Bye.

4/2/10

Went to southern cross in the morning...did not find Ian thr was told he comes in the evening...went around to look for a coupla flats...got walking all the way...

Hectic list in the afternoon..8 patients...no time to think...2 knees and 6 shoulders...got to scope both the knees

Went on to put the portal and do diagnostic in 4 shoulders...make anterior portal in one...very efficient surgeon...i admire him

He was a real good teacher...love him for that....he did 5 subacromial decompressions and i double triple row repair of supraspinTUS TENDON. Wonderful Man!

Saw how efficient the whole team was!

Had dinner there at the hospital tea room

Will catch you again tom..have to go to Burwood in the morning at 7 is the bus...see you then...bye

5/2/10

Was up at 6 45 ready by 7 15 reached bus station at 7 30 was in the hospital at 8 00 had four cases two metal exit one shoulder arthroscopy and open cuff repair one scaphoid fracture fixation with bone grafting by dorsal approach

Was over by 2 pm

Went to st george’s waited for some time to meet Khalid over there...nice man...he took me to his house wonderful family they have got....he gave me a book on shoulder surgery and a suture table to practice...and a journal to read for the weekend....for the Friday meeting...

Has asked me to talk to Chetan about the AC joint thing...will possibly mail him tomoro...talked to mom dad yesterday...really felt very well...goin to sleep...

Had naan rice and malai kofta for 10 $ really wonderful and tasty...it’s a restaurant called little india...

Am goin to move to the room tomro any one either at Bealey ave or at sherbourne street...at the end of the day... Sherborne seems to be good...lemme think tonight...

14/02/10

Am one of the laziest buggers around....have not written a diary for so long

I have moved into a new house and it’s more than a week now...8 days

The house at Sherborne street

It’s good...my flatmates are Sam a chef from Auckland, Kathie from Korea learning English, two American girls and a french couple.

Today is Sunday.

Planning to do some useful work

Nothin I am gopin to gain from all this nuisance....drinking, partying and dancing to hip hop;;;

Every city is the same.

It has got people who try hard to earn money to spend it just to keep themselves on par with others;

Life runs in running after unnecessary things just to show;

Later on it becomes a routine that the inner motive is forgotten; a false sense of joy and satisfaction comes;

I have come here to learn shoulder surgery; I have to get serious; no time to roam around like a dog.

I have a lot to study. I see my consultants have worked hard and are still working so hard to keep up to their skills and knowledge. I am shallow and ignorant when compared to them. I have a lot to learn from them. I remember what Prof. Kotwal had said: “ Dont show off” it decreases the prospects of learining. It shows you are not prepared to learn. Prof Kotwal is gem of a person. Even if you know, dont show off. Ok...lemme do some useful reading today.

Bye

09/03/2010

I am atttending the clinical audit in the public. It is really really interesting. Registrars prepare and present all complications in the last three months.

Some of which I noted are

1. Patella TBW failure twice possibly due to malposition of wires in the distal fragment
2. Short PFN periprosthetic fracture – revised with recon nail
3. DHS cutout treated with blade plate but fell short and went to varus
4. Immobilize communited fractures – it may displace if mobilized early
5. Be careful about Tip Apex distance in DHS
6. Improperly contoured 3.5 DCP for fibula may pull out the diastasis screws
7. Short PFN has larger proximal screw than Long PFN and the biggest long PFN is 10mm
8. Look at X rays very carefully – can miss out subtle fractures
9. Never be overconfident!!!!!
10. --------do-------------
11. Longer neck cut – overbroaching – calcar fracture
12. Primary pyomyositis of hip!!!---?

14/03/2010

Much has happened since I last wrote. Most notable were my reading of “Half a life” and watching of “mystic masseur”. Both are stories of V.S.Naipaul, UK based author of Indian origin born in Trinidad. His childhood and his parentage are well traceable from his stories. He in the book talks about the problems or issues with people of mixed parentage. The hero of the novel happens to be one. His is father is a brahmin and his mother is a lower caste woman. In depicting his father, Naipaul has talked beautifully about the mundane man who is very comfortable in his routine life akin toa jail, ignorant or acting to be ignorant of it. His father breaks it by marrying a lower caste girl and then starts the problem. The hero, Willie starts hating everyone responsible for his status as a boy of mixed parentage, all including his father and mother. His father, he thinks had no direction and no ambiton and lived a wasteful life as a sant in an ashram. The author beatifully describes willie’s life and how he becomes very much alike his father.

We all seek hiding places...we all want to run away from problems...we want to be ignorant of problems and we are always afraid of losing the current comfort when it comes to taking up a challenge. That is how a common man is born, lives and dies. Willie’s father was expexted to lead a similar life marrying a same caste girl and working in the government for a maharaja. But he was not ready for that. But he was unsure of the next action plan. In a way, as the author says through him, he was destined to become a mendicant and run an ashram.

Willie sets out to study in London. He lives in London for three years. He writes stories and publishes them as a book.

Every man looks out for a woman who can accept and love the man as he is and more than that love for what he is. Willie is also on constant search and finds a woman in Ana. He becomes ready to do anything for Ana. He sets sail for Africa which is Ana’s place and lives there for 18 years.

An interesting story which has strengthened my desire to write. I will try and write as much as possible. The mystic masseur is another wonderful story about a pandit in Trinidad, his life and his acheivemnt.

A book appeals you only if you can identify yourself with some of the charachters in the book. Atleast that is how you start reading books. I have this peculiar instinct of doing stuff I see. If I read a book, i feel i should write one. If I hear a song, I feel I should sing.

Sam is sitting next to me and happily smoking a joint. He is a happy man. He always says I do what I like to do and I am happy. I really doubt if he ever wanted to be useful to others. I always wanted to be useful to others. But deep inside, being useful to others was a way to find your own identity and establish your own recognition. Of course, no one in normal ego life can live without that motive. This constant urge was which took me to New Zealand with all the arrangements made by almighty. When it comes to trusting him, then all arguments cease. A complete trust in Lord alone can deliver us out of the cycle of pleasure and pain.

I am finding a hard time figuring out the right statistical test for my analysis. I regret for not concentrating in the statistics workshop which i attended in Sep last year at lucknow. Every move of God has a purpose. The purpose is to deliver.

I am realizing that I am weak in English vocabulary. I have to figure out a way to improve it. I was reading the biography of Naipaul .This man does not have a straight personal life. After marriage, he was roaming with another married woman it seems. Writers or men with that bent often live in their own world.

I have to work on only few things:

1. Shoulder – enriching my knowledge and skills
2. Being truthful to my consultants
3. Physique – very important
4. Discipline – Self discipline

I ‘ll start writing my book soon.....:) Of course with Almighty’s direction!

22/03/2010

It’s been a good long weekend....

Went to Akaroa y’ day

In car

With Kathie

87 kms...

Went on the cruise

Went trekking

Had good food in the night

Contemplating now

Met Mr Mo Chaudhry on the cruise...he is a 65 yr old young man....gave me some advice

To make maximum use of this age

It seems i will regret later

Kathy’s advice was to hang out with girls...so that i can improve myself

Improve myself in taking care of my future wife

We set out from our house at about 8ish..

I’m receiving some good comments on the photos in orkut

I get into these things pretty late i suppose!

23/03/10 8 15 am St George’s OT

It’s been a thunderous night y day and i excused myself for getting up later than i planned today. But i am worried that I am not able to execute what i plan. I should be able to run for atleast half an hour from tomorrow.

Learning is on the lower side. Should start studying again..as hard as possible.

Not hardly....

8 pm Leinster chambers:

Looking into some literature...

Have to do a lot of reading!

Loads of other work to do as well!

Bye!

28/03/10

Complacency creeps in without notice. It is anature of the mind without thirst. It symbolises idleness and a harbinger of downfall. The urge to stay ahead is what pushes a man forward.

31/03/10

Morning, had a X ray session with Mckie, good Ilizarov case- done with TSF

BACK TO SCHEDULE

Its started becomin hectic again....marathon surgeries, unending casuality duties....patients, patients and patients everywhere.....starvation in Operating Room until you feel homicidal, anesthetists who really increase your homicdal tendencies, sucking instruments which mess up any surgery, irritating mess food and after all this the haunting loneliness.
I have to really do something to tackle the anestheeists. The first case was over by 12 30 and the next patient was takena t 3 30 pm imagine...3 hours of wasteful resident's time. Let me see what I can do for this.