Ecstatic Epilepsy

This one is dedicated to my Grandfather.and GRAND ,he was..

Epilepsy is the disease in which seizures occur (jhatke aana)
Never had I thought It will change my perception of things.
It began when as a child, I used to sit in religious rituals watching my grandfather, as after all the conondrum of bells, the smoke from the fire which filled the entire room.
He would suddenly go in a trance like state and blurt out prophecies in an altogether different tone of voice, and as a child I saw many such intriguing cases.
After having understood the basic mechanisms and effects of a seizure, (thanks to my residency, ) I came to think of it as a phenomenon.
The human Brain is a very highly differentiated organ, critical for survival.
But alongside our basic life processes, evolution gifted humans with a brain so powerful, and so potent, it could actually shake up things around.
We Humans have changed everything around us as per our convenience.
But with great power, comes great responsibility...
We are all imperfect, and the brain too has its own set of issues.
The human brain is like a gamut of multiple core processors, all synchronous and interconnected through synapses.
There's a region for controlling everything. From feeling hungry to feeling angry, from depression to extacy..
You could liken it to a fuse.beyond certain current, the fuse melts to avoid damage to the machine.
Sadly,or gladly, we were not blessed with any such thing as a fuse.
When the neurons discharge excessively, the sentient gets a seizure.
Different areas of the brain could be involved in this 'sparkly activity' which is like a party gone wrong for the brain..seizures from each region have typical features as we know.Temporal lobe, for example, would cause a person to enter altered mental states.If the region responsible for peace, contentment. Happiness is involved, its an altogether different story.
Experts say the anterior cingulate gyrus is found to be involved in such kind of 'ecstatic seizure'
It was a chance discovery which opened up many closed doors..
It could be possible that all those shaman's, all those ppl who give a message from the other side, the paranormal, the superhuman and the divine, could have this sort of epilepsy, or some, may even be using the bells, the lights, the noise,the chants to get that ecstatic seizure ,which opens up a window into the other side, prophecies, sermons, prediction, even messages from the 'other' side.
So after much reading and deep thought I concluded that it must be some sort of ecstatic seizures which happen to people amongst all rituals.
Finally, I got the answer to my question.
Now what altered states lead to, how the predictions work, how the messages from the other side are conveyed is still a matter of contention. And , we need to think more about that.maybe in the next blog !
Still interested? Read on..
Relevant article :

http://www.newscientist.com/article/mg22129531.000-diagnosing-dostoevsky-understanding-ecstatic-seizures.html#.UujoCZ-3TqB

An Interesting case of TRUCUSPID VALVE TEAR in a patient with RHD

Patient was. 30/M, known RHD, presented with
Acute onset SOB GR IV NYHA
chest pain
Palpitations.
On clinical examination,
Pulse 120bpm regular rhythm (sinus tachycardia)
BP 90/60 mm Hg
JVP FULL
B/L minimal pitting pedal edema
CVS
apex L 5th ICS inside MCL tapping type
PALPABLE THRILL AT MITRAL AREA
DIASTOLIC SHOCK (palpable P2) at PA
Palpable thrill at tricuspid area
LOUD P2 at Pulmonary area,
SOFT S1 at Mitral area

MDM GR IV at MA ,low pitched,rumbling murmur, best heard with bell in Left lateral position at expiration.

PSM GR IV at TA ,high pitched , best heard in supine position at end expiration

EDM at NAA Gr II high pitched, best heard I'm sitting position at end expiration.

ECG FINDINGS
Bi Atrial enlargement…
RV +

ECHOCARDIOGRAPHY FINDINGS
Heavily calcified Mitral Valve leaflets
Severe MS
MVA 0.66 cm ²( PHT method)
0.82cm ² ( PSAX Planimetry)
Grossly dilated RA &RV
RA volume approx 300 -350,ml
(77x70x71)
RVID basal Diameter 41mm
And now the most interesting finding
Severe TR WITH  'Double ' JET
I tried to see if the jets were arising fromthe same place, but on close observation  and different planes & views, it was clear that both jets were different.
One jet arised from the normal TRICUSPID INFLOW while the other jet originated somewhere laterally .
The velocities of both these regurgitant jets were different.
Central jet being 4.5 m/s
While lateral jet 2.6m/s
They both gave a separate distinct jets visible on Color Doppler.
there was also mild PULMONARY REGURGITATION,
Mild MITRAL REGURGITATION
MILD AORTIC STENOSIS WITH MILD AORTIC INCOMPETENCE.

thankfully there were no clots.
FINAL DIAGNOSIS :
VHD
severe MS (?CRITICAL) with heavily calcified both leaflets
mild MR
Grossly dilated RA RV
SEV TR WITH DOUBLE JET (? TRICUSPID LEAFLET PERFORATION)
SEV PAH
(PASP 75 mm Hg)
Mild AS with AR.
Probably Rheumatic in origin

An interesting case of ?RV CYST ?Pulmonary Embolism

Patient is a 48yr old female , who presented to us with c/o SOB GRIII /IV NYHA
cough
Low grade fever
swelling all over body
since 8 days
She was treated at various hospitals for her condition diagnosed from LRTI to pericardial effusion.
Clinically she had tachycardia, BP was 100/70
Pitting pedal edema
Full JVP
CVS
APEX L 5TH ICS INSIDE MCL
PROMINENT EPIGASTRIC N SUPRASTERNAL PULSATIONS

PALPABLE P2
Loud P2
PSM GR III at TA
RS
trachea central
B/L crepts IMA ISA L>R

ECG findings :
P pulmonale in lead II(RAE)
right Axis deviation
R positivity in V1 V2
(RVH)
incomplete RBBB

I performed a bedside ECHOCARDIOGRAPHY
WITH FOLLOWING FINDINGS

DILATED RA RV
RVID 38mm
Severe TR
TR Vmax 3.6 m/s
Tr Max PG 56 mm Hg
Mild PR
CLOT in RA Appendage
And CLOT IN RV APEX (15-20cc each)
DILATED IVC (18.5mm)

Since ECHO was bedside it remains to be checked if there was an ASD or not.(on a better machine maybe)

patient was started on Anticoagulants immediately with target INR 2.5-3.5.

Pulmonary embolism is often missed out on routine diagnosis.
The triad of Cough ,Shortness of breath , Hypotension must be kept in mind for every patient with unexplained symptoms.
This patient had cardio megaly on x ray
And poor R progression inECG
She was misdiagnosed as CAD n LRTI
In this case patient presented when she developed CCF secondary to Right sided failure.
So moral of the story : Always think of PULMONARY EMBOLISM whenever any pt presents with unexplained cough DYSPNEA .
Corelation of CLINICAL FINDINGS, ECG AND ECHO ARE A MUST.
Images attached.
Comments n queries most welcome..

Update : 22/01/2014

Cardiologist opinion is that its a RV Cyst n not a clot.

Were searching for cysts in other areas

Roadmap of Life

Step 1 : Formulate
Step 2 : Plan
Step 3 : Overview resources
Step 4 : Chart paths
Step 5: Implement
Step 6 : Finalize
Step 7 : Modify, Improvise and Optimize

THE PSYNAPTIC THEORY

0. The number zero is deceptively complicated. It is defined as nothingness. And in the universe that we live in , there is nothing to demonstrate nothingness. There is no nothing.which brings us to the big question can Everything be Nothing? Or can Everything be nothing? Is the world that we live in and the life that we live which means everything to us be nothing? I recollect as a child when I asked my Grandfather who made the Universe n I remember he answered God. When I asked him who made God he said No one. It always intrigued me how NO ONE COULD HAVE MADE EVERYONE. The answer to this puzzle would be in the question itself . DID NOTHING MAKE EVERYTHING? ANS : NOTHING MADE EVERYTHING
0.Being a doctor I would say we are here because of millions of years of evolution right since the beginning of life itself.
             Where some conditions caused some reactions which led to some compounds which started interacting with each other and the environment.And began to replicate itself.
One thing led to another and the first life was created on earth.That cell began to improve and there was a mutation.  This mutated cell began to interact with its surroundings and the mutated cell further went on to become a plant or animal
             Animals evolved   over millions of years of trial and error and after all the probabilities that led to the creation of the human race.And here we are today. Possibly still evolving in the quest for super intelligence in the middle  of this all.
We may become Another species which is superior to the current one.With a better and more efficient brain.             
               This brings us back to the question.WHY HOW WHAT WHEN WHERE. Is it just the creation of Life which is to be taken as a point of reference?     Or should the creation of Life have another precluding event?  
The Big Bang?        Precisely a YES.
But how far can we go  to trace our origins and how far can we go in the future to find out .Lets see how far back we can go.
                Did the big bang really occur?
How are we to know about it? Scientists assume the big bang theory by observing the expansion of the universe and the continuum of the expansion.It led to the creation of all that we know exists in the world.
Could you imagine that simply lying on the bed and doing nothing you could simply ponder over WHERE you are
And   WHAT You are.
               You are lying on the bedsheet which is above the mattress   
Which is lying on the bed
which is lying on the floor       
Which is  the floor of a room
Which is the room of a floor
Which is the floor of a building
Which is the building in a locality
Which is the locality in a city /village
Which is located in a district
Which is located in a state
Which is located in a country
Which is located in a continent
Which is on planet earth
Which belongs to the solar system  
Which belongs to the Milky way Galaxy
Which is part of a Galactic cluster        
Which is part of a super cluster
Which is part of the universe
Which is part of the multiverses
Is that it?                               
Phew.It was so simple to just lie on bed!
It can thus be assumed that the Big bang did really occur.         
Lets look at things the other way round now.
You are lying on the bed
You are human
You are an animal
You are a living being.Along with other non living objects
Composed of compounds
Composed of elements  molecule         
Composed of  an atom
Composed of quarks
Composed of matter and antimatter
Composed of a variety of particles which come to existence and vanish being interchanged among each other.
Being oscillating strings which oscillate from antimatter to matter
The higgs boson.

If we observe the two things closely we could see some fascinating similarities.A recognisable pattern.
A fractal.
But a fractal is 2 dimensional
Imagine a 3 dimensional fractal in which the centre meets its periphery.
What we get is that the beginning itself leads to the end.So on and so forth. 
So at the boson level it could be labelled a mini big bang occuring with every particle.
           In the larger sense this would mean that there are big bangs occuring at both ends of the spectrum.
And if we could correlate with our fractal the small big bangs and the large big bang would mean the same thing but happening at a different scale.
It is possible that our universe itself is the higgs boson that we are looking for. Just that currently it is in the state of expansion
After a point in time it will result in a Big crunch and the universe would become the antimatter likened to       be coming into existence and non existence.
Probability is the main player here.
So the current state of the universe may be described as the culmination of the infinite probability of events that led to its creation. Which would eventually lead to its own destruction and then recreation.
Possibly this cycle of creation destruction recreation is a part of the larger multiverse which may be in existence.
All the properties of the universe are
A result of the probabilities that led to its creation.     Encompassing energies
Like light matter and space time
And keeping in mind the fractal we could assume that if the universe has been created it will even be destroyed.and the destruction would lead to its recreation. It would oscillate between existence and non existence.
It is even possible that every creation would be leading to different energies each time. Energies unknown to us and beyond our comprehension or thinking abilities.Beyond our computational power of probabilities
And it can even be assumed that if the universe while being created led to these entities like energy matter and space time there would even be entities equal and opposite to these and if that were to happen then time would start to go in the reverse direction. Again culminating in the non existence of it all.
The measures of time scale of the universe are beyond our comprehension  but we could still give it a shot. 1 second in time is irrelevant to us but that one second must be the whole lifespan of a matter.  For a fly a time of 1 year may be infinity.For a tortoise even one century would mean that it was in adulthood. Similarly the magnitude of time taken by the   universe to collapse and go into non existence would be infinite for us to think and comprehend but it may be possible that time itself is looped like our 3D fractal  . From the smallest of units to the largest of it.connected to one another.
A seamless transition from infinity to singularity.
There may possibly be   a negative finity as well linked at nothingness.
It also corelates to the number Zero.
The shape of which is a matter of great amuse being round suggesting a loop.again pointing towards my 3D looped   fractal.
One can even corelate this with the brain which is a network of neurons interconnected to each other
Through the synapses.
It may be possible that the events have taken place through probability to result in the creation of the human mind is a culmination of the big bang so that we understand the big bang itself.  So that we can  know how it all happened. Another loop.
Hence I conclude by giving a model of the 3D looped Fractal which may be the answer to all our questions. With the understanding of all this it may one day be possible  to travel faster than light or travel backwards in time.        There may be big bangs occuring at the smallest possible level and even the current big bang may be a part of a similar event of a much larger scale.
In The process of knowing this and proving it right we might just discover many new things or newer modalities which help us  improve our daily life .Life which again a cycle.Of life and death.

After death the human body disintegrates into the atmosphere. The same carbon molecule goes back to the soil where it may be absorbed by a plant which may be eaten by a human being and form his skin and flesh.
Another 3D FRACTAL. WHY ? because we can.WHEN ? Since infinity till infinity.WHAT?    Everything and Nothing.WHERE? Right here right now and nowhere.HOW ?     By asking and finding the reason WHY?         Ultimately summing up to 0.

                                  Dr.Neelesh Kamath