A journey !

I have been a student of the Magnetic Resonance Image studies of the brain for the last thirty three years.

As a medical student I had an opportunity to learn about x-ray imaging of different part of the body.

The MRI facility was introduced in Chennai in 1986 at two hospitals around the same time. It was the KJ Hospital in Egmore which had the unique distinction of having the first CT machine in south India  in the late seventies. But it was the Apollo hospital, Chennai which acquired the MRI first. 

I had moved on at that time to full time practice of Developmental Paediatrics. I was volitionally averse to neurology from my post graduate training days. So anything with neurology was distant to my thinking. But when Anna and I sensed a calling to pursue this specialty, I had discovered a growing desire to learn the essentials of EEG and MRI brain.

The stimulus for this came from Professor Ken Holte, professor of Child Neurology and Developmental Paediatrics at Wolfson Centre, Children's Hospital, Great Ormond Street, while undergoing child Development training at the Institute of Child Health in 1986. His views on EEG and MRI brain were fascinating: Look for clinical signs and locate the sites in the brain which can cause these signs.  

Dr Raju Abraham, a neurologist at Hammersmith Hospital, London gifted me a book on Epilepsy. That prompted me to develop the habit of reading. He even arranged for me to be a visitor-observer at the Electro-physiology lab at the great Ormond Street children's Hospital.  

Dr K.N.Nambudiripad, a neuro-surgeon at CMC Ludhiana spent his latter years in neuro-imaging department to help the radiologists to develop this integrated thinking: 'Look for sites of lesions in the brain responsible for clinical signs'. Later, while undergoing neurology training at the Institute of Neurology, Madras Medical College, Chennai for three years from 1992, Professor Sayed Ahmed, an Electro-physiologist by training as his neurology sub-speciality took an exceptional interest in helping me to build foundations in neuro-imaging and electrophysiology. 

Now, after thirty three years, when I look at at least two MRI of brain and about five EEG tracings of children each day, I have an immense sense of gratitude to these eminent mentors who set me on a self directed journey in this science of interpretation of clinical signs by locating the pathology with the help of the two valuable diagnostic tools.  

The MRI of the brain in this blog is of a child who had perinatal risk factors. The images reveal likely pathology of ventriculitis, vascular insult, periventricular white matter volume loss, and the associated adverse effects on the visual pathway to the occipital cortex on the left side, compromise to the pyramidal tracts affecting muscle tone, power and co-ordination of functions on the right side of the body, perhaps affecting the right lower limb more. The language areas and motor cortex are probably spared. The increased ventricular volume of CSF in the posterior horn of the left lateral ventricle would need to be monitored. The pathology of anoxia, infection and vascular insult had a cascading effect on the brain.

This information was decisive to plan for the developmental prospects of this child and prognosticate the academic skills and neuro-motor outcome.   

I am awed by the clarity of thought which corresponds with clinical signs in such situations. This defines the content of the neuro-developmental support and helps the psychologists and therapists to be precise and area-centric while planning for activation of the the neural functions.

Science is largely observations leading to evidences.

I feel grateful for having been on this journey! It continues.

M.C.Mathew(text and photo)

Seven years and the eight year !

I got out into the courtyard while it was still dark today to check on Dffney, who is convalescing after an infection which made her weak and kennel bound!

My eyes fell on a small rose bush in our garden opposite the kennel. It had seven flowers and one bud!

That sight was a symbolic of 14th September, 2012 when Anna and I joined MOSC Medical College at Kolenchery.  

In fact, 14th September happens to be the hospital day, and this year it is the fiftieth year of the hospital which is being celebrated with many events. 

For Anna and myself the last seven years was a journey of learning abut life, living, and working in health care in the state of Kerala, which was different from all the experiences we had elsewhere in  three states in India or overseas.

For Anna it was becoming part of the pharmacology department and contributing to the continuing medical education initiative and beginning the Institutional Review Board, leading to considerable research activity among medical students. Now Anna is involved in helping to introduce the new medical equation plan of learning for medical students. The innovative hands on practical learning with computer and laboratory based approaches is unfolding in her department. Anna found immense satisfaction from her association with about forty research projects with more than half of them already published in journals. The team of other pharmacologists in her department are her cordial companions in this journey!

As for me, the Developmental Paediatrics and Child Neurology department is hopefully beyond its infancy the end of seven years. The highlight of this experience is the array of services this facility offers to children and parents. Although we ought to be a team of 12 people, we rarely had eight professionals at any one time. Excepting for four of us, the average time other professionals spent in the department was one year, all of them leaving following their marriage. This arrival and departure rhythm would normally dislocate services, but I marvel at the way all the professionals adapted to the needs of children and family to improve the repertoire of services we offer. The five strands that evolved by the seventh year are: child development services, Learning support services, academic initiatives, partnership programme and family support perspectives. 

The rose bush is the smallest of all the rose plants in our garden. Out of curiosity I looked at all the other rose bushes. None of them had more than three flowers or buds this morning. There is abundance of life in that small rose bush as there at least three other tiny buds in formation!

The seven year is the jubilee year for the jewish people according to the instructions given to them in the book of Deutronomy in the Old Testament of the Bible. The jubilee is to celebrate the fruits they received from the land and to give rest for the lant from cultivating for one year. They were to live one year from the produce of the land gathered during the seven years. They were also required to cancel the debts others owed to them. This is an invitation for gratefulness and mindfulness! 

Now that we crossed the seventh year in the department where I work, what inspires me is the one bud in the rose plant. The eighth year is before us! The eight year follows on the seventh year when jubilation and rest was the theme. The eight year is the beginning of a new phase of sowing, planting and gathering of fruits. That is an invitation and an opportunity!

For Anna and me the last seven years was eventful- relocation from Vellore; coping with my cardiac surgery; upkeep of the property and the cottage; some stressful experiences during my association with the governing board of Christian Medical College, Vellore; losing professionals and finding new ones; growing older with several adjustments to make...! 

We found all those challenges bearable because both of us found our colleagues in our departments caring and cordial.

The families of our two children and five grandchildren blessed and delighted us in several ways.

With the blurring of vision in one eye following keratitis during this week, I sensed that the three habits I enjoy most, reading, watching sights of nature, children and people, and photography would suffer! 

So the eighth year would also throw up some challenges ! 

Th rose plant with seven flowers and one bud is rooted in the soil. So it shall flourish.

To grow in that consciousness that we belong to God 'in whom we live, move and have our being' is  both anchoring and restful! 

M.C.Mathew(text and photo)

Golden hour bird photography !

I noticed this bird resting on the enclosed electric power cable in our courtyard. The first picture is of that position when the bird was facing east and the Sun which appeared in the horizon was brightening the sky. Immediately after, taking the first photo the bird moved on to be seated on a water pipe in a dark area.  I gave up on photographing the bird as it looked a difficult task.

I have only a limited experience in bird photography. 

Birds move, especially this one hardly sat in one place for a few seconds, surely not giving enough time to my ageing skills in photography. Most bird photographers use tripods, which has not been my practice because of my laziness to organise that. Bird photographers are usually ready at a particular spot with bird feeds placed in a prominent place to attract birds early in the morning, when they look around for the morning feed. My attempt to have a bird feed corner has not produced the desired effect.  The telephoto lenses make a huge difference. The micro third camera and telephoto lenses I use have some limitations. I moved on to Panasonic system from Canon two years ago as the Panasonic mirrorless camera was lighter. Although I have a full frame mirrorless camera, the long telephoto for it lens is not yet available. 

I have no sense of physics of light. I have gross limitations to use the manual modes in the camera. So I depend on the automatic system and most bird photographers consider that as a lazy way for bird photography.

All the above photos in this blog are grossly deficient in sharpness, exposure, background, colour contrast and composure.   

What amazes me about this bird is the unusual colour complexion of this bird which is about 10 centimetres in length. Its bird song has an outstanding musical pitch. Its body movements are dexterous, although fast and jerky sometimes. It is a movement specialist considering all the different postures it took in that one minute or so the bird was on the second position while photographing. 

From a distance of 100 meters under low light conditions without a tripod, I realised that this was the best that was possible. I confine myself to one cup of coffee a day in order to avoid tremors which have a propensity for those in the seventh decade of life. Now it looks like, even that one cup might be too much if I have to have a better steady grip on the camera.   

I have poor skills in bird identification. Therefore I do not even try to identify them. However, this bird might be a male Purple Rumped sunbird.

What moves me is the elegance in body complexion and its visually pleasing moment behaviour.

Thebirds fly all the time. They begin the day not knowing where to find the daily food. And yet, except occasionally I do not notice a hurry, haste or anxious body language in the birds who visit us in our garden.  

Take time to look at birds. They remind us of the truths Jesus of Nazareth referred to: '.. they do not sow or reap and yet their heavenly Father provides for them..'! 

To me birds are messengers of goodwill giving us a sense of comfort and peace, although they are migrants and have no permanent dwelling place. They have the least of creature comforts and yet they soar high in the sky telling gall of us, that ' live is to experience of fullness of life'!

M.C.Mathew(text and photo)