On that Night of Terror ten years ago, I was just a few feet away as hundreds died! The Press Club where I was spending that evening and finally the whole night, along with the Editor of the Trinity Mirror is situated a few hundred feet from both the CST station where innocents were mercilessly gunned down, and the Madam Cama hospital where others were ruthlessly shot point blank that night, and a kilometer from the Taj Hotel where mass executions took place. As gunshots receded, we heard the sound of the lone jeep which sped down the road outside, and which carried the three brave officers who became lifeless bodies in a few minutes.

I saw photographers running in, unloading ghastly pictures of the bloodied railway station, where terrified men, women and children, in crouching positions, behind sad, pathetic remnants of their baggage were mowed down by the machine guns of Kasab and his accomplice.

I was hardly a few feet away, and it was only providence that did not allow these terrorists from walking towards the bright lit Mumbai Press Club, where we would have all been sitting ducks for slaughter.

But I believe there’s a reason we scribes were spared; and that, to tell the world, “Never Again!”

Never again should such carnage take place, where both poor and wealthy were targeted and killed, even as they looked at their bloodied selves with lifeless eyes, asking ‘Why?”

Yes why? What made Kasab and gang to willingly sail stormy seas, risk their lives from Navy and Coast Guard, strut through strangers and walk fearlessly into four different locations to kill, and be killed?

Why? Well, evidence gathered, shows they had been fed with scenes of atrocities and conditioned to believe that injustice of a high magnitude was being inflicted on their community in our country. In their minds, they repaid hate with hate. And that is how terrorism thrives; on the wheels of hate!

Those wheels are turning now. With no thought of the damage this can do to our nation, hate is being used as a tool to win elections. Anger, harnessed to create the right atmosphere for violence, and with violence comes injustice as we have seen time and again.

I was hardly a few feet away when the carnage took place. Why, were we spared? I believe, to warn the nation today, that this atmosphere being cunningly created will lead ultimately to more innocents losing life, limb and loved ones!

You can stop it! By stopping such leaders from spreading their messages of animosity, and by you yourself, learning to speak and act without hurting others who do not worship as you do!

Lifeless eyes, from the Taj, CST station, Leopold Café and the Jewish House, plead silently, “Not again..!” 

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Last night I flew back home. While meeting friends in New York, many would tell me how they longed to visit India, “But your flights are so long!” they groaned, “Seventeen long hours! How, do you manage?” Well I’ve managed pretty well, I must say, and quite often have been upgraded to business class, which meant luxury seating and extravagant service, otherwise I’ve found myself occupying a whole row of empty seats where I could stretch out and read or sleep.

This time, as usual I prayed, yes prayed for a comfortable flight!

“We couldn’t get you a window seat dad!” said my daughter after they checkedme in online. When I reached my seat, I saw that the guy next to me had a shoulder and muscles to match that stretched across his seat into mine, and since mine mentally had already lost battle with his, would be kept imprisoned on one third of the seat.

“Didn’t you hear my prayers God?” I moaned as I sat and felt my shoulders ache.

“You slept like a baby!” said Ibrahim Alfaqieh, my broad shouldered Jordanian neighbor.

“Did I?” I asked.

“Well we’ve just landed!” he said with a smile.

I’d slept the whole flight through! And yes ‘like a baby’ as Ibrahim had mentioned.

And that’s when I realized that God’s answers to prayers are different from what we perceive His solutions to be. I asked for a good seat, He gave me good sleep!

A few years ago, when I got into full time writing, our family suddenly needed finance for a medical problem. I knew I had to make money quickly, and decided on three ways. One, a ‘friend’ wanted to sell his house. I asked him, what he expected to get. He told me, and I asked whether, I could help sell it, using ingenious, out of the box ways, and pocket anything extra I made, “You can’t Bob!” he said, “I’ve already told you a very high figure. But do try!”

I did. I made a handsome profit. But the ‘friend’ with his money and with what I was entitled todisappeared to New Zealand. I was then called to design a doctor’s clinic since that was a field, I had been in. The doctor, showed me his clinic. I worked on the design, and suddenly got a call from him, saying he was buying a ready-made already designed clinic.

Two deals falling flat, and the third one, also a business deal, went kaput!

“Why didn’t you allow me to make that much needed money?” I cried out in prayer, and then lo and behold found the money was not needed as the medical problem had disappeared.

“Sleep my child!” whispered a God above, “Don’t worry if your window seat didn’t work, I just increased your sleep dosage..!” 

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Dr. Pradeep Muley

Cancer seems to have a way of deeply invading the lives of those stricken by the disease. And very often the treatment isn't much friendlier to patients. But some recent advances in cancer treatment are helping, including some minimally invasive and non surgical procedures, especially in case of Liver tumours.

While surgery to remove a liver tumor offers the best chance for a cure, surgery is not an option for more than two-thirds of patients with primary liver cancer which is said to be the fifth most common cancer and the third most common cause of cancer-related death worldwide. Approximately, seventy percent of patients with liver cancer cannot opt for surgery for many reasons, like, the tumours could be too large to be removed or they could be too close to major blood vessels or other organs. And many a times, patients may have many small tumors in the liver, thus making surgery too risky or impractical.

Also liver surgery is a complex procedure because many of the major blood vessels leading to and from the heart pass behind or through the organ. In addition, the liver can tear easily and will bleed profusely if injured.

When liver tumors are small in size and number and have not spread to nearby blood vessels – and no cirrhosis or other liver conditions are present – patients may also be eligible for a liver transplant. But again, not many patients are in condition to go through a liver transplant surgery.

In such circumstances, interventional radiologists may perform minimally invasive surgeries like embolization or thermal ablation, etc, depending on the patient's case history. These minimally invasive therapies use imaging techniques such as CT, ultrasound, or MRI to guide the delivery of treatments directly to tumor sites.

In a typical Embolization surgery, the interventional radiologists inject chemotherapy drugs through a thin tube into the major vessel that delivers blood to the liver. The drug is mixed with a substance that not just blocks the artery for cutting off blood flow to the tumor but also restricts most of the chemotherapy drug from reaching out to other parts of the body. Thus, it is trapped near the tumor only.

This type of treatment often keeps the tumor away from getting the oxygen and nutrients it needs to grow, and therefore, healthy tissue is protected. The blockage may be temporary or permanent, depending on the kind of drug that is used to block the blood vessel. The liver still receives blood from a vein that brings blood from the stomach and intestine to keep the healthy tissue alive. Embolization can be repeated to treat recurrences that may develop later.

If required, radiologists may use this procedure to send radioactive particles to tumors that are too large to be treated with surgery which is called radioembolisation. It's a therapy used to treat both primary and metastatic live tumors. This is primarily a palliative, which means it relieves patients' of symptoms and is not a curative treatment. It elicits fewer side effects if compared with standard cancer treatments.

Another alternative way is to send particles into the tumor to release chemotherapy directly inside it for days or weeks. This is usually done with the help of X-rays, that guides surgeon/ radiologist directly to the tumor.

Another technique involves destroying tumor by heat or cold. This technique is often meant for people with three or fewer tumors. There are several types of thermal ablation, including radiofrequency ablation, which uses radio waves to superheat the tumor, and cryoablation, which freezes the tumor. Other types of thermal ablation use lasers, microwaves, and focused ultrasound waves to kill tumor cells. The selection of heat or cold depends on the size, location, and shape of your tumor.

Another non surgical way to treat liver Tumor is through minimally invasive laparoscopic or robotic surgery. In this procedure, a thin, lighted tube with a camera on its tip is inserted through a tiny incision in the abdomen to remove tumors or, in selected cases, part of the liver.

Medical professionals are evaluating the effectiveness of these minimally invasive approaches and their potential to reduce complications that can often arise with traditional, open surgery. For instance, having minimally invasive surgery can significantly reduce recovery time compared with traditional surgery.

Also these treatments benefit patients not just by extending their lives but also improves their quality of life, which is of utmost importance in cancer patients.  

*Dr. Pradeep Muley is the Head Interventional Radiologist at Fortis Hospital, Vasant Kunj

By Dr Vipul Gupta

Pediatric strokes even though rare, is one of the leading causes of significant morbidity and mortality. In comparison to stroke occurring in adults, children present differently with unique risk factors that often optimizes the outcomes. As the risk factors for pediatric stroke vary from that in adults, the cases are often diagnosed at later stages, or remain misdiagnosed.

According to the data reported in various International journals, mortality rate of children suffering from stroke under the age of 15 years is around 25% and the remaining will have a recurrence or will have persistent neurological disorders, difficulty in learning or seizures.  Unlike adults where the risk factors are predominated by diabetes, hypertension and atherosclerosis, pediatric risk factors are more diverse and larger in number.

However the instances of pediatric stroke are under reported and may be more than we realize. This is attributed to the fact that the symptoms mimic other diseases that lead to misdiagnosis and hence delay in its treatment. With recent advancements in the field of neurointervention, the survival rates of pediatric stroke (also suffering from congenital heart ailments, sickle cell disease or other blood disorders) has doubled due to improved intervention and awareness.

What is pediatric stroke?

Stroke is caused by the occlusion or rupture of arteries and veins in the brain and can be ischemic or hemorrhagic or both. Ischemic strokes are more commonly caused due to arterial blockage, but can also happen with venous blockage. When the blockage leads to rupturing of the blood vessels causing bleeding it is termed as hemorrhagic stroke. Ischemic stroke in adults accounts for 85% of all strokes whereas only 50% are attributed in the case of pediatric stroke.

Children are also vulnerable to a mini stroke (Transient Ischemic attacks – TIA) when the blood supply to the brain is interrupted for a very short time. Usually the symptoms subside immediately after TIA, but the chances for a stroke to occur within the next 24 hours doubles.

What are the symptoms?

As stroke can happen at any age, from infancy to adulthood, the age determines the appropriate treatment option for the neurointerventionist. It is thus often misdiagnosed due to the fact that the effects of stroke or its symptoms are not noticeable.

Strokes are first detected when the problems arise with their learning and development. Most noticeably there may be problems with movements in only one side of the body. Seizures are the most common symptom in infants upto 28 days old and in children upto 18 years may experience weakness or paralysis on one side of the body, facial drooping, speech problems and headaches. These symptoms are most commonly associated with ischemic strokes. Symptoms for hemorrhagic strokes include vomiting, seizures and occasional headaches.

The effect of stroke depends on the area of occurrence of stroke in the brain and the amount of damaged caused. People having larger strokes can be permanently paralyzed on one side of their body or lose their ability to speak. But some having small strokes may only have temporary problems like weakness of an arm or leg. With timely intervention most of the cases are recoverable completely.

Who is at more risk?

The risk factors and reasons for pediatric stroke are distinct and varied including malformations in the blood vessels and other congenital abnormalities.

Ischemic stroke is the leading cause pediatric stroke and the risk factors include –

1.    Congenital heart ailments - Heart disorders cause up to 25 per cent of ischemic strokes in children. They can be a result of congenital heart disease, an abnormality present since birth or acquired heart disease. Stroke is not usually the first sign of heart disease. Often heart disease has been diagnosed before the child has a stroke.

2.    Congenital Blood Disorders – also known as prothrombotic disorders, the condition causes the blood to thicken and clot faster. Sickle cell Disease (SCD) is another inherited condition that affects the development of RBC and changes its shape from round to sickle. Though rare, it can also cause bleeding in the brain blood vessels. Other conditions include leukemia, Anemia, and autoimmune disorders.

3.    Arterial Malformation – stroke can occur due to irregular formation of arteries in the brain. Being congenital, children born with this condition often go undetected until the symptoms of stroke are persistent. Such kids need regular monitoring for recurrent strokes.

Hemorrhagic strokes attributes to 50% of the cases of pediatric stroke and the main reason is Arterio-Venous Malformation (AVM). It is a rare malformation of the arteries and veins where the high pressure blood pumped from the heart to the brain directly move to the veins that passes blood at relatively low pressure. This change in pressure causes rupturing of the vessels thereby causing bleeding.

How is it treated?

The treatment for hemorrhagic stroke focuses on stabilizing the child by controlling the blood pressure, body temperature and prevents shortness of breath before treating the hemorrhage. The surgical options include microsurgery to clip the aneurysm or remove the abnormal vessels.

The treatment for ischemic stroke works on to reduce the damage to the brain and prevent another stroke. Doctors prescribe blood thinner and also monitor reflexes, eye movements, speech skills, swallowing and other body functions. Also how the child is processing to and reacting to light, pictures, sound and touch. 

Dr Vipul Gupta is the Director, Neurointervention, Agrim Institute for Neuro Sciences, Artemis Hospital

In America, there are many who ask Trump, where’s the Wall he promised he would build. A wall that would keep outsiders out. And in India, there are many who ask about the Temple. Where is the Temple, that was supposed to be built?

Where is The Wall and The Temple? Why have they not been built, the people cry.

“Hey people! Are you so blind, that you cannot see?”

“What?” cry the people who have asked for wall and temple.

“That the Wall has been built, and the Temple too!”

“Where?” ask the people, surprise on their faces, “Where has the wall and the temple been built?”

“In your minds!”

“Walls have been built in what were once the United People of America, dividing, the white man from the rest, and the country from the rest of the world!”

“And the temple? Where has it been built?”

“Again, in your minds! Dividing the people who worship in temples and the people who don’t!”

“Yes!” cry the people, a hush entering their voices “We do see the Wall and we do see the Temple, built in our minds!”

And then from the Wall and the Temple do I hear a cry, “We are not meant to separate! We are meant to protect! We are not meant to divide, we are meant to unite!”

“I,” says the Wall with humility, “Protect, those that stay within, against those that attack my people in the world outside. I am not meant to divide, but to stand, shoulder to shoulder with each brick that makes me up, and safeguard, those who live within! How, ever, was I made a wall that divides?”

“And I,” says the Temple, “Am built to bring peace in the minds of men. To show that war and murder are not the ways for man to impose his feelings on another. How, ever, did I become a temple that divides?”

In silence the people stare, and then cast down their eyes. “It is we who have allowed those bricks to be built to divide,” they say, “It is we who opened our minds to division and destruction!”

“Then open your minds again!” cries the Wall.

“Open your hearts!” cries the Temple.

“Let peace and quiet be restored in you!” cry the Wall and the Temple, “Let nobody plant thoughts about us that are not the truth! We are meant to protect and pacify. Not divide and destroy!”

Yes dear people, pull down brick by brick, false walls and temples built by those who want to separate and sever, and build instead Walls and Temples that Safeguard and Still the minds and hearts of men..!

Which is what walls and temples are for, isn’t it? 

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