Live in the moment, Life is momentary

Mind wonders at the daily miracles of life

It's not very unreal appraising those that came along the path of my strife

I wonder why am I here?

What is the purpose of my life?

When limbs are numbed while strength is usurped by pain

Pain can't seem less miraculous than my happiness

When restlessness and deathly silence spread over the pain

Deadly calmness after surviving nerve-searing  pulses bring on hilarity with creepiness

When Mum hugs me

There's a mood of merriment 

A display of gaiety as dopamine dances in my brain

Walking trifle unsteadily

During my repair process 

I smile readily

There are seasons in life and serotonin 

Brings on a tempest of laughter

Who are you? Where are you from?

I am beyond the laws of Nature, says he

I am within you and every creature

Time, matter space are within my control

I know your pain, grief, poverty

 I am the universe where I created wormhole and black hole 

You have liberty

Listen to the melody

I guard you in your times of fear

Because of me, you are here

You are a belligerent soul and I am always here

I am no horrible stranger exploiting  your consciousness

I am happy with my creation's with daring and boldness

I shall bring you a parcel of happiness 

I reside in you since endless time

As the road is long and hard to climb

Your curiosity with too many questions in mind

When Death will visit you, your vivacious and cheerful nature he will find

Your mind will raise a question about his identity

Carrying the noose hearing  the melodies inside, flabbergasted 

He would ask his bookkeeper to look for any vice, immorality.

 Toing and froing he'd return to his throne in netherland

The shadowland where spirits get 

 justice 

I believe in you every morning and after 

Strengthened by my high-spirits you are no joke to be forgotten

 As dopamine motivates and shakes hands to up the mood with   serotonin 

With palms pressed on my head

I said

“Creator, I am thy creation. Thou hast  fashioned me and to thee, I owe the joy of my decaying life.”

Wind of change howling outwards

Whispers in my ears

Good tidings will come

Meanwhile, you will just keep afloat

Traveling in the staunchest but leaky boat

You would have serenity, in monsoons and winters

As soon as the sun enters

Wisdom makes you live intensely

 Life is a snapshot of fairness, hope, happiness

Maintaining equilibrium matters immensely 

I wrote a book where did it go?

I can't wait to think about it tomorrow 

It is your hard work

But her harvest season

I am God, I call it treason

In misery and pain and complicated life, 

It's your strife

She is one of those who desire you would be swallowed 

Indulgent minds  try to gain prosperity by unjust means and don't really care

Their luxury, malicious and unkind nature, success so hollow

Sarvam Dukham Dukham

The desire for money is useless as money can't buy peace and happiness 

 As much as you need for your own personal provision will always be provided 

The hobby of collecting money, being greedy makes the selfish creatures divided

I created humans and put in compassion to work hand in hand

Now it's punishable where they stand

Kinship and friendship destroyed in every land.

Sarvam Kshanikam Kshanikam,

Everything is Temporary, 

The money and wealth acquired by unfair,  unjust means you can't carry

Live in the moment, Life is momentary

Future is Shunya, naught

Give it a wise thought 

There's a great deal of learning to do,

 Life's too meaningless unless delved deep inside questioning self and life

I am not into idleness

I have no grand illusions

Pain and discomfort are a part of life

I do not wish for glory

I do what I am destined to do, suffer 

Without any whimper

I do my duty without considering the outcomes

Not concerning with the implications

I do my work without thinking about the fruition

My pride goeth with ernest devotion

I don't have a disease called fear

When I suddenly found nobody near

God designed us connected and sociable

The stronger the linkup the more fondness

Love, warmth, attachment, tenderness, kindness

Cells are the basic unit of life

All cells only arise from pre-existing cells

 The soul is changing as in the body as it dwells, 

Every moment sometimes as a child, sometimes as a youth 

     And sometimes as an old man.

Ultimately body at death and transmigrates to another body

This is the silent truth 

This is how life began

That's the story of the life of everybody 

I would love to believe that when I die I will live again, that some thinking, feeling, remembering part of me will continue. But as much as I want to believe that, and despite the ancient and worldwide cultural traditions that assert an afterlife, I know of nothing to suggest that it is more than wishful thinking...If there were life after death, I might, no matter when I die, satisfy most of these deep curiosities and longings. But if death is nothing more than an endless dreamless sleep, this is a forlorn hope. Maybe this perspective has given me a little extra motivation to stay alive....The world is so exquisite, with so much love and moral depth, that there is no reason to deceive ourselves with pretty stories for which there's little good evidence. Far better, it seems to me, in our vulnerability, is to look Death in the eye and to be grateful every day for the brief but magnificent opportunity that life provides.-Billions&Billions 

Tale of a bibliophile

 

Oh! My books you are my best friend

Until my end 

My silent companion

Sharing knowledge forever and anon 

You have listened to my all my woes but don't turn away in  my sorrow

I need you today and tomorrow

Traveling to lands of my dream

What I experienced is supreme

Fighting crime without overtime

I'll show them maybe by fighting injustice the next time

I had to keep fighting! I was going to keep fighting!

By looking at you I can visualize, monsters, dragons in distant land

As the naked truth expand

I surrender my heart to joy from the depth of good and ill

Mystery enthralling still.

Oh! My faithful ally

Disclosing secrets

Finishing up an experience I have regrets

The mystery binds me still

As the villain struck the girl on top of the hill

Her hope he tried to kill

She knew despair and valued hope

Thus tried to climb uphill 

With head held high

Where the turf is uncertain

So is the terrain

When she wanted to sigh

She got up with head held high

Choosing a path never trodden by

As lightning struck in the sky

Amidst thunder and storm

Dark clouds taking from

Blessed by heaven so blue

As the demon came into view

She killed the fiend!

Oh, my good friend!

I enjoyed your company until the end 

Understanding of MDR-TB with immunosuppression with latent TB

To all Deus ex machina, every well-wisher, Doctor of mine, and largely to Mum.

World Health Organization says -"Each year, we commemorate World Tuberculosis (TB) Day on March 24 to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic. The date marks the day in 1882 when Dr. Robert Koch announced that he had discovered the bacterium that causes TB, which opened the way towards diagnosing and curing this disease."

The necessity of immunosuppressants for solid organ transplantation.

The transplanted liver needs the immune system to be suppressed so that it isn’t rejected like any pathogen. Immunosuppressants are expensive life-saving medicines. I am on immunosuppressive medicines for life after a liver transplant.

The essence behind continuing an immunosuppressive regimen is that the transplanted organ into the body of the host is not similar in the genetic structure(DNA) of the recipient.

We have been endowed with a wonderfully complex structure called the immune system to protect us from viruses which are essentially nucleic acid DNA or RNA.

Hence, the immune system not having the capacity to distinguish between a new organ transplanted to save life destroys it instead which results in rejection.

Immunosuppressive treatment begins during the surgery and continues throughout the patient's life. Regular blood tests and other maintenance strategies by which medicines at specific doses are adjusted periodically by constant monitoring to prolong the transplant recipient's life and prevent acute or chronic rejections of the graft.

Steroids and anti-rejection medications target T-cells, which are lymphocytes that control the immune response. All immunosuppressants leave the patient more susceptible to infections and less able to fight them off.

Cyclosporine was my first immunosuppressant but I had a side-effect gingival hyperplasia and I looked like a gummy teeth Marvel villain and then I was put on Sirolimus. It worked wonderfully, keeping brain tumors at a minimum. Then again time came for an incisional hernia repair which led to debridement. Sirolimus has a side-effect of slow wound healing so I was put on tacrolimus and mycophenolate mofetil as an add-on. 

When ultimately tacrolimus was changed to Sirolimus I found out in routine MRI I got 2 new brain tumors. But mycophenolate mofetil remained as an add-on since 2016.

The anti-rejection protocol generally is just a shot to your system to suppress everything.

 This almost implies that if you are taking some of these medications you will fall ill every time you pass by someone with the sniffles along with the big stuff, like the flu or tuberculosis. 

Yes, I was diagnosed with tuberculosis which was later found to be Multi-drug-resistant Tuberculosis.

My experience with infections

Soon after discharge I got viral infection varicella and was treated with Zovirax.

I am an MDR- TB survivor with pulmonary, lymph, and bone involvement.

Two years after liver transplant I had a high fever and a lymph node just at the angle of my right jaw used to be swollen. The fever wasn't abating with any antibiotics and I used to have partial seizures.

I got a biopsy of the lymph node which showed AFB+: Acid-fast bacillus (AFB) is a type of bacteria that causes tuberculosis.

TB is a serious bacterial infection that mainly affects the lungs. It can also affect other parts of the body, including the brain, spine, and kidneys. TB is spread from person to person through coughing or sneezing.

More than 4 months of being on anti-Tb-treatment showed lung condition worsening. HAIN test confirmed that the bacteria is resistant and I have MDR TB. MDR TB is a particular type of drug-resistant TB. It means that the TB bacteria that a person is infected with are resistant to two of the most important TB drugs, isoniazid (INH) and rifampicin (RMP). If bacteria are resistant to certain TB drugs this means that the drugs don’t work.

Cogito, ergo sum: I think, therefore I exist. I was only 3 years of age and my father took me to an eminent doctor who has written a chapter on orthopedic surgery which is taught in the UK.  He used to jab and poke every angle of my body with his son-in-law. Perhaps he was looking for my pains and weaknesses while my father used to sit outside. Wounded, hurt, damaged I wouldn't utter a word when auto-vaccines were jabbed in my butt. I couldn't climb the stairs. I dragged myself up then into the bed. I was never fragile or vulnerable, nonplussed or hurt with a cool attitude, I always said there was no pain thinking, this way I might be able to avoid the doctor. It continued for four years when he told my father he has never been a failure but this was the first time. But his unfortunate treatment with cloxacillin made me resistant to plenty of antibiotics. All he had to do was diagnose a blood-filled tumor of von-Hippel Lindau.

This incident at a very tender age made me resistant to plenty of antibiotics. 

After a few months of treatment including streptomycin injections, I got a surgical removal of lymphadenopathy which was still AFB+.

Then I was sent to Dr.Randeep Guleria at AIIMS who changed the medicines to the highest degree antibiotics and the expensive drugs cured MDR-Tb but till this day I need a walking stick to walk and can't do most of the daily jobs for which I have to depend on her 69 years old mother. 

The fun ingredient of life is not only you get bombs in your lungs wherein you gotta lie low hoping they won't go off; they can be diffused by a squad with proper knowledge. Looking forth to sunshine so that the landmines (leptomeningeal hemangioblastomas) don't blow me off with an utter BOOM! 

TB can be latent or active. If you have latent TB, you'll have TB bacteria in your body but won't feel sick and can't spread the disease to others. If you have active TB, you'll have symptoms of the disease and could spread the infection to others. I might have had latent TB, my middle uncle was close to me and I learned from Ma he had TB before my birth. Also, my thinking process says musing about my spleen: The spleen is part of your body’s lymphatic system. The lymphatic system helps remove cellular waste, maintain fluid balance, and make and activate infection-fighting white blood cells for the immune system. It’s also responsible for making substances that play an important role in inflammation and healing. It was noted down during my transplant " splenomegaly with free fluid" but at the same time of TB after my father's death, I realized that I had no report of the test result of the fluid!

Well, Dr. Guleria not only changed medicines but did regular whole-body CT, ultrasound of the neck, and chest X-rays for radiological conferences. He found that from old X-rays I might have latent TB which dated back to my adolescence days. 

I reflected I probably had latent TB which flared up once I was put on immunosuppressants.

In 2013 two brain tumors were diagnosed in those routine CTs and a conference, it was confirmed no, TB hasn't spread to the brain. Unfortunately within 6 months, MRI revealed that I have got leptomeningeal hemangioblastomas.

Supratentorial HB is a rare and benign neoplasm. Very scarce literature is available regarding supratentorial HB. Supratentorial HB, which is quite rare, was first described by Bielschowsky in 1902.

They are most commonly found in the frontal lobe of the cerebrum followed by the parietal and temporal lobe. Mine was in the parietal lobe.

 Embolization was necessary before the prior surgery else all will end up like me.

All patients who underwent primary surgery for HB of the CNS. The median interval from initial surgery on HB of the CNS to the identification of leptomeningeal dissemination was 96 months. I was diagnosed in 60months.

It is very rare approximately from 1902-2013 only 132 cases have been globally reported.

Prior to surgery of the initial tumor, planned embolization should be undertaken if possible to reduce blood loss. However, depending on the actual tumor structure embolization may be found not to be possible. Reducing blood loss may also help in reducing tumor cell spillage and spread. I recall correctly what happened in the OT as I came to and I previously established Brain and mind are not the same. Hippocampus, located in the brain's temporal lobe, is where episodic memories are formed and indexed for later access. Episodic memories are autobiographical memories from specific events in our lives. I recall the bleeding and the total paralysis of the left side.

In 2015 it destroyed my right optic nerve and I am partially blind even after killer sessions of radiation therapy. After 2017 radiation therapy of two growing tumors I got trigeminal neuralgia and chronic ischemic brain.

Cerebral ischemia or brain ischemia, and when there isn’t enough blood flow to the brain leading to limited oxygen supply it may lead to the death of brain tissue, or ischemic stroke.

The trigeminal nerve is also involved with the teeth and often sets in tooth pain so under the advice of my transplant hepatologist I visited the dentist under antibiotic coverage last year. But after returning I felt feverish and fever rose to 105 degrees and three lymph nodes in the neck stood out.

Such unforeseen infections haunted me throughout my life increasing the cost of health maintenance.

Detecting and treating the condition of leptomeningeal hemangioblastoma without delay seems to help survival, though the number of patients analyzed is small. Patients may have other underlying health issues that may affect the data.

Tumors affected lots of body parts like I can't swallow, headaches, uncontrolled menstruation, dizziness, fall at the lightest touch on my leg, my gait is also a problem. I banged myself on the bookshelf, bit my tongue while eating or speaking, pain behind the ear straight from the neck, triggered by chewing, coughing, yawning, talking, and swallowing, and sneezing. When vomit rises from my throat  I feel life is drool-worthy.

I can't go for surgery or biopsy because these tumors are highly vascular and there would be more blood spillage with the risk of bacterial meningitis and thus proton beam therapy can save me. But

a Ga-DOTANOC PET-CT based SSTR imaging because VHL syndrome-associated hemangioblastomas frequently express SSTR confirmed that the floating lights in the brain are hemangioblastomas. With this, the true nature could be seen and the diagnosis was confirmed.

A proton beam directed at a tumor travels in a straight trajectory towards its target, gives off most of its energy at a defined depth called the Bragg peak, and then stops. While X-rays often deposit more energy within the healthy tissues of the body than within the tumor.

A beam of X-rays irradiates not only the area of the tumor but also the healthy tissue that the beam encounters on its way towards the tumor and beyond the tumor. X-rays used for treating cancer usually do not stop within the body. X-rays travel right through you. On the other hand, proton beam therapy is delivered by larger, much more expensive accelerators called cyclotrons and synchrotrons.

My life is short but not void but blessed

I am trying to survive with my Mum throughout giving my best.

Kind giving tree

 

Behold the monster man

My memories remind how he killed 

How he killed his innocent brother

Then hid it and hushed it as best as he can 

And, while my soul is left alive, 

                              As the night-roaming demons still strive.

To  cut the throbbing heart

Right out of the hollow chest,

Making all belief

That the demons perceived best.

And as I shrieked a long and bitter cry

In toil weariness and pain

The most swollen eyes never dry

The thunderbolts that grow with fury, flash, and fly

The world is mournful with grief and pain

Turn it off, it comes again

Silent screams have been going on for years,

But it only falls onto deaf ears.

One to whom the examining Justice sure would cry

" Your honor, how long will be the delay

What makes justice stop and all wonder why?

Why am I denied and why does he roam scot-free

I suffer pain and the reckless, cunning Man roams blame-free

"Life's most persistent and urgent question is, 'What are you doing for others?"

The disease brought misery and agony

But struck life and soul

And soon holding on to happiness became like holding water in hands

Now I can't meet my everyday demands

The horrible death his brothers did die.

He's trying the same with me, have mercy Sir, says I.

The body has taken enough punishment 

Only Mum has provided nourishment

I feel sinful and broken

Hearing words that I thought will never be spoken

I always respected the judicial system now I want to be free

 After fulfilling my destiny

Then taking shelter in the other world under some kind of giving tree

Nurture Mother Nature

The earthy calm with its flora nurtured humankind                        

Nature lent her aid as was ordained by God

Who had a long way to trudge

They stained expectations, 'Tis easier to judge

That his creation would eventually bring its fall

With a mind so small

Heaven never knew they'd grow thicker than peas in a pod

Never knowing in the barren brains with deep vermins of conceits made them blind

        God created them to be bounteous, holy, just,  wise,

Nay, in pursuing fame with lust, temptation

 Lost truth, justice, reputation 

Forgot to be, gentle, kind,

Unenvious, of a grateful mind

Sought the highest bliss and forgot to be humane kind

From fire to tools Mother Nature lent her aids to bless

Gave wise advice to mingle  with charming flora for success

Mosquitoes, worms, and little venomous flies they could slap out of existence

Wild beasts who were meant for coexistence 

With bosom filled with fear

With gazes interlocked wondered if they have a soul

Thought will find when death takes its toll

Heedless of the first sin killed the prey 

Her Mum a fierce lioness was looking for her cub gone astray

Pierced its breast by the arrow on the bank

Others drew back with a doubt of dread 

As one man's foot roused a snake

Who spit venom and all started to shake

Standing close to the water's edge

Saw something flowing downstream

Alive and gleaming under the moonbeam

It was a sweet living thing

From the grassy shore into the shallow water

There came a lance to pierce and it was the first slaughter.

Oysters, crabs, turtles to taste them was another thing

The rest of the world doesn't matter;

For the Thousandth Man will sink or swim

Acclaiming, proclaiming, declaiming Him

Hunting wild pigs, cattle, goats, sheep, deer

As men became advanced science made them aware of the cosmos Every night  they saw yonder hell-fire 

Planets circling and they unite

To decide in the blinking stardust of the pale blue light

For their authority, they'd fight.

Build advanced weaponry 

To protect their territory 

Shine or rain

Clouds of weapons filled the air

Innocents suffered in despair

When weapons clashed heroes bled

Nobody remembered that flowing red

Big Towns were built cutting down woods and meadows where wildlife play

All creatures ran away

Birds flew away

God wishes to punish as humans don't comprehend 

Necessity, pleasure, or lust knows not where Necessity ends

God who grants what his creations hear from every soul 

The only good pleasing news is pained

As he finds his project " Earth" has gone in vain

The sickening human mind is disturbing the food chain

The wretch who can, while he Mischief designs,     

Pull down  old rotten houses, Meadows Mines;

Burns stubs of chopped down trees and spreads dust and smoke

Breathing in polluted air lungs get stressed and choked

Cold and cunning comes forth

Sans wisdom as it has no worth

To punish the wheel of time plans with stars and combine

The foolish heart who wants more

Demands redesign.

What horrid sin condemned the crammed Earth, 

 And cursed a few wombs with such a strange birth?

Tobacco! Oh, the very name doth kill,

Cancer became the deadliest disease.

Sneeze, cough while burning piping hot

Innocents just hang on with what you got

Is the boss of the Earth's disease

The world is stifled but it will not vanish because it is Chinese,

The disease has reduced the overcrowded Earth 

Yet with advanced Science and vaccine refuses to decrease

Because the upper story is empty in most birth

This is like a deadly killer

Who is a winner

Unless we rectify ourselves, use our God-endowed wit

It will push us to the dark abyss, the bottomless pit

So remove all litter

Make sure the air is pure and clear

Nurture Mother Nature and heal her

All sins will be absolved!