Note: Shashikant finished writing this around 1st of October.
This report is about a harrowing medical emergency I went through about a month ago. To be precise I had a terrible problem on the morning of August 23rd. I thought I will document it for my own satisfaction for posterity. I was motivated by similar write ups penned by a doctor I know, Dr. Shantanu Abhyankar from Wai, a town near Mahabaleshwar, Maharashtra, who suffered from cancer. Being a doctor himself, he was able to analyse what was happening to him through his medical understanding and that made his write up very informative. I was quite impressed by it. I had been impressed by the detached way in which he had written it. I thought I will try to do the similar thing. But, of course my report will only describe my experiences. He had looked at what was happening to himself and described it vividly. I will not be able to provide any medical insight in my report.
The actual problem occurred on August 23rd but I will start the description from a couple of weeks before that. A problem started on August 10th when I thought of putting all flower pots I had in the gallery (what people call ‘patio’ in the US, a term I learned from my grand-daughter) on a couple of steel racks to make the set up look nicer and also make it easier to clean the floor below the plants. Purchasing racks and bringing them home was no problem. But the mistake I did was to put the pots on the racks myself. Even worse, I put them in a wrong way, i.e., lifting the pots while bending my back instead of kneeling and using my legs for lifting. Theoretically I knew it was wrong but I had lifted things this way many times before. So I thought that doing it again would be fine. It was not to be this time. May be because there were about a dozen pots and they were quite heavy as well. While doing this, I got severe pain in my lower back. Almost like beginning of spondylitis. I made a make shift belt, took some pain killers and managed that night. Not a great problem. Next morning I was feeling ok. So I decided to do my usual morning walk, although a bit shorter – about 4 kilometres. I was extra tired after that but it was not too bad. After a few hours I realised a new problem seems to have started. Now the pain in the back had stopped but the pain had shifted to my upper leg muscles. It seemed to be just muscular pain, so I took some more pain killers, applied volini (a pain balm), and decided to rest for the day. By evening the pain had subsided so I just slept over it.
Next day we had to visit our family doctor Dr. Mishra regarding my wife Meera’s diabetes related issues. I could not go for my usual walk as the appointment was in the morning. In any case, I was also not feeling up to it. Around 10:30 in the morning we went to the clinic by auto rickshaw. One has to climb a few steps there for reaching the lift. I tried to do that but I found my right leg was unable to lift me. It just gave up and I found myself sitting on the floor. Meera and some other people around lifted me and then I climbed these steps using just my left leg. I could do that without any problem. I had no issues walking on flat surfaces. However, I could not put any weight on my right leg while climbing. In fact we had got down at our apartment, walked to the auto rickshaw, and walked into the clinic building without me realising that I had any issues climbing. So the doctor had two patients now, instead of one. She suggested that we see a specialist at Deenanath Mangeshkar hospital. After leaving the doctor's clinic we went to the bank, which was nearby, did some transactions there and went home. I was tired but not very much. There were no visible effects of the pain in the leg muscles. But I had to make sure I did not climb using my right leg. If I did, I would have to pull myself up using my right hand.
Deenanath Mangeshkar hospital is one of the large charitable hospitals in Pune. Mangeshkar siblings initiated the idea of such an institution to be built in Pune in the memory of their father, Deenanath Mangeshkar. The Mangeshkar siblings, Lata and Asha are well known even among many non-Indians. They are of course legends who will be remembered forever. Many will not know of Deenanath. He was a classical vocal singer but in Maharashtra he was better known for his natya sangeet. He was a singer-actor in Marathi musicals. He died quite young when the Mangeshkar siblings were children but before his death, he trained them in classical singing. That is considered as a solid grounding for them in music. Hrudaynath Mangeshkar is not as well known as Lata Mangeshkar and Asha Bhosle but he has also sung and given music to many songs. He is better known for his music compositions. To cut the long story short, Deenanath hospital is a large charitable hospital in Pune. It is not like a public hospital where treatment is free. There are charges which are not too large. But it is not expensive like the five star hospitals which have come up in big cities. It primarily caters to middle income group and has made medical facilities affordable. This is a noble service the Mangeshkars have done and it will be remembered forever, in addition to their music. It is also a large hospital having practically all specialities under one roof.
As suggested by Dr. Mishra, we took an appointment with an orthopaedic expert, Dr. Pathak at Deenanath and saw him. He examined me, including an x-ray scan. After the examination he said there was no bone problem but a muscular issue, confirming my suspicion. He gave me some tablets and asked me to see a physiotherapist who recommended some exercises and ultrasound therapy. That was under our control as well. But it meant visiting Deenanath every day for a week. That course was done and then I met Dr. Pathak again. He was happy with the progress of the leg and suggested that I start my walking routine and increase the length of the walk slowly. I was doing a few thousand steps every day at that stage. I was still not forcing anything on my right leg. Dr. Pathak's assistant had suggested that exercises for the right leg should wait for some time.
That was the state for a few days. I was not getting very tired and there was no breathing problem either. But on August 21st, I got extremely tired after walking about five hundred steps or so. So tired that I had to sit and recover my breath. I did one more round but the same thing happened again. So I stopped and went home. Then I realised that I was getting breathless after walking just from the bedroom to the living room. I was able to recover my breath after a couple of minutes or so. That should have been a warning signal but thought I would get over that. That was the state on the night of August 22nd. In between we had seen another doctor, Dr. Apte, who recommended a test called HRCT of the chest to check if there was any infection. He saw the test results and recommended some tablets.
On the morning of August 23rd, I got so tired after going to the toilet that I was panting for nearly 10 minutes. I thought of checking my oxygen level (SpO2). It had gone down to below 75. My breathing was so heavy that I thought my heart was on the verge of giving up. After spending about 10 minutes in this condition, my breathing started stabilising, SpO2 started climbing and after 10 more minutes, my breathing recovered and SpO2 climbed above 90. I thought I had had a heart attack – or at least very close to it – during those 10 minutes.
After this incident, Meera and I were rattled. Meera called Dr. Apte and asked if he would come and examine me. He said he did not do home visits and suggested that I be taken to Deenanath for emergency treatment, During the 2 years we were in Pune, we did not have any occasion of consulting a doctor urgently. In fact we did not have a family doctor here. Now we have found that there are panels of doctors whom we can call in emergencies. One of the doctors on the panel would do a home visit and advise. Anyway, we called our regular driver. It took some time for him to come and take us to the hospital. We have a car but I don't drive now. And in my present condition, driving was out of the question anyway. We call a driver who comes and does chauffeuring. So, in a way there is a panel of drivers as well. Anyway, we were at Deenanath by about 11:00 AM and I was immediately examined. But no rooms in the ICU were available immediately. So I was parked in one of the enclosures in a large hall with about 10 such enclosures, where my treatment was started. Each enclosure had essential instruments and anything more can be set up if required. I was being monitored by a junior doctor who was in consultation with the specialist, Dr. Kulkarni. I was observing a flurry of activity around me but was not in a position to comprehend much. Eventually an ICU room was available at around 6:00 PM and I was moved there.
I was on a bed in the makeshift ICU and the bed itself was moved to the regular ICU. Actually, it was a set of twelve ICUs in a big hall. I was moved into that area and now I was completely by myself. Nobody was allowed in except when I called for whatever reason and visitors could not linger there. Each room was large but somewhat bare. Not many instruments were there on a permanent basis. But it could be upgraded as per requirements. For example, the room which I was in could be upgraded to a dialysis room if required. In fact that's what happened after a day. There was a patient for dialysis so I was moved to another room. Besides this set of twelve ICUs, Deenanath has twenty odd more ICUs which are called semi ICUs as they are not as well equipped as the twelve I mentioned earlier. Patients who are not critical and do not require constant nursing assistance are moved there. This roughly gives the reader an idea of the number of patients treated at Deenanath.
After a couple of days I came to know the gravity of my situation. My lungs were practically not functioning. I was being supplied oxygen at the rate of 18 liters per minute (LPM) and it was lowered to 16 LPM the next day. I had severe infection and had developed fibrosis of lungs. Dr. Kulkarni had told Meera that I may need oxygen all my life now as the fibrosis is permanent. This condition occurs among people working in mines. Heavy smokers are also likely to develop this condition. I used to smoke but had stopped about 25 years ago. While my earlier smoking may have taken its toll, I was jogging and walking without any breathing issues until very recently. But in my case, this problem had escalated in just a couple of days. So, my mind was telling me that it could be reversed and that it was not a chronic issue. It may take long but with breathing exercises and pranayama it should be possible to reverse the fibrosis. But I kept this opinion to myself. I thought I would wait until I returned home and then start pranayama etc.
After about a week in the ICU, oxygen requirement was reduced to 6 LPM and considering other parameters, Dr. Kulkarni thought I don't need to be in ICU. So I was moved to a regular room. He said when the oxygen requirement fell below 4 LPM, I could go home. That happened by September 4th but we had to arrange oxygen supply at home. That took a bit of time due to the ongoing Ganapati festival.. Ganesh Chaturthi was on September 7th and 8th was Sunday. On Ganesh Chaturthi, everybody (well practically everybody) brings Ganesh idol home and does Puja etc. So, practically nothing moves. As a result, we got the oxygen concentrator installed and working on the 9th and I was moved home on 10th evening. The occasion was celebrated with a cup of tea. The oxygen requirement was now between 3 and 4 LPM.
I have not figured how the concentrator works. Basically it separates nitrogen from the air to get concentrated oxygen. It has to attain 90-95% purity. The amount concentrated per unit time is small and it is passed on to the user. My guess it could be using centrifuge technique. But I need to do some reading on that. Besides the concentrator, we have some oxygen cylinders as back up.
Today is September 21st so I have been home for 11 days. Let me review what has happened in this time. The oxygen requirement was 3-4 LPM on 10th. We have been reducing the intake gradually. Over these eleven days the intake has been reduced to 1 LPM. With this amount, the SpO2 is stable above 95 while resting. When there is some exertion, like a bit of walking, standing etc., SpO2 value comes down to 85-90. After a few minutes of rest it goes back up above 95. If I just rest without oxygen support, it takes 10-15 minutes for SpO2 to drop below 90. So, this experimentation means that the lungs are improving their capacity, albeit slowly. Deep breathing seems to help. I will need to continue the process over a long period of time.
In the mean time, another problem has cropped up. I am being given steroids for quick recovery of lungs. That has led to an increase in my blood sugar. Dr. Kulkarni had not given any medicines for this. We consulted Dr. Mishra about this problem and she suggested I start long time acting insulin supplemented by small dose of fast acting insulin before each meal. With this regimen, my sugar is also in control. I have lost substantial amount of weight, about 9 kg. The weight loss is mostly muscle mass. That can only be reversed when I do some exercises. Just walking inside the house will help in the initial phase. Later, I will need to go out and walk. But that is a few weeks away. Our apartment complex has a nice terrace where I can do initial walking. When the walking distance becomes large I can go on the road. This is all for the future.
But the doctors are not as optimistic. The diagnosis is that I have fibrosis of lungs possibly due to some infection I had. That means the capacity of my lungs has severely reduced. Because of fibrosis, lungs cannot expand as much as normal so the oxygen in the lungs cannot be transferred to the blood. That is the reason for low SpO2, especially when I physically exert myself. Doctors think this cannot be reversed so I will need oxygen support for life. But I think with some pranayam and breathing exercises the condition can be reversed at least to some extent.
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