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Paediatric & Adult Spine Clinic

Happy to announce that the Spine Clinic for Children and Adults will be functioning on all days except Thursday at Palakkad District Cooperative Hospital & Research Centre, Palakkad, Kerala.

This will cater to all variety of Spine diseases in Children and Adults.

Common diseases like Disc Problems, Infections of Spine ( Septic Spondylitis ) , Tuberculous Spondylitis, Scoliosis, Spina Bifida are treated here.

I am available for consultation on all days except Thursday from 10am to 4:30 pm. Please contact Palakkad District Cooperative Hospital for details and appointment.

Please find the location of the Hospital here

Paediatric and Adult Spine Clinic, Palakkad, Kerala
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Children’s Fracture Clinic

My Clinic restart has been delayed due to Covid situation and we have noted that children with fractures are having difficulty getting consult for emergencies.

A speciality Fracture clinic for Children run by Dr. Easwar TR is operating at Malabar Hospital Palakkad.

Treatment is provided for all types of children’s bone problems, sports injuries and fractures. The service is available around the clock in association with Orthopedic doctors at Malabar Hospital, Palakkad.

For Emergencies and Appointments please contact Malabar Hospital for appointments.

Phone 📞 :  0491 252 8200,
                    0491 252 8201,
                    +91 99952 33666

Children’s fracture clinic for bone and joint problems, fractures, sports injuries at Malabar Hospital Palakkad Kerala by Children’s Bone Specialist Dr Easwar TR

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The COVID19 Challenge ~ MedTatva Apps

To help with ongoing #COVID2019 #Pandemic crisis we at https://medtatva.com have launched 2 apps 1) https://bit.ly/3dPx1Kx for #CoronaVirus Symptom checker to allay public fear and 2) #COVID19 #AI #Chest #Xray analyser for #healthcareprofessionals https://bit.ly/39Kvx0T

You will need a free account to get started. Registering is simple and free. Get yours at https://medtatva.com/signup. Remember to read the Terms and Conditions, Privacy and Disclaimers before using the App and the website. Kindly keep in mind that Privacy policy when uploading data / personally identifiable X-ray on the website.

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MedTatva : Tool to screen for #COVID19

We are all going through a tough time with #COVID19 #Epidemic. It has been a testing time for doctors, public and administrators alike. The poor have been hit badly and are under threat as the epidemic is still spreading in various countries as we speak. Access to healthcare, paying capacity, travel are all issues that the citizens of various demographics have to confront.

We at MedTatva [ https://medtatva.com ], have been trying to solve accessibility to healthcare and diagnostic tools by using technology.

Past few days we have put together the best recommendations from CDC and WHO to build a symptom checker that is simple and which could be completed in less than a minute by a non-medical person.

Please find the screening tool here : https://medtatva.com/coronavirus/home

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Tribute to the Eternal Mother ❤️ – Digital #Art of Cerebral Palsy

Cerebral Palsy is such a difficult disease to handle and treat for the health care professionals.

The treatment process needs to take the parents and family members along so that these children get optimal care. It’s important to reinforce on the parents and lift their morale throughout the course of long and arduous treatment.

I routinely arrange seminars and medical camps and arrange public events in association with groups serving these children to help them and keep caregiver morale high. It’s a fight, a relentless fight against Cerebral Palsy.

It never ceases to amaze and move me that the mother , however humble or rich , illiterate or well educated, they may be cares for the child and stays with child through thick and thin.

Wacom One CTL and MyPaint on Linux works like it’s a match made in heaven.

My Digital Art on a mother caring for her child with Cerebral Palsy – Drawn using Wacom One CTL 472 and MyPaint Open Source Software.

This painting is part of the #ArztForACause fundraiser for children with Cerebral Palsy , Autism and Movement Disorders

She literally is the guiding light of the treatment, showing the way and proving that she’s the true representative of the all giving , ever loving Divine Mother

Cerebral Palsy - Digital Art
A Mother leading and lighting the way of care for her child with Cerebral Palsy – Digital #Art
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Story of Anuiruddhan – Junior National level Roller Skater

Anirudhan V, Roller Skater National Junior Champion prospect ~ an inspiration !

Am writing below the inspiring story of Anirudhan V, studying in the 5th class at Bhavans Vidya Mandir, Chithali, Palakkad, Kerala.

He is the son of Advocate S. Vinod and Advocate M. Deepa of Kuzhalmannam, a sub-urb of Palakkad in Kerala State.

 

Aniruddhan with his father. His latest fracture a minor blow in his quest

How I met Aniruddhan and his father

 

He came in to my Outpatient clinic, brought by a common friend who’s son is also a roller skater. Aniruddhan suffered a fall while practicing and had fractured his right wrist. With a competitive sports time away from tracks and practice is time somebody else could spend to improve and get ahead of you. I advised his father that since the fracture could be immobilised in a cast with artificial material giving it some strength that a regular plaster of paris would, he could get back to practice with his cast on the same day. We could always do weekly check-ups to see whether the cast is becoming loose or if the fracture is moving and alter treatment plans accordingly. Aniruddhan’s dedication is so much that he jumped at the idea. His father, who has been encouraging him also advised him to do the same. 

 
This simple act of dedication and ability to tolerate an adverse event inspired me to ask more about him. What I heard from his father about him merited a small story. I cannot divulge many of his early struggles because of patient confidentiality, but what ever his father found non-sensitive I am sharing with the world to inspire other kids (and parents) who dream. Hopefully it would make them dream bigger and reach higher. 
 

His story, a simple inspiration

His story of how he overcame hurdles in his early education and learning difficulty by complete dedication to his sports and earned peer recognition is wonderful to hear. Not only did it help him achieve laurels in sports it also helped him overcome his difficulty in learning and progress there too. I suppose sports does that to people. With intense training in balance, coordination, fitness, struggle against odds, facing the exhilaration of success and depths of failure character builds. 

Doubtlessly.

 

Tough Life of practice, dedication to sports and education

Aniruddhan is now 11 years, in 6th class has been religiously getting up at 3 am every morning for the past 4 years. His father accompanies him to Coimbatore, a nearby town about one and half hour by road, where there are facilities for roller skating practice. After practicing for 2 hours he returns at 8 am and then does his full days school and then in the evening does his road practice on Roller Skates.

 

 

It is no wonder then that Anirrudh is a National Level Skater and deserves every bit of encouragement he can get. He sustained an unfortunate accident and fractured his wrist last week. Aniruddhan has a cast on him now, but his spirit has not been dampened. I have recommended to practice roller skating with his cast on !

Aniruddhan’s story has just begun. He is at the Junior National level now with mile of hard training struggle ahead of him to get ahead of the tough competition. However, if what I have seen is the attitude he keeps then his success is sure, in time.

 

He has now moved to inline skates and is entering the world of elder children with some tough competition ahead of him. I am sure that with his dedication to the sport and will to practice in spite of odds he will shine through and bring laurels to his loved ones and country !

The story of Aniruddhan is one among the many who have come out of all odds and made it to the top. Watch this space for more inspiring stories of child athletes, their battle against sports injuries towards victory.

 



Aniruddhan V , on Roller Skates

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World #CerebralPalsy Day – October 6, 2018

#WorldCerebralPalsyDay is afoot. Like last year, I am planning to conduct month long events across Palakkad and Shoranur to raise parental awareness on treatment of #CerebralPalsy.

Most of the parents who come for care of their children come late, unfortunately with joint contractures, hip subluxations, alteration in knee mechanics and foot deformities. Aside from these the problems these children have with upper limbs, hands and doing activities.

Many of these children have uncontrolled seizures, terrible difficulties communicating, speaking out their issues apart from ambulation.  Ambulation may in fact be least of their issues. This sad fact goes to show how important early referral is and how important it is to enroll the child under a care of a Pediatric Neurologist, Pediatric Physiotherapist who can then co-ordinate care with their colleagues in Pediatric Orthopedics, Pediatric Medicine, Occupational Therapy, Speech Pathology, Audiology etc ..

Cerebral Palsy care is a great team effort. No part of the team is greater than other, but the role of the General Practitioner / Pediatric Medicine Doctor, Pediatric Physiotherapist is central, at least in India. They determine the sole referral entity, a person with whom the parents spend their maximum time and trust with. They are the ones in whom they confide most of their issues with.

World Cerebral Palsy Day is a wonderful concept to reinforce these simple care giving principles. Parent education and empowerment being central to the cause of care of these children. Like 2017, we are organising activities across the district of Palakkad – in Palakkad town and neaby rural areas and Shoranur town to educate parents and also conduct early detection and intervention camps to identify children who need care.

World Cerebral Palsy Day - at Palakkad and Shoranur, 2018
World Cerebral Palsy Day – at Palakkad and Shoranur, 2018

Activities planned :

  • Free medical camps for underpriviliged children
  • Special clinics with Gait Analysis
  • Funded Orthotic programme for poor children
  • Pediatric Physiotherapy advice
  • Custom made Wheel Chair fitting
  • Parent awareness of Cerebral Palsy – lectures and symposias in rural areas
  • Notices and public handouts to improve general awareness
  • Involvement of other NGOs , social service organisations to improve public outreach

These activities would be done throughout Ocotober 2018 under aegis of the Cerebral Palsy Clinic at Rajiv Gandhi Cooperative Hospital & Research Centre and ICCONS, Shoranur

Contact Numbers for Clinic bookings  and more information:

  1. Rajiv Gandhi Cooperative Hospital, Kallekkad, Palakkad : 0491-250-9000
  2. ICCONS, Shoranur, Palakkad                                                   : 0466-222-4869
  3. Contact me                                                                                  : EMAIL

 

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Making Media rich Medical Presentations using Emacs, Org-mode and Reveal.js – Part 1

Scenario

As a practicing Paediatric Orthopaedic Surgeon, I am called to meeting to present my work. This involves presenting to peers, co-workers, patients and parents of children I care for. Each of these presentations will be with a different focus on a particular topic. 

While this is not an uncommon scenario, the solution to create a reusable presentation slides using #OpenSourceSoftware tailored to individual audience is. Most doctors are not familiar with programming environment  and shy away from anything that is not WYSIWYG. They rely on good old #PowerPoint / #Keynote to save them. At the most some of them may try and use the clunkly #LibreOffice or #OpenOffice if they want to stick to OpenSource. Recently with advent of tools like Prezi, media heavy interactive presentations have become popular. The popular presentation softwares of KeyNote, PowerPoint have also spruced up their animations and transitions to enable them to look more attractive. Still the WYSIWYG nature of these and point-and-click makes them very slow. We could achieve better, faster and more attractive results with using #FOSS tools. 

 

What I use now

For the past few years I’ve been using a combo of 

  1. #LaTeX via #beamer class 
  2. #RevealJS ,
  3. #Emacs, Org-Mode, org-reveal
  4. #HTML5 and #CSS3
  5. FOSS Image and Video editing softwares as required to arrange the media. I mainly use GIMP, InkScape, KdenLive, OpenShot, HandBrake to arrange my media and encode them. 

My choice depends on the demands of the presentation. 

For media heavy, especially video heavy presentations I use RevealJS. For presentations that are more of less static with few videos I tend to use Beamer / LaTeX. What I note below are my experiences as I tried to create a smooth workflow that could replace PowerPoint ( or KeyNote / LibreOffice ) as a tool to create #Medical Presentations. 

Overtime I have refined my workflow and now I find that I am far more productive and my slides can pack much more information than a power point slide. While the more advanced interactions would require some knowledge of JavaScript, and therefore would turn off most doctors, most of what follows require minimal programming use. 

I will detail my workflow to create simple fast layout using Emacs and RevealJS without handcoding of JS and HTML. We will be relying on the RevealJS, Emacs, Org-Mode and ox-reveal package to do the lifting. 

 

Disclaimer : Even though it doesn’t need programming knowledge, ability to use Emacs is a must for this workflow. It is preferable that one is on a Linux OS as the attempt is to go all #FOSS here. 

 

so, here goes ….

 

Aim

To create an visually impressive medical presentation using non Power Point open source (FOSS) softwares.

Tools

  1. Emacs (24.3 or greater)
  2. org-mode
  3. org-reveal
  4. Reveal.js
  5. Chrome Browser
  6. Open source video codecs on the system

Why this and not PowerPoint ?

Over the years Medical Conference presentations have got mature and old tools have got boring. Varied audiences, topics, media content , interactivity required, transitions and animations to keep audiences interested have all changed.

PowerPoint with it’s traditional set of tools is boring to say the least. The point and click interface is slow by comparison to plain text typing. This seems counter intuitive to PowerPoint pandits but I’ve found that once the media is arranged and readied, once can create more far more attractive presentations with the tools mentioned above. 

As far as medical presentations go, the video presentations embedded PowerPoint / LibreOffice have a habit of breaking on stage. I have seen numerous instances of this happening.

And, of course PowerPoint costs 💰💰

It is also Closed Source making it difficult to edit and reproduce when you are with a system where it is not installed.

 

Okay, but why Emacs, why indeed ?

Emacs is Open Source

Emacs is stable

Emacs is good

Emacs is better than #Vim

Emacs has un-paralleled number of extensions and programming support

Emacs has Org-mode… 

 

Okay, So why org-mode, what has that got to do with presentations ?

org-mode is cool

org-mode is simple text

org-mode can be manipulated anywhere with text-editor

Its FOSS

It can be extended with other tools like org-reveal

 

Hm, Okay, but why Reveal.js ?

An actively developed FOSS Tool with a community

Allows 2D stacking of slides permitting nesting

Plugins and all the JS/CSS/HTML5 goodies can be integrated

Very good slider-presenter notes

PDF export option for handouts

Very nice transitions and animations

Good builtin themes and literally infinite customisation options as per CSS

Works very well with slide-projectors and remote tools to advance slides

 

Okay, but why use org-mode / org-reveal with Reveal.js ?

Org-mode is cool, easy, transparent text typing

org-mode is structured and nested just like a regular presentations would be

One can easily do a text-only sketch of a presentations by typing out a few lines of text in org–mode formatting and out put a neatly animated stacked presentation in Reveal.js

If one were to code HTML and JS with Reveal.js, it would be considerably opaque, with HTML markup and JS obscuring the structural details of the presentation.

By integrating org-mode, org-reveal and reveal.js we are integrating all that is good in respective tools while sticking to what the non-programmer user ( an average medical professional ) would like to do – type text and structure the presentation.

 

So, How to go about making one ?

Part 1 : Preparing the ground

Step 1 :

Install GNU-Emacs > 24.3

 

Step 2 :

Update package-archives and use Melpa archive.

Update org-mode.

 

Step 3 :

Install ox-reveal package

 

Step 4 :

‘require(ox-reveal) in your .emacs file

 

Step 5 :

Download and keep the Reveal.js file in a folder.

Note down the path to the folder relative to the folder where the presentation will live.

If you have Bower installed you can just do bower install revealjs

 

Step 6 :

Create a folder where your presentation will live. 

Inside the folder create subfolders for Images, Videos, Scripts, CSS styles and other documents which may be needed for the presentation. 

Now we can create the main file of the presentation – the Org-mode file using Emacs.  Org-mode file is a simple text file which can be opened using any other text-editor. It has the extension of  “.org”

While using Emacs and Org-Mode, however, it provides lot of goodies. Org-Mode in Emacs has lot of extensions one can install that extends it functionality. One can for example use the same org-mode file to output HTML, LaTeX, and PDF. 

So let us create the main presentation file. I title my presentations the following way, giving it context, separated by underscores : <topic>_<audience>_<date>_<venue> . For example if I am giving a public talk on Cerebral Palsy at my home town of Palakkad, on July 30th,2019 , I would title my presentation like this : “CerebralPalsy_PublicTalk_Palakkad_30072019.org”

This allows me to keep separate org-mode files for different audience and keep using the same images, videos etc.. Therefore I am fully portable and self-contained when I have to whip up a presentation tailored to any particular audience – technical or non-technical. 

C-x C-f  in Emacs  to the file you want to create with .org extension.

C-C C-# to insert Template for a Reveal.JS presentation.

If you have ‘ox-reveal loaded it should be available as a choice.

Once chosen it will list some options at the top of the org-mode file.

We will need to provide the path to the REVEAL_ROOT directory to the place we have stored the reveal.js library. This path is relative to the folder where the file for presentation lives. 

Once these are done, It is important to get the images, videos ready. They have to be edited using FOSS tools for editing photos and videos. Once edited they’ve to be named properly so that we can reference them in our presentations. 

 

This completes the ground work required to start writing the presentation. While this may seem a lot of work, one must remember this is one time effort.

We will deal with the actual creation of  org-mode file, the options while using Reveal.JS in the next part ….

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DDH – Its June !! It’s Dysplasia Awareness Month

DDH otherwise called Developmental Dysplasia of Hip is a condition where the ‘ball-and-socket-joint’ of the hip is not formed well at birth. It used to be called Congenital Dislocation of Hip.

The child is born with a slightly misfitting hip joint where the ball is slightly shifted out of cup or a hip joint where the ball is completely outside the cup and cup is also very shallow. This can occur on one side or both sides.

Developmental Dysplasia of Hip - Left hip is dislocated
Developmental Dysplasia of Hip – Left hip is dislocated

Why does it happen ?

Most times its ‘Idiopathic’ , a medical term which means – cause is not known. In many other patients, the child will be having one of the syndromes (a group of clinical features and disorders in other organs systems and external appearance) or neurological issues in the spine (like meningomyelocele) that also causes this. This second group is sometimes medically referred to as Teratogenic DDH and is much more difficult to treat.

We will discuss below the aspects as related to Idiopathic DDH. They don’t apply to Teratogenic or Neurological DDH.

How do we know the child has DDH ?

Most newborn screening procedures at the hospitals have doctors checking to see if the new born child has clinical signs of DDH. It is easiest to detect and treat it at that early stage.

Once a clinical suspicion of DDH is there the Neonatologist usually refers the child to a Pediatric Orthopedic Surgeon. In addition to establishing the clinical diagnosis by physical examination, the doctor will order an x-ray and an Ultrasound Scan of the Hips to check the dislocated hips. Several measurements need to be taken and ease of dislocation need to be established under Ultrasound scan by a procedure called Dynamic -Ultrasound. The treatment starts after these are done.

In many children, the initial diagnosis may not be made in the immediate post-delivery period. Children may be brought to the OPD by parents with complaints that the thigh skin fold dont look symmetrical and the hips don’t open out fully for parents to change diapers.

In older children parents may notice a limp when the child walks or a limb length difference may also be noted with the dislocated side being shorter.

Limb Length Difference in DDH
Limb Lengths may be noted to be different in DDH when child is older and walking. The limb with the dislocated hip will appear shorter.

How soon should the treatment start ?

As described in previous section, treatment should ideally start in neonatal period once the problem has been detected. After clinical examination and Ultrasound examination, your doctor will suggest usually a belt type device called Pavlik Harness to be applied on the child to keep the hip reduced inside the cup. This harness is to be worn full time. Parents are counselled on how this is applied and how the straps are tightened.

Ultrasound exam for a child with Hip and Knee dislocation
Ultrasound exam for a child with Hip and Knee dislocation

Once this harness has been applied, the hips are scanned with Ultrasound every 2 weeks to check for improvements. Ideally this has to be kept for about 3 months and taken off after the hip stabilizes inside the socket. A slow weaning period is there before the child can be fully taken off the Pavlik Harness. This is to ensure that the Ball ( head of femur ) stabilizes inside the socket (Acetabulum of Pelvis) and the hip is stable. The tissues around the hip also has to shrink and adapt to the new location of Head of Femur. Otherwise re-dislocation or partial slip (medically called subluxation) is a possibility.

In many cases the parents may not be willing for a device to be applied on the child full time post-delivery or the DDH itself may go undetected. This child eventually may be brought later in life by the parents with complaints necessitating surgical procedures.

What is the treatment options for DDH?

As previously described if the newborn is detected to have DDH the treatment is to apply Pavlik harness on the child after Ultrasound exam proves hip is reducible and stable in what is called a safe zone. Safe Zone is a zone where the position in which the harness has to be applied to the child does not compromise the blood supply the head of femur. This is very important decision to make.

Pavlik Harness for DDH hip needs to be fitted properly
Pavlik Harness for DDH hip needs to be fitted properly

Hip Spica Plaster in child with DDH
Hip Spica Plaster in child with DDH

Application of Hip Spica under anesthesia in DDH
Application of Hip Spica under anesthesia in DDH

If the child is brought later in life, before 1 year, the hip has to be checked for reducibility as the tissues around the hip would have become contracted and sometimes it is difficult to reduce the hip back into the socket. Usually anaesthesia would be required and the hip once reduced back into the socket is held there by application of the plaster of paris or POP called Hip Spica. This is kept for approximately 3 months until the hip has stabilised inside. A CT scan to verify whether the hip is reduced should be done while child is in POP as slippage of the hip socket is also seen when POP cast becomes loose with time.

Surgery is the only option in older children with DDH. These range from relatively simple procedures to complex hip reconstruction procedures depending on age of the child, slope of cup, angle of rotation of the neck of the thigh bone and shape of the head. These are best evaluated as per the needs of the child.

Arthrogram for DDH
Arthrogram for DDH

Generally these surgical procedures can be grouped into a few types :

  • Open Reduction of Hip and Capsulorraphy (medical term meaning stitching up of capsule or the covering around the joint)
    • This is basic necessity. Here the hip is reduced back into the socket and the covering, the capsule, which is loose is tightened with several sutures
  • Femur Derotation Osteotomy with shortening
    • This would involve a slight shortening of the hip bone and turning it around. The bone would then be stabilied with a metal plate and screws
    • The need for your child to have this done depends on the age of the child and the angle of the ‘neck of the femur’, something medically known as Anteversion. This procedure essentially de-rotates the femur neck and allows the head of femur (the Ball) to deeply sit inside the Acetabulum (the socket). A slight shortening of the thigh bone may be needed as the child , if old enough, would have developed tightness of the tissues and hip should be sitting inside the socket slightly loose than in tension.
  • Acetabular Osteotomy
    • In many children, when they present to the clinic their Acetabulum would be shallow and not deep enough to receive the Head of Femur. In such children deepening of the Acetabulum by a surgical procedure called Osteotomy (a type called Salter Osteotomy being the most popular) may be done.

The above procedures may be combined along with Open Reduction as the surgeon sees fit after evaulating the child. These options and its pros-and-cons would be discussed with the parents before the surgery.

What happens if we don’t treat DDH promptly ?

Best time to treat the child is in the newborn period. With time the tissues around the hip gets tighter and the bone structure of thigh bone and pelvis alters since the normal growth with moulding of the ball being inside the cup doesn’t happen.

This lack of moulding results in a shallow cup. Additionally the thigh bone’s upper end would be twisted out of shape and the ball also would be misshapen since it has not been moulded by the acetabulum.

All these result in a much more complex procedure to try and restore the hip.

Left untreated DDH causes osteoarthritis or the Hip joint and Hip pain in early adulthood often requiring complex reconstructive procedures.

It is best if the treatment is not postponed and done at the earliest.

Hip Dysplasia Awareness Month – June !!

The Hip Dysplasia Awareness Month of June is to educate parents on Hip Dysplasia and its treatment methods. We hope that parents would bring children to care centers at the earliest if suspicion of hip dysplasia is there.

For more information please visit : http://livingwithhipdysplasia.com/june/ or consult your Pediatric Orthopedic Surgeon.

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Cerebral Palsy Medical Camp at Shoranur, Kerala

A free medical camp for underpriviliged children suffering from Cerebral Palsy and Pediatric Orthopaedic disorders was organised by Dr. Easwar T.R and the administrative team at ICCONS, Shoranur, Kerala on 24th, May,2018.

A gamut of problems commonly seen in children with Cerebral Palsy was observed in OPD. While some parents had the good fortune of seeking medical care and intervention early in course of disease and others were not so fortunate. Lack of parental knowledge, distance / accessible care, financial cruch, normal siblings to care for and single parent challenges were the most important issues observed on casual data collection.

The medical camp was followed by an awareness class for parents, therapists and other care givers by Dr. Easwar T.R on the various aspects of Cerebral Palsy.

Custom wheel chair and mobility solutions for needy patients was discussed with Physiotherapists and low cost solutions for the same identified. Mobility solutions continue to be a major challenge for children in rural areas with poor roads, small homes with narrow doors and steps inside homes especially with outdoor toilets.

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World Clubfoot Day on June 3rd

This 2018, on June 3rd, we at Palakkad District Co-operative Hospital and Research Centre are celebrating the World Clubfoot Day.

We are planning special Outpatient Clinics for children with Clubfoot disorder in and around Palakkad, Kerala.

Please find below the Malayalam Poster for the #ClubFoot Day

Screenshot from 2018-05-25 16-07-28.png

 

Guru Poornima

A poem to the Guru, the eternal teacher who’s soul reincarnate who pervades all and guides the wandering seafarer home. Without fail. Everytime. Until the last one.

Winds are getting rough, 
The sea churns,
Sharks jump unforeseen,
Vultures circle for prey afloat,
Path is dark, no stars above,
My boat leaks, filling slowly,
The three sandbags of gold,
Hang anchoring me to churn,
From far away land a twinkle,
Catches my eye, amongst mist,
Swirling and spray amidst the clash,
Hope springs anew, there's land ahoy !
Desparate I turn and whirl the wheel,
With all my might, to keep it in view,
The dim yellow light , my pole star,
Light gets brighter but my sandbags,
Stall and fill my boat, tossing more,
The final stretch alas, run aground,
I hurl myself in shallow water,
To swim to the sandy beach and race,
Ahead to meet the light house that,
Guided me home, standing tall,
Unshaken, uncaring, unyielding,
On the rocks, amidst crashing sea,
I join my brethren on the beach before,
Me as they welcome and we join chorus,
Of praise to the lighthouse, as full moon,
And stars are all there again.

~Dr. Easwar TR
The lighthouse

Tiruppavail of Saint Andaal – Pasuram 6

Long time, year after year, I resolve to translate one Song ( Paasuram ) a day from the Thiruppaavai, written by Saint Andaal ( the only female Viashnava Saint among the 12 Alwars ) . This year, after missing first 5 days I made an effort finally.

Find it below.

A humble offering at the feet of Saint Andaal .

புள்ளும் சிலம்பினகாண் புள்ளரையன் கோயிலில்
வெள்ளை விளிசங்கின் பேரரவம் கேட்டிலயோ
பிள்ளாய் எழுந்திராய் பேய்முலை நஞ்சுண்டு
கள்ளச் சகடம் கலக்கழியக் காலோச்சி
வெள்ளத் தரவில் துயிலமர்ந்த வித்தினை
உள்ளத்துக் கொண்டு முனிவர்களும் யோகிகளும்
மெள்ள எழுந்(து) அரியென்ற பேரரவம்
உள்ளம் புகுந்து குளிர்ந்தேலோ ரெம்பாவாய்.

puLLum silambina kaaN
puLLaraiyan kOyilil
veLLai viLisangin pEraravam kEttilaiyO
piLLaay ezhundhiraay

pEy mulai nancundu
kaLLac cakatam kalakkazhiyak kaalOcci
veLLaththaravil thuyilamarndha viththinai
uLLaththuk kondu munivargaLum yOgigaLum
meLLa ezhundhu
“ari” enRa pEraravam
uLLam pugundhu
kuLindhElOr embaavaay.

Look ! The temple birds preach sweet !
Hear ! White conch blows forth primeval !
From inner sanctum of Holy Bird’s Lord !
Don’t you hear any ? Up my child !

Lord who drank from poisoned breasts,
Lord who kicked off monstrous killer carts,
Lord who reposes on waters atop serpent,
Lord the cause seed of the Universe,
Lord the image Yogis, Munis keep in,

To Him, do chanting ‘Hari’ in happy chorus,
To Him, do in-turned our hearts cool, abide,
To Him, Prayer mine, awake my dears you too !

Tiruppavai – 6 by Saint Andal

Adaptive Sports in Cerebral Palsy

On #WorldCPDay this year, amid the pandemic, we’ve managed to launch a new rehabilitation facility in association with Karunya MVRC, Palakkad, Kerala, India ( @Karunyamvrc on Twitter )

Kerala State loves Sports, and specially loves Football. We married care for children with Cerebral Palsy and Sports, to setup a one of a kind Adaptive Sports Environment where children would be trained with Physiotherapist’s support by well known Sports Coaches.

Paediatric Orthopaedic Surgeon’s service is also available to assess these children and triage then into various categories from where they can be rehabilitated.

Our Cerebral Palsy Adaptive Sports Team

Ms. Valarmathi- Physiotherapist


Mrs. Valarmathi- Senior Special Educator

Mr. Ravindran – Retd SI and Kerala, Police state and national team Football coach


Ms. Dhanya Ravi- Change Maker, mentor, PwD, National Award winner in the Role Model Category under Empowerment of People with Disability


Mr. Anudarsan – Director , Karunya Medical and Vocational Rehabilitation Center


Dr. Easwar TR Paediatric Orthopedic Surgeon

Karunya MVRC Contact Details


Websitewww.kmvrc.in

Address: Karunya, Chenkol, Karingarapully, Palakkad 678551
Phone – 9061000101 /8590667698

What is Adaptive Sports ?

Adaptive Sports is a special type of Sports training given to children with special needs by adapting the requirements of sports to the specific difficulty the child faces.

This would often involve some change in rules, some Assistive device support, fall prevention and a completely tailored coaching system to enable the child to play effectively.

Why Adaptive Sports ?

Well known rehabilitation method for Cerebral Palsy is Physiotherapy. Often times children find repeated therapy sessions boring, painful at times and many fall out of care. We’ve seen this happen over the years.

Also, there are several limitations to traditional physiotherapy approach when given as a single rehabilitation modality.

Sports training allows much the same benefits of improved strength, coordination and improvement in function that we get out of Physiotherapy but also improves the quality of Physiotherapy session as the child is a willing participant because of the interest in sports.

What are the special challenges in setting up Adaptive Sports in India ?

Coaching for Adaptive Sports is a patient art and the skill is much in dearth. The Sports coach has to tailor his or her expectation to the unique medical issues of the child and training method is customised accordingly.

Often these children have profound muscle weakness, spasticity ( unusual tightness of the muscles ), contracture, ataxia ( issues with body balance ) and inability to selectively more a body part. These result in delayed improvement a ability to perform in Sports activity. These children need care and support of their team to get ahead.

The coach has to be understanding of all these aspects and train the child.

What have we launched in Palakkad ?

Details about our effort to train children in Adaptive Sports here :

#ArztForACause Art to raise health awareness

I am writing to this now after I had composed an artwork. It had been brewing for about a week since my friend forwarded me an appeal for medical/financial help by a patient with #AnkylosingSpondylitis a medical disease which causes destruction of joints and loss of movement at spine and hips.

This particular patient was bedridden for past several years and last few months have been extremely troubling

He lives in a small tin roof hut built by kind neighbours with his young family. He himself is in prime of hia youth abd his ilness had crept in on him and progresses considerably. Without medical and financial help he is not taking any, and cannot afford any. As a result his joints have become immobile and he requires somebody to come to turn him around in bed or prop him up. The pain while moving is excruciating he says.

He has been fighting it out though and making paper Ballpen abd Umbrella for a living. There are some steady clients but past few months have been terrible. He has been unable to send his products due to lockdown since courier and speed post services also have been stopped due to #COVID.

I had bought a small number of pens under my personal capacity to encourage this chap and give him a morale boost.

Today I decided to doodle it for #ArztForACause project and raise awareness about Ankylosing Spondylitis a medical condition where joints lose mobility and spine hunches forwards and bend over acutely; so acutely that one cannot even look up

What I’ve attached below if the drawing I made just now.

Paper Coffee cup – digitally retouched
Paper roll, handmade Paper Pen
Same ☕ cup without digital retouching

About Ankylosing Spondylitis

It’s a medical condition where there is an inflammatory process in the tissues and joints.

This inflammation is relentless, progresses fast and is an extremely painful process.

Usually this disease affects spine and other major joints like Hip Joints causing pain, inflammation and stiffness. Overtime the joint itself ‘fuses’ much like how a metal hinge can we welded and rendered immobile.

This happens frequently in spine and hips. As a result the patient becomes completely immobile at those joints and cannot move about.

The entire process starts around the twenties and progresses fast and by late thirties or forties patient is bedridden.

There are basic medications and some expensive injections called ‘biologicals’ which can ease or slow down the process but none can stop it. Supervised Yoga or exercises have be extremely gentle as risk of fracture of spine is very high. Deep breathing exercises for chest is very important as all the ribs tend to join at the breastbone instead of staying flexible. When ribs fuse with breastbone the chest wall becomes rigid and doesn’t expand when patient breaths. As a result he has to use his diaphragm muscle and abdomen muscles to breath.

Early intervention is paramount along with physical therapy and supervised exercises.

Consult your Doctor to know more about Ankylosing Spondylitis if you’ve symptoms of back or upper back pain, tightness in chest, early morning pain, pain while sleeping and joint pains with swelling.

Some patients also have symptoms of irritable bowel, inflammation inside their eyes which causes them to water and many other symptoms.

Who’dve Thought ..

Who’dve thought civilized nations would be told to wash hands and cover when they cough ?

Who’dve thought that nations would succumb and leaders breakdown as the juggernaut came ?

Who’dve thought it would come upon us when we where busy ironing out tirival creases of our differences ?

Who’dve thought that next big war would be fought between Humans & Viruses ?

Who’dve thought that the only religion that mattered is whether one’s human or not ?

Who’dve thought that the only politics that mattered is whether one’s sick or not ?

Who’dve thought the only accolade, only badge that mattered is whether we are alive or not ?

Who’dve thought that doctors will be frontline, and soldiers would do rear guard ?

Who’dve thought that cannons will be silent and syringe will hold the key ?

Who’dve thought that brute force and politics would bow down before knowledge and selflessness ?

Really, Who’dve thought ?

~ Dr. Easwar

#LockdownNow
#COVID19outbreak

#CoronaVirus

#Poetry

My Teachers said …

my Teachers said …

My routine broke, as they hushed “Don’t !!”,
Muffled voices echoing faintly across time,
Didn’t care listen, in a hurry, who has time ?
Am in hustle to put one upon my fellowmen,
To Conquer .. the conquest and the victory,
Surrender and subjugation, The Happiness …

But nature cares, for a mother can’t but,
When she sees her child wandering thus,
Her patience for the truants runs short,
Her rebuke, a gentle slap of no avail as she,
Unleashes pestilence, her stormtroopers,
To sweep, clean the home; they do, ruthless,

It seems best is to stay put, clear off streets,
Voice low, no splurge and abide in quiet self,
Closetted with partners and one’s own clan,
Coccooned in quiet contemplation on the ills,
Waiting for her anger to wash over the kind,
It’s message is to mend ; stark one too ..

Seems my teachers said, about this too,
The material, evanescent like the wealth,
It seems he said a time would come, when,
The money is not worth the paper it’s in print,
What to say of success, more than the King,
Who’s mortal hand, as empty as a newborn,
As his mortal was led down the street lined,

Seems they said much more ; now real too…
It is time to hear those faint echoes of time,
Ancients, strange habits seem so in tune,
Let’s put our ears on the ground, let’s listen,
To the faint voices of teachers across time,
For we can hear it better as troopers near..

~Dr. Easwar

#corona

Rare Disease Day 2020 – CME at ICCONS, Kerala

Great program on #rare #genetic #disease at #iccons covering #neurogenetic disorders and it’s genetic basis.

Dr. Anitha PhD, Convenor of the CME on Rare Genetic Diseases speaking at the Inauguration
Handbook of Genetics by Dr. Anitha – book release

My talk of Cerebral Palsy and Genetic trends

I will be speaking on #cerebralpalsy and genetic trends this noon. Cerebral Palsy , while not under rare diseases does have some very interesting new genetic trends emerging which promises positivity in the care of these children.

Future Skeletal Dysplasia Clinic

I will also be interacting with doyens in field of Genetics in India and Paediatricians with experience in rare diseases to setup a rare Disease clinic at ICCONS that caters to Skeletal Dysplasia like Achondroplasia, Pseudo-Achondroplasia, Hypochondroplasia, SpondyloEpiphyseal Dysplasia etc..

Many of these disease are rare with rare mutations. Setting up a clinic with many specialists is very important to cater to this group comprehensively.

Today we take baby steps in this directions.

CME Programme for Rare Genetic Diseases

Dr. Anitha’s Book on Handbook of Medical Genetics

Dr. Anitha with her excellent resource book Handbook of Medical Genetics

@childortho https://t.co/u88Fh8D6wV

Maarghazhi Sun

This sod tosses hapless, to the left and then to the right,
As the Lord’s poetic beauty pulls at it, to have it whole,
He pulls at it with his beloved’s and their poetic beau,
Written on palm, written by him, timeless, faded but kept alive,
Sung by devout, heard by this sod, loved by all,
Helplessly pulled to the beloved it sings,
Like the garland tossed worn once and then twice,
First to the right and then to the left,
Each as beautiful as other, What to choose,
Between the fathomless fire and the conch’s grace,
‘Tis the last month of the westerners days,
With his twelve books under lock,
The Lord in his grace and yearn,
To meet his beloved and unite,
As a morning lore to the sleeping devout,
Sung by friends to raise her to union,
Thus the song goes sung by the Lord,
This month where he yearns his children back,
How beautiful is the next month, when a child sings,
Waiting for his Grace to swoop down on holy bird,
The union she craves, to her Lord she prays, alas,
To the lover demigod she then beseeches and then to her brother,
One month and then the next she waits for her Lord,
His grace does come and she does unite, as,
They call him to receive the palm leaves he scribed, 
As Sun moves North after it’s sojourn south,
He moves me from south up to the north,
The south facing Lord pushes my swing,
As it sails north to the hands of the Lord with the conch,
The new rice boils over, sweet jaggery crusted,
Thimble can’t contain the ocean that swells forth.


Maarghazhi is the Tamil month which falls between December – January. Thaai is the next and Maasi after it.

These three months also coincide with excursion of the Sun and it’s travel north, uttaraayana, as per Indian calendar. This is considered auspicious. The festivals of Samkraanthi and associated Tamil festival of Pongal, Paavai Nonbu, Manmadan Nonbu are all done at this time.

Paavai Nonbu, Manmadan Nonbu are Vaishnavite vows where they simulate Aandaal, a lady Vaishnavite saint of Tamil Nadu and her intense longing to unite with Vishnu.

Similarly in Shavite tradition this month is a time where the twelve Thirumurai books are kept under lock and only a section from Thrivaasagam, the ThiruvenPaavai composed by Saint Manickavaasagar is sung. This is a long followed tradition.

Thiruppavai sung by Saint Aandaal and ThiruvenPaavai sung by Saint Manickavaasagar are Vaishnavite and Shaivite hymns that attract the devotee with sheet poetic beauty and surprisingly composed around the same theme raising the devotee to an union with the beloved.

Comprehensive Pediatric Orthopedic, Cerebral Palsy and Spine Rehabilitation Centre and Palakkad, Kerala – Inauguration

Extremely happy to announce that we will be inaugurating our new comprehensive Spine & Pediatric Ortho Therapy centre at Palakkad.

Please find the invitation attached.

The rehab centre is fully equipped for Spine rehab, Pediatric Orthopedic rehabilitation with special focus of Pediatric Sports Injuries, Cerebral Palsy and Spine disorders.

Please find attached below the invitation for the event tomorrow, 04/01/2020 along with the services available there.

Malayalam Invitation Note and Brochures

Paediatric Orthopedic and Spine Clinic Announcement

International Day of Persons with Disability programme at ICCONS, Shoranur

Disability Day programmes we are organising at #ICCONS, #Shoranur, #Kerala

We are covering all levels and types of disabilities with medical camps, parent awareness and other community programmes designed to raise awareness, promote inclusiveness and improve accessibility to services.

This year we have an elaborate programme with Pediatric Orthopedic disability, Cerebral Palsy, Autism, Hearing Disability, Genetic Disorders all included in the programme. Please find details below and do share among your groups.

Programme

Attaching the brochure below this with programme details.

International Day for Persons of Disability 2019
International Day for Persons of Disability 2019

Time and Place

Institute for Communicative and Cognitive Neurosciences , Shoranur , Palakkad

Phone : 0466-2224869

Email : icconssrr@gmail.com

Website : https://iccons.co.in

World Cerebral Palsy Day 2019 #GoGreen4CP

It’s October 3rd.

3 days to go

October 6th we will join the world at ICCONS, Shoranur , Kerala in celebrating #WorldCerebralPalsy day.

What we are lining up this month ..

We are starting the programme by joining the #GoGree4CP movement to dedicate ourselves to the care of #CerebralPalsy affect children.

We will be lighting up the entire building in green for the entire month and put prominent placards, posters and banners in local language of Malayalam and English to spread awareness about CerebralPalsy among general public.

Lined up after that is our free medical camps in both Paediatric Oethopaedics and Paediatric Neurology and Developmental Paediatrics along with cultural activities, parents education seminars, assistive technology programmes, research on Cerebral Palsy, Counselling for parents and other events.

We have dotted the events across this October to keep the awareness and dedication alive.

Attaching below is a poster and a banner of our medical camp and GoGreen4CP initiative.

#Onam, a festival in #Kerala to honour erstwhile King Bali and Vamana, the Avatar of #Lord #Vishnu ~ A Poetic Symbolism

Childhood in Kerala growing up was a pleasant time. There were no mad rushes, lot of rain and then, Onam. Onam celebrated on the Thiruvonam (Shravana Nakshatram) star day is a festival that is steeped in Hindu Puranic lore. The story involves the great King Bali (sometimes referred to as Maha-Bali ) and Vamana ( an Avatar or Incarnation of Lord Vishnu ).

The Onam / Vamana Jayanti Story, What it was and what it has become …

The story as in many Puranic lores is of the classic clash of a devout, efficient, benevolent King who is an Asura ( literally, one is not-a-Deva ). The benevolent Asura King usually causes flutter in the Deva Kingdom ( It’s king being Indra ) forcing the Gods to incarnate, kill the Asura and rescue the Devas. The story of Onam here follows this same storyline; only as in the other stories the symbolism is hidden, deep and often missed when one keeps celebrating festivals superficially. In the case of Onam there has been a systematic over-simplification of festival. I remember in my childhood we use to keep Trikkaakarayappan (Vamana) and Mahabali (sometimes called Maveli) as little clay pyramids in midst of the flower arrangements (Pookkalam ) we used to do in our home portico. Over the decades, this has all but disappeared from the celebrations. There is hardly any mention of Vamana anymore, no clay pyramids, many do not know Thrikkakarayappan. Some years back there was even a needless political controversy when Vamana Jayanti (Birthday celebration of Lord Vamana) wishes were given on even of Onam. The simple fact is, Vamana Jayanti is celebrated in our households and many Vaishnava homes just as it was earlier. It is just that with increasing commercialisation, securalisation of Onam and making it a harvest festival Vamana Jayanti seems to have been forgotten. This is unfortunate as Vamana Jayanti is Onam itself. There is no Onam without Vamana as much as there is no Onam without Mahabali.

In all this pell-mell of making it more secular, more harvest and less Hinduism, more commercial and less spiritual, more literal (Rich Noble Asuric King subdued by Brahmin Vamana and rudely pushed underground ) a narrative that suits the more left-leaning, liberal-leaning of the political spectrum has been woven into this mixture.

It is important that ancient India, it’s traditions cannot be painted with same brush. It is also important that one goes in to the original Sanskrit texts to reference stories of Mahabali and Vamana and read for oneself the narrative.

The Onam / Vamana Jayanti Spiritual Symbolism

Now is the time to resurrect the Vamana Jayanti Tradition, It’s symbolism, the true stature of MahaBali the Noble King. My poetic attempt at is below…

What is Onam without Thrikkakkarayappan , the Vamana ?

Symbolism Note : The reference to “Wild Sugarcane tasting ripe and sweet” is a reference to a Saivite Saint from Tamil Nadu, Pattinathaar or Pattinathu Swamigal. He was told by the Lord that he will attain Samadhi when the wild sugarcane tastes sweet. He used to go to the grove and taste sugarcane everyday to see if the day of his Moksha had come.

Clubfoot Parental Awareness and Caregiving advise Programme at Palakkad , Kerala

Clubfoot Care Team at Palakkad District Cooperative Hospital, Palakkad, Kerala, India
Clubfoot Care Team at Palakkad District Cooperative Hospital, Palakkad, Kerala, India

I am happy to announce that we successfully organised a Clubfoot Parental Awareness and Caregiving Programme at the Palakkad District Co-operative Hospital, Palakkad, Kerala on August 31st, 2019. This was done to organise parents into a self support group and to provide parents the necessary group counselling on Ponseti Method of Clubfoot treatment.

We have been organising World Clubfoot Day programmes, Free Medical Camps of Clubfoot and assiting children from underprivileged backgrounds get Ponseti standard of care Clubfoot along with CTEV Foot Abduction Orthosis via our charity trust https://mitratrust.org. We also described out #ArztForACause art and painting fundraiser which is undertaken originally to raise funds for children with Cerebral Palsy and now extended to children with Pediatric Orthopaedic Deformities.

The programme was well attended and was co-ordinated with our Obsterician colleague and all the staff nurses who are part of the Clubfoot Care team who counselled the young mothers on Breast Feeding, Child Nutrition, Clubfoot, Braces and Ponseti Exercises.

We were pleasantly surprised at the turnout on the day as it was organised in short notice. This programme will be followed up more such programmes on Clubfoot ( sometimes called CTEV : Congenital Talipes Equino Varus ) for Staff Nurses and train them in Ponseti Care .

Attaching below are the pictures from the event.

Clubfoot Parental Caregiving Interactive Session at Palakkad

#Clubfoot guide and interactive session for patents at #Palakkad Cooperative Hospital is being organized on August 31st.


The program includes a lecture by me on Clubfoot for parents and a interaction with our Clubfoot Care Team , Orthosis Check, Doubts about casting, checking recurrence of deformity and general clarification on Clubfoot care.

Parents will have an opportunity to interact with other parents exchange their experience about treatment, the issues and build a support community.

Attaching the Program details below. Please call the number for registration.

Clubfoot Parental Caregiving Interactive Session at Palakkad, Kerala

#Pediatric
#Children
#Orthopaedics


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