Liz's Medication

i. after breakfast
1. CLAVIX
2. TRENTAL 400
3. COMPAMINA RETARD
4. AMACE
5. FEFOL
6. EVION
7 BETNESOL FORTE
8 FOLVITE 2 TABS
----------------------------------------------------------------------EVERY THU. BIOTREXATE 2.5 FIVE TABS.

II. AFTER LUNCH
1. ECOSPRIN
2. TRENTAL 400
3 .RECHARGE FORTE
4 BETNESOL FORTE
5 TEGRETOL 200

III. AT 6 P.M.
1. ACETROM

IV. AFTER DINNER
1. CLAVIX
2. TRENTAL 400
3. COMPLAMINA RETARD
4. FEFOL
5 BETENESOL FORTE
6 VALDON 40
7 TEGRETOL 200
8 FOLVITE 2 TABS

V.BEFORE SLEEPING
2. ATORVA

Dr Anand dropped in every alternate day to check on Liz, and observe her condition. He was a bit perturbed because of the constant pain Liz was experiencing off and on. Liz throughout the winter suffered agonizing pain. The Ordeal of watching and waiting has now taken an ominous turn, what was going to be in store for Liz. Would all her praying and making offerings, make any difference to her condition. My concern and that of the doctors were would the drugs meted out to her be able to contain the disease, �IF NOT� would I be able to stand to see the slow and agonizing wasting away of a most wonderful and fun loving soul. The chilling thought of losing her left a void in my very being. I�m an agnostic, and to please her and keep her in a positive frame of mind I was willing to sacrifice personal principles for her sake. I visited the church of my forefathers giving her immense pleasure. She always wanted that I would some day be seen in the church as a true catholic doing my duty to which I was baptized for. The medication, and the pain killers were only just having a slight affect on her overall condition, sleeping tablets had now to be administered to give her respite from the hell she was going through. The big toe, started to pack up, it had taken on a purplish hue which gradually started to turn black, and the dying of the tissues was causing mind-boggling pain. Dr Anand said there was little any one could do, he said let nature take its course, since it was dry gangrene, we would have to wait and see how far it would progress. I really marvel at this ladies forbearance to face the reality of having to go through the pain and the possible amputation of her foot.

Mount Abu --The Newnes Rita & Derek

The Newnes, Derek & Rita
 Very good and considerate Friends, ever ready to help those in distress at the drop a hat. Rita Liz�s beacon of light was at her side when she needed moral and physiological support the most. It takes a woman to understand the in-depth feeling of another woman in distress. I shall always be grateful to this ever loving couple, who always go out of their way to help anyone or anything even animals in distress. A very good friend of Dr Sharma, the only couple who helps this doctor to run his Free clinic in Abu. Dr Sharma another Albert Schweitzer of this modern Era is another �Oganda� to the poor and destitute of Abu. Back to Dr.Kela�s
Clinic the operation was conducted by Dr.Anand. The operation went off without a hitch the small toe had been removed successfully. The after effects of the Anastasia, on Liz even today makes me smile, she sure had one hell of a trip. Crying, laughing, bouts of fear, and elation, I suppose all her fears and stress of the months suffered by her were released like some fury pent up in an explosive bottle. Since the operation was a mild one, I brought her home the next day. Rita and Derek dropped in daily to dress the foot. The pain in Liz�s foot did not subside. She was strongly advised by Dr.Sharma to adhere to her medication as her very life depended on it.
Here is the medication that she was put on.

Mount Abu - Dr.Anand Subbarayan Liz's Mentor

Dr Anand Subbarayan Liz's Mentor

Dr.Anand Subbarayan 

Let me first introduce you to this fantastic and wonderful surgeon.
Dr.Anand.Subbarayan M.S., M.N.A.M.S., F.I.C.S., Dip. Laparoscopy (Germany) General & laparoscopic Surgeon Endoscopist, Ultrasanaligist.Dr.Anand a very sensible and Practical man wasted no time on dramatics, he immediately and without much ado examined Liz, He went through her medical files, her Doppler test and her angiography. After a thorough study of her case, he then spoke to her about the pros and cons. He drew the same conclusion that Dr.Sharma had already drawn, Liz's extremities her toe had gangrene and that it would have to be removed, he said, fortunately, she had "Dry gangrene", He then explained how this happened and why Liz experienced the excruciating pain that she was undergoing. Since she was not diabetic there was not that morbid fear of the gangrene spreading to the whole of the leg. He then told her that the toe had to be removed as it was now physically dead. Being the practical surgeon he refused to amputate the foot and said only the toe would be removed. He spoke to Liz with confidence and assured her not to worry, all was not lost even if she lost her foot she would be mobile within a short time. The operation was slated for the 21st January 04, Dr.Anand accompanied by Dr.Kela of Abu Road was to perform the operation.

THE ORDEAL Mount Abu

Takayasu arteritis

The final diagnosis showed Liz had contracted the dreaded Takayasu arteritis. I knew we were in for something horrible, how horrible only time would tell. Abu is cold in the winter, the night temperatures dip to around 0 to -5 C. This cold climate and the fact that Liz was in real misery did not help us in any way. Intense pain was experienced by Liz. The pain would begin around midnight and drain her very soul till early parts of the morning, the painkillers only worked for a short spell. I found that If I stayed awake reading or doing some work on the computer it kind of helped her to drop off into an undisturbed sleep. Her pain seemed to haunt her between midnight and 2 a.m. I found that staying awake around this time seemed to help, so this became a regular feature for me for months to come. In the beginning, I thought it was a psychological factor that was causing Liz this extreme bout of pain, but it was far from the truth. The pain was genuine and it began to manifest in its true and ugly form. Her little toe, the one she had banged had turned blue-black, the excruciating pain now was becoming intolerable. I was at a total loss, physically and mentally drained, I knew something had to be done and done fast as this situation could not go on forever. Dr.Sharma who was monitoring the situation on a day-to-day basis said that she was heading for gangrene. "GANGRENE" On hearing this word my very being froze. It's like telling a patient that he has cancer. How was I to break the news to Liz, and break the news soon was imperative, because any delay now would be curtains for Liz. With a heavy heart, I approached her bed and was on the verge of telling her that her condition had gone from bad to worse when my mobile rang and I heard Dr.Sharma's voice. He told me an extremely competent surgeon, Dr Anand. Subbarayan was down from the Maldives on a holiday, here in Abu and was a close associate, and he had agreed to see Liz on Dr Sharma's request. I went to Dr.Anand's residence immediately and picked him up. On the way, I told him the story of Liz, and what hell we folks were going through.
�Dr Anand Subbarayan Liz's Mentor

Ahmedabad Sal Hospital

Takayasu arteritis is a complex and challenging condition

Sorry could not upload the snaps of the angiography, they are extremely good!
snapshots of the angiography performed by Dr Dhani on 8th Dec 2003 at 8pm. What followed next was a chain of events that will haunt me for the rest of my life. While the operation was on I was in touch with my family doctor back home, during the course of my conversation he suddenly asked me to hand the mobile to Dr.Apurva. He instructed Dr Apurve to run an investigation on Liz to determine whether she had Takayasu arteritis, this was a new word that I had never heard of and from Dr.Apurva's facial expressions, I kind of guessed it was something not of the ordinary, made a mental note of it and decided I would get in touch with my doctor after the operation.
From the results of the angiography, it was confirmed that the artery carrying blood to the foot had a blockage in it and that the blockage was in the ankle. Conclusion An immediate operation of microscopic proportions would have to be performed and that too with abs no guarantee that it could be pulled off. The other option was an injection, (ST.PASE INJ ), so Heparin was stated for 2 days then Liz was diagnosed with thrombolysis with SK for 48 hr.T these 48 hours were a nerve-racking period, for both Liz and myself. I phoned my doctor next and asked him what was Takayasu arthritis, and he told me ran my blood cold. I walked to the nearest cyber cafe to surf the internet to glean what I could about this dreaded disease. I was numb and I felt a vice-like dread gripping my very being, the more I read the more I was convinced there was very little hope to hold on to. I returned to the hospital with a heavy heart and a dread of impending doom.
The staff at the Sal Hospital were very cordial, the interims, and the doctors were considerate and made the patients at the hospital feel comfortable, there was an air of trust that the doctors instilled into the patients. Liz had been monitored around the clock by a batch of competent nurses and young interim doctors who were ever ready with a smile and an encouraging word. Liz's condition was stable there was a slight improvement in the temperature of her foot, but the pain persisted and she was put on heavy painkillers. The doctors speculated as to what action should be taken, should they go in for an amputation of the foot, if so how much of the leg should be amputated, since the blockage was in the ankle should they amputate just above the ankle leaving most of the leg intact. The very fact of having a part of her leg amputated sends shivers down my spine. Liz was devastated, she asked me to take her home and to let providence play its part. I approached Dr Apurva the chief surgeon and told him of our decision. He was very considerate and only wished us the very best, before parting he advised us to see that under no condition was Liz to hurt that foot or even get it scraped as it would never heal. He also assured us should we ever need his services in the future he would be there for us. With a heavy heart, and dreading what was going to happen in the near future I packed our stuff got a cab and left Sal Hospital on the 13th Dec 2003 for our Abode in Mount Abu.