GM diet second time around

Encouraged by the two-and-a-half kilogram weight loss I got during my previous stint in October (read this HERE), I decided to repeat the diet again this month. As I write this, the fourth day has just passed. The first three days were great. Unlike my aversion to natural foods last month, I had a much more pleasant experience this time. I was actually looking forward to the diet as I began it on Monday last. The first day passed off smoothly. I never needed to cheat. 

The second day, too, was very nice. I had a fresh green salad at lunch and boiled vegetables at dinner. On day 3, I combined the best foods of the first two days. After three days, I was sure that there would be no further problems. However, I had a spell of low blood sugar on the evening of day 4 (Thursday). The episode caused a feeling of chilliness and profuse sweating. It was severe enough for me to rush to the kitchen, grab the container with sugar and swallow about a tablespoonful of it. Also, I retrieved a dual pack of Snickers chocolates, and had the entire thing. The calorie gain for each bar of 40 g was 200. Also, my condition prevented me from going out to walk, an activity that I have been doing religiously since the past week or so. (I usually walk briskly for about 45 minutes, burning about 260 calories and walking over 4.5 km in the process.) 

The lesson here is that if you are, like me, a diabetic, you need to cut down your medication as the GM diet is low in carbs. Else, such episodes are going to occur. They are called "hypo"s in common parlance.

So, what are the results so far? Well, to be honest, I have never felt better (other than the episode of hypoglycemia that I had today, see above). My BP is down, as is my fasting and post-lunch blood glucose level. I have lost about 1.5 kg in the first three days. My waist is slightly narrower, but I haven't measured it every single day. 

Tomorrow (actually later today) is day 5 and I will be looking forward to eating beef patties and raw tomatoes. I will provide a second update after another 4 days. Thanks for reading this.

So, what's happening? A tribute to my study colleagues.

Okay, so first out, thank you dear readers for your comments and for your good wishes to me! I really appreciate it. We have formed a small study group. We use various media to study online. For example, we have a group on Facebook where we share files and pictures, videos and schedules. We have a group on Whatsapp where we share questions, videos, and so on. And, finally, we have a Skype group where we practice case scenarios and communication skills. 

I must mention a few of these dear colleagues here. First out, let me talk about Dr. Sanjay Shukla. He hails from Jaipur, Rajasthan. We go back at least a year and a half, since I began studying in mid-2013, and we have been together since then. In fact, we were together in June 2014 when we both went to attend a study course in Bangalore, India. Sanjay is a very pleasant-mannered person, and he is very keen to complete this certification for Membership of the Royal College of Paediatrics and Child Health (MRCPCH in short).

Next on my list is Dr. Imtiaz Beg. He is a young pediatrician from Lucknow, India. He is currently working in Saudi Arabia and stays here with his family. He is a sharp, well-read person, and exudes confidence whenever we meet online. I have learned a lot of things from him, and he continues to inspire me.

Then, there is Dr. Sarita Shenoy from Mumbai. Daughter-in-law of my M.D. guide Dr. N. B. Kumta, Dr. Sarita joined our group fairly recently, but has been a great colleague and I love her way of counselling a patient in mock communication scenarios, as well as her grasp of common paediatric challenges.

On to my friends from other countries then. Last year, one Dr. Ahmed Sallam was the driving force, and he taught us a lot of things that we did not know as we began our journey to MRCPCH Clinical exams. I miss him greatly as he was really confident. Although we have parted ways, I do call him up from time to time and keep in touch with him He works in Madina in the Saudi-German Hospital there. 

Between May and July, I met Dr. Sherif Sharaka online. Like Dr. Ahmed, he, too, is an Egyptian. He works as a Neonatology registrar in a private hospital in Riyadh. When we first interacted, he was just beginning to study, but he learned fast. When I needed a particular study book, he photo-copied the whole book and couriered it to me in Al Muwayh! And this, without any charge. We dropped out because my internet connection at that time wasn't fast enough, and our Skype sessions used to fail as a result.

Many female Egyptian and Sudanese doctors have also been a part of my study circle, and I must mention that they have all been useful to my own understanding of paediatrics. Some of them have provided me with a perfect foil for me to practice my own methods of communication and case-presentations, and to them I am equally grateful. I must mention Drs. Hala, Huda, Eman, Shreen and Nazik.Thank you all.

There are many more such as Dr. Pranav, Dr. Abdulraheim, Dr. Anu, Dr. Shaju ... and I have surely missed some. I apologise for missing any names. But my thanks go to all of you.

And that's it for this entry.

Future trajectory: An update on where I am and where I plan to go from here on

As I had said at the beginning of my tenure in Saudi Arabia, my intention was to stay here for three years, and no more. However, some circumstances have forced me to continue my work here, albeit not for long. One of the main reasons was that although I had applied to the MRCPCH exams due in September 2014, I was not accepted at that time, so I had to stay on over here till I would be. I am happy to say that now I have been accepted for the January exams in India.

The second reason is that money requirements went up tremendously! Our Mumbai house has undergone recent renovation, and the estimates have got exceeded by nearly 100% because an unexpected situation arose while removing old furniture from the kids' room. The third reason is that both my children, as also myself, have invested money in better training  and education in our respective fields. Thus, while Inas recently completed a Make-up course, I have started a Ph. D. in Healthcare Management from an Online American University. Hannah is nursing ambitions of travelling to the U.S.A. to pursue higher management studies. 

The third reason is that I have no place to practice in Mumbai even if I were to return to India and resume my practice! As my well-wishers are aware, my better half and I used to work in the same place, and after I came to Saudi Arabia and sort of settled down, Nishrin decided to break-down the place and create a complete salon in lieu of a fractured clinic-cum-parlour.

The final reason is a little borne of introspection of where I was going with my practice before I left for Saudi Arabia. It is a fact that my practice had sort of levelled out, and there were no challenges and growth. Returning to the same environment and practising at a new location will mean starting from scratch. This is something that I dread to do. 

Hence I am looking at moving to the UAE. I have already passed their qualifying exam and received an eligibility letter from the Dubai Health Authority. Now, it is a wait for a great opportunity that will soon materialise - at least I hope so!

Into the last lap

This time, I think it is for real, unless there is a last minute mistake. The board of the MRCPCH have accepted me for the January exams in Ahmedabad, India. So, it may be polite to say: here I come. It might not be timely to predict whether I will or will not pass, but I can only hope that I do. It is a tough exam, and a lot depends upon the examiners. We are tested on 10 stations, one on child development, one on videos of sick children, three on taking a proper history and communicating with patients or their relatives or health personnel, and five on real patients with real ailments. Thus, there are ten stations, and one can get a maximum of 12 marks on each; to pass, one must gain 100 out of 120 - a really daunting task if you ask me! Many candidates reach 96+ and still fail because they did not reach a 100. They may ask for a re-valuation of their marking, but it is something not many people do, as the perception is that the examiners did the best they could and there was no margin for error.

Thus, I have begun to study more energetically, albeit still less than 4 hours a day, a figure that I hope to increase in the weeks to come. My small online study group has around 6 active members; we exchange clinical photos and videos on a whatsapp group, files on a secret Facebook group and we chat and discuss cases every evening on Skype. Thus, we are trying to optimise the use of electronic media to study in the most feasible manner. Two of these six friends are from the candidates I mentioned in the first paragraph. Thus, they are both in line to attempt the exam for a second time. 

In other news, a new week begins now ... and I am not on call this week. Let us see where this goes. My health has been satisfactory. Back home, Hannah, my younger daughter is away on a trip to Goa with her friends, while Inas is on her job, as always. 

That's all for now. Thanks for reading. Do leave your comments.

On-call vs. Off-call

As a doctor, one has to be on-call at times, and one goes off-call at other times. Let me explain what this means. When you are on-call, you have to be available 24x7 to attend to any and every emergency situation that develops in the hospital. When you are off-call, you basically work during the morning consulting hours, but are then free to pursue any avocation you wish to, until the next morning. In fact, when you are off-call (which means that your colleague is, at that time, on-call), you can even escape your morning duties by utilising your leaves and go on a holiday to any place of your choice within the kingdom. 

This is what my colleague and I practice here. We stay on-call for 7 days beginning on Sunday of any week (which is the first day of the working week in Saudi Arabia), and continue the on-call until the next Sunday morning. After this, the off-call guy takes over for the next week and the on-call guy goes off-call. This means that if you have sufficient numbers of stacked up leave forms with you, you can proceed on vacation every alternate week! Now, isn't that cool. The only problem, the thorn in the bouquet is that we do not accumulate many leaves in Pediatrics. Emergency visits to the hospital are the way to accumulate leaves. Six visits documented on an official paper and signed by the on-duty administrator gives you one day off. This means that when you collect six signatures, the paper with you entitles you to go on one day's leave. Put in other words, you need at least 24-30 visits to actually take the entire week off and go to, say, Jeddah, Dammam or Taif and enjoy the time!

This is how I took my leave last week when I was in Taif. I stayed in my usual hotel, went to the conference in the day-time, and lazed around in the evenings, sleeping, going around, and relaxing. I guess that explains what on-call and off-call means, does it not? What do you think?

I also wanted to share a few more things: this week, I am on-call. Was called today early in the morning to attend a Caeserean delivery for a mother who came with labour one and a half months before her due date. The entire process of delivery and then arranging the transfer of the premature baby to a larger hospital in Taif took well over 2 hours! Although I did not actually go to Taif to leave the kid, I finished my side of the call at 2.5 hours after I had left the house at a little after 5 a.m. In the process, by the time I finished, a new work day had begun, and I thus got a chance to return home only in the afternoon for lunch, and at the end of the work day. Pretty busy, hnnh?

That's it for now. Please do read, comment and interact with me. Tell me what you would like to know more about. 

P. S. My write-up on Jeddah was published on www.ghumakkar.com. Do click HERE to read it.

... And now, back in Al Muwayh, on duty

I returned to Al Muwayh in the evening on Saturday. The return trip was with Dr. Niaz Qureshi, the ObGy specialist who works with me in Al Muwayh, and who was also, like me, in Taif for the previous few days. He stays with a friend in a place called Arafa, which is about 35 km from Taif on the way to Al Muwayh. So all I had to do was to pick him up from his station. It was a comfortable ride for us, and we reached our village around half past seven. 

The news from Al Muwayh was nothing much. I had my Skype session at about eight p.m. with three of my colleagues in attendance. All three were females - one, a pediatrician from Mumbai, and two of them, both Egyptian but working in Saudi Arabia. My colleague Dr, Sanjay joined us too after a while and we had good sessions on case presentations and a small didactic talk by one of my Egyptian doctor friends.

For dinner, I had the dal and rice that my room-mate Dr. Afzal had made. His cooking skill is much better now than when he had first arrived in the Kingdom, and it was food that was good and wholesome. 

The switch I made from the modem-based net connection to a wired DSL network has made a significant difference to my internet access. I am now able to open all websites pretty quickly and also do the Skype studies in the evening without much of a problem. This means a loss of nearly SR 350 to me, but, seeing that this is for exams that I plan to give in January, I guess it is okay to take this loss. I am trying to sell off my modem and card to someone else, even if it is at a discount, so let's see where this goes. 

One more thing. Inspired by my attempt to do a crash diet a week and a half ago, my Pakistani acquaintance Mr. Ameer Ali Burq has also begun the diet in right earnest. As per his updates, he has already lost over 5 kg in the first four days! More strength to him. God Bless him and the GM diet, which has changed the lives of thousands of people all over the world.

That's about it.

Taif-then Al Muwayh-then back at Taif

The last four days have been quite eventful. I had registered for an accredited learning program on Rehabilitation after a spinal cord injury that was organised by the Armed Forces Rehab Center in Taif from this week's Tuesday until Thursday. Dr. Afzal was on call this week, and so I proceeded to go to Taif early on Tuesday morning. I reached the AFRC on Jaish street at about half-past ten in the morning. The registration I had done was over the phone, and I was to go to the registration counter and confirm my presence, pay my fees for the meeting and collect any gifts etc. from them. When I arrived there, however, I saw that the registration counters were overflowing with doctors, awaiting their turn to pay the applicable monies and do a spot registration. The organisers had decided that since the money was flowing, there was no harm in taking more and more registrations. They took advantage of the huge demand and demanded a premium of SR 100 over and above the previously announced SR 150 for the entire meeting. In return, the Saudi Commission for Health Specialties had granted the meeting 30 accredited Saudi license points. 

The doctors and nurses are very keen to collect these points not because they wish to learn; rather, they need those points to continue their professional practising license. You need 120 points to extend your professional license for 3 more years. Thus, I gave SR 250 to make a spot registration and then moved to the main hall where a lecture was in progress. Even if you were to remove all the chairs in the hall and make people stand in close proximity to each other, the hall would barely accommodate 150 participants at one time! And here, they were registering any one and everyone, reaching more than 1600 registered delegates at the time of the end of the first day's deliberations.

They served unlimited tea and coffee; lunch at noon; and, as I discovered on the next day, they also served snacks at half-past ten. I returned to Al Muwayh in the evening on the first day, and went back to Taif on the second morning. The conference was quite a good one, actually, and the topics ranged from psychological aspects to various systems, to orthotics (use of appliances to help people locomote, rehabilitate and so on), to pervasive problems like bed-sores, deep vein thrombosis, disfigurement and deformities, etc. I was impressed by the knowledge of some of the Saudi doctors. Not just that, some of them spoke perfect English, which was, to me, surprising. 

I booked a single room in the Ahle-Saif hotel in the afternoon after completing the attendance of the second day at the AFRC. I discovered that the net here was working just fine, and I was therefore able to complete several internet-based tasks like online study, uploading stuff on Facebook or elsewhere, checking my mails and downloading movies on to my laptop. Significantly, I was able to complete more than 10 modules - related to Quality and Safety in Healthcare, and some Pediatric topics - on BMJ Learning website. 

The meeting ended on Thursday, but I decided to stay on in Taif, and thus, I spent the entire Friday here. Mostly, I relaxed or studied. I had my Skype sessions on all the evenings except on Friday when my study colleagues did not turn up at all.

That's it for now. Have a good Saturday.

The Diet is over and ...

So, I completed the seven days' GM diet that I spoke about in my previous entry on this blog. The experience can be summed up as follows:

It was a unique diet, for sure. It was unlike any of my previous meals, diets, or weight-losing experiments. I have eaten all the things that I had to eat during the week I was on the diet, but never in this way, and in such combinations! I ate only fruit on day 1, only vegetables on day 2, only tomatoes and beef on day 5, and only milk and bananas on day 4! In this manner, the diet took me on a journey where I learned to discover how to control my urges to eat junk food, how not to crave for milk-tea, how to avoid eating any form of rice/wheat or other cereals (the diet only permitted brown rice on day 7) and how to avoid carbonated beverages altogether. Imposition of rules can cure even a person like me who can never resist all the above things in his daily diet!

In the end, I lost just 2.5 kg in 7 days, against a standard of 5 kg or even more reported all over the internet where GM diets are described, debated and discussed. I lost nothing from my waist or hip measurements; on day 6, in the evening, I experienced an episode of a low blood sugar, which led me to run and get myself some much-needed carbs; in that spell, I swallowed a tablespoonful of sugar, as well as about 4 medium-sweet cookies. This extra load of food rich in carbs must have blunted my diet-effects, for, on the next day, I had not lost, but actually gained a few hundred grams!

Where else did I cheat? One of my favourite foods is munching on dry fruit; my kitchen has a large tin with mixed, unsalted, plain dry fruit (cashew nuts, pistachio nuts and almonds); from this, I drew about a dozen or two of the nuts and ate them slowly on the 4th, 5th, 6th and the 7th days. In addition, I had one can of zero-cal Pepsi on day 5, a few extra helpings of sweet foods on the evening of day 6 when I went to the local garden to meet all the other Al Muwayh doctors to give a farewell party to our medical director Dr. Shehabeldin and a little excess of an allowed food on some of the days. 

Thus ended my fad diet of a week. I am inspired by some of the internet commentators who have been repeating the same schedule for a week each month. And, Allah willing, I plan to do the same as well. Thus, I will once again follow the GM diet in the last week of November, the last week of December and so on. 

Today was the eighth day. I am back to eating my normal food, but I continue to drink tea sans milk. And I haven't felt the difference.