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Archive for March, 2013



I showed this case to an orthopedic professor from Texas while he visited us. The first thing he said is that, ‘I don’t do worms.’ Then he sat. It‘s the case of an elderly man from Morocco who was becoming paralyzed. They operated in Morocco and saved his walking but now his bowel and bladder function was deteriorating. No treatment had been given after the surgery. I found tumor in the bottom of his spine, in the muscle to the side of his spine, and in his pelvic bone. And worse, in reading about this particular worm, it had a tendency to spread when you opened the cysts and the cyst fluid was highly irritating to the surrounding tissues. I started him on anti-worm drugs and then cast about for a surgical opinion. The next time the patient returned his wife patted me appreciatively on the arm. My assistant translated that she was telling that the patient was much better. He could stand and had better bowel and bladder control. Ok! I’ll take it! He still has a spinal sac full of worms and his spine is likely to collapse. And we haven’t nearly begun to treat the infection with enough medication. But anytime you are in the plus column – take it.



Here’s one more for a few select colleagues who look in on my blog from time to time. This is an older woman from Yemen. She has had a biopsy a year ago and was told she has a tumor. The pathology is not available to me. What she has is a tumor that has taken the skull base and the upper two cervical vertebrae. That means here head is sitting on her shoulders without any support. Having just attended the Jeddah Spine Summit, I found several surgical solutions. The good thing about a meeting like this is that there is never a time when something is completely inoperable. In other words, beware. I don’t walk on water and still must dress one leg at a time. But it’s good to have some alternate suggestions. So far the patient has not returned. Which in the scheme of things might not be the worst that could happen.

Historical Evidence


I have to say that at this point, ‘What is there that I haven’t seen neurosurgically?’ And my answer is that when you go somewhere else, you’ll find out. Even if you have no idea, understand that this is a side view of the neck and you are looking at the spinal cord. It has dents in it and there’s a white streak in the middle. That’s a bad thing to see. It’s an automatic recommendation for surgery when I see it. Others might disagree, but I have seen, even recently, what happens if you fail to act. So this woman comes in… and after I look at the scan and go through my recommendation for surgery, I look closer and see that this image was from 2008 – five years ago! Well, I have now learned that if you are indeed lucky, you might go on for years and never get worse.

Just when I was questioning my sanity and about to throw over what I believed, a 39 year man came to see me. he’s virtually paralyzed. He has contractures so bad that he can’t even straighten his arms or legs. He has had bed sores so bad that they required surgery to repair. And he has the same condition. His family wants to know how soon after the surgery he will begin to walk again. I can only say that I don’t do magic.

ICP Conference


I got a call to attend an ICP [intracranial pressure] conference. I agreed. As usual, I knew nothing of the details. I just showed up where they told me to go. It turns out we were in a hotel. Some representative from a well know company were sent out from the USA to tour the Middle East and speak about their ICP products. The group they invited were my OR staff, neuro and otherwise, as well as my office staff. Curiously, they left out the ICU nurses who actually take care of the ICP monitors. Go figure. They like to do group shots. So the nurses saw my camera and lined up and we got shot. Then we hit the hotel buffet dinner, which as they say, was the main event. No one went away hungry.



Swell! I can cook. It’s just that I’m used to more spice and a larger selection of pots and pans. But the vegetables are fresh. There are two types of carrots – local and from elsewhere. Stay away from local, they’re limp and lifeless. And I’m used to fresh and firm. Depending on the day the eggplant or the cauliflower are not edible. So you make do with what is good and bide your time that good egg plant and so forth will eventually show up. This dish really didn’t need the flavors I brought back from NY. But until they were available, I didn’t have any incentive. I just wanted a white sauce here.



Well, I ate out for six months. Really! The most I did was cut some cheese, maybe a sandwich from cold cuts. But really the stove was pristine. And the oven has known no heat. At Xmas when I visited NY, I took the opportunity to return with soy sauce, sesame oil, and hoisin sauce. Olive oil, oregano, salt, pepper, and some basil, you’re good to go. I had all manner of things in my suitcase on the return trip, including a down quilt, king sheets, and Paul Deen frying pan. Don’t ask. I was in Target and it was an impulse buy at the right price. The bottle of soy was the kicker. Coming through Saudi customs on the way in, I had all manner of vitamins and pills with me. I had ordered a year supply from NY. They started to tear apart the luggage and sailed right past the pills/drugs. Something on x-ray had the agent in a frenzy. After I was pretty much unpacked, he pulled out the paper bag with the soy. It’s in English and Chinese so he asked what it was. And then I realized he meant to confiscate it for alcohol. Ha! Well, you can see he let me have it.



My clinic is in the middle of the hospital in a room with fluorescent lighting and no windows. I’d call it a prison cell; there is a locked door. But they tell me it’s not a prison as long as you can open the door yourself. One of our patients was late, he was caught in the ‘terrible’ sand storm. I was impressed. I immediately imagined ‘Lawrence of Arabia’ with blinding swirling wind and sand obscuring the landscape and making it possible for marauding bands of bandits to have their way. Too much…. Around here it doesn’t blot out the sun and the light of day remains. It’s just a bit cloudy, windy, and looks more like haze or fog to me. Ah yes the sand blows up to your doorstep. Therein lies the annoyance. They take a hose and wash the marble stoop. The water washes under the door and on into your villa and you have a sandy floor to wash and sweep. Why not just let the sand blow away again?IMG_9348

King Fahd Fountain


From the location of the Spine Summit at the Hyatt Hotel, you have a splendid view of the fountain. Since I had my trusty Canon G11 on my shoulder, it was but a moment to get this sunset. There were a few mosquitoes, so I ran inside after this shot. To the left there is an artificial island, which I am told was owned by a deceased king. The island has about one thousand caretakers who still reside until the next king/prince will take possession. Seems like a lot of wasted space at the moment. Oh, I almost forgot. The fountain is powered by a jet engine. When I looked up tourist spots this is listed but that wonderful museum remains a local treasure.

Spine Summit


For months there have been 10 foot tall posters throughout the hospital announcing this important meeting. Unfortunately visas are hard to get, so the audience was mainly limited to Saudi Arabian MD’s. We could have had an international audience but the government has no interest in allowing foreign MD’s in for a visit. As it was, we apparently had a devil of a time just getting the international faculty a visitor’s visa. Here, are the nurses who comprise the neuro and spine team. I managed to get them here because it’s an important teaching event. Thankfully in the OR we all wear scrubs. But out in the world, they even had screens up in the lecture hall to separate men and women. It was primarily in case the religious police checked. Mostly everyone ignored the screens. But the screens did hamper the flow of traffic.



They said, ‘Ah, Lana! She’s Sudanese and all dressed in color!’ Ok, I plead ignorance to the statement. She’s been driving me crazy because we have scheduling problems in the office. At this point they are all afraid of me so anything they need is requested through my assistant Khalid. But tonight, it was all smiles and friendliness. Maybe there’s a thaw in relations. How you get around without the black abaya, maybe she wore the black and could walk around inside in all the colors. You surely do look different when you’re not in black.




That would be him there on the left. Faisel [exercise group] is in the middle. He was invited along to the banquet though I’m not sure of his relation to the Spine Summit. And the US Ambassador was also invited, accepted, but did not attend. I still don’t get how things work. So faculty and friends and many people I met for the first time gathered here. A good time was had by all. We got a tour of the museum, ate skewered whole roast lamb, and watched local musicians play and sing. No belly dancing…too bad.

Private Party/Banquet/Residence/Museum


The Jeddah Spine Summit was a grand success thanks to the hard work and planning of Farid. You really need to watch every single detail and he did it. The opening banquet was held in a museum in Jeddah. It was a big social event for the folks at the hospital, and many departments other than orthopedics were on hand. Neurosurgery was represented. The place was one where virtually everyone knew about it but had never been to visit. It’s kind of like visiting the Empire State Building for a New Yorker. The place is huge and is privately owned. A collector/owner has gathered art and collectables of Middle East life into  a huge compound and four story building which ranges from costumes and jewelry to weapons and art. There are some interesting items of junk as well. But overall it is a fantastic collection of contemporary life. Since it is really not curated, everything is pretty confusing. It was, however, very very impressive. I’ll probably not see this again.




In order to visit Jeddah, you need a lot of paperwork in order. First you need a visa invitation. That would mean that I have to have HR cut a request for a visit from my daughter. They turned her down. She’s coming for a week. They requested 3 months – denied! Then we went and asked for 30 days. OK! But I had to take the application to the visa office myself and then stand on three lines and talk with 4 people and then they said ok. And I don’t speak Arabic. Now I have to have her send a copy of her birth certificate to prove she’s my daughter. They say it will be harder for my son; and forget my brother. Can anything be more complicated? So the visa invitation is addressed to the New York consulate office near the UN. I have to send everything to Washington DC. But since the invitation is addressed NY, they will mail it back to NY and then process from Washington. Don’t ask and I don’t want to know. Bottom line – who knows if this will all happen? I’m not holding my breath.

I would have to say that going online, buying a ticket, getting on the plane,  and just go – never sounded so good.



Every once in a while I’m left without an explanation. This motley group is some of the guys I workout with in the morning. Except for Faisel we’re all surgeons. They decided to eat at the Brazilian churrascaria. It’s bring and appetite an expect to eat a lot of meat. The Middle East diet is partial to lean, which means dry meat. The best offering was the short ribs which were fatty, moist, and flavorful. No one else liked them. The ostrich and deer were too dry. Even the lamb was overdone and dry. As for the exercising, you can see that we are all in varying degrees of health and fitness. No one brought their spouse so we ate in the singles section, meaning no women or kids. I ate a lot and have no regrets in the least.

Parrot Fish

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Lest everyone that I know in New York and so forth get unhappy, I’ll not belabor the nice weather too much more. Parrot fish are skittish. I guess you would be too if everyone else sees you as a meal. In all my gear I don’t really get close. So I was able to drift above this guy and then catch him with his fins deployed. It’s not a view I get very often. I will say that it takes time to remember all the safety things when you haven’t been diving in a few months. I forgot to open up the valve on my tank. That took one breath and a few seconds to remember. But I didn’t forget the camera and there were no mishaps with the underwater housing. So far so good.

Follow The Leader

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I haven’t been diving in a few months. It’s winter here and Farid says the water is too cold. That would be 77 degrees in the water. The nights are in the 70’s. And the days are their usual hot sunny 90+. So what’s cold? In NY it’s 40 degrees outside and 38 in the water. In the summer I wait all season for the pool to reach 80. Hey! It’s warm enough to scuba! But anyway for the first time in months we go to the beach with his kids. I actually got a pretty good burn on my back from the sun. The first thing Farid did was declare the water too cold after he dipped his toes at the beach’s edge. We dove anyway. One tank about an hour and the water was chilly but not at all annoying.

Later we got into the water with the kids. Rather, Farid suckered me into wading out with the kids, one hand on each. And then he sat and refused to come in. What a laugh. But the weather is so good mostly that you complain if it’s not perfect. Relatively, Silva, Farid’s wife, said the day was poor because their was a little haze and sand in the air. Geeez! Well anyway, the fish were happy to see us.

Layout Position

_DSC9909I attended a judo match. The kid to the right is Nicholas, Farid’s son. Farid had arranged for the school to hold an exhibition/competition in the hospital. Our CEO had just arrived about midway through the program. So they asked the kids to put on an exhibition. The kids went at it enthusiastically. Both kids were throwing back kicks and then, in the blink of an eye, Nicholas was in full layout position headed for the floor. He landed on his chest followed by his chin. From five feet away I could hear the sickening thud. Little kids are pretty tough. Nicholas bounced up and got into a fighting stance, sobbing, and trying to catch his breath. It seems that this happened so quickly that even Farid missed the fall. The poor kid needed a timeout and a hug from his mom. This is the shot. A moment, really a millisecond later and I’d have had his chin bouncing off the floor. It’s a mixed emotion. His dad missed seeing the fall. I saw it but missed the critical moment.



I am not an early morning person. Which is to say, that sunrise photos are few and far between in my portfolio. However, my calculations indicated that we were on a cliff facing east from our accommodation in Zanzibar. It was just step out of bed onto the walk and we were overlooking the ocean. So for several mornings the sunrise would awaken Julia and me. We would run out, shoot the sunrise, and then clamber back for another hour of sleep before breakfast. Yeah that’s about as easy as it gets. Oh, that’s the hotel’s infinity pool in the foreground.



Stone Town. I reference my experience in the market in Zanzibar. It was early morning and before my daughter was up and about. So I took the big Nikon and wandered the market looking for images. Here goes a swordfish to market. It just didn’t seem right that it should be dragged along the street. I suppose if you don’t eat the skin then it’s all right. It was around this time that I began to shoot from the hip at wide angle without looking into the viewfinder to compose the shot. There are times when this really does work. All these years and I’m just now finding out it’s called street photography.

Fish Market


I can’t say how I came up with this idea. On my last day in Dar es Salaam, I was going to take a walk. The hotel told me that I mustn’t walk alone. I had already done this at the beginning of the trip (and survived). But heeding the warning now, I hired a car and driver. I asked him to take me to the local fish market. I had had some success in the market of Stone Town and figured I could kill a few hours before my flight. It turned out to be a great time. No one seemed to mind me wandering about. I got to shoot local people and get a sense of the daily life one does not ordinarily encounter.


Panorama Ngorongora

I put together this landscape. It’s interesting enough to me because the main element is my family in lower right. We had stopped by this pond/lake and there were hippos in the water. It was a non-event. The hippos were just noses barely poking out from the surface. You don’t go close to hippos. They will kill you. They have skulls in which there are teeth that look like they were derived from a saber-toothed tiger. I didn’t know they were so dangerous. But they never let us get near.

Night in Stone Town


It used to be that after the sun went down, I would hardly take another shot until morning. Tungsten lighting, ASA/ISO speed, and a bunch of other reasons made it near to impossible to adjust. Now that white balance can be adjusted on the fly and IS0 can be made to almost see in the dark, it’s so easy to get night shots. Now the question is to see the image and then capture it. Like everything else sometimes you surprise even yourself.



That’s a dhow in the picture. It’s sunset and I imagine that it is headed out to fish overnight. Otherwise how would the fish market be so full in the morning. Once again it is an opportunity that presented itself. I don’t otherwise bring along a tripod and sit and wait. I don’t have the inclination, patience, or the time. But every once in a while I happen to be in the right place at the right moment.

Rest Period


We arrived in Zanzibar and my daughter flopped onto the bed to read the guidebook and plot our next move. We were in Stone Town in a neighborhood where we had to abandon our vehicle and walk in among narrow alleys to reach our hotel. It made her a little nervous. Ok, so I was too. But as I have often said, window lighting is like a soft box. You can really get some nice images.