As and when one gets the intense urge to share one’s desires, passions, needs, feelings, thoughts, imaginations, intuitions, dreams and convictions; one is motivated; to talk, sing, dance, write, paint etc.

The activity of sharing becomes a pleasurable lifeline! This activity of sharing gives immense pleasure, when it is easy. Thus sharing of passions of food, sexual gratification, traveling; sentiments of love, care etc; and aspirations such as money, power, publicity etc; are easily shared. The feelings of anger, revenge, insecurity, fear etc are also easily shared. One can get gratification from such sharing, though it fades through time and one is left to bask in the glory of bygone past, or get depressed!

But sharing the aspirations of welfare of universe is very difficult to articulate and share effectively. This is because such aspirations have a relatively weak physiological substrate or template in the brain, in the form of cerebral cortex; as against the other aspirations which are strongly supported by subcortical structures in the brain.

The TOTAL STRESS MANAGEMENT (not merely the individual stress, tensions etc and their ad hoc, reductionist and escapist stress management or stress relaxation) is therefore; very difficult to articulate and share! The concept, scope and potentials of NAMASMARAN are also difficult to articulate and share smoothly and pleasurably!

In as much as the sharing (studying, practicing, talking, reading, writing etc) the TOTAL STRESS MANAGEMENT form part of TOTAL STRESS MANAGEMENT, it does not produce instant results and hence is not as gratifying as the sharing of other things is! One has to keep on sharing while constantly and continuously remembering that; even though the TOTAL STRESS MANAGEMENT is the holistic and most urgent solution to universal stress, it is very difficult to comprehend, appreciate and practice! This remembrance makes one; patient, buoyant and strong enough; to victoriously pursue the practice and sharing of TOTAL STRESS MANAGEMENT without getting depressed and frustrated.

Right from the birth; “I” begin to need! I need food, protection, nursing, shelter, clothes, entertainment, pampering and so on!

Gradually my “needs” begin to get converted into “wants”!

I start “wanting” better food, better protection, better nursing, better shelter, better clothes, better entertainment, more pampering and so on!

Soon, all these “wants” necessitate the physical, political and monetary power and thus “craving” for power is produced!

The “craving” leads to all actions directed at fulfilling the “craving” irrespective of; or rather at the cost of others!

But why should there be stress?

Strange it may appear, but; even if every craving of mine is fulfilled, still I remain restless and unsatisfied (stressed); unlike the animals and plants!

The reason is; the plant and animal life is apparently almost free from choices and hence almost free from conflicts (and stress)!

I am however; evolved to get the “freedom” to make choices and “condemned” to get conflicts (and stress) due to dilemmas!

Barring the infancy, the choices begin to hover around and conflicts begin to emerge, producing stress and erosion!

Satisfaction of physiological needs, instincts, emotions, thoughts and behavior are influenced variably by ethics, rules, regulations, laws, conventions, traditions, religious precepts, commandments and so on! They all cast their influence and create conflicts and stress!

The stress is especially marked; because, neither can I; further revert back to animal behavior and feel satisfied, nor can I cope with the preaching of selflessness!

Even if I begin to forego my cravings, wants and even needs, the subtle desires that I should be loved, respected, admired, cared for, served and so on; still remain active; though in dormant form! The feelings that “my” desires are fulfilled, “my” advice be obeyed, “my” concepts be practiced, create stress!

The human life is apparently very short to transcend from selfishness to selflessness!

The stress therefore; does not get managed, either in “me” or in the society!

One way of expediting this stressful, strenuous and tardy transition from physio-pathological and animalistic selfishness to conscientious selfless cosmic consciousness; is getting involved in the practice and propagation of NAMASMARAN!

Why should I (not merely practice, but) propagate NAMASMARAN?

It is because, “the love of NAMASMARAN” is not as physiological and as strong as the various needs, wants and cravings described in the foregoing; and hence the hype of selfishness can burn; the selflessness and cosmic consciousness; budding in my (and everyone’s) heart!

It is also because, if I do not propagate and promote NAMASMARAN, it would amount to boosting, promoting and passively propagating the dehumanizing forces that hinder the process of selfishness to selflessness; by crushing the selflessness and cosmic consciousness blossoming; not only in my mind but also; in the social psyche!

Practice and propagation of NAMASMARAN ought to lead to the evolution of perspective, policies, plans and programs of universal benevolence, amongst the leaders (international, national and local) on the one hand; and the ability to support and follow them amongst the common people.

This is what would create the environment of optimal fulfillment of needs; and facilitation of the transition of selfishness to selflessness, thereby ushering in greater unity and harmony in various aspects of individual and global life!!

Practice and propagation of NAMASMARAN, ought to ensure that the philosophy and spiritualism no more indulge in hollow jargons! Selflessness is no more preached to those who have nothing to lose! Nonviolence is no more hammered on those who are the victims of worst possible violence! The lessons of love and romance are no more professed to those who have to go through violent struggles for every morsel of food and every sip of water.

The practice and propagation of NAMASMARAN must inevitably conceive and ensure that the laws, rules, regulations, traditions, conventions are organized and reorganized around the premise of “Progressing from selfishness to selflessness amidst the environment of optimal fulfillment of physical, instinctual, psychomotor, productive, emotional, creative, intellectual and spiritual needs and aspirations; of one and all”!

Some people might have thought it queer to coin the new term “cerebral orgasm”! But I coined the new term any way!

The explanation of this new term is given in my article entitled “Cerebral Orgasm”.

Here it is necessary to indicate that sexual orgasm; is inbuilt need of the organism! Through timely growth and maturation of an individual, this need gets consciously felt as urgency and motivates for certain behavior. Apart from needs such as survival, food, water, security and later on emotional, intellectual and social needs; this need orgasm substantially determines the human and the civilization and the cataclysms in the history.

But the need of cerebral orgasm is also inbuilt. But not felt by an individual, as concretely as the need of sexual orgasm! The cerebral orgasm is described differently by religious and spiritual traditions of yoga, hathayoga, bhakti etc.

Since the need of “sexual orgasm” is commonly and concretely felt but the need of “cerebral orgasm” is not felt by most people the stress produced by the sexual deprivation is easily understood and appreciated, but the stress produced by the deprivation of “cerebral orgasm” is not felt by a large majority.

Like the sexual orgasm, where the excitement is predominantly pelvic the ecstasy in “cerebral orgasm” is in the head!

Just as one temporarily ‘forgets’ everything; during the orgasm; one ‘forgets’ but permanently i.e. gets freed from the stupefying influence of the internal and external environment i.e. MAYA; during “cerebral orgasm”.

The characteristic of “cerebral orgasm” is that it is far more intense, durable and casts wide spread “freeing and blossoming” influence, thus helping millions; in managing the stress, they are not aware of!

The readers, can verify whether the various spiritual penances, techniques of meditation, religious rituals, ways of worship, ethical codes etc and the universal practice of NAMASMARAN culminate in “cerebral orgasm” and “freedom” from MAYA; or no!

For the first 2 weeks stay on liquid diet.You need 2 quarts of liquid daily to avoid dehydration.sipping slowly is best.Do not try to gulp large amounts,You will vomit.Any low carbohydrate liquids are ok.non dairy based soups are great.
The third week,start pureed food.cream of wheat,oatmeal,and thin mashed potatoes.The types of food you would feed a 5-6 mth old infant.Small amounts of about 1-2 tablespoons will be enough for now.
After the first 3 weeks,you should be able to start a solid diet.add eggs and meat to the diet plan.start slowly and eat very small amounts.Cut your food into tiny pieces.Avoid fibrous foods .watch out for seeds.chew thoroughly before swallowing.The new opening into your intestine is very small and only well chewed food will pass without problems.
If you do not have tolerance to your solid food, go back to liquids for a day or two and try again.Patience is required.
Family members may think you are not getting enough to eat and tempt or urge you to eat more.Resist this.If you are 100 lbs overweight you have enough extra calories in store to support you for few months.

AN EXPERIENCE OF TREATMENT FOREARM FRACTURES BY CLOSED NAILING
DR.K.HYDAR. ORTHOPAEDIC SURGEON, MALABAR HOSPITAL, MANJERI, KERALA, INDIA.

Introduction.

The Forearm fracture requires an aggressive and exacting management, as it serves an important role in the upper extremity function. There are a variety of options for treating fractures of forearm like cast immobilization. Plate fixation, Intramedullary fixation and external fixation.

Aim of the study is to asses the result of closed nailing, which is less traumatic, less expensive, and to find out the anatomical and functional acceptance of the procedure.

Patients & Method.

In this study 78 forearm fracture ( both bone 58 & single bone 20) treated by closed nailing during December 2000 to June 2003 ( 30 months) at Malabar Hospital, Manjeri, Kerala, India. Age group varies from 12 years to 60 years. 44 were male and 34 were female patients. 26 patients sustained injury following road traffic accidents and 52 patients sustained injury following fall.

After closed manipulative reduction under image intensifier, fixation done with square Nail by closed method. All cases were done under regional block anesthesia. In 30 cases ulna was fixed first and the rest of the cases radius first. In 9 cases because of soft tissue interposition reduction was not stable, so stab incision was made and reduction performed with help of bone leaver. All patients were discharged on the 2nd day. Suture removal was done on 10th day, POP slab converted to above elbow cast for 4 to 6 weeks. After removal of the plaster patient was sent for physiotherapy for 5 days

Results.

AGE GROUP 10 – 20 YEARS.


Fracture
Site

No.
Difficulty
in
Reduction Union Complication

Clinical
Radio
logical
Func-
tional
Work
Infection
Delayed
Union

Nail
Migration

Proximal
3rd
6
1
6
8
8
11
0
1
1

Middle 3rd
10
0
6
8
8
11
0
0
0

Distal 3rd
11
0
6
8
8
12
0
0
1


27
1
6
8
8
11
0
0
2

AGE GROUP 21 – 30 YEARS.


Fracture
Site

No.

Difficulty
in
Reduction Union Complication

Clinical
Radio
logical
Func-
tional
Work
Infection
Delayed
Union

Nail
Migration

Proximal
3rd
2
1
6
8
8
11
1
0
1

Middle 3rd
6
1
6
8
8
11
0
1
1

Distal 3rd
7
0
6
8
10
12
0
0
0


15
2
6
8
8
11
1
1
2

AGE GROUP 31 – 40 YEARS.


Fracture
Site

No.

Difficulty
in
Reduction Union Complication

Clinical
Radio
logical
Func-
tional
Work
Infection
Delayed
Union

Nail
Migration

Proximal
3rd
1
1
6
8
8
10
0
0
0

Middle 3rd
7
0
6
8
8
11
0
0
0

Distal 3rd
8
0
6
8
10
12
0
0
0


16
1
6
8
8
11
0
0
0


AGE GROUP 41 – 50 YEARS.


Fracture
Site

No.

Difficulty
in
Reduction Union Complication

Clinical
Radio
logical
Func-
tional
Work
Infection
Delayed
Union

Nail
Migration

Proximal
3rd
1
1
6
8
8
10
0
0
0

Middle 3rd
5
1
6
8
8
12
0
0
1

Distal 3rd
6
0
6
8
8
12
0
0
1


12
2
6
8
8
12
0
0
2



AGE GROUP 51 – 60 YEARS.


Fracture
Site

No.

Difficulty
in
Reduction Union Complication

Clinical
Radio
logical
Func-
tional
Work
Infection
Delayed
Union

Nail
Migration

Proximal
3rd
2
0
6
8
10
10
0
1
1

Middle 3rd
3
1
6
8
10
12
0
0
1

Distal 3rd
3
0
6
8
10
12
1
0
0


8
1
6
8
10
12
1
1
2

Total 78 7 1 3 8


Results were analyzed by dividing the patients in to different groups depending on age and site of fracture.

In the 1st group, there were 27 patients in the age group of 10 – 20 years, of which 6 had proximal 3rd fracture, 10 had middle 3rd and 11 had distal 3rd fractures. One fracture had difficulty in reduction because of soft tissue interposition. Clinical union by 4-6 weeks and radiological union by 6-8 weeks. All cases had functional union by 10 weeks.

In one of the case of proximal 3rd fracture had delay in union by 2 weeks. Two patients had nail migration which removed after 3 months.

In the 2nd group patients between the age group of 21-30 years, there were 15 patients; of this 2 fractures had difficulty to reduce. All fractures were united Clinically by 6 weeks, radiologically by 6-8 weeks, and functionally by 10 weeks. One case was delayed to unite by 3 weeks. Two patients had nail migration.

In the 3rd group there were 16 patients; one patient had proximal fractures, 7 patients had middle and 8 patients had distal 3rd fractures. One fracture had difficulty in reduction. All cases had functional union by 8 weeks. There were no delayed union or nail migration.

In the 4th group, there were 12 patients, of which 2 had difficulty in reduction. 2 patients had nail migration which was removed after 3 months.

In the 5th group there were 8 cases. In one case reduction was difficult One patient had superficial infection and one had Delayed union. 2 patient had nail migration.





Of these 78 cases, 7 cases had difficulty in reduction which is more in proximal 3rd fractures (4 proximal 3rd and 2 Middle 3rd fracture) especially in muscular patients. These cases were reduced with bone lever through a stab incision.

Delayed union was seen in 3 cases, which was also more in proximal 3rd and Middle 3rd fractures. One patient had superficial infection which is treated with antibiotics.

Of the 78 cases, 8 cases had nail migration, which was treated by nail removal after clinical and functional union.

All cases were united clinically by 6 weeks and radiologically by 8weeks. Functional union by 10-12 weeks. Patients were started working after 12 weeks.

Discussion

Closed nailing for the forearm fractures showed good results, comparing to the other modes of treatment. For forearm fractures DCP is still the gold standard treatment. But considering short operating time (30 – 40 mints) surgical trauma, infection, short hospital stay, less expense and minimal scar, closed nailing is to be considered as an alternate method of treatment.

In this present study, closed nailing gives better results in younger age group of patients (10-20 years). Difficulty in reduction is more in muscular patients and in proximal 3rd fractures. So selection of cases is important for closed nailing. Better results were with Middle and distal 3rd fractures and in younger age group 10-20 years.

Selection of nail is important, considering the length and size of nail. Chances of migration is more in thin and shorter nail. One disadvantage of nailing is the need for immobilization for 6 – 8 weeks . Nail migration may effect elbow and wrist movements.

Conclusion

• Closed Nailing for forearm fracture gives better results.
• For patients of younger age group (10-20) had better results.
• Compared to proximal fractures middle and distal fractures are easy to treat by closed method.
• Considering the economics, trauma, medicine, hospital stay, infection, non-union, bone grafting, and cosmetic aspect closed nailing gives better results




****