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Member since Jun-04-08 · Last seen Aug-19-14
Good Day to All! Ma-ayong adlaw sa tanan. And my thanks to for this excellent website. Salamat Opinions:

1. World Chess Championship

The true Chess World Champions are the holders of the Traditional Title that originated with Steinitz & passed on in faithful succession to Lasker, Capablanca, Alekhine, Euwe, Botvinnik, Smyslov, Tal, Petrosian, Spassky, Fischer, Karpov, Kasparov, Kramnik, Anand, and Carlsen. The sacredness of this Title is what makes it so valuable.

And how does one become the true Chess World Champion? In general, by beating the previous Titleholder one on one in a Match! Matches are preferred over Tournaments because of the Tradition of the WC Succession & because the chance for pre-arranging a Tournament result is more likely. The only exceptions to this rule:

A. In case where the Candidates and World Champion participate in an event that all the participants agree to be a World Championship event because of extraordinary circumstances.

Thus, the 1948 World Championship Tournament was justifiable because of the death of the Title holder Alekhine.

Likewise, the 2007 WC Tournament was justifiable under the extraordinary circumstances of the Chessworld trying to heal its internal rift over the 1993 Kasparov Schism. Anand himself became the World Champion in this 2007 Tournament & not in 2000 when he won a knock-out FIDE Tournament. Caveat: Some chess fans deem the 2007 WC Tournament as illegitimate, considering that Anand became the World Champion only in 2008, when he beat the previous Titleholder Kramnik in a WC match. From this perspective Anand only became the Undisputed World Champion in 2008.

Karpov lost his Title to Kasparov in 1985, & never regained it in the 1990s events that FIDE labeled as 'world championships'. All solely FIDE Champions that emerged outside WC Traditional Succession elaborated on above, strong as they were, were not true World Champions (eg., Bogolyubov 1928, Khalifman 1999, Ponomariov 2002, Kasimdzhanov 2004, Topalov 2005).//

B. In case the previous Titleholder defaults an event that the Chessworld largely deems as a World Championship event in the Tradition of the World Championship Succession. Thus, Karpov was the true successor to Fischer who defaulted their WC Match in 1975.

2. The strongest chess events in different eras of chess history?

Because of the brain's limitations explained below, the best professional (amateurs don't matter much in top level chess) chess players of each generation beginning in the Lasker era have always played at a similar level - near the maximum allowed by human standards. Now there are larger cohorts of chess professionals post WW2 than preWW2 thanks to government state funding in the Soviet era and presently corporate funding. The result is that large preWW2 tournaments had numerous 'bunnies', relatively weak players. By the Kasparov era, super-tournaments that featured most of the top ten, and no bunnies, had became more common. However, the top 4 or 5 since Lasker's time have always been very strong.

Consequently the smaller the top-player-only tournament, the stronger it gets. For any era. If there was a double round robin tournament in 1914 featuring Lasker, Capablanca, Alekhine, and Rubinstein, and no other, it would be as strong as any present day super-tournament.

Now weed out everyone except the two strongest players in the world. What we (usually) get is the chess World Championship match.

There has been talk of elite tournaments, composed only of the strongest top masters and no weaker bunnies replacing the World Championship match in prestige, probably because of the assumption that they would be the strongest chess events possible. False assumption. The strongest chess events in chess history generally have been World Championship matches. Even the strongest masters in each generation usually do not match the world champion and challenger in chess strength. In a World Championship match, the contestant has to meet the monster champion or challenger over and over again, with no weaker master in between. Capablanca vs Lasker 1921 was just as strong a chess event as the recent Carlsen vs Anand 2013, and far stronger than Zurich 2014. (Imagine having to play 14 straight games with a computer-like errorless Capablanca at his peak.)

3. The strongest chess players in chess history?

IMO the 1919 version of Capablanca & the 1971 version of Fischer, both of whom played practically error-free chess, are it; updated in opening theory, they should beat anyone in a match.

If computers were self-aware, I have no doubt that they would unanimously choose the 1916 to 1924 Capablanca as the strongest chess player in history. And please no red herring remark that Capa played only 'simple' chess. This young Capablanca played some of the most complicated, sharp, double edged, and bizarre positions possible; and played them without making a single losing error (and by all accounts with unsurpassed quickness), something that has always befuddled my mind when I got to peruse through his games.

We have to take this question in the context of the limits of the human Anatomy and Physiology. A concrete example would be the one hundred meter dash. The human body is designed such that the limit it can run is about 9 seconds. In order for a human being to run faster, we would have to redesign the human anatomy into that of say a cheetah. One can rev up the human Anatomy and Physiology, say with steroids, but this regimen would hit an eventual Stonewall too; the same way that we could rev up human proficiency to learn openings with computer assistance.

Since the Nervous System has physiological limits (example of a limit- neuronal action potential speed don't go up much more than 100 m/s) and so limits the human chess playing ability, increasing the number human chess players, thus expanding the normal curve of players, simply creates more possibilities of players playing like a Fischer in his prime, but will not create a mental superman who plays chess at computer levels. This explains why human and computer analysis indicate that Lasker was playing on a qualitatively similar level as more recent WCs.

'Worse' in chess, any computer assistance ends once the opening is over. After a computer-assisted opening prep, every GM today has to play the game the way Lasker did a hundred years ago, relying on himself alone, with the same fundamental chess rules and chess clock. An Encyclopedic opening repertoire is not a necessity to be a top player. In fact, there are World Champions who did not do deep opening prep; they just played quiet but sound openings that got them into playable middlegames and then beat their opponents in the midlegame or endgame. Just look at Capablanca, Spassky, Karpov, and now Carlsen.

Because of subconscious adherence to the narcissistic generation syndrome, the belief that everything that is the best can only exist in the here and now, many kibitzers would not agree to the above theses. While it is true that there have been more active chess professionals and consequently larger cohorts of top chess masters on a yearly basis since WW2 thanks to Soviet state funding and present corporate funding, the very top chess masters since Lasker's time have always played at a similar level- within the limits imposed by the human brain. There is no physical law that bars a pre-WW2 chess master from playing chess as well as today's generation. The human brain has not changed in any fundamental manner in the past tens of thousands of years.

4. The greatest chess players in history?

A related question is who is the greatest chess player in history. The answer depends on the criteria one uses. Since I place great emphasis on the ability to play world class chess for the longest period of time, Lasker would be it. He was playing at peak form from 1890 age 22 (when he began a remarkable run of match victories over Bird, Mieses, Blackburne, Showalter, and culminating in his two massacres of Steinitz) until 1925 at age 57 (when he nearly won Moscow after winning new York 1924). Kasparov (high plateau from 1980 to 2005) and Karpov (high plateau from 1972 to 1996) would follow. (At their very peak though, I believe that Kasparov was stronger than Karpov, and both were stronger than Lasker; and the peak Capablanca and Fischer were stronger than any of them.)

5. Computers vs Humans, who is stronger?

Another related question is how history's top masters would fare against computers. It's obvious from Kasparov's time that computers would totally crush them all. Opening knowledge would not matter much. Computers swamp human opponents in the middle game, simply by calculating more variations more rapidly by several orders of magnitude. Peak Capablanca probably would have the best score among humans. Talk about another level of playing is fans' subjective and IMO wrong words for their favorite players, unless one talks about chess computers. Chess computers do play at a higher level.

6. On the game and chess players young and old, past and present:

The proposition that an older player would not be able to adjust to the openings and methods of a younger generation is false, as evidenced by the observation of strong masters whose careers happened to span generations beating the tar out of weaker masters of the next generations. Lasker provides a classic example; he was beating Mieses, Blackburne, and Steinitz in the 1890s, and crushing masters versed in the hyper-modern teaching of controlling the center indirectly- Reti, Bogolyubov, and Euwe in the 1920s. In more recent times, we have Victor the Terrible, who learned most of his chess in the 1940s and 1950s, whom we have seen competing successfully with the so-called computer generation even at an advanced age.

The notion that computers are more advantageous to younger players IMO is not quite right. Younger players should have more energy and stamina in studying chess openings and endgames for long hours everyday compared to older players without computers, but the use of computers would tend to make the learning process easier for every one including the older ones.

As a corollary, computers also make it easier today for very young players in their early teens to peak at a younger age than in past eras, although they tend to level off in their early 20s to their high plateau, defined by their inborn talents and determination.

In brief. computers tend to level chess learning for everyone, young and old.

This is not a rigid rule. The best games I have ever seen played by a 12-13 year old are Capablanca's; and Tal, Karpov, and Kasparov reached their high plateau in their early 20s in a computer-less era, similar to computer age Carlsen. However let it be noted that Carlsen reached his peak sidestepping intensive computer-prepped tactical openings and beating his competitors in the old fashioned way in the middlegame and endgame. These masters peaked early not because of computers by because of their immense chess talent. Perhaps normal rules do not apply to these geniuses.

Another false notion is that the nature of the middlegame today is somehow different from the middlegame in the past. The easiest way to prove the wrongness of this proposition is by observing CG's daily puzzles. Do not peek at the names of the players that played these puzzles, and don't look at the dates. Can you glean from the middlegame play and combinations in the puzzles the date they were played? You can't. You would not know if it was played in 2014, 2000, 1950, or 1900. Chess combinations don't just suddenly change their stripes just because a hundred years have passed.

Another observation is that when the best masters of the past, Lasker and Capablanca met the occasional 'modern' structures of the Sicilian Scheveningen and Dragon, KID, Modern Benoni, Benko Gambit, they played strategically perfectly, in just the way these opening structures should be played. So how did these masters play openings and the resulting middlegame structures that are deemed incomprehensible to them by some of today's dogmatically 'modern' kibitzers? The answer is that chess rules and principles have not changed. Center, rapid development, open files and diagonals, holes, weak pawns, piece activity, initiative and attack, positional sacrifices and all types of combinations were as familiar to them as to us.

Instead, it is the frequencies of a few middlegame pawn structures have changed since WW2. Not the Ruy Lopez or QGD, but obviously Sicilians and KIDs are much more common post-WW2. Since so many games nowadays begin with the Sicilian and KID, people associate these with being 'modern' (which is a rather vague undefined term IMO). But certainly Lasker and Capablanca understood the middlegame principles behind them and when they did get these positions they played them excellently, like the top masters they are.

7. On ratings:

Elo ratings reflect relative and not absolute chess strength.

Chessplayers are naturally arranged in populations partitioned by geopolitical regions & time periods that have infrequent contacts with one another. Within such a population, players get to play each other more frequently, thus forming a quasi-equilibrium group wherein individual ratings would tend to equilibrate quickly; but not with outside groups. With caveats & in the proper context, FIDE/Elo ratings are simply fallible descriptors & predictors of an active player's near-past & near-future performances against other rated players, & only within the same quasi-equilibrium group.

As corollaries: the best way to evaluate a player's strength is to analyze his games & not his ratings; one cannot use ratings to accurately compare the quality of play of players from the past and present, or even the same player say a decade ago and today; & care should be taken in the use of ratings as a criterion in choosing which players to seed into the upper levels of the WC cycle. All the above often entail comparisons between players from different quasi-equilibrium groups separated by space and/or time.

Regarding inflation deniers, they imply that Elo ratings reflect absolute and not relative chess strength. Professor Elo himself would condemn their view. If the top 20 players were to suffer a serious brain injury and begin playing like patzers, but play no one else for the next decade, they would more or less retain their 2700s ratings, although they would be playing terrible patzerish chess.

8. Best Qualifiers?

The credible, fair, tried & tested Zonals - Interzonals - Candidates (with known strong players directly seeded into the Interzonals & Candidates; & here ratings may be used with caveats) over the random World Cup and the elitist Grand Prix. If possible long Candidate matches and 16 to 24 game World Championship matches. However, with the passing of the state-funded chess era of Soviet times, I begin to doubt if the strict money guzzling qualification process above can be re-installed.

9. The 1993 Chess Rift and Kramnik:

Regarding the Rift in the chessworld after Kasparov split in 1993, I believe that Kramnik has done more than any other individual in helping heal it by concrete actions - agreeing to a WC Match with Topalov in 2006 & not walking out when he could have done so with the support of most of the world's top GMs after getting accused of cheating; & agreeing to Defend his Title in a WC Tournament in 2007, the first time a living Titleholder has agreed to do so in chess history. My eternal gratitude to him.

10. Finances of a would-be Challenger:

Regarding all kinds of problems chessplayers outside of Europe & the USA face in their quest for the Title, Capablanca & Anand have proven it's possible for a non-European non-USA chessplayer to be World Champion; but apparently only if you have the chess talent of a Capablanca or Anand! For others, I guess they would have to try to get monetary support & good seconds somewhere to have some hope for a Title shot.

11. Ducking a World Championship re-match:

Alekhine vs. Capablanca - Not definitively resolved. If pushed, I would tend to favor Capablanca given that pre-WW 2, there was no definitive cycle to choose the Challenger &, after all is said and done, it was the Champion who set the conditions & who chose his Challenger. AAA could & should have chosen Capa; & there was ample time, more than a decade, to do so before WW2. On the other hand, Capa's pride may have caused him to behave arrogantly & thus offend AAA. The issue is very much debatable. //

Kramnik vs. Kasparov - For me, it's resolved. Kudos to Kramnik for trying his best to install a decent Qualifying Event. Kasparov for his reasons clearly did not want to go through the Qualifying Event that he himself had pledged before losing his Title; & did not even seem serious in playing the solely FIDE champions. Why? I can only speculate that Kasparov would rather retire than risk a loss in a Qualifier or a match to either a FIDE champion or to Kramnik. If he regained his Title, he would be the greatest Champion in history, but there was risk involved. If he retired, he would still be the greatest Champion in history, but there would be no risk involved. Kasparov chose the latter & no one should blame him for that decision; & more so don't blame Kramnik!

12. Predictions for Hypothetical World Championship Matches:

Lasker vs. Pillsbury, Rubinstein, Maroczy - Lasker wins 2, loses 1 match //

Lasker vs. Capablanca (inexperienced) 1914 - Lasker close win //

Capablanca (not overconfident & not having TIAs) 1929 to 1937 vs. Alekhine or any other master - Capa win //

Alekhine (sober & prepared) vs. Capablanca (w/ severe HPN & numerous past strokes), Botvinnik, Keres, Fine, Reshevsky, Flohr 1939 - Alekhine win //

Alekhine (alcoholic, ill, & depressed) vs. Botvinnik 1946 - Botvinnik win //

Fischer (inactive for 3 years) vs. Karpov 1975 - Karpov win//

Kasparov vs. Shirov 2000 - Kasparov win. (But GKK should still have given it to Shirov. And don't blame Kramnik. Had Kramnik declined, GKK would have chosen another; & Shirov would still be frustrated.)


I have opened a <'multi-experimental' forum> below. Its nature is that of several secret social and psychological experiments, whose objectives and parameters, and the rules that follow, are strictly defined and which I may or may not reveal. Readers of this forum might be able to deduce some of these rules. Accordingly messages shall be retained or removed with or without explanation, even those from my dear friends here in CG, although I am making it clear here that absolutely no offense is intended to any one in this experiment. I may or may not respond to certain questions and messages, also according to the rules. To my friends: Please bear with me in this matter. There can be a certain amount of disinformation and propaganda in the messages that are retained.

The title of this <'multi-experimental' forum> is:

Biased Journal of a Fourth World Brain Operator

Some abbreviations

CiH = the public City Hospital

PrvH = Private Hospital. There are three main ones. So PrvH 1, PrvH 2, PrvH 3.

ProvH = the public Provincial Hospital

SOL = Space Occupying Lesion

SQ = Subcutaneous tissue layer of the skin or scalp

CVA = Cerebrovascular accident = stroke

EDH = Epidural Hematoma, blood above the dura mater, the outer covering of the brain, and beneath the skull.

SDH = Subdural Hematoma, blood beneath the dura mater.

ASDH = Acute Subdural Hematoma, SDH incurred recently, usually less than a week

CSDH = Chronic Subdural Hematoma, SDH that is more than two weeks old

HCP = Hydrocephalus, too much CSF in the brain's ventricular system

CSF = Cerebrospinal Fluid

CNS = Central Nervous System

CAB = Continuous ambubagging

ETT = Endotracheal tube (for airway purposes)

NGT = Nasogastric tube (for feeding purposes)

NOD = Nurse on duty

The Oracle = personification of the CT (computed tomography) scan.

Magic mirror = the computer monitor where one can see CT scan images.

Witching Hour Admissions or Referrals = 12 midnight to 5am

MF = Motorcycle Fall

Craniectomy = neurosurgical procedure that involves removing a portion of the skull

Tracheostomy = a surgical procedure to create an opening through the neck into the trachea (windpipe)

INTUBATE: To put a tube in, commonly used to refer to the insertion of a breathing tube into the trachea for mechanical ventilation

EXTUBATION: the removal of a tube especially from the larynx after intubationócalled also detubation.

Uneventful day = Most likely still a busy day, making daily rounds in the hospitals, following up post-op patients, seeing patients in the OPD, answering referrals, admitting all kinds of patients in the hospitals; nevertheless a day in which nothing interesting has caught my attention.

>> Click here to see visayanbraindoctor's game collections. Full Member

   visayanbraindoctor has kibitzed 6581 times to chessgames   [more...]
   Aug-19-14 twinlark chessforum (replies)
visayanbraindoctor: <twinlark> Russian media has announced that Russia is pushing the UN Security Council to make public the investigations on the MH17 shoot down and that Kiev should make public the radio communications between Kiev air traffic controllers and the plane before it was ...
   Aug-19-14 visayanbraindoctor chessforum (replies)
visayanbraindoctor: 19 August 2014. Entry 1. People below 40 usually do not get hypertensive hemorrhagic strokes. That is according to traditional medical literature. Nowadays though, it does not surprise me anymore. At 12 midnight I got called to PrH2 ER. There I admitted 37M, who had ...
   Aug-16-14 Jose Raul Capablanca (replies)
visayanbraindoctor: <Everett: In fact, the year or two leading up to winning the WC is usually remarkable.> Also true for Lasker. He played a series of matches against the world's finest players, probably the alternative in an era where there was a lack of chess tournaments. ...
   Aug-15-14 Kenneth Rogoff (replies)
visayanbraindoctor: Survey update: <Who shot down Malaysian plane flight MH17? A. The Novorossiya militia intentionally. (If this is your opinion please state if by MANPAD or BUK.) B. The Novorossiya militia by accident. (If this is your opinion please state if by MANPAD or BUK.) C. The ...
   Aug-14-14 Chess Olympiad (2014) (replies)
visayanbraindoctor: <Appaz: Congratulations to China, yes, a sign of times, and also to the Indians - quite an effort without two of their strongest players.> Yes without Wang Hao for the Chinese and without Anand for the Indians. I wonder what would have happened if these two were ...
   Aug-12-14 Topalov vs Vallejo-Pons, 2014 (replies)
visayanbraindoctor: This could be the best game in the Olympiad. A genuine tactical brilliancy. Stylistically Topalov is of the same line as Alekhine, Tal, and Kasparov. These people just can't help it; somehow they just keep on producing these tactical masterpieces.
   Aug-10-14 Kramnik vs Vallejo-Pons, 2014
visayanbraindoctor: As a Kramnik fan, I am saddened to see Kramnik play this way. When Vallejo's Rook found its way to d3, the old Kramnik, the one that beat Kasparov, would surely have driven this powerful piece away and neutralized it, perhaps with a maneuver like 20. Qe2 and later on ...
   Aug-10-14 B Predojevic vs Carlsen, 2014 (replies)
visayanbraindoctor: Another game in which Carlsen's opponent gets swamped by his square grabbing style. Block and grab, block and grab. Carlsen fights for the d4 square, and when he plants a Knight there, his opponent decides to exchange off this strong Knight. It however allows Carlsen to ...
   Aug-10-14 Carlsen vs Naiditsch, 2014 (replies)
visayanbraindoctor: I think World Champion Carlsen overlooked the maneuver 30.. Nf3 31. Bc3 g5 32. h3 h5 33. Kg2 g4. Naidich went for the f3 square. Suddenly, Carlsen's King is trapped away from the action, and it's now Naidich who has grabbed a juicy square, the f3 hole (usually it's ...
   Aug-09-14 Kasimdzhanov vs Kramnik, 2014 (replies)
visayanbraindoctor: 16... Nxe5 IMO is a positional mistake that's of a type that keeps popping up in Kramnik's games recently. After 17. de5 Qe5 18. Qxb6 Kramnik has essentially surrendered his Queenside, while he is still underdeveloped and uncoordinated, and with Kazim's rooks aimed right ...
(replies) indicates a reply to the comment.

Kibitzer's Corner
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Premium Chessgames Member
  visayanbraindoctor: <perfidious: Is it your experience that some people are put off by such crises and do not respond well, whilst others seem to gain in strength and show what they are made of when things are at their most difficult? In your profession, surely you see the widest range of behaviours, for better or worse, in such circumstances>

Human behaviors vary much in the face of the imminent possible death or hospitalization of a relative.

1. Some stick to their relative and do their best to get all the medicines. I like these persons. Even if they can't procure all medicines and OR needs, I do my best for the patient, and never demand payment if they are poor and truly can't afford.

2. Some stay put, but don't procure medicines and don't do anything else. Useless as a wallflower.

3. Some show up briefly, or don't show up at all. More useless than a ghost.

4. Some stick around, don't buy meds, don't do anything, but demand that I make their patient get better, cajole, threaten, scatter intrigues, and generally make mules and asses out of themselves. This is the worst.

Premium Chessgames Member
  visayanbraindoctor: 5 August 2014. Entry 1. Uneventful day.
Aug-05-14  OldTimr: My vote is for D (kiev faction's false flag).
Premium Chessgames Member
  visayanbraindoctor: <OldTimr> Noted your response in the Rogoff page.
Premium Chessgames Member
  visayanbraindoctor: 6 August 2014. Entry 1. In the morning, I operated on 14M, who fell off a santol tree. He sustained an open depressed fracture on his parietal bone. The operation in such cases consists of removing dirty scalp and bone, and covering dural defects with periosteum or muscle.

Many fall-of-a-tree cases among children and teenagers are from santol trees. I used to spend a lot of time up a santol tree myself when I was a kid, plucking and eating its fruits and enjoying the sensation of being high above the world.

Premium Chessgames Member
  visayanbraindoctor: 6 August 2014. Entry 2. Early evening I intubated 6M in PrvH1 ER. He jumped out of a tricycle while it was still moving and hit the road hard. His left pupil was dilating. The Oracle showed a 70cc epidural hematoma underneath his left parietal bone. His family being poor, I rushed him to the public CiH, and operated on him fast and furious before his other pupil dilated. Thankfully post-op his pupils normalized and he woke up.

Epidural hematomas are usually caused by a fracture in the skull bleeding into the epidural space just underneath. The patient is usually awake, walking, and talking, just as 6M was, before the steady bleeding inside the skull causes enough brain compression to conk him out. The patients are for the most part otherwise completely healthy, and if they survive, there is usually complete recovery and no neurological deficit. My personal attitude generally is: Act fast and furious in EDH cases. No one should die of epidural hematomas.

Premium Chessgames Member
  Annie K.: It's thanks to your wonderfully clear and detailed explanations, that by now when you write a "simple" sentence like <His left pupil was dilating>, every one of your readers should immediately understand just how bad and urgent that is.

<I think the opposite happens. The Wernicke's area is a bit dysfunctional and so the patient does not comprehend her own speech well.>

Not to argue, but I just like to figure things out... :)

So, it's the Wernicke's area (comprehension in general) that is weakened at this stage, not the Hesselbach's area. And you say the Hesselbach's area is very well situated to easily transfer data to the Wernicke's area... so it doesn't seem like the opposite happens?

The picture I get is that the patients talk so much, and repeat themselves, because specifically <auditory> practice helps them improve their comprehension at this point - as opposed to other input/practice types, such as thinking things over quietly, for example. They don't comprehend *anything* well yet, but relatively speaking, unvoiced thoughts just don't "stick" as efficiently as voiced ones, because these register via the Hesselbach's area, which seems to be a particularly helpful route?

Premium Chessgames Member
  visayanbraindoctor: <Hesselbach's area is very well situated to easily transfer data to the Wernicke's area> Theoretically it does, and then we 'comprehend' in the Wernicke's. Data from there then goes to the rest of the cerebral corttex for interaction with other data and for storage.

<but relatively speaking, unvoiced thoughts just don't "stick" as efficiently as voiced ones, because these register via the Hesselbach's area, which seems to be a particularly helpful route?>

I tend to agree.

Caveat: Other senses have different pathways. Visual data goes into the calcarine fissure in the occipital lobe. Pain and temperature to the thalamus. That's why if you want to memorize something, best do so by using different senses as well as repetition. For a student of Medicine who has to memorize loads of stuff, that means reading on a topic before class, listening to the lecturer during class about the topic, discussing the topic with classmates after, and studying it again before the exams.

Premium Chessgames Member
  visayanbraindoctor: 7 August 2014. Entry 1. I debrided the left frontal scalp laceration of a MF patient 42M, who came from an adjacent province, this noon in CiH ward under local anesthesia. Before doing so, I also took a look at his bandaged left foot and thigh. It turned out that he had huge lacerations on his thigh and foot. I had to spend nearly two hours debriding, cleaning, and suturing under LA. Not really my job, but they were beginning to infect. It was hot in the ward and I was drenched in sweat after.
Premium Chessgames Member
  visayanbraindoctor: 8 August 2014. Entry 1. Uneventful day.
Premium Chessgames Member
  visayanbraindoctor: 9 August 2014. Entry 1. <<31 July 2014. Entry 1. A MF patient, 55M came in last night in PrvH1 ER. He had a bifrontal cerebral contusion, which in my assessment was non-operative. During the night he steadily deteriorated, lowered sensorium and productive cough. Next morning during my rounds, he was comatose, anisocoric, and showing signs of respiratory distress. I intubated him. His sensorium improved to the point were he again began exhibiting volitional movements. Unfortunately in the afternoon he pulled out his ETT, and slipped back into a coma. I reintubated him. No money for a craniectomy. The relatives will probably transfer him to the public CiH.>

And so they did transfer. I did a bifrontal craniectomy on 55M in the evening. Turned out that his left frontal lobe had burst, releasing the intracerebral hematoma into the subdural space. I also did a tracheostomy, since I expect some time for him to regain full consciousness (if he survives).>

Still alive, but 55M has begun to suffer from respiratory distress.

Premium Chessgames Member
  visayanbraindoctor: 10 August 2014. Entry 1. Uneventful day.
Premium Chessgames Member
  visayanbraindoctor: 11 August 2014. Entry 1. Uneventful day.
Premium Chessgames Member
  visayanbraindoctor: 12 August 2014. Entry 1. Uneventful day.
Premium Chessgames Member
  visayanbraindoctor: 13 August 2014. Entry 1. Uneventful day.
Premium Chessgames Member
  visayanbraindoctor: 14 August 2014. Entry 1.

<30 July 2014. Entry 1. I operated on 61F, removing a right basal ganglia hypertensive hemorrhage. The previous night, she had deteriorated in the ER of PrH1, but could not afford private rates. So I intubated her, and then transferred her to the public CiH.>

61F died 8 July of pneumonia and sepsis.

<31 July 2014. Entry 1. A MF patient, 55M came in last night in PrvH1 ER. He had a bifrontal cerebral contusion, which in my assessment was non-operative. During the night he steadily deteriorated, lowered sensorium and productive cough. Next morning during my rounds, he was comatose, anisocoric, and showing signs of respiratory distress. I intubated him. His sensorium improved to the point were he again began exhibiting volitional movements. Unfortunately in the afternoon he pulled out his ETT, and slipped back into a coma. I reintubated him. No money for a craniectomy. The relatives will probably transfer him to the public CiH.>

55M died early this morning of pneumonia and sepsis. He was a smoker, which makes it more difficult to treat pulmonary problems.

If a Neuro patient does not wake up within 3 days of the operation, the probability of dying from pneumonia and sepsis begin to increase.

Premium Chessgames Member
  visayanbraindoctor: 14 August 2014. Entry 2.

Did a craniectomy and removal of acute subdural hematoma on 35M, a MF patient. When I opened up the dura and removed the ASDH, I saw that his brain had lots of subarachnoid hemorrhage; and was quite swollen. That worries me more than the garden variety type of cases. It indicates that he would be more prone to strokes and seizures for a week post-op.

Premium Chessgames Member
  visayanbraindoctor: 15 August 2014. Entry 1. 35M surprised me by waking up. I extubated him noontime.
Aug-16-14  SugarDom: INTUBATE: To put a tube in, commonly used to refer to the insertion of a breathing tube into the trachea for mechanical ventilation

EXTUBATION. : the removal of a tube especially from the larynx after intubationócalled also detubation.

You might want to add that to medical section in your bio, Doc. ;)

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  visayanbraindoctor: <SugarDom: You might want to add that to medical section in your bio, Doc.> Will incorporate it.
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  visayanbraindoctor: 16 August 2014. Entry 1. Uneventful day.
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  visayanbraindoctor: 17 August 2014. Entry 1. Uneventful day.
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  visayanbraindoctor: 18 August 2014. Entry 1. Uneventful day.
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  visayanbraindoctor: 19 August 2014. Entry 1. People below 40 usually do not get hypertensive hemorrhagic strokes. That is according to traditional medical literature. Nowadays though, it does not surprise me anymore.

At 12 midnight I got called to PrH2 ER. There I admitted 37M, who had suffered from sudden decrease in sensorium and right sided hemiparesis. The Oracle showed a left basal ganglia bleed at least 40 cc.

Usually I do not operate on left sided brain lesions if I can help it, because I do not like fooling around inside the dominant hemisphere (which is usually the left). I decided to observe 37M. At around 2am, 37M's sensorium dropped from GCS 9 to 8; and he became bradycardic with HR at 50 and with BP spikes over 200 systolic. Classically increased intracranial pressure manifests as 'Cushing's triad' -increased BP, decrease HR, decrease RR. So I rushed 37M to the OR, and did a wide craniectomy on the left temporo-fronto-parietal bone. I did a frontal lobe cortisectomy 6cm anterior to the motor cortex. (I dislike the traditional temporal approach where you often encounter branches of the middle cerebral artery, which if severed would mess up the operation by spurting out red blood.) At about 6cm depth, I managed to access the blood clot. I removed most of it. The brain collapsed back below the inner table of the skull, my signal to stop the operation and close up.

I left the hospital at 8am. No sleep for me this day.

One thing I noticed about 37M. He was massively obese. No wonder he had a stroke at such a young age.

I usually advise such patients to avoid eating lots of rice, lechon (roasted pig that is so popular in many former colonies of the old Spanish Empire), chicken skin and other oily foods; and increase uptake of vegetables.

Aug-19-14  SugarDom: I see some people like eating the fat in pork chop and pork barbecue, i think this is very bad.
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