Monday, September 23, 2013

unexpected side effects

                                                         Unexpected side –effects!!
                                        Vivek Hande

The practice of medicine revolves around the central ethos of “Primum Non Nocere” or First, do no harm. A physician’s efforts are directed towards beneficence in respect of the patient. The practice of medicine, in many ways is not science, but truly an art. It throws up many challenges and at times, rather, strange and unexpected results.

One directs therapy with a particular goal in mind and the outcomes may be gratifying – for different reasons. I recently had a crusty old octogenarian, who was suffering from chronic constipation along with other myriad ailments. After some persuasion, he consented to undergo a colonoscopy.  He was certainly not enjoying the procedure and he let me know in no uncertain terms what he thought of me and the entire procedure. He bellowed, “Doc, you have the damn tube up my backside and you are telling me everything is fine and asking me to be normal and to take it easy. You must be joking or you must be out of your mind!” Well, we got through the procedure and he got out of the endoscopy room generally muttering and cursing and conveying his displeasure most vocally. I knew we were not going to be friends ever.  I was not looking forward to his OPD follow up visit a fortnight later. I was amazed when the gent walked into my chamber with a huge grin and beaming from ear to ear. He actually gave me a bear hug and told me in his booming voice, “Doctor, I remain constipated but the colonoscopy has completely cured my chronic sinusitis.  Ever since you shoved that damn tube , I have not sneezed. I don’t have a headache and I have not taken any anti-histaminics. I have tried everything for my sinusitis but nothing has ever worked. I need a colonoscopy every month for my sinuses!”  Well, that is certainly a new one and I am trying to get see if one can add this unexpected benefit to the list of indications for a colonoscopy!

Then I had this chirpy middle aged lady who was under treatment for dyspepsia for several years. Her dyspepsia did not seem to be getting well but she would nevertheless, faithfully report every month for her quota of antacids. She would also insist on a prescription of multi-vitamins and Calcium and Zinc for her “weakness”.  After some months, she reported to me for her monthly renewal and said she was doing fine and needed only her vitamin supplements and nothing for her dyspepsia. I went along with it , happy that her dyspepsia was finally coming under control . The next month around she said, “No antacids but I need a double dose of vitamins and other supplements for weakness!”  I did not think she had significantly “weakened” and I asked her why she needed so many vitamin pills. Her answer stumped me, “My kitchen garden and my flowers are coming around excellently thanks to your multi-vitamin pills. I have been using them on my plants; the last few months are they are doing great.  I work long with my plants and my digestion has improved and I don’t need those silly antacids. Doctor, you have to keep my dyspepsia under control by helping my plants grow!” Convoluted logic, but unexpected benefits of treatment, so to say!!

I had yet another patient, an ex- serviceman, who had many gastrointestinal complaints. He was on a regular follow up and some months later told me that he had changed jobs and that was causing his eating habits and bio-rhythm to go a trifle haywire. He started developing many symptoms after the change of job and every month he had a fresh complaint. He complained of chronic headache; blurring of vision; recurrent coughs and colds; chest pain; lack of sleep and anxiety related symptoms and itching of skin and an ongoing list of ailments. After unsuccessfully attempting to sort out his problems, I started referring him to concerned specialist OPDs –ENT; Eye: Neurology: Chest ; Psychiatry and so on. Six months down the line he came to my OPD and offered some sweets to my staff and me. I thought it was in gratitude for sorting out his GI problems. He elaborated, “Sir, six months ago I changed my job and became an Insurance agent. It was very difficult to enlist new customers but thanks to you I have met so many doctors and their staff members. I have sold so many Insurance policies in the last six months. Thanks to your clinical judgment, I have met the correct specialists and I got a huge bonus today. Sir, I have this new problem – my joints are paining at night and I think I need to see an Orthopedic surgeon. Could you please refer me?” I choked on my Barfi and pushed him out as gently as I could. Unexpected side –effects, I daresay?

Each day in practice teaches you something new and the results are at times baffling, unexpected and quite out of the ordinary. I continue to learn…

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