living bridge

Thursday, February 23, 2012

Refletions of a day in my consulting chamber


Good morning Doc.

Good morning Shantha.. Nice to see you after nearly 10 years

It is sweet of you to remember my name after a long time

[said to myself : I cannot let her down of appreciating my memory –for I got her name from the data base given by my secretary earlier}

Thank you. How can I help you this time?

I have this back and neck pain on and off but it is o.k with the tablet. It is the nagging tummy that I am worried about. My friend’s father had the same problem and it turned out to be cancer.

Just then her mother

I will tell you doc.she lives at Bangaluru,sharing a room with herfriends, doesn’t eat properly, sleep less,watch t.v.
I am also concerned so we did a master check up.

She produces a big file for me to go through. I received the file and kept aside.

Have you brought the old report and the discharge summary?

IT has been a longtime and since we changed the house- some how the file is missing
But I have the tablets which I take now and then

Show me the prescription

So sorry that too is not with me

O.k. let me see what you have

She produces two strips of empty blister packs the prints over the glistening foil couldn’t be read.

Why do you keep them?

The doctor told me to take whenever I have pain at the back.

How do you buy them without the prescription?

Oh!.my chemist recognizes the foil and gives the medicines

I am left speechless by the way some patients treasure the opened foil pack without any
Concern for the doctor’s prescription or discharge summary

Mother : They told us that nothing wrong with the tests but I will be happy for you to go through the results and give your opinion.

Sure but let me examine you first

But Doc they have already diagnosed as peptic disease. I cannot understand why I get this because I don’t eat citrus fruits

O.k. my dear if you could clarify certain points

What is your working time?

8am to 9pm

What time you get up?

By 6 or 6.30am take the company bus by 7-15am and reach office by 8am

How about your bowel habits?

Oh! I manage it alright, .take the news paper or some reading material, spend about 15 mins, by the time I manage to evacuate.

Don’t you have a better place for reading?

Sure it is the time factor at my disposal. It works out as 2-in-1 at the toilet

Do you feel empty?

Mostly, but some times I have a second do at the office

O.k tell me about your diet habits.

I usually skip breakfast. It is usually bread, fried eggs at the office for the brunch, and for dinner I buy from KFC or make some noodles at my room
By the by ,Doc I have this nagging pain at the back and neck. Why is that?

What do you do for that?

I take this tablet producing a chemist receipt

I am amazed and floored again by the way patients preserve the receipt rather than the
Prescription.!!!! Are they going to get the money refunded? I wonder!!

How often you take them.

Almost every other day, then only I am able to concentrate with the sys tem.

Do you keep a writing pad?

No way, working with the system I have to lean forward..

O.k my dear let me examine you.

Just tell me Doc what is peptic disease? What should I do? Is it cancer?

Just relax and take the couch.

Mother : let the doctor examine you dear.

As I proceeded with my routine, with inspection, palpation, percussion and auscultation Shantha was in no mood to co-operate for she wants a one word answer to her peptic disase..she couldn’t understand my reason looking at her tongue,eyes,status of her oral hygiene . When I auscultated her tummy she thought for a moment I made a mistake by listening to the tummy rather than her heart..
When I wanted to do a rectal exam she declined initially but after persuasion by her mother and proper screening she agreed. She had severe tenesmus and skin tag which is a tell tale feature fissure-in-ano. Rectal exam was painful but I had no choice. After a few 10 mins in the couch she felt better and eased herself to the chair. Meanwhile I browsed through the file and found nothing alarming except antral gastritis,+ve for H-pylori and E.H cyst in the motion.

O.K doc what is the score? It is not cancer or is it ? do be frank. I will take it..

Relax my dear first believe yourself and then believe me. 100% it is not cancer I assure you.

Are you sure?

Yes believe me.

Mother : thank God I am relieved..

Then what is it doc?

Yes you have peptic disease and what I call, as I.T SYNDOME

Exactly what is it?

It is a combination of upper gastric disturbances, constipation, backache, worry and may even lead to depression

Why? I even avoid citrus fruits.

It is due to your life style, food habits, stress, frequent intake of pain killing drugs .
No doubt you are making a fat income only to spend all in the next few decades for health care.

Mother: O.k doc what is you answer to her problem ?

First let me deal with the nagging peptic disease

1} Never skip breakfast. You are breaking overnight fast and that is reason it is called breakfast. Skipping will lead to obesity and the sequela
2} avoid deep fried foods, masala, foods saturated with oil and pain killing drugs etc
3}help yourself with good quantity of. Vegetables, greens, fruits, and some dried fruits
And liberal vol.of water
4} regarding your constipation, my advise is to stick to BILOGICAL CLOCK i.e sleep while you feel sleepy, eat when you feel hungry, pass urine when you feel like so,daefecate when you feel so


5} never go to the toilet straight from the bed. Drink a glass of warm water, coffee or tea
For the bowel to set in motion of propagative waves to expel the matter. This is called gastrocolic reflux. Wait for the urge to be felt at the bottom-then you will completely empty without straining .PLEASE DON’T TAKE READING MATERIALS TO THE TOILET.

Mother : in fact she has a cupboard in the toilet.

First get rid of the cupboard

O.K doc but how about my backache?

It is mainly postural. Sit well back in the chair, with the back well supported, use a writing pad wherever possible. Don’t; lean forward..
Also keeps your back relaxed while driving a two wheeler
You are also little overweight at 75 kg. Shedding a few kg also will help.
Early morning walk for ½ hr will help to reduce weight.

But Doc ,I have just enough time to catch the bus and reach the office by 8a,m

You have to get up ½ hr earlier- that way you still have your 24hrs..

Mother :I have been telling her. These days, they don’t listen to us.
Why don’t you give some good medicines?

As said earlier stick BIOLOGICAL CLOCK, avoid junk foods, eat liberal fruits, greens
Keep upright posture while driving and at the work station. Make it habit to walk 5km a day. Avoid pain killing drugs.. As for specific medication, take a course of anti amoebic drugs.

Mother : thank you doc I am relieved it is not cancer. Hope she follows your advice.

Shantha : thanks a lot doc. I will try to follow your instructions.

You better. Do keep intouch reg.your progress


1} Choose your family physician, and let him examine and order for relevant tests
And refrain from choosing for master check up your self . The symptoms are better narrated from the horse’s mouth rather than the anxious relatives

2}Keep a health file with all the tests done earlier,and discard old used foil blister packs

3}Do not buy medicines across the counter

4}Stick to biological clock—eat when you feel hungry, sleep when you feel sleepy, evacuate the bowel only after you get the urge

5} Avoid reading at the toilet.

6}Keep a straight back always when using the system