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Let me tell you a story. Story of a
man and his gas in love.
There was this patient, a friend of mine who loved to suffer
from severe ‘Gas’. His days and nights were overshadowed by gas.
His most important topic for discussion amongst friends was gas.
He would wake up if the morning, if he had slept at all, with
gas trying to push it’s way through his throat onto his head. He
could feel the gas climbing and banging against his chest wall.
The gas would burn the throat and chest on the way and reach his
head. There, the chaos would be much worse, he would get
throbbing headache, vertigo, nausea, tingling in the ears. As
day progressed his suffering would worsen. Whatever he ate or
drank would never be digested. Food would enter the stomach and
turn into gas and acid. The gas would then turn the abdomen into
a football; even the slightest tapping would give a sound
resembling that of a drum. He would not feel like taking the
next meal.
Worst of all, his bowels would never be ‘clear’. He was never
satisfied with his bowel movement. He would try to dispel the
gas by belching. Fortunately belching came automatically. The
whole day he would belch out gas, politely with minimum noise in
the office, but as strongly and as loudly possible in the
quietness of his nest. Belching gave some relief. But peace
would not even be in the horizon. After sometimes gargling
sounds would emanate from the tummy. He would make a few futile
attempts in the toilet to clear his bowels, but God has never
been good to good people like my friend.
The only consolation was that my friend was a serious worker.
Whenever he was in the office, he was obliged to forget about
his personal problems and work like mad. That gave him some
peace. Frustration would creep in by the evening. Back in the
quietness of home and a loving wife his turmoil would bubble
again. His wife would enquire about his gas and he would tell
her the whole story of daylong gas-trick in the most detailed
form. In the evening and night they would discuss what all
things not to eat to avoid further exacerbation of the mighty
enemy. For dinner they would swallow a bit of pale boiled soft
food-like substance to offer minimum help for gas and try to
sleep. But gas had already gone to the head by then. He would be
disturbed in his sleep by the hot tummy, wake up two three times
and have a restless awakening in the morning.
He did everything possible to get relief. He had been to all big
doctors. got every possible test done, tried every medicine.
When sonography arrived in the scene, he got the best hope of
his lifetime. Ultrasonography showed one large stone floating
mischievously in his gall bladder. ‘Eureka’, the doctor said,
‘here you are, get operated and you would be fine’. This led to
a loss of Rupees Fifteen thousand and a week in the Nursing
home. Three months later he was back to square one. A further
sonography suggested ‘gas’ in the abdomen. He had got done
Endosopy at least five times. Every ‘scopy’ confirmed the
existence of severe gas. He tried out, as per the recommendation
of big doctors, all the latest gas medicines. He started with
cimetidine, then gradually through famotidine, omeprazole,
pantoprazole, he had now graduated to the latest Rabeprazole.
But then his gas was so strong that these medicines did not help
at all. He was frustrated but did not stop taking these drugs.
Every day he would pop in five to six medicines for gas and some
to clear his bowels.
He decided to go outside Tripura for treatment. He visited
Asia’s number one physician there. This doctor was so famous and
great that you could not get an appointment before one year. So
my friend had to bribe the secretary to get one appointment
within a month. This physician did all possible tests, including
echo, CT, holter and complete blood studies. He was so serious
about my friend’s disease that he did Endocsopy thrice in one
week to see the changes in gas position. My friend had told him
not to worry about the bill. What was money after all, if you
were not healthy? The great doctor after 10 days of intensive
investigation suggested a strict diet chart that forbade
everything even remotely related to taste. My friend was allowed
only boiled rice and vegetables. No tea, no food outside home,
no chilies, no masala, no fish, no meat. He was supposed to eat
several times a day in small scoops. He discovered another
Rabeprazole with D attached. My friend, lighter by thirty
thousand, came back a happy man. Five days later he was back
where he was, five months later he had lost ten kilos and was
really sick. Gas would eventually kill him, he declared.
He tried every home remedy. He would take two liters of water in
empty stomach in the morning. He would not drink water for
thirty-seven minutes after taking whatever junk of food he was
allowed; he constantly practiced ‘Pavanamuktasana’ and all other
modern yoga. He visited Baba purchasing a first class ticket. He
tried washing his stomach after drinking water. Nothing worked.
My friend was waiting for death. Even that eluded the wretched
sufferer.
What was my role in these twenty years you might ask? He’s a
good friend and would trust me with all his property, but not
with his health. I have been trying to convince him about the
myth called gas. I had told him that there is no such disease
called gas anywhere in medical science. I tried to convince him
about the physiology of the stomach. He is an educated man,
works in the University and I thought he would understand. Every
time I made an attempt to explain, he would give me a look of
mistrust that chilled my spine and then he would disappear for
six months. He would again surface after visiting a new
consultant, who had approved of all his symptoms and started the
latest gas medicine. He would show me the prescription and
declare his imminent cure. This continued for twenty long years.
Ultimately he stopped coming to me. We had contact over phone,
but hardly saw each other.
A year back I had to get some papers from the university. I had
no option but to call my friend, to avoid driving to Timbuktu,
where the University was located. He was so good. He paid for
the forms and suggested that he would drop in and give me the
forms. I rejected the proposal politely and reached his home on
the next Sunday morning. I was shocked to see him. He was half
the size; dark circles were clearly seen under his eyes. He was
trembling. Walking was difficult, so was talking. My shocked ex-pression
brought tears in his eyes. His wife came in, sad looking,
depressed and wondered what was the fun of having a doctor as
friend if they had to suffer like this.
What could I do? There is nothing serious about gas you might
say, but I did take it seriously enough to talk to you. More
than 90% of my patients, irrespective of their caste, economic
status, age, sex, disease profile, anything, complain of ‘gas’.
Some patients do surprise me sometimes by not talking about gas,
but they are a negligible minority. I have been wondering about
it. I wrote my first treatise on Gas about 20 years back. Dr.
Rathin Datta had given me an appreciative poke on my tummy after
reading that article. For the last two decades I have tried my
best to convince each and every patient about the myth called
gas. Looking back after 20 yrs, I do not think I have been very
successful.
I spent a couple of hours with them, perused all the documents
he had compiled through the years, and declared that I could
treat him provided he would very strictly adhere to what all I
asked him to do whether he believed me or not. My friend did not
look interested. I was not the Asia number one; also amongst the
doctors in Tripura I was ranked one thousand and fifty seventh
out of a total of one thousand fifty eight. The last one was
kept below me because there was some doubt about the
authenticity of his degree. More over, I was not of the same
faith, I did not believe in his God, Gas. What a blasphemy! But
this time the wife, with her feminine instinct, decided to
overrule her husband. She was firm. ‘No dada’, she said, ‘you
treat him. We have done everything possible. It is intolerable.
He would do whatever you ask him to. I take the guarantee’. I
looked at my friend. He was too weak to fight. He nodded.
I picked up a piece of paper and jotted down a prescription. It
read thus
1. Thou shall not accept any suggestions regarding treatment
other than mine.
2. Thou shall stop talking about the disease to any one except
me.
3. Thou shall eat a normal diet; there should be absolutely no
exclusion.
4. Thou shall not drink water in empty stomach, drink only when
thirsty, never from a bottle directly.
5. Thou shall not belch.
6. Thou shall not vomit intentionally to wash the stomach.
7. Thou shall not bother about the amount of stool passed.
8. Thou shall not utter the word gas for next six months.
9. Thou shall visit me once every month, not more.
10. Thou shall take one tablet of XYZ at night, non-stop.
The Ten Commandments, Sarvadharma parityajya mamekong sharnam
braja.
‘You are sure about this’, my friend was perplexed, ‘you’re sure
you don’t want to kill me? You are not doing any tests to
confirm your diagnosis! You want me to take only one tablet, and
this does not sound like any ‘gas medicine’ that I have ever
consumed. I am afraid if I follow your advice, I may not live
for a month. No food restriction, no drinking water every
morning, are you mad. The whole world knows that we must drink
at least two liters of water; some even say five, in empty
stomach in the morning to clear our bowels; you must be crazy’.
‘The whole world is not sick my friend, you are’. I gripped my
friend’s hand and told him firmly that it was entirely his
choice. He could take it or leave it. These are the Ten
Commandments; follow them if he wanted relief. Anyway he had
tried everything else, everything else that he and his world
believed in, still got no relief.
I invited him to come to a new world. In our world nothing runs
on belief. We either know or do not know; we do not believe
anything. Everything here is evidence based. We do not believe
that he’ll get relief by following these advise, he may or may
not, but we know this is the scientific way of treating him, if
he’s ever to get relief, he could get it only through this
method. ‘Anyway you are as good as dead now, why not have faith
in me once and take a chance’.
‘But doctor so and so, Asia’s number one in rank, who goes to
the states every other month to treat patients there, told me
that I must take rabeprazole daily’, my friend cried. Refer to
the first commandment, I quietly reminded him. ‘I should not
take spices, they are poison for gastric’, he pleaded.
‘Commandment number three’, I rebuked him, ‘and you do not
disobey commandments’. My friend’s wife stepped in, ‘ He is
going to follow each and every word of it, and I assure you’. I
left with a warning, ‘Do not forget the number two’. I asked her
to go through the commandments daily to see everything was
followed in toto.
One month later the couple came to my clinic, he was much better
off. Most of his problems had disappeared. He was eating normal
food; he was not belching; he was sleeping well at night. He was
less tense; his habit of talking about gas had nearly
disappeared. He did not believe what was happening to him. A
temporary relief, he wondered. He still had one problem though.
‘But doctor I am not passing sufficient stool’. ‘Yeah’, I said,
‘refer to the seventh commandment’.
Three months later he was absolutely normal. Even my friend
agreed that he was fine, no gas, no acid, nothing, but he asked
me very politely, could he take one rabeprazole if ever gas
formed suddenly in his stomach! ‘The eighth’, I admonished him.
He is fine now. He has gained weight, sleeps well, his abdomen
does not bloat and he eats well. I do not see him often, but I
know he is fine. He looked sad though; he had to part the
company of his long time consort, gas. There is one worry; he
might take a flight back to his ‘universe of gas’ any day. One
small stimulus and he would be back to his lost love.
What was wrong! For years I did not know the reason. I used to
think that these people were crazy not to listen to sensible
advice; I thought these doctors were making money by exploiting
such patients. But recently a monograph on ‘medical models’
opened my eyes.
What did I do? I diagnosed that the patient was suffering from
Generalized Anxiety Disorder with superimposed misconceptions
about gas and acid and the amount of stool that should be passed
daily. He was a severe case of aerophagia, swallowing air by
various methods like drinking water and belching. This swallowed
air caused discomfort in the abdomen. His misconceptions were
reinforced by discussions with his friends and relatives, who
had the same model in their minds. His doctors knowingly or
otherwise belonged to the same community of gas worshippers.
Once I forcefully separated him from the community, without
reinforcement and one added anxiolytic, antidepressant, he was
all right in months.
Every individual grows up in a particular socio-cultural set up.
This set up includes beliefs, faiths, myths, local treatment
norms, local words for diseases, and religious teachings. Every
person grows a model of illness in the mind, which he or she
believes to be true and imparts the knowledge to the offspring.
When these persons go to a doctor they have already made up the
model of the illness in the mind, and to confirm the diagnosis
they use words that they know would lead to the illness model
they believe they’re having.
They even stress on symptoms, which would divert the doctor to
the desired goal. “Last night”, one would say, “I had taken meat
at my sisters place. I had severe gas, which climbed up to the
chest and head. It was upward gas, so I had severe chest pain,
headache and breathing difficulty”. The gas was so severe, one
would re-affirm that even double dose of rabeprazole with liquid
white antacid did not work. The doctor is looking for a disease;
the patient is talking about an illness. The illness is the
signs and symptoms plus the patient’s faith, myth and belief. It
is only on persistent and rigorous inquiry that the doctor would
discover that the patient was an old case of negligent COPD and
hypertension, and was presently having a heart attack. I have
seen many patients die, just because they uttered the word gas.
The statement delayed their diagnosis. Even after death the
diagnosis of gas persisted. Fortunately they never put it on the
death certificate.
The other side is also analogous. If you go to a doctor, and you
commit the blunder of not talking about gas, he would seize the
initiative from you, and ask you, if you had gas! Recently I met
with an accident. I hit a pedestrian on the road with my car. I
picked up the young man from the road and took him to the
hospital. The doctor there was very friendly to me, asked me not
to worry. He wrote some injections to be purchased immediately.
I was too tense to look at the prescriptions. The young man was
having bruises all over his body. I thought that the doctor had
prescribed some antibiotic. The cost of two injections was
nearly Rupees Three Hundred! It was only the next day that I
realized that the doctor had prescribed injection for gas. It
suddenly dawned on me, both the doctor and the patient live in
the same universe; they have the same model of disease and
illness, a universe full of Gas.
Let us not start a blame game now. I am not here to fix
responsibilities or find faults. We have a problem; we need a
solution. It is not surprising that both the doctor and the
patient have the same disease model in their minds. The doctors
and the patients belong to the same set of parents; they share
the same myths, the same language and have the same
socio-cultural understanding of disease. The illness model thus
formed is so strong that it overcomes the training imparted in
the Medical Colleges. Whatever they learn in the medical
colleges, they unlearn when practicing and revert to the old
faith. Even postgraduate training has hardly any effect. Any
doctor who even remotely disagrees with these models is out of
business immediately.
What is the solution! I do not know, but the repair must start
from the doctors. May be we should have open discussions on
medical management where university teachers and social workers
would participate along with doctors. We must depend on evidence
to accept anything. ‘I am doctor Big Gun, I tell you so’, should
no longer be a valid argument. But before that the non-medical
person should know at least some of the myths and some of the
answers. They must look up the net to know the truth, as it
exists today. They must do their homework. Medical knowledge is
not the territory of doctors alone. Health is too serious a
business to be left to the doctors. The government must step in
because otherwise the so called big doctors would avoid coming
to such seminars, as they did when I presented a paper on
medical mistakes in an IMA conference two years back. The hall
was empty; only a few external guests remained to encourage me,
there was no discussion.
Here we go; here are some of the most popular myths and medical
models we have.
1. Gas would take the exulted number one position. By the way,
would you be shocked to know that the gas medicines like
Omeprazole, Rabeprazole, Aciloc, Zinetac, have absolutely no
affect on abdominal gas, in whatever form. They were not meant
for this use at all. Do not believe me; go check the textbooks.
But they do work, you might say. Do they really, or you believe
they do!
2. ‘Baat’ is the second most confused subject. Language is the
culprit here. Uric acid measurement and management is one of the
most fundamental mistakes committed by the doctors, including
Asia’s number one orthopedic surgeon glorifying Kolkata. Also
when next time you see a patient on Penidure LA injection for
baat, doubt the diagnosis, because many of the doctors ignore
the diagnostic criteria suggested in the basic text books and
depend on the ASO titer in the blood, which has no diagnostic
value. They have a disease model of Baat in the mind that is
without any scientific basis.
3. Diabetes diet prescribed by the doctors actually robs at
least ten years of life from a diabetic patient, not to mention
about the quality of life. Doctors hardly ever suggest the most
important tests for diabetes; the tests are important tools to
prevent diabetic complications. Nobody questions them.
4. Cholesterol is a different ball game altogether. This is a
myth that was intentionally implanted in the minds of doctors
and subsequently to the gullible public by the drug companies
with vested interest; this is a multi billion-dollar myth.
5. The least harmful of the myths is the vitamin. It does cause
a bit of confusion but the dangerous part is that it encourages
illogical thinking process in the mind of the doctor.
That should be enough for the day. Go hunting. All the best.
ashokagt2@yahoo.com.
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