IN LOVE WITH GAS, A STORY TOLD BY A DOCTOR

[Guest guest]

This is my recent writeup in Tripurainfo.com, some of you might find

it interesting

IN LOVE WITH GAS, A STORY TOLD BY A DOCTOR

Dr. Ashok Sinha

ashokagt2@...

Let me tell you a story, the 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 sometime 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 expression 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.

Ashok Sinha