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Timing and How to Advise Different Medicines
H Sant
 

Sir,

We have been reading Dr. OP Kapoor’s pearls of wisdom since many years. His approach inspires us all to take more and more care while listening carefully to the patients complaints and always read, re-read and change ourselves according to the feedback we receive of the treatment.

I am sending you some hints, which may benefit other readers. I have given words to thoughts, all of us have, to pardon me for presumption. We all are for corrections and waiting for a different view of the same thing we think we know!

Our Upanishads say - ‘Let all Good and new thoughts come to me from all sides” and ‘Change is the second - true meaning in this world’. It implies that we all continuously monitor our prescriptions and the result of each drug we prescribe for each symptom for each different type of patients. Lifestyle change, position of sleep-activity-rest, nutrition - diet advice is the primary duty of all those who advise.

Patients have to be seen as a whole and not through a key hole of a medical super speciality. Basic pharmacology of each new or old drug and its effects of our body’s patho-physiology have to be re-read periodically for good results. Proper time, way, dosage, individual response and interactions with other drugs given simultaneously have to be considered.

  • Iron and calcium as all analgesics, anti hypertensives, anti-ischaemics cause constipation. They should be given after stools are passed. Bowel movement are aided by diet, food additives like amla powder-triphala, senna with isapghol each according to a patient’s requirement. Some Iron preparation claim lesser constipation.
  • Patients having stone have one diet advice-drink as much water so as to have clear water like urine every time - quantity as per patient's need. Avoid anything grown under soil-tubers limited and all skins even of daals (Uric acid). As such phytates of all vegetables have unabsorbable calcium.
  • All patients on anti Tuberculosis treatment should receive famotidine 40 mg or anti emetic. First take care of stomach and nutrition. Give these in the (Early) morning at 6.30 am followed by Rifampicin 7 am then food followed by each of INH, Pyrazinamide divided in half 750+750 given after half hour interval esp. dispersible forms with sufficient water - (between 7.30 am and 9 am).
  • All antacids should be given 7 pm on empty stomach. Patients are given diet advice - never fill your stomach and sleep on left side. Sleep with head end of bed raised by block under the bed legs. The gaseous distension is relieved as both the exits from stomach are on right side!! In severe cases repeated 7 am too, till received. Take only till symptoms persist and can be taken SOS if symptoms recur or till some drugs are on.
  • For Reflux, tab Itopride 50 mg 7 pm / 7 am, is better than any ‘large doses of antacids. ‘We have to treat the cause not the effects. Acidity is NOT due to Acid - wrong amount of acid for wrong duration for bad number of times due to bad proanal motility which is the law of the GUT breached - is the main cause of acidity symptoms. Oesophageal clearance is the most important thing. Avoid Milk and its preparations at all cost - NEVER TAKE ANY MEDICINES WITH MILK. It actually causes increase gastrin and acidity plus decreases absorption of most drugs!!
  • All dispersible drugs -diclofenac or even Aspirin etc. taken with 200 ml water if needed after antacid drugs are problem free, if taken after some dry food.
  • All those who REALLY require enzymes for digestion should be given those preparations having more than 14000 lipase activity, half an hour BEFORE food. Most patients require carminatives, food additives like garlic, ajwain, jeera etc. or promotility drugs - itopride to relieve their distension. Mild exercise before and after food will avoid over medication. Food and the way it is cooked or consumed, is the cause of disease and its cure in most of the gastric complaints. Only persistent ones with warning signs need endoscopy or more.
  • Sitting on a commode and never ever straining at all cost is most important for all. Amla, triphala or any high fibre supplement with promotility one like senna in severe case is enough. Avoidance of urge to pass, early morning mild activity and taking advantage of gastro colic reflex - drink water - eat food - distend stomach to stimulate stool stored in transverse colon.
    Tegaserod 6 mg od/bd or in bad case Cisapride for few days is given at night. Kathol (Pulses) or all legumes well made taken at breakfast are the best nutrition too.
  • The most painful sensitive area of body is the inner or whole of the thigh. The Abdomen and its fatty apron below the umbilicus is the most convenient location - least painful too-easily seen from top-easily pinched up for introducing the needle no. 27!
  • Why we prescribe high protein diet supplements to those who really cannot afford? The 200 gms of the 200 Rs. Powder of whey or milk or soya gives hardly 40 gms per 100 gms protein! A channa or peanut will give 24 gms per 100 gms and if made into a sukhdi or jaggery mixer is better in every way. Almonds and Kajus give only 20 gms per 100 gms consumed!
  • Count Calories is the mantra apart from metabolic care of patient’s nutrition NOT illogical ‘fatwas’ from uncaring doctors! Exercise immediately after diet and proper exchange know-how can make the life of a diabetic more bearable. Avoiding all tasty foods and nuts legumes daals which have 400 or more calories per 100 gms is the key for diabetics and weight watchers. Taste is all for the tongue not for filling the stomach is the hint given.

Let us all use our ears and minds to find better ways to palliate patients, many of whom do not have a disease. Only those with persistent problems or warning symptoms should be investigated by a professional protocol decided by peer reviews and caring mind always alert to exceptions. This seems to be the only way for doctors and their science to reinforce their status in the hearts and minds of all.

Hemant Sant
Sant Surgical Hospital, GPO - Kharivav Road, Raopura, Vadodara 390001.

 
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