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TWO MOST COMMON ILLNESSES IN THE WORLD
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
There are two illnesses which affect more than 90% of the world population and result in loss of billions of working man hours. The unfortunate thing is that although allopathic science has advanced so much, there is no specific treatment for both these illnesses. However, it will be better if the public and the doctors are educated in the management of these 2 conditions.
The first is common cold which can occur in the normal population once a year or so. There is a common saying that "if treated it takes one week and if untreated it takes seven days to heal." The public should be taught that the attack will pass off within a week. They may or may not use nose drops or cold pills or take simple paracetamol table three times a day along with some steam inhalation and salt water gargles. They should be told not to lie down at home but to keep themselves busy with the office work till the attack passes off within a week. Till now we have not got any specific single dose treatment for common cold like we have Albendazole for abdominal parasites.
The next illness is acute and chronic backache. It is very important to know that irrespective of the severity of the backache which will depend on the patient’s level of tolerance, more than 90% of the backaches are mechanical and involve the strain or wear and tear of the muscles, ligaments and tendons.
Even the most severe backache in a patient in whom the MRI shows a prolapsed disc should not be treated seriously. With the new imaging devices and passage of time, we have realised that in the human body the degeneration and the repair process go on simultaneously. Most of these so-called prolapsed discs seen on MRI do shrink with the passage of time. The severity and the length of the period of pain increases because of the diagnosis and the fear created in the patient. Unfortunately, low backache is most often related to the state of mind. Thus, the public should be educated that not more than one day’s bed rest (at the most 2 days) is required for any severe backache.
Tests like MRI or even X-rays should not be done as these create fear psychosis because of their misguiding reports. The patient must attend to the work at the most with the help of a lumbo sacral belt and continue using heat or ice therapy, i.e. by using Electric thermopad at home, associated with a good oil massage done by the spouse or the servant. Even the pain killers should be taken in minimal quantity and if possible only at the level of paracetamol.
The question arises then, how can a family doctor pick up those rare patients who really have a large prolapsed disc or rare conditions affecting the spine like - tuberculosis in young patients, secondary deposits in old patients and crush fractures of the vertebrae due to osteoporosis in very old female patients (often 20 years after menopause)?
The bad prolapsed disc should be diagnosed only by presence of sciatica and that too if the pain goes down below the knee upto the ankle or sole of the foot. Not only that, the physical signs must support the diagnosis. This includes a positive straight leg raising sign, and either a diminished or loss of ankle jerk, or a diminished dorsi or plantar flexion of the toes of the foot specially the great toe with or without slight loss of sensation in the sole of the foot or at the back of the leg.
Tuberculosis of the spine should be thought of if the duration of the illness and ill-health is of few weeks, and is associated with low fever, loss of appetite and weight and a markedly elevated ESR (usually more than 60-70 mms).
Secondary deposits should be thought of in patients who had some cancer surgery in the past and have a raised ESR, anaemia and increased Serum Alkaline Phosphatase. Crushed fracture due to osteoporosis can be diagnosed only by the age and sex of the patient and confirmed by a simple "lateral view" X-ray of the lumbar spine and not by DXA studies!!
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