Medicines for acidity may not be all that safe!

One of the commonest type of drugs in clinical use that bring us relief from “acidity”, by blocking the formation of hydrochloric acid in our stomachs, may not be as innocuous as was earlier. thought Commonly known as proton-pump-inhibitors (PPI), these familiar names such as omeprazole, lansaprazole, pantaprazole or rabeprazole, that we pop so often, are increasingly being shown to have health risks with prolonged use.

A patient of mine, Maya Singh, who was troubled from her young days with severe “heartburn” and acidity, found succor with these medicines. Once troubled by sleepless nights and frequent need to gulp Digene syrup every 2 hours, these new medicines soothed her burning food pipe and provided relief enough to let her sleep peacefully at night.  

Days stretched into weeks into months and into 25 long years. If she missed out a single day’s dose, her “acidity” returned to harass her at night.

Her endoscopic examinations, which had shown redness and mild ulcers due to hyperacidity in 1987, recently showed multiple small “polyps” or tumorous growths in her stomach, a recently recognized consequence of prolonged use of these drugs.

The list of side effects from prolonged use of PPIs is indeed growing. Doctors in ICU have noticed that excess-suppression of gastric acid in critical patients, with the intent of preventing bleeding from the stomach, was associated with higher rates of pneumonia.

Gastroenterologists have now come to recognize that people on PPIs more often have excess germs in their small intestines. This condition called SIBO (small bowel bacterial overgrowth) seems to arise as we subdue the stomach’s capacity to kill wandering germs that try to enter the small bowel with our food.  Recurrent intestinal infections, loose stools and impaired absorption of nutrients are the prices we then land up paying.

Another peculiar problem often seen in such people is the development of “gastrinomas” or tumors that produce a hormone called gastrin that regulate acid secretion. When production of gastric acid is switched off by these powerful drugs, these glands produce gastrin in very high amounts to try and compensate, often ending up as tumors.

Recent studies have also started linking these drugs with osteoporosis, a condition in which our bones become fragile. An even more worrisome is the growing suspicion that gastric cancers may occur more commonly in people who suppress their natural “acid barrier” too much and for too long.

As one section of the medical fraternity is trying to investigate the long term consequences of our interfering with nature by blocking gastric acid, another segment is hard at work trying to develop stronger molecules that would suppress it further and offer better symptom control. 

But nature has her own way of teaching us lessons!

As published in HT City ( Hindustan Times) dated 6th January, 2013.

Dealing with Rape

The recent death of 2 victims of rape that the media highlighted is a gruesome reminder of how pitiably inadequate our state of preparedness is for dealing with this hazard to health and life.

I am told that the reason why crime rates in Singapore are one of the lowest in the world is because people there are scared to commit them. What deters potential criminals is a high chance of being nabbed (good policing) , that no amount of phone calls can prevent or reverse. Further, the punishment for crime is strict and harsh.

What happens in India is quite the opposite. Most rapists feel confident of getting away. The girl, they feel, would be so shocked, “stigmatized” or perhaps even dead that she and her family would probably not dare to complain. The culprits of the Delhi gang-rape case in which 6 criminals assaulted a 23 year old in a bus probably thought that way!

What deters a victim further is the lack of grooming of the hospital and police staff to attend to a victim’s complaint in a supportive reassuring manner, that helps her regain her bruised dignity and confidence. Then comes the need for timely and quick action by law enforcers who are not only required to catch the culprits, but ensure adequate protection to the victim and her family. 

This was the tragic saga of the 17 year old in Patiala, who despite physically surviving a gang-rape, had the courage to speak out and complain. But why did the law enforcers and society betray her instead of supporting and protecting her, that pushed her to take the final drastic step in utter frustration and end her life.? Obviously “unequal justice”! The culprits were smug that “someone” will protect them!

Last, but not the least, is how we protect girls from such criminals. In the aftermath of these torrid events several politicians have tried to touch the common cord by stating they have daughters too. The grim reality is that the daughters who got raped belonged to vulnerable sections of society, had no cars, contacts or powerful fathers, and could but rely only on what the society and the “system” had to offer.  And we saw what they got!

While we are still trying to come to terms with the horrific tragedy, legal pundits are already waxing eloquence on mitigating the punishment for the “juvenile’ culprit in the Delhi crime.

The Singapore and middle-east examples tell us that only if punishment is exemplary does it serve as a deterrent. But even those whose hearts are full of compassion for criminals should try to answer how safe would feel to have the18 year old boy whose fatal shove of the iron rod into the girl’s interiors caused her death, to be allowed to roam free in the neighborhood where defense-less young girls reside?

A society is judged not by its economic or military might, but by how it cares for its vulnerable sections.

Wheat Intolerance

Many people find it hard to imagine that intestines could revolt against as innocuous and staple a food as wheat, and could be the cause of a disease that can even kill. Celiac Disease, a condition in which the body reacts to gluten, a protein present in wheat, is on a steep rise in India. Tables are now being turned on the long held view that it is a “Western disease” that does not occur in India.

Neha (name changed), a college student from Delhi, came in to see me for problems of 2 to 3 loose stools every day for 4 years.  Several doctors she had consulted had diagnosed her condition as IBS (Irritable Bowel Syndrome) and prescribed medicines either for infection or to slow her “hyperactive” bowels. Her relief had predictably not been lasting.

What struck me at the outset was her “thinness”. Although she claimed to eat well, she had a Body Mass Index of 17 (normal range 20-23.5). She also looked anemic (Hemoglobin was 9).  Endoscopic examination of the stomach and large intestine had been normal.

 On my suggestion she got her blood tested for TTG (Tissue Trans-glutaminase) and Anti-Endomyceal Antibody, that detect wheat “allergy” and returned 2 weeks later with strongly positive reports for both.

Getting this young college girl to stop wheat, a staple food and a common ingredient in many items we commonly consume, posed a challenge.  Stopping roti, chapatti, paratha, puri and biscuits for life can be incredibly difficult especially for people from the “wheat eating” regions.

For Neha to say “NO” to biscuits, wheat noodles, snacks and cookies was even more difficult as she stayed in a hostel and did not have much food options. Fortunately, her elder sister who works as a dietician, understood the importance of diet-regime and offered to cook rice and rice noodles for Neha.

Neha gained 3 Kg of weight in the next 2 months, something she had not thought possible for 4 years. And her energy levels had tripled!

Celiac Disease has already emerged as the commonest cause of diarrhea and weakness in children, says Dr Ujjal Poddar, Pediatric Gastroenterologist at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, who has worked on this condition for over 15 years. Diagnosing it in adults who present with milder manifestations now still remain a challenge.

It is quite a familiar entity in the Western world. People with this affliction come together through networks and form their own social groups in cities and regions. Further, a range of gluten-free food items are easily available in departmental stores and groceries to cater to their special needs.

While the formidable thing about Coeliac Disease is to stay off gluten-containing food for life, the encouraging fact is that life and growth reverts to “normal” without the requirement of any expensive medications. 

Neha has put on another 2 Kg in the last 2 months!

As published in HT City ( Hindustan Times) dated 23rd December, 2012.

Are Schools Doing Enough to Curb Bullying?

In the recently held inter-school skit competition named HOPE-SKIT, yet another of HOPE Initiave’s innovative ways of creating awareness on health issues,  more than half of the 46 participating schools focused on  bullying as their central theme, finally pulling it out from from under the carpet and placing it on  center stage as a major health menace.

A chief hurdle in controlling bullying in schools, as illustrated by students of Lucknow Public School, Janakipuram,, is the victim’s diffidence and lack of courage to complain. 

But are the victims really to blame? Victims of bullying are usually the most timid and innocent of the lot, and it requires sensitivity to understand why they prefer to suffer silently rather than raise their voice in protest. The harsh truth is that they feel uncertain about the sincerity and ability of their teachers and parents to protect them from the retaliation from their tormentors.

At the core of the issue, therefore, is the question “ How far are we prepared to go to protect a child who has dared to complain against a bully?”. Also, we need to remember that there are 20 others watching from the wings the fate of the first whistle-blower to decide what they should do.

Parents should be suspicious of schools that deny outright of bullying as a problem in their premises. Knowledge of the spectrum of human behavior tells us that in our age of increasing aggression, violence and frustration, it is too good to be true.

What should in fact inspire confidence is if the school management has an Anti-bullying policy in place. This should first ensure complete confidentiality and protection of the victim who has dared to complain.

The next step is to have a child counselor or psychologist to evaluate the bully, understand the cause for his aggressive behavior, counsel him, and discuss the problem with his parents to find a lasting change. 

Counseling is not always an easy job. Parents of bullies are often aggressive themselves, as hostile behavior often runs in genes, and tend to defend their kids.

Merely rebuking or punishing the bully can be counter-productive; it often shifts the scene of violence from inside the school premises to outside, making it even more hazardous.

Bullies are not strong healthy people that they portray themselves to be. They are weak within, with desperate need to cover their sense of “inferiority” with a strong exterior cover. They have often being victims of bullying themselves, either at school, or at home by frightful dominating parents.

It is time that the administration of all schools and colleges took cognizance of this malady and evolved steps to address and tackle it effectively. With the efforts of HOPE (Health Oriented Programs and Education) Initiative, the march against bullying has finally begun.

As published in HT City ( Hindustan Times) dated 16th December, 2012