H. pylori

          My friend, Bai Goanna, had a pain in the stomach. Often bad, occasionally less, it was always present (the pain, I mean, not the stomach). Then she had really bad ‘loose motions’ (easier to spell than diarrhoea) and the doctor gave her medicines to kill the bugs that caused it. The ‘loose’ stuff bound well, the frequency of running to the toilet lessened to a single digit again, but the pain stayed. Worsened, actually, with a lot of nausea thrown in. Bai Goanna began to look pale and often had a hand on her stomach, rubbing it in the hope it would give comfort. Didn’t work.

          Get multiple opinions, well-wishers said. Try nature-cure, homeopathy, Ayurveda, meditation, prayers, and salt-water baths, swallow ground neem-leaves with turmeric and garlic, they said. Nothing worked.

          From family physician (a nearly extinct valuable institution) to specialist she ran. To meet the latter, she had to take an appointment, and in spite of that, wait for many minutes. I guess it’s hard for doctors to predict how long they might take with which patients, making those in queue wait indefinitely. Happens, and no one minds. Bai Goanna made friends with those sharing her bench and compared symptoms, adding some to her own, subtracting some from theirs, discussing family histories and others’ treatments.

(Waiting rooms of doctors, Shri Husband tells me, are great democratic spaces and natural equalizers. Big words he uses, but I understand them, sort of.)

          “Acidity,” declared the specialist to Bai Goanna, “is your problem, maybe an ulcer.”

          The moment Bai Goanna came home with the prescription plus a packet of medicines and announced the diagnosis to family and friends, free advice came by the shovel: “Drink milk, give up alcohol, eat soft vegetables, don’t eat sour/spicy food.”

That was followed by contrary counsel: “Avoid milk, it gets converted into lactic acid, the odd peg of alcohol hurts no one, all vegetables when cooked become soft, sour/spicy food firms up the immune system.”

Surprising how many people or their siblings/in-laws/colleagues/classmates suffered from ‘exactly the same thing’.

          The course of pills/tablets got over, but Bai Gaonna’s pain persisted. Now the specialist proclaimed: “Endoscopy.”

          After fasting and thirsting overnight, Bai Goanna went to the hospital as asked to report. Punctual, as always. She had to wait for half an hour or so. She’s used to it (both the punctuality and the waiting), so she kept herself occupied with her i-phone, slyly eavesdropping on visitors’/nurses’ conversations. They (the conversations, not the visitors/nurses) were entertaining, more of those some other time.

          In the privacy of a side-room, on a trolley, she lay down on her side. A desensitizing anaesthesia was sprayed down her throat, and inside/through it went a camera attached to a cable. She was told to swallow it without gagging, to control the instinct to pull it out. Bai Goanna’s will-power’s better than mine, for sure. The photos of her insides showed up on a monitor/screen that the green-robed and masked doctor inspected. “No ulcers, no polyps, no nothing,” he mumbled. Then, he put in a tiny pincer through the very same cable and pinched out a bit of flesh for further testing. “For H. pylori,” he declared.

          H. pylori, short for Helicobacter pylori, was something that I remembered from long years ago, from an article in The Readers’ Digest (anyone remembers that magazine? Is it alive? Used to be my standard monthly read and I preserved the issues for decades, until mites, fungus and the internet took over).

Once scientists discovered what mischief it (the bacterium, not the magazine) caused, whichever abdominal pain was blamed on ulcers was thenceforth blamed on H. pylori. I did a quick read online on this shy organism, previously called Campylobacter pylori. I love these scientific names. They roll musically on the tongue.

          “I’m changing my name to a more Latin sounding Shila-cter jaywanti,” I said to Shri Husband.

          “Silli-opinioner quiet-nowi would be more appropriate,” he replied. I took the hint.

          I accompanied Bai Goanna to the chemist to buy the medicines.

          “Why,” acquaintances wanted to know, didn’t the doctors do the test right in the beginning? Another quipped: “They should routinely do CT/MRI/ blood-work/ECG/EEG/USG, whatever else they can do to diagnose and treat phataphat. Why waste time and make people suffer? When there’s technology to help, why not use it?”

          I confessed to Shri Husband: “These same people complain if too many tests are done. Then they say, it’s a scam, doing unnecessary tests, making money these people. Just because there’s technology, doesn’t mean you let your clinical skills and professional instincts die. Where does one draw the line?”

          Shri Husband said he felt sorry for doctors, ‘specially in the public hospitals where they’re overworked, underpaid, have to deal with politically-connected bullies, and race against time to save lives whilst studying for exams and completing documents.

          “…as for opinions,” he added sombrely, “opinions are like noses: everyone has one.”

          That’s awesome, I thought, dwelling on his wise words as I started typing my column.

Feedback: sheelajaywant@yahoo.co.in

         

         

Grow Your Own Heart.

(28 Feb ’10)

            After anti-biotics, this is THE breakthrough in medical science. In the past so many years, all Nobel Prizes for medicine have gone to those who have done research in cytology or cell-related studies.

You’ve read or heard about stem cells, those magical things from which you can grow in a glass jar, a living replica of yourself, more than a twin (which has its own set of genes), a clone (which has your exact combination). I attended an ‘open forum’ arranged by the Indian Council for Medical Research in which top notch scientists explained what all this was about.

It’s still experimental, so if anyone promises to cure you yet of any disease using stem cells, don’t believe it hundred percent. Yes, those who are desperate, paralyzed due to injury or with a failed organ or end stage dreaded disease are going to try anything at all. But it’s good to be informed, nevertheless, for at present, it is hype versus hope. What is it all about?

The female ‘egg’ or ova is potentially able to become any tissue, organ, or even a full person. It’s a single cell. The moment it gets fertilized and starts to multiply, there are several such cells which can potentially become any tissue, organ, etc. These cells keep multiplying rapidly and at different stages are known by strange names like blastula, gastrula and, much later, foetus. Sometime during these stages, the cells become ‘specialized’. Their future functions are defined. Either they will become skin and bone (ectoderm) or nerves, brain, muscle (mesoderm) or stomach, liver, etc (endoderm). Once their roles are known, they have a fixed life cycle, they will fulfill their duties and die, to be replaced by others. So if one has to grow cells to do what we want, we have to catch ‘em ‘young’. That is, at a stage when they are still not ‘specialized’ or ‘defined’.

As of now, we can’t make these cells in factories, we can only ‘harvest’ them from placenta, embryos, women. Take out the nucleus from a stem cell, put in one from a patient’s kidney or heart-muscle, and voila, you can place that cell inside the patient and it’ll grow into that particular organ. Magic? Yes, but it’s more complicated than it sounds.

There are many parents who want to store/freeze their children’s placenta cells so that at a future date they may be useful in the treatment of disease. It’s an expensive proposition, but those who have Crohn’s disease or are on dialysis would do anything to spare their offspring the agony. (There are parents who have stored ‘spare’ embryos, too). We need to think: for how long can/will these cells (or embryos) stay ‘live’ and, if they are thawed after a couple of years, how effective will their use be? If they are not used at all, these ‘banks’ will overflow: how then will they be destroyed? Can they be destroyed without the consent of those whom they belonged to? So many ethical questions arise.

If someone offers ‘treatment’ by stem cell use (and presently other than bone-marrow transplants it isn’t the standard of care in anything else), please ASK a zillion questions. What cells are being used? Is the treatment investigational? Is the person or institution licenced? How many people were ‘treated’ thus before you and what was the response? Is anyone willing to give in writing the risks, specially the long term ones? What are the costs and what do the costs include? Remember, a single success story told to you, or even four or eleven such aren’t proof. Of safety or of cure. 

There are already companies which are selling processed stem cells (like one would sell drugs or any medicinal products) for skin and some other ailments. They are useful for bad burn cases, for example, or patients who have got paralyzed because of a damaged spinal cord. Stem cell therapy will benefit organ-failure patients, those with ulcerative colitis, Alzheimer’s disease, diabetes, etc.

There are several legal, ethical, religious issues yet to be debated. In-vitro fertilization or IVF is already helping so many couples to have children. It’s been around for years, and is still being debated. In a country like India, we have to be very careful about vulnerable patients: the poor, women, children, prisoners, the very old. They should not be exploited for research in the name of science or progress. Voluntary consent, voluntary informed consent is very important before anyone participates in any research activity.

I appreciate the ICMR’s initiative to have public consultations (like the one I attended) in four regions of the country. It has given rise to many questions in my mind. I’m spreading the word so that it can set off the thinking, questioning process in others, too.

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