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This
text is designed for an International readership at Dr Ashutosh Jindal’s
Website
www.healthybaccha.com
While
we have tried to keep the content international
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some phrases and ideas may be unfamiliar for some regions of the World.For
clarifications please feel free to e mail Dr Jindal.
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application.
UPDATE
# 3
RANDOM
TIPS
Let
us now, for a moment take a break from the earlier theme of vaccines and
take a walk down an uncharted sea !! – please allow me the poetic license.
I
am penning down some tips which are coming to my mind and you may not find
any particular sequence.If you, on the other hand gain something from these,
I shall feel rewarded.
By the way , if you are
interested in general reading, I may strongly recommend a book by Erich
Segal – ‘ Doctors’ . It is a treat reading the book just as it a
treatise on the psyche of Doctors.
This
is a question that is debated over and over again in almost all our
scientific meetings and conferences.
At
the end of the day – we are as puzzled as the speaker/ specialist is !
To
be honest, antibiotics are more far more often used than they are needed.
The
reasons are difficult to identify – but there are some peculiar
compulsions that often make the Pediatrician write out an antibiotic ( I MAY
BE APPEARING TO BE DEFENDING MY BRETHEREN)
-
It is not
always possible to order investigations in every case of “minor”
problems ( say , a couple of days’ fever) and the poor Pediatrician
bases his judgement on purely clinical grounds.
-
Quite often, the poor Pediatrician is under parental pressure “ I can
not see my child so miserable – please give something that works fast.
Now , here, human being as the Doctor is , does at times succumb to this
pressure and write out an antibiotic when he could have chosen to simply
wait and watch.PLEASE DO NOT PUT A PISTOL TO YOUR DOCTOR’S TEMPLES.
-
If you Doctor
– shop : you are very likely to have a change of the antibiotic.Please
stick to the Pediatrician who vibes with you and then follow him unless
you get a gut feel that this time there is something really wrong in his
approach.
-
Please do give
the antibiotic for the proper length of time and do not make the mistake
of stopping it mid-way since you feel the child is now appearing to be
okay.You know well about drug resistance – the reason why we insist on
proper duration of antibiotic is to prevent this drug resistance.
-
Strong
Medicine :
It
is rather common for some parents to feel that a particular Pediatrician
prescribes “strong medicine”.
Yes,
we all have our own levels of experience and
also a good amount of “gut feeling” when it comes to
prescribing.What the text book says does not always work out the same way in
real life situations and the Doctor does need to innovate.During this
process there are Pediatricians who tend to write rather long prescriptions
while others may be an example of brevity.
Who
is right , who is wrong – very hard to comment.
I
shall just give a small sketch that might help clear some clouds:
-
Pediatricians
are generally sensitive to the fact that administering a dose to a child
is usually rather difficult and they tend to keep their prescriptions
brief. All the same, there might be a particular situation ( e.g.
pneumonia ) that may need a longer list of drugs.Please do allow your
Pediatrician this freedom.
-
“ Strong
Medicine “ is quite often associated with the price of the medicine.
With the advent of newer medicines , medication is getting more target
oriented and the newer drugs are generally costly.A case in point could
be Childhood Asthma where an ORAL steroid would cost hardly anything ,
give good relief but may not be the best thing to be done.Instead, an
Inhaled drug would work tremendously better, cost tremendously more and
may APPEAR TREMENDOUSLY STRONG MEDICINE TO YOU !
-
There is thus
NO strong medicine – NO light medicine – it is medicine that is
appropriate for the particular situation !
-
My
child does not eat well…….some appetite stimulant, please !
Oh
no , not again.
This
is a complaint made by every second mother.
I
recall an interesting anecdote : a child with head injury with bleeding all
over his scalp rushes into my Chamber.I am busy examining the child, getting
a CT scan of the brain organized – the mother somehow happens to have the
presence of mind to sneak in the question – by the way, he does not eat
well !
Till
date, medicine does not have any rational and safe appetite stimulant.There
is one product that is commonly prescribed ( usually under parental duress )
– Cyproheptadine. This does increase appetite but usually causes excessive
sleepiness and the textbooks do NOT recommend it for use as an appetite
stimulant.
You
may , at best , try any brand of B Complex syrup – it is harmless , may
boost appetite , will keep you busy.
There
is no medicine that can increase the height of your child.
Yes,
your Pediatrician shall ascertain there is nothing medically wrong with the
child that is keeping his height below the expected.
If
there is no medical disease – there is no medicine needed – there is no
‘ height tonic’.
The
quest for better anti – fever ( antipyretic medicines ) has been going on
since the discovery of Paracetamol ( the oldest one ).
Aspirin
was perhaps even older but got dropped off due to its tendency to cause
gastritis and an association with a fatal liver failure in some select
cases.
Then
came Ibuprofen and the Pharmaceutical Industry gloated with pride over it
just as we found a mini revolution.Enthused by the sale curve , they mixed
Ibuprofen and Paracetamol. Then came Mefenemic Acid ( did not gain much
popularity ) .
The
Pharmaceutical Industry, just as any other industry, has its bottom line
very clear.Of course, they are bound by strict scrutiny and drugs have to
pass several trials till they hit the road. The United States’ Food &
Drug Administration ( US – FDA ) is perceived to be the strongest
regulatory body.This is the final hurdle to be crossed by any drug.
Interestingly
, the US anyway is the watchdog for the whole World !
Why
I have sketched this background has a reason. It gives us a glimpse of the
ever changing prescribing affiliations and patterns of Doctors.
Nimesulide
was introduced with a BANG.
There
is still a fair amount of dust around the drug and it may be best to stay
put till we have more research
and Global consensus. Till such time, I guess plain,old Paracetamol is our
best friend.
There
shall be more coming from us soon – till then good luck and happy
parenting.
Dr
Jindal and team Healthybaccha.com
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