Let’s travel through a story of a 68 year old man who came to OPD on a bright sunny day. It was the time when the opd counter closes for the day. The old man requested the person in a ticket counter for a ticket. The employee said, ” The counter has closed. Come tomorrow. ” The grand pa didn’t like his arrogant tone of voice. He was taking tablets for diabetes mellitus since many years. That day he had persistent hiccups since the morning. Contrary to general belief of hiccups as a benign condition, it can be pathological at times. Did you know this ?
When I was heading towards my quarter, I saw the old man sitting on a floor with hiccups. He saw me and sighed a great relief. He was trying to tell his story. But his hiccups didn’t allow him to complete the sentence. As he was a regular patient in OPD, I recognized him.
He used to come every 3 months for antidiabetic medicine that is provided free of cost from the health center. I had started him on statin and aspirin tablets one year back. I prescribed him aspirin because he reported angina like symptoms. He was reluctant to visit the better centre with facilities. Why did he need statin ? Think about it. Did he need statin if it were not angina ?
I requested nurse in emergency department to take his ECG. It seemed quite normal on a bird’s eye view. But, Reading an ECG should be a stepwise process following the rules. On a careful observation, it revealed tall T waves. It could suggest potassium excess or myocardial ischemia. I needed to refer him to better health facility in time. So I referred him to cardiac centre which was 3 hours from the health centre.
I was thinking about him and wondering what happened to him. One day, he came to the opd with his files. I was happy to see him. I greeted him with a smile. He replied with smile spread over corner of eyes. It was a great relief to myself that I sent him to better centre then. He had Myocardial Infarction evident with changes in ECG and enzymes in blood.
He was treated in coronary care unit and discharged after 5 days. He underwent angioplasty with two stents in vessels of the heart.
He came to ask me the dose and dosage of medicines he needed to take regularly. So, what do you think about Hiccups now ? Persistent hiccups may need a good attention. Missing a symptom in time is missing an opportunity to treat a dying person. Follow writers blog for more! http://www.shambhukhanal.com.np