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FIGURE OF "THREE"
O P Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
The slogan of my teaching during four decades and more has been three symptoms, three signs and three common causes of any disease. Now I wish to add some more "Three's.Symptoms
1.Bronchial Asthma : If the patient starts getting more than 3 attacks of bronchial asthma per week, he must be put on steroid inhalers.
2.Migraine : If the patient starts getting more than 3 attacks of migraine per week, he must be put on betablockers or cyproheptadine.
3.Constipation or Diarrhoea : If the patient passes more than 3 stools per day, it should be taken as abnormal. Upto 3 per day is normal in our population who are taking high fibre diet.
Similarly, if the patient passes stools upto 3 times a week, do not diagnose this as constipation unless the stools are very hard or he has to sit for a very long time in the toilet to evacuate.Investigations
There are "three" good examples of false positive blood tests due to "cross reactivity". These are:
1.A positive ANA test in patients having sarcoidosis2.A false positive ANA test in patients having toxoplasmosis
3.A false positive ANCA test in patients having leprosy.
Treatment
1.Headache : Sumatriptan is one of the most powerful (but very costly) drug to abort an attack of migraine. However, if it is used more than 3 times a week, this drug itself can cause headaches.
2.Prolapsed disc : It has been now shown that with bed rest and epidural injection of steroids many discs can shrink with passage of time. Though micro-discectomy (MIS) has become popular, it is very costly. After the surgery, nearly 40% patients all over the world have residual symptoms of "F.L.B.S.S." - (failed low back surgery syndrome). Such patients can continue getting backache off and on due to multiple reasons. The figure of three should come handy before advising surgery to these patients. Because it is so expensive and not fool proof - it is advisable to persuade your patient to wait for 3 months before deciding to opt for that surgery.
3.Chronic cough : While treating such a patient remember that if :
a. he is not a smoker
b. he is not on ACE inhibitors
c. his x-ray chest is normal
Then there are only 3 possible causes of chronic cough.
i. allergic bronchial asthma
ii. post nasal drip
iii. GERD - gastro-oesophageal reflux disease.
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