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General Practitioner's Section
 
Figure of ‘3’ in Private Practice

OP Kapoor
 
Introduction

Although, few years back, I mentioned the figure of ‘3’ in the management of bronchial asthma, migraine and constipation/diarrhoea,1 I want to add a few more conditions ,where the figure of ‘3’ is helpful.

  1. In a migraine patient, do not give ‘Ergot’ for more than 3 days a week. Otherwise the patient may experience symptoms of ‘Ergot toxicity’
  2. In a migraine patient, do not give Sumatriptan for more than 3 times a week, otherwise the patient may develop rebound headaches.
  3. In stable angina pectoris, if the patient starts getting more than 3 attacks of pain per day, he should be labelled as a case of ‘Accelerated Angina’, and then should be treated as a case of unstable angina, where in the modern days the management is the same as acute coronary syndrome.
  4. Albendazole given for 3 days in double dose of 10 mg/kg body weight cures strongyloides infection, which is otherwise very difficult to treat.
  5. Albendazole in a dose of 10 mg/kg for 3 months is adequate treatment for neuro-cysticercosis of the brain.
  6. Albendazole given in a dose of 10 mg/kg for 3 months is an adequate treatment for treating hydatid cysts, especially in patients, where big cysts have been removed surgically.
  7. Lower Urinary Tract Infection (LUTI) which is very common in females, should be treated with antibiotics only for 3 days.
  8. Upper Urinary Tract Infection (URTI) i.e Pyelonephritis patient should always be given at least 3 weeks treatment. This is very important because you are facing a situation, where the kidney could be having micro-abscesses.
  9. Non-gonococcal prostatitis, which is the commonest sexually transmitted disease, should be treated with drug combination for eradicating chlamydia, trichomonas, herpes simplex and other bacterial infections for a period of minimum 3 months, otherwise it might relapse.
  10. In neurology, all acute severe backache patients diagnosed as "prolapsed disc" are being offered Micro-discectomy operation, which is a day care hospital procedure, but very costly.

    The figure of 30 - 40% of "failed low back syndrome", after the procedure should warn the family physicians against hurrying up to advise this operation. Not only that, in future, these patients will have to continue back exercises, follow do’s and don’ts about backache and lose weight.

    Then, why not wait, specially when the patient is unable to spend such a large sum of money? Recently, even the value of bed-rest is being doubted. Advise the patients to wear a belt, keep going to work , do some back exercises, and swimming and it is better to pass 3 months period, before surgery is advised.

    It is interesting to note that a number of patients settle down by this time without surgery. Of course, patients who are rich or are going for international business meetings or those who have neurological signs (not CT scan findings), can of course be operated upon earlier.
  11. Finally, in the modern days of AIDS, when cerebral toxoplasmosis is becoming extremely common, do not depend on the imaging report, where the images produced by lymphoma can look like cerebral toxoplasmosis. A therapeutic test with a course of a combination of sulphadiazine and pyrimethamine should be tried for 3 weeks.
 
Reference
  1. Kapoor OP. BH Journal 2000; 42 (2) : 390.

 

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