□ A Rose With A "Bouquet" of Thorns □
Knocking off pain with the "Cocktail of Doom"

The Cocktail of Doom. Every doctor is all too aware of it, maybe not with a phrase as catchy as mine shaaa. But it's after effect is always there for us to battle, constituting nuisance & sometimes outright threat to life.

Like a Rose riddled with thorns, you can't accept it's good without it's harmful effects, more so when the proportion of thorns far outstrips that of the rose itself.

NSAIDS[a group of analgesics which include common pain killers like Aspirin, Piroxicam, Ibuprofen, Diclofenac etc] and pain, they are like the two sides of a heinous coin, a sort of Jekyl and Hide with a delicate balance, which is often tilted towards the deleterious when the balance is upset by the abuse of NSAIDS.

Pain[whether that of an arthritis, painful menstruation, following an accident] in itself is discomforting as well as it is debilitating, and sometimes can be so severe that it interferes with one's daily activities. For this reason, analgesics including NSAIDS are made for the prompt relief of pain. But while the relief of pain may be desired, care should be taken to avoid doing so aggressively as most of these analgesics[especially NSAIDS] have sinister long term side effects, the most common of which is Gastritis[an ulcer like condition] and worsening of an already existing ulcer with either of the following:

` Massive internal bleeding[I have seen a case that required about 12 units of blood within a space of just 24 hours! That's right]

` Mild to moderate internal bleeding which may manifest as:
□hematemesis[vomiting of frank blood or altered blood the colour of coffee]
□hematochezia[passing frank blood in faeces]
□melena[passing of dark tarry stool. So when next your stool becomes so dark, don't write it off as "just" veges(I.e vegetables) or blood tonic effect!]

` Perforation of the stomach or part of the intestine called duodenum with serious life threatening complications.

` Severe worsening of the ulcer pain referred to as "Acute Exacerbation of Peptic Ulcer".

` etc

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Without having this knowledge, Patent medicine dealers["chemists] usually dish out these drugs "generously", sometimes combining/'mixing' three different drugs[all NSAIDS] with the same function. While the additive effect may give instant pain relief, it also heightens the accompanying deleterious effects, constituting the classical cocktail of doom.

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□ Case Study

They brought her in, a beautiful 35 year old woman with complaints of generalised abdominal, so severe she could hardly move, cough or even take a deep breath without feeling excruciating pain in her tummy.

The pain had started 3days after her menses[more like continued from her menstrual cramps], and subsequently worsened necessitating her coming to the hospital. There was also occasional fever, anorexia, vomiting and weakness.

On examination she was apprehensive and in obvious painful distress with generalised tenderness[pain elicited by touching a part of the body] in her tummy worse on the central portion of the upper abdomen[epigastrium], central portion of the lower abdomen[suprapubic area] with rebound tenderness at the right lower abdomen[Right Iliac fossa].

The abdomen barely moved with her breathing, and there was a little fullness at the flanks[ I.e bulging of the sides, denoting possibility of fluid inside her tummy]

The breathing pattern was shallow and pretty fast, pulses were equally fast and of moderate volume, but the blood pressure wasn't low[she is hypertensive].

Now there were a lot of possibilities, given that she is a woman[Arrrgggghhhh! these are complicated species I tell you, especially when it comes to abdominal issues], and that she is a known Peptic Ulcer patient.

` Ruptured Tubal Ectopic Pregnancy[ I.e pregnancy with the baby growing in the tube instead of the womb] ...
Would have been classical but she just finished seeing her period, also she hadn't missed her period in the recent past. So she couldn't be pregnant.

` Acutely Rupture Appendix ...
Damn it, she had her appendix removed 14 years ago.

` Endometriosis [ presence of lining of the womb at places other than the womb, with a result of "menstruation" occuring also at such places ...?
Fits a little bit; symptoms started arround her period of menstruation and she has been having similar occurrences but of varying severity in a cyclical pattern, usually arround her menstrual period. Also she has chronic Pelvic pain, deep dyspareunia, congestive dysmenorrhoea, heavy menstrual bleeding, subfertility... etc But with fever and vomiting it didn't seem right.

` Acute Pelvic Inflammatory Disease[PID] ... Nah ... no vaginal discharge, no history of promiscuity and she didn't have the "toxic" look of PID.

` Perforated Peptic Ulcer ....?
She is a known Peptic ulcer patient.
Was diagnosed 2 years ago as having symptomatic Fibroid with heavy menstrual bleeding and severe dysmenorrhoea[painful menstruations]. So she has been abusing NSAIDS for the menstrual pain with a resultant flaring of the ulcer symptoms in a cyclical pattern, every time she is seeing her menses and is taking painkillers for it.
In the present illness there was prior worsening of the ulcer pain with referral to the back[ a sinister sign, usually heralding impending perforation]. And there was also epigastric tenderness.

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Perforated Peptic Ulcer seemed the best bet. So hours later [after initial resuscitation] when I was staring at her Chest Xray on the viewing box with a column of air visble on the left hemidiaphragm, separate from the gastric air bubble, I wasn't surprised.

Simply put, the Ulcer had become bad and had perforated her stomach, with the inevitable consequence of the stomach acid leaking into her abdomen causing peritonitis with severe pain.
The "air under the diaphragm" was actually swallowed air that escaped from the perforation in the stomach to go and occupy what is usually an air tight space.

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□ Morals

` For starters, obtaining over the counter medications from "chemists" without a doctor's prescription is a potential .... no a real health hazard rather.

` NSAIDS especially when abused complicates an already existing ulcer, can induce an ulcer even where not present before, and has other potential side effects like causing Chronic Kidney Disease.

` Ulcer patients should desist from indiscriminate use of NSAIDS, unless specifically prescribed by a doctor who is aware that they have the condition. Thus always make it known to the doctor in any hospital you go to that you have Peptic Ulcer before receiving treatment.

` Non ulcer patients should desist from indiscriminate use of NSAIDS too, and if it must be taken, it should be taken with food and not for a time period longer than 5 to 7 days unless otherwise instructed by a doctor.

` Dark stool may not necessarily be "veges" or blood tonics in faeces, sometimes it may denote an internal bleeding from an ulcer, especially when it is black and tarry.

` Those with chronic painful conditions should be mindful of the fact that the cocktail the chemist "mixes" for them to "knock off" the pain with one hell of a "punch" might as well be a cocktail of doom.
Be warned, don't fall a victim.
Am out.
https://www.facebook.com/chibuikesupercj.chukwudum/posts/684424871661874

Pls summarize

Beware of the drugs you buy in the chemist shop, especially without a doctor's prescription, esp for pain. They end up usually giving you a multitude of drugs, all with similar function and this summing up their side effect. They would now d use of a drug, but most times the side effects are blank to them.. The woman ended up with a perforated stomach ulcer, that was discharging acid into her abdomen, after taking this dangerous mix of pain killers for her menstrual cramp.