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Self-treatment can be a costly mistake

Dr. Victor Ti, / Khmer Times Share:
The common practice of selling antibiotics over the pharmacy counter without a doctor’s prescription in Cambodia is certainly a bad and dangerous practice. Photo: Sonny Inbaraj Krishnan

Sopheap (not her real name), a 25 year-old Cambodian lady had ‘stomachache’ and fever. She went to the pharmacy to buy some pain and fever tablets. The pain and fever were suppressed. Thinking that her problem was improving, she continued taking the tablets.

Three days later, her infected appendix burst and she had a sudden excruciating pain at her lower abdomen. She was then rushed to hospital. Surgery was difficult as the content of the dirty infected appendix had contaminated the whole abdominal cavity. The surgeon had to do a thorough wash out. Despite that, she developed a collection of pus in her abdominal cavity two weeks later.

A second operation was done. When she finally recovered from her surgery, she suffered recurrent severe abdominal pain because her intestine had adhered to the abdominal wall requiring the surgeon to go in the third time to release the adhesion. She recovered but was unable to conceive although she had been married for three years thereafter. Infertility is a known complication of a ruptured appendix.

If Sopheap had consulted a doctor instead of treating herself with the pain-killer, her appendix could have been diagnosed earlier before it ruptured. Surgery would be much simpler and she would have recovered quickly without any complication or the need for more surgeries. Indeed, self-treatment can often turn out to be a costly mistake with serious implications to one’s long-term health.

Srey (not her real name), a 60 year-old lady had been coughing for four months. She had been taking her favourite cough mixture. One day she coughed out blood-stained sputum. Her daughter who noticed that insisted that she should consult a doctor. The doctor confirmed that she had tuberculosis (TB) after doing a chest X-ray and sputum test. All her family members were subsequently screened for TB and another two of them were diagnosed as having TB as well. The other family members who were with her over the past four months could be carrying the TB germs in them and may develop the disease later. TB is a serious health problem in Cambodia requiring at least six months of continuous multiple drug therapy.

In November 28, 2017, USAID reported that approximately two-thirds of all Cambodians carry the TB bacterium, one of the highest rates in the world, and some 13,000 Cambodians die annually from the disease. The common practice of self-treatment in Cambodia leads to many missed or delayed diagnosis of TB in Cambodia. The undiagnosed infected individuals continue to pass the TB germs to the people around. This has contributed greatly to the high prevalence of TB in Cambodia. Thus, I would like to advise that all individuals coughing for more than two weeks should consult a doctor.

Zhou (not his real name), a 25 year-old Chinese national self-treated himself for cough and fever. His symptoms worsened over the next few days and he was prescribed Augmentin, a wide spectrum antibiotic by a doctor in a local hospital. Two days later, he consulted me for his persistent cough and high fever. After examining him, I told him that he had pneumonia that was later confirmed with a chest X-ray. Thinking that he should respond to the wide spectrum Augmentin, I advised him to continue the antibiotic for another day while helping him to expel a large volume of thick green sputum with chest physiotherapy. Two days later, I noted that his pneumonia had extended from the base of his right lung to the middle zone. At this point of time, suspecting that he was likely to be infected with germs that were resistant to Augmentin, I decided to treat him aggressively by substituting the Augmentin with two other wide-spectrum antibiotics while continuing the chest physiotherapy and nebuliser treatment as he
was making plans to return to China three days later for his Chinese New Year family reunion. I am glad that his condition improved remarkably and he was fit and comfortable enough to travel home for further treatment and his family reunion. I was informed later that he had recovered from the ordeal.

This case is highlighted here to demonstrate the increasing emergence of dangerous antibiotic resistance strain of germs called superbugs due to rampant indiscriminate use of antibiotics without consulting a doctor. It is sad to note that Chinese nationals often come to Cambodia with a bag of different antibiotics for self-treatment. The common practice of selling antibiotics over the pharmacy counter without a doctor’s prescription in this country is certainly a bad and dangerous practice. Antibiotic treatment should not be instituted without a confirmation of bacterial infection by a qualified doctor. The antibiotic prescribed must strictly be in an adequate dose over an adequate duration to prevent the emergence of antibiotic resistant germs or superbugs. Superbugs are a real monstrous threat to all of us. Once infected, the outcome is often fatal.

People who self-treat their chronic diseases such as high blood pressure and diabetes often end up with serious complications of stroke, heart attack, kidney failure, blindness or death at an early age. Their choice of medications are often inappropriate. Their compliance and monitoring of the result of their self-treatment are obviously poor. They invariably fail to achieve a high standard of continuous care due to their lack of knowledge, awareness and motivation to manage their diseases appropriately. They will also fail to see the importance of a lifestyle modification towards a healthy endpoint.

Lifestyle modification is a great challenge that comes with great rewards. Consistent physical exercise, dietary modification, stress reduction and good refreshing sleep certainly play a superior role in the management of chronic diseases. The level of success depends greatly on the physicians’ knowledge and experience in behavioural therapy. Together with the patient’s cooperation and commitment towards change, lifestyle modification can greatly change the outcome of chronic diseases and overall general health. A good physician would always play his part in modifying his patient’s perception and attitude towards a good healthy lifestyle.

In conclusion, I would like to highlight here that self-treatment is often a blind treatment. It negates oneself of good professional consultation towards accurate treatment of an accurate diagnosis, apart from the important ruling out of the possibility of other sinister diseases with serious complications.

It is wise to pay for safety and good health.

My next column will be on ‘Hemorrhoid – The angry asshole’.

Dr. Victor Ti, MD, MFAM (Malaysia), FRACGP (Australia), Dip P Dermatology (UK), Dip STDs/AIDS (Thailand), Dip. AARAM (USA), LCP of Aesthetic Med.(Malaysia) is an experienced expat specialist generalist (Family Physician) of BH Clinic, Phnom Penh. As a specialist generalist, he is skillful at diagnosing all general diseases and excluding the sinister ones. Apart from the general diseases, Dr. Victor is also known for his skill in skin diseases, sexually transmitted diseases, minor surgery and aesthetic medicine. He can be contacted via email [email protected] Tel: 023900446 or Whatsapp: +60164122977

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