Asses can be stubborn!

Sometimes, I think medicine is just being re learnt and that our ancestors knew everything there was to know, without the genetic testing and millions in research being spent today. All they did was study nature.

Take for instance the fact that Asses are the most stubborn creatures out there! Now, I know you're thinking what the hell does this have to do with medicine. I'm getting there...

A Pilonidal sinus (a small opening at the cleft of the buttocks which usually results from hair in that area getting into the skin and causing an infection and a break in the skin) is an incredibly intelligent disease which chooses that particular region of the body which would be the most stubborn to heal (namely the Ass). It is more common in males (more males are asses than females), has been known as jeep's bottom and truck driver's disease (these particular male drivers are known to behave like asses) and occurs in hairy young men and hardly ever once you cross the age of 40 (need I say more).

Over the years, I've seen patients with pilonidal sinuses getting operated, choosing conservative treatments, trying ayurveda and homeopathy, lasers, photocoagualtion, cryosurgery and everything else you can think of. It just does not heal and though the recommended treatment is surgery, there is a 20% chance of it recurring. This increases if you close the wound. So what I'm saying is that it needs to be left open to heal, which can take about 8 weeks. 8 weeks of discharge, slime, pus, hair, blood with no riding on a bike or driving a car. Stubborn isn't it.

Funnily enough, the thought that came to my mind when I first read about it was whether the ass in humans was named after asses in nature based on this disease? Another thing, asses almost never ever suffer from pilonidal sinuses. So, who's the real ass here??

Pyrexia of Unknown Origin (P.U.O.)

A fancy way for Doctor's to say they don't know what is causing the fever is Pyrexia of Unknown Origin or P.U.O. When we say it to our patients, it makes us feel good about ourselves, in the sense that we have at the least given them something and proved that we are on the job. In reality, we know just about as much as the patient's relative at that point of time. The relative's guess will probably come true in the end. The only difference being that we will get the answer at the end of the day and the relative will speculate.

I, unfortunately, had the experience of being both the doctor and the patient in terms of P.U.O.

Now, you must understand that it takes a hell of a lot of guts for a doctor to say he doesn't know what is wrong with you or what is causing the fever and the reason for that is simple. Our psyche in India is such that if a Doctor says he doesn't know what is going on, we head off for 2nd and 3rd opinions and when that doesn't satisfy us, we change tracks completely and go to the homeopaths and ayurveds! I have nothing against alternative medicine other than the fact that it is not an exact science in the sense that most of it relies on general build up of immunity and helping the body battle the problem on its own. While this might sound like a good thing, in most cases it is not. There is usually a particular cause for a particular problem, even if it is labelled as P.U.O. initially, and the doctor will find that cause and treat it specifically leading to resolution of symptoms and signs.

Back to the problem at hand. While being the doctor for a P.U.O. patient, I was at the stage where I was to say that I don't know what is cauing the fever. I said it as if it was the most pausible explanation in the world and it should satisfy the patient. For the initial few days it does. Then its upto the doctor to realise that we need to order a few tests to find out exactly what the unknown origin is. We did that. Initial tests were the usual blood counts and liver profiles followed by a blood culture which finally gave us the answer. Typhoid, enteric fever, typhus, salmonella whatever you want to call it.

Soon after that, I had the fortune of being the victim of P.U.O. I say fortune because that would be the only way I would realise the meaning of the sentence given by docs to the patients. Its pyrexia of unknown origin I was told. Being a doctor it didn't make sense to me. I wasn't ready to accept it. What do you mean unknown origin? There has to be a cause. My wife was even more vociferous! Do some tests, find something. There has to be a cause. We did the blood tests, we did ct scans (I was coughing violently), we did an ultrasound (abscess) we did everything and came up with the answer.

The point I'm trying to make here is this - If we as doctor's are sure we are going to get to the answer in the end, why must we give some bullcrack about fancy latin sounding Pyrexia of Unknown Origin to patients when we wouldn't like to hear it oursleves. Secondly, why must we as patients not have enough faith in a doctor to take his time and figure out what is wrong, instead of houding him every hour with temperature updates and the ever lasting question...what is it? what is it?

If our forefathers were to be asked, they would blame it on technology and stress and hectic lifestyles. I think they would be correct. We are in an age of instant updates, live chats, google wave, skype and we want instant answers and instant solutions. This is the problem, this should be the solution and I should be up and about tomorrow. Sometimes, thats just not how it works.

P.U.O. is a way of our bodies telling us to slow down and take time off.