Sekolah Bogor Raya

Disclaimer
WARNING: What you are about to read may be hazardous to your health. Do not blindly follow my example.

First, some background information. I come from a science-oriented family; my older brother is a PhD microbiologist, my younger sister is a neurologist, and I am a vet. Three types of doctors in one family, if there’d been more siblings we could have tried for a dentist or a doctor of divinity.

For the past 26 years I have lived and worked in Indonesia, a country not noted for its science, (which is why I came here in the first place), the quality of its medical care, or much else, come to think of it.

So, naturally, I think, with my quasi-medical background, whenever I feel sick, which fortunately is not often, I try to work it out myself. And since most prescription drugs, except the really hard stuff, are readily available to anyone at any pharmacy, I usually treat myself. And, the proof is in the pudding as they say, I’ve been reasonably successful. Of course, I was lucky and didn’t get dengue, malaria, or leptospirosis, to name a few diseases that felled colleagues over the years.

As a last resort, or to confirm a particularly nasty diagnosis, I will make an excursion into the nation’s capital to visit a doctor. In fact, one morning last month, as I lay vulnerable on my deathbed after a terrible night of nonstop coughing, fever, sweating buckets and diarrhea, my dear wife extracted a promise to visit the doctor later that day. And so I did. By the time I reached the clinic, my cough had all but ceased, and, when asked for a faecal sample, all I could supply was gas. The doctor was concerned about GERD as a cause of cough, and asked me to wait several hours for an endoscopic examination to confirm his diagnosis. I refused, arguing that he should treat me based on his suspicions rather than refine the diagnosis.

Now, I fully understand the medical profession’s penchant for attempting to make a definitive diagnosis before treating a condition, but my personal experience is that it is far cheaper just to treat the condition, and use response to treatment as confirmation of diagnosis. And as I pay my own medical bills, economics are very important.

So upon return to work, I googled GERD cough, and I learned a lot. For instance, lifestyle changes alone may be effective in reducing or eliminating GERD symptoms. And looking at the list of recommended lifestyle modifications, I can see much room for change (marked with *). Did the doctor tell me anything about this? No!

Lifestyle Modifications affecting GERD
Positional modifications
Avoid lying supine for 2 to 3 hours after a meal*
Elevate the head of the bed*
Sleep left side down*

Dietary modifications
Avoid foods that precipitate symptoms:
High-fat foods*
Citrus fruits*
Tomato-based foods*
Coffee (including decaffeinated brands)*
Chocolate*
Alcohol*

Others
Avoid smoking
Lose weight*
Avoid classes of drug known to cause reflux (calcium channel blockers, anticholinergic medications, oral 2-agonists)

I further found that in this case at least, the august American medical profession actually agreed with me that empirical treatment of GERD-related cough was the most cost-effective approach. “GERD should be considered if there are typical gastrointestinal symptoms or if cough remains unexplained after standard investigations. If heartburn and/ or acid regurgitation are present, no further testing is required before starting medical antireflux therapy. The diagnosis of GERD as the cause of cough can only be made with certainty when cough goes away with specific antireflux therapy. Empirical medical therapy targeted towards reducing reflux is justified in such patients and is more cost effective than testing followed by treatment.”

While it is quite easy to find unsupported medical information on the internet, I’ve seen North American house hippos foraging in kitchens and I’ve seen spaghetti growing in Swiss gardens, so I am well-poised to detect false or aberrant internet info. What I have cited here is just a very small part of the medical literature on GERD and cough.

So I purchased some PPI (proton pump inhibitor) and started treatment, including several of the less painful lifestyle changes. I couldn’t quite give up chocolate and alcohol. And now, almost a month later I’m almost cured. Which to my way of thinking, confirms the GERD diagnosis.

The bottom line is that I, as a google-informed quasi-medical scientist once again successfully treated myself, once again saving millions of rupiah. And I will continue to use Google as my doctor.
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Would I recommend that others do so? Not really, unless they have a medical/scientific background. However, what I would recommend is that Indonesians start questioning their medical profession about diagnoses and treatments, and that they google everything, so that they might form an educated second opinion. Too many middle class Indonesians blindly accept poor medical care, through ignorance or submissiveness to authority, both qualities inculcated and cherished by earlier regimes.