Incredible events in my medical practice!
# When I saved a near-broken marriage.
A young lady visited my clinic for a consultation for dyspepsia. She was married 2 years back and went through a complex impending matrimonial disaster. Right from the word go, she would choke within minutes of lying down in the bed and needed to sit up and drink water to get relief. The husband was highly understanding and caring and sought medical help from a number of physicians within and outside the state and investigations, including a series of lab tests, CT scans, and bronchoscopy. All were normal. A Psychiatrist's help was sought, and a diagnosis of Genophobia [fear of sex triggered by earlier sexual assault] was made. However, she had no sexual assault in the past. Psychotherapy and anti-psychotic medication failed to relieve her episodes. In view of the failure to maintain a matrimonial relationship, the couple mutually decided to break the marriage to get on with their lives, and the divorce process was to be completed within the next few days. While this drama was on, the wife desired to get a medical checkup for her dyspepsia, which had been bothering her, and the caring husband landed in my clinic.
I listened to the painful story and ordered a routine abdominal ultrasound examination. Ultrasound revealed multiple moving roundworms (Ascaris lumbricoides) in the stomach and duodenum. A video-upper GI endoscopy done within minutes of ultrasound examination was shocking. A large, thick, stout, roundworm (25 cm long) was sitting in the upper esophagus (color Photo). I immediately caught the worm with forceps and extracted it. The stomach and duodenum were loaded with a large number of actively motile roundworms, and it took me some time (same session) to remove all the worms from the stomach. I explained to the couple the nature and cause of her symptoms (as shown in the 3 images) and advised against the impending divorce. She had no more episodes of choking.
[Note: Nocturnal choking caused by roundworms in the food pipe is a common symptom in our community. A seminal paper on Gastric ascariasis was published by Dr. Khuroo’s Medical Clinic in the American Journal of Gastroenterology (2010;105 (7):1675-77). Among 22 patients with gastric ascariasis, 3 presented with nocturnal choking caused by worms entering the laryngeal lumen lying down. The patients must sit up and flush the worm out of the larynx by drinking a glass of water. Since then, whenever a patient presents with such symptoms, I manage with effective anthelmintic therapy with excellent results].