How a Pill ruined Mom's kidneys over two decades?

The biggest revelation that Nephrologist No. 3 (N-3) at Hospital No. 3 made to us was that "It was my mother’s prolonged use and consumption of a painkiller drug by the name of Brufen or Ibuprofen that had caused her Chronic Kidney Disease/CKD".

The story behind my mom and her relationship with Brufen tablets goes as follows:

My Mother gave normal birth to my younger brother, but since the Delivery was a Dry one, she suffered severe back pain during that time. To help her heal, the Gynaecologist  had advised my mother to undergo Physiotherapy. The first day she went for her Physiotherapy session, I had a fall, my grandparents could not look after me even for those few hours; my mom returned to see a gaping bleeding wound on my forehead and then rushed me, her 3 year old to the Doctor to get me stitched up. That was the first and last day of her Physiotherapy sessions.

And from that day onwards, my Mummy had brought me and my brother up as a Single Mother and a working one at that, she had been toiling away bringing us up and working simultaneously over 26 long years since that day at N-3’s cabin…and in those 26 years, for a prolonged period of over 10 years she was gulping a tablet called BRUFEN or IBUPROFEN* like a toffee candy  multiple times in a day to numb the pain in her bones and spinal region, that would enable her to continue with her daily chores which even included looking after my father’s parents and other family members. By ‘looking after’ all, I mean that she was doing most of the cooking and laundry of all family members besides looking after her children’s needs and those of the house and its maintenance along with toiling away physically managing a Business-which was started by my father and not meant to be commanded or managed by a woman in the first place, still my mom was courageously doing it all, as I can say now, at the cost of her own health and happiness.

My very selfish, self-obsessed and self-centered father was least concerned about her health issues, he used to visit us sporadically twice a year only to meet all his relatives out here in Delhi. Both I and my brother were too young and naive to help our mother during her bouts of pain, which we frequently used to see in all these years growing up. She also used to ask us both to massage her back and sometimes hit it with our fists to help ease her pain. She often used to get Neurobion injections as well to help her aching spine. It was only in 1999 when my mother was popping a Brufen on a bus ride, a senior lady seated next to her advised her not to do so if she valued her life!

*Now to come to the point, BRUFEN belongs to a class of NSAIDs i.e. Non-Steroidal Anti-inflammatory drugs which are commonly used as Over-the-counter Painkillers. Research worldwide has proved, though not conclusively that, heavy or long-term use of some of these medicines, such as ibuprofen, naproxen, and higher dose aspirin, can cause chronic kidney disease known as chronic interstitial nephritis, which in simple English of a non-medical author like me means that, since these medicines are excreted through the Kidneys, they have the capacity to damage the kidney filters in a way that the kidney starts loosen its ability to filter out toxins from the blood because either the filters are damaged or blocked. A link to one such reference article is https://www.kidney.org/atoz/content/painmeds_analgesics

Later, in the month of August 2015, Delhi Government made NSAIDs including Brufen, a prescription drug and Chemists were barred from giving it Over-the-Counter to anyone not having a prescription from a registered Doctor for the same. (News reference link: https://economictimes.indiatimes.com/industry/healthcare/biotech/pharmaceuticals/delhi-government-bans-over-the-counter-sale-of-nsaids-without-prescription/articleshow/48441880.cms)

Mom's Kidneys

In my absence, my mom decided that it was high time and she should get herself checked up by a Gynecologist and get all medical tests done that a woman should ideally in her Menopausal stage, so she chose to visit Hospital (Hospital No.1) near our home and got her Intrauterine Copper-T device removed and also got her basic Blood tests done which include CBC: Complete Blood Count, KFT: Kidney Function Test and LFT: Liver Function Test and also Thyroid and Lipid Profiles; to her shock, almost every count came abnormal, but the worst were the kidney counts with Creatinine values as high as 2.6 and also increased Blood Urea and Uric Acid levels which were perhaps resulting in the bitter taste in her mouth all-the-time.

What next? My mom chose to go to Hospital No.2.

One of my cousin’s wife is a Doctor who is the head of the Blood Bank in Hospital no.2 and in my physical absence, she thought seeking my cousin sister-in-law’s advice will be helpful in getting herself checked up by a Nephrologist whom I will now refer to as Doctor N-1 who in a blink of an eye, upon seeing my mummy’s reports suggested that she get an Ultrasound from that Hospital. The Medical Practitioner who did my mother’s ultrasound of the Abdomen region told my mom as he was doing the Ultrasound and looking at the Display screen showing her internal organs, “it is a wonder you are still alive Aunty, as per what I am seeing, your kidneys, both of them are beyond repair and you should have been dead by now!” Who speaks that way, mummy wondered.

N-1 then told Mom to get herself admitted in that Hospital and undergo a Kidney Biopsy. And obediently so and in the meantime put my mother on a strict diet, with boiled vegetables and no sugar or salt, my mother got herself admitted and with her sister by her side she got a Kidney Biopsy done. N-1 got N-2, a senior Nephrologist who had retired from one of Delhi’s most premier Government hospitals on board as a Consultant to conduct the Biopsy. Then they told her to collect the reports some days later.

When she enquired about the reports N-1 had the cheek to tell her, “Mam, your Biopsy slides didn’t get made properly so please get yourself admitted again for another Kidney Biopsy, but otherwise we are telling you that both your kidneys are severely damaged and on the verge of failure. You should get your dialysis started immediately and start looking out for kidney donors as you would need a transplant very soon”.

Getting Biopsies, dialysis or transplants done is and never was or will be a joke for anyone, but it was astonishing to be hearing it in that cold and heartless way from a doctor of repute.

My mother’s intuition told her she was in the wrong Doctor’s hands and then through my sister-in-law, mom connected with the old senior N-2 to check if he had any spare slides of the Biopsy conducted by him, luckily he had and he willingly gave a slide that my brother went and collected from my sister-in-law.

What next now? Mummy sat pondering. She lost a lot of weight during that duration as well because of the kind of diet she was on based on the advice of N-1 at Hospital No. 2, which she had since lost faith in and abandoned!

As my mother tried to think who is the next Doctor she can possibly approach, she picked the phone up and rand a Neuro-specialist who had helped diagnose my young brother’s Ocular Myasthenia about 5 years back in Year 2007. Mummy called him and sought his help to refer her to a good Nephrologist. He referred Mummy to a lady Nephrologist Doctor working in that same hospital, he was working in. Allow me to name that (lady) Nephrologist as N-3 in Hospital No.3.

As the case is with most hospitals, which we gradually learnt, they fail to believe in Diagnostic test reports of other Hospitals and thus N-3 advised my mother to get her blood tests done from Hospital no.3 again. However, there was a bright point here amidst all the gloom that had descended, N-3 while preparing her case sheet had asked mom a lot of questions to help her understand the origins of her kidney related problems, and one of the findings and learnings that I want to share with you all follows in my next post: It is about a deadly pill that had ruined it all!

Those early days

It was the month of May 2012, I had saved enough to embark on my two month long solo trip across the European continent, had got my Visas and was so excitedly looking forward to this dream trip which was all set to begin on the 1^st June 2012.

The dampener to my excitement however was that my Mummy, aged 55 years was not feeling that well in those last days on the month of May 2012, she was suffering from bone pain, digestive problems and feeling very weak. I thought she was feeling low because I was opting to go solo traveling this long, her sadness does take a toll on her health so I had reasons to believe that this too was that kind of a phase.

I told her that I will cancel my trip if she does not get well, true to her nature she started ‘acting’ fine so that I do not cancel my travel plans and went to a Doctor in the neighbourhood (Doctor P-1 who was a General Physician) to get her blood test done and started taking the medicines prescribed by him for her indigestion related problems as she was having a consistent bitter taste in her mouth and vomiting frequently (gastric reflux as he termed it). There was temporary relief but not much. Her Kidney Function Test from the Diagnostic test performed at that very Doctor’s diagnostic laboratory did reveal partially high creatinine counts which the Doctor chose to ignore and he said to my mom, “It’s all fine, just take these medicines and you will feel better. Drink lots of water.” He gave her some antacids and broad spectrum antibiotics for a week long course.

In hindsight, I was probably able to decode why he said so to mom, perhaps because he was on the Panel of a Medical Insurance company that was renewing my Mother’s Medical Health Insurance at that time and my Mother’s insurance premium not going to that Insurance Company would have robbed him of his referral commission as well.

And 1^st June 2012 arrived and I boarded the flight to Heathrow and began my once-in-a-lifetime journey, praying that mummy and all my loved ones at home will remain fine while I live my dream over the next two months.