"Umami"

Monday, my regular clinic duty at Megaclinic. It was relatively uneventful. I even got two free meals from my patients. I only saw a handful of patients but the rest of the day I was doing annual physical exam evaluations.
Around half past eight in the evening, which is almost closing time, I was writing a laboratory request to Che, husband of my friend Lea. Everybody is preparing to go home and the nurses are already cleaning the instruments and doing final endorsements. After I bid goodbye to Lea and Che, a nurse came up to me and said there is a patient who came in at the treatment room due to ingestion of monosodium glutamate (MSG). At first, I thought it will be an easy case and I can discharge the patient in no time. As far as I know, allegations regarding MSG as a toxic substance has been disproved long time ago. Recently, I attended a post-graduate conference saying that MSG is even safe in pregnancy.
When I came to the treatment room, there was this middle-aged man wearing a blue shirt with a patch of a montessori school where my niece is going to. With him are two staff from Cabalen where he had dinner few minutes prior. He recounted what happened to him. He said he was having “palitaw” and allegedly took some seasoning on a bowl containing what looked like sugar with some pepper or beans. He poured around two teaspoons of it on his palitaw and after eating it, he noticed that it tasted different. He checked on the bowl and noticed that there were some whitish cube-like powder inside the mixture. He asked the staff what it was and eventually they admitted that one of the staff accidentally poured on MSG instead of sugar. The man suddenly felt nauseaus and vomitted in the toilet. He felt dizziness, sweating and tightness of his abdomen. It was at that time that the staff of the restaurant decided to bring the man to our clinic.
The vital signs were normal. He was ambulatory with no signs of cardiopulmonary distress, except for the anxiety. During the brief encounter, he was a bit defensive. I can see the look on the restaurant staff faces that they are also scared. I was a bit relaxed at that time and reassured the patient that MSG is not toxic. He then told me of a story of a dog that was fed with MSG and died instantly. I said that that is not backed up by medical evidence. He said that he is not really going to complain against the restaurant and that he just wants to know why he felt what he experienced after eating the alleged concoction with MSG. I reassured him that it could be something else or probably a temporary reaction to the MSG. He said he took some samples of the seasoning with him as evidence and asked the staff of Cabalen not to tamper with the original source of the seasoning. I advised the patient to seek consult to a hospital in order to have a more sophisticated test if he wants to formally file a complaint against the restaurant because our clinic is only an urgent-care facility and the clinic is about to close. I told him we cannot really do much in our facility. Surprisingly, he got upset and walked out because we were not doing anything to him. He later threatened to complain me for not doing anything and not issuing any medical form. I told him I am not issuing anything because he is clinically normal and I am advising him to transfer to a better facility. He continued his threat that if something happens to him when he transfers to a hospital it will be my fault. I told him that his case only warrants observation at this time since he is not showing any abnormal signs or symptoms during his stay at our clinic until he left. He was creating a scene in the clinic now putting the blame on me. Later on, I was able to convince him to transfer to a nearby hospital because it is much more to his advantage because he can demand that the restaurant pay for all the tests to be done to him including admission. It brought a smile to his face and agreed to go. The restaurant staff came up to me and thanked me for assisting them. I reassured the staff that it is better to bring the patient to a hospital to further disprove his allegation that he was intoxicated by the MSG.
We all felt that the patient was a bit acting weird. Although his symptoms may be valid, his reaction is way out of proportion to what actually happened. I was offering to have him stay in the clinic and take paracetamol for the headache, but he refused it. He wants an instant explanation that what he felt was due to the MSG. When he left, I just added some notes on the chart where the nurse recorded his vital signs. We didn’t even get his name and age because of his defensive approach. I went back to my room to pack up. I quickly googled on MSG and true enough all the articles confirmed what I know that it is considered SAFE. There is NO TREATMENT needed in case of excessive intake. The patient did show some rare symptoms of excessive MSG ingestion but it resolved spontaneously. Funny thing, I have been curious with the advertisement of Ajinomoto because of the word “UMAMI”. I was wondering what that meant and only because of this incident that I discovered that it refers to the “fifth tase”, meaning savoury-like taste. I guess the fifth taste doesn’t apply to the patient’s palete.