Monday, January 19, 2009

It seemed they all wanted her to die.Part 3

Yes, they all wanted her to die,may be even myself.And she died.
The girl I mentioned in 2 of my earlier posts [November,December]died few days ago. Not seeing her come for review for last 2 months, I called the cell number I had obtained from Hospital records again.The person who answered immediately gave it to the girl's mother.
Why you are not bringing her to me?How is she? I asked in an accusing tone.
She is no more,died few days ago', was the matter of fact reply.
I was shocked.
' Did you take her to any doctor?'
'No, She was better with your medicines'.
'Did she die in a hospital or home?'
'She died at home'.
I held the line for a few seconds not knowing what to do.Then I disconnected.
Sense of depression engulfed me.And guilt.May be I should have been more pro-active.Should have telephoned that number more regularly and threatened them of action if they did not bring the girl to me.Or I should have asked one of my acquaintance in the District Positive network[an NGO of Positive ppl] to go and find out where she lived and try to interact with the family.
I hid an important fact in my first posting about that girl.The fact was her father died few years ago due to HIV/AIDS and she might have been a victim of incestuous relationship[.Her mother was negative.]This was one of the most important factor that made her family want her to die.For them her death means an end to their humiliating secret.
She was severely ill,with her CD 4 count 20[indicating very advanced AIDS] at the time of diagnosis.Still with proper care there was a 40/60 or on the pessimistic side 20/80 chance that she will recover.
But they never wanted her to recover.Should I blame them? For them she was a dirty stain on the family,someone they wanted to forget fast.
May be I should have been able to ask some NGOs to take her under their wings.Take her out of the house where she is not wanted.If she was an orphan I might have done that before discharge from the hospital.But she was not an Orphan.She had a mother,sister and brother, and Uncles.
I wish she was an Orphan.Then she might have survived.

Friday, January 16, 2009

Why some Doctors discriminate against patients?

He,let us call him Mr M, is 30 years old,single working in a Bank in one of India's big Cities.His native place is near my clinic and I know him for last 6 years. I know him because he is positive for Hepatitis B Virus.

I remember him coming to me in distress as the technician in the Blood Bank had rejected his donated blood and asked him to see a Physician.He was told he is having jaundice.
I understood what the technician meant.Such rejection meant the blood is positive for either Hepatitis B or Hepatitis C Virus.

I ordered a whole series of tests on his blood. Results showed he was harbouring Hepatitis B Virus in his blood,but all the other tests were negative.

Both Hepatitis B and C are transmitted by inoculation of infected blood and blood products or body fluids.Unprotected sex, unhygienic medical procedures and unsafe blood can cause transmission.Once the virus enters the body it lives and replicates in the Liver causing hepatitis which may or may not produce jaundice.In most patients the immune system kills the virus completely and the person becomes negative to the test for virus.
But in a minority of patients the virus persists in the Liver and blood in a dormant form.Such a person is called a carrier in whom the virus will not produce any problem but can potentially transmit it to others. Our Mr M was such a carrier.Later in life [may be after 10 or 20 years] in a small percentage of carriers,the virus may again become active producing severe permanent Liver damage and even Liver cancer.So Mr M will have to undergo periodic lab tests to assess the activity of the virus.

While I explained all this his face revealed a depressed mood.
'I never had any unprotected sex doctor.Also never received blood donation'.
Any major medical procedures or injections? I asked.
'I had a few shots for various reasons.Also few dental procedures'.

If he was speaking the truth, probably we the health care personnel might have carelessly passed the virus in to his blood.I stopped that discussion there.

From then on he had came to me every year doing a series of lab tests confirming that the virus is there but not doing any harm to him.

Today Mr M was before me again.After reviewing the lab tests I gave him a smile saying everything is all right except that he is continuing as a carrier. I asked him about plans for marriage.
'Family is after me, pushing for marriage',M said.'But I do not want to hide my carrier state'.

'You can immunise your future wife with vaccine.Then you need not worry about transmitting the virus', I reassured him.

'Will anybody willingly come for an arranged marriage with a Hep B carrier?' M asked.
'Then love somebody,that may solve your problem', I replied.He gave me a shy smile.

'I have another problem doctor',he hesitantly said.
'Tell me' I encouraged him.
'I need some dental procedure done.I went to 3 different dentists in the City where I work.When I revealed my Hep B positive status they became very hesitant in doing the procedure.They came with excuses like we do not have separate instruments,or we do not want to take a risk of transmission of virus to other patients etc..'M said.' I do not want anybody else to suffer like me,that's why I am revealing my Hep B positive status'he added.

I was ashamed but not shocked.
I have seen this behaviour many times in doctors[both dentists and other doctors] when confronted with Hep B or more often with HIV.These docs will do the procedure gleefully and pocket the fees if Mr M was not so truthful.And they are doing countless procedures on un tested or untruthful positive patients day in and day out.If the Universally accepted precautions are properly taken all procedures are safe.Why these doctors discriminate like this? Are they not confident about the safety measures they are taking in their clinics?
More over in case of M, he must have got the virus from an unsafe injection or procedure.So health professionals are even more to be held responsible.
I immediately send him to a Dentist friend, with a letter in such strong words that he will not even think about rejecting Mr M. I hope he will get the required treatment and will not ever be rejected again for being truthful.

Thursday, January 1, 2009

Rheumatoid Arthritis a risk factor for Heart Attack and Stroke

My Aunt died suddenly few years ago due to a massive Heart Attack[Myocardial Infarction]. She was suffering from Rheumatoid Arthritis[RA] for a long time.Her Arthritis was fairly under control and was active in life when she was suddenly taken away by death. Her sudden death was a shock to me.It made me research the literature to find out any connection between Rheumatoid Arthritis and Heart Attack.The findings were very revealing.
Several studies have found out that those who are suffering from RA has double the risk for Cardiovascular disease [which includes heart attack and stroke] than General Population.The risk is almost same as those who have Type2 Diabetes.
As more more and more such studies were published an expert committee was appointed by European League against Rheumatism[EULAR], the professional body of Rheumatologists in Europe.Now the Task Force has come out with its recommendations which can be read here. This was published at EULAR 2008 the Annual Congress of the European League Against Rheumatism in Paris, France in June 2008.

The EULAR Task Force’s multidisciplinary steering committee comprised 21 members, including rheumatologists, cardiologists, internists and epidemiologists, from across nine European countries.
This recommendations are applicable not only to RA patients but also to Ankylosing Spondylitis[AS] and Psoriatic Arthritis[PsA] patients.
What does this recommendations mean for RA,AS,PsA patients?
Persons suffering from RA,AS orPsA have very high risk of getting a Heart Attack or Stroke when compared to those who do not have RA,AS or PsA.
Any one having the above rheumatological diseases should undergo active screening for other Cardiovascular risk factors like Diabetes,High Blood Pressure,High Cholestrol etc.If any such risk factors are present they should be actively managed by lifestyle modification including diet and exercise,medicines and frequent monitoring. They should refrain from using tobacco.They should also undergo frequent screening for Coronary Artery disease by Electrocardiography[ECG/EKG],Exercise Stress Test[Treadmill Test] and or Angiography which ever is applicable in a particular patient.
Though the task force have not specified a target value,it can be inferred that the target values for Blood Pressure, HDL and LDL Cholesterol should be similar to the target for Type 2 Diabetes patients.
So RA patients should keep their
Blood Pressure below 130/80
LDL Cholesterol below 100mg/dL
HDL Cholesterol above 40mg/dL

It is hoped that the Task Force recommendations will directly contribute to improved clinical practice and better the life of Rheumatoid Arthritis patients.
I wish such recommendations were there 5 years ago.If so my Aunt might have been still alive.