"This is one of the best disease you can have"

" This is one of the best disease you can have"..........
......oops what I am saying to this patient?
I stopped myself.Is there anything like a good disease or a bad disease?
I was speaking to a 40 year old lady sitting in front of me. She had come to me 2 days ago with feeling of fatigue and tiredness. She is sleepy during day time even though she sleeps well at night.She said she is feeling depressed as she is not able to work properly. She is working as a clerk in an office and also have to do lot of work in her house.
" How is you bowel habits? Are you constipated? " I asked.
' Yes, I do not get regular motion nowadays" she said in a hoarse voice.
"Is your voice like this or is there any recent change?"
"Oh that is because of my throat,it is like this for few days now" she replied.
" Do you always feel like sleeping under a blanket?
" Yes feeling chilly sometimes" was her reply.
" Any increase in hair loss?"
" Yes, after I started using that new shampoo it is like that. I stopped using that but still I loose tonnes of hairs every day".
She seemed to have a reason for all her problems.
When I touched her hand the skin felt coarse. Otherwise I could not find anything wrong in her physical examination. I carefully palpated her neck and could make out mild enlargement of her thyroid gland. Even if I did not find an enlargement I never had any doubt what test to order for her. She needed a Thyroid function test. Most probably she is suffering from Hypothyroidism.

Now the report of the Thyroid function test is in front of me and I was sitting with a smug smile.
"Is it normal doctor?" She might have thought it is normal seeing my smile.
'No it is abnormal. You are suffering from Hypothyroidism".
"Is it a dangerous disease?" Her face showed her extreme worry.
"No. It is treatable but usually not curable."
"So I am having an incurable disease?" She seemed to be almost in tears.
Then I said the above line.
"This is one of the best disease you can have."
"Hypothyroidism is easy to treat in almost all the patients," I explained.
"Your thyroid gland is incapable of producing enough hormone.So you need to take Levothyroxine,a hormone tablet daily and check to see your thyroid hormone levels are maintained in normal range. The medicine is safe and after you have stabilised your dose you need to test only once in a year. There are no complications. So it is much better than conditions like Diabetes,increased blood pressure or increased cholesterol".
"When can I stop the medicine?"
" Most probably you will have to continue the medicine life-long".
" Can I try Ayurveda or Homeopathy? I do not like to take toxic 'English' medicines life long".
"As far as I know Ayurveda and Homeopathy or any other alternative system of medicine do not have any therapy for Hypothyroidism. I very well know that family members of Ayurvedic and Homeopathic doctors are taking 'English' medicine Levothyroxine.So better not to take a chance."
Then I narrated the story of a nurse who had hypothyroidism. She was working in my hospital. About 7 years ago. I had diagnosed hypothyroidism in her and started treatment. As I had changed my place of work I did not see her for long time. Recently she came to me with almost the same symptoms as she had 7 years ago. I was surprised.I thought she may need an increase in dose of the drug. I asked her how much of levothyroxine she is taking. To my surprise she said she stopped the medicine 8 months ago. Some one said Homeopathy can cure hypothyroidism and so she is now taking homeopathic treatment. I was shocked to hear this,that too from a Nurse. I asked her to do her Thyroid function tests which proved that she is again hypothyroid.
' So don't worry,soon you will be all right". I reassured my worried patient.
I am sure with in 2 months she will be fine.Among the chronic illnesses such a confidence I get only while treating hypothyroidism,because it is an easily treatable condition.
That is why I said 'this is one of the best disease you can have".

To know more about Hypothyroidism click here

Feverish Rainy Season

The Monsoon is here.Though it really began pouring down only last week the Fever season started by early June. OPDs are overflowing and it is hard to get a hospital bed.
What kind of fevers are more commonly seen this year?
The usual influenza like upper respiratory tract infection is the commonest but the more serious fever this year is Dengue fever.Chikungunya fever is less common when compared to last year.
Dengue Fever[DF]
Dengue is a mosquito-borne infection that in recent decades has become a major international public health concern. Dengue is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.As per current estimates, availability of at least 100 countries are endemic for DF and about 40% of the world population (2.5 billion people) are at risk in tropics and sub-tropics. As per estimates, over 50 million infections with about 400,000 cases of DF are reported annually which is a leading cause of childhood mortality in several Asian countries.

Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. Symptoms appear 3—14 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults.
Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue. It is important to maintain hydration. Use of acetylsalicylic acid (e.g. aspirin) and non steroidal anti-inflammatory drugs (e.g. Ibuprofen) is not recommended.
Dengue hemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical diagnosis and careful clinical management by experienced physicians and nurses increase survival of patients.
My Experience
When a patient presents with sudden appearance of high grade fever and headache without congested nose or cough my thoughts are about Dengue fever.If there is severe joint pain and swelling especially of small joints of hand I may consider Chikungunya as the first possibility.
I will then order a Complete Blood Count. A low total WBC count along with low Platelet count make my suspicion of Dengue fever stronger. Chikungunya fever may also have a low WBC count but the Platelets are usually not very low.
I admit the patient if the Platelet count is below 100000 or if the patient looks very sick. Maintaing hydration and blood pressure is most important. I had more than 20 patients with suspected Dengue fever since the beginning of June, but only one had the complication of Dengue hemorrhagic fever.There were no loss of life.

Diagnosis of Dengue fever is mainly by clinical features and not by laboratory methods.By the time the antibody levels rises and is detectable by blood tests the disease would have subsided.

Prevention of Dengue fever is mainly by reducing the mosquito breeding.Aedes breeds primarily in man-made containers like earthenware jars, metal drums and concrete cisterns used for domestic water storage, as well as discarded plastic food containers, used automobile tyres and other items that collect rainwater.
Vector control is implemented using environmental management and chemical methods. Proper solid waste disposal and improved water storage practices, including covering containers to prevent access by egg-laying female mosquitoes are among methods that are encouraged through community-based programmes.
The application of appropriate insecticides to larval habitats, particularly those that are useful in households, e.g. water storage vessels, prevents mosquito breeding for several weeks but must be re-applied periodically. Small, mosquito-eating fish and copepods (tiny crustaceans) have also been used with some success.
Fever season is always a challenge for an Internist like me. I love that challenge. Hope I can rise up to it.