Sunday, September 27, 2009

What is the cause of his respiratory distress?

                     He was admitted sometime late in the night. The doctor on night duty had called me and told me about this patient. He said that a patient with no history of asthma has come with severe respiratory difficulty. The pulse oximeter showed unusually low value of oxygen level in blood. ECG showed only an increased heart rate and X-ray Chest was hazy on either side.

" Sir, What could it be?"

'Let the blood results come and let me see the patient in the morning”. I replied.

The patient was 46 years old, working in one of the Metro Cities. He came to his hometown here 5 days ago. He was having cough and breathing difficulty for about 2 weeks now and was getting some treatment with mild relief. There was on and off fever and severe fatigue. He was suffering from Diabetes for last 2 years, but not on any regular medication nor was doing frequent blood sugar tests. He had lost weight considerably in last few months.

His clinical examination showed white patches on his tongue with chest showing features of pneumonia. With Oxygen administration in high pressure he was much better than the time of admission.

His blood sugar was high and Liver function Tests were slightly deranged. The WBC count was low with lymphocytes predominating suggesting a non-bacterial cause for pneumonia..X ray Chest showed ground glass like haziness.

What is this?.............

Sub acute onset of illness, severe breathlessness and low Oxygen level, fungal patch on the tongue, low WBC count, ground glass haziness on Chest X ray............

Yes, I want to test his HIV status.

He has features of Pneumocystis Pneumonia, caused by a fungus found in patients with very low level of immunity, mostly HIV positive patients.

Patient was drowsy and was not in a state to give his consent for the test. I talked to his wife and got an oral consent. Did she want to say something? Or was I imagining?

The rapid test for HIV antibody was positive. I called the wife again and told her about the result. Then she told me everything. Yes they know he was 'positive’. She was also 'positive' too. He was seriously ill 2 years ago and was found to 'positive'. He took medications for about a year and was much better. Against doctor's advice he suddenly stopped the Anti retro-viral medicines and started some alternative system of medicine with the hope [that someone gave him] that he will be completely cured. He slowly became ill again and is now in this state.

I have heard this story many times. Modern medicine being based on scientific evidence based medicine will not claim cure for conditions, which has no cure. But most of the illnesses can be well controlled with continuous medications. This is true not only for HIV/AIDS but also for other chronic illnesses like Diabetes, Hypertension, Coronary Heart Disease etc.

After taking modern medicine treatment for some time many people try to experiment other systems of medicines/practitioners because they falsely claim complete cure. Finally after worsening of their condition and realizing there is no permanent cure they come back to modern medicine. By this time much damage to the body would have been incurred.

He is critically ill now. If he had continued on medicines advised for him under modern medicine treatment he would not have been fighting for his life like this.

Who should be blamed here?

1 comment:

Anonymous said...

There are so many thongs that need awareness drives, I am surprised how little we realise the importance of awareness dives...

There's so much available on AIDS, they could also add some information on what never to do... :(

Doctors - most doctors are generally not able to answer the (endless) questions that patients may have, while quacks are out to sell, they talk, promise and sell miracles...

We should have counselors and helplines that really work.