Special to USAfricaonline.com – USAfrica magazine, Houston
By CLEMENT E. ANYIWO, MD and Professor of Medical Microbiology and Immunology, Specializing in Infectious Diseases. Former Dean/Provost of the Nnamdi Azikiwe University, College of Health Sciences, Nnewi, Nigeria, and was President, Federation of African Immunological Societies. This is his fourth commentary as a contributing Editor of USAfricaonline.com and USAfrica magazine.
It is the end of the year, and we are entering into a new year with new resolutions. Our health choices and resolutions are very important. Hence, I am advocate for preventive (proactive) medicine rather than therapeutic (reactive) medicine. It is said that prevention is better than cure. Preventive care helps us to get healthier and stay healthier.
Which is cheaper to manage hypertension or stroke, which is its complication? Which is wiser to identify the trigger of Asthma and avoid it or start pumping chemicals inside the body endlessly? Should we wait for somebody to go into diabetic coma or recommend blood sugar screening?
Some questions to consider if you want to subscribe to a cheaper and more beneficial medicine:
- Do you have a health insurance?
- Are your health insurance contributions to town associations or societies whose benefits are given posthumously?
- Is there any need for medical check-ups yearly to detect symptoms of hidden illnesses?
- Should you go to the doctor when you are not sick?”
Although Jesus said that it is only the sick that needs a physician. The interpretation of this metaphor is that you do not preach to the converted. You will remember that Jesus said this when the Pharisees were criticizing him for associating with the sinners. In focus here was Levi the tax collector. Jesus replied that he has come to call the sinners to repentance. For the full account of this encounter which you are all familiar with read Matthew 9: 9-13.
Some causes of death during illness:
1. Culture of ignoring signs and symptoms of disease
2. Confidence in the infallibility of sorcerers and native doctors
3. Trying some alternatives to medical care, sometimes for years before seeking informed medical opinion at terminal stage of disease
4. Going to prayer houses and diviners for help forgetting that faith without work is dead as we read in James 2: 17-20
5. Superstitious belief that it was karma for false swearing and testimony before an oracle
I recollect my experience with treating an AIDS patient in the 1990s when I was at Nnamdi Azikiwe University Teaching Hospital at Nnewi, Nigeria. This patient was making progress based on the fact that his CD4 cells were appreciating. His treatment was paid for at a discounted cost by a relative, but he decided to go to a prayer house and abandoned the clinic. He died after 4 weeks.
6. Silent carriers
7. Carcinogenic foods and drugs. Consumption of foods preserved with carcinogenic chemicals such as sodium nitrate and chloride benzene to mention a couple. Have you wondered why processed red meat (beef) is always looking fresh? It is most probably preserved with sodium nitrate to prolong shelf life. Hot dog is preserved with a carcinogen called chloride benzene. There is evidence to show that refined artificial sugar feed cancer cells. According to Prof. Jibril Ibrahim, a development consultant, the herbicide glyphosate is still being used in Nigeria to preserve genetically modified crops which have been enhanced genetically to tolerate it despite the fact that it was declared by WHO as a carcinogen.
8. Fake drugs sold by fake pharmacists for selfish economic interest at the expense of the health of the common ignorant man.
9. Emotional stress. Stress is a general denominator of illnesses because it compromises the immune system making the individual vulnerable to a host of diseases. Based on the study of Dr. Steve Sandiford-Chief Cancer Surgeon of The American Cancer Treatment Centre in Philadelphia and Rev ( Dr.) Michael Barry we learn that negative emotion leads to anxiety which in turn leads to production of two important hormones- Adrenalin and Cortisol which cause the depletion of Natural Killer(NK) cells- soldiers of the immune system which kill cancer cells.
10 . Shyness in reporting an ailment. Prostrate problem is one example. Talking about prostrate can be uncomfortable. Millions of men suffer prostate problems and most in silence. Perhaps the explanation below will persuade men to report themselves. Prostate enlargement or Benign Prostatic Hyperplasia (BPH) is a common complaint affecting men and is a symptom in a condition called Andropause just as Menopause is for women. The cause of BPH is unknown but the predisposing factors are genetical as well as age and race. Africans are more susceptible than other races. At age of 40 the male hormone Testosterone suddenly shifts into overdrive causing a surge of an enzyme called 5-alpha reductase that changes healthy testosterone into a more damaging kind of the hormone called DHT (Dihydrotestosterone). This destructive DHT is responsible for enlarging the prostate and irritating the bladder. At age 60 about 50% of men will have enlarged prostate. At 80 some 90% of men will be stuck with BPH. What to do? See a doctor (urologist) to perform two tests: DRE ( Digital Rectal Examination) and PSA (Prostate Specific Antigen) when you observe symptoms such as frequent urination ( when not diabetic) urine retention, pain during urination, dribbling urine, urge to go but no urination etc.
Many of these diseases mentioned earlier causing the so-called brief illnesses from which death results are preventable. Patients in Nigeria and perhaps elsewhere are most of the time brought late to the hospital. Some pronounced dead on arrival or brought in dead to fulfil all righteousness. It does injustice to the memory of the deceased to claim that they died of brief illness when indeed they had suffered for long and battled to survive.
Nigeria is a society in denial which reflects a collectively weak attitude to having a good health. Dying in silence.
There is no better way of summarizing this write-up than quoting from the article” Death after a brief illness” by Dr. Sylvester Ikhisemojie:
“Frequently these people who have died after the so-called brief illness were in chronic ill-health often for many years and they were simply in equilibrium with their ailments for that length of time. In other words, they have adapted. If however, something fundamentally different occurred in the course of the illness, such as unexpected infection or bereavement, or some other emotional or physical challenge, that little reserve that has enabled the person cope with their illnesses suddenly give way and death is the result. “A brief illness” is the culprit”.
Put differently when the patients’ immunity gets challenged and gets compromised, they are no longer able to withstand the attack.
In conclusion, it is therefore clear that many people who die after the so-called brief illness do so because of a neglected and previously undiagnosed illness. Do not conceal your health problems from your spouses and close relatives. Seek medical consultation on time. Brief illness, the way it is erroneously perceived, is therefore a Myth. It is a brief manifestation of terminal stage of a neglected underlying disease, for example of heart or kidney. According to Albert Einstein “By passionately believing in what does not exist, we create it”.
Unfortunately, misdiagnosis in medical practice is rampart these days. This can be intentional or unintentional. And they are not without consequences which can cause, among other things, revocation of license, permanent disability, or death.
Intentional misdiagnosis:
This is malpractice in a nutshell. Some laboratories, particularly in developing countries conduct laboratory tests at times with expired reagents and generate false results that negatively impact on the health of patients. You hear excuses such as the shelf life of the reagents has only expired barely two weeks ago. It is still OK. The technologist would enter in the record book results of tests he/she did not conduct because they are conversant with likely results that would be obtained if the tests are performed. An example of such is what a professor of pathology in Nigeria called “Laboratory typhoid” that is laboratory-generated typhoid. The doctor on getting this result justifiably prescribes the antibiotic, chloramphenicol because the stool culture stated that salmonella typhi was isolated. The patient spends his hard-earned money to buy a medication that he does not need.
Besides, this antibiotic is known to cause bone marrow depression, aplastic anaemia and inflammation of the optic nerve to mention a few. The bad eggs in some laboratories falsify blood screening tests to justify blood donation and satisfy their monetary indulgence. I happen to know all these when I served as a member of the Nigerian Medical Council delegation charged with the responsibility of inspecting medical laboratories. Wrong microbiology with indiscriminate use of antibiotics can eliminate the commensal bacterial flora that are beneficial in our metabolism. The benefits of correct lab results cannot be overemphasized. Lab tests are used to: diagnose or aid in diagnosing a disease, plan a treatment for a disease, evaluate response to treatment and monitor the course of a disease over time. Some lab tests are precise, reliable indicators of specific health problems, while others provide more general information that gives doctors clues to one’s possible health problem e.g. blood sugar to diagnose diabetes or low-density cholesterol (LDL) that aids development of hypertension.
Not long ago a medical doctor in the United States gave a bad reputation to medical practice by operating what CNN reported as breaking news that was later confirmed by one Mike Adams, a forensic research scientist and investigative journalist. Dr. Farid Fata is a Michigan-based Lebanese American oncologist operating a lucrative cancer industry racket with his criminal accomplice-pharmaceutical companies. This doctor is now serving a 20 years prison term since 2015 for intentionally falsely diagnosing and treating cancer in Black people, who genetically are vitamin D- deficient, by dosing them with the harmful chemotherapy which absolutely was not needed and billing government insurance companies. It is known that people that are vitamin D3- deficient are more vulnerable to develop cancer because this vitamin is vital in combating cancer.
Unintentional misdiagnosis:
This is caused by faulty diagnostic devices that are not serviced which leads to instrument malfunction, inexperience of some technologists, use of improperly stored specimens such as blood or urine and fake doctors to mention a few. Faulty diagnostic machine (for example Enzyme Linked Immunosorbent Assay (ELISA) machine can generate wrong and stigmatizing results such as HIV positive. Asymptomatic diseases, such as “silent diseases”, “silent carriers” or diseases that disguise their symptoms can also cause misdiagnosis. As recent as May 2020, Tanzania and COVID-19 hit the headlines: “Tanzanian president exposes faulty COVID-19 testing by submitting non-human samples”. Dr. John Magafuli, who hold a doctorate in chemistry is not unfamiliar with chemical reactions. He sent to his National Health Laboratory responsible for coronavirus testing, specimens from fruit (paw paw), quail (game bird) and goat given them human names and ages. All the reports came back positive for COVID-19! This cast doubt on the credibility of the laboratory equipment and technicians. Or should the blame go to testing kits? Before this could be sorted out, he suspended the head of COVID-19 laboratory. Should paw paw, bird and goat now be quarantined? Your answer is as good as mine.
A diagnostic device can be an in-vitro or imaging tool that provides information that is essential for safe and effective use of a corresponding therapeutic product. You can imagine the results one can get from a malfunctioning oximeter, ECG machine or blood pressure monitor. You would not know the amount of oxygen in the body or the function of the heart or the true level of your blood pressure. Classical examples of “silent carriers” of disease are patients with HIV and Hepatitis C. They are not easily diagnosed because they could be asymptomatic. Non-diagnosis is as bad as misdiagnosis. Such diseases are now being diagnosed with what is called Stimmunology technique. An example of a disease that disguises its symptoms is cervical cancer. This cancer ranks fourth most common cancer in women especially in developing countries. There is usually no early warning signs or symptoms. However, at later stages can be confused with menses, as was mentioned earlier, when it presents with pelvic pain and vaginal bleeding.
Some examples of diseases that are misdiagnosed or underdiagnosed
Diabetes:
About 8.1 million of 29.1 million diabetics (28 %) don’t get diagnosed. Patients won’t realize this until it gets severe enough that they start developing side-effects, like problems with their vision, or numbness in their feet and hands”. (Prof. David Fleming- president, American College of Physicians) This could further result in stroke, retinopathy leading to blindness, kidney failure or gangrene that may require amputation. Often the classical 3Ps- Polyuria (frequent urination); Polydipsia (frequent urge to drink water) and Polyphagia (wanting to eat all the time) are misinterpreted particularly in developing countries. At times you hear statements like “he eats too much”.
Hypothyroidism:
This is caused by Hashimoto’s Thyroiditis and mimics depression according to Dr. Eugene Shapiro ( Deputy Director of Investigative Medicine at Yale University, United States) The demographic of people affected are those over 60 years of age, particularly women. Doctors tend to attribute this symptom to under-reactive thyroid (decreased production of hormones) caused by “wear and tear” that comes with age.
Appendicitis:
Diagnosis could be easy when classical symptoms of nausea, pain and tenderness around the belly button are present. However, according to Dr. Eugene Shapiro “Some people have an appendix that points backwards instead of forwards in the body, so the symptoms present in a different location.
Lupus or Lupus erythromatosis:
This is a chronic autoimmune condition manifesting as an inflammatory disease when the body’s immune system attacks own tissues and organs. Classical symptoms like a facial rash that resembles the wings of a butterfly unfolding across the cheek do not occur in all cases of lupus. Full physical, blood and urine tests are recommended to aid diagnosis. Otherwise it could be misdiagnosed.
Lyme disease:
Caused by the bacterium Borrelia burgdorferi and transmitted through bite of infected black-legged ticks. Symptoms include fever, fatigue, headache and a characteristic rash called erythema migrans. Often these symptoms do not present themselves. Blood test for Lyme disease antibodies is performed but at times the detection of antibodies can be delayed for weeks and may turn out to be unreliable.
Parkinson’s disease:
This is a chronic and progressive movement disorder caused by the malfunction and death of neurons which produce dopamine-a chemical that sends messages to the part of the brain that controls movement and coordination. It is not known why there is malfunction and death of neurons. There is no cure and no lab tests. As the disease progresses the amount of dopamine decreases leading to inability to control movement normally. Often confused with Alzheimer’s disease, stroke, stress and traumatic head injury.
Irritable Bowel Syndrome (IBS):
Difficult to diagnose on the account that there is no real test to prove its existence. IBS is a common condition that affects the large intestine (colon) It causes crampy abdominal pain, bloating gas, diarrhea and at times constipation. Prof. David Fleming suggest what he calls diagnosis by elimination. It is often misdiagnosed because “The devil is in the details”.
Rheumatoid arthritis (RA):
Autoimmune disease caused by the immune system attacking the joints. Synovium (tissue that lines the inside of the joints) thickens, resulting in swelling and pain in and around the joints. Early stages of RA can mimic many other conditions presenting as aches or stiffness in the joints such as degenerating joint disease, osteoarthritis, or gout.
Fibromyalgia:
A disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues, depression and anxiety. Symptoms of fibromyalgia can be confused with those of arthritis. Because this condition can also present with digestive problems such as abdominal pain, bloating and constipation it has often been diagnosed as IBS. Fibromyalgia involves what doctors call “medically unexplained symptoms”- a term that doctors use to describe persistent complaints that don’t appear to have an obvious physical cause.
Celiac disease:
Serious genetic autoimmune disorder where the ingestion of gluten (substance present in cereals) leads to damage in the small intestine. The world-wide prevalence is 1 in 100. About 2 and I/2 million Americans are undiagnosed. Symptomatology is confused with that of IBS where you have vomiting, abdominal pain, bloating, anaemia and leg cramps.
Because of the above-mentioned diagnostic inadequacies and challenges, it is therefore advisable that patients go to reputable doctor clinics and laboratories for their health care and if still in doubt to seek a second opinion. Finally, a guide to diagnosis which I call The Rule of the Tongue. Research shows that, to an extent, the tongue mirrors what is happening in our inner body. Tongue diagnosis is a 4000-year old Traditional Methodic System, approved by the World Health Organisation, using images of the tongue pioneered by Chinese doctors. See the figure below. Upload your tongue in front of a mirror to have an idea of what may be happening to you. This will prompt you to see your doctor for confirmation.
