Monday, February 11, 2019

Triple Whammy - Dehydration uncover's Malaria Stain & Hepatitis C !

"Life is a balance of building up & letting go ! " - Rumi

Kenya, August 2010, our first trip during the Migration season. Many a wild beasts to be seen & weather, just right for the visit, cold ,yet , the sun bright,spreading just enough warmth. 

The trip begins with an amalgamation of every aspect of a good trip. Being pampered by my cousin & his wife, cafe's , restaurants & exploring Kenya, as one would with a local.

It's difficult to pinpoint when Trouble began. A slow but steady decline in my health began primarily with my aversion to food. Anything that I ate , tried to eat , either tasted funny or the aroma , completely put me off almost all types of cuisines. For someone who is a complete foodie , this was heart wrenching to neither be able to eat nor be around the most aromatic dishes! Therefore , I survived mainly on curd rice. I felt like a ballon almost always & Coke with lemon juice & sprinkle of black salt became my favourite drink ! The pleasure of a Burp was soul satisfying ! 

This did not deter me from the week long trip that was lined up. Physically incapable of taking the 5-7 hours road trip to Masai Mara , I fly both ways, while the family takes on the road journey. Inspite of my condition taking a constant plunge , I manage to survive trips to Lake Nakuru , Sweetwaters, Serena Mountain lodge. Other complications are cropping - swelling on my feet , low Fever, Cold inspite of the weather being quite moderate, every morsel I eat , I want to throw up. An occasional Foot Massage at the Spa was a temporary relief.  

Extremely weak, is how I head back to Nairobi. Medications are not helping. We speak with my cousins friend , Dr Mohapatra, who is a physician,  suspects Malaria ( since we have taken Yellow fever vaccine & both are spread by an infected mosquito ) when the symptoms are mentioned & wants to do a blood test . He sends a technician home ,who cannot draw out any blood. Next day , I wake up with stomach cramps & am taken to Dr Mohapatra's clinic. His assistant tries to draw , it's multiple punctures again , which , Dr Mahapatra suspects , might be due to an extreme case of Dehydration. After much difficulty , blood is drawn out & sent for testing. In the mean while , he gives me some medication & asks me to drink plenty of liquids to hydrate myself. He sends me home , suggesting  , I am taken to the hospital to administer Saline drip ( a counter for Dehydration) , in case there is no improvement. 

However, by evening,  things go from bad to worse, the cramps are killing me. I am carried to the Agha Khan University Hospital , an immediate admission, blood test carried out, Saline Drip is initiated. The haemoglobin has reached a high of a little more than 20 gms. It's a classic case of extreme Dehydration & due to that, Creatinine, Urea & all other parameters have gone erratic. Being a kidney transplant patient , consulting nephrologist, Dr Twahir Ahmed is briefed, who ensures the transplanted kidney is not affected , Saline drips is on for 3 days, untill all parameter's get to normal & any calamity due to dehydration is averted. 

This would have been a simple end to a critical issue. However, Dr Mohapatra , does an additional manual testing , since Malaria is not detected in the reports ( clinic & hospital ) & wants to take no chances.Reports of this test puts him on an alert. He discovers Malaria stain( which according to him is an old one & not one acquired on this trip) , which wasn't as grave, as uncovering, that I had the HepC virus !  Dr Mohapatra apprise's Dr Twahir on these development , both surprised that we are completely clueless about this virus & HepC test has never been a part of any blood test. The closest association of any form of Hepatitis for us was Jaundice.There is a possibility of some symptoms like vomitting ,etc, were due to the HepC Virus. Not wanting to alarm us, we are given the fundamental facts & treatment. Since Dr Twahir is acquainted with  Dr Gandhi, he writes a personal note , regarding the Malaria stain & HepC , with his recommendation.Three days later , I am discharged & soon after ,we return to Bombay, with Dr Mohapatra's clear advice,  on a thorough check up & treatment for both. My first trip to Kenya has become an iconic one! 

It's not even a day , since my return to Bombay & I am hit by the chills , fever. Since Malaria test is done when the patient has fever, I am taken to the hospital & as a safety measure admitted. The Malaria virus has resurfaced & I am put on medications. Dr Gandhi is informed & he is given the letter written by Dr Twahir. Simply put, all hell breaks loose. I am referred to, Dr Samir Shah , the consulting Hepatologist &  I am subject to every conceivable & available test pertaining to HepC, before & after discharge at BCH ( Breach Candy Hospital) & Jaslok Hospital. After a detailed study of reports , Prognosis of the virus being inactive ( was it some medication that had been given to me at Agha Khan hospital, Nairobi or was it the body managing on its own , we still do not know) , puts everyone at ease to some extent & major , when my Mama , Dr Atul K Mohanty ( Mom's brother , who himself is a Pathologist  ) , gives this simple explanation - " There is an uninvited guest in the body , living there , not interfering in anyways - leave the guest , don't remind the guest of its presence which might create upheaval ! ". And we did just that. The virus is very much a part of Me, a Dormant Guest who hasn't made its presence felt in so many years & I trust , it will Never ! 

Retrospect
Trouble began, a week after our arrival. My cousin from London was to arrive. With time in hand before heading for the airport , we spent the day , driving around & visiting a few places , which included a few Cafe stopovers for some locally brewed coffee. The weather being very pleasant , cool breeze - I wasn't thirsty & the day went past with me drinking only Coffee & just a few sips of Water. Water is the Nectar & I should have had enough Water through the day , irrespective that I wasn't thirsty & the fact that , I was drinking excessive coffee! This, in most probability, was the beginning of Dehydration. 

Preposterous
It's a family trip to China the following year of July 2011. Two weeks of total family & visits to the main cities & attractions, is marred withing a few days , by fever & chills. Initially I tell no one about it , just have Crocin ( paracetamol ) & enjoy the elements. However, it's becoming difficult to keep it hidden, I am also starting to feel Tired more easily & my Enthusiasm levels are fluctuating  . Fearful that I might not be Hydrating enough since it is cold , I make sure there is enough liquid intake. Some ups & downs , however , it's been a wonderful 2 weeks. Back to Bombay , fever still persists & once again , admitted to BCH. Blood tests & once again Malaria is detected. With all attention moving to HepC in 2010, although I was discharged once the fever was under control, the Malaria stain/ virus , had not been tackled. This time around , the treatment eradicated every stain of the virus. Since then , Grace working double time, Malaria has not shown up & I do take precautions to ward of mosquitoes - no surprises wanted ! 

Lesson learnt
~No matter, the weather is cool , chilly & one is not thirsty - you are on a Holiday or at Home - you still need to HYDRATE , drink enough liquid .  

~Liquids means primarily Water . Coffee , Aerated drinks , Tea , Alcohol , do not come under the category of Liquid & just in case you indulge once in a while in these , compensate by a double intake of water! 

~Insufficient liquids intake is as concerning as is Excessive liquid intake. Be Aware - a Delicate balance needs to be maintained. 

~If you have been hit by the Malaria virus , make sure every stain is removed , with the right treatment. 

Precaution , since I know I have dormant HepC virus , which can surface anytime,physical fitness is a must & diet is not only about Kidney but Liver as well , basically be disciplned enough with eating & drinking to protect both ! 

The Doctors 

His knowledge on Medicine is extensive - which helped him diagnose my issues ! 



Information:
* Most questions regarding HepC answered  in this link -

Mandatory screening of donated blood for Hepatitis C virus was introduced as late as 2002 under the National Blood Policy. Blood banks now screen for Hepatitis C along with Hepatitis B, HIV, Syphillis and Malaria. But many had already been infected before the policy came into being, main culprit being , Blood transfusion ( just like me ). Most patients who have had a blood transfusion before 2002, are likely to have a Dormant HepC virus. It's common , remains undetected & causes absolutely No Harm. However, there is a chance that the virus will affect the liver & one might end up with a liver transplant. 

* It's a challenge for the doctors to maintain a transplanted kidney & at the same time to treat a Liver ailment, the treatments being quite contrasted. An active HepC virus, is a grievious complication for any CKD patient. However , with medical science progressive extensively , medications ,treatments & liver transplant , HepC is being tackled.

* The normal range for hemoglobin is: For men, 13.5 to 17.5 grams per deciliter. For women, 12.0 to 15.5 grams per deciliter.

Yellow fever virus is spread by the bite of an infected female mousquito. And a vaccine is mandatory for some countries - Kenya being one of them. 

Pillars at Kenya
* Pannaga ( Cousin)  & his wife , Rinnie - strength of family at Kenya - the backbones.
* Sabrina ( Cousin) , in her A levels, has decided to pursue Medicine since she was a kid, got her first experience on what it's like to be faced with & handle medical emergencies.
* Vicky & his wife, Dipti -  friend of Pannaga , his unconditional support can never be measured. 

"Faith does not mean trusting God to stop the Storm. it means , trusting him to strengthen us, as we walk through the Storm! "
~ Prayers are an integral part  , as are some Humour , Laughter & Smile , through the crisis. 
~ an Abhishek at a temple in Hyderabad , by Dad & Shubhada Amma
~ Mom manages for 3 days in the hospital under most uncomfortable & difficult situation.


3 comments:

  1. My Wisdom lady.. you are such a daring soul...After reading your writing in fact I had goosebumps....Firstly visit to Kenya then China...dealing with health issues outside your country is such a brave thing itself ...how come you managed....Hats off to you !!! Out of all the writing this one has been an eye opener that one doesn't know when anything can go wrong in your body especially people with tx. Any virus can get activated as well can be deactivated for life long.Lots of thorough lesson learnt from this one.But most importantly learnt to grow in faith and to achieve balance in your mind ...The toughest thing to do but much needed in type that of situation.Thanks for sharing this one...Would love to read your other writing in the future as well as they are the powerhouse of information based on your personal experiences.

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  2. Interesting travel diary with many tense moments. Good information on healthcare post transplant.

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