Medical Bytes with Dr. K
DISEASES - YOU CAN PREVENT IT
On a bright sunny day, 38-year-old Vijay was driving his taxi as usual. It was about 2pm when he finally got some time to eat his lunch. He stopped at a nearby café and bought himself fish and chips and a bottle of coke. This meal had become his daily routine for the past 12 months. After finishing his meal he got into the taxi to continue his shift. 30 minutes later he had a sudden onset of chest discomfort, started sweating profusely and felt extremely sick. He was lightheaded and within minutes lost consciousness. His car veered to the side of the road, crashing into a post. Vijay did not survive. An autopsy concluded that he had suffered a massive heart attack. One fine weekend on the other side of town, 50-year-old Sally was home alone as her husband was away for the weekend. She had a longstanding history of high blood pressure and struggled to comply with her medications. On many occasions, her doctor had advised her of the potential risks of uncontrolled blood pressure. Sally had woken up feeling unwell. After breakfast she headed to the shower where she suddenly experienced a severe headache. She felt as though she had been hit on the head with a bat. She vomited and collapsed onto the floor. Her husband found her in the shower the next day when it was far too late to rescue her. Sally had suffered from a hemorrhagic stroke (an aneurysm rupture secondary to hypertension). A few houses down from Sally lived Tevita, aged 60, who had been diagnosed with diabetes five years earlier. Tevita was on a few diabetic medications. He visited the local health centre infrequently. He was not a fan of medication and could not understand why he had to take so many pills every day. As a result of his diabetes Tevita had been having issues with feeling sensation in his feet for a few months, which he had ignored. While gardening he stepped on a nail without even knowing because he did not feel the pain. A week later his right foot was swollen and extremely red. Tevita applied a few leaves that he thought would help. A few days later his whole leg became gangrenous. When Tevita presented to the hospital, the doctors were alarmed. They had to amputate his right leg below the knee to save his life. Tevita was in tears, he did not want to lose his right leg. He was a farmer and could not imagine his life without his leg. All the above people were of different ethnic backgrounds, age and gender but had one thing in common – they were all victims of non-communicable diseases. Non-communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, environmental and behavioral factors. The main types of NCDs are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes. NCDs disproportionately affect people in low and middle income countries where more than three quarters of global NCD deaths – 31 million – occur. The leading causes of NCD deaths in 2015 were cardiovascular diseases (17.7 million deaths or 45% of all NCD deaths, with 6.5 million under the age of 70), cancers (8.8 million or 22% of all NCD deaths), and respiratory diseases, including asthma and chronic obstructive pulmonary disease (3.9 million). Diabetes caused another 1.6 million deaths. (WHO) In Fiji the major non-communicable diseases are diabetes and cardiovascular disease. To give you an idea of the huge problem of diabetes, in 1980 there were 108 million people with diabetes worldwide. In 2015 there were 415 million people with diabetes. In three decades the prevalence has increased fourfold. It is projected that a staggering 642 million people with be affected by diabetes by 2040. In Fiji this disease affects 1 in every 3 Fijians and is the second biggest cause or mortality. According to the latest WHO data published in May 2014, coronary heart disease deaths in Fiji reached 1,294 or 24.23% of total deaths. The age-adjusted death rate marks Fiji as rank number 19 in the world out of out of 172 countries with regard to the mortality rate. Similarly, with regard to stroke, deaths in Fiji reached 492 or 9.22% of total deaths. The age-adjusted death rate ranks Fiji at number 96 in the world out of 172 countries. Who is at risk of non-communicable diseases? To be really honest, each and every one of us is at risk in this day and age. People of all age groups, regions and countries are at risk. In the past, these conditions were mostly rampant in older people. However over the past few years, evidence shows that 15 million of all deaths attributed to NCD’s occur between the ages of 30 and 69 and can be called premature deaths. While talking about risk factors the acronym ‘SNAP’ is very helpful. S stands for smoking, which is a contributing factor. N stands for nutrition and unhealthy diet is yet another risk factor. A stands for alcohol and harmful alcohol intake is a risk factor. Finally P stands for physical activity, and physical inactivity is a major risk factor for NCDs. These diseases are driven by urbanisation, globalisation of unhealthy lifestyles and aging. Modifiable behavioral risk factors are important to address as we can improve the situation by stopping smoking,
becoming physically active, eating nutritious food, and reducing alcohol consumption to safe levels. Metabolic risk factors, which are the biochemical processes involved in the body’s normal functioning, contribute to four key metabolic changes that increase the risk of NCDs – raised blood pressure, obesity, hyperglycemia (raised glucose) and hyperlipidemia (raised fat levels in the blood). To reduce your risk of NCDs as an individual, you can work on your own lifestyle factors. Becoming more physically active, even if it means walking for 30-40 minutes four days a week. Or small measures such as taking the stairs instead of the lift. With regard to your diet, small measures include reducing the amount of salt in your food, reducing processed and packaged foods, reducing your sugar intake and increasing the amounts of fruits and vegetables that you eat. You may not have any symptoms, or they may not seem prominent, however it is important to maintain regular checkups with your general practitioner or the local health center. As a country, all sectors can work together to improve the quality of life for its people, whether it is the health, finance, agricultural or transport sector. Improving access to parks where people can walk, exercise and ride their bicycles. Work places can introduce after work classes such as zumba, yoga and aerobics to encourage employees to participate in exercise. We need to encourage people to grow their own vegetables at home. By increasing the taxes on alcohol, cigarettes and carbonated drinks, we may discourage people from increased consumption of these items, which increase the risk of NCDs. Strict policies in school canteens (as done recently by the Ministry of Health) about what food and drinks can be sold need to be enforced. Most of all we need to educate people to take responsibility for their own health as good health really is in our own hands. Wise words by medical expert and author Brian Carter: “Your lifestyle – how you live, eat, emote and think – determines your health. To prevent disease, you may have to change how you live.” Till next month, stay active, eat healthy and be positive.
“...NCDs disproportionately affect people in low and middle income countries where more than three quarters of global NCD deaths – 31 million – occur.”
DR. KRUPALI RATHOD TAPPOO is an Australian qualified General Practitioner, a Fellow of the Royal Australian College of General Practitioners and the Medical Coordinator for Fiji-based NGO Sai Prema Foundation. Dr. Krupali is based at Mitchells Clinic in Tappoocity Suva and has a special interest in women and children’s health.