Med­i­cal Bytes with Dr. K


mailife - - Contents -

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.

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