By Henrylito D. Tacio
Author’s Note: Some of the names with asterisk have been changed to protect privacy. This article appeared in the Asian edition of Reader’s Digest.
In December 2000 Ardy and Tingting Roberto returned home to Manila, Philippines, from a relaxing two-week holiday in Australia. Almost immediately 36-year-old Tingting fell ill – she felt tired all the time, lost her appetite and suffered an on-and-off fever.
“Rest and sleep it off,” advised Ardy, believing she would bounce back quickly. On some days she did feel better, but on others, her condition got worse. She went to a leading private hospital, where she underwent blood tests. “It’s just anemia,” the doctors told her when the results came back. But she was not getting better, so she quit as her husband’s partner in an international direct sales distributorship.
In March 2001, Tingting was overcome with excruciating stomach pains. Again tests turned up nothing. In the following months, she was in and out of the hospital. Her condition was getting worse. “I felt like I was floating,” she recalls. “I was confused and depressed not knowing what was happening. I was in my bedroom all the time since I couldn’t stand the intense heat. I didn’t feel like eating and I had more than a dozen open sores in my mouth. It was terrible. I would wake up screaming in pain every early morning.”
Finally, after a restless night while at the hospital, Tingting woke up with a slight rash across her face. The attending doctor saw this and asked Ardy if she was out in the sun before the “mysterious disease” came. He remembered that his wife was sun bathing in the beaches of the Gold Coast in Australia six months earlier. After hearing this, the doctor ordered an ANA (anti-nuclear antibodies) blood test. The result confirmed what the doctor thought – that, indeed, Tingting was suffering from lupus.
For over half a year, Tingting suffered from this potentially fatal disease and no doctor had noticed it. Unfortunately, stories like this are far more common than they should be. Diseases and disorders sometimes develop stealthily, presenting no obvious warning signals. Or they may exhibit symptoms so vague that doctors are left scratching their heads as test after test fails to detect anything amiss.
This disease, in which the body’s immune system attacks its own tissue and organs, has a genetic basis, but much about it remains a mystery. “It’s not contagious and its cause is still unknown,” says Professor Feng Fao Hsii, chairman of Singapore’s National Arthritis Foundation. It affects the skin and other vital organs and may inflame and damage the connective tissue in the joints, muscles, and skin, as well as membranes surrounding the lungs, heart, kidneys and brain.
Who’s at risk: Lupus is most common among young women, says Dr. Alberto Santos-Ocampo, a Filipino rheumatologist who now works at the Straub Clinic and Hospital in Hawaii. “Its peak age at onset is between 15 to 40 years of age,” he says.
Symptoms: They’re maddeningly tough to predict. “Lupus affects almost all parts of the body,” says Feng. “Often, not all of the symptoms are present simultaneously.” One person may have swelling in the feet and pain while breathing. The next patient may have sores in the mouth and nose or rashes.
Diagnosis: It’s difficult because symptoms often mimic other diseases and vary from patient to patient. Doctors consider a patient’s medical history and immune function. One survey suggests more than half of all patients suffer for four or more years and visit three or more doctors before being diagnosed.
Treatment: A variety of drugs are used, depending on how lupus manifests itself. “Treatment of lupus is target-organ oriented,” says Dr Santos-Ocampo. “Currently, controlling lupus is a more realistic goal than ‘curing’ it.” Tinting is now back to her normal health. Although she’s no longer gulping medicines, she’s taking fish oil as anti-inflammatory, multivitamins and antioxidants. She also avoids stressful situations and makes sure to have regular massage every week.
Experts have likened aneurysms to time bombs for good reason: You can be symptomless until the faulty blood vessel bursts. The major arteries in the chest and head are the most notorious – and fatal – places to have an aneurysm; half of all victims die immediately. (Martial arts movie star Bruce Lee is thought to have died of cerebral aneurysm.) However, the prognosis is good for people who have aneurysms removed before they burst, says Dr. Philip Chua, chairman of the cardiovascular surgery center at the Cebu Doctors Hospital and College of Medicine in central Philippines.
Who’s at risk: “People with high blood pressure, high cholesterol and smokers are the most likely to suffer,” says Dr Alfred Cheng, head of the cardiac clinic at the Mt Elizabeth Medical Centre in Singapore. “Those with close relatives who have had aneurysms and diabetics are also at risk.” Men are eight times more likely to have an aneurysm than women.
Symptoms: If a brain aneurysm bursts, it causes the instantaneous onset of an unusually severe headache, says Dr Chua. Other symptoms include nausea and vomiting, blurred vision, pain above and behind an eye and stiff neck. Aortic aneurysms announce their presence with crushing chest or abdominal pain.
Diagnosis: Dr Cheng offers two pieces of advice: If you suspect a burst, go to a vascular neurosurgeon immediately. Second, if you are at risk for having an aneurysm, ask your doctor to do an MRI screening.
Treatment: Quick surgery can save a person’s life.
In January 1995, 45-year-old Taiwanese businessman Kevin Chen* from Taipei was enticed by his girlfriend to inject heroin. The syringe his group was using was passed on from one person to another. He attended this kind of session several times until he found himself addicted.
Several months later, Chen noticed that he felt uneasy most of the time and was constantly tired. His physician said he was in good health and recommended rest and vitamins. Later he read an article about hepatitis C and realised that the symptoms were identical to his. A liver specialist confirmed that he had acute hepatitis C.
The disease is caused by a virus, which is spread by contact with infected blood, leading to inflammation and scarring of the liver.
Who’s at risk: Anyone who had blood transfusions or organ transplants before July 1992, when better testing of donors was implemented. Also at risk: health care workers who may have been jabbed with a needle or splashed with blood, people who have frequent exposure to blood products, and infants born to infected mothers. At highest risk are users of illegal drugs, people with tattoos and long-term hemodialysis patients.
Symptoms: Hepatitis C is a silent killer – al most a third of the people who have the disease do not realise they are infected. “If symptoms do occur, the most common complaints are fatigue, abdominal pain, poor appetite and weight loss,” says Dr Jia-Horng Kao, director of the Hepatitis Research Center in Taipei. Late-stage symptoms include digestive upsets, muscle and joint pain, kidney disease, autoimmune problems and cirrhosis.
Diagnosis: A simple blood test can detect the virus.
Treatment: A combination of anti-viral drugs can slow or stop the disease, but the course can last up to 48 weeks. Chen had been given this combination therapy. A follow-up liver biopsy performed at week 50 showed his hepatitis C on remission.
Justin Estrera* of Manila was nine when his parents noticed he had become restless, disobedient and hard to manage. He was always tired and was losing weight because he didn’t like eating. The parents took Justin to a doctor, who observed nothing unusual about him except that he was thin. After five months of consulting various physicians, a doctor finally diagnosed celiac disease.
Imagine being sensitive to most grains – wheat, barley, rye. They all contain the protein gluten. And when Justin eats grains, the hairlike projections in her small intestine called villi – they absorb nutrients from food – shrink or disappear, leaving her unable to digest properly. Celiac disease can lead to osteoporosis, iron-deficiency anemia and serious vitamin deficiencies.
Who’s at risk: “About 10 per cent of people with celiac disease have a close relative with the disease,” says Dr Atenodoro Ruiz, Jr, a gastroentologist and former consultant with the St. Luke’s Medical Center in Manila. Among children can manifest itself after weaning when cereals are added to their diet. In genetically susceptible people, the disease can be triggered by pregnancy, severe stress, surgery or viral infection.
Symptoms: Typically, they include abdominal cramping and bloating, gas, diarrhea or constipation, unexplained anemia and mysterious weight loss or gain. Sufferers may also feel joint pain, fatigue or depression, and some develop a substantial rash..
Diagnosis: Doctors look at the symptoms and rely on blood tests to detect the sensitivity, followed by a small-bowel biopsy.
Treatment: Avoidance of all gluten-containing foods such as bread and pasta. These days Justin, now 10, eats gluten-free alternatives like potatoes, rice and corn and is back to his old happy and healthy self.
Impaired Glucose Tolerance
People who have a reduce ability to regulate glucose (sugar) levels in their blood have impaired glucose tolerance (IGT). “This is the same problem as diabetes but in a milder form,” explains Dr Gauden Galea, a public health physician at the World Health Organization (WHO) in Manila. People with untreated IGT has a 50 per cent of developing diabetes.
Currently, about 200 million people have IGT worldwide, more than half of them in Asia. “The total figure will blow out to about 400 million by 2025,” says Professor Paul Zimmet, director of the Melbourne-based International Diabetes Institute.
Who’s at risk: IGT is common among those who are overweight (particularly people with a lot of fat in the abdominal region), who are inactive, who have a family history of diabetes, who have history of heart disease and/or stroke, and who have high blood pressure.
Symptoms: Because IGT has no signs or symptoms, sufferers may not know they have it. If symptoms occur, they are similar to the mild early symptoms of diabetes, which include excessive thirst and appetite, increased urination, weight loss, and fatigue.
Diagnosis: A person comes to the clinic fasting. Blood glucose is measured. A standard glucose drink is given (containing 75 grams glucose for adults). Blood glucose is again measured at two hours after the test. “Someone with IGT will get higher levels of glucose over a longer period,” says Dr Galea.
Treatment: People with IGT are encouraged to increase their level of physical activity, achieve a healthy weight and follow a healthy, balanced diet. Drugs can help slow down the IGT from developing to diabetes.
Because it usually tells no symptoms, cervical cancer is oftentimes misdiagnosed by doctors. Perhaps, this must be the reason why Hong Kong pop star failed to take notice of her cervical cancer even though her sister Ann died of the disease. In a news conference in September last year, she announced that she was suffering from the deadly disease. By December, she lost her battle against the disease and died of respiratory disorder at Hong Kong’s Sanitorium Hospital at age 40.
Studies show that more than nine out of 10 cervical cancers originate in surface cells lining the cervix, the knoblike lower portion of the uterus that connects the uterus to the vagina. Human papilloma viruses, which have been implicated in causing the cancer, are transmitted during sexual intercourse.
Who’s at risk: In Asia, about 184,000 new cases are reported each year. It affects women aged 25 years and above and is most prevalent among older women (50-65 age group). “All women who are or were sexually active, are at risk of developing the disease. But women at highest risk are those who had their first intercourse at early age and had multiple sexual partners,” says Dr Zarihah Zain, a cancer epidemiologist with the disease control division of the Ministry of Health in Malaysia. Cervical cancer is also strongly associated with smoking.
Symptoms: In its early stages, cervical cancer causes no pain or other symptoms. “Abnormal bleeding from the vagina like bleeding in between menstruations or bleeding after sexual intercourse are the commonest symptoms,” says Dr Zain. If the cancer has spread to nearby tissues, symptoms may include difficult and painful urination, dull backache or swelling in the legs, fatigue, loss of weight and appetite, and general feeling of illness. Cervical cancer, however, takes about 30 years to develop.
Diagnosis: Doctors often recommend that women have their first Pap smear test when they become sexually active or reach the age of 18 and that the test is performed annually. If their test results have been normal for 3 consecutive years, women may schedule Pap tests every 2 or 3 years as long as they don’t change their lifestyle. If an abnormality is found on Pap test, an examination called a colposcopy will be needed. Some women may need to have a further test called a cone biopsy to assist with diagnosis.
A new technique is currently under test: Visual Inspection with Acetic Acid Wash (VIA). In this technique, an internal exam is done (as for Pap), the cervix is washed with acetic acid. “If certain lesions appear, they are treated on the spot,” says Dr Galea of WHO. “This results in cheap, simple, one-visit screen and treatment.”
Treatment: Most cases are cured or controlled by a combination of surgery, chemotherapy, and radiation therapy. A variety of alternative therapies might prove useful in easing side effects and improving overall health. Any woman who has had cervical cancer should see her doctor regularly for at least five years after treatment to check for recurrence.
The thyroid is a small, butterfly-shaped gland found just below the Adam’s apple. When it fails to make enough thyroid hormone to maintain the body’s metabolism, the body starts slowing down. Sufferers gain weight, feel tired, suffer memory lapses – the symptoms are myriad and confusing.
Who’s at risk: Women are five times more likely to develop hypothyroidism than men. “The disease tends to manifest itself as the person ages,” says Professor Mafauzy Mohamed, consultant endocrinologist and campus director of Universiti Sains Malaysia. By age 60 as many as 17 per cent of women have hypothyroidism. Among newborns and infants, hypothyroidism poses a special danger as a lack of thyroid hormones in the system can lead to mental retardation and stunted growth.
Symptoms: Cold intolerance, fatigue, weight gain, heavy periods, hoarse voice, dry skin and hair, memory lapses, loss of energy, depression, sleep difficulties and hair loss.
Diagnosis: A simple blood test can reveal an underactive thyroid.
Treatment: Patients get a daily dose of hormone replacement drugs.
Polycystic Ovary Syndrome (PCOS)
Ana Marie San Diego*, 30, a private secretary in Davao City, Philippines, had a long history of irregular periods. More recently, her weight ballooned to 50 kilograms. San Diego didn’t know it, but her ovaries were riddled with cysts. “I saw three or four doctors over the last three years, but none of them could offer a diagnosis,” she recalls.
San Diego finally got an answer when she visited the Brokenshire Women’s Center. She had PCOS, a condition in which her high levels of testosterone prevented her ovaries from releasing eggs, which then became cysts. She was advised to take different hormone therapy, including oral contraceptive pills. “I can live with regular monthly intake of hormones to regulate my cycles, but I am worried about my chances of getting pregnant in the future,” says San Diego who has now have a regular period and has lost the weight she gained.
Who’s at risk: About 5 to 10 per cent of women aged 20 to 40 have it.
Symptoms: Women with PCOS are often overweight and have excess body and facial hair, irregular menstrual cycles, infertility, acne, insulin resistance and difficulty losing weight.
Diagnosis: Pelvic exams, ultrasound, and blood tests to measure hormone levels can reveal the condition.
Treatment: Birth-control pills can treat irregular periods, and a diet and exercise program can work wonders.
Doctors miss this bacterial infection because people don’t realise they’re infected. Unless it is picked up in a routine doctor’s visit, a person wouldn’t know he or she had it. “Most people who have chlamydia are symptom-free,” says Dr Bernard Fabre-Teste, an advisor with the sexually transmitted infection unit of regional WHO office in Manila. In 80 to 90 per cent of women, and in 70 to 80 per cent of men, there are no symptoms.
Among women, untreated chlamydia can cause pelvic inflammatory disease, scarring of the fallopian tubes, ectopic pregnancy and, in some cases, infertility, also a problem for men. Among children born from mothers who have chlamydia, complications include pneumonia and eye infection.
Who’s at risk: Technically, any sexually active man or woman, especially under the age of 25. Experts recommend that people who fit in this category be screened every six months.
Symptoms: Initially, they consist of discharge or itching that is so mild most people don’t see a doctor. Over time women can experience lower abdominal or back pain, pain during intercourse, bleeding between periods and nausea or fever. For men, discharge from the penis, pain or burning during urination, or pain and swelling of the testicles.
Diagnosis: A urine test or a pelvic examination will reveal chlamydia.
Treatment: Chlamydia is treated with a single dose of antibiotics.
Cartoons have long poked fun at thunderous snoring, but experts are realising the noise is serious. Snoring may indicate sleep apnea, which can lead to high blood pressure, heart disease and strokes.
A collapsing airway triggers the snoring, and it can interrupt breathing for as long as a minute. Sufferers awake – usually without realizing it – to restart their breathing. That continual arousal interferes with the quality of sleep, says Dr Adrian Siew Ming Saurajen, a consultant at the Ear, Nose, Throat and Snoring Center of the Mt Elizabeth Medical Center in Singapore. Yet many doctors still don’t realise how harmful this can be; getting a proper diagnosis is difficult.
Who’s at risk: In the past, it was thought to affect only in men who smoke, drink and who are obese but, according to Dr. Saurajen, post-menopausal women, Asians and children also suffer from it. “Asians tend to have greater severity of sleep apnea compared to Caucasians due to our facial and skull morphology,” Dr Goh Yau Hong, a Singaporean ENT doctor also working in the same medical center.
Symptoms: You guessed it: snoring. Also, daytime sleepiness, morning headaches, inability to concentrate, depression and decreased sex drive.
Diagnosis: Unexplained daytime sleepiness is a key sign of sleep apnea or other sleep disorders, Goh says. “Those who seek help usually are those who suffer social (bed-partners’ complaints, excessive daytime tiredness) or medical (high blood pressure, for instance) problems.”
Treatment: Mild cases can improve with weight loss; sleeping on one’s side can also help. For more severe cases, patients find relief by using a machine that forces air through the nasal passages during sleep. — ###