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Journalism of Courage
Sometimes, the simplest of health issues that you think you can handle with supplements may hide a bigger problem. A 40-year-old woman came to the OPD with complaints of extreme fatigue, hair loss, low grade fever, headaches, oral ulcers and fluctuating body weight. Her blood work showed a haemoglobin count of 10 g/dL (12-16 g/dL is the normal range). Not too low. “I’ve had this reading for a long time now, I have heavy periods and blood loss, so have been taking iron supplements on my own,” she told me. Why then was she not getting better?
I got two more tests done, for iron and vitamin B12. I was surprised to find that her iron levels were higher than normal, a fallout of the iron supplements she was taking on her own. Her low haemoglobin count had nothing to do with iron deficiency. But her vitamin B12 levels surprised me, they were low. That was when we got her tested for autoimmune disorders, which are known to stall vitamin B12 absorption in the intestine. She came out to be strongly positive for lupus in an antibody test.
In a few weeks, she got chest pain and had to be admitted to hospital. Her chest X-ray showed fluid in the sac around the heart because of inflammation. This excess fluid had put pressure on the heart, potentially affecting its ability to pump blood effectively. At times, this kind of fluid accumulation gets mistaken for tuberculosis too. She was treated with steroids and immunosuppressants and is much better now.
I keep on telling people that popping supplements, no matter how innocuous they may look to you, may not address your underlying health condition if you do it without your doctor. A bloodwork has to be interpreted correctly, looking at several factors, which a lay person won’t be able to.
Lupus is an autoimmune disease, which means that your immune system, which is meant to fight infection, attacks healthy tissue instead. This can cause inflammation and pain in any part of your body, be it skin, joints and organs like the kidneys and heart. It is because it affects many parts of the body that there are different and flitting symptoms, the kind my patient experienced.
No one knows what causes lupus but autoimmune diseases run in families. My patient’s aunt also had lupus. Sometimes it may develop in response to certain hormones (like estrogen) or environmental triggers and infection.
It’s common in women in their reproductive years, between 15 and 45. The prevalence in India is 30 to 50 per 1 lakh. It is less common in men but then they have a more severe manifestation.
Kidney inflammation can progress to chronic kidney disease – a gradual loss of kidney function over time. Then there could be secondary hypertension, low platelets, heart disease, arrhythmia and pulmonary embolism (blood clot in the artery of the lungs). Women may go through recurrent abortions as a result of lupus. All of these challenges affect their mental health in such conditions.
(Dr Tickoo is Director, Internal Medicine, Max Healthcare)
