MUST READ........Sepsis Is a deadly disease

This is Dr. Sylvester Ikhisemojie

Sepsis is a serious and rapidly progressing disease that results when microbes invade a person’s body and begin to reproduce within their blood stream and inside various cells. They churn out large amounts of toxins, powerful chemicals, which induce a sequence of very unpleasant events in the various victims. Many of these infections begin outside the hospital setting. It is the presence of the infection that makes such people go to the hospital for treatment. Often the diagnosis is missed, not because the attending workers are not well trained, but because several other infections share similar features with sepsis. It will outwit many medical staff unless they have a high index of suspicion that it may be the cause of the person’s ailments. If treatment is not started early with intravenous fluids and antibiotics of the broadest possible kind, with energy and diligence, death is the inevitable result.

Sepsis is characterised by certain abnormalities developing within the body. The heart rate becomes rapid and weak. The blood pressure also falls and becomes low. The rate of breathing becomes so fast that the sheer effort of doing so can kill anyone from muscle fatigue alone. In addition, even the body temperature may become too low to be recordable by standard techniques. Such an individual can therefore be gravely ill and be entirely free from having a fever even in the face of such an infection. The person may manifest some confusion and may end up in shock. The state of shock is reached when the low pressure in the blood vessels is insufficient to sustain the health of the body’s cells. When this stage is reached, in most instances, death is the result. Such shock is termed as septic shock.  That kind of end could come within a few hours or it may be days or even months. It is very unpleasant and every one who has it suffers greatly. The infections often result from the genital and urinary systems, the alimentary system or as a complication of a skin infection or from pneumonia.

No age group is exempted from it, but it is most common at the extremes of life and in those who are suffering from a compromised immune system such as in AIDS. People on treatment for cancer and those on treatment with steroids are also at particular risk of this terrible state. Premature babies and the very old are at great risk as are those people with long-standing liver or kidney disease. Among premature babies, such an infection may result from a contaminated umbilical cord or as a complication from meningitis. If we do not give these bacteria an opportunity to invade our body by certain habits and acts we indulge in, these problems would not result.

The possible associations are virtually without limit but some of the organisms are more commonly found to be the culprits than others. It is made worse by the fact that the diagnosis is tricky. There are no quick and dependable tests you can quickly perform at the point of hospital admission. Usually, the diagnosis is made in the classical way of taking a history of the illness and properly examining the patient. The relevant investigations may be no more than a complete blood count and a blood culture. The former only points a finger in the direction of sepsis especially when the white blood cell count is abnormally raised. It does not confirm the disease, however. A blood culture, on the other hand, is useful in helping to identify the malicious organism but that result may arrive too late from the laboratory to be of any benefit to the patients or to save them. Most of the time, many doctors get a head start by combining medications that have the widest possible spectrum of activity based on a knowledge of the likely organisms from that part of the body while the results are awaited.

Sepsis is already a disease causing plenty of worry in some countries.  In the United States, it is the second most common cause of hospital re-admissions following discharge for different reasons, but mostly operations. This is happening in a country already reeling from the havoc being caused by multi-drug resistant bacteria and powerful fungi that have great power to invade the body. It is thought that these organisms are possibly more frequently involved in the development of sepsis.  If such a combination were to take root in this part of the world, we would be in deep trouble. Inevitably some survive and some others die.

As in other aspects of health we have discussed on this page for some time, the prevention of this development is possible to some degree. Children and teenagers can have immunisation for meningitis and pneumonia, two very severe infections that can often be complicated by sepsis. This serves the purpose of preventing the disease in the first place. In resource scarce nations like Nigeria, this is a very important measure and it will avail much. Many others may not be similarly preventable, but because the majority fall into the group of young people, that alone is significant.  Not every death is possible to stop, but the number of losses can be mitigated. Another preventive measure is the routine if simple task of washing the hands. That alone helps to prevent some 65 to 70 per cent of common infections. These are real issues that people have turned into habits and have saved countless lives when taken together with immunisations. It now must be taken as the responsibility of everyone to promote proper hygiene. Also, there is much good to be gained from the frequent washing of the hands as our individual contribution to preventing the disease. If this is taken with similar seriousness to what was done with the various immunisation campaigns, many more lives can be saved.

As microbes device ways of outwitting mankind and the array of weapons ranged against them, we must also improve on our means of securing our environment and maintaining our health. That is the minimum condition required to guarantee our freedom from the most deadly effects of many micro-organisms.

Ask the doctor

Dear doctor, I have worked as a secretary for 24 years. Not long ago, I read that it is not good for one to sit down for too long. I am feeling pains in my bottom. What can I do or use to relieve me of the pain since I am still working?  070318xxxxx

What you read is very true. Apart from the pains which you could feel from the sheer pressure of sitting on a particular pressure point, there is also the risk of developing deep vein thrombosis which can cause a heart attack or a stroke even in somebody who did not previously have hypertension. There are several things you can do to relieve your pain. The first thing is to get a properly padded chair that will cushion your buttocks better. That way, the pain you feel now will disappear.  The second thing is that you must learn how to sit properly at an office table. You should do that in a way that your back remains erect and such a position diminishes the pressure on your back and legs. Finally, for every two hours in which you remain seated, you must find a reason to walk around the office a bit, even if it is only for about 10 minutes. When you have done all that for a period of four weeks and the pains are still present, then you must see a doctor to undergo some examination prior to obtaining a prescription.

Dear doctor, I am an 18-year-old lady. Please sir, I would like to know if there is any supplement that I could get to make me grow fat or tall. I look very much younger than my age, being so skinny and short. Thank you. 081054xxxxx

You are very interesting. To be fat and tall are two different things. I am not aware of any medications that can help you achieve both. However, you can become fat essentially from over-eating, but it is a different matter whether you will grow tall or not.  That will depend to a large degree on whether your parents and your siblings are tall or short. But most importantly, as a young woman, it is a good thing for you to look younger than your age. It is complementary, and not a minus. So do not seek any medications for what you desire now. Take care.

Dear doctor, may God bless you richly for the good work you are doing. Amen. I am a 46-year-old woman. After previously having three kids, I am now pregnant with my fourth child. Please sir, can I cope at my age? This was not deliberate.  070632xxxxx

Amen madam. By God’s special grace, yes you can cope. We are now in an era where women have children at the age of 57 and older. At the moment, I know another woman who is pregnant at a year older than you. So, it is possible. All you have to do is register early for ante-natal care at a large hospital that can offer you all the experts needed to take care of you during this pregnancy and delivery. Your hospital visits will be more frequent than is usually the case. Good luck and many blessings.

Dear doctor I have a vaginal infection and whenever I have sex, it is very painful. What can I use to treat myself?  090580xxxxx

Several different types of bacteria are possible as causes of what you have. As a result of that, prescribing what you ought to be using is not the answer.  You need to see your doctor for appropriate tests to be conducted following which you will have the desired treatment together with your partner.

Dear doctor, please can you advise me on what specialist to see. I suffer from foot ache and a terrible lower back pain when I wake up. I am a 40-year-old female. Thanks. 080378xxxxx

You will have to see an orthopaedic surgeon or a spinal surgeon for the kind of examination you need and the eventual treatment. Spinal surgeons are much fewer than orthopaedic surgeons and are therefore harder to get. So, if an orthopaedic surgeon has seen you and determined that you need to see a spinal surgeon, they will know where you can see one.

Dear doctor, I suffer from this terrible headache which can last for a whole day or up to two weeks and then stop for a whole before coming back. Initially, I went to see a doctor who said it was malaria and he prescribed Arthemeter which made the headache to stop for a while, but it returned eventually. The headache is usually accompanied with dizziness and at times, it is focused on one side of my head or in between my eyebrows and eyelids. In addition, I find it difficult to read when it occurs (like I can’t actually look up, look down or keep my eyes open). What can l use to stop it? I am 18 years old.

I have no specific recommendation for what you can use to stop it. Several possibilities exist for the problem you have with your eyes. First of all, you will have to see an ophthalmologist for a comprehensive assessment. That way, any other problem associated with and contributing to your current difficulties can be addressed at the same time. That is my recommendation.

Dear doctor, three years ago I was diagnosed with kidney stone in one of my kidneys. Since then, l have not met anyone who can tell me how to go about removing it other than the advice of taking large quantities of water. Removing it will surely be one of the greatest goods done to me in life. I suffer agonising pains intermittently. Could you please proffer any advice different from the one I have become used to? God bless you. 080593xxxxx

If that is the advice you have been getting up till now and the pains you experience remain as bad as they are, it is time for a change of approach. You must see a urologist without delay for a comprehensive assessment and a definitive plan to have the stone removed because with so much pain over such a long time, the stone is likely to be a large one.