The Most Disgusting Diseases in the World (and How to Catch Them) – part 2

Following on from part one, and in the same vein for which Punch magazine was known, I bring you four more of the most disgusting diseases in the world.

I had to include acromegaly as the insistence of my son whose interest in endocrinology began at the tender age of four when we were on holiday in Switzerland and happened on a particularly florid case of the condition. By then, the diagnosis could have been made from a cable car 50 metres away (which it was).

“Mummy, why are that man’s hands so big? And why has he got pillows instead of shoes?” He pointed, I told him not to, and so on, until I noticed the man in question who really was sporting pillows strapped to his feet.

I explained about the pituitary gland and growth hormone, and my youngster thereafter abandoned Postman Pat books in favour of the British Medical Journal.

However florid acromegaly may become, the onset is invariably subtle, with coarse skin, greasy hair, an increase in hat size, a little deepening of the yodel, and difficulty making watches or doing up lederhosen. To avoid resembling our Alpine acquaintance, it’s best to seek help while you can still fit into your ski boots.

Even pillows may not be roomy enough if you’re infected with wuchereria bancrofti. Everyone seems to have heard of elephantiasis but there are two important things to note: you don’t catch it from elephants, and it usually begins with just a few enlarged lymph glands on the groin. Walking is therefore still possible, for a while. Swelling sets in later, often only in one leg, and sometimes in the scrotum too, should you possess one.

Eventually the skin develops rough folds and warty outgrowths, and the scrotum, if affected, can hang down to the knees, which poses problems at the tailor’s, and elsewhere. Prevention is key. Use a mosquito net, and avoid falling into Burmese septic tanks if you want to wear both legs of your trousers at the same time.

If you dislike rodents, you’ll hate Lassa fever. Transmitted by rats, it was discovered in the Nigerian village of the same name, which you might like to make a note to avoid on your travels.

After it was first described in 1969, the department of health send circulars so that no GP would miss this diagnosis.  As the years passed, I never saw a case, but the bumph was useful for wobbly dining tables.

Lassa has an insidious onset with symptoms that resemble other conditions, like fever, malaise, a flushed face, red eyes, nausea, and vomiting. Later, the nose, gums, mouth, stomach, and lungs bleed spontaneously – a plague of blood, with a high mortality rate. As I recall, Lassa is similar to other haemorrhagic fevers such as Marburg-Ebola, Green Monkey Disease, and Crimean-haemorrhagic-Congo-Hazara fever, though I’d have to check under the dining table to be sure.

Anyone who’s unconscious when arriving by plane from West Africa runs the risk of his drunken state being mistaken for Lassa fever, with the result that masked attendants whisk him off to a plastic tent in the nearest isolation unit until the tests are back. I need hardly add that the outlook is far worse when Lassa fever is mistaken for excess alcohol.

Next up is typhus, not to be confused with typhoid. Typhus is caused by germs called rickettsiae which breed in the gut of the louse, and spread to humans via louse faeces. Louse bites are itchy, and scratching them rubs infected droppings into the skin.

Weakness is one of the early symptoms, and it all goes downhill from there, eventually, if untreated, leading to multiple organ failure.

As alarming as typhus is, Tsutsugamushi fever (aka scrub typhus) is much more popular with medical students, because it has so many syllables and because it forms a painless but picturesque ulcer covered with a crust. More importantly, unlike other forms of typhus, an attack of Tsutsugamushi gives no immunity against further infection. Medics can therefore imagine repeated episodes of scrub typhus at each outbreak of acne, and some of them have been known to scratch for years after exposure to a single lecture.

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them): head, shoulders, knees, and toes.

You may also like to catch up on The Most Disgusting Diseases part one.

The Most Disgusting Diseases in the World (and How to Catch Them) – part 1

Putting my decades of medical practice to use, I bring you the chance to brush up on all the gruesome diseases you don’t remember, especially if they’re ones you never knew about in the first place.

It’s tongue in cheek, but, if you’re squeamish or easily offended, you may prefer a blog about macramé instead.

Feeling out of sorts lately? If friends think you look tired, colleagues call you burnt out, and Great-Aunt Frieda reckons you need a tonic, better check out your appearance in the bathroom mirror. Are your fancy new glasses slipping down your nose? If so, either you’ve been too busy to pop into Specsavers to get them adjusted, or that jaunt to South America didn’t agree with you.

You may have got New World Leishmaniasis. Don’t let the name fool you. It’s as old as the hills, and it’s still a neglected disease. The parasite finds a sandfly to hang out in, until the sandfly finds you. Within 18 months or so, the bridge of the nose collapses. Leishmaniasis also destroys the mouth and tongue, so that bottle of Gevrey-Chambertin you’ve been saving tastes just like British sherry. Soon, however, you will no longer care.

The cause of all the trouble is the innocent-looking leishmania parasite with a cute little tail. Rather like a spermatozoon, actually. But, unlike pregnancy, leishmaniasis can be avoided by simple measures such as sleeping on the roof. Sandflies can’t fly much higher than three metres. 

What could be worse than leishmaniasis, apart from income tax, baldness, and wheel clamps? It’s the infection so dreadful that doctors often refer to it as Hansen’s disease to avoid inducing panic in the waiting room. The condition starts with a bit of catarrh then progresses to muscle pains, enlarged lymph nodes, and sometimes a patchy rash.  If you’re any kind of hypochondriac at all, you’ll suspect from the very first sneeze that this is leprosy.

Soon you lose a little pigmentation, then a few fingers because they’re numb and you chop them up with the celery. By the time leprosy bacilli gets into their stride, the face is covered in boils and bumps, and friends are apt to be too busy to see you. There may be other complications including inflamed testicles and a spleen the consistency of sago. But enough. More details might be in poor taste.

Leprosy is highly infectious. Or else it isn’t. The experts don’t all agree. If your doctor rushed out of the consulting room, you’ll know which school of thought she favours. One study showed that the only sure way of contracting leprosy is to share a bed for twelve years with a leprosy patient. So there’s really no need to avoid waiting rooms, though you might want to steer clear of lactating ladies with leprosy because they shed the bacilli like there’s no tomorrow.

Actually, there is a tomorrow because leprosy is curable. Too bad that treating an entire village for a month costs nearly as much as a good lunch for four, not including service. 

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them), I’ll be talking about conditions affecting hands, feet, and other members.

My earlier version of this series originally appeared in Punch, an iconic magazine that eventually succumbed to circulation problems.

One Year Older, Still Alive and Kicking

On my birthday just recently, I experienced a disconnect between the joy of being the birthday girl and the reality of being, frankly, older than I’ve ever been before. One day, I’m scoring goals in the back garden. The next thing I know, I sit down with an audible Oof! at every possible opportunity.

If you’re anything like me, you don’t always appreciate how fast things are changing until something pulls you up short. Like the photo that shows how short you are compared with your children. Or a birthday card like this one.

What presents might be heading my way? Another pair of slippers, maybe, or a voucher for Specsavers. Material gifts lose some of their appeal as the years slip by, as does blowing out candles on a birthday cake. I don’t have that kind of puff. Or a fire extinguisher to hand.

But I’m not a grumpy old thing who pads around in her gardening clothes and moans about the passing years. On my birthday I dressed up in my new shoes.

Along with a top from Help the Aged. Don’t tell me the shop is now called Age UK. This purchase goes way back.

I didn’t fancy going out for a celebratory lunch. Not when we have so much in the fridge, and the tarragon on the patio is doing so well this year that it’s a shame not to use it. So risotto it was.

The old joints may be creakier than they were, but I can’t complain. Getting older is a privilege. Give me a head of grey hair and as many laughter lines as Mick Jagger (though, come to think of it, nothing is that funny).

Health problems become more likely as the years pass, but then ill health can strike at any age. Having worked in paediatric rheumatology, I can see just how challenging mobility issues can be at a young age. And of course there are many other conditions that can become limiting.

That’s why I’m delighted to get behind the new campaign from Sport England. It doesn’t have to involve a sport. #WeAreUndefeatable aims to help the two thirds of people with health conditions increase their physical activity in any way they can.

I’d need a really long blog post to cram in all the benefits of moving more. Instead, watch this lot living every moment. The clip lasts just 30 seconds. 

If you have a long-term condition, or know anyone who does, please take a look at some of the inspiration at We Are Undefeatable

Happy Birthday to Hope Hospital

April 5 is the end of the tax year, but, if you’re hoping for a side-splitting post about ISAs and tax returns, you need to look elsewhere. This week it’s a serious message about sick kids.

Just over two years ago, the People’s Convoy set off from London on an overland journey, taking with it supplies to build a new children’s hospital in Syria.

War has devastated Syria

After six years of war – with the deliberate and outrageous targeting of hospitals – the humanitarian situation was dire. There was no children’s hospital left in Eastern Aleppo, leaving about 250,000 people without medical care.

Hope Hospital, enabled by the People’s Convoy and run by the Independent Doctors’ Association, literally rose from the ashes of oblivion. As the world’s first crowdfunded hospital in a war zone, Hope is a triumph of humanity.

It took 8 dedicated organisations, over 5,000 generous people and £246,505 to open Hope Hospital. When the hospital was damaged by a car bomb, it was repaired. And when funding ran low last year, people raised an additional £480,505 to keep the light of Hope on.

Hope Hospital has now provided 98,707 consultations, checked 26,309 children for malnutrition and given specialist treatment to 52,846 children – children like Hanan, shown here.

Young Hanan’s story

Hanan’s mother suffered hugely during Hanan’s birth in October last year, not least because she had to travel for more than 60 km to reach hospital. Then, at 10 days old, Hanan developed a fever which wouldn’t respond to initial treatment.

Dr Hatem, Hope Hospital’s Director and lead paediatrician says, “Hanan came to the hospital suffering from convulsions… A CT scan showed cerebral oedema, which can cause irreversible damage and even death.” 

Thanks to Hope Hospital’s specialist care, Hanan improved enough for her to be discharged, to the great relief of her mother. She needs to continue with treatment and have ongoing hospital check-ups at the hospital, but is expected to make a full recovery.

Thousands of children need medical care

Dr Hatem says, “We receive dozens of cases like Hanan’s monthly. We are so grateful for the unique presence of this free hospital. Despite the dangerous environment, we are able to save the lives of thousands of children annually.”

Friday 5th April will mark two years since Hope Hospital officially opened its doors. To celebrate, CanDo – one of the lead organisations of the crowdfunding campaign – and the Independent Doctors Association of Syria are sending messages of thanks, hope and humanity.

Dr Rola Hallam, co-founder of CanDo who travelled with the People’s Convoy, says, “Hope Hospital is a shining beacon of what we can do when we believe in our shared humanity. The amazing staff there are saving lives every day thanks to people-to-people care, action, and hope.”  

Hope Hospital is a beacon in a dark world

My grandmother’s family was Syrian, and I’m often glad so few of them are left to see what the conflict has done. But, in a war that has been raging for over eight years, has killed hundreds of thousands and displaced over six million people, the story of Hope Hospital is a rare and precious positive. So I thought you’d like to hear this uplifting story.  You can watch a short video celebrating two years of Hope Hospital.

And here’s where to find out more from CanDo

You too can send a message

Many happy returns to Hope Hospital. If you too would like to send a personal message for #2yearsofHope, it’s easy to do on this link Happy Birthday to Hope

A Family Doctor’s Casebook (part 1)

General practice partnerships are like marriage without the sex, muses Geoff as he installs himself at his consulting room desk.  He knows that kind of marriage. Shoving aside the piles of letters that need answering, he begins tending to the sick of North London.

Geoff is a GP from my novels One Night at the Jacaranda and Hampstead Fever.  Despite his problems and hang-ups, he’s everyone’s favourite. Geoff is a firm believer in the NHS, but the changes he’s seen in the 15 years since he qualified frustrate him immensely.

1 The first patient is a three-month old baby with the Lexus of pushchairs and a Yummy Mummy who reminds Geoff of his ex-wife.  She begins by complaining about the 20-minute wait, and the perennial parking problems within a mile of the health centre. All this is extremely inconvenient as she’ll now be late for her Pilates.

Geoff asks what he can do for her.

“It’s Alistair’s head,” she throws down like a gauntlet.

She’s right in thinking her baby’s skull is a tad asymmetrical. Plagiocephaly is common now that babies all sleep on their backs.  Geoff reassures her that it’ll right itself in time, once Alistair lifts his head and becomes more mobile.

FreeImages.com/Johan Graterol POSED BY MODEL

Yummy Mummy is sceptical. “Doesn’t he need one of those special helmets?”

Geoff explains that there’s no evidence they help.

The mother seems unconvinced. She’ll probably go and splash out thousands of pounds on a contraption that will only cause discomfort and inconvenient. Still, she’s now ready to move on to the next symptom. The practice has a new policy of one symptom per consultation, which Geoff routinely ignores. It’s demeaning to patients and wastes everyone’s time in the end.

The rash on Alistair’s buttocks looks like a common yeast infection which should soon respond to the cream Geoff recommends. This pleases the mother, until Geoff asks her not to leave Alistair’s dirty nappy in his consulting room bin.

“I don’t want to stink out the car,” says Yummy Mummy.

Geoff eventually persuades her to take the offending object away, even though he thinks she’s likely to dump it in the waiting room on her way out.

2 Next it’s Mr Legg in his nineties, with an aching left knee. Sometimes it’s his right knee, and sometimes it’s both, which is no wonder since both legs are badly deformed by arthritis. He attends the health centre every couple of weeks, yet refuses hospital treatment. As he puts it, “I don’t want to be a bother. There’s plenty of younger folks who need it more.” Mr Legg adds that he doubts it’s arthritis anyway.  “It’s probably just down to the shrapnel what got me during the war.”

Geoff asks where the shrapnel got him.

“In a little village near Germany, Doctor.”

doctor's bag

3 It’s a relief to see that young Mohammed’s eczema is improving. For a long while, his mother believed that a mild steroid was totally unsuitable for a three-year old, but the cream, along with emollients, has made a huge difference. Mohammed sleeps well now that he doesn’t scratch himself to ribbons. All in all, he’s a happy chappy, apart from a streaming cold that’s not a problem until he flings himself at Geoff and plonks a kiss on his cheek.

Geoff usually washes his hands between consultations. Today he washes his face as well.

FreeImages.com/Toni Mihailov

 

4 Now a young man sits before him. Unemployed, with a squat nose and tats up one arm. “Pain in me bollocks,” he says.

Might be a torsion. Uncommon in adults, Geoff knows, but, unless treated promptly, it can lead to gangrene of the testicle.

“Right. I need to take a look,” Geoff says, pulling the paper curtains across.

As he waits for the fellow to undress, he wipes the photo on his desk with a tissue. It’s Davey, aged four, at the beach in Norfolk. Happy days before the divorce.

“Ready yet?” Geoff calls out, increasingly aware of how late his clinic is running.

“Yeah. Course.”

Turns out the man is sitting fully clothed the other side of the drapes.

Patiently, Geoff explains what he needs to examine. Another three minutes pass while the man undresses.

On examination there’s nothing abnormal about the patient’s tackle, apart from the stink. Geoff peels off his gloves and flings them in the bin. “Hmm. All’s well there. When did you first get the pain?”

The man shrugs. “Maybe a week ago. But I ain’t got it no more, like. Not since I pulled that bird the other day.”

“Fair enough,” says Geoff, even though there’s nothing fair about it. The ugly, unemployed fucker gets laid just like that, while he, Geoff, has been celibate for ten months and counting.

***

Coming up soon, Geoff deals with a very personal problem. Meanwhile you may enjoy one of these posts:

How to Alienate Your Doctor in Ten Easy Steps

What Your Doctor is Really Saying

or, on a more serious note, an overview of sepsis in The Disease Nobody Knows About Until It’s Too Late.

Four Hours in the Eye Surgery Day Unit

On looking back, the signs had been there for years. First, Nadia had trouble at night from the glare. Then reading got harder, especially the day she picked up an Egyptian newspaper in Paddington. Arabic, with its tiny script and its proliferation of vital dots above and below the letters, is the least appropriate language for someone with poor vision.

She wonders why she’d got cataracts by the age of 55. Probably to do with a stupid game they used to play at the beach in Alexandria.  She, Zeinab, Chou-Chou, and of course her sister Simone all dared one another to look straight into the sun for as long as they could. Nadia still has the memory of the after-burn. How was she to know, until Simone told her, that her school friends all cheated by shutting their eyes when she wasn’t looking at them?

“The Nile has cataracts too,” says Chou-Chou. She is still stupid despite being middle-aged now.

“They’re not the same thing,” Nadia replies loftily, even though she is unsure of the difference.

Nobody gets a bed on this day surgery unit. They get an armchair, but only if there’s one free at the appointed time. There isn’t. Along with three other patients, Nadia sits in the corridor. Waiting in corridors is normal in the NHS. It was never like this in Egypt, if you could afford bakshish.

An Iranian nurse and two Irish nurses seem to run the place. Each of them asks Nadia if she is diabetic.

“I’m not diabetic.”

In a nearby office, a doctor sits with the door open. Nadia can hear her complain about the computer system. Doctors always do this.

Once Nadia is installed in her allocated chair, an Irish nurse comes in to put drops into her left eye. “Are you diabetic?”

“No.”

After two lots of eye drops, her vision is so blurred that she can no longer decipher the stream of bile about immigrants, shameless young people, and disgraced celebrities in the newspaper someone discarded.

A young doctor comes to explain the op, reeling off a long list of potential complications. “There’s a one in 1,000 chance of losing all the sight in that eye.”

Nadia recalls a handsome man at Montazah who wore tiny briefs and an eyepatch. He liked to say he’d lost an eye in a duel, though, as her sister told her later, it was really a cataract operation gone wrong. She signs the consent form, sure that things have moved on and that it won’t happen to her.

The surgery is under local while her surgeon hums snatches of an aria and asks about her family.

“There’s nobody left.” Still, Nadia cradles the hope that improved vision will help her find her lost sister.

Everything is bright with a watery blue light. A machine buzzes, and the lens fragments are washed out before a new lens is put into place. She feels nothing.

Soon he says, “All done,” and peels the plastic drape off.

“You can sit up now,” says someone else.

So many voices she doesn’t know, and her head swims when she sits up.

Once back on the ward, a nurse offers her tea and asks again if she is diabetic.

Nadia checks in the mirror that she always keeps in her handbag. There she is, a plastic shield over one eye, with two long strips of tape holding it down.

The nurse returns with tea and instructions: eye drops for the next four weeks, eye shield on at night for a week, sunglasses for a few days, and no hair-washing for five days.

Of course Nadia will wear sunglasses! If her hair is going to be filthy, she doesn’t want anyone recognizing her.

The next day, she removes the eye shield for the first time. Everything is so bright. She can see every leaf on the trees, every speck of dust on the windowsill, every wrinkle on her face. They don’t make mirrors like they used to, that’s for sure.

***

Nadia is a character from my next novel, which is set in Alexandria and London.

If you’d like to know more about cataracts, try this link from Moorfields Eye Hospital.

You may also enjoy Six Lessons from the Eye Clinic.

The 12 Allergies of Christmas

Think you’ve got enough to worry about in the run-up to Christmas? Spare a thought for people with allergies, for whom the festive season is fraught with danger. But, with a little consideration, you could prevent an allergic reaction, and even a trip to Accident & Emergency.

1 Real Christmas trees can contain moulds, a health hazard for those allergic to them, while the sap can trigger skin reactions. The mould content is highest when the tree is cut some time in advance and kept in a moist atmosphere. After buying the tree, it helps to store it in a dry place like a garage, and then shake it before bringing it indoors. Note that, once the tree is inside, mould spores can grow within two weeks. For those with symptoms, fake trees may be the answer.

2 Mistletoe allergy is uncommon, though it can cause skin reactions in some people. The main danger comes from the kiss. Proteins can linger in saliva for several hours, so a snog can deliver a sizeable dose of nuts or whatever else the person last ate. Those with food allergies may find their luck running out, just when they thought it had come in.

FreeImages.com/Stephanie Berhaeuser

3 Problems with latex are on the rise. About 4% of the general population is allergic to latex (the natural type from rubber), while nearly 10% of healthcare workers are. The incidence is growing because gloves are more often used for procedures which were done with bare hands in the bad old days. What has this to do with Christmas? Balloons and most condoms contain latex, and both may feature at the seasonal office party. 

4 Alcoholic drinks can lead to allergic reactions. There are often nuts in speciality beers, and there’s obviously dairy in Irish cream liqueurs. There’s even almond oil in Bombay Sapphire gin, as the Anaphylaxis Campaign reminded me. Besides, alcohol can lower your guard and make you blasé about risk.  And large amounts of alcohol tend to worsen allergic reactions.  

5 Presents that smell nice, like bath oil, soaps, hand creams, and reed diffusers, may contain almond oil or other essential oils. These cause no trouble for most people, but they can trigger nasty reactions in those with allergies to the ingredients.

6 Festive candles are, again, mostly harmless, unless you’re careless enough to start a fire. But, for those with allergies, the soya present in some posh candles can be an issue. Candles may also contain pine, a potential problem for anyone allergic to pine resin.

7 The poinsettia plant is related to euphorbia (spurge). It’s not often an allergen, but it can be, especially for those with latex allergy. Symptoms include rash, wheezing, and shortness of breath. It’s wise not to have a poinsettia if you’re latex allergic.

FreeImages.com/D Fleiderer

8 Chocolate can contain dried fruits and nuts (which you may not spot if it’s in the form of a paste). It usually also contains soya lecithin. If you have a food allergy, check the label before indulging – if, that is, the label is anywhere to be seen. This can be a problem when chocolate treats are unwrapped and passed around on a plate at Christmas.

9 Sulphites are food preservatives commonly used in sausages, as well as in many pickled foods, dressings, and soft drinks. Some people react to sulphites with asthma symptoms or an urticarial rash. In most cases, the reaction is a sensitivity rather than an allergy.  But occasionally there is a true allergy, with a severe reaction called anaphylaxis.

10 Fancy turkey stuffing can contain a multitude of allergens, including pecans and hazelnuts. One of the most widespread ingredients is celery. Although allergy to celery seems fairly rare in the UK, when it does occur, the reaction can be severe and may lead to anaphylactic shock.- see more about anaphylaxis.

11 The traditional Christmas pudding is full of nuts, an obvious problem to those with an allergy to them. But it is possible to source tasty nut-free versions in most large shops.

12 Christmas cake, as a rule, contains nuts. It’s easy enough to study the ingredients when out shopping and choose a product that doesn’t contain a particular nut or fruit (though it’s impossible to do without almonds if you want stollen or any other cake with a marzipan layer).  If you have a nut allergy, visiting friends and family can still be risky, though. It’s not always enough to avoid a food that’s a trigger. There may be cross-contamination, which can be critical with severe allergy.

This list of Yuletide allergies is obviously far from inclusive, so please take care and have a happy, healthy Christmas.

I’ll be back in the New Year. Meanwhile, for more information about allergies, including anaphylaxis, visit the Anaphylaxis Campaign.

You may also enjoy The dreaded Christmas newsletter.