Life flipped for Dubai resident after delay in liver disease diagnosis

Just after her 28th birthday last year, Bhakti started feeling lethargic and uneasy. She did not pay much attention until she noticed a slight yellowing of her eyes. Little did Bhakti Prakash Bahirwani know that these symptoms would end up turning her life upside down from being diagnosed with acute liver failure to undergoing a liver transplant from a cadaver her own age.
Shuttling between one doctor to another in Dubai, Bhakti says a delay in diagnosis resulted in her having to undergo a major surgery. At one point, doctors had given up hope for her survival. Born in India but having lived most of her life in Dubai, Bhakti lost her father 10 years ago. She now lives with her mother, sister and a younger brother who have been her pillars of support. "A few days after my birthday in July last year, I was feeling lethargic and uneasy," she tells Khaleej Times. "I had no symptoms other than slight yellowness; but in early August, the yellowness increased and I doubted that it might be jaundice," she says.
A day later, Bhakti went to see a homeopathy doctor who ran a few tests and by evening, it was confirmed that Bhakti had jaundice. Her test results showed elevated levels of liver enzymes; bilirubin at 5.26 (the maximum being 1). She was given medicines and asked to visit after a week. However, the yellowness kept increasing and tests were redone. The reports came back worse suggesting a polyp in her gall bladder and higher bilirubin and liver enzymes. "I was advised to get admitted and get drips immediately."
In the evening, she was taken to emergency in a hospital in Bur Dubai where she was put on drips. "I was waiting for insurance approvals and LFTs, hepatitis markers and some other tests were done," she says.
A radiologist said she had a polyp. "The duty doctors, who weren't sure, scared me further until the doctor-in-charge said I shouldn't worry." He further said that the enzymes had reduced and she was to be discharged. "I was being fed pasta, desserts etc which is definitely not what a patient in my condition should be given," she explains.
She was asked to come back after two weeks. "I went home again feeling miserable, lethargic, with a loss of appetite, constipation and was very sensitive to light and would get major headaches."
She then went to a government hospital where she was put on drips, and again, a number of tests were done. "An average of one prick every 45 minutes was done. I was exhausted while interns came in giving me an impression that something was terribly wrong whereas they couldn't figure out anything," she says.
All tests came back negative but she was put in isolation in the infection ward from where she decided to come back home. Not feeling any better, Bhakti went to another clinic just to see her progress. "The bilirubin was at 14 then. The doctor suggested that I get admitted again."
She went to another hospital where she underwent the same drill. "The doctor there sent me a deep fried cutlet for lunch." She stayed there for seven days and had insurance problems when she decided to go back home. "I left with a bilirubin of 10 and enzymes that were still above the range."
The family then tried home remedies which didn't help. Bhakti then went to another clinic where the doctor noticed that she had started developing fluid retention in her abdomen while another hospital refused to take her case. It was mid-September by then when Bhakti kept shuttling between clinics, hospitals, number of tests and insurance. The bilirubin was 25 and INR (liver function test) was 3.8 (both should been less than 1) 
"I was rushed to a hospital again where the gastroenterologist said that he suspected acute liver failure." Bhakti had to be flown to India that very night. "I thought that this will be the end to my misery and I will be back home in two weeks. Little did I know that this was only the beginning and worst was yet to come."
Her bilirubin was now 31 and INR 6.5 indicating an immediate transplant but none of her family member's blood group was compatible. "The doctors then suggested a swap in which my brother would donate a part of his liver to another patient who was compatible and his wife would donate a part of her liver to me. But after months, the other party backed out," she says.
By December end, doctors declared that it was a case of chronic liver cirrhosis. "Doctors had given up on any hope of my survival unless I'd find a cadaveric liver in time."
Edema caused her body to swell up and she put on 35kg, had darkened skin, lost all her hair, had bed sores while the haemoglobin was going down to 4.5, INR shot up to 8.5 and was also suffering from internal bleeding.
 Her parameters got Bhakti on top of the priority donor list in Hyderabad, Bangalore, Pune, Chennai and Vizag. In mid-January this year, a liver was available but after being prepared for the transplant, it was found that it did not match in size.
Finally on January 30, a cadaveric liver had been found in Coimbatore of another 28-year-old man who had died due to brain hemorrhage. Bhakti was operated the next day. However, she had one episode of organ rejection but she was finally sent to Hyderabad where she completed three months.
She flew back to Dubai in April with a mask and is on immune-suppressants. Now she has developed pain in joints and finger deformities.
"I am asked to take a set of tests every month and send the reports back to India, based on which my medication would be adjusted," explains Bhakti.
However, all this remains a challenge as test results are not approved. "I'm really saddened to see negligence in healthcare and on the part of insurance in Dubai," she says.
"I wouldn't want anyone to go through what I and my family have seen." She went to India in August on completion of six months of her surgery for a check-up and is now due for the main check-up in February 2019.
"My life flipped and I will never be the same as I was." However, despite these moments of lows, Bhakti is thankful to her family and friends who have stood by her like a rock. "Life is going to be challenging like never before, but if we can come out of that, then I'm sure I'll make it through this too," she adds.
asmaalizain@khaleejtimes.com
What is chronic liver disease
Chronic liver disease is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis.
The disease takes several years to develop and the condition may not be recognised unless there is clinical awareness of subtle signs and investigation of abnormal liver function tests. Testing for chronic liver disease involves blood tests, imaging including ultrasound and a biopsy of the liver. The liver biopsy is a simple procedure done with a fine thin needle under local anaesthesia.
The treatment of chronic liver disease depends on the cause. Specific conditions may be treated with medications including corticosteroids, interferon, antivirals, bile acids or other drugs. Supportive therapy for complications of cirrhosis include diuretics, albumin, vitamin K, blood products, antibiotics and nutritional therapy. Other patients may require surgery or a transplant. 
Complete recovery from stroke possible if the patient gets treatment in 'golden hour'
Strokes are attacks of the brain. It is the third most common cause of death worldwide. Stroke happens when the blood supply to the brain becomes blocked. It is a medical emergency that needs immediate attention.
There are three main types of stroke:
> Ischemic stroke: The most common type of stroke. A blood clot prevents blood and oxygen from reaching the brain. Ischemic strokes are caused by arteries gets blocked or narrowed, and so treatment focuses on restoring an adequate flow of blood to the brain 
> Hemorrhagic stroke: Occurs when a weakened blood vessel ruptures and normally occurs as a result of a high blood pressure or aneurysms or arteriovenous malformations
> Transient ischemic attacks (TIAs): Referred to as a mini-stroke, these occur after blood flow fails to reach part of the brain. Normal blood flow resumes after a short amount of time, and symptoms gets cleared.
The Stroke Association urges people to recognise stroke symptoms with 'Fast'. Fast is an acronym for:
> Facial weakness - Can the person smile? Has their mouth or eye drooped?
> Arm (or leg) weakness - Can the person raise both arms?
> Speech - Can the person speak clearly and understand what you say?
> Time to call emergency
Treatment starts with drugs that breaks down clots and prevent others from forming. Aspirin can be given, and an injection of tissue plasminogen activator (TPA). TPA is very effective at dissolving clots but needs to be injected within 4.5 hours of onset of stroke symptoms which is called the "Golden Hour".
There are chances for complete recovery if the patient reaches hospital within this time. Emergency procedures include administering TPA directly into an artery in the brain or using a catheter to physically remove the clot. There are surgical procedures that can be carried out to decrease the risk of stroke. A carotid endarterectomy involves a surgeon opening the carotid artery and removing any plaque that might be blocking it. Alternatively, an angioplasty involves a surgeon inflating a small balloon in a narrowed artery via catheter and then inserting a mesh tube called a stent into the opening. This prevents the artery from narrowing again. Surgery can be used to repair any problems with blood vessels that have led or could lead to hemorrhagic strokes. Neurosurgeons can place small clamps at the base of aneurysms or fill them with detachable coils to stop blood flow and prevent rupture. If the hemorrhage is caused by arteriovenous malformations (AVMs), neurosurgeons can remove them.
The best way to prevent a stroke is to address the underlying causes. This is best achieved through lifestyle changes, including eating a healthy diet, maintaining a healthy weight, exercising regularly, stop smoking and avoiding alcohol. 
Healthy diet includes plenty of fruits, vegetables, whole grains, nuts, seeds, and legumes. Avoid red or processed meat and limit intake of cholesterol and saturated fats. Minimise salt intake to reduce blood pressure. Also, keep blood pressure and diabetes under control. Along with these lifestyle changes, we can help to reduce the risk of future ischemic strokes through prescribing anticoagulant or antiplatelet medication. 
Dr Chelladurai Pandian Hariharan is a specialist neurosurgeon at International Modern Hospital, Dubai.
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