CURSE OR CURE?

Leprosy is one of the most dreaded words. It used to be so and continues to be so due to misinformation. People are not aware of the discoveries made in curing and eradicating Leprosy. Taking undue advantage of the general phobia, authors and comics-writers also have been responsible in propagating the old myth of Leprosy  as being a disease with drastic effects such as suppurating wounds with eaten up fingers, toes and nose, total lack of sense of touch and more than anything a disease which is highly communicable and hence one requiring isolation from the society.

Nothing can be farther from the truth. The multidrug therapy(MDT) with which the patients are treated right from the day it is diagnosed makes sure that the patients are not infectious and so can live a normal life among their own family and society. To rid the disease of the stigma associated with the name Leprosy, it is now called Hansen’s disease and it is treated not in isolated hospitals and leprosaria but by dermatologists in  general hospitals.

To give a true picture, I have reproduced here a letter written in the Health supplement of The Week.

ROOTING OUT THE  STIGMA

My mobile phone was ringing rather persistently. Assuming it to be one of those telemarketing calls, I kept pressing the ‘do not answer’ button . Finally, fed up by the ringtone, I answered, not expecting the gravity of the news I was about to hear. My friend Puja (name changed) was at the other end.

“Do you know I have become a leper?’. I was ready for the banter. “What crime did you commit to deserve ostracisation from the society?” I joked.  Her voice shaking, she replied, “You don’t understand. I have become a medically- diagnosed patient of leprosy.”

A leprosy patient was someone I had imagined begging on the roads, with hands and feet wrapped in dirty bandages, and the nose eaten up or being transported in push carts. A situation I could not imagine my friend in.

“No,”She explained, “ Most such cases are victims of syphilis and other sexually transmitted diseases. This is leprosy, known as Hansen’s disease.”  She asked me to visit her at home to discuss the matter further.

I was hesitant.What if she transmits the disease to me, I thought. She understood my pause and said, “Leprosy is the most misunderstood disease. A patient can live among others and need not be an outcast”.

Puja had been on  immuno-suppressants for 12 years after she was diagnosed with rheumatoid arthritis.  She had hypertension and hyper thyroidism. She had  hypersensitivity to sun. She also had a patch on the back,which itched. Her dermatologist said it was atopic dermatitis. It would flare up and subside after medication. When it became thicker, he prescribed tests for Lupus and sensitivity to her medications. In the meantime, the patch (on the back) had become big and  lesions had appeared on hands, feet and ears. Finally, a bit of the patch was removed and sent for biopsy. The diagnosis- leprosy, borderline tuberculoid.

Her  doctor told her that the term Hansen’s disease removed the association with social isolation.  She could lead a normal life, he said.

There was no history of the disease in Puja’s family. Her doctor conjectured that she might have caught it on an all India pilgrimage 20 years ago and it manifested when the drugs lowered her resistance.

Puja was put immediately on Multi drug therapy(MDT) for at least a year, to ensure that she did not transmit the disease-leprosy often spreads through the droplets of the nasal secretions in the air. When she told her family, they supported her, one relative even joking about buying a house on an island where leprosy patients lived.  There were no more Leprosaria or isolated hospitals, they found and the patients were treated by dermatologists.

The leprosy lesions are not open wounds but changes under the skin-mycobacteria attack nerve ends, leading to loss of touch.

One year and three months later, Puja’s lesions started shrinking.  As healing progressed, they turned chocolate brown which was cosmetically distressing for her. But they cleared up in six months.

One and a half year after her ordeal began, a slit skin smear test confirmed that she was  her 100% cured with minimal damage to nerves.

She now leads a happy, normal life and goes out. She is all the more stronger and thankful after her ordeal.

Vimala Ramu

On email.

(courtesy THE WEEK)

PS- The above letter had won the prize’ Best letter of the week’

MY DENTAL IMPLANT-Part I

 

DENTAL IMPLANT-Part 1

Procedure

‘Implant’ has been a word which has come into vogue more recently. Though nose implant, breast implant and tooth implant etc have been in use, dental implant (correct usage) is the most misunderstood term by the lay persons including yours truly. A case of the dental implant was said to have been  discovered in the cadaver of a woman in twenties from Mayan civilization with three tooth shaped shells placed in the sockets of missing teeth. What is more, the radiological study revealed that the bone had accepted the implant showing that the implantation had taken place when she was alive (ref Wikipedia).

Not withstanding this, the modern usage of the dental implants started in 1950’s. I was under the impression that implant meant our own decayed tooth would be cleaned and cleared and the empty shell put back. How wrong I was!

‘Dental implant’ is a screw made of Titanium which would be embedded in the jaw bone to which artificial denture or individual tooth or bridges could be screwed on. This relieves the wearer from removing the denture every time.

In my case, the whole dental set had to be screwed on to the implants.

It all started with the erosion of my teeth due to the prolonged effect of Rheumatoid Arthritis and its medications, in spite of regular visits to dentists and in spite of bridges, fillings and root canals carried out at regular intervals. Finally when the chewing teeth were gone, I started using the front teeth for the purpose which left them broken, worn out and altogether sinister looking. That’s the time I thought of implanted teeth. But I was shocked to hear that each implant cost Rs 25,000 and so gave up the idea.

I went back to the free dentist at our family welfare centre.

The dentist shook every tooth. Mournfully shaking his head, he decried the civilian dental work, “What has he been doing for your teeth apart from making you pay through your nose?” and gleefully removed 6 teeth on one day and 3 on the other and gave me a partial denture set costing Rs 54.

After about an year, finding myself not happy with the partial denture, lower one of which gave me ulcers and the upper one needed cleaning every time I snacked on some thing, I decided to go to an implantologist and risk the whole process.

Fortunately I found that a branch of the state of the art chain of dental clinics run by prestigious health care organization located very close to my house.

When I approached the dental surgeon, he had a look at my teeth (the absent ones), tut-tutted the work of the welfare centre dentist and explained the steep expenses involved in the implantation process, each implant now costing Rs30, 000. He promised to get a senior citizens’ discount and left me to decide. With the permission of the finance sanctioning authority aka the husband I decided to take the plunge.

The implantation was done in two phases. In the first phase, I was first asked to get an OPG ( ortho pantomograph), a two dimensional radiograph of the skull in the special place which caters for such special radiology and it was e mailed to the doctor. He saw it and fixed the date for the implantation of the upper jaw only. I was asked to get a fresh blood sugar report on the morning of surgery. The prosthetist met me the previous day and took the impression of my mouth for measurement.

On the scheduled day when the process began, the surgeon invited my husband into the operation theatre to witness the process which he kept explaining at every step.

Before

When the numbing injections, six I presume, were given I felt only the first two and afterwards I was just an inert recipient of the whole thing, It was only my husband’s account later that told me what was done.

First of all one ‘mobile’ tooth in the upper jaw was extracted. For implanting, a slash was done in the gum and flap was held back by a retractor. In the recipient bone that was exposed, 6 holes were drilled following the OPG closely parallel to the direction of the teeth. Ice cold water was being sprayed continuously and suctioned off. Six implants were placed one in each of the holes.

The ‘implant’ was imported from Israel. It looked like the lead jutting out of the wooden part of the pencil. It was encased in a metal spring. After placing the implant in the hole, the spring was wound out. The flap on the gum was closed and sutures put which were removed 10 days later. A period of 4 months’ gap was given for the implant to  osseo-integrate at the end of which the ossification would have taken place and the implant would have merged with the main bone (which was possible only with titanium which for reasons unknown does not get rejected as foreign material). The swelling of the mouth was rather dramatic with all blue and red color making me look like monkey God for four days. No pain was felt during this period thanks to the painkillers and other medications.

After about a month,when I went to the doctor for the second phase, he sympathised with me, “If only you had come to us one year earlier, we could saved your teeth” and promptly extracted 7 teeth from the lower jaw and put the sutures , leaving me in a totally edentulous state except for two teeth one at each end of the upper jaw. 40 days were allowed for the healing of the extraction. Later one more OPG was taken, one more blood test was done fresh and the process of implantation was repeated for the lower jaw with 6 implants. The swelling for the lower jaw was not much. Ten days later the sutures were removed. A three months gap was allowed after which the denturing part would be done.

The intervals between the steps in the procedure are taken totally at the discretion of the implantologist.The payments are also taken in instalments.

So having lost the God given smile, I am waiting for the dentist given smile at 76 years of age.