Monday July 2 2018

Did my last doctor lie?


By Dr Vincent Karuhanga

Due to urination complications, my prostate was removed 16 years ago. Recently, the problem returned and another doctor says I have prostate cancer. How is this possible?

Dear Ikona,
A prostate is a sexual gland that produces about 30 per cent of seminal fluid that carries sperms and because it surrounds the upper part of the urethra, it may interfere with urine passage when it grows bigger as happens when men get older.

If it just grows bigger but is not cancerous, this is known as a benign prostatic hyperplasia (BPH) but it can also grow bigger due to cancer with both cases obstructing urinary flow.

When the urinary flow is obstructed, a man will find it difficult to pass urine requiring surgery as a relief and to prevent other urinary tract complications, especially those affecting the kidneys. Surgery may then be done to remove all (if it is due to cancer) or part (if it is BPH) of the prostate gland in what is called prostatectomy.

Both BPH and prostate cancer happen at older ages with the cancer generally happening at an older age than the BPH.
The prostate gland is divided into areas called zones. The peripheral zone is most affected by the cancer with 70 to 80 per cent of prostate cancers originating from the peripheral zone. Only 20 per cent of cancers originate from the transitional zone usually affected by BPH.

In BPH, since usually the affected part is removed, this may leave parts which may later be affected by cancer. Removing part of the prostate rather than the whole of it helps in preservation of urinary and sexual function and minimises the side effects of removing the whole prostate.

So, the doctor was right to treat your prostate enlargement, the reason you could urinate well after the operation and most likely your sexual function was preserved. Unfortunately, as you grew older, you got cancer in the part that was left after the operation because it was previously not diseased.

Can one get cured of Hepatitis B naturally?

Dear Amisi,
Hepatitis B is a viral infection which damages the liver with a likelihood of death if one does not get treatment. Once one is infected, majority of adults clear the infection on their own within six months, failure of which the disease turns chronic, risking liver damage (liver cirrhosis), liver cancer, liver failure and death. Chronic infection is most likely if a child of less than five years is infected.

Once the infection turns chronic, it will not disappear even with the best available treatment, though treatment is necessary to slow the progression of liver disease into cirrhosis or liver failure and reduce the incidence of liver cancer.
Treatment of hepatitis B with drugs should happen in all those 30 years or older, those whose tests are showing liver damage or those showing that the virus is multiplying.
Therefore, in majority of adults who get infected, healing within six months happens naturally using their immunity.

Are yellow eyes infectious?

When she delivered, my daughter got yellow eyes and now the baby also has yellow eyes. Can a child get yellow eyes from the mother?

Dear Angella,
Yellow eyes caused by excess bilirubin, a yellow pigment in blood which is produced due to breakdown of Red blood cells in blood. Excessive breakdown of red blood cells like in people with sickle cell anaemia or severe malaria in the mother can lead to this.

The liver removes the bilirubin and takes it to the intestines to help digest food and neutralise acids in the small intestines. If the liver for whatever reason fails to remove bilirubin and expel it into the small intestine, then the mother will have yellow eyes.

Hepatitis B infection of the liver commonly leads to yellowing of the eyes. Cholestasis of pregnancy and preeclampsia may also lead to yellow eyes in the mother.

Babies commonly turn yellow within two to three days after birth due to physiological jaundice resulting from breakdown of excess red blood cells and a liver which is not yet mature, failing to remove the resulting bilirubin.

It is true, Hepatitis B in the mother can worsen during pregnancy and lead to yellow eyes before and after delivery but even if she may have passed it to the baby before or during delivery, both are unlikely to show yellow eyes at the same time soon after delivery.

It is likely the mother has a different cause of yellow eyes from her baby both of which are worth investigating and managing.

What drugs treat Hepatitis B?

I am three months pregnant and have tested positive for Hepatitis B. Since my husband is negative, what drugs can I take to treat it?

Dear Prudent,
The Hepatitis B virus is spread when blood, semen, or other body fluids infected with the hepatitis B virus enter the body of a person who is not infected. This may be through sex, blood transfusion and mother to child transmission, among others.

In adults, the majority of people may clear the virus within six months, failure of which the condition turns chronic. Once it turns chronic it may be impossible to cure with drugs.

However, if a woman is pregnant, she may pass the virus to the unborn baby if her virus concentration in blood is high, requiring that a viral load is done and if it is high a drug called tenofovir is given in pregnancy. Most times however, the mother may infect the baby during delivery as the baby is exposed to the mother’s blood.

Babies born to a mother infected with Hepatitis B require delivering by caesarean section to minimise the time of exposure to infected blood. Once the baby is born, two types of immunisation are given to the baby within 12 hours after delivery to further reduce the likelihood of mother to child transmission.

Much as you are surprised that your husband does not have Hepatitis B, if you continue having unprotected sex with him, you are likely to infect him, requiring that he uses condoms and that he gets immunised against Hepatitis B apart from seeking counselling from his doctor about what to do next.