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Saturday, March 27, 2010

Iatrogenic Disease - Janet's Case

Janet is a case in point.  She was diagnosed as having Lupus after showing skin rashes and became more sensitive to the sun's exposure.  Systemic Lupus Erethematosus or SLE is an auto immune desease which involves every organ in the human body. Janet is an out patient receiving anti-malarial prescription drugs for her skin disease, joint pains and inflammation.  She then complained of dizziness and chest pain.  One day she collapsed while attending church services.  Her doctor insisted hospitalization.

Since Lupus developed a life threatening complications, her doctor prescribed steroids, an immuno suppressive drug, also called cytotoxic drugs.  These treatments have undesirable and dangerous side effects.  Steroids are the mainstay of treating Lupuz.  It reduces the activity of the patient's immune system, increasing the susceptibility to infection, destruction of the red blood cells in the bone marrow, bladder inflamation and the susceptibility of causing cancer. 

The steroid causes her psychic disturbances - such as insomnia, depression, bad dreams and a sense that she was 'going crazy'.  At times of acute flare ups, a very high dose of prednisone ( a type of steroid) was given 3 to 4 times daily.  Despite the appearance of side effects, treatment was continued until the flare ups were under control.

Each day Janet's condition worsened.  She was placed under the intensive care unit or ICU.  The complications of systemic Lupus drugs lead to severe destruction of the central retina that the patient totally lost her vision. Then her nervous system was affected with general involvement of the brain.  She demonstrated a psychiatric disorder and was having seizures.  Her blood pressure rose to an alarming 240/120.  The systemic drugs were withdrawn because she was in comatose.  After two days the patient died.

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