Why do well-to-do Sri Lankans die so young?

Why do well-to-do Sri Lankans die so young?
September 5, 2016, 7:46 pm

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By Dr. Upali Illangasekera,

Retired Professor of Medicine,

A 42-year-old male patient of mine from Badulla working in a private institution got admitted to a private medical institution in Kandy recently for a medical check-up. He looked so healthy and when I wanted to know why he wished to undergo the check up it was mentioned that his 49-year-old boss, who looked healthy had dropped dead of a heart attack a week before. He attributed the death of his boss to office stress. The newspapers are full of obituaries of such relatively young well-to-do people of ages ranging from 35 to 60 years dying suddenly. These exclude sudden deaths caused by vehicular accidents. It is sad to see people, in the prime of their lives with young children and attractive careers, die in that manner. In developed countries such as the US such deaths in young people are rare compared to ours thanks mainly to the high motivation of Americans to maintain good health as well as due to the advances they have made in clinical care.

The purpose of this article is to inform the public that no one will die unless there is an illness which is mismanaged either by the doctor or the patient (mainly by the latter) by not following the advice provided. Most of these people have access to top medical professionals and laboratories that are capable of identifying illnesses that remain dormant but it is sometimes their indifference that brings about death.

The illnesses that remain dormant include cancer, diabetes, high blood pressure, high cholesterol, and a recently recognised condition called "prediabetes". Among cancers a common organ that gets affected is the liver and in some cases it precedes deposition of fat in the liver (fatty liver) which is common and associated with conditions such as diabetes. Therefore, it is mandatory for all patients with diabetes to check their liver functions which should include scanning of the liver. The unfortunate situation is liver cancers can remain dormant and suddenly flare up and therefore should be identified early. In contrast, the cancers in the lung or breast would show early symptoms and, therefore, early diagnosis is possible. There is no doubt that some of the deaths in young Sri Lankans are caused by liver cancers. There is a tendency among us to attribute fat in the liver to excessive alcohol consumption which even though common could still be an early sign of liver cancer. In the case of cancer there is no single screening test to identify dormant cancers particularly in males though in some countries such as the US it is incumbent on the elderly population to undergo at least annual screenings for prostate cancer. The current thinking is that if someone feels physically unwell for more than two weeks a dormant cancer should be thought of seriously once the other common conditions are excluded.

Most well-to-do Sri Lankans undergo blood sugar and cholesterol tests at least once a year. They also regularly have their blood pressure tested. However, in some cases they do not test for the other associated risk factors for cardiac deaths and strokes such as protein in the urine. It is also important to totally desist from smoking and heavy alcohol consumption.

Mental stress, in the writer’s opinion, is an important contributor to deaths in well-to-do Sri Lankans. However, well they look after their physical health hardly any attention is paid to mental stress. These would include office stress, stress associated with children’s education and marital disharmony. It is unfortunate that there aren’t many structured programmes to teach Sri Lankans how to tackle stress. Even in the developed countries facilities such as meditation and yoga are available in some institutions including hospitals to reduce stress. Ours being a predominantly Buddhist country meditation programmes are freely available to most of us, but proper use is not made use of these.

The concept of "prediabetes" has come into vogue recently since it could not only cause diabetes but also cause complications such as heart attacks. It is the writer’s experience that sufficient attention is not paid to this condition. "prediabetes" is recognised when the fasting blood sugar (FBS) is between 100 and 125 mg/dl and also by doing a test called a Glucose Tolerance Test(GTT). Prediabetes is diagnosed when the values are between 140 and 198mg/dl. It is important to identify those with prediabetes because some of them could suffer heart attacks and strokes similar to those with overt diabetes. Those with prediabetes could be prevented from suffering from diabetes through adequate treatment measures.

Even in the case of diagnosed diabetes such unfortunate deaths are common however well they are managed. Such possible causes include "silent heart" attacks, low blood sugar and strokes. A high degree of suspicion is needed and it is advocated that those with several associated risk factors for heart attacks should undergo routine heart tests such as an echocardiography and an exercise ECG. Low blood sugar (hypoglycaemia), too, is a possible cause of heart attacks and it is mandatory that bouts of low sugar should be avoided by adjusting the diet and the frequency of administration of the drugs.

"Attribution error" about which the author wrote to The Island of 14/8/2007 too is an important cause of death. This simply means that some patients and sometimes even the doctors attribute the symptoms of a serious illness to something less sinister. A common label is "gastritis" which may even bring in deaths due to heart attacks which could have similar clinical presentations. The important factor to remember is whether there is a high risk of a person developing a serious illness whatever the clinical presentation is.

Another possible cause of such unfortunate deaths is the patients sticking to the same doctor. Doctors are not infallible and it is in the interest of both to obtain a second opinion. This practice should be adopted by both the patient as well as the doctor. This would save patients life as well as a large amount of money. I am aware of several patients in whom urgent major surgeries were advocated but still living happily following a second opinion from another doctor!

Peer pressure is another factor contributing to deaths in the well to do. Because of their high social positions they, too, get wrong advice from several purportedly well meaning people. The best person to provide sound advice is one’s family doctor!

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