National awareness campaigns on viral hepatitis have equipped the general public with vital information on how to prevent getting the dreaded viruses, particularly hepatitis B and C, which can lead to cirrhosis and liver cancer. The downside though is that it has also generated some sort of a “yellow phobia” affixing a stigma on those discovered as carriers of the hepatitis virus.
I remember one particular instance many years ago when Joel D., one of my patients who was already due to leave for a once-in-a-lifetime opportunity to work in a big bank abroad as a junior executive, came back to me because he failed his medical check-up. I’ve been treating him for mild hypertension which was adequately controlled with antihypertensive medications; and I told him I’ll write a medical certificate assuring his employers that his cardiovascular status was nothing to be worried about.
Joel explained that it was not his blood pressure problem that made him fail his physical exam, but the positive hepatitis B surface antigen (HBsAg) in his lab report. Otherwise, he was in the pink of health, and never had any hepatitis symptoms. I referred him to a gastroenterologist who requested for additional exams on his liver; and he was subsequently cleared for overseas employment.
Many inactive carriers of the hepatitis B and C viruses (HBV, HBC) suffer the same fate and stigma, and the consequent anguish as Joel had. For HBV, it is estimated that around 400 million people are inactive carriers worldwide. The inactive HBsAg carrier state is diagnosed by absence of HBeAg and presence of anti-HBe, In short, they have the virus, and the antibody, but no indication of an acute liver inflammation. Some labs are able to measure the HBV DNA in PCR-based assays, and the levels are usually very low. Repeat exams for ALT levels are also normal, and ultrasound or CT scan examinations of the liver show minimal or no necroinflammation. At most, slight fibrosis, may be noted with normal histology on biopsy.
The far bigger majority of inactive carriers—usually accidentally discovered—have a benign course, based on long-term follow-up studies (up to 20 years). Biochemical remission is generally expected for the vast majority of these carriers; and only a very small percentage progress to develop cirrhosis or hepatocellular carcinoma (HCC).
So, more than the actual medical or physical risk of HBV reactivation or progression to cirrhosis or HCC, the psychological impact of being identified as a carrier of the virus is much more discomforting and possibly disabling. The risk of transformation of the inactive carrier state from benign or subclinical to acute symptomatic hepatitis state, or rarely, fulminant hepatitis, is probably much smaller than developing another life-threatening condition not related to any of the hepatitis viruses.
Many Filipinos fight the battle against stigma and discrimination of being labeled as a hepatitis B virus carrier. Dr. Jun Ruiz, our regular contributing editor, and his gatroenterologist/hepatologist colleague at The Medical City, Dr. Janus Ong, as well as our assistant editor, Mylene Orillo, write the cover stories for this issue to provide updates in the treatment and prevention of this prevalent disease; and how we can fight discrimination in the workplace. (pg 28)
In his column, former Sen. Edgardo Angara, writes an insightful commentary on the relationship between nutrition and child development, a major problem which our government must address. He cites research findings that poor nutrition causes “toxic stress” due to a high level of cortisol, which subsequently impairs the child’s brain development and his/her capacity for impulse control, emotional regulation, error processing, and healthy metabolic functioning. (pg 20)
Dr. Ramon Abarquez, Jr., writes another thought-provoking analysis on the factors that accelerate the development of vascular aging and arterial stiffening, which are generally a source for concern for hypertensive patients. He associates these though with adverse growth patterns in early postnatal life, as influenced by birth weight and age of gestation. (pg 21)
We’ve always known that crossing time zones during long-haul travels can be stressful to our bodies. Our US-based columnist, Ed Susman, files a report on the risk posed on diabetics with these long-haul travels, particularly the risk of hypoglycemia due to failure to adjust insulin dosage. He gives us some updates discussed during the recently annual meeting of the American Association of Clinical Endocrinologists (AACE). (pg 22)
Dr. Ronnie Baticulon, our neurosurgeon-columnist, who has just returned from a year of training in Australia, can’t help but lament at the great disparity in health care between our country and the socially progressive country down under. He poignantly declares that “one does not deserve to die a needless death, just because you happened to be poor and Filipino at the same time.” (pg 52)
Dr. Malaya Santos takes us on a food trip, stressing though that we should maintain our “balance sheet” of calories if we want to maintain a healthy weight. (pg 46)
Varying weather conditions can impact the public’s health, and the pendulum-like swinging of the weather—from hot and humid, to wet and floody—can cause a rise in many infections and blood-borne diseases. Henrylito Tacio gives us the not so cool flipside of El Niño–La Niña, and its attendant health problems. (pg 32)
On the lighter side, our Off Duty columnist, Monical Verallo, takes us on a melancholic trip reminding us of the glory of Escolta, which was once the place to go to and be seen at, in the heart of Manila. She writes about the ongoing efforts to revive Escolta, and the plan to reconfigure it as a different shopping destination in this modern age. (pg 48)
And as usual, we can never put to the printing bed any issue of H&L without the Last Call column of Dr. Saturnino ‘Bong’ Javier, who engrosses our interest this time with his witty commentary on the unique form of terrorism every traveler is confronted with in our local airports—the ‘Tanim-Bala’ threat, which can cause a lot of misery and anguish on the hapless victim. (pg 60)
We hope you enjoy reading these and many more interesting articles in this issue of H&L.
RAFAEL R. CASTILLO, MD
July 2016 Health and Lifestyle