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Genghis Khan and your children
Some medical facts: Bruises on a child’s body are often
considered proof that a baby has been battered. A visible bruise on the
buttocks, the shape of a hand and five fingers is almost ‘undeniable’
proof. In fact, there was a very celebrated instance of a GP in the UK
having discovered that so many of the Asian babies in the practice were
showing signs of being ‘battered’ that the children’s welfare people were
called in and an enormous number of children taken away. However, the
highly observant GP was wrong!
In Thailand, and the rest of Asia, a
new-born baby with the ‘handprint’ bruise is very common, while child abuse
is not common at all. The problem, or rather the condition, relates back to
Genghis Khan and the Mongol hordes. It is a wonderful piece of folklore and
also a fine example of applied genetics.
Let’s look at the folklore first, and
you are going to have to dig very deep to get this tale anywhere else! A
Mongolian baby, called Tanujin, was born just over 1,000 years ago, but did
not breathe. His father, in desperation, held his new-born son upside down
and smacked him severely over the bottom, so much so that the baby drew
breath and lived, but carried the life giving bruise for the rest of his
days. That baby later became Genghis Khan (which means King of the Earth),
and by the time he died in 1227 he was the ruler of a large chunk of it,
including the area which later became known as Thailand.
History has chronicled that the Mongol
hordes raped, pillaged and annexed countries from China to Persia. His
highly mobile troops traveled the difficult terrain of Siberia. Famous
cities were captured and looted such as Tashkent, Baghdad (still a good
place to stay away from, thanks George) and Bokhara. Cities that
surrendered were spared but those that resisted were razed and the people
slaughtered. The Mongols conquered northern India and Afghanistan. In
1222, they defeated the Russian and Bulgarian armies. At the time of
Genghis Khan’s death, his empire stretched from China’s Yellow River to the
Dnieper, in Russia.
And now back to some interesting
folklore. The descendants of Genghis Khan also showed the hand-shaped
bruise on the buttocks, beginning with his four sons Ogdai, Jagatai, Juji
and Tule, who were given one quarter of the empire each after their father
died. They in turn passed on this ‘trademark’ and so this continues till
today. If your “Luk Krung” children have the sign of Genghis Khan, called
Mongolian Blue Spot, you can claim descent from the warrior king. However,
there is quite a number of you, so I think there won’t be much left in
Genghis’ estate by today.
Now Mongolian Blue Spot, as a clinical
condition, is well documented, and I came across figures suggesting that at
least one Mongolian spot is present on over 90 percent of Native Americans
and people of African descent, over 80 percent of Asians, over 70 percent of
Hispanics, and just under 10 percent of fair-skinned infants (Clinical
Pediatric Dermatology, 1993).
Medically we describe Mongolian Blue
Spot as flat bluish to bluish gray skin markings that commonly appear at
birth (or shortly thereafter) and scientifically they are called congenital
dermal melanocytosis. They are flat, pigmented lesions with nebulous
borders and irregular shape. They appear commonly at the base of the spine,
on the buttocks and back, but also can appear as high as the shoulders and
elsewhere. The medical text books also warn that occasionally Mongolian
Blue Spots are mistaken for bruises and questions about child abuse arise.
Obviously a text book that the UK GP did not read! Mongolian Blue Spots are
birthmarks, not bruises.
So, for all of you with children with a
peculiar blue birthmark on their bottoms, or for those interested in
checking friends and neighbors (or the young ladies dancing in the chrome
pole palaces), it seems fairly positive that the lineage is verified. You
really have found descendants of the man who conquered more of the world
than Alexander the Great. And guess what - my children have it too!
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Stenting - a common procedure
The advances in cardiac surgery have been enormous over
the past 20 years. We have gone from some fairly primitive high-risk
surgery, to some very, very sophisticated interventional techniques, which
have given cardiac patients a new lease of life. In fact, if the techniques
that are available now, were able to be carried out 30 years ago, my father
would in all probability, still be alive today.
However, before getting into modern
life-saving techniques, a short review of cardiac pathology is in order.
Myocardial infarction is the common cause of cardiac muscle death, and
finally ours. (Make that “yours” as I’m not going yet!)
The heart muscle is supplied with
oxygenated blood by its own system of arteries. The heart does not get its
oxygen from the blood in its chambers. Instead, there is a network of
‘heart’ arteries (called the coronary arteries) which supply the cardiac
muscle. If any of these get blocked, this is known as a “stenosis” or an
“occlusion”, which in turn can bring on the coronary “conclusion”! The
death of the muscle is called “infarction”.
The blockage is most often caused by
Cholesterol, which gets deposited on the inside wall of the arteries and is
called “plaque”, and then red cells stick on the surface of the deposit and
it builds up from there. If you have a 50 percent stenosis, you will start
to get chest pains on exercise. If you have a 100 percent stenosis, you may
drop dead during the exercise.
To correct this problem, the only way
we knew was to carry out an open heart operation, replace the blocked
coronary arteries with vessels taken from other parts of the body, usually
veins from the leg. However, now we can leave your arteries where they are,
but do something to relieve the stenosis, or blockage. This is called
“Angioplasty”.
One way is to send an inflatable
balloon to dilate the blocked area, and this is known as coronary balloon
angioplasty. It is more formally known as percutaneous transluminal
coronary angioplasty (PTCA): percutaneous meaning "through the skin,"
transluminal meaning "inside the blood vessel," coronary meaning "related to
the heart," and angioplasty meaning "blood vessel repair."
Angioplasty involves creating space in
the blocked artery by inserting and inflating a tiny balloon, which
compresses some of the blocking plaque against the arterial wall. When the
balloon is deflated and removed, the plaque still remains compressed,
clearing a space in the artery and improving blood flow. While angioplasty
does not always completely clear an artery, more than 90 percent of all
procedures are immediately successful.
There are other techniques available,
and the most common is by using “stents”. This is called percutanous
coronary intervention (PCI). The success in today’s cardiac surgery is due
in part to the increased use of these tiny wire mesh tubes called stents,
which cardiologists began using in the 1990s to help keep arteries open
following angioplasty. About 70 to 90 percent of all angioplasty patients
receive a stent, which is inserted permanently at the site of the blockage.
Stents can be used in a number of ways
with angioplasty procedures. A stent may be inserted during an original
angioplasty to prevent possible arterial collapse and lower the chance of
heart attack and re-narrowing of the artery (called re-stenosis). A stent
also may be inserted during a second angioplasty to prevent recurrent
restenosis. Stents can also be used in the unlikely event that an artery is
injured by the catheter. Experienced doctors are able to install stents in
one or more arteries with a high probability of success.
The use of stents has decreased the
abrupt and unpredictable closure of an artery, which necessitated emergency
coronary artery bypass surgery. Studies show stents are better than
angioplasty alone in preventing re-stenosis, which is one of the most common
problems associated with angioplasty.
Evidence suggests that angioplasty
patients are doing better today because doctors are better able to target
blockages, by using such techniques as the 64 Slice CT, so your
interventionist is able to pinpoint the blockage with greater accuracy.
However, we will deal with the 64 Slice CT technology another week.
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Statins are good for you
When I was in General Practice in Australia, the
cholesterol-lowering drug Simvastatin became available. After telling
patients to cut down on animal fats to lower their cholesterol, there was
now a drug that could help.
I was never one to be the first to
prescribe new ‘wonder’ drugs, but with the cardiologists sending patients
back on this drug regimen, I too began to prescribe it. Simvastatin became
one of the drugs I enjoyed prescribing most - it actually did work! Not
that other prescribed medications did not work, but Simvastatin produced an
amazing lowering of the body’s burden of cholesterol very quickly. And
every time.
However, the long term results of any
drug use are sometimes difficult to demonstrate at first. After many years,
does your blood pressure go through the roof? Or do your dangly bits fall
off? In some instances it could be a case of ‘wait and see’. However, as
far as is possible, the results of longer term usage are looked at through
many ways, including animal testing. The poor old laboratory mouse is flat
out keeping numbers up to scratch!
There is just so much information to
collect - there are epidemiological results found from over hundreds of
thousands of cases and critically reviewing the results at the end. This is
one of the ways that differentiates between the pharmaceutical industry and
the “alternative” industry.
Now, a startling fact has emerged from
one of the longer term examinations of statin usage. It appears that
statins safely reduce the risk of cardiovascular illness even years after
treatment is stopped, according to a probe into the popular
cholesterol-lowering group of drugs published in November.
A look at the background is justified
here. Statins work by blocking a liver enzyme that makes fatty molecules,
which line arterial walls and increase the danger of heart disease and
strokes. With worldwide annual sales of more than 20 billion dollars, the
drugs have been dubbed “the aspirin of the 21st century” because of their
benefit and wide use. However, lingering questions persisted about their
long-term safety for the heart, liver and cancer risk.
In this latest examination, researchers
at the Heart Protection Study Collaborative Group in Oxford in the UK looked
at 20,536 patients at risk of cardiovascular disease who were randomly
allocated 40 mg daily of simvastatins or a dummy look-alike (known as
placebo’s) over more than five years.
During this period, those who took the
statins saw a reduction in “bad” cholesterol (LDL) and a 23 percent
reduction in episodes of vascular ill-health, compared to the placebo
group. The exhaustive study did not end there. The monitoring of the
volunteers continued for a further six years after the trial ended. The
investigators found that the benefits persisted throughout this monitoring
period even among those volunteers who had stopped taking the statins. Now
that is somewhat amazing. In addition, there was no emergence of any new
health hazard among those who had taken, or were continuing to take, the
drugs.
“The persistence of benefit we observed
among participants originally allocated simvastatin during the subsequent
six year post-trial period is remarkable,” said one of the investigators,
Richard Bulbulia.
As far as cancer incidence was
concerned, a number of cancers (nearly 3500) developed amongst the 20,536
volunteers during this follow-up period (roughly one in six), but there was
no difference in cancer incidence between the statin and placebo groups.
Richard Bulbulia continued, saying, “In
addition, the reliable evidence of safety, with no excess risk of cancer or
other major illnesses during over 11 years follow-up, is very reassuring for
doctors who prescribe statins and the increasingly large numbers of patients
who take them long-term to reduce their risk of vascular disease. A
previous investigation in November 2010 found that long-term use of statins
was less risky than thought for people with non-alcoholic fatty liver
disease (NAFLD), a common liver ailment.
So what does all this mean as far as
cardiovascular disease is concerned? It has been shown, beyond doubt, that
LDL cholesterol is a major factor in coronary artery disease. It has now
been shown that statins do reduce LDL, do reduce your risk, and appear safe
and have lasting benefits.
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Heredity - your parents are to blame
As medical knowledge continues to grow, we have found
that for many conditions there are familial, or hereditary, factors as to
whether you are going to have the same problems. Pity those who are orphans
- they never get the ‘advance warning’ that children with both sets of
parents get.
Of course, we all have much to thank our parents for. Just letting us grow
up for starters. However, heredity is one of the ‘clues’ to your health in
the future, and what you can do to enjoy a long, lively and healthy one.
This is really where ‘thanks Mum and Dad’ comes in. One problem of being an
orphan is that it leaves the person with no idea as to what ailments are
going to befall them. Dad might have legged it or ‘fled the scene’, but did
he live to tell the tale when he was 60?
With the increasing research into genetics, we are able to map out our
likely futures and can predict such ailments as diabetes, epilepsy and other
neurological problems like Huntington’s Chorea and Alzheimer’s Disease, some
cancers such as breast, ovarian, lower bowel, prostate, skin and testicular,
heart attacks, blood pressure problems, certain blood diseases like Sickle
Cell anemia and so the list goes on.
However, you do not need to have multi-million baht examinations done on
your DNA to see where you are headed, all you need to do is to start asking
the older family members about your inheritance. Not the money - your
genetic inheritance in the health stakes.
Have you ever wondered why the questionnaire for life insurance asks whether
any close member of your family has ever suffered from diabetes, epilepsy
and other ailments and then also asks you to write down how old your parents
or brothers and sisters were when they died, and what they died from? All
that they, the insurance companies, are doing is finding out the relative
likelihood (or ‘risk’) of your succumbing early to an easily identifiable
disease. This does not need a postgraduate Masters degree in rocket science.
It needs a cursory application of family history.
If either of your parents had diabetes, your elder brother has diabetes,
your younger brother has diabetes and your cousin has diabetes, what are the
odds on your getting (or already having) diabetes? Again this does not need
Einstein. The answer is pretty damn high! And yet, I see families like this,
where the individual members are totally surprised and amazed when they fall
ill, go to hospital, and diabetes is diagnosed.
It does not really take very much time over a family lunch to begin to
enquire about one’s forebears. After five minutes it will be obvious if
there is some kind of common medical thread running through your family.
That thread may not necessarily be life threatening, but could be something
like arthritis for example.
Look at it this way - your future is being displayed by your family’s past.
This could be considered frightening, when your father, his brother and your
grandfather all died very early from heart attacks. Or, this could be
considered as life saving, if it pushes you towards looking at you own
cardiac health and overcoming an apparently disastrous medical history.
This is where careful application of family history can be life saving. If
there is a common thread, then go looking for it. This is the advantage that
you get provided you are not an orphan. You know what to look for before it
becomes a problem. Going back to the family with diabetes, what should the
younger members do? Well, if it were me, I would be having my blood sugar
checked at least once a year from the age of 20. Any time I had reason to
visit the doctor in between, I would also ask to have the level checked. We
are talking about a very inexpensive test that could literally save you
millions of baht in the future, as well as giving you a better quality of
life, and a longer one.
Ask around the dinner table today and plan to check your medical future
tomorrow. It’s called a ‘Check-up’!
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Despite your check-up, are you going to die?
There are many trusting souls that believe that because
this year’s check-up showed no earth-shattering abnormalities, they are then
fine for the next 12 months until the next check-up. Almost like getting a
warranty on yourself. Ah, if only it were that simple.
Are you going to die? Undoubtedly yes
(but hopefully not in the immediate future, so let’s enjoy Xmas). However,
despite all the advances in medical science, the death rate will always be
the same - one per person! Being born is, after all, the very first step in
the dying process. One of the world’s great truisms - you are born, so that
you can die. It’s the old death and taxes routine. You can’t escape the
grim reaper or the Inland Revenue man.
Now, I fully realize that there are
those of different faiths who are happy in their belief that there is an
after-life, or reincarnation, or some other way by which they can do it all
again, and I am not at cross purposes with that. I am merely talking about
the ‘here and now’ - the next life can look after itself, in my book, but I
don’t want an early morning wake-up call either!
I want you to ponder on the following:
in our respective lives, there will be those of us who seem to fly though it
all, the veritable ‘butterflies’ who flit from flower to flower, savoring,
tasting and, need I say it, enjoying. Eventually, they run out of puff and
quietly fold up their wings and pass on. On the other hand there are those
of us who stumble like buffalos from one disaster to the next, one illness
to another and eventually succumb - a victim of some tragedy. Almost as if
it were written in the stars (but it isn’t).
Does the first group have a charmed
life and the second are only living on borrowed time, or was it really
written in the stars? Being personally of the ilk that does not believe in
prophecy, until one of the seers or fortune tellers round the place predicts
the winning lottery numbers for himself, I shall disregard the ‘prophecy’
concept. Those people who do believe in the itinerant gypsies with crystal
balls, should stop for a moment and enquire as to whether the prophecies
have made the fortune teller the fortune that should be well within their
grasp. I can tell you the answer already!
However, let us look at the butterflies
and the buffalos. As far as ‘borrowed time’ is concerned, both are in the
same situation. Our lives are fleeting visits to planet earth, and that’s
all. Like going on holidays, you try to make the most of your two weeks on
the Costa Plenty, so also you should make the most of your next six months
in Thailand.
“Six months!” I hear you shout. “Is
that all I’ve got?” In a way, yes.
You see, it is difficult to look ahead
much further than that in the medical sense. So much can happen. Six
months is enough time for a fulminating infection to carry you off, or to
develop an aggressive cancer that will do the same.
So if we are looking at six months
worth of future, how can we make it such that it is not this coming six
months, but six months way in the future?
The answer is still a simple medical
check-up. This will predict your future life for you, much better than the
Indian fortune teller with a turban and a well thumbed set of Tarot cards.
Advance notice of when the Bank of Life is going to foreclose comes from
your medical records, not the soothsayers.
But what is the difference between the
butterflies and the buffaloes? Nothing really. Both are on “borrowed”
time. It is merely different attitudes to life and living. You can
complain about only having a handful of rice, or be thankful that you’ve got
something to eat, many do not. The butterflies have it right. They remain
carefree and enjoy life, no-matter how short, while the buffalo carries the
world on its shoulders to its grave. The choice is yours.
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