Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [80]
“Why don’t you call my internist,” the cardiologist offered. “I’ll let his office know that you’ll be contacting them.”
After the meeting, Omar looked in the mirror but didn’t see any change in his eyes. He called the internist’s office. The secretary told him that the doctor wanted him to stop by for blood tests so the results would be back in time for his appointment.
“In retrospect, I had been feeling tired for a while,” Omar told us. “But I thought it was just because of my busy schedule. I had been staying up late working on the research proposal, and then I had to change time zones after a trip to Europe.”
Omar picked up his son from a music lesson, and as soon as they returned home, he asked his wife, Ayesha, who taught linguistics at a local college, to look at his eyes. “She didn’t see anything abnormal,” he recounted. “Neither of us could really tell whether there was anything wrong.”
A few days later, Omar went to see the internist. He greeted Omar warmly and then said, “I’ve heard from our mutual friend that your research is very cutting-edge.”
Omar had been a precocious student, at the top of his class through high school and college. He came to the United States for his PhD in biochemistry and stayed for postdoctoral training, ultimately taking a position on the faculty at the medical school. Ayesha had been raised in the same town as Omar, and after finishing her degree in linguistics, they married and she moved to the United States to be with him. Many of Omar’s relatives had since followed them to the United States.
“Your blood tests are back,” the doctor said as he turned the computer screen on his desk so that Omar could see it. All of the test results were lit up in red. Omar’s bilirubin, the yellow pigment that is normally passed through the liver and excreted in the stool, was elevated at 2.7, just at the level where jaundice can be detected. His transaminases, enzymes that reflect the health of the liver, were also abnormal, in the 200s. “But what was really frightening were my blood counts, my CBC,” Omar told us. The doctor said he had “pancytopenia,” meaning a low red cell blood count, reduced white blood cells, and a serious reduction in his platelet count.
The internist examined Omar and told him that he could feel the tip of his spleen below his left ribs, indicating that it was enlarged, but the liver was not enlarged or tender. The doctor ordered more blood tests and several days later called back and informed Omar that he had hepatitis B.
Hepatitis B is one of the most common viral liver infections in the world. It is particularly prevalent in Asia and the Middle East but also widespread in Europe and the Americas. Omar’s son had been vaccinated against hepatitis B as part of the routine immunizations now given to children in the United States. “In my home country,” Omar told us, “no one paid much attention to hepatitis B, and we were not vaccinated against it.”
The hepatitis B virus was identified by Dr. Baruch Blumberg while he was studying the blood of Australian aboriginal peoples and was initially termed “Australia antigen.” Blumberg won the Nobel Prize for this work in 1976. Routine vaccination of American children for hepatitis B began in 1991. More recently, drugs known as nucleoside analogues have been developed to treat hepatitis B infection. This new class of medications grew out of research on AIDS, where related drugs were found to potently block HIV. Although nucleoside analogues can have significant side effects, their use against AIDS and later hepatitis B infection has revolutionized treatment of these serious maladies. Omar was started on a drug called entecavir and was told that if it didn’t work, there were similar medications that he could try, as well as experimental therapies. But these other treatments proved unnecessary; entecavir controlled the virus.
Despite this success, Omar’s liver function tests worsened over the next two months. Scans of his liver and a biopsy showed cirrhosis, extensive scarring of the tissue from years of undetected