Hopes dim for Yar'adua

•Doctors fear chronic pericarditis
•Why he may be in hospital indefinitely

Even though those who profess to be close to President Umaru Yar’ Adua are going on as if they have all been briefed to talk only about the weather, medical experts have thrown more light on why the President may be spending a long time in his hospital bed. Sunday Sun sources said all the talks about the President returning soon are just proceeds of spin doctors’ imagination.

Playing politics with President’s health
“Some people are just trying to hide behind a finger while trying to play politics with the President’s health. When next anybody tells you the President is returning soon, ask the person when last he spoke with Yar’Adua. If he or she says they saw him, ask him how many life support machines are in the President’s room.

“While we all hope and pray that Yar’Adua pulls through, the truth is he is in no shape to return now. He is in no shape to travel. His doctors know that and I believe the Ministers also know. That is why they told the nation on Wednesday that only the President’s doctors can determine his return date. Right now, that date is unknown,” our source, a Peoples Democratic Party (PDP) chieftain said.

Why Yar’Adua is still hospitalized
Sunday Sun asked doctors why the President was still in hospital and had not recuperated enough to enable his transfer to another country as earlier planned.

A surgeon and medical director of Joekem Clinic, Lagos, Dr Emmanuel Enabulele, believes Nigerians are not being told the truth about the president’s real clinical condition, and what the prognosis (the outcome) may be like.
“I mean, the world over you can always invite experts to any health facility, so long as all the necessary equipment are there. All he needs is the experience to come and see the patient,” he said.

Why now is there an urgency to move him out of Saudi Arabia to America or Germany? Is it religious? Is it because they have sworn to an oath of secrecy?

Dr Enabulele continued: “Perhaps, they realize that America is a very liberal democracy, and not the kind of place you can hide information. So maybe what the Saudis are not able to say, they want the Americans to say it.

“There must be something that is not very clear about the whole situation. I think that Nigerians are entitled to know instead of the present spate of speculations that are hitting up the polity.

“I recall that there was a time the Russian Prime Minister, Vladimir Putin, had to undergo a special surgery. American experts were invited to Russia to observe. But the surgery was performed by Russian surgeons.”

In a general case, when a person has Churg-Strauss Syndrome, what are the complications that may arise? Sunday Sun asked.
“Churg-Strauss Syndrome is not a common phenomenon in Nigeria. But we know that there are three stages. The first stage is where the person may be having allergies. In the second stage, the person may be having multiple organ involvement and failures (the liver, the kidney, etc.) because you have immunological basis; and the third stage is always terminal. It is described as the end stage.

“Being the first citizen, his health condition should not be hidden from Nigerians because he is already a public property, so they should not keep people in the dark. We are all praying for his recovery.
“This whole talk of flying him to America or Germany, I just wonder why they cannot fly in the experts into Saudi Arabia. Maybe somebody wants somebody else to say something he ought to have said.”

Complications in pericarditis
According to Richard N. Fogoros, who practiced and taught clinical cardiology for 20 years, directing cardiac electrophysiology at the University of Pittsburgh, and then at Allegheny General Hospital in Pittsburgh, while pericarditis usually resolves within a few days or a few weeks, three complications can occur. These are tamponade, chronic pericarditis, or constrictive pericarditis.

Tamponade, he explained, occurs when fluid accumulating in the pericardial sac (a condition called pericardial effusion) prevents the heart from filling completely. When this happens, the blood pressure drops and the lungs become congested, and the patient experiences weakness, dizziness and lightheadedness, and extreme shortness of breath. If treatment is not given, death can occur. The diagnosis of tamponade is made with an echocardiogram.

Fogoros, who was listed in Best Doctors in America from its inception until he retired from practice and author of numerous scientific works, also documented that chronic pericarditis occurs when the pericardial inflammation does not resolve within a few weeks. It can be associated with all the symptoms of acute pericarditis, and in addition is often accompanied by particularly large pericardial effusions.

Constrictive pericarditis occurs when a chronically inflamed pericardial sac sticks to the heart muscle, squeezing it and constricting it. The symptoms are the same as with tamponade, but usually have a much more gradual onset. The diagnosis usually requires a careful cardiac catheterization.

A Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) scan can also help to diagnose chronic or constrictive pericarditis, by showing the thickening of the pericardial lining associated with these conditions.
In the wake of the Presidency’s disclosure that Yar’Adua was suffering from acute pericarditis, Sunday Sun had reported that the Number One citizen might not return until next year. One of the doctors we spoke to then, Dr Enabulele, had said that for “somebody who had been chronically ill and now developing acute pericarditis, in health terms, it means that he has more days of hospitalization.”

Continuing, he said: “Most acute pericarditis cases take a minimum of six weeks to resolve. Usually when pericarditis occurs, it becomes a little difficult to know what must have caused it. But we know that the President had a renal condition, and uremia is a known cause of pericarditis. It just means that days of hospitalization ahead of us are still many. Definitely, he would have more days of hospitalization.”

The surgeon had earlier alerted that acute pericarditis could either resolve in six weeks or worsen and could progress from acute to chronic.
“Acute pericarditis can resolve in six weeks. Anything above six weeks, we will start talking about sub-acute. If it then moves from sub-acute to chronic, that is a situation that would necessitate serious debate.”

He explained further that the patient becomes more debilitated, more fatigued with his general health condition not conducive for active services, which governing entails.
Consultant Cardiologist, Dr Adewale Akande, also authoritatively told Sunday Sun that the inflamed heart covering ordinarily could be taken care of in one week once the sedimented fluid is gotten rid of, saying: “It could take 4-8 weeks if there are other causes apart from a kidney problem in a patient with acute pericarditis.

“The inflammation would be taken care of and the life-threatening situation arrested. The patient could go home within two weeks. However, if there are other co-morbidity causes, treatment could take longer. If there are other primary problems or causes, they have to be taken care of. There is no rough idea of time that is absolute. A lot of things could come into play but where all things are equal, it could take between four and eight weeks before the patient can become very stable.”

Today, 20 days after Yar’Adua arrived the King Faisal Specialist Hospital in Jeddah, feelers from the hospital is that other factors may have shown up necessitating ‘bed rest and long hospitalization.’
However, some doctors have decried the secrecy with which the President’s state of health has been shrouded, saying that this makes it difficult to really ascertain whether his return to the country will be soon, later or never.

Medical practitioners still cautious
Reacting to Sunday Sun’s inquiry on what the relapse of his ailment, which was diagnosed as acute pericarditis, portends, a private general practitioner in Lagos, Dr. Julius Osuntuyi, said it is difficult to give an expert opinion given that his actual ailment has never really been divulged.

“The truth is nobody has told us what is really happening to the president save what we hear from the media. The people who are supposed to tell us what is happening are not.”
According to him, most of the information available amount to playing to the gallery, and as such it is quite difficult to make conclusions.

Speaking in the same vein, a consultant surgeon, Dr Tokunbo Madarikan, said the president’s actual ailment has not been divulged, thus making it difficult to speculate.
“I don’t think anyone can really say much about the president’s ailment because we have little or no information about it. And the people who know are not saying anything. We are all just speculating.”
While Osuntuyi wishes the president well, he however said that based on information gathered in the media on his health, it is a grave situation.

“From what we have heard, the prognosis is not too good. Of course, it is God that owns life. But it does happen that when even doctors have tried all they know, it is God that can really determine the outcome of an illness.”
Speaking further, he said if indeed his condition does not improve, it could be fatal.
“If it is pericardiatis, we are talking about the heart being compressed. And with no improvement, when the heart fails it means death.”

Reacting to the report that the president is probably too ill to be flown to the United States, he said that is probably not true as there are air ambulances that can convey a patient to another facility if the need arises.
“That he cannot be moved to another place because of his condition is just another misinformation being peddled because there are air ambulances that can convey a patient to another facility if the need arises, and it will be as good as being in Intensive Care or an Emergency Unit of a hospital.”