“Ayubowan” – May you have the gift of long life! With this traditional Sri Lankan greeting Dhanundhara was welcomed to his place of birth by his grandparents. Just as this tear shaped island country is the sparkling jewel of the Indian Ocean, so was Dhanundhara the jewel of his family, doted by one and all.
All of 3 years, he was too small to express in poetic language the natural beauty of his country. The magnificent coastline along azure seas lined with palm trees, sun drenched beaches, lush green jungles, cool refreshing hills had a magical effect on him – transforming him from the quiet reserved child that he was, to a chirpy kid squealing with joy at every new experience.
His parents had migrated to UAE and it was his skin condition that had brought them on this trip. Dhanundhara suffered from vitiligo, a skin disease that causes white patches on the body. Full of its traditional heritage as their country was, they banked on an alternative medicine therapist to try and heal him with herbal medication. Sadly, it became the source of their nightmare.
He had been on his herbal medications for a few weeks when he began to have fever and then vomitings and jaundice. He had developed hepatitis, ie inflammation of the liver. His parents took him to back to Abu Dhabi for medical care but his condition progressively deteriorated. He had developed acute liver failure and was susceptible to life threatening bleeding or coma if his liver function continued to deteriorate any further. He needed an urgent liver transplant.
Emergency contact with the team of liver specialists at Indraprastha Apollo Hospitals was made and he was flown to India. It was inferred from his clinical course and diagnostic workup that he had developed liver failure due to the herbal medications as all tests for an infective cause or underlying silent chronic liver disease were negative.
Preparations were started and he was admitted to the intensive care unit. It was a herculean task to care for him. He would speak little and would resist blood tests with all his might. His long dark curly hair made the staff mistake him time and again for a girl, causing him to sulk further. Only his mother could understand his agitated state of mind behind his quiet persona that gave a false perception of tranquility. She was his magic charm and became his donor, giving him life twice.
The transplant surgery was a success and he was off the ventilator within a few days. When all seemed fine, arose another problem. He would not accept his oral medicines. He hated them. He had always been averse to taking medicines, said his mother. He would just shut his mouth and require coercing for hours together, becoming agitated when forced. After undergoing a transplant one needs to take regular medications, to prevent the body from rejecting the new liver. Am I going to struggle daily to administer them, wondered his mother. For a few days, his oral feeding tube was not removed after surgery so that he could be given his medications. The magic charm that his mother was, she gradually and loving brought him around and he slowly overcame his strong aversion to medicines.
By the time of discharge, his syrups didn’t anger him, the needles and syringes didn’t terrify him. All he wanted was to go home to live the life he had been blessed with.
|The Clinical Perspective Acute liver failure is a grave medical emergency as the mortality risk is very high. An urgent liver transplant has to be arranged before the patient develops complications involving the brain, kidneys and other organs that would render a transplant unfeasible and/or futile. Dhanundhra had to be airlifted to our hospital from UAE at a very short notice. Meticulous preparations ensured he underwent a timely transplant.