Our bodies are constantly talking to us, provided we’re listening. Mostly we’re not. Most of us are deaf to the voice of the uproar simmering inside our biological machines. But then there are times when there is complete silence from the other end. No communication. No warning. Complete stillness, as though all is perfect. And one day, like the calm before the storm, the silence is shattered into a thousand pieces all at once, leaving behind a jolt of horror. That’s how many silent killers take away from us the most important thing—our life. It so happened with 38-year-old Prakriti Hans, a businesswoman who assisted her father at his button factory in Sonipat on the outskirts of Delhi. A sudden thud from her room made everybody run towards her in unison. There, Prakriti lay on the wooden floor, eyes dilated, skinny hands stretched out and her petite frame forming a loop around the feet of the chair she was sitting on. No one knew she was dead. But in a few hours they all came face to face with the reality of her permanent absence.
Immunoglobulin Light Chain Amyloidosis was the demon that silently dragged Hans to the horrific corridors of death. She was oblivious to the fact that her bone marrow had started producing abnormal antibodies which couldn’t be broken down easily. With indeterminate symptoms, the disease couldn’t be detected. Her brother Rachit Hans is still grieving her loss as the sudden bereavement left him in shock.
The Surprise Trap
Disguising their symptoms under the garb of normalcy, these diseases could prove fatal if not diagnosed and treated in time. Chances are that you could be living with them for days, months, or worse, years, without even knowing they’re eating into your health. While we’re all aware of the usual suspects like hypertension, heart attacks and diabetes, there are several other silent killers that need your immediate attention.
Early detection could have saved Prakriti’s life. “She was fit as a fiddle. Her routine was set: early morning walk followed by some pilates, a hearty breakfast, 9 hours of factory work, and sleeping as soon as the clock stuck 11 pm,” says her brother, who believes that even though everything was seemingly fine on the outside, her disease was quietly rotting her body from the inside. “Regular full body checkups could have helped us diagnose the issue when it started, but we never took those seriously. Our attitudes were one of indifference and that took Prakriti away from us,” says Rachit.
In the line-up of some of these deadly diseases, Obstructive Sleep Apnea (OSA) occupies a distinctive position. Left untreated, it can morph into bigger health issues such as uncontrolled hypertension, heart disease, arrhythmias, heart failure, stroke diabetes, weight gain and cognitive dysfunction, according to Dr Shripal Shrishrimal, who is an American Board-certified sleep physician and Director at Keystone Center for Sleep Disorders in the US. He says, “It can affect people of all ages, but prevalence increases from adulthood through the sixth or seventh decade, with men being affected two-three times more than women, but post menopause, the gap narrows.” In people already suffering from obesity, this is the most common silent killer, believes Dr Karan Chopra, Cardiologist at Park Hospital, Gurgaon. He explains that this apnea occurs when something partly or completely blocks your upper airway when your eyes are shut. That makes the diaphragm and chest muscles work harder to open the obstructed airway, and pulls air into the lungs. Breathing usually resumes with a loud gasp, snort, or body jerk.
The condition can reduce the flow of oxygen to the vital organs and cause irregular heart rhythms. OSA is also a risk factor for developing heart disease and strokes, and is probably an important cause for vehicular accidents, shares Dr George A D’Souza, Dean, St. John’s Research Institute and National Academy of Health Sciences, Bengaluru. Jagadeeshwar Reddy (name changed) from Narsapur town of Andhra Pradesh knew how that felt. He would snore so loudly that his wife and neighbours would find it difficult to sleep. However, he ignored it. Later, when he developed serious heart problems, it was revealed that Reddy had underlying OSA. Sleep apnea and blood pressure turned out to be a fatal combination for the 45-year-old man.
Another deadly condition that smites unannounced is Cardiac Arrhythmia, a problem of abnormal heart beat that grows when electrical impulses that coordinate one’s heartbeats don’t work properly, causing the heart to beat too slow or fast. In prior case, it’s called Bradyrhythmia and latter is Tachyrhythmia. Jegathiswaran Chari, a sesame oil trader from Coimbatore, suffered from the same and didn’t come to know till he casually went for one of his yearly health examinations. “There were major signs or symptoms. I was most surprised to learn that I had this disorder for almost two years, considering I had never felt too much of discomfort. Yes, at times, I experienced palpitations, but I always ignored them thinking it may be because of angst related to work or my daughter’s college admission. The thought that it could have taken my life away, had I not gone for that check-up jolts me to this day,” he says.
Another one that can kill you instantaneously is dissection of aorta, medically called Aortic Dissection, caused due to weakening of the walls of the aorta which supplies blood to all parts of the body. “The doctor who classified these aortic dissections himself died of it,” says Dr Pratik Soni, Consultant Cardiologist at Wockhardt Hospitals, Mumbai. Aortic dissections are more likely to occur within a thoracic aortic aneurysm than within a normal size aorta. Aortic Aneurysm, Dr Shashidhar K P, Consultant Vascular and Endovascular Surgeon at Apollo Hospitals in Bengaluru, explains: “The aorta that carries oxygen-rich blood pumped out of, or away from the heart, and runs through chest is called the thoracic aorta. When it reaches the abdomen, it is called the abdominal aorta. The abdominal aorta supplies blood to the lower part of the body. In the abdomen, just below the navel, the aorta splits into two branches, called the iliac arteries. If there is an enlargement of the aortic artery in the chest, it is known as aortic aneurysm. This can weaken the heart and give a blow to a person who otherwise looks hale and hearty.”
The list doesn’t end there. Pulmonary Embolism, a condition wherein there is a blockage in one of the pulmonary arteries in your lungs, strikes when blood clots form in the veins of the leg. Usually this happens during prolonged sitting or standing or immobility. “The clot in the leg veins travels upwards to the heart. From the right side of the heart, it goes out from the right pumping chamber into the pulmonary arteries. This cloister, if large enough, can block the blood supply to the lungs and can kill a person by depriving him or her of oxygen. Most deaths that happen at airports are because of this,” says Soni.
A close encounter with death can leave the best of us in a lasting state of trauma. Vinay Aggarwal, a happy and healthy 64-year-old banker who enjoyed life to the fullest, went through a similar state. After retiring from his job of 30 years, he joined a new company as a consultant. Prior to joining, he was required to get a health check-up, something he had never done before. In the results, his PSA levels came high and he was referred to an uro-oncologist for evaluation. To his horror, he was diagnosed with prostate cancer. “This man had no urinary complaints, no blood in urine, and no weight loss. He had just finished a half marathon three months ago,” says Dr Anup Ramani, Uro-Oncological and Robotic Surgeon, Lilavati Hospital, Breach Candy Hospital, Saifee Hospital and Welcare Hospital, Dubai. While all cancers are silent killers, this one is really hard to detect. Roughly one of 10 men will develop cancer in the prostate gland. Most of the leukemias too, like blood cancer, come silently and the affected individuals or relatives come to know when it is too late. Some other malignancies like bone tumors, lymphomas and sarcomas also fall in this category but not as silent as leukemias. “Problem is at the level of stem cells in the bone marrow in case of leukemias. Other malignancies are related with the respective tissue category. They send signals but manifestation is late, that’s why they approach the doctor late. And, sometimes growth of cancerous cells is very fast,” says Dr Briju Paul, Director, Oncology at Park Super Specialty Hospital, Delhi. Ovarian Cancer is a silent killer that affects more than 75 per cent of the women who get diagnosed when they reach the advanced stage, says Dr Nikita Gupta , Gynaecologist, Park Group Of Hospitals, Gurgaon.
In his eight years of practice, Dr Pradeep Gadge, Consultant Diabetologist, Gadge’s Diabetes Centre, and Visiting Consultant at Breach Candy and Sevenhills Hospital, believes that one of the most dangerous silent killers besides OSA is fatty liver disease, a condition in which the liver has difficulty breaking down fats that get deposited in its tissue. A person is at a greater risk if suffering from gastric bypass surgery.
Mind Games
While the physical body may not show any sure signs of a malfunction, mental illnesses are on a higher chance of going undiscovered. Even though depression is a fairly common killer, doctors are now clubing it with hypertension, myocardial infraction and sleep apnea. “Brain disorders like depression, schizophrenia, bipolar disorder also carry an increased risk of mortality, i.e. suicides, with close to one suicides reported worldwide annually. The rates are even higher in the age bracket 15-25-year-olds, suicides being the third most common cause of death,” says Dr Meera Narasimhan, Associate Provost Health Sciences, University of South Carolina and Professor and Chair, Department of Neuropsychiatry and Behavioral Science University of South Carolina School of Medicine. She believes that there is a need to be more aware of one’s mind-body-spirit connection since there is a bidirectional relationship between emotional health and physical health. For instance, there are high rates of depression in those with cancer, heart disease, stroke, Parkinson’s, diabetes and others.
While most experts will suggest an active lifestyle to all kinds of ailments, in the case of Hypertrophic Obstructive Cardiomyopathy (HOCM), which affects one in 500 persons, Dr Harihara Subramonia Sharma, Consultant Cardiologist of SK Hospital, Thiruvananthapuram, says it is a major threat that strikes people who are active, especially young athletes. He says younger people are likely to have a more severe form of HOCM, caused due to excessive physical strain. Meanwhile, Dr Muhammed Shaffi, public health expert and Academic Registrar of Global Institute of Public Health, Thiruvananthapuram, cautions that the people are not aware of such killers but generally believe it to be a cardiac arrest. He opines that people having family history of cardiac issues, blood pressure, diabetes and other issues should go in for early screening.
Born with a Burden
Though silent killer diseases like hypertension and diabetes mellitus are well known in adults, the spectrum for infants and children is truly ill-defined. It varies from Sudden Infant Death Syndrome (SIDS), commonly referred to as Crib Death, to metabolic disorders which may be symptomatic but the signs are not given credence in time. “A whole lot of cyanotic diseases with good mixing with minimal cyanosis and acyanotic heart disease with neglected symptoms can present as fatality, but do not really fit the definition,” says Dr. Vishal K Singh, Associate Director, Pediatric Cardiac Critical Care, Jaypee Hospital, Noida. He adds Myocarditis, especially viral in origi, may manifest as sudden death with neglected symptoms of palpitation or overt heart failure, occasionally exacerbated with complete heart block or ventricular arrhythmia. The most common conduction system abnormality resulting in sudden death, including Wolff-Parkinson-White (WPW) syndrome and long QT syndrome and both, has a genetic component with history of sudden deaths in family.”
Prevention is better than cure
As diseases continue to show their ugly face in the most surreptitious ways, the crux of the health advisory remains in educating individuals on the importance of regular health check-ups, which are the only way of diagnosing efficiently. “Family histories must be documented. Prevention, as they say, really proves to be better than cure in this case,” says Singh. with Sunita Raghu, Suhas Yellapantula, Prabhat Nair and Yacoob Mohammed
Death in disguise
Immunoglobulin Light Chain Amyloidosis A rare disease that occurs when amyloid (abnormal protein produced in the bone marrow) builds up in one’s organs.
Obstructive Sleep Apnea
A sleep disorder, wherein an individual’s breathing repeatedly stops and starts during sleep.
Cardiac Arrhythmia Electrical impulses that coordinate one’s heartbeats don’t function properly, when the heart beats too fast or slow, sometimes irregularly.
Aortic Dissection A condition wherein the inner layer of the aorta tears. As blood gushes through the rupture, the inner layers separate (dissect).
Pulmonary Embolism
Blockage of an artery in the lungs by a substance that travels from another part of the body through the bloodstream.
Prostate cancer
Cells in the prostate gland start to grow uncontrollably.
Fatty Liver Disease
Unhealthy amounts of fat builds up in one’s liver.
Hypertrophic Obstructive Cardiomyopathy The myocardium (heart muscle) becomes abnormally thick, making it difficult for the blood to pump.
Sudden Infant Death
Syndrome Also called crib death, a child less than one year old usually dies while asleep. This could be due to abnormalities in the portion of their brain.
Wolff-Parkinson-White
Syndrome The extra electrical pathway between one’s heart’s atria and ventricles causes a fast heartbeat.
Long QT Syndrome Chaotic heartbeats that could cause a seizure.