Tola Dehinde
Over the months, I have talked a lot of about joint pains with sickle cell anaemia. This time, I would like to talk about the disease and abdominal pains. The latter is common among people living with the disease.
Although I don’t usually suffer abdominal pain, I had one recently. My stomach protruded like that of a pregnant woman who was in her third trimester. It was so painful and horrible. Not knowing what else to do, I just kept taking drugs and hoping for the best.
As a little girl, whenever I had abdominal pains, I used to think it was because my body reacted to the drugs that I was taking. Now I know better.
The immune system of a person living with sickle cell anaemia gradually becomes weak. Affected people are highly susceptible to infections from certain forms of bacteria. Some of the most common infections are from flu viruses, pneumonia, and salmonella (a type of bacteria).
Infections: People living with the disease are at risk of being exposed to infections, especially in the lungs, kidneys, bones, and central nervous system.
Acute pain, fever, muscle spasm and leukocytosis are frequent during such crises. They are probably due to the sequestration of sickle cells in the circulation of the gut.
The exact etiology of the resulting abdominal pain is not known. It is usually secondary to vaso-occlusion and may be a sole complaint or associated with generalised pain crisis in other parts of the body. When it is a solitary complaint, it mimics a wide range of abdominal surgical emergencies, which may trap the clinician to offer surgical intervention with its attendant risks.
Four patterns of an acute sickle cell crisis are now recognisable. They are based on the part of the body where the crisis occurs.
Bone crisis: An acute or sudden pain in a bone can occur, usually in an arm or leg. The area may be tender. Common bones involved include the large bones in the arm or leg: the humerus, tibia, and femur. The same bone may be affected repeatedly in future episodes of the bone crisis.
Acute chest syndrome: Sudden and acute chest pain with the coughing up of blood can occur. Low-grade fevers can be present. The person is usually short of breath. If a cough is present, it is often non-productive. Acute chest syndrome is common in a young person with sickle cell anaemia. Chronic (long-term) sickle cell lung disease develops with time because the acute and sub-acute lung crisis leads to scarred lungs and other problems.
Abdominal crisis: There is constant pain in the abdomen. The pain may or may not be limited to one part of the abdomen. Nausea, vomiting, and diarrhoea may or may not occur.
Joint crisis: Acute and painful joint crisis may develop without a significant traumatic history. Its focus is either in a single joint or in multiple joints. Often the connecting bony parts of the joint are painful. Range of motion is often restricted because of the pain. Avascular necrosis of the hips can occur, thereby causing a permanent damage.
Abdominal pain may be felt by the affected person in different ways and it is important to recognise that the possible diagnoses are numerous. Not all cases are due to vaso occlusive crises. Early diagnosis and prompt treatment can be life-saving.
You all know that I always like to end my columns with an advice on food that is good for people living with the disease. I want to advise you to eat more of jute leaves, which are also known as lalo, bush okra, ayoyo, kerenkeren or ewedu. Jute plants are widely found in tropical and sub-tropical areas from Asia to Africa where they are mostly used in cooking.
The leaves are used in making stews, soups, tisanes or teas. The vegetables are also rich in calcium, folate and vitamins, including vitamins A, C and E. They may not sound particularly appetising, but the slimy leaves of jute plants, African nightshade and the spider plant may be about to become the latest trendy super foods.
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