Filipino endocrinologist calls GMA spokeswoman “funny”

By Raïssa Robles

If  Gloria Macapagal-Arroyo has a life-threatening illness, then by all means let GMA fly abroad to get the best medical help.

With that in mind, I thought I could help GMA out. So I asked a noted Filipino endocrinologist this question:

From what you have been hearing and what you have been seeing about Arroyo’s condition, in your medical opinion, do you think she’s in danger of dying from hypoparathyroidism and therefore needs to travel abroad at once?

My source – who is known in the field of endocrinology and whom I will call “Mar” which is short for my source’ first name – replied:

No. she’s not. I treat patients with that condition. It’s not life threatening.

Mar then asked me,

Did you listen to Anthony Taberna this morning?

Mar was referring to Taberna’s one-on-one interview on Channel 2 and ANC with Arroyo’s spokeswoman Elena Bautista-Horn who had insisted that Arroyo needed a “metabolic bone biopsy” which is not available in the Philippines. Horn even said:

I challenge Secretary Ona to give us names of experts who can do metabolic bone biopsy in the Philippines. Iba po yung metabolic bone biopsy sa bone biopsy.

Blunt about expressing opinions when it comes to this particular subject, Mar said of Bautista:

She’s funny. Why does Arroyo have to get a biopsy? I don’t know why she has to get a biopsy. She (Bautista) said GMA has to travel abroad and she needs that procedure. Is that really necessary?

Mar was busy with a patient when I called. So Mar could not tell me all about hypoparathyroidism. But Mar suggested I read up on it on the Internet before phoning back at a later agreed time.

And so I decided, among the dozens of websites to choose from, to read the website of the Mayo Clinic which has an extensive discussion of hypoparathyroidism. Let’s all learn together about this rare, rare illness that has suddenly struck our beloved former President.

Before I share with you what I’ve read, I just want to run by you a thought that just occurred to me. If the Arroyo camp knows she has hypoparathyroidsim, then why does she need a metabolic bone biopsy test?

Doctors order a biopsy to help in the diagnosis of an illness  in order to determine the course of treatment, right? But in this case, GMA has already been diagnosed with hypoparathyroidism. So what is the biopsy intended to accomplish?

Will the doctor who ordered the metabolic bone biopsy please speak out instead of Mrs Horn?

Meanwhile, to help us understand this rare disease, here are extracts on hypoparathyroidism from the Mayo Clinic website:

First, it explained that the each of us has four parathyroid glands, each one  no bigger than  a grain of rice.

Source - Mayo Clinic website

Definition
By Mayo Clinic staff

Hypoparathyroidism is a rare condition in which your body secretes abnormally low levels of parathyroid hormone (parathormone). This hormone plays a key role in regulating and maintaining a balance of your body’s levels of two minerals — calcium and phosphorus.

The low production of parathyroid hormone in hypoparathyroidism leads to abnormally low ionized calcium levels in your blood and bones and to an increased amount of phosphorus.

Treatment for hypoparathyroidism consists of taking supplements to normalize your levels of calcium and phosphorus. Because hypoparathyroidism is a chronic condition, treatment is generally lifelong.

Symptoms

By Mayo Clinic staff

Signs and symptoms of hypoparathyroidism can include:

1. Tingling or burning (paresthesias) in your fingertips, toes and lips
2. Muscle aches or cramps affecting your legs, feet, abdomen or face
3. Twitching or spasms of your muscles, particularly around your mouth, but also in your hands, arms and throat
4. Fatigue or weakness
5. Painful menstruation
6. Patchy hair loss, such as thinning of your eyebrows
7. Dry, coarse skin
8. Brittle nails
9. Anxiety or nervousness
10. Headaches
11. Depression, mood swings
12. Memory problems

When to see a doctor

If you have any of the signs and symptoms associated with hypoparathyroidism, make an appointment with your doctor for an evaluation. Once you’ve been diagnosed, contact your doctor immediately if you have a seizure or have difficulty breathing, both of which can be complications of hypoparathyroidism.

Causes
By Mayo Clinic staff

Hypoparathyroidism occurs when your parathyroid glands don’t secrete enough parathyroid hormone. You have four parathyroid glands — each normally about the size of a grain of rice — situated in your neck, adjacent to your thyroid gland.

The low production of parathyroid hormone leads to abnormally reduced calcium levels (hypocalcemia) in your blood and bones and to increased levels of phosphorus (hyperphosphatemia).

Factors that can cause hypoparathyroidism include:

1. Acquired hypoparathyroidism. This most common cause of hypoparathyroidism develops after accidental damage to or removal of the parathyroid glands during surgery. This surgery may be a treatment for diseases of the nearby thyroid gland, or for throat cancer or neck cancer. Today, surgeons are aware of and more careful to avoid injuring the parathyroid glands during surgery.
2. Hereditary hypoparathyroidism. In this form, either the parathyroid glands aren’t present at birth, or they don’t work properly. Some types of hereditary hypoparathyroidism are associated with deficiencies of other hormone-producing glands.
3. Autoimmune disease. In this condition, your immune system creates antibodies against the parathyroid tissues, trying to reject them as if they were foreign bodies. In the process, the parathyroid glands stop manufacturing their hormone.
4. Extensive cancer radiation treatment of your face or neck, which can result in destruction of your parathyroid glands, or occasionally because of radioactive iodine treatment for hyperthyroidism.
5. Low levels of magnesium in your blood, which can affect the function of your parathyroid glands. Normal magnesium levels are required for optimum secretion of parathyroid hormone.

Risk factors
By Mayo Clinic staff

Factors that may increase your risk of developing hypoparathyroidism include:

1. Recent neck surgery, particularly if the thyroid was involved
2. A family history of hypoparathyroidism
3. Having certain autoimmune or endocrine conditions, such as Addison’s disease — a condition characterized by a deficit in hormone production by the adrenal glands

Tests and diagnosis
By Mayo Clinic staff

Medical history

A doctor who suspects hypoparathyroidism begins the diagnostic process by taking a medical history and asking about your symptoms, such as muscle cramps or tingling of the extremities. He or she will also want to know whether you’ve had any recent surgeries, particularly operations involving the thyroid or neck.

Physical exam
Next, your doctor will conduct a physical examination, looking for signs that suggest hypoparathyroidism, such as facial muscle twitching.

Blood tests
You’ll also have blood tests, and the following findings may indicate hypoparathyroidism:

1. A low blood-calcium level
2. A low parathyroid hormone level
3. A high blood-phosphorus level
4. A low blood-magnesium level

Your doctor also may order these additional tests:

1. Electrocardiogram (ECG). This test involves taking electrical readings of your heart’s activity. It can detect arrhythmias associated with hypocalcemia and, in turn, hypoparathyroidism.
2. Urine test. Evaluation of a sample of your urine can show whether your body is excreting too much calcium.
3. X-rays and bone density tests. These can determine whether abnormal calcium levels have affected the strength of your bones.

In diagnosing children, doctors check to see whether tooth development is normal and whether they have met developmental milestones.

Hmmm. Do you see ANY  metabolic bone biopsy recommended here?

But let’s go on educating ourselves on this rare illness:

Treatments and drugs
By Mayo Clinic staff

In considering treatment for hypoparathyroidism, doctors take into account your symptoms, including their severity, and your overall health. The goal of treatment is to normalize the levels of calcium and phosphorus in your body. A treatment regimen typically includes:

1. Oral calcium carbonate tablets.
2. Vitamin D, which can help your body absorb calcium and eliminate phosphorus. The forms of vitamin D called ergocalciferol, dihydrotachysterol or calcitriol are recommended most often because they have a longer duration of action or are more potent than are other forms of this vitamin. Often, the required doses of vitamin D are much higher than are those used for a typical daily vitamin supplement.
3. At high doses, calcium supplements can cause gastrointestinal side effects, such as constipation, in some people. For that reason, take these pills only with the guidance of your doctor.
4. Some studies have shown promising effects of treatment with recombinant human parathyroid hormone (PTH), currently used to treat the bone-thinning disease osteoporosis. More study is needed.

Dietary steps
Your doctor may recommend that you consult a dietitian, who is likely to advise a diet that is:

1. Rich in calcium. This includes dairy products, green leafy vegetables, broccoli, kale, and fortified orange juice and breakfast cereals.
2. Low in phosphorus-rich items. This means avoiding carbonated soft drinks, which contain phosphorus in the form of phosphoric acid. Eggs and meats also tend to be high in phosphorus.

Intravenous infusion
In some cases, when you need immediate relief of symptoms, your doctor may recommend hospitalization to administer calcium by intravenous (IV) infusion. These IV infusions may be important if you’re having severe spasms associated with tetany. After hospital discharge, you can continue to take calcium and vitamin D as an oral supplement.

Regular monitoring
Your doctor will regularly check your blood to monitor levels of calcium and phosphorus. Initially, these tests will be weekly to monthly. Eventually, you’ll need blood tests just twice a year.

Because hypoparathyroidism is a long-lasting (chronic) disorder, treatment strategies are generally recommended for the rest of your life, along with regular blood tests to determine whether calcium in particular is at normal levels. Your doctor will adjust your dose of supplemental calcium if your blood-calcium levels rise or fall.

If calcium in your blood remains low, despite treatment, your doctor may add a prescription diuretic medication — specifically, a thiazide diuretic such as hydrochlorothiazide or metolazone. While some other types of diuretics (loop diuretics) decrease calcium levels in your bloodstream, the thiazides can increase blood-calcium levels.

Most people who are treated for hypoparathyroidism can keep their symptoms under control if they continue to receive treatment long term. Early diagnosis and treatment can help prevent complications of hypoparathyroidism, some of which are permanent.

Did this say to avoid phosphorous-rich food? Oh, oh, there goes one of GMA’s favorite drinks – wine – which has phosphorous.

Complications
By Mayo Clinic staff

Hypoparathyroidism may result in numerous complications.

Reversible complications
The following complications are due to low calcium levels, and most are likely to improve with adequate treatment:

1. Tetany. These cramp-like spasms of your hands and fingers may be prolonged and painful. Tetany also may include muscle discomfort and twitches or spasms of the muscles of your face, throat or arms. When these spasms occur in your throat, they can interfere with breathing, creating a possible emergency.
2. Paresthesias. These are characterized by sensory symptoms of odd, tingling sensations or pins and needles feelings in your lips, tongue, fingers and feet.
3. Loss of consciousness with convulsions (grand mal seizures).
4. Malformation of the teeth, affecting their shape and size.
5. Impaired kidney function.
6. Heart arrhythmias and fainting, even heart failure.

Irreversible complications
Other complications associated with hypoparathyroidism will not improve with calcium and vitamin D treatment:

1. Stunted growth (short stature)
2. Slow mental development (or mental retardation) in children
3. Calcium deposits in the brain
4. Cataracts

Here’s the link to the Mayo Clinic website.

Cable news network CNN gave the same link in its write-up on hyperparthyrodism earlier this year:

So if  hypoparathyroidism is not a life-threatening illness, why the undue haste to go abroad?

Justice Secretary Leila de Lima has noted that three separate requests for GMA’s travel showed various destinations, rendering her confused as to GMA’s real reason and destination.

Here are the three separate requests:

1. October 16 request  to travel to – the United States, Germany and Switzerland.
2. Second travel request to – US, Germany, Singapore, Spain and Italy.
3. October 21 request to DOJ to travel to – Singapore, Germany and Austria.

Notice that in all three travel requests, the travel to Germany is a constant.

Do you recall that in 2007, there was this sudden trip by Arroyo’s husband Jose Miguel a.k.a. Mike to Germany?  With reporters in tow, Mr Arroyo went to a certain bank to prove to one and all that the family had no money there?

Since that incident occurred long before Philippine newspapers started really going online, I could only find tangential references to that event.

You can find the references by clicking here and here. 

Even the German bank officer came out and told the Filipino reporters in tow that the Arroyo couple did not keep any money there.

Hmm. Don’t the Arroyos believe him?

While we ponder on that one and on hypoparathyroidism, let’s watch this seemingly “boneless” man shrink in size as he performs in a street in Paris.

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