First encounter with Fluorosis
My first encounter with examining a serious skeletal fluorosis case
I returned to India in January of 1968 after finishing my training in neurosurgery in England and United States of America. On coming back, I joined Osmania Medical College as assistant professor of neurosurgery and as a neurosurgeon at Osmania General Hospital.
Within a few weeks after my joining I saw a middle aged person hailing from Nalgonda with weakness in all four limbs. He had great difficulty in walking and had also became bedridden. On examining him I found that the he had a spinal cord compression in his cervical region which was confirmed by doing a cisternal myelogram. Back then in the late 60’s CT and MRI scans had not been invented and doing a cisternal myelogram was the only way of investigating a diseases that affected the spinal column.
X-Rays of forearm bones confirmed that the patient had been suffering from skeletal fluorosis. The patient had developed a bony overgrowth from the bones in the vertebrae which was causing a compression of his spinal cord. The only treatment available for such a case is operative removal of spinal cord compression. I operated upon this patient with great difficulty. He improved remarkably and was able to walk without support but had spasticity of the limbs so it was difficult to get him to be completely normal.
I can say that he was relatively lucky as at least he was able to walk post operation!
But not all patients with a spinal cord compression are suitable for surgery. Some of those who are in poor general health cannot withstand the surgery. Some have extensive compression of the spinal cord from neck down to lower back and need multiple operations which they refuse.
This was my first encounter with a skeletal fluorosis case. Since then I have carried out around 400-500 skeletal fluorosis operations. I also got closely involved with INREM Foundation, around 6-7 years ago, who have a field program on fluorosis in Jhabua, Madhya Pradesh, essentially to see which interventions worked for helping arrest the disease.
It’s been an exciting involvement in trying to find out what works and what doesn’t in reducing the disease’s burden. With INREM Foundation becoming the secretariat for the Fluoride Knowledge and Action Network to rally people around to work on the issue nationally, it gives me further hope for the Fluorosis affected in the country.