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| Sunday, 8 December 2002 |
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Features |  |
| News Business Features Editorial
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compiled by carol aloysius When your limbs go lifeless... Strokes affect thousands of people everywhere. In Sri Lanka the number
of stroke victims has increased significantly in recent years. In the following article, Lasni de Alwis, a speech pathologist and audiologist discusses some of these speech impairments and most importantly the importance of early interventions to rehabilitate the patient. Stroke is an interruption in blood supply to any part of the brain due to narrowed, blocked or ruptured arteries. This deprives a part of the brain of required oxygen and nutrition. Subsequently the affected cells die, thereby damaging the brain. Who can get a stroke? Abrupt onset of sickness on one side of the body, in the face, arm or leg. Sudden loss of sensation on one side of the body, in the face, arm or leg. Sudden loss of vision in one eye or double vision. Sudden loss of ability to speak, find words and understand others. Sudden onset of unsteadiness, dizziness or falling without any apparent cause. These are the symptoms of transient ischemia attack, or temporary stroke, which usually disappear within 24 hours. If you ever experience or know of someone who has experienced any of these symptoms consult a physician specialising in brain disease immediately. Disabilities Common physical impairments associated with stroke are weakness or paralysis of limbs, loss of sensation for pressure, pain and temperature, inability to see things on the left/right side, impaired swallowing leading to aspiration of food and paralysis of speech related muscles leading to Dysarthria (difficulty in speaking). Stroke is also associated with change of behaviours and linguistic disabilities. Dysarthria.... Patients with Dysarthria speak slowly and their speech is not very precise. Speech language pathologists specialise in communication can help these patients to speak clearly and slowly. Aphasia inguistic impairment.... Aphasia is an impairment in the ability to use language in strokes, where the patient cannot express himself or herself and/or understand others. An aphasic patient can experience difficulty in one or many language functions, such as comprehending written and spoken language, speaking, writing and reading. No two aphasic are alike. One should not confuse language impairment due to Aphasia with the loss of intelligence. The patient has not lost the ability to think and reason. Rehabilitation Once a stroke has occurred, there may be spontaneous recovery of lost functions in some patients while others are left with serious physical and communication problems. Rehabilitation is the most important remedy available for stroke patients, particularly for those who will not completely recover on their own. Rehabilitation is most effective if it is started immediately after the stroke. It improves the quality of life of patients by teaching them ways to overcome physical disabilities and promoting their channels of communication. Early rehabilitation prevents the progression of disability while the speech pathologist helps the patient to overcome his or her communication disability. The physiotherapist and occupational therapist helps patients to overcome their physical disabilities. &&&&&&&&&&&&&& How long can cooked food be preserved? In Sri Lanka food is usually served after cooking, sometimes immediately after, and sometimes several hours later without subjecting it to any form of temperature control. Some people shun meals cooked for mass catering, on occasions like 'Dhana', certain festivals, and even some occasions like parties. Asked why, they usually reply that foods served on these occasions do not agree with them. The truth is that the food they have eaten has been contaminated. The contamination could have been prevented if the time - temperature link knowledge is given to those who prepared the food. Usually, in a typical home food preparation for a party or a 'Dhana' intended for a large number of people, quite a few number of dishes are prepared (cooked) or preparation of ingredients, like meat, fish etc done in the previous night. Dishes prepared in the previous night are kept for service for over six hours under room temperature before serving and meat and other potentially hazardous components of some dishes are kept under room temperature for thawing. These are ideal conditions for proliferation of pathogenic organisms and hence the food poisoning. It should therefore be remembered that food intended for serving after several hours of preparation, should be cooled quickly to 20 degree celsius within 2 hours and to 4 degrees celsius within additional four hours and stored. The food so stored should be re-heated to a minimum internal temperature of 74 degrees celsius before service. If a facility for the above procedure is not available, food should be cooked, so that it could be served as quickly as possible. In any case, food so prepared should not remain in the ambient temperature for more than 4 hours. &&&&&&&&&&&&&& Scourge of Hepatitis B The Lankan scenario A hepatitis B vaccine will be introduced into routine infant immunisation from Jan 1, 2003 Viral hepatitis is endemic in all parts of the country. It is a notifiable disease. The average annual rate of admission to government hospitals was 57 per 100,000 population in 1991, 47.6 per 100,000 population in 1994 and 14.5 per 100,000 population in year 2000. The hospital mortality rate from viral hepatitis is around 0.4 per cent - 05 per cent. However, a large number of hepatitis cases are unreported as most do not seek hospital admission for the disease. The majority of cases notified from hospitals are hepatitis A and this is the commonest type of viral hepatitis in the country. Serological surveys among general population and special groups have found that the presence of HBV is not common in Sri Lanka although located in a region where HBV infection is highly prevalent. Data from several studies carried out by Central Blood Bank shows that HBsAg positivity among its blood donors range from 0.1 per cent - 0.7 per cent. Therefore Sri Lanka is considered a low endemic country for HBV infection. A study carried out by the Epidemiological Unit in 1993 in districts of Kandy, Hambantota and Kalutara found sero-prevalence in the community to be 0.24 per cent. None of the health care workers and pregnant women in the sample of this study were found to be HBsAg positive. Hepatitis is defined as inflammation of the liver. Identified viruses such as A, B, C, D, E, G are the major causes of the disease. Inflammation of the liver caused by these viruses is called viral hepatitis. Hepatitis B viral infection is caused by hepatitis B virus which is a double stranded enveloped DNA virus belonging to Hepdnaviridae family. Modes of transmission HBV is similar to HIV in its primary routes of transmission. But it is 100 per cent more infectious than HIV. The hepatitis B virus is transmitted to a non-infected person by either skin puncture or mucous membrane in contact with infected blood or other infectious body fluids from HBV carriers or from those with acute infection. The highest concentration of virus is found in blood. Other body fluids such as semen, saliva, wound secretions and vaginal fluids are also known to be possibly infectious. HBV is NOT spread by air, food or water Child to child transmission - Spread through sores or breaks in skin or mucous membranes in contact with infected blood or other secretions Can spread through bites via infected saliva Can spread through inanimate objects containing infected secretions e.g. shared towels, tooth brushes etc, from an infected child through skin puncture or mucous membrane of uninfected children. This may occur in household settings, child care centres and pre schools Parenteral or permucosal - Through unscreened blood transfusions Re-use of poorly sterilized/non sterilized contaminated medical/surgical/dental equipment in all invasive procedures IV drug users sharing needles Sexual contact - Unprotected sex with an infected partner HBV infection can be acquired at any age. Symptoms Clinical features of acute hepatitis B infections are indistinguishable from those of other forms of viral hepatitis. According to WHO classification, a suspected case of acute viral hepatitis is an acute illness typically including acute jaundice, dark urine, anorexia, malaise, extreme fatigue and right upper quadrant tenderness. The incubation period of acute hepatitis B infection range between 6 weeks to 6 months. Persons infected with HBV have both short-term and long-term outcomes. Effects of chromic HBV infection 1. Chronic hepatitis, 2. Cirrhosis, 3. Hepatocellular Carcinoma Chronic hepatitis can progress to cirrhosis of liver and those with cirrhosis are at high risk of developing hepatocellular carcinoma. The age at which a person becomes infected with HBV is the main factor that determines the risk of developing chronic infection. Diagnosis of hepatitis is usually done with liver biochemistry (serum AST, ALT, GGT, Bilirubin) and haematological tests such as prothromibin time, are at times useful. Prevention Practice of Universal Precautions with regard to all invasive procedures and selection and screening of donated blood for HBV markers will minimize transmission of the virus through this mode. Practice of safe sex is expected to prevent the sexual spread of hepatitis B infection. Immunization with hepatitis B vaccine has been proved to be one of the most effective methods of prevention of HBV infection through all its modes of transmission. At least 85 per cent-90 per cent of HBV associated deaths are vaccine preventable. This vaccine is the first and currently the only vaccine against a major human cancer; hepato cellular carcinoma How HBV spreads * HBV infection is caused by hepatitis B virus * Approximately one third of the global population is infected with hepatitis B virus * This virus is transmitted through punctured or broken skin/mucous membranes of a non-infected person, in contact with blood or other body fluids of an infected person. * Perinatal, child to child, parenteral and sexual are the main routes of transmission of hepatitis B virus. * Chronic hepatitis, cirrhosis, Heparocellular carcinoma are the main sequalac of chronic HBV infection. * Age of infection is one of the important factors which deter mines the risk of development of chronic infection. * Hepatitis B vaccine has been proved as one of the most effective method of prevention for HBV infection. Immunization strategies Most of the serious consequences of HBV infection occur among persons who are chronically infected. Also, patients with chronic infection serve as the main reservoir for the transmission of new infections. The principal objective of hepatitis B immunization strategies is, therefore, to prevent chronic HBV infection. Routine infant immunization Primary purpose of infant vaccination is the prevention of chronic HBV infection. Therefore, routine vaccination of all infants as an integral part of national immunization schedule has been given high priority. (Health Education Bureau) &&&&&&&&&&&&&& Bio-energy: key to longevity Ayurveda Ancient Acarya Charaka says that, "Ayurveda has no limit, it is capable of indefinite expansion or progress." Charaka Sutra 1.25. According to the Ayurveda Act of 1961 - No. 31, "If there is any Indigenous Traditional System of Medicine in Eastern World that is Ayurveda."
One ola leaf (Puskola potha) belonging to my father which is from ancient Sinhalese medical lore from Udarata Kalubululanda Rajamahavihara Palugama Veda Paramparawa says that this Bio-energy Treatment is 'Bala Chikitsa.' Thus the best cure should be the one which would be physiological in approach and in tune with the Nature. It should work through the inherent natural healing power of the body. This is called Bio-energy which draws on natural energy for healing and regeneration as against artificial or synthetic drugs that have adverse effects. The correct treatment should not act against Nature, blocking natural pathways, in the body or destroying commensal bacteria, which occurs as side effects, of allopathic drugs, such as Beta Blockers, Calcium channel blockers and Antibiotics. Natural herbs which the Ayurvedic approach advocates is entirely without side effects. The cure in Ayurveda Science, started with this fundamental view in all schools of medicine throughout the world. Unfortunately, in the middle ages, the resurgence of allopathic medicine has progressively influenced the life sciences and greatly undermined the role of life processes and bio-energy. This led to the development of chemical drugs and surgical interventions as main tools of cure. The growing awareness about the limitations of this kind of medicare system in recent time is proving to be a turning point in medicine and more attention is now being paid towards the holistic bio-approach. This bio-energy treatment can be used to cure many disease such as: 1. Diabetes Condition of the body - * Ischemic Heart Disease 5. Degeneration of macula as a regeneration of treatment Dr.Rathnapala Bangama Arachchi (Ayurvedic Physician) What are probiotics? Probiotics are live micro organisms which, when consumed in adequate amounts as part of food (including water), confer health benefit on the host. 'Probiotic literally means 'for life' and is currently used to name bacteria associated with beneficial effects on humans and animals. The theory was first suggested by a Russian born scientist (Nobel Prize winner) Eli Metchnikoff at the beginning of the last century. He suggested that 'The dependence of the intestinal microbes on the food makes it possible to adopt measures to modify the flora in our bodies and to replace the harmful microbes by useful microbes.' &&&&&&&&&&&&&& You & Your Doctor 'Mistaken diagnosis' Q: I'm a 56 years old male. Ever since I retired from my job in a government department, I have been feeling very lethargic, and tend to lose my temper often. I have also lost my appetite. I cannot sleep at night, and have no interest in work, in any other activity. I feel sad, hopeless, and dejected all the time. Before I became dejected I developed aches and pains in my joints, and had backache, headache and numbness of my leftarm. I was treated by various doctors with diclofenalsodium, Famotidine, and some injections into my knee joint etc. I am still on the drugs. Doctor, don't you think, my present problems are due to the side effects of those drugs? Would you explain what's wrong with me? What should I do now to overcome my problem? - Worried A: Going through your history, it is obvious that you are having a "non-physical" illness - most likely A Depressive Disorder (or depression). Even those symptoms you developed at the onset of your illness could have been that of depression itself. I'am sure your present symptoms are not the side effects of those drugs you have taken already. The root cause of your illness is in the mind, but the presentation of the symptoms, as any other disease, is through the body. Apart from the symptoms you have mentioned in your letter, a list of symptoms a depressed patient usually encountered, is given below - . Dejected appearance and distractability, feeling worthless of oneself, poor concentration in your work, thinking that he is guilty of anything that goes wrong around him, patient believes he is an unwanted burden on society and family, giving exaggerated account of an existing illness, suicidal thoughts, excessive drinking of alcohol, smoking or eating as a cover up for his illness. There is also a condition called "Manic Depressive Psychosis" where the patient's mood swings between elation (extreme happiness) and sadness. Usually in most individuals the expression of depression is masked by complaints which appear to be biological like anorexia, constipation, poor sleep, joint aches and "feeling unfit." There are drugs for your illness which are called "Antidepressant" Drugs - which has to be continued for very long periods under the supervision of a Doctor. Self medication is very dangerous because of the serious side effects. Some drugs even cause impotence, irritability, dry mouth, blurred vision etc. ECT (Electro Convulsive Therapy), commonly known as applying electric current to the head, is also one of the accepted treatment, specially for patients with suicidal tendency. As I said earlier root cause lies in the mind, which may be a "Traumatic Painful Memory" in the past. It is more rational to explore of "unconscious part" of the mind by a method such as "Clinical Hypnosis." Drugs cannot enter the mind and they can only alleviate the symptoms of depression. Therefore recurrence of the illness is a rule unless drugs are being used for a very long period-may be for years. Dr. Sampath Nanayakkara |
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Tragically,
as hospital admission statistics reveal, an increasing number of young
people in the 20's and 30's are now falling victims to strokes or brain
attacks, described as the second largest killer disease in the world.
Apart from the serious physical disabilities including paralysis that
follow a stroke many patients also suffer from various language
disabilities.
Bio-energy is a very important concept in Ayurveda for the cure of many
diseases. The changing concepts of health and disease in recent years and
an emergence of divergent views on the total understanding of life
processes have demonstrated that the cure of an ailment is no longer, the
sole responsibility of the physician or surgeon.
