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| Sunday, 02 March 2003 |
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| News Business Features Editorial
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When the spirit takes over .... Excerpts from the Presidential Address delivered by Dr. Sunil Seneviratne Epa on the occasion of his induction as the new president of The Sri Lanka Medical Association, in January this year.
Research has now established that people with deep religious commitments have better health and live longer. More and more physical diseases are now becoming amenable to cure through interventions on mind. Effects of mind on skin diseases is one good example. Viral warts can be made to disappear through mere suggestion. How does this happen?. Probably via the process called immune modulation or effects on blood supply. Eczema is another good example. It is common knowledge that stress worsens eczema. Similarly relaxation and meditation improve this condition. Psychological interventions are being increasingly tried out with success in conditions which were not thought to be amenable to such treatments earlier. Infertility and diabetes are only two such examples which are now being treated through psychological intervention. Relief of pain through meditation is another good example.
The challenge we face in the 21st century is to find ways and means of enhancing the healing powers of mind. We have virtually come to the end of the road with our present health model and certainly need to go in a new direction in health. It should be a direction that recognizes the 21st century understanding of body mind interaction. Dr. George Angel from the USA proposed "Biopsychosocial health model" to replace the present "Bio medical health model" which has no provision for a spiritual dimension. An Indian doctor called Dr. Bisht proposed to the WHO to include a spiritual dimension in the definition of health. He called this the fourth dimension of health. So the proposed new definition of health which should read as follows: "A state of complete physical, mental, SPIRITUAL and social well being and not merely absence of disease or infirmity". This in fact marked a significant milestone in the recognition of body mind interaction in health. What we need today is a health model which recognizes this new dimension - the spiritual dimension of health. There is already enough evidence that the trend towards spiritual health has already started in the 21st century. Recommendations I wish therefore to make the following recommendations for recognizing the spiritual dimension in health in Sri Lanka. 1) We need to openly acknowledge the compelling evidence of the existence of the spiritual dimension of health. 2) We need to train doctors and other health professionals at undergraduate and post graduate levels to address this issue. For this we need to make changes to the existing medical curriculum. I am pleased to note that Colombo and Kelaniya medical schools have already incorporated a module on behavioral medicine in their undergraduate curriculum. 3) Relaxation, meditation and spiritual involvement should be recognized as health promoting activities as much as physical activity promotes good health. 4) Patients should be educated on the healing powers of relaxation, meditation and other spiritual practices. 5) These practices are not to be regarded as an alternative to the orthodox medicine, rather to be considered as complementary to it. 6)Hospitals should be made an environment which promotes and nourishes patients' inner capacity for healing by providing appropriate spiritual support. How to manipulate mind for better health should be the theme for a 21st century health model. We should usher in a new health model to replace the 17th century biomedical Health model. I propose to name this new health model as Medicospiritual Health Model. ##################### Medical update..... : thalassaemia care program launched A Thalassaemia and Haemophilia Care Program was launched at the Apollo Hospital Colombo premises during the Haematology Continuous Medical Education (CME) program held by the hospital recently. The program was introduced by Dr. Amal Harsha de Silva, Director Pvt Health Section Development. The Thalassaemia and Haemophilia Care Program is designed to provide comprehensive care at an affordable price for people with Thalassaemia and Haemophilia. The key features of the care program include providing daycare facilities for transfusion of safe blood and blood products, p;eriodic screenings for blood transfusion associated infections and related problems,with a strong emphasis being made on rehabilitation of haemophilia patients with patients with physical disabilities. Counselling service for patients and families is an integral part of the program. Thalassaemia or Beta-Thalassaemia is an inherited disorder of the blood. Patients who have Thalassaemia, have a decreased production of normal haemoglobin, which causes Anaemia. Patients with a severe form, Beta-Thalassaemia major, require regular blood transfusion and drugs to prevent iron accumulation so that they can survive. Current estimates show that over 100,000 patients are born each year worldwide with the most extreme form, Beat-thalassaemia major. In Sri Lanka there are about 2,300 patients with this disease, and with the current birth rate it is approximated that there will be 60 to 80 new cases of the most serious form added each year. Haemophilia is both an inherited disorder of the blood and a bleeding disorder. Patients living with this disease have spontaneous and recurring episodes of prolonged bleeding. These patients develop severe physical disabilities because of repeated episodes of bleeding into their joints and muscles. It has been estimated that there are about 420,000 people living with Haemophilia worldwide with 80 per cent being from developing countries. The majority of people living with Haemophilia in developing countries receive little or no treatment, with most dying before the age of 20 years. Current calculations suggest that Sri Lanka has about 1,000 patients with the most severe form of Haemophilia. Both Thalassaemia and haemophilia are treatable even in their severest forms, but the management of these two diseases in developing countries presents an overwhelming challenge to providers of health and social care. ##################### Myths and facts.... : Alcohol and your health There have been many claims in the press about the miracles that the red wine or other forms of alcohol can prevent heart attacks. This gives the impression that we can take the magic potion and we can eat smoke or do anything we like and still not get a heart attack. Do the benefits accrue only if you drink wine and more specifically red wine? Will grapes or grape juice confer similar protective effects? Should women with high risks of breast cancer abstain? What about pregnancy and breast feeding? Dr. D.P. Atukorale takes a look at the common misperceptions about alcohol and health..... Red wine is the best alcoholic beverage for preventing heart disease. The popular notion that red rather than white wine, beer or mixed drinks is the magic potion has never been confirmed. The bulk of the evidence indicates that any alcoholic beverage protects against heart disease. Researchers have singled out certain substances present only in red wine that may ward off a heart attack. These are called flavonoids which include a subclass of compounds known as phenols and these substances come from grape skins. They appear to act as antioxidants that keep bad LDL cholesterol from forming artery blocking plaques. There is some evidence that flavonoids have an anti-clotting effect on the blood which could protect against heart attacks. Harvard University Eric Rimm MD, one of the leading researchers looking into the connection between alcohol and health however says that the added benefit due to taking alcohol is very small. Studies have shown red wine is not the best alcohol beverage when it comes to staving off heart attacks as the amount of antioxidants in red wine is low, very much lower than what you get in a balanced diet with fruits and vegetables. The quantity of flavonoids in tea is higher than what you get in a glass of red wine. To get the amount of antioxidant protection one has to consume a dangerously large amount of red wine. Myths Alcohol protects against heart disease by thinning the blood Alcohol appears to render "cells" in the blood called platelets less sticky and therefore less likely to aggregate and form a clot in coronary arteries. Alcohol also raises the blood level of HDL (good) cholesterol. HDL level of below 40mg is risk factor for heart attacks. You are okay if your HDL level is above 55 or more is very advantageous. Alcohol raises the risk for breast cancer Alcohol seems to raise the risk of breast cancer in women apparently by raising the level of hormone, estrogen which promotes the development of certain types of breast tumours. If a woman has one or more risks of breast cancer such as a strong family history of breast cancer, or had onset of menstruation before the age of 12 years, first pregnancy after 30, never having children or menopause later than 55, she should not drink. On the other hand if a woman does not have any particular risk factors for breast cancer, yet has heart disease risk factors such as hypertension, diabetes, smoking or high blood cholesterol she might choose not to stop drinking moderately if that is already one of her habits. Moderate drinking means a maximum of two drinks a day The two drinks a day recommendation often made in reference to men is not appropriate for women, older people and those taking prescription drugs and over the counter medications that do not mix with alcohol. Women are not supposed to have more than one drink daily according to U.S. Dietary Guidelines for Americans. Because women have proportionately more fat and less water than men, so alcohol does not get diluted in their bodies. Women also have less of an enzyme called alcohol dehydrogenase that breaks down alcohol before it reaches the blood stream and so it is more likely to go their heads. Many old people as well as significant proportion of middle-aged men and women take medications that do not interact with alcohol. Certain heart drugs can combine with alcohol to make blood pressure drop precipitously, causing giddiness and faintish feeling. Drinking also increases the risk of gastrointestinal bleeding in people who regularly take aspirin like arthritis patients. Beyond two drinks a day alcohol affects the heart In case of men, drinking more than two alcoholic beverages a week, the risk of death from other illnesses appear to go up sharply. In case of men, they have a greater chance of dying from several different types of cancer, including cancer of oesophagus and stomach and perhaps cancer of colon and rectum as well. They might also be more likely to get a stroke. Cirrhosis of liver, falls also increase. Other effects Consumption of large quantities of alcohol can result in hypoglycaemia (lowering of blood sugar) which may follow even 30 hours after ingestion of alcohol. Hypoglycaemic if not successfully treated in time, can result in brain damage. Alcoholics are more prone to infection and alcoholics have low serum albumin. Continued alcoholic intake produces alcoholic liver damage and after about six years of chronic abuse, alcoholic hepatitis can develop which progresses to alcoholic cirrhosis if alcohol is not discontinued. Chronic and acute pancreatitis (inflammation of the pancreas) are frequent in people who drink alcohol regularly. ##################### Pollution from motor vehicle fumes by Dr. D. P. Atukorale In Sri Lanka motor cycles, scooters, three-wheelers, most cars and vans are powered by petrol engines. A significant number of cars, almost all heavy vehicles, buses and machinery are diesel driven. In future there could be an increase in the number of diesel powered cars as the diesel engine is much improved and also because of the cheaper cost of diesel fuel. There is a misconception among majority of the Sri Lankans that exhaust fumes from diesel engines are a bigger danger to the health than fumes from petrol vehicles. The following article shows that fumes from petrol vehicles are more deleterious to health than fumes from diesel fumes. Exhaust fumes The nature of exhaust fumes from petrol engines differ from that from diesel engines. In petrol engines, the fuel is ignited by a spark and is burnt in an inadequate quantity of air. As a result, fumes from petrol engines contain a poisonous gas called carbon-monoxide. Although leaded petrol was used by majority of owners of petrol driven vehicles until recently, causing subclinical lead poisoning, thanks to the Sri Lanka Petroleum Corporation, both grades of petrol available in Sri Lanka at present are unleaded. In addition to above chemical fumes from petrol vehicles contain hydrocarbons produced as a result of chemical reactions taking place in the engine. Hydrocarbons are also formed due to feeding of excess of fuel. Some hydrocarbons especially the olefines take part in chemical reactions in the presence of ozone and oxides of nitrogen and strong sunlight resulting in peroxyacyl nitrates which cause lacrimation (tearing of eyes). Narrow crowded streets, bus stands, large car parks, three wheeler stands and other places where traffic congestion occurs may contain significant quantities of CO in the air causing subclinical CO poisoning. Atmosphere pollution due to CO, hydrocarbons and peroxyacyl nitrates is more common in urban and suburban areas than rural areas. To summarise the most important poisonous chemicals emitted by petrol engines is carbon monoxide (CO) gas. The amount of CO in the blood depends on the duration of exposure to petrol fumes. CO forms a chemical compound called carboxy-Haemoglobin (COHb) by combining with haemoglobin (Hb) thus reducing the amount of Hb which can carry oxygen into vital organs of your body, causing hypoxia (lack of oxygen) to vital organs. Other common cause of hypoxia due to COHb is smoking. In smokers the blood level of COHb is between 5-15 per cent. But in non smokers the level of COHb rarely exceeds 3 per cent. But in non smokers exposed to petrol fumes the level of COHb can be very high and in smokers the level of COHb can be very much higher than 15 per cent causing severe hypoxia to vital organs. Effects High concentrations of CO in the blood can cause impairment of perception and performance of fine tasks and thus interfere with decisions taken during driving because of hypoxia to the brain. CO and other gases such as hydrocarbons in petrol fumes can increase symptoms such as dyspnoea (Difficulty in breathing) in patients suffering from respiratory diseases such as bronchial asthma and bronchitis. Exhaust fumes from diesel engines on the other hand do not contain significant quantities of CO. In diesel engines the air is compressed to a high degree and the fuel is injected as a very fine spray which self-ignites in an adequate quantity of air and the exhaust fumes contain only a trace of CO. As in case of petrol engines, diesel engines too emit oxides of nitrogen due to fixation of atmospheric oxygen and nitrogen in the combustion chambers of the engine at high temperature and pressure and nitric oxide predominates. If a diesel engine is over loaded or maladjusted it may emit soot containing fine carbon particles which are mixed with small amounts of polycyclic hydrocarbons. Even a good diesel engine may emit a small amount of smoke when starting. Exhaust fumes from diesel engines have a more disagreeable odour than fumes from petrol vehicles. When a diesel engine is started, it emits fumes containing polycyclic hydrocarbons which are potentially carcinogenic. Soot emitted by diesel engines is more offensive to the nose, eyes and sinuses when compared to petrol fumes. As far as I am aware polycyclic compounds and oxides of nitrogen and sulpher dioxide emitted by diesel engines do not cause serious problems. To conclude fumes from petrol engines are more dangerous to health as these cause CO poisoning unlike diesel fumes. People like traffic constables, people living in congested streets and schoolchildren should be protected from the dangers of vehicle fumes. Very old vehicles which are not roadworthy should be prevented from using public roads. ##################### You & Your Doctor by Dr. Sampath Nanayakkara Suspected Hernia Q. I suspect having Inguinal Hernia please let me have the following information: What is Inguinal Hernia ? What are its symptoms ? Could I get a relief without undergoing an operation? If I ignore Hernia ? what would happen to me? Is there any laboratory test to identify Hernia? - S. MATHEW Inguinal Hernia Q I am 65 years old. My doctor suspects me of having Inguinal Hernia. Can I get it cured by using a Hernia Belt? If I ignore this what will happen to me? - A. S. FERNANDO A: Hernia means protrusion of any body structure through the walls which are intended to contain it. (a) Inguinal Hernia is protection of the structures behind your lower part of the abdominal wall in the groin through the INGUINAL CANAL (the passage through which the spermatic cord runs upwards from the testicles to enter the body.) Hernia may even enter the scrotum of that side and becomes a huge scrotal hernia one day. This form of Hernia is called Indirect or Oblique - inguinal Hernia. The second form is called "Direct", and is less common and smaller than Indirect, as a rule. It tends to bulge outwards than running inward and downward to the scrotum "Direct Inguinal Hernia' can be associated with strain such as cough, lifting heavy objects and straining at stools. The only symptom you may get is bulging lump seen in your groin which becomes larger when straining and coughing. All inguinal Hernia are best treated by operation. A hernia belt or "Truss" is indicated only in special situation decided by the doctor. It is absolutely essential that a doctor examines the Hernia and advises on the best course of action. If you ignore a hernia it will gradually becomes larger and larger and likely to undergo "Strangulation". If a loop of bowel is present in the hernial sac, obstruction of the bowel is a common complication. No Lab test or X'ray or Urine test can confirm diagnosis which could be done only by clinical examination. |
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There is now a lot of interest on the subject of meditation. This seems
to be a way to manipulate body mind interaction in a favourable direction
to achieve better health. This brings us to a whole new dimension in
health - spiritual health spirit is something difficult to define, yet all
of us can perceive it. Faith beliefs, emotions, aspirations all constitute
the spirit of an individual. In fact some people believe that it is the
spirit that distinguishes us from animals.
What we now need is to acknowledge the fact that patients have what is
called inner resources of healings or inner healing capacity. This is the
power of mind in healing.
