History of cardiac rehabilitation in Sri Lanka
by D. P. Atukorale
Cardiac rehabilitation in Sri Lanka dates back to about 1973 and Dr.
N. J. Walloopillai can be considered as the father of cardiac
rehabilitation program in our country.
 He made arrangements to send a physiotherapist to U. K. for special
training in cardiac rehabilitation and made arrangements to have
facilities for rehabilitation in the Coronary Care Unit (CCU) and
Intermediate Coronary Care Unit (I.C.C.U.) and the third floor of
Cardiology Unit for rehabilitation work and he made use of two
physiotherapists to help the patients to start cardiac physiotherapy in
1973.
When I started my training programmes in the National Hospital (NHSL)
in 1964, all the myocardial infarction patients (heart attack patients)
were given strict bed rest for about six weeks and the V. P. in charge
of the medical ward told me that the heart attack patients who
"disobeyed the ward rules" and walked to the toilet at night faired
better than those who followed our instructions to the letter.
This was in 1964. Those patients who were confined to beds for 6
weeks, faced period of invalidism and majority of them were cardiac
neurotics for remainder of their lives. Cardiac rehabilitation program
had not been started during that time at N. H. S. L. I was trained in
cardiac rehabilitation for the first time in the Department of
Cardiology, Manchester Royal Infirmary (M. R. I.) in 1971.
Here I saw how uncomplicated heart attack patients were made to sit
out of CCU bed, on the second or third day of the heart attack, and they
were shifted to the "normal" cardiology wards on the fourth day.
The cardiac physiotherapists started their physiotherapy (breathing
exercise and hands and leg movements etc) on the first day of the
infarct and the patients were discharged from the M.R.I. on sixth or
seventh day of the infarct.
When I returned to Sri Lanka in 1973 October, Dr. Walloopillai (N.J.W.)
had already started cardiac rehabilitation and cardiac rehabilitation
was just "soft sailing" for me at that time.
In 1973, we in Sri Lanka did not have very successful coronary artery
by-pass surgery (CABG), balloon angioplasty (PTCA), stenting etc.
I wrote the first booklet on "After A Heart Attack" in 1974 and about
10,000 copies of this booklet which devotes a portion of the booklet for
cardiac rehabilitation were distributed in all three languages, free of
charge.
This booklet gave an account of (a) as to when the heart attack
patients can get back to their jobs; (b) what kind of foods should you
eat; (c) what type of exercises the patient can take; (d) how to avoid
stressful situations; (e) how to get over insomnia and depression after
a heart attack (f) how to avoid another attack and (g) how to tackle
your cardiac risk factors.
The booklet, too, gave an account as to (a) when a heart patient can
have sex life (with his or her partner) (b) when he or she can get back
to his or her job (c) when he or she could start driving (d) when the
patient can start taking exercises such as walking, bicycling, swimming,
tennis, badminton etc, (e) when the patient can go on a picnic or a
holiday (f) when the patient can safely fly.
The booklet also stressed the importance of regularly checking
patient's blood pressure (b) regularly checking his or her blood sugar
(c) regularly checking his or her serum cholesterol (LDL and HDL) and
serum triglycerides (d) maintaining an ideal weight (BMI). Heart attack
patients were advised to avoid a heavy dinner and unlike UK patients we
discouraged them from taking alcohol in moderation.
E.C.G.'s and 2D - Echocardiograms were regularly done in all
patients. We encouraged our heart attack patients to ask questions and
advised them to write down their questions when they see us. We
encouraged the patients to see their family physicians if they have
their own GPs, if have any cardiac problems.
Smoking (cigarettes, pipes, beedis and cigars) are completely banned
after a heart attack. In the same way chewing betel with tobacco is
fully banned, after a heart attack.
Coronary Angiography, Angioplasty (PTCA) and Coronary Artery Surgery
(CABG) are performed by cardiologists and cardiac surgeons more and more
frequently now, as these are very safe procedures now and are performed
both in private sector as well as in government hospitals. Out of these
procedures PTCA (including stenting) is very expensive.
Returning to work
Not all patients after cardiac rehabilitation choose to return to
work. Those who can return to work benefit psychologically, socially and
financially. The possibility of returning to work after hospitalisation
is influenced by a number of factors, including the patients age,
motivation, medical condition, satisfaction with his or her job and the
amount of physical activity that is involved in the job.
Some cardiac patients decide to return to work on a part time basis
or find a job that is less stressful or requires less physical exertion.
The future
After a heart attack it is by no means certain that you will have
another heart attack. You can avoid having another attack by observing
the following rules:-
(a)Keep your weight down to normal or below for your height and age.
(b) Stop use of tobacco completely.
(c) If you have hypertension or diabetes keep a watch on your
pressure and blood sugar.
(d) If your blood lipids (fats) eg. LDL cholesterol, triglycerides
are high or if your HDL (good) cholesterol is too low, follow the advice
of your physician or dietician.
(e) Keep off those who want to make you a permanent invalid and
advise you to take it easy for the rest of your life.
(f) Do not put your faith in drugs as at present most of the drugs
used has no influence on atherosclerosis and restoring youthfulness to
coronary arteries.
(g) Extra - marital sex is best avoided after a heart attack
(h) Keep yourself fit and active in mind and body
(i) If you have not got back to your job two months after an
uncomplicated heart attack it is advisable to change your physician or
cardiologist. You must consider a heart attack as a signal that there is
something very much amiss with your pattern of living and as an
opportunity to make the necessary changes in your way of life.
New year resolution: Stay healthy with right diet
by Shanika Sriyananda
The dawn of a new year knocked the doors of yours' few days ago.
Welcoming 2008 with fresh hopes, you wished every one whole heartedly.
Surely you had made some new year resolutions to make your life and the
family better.
 Wish for peace would be the utter most priroty in your list. Just a
minute... did you think 'Good Health' as another priorty in your
resolutions for 2008? If not, here is a chance to refresh your thoughts
to make your 'Health' more 'HEALTHY'.
You may have different versions of ideas about what is good health.
When talks about good health, one may think that a person who does not
smoke, eat less and active more would be the role model for a healthier
person. But remember all those who practise these habits are not
healthy.
You need to do more to become healthy, which define by nutritionists.
Then who is a healthy person? According to Dr. Renuka Jayatissa, the
Nutrition Specialist of the UNICEF, a person who is active and is able
to maintain a balanced weight according to his height can be called a
healthy person.
Busy and tight work plans which make most of people lazy to walk or
engage in some sort of physical activity is one of the main causes for
the unhealthy population in the world around. "Those who work less and
engage in professions with less physical activities should be take care
of their eating habits more", she warned.
According to Dr. Jayatissa having three meals a day is compulsory for
better health but these three meals should contain enough nuritents that
needs the body for a day. "The breakfast is the most important among all
and a light diet is ideal for lunch. But the most important factor is
having variety of food items with different compositions", she said.
She said that it is necessary to avoid over boiling vegetables to
avoid losing of Vitamin C and folic acid and also active men should have
a larger portion than women and children.
Above management of good health through proper maintainance of body
weight and height putting an end to smoking -the toxic cocktail - which
is found to be the NO 1 cause for many disaterous evils is a must in
one's life to face a better future. It is found that smoking accounts
for one in four cancer deaths and kills five times more people than road
accidents, overdoses, murder, suicide and HIV all put together world
wide.
Think twice before you put your plate forward for the second
helping", Dr. Jayatissa advised. She said that one need not fill the
plate with lots of stuff. Fruits will play a major role in your life and
eating lots of fruits will bring better results.
It is simple - Walk every day. The aim should be to do around 10,000
steps which equates to around 60-90 minutes of walking. On the way to or
from work, shops, or meetings, leave the car or public transport a bit
short of your destination. In the office, use stairs rather than the
lift.
A total of one hour per day on most days of the week of moderate
intensity activity (walking). 30 minutes of moderate activity is
sufficient for cardiovascular/metabolic health, but not for all health
benefits.
Physical activity
* Just adding a little movement to your life can:
* Reduce the risk of heart disease, stroke and diabetes.
* Improve joint stability.
* Increase and improve range of movement.
* Help maintain flexibility as you age.
* Maintain bone mass.
* Prevent osteoporosis and fractures.
* Improve mood and reduce symptoms of anxiety and depression.
* Enhance self esteem.
* Improve memory in elderly people.
* Reduce stress.
So, even if you opt for small changes and a more modest weight loss,
you can see the benefits are still pretty good. One study has found that
just a 10% weight reduction helped obese patients reduce blood pressure,
cholesterol and increase longevity.
****
Be happy to live healthy
People who are happier in their daily lives have healthier levels of
key body chemicals than those who muster few positive feelings, a new
study suggests. This means happier people may have healthier hearts and
cardiovascular systems, possibly cutting their risk of diseases like
diabetes.
Previous studies have shown that depression is associated with health
problems compared to average emotional states. But few studies have
looked at the effects of positive moods on health. Now, researchers at
University College London, UK, have linked everyday happiness with
healthier levels of important body chemicals, such as the stress hormone
cortisol.
"This study showed that whether people are happy or less happy in
their everyday lives appears to have important effects on the markers of
biological function known to be associated with disease," says clinical
psychologist Jane Wardle, one of the research team "Perhaps laughter is
the best medicine," she adds.
"This is the best data to date that associates positive emotional
feelings with good effects on your health," says Carol Shively, at Wake
Forest University Baptist Medical Center in Winston-Salem, North
Carolina, US. "We usually concentrate on things that are either bad or
wrong, rather than good or right."
The team studied 216 middle-aged men and women living in London, UK,
who are part of the ongoing "Whitehall II" study of thousands of civil
servants, led by Michael Marmot.
This subset was asked to rate how happy they had been feeling in the
last five minutes at about 33 points during their working or leisure
days. At these points, their heart rates and blood pressures were also
measured by an automated system.
Saliva samples were also taken from the volunteers at eight points
during a working day and a leisure day to test levels of the stress
hormone cortisol.
On one occasion, the subjects were invited into the lab and given a
"mildly stressful" task to perform while their biological responses were
measured.
The team controlled for factors such as socioeconomic position, age
and gender to try to tease out the effects of happiness alone on health.
"The happier you were, the lower your cortisol levels during the
day," says Wardle. "For men, but not for women, the happier you were the
lower your average heart rate was."
Cortisol is a stress hormone of which high levels are linked to
conditions such as type II diabetes and hypertension. And lower heart
rates are associated with good cardiovascular health. |
