Health wise

Paediatric leukemia:

Bone marrow implant best therapy

by Harshini PERERA

Linear Accelerator used in the diagnosis of cancer

Leukemia has no favourites - age, gender or poor do not matter. There are so many tragedies to which most of us turn a blind eye, but we cannot avoid the stark realities of life.

Leukemia is cancer of the blood which strikes mostly children compared with other cancers. The Consultant Oncologist who has specialised in National Cancer Institute of Maharagama, Dr. Prasad Abeysinghe, who has specialised in paediatric oncology elaborated on acute Leukemia which most of the children suffer from.

There are two types of leukemia identified in Sri Lanka as well as in the rest of the world. The acute leukemia and chronic leukemia and mostly children suffer from acute leukemia, which is known as an unusual growth of white cells in the bone marrow which will thereafter enter the main blood stream. If not treated it has the potentiality to make the patient's condition worse. Chronic cancer, though they are slow in progression and showing symptoms, can become a deadly cancer.

Among the types, Acute Lymphoblastic Leukemia(ALL) is the commonest among children. Since the production of immature blood cells (white cells) are high and red cells and plates would not be able to do their job of producing oxygen to cells. Therefore, children with symptoms like anaemia (a condition in which the number of red blood cells is below normal), easy bleeding is common because of the less number of plates. So, those children suffer mostly with fatigue, easy bruisibility such as gum bleeding or red spots under the skin, easily prone to infection as it spreads down the central nervous system.

He explained the possible risk factors, like family history, in which case, even an identical twin has a 20% risk of getting cancer if one of them has been suffering from the same radiation exposure during pregnancy or during early childhood too can lead to leukemia after being exposed to certain chemicals and the use of anti-cancer drug or chemotherapy can also lead to leukemia. Some children especially those who suffer from Down Syndrome can also be afflicted with leukemia.

"The treatment of leukemia, is done in phases. In the first phase few investigations are done, like a full blood test, bone marrow biopsy, cytogenetic analysis or immunostain. Then in the first phase, Induction therapy is started to put the leukemia into remission. For this, we categorise patients as low risk and high risk considering the results of the tests. Since 2006, we had been practising a tailor-made treatment for every leukaemic patient". Dr. Abeysinghe said. But from 2006 onwards on an initiative by a senior consultant, this new specialisation came into effect which has shown extraordinary results.

"Then in the second phase, consolidation is being done to prevent the spread of leukemia cells or the regrowth which may cause a relapse. In the third phase, maintenance will be carried out to kill any remaining leukemia cells. Although the final phase is given less intensive treatments." he explained further.

At the same time he said that parents' support during the period is essential while counsellors would help them in their distress. Even though, they will be treated fully and show no symptoms, it should be followed up during their entire life because leukemia is a disease which can result in a second malignant.

There are late effects in some these treatments. Some can suffer from malfunctions due to the radiation therapy. Specially, women who are treated for leukemia they tend to develop breast and thyroid cancer, in the long run. For some patients fertility issues may arise in their future. Therefore, the consultants are very much concerned on the minimal use of drugs which can cause infertility. Dr. Prasad Abeysinghe stressed the use of follow up tests to prevent the relapse of leukemia.

Examination of a sample

Childhood Acute Myeloid Leukemia (AML)is the other type of cancer in which the bone marrow produces a large number of unusual blood cells. This creates at the Cancer Institute. Because Sri Lanka do not facilitate bone marrow transplantation, a must in the treatment of AML.

Though an expert team including dedicated oncologists, haematologists, pathologists, microbiologists, radiation oncologists, paediatric surgeons, anesthetists, paediatric nurse specialists, nurses and other staff to tackle leukemia at the National Cancer Institute, the absence of bone marrow transplantation facility had become a serious problem in the treatment of patients. "We have no space in the wards and in one section which can take only two patients at a time is shared by four patients including their parents. Since they suffer from leukemia, with their immune system malfunctioning, the body is not resistant to infections, which has become a cause for infections." he said further.

The National Cancer Hospital has a ICU for children and a new linear accelerator, quite helpful in diagnosing the disease but due to less number of staffers including nurses and minor staff, the unit is faced with many shortcomings.

If the government arranges to arrange a Bone Marrow Implantation in Sri Lanka, it will help retain the money spent in India, Singapore and Australia. According to the information given by the consultant, a bone marrow transplantation costs around 10 million.

It is not only leukemia patients would benefit from that but also the thalassaemia patients. Though with minimum conditions, National Cancer Institute in Maharagama is doing a good job compared to other hospitals in Asia.

Health is wealth a man would always hope for, and is the same with leukemia patients. For them an extra moment in their lives will be more valuable than a thousand lives.

No link found between pregnancy and breast cancer

by Allie MONTGOMERY

We all know that pregnancy can be a wonderful and difficult time in a woman's life without adding any other obstacles such as breast cancer.

However, there may be hope for the women who develop breast cancer during her pregnancy. New research shows that women who develop breast cancer during their pregnancy do not have worse odds of death or of the cancer returning than any other young breast cancer patients.

This breast cancer study is one of the largest to look at whether breast cancer hits pregnant and recently pregnant women harder than other women.

However, it does contradict some earlier smaller studies that suggested that maternity made things worse.

Dr. Beth Beadle from the University of Texas M.D. Anderson Cancer Centre and lead author of the study said, "If we can get them early, we can treat them aggressively and have good and promising outcomes for both woman and child." The Houston hospital has the world's largest registry of pregnant women that have breast cancer and their children.

Although breast cancer if frightening for any woman, a diagnosis of breast cancer is particularly terrifying for a woman that is pregnant. It presents complicated decisions on how to treat the mother while causing no harm to the fetus. Some doctors have recommended abortion so they can focus only on treating the mother.

In this new study, which was published this week in the journal *Cancer*, the researchers analyzed data from approximately 652 women that were ages 35 and younger who were treated for breast cancer at M.D. Anderson from the years 1973 to 2006. The group included 104 women that have pregnancy-associated cancers, 51 women that have breast cancer during their pregnancy, and 53 women who developed breast cancer within the year after giving birth.

Researchers found that the rates of the cancer recurring, the spread of cancer and the survival of the cancer were all about the same for the women that has pregnancy-associated breast cancers as they were for the other women. The women that were pregnant had tumours at a more advanced stage than the other women, probably because women and their doctors may have discounted changes in their breasts, attributing them to the pregnancy or breastfeeding.

Generally, breast cancers are far more aggressive among young women, and the rates of survival are significantly lower. While age could be a factor, it is not clear that pregnancy is. There was no evidence in this study that proves that tumours were growing faster in the women that were pregnant, stated Beadle, who is a radiation oncologist.

Radiation, which is dangerous to a fetus, is commonly used in mammography and for the treatment of breast cancer. However, ultrasound can be used to look for the breast cancer tumours instead of using radiation. Also, surgery and certain kinds of chemotherapy can be used to treat the caner without poisoning the womb. However, it still remains a complicated medical situation that can depend on the severity of the cancer and how far the mother is into her pregnancy, said Dr. Ruth O'Regan, who is an associate professor at Emory University's Winship Cancer Institute in Atlanta. "It's quite complicated, but all of us have been able to treat pregnant women successfully."

The study, however, did not present any data on how well the children did.

Beadle said that other researchers from M.D. Anderson have not found any developmental problems in those children. (Health News)

'Symposium on preventing stroke through Exercise'

The Director General of the Institute of Sports Medicine (ISM) Dr. Githanjan Mendis has organised one-day symposium on `Preventing Stokers though Exercise' in response to several queries as to whether strokes could be prevented by changing lifestyle, by the Sunday Observer readers.

The symposium will be held on Sunday, March 8 at 10 a.m. at the Sports Medicine Institute at Independence Square.

The panellists at the symposium are: Dr. Githanjan Mendis, Consultant Neurologist, Director General ISM and member, Medical Advisory Panel 'Herthwatch'.

Dr. Arajuna de Silva, Consultant physician, ISM.

Mrs. Sigrid de Silva, Nutritionist.

Mr. Kamal Chandana, Specialist Exercise.

Readers are welcome to send their queries to the symposium through The Sunday Observer.

Address:Symposium on 'Stroke Prevention

C/o Editor,
Sunday Observer,
Lake House,
No 35, D. R. Wijewerdena Mawatha, Colombo 10.

Uncontrolled anger can be deadly

by Drucilla DYESS

Anger is a normal, and usually healthy, human emotion. However, when anger gets out of control and becomes destructive, it can lead to problems in your personal relationships, issues at work and possibly cause a life-threatening irregular heartbeat. How your heart deals with anger appears to foretell if you are at risk of developing abnormal electrical activity in the heart known as arrhythmia.

Previous studies have found that an increase in death rates from sudden cardiac arrest have occurred surrounding devastating events such as earthquakes and war. In addition, emotions such as depression and hostility have been established as being harmful and are even considered risks for developing heart disease.

Now, U.S. researchers led by Dr. Rachel Lampert, a Yale University cardiologist, have just released findings that suggest there is a pattern in the EKGs of certain heart patients when they recall an angering event.

Dr. Lampert explained that in people who are already vulnerable, "anger causes electrical changes in the heart." And, she notes that when these changes occur during a physician's examination, "that means they're more likely to have arrhythmias when they go out in real life." The report can be found in the Journal of the American College of Cardiology.

During cardiac arrest, the heart's electrical system becomes erratic and the heartbeat abruptly stops. A patient's survival then depends upon a fast deliver of an electrical shock from a device called a defibrillator.

Approximately 100,000 defibrillators are implanted into patients at risk of irregular heartbeats each year.

Factors for increased risk of arrhythmias include damage caused by previous heart attacks, genetic disorders and certain other conditions.

Scientists continue to seek more effective ways to identify patients who are most in need of defibrillator implants. Having the ability to distinguish those patients through an anger spike could be a forward advance.

During Dr. Lampert's study, researchers performed EKGs on 62 defibrillator implant patients who suffered from heart disease to track the effect of anger. When participants recounted incidents that had angered them, some experienced beat-to-beat EKG variations similar to those seen during treadmill stress tests performed by doctors. In this case, the emotional stress rather than physical was generating an alert much like physical stress can. However, with the lack of increase in heart rate that exercise produces, the results suggest that an adrenalin rush caused by anger may directly affect heart cells. Dr. Lampert noted, "One implication of our study is that the changes in the ECG you see with anger are what you see in a stress test. Is the anger test as good as a stress test? This suggests that it is."

The findings showed that participants having EKGs that showed a large anger spike have 10 times greater the likelihood of needing their defibrillators to deliver an electrical shock that could save their lives within the next three years when compared to those patients whose hearts had no reaction to anger. The next phase of study will focus on whether or not techniques to reduce anger could prevent high-risk patients from experiencing irregular heartbeats.

It is not yet known if anger has any electrical effects in people who do not suffer from heart disease. According to Dr. Nieca Goldberg, a spokeswoman for the American Heart Association and a cardiologist at New York University School of Medicine, a clear connection exists between the heart and the head, and chronic negative emotions are somehow heart damaging.

She acknowledged, "We haven't been able to explain why that happens" yet noted, "This is a step in the right direction."

According to the American College of Cardiology, sudden cardiac death is the cause of over 400,000 deaths within the United States each year.

(Health News)