Healthwise

"Landmark" medical interventional procedure:

Miracles are made in hospitals

Dhaneshi YATAWARA

Nandani Rajapaksa, the patient with the medical team.

For Nandani, a mother of two little kids, hopes returned to her life through greater suffering. She did not overcome breathlessness, tiredness and all that may have looked like a lung disease for over one and a half years until her fate made a miracle in her life.

"Doctors gave treatment for my tiredness. But it never got cured," Nandani said. "I don't have words to describe the suffering I underwent. I couldn't speak even a few words at a stretch," she said now in a flawless voice. " Now my one and half year old son is thrilled because I can lift and carry him about," she beamed with joy - she just could not cuddle or cradle her little son because of her impediment.

Nandani Rajapaksa (42) with her two children lives in Kegalle under the loving care of her sister. Her unfortunate period, of time and all of a sudden saw a ray of hope, thanks to her nearest and dearest who were never ready to give up.

According to medical terminology, she was suffering from Pulmonary Arteriovenous fistula in the right lung - A sort of a pathological disorder in the communication system between the pulmonary vein and the pulmonary artery bypassing the lung, where the oxygenated blood gets flows back to the heart. In the fistula the 'clean' blood get mixed with the 'unclean' blood diluting the oxygen percentage in the blood. Thereby, her entire body was suffering from oxygen deficiency.

"About one and a half years ago my nail, both fingers and toes, were turning blue and I also developed breathlessness and tiring very quickly," Nandani said.

After working in Kuwait for seventeen long years until she got married, she was leading a very normal life since her birth and this sudden change was a shock to her entire family. Her husband Wipul Samansiri, her brother Luxman were desperately trying to find a cure for her while her entire family lovingly cared for her, who was now almost bedridden.

"My children, Aruni Bhagya (6) and Ashen Dhanujaya (1 1/2 years), were born under normal conditions. I was working in Kuwait for 17 years and not even the climate change affected me," she added. As Nandani said, she came to Sri Lanka with her two kids in 30 September 2007 as the couple wanted to raise the children in Sri Lanka and to be educated in Sinhala. Her husband is still working in Kuwait, for seven years, as a driver in a private company.

When she consulted a doctor at the Chest Clinic of the Kegalle Hospital the doctor has confirmed that her this has oilnment had nothing to do with lungs. Only then she was put on the right track and after several medical checks was referred to Dr. S. Mithrakumar the Chief Interventional Cardiologist of the Cardiac Unit of the Nawaloka Hospital, Colombo.

Looking for all possible options a cure for his sister, Nandani's brother, Luxman Rajapaksa had strangled across a news article about Dr. Mithrakumar, who was willing to help patients with risky heart conditions.

The miracle

With her family she came to meet Dr. Mithrakumar a week ago. "He was very friendly and kind to me. I really had a lot of confidence in him," Nandani added. Nandani had to first find the money for the procedure. She, her brother and her husband were not ready to give up. For people like Nandani, coming from an average Sri Lankan family, the cost was pretty high. But, luck was with her. Her Family collected the money within two months and came back to the specialist. Seeing her courage and determination, the team of doctors were kind enough to waive off their fees.

Dr. Sharma, Dr. Lalini Kapuruge and Dr.Mithrakumar after their ‘landmark’ medical interventional procedure.

"This was one of those rare case, and I weighed the case with my team. To me their contribution meant a lot. Their ideas, decisions at different crucial levels will be the main contributor to our achievement," he added.

"At the very start, there was a slight hesitation but the patient's was a personal challenge to our ego". bring hope and enjoyment for another human being.

It is worthy to mention, Dr. Mithrakumar and his paramedical staff had the support of Consultant Interventional Cardiologist Dr. (Mrs) Lalani Kapuruge and the Consultant Cardiac Anaesthetist Dr. S. K. Sharma.

In the natural blood circulation system of the human body, periphery veins bring the deoxygenated blood (with very low oxygen percentage) to the right side of the heart and through the Pulmonary artery the 'dirty' blood is sent to the lungs to be oxygenated and after through the pulmonary vein the 'clean' blood is sent back to the left side of the heart and then from there it is pumped out to be circulated through the entire body.

"In this case there was an abnormal connection between the artery and the vein which had enlarged over time as the blood presses the walls," Dr.S.K. Sharma explained. Hence, proper oxygenation of the blood was not taking place in her body. At the time of her admission to it was to the hospital her oxygen saturation level was between 60 -65% even with an external oxygen supply.

"When blood with low oxygen percentage circulates through the body we can see blue colour in nails and lips. This is due to the blue colour of the deoxygenated blood. Oxygenated blood is of pink colour," Dr. Sharma said explaining the symptoms seen on Nandani.

Planning

The team led by Dr. Mithrakumar immediately took Nandani for an examination and discovered the fistula - the exact cause for her illness.

The next step was planning the treatment. "Since this was inside the lung we could not go for a surgery because it might damage the lung tissues," Dr. Kapuruge added.

"Anaesthetizing such patients is also risky as their oxygen level is very low. And when she is unconscious she does not feel anything as to what is happening to her which is another great risk," Dr. Sharma, the Cardiac Anesthesist of the team, said.

"So we just had to sedate her and perform the procedure with a local anaesthesia at the small incision in her right thigh," Dr. Mithrakumar added.

A small catheter was inserted through her right thigh to the right side of heart through the femoral vein and then to the pulmonary artery and to the fistula.Dr. Mithrankumar identified that this fistula needed to be blocked to avoid blood entering it and make the blood flow in the correct path. In trying to find a blocking device they decided to try Atrial Septal Occluder, the mesh like blocker that is used to cover holes in the heart - A thought that would only tickle in the brain when a doctor thinks going out of the frame.

Yet, to assure that their procedure is correct first they sent a Atrial Septal defect measuring balloon through the catheter - a device normally used to open narrowed arteries blocked with cholesterol, to block the fistula and to see the improvement in the oxygen saturation of the patient.

Immediately the oxygen saturation level started to gradually rise to 92% from 65%. Her body responded positively.

Based on improvement the team went ahead and decided to insert the Atrial Septal Occluder device, the mesh, as the blocker.

The diameter of the fistula was 13 -14 mm and they chose the device with 17mm width so it can stay attached to the walls of the fistula tolerating the pulmonary artery pressure. The Atrial Septal Occluder device was sent through the catheter in to the fistula.

"In a period of time this will get permanently blocked. Platelets and blood cells will stick to the mesh, as there is still a flow of blood, at a negligible level, to the fistula.

As the blood gets clotted it will form a firm block," Dr. Sharma explained further.At the time of her discharge, few days ago, her blood oxygen level rose to 92%.

"This, according to my knowledge, must be the first time such a case was solved using an interventional procedure," Dr. Kapuruge added.

Recovery

Nandani lost 16 killogrammes of the her body weight during the one and half years she suffered. "I want to get my strength back and look after my family. For that I totally depend on the advice of Dr. Mithrankumar. They saved my life," Nandani was at a loss for words to express her gratitude.

Last but not the least, the team of experts did not forget to express their thanks to their institute - the Nawaloka Hospital, especially the recent expanded the Emergency Care Unit.

"Without a proper equipment and technology we could not have saved the life of this innocent person and bring back the joy to her and her family," they echoed.

Health News:

Innovative patient-centric initiative from Singapore's ParkwayHealth

Samangie WETTIMUNY

Singapore's ParkwayHealth which is one of Asia's leading private healthcare providers recently launched the second phase of its fixed price package in response to the current economic condition, with an intention of helping patients with better managed costs. The first phase of introduction of fixed price package took place in late March, 2009. The packages cover key areas, cardiology, ENT surgery, Gastroenterology, general surgery, neurosurgery, obstetrics and gynaecology, ophthalmology, orthopaedic surgery and urology.

(From left): Dr. Lewis Liew, Consultant Urologist, Kamalijeet Singh Gill, Chief Marketing Officer, Global Corporate Marketing of ParkwayHealth, Dr. Lim. Cheok Peng, Executive Vice Chairman, Managing Director, Group President and Chief Executive Officer of Parkway Holdings Ltd, and Prof. Lim Yean Teng, Consultant Cardiologist at the launch of ParkwayHealth’s innovative patient-centric initiative held in Gleneagles Hospital auditorium in Singapore recently.

In total there are 34 `most inclusive, comprehensive and innovative' packages, with a validity period of one year. ParkwayHealth totally believes that the packages are innovative mainly because they are the No. 1 private healthcare provider in Singapore that combine patient safety and quality of service with competitive and all-inclusive pricing.

"We believe that fixed price packages would bring cheer to those who are in need of medical attention, said Dr. Lim. Cheok Peng, Executive Vice Chairman, Managing Director, Group President and Chief Executive Officer of ParkwayHoldings Ltd speaking at the launch.

He further added that the aim of ParkwayHealth is to make essential treatment affordable and accessible during this crisis period. All 34 packages are meant to cater to meet the needs of local and foreign patients.

"Parkway never compromises when it comes to health. Healthcare needs should be addressed during bad times as well. We believe that with these all-in-one packages, both local and foreign patients will be encouraged not to delay or put off much needed surgery."

According to Kamalijeet Singh Gill, Chief Marketing Officer, Global Corporate Marketing of ParkwayHealth, the fixed pricing structure allows ParkwayHealth to deliver their fixed-price promise to help patients who are in need of medical care to bring down their healthcare costs.

Gill further emphasized that the new price packages are truly a patient-centric initiative that aims at easing costs for patients. More information regarding fixed price packages could be obtained from www.parkwayhealth.com, www.parkwayholdings.com or www.ppac.sg.

ParkwayHealth which is based in Singapore operates 15 hospitals in Asia and 43 patient assistance centres around the globe and the Colombo office is located at 389 High Level Road, Nugegoda.