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| Sunday, 03 August 2003 |
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Features |  |
| News Business Features Editorial
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Correcting heart defects without surgery
Birth defects of the heart affect eight out of every 1,000 children born in Sri Lanka. Until last year most of these children had to undergo surgery or else seek treatment from abroad. Now a non - surgical procedure that requires minimum hospitalisation is available for the first time in this country. Dr. K. Sivakumar, Paediatric Interventional Cardiologist of the Apollo Hospital, Colombo talks to Carol Aloysius about the new procedures he carried out Q: What is congenital heart disease? How does it affect the health of a young victim? A: Congenital heart disease is a defect in the heart that is present at birth. It can be either a hole in the septum allowing a mixture of the oxygenated blood and de-oxygenated blood between the right side and left side of the heart valve.It can also be an abnormal heart valve (e.g a narrow valve) These defects result in the enlargement of the heart, lead to heart failure, poor growth and frequent infections in young children. Q: What causes such defects? A: Research is still under way as to the exact reasons for such diseases. But we do know some of the contributory causes.eg Maternal alcohol intake, or the intake of drugs to control fits on the part of an expectant mother. Other causes could be Rubella during pregnancy , nutritional deficiency e.g. folate deficiency and chromosome abnormality. But the majority of heart diseases are simply birth defects , the causes for which are still unknown.
Q: How common are these conditions in Sri Lanka? A: Every year around 350,000 babies are born in Sri Lanka of whom 2800 (i.e. 8 out of every 1000 births) are born with a heart defect. Q: So how many of them need to have surgery or some other kind of intervention? A: About 50 percent require closure of a hole in the heart or correction of a valve within the first year of their lives. Q: Is surgery the only option? A: No. In many countries including India from where I come, we are now resorting to non surgical methods to correct heart defects in children. Q: What do these procedures involve? A: What we do, is to try to close a hole in the heart by passing catheters through blood vessels into the heart with a specially made instrument. The patient is given a local anaesthesia using an injection given into the groin. Then a small catheter is passed through the blood vessels in the groin into the heart and the narrowed blood vessels are dilated using balloons. The holes are then closed by special devices. Q: I understand that the Apollo Hospital was the first to introduce this procedure to Sri Lanka last year. How successful have these interventions been so far? A: We have successfully corrected 115 heart defects in babies (75 with ASD) and (40 with PDA) closing their defects with non surgical methods in the past one year. Q: And the advantages of these procedures over surgical operations are ...? A: Several. Not only does the patient spend very little time in hospital, it is safer, and cheaper as well. Q: In what respects? A: When surgery is involved, the patient has to stay in hospital for between 8-10 days. Since it involves making a long incision in the chest, the patient will have to be anaesthetized and requires artificial ventilation in an ICU for 2-3 days. He/she will be able to return to school or work only after 3 months. On the other hand, the non surgical method eliminates incisions and the procedure itself takes a very short time (less than one hour). The patient requires no anaesthesia, (except a local anaesthesia), there is no bleeding so no blood transfusions are needed and the patient feels no pain. There is also a cosmetic advantage of this procedure since it leaves no permanent scars which is embarrassing especially for growing children. Q: What type of heart defects can be corrected using this procedure. A: Both Atrial Septal Defect (ASD), and Patent Ductus Arteriosus (PDA). Three fourths of ASD can be corrected with this new procedure. Q: What happens if these conditions are not treated? A: They can lead to enlargement of heart chambers, heart failure or raised blood pressure (Pulmonary hypertension) and irregular heart beats (Arhythmias) and many other heart related ailments that are equally life threatening. Q: Why is it that such procedures are not used in most other hospitals? A: Probably because of the lack of awareness. We are trying to create more awareness among parents and paediatricians. Recently held an interactive workshop on these new interventions by demonstrating the procedure on six patients to key practitioners in cardiology and paediatrics. Q: How can parents identify a heart ailment in their child? A: Watch out for the following signs. Poor growth; frequent chest infections (coughs and colds); breathing difficulties and bluish discolouration of tongue and nails. A check up with the doctor if these conditions persist is the best way to detect a heart defect in a child early. The earlier a defect is treated the sooner the patient will recover. ###### The food for all ages by H. C. S. Peiris Elie Metchnikoff attributed the longevity of Bulkan people to the consumption of fermented milk products containing Lactic acid forming Lactobacillus bacteria. Elie Metchnikoff received the Nobel prize in 1908 for his work. This bacteria was named as Lactobacillus bulgaricus in recognition of the country of origin. In Sri Lanka Bacterial culture used for Yoghurt is mostly Lactobacillus bulgaricus and Streptococcus thermophillus. These two bacteria have a symbiotic effect and set Yoghurts within four hours when maintained between 42 degrees C - 44 degrees C, while other probiotic bacteria individually may take about 24 hours. In order to provide more health and medicinal properties other probiotics and prebiotics are used as an adjunet starter. Hence in all Yoghurt products, traditional cultures of Lactobacillus bulgaricus and Streptococcus thermophillus is used to facilitate flavour production, rapid setting, health properties and nutritional and natural antibiotic properties. Probiotics are bacteria with health benefits to man. There are about 56 species of Lactobacillus and 29 species of Bifido bacteria, and among them nineteen bacterias are named as probiotics (10 Lactobacillus and 09 Bifidobacteria). Average percentage of fat in plain yoghurt is 3.5 per cent proteins 3.3 per cent 4.7 per cent Carbohydrates, Minerals 0.7 per cent of which 0.12 per cent Calcium, 0.10 per cent Phosphorous and Sodium 0.05 per cent and vitamins. Some of the recorded health benefits of fresh yoghurts with probiotics are as follow: . Reduction of Gastrointestinal disorders, such as diarrhoea, gastritis, peptic ulcers. . Lactic acid kills pathogens such as cholera bacteria. A product similar to Yoghurt with lactic bacteria is used to prevent spread of Cholera epidemics. . Prevention of infant diarrhoea, a major cause of infant mortality in many countries. . Detoxify gastrointestinal tract and assist in digesting nutrients. Create a good environment in the digestive tract for healthy growth. . Good source of Calcium. Absorption of Calcium is greatly facilitated when a prebiotic such as inulin dietary fibre is used. . Probiotics in Yoghurt are seen as a means of fighting antibiotic resistant strains such as Staphylococcus instead of drugs. . As antibiotics destroy the good bacteria of the intestine, probiotic bacteria is a way to offset this effect. . Research work also has discussed the role of lactic acid producing bacteria in preventing Carcinogen induced preneoplastic lesions and tumours in the colon of rats. . Lactic Acid in milk or yoghurt, chelate heavy metals such as Lead and remove them from the body and hence is recommended specially for those working in lead emmission environments. ###### Treating a viral flu The flu can be a miserable illness, with headache, sorethroat, fever, muscle pain, cough and running nose. Sometimes there is vomiting and diarrhoea. Occasionally there is such severe pain in the calf muscles specially in the case of a child who is reluctant to walk can minimise a serious neurological illness. The fever can last a minimum of 5 to 7 days but the cough can last even longer. A person can come down with the flue just a few days after having been exposed to it. Symptoms usually start about 5 to seven days after the exposure. One will be contagious even before he/she begins to feel sick and will remain contagious until the fever is gone. This is why the illness of flue spreads so rapidly. Flu comes as outbreaks any time of the year specially after floods and droughts. The first outbreak of flue to be described and recorded was in Italy as far back as 1743, and it was then that it was given its name 'influenza'. 'Influenza' is an Italian word meaning influence, in the sense of an occult influence from a supernatural power put on the sufferers. Today this supernatural power has been identified as 'INFLUENZA VIRUS' which infects millions of people throughout the world. There are many types and subtypes of influenza virus family. An infection by one particular type or subtype of the same family does not give immunity to the others, in contrast to another viral disease i.e. Measles, once infected with measles one develops full immunity to it for the rest of his/her life. That is why we have almost come to expect the periodic out-breaks of 'flu' from time to time. But each individual outbreak of 'flu' may have its own characteristic symptoms. 'Common cold' and 'flu' are two different illnesses,even though one can have a runny nose in 'flu' condition. Influenza being an infection is spread from person to person by droplet infection in the air susceptibility to infections depends, to some extent at least, on the standard of general health. Those who take regular exercise, get plenty of fresh air, good food and rest show some resistance. The antibiotics are powerless against influenza virus and only treatment necessary is to control the symptoms such as fever, headache and pains etc. One should take a physical rest until the temperature remains normal for twenty four hours, take plenty of fluids and normal diet. If the temperature does not come down after 3 days or once gets earache or troubled breathing or in the case of a child who is unusually ill, it is the time that one should consult a doctor. Ear infection, sinusitis, bronchitis and rarely pneumonia can follow 'flu' as secondary infections and need treatment with antibiotics. ###### If you are prone to fits and fainting attacks for no reason you are probably suffering from... : Psychological disorders by Dr. R. A. R. Perera Patients who present to doctors with fits, fainting attacks and dizziness, for which there is no physical explanation, are frequently suffering from an undiagnosed psychological disorder. Often, these fits, and fainting attacks are presented in a dramatic manner. Commonly, the physical diagnoses are pursued with extensive investigations, while the possibility of a mental disorder is relegated to a diagnosis of exclusion. This can lead to common psychological disorders not being formally diagnosed, and therefore not being adequately treated. Apart from the disability for the individual patient whose psychological disorder remains undiagnosed, the cost to the patient of ongoing, unnecessary investigations and consultations is substantial. The clinical presentation of a psychological disorder as a fit or a fainting attack is an example of a condition called 'somatisation'. The term somatisation is defined as 'the tendency to experience mental states and distress as physical symptoms.' Somatisation is perhaps the most common of the psychological phenomena seen by doctors, with the presentation of physical symptoms in the setting of a mental disorder. This is not surprising since throughout history and across cultures, the expression of psychological distress through physical symptoms has really been the norm. The doctor should assess the presence of both psychological as well as, physical causes for his/her condition. Often patients are told 'there is nothing wrong' without having their fears addressed. Patients are often not reassured by simply being informed of normal diagnostic tests. Many patients will need assistance to understand the link between their physical symptoms and their emotional state. It is very important to keep an open mind to alternative diagnoses as a patient is followed up. There is a strong association with stress and 'fits', and therefore it is important to obtain corroborative history to differentiate this from a 'fit' due to a physical cause. A major depression due to an unresolved grief like a death in the family or a separation can cause dizziness and fainting attacks. A person with anxiety and panic attacks like fear for heights or crowds can cause fainting attacks. In eastern countries like Sri Lanka fainting attacks are a common occurrence in funeral houses and in schools, especially in girl's schools. Another place, which you see, these mass fainting attacks are in the factories at free trade zone where majority of workers are girls. The press, reports frequently about incidents where sometimes - large numbers of girls are being admitted to the hospital due to fainting attacks. These are called mass hysterical reaction. Management of a person with these difficulties includes a careful history, clarifying what the person means by the 'fit' or the fainting attack and the assessment of his depression and/or anxiety. Reassurance of the person showing that all his tests is within the normal range. These patients should be given Psychological - education about, fainting due to panic attacks and due to an unresolved - grief reactions or a separation. Cognitive behavioural therapy techniques, relaxation and slow breathing exercises also helps these persons. Sometimes medications involving anti-depressant drugs or anti-anxiety drugs are useful. |
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