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| Sunday, 3 April 2005 |
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Features |  |
| News Business Features Editorial
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Can the bypass be bypassed? by Dr. Swarnamali Welagedara Gunawardene "Heart operations - eight year waiting list - At present there are only 4 cardiac surgeons in the government sector" - GMOA. Since reading the above news item which appeared in a Sunday paper disturbing thoughts has been going through my mind.
As the cost of cardiac surgery to be done without delay at a private hospital in Colombo is colossal, only the rich can afford it. Some borrow or mortgage their possessions to find the money The poor, especially the village folk simply have to wait their turn. Would the patient be lucky enough to still be alive? Wouldn't the condition deteriorate? Perhaps beyond surgical help? However, even for those who could afford the expenditure incurred, the angiogram (an invasive investigation of the blood vessels of the heart prior to surgery), anaesthesia and surgery carry a risk of morbidity and mortality. The patients and relatives are rightly informed of the above before the consent is taken for cardiac surgery. Is there an alternative? 'Especially for those who cannot afford the fees at private hospitals, and for those who are unable to come to the city for treatment or even those faint hearted to undergo surgery. A large proportion of patients for heart surgery come for Coronary Artery Bypass Srafts. This is the surgery performed for blockage of blood vessels supplying the heart. The narrowing of the blood vessels which over time leads to blockage is due to the build up of calcium along with cholesterol and other deposits leading to formation of plaques. For those awaiting bypass surgery, there may be an alternative. Chelation therapy is not new but has been used since 1950 to 'UNBLOCK' blocked blood vessels thus improving circulation to the brain, heart and legs. It is practised in USA, UK, Europe. and other countries. In USA, the primary organisation promoting chelation therapy is American College in Advancement in Medicine. British Heart Foundation has an open mind about Chelation Therapy Back in the 1950s. Chelation was praised as a miracle solution for many problems in the U.S. But in the 1960s, the advent of conventional medical treatment such as by-pass surgery, basically moved to the forefront and chelation therapy became suppressed. The drug used for chelation is EDTA (etheylenediamine acetate) - which is a chemical which was originally used to treat lead poisoning, It is FDA approved. It was Dr. Norman Clarke, Director of Research at Providence Hospital in Detroit, Mitchigan who in 1950, noticed that the patients he treated for lead poisoning benefited in other areas as well, notably those associated with improved circulation. Some patients reported that their angina (chest pain) was gone. In others like the diabetics, the pain in the legs got less or vanished. This was a yet another scientific discovery which occurred serendipitously, as they often do. Chelation stems from the Greek word Chelae meaning 'claw' as EDTA actually grabs on to metal particles like a claw of a crab, thus capturing them One theory behind Chelation therapy is that once EDTA is injected to the blood stream, it binds to metals like a claw and forms metal complexes that are carried through the blood stream to be excreted from the body in the urine, like a chemical that cleans a plumbing system is drained out. It is this chemical process which removes metals like calcium and other metals which are constituents of the plaques causing narrowing, hardening and blocking of the blood vessels. The second theory which is more widely accepted, and one that continues to be popular suggests that by removing toxic metals, EDTA also removes a significant source of destructive oxygen molecules known as free radicals. With the free radical production slowed the arteries could heal shedding the plaque and lessen the symptoms of heart disease. The pioneer in Sri Lanka, for Chelation therapy is the Chelation clinic at Ratnam hospital in Colombo. It is run under the auspices of Poorma Health Care Trust, and was opened in June 1997. Since then, doctors who have learned the art and the science of Chelation therapy at the above clinic have opened a few clinics in other private hospitals in Colombo and Kandy. Patients seeking chelation therapy are screened by performing laboratory tests including those of blood and urine. They are then medically examined and selected for therapy only if they are deemed fit. Therapy is given under supervision of the doctor and nursing sisters. The course consists of a series of drug infusions into a vein in the hand totalling 30 in number, which are given once or twice per week. The patient is treated as a day patient. No anaesthesia is required. The patient can go home after each session. He or she could resume normal work and diet after the session. There is no hospitalisation and convalescence period. Does the therapy work? I have interviewed patients from all walks of life who are undergoing Chelation therapy. Many are heart patients. Diabetics, patients suffering from rheumatoid disease, and Parkinsonism, etc. constitute the rest. At the first session of treatment, they look and sound very much stressed and strained. Usually by about the 10th to 15th treatment they look happy and relaxed. If the smiles on their faces and the feel good factor, and the improvement in exercise tolerance go by, yes, it works and is very rewarding. Further, the very fact that a large number of new patients come on the recommendation of those who have had chelation fortifies the issue. However, chelation therapy is a topic of continuous controversy. There are opponents and proponents to the theory, both in Sri Lanka and the rest of the world. Opponents claim that statistically there is no valid proof. The belief of proponents is that it is not to be scoffed at, as it is very much less invasive than heart surgery, and much much cheaper. They also claim that since it flushes the whole arterial tree, it would remove all plaques from, throughout the arterial tree, even the minute ones, as opposed to by-pass surgery which is a mechanical repair of one or a few more sites only. In some countries, it is customary for the cardiac surgeons to inform the patients of alternative therapy like Chelation when they come to see them for surgery. There are also cardiac and vascular surgeons who would like to combine both surgery and Chelation by advocating a few sessions of chelation prior to surgery. This is to ensure healthier blood vessels when they come for surgery, the outcome being a better anastomosis of the cut ends of the blood vessels following surgery. Some cardiologists would recommend chelation after by-pass or stents. Chelation therapy can easily be introduced to outstations, as no special equipment or highly specialised expertise is needed. The cost incurred is relatively much less than that for cardiac surgery. Chelation therapy could be worth a try for those of us in the waiting list, to go under the knife for by-pass surgery. The writer holds an MBBS (Ceylon), D.A. (Lond) F.R.C.A. (Lond) Former, Hon. Clinical Associate Professor University of Hong Kong and Specialist Anaesthesiologist, Duchess of Kent Children's Hospital, Hong Kong. Fundamentals in Ayurveda : Realising the basic principles by Dr. Danister L. Perera Ayurveda is a system of natural medicine as it follows nature's law and order. It accepts and respects nature's healing power. Ayurveda teaches how to control the natural effects by obeying it. It utilises nature's energy and essence of benediction for expelling the discomfort caused by the diseases. Therefore it is necessary for us to realise the basics of nature. Everything in this universe is composed of five elements. The human body is also made up of the five elements and the soul. These are like elementary fractions or primordial units of the life. In Sanskrit these are called Pancha Maha Bhootha or five great elements. But it is very important to understand the real literary meaning of Bhoota. That is the basis of existence. The primal form of existence is called Bhoota. They bear unique qualities of nature. * Prithvi * Ap * Tejas * Vayu * Akash It means that these five elements are the basic constituents and everything can be explained in terms of these five elements. Even in an atom these five elementary qualities are available. But no element can be traced or abstracted in its pure or absolute form. They are always synergic. These five elements in their biological form in the living body are of three different kinds. These are three primary life forces or three biological humours. The Ayurvedic term for these forces is Dosha. As they are three in number they are called Tridosha (Tri means three). In Sanskrit they are known as: Vata, Pitta and Kapha. These are bio-regulatory principles of the organism. As these are specific terms or names of the three types of humours in the body, it is not possible to translate them into English. They can be understood, experienced or felt only from their qualities, behaviour and actions in the body. The nearest translation, meaning or comparatives of these terms, depending upon their qualities, actions and behaviour are: Vata is functional energy or dynamic force of the body. Pitta is thermogenic principle which controls the metabolic functions. Kapha is thermotaxis force which counteracts on Pitta energy. Other important basic principles of Ayurveda which are briefly mentioned here are: 1. Dhatus - These are the basic tissues which maintain and nourish the body. They are seven in number namely - chyle, blood, muscles, fatty tissue, bone, marrow and semen. Proper amount of each dhatu and its balanced function is very important for good health. 2. Mala - These are the waste materials produced as a result of various metabolic activities in the body. They are mainly urine, faeces, sweat etc. Proper elimination of the malas is equally important for good health. Accumulation of malas causes many diseases in the body. 3. Srotas - These are different types of channels which are responsible for transportation of food, dhatus, malas and doshas. Proper functioning of srotas is necessary for transporting different materials to the site of their requirement. Blockage of srotas causes many diseases. 4. Agni - These are different types of enzymes responsible for digestion and transforming one material to another. To be continued Medical update Contact lenses react to blood-sugar levels Contact lenses that change their appearance according to the wearer's blood-sugar level could one day help people with diabetes to keep track of their levels non-invasively, new research suggests. Diabetes affects the body's ability to make or use the hormone insulin, which can cause dangerously large swings in levels of blood sugar, or glucose. Currently, most people suffering from diabetes monitor their blood sugar by pricking their skin and drawing blood. Developing a monitoring system through contact lenses makes sense because many people with diabetes also need glasses or contact lenses due to the way diabetes affects the blood vessels in the retina. To make glucose-sensing contacts, scientists added boronic acid to disposable contact lenses. The new contact lenses are not yet available in the market. - Courtesy: New Scientist Hair - A good source of stem cells Most people have about 100,000 hairs on their head and US scientists say that they found a good source of stem cells - hair follicles. The fact that hair grows quickly and is continually replenished makes it an attractive source to harvest the amount of stem cells needed for treatments. The Proceedings of the National Academy of Science study shows nerve cells can be grown from hair follicle stem cells. Stem cells are immature cells that have the ability to become any kind of tissue in the body. Hair grows from follicles and new follicle cells are born from stem cells that exist in a small bulge on the side of the hair follicle. Researchers from the University of Pennsylvania have already suggested that these stem cells might be a way of treating baldness. Now Dr. Yasuyuki Amoh and colleagues from the University of California, San Diego, have shown that the same stem cells could potentially be used to treat neurological conditions. - BBC News Baby care kits for new moms Reckitt Benckiser (Lanka) Ltd in collaboration with Maternity and Children's hospitals launched a Rupees three million maternity programme under which, Dettol is providing 100,000 units of file-folders and 15,000 units of Baby Care-kit to De Soysa Hospital for distribution among the patients. The Baby Care-kit includes basic Childcare guides, a notebook for recording the key events of the baby's life, a height chart to follow the baby's growth, along with Dettol Soap and Liquid, The file-folders, covering the hospital's one year's requirement, provide the patients the opportunity to retain all the prescriptions issued by the hospital along with other medical reports. They also provide information on services provided by the hospital along with details on special clinics conducted on specific days of the week. Dr. Roy Perera, Director of the De Soysa Maternity Hospital while accepting the items at the official launch of the programme, said that the hospital was grateful to Dettol for providing the file-folders and the Baby Care-kit. He added that the file-folders would be helpful for the mothers to retain their documents. He also stated that the booklet on child healthcare tips would be useful especially to mothers who have delivered their first baby since they lack experience on child health and hygiene related matters. Bertram Paul, Head of Marketing at Reckitt Benckiser Lanka Limited (RBLL) in a statement said that Reckitt Benckiser is always open to the requirements of the local community and this is one such occasion where they have come forward to help the Sri Lankan Community. He added that RBLL has spent over Rupees ten million for Social Responsibility activities during the past year. On-line health Giving a unique opportunity for medical practitioners, students, patients and the general public to gain up-to- date comprehensive information on diseases, drugs and medical breakthroughs, www.srilankaehealth.com by the Ceylinco Internet Services Sri Lanka (CISL) was launched recently. It is an online resource base, which, focuses on providing up to date and comprehensive information on medical conditions, drugs, treatment and relevant news to the general public as well as medical professionals. Sensitive information will be available only to doctors who are pre-registered and have obtained the access card from Ceylinco Internet Services Ltd (CISL). The site is hosted by CISL in association with virtual medical center.com of Australia. The web site currently spotlights cancer and disease conditions created by the recent tsunami, but the CISL intends to add more virtual medical centres for sports medicine, cardiology and neurology in the near future. The site is updated every twelve hours by qualified medical researchers, and all information is sourced from a panel of physicians who are highly acclaimed in their areas of specialisation. Srilankaehealth.com also offers its viewers an opportunity to become a member for free. Fast food consumption : Factor for Obesity and type 11 Diabetes by Dr. D. P. Atukorale The frequency of obesity has risen at an alarming rate in all age groups in all the developed countries such as USA and UK and this epidemic of obesity is fast spreading to urban and suburban areas of developing countries like Sri Lanka. The medical and economic outcomes of excessive bodyweight are great. One particularly ominous public health issue as a result of obesity, is the occurrence of glucose intolerance and type 11 diabetes in obese adolescent and young adults. The epidemic of obesity can be attributed to environmental factors affecting diet or physical activity level (lack of exercise). One potentially important dietary factor for obesity is consumption of fast food which can be defined as convenience food purchased in self-service or carry-out eating places. In the urban and suburban parts of Sri Lanka, fast food consumption has increased by leaps and bounds during the last decade. Several factors inherent in fast food as it now exists could promote a positive energy balance and thereby an increased risk of obesity and diabetes including excessive portion size with single large meals often approaching or exceeding individual daily energy requirement. Palatability emphasising primordial taste, preferences for sugar, salt and fat, high energy density and high glycaemic load might also enhance risk of diabetes through energy-independent mechanisms. With a view to investigate the association between reported fast food habits and changes in body weight and insulin resistance over a 15-year period in young black and white adults in USA, Mark A. Pereira et al studied 3031 young (age 18-30 years in 1985-86) black and white people who were followed up with repeated dietary assessment.After adjustment for life-style factors, it was found that baseline fast food frequency was directly associated with changes in body weight. Changes in fast food frequency over 15 years was also directly associated with insulin resistance in both black and white people. People who visited fast food restaurants more than twice a week gained an extra 4.5kg of body weight and had a two-fold increase in insulin resistance. The researchers concluded that fast food consumption has a strong positive association with weight gain and insulin resistance suggesting that consumption of fast food increases the risk of obesity and type 11 diabetes. it is high time that Sri lankan health educators epidemiologists physicians and dieticians carry out a survey of obesity type 11 diabetes and fast food consumption. You & Your baby Advantages of a USS test With Dr. Hemantha Dodampahala, Consultant Gynaecologist and Obstetrician The Ultra Sound Scan (USS) gives you the first glimpse of your baby. You can see the tiny legs and hands and even how its heart beats. This will be a moment that will remain etched in your memory for the rest of your life. Ultra Sound Scans are widely used and very essential today, especially to detect any abnormality of the foetus and ascertain the correct date of delivery. But, remember USS test has to be done under your doctor's recommendations. If you have a family history of a genetic condition or if your pregnancy is not progressing normally, your doctors will most probably advise you to undergo a USS. If you are advised to undergo one, do not panic as it is a simple procedure that lasts just half an hour. A gel is rubbed over your belly and the doctor will move a transducer or probe over your stomach, pressing down slightly and moving in all directions. The sound waves are transmitted via a computer to make a picture on the screen. And that is your baby. The doctors will judge how many weeks pregnant you are by measuring your baby and also check growth rate, locate the placenta, monitor the heartbeat, assess the amniotic fluid and look for any possible abnormality in the pregnancy. During the first three months, the USS is very helpful in identifying abnormalities in the various systems of the baby's body, especially neural tube defects and heart defects. This is widely used to detect abnormality in early pregnancy. Over 30 to 40 per cent of women are admitted to hospitals with bleeding, but it is not a serious condition and would not affect the baby. But serious abnormalities can easily be detected through the USS. The USS will help make sure the exact date of delivery. The dates given by one third of the mothers do not correspond with the foetus true age. So a 'dating scan' will help you, especially if you have irregular periods, to know the correct date of delivery. Scans have been carried out for nearly 30 years and there is no evidence that the process is harmful. It is based on sound waves with low intensity. Research in Sweden found that children scanned in pregnancy had no increased risk of hearing or sight loss than those who had not been scanned. There is no risk to your baby due to USS tests. Compared to other scan tests, the USS. It is very safe with accurate results. The USS test will also help you to know the sex of your baby. Normally it is easy to identify a baby boy rather than a girl due to his physical structure. However, the USS cannot pick up every potential problem as some problems cannot be detected by scans because they are not physical abnormalities and are recognised only after the baby's birth. |
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