Health wise

Vascular disorders preventable

By Samangie WETTIMUNY

Dr. C. Sivathasan

Dr. C. Sivathasan, Consultant cardio thoracic surgeon of the Heart and Vascular Surgical Centre of Mount Elizabeth Hospital and Gleneagles Hospital ,Singapore , briefed the media on 'Heart and Vascular diseases and preventive measures' at a recent medical discussion held in Colombo.

Excerpts:

Heart diseases that are prevalent in Sri Lanka can be categorised into three groups. Chronic , rheumatic heart diseases and congenital/birth defects. In most developed countries (even in Sri Lanka) the number of rheumatic heart diseases are on the decline. Rheumatic heart disease which normally affects children within the age group of 10 -12, is widespread among those who live in overcrowded cities with poor housing facilities. It causes inflammation of heart valves damaging them in the long run, which would require treatment.

Congenital diseases:- Hole in the heart; blue babies

Coronary artery disease is the commonest heart disease that occurs in adults (45-50 and above). It is a condition in which plaque (cholesterol, calcium) builds up inside the coronary arteries. The causes that lead to coronary heart disease can be grouped into two as modifiable factors and factors that cannot be modified. Coronary heart diseases that occur due to modifiable factors are also called lifestyle-related heart diseases,which are overweight, unhealthy diet, smoking, high blood pressure, uncontrolled diabetes and physical inactivity. If people take care of themselves, all these factors could be avoided. Factors that cannot be modified include family history, old age, males (Heart diseases are more common in males), females vulnerable after menopause Protected by hormones, and become vulnerable after menopause.)

Vascular diseases

Vascular diseases are conditions that affect the blood vessels-arteries and veins that carry blood to and fro all parts of the body. The same factors that cause heart diseases lead to vascular diseases. Vascular disease affecting the arteries is called arterial disease. Vascular conditions that affect veins are called venous diseases. Arterial disease could occur either due to narrowing of the artery (occlusive disease) or due to the enlargement of an artery (aneurysm disease).

With time, cholesterol may get deposited in the blood vessel wall , narrowing the artery which would in turn interfere with smooth blood circulation.

For example when Carotid artery which supplies blood to the head and neck with oxygenated blood gets narrowed , blood circulation to brain may get blocked.It is called carotid stenosis.Carotid artery stenosis is caused by hypercholesterolemia (too much of cholesterol in the blood.)

Lack of blood supply to the brain may lead to a stroke. This could be either due to a rupture(bursting of a blood vessel) or due to a blockage. Uncontrolled blood pressure may ultimately lead to bursting of a blood vessel in brain which would cause bleeding into the brain resulting in a stroke. In extreme cases patients can even go into a coma. If the bleeding is massive it could be fatal. If the stroke is on the right side of your brain, reactions may arise on the left side of the body and vice versa.

Carotid artery stenosis often goes undetected for a while as no symptoms show on some of the affected individuals. But for others , the same signs of stroke can be observed.

Signs

1.Sudden weakness or even paralysis of a leg, arm or hand

2.Transient blindness or severe blurring of vision.

3.Transient slurring, garbled or inappropriate speech

4.Transient one-sided facial droop

5.Blackouts, spells and severe headache

"Unfortunately people tend to ignore the symptoms until they reach a critical stage. Though people are highly concerned about heart diseases, they do not seem to pay similar type of caution to vascular diseases. By the time they consult a doctor their condition would have turned for the worse."

People who are more prone to this disease should be more cautious of the type of food they eat. It is advisable for them to maintain a diet that is low in cholesterol, but high in nutrition. Blood pressure of a person susceptible to carotid artery stenosis should be monitored and controlled at all times. Smoking and alcohol consumption should be reduced, if not stopped completely. Diabetes should be controlled and treated accordingly.

Treatment of Carotid artery stenosis:

Carotid edarterectomy: The procedure is performed by surgically removing the plaque or the build up that is causing the narrowing of the artery.The surgery is performed only on patients whose arteries have narrowed by as much as 70% or higher.If it is just 50% or less medications may be prescribed.

Angioplasty: stretching the artery where it has narrowed with a balloon

Peripheral vascular diseases

Peripheral vascular diseases are complications in blood vessels outside the heart and brain. It is often a narrowing of a vessel that carry blood to legs, arms , stomach and kidneys. Peripheral artery disease can cause claudication- narrowing or blockage in the main artery taking blood to one's legs.

Femoral artery is the main blood vessel in the thigh that carries blood and oxygen to the legs and when it is blocked the blood flow in the leg region is reduced.

Claudication is preventable. It occurs much early in life in people who smoke and those who have diabetes, high blood pressure or high levels of cholesterol in the system. There are three approaches to treating claudication:exercise, angioplasty or a bypass surgery.

"People usually tend to ignore diseases in the legs. Sometimes people who have diabetes may not feel any pain even if they have wounds on their legs, whereby in the end it will lead to leg amputation."

In certain remote areas in Sri Lanka people are addicted to 'beedi', and it causes much more harm to vessels in the leg than anyone could imagine.

Patients, specially diabetics are advised to attend diabetic foot clinics regularly so that preventive measures could be taken.

Prevention of breast cancer

Is routine mammography helpful:

Doctors often advise women with genetic risk and family history of breast cancer to get mammography, especially for those who are positive for B R C A genes. It should be noted that undergoing tests such as mammography and genetic tests does not appear to help in the prevention of breast cancer.

It is noteworthy that mammography helps the doctor to diagnose breast cancer in the early stages of the cancer; doing mammogram does not help doctors to diagnose the breast cancer before the cancer has started growing.

If breast cancer is detected in the early stages, results of surgery i.e. mastectomy are better and a significant number of these patients can live five years, whereas if the cancer is detected after it has spread to surrounding tissues, results of surgery are not all that good.

Management of high risk patients

There are four options for the management of those women with family history of breast cancer and are positive for B R C A genes.

1. Watch and wait.

2. Take oestrogen lowering drug tamoxifen for rest of their lives. Tamoxifen has various side-effects such as stroke, cataracts, deep vein thrombosis, uterine cancer and pulmonary embolism.

3. Undergoing mastectomy (surgical removal of breasts).

4. Nutritional approach i.e. consuming a diet free of animal-based foods and low in refined carbohydrates aided by regular monitoring of those at high risk. Internationally famous nutritionist T. Collin Campbell PhD says "I stand by the usefulness of the fourth option even for women who have already had a first mastectomy".

It is noteworthy that diet is an effective treatment of already-diagnosed disease with advanced heart disease (Ornish D etal, JAMA, 280, 1998, 2001-2007), liver cancer, and melanoma, and clinically documented Type II Diabetes.

Dr. D. P. Athukorale

Over 2000 leprosy patients treated annually

International Leprosy Day falls today:

by Harshini PERERA

Even though Sri Lanka has declared the elimination of leprosy in 1954, a number of patients are still being found in Sri Lanka. The reason behind it is the fact that it has a long incubation period.

Therefore, symptoms are understood quite later than other diseases. International Leprosy Day falls on January 25 each year, and recalls our memory of this slowly progressive disease.

Leprosy is a skin disease widely known as the oldest which even bear biblical references and is caused by a bacteria identified as "Mycobacterium leprae." Leprosy is understood by its two types; Pauci Bacilary Leprosy (Non-transmittable) and Multi Bacilary Leprosy (Transmittable). Leprosy is a disease generally transmitted through the respiratory system. Consequently, sneezing or coughing of an infected person with a transmissible leprosy can only transmit the disease. It generally has an incubation period ranging from three months to 20 years.

Senseless lesions (abnormality of the tissues of the skin) is the first symptom of the disease. They can be light or bronze in colour but can be senseless. Moreover, if lesions appearing are less than five in number it is identified as non-transmissible while more than five lesions are considered transmissible. This bacteria can directly affect the immune system and as a result of it one's sensory system can be damaged. When the immune system malfunctions, his sensory system invariably goes senseless. Therefore, he may not feel getting injured. In such a state one could get wounds similar to that of created by diabetes. Considerable amount of people can be subjected to deformations of limbs and hands when the disease is spread across the immune system. Number of patients recorded means the disease is not hidden any longer where around 2000 patients were found in 2007.

Large number of patients were recorded in the Western Province (44%) and 14% were recorded in Eastern Province. Leprosy, none other than the misconceptions towards it, has submerged the disease, but fortunately a change in the number of patients is recorded after the Multi-Medication Campaign which was started in 1983. In the year of 2001 treatment for leprosy was interlinked with normal channelled services in hospitals. That enabled more patients to come out of their fears and get treated.

The population density and availability of facilities in the Western Province have reported a large number of patients compared with other districts. That does not mean that other districts are less in numbers. People usually hesitate to get medicine for leprosy due to the attitude the society towards the disease.

Even though other countries show a steep decline in number of patients recorded, since its incubation period is long, Sri Lanka may have to tackle leprosy for many more years.

Leprosy is a curable disease which has to be treated at its early stage. There are two different medications for both transmittable and non-transmittaible leprosy. Depending on its type, medication is directed for six months as well as 12 months. A patient, who is undergoing medication, could not transmit the disease to a healthy person.

Ninety percent who undergo medication will not get any side-effect while others may have discoloured skin, eyes and urine turn yellowish while some may suffer from a slight fever and symptoms of hepatitis due to the effect the medicine does to the kidneys. Deformation of the body can be prevented on early detection. If not daily exercise and medical surgery can take them into normalcy.

There is no need to keep them separated in leper colonies. For example Leprosy Hospital in Hendala. People who do have strong immune reaction to the disease would not entertain it while only 10% of the entire population can be affected by leprosy. Once they are treated, society should accept them as normal human beings and should remember that leprosy is an ordinary disease which can be eliminated. Statistics show that before 1990 there were only 1000 new cases detected while 2500 patients were recorded from 1990-1994. The number of patients detected in 1995-2000 were only 2000. It further states that each year around 2000 patients were found with leprosy from entire Sri Lanka.

Tips for patients seeking cataract surgery

Presently in Sri Lanka, the patient needs to purchase the intra-ocular lens.

The model and price of each lens (CDDA approved) is quoted below.

Foldable lens for cataract surgery

. Alcon (USA)

Acrysof single piece SA 60 AT

Rs. 11,900.00

Acrysof IQ SN 60 WF Rs. 15,300.00

Acrysof Toric SN 60 T3 Rs. 48,000.00

Acrysof Restor SN 6 AD3 Rs. 71,000.00

. AMO (USA)

Sensar (AR 40e) Rs. 11,900.00

Tecnis (ZA 9003) Rs. 15,900.00

. Bausch & Lomb (USA)

Akreos (adapt) Rs. 11,900.00

Akreos (AO - Zero aberration)

Rs. 15,900.00

. Aurolab (Indian) Rs. 5,000.00

. Omni (Indian) Rs. 7,000.00

. Appasamy (Indian) Rs. 6,600.00

Non foldable lenses

. Alcon (USA)

PMMA MC 50BD Rs. 4,500.00

. AMO (USA)

Dura (65T) - PMMA large optic Rs. 4,900.00

Dura (53) - PMMA small optic

Rs. 4,900.00

Eyekon (USA) Rs. 4,900.00

Omni (Indian) Rs. 1,000.00

Curamed (Netherlands) Rs. 4,500.00

Raiyan

Rs. 1,000.00

Katriol (Indian) Rs. 750.00

Fred Hollows (Indian) Rs. 1,000.00

Aurolab (Indian) Rs. 1,000.00

Visiflex (Indian) Rs. 750.00

Appasamy - Liberty (Indian)

Rs. 3,250.00

Appa lens Rs. 1,000.00

The patient is advised to pay the amount stated above for lens of his/her choice.

Further the patient is advised not to purchase a non CDDA approved lens some of which are marked up at over 300% of its true value.

The prices quoted are correct at the moment but may vary and be revised with change of the US Dollar and the Indian Rupee.

Finally I would like to state that 30 intra-ocular lenses are supplied free to each Ophthalmologist in the Provincial hospitals by the Sri Lanka Eye Foundation. You may inquire from your surgeons about this lens implant.

-Dr. C. R. Seimon, MBBS (Cey), DO (Lond), FRCS (Eng), FR Cophth (UK)

Chairman, Sri Lanka Eye Foundation and Consultant Ophthalmologist.