World Diabetes Day falls tomorrow:

Juvenile diabetes on the increase

By Nilma DOLE

There is an exponential increase in the number of diabetes among children,said President of the Medical Association (SLMA), Prof. Sanath Lamabadusuriya at a seminar held to mark World Diabetes Day at the Government Information Department. He said that the genes of Sri Lankan children have not changed over the years but it is because of changes in the environment, changes in their lifestyle, decrease in physical activity and increased intake of the wrong kind of food that has led to juvenile diabetes. "Nowadays televisions, computers and social networking sites keep children occupied at home.

They spend long hours on the televisions and computers which is at the expense of outdoor activity," said the doctor. He said that earlier, youngsters used to sweat it out, play games and sport and kept their metabolisms level high but nowadays, it is an entirely different story.

Adding to the problem of decreased physical activity, there are a number of fast food restaurants and children today eat junk food and drink fizzy soft drinks that are high in sugar. "Decreased physical activity and increase intake of calories contribute for children to become overweight and develop diabetes early," said Prof. Lamabadusuriya. According to the doctor, it is not just the problem of our ageing population in which the longer they live, the more prone they are to develop diabetes.

"However, it is not only the problem of the ageing population but even children are becoming more prone to developing diabetes now as we see a shift in eating and exercise habits," he said. He said that they will develop all sorts of complications later on in life. The public need to be made aware and take on programs to try and control the prevalence of diabetes and prevent complications by better management of their lifestyle.

Prof. Chandrika Wijeratne, President of the Diabetes Task Force, known as Nirogi Lanka said that diabetes is not a disease which should be singled out as one ailment. "Diabetes goes hand-in-hand with other diseases such as high blood pressure, high cholesterol as well as obesity," she said.

In those terms she said that we need to encourage our young population, men and women to adopt a good lifestyle or it will lead to consequences. "In fact it has been found that women are more affected than men, in preventing heart attacks, kidney failures, losing eyesight and losing their feet." Moreover, she said that the discipline and maintaing a healthy lifestyle by sticking to it is lacking. People are ignorant or don't really follow a healthy lifestyle and a balanced diet. "For those reasons, we need to ensure that these people follows a healthy diet and a healthy lifestyle and has minimum stress as possible. We are all stressed but we should be able to cope with stress is what we should encourage," said the Professor.

Similarly the advertising and promotion of unhealthy food should be regulated. A healthy balanced diet and addictions such as alcohol and smoking increases the risk of diabetes. She said, "When we talk about non-communicable diseases, we need to talk about high risk issues such as smoking and cancer as cancers are linked to obesity." As a group, the Ministry of Health and the SLMC have joined hands and worked together in association with the World Health Organisation to bring about certain changes.

The World Diabetes Foundation has given funds to the government and together with the SLMC started a project called Nirogi Lanka. In this regard, a new line-up of activities has been planned to inculcate a healthy lifestyle and a good balanced diet program. For World Diabetes Day 2011, there is a walk that is planned today at 7am with a series of activities on having a healthy diet, doing yoga sessions and healthy refreshments being served to participants.

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[World Diabetes day program]

*0700 to 0800 : Diabetic Walk from Town Hall to BMICH
*0830 to 0850 : Healthy refreshments
*0850 to 0900 : Welcome Speech
*0900 to 0930 : Towards Healthy Living - An interactive session by Dr. Ranjuka Ubayasiri, Consultant [Vascular Surgeon ]
*0930 to 1000 : Yoga for everyone - Yoga session by Vyasah Kalyanasundaram
*1000 to 1030 : Act Now to prevent diabetes by Kotte and Kolonnawa residents
*1030 to 1100 : Be active, be healthy - A demonstration of physical exercises by Allied Health Sciences [Unit, Faculty of Medicine, Colombo ]
*1100 to 1130 : Mindfulness in health - A meditation session by Prof. Wasantha Gunathunga, Department of Community Medicine, Faculty of Medicine, Colombo
*1130 to 1145 : Composed by Dr. Geshan Kalupahana and Dr. Suran Kuruppu. SLMA Declaration, a call for adoption of a healthy policy and practice of sponsorship by professional medical associations in Sri Lanka. (Courtesy Nirogi Lanka project)

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Australia passes plain-packaging cigarette law

Australia is to become the first country to enforce the plain packaging of cigarettes but tobacco companies have vowed to fight the new legislation in court.

From December next year, all cigarettes will be sold in olive green packs, which research has shown is least appealing to smokers.

Under the new laws, approved by the upper house of parliament, no trademark brand logos will be permitted on any packaging of tobacco products, although companies will be able to print their name and the cigarette brand in small, prescribed font on the packets.

The boxes will continue to carry stark health warning messages and pictures, which will cover 75pc of the front of the pack and 90pc of the back.

"If this legislation stops one young Australian from picking up a shiny, coloured packet and prevents them becoming addicted to cigarettes then in my view it will have been worthwhile," said John Faulkner, a Labour senator, during the parliamentary debate. The debate in Australia has been keenly watched around the world, including in Britain, Canada and New Zealand where similar plans to curtail branding are being considered.

Cigarette giant British American Tobacco, which owns 46% of the Australian market, plans to challenge the legislation in the high court on constitutional grounds. "The government can't take away valuable property from a legal company without compensation," said Scott McIntyre, spokesman for British American Tobacco Australia.

McIntyre said the company's brands, including Winfield and Benson & Hedges, were worth billions of dollars.

"We're a legal company with legal products selling to adults who know the risks of smoking. We're taking this to the high court because we believe the removal of our valuable intellectual property is unconstitutional," he said.

Cigarette makers Philip Morris Australia said the legislation meant it had little option but to pursue its compensation claim "through international arbitration against Australia and to also consider domestic legal action under Australian law".

The health minister, Nicola Roxon, said the government would not be bullied by the tobacco industry's threat of a legal challenge.

"We're ready for that if they take legal action. We hope that they don't. We believe that this is a measure that's in the interests of the community and it would be better off for tobacco companies to look at ways they could invest in something that's not so harmful for the community," Roxon told reporters in Melbourne.

Cigarette companies also say the plain-packaging legislation will increase the sale of illegal tobacco. "Once the packs all look the same they will be very easy to copy," said McIntyre.

Fifteen thousand Australians die from smoking-related illnesses each year with the social cost of smoking to the Australian economy estimated to be more than A$30bn (£19bn) a year. Anti-smoking groups have welcomed the legislation. "We believe that it will reduce smoking in younger people and the fact that tobacco companies have been using packs very effectively as one of the last forms of advertising is one reason why they're so upset about it," said Professor Ian Olver, chief executive officer of the Australian Cancer Council.

Fifteen per cent of adults in Australia smoke compared with 23% a decade ago. In Britain about 22% of the adult population smokes, according to Cancer Research UK.

Australia already has some of the toughest smoking regulations in the world. Cigarettes must be sold behind closed doors in retail outlets and advertising and sponsorship deals are banned. It is illegal to smoke in any public places including bars, restaurants or entertainment venues. Some local councils have banned smoking in parks and outdoor areas.

- Guardian.co

Giving dignity to life

Palliative care available in a hospice is care which helps alleviate or eliminate patients' suffering - psycho social, physical or spiritual, manages symptoms and side effect and provides pain relief so as to improve the quality of life for the patient who has a life threatening disease.

While hospices worldwide house patients with various diseases, Shantha Sevana in Maharagama is dedicated to providing palliative care to those terminally sick with cancer. "Dedicated" here is not mere wordplay.

Shantha Sevena offers those who feel they have very little hope the dignity and respect needed to live the rest of their life in peace and even, happiness. Most often this extends beyond physical care and medicines to mental, emotional and spiritual support as well as social acceptance.

Palliative care at Shantha Sevana includes constant vigilance and nursing, pain management and relief, alleviating distressing symptoms, feeding, keeping the patients clean and cared for. Their psychological, social and spiritual needs are also addressed.

Started in 1996 as the first of its kind in Sri Lanka, the staff now consists of a group of doctors, trained nurses, hospice aides and support staff.

The gardens of Shantha Sevena are remarkably well laid out.

Compared to the hustle and bustle of the Maharagma Cancer Hospital which stands adjacent to it, there is calm around the clean, beige-painted corridors of the hospice.

Nurses in their crisp uniforms and spotlessly dressed hospice aides walk around busily attending to their duties while various doctors and family members make their way in and out of this home for the terminally ill.

October 8, 2011 saw the world celebrating World Hospice and Palliative Care Day, and although the terminology of cancer, chemotherapy and mammograms are familiar to most, hospices and their services are usually less familiar.

For those diagnosed with incurable non-communicable diseases, care options can be limited.

A heavy emotional burden is often borne by the patient and the family. A "hospice" is a care institution for those with such diseases may it be cancer, cardiovascular diseases, respiratory syndromes, diabetes related or other.

In other words, it is a care institution for the terminally ill aiming to help patients in the final stages of their lives to live as pain free and as comfortable as possible, in dignity and surrounded by loved ones, where possible.

The disease is not treated here, but instead every effort is made to ensure the quality of life left. A hospice while affirming and respecting life, does not attempt to delay death.

At the hospice, all services come completely free including admission, care and food. The single requirement for admission is a referral by a medical professional confirming that the patient is "terminally ill resulting from cancer". Absolutely no discrimination is made on the grounds of ethnicity, religion, social status etc.

Even amidst death, sickness and pain, the amazing thing is that cheer never lacks at the hospice. Patients are sometimes quietly watching TV, engaging in handicraft activities run by volunteers, reading, etc. Inmates are encouraged to keep busy and more importantly, happy. Visits by family members are greatly encouraged at Shantha Sevana.Although hospices are prevalent in the sub-continent and some of the best are in India, Sri Lanka has very little knowledge of their existence and more so their function.

The lack of knowledge of the nature of a hospice and its immense value to the terminally sick and their families has ironically resulted sometimes in underuse of this high caliber care institution.

A public education program to familiarise the concept of a hospice would be greatly beneficial. Shantha Sevana is blessed with the donations of a group of truly dedicated and committed benefactors and so is financially secure.

It is satisfying as well as a tribute to the institution to see the number of families of patients who have benefited from the care and love of Shantha Sevana, return to help in whatever way they can, whether it be to give alms, donations or just spend time with other patients.

Shantha Sevana relies on volunteers who can commit a few hours to come in and spend some time with the patients who eagerly await the company and warmth and also the connection with the outside world. Volunteers are always welcome.

The number of touching tributes paid to the institution by family members of patients who have passed away, at the recently helped hospice day celebrations was proof of the service it renders.

Shantha Sevana is truly a haven for the terminally ill with cancer, and a blessing for their loved ones who cannot care for them fully. It is a home away from home where life is respected and death is not feared. It is a 'somewhere' - where the terminally ill will have their hand held gently and eased on in their life's journey.

- A.K.

Pain management - a separate subspeciality

Sunday Observer spoke to Dr. Rohitha Jayamaha, Resident Physician at the Teaching (General) Hospital Kandy on Interventional Pain Practice. An expert in the field, he is one of the Sri Lankan doctors to qualify in this area of specialisation, winning the Most Innovative Physician (Outstation) by the College of Physicians in 2008. He is also a Fellow of Interventional Pain Practice (USA).

Question: Describe your area of specialisation.

Answer: I started in the Moneragala district general hospital as a Specialist Physician in 2007. I took care of patients for various medical ailments and could manage many of them successfully. However, there was this category suffering from long-standing neck, back and joint pain. These patients were continuously consulting me without any relief. It was a real problem initially as a first contact level physician but then I managed to convert it to an "interest".

Q: How did you manage to tackle the issue?

A: When I realised the problem, I opened a "Pain clinic" and started looking at them more closely. I started with 1500 patients at the pain clinic during the first three months. I realised that they were all prescribed with all sorts of pain-killers. In addition to that, anti-depression medications and gastritis treatment was prescribed to them for many years. However, their pains had never been abated. I tried my best to adjust the medications and also got the help of our physiotherapists because pain associated with movement disabilities are a major component of treatment. Unfortunately, I was never able to cure them or even mobilise them back to work compared to when they were healthy.

Q: What did you do to help these patients?

A: I had two options either to ignore all these patients' complaints or to study and analyse it further. I opted for the second option and I started thinking, reading and consulting other colleagues. Eventually I realised that there was a "missing link" in pain management.

When we use all the possible drug combinations and fail to treat a pain with no surgery, it is not really possible to treat their pain problems, especially when it is long standing. When studying the problem deeply, I also understood that even if the pain started as a warning symptom of an underlying disease, with time, if it is not managed properly, it becomes a disease by itself. Therefore, long-standing pain conditions sometimes become untreated.

Eventually these patients became silent sufferers as there is no available remedy.

Q: What is the magnitude of this problem?

A: Chronic pain conditions are supposed to be more prevalent than diabetes, heart diseases or cancers across the world.

In general, 25 to 30 percent of our population is affected by chronic pain conditions. Back pains, neck pains and headaches are the commonest in poorly treated chronic pain conditions. These conditions affect family/social life and leads to an endless suffering with about a 20 times higher suicidal risk among the affected. It also leads to loss of productivity and a huge expenditure on the health budget.

Western medicine is very advanced today but we haven't got any way out yet! Today, "Pain medicine" is a separate subspeciality in the world. When I faced with this problem of the missing link in our health sector, I started reading literature and took my studies one step further by visiting "Pain Clinics" in other countries. I found the missing link called "Interventional Pain Management". IPM is widely accepted and utilised in USA/Europe and to some extent, in other countries. During the past few years, I got trained in some of those clinics and started practising IPM on my own pain patients. I had very good outcomes most of the time and it should also be mentioned that there may be some other specialists practising IPM in Sri Lanka but it is not widely known.

Q: What sort of specialisation is IPM about?

A: When there is no possible medical or even a surgical treatment for a chronic pain condition, we are in trouble. What we do in IPM is firstly localising the pain generators and then inject them with some medications or apply a small electrical pulse on them. We use X-rays/ultrasound for visualising tissues and the procedures are done under local anaesthesia. Done with experienced hands, they are very safe procedures and take off the pains for months to years when you can do your physiotherapy/exercise making a full functional recovery.

Q: What chronic pain conditions can be treated with IPM?

A: There are many pain conditions which cannot be treated surgically or medically but can successfully be treated with IPM even in patients with cancers. Some of them are:

1. Spinal pains - joint diseases, some disc diseases where surgeries are not indicated, Vertebral fillings, Failed neck/back surgical pains
2. Treatment resistant Non-Spinal pains - myofacial pain,
3. Some forms of treatment resistant headaches - Trigeminal Neuralgia, Cluster Headache
4. Pains due to poor/deranged circulation in limbs
5. Chronic Pelvic Pains, especially in females
6. Cancer pains - N.D.