SUNDAY OBSERVER Sunday Observer - Magazine
Sunday, 16 February 2003  
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Compiled by Carol Aloysius

Trail blazing cardiac surgeon says ... : Heart-valve registry on the cards

by Carol Aloysius

Sri Lanka's growing number of cardiac patients who have undergone surgery for their ailing hearts can look forward to a longer lease of life - if the vision of a pioneering Cardiothoracic surgeon becomes a reality. Sri Lankan born Dr Nihal Kulatilake, a Consultant Cardiothoracic surgeon currently attached to the Department of cardiothoracic surgery, at the University of Wales Hospital in the UK, is convinced that the new facility he hopes to introduce , will benefit all heart patients in this country, because it will regularly monitor and check on the state of their heart valve replacements, thus ensuring them a longer life span.

"The Heart-valve Registry I have envisioned, will be a Data Base containing all the relevant details of patients who have undergone heart valve replacements. It will fill a huge void in post operative care for such patients", he told the Sunday Observer in an interview.

At present, he points out, the vast majority of heart patients who have undergone surgery, have no proper follow up on the state of their heart valve replacements. "If the valve has deteriorated many of them could easily die even after a successful operation. A mechanical valve will last forever if it is looked after well. A tissue valve on the other hand may need to be replaced since such valves usually undergo deterioration after about 20 years.

Hence it is important to have some kind of data base containing names, addresses etc of such patients so that we can establish contact points and follow up on the state of their replaced valves". Which is why he explains,he is seeking government help to get the new facility into operation, as soon as possible".

Along with the Heart-valve Registry, he also hopes to set up a mobile heart clinic which can serve heart patients islandwide, check on their blood levels and give them drugs if needed. "One of the disadvantages in using mechanical heart valves which is commonly used here, is that patients need to have very good control of the thinning of the blood so as to avoid clotting: For this they need regular and accurate blood testing and good quality drugs- both of which are lacking in this country. The mobile clinic we have in mind should be able to fill these gaps".

This is not the first new facility exclusively for the benefit of heart patients which this trail blazing heart surgeon will introduce to Sri Lanka. In 1994 in response to a request by Dr Thenabadu, a senior cardiologist, Dr Kulatilaka helped to set up Sri Lanka's first privately owned state- of- the art Cardiac unit at the Nawaloka hospital, bringing his own team of trained theatre nurses, anaesthetists and other personnel required from the hospital he worked for in the UK. " At that time there were no coronary by- pass operations done in Sri Lanka , and people had to go abroad for these operations which were very costly.", he recalls.

Nevertheless , when the operations commenced in Sri Lanka, he and his team of doctors had to face a negative reaction from the public. "They felt that we were not really capable of performing these advanced operations . After the tenth month of performing these operations we couldn't cope with the demand!", he says in retrospect.

Six years later, in May 2000 this pioneering doctor helped to set up a similar unit at the Durdans hospital. Once again bringing down his own theatre nurses and doctors along to set up the unit. Today, both hospitals perform between 100 to 200 by -pass operations a month with successful results, he says..

"Any heart operation except the very complicated few can now be done in Sri Lanka because we now have well equipped heart units as well as skilled and experienced doctors to perform them. There is absolutely no reason why anyone should leave the country to un" he says confidently." There is no reason why anyone should go abroad for a heart operation, unless it is a very complicated one".

Dr Kulatilaka's vision for Sri Lanka is a country free of heart patients. "But that will happen only when there is a complete change about in life styles and attitudes regarding eating habits," he stresses.

Taking out the stress in your life

Are you a victim of trauma? Does your daily work schedule leave you tense and irritable? Then here are some simple exercises to overcome trauma and stress by a former principal of the school of physiotherapy and occupational therapy Ms Theera Fernando. She tells you how physiotherapy can help.

Physiotherapy is aimed at total rehabilitation of the individual by:

. Relief of pain;

. Achievement of relaxation of body and mind;

. Maintenance of strength, mobility and endurance both physically and mentally; and

. Restoration of function and economic independence.

Teamwork is essential to achieve these aims.

The patient is the most important member of the team.

Relaxation of the body and mind is the first step towards rehabilitation. Since most patients are very tense and may have been deprived of good sleep. Therefore by relieving tension, promoting good sleep is an essential component of the treatment. Good sleep is essential for health.

Practise every night for at least two weeks.

Do the following exercises to relax:

1. Bend your toes fully, then relax fully.

2. Pull your feet up fully, then relax fully.

3. Press your knees down, then relax fully.

4. Press your heels down, then relax fully.

5. Arch your back, then relax fully.

6. Squeeze your hands, then relax fully.

7. Press your elbows down, then relax fully.

8. Press your shoulders down, then relax fully.

9. Press your head down, then relax fully.

10. Screw up your face then relax fully.

Close your eyes. Breathe in and out slowly and relax. Repeat steps 1 to 10 till you feel relaxed. Think of your breathing only till you fall asleep. Say to yourself "I am breathing in slowly and relaxing". Remember to repeat this every night and make it a good habit.

You & Your Doctor


Q: Dear doctor,

My son who is in his late twenties, perspires profusely, from his small days. Now it is a little more than before. This happens even during cold weather. Treatment given some years back has not made any difference. The fan is on in cold weather too. In addition he gets fits of sneezing which turns into a cold. This happens very often after a nap in the afternoon and sometimes in the morning. Will this lead to any other illness? Please tell me what could be done to overcome this sickness?

- Anxious mother

A: Perspiration is sweat. It is a fluid secreted by a vast number of tiny glands called sudorific glands, in all over the skin. Its function is to evaporate by absorbing the body heat and hence to cool the body. There are some disease conditions which cause excessive sweating. One such condition is over activity of the Thyroid gland (in neck) called, "Thyrotoxicosis" in which one may produce other symptoms as well, such as, palpitations wasting of the body, anxiety, irritability, (rapid heart rate) a large appetite and protrusion of the eye ball and visible gland (goitre). On the other hand the sweat glands are directly under the control of Nervous systems, people who are very nervous, tense and in emotional stress may produce heavy perspiration from the palms and soles. This condition is called Hyperhidrosis, the best treatment for that is clinical Hypnotherapy.

You are advised to see your family doctor who will do the necessary tests to exclude Thyroid disease etc. Once this is done you may see a qualified clinical Hypnotist for help.


Bad odour

Q: I am a 25-year-old male. My tongue always has a white coating which produces bad odour. How can I remove this white coating? Why do I get this white coating on my tongue? What is the treatment you suggest?

I remove this white coating with a plastic tape (tongue cleaner). But after 20 minutes again white deposit forms on my tongue. I use tongue cleaner 10 or 15 times a day. Otherwise I get a bad odour. I used salt water and lime as well but it has not worked. Please help me.

- K. Patrick.

A: Most probably you are having a fungal infection. Self cleaning your tongue with tapes is not advisable at all.

It may lead to further complications later on. Sometimes the coating may be the result of over-rubbing of your tongue. You may use simple remedy like common salt water to clean your tongue and mouth.

Brush your teeth in the correct way after each meal. (i.e. breakfast, lunch and dinner) to maintain good dental hygiene. Stop rubbing your tongue. If no response to these measures go and meet a dentist for opinion.


Dark skin

Q: Dear Doctor,

My daughter's armpits are very dark in colour (almost black) although she is fair. It has been like this from her childhood days. She is now 20 yrs old.

Washing with soap has not helped her much.

Please suggest a remedy for this. Gradually her eyelids are also becoming dark. Kindly help me.

- Worried Mother

A: Your daughter seems to have a skin problem, but the details given by you are not enough to confirm it. Skin problems cannot be diagnosed without a proper examination. Probably, your daughter is having hyperpigmentation of the skin due to Hormones or Fungal infection. (Hyperpigmentation - excessive activity of the skin colouration cells) Please see a "Dermatologist Doctor."

Radiant complexion

Q: How would you describe a radiant complexion? How can I achieve this?

A: A radiant complexion means, smooth skin, tight pores, firm facial contours and well structured features, and a skin that glows of course.

Q: What must one do to have a radiant complexion?

A: A daily skin care routine is essential for obtaining visible results.

Golden rules to a radiant and beautiful skin are:

Cleansing: Gently cleanse your skin twice a day with a cleansing cream, a milk or a face wash and follow up with a suitable toner - which is essential as Toning is part of cleansing.

Protection: Your skin needs to be protected from the sun, pollution and other aggressions.

This is the important role of your Day Cream / Sun Cream.

An Energising Morning Cream is ideal.

Re-balance and replenish your skin daily using a Multi Active Night Cream / Lotion or one could use a face treatment oil and wake up with a fresh, rested and a glowing skin.

Compliment your skin with regular exfoliations and masks once or twice a week.

There are masks available for different concerns, such as, firming, vitality, instant youthful radiance, purifying etc...

- Sharminie Wijeyesekera from Exclusive Lines

When your child's speech becomes a babble...

Language disorders in children may be congenital or acquired. A language disorder or congenital aphasia can be described as an inability, total or partial, to understand or to use language in any one or all of its forms, such inability being independent of any other mental capacity or deformity or disease affecting the organs of articulation (speech).

Parents fondly report the pre-language phase of initial babble as the first meaningful words - such as 'mum mum', 'da da' 'nan', etc. - not realising that the baby is simply vocalising and not using the babble as person specific labels. This pre-language phase disappears in normal development. The unwary doctor may be lulled in to believe that a congenitally aphasic (language disorder) child has lost a true verbal skill and may misdiagnose an acquired language disorder.

Children whose language is delayed as a part of mental retardation or whose overall development has been inhibited by unfavourable environmental circumstances should not be included. Congenital language disorders range from 1%-2% in Sri Lanka. And the prevalence of acquired language disorders under the age of 5 years is fairly small.

When a mother brings a child for language disorders a correct appraisal of the past medical history, paediatric examination and a test of hearing should be performed before undertaking management. Correct diagnosis hastens the implementation of appropriate help to the child, facilitates resolution of the disorder and minimises secondary handicap.

Congenital langauge disorder could be primary or secondary. Primary are mainly due to constitutional (congenital brain damage) difficulties.

Secondary is mainly due to severe environmental stress and due to brian damage (due to viral infection, rubella, difficult childbirth, and jaundice) after conception and before the establishment of speech.

Genetic advice for parent of a child with a primary disorder is very important. Likewise, primary care personnel, especially speech therapists, should be alerted to the need to observe the language development of all other children of affected families. Earlier it was thought that left-handed children were affected more in speech problems. But it has been scientifically proved now that there is no connection between left handedness and speech difficulties.

Severe deafness, when present alone or in combination with brian damage, always resulted in a uniform impairment of all aspects of language. Non uniform impairment of langauge occurred among brain damaged children with normal hearing. Non-uniform patterns of impairment never occurred in the absence of brain damage.

Therefore the cause of language disability in a child presenting with a non-uniform pattern of impairment should not be attributed solely either to social factors or to deafness.

In Sri Lanka to improve the prognosis of language development we should introduce a langauge intervention program at pre-school level.

A speech therapist should see the mother and the affected child every 6 weeks and demonstrate how the mother can bring language learning in to the daily routine of her child. In the nursery class the child should receive intensive help from the pre-school teacher. Both methods are developmentally based and flexible so that help is tailored to the child's individual needs.

The period in which maximum language learning takes place in normal development is 1 1/2-4 1/2 years. From 3 1/2 years of age, language is increasingly integrated with other intellectual processes and becomes the main media of thinking. So inability to communicate will affect social and emotional development of the child.

- Dr. R.A.R. Perera

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