Online edition of Daily News

At the Health Watch organised doctor-patient discussion held last month at the Asha Central Hospital Auditorium in Colombo, one of Lanka's leading Heart Surgeons explained how nature comes into the rescue of many people affected with minor blocked arteries by creating what he called - natural bypasses by dilating the small blood vessels in the heart to take over and speed up the blood circulation, thus keeping the heart functioning normally, that the person won't know anything of the blocked arteries.

He was responding to a question from a participant whether a person could live a normal life with a blocked artery in the heart with no knowledge about it.

The discussion lasted for well over three hours, as the medical panel kept it going with light hearted banter thrown in between the serious discussions. At the end they had to call it a day promising to have another one shortly.

In answering a question from a participant how often a patient could use a TNT tablet under the tongue when he gets a heart pain, Dr. Laxman Dalpadadu said.

The Medical panel at the discussion. From left Dr. Githanjan Mendis (Consultant Neurologist), Dr. D. P. Atukorala (Consultant Cardiologist), Dr. Dennis J. Aloysious (Family Physician) and Dr. Laxman Dalpadadu (Heart Surgeon).

"TNT is an explosive substance, if you put that under the tongue. You wont live to do that again, because it could explode.

The tablet is not TNT it is GTN. How this mix up has taken place I don't know but most doctors are making this mistake by force of habit.

Dr. Dalpadadu in replying to a question whether a particular food item was good for the heart patients said he said advising on such matters had been done carefully. In his opinion doctors should not strongly recommend publicly things like food items as either good or bad for people, because food analysis is done by bio-chemists and not doctors.

Cardiologist Dr. Mohan Jayatilleke listening to a patient, who wanted to get a point cleared which he had not been able to follow at this discussion.

There is the possibility of so many yet undiscovered chemical and nutritional components being there in the food items we consume. We knew reactions to food items differ with each individual. So while advice could be given to a particular individual with regard to food, people should not treat that as a general recommendation.

He substantiated his argument by referring to media publicity given in this country sometime back to the effect that karapincha was good for the heart, and sometimes later some other people coming out with the theory that it is bad for the heart. This kind of thing can create confusion in the public mind.

Dr. Dalpadadu also explained to the audience the rare condition of 'fluid being round the heart'.

He was again responding to a patient's querry on the issue. He said here what happens is the accumulation of fluid in the space between the pericardium and the heart. This is a rare condition which results due to viral infections, and T.B.

Dr. Dalpadadu also said what is meant by change of life style after heart surgery was, that the patient has to follow a

Dr. Dalpadadu had this to say on smoking - that 90 per cent of the patients on whom he had done bypass operations were non-smokers.

Dr. Dennis J. Aloysius (intervening) all my batch mates who were heavy smokers are now dead and gone.

It was also explained to the audience by the medical panel that, it was possible for a person to live with a blocked artery in the heart, as in some such cases Dr. Nature creates natural bypasses in the heart by diloting the small blood vessels allowing for free flow of blood and the affected person would never know that he had a blocked artery.

Consultant Neurologist Dr. Githanjan Mendis responding to a query relating to TV, Radio and press advertising of food items, and their possible impact on the nations health said some of those advertisements could mislead the public and possibly cause health problems.

As such under the open economic system there is an urgent need for the Authorities to look into this matter and evolve a code of ethics to be followed by the Advertising Agencies.

He said as far as Western Medicine is concerned there is a code of ethics on advertising, evolved by the Sri Lanka Medical Council.

Pressure sores are areas of injured skin and tissue. They are usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn't occur often enough and the blood supply gets too low, a sore may form. Bed sores are also called pressure sores, pressure ulcers and decubitus ulcers.

Bed sores can be serious, depending on how much of the skin and tissues have been damaged. You should call your doctor if you think a sore is forming.

* Stage 1 - Constant warm, pink, or red area of unbroken skin, usually over a bony area.

* Stage 2 - The sore looks like a blister, small break in the skin, or a shallow crater. The surrounding area may be red.

* Stage 3 - The sore goes all the way into the layer of fat just under the skin. It may be white or black in color; may have a foul smell or may be draining.

* Stage 4 - The sore extends into muscle or bone. It may be white or black in color. The surrounding area may be warm to the touch or red. There may be foul smelling drainage.

Deep sores can go down into the muscle, or even to the bone. If pressure sores are not treated properly, they can become infected. An infection in a pressure sore can be serious. Bed sores also hurt a lot and make it hard for a person to move around. Who gets bed sores?

Anyone who sits or lies in one position for a long time might get bed sores. You are more likely to get bed sores if you use a wheelchair or spend most of your time in bed.

However, even people who are able to walk can get bed sores when they must stay in bed because of an illness or injury. Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for bed sores to heal because of a poor blood supply to the area.

Bed sores usually develop over bony parts of the body that don't have much fat to pad them. Bed sores are most common on the heels and on the hips. Other areas at risk for bed sores include the base of the spine, the shoulder blades, the backs and sides of the knees, and the back of the head.

Established bedsores are painful and life threatening. They lengthen the time spent in hospitals or nursing homes and increase the cost of care.

Prevention is the top priority, and deep bedsores can almost always be prevented with intensive nursing care. Preventing sores often involves the participation of attendants and family members in addition to nurses. Careful daily inspection of a bedridden person's skin can detect early redness. Any sign of redness is a signal that immediate action is needed to prevent skin breakdown.

Bony projections can be protected with soft materials, such as cotton or fluffy wool.

Beds, chairs, and wheelchairs can be padded to reduce pressure. People who can't move themselves should be re-positioned frequently; the usual recommendation is to turn them every 2 hours and keep their skin clean and dry. People who have to spend a lot of time in bed can use special mattresses. For people who already have bedsores on several body sites, air-filled mattresses or sponge rubber "egg-crate" mattresses can shift pressure and offer extra relief. An air-suspension mattress may be needed for people with many deep bedsores.

Treating a bedsore is much more difficult than preventing one. Fortunately, in the early stages, bedsores usually heal by themselves once pressure is removed. Improving general health by taking protein and calorie supplements may help speed healing.

When the skin is broken, protecting it with a gauze covering can help it to heal. Teflon-coated or petroleum jelly-impregnated gauze has the advantage of not sticking to the healing wound. For deeper sores, special dressings that contain a gelatin-like material can help new skin grow. If the sore appears infected or oozes, rinsing, washing gently with soap, or using disinfectants such as povidone-iodine can remove the dead and infected material.

However, cleansing too harshly slows healing. Sometimes a doctor needs to remove (debride) the dead material with a scalpel. Chemical agents can be used instead, but they are generally less thorough than a scalpel.

Deep bedsores are difficult to treat. Sometimes they require transplanting healthy skin to the damaged area. Unfortunately, this type of surgery is not always possible, especially for frail older people who are malnourished.

Often when infections develop deep within a sore, antibiotics are given. When bones beneath a sore become infected, the bone infection (osteomyelitis) is extremely difficult to cure and may spread through the bloodstream, requiring many weeks of treatment with an antibiotic.

These pictures tell some what of a relieving story to victims of violence and accidents who suffer with broken or chopped off limbs.

The story reveals that in such incidents if the public who may come to help the victim have a bit of common sense to carefully collect the separated part of the victims body put it in a polythene bag and despatch it along with the injured victim to the hospital, the doctors have a chance of restoring that part to the victim’s body, and thus save him from being a disabled person for the rest of his life.

In this composite picture No.1 shows the chopped off palm of the victim (picture No.4) in an incident of violence in Aranayake in the Kandy district. Picture No.2 shows the Surgical Team in the Peradeniya Teaching Hospital headed by orthopaedic Surgeon Dr. Hillary Suraweera, Senior Registrar Dr. Lionel Weerawardene and Senior Lecturer Dr. Shankat Esufali, surgically rejoining the separated palm and wrist back to the hand and picture No.3 shows the Surgeon holding the palm after surgery.

We thank our Kandy South Group Correspondent S. M. Jiffrey Abdeen for sending the pictures and the story to us.In his note about the incident he writes:-Kapila Senanayake (28) of Udagama in Aranayake, earlier this month while driving a three wheeler in the night with some friends, was allegedly encountered by an armed gang who assaulted them unmercifully as they suspected them of having tipped off the police regarding kassipu illicit liquor distilling which is a thriving business in the area. Kapila Senanayake appeared to have been their target.

They had allegedly cut him with a sword whilst fallen down in a precipice.He had found blood oozing out from the blunt end of his left hand while the severed wrist was hanging from a thin strand of flesh. Meanwhile people had collected and despatched him to the Aranayake Hospital. From there he had been transferred to the Kegalle District Hospital which had better facilities to handle injuries of this nature.At the Kegalle Hospital the doctors had done a good job in tieing up the arteries and veins arresting the flow of blood as otherwise, the patient could have bleed to death.

The doctors at the Kegalle Hospital also cut off the strand of flesh from which the wrist was hanging and placed the wrist in a polythene bag and tied it.

This was placed in another bag containing ice and patient and hand despatched to the Peradeniya Teaching Hospital.The time had been around 8 p.m. when Dr. Shaukat Esufali and Orthopaedic Suregeon Dr. Hilary Suraweera got the message. They immediately rushed to the ward of the Peradeniya Teaching Hospital and this was the second such case they had encountered in recent times and the first one they successfully joined and the victim is understood to be near normal now.Dr. Esufali explaining, said that the Kegalle Hospital did the right thing from the start whereby they were able to carry out their operation successfully.

If the severed wrist was not brought in a bag containing ice, process of decomposition and infection is quicker. The severed limb has to be brought in this manner and as quickly as possible.Dr. Esufali continued that since the doctors at the Kegalle hospital had tied up the blood vessels, they had to untie them and later suture the main blood vessels. The veins and nerves too had to be sutured.

The bones will have to be connected with the help of pins and kept in their places. Tendons too had to be sutured and the skin closed.They did all these and a medical student Rasnayake from the Jayatillake Hall took photographs of the operation and the severed hand with the camera he had in his possession. It was due to efforts of medical student Rasnayake that the pictures of the injured hand and the surgery in progress was made available.The team of doctors were overjoyed when shortly afterwards there was response from the severed wrist when the flow of blood into it was noticed.

There was also warmth. The smaller blood vessels which are virtually microscopic will join by itself through a process by nature.Five days later Kapila Senanayake was able to move the fingers a little which he displayed to this writer who visited him at the hospital. There is also a little sensation in the hand and the patient feels when he is pinched. These are positive signs that this major surgery has been successful and after over a period of time the patient could make normal use of the hand doctors said.