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| Friday, 6 February 2004 |
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Sex taboo for the Bypassed
A one month's sex taboo for those who have undergone bypass surgery was advised by the cardiologists who were participating in the Health Watch Medical Advisory Panel and Durdans Hospitals Heart Centre jointly organised doctor-patient discussion on the bypass operated in Colombo on Sunday at the Durdans Hospital. The Cardiologist panellists comprised Drs. D. P. Atukorala, Vasantha Hettiarachchi, Asanga Dunuwilla, S. Shantharaj and Durdans Cardiac Centre Head Cardiac Surgeon Dr. S. Amith Chandra. Several questions from the young and elderly bypass operated centred on how soon to resume their normal family life including sex, and the doctors were responding to that. Dr. Atukorala had this to add "sex only with your legal partner, and no sex outside". Somebody from the audience jokingly asked-why? Doctor too smilingly said "because anxiety and the stress will be a little too much for the heart". Dr. Dennis Aloysius (Chairing the meeting). There is nothing to feel shy about these matters. Sex is part and parcel of life. The three hour discussion from 10 am to 1 pm apart from very serious medical advices, were interspersed with somewhat of a medico-mirth evoking exchanges like the sex issue. There were some opinion clashes, too, at this discussion which centred on coconuts and chelation therapy. Most of the audience welcomed these exchanges saying "we are living in a democratic society, why shouldn't we have democracy in medicine too". When a question on diet was raised, and the patient wanted to know the Cardiologist's view on coconuts, Dr. Atukorala who makes no bones about his pro-coconut advocacy, went on in his usual style saying that since he began practising Cardiology he has been advocating his patients to fear not taking coconut and coconut oil in their diet as usually the people in this country have been doing for ages. He said that he had found no adverse effects on his patients. Dr. Wasantha Hettiarachchi taking a different view said he would not agree with Dr. Atukorale's view point as most of the cardiologists do the world over for valid reasons, and would advise people to use sunflower or olive oil, which had no saturated fat like coconut oil. He also said that according to available statistics heart diseases in the rural population has been on the rise due to coconut consumption and less active life they are now living, taking to the lifestyle of the city dwellers, unlike in the past. Dr. Shantharaj at this stage intervening said that he too felt coconut if it could be avoided is better. However there was one thing to consider that it was bad to re-use olive, and sunflower oils. This would be somewhat of a costly thing for the average man. For such cases he would say better use coconut oil which can be re-used with not much ill effects. Finally the panel came to the conclusion that as Buddha said in life anything moderation is the best. Another controversy started on Chelation therapy. This came up when a patient wanted to know the alternative for bypass surgery available at present and what advice the panel would give on chelation therapy. Here Dr. Wasantha Hettiarachchi held the view that although some claimed Chelation therapy (the 30 injection treatment) as an effective alternative to bypass and angioplasty, it has not yet been subjected to the needed trials like double blind tests for approval as safe and effective to practise by the medical profession. Therefore with responsibility no doctor could say openly go for it as an alternative for bypass. Dr. Atukorale again like in the coconut controversy took the opposite view saying upto now he had sent about 300 heart patients with arterial blocks who either feared surgery or were financially not stable to bear the high cost of surgery and angioplasty to go for chelation therapy and all of them had successful results. He said in Sri Lanka the chelation therapy cost only about Rs. 45,000 for the full treatment whereas bypass surgery costs around Rs. 400,000. In America, Britain, India and several other countries too this therapy was being done successfully though it had not yet undergone the medically required trials for official approval and recognition. Dr. Atukorale said that Poorna Health Care Trust run by Penny Jayewardene was giving this treatment free to the poor heart patients. Dr. Shantharaj giving his view on the controversy said, chelation therapy may become the treatment for heart disease in future yet at present, since it had not been subjected to necessary trials, it's not possible to recommend it. An interesting discussion took place on diet and fast food which will be carried in this page next week. Health Watch Medical Advisory Panel wishes to thank Management of the Durdans Hospital, Dr. S. Amith Chandra of its Heart Centre, the Cardiologists and the other panellists who took part in the discussion and Anchor Milk Food, Asitha Meemaduma of Novartis Nutrition and Mrs. Mala Ranatunga of Lanka Soy for donating gift packs and sponsoring the event. ############## British study says screening for diseases before marriage A Nottingham University study in UK has found that in marriage one partners not only with the girl or the boy but with his or her diseases as well. Hence they feel it appropriate for the couples to go for a disease screening before marriage. The following is the synopsis of the study published in the British Medical Journal (volume 325) a copy of which has been sent to us by Health Watch Medical Advisory Panel Member, Dr. Dennis J. Aloysius. Researchers from the University of Nottingham set out to determine whether people whose marital partners suffered with a certain condition such as depression, high blood pressure or asthma were at increased risk of suffering from the same disease. Over 8,000 married couples aged between 30 and 74 took part in the study. After adjustments were made for age, obesity and smoking status in both partners, it was found that the partners of people with asthma, depression and peptic ulcer disease were 70 per cent more likely to suffer from the disease themselves. People with partners suffering from other conditions such as high blood pressure and hyperlipidaemia (excess cholesterol in the blood) were also more likely to suffer from the same conditions as their spouse. The link is most likely to be caused by the environment within which the couple live, with shared environmental factors putting cohabiting partners at risk of developing the same diseases. The finding for asthma may be due to shared diet or shared exposure to allergens, whilst findings for hypertension and hyperlipidaemia suggest that diet and the pattern of physical exercise shared by couples has an important role in the disease's cause. Another possible explantation for the findings is that couples may share similar attitudes towards healthcare and seeking health advice. The researchers claim their findings could have implications for screening and other interventions. Interventions targeted at couples may prove more effective and screening spouses for some diseases should be considered. ############## Nutritional value of eggs by Dr. D. P. Atukorale I refer to the articles including the article written to "Health watch" Daily News by the veterinarian Dr. A. Nandakumar (AN) where AN advises the readers to "take an egg a day to keep the doctor away". The veterinarian's articles are full of inaccurate statements regarding the nutritional value of eggs. Some of his inferences don't apply to human beings as far as I am aware. AN's articles give the impression to the readers that consumption of eggs is safe for everybody irrespective of their coronary risk factors (smoking, hypertension, hypercholesterolaemia, diabetes, obesity, lack of exercise and family history of coronary artery disease). AN in his articles to the news media refers to two professors attached to the Egg Nutrition Centre Washington and to an Egg Conference Report. It is noteworthy that AN, in none of his articles, published in the news media, ever refer to any international recognised medical journal such as BMJ, JAMA, Lancet, New England Journal of Medicine, American Heart Journal or American Journal of Cardiology or American Journal of Clinical Nutrition (which I consider as the most recognised journals on nutrition) to support his hypothesis. In one of the articles, the veterinarian doctor says that selenium present in eggs can prevent Keshan's disease (which is an extremely rare serious disease reported in North West and South East China) Keshan's disease has not been reported from India where there are millions of vegetarians (including vegans) who never consume eggs. Keshan's disease has not yet been reported in Sri Lanka where there are millions of people who don't consume eggs. Eggs are not a popular dietary item among the rural Sri Lankan folk who comprise 70 per cent of our population and there is one million vegetarians in Sri Lanka. One does not have to eat eggs to get his or her selenium requirement as selenium is present in bread, dairy products, molasses, wheat germ and sea food. Another reason given by the veterinarian in support of egg consumption is that eggs contain the trace of element zinc. I fully agree with AN that eggs contain zinc. Good sources of zinc are pumpkins, seed kernel, sesame (gingili) seeds, peanuts, miso, tofu, wheat, cheese, cashew nuts, chicory, barely, baked beans and meat. Choline, Lecithin and Lutein AN advices the readers to eat eggs to obtain their choline, lecithin and lutein requirements. As far as I am aware choline is a compound essential for animals and not for humans. Choline is often linked with vitamins by some drug companies which attempt to mislead the public that choline is an essential vitamin. Lecithin which is a phospholipid contains choline and is sold by drug companies with the false claim that lecithin can reduce blood cholesterol, a feat which it does not achieve in humans. I would be very grateful to AN if he can quote a reference from a recognised medicall journal or medical book that lecithin can reduce blood cholesterol level in humans. Another misleading statement the veterinarian doctor has made is that lutein present in eggs reduces the incidence of heart disease. I would be very grateful to AN or any other reader if he or she can quote a reference from a recognised medical journal or medical book to support the statement that consumption of eggs (which contain lutein) reduces the risk of heart attacks in humans. Folate (Vitamin B9) I fully agree with AN that folate present in eggs is a very important vitamin for human growth, prevent anaemia and is necessary for development of central nervous system of the human foetus. The word folium in Latin means leaf and this is the best source of vitamin B9. Eggs do contain folate and meat is a very poor source of folate. Good vegetable sources of folate are spinach, cabbage, okra, wheat germ, bean sprouts, asparagus, peanuts, kidney beans, sea weeds, sweet corn, avocado, gingili seed, rice, papaya, slit beans and broccoli. One does not have to eat eggs which are full of cholesterol to get his or her folate requirement. Prospective studies Two prospective studies have shown that there is no risk of heart attacks or strokes for healthy people consuming one egg per day. (JAMA, 199; 281:1387-94). The researchers have recommended consumption of one egg a day for healthy people ie for those who don't have coronary risk factors such as high blood cholesterol, hypertension, smoking, diabetes, obesity, lack of exercise and healthy eating pattern. It has been found by above researchers that people who eat eggs were more prone to consume bacon, whole milk and less likely to eat vegetables, fruits and skimmed milk. According to above researchers there is no definite evidence that an egg a day is safe for healthy women. In case of people with diabetes there is a definite increased risk of heart attacks if they consume one egg a day. It is common knowledge that genetic influences and lifestyle play an important role as to whether a person will develop chronic diseases such as ischaemic heart disease. According to American Heart Association you lessen the likelihood of heart disease by not smoking, controlling blood sugar, maintaining blood cholesterol level below 200mg/dl, exercising regularly. Family history of heart attacks and obesity are some other important risk factors for heart attacks. Currently US Dietary Guidelines and American Heart Association recommendation of an average daily intake of not more than 300 mg of cholesterol a day has not yet been challenged by any medical authority. An egg yolk contains 212 mg of cholesterol more than a days ration of cholesterol for people at high risk. All physicians advice people with high blood cholesterol to avoid consumption of dietary items containing high levels of cholesterol. In my experience majority of people who eat eggs have a fat tooth and in addition to eggs they also consume red meat and dairy products and their blood cholesterol levels are usually high. Moderation in all good things A healthful diet does not exclude any one food group. The best diets are based on breads, grains, cereals, fruits and vegetable (i.e. those containing complex carbohydrates and fibre) low in fat and low in free radicals and full of vitamins and minerals. Finally don't forget fluids. Drink at least six glasses of water a day, milk or juice even when you don't feel thirsty. If you love eggs you may consume two eggs per week if you have not yet checked your lipid profile. A large egg contains 4-5 gm of fat, (1.5 gm of which is saturated fat) and 212 mg cholesterol. Always refrigerate eggs at home. Prepare and serve eggs with low fat food items such as vegetables, fruits, whole grain, bread or rice and low fat cheese. Another concern about eggs is the possibility that eggs might be contaminated with salmonella enterotidis, a common bacterium responsible for food poisoning. People with weakened immunity such as elderly persons and those with AIDS must be especially vigilant about food borne bacterial contamination and the vulnerable people should care to cook eggs completely. It is dangerous to eat eggs bought from boutiques and supermarkets without boiling or cooking. So if you have a tooth for eggs, it is advisable for you to get your serum cholesterol estimated from a reliable lab and if the serum cholesterol is over 200 mg.dl, get advice from your family physician regarding egg consumption. If you are a healthy person without coronary risk factors mentioned earlier, you can consume an egg a day without any fear. Always consult your family physician get a check-up at least once a year if you are over 30 years before starting the habit of "eating one egg a day to keep the doctor away". ############## On Angina Question: A reader from Kotagala writes: My husband 67 yrs is mild diabetic and suffers from high blood pressure for the past 20 years. He is taking Atecard 50 mg (1) tablet every morning. Very recently he got chest pains and finally has told us he is suffering from Unstable Angina. (a) Could you please explain me differences between Angina and Unstable Angina? (b) Taking on Atecard tablet what should be the appropriate time to take the medicine-night or morning. Dr. D. P. Atukorale replies:- Unstable Angina Angina is the pain that occurs during periods of ischaemia (lack of oxygen) to myocardium (heart muscle) and consists of a constructing discomfort felt behind the breast bone which may radiate to either arm, throat or the jaw and may be associated with sweating and shortness of breath and is usually a manifestation of coronary artery disease (C.A.D.) but any other cause of imbalance between myocardial oxygen supply and demand may cause angina. There are three types of angina. These are (a) stable angina, (b) unstable angina and (c) variant angina. Stable Angina Stable Angina can be provoked by any stimulus which increases oxygen demand to heart muscle (myocardium) and typically it is provoked by exertion and relieved with 2-10 minutes of rest or administration of a sublingual nitroglycerine (GTN). Other provocative factors are emotion, sexual intercourse and also after a heavy meal which increases the heart rate. Stable angina is associated with a smooth endothelial coronary plaque causing luminal stenosis and stenosis in excess of 70 per cent of the coronary luminal diameter may restrict blood flow to myocardium and cause angina. Unstable Angina This is provoked by abrupt rupture of an atheromatous plaque in a coronary artery thus exposing its contents and providing a focus for platelet deposition and thrombosis. In unstable angina the thrombosis is sub occlusive (i.e. does not block the lumen of coronary artery completely) and causes intense myocardial ischaemia. Progression to complete occlusion of the coronary artery and development of myocardial infarction (heart attack) occurs in up to 30 per cent of cases of unstable angina within 3 months of getting first attack of unstable angina. In unstable angina, the patient gets recurrent and unusually prolonged episodes of angina occurring on minimal exertion or at rest or during sleep and may be the first manifestation of coronary artery diseases (C.A.D.) or may occur as an abrupt change in an established pattern of chronic stable angina. Attacks of angina are severe and are often associated with reversible changes in the ECG. Unstable angina is a medical emergency requiring management in a coronary care unit (C.C.U.). Myocardial infarct or death occurs in up to 30 per cent of cases of unstable angina within 3 months. Drugs such as aspirin (or clopidogrel) and heparin have been shown to improve the progression of coronary thrombus to complete occlusion. Other drugs given for unstable angina are beta blockers such as atenolol, calcium channel blockers such as diltiazens and nitrates. If the patient is on nifedapini, this drug should be completely stopped. In well established cardiology units, coronary angiogram is performed with a view to angioplasty (P.T.C.A.) or coronary artery surgery (CABG) especially if angina does not settle promptly. As your husband is 67 years and has diabetes mellitus and hypertension and as his angina is of recent onset. I fully agree with your family physician's diagnosis of unstable angina and I am of the opinion that your husband should be admitted to a hospital preferably one which has intensive care facilities, without delay, for the necessary investigations and treatment. (b) Atenolol Atenolol is a beta blocker used for hypertension and angina. In case of hypertension, atenolol is usually administered in the morning. Usual dosage is 50 mg or 100 mg per day depending on the blood pressure and pulse rate. In case of patients with angina atenolol can be administered either in the morning or twice daily (both in the morning and evening). I am sure that your physician will prescribe aspirin in addition to atenolol and may increase the dose of atenolol to 100 mg depending on the pulse and blood pressure. Your physician will prescribe statins if the patients LDL (bad) cholesterol is elevated (over 100 mg per dl in addition to low cholesterol, low saturated fat, diabetic diet. |
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