Educating the public on health, Gastritis in the elderly

Consultant Senior Cardiologist Dr. D.P. Atukorala, who is a member in our (HealthWatch) Medical Advisory Panel is contributing this weeks health educating article on - Gastritis in the elderly.

He is making use of a HealthWatch reader’s J.E. Vethanayagam from Moratuwa in his letter seeking advice to get over his gastritis problem, which he has been going through for over 7 years in spite of medication to write this article, educating the public on this medical issue.

Here’s Dr. Atukorala’s advice to Vethanayagam, which is health educative on gastritis in an elderly males.

As your long lasting gastritis (chronic gastritis) is not responding to usual antacids prescribed by your G.P., and as you are an elderly person, I am of the view that you should consult a gastroenterologist (a physicians or surgeon specialised in diseases of the gastro-intestinal disorders) either in the Government or in the private sector without delay as you may be a case of (a) peptic ulcer disease (chronic gastric or chronic duodenal ulcer) or a gastric cancer.

It is noteworthy that most of our provincial and Base Hospitals have specialists trained in endoscopy. Majority of private hospitals too have experienced gastroenterologist physicians and surgeons.

When you consult one of them, it will be very useful to the doctor if you take the following reports: (a) stool test for occult blood which will be often positive in both cancer of the stomach and in case of a chronic peptic ulcer, (b) full blood count and, (c) an ESR report.

Being only a consultant cardiologist with no experience in the latest treatment of above illnesses. When a patient with gastric symptoms consults me, I always refer him/her to a gastroenterologist after excluding a cardiovascular lesion such as coronary heart disease (CDH).

I have come across hundreds of patients with myocardial infarction (heart attacks) who have been treated by doctors for gastritis prior to admission.

These unfortunate patients when they see me have significant damage to the myocardium (heart muscle) because when they present to the Institute of Cardiology or private hospitals, we are unable to give thrombolytic therapy which is not beneficial if they come after 48 hours.

The lesson doctors can learn is that, whenever they see a middle aged or elderly person with symptoms suggestive of gastritis especially in the evenings or early mornings and if the patient has coronary risk factors such as smoking, obesity, hypercholesterolaemia, hypertension, diabetes or strong family history of CHD, they must urgently arrange for an ECG or get an opinion from another colleague and admit the patient to the nearest hospital with ICU with facilities.

I know a doctor working in Colombo who developed severe upper abdominal pain in the right and swallowed a bottles of antiacid syrup (in spite of his wives advice to get admitted to the Cardiology Unit, Colombo) and had a cardiac arrest and died at home.

Especially in case of chronic gastritis in a middle aged or elderly person, the patients G.P. or family physician should refer patient to a consultant gastroenterologist physician or surgeon (interested in gastroenterology and well versed in endoscopy) without delay as the patient may be a case of chronic peptic ulcer or a gastric carcinoma case.

Gastric cancer is communion in people who: (a) smoke, (b) consume alcohol, (c) suffering from H. pylon infection (which can be cured by antibiotics), (d) patients with polyps affecting the stomach and (e) those with family history of gastric cancer (Blood Group ‘A’ appears to be the commonest blood group in patients with stomach cancer).

Gastric cancer is common in China, Japan and South America and is less common in USA (patients with chronic gastritis should avoid smoking and salted foods, pickled foods; foods containing nitrites and nitrates, and should consume plenty of fruits.

They should avoid NSAIDS such as Asprin, devilled foods such as devilled chicken, tomato and chilly source and soups like “Rasam”.

To conclude, Vethanayagam should at his earliest consult a gastroenterologist (with a referral letter from his GP if he has one).

When you consults a gastro-enterologist, it is worth taking a stools (faeces) report for occult blood (which may be positive in ulcer patients and in cancer patients). I am sure that your gastro-enterologist will do a test called endoscopy and if necessary do a biopsy if he suspects cancer or H-pylori infection, without anaesthesyzing you.

References

1. Davidson’s principles and practice of Medicine 20th edition (2006).

J.E. Vethanayagama from Moratuwa in his letter to Dr. D.P. Atukorala stated.

We, the patients are for ever grateful for various medical advise you have given to patients with prolonged illnesses and they are relieved of such matters. I too have a long lasting gastritis problem for 6 to 7 years.

I am 87 years. No BP , No BS. I was quiet healthy, but now I suffer from this problem. I tried of various medications. But of no avail. Usually I have dinner at 7 or 8 p.m. But again I feel very hungry in the night.

I take 2 of 3 biscuits 2 or 3 times. The stomach is heavy and fluffy I have very disturbed sleep in the nights.

Sometimes I feel very hungry and sometimes no hunger at all. Please be good enough to give your medical advice, so that I can be relieved my uncomfortable and uneasy stomach problem.

I am a regular reader of HealthWatch in Daily News.

Older men’s blood pressure sensitive to alcohol

Regular drinking is known to raise blood pressure in some people, but the effect may depend largely on age and cholesterol levels, a study of Japanese men suggests.

The study found that unlike younger men, men in their 50s who drank even moderate amounts of alcohol generally had higher blood pressure than non-drinkers.

Among men in their 20s, only heavy drinkers showed elevated blood pressure, and even then the effect depended on a man’s levels of “good” HDL cholesterol.

In contrast, HDL levels had no bearing on the blood-pressure effects of alcohol in older men.

The findings suggest that older men’s blood pressure is more sensitive to the effects of drinking, according to study author Dr. Ichiro Wakabayashi, of Hyogo College of Medicine in Japan.

Still, that doesn’t mean that older men should universally abstain from alcohol, Wakabayashi told Reuters Health. Though drinking can boost blood pressure, moderate amounts of alcohol also have heart-protecting effects, he explained.

Besides raising heart-healthy HDL levels, modest drinking may help lower “bad” LDL cholesterol and inhibit blood clotting. In addition, numerous studies have linked moderate alcohol intake to a lower risk of developing heart disease.

However, Wakabayashi said, older drinkers who see none of the HDL benefits, but do have higher-than-normal blood pressure, may want to cut back.

For the study, published in the journal Alcoholism: Clinical & Experimental Research, Wakabayashi used data from more than 21,000 men in their 20s and 50s who underwent periodic workplace health exams. As part of their checkups, the men reported on their average weekly drinking habits.

Those who drank less than 30 grams of alcohol per day roughly equivalent to three drinks were considered light-to-moderate drinkers. Men who drank more than that were considered heavy drinkers.

In general, young men who drank heavily had higher blood pressure than their peers who drank moderately or not at all. This effect was only seen among young men with average or high HDL levels, however; drinking had no apparent effect on blood pressure among those with low HDL.

On the other hand, drinkers in their 50s tended to have a higher blood pressure and a higher risk of overt hypertension than non-drinkers. The effect was seen even among men who drank moderately, and HDL levels showed no influence, Wakabayashi found.

All of this, according to the researcher, suggests that older men are typically more sensitive to alcohol’s blood-pressure effects than younger men are possibly because of age-related changes in the nervous system’s response to drinking.

For some men, Wakabayashi noted, any HDL benefits may be “weak” in comparison to the negative effects on blood pressure.

SOURCE: Alcoholism: Clinical & Experimental Research, September 2007. REUTERS

Effective healthcare system with rural people’s participation - Dr. Lakshmi Arambewala

Dr. Lakshmi Arambewala, a Board Member of the Ayurvedha Drugs Corporation, who was recently awarded the gold medal by the Institute of Chemistry for Research on Medicinal Plants, has in this short article in Chemistry in Sri Lanka Vol. 24 on Sustainable Medical Plant Sector in Sri Lanka has stated.

“The quality control of herbal drugs produced by rural folk, with improvement of their drug manufacturing facilities has enabled rural people to be linked to safe and effective healthcare system.

Here’s Dr. Arambewala’s article on the subject.

Towards a Sustainable Medicinal Plant Sector

Human beings have been utilizing plants for healthcare since times immemorial. Due to the growing importance attached to medicinal plants locally and globally, a multidisciplinary programme of research was initiated at the Industrial Technology Institute.

To sustain the medicinal plant resource base that is depleting rapidly, agronomic studies were conducted on several medicinal plants. Of these Catharanthus roseus, Cassica angustifolia, Solanum xanthocarpum, Kaempheria galanga, Piper longum and Withania somnifera are some important medicinal plants.

The optimum harvest time and the effects of fertilizer were studied. Planting material was distributed to the farmers and required agronomy data was also made available to them.

In the Evaluation of Traditional Medicines ‘Rasna Saptakaya’ which is commonly prescribed for arthritis was subjected to toxicological, pharmacological and clinical studies and standardisation. Toxic effects were not observed and the clinical trials revealed significant improvements in daily activities.

To determine the commercial potentials of the resource base, phytochemical and pharmacological studies were carried out on Alstonia macrophylla, Alstonia scholaris, Hunteria zeylanica, Neiosperma oppsoitifolia, Tabernaemontana divaricata, Rauwolfia canescence, Rauwolfia densiflora, Kaempheria galanga, Alphinia calcarata and Piper betle.

The development of value added products from medicinal plants and transfer of technologies enabled many entrepreneurs to put out new products to the market, thereby enhancing the value of the medicinal plants.

The quality control of herbal drugs produced by rural folks and improvement of their drug manufacturing facilities enabled rural people to be linked to safe and effective healthcare systems.

The export market of the medicinal plants was enhanced by issuing quality control reports based on the analytical studies carried out by us.

Trained human resource forms an integral part of any development programme. The training of M.Sc, M.Phil. students, graduates, undergraduates, research officers, technical officers, farmers and rural folk on various aspects of medicinal plants has contributed towards human resource development.

Information dissemination and co-ordination in the medicinal plant sector were handled as the local co-ordinator to the Asia-Pacific Regional Network for Traditional Medicine and Herbal Technology (APTMNET) and the Asian Network on Medicinal and Aromatic Plants (ANMAP) and through 140 publications and communications in international and local journals and conferences. (Chemistry in Sri Lanka, Vol. 24 No. 2)

The public perspective on medical service

The IMPA in its news letter of March 2007 has this view on “The Public Perspective-on Medical Service.”

Editorially it says: “The question that is often asked of any service, is whether it is “user friendly”. This is a fundamental test.

Quality, competence and experience are all very important.

But if the efforsaid attributes are administered in a surely, dialatory or a manner heaping unnecessary and avoidable expenses of time, energy and time to ones clientele, then by definition the service fails to be a service.

(Sent to Healthwatch by a medical student)

Sri Lanka Optometric Association Annual Sessions

The Sri Lanka Optometric Association will hold its annual scientific sessions this year at the Fingara Town Country Club, Boralesgamuwa, September 2. The chief guest will be Prof. Benitta Stephen.

Among topics to be taken up at the scientific sessions are:

* Vision threatening disorders in children by Dr. Amila de Alwis

* Diagnosis and Management of Glaucoma in optometry

by Opt. Sandalanka Lenagala.