Lifestyle modification in chronic disease at SLMA sessions

At this years annual congress sessions of the Sri Lanka Medical Association there will be symposium on Life Style Modification in chronic disease on the fourth day of the sessions on March 20th.

The Chief Guest at this years sessions will be the Cambridge University’s Emeritus Professor of Surgery Prof. Sir Roy Calne Frs. while the Melbourne University’s Nephrology Departments Director Prof. Gavin John Becker FRACP will be the Guest of Honour.

The five day sessions will start on March 14th and conclude on Saturday March 21st at the Cinnamon Grand hotel. The first two days will be devoted to the pre-congress sessions, which will be at the SLMA auditorium. The pre-congress sessions will be on the following topics occupational health; Telemedicine, Ethics of International Collaborative Research.

While the main Congress topics to be dealt with will include the following among others. Human genetics; molecular genetics; re-generative medicine, Life Style Modification in chronic disease; Food safety.

Here’s the programme in full: Professor Gavin John Becker MB BS, MD, FRACP Professor and Director, Department of Nephrology, The Royal Melbourne Hospital & The University of Melbourne Clinical Director, North West Dialysis Service, Melbourne Health President, Asia Pacific Society of Nephrology.

Guest of Honour: Prof. Sir Roy Calne FRS Professor of Surgery Emeritus - Cambridge University Yeoh Ghim Professor of Surgery - National University of Singapore General Surgeon and Consultant in Transplantation Surgery. (Chief Guest)

Cardio-Pulmonary resuscitation (CPR)

D. P. Atukorale

Cardiac Arrest

Sudden cardiac arrest (S C A) is a leading cause of death in all the countries and is due to ventricular fibrillation (V F) ventricular tachycardia (V T) or due to cardiac asystole (C A). Results of resuscitation are very much better in patients with V F or V T as compared to patients with cardiac asystole. The common causes of cardiac arrest are heart attacks, trauma, drug overdosage, electric shock and drowning and asphyxia in case of children.

Cardio-Pulmonary Resuscitation (C P R)

Three to five minutes of collapse can produce survival rate as high as 49% to 75%. As soon as you come across a collapsed person (with cardiac arrest) you must call for help and start immediate C P R. Look for regular chest movement and if the collapsed person is breathing, there is no immediate necessity to start mouth to mouth (or mouth to nose) respiration. If the victim is not breathing and if the pulse is not palpable start cardiac massage with rescue breathing without delay. The procedure of C P R is given below;

(a) Open The Airway

Lift the chin with one hand, push down on the forehead with the other hand to lift the head back. Remove any foreign bodies in the mouth such as dentures and pull the tongue out if the tongue is interfering with respiration.

(b) Breathing

If the patient is not breathing, give the victim mouth-to-mouth (or mouth-to-nose respiration). Place your mouth over the patient’s mouth (or nose) so that no air can escape. Give two or three breaths into the mouth or nose. Majority of people who give C P R prefer mouth to nose respiration as far as I am aware.

(c) Check The Carotid Pulse

Place your hand on the patient’s carotid artery (next to the Adam’s apple in the neck) and check for the carotid pulse. If there is no pulse begin cardiac massage immediately.

Cardiac Massage

Kneel beside the patients chest. Find the sternum, the breast - tone where both sides of the rib-cage meet and place your hands on the sternum. Bring your shoulders over the victim’s chest, keeping your arms straight.

Press down on the sternum about one to two inches. Then, relax the sternum and let the sternum rise back to the normal position. But do not remove your hands from the chest. Give 15-20 such compressions for every two breaths you give. You must give about 100 compressions per minute.

In case of cardiac arrest (when the heart has stopped pumping blood) hypoxia (lack of oxygen) to brain begins to occur in about four to five minutes after the cardiac arrest. Brain death usually occurs after eight to ten minutes and C P R should be ideally started in the first five minutes, of arrest as permanent brain cell damage or death of brain cells would have occurred in about ten minutes after arrest.

Risk To The Rescuer

In Sri Lanka where pulmonary tuberculosis is still common there is the risk of the rescuer getting TB, HIV infection is a problem but it is very rare. So it is advisable for the rescuer to use his or her handkerchief during mouth-to-mouth or mouth-to-nose respiration so that victims mouth or nose does not come into direct contact with the rescuer. In Sri Lanka, as far as I am aware many children do not receive C P R because of rescuer’s fear of causing harm to the victim.

This fear is unfounded and C P R should always be done in case of children. Readers will agree with me that it is better to have a live child with a few rib fractures than to have a dead body without fractures. For lack of space, I am not discussing C P R in case of children in this article.

Immediate C P R and defibrillation (electric shock to the heart) within three to five minutes of collapse can produce survival rates as high as 78%.

As soon as you come across a person with cardiac arrest you must call for help and start immediate C P R until an ambulance arrives.

Look for regular chest movements and if the collapsed person is breathing, there is no immediate indication for starting mouth-to-mouth or mouth-to-nose respiration. As mentioned earlier if the victim is not breathing and if carotid pulse is not palpable, cardiac massage with rescue breathing should be started immediately.

With effective Ventilation, chest will expand. Blow into the victim’s mouth or nose twice and then give about 20 chest compression.

Continue with chest compression and rescue breathing in a ratio of 30:2. If the victim starts normal breathing continue with the chest compression. Continue C P R until qualified help arrives and takes over. If you are exhausted give over C P K to another person.

Prevention of Breast Cancer

Is routine mammography helpful?

Doctors often advise women with genetic risk and family history of breast cancer to get mammography, especially for those who are positive for B R C A genes. It should be noted that undergoing tests such as mammography and genetic tests does not appear to help in the prevention of breast cancer.

It is noteworthy that mammography helps the doctor to diagnose breast cancer in the early stages of the cancer; doing mammogram does not help doctors to diagnose the breast cancer before the cancer has started growing.

If breast cancer is detected in the early stages, results of surgery i.e. mastectomy are better and a significant number of these patients can live five years, whereas if the cancer is detected after it has spread to surrounding tissues, results of surgery are not all that good.

Management of High Risk Patients

There are four options for the management of those women with family history of breast cancer and are positive for B R C A genes.

1. Watch and wait.

2. Take oestrogen lowering drug tamoxifen for rest of their lives. Tamoxifen has various side-effects such as stroke, cataracts, deep vein thrombosis, uterine cancer and pulmonary embolism.

3. Undergoing mastectomy (surgical removal of breasts).

4. Nutritional approach i.e. consuming a diet free of animal - based foods and low in refined carbohydrates aided by regular monitoring of those at high risk. Internationally famous nutritionist T. Collin Campbell PhD says “I standby the usefulness of the fourth option even for women who have already had a first mastectomy.”

It is noteworthy that diet is an effective treatment of already - diagnosed disease with advanced heart disease (Ornish D et al, JAMA, 280, 1998, 2001-2007), liver cancer, and melanoma, and clinically documented Type II Diabetes.

Reference

The China Study by T. Collin Campbell PhD and Thomas M. Campbell.

A paper on heart surgery at medical congress in Taipei

A paper on the present status of the Coronary Artery Bypass Grafting surgery in Sri Lanka between the government and the private sector hospitals based on a recent study done on this surgery is to be presented at the 17th annual sessions of the Asian Society for Cardiovascular and Thorasis surgery in Taipei Taiwan, next month by a combine team of doctors from the Colombo Apollo, and the National Hospital Sri Lanka NHSL.

The team head of this study group who is to present this paper Dr. Sujeeth Suvarna, FRCS Consultant Cardiothoracic Surgeon of Colombo Apollo Hospital in an interview with the Healthwatch said that among the conclusions arrived by the medical team in this study are that most of the CABG operations done in the private sector hospitals here are those of the elder patients than the younger, compared to the operations than in the government sector hospitals like the NHSL, and they are more complicated with higher BMI, hypertension, diabetes than the cases handled in the State sector.

Background: A recent study of CABG in the government sector of Sri Lanka established its baseline characteristics as being different from that of the current trend in developed countries.

However, whether this is true in the private sector, which handles half the CABG workload of the country, is unknown. Therefore the objective of this study was to establish the present status of CABG in the private sector of Sri Lanka in comparison to that of the government sector.

Methods: We retrospectively reviewed the case records of all consecutive patients who underwent isolated CABG in a single centre at Apollo Hospital, Sri Lanka from June to October 2008. We compared this data with data published in 2008 of the clinical profile of CABG patients at the National Hospital of Sri Lanka (NHSL).

Results: The 59 patients who underwent CABG at Apollo were compared with the 112 patients at the NHSL.

Results of C P R

Results of resuscitation in case of patients warded in CCU are excellent especially, in case of primary ventricular fibrillation, thanks to the efficient nursing staff and doctors in the CCU, who work as a team.

I can remember a 62 years old female patient who had been resuscitated successfully for cardiac arrest in 1974. This fortunate lady who was a famous Maths teacher, lived upto the ripe old age of 95 years after discharge from hospital and passed away two years ago. The above patient was brought to CCU in a collapsed state by a family physician who had given both cardiac massage and mouth-to-mouth respiration, during transport of the patient in an ambulance.

Laughter the best medicine

A man entered a crowded restaurant and was obliged to share a table with a stranger.

The man ordered his dinner, a juicy steak, and when it was served, he burrowed into his pocket looking for something.

Looking at the stranger he exclaimed “Oh dear, I have forgotten my dentures”.

To his surprise the stranger dived into his bag and produced a set of dentures and said “Let me help you, try this.”

The man tried them, but they did not fit too well; so the stranger produced another set; then another and another and finally the last one fitted well.

Well pleased the man addressed the stranger “Doctor, I have always been troubled with my dentures; but this set fitted me perfectly. May I have your name and address, as I would like to consult you professionally.”

The stranger shook his head and said “I am not a doctor, but an funeral undertaker.”