First crack down on those quacks

Recently, the death of a child following immunisation at a medical clinic run by a general practitioner, hit the headlines in the media.

As we understand, the inquiry into the death is still pending as are the autopsy findings which await toxicological analysis. But for all intents and purposes the media has portrayed the doctor concerned as virtually guilty.

We cannot, and do not wish to comment on whether the doctor concerned was in fact guilty or not. For his part, he has said that the proper vaccine was administered and that the proper procedures were followed and the death was one of the rare instances where a child can develop a severe reaction to the vaccine. The parents of the child of course doubt this hypothesis.

We must leave arbitration of that issue to the proper authorities. What we are concerned however is that even though the media makes a hue and cry over such an incident when it does occur- as perhaps it should- it chooses to ignore the routine atrocities committed on the public by unqualified persons posing off as medical personnel.

This recent immunisation incident was performed by a qualified doctor- and if he did any wrong he must be penalised for it. But what of the procedures daily undertaken by thousands of 'quacks' throughout the country?

Abortionists are probably the worst offenders. There must be over a thousand in the country and some of them even blatantly advertise in the newspapers! There are other quacks who prescribe drugs without a licence and some of them run dispensaries and even perform minor surgeries!

The Medical Council lacks the legal teeth and the financial resources to fight this menace. It recognises there is problem but finds itself impotent in trying to tackle it. Clearly, there is a role for the state agencies to intervene to prevent such offences being committed on patients. The Ministry of Health which sends 'flying squads'to nab errant doctors doing private practice is strangely silent on this issue!

Is it not time then for the government to act to curb this malpractice which must be taking a terrible toll in terms of lives - but which must be passing unnoticed even to the media which hastens to highlight the alleged misdeeds of qualified doctors? Or, is that too much to expect from the Ministry of Health, the law enforcement authorities and the media?

Don't ignore the first signs

The kidneys are bean- shaped organs, each about the size of a fist. Every day, the kidneys process a large volume of blood to sift out waste products and extra water. The waste and extra water become urine, which flows to the bladder from where it is excreted.

The wastes in blood come from the normal breakdown of active muscle and from food. If the kidneys did not remove these wastes, the wastes would build up in the blood and damage the body.

Most kidney diseases attack the 'nephrons'-important functioning units that form the kidneys, causing them to lose their filtering capacity. Damage to the nephrons may happen quickly, often as the result of injury or poisoning. But most kidney diseases destroy the nephrons slowly and silently. It may take years or even decades for the damage to become apparent. The two most common causes of kidney disease are diabetes and high blood pressure.

Diabetes is a disease that keeps the body from using sugar as it should. If sugar stays in blood instead of breaking down, it can act like a poison. Damage to the nephrons from unused sugar in the blood is called diabetic nephropathy. High blood pressure can also damage the small blood vessels in the kidneys. The damaged vessels cannot filter poisons from blood as they are supposed to.

Some kidney diseases also result from hereditary factors. Polycystic kidney disease (PKD), for example, is a genetic disorder in which many cysts grow in the kidneys. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure.

In a child, the first sign of a kidney problem may be high blood pressure, a low number of red blood cells (anemia), or blood or protein in the child's urine. It is important to remember that frequent and incompletely treated urine infections are a major cause of kidney failure in young people in our country.

If the doctor finds any of these problems, further tests may be necessary, including additional blood and urine tests or radiology studies. In some cases, the doctor may need to perform a biopsy _ removing a piece of the kidney for inspection under a microscope.

Some kidney problems happen quickly, like an accident that injures the kidneys. Losing a lot of blood can cause sudden kidney failure. Some drugs or poisons can make kidneys stop working. These sudden drops in kidney function are called acute renal failure (ARF) and may lead to permanent loss of kidney function. But if the kidneys are not seriously damaged, acute renal failure may be reversed.

Most kidney problems, however, happen slowly. Gradual loss of kidney function is called chronic renal failure or chronic renal disease.

People in the early stages of kidney disease may not feel sick at all. The first signs that one is sick may be general: frequent headaches or feeling tired or itchy all over the body.

If the kidney disease gets worse, the patient may need to urinate more often or less often, lose his appetite or experience nausea and vomiting. His hands or feet may swell or feel numb and may get drowsy or have trouble concentrating. His skin may darken and he may have muscle cramps. If a patient sees a doctor with these symptoms, some investigations can be done to confirm kidney disease and evaluate its extent.

Unfortunately, kidney disease cannot be cured. But if a patient is in the early stages of a kidney disease, he may be able to make his kidneys last longer by taking certain steps:

*If he has diabetes, watch the blood sugar closely to keep it under control. Consult a doctor for the latest in treatment.

*Have the blood pressure checked regularly. Talk with a doctor about the best medicine to keep your blood pressure under control, when there is concurrent kidney disease.

*Avoid pain pills that may make kidney disease worse. Check with a doctor before taking any medicine.

*People with reduced kidney function need to be aware that some parts of a normal diet, especially proteins- may speed their kidney failure. Again, the appropriate diet should be discussed with the doctor.

Computers can make you sick!

We all know that computers cause eye strain and that can lead to long-term problems with vision. But now, researchers are identifying computers as the culprit of a new disease which they call 'Repetitive Strain Injury (RSI)'- a muscle and joint condition that occurs as a result of too much time in front of the machine!

Occupational overuse syndrome, work-related upper limb injury, and isometric contraction myopathy, are all phrases used to describe what is more commonly known as RSI. What really happens is the overuse of the muscles of the hands, wrists, arms, or shoulders on a repeated, and usually, daily basis, causing injury to these muscles. This results in inflammation that is never really given a chance to recover, since these everyday harmful activities invariably continue. Most often blamed for RSI are the computer keyboard and mouse, but they shouldn't be charged with sole responsibility. For a start, the body was never designed to sit hunched over a desk. Poorly positioned and organised workstations add to the problem. Let's not forget, the longer someone puts a strain on muscles by sitting incorrectly for far too long without taking a break, then the more likely the body is to suffer the consequences.

The change in our home life and activities also contributes. Computers are ever present, and young children and teenagers are at risk of developing RSI because of the use of computer games, whether they be hand-held or played on the TV or computer. Tense muscles do not function correctly, which means that someone under stress is also much more likely to suffer muscle damage and subsequent RSI. But RSI is not a new phenomenon. Tennis elbow and golfer's elbow are two common examples of other overuse syndromes. They have been around for a long time and you don't have to play tennis or golf either. Anyone who overuses their muscles in their arms and hands repeatedly may develop RSI.

Workers on factory assembly lines, musicians, dressmakers, and cleaners; the list of people who often suffer is long. It's only since office work and computers have become such a prominent part of everyday life that these have fallen under the spotlight. It may be months, even years, before someone starts to experience the discomfort and pain of RSI. This is because it takes time for the repetitive damage to reach a level where it causes problems. A slight ache every now and then may be all that's felt to start with and, when this is the case, it will probably be ignored. As time passes and the damage continues, symptoms occur whilst performing the repeated activity, when typing for example.

As the situation becomes more severe, pain may be felt most of the time, even with the slightest movement. One or both upper limbs may be affected, depending on which is being used to perform the repetitive activity causing the problem. Many people find they also experience numbness and tingling. Sometimes, this and the pain mean that they find it difficult to hold objects, and often drop them. Prevention is always better than a cure, which is why it's important to ask your employer to assess and make sure that your workstation and seating position are correct. Try not to sit for longer than 20 minutes without taking a short break to stretch and relax. Stress makes matters worse, so relaxation techniques or yoga can be a good help. Gentle stretching exercises are all that's needed.

Heat or cold packs, painkillers such as paracetamol and anti-inflammatory medicines, such as ibuprofen that comes in tablets, gels, and creams; can all relieve pain and discomfort. They are available from the pharmacist, as are elastic wrist support bandages that help too.

When the situation becomes bad, stronger medicines may be needed from the doctor, who may also recommend wrist splints to help relieve the pain.

When black and yellow stones get into that pouch

Ask a question from Dr. Maiya Gunasekera, MBBS Hon (Cey) M.S. FRCS (Eng) FRCS (Ed) FICS, Consultant Surgeon/Gastro Enterologist at the Nawaloka Hospital.

If you wish to consult him on your personal health through this page, do write in, c/o The Sunday Times, P O Box 1136, Colombo

By Chris Fernando

Q: I am a housewife who was diagnosed to have gall bladder stones via an ultra sound examination. I underwent this test because my GP advised me to do so as I was suffering from recurring abdominal pains. Now I am advised to undergo surgery for the removal of the gall bladder. I am made to understand that laparoscopic surgery is better than open surgery. I am a bit confused as some of my friends tell me that open surgery is better. Please tell me whether surgery is really necessary.

Dr. Maiya says: The main function of the gall bladder is to serve as a temporary storage for bile and send it to the intestines as and when required. The bile, which facilitates food digestion, is produced in the liver.

The gall bladder can be described as a pouch situated on the right hand side of the upper abdomen, under the liver. So a patient with gall bladder diseases would experience pain and discomfort on the right upper abdomen or the upper abdomen above the navel.

Fatty food in the intestines send messages to the gall bladder to contract and release bile, so most people who suffer from gall bladder disease would have an intolerance to fatty foods.

The gall bladder is connected by the cystic duct to the main bile duct (common bile duct), which is the outlet for bile into the intestine. The constitution of the bile can vary from individual to individual and the stones that form can be of the pigment variety which are dark black to cholesterol stones which are yellow. You can also get mixed stones.

When these stones get impacted at the outlet of the gall bladder, patients experience pain and the biggest danger would be if these stones find their way into the common bile duct, thereby blocking the main outlet for bile. The patient would then become jaundiced and stones would have to be removed by surgery or through the endoscope.

In Sri Lanka, gall bladder stones are common in the affluent class of society in which foods rich in fat constitute the daily diets. In countries such as Saudi Arabia where a lot of fatty food is consumed, gall bladder stones are common and any emergency medical unit in a hospital in Saudi Arabia would have at least four to five cases of abdominal emergencies due to gall stones, every day.

Once the gall bladder has formed stones, the stones become a further focus for infections and become a constant source of trouble to the patient.

Therefore, I think that in your case, if your pain is due to gallstones, the gall bladder would have to be removed.

I would also advise you to have an upper Gastro intestinal endoscopy to exclude any pathology in the stomach, since one can easily miss a stomach lesion under these conditions. So it is also mandatory that you have an upper intestinal endoscopy done. I would also advise you to get a pancreatic enzyme study done to exclude any pancreatic pathology since this is an organ, which is in close proximity to the gall bladder and stomach. A liver enzyme study is also recommended.

Before surgery, it is mandatory to be 100 percent sure that there are only gallstones and that there is no other pathology in the adjacent organs, and that the pain is due to gall bladder stones.

Laparoscopic surgery is safe and easily performed and leaves no scars. The gall bladder is removed by introducing a thin and fine instrument via three to four punctures in the abdomen. Surgery is done by the aid of a TV screen where the anatomy is magnified and even small structures are visible and easily identified. Tiny metal clips are used to clamp vessels and ducts and the gall bladder with its stones are completely removed. But if one has an infected gall bladder where the wall is fragile and swollen, it would be difficult to perform its removal through the laparoscope, since the gall bladder would easily fragment and bleed. In cases of acutely infected gall bladders, open surgery is preferred.

A gall bladder can also be removed through open surgery with a midline, subcostal or a small transfer incision in the abdomen.

The difference would be that the patient undergoing open surgery would suffer some discomfort and pain because of the incision and the patient undergoing laparoscopic surgery would find the immediate post-operative period comfortable and would be up and about after 48 hours. But after two or three weeks following surgery, either by the laparoscopy or open method, there will be absolutely no difference in both patients other than a scar on the patient who underwent open surgery.

I would strongly advise you to first get an upper Gastro intestinal endoscopy and enzyme study done for the pancreas and liver. If these are found to be normal, you should go ahead with the laparoscopic removal of the gall bladder.

Aspirin a day keeps heart trouble away

By Uthpala Gunethilake

Over 200 years ago, Felix Hoffman, a German chemist, was looking for a drug to ease his father's rheumatic pain. After many experiments, he finally put together two chemicals -acetic acid used to make vinegar and salicin, found in plants- and made a white powder. It worked well, though causing slight stomach irritation. Hoffman's employer, Friedrich Bayer & Company began marketing the drug under the name 'aspirin'. It was the world's first commercially marketed drug and today, it is being discovered anew for healing properties hitherto unknown.

Though earlier aspirin was known only for its analgesic properties, in a major breakthrough in 1974, researchers discovered that aspirin was invaluable in preventing heart attacks. Professor Peter Elwood, honorary professor of the University of Wales College of Medicine and University of Bristol, who was in Sri Lanka recently, is part of a team conducting research on further uses of this common drug.

"You just need about quarter of a normal aspirin tablet a day to prevent heart attacks," says Prof. Elwood. He explained that aspirin acts very fast to reduce the risk of blood clots forming in the vessels that carry blood to the heart, through a process commonly known as "thinning the blood".

About 100 milligrams of aspirin can reduce the risk of heart failure by about 30 to 40 percent, explained Prof. Elwood. The regular tablet contains 300 milligrams. He said that soluble aspirin, sold under the name Disprin here, works faster and lessens the severity of side effects such as irritation and bleeding of the stomach. "Anyone who has had a heart failure once should carry soluble aspirin with him," he stressed. Taken at the moment when severe chest pain or any other symptom of heart failure occurs, aspirin can hold off the attack.

"Those who are suffering from high-blood pressure, are overweight or have any other condition that can lead to heart diseases, as well as smokers, could take a small dose of aspirin a day on a doctor's prescription," advised Professor Elwood.

Because it helps reduce inflammation aspirin may even help in preventing Alzheimer's, dementia, and pre-eclampsia, a dangerous condition during pregnancy.

Gummy problems

Plaque build-up, crooked teeth, illness, poorly fitting dentures, trapped food particles and certain medications can irritate or destroy your gums.

With good oral hygiene, however, you can prevent periodontal (gum) disease. If caught in the early stages, gum disease is easily treated. If ignored, the gums and supporting tissues wither and your teeth may loosen and fall out.

Here are some important do's and don'ts: What you can do is to try and maintain your gums if they are healthy. For that-

*Make sure to brush and floss your teeth regularly. Use a soft, rounded bristle toothbrush (unless your dentist has told you otherwise).

Have your dentist show you how to brush and floss your teeth correctly.

*Eat sugary foods infrequently. When you eat sweets, do so with meals, not in between meals.

*Include foods with good sources of vitamins A and C daily. (These two vitamins promote gum health.) Vitamin A can be found in spinach, liver and dairy products fortified with vitamin A. Good vitamin C food sources include oranges, grapefruit, and tomatoes.

What you shouldn't do is to try and self-medicate with home remedies if any of the following signs are present:

*Swollen gums

*Gums that bleed easily

*Teeth exposed at the gum line

*Loose teeth

*Teeth separating from each other

*Pus around gums and teeth

*Bad breath or a foul taste in the mouth