She was born to be a doc

Dr. Feizal Waffarn still marvels about the premature baby girl born 17 years ago, tipping the scales at 2 pounds, 1 ounce, and the slim chance that he and other specialists gave her of surviving.

Michaela Jobes was delivered at Hoag Memorial Hospital Presbyterian on Feb. 19, 1981, 2 1/2 months early, under the most trying of circumstances. Her mother had gone into labour while on a flight from London to Los Angeles.

Shortly after her birth, Michaela was transferred to UCI Medical Center's neonatal unit, where she went into cardiac arrest and was revived by nurses.

"It was a premature birth. Her heart stopped. She was at risk for brain damage. Frankly, it didn't look good for Michaela. I wanted to make sure that her mother was aware of the possible consequences," Waffarn said.

Waffarn was not optimistic about Michaela's chances for survival, and if she lived, her quality of life. After arriving at UCI Medical Centre in Orange, she dropped to 1 pound, 7 ounces.

Seventeen years later, Michaela, now a Carls- bad High School senior, is back at UCI Medical Centre.

But this time the honour student is on a three-month internship, learning about new technology that has greatly improved the survival chances of premature babies, and moving one step closer to her dream of becoming a doctor.

Michaela not only survived, she flourished. In addition to being an honour student, the slender, blond young woman is an athlete. She runs sprints and hurdles in track and has played basketball, soccer and softball.

As she walked through the neonatal unit with Waffarn and the nurses who care for the "preemies" hooked up to respirators and monitors, Michaela said she cannot picture herself in an incubator, fragile and helpless without the medical staff who perform miracles every day.

"I think, 'No way was I that small.' But I spent the first four months of my life here.... When I arrived, my size was small, but now I would be considered one of the bigger premature babies," Michaela said.

Waffarn, professor of paediatrics at UCI and chief of the medical center's neonatal unit, said Michaela is the first of the hundreds of premature babies he cared for over the last 25 years to seek him out as an adult.

"It gives me goose bumps to remember her as she was and see her now as a beautiful young woman. After her mother checked her out, I didn't see her again until a few months ago, when she asked if she could visit me to talk about a school internship she wanted to do. I was overwhelmed," Waffarn said.

Commuting from her San Diego County home to the medical centre, Michaela spends between six and eight hours on Saturday or Sunday as part of her three-month school project. Michaela said she has to deliver a research paper and presentation in front of classmates and teachers by February. Recently, she got to review her five-volume medical file, which doctors kept during her four month stay at the neonatal unit years ago.

Michaela said her mother, Valerie, "has always made me aware of what I went through when I was here." Looking at her hospital records was an opportunity to peek into a part of her life that until Sunday was nothing more than a story that others have told her.

Over the years, Michaela said, she often thought about her near death experience as a premature infant and wondered if she should go into medicine. Occasionally, she would visit the nurses who cared for her in the neonatal unit, and she sent them Christmas cards and photographs of herself.It was during a visit two years ago that she decided to aim for medical school, Michaela said.

"It really hit me then.

That's when I knew what I wanted to do with my life. I want to work with these kids and give them the same chance at life that I got," she said. "I want to major in biomedicine or bioengineering.

I'm ready for the challenge, because I've always been one to challenge myself. My life began in a difficult way, and I've never taken the easy way out."

All about the Lankan doc.

Dr. Waffarn is an old boy of St.Joseph's College (1953-1961) and after completing medical school at Madras Medical College, Madras, India he went on to do Paediatric training: Henry Ford Hospital, Detroit, Michigan and Neonatology training: LA County -USC Medical Center. He is presently Associate Professor of Paediatrics at the University at California, Irvine and also the Chief of Neonatal medicine at the UCI Medical Center.

Dr Waffarn is the son of the late Dr. A.R.M. Waffarn and Mrs. Sithy Waffarn, and is married to Dorothy Waffarn, with two children Elizabeth (17) and Jacob (10).

Your Health

Nostradamus was right then

By Dr. Sanjiva Wijesinha

Nearly five hundred years ago the French astrologer Nostradamus made a bold prediction.

"After assessment gives the unique frequency to operate on patients," he wrote in verse III-65,"waves of sound kill the cancers. They become lifeless and the poisons leave the body."

At that time, people must surely have thought that Nostradamus (even though he was a physician) was mad - but events taking place in the medical world these days certainly reveal that the old doctor wasn't far off the truth.

At London's Royal Marsden Hospital, Dr. Gaiter Haar and her colleagues are working today on a technique called High Intensity Focused Ultrasound (HIFU) which uses energies about 10,000 times more powerful than those used for diagnostic ultrasound scans.

Focused on a small volume of body tissue for just a couple of seconds, such powerful sound waves can literally cook these living human cells.

Research workers in the field predict that HIFU will soon be used to treat many conditions currently requiring surgery, from destruction of epileptic foci in the brain to sealing bleeding blood vessels after injury.

The ultrasound transducer used at the Marsden is designed to create a cigar-shaped "burn" approximately 2cm. long and 2mm. wide. A single burst from this machine raises the temperature of the cells on which it is focused to about 55-80 degrees Centigrade - enough to coagulate and kill the cells within the region of tissue.

"The device," claims Dr. ter Haar, "is very precise - creating a margin only about six cells wide between destroyed and normal tissue - and is actually sharper than a scalpel."

And, since the transducer can be focused within the body to a depth of about 15 cm, tissue in virtually any organ can be targeted.

Says ter Haar, "If an area can be imaged with diagnostic ultrasound, you have a very good chance of being able to treat it with therapeutic ultrasound."

In a preliminary trial conducted at the Marsden, a group of 23 patients with prostate, kidney or liver tumours were treated with HIFU.

The treatment did not require anaesthesia - and was well tolerated. The team is now planning a second trial involving 50 patients with secondary cancers in the liver.

Before ultrasound energy cleans up surgery, however, a few problems need to be sorted out - in particular, the images that HIFU operators depend on to visualise their targets.

Because the area on which HIFU "rays" are focused is so small, any tumour needs several carefully placed "shots" so that no cancer cells escape destruction. Aiming an ultrasound beam this accurately is difficult, because not only do patients and their organs not lie still, but changes caused by treatment can alter the acoustical properties of organs and distort the sound waves.

One way of tackling the problem is by developing computer-controlled transducer arrays.

Dr. Kullervo Hynynen of Boston's Brigham and Women's Hospital and Dr. Emad Ebbini of the University of Michigan in Ann Arbor are two researchers working on this problem attempting to adjust the HIFU beam so that it can compensate for the distortions in sound transmissions that take place when the beam passes through various tissues.

"It is possible," claims Dr. Hynynen "that we will eventually be able to perform this type of therapy even through the intact skull."

Another role envisaged for HIFU is in cauterisation during open surgical operations. Currently, surgeons use low voltage electrical current to coagulate blood vessels and stop them bleeding.

The advantage of HIFU is that it can be used to cauterise vessels deep within an organ (even a very vascular organ such as the liver or kidney) so that it can be cut with a scalpel with minimal bleeding.

Soundwave surgery is, admittedly, still in the experimental stages - but once present day techniques are improved and refined, it should become readily accepted - just as the shattering of kidney stones by soundwaves, termed Extracorporeal Shock Wave Lithotripsy, has now become the first line of treatment for patients who would previously have been "cut for stone."

Says Lawrence Crum, whose research team at the Applied Physics Laboratory of Seattle's University of Washington is working on the use of HIFU devices to locate and treat internal bleeding in battlefield injuries, "We are on the verge of a revolution. It may all sound a bit like science fiction - but people are doing these things right now."

And Nostradamus, wherever he is at the moment, must be smiling to himself.

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