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28th March 1999

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Medical Mesures

Good thinking is lacking in the corridors of power

Second Opinion

The distressing news in the state health sector these days is the strike launched by the Government Medical Officers Association (GMOA). The issue is still not fully resolved at the time of writing with Cabinet resorting to the usual tactic of appointing a Cabinet Sub Committee to deal with the matter.

We have in these pages said time and again that the GMOA should resort to strike action only as a last resort and not as a first option. It must therefore be said that at least on this occasion the GMOA has acted responsibly.

The issues on which this week's strike was launched are numerous, the main demand among them being the request that medical officers be recognized as an all-island service and not be brought under the purview of the Provincial Councils.

Whatever the merits and demerits of these demands it is a fact that when these demands were first forwarded, the Minister of Health had agreed to them but they had not been implemented either due to the all-pervasive lethargy of our bureaucracy or worse still, deliberately.

The government, the Health Ministry and the Minister of Health are clearly culpable on this issue. One could perhaps argue that the GMOA could have resorted to other action rather than inconveniencing patients but then it could be counter-argued that such attempts have not moved the authorities into action in this instance.

This is not the first time that doctors' strikes have been referred to cabinet sub-committees. Invariably, demands that have been rejected outright by the Minister of Health are granted by the sub-committee and the matter is then settled. This state of affairs only erodes the confidence the public has in the Minister of Health be it Mr.Nimal Siripala de Silva or Mr.Fowzie.

Worse still is the response of the authorities to this week's strike. The Health Minister was on record as saying that public opinion should be mobilized against doctors who strike which was tantamount to inciting violence against the doctors. Such attitudes will not resolve the outstanding issues, ever.

The issue at stake-retaining doctors within the purview of the central government- is a justifiable one. This newspaper last week highlighted the administrative quagmire a doctor would have to plod through to obtain a transfer if they were to be brought under the control of the provincial councils and that should offer food for thought to the authorities.

Clearly then, good thinking and common sense seems to be lacking in the corridors of power which is why the health sector is what it is today. No wonder then that old timers in the medical service yearn with nostalgia for the days when the likes of Siva Obeyesekera, Gamani Jayasuriya and Ranjith Attapattu were Ministers of Health. Yes, doctors had their problems with the powers that be even then, but they respected the persons who dealt with them.

The GMOA may not be the most principled trade union in the country today. But then, trade unions rarely win popularity contests except among their members. But on this occasion one can hardly blame them, given the lackadaisical attitude of our legislators.

Part of the brain "dies"

Your Health
By Dr. Sanjiva Wijesinha

Strokes are becoming known with increasing frequency as Brain Attack these days.

The reason for the new name is that people are realising that a stroke does to the brain exactly what a heart attack does to the heart - with the same devastating consequences for the patient.

In a heart attack, what happens is that the blood supply to a part of the heart suddenly stops, resulting in death of part of the heart muscle. If a minor segment of the heart muscle dies, the patient experiences severe chest pain - but can usually recover, albeit with a weakened heart. If a major part of the heart muscle dies, then the heart cannot continue beating and the patient dies.

The reason for the sudden cutting off of blood is that the arteries which carry blood to the heart have become narrowed - and a final straw (such as a clot of blood getting stuck in the narrowed vessel) blocks blood flow.

The same thing can happen in the brain - but when a portion of the brain "dies", if the patient does not die outright, the resulting brain damage compromises the brain's ability to function properly.

This may manifest as muscle paralysis (as is commonly seen in people who have suffered a stroke, who have weakness of a limb or one side of the body or slurring of speech). A stroke can also damage a part of the brain controlling sensation - so that some types of stroke can leave a person blind or unable to feel some part of the body. It could also rarely damage a part of the brain involved with the emotions or knowledge storage - which is why a person who has suffered "brain attack' might appear to forget things easily or exhibit a changed personality after the event.

How can we prevent a stroke?

The simple answer is by following the same precautions that we use to prevent heart attacks - which means taking those steps that minimise narrowing of the blood vessels and clot formation. Keeping blood pressure within normal limits, keeping our weight and cholesterol under control, not smoking, reacting appropriately to stressful events, getting enough physical exercise - all the things that we try to do to avoid a heart attack will also afford protection against a brain attack.

Of course, just talking about preventing an attack isn't enough - we must be committed enough to go out and do something about it!

Want a millennium baby? Try April 9

Planning for a baby to be born at the dawn of the new Millennium, on the first of January of the year 2000?

Doctors, both locally and in other countries say that many couples want to do just that but if that is so, now is the time to think about it or very soon it will be too late!

Well, it works like this: A pregnancy usually lasts forty weeks and that is how your obstetrician calculates the probable date of delivery, working out the date from the first day of the last period the mother had.

Based on this calculation a couple conceiving on or about the 9th of April this year is likely to deliver the baby on the first day of the new Millennium.

But, of course, doctors warn, the date of delivery is also influenced by a variety of other individual factors so one can never be sure that the date will be exactly on January 1, 2000.

Nevertheless, for those who want to try, the period for conceiving is around the April 9, give or take a few days, provided of course that the mother's menstrual cycle is in a favourable phase for conception during that time.

And, for any clarification's in this regard it is best to contact your general practitioner or Obstetrician....

Address stress instead of being distressed

Stress is a widely used- and much abused- word these days. The popular belief is that everyone from the year five student sitting his scholarship examination to the corporate executive is "stressed".

But what exactly is stress? And how do you deal with it?

Stress, in a sense is the state of mind that keeps us on edge, mindful of the possible dangers that lie in wait for us, preparing ourselves both mentally and physically for such situations.

It is, therefore, a natural mechanism that has evolved to help us overcome these crisis states. Substances called 'hormones', which bring about these changes, mediate stress.

What is harmful however is that a constant outpouring of these hormones in a person who is under stress for a good part of the day could have certain ill-effects. This has even been implicated in diseases such as High Blood Pressure (Hypertension), Heart Disease and Diabetes.

Those who are liable to constant stress are those who seem to be " always on the go"-they are planning their next meeting or target and want to get on with it.

When that target is met, they set another goal for themselves. They are sometimes referred to as "Type A" persons.

Those who are under stress show telltale signs- they smoke a lot, find it difficult to sleep, they find it difficult to make decisions and they may find it difficult to concentrate on an issue at hand.

Some persons may even show physical symptoms such as a dry mouth, sweaty palms, awareness of the heart beat (palpitations) and tightness in the stomach.

If you think you have these signs and symptoms or if you are simply worried that the rat race of life is too much to cope with you might try a few simple methods to reduce your level of stress. Here are a few helpful hints:

* Take note of the stressful situation-the traffic light that is taking ages to change to green, maybe-and tell yourself that it is too trivial an issue to worry about in your larger scheme of things in life.

* Take more physical exercise-jogging, cycling, swimming, gardening, whatever. Set apart a time for it. Any form of physical exercise helps you to "unwind" and feel refreshed.

* Reduce smoking and drinking. The "relief" you get from these habits are only temporary. Besides, they have their own harmful effects and are addictive.

* Plan your day. List the things to be done according to priority and slot in a few minutes extra, so it can be used if a job cannot be completed in the time allotted to it. Do not accommodate too many tasks to be done in too little time.

* Take a vacation. This can be a "reward" for a completed task or programme. That way, you will be looking forward to the vacation, not to the next task awaiting you.

* Even in your normal working day set apart a time for relaxation-watching TV or engaging in a favourite hobby- and do not sacrifice this for other needs.

And if you are still worried after doing all this, maybe you should see a doctor...

Colic is a normal part of baby's development

By Kathleen Kelleher

"You know your baby has colic," says one pediatrician versed in the phenomenon, "when you have an irresistible urge to get him his own apartment.

Sure, this is funny. But only if you don't have a colicky baby in your household. Colic, perhaps the most difficult syndrome of early infancy a parent faces, is defined by the American Academy of Pediatrics as unexplained crying that lasts one to two hours (or more) and occurs once or twice a day in an otherwise healthy baby, aged two weeks to four months.

The crying of colic has been described as crying of the highest intensity, indistinguishable from crying caused by acute pain, hunger or loneliness. The baby is inconsolable and appears to be in pain with legs crunched, back arched, tummy tight, red face and fists formed. Some babies also pass gas. An estimated 10 percent of babies have colic.

Theories about what causes colic - a baby's underdeveloped nervous system, underdeveloped digestive tract, milk protein intolerance, swallowed air - are as varied as treatments (heating pads, antigas medicine, enemas, hypoallergenic formulas, vibrating cribs, baby holding methods, white noise). While there is no consensus on what causes colic, a number of researchers and pediatric gastroenterologists are beginning to see colic as a normal part of early development combined with a sensitive temperament rather than an abnormality or a sign of pain.

"The real take-home message from all the research has to be that the majority of these kids are not in pain," says David R. Fleisher, associate professor of gastroenterology at the University of Missouri School of Medicine, Department of Child Health, who recently wrote an overview article on colic research and treatment for the journal Contemporary Pediatrics.

"Virtually all the studies that have looked at antispasm, antigut medicine found that none of them worked.

Most colicky babies are not allergic (to milk) - the majority do not respond to switching to hypoallergenic formula. The other thing is, it is an on-and-off phenomenon, which would not occur in a kid who is in pain or hungry.'

The concern that there may be something seriously wrong with an inconsolable baby who is so wracked by hard crying that his body distorts is understandable. Naturally, a pediatrician should be consulted to rule out any potential illnesses. But Ron Barr, a professor of pediatrics and psychiatry at McGill University in Montreal, Canada, who has conducted numerous studies investigating the causes and treatment for colic, speculates that only roughly one out of 20 infants actually has an organic disease contributing to colic.

(There are no definitive studies showing the rate of organic diseases in colicky babies.)

Research conducted by guru pediatrician T. Berry Brazelton established that healthy babies, regardless of temperament, cry more in the first four months of life. Crying peaks at six weeks to an average of 3 and 1/2 hours a day but declines at about three months to about an hour and 20 minutes, where it stabilizes for the first year of life. Crying declines at 3 months, Brazelton and other pediatricians postulate, because as a baby matures developmentally, she is better able to communicate her needs to parents and better able to soothe herself (by finding a pacifier or thumb).

During this period of increased crying, Brazelton and a number of other pediatricians hypothesize, babies, particularly those of a hypersensitive, hyperreactive temperament, are more likely to blow off stress from a full day of environmental stimuli with a good cry.

"They simply react to anything that perturbs them by crying intensely," says Tom Metcalf, a pediatrician in Salt Lake City whose double-blind study found that an antigas treatment was no more effective than a placebo in treating colicky babies. "The kid cannot regulate or calm himself so he freaks out and cries," Metcalf says.

What makes babies cry, particularly those with a hypersensitive temperament, says Fleisher, is difficulty adjusting to different states during the day (from awake to sleep, from empty stomach to full, from a day of activity to low stimulation). Crying is the way these babies cope with change. As a baby reaches 3 or 4 months, crying lessens as babies are given the opportunity to learn to soothe and calm themselves.

Soya- the wonder bean

The Soya bean has long been touted as a rich source of protein for the poor. But the bean, first discovered in ancient China and then popularised by Americans, has many other beneficial properties as well. Why then do many doctors call the Soya Bean the ideal health food? This is how Soya helps your body.

Against heart disease- Soya is thought to be beneficial for patients with heart disease because it lowers the levels of blood cholesterol, the deadly lipid that increases your chance of having a heart attack.

Against Diabetes- it has been found that diabetic patients on a regular diet of Soya show a better control of their blood sugar.

Against high blood pressure- Soya promotes the excretion of Sodium which helps reduce blood pressure. It may also act by reducing the activity of certain enzymes, such as Angiotensin Converting Enzymes (ACE) which also lowers the blood pressure.

Against Cancer - Soya beans contain a number of substances that protect the body against cancer so much so that some researchers have suggested it as an anti-cancer drug. Of special note is its proposed action against lung cancer and cancer of the colon.

Added to all this is the fact that Soya, of course, is a storehouse of natural protein. The percentage of proteins in Soya- about 40%- is much more than that of more expensive foods like fish, meat or poultry. Soya also has many vitamins- vitamin B in particular- and many other nutrients. No wonder, then, that they call Soya the wonder bean. So, think about including some of it in your diet from now on. Remember, you need not be sick to eat Soya!

Medical Diary

Sunday, March 28, 9.00 a.m.- Health Walk , concluding the 112th annual academic sessions of the Sri Lanka Medical Association (SLMA) at Kandy.

Tuesday, March 30, 3.00 p.m.- "The doctor, patient, computer relationship" : Lecture by Dr. Ian Purves at the College of General Practitioners monthly continuing medical education session, at Lionel Memorial Auditorium, Wijerama Mawatha, Colombo 7.

Sunday, April 4 -8.00 a.m. to 1.30 p.m.- First academic sessions of the Health Informatics Society of Sri Lanka at the Lionel Memorial Auditorium, Wijerama Mawatha Colombo 7. (For registration contact Department of Anatomy, Faculty of Medicine, University of Colombo.)

Tuesday, September 28,1999, 4.00 p.m.- MRCP (UK) Part I Examination conducted by the Ceylon College of Physicians at the British Council, Colombo 3. (Local closing date for registration- May 18, 1999;Candidates should contact the Ceylon College of Physicians Office at 695418)

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