Life style
Why isn’t your back pain improving with treatment!
Understanding complex rheumatological conditions requires both medical expertise and compassion. In this exclusive interview, Dr. Aruna Caldera, Consultant Rheumatologist, speaks with Zanita Careem about the growing burden of early diagnosis, advances in treatment, and how greater awareness can help patients lead healthier and more fulfilling lives. The discussion explores how lifestyle posture, inflammation and underlying rheumatological conditions, can contribute persistent pain, while highlighting ways to protect spinal health and maintain mobility
Back pain is one of the most common health problems worldwide, affecting many people at some point in their lives. Most episodes of acute low back pain improve within weeks, often with conservative care, though recurrence is common. Unfortunately, there is a proportion of patients who continue to suffer long term.
A large number of these patients are treated for common causes of back pain, such as degenerative changes (wear and tear), whereas the actual cause of their back pain is for totally different reason/s, hence the poor outcome. The main issue in our setup is the public perception of back pains can be cured with local applications alone, whereas the reality is totally different. Pain may reduce temporally with a local application, whereas the underlying root cause remains unaddressed.
Let’s look at why back pain sometimes does not improve with common treatments. Here, I am mainly referring to chronic back pain (long-standing back pain). However, I will also briefly discuss acute and subacute (back pains with a short history) back pain because of their potential seriousness.
When evaluating patients with back pain, a considerable number fall into the category of non-specific back pain, meaning a clear diagnosis cannot be identified. The clinician’s experience and diagnostic skills play a major role in this. When a definite diagnosis can be made, patients often require specific treatment, tailored to that condition. “Paracetamol for every fever” theory cannot be applied for chronic back pain.
Before prescribing treatment for back pain, the clinician should first have a clinical diagnosis, and then only decide which investigations, such as blood tests, X-rays, CT scans, or MRIs are actually needed. Radiating pain down the leg (sciatica), which is commonly associated with back pain, is an important symptom, but should always be interpreted in conjunction with the patient’s history, physical examination findings, and imaging where appropriate. An incorrect clinical diagnosis can lead to unnecessary investigations and may delay identifying the true cause. Nerve root compression, seen on MRI, may not necessarily explain a patient’s symptoms and should always be interpreted in the context of the clinical findings. Furthermore, people with similar MRI finding may not have back pain.
This is why it is important that back pains not settling for primary treatments need to be considered for evaluation by relevant specialists early. Some conditions, such as inflammatory back pains due to axial Spondyloarthritis (previously known as ankylosing spondylitis), may require early specific treatment to prevent complications.
When evaluating a patient with back pain, it is essential to watch for “red flag” symptoms that may indicate serious underlying disease. Conditions, such as spinal cord compression, spinal tumours (often spread from breast, prostate, kidney, or lung cancers), multiple myeloma, spinal epidural abscesses (collections of pus), osteomyelitis (infection of vertebral bones), spinal tuberculosis, must be identified and treated as quickly as possible. Unfortunately, the X-ray, which is the go-to investigation in back pain, may be normal, and blood tests may not reveal specific findings, even in a patient with a serious underlying condition mentioned above! Without proper treatment, these conditions can result in permanent disability, or even death.
Many patients with these serious conditions may present late to relevant specialist care. One main reason for that is the capability of even non-specific treatments to temporarily reduce the pain, at least initially.
Chronic or long standing back pain has numerous causes. Osteoporotic spinal fractures (sometimes occurring without the patient realising it!), radiculopathy (compression of nerve roots exiting the spine), spinal stenosis (narrowing of the spinal canal), spinal deformities such as scoliosis and kyphosis, axial Spondyloarthritis (previously known as ankylosing spondylitis; a chronic inflammatory rheumatic disease that can cause significant disability if untreated).
We must not forget that cause of the back pain is not always related to the spine. Kidney and ureteric stones, certain kidney diseases, enlargement of major abdominal blood vessels (aneurysms) and bleeding within them (aneurysmal rupture), reactivation of herpes zoster, some gynaecological conditions, psychological causes, fibromyalgia, etc.
There are other rheumatological conditions which can present with back pain. Sometimes these diagnoses are missed because the back pain is attributed to the changes in the spine X-ray due to wear and tear. Greater Trochanteric Pain Syndrome (GTPS) (pain arising from structures around the outer hip, often related to gluteal tendinopathy and sometimes involving the trochanteric bursa), adductor tendinitis (inflamed inner thigh muscle which may have associated groin pain), piriformis syndrome (sciatic nerve compressed by piriformis muscle in the butt), Bertolotti’s syndrome (lowest lumbar vertebra fusing with the sacrum), coccydynia (tailbone pain), arthritis affecting the hip, are some examples.
When the actual cause of back pain is not identified, treatments aimed for findings in X-rays, CT scans, or MRI scans may not be successful. One reason is that in many people, over the age of 40, MRI scans commonly show degenerative changes, especially at L4/L5 and L5/S1 levels, such as disc degeneration and minor exit nerve root compression, even when the person has no symptoms at all! Electrodiagnostic studies (nerve conduction tests) may not always correlate with MRI findings, as they assess nerve function rather than anatomical appearance.
Treatment should primarily be based on the clinical diagnosis derived from the patient’s history and physical examination. Treating the scan report, rather than the clinical diagnosis, may lead to poor outcomes in certain patients.
Another major drawback is that if the clinical diagnosis is wrong, the MRI may be focused on the wrong area. For example, if Spondyloarthritis is suspected, MRI of the sacroiliac joints should be included in the protocol.
Poor clinical information on imaging requests may contribute to delayed diagnosis, although delayed recognition and referral are also important factors. Sometimes MRI findings are less informative because the imaging request lacks sufficient clinical details to guide image acquisition and interpretation.
The treatment is multimodal. Evan a layperson would know he/she may need some medicines to reduce the pain (at least initially) and some form of physiotherapy. Actually, this is true for all back pains and this is where the problem actually starts. Many patients will experience at least some temporary improvement with basic treatments, but actually they aren’t getting the ideal treatment. Some may need muscle relaxants, some may need guided root injections, some may need epidural injections, some may need surgery immediately, some may need surgery later, some may require surgery / minimally invasive surgery (MIS), some may require nerve ablations, some may need bursal injections, some may need intra articular injections, some may need even disease-modifying anti-rheumatic drugs (DMARDs). That is why the diagnosis should be as accurate as possible and made by a doctor essentially which isn’t always the case in the Sri Lankan setting unfortunately.
We all are aware of the disaster if a cancer deposit in the spine is missed. It is often overlooked that missed osteoporosis related wedge fracture may the first sign of an impending hip fracture. What public may not be aware of is that up to 1/3 of patients, who suffer hip fractures, die within 12 months. So much so, a wedge fracture in the spine (however small) requires evaluation for osteoporosis and initiation of treatment where appropriate to prevent a hip fracture and prevent further spine fractures.
Young people with back pain have a different set of diagnostic priorities. Significant degenerative spinal disease is less likely to explain chronic inflammatory-type back pain in a 30-year-old patient, and axial Spondyloarthritis should be considered. Furthermore, X-rays of the spine as well as the involved sacroiliac joint could be also normal! These patients may require MRI of the sacroiliac joints, particularly when clinical suspicion remains high, despite normal X-rays.
What if the patient is not improving? It may be due to an incorrect diagnosis, disease progression, poor adherence to treatment, psychological factors, central sensitisation, treatment limitations and other comorbidities.
As you’re reading this, you may be sitting there holding your back and wondering why your back pain never got better. The reason may very well be one of the issues I have mentioned above. Also remember that reduction in pain does not mean an arthritis condition has been dealt with. Persistent or concerning back pain should not be ignored and should be assessed appropriately.
Life style
Science, policy and persistence: Praveen Bhargav’s roadmap for Elephant Conservation
By Ifham Nizam
Wildlife conservation cannot be driven by emotion alone. It must be backed by sound science, reliable data, effective policy and practical solutions that work on the ground, according to Indian conservationist Praveen Bhargav, Managing Trustee of Wildlife First.
Bhargav is in Colombo at the invitation of the Wildlife and Nature Protection Society (WNPS) and delivered a special World Elephant Day lecture, focusing on elephant conservation, India’s policy and legal framework and conservation interventions that have produced positive results.
Speaking exclusively to The Sunday Island, Bhargav said the real challenge today was not merely identifying the problems confronting elephants, but finding workable solutions.
“The real need is to try and present or offer solutions to the many challenges that face us,” he said, stressing the importance of a solutions-driven approach that could also assist policymakers and others responsible for taking decisions.
Bhargav said understanding the ecological and scientific dimensions of conservation was vital because the present generation had a responsibility to protect wildlife and hand it over to future generations.
“This generation has a great responsibility to conserve what is there and hand it over in trust to the next generation. And that’s a huge responsibility on all our shoulders,” he said.
While emotion was an important part of wildlife conservation, he said it could not replace science and data.
“While emotion is certainly important, because nothing will work without an emotional link to the issue at hand—in this case, elephants—but going beyond emotion, we need to be very, very clear in terms of what is the data and scientific insights that we have today,” Bhargav said.
He also stressed the need to acknowledge gaps in knowledge and encourage scientists to focus research on areas where reliable information was deficient.
One of the biggest challenges facing elephants and other large mammals, he said, was habitat fragmentation.
Although countries across the elephant range had laws and mechanisms to curb hunting, illegal wildlife trade and other direct threats, protecting elephants from direct killing was only one part of the conservation equation.
“Their habitat needs to be conserved,” Bhargav said, pointing out that elephants are mega-herbivores requiring large areas in which to move.
The challenge before conservationists and policymakers, therefore, was to balance the ecological requirements of elephants with society’s legitimate needs for development and livelihoods.
“This is where I believe that good science and data must be applied to come up with a credible solution in order to ensure that the interests of these endangered species are taken care of without, of course, affecting the needs of people, whether it is development or livelihood,” he said.
Bhargav argued that policy decisions must have strong ecological foundations. Even decisions taken with good intentions could have unintended consequences if they were not scientifically validated.
“Without proper ecological underpinnings in policy, we may be taking the wrong decision. Intentionally it may be good, but we may be going in the wrong direction,” he said.
India’s experience, he explained, provides several examples of practical interventions aimed at restoring and strengthening fragmented wildlife habitats.
One such intervention is the voluntary resettlement of people from critical wildlife areas with appropriate incentives. Bhargav said this process was helping in certain parts of India to reconnect fragmented habitats.
Another important intervention has been the scientific identification and assessment of elephant corridors and colonies, followed by efforts to secure critical areas so elephants can move across their natural range.
“It’s not that there are no problems. Conservation will also be eternally working with problems. But thankfully this is being recognised and it’s being implemented on the ground. And we are seeing positive steps in that direction,” he said.
Bhargav urged conservationists not to become despondent because progress in wildlife conservation is necessarily gradual.
“I believe that there are solutions and we as conservationists need to work with the system to ensure that those solutions reach or fructify on the ground,” he said.
“Conservation is not a T20 game. It’s a marathon. You need to keep playing. You need to be at it. And that’s when these changes do percolate to ground level.”
A key principle, according to Bhargav, is that conservation solutions must be site-specific. An intervention that succeeds in one location may be unsuitable or unnecessary elsewhere.
“We need to, as conservationists, use science, data, knowledge and ensure that site-specific solutions are crafted,” he said.
He also advocated calibrated approaches, where measures could be introduced progressively rather than attempting to implement everything at once.
Keeping “a finger on the pulse” of what is happening on the ground is equally important, he said, because conservation decisions made without understanding local realities risk operating in a vacuum.
Bhargav also emphasised the importance of scientifically estimating wildlife populations. He noted that wildlife monitoring had progressed from total counts towards sampling-based assessments.
“These rigorous estimations are absolutely essential to find out whether we are heading in the right direction or not,” he said.
Ultimately, the most important measure of a conservation policy, he said, was whether wildlife populations and their habitats were actually benefiting.
Bhargav’s conservation work has also involved policy advocacy at the highest levels in India. He has served on the National Board for Wildlife and on expert committees, while Wildlife First has continued to engage with the government on conservation issues.
One example, he highlighted, was India’s approach to linear infrastructure, such as roads and power transmission lines.
While recognising that infrastructure is necessary for development, Bhargav said the first principle should be avoidance—wherever possible, important wildlife areas should not be crossed by major infrastructure.
Where avoidance is impossible, mitigation measures, such as wildlife overpasses, underpasses and appropriate infrastructure designs can reduce impacts.
He said this approach had subsequently become part of government policy, with projects being redesigned in some cases to reduce disruption to wildlife corridors.
In one case, he pointed to the construction of an elevated highway through a critical wildlife corridor, allowing animals to continue moving at ground level while traffic passed above.
“These are kind of interventions that are essential in order to carefully balance both the competing needs,” he said.
Bhargav also stressed that wildlife protection requires “eternal vigilance”, particularly against illegal wildlife trade.
“We can never say that we have won the battle against illegal wildlife trade. We need to be constantly on guard.”
He mentioned that India had a specialised Wildlife Crime Control Bureau and that recent legal changes had strengthened the ability of enforcement agencies to deal with wildlife-related offences.
Bhargav has also been involved in training customs officials on wildlife-related issues.
Despite continuing pressures, he remained optimistic about the future of conservation.
“I’m not saying there’s no pressure. But one should not get despondent and disappointed that, oh, nothing is happening, everything is going wrong. No. We are making progress,” he said.
“There is advancement in science. Some of it is getting into policy. Some actions are being taken on the ground.”
However, he cautioned that progress should never lead to complacency.
“We can’t let our guard down,” he said, stressing the continuing role of civil society in working constructively towards conservation.
Bhargav said his visit to Sri Lanka was his first and that he was keen to learn more about the country’s elephant conservation challenges through discussions with WNPS and others.
He had not yet held discussions with Sri Lankan government officials, although he understood that some officials might attend his World Elephant Day lecture.
Asked what message he would have for Sri Lankan policymakers and wildlife officials, Bhargav returned to the central theme of his approach: knowledge-driven, site-specific conservation.
“Good knowledge to drive policy. And a threadbare assessment is essential,” he said.
“We need to have site-specific solutions, which is very important, in order to ensure that things are changed, we bring about a change on the ground.”
His message ultimately was one of optimism—but optimism accompanied by responsibility.
“Let’s be positive. Let us be positive. Because we do have the strength,” Bhargav said.
Across the world, he noted, there was considerable concern about saving endangered species, and that goodwill should be harnessed to strengthen conservation.
“I believe that that is possible,” he said.
Life style
Vietnam meets Sri Lanka: Two destinations one beautiful journey
By Zanita Careem
From the timeless charm of Vietnam’s ancient cities and emerald landscapes to Sri Lanka’s golden beaches, misty tea hills and rich cultural heritages, two captivating Asian destinations are finding new ways to bring their world’s closer. Tourism is emerging as a particularly glamorous bridge between Viet Nam and Sri Lanka, offering travellers the promise of culture, cuisine, wellness, adventure and unforgettable experiences. There is a strengthening of tourism relationship between the two countries taking centre stage.
In this exclusive interview with the Ambassador of Viet Nam to Sri Lanka Trinh Thi Tam, we explored the beauty of this emerging tourism partnerships, the experiences that could entice Sri Lankan travellers to Viet Nam, and welcoming more Vietnamese visitors to Sri Lanka.
(Q) How would you describe the current tourism relationship between Viet Nam and Sri Lanka?
(A) Tourism is one of the most promising areas of cooperation between Viet Nam and Sri Lanka. Our two countries share rich histories, cultures and Buddhist traditions, while offering distinct travel experiences. This makes our two destinations complementary rather than competitive.
In the first seven months of 2026, nearly 5,000 Vietnamese visitors came to Sri Lanka, compared with around 4,000 for the whole of 2025. Viet Nam also welcomed nearly 9,000 Sri Lankan visitors in the first seven months of 2026.
Tourism is growing, but there is still considerable room for expansion. Better air connectivity, stronger promotion and closer cooperation between travel companies can help make tourism a major pillar of our bilateral relationship.
(Q) How significant are the new direct flights between Viet Nam and Sri Lanka?
(A) The new direct flights are a major step forward for tourism relations between our two countries.
For many years, the lack of direct air connectivity was one of the main obstacles. Although Viet Nam and Sri Lanka are geographically close, travellers often had to transit through a third country, adding time, cost and inconvenience.
(Q) Do you expect the new air connectivity to bring a significant increase in Vietnamese tourists to Sri Lanka?
(A) We are already seeing encouraging signs. As mentioned earlier, in the first seven months of 2026, nearly 5,000 Vietnamese visitors came to Sri Lanka, compared with around 4,000 for the whole of 2025. This shows that interest in Sri Lanka is growing even before direct connectivity is fully established.
Viet Nam is also a large and growing outbound tourism market, with a population of more than 100 million and a rapidly expanding middle class. Vietnamese travellers are increasingly looking for new destinations and experiences. Sri Lanka has many products that can appeal to them, including Buddhist pilgrimage, beaches, wildlife, tea plantations, cultural heritage, wellness and cuisine.
(Q) What aspects of Sri Lanka do you think appeal most to Vietnamese travellers?
(A) Sri Lanka offers a particularly attractive combination of culture, spirituality, nature and hospitality.
First is culture and history. Vietnamese travellers value destinations with a long history and strong cultural identity. Sri Lanka offers ancient cities, temples, UNESCO heritage sites and traditions preserved over centuries.
Second is Buddhism. This is particularly important. Viet Nam has a large Buddhist community, and many Vietnamese people are interested in visiting important Buddhist sites.
Third is nature. Despite its relatively small size, Sri Lanka offers a remarkable variety of landscapes and experiences, from beaches and mountains to tea plantations, forests and wildlife. Visitors can see elephants, whales and many other species.
And I would add that Vietnamese travellers value friendliness and hospitality. Sri Lankans are warm and welcoming, which adds greatly to their travel experience.
Finally, Sri Lanka offers something different. Vietnamese travellers are familiar with many destinations in East and Southeast Asia. Sri Lanka provides a new experience while retaining cultural and spiritual connections that Vietnamese visitors can easily appreciate.
(Q) How important is Buddhist tourism in attracting Vietnamese visitors to Sri Lanka?
(A) Buddhist tourism could become one of the strongest tourism links between our two countries.
Sri Lanka has a special place in the history of Theravada Buddhism. Vietnamese pilgrims and Buddhist followers are interested in visiting sacred places such as Anuradhapura, Kandy and other important Buddhist sites.
At the same time, interest in spiritual and cultural travel is growing in Viet Nam. Many travellers are looking not only for a holiday, but also for meaningful experiences.

Ambassador Trinh Thi Tam at Hotel Show Colombo 2026, with Professor Ruwan Ranasinghe Deputy Minister of tourism
This is an area where Viet Nam and Sri Lanka have a natural advantage. The historical and spiritual connection already exists. Our task is to turn that connection into practical and attractive tourism products.
(Q) Do you see potential for Vietnamese investment in Sri Lanka’s tourism?
(A) Vietnamese companies are increasingly exploring international markets, and tourism is one area where Sri Lanka could attract Vietnamese investment. Vietnamese companies also have experience in destination development, hospitality, transport and tourism infrastructure.
Sri Lanka has a strong tourism base, but there is still significant room for new investment in hotels and resorts, eco-tourism, wellness, entertainment, food services, tourism technology and integrated tourism projects.
. Joint ventures with Sri Lankan partners could be particularly useful, combining Vietnamese capital, business experience and marketing capacity with Sri Lanka’s destinations and local expertise.
(Q) How can both countries encourage more Sri Lankan tourists to visit Vietnam?
(A) The key is to make Viet Nam more visible and easier for Sri Lankan travellers to discover.
Viet Nam already offers many attractive products, including culture, beaches, cuisine, shopping, nature and Buddhist heritage. We should also develop tourism packages tailored to the Sri Lankan market.
Direct flights will be important, but promotion is equally essential. Sri Lankan travel companies, airlines and media should have more opportunities to visit Viet Nam and experience its destinations first-hand.
(Q) How can Sri Lanka attract Vietnamese travellers beyond Colombo and the traditional tourist attractions?
(A) Sri Lanka should be presented to Vietnamese travellers not simply as Colombo and a few famous attractions, but as an island offering a wide range of experiences.
Kandy can be promoted through its Buddhist heritage and cultural traditions. Sigiriya and Dambulla offer history and heritage, while the hill country combines tea plantations, scenic landscapes and memorable train journeys.
For nature lovers, Sri Lanka offers wildlife and safari experiences. Younger travellers can enjoy beaches, surfing, hiking and other adventure activities.
Wellness and food tourism also have strong potential. Vietnamese travellers increasingly seek experiences rather than simply sightseeing. They want to meet local people, taste local food and discover less crowded destinations.
The industry could, therefore, develop flexible packages tailored to different interests, including Buddhist pilgrimage, culture, nature, beaches, wildlife, wellness and luxury travel.
(Q) What potential do you see for MICE tourism, destination weddings and luxury tourism between the two countries?
(A) Both Viet Nam and Sri Lanka are becoming increasingly attractive destinations for higher-value tourism. Sri Lanka’s beaches, resorts, cultural sites and scenic landscapes are well suited to weddings, honeymoons and luxury holidays.
MICE tourism is another promising area. Vietnamese companies are increasingly organising conferences, incentive trips and team-building programmes abroad. Sri Lanka can offer a combination of business facilities and leisure experiences.
Destination weddings could be particularly promising. Sri Lanka offers beaches, luxury hotels, cultural settings and beautiful landscapes, while Vietnamese couples are increasingly interested in overseas weddings and honeymoons. Vietnnam has recently become a destination for weddings of many Indian couples.
The key is to offer complete packages rather than individual services. Hotels, airlines, travel agencies and event organisers should work together to provide a seamless experience.
(Q) How can both countries promote sustainable and responsible tourism while increasing visitor numbers?
(A) I believe tourism growth and sustainability must go hand in hand.
Tourism should create income and jobs while protecting the environment and respecting local communities. Sri Lanka’s beaches, forests, wildlife and cultural heritage are the foundation of its tourism industry. Protecting these assets is, therefore, essential.
Both countries can share experience in eco-tourism, waste management, marine conservation and responsible tourism.
The goal should not simply be more tourists, but better tourism.
(Q) Should Sri Lanka increase its presence at Vietnamese tourism fairs and travel destinations?
(A) Viet Nam has a large and increasingly sophisticated tourism market, and Sri Lanka should have a stronger and more regular presence there. The Sri Lankan Embassy in Hanoi has already organised tourism promotion activities involving Vietnamese travel agents and industry representatives. In 2025, a familiarisation trip also brought 20 leading Vietnamese travel agents to Sri Lanka.
These are useful initiatives, and I believe we should build on them.
Sri Lanka should participate regularly in major Vietnamese tourism fairs. I would also encourage direct promotion in key tourism markets such as Ho Chi Minh City, Hanoi, Da Nang, Nha Trang and Phu Quoc, among others.
(Q) What would your vision for Vietnam–Sri Lanka tourism be five years from now?
(A) I would like tourism to become one of the strongest pillars of the Viet Nam–Sri Lanka Comprehensive Partnership.
I would like to see regular and convenient direct air connectivity between our major cities, with many more Vietnamese tourists discovering Sri Lanka and many more Sri Lankan tourists visiting Viet Nam.
I would also like to see more specialised tourism products, including Buddhist pilgrimage, cultural tourism, eco-tourism, wellness, luxury travel, MICE and destination weddings.
Tourism can create investment, jobs and new services. Most importantly, it can bring our people closer and deepen mutual understanding.
Life style
Inside the world of heart care with Dr. Haniffa
By Zanita Careem
Dr. Zacky Haniffa, Secretary to Sri Lanka College of Cardiology at Durden’s Hospital, is a distinguished Royal College alumnus who graduated from the University of Colombo and furthered his medical education in London.With his expertise and dedication to cardiac care, he has made a meaningful contribution to the field of heart health. His work reflects the growing importance of early detection, preventive care and greater public awareness of cardio vascular disease, In an exclusive interview with Zanita Careem, Dr. Haniffa speaks about his medical journey and the importance of protecting the heart through greater awareness, early detection and timely care. From understanding risk factors to encouraging people to take charge of their health, before symptoms appear, he offers a timely and valuable perspective on protecting the heart. His association with Durdans Hospital adds another dimension to his career, connecting his expertise with one of o Sri Lanka’s long established private healthcare services, Durdans, founded in 1945, has developed a reputation for medical excellence and innovation.
(Q)What are the most common heart conditions you see today?
(A)The most common problems we see are coronary artery disease, heart attacks, high blood pressure, heart failure and abnormal heart rhythms (beating). We also see a significant number of patients with heart-valve problems.
Globally, cardiovascular disease remains the leading cause of death, with approximately 20.5 million deaths in 2025. The encouraging news is that a large proportion of cardiovascular disease is preventable.
(Q) Why is heart disease increasing among younger adults?
(A) Young people often feel, “I am young, so nothing can happen to me.” That is a dangerous assumption.
Heart disease is not only a disease of old age anymore. I am seeing many younger people with risk factors, such as diabetes, high cholesterol, high blood pressure, and obesity.
Further, our lifestyle has changed dramatically. We are sitting more, moving less, eating more processed and high-calorie food, sleeping poorly and living under considerable stress. Smoking, alcohol, other illicit drugs also remain important risks.
Your 20s and 30s are not too early to start looking after their heart. They are exactly the right time.
(Q) What are the biggest risk factors people tend to ignore?
(A) As mentioned, the biggest ones are surprisingly ordinary: Smoking, high blood pressure, diabetes, high cholesterol, obesity, physical inactivity and an unhealthy diet.
The problem is that several of these cause no symptoms at all. They silently damage the blood vessels for many years before a person feels any symptoms.
(Q) How can people tell the difference between a heart attack and heartburn?
(A) Unfortunately, you cannot always tell the difference with certainty, based on symptoms alone.
Heartburn usually produces a burning sensation in the upper abdomen and or behind the breastbone, often related to meals or lying down. But a heart attack can also feel like burning, indigestion, heaviness or discomfort in the chest.
A heart attack may cause pressure, squeezing or discomfort in the centre of the chest, sometimes spreading to the arm, shoulder, back, neck or jaw. Breathlessness, sweating, nausea, dizziness or unusual weakness may also occur. The symptoms might be very subtle in elderly, diabetics and women.
My advice is simple: if you are unsure, do not assume it is gas.
It is far better to go to hospital and discover that it was heartburn than to stay at home thinking it was heartburn when it was actually a heart attack.
(Q) What are the early warning signs that should not be ignored?
(A) Never ignore new or unexplained chest discomfort, especially if it occurs with exertion or is associated with breathlessness, sweating, nausea, dizziness or pain spreading to the arm, back, neck or jaw.
Also pay attention to symptoms such as unusual breathlessness, unexplained reduction in exercise capacity, fainting, persistent palpitations or swelling of the legs.
Women, in particular, may sometimes have less typical symptoms, including unusual tiredness, nausea, breathlessness, back or jaw discomfort.
One of the biggest mistakes, I see, is people waiting to see whether the symptoms will disappear.
When it comes to a heart attack, time is heart muscle. The earlier treatment begins, the better the chance of saving heart muscle and saving a life.
(Q) What are the three most important habits for maintaining a healthy heart?
(A) If I had to reduce it to three things, I would say:
Move regularly. Eat sensibly. Don’t smoke.
And I would add a fourth: know your numbers—your blood pressure, blood sugar, cholesterol and Body Mass Index (BMI).
You don’t have to become a professional athlete or follow an impossibly strict diet. Small, consistent changes made over many years are much more powerful than occasional bursts of healthy living.
(Q) How much exercise is enough to maintain a healthy heart?
(A) For most adults, a good target is at least 150 minutes of moderate-intensity activity a week, such as brisk walking, or 75 minutes of vigorous activity. Ideally, add muscle-strengthening exercise at least twice a week.
That sounds like a lot, but it is only about 30 minutes on five days a week.
And please don’t think that exercise only counts if you go to a gym. Brisk walking, cycling, swimming, dancing, gardening and active household work all count.
If you currently do very little, don’t wait until you can do 30 minutes. Start with 10 minutes. Then build up. Some movement is better than none.
(Q) What role does diet play in preventing cardiovascular disease?
(A) Diet plays a huge role—but a heart-healthy diet does not have to be expensive or complicated.
Eat more vegetables, fruits, pulses, whole grains, nuts and fish, and reduce highly processed foods, sugary drinks, excess sugar, saturated fats and trans fats.
For Sri Lankans, I would emphasise one particular issue: salt. We traditionally use a lot of salt in cooking and may also consume considerable amounts through processed and packaged foods. WHO recommends keeping salt intake below five grams a day—roughly one teaspoon in total from all sources.
We don’t need to abandon our traditional food. We need to make our traditional food healthier—less salt, less oil, less sugar, more vegetables, more pulses and sensible portions.
(Q)How have advances in cardiology improved patient outcomes?
(A) The changes have been remarkable.
Today, we can diagnose heart disease much earlier and treat many conditions that were previously extremely difficult to manage.
For heart attacks, modern angioplasty and stenting can rapidly restore blood flow. Better imaging allows us to see the coronary arteries and heart structures in much greater detail. We have sophisticated treatments for heart failure, modern devices for abnormal rhythms and minimally invasive procedures for certain valve diseases.
Even in heart failure, the treatment landscape has changed enormously, with newer medicines.
The exciting part is that cardiology is moving increasingly toward earlier diagnosis, personalised treatment and less invasive procedures.
But I always tell my patients: the best heart attack is the one we prevent. Technology can save lives, but prevention is still more powerful than any procedure.
(Q) When is angioplasty recommended instead of open-heart surgery?
(A) Angioplasty—usually called PCI—is an excellent treatment for many patients, particularly during an acute heart attack, when reopening a blocked artery quickly can be lifesaving.
But angioplasty is not automatically better than bypass surgery.
The decision depends on the number and location of blocked arteries, the complexity of the disease, diabetes, heart function, age, other medical conditions and the patient’s overall situation.
Recent evidence continues to support making this decision individually rather than taking a “one treatment fits everyone” approach.
The important thing is that the decision should be made by the heart team and the patient together, based on the best available evidence.
(Q) What are the biggest misconceptions people have about heart disease?
(A) There are many.
“Heart disease happens only to old people.”
Not true.
“If I feel healthy, my heart must be healthy.”
Not necessarily. High blood pressure and high cholesterol can remain silent for years.
“I don’t smoke, so I don’t have to worry.”
Not true. Smoking is one risk factor among many.
“Heart disease is mainly a man’s disease.”
Definitely not. Women can develop serious heart disease, and their symptoms may sometimes be overlooked.
“If I have a heart problem, I should avoid exercise.”
Many heart patients actually benefit greatly from appropriate physical activity and cardiac rehabilitation, under medical guidance.
“I’ll see a doctor if it gets worse.”
For a heart attack, waiting can cost precious heart muscle and the life.
(Q) Is there a patient story that changed your perspective as a doctor?
(A) I think every cardiologist has patients who stay with them long after they leave the hospital.
“One patient I will never forget was a 31-year-old young father who came to the emergency department around midnight with severe chest pain, accompanied by his 26-year-old wife and their six-month-old baby.
His ECG showed a major heart attack. We immediately took him for angioplasty and successfully opened a completely blocked coronary artery.
The next morning, I saw him smiling in the ICU bed. Three days later, he walked out of the hospital completely well.
That experience reminded me that behind every blocked artery is a person, a family, and an entire life that can change within minutes. It reinforced why, as doctors, we must act decisively and quickly—but never lose sight of the human story behind the disease.
What changes us as doctors is not simply seeing a heart attack—it is seeing what that heart means to a family.
I have seen patients who arrived frightened and critically ill, and then, after treatment, return months later with their families, smiling and grateful simply to be alive.
Those moments remind me that we are not treating an ECG, an angiogram or an echocardiogram. We are treating a person—a parent, a husband, a wife, a son or a daughter.
Medicine has technology, machines and procedures, but ultimately it is about giving someone more time with the people they love.
(Q) What message would you like to share with Sri Lankans about preventing a heart attack?
(A) My message is very simple:
Please don’t wait for your heart to give you a warning before you start taking care of it.
Know your blood pressure. Know your cholesterol. Check your blood sugar. Don’t smoke. Keep your weight under control. Walk every day. Eat less salt and processed food. Eat more vegetables, fruit and pulses. Sleep properly. And if you have been prescribed medication for blood pressure, diabetes or cholesterol, take it regularly rather than stopping when you feel better.
And if you develop symptoms suggestive of a heart attack, don’t wait at home and don’t try to diagnose yourself. Seek emergency medical care immediately.
We cannot choose our genes, gender or our age. But we can choose many of the things we do every day.
(Q) What inspired you to specialise in cardiology?
(A) What attracted me to cardiology was the combination of science, technology, urgency and, most importantly, the opportunity to make an immediate difference in someone’s life.
There are very few areas of medicine where you can see a patient arrive critically ill and, within a short period of time, use modern medicine to restore blood flow, correct a dangerous rhythm or stabilise a failing heart.
But over the years, what has kept me passionate about cardiology is not simply the technology.
It is the people.
Every patient reminds you that behind every heartbeat there is a life, a family and a story.
(Q) What has been the most rewarding part of your career?
(A) Without question, seeing patients return to their normal lives.
A successful procedure is satisfying, but seeing a patient come back months or years later and say, “Doctor, I am working again, I am walking again, I am watching my grandchildren grow up”—that is the real reward.
As doctors, we sometimes focus on numbers: the ECG, the blood pressure, the cholesterol level, the ejection fraction, the angiogram.
But ultimately, the greatest outcome is not a perfect test result. It is a person getting back to living their life.
That is why I believe cardiology is not only about treating heart disease. It is about protecting the life that depends on that heart.
In summary:
“I would like people to remember one thing: your heart does not suddenly become unhealthy on the day you have a heart attack. The process often begins many years earlier, silently. That means we have a tremendous opportunity to prevent it.
Please don’t wait for symptoms. Know your numbers, move your body, eat sensibly, don’t smoke, and seek help early when something doesn’t feel right.
We cannot prevent every heart problem, but we can prevent many heart attacks and strokes. And sometimes a small decision made today—going for a walk, checking your blood pressure, stopping smoking, reducing salt, or seeing your doctor—can give you many more years with the people you love.”
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