Connect with us

Features

Giving ‘wrong’ medical advice?

Published

on

by Dr Upul Wijayawardhana

“Have I given wrong medical advice?” From the time I read the interesting and heart-rending account ‘My 18 week ordeal of double trouble’ by my friend Dr Lakshman Abeyagunawardene (Sunday Island, 25 October) I have been pondering over this question. Poor Lucky has had a double whammy, on top of the lockdown, due to Shingles on his face (Herpes zoster) followed by heart block necessitating a pacemaker implantation. He suffered first due to severe neuralgic pain following Shingles, which is well-known to be one of the most severe and intractable pains, and due to the limitations imposed following the pacemaker implantation. My thoughts were provoked by the following comments:

“I had to go through the procedure of pacemaker implantation while the pain in my right eye persisted. It was after my fainting episode and pacemaker implantation was recommended that I was debarred from climbing stairs. I was confined to the guest room and this is where my agony really started. My wife did not allow me to even go to the living room which was just three steps below. Towards the latter stages, I watched news on the small TV in the kitchen. I had to be satisfied with the laptop computer that my son brought. But it was a far cry from the desktop I was used to. I missed my weekly shot of an alcoholic drink! I had not taken even a beer since the beginning of June.

I think I had a turnaround in my fortunes after the doctor did the Programming on September 27. It was this doctor’s advice that I strictly followed (more so my wife and son) because there was nothing more the Neurologist who was treating my neuralgic pain could do.”

What perplexed me was the advice given not to climb stairs which made my friend’s life miserable. I had never given this advice though I implanted many permanent pacemakers in Sri Lanka as well as in UK. In fact, I can claim credit for starting the permanent pacing programme in Sri Lanka, way back in late seventies, when pacing was in infancy. In spite of the very ‘primitive’ devices I used at the beginning, I did not impose this restriction.

A permanent pacemaker is needed when there is a failure in the electrical conduction system built in the heart to ensure an appropriate heart rate response to bodily needs as well as to coordinate contractions of the four chambers of the heart. The permanent pacing system has two major components. First, there is a ‘box’ with the electronics and a battery. Due to the huge advances in electronics ‘the brain’ of the pacemaker is tiny, the size of the pacemaker depending on the size of the battery. The second component, the leads (electrodes) deliver a tiny current generated in the ‘box’ to the right side of the heart after sensing whether the heart’s own electrical system is functioning properly or not. Invariably, two leads are used, one to the small ‘collecting’ chamber; the atrium and the second to the large muscular chamber; the ventricle. The procedure of implantation is done under strict aseptic conditions. First, the vein underneath one of the collarbones is punctured and the lead is advanced to the heart under x-ray guidance. Once a satisfactory position is found the lead is fixed and connected to the box, which is then implanted in a pocket under the skin.

When I started implantations, batteries lasted only two to five years but today most pacemakers have much smaller batteries lasting more than 10 years, due to improved battery technology. The electronics in the box then was very simple, just discharging a current when it did not sense innate activity but the electronics today is so sophisticated that the pacemaker is able to record and store heart beats continuously. Stored data can be retrieved by interrogating the pacemaker using an externally held device which is also used to programme, to tailor the pacemaker for the needs of each person. Not only the electronic circuitry and batteries but also leads have improved very significantly, becoming slimmer and having fixation devices at the end to make sure the lead tip does not displace. My nightmare, at the beginning, was lead displacement, as there were no fixation devices. This resulted in not infrequent reopening and adjustment, a tedious process.

In spite of refinements lead displacement still occurs, though very rarely, and it is to reduce this that some limitations are imposed. However, I could not find advising against going upstairs in guidelines issued by any renowned Cardiology institution. Patients are advised not to lift the arm of the implant side above shoulder level for four to six weeks. It may well be this recommendation that had been misinterpreted or miscommunicated.

Notwithstanding allegations of overdoing procedures for gain in the private sector, some of which are true unfortunately, I am well aware that the standards of practice of cardiology are very high in Sri Lanka. As a ‘veteran’ who contributed to the establishment of the speciality of cardiology on a firm foundation I can look back with a sense of satisfaction. Therefore, these comments are not meant, in any way, to be critical of the Electro-Physiologist who implanted the pacemaker but to highlight the importance of communication in medicine; an art we had to master on our own. I do not know whether things have changed since and Medical Schools are teaching how to communicate.

Am I guilty of having given wrong advice to patients? Yes, but in my defence, it was mostly ‘authenticated’ wrong advice. What do I mean by that? We give medical advice on the basis of existing medical knowledge which on hindsight may prove wrong. Concepts change with advancing knowledge; accordingly, we change management as well as advice. When I was a young doctor, we advised patients with heart attacks to have strict bed rest for six weeks. It transpired later that it did more harm than good. With new evidence we changed and treatment revolutionised. Now, a patient with a heart attack has an angiogram straight away and the ‘culprit’ vessel is dilated with a stent. Patient is out of bed the next day! I can go on giving many examples. Medicine keeps changing, like any other science. That is the difference from religion where belief is the foundation, not exploration and experiment.

When I was in active practice, I found it difficult to keep pace with advances in my speciality till the world wide web came into being. Since then updating knowledge has become so easy. Before that, I may have given wrong advice without realising that knowledge has passed me by. At least, we know our limitations but wonder whether those who practice static systems of medicine protected for political and historical reasons realise that they are giving outdated advice. We need to be in touch with new developments and revise our advice accordingly. Admittedly, it is no easy task but one that should be done, as misguided advice can make life intolerable for patients, as Lucky’s story clearly illustrates.



Continue Reading
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

Features

Issues in ‘terror’ refusing to go away

Published

on

It’s the biggest single loss of life from terrorism in Moscow since Chechen separatists took hostages in 2002 at the Nord-Ost theatre, where at least 170 people, including the dozens of attackers, died during a botched rescue mission.

The hearts of sensitive people the world over are bound to be with the Russian people in this their hour of profound grief. Those 140 or more men, women and children who were brutally killed, besides others who were seriously wounded, at a concert hall in a Moscow suburb recently by rampaging gunmen, were part of the peace-loving ‘silent majority’ of Russia. Their agony is bound to make all righteous hearts bleed for them in empathy.

The mindless act of terror will stand condemned by all right-thinking people and it would be correct for civilian publics and governments the world over to increasingly and unanimously decry the maniacal burst of brute force and stand in solidarity with the Russian people.

This is a time of formidable challenge for the Putin regime. The domestic and international issues growing out of the tragedy are numerous and wide-ranging and the impartial analyst would be right in taking up the position that ‘course correction’ by the regime is needed in a number of areas. To begin with, the question needs to be asked whether President Putin did right by stating unreservedly that ‘radical Islamists’ were behind the attack.

It could very well have been that the attackers were driven by some sort of fanatical religious zeal but considering the harm it could do to the religious susceptibilities of peace-loving followers of Islam, the term ‘Islamists’ could best have been avoided by the Russian President. Former US President Donald Trump resorted to phrases, such as, ‘Islamist terrorists’ quite often and the practice, as could be seen, did not do the world any good.

The likes of the Russian President ought to know by now that indiscreet and controversial labelling of people has the effect of alienating them and eventually radicalizing them against governments and polities.

However, what the world needs now is reconciliation and bridge-building among communities. Putin’s words could result in Muslims further distancing themselves from the wider Russian public. The consequences of such distancing could be distressing for the Russian people.

Such labelling could also have grave implications on the foreign policy front for the Putin regime. If the ISIS was indeed the mastermind behind the concert hall carnage, Putin’s pronouncement could only further antagonize ISIS and other such outfits that have been waging wars of attrition against the Russian state in the Middle Eastern theatre in particular.

If some intelligence agencies are apprehensive about more terror attacks inside Russia they could very well be correct because the Putin regime, even at this juncture, is not perceiving the advisability of following a reconciliatory course in its foreign relations. The Putin regime is obliged to halt in its tracks and take cognizance of the possible fallout on the Russian people of its policy indiscretions.

Interestingly, intelligence failures are currently occurring in what seem to be the most security conscious states of the world. There was the case of Israel in October last year and now Russia. If the Russian state thinks that rule in perpetuity by President Putin could bring it enduring stability, the recent bloodbath has proved it wrong.

Apparently, national security could not be the sole key to good governance. While national security is indispensable for effective governance, good governance is also a coming together of a number of major elements, such as, redistributive justice and cordial coexistence among communities and religions. A policy of attaching priority to national security could enable repressive governments to remain in power for some time but it would not help the people concerned much.

On the question of intelligence failures, the Putin administration seems to have attached too great an importance to ‘national pride’ and not taken into consideration intelligence information coming from the US. Going by current reports, the Russian security establishment had been warned of an impending ISIS terror attack by its counterparts in the US but had failed to act on the warning. If this is true, the security of the Russian people has not weighed heavily with the Putin regime. Well-wishers of the Russian people are likely regret such neglect on the part of the regime.

Given the complexities of the issue of ‘terror’, there is unlikely to be an international consensus on its definition and on ways of resolving it any time soon but states could cooperate for the time being on managing the conundrum effectively. Accordingly, Russia could cooperate on this basis with the US and vice versa, for example. Information-sharing should not be fought shy of, besides other ways of cooperation.

Right now, the world has no choice but to collaborate on managing ‘terror’ until long term solutions are found to it. What needs to weigh on governments’ minds is the fact that ordinary publics pay a prohibitive price for their blunders in handling ‘terror’.

This is a crucial point that the political and security establishments in small Sri Lanka as well need to keep in mind, particularly in relation to the Easter Sunday bombings. In the latter case, governmental blundering and negligence of duty at the highest levels of the state brought catastrophic consequences for the people. To make matters worse, the wrong-doers in this crisis are yet to be brought to justice.

With the allegation that Ukraine had collaborated with the perpetrators of the concert hall carnage, President Putin seems to be in an attempt to deflect accountability for the blood-letting from his regime to an external quarter. This allegation, though, remains to be proved. Moreover, the fact remains that a massive intelligence failure on the part of the security agencies of the state brought about the devastation.

These attempts to point to an external source for the current tribulations of the government should also be seen as part of the Putin regime’s strategy to remain powerful at home. The strategy has been tried out time and again by repressive governments that are apprehensive about their power ebbing away from them in the wake of internal crises. The ploy enables political strongmen to resoundingly rally the people behind them, while giving the impression that they are remaining strong and in total control of the state.

If civilized norms are to be given a chance to prosper in international relations, democratic development needs to be prioritized by governments and the world community under the leadership of the UN. ‘Terror’ has its roots in mainly socio- economic deprivations and the world has no choice but to strive towards ending them.

Repressive rule, however, is no guarantor of social and economic equity and it is only democratic dispensations that aim at socio-economic equity or democratic development that could bring about this state of affairs to at least a degree.

Continue Reading

Features

Kate, the brave!

Published

on

Kate and William

By Dr Upul Wijayawardhana

BBC viewers were in for a great surprise when the main news bulletin at 6 pm on Friday 22nd went straight to a video of Kate, Princess of Wales, without the customary mention of news headlines. Dressed in a long-sleeved white top with narrow black bands across and light blue jeans, seated on a bench in the +-Windsor Castle with spring blooms in the background, what she told whilst nervously moving her fingers and faltering voice at times, shocked the nation. Many an eye would have been wet by the time she finished her two-minute statement wherein she explained that following the planned surgery she had in mid-January, a cancer had been detected unexpectedly and she is in the early stages of having preventive chemotherapy. She added:

“This of course came as a huge shock, and William and I have been doing everything we can to process and manage this privately for the sake of our young family. As you can imagine, this has taken time. It has taken me time to recover from major surgery in order to start my treatment. But, most importantly, it has taken us time to explain everything to George, Charlotte and Louis in a way that is appropriate for them, and to reassure them that I am going to be ok. As I have said to them; I am well and getting stronger every day by focusing on the things that will help me heal; in my mind, body and spirits.”

It would have taken enormous courage to declare to the whole world that she is being treated for cancer at the age of 42 but it would have been even more difficult for Kate to explain to their three young children aged 10, 8 and 5 years that she is afflicted by a disease that usually affects much older people. The public announcement coincided with the start of the Easter break in schools, which may have been done purposely to protect the three young royals. There was a tremendous outpouring of public sympathy not only because of her predicament but also for the graceful manner in which she delivered her message. Many thoughts that her staff may have written the message but it transpired later that she had written the message herself and the recording had been done in one-go by BBC studios.

She won the hearts of many families affected with cancer as she ended her message with the following: “At this time, I am also thinking of all those whose lives have been affected by cancer. For everyone facing this disease, in whatever form, please do not lose faith or hope. You are not alone. “

At the time of a great personal tragedy, thinking of others similarly affected showed the great humane qualities of the Princess and it becomes even more significant considering the horrible period she went through.

On 17 January, it was announced that the Princess of Wales had undergone planned abdominal surgery for an undisclosed medical condition that was not cancer, at The London Clinic and that she had postponed all of her public engagements and duties until after Easter. Around the same time, King Charles was admitted to the same hospital for planned prostatic surgery and it was later announced that an unrelated cancer had been detected during the procedure. As the King was to have a course of treatment for this, he too was forced to withdraw from public duties but he continued to conduct the affairs of state including the weekly meetings with the prime minister. The absence of two of the most senior royals from public duties piled the pressures on Queen Camilla and Prince William.

On 27 February, a thanksgiving memorial service was held for King Constantine II of Greece, the last monarch of the country and godfather to Prince William, at St. George’s Chapel at Windsor Castle where Prince William was due to give a reading but he withdrew at the last moment citing ‘an urgent family matter’. Rumour mills went to overdrive to explain all these and conspiracy theories abounded. In addition to extensive media attention, social media were full of inuendoes.

To calm the waters, a photograph taken by Prince William showing Princess of Wales embraced by her three children was released on Mother’s Day, 10 March, but it was a disaster, mostly due to an overreaction on the part of news agencies. As the photograph seem to have been edited, they issued a ‘kill’ notice in spite of many commentators pointing out that almost all royal photographs released since the time of Queen Victoria have been edited! Wonder whether there was a secret hand behind this action!

To her credit, Princess of Wales, who is a keen photographer issued an immediate apology admitting that she, like many amateur photographers, “occasionally experiments with editing”. But it was not enough to stem the tide in the sewer of social media and Kate had no choice but to come out with the statement which, hopefully, would make conspiracy theorists leave her in peace for recovery from a major unexpected illness.

Associate editor Camilla Tominey’s comment in the front page of The Daily Telegraph of 23 March on this is hard to better:

“We already knew that social media was a sewer, occupied by faceless rats intent on infecting others with their disease of hatred. But their cruel treatment of Kate since it was announced she was undergoing abdominal surgery in January has been sickening beyond belief. From the peddling of hurtful conspiracy theories to the propagation of unsubstantiated lies, the keyboard warriors have inflicted an unnecessary amount of suffering on a woman now undergoing chemotherapy after a major operation. Shame on them.”

Whilst Kate received numerous messages of support from ordinary folk as well as world leaders, perhaps the best being from President Macron, the message from her estranged brother-in-law and his American wife is most intriguing: “We wish health and healing for Kate and family, and hope they are able to do so privately and in peace.”

In addition to increased awareness of prostatic problems and cancer due to King Charle’s illness, Kate’s diagnosis has raised the issue of cancer in the young. Many experts are expressing the opinion that cancers in the young are on the rise and this may be due to environmental factors. I am sure, when she returns to active duties, Kate would actively support further research in to this issue, in addition to continuing her many charities.

Our hearts go out to you Kate and we wish you a rapid and complete recovery!

Continue Reading

Features

Mother…her pillar of strength

Published

on

Chit-Chat

Minanga Abeyesundere

Over the past few weeks, I’ve had readers inquiring whether it’s possible for me to do a little Chit-Chat scene with the spotlight on some of our models as that would also make interesting reading, they say.

Well, why not…and this week I’m doing just that, with more to follow.

01. Tell me something about yourself:

My name is Minanga. I’m 20 years old. My close friends and family call me Mini. I have completed my degree in Visual communication and currently focusing on my modelling career. I’m the youngest in my family. I am a person who sets certain goals for myself and will definitely try my very best to achieve them the right way. I generally don’t give any thought to people’s negative words and opinions. I love to travel with my family and cherish my time spent with them.

02. What made you decide to be a model?

I have always liked to do modelling for as long as I can remember. Then, as I grew older and taller, than most people my age, my friends and relatives kept telling me to go into modelling. This made my desire stronger to pursue this field. I decided to first start my studies and then, subsequently, start my modelling career. I must state that it was Brian Kerkoven who saw my potential and gave me a chance to show my talents and capabilities. My first runway show was modelling one of Brian’s designs. I will always be thankful to my mentor and agent, who has taught me everything I know about this field. He is always willing to give his feedback whenever I ask him.

03. What do you think sets you apart from other models?

I would say I give my 100% to every show and photo shoot and am always willing to learn from my senior models. I can adapt to different styles and looks, whether it’s high fashion, casual, or even themed shoots.

04. What clothing do you prefer to model?

As a model, one cannot really have a preference, but I prefer not to model very revealing clothing. That is my personal preference.

05. What do you think is the most important aspect of modelling?

I believe that as a model, you must always remember to model every outfit to do full justice to the hard work that has gone into making it by the designer and their team.

06. If you could change one thing about yourself, what would it be?

Minanga: Currently focusing on her
modelling career

I don’t really want to change anything about myself. I am very happy with myself. My flaws, despite their imperfections, are what make me who I am.

07. School?

Holy Family Convent, Bambalapitiya. I was in the basketball ball team for a short period.

08. Happiest moment?

There have been so many wonderful moments in my life that it’s hard to choose just one! But if I had to pick, I would say one of my happiest moments was when I achieved a personal goal that I had been working towards for a long time. It was such a fulfilling feeling to see all my hard work pay off, and to know that I had accomplished something meaningful to me.

09.What is your idea of perfect happiness?

My idea of perfect happiness is doing what I’m passionate about and living in the present moment because, if you really think about it, that’s all we have. It’s always only that present moment. It’s all about being happy in that moment and making the best of it.

10. Your ideal guy?

A person who is confident enough in himself to give me the freedom to follow my dreams and goals.

11. Which living person do you most admire?

The person I admire the most is none other than my mother. She has always been my biggest motivator, supporter, and pillar of strength. She has always supported me in following my dreams and never discouraged me from pursuing my interests, providing me with invaluable advice whenever needed. My mother has such a significant influence on every aspect of my life. She has been there for me through thick and thin, guiding me and teaching me valuable life lessons. I will always be grateful for her presence.

12. Which is your most treasured possession?

My most treasured possession, up until now, is an emerald ring I got from my mum, which she had from her childhood. As we are both May born, we share the same birthstone.

13. If you were marooned on a desert island, who would you like as your companion?

I would love to have my brother and sister as my companions. They’re always there for me, and we have so much fun together. We could keep each other company, come up with creative ways to survive, and keep each other’s spirits up.

14. Your most embarrassing moment?

It’s a secret for me to know and you to find out.

15. Done anything daring?

Not anything as of now but there are some on my list, like sky diving, travelling overseas alone which I would love to do.

16. Your ideal vacation?

Spending a weekend at Kandalama Hotel. I love the vibe there. I also love the architecture of the hotel and how it blends into the jungle around it. It’s so calming and peaceful.

17. What kind of music are you into?

I like pop music and even music from the ’80s.

18. Favourite radio station:

I don’t really listen to the radio. If I do, it’s in the car with my family, and we listen to Gold FM. I would say I am an old soul when it comes to music.

19. Favourite TV station:

I’m also not a person who watches TV. I watch Netflix movies, and movies at the cinema. I love watching movies with my mum. She is my movie buddy.

20. Any major plans for the future?

Yes, first, I want to be a supermodel, here in Sri Lanka, then model internationally and bring pride to my country. I also want to start up my own business in Merchandising.

Continue Reading

Trending