email forwarded by Asoka Tinto nee Athulathmudali
FYI. I personally know Prof Channa--he was
a final year student when I did my internship in Kandy and he was a great
support--his colleagues students and his good karma have helped him. May
he have a long and healthy life.
PS
I recall Channa presenting the concept of early repair of carotid artery plaques to prevent cerebral strokes, at a clinical presentation in Kandy GH, when I was Consultant Surgeon there and Channa was in the Medical Faculty of the University of Peradeniya, already building a name for himself in the field of vascular surgery. This was somewhere in the late 1980s. It was received with much incredulity by the Consultant Physicians in the audience. This was in an era when one flew to the UK to get a coronary by-pass done. We in Sri Lanka have come a long way since then, thanks to the pioneering effort by people of Channa's caliber. We and Sri Lanka as a nation, have to be grateful to him for his pioneering work in vascular surgery.
Philip G Veerasingam
My story
Prof. Channa Ratnatunga recounting his
remarkable recovery from a potentially deadly stroke, calls for life-saving
stroke units to be set up in hospitals around the country
View(s):
I was a perfectly healthy
individual who had only a mild elevation of blood pressure, kept under control
with medication. I did not smoke and always had normal cholesterol levels and
blood sugar. A very active seventy two to boot.
Prof.
Ratnatunga addressing the gathering as Guest of Honour at the induction of the
new president of the College of Surgeons of Sri Lanka in January 2015
In March of 2015, I had a
stroke. It was a ‘Basilar stroke’, the worst kind. When afflicted by this kind
of stroke, one usually died 80-90% of the time if no active treatment was done.
As you can see I survived
and am writing this, eight months into rehabilitation. I am walking around the
house now and am able to function almost independently. The progress has been
steady though slow.
I am confident that I will
be able to reach a normal level of functionality within the next few months.
The journey from March up to now has been challenging to say the least, for all
concerned.
I feel that my story will
help many out there who are afflicted by, or are caring for someone suffering
from a stroke, as well as open the eyes of those who are yet to face this
challenge, on the treatment options that are now available.
I also hope to motivate the
powers that be to invest in the technology that helped save my life, so that it
may be made available to all.
I write my story with the
hope that it will inform all who suddenly have to make decisions as to what to
do when a near and dear one is afflicted with a stroke.
I am a doctor working in
Kandy and was in hospital at the time going about my usual routine, when I
suddenly felt dizzy. I had a sense that something was amiss and a little more
out of the ordinary than just feeling under the weather.
Having sat down, I soon found
myself collapsing and unable to speak or swallow. And so it began at about5
p.m. that Saturday at
the end of March 2015.
A large blood clot had
wedged itself in a major artery (Basilar artery) that supplied the lower part
of my brain, – the brain stem. My saving grace was that this event happened at
a hospital, where my colleagues Dr. Vasanthi Pinto and Professor Indika Bandara
Gawarammana among many others were on hand to assess, diagnose and respond
within minutes.
Thanks to the tireless
efforts of Dr. Manoji Pathirage, Dr. Indunil Wijeweera, and many other doctors,
I was rapidly administered medication to dissolve the clot in my brain that had
made me by this time paralysed.
With hours ticking by,
there was no improvement. I had been made unconscious to minimize the damage to
my brain. I was in the ICU overnight at the Teaching Hospital Kandy.
The following morning CT
scans were done to assess whether the medication given to dissolve the clot had
done its job. However it was not to be and things were looking ominous.
My colleagues in Peradeniya
and Kandy hospitals, many of them my students, too many to mention
individually, rallied around me, and did everything possible in Kandy. I am
ever thankful to them.
After much deliberation, my
colleagues, along with my family decided to move me to a private hospital in
Colombo, which had a team of skilled doctors able to perform a procedure which
would extract the clot from the artery in my brain.
This procedure is
relatively new to Sri Lanka though practised in some technologically advanced
centres abroad.
I, who was unconscious and
on a ventilator in the Neurosurgical ICU at the Kandy Teaching Hospital at the
time, was to be airlifted by helicopter courtesy of Sri Lanka Air Force,
arranged by my colleagues, to whom I am eternally grateful. Time was of the
essence. Already twenty hours had elapsed.
I was airlifted under the
expert care of Dr. Udaya Karunaratne who ensured that I was kept alive during
the transfer.
I was pleased to learn from
my son (who accompanied me), himself a doctor at the National Hospital of Sri
Lanka (NHSL), that the skilled Air Force pilots flew low over the hills, in
order to prevent any drop in atmospheric pressure which could have been lethal
to me. It took only thirty minutes flying time to arrive in Colombo.
I was picked up at the
airfield by a waiting ambulance, and whisked off to the Central Hospital on
Norris Canal Road. A highly skilled team consisting of two Interventional
Radiologists: Dr. Nihal Wijewardena, Dr. Lakmalie Paranahewa and a Stroke
Physician Dr. Thurul Attygalle immediately took me up for the procedure.
Because I had arrived some
20 hours after the event which was well outside the recommended interval for
performing this procedure, they hesitated at first, but eventually decided to
take on the challenge.
I am glad that my
colleagues decided to do so, intervention giving me the best chance of a
recovery, by removing the clot.
Within minutes, I gather,
they had inserted a catheter through my femoral artery in the upper thigh and
had reached the basilar artery in the brain and taken the clot out.
The skill required to
navigate to and reach the Basilar artery in the brain from my thigh, in the
first attempt, for those who know the perambulations of the human arterial
tree, beggars description.
We in this country know
little of what human treasures we have, who go about their normal work without
much ado, unheard, unsung. I am personally ever grateful to them.
I regained consciousness
next morning. It was a Monday. I could
feel my whole body, my mind was normal, but all four limbs were paralysed. I
could move only my eyelids.
“It’s called the locked in
syndrome”. However my children devised a method of getting me to communicate by
blinking on a written alphabet they held up. I was in touch at least with the
world outside!
As I was at risk of
inhaling my own saliva and whatever liquids I drank, Dr. Attygalle, in
consultation with the NHSL Neurologist Dr. Padma Guneratne, recommended that I
have a tracheostomy (a tube through my neck, to the airway so protecting it)
and a tube inserted into my stomach (percutaneous endoscopic gastostomy-PEG for
feeding) which were expertly done by Dr. R. P. Dayasena and A. Somaratne
respectively.
They were safely done by
them despite me being on a blood thinning drug which won’t allow the blood to
clot.
To cut a long story short, I was transferred after one week at the Central
Hospital ICU.
I was fortunate to be
offered care in the Neuro-trauma ICU II at the National Hospital of Sri Lanka.
(NHSL), after a confirmatory MRI and MRA which showed up a significant area of
infarction in my brain stem.
I was under the expert care
of Neurologist Dr. Padma Guneratne and Neurosurgeon Dr. Saman Wadenambi (both
happened to be my students), and the Consultant Anaesthetist, Dr. Shirani
Happuarachchi leading a team of intensive care doctors and nurses.
Arrow
showing the region of the brain where the Basilar artery is located
They offered me a level of
medical care I would be hard pressed to find anywhere in the world. I was
looked after royally by the nurses and the minor staff under Sister Wijeyanthi
who was the Sister in-charge of the ICU.
The quality of care I
received at this unit was par excellence. Having spent 40 years in the
government health sector myself as a doctor, I suddenly realized how hard the
ICU nurses worked under difficult conditions and hours, and the sacrifices and
compromises they had to make in their personal lives, due to their unwavering
commitment to their profession.
The brilliant team of Physiotherapists in the Neuro-trauma unit, under Amal
Gunerathne, were miracle workers.
The team including Mahesh
Herath, Eranga Gunawardane, and Lahiru Laknath, coaxed my completely paralysed
body to walk within four months; a feat almost unheard of in patients
suffering a brain stem stroke.
I had almost complete
paralysis of my hand muscles which made it impossible for me to achieve the
simplest of manual tasks.
I couldn’t even press a
button on a bell or hold a pen, let alone write. Daily occupational therapy
sessions by the dedicated, ever–patient Ms. Lasanthi Siriwardana, occupational
therapist of the Neurology Rehabilitation Unit under Dr Padma Guneratne at the
NHSL helped me progress to a level that I could hold a pen and scribble
illegibly at four months to legible formed writing by seven months.
Initially I could not
speak, swallow nor make any form of facial expression due to the paralysis.
From that state to my current ability to eat and drink normally with full
facial muscle control and near normal speech was due to the hard and patient
work put in by Ms. Prabhani Dineshika, Asanka Weerasinghe and Asanka
Wijerathne, speech therapists of the team at the Speech and Language therapy
unit at NHSL.
After four months of
intensive rehabilitation at NHSL I came home to Kandy where I have been on a
regimented physiotherapy and rehabilitation schedule under the able guidance of
Senaka Divaratne and his team at the Peradeniya Teaching Hospital, where I had
worked for the better part of my life.
I am now close to normalcy
with the tracheostomy, urinary catheter and PEG out, and ambulant without
support, inside the house, though I have made a few sorties outside.
Considering the significant delay wherein there was a relative shortage of
blood supply to my brain stem, I am very lucky to have escaped almost scot
free.
Picture
of an angiogram showing a clot in the Basilar artery. Pic courtesy the Lancet
Having since gone through
the medical literature I was surprised to find that in the current day and
time, it is not only that the stroke could be prevented but it could be
effectively treated with many newer modalities of treatment. Many of these
facilities are not known to most Sri Lankans.
Knowledge on the urgent
need for treatment and the availability of basic and advanced facilities in
major hospitals would avert disability and many deaths that are caused by this
deadly disease, stroke.
Intensive care for stroke
patients, facilities for dissolving the clot by the clot buster within the
first 4.5 hours and removing the clot stuck in bigger blood vessels within
six hours, and multi-disciplinary rehabilitation in stroke units are basic
facilities that should be established in any teaching hospital including in my
own district Kandy.
In the meantime the
facility and the expertise, exists in Colombo, in the hospital that attended to
me. In the event of a stroke, the attending stroke physician decides on the
nature of the stroke, its cause and whether it is amenable to intervention.
Most stroke units in the
western world offer immediate dissolution of the clot and if it fails -which
occurs about fifty percent of the time- would attempt its removal by the
procedure that I underwent.
That is to take it out by
‘interventional radiology’. If the patient arrives at the Stroke centre within
four hours, (some even say eight hours) the result is likely to be
significantly better e.g. “sometimes be able to walk out of the hospital in the
next few days”. That such a facility exists in Sri Lanka, unheard and unsung,
was an eye opener to my family and myself.
I am writing this to make
the public aware of this facility which enables better results from this common
ailment. It is very important to bring your patient to the unit as early as
possible for any form of treatment.
I am aware that to equip an
interventional lab to perform this procedure is rather expensive. But when one
thinks of the cost of rehabilitating a stroke patient and the handicaps he/she
will have afterwards, it is well worth it– certainly well within the national
budget for health.
Now that budgetary
provision has been allocated for stroke units, the Ministry of Health, should
go ahead by first establishing them in the government teaching hospitals.
I would like to
substantiate what I say to the doctors in the readership by asking them to read
the reputed New England Journal of Medicine in January and June of 2015.
I would like to digress a
bit at this stage. In 1975 a close friend of mine, Dr. Gamini Wijesekera (who
unfortunately died in the bomb blast on that tragic day in the port some years
ago) often told me of the trials and tribulations of the Consultant Physician
Dr. Ivor Obeysekera whom he had worked with.
At that time, Dr.
Obeysekera was the appointed Cardiologist to the General Hospital Colombo, and
his dream was to establish a Cardiology Unit in the hospital. The impression he
gave me was that Dr. Obeysekera’s own colleagues with vested interests brought
up several arguments opposing this venture.. eg
“ heart patients belong to
the old non-contributory section of society, so why spend money on them.”.They
had claimed that they had the experience to look after the heart patients in
the general wards.
Like the true pioneer that
he was, Dr. Ivor Obeysekera fought tooth and nail and today we reap the
benefits of a Cardiology Unit on par with those anywhere in world – thanks to
him and the yeoman service rendered by the many distinguished Cardiologists who
followed.
I quote the above anecdote
to indicate how difficult it is to establish a unit in this country. I reiterate,
we are in desperate need of stroke units in every district. They will
definitely save lives and certainly minimise the handicaps that such persons
suffer.
Like the cardiology units
that have since proliferated throughout the country, and have been doing yeoman
service all over this land, Stroke units too are needed to fill the huge void
in the prevention and treatment of this common Non Communicable Disease (NCD)
in Sri Lanka.
Several individuals have
been trying their best to pioneer interventional therapy in Sri Lanka which has
been an up hill struggle so far. They need public support to garner a receptive
ear from the powers that be.
To reiterate, stroke care
has been given stepmotherly treatment by the (public) health sector. There is
now hope with the thrombolytic (clot dissolution) drugs, and this new
procedure, to give a better deal to stroke patients.
I am in debt to all my
colleagues and staff in Peradeniya and Kandy hospitals, Suwasevana Hospital
Kandy, Asiri Central Hospital Colombo, and the National Hospital of Sri Lanka,
for their untiring efforts to support my recovery.
I have to thank all my family members, friends and colleagues who
supported me during my long journey, and my wife and two children, without
whose daily unstinted care and concern, this dramatic recovery, would not have
been motivationally possible.
