You’ve heard about channelling your doctor through the internet or your phone. But what if, you could actually talk to your doctor and get your diagnosis without ever having to visit the hospital?

TeleChanelling allows you to do just that! Gone are the days where you would have to go through the process of channelling and then, physically visiting a doctor. Now, with only a stable internet connection and the eChannelling app, you’ll be able to make your phone do all the work for you!

TeleChanelling is the newest service offered by medical professionals over at eChannelling. With it, you will be able to connect one on one with a doctor through a video call and then the doctor will be able to diagnose you wherever you may be!

All you need to do is:

1. Download the app.
2. Take a look through the list of doctors registered for Video Consultation Services.
3. Select your preferred doctor and make a reservation after paying the service fee.
4. Enter your Name/NIC/Contact number which is mandatory for the reservation.
5. You will receive a confirmation SMS with the consultation time and transaction reference number.
6. Then all you have to do is wait till you receive a video call once the doctor dials you!

And that’s not all, TeleChannelling also includes a chat feature that can be used to communicate with your doctor through text before and after the appointment. This will allow you to share any issues you have much more clearly before the call. And to add to that, you will also be able to upload any prescriptions that you have to the chat.

As the leading software provider for the medical industry in Sri Lanka, eChannelling has expanded its services within the digital world by connecting the doctor and patient directly through this video consultation service. And with it, you will be able to experience the best medical care in Sri Lanka regardless of where you live or if you are traveling.

Overall, Telechannelling is a service that breaks the traditional method of physically meeting a doctor and conducting the entire process from channelling to payment to consultation online. So the next time you need to see a doctor, don’t worry, you’ve already got the best care you could wish for on your own phone!

Breast cancer is one of the most common types of cancer in the world. There are significant numbers of women losing their lives to this. Considering the number of deaths in the world, the 5th place is due to cancer, in particular breast cancer. Taking the context in Sri Lanka, it is very similar to what it is in the rest of the world. Around 12 women a day are reported with breast cancer, and each day 2 women lose their life because of this. Unfortunately, the type of cancer associated with breast cancer is not something that can be prevented.

If so, what can we do about this?

If we are able to diagnose breast cancer, before it shows external signs in the breast, then we are able to cure it completely. Up till the 1980s, the quality of the treatments for breast cancer did not see any significant improvement, which meant as much as there were attempts to advance the cure, there was no way to save their life or heal them fully. However, after that once the treatments were improved in such a way to diagnose breast cancer head on, the rate of curing increased substantially. The biggest role played in this is the introduction of the Mammography Testing. After this, women had the opportunity to identify breast cancer even before they observed or felt any physical signs in their breasts and at the very beginning stages of the cancer. They were able to cure it completely through the standard treatments. From this we can avoid situations of removing whole breasts or going for treatments such as chemotherapy.

Which ages of women should do this Mammography? 

Women over 40 years old should do this testing yearly, or as the recommendation from a doctor here from Sri Lanka, at least once every 2 years. However, Sri Lanka does not have that privilege to do so. 

Then what can we do?

Even though it is not as effective as Mammography, we advise all women to self-diagnose the status of their breasts if they are above the age of 20. They can do so when 7 – 10 days have passed after their monthly period. Here, they should observe their breasts in front of a mirror by themselves, feel for any irregularities in the surface, unusual discharge from the nipple or other signs for   breast cancer, and seek immediate medical attention if needed.

There is the option of clinical diagnosing as well, where a professional would examine the woman’s breast. It is recommended that women in the ages of 20 -39 should get these clinical examinations done at least once every 1 – 3 years, and those above 40 should conduct these at least once a year. This is all relevant to women who have a normal risk of having   breast cancer. 

Nevertheless, there could be women with high chances of having breast cancer because of maybe the history of their mother, sister or a close relative who has undergone breast cancer before. We consider them as people with extremely high odds of having breast cancer, and through a proper assessment of the risk we may prescribe the Mammogram Testing even before 40. It should also be known that we do not recommend Mammography to women under 30 because the sensitivity of the test declines gradually under the age of 40. For them we conduct the Ultrasound scan and an MRI scan for the breasts. If we have a suspicion, then we take a small sample and diagnose accurately if it is a cancerous condition. In an instance that shows it to be true, we quickly check if it has spread in any way to the rest of the body, particularly by the PET-CT scan. This also can only be conducted for a very limited number, because there is only one machine each in the private and governmental sectors.

We go ahead with the CT scan and Bone scan testing to decide on the best treatment for this breast cancer patient based on the outcomes. We recommend surgery if cancer has not spread to distant organs yet. If it is in the early stages, we have the option to remove only the cancer without removing the breast completely – Breast Conservation Surgery. After such a surgery we proceed with radiation therapy for that breast. However, if the cancer is very large compared to the breast, then we will have to opt for removing the breast completely. Regardless, now there are ways to reconstruct the breast through maybe prosthetics or using their own tissue.

After all this, taking into account all the tests conducted and the related reports, we decided that, even though there were no signs that it had spread to the rest of the body, it has the potential to reach the insides microscopically. We would then continue to recommend more treatments. Chemotherapy, Immunotherapy, Targeted therapy for cancer, Hormone treatments and many others are such treatments. There are stories of women who have undergone these treatments and are fortunate to live a long and healthy life as a regular woman. But also we meet women who were unfortunate and who had this cancer spread throughout their body. Through standard methods of nursing, we do have the ability to give these women a long, healthy life. In addition to these standard procedures, there is also a vital type of treatment known as Palliative Care. There is a grave misconception that it is for people who are in their death beds. This Palliative Care should go hand in hand with the disease directed treatments when a cancer is diagnosed. The advantages for people in their very last stages of life, the effect of this care is priceless, and especially for someone who is at a point of incurable cancer, going through it without such comfort care is quite awful. The physical, mental, spiritual and social suffering that they and even their family members go through, could be benefited a lot through this care.

Being educated and aware of breast cancer is important because it could be your mother, sister, grandmother or someone very close to you who could be at risk. If women are attentive towards their breasts and will conduct regular testing to get to know this well ahead, they would be in luck to heal breast cancer fully!!

Dr. Shama Goonatillake
MBBS (Colombo) MD (Colombo) SLMC Reg No. 17334,
Consultant Clinical Oncologist
Head of Clinical Department
Asiri AOI Cancer Centre

Lower back pain is a common medical condition that affects about 80% of the population at some point in their lifetime. Sri Lanka is not immune to back pain and there are as many cases as you would see in the West where it is also a very common medical problem.

The main causes of lower back pain are disc bulges and facet joint arthropathy. The two joints on either side of the vertebrae are known as facet joints.

In addition, muscles that go into spasms and ligaments that join the vertebrae can cause back pain.

There are different ways to treat back pain:

1.  Simple analgesics which is very common.
2. Complementary therapy consists of Physiotherapy, Acupuncture, Hydrotherapy, etc.
3.  Interventional treatment is done by carrying out procedures. Examples of interventional treatment include:
   • Trigger point injections
   • Facet joint injections done under X-ray guidance (fluoroscopy).
   • Spinal root blocks
   • Dorsal root ganglion blocks
   • Epidurals with epidurogram
   • Radio frequency denervation
   • Pulse radio frequency denervation

Epidurals

Can be a Lumbar, Caudal or Cervical Epidural. However, it is important to remember that Epidurals should always be carried out under X-ray while putting a contrast (Epidurogram). If someone would proceed to have an epidural, there should be an MRI-proven disc bulge that is pressing on the nerve roots. 

It is nevertheless crucial to stress the necessity of an MRI scan before administering an epidural and to provide evidence that there is in fact a nerve disruption because of a disc bulge.

In the UK, 5 million days are lost each year due to back pain, which has a serious impact on the economy.

Unfortunately, Sri Lanka lacks adequate referral systems, and patients select their own consultants, which might lead to overlap and at times, the inability to identify patients with back pains.

In England, there is a musculoskeletal pain unit consisting of a team of pain medicine consultants, neurosurgeons, and orthopedic surgeons specializing in spines, and patients are referred to the appropriate consultant by the general practitioner.

In Sri Lanka, patients are not always educated or informed enough to choose the right consultant for their disease. This system needs to change so that patients can make more informed decisions based on their condition.

Dr. Namal Senasinghe
MBBS, FFARCS, Dip in Pain Med, FFPMCA, CCST(UK),
Consultant in Pain Medicine
United Kingdom (GMC – 4498708 in the specialist register)
Sri Lanka (SLMC – 10475 in the specialist register)

Not only do we hear more about cancer today than in the past, but the harm caused by cancer to humans is increasing more and more. However, throughout recorded history, cancer has been recorded not only in humans but also in other animals. Among the earliest evidence of cancer are bone tumors found in ancient fossils, cancer found in mummified human corpses in Egypt, and cancer written in ancient records. Thus, it is clear that cancer is not a new disease.

In the year 2020 alone, 19.3 million new cancer cases were diagnosed worldwide, and the number of people who died from cancer in that year is around 10 million. Breast cancer in women has become one of the most common cancers in the world. Previously, lung cancer was the first, and now it has been pushed to second place in terms of cancer prevalence. After that, colon and rectal cancer, prostate cancer and stomach cancer occur in descending order. However, lung cancer still accounts for the highest cancer deaths worldwide, accounting for 1.8 million in 2020. The next leading causes of cancer deaths were colon and rectal cancer, liver cancer, stomach cancer and breast cancer.

How cancer develops is a big question for many people. Some people think that cancer is caused by a fault in the genes they inherited from their mother and father. It means that they got the cancer-causing genes directly from them. Cancers that occur like this are less than 10%. One reason for people thinking that way is that cancer is a genetic disease. However, about 90% of cancers are caused by changes or mutations in genes that happen after conception.

Many factors contribute to the development of cancer-causing genetic mutations. Most mutations can occur randomly. When the cells of the body divide to make daughter cells, random mistakes can happen in this manner as the DNA is divided and given to the daughter cells. But cells have a very complex system of correcting these mistakes. As you age however, this process weakens. Another cause of genetic mutations that leads to cancer is the exposure of genes to certain factors in the environment outside the body or in the body’s internal environment. Accordingly, about 1/3 of all cancer deaths are caused by some form of tobacco use (cigarettes, use with betel leaves, etc.), obesity, alcohol use, eating fewer fresh fruits and vegetables, and less exercise. About 30% of cancers in the world’s poor countries are caused by cancer-causing viruses, bacteria, fungi and protozoan infections.

There is a chance to avoid cancer. There are two main methods for that. One is to follow good health habits to prevent cancer. Not consuming tobacco and alcohol, maintaining a body weight appropriate for the height, exercising regularly, and eating more fruits and vegetables are some of them. The other method is to prevent the development of cancer by identifying the initial changes in the body when cancer occurs and treating it properly.

In addition, 1/3 of other cancers can be detected and treated properly before they spread. Unfortunately, the last 1/3 of the cancers are not curable. The reason for this is sometimes the form of cancer being dangerous or the difficulty of proper treatment due to factors such as the age of the cancer patient, other medical conditions, etc.

වෛද්‍ය ශාමා ගුණතිලක
MBBS (කොළඹ) MD (කොළඹ) SLMC ලියාපදිංචි අංක 17334,
උපදේශක සායනික ඔන්කොලොජි
සායනික අංශයේ ප්‍රධානී
ආසිරි AOI පිළිකා මධ්‍යස්ථානය

Diabetes – a word with a lot of negativities associated with, where people might be even fed up with hearing. However, let me tell you 3 stories on diabetes that have positive endings. Let us see what we can learn and take from those experiences.

The first patient I would like to talk about is a 28-year-old male who has just found out that he has diabetes. It is widely known that if you have diabetes, or “Sugar” as some refer to, you will have to deal with it your entire life while undergoing many treatments. This patient, frankly, wanted to get rid of diabetes completely or, rather, not have to take medicine for diabetes the rest of his life. Reaching a point where you do not need to drink medicine for diabetes is what we call “remission of diabetes”. He wanted to live without having to drink medicine for years, so we came up with a plan for that. Research shows that there are ways and methods to get rid of diabetes, even though they are not suitable for everyone, but some can benefit from remission. Especially people who are in the early stages of the disease have the potential to go for a diabetes remission plan.

First, we focused on weight loss; second, lifestyle changes such as exercise and food consumption; and lastly, we monitored how the blood sugar levels were responding. This is the plan we came up with, and we started working on it. For example, to reduce weight, he needed a change in his food, and I created a meal plan suitable for that based on what he liked. Everyone needs exercise, so we tried to incorporate a few exercises to his way of life, and he gradually got into the habit of exercising 1 hour a day through activities like walking, etc. To lose weight, we started using medicine for weight loss as well. In particular, Empagliflozin, an SGLT2 inhibitor, and Victoza injection a GLP receptor blocker were both used.

With all these, he was able to achieve remission of diabetes and gain the ability to live without having diabetes or having to drink medicine for it. We are aware that research shows that people who lost weight, especially during the early stages of diabetes, experience a decrease in their blood sugar levels. While he shows normal results in HbA1c tests, I believe that he will be able to live 10, 15, or 20 years in this state. He had diabetes before, but not anymore. If he is consistent with the new lifestyle and changes, he can remain in diabetes remission.

The second story I have is of a 45-year-old who has had diabetes for 10 years but is not showing any symptoms of it, and they are concerned about what will happen to their body if they continue in that fashion. I will walk you through the plan I made with them. We say that we cannot cure diabetes, and even though a few do, some will have to get accustomed to living with it. Usually, for someone who is 45 years old, we try to do what is needed for them to live up to 85 years without facing complications such as heart attack, stroke, kidney issues, eye complications such as retinal damage or retinopathy, neuropathy, or issues in blood flow to the legs that would affect recovery of wounds and lead to amputating a leg etc., and to live comfortably, which is what I discussed with them.

I told them to observe the novel vehicle maintenance technology in place. Technology before was based on doing repairs to the vehicle, not servicing it. So, when a vehicle breaks down mid-trip, it is taken to the garage. But now, we service and maintain the vehicle in such a way that it is prevented from breaking down altogether. That is the theory we use for diabetes. Every 3 months, we check and assess the risks status related to blood sugar levels, just like checking the filters in a vehicle. During these checks, we make sure to examine eyes, nerves in the leg, kidneys, cholesterol levels that could result in heart attacks, and other risk factors. I described to them a life where they could live up to 85 years while on medications and preventing such complications. 

That is the positive side of this new technology. We have new methods for treating and preventing organ damage caused by diabetes. Many use this concept, even internationally, which is to not wait until the problem arises but prevent it completely. Not that I like to talk about politics, but there are some things you can learn from Sri Lankan politics!  When you observe Sri Lanka, you will notice that we deal with problems as they arise, but we rarely work to prevent them! That is not what we do with diabetes. We should have an understanding of how we carry this forward without a problem for 40 years, how exactly we can do it, and how we can create the best plan to not face any complications during all those years to come.

The third story is of a patient who is suffering from problems in their kidney. This arises from living without controlling their diabetes, blood pressure, or cholesterol levels properly. People have the misconception that these kidney-related issues are due to medicine, when in fact they are a complication of diabetes. For many in similar conditions, we used to say that there was nothing to be done about it and that they would eventually have to undergo dialysis or a kidney transplant. However, with new technology, that is not what we do now. Just like Remission of diabetes discussed above, we have Diabetic Kidney Disease Remission. For this patient, I said yes, we have a way, and, in the beginning, we identified and reduced the basic risk factors. The new medications we have are not just to control blood sugar levels; they also have a positive effect on the kidneys. It is not uncommon for many to be concerned that the usual medicine we use for diabetes would cause damage to the kidneys, which is why we use medicine that is good for the kidneys too. Same with medicine for high blood pressure – prescribing medicine for that patient that has positive effects on the kidneys, they might have to take 7 or 8 medications, but it would ensure that their blood pressure, cholesterol and blood sugar levels are in check with minimal side effects on the kidneys.

Usually, over the years, it is known for the kidneys to weaken, but with new research, we have observed that these new types of medicine will improve kidney health. I tell my patients that even though they grow old, their kidneys just get younger! For patients to live a normal life, we can create remission of diabetic kidney disease and turn things for the better.

Through these three stories, what I want to say is that diabetes is not something you should be afraid of. The good news is that we can make a plan for people who have no control to gain control, for those who have diabetes to go to a diabetes remission scheme, for people who have had their organs damaged to live a normal and comfortable life, and even for a someone who will have to live a long life with it to go through that journey without difficulty.

Dr. Noel Somasundaram
MBBS MD FRCP,
Consultant Endocrinologist