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It also operates more than 35 ParkwayHealth Patient Assistance Centres (PPAC) worldwide, reaching out to patients and providing them with fuss-free access to their healthcare services.
ParkwayHealth Patient Assistant Centre (Sri Lanka) has specialists come to Sri Lanka every now and then, to empower people with vital information which would help them to prevent illness or seek treatment.
This time, Consultant Orthopaedic Sports Surgeon Dr. Tan Jee Lim and Obstetrician, Gynaecologist and Urogynaecologist Dr. Christopher Chong flew down to the island to address a public health seminar. The Daily FT spoke to both doctors and discovered a few medical issues and hitherto unheard of treatment options.
Stress urinary incontinence and pelvic organ prolapse
Urinary incontinence is the leakage of urine and pelvic organ prolapsed is the dropping of the womb, bladder or bowel through the vagina. These are common female problems with an incidence as high as 50% but they are rarely heard of because of the embarrassment attached to the nature of the illnesses; people do not realise that these are problems or they do not know where to seek treatment. Consequently this can affect a woman’s quality of life, sexual health as well as her work life.
Dr. Christopher Chong stresses the importance of educating people on this issue. A powerful way to prevent any illness is patient education. The purpose of his visit to Sri Lanka was to increase awareness on these medical issues, educate people on the importance of preventing such illnesses and directing them to the resources available to help them. He said there is new treatment for these problems, but prevention is better than cure. That is where education on this matter comes in. There is a Prevention Clinic to teach patients prevention techniques and a Screening Clinic to detect these problems in Gleneagles Hospital, Singapore.
Dr. Chong said there are three main causes for incontinence and prolapse: childbirth (chances increase with each additional birth), menopause and obesity. Preventive methods involve exercises to tighten the pelvic floor muscle – Dr. Chong’s first step in treatment is the ‘Kegel exercise’. He tries this for three months and only if unsuccessful does he recommend surgery.
He strongly suggests that patients see a doctor early because there are three stages of this illness: mild, moderate and severe; in most cases, patients recover simply through the Kegel exercise if they are in the mild stage but chances for recovery through exercise lessens at the later stages by which time the only option for recovery would be surgery.
The surgeries that Dr. Chong performs have high success rates, low complications and minimal pain. His areas of expertise include prolapse, incontinence and pelvic floor reconstruction surgery, vaginoplasty and sling surgery, among others. The sling surgery, using tension-free tape has been used for more than 18 years and its success rate is up to 95%. This is an uncomplicated procedure which takes around 10-15 minutes. It is the task of treating patients with severe prolapse that is challenging. Urogynaecologists add hitching surgeries and a net (mesh) to prevent recurrence.
After talking about how patients end up going through the wrong treatment and surgery, he advised: “Choose the surgery with the best cure rate.” Conventional surgery for severe bladder prolapse has a success rate of at most 70% whereas Dr. Chong’s method using the prolene mesh achieved a success rate of 95%. Moreover, since the surgeries are done vaginally, there are no scars and the patient can be up and about in one to two days.
Knee injuries and cartilage transplant
Dr. Tan talked about injuries and cartilage damage particularly related to the knees. He focussed on sports derived injuries but also addressed questions on non-sports related conditions such as arthritis. His area of expertise is the cartilage transplant, which is a highly recommended method used in treatment of damaged cartilage. He explained,
“When cartilage is damaged, it doesn’t heal on its own; it continues to get worse and worse; patients suffer from pains, cannot bend and the knee swells.” In the past, when people get old and have severe arthritis or cartilage damage, they opt for a replacement (artificial joint). Now cartilage transplant is the better option.
In the cases of people suffering from arthritis (which is mainly due to genetics) or basically any form of early cartilage damage, he said that an MRI is required to detect early stages. A normal x-ray is not enough to detect the early signs; by the time an x-ray is able to detect arthritis, it would already have developed to a more severe stage by which time it could be too late.
He reiterated the value of using a state-of-the-art examination like an MRI to detect early stages of damage. If ignored, it gets worse. “By the age of 60, it was found that 60-70% of people suffer from arthritis either on the ankle, knee or some joint; but it’s usually the leg because it carries the whole body weight,” he said.
When talking about prevention, the doctor warned of the dangers of being overweight: “If overweight, you’ve got to lose that weight, friend.” He further elaborated: “Every step you take you carry twice your body weight; every time you run, that’s five times the body weight and every time you jump and land, that’s seven times the body weight.” He talked about the importance of being active and how our lifestyle can be a contributing factor to cartilage damage. Our biological make is another factor.
Started around 13 years ago in 2000, a cartilage transplant involves taking the patient’s own cells, growing those cells in a lab outside the human body and putting it back two months later. “From a few thousand cells, it multiplies to 3.5-5 million cells in two months. Then we put it back. So there is no risk of transmitting disease, no rejection because it’s from the patients themselves and there is no need to take lifelong medication,” he explained. “The best part is: because it alive, it will live like you, it will last as long as you,” he added.
He was comparing this to an artificial joint, which is made out of metal and plastic and would only last for 10-15 years and was more suitable for older people. The younger ones would benefit more from a cartilage transplant as they have many more years to go.
With a success rate of 85-95% Dr. Tan’s treatment is becoming increasing popular. Although successful, he doesn’t perform this surgery on every patient who comes seeking it. He said his approach is patient selection— knowing the right surgery for the right person. People contact him from abroad but he insists on seeing the person first, perusing the MRI, evaluating the three contributory factors to cartilage damage (the extent of the injury; the lifestyle of the patient; biological make) and he finally assesses suitability.
The treatment offered by both doctors are not available in Sri Lanka yet, but fortunately patients now have an option of seeking the treatment in neighbouring Singapore. Under the care of these two doctors, other professionals who are trained by them and state of the art equipment, patients suffering from the above illnesses can look forward to healing with greater optimism.
