21 May, 2024

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From The Curry House To The White House & Beyond: The Trajectory Of High Blood Pressure

By Ariaratnam Gobikrishna

Ariaratnam Gobikrishna MD

At the tail end of World War II, with victory looming in the backdrop, the Allied Heroes convened in Yalta to chart the postwar future of Europe. Seated between Churchill and Stalin was Roosevelt, looking majestic and jubilant, so we thought, but with the benefit of hindsight, one can sketch a contrasting picture portraying a sick man in the middle, experiencing fleeting bouts of memory lapses. But in 1945 no one knew about transient small strokes or sentinel bleeding (warning leaks), portending a major catastrophe around the corner. High blood pressure was not even in the medical lexicon, let alone its effect on bargaining power against Stalin. In fact, Franklin Roosevelt was a sick man, noticeable to his comrades but not to his personal physicians.

Back home, on his daughters insistence, Roosevelt was examined by a cardiologist at Bethesda who found the President in heart failure with significantly elevated blood pressure, but elevated blood pressure was not considered a malady then so he was  prescribed digitalis — a drug to increase  pumping of the heart— to ameliorate his heart failure. He was also prescribed rest, reduction in the number of cigarettes he smoked and alcohol he consumed. All in all, it was the right move in the right direction, but it proved to be too little, too late. Shortly thereafter, Roosevelt would succumb to a cerebral bleed.

On the other side of the Atlantic, one and a half centuries before President Roosevelt’s somber fate, an Indian named Sake Dean Mahomed arrived in Ireland, armed with a multitude of talents in surgery, shampoo baths, and Indian cuisine. He was a trailblazer in many regards: the first to introduce shampoo baths, the first Indian to pen an autobiography in English, and later the pioneer behind England’s enduring love affair with chicken tikka masala through the establishment of a curry house. From this culinary venture emerged a second-generation descendant, a physician named Frederick Akbar Mahomed, who would go on to invent the sphygmograph (1870s) to measure blood pressure and coin the term “Essential Hypertension”—elevated blood pressure without antecedent causes (At that time, hypertension was perceived as an offshoot of kidney disease). During his brief lifespan, he would also accurately predict the long term complications associated with essential hypertension.

But Dr. Frederick Akbar Mahomeds discovery and predictions would simply be ignored for another century by the medical establishment. Consequently, President Roosevelt would fall victim to this intellectual malaise, paying the ultimate price. However, his death served as an eye-opener for America, prompting President Truman to declare the National Heart Act, which laid the groundwork for the Framingham Heart Study (FHS) in 1948.

As the name implies, “Essential Hypertension” was interpreted as essential for normal bodily functions until as late as the 1960s, despite mounting evidence to the contrary. Expert after expert ridiculed the notion of treating hypertension, considering it a great folly. Although, early on, the FHS identified high blood pressure as a detriment to healthspan, the scientific community faced opposition from influential detractors, including renowned cardiologists like Dr. Paul Dudley White — who once said Hypertension may be an important compensatory mechanism which should not be tampered with, even were it certain that we could control it.” — and Dr. John Hay, the British cardiologist credited with describing heart block. Dr. John Hay, for that matter, vacillated in his beliefs, infusing strong ambiguity into its discourse, as he once stated, “The greatest danger to a man with high blood pressure lies in its discovery, because then some fool is certain to try and reduce it.” Its fair to say that both cardiologists later walked back their statements and became strong believers in the detrimental effects of hypertension. It is also fair to say that the ambiguity emanated from many luminaries certainly delayed drug development.

However, the life insurance companies held a different perspective. Early on, they classified individuals with elevated blood pressure as high risk for their business. Their meticulous record-keeping and astute observations eventually spurred scientific investigations focusing on blood pressure reduction. Towards that end, the visionary Dr. Edward Freis threw himself into the drug trial at the Veterans Administration in Washington DC. In a groundbreaking moment, in 1971, his efforts proved medication-induced reduction beneficial for the first time, validating the predictions made by Dr. Frederick Akbar Mahomed a century prior and inspiring further similar trials to follow.

A major credit should also be attributed to Dr. Nicolai Korotkov, without whom the identification and monitoring of hypertension would have been far more cumbersome. In 1905, during the Russo-Japanese War, this young man’s painstaking efforts led to the discovery of the first working sphygmomanometer. He utilized auscultatory sounds, later known as Korotkov sounds, to achieve this breakthrough.

Although both systolic and diastolic blood pressure proved detrimental, treatment was initially instituted only for diastolic hypertension, based more on hunch than concrete evidence. However, numerous drug trials over the years gradually changed this perspective. Yet, this shift didn’t come easily. For decades, the diagnosis excluded the so-called elderly—individuals aged 60 and above. Reluctantly, trial investigators included those above 60 with isolated systolic hypertension and were astonished to find benefits in this age group. This paved the way for trials on individuals above 80, the very elderly, and once again, benefits prevailed across all age spectrum.

Since 1976, the National Heart, Lung, and Blood Institute has been at the forefront of advocating for cardiovascular health, regularly releasing Joint National Committee (JNC) reports. These reports, typically issued every 5 to 7 years, represent a consensus among experts in the field. However, after the 7th JNC report in 2003, the committee faced internal discord, leading to a lack of an official consensus statement for the 8th JNC release. Instead, in 2014, a publication in the Journal of the American Medical Association (JAMA) attempted to fill this void, albeit amidst significant dissent among the authors, particularly concerning the acceptance of a systolic blood pressure target of 150 for individuals aged 60 and above.

In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) stepped in, assuming responsibility for providing guidance on blood pressure management. Their recommendations emphasized more stringent control measures, advocating for lower blood pressure targets (130/80) for all age groups with caveats. While the European Society of Cardiology generally aligns with many of these recommendations, disparities persist, particularly concerning the cutoff for systolic blood pressure levels pertaining to drug therapy (140/90) as well as reduction targets for the elderly (above 65) (not less than 130). Lately, ambulatory blood pressure monitoring and home recordings supersede doctors office recordings, taking into consideration the nature of fluctuations and white coat effect, necessitating multiple readings for the diagnosis.

Even though accepting hypertension as a malady faced numerous hurdles, they were insignificant compared to the challenge of identifying its causation. Over time, the cascade of discoveries related to hormones, chemical substances, neural pathways, environmental factors, genetic influences, and the evolving changes in vascular function with aging has revealed the intricate web of interactions among these elements. This complexity has rendered the pursuit of a single unifying theory impossible. However, these individual components have paved the way for drug discovery, ultimately culminating in the success of combination therapy contained within a single pill, which has become increasingly popular in the Western world.

The notion of taking medication is often a bitter pill to swallow. Although there are slight differences, individuals classified as stage 1 according to American guidelines and grade 1 according to European guidelines will typically undergo lifestyle changes for six months before being considered for drug therapy. These lifestyle changes encompass weight reduction, regular exercise, decreased alcohol consumption, smoking cessation, reduced salt intake, and adherence to a diet akin to the DASH (Dietary Approaches to Stop Hypertension) diet. The DASH diet, in turn, shares similarities with the Mediterranean diet, emphasizing the consumption of ample fruits and vegetables, low saturated fat intake, and a high intake of polyunsaturated and monounsaturated fats, whole grains, fish, legumes, and seeds, all with a low sodium content.

Given the genetic predisposition for heart disease among South Asians, it’s noteworthy that individuals of African descent face a genetic disadvantage in the context of hypertension, often resulting in a higher incidence of kidney failure. Individuals of Sub-Saharan African descent occasionally harbor a mutation in the Apo L1 gene, providing resistance against trypanosomiasis (sleeping sickness) while simultaneously elevating the risk of kidney failure. This mirrors the scenario seen in carriers of the sickle cell trait, who demonstrate resistance to malaria. These instances underscore the concept of natural selection being advantageous during endemic diseases, yet potentially problematic in their absence.

There are occasions when hypertension stubbornly resists treatment, posing a looming threat of severe bodily harm—an occurrence referred to as resistant hypertension. In eras predating the availability of medications, surgical nerve disruptions were implemented with success. Building upon this legacy, contemporary approaches involve less invasive radiofrequency procedures targeting nerve endings around the kidneys. While initial results have shown limited success, ongoing endeavors aim to refine and enhance this technique at present, particularly for this category of resistant hypertension.

We have traversed a circuitous arc of trajectory vis-à-vis high blood pressure: from regarding the condition as benign, to seeing it as a necessary compensatory mechanism, to recognizing it as a symptom of underlying diseases. Now, we predominantly identify it as a standalone condition, termed essential hypertension. Cases linked to other underlying conditions are now categorized as secondary hypertension, representing a small minority and considered only in rare circumstances.

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Latest comments

  • 16
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    A thoroughly satisfying read on a very important health topic. Much appreciation to Dr. Ariaratnam Gobikrishna.

    I have read hypertension being referred to as a silent killer! Of course, BP testing has become rather common now, and hence often diagnosed and treated.

    Also my hunch is that the article indirectly answered the question why some patients are prescribed two or three different anti-hypertensive drugs simultaneously!

  • 11
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    “Essential Hypertension”
    ‘Essential’ has a few other meanings like ‘fundamental or central to the nature of something’.
    In medical science it means “with no known external stimulus or cause”.
    These may relate to usages like ‘essential oil’. An essential oil is not essential to any but a natural oil typically obtained by distillation (like in ‘essence of chicken’).

    • 10
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      SJ, interesting! Had wondered why some of these oils are referred to as essential oils.

      Here’s a juxtaposition for interest’s sake: essential amino acids.

    • 10
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      Hello SJ
      Here is another use of “Essential” It is essential when making assertions that you check their validity. The author says that “Frederick Akbar Mahomed, who would go on to invent the sphygmograph (1870s)”. However the “Sphygmograph is a medical instrument that records graphically the rise and fall of a pulse and its rate. It was invented in 1854 by a German physiologist Dr Karl von Vierordt” I know that in the context of the article it is nit-picking, but high blood pressure diagnosis and treatment is still contentious.

      Dr Mahomed was involved in experimentation with the sphygmograph and did a great deal of research on Hypertension https://www.sciencedirect.com/science/article/pii/S0085253815595033
      I remember having my blood pressure measured by my GP in the mid 1950s.
      The high consumption of salt and saturated fats in Scotland and Sri Lanka has contributed to the poor health in both nations.
      For Sugandh also a link to the “Silent Killer” – https://www.news-medical.net/news/20231028/Experts-warn-of-silent-epidemic-of-high-cholesterol-in-the-UK.aspx
      As one doctor says “the fact that we have not uncovered yet the full spectrum of the etiology and pathophysiological basis of hypertension merely reflects our failure, so far, to decipher complex diseases such as hypertension”
      Best regards

      • 7
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        LS – “but high blood pressure diagnosis and treatment is still contentious.”
        .
        What made you say that?
        .
        Any (medical) practitioners that advocate not treating hypertension that you know of? Here or in the UK?
        .
        Of course I am referring to western medicine not the Ayurvedic ones who essentially are certified quacks.
        .
        From a theoretical point of view I could understand treating a diseases could be contentious as our understanding them is not complete and is evolving.

        • 8
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          Hello Ruchira,
          Here are two different medical opinions on the use of Statins for Blood Pressure and High Cholestorol – https://www.hopkinsmedicine.org/health/conditions-and-diseases/high-cholesterol/3-myths-about-cholesterol-lowering-statin-drugs

          and – https://carolinatotalwellness.com/blog/index.php/2019/07/10/controversial-new-study-reports-statins-useless/
          I have known about the debate over Statins for a number of years. The Philippinos that I knew in Qatar were all on Statins. Every year we did an Offshore Medical through Qatar Petroleum. This was very thorough and every year the same ones would fail on Blood pressure and Cholesterol. They went on emergency diets and exercise for 3 months to enable them to pass the Medical. All were on Statins. My British Colleague and myself always passed with no issues apart from being a little overweight (but not now in Sri Lanka at 75 Kgs)
          Best regards

          • 6
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            Thanks for the links LankaScot. Functional medicine is…. you know … a little on the woo woo side… but nevertheless research they cite may be legit.

      • 13
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        Hello LankaScot, thanks for the link (and the many links you have shared elsewhere).

        Interesting finding that blood lipid profile maybe contributing to hypertension.

        Hypertension by itself has been long referred to as a silent killer:
        https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-a-silent-killer.

        Untreated, it carries on a vicious cycle of thickening of the arterial walls which in turn augments the hypertension, resulting in sustained narrowing of the lumen.

      • 10
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        Dear LS,
        .
        “As one doctor says “the fact that we have not uncovered yet the full spectrum of the etiology and pathophysiological basis of hypertension merely reflects our failure, so far, to decipher complex diseases such as hypertension””

        This is very correct. I think a large proportion of the Sri Lankan and SA population is associated with health problems related to asthma and what they called ” PEENASA- catarrh, which indirectly increases the incidence of heart disease and hypertension in the region.
        .
        The symptoms of hypertension are often subtle or non-specific, with some individuals experiencing headaches, nosebleeds, or shortness of breath. In many cases, high blood pressure has no identifiable cause.

        To accurately diagnose and effectively treat hypertension, it is essential to understand its various types, stages, and risk factors.

        tbc

        • 8
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          Hello leelagemalli,
          If we all carry on with our research some good may come of it. We will all get jobs as Consultants in the Health Service😎.
          Best regards

          • 10
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            LS,

            I thought that almost everyone works as consultants in our motherland? Dont you think so LankaSCOT ?

            This is how our people behave on the street, in the pharmacy, in the supermarket, anywhere. As if They know almost everything better.

            As you know also on this forum, we have living examples that make every effort to be self-proclaimed experts. They dont care little about the factual basis of anything.

            They dare to argue about medicine, biochemistry, engineering, astronomy or anything like “omnipotent-all-knowing”.
            That’s why Gotabhaya and other advisers banned fertilizers and destroyed agriculture. and let farmers be fallen deep.. remember? That may well be the reasons,why srilankens let those south koreans to overtake them during the last 50 years.
            Just to tell you, last November I had several pharmacy assistants tried their best to become medical specialists in front of me. This I experienced as I bought some anti-allergy tablets for my friends from Kadawatha and Wellawatta drug stores.

            • 8
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              LM,
              Whom do you think is the Best informed on FLOODS, Reservoir Levels and Impending opening of Sluice gates to Prevent Disaster!!!???
              THE LIFT OPERATOR AT THE IRRIGATION DEPARTMENT AND MAHAWELI MINISTRY!!!??? You happen to meet him, he will give you a free, 30-minute FoC Lecture/Thesis on why, how and when it is going to happen!!???
              This Maestro, learnt all the Ropes of the trade, from Hearsay of the wide and varied officials using the LIFT!!??? You wouldn’t dare have any conviction – who doesn’t hesitate to Quote, as attributable to the Director of Irrigation (DI), or his many Deputies, with offices in the building, countering such confident Expertise!?
              Such are the Vagaries of Life, EXPERTS AND Consultants, devoid of inherent Know-How but those borrowed, whilst enjoying erudite company – YES, in a LIFT!!???

    • 16
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      Dr. AG seems to be as good a writer as he is a doctor. I must confess that I googled some of the passages in the article to see if they had been lifted, but they turned out genuine. Congratulations!

      • 16
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        “. In 1905, during the Russo-Japanese War, this young man’s painstaking efforts led to the discovery of the first working sphygmomanometer. He utilized auscultatory sounds, later known as Korotkov sounds, to achieve this breakthrough.”
        This should be required reading for the pair of dimwits who recently argued that native physicians cannot diagnose heart disease by feeling the pulse.

        • 7
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          Idiot – There’s a difference between heart disease and coronary artery disease. First learn that and then try again.

          • 15
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            You must find it difficult to walk with your foot in your mouth most of the time!

            “Heart disease describes a range of conditions that affect the heart. Heart diseases include: Blood vessel disease, such as coronary artery disease. Irregular heartbeats (arrhythmias) Heart problems you’re born with (congenital heart defects)”
            https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118

            • 13
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              Sugandh,
              “You must find it difficult to walk with your foot in your mouth most of the time!”
              This guy is such a sucker for punishment . 🤣🤣

          • 15
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            “difference between heart disease and coronary artery disease.”
            Says the cretin who doesn’t know the difference between “corporate” and “corporate”. 🤣🤣🤣

            • 14
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              “Co-operate” and “corporate “

          • 16
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            ?????????? Ischemic heart disease (IHD) is also known as coronary heart disease(CHD) , or coronary artery disease ( CAD). Heart has many layers epicardium, endocardium, myocardium (muscles ), and pericardium. Coronary arteries penetrate and branch out within cardiac muscles supplying blood. (oxygen and energy). Hence any obstruction will lead to ischemia ( Angina ) followed by infarction (dead tissue). Similar to stroke in evolution or transient ischemia and actual stroke / infarction. Heart diseases other than infarction can involve inner most smooth layers endocardium, or it’s valves (thickening , or regurgitation ), or the actual pump called SA node / AV node (irregular rhythm ), or the blood supply discussed here . . . . . . ……., most causing functional / PULSE abnormality.

            • 13
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              Hello chiv,
              As I have mentioned before, my stepson Dinesh died nearly a year ago in Kandy Hospital from Cancer and Covid 19 (contracted in the Cancer Ward). He had suffered many years from night sweats and occasional (seeming) heart pain. All this time I and his mother were in Qatar. When we came back to Sri Lanka he seemed to be a little better and then got worse. I measured his heartbeat, blood pressure and %O2. His pulse rate was around 150 bpm Pressure 150/90 and 90 % O2. My immediate thought was Covid 19 or SVC (Superior Vena Cava) Syndrome. I asked him how long he had been like this and if the Doctors that he had visited had not advised him to go to Hospital. He was very reluctant to go to Hospital. With the help of 2 cousins we bundled him into the car and took him to Peradeniya. They diagnosed after some tests, first Pneumonia and eventually the real problem – a large Thymoma in the Mediastinum was intruding into his heart valves and causing the SVC Syndrome.
              TBC

              • 10
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                Continued
                My point here is that of all the doctors that treated him prior to his Diagnosis not one thought to look into his Hypertension. Dinesh admitted later that he had visited many Ayurvedic Doctors (and others) and that only one had refused to give him medicine and told him to go to hospital. The ensuing Chemotherapy and Radiotherapy treatments gave him an extra 9 months of life. The Consultant told me that if we hadn’t brought him to Peradeniya Hospital he probably would not have survived another night.
                Best regards

                • 12
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                  LS
                  Sorry to hear about your stepson’s untimely death.
                  Complete ignorance and stubbornness is the number one reason many Sri Lankans are stuck with their major health problems. Even drugstore clerks or assistants act like they know more than a doctor or heart surgeon. Today some MLT’s or MTA’s or TA’s are acting as senior doctors on the street. THeir misinterpretations of lab sheets lead to confusions.
                  :
                  They should not forget that the media and half-baked native doctors are misleading the people.
                  No matter what anyone says or does, generally Ayurvedic doctors in Sri Lanka and India are unable to cure cancer. Unselective drug therapies can cure some health problems, however, the outcome can also be worsened since it iwas not targeted therapies. They urge their patients to finally find Western medicine. Prof Nalinda Silva aka ultra SINHALA racist, talks loudly against western medicine, but he too saved his life thanks to western medicine in his heart surgeries.
                  Those diagnosed early can live with cancer while others do not because of abnormal growth of cancer cells. Old codgers can be good. Some doctors are good at diagnosing blockages in arteries, but they can’t predict what an angiogram might do. Today it is easier if patients cooperate to find quick solutions.

                  TBC

                  • 12
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                    Hello leelagemalli,
                    I have no doubt that some traditional Herbal/Mineral treatments may be helpful in treating illness, however without double-blind trials, chemical analysis and risk analysis etc their efficacy or toxicity is indeterminate.
                    Having a good sense of smell I have noticed over the years that illness can cause people to smell strange/bad or they have bad breath. About 20 years ago in the UK I had a meeting with an IT Manager who’s breath smelled like an open grave. I mentioned it later to the General Manager and when I returned a couple of weeks later the General Manager told me that the IT Manager (who had recently returned from a trip to Nigeria) was having treatment for TB. https://newsinhealth.nih.gov/2018/09/smelling-sickness
                    Best regards

                    • 13
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                      LS
                      The problem with native/herbal doctors is that many don’t know their limits, and consider themselves the equals of Western medicine practitioners, going as far as interpreting things like CT scans.That said, many modern medications do have herbal roots. That includes Digitalis, Aspirin, Quinine, and Metformin. Before these were synthesised, herbalists used various plants as cures for diseases like diabetes. They didn’t know what caused it, but could treat it.
                      Even animals are known to search out particular plants for medical purposes. Have you heard that Neanderthals used an aspirin precursor?
                      https://cosmosmagazine.com/science/biology/neanderthals-used-aspirins-ancestor/#:~:text=Ancient%20DNA%20scraped%20from%20Neanderthal,in%20Aspirin%20%E2%80%93%20found%20on%20teeth.

                    • 6
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                      Dear OC and LS,
                      .
                      “many modern medications do have herbal roots. That includes Digitalis, Aspirin, Quinine, and Metformin. Before these were synthesised, herbalists used various plants as cures for diseases like diabetes. They didn’t know what caused it, but could treat it.

                      Even animals are known to search out particular plants for medical purposes. Have you heard that Neanderthals used an aspirin precursor?”

                      Not many, but almost all.
                      Long before they synthesized aspirin, they relied on herbal extracts.
                      Acetylsalicylic acid (aspirin) is a widely used drug in the world today.. Its origin, salicylates, including salicin and salicylic acid, are found in the bark and leaves of willow and poplar trees.

                      Today, patients with heart and vascular disorders will not be without aspirin. They use it as a combination of aspirin with Plavix (clopidogrel) to prevent strokes.

                    • 6
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                      cont.
                      .
                      And I don’t think it is right you, OC to say “even animals” in the comment above.
                      How do we know that for sure ? some animals are , in fact, smarter than average humans or not ?
                      For me, I know more examples that prove it again and again.

                      My unforgettable female domestic cat (named Punchyhammy, no different to that Garfield or similar) who knew how to make her feel better, no matter what ailments she had from food poisoning and other health issues.
                      She used to go to the nearest garden and feed her with “Kumpamania” and the next day she was a very healthy cat. https://en.wikipedia.org/wiki/Acalypha_indica

                      You brought me back to my senses, thanks for that.

                      I really miss my parents more than ever today.
                      Throughout my childhood we enjoyed adorable cats, dogs, giant squirrels, parrots, polecats and many more. My mom knew that and let me have a good time in my adolesence.
                      :

                    • 2
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                      LM,
                      “some animals are , in fact, smarter than average humans or not ?” Dogs seem to have an ability to smell some human diseases, like cancer.
                      Animals do seem to have remedies for some ailments hard-wired into their brains. We pass on knowledge by word of mouth, or write it down. Some knowledge, (like aspirin) may have been acquired ages ago, but since it isn’t hard-wired, we keep losing it. Herbal doctors know a lot of things, but then put the cowdung in the curd by trying to deal with diseases they know nothing about.

                • 15
                  9

                  LS, I’m really sorry to hear the loss of your step son. Though not specialized in assessing prognosis I believe it’s something which can be detected by a simple scan. For an experienced radiologist some times a chest x’ray is good enough to suspect by identifying a mediastinal mass or seeing a shift to one side because of pressure effect. ( I guess in his case to the left ). Corelating clinical history with such radiological findings makes thymoma more likely among differential diagnosis.

                  • 6
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                    Hello Chiv,
                    Thanks, you are correct the Thymoma had grown from the centre to the left and invaded the SVC and Right Atrium. Thymoma’s are far more common in South Asia than the UK or USA. A CT scan was conclusive, X-Ray was occluded for some reason. “Patients with SVCS as a result of lung cancer usually live less than 24 months.” https://www.ncbi.nlm.nih.gov/books/NBK441981/
                    As he was Stage IV it was much less. We looked back at photographs taken over a 10 year period and we saw signs of neck swelling off and on from about 7 or so years ago (a sign of possible SVC Syndrome). He was only 38, so even quite young men are susceptible to this condition. The causes of Thymoma are unknown. Sri Lanka doesn’t have General Practitioners (Like the UK and other European countries) or a centralised Health Service IT System. Medical Information in Sri Lanka is, sadly, poorly circulated, subject to misunderstandings and not kept up to date.
                    Best regards

                    • 6
                      1

                      Dear LankaScot,
                      .
                      It is sad to hear that Dinesh lived only 38 years. From what you’ve told me about how he faced up to the end that he knew was coming, it is clear that he had sterling qualities, just as you have. All of us deserve to live longer.
                      .
                      The average human life has become longer, but go we all must. I must now go looking for a few other items of food, but I will complete my cogitations later.
                      .
                      It is clear that you loved Dinesh; my sympathies to you, but even more to your wife, to whom this death must have been a cruel blow. We are prepared to go – we know not whither – but we want our children to live on. Why? Richard Dawkins’s explanation is convincing. As I understand him, his selfish genes want to live on.
                      .
                      What more can we be certain of? LS, I also know that I have learnt much from you, chiv, SJ, Ruchira, – and LM!

                    • 9
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                      Dear serious readers,
                      whatever idealogical differences we have been arguing with, SM is an honest person. This was the reason, why I TRUSTED him at the begining.

                      He is so dedicated to bring NPP. It is alright with me, it is his uttermost wish. There is a common saying in Germany, ” jedem das seine” (each to his own).

                      But I have not least trust about they have the capabilities. When Sunil Handunetti proudly speaks about some critical issues in today’s economic situation, I am wondering he has the ability to be the minister of finance/economics in a future NPP govt. Once bitten twice shy…. no again GOTABAYA-style politics/politicians whoever attacks all other leaders today. I think we should not hang on throwing at allegations only… we should all come together and work for our national goals considering the edge of the precipice we are deliberately fallen in. At least for a period of 4-years they should come together… that is how GERMANY and OTHER countries reubilt after all kind of disasters they experienced either through civil wars and varied other disasters. Our issue is more related to not being able to build up consensus also for national policies.

                  • 13
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                    C
                    I learned something valuable.
                    TThanks

                • 9
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                  LS – “My point here is that of all the doctors that treated him prior to his Diagnosis not one thought to look into his Hypertension.”
                  .
                  Negligence is the norm here, not the exception. Most people are too ignorant to know.
                  .
                  I knew a guy with an on going cough, had gone to several specialists, well known ones, without a proper diagnosis being made. His wife was known to me and one fine day told me about her husband’s cough. I said must be TB and guess what? TB it was – none had previously tested him for TB.

            • 13
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              Chiv,
              These two clowns keep us entertained. I think CT should pay them for their opinions on everything from oscilloscopes, calculus, and heart attacks, among other things.

          • 19
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            “Idiot – There’s a difference between heart disease and coronary artery disease. First learn that and then try again.”

            Time to see who is the real fool here. I think if you’re talking about heart disease it’s not easy to avoid talking about coronary heart disease. I have been involved with vascular disease for some projects over the years. Many of my colleagues are cardiologists, radiologists, physicians, vascular surgeons and not only natural scientists. So most of them are world experts producing high impact factor journals. Even they dare not draw a clear line between coronary disease and heart disease. Certainly none of the candidates are idiots.

            • 11
              11

              “IDIOT – There’s a difference between heart disease and coronary artery disease. First learn that and then try again.”
              We seem to have more Company of Elitists!!!???
              ‘MORE THE MERRIER SEEMS THE QUOTES OF THIS HOUR’
              Be comforted in your thoughts – Ever so blessed, Lord Almighty God!!??

          • 11
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            “Idiot”!!!???
            Is it solemn case – “ONE RECOGNISES THE OTHER”!!!???

        • 12
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          Quote
          “. In 1905, during the Russo-Japanese War, this young man’s painstaking efforts led to the discovery of the first working sphygmomanometer. He utilized auscultatory sounds, later known as Korotkov sounds, to achieve this breakthrough.”
          This should be required reading for the pair of dimwits who recently argued that native physicians cannot diagnose heart disease by feeling the pulse.”
          Unquote
          .
          Fully literate half brained idiot can’t write a meaningful comment.
          .
          Korotkov sounds can not be heard by feeling the pulse to begin with even if you are a native quack.

          • 16
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            Ruchira,

            Yes, that clown is still endorsing diagnosing heart disease by feeling the pulse. He also thinks his “hearing” is more accurate than a digital oscilloscope. He would rather “draw” the waveform himself. Either a modern-day Da Vinci or lifelong Ranil-sycophant failure.

            • 14
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              Lester – Some issue somewhere for sure. I’ll go with sycophant…

          • 14
            14

            I see you’ve used up your father’s entire stock of Scotch today 🤣🤣🤣

            • 13
              0

              Hello OC,
              Are you suggesting that Scotch degrades your thinking. Oh well, I have to give up my single glass (small) at the New Year😢
              Best regards

              • 12
                13

                LS,
                “Are you suggesting that Scotch degrades your thinking ?”
                Certainly not. It’s drinking with your father that does it 😂

      • 8
        4

        Dear old codger,
        .
        I whole-heartedly agree with you; Ariaratnam Gobikrishna is a good doctor, a good writer, a good human being – and he’s one of us!
        .
        https://www.healthgrades.com/physician/dr-ariaratnam-gobikrishna-g3rhd
        .
        Although he had qualified “from Thanjavur Med Coll-Madras University” he has clearly been from Lanka.
        .
        I ought to stop there, but my naivety is well known.
        .
        This is his third article on CT. All have been recent. Welcome! And I hope that you will soon visit this land of your birth and childhood. We may even be able to surmise that had we had this country in better shape he would have qualified and returned as a doctor much earlier.
        .
        Panini Edirisinhe, (NIC 483111444V) of 51B, Golf Links Road, Bandarawela

        • 16
          0

          Heello SM,
          Thanks for the sentiment previously, Dinesh wanted me to tell of his experiences and to make sure that I explain that it is absolutely crucial that Sri Lankans go to Doctors or Hospitals as soon as they become aware of their health problems. Parents should not lose their children
          As I said before you have one life, make the best of it.
          Best regards

        • 14
          11

          SM,
          Yes, he writes well. It is sad that some here view him as just another Tamil terrorist.

        • 10
          20

          Dear Panini –
          .
          You are too decent for this forum. The author’s first piece, assuming that it was his first, was I thought written immediately after a visit he made to Sri Lanka. In which he makes a rather poor attempt to convince that Sinhalese descent from South Indian Tamils. Not that it matters but the very attempt made by the author seems to indicate that it does to him and atleast to some of the Tamils that are very vocal here.
          .
          His second article was an advertorial for lipid lowering drugs written on the pretext of promoting heart health but I don’t expect you to recognize it for what it is.
          .
          This third article seems a little better. Seems being the key word.
          .
          That said I have no doubt he is a good Cardiologist and an accomplished one for that matter. But as usual he too seems to have fallen victim to Tamil Diaspora’s propaganda network that seems to be still very active.
          .
          TBC

          • 8
            19

            CTD
            .
            Anyway I was humbled to see that you have mentioned me elsewhere as one of the persons among those you benefited from on this forum. Thank you.
            .
            With traditional New Year around the corner I may not frequent CT that much – got some other activities planned. In case I don’t come here, I expect to catch up with you later outside this forum.
            .
            You’ve been a good sport and an abosolute gentleman. Keep up the good work you do and I wish you a happy traditional new year!

            • 7
              19

              PS – in case we don’t catch up outside this forum let me tell you that it was an absolute pleasure to have run into you here.

          • 20
            11

            Insecurities and paranoias of a Sinhala-Buddhist racist.

            Or is it deliberate PR to whitewash Sinhala-Buddhist fascism?

            Either / Or, simply pathetic.

            • 8
              10

              Sugandh,
              I think he dropped in here wearing a mask of sweet reasonableness, but started snapping at imagined slights , bringing out his true personality. From there it was all downhill. Paranoia? Can you beat “” Muslims are trying to convert my family” ?

  • 18
    11

    The term essential can be confusing or a misnomer for many , including doctors in past. But not anymore. If anyone reads the last paragraph the author explains the difference between benign, necessary compensatory mechanism ( usually in elderly, due to thickening of vessels with ageing) and a underlying disease. But Hypertension is detected in all age groups starting as young as in 20’s. High blood pressure in young will obviously stress the heart and may also lead to small vessels rupture elsewhere. The word essential is still in use to stress that a basic pressure is needed , so that a tiny heart to maintain supply through out whole body mass. It’s equally harmful to organs, if blood pressure falls significantly below the required pressure (hypotension). Hence, even in patients with extremely high blood pressure, doctors are cautioned to gradually lower pressure to avoid harm. To my knowledge the word ESSENTIAL is rarely used to any other pathology we know of. As author mentioned secondary hypertension is not so common but can be explained as in kidney diseases where the fluid balance is not maintained ( retention). If interested read pre-eclampsia / eclampsia , where blood pressure ,suddenly shoots up to extremely high levels, in young pregnant women, causing kidney damage, seizures or even death. ( totally different pathology, causes ).

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