SuperSight Surgery – Read all about it! Without glasses!
It is a couple of years since I wrote
about SuperSight Surgery. This is a revolutionary procedure that has changed
the lives of many in Pattaya, and as the news traveled throughout the world,
the world traveled to Pattaya to have this life-changing operation. In fact,
two of my doctor friends here in Pattaya have had this done, and both are
very happy with the end result.
So, are you over 50 and using
spectacles to read this article? Do you hate your reading glasses? If so,
help is at hand! This is SuperSight Surgery (not to be confused with LASIK).
SuperSight Surgery is in the forefront
of ophthalmic procedures. The world leader is Dr. Somchai Trakoolshokesatian
and he consults out of the Bangkok Hospital Pattaya. He has been carrying
out this procedure for nine years on over 3000 patients and has perfected
the technique to ensure good results for each individual patient, with
success and satisfaction rates of almost 100 percent.
Unfortunately, the need for reading
glasses is a natural progression of aging. The first signs are the fact that
you have to hold this newspaper further away to be able to read it, and you
also find that you need a good light to be able to see the words clearly.
Eventually you succumb and buy reading glasses, to which you become a slave.
Eventually you keep one pair at home, another in the car and another in the
office. And your nose gets funny indentations either side of the bridge,
where the spectacles settle.
As you get older, all the ‘elastic’
tissues in your body become less pliable. Knees, lower back, fingers, neck,
the list is endless. However, you have to add to that list, the lens in your
eye. The fiddly little lens, supplied at birth as a standard feature, does
not have a fixed focus, but under your control you can make it focus close
up (to read) and then also focus at a distance. The way you do this is by
‘bending’ the lens to be able to focus on near objects. Unfortunately, as
the lens becomes less pliable, the muscles in your eye become unable to bend
the stiffening lens enough to produce the near point focus. The near point
moves further away, until you have run out of arms, as described previously.
We call this condition ‘Presbyopia’.
Unfortunately there is yet another
result of aging that occurs in the lens of the eye. This is a gradual
cloudiness which lowers the visual acuity, and eventually brings on
blindness. This is called a cataract. So not only can you not see well
enough to read the magazines, but you also begin to lose your distance
vision. Welcome to the wonderful world of white sticks and Labrador dogs.
Even the World Health Organization says there are currently between 12 and
15 million people blind from cataracts.
The initial method of treating this was
by removal of the now optically inefficient natural lens, and attempting to
return some usable vision through the introduction of very thick and heavy
spectacles placed before the eye. These glasses looked as if the lenses were
made from the bottom of Coca-Cola bottles (registered trade mark and all),
and were just as heavy. The patient could see again, but reading required
even thicker lenses, or hand-held magnifying glasses. Not all that
comfortable, but beats the alternative.
So we come to the latest development in
intra-ocular lenses (IOLs), where the hardened lenses are replaced by other,
very special lenses. These can be focusable lenses, under the control of the
patient’s own intra-ocular muscles, or multi-focal lenses, with the brain
picking the necessary focus as required. This is SuperSight Surgery and with
these lenses you can read your golf scorecard with your near vision, focus
on the ball on the tee with your intermediate vision and then using your
distance vision watch it gently arcing into the water hazard. (These new
IOLs can improve your sight, but not your golf.)
If you want to know more, go and
consult Dr Somchai and reduce your dependence on contact lenses or glasses.
You will be amazed.
Mata Hari, frogs, dogs, horses, toy trains and EKGs (ECGs)
Everyone is familiar these days
with the electrocardiogram, known by the acronym ECG or EKG (US style,
which comes from the German spelling). This is an invaluable medical
test to show the electrical conductivity of the heart, which in turn can
give the doctor an idea of the health of the heart muscle itself. Many
think of this as one of the newer developments in medical science, but
it is not, having a history dating back to the mid 1600s.
In 1664, Jan Swammerdam, a
Dutchman, disproved Descartes’ previous mechanical theory of animal
motion by removing the heart of a living frog and showing that it was
still able to swim. On removing the brain all movement stopped. (This
reminded me of the professor who proved that fleas heard through their
legs. When he told intact fleas to jump they did – but after he removed
the legs they no longer moved, proving they must have previously heard
through their legs.)
Almost 200 years later, in 1856,
researchers Kolliker and Muller accidentally discovered the electrical
activity of the heart when a frog sciatic nerve and leg muscle
preparation fell onto an isolated frog heart and both muscles contracted
The investigation into the
electrical stimulation of muscles continued, with the main stumbling
block being the difficulty in measuring such small voltages. However, in
1887, Augustus Waller, working in St Mary’s Medical School, London,
published the first human electrocardiogram, having recorded the
electrical activity of the heart of a Thomas Goswell, a technician in
the laboratory. This required not only wires, but the subject sitting
with his hands in glass jars of salt solution. Waller’s
electrocardiograph machine consisted of an electrometer fixed to a
projector. The trace from the heartbeat was enlarged by projecting it on
to a photographic plate which in turn was fixed to a toy train, to
produce a graphical, moving record! Unfortunately Waller did not see the
clinical application of his EKG at that time.
Two years later, in 1889, Dutch
physiologist Willem Einthoven saw Waller demonstrate his technique at
the First International Congress of Physiologists in Bale. Waller often
demonstrated by using his dog “Jimmy” patiently standing with his paws
in glass jars of saline, and began to develop the technique further.
What Einthoven, who was working in
Leiden, did was to throw away the toy train and use a different and much
more sensitive string galvanometer that he had invented himself in 1901.
The different wave formations could be more easily identified, and it
was Einthoven who assigned the letters P, Q, R, S and T to the various
deflections, and described the electrocardiographic features of a number
of cardiovascular disorders, such as atrial fibrillation.
In 1909, Thomas Lewis of University
College Hospital, London bought an Einthoven string galvanometer and
published a paper in the BMJ detailing his careful clinical and
electrocardiographic observations of atrial fibrillation. Lewis
identified a fibrillating horse using the string galvanometer’s
electrocardiogram recording, and then followed the horse to the
slaughterhouse where he could visually confirm the fibrillating atrium.
By 1924, the EKG, in a form close
to that we know today was developed by Einthoven, who that year was
awarded the Nobel Prize in Medicine for his discoveries.
Since then, the EKG has become even
more sophisticated, and the equipment much smaller in size. However, it
was not until 1963 that we began to carry out EKGs while making the
heart work. This exercise ECG concept was promoted by Robert Bruce to
describe their multistage treadmill exercise test later known as the
Bruce Protocol. “You would never buy a used car without taking it out
for a drive and seeing how the engine performed while it was running,
and the same is true for evaluating the function of the heart,” he is
rumored to have said. He was quite correct, and the Exercise Stress Test
EKGs are important features in modern cardiac diagnosis.
And Mata Hari? Mata (1876-1917)
lived in Leiden as a young girl when Einthoven (1860-1927) was doing his
experiments there. Who knows, she might have electrically stimulated
young Willem as well as her other later exploits which led her to the
What to do
Thailand is infamously
known as a culture where certain anatomical bits have been lopped off by
unhappy ladies. Following retrieval, re-attachment generally does go well
(the Bobbit operation), but much depends on the offending bit being viable.
However, there are
other anatomical items that become severed. There are about 10,000 cases of
job-related amputations in the United States each year; 94 percent of these
involve fingers. Few statistics are available for the outcome of
replantations, but with modern surgery the success rate is increasing.
I did come across a
report on a series of 208 digital replantations from the frigid zone within
the People’s Republic of China. The extremely cold climate (30 degrees
below) presents the additional problem of warming the amputated digits prior
to replantation. An overall replantation survival rate of 94 percent was
reported, and this included 45 cases of multiple digit amputation. Clever
people, these Chinese, but you never know, were they ‘copy’ fingers?
Now, to successfully
sew the finger(s) back on needs the patient to appear fairly smartly at the
hospital, and to also bring the missing digit. Despite some claims to the
contrary, we are not yet at the stage of being able to grow new fingers for
Recently, an injured
person arrived at ER with his nine good fingers, but without the 10th one
that had been lopped off. The wound was clean and so the hand surgeon sent
the patient’s friends off to find the missing finger, as there was a good
chance of successful replantation. They appeared later with a bag of chicken
giblets straight from the refrigerator, proclaiming the missing digit was
inside. When the surgeon looked, the bag of chicken pieces, which still had
the name of the supermarket on it, had not been opened! There was certainly
no finger inside with the giblets, and all that could be done was to trim up
the traumatic amputation, and hope that the patient was not an accountant.
So, how should you
transport missing body parts (people get more than fingers lopped off)? To
save the tissue from further damage, keep the amputated bit wrapped in cling
film, preferably in a jar or cup with a lid. Do not put it directly in water
as this will cause it to shrivel up and become unusable for the surgeon
trying to reattach it. Put the container with the finger or whatever inside
another large bag with cold water, to keep the amputated part cold. Some
authorities say ice water, others say just cold water, and I tend to go
along with the ‘cold’ concept.
Be sure to gather up
all parts of a severed digit, no matter how small. The body cannot grow a
new nail bed, the tissue directly under the nail, so being able to use the
original tissue makes a big difference to whether a full reconstruction can
Generally, the tissues
will survive for about six hours without cooling, and if the part is cooled,
tissue survival time is approximately 12 hours. Fingers, by the way (and not
chicken giblets) have the best outcome for transportation survival, since
fingers do not have a large percentage of muscle tissue.
required to successfully replant fingers (and the other bits that were
lopped off and offered to the ducks) is very exacting, as nerves, arteries
and veins all have to be reconnected. Very often the surgeon has to shorten
the finger, so that there is no tension on the sewn up structures. All this
takes an enormous amount of time and patience. With one celebrated case in
the UK, a woman lost six fingers and it took a team of surgeons working in
relays to reattach all six fingers during 17 hours of microsurgery. It is
said to be the first time so many fingers have been replanted in one
Many other factors are
involved in whether there is a successful outcome. Generally, severe
crushing or avulsion (tearing away) injuries to the fingers make
replantation difficult. Additionally, older persons may have
arteriosclerosis impairing circulation, especially in small vessels.
But if you are
unfortunate to cut off a finger, remember to bring it with you, not the
AAA – and it’s not your credit rating
I was reminded of this condition when a patient
presented with an AAA and he wondered what to do next.
AAA stands for
Abdominal Aortic Aneurysm, and as I have often pointed out, we doctors
love acronyms. I am sure that the education bodies have decreed that the
medical course should contain three years of acronyms, as well as
another three years of clinical practice.
So what is an
abdominal aortic aneurysm (AAA)? First off, what is the aorta? The aorta
is the main artery of the body, directly connected to the heart and
taking the vast majority of the blood from that important central pump
to the abdominal organs and the legs. This artery is around 2 cm in
situation can occur, whereby the artery begins to bulge and can grow to
four or five times the normal diameter. It is this swelling that is
called an ‘aneurysm’. Being of the Abdominal Aorta, then explains the
AAA description. An aorta is considered ‘aneurysmal’ when it grows more
than 50 percent over its normal size. By the way, aneurysms may occur in
any blood vessel in the body, but the most common place is in the
abdomen below the renal arteries (the blood vessels that provide the
blood to your kidneys). Interestingly, aneurysms are four times more
common in men than women and occur most often after 55-60 years of age.
Elderly males have yet another aspect to monitor, as well as their
The danger of the
AAA comes from the fact that this can burst, like an over-inflated
balloon, and the patient experiences a catastrophic internal hemorrhage.
This is generally fatal. Aneurysm rupture affects approximately 15,000
people per year making it the 13th leading cause of death in the US. The
incidence of aortic aneurysm increases every decade as the population
ages. Fortunately, early detection and diagnosis is increasingly
possible as more sophisticated medical screening methods become
So why does this
aneurysm occur? Aneurysms are caused by a weakening or damage in the
wall of a blood vessel. There are many conditions known to contribute to
the weakening of the artery wall including atherosclerosis (hardening of
the arteries), cigarette smoking, high blood pressure and inflammation
(hardening of the arteries) is the most common cause of abdominal aortic
aneurysms. This occurs when substances such as cholesterol, minerals,
and blood cells build up in the walls of the artery, and thus damaging
it. The muscular wall of the aorta weakens and with the pressure inside
the artery, it begins to bulge. High blood pressure may speed up the
weakening, but it is not the cause. Aneurysms also tend to run in
families, so there is the thought that genetics may play a role in who
gets an aneurysm. (When in doubt, blame your parents – for everything!)
There is a strong
link between cigarette smoking and the occurrence of aneurysms. Smokers
die four times more often from ruptured aneurysms than nonsmokers.
Aneurysms in smokers also expand and weaken faster than those in
nonsmokers, making this the one hundred and twenty thousandth good
reason to give up cigarettes.
until an AAA bursts, there are generally no symptoms to let you know you
have one of these ‘time bombs’ sitting in your belly. The discovery is
then usually during an annual physical, where it can be palpated by the
doctor, but by far more accurate is an ultrasound, which can give exact
dimensions, and thus progressive indication of how rapidly the swelling
The answer to this
is an operation to replace the swollen, weakened artery, with a suitable
piece of highly expensive ‘garden hose’ of correct length and diameter.
This is a major operation, but once you have had an AAA detected, there
is no other way around the problem. There is also some work being done
on encasing the aorta to contain the swelling, but this is not the usual
method of ‘defusing’ an AAA.
You should be
lining up for a routine health check every 12 months, after you reach 40
years of age. When was your last one?
If you don’t eat your meat –
you can’t have any pudding! (Pink Floyd)
What we eat is something that has fascinated us for
centuries. We have made rituals and even fetishes out of eating and
drinking, and the oldest gourmet group in the world, the Chaine des
Rotisseurs, is still going and began in 1248 AD. That’s a long lunch!
with our tentative forays into ‘real’ science, our dietary habits have also
been scrutinized plus the many claims made for modifying the kind of food we
eat and what we drink. This in turn, has produced legions of people who
swear by various foods which will cure everything from falling hair to
falling arches (or even falling stock markets)!
it is very difficult to ‘prove’ that by taking Vietnamese ground nut leaves
or similar items, that ‘something’ (usually cancer) does not happen. Even
more outrageous are the claims that some herb, poppy or whatnot can actually
‘cure’ cancers. Is it all just poppycock?
To be able
to prove these claims needs medical science to look at a large group, or
population, and compare its cancer experience with another similar large
group or population. Ideally, the two groups are matched for
age/sex/ethnicity/working environment, location, etc. You get no worthwhile
results comparing Welsh coalminers with sub-Saharan Africans, for example,
to go to extremes.
results of a 15+ year study in Australia were presented at the CSIRO
Prospects for Cancer Prevention Symposium. The findings emerged from the
Cancer Council’s Melbourne Collaborative Cohort Study, an ongoing research
project involving 42,000 Australians who have been monitored since 1990.
the dietary habits and the cancer connection, Dr Peter Clifton, director of
the CSIRO’’s Nutrition Clinic, said there was “zero evidence” that eating
fruit and vegetables could protect against cancer. The nutritionists and the
healthy eating proponents were shattered. However, this to me is a much more
compelling argument than something that comes from folklore, or the lady
next door who swears by it.
survey did show was that the three prime risk factors as far as predicting
cancers were concerned were identified as obesity, drinking too much alcohol
that, staying within a healthy body weight range was found to be more
important than following particular nutritional guidelines. This means a
thin person who does not eat enough fruit and vegetables would have a lower
risk of developing cancer than someone who is overweight but eats the
recommended daily amount of fruit and five colors of vegetables.
Dallas English, of the Cancer Council of Victoria, told the symposium that
despite decades of research, there was no convincing evidence on how
modifying one’s diet would reduce the risk of cancer.
important thing about diet is limiting energy (kilojoule) intake so people
don’t become overweight or obese, because this has emerged as a risk factor
for a number of cancers, including breast, prostate, bowel and endometrial
(uterus),” he said.
between eating red meat and bowel cancer was “weak” and the Cancer Council
supported guidelines advising people to eat red meat three or four times a
week, Professor English said.
Australia, the biggest killer is still heart disease, so healthy eating will
lower one’s chances of heart disease, even if it does not protect you
Professor English and Dr. Clifton predict an increase in the incidence of
cancer as a result of Australia’s obesity epidemic, but say exercise can
play a vital role in cutting cancer rates, potentially halving the risk of
some cancers. That I find a rather sweeping claim, but there is no doubt in
my mind that moderate exercise is good for you.
And while on
exercise, it does not have to be pedaling an exercise bicycle to nowhere,
which is mind numbing, the best exercise is half an hour of swimming three
times a week.
So there you
are – get down to a healthy weight and exercise regularly, drink alcohol in
moderation only (be aware, Australians do not know what “moderation” means)
and stop smoking. In this way you will lower your chances of heart disease
and cancer. Ignore other fanciful claims!
you might even outlive your doctor!