This blog (created in March 2011 by Lucky) is about new entrants to the Colombo Medical Faculty of the University of Ceylon (as it was then known) in June 1962. There were a total of 166 in the batch (included 11 from Peradeniya). Please address all communications to: colmedgrads1962@gmail.com.
Header image: Courtesy Prof. Rohan Jayasekara, Dean, Faculty of Medicine, University of Colombo (2011 - 2014). Please use the search bar using a keyword to access what interests you
In politics stupidity is not a
handicap. - Napoleon Bonaparte
Since my early childhood I have
had very little interest in politics but have been eminently aware of the
impact they’ve had on my life and well-being. The high-profile politicians
during the British Colonial times had many confrontations with the existing
regime and even spent time in jail. Although politics is not for everyone it is
a profession someone has got to do. For politicians nowadays it is more than a
job it is like winning the lottery.
Four of my subjects for the
portraits are committed socialists. It is hard not to have a social
consciousness growing up in a developing country with so much poverty around. All
of them were Influenced by Karl Marx and Lenin while completing their education
abroad. The LSSP certainly influenced the trade unions and brought politics to
the people. The LSSP remained on the fringes and sadly the party fractured and
disintegrated in the early 1950’s and lost its power and appeal. Thanks to Karl
Marx and the many die-hard socialists who disseminated the philosophy, many of
the main stream parties worldwide acquired and added socialist policies to
their election pledges for the benefit of the poor.
All the politicians below are
known for their integrity, honesty and probity.
I do respect the Latin aphorism “De
mortuis nil nisi bonum” (Of the dead say nothing but good).
Robert Gunawardena (1904-71)
Don Benjamin Rupasinghe
Gunawardena was later known as Robert Gunawardena. He was a founder member of
the LSSP and was a Marxist in the true sense of the word. He was a long serving
MP for Kotte. He was jailed by the British for his activities against the
British Colonial regime. Robert led the 1953 hartal and also the Suriyamal
movement. They used Suriya flowers in place of the British Poppy to remember
those Ceylonese who gave their lives in the war. He was a member of the Colombo
Municipal Council. When he lost his seat in the election in 1965 Dudley Senanayake
made him the Ambassador to China.
S.J.V Chelvanayagam
(1898-1977)
Before his journey into politics
he was a greatly respected teacher in my old school, Wesley College. He
qualified as a lawyer and became a Kings Counsel.
Elected to parliament in 1947 he
was a political leader of the Ceylon Tamil community for over two decades. He
is well known for his pacts with the government and his support for federalism.
He is remembered for his integrity and the use of non-violent methods to
achieve his goals.
Dudley Senanayake (1911-73)
Dudley Senanayake was the head
prefect and captained cricket at St Thomas’ Mt Lavinia.
He then went on to Corpus Christi
College, Cambridge to read for Natural Science Tripos and after graduation
gained admission to the Middle Temple as a barrister. He was the second Prime
Minister of independent Ceylon. Dudley is credited and remembered for initiating
the Mahaweli Development Programme and the Gal-Oya project. He is known for his
simplicity and tolerance and regarded as a true statesman.
Colvin R De Silva (1907-89)
He was called to the bar as a
barrister from Lincoln's Inn in London and later became an advocate in the
Supreme Court of Ceylon. He appeared in many prominent and high-profile
criminal trials of the day. Colvin was a founder member of the LSSP and became its
president in 1935. He was elected to represent the Wellawatte -Galkissa seat in
parliament in 1947 and later to the Agalawatte seat. He continued his legal
practice until his death.
About that famous saying “The sun
never sets on the British Empire”: Colvin said "That's because God does
not trust the British in the dark."
Philip Gunawardena (1901-72)
He was the father of socialism in
Ceylon and was called the Lion of Boralugoda, which was his home town. He was a
member of the State Council and later of the Parliament of Ceylon. Robert
Gunawardena was his brother. Philip had his University education in the USA. It
seems it was there he was “radicalised” and became a die-hard socialist during
the declining labour movement of the great depression. Philip Gunawardena was
an eloquent speaker. He too was deeply involved in the Suriya Mal Campaign. Philip
Gunawardena was so outspoken that the Colonial Government banned the LSSP and
he was imprisoned together with other LSSP leaders in 1940. In 1951 he formed
the MEP and in 1956 became the Minister of Agriculture in the SWRD Bandaranaike
government. In 1964 he became the Minister of Industries and Fisheries in the
Sirimavo Bandaranaike government. He lost the election in 1970 and died in
1972.
N.M Perera (1904-79)
After his University degree in
Ceylon he joined the London School of Economics in 1927. He was taught by
Harold Laski who was a political theorist and a high profile member of the
British Labour Party. Joining the Suriya Mal Campaign he worked and supported
the poor and oppressed people of the Kegalle district. He was a founder member
of the LSSP. He too was imprisoned by the British at the break of WW2. In 1947
he was elected to the Ruwanwella seat and became an MP. He was well known for
his support of the Trade Union Movement organising strikes for better pay and
conditions for workers. In 1964 and in 1970 he served as the Minister of
Finance. Being an ardent cricket fan, in
1977-78 he was appointed the Chairman of the Board of Cricket in Sri Lanka. He
died from the complications of gall bladder surgery at the National Hospital.
I am very fond of the Shadows as a musical group. I am sure colleagues recall the Jetliners who fashioned themselves on the Shadows. The lead singer Ishan Bahar was a classmate of mine at Royal.
The Shadows and Cliff Richard are inseparable as you all know. Talking of the Jetliners, Remember the Coconut Grove!
My Yamaha Genos has and continues to give me, hours of sheer pleasure. Its potential is only limited by your imagination.
This is "Sea Breeze", composed with the Shadows in mind in their style and where else but the splendid seashores of Sri Lanka to play the song! Click on the image below and I do hope you enjoy it as much as I did producing it!.
It is with immense sadness that I record the passing
away of Lakshman (Lucky) Weerasooriya. He lived in Florida, USA. The news was sent to me by Lucky
Abey to be published in the Blog.
The new photo was sent by Lucky and replaces the poor quality image which was extracted from a Batch Reunion Group photo taken
in 2007 at Habarana, Sri Lanka.
Lucky belongs to the famous and illustrious Dodanduwe Weerasooriya clan. He was a General Practitioner based in Englewood Florida, USA. He was married to his teenage sweetheart Ruvini and they have 3 sons. The first two, Romesh and Shanaka, are Dentists and the third Viraine is a Paediatric Gastroenterologist. Lucky had a degenerative neurological condition which made him dependent in his last years. He was well cared for by his loving wife and children.
We all join in sending our deepest condolences to his family.
Until he ran into medical problems, Lucky demonstrated his
artistic skills with several high-quality photographs and paintings which were
published in our blog. The last painting appeared in March 2014. Painting
became a hobby after his retirement.
I am posting one of his superb paintings, “A street in Madrid
after rain” as a tribute.
These are supposed to be sentences exactly as typed by medical secretaries in an NHS (National Health Service) Hospital Trust in the UK I can not vouch for its veracity, but they certainly made me laugh! - Speedy
1. The patient has no previous history of suicide.
2. Patient has left her white blood cells at another hospital.
3. Patient's medical history has been remarkably insignificant with only a 40-pound weight gain in the past three days.
4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. The patient is tearful and crying constantly. She also appears to be depressed.
8. The patient has been depressed since she began seeing me in 1993.
9. Discharge status: Alive, but without my permission.
10. Healthy appearing decrepit 69-year old male, mentally alert, but forgetful.
11. Patient had waffles for breakfast and anorexia for lunch.
12. She is numb from her toes down.
13. While in ER, she was examined, x-rated and sent home.
14. The skin was moist and dry.
15. Occasional, constant infrequent headaches.
16. Patient was alert and unresponsive.
17. Rectal examination revealed a normal size thyroid.
18. She stated that she had been constipated for most of her life until she got a divorce.
19. I saw your patient today, who is still under our care for physical therapy.
20. Both breasts are equal and reactive to light and accommodation.
21. Examination of genitalia reveals that he is circus sized.
22. The lab test indicated abnormal lover function.
23. Skin: somewhat pale, but present.
24. The pelvic exam will be done later on the floor.
25. Large brown stool ambulating in the hall.
26. Patient has two teenage children, but no other abnormalities.
27. When she fainted, her eyes rolled around the room.
28. The patient was in his usual state of good health until his airplane ran out of fuel and crashed.
29. Between you and me, we ought to be able to get this lady pregnant.
30. She slipped on the ice and apparently her legs went in separate directions in early December.
31. Patient was seen in consultation by Dr Smith, who felt we should sit on the abdomen and I agree.
32. The patient was to have a bowel resection. However, he took a job as a stockbroker instead.
33. By the time he was admitted, his rapid heart had stopped, and he was feeling better
A New Series on our Blog. I shall request colleagues to enlighten us on topics of great interest to us as we are all well into the stage where these topics have become more relevant to us. I shall add some relevant prior posts to this category.
The first is on cataracts and cataract surgery by our Batch expert Chirasri Jayaweera Bandara, retired Consultant Eye Surgeon who very kindly responded to my request.
CATARACT SURGERY -Dr Chirasri Jayaweera Bandara
TYPES OF CATARACTS:
1.Senile 2.Congenital
3.Traumatic 4.Metabolic 5.Druginduced
a.Contusion a.Diabetes a. Corticosteroids
b.Penetrating injury b. Galactosemia oral & topical
c.Radiation c.Hypocalcaemia b.Phenothiazines
d.Electrical injuries
e.Chemical injuries d. Wilson’s disease c. Miotics
e. Myotonic Dystrophy d. Amiadarone
e. Statins
f. Tamoxifen
VARIETIES
OF CATARACTS
1. Cortical - Lens opacities in the periphery
2. Nuclear - Lens opacities in the nucleus
3. Posterior
Sub Capsular (PSC) Lens Opacity – Starts as a small lens opacity at the back of
the lens right in the path of light
·Early
decrease in vision is noted by patients in the 2nd and 3rd varieties of
cataracts mentioned above.
·This
is felt mostly when exposed to the sun as pupils get constricted and block the
light through the periphery of the lens. Wearing dark glasses will help initially
at this stage.
·Treatment
for cataracts is only surgery when vision is compromised.
·Surgery
is done when patients find it difficult to carry out their daily routine
satisfactorily.
SURGERY
Historically done under general anaesthesia or retrobulbar
Lignocaine injection.
At present, it is usually with topical anaesthesia (
Lignocaine ) and occasionally with subtenon Lignocaine injection.
IN THE PAST
IntraCapsular Cataract Extraction
(ICCE)
The whole cataract was extracted after pupillary
dilatation and after making the incision at the superior half of the limbus. (corneoscleral
junction).
This was done with the Erysophake or Intracapsular
forceps or the Cryoprobe.
Next, ExtraCapsular Cataract Extraction
(ECCE)
After pupillary dilatation, an incision is made at the
superior half of the limbus, then a Capsulotomy is done where the anterior
capsule is cut in a circular manner with a bent tip of a 26 G needle. The
circular piece of the anterior capsule was removed, leaving an annular anterior
capsule and the whole of the posterior capsule intact.
Once the cataract is removed the vision will only be 1/60 (i.e. only
one meter
distance will be visible).
In the past after cataract extraction patients were
given very thick glasses.
+10 to +12
Diopter power glasses (“ bothal adi “ glasses ) as IOLs were not available.
INTRA
OCULAR LENSES (IOL)
Biometry is done prior to the surgery to calculate the
IOL power to suit the patient's eye measurements.
PMMA
PolyMethylMethAcrylate IOL is
inserted through the large limbal incision after extracapsular cataract
extraction. Because of the relative rigidity of these lenses, a large incision
was required.
CURRENTLY
PHACOEMULSIFICATION CATARACT
SURGERY
Preoperatively,
·Best
corrected vision is noted.
·Cataract
assessment is done at the slit lamp.
·The eyelids for blepharitis, clarity of the cornea, type of cataract and the viability of the
capsular bag and the zonules which hold it in place are examined.
· Intra Ocular Pressure ( IOP) is checked.
· Pupils are dilated and the retina is checked
to assess visual prognosis.
·Fasting
blood sugar, ECG along with a general systemic examination is done.
·Antiplatelets
and anticoagulants are omitted with cardiology guidance, but this is not
compulsory as the incision could be made at a bloodless area through the
cornea.
·IOL power is calculated with biometry.
·The
pupil is dilated fully.
Intraoperatively,
·Topical
Anaesthesia Lignocaine is instilled along with dilute betadine solution prior to
commencing the surgery.
·Sterile
drape applied.
·Speculum
placed to keep the lids opened and eyelashes out of the field of surgery.
·Done
under an operating microscope with the patient lying supine.
·Surgeon
sits at the head end of the operating table or on the (temporal) side of the
head.
·Incision
2.2 mm made with a Keratome at the limbus. (main port)
·Combined
solution with anaesthetic and dilating agent is introduced into the anterior
chamber.
·Methylene
blue is injected into the anterior chamber to stain the anterior capsule of the cataract.
·26 G Needle
tip is bent in preparation of capsulotomy.
·Methylene
blue (injected earlier) is washed off with balanced salt solution (BSS) .
·Viscoelastic
material is introduced into the anterior chamber to maintain intraocular space
for the next steps of the surgery.
·Capsulotomy
is done in a circular curvilinear manner central to the dilated pupil with the
bent tip of a 26 G needle or with a
Capsulorrhexis forceps.
·Circular
piece of the anterior capsule is removed.
·Hydrodissection
is done by injecting Balanced Salt Solution (BSS) under the remaining capsule to
separate the nucleus from the capsule.
·Two
side ports 1.1 mm are made opposite to each other, generally around 90 degrees
from the main port (according to the surgeon’s preference).
·The
Phacoprobe is introduced through the main port into the anterior chamber.
PHOTO 1 PHACOPROBE
Note at the bottom (diagram)
The Ultrasound power line is attached to the centre of the probe, the irrigation and aspiration lines alongside.
Also note above (diagram)
The irrigation port near the tip and
aspiration port at the tip.
· A groove is made in the cataract with the
Phacoprobe as shown below.
PHOTO 2
GROOVING
·The
nucleus is rotated and another grove is made at right angled to the former.
·The
nucleus is first cracked into 2 as shown below.
PHOTO 3 NUCLEUS OF THE CATARACT
CRACKED INTO 2
·The halves are then cracked further resulting
in 4 quadrants.
· Finally it is emulsified and aspirated.
·Then the remaining cortical lens matter is
aspirated and a clean capsular bag with
an annular peripheral ring of the anterior capsule and the whole intact posterior
capsule is left for IOL insertion.
·Foldable
Acrylic IOL is introduced through the main port. The IOL
unfolds
itself into the capsular bag.
·Premium
IOLs – Multifocal/astigmatic IOL s are also available on request.
·The
incisions are sealed by hydrating with BSS which will cause a small localized
opacity lasting only a few minutes
PHOTO 4
FOLDABLE ACRYLIC I.O.L.
POST OP
·Antibiotics,
Steroids and Non Steroidal Anti Inflammatory Drugs (NSAID)
eye drops
are prescribed, with a tailing off dose spanning a month or so
(if uncomplicated)
·Surgery
could be done as a day surgery (in the Private sector in Sri Lanka)
·In the
Government Hospitals in Sri Lanka, the patients are routinely admitted the
previous day and they may be discharged the next day.
·Glasses
are prescribed for near work (presbyopic glasses).
·Patients
who get Multifocal IOL inserted at the time of surgery, could do near work
without the need for presbyopic glasses.
Surgery was
done by my daughter Anjali Jayaweera Bandara Senior Registrar, Eye Hospital
Colombo.
I am thankful
to Anjali for recording her surgery and producing the video with captions.
Note from Speedy...
What follows is a video of a cataract surgery performed by Chira's daughter Anjali Jayaweera Bandara Senior Registrar, Eye Hospital Colombo.
Please read the steps of the surgery given above before watching the video of cataract surgery.
Please click on the image to commence the video.
To see the video in FULL SCREEN, when the video starts, please click the icon at the bottom right (as in any YouTube Video). The icon will appear ONLY when you start the video.
ASK THE EXPERT.........Questions on Cataract Surgery
(sent by Mahendra )
1. Q.
Will all who develop cataracts need an operation if they live long
enough?
A.
Not if the vision is good and you are managing your daily routine satisfactorily.
2. Q. How
important is the timing of when to remove?
A. When you cannot manage your daily routine and feel you need better
vision.
3.Q. Will
a delay in an operation lead to a poorer outcome?
A. When the cataract becomes hypermature,
the proteins leak out through the
capsule,
causing a reaction in the anterior chamber, increasing the intraocular pressure
which results in a painful red eye. This is called Phacolytic Glaucoma.
Then the patient is initially treated to reduce the eye pressure and inflammation preoperatively. In some cases,
vision may not be very good.
4.Q.Is it common for senile macular
degeneration to coexist with cataracts?
A. No,
it generally has a different pathology and is not as common as senile cataracts
5.Q. What are the indications for operation?
A. Poor vision, when the patient cannot manage
the daily routine.
When glaucoma is secondary to cataract
A breach in the lens capsule (in case of
traumatic cataracts)
6. Q. Can both eyes be done at the same time?
A. Not routinely, because of the rare
complication of infection.
7.
Q. If not how far apart should they be if both need doing?
A. Generally, after 3 months but it could be
done before if indicated.
8. Q. How
safe is it?
A. Safe
in good hands.
9. Q. Are there recognised complications?
A. Posterior
capsular rupture (PCR) during surgery.
Rare complication of lens drop into the
vitreous after PCR.
All these could be managed
successfully.
Rare complication of infection.
10.Q. How long does a cataract extraction take to
perform from the time of entry to the theatre to leaving?
A. Between 20 to 25 minutes. ( the surgery
itself 15 to 20 minutes.)
11.Q. Is
it always a day operation?
A. It is day surgery in the
private sector in Sri Lanka but in the Government
sector patients are admitted the previous
day and maybe discharged the following day.
12. Q. Am I conscious during the operation?
A. Yes,
surgery is done under topical anaesthesia or occasionally local nerve blocks.
Not
done under GA unless exceptional cases or opted for.
13.Q. How do I keep my eye still during the
operation?
A. The patient is simply asked
to look straight and it is aided by instruments by the surgeon.
14.Q. How much aftercare is required after the operation?
A. Not much but to instil antibiotic and steroid eye drops and to
wear an eye shield for physical protection.
15.Q.
How soon can I drive a car
again?
A. In a couple of days depending on the
vision in the other eye.
16. Q.
What types of lenses are
used to replace the affected lens?
A.
Foldable Intraocular lenses made of Acrylic material are inserted during Phaco
surgery.
PMMA (PolyMethylMethaAcrylate) material IOLs
are inserted in Extra Capsular Cataract Extraction. PMMA IOLs are rigid could
be inserted after phaco surgery too after enlarging the incision. (If foldable
IOLs are not available.)
Multifocal IOL are also inserted on request by the patient, where spectacles
are not required for close work.
17. Q.What can a person
expect as an outcome and when will the benefits be seen?
A.Excellent outcome
and benefits will be seen immediately intraoperatively provided the rest of the
eye is normal.
18.
Q. Can any Ophthalmologist do it or are
there those who have specialised?
A.
Any Consultant Ophthalmologist,
Senior Registrar and trained Registrar
can do the surgery.
If readers have suggestions for the next Ask the Expert, please email me.
