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What is Lymph System? – Written by Dr harold Gunatillake-FRCS, MBBS, FICS, FIACS, AM(Sing)-Health writer


Just like there are arteries and veins to circulate blood carrying nutrients, other metabolites and waste material to and from the tissues and organs there is another system called the lymph system which is filled with watery milkish fluid called lymph carrying nutrients and waste material between the body tissues and the bloodstream? You could compare the two transport systems like the road and railway systems, respectively. The lymph system is composed of very tiny thread-like meshwork of vessels under the skin (subcutaneously) and deep in relation to the blood vessels, mainly accompanying the veins.

Like the railway system there are stations joining this system called nodes, commonly found in the neck, armpit and the groin. These nodes are bean shaped organs and are part of your body’s defensive barrier – the immune system. There are several hundreds of these glands in the body. The lymph carries bacteria and cancer cells into these nodes where white blood cells attack and kill them. These glands enlarge in the process and become palpable. Even after the infection is controlled and or cancer cells killed and prevented from further travel, they can remain enlarged for many years. We call them shotty glands which you can feel by rolling your fingers over the gland.

In the upper neck behind the angle of the jaw there are a few glands labelled as tonsillar glands. These regional glands enlarge when there is an infection of the tonsils. The tonsils could enlarge and become cherry-like and may need removal for the tonsillar gland to subside.

When you have a foot infection like in-between toes, or nail-bed, the groin glands get activated and large and tender- goes into defensive mode to kill any germs that ascend through the lymph vessels in the lower extremities.
There are lymph systems in your spleen, tonsils, adenoids (back of the nasal cavity), and thymus (gland behind the upper sternum (breast bone). These organs fight bacteria and viruses that cause infection or any illness. The thymus gland makes defensive white blood cells to kill germs when you are young and shrinks off as you age and is replaced by fat tissue.

The spleen though defensive organs like the appendix can burst and may require removal. Spleen enlarges as a defensive organ in Malaria and certain kinds of leukaemia. You tend to get infections without you spleen and yearly vaccinations are given to prevent certain bacterial infections.

When your doctor feels the sides of your neck, he or she is checking your lymph glands to see if they are swollen and tender to the touch. Swollen glands are triggered by bacteria and viruses like the common cold virus, and they resolve when the infection clears.

Lymphoma
The white blood cells have a life span- they die and new cells grow. In the tumour lymphoma quite prevalent these days the white blood cells in the glands do not die, but grow and further multiply. With time they lose their defensive function. It is a type of blood cancer that occurs in the white cells and the glands may develop in many parts of the body, including lymph nodes, spleen, bone marrow and other organs. You may have heard Hodgkin’s disease which is one type of lymphoma.

Lymphedema
In Sri Lanka this was prevalent in the past when filarial mosquito was not eradicated. The legs swell, and sometimes the scrotum, too due to blockage of the lymphatic threads in the lower limb, and lymph fluid retention and tissue swelling occurs to cause the oedema. Part of the swelling is due to the reactionary fibrous tissue.
Lymphedema occurs in the upper extremities after radical breast surgery for cancer. When arm-pit lymph glands are damaged or removed in the radical procedure there is blockage of the flow of lymph mainly from the arm. There is no cure to remedy the swelling.

Lymphadenopathy
This is a term doctor’s use when the lymph nodes are abnormal in size, number or consistency and is often used as a synonym for swollen or enlarged glands. Common causes of lymphadenopathy are infection, autoimmune disease or malignancy.

Most times doctors need to do further investigations to find out the cause of the lymphadenopathy.

Acute lymphangitis
When lymphatic vessels get inflamed due to a virus or bacterial invasion through a skin cut or wound you could see red streaks going from the wound towards the nearest lymph glands, very prominent on white skins. This could be accompanied with fever, chills and general sense of illness. You need to see your doctor to check out the cause and treatment.

Lymphatic stasis
This is a situation where the lymphatic flow is reduced due to immobility being seated for long hours on a plane trip. Frequent movements of the ankles in a rotatory manner, sometimes demonstrated on the screen, helps to pump the lymphatic fluid, or regular walks on the isle would do.

Infective mononucleosis
This is caused by Epstein-Barr virus spread through usually the saliva. This affects mostly children, and may not produce any symptoms. In young adults the disease results in fever, sore throat, and enlarged lymph flands in the neck. Most people get better in tow to four weeks, however the tiredness may last for months. In a small percentage of cases the spleen can enlarge and rupture in this disease and needs emergency removal.

The bottom line is if you feel any enlarged glands in your neck arm-pit or groins or red streaks or patches on your limbs see your doctor for a check-up.

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Are you taking a low dose Aspirin, daily? – Good advice by Dr.Harold


Your doctor will recommend you to take a low dose of aspirin after the age of forty. Most people do not take it seriously until they are about 60 years and over.

Why does your doctor does want you to take aspirin, daily? The reason is that a low dose of aspirin daily lowers your risk of getting a heart attack or stroke, by thinning your blood. Normally, clotting of blood occurs by clumping of platelets in your blood stream. At times of a bleed from an artery chemicals are produced to make platelets paste to each other and form a bung. Aspirin tend to delay this process. Further, if you happen to get chest pain (angina) whilst driving, you might escape a severe attack by taking one or two aspirins immediately, which may help to dissolve a clot, if you are on your daily dose.

Recent studies have shown published in The Lancet, that aspirin also prevents cancer. In those studies, Professor Peter Rothwell of Oxford University in the UK, a world expert on aspirin studies confirms that for people in middle age, a daily dose of aspirin can reduce the risk of developing several cancers. Furthermore, the studies have shown that the spread of cancer can be reduced by taking aspirin, daily.

Aspirin may double the chance of survival for patients with gastro-intestinal cancers according to the results of a new study presented at the 2015 European Cancer Congress in Vienna, Austria.

Long term aspirin usage reduces the risk of ovarian cancer in women, and colon, stomach, oesophageal and liver cancers in both sexes.
Those suffering from stomach ulcers (peptic ulcers) should not take aspirin. Aspirin also may give stomach ulcers. Those suffering from age related muscular degeneration (AMD) should avoid taking aspirin daily.

So, for that question in your mind, “Should I take aspirin, daily? –the answer is yes, better start tonight if you are not on it, after discussing with your doctor.

One important side effect of taking aspirin on a daily dose may lead to bleeding in your gut. In most situations, you wouldn’t know whether you are bleeding, as it is so microscopic and goes undetected. If ever you detect dark tarry stools you need to suspect upper abdominal gut bleeding. The stomach acid changes the colour of stools to black. If you detect brown colour stools, the bleeding could be in the large bowel, and detecting fresh bleed is from an anal region as from piles (haemorrhoids).

In most situations bleeding due to taking aspirin stops with time.

You should not take aspirin daily without the guidance and supervision of your doctor.

Some schools of thought are that there is no necessity to take daily aspirin among healthy people having no history of cardiovascular or cancer history in the family.

Some authorities believe that taking aspirin will worsen the situation of bleeding from plaques in the arteries. The platelets under normal conditions form clots in vascular plaques, and may prevent bleeding through ulcerations of the plaques… Taking aspirin may hinder the clotting process and lead to further bleeding and cause heart attacks and stroke. This is the opinion among some doctors.

On the same token, aspirin reduces the ability of platelets clumping together thereby lowering the risk of having a heart attack or stroke. So, your thoughts would be between the Devil and the deep blue sea, as far as deciding to take this life-long medication, or not. Listen to your doctor, and he will guide you on the right direction, whether you should be on aspirin or not.

The risks of bleeding among people who take low doses of aspirin are higher for those who eat fruits daily, eating veggies like the crucifers and spinach, on certain medications like ibuprofen, cortisone preparations and supplements like fish oil. If you suffer from asthma you should avoid taking aspirin. Kids under one year should never be given any paediatric aspirin preparation.

Some people may, as a side effect get nausea and indigestion on taking aspirin. Never take aspirin on an empty stomach.
Some may experience heart burn after taking aspirin. In such an event drink some cold milk and eat a few slices of cooled cut cucumber straight from the fridge to bring immediate relief.

Women who take aspirin daily may increase the chance of pregnancy, especially those having a history of miscarriage.
The main use of aspirin or salicylate is to reduce fever and relieve mild to moderate muscular pains. For the same reason it is used in conditions such as arthritis. It works by blocking certain natural inflammatory chemicals in your body to reduce pain and swelling. Children under 12 should not be treated with salicylates.

Aspirin was the only treatment available for rheumatic fever in the old days. Much larger doses such as three tablets a day, or the Salicylate mixture, was the standard treatment for such diseases. Low dosage aspirin is used only to prevent clotting of blood.
Conclusions: Aspirin is a ‘magic drug’ taken daily by millions of people in various countries, and is the most widely used drug in medicine. Aspirin is also one of the oldest drugs in use, with a history dating back to the period of Hippocrates and Galen. It was then obtained from the bark of the willow tree. The incidence of side effects is minimal compared to the numbers taking this medication right through the ages.

So do not hesitate, to talk with your doctor and take low dosage of aspirin daily. There are similar other medications (antiplatelet agents), that thins the blood, such as Clopidogrel, Dipyridamole, Prasugel and so on. These latter agents are prescribed after heart attacks. Your doctor will decide what’s best for you.

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Should we eat more Bananas? – Written by Dr Harold Gunatillake FRCS, clinic FICS, cialis 40mg FIACS, AM (Sing), MBBS-Health writer

Bananas are available in every little way-side tea boutique or street eating outlet in Sri Lanka on the main trunk roads.  Bananas are kept hanging in most of these places. The secret is that hanging unripe green skin bananas change as they ripen and become sweeter. There are enzymes in bananas that begin to break down starches into sugars. What this means is that it is already digested into sugar for easy absorption, unlike most other fruits. Hanging seems to accelerate this enzyme activity.

You can stop your vehicle and order a bunch and feed your hunger pans, quite fresh and filling, too.  The question is asked how healthy are they, and are they low calorie? They are extremely healthy full of nutrients and most average size banana (6-7 inches-101grams) have approximately 90 calories.

Japanese researchers recently discovered something fascinating about bananas, as they ripens, produces more antioxidants in them.

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Diabetics must eat starchy carbs

Did you know that you eat basically two varieties of carbs, approved both equally beneficial to your health and survival?
They are classified as starchy ones and leafy ones. One cannot survive on the healthy leafy vegies alone you need starchy ones too to feel full, page satiated and get the required micronutrients.

Just imagine you eat many cupful of healthy gotukola or kale, viagra you’ll never be satisfied how healthy they are, and not been able to concentrate on your daily work or relate to colleagues and family. When adding a few starchy vegies you tend to promptly revive.
Starchy vegies contain more complex carbs and more calorie-dense compared to those non-starchy ones mostly rabbits eat. The common starchy ones are corn, potatoes, zucchini, parsnip, pumpkin, butter squash, sweet potatoes, yams and other underground rhizomes.( Rice and wheat are grains and not vegetables).These starchy vegies are packed with energy, nutrients, phytochemicals, antioxidants, vitamins and so on. Some starchy vegies have vitamin C, lutein, zeaxanthin, beta-carotene and beta-crypto xanthin that help to reduce cataract and macular degeneration.

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The Perahera season is starting in a few days in Kandy and a variety of home grown fruits are galore and the vendors are making preparations for their harvest.

The smell of durian fruit is all over, search in the streets and most homes. Mosquitoes so abundant have disappeared temporarily when normally they buzz, malady and the biting starts at dusk. Meanwhile, the monkeys on coconut trees wait to aim a nut on your head, which could be hazardous.

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