Welcome to Tapion Hospital

Started 26th November, 2007.

Please contact the following:

Dr. Romel Daniel (Cardiologist / Internist)
Dr. Martin Didier (Internist)
or the Administration Department

Reasons for Pacemaker Implantation

Almost all pacemakers are implanted to treat slow heart beating, which is called "bradycardia." At rest, the heart usually beats about 50 to 70 times each minute, and the heart rate may increase 2- to 3-fold during stress or exercise. If the heart beats too slowly, the brain and body do not get enough blood flow and a variety of symptoms may result.

Symptoms Associated With Need for a Pacemaker

Fainting
Near fainting
Dizziness
Lack of energy
Fatigue
Shortness of breath
Exercise intolerance

Extreme slowing or complete stopping of the heartbeat can be fatal. In other cases, people may have no symptoms but are at high risk for dangerously slow heart rates because of disturbances of the electrical system of the heart. A pacemaker may be recommended for these people before symptoms occur.

The normal heartbeat is controlled by a natural pacemaker in the heart called the sinus node. The electrical signal generated by the sinus node spreads throughout the heart causing it to beat. The most common reason for pacemaker implantation is because the sinus node function becomes too slow from age, heart disease, or heart medications. The other leading cause for pacemaker implantation is failure of the normal electrical signal to reach the main pumping chambers, causing the slow heart rate known as heart block. The artificial pacemaker implanted by physicians corrects both causes of slow heart beating by providing electrical signals to tell the heart to beat at the proper rates and by delivering the signal to the appropriate chambers of the heart.

What to Expect After the Pacemaker

After the pacemaker is implanted, it should be evaluated by your cardiologist every 3 to 6 months with the use of a computer that will provide information about how the pacemaker is working and about the life of the battery. Such periodic checks on the battery usually give a several-month warning before the pacemaker requires replacement because of low battery voltage. The average pacemaker battery lasts about 5 to 8 years. Some people may be advised to have their pacemakers checked monthly over the telephone (known as telephonic surveillance). In the vast majority of patients, the presence of the pacemaker does not change lifestyle or activities in any way. Your cardiologist will review any possible restrictions with you. There are some situations, however, that are to be avoided if you have a pacemaker, such as full-contact sports, which may damage the pacemaker, exposure to arc welding equipment, magnetic resonance scanners (MRI), and high-voltage commercial transformers.

Please contact Dr. Romel Daniel or the Administrative Department

BREASTFEEDING WHAT EVERY FAMILY AND COMMUNITY HAS A RIGHT TO KNOW(UNICEF, 2002)

Breast milk alone is the only food and drink an infant needs for the first six months. No other food or drink, not even water, is usually needed during this period.
There is a risk that a woman infected with HIV can pass the disease on to her infant through breastfeeding. Women who are infected or suspect that they may be infected should consult a trained health worker for testing, counseling and advice on how to reduce the risk of infecting the child.
Newborn babies should be kept close to their mothers and begin breastfeeding within one hour of birth.
Frequent breastfeeding causes more milk to be produced. Almost every mother can breastfeed successfully.
Breastfeeding helps protect babies and young children against dangerous illnesses. It also creates a special bond between mother and child.
Bottle-feeding can lead to illness and death. If a woman cannot breastfeed her infant, the baby should be fed breast milk or a breast milk substitute from an ordinary clean cup.
From the age of six months, babies need a variety of additional foods, but breastfeeding should continue through the child's second year and beyond.
A woman employed away from her home can continue to breastfeed her child if she breastfeeds as often as possible when she is with the infant.
Exclusive breastfeeding can give a woman more than 98 percent protection against pregnancy for six months after giving birth - but only if her menstrual periods have not resumed, if her baby breastfeeds frequently day and night, and if the baby is not given any other food or drinks, or a pacifier or dummy.

Dr. Jacqueline L. Bird
MB:BS DCH DM(PAEDS)(UWI) CHILDHEALTH SPECIALIST
Tapion Hospital, Castries, St.. Lucia. Tel.(758)459-2223
Tapion Clinic, Bridge St. Soufriere 457-1144; Fax 459-2302: jbird@candw.lc

Risks of introducing other foods to breastfed babies before 6 months

Foods or infant formula may be difficult for baby to eat, digest and excrete.
Colic (unexplained fussing and crying) may be exaggerated and prolonged.
Constipation (hard, infrequent, painful stools) often becomes a problem and may persist long after infancy.
Babies will consume less breastmilk which means that:

overall nutrient intake is lowered because the foods given are usually less nutritious than breastmilk, and may also reduce the bioavailability of nutrients in breastmilk (such as Iron and Zinc)
babies receive less of the protective factors unique to mothers milk.
breastmilk production will be reduced.

The risk of developing allergies, eczema.,wheeze, asthma and latent heart disease increases.
The risk and severity of diarrhoea and other infections increases because of potentially greater exposure to germs and decreased protection from breastmilk
Early formula or mixed feeding may exaggerate Iron deficiency of infancy.
Giving solids or other milks early interferes with the contraceptive effect of breastfeeding
For HIV-positive mothers, the risk of transmission of HIV through breastmilk increases when the baby also receives other foods and liquids, known as "mixed feeding". This has implications especially for mothers who are unaware of their HIV status.

Exclusive breastfeeding for 6 months, should be a matter of course, unless medically contra-indicated.

BE PROUD OF YOURSELF! GIVE THE BEST CHANCE AT A HEALTHY LIFE!

HAVE A "BEST"-FED BABY!

THE HEART AND ITS ELECTRICAL SYSTEM The heart is divided into right and left sides. Each side has a chamber that receives blood that is returning to the heart (called atria) and a muscular chamber that is responsible for pumping blood out of the heart (called ventricles).

Blood that has traveled to parts of the body and is now oxygen poor returns to the heart and enters the right atrium. This blood is then pumped by the contraction of the rightatrium in to the right ventricle. The right ventricle in turn contracts and pumps this blood to the lungs, where it absorbs oxygen. The oxygen's rich blood then returns from the lungs to the heart and enters the left atrium, where it is pump into left ventricle. The left ventricle is the most muscular of the heart's chambers and serves as the main pumping chamber of the heart. When the muscular tissue of the left ventricle contracts blood is pumped into the aorta, the main artery of the body, which supplies blood to other arteries. Oxygen's rich blood travels through the aorta to other arteries of the body and then, in turn to the organs and tissues of the body, which require oxygen to function. Oxygen's poor blood returns from these organs and tissues through the veins back to the right atrium of the heart, and the cycle repeats itself.

The contraction of the different chambers of the heart are normally organized in a very specific manner, a special type of electrical impulse travels through the heart and sets off contractions in the chamber as it passes through the chambers.

The hearts normal spark plug is an area of specialized tissue called the SA node which is located in the right atrium. Each time this tissue fires, an electrical impulse is generated that travels first through the right and left atria, signaling these chambers to contract and pump blood into the ventricles. The impulse then travels down into another small patch of specialized tissue called the AV node, which is located between the atria and the ventricles. The electrical impulse is conducted through the AV node and then through specialized pathway into the ventricles, where it signals the ventricles to contract and to pump blood out into the lungs and through the body, the normal sequence of electrical activation of the chamber of the heart is called sinusrhythm. This sequence occurs each time the heart beats, usually about 60-80 times per minute.

High Blood Pressure- Basics for Patients

High blood pressure (or Hypertension) affects more than 155 to 28% of the world. It accounts for more than 6% of adult deaths worldwide and is common to all human populations.

The primary determinants of geographic variation in hypertension are obesity, sodium and fat intake. You can do much about high blood pressure. First and foremost you can prevent it.

If your blood pressure is already high you can control it. High blood pressure is a chronic disease. You may lower your blood pressure in the “short term” but the goal is “long-term control” to prevent other medical consequences.

High blood pressure can wreak havoc on your heart (heart attacks or failure) kidneys (Kidney failure) and brain (stroke).

Most of the sickness and deaths due to high blood pressure is preventable. It may be costly in terms of time and resources, the savings in freedom from illness and a longer life is worth it.

Treating high blood pressure involves making use of the knowledge of all of the known contributing factors that cause hypertension.

Treatment includes:

1. A diet low in salt and fat and involves eating more grains, fruits and vegetables. This changes your lifestyle for the better.

2. Regular exercise is absolutely essential.

3. Elimination of poisons such as tobacco, excessive alcohol, recreational drugs, and excessive caffeine

If lifestyle changes do not work the drug therapy is then necessary to prevent long-term consequences of high blood pressure which are deadly and cause excessive morbidity with personal disability and excessive financial costs to the family and country.

Drugs should not be a substitute for improvements in lifestyle changes but an “addition” to lifestyle changes. You should always be aware of and be honest with your health care provider (HCP) of the following:

1. Duration of the blood pressure (when it was diagnosed).

2. Whether it has always been high.

3. Any family history of blood pressure.

4. Your lifestyle, (smoking, alcohol use, recreational drugs.)

5. Previous treatment with drugs diet, exercise or other means (herbs, bush, teas)

6. Use of drugs that could worsen blood pressure such as steroids, birth control pills or other non-steroidal agents (for pain or arthritis)

7. If you are on medication for blood pressure discuss freely their effects on your lifestyle especially your sex life.

Here are a few simple rules to follow to get an accurate reading if you have a monitor or are in the clinic:

1. Don’t smoke or drink alcohol or coffee within 15 minutes of a blood pressure measurement

2. The length of cuff in your BP instrument should be 80% of the circumference of the upper arm. That means that heavy or muscular people need a larger cuff and children need a smaller cuff.

3. Posture is important. Sit with your back supported and your elbow about the level of your heart (home) or lying down in the clinic.

4. You should rest for several minutes before the measurement.

5. Don’t talk during the measurement

6. Your urinary bladder should be empty before the measurement.

7. Take the measurement at the same time each day.

After you have established your systolic blood pressure (SBP) and your diaslotic blood pressure (DBP) measurement, your doctor or health care provider will determine whether it is “high”.

In 2014, new guidelines were established by the Joint National Committee on Prevention, Detection, and Evaluation and treatment of High Blood Pressure (JNC 8) which we use in St. Lucia.

The new guidelines states simply that the point at which action should be taken is as follows:

1. BP 140/90 under the age of 60 years.

2. BP 150/90 over the age of 60 years if the blood pressure is elevated.

People with diabetes and kidney Disease are special and should be treated as such.

Blood pressure varies widely. You should be aware that:

1. Blood pressure tends to drop quickly sleep.

2. Blood pressure quickly increases when you awaken- in the morning.

3. Respiration and heart rate affect blood pressure-it is increased.

4. Mental and physical activity affect blood pressure.

5. The night time fall in blood pressure is less in the elderly and people with diabetes.

6. Smoking raises blood pressure with each cigarette.

7. Sleep deprivation raises blood pressure.

8. Defecation or a bladder full of urine may raise blood pressure.

9. Consuming more than two ounces of alcohol on a dialy basis raises blood pressure.

10. Your blood pressure may be higher at the clinic.

Remember to check your doctor or nearest health centre or the St. Lucia Diabetes and Hypertension Association (SLDHA) for advice on how to treat your elevated blood pressure.

Remember high blood pressure (Hypertension) is a chronic disease known as the “silent killer” a medical terrorist among us.

Uncontrolled hypertension can lead to block arteries and serious damage to many parts of the body including brain and heart.

Symptoms of Heart Disease and Kidney Disease include shortness of breath, swelling of legs and abdomen.

Stroke can result from blocked arteries to the brain. People of African descent are more likely than whites to develop kidney disease, sometimes as a result of uncontrolled hypertension.

By seeing your doctor or health care or health care provider you can spot these problems early and with the help of a good diet, exercise and medication if necessary bring them under control.

D. Martin Didier, Consultant Physician, Internal Medicine, MBBS, DM, FACP, FRCP, FACC, FESC, Patron os St. Lucia Diabetes & Hypertension Association.