Medical Articles in Cayman Islands
Dr De Alwis Cayman OBGYN offers some great medical articles for your information to answer any questions that you might have.
Baby survives cord wrapped around neck four times
A family in Cayman is celebrating the arrival of a new son with relief after the baby survived a traumatic birth this month…
“In 30 years of practice, I’ve never seen this happen before,” said Dr. Sarath de Alwis, who delivered the child in a Caesarian section operation.
Although umbilical cords wrapped around babies’ neck is not uncommon, Dr. De Alwis said it was “extremely rare” for a cord to be wrapped four times around the neck.
The medical team unwrapped the cord from the child’s neck. Umbilical cords can be cut or untwined from a baby’s neck during delivery.
Ms Scott said she had been going for regular checks at the hospital and was admitted to the hospital at 37 weeks for the baby’s delivery.
“I had an epidural and I knew nothing about it until the next morning when Javier’s father, Jovin, told me what had happened. Then the doctor came in and told me the same thing,” she said.
Ms Scott, who also has two-year-old twins, said her baby was in good health. Javier was 6.2lbs when he was born and has been putting on weight since.
Cords wrapped around babies’ necks can cause foetal distress. In this case, there appeared to be no foetal distress, but the baby was a breach birth so the medical team decided to go ahead with a Caesarian section. Dr. de Alwis said it was not apparant from the scan that the cord was wrapped around the baby’s neck.
Ms Scott was released hospital two days after the delivery and little Javier, who had been transferred for follow-up care to the Cayman Islands Hospital, was released on Monday, 17 May.
“It’s good to have him home,” she said.
Cayman doctor’s surgery recognised
American surgeons are being urged to adopt a keyhole surgery technique developed and named after a doctor in the Cayman Islands…
Dr. Sarath de Alwis, a consultant/specialist of obstetrics and gynaecology attached to Chrissie Tomlinson Memorial Hospital, has been using the innovative laparoscopic entry technique in Cayman for more than two decades.
Now, doctors at Harvard Medical School are using this method and an article on the technique, called the “Modified Alwis Method”, has appeared in the latest edition of the medical journal Reviews in Obstetrics & Gynecology.
The article stated: “Although we acknowledge that no entry method is foolproof, we have yet to experience an entry–related injury using this method, with the lead author [Dr. Jon Einarsson] performing 450–500 advanced laparoscopic cases per year.”
It continued: “We encourage surgeons to standardise entry techniques as much as possible and to seek guidance from other surgeons if they are encountering frequent complications during laparoscopic entry.” Dr. de Alwis introduced his surgical method to Dr. Einarsson, director of Minimally Invasive Gynaecologic Surgery at Brigham and Women’s Hospital and assistant professor of Obstetrics, Gynaecology, and Reproductive Biology at Harvard Medical School in Boston, more than two years ago.
Laparoscopic surgery is a non–invasive method of entering the abdomen though a small incision to enable a scope to be inserted to view the internal organs.
The entry of the scope, through the bellybutton, however accounts for 40–50 per cent of complications arising out of the procedure.
“We developed a technique to minimise that type of injury,” Dr. de Alwis Dr. de Alwis at his clinic at Chrissie Tomlinson Memorial Hospital. said. “We showed it to Harvard medical professors; they accepted it and have published it in this journal under the “Modified de Alwis Method”.
“I’ve been using this technique for decades. I started this a long time ago because of the fear of bowel injury,” he explained.
Using the method, Dr. Alwis said he had removed 47 fibroids from the uterus of one patient and 41 fibroids from the uterus of another last month. He performed his first laparoscopy in Cayman in 1995 and has worked with Chrissie Tomlinson Memorial Hospital since 1996.
His method relies as much on his ears as on his surgical skill because he is guided by the sound of negative pressure being made in the abdomen of the patient to determine exactly where to insert his surgical instruments. Dr. de Alwis explained the method in layman’s terms, at his office in the Chrissie Tomlinson Hospital surrounded by members of the team he said were instrumental in the success of the procedure.
“It’s a simple technique. If you stand on your head, the bowels don’t drop because [of] surface tension that holds things together,” he said, licking his finger and touching a piece of paper which he then lifts off the table, attached to his finger. “That’s surface tension,” he explained.
“The bowels do the same thing. They hold onto each other because of surface tension… In the abdominal cavity, that surface tension prevents bowels from dropping and changing position. Using that principle, we put a little gas in and test to hear the response to that negative pressure inside the abdomen.
“With that technique, we are able to say that we are definitely in the abdominal correct place or not, so we don’t have to put trocars in the wrong place,” he said.
Trocars are metal tubes that are inserted in the abdominal cavity during laparoscopic surgery.
“It is similar to the mouth. If you suck in the lips, when you let them go you hear a noise. That’s the movement from high pressure to low pressure,” he said.
Being able to listen to and identify the exact noise made in the abdomen during this surgery has enabled him to carry out about 10,000 of the procedures. The modified version entails surgeon using monitors and machinery to detect the negative pressure, rather than relying merely on the sound.
With the modified version, a warning alarm will sound and a negative pressure warning will appear on a monitor.
“It is important that in a small country like Cayman, we have a procedure that has been accepted in a leading medical school,” Dr. de Alwis said.
Dr Sarath de Alwis-Seneviratne, a leading consultant/specialist in obstetrics & gynaecology attached to the Chrissie Tomlinson Memorial Hospital (CTMH), has devised a new and effective method of performing the laparoscopic entry surgery that would minimise risks, injury and even death of patients.
This new technique was published in an article entitled “Laparoscopic Entry: The Modified Alwis Method and More” in the Summer 2009 quarterly edition of the ‘Obstetrics & Gynecology – MedReviews’ magazine. Dr de Alwis wrote the article together with professor Jon I. Einarsson of The Harvard Medical School of the United States.
One of the greatest advances in medicine this century has been the advent of laparoscopic surgery, which is a non-invasive way of entering the abdomen through a very small incision to view the internal organs, through the use of a “scope”, called a laparoscope. This type of surgery is also known as “keyhole” surgery and is used for conditions such as ovarian cysts, fibroids, endometriosis, ectopic pregnancies, hernia, certain cancers, gall bladder, appendicitis, etc.
Despite the rapid advances in laparoscopic surgery in the past two decades, the initial entry with the scope into the body has accounted for 40 percent to 50 percent of the complications from the delicate procedure; a number of cases have even resulted in death. Due to this fact, a variety of laparoscopic entry methods have been described and used by doctors, to try to eliminate possible complications.
The article stated, “The basic principle of umbilical entry technique is to take advantage of the negative intraperitoneal pressure that is generated by pulling on the abdominal fascia. We have been performing this technique for several years with good success, but recently heard of a similar technique that has been performed successfully for decades by Dr Sarath de Alwis in the Cayman Islands. In his honour, we have named the technique the modified Alwis method.”
The article concluded, “Although we acknowledge that no entry method is foolproof, we have yet to experience an entry-related injury using this method, with the senior author performing 450-500 advanced laparoscopic cases per year. We encourage surgeons to standardize entry techniques as much as possible and to seek guidance from other surgeons if they are encountering frequent complications during laparoscopic entry.”
Earlier this month, at the CTMH, Dr de Alwis, with the assistance of Dr George Meggs, removed 47 fibroids from the uterus of a patient and reconstructed it. Last week, he removed 41 fibroids and reconstructed the uterus.
Dr Sarath de Alwis has to his credit the first laparoscopically-assisted hysterectomy surgery, with the late Dr Shri Jog, performed in the Cayman Islands, and the first laparoscopic ectopic surgery in 1995.
This article can also be viewed at www.medreviews.com.
The citing of Dr de Alwis for his professional expertise by Harvard is not the first time that he has been recognised for his medical contributions. He was also highly commended by Dr Michael Barrie, a general practitioner at Epsom Hospital, London.
In Dr Barrie’s book “The Surgeon’s Rhyme – A Memoir” first published in 2004, Dr Barrie stated, “How can one change oppressive patients, who make unreasonable demands left, right and centre? How can one, temper the intemperate?” There is a way he says: “Sarath de Alwis-Seneviratne, a gynaecologist with whom I worked at Epsom Hospital, impressed on me the high value of a patient’s belief and expectations. Sarath taught me far more than obstetric techniques.”
He further explained, “He possesses endearing charm and wit every time, bringing round even the most challenging patient to his way of thinking. He has a knack for it and pulls it off perfectly, not just some of the time, but all of the time.”
Dr Barrie relates an instance where he had to look after a special troubled teenager, who was heavily hooked on drugs and was now pregnant with various complications. It was at once clear to him that she would require a special kind of obstetrician – not just a skilled doctor but also someone who would be sensitive to the complexities of the situation, a doctor, who would not malign the patient or pass judgement for the life she led, or vilify her partner for the part he had played in perpetuating her problems. The answer was evident: “I would ask Sarath to look after her. I telephoned him and outlined her case. Not once did I detect a hint of regret in his voice nor hear a soft sigh of reluctance. He was typically enthusiastic, and reassuringly was pleased to have been asked.”
When asked what his guiding principle in medicine is and what makes him happy and fulfilled in his profession, Dr de Alwis replied, “My utmost priority is giving comfort and relief to my patients. I feel a sense of fulfillment whenever I am able to let patients get on in life with dignity. It is also very rewarding being able to treat infertility. Nothing in the world can replace the joy of bringing a baby out in the world.”
Dr de Alwis specialises in treating infertility cases and about 60 percent to 70 percent of his patients comprise this segment. His most recent accomplishment was when he was able to let a 46-year-old woman conceive (without the need for an ‘in vitro fertilisation’ method — IVF) and give birth to a healthy baby, after 28 years of trying. The case of the patient is special because she is a diabetic and on insulin medication.
Dr de Alwis agrees IVF is good but only once all other avenues have been exhausted. ‘In vitro fertilization’ is expensive and the success rate ranges from 9 percent – 60 percent only. In Jamaica it costs around US$6,000 and in the United States from $10,000 – $15,000. At the CTMH, however, the cost of infertility treatment is less than a third of the cost in the United States. But Dr de Alwis still prefers to first use conventional methods like medication and injections, before opting to use IVF. Only a small fraction of his patients have needed to go for IVF. Dr de Alwis maintains a success rate of over 90 percent.
When asked what makes him successful in his profession Dr de Alwis replied, “I am extremely careful and meticulous when operating or treating my patients. I always think that the person I am dealing with or the person lying on the operating table is my mother or wife. It always works for me.” He owes his success to his divine parents, wife Rashantha and son Sacha, without whom he would not have achieved it.
“But I would like to commend all the staff that make up the Chrissie Tomlinson Memorial Hospital. They make my job easier and give excellent support every time. I remember one instance when I requested the latest suture material from a staffer, Shern Williamson. He immediately acted on my request and gave me the best suture material in the world in a week’s time.”
“Not only do I appreciate the staff that makes up the operating team, but also each and every person that runs the Chrissie Tomlinson Memorial Hospital. It’s a team effort. I cannot do everything alone. Credit must be given to the maintenance staff, to the gardener and kitchen helpers; everyone is very efficient and contributes to the warm family atmosphere that brings healing to our patients. Dr Steve Tomlinson likewise believes in the values of dedication, compassion and sincerity,” added Dr de Alwis.
Dr Sarath de Alwis-Seneviratne regularly holds clinic and consultations at the Chrissie Tomlinson Memorial Hospital, including Saturday mornings.
Two babies greet New Year
New Year’s morning saw the birth of two babies in Cayman’s hospitals.
Sian Alexi was the first baby born in Cayman in 2011, arriving by c-section at 1.30am at Chrissie Tomlinson Memorial Hospital, while Joel Angel was the first boy of the year – born at 9.16am at the Cayman Islands Hospital.
Dr. Sarath de Alwis performed an emergency caesarian section on Katie Euter to deliver baby Sian, who was born weighing 5 pounds, 13 ounces.
Almost eight hours later, Myrna Powell also underwent an emergency c-section, performed by Dr. Gilbertha Alexander. Her baby, who was due on 27 December, came into the world weighing 7 pounds, 12 ounces.
Sian’s father, Dwayne Euter, said it felt good to be the father of Cayman’s first baby of 2011, not because she was a new year baby, but because “she’s a princess”.
Ms Powell said she was delighted to be the mother of a new year baby. “I am excited to bring a new life for the new year. That’s the best gift I could ask for,” she said.
Both mothers have been discharged and have returned home, and the mums and babies are all doing well.
Initial baby supplies were taken care of by Lasco Cayman Distributors, which gave both mothers gifts of six months’ supply of baby formula and diapers.
Baby Mikko fought to be born
Little Mikko Irelynd Moxam-Watson seemed to decide she wanted to see the world earlier than her mother and her doctors expected or wanted…
When she was just 25 weeks pregnant, Melanie Montemayor’s baby resolved it was time to be born.
Ms Montemayor’s doctor Sarath de Alwis, a consultant/specialist of obstetrics and gynaecology, explained: “When the mother was about 25 weeks, she presented with a little abdominal pain. I did a scan and found she was two centimetres dilated and her cervix was fully effaced, which meant imminent delivery.”
He managed to arrest the labour and sent Ms Montemayor to Baptist Health South Florida hospital where she remained for four weeks under observation and being given drugs to stop her going into labour.
“After about four weeks, she got fed up waiting in the States and against advice, she left the hospital,” Dr. de Alwis said.
Taking a commercial flight from Miami, Ms Montemayor, who was by then almost four centimetres dilated, returned to Cayman. “I just wanted to come home and get back to normal,” she said of her decision to leave Miami.
“I warned them as I stepped on the plane,” said Ms Montemayor who admitted she did not tell the airline she was 29 weeks pregnant when she checked in.
“I was told to go straight to George Town hospital, but I felt fine so I first went home and cleaned my house,” she admitted sheepishly during an interview at Dr. de Alwis’ office in the Chrissie Tomlinson Memorial Hospital this week, with Dr. de Alwis and Dr. Gillian Evans-Belfonte by her side.
Dr. Evans-Belfonte, who works at the Cayman Islands Hospital, delivered little Mikko because Dr. de Alwis was off Island at the time.
She recalled that when Ms Montemayor first came to her, the mother-to-be was just 29 weeks’ pregnant. “She was quite well, The day after she came over, she wondered if her waters had gone… but there was no evidence of that.
She came back again the following day and stayed in… On the Thursday morning, six days after returning [from Miami], she was not feeling that great and was wondering about the baby’s movements. We did an ultrasound scan and the biophysical profile was zero – zero out of eight.” That meant that there was no signs of movement or breathing from the baby. “We rushed to do an emergency caesarean and the baby came out crying,” she said, adding that the baby also had a breach presentation.
“She just wanted to be here,” said Dr. Evans-Belfonte. “Mom did perfectly afterwards and baby had no problems.”
Ms Montemayor said: “She didn’t even go on a ventilator. I don’t think she even had to have any drugs [apart from antibiotics].”
“The important thing is the baby managed to get up to 29 weeks,” Dr. de Alwis pointed out.
“They kept telling me in Miami thank God Dr. de Alwis got you out quickly, because when I landed I was already 3cm [dilated].
They expected me to go into labour. There were all sorts of precautions being taken and they showed me babies born at 25 weeks, and it was scary,” Ms Montemayor said.
Dr. de Alwis had given the mother magnesium sulphate to try to stop her going into labour and delivering the baby prematurely and the hospital in Miami continued her on that medication. “Fortunately, the uterus responded to the magnesium. That’s why she did not go into active labour,” he said.‘Princess’ doing well.
Now six months old, Mikko, which means “princess” in Japanese, has gained weight at the same rate of a baby born at full term. She can see and hear normally and responds to stimuli, Dr. de Alwis said. “All those are very good indications of normal health,” he said.
Ms Montemayor commended the staff at the Cayman Islands Hospital maternity ward, describing them as “magnificent”. “All the staff at the George Town Hospital and also Chrissie Tomlinson were wonderful. The support I got was just tremendous. I could not have done it without them,” she said.
Dr. de Alwis said it was uncommon for a mother to be dilated to two to three centimetres and not deliver for several weeks. “It’s rare. Normally, once they are three centimetres dilated, they’ll either get into established labour in a few days or pop their waters. Once you have premature rupture of the membrane [a common occurrence with early dilation], 90 per cent of them go into active labour within 48 hours,” he said.
“It is great that the mother was strong enough to make decisions and stay [in hospital] for the crucial period of time of four weeks” Dr. de Alwis said.