The Express Tribune hi five - January 18

Ms JANUARY 18, 2015

ISSUE NO. 135

Your guide to Parkinson’s disease page

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Wrought-iron Vs wooden furniture

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inside En vogue —

Eastern Elegance

Domestic goddess —

Cinnamon madness!

Section In-Charge: Sarah Munir Sub-Editors: Amna Hashmi Nisma Chauhan Feedback: women@tribune.com.pk

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The talented Saira Rizwan

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The buzz

THE EXPRESS TRIBUNE, JANUARY 18, 2015

UNDERSTANDING PARKINSON PARKINSON’S

— THE SHAKING PALSY

MsT sheds light on Parkinson’s disease — one of the most disabling of physical conditions

By Ans Khurram | Design By Omer Asim

Back in the year 1817, English surgeon James Parkinson published a research paper titled An Essay on the Shaking Palsy. Herein, he systematically described a condition which caused characteristic paralysis, diminished muscle strength, abnormal postures and resting tremors in six individuals he had studied. Not only did James manage to distinguish this special type of tremors from other bodily tremors, he also found that the symptoms exhibited by his subjects progressed over time. James referred to the condition that would later bear his name as paralysis agitans or the shaking palsy. Although he died seven years after, his research was continued and 60 years later, the condition was given the name of Parkinson’s disease.

Now, nearly 200 years after James’s discovery, Parkinson’s has become the second most common neurodegenerative disorder in the world, affecting approximately seven million people globally. Out of this, one million patients hail from the United States alone. According to an estimate issued by the Pakistan Parkinson’s Society, about 400,000 people suffer from Parkinson’s in Pakistan. Unfortunately, a large part of our society remains unaware of the diseases completely, let alone understands its causes, symptoms and treatments.

What is Parkinson’s disease?

In a nutshell, Parkinson’s is a degenerative disorder of the central nervous system. It is the most common form of ‘Parkinsonism,’ an umbrella term for a group of motor system disorders sharing four primary symptoms: tremors, slowness in movement, postural instability and rigid limbs.

According to Dr Zafar Iqbal, professor of neurosurgery and founding member of the Zafar Brain and Spine Clinic in Lahore, “Parkinson’s is both chronic and progressive in that is persists over a long period of time and escalates as time goes by. Fortunately, though, it is neither contagious nor hereditary.”

Upon onset, the most discernible symptoms of Parkinson’s are usually movement related but as it progresses, a patient may experience thinking and behavioural problems like depression and even dementia. “It took me over a year to realise something was wrong as I couldn’t exert the same amount of force with my hands,” shares 51-year-old architect Humeira Naim. “My movement was compromised and I could barely hold things by the time I was finally diagnosed

in 2010.” Sixty two-year-old accountant Jamal Khalid had a similar experience in that he sensed something suspicious while driving. “I started having trouble changing gears,” he recalls. “Also, my writing had become slanted and illegible.

That was when I realised I might have Parkinson’s.”

What causes Parkinson’s disease?

Initially, James predicted that the shaky movement and tremors experienced by the patients were caused by lesions in the cervical spinal cord. He was, however, proven wrong in the early 60’s by researchers that indentified a fundamental brain defect that is the hallmark of Parkinson’s disease: the loss of dopamine which promotes muscles activity.

“Dopamine is a chemical messenger of sorts which transmits signals from the brain to the rest of the body to induce smooth and meaningful muscle activity,” explains Dr Zafar. “The loss of dopamine causes the nerve cells in the brain to lose control, thereby making it difficult for patients to control their movements.” Typically, patients suffering from the disease have lost 80% or more of their dopamine-producing brain cells. Unfortunately, the cause of cell impairment or cell death still remains unknown, rendering Parkinson’s an idiopathic disease.

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Do gender and age matter?

According to studies like the Clinical Spectrum of Parkinson’s Disease from Pakistan, 63% of the patients diagnosed are male. Another research released by the UK Parkinson’s Disease Society Brain Bank, showed that age plays a key role in diagnosis and treatment as the disease generally occurs in people over the age of 50. The average age upon diagnosis is 60 years but there have been a few, sporadic cases of patients exhibiting symptoms before the age of 40.

Nonetheless, Parkinson’s affects everyone differently and can progress much faster in some patients than others. For Humeira, walking has now become a luxury.

“Parkinson’s has affected my ability to use my legs the most,” she says. “Not to mention, my right side — hands and leg — has deteriorated more than the left.” In Jamal’s case, Parkinson’s has impaired his speech and most recently, sparked skin rashes. “My voice has become slightly raspier and high in pitch, I think,” he claims.

It took me over a year to realise something was wrong as I couldn’t exert the same amount of force with my hands,” My movement was compromised and I could barely hold things by the time I was finally diagnosed in 2010 Architect Humeira Naim

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THE EXPRESS TRIBUNE, JANUARY 18, 2015

Could you have Parkinson’s disease?

A range of symptoms follow, some of which are minor and ignorable while the others can be rather bothersome. Of course, it is difficult to predict which symptoms will manifest themselves in an individual patient or how intense they might be but most of them can be treated with appropriate medication or physical therapy. According to the Pakistan Parkinson’s Society, the motor symptoms (movement related) include • Tremors: These can be rhythmic, back-and-forth movements of the thumbs and forefingers, also called ‘pin rolling.’ Tremors are rarely disabling and usually disappear during sleep or improve with intentional movements.

• Rigidity: In normal human beings, movement occurs as a result of one muscle becoming active and its opposing muscle relaxing. In Parkinson’s disease, however, this balance is skewed, causing the muscles to become tense and contracted perpetually. As a result, the limbs become weak and patients experience chronic aches.

• Bradykinesia: This refers to the slowing down and loss of spontaneous and automatic movement in the human body. Bradykinesia is quite unpredictable and therefore, extremely problematic in that routine activities (such as washing or dressing) that were once done quickly can now take up to several hours to complete.

• Postural instability: Typically a feature of late-stage Parkinson’s, postural instability hinders structural balance and causes frequent falls and bone fractures. Many patients also develop stooping wherein the head is bowed and shoulders drooped, with the abdomen bent forward all the time.

• Retropulsion and festination: These affect the walking movement of patients directly. Retropulsion causes a backward lean in the body as patients tend to step backwards when walking. Festination, on the other hand, makes patients walk in a series of small, quick steps as if hurrying forward in order to maintain balance.

Can Parkinson’s be managed or treated?

Dr Zafar says that although there is yet to be a breakthrough cure for Parkinson’s, most of the symptoms can be curtailed using different medicines, surgery and multidisciplinary management. Both Humeira and Jamal, for instance, get a variety of treatments to ease their condition. And when medication does not suffice, surgery and deep brain stimulation (DBS) can be helpful.

Levodopa (also called L-Dopa) is commonly administered in order to replenish the amount of Dopamine in the brain.

Unfortunately, only about 10% of the drug crosses the blood-brain barrier as most of it is metabolised to Dopamine elsewhere in the body. This can perpetrate nausea and stiffness in the bones. Dr Zafar suggests Levodopa should be combined with another drug called Carbidopa which, he says, “Delays conversion until the Levodopa has reached the brain cells.”

Of course, even a strong combination of drugs can prove futile in many patients like Humeira who claims homeopathic medicine helped her more. “I take Levodopa and Carbidopa with Dopamine agonists but they didn’t help me as much,” she explains. “Homeopathy, however, helped me regain circular movement in my arms and has fewer side effects too.” For Jamal, the same medication actually sparked dyskinesia (involuntary muscle activity) and he began to have involuntary movements in his left foot.

During the initial stages of Parkinson’s, all treatment should aim to achieve the optimal balance between managing the symptoms and side effects. The administration of Levodopa may be delayed via other medications like MAO-B inhibitors and Dopamine agonists. Surgery is sought only if the drugs given are no longer sufficient and less than 10% of all Parkinson’s patients qualify for it. “Initially, we would perform a thalamic surgery on the brain but that is dangerous,” says Dr Zafar. “Now, we usually opt for deep brain stimulation wherein we drill a hole in the skull and insert an electrode that transmits electric impulses to certain parts of the brain.”

Other than DBS, ablative surgery (the irreversible burning or freezing of brain tissue) and transplantation/restorative surgery are two more options.

Nonetheless, Parkinson’s disease calls more for palliative care to improve quality of life than anything else. Exercise and physical therapy, for instance, has proved to improve motor function in many patients like Jamal, even in the final stages of the disease. “I walk on a treadmill for at least an hour, every day and it has helped reduce the rigidity in my body,” he says. Humeira also indulges in yoga daily to maintain her flexibility.

Sadly, Pakistan needs to improve its current palliative facilities to cater to the growing demand. “There is a lack of neuro-physicians here,” says Dr Zafar. Only a 100 neuro doctors cater to a population of 180 million! Fortunately, the drugs for Parkinson’s are relatively inexpensive and hospitals across the country are striving to become better. For instance, the Lahore General Hospital recently launched DBS but the treatment remains too expensive for most patients.

Inspiration for those suffering from Parkinson’s Mohammed Ali (Boxer) Mohammed Ali, who is considered to be one of the greatest boxers of all time, suffers from Parkinson’s and claims it to be his “toughest fight.” He has also established the Mohammed Ali Parkinson Centre in Pheonix, Arizona which serves as an outstanding resource for patients suffering from movement disorders. Both Michael and Mohammed Ali have gone on record to say that realising Parkinson’s can’t be cured and only managed is important for patients to develop a positive outlook and lead productive lives.

Inspiration for those suffering from Parkinson’s Micheal J Fox (Actor) Many celebrities across the world suffer from Parkinson’s and prove that you can lead a healthy life, even after diagnosis. One such example is veteran Hollywood actor Micheal J Fox who was diagnosed in 1991 and semi-retired from acting as his disease worsened. He has since become an advocate for research to find a cure for Parkinson’s. In fact, Micheal has even established the Micheal J Fox Foundation and was awarded the honoris causa degree by Sweden’s Karolinska Institutet for his efforts in March, 2010.

Non-motor symptoms of Parkinson’s disease There are some neuro-psychotic disorders and bodily impairments that can serve as warning signs for early Parkinson’s. These include: • Depression • Memory loss • Slow thinking • Intellectual loss and dementia • Changes in speech • Difficulty in chewing and swallowing • Urinary and digestive problems • Disrupted sleep patterns • Excessive sweating • Skin problems

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En vogue

Anam Akhlaq displays her new eastern formal wear Coordination: Loop Designer: Anam Akhlaq Makeup: Zara Imtiaz Photographer: Arshad Javed Model: Sonia Haider

THE EXPRESS TRIBUNE, JANUARY 18, 2015

THE EXPRESS TRIBUNE, JANUARY 18, 2015

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Lifestyle

THE EXPRESS TRIBUNE, JANUARY 18, 2015

Wrought-iron vs. wooden furniture — What is your choice for home decor?

By Wishaal Khalid Design By Omer Asim

Recent trends in home decor suggest that wrought-iron has become a thing of the past, replaced by simple, lightweight wooden furniture. MsT sheds light on this current trend and why it might be more suitable for the modern household When American stylist Rachel Zoe claimed that “Style is a way to say who you are without having to speak,” she hit the nail on the head. While her statement was meant primarily for clothing and accessories, it can be applied to yet another aspect of style which we often tend to overlook: home decor.

If friends and family visit you, they aren’t just looking at your living space — they are also looking at a reflection of yourself. Much like fashion, how one decorates and maintains their home can speak volumes about their tastes and personalities and as more and more people are realising this, the world of home decor is undergoing massive changes.

Gone are the days when one would simply visit a carpenter and purchase what was on offer. Interior decorating has become an art itself; a thriving business wherein every customer wants the very best. In these competitive times, decorating trends are constantly evolving and nowhere is this evolution more prominent than furniture.

The wrought-iron revolution that had taken over our homes in the early 2000s, for one, has been replaced by lightweight wooden furniture that caters to our fast-paced lifestyles. Our focus has switched from wrought-iron beds, cupboards, chairs, tables and shelves to all things simple and easy to manage, aka wood.

Initially, wrought-iron was thought to have unlimited possibilities in terms of style. It looked great and the iron could be polished to disguise it completely. Copper and Steel, a Karachi-based design house is one outlet which still swears by the wrought-iron trend and works wonders with metal regularly. Nonetheless, much of their clientele now prefers long-lasting wooden pieces that boast affordability and style. Fahad Aqeel, head of design and architecture at Design 19, another Karachi-based furniture boutique lends credence to this by sharing that, “We base our designs on what customers want, most of who are opting for wood nowadays.” Similarly, Atif Hussain, a senior incharge at lifestyle giant Habitt says that, “Almost every customer that comes in is looking for wooden furniture.”

According to Atif, one of the main reasons for this shift from wrought-iron to wood is that many people lead busy lives out of apartments that are hard pressed for space. “The less space the furniture takes, the more people have for themselves to walk around,” he explains. He also hints at changing preferences within wooden furniture as the heavily-carved, Chiniot wooden antiques that were the norm until a few years back, have been replaced by sleek, modern-looking items that are easy to move around. In fact, many designers suggest that the very process of polishing wooden furniture has changed — or even been eliminated completely — as the more natural the item looks, the more customers seem to like it.

Nonetheless, the variety of colours and types one can pick from is arguably one of the main reasons why people now favour wood over iron. Dark, light and mahogany are just some of the hues in the wooden furniture colour palette. Not to mention, options like teak, timber, walnut and oak, etc, all afford an aura of their own. A few colours and types may also be combined to give an item a unique look. And the best part is that regardless of what one chooses, the furniture is versatile enough to match with virtually any and everything.

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We base our designs on what customers want, most of who are opting for wood nowadays Fahad Aqeel of Design 19

Of course, there is much more to wooden furniture than just aesthetic prowess.

Wood isn’t better only in terms of beauty and versatility but also longevity, especially when compared to wrought-iron which can corrode, become dented or lose its shine with age. Indeed, some wood is vulnerable to fungus, termites and general deterioration but good quality wooden furniture will pose no such problem. It may be placed outdoors in the form of patio furniture but will rarely ever go bad, even in poor weather conditions. Many designers also feel that age, cuts, dents and scratches on wood can actually add to its natural artistry. And should one grow bored of the surrounding theme, wooden furniture can easily be re-painted, re-designed, re-sold and replaced on a very economic budget. In fact, the resale value of high-quality wood is quite high and increases with age. Therefore, for those who like to re-do their homes frequently, wooden furniture can fetch a great price.

However, one must remember that simply opting for expensive items does not guarantee the quality of wood that was used to construct it. Adequate research and sampling must be undertaken to ensure that the furniture they are investing in is pure and sturdy. Lifestyle and decorating magazines, as well as interior decorators, can be a great source of information and help to achieve the style one is hoping for accurately.

Wooden furniture available at local design houses

PHOTO: HABITT

PHOTO: HABITT PHOTO: DESIGN 19

Domestic goddess 7

THE EXPRESS TRIBUNE, JANUARY 18, 2015

By Simee Aamir

Cinnamon Flutes

These twisted flutes are coated in cinnamon, butter and sugar which makes them a perfect fit with warm, winter beverages

Ingredients • Bread slices 8 -10 • Cream cheese ½1/2 cup • Granulated sugar 4-5 tbsp • Butter 1/4¼ cup • Cinammon powder 3 tbsp

Cinnamon — The most popular spice tree throughout Asia Although cinnamon is probably amongst the most liked and commonly used spices in Pakistan, few of us know about it beyond the fact that it is derived from the bark of special trees. While this is indeed true, did you know that cinnamon trees hail from the Lauraceae family, along with avocados and bay leaves? The trees are typically woody, with shrubs but evergreen. Unlike most trees which supply food, the bark of the cinnamon tree has to be dried to extract the spice.

There are two major species of the cinnamon tree which supply most of the cinnamon sold in international markets. The Cinnamomum Cassia is commonly found in the United States and offers dark-coloured cinnamon with a strong taste.

In comparison, the Cinnamomum Zeylanicum provides a sweeter taste and is known as the ‘true cinnamon’. Sri Lanka provides almost 70% of true cinnamon and its largest importer is Mexico. Some other, less common types of cinnamon include the Burmanni and Loureirii from Indonesia, Oliveri from Australia and the Cinnamomum and Tamala from Papua New Guinea and India respectively.

The best part about cinnamon is that unlike other spices, it can be used for a variety of recipes. It can be sprinkled onto typical breakfast foods like bread, cereal or buns.

On the other hand, you can enjoy cinnamon sticks with warm beverages like coffee, hot chocolate and even plain milk. Cinnamon also offers numerous health benefits, such as regulating cholesterol, reducing pain linked to arthritis and even improving the hormonal balance in the human body.

• Semi-granulated or powdered sugar 4 tbsp

Cinnamon and honey drink for weight loss

Method o

• Preheat oven to 200 C. • Melt the butter in a large bowl.

• In a separate bowl, mix the cream cheese and granulated sugar together.

• Mix the cinnamon and sugar powder together as well and set it aside.

• Cut the crusts off the bread slices and flatten each slice out using a rolling pin. Roll them out as thin as possible without tearing the bread.

• Spread the cream cheese and sugar mixture on the flat bread slices and roll them into the shape of a flute.

• Dip the flutes in the melted butter, coating all sides.

• Dip the buttered flutes in the cinnamon and sugar powder mixture.

• Lightly grease a baking tray and place the flutes on it with the rolled edges facing down.

• Bake for about 15 minutes or until the bread becomes crisp and slightly golden.

• Serve warm.

This delicious mix of cinnamon and honey can help you shed pounds fast! Honey boosts metabolism which ultimately spurs the fat-burning process and cinnamon improves insulin function which promotes weight loss.

Together, the two ingredients cleanse the digestive system of parasites, fungus and bacteria and also give off a feeling of fullness in the stomach. Read on to find out how you can avail all of these benefits with just one glass of this quick and easy drink.

Ingredients • Organic honey 1 tbsp • Organic cinnamon 1 tsp • Filtered water 1 cup Note: Two parts honey and one part cinnamon is the ratio you should aim for.

Method • Place the organic cinnamon in a large bowl.

• Boil the filtered water thoroughly and pour it over the cinnamon. Allow the cinnamon to soak for about 15 minutes or until the water cools completely (Hot water will destroy the enzymes in the raw honey and you must therefore, wait until the water has cooled completely).

• Add honey to the cooled liquid and mix.

Your weight-loss drink is now ready.

woman of the week 8 What is the hardest part about working in the industry?

Dealing with labour and getting work delivered on time are just some of the troubles we have to deal with. External issues such as strikes can disrupt the work routine.

What makes for a good fashion show?

A collection that is unique and edgy with an exciting colour palette, good styling, music and choreography.

What sparked your interest in the fashion industry?

I suppose it was my love for clothes. Designing clothes makes me happy.

How do you bring your ideas to life?

I do a lot of brainstorming with my team.

What is the most important thing you keep in mind before styling a costume?

Colours are crucial! I also look at all aspects of designing to make sure it is economical.

How has the Pakistani fashion industry changed over the past few years?

It has grown a lot! The entire industry is much more professional now than ever before. The people in it and those who follow it are more aware and competition has increased gradually. The new talent coming in is creative, meticulous and enthusiastic.

All dressed up

What is the simplest design you think could work for all seasons?

I think kurtas are great.

for an event.

Do you try to keep with trends or make your own?

I like to do my own take on current trends.

With Zara Gul.

Any advice to young women aspiring to become designers?

Work hard, stay focused and be positive.

Fashion Designer

Is the fashion industry welcoming towards new talent? How has your experience of seven years been?

Yes, it is open to anyone who is hardworking, determined and patient.

With Rizwan an d

Lounge workouts for a fitter you Save up on valuable time and money by working out at home Design By Omer Asim If you are anything like us, putting in the effort to dress up and drive to the gym when all you really want is to relax at home probably feels like an ordeal. In fact, the lethargy sets in the second we step out of our offices and rush home to a hearty meal and warm beds.

But there is some good news and some bad news for people like us! The bad news is that avoiding exercise and curling up in bed after dinner can be very detrimental to our health. The good news, however, is that experts have devised a series of simple, time-saving exercises we can do at home and spare ourselves the trouble of going to the gym. Read on and follow our instructions for three quick, fat-burning workouts that can make you fit right within the comforts of your home!

Work out 1: The Superman Step 1: Lie flat on your tummy with your hands stretched out above you and your palms facing each other. Keep your neck aligned with your spine and point your toes backwards.

Step 2: Exhale and deepen your abdominal muscles and core. Steadily, straighten out your arms above the floor while keeping your neck straight.

Raise your legs a few inches and stretch your toes. Maintain this position for at least 10-15 seconds. Remember not to raise your arms and legs too much above the floor lest you pull a muscle!

Step 3: Inhale and lower your arms and legs back gently, going yg g back to the starting position without moving your back or hips.

Adnan Siddiqui.

Workout 3: Forward Lunge W Step 1: Stand upright with your feet together and pull your shoulder blades back, towards your hips. Engage your core muscles to stabilise your spine.

Step 2: Step forward by slowly lifting one foot off the floor and balancing on one leg. Pause in this position for a few seconds. Land the raised foot on the floor and slowly shift your body weight onto it without tilting to either sides.

Step 1Â Step 3: Once in the lunge position, move your hips downward toward the floor. Continue lowering your body to a comfortable position and bend forward at your hips, keeping your back straight.

Step 4: Firmly push off with the front leg and Step 2 return to the starting position. Repeat the movements with your other leg. Do a set of 10 lunges alternating between sides.

Workout 2: Lying Hip Abduction W Step 1: Lie on your right side on the floor, with your right arm under your head for support. Lengthen your body horizontally, keeping your hips and shoulders aligned to the floor. Place your left arm on your left hip and keep you feet neutral.

Step 2: Gently raise the upper leg off of the lower one and exhale while keeping the knees straight and feet in neutral position. Raise the leg above until the hip begins to tilt or until you can feel a tension developing in your lower back. Try to achieve a 45 degree posture and maintain it for a few seconds.

Step 3: Inhale while returning the leg back steadily and repeat the process by rolling over and starting with the opposite leg.