Health+ Newspaper March 2016 Issue 04 by Health+ Newspaper

business

To reach a better world in healthcare ... page 13

Sime Darby Foundation actively supports the community in five core areas

www.healthplus.com.my

MARCH 2016

RM5.00(+GST) issue 04 KDN: PP18743/05/2015 (034197)

The Pulse of the Nation

Being overweight or obese is no laughing matter – it can kill if you don’t do something about it quick. Start shedding those unsightly flabs, so that one day Malaysia will no longer be the “fattest” nation in Asia

Jan 2015

95kg

Jan 2014

220kg

Battling Obesity Xtra

Local news+

Zika epidemic poses grave dangers globally ... page 04 Dreadful disease, which WHO labels as a global public health emergency, is taking world by storm

... pages 07- 11

Even macho men get depression

Men + Don’t hide it but get professional help if you think your condition is getting worse and worse

... page 20

02 •

FOREIGNNEWS+

March | 2016

Editor’s Note

Overcoming obesity to stay healthy

eing overweight or obese is no laughing matter. The mere mention of the word “obese” can sometimes spark off debates about political correctness – or incorrectness – as the case may be. The growing number o f o v e r w e i g h t M a l ay sians has earned the country the inglorious title of the “fattest” nation in Asia, in a survey by British medical journal, The Lancet. Health Minister Datuk Dr S Subramaniam reportedly said “almost half the population of Malaysia are either overweight or obese”. This means that 15 million of the 30 million Malaysians are overweight or obese. Despite the prevalence of overweight people in our midst, there’s still much hope as more and more Malaysians embrace a healthy lifestyle. Healthy food restaurants and takeaways are trending, gyms are mushrooming everywhere, jogging and cycling are getting widely accepted as family activities and more people are coming forward for health screenings now than ever before. Campaigns such as Jom Kurus 1 Malaysia (JK1M) have helped many people lose weight. We feature two brave individuals whom JK1M helped shed those unwanted flabs. Nur Farhiyah Ahmad Fadli had never felt the need to lead a healthy lifestyle as she was so used to eating unhealthily as was the habit of most of the people around her. Her unhealthy habit of overeating and inactivity took a heavy toll on her health. She decided to join JK1M after her sister told her about

... “almost half the population of Malaysia are either overweight or obese”.

– Health Minister Datuk Dr S Subramaniam

means

million of the 30 million Malaysians are overweight or obese

the popular weight loss programme. However, the going was tough and she often found herself wanting to quit and slip back to her old habits again. But she eventually prevailed and has since faithfully continued her diet and exercise. Muhammad Aizat Abdul Razak joined JK1M in 2014, after hitting the scales at a whopping 230kg. Like Farhiyah, he used to overeat and did little to none exercise. After years of leading an unhealthy lifestyle, Aizat finally found his turning point in his mother’s words. “I remember her asking me for how long will I be fat. Who will take care of me when she is no more? Those words jolted me to look for ways to improve my unhealthy lifestyle.” Aizat was one of the first participants to join JK1M in 2014 when it was initiated by Kevin Zahri. Aizat is seen as the poster boy for the programme because of his achievement to lose more than 135kg through it. He says the most important factor in losing weight is to control your eating habits. He now enjoys life as a healthier and fashionable individual while continuing to eat healthy and exercise regularly. If Nur Farhiyah and Aizat could shed those unsightly flabs, there’s certainly hope for those who are still battling the bulge. Remember, a millionmile journey always starts with a single step. So, be courageous and start your journey and

keep at it. In conjunction with World Kidney Day celebrated on March 10, the focus for this issue is our kidneys. These complicated and amazing organs do many essential tasks to keep us healthy. Since our kidneys are vital to our overall health, it’s important to look after them. However, the sad reality is many people don’t – in fact some abuse these precious organs until they’re finally injured beyond repair. According to the World Kidney Day website, kidney diseases affect millions of people worldwide, including many children who may be at risk at an early age. It is therefore crucial that we encourage and facilitate education, early detection and a healthy life style in children, to fight the increase of preventable kidney diseases and to treat children with inborn and acquired disorders of the kidneys worldwide. We also have many more interesting reads for everyone, and we invite you to turn the pages to enjoy what we’ve in store for you. Among others, we share with you how to restore the shine to your discoloured teeth, make adorable double eyelids and how trichotherapy can make your hair and scalp problems – and bruised ego – go away. Till we meet again in our next issue, happy reading and may you stay healthy always!

BUSINESS

To reach a better world in healthcare ... page 13

Sime Darby Foundation actively supports the community in five core areas

www.healthplus.com.my

MARCH 2016

RM5.00(+GST) ISSUE 04 KDN: PP18743/05/2015 (034197)

THE PULSE OF THE NATION

Jan 2015

95kg

Jan 2014

220kg

Battling Obesity XTRA

LOCAL NEWS+

Zika epidemic poses grave dangers globally ... page 04 Dreadful disease, which WHO labels as a global public health emergency, is taking world by storm

... pages 07- 11

MEN +

Even macho men get depression

Don’t hide it but get professional help if you think your condition is getting worse and worse

... page 20

Battling obesity

www.healthplus.com.my

Growing problem has earned Malaysia the inglorious title of ‘fattest’ nation in Asia

... pages 02-09

THE PULSE OF THE NATION

MARCH | 2016

LOVING OUR KIDNEYS Our kidneys are amazing organs that do many essential tasks to keep us healthy. Hence, we need to take good care of them. However, the sad reality is many people don’t – in fact some abuse these precious organs until they’re finally injured beyond repair... pages 10-17

SOCSO steps ahead with dialysis support

Scheme provides dialysis facilities for contributors suffering from end-stage kidney failure

... pages 14-15

Taking HIV by the horns

Andrew Tan, living with HIV for 20 years, finds peace helping others with similar condition

... page 18

Huang Ruifu Editor

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Lot 2063A, Jalan Kusta Sg. Buloh, Kawasan Industri Taman Jaya, 47000 Sg. Buloh, Selangor, Malaysia. Tel: +603-6145 8163 (100 lines) Fax: +603 6141 2345 http://www.superiorpress.com.my/ Disclaimer: The content of this publication aims to inform and educate the public on health issues, developments and news, both locally and globally. In addition to our editorial team, we also invite distinguished medical practitioners and other experts to contribute articles on their respective fields of expertise. The information contained in this publication is for general information only, and readers should always seek independent, professional advice and consultation where appropriate. Whilst every care has been taken to ensure that the content is correct, the publisher and editors of Health+ will not be held liable for any loss or damage resulting from reliance upon any information in this publication, including products and services advertised. Unauthorised reproduction of this publication is strictly prohibited, in whole or in part, without the written consent by the publisher. Statements and opinions expressed by writers, contributors and advertisers are not necessarily those of the editors or publisher.

March | 2016

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localNEWS+

march | 2016

Zika epidemic poses grave dangers globally Dreadful disease, which WHO labels as a global public health emergency, is taking world by storm

he Zika virus disease outbreak, which the World Health Organisation (WHO) has labelled as a global public health emergency requiring a united response, is causing great panic and concern around the world. In fact, due to the mounting fears, some quarters have warned competitors and visitors against going for the 2016 Olympics to be held in Rio de Janeiro, Brazil in August. The culprit of the Zika outbreak is the potent Zika virus that spreads to people primarily through the bite of an infected Aedes mosquito called Aedes egypti – the same species that spreads dengue and chikungunya. Scientists believe the species originated in Africa and spread to other continents through shipping and airplanes. And now it’s found throughout the world. It was also speculated that Zika may have arrived in Brazil in 2014, carried by visitors attending World Cup soccer games and it started a chain reaction. Recent news reports said the rampant spread of Zika in Latin America and the Caribbean has affected an estimated 1.5 million Brazilians and, according to WHO, it could infect as many as four million people in the Americas. BABIES WITH ABNORMALLY SMALL HEADS Humans are susceptible to being bitten by Aedes aegypti mosquitoes both during day time and at night. Even worse, it was reported that the Zika virus can also be transmitted from a pregnant mother to her baby during pregnancy, causing microcephaly to the baby, which is abnormal smallness of the head and underdeveloped brain. There had also been recent reports of transmissions via sexual intercourse. WHO says research into the etiology of new clusters of microcephaly and other neurological disorders should be intensified to determine whether there is a causative link to Zika virus and/ or other factors or co-factors. As these clusters have occurred in areas newly infected with Zika virus, and in keeping with good

public health practice and the absence of another explanation for these clusters, the world body highlights the importance of aggressive measures to reduce infection with Zika virus, particularly among pregnant women and women of childbearing age. HIGHER RISKS FOR PREGNANT WOMEN Concerning Zika virus transmission, WHO says women of childbearing age, particularly pregnant women, need to be made aware of the risk factors associated with the disease and given the necessary information to reduce risk of exposure. Also, pregnant women who had been exposed to Zika virus should be counselled and followed for birth outcomes based on the best available information and national practice and policies. Prof Dr Sazaly Abu Bakar from the University of Malaya’s Department of Medical Microbiology tells Health+ that the virus is already in Malaysia, perhaps among monkeys and mosquitoes. “The Zika virus has already been here since 1969 at least,” he says. On the prospect of developing a vaccine against the Zika virus, Dr Sazaly says: “A number of countries have initiated programmes to develop vaccine for the infection, but, unfortunately, not in Malaysia.” As a precautionary measure, WHO recommends that surveillance for Zika virus infection should be enhanced, with the dissemination of standard case definitions and diagnostics to at-risk areas. PREVENTION The prevention of Zika virus infection and disease is the same as that for dengue. The most effective way to prevent the virus from spreading is by eliminating grounds for mosquitoes by means of good environmental practices. Keep drains free from choke, cover containers that hold water to prevent mosquitoes from it, properly dispose of items that can collect water, install mosquito screens on windows, and clear water in saucers of potted plants. And as the saying goes time and again, prevention is better than cure.

... rampant spread of Zika in Latin America and the Caribbean has affected an estimated

1.5

million Brazilians

Deadly virus linked to microcephaly in babies

Microcephaly is a rare neurological condition in which an infant’s head is significantly smaller than a regular size head. It is usually the result of the brain developing abnormally in the womb. Experts say babies born with microcephaly can grow up to have a few or no complications, but it depends on the severity of the condition. In the worst case, an underdeveloped brain can lead to seizures, developmental delays, intellectual disability, problems with movement and balance, hearing loss and visual problems. Microcephaly can be caused by a variety of genetic and environmental factors. But now, there is a strong link between the Zika virus and microcephaly in babies from infected pregnant women. There are no treatments for microcephaly. However, early intervention with supportive therapies, such as speech and occupational therapies, may help the child’s development and improve his or her quality of life. With the Zika virus becoming a global epidemic, it is recommended that pregnant women see a doctor for a baby checkup. However, if by any reason your baby’s head is smaller than normal, talk to your doctor.

by DATUK DR MOHD NOOR AWANG

‘Reverse’ obesity after marriage

BEFORE

AFTER

localNEWS+

2016 | march

adults continue to use tobacco every day. Dr Saunthari says lung cancer is the second most common cancer affecting men in Malaysia, and the third most common cancer with 2,100 Malaysians diagnosed each year. Dr Noraryana Hassan, senior principal assistant director for tobacco control & FCTC (Framework Convention on Tobacco Control) of the Health Ministry, commended NCSM for starting the clinic. “We hope to see more establishments like NCSM encouraging smoking cessation and I am proud to be at the launch to support it. Smoking is a burden in Malaysia and affects not just smokers but their families and the wider public at large. We can minimise tobacco cigarette cravings. NRT has been shown to aid smoking cessation in at least 50% of people trying to quit,” she says. It is important to raise awareness and educate the public on the dangers of smoking to control the spread of cancer. Smoking is linked to at least 16 types of cancers – mouth, larynx (voice box), nasal cavity and sinus, throat, oesophageal, lung, liver, stomach,

Launch of the clinic.

You can do it at NCSM Quit Smoking Clinic Medical help and counselling for smokers who want to kick the habit and deal with withdrawal symptoms

By Ali-Azmin Hassan

UAL A LUMPUR: Smokers have another avenue to kick the habit. The National Cancer Society of Malaysia (NCSM), recognising the harmful effects of cigarettes, recently launched its Quit Smoking Clinic to provide medical help and counselling for those who want to quit smoking and deal with nicotine addiction, withdrawal symptoms and the urge to return to the habit. Speaking at the launch on February 18, NCSM president and medical director Dr Saunthari Somasundaram says: “NCSM is the first cancer-related not-for-profit organisation in the country and over the last 50 years, we have established clinical and diagnostic services as well as provided care and support to people affected by cancer and their caregivers.” “As the theme for World Cancer Day is ‘We Can, I Can’, it is

imperative to continue our efforts on cancer prevention and focus on the dangers of smoking. Smoking cessation is something we can all encourage and this is what NCSM aspires to do by starting this Quit Smoking Clinic for the public. The clinic is an addition to the many different clinical services and facilities that we already provide under NCSM,” she says. The clinic, which is run by NCSM’s highly-experienced smoking cessation specialist, offers subsidised rates and facilities to help, support and advise smokers who want to quit. Its services include a combination of counselling and nicotine replacement therapy (NRT) where smokers are provided with low doses of nicotine to minimise cigarette cravings. Quit smoking services at the primary care level have been available in Malaysia since 2000. The number of public clinics offering such services has increased from 694 in 2011 to 731 clinics in 2014. Some 19,100 Malaysians are killed by tobacco-related diseases every year. In addition, 126,000 children and more than 4.7 million

• 05 pancreatic, kidney, bladder, ureter, ovarian, colorectal, cervical and also acute myeloid leukaemia. Lung cancer is the most common cancer among Malaysian males and the fourth most common among females. At the launch, Abdul Harith Khairuddin, 59, related how he overcame the smoking habit. The father of four started smoking at 15 and only stopped in 2013. He says “overcoming the addiction, the shakes and the mental pressure” rendered him speechless. It has been a year and a half since he started his mission to quit smoking, and he has been “clean” ever since. His advice for those who want to quit: “For the sake of your future, to live happy and successful, you need to overcome your desire to smoke.” For those who need more reasons to stop smoking, quitting the habit not only helps you and your family save some money, it can make you feel and look healthier, live longer and also reduce the risk of impotency. And you don’t have to be shy about your stained teeth too.

“As the theme for World Cancer Day is ‘We Can, I Can’, it is imperative to continue our efforts on cancer prevention and focus on the dangers of smoking.” – Dr Saunthari Somasundaram

Some

19,100

Malaysians are killed by tobacco-related diseases every year

“We hope to see more establishments like NCSM encouraging smoking cessation and I am proud to be at the launch to support it.” – Dr Noraryana Hassan

“For the sake of your future, to live happy and successful, you need to overcome your desire to smoke.” – Abdul Harith Khairuddin

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localNEWS+

march | 2016

It’s the thought that counts Yakult brings Chinese New Year cheer to less fortunate

By Syed Zaid Syed Osman

UAL A LUMPUR: Yakult Malaysia joined forces with its newlya p p o i n te d b ra n d ambassador, popular MyFM radio announcer Jack Lim, to bring cheer to the less fortunate during the recent Chinese New Year. The event – “A small yet thoughtful gift; a simple but meaningful meal” – was held at SJK (C) Kung Min in Pudu on February 28. Yakult, assisted by Jack and Malaysia Scout Club (MSC) members, prepared a simple and healthy meal for about 600 senior citizens and homeless people in the Pudu area. The meal consisted of chicken rice, bottled water, snacks and fruits as well as a bottle each of Yakult Ace and Yakult Ace Light. Yakult also gave each participant an ang pow. The drinking water was sponsored by Jantzen while Massimo sponsored the Chiffon in A Cup snacks.

In conjunction with the event, Yakult, represented by its sales and marketing director Hiroshi Hamada, signed a memorandum of understanding (MOU) with MSC, represented by its president Datuk Seri Chong Lian Foo. The MOU is to extend their collaboration whereby Yakult will provide 300 bottles of probiotic health drink Yakult Ace Light for each of the 24 charity events organised by MSC throughout the year. The sponsorship is worth over RM6, 000. “We appreciate Yakult’s generosity in sponsoring Yakult Ace Light health drinks to us every month for this whole year and they will be given to those in need,” says Chong. Yakult’s public relations and science deputy manager Lim Siew Ling says the event was part of the company’s marketing campaign for the Chinese New Year to educate the public on the health benefits of Yakult probiotics drinks in boosting the immune system and reducing risk of infectious diseases. “It is common for senior citizens to have weak immunity as the ageing process takes a toll on our immune system and exposes us to higher risk of infectious

PARTNERS IN CHARITY: Hamada (left) and Chong after the MOU signing ceremony.

IT’S GOOD: Chong (2nd left), Hamada (middle) and Jack (2nd right) with some of the guests.

diseases. Most people are aware that our immune system can be strengthened by factors such as eating a healthy diet and practising a healthy lifestyle. But many are not aware that drinking probiotics drinks with live Shirota strain like Yakult can also boost our immunity,” she explains. “These facts have been proven through scientific research conducted by Japanese researcher and immune specialist Dr Kazuyoshi Takeda of Juntendo University, Tokyo.” Besides boosting the immune system, the Shirota strain has also

been shown to be able to support a healthy digestive system to avoid problems like bloating, indigestion, food poisoning and constipation that are more common during the festive season due to change in regular eating habits. “When I was younger, I used to neglect my health and didn’t pay much attention to my diet. But now I have become more health conscious. I make sure my family and I eat a healthy balanced diet daily and we have started consuming Yakult to supplement probiotics in our intestines since last year. I consider it an investment for my health for the long term,” Jack relates his experience with Yakult. The Chinese New Year campaign is in line with Yakult Malaysia’s philosophy of prevention is better than cure, a healthy gut leads to long life and to deliver good health to as many people as possible as advocated by its founder, the late Dr Shirota.

the Dewanita, give full support to the programme and may Allah bless this programme for years to come.” Aesthetic consultant Dr Norman Noorawi explained the spa business model and how it can benefit participants. “Age is a matter of number while appearance shows preference,” he says

in explaining why the industry is growing rapidly. Beautician Michael Tan later worked his magic demonstrating the mobile spa to those present. The MOU signing ceremony was witnessed by guest of honour Datuk Mohd Sheriff Mohd Kassim and KLMCC president Datuk Dr Sharifuddin Musa.

Helping women to earn own income By Syed Zaid Syed Osman KUALA LUMPUR: An entrepreneurship programme was launched recently to help women start their own business to achieve financial freedom and economic stability. A soft launch of the programme was held on March 3 in conjunction with the signing of a memorandum of understanding (MOU) between Kuala Lumpur Malay Chamber of Commerce (KLMCC) and Eiva Healthcare Sdn Bhd. In his speech, Eiva Healthcare chairman Dr Mohd Noor Awang says besides tapping the great potential in the aesthetic industry which is growing globally, the company wants to help local women

earn their own income. “The nature of the business is simple. It’s to provide participants with the equipment and skills required for a house visit spa treatment so they can create their own name in the trade,” he says. “Assistance can be obtained for we have worked out a plan with Koperasi Perkhidmatan Pelajaran Nasional (KOPENAS) and an easy payment plan with Bank Rakyat for those who need the capital to start.” “I sincerely hope this will be helpful for women to realise their dreams to achieve financial freedom,” says Nur Fatin Ibrahim, representing Dewanita, the women’s wing of KLMCC. “We,

MODUS OPERANDI: Dr Mohd Noor explaining how the spa business works.

BEAUTY MATTERS: Age is a matter of number while appearance shows preference, says Dr Norman.

localNEWS+

2016 | march

Gathering of great minds Medical practitioners share and exchange ideas on new technologies and practices at 7th ENT Summit

By ALI-AZMIN HASSAN

UALA LUMPUR: Some 150 doctors, medical practitioners and experts had a fruitful time at the recent 7th ENT Summit sharing, discussing and exchanging ideas on new technologies and practices in their respective fields. The two-day conference organised by Prince Court Medical Centre was held on February 26 and 27. Its medical director Datuk Dr Kuljit Singh says: “There’s a lot of exchange of ideas between experts and the audience. The audience are also considered experts because they are also operating and treating patients daily. They are not here to learn the basic stuff. They are here to discuss the usual issues patients face or what they face during their practice.” Topics discussed included septoplasty, pharmacology, nasal stem research, nasal airway evaluation and treatment, rhinology and infectious throat diseases. Dr Peter Catalano, professor of otolaryngology and one of the keynote speakers, tells Health+ the interactive conference is one of many educational avenues for doctors and medical experts to share their experiences and discuss practice-related issues.

• 07

UNITED: Representatives from THONEH and QUEST finalised their partnership to benefit the students.

NIOH enters into twin partnerships By NORMAN HUSSAINI

SHARING IDEAS : They are here to discuss the usual issues patients face or what they face during their practice, says Dr Kuljit (right). With him is Dr Catalano.

and also in a less morbid way. Hence, it allows for shorter recovery time. Patients can return to work in a day with no pain, and no external evidence of any surgery,” says Dr Catalano. Many hospitals in Malaysia have started using these new technologies, albeit not widely. “The reason is surgeons are sometimes used to what they’re doing. We need to convince surgeons and doctors that they need to adapt new technologies and techniques so that the duration of patients’ length of stay at the hospital and recovery is shortened. This is the reason for this summit,” says Dr Kuljit.

progressive medium “It’s a very progressive medium in terms of management of problems and new technologies to address problems. Practice changes all the time. Our understanding of problem changes as we get more information. New technologies are developed to treat patients in new and better ways and less traumatically (than before). It’s very important to stay current. This meeting allows us to interact on a very progressive front. So it’s a very stimulating meeting.” There was also a live surgery performed on three patients to show and tackle issues such as nasal obstruction, headaches, sinus infections, stuffiness and other common issues faced by medical practitioners. “The surgery demonstrated new technologies that allow surgeons and doctors to do it in a safer and quicker way, use less anaesthesia

nasal obstruction One of the topics discussed by Dr Catalano which has generated much interest lately was nasal airway evaluation and treatment. “Because everybody knows somebody who snores, has sleep apnea, allergies or doesn’t breathe well. There’s a lot about nasal obstruction which is probably the key element in facial growth and development or abnormal facial growth and development, as well as sleep patterns and behaviour. “Our understanding of nasal breathing is changing with time. You think everybody knows how to breathe but that’s not true. In the last 5-10 years, there is more information and better understanding of how we actually breathe through our nose and the impact of breathing on the rest of your health,” he says.

STAYING PROGRESSIVE: It’s very important to stay current, Dr Catalano.

ADAPTING TO CHANGE: We need to convince surgeons and doctors that they need to adapt new technologies and techniques, Dr Kuljit.

PETALING JAYA: The National Institute of Ophthalmic Sciences (NIOS), the academic arm of Tun Hussein Onn National Eye Hospital (THONEH), has established two academic collaborations and partnerships with QUEST International University Perak (QIUP) and Lincoln University College (LUC). They signed a memorandum of understanding (MOU) on with QIUP on February 22, and LUC on March 10 to work together in areas of mutual interest such as co-operating and working together in student selection and providing students’ placement and admission into degree programmes. THONEH and NIOS were represented by general manager and chief executive Dr Norasidi Salim al-Haj. QIUP was represented by vice-chancellor Datuk Dr Raman Narayanasamy and chief operating officer Nicholas Goh, while LUS was represented by pro chancellor Datuk Dr Bibi Florina Abdullah. Under the MOU, the three parties will continue to explore further potential academic opportunities. “We are here to sign an MOU to work with NIOS and THONEH. Since both of us are investing in the same area, we have decided to work together. The Health Ministry has encouraged us to stop the competition and create healthy partnerships with one another,” says Goh. “This sets an example on how we need to move forward. It is important for us to collaborate with entities such as QIUP and LUC instead of competing. THONEH, QIUP and LUS have their own strengths and this MOU will ensure we work together to tap each other’s strengths,” says Dr Norasidi. “It has always been the hope of NIOS to widen its collaboration with other IPTS (private higher learning institutions) to other field of knowledge that will equally benefit the university as well as optometry in developing smart-partnership in academic joint collaboration.” WORKING TOGETHER: Dr Raman (left) and Dr Norasidi preparing to for the signing between QIUP, THONEH and NIOS.

DONE DEAL: Dr Bibi (left) exchanging documents with Dr Norasidi after signing MOU between LUC, THONEH and NIOS.

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Commemorating world cancer month Nilai Medical Centre holds community event to raise public awareness on prevention and management of disease

By Syed Zaid Syed Osman

UALA LUMPUR: To mark World Cancer Month in February, Nilai Medical Centre in collaboration with Breast Cancer Welfare Association and Lions Club of Nilai organised a

community event on February 27. Nilai Medical Centre director of business development and operations Vincent Wan says the corporate social responsibility event is to create public awareness on the prevention and management of cancer. “The intention is to educate the public about cancer. Parents are encouraged to bring their children so they can learn more about cancer at a young age,” Wan says in

SAVING LIVES: The blood donation drive collected 54 bags of blood from donors.

an interview. “It is important for the public to know that preventing certain types of cancer is possible.” The event, which attracted over 200 people, provided free health checks on blood pressure, glucose, body mass index, clinical breast

PREVENTION IS KEY: Wan implores the public to know about cancer so that prevention can be done. examination, mammogram as well as a cancer exhibition booth, health talk and blood donation. The blood donation booth set up by Hospital Tuanku Jaafar collected 54 bags of blood from donors. Besides Bravida, which provides breast cancer prosthesis and chemotherapy support, staff from Kotra Pharma and CCM Pharmaceuticals also shared

cancer-related information with the public. The medical centre’s consultant clinical oncologist Dr Hayani Abdul Wahid gave an informative talk on “Cancer – What you must know” which was attended by more than 50 participants. The talk focused on the types of cancer with preventable causes and how to avoid them. The second part of the talk on cervical cancer was given by gynaecology oncologist Dr Viknesh Visvalingam. Three cancer survivor patients of Nilai Medical Centres also shared their experiences. Dietician Aida Noorsyuhada Zuraidi demonstrated how to prepare two high-fibre meals for the patients. The medical centre also provided day care services for children while the adults were participating in the event. To keep the children occupied, there was also a colouring contest which attracted 60 participants. The day ended with a lucky draw for those who completed their health check, and this was followed by lunch. Nilai Medical Centre is a multidisciplinary hospital established since 1999 pioneering in cancer treatment and clinical research. It also offers a wide range of other services such as in cardiology, ear nose and throat, gastroenterology, general surgery, internal medicine and interventional radiology. It has 24 consultants supported by state-of-the-art equipment as well as skilled and experienced nurses.

ALL EARS: The crowd listening attentively to Dr Hayani.

foreignNEWS+

2016 | march

hildless couples from around the world have been left in limbo after the Indian government revealed plans recently to ban them from the country’s booming multi-million dollar surrogacy industry. The industry has exploded in recent years with thousands of infertile couples flocking to India, one of only a handful of countries offering cheap surrogacy using skilled doctors and with relatively little red tape. However, the unregulated industry’s growth has sparked debate about exploitation of the 25,000 mainly poor Indian women whose wombs are hired to carry couples’ embryos through to birth. After announcing plans for legislation banning commercial surrogacy, the government issued a notice to the country’s 350-odd fertility clinics, ordering them “not to entertain any foreigners”. The move sparked an outcry from fertility specialists, along with rallies by surrogate mothers, pressing the government to dump the decision in favour of strict regulation of the industry. “Why should foreigners be discriminated against? We are all human beings,” Nayana Patel, one of India’s leading IVF specialists, tells AFP. “I have been doing this for 11 years and it’s a beautiful arrangement. Banning it is not the answer,” Patel, who heads the Akanksha clinic in western Gujarat state, says. Clinics scrambled to reassure confused and anxious foreigners who have already started the process, but others have been told to put their plans on hold. “We have told couples who are still at the very start to wait and watch what happens,” Patel says, adding her clinic has given such advice to 30 to 40 couples in recent days. Two clinics in Mumbai were successful in getting the ban lifted temporarily for couples already

• 09

Anguish over India’s ‘rent-a-womb’ ban Many childless couples from around the world in a fix after India bars cheap surrogacy expecting a surrogate birth, after taking legal action. But their lawyer Vikrant Sabne says the Bombay High Court’s order did not apply nationally. Shivani Sachdev Gour, head of Surrogacy Centre India in Delhi, says it was “logical” that parents already signed up be allowed to continue. “There are no guarantees but if they have started the process they should be able to keep going,” she adds. A health ministry official declined to comment until after the Supreme Court resumes hearing a lawyer’s petition in November that seeks to shut down the “unethical” industry. only option After arriving from Ireland, one couple said they were determined to go ahead, confident that since they already registered with a clinic, “our case holds up in a court of law”. Unable to have children and

SURROGATE BABY: The move sparked an outcry from fertility specialists, along with rallies by surrogate mothers, pressing the government to dump the decision in favour of strict regulation of the industry.

born with a heart defect that rules out IVF treatment, the woman said they turned to India as a last resort after learning adoption was outlawed in Ireland for people with certain medical conditions. “Realistically this is our only option,” the 35-year-old from Cork, who did not want to be named, said at a Delhi clinic. “Ninety-nine percent of the children born this way will have a more loved life because their parents have made so much of an effort to have them,” her husband, also 35, added. “It would be madness to ban it.” After opening up to surrogacy in 2002, India has become one of the world’s leaders, generating between US$500 million and US$2.3 billion annually, according to various estimates. Russia, the Ukraine and some US states are among those that also allow commercial surrogacy. But India’s clinics charge couples between US$20,000 and US$30,000, a fraction of the price in the United States. Thailand passed a law last year banning commercial surrogacy for foreigners after a series of highprofile scandals. Nepal’s top court also closed the doors in August, leaving dozens of expectant parents in turmoil, before the government stepped in, granting visas allowing them to take their babies homes. India has steadily tightened its industry, barring gay couples and single people from using surrogates in 2012.

Denied payment Currently, couples and surrogate mothers, many of whom live in shelters during pregnancy, sign a contract before starting the process. However, research shows some surrogates do not receive a copy, while others do not understand its contents. Many women, some illiterate, have children of their own, but few have undergone a caesarean – commonly used in surrogate pregnancies – and are unprepared. Others are not paid the promised amount and lack health insurance if things go wrong, the Delhi-based Centre for Social Research says. But Manasi Mishra, the centre’s head of research, says a ban would only force the industry onto the black market and out of reach of regulators. “The industry will go underground and the bargaining capacity of the surrogates will diminish even further,” Mishra tells AFP. For Manu Kami, the reasons for bearing another woman’s child were clear. Her husband earns 6,000 to 7,000 rupees (US$96 to US$106) a month as a cook, barely enough to feed their two young children. After being paid 300,000 rupees (US$4,500) for her first surrogate pregnancy to an American couple, Kami could afford school fees and a new home. “It has one bedroom and a kitchen and a bathroom,” the 28-year-old says with a smile. – AFPRelaxnews

Video game addicts more responsive to danger, but highly distractible The brains of video game addicts are different from those of non-addicts as evident in a recent American study published in Addiction Biology. The study, carried out in South Korea, focused on the brains of young video game addicts. The findings suggest that the brains of these inveterate players are wired differently. The American researchers observed hyperconnections between certain regions of the brain in these compulsive gamers, mainly regions connected with vision and hearing. The scientists believe that this situation could have positive and negative effects on their behaviour. On the one

hand, it helps them to respond to new information, including danger, and to concentrate on precise objectives. On the other hand, this hyperconnectivity seems to be associated with distractibility and poor impulse control. The study involved the researchers taking an MRI (magnetic resonance imaging) of 106 boys, aged between 10 and 19, who were seeking treatment for video game dependency. These scans were compared with those of 80 boys who did not have internet gaming disorder. They were then analysed for regions which were activated simultaneously when the participants were at rest. After having analysed activity in 25

pairs of brain regions, with 300 combinations in all for the two groups of patients, the researchers identified a very strong connection between the two regions which could be responsible for increased distractibility – the dorsolateral prefrontal cortex and the temporoparietal junction. The more simultaneous activation in the two regions, the greater the connection between them. “Most of the differences we see could be considered beneficial. However, the good changes could be inseparable from problems that come with them,” says Dr Jeffrey Anderson, associate professor of neuroradiology at the University of Utah School of Medicine in the US.

VIDEO WIRED: The brains of video game addicts are different from those of non-addicts as evident in the study. Dr Anderson says this increased coordination between these two brain regions is also seen in patients with schizophrenia, Down’s syndrome and autism, and in people with poor impulse control. It is not yet known whether the video games change the brain’s wiring or if differences in the brain’s wiring increase the attraction to video games. – AFPRelaxnews

10 •

foreignNEWS+

march | 2016

Early, intense intervention helps schizophrenics recover Talk therapy and low doses of anti-psychotic medication more effective than routine treatment

alk therapy coupled with early intervention and low doses of anti-psychotic medication can be

more effective for people with schizophrenia than routine treatment, says a major US study. The research published

in The American Journal of Psychiatry suggests a new and more effective approach to mental health care, which many experts complain is

sorely lacking in the United States. “We feel that getting the right treatment at the right time is really key,” says lead researcher John Kane, professor and chairman of the department of psychiatry at The Hofstra North Shore-LIJ School of Medicine. “That means a combination of medication and family psycho-education, supportive education and employment, and individual therapy,” Kane tells AFP. “And that should be given by a team that is working together and focused on helping the patient.” The project, funded by the National Institute of Mental Health, was implemented in clinics around the country and involved 404 patients. In an approach modelled after programmes already in place in Australia and Scandinavia, a team of specialists “offered recovery-oriented psychotherapy, low doses of antipsychotic medications, family education and support, case management, and work or education support, depending on the individual’s needs and preferences,” says the study. The results published were based on two years of follow-up with the patients, some of whom reported learning how to better control their reactions to hearing voices. Those who were treated with the new approach “remained in treatment longer, and experienced greater improvement in their symptoms, interpersonal relationships, quality of life, and involvement in work and school,” compared to those given routine treatment. So just what is routine care in the United States? Part of the challenge is that it varies enormously, says Kane. “Some clinics may be doing a terrific job, other clinics maybe less so,” he tells AFP. In some places, patients may not get the same level of educational support for themselves and their families, to help them deal with their illness, he says. “We need to make routine care a little bit more uniform and a little more evidence-based so that we know that everyone is getting access to the things that have been shown to be helpful.” As for costs, the researchers have not yet published any projections or calculations, but Kane says he believes the new approach will prove cost-effective in the long run. Drug doses The study also did not publish any data comparing how different doses of anti-psychotic medications affected patient outcomes. “When people are in their very first episode of psychosis, they will often benefit from lower doses of medicine than are used to treat people who have been ill for a long time,” Kane explains.

foreignNEWS+

2016 | march

Negative feelings on ageing impact memory, hearing Study results suggest correlation between negative views on ageing and poor performance in memory and hearing tests

hen older adults hold negative feelings towards ageing, it may have a negative impact on their memory and hearing, results from a Canadian study

suggest. Researchers from the University of Toronto, Baycrest Health Sciences, the James H Quillen VA Medical Center, and Phonak AG together co-authored the study, which examined three variables in 301 older people aged between 56 and 96. The team looked at participants’ views on ageing, their self-perceptions of their memory and hearing abilities, and their actual memory and hearing performance. It is the first time that a study has looked all three of these variables together with the same group of participants. To assess the variables, researchers asked the participants to complete a series of hearing tests and memory recall tests, as well as respond to a series of questions and statements relating to their own perceptions of their hearing and memory abilities. To record their views on ageing, researchers asked participants to imagine 15 different situations and rate their concerns about each one based on age. They were also asked to answer questions on issues that might worry them as they got older such as being alone, losing their independence, and finding contentment in their lives. The results showed a correlation between negative views on ageing and poor performance in memory and hearing tests, with lead author of the study, Alison Chasteen, concluding that the strong correlation between the variables occurs “when a negative view impacts an individual’s confidence in the ability to function”. “Those feelings are often rooted in stereotypes about getting older and comments made

“That doesn’t mean that we found that the use of lower doses in the experimental group contributed to their advantage,” he says. “We haven’t even analysed the dose data yet.” Rather, he says the take-away message for people who may be suffering from psychosis or schizophrenia should be to aim for a proper combination of medication and talk therapy. Important study “This was an incredibly important study,” says Katherine Burdick, professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai in New York.

NEGATIVE FEELINGS: The research team believes the negative beliefs on ageing can cause stress in an individual. by those around them that their hearing and memory are failing,” says Chasteen, “Knowing that changing how older adults feel about themselves could improve their abilities to hear and remember will enable the development of interventions to improve their quality of life.” Another study published recently in the journal Psychology and Aging and carried out by the Yale School of Public Health, linked negative beliefs to a possible increased risk of Alzheimer’s, with those who held negative beliefs on aging showing a decrease in the volume of the hippocampus, the area of the brain associated with memory, and an increase in amyloid plaques and neurofibrillary tangles, the proteins that build up within brain cells. All three of the brain changes are strong indicators of the disease. The research team believe the negative beliefs on ageing can cause stress in an individual, and it is this stress which leads to the brain changes that contribute to the disease. – AFPRelaxnews

“The results provide support for what has been consistently acknowledged by most researchers and clinicians – that the earlier we can intervene, the better,” says Burdick, who was not involved in the research. Jeffrey Borenstein, president and CEO of the Brain and Behavior Research Foundation, says the approach shows how it is possible for people to regain their mental health. “Unfortunately, too many people do not receive this level of care,” he says. “While this study is a step forward, we need to put funding into additional research to develop even more effective methods of treatment and prevention.” – AFPRelaxnews

• 11

Children’s toys can affect language learning A US study has found that traditional children’s toys such as wooden puzzles, rubber blocks and shape-sorters are more effective in increasing the quantity and quality of language in young children than modern electronic toys that produce lights, words and songs. In the study, published in the journal JAMA Pediatrics, a team of researchers from Northern Arizona University, USA carried out a controlled experiment with 26 children aged 10 to 16 months old. The children were given three different sets of toys, electronic, traditional, and books, for playtime with a parent in their own homes. The sound of the playtime was recorded in the home using audio equipment for researchers to analyse later. After listening to the recordings, the team found that when compared to playing with books and traditional toys, playing with the electronic toys decreased the quality and quantity of language used by both children and parents, with fewer adults’ words, fewer parental responses, less content-specific language, and less back-and-forth conversation. BASIC PLAYTHINGS: Traditional toys like wooden puzzles, rubber blocks and shapesorters are more effective. Parents also used fewer words and less contentspecific words when playing with the traditional toys than with the books, but the authors noted that the largest and most consistent differences were between electronic toys and books, followed by electronic and traditional toys. The researchers concluded that both book reading and play with traditional toys are effective for facilitating language and encourage “a rich communicative interaction between parents and infants,” whereas playing with electronic toys, which are often promoted as being educational and are often more expensive than traditional toys and books, should be discouraged. Limitations to the study, funded by a research grant from the American Speech-Language-Hearing Foundation, include the small sample size and a lack of diversity in the participants who were all of a similar race/ethnicity and socioeconomic status. However the study still supports previous research, with the American Academy of Pediatrics (AAP) releasing last year its first official policy on the benefits of reading to children in infancy. Reading with young children “stimulates optimal patterns of brain development and strengthens parent-child relationships at a critical time in child development, which, in turn, builds language, literacy and social-emotional skills that last a lifetime,” the AAP guidelines said. The AAP also advised that the best kind of learning for children is through interactive play with humans and toys, not electronic gadgets and screens. “We can stimulate greater brain development in these months and years,” says Peter Richel, a fellow of the AAP, adding, “I do see earlier word recognition, earlier phrases and sentence formation, and singing – I always recognise that in those who are exposed to daily reading.” – AFPRelaxnews

12 •

business+

Zooming into Zummo Juicers You can now enjoy benefits and goodness of pure 100% orange juice from vending machine

uicing is the future. While some established booths and shops sell juices, Instafresh Sdn Bhd brings in all-new freshly-squeezed juice vending machines that produce Poster_MRI_FINAL_co.pdf 1 18/03/2016 9:46:47

CMY

luxury-grade juices in a moment’s notice. The technology was brought back from Europe by Syed Farid Alattas, a brilliant entrepreneur who simply has the passion for healthy living. Together with his wife Dalena

march | 2016

JUICE TRIO: Syed Farid (left) with sales director Mohd Zukhri Che Chim and Dalena. Berhan, he founded Instafresh, the sole authorised distributor of Zummo Juicers vending machines in Malaysia. By Syed Zaid The couple’s plan is to educate the Syed Osman public on the benefits of drinking citrus fruit juices while promoting healthy living locally. Instafresh has been distributing the vending machines for two years now. The first year was spent surveying the public acceptance of its business idea – to sell freshly-squeezed juices from vending machines. Through hardship, smart work and endurance, Instafresh has established its name in the local juice market and plans to take the business to the next level. The mother company, Zummo Innovaciones Mecánicas SA, was founded in Spain in 1992. It specialises in designing and manufacturing automated citrus fruit juicing machines for catering trade purposes. Zummo Juicers offer patrons freshlysqueezed, 100% orange juices with no sugar, water or any preservatives. The process is shown through the machine’s Open View system that shows the squeezing process from the start. The patented Efficient Vertical System was created specifically to squeeze the maximum amount of juice for every citrus fruit. Juices are not new Juices are not new to Malaysia as “fresh orange” juices can be easily purchased in local food and beverage outlets as well as supermarkets and other retail outlets – the sweet, watered-down ones at least. Syed Farid, who is Instafresh’s marketing branding director, dislikes the idea of commercialised orange juices as they lack the taste and nutrition of fresh juices he has in mind. So he decided to bring in Zummo Juicers to show the public the real potential of citrus juices which everybody can enjoy. Lamenting that most people are still unfamiliar with drinking pure juices, Syed Farid is determined to change that through the company’s products. He wants to promote natural cleansing through organic resources rather than using synthesised supplements, so that the public can enjoy freshly-made juices and healthy living. Besides selling juice vending machines, Instafresh plans to help customers who need special vegetables or fruits. It plans to introduce an all-juice diet programme tailored for those determined to lose weight. “If we have to blend cabbages for you, we will blend cabbages,” says Syed Farid. “Nowadays we see a lot of obese Malaysians,” he speaks in a soft tone. Recognising the growing obesity problem, he wants to supply nutritious juices to the public so that they can stay fit. Zummo Juicers offer only orange juices, but the company plans to introduce more choices by including every possible fruit and vegetable for its new project – the Globe as the booth is shaped like an orange. It plans to launch this by year-end.

business+ • 13

2016 | march

To reach a better world in healthcare Sime Darby Foundation actively supports the community in five core areas By Norman Hussaini

ith the growing number of health issues facing Malaysians, many organisations are stepping in to complement government efforts to help the needy out of their hardship. Those suffering from severe illnesses such as cancer, diabetes and AIDS, particularly the underprivileged, are all in need of support. Sime Darby Foundation (SDF) has been helping the needy for some time. “The foundation was founded in 1982, and was originally only providing scholarships for students to continue their studies abroad. In 2009, the prime minister launched our new foundation and it was given a breath of fresh air. That was when the five pillars happened,” foundation CEO Yatela Zainal Abidin tells Health+. SDF’s pillars are education, environment, community and health, youth and sports as well as arts and culture. Under its community and health pillar, SDF supports community-based programmes and sustainable initiatives aimed at promoting the wellbeing and health of disadvantaged people. “The community and health pillar is relatively new, but we have done a lot on healthcare over the years. As for our community and health, we have been very active supporting various organisations to help local communities with their state of health,” says Yatela. COMMUNITY AND HEALTH PILLAR SDF’s notable contributions are channelled to various efforts to combat illnesses plaguing the people. For instance, the foundation partnered with Cancer Research Malaysia (CRM) to help support more than 4,000 women diagnosed with breast cancer through its patient navigation programme. SDF’s contributions for the five-year deal since 2012 amount to RM27.5 million. “The contributions to CRM are by far the biggest by the foundation,” says Yatela.

In addition, SDF also helps people living with HIV and AIDS. Its active support for HIV awareness advocacy is evident through its collaboration with the Malaysian AIDS Council (MAC) and the Malaysian AIDS Foundation (MAF). A total of RM870,000 and RM1.5 million were given to MAC and MAF respectively over a three-year period. The foundation also supports the advancement of palliative care through its collaboration with Hospis Malaysia. With a contribution of RM1.03 million over two years, it has mobilised three palliative care nurses and doctors to 8,400 homes throughout the Klang Valley. Diabetes, the most common lifestyle disease, is also under SDF’s radar. “We have been working with two organisations that tackle diabetes. We had supported Diabetes Malaysia through workshops and contribution of monitoring devices for type 1 diabetes patients. “We had also worked with National Diabetes Institute with its programme to reach out to the Orang Asli community to get tested for diabetes. And we are now working with the institute to organise a programme targeting diabetes-related pregnancy,” says Yatela.

TEAMWORK: The team for community and health works tirelessly to support various organisations with healthcare programmes for the community. And in February, SDF made another generous contribution of RM2 million to the University of Malaya Medical Centre (UMMC) to treat coronary heart disease

AT THE HELM: Yatela has been with Sime Darby since 1996, first as internal auditor and now leading the Sime Darby Foundation.

The foundation will continue with its efforts in working with programmes that we see can create the most sustainable impact and the most difference in the lives of others.” – Yatela

patients. This is the foundation’s second contribution to UMMC for heart disease; the previous was in 2013. “ We helped 246 underprivileged patients undergo angioplasty, a surgery to unblock the coronary artery the last time. The impact we had seen from that contribution had given us the drive to extend our contribution for the second time,” she adds. BUMPY WAY FORWARD The need to support and contribute to our community will always exist, and SDF is not hitting the brakes anytime soon, although it might hit a few bumps and potholes along the way. “To be frank, the economical state of the country – globally actually – is not so good now. Quarterly reports tell us profits had reduced quite drastically compared to the same period last year due to various factors. Our donations from Sime Darby have also been drastically cut because of the total profits projected,” she admits. It seems the country’s current economic condition will greatly affect the foundation’s valiant efforts. However, Yatela and her team are undaunted. “The foundation will continue with its efforts in working with programmes that we see can create the most sustainable impact and the most difference in the lives of others,” she says. This means the foundation needs to be more selective over the next five years on the types of programmes it supports. “I do see us stretching our ringgit and doing the best we can to support our partners and creating the greatest impact we can on people’s lives,” she says. On a positive note, the foundation says it will continue to help others while also advocating the efforts of partner organisations for their roles in healthcare. “We hope other corporate bodies can come in to assist the causes we support for the good of the public,” she adds.

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business+

Solving hair loss the herbal way Neeta’s Herbal gives hope to those with hair issues By PRASAD CHANDRA SEGARAN

any people have the misconception that when it comes to hair loss and scalp problems,

the only way to treat it is to enrol for an expensive and sometimes ineffective treatment that often involves the use of harsh chemicals and multiple side effects. While

march | 2016

RENEWAL: Neeta says Ayurveda uses herbs to rejuvenate health and beauty.

in today’s world, wellness is evolving to incorporate more natural forms of treatment, the real question for the modern consumer is: Have you ever considered time-tested natural, herb-based treatments? Ayurveda is as ancient as the beginning of civilisation, a science of medical treatment using natural herbs and plants. It is growing in popularity all over the world, and Neeta’s Herbal is at the forefront of this wellness concept. Neeta’s Herbal started its first outlet in 1987 in Brickfields, Kuala Lumpur. “In the early days, our treatment was viewed with scepticism but response was slow and lukewarm. The public awareness of natural alternative therapy was reduced to what grandma had left as a legacy,” says its director Neeta Gosalia. “People didn’t have any idea how Ayurveda worked and its effectiveness in using herbs for rejuvenation of one’s health and beauty.” The application of herbs with active ingredients suitable in rejuvenating at cellular levels is supported with mental and emotional counselling to ensure a holistic treatment with phenomenal results. CHANGE IN FORTUNES The beginning of the 90s was the watershed years when Neeta’s Herbal saw a dramatic change in fortunes. A chance interview in 1987 on TV3’s Nona programme with Neeta, brought in renewed interest in alternate therapies along with rave public reviews. Neeta captivated the public’s attention with her honest and straightforward response to hair loss and what her treatment offered to elevate the trauma experienced by thousands afflicted by this malady. Neeta’s Herbal plays its role in society with great responsibility and care to be a strategic partner in health promotion in Malaysia and globally. Health and disease are critical concepts in bioethics with far-reaching social and political implications. Promoting health emphasises that everyone has a role and responsibility in health promotion and encourages integrated participation, be it in education, environment or business, as the best way to make the most positive improvement in people’s health. “My business took a turn for the better when through word of mouth more and more customers came to me for a solution to their hair loss.” Neeta recalls. THOSE who seek treatment So at what age does one go for hair problem treatment? “The general age to come for hair treatment is 25 to 40 years old. But we have younger ones age nine and 10. Young clients normally have scalp disorders while older ones have hair loss problem due to ageing,” she says. People who seek treatment are usually widely exposed to chemicals and those who lead unhealthy lifestyle. “Anxiety also causes hair thinning. Different groups come with different reasons that cause hair loss problem. A common problem among the middle age is hormonal imbalance,” explains Neeta. Which gender seeks treatment more often? Both, in almost equal numbers, she says.

Senior+

2016 | march

• 15

Ageing changes bones and joints Exercise and stretching help to make bones stronger and maintain joint flexibility

s we age, our bodies undergo many changes. Muscle size and bone density generally decrease, resulting in loss of bone tissue. Bones become less dense for a number of reasons such as inactive lifestyle, hormonal changes, and loss of calcium and other minerals in the bones. Changes in posture and gait are also common with ageing. For most people, all these changes are inevitable as they are part and parcel of the normal ageing process. But then it doesn’t have to be so. Dr Hisham Kunhimon, consultant orthopaedic surgeon at Tropicana Medical Centre, says exercise can prevent many age-related changes to muscles, bones and joints. “Exercise and stretching are good ways to make bones stronger and help maintain joint flexibility,” he says in a lecture on bone and joint issues organised by the medical centre. He also spoke to Health+ about some bone issues faced by the elderly. Dr Hisham says the most common conditions affecting muscles and skeleton, or the musculoskeletal system in older people, include osteoarthritis, osteomalacia, osteoporosis, rheumatoid arthritis, as well as muscle weakness and pain. What about alternative treatments for bone problems such as osteopathy? “It only comes in the early phase. It doesn’t have to be modern techniques,” he says. “If you want to do yoga or pilates to strengthen yourself, go for all these activities. As long as you know your limitations, you should know what to do and what to avoid. Most of these activities can help. Therapy in any from should help.” Dr Hisham says knee pain is one of the most common issues faced by the elderly. “If one’s knee is severely damaged by arthritis or injury, performing simple tasks such as walking or climbing stairs may be hard. If the condition is severe, the best way to treat it through total knee replacement. Total knee replacement is where – Dr Hisham the surgeon replaces the knee with an artificial joint. This requires major surgery and hospitalisation,” he explains. “Knee replacement is usually done if there’s an indication of pain which is not relieved by alternative treatments such as therapy and taking supplements. The other indications are when the pain is relieved only by taking lots of medication, when there are deformities in the joint, and when it prevents you from doing your daily activities.”

If the implant is damaged and causes pain and instability, you may need another surgery where the implant is taken out and replaced with a new one. If possible, we try to avoid the second surgery.”

By Ali-Azmin Hassan Are there new technologies and treatments to treat bone diseases and issues? Yes, says Dr Hisham. “There are a lot of new things coming up such as in focal damage

in cartilage where there’s research being done. The others are mostly advances in surgical techniques and methods. Every so often we come up with new designs, but so far there are no perfect designs. Even for total knee replacement, we can’t mimic the original. We are getting close but we are not there yet. But there are different designs coming and different materials that can

last longer to reduce the wear and tear in the implants.” Dr Hisham told the participants that knee replacement may last up to 10 or 15 years. “If the implant is damaged and causes pain and instability, you may need another surgery where the implant is taken out and replaced with a new one. If possible, we try to avoid the second surgery,” he says.

16 •

Senior+

march | 2016

ADVERTORIAL

The trouble with acid reflux

illiam’s hand goes to his chest, there is a burning pain. His tummy contents seem to seek an escape route... upwards. William’s symptoms are worse after a heavy meal and especially when lying down on his back. His wife has been noticing his bad breath and there is often a sour taste in his mouth. Gas, tummy discomfort and bloating – these are familiar symptoms the rather overweight William faces almost daily. He is not having a heart attack but is experiencing acid reflux, a condition known commonly as heartburn. Acid reflux is a condition where acid contents from the stomach are pushed back up into the oesophagus causing symptoms described commonly as heartburn. Symptoms of acid reflux may be a sign that stomach acid has inflamed your oesophagus, the tube connecting the mouth to the stomach. When that happens, stomach acid can damage the lining of the oesophagus and cause bleeding. Acid reflux disease has risen by nearly 50% over the last decade, according to one of the largest studies ever conducted in Norway. The study also highlights the link between reflux, smoking and obesity. With Malaysia being ranked the fattest country in Southeast Asia and the sixth in the Asia-Pacific Region, it is not surprising that the incidence of acid reflux here is up to 16% amongst Malaysians. Acid reflux, gastritis, and stomach ulcers are but some of the ways our digestive system signals distress. In our fast-paced world demanding quick relief, we often resort to a gulp of antacids or popping an acid-blocking pill to deal with the immediate problem. Unfortunately, such short-term measures only mask the pain but not go to the root of tummy troubles. Rising Acid Reflux When we eat something, the food reaches the stomach by travelling down a muscular tube called the oesophagus which has two valves (gateways). One valve lies at the top of the oesophagus (at the junction with the upper throat) whilst the other is at the bottom of the oesophagus (at the junction with the stomach). When there is backward flow of the stomach contents up through the valves into the oesophagus, this condition is known as Gastroesophageal Reflux Disease (GERD).

Symptoms include abdominal discomfort, indigestion, bloating, gas and upper abdominal pain. GERD is also the third leading cause of chronic cough after sinus problems and asthma. If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD, or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx and lungs) are much more sensitive to stomach acid and digestive enzymes, so smaller amounts of the reflux into this area can result in more damage. Symptoms of LPRD include reflux cough especially at night, difficulty breathing, hoarseness, bad breath, excessive phlegm, throat irritation and dryness, frequent throat clearing and difficulty swallowing. Acid reflux cough is the third leading cause of cough after asthma and sinusitis. Complications If left uncontrolled, chronic heartburn, GERD and LPRD can result in serious problems. When stomach acid repeatedly comes into contact with the lining of the oesophagus, it causes injury which can include bleeding or ulcers. Damage from acid reflux can cause abnormal changes in the lining of the oesophagus which can be a breeding ground for cancer to develop. Drug Treatment Proton-pump inhibitors (PPIs) or acid blockers such as pantoprazole, omeprazole and esomeprazole are the leading group of drugs commonly used for upper gastrointestinal disorders, including GERD, dyspepsia, and peptic ulcer disease. As potent suppressors of gastric acid, PPIs work by reducing acid production to prevent it from irritating the sensitive oesophageal lining. Although current guidelines recommend that PPIs be used for only 4 - 6 weeks1, patients are often on these drugs for many months and indeed many years. Such long-term use of PPIs has raised concerns over their potential risk for adverse effects and long-term harm due to their profound acid suppression actions.2 Acid exists in the stomach for good reason. It primarily helps break down food, absorb vitamins and minerals and act as first line defence against harmful bacteria. When this acid is suppressed over time, the body’s microbial flora in the gastrointestinal tract and lungs will be compromised leading to likely failure in nutritional

state and natural immune defence. Says Dr. Joseph Stubbs a former president of the American College of Physicians, “When people take PPIs, they haven’t cured the problem of reflux; they’ve just controlled the symptoms.” Natural Therapies Besides incorporating healthy lifestyle practises, patients with reflux and stomach problems can also consider a clinically researched pine needle extract known as Bioeffective® A. Professor Vladimir Bespalov, Chief of Cancer Chemoprevention at the N.N. Petrov Institute of Oncology in St. Petersburg lead a study which looked at treatments to improve pre-cancerous conditions of the stomach (atrophic gastritis). In this research, patients with atrophic gastritis (stomach precancer) were recruited. Half of the patients from each group were also found to be infected with H.pylori. These patients were then treated with Bioeffective® A and compared to a control group. Patients in the group treated with Bioeffective® A experienced a 92% improvement in their reflux problems, including improvement of symptoms such gastritis, acid reflux, gas and bowel disorders. Not only did the symptoms improve, endoscopic examination of these patients’ also revealed physical improvements of their condition. A dose of at least 320mg three times daily before meals is required to achieve clinical results. Bioeffective A works by supporting the healing of areas such as the oesophagus and valves which are inflamed and damaged besides helping to normalize normal acid production. Given a chance to heal,

the valves within the oesophagus can then work better to keep acid moving in the right direction and not come back up hence relieving acid reflux. Tips to Overcoming Reflux In addition to keeping a healthy weight to prevent increased pressure on the stomach and quitting smoking, there are some practical ways in which those with acid reflux problems can minimise pain and discomfort to better manage their condition. Relax and eat food slowly Limit beverages during meals Avoid high fat meals and choose instead lean proteins Watch out for potential trigger foods such as fried or fatty foods, alcohol, caffeinated beverages like coffee and tea, chocolate, mints and mintflavoured items, citrus juices, fruits, tomatoes, spicy foods, onions, garlic, and carbonated beverages. Don’t lie flat for a minimum of two hours after you’ve eaten a meal or snack. This article is brought to you by the Nuvaceuticals Division of Nuvanta Sdn Bhd. 1. Talley NJ; American Gastroenterological Association. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 2005;129(5):1753–1755 2. Joel J. Heidelbaugh, Andrea H. Kim, Robert Chang, and Paul C. Walker. Overutilization of protonpump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. Jul 2012; 5(4): 219–232

Senior+

2016 | march

DANGER LURKS: “If it rains, don’t go, because the rocks can be very slippery and there’re higher chances of you slipping and falling.” – Izhar

Old but gold Age is no barrier for Adi Satria and friends as they’re game to conquer hills and mountains

By Ali-Azmin Hassan

ere ’ re some thoughts. When was the last time you climbed a hill or a mountain? Or have you ever done it? Better still, will you do it? Nowadays, most people tend to get complacent with life, especially when you reach retirement age or when you sense you’re somehow over the hill. Not only the elderly think this way, even the younger ones harbour such thoughts too. Most people just want a stress-free life and often succumb to the idea of eternal relaxation. But ask yourself, what’s

the point? Where’s the fun? What am I going to put for the books in my life? A group of elderly adventurers has already made their mark in living lives to the fullest. They have taken up a great challenge, not to let time alter their minds and physical prowess. Adi Satria, a 65-year-old marketing communications retiree, climbed Bukit Tabur with his friends, Izhar Saad, Wahab Rejab and Chew Sze Meng, to test their strength and mettle, not letting age slow them down. Bukit Tabur is located in Selangor. Known locally as Bukit Hangus, the hill is a prominent part of Klang Gates Quarts Ridge and can even be seen from the Kuala Lumpur Middle Ring Road 2. Climbers enter the hiking trail via Kampung Klang Gates. The climb

Tips on mountain climbing for beginners Mountain climbing is viewed as an extreme sport. It can be dangerous and even fatal. But the exhilaration of the climb is like no other. Once you’ve reached the peak, the only thing to feel is good and a sense of achievement. What most could do but didn’t, you actually did. Isn’t that what everyone wants to feel? If you’re new to mountain climbing, here’re a few tips to start you off.

Assess your mental strength

Mountain climbing has a lot to do with your mental attitude. Because once you’ve started climbing, you need to always be on your feet and make fast judgments about conditions, directions and safety. For those whose always on their usual routine of air-conditioned offices and easy lifestyles, you will be thoroughly tested mentally. Remember, never panic and push past the pain.

Get fit

Mountain climbing requires good fitness and endurance skills as it’s obviously an intense physical activity. Train your fitness and strength in ways that benefit you best. Running, jogging, weightlifting, climbing practice, or anything that improves your strength and endurance are good to improve your fitness for mountain climbing.

Learn about mountaineering ethics

There’s more to mountain climbing than the physical and mental aspects. The ethics of climbing are very important too. Climbing mountains is one of the ways to become one with nature. Everyone who climbs mountains must be advocates for wilderness protection and to conserve the environment. It is important to keep mountains in their original condition, which means don’t pollute them by throwing your trash around, don’t smoke, and don’t harm the flora and fauna.

Keep improving your skills and try harder mountain climbs

OLD TIMERS: “We are looking for another hill, probably Bukit Cherakah or Gunung Nuang. If even young girls can make the climb, why can’t we?” – Adi

Finally, accept and enjoy mountain climbing as a part of your life. There’re many mountains and hills in Malaysia for beginners and experts. For example, Bukit Broga is great for beginners and as you gradually get better, keep climbing harder mountains like Bukit Tabur. And who knows, maybe one day you can scratch climbing Gunung Kinabalu off your bucket list.

• 17

STILL GAME: We love to prove to ourselves that we can take the challenge,” says Adi.

takes roughly three to four hours, which means if you start climbing at 4 in the morning, you’ll be lucky enough to catch the magnificent sunrise by 7. Adi climbed on the western section of Bukit Tabur, the most familiar part of the hill. The eastern side, on the other hand, offers a more challenging hike and is said to be steeper and riskier if you’re unfamiliar with the trail. What made Adi’s feat more impressive is that he did it at 65. Asked why he wanted to climb Bukit Tabur, he gave a simple, yet philosophical answer: “Because it’s there. We love to prove to ourselves that we can take the challenge.” Adi says one has to be fit to climb Bukit Tabur. “If you’re an old timer and have heart or knee problems, don’t climb Bukit Tabur. Even the first 50m of the climb can be hard. For old timers, you have to train. Get back your stamina by swimming or walking regularly. You have to earn your stamina. I trained for weeks to get the stamina to climb Bukit Tabur.” During the climb, Adi saw a fellow climber fall off the ledge of the hill. The man hit his head on the rocks and was bleeding, but fortunately, he was okay and was rescued soon after. Adi’s fellow climber, Izhar, 65, a retired army lieutenant colonel, also shared his experience conquering Bukit Tabur. “I had climbed many mountains when I was in the army. It was more challenging climbing mountains back then. We had to carry heavy packs, weapons and even anticipate enemy attacks.” His advice to climbers is: “If it rains, don’t go, because the rocks can be very slippery and there’re higher chances of you slipping and falling.” Bukit Tabur is just a recreational climb for Izhar. “It’s interesting and enjoyable. I will climb again,” he says with gusto. What’s next for Adi Satria and his gang? “We are looking for another hill, probably Bukit Cherakah or Gunung Nuang. If even young girls can make the climb, why can’t we?” he asks confidently.

18 •

men+

march | 2016

CREATIVE COMMONS

Men do get breast cancer Condition may be rare but if you detect abnormalities, go for screening early

By Norman Hussaini

reast cancer occurs mainly in women, but men can get it too. Many people do not realise that men have breast tissues and that they can develop breast cancer. According to the National Cancer Society Malaysia (NCSM), breast cancer affects about 4,000 women a year in the country. The statistics translate to one in 19 women diagnosed with the condition, mostly between 35 and 60 years old. However, the prevalence of breast cancer among men is rare. NCSM statistics show only 1% of those who are affected are men, but the rate seems to be rising. But how does breast cancer affect men? Is there any difference? According to Cancer Research UK, the symptoms, diagnosis and treatments are all very similar to women, although the risks and

causes might vary slightly. The general consensus towards breast cancer is well established through the symptoms it exhibits. As in women, the symptoms in men include: Oozing from the nipple (a discharge) that may be blood stained Swelling of the breast A sore (ulcer) in the skin of the breast A nipple that is pulled into the breast (called nipple retraction) Lumps under the arm With virtually the same symptoms as in women, diagnosing the condition in men is also similar. Test for breast cancer usually involves a painless, ultrasound scan or a breast X-ray called a mammogram. Types of treatments are also similar for both genders. The treatments to be adopted are decided by how far the cancer has progressed and whether the cancer cells have receptors for particular hormones or biological therapies. Usual treatments include surgery, radiotherapy, chemotherapy,

DISARRAYED: Men who are diagnosed with breast cancer feel confused and isolated.

hormone therapy and biological therapy. What’s the difference? As stated earlier, the difference between the condition in men and women is in the risk factors and causes. Some of the risk factors for men are: High oestrogen level It is normal for men to produce oestrogen as how it is normal for women to produce testosterone. Oestrogen is partly made in the fat tissues in the body. Therefore, it is found that men who are obese produce more oestrogen due to the increased amount of fat tissues. Men who are suffering from chronic liver conditions such as cirrhosis also have higher levels of oestrogen, which in turn increase the risk of breast cancer. Another factor of high oestrogen is having a genetic predisposition to produce more than normal levels.

CREATIVE COMMONS

C-TEST: Test for breast cancer usually involves a painless, ultrasound scan or a breast X-ray called a mammogram.

Family history Men who have female relatives with breast cancer have an increased risk of breast cancer, especially if the women are their mothers or sisters. The risk is higher if the women were diagnosed at a younger age (below 40). It may seem that anyone – regardless of gender – can be a victim of faulty genes being passed down. However, Cancer Research UK had found that men are more susceptible to inherited faulty genes. Statistics show about three in 100 breast cancers diagnosed in women are thought to be direct cause of inherited faulty genes. On the other hand, in men, breast cancer caused by inherited faulty genes is more common with 20 out of 100 patients. This

indicates men are more susceptible to breast cancer caused by faulty genes than women. Other factors that must also be taken into account are extended exposure to radiation and men with Klinefelter’s syndrome. Both are quite rare instances yet can heighten the risk of breast cancer in men significantly. Real problem with breast cancer in men Saying that men are less likely to get breast cancer also affects the way men think of the condition. While many organisations and groups are committed to supporting people with breast cancer, they work largely with or publicise their services to women more. Hence, men who are diagnosed with breast cancer feel confused and isolated. According to the head of cancer screening clinic in NCSM Dr Dalilah, many men are not coming forward for screening and enquiries, resulting in delayed diagnosis or the condition being at a more severe stage when detected. Breast cancer support groups and organisations are undoubtedly able to provide support for men just as they do for women, yet the way men view the condition will make it harder for them to approach these groups. It is therefore important to create greater awareness among men that it is possible for them to get breast cancer, and they should go for screening early if any abnormalities are detected. Furthermore, it is possible for them to find treatment and support just like any other person would. (Parts of the above information are extracted from the National Cancer Society Malaysia and Cancer Research UK)

men+ • 19

2016 | march

CREATIVE COMMONS

Blueberries, citrus fruits, red wine reduce ED Diet full of flavonoid-rich foods can help lower risk of erectile dysfunction

new collaborative study between Harvard University in the US and the University of East Anglia in the UK has found that a diet full of flavonoidrich foods can help reduce the risk of erectile dysfunction, a condition which affects up to half of all middle-aged and older men. Exercise is already known to be beneficial for those suffering from erectile dysfunction, however this is a pioneering study in terms of looking at how the condition can be improved by eating a diet rich in flavonoids, the compounds found in many plant-based food and drinks that are known to have an antioxidant effect on the body. To conduct their research the two teams looked at more than 50,000 middle-aged men and questioned them at four-year intervals on their ability to have

and maintain an erection that enabled them to take part in sexual intercourse. The men were questioned in 2000, 2004, and again in 2008. They were also asked to provide a history of their erectile dysfunction that dated back to 1986. Focus on six flavonoids Information on their diet was also collected every four years, with the team focusing on the effects of six commonly consumed different types of flavonoids. More than one third of the men reported that they suffered from erectile dysfunction, however the results showed that those consuming a diet rich in flavonoids were less likely to suffer from the condition, with just a few portions a week of flavonoid-rich foods decreasing the likelihood of suffering from erectile dysfunction by

ED HELP: Thanks to their high content of flavonoids, blueberries can help reduce the risk of erectile dysfunction.

10%, with the strongest benefits seen in men under the age of 70. A diet high in fruit also reduced the risk by 14%, and when combining a flavonoid-rich diet with exercise, the risk was reduced even further, by 21%. The research also showed that eating a flavonoidrich diet is as beneficial for those suffering from erectile dysfunction as briskly walking for up to five hours a week. Of the six flavonoids studied, the team found three in particular to be the most beneficial: anthocyanins, found in blueberries, cherries, blackberries, radishes and black currants; and flavanones and flavones, which are found in citrus fruits. The most popular sources of these three flavonoids in the US are strawberries, blueberries, red wine, apples, pears and citrus products.

And according to Dr Eric Rimm, senior author on the study, a diet rich in flavonoids could also have additional benefits. “As well as improving sexual health for middle-aged men, there is another important benefit linked to heart health. Erectile dysfunction is often an early barometer of poor vascular function and offers a critical opportunity to intervene and prevent cardiovascular disease, heart attack and even death. “Men with erectile dysfunction are likely to be highly motivated to make healthier lifestyle choices, such as exercising more and eating the right foods – which would greatly benefit their long-term cardiovascular health as well.” The research was published recently in The American Journal of Clinical Nutrition. – AFPRelaxnews

patient’s quality of life more than pain. It can also leave participants with an increased general sense of well-being as well as a result of taking part in a social, group activity that promotes mediation, fitness and health. Previous studies had shown the benefits that yoga could have on cancer patients, but had often concentrated on female breast cancer patients, due mainly to the perception

that men would be unwilling to participate in a holistic fitness regime such as yoga. National statistics show that of those that practice yoga, 72% are female, and only 18% of those that practice are over the age of 55. According to the American Cancer Society, which funded the new study, nearly 240,000 men are diagnosed with prostate cancer each year in the United States, and the median age for diagnosis is 65. – AFPRelaxnews

Yoga can help prostate cancer sufferers deal with side effects Men undergoing radiation treatment for prostate cancer can stabilise and even decrease the side effects of the treatment with yoga, according to researchers at the Perelman School of Medicine at the University of Pennsylvania. For the study presented at the Society of Integrative Oncology’s International Conference recently, 68 eligible prostate cancer patients were invited to twice-weekly 75 minute yoga Eischens classes, with 66% willing to participate, and 40% completing the course. The effects of the yoga were measured by researchers in a series of questions on the patient’s fatigue, erectile dysfunction, urinary incontinence, and general quality of life, all chosen for being common side effects

among prostate cancer sufferers. Eischens yoga was chosen for its suitability for all body types and all levels of fitness and experience. Men who had participated in and completed the intensive yoga course while undergoing radiation treatment showed stabilised results when tested on erectile dysfunction and urinary incontinence, and an improvement in cancer-related fatigue, a side effect reported by 60-90% of those receiving radiation treatment. A possible explanation for these benefits is that yoga strengthens the pelvic floor muscles and increases blood flow, which may in turn improve urinary incontinence and erectile dysfunction, as well as reducing feelings of fatigue, which can lower

YOGA POWER: A possible explanation for these benefits is that yoga strengthens the pelvic floor muscles and increases blood flow.

20 •

men+

march | 2016

Even macho men get depression Don’t hide it but get professional help if you think your condition is getting worse and worse By Ali-Azmin Hassan

epression can manifest in different ways with different people. One major confusion about this increasingly

prevalent mood disorder is the difference between having depression and feeling depressed. Almost everyone feels depressed from time to time. Getting bad grades, losing

a job, breaking up with someone you love, and even a rainy day can make you sad. But nevertheless, there’s a difference. What is depression? According to the National Institute of Mental Health (NIH), “depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, handle daily activities, such as sleeping, eating or working.” Depression can hit anyone – it can affect any age group, any race, any culture, and any class, male or female, young or old, rich or poor. In fact, it is no respecter of person. In other words, you men out there, including those who think they’re macho, depression can strike any man, anytime. So beware, lest you are floored by this insidious disorder! Causes, signs and symptoms While symptoms used to diagnose depression are the same regardless of gender, the factors that cause depression can be different among men and women. However, depression in men is not commonly recognised. Men generally tend to deny that they have problems because of the dogma that men are supposed to “be strong”. Many men do not recognise, acknowledge or seek help for their depression due to this dogma. They put on a face not because they want to, it’s because they have to. Depression is a real and treatable illness and it can affect any man at any age, and, of course, at any time. In some culture, if men were to express their emotions, they are considered weak. Boys are brought up with the imposition being sensitive is not the “manly way”. “Boys shouldn’t cry! Be strong and man up!” a father says to his son. As a result, men who are depressed are more likely to talk about physical symptoms of their depression rather than symptoms related to emotions. Most people can get over their depression when their circumstances change. But there’s another level of depression called clinical depression. Clinical depression is different. It’s a medical disorder, and it won’t go away just because you want it to. It lingers for weeks and can interfere with your ability to work, play, or love. If you feel or think that you, or men in your life, either your father, brother, friend, or a spouse, has depression, NIH lists down the following symptoms: feeling sad or “empty” feeling hopeless, irritable, anxious or angry loss of interest in work and family feeling very tired inability to concentrate inability to sleep as well as sleeping too much overeating or not wanting to eat at all thoughts of suicide aches or pains, headaches, cramps or digestive problems Dealing with depression Depression drains your energy, hope, and drive, making it difficult to do what you need to feel better. But while overcoming depression isn’t quick or easy, it’s far from impossible. You can’t just will yourself to “snap out of it,” but you do have some control – even if your depression is severe and stubbornly persistent. The key is to start small and build from there. Feeling better takes time, but you can get there if you make positive choices for yourself each day. There are countless literature and advice on how to overcome depression, but this article will not delve on them here. But suffice to say, if you find your depression is getting worse and worse, seek professional help. Needing additional help doesn’t mean you’re weak. Sometimes the negative thinking in depression can make you feel like you’re a lost cause, but depression can be treated and you can feel better! So go for it and seek professional help!

2016 | march

women+

International Women’s Day pledging for parity Everyone can pledge to take a concrete step to help achieve gender parity more quickly

nternational Women’s Day on March 8 had come and gone without much fanfare in Malaysia. Health+ salutes every woman who has contributed in one way or another to make this world a better and healthier place to live in. Women play many important roles in our daily lives – as mothers, wives, sisters, colleagues or in whatever capacity. There’s this post on a social website proclaiming: “When you need some information you will look for Google; when you need something in your home you will look for your mum.” Without any doubt, every woman is important no matter what role she plays.

GENDER IMPARITY: In many societies, more importance is still attached to men and women are often not treated equally. This year’s International Women’s Day theme is “Pledging for Parity!” Everyone can pledge to take a concrete step to help achieve gender parity more quickly – whether to help women and girls achieve their ambitions, call for gender-balanced leadership, respect and value difference, develop more inclusive and flexible cultures or root out workplace bias. Each of us can be a leader within our own spheres of influence and commit to take pragmatic action to accelerate gender parity. In many societies, more importance is still attached to men and women are often not treated equally. They are sometimes regarded as servants in their own families while many continue to be victims of violence perpetrated by men. Thus, many governments had made laws to protect women and their fundamental rights. Many non-governmental organisations have set up 24-hour counselling centres to help women victims of domestic violence. International Women’s Day

• 21

By YOUNG SIN YEE is celebrated in a big way in some countries where it’s a public holiday for women while others grant women a half day off.

22 •

women+ opinion

march | 2016

women

By Dr Hayani Abdul Wahid

Things to know about breast cancer

any people who hear about cancer always picture the worst scenario leading to death. The same goes for women – whenever they hear about breast cancer, in their mind they picture women without breasts and who subsequently lose their sexual lives, husbands, jobs, hair due to chemotherapy, and eventually their lives too. We need to stop these stigmas and misconceptions, and spread positive things about breast cancer so as to improve the overall outcome of breast cancer in the country.

Some facts on breast cancer The incidence of breast cancer in general is rising worldwide. Western women are affected more than their Asian counterparts. In Malaysia, it is the second leading cause of death after lung cancer. The risk of developing breast cancer increases with age, peaking at about 50 to 60 years old. Those with high risk include women with family history of breast cancer (risk 2-3x, risk of both breast being affected and risk 7-8x at premenopausal age) and personal history of breast cancer. Other risk factors include prolonged unopposed oestrogen – early menarche, late first pregnancy, late menopause, null parity (never having children), obesity, high dietary fat intake, history of premalignant condition – DCIS (ductal carcinoma in situ), FCD (fibrocystic disease), radiation exposure and use of exogenous oestrogen such as oral contraceptive pills and hormone

replacement therapy. Symptoms Breast cancer symptoms are many but typically women complain of painless lumps with or without other associated factors in the early stage. Only when it is at more advanced stage that it becomes more symptomatic with complaints of pain, skin changes, nipple changes, armpit swellings, jaundice, abdominal distension, lung symptoms, bone pain, fracture, weakness or paralysis, and confusion. In addition, there are also generalised symptoms such as loss of appetite and weight, as well as chronic lethargy. Screening To diagnose breast cancer, few investigations are required after clinical examination is performed. These are mammography or ultrasound breast and biopsy. Once the cancer diagnosis is confirmed, it is important to stage the disease properly. Early stage breast cancer requires ultrasound liver and chest X-ray whereas more advanced tumours require full imaging with computed tomography of lung and liver before full recommendation of treatment can be discussed. Treatments Treatment of any type of cancer generally involves multidisciplinary and multimodality approach. For breast cancer in particular, the treatment plan typically includes surgery, chemotherapy, radiotherapy and biological agents. The treatment recommendation depends on the type of breast cancer, its grade (architecture of the cancer cell), stage of the cancer, hormonal receptor status (oestrogen and progesterone) and presence of genetic amplification on the receptor (HER2). Additionally, treatment also takes into account general health of patients in order to minimise complication. Surgery is the gold standard treatment for operable breast tumour. It is curative for early stage tumour but also indicated for locally advanced tumour which responds to neoadjuvant chemotherapy. Sometimes it is offered as palliation for symptomatic breast cancer and stage IV disease which has responded to treatment.

Support from spouse, family members, friends and involvement in cancer support group are great contributors towards success of cancer treatment and cancer survivorship of a patient.”

Types of breast surgery include mastectomy and breast-conserving surgery (BCS). In order to stage the cancer properly, nodal surgery is also carried out and this includes sentinel node biopsy and level II/ III axillary clearance. Nodal status is the most important prognostic factor for breast cancer. As for the chemotherapy, it is use in neoadjuvant, adjuvant and palliative setting. Neoadjuvant acts to downstage tumour for better surgical outcome. This is typically used for large tumour at presentation or tumour with palpable nodes. Unlike neoadjuvant chemotherapy, adjuvant chemotherapy is used to comprehend surgery to reduce relapse and prolong overall survival in early breast cancer and high-risk breast cancer such as stage II and above, nodes positive, hormone negative, and high grade types. Palliative chemotherapy, on the other hand, is when chemotherapy is used for advanced or metastatic disease, to reduce local and systemic symptoms. Chemotherapy for breast cancer is usually administered as a short infusion. Combination chemotherapy has been proven better than single agent (anthracycline-based, taxane-based or platinum-based) and is typically given in three-week interval for 4-6 cycles. Taxane combination is often recommended for high-risk patients due to its better outcomes, but it has higher toxicity than non-taxane chemotherapy. Similar to chemotherapy, radiotherapy treatment is also indicated for breast cancer as adjuvant, palliation and rarely radical. Adjuvant radiotherapy is used to increase local tumour control and reduce recurrent risk of relapse, examples for all BCS, margin positive, nodes positive disease, large primary tumour, skin or chest wall involvement. It has been proven to increase survival of breast cancer patients. Palli at ive radio therapy is delivered to control local

symptoms such as pain, bleeding and discharge from fungating breast cancer. It is also used to control symptoms from metastatic breast cancer such as bone pain, nerve compression and brain metastasis. Sometimes radiotherapy is also recommended for ovaries (also known as ovarian ablation) to remove endogenous oestrogen which causes growth of breast cancer. R are indication of radiotherapy includes radical radiotherapy for non-resectable breast tumour either due to medical, surgical of personal reason. Finally, hormone therapy and biological therapies are also part of breast cancer treatment. Hormones therapy can be in adjuvant, neoadjuvant or palliative setting and indicated for all hormonesensitive breast tumour. Tamoxifen and aromatase inhibitors are two classes of hormones which have been proven to prolong survival of breast cancer patients. Biological therapy like trastuzumab (herceptin) is also proven to improve outcome for breast cancer patients who harbour genetic amplification of HER2 receptor. It is however associated with considerable risk of cardiac failure, hence requiring close monitoring of cardiac function during treatment. Dealing with all these types of cancer treatments requires knowledge, understanding and specific skill. Hence, upon diagnosis, it is recommended for a cancer patient to find reliable source of information to enable greater understanding of the cancer, its treatment modality, treatment side effects and ways of coping with them. Support from spouse, family members, friends and involvement in cancer support group are great contributors towards success of cancer treatment and cancer survivorship of a patient. Dr Hayani Abdul Wahid is a consultant clinical oncologist at Nilai Medical Centre.

2016 | march

women+

• 23

Measuring to your own expectations With advancement in technology as well medical and cosmetic practices, there’s always a solution for breast issues

one’s breasts. reasts are a very special area of the female body. Most men can vouch for that statement Are there risks and complicaalmost immediately. To a lover, a healthy and tions involved? Yes, there are but fit breasts are a sign of fertility. To a baby, it’s about nourishment. Nevertheless, discussions around breasts are rarely controversy-free, especially in Malaysia where it’s generally a taboo to openly speak about it. One could say that talking about it is indecent, but granted, to each his own. One of the issues of breasts that women are facing today is “measuring up” to cultural expectations. Breasts can be beautiful but they can also be a source of anxiety, illness and pain. And each woman’s breasts – and story – are uniquely her own. No matter the size, shape and symmetry, every woman should be proud of her breasts. But even if she thinks they are not enough, or if they are too much, that’s perfectly fine and it’s okay to feel that way. Every woman should be free from her insecurities. With advancement in technology as well medical and cosmetic practices, there’s always a solution. Dr Benjamin George Jr, a consultant plastic and cosmetic surgeon at George Plastic Surgery, shed some light on what breast augmentation is all about. “B re a st implants mean “Basically, breast you put in some- implant has to do with thing foreign. An implant generally a person’s psyche. implies the fact Some women just lost that you have volume. The fact is they got something that is in a bag just want to replace the that you insert,” volume and look normal Dr Benjamin tells again. And that’s all it is. Health+. H o w e v e r , It changes the person’s with the talk of self-confidence; it has augmentation which is the a lot to do with the more generic person’s psychology. way of looking at We’re actually treating it, the procedure could be with both physical and mental implants or fat. aspects.” Fat referred here is fat transfer – Dr Benjamin breast augmentation. The purpose of breast augmentation is to increase the size of a woman’s breasts or restore breast volume that has been lost after weight reduction or pregnancy. Basically, breast implant uses saline or silicone, and both have their pros and cons. Silicone implants look and feel more realistic, but it is harder to detect if there are ruptures in the implant due to their gel-like consistency. Saline implants, on the other hand, will show ripples in certain part of the breasts since they have a water-like filling. What has changed is the fact that they can use fats, which were introduced many years ago. Fat transfer breast augmentation essentially uses liposuction to take fat from other parts of the body and inject it into

By Ali-Azmin Hassan quite minimal, says Dr Benjamin. “Assuming that 10% of women like to have their breasts enlarged

and have their implant done, there are complications. Complications include wrong position, asymmetry, scar issues, pigmentation issues and infection. You add all this – the risk is about 5%, but 95% will sail through,” he says. “So why do we do breast implants? Basically, breast implant has to do with a person’s psyche. Some women just lost volume. The fact is they just want to replace the volume and look normal again. And that’s all it is. It changes the person’s self-confidence; it has a lot to do with the person’s psychology. We’re actually treating both physical and mental aspects.”

24 •

junior+ opinion

march | 2016

junior

By Ang Hui Inn

Tackling childhood obesity

hildhood obesity is a serious public health challenge in the 21st century. The rapid increase in the prevalence of childhood obesity worldwide has alarmed public health agencies, health care clinicians, researchers and the public. According to the World Health Organisation (WHO), the number of overweight children under the age of five is estimated to be over 42 million globally in 2013. In Malaysia, it was reported that one out of five Malaysian primary school-age children are overweight, irrespective whether in urban or rural areas. Childhood obesity is the abnormal or excessive fat accumulation in the body whereby the child’s weight gain is disproportionate to the change in height. In other words, the child’s weight is well above the average for his or her height and age. Childhood obesity will likely progress to adulthood if left unchecked. They are at a higher risk of developing health problems such as diabetes, heart disease, high blood pressure, knee pain, depression and some cancers. In view of these public health concerns, childhood obesity trends should be tackled and closely monitored. The most common causes of childhood obesity are unhealthy eating habits, inactive lifestyle and genetic factors. Instilling healthy eating patterns and lifestyle in children from a young age is the primary prevention of childhood obesity. WHO advocates exclusive breastfeeding from birth to six

months and continued breastfeeding up to two years, as an important way to prevent infants from becoming overweight. Choices of food Parental choices of toddlers’ food is of utmost importance to prevent picky eating habits. Balanced and nutritious meals that comprise wholegrain products (rice, bread, noodles, oatmeal, crackers), variety of lean protein sources (meat, poultry, fish, eggs, beans, nuts), with emphasis on vegetables and fruits should be encouraged from young. This can be achieved through family-based meals where parents become the role model of nutrition and healthy eating behaviours. Parents should minimise feeding energy-dense, high-fat, high-sugar or salty snacks to young children, including processed foods like sausages, chips, fries, pastries, cookies, sweetened desserts and sugary beverages. Appropriate food choices with moderate portion sizes and regular meal times are the keys to promote optimal health in children. School-going children and adolescents often make independent and unsupervised food choices as they spend most of their time in school. Therefore, families and schools are the two critical environments to provide a foundation of healthy behaviours. Parents need to show continuous effort to encourage their children or adolescent kids to make healthier food choices when eating out or in school. Fast food consumption should be discouraged as they are high in energy, fats and often come in large portion sizes. On top of that, parents should ensure children have proper breakfast as it is the most important meal of the day to refuel the body with nutrients. Children who eat breakfast are found to have better school performance and concentration, more energy and better overall health. Children who skip breakfast tend to overeat later in the day which leads to unnecessary weight gain over time. Some of the good breakfast choices are wholegrain cereals or breads, sandwiches, breakfast bars, milk, eggs, low-fat cheese, yogurt, dried or fresh fruits. On the other hand, schools should be an environment that promotes healthy eating habits. Fried foods and foods loaded with sugar and salt should be minimised in canteens. Instead, fresh fruits, vegetables and healthy snacks

Source: The Nutrition Source, Department of Nutrition, Harvard TH Chan School of Public Health

should be made easily available and affordable at all food stalls and vending machines. Physical activity Besides healthy eating, physical activity is very important to prevent or tackle childhood obesity. According to the American Heart Association, it is recommended that children and adolescents participate in at least 60 minutes of moderate to vigorous physical activity daily. Families are encouraged to engage children in active indoor and outdoor activities. This can also strengthen family bonding among family members while spending quality time together. Apart from that, inactive habits such as watching television or playing computer games

should be limited to no more than two hours a day. In school, children are strongly encouraged to participate in physical education and join school sports team such as ball games, running or swimming, in a safe physical and social environment. In a nutshell, childhood obesity has become a serious nutritional disorder in many parts of the world. A good nutritional start and active lifestyle is crucial for children to grow, develop optimally and perform well academically. Prevention is crucial to lessen the psychosocial burdens and health risks that could arise in the long run due to childhood obesity. Ang Hui Inn is a dietitian at Assunta Hospital.

Fast food consumption should be discouraged as they are high in energy, fats and often come in large portion sizes. On top of that, parents should ensure children have proper breakfast as it is the most important meal of the day to refuel the body with nutrients. Children who eat breakfast are found to have better school performance and concentration, more energy and better overall health.

opinion junior+ • 25

2016 | march

junior

By Dr Ling Shih Gang

ohnny is six and has entered Year One recently. How proud the mother was when she held his hand and led him into his classroom for the first day of class. However, the few months that followed brought much concern to Johnny’s mom. His class teacher has started complaining that Johnny simply cannot sit still in the class. He will start showing funny faces at little Tommy seated next to him, runs across the class to grab little Wendy’s books or pencils, and sneaks to the back of the class to draw doodles on the wall. The class teacher simply cannot control him despite numerous reprimands. His concentration span is short. When he is supposed to write a full page of words, he would complete only one or two lines. Several days earlier, when he was asked to colour a picture of Snow White and the Seven Dwarfs, he could only colour Grumpy and Dopey, and that too with purple and green faces. As a well-informed parent, Johnny’s mom is worried whether her son could have attention deficit hyperactivity disorder (ADHD). Many parents are in the same predicament as Johnny’s mother. While all children with ADHD are hyperactive, not all hyperactive children can be diagnosed as having ADHD. Some of these children do not fulfil the diagnostic criteria for ADHD. Most of these children have an underlying reason that has led them to be hyperactive. So what are several other reasons for a child’s hyperactive, uncontrolled behaviour? 1. Lack of Clear Boundaries Children need guidance and direction from parents regarding what is right and wrong. By providing such boundaries and limits, parents provide a sense of security to their children. Children without clear guidance to appropriate behaviour would just do anything his immature mind can think of. If this child has a strong-willed temperament, it is very likely that he would be difficult to pin down and would cause untold damages in his wake. Such children usually know in what situations and with whom they can break boundaries. Under a caring but firm caregivers, it is less likely they would misbehave. In some homes where one parent is too lenient while the other is firm, the children would behave

differently under the care of each parent. Therefore, if parents find their children to be overly active and out of control, they need to ask several questions: Have I set clear boundaries and limits for my children? Setting clear boundaries means teaching the children what types of behaviour are acceptable and what are off limits. Parents must ensure the children truly understand what the limits are and the consequences for flouting them. Is there consistency in the boundaries set? Boundaries set must be consistent. For example, if children have been taught to talk quietly and not shout at home, they should also be expected to do the same even when their parents are entertaining guests. Consistent boundaries make things clear and avoid confusion. Are these boundaries enforced? Parents may set clear and consistent boundaries, but children will often test these limits to see whether anything would happen if they step out of them. If these boundaries are not enforced with consistent and firm discipline, children will know they can get away with misbehaviour and whatever boundaries set will become useless. 2. Emotional Problems Emotional problems in children usually arise from events that occur around them, such as change of school, arrival of a new sibling and death or divorce in the family. Some children respond to these unsettling events by becoming hyperactive. In many ways, this could be a form of attentionseeking behaviour to overcome their feelings of fear, anxiety and insecurity. Such children manifest hyperactive behaviour in the presence of others. In environments where no attention can be gained, such as when the children are alone in their rooms, their hyperactivity can become less obvious. Issues that need to be addressed include: Are there recent events or changes in the life of my child? Parents should try to recall any event that has occurred that may coincide with the time the child started manifesting hyperactive behaviour. Recent changes in the parents’ lives such as a change in job that require parents to spend more time away from home may also be a contributory factor.

The Young Ones

Behind the veil of hyperactivity CREATIVE COMMONS

RIGHT DIAGNOSIS: While all children with ADHD are hyperactive, not all hyperactive children can be diagnosed as having ADHD. How can a parent help? Such children need all the love and support they can get. Ways you can demonstrate love to them include putting aside special time for them, listening, affirming and performing acts of kindness for them. The last thing they need is further punishment for their hyperactivity, which will make them feel even less understood. You also need to take to them about the events or changes that have occurred. 3. Learning Difficulties While hyperactivity and poor attention span may lead a child to having learning difficulties, the converse is also true. Children with learning problems may find it difficult to follow the rate of learning of their peers, and as a result be left behind in their studies. They may become disinterested and may resort to diverting their energies to other activities. At times these children may appear hyperactive and difficult to control in class. These children tend to show disinterest and attention deficit in certain learning activities that they find difficult. However, they can be extremely focused in other learning activities that are suited for them. For example, a child with dyslexia may not sit still while reading or writing but is able to be fully attentive while colouring or drawing a picture. For children with learning difficulties, a proper assessment is needed to determine the extent of the problem. In some instances, these children need to be put in special classes for slow learners or be given extra tutoring outside

school time. For those with specific learning difficulties, the problem needs to be tackled with special learning programmes. These children’s energies can also be channelled to learning activities that they can do well in. In conclusion, not all children who appear hyperactive have ADHD. In fact, some of the hyperactive behaviour may be an expression of these children’s need for help and support. It is vitally important for parents to realise this, seek to identify and then resolve the root cause of the hyperactive behaviour. Dr Ling Shih Gang is a consultant paediatrician at Tropicana Medical Centre.

26 •

junior+

march | 2016

Shortage of surgeons for new-borns, kids

CREATIVE COMMONS

Dire need for more paediatric surgeons, but few coming forward to be trained in sought-after expertise

By Norman Hussaini

here are many conditions and illnesses that children are susceptible to, even more so because of their developing immune system. Yet no other conditions are less preventable than congenital conditions. Also referred to as congenital disease or abnormality, congenital conditions are medical conditions where people are born with that can seriously affect their health. In Malaysia, conditions affecting new-borns are in abundance, with awareness among parents at a worrisome level. This puts new-borns at greater risk of growing up abnormally and, in many cases, even resulting in death. Then there is another related issue – a dire shortage of surgeons who are trained to treat new-borns with congenital conditions. Although the causes for congenital conditions are generally not entirely conclusive, the need to treat them is. Dr Syariz Izry Sehat, a consultant paediatric surgeon at Prince Court Medical Centre, talks to Health+ about the lack of awareness about congenital conditions and the shortage of surgeons in Malaysia to treat such conditions. The issue “The international standard for paediatric surgeons for the country is one surgeon for every 250,000 births. So there should be at least four paediatric surgeons for every one million births. Having just about 30 paediatric surgeons for the total population in Malaysia is a serious shortage,” says Dr Syariz. He says a paediatric surgeon is someone who specialises in performing surgeries on new-borns up to children aged 16. Hence, a paediatric surgeon treats mainly congenital conditions in infants. His statement then raises some questions. Why is there a need to have surgeons specialising in treating children when there are already general surgeons? Don’t they perform surgeries on everyone as the name implies? But as it turns, that’s not the case. According to Dr Syariz, there

are limits to what general surgeons specialise in, and performing surgeries on infants and children is one of them. “The training to become a general surgeon usually includes paediatric surgery (training) of only about three months maximum, if any. The training is of course not sufficient for a general surgeon to treat congenital conditions in new-borns, for example.” “What makes it worse is half of the 30-odd paediatric surgeons are practising in Kuala Lumpur. So parents in other states are quite deprived of the help they may need with their infants.” Another issue related to treating congenital conditions is insurance coverage, or the lack of it. Insurance companies in Malaysia generally do not cover the cost of surgery for congenital conditions. Why the shortage? The profession is in short supply not only in Malaysia but in neighbouring countries as well. The reason, says Dr Syariz, is the longer period of training to become a full-fledged paediatric surgeon. “Paediatric surgery is considered one of the toughest fields in surgery. To visualise it, after a twoyear housemanship and becoming a medical officer, you may apply to study paediatric surgery which takes four years to complete the master’s programme. After finishing the studies, however, you are only gazetted to be a full-fledged

paediatric surgeon after another three years of training. So it takes longer as opposed to becoming a general surgeon.” This may be one of the factors why the speciality is not the favourite of medical students. “It is also much more challenging as performing surgeries on (sometimes premature) new-borns is a very intricate process,” he adds. Parents should be more aware As one of the few doctors specialising in paediatric surgeries, Dr Syariz has handled countless

The international standard for paediatric surgeons for the country is one surgeon for every 250,000 births. So there should be at least four paediatric surgeons for every one million births. Having just about 30 paediatric surgeons for the total population in Malaysia is a serious shortage.” – Dr Syariz

cases while working at Hospital Kuala Lumpur, Hospital Universiti Kebangsaan Malaysia and now in Prince Court. “Congenital conditions are quite common among new-borns in the country. However, the awareness among parents seems to be quite poor,” he explains. Although congenital conditions are quite easy to detect after babies are born, in most instances during preliminary inspections, parents must be made aware of the possibility of their children having such conditions. A good sign of a strong awareness towards congenital conditions is seen by expectant mothers who go for antenatal check-ups during pregnancy. Antenatal tests can help them to better identify the risks of congenital conditions. Gloomy future With the dire shortage of paediatric surgeons and the lack of interest to be one, will we see greater interest among doctors to specialise in this sought-after expertise in future? Dr Syariz seems sceptical. “Presently, there are two universities in Malaysia that offer masters in paediatric surgery. If I am not mistaken, it is possible to produce about eight surgeons per year – a very slow pace considering the need.” The interest among medical officers to become paediatric surgeons also seems negligible. “To be frank, the profession (is not that) financially rewarding (compared to other areas of specialisation). And the longer time taken to complete the training means there won’t be a spike of interest in it anytime soon.” “Looking back,” he recalls, “paediatric surgery services were first offered in Malaysia in 1976. So with only about 30 surgeons currently, there hasn’t been a rocketing increase over the years.” With the continuing shortage, treating congenital conditions among the young ones is proving to be a problem. There is always an option to go overseas for treatment though, but transferring a sick baby overseas is risky, depending on the condition present.

BEAUTY+

2016 | march

DUO POWER: Farah (left) and her mother Dr Wan Julia are both certified clinical trichologist consultants.

series of encapsulated hair treatments. “Encapsulated hair treatment is more about using serums and nutrition. The serums we use are all halal products where we use plants and essential oils. Essential oils have their role in hair growth,” she adds. How long does it take for hair to grow again? Farah says it usually takes about 3-6 months to a year. “But for those who are completely bald, it is untreatable, unless you go for hair transplant. But if you have hair follicles,

Try trichotherapy treatment for hair loss Holistic approach can treat your hair and scalp problems – and bruised ego too

By Ali-Azmin Hassan

hinning hair and hair loss are common in both genders, and affect the young and old. To some, these twin problems can be rather demoralising as hair can signify one’s health status. The reasons for thinning hair and hair loss range from basic vitamin deficiency to more complex conditions such as genetics or other underlying health issues. But for those of you with such hair problems, do take heart, for there ways to treat them – and your bruised ego as well. Siti Farah Azwin Abd Khalid, Hair Rich World CEO and a certified clinical trichologist consultant, and her mother Dr Wan Julia Sham Ariffin also a certified clinical trichologist consultant, enlightened Health+ on the issue of hair loss and treatments to counter it through trichotherapy – the diagnosis and treatment of diseases and disorders of the human hair and scalp. four factors “Hair fall is caused by genetics, imbalanced hormones, lack of nutrients, imbalanced diet and the environment, especially stress. These four factors play very important roles. Your hair is an indicator of your health,” says Farah. Hair loss factors are almost similar for both males and females, except for hormones, in terms of estrogen, dihydrotestosterone and thyroid levels. “Thyroid is very important. If you have hypothyroidism you might have hair fall. Other than that, genetics play a role as well, in terms of androgenetic

alopecia where men have M-shaped hairline, beginning above both temples. This condition is also known as malepattern baldness,” she explains. Farah says hair fall can also be caused by intensive or excessive hair treatments such as colouring your hair too much, straightening it too many times as well as hair grafting. “Firstly, we highly recommend that they (those with hair fall problems) come to see us or another trichologist for consultation, which includes looking at their family and health history, as well as past traumas which can cause hair loss. For example, if you had an accident six months ago, you might have hair fall three months later. “We will recommend a blood test review, including the hormone level. We will also check your DHT level and progesterone, testosterone, estrogenic and thyroid. Other than that, we will check your ferritin, zinc and iron levels as they are very important for the health of your hair.” growth factor One of the most effective ways to treat hair loss is using growth factor from fibroblast. “We will make a puncture on your scalp using a very small needle and put growth factors directly on your scalp to stimulate its nutrient and blood circulation,” says Farah. Hair Rich World also provides other services where clients go through a

there’s still hope for your hair to grow.” Farah also explains how to prevent balding. “First, you need to know your family background. Check whether your parents or grandparents had androgenetic alopecia or male-pattern baldness. This way, it’s easier to know if you’re balding so you can prevent it earlier,” she says. “Also, make sure the shampoo you’re using is of good quality – it is plant based or have essential oils. It might be expensive but it’s worth the money because it can help you (avoid hair) treatments in future. Also ensure your shampoo doesn’t have sodium lauryl sulfate or alcohol.” supplementation “And then, (look at) supplementation which is the key to everything. You need to have (supplements) in your daily diet. You need saw palmetto, vitamin C, omega, CQ10 as anti-oxidants and multi-vitamins, such as zinc, biotin and iron. You also need to watch your diet because if you’re fat, you might get hair fall as well.” Trichology is new in Malaysia. Moreover, not many qualified people provide such services here. “Even doctors are not very familiar with trichology,” says Dr Wan Julia. “That’s why we started this health centre (Hair Rich World) to help people with hair loss.” To treat hair loss, unlike in antiageing treatments, it is definitely more than just using cosmetics – people’s mindsets have to change too. “We need to change the mindset of doctors too. Practising medicine is not just about drugs. It’s about changing your lifestyle,” she adds.

Hair fall is caused by imbalanced hormones, lack of nutrients, imbalanced diet and the environment.” – Farah

• 27

How people lose their hair So you think you are losing your hair? And along with it goes your self-confidence and big ego! The bare truth is hair thinning problems in both men and women have become common these days. Hair fall is caused by various reasons like ageing, hereditary, stress and medical issues.

ANDROGENIC ALOPECIA

The most common type of hair loss is androgenic alopecia which affects both genders. Male-pattern baldness is related to male genes and sex hormones. It usually follows a pattern of receding hairline and hair thinning on the crown, and is caused by hormones and genetic predisposition. Each strand of hair you have sits in a tiny hole (cavity) in the skin called a follicle. Female pattern baldness is the most common type of hair loss in women where hair usually thins on top of the head. Hair thins mainly on the top and crown of the scalp. It usually starts with a widening through the centre hair part. The front hairline remains. The hair loss rarely progresses to total or near total baldness, as it may in men.

SCARRING ALOPECIA

Another type of hair fall is scarring alopecia, also known as cicatricial alopecia. This diverse group of rare disorders destroy hair follicles, replace them with scar tissue, and cause permanent hair loss. A variety of distributions are possible. In some cases, hair loss is gradual, without symptoms, and is unnoticed for long periods.

TELOGEN EFFLUVIUM

Telogen effluvium is when some stress causes hair roots to be pushed prematurely into the resting state. Telogen effluvium can be acute or chronic. If there is some “shock to the system”, as many as 70% of the scalp hairs are then shed in large numbers about two months after the “shock”.

ALOPECIA AREATA

The immune system can also cause hair fall and this is known as alopecia areata. This causes baldness like patches the size of a coin which can occur anywhere in your body. It affects mostly the younger generations aged 15 to 29.

ANAGEN EFFLUVIUM

Medications like chemotherapy and radiotherapy also cause baldness due to impact of heat to the skin surface during treatment. In most cases, the hair should start growing after treatment has stopped. Fortunately, anagen effluvium is not a permanent hair loss problem.

28 •

beauty+

march | 2016

Switch to natural cosmetics reduces chemical exposure Break from beauty products can significantly reduce chemical exposure in teenage girls

witching to more natural cosmetics for just a few days is enough to significantly lowers the levels of hormonedisrupting chemicals in teenage girls, a new US study has shown. A team of researchers from UC Berkeley and Clinica de Salud del Valle de Salinas looked at Latina teenagers who were participating in the Health and Environmental Research on Makeup of Salinas Adolescents (HERMOSA) study, set up to look at the effect of endocrine disrupting chemicals (EDCs) on adolescent teens. The researchers looked at females not only because women expose themselves to more EDCs than men, using on average 12 self-care products daily compared to the average man who uses just six, but also because previous research has suggested that teenage girls use even more self-care

products than the average adult woman, exposing themselves to hormone-disrupting chemicals during an important period of rapid reproductive development. Free from hormonedisrupting chemicals In the study, the researchers asked 100 teenage girls to take part in a short three-day trial, switching from their usual cosmetics to products with a lower level of chemical ingredients. These products were provided by the study’s researchers and labelled as being free from hormone-disrupting chemicals such as phthalates, parabens, triclosan and oxybenzone, all widely used in everyday beauty products such as make-up, fragrance, hair products, soaps and sunscreens. To test any changes in chemical exposure during the trial, the participants submitted urine samples before and after the three days. The results, published today in

NATURALLY EFFECTIVE: Switching to more natural cosmetics significantly lowers the levels of hormonedisrupting chemicals in teenage girls.

the journal Environmental Health Perspectives, showed that after these three days, levels of chemicals in the body had dropped significantly. Levels of diethyl phthalate, commonly used in fragrances, decreased by 27%, methyl and propyl parabens, used as preservatives in cosmetics, by 44% and 45% respectively, and triclosan, found in antibacterial soaps and some brands of toothpaste, and benzophenone-3 (BP-3), found in some sunscreens under the name oxybenzone, both dropped by 36%. Small changes make big difference From their results the team

concluded that women can significantly reduce their exposure to EDSs -- linked with neurobehavioural problems, obesity and cancer cell growth – by taking just a short break from self-care products or by choosing products with fewer chemicals. The results were even significant enough to lead one of the researchers to change their own beauty products and switch to organic where possible. “We know enough to be concerned about teen girls’ exposure to these chemicals. Sometimes it’s worth taking a precautionary approach, especially if there are easy changes people can make in the products they buy,” concluded lead author Kim Harley. – AFPRelaxnews

ADVERTORIAL

Every scar has a story Scars pose a significant concern to individuals and can have a profound effect on their lives, functionally and aesthetically, particularly when highly visible. On average, an individual has three scars on his or her body. It is estimated that, of all the new scars formed, most can be attributed to everyday cuts, grazes and minor burns. The rest are mainly caused by hospital surgery, trauma, elective surgery, cosmetic surgery and mole removal. No matter how big or small our scars are, most of us are conscious of them and would keep them covered under long-sleeve shirts and long fringes just to shield them from public eyes.

Effects of Scarring

Apart from causing physical discomfort, including pain,

itchiness and tenderness, scars can also cause distressing psychological effects resulting in low self-esteem. These psychological effects often vary depending on the location of the scar, how it occurred, as well as the age and sex of the scar bearer. Studies have shown that almost 65% of women and 35% of men are conscious of their scars, so scarring affects both genders.

Your Scar Story

If you have a scar on your body, just take a look at it and see if it reminds you of an incident or flashback of some memories? Every scar has a story. It could be caused by a joyous event or even a tragic experience that you do not want to be reminded of. For example, a mother who had undergone a c-section for child

delivery will always be reminded of her child-giving experience, which can be a pleasant memory. A woman with a scar across her body caused by a snatch theft incident would not want to be reminded of the painful experience. No matter how scars are formed, women want to conceal these unsightly marks. The mother who has the c-section scar may be too self-conscious with her spouse while the woman with the scarred body may shy away from social events.

Coping Strategies Support Network

Before coming to terms with a disfigurement, it appears that most people go through a stage of mourning the loss of how they used to look before accepting their new self. Throughout the grieving process, it is important to talk to family members, close friends, medical professionals or other scar bearers about their feelings. A good social support network is an effective way of helping people to

deal with post-scarring stress.

Specialist Skincare

The most affordable and common practice in scar management is to use a topical product such as Bio-Oil, which has been clinically proven to help improve the appearance of scars of all types, old and new. Bio-Oil contains plant extracts such as Chamomile, Lavender, Rosemary and Calendula oils, together with Vitamins A and E, and the breakthrough ingredient PurCellin Oil™ that acts as an emollient, making the skin soft, smooth and supple. After the scars are fully healed, Bio-Oil should be applied to the affected areas twice daily and massaged in a circular motion until fully absorbed, for a minimum of three months. In a clinical trial conducted in proDERM Institute for Applied Dermatological Research, Hamburg, Germany, 92% of the subjects concerned showed an improvement in the appearance of their scars just after eight weeks.

2016 | march

ADVERTORIAL

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Total Image Whita Glo L-Glutathione provides a daily dose of 400mg L-Glutathione at only the retail price of RM135.68 (inclusive GST) for 30 capsules (one-month supply). Simply take 1 capsule a day after meal and the average period where a user can see visible change in skin is about 1-3 months. Less exposure to sunlight is also important for more visible results as harmful UV rays stimulate the production of melanin. As levels of Glutathione in the human body decline with age, it is recommended to start taking L-Glutathione as early as 20 years old to keep skin youthful with glowing radiance. Total Image Whita Glo L-Glutathione 400mg is registered and approved by Malaysia Ministry of Health to be safe for consumption and certified HALAL by JAKIM to be safe for consumption by Muslims. Total Image Whita Glo L-Glutathione 400mg is available at Guardian, Watsons, Caring, Vitacare and other independent pharmacies nationwide. The product is sourced from Japan and is suitable for both men and women. For more information on Total Image Whita Glo L-Glutathione 400mg, please contact: 03 – 6272 1111.

beauty+ • 29

Blackout tattoos the latest trend Tattoos, once the reserve of the rebellious by nature, have become a mainstream beauty accessory over the past few years. But the latest trend for blackout tattoos is only for extreme ink lovers. Singapore-based artist Chester Lee of Oracle Tattoo recently drew attention to the trend when he posted a photo on Instagram of one of his clients sporting a large tattoo with scalloped edges spreading across her upper torso and covering her arms. The image has since gone viral, garnering thousands of likes and sparking online debate about the daring look. The artist has also shared pictures of other clients who have opted to completely cover different body parts such as lower legs or backs. Some have opted for a

design that combines large sections of block colour with intricate designs, giving the impression that large swathes of the body are entirely covered up. The overall effect is not unlike that of body paint, with the difference being, of course, that this art form cannot be washed off. As Lee explains to Cosmopolitan.com, one of the principal advantages of blackout tattoos is their capacity to conceal and correct past mistakes, although this is a look customers will want to be sure about before they commit. Other ink fans are using the concept as a way to create a background for striking graphic designs that are created via the negative space created by the bare skin left peeking through. – AFPRelaxnews

30 •

eye+

march | 2016

Silencing the silent stealer ISEC commemorates World Glaucoma Week with free eye check-ups for early detection By Norman Hussaini

orld Glaucoma Week is observed every year in March to spread awareness on the dangers of glaucoma, an eye condition dubbed the “silent thief of sight”. The International Specialist Eye

Centre (ISEC) celebrated the event on March 10 with free eye checkups for glaucoma. Themed “Beating Invisible Glaucoma”, the day saw a crowded clinic with families lining up to get tested for the condition. Health+ spoke to ISEC consultant ophthalmologist and eye surgeon Dr Fang Seng Kheong to know more about the eye condition and the people at risk. Dr Fang is a leading expert in glaucoma with more than 20 years of experience in the industry.

CLEARER VIEW: Dr Fang explaining how glaucoma affects the eye and what can be done to manage the condition.

What is glaucoma? “Glaucoma is basically a condition where the optic nerve on the back of the eye is damaged by various causes. Also known as optic neuropathy, one of the most common modifiable risk factors of the condition is an increase in eye pressure,” explains Dr Fang. “The condition gradually progresses and will first affect the peripheral vision. As it progresses, the field of vision becomes more constricted and can eventually affect the central vision which may then cause blindness.” It’s a scary notion that glaucoma can affect anyone. However, a question remains: As the common cause for the condition is the increase in eye pressure, what makes it go up? According to Dr Fang, eye

pressure increases with age. “A normal eye functions with the aqueous humour (transparent, gelatinous fluid in the eye) flowing through the posterior chamber to the anterior chamber and draining out through the trabecular meshwork. “With age, there is an increased resistance to the outflow. It works much like a drain pipe. A pipe that is being used for many years may start to clog and resist proper flow of water and increase the pressure.” This, he explains, is labelled as open-angle glaucoma. He says another type is called closed-angle glaucoma. This is when iris closes up the drainage angle at the root of the iris, which can occur over a period of time (chronic), intermittently or suddenly (acute angle closure).

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Jamiat Ulama-E-Maharashtra (JUM), a non-profit organisation recognised by Jakim Malaysia. Tasting like Kiwi juice, it is the best way to burn fat and become a slimmer, slenderer you.

eye+ • 31

2016 | march

This normally happens in eyes predisposed to angle closure. Who are more susceptible? People normally develop this resistance to flow at 40 and older, which means those above 40 should go for eye screening. “Statistics show that generally 1-2% of the population older than 40 are more likely to contract glaucoma,” says Dr Fang. He says there are also other risk factors. “Besides age, closed-angle glaucoma specifically is more likely to affect women more than men. It is also found that Chinese people are more susceptible to it as well. Open-angled glaucoma, on the other hand, affects people with darker skin.” He says people who are shortsighted and those who use steroids are also more susceptible to openangle glaucoma, while people with long-sightedness are more prone to closed-angle glaucoma. Treatment He says unlike treatment for cataract, for example, treating glaucoma is more in terms of managing rather than curing it. Different types of treatments are available for each type of glaucoma. “Open-angle glaucoma is mainly manageable using eye drops. The eye drops lower the eye pressure to help maintain the vision and prevent potential blindness.” Closed-angle glaucoma, however, need to be treated differently. “With closed-angle glaucoma, the definitive treatment involves laser which is called laser iridotomy used to relieve pupillary block from the iris closing up the angle. Yet closed-angle glaucoma can develop into a more severe state (chronic close-angled glaucoma), in which case eye drops are also needed.” Surgery, he adds, is done as a last resort when eye drops and laser treatment fail to maintain the person’s vision. The procedure is mainly to create a new channel and bypass for the clogged drain. State of glaucoma As the president of the Malaysian Society of Ophthalmology, Dr Fang expressively says awareness on glaucoma is still poor among Malaysians. However, it is higher among people in urban areas than those in rural areas. “That is why we have initiatives such as World Sight Day and World Glaucoma Week to help reinforce the awareness among the public and get them to go for screenings when they are of age (40 and above).” He also thinks that testing and screenings should be ongoing and not just for a couple of days each year. “We can only screen a limited number of people in a day or a week, so it is never enough to reach everyone.” He also emphasises that blindness is preventable when glaucoma is detected early but once the eye is blind from glaucoma it is not reversible.

Making adorable double eyelids If you don’t have those appealing and charming extra permanent folds, surgery can create them for you

By YOUNG SIN YEE

o you have adorable double eyelids? If you don’t, have you ever longed to have them too? Most of us admire individuals with double eyelids – in fact some of us have the habit of looking at people’s eyelids, especially when we meet them for the first time! Well, you may say this is a rather odd habit, but you must understand that those people who usually do it are simply admiring double eyelids because they have only single eyelids. It cannot be denied that double eyelids are very appealing and charming compared with single eyelids. If not for anything else, double eyelids appear to have more vitality and also the contour of the eye area is more obvious than that of single eyelids. However, more than 50% of Asians have only single eyelids and hence they are always looking for ways to create double eyelids, even if they are just temporary ones. These days, there are many ways to create temporary double eyelids such as double eyelid stickers, fibre threads and double eyelid glue, which usually cost only a couple of hundred ringgit. But for those who want permanent and natural-looking double eyelids, a cosmetic surgeon can create them for you. Cosmetic surgery is getting popular, particularly among Koreans with many of them going for double eyelid surgery when they are in their teens or early adulthood. Some parents even reward their children with such surgery when they do well in school or college. This trend is catching on in Malaysia, particularly among the younger generation, probably partly influenced by Korean pop culture, a phenomenon that has also spread to other Asian countries. Dr Stephen Cheng, a doctor at KO Skin Specialist, says most patients seeking

DOUBLE BEAUTY: Dr Stephen says most patients seeking double eyelid surgery at the centre are young women, aged 20 to 30. double eyelid surgery at the centre are young women, aged 20 to 30, but some in their 40s also go for surgery to adjust their drooping eyes in order to look younger. Generally, a doctor will discuss with their patients and advise them on a suitable type of surgery. The doctor will also brief them on the procedure, including the inherent risks and benefits. “Once the patient feels comfortable and agrees to proceed with the surgery, the doctor will set an appointment to perform the procedure which normally takes one hour or less,” says Dr Stephen. What is the main reason people go for double eyelid surgery? Dr Stephen says the main reason is that people simply want to look brighter, younger and more charming. “The surgery will better their eyelids to make them look brighter and more attractive. Single eyelids may cause people to look puffy and tired because they do not have a pair of bright eyes.” Is there any risk? “Any surgery will always have a certain degree of risks of infection and bleeding. But precautionary measures will be

taken to minimise the bleeding as it is just a small area, and antibiotics will be given to prevent infections. There will be a bit of swelling after the surgery and it will take about one to two weeks (for the patient) to recover by taking the given medications as well as applying ointment on it,” says Dr Stephen. The patient must take some precautions before and after the surgery. “Basically before the surgery, the doctor will ask for and discuss the patient’s personal and family medical history such as blood pressure and cholesterol control. The procedure is normally done under local anaesthesia,” he says. “Local anaesthesia involves only the local part where the surgery is done, and the patient is still awake. The doctor and the anaesthetist together with the patient will discuss and determine the best and safest treatment or procedure to be taken before the surgery starts.” After the surgery, the main precaution is to take good care of the wound. “The patient has to make sure the wound is clean at all times, take the antibiotics given and avoid touching the area around the wound.”

Methods to create the folds There are different methods to create double eyelids. Besides stitching and cutting which are more commonly used, plasma skin tightening therapy such as Plexr which is the latest technology to create the permanent folds The stitching method involves no cutting but just sewing around the eye

areas. The cutting type involves cutting the areas above the upper eyelids to create a crease. When performing the cut, the doctor ensures that the crease looks natural, so that when the patient closes her eyes, the scars hidden inside the folds are not seen. Plexr is a plasma device that utilises plasma formed through ionisation of

atmospheric gases, to stimulate instant contraction and tightening of skin fibres. This is more preferred by patients who are unwilling to have their eyelids cut or stitched due to the uncomfortable feeling. But this method requires a few treatments to get permanent result. This procedure is performed by a doctor who has undergone specific training.

32 •

dental+

march | 2016

Restoring the shine to discoloured teeth Discolouration is normal, but thanks to teeth whitening, you can smile more often and with confidence

By Syed Zaid Syed Osman

survey by the American Academy of Periodontology found that 50% of respondents said a smile is the first feature they notice in a person. It is said women smile at an average 62 times a day while men have only eight to show. Smiling illustrates happiness and safety. Psychologists agree a smile with exposed teeth conveys a welcoming aura to others. Simpler said that done, not everybody can muster a smile like Anne Hathaway, showing off a set of perfect white teeth almost spontaneously. Some compare their teeth with the impossible standards set by celebrities. Having a great smile with bright white teeth is a great personal asset. But then, not everybody is endowed with those sparkling white teeth. For various reasons, teeth can sometimes get discoloured and stained over time. Unsightly discoloured tooth can cause great embarrassment and keep people from smiling. According to Dr Yeo Wee Kwong of Whitesmile Dental Clinic, teeth discolouration is normal. “It occurs to everyone because of food and beverage preferences, lifestyle choices, medications and even from simply ageing.” The question is what makes your teeth yellow? The answer is simple – it’s the enamel and dentine. The dentine has a yellow appearance and is protected by the translucence coloured enamel. In time, the yellow from dentine will develop into darker shades of yellow which will eventually show through the enamel. The colour concentration of the dentine is different from one person to another due to various reasons such as genetic traits and medications. When it comes to food and beverages, those with high acid or sugar content can corrode the enamel layer of the tooth. The component stays on the enamel,

thinning out the barrier over time causing parts of the dentine to be exposed. Once bare, it is easier for colouring agent to be absorbed into the tooth and staining the enamel from inside. While the amount of sugar may not affect your teeth directly, the duration of the sugar stay in your teeth poses greater threat. Restoration Discoloured teeth can be restored to the underlying, natural tooth shade through teeth whitening. Teeth whitening, also known as teeth bleaching, is a process where a dentist utilises bleach to whiten the teeth. It is a commonly known service for most orthodontics or dentists to practise in their clinics.

BARING DANGER: Cross sectional diagram of the human tooth. In time, the yellow from dentine will develop into darker shades of yellow which will eventually show through the enamel.

The whitening of teeth can also induce temporary teeth sensitivity. In this case, the dentist will apply a desensitiser to counter the effect until it goes away.” – Dr Yeo

WINNING SMILE: Psychologists agree a smile with exposed teeth conveys a welcoming aura to others.

The commonly used bleaches are hydrogen peroxide and the carbamide peroxide. The process takes an hour including the breaks over three sessions consisting of 15 minutes per cycle. The gum is protected by vitamin E gel to protect the tissue from being damaged by the bleach. The bleach is then applied to the teeth. The compound applied will seep into the enamel breaking the stains into smaller pieces to dilute the concentrated colour which will result in brighter and whiter teeth. Another alternative available is the off-the-shelf teeth bleaching products. They come in the form of carbamide peroxide and requires water to develop into hydrogen peroxide. Various choices are available in nearby pharmaceutical companies and can be done in the comfort of one’s home. However, teeth whitening has limitations. Bleaches are unable to whiten darker shade of fillings. Those with cavities are not recommended to undergo the procedure.

Furthermore, the whitening may work fine on yellow teeth. Unfortunately it will not be helpful for discolouration caused by injury or medications. Before running out to purchase off-the-shelf products, be reminded to consult your dentist first. Consultations on how suitable one’s teeth for bleaching are always available within the next appointment. “The whitening of teeth can also induce temporary teeth sensitivity. In this case, the dentist will apply a desensitiser to counter the effect until it goes away,” says Dr Yeo. In the end, teeth whitening does nothing more than what the name suggests. It may help to improve the customer’s selfesteem and confidence but teeth whitening does not help cure decaying teeth and it may not be suitable for everyone. “The procedure is more of an aesthetic nature” says Dr Yeo. It is recommended for those who want to look good to feel good.

dental+ • 33

2016 | march

Healthy mouth, healthy body

n conjunction with World Oral Health Day 2016, Philips Malaysia and the World Dental Federation (FDI) will actively promote the importance of good oral health and spread awareness of its impact on people’s overall health. Themed “It all starts here. A healthy mouth. Healthy body”, this annual event receives participation from millions of dentists worldwide. According to a report by FDI, oral health is more than just dental care as it covers the health of gums, hard and soft palate, linings of the mouth and throat, tongue, lips, salivary glands, chewing muscle and upper and lower jaws. Oral health and general health are closely linked as oral diseases can also lead to infections, inflammation and other serious impact on overall health. In a media briefing, Dr Halina Haron, a dentist with more than 25 years of experience, says “the research done by the Health Ministry indicated that as many as 98.3% of Malaysians did not have sufficient oral healthcare with 94% of them having gum problems.” “Malaysians need to know that gum disease can have an impact on their general health. For example, gum disease can be the starting point of noma and can even cause complications for diabetics. There is also a research on a possible link between gum disease and infective endocarditis, cardiovascular disease and even risk of low-weight babies among pregnant women.” As a general knowledge to acquire, oral care is compulsory for everyone as it ensures good oral health. It is a good start to brush our teeth at least twice a day and floss them once a day to achieve better oral health as 90% of dental problems usually arise from accumulation of plaque between the teeth. Therefore, brushing your teeth effectively is a must to remove as much plaque as possible. “We must not forget flossing as well,” says Dr Halina. “It is the only way for us to remove plaque from tight gaps and reverse gum disease in its early stages.” She advises parents to educate and motivate their children to practise better oral hygiene. “It is also important for the parents and the children to not be afraid to go to the dentist,” she says. “In my years of experience, I have noticed that there is barrier created between the public and dentists. This should not be so. I implore everyone to create a good relationship with your dentist

so that your oral health can be preserved.” Dr Halina demonstrated proper techniques of flossing as it is still not a common practice among Malaysians. Philips Malaysia marketing manager Chung Ngan Leng showcased and explained the company’s

latest electric floss and toothbrush technology. “It is said that 40% of our teeth are concealed in the small gaps we have between them. While brushing your teeth is a must, quite an amount of plaque is hidden between the small gaps. This is why flossing is just as BUZZY CLEANING: Chung (left) showcasing the two latest Philips oral healthcare products with Dr Halina’s support.

important,” she says. Philips country manager for Malaysia Muhammad Ali Jaleel says this year’s World Oral Health Day is an opportunity to engage with dental professionals and the public to highlight the far-reaching impact of oral healthcare. “We want to remind Malaysians that brushing and flossing can do much more than just giving you a nice smile and pleasant breath,” he says. “In line with Philips’ aim to improve lives through meaningful product innovation, its range of Sonicare oral healthcare products were designed to help people achieve good oral health with minimum hassle.”

34 •

fitness+

march | 2016

Womanhood, sisterhood for health’s sake Welcome to Curves, a gym specially designed for women where you can just be yourself

HELPING HAND: There’s also a circuit coach to train and motivate members at every workout.

By Ali-Azmin Hassan

oing to the gym can be a scary experience to some. You go there and you’ve no idea what you’re doing. It’s terrifying being surrounded by bodybuilders who are certainly far fitter than you, and what’s worse is you’re constantly being judged by staring eyes. Of course you shouldn’t care as you’re there for your sake, for your own health. But being in that environment can be somewhat intimidating. To those who can’t control their deep thoughts, you might be saying to yourself that maybe you’ll never be as good as them, so why even try? But don’t give up just yet. If conventional gyms are a bit too much for you, here’s Curves, a gym specially designed for women. Curves Malaysia CEO Alison Chin enlightens Health+ on what makes Curves different from conventional gyms. “Curves is a specially-designed programme. The workout consists of five components – warming up, strength training, cardio, stretching, and cooling down – in just 30 minutes. Curves is more than just a gym. Here at Curves, it’s a form of community where women get to meet each other in a fun environment and where we can just be ourselves and don’t have to worry about how we look like,” says Alison. circuit coach There’s also a circuit coach to train and motivate members at every workout. Members use CurvesSmart personal coaching technology that also enables them to track every workout, see calories burned and workout trends. “Some women who joined gyms sometimes feel lonely or intimidated, or may not have exercised in years, but being here at Curves, it feels like we’re all on the same boat,” says Edeareena Nor, owner and manager of Curves Ampang. Curves strongly emphasises

strength training which helps to preserve and enhance muscle mass, regardless of age. It can also improve blood circulation, coordination and balance. Some women, especially married housewives with kids, those taking care of elderly parents at home, or career women, may find it hard to find the time to work out and exercise. Besides, when one stops exercising, health problems may set in. With Curves’ 30-minute workout regimen, busy housewives and working women have no excuse not to exercise. Consistency of going to the gym is of course important for anyone who wants to lose weight. “Some come in because they want to lose weight, while others have health concerns like high blood pressure, diabetes and joint pains, and their doctors have advised them they must exercise.

Specially designed: The workout consists of five components in just 30 minutes.

Strength workout for women builds strength and fitness UNIQUE: Alison says Curves is different from other conventional gyms. There’s no short cut for that. Other ladies simply love the community of support and friendship gained at Curves” says Alison. “The 30-minute workout is just for yourself. We need to prioritise our health first. It’s about being healthy, not just about weight loss,” she adds. comfortable Azura Idayu Zulkifli, 32, who joined Curves a year and a half ago, feels comfortable working out there as it’s a women’s gym. “It’s flexible and I can come whenever I’m free because I’m working. So I can come during lunch hour or after work. I feel more comfortable as it’s an allwomen’s gym and that’s a pull factor for me.” Millie Kwek, 62, simply loves the gym. “I find it’s so different from other gyms that I’ve attended and the results are so amazing. A 30-minute workout really works and members are so motivating and we motivate each other. Hence, I feel comfortable here.” What makes Curves different from others is the sense of community where women can be comfortable with one another. Whenever they enter the gym, there is absolutely zero judgement. And Curves allows every member to communicate and empower each other to be healthy.

When it comes to working out, many women want to know whether their training should be different from their male counterparts. If they trained in a similar manner to that of men, would they then start to look like them? Fortunately, that’s not true at all. So, do men and women really need to train differently? No, women do not have testosterone in their bodies to be able to look like muscular men – unless, of course, if they use supplements with testosterones. Also, do keep in mind that just because you train like men doesn’t mean you will end up looking like them too. Although women’s workout routine typically focuses on cardio, there’s nothing wrong with such workout. It’s affective to shed some pounds and keep your heart in good shape, but in terms of body shaping and improved fat burning, cardio won’t do much. The first step is always the hardest, but in the long run, you won’t regret it. So, where do you start to get yourself on a lifting routine? There are many various workout and training regimens, and gyms should have the proper equipment for you to start lifting. Weight lifting and strength workout are integral part of getting a perfect body. Don’t be afraid to lift heavier weights, because if you think lifting very light dumbbells for a high number of reps would be enough, the results will be lacklustre. Lifting heavier weights does not necessarily mean you can get a large degree of muscle mass. Women develop muscle at about half the rate of men, so there is no cause for concern. Strength training is a key component for overall strength and fitness. It helps to preserve muscle mass, controls weight, reduces risk of osteoporosis and decreases injury risk. Before you say “no thanks” to weights, take some time to learn the importance of strength training. And you would be glad you did!

fitness+ • 35

2016 | march

Brisk walk really great workout Correct your technique, walk faster and longer, and those unsightly flabs will go off faster By Huang Ruifu

his activity will melt away the pounds, tone your flabby bits and leave you on an emotional high. Yet the form of exercise does not require gym membership or a personal trainer. All you need to do is walk. Walking is free, enjoyable and already a part of everyday life. All you need to do is correct your technique, walk faster and longer, and you will lose weight. As a brisk walker, I always feel that walking is better value for money than signing up for a gym. There is much evidence of the benefits of walking. Scientists at the University of Pittsburgh revealed that overweight people who walked briskly for 30 to 60 minutes a day lost weight even if they didn›t change any other lifestyle habits.

How much, how often? Health experts recommend that we should walk 10,000 steps a day (about 8km) to stay healthy. Personally, I think 5km three times a week is good enough as I feel healthier and fitter these days since I started walking five years ago. Perfect your technique To burn fat quickly and effectively, experts suggest power-walking. Without it you will struggle to increase your pace and your weight loss will plateau. Stand tall with your arms by your sides and pull your navel towards your spine so that your core muscles are working. Focus your eyes 5-6m ahead and keep your shoulders relaxed. Bend your elbows at a 900 angle and cup your hands lightly, rather than clenching your fists. Leading with the heel, take a step forward with your right foot and move your arms in opposition,

that is your left arm moves forward, your right moves back. Transfer your weight through the heel of your right foot. Vary the terrain Adding hills to your route will speed up calorie burning. Experts say on really steep inclines, it’s not unusual for even a fit person’s heart rate to increase by about 20%. Going downhill, you have to contract your leg muscles to work

against gravity and slow your descent. Walking on softer surfaces such as mud, sand or grass also uses more energy than walking on concrete. Every time your foot hits the ground, it creates a small depression so that the leg muscles must work harder to push upwards and forwards for the next step. Walking on cobblestones or rocky ground may have even more benefits.

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Detox to a healthier you It is not necessary to have the symmetrical features to look beautiful but there is one aspect of beauty accepted by all as beautiful – healthy and radiant skin. When your body receives the needed nutrients, coupled with a healthy lifestyle, your glow and zest for life is translated into beauty and personality. On the other hand, if the body is experiencing a nutrient deficiency or overloaded with toxins, the entire system will run sluggishly, leaving you lethargic. A sluggish body system shows on your skin and this is one reason for a dull-looking and problematic skin. Keep sluggishness and dull complexion at bay by detoxifying. Detoxify is the simplest way to restore the body to tip-top condition.

Benefits of detoxification

Improves digestion for better

nutrient absorption as well as relives digestive problem such as bloating and flatulence. Ease constipation by gently restoring normal bowel movements and flushing out toxins and hardened waste from the intestinal tract. Boost energy levels with greater vitality and more productivity. Weight loss through moving excess waste out of the body system quickly and minimising water retention. Better health by restoring healthy digestive system and increasing nutrient absorption rate. Improves skin complexion. Scavenges free radicals for healthier cells and prevents premature ageing. Detoxifying is as simple as having a cuppa. Drinking a cup of detox tea from NH Detoxlim is one of the best solutions to keep your health at peak levels. Made from

100% organic green tea and natural herbs, it helps to restore normal bowel movements and flush out toxins and hardened waste from intestinal walls. It works gently, without causing any damage to the colon muscles. These herbs, which are friendly to the body, help relieve constipation, irritable bowel syndrome, flatulence and a bloated tummy. In a nutshell, drinking this tea helps you enhance your health in an easy way. NH Detoxlim takes its quality very seriously. Its herbal tea ingredients have been approved by the Ministry of Health and are certified HALAL by Jabatan Kemajuan Islam Malaysia. The herbal tea contains no harmful laxatives or added sugar. Its manufacturing processes comply with international Good Manufacturing Practices standards.

Mila’s Choice

Akademi Fantasia 5 winner Mirin Jirin is a satisfied user of NH Detoxlim’s detox tea. “I always believe that a person with a radiant complexion and

slender body most likely has a healthy body and a clean colon. Therefore a consistent detox programme is necessary for me to flush out all the toxins from my body,” said Mila. “Before I started taking this tea, I had constipation and digestion problems. Now, I find it easy to maintain a slender body and flat tummy. I feel energetic as toxins are flushed out every day when I go to the bathroom. I definitely will not miss taking a cup of detox tea after my meal now,” she added. Just a cup of tea after your meal, you will soon notice the difference. NH Detoxlim’s tea is sold at all leading pharmacies, hypermarkets and selected traditional medical halls nationwide. It is also available at leading pharmacies in Singapore and Brunei. This product now carries a Product Liability Insurance valued up to US$1 million, an assurance of the potency and safety of its all-natural ingredients with no side effects. This tea also won Guardian Customers’ Choice Award from 2008 till 2014.

36 •

wellness+

Tranquility of Thai massage Serenity Telawi offers traditional Thai massages, aromatherapy, foot reflexology and shoulder massages By Syed Zaid Syed Osman

raditional Thai massage is not foreign to most Malaysians, particularly those who love good authentic

march | 2016

BOTTLE OF THERAPY: Equipped with premium balm and medications, Serenity Telawi aims to be the best in the massages at affordable rates. After all, this genre of neighbour- massage has been around for quite a while, and is much hood. sought after by many for diverse reasons. Like borrowing sugar from the neighbour, this massage technique was brought in from Thailand and is recommended to those seeking alternative treatments for illnesses, increased focus and other health benefits, or simply to pamper the body. Klang Valley folks are spoilt for choice when it comes to indulging in a pampering Thai massage. Located in the affluent Jalan Telawi in Bangsar is Serenity Telawi, which is difficult to miss with its fierce tagline on its business sign. Once you step through the peaceful and inviting entrance, the award-winning centre is ready to take your body, soul and heart on a journey to tranquillity. Serenity Telawi, which opened its doors in 2014, aims to be the best in the neighbourhood. Awarded with a Silver status by the Ministry of Tourism and Culture, it offers traditional Thai massages, Thai aromatherapy, foot reflexology and shoulder massages. “We (specialists) received speci al training in practising the art,” Yim Thanat, a T hai massage therapist, tells Health+. “Serenity Telawi chooses only the finest to attend PROFESSIONAL: Yim had to guests,” says Yim, four years of experience in who had rich experithe field and 240 hours of ence in the field and training in Bangkok when 240 hours of training she joined Serenity Telawi in in Bangkok when she its early days. joined the centre in its early days. Traditional Thai massage is different from other types of massages. Unlike western massages which focus on only parts of the body with the guest’s consent using a good amount of force, Thai massage is performed on the whole body, which may be done using other parts of the limbs. The main focus of Thai massage is the body’s energy line system, known as sen lines. There are 10 main sen lines and when disharmony occurs, it results in blockages and diseases. Thai massage helps clear these blockages, assisting the body’s own natural healing process to restore balance. Yim says the pressure points are utilised to release the sens of the body. “Additionally, traditional Thai massage helps to release tension, relax muscles and increase the flexibility of the guest.” In Thai massage, communication between the guest and the masseuse is encouraged to build closer bond which evidently helps the guest’s body open up the sens. Good hygiene and cleanliness are essential in the daily operation of the massage centre. Yim says sheets are cleaned and sanitised after each service to avoid the risk of unwarranted health issues for guests. “They are sent to the dry cleaners daily and inspected after each service to avoid cross contamination of bacteria among the guests,” she says with firm certainty. The price for each service depends on the type, package and duration, and starts from RM70.

opinion • 37 OPINION+

2016 | march

WELLNESS

By Datuk Dr Rajbans Singh

he interaction between gene and environment has brought us to the era of nutrigenomics, which looks at how food and lifestyle choices affect our genes and how individual genetic differences can affect the way we respond to nutrients and other natural occurring compounds in the foods we eat. Nutrigenomics is a field in which we are able to select the right foods and exercise according to our genes. By knowing our genetic predispositions through DNA profiling test, a personalised wellness programme can be designed to help us bring out the greatest potential in our genes and deactivate some genes that may cause diseases, thus enabling us to stay fit and healthy. genetic profile DNA profiling test provides us information about our genetic weaknesses, how our body responds to inflammation, detoxifies and reacts to free radicals and other aspects. All these are related to the development of chronic diseases. However, it is important to note that our genetic profile only tells us that we may have an increased risk of developing certain diseases but it does not mean that we will definitely develop those diseases. Diet and lifestyle changes form a vital aspect of preventive health measures to reduce our risk of diseases. The synchronisation of our genetic profile with a personalised dietary and lifestyle programme tailored specifically for our unique genetic make-up is known as nutrigenomics. foods affect genes Nutrigenomics is the study of how foods affect our genes. Good food and lifestyle choices send “healthy” message to our genes, while poor choices can damage our genes, disrupt our cell functions and clog them with toxic by-products. If this process is ongoing day after day, diseases will undoubtedly be the inevitable consequences. Research shows that certain natural occurring compounds in the food we eat exert nutrigenomics effect. One of the extraordinary nutrigenomics molecules found in food is sulforaphane, a phytochemical present in various cruciferous vegetables, especially broccoli

sprout, is able to “switch on” lazy genes and “switch off ” overactive genes. With the influence of this powerful nutrigenomics compound, it helps to restore cell activity back to normal whereby cells which have lost their ability to regulate properly can work again more efficiently. Sulforaphane Sulforaphane is a potent antioxidant and stimulators of natural detoxifying enzymes. The antioxidant action of sulforaphane helps to prevent against development of cancers, reduce high cholesterol and maintain a good heart health. Apart from that, research also shows that sulforaphane is able to switch “on” body’s natural detoxification enzymes. These detoxification enzymes are specifically targeted at modifying the chemical structure of toxic molecules so that they can no longer damage body cell structures. Coupled with its ability to enhance the cell’s antioxidant status, sulforaphane is also one of the most important nutrigenomics compounds available that we can use to enhance the defence mechanisms of cells. Scientists have found that there are around 200 genes of the human cell defence system known to be influenced by sulforaphane. Food and human health Nutrigenomics has revealed the role of food in human health. Food is so much more than a way of satisfying our palate or appetite. Certain food molecules exert very powerful health effects, activating switches that can significantly influence the internal health of cells and their ability to defend and repair themselves. By selecting the right food to be regular “visitors” to our cells

wishing well

Nutrigenomics: ‘Switch’ on and off your genes

health effects: Food is so much more than a way of satisfying our palate or appetite.

based on our genetic profile and practising a healthy lifestyle, we can literally take back control of our own health to stay fit and healthy without depending on pharmaceutical drugs and surgery! Datuk Dr Rajbans Singh is a consultant physician and geriatrician, and healthy ageing specialist at Beacon Laureate Sdn Bhd.

By selecting the right food to be regular ‘visitors’ to our cells based on our genetic profile and practising a healthy lifestyle, we can literally take back control of our own health to stay fit and healthy without depending on pharmaceutical drugs and surgery!

38 •

opinion+

march | 2016

mental Creative Commons

By Urmilah Dass

Understanding difficult people

ART BOOST: Dr Davies says whether a person prefers listening to music, reading, colouring, creative writing, watching movies or attending concerts, the knowledge that arts engagement positively impacts mental wellbeing is empowering.

here are times when we just can’t seem to understand or get along with someone. We rack our brains trying to figure out if we are being difficult or may be just plain judgmental, but no matter how hard we try, our annoyance does not go away. This is a common dilemma faced by many people, even psychologists. Sometimes even trained professionals in mental health have the problem of initially not being able to “manage” a person’s personality. However, after a while, we realise something is amiss and we begin to understand. Psychologists are trained to identify the traits of people with personality disorders and work with them so that they can function better. Ten types of personality disorders have been identified. To get a better understanding of these personality disorders, you can refer to the Diagnostic & Statistical Manual V (DSM V) which provides information on all mental and developmental disorders. Why are some people so difficult? What does a personality disorder mean? Well, it means that people with such disorder may have difficulty living fully functional lives. They have a maladaptive way of processing information, display unhelpful behavioural patterns and have difficulty understanding inner experiences. They may not be able to study or work. They may also be unable to have functional relationships. Life becomes difficult for themselves and for others around them. Personality disorders are

Interest in arts can boost mental health

One must remember that a personality disorder is about an individual’s personality which affects his mood and behaviour. Information processing becomes maladaptive and this causes dysfunction. categorised into three groupings. Cluster A, also known as the “odd, eccentric” cluster, comprises the schizotypal, schizoid and paranoid personality disorders. The main characteristics that stand out are social withdrawal, social awkwardness and distorted reality. Cluster B personalities are famous for “dramas” that can play out as erratic. This cluster comprises borderline, histrionic, narcissistic and anti-social personality disorders. Their main characteristics are that they have problems controlling their impulses and regulating emotions. Cluster C, also known as the fearful and anxious group, consists of avoidant, dependent and obsessive-compulsive personalities. They have intense fears of being criticised or ridiculed. This in turn limits their social activities which can affect their social skills. How can this happen? Research shows that personality disorders can sometimes be attributed to an abusive environment, long-term trauma, genetics and other factors. The familial gene can be passed down either directly from our parents or from someone from the same gene pool. Research also shows that prolonged emotional and physical abuse can cause

changes in personality. One must remember that a personality disorder is about an individual’s personality which affects his mood and behaviour. Information processing becomes maladaptive and this causes dysfunction. What can be done? Can a person with a personality disorder change? Well, it really depends on the person involved. The first thing one needs to have to get on to the road of recovery is to develop insight. Insight means to take responsibility of the things that go on in your life. For a person with personality disorder to get better – which is to lead a more functional life, get along better with others and manage their dysfunctional thinking – he needs to see a mental health professional. With the help of a psychologist, he can work on his issues and try to change the way he thinks and behaves. In the end, no one else can do the work to repair yourself, except YOURSELF. So if you think you need help, make that appointment to seek expert help. Urmilah Dass is a clinical psychologist at Valley Psych Human Development Centre, Bangsar.

Engagement in the arts for enjoyment, entertainment or as a hobby, for two or more hours a week, is associated with good mental wellbeing. The link was discovered by researchers at the University of Western Australia recently. The award-winning study, published in BMC Public Health, is the first internationally to quantify the relationship between mental wellbeing and arts engagement in the general population. The university website quoted lead author Dr Christina Davies as saying good mental health was the foundation for individual and community wellbeing, yet every year one in five Australians experience mental illness. “People need a range of easy enjoyable options they can use to stay well,” she says. “Depending on a person’s interests, the arts can provide a range of health-enhancing opportunities, activities and events.” Dr Davies says whether a person prefers listening to music, reading, colouring, creative writing, watching movies or attending concerts, the knowledge that arts engagement positively impacts mental wellbeing was empowering. “Arts engagement increases happiness, confidence, self-esteem and reduces stress and social isolation,” she says. “It results in the creation of good memories and has an impact on a person’s knowledge and skills. People need to give themselves permission to be creative and to make time for the arts activities and events that they enjoy.” Dr Davies says the study, which won a Department of Health Future Health WA Award, the Public Health Association (WA) Post Graduate Award and the Arts and Health Australia Award for Excellence, provided new insights into the relationship between the arts and population health.

opinion+ • 39

2016 | march

hearing

By Dr Mallina Sivarajasingam

Seek early treatment for hearing loss

SYMPTOMS Symptoms of hearing loss may include: Certain sounds seem too loud Difficulty following conversations among two or more people Difficulty hearing in noisy areas Hard to differentiate high-pitched sounds such as “s” or “th” Trouble hearing high-pitched or more feminine voices Problems hearing when there is background noise Voices tend to sound mumbled or slurred Other symptoms include: Feeling of being off-balance or dizzy Pressure in the ears Ringing or buzzing sound in the ears CAUSES Conductive hearing loss This type of hearing loss occurs due to a mechanical problem in the outer or middle ear. The three tiny bones of the ear (ossicles) may not conduct sound properly; or The eardrum may not vibrate in response to sound. Conductive hearing loss due to the following causes can often be treated: Buildup of wax in the ear canal Damage to the very small bones (ossicles) that are right behind the eardrum Fluid that stays in the ear after an ear infection Foreign object that is stuck in the ear canal Hole in the eardrum Scar on the eardrum from repeated infections Difference in pressure inside and outside the eardrum, which is experienced in scuba diving or taking a plane flight, especially during descent. Sensorineural hearing loss This occurs when the tiny hair cells (nerve endings) that detect sound in the ear are injured, diseased, do not work correctly or have died. This type of hearing loss often cannot be reversed. Sensorineural hearing loss is

Loud and clear

earing loss is a common problem caused by noise, ageing, diseases and heredity. Hearing is a complex sense involving both the ear’s ability to detect sounds and the brain’s ability to interpret those sounds, including speech. There are three types of hearing loss: conductive hearing loss, sensory hearing loss and mixed hearing loss.

commonly caused by: Age-related hearing loss Childhood infections like meningitis, mumps and measles Constant exposure to loud noises, such as at work or during recreation Use of certain types of medicine (ototoxicity) Acoustic neuroma Meniere’s disease Mixed hearing loss This is a combination of conductive and sensorineural hearing loss, which means there is damage to both the outer or middle ear and in the inner ear, cochlea or auditory nerve. This type of hearing loss ranges in severity from mild to profound. For people with mixed hearing loss, sounds can be both softer in volume and more difficult to decipher. WHEN TO SEEK MEDICAL CONSULTATION Hearing problems interfere with your

lifestyle Hearing problems do not go away or become worse Hearing in one ear is worse than the other Sudden, severe hearing loss or ringing in the ears (tinnitus) Ear pain with hearing problems Hearing loss associated with giddiness or imbalance Hearing loss associated with facial numbness or drooping Communication is critical in life. Our jobs, relationships and social interactions are more rewarding when we communicate confidently, and hearing is key to all these. The warning signs discussed earlier indicate that your hearing is in jeopardy, and you must seek treatment fast. Dr Mallina Sivarajasingam is an ENT consultant, head & neck surgeon at Tropicana Medical Centre.

Sound of voice can affect mood We are unaware of our emotional expressions and our mood can be changed without our knowledge, according to study by the French National Centre for Scientific Research (CNRS). Recently-recruited research associate on the CNRS “Perception and Sound Design” team, Jean-Julien Aucouturier, has published new research looking at the mechanisms by which emotions are produced in the brain in response to different sound stimuli. “Previous research has suggested that people try to manage and control their emotions, for example hold back an expression or reappraise feelings. We wanted to investigate what kind of awareness people have of their own emotional expressions,” says Aucouturier, in the study published in the Proceedings of the National Academy of Science (PNAS) journal. For the purposes of the study, the team built a digital audio platform capable of modifying the emotional tone of voices in real time, making them sound happier, sadder or more fearful. Participants were asked to read a short text aloud while simultaneously listening to their own surreptitiously altered voice through headphones. The results showed that when hearing their own voices altered to sound happier, sadder or more fearful, the emotional state of participants changed in accordance with the modification made. Participants were not aware that their voices were being altered or that this modification had affected their mood. The study’s authors see their voice-transforming platform as a key tool for opening up new areas of research and experimentation. “Previously, this kind of emotional manipulation has not been done on running speech, only on recorded segments,” says Jean-Julien Aucouturier. Katsumi Watanabe, one of the report’s co-authors from Waseda University and the University of Tokyo in Japan, suggests that the platform could find therapeutic applications, such as the treatment of mood disorders, inducing a positive attitude change by recounting emotionally-charged events with an artificially altered tone of voice. It could also serve to control the emotional atmosphere in conversations in online meetings and video games. The researchers have made the platform available as an open-source application on their website (http://cream.ircam. fr/?p=44) so that anyone can download and experiment with the tools. –AFPRelaxnews

40 •

education+

march | 2016

Six-star education in healthcare Ramsay Sime Darby Healthcare College is a leading institution offering nursing and allied health science courses

HANDS ON: RSDHC emphasises practical training as the best way to approach education.

THRIVING STAR: Six-star rating puts RSDHC in the forefront of healthcare education in Malaysia.

he Ramsay Sime Darby Healthcare College (RSDHC) is one of the earliest local colleges offering high quality healthcare education. The college, established in 1995, is a registered institution of higher education with the Education Ministry. As an official institution, the programmes offered by RSDHC are approved by the Malaysian Qualifications Agency (MQA) and accredited body appointed by the ministry. R S D H C achieved a milestone for quality and excellence late last year when it received a sixstar rating from MyQUEST, a quality rating system developed by the ministry as a way to recognise excellence in education among institutions in Malaysia. T he college offers nursing and allied health science courses, HI-TECH: Students have access including physioto sophisticated facilities to therapy, healthcare ensure the best training. service, medical laboratory technology, medical assistant and foundation in science programme. It also provides sub-specialty clinical courses in nursing and postgraduate certificate in teaching. The RSDHC campus is equipped with comprehensive training facilities that nurture students to become competent and confident healthcare professionals ready to showcase their skills when entering the industry. In line with its mission of educational excellence and quality, students are trained by highly professional medical and paramedical practitioners with years of experience. The students are given invaluable hands-on clinical practice during their clinical training sessions in one of many Ramsay Sime Darby Healthcare Group hospitals in Malaysia. RSDHC was awarded both the six-star outstanding rating in college-based category and the six-star outstanding rating in healthcare and welfare education sector. It was one of three colleges to win the six-star rating in college category and one of five to win in healthcare and welfare education sector. “This is a testament to our staff team’s relentless efforts towards highest quality of education. This results in our graduates being sought after by the industry in Malaysia, Singapore, and the Middle-East,” RSDHC CEO Shanaz Mawji said in a report. MyQUEST was developed by the Education Ministry to evaluate the overall academic quality of private colleges. RSDHC believes its ability to teach excellence backed by its own group of world-class hospitals will benefit students across the region seeking to be healthcare professionals.

general+

2016 | march

CREATIVE COMMONS

NEVER SAFE: Dengue mosquitoes fly only few feet from the ground, but then they can get into your elevator too.

Myths and facts about dengue fever

• 41

Late nights at mamak stalls make you fat

Disease has been around for as long as we can remember, yet many still have misconceptions about it

MOZZY HABITAT: Dengue mosquitoes actually breed in all types of stagnant water.

By PRASAD CHANDRA SEGARAN

engue fever is not something to trifle with as the number of deaths caused by the disease in the country spiked more than 50% last year compared with 2014, the Health Ministry said recently. This is the highest number of dengue deaths ever recorded. Despite dengue having been around for as long as we can remember, many people still have misconceptions about it. To give you a clearer picture about the disease, we’ve compiled some myths and facts about dengue. MYTH # 1: Dengue is most common in rural areas. FACT: Many people think dengue fever spreads only in rural areas, but the fact is the disease is more prevalent in urban areas. This is because city folks are so busy with their lives to think about hygiene and cleanliness which are crucial to prevent the Aedes aegypti mosquito – the species of mosquito that spreads dengue – from breeding and laying eggs. MYTH # 2: Dengue mosquitoes breed and lay eggs only in river water and lake water. FACT: Dengue mosquitoes actually breed in all types of stagnant water. They can breed and lay eggs behind your home, at the park and even in your garden – as long as there’s stagnant water. MYTH # 3: Dengue mosquitoes bite only at night? FACT: Dengue is transmitted by the bite of the Aedes mosquitoes that typically attack in the early morning and late afternoon. MYTH # 4: Drinking

100Plus, crab soup, guava juice, papaya leave and guava juice can increase your platelet count. FACT: When you are diagnosed positive to dengue virus, your body should have enough liquid to keep yourself hydrated. It means drinking any form of liquid that helps you to gain platelet count. However, drinking liquid with too much sugar make you urinate a lot, causing your body to be tired. Drinking plain water helps you more than drinking juices like guava and papaya leave juices. MYTH # 5: It is not possible to be attacked by dengue twice. FACT: People can get dengue more than once in their lifetime. Studies have found four different strain types of dengue which mean there are different types of dengue. When you are infected by one type of dengue virus, there are chances of you getting the other types of dengue again later on. MYTH # 6: Dengue mosquitoes prefer women than men. FACT: This is obviously false as no research has proven it. There is a theory that women are “attractive” during their ovulation but there is no scientific proof to it. MYTH # 7: Spraying insecticides is more than enough to kill dengue mosquitoes. FACT: In most cases, the common ways to kill dengue mosquitoes are by fogging and spraying with insecticides. Unfortunately insecticides kill only adult mosquitoes

that are outside your home. The larvae breeding inside stagnant water and adult mosquitoes inside your house still continue to live and grow. Therefore fogging or spraying with insecticides will not totally eliminate dengue mosquitoes. MYTH # 8: Staying in a highrise building may prevent you from getting dengue. FACT: It is a fact that dengue mosquitoes fly only few feet from the ground, but then mosquitoes can get into your elevator too. Hence, living in an apartment or condominium doesn’t protect you from dengue mosquitoes. MYTH # 9: Low platelet count means you have dengue. FACT: If you have a low platelet count and fever, it may not be caused by the dengue virus. Fever and a low platelet count can also be symptoms of other diseases like yellow fever, chikungunya and hepatitis. The best way to find out is to be examined by a doctor. MYTH # 10: Dengue can be infected through physical contact. FACT: You will not get dengue by having physical contact with an infected person. There is no medical evidence that an infected person can transmit the dengue virus to others. You can be infected by dengue when you’re bitten by a dengue mosquito which has earlier bitten an infected person. Information source: World Health Organisation & CNN.com

LATE-NIGHT MUNCH: A typical mamak stall in urban centres opens 24 hours, catering to our unhealthy habit of staying up late and indulging in high-calorie food. By ALI-AZMIN HASSAN DIETING is harder if you live in a country with an abundance of food. The local food culture is just too good to pass. But then, it is not impossible to lose those extra pounds, and neither is it impossible to not gain those sightly flabs. All it takes is self control. What really causes people to gain those extra pounds is probably due to eating past bed time. This can happen to those who frequent mamak stalls every night to catch up with their buddies until late at night, drinking iced milk tea, eating fried rice, fried noodle, roti canai or all those high-calorie foods. There’s a misconception that eating late at night makes you fat. No, it doesn’t. However, eating too much late at night will, particularly if you simply love your favourite mamak stuff. Other factors that can make you gain weight is irregular sleeping patterns. According to the American Journal of Clinical Nutrition, sleep deprivation can cause people to pack on extra pounds. Hence, by combining late night eating habits and sleeping late, you can gain weight twice as much. The best way to handle this is to practise moderation. There’s nothing wrong catching up with your friends late at night. However, doing it too often and indulging in high-calorie foods will bound to have side effects. Sleep early and practise a healthy diet, and you’ll keep those extra and unsightly pounds away. Roti canai contains about 302 calories on average per serving, while mee goreng packs in about 331 calories.

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general+

march | 2016

Alarming number of SUDS deaths 3,000 Nepalese had died of SUDS while working in Malaysia over the past 12 years By Prasad Chandra Segara

and even strenuous sport activities.

udden unexpected death syndrome (SUDS) is getting very common these days judging by the alarming number of deaths caused by this syndrome in recent years. A local medical specialist says the disease is also known as sudden adult death syndrome (SADS). Sudden death syndrome is also known as sudden cardiac arrest syndrome or sudden arrhythmia. This happens when there is no specific reason found for the death of the victim and a serious abnormal change in the heart rhythm called arrhythmia causes the sudden death. Perhaps a sudden cardiac death does not involve cardiac arrest or heart attack, which is also known as myocardial infarction. Sudden death can be avoided by working in a healthy environment, eating good food, getting enough rest and going for frequent health checkups. Researches show that SUDs can be caused by too much heavy work under hot and humid conditions, lack of medical attention and working under great stress. Many cases are also due to lack of sleep, unhealthy heart condition, cardiac arrest, arrhythmia

425 NEPALI WORKERS DIED According to The Nepal Times, some 3,000 Nepalese had died of SUDS while working in Malaysia over the past 12 years. It said statistics provided by the Nepal embassy in Kuala Lumpur showed that 425 Nepali migrant workers had died in the country in just a year, from July 2014 to July last year, and another nine per week from July to November. This is equivalent to more than one Nepalese dying every day, it added. The report said the victims were too young to die. “Some months ago one of the Nepal employees collapsed while going to work and later was reported it was a heart attack,” Dilip Malla, 43, a security guard in Damansara, was quoted as saying. Malaysian doctors are confused why Nepalese contract workers were particularly susceptible to SUDS. Aegile Fernandes, programme director of Tenaganita, which champions the rights of foreign workers in Malaysia, wants the government to seriously look into the issue. “We see high suicide rates and several sudden deaths. The government should be more transparent and an indepth study

Sudden death among babies

TOO HOT: Fernandes says migrant workers might not be used to working under extremely hot weather conditions. should be carried out. Unless that is done, we won’t know why they are dying,” says Fernandes. She says migrant workers might not be aware of precautions to take, claiming that they might not be used to working under extremely hot weather conditions. Apart from Nepalese nationals, SUDS had also claimed the lives of other foreign workers and locals. Fernandes calls on the National Department of Occupational Safety and Health to visit the migrant workers’ clinics to help migrant workers overcome these health issues and diseases. YOUNG MEN ARE MORE SUSCEPTIBLE Studies show that young men are more susceptible to SUDS. Many heart attack victims may also be caused by the syndrome, which were often detected only during post-mortems. Many experts say there is no one particular reason for a person to be affected by SUDS. In fact anybody can be affected and, in most cases of sudden death, the cause is hereditary where family members had the disease before. With proper treatment and medical assistance, this disease can be prevented.

Sudden infant death syndrome (SIDS) – sometimes known as cot death – is the sudden, unexpected and unexplained death of an apparently healthy baby. According to the UK National Health Services, SIDS is rare and the risk of your baby dying from it is low. Most deaths happen during the first six months of a baby’s life. Infants born prematurely or with a low birthweight are at greater risk. SIDS also tends to be slightly more common in baby boys. SIDS usually occurs when a baby is asleep, although it can occasionally happen while the baby is awake.

CAUSES AND PREVENTION

The exact cause of SIDS is unknown but it’s thought to be down to a combination of factors. Experts believe SIDS occurs at a particular stage in a baby’s development, and that it affects babies who are vulnerable to certain environmental stresses. This vulnerability may be caused by being born prematurely or having a low birthweight, or because of other reasons not yet identified. Environmental stresses could include tobacco smoke, getting tangled in bedding, a minor illness or a breathing obstruction. There’s also an association between co-sleeping (sleeping with your baby on a bed, sofa or chair) and SIDS. Babies who die of SIDS are thought to have problems in the way they respond to these stresses and how they regulate their heart rate, breathing and temperature. Parents can reduce the risk of SIDS by not smoking while pregnant or after the baby is born, and always placing the baby on their back when they sleep.

Treating, preventing common ear problems By Norman Hussaini

he ear is one of the key organs we depend on to get through our daily activities normally. Our sense of hearing is dependent on the health of our ears, and some habits that we are so used to can greatly affect them. Health+ talks to KPJ Selangor’s consultant ear, nose, throat, head and neck surgeon Dr Zabri Affendi Muhamad to shed some light on some common ear diseases. He had earlier given a talk to general practitioners at an event organised by the Malaysian Society of Otorhinolaryngologist. “My intention (for the talk) was to help other doctors understand better some of the problems

with the ears that can be treated in either a primary care setting or by a specialist,” he explains. He says most of these common problems are treatable with simple antibiotics or ear drops, and are preventable by self-restraint. “Ear diseases commonly occur within the external and middle ear which can cause conductive hearing loss and extreme pain,” he says. He outlines some common ear diseases and how they can be treated. Ear bleeding Dr Zabri says bleeding of the middle ear is common when unsuitable habit of cleaning the ears is performed. “This condition is commonly caused by the use of cotton buds to clean the ears. The

treatable: Dr Zabri says most common ear conditions are very treatable yet pose higher risk if left untreated.

advice then for patients is simple – do not use cotton buds.” It is quite surprising that some of our common household items pose a danger to our ears. “There are no treatments for bleeding caused by cotton buds. The bleeding will usually stop after a while and should be left to heal by itself. Antibiotics or ear drops are not needed, yet if the patient complains of pain then a minor pain relief can be prescribed,” he says. Auricular seroma Auricular seroma, also known as

pinna seroma, is the swelling of the external ear caused by trauma. The condition is a development of a cystic swelling that contains liquid caused by rupture of the blood vessel collecting within the cartilage of the ear. A more severe state of the condition is when the swelling develops throughout the whole ear and this is described as a “cauliflower ear”. “The treatment for this is to drain the fluid by small incision and regular dressing until the wound heals. Oral antibiotics can be prescribed during the recovery

general+

2016 | march

• 43

Walking tall in hip replacement Dr Ruslan Nazaruddin performs yet another successful anterior minimally invasive surgery

s life expectancy increases with improved lifestyle and better healthcare, more joint replacement surgeries, such as knee and hip procedures, are necessary for better quality of active life. Datuk Dr G Ruslan Nazaruddin Simanjuntak recently performed an anterior minimally invasive surgery (AMIS), a ground-breaking method for hip replacement, and the third to be done in Malaysia. Dr Ruslan also did the first total hip replacement using AMIS last year. Originating in France over a decade ago, the AMIS method was brought to Malaysia by KPJ in 2014. The procedure is similar to traditional hip replacement methods, except that the incision is made from the front (anterior) section of the thigh, rather than the side (lateral) or back (posterior). The incision is shorter than the conventional incision and it does not go through any major muscles and avoids most nerves, thus resulting in much less pain and bleeding for the patient.

The recovery time is significantly shorter as the patient is expected to walk normally again in just 4-6 weeks without limping, and can start treatment, such as physiotherapy, a day after the surgery, compared to the posterior method, which can take up to a few months. The actual procedure takes a much shorter time as well, as demonstrated by Dr Ruslan who took just under an hour, considerably faster than the conventional method. The surgery was performed in Malaysia’s first digital operating theatre (OT), located in KPJ Tawakkal Specialist Hospital in Kuala Lumpur. The two earlier surgeries were also done here. The OT, besides having the best tools for the job, also has a camera capable of recording high-quality footage, allowing for the entire procedure to be streamed and telecasted in the teleconference room, a few floors above. Among those who attended were orthopaedic surgeons from Universiti Kebangsaan Malaysia,

period to prevent infections,” says Dr Zabri.

Acute otitis media and acute mastoiditis A more serious condition is acute otitis media (AOM), an inflammation and infection of the middle ear. This condition is common in children under the age of five. Symptoms of a child having AOM include: fits of fussiness and intense crying (in infants) clutching the ear while wincing in pain (in toddlers) complaining about a pain in the ear (in older children) The condition is caused by a child’s eustachian tube being swollen or blocked and traps fluid in the middle ear. The trapped fluid can become infected. A swollen or blocked eustachian tube is usually caused by a cold or sinusitis (inflamed sinus lining). However, it may also be caused by other factors such the use of pacifier, exposure to cigarette smoke, change in climate and living in cold climate. “The treatment for AOM is definitely antibiotics. It has been found that antibiotics are most

Acute otitis externa Acute otitis externa (AOE) is described as an inflammatory condition of the ear canal with or without infection. Being the most common condition in Dr Zabri’s clinic, it causes the person to experience ear discomfort, itchiness, impaired hearing and discharge. It is a very painful condition to have. “I had a patient with AOE recently who came to after feeling discomfort in his ear. His ear felt very itchy after a swim and he decided to use a cotton bud to alleviate the itch. The result was an inflamed ear canal and infection,” Dr Zabri relates. Also called “swimmer’s ear”, the condition’s risk factors include water exposure, instrumentation or development of an existing dermatological condition. AOE is usually treatable by taking analgesics, antibiotics, pain and certain antibiotic ear drops as well as to restraint from further contaminating the ear.

PIONEER: Dr Ruslan also did the first total hip replacement using AMIS last year.

GROUND BREAKING: The state-of-the-art equipment helps increase the quality of surgery. Universiti Islam Antarabangsa Malaysia, Universiti Sains Malaysia and private surgeons with interest in the AMIS technique. Prof Bo Nivbrant, a Perth-based orthopaedic surgeon specialising in the AMIS method, was also present in the OT when the surgery was performed, carefully monitoring and guiding Dr Ruslan from start to finish, ensuring a smooth procedure for the patient. The hospital’s state-of-the-art equipment, such as specialised beds and tools, combined with its impeccable standards ensure that all patients have their surgeries done in the best and safest manner. KPJ Healthcare has been dedicated to patient’s welfare since its inception, and pioneered a number of new procedures, especially alternative ones, in the medical field. Doctor in charge Dr Ruslan heads KPJ Tawakkal Specialist Hospital’s orthopaedic services. The consultant orthopaedic and joint replacement surgeon is a dedicated doctor who

constantly updates himself on the latest orthopaedic practices and technology to fulfil his vision to set up a dedicated Joint Replacement Centre of Excellence in Malaysia. He speaks regularly in conferences around the world and is also much sought after in the KPJ group of hospitals and often consulted on his expertise. Dr Ruslan, a former president and arthroplasty chief of the Malaysian Orthopaedic Association, believes in using technology in his practice to bring the best outcome for his patients. He set up KPJ Tawakkal Specialist Hospital’s Centre of Excellence for Orthopaedics when the hospital moved into its new building in 2010.

therapy with subsequent oral antibiotics afterwards. In a more advanced stage, the infection may spread intracranially and can cause facial paralysis, meningitis or even brain abscess which can be life threatening. beneficial to children younger than two years old. Older children with mild AOM can be observed and treated accordingly. “If left untreated, the condition acute mastoiditis may also develop,” he adds. Acute mastoiditis is an infection of the mastoid bone behind the ear that causes swelling and extreme pain. The treatment for this condition involves an intravenous antibiotics

Right treatment All in all, Dr Zabri advises general practitioners and the public to be aware about common ear conditions which can be treated easily. “We have to understand that not all ear conditions are the same. They can be bacterial or fungal infections and not all need antibiotics and ear drops. It is also important to know that cleaning your ears with cotton buds or any other instruments can be hazardous.”

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general+

march | 2016

Power of virgin coconut oil Once a villain, ‘the heathiest oil on earth’ is said to have many health benefits

n recent years, there seems to be renewed interest in coconut oil, with topics as far-flung as using it as a sunscreen. Coconut oil is often described as the “healthiest oil on earth”. This wasn’t always so. For years it had a reputation of being unhealthy because of its high saturated fat content.

SUPER OIL: Virgin coconut oil is How did coconut oil get a bad reputation? Coconut derived through a oil is saturated oil which is understood to raise blood wet-milling cholesterol and cause heart disease. A specific study process. conducted 40 years ago seemed to verify this concern. But, what no one at the time seemed to take into account was that this study was done on hydrogenated coconut. The problems with hydrogenated oils are well documented by numerous studies. Even the general theory of saturated fats is now suspect. Coconut oil has been used throughout Asia and the Pacific for thousands of years as both food and medicine. In tropical climates like Polynesia, Sri Lanka and the Yucatan where they have a diet high in coconut oil, the people are healthier, have less heart disease, cancer, and colon problems than unsaturated fat eaters. Once a villain, coconut oil, specifically virgin coconut oil, has charmed the health food world for its good cholesterol, good saturated fats and countless benefits. Virgin coconut oil is derived through a wet-milling process where oil is extracted from fresh coconut meat without drying first. Coconut milk is expressed first by pressing it out of the wet coconut meat, and then further separated from the water. Health Benefits The American Heart Association, the US Department of Agriculture and the American Dietetic Association have in the past warned against consuming coconut oil because of its high saturated fat content, which can raise cholesterol and blood lipids, possibly leading to heart disease. However, recent studies have shown that coconut oil, particularly organic extra virgin coconut oil, may have some health benefits if consumed in small amounts. Some studies use hydrogenated coconut oils that contain trans fats, which have been linked to higher cholesterol and LDL levels. More recent studies using virgin coconut oil have shown health benefits which include: Thyroid-stimulating Research shows that coconut oil contains a medium-chain fatty acid accelerate that stimulates metabolism, giving you more energy. Keeps candida in check Coconut oil has a good quantity of caprylic acid in it which is well known to kill off excess candida by targeting harmful bacteria. Lowers cholesterol It is rich in lauric acid which protects your heart by reducing total cholesterol and increasing good cholesterol. Helps with weight loss Although coconut oil is a fat, it actually helps with weight loss! The healthy medium chain fatty acids do not circulate in the bloodstream like other fats. They are sent directly to the liver and are converted into energy. Thus the body does not store the fat in coconut oil as fat. Instead it uses it to produce energy instead. Helps keep diabetes in check It does not produce an insulin spike in your bloodstream. Instead it helps control blood sugar by improving the secretion of insulin. Reduces heart disease Studies on people in the Pacific Islands found that their total caloric intake included 30-60% from fully saturated coconut oil. These Pacific Islanders have nearly nonexistent rates of cardiovascular disease.

opinion+ • 45

2016 | march

general

By Dr Terence Tay Khai Wei

Excessive texting can cause carpal tunnel syndrome

exting has become a popular trend in today’s digital age as many, including the young and the old, have dominated their work and personal lives with smartphones and tablets. What many of us don’t realise is that excessive texting can lead to a painful clinical condition called carpal tunnel syndrome. “Considering how much we use the mobile phone keypads, it is essential that we learn how they affect our health,” says Ewa Gustafsson, an ergonomist at the Sahlgrenska Academy in Sweden, who authored a study on the matter. “Researchers also analysed texting technique, measuring electrical muscular activity and thumb movement using an electro goniometer, an electrical device that measures flexibility, in 56 young adults,” he says. Results showed almost half of them developed symptoms over their hands, forearms and arms. Repetitive stress injury, which occurs when there is strain in the motions of thumbs or wrists, can lead to tissue irritation, inflammation and pain over time. Text messaging normally involves holding the phone with both hands and using the thumbs to strike the keypad. In this position, the thumbs are at risk of injury from overuse. More commonly, pressure exerted at the tip of your thumb, is magnified at the base of the thumb and wrist. Increased pressure at the wrist can lead to nerve compression injuries – the more frequent the use, the higher the risk of injury. What is carpal tunnel syndrome? Carpal tunnel syndrome is a condition that may occur when the median nerve, a major provider of sensation to your hand and fingers, becomes compressed within the tight space in the wrist. The carpal

tunnel is bounded by the eight carpal bones and the transverse carpal ligament. The tunnel acts as a narrow passageway at the palm side of your wrist through which the median nerve and nine other tendons pass to reach your fingers and hand. Compression of the median nerve, which occurs due to a decrease in the space inside the tunnel, can be caused by fluid retention, thickening of the synovial tissue lining the tendons, presence of a cyst, an abnormal muscle structure, or other conditions. Since texting has become the rage, particularly among teenagers, the amount of time spent on keyboards and smart phones has caused a rise in instances of carpal tunnel syndrome, especially in the past decade. Symptoms You may feel as though your hand is “going to sleep”. Usually, the thumb and index fingers are most affected, but the sensation may occur throughout your hand. Sometimes, you may be awakened from sleep with numbness or shooting pain, which may be relieved when you shake or rub your hand. Carpal tunnel syndrome may occur in both hands, but they are usually worse in one hand. Symptoms initially come and go, but over time they may become constant. Symptoms such as clumsiness or weakness can make delicate actions, like grasping small objects, difficult. These feelings may cause you to drop things. If the condition is very severe, muscles at the base of the thumb may become visibly wasted. Treatments In most cases, treatment will begin with nonsurgical approaches that may relieve your symptoms. Many patients get relief from simply modifying their activities which reduces pressure within the carpal tunnel, and wearing a wrist brace to keep their wrists in a neutral

Repetitive stress injury, which occurs when there is strain in the motions of thumbs or wrists, can lead to tissue irritation, inflammation and pain over time.”

position. A steroid injection may also be used to relieve symptoms. Taking oral medications, such as vitamin B6 or nonsteroidal antiinflammatory drugs, can also be used to relieve symptoms in some patients. Nerve conduction studies and electromyography (NCS/ EMG) may be used to confirm the diagnosis and evaluate the severity of your condition. If the nonsurgical methods are unsuccessful, surgery may be recommended. The goal of surgery is to reduce pressure within the carpal tunnel, hence alleviating median nerve compression. For those with “textinginduced” carpal tunnel syndrome, “video thumb” or “smartphone carpal tunnel”, you can reduce your risk of carpal tunnel syndrome by: Reducing the amount of time you spend typing and texting each day; Don’t type all the time with your thumbs; use different fingers; Perform hand and finger exercises to stretch the joints and nerve; and

Wearing a wrist brace to alleviate pressure at the wrist Dr Terence Tay Khai Wei is a consultant orthopaedic surgeon at Beacon Hospital.

46 •

nutrition+

march | 2016

Food from the heart Ashley’s is a good spot to relax and grab some healthy alternatives for lunch or dinner By Norman Hussaini

y continuous journey to find good, unique and delicious healthy food recently took me to quite a trendy yet casual restaurant in Jalan Telawi, Bangsar in Kuala Lumpur. Ashley’s by Living Food is a restaurant founded by its sister company, Living Well Consultancy. The restaurant is named after its young and talented chef who helms the kitchen with firm yet delicate hands. A family establishment, chef Ashley says her father built Living Well Consultancy to help people who want to improve their lifestyles to something healthier. “My father used to be overweight but he managed to change his diet to become healthier while my mother also had previously gone to the US to learn about vegan foods. Because of that, I grew up around healthy food,” she says. They opened their first restaurant in 2011 called the LivingFood Bistro and Café in Jalan Tun Razak in Kuala Lumpur. Ashley’s opened a few years later as a way to appeal to more customers and widen their presence in Kuala Lumpur as well as creating new and exciting menu. LivingFood is more focused on foods which are more vegan (raw vegetables) in nature while Ashley’s bring more depth into them while still serving meats.

The Food Before sharing my experience tasting the food, I need to explain a few things. Raw foods, according to chef Ashley, are vegetables which are cooked under 40°C. So they are technically raw as they are not “cooked” in the traditional sense. Ashley’s is a place that prides itself in serving not just raw foods, but also clean ones without preservatives. For chef Ashley and her team to do that, they make their food from scratch. From the breads and sauces to the bases and pastes, everything is made by the team. The menu offers a huge array of unique dishes to choose from. For someone not well accustomed to such unique ingredients, names like bario rice chazuke, grana padano, yuba, rigatoni, jeju sauce and jicama rice definitely stirred my interest. With the help of chef Ashley, I sampled four of the restaurant’s most popular – and as she puts it – “for beginners” dishes. Laksa Borneo Inspiration for the Laksa Borneo came from Ashley and her family’s heritage. As you might have imagined, it is not your typical laksa. The dish consists of brown rice vermicelli – bihun to many of us – served with spicy almond milk broth, topped with grilled tofu and vegetables. It was also accompanied with miso sambal. By far the most interesting part of this dish is the almond milk broth. As laksa broths are usually made with coconut milk (santan), the switch to almond milk is quite innovative. Ashley says the almond milk replaces the santan in

Daging masak hitam, another traditional Sarawakian dish.

QUAINT: Ashley’s provides ample space and comfortable ambience to enjoy its healthy and hearty food. giving the broth that much needed creaminess. After giving it a gulp, I found it makes for a decent meal. The broth serves its purpose well by giving the dish a certain level of spiciness and creaminess. The miso sambal also complements the dish well by giving it that extra kick. To be frank, I wouldn’t go so far as to say the dish can satisfy every hardcore laksa lover. It is, however, an interesting twist to a traditional and well-loved local dish.

Lamb burger is ‘posh’ due to its lavish ingredients.

Daging Masak Hitam (Sarawak beef stew) Another traditional Sarawakian dish, the beef is slow-cooked with aromatic spices and raisins served with bario rice and spiced vegetable (acar). As with the broth for the laksa, the beef stood out from the other components of the dish. It is sweet yet rich in spice, a harmonious mix. Though the bario rice is a treasured ingredient from Sarawak, it brings a minimal role into the dish in terms of the taste. Though its nutritive value beats regular white rice substantially. Lamb Burger Ashley describes this as the “posh” burger due to its lavish ingredients. It is made from grass-fed Australian beef topped with provolone cheese, balsamic reduction and almonds, placed in-between the restaurant’s

Laksa Borneo it is not your typical laksa.

homemade red yeast bun. As a big fan of lamb, I’m very happy with the lamb burger. The patty is moist and is seasoned perfectly. The addition of the provolone cheese, balsamic reduction and almonds only makes it better. The bun completes the dish favourably. Wrap and Roll Despite the lamb burger being my favourite, the wrap and roll takes the cake for being the most interesting. It is a dish made out of cucumber, carrot, pineapple, mushroom, garlic sesame and jicama rice, all wrapped neatly with a mango crepe and drizzled with jeju sauce. There is a lot to take in when I first tasted it, yet I feel that is not too different from our all-time favourite dish – rojak buah. The Jeju sauce puts the wrap into the spotlight for being sweet, salty and spicy all at the same time. Cooking from the heart All in all, I think Ashley’s is a good spot where people can relax, kick back and grab some healthy alternatives for lunch or dinner. It might not be cheap, but it does offer a unique take on healthy food. I can see from the food chef Ashley makes that she really believes in them and cooks with her heart. The meal I had was indeed a great experience for me.

Wrap and Roll is indeed the most interesting.

opinion+ • 47

2016 | march

nutrition

By Shaleen Rajasegaram

Myths and facts on diet and high cholesterol Myth #1: We can survive without eating fat. Fact: Dietary fat is very important to our health. It performs many functions to ensure that our body remains functional. For example, the absorption of vitamins A, D, E, and K requires dietary fat. The recommended intake of dietary fat is only 30% of our total calorie intake, which means if we are on a 1,800kcal diet, we should be taking about 60g of fat a day, equivalent to 12 teaspoons of oil a day. Myth #2: All fats are bad fats. Fact: There are four kinds of dietary fats – saturated, trans, monounsaturated and polyunsaturated. Each type of fat performs different functions. Choosing the correct amount of each type can help optimise cholesterol levels. Since our total fat intake should only be 30% of our total calorie

intake on an 1,800kcal diet, we should be taking 16g of saturated fatty acid, 12g of polyunsaturated, 26g of monounsaturated and zero trans fatty acid. Trans fats are the only type of dietary fats that we do not need in our body. Myth # 3: I can only get omega 3 and 6 from supplements. Fact: Omega 3 and 6 can be obtained from natural food sources or foods that are fortified with omega 3. For example, foods such as sardines and hazelnut are naturally high in omega 3, soya bean oil and corn oil are high in omega 6, while foods such as eggs and milk may be fortified with omega 3 and 6.

offee is enjoyed in many parts of the world in countless ways. In fact, so many derivations of the bitter beverage had been developed over the centuries that they wouldn’t possibly fit into a cup. Derivations of coffee usually involve putting different things into your typical cup of joe to make it more interesting with a stronger and more aromatic flavour – and better tasting too, in most cases. From the typical additions of sugar, milk or cream to the more peculiar ones like pumpkin spice or chilli pepper, coffee has become much more exciting than our typical morning beverage of choice. But probably the most peculiar, yet well-received one is mixing butter and oil into our much-loved beverage. To be fair, there is nothing wrong with trying new things or

Shaleen Rajasegaram is a dietitian at KPJ Selangor Specialist Hospital.

Myth #5: I have normal BMI so I will not get high cholesterol. Fact: Some of us have high metabolism, which means even

Myth #4: I have high cholesterol so I cannot eat high cholesterol foods.

Going gaga over coffee with butter By Norman Hussaini

Fact: Our body needs a certain amount of cholesterol to maintain proper function. The amount of cholesterol we consume meets about 20% of our body requirements, the other 80% will be generated by our liver. If we were to consume more cholesterol, our body generates less, and vice versa. Therefore, is not beneficial to avoid foods for the purpose of avoiding cholesterol only.

we eat in excess, it’s difficult for us to gain weight. Having high metabolism does not mean you are immune from non-communicable diseases like diabetes and high cholesterol. In fact, it may lead to higher risk of getting these diseases just because your body isn’t showing you the signs of overeating.

creating new recipes to enjoy. The Tibetans had been using yak butter as an ingredient for their tea long before we thought about putting it in our coffee. However, when there is a notion that adding butter and oil to your morning coffee actually replaces your breakfast while promoting improved mental awareness and energy, then it starts to become misguided. Last year, a bold entrepreneur decided to change the way people have breakfast every morning by promoting his “Bulletproof Coffee”. Dave Asprey created his “bulletproof diet” after he saw the Tibetans drinking their yak butter tea while visiting Tibet. The diet entails two cups of coffee blended together with two tablespoons of grass-fed, unsalted butter and a tablespoon of MCT oil (a manufactured oil said to be healthier than coconut oil). Currently, there is no scientific evidence to show that the diet leads

to weight loss, prolonged energy, endurance or satiety. Any proof so far has only been testimonies of those who have tried it. Dietitian Shaleen Rajasegaram, weighing in on the claim, says caffeine is known to be a psychoactive drug with three to four hours of potency. Therefore, by drinking two cups of coffee in the morning, it would explain the boost in energy as many have testified. Another aspect of the growing trend is the use of butter. Shaleen explains that butter is a form of

saturated fatty acid. For optimal health, we are advised to consume 7% to 10% of our total daily calorie intake, which works out to about 14-20gm of saturated fatty acid in a 1,800kcal diet. The drink however provides 30gm of saturated fatty acid, which is more than the recommended amount. The claim that it can replace breakfast is also substantially misguided because we need at least three balanced meals a day. Replacing one of them with a drink that is high in caffeine, fat and calories throws the balance out of proportions. It also makes the consumption of enough protein, vitamins and minerals in our daily diet more difficult. In reality, the idea of replacing your breakfast with two cups of coffee laden with butter and oil is never a good one to start with. Without conclusive evidence, a diet based on other people’s testimonies like this is not advisable. I personally think that butter and coffee should stay away from each other for good. Butter is versatile enough without it ever greasing up your morning cup of coffee. Besides, don’t eggs, waffles, salads or sausages sound better than a coffee blended with butter for breakfast?

48 •

alternative+

march | 2016

Tuina has some health benefits Traditional Chinese massage is said to benefit people with medical conditions and those who just want to strengthen their bodies

By YOUNG SIN YEE

ollowing the reported death of a 26-year-old woman in Singapore during a tuina massage, many people are suddenly curious about this traditional form of therapy. Tuina is a type of traditional massage from China. The term tuina was first seen during the Ming Dynasty. This ancient form of selftreatment was borne out of human instinct as it’s natural for people to pat their injuries in order to relieve the pain. This ancient form of massage eventually transformed into what we call tuina today. What can tuina do? A tuina massage is always done by hand on certain acupuncture points and some people do benefit from it. For someone who developed a sprain or experienced some pain in the body, a tuina session is said to be effective in bringing relief to that body part that is sprained or painful and to reduce any swelling. Sometimes the massage may even restore dislocated bones to their original positions. For the inner part of the body, tuina is said to cure different types of sicknesses by restoring the yin and yang balance. Tuina is not only for people with medical conditions as those who are not sick can also go for treatment to strengthen their bodies. Techniques and treatments In the past, different schools of tuina had their distinct form of treatment. However, in modern times, Chinese traditional chiropractors study tuina in medical institutes in China, which means they basically practise the same type of tuina. Tuina uses many different techniques such as firm pressure, slow motion kneading, brisk rubbing and quick tapping. The chiropractor will select the techniques best suited for each patient’s situation. A tuina treatment for a sick person usually takes five to 15 minutes. However, if the patient comes with a host of health problems, the session will be longer. Patients with complicated problems are advised

to undergo a few treatments until the problems have improved. For someone who is not sick but just want to strengthen his body, each massage session will last about 30 to 60 minutes. According to Dr Yee Dreevern (pic), a chiropractor with 10 years of practical experience in tuina, his patients used to be mostly aged 30 years old and above, but in recent years, they are getting younger in the 10-20 age bracket. Treatment fees Each tuina treatment usually costs between RM60 and RM150, but in some cases, the fee can go up to RM200. The fee charged depends on the complexity of each patient’s health problem and duration of each treatment. Precautions and medications Are any precautions to be taken before, after and during each massage session? Yes, there are, says Dr Yee. “We advise people to bathe before coming for massage and wear loose shirts so they feel more comfortable during the treatment. After the massage,

they must have enough rest.” He says tuina is not suitable for pregnant women and those with serious heart problems and open injuries on the skin. “They can arrange for their treatment after their injuries have healed or, in the case of pregnant women, after the delivery of their babies. Tuina is also not suitable for specific groups of people such as those with very sensitive skin.” Besides the massage treatment, the chiropractor will prescribe Chinese medicine to patients, depending on their conditions. Those with injuries will be given medicine to relieve pain and reduce swelling, while those who go for normal massage will be given medicine to help strengthen their immune system. How safe is tuina? What are Dr Yee’s views on the case of the 26-year-old woman in Singapore who died during a tuina massage? “I cannot comment too much on the case. But logically, if tuina is dangerous, why are there so many tuina or massage centres around?” He says the tragedy is just an accident, which can also happen when people take a plane or drive a car. “Massage is more acceptable to the public than asking them to take medicine.” Dr Yee advises the public to seek the services of trained chiropractors to reduce the risk of mistakes such as when someone presses the wrong acupuncture points. He also cautions those who are sick not to go for any massage unless they have undergone proper check-up and certified medically fit to do so.

Young woman dies during massage A 26-year-old woman reportedly died on February 14 while undergoing tuina massage at a massage centre in Midpoint Orchard shopping centre in Singapore. Serene Lim Xin Hui was the only child in her family. Reports said about a year before her death, she was hospitalised due to malnutrition. Prior to the massage, she reportedly told others she was feeling unwell and had body pain, so she went for the treatment. The reports said a diagnosis conducted by the massage centre’s therapist revealed that her body was weak, so the chiropractor was told to apply less pressure during the massage. The reports said Serene was talking to the chiropractor during the massage when she suddenly had a seizure and died after she was rushed to hospital. Police have yet to classify the case, pending results of a coroner’s inquiry. Investigations are ongoing. Commenting on the case, a doctor said Serene’s death was related to aneurysm which led to her seizure and coma. He said some diseases are linked to the brain and are difficult to identify unless an MRI or CT scan is carried out on the patient. His opinion is that Serene’s death was not directly related to the tuina massage, but could be caused by another issue.

Osteopathy – balance through By Ali-Azmin Hassan Osteopathy is a hands-on-approach of manual healthcare which recognises the importance between the structure of the body and the way it functions. The study of osteopathy focuses on the skeleton, joints, muscles, nerves, circulation, connective tissue and internal organs and how they function as a holistic unit. Osteopathy is a way of detecting, treating and preventing health problems by moving, massaging and stretching a person’s muscles and joints. However, osteopathy is distinct from osteopathic medicine. In the UK, osteopathy is considered a form of alternative medicine because practising osteopaths use conventional medical techniques which are not always based on scientific evidence. Osteopaths help with conditions that affect the muscles, bones and joints, such as neck, shoulder and back pains. They also help with arthritis, problems with the pelvis, hips and legs, sports injuries, as well as posture problems. Nicolas Grimaldi, founder of One Osteo and a certified doctor of

osteopathic medicine, enlightens Health+ on osteopathic medicine. What is the difference between an osteopath and a chiropractor? Osteopathy and chiropractic have the same roots, but the founders took different paths and separated as their philosophies were different. Chiropractors consider only the spine as the key of all problems. Part of their work is manual but most of them use machines and will need 10 to 20 treatments more. Osteopathy considers the body as a whole unity. Even though the spine is important in our work, we are not just a walking spine. Every structure is connected and interrelated mechanically, chemically or through the nervous system. The hands of osteopaths are trained for six years to feel the tensions, blockages, lack of movement of a joint or change of texture, which are signs of a mechanical dysfunction. Osteopathy and chiropractic are two different jobs and approaches with common roots. What medical conditions do osteopaths treat?

We do not treat medical conditions. We only treat ailments caused or related to mechanical disorders. Studies of osteopathy contain education of semiology. You should go to an osteopath if you have migraine/headaches, slipped disc/sciatic, sinusitis, rhinitis, allergies, bronchitis, otitis, digestive problems, constipation, hiatal hernia, gynaecologic/urinary problems, infertility, urinary infections, menstrual cramps, scoliosis, stiff neck, frozen shoulder, trapped nerve, depression, and any kind of pain. Are there regulations or health checks on patients before their first osteopathy treatment? We will ask a lot of questions about their actual conditions and their health history which will give us some information to determine if we can proceed with our treatment. Usually, patients will come to us after seeing a doctor with their x-ray, MRI results, etc. Are there any risks involved? All the techniques we use are pain free and respectful of the physiology of patients. All studies made on the subject

opinion+ • 49

2016 | march

alternative

By Adi Satria

In the first of our two-part article in the last issue, we looked at how Mubarak started his water fast odyssey. He almost gave up on Day 25, but spurred on by his ex-classmates, he persevered and completed his 30-day feat, losing 13kg besides being more flexible at the joints and with no knee pain.

s Mubarak continued his water fast odyssey, Sze Meng, another ex-classmate living in France, says fasting has no monetary value as a therapy and therefore cannot be developed into a business. Notwithstanding that, Dr Vaster Longo has demonstrated that fasting can greatly increase the benefits of chemotherapy. He recommends a five-day fast before starting the treatment. Cancer cells thrive on high blood sugar, but slow down and shrivel when the body is on prolonged ketosis. I can attest to that theory because my late mother was on a liquid diet of Sustacal for six months while undergoing chemotherapy treatment. She was 70 then and, with God’ blessings, lived for another 22 years till she passed on two years ago. And I

noticed she consumed at least two to three litres of water daily. A s Mubarak ’s o dysse y continued, the anxiety of our exclassmates from around the globe turned to wonder and admiration for the Amigo. Day 15 and it was still smooth sailing. His weight had strangely remained constant in the last five days – either because his metabolism had slowed down to less than 1,000 calories per day, or it was simply water weight. Blood and blood pressure readings couldn’t be better. There was some muscle loss but fat loss was more evident, and hopefully visceral fat as well. On Day 17, he felt absolutely lucid with no signs of hypoglycaemia, and his body had physiologically gone into a ketoadaptive state. His glucometer was unable to detect ketones and ketone bodies, the alternative fuel,

Different Strokes

Mind triumphing over matter

motion have shown that it is safe. How can osteopaths treat babies? The baby’s first trauma is at birth. Birth is not supposed to be traumatic but in modern society, babies are extracted with forceps, vacuum or perhaps even the position of the woman is not ideal. Hence, the labour could be more difficult, so it will involve more pressure and constraint, and potentially more mechanical disorders for the baby. Other problems that affect babies which osteopath can treat are abdominal hyper/hypo-tonicity, birth head deformation, plagiocephaly, stiff neck, digestive troubles, colitis/constipation, breast feeding problems, sleeping problems, allergies, asthma, bronchitis, otitis, limb deformation, and many more. Treating a baby with an osteopath treatment after birth can realign the balance. As the balance you get from birth is the balance you get for life, it is therefore important to check and bring balance back to the baby’s body, or else it can’t be change anymore. What are the benefits of osteopathic treatments?

WHOLE: Grimaldi says osteopathy considers the body as a whole unity. Basically, osteopathy will improve your health. Osteopathy can get rid of any kind of pains, aches or mechanical disorders, in a few sessions. It will improve one’s vitality and health on a longer term. One Osteo clinics are the only authorised centres to practise and perform the Gesret method. Its patients come from countries such as Australia, Hong Kong, Soudan and Qatar.

floating in his blood. In fact, on Day 20, he reported that his sugar level had fallen to 2.2 the day before but with no signs of hypoglycaemia. Later it turned to 3.2 – of course he felt weaker than when he first started fasting. The plus point was his version of a six-pack abs around his abdomen was beginning to show for the first time in 50 years due to muscle loss! Then he dropped a piece of not-so-good news – he may have to reduce his fast to 25 days as he had to attend to an important vipassana retreat in Penang which involved some heavy manual work in the kitchen. The news was greeted with some slight disappointment but lots of encouragement from our ex-classmates. Mubarak’s feat had also inspired others, like Lianee who wanted to fast as well after discovering its many benefits. Rahumat, from Penang, felt Mubarak should publish his feat to encourage others to fast too. On Day 24, Mubarak decided not to disappoint us by continuing his fast to complete the 30 days. “What’s five more days for friends,” he said after postponing his vipassana work to March. By then his weight had dropped 12kg to 57kg, and his waistline had trimmed five inches to 26 inches – his body measurements of “yonder days way back in Form 5”. He joked that Jenny Craig and Marie France could take a page of this exercise – which was almost free, except the cost of four litres of distilled water daily. Blood pressure at 106/63, resting pulse 48 bpi and glucose level 4.7 – just after one-hour resistance workout a few hours before. It simply shows one must continue to exercise to maintain stamina. Inspired by these amazing results, Lianee and her daughter in Shanghai, together with ex-classmates Cheng Ee in the UK and Sze Meng in Paris, decided to join Mubarak in a symbolic “last mile” on January 30 for a 24-hour water fast. These ex-classmates had never fasted in their lives, and at 64, they were about to start something that could change their view of health maintenance and life itself. For me, this was nothing new as I took up scuba diving at 50, and experienced a whole new world of physical fitness.

Mubarak completed his 30-day water fast at 11pm on January 30, and then symbolically passed the “baton” to the other four to complete the “home stretch”. All of them had only good things to describe the effect of their fast on their minds and bodies, even vowing not to make this their last. Mubarak broke fast with only 250ml of coconut water and young coconut meat as they contain lots of nutrients and minerals. He is feeling much lighter after losing 13kg besides being more flexible at the joints and with no knee pain. Due to the re feeding process for another week, his body was still in fasting mode. He consumed a cocktail of 4x12 oz of pineapples, apples, fresh moringa leaves , mulberry leaves, mung bean sprouts and a good dollop of water kefir-laden bacteria drink to jump-start his gut microbiome - all DIY stuff, including the water kefir culture. He feels the full benefits of the water fast will last for another 60 days provided he doesn’t gum up the works with his eating habits. It will indeed be a case of mind over matter. Adi Satria was in marketing communications for 30 years. After retiring from corporate life, he is on an active physical and mental journey of discovering the elixir of long life via alternative and time-tested therapies from various cultures.

50 •

health tech+

march | 2016

Target acquired: breast cancer National Cancer Society Malaysia is one of few local users of 3D mammography technology

reast cancer is the most prevalent type of cancer among women globally, including in Malaysia. As one of the well-known NGOs for cancer in Malaysia, the National Cancer Society Malaysia (NCSM) is the first local organisation

to use 3D mammography technology for breast cancer screening. The 3D breast cancer detection system using tomosynthesis technology provides exceptionally sharp images, seamless transition between imaging modes, sophisticated

CUTTING-EDGE TECH: The Hologic Selenia® Dimensions® is the best way to detect early onset of breast cancer. user tools that simplify operation, and advanced clinical applications. It also provides the world’s first and only tomosynthesis-guided biopsy and an ergonomic design for patients’ comfort and ease of operation. Dr Sulaiman Tamanang (pic), NCSM’s consultant radiologist and person in charge of the machine, explains the difference between 3D mammography and the older 2D digital mammography. “The tomosynthesis (3D) mammography camera moves in an arc over the breast and has the ability to take 15 mini-pictures within four seconds. These multiple pictures create a layer-by-layer image – 1mm at a time – of the breast tissue and can lessen cases of hidden cancer or mistaken tumours,” he explains. Its applications provide better imagery to pick up invasive tumours and can avoid false alarms. Moreover, researchers had found that the technology detects 40% more breast cancer since its introduction. It is also found that there had been a 15% drop in the number of women who had to return for more tests because of suspicious and unclear mammogram findings. The 3D mammography technolog y is not particularly new, but NCSM brought in the machine to Malaysia only in 2010. Besides NCSM, Dr Sulaiman says, KPJ Selangor Medical Centre, Prince Court Medical Centre and UniACCURACY: Dr Sulaiman versity of Malaya says the machine helps Medical Centre produce detailed images to also offer 3D ensure accurate findings. mammography services. “Being an expensive machine, the maintenance cost is hefty. We allocate contributions and our savings for the maintenance,” he adds. Despite the expensive technology, NCSM’s 3D mammography breast cancer screening costs only RM200 per session. “There are many new technologies in the market used to detect early breast cancer but mammography is still the best imaging modality proven to detect early onsets of breast cancer. It is readily available and is quite cheap for consumers,” says Dr Sulaiman. NCSM uses the Hologic Selenia® Dimensions® machine which was introduced in 2010. It features various modes and systems that maintain its efficiency. It features high-resolution display, optimised face shield, FAST paddle system, streamlined tube head, and multiple procedural modes to help better analyse screenings.

what’s new+ • 51

2016 | march

Pampering massage by OSIM ulnfinity Getting a great massage is an excellent way to eliminate pain, ease stress, and gain more energy to get through your hectic lifestyle. To meet customer’s changing needs and wants, OSIM regularly updates its products to think beyond satisfying customer’s physical comfort. With this in mind, the company launched its latest product – OSIM ulnfinity – which is known to be the one of the most unique and humanised massage chairs, with both manual and automatic massage options. Users can choose either a whole-body massage

or just on a specific spot. The revolutionary massage chair has a built-in stereo sound speaker for you to enjoy your favourite music during your massage. It also comes with an ottoman and more living space where the footrest is more than just a leg massager but can also be retracted under the seat to provide extra space and give your legs some rest. OSIM ulnfinity has a touch-screen controller which is a colour-rich LCD screen for you to control your every massage action by just having a relaxed sit on it.

Drink more water with The Right Cup As part of an independent project by an entrepreneur from New York, The Right Cup is the brainchild of one Isaac Levi. The revolutionary cup helps people drink more water while creating its own flavour without any additives, preservatives, carbohydrates and sugar. Levi was diagnosed a couple of years back with diabetes, and was told by his doctor that he could drink only plain water to manage his condition. He hated drinking plain water as it was tasteless yet acknowledged its benefits. After six years of developing the technology with the help of experts, he came up with The Right Cup early this year. As an entrepreneur not attached to any big company, he never had the capital to start mass production and distribution. The Right Cup then became a featured product on the popular crowdfunding website Indiegogo. The product found tremendous support among the public and had accumulated US$541,999 (current amount at time of writing) to fund its production. How it works? The overall flavour experience is a result of the combination between scent and taste. While the tongue only tastes five sensations (sweet, bitter, sour, salty and umami), it is the sense of smell that’s responsible for 80% of the flavour

experience. That’s why when your nose is stuffed, you hardly taste any flavours at all. The Right Cup took the same FDA-approved aromatic fruit flavours which beverage companies use in their drinks, and by using proprietary technology managed to safely insert them directly into The Right Cup instead of into the drink. The unique design positions your nose right over the opening, so your nose fully picks up the fruit aroma while your tongue flirts with a hint of sweet taste. As a result, your brain is led to believe you’re drinking deliciously flavoured water, while in fact you’re drinking natural, healthy water. Simply pour pure water into The Right Cup and enjoy the flavour your brain craves while your body will get the healthy hydration it needs, without any of the junk. The product features multiple flavours including mixed berry, lemon lime, apple, orange, peach and cola. The Right Cup is still currently perfecting its design and are scheduled to be available to its backers (people who funded the project) in May. The product will be made available to all consumers once it receives positive feedback from its backers. Know more about The Right Cup by visiting the page on Indiegogo at www.indiegogo.com and search for The Right Cup.

Adidas introduces PureBOOST ZG Adidas has released PureBOOST ZG, a new running shoe featuring adidas Primeknit technology constructed to provide a fit that adapts to the foot’s natural movement and expansion. The full-length BOOST midsole delivers responsive energy return and superior comfort, cradled in a stretch web inspired outsole. PureBOOST ZG keeps your foot secure with a lock-down midfoot band and heel counter. The cityscape-inspired knit pattern accentuates the premium tongue and heel tab for an urban appeal. The colour pop outsole highlights the BOOST midsole to keep them staring at your every step.

Eargo – new, virtually invisible hearing device A new, virtually invisible hearing device launched recently that’s described as a blend of high-end consumer electronics aesthetics with medical device engineering. Characterised by the feather-like fibres that make it comfortable, Eargo was designed by otorhinolaryngologist (ENT) surgeon Dr Florent Michel. Called Flexi Fibers, they let the ear canal breathe and are said to enable some natural bass sounds to pass through. Eargo comes in pairs with four pre-set sound profiles engineered to meet the needs of the majority of mild to moderate hearing loss cases. The rechargeable units come with a pocket-sized portable charger. If your hearing loss condition doesn’t match the pre-set profiles, the company has a team of in-house audiologists on hand to custom-programme the devices based on your audiograms. Eargo has been unofficially available since 2013 when founders Dr Michel and his son Raphael Michel, along with Daniel Shen, received seed capital from Maveron. Just about everyone undergoes some hearing loss over time, says Michel, who says it begins typically in the 30s. The father-son pair envisions a younger clientele than the seniors normally associated with hearing aids, hinting that earbuds, loud public sporting events and decibel-busting concerts account for increasing hearing loss. “The category is no longer just about senior citizens,” says David Wu, a general partner at Maveron. “Today, it encapsulates everyone from the ear bud wearing Millennials to a maturing Generation X and of course, a still very active Baby Boomer generation.” – AFPRelaxnews

â&#x20AC;˘

March | 2016

Battling obesity

www.healthplus.com.my

Growing problem has earned Malaysia the inglorious title of ‘fattest’ nation in Asia

... pages 02-09

The Pulse of the Nation

March | 2016

SOCSO steps ahead with dialysis support

Scheme provides dialysis facilities for contributors suffering from end-stage kidney failure

... pages 14-15

Taking HIV by the horns

Andrew Tan, living with HIV for 20 years, finds peace helping others with similar condition

... page 18

02 •

march | 2016

Battling obesity Growing problem has earned Malaysia inglorious title of ‘fattest’ nation in Asia

By Norman Hussaini

umans are fascinating beings. We can fit in different types of situations – we can live in cold climates by building shelters and heaters, or in hot climates by building electric fans and air conditioners. Buildings, bridges, highways and dams are what make us live comfortably and with ease. And

with all these technological and social developments come various technological and social problems to boot. Riding in cars and living in comfortable homes with tons of entertainment mediums have made us less active. As a result, we’re plagued by one of the biggest, oversized lifestyle diseases – OBESITY. Being overweight or obese is no laughing matter. The mere mention of the word “obese” can sometimes spark off debates about political correctness – or incorrectness – as the case may be.

The growing – no pun intended – number of overweight Malaysians has earned Malaysia the inglorious title of the “fattest” nation in Asia, in a survey by British medical journal, The Lancet. Health Minister Datuk Dr S Subramaniam had reportedly said “almost half the population of Malaysia are either overweight or obese”. This means that 15 million of the 30 million Malaysians are overweight or obese. Subramaniam added that “the prevalence of obesity has increased drastically from 4.4% in 1996 to 14% in 2006. Then it increased to 15.1% in 2011 and continued to increase to 17.7% in 2015.” To say obesity is a problem now is an understatement. Recent email correspondence with the Health Ministry provides Health+ with some interesting statistics. The findings of the latest National Health and Morbidity Survey (NHMS) 2015 had estimated 3.3 million adult Malaysians are obese. Looking at a nutritional

From flab to fab

“I believe that determination is the key for me. We should continue fighting to be better individuals as best as we can.”

How Jom Kurus 1 Malaysia transformed the lives of two overweight and unhealthy individuals By Norman Hussaini

besity is a buzzword in our society these days given the amount of unhealthy food we eat day in and day out. Though the weighty problem continues to affect our population, we have seen encouraging changes in the general awareness of healthier eating and increased physical activity in recent years. More and more people leading unhealthy

lifestyle are stepping forth to try to change, ultimately becoming healthier and breaking free from the clutches of obesity. Of the many weight loss programmes available, Jom Kurus 1 Malaysia (JK1M) has transformed the lives of many since its inception a few years ago. And for two inspiring individuals Health+ spoke to recently, the impact of the programme on them is nothing short of spectacular.

Nur Farhiyah Ahmad Fadli Bank officer Farhiyah had never felt the need to lead a healthy lifestyle as she was so used to eating unhealthily as was the habit of most of the people around her. “I had been overweight all my life. My family and I were all big sized so I never felt out of place and was comfortable,” she says. However, her unhealthy habit of overeating and inactivity took a heavy toll on her health. “I realised that I started having awful skin conditions and my legs were always swollen because of my weight. That was when I felt that something needed to change.” Farhiyah decided to join JK1M after her sister told her about the popular weight loss programme. “We thought it would be a great

idea to join the programme together as a way for us to support each other. We wanted to change – we wanted to lose weight.” Her experience “I was surprised to see that JK1M was so much more than just a weight loss programme where you exercise to lose weight. It offered educational materials to help us lose weight and also eat healthier.” She also had the opportunity to explore new things with diets and exercise through the programme. The programme caters to each individual’s ability and is not meant to torture participants. “I started doing exercise for beginners and gradually worked up to more advanced exercise regime

NEW JOY: Farhiyah found happiness after leading a healthier lifestyle.

point of view, findings from the Malaysian Adult Nutrition Survey (MANS) 2014 showed that more than 90% of Malaysian adults were taking all the recommended three main meals daily. However, it also reported a high prevalence (31.9%) of them taking heavy meals after dinner or supper. Moreover, MANS found that daily intake of fruit and vegetables was greatly lacking. The survey showed 1.4 and 1.5 servings of fruit and vegetable consumed respectively, undermining the recommended guideline of two and three servings. Unhealthy lifestyle is the keyword in most cases of obesity. Malaysia is well known for an incredible amount of delicious food, and many Malaysians have abused its abundance for the worst. The unhealthy lifestyle and habits we practise bleed down to our children as well, resulting in growing childhood obesity. Obesity is not a disease on its own but a gateway for a plethora of other diseases to conquer

– Farhiyah

over time.” She never felt that the exercise was overly strenuous. However, it was not easy for her to follow a new diet and exercise as she often found herself wanting to quit and slip back to her old habits again. “It was during the last season of JK1M when I found myself cheating on my diet and eating like I used to,” she admits. “I was able to lose a lot of weight and because of that, I started to overeat again.” Eventually, she realised the effort she had put in FITTER IMAGE: Aizat admits he is more fashionable and comfortable with his image now.

for months to get where she was had meant nothing if she went back to her old eating habits. “I received my wake-up call after about two weeks of slipping back to my old habits. Then I started my healthier diet and exercise as usual.” A valiant effort to make a better person of herself, Farhiyah faithfully continues her diet and exercise till today. She now mostly cooks her own food daily and exercises three to four times a week for an hour. “I believe that determination is the key for me. We should continue fighting to be better individuals as best as we can,” she says with much conviction.

Muhammad Aizat Abdul Razak Another familiar face in JK1M is Aizat who joined the programme in 2014, after hitting the scales at a whopping 230kg. Like Farhiyah, he used to overeat and did little to none exercise. “I was similar to Farhiyah in a

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our wellbeing. Obesity can be described as a condition where a person has accumulated so much body fat that it might perpetuate negative effect on his health. Diseases like heart diseases, stroke, high blood pressure, diabetes, some types of cancer, gallbladder diseases, osteoarthritis, gout, sleep apnoea and asthma can all be the result of being obese. Prevention of all these illnesses can be achieved by practising a healthier and more active lifestyle. Yet the prevalence of obesity among us proves otherwise. There have been numerous ongoing attempts to tackle our obesity problem. Countless campaigns, marathons, seminars and events had been organised to address this disease. Many people had defeated obesity and emerged victorious, and they should be our shining examples to do likewise. There is growing awareness of healthy lifestyle among Malaysians too. Healthy food restaurants and takeaways are trending, gyms are mushrooming

lot of ways. I was very big and was always demotivated when it came to doing something active.” His condition affected his emotions quite often. After years of leading an unhealthy lifestyle, Aizat finally found his turning point in his mother’s words. “I remember her asking me how long I will be fat. Who will take care of me when she is no more? Those words jolted me to look for ways to improve my unhealthy lifestyle.” Aizat was one of the first participants to join JK1M in 2014 when it was initiated by Kevin Zahri. His experience Aizat is seen as the poster boy for the programme because of his achievement to lose more than 135kg through it. “I was ready to change. I wanted to become a better person than I was, physically and emotionally.” Members of his training group helped him a lot to go through the programme. “I received continuous support from the trainers as well my peers during the programme. We were all aiming for the same goal – losing weight – so all of us had each other’s backs.” Aizat admits it is good to share feelings and emotions because we tend to lose our confidence from time to time. He says the most important factor in losing weight is to control your eating habits. “We must have discipline in controlling what we eat. Working out and exercising always come second.” He followed a very strict diet during his first six months in the programme and gradually became more lenient over time.

everywhere, jogging and cycling are getting widely accepted as family activities and more people are coming forward for health screenings now than ever before. Campaigns such as Jom Kurus 1 Malaysia had recorded immense success in terms of number of participants who had lost weight. Doctors and experts are also coming forward to educate and inform the public on various subjects relating to obesity. However, the change in awareness and efforts is gradual and slow, and still miniscule compared with the growing rate of obesity. However, a million-mile journey always starts with a single step. Battling obesity is a continuous uphill fight with no sure win in sight, but the most important thing to do is to persevere and keep at it. Practising healthier eating habits and less sedentary activities is a lifestyle to adopt, not a trend to follow. It is to ensure a healthier future for ourselves and our future generations.

Body Mass Index (BMI) chart

What is obesity and how to determine it Obesity is defined as a condition where a person has accumulated so much body fat (or adipose tissue) that it might have a negative effect on his health. There are many ways to determine excess body fat in a person, with the most common one being the Body Mass Index (BMI). It is an international standard to determine ideal body weight. BMI is calculated by dividing a person’s body weight in kilogrammes (kg) by his height in metres squared (m2). According to the rule set up by the World Health Organisation (WHO), a BMI between 25 and 29.9kg/m2 is considered pre-obese, and anything above is obese. The use of BMI to determine

“We must have discipline in controlling what we eat. Working out and exercising always come second.” – Aizat He says a good eating habit is to eat many times a day but in smaller portions. “As I was accustomed to eat a lot, I often had cravings going through the programme. So eating smaller portions helped me to fight off my cravings,” he says. “As for exercising, I never did more than three times a week. Obviously I did light exercises when I was overweight and did heavier exercises when I started losing weight.” Aizat now enjoys life as a healthier and fashionable individual while continuing to eat healthy and exercise regularly.

obesity, however, has fluctuating factors. This is because BMI determines only body weight but not the percentage of body fat. Therefore, athletes or bodybuilders are exempted from using BMI to determine obesity as they have an increased level of muscle tissue, making them heavier in a sense. Another way to determine obesity is by measuring the waist circumference. This measurement determines the amount of abdominal fat proportional to total body fat and is used to predict risk of obesity. The generallyaccepted risky waist measurement is 40 inches (102cm) and above for men and 35 inches (89cm) for women.

Classification of weight by BMI (Evidence level c) Classification BMI (kg/m2)

Risk of co-morbidities

Underweight

< 18.5

Low (but increased risk of other clinical problems)

Normal range

18.5 – 22.9

Increasing but acceptable risk

Overweight

≥ 23

Pre-obese

23.0 – 27.4

Increased

Obese I

27.5 – 34.9

High

Obese II

35.0 – 39.9

Very high

Obese III

> 40.0

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march | 2016

Fit for the better

By Norman Hussaini

osing weight is like climbing a wall which many people are engaged in as a way to become better, both physically and mentally. With the growing concern of obesity among Malaysians, that wall seems to be getting larger and taller than ever before. Although a new, healthier eating and living trend is slowly emerging among Malaysians, being overweight is still an oversized concern. Health+ met up with Kevin Zahri, one of the country’s best-known trainers and health consultants, to talk about how the Jom Kurus 1 Malaysia (JK1M) programme is helping people live fitter and healthier lives. JK1M, which started out as an educational seminar programme at Prince Court Medical Centre in Kuala Lumpur, is a nationwide phenomenon with thousands already part of it and enjoying a healthier lifestyle. “The programme started about

Jom Kurus 1 Malaysia programme is tailored to help people live fitter and healthier lives

INSPIRING: Kevin’s programme has helped many people take control of their bad habits and lead a healthier lifestyle.

four or five years ago. The seminar was done as a way to structure the best weight loss plan for participants. It was aimed at the public to join and was done to inform how weight loss works and how the participants can lose weight, either with more exercise, with better diet, or both.” “The seminar,” he adds, “acts as a guidance and empowers the participants to lose weight.” However, as a simple educational seminar, most participants felt the need to receive more guidance in terms of actually executing the practices taught. With a growing number of participants wanting to receive instructions, the programme evolved to become a six-week educational programme complete

Key causes of obesity

Training to fight obesity takes commitment If at first you don’t succeed, try doing what your trainer told you to do the first time

By Ali-Azmin Hassan

ecoming a personal trainer is a noble cause. To commit one’s time and energy every day for the sake of others to become healthy is true commitment. There’s no career quite like it and it is far from the usual one-size-fits-all option. Health+ met up with Raja Faisal Raja Aziz, a personal trainer for seven years and now training at Fitness First, to give us the low

down on what a personal trainer does and his efforts to promote healthy lifestyle and help people beat obesity. He thinks having the right mentality is critical if someone wants to lose weight. “I go through my clients’ mindset and attitude first to train them and make sure they always come on time. That is my personal touch and style on how I motivate my clients.” On training to overcome obesity, he says it all depends on the person’s motivation level and consistency in training. “There is a big difference one can make between coming once a week and five times a week. You really need

FOOD GUARD: The key challenge in losing weight is food, says Faisal

to slot your gym time into your daily routine. “The key challenge that one can face in losing weight is food. When you are on training to lose weight, you have to restrict high calorie and fried foods, soda drinks and many other sweet foods. But we’re human and sometimes we lose control. The price of restriction is rejection. Your body and mind are going to react to your cravings. And that’s why your mentality and commitment to lose weight are important,” he says. Training for obese people

is different from those who are not. “They need longer resting time. For each round they do, they need at least a two-minute break to reregulate their heart rate. If they were to push more than they could, they would feel dizzy and possibly, even black out. There are restrictions and limits to their workout routine for their own good and safety,” says Faisal. Obesity is at a dire level in Malaysia as a 2013 study by The Lancet, a weekly peer-reviewed general medical journal, showed

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with education and practical training. “There had been many success stories from the six-week programme. Once we published those stories online, the demand for it increased substantially,” says Kevin. unique programme Kevin tells Health+ the programme is a unique take on the traditional trainer-trainee relationship. He explains that because the programme is conducted simultaneously in different parts of the country, it must also be suitable to each environment. “It is never a fixed programme because fitness can come anywhere, be it indoor, outdoor, working out in the gym, playing sports or running. Each trainer – also called a team leader – who trains the participants in each area is given the flexibility to set the type of programme. “We empower team leaders to use their speciality to the fullest. So their job is not just to train the participants, but to also arrange the programme.” Kevin says the trainers take into account what the participants want to do as well, so the programme is tailored to the

that we are the most obese country in Asia. Faisal says most people only train to lose weight and be healthy when they realise their health is at a critical level. “Back in the day, obesity was not a major problem in Malaysia. People farmed, gardened and did a lot of physical work. Our bodies are designed to do many things, but with our current lifestyle, we sit a lot, especially in the office. We have snack bars and pantries in the office, and all these create an unhealthy culture. And to counter all these, one should take

participants’ wants and needs. programme’s success “The success of the programme didn’t come from only myself. I think the biggest factor the programme is successful is the sense of community it creates. With the programme, participants are surrounded by their own peers working together for a common goal – to lose weight. So it helps tremendously and gives them great motivation,” says Kevin. The programme’s ability to become a nationwide phenomenon, however, is due to the many success stories seen on various social media platforms. All of them provoke the question of “they have done it, why can’t you?” “All the success stories came from the people who had gone through the journey and were successful. So they bring about more impact to others than I could ever do.” Additionally, individuals who participate in JK1M are also entitled to various educational materials like e-books and videos as part of the programme. “These materials are a good way to learn whenever and wherever you are,” says Kevin.

a few minutes to walk outside the office, stretch and even standing is good enough. You might even get weird looks from your colleagues but you know what you got to do,” he says. As a personal trainer, Faisal’s biggest achievement is to get gym members to change their lifestyles. “When they see the benefit of changing their lifestyles, you can see their consistency. It is not going to be just a one-time thing for them anymore. The healthy lifestyle will stick with them for the rest of their lives.”

How to definitely lose weight and stay slim Mal aysia is the most obese country in Asia with an obesity rate of more than 45.3% (BMI more than 25), according to British medical journal, The Lancet. This clearly shows Malaysia is hit by an obesity epidemic with no cure in sight. This growing problem which has adverse effects on children and adolescents have threatened to roll back much of the country’s progress made in living healthy and independent lives as well as in creating social harmony and economic productivity. Being overweight or obese puts you at risk for a number of diseases, including heart disease, diabetes, high blood pressure, cancer, stroke, gallbladder disease, osteoarthritis and respiratory disorders. This is evident in Malaysia’s rising rates of diabetes and high cholesterol cases which have increased in tandem with the rise in obesity rates to 17.7% and 42.1% respectively, according to the Health Ministry. Also, risk of developing these diseases is even higher when weight is concentrated near the waist – most commonly known as belly fat. Despite continuing research on obesity, there are no medicines, herbs or supplements that can help you lose a significant amount of weight, without side effects. An individual must take a comprehensive approach to losing weight, which involves three lifestyle changes: Appetite control – eating less harmful food Firming the body – increase lean mass (muscles, skin and inner organs) Reduce weight – reduce fat mass Appetite Control Our hormones work together to tell us when to eat and when to stop. However, for many people who are obese or overweight, this system is off balance. Hence, maintaining a healthy routine is the key element to appetite control. The routine consists of: Sufficient sleep Drinking more water Eat slowly by chewing more Make healthy choices for your meals – avoid fast foods, eat more fish, fruits and vegetables, and avoid foods high in carbohydrates or fats. Take appetite-reducers – nutrients and hormones Reduce stress, frustration and anxiety level Increase energy Sleep and weight reduction Timing your sleep is like timing an investment in the stock market – it doesn’t matter how much you invest, it matters when you invest. Sleep is an

important modulator of neuroendocrine function and glucose metabolism. Sleepdeprived individuals have been found to experience metabolic and endocrine alterations, due to increased levels of ghrelin, decreased levels of leptin, and increased hunger and appetite, especially carbohydrates and sweet food, according to the University of Chicago. Growing evidence revealed in both laboratory and epidemiological studies points to short-sleep duration as a new risk factor for the development of obesity and its complications. The obesity epidemic in the US is associated with sleep deprivation among its people, as selfreported sleep duration recorded there has reduced by two hours. The link between obesity and sleep deprivation is further established by studies conducted by the University of Chicago, which concluded total sleep deprivation in humans leads to hyperphagia. To tackle the issue of obesity and appetite control, we must look at the causes of sleep deprivation. Today, individuals are watching TV and surfing the internet late into the night and even early morning, and getting poor quality sleep due to excessive stress or other causes, which deprive them of the required seven or eight hours of sleep needed for a normal appetite. Studies also found that watching TV for more than two hours a day and eating while indulging in the habit, have been linked to a factor causing bad appetite control among women. An individual is recommended to sleep daily latest by 11.00pm to allow rapid eye movement (REM) phase of sleep to be concentrated at 1am to 3am. These are the peak hours of liver function whereby it undergoes detoxification and regenerative process, and this process should ideally be done in a deep sleep state. If you are facing issues resetting your sleep cycle, limit watching TV and surfing the internet before going to sleep to avoid the common causes of sleep deprivation. Both activities are stimulating to the mind and significantly impair the secretion of melatonin due to the strong light they emit. Also, to ensure better quality sleep, you can take sleep-improving nutrients and hormones. Hence, you should examine your sleep schedule. Are you getting at least seven hours of sleep each night? Do you wake up feeling refreshed or lethargic? Do you wake up frequently during the night? Are you underweight, overweight or just right? This article is contributed by Dr Alice Prethima, head of aesthetic physician at Dr Alice Total Wellness Center.

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Correcting misconceptions about liposuction Procedure is for contouring purposes only, not to help you control and lose weight

By Norman Hussaini

at-removing procedures such as liposuction – a surgical fat removal procedure that first became popular in the 1980s – are known the world over as easier for people to shed excess and unwanted fat off certain parts of the body. This form of cosmetic surgery has become so vogue that it has subconsciously created misconceptions among the public. Dr Mohamad Nasir Zahari, medical director and consultant plastic, reconstructive and cosmetic surgeon at Beverly Wilshire Medical Centre, says the term “cosmetic” essentially means making things look better, and liposuction does just that. Yet because of its ability to remove fat, people feel the surgery is a shortcut to become thinner and actually beat obesity. “There are two things about liposuction we always tell our patients, and they must understand these very clearly,” he tells Health+. “The first thing is that the procedure is for contouring purposes only. Secondly, it is not a procedure to control and lose weight.” He says some people have asked whether the procedure can take a significant amount of weight off their bodies so that they may not be overweight anymore. “That is not how liposuction works. Removing that much fat with surgery will endanger your life.” WHAT’S LIPOSUCTION? So what is liposuction actually, if it is not for overweight people

to become thinner? And what is contouring? “Liposuction is basically a surgery where we remove a certain amount of fat in a particular part of the body, per the patient’s request. It can be done pretty much on every part of the body except for a few,” says Dr Nasir. Contouring, on the other hand, is a term used to describe an adjustment of a particular part of the body which the patient is dissatisfied with. “For example, let’s say one feels the shape of the thighs is unsatisfactory and is making it hard to fit into a particular outfit. Liposuction can help that person ‘adjust’ the shape by removing some fat on that particular area.” Any kind of surgery comes with its own set of risks, and liposuction is no different. However, the risks are very minimal, says Dr Nasir. “The procedure is very straight forward. Provided that the person is healthy and fit for surgery, risks of complications will be below 5%.” “Risks like bleeding and infections are quite rare. In comparison, there is higher risk of you getting injured when crossing the road than to have infections and bleeding from liposuction,” he says. VERY PAINFUL PROCEDURE However, he says the procedure is very painful. “I am not trying to scare anyone, but it is important to know that the procedure will cause quite a pain during the recovery period. A full recovery usually takes about six weeks.” That is why Dr Nasir feels that it is important for someone seeking to go for liposuction must be ready physically and mentally. “Cosmetic surgery is not a 100% guarantee success – it never

ORDEAL: The procedure is very painful, warns Dr Nasir.

Cosmetic surgery is not a 100% guarantee success – it never is. We are careful to project that clearly to our patients before they take the dive. We opt for a few consultations if required so that they understand the procedure and its possible results as best as possible.”

95% of patients are reasonably happy with the results of their surgery.

– Dr Nasir is. We are careful to project that clearly to our patients before they take the dive. We opt for a few consultations if required so that they understand the procedure and its possible results as best as possible.” He adds that about 95% of

his patients are reasonably happy with the results of their surgeries. So at the end of the day, liposuction is just a procedure to improve the aesthetics and to help people look better than they do before. Or is it?

Practical aspect Dr Nasir says the procedure does have a practical aspect to it as well. “Take for example a person who works as a cabin attendant. He is required to fit into a particular size before he is qualified. Or even for a normal person, a bit of fat off the tummy or thighs can make it easier for him or her to exercise and lose

weight.” The procedure can help certain people perform better at their jobs and daily activities. So does Dr Nasir feel that there is a substantial amount of misconception towards liposuction? He answers with a resounding yes.

“There definitely is. That is why it is important for me to stress that the first point I made earlier. The procedure is for contouring purposes only, not to control weight. Although it can be a tool to help people exercise better, it is not a way to fight obesity.”

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2016 | march

By Ali-Azmin Hassan

ndividuals who are severely obese are unaffected by conventional therapies such as consuming fewer calories and increasing exercise, says the National Institutes of Health (NIH). Severe obesity is one the most serious stages of obesity, and those affected may feel trapped in a weight gain cycle, making conventional means pointless. NIH, one of the world’s foremost medical research centres, recognises gastric bypass surgery as the best solution to combat severe obesity and maintain weight loss in the long term. As it appears, gastric bypass surgery is an effective shortcut to overcome obesity. Being obese is different from being overweight. One can be overweight from muscle, bone, fat and body water. Obesity, on the other hand, is having excess body fat around the abdomen, hips, thighs, waist and buttocks. Most people have the misconception that obesity surgery is similar to cosmetic surgery such as liposuction and tummy tucks which are superficial enhancements at best. The purpose of gastric bypass surgery focuses mainly on health reasons and not a superficial one. When every possible option to lose weight has been exhausted, many view gastric bypass surgery as their last option. Choosing this option is a difficult decision because weight loss surgery is a life-altering decision and it involves discussing with medical experts. Dr Andrea Ooi, a dedicated surgeon with more than 17 years of medical experience and also an expert in obesity and metabolic management at Andrea Bariatric Surgery, shares her insight with

Bariatric surgeries to overcome obesity Although patients enjoy many benefits, there’s 5% chance they will regain weight Health+, concerning obesity issues and the varieties of procedures for the purpose of weight loss to maintain or regain health. “Bariatric surgeries such as gastric bypass, gastric sleeve, and laparoscopic adjustable gastric banding, work by changing the anatomy of one’s gastrointestinal tracts” says Dr Ooi. Surgery causes different physiologic changes in one’s body that alter his energy balance and fat metabolism. “Bariatric surgery has been shown to help improve or resolve many obesity-related conditions such as type 2 diabetes, high blood pressure, heart disease, hypertension, and more,” says Dr Ooi. Despite the many benefits of a gastric bypass surgery, there are risks and complications involved. For example, there’s a 5% chance for a patient to regain weight. In dietary weight loss, energy expenditure is reduced to levels lower than would be predicted by weight loss and changes in body composition. This change in energy can often lead to weight regain. Dr Ooi classifies the types of bariatric surgery as restrictive and mild absorption. Restrictive surgery is by reducing the size of the stomach to reduce the amount of food intake. Hence, with this

Some people can become overweight due to depression which makes them eat a lot, says Dr Ooi.

process, it helps to mobilise other parts of the fat to reduce the body size. Basically, this surgery helps one to control his appetite so that he eats less. Mild absorption, on the other hand, is decreasing the amount of nutrient when one is eating to help in weight loss. Dr Ooi explains the restriction of diet after one had undergone surgery. During the first week after surgery, it is imperative for the patients to consume clear fluid foods such as water, broth and clear juices. Gradually, after each week, patients can consume thicker fluids, and eventually, soft and solid foods. This is because the patients need time for the cuts in the stomach to be healed. Strenuous activities are also restricted. The only instance where one is rejected from getting a bariatric

surgery is mental instability. “Clients need to go through a psychological assessment. Some people can become overweight due to depression which makes them eat a lot. The patients need to follow a diet plan for them to recover after the surgery. If this is a certain factor, then it’s dangerous if we conduct the surgery for them,” says Dr Ooi. It is important to remember that bariatric surgery is a “tool” to help one lose weight. The total success of weight loss depends on many other important factors such as nutrition, exercise and behaviour modification. Bariatric surgery can result in long-term weight-loss success, and besides improvements in health and longevity, it can improve overall quality of life.

Surgery last resort if diet and exercise don’t work There’re many types of bariatric surgery, and choosing the right one will depend on a patient’s condition, says obesity surgeon Dr Haron Ahmad By Ali-Azmin Hassan

eight-loss surgery is an option for those who are severely obese and are unable to lose weight through diet and exercise. “We only do this surgery as a final option when dieting and exercising do not work,” says Datuk Dr Haron

Ahmad, an advanced laparoscopic and obesity surgeon at KPJ Damansara Specialist Hospital in Petaling Jaya. “Weight-loss surgery is very risky as obese people have diseases such as diabetes, hypertension, hyper cholesterol, anemia, sleep apnea and liver problem. These are metabolic diseases that can pose risks to the operation,” continue on page 08

BENEFITS GALORE: Losing enough weight after the surgery can improve many medical conditions such as asthma, high blood pressure, high cholesterol, obstructive sleep apnea, hypertension and type 2 diabetes.

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march | 2016

Losing weight through detoxification Loads of detox programmes and products claim to help weight watchers shed those unsightly flabs

By Ali-Azmin Hassan

e toxific at ion programmes and products are gaining popularity everywhere. Some might consider this trend a new diet fad which will eventually fizzle out just like any other new diet fads. You may think you exercise enough and maintain a balanced diet, and you’re set and well, that’s enough. Okay, sure, but what about supplementing that with detox – or short for detoxification? Despite the hype and publicity onslaught, it’s important to know that detox is no magic to help you lose weight without exercising or dieting. It’s meant to clean your body from the inside, making exercising and dieting easier – hence making you healthy. Detox products help to cleanse, purify and detoxify your organs. Sharon Wong, general manager of Total Image Regional (M) Sdn Bhd, a company that provides detox products, among others, explains to Health+ the benefits of detox and how it can help one to lose weight and live healthy. She says the reason detox can work to help you lose weight is the plethora of raw fruits and

vegetables in its ingredients. These ingredients help remove toxins and extra body fat, in addition to exercising and maintaining a well-balanced diet. Raw fruits and vegetables have more nutrients than cooked produce simply because they’re still in raw state. Blocking body’s ability to make fat Wong says one of the ingredients used for Total Image products is garcinia cambogia, which is known to be very effective for weight loss. Garcinia cambogia, a tropical fruit also known as malabar tamarind, supposedly blocks your body’s ability to make fat and puts the brakes on your appetite. It also keeps blood sugar and cholesterol levels in check too. “A lot of people are chasing products that contain garcinia cambogia. In fact, this ingredient has been around 10 years ago, but only quite recently it has gained popularity,” says Wong. “Every day we eat different kinds of things and we always overeat. So we need to detox our body. So for people to lose weight, I think you need to detox first to get better result. “Detox happens when you sweat. When you detox, it’s easier for you to lose weight effectively. Detox also helps to improve your digestion to make you feel lighter and less bloated.”

Wonder of garcinia cambogia Garcinia cambogia is used in many slimming products. The active ingredient is hydroxycitric acid found in the fruit skin which is said to boost fat-burning and cut back appetite. It appears to block an enzyme called citrate lyase which is used by the body to make fat. It also raises the serotonin level in your brain, which makes you feel less hungry. Although many slimming products contain garcinia cambogia that is said to help one lose weight, the actual weight loss results are not that impressive. Studies have found that people who took garcinia cambogia lost about two pounds more than those who didn’t take it. Reviewers couldn’t say for sure whether that weight loss was due to garcinia cambogia, or simply due to other reasons such as exercising or lower-calorie diet. Nevertheless, garcinia cambogia is still beneficial to one’s health and although its effectiveness to help one lose weight is still being researched and at times questioned too, it seems there’re more benefits to take it rather than not.

Detox for how long? How long should one undergo detox to lose weight? “It all depends. For our products you do not require meal replacement or special diet. We recommend at least 1-3 months of detoxification,” says Wong. As mentioned earlier, detox is no magic to make you lose weight. “You need to combine it with exercise and balanced diet. Even for myself, I use the products and even go for exercise and maintain my diet. We always advise our customers to live healthy and exercise and use the products for faster results,” she advises.

“We’ve been in the market for 32 years, we always try to source for other products such as hair care, but we focus mainly on slimming and beauty. A lot of people have the mindset that Total Image relates to this industry only. In fact, we want to have more beauty and slimming products. Most of our customers are women. We want to keep them beautiful and healthy so they can have more confidence. This is what keeps us going,” says Wong, adding that Total Image detox products are approved by the Health Ministry.

Many types of bariatric surgery from page 07

he tells Health+. There are many types of bariatric surgery, and choosing the right one will depend on each patient’s condition. In all types of bariatric surgery, patients will be under general anaesthesia to induce sleep and ensure a pain-free procedure. LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING Laparoscopic gastric banding is a surgery whereby the surgeon places a band and constricts the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat and this will go down slowly to the stomach. “We can adjust how tight the band is by putting in fluid inside the port that is placed beneath the skin. This surgery has been done for many years but it’s slowly losing its popularity. This is because after many years we have found there are many complications. After a month, the band will loosen because the fluid that tightens it gets dissipated. Patients then have to go for check-up regularly to recalibrate. So we have found that it’s difficult to follow up,” says Dr Haron. “Other than that, there’re also some complications related to the band. For example, ulceration, gastritis, heartburn and the gastric band may even slip partly out of place. The surgery does not involve any cutting or stapling inside the belly.” GASTRIC BYPASS SURGERY Gastric bypass is a surgery that helps you lose weight by changing how your stomach

and small intestine handle the food you eat. “The procedure involves creating a stomach pouch out of the portion of the stomach and attaching it to the small intestine. The bigger portion of the stomach is still necessary because it produces enzymes and acid for digestion. So when the food is flowing through the small pouch of the stomach that is connected to the small intestine, the enzymes and acid from the stomach flow through the duodenum which will also be connected to the lower part of the small intestine through surgery,” says Dr Haron. “So the absorption of vitamins from the food doesn’t happen in the stomach because as the food goes straight through the small intestine and so do the enzymes and acid. That’s why it’s called a bypass.” Gastric bypass is a major surgery and hence has many risks. Just like laparoscopic adjustable gastric banding, it can cause gastritis, heartburn or stomach ulcers. “Despite the risks of complications, the benefits of this surgery outweigh the risks. Losing enough weight after the surgery can improve many medical conditions such as asthma, high blood pressure, high cholesterol, obstructive sleep apnea, hypertension and type 2 diabetes. You won’t feel tired as much, you’ll walk well, there’s no knee pain and you feel more confident,” says Dr Haron. Does a patient regain weight after the surgery? Yes, you can, says Dr Haron, if you don’t control or take care of yourself. “After the surgery, you need to be with us for check-ups at least for one-and-a-half years, so I can change your behaviour. Weight-loss surgery also involves forced

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2016 | march

Obese children at risk to bone, joint problems

plate. It usually affects older children in their adolescent years. Like Blount’s disease, most children diagnosed with the condition are usually overweight. Signs of SUFE can be detected when a child becomes less active or develops a limp. Sometimes, the child cannot even walk due to the pain. Previous injuries from a fall might also aggravate the slip. OVERWEIGHT CHILDREN AT RISK “The theory dictates that SUFE and Blount’s develop in overweight children because of their still tender growth plates. They can’t function normally because of the unusual weight of the body. It doesn’t affect adults as adults have reached bone maturity,” adds Dr Razak.

The severely overweight are more prone to Blount’s disease, slipped upper femoral epiphysis

hen talking about bone and joint health, most people will straight away think about conditions that come with old age or after being involved in traumatic accidents. However, there is a certain condition that occurs in children which greatly affects their ability to physically develop properly. Health+ spoke to Dr Abd Razak Muhamad, a paediatric orthopaedic surgeon at Gleneagles Kuala

Lumpur, to find out why and how obese children are at risk of developing Blount’s disease or slipped upper femoral epiphysis (SUFE). BLOUNT’S DISEASE Blount’s disease is an abnormal or asymmetrical growth disturbance at the medial (inner part) of proximal leg growth plate derived from excessive stress due to overweight. This causes asymmetrical growth at the upper part of the leg and progressive bowing deformity. Dr Razak says most children

ANTI-SLIP: Surgery involves inserting a screw in the hip joint to prevent further slip.

change of behaviour. It’s about changing you to become a new person. We want to modify the way you eat. Even when drinking, you’ll be sipping instead of gulping. This is all for the benefit of your health,” he explains. VERTICAL SLEEVE GASTRECTOMY Sleeve gastrectomy is a surgical weight-loss procedure in which a large portion of your stomach is removed. The new, smaller stomach is about the size of a banana. “It limits the amount of food you can eat by making you feel full after eating small amounts of food. This one has no bypass – it only makes your stomach smaller,” says Dr Haron. Weight-loss surgery is not a quick fix for obesity, but it helps to change your lifestyle. After the surgery, it forces you to want to eat less than you regularly do. With a control diet and exercise, you’ll soon see changes to your body. Before deciding whether you should go for a weight-loss surgery, Dr Haron will ask a few questions. “Firstly, have you tried to lose weight? Secondly, are you obese? In Malaysia, someone is obese if his or her body mass index (BMI) is 28 and above.

SUFE: A typical slipped upper femoral epiphysis in children.

“When you come and see me, you’ll meet the whole team. My team consists of surgeons, physicians, a psychologist and a dietician. You will be assessed by all these people. If you’re a drug addict or an alcoholic, or have mental illness, I will not treat you. It’s because I need to trust people to follow instructions after the surgery.” Is weight-loss surgery covered by health insurance? Generally no, says Dr Haron. “Bariatric surgery in Malaysia is considered a lifestyle classic surgery, which is wrong. Being fat is considered a lifestyle problem, but when you’re obese, it’s a disease. But right now, obesity is declared by the World Health Organisation as a disease and epidemic. The best thing the government can do is to tell people not to get fat and promote healthy lifestyle.”

BOWLEGS: Bowing of the legs is caused by Blount’s disease.

NATURAL: Dr Razak says most children are born naturally with mild bowing of the legs. are born naturally with mild bowing of the legs. This, he adds, is normal and is caused by the baby’s position in the mother’s womb. This natural occurrence makes babies under two years of age to have bowlegs, which will eventually straighten as the bones develop. However, a child with Blount’s disease may not grow out of bowlegs after this age with the condition getting worse rather than better. “Progressive bowing will alter the normal alignment of the lower limbs and the resulting malalignment will cause an abnormal stress to the inner part of the knee joint leading to chronic pain and in a long term, premature arthritis of the knees,” says Dr Razak. THREE INSTANCES He says there are three instances when the disease occurs in children. The first, which occurs when children are between two and four years old, is known as infantile Blount’s. The second is called juvenile Blount’s which occurs in children between four and seven years of age. The third is called adolescent Blount’s which occurs in children in their adolescent years. “What is peculiar about adolescent Blount’s is that it is usually occurs quite progressively in a short period of time, usually involving children between the ages of 10 and 12. This particular type of Blount’s is said to be strongly caused by childhood obesity,” says Dr Razak. SUFE SUFE, on the other hand, is an unusual slipping of the adolescent hip. It is a caused by the separation of the upper part of the femoral head from the neck causing a deformity of the hip joint. This is due to weakness of the growth

TREATMENTS There are two types of treatment for Blount’s disease – non-operative and operative. Non-operative treatment, which includes the use of braces, is usually for children below three years old. Bracing usually takes about two years for maximum effectiveness. However, due to compliance issues, bracing has limited indication and poor success rate. Operative treatment, on the other hand, includes surgery, which is usually needed if braces do not work, or if the deformities are progressive after the age of two. For SUFE, treatment should be immediate. The goal of treatment, which requires surgery, is to prevent further slipping of the femoral head until the growth plate closes. If the head is allowed to slip farther, hip motion could be limited, and premature osteoarthritis could develop. Dr Razak says early diagnosis of SUFE provides the best chance to achieve the treatment goal of stabilising the hip. Fixing the femoral head with pins or screws has been the treatment of choice for decades. EARLY DETECTION IS ALWAYS BETTER As a paediatric orthopaedic surgeon, Dr Razak deals exclusively with children with various bone and joint problems, mainly treating congenital conditions. He says Blount’s disease and SUFE are some conditions that can be prevented if detected early. “It is therefore important for parents to take necessary actions if they notice their children limping or when they complain of pain of the lower limbs. It is easy for parents to detect such conditions as they make their children less active,” he explains. As childhood obesity becomes more prevalent, these conditions are likely to occur in more children and parents should be vigilant and watchful to detect potential cases of Blount’s disease and SUFE.

10 •

march | 2016

Losing weight can affect your health Two studies show over-the-counter slimming supplements are ineffective

rom slimming supplements to prescription drugs, pharmacies are full of products destined to help lose weight, but their use can come at great expense, both financially and health-wise. At the 11th International Congress on Obesity hosted in Stockholm, experts were clear when it came to over-the-counter slimming supplements: “save your money, the only thing you are going to lose is your money,” said Judith Stern, a professor in the Departments of Nutrition and Internal Medicine at the University of California Davis. Two studies presented at the congress showed supplements were ineffective. Thomas Ellrott, a professor at the University of Goettingen in Germany, presented a study in which nine popular supplements, proposing nine different weight loss solutions, were tested against placebo pills in a controlled trial. “There are scores of slimming supplements out there claiming weight-loss effects through all sorts of mechanisms of action... the market for these is huge, but unlike for regulated drugs, effectiveness does not have to be proven for these to be sold,” he said. The participants in his study

that took weight loss supplements lost between 1-2kg, while those taking the placebo lost 1.2 kg on average. “Not a single product was any more effective than placebo pills in producing weight loss over the two months of the study, regardless of how it claims to work,” he said. Despite their proven lack of effectiveness, the market for supplements ranging from cabbage powder to fibre pills to plant extracts generates a whopping US$13 billion (RM53 billion) per year, said Igho Onakpoya of the Universities of Exeter and Plymouth in Britain. “People think these supplements are a short cut to weight loss and may spend huge sums of money on them, but they may end up disappointed, frustrated and depressed,” he said. For a more effective chance at tackling weight loss, experts recommend turning to prescription drugs, but these are not free from side effects. An anti-obesity drug that targeted the cannabinoid receptor CB1 had received all regulatory approvals but was then withdrawn from the European market after widespread use showed it carried a risk of psychiatric side effects. “Depression is not an acceptable trade-off for weight loss,” said Christian Elling, vice-president of the Danish pharmaceutical laboratory 7TM Pharma. His team is working to develop a new drug based on a molecule that acts the same way on organs and muscles linked to metabolism as the withdrawn drug, with the important difference that it does not penetrate the brain. “ The lack of significant exposure in the brain seen in our pre-clinical experiments provides optimism that blockade of the CB1 receptor may still be an effective and safe approach to treat obesity and related diseases,” he said when presenting his laboratory’s findings at the conference, adding more trials were still needed before commercialising the drug. Other prescription drugs have been proven effective, allowing to shed up to 10% of total body weight, or 8-9kg per year. And even these are not health

If the patient is not happy because he’s not losing weight fast enough or he wants to lose more, he starts experimenting, doubling doses... and then, (prescription drugs) become a health risk.” – Luc van Gaal

US$13b market for supplements ranging from cabbage powder to fibre pills to plant extracts

risk free, because of the psychological aspect of fighting against a weight surplus. “Patients are often victims of their expectations,” said Luc van Gaal, of the University of Antwerp in Belgium. “If the patient is not happy because he’s not losing weight fast enough or he wants to lose more, he starts experimenting, doubling doses... and then, (prescription drugs) become a health risk,” he said, hinting that patients blinded by an obsession to slim down could manage to get their hands on medicine illegally. – AFPRelaxnews

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2016 | march

and monitor your blood pressure level regularly. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and cardiovascular diseases. Eat healthy and keep weight in check This can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease. Reduce your salt intake – the recommended intake is 5-6gm per day (around a teaspoon). Limit the amount of processed and restaurant food and do not add salt to food. It is easier to control your intake if you prepare the food yourself with fresh ingredients.

STAY HEALTHY: Keeping fit helps to reduce our blood pressure and therefore reduces the risk of chronic kidney disease.

Loving our kidneys Take good care of those precious organs for they are vital to our overall health

and obesity. This will also translate to better kidney health for Malaysians.”

ur kidneys are complicated and amazing organs that do many essential tasks to keep us healthy. Their main job is to remove toxins and excess water from our blood. They also help control our blood pressure, produce red blood cells and keep our bones healthy. Each roughly the size of our fist, and located deep in the abdomen, beneath the rib cage, these vital organs control blood stream levels of many minerals and molecules, including sodium and potassium, and help to control blood acidity. Every day our kidneys carefully control the salt and water in our body system so that our blood pressure remains the same. Since our kidneys are vital to our overall health, it’s important to look after them. However, the sad reality is many people don’t – in fact some abuse these precious organs until they’re finally injured beyond repair. According to the World Kidney Day website, kidney diseases affect millions of people worldwide, including many children who may be at risk at an early age. It is therefore crucial that we encourage and facilitate education, early detection and a healthy

REDUCING RISK Kidney diseases are silent killers. There are however several easy ways to reduce the risk of developing kidney diseases.

life style in children, to fight the increase of preventable kidney diseases and to treat children with inborn and acquired disorders of the kidneys worldwide. In Peninsular Malaysia, the overall prevalence of chronic kidney disease is 9.07% based on a published sub-study of the National Health and Morbidity Survey 2011. Only 4% of respondents were aware that they had chronic kidney disease. According to Director-General of Health Datuk Dr Noor Hisham Abdullah, the number of Malaysians diagnosed with end-stage kidney renal failure and requiring dialysis treatment is increasing every year. “Over a 10-year period, the number of new patients requiring dialysis had increased from 3,134 in 2005 to 7,055 in 2014. Similarly, the prevalence of patients on dialysis had increased from 13,332 in 2005 to 34,767 in 2014. The leading cause of end-stage kidney failure is diabetes,” he says. “Sixty-one percent of all new patients requiring dialysis treatment in 2014 developed end-stage kidney failure due to diabetes. Malaysians need to do more in terms of practising a healthy lifestyle to prevent and better control diabetes, hypertension

1.5 to 2 litres of water is the minimum per day.

61%

of all new patients requiring dialysis treatment in 2014 developed end-stage kidney failure due to diabetes.

Keep fit and active Keeping fit helps to reduce our blood pressure and therefore reduces the risk of chronic kidney disease. Keep regular control of blood sugar level About half of people who have diabetes develop kidney damage, so it is important for those with diabetes to have regular tests to check their kidney functions. Kidney damage from diabetes can be reduced or prevented if detected early. It is important to control our blood sugar levels. Monitor blood pressure Although many people may be aware that high blood pressure can lead to stroke or heart attack, few are aware it is also the most common cause of kidney damage. The normal blood pressure level is 120/80 mm Hg. Between this level and 139/89, you’re considered prehypertensive and should adopt lifestyle and dietary changes. At 140/90 and above, you should discuss the risks with your doctor

Maintain healthy fluid intake Although clinical studies have not reached an agreement on the ideal quantity of water and other fluids we should consume daily to maintain good health, traditional wisdom has long suggested drinking 1.5 to 2 litres (3-4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease, according to researchers in Australia and Canada. The findings, the researchers said, do not advocate “aggressive fluid loading”, which can cause side effects, but they do provide evidence that moderately increased water intake, around two litres daily, may reduce the risk of decline in kidney function. It’s important to keep in mind that the right level of fluid intake for any individual depends on many factors including gender, exercise, climate, health conditions, pregnancy and breast feeding. In addition, people who have already had a kidney stone are advised to drink 2 to 3 litres of water daily to lessen the risk of forming a new stone. Stop smoking Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly. Smoking also increases the risk of kidney cancer by about 50%. Stop taking over-the-counter pills on a regular basis Common drugs such non-steroidal anti-inflammatory drugs are known to cause kidney damage and disease if taken regularly. Such medications probably do not pose significant danger if your kidneys are relatively healthy and you use them for emergencies only, but if you are dealing with chronic pain, such as arthritis or back pain, work with your doctor to find a way to control your pain without putting your kidneys at risk.

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march | 2016

In the dark about medical condition Only 4% of respondents in a study were aware that they had chronic kidney disease

ith the growing prevalence of diabetes, there is an increasing need for greater public awareness of kidney-related disease, particularly on the risks involved. Director-General of Health Datuk Dr Noor Hisham Abdullah shares his thoughts with Health+ on the state of kidneyrelated diseases in the country. Q: How prevalent is kidneyrelated diseases in Malaysia? A: The overall prevalence of chronic kidney disease in Peninsular Malaysia is 9.07%. This is based on a published sub-study of the National Health and Morbidity Survey 2011. Only 4% of the respondents in this study were aware that they had chronic kidney disease. (Reference: A population-based study measuring the prevalence of chronic kidney disease among adults

in West Malaysia. Lai Seong Hooi et al. Kidney International (2013) 84, 1054-1040) Q: How prevalent is kidneyrelated disease stemming from obesity? A: There is presently no local data on chronic kidney disease stemming from obesity. However, obesity is a major risk factor for diabetes and hypertension. Diabetes and hypertension are the two leading causes of chronic kidney diseases.

HEAVY RISK: Dr Noor Hisham says obesity is a major risk factor for diabetes and hypertension.

unable to afford the treatment are given a subsidy of RM50 per haemodialysis treatment and their treatment with erythropoietin injections are also paid for by the Health Ministry.

Q: We see a lot of dialysis centres in the country. Are there any dialysis centres that are fully supported by the Health Ministry besides those in government hospitals? A: Only dialysis centres at the Health Ministry hospitals and health clinics are fully supported by the ministry. However, patients at NGO dialysis centres who are

Q: The cost of medication for dialysis is not cheap. Is there a subsidised rate for patients? A: At the Health Ministry centres, drugs are highly subsidised and patients on dialysis do not usually

Treating and preventing kidney diseases National Kidney Foundation aims to treat, prevent and spread awareness of kidney diseases among Malaysians

By Norman Hussaini

he incidence of kidney diseases among Malaysians is growing yearly, indicating that we are putting our kidneys at risk due to unhealthy lifestyle. Although the reported number of patients with kidney failure is quite low, the trend is worrying, says Datuk Dr Zaki Morad, chairman of the National Kidney Foundation (NKF) and consultant

nephrologist at KPJ Ampang Puteri. “If we look at all aspects of kidney diseases from the mild to the more severe one, 9.6% of the overall Malaysian population is reported to have them, according to a survey done by the Health Ministry. If we are looking at kidney failure cases, NKF receives about 300 cases annually,” he tells Health+. NKF has 26 dialysis centres, a fraction of the total in the country. And the growing need for more dialysis centres indicates that the number of patients with kidney failure is ever increasing.

NOBLE CAUSE: NKF, chaired by Dr Zaki, is dedicated to help people with kidney diseases access better treatment and support.

NKF’S ROLE NKF is a non-government organisation dedicated to all things kidney. According to Dr Zaki, the foundation’s main roles relate specifically to kidney health. “Our main role as an organisation is to educate the public on early detection and prevention of kidney diseases. This involves knowing the types of kidney diseases and the symptoms to look out for,” he says. Besides that, the foundation also provides affordable haemodialysis treatment to patients

have to pay for their medications. The majority of patients who are receiving dialysis treatment at NGOs and private centres still come to the Health Ministry hospitals and health clinics to get their highly-subsidised oral medications. Q: We understand some patients receive free treatments. What are the criteria to be eligible for free treatments? A: At the Health Ministry facilities,

with kidney failure. “We do this to complement the government’s programme. We know the government provides dialysis facilities throughout the country but these are not enough,” says Dr Zaki. NKF’s facilities which offer subsidised rates are for patients who cannot afford to go to private hospitals for treatment, he adds. Apart from promoting greater awareness on early detection and prevention of kidney diseases, as well as providing dialysis treatment, NKF also provides training to nurses to take care of kidney patients undergoing dialysis treatment. “As a foundation, we also do not shy away from giving support to any kidney health related research to be done in Malaysia,” he adds. KIDNEY DISEASES AMONG DIABETICS Some 6,000 cases of kidney failure are reported annually in Malaysia, and the worrying part is the growing incidence among diabetic patients. “The most common kidney disease catalyst among the adult population is diabetes. It accounts for about 60% of patients taken into dialysis. It is very important

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2016 | march

patients are required to pay RM13 for each haemodialysis treatment. In the event they are unable to pay, and confirmed by an evaluation by a medical social worker, then the fee is waived. Q: We understand the Health Ministry had stopped transplant surgery in private hospitals last year because of unwarranted fatalities. Are any private hospitals allowed to do transplant now? A: At this point in time that is true. However, a private hospital is in the process of fulfilling the required conditions and will be reapplying for approval. Q: What is the overall success rate of kidney transplants in Malaysia over the years? A: The overall success rate of kidney transplants in Malaysia is comparable with that of other more developed countries. In addition to improving a patient’s quality of life, receiving a kidney transplant will still be better in terms of survival than continuing on dialysis. The patient and kidney graft outcomes are as below:

Q: At which stage of a patient’s condition before he/she needs a kidney transplant? A: A patient who has been diagnosed which chronic kidney disease (CKD) stage 5, i.e. at a stage when his/her kidney function has deteriorated to a point that his/her life may be in danger if he/she does not undergo renal replacement therapy such as renal transplant or dialysis. Kidney transplants may be done after dialysis treatment has been initiated or pre-emptively just before the patient needs to be put on dialysis.

Number of patients on waiting list for kidney transplants from deceased donors: 19,932 Number of Malaysians who have pledged to donate their organs after death: 326,738 (this is slightly more than 1% of the Malaysian population)

Statistics from 1975 till now: Total number of living kidney donors (donation to their relatives): 1,274

Living Donor

Deceased Donor

1 year

98%

92%

5 years

95%

85%

10 years

80%

WHO NEED TO GO FOR DIALYSIS A person with kidney disease will lose the functions of the organ, sometimes quickly but mostly gradually. When the kidney function drops to below 10%, the patient will have major symptoms such as fatigue and loss of appetite. “As a common practice,

Total number of deceased donors (donation after death): 513

Q: Are there many kidney donors in Malaysia? A: The number of kidney donation after death has increased in recent years due to greater public awareness. However the numbers are still low when compared to other more developed countries.

Patient Survival (Patients Alive)

to know that correlation,” Dr Zaki stresses. “Diabetes is something that can be prevented and controlled, which can subsequently prevent kidney failure as well.” He says while diabetes affects every organ in the body, the kidneys are affected first. Hence, preventing diabetes is crucial to prevent kidney diseases. Dr Zaki says although diabetes can be inherited, in most cases, people with diabetes are those who fail to lead a healthy lifestyle. Obesity, he adds, is also another key factor that causes diabetes, besides other severe conditions. He says there are also other kidney diseases that are not connected to diabetes such as kidney stones, glomerulonephritis (inflammation of the kidney) and polycystic kidney disease, which account for 40% of kidney patients.

The leading cause of end-stage kidney failure is diabetes.

patients whose kidney function has dropped to about 15% are to start haemodialysis treatment. However, a patient can only undergo haemodialysis after a few months because certain procedures must be carried out prior to treatment.” Dr Zaki advises the public to go for regular health screenings, particularly so if any family members have kidney diseases. “We always encourage the public to know about their state of health and to go for screenings on a regular basis. As with any type of conditions and illnesses, prevention is always better than cure.” SPREADING LOVE FOR KIDNEYS NKF organised an event at Taman Metropolitan Kepong on March 12 to commemorate World Kidney Day 2016, an annual global awareness and education event dedicated to spread the importance of kidney health. The event, with the slogan “Kidney Disease and Children”, was to create awareness about kidney health among the younger generation and their parents. Fun and educational activities included diet counselling, free screenings and colouring contests.

19,932

patients on waiting list for kidney transplants from deceased donors

Q: Is the Health Ministry planning any programmes in conjunction with World Diabetes Day 2016? A: World Health Day 2016 will be dedicated to diabetes and will be observed by the Health Ministry (tentative date is April 7, 2016) and various activities have been planned, including health promotion activities and diabetes awareness campaigns. Q: Will the Health Ministry support any NGOs for the World Diabetes Day 2016 celebration? A: The Health Ministry aims to work together with various NGOs, including Diabetes Malaysia. Q: Has there been any new development in kidneyrelated disease treatments in

recent years? A: There have been some new drugs that can improve the management of dialysis and transplant patients. Innovations in home-automated peritoneal dialysis machines now allow remote monitoring of home therapy by doctors and nurses. The “artificial wearable kidney”, a small portable wearable dialysis machine, is now undergoing trials in a number of countries. Hopefully this technology will become a reality in the next 5-10 years. Q: What is your opinion on the state of kidney health among Malaysians? A: We are very concerned that the number of people diagnosed with end-stage kidney renal failure and requiring dialysis treatment is increasing every year. Over a 10-year period, the number of new patients requiring dialysis had increased from 3,134 in 2005 to 7,055 in 2014. Similarly, the prevalence, i.e. the number of patients on dialysis, had increased from 13,332 in 2005 to 34,767 in 2014. The leading cause of endstage kidney failure is diabetes. Sixty-one percent of all new patients requiring dialysis treatment in 2014 developed end-stage kidney failure due to diabetes. Malaysians need to do more in terms of practising a healthy lifestyle to prevent and better control diabetes, hypertension and obesity. This will also translate to better kidney health for Malaysians.

Types of dialysis treatments A patient with kidney failure generally has to undergo treatment known as renal replacement therapy. The therapy is mostly known as dialysis treatments and functions as replacement kidneys, so to speak. There are two types of treatments:

HAEMODIALYSIS

It is a process of purifying the blood of a person whose kidneys are not working properly. The treatment makes use of an “artificial kidney” in a form of a haemodialysis machine. It basically replaces the function of the kidneys which is to remove unwanted wastage in the blood. The treatment can be an outpatient or inpatient therapy, depending on the patient’s circumstances. A prescription for dialysis from a nephrologist will specify various parameters for the treatment. These include the frequency, length of each treatment and the blood and dialysis solution flow rates. The treatment will usually be prescribed only after a certain procedure has been done prior to starting treatment. Usually, a patient need to undergo surgery to make his veins bigger so that treatment can be carried out. The process

is called arteriovenous fistula.

PERITONEAL DIALYSIS

This is a treatment for patients with severe chronic kidney disease. It is done by inserting a tube into the patient’s stomach by minor surgery. This surgery uses the patient’s peritoneum – the membrane lining the abdominal cavity – as a membrane across which fluids and other dissolved substances are exchanged from the blood. Fluid is introduced through a permanent tube in the abdomen and is flushed out every few hours. Patients are trained to run the treatment at home, instead of going to a dialysis centre. Peritoneal dialysis offers more mobility for the patients as they can continue working or travelling while receiving treatment. Another version of the treatment, known as automatic peritoneal dialysis, allows a patient to change the fluids only before going to sleep as the process runs through the night. The automatic peritoneal dialysis is not as popular among the public as it is still new and costs a lot more than regular peritoneal dialysis.

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SOCSO steps ahead with dialysis support Scheme provides dialysis facilities for contributors suffering from end-stage kidney failure

By PRASAD CHANDRA SEGARAN

ecogni sing the rising cost of dialysis treatment, the Social Security Organisation (SOCSO) has put in place a scheme to help insured dialysis patients. The scheme provides dialysis facilities to support contributors suffering from severe chronic kidney disease – end-stage renal failure (ESRF). Haemodialysis is a process where machines are used to filter out waste fluids in the kidney. Without life sustenance, once a person with kidney disease reaches ESRF, toxin build-up in the body and death usually comes within a few weeks. SOCSO is one of the main bodies that create awareness

among workers on the importance of caring for their kidneys. As a caring organisation and leader in social security, SOCSO looks after the wellbeing and welfare of its contributors affected by kidney diseases. SOCSO started the scheme in early 1999 after the then minister of labour and manpower Datuk (now Tan Sri) Lim Ah Lek mooted the idea to provide haemodialysis treatment for its contributors affected by ESRF. The dialysis treatment is extended to all eligible members for life when they are unable to work and certified invalid by the SOCSO medical board. In 2005, the service was extended to include eligible SOCSO contributors claiming for Invalidity Pension Scheme subject to recommendation by the medical board. SOCSO came up with subsidised peritoneal dialysis treatment to help those who are medically prescribed by its nephrologist. SOCSO also started subsidising

The public should know what is happening to the money they have contributed to SOCSO. The awareness is not just about providing services to the patients or the public; it is more about how we prevent them from getting these diseases.” – Dr Azman

Ayurveda possible cure for kidney diseases Indian traditional treatment can be used to treat, and sometimes even cure such chronic ailments

hen it comes to treating kidney diseases – or for that matter any diseases – most people will first think of mainstream or western medicine. But then, like almost everything else,

there are always alternatives to consider – from natural cures to home remedies and many other types of alternative treatments. Of all the alternative choices to treat diseases, Ayurvedic treatment is probably one of the oldest whole body – or holistic – healing

systems. Ayurveda originated in India more than 5,000 years ago and remains one of the country’s traditional health care systems. One of the foremost practitioners of Ayurveda in Malaysia is Vaidya CD Siby, who has a Bachelor in Ayurvedic Medicine and Surgery (BAMS) from India. For close to 28 years, he has been treating people who come to him suffering from various ailments from kidney diseases and cancers to diabetes and hypertension. Today, he is the chief Ayurveda physician of Ayur Centre, a premier Ayurveda centre set up in 2000. It has a branch in Petaling Jaya and another in Seremban. The basis of Ayurveda is the need to balance the mind, spirit and body. Ayurvedic medicines are primarily aimed at promoting good health, and in certain cases, Ayurveda can provide a cure. “Every system of medicine has a role to play in health management and no system is complete,” says Siby. “Modern conventional

system is a progressive science with advanced technology, while Ayurveda is based on a traditional approach. Also, surgery is a branch of Ayurveda that is no longer in practice today.” Siby says the effectiveness and duration of treatment for any disease depends on various factors, including the patient’s age and the stage of the disease. In the case of kidney disease, the first step is to identify the type. Is it related to other diseases such as hypertension, diabetes or cancer? Are there lifestyle changes that can be made to help the patient? Siby believes that when a patient is suffering from a very early stage of kidney disease, there are times when the condition can be reversed with proper diet and medication. “However, when the kidney is damaged, and if the patient is suffering from other chronic diseases, the best we can do is help the patient’s quality of life with proper diet, medicines and other supplements.

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erythropoietin (EPO) injection in 2009 to treat and improve the health of those suffering from anaemia due to chronic kidney diseases. It also provides assistance to subsidise immunosuppressant drugs to contributors who have undergone kidney transplant. Treatment at private, government dialysis centres The haemodialysis treatment for SOCSO contributors is available at 471 private sector and non-governmental organisation (NGO) dialysis centres and 125 government hospitals nationwide. A total of 11,025 contributors are receiving haemodialysis treatment at private dialysis centres and another 1,086 at government health facilities. The total number of SOCSO contributors receiving dialysis treatment under the scheme is almost a third of the total number of patients nationwide. SOCSO CEO Datuk Dr Mohammed Azman Aziz Mohammed says the number of kidney patients in the country is increasing due to kidney failure caused by kidney disease complications. “SOCSO has two main schemes. The first is Employment Injury Insurance Scheme which covers accidents that happen to contributors during or at work. The second is the Invalidity Pension Scheme. This 24-hour coverage is basically not related to injury or accidents, but due to any kind of physical diseases like heart disease, stroke or even kidney failure, for which you can come forward to claim the pension,” explains Dr Azman. A contributor is eligible to claim for the pension under the Invalidity Pension Scheme after

being certified invalid by the medical board. “Looking at the facts, every year the number of cases increases by about 15-20%, which is quite serious,” says Dr Azman. He says diabetes is the main cause of kidney failure and for such cases, contributors can apply for invalidity. Alarming number of kidney failures SOCSO says the risk of kidney failure is high because obesity statistics are about 72%, high cholesterol is about 61%, high blood pressure is about 41%, and diabetes is 9%. This is based on health screening carried out by SOCSO. “It’s alarming that the number of cases has doubled over the last five years. The number of kidney disease cases in Malaysia is increasing compared to developed countries. Over the years, SOCSO has provided more than 500 haemodialysis machines to NGO dialysis centres and government health facilities to ensure accessibility to eligible patients and when we do this, we make sure the press covers the event so that the public and stakeholders are aware of it,” says Dr Azman. “The public should know what is happening to the money they have contributed to SOCSO. The awareness is not just about providing services to the patients or the public; it is more about how we prevent them from getting these diseases.” Dr Azman says SOCSO started the awareness programme in January 2013 through the health screening programme. Twenty percent of contributors who are

Risk of kidney failure obesity is about

72% high cholesterol is about

61%

high blood pressure is about

41%

Training for jobless patients Dr Azman says some patients

SELF LOVE: When you start loving yourself, that’s when the body system won’t cheat you, says Siby When someone is at the terminal stage of any disease, there is very little Ayurveda can do to reverse the situation. The best that it can do is to help manage the condition and improve the quality of the patient’s life. In most cases, patients are encouraged to stay at Ayur Centre

for two weeks to allow Siby and his team of therapists to monitor their diet. “We will be very strict and they will be allowed to eat only certain vegetarian food,” says Siby. The patient will also be administered suitable herbal medication which he says are sometimes manufactured locally. “However,

eligible for the SOCSO health screening programme had undergone the screening. Previously, the dialysis facilities were only for those on the pension scheme. Recognising the growing need, SOCSO has relaxed the conditions to include contributors who are still working and have made at least 12 contributions. SOCSO extends its facilities to contributors who require such services even though they are not certified invalid by the medical board. Besides the high cost, haemodialysis treatment also takes up a lot of the patients’ time. Hence, SOCSO also provides peritoneal dialysis which is more convenient as it allows the patients to carry out their normal daily routine.

some medicines are produced by us in India and imported to Malaysia.” The patient may also be required to undergo external oil massages. In all, Siby’s message is clear: “In Ayurveda, we call upon one’s own body’s energy to combat any disease. It won’t be easy to do this if the body is unhealthy. It is difficult to maintain a healthy body, and you won’t get a healthy body when you are exposed to all kinds of environmental poisons including water, the air we breathe and the place we live in

had lost their jobs because their employers don’t accept workers with health problems. “In such cases, SOCSO provides training and get them other jobs or even encourage them to be entrepreneurs. Regarding the peritoneal dialysis, SOCSO provides the patients with its equipments and accessories such as the catheter in the stomach and the solution that costs around RM2, 000 per month,” he adds. “We don’t want dialysis patients to just sit at home. SOCSO believes dialysis patients can also be very productive.” Azman advises contributors to make use of SOCSO’s health screening as prevention should be everybody’s ultimate goal. “There is no cure for kidney disease, unless if you go for kidney transplant, but that requires you to be under medication for life,” he says.

which is a challenge to our body system.” His advice, therefore, is to start loving your body. “When you start loving yourself, that’s when the body system won’t cheat you. Pretend as though your body is a car and you’re the driver. To make sure your car runs well, you have to maintain it well. Similarly, if you maintain your body well, it will function well too. Don’t take your system for granted as prevention is always the better than cure.”

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Staying positive and accepting life Dialysis patient Ramzy can’t do many things he did before, but has learned to live with his condition

By Norman Hussaini

he number of kidney patients is increasing every year, resulting in many of them in need of dialysis treatment. According to the Health Ministry, the number of kidney patients in need of dialysis treatment increased from 13,332 in 2005 to 34,767 in 2014. To support patients requiring dialysis treatments, the ministry provides comfortable dialysis centres in major hospitals nationwide as well as subsidising medicine and treatment costs. In addition, organisations like the Social Security Organisation (SOCSO) also provide support for workers in need of dialysis treatments. The support given by the ministry and SOCSO, among others, has impacted many Malaysians who otherwise might not be

able to receive ample treatment for their conditions. One of them is Ramzy Hashim who is undergoing dialysis treatment at Hospital Sungai Buloh as part of the SOCSO’s health scheme. His is a story of hardship, determination and acceptance. It’s a powerful testimony of how SOCSO’s support has brought light into the life of a man coping with kidney failure. Ramzy was a hardworking member of the society, living his days on the factory floor with vigour. After years of service, he was given the opportunity to work in Langkawi and was all set to take on the job. However, his luck turned when he was diagnosed with kidney failure during his stay in Langkawi following his job offer. “I was diagnosed with kidney failure in 2012. The condition wasn’t at a critical point yet, so I was going back and forth to the hospital every month for the doctor to keep track on my condition,” he tells Health+. Due to his condition, he was no longer

Dialysis patients increased from

13,332 in 2005 to

34,767 in 2014

qualified for the job and had to opt for early retirement. He never struggled while going in and out of the hospital and living off his retirement from SOCSO, and neither was he happy. “I was living with the condition for three years before it came to a point where I needed to undergo dialysis.” His kidney functions had deteriorated over 15% and his doctor told him to go for dialysis treatment. Challenging life Ramzy is pleasant and soft spoken, and talking to him reflects how strong he is in dealing with his condition. He earnestly laments his first experience undergoing dialysis treatment. “The first time was the hardest. I was uncomfortable with the needle and the pain was daunting. The amount of time I had to stay for the treatment also made me very uncomfortable.” Ramzy is on four-hour dialysis treatment three times a week. He started his treatment in July last year and is now more comfortable and used to the process. “Thinking positively of the treatment has helped me get used to it over time,” he says. The down side of living with kidney failure, says Ramzy, is that he gets tired and exhausted rather quickly. “I was very active before this. I used to climb hills and go jungle trekking all the time as it was my hobby. But now I am unable to do any of these as I would be at the risk of collapsing.” A great sacrifice to make, Ramzy now finds himself unable to even drive a car for an extended period of time as he would get exhausted. “I can drive but I have limits on how long I can drive. I can’t go too fast either because it would require me to be more

Looking back, I’ve never felt regret having this condition. Sure I may no longer be able to climb hills, jungle trek or eat whatever I want, but I believe there is a reason for me to be what (my condition) I am now. I’ve learned to live with it and to think positively.” – Ramzy

focused which makes me tired quicker.” Helping hand Hospital Sungai Buloh is one of the pioneering hospitals to set up a dialysis centre to provide treatments to patients. Health+ also spoke to the hospital’s medical assistant Ahmad Nizam Mat Yunos during the interview with Ramzy. Ahmad Nizam was the pioneering staff of the dialysis unit and has been serving there for 10 years. “My primary role is to manage patients’ admissions to the centre. I also oversee the staff and nurses to ensure (everything is) smooth sailing,” he explains. Nizam keeps a tight ship managing the centre, and is responsible for the comfort of Ramzy and other patients throughout their treatment. Ramzy is fortunate to get SOCSO’s help and the treatment at Hospital Sungai Buloh. “Because of my background as a factory worker, it was never a hassle to get the help from SOCSO to cover the expenses for my treatment. The process to apply for insurance from them was simple once I had all the necessary documents.” Positive acceptance Ramzy says it has been tough adjusting to the changes, abstaining from enjoying his hobbies and going for dialysis treatment three times a week for the rest of his life. However, he has accepted his fate and found that it is all in the hands of God. “Looking back, I’ve never felt regret having this condition. Sure I may no longer be able to climb hills, jungle trek or eat whatever I want, but I believe there is a reason for me to be what (my condition) I am now. I’ve learned to live with it and to think positively.”

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Filtering out the negatives through dialysis

IN GOOD HANDS: Nizam keeps the dialysis unit running smoothly.

KPJ Selangor treats hepatitis C patients KPJ Selangor is one of few hospitals equipped to treat hepatitis C patients. Hepatitis C is transmitted when the blood of an infected person contaminates the blood of someone who is not. One of the known ways of spreading hepatitis C is sharing needles or other drug injection equipment to administer drug which process is similar to the treatment of dialysis. KPJ Selangor senior state nurse Natalia Thamil Selvi Perumal (pic) says most government centres are not equipped to treat patients with hepatitis C condition due to the travelling nature of the sickness. “Patients with hepatitis C require different care. While treating them,

the centre has to take extra precautions to contain the condition,” she tells Health+. KPJ Selangor’s dialysis centre is equipped with a cubicle for those with hepatitis C. The law requires patients with such conditions to be isolated from other patients to restrain the virus. “The room has to be well taken care of. We pay attention to the smallest details down to the piping system,” she adds.

After about a month of feeling sad, I accepted my fate. I’m sure God has a plan for me and I was ready to live again” – Zainy

By Syed Zaid Syed Osman

arly every morning, Zainy @ Ahmad Zainy Che Agus wakes up to perform morning prayers, then heads down for a nice breakfast with his family before going about his daily routine. The Kelantan-born father of five spends most of his mornings at home before leaving his house on his old Kembara en route to Jalan Pahang in the heart of Kuala Lumpur. For the past seven years, he has been on dialysis at KPJ Tawakkal Specialist Hospital. He was 28 when the first complication showed up. He noticed that his urine output had decreased every now and then; he sensed his breath was getting shorter and he felt drowsy most of the time. Back then, Zainy considered himself fit. He was active in sports, focusing on his football games before he was admitted to hospital for the first time. The doctor told him the creatinine level in his blood was slightly higher than the amount in his urine, indicating his kidneys weren’t working properly. As time passed, his condition got from bad to worse, and finally, he was required to undergo long-term dialysis. “The dialysis centre is basically my second home now” he tells Health+. He commutes from his house in Putrajaya to the hospital every Monday, Wednesday and Friday at 1.35pm for his appointment.

CHEERFUL: Zainy is still able to keep his smile despite what he is going through.

Zainy took his time adjusting to the treatment. “I remember the time when I felt death was so near to me,” he recalls. “My breath was out of rhythm and in shorter pace while I felt my strength leaving my body.” He was rushed to the hospital and was given anti-depressants by the attending doctor. He was later told that his symptoms came from the stress that originated from the changes around him. “After about a month of feeling sad, I accepted my fate. I’m sure God has a plan for me and I was ready to live again,” he vocalises in a positive tone. Now he treats his four-hour dialysis as one of his daily tasks. “Get it done and move on to the next thing in my to-do list for the day,” he says with a smile. Like other dialysis patients, Zainy has to adjust to major changes. He says the changes were initially difficult but slowly he has managed to change his lifestyle and diet. “Humans are creatures of adaptation. That is for certain.” Zainy has completely stopped playing any sort of sports because of the treatment. Despite the hardship, he shares the joy from the support of his family and close friends. Filled with positive energies around him, he says his wife has remained strong and persevering throughout his illness. “I still do wish that this illness can be cured someday,” Zainy says with much hope. Despite being chair-bound for the next few hours, he is filled with optimism. His parting words were very encouraging: “Whatever predicament you are in, be patience. That is always the key”.

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Taking HIV by the horns Andrew Tan, living with HIV for 22 years, finds peace helping others with similar condition

By Norman Hussaini

ndrew Tan grew up in a normal neighbourhood, went to a normal school, had normal friends and lived with his normal, loving family. Yet his life was never actually normal. Andrew’s story on discovering his condition and living with it is far from boring. He now serves as an Exco member of the Malaysian AIDS Council (MAC) and is part of the Kuala Lumpur AIDS Support Services Society (KLASS), a society providing peer support to HIV patients. Andrew fell terribly ill one day in 1994 when he was just 34, and decided to go to the doctor after a nudge from his mother. After some tests, the doctor told him he had a viral infection, though it was not known specifically what type. He was reluctant to leave the hospital without knowing everything. “Of all the tests the doctor had done, some were left out and the HIV test was one of them,” he says. He didn’t know much about HIV as public awareness was limited then. Sure enough, after the tests, he was declared HIV positive. The sad part was that he was sent home after the diagnosis. “The doctor told me that I could go home after I was told I had HIV. Back then, medication for HIV was still uncommon in Malaysia. Even the ones available were very expensive and were not subsidised by the government.”

The doctor’s response to his condition solidified his feeling of finality to his life. “It was like there was nothing I could do but to wait for death. It all happened on my birthday – no less, great birthday present,” he jokingly says. AGAINST ALL ODDS “I felt that I had transformed from someone who felt indestructible to someone who was to face death anytime.” He found the experience harrowing. “I must admit that I had thought about suicide at one point in time, yet I never had the courage to commit such an act.” He lived a full year without going to the doctor and became ill day by day. His condition transgressed to a level where he actually had AIDS. “After a year of living with the sickness, I finally found the courage to seek help. I confided with a trusted friend who volunteered with PT Foundation and was referred to a doctor at the University of Malaya Medical Centre (UMMC) to consult with.” He started his medication and sought support from the foundation through its support groups. Even then though, he found new challenges. “Back then there was only one type of medicine to control HIV in Malaysia called zidovudine. It was very expensive and I had to spend most of my salary just for the drug.” Being a person with a different sexual orientation and living with HIV caused serious self-stigma and self-discrimination. “I had known from a young age that I was different, and that I was gravitating more towards men than women.” Homosexuality was such an alien idea then and that made it more challenging for him as a young lad.

I think my spirit of never giving up was from my father. He was always a high-spirited person and had enjoyed helping other people.” – Andrew

RESILIENT: Living with HIV is no small feat for Andrew, but he prevailed while helping others in the process.

SERVING THE HIV COMMUNITY Andrew was very fortunate. Even when his health had fallen to a critical level, he had the courage and tenacity to keep surviving and living his life. “I think my spirit of never giving up was from my father. He was always a high-spirited person and had enjoyed helping other people. I also set my personal goals, shifting the goal posts a bit every time I made some progress. My partner encouraged me every step of the way,” he says. As a member of KLASS, he loves helping and supporting people who are going through what he had gone through. His previous doctor was the one who wanted him to join KLASS. “My doctor said my condition had transcended so well that I can be an example for other people

who are diagnosed with HIV,” he says. Andrew found KLASS to be a safe place. He joined its support groups and has since started helping to support others. “My duties usually involve me going to hospitals and visiting people who had recently been diagnosed with HIV. I will go in after visiting hours right before their bedtime as I find it to be the perfect moment.” He feels very lucky to have the opportunity to touch other people’s lives and empower them to face any personal challenges they have. “I think the general perspective towards HIV is still in need of changing. And I feel that a very good way of doing that is to present the success stories of people living with HIV to a wider audience.” With KLASS and its dedicated members, it will certainly go far.

KLASS lends a helping hand The Kuala Lumpur AIDS Support Services Society (KLASS) was set up in 2001 to focus on filling the gaps in HIV support services in the country. It is committed to complement the available services already set up by the Health Ministry and various other organisations. Its main target is the Chinese and Indian-speaking communities, where

the level of comprehension and support is still poor. As part of its services, KLASS, which is located next to the Malaysian AIDS Council office, provides counselling to people with HIV by giving them ample information on HIV prevention, treatment and management. It also provides comfortable meeting place for them to share and meet by way of support

groups. KLASS members are also active volunteers carrying out HIV and AIDS related projects, especially those which disseminate information. As an organisation dedicated to complement the already established support for HIV, it also works regularly with other NGOs to carry out projects for the community.

KLASS is conducting a pilot project funded by the Global Fund to engage the key affected population of the MSM community (men who have sex with men) via social apps. The project aims to encourage greater acceptance for MSM to “Know Your Status” with free anonymous test in an effort to reduce the fear of testing for HIV within the community.

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CREATIVE COMMONS

GENETICALLY SPEAKING: To reduce risk of heart attack, the benefits of a healthy lifestyle are clear, but genetics can still stack the deck.

Genetic errors may prevent heart attacks Findings of new study may guide design of new drugs, similar to how statins lower ‘bad’ cholesterol

o reduce risk of heart attack, the benefits of a healthy lifestyle are clear. But genetics can still stack the deck. Some people’s genes bestow a natural advantage – or disadvantage – in protecting against heart disease, the leading cause of death worldwide. Now, a new study led by Washington University School of Medicine in St. Louis that included genetic data from more than 190,000 people has identified two genes that, when altered in specific ways, either promote or undermine cardiovascular health. In a press release announcing the findings, the university says this may reduce risk of heart attacks and serve as a basis for developing new drugs designed to prevent heart disease. The findings may help guide efforts to design new preventive drugs, similar to the way statins are prescribed to lower “bad” cholesterol to reduce the risk of heart disease. The research, from Washington University School of Medicine in St. Louis, the Broad Institute at Massachusetts Institute of Technology and Harvard, and

numerous other institutions, was published online in The New England Journal of Medicine. “ We identified genetic variation in several genes that associated with protection from coronary heart disease,” says first author Nathan O Stitziel, a Washington University cardiologist and assistant professor of medicine and genetics. “Our findings support the idea that therapies focused on a major pathway regulating triglycerides should help prevent the build-up of plaque in the heart’s coronary arteries and protect against heart attacks.” DNA data To identify genes that might be relevant for drug discovery, the investigators plumbed DNA data from patients with coronary disease and from healthy controls. They searched across more than 220,000 genetic variants that altered proteins to identify those that appeared to influence heart disease risk. Errors in proteins can have major physiologic consequences. As part of the study, the researchers confirmed past work identifying genes already shown to confer an advantage

35%

reduction in triglyceride levels in the blood of people with a disabled copy of ANGPTL4 compared with people with two working copies of the gene.

or a vulnerability in protecting against heart disease risk, and they implicated two new ones — ANGPTL4 and SVEP1. Rare errors in ANGPTL4 were associated with reduced risk of coronary artery disease. The reduction varied from 14% for a small error in the gene to cutting risk by about 50% when an entire copy of the gene was disabled. The other gene, SVEP1, showed the opposite correlation – a rare error increased risk of coronary artery disease by about 14%. Mystery While ANGPTL4 has been the subject of much study, the other gene newly implicated in cardiovascular health is a bit of a mystery. In the new study, Stitziel and his colleagues showed that the error in SVEP1also was linked to higher blood pressure in their study populations, but beyond that there are few clues to what it’s doing. In contrast, ANGPTL4 has long been known to play a role in processing triglycerides, a type of fat that circulates in the bloodstream. Doctors measure levels of triglycerides as a marker of heart disease risk, though whether these fats play a role in causing plaque to build up in arteries historically has been a matter of debate. ANGPTL4’s role in processing triglycerides is part of a system called the

lipoprotein lipase (LPL) pathway. Blocking ANGPTL4 actually opens up this pathway, allowing the body to process triglycerides from the diet and get them out of the bloodstream. “The gene’s association with lower triglycerides has been known for a while,” says Stitziel, who also sees patients at Barnes-Jewish Hospital. “But for a long time it was not clear that high triglycerides were a cause of coronary disease rather than a marker of it. Now we know that errors in ANGPTL4 associate with both reduced triglycerides and lower risk of coronary disease. This is another piece of the puzzle that points to a causal role for triglycerides in coronary disease.” “If that’s correct, strategies to lower triglycerides should help,” he adds. “Our study indicates that those strategies could include blocking ANGPTL4 or manipulating other elements of the LPL pathway.” Lower triglyceride levels In people with a disabled copy of ANGPTL4, triglyceride levels in the blood are reduced by about 35% compared with people who have two working copies of the gene. Stitziel also pointed out that variations in the gene were not associated with changes in levels of “bad” LDL cholesterol. So any drug that impacts this pathway would, in theory, work independently of statins as well as PCSK9 inhibitors, a new and potent cholesterol-lowering therapy that was approved in 2015 by the Food and Drug Administration. Stitziel notes that these recently approved therapeutics that inhibit PCSK9 were developed after similar genetic studies showed an association with LDL cholesterol levels. “The poster child for human genetic studies leading to new therapies is PCSK9,” Stitziel says. “Rare errors in PCSK9 were first found to cause high LDL cholesterol and different errors were later associated with low LDL cholesterol and protection from coronary disease. And within 12 years of those findings there are now new therapies. The key insight from human genetic studies is the ability to identify biological pathways that are relevant to human disease.” With future therapeutics in mind, Stitziel points out that early versions of inhibitors targeting ANGPTL4 and other members of the LPL pathway are in development. While none of these are clinically approved therapies, the new study linking these genes to reduced coronary disease and lower triglycerides suggests the line of investigation is worth pursuing, he adds. As for the mystery gene implicated in the new study, Stitziel says he and researchers in his lab are working to unravel the role of SVEP1 in coronary disease risk.

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March | 2016