Health+ Newspaper May 2016 Issue 05 by Health+ Newspaper

junior

‘Butterfly Children’ need tender care ... page 28

Debra Malaysia set to help children and families dealing with Epidermolysis Bullosa

www.healthplus.com.my

MAY 2016

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

The Pulse of the Nation

Beating infertility

Many think babies are sure products of sexual union. Sadly that’s not the case for everyone. But then, infertility is not the end of the world. A number of proven treatments are available to help those in dire need

Local news+

No cure for allergies ... page 11 Recent study found that many still believe there is a cure for allergies

Tattoo culture flying high

Xtra

... pages 02- 12 general + Quality equipment and ink is a priority to ensure good health

... page 42

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FOREIGNNEWS+

MaY | 2016

Editor’s Note

Hope for couples with infertility problems

ANY think babies are sure products of sexual unions, but sadly that’s not the case for everyone. The truth is one out of ten couples faces infertility problems, and most of those facing infertility problems are not even aware about the issue themselves. According to the Malaysian Population and Family Survey conducted by the National Population and Family Development Board, the infertility rate increased from 6.9% in 2004 to 8.6% in 2014, while total fertility rate declined from 6.7% in 1957 to 2.1% in 2012. Getting pregnant nowadays is a challenge for some women. Our lifestyle is rapidly evolving both in positive and negative ways. The negatives, which include smoking, excess alcohol consumption and promiscuity, can affect your ability to bear a child and it’s not gender bias. It affects both men and women. Many years ago, the blame was almost always on women. Only a handful of men, if not at all, contributed to the infertility chart while their fingers were pointing to the women. However, recent data show men are contributing in about just the same amount. Infertility does not discriminate between races. The odds of a Chinese couple being infertile are basically the same as the odds of the Malays and the Indians. Furthermore, the issue is often found in couples in urban areas. When the couples are back from work and are tired, their sex drive decreases.

From that, the couples tend to delay their plans to conceive until they think they are ready, but then, time is not your friend. Studies have shown that total fertility rate among women decreases in locations where the people are career-driven. Age is one of the outside factors that can affect the total fertility rate. As people get older, the grade of their produce decreases. The sperm count and quality in men decreases with the ovary’s quality. After a man reaches a certain age, his hormones change and cause the production to reduce the sperm count when he ejaculates. Simply put, as a person gets older, the sperm count and quality steadily drop. Hence, couples who are planning to have children must accelerate their plans before the women turn into their 30s. This increases the chance to conceive for the eggs’ quality is at its peak. Infertility is not the end of the world. Treatments are available to those who seek. One preferred treatment is in vitro fertilisation, a fertilisation process which manually combines an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. There are other options too, depending on the gravity of each situation, such as hormonal medications or injections, and intrauterine insemination. Health+ believes that clean air is our right. We all need clean air to live healthy and enriching lives. All too often, this fundamental right seems too obvious in our

Infertility does not discriminate between races. The odds of a Chinese couple being infertile are basically the same as the odds of the Malays and the Indians.

increasingly urbanised world. Since we spend so much time indoors, the question of clean air is even more important whether that be in our homes, offices, schools, health centres and wherever we go. And many of us take clean air – or the lack of it – for granted. However, in recent years, with the almost seasonal haze blanketing us and disrupting our lives, clear air is certainly a commodity we have obviously learned to treasure. It is a common misconception among cigarette smokers that they are hurting only themselves. The truth is they are not hurting only themselves, but also the earth, and everybody and everything on it, in our generation, and the generations to come. Studies show that cigarettes contain over 4,000 chemicals which are exhaled and released into the air. Research shows air pollution emitted by cigarettes is 10 times greater than diesel car exhaust. In view of the deadly effects of smoking and second-hand smoke, we need to work together to restore our fundamental right to clean air. Besides delving on fertility issues and how we can create health-promoting environments to combat diabetes, we have also lined up for you some interesting reads such as how tummy sculpting can help sculpt your body to look fitter and increase your confidence, and how to instil good discipline in our children. In addition, we also keep you up with what’s happening on the local health scene. We invite you

junior

‘Butterfly Children’ need tender care ... page 28

Debra Malaysia set to help children and families dealing with Epidermolysis Bullosa

www.healthplus.com.my

MAY 2016

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

The Pulse of The NaTioN

Beating infertility

LocaL news+

No cure for allergies ... page 11 Recent study found that many still believe there is a cure for allergies

Xtra

... pages 02- 12 generaL +

Tattoo culture flying high

Quality equipment and ink is a priority to ensure good health

... page 42

Most infertile couples are not aware of their conditions, but there’s still hope

Beating infertility... pages 02-03

www.healthplus.com.my

THE PULSE OF THE NATION

MAY | 2016

Clean air, our right Tobacco use is the leading preventable cause of death globally. Besides harms smoking causes to smokers, exposure to second-hand smoke is a major health hazard. Clean air is our fundamental right. Health+ supports the Blue Ribbon Campaign to inform smokers and non-smokers about the potentially-deadly effects of tobacco smoke. See pages 14-16

More fertility options for couples

Dr Helena Lim discusses alternatives to in vitro fertilisation and their selection factors

... pages 04-05

Bringing hope to the infertile

National Population and Family Development Board offers wide range of services to couples with fertility issues

... page 09

to flip the pages to find out what we’ve in store for you. Happy reading and remember to always make healthy choices! Huang Ruifu Editor

Published by: Hash Plus Communication Sdn Bhd (1110279-M)

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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.

MAY | 2016

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maY | 2016

Keep your heart pumping National Heart Institute, Novartis Corporation launch heart failure awareness campaign

By ALI-AZMIN HASSAN

UALA LUMPUR: Keep your heart pumping – that’s a powerful and needful message to everybody from the National Heart Institute (IJN) and Novartis Corporation (Malaysia) Sdn Bhd when they launched a heart failure awareness campaign. The campaign themed “Keep It Pumping” is to create mass awareness on heart failure. Novartis also introduced Entresto, a first-in-class medicine that reduces the strain on failing hearts. The campaign’s core objective

is to inspire people to understand and share the importance of education; to be educated about heart failure, from symptoms and prevalence, to consequences and what can be done to detect the disease early. “Understanding the challenges faced by heart failure patients, we’ve developed a heart failure patient care pathway programme at IJN. The programme is led by a group of cardiologists and dedicated nurses that cross-collaborates with other departments to help patients by reducing the length of stay at hospitals, unplanned readmission and improve quality of life,” said Datuk Dr David Chew Soon Ping, senior consultant cardiologist of National Heart Institute of Malaysia.

From left: Dr Chew, Gruber, Dr Aizai and IJN consultant cardiologist Datuk Dr Azmee Mohd Ghazi.

Despite the growing prevalence of heart failure in Malaysia, fewer than one in 10 people can identify common symptoms of heart failure, such as severe breathlessness, swollen ankles, rapid weight gain and difficulty in moving. Entresto is proven to reduce the risk of cardiovascular death by 20% and heart failure hospitalisation by 21% in an extensive study against enalapril, a standard of care to treat heart failure. “The trial’s encouraging results of survival advantage for Entresto give cardiologists an option to provide better quality care to their heart failure patients. Entresto is expected to change the management of heart failure in years to come,” said Datuk Dr Aizai Azan Abd Rahim, IJN head of cardiology department and senior consultant cardiologist.

Susanne Gruber, franchise head of cardiometabolic and respiratory of Novartis Malaysia, said: “Heart failure has a major impact on patients’ lives as they are not equipped with the knowledge on the disease and proper management of the condition. Many people do not know that heart failure is more deadly than some types of cancer and Malaysia has a high prevalence of cardiovascular disease that can lead to heart failure. “Moreover, half of the hospitalised heart failure patients may die within five years. Through our collaboration with IJN, we hope to increase the understanding on the disease management, provide guidance and support patients to have a better quality of life and reduce the number of costly hospitalisations.”

deaths in diabetic patients are caused by cardiovascular disease. Hence, there is a need to address the potential risk in diabetics when it comes to diabetes-related complications.” The medicine is proven to have additional benefits such as helping patients to achieve a glycated hemoglobin (A1C) of less than 7% and reduce fasting blood sugar levels by an average of 19 or 25 points. Although Jardiance wasn’t created to help patient lose weight or lower blood pressure, studies have shown it helps patients in both. According to Boehringer Ingelheim Malaysia general manager Mark Lewis, real customer value can only be created by constantly developing new and better solutions. “With the launch of Jardiance

in Malaysia, we believe this medication would help many patients control their diabetes and thus lower the risk of developing other diabetes-related complications such as cardiovascular diseases,” he said. Diabetes affects more than 382 million people worldwide. It has contributed to over five million deaths per year and is a leading cause of death in most developed countries. In Malaysia, diabetes prevalence was 17.6% in 2014, which means at least one in six persons had diabetes. About 3.2 million were diabetic patients and another 1.7 million lived with undiagnosed diabetes. Malaysians are more inclined to develop diabetesrelated complications, such as cardiovascular disease, blindness and kidney failure.

New medicine for diabetics KUALA LUMPUR: Here’s some good news for the diabetic community! Boehringer Ingelheim recently launched Jardiance (empagliflozin), a prescription medicine used along with diet and exercise to lower blood sugar in adults with type 2 diabetes. Jardiance, approved by the European Commission in 2014, is an oral, once daily, highly selective sodium glucose co-transporter 2 (SGLT2) inhibitor. It targets glucose directly and works independently of β-cell function and the insulin pathway. It reduces reabsorption of glucose into the blood stream, allowing excess glucose to pass through urine, leading to urinary glucose excretion. It has shown to be an effective way of lowering blood glucose in the body with positive effect on body weight and blood pressure. The medication is however, not suitable for patients with type 1 diabetes. “Studies on Jardiance have

shown encouraging outcomes. We hope the medicine will be able to help diabetics have better control of the disease,” said Prof Dr Chan Siew Pheng, consultant endocrinologist and council member of the Malaysian Endocrine and Metabolic Society (MEMS). Together with diet and exercise, Jardiance can be taken alone when metformin is considered inappropriate due to intolerance, or with other medicines that lower blood glucose. However, it has some common side effects, such as urinary tract infection, increased urination and itching. Hypoglycemia is the most frequent side effect when used with sulphonylureas or insulin. Dr Zanariah Hussein, consultant endocrinologist and MEMS council member, said recent trial outcomes have shown positive effects of Jardiance. “Diabetes is a debilitating disease that affects 3.3 million Malaysians and about 75% of

GOOD NEWS: Dr Nor Azmi Kamaruddin (left), Dr Chan, Dr Zanariah and Lewis launching Jardiance (empagliflozin).

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2016 | maY

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Autistic community needs more tolerance Early Autism Project wants to create philosophy of inclusion and acceptance for those with condition

UA L A L U M P U R : Society needs to be more open to understand what it is like for children with autism and also for them to transition into adulthood with the condition. Early Autism Project (EAP) Malaysia programme director Jochebed Isaacs said adults with autism face discrimination due to lack of understanding about the condition. “The tolerance that is extended to children with autism is often lacking and we hope that we can begin to create a philosophy of inclusion and acceptance. “Intensive behavioural treatment is still critical in ensuring the best future for your child. We also want to begin advocating and creating a society that includes and accepts people with autism,” she said at the World Autism Awareness Day 2016 at the UCSI University Cheras campus recently. Jochebed Isaacs said the event is to celebrate the achievements of individuals with autism and give hope to families affected by autism. Some 100 people came to support and participate in the activities. World Autism Awareness Day is celebrated globally to increase community awareness about individuals, especially children with autism. The day often features educational events for teachers,

healthcare workers and parents, as well as exhibitions showcasing work created by children with autism. This year’s themes were the hashtags #lovesomeonewithautism and #welcometohope aimed at celebrating hope for families affected by autism and advocating acceptance for individuals with autism. To officially launch the event, a little boy with autism together with event participants released blue balloons in the air to symbolise hope for autism. Blue is recognised internationally as a colour synonymous with autism. Among the activities held was a dialogue with parents of children with autism, hosted by Miss Malaysia Universe 2011 Deborah Henry assisted by an 11-year-old autistic boy. Parents shared their stories on how they coped with their children’s autism diagnosis and how the progress made by their children gave them hope. The event was made more memorable as UCSI Cheras sponsored a wall at its campus to host Malaysia’s first ever Paint for Autism project. The idea behind the activity is to convey the message that it takes many to work together to understand a child with autism. Thirty-five pieces of canvas were painted by event participants and pieced together like a jigsaw to reveal an artwork with the words

NOBLE CAUSE: Deborah lending her support for the Paint for Autism Project.

SOLE VOICE: The Early Autism Project Malaysia team and visitors at the unveiling of the art project.

“The vastness of this universe can’t stop a child from shining ever so brightly like a star”. More than 80 UCSI students, mainly from the university’s Psychology Department, facilitated the day’s event. The department also presented different forms of expressive arts therapy as a form of stress management. Participants at the community event were also treated to a variety of activities which included arts and crafts for children and games. There was also a screening booth for parents to bring their children for an initial assessment for autism risk factors. Local Malaysian artistes Kent Sim, David Soh and Samuel Lopez

entertained visitors with busking performances throughout the event. Autism affects 1% of the world’s population and, according to the US Centre for Disease Control and Prevention, one in 68 children is born with autism. EAP, which celebrates its 10th year anniversary this year, focuses its initiatives on producing social media awareness videos as well as education with schools and universities to begin inculcating a sense of tolerance and acceptance into the community. It also reaches out to the greater community through providing support via information booths in Gleneagles KL and Pantai Hospital KL in March.

by DATUK DR MOHD NOOR AWANG

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maY | 2016

Help is here for sleep disorder sufferers Talk therapy and low doses of anti-psychotic medication more effective than routine treatment

ETALING JAYA: Good news for those living with sleep disorders! The ASEAN Sleep

Research Competence Centre (ASRCC), located within the premises of University Malaya Hospital, was opened recently. The state-of-the-art sleep

centre, a partnership between Philips Malaysia and University of Malaya Specialist Centre (UMSC), is the first in the ASEAN region dedicated

UNAWARE: Dr Sunila says 80% of sufferers do not know they have disorder.

to addressing sleep disorders. A media briefing was held recently in conjunction with World Sleep Day 2016 at the new sleep centre. Through training, clinical research and a corporate service centre, the ASRCC drives early diagnosis and awareness of sleep disorders. Its multi-disciplinary team of experts evaluates the full range of sleep problems, determining whether they arise from an underlying medical problem such as obstructive sleep apnoea or restless leg syndrome, other underlying medical and psychiatric conditions, or from poor sleep habits, stress or anxiety. “Improving the quality of sleep is one of the ways that Philips is using our innovations to improve people’s lives. Beyond raising awareness on the importance of good sleep, we are innovating sleep solutions that work together to promote better health – with clinical devices designed to help people with sleep disorders. Philips delivers intuitive, simple-to-use solutions to help people with chronic conditions live better – in the comfort of their own homes,” said Philips Malaysia country manager Muhammad Ali Jaleel. Dr Sunila Rolani Sirisinghe, UMSC clinical sleep educator, said Malaysians, like people in many developing countries, experience poor sleep or lack of sleep due to universal causes such as stress, distractions caused by technology and the broadcast media, as well as undiagnosed medical conditions. “For example, approximately 24% of Malaysian males and 9% females suffer from OSA (obstructive sleep apnoea), yet 80% of these sufferers do not know that they have it. This problem is a global one. More than 100 million people globally suffer from OSA, but an estimated 80% of people with OSA remain undiagnosed. Many do not seek medical attention because they do not know that their disrupted sleep isn’t normal.”

New Philips website to promote good night’s rest TO HELP people sleep better and enjoy better quality of life, Philips launched SendMeToSleep.com in conjunction with World Sleep Day 2016. This online resource helps those who struggle with sleep get a better night’s rest. The website features a variety of visual content, including videos and images to help restless sleepers, as well as resources for chronically sleep deprived individuals who may have an underlying sleep issue. “Sleep impacts everything we do, and it’s no secret that we’re not getting the recommended eight hours (of sleep),” said Philips chief medical liaison Dr Teofilo LeeChiong. “While it’s one thing to recognise lack of sleep as an issue, it’s another to take active steps to get a better night’s sleep. With this website, we hope to engage the average person in thinking about how sleep contributes to their overall health and well-being.” Research has shown that belief in the need for quality sleep does not correspond to achieving good sleep. According to a 2015 Philips Respironics survey, 96% of respondents said sleep was valuable to them and 87% ranked sleep as an influence on their overall health and well-being, yet only 17% consistently slept through the night.

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GOOD CAUSE: The MAF Marathon des Sables 2016 Challenge has so far raised RM120,000.

All geared for Sahara challenge Jeff Lau ready for Marathon des Sables 2016 in aid of Malaysian AIDS Foundation

UA L A L U M P U R : Red Ribbon Youth Icon Jeff Lau is all set to step into a familiar but highly unpredictable and harshly brutal territory, the Sahara Desert, for his second

Marathon des Sables Challenge in aid of the Malaysian AIDS Foundation (MAF). From April 8 to 18, he will be running across 251km of arid desert terrain in southern Morocco alongside 1,000 other

top global endurance runners. His goal is not only to complete the race and improve his previous time, but also highlight the HIV crisis affecting women, children and young people in Malaysia, and along the way raise funds to support high-impact HIV intervention programmes designed for them. “I have been training for the marathon since December last year, but more intensively in the past couple of months,” said Jeff. “I ran twice a week over 35km each time carrying an 8kg backpack. As Marathon des Sables is a self-sufficiency multi-stage race, in addition to battling the elements, all runners are required to carry with them food and everything else they need to survive on their back. It is not called the ‘toughest footrace on earth’ for nothing. “While I try not to think too much of the challenges that lie ahead of me, I certainly look forward to making new friends and talking to them about my mission and the plight of underprivileged people living with HIV in Malaysia,” added the 26-year-old runner, the only Malaysian participant in this year’s race. Since its launch in January, the MAF Marathon des Sables 2016

Challenge has raised RM120,000 from corporates and individuals, and is nearing its RM160,000 target. The donors include cosponsors AMP Corporation (M) San Bhd, Cocoaland Holding Bhd and MAA Group Bhd, with RM10,000 each. “We are most sincerely grateful for the generous contributions of our donors and sponsors,” said MAF chairman Professor Dr Adeeba Kamarulzaman. “This year’s edition is of greater significance to us as it will coincide with the start of the Ending AIDS by 2030 global campaign that looks to, among other things, improve access to HIV testing, treatment and care for the most vulnerable and oft-ignored segments of society, including women affected by HIV and their children, by 90%.” Award-winning Malaysian artist CN Liew contributed a specially-commissioned artwork worth at least RM100,000. “We are deeply honoured by CN Liew’s contribution,” said Andrew Tebbutt, chairman of the MAF Marathon des Sables 2016 Challenge project committee. “The artwork will be inspired by Jeff ’s motivation for and experience in his second Sahara mission, which makes it even more meaningful to us.” The MAF Marathon des Sables 2016 Challenge is supported by the Health Ministry, Hilton Kuala Lumpur as the official hospitality partner, and Sanctband Active as the official resistive training partner.

Call for global drug policy reform

NASAL MASK: Eddie Wong, Philips country sales manager demonstrating it’s Dreamwear range. In recent years, Philips has made a significant effort to encourage people to be screened for obstructive sleep apnoea (OSA) and other sleep disorders. The company offers a host of resources to patients on its site www.sleepapnea.com showing a continued dedication to improving the lives of patients suffering from OSA or other serious sleep disorders. Along with its online resource, Philips encourages people with poor sleep habits to take an online risk assessment test to determine their risk level for OSA.

KUALA LUMPUR: A recent report has called for non-violent minor drug offences, including use, possession and petty sale, to be decriminalised. The Johns Hopkins-Lancet Commission on Drug Policy and Health has urged countries to do away with harsh punishments meted out for minor drug offences and consider other more holistic ways to deal with the scourge of drug abuse worldwide. Professor Dr Adeeba Kamarulzaman, HIV & AIDS champion and dean of the Faculty of Medicine, University of Malaya, and experts from the commission launched the report on drug policies and the call for a global drug policy reform in a press event in New York City recently. It was held ahead of the United Nations General Assembly Special Session (UNGASS) on April 19 – the first UNGASS meeting on drugs since 1998. The commission’s study showed that 50 years of drug policies which restricted and criminalised drug use have had serious detrimental effects on health, well-being and human rights of drug users and the wider public. It also found that the biggest

contributing factor to higher rates of infectious diseases among drug users is the excessive use of incarceration and the systematic exclusion of drug users from HIV and hepatitis C prevention services such as needle exchange, and treatment like opioid substitution therapy – whether in the community or in prison. New analysis Indeed, new analysis by the commission found that harsher prison sentences are also associated with higher rates of hepatitis C infection among injecting drug users. This stands in stark contrast with the past 30 years of progress made in reducing sexual transmissions of HIV. “Approximately 11% of people who used illicit drugs worldwide are classified as problematic drug users. But the idea that all drug use is necessarily ‘abuse’ means that immediate and complete abstinence has been seen as the only acceptable approach,” said Dr Adeeba. “In countries and regions where opiate substitution therapy remains unavailable or not provided to scale, HIV and HCV epidemics continue to expand. Furthermore, continued criminalisation

of drug use fuels HIV, HCV (hepatitis C virus) and TB (tuberculosis) transmission within prisons and the community at large. “There is another way. Programmes and policies aimed at reducing harm should be central to future drug policies,” she added. The commission has reviewed the global evidence based on the health impacts of drug policy. The report provides compelling evidence from countries such as Portugal and the Czech Republic that have modified or rejected the prohibitionist approach to drug policies, and as a result, these countries have seen significant public health benefits, cost savings and lower incarceration with no significant increase in problematic drug use.

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maY | 2016

‘Greening’ our hospitals Healthcare sector urged to stop contributing to carbon footprint by building green, resource-efficient facilities

UALA LUMPUR: The healthcare sector contributes significantly to carbon dioxide emissions as well as various waste materials from its operation. Ar Chan Seong Aun, chairman of Green

Building Index Accreditation Panel (GBIAP), says ironically, the trillion-dollar healthcare sector is working hard to save people from diseases attributed to environmental factors, but at the same time is unintentionally contributing to the world’s carbon footprint.

TIME TO GREEN: (from left) Ar Chan, Dr Seow and Ir Chen emphasising the need to create greener hospitals is increasing each year. Below: Participants at the seminar. “A lot of the focus is on greening commercial buildings or residential homes, and recently in malls as well as hotels. However, many are unaware that the healthcare industry is yet another sector that negatively impacts environment sustainability,” he said at a recent Green Hospital Seminar. The seminar was organised by Green Building Index Sdn Bhd (GBI) in partnership with Nippon Paint Malaysia Group. Other speakers were GBIAP co-chairman Ir Chen Thiam Leong and Nippon Paint South East Asia Group chief technology officer Dr Richard Seow. The Green Building Index (GBI) is Malaysia’s green rating tools for buildings and townships, created to promote sustainability in the builtenvironment. GBI is developed specifically to suit the Malaysian tropical climate, environmental and developmental context, cultural and social needs. GBI launched the GBI Hospital Tool last year. It covers six key criteria – energy, efficiency, indoor environmental quality, sustainable site planning and management, materials and resources, water efficiency and innovation. Both, existing hospital buildings and new constructions can be accredited under the tool. As of March this year, 11 hospital projects have been certified and recent certification under the GBI Hospital Tool was the Amanjaya Hospital in Sungai Petani, Kedah. “There’s a key challenge when it comes to greening a building, be it a factory, a mall, a hotel or a hospital, as many operators have the funds and may even have the knowledge, but it is always being prioritised lower than other initiatives. “With the extension of incentives for green technology initiatives to 2020 and amplified educational efforts, I am confident there will be more urgency on the need to protect the surrounding environment as greater awareness on cost savings can be simultaneously achieved,” said Ir Chen when asked about the adoption rate of green buildings in Malaysia. Hospitals are increasingly playing leadership roles in leveraging their positions to advocate policies and practices that promote both human and environmental health. Ultimately a healthier environment will lead to healthier people, as the World Health Organisation attributes a quarter of all human diseases and deaths to environmental-related factors. These factors include indoor and outdoor air pollution, unsafe drinking water, poor sanitation, and climate change, among others. Dr Seow called on hospital operators, business owners and every stakeholder to look beyond the short term to claim ownership in safekeeping and nurturing the lands in which they operate on. “It is our children who will bear the consequences of our neglect to the environment,” he said.

2016 | maY

localNEWS+

Waning sex lives

Independent superwoman

57% of Malaysian men dissatisfied due to fatigue, business or family commitments

UALA LUMPUR: Some 57% of Malaysian men are dissatisfied with their sex lives because they are either too tired or busy with work or family commitments. This was among the findings of a study conducted by Pfizer Malaysia on Malaysian men’s perceptions and attitudes towards sex, their sex lives and their overall confidence. The study revealed that 53% were dissatisfied because their wives or partners were busy while 50% of men found it difficult to find suitable occasions for sex. The pressure of being a “real men” was also a factor. The findings showed 40% of men believed that “real men” are always able to please their wives sexually and it is their duty to do so. The pressure contributes to their ability to actually perform well during sex, leading to a form of erectile dysfunction (ED) affected by their mental state rather than biological issues. Pfizer Malaysia broached the touchy subject of ED at a recent talk show to create awareness on the male sexual condition and highlight the importance of open communication in marriages. The awareness variety show “The Entertainment Show with Papi Zak, Couple ED-ucation” programme is the first of its kind which featured ED awareness, interviews and games as well as a discussion panel in a fun, entertaining talk show format done. Local stand-up comedian Papi Zack, who hosted the show, brought much laughter by approaching the ED subject in a frank yet humorous manner. Prof Dr Zulkifli Md Zainuddin, deputy dean and director of human resources development and senior urologist at Hospital Universiti Kebangsaan Malaysia (HUKM), shared his experience based on his years of consulting men with ED and relationship with their wives or partners, as well as their frustrations due to their inability to verbalise the problem. “The low self-confidence that men feel due to their ED creates a challenge for them to make the decision to see a doctor. I feel partners can play an important role here. By being supportive and encouraging, you can help your partner to garner the courage he needs to seek help and address the

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COMMUNICATION HICCUPS: Dr Zulkifli says many couples have problems communicating with each another on ED issues.

problem,” he said. “After all, we need to be aware that ED is our body’s way of telling us that something is not right. ED is often a precursor to other problems, mainly cardiovascular disease. It is important that men feel that they can approach proper channels of consultation to address their health problems.” Dr Zulkifli highlighted the growing prevalence of counterfeit and unproven medications to treat ED. Stand-up comedian Harith Iskander and his wife Dr Jeanine shared some tips on the importance of maintaining a healthy relationship based on open communication. Using their busy lives as an example, Harith shared how they made their relationship a priority. “The most common source of miscommunication in any relationship is a very simple one: people routinely fail to realise how little they are actually communicating. In other words, we think we have said a lot more than we actually have,” he said. “In this increasingly disconnected world, we often are distracted by our gadgets, appointments and lives that we forgot how simple it is to connect with someone. Have a few conversations and spend time together and with the children. Know that you can rely on each other through all difficult times, especially on health related issues.” Pfizer Malaysia director of medical affairs Dr Vicknesh Wellupillai commented on the growing concern over issues relating to ED and the objective of the event. “ED is often a very difficult topic to approach and it is important for us to be able to address conversations and attitudes surrounding ED through this special event. “It is our goal that through the programme today, we hear from different experts and influencers that can help us share this important message of awareness with Malaysians.”

PETALING JAYA: Set priorities straight to achieve independence while having quality time with family and friends, advises radio presenter and producer Freda Liu. “If a person needs to have changes in his or her life, be determined to find the means to realise them and to wake up using whatever means necessary,” she says at the recent “Guide to Becoming Independent Superwoman” seminar organised aby Zurich Insurance Malaysia Bid (ZIMB). “It is possible for women to balance out their various life aspects such as family or career and being able to set priorities on important aspects to help focus on improvement.” “We can achieve independence but we are also interdependent individuals. Independence and isolation do not carry the same meaning and for me, I would not have done a lot of things (without) the support of my family and friends,” adds Freda, who is also a certified life coach. In addition, she rewarded two lucky guests each with a signed copy her books. Women make up of 52.4% of the workforce in Malaysia, according to a survey last year. Thus, women play a very pivotal role in our community, s a y s Ye e Shiao Fong, ZIMB head o f b ra n d marketing and communications. “(It’s) not just in (the community) we work in but also in the community we do our business in. Therefore, we are doing this to show our appreciation and support to the women in Malaysia.” The session was ended with a quick snack and pink roses were handed out to the guests upon exiting. Traditionally, the pink roses represented symbol of gratitude and appreciation as a symbol of meaning for the talk.

WELCOMING: Yee, representing Zurich Insurance, initiated the event with open arms.

ed not fun: (from left) Harith, Dr Jezamine, Dr Zulkifli and Papi Zak. HAPPY FACES: Freda (fourth from left) and Yee (third from left) with the attendees of her talk.

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The power of positive attitude Two cancer survivors share inspiring journeys at SJMC roundtable discussion

UBANG JAYA: Cancer survivors must maintain a positive attitude about themselves – that’s the message from Regina Tan, one of two cancer survivors of Subang Jaya Medical Centre (SJMC) who shared her inspiring

story at a recent roundtable discussion. The event hosted by SJMC focused on cancer issues and progress made by Malaysians in battling the Big C. Regina, 44, was on the verge of tears while relating

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By ALI-AZMIN HASSAN her journey of battling cancer. She was diagnosed with colorectal cancer in 2009. “It has been a long journey for seven years. I’m happy that I have a good doctor and radiologist to help me. The past seven years have been good. To me, cancer survivors have to be really positive about (themselves),” she said. Shahreen Hazaline, 38, also related her struggle after she was diagnosed with breast cancer in 2014. “At that time, I was pregnant with my fourth baby and was still breastfeeding my third child,” she said. Shahreen discovered a lump on her breast and told her gynaecologist about it when she had her regular check-up. The gynaecologist scanned the lump and confirmed it was cancerous, and Shahreen had no choice but to go through the chemotherapy treatment despite pregnancy. With numerous operations before and after her pregnancy, her child was born healthy. Both Regina and Shahreen are in remission of their cancer and are doing quite well. Their journeys battling the Big C have so far been painstakingly difficult, both emotionally and physically. Datuk Dr Jacob Thomas, chairman of R amsay Sime Darby Health Care EMOTIONAL: Regina was and president of the on the verge of tears while Association of Private relating her journey battling Hospitals in Malaysia, colorectal cancer. said 32,000 known cases of cancer were diagnosed in 2008. “The number of cases increased to 37,400 in 2012, and is expected to go up to 56,932 by 2025 unless we do something. The majority of patients who present themselves today are in a very late stage of their disease. That’s why we felt that a session like this is so important to create awareness and DIFFICULT: Shahreen we need to shout out related her struggle after she more and let everyone was diagnosed with breast around us know what cancer in 2014. can we do and what is the real story,” he said. According to the discussion, cancer is the leading disease worldwide with 12.7 million new cases in 2008. Lung cancer is the most common among men, contributing 16.5% of new cases. In women, breast cancer is the most prevalent with 23% of new cases. Cancer is the leading cause of death with 7.6 million deaths in 2008 globally. In Malaysia, one in four persons will develop some form of cancer by the age of 75. SJMC is one of the first local hospitals to embark on a routine measurement of the performance of its cancer care services. It has always been at the forefront of medical technology and advances over the years and provided high quality patient care. To acquire such an achievement, a research was conducted to measure the percentage of cancer survivors among patients who sought follow-up treatment at the SJMC Cancer and Radiosurgery Centre (CRC) from 2008 to 2012. The centre is renowned as world class as its study involved 675 patients diagnosed with breast cancer. Its extensive treatments have made SJMC one of Asia’s most comprehensive one-stop centres for cancer diagnosis and treatment.

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No cure for allergies Malaysians are generally under misconception there is, reveals awareness survey

UAL A LUMPUR: Malaysians generally believe there is a cure for allergies when in fact there is none. This is one of the eye-opening findings of a survey conducted by the Malaysian Society of Allergy and Immunology (MSAI). MSAI president Dr Amir Hamzah Abdul Latiff, in revealing the results of the first Malaysian Allergy Awareness Survey recently in conjunction with World Allergy Week, said interim results indicate that most Malaysians lack the knowledge and information to seek out treatment for allergies. “In fact, if I could be bold enough to add that treatment for allergies is not the ultimate endgame. Prevention is the goal as there is no cure for allergies.” The survey revealed 50% of respondents believed there was a cure for allergies, and one in three respondents was unaware that allergies could be inherited. It also highlighted the top allergy concerns were food allergy (55%), followed by food intolerance (45%), eczema (42%) and allergic rhinitis (29%). “Worldwide, allergy patterns are evolving. Initially it was asthma and allergic rhinitis, but recent studies have indicated a rise in food allergy prevalence among children in particular,” said Dr Amir. Food allergy, which affects all age groups, occurs when the body’s immune system sees a certain food as harmful and reacts by causing one or more symptoms. The top five most common food allergens perceived by respondents were seafood (90%), tree nuts (47%), soya (44%), wheat (30%) and eggs (30%). Food intolerance is often mistaken as food allergy as both share similar symptoms. Yet unlike food intolerance, food allergy can cause a severe and sometimes life-threatening reaction called anaphylaxis. The survey showed many respondents had little knowledge of anaphylaxis. Associate Professor Dr Intan Hakimah Ismail, head of department of paediatrics at Universiti Putra Malaysia (UPM) and lead investigator for the survey, shared passionately how allergies impacted her family. “Symptoms of food allergy may include hives, swelling, rashes and difficulty in breathing. If you fail to identify the symptoms and allergens early,

PREVENTION: Dr Kent explaining preventative measures to avoid allergic reactions.

INAUGURAL INFO: Dr Amir sharing the survey findings in his gripping yet fun presentation.

it may result in a dramatic impact on not just the child’s life, but the entire family,” she said. “An encouraging 71% of respondents acknowledged this and felt a child’s future and his or her quality of life would be affected by allergies.” Dr Kent Woo Chee Keen, physician, clinical immunologist and allergist, drove home the severity of allergies in his thought-provoking discussion “Why is there no cure for allergies?” He explained that since there is no cure for allergies, prevention takes top priority to tackle it, and outlined a three-pronged approach to manage them. The first step is to identify the allergy risk level. “In Malaysia, it is estimated that up to four in five children are at risk of developing allergies when both parents have a pre-existing allergy,” he said. The second, he explained, is to provide sufficient nutrition, which includes practising breastfeeding. The third is to identify what triggers the allergic reaction and learn to avoid it. MSAI plans to develop a Malaysian Allergy Roadmap which empowers MSAI, UPM and healthcare professionals nationwide to reduce healthcare costs and create specialised programmes to improve the quality of life of those affected by allergies.

PASSIONATE: Dr Intan sharing her experience.

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Creating an allergy-free nation MAKING Malaysia an allergy-free nation – that’s a pretty bold statement to declare. Before you even think of belittling or rebutting it, here’s a caution though. The statement is not meant to be taken literally, rather it’s more of the idea behind it. Malaysian Society Allergy & Immunology (MSAI) president Dr Amir Hamzah Abdul Latiff (pic) shared with Health+ his mission of an allergy-free nation. He has created the Allergy-Free Nation programme to raise public awareness on allergies in Malaysia. “The time has come for them (the Health Ministry) to recognise that allergy is a problem that needs to be handled by specific specialists. “And it’s not just with training as a medical student, or even has some interest in it. The minute we have those sort of situations, then we will never move forward in terms of tackling the problems of allergy,” said Dr Amir. “We want to create a sense of knowledge and awareness among parents and the community. A simple survey among parents in 2011 to assess the risk of developing allergies among children of parents with or without allergic diseases, showed that one in five children was at risk of allergy.” When it comes to allergies, people generally look at them only from an individual organ or body system, for example a respiratory position such as asthma. However, there are other allergies such as eczema, food allergy, allergic rhinitis and drug allergy that affect not only specific body systems, but also coexisting with each other. “Hence, a dermatologist may manage well a child with eczema, but may not optimise treatment for asthma or rhinitis or food allergies,” lamented Dr Amir. Through the Allergy-Free Nation programme, Dr Amir wants to increase public awareness on allergies so that the people know this is a major problem. “We’ve met many people and policymakers, but it seems to be not so effective. So we’re now getting the public to ask the questions.” The programme provides an online survey for respondents to answer some questions on allergies. “The purpose is to know exactly the awareness and what people think of allergies. Once we get all the data, we can establish the level of awareness of allergies among Malaysians. With the data, we can try to emphasise what we have established in the survey,” said Dr Amir. Since its inception in 1998, MSAI has been raising public awareness on allergies, which many regard as trivial. “Even doctors would say ‘just avoid this, take antihistamines and you’ll be fine’,” he added. Dr Amir and his team want the public to have the best quality and proper management of allergies. “That’s the key thing. Sometimes the diagnosis and tests are not even done properly. So it’s an educational thing,” he said. “We need to move on and make bold statements such as ‘allergy-free nation’ even though it’s not easily achievable. So when is this going to happen? I say 10 years. My allergist/immunologist colleagues and I have been championing this for seven years trying to get clinical immunology as a specialty in its own rights because patients deserve better than what they’re getting.”

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BFM Health and Living Live 2016 captivating Live programme designed to help public answer medical questions, promote awareness about chronic diseases and health issues

UALA LUMPUR: Business.fm (BFM) recently broadcast its Health and Living Live 2016 in front of more than a thousand participants comprising members of the public, representatives of pharmaceutical companies, insurance agencies, doctors and others. The programme, streamed live from 10am to 5pm, was designed to help the public answer some of their medical questions as well as to promote awareness about chronic diseases and health issues. The event kicked off with a dialogue between Health Minister Datuk Seri Dr S Subramaniam and BFM presenter and producer Meera Sivasothy. Among the topics covered were some frequentlyasked questions. The dialogue ended with an open overview of the health ecosystem, its direction for the future and how policy decisions affect the public. BFM Media Sdn Bhd managing director Malek Ali says encouraging Malaysians to adopt a healthy lifestyle in this age of abundance is a difficult challenge. “It requires the cooperation of government, the medical fraternity, small and big pharmacies, NGOs and both public and health institutions. This conference aims to take that first step to bring these institutions together to identify priorities,

and develop a concerted effort to address the next decade’s public health challenges.” The event was aimed at bringing together the various stakeholders, each sharing their expertise and experience in pursuing a healthy lifestyle while informing the public. In addition, a forum debunking myths about heart diseases, diabetes and hypertension was held to disprove urban legends about these diseases such as the papaya leaf theory. Also covered were management of cancer, diet recommendations, ageing, healing, fertility issue, ageing eggs, and sperm count crisis. The participants were obviously eager to learn from the talks. “Because I have been following the Health and Living programme daily, I feel excited to learn more about cancer treatment and the dialogue with the Health Ministry,” says Leong from Kajang. “I get new exposure and knowledge through these programmes. They keep me up with the latest health trend,” adds Fauziah, a unit trust consultant. Insurance agencies, pharmaceutical retailers, and healthcare universities nationwide participated in the exhibition. The event was hosted by Dr Jason Leong with moderators from BFM’s team of presenters and producers.

ON AIR: The programme was broadcasted live in front of 1,000 participants.

GREAT MINDS: Dr Subramaniam and BFM’s Meera exchanging ideas on stage.

THONEH celebrates 30 years of eye care

PETALING JAYA: The Tun Hussein Onn National Eye Hospital (THONEH) celebrated its 30th anniversary recently. Established by the Malaysian Association of the Blind (MAB) in 1986, THONEH has grown by leaps and bounds to contribute significantly to the prevention of blindness efforts, including the continuous quest for upgrading industry knowledge through the establishment of its educational arm, the National Institute of Ophthalmic Sciences. The national eye hospital remains committed to providing Malaysians eye care through constant innovation, education and research programmes in ophthalmology. An eye hospital initiated by Malaysia’s third prime minister and MAB chairman the late Tun Hussein Onn, THONEH began operations on March 22, 1986 with equipment donated by various well-wishers. A year later, on March 21, 1987, it was officially opened by the His Royal Highness, Sultan of Selangor, and has continued to enhance its services through

various initiatives, including the setting up of sub-specialty clinics, acquiring specialised equipment, and introducing training and research programmes. Thanks to its eye care services, THONEH obtained ISO 9001:2008 certified accreditations from UKAS, CONFRAC and Standards Malaysia in 2008, and won the Brand Laureate, SMEs Chapter Award 2009 for the Best Brands Healthcare Eye Hospital by the Asia Pacific Brand Foundation (APBF). In February 2014, THONEH attained Joint Commission International (JCI) accreditation, an international mark of endorsement for quality patient care and patient safety. Over the years, THONEH has continued to extend its support regionally, and initiated the founding of the ASEAN Association of Eye Hospitals by collaborating with other eye hospitals in Southeast Asia. In conjunction with the celebration, THONEH will hold various promotions to thank the community for their ongoing support.

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Coalition to combat dengue menace Allied Against Dengue to tackle killer disease in holistic manner, from prevention to management

By ALI-AZMIN HASSAN

UALA LUMPUR: In an effort to raise awareness on dengue, GlaxoSmithKline (GSK) Consumer Healthcare has joined forces with other organisations, including the Health Ministry, the Malaysian Medical Association, the Malaysian Pharmaceutical Society, and Guardian Health & Beauty. The Allied Against Dengue (AAD) coalition is a nonprofit multilateral organisation to empower healthcare providers, organisations and communities, and, most importantly, to tackle dengue issue in a holistic manner, from prevention to management. Health Minister Datuk Seri Dr S. Subramaniam, who was at the event to commemorate the coalition, said ADD is a praiseworthy initiative that helps to educate, manage and defeat dengue. “The Health Ministry has put in a lot of effort into the prevention and control of the vector-borne disease. Now with the coalition of healthcare providers, private organisations and communities’ collective expertise and resources we will be enable to achieve a bigger impact in the war against dengue,” he said. AAD aims to achieve its mission through a coherent nationwide education campaign on prevention and appropriate dengue fever management. It seeks to make a real difference to the lives of Malaysians and curb the incidence growth rate. The coalition’s strategies to tackle this issue are through community empowerment and healthcare providers who can detect dengue fever at its onset and provide appropriate dengue treatment quickly. Secondly, it is through integration of preventive

THE INITIATION: Dr Subramaniam and Stacy launching the coalition.

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control activities driven by the Health Ministry, academia and organisations with education on dengue fever management advocated through healthcare practitioners and retailers. The third strategy is to deploy a robust education campaign through multiple channels, including digital, mainstream and social media, and ground activation. AAD has set ambitious targets this year – to engage 8,000 healthcare providers, recruit 3,000 dengue warriors in the community and educate one million Malaysians. To achieve these targets, it will roll out a series of initiatives, including train-the-trainer programmes, organised information centres through the coalition partners’ network, and community

education roadshows. Dengue is widespread in Malaysia and in Southeast Asia. The disease outbreak is spreading to more areas and impacting more lives. The problem is growing rapidly with the incidence rate rising about 20% in 2014 and 50% last year. What’s worse is there is no cure or preventive vaccine. GSK Consumer Health Malaysia & Brunei general manager Stacy Wallace said GSK was motivated to champion this cause as it was concerned about the escalating hazard and effects of dengue on the nation. “While we have initiated Allied Against Dengue to garner bigger impact we have galvanised key forces and efforts to unite, take action and defeat dengue.”

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Strong turnout at wound care symposium 179 healthcare professionals learn latest techniques to care for diabetic patients at SunMed session

E T A L I N G J AY A : Sunway Medical Centre (SunMed)’s recent Mini GP Symposium on Wound Care held on March 6 closed its World Diabetes Day 2015 campaign on a high note. The symposium, open free to general practitioners (GPs), clinicians and nurses, was part of SunMed’s efforts to raise awareness on the management of wound care, which also includes diabetic wound care. Being the last in a series of activities organised by SunMed beginning in September, the symposium saw very encouraging response. A total of 179 healthcare professionals attended, comprising 147 external GPs and nurses, from as far as Penang, and 32 medical officers and staff nurses from SunMed. “It is well known that wounds are bad news for diabetics, but

with advancements in medicine, wound care for diabetics continues to see new developments. The team at Sunway Medical Centre organised the symposium to share the latest knowledge on wound care as we believe that all healthcare professionals should work together as a team for the benefit of society. “Thus, with our expertise and experience in the latest developments in wound care and care for diabetics, it is important for us to continuously engage with local GPs and nurses to share this knowledge. The topics that we have chosen will benefit all medical practitioners and help bring them to the forefront of medical development,” said Sunway Group Healthcare Services managing director Lau Beng Long. The symposium featured eight speakers, comprising wound care specialists and surgeons with

LEARNING FROM EXPERTS: The sessions in the form of lectures, forums for the exchange of ideas, and workshops drew huge enthusiasm from the participants.

multi-disciplinary subspecialties such as orthopaedic and trauma, hand and microsurgery, foot and ankle, dermatology and plastic and reconstructive surgery, as well as a diabetes nurse educator. They shared their clinical cases in acute care, home care, long-term care and care in clinic and outpatient settings. The topics covered areas such as causes and types of wounds, diagnosis, treatment, prognosis and management of wounds. The sessions in the form of lectures, forums for exchange of ideas, and workshops drew huge enthusiasm from the participants, who posed questions to the panel of speakers during the Q&A sessions. Meanwhile, during the

lunchtime video screening, SunMed introduced the SunMed@ Home programme. The video featured professionally-trained nurses and therapists providing specialised and individualised home nursing care to patients, delivered through scheduled home visits and private nursing care with extended hours. The services include management of wound from accidents, operations, diabetic ulcers and bedsores. The participants also visited the booths of 13 participating sponsors – Getz Healthcare, Jetpharma, Mölnlycke Healthcare, Mundipharma, Pfizer, Schülke, Smith & Nephew, Soza Healthcare, SPR Surgicare, Sterling Profile, Triniaire, Convatec, and United Italian Trading.

Healthcare Bhd Group. With a capacity of 200 beds and providing a full range of healthcare services by 70 specialist consultants and supported by over 800 employees, the hospital serves more than 17,000 inpatients and 180,000 outpatients a year, of which about 5% are foreigners.

KPJ Tawakkal Health Centre is an ambulatory care that provides comprehensive outpatient healthcare services such as KPJ KL Dental Specialist Centre, KPJ KL Rehabilitation Centre, KPJ Senior Living Care (Nursing Home), Consultants Clinics & Haemodialysis Service.

Bringing love and fun to refugees KUALA LUMPUR: Despite what they are facing, children of refugee communities are pretty resilient and can find ways to cope and draw strength from family members and surrounding communities. By learning, playing and having space to explore their talents and skills, children can be active members of our community. Recognising their potential, KPJ Tawakkal Specialist Hospital and KPJ Tawakkal Health Centre recently organised the Love & Care by KPJ Tawakkal for Somalian children refugees here. The programme was initiated with the focus to provide interactive educational activities for the children and to raise awareness on the importance of hygiene and healthy lifestyle. The activities included fun, basic exercises, tooth-brushing demonstration,

hand-washing demonstration, a magic show, colouring contest, and various exciting interactive games. KPJ Tawakkal Health Centre general manager Farahiyah Badri said the programme was in line with KPJ’s corporate social responsibility effort to contribute to the local and international community. “This programme also encourages children to gain confidence and improve their communication skills not only within their groups, but also among the surrounding communities.” Prior to the event, KPJ Tawakkal team had refurbished the main area of the school with new facilities to inspire and motivate better learning environment for the children. KPJ Tawakkal Specialist Hospital, located in the heart of Kuala Lumpur, is a member of the KPJ

HAPPY MEMENTO: The team from KPJ Tawakkal posed with the Somalian refugees after a fun-filled day.

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3,200 expected for World Cancer Congress 2018 Malaysia will be first in Southeast Asia to hold twin events with experts from 115 nations

UALA LUMPUR: Over 3,200 cancer experts from 115 countries representing the entire spectrum of the global cancer control community will converge in Kuala Lumpur on October 1 to 4, 2018. They will be attending the leading international conference in cancer control, the World Cancer Congress and the World Cancer Leaders’ Summit, at the Kuala Lumpur Convention Centre (KLCC). It will be held for the first time in Southeast Asia, Malaysia started lobbying for support by participating at the booth exhibition at the World Cancer Congress in Montreal, Canada, in 2012, and in Melbourne, Australia, in 2014. “The National Cancer Society of Malaysia (NCSM) worked closely with Malaysia Convention & Exhibition Bureau (MyCEB) on the winning bid proposal which was submitted in September 2014 and a final decision on the host city was made in April 2015,” says MyCEB CEO Datuk Zulkefli Sharif. “In terms of economic impact for the country, we anticipate approximately RM30 million from this business event as over 60% of the delegates will be coming from various countries,” he adds. NCSM signed a memorandum of understanding (MoU) with the Union for International Cancer Control (UICC) in October last year to host the twin events. “In addition, we lobbied NCSM president Dr Saunthari Somasundaram to sit on the board of UICC. She is well known for playing an active role in cancer awareness activities in the region,” says NCSM vice-president Clare Ratnasingham at a recent media launch. “The last World Cancer Congress in 2014 held in Melbourne garnered strong recognition among the global cancer community and has been acknowledged as the leading international conference on cancer control. Moving forward, NCSM and MyCEB are working closely to bring more delegates to Malaysia and help create wider awareness on cancer from leaders, advocates, scientists, researchers, and health experts,” she adds. Besides MyCEB, the Health Ministry, the National Cancer Institute, the Women, Family and Community Development Ministry, the National Population and Family Development Board and the Tourism and Culture Ministry are providing support in hosting both events. “Together, Malaysia and Southeast Asia can help UICC to take the lead to convene the global cancer community and leave a long-lasting impact within the region. This is the region where cancer control, better advocacy on cancer prevention, care and support are needed most. This will ultimately be the legacy from this World Cancer Congress,” according to a statement in the winning bidding document submitted to UICC by NCSM. UICC is the largest cancer fighting organisation of its kind, with more than 400 member organisations in 120 countries. With its headquarters in Geneva, Switzerland, it is the leading non-governmental, non-profit, non-political and non-sectarian cancer organisation. Its mission is to eliminate cancer as a life-threatening disease for future generations. Held every two years, the World Cancer Congress is a leading platform to exchange best practices in the implementation science of cancer prevention and control, and serves as a networking

From left: Clare, NCSM principal patron Tan Sri Rafidah Aziz, and MyCEB general manager of business events Ho Yoke Ping. opportunity for the global cancer and wider health community. This year’s World Cancer Congress will be held in Paris, France, on October 31 to November 3. The Congress represents a unique

and ideal platform for the international cancer control community to meet, discuss, share, learn, inform each other, and connect to find solutions to reduce the impact of cancer on communities globally.

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maY | 2016

Mid-life crisis just a myth Happiness doesn’t drop as we reach middle age, says new research

NEW research challenges the long-held belief that our happiness levels hit a low point in middle age, causing us to embark on a spending spree of sports cars as part of the “mid-life crisis”. According to the results of a 25-year study by the University of Alberta, Canada, an increase in our level of happiness starts in our teens and early 20s, but doesn’t necessarily fall as we grow older and reach mid-life. To research more about happiness levels as we age, and to observe the ups and downs of happiness at different ages and life stages in the same individual,

the team of researchers followed two groups of participants for up to 25 years. A group of high-school seniors were followed from age 18 through to 43, and a group of university seniors were followed from age 23 to 37. At different stages during the study the participants were asked questions such as “How happy are you with your life right now?” The researchers did not ask for examples of happiness; participants simply answered using a rating scaled from “not very happy” to “very happy”. The researchers also did not give any definitions of happiness to the participants. The results showed that after

MYTH DEBUNKED: Wrong to think happiness hits low point in middle age, causing us to embark on spending spree of sports cars as part of the mid-life crisis.

leaving high school and university, happiness levels increased right through to the 30s in both samples, showing that happiness is not only for the young. And only a slight decrease in happiness was seen by age 43 and only in the high school sample, going against the myth of the mid-life crisis. OTHER happiness Factors However there are other factors that can influence happiness levels such as marital status, unemployment, and physical health, and levels of happiness can differ in different individuals based on these factors. “If I’m divorced and unemployed, and I have poor health at age 43, I’m not going to be happier than I was at age 18,” says Nancy Galambos, one of the study’s authors, “It’s important to recognise the diversity of experiences as

Mayan traditional steam and spiritual bath THE growing importance of spiritual wellness in travel has spawned interest in a Mayan tradition called Temazcal, which experts predict is poised to go global and become as common as the Swedish or Thai massage. In an age when emails are never turned off, increased screen time is reducing human interaction, and rabid consumerism is being used to fill voids, exhausted travellers are increasingly seeking vacations that can put, not only their minds at ease, but also undernourished souls. Enter Temazcal – translated roughly to “house of steam” – an ancient Mexican practice that goes beyond the standard steam bath to include the presence of a shaman, who recites ancient prayers and chants to help guests slip into a meditative trance. According to trendspotters at Spafinder, Temazcal is experiencing a surge in popularity in Mexico and will gain momentum this year, according to a recent Global Spa and Wellness report. With a history that can be traced back to ancient Mayan and Aztec civilizations, Temazcal takes place in a stone or adobe hut. Water is thrown on heated, volcanic stones which fill the dome with hot steam for a sauna-like effect, while incense and aromatic herbs perfume the air. Then, a Temazcalera leads participants through a ritual of chants and prayers aimed at cleansing, not just pores, but minds and spirits. Built intentionally to resemble a woman’s womb – the entryway representing a birthing canal – the overarching theme of Temazcal is rebirth. Authors of the report also credit Temazcal’s resurging popularity to the growing demand for

“authenticity” among wellness seekers: local, indigenous culture is cited as the top luxury travel trend worldwide. “As the wellness-inclined increasingly look to the wisdom of the ancients to nourish their mind, body, and soul, Temazcal serves as a prime example of our blossoming interest in ‘indigenous spirituality,’ an experience that combines a culture’s unique spiritual perspectives with universally acknowledged healing techniques,” the report reads. Contemporary, luxe versions of Temazcal treatments are found in El Dorado Royale, Rosewood Mayakoba, The Viceroy, Belmond Maroma Resort & Spa and Cancun Temazcal. Here are a few other ideas for spiritual wellness holidays:  Plum Village, France With more than 200 resident monks and nuns, Plum Village, located in the south of France, is the largest Buddhist monastery in Europe. Founded by two Vietnamese monastics, the centre holds sessions throughout the year, teaching participants how to practice mindfulness and live simply.  Suan Mokkh International Dharma Hermitage, Chaiya, Thailand The Suan Mokkh International Dharma Hermitage in Chaiya, Thailand has hosted more than 22,000 visitors looking for peace and quiet. On the first day of every month, the centre organises a 10-day silent meditation retreat that teaches participants how to meditate using the power of silence. This is a no-frills retreat, where visitors sleep on a simple straw mat, wooden pillow with a blanket and mosquito net. Be warned: the wake-up call is at 4am. - AFPRelaxnews

people move across life.” The team believe the results are important as happiness is key to our wellbeing, with happier people known to be healthier and live longer. The Canadian government is even collecting information about happiness as part of Statistics Canada’s General Social Survey questionnaire. “It’s seems trite – ‘just be happy’ – but behind that are the policies shaping society,” says Harvey Krahn, another of the study’s co-authors, “The policy implications of the study are about changing the conditions that cause grief, like being unemployed, like losing your home, inequality, being a refugee, crime, addictions – these things will make you less happy, age notwithstanding.” The study was published in the journal Developmental Psychology. – AFPRelaxnews

Twin births almost double in rich countries TWIN births have almost doubled in developed countries in four decades, say researchers who caution about the associated health risks. In a study published in the US journal Population and Development Review, scientists say the rate of twin births nearly doubled in the Creative Commons United States from 9.5 twins per 1,000 deliveries in 1975, to 16.9 in 2011. They found similar trends in Britain (from 9.9 per 1,000 to 16.1), Germany (9.2 to 17.2), France (9.3 to 17.4), Denmark (9.6 to 21.2) and South Korea (5.0 to 14.6). The researchers attributed the surge to an increase in DOUBLE BOOST: Twin births “medically-assisted have almost doubled in reproduction” (MAR) developed countries in four since the 1970s when decades. scientific advances produced techniques such as ovarian stimulation and in vitro fertilisation. Both methods are associated with higher odds of producing multiple foetuses in a single pregnancy. “We’re not sure if the rate will continue to increase, but the data is increasingly seen as a public health crisis,” says Gilles Pison of France’s Ined demographic research institute, who co-authored the study. Not only is it more dangerous for the mother, but twin babies are also more fragile than single ones.

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Lack of sleep linked to online browsing Not getting enough rest? You’re probably on Facebook or other social media websites, says study

ACK of sleep is linked to a higher level of online browsing, including checking social media websites such as Facebook, says researchers. Wanting to look at how sleep duration could affect internet use, rather than how internet use affects sleep, the team from the University of California in Irvine, recruited 76 students and monitored them for a week. Using logging software the team could monitor participants’ computers and smartphones to see how often they spoke on the phone, texted, or used applications. Sensors were used to measure their behaviours, activities and levels of stress. Participants were also asked to complete a survey every morning reporting on their sleep and to complete an end-of-day survey at night. The students also had to complete a general questionnaire and take part in an interview. The researchers collected further data by asking participants during the week about their mood, the level of engagement in their work, and how difficult they were finding the task they were working on. sleep debt The study also looked into the idea of “sleep debt,” the accumulated difference between the amount of sleep needed and the amount experienced. After taking into account factors such as gender, age, university work load, and course deadlines, the results showed a direct connection between a chronic lack of sleep, a cranky mood, lower productivity, and also more time spent checking Facebook.

Twins are more likely to be born prematurely, have a lower birth weight and die in childhood. The use of IVF and other assisted reproduction techniques has soared as first-time mothers have become older, waiting until they are financially secure or have built a career to have a child, the authors pointed out. The mean age of first-time motherhood has moved up to 26 in the United States from 22.7 in 1980, according to the US Centers for Disease Control and Prevention. In 1970, only 1.7 out of 1,000 women between the ages of 35-39 years gave birth to their first child. By 2012, the rate had gone up to 11 out of 1,000. Measures to stem the rise in twin births could include implanting fewer embryos per pregnancy, the researchers suggest. AFPRelaxnews

The researchers also found that not enough sleep leads people to be more easily distracted, with their attention flicking between different computer screens and apps. “When you get less sleep, you’re more prone to distraction,” says lead researcher Gloria Mark, “If you’re being distracted, what do you do? You go to Facebook. It’s lightweight, it’s easy, and you’re tired.” The study’s findings will be presented at CHI, a leading computer-human interaction conference in May in San Jose, California. The effect of technology on quality of sleep has been shown in many previous studies, with a recent study in the Journal of Child Neurology finding that teenagers who continue to text at night after they have switched out the lights experience poorer sleep and poorer grades than those who text with the lights on. The study found once the lights go out, the “blue light” emitted from smartphones and tablets is intensified in the dark, delaying the release of melatonin, the hormone that makes you feel sleepy, and disrupting our sleep patterns and quality. Blue light can affect the release of melatonin and our sleep even if it is emitted from the phone when eyelids are closed. – AFPRelaxnews FACEBOOK BUDDY: Mark says many go to Facebook when they’re being distracted.

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Mosquito nets can fix groin hernias A Swedish-Ugandan study has found that mosquito nets can be used as an inexpensive alternative to costly surgical meshes in fixing common groin hernias, says Stockholm’s Karolinska Institute. “Commercial hernia meshes cost US$100 or more, which is too much for the health services and people living in poor countries,” says Jenny Lofgren, a researcher for the study published in the New England Journal of Medicine. A groin, or inguinal, hernia is a hole in the abdominal wall around the groin, through which intestines and other abdominal organs protrude. Without surgery, such hernias usually cause great pain and can lead to complications responsible for some 40,000 deaths a year. There are about 20 million operations for the hernia annually for the condition which mostly affects men. Researchers at the Karolinska Institute and Makerere University in the Ugandan capital Kampala conducted a randomised surgical trial comparing sterilised mosquito nets, costing as little as US$1, with the regular and more expensive mesh usually used in hernia operations. Some 300 adult males from rural eastern Uganda were randomly assigned to receive one or the other type of surgical reinforcement by surgeons at the Kamuli Mission Hospital. The participants were then monitored for a year. The results showed no significant differences between the groups, and just one patient in the mosquito-net group had a recurrence. “These results are of great potential benefit to the many millions of people who lack access to good surgical care for their hernias,” says study project leader and surgeon Andreas Wladis, an associate professor at the Karolinska Institute’s Department of Clinical Science and Education at Stockholm South General Hospital. – AFPRelaxnews

‘Supervised’ robot does soft-tissue surgery A robotic machine has succeeded at stitching two segments of a pig’s bowel together, an advance for the tricky field of soft tissue surgery. The machine, called the Smart Tissue Autonomous Robot (STAR), does not replace the need for a skilled surgeon, but acts as a tool to improve the accuracy of stitching, says a report in the journal Science Translational Medicine. The study showed STAR outperformed expert surgeons and a well-known robotic surgery tool already on the market, called the da Vinci robot, which is held in the surgeon’s hand and used to perform

surgeries such as hysterectomies through a few small incisions. Until now, robotic surgeries have largely relied on a surgeon’s expertise and outcomes have varied according the doctor’s skill, researchers say. Soft tissue is particularly complicated because it is malleable and moveable. But being able to improve on such surgeries “could potentially reduce complications and improve the safety and efficacy of soft tissue surgeries, about 45 million of which are performed in the US each year,” according to the study led by doctors at the Children’s National Health System

in Washington, DC and Johns Hopkins University in Baltimore, Maryland. The STAR was tested on a procedure called anastomosis, which comes after a surgeon has cut open the patient’s body and completed the main goal of the surgery – for instance by removing a tumour from the bowel – and is then reconnecting two sections, “like trying to put together a garden hose, which has been cut,” explains co-author Ryan Decker. Anastomosis is performed more than a million times each year in the United States, for surgery involving the intestines, as well urologic and gynaecologic operations. – AFPRelaxnews

18 •

BUSINESS+

maY | 2016

Exercising while holidaying Active Nation seeks to enhance well-being of healthconscious consumers through travel experiences By ALI-AZMIN HASSAN

any people seem to have the impression that holidays are meant to just chill, relax and get fat. Once your holiday is over, you get into overdrive mode to try to lose all that fat. But, maybe it shouldn’t be that way. Why can’t we stay fit while on holiday? Or maybe you want to learn how to be fit while holidaying. Then perhaps it’s about time you check out what fit tourism is all about.

Active Nation is one of the first community-based programmes for health-conscious consumers, seeking to enhance their well-being through travel experiences. Andrea Ong and Hawari Farihin started Active Nation in Malaysia with the aim to include fitness programmes into holidays. Consumers who go for fit tourism seek to look and feel better, lose weight, relieve pain or discomfort, manage stress, and generally improve their health. “Most people nowadays get demotivated in the gym. Somehow they feel bored, stuck in one environment. So we figured out something that can bring that fun into exercise,” says Hawari. “For example, not everyone

wants to be affiliated with a gym or sign up for crossfit. Some of us don’t know what we want yet. Some of us also like to do various activities. We thought that with Active Nation, we can come up with different activities for our members to do at different places. And that way we can create something exciting and a new experience for them,” Andrea chips in. Active Nation provides and organises all the activities and food for their customers, regardless of whether they want to escape to a small getaway in Cameron Highlands or take a week excursion on an island. “We want our consumers and members to get everything out of Active Nation. We try to create events around Malaysia so it could come down to going for a hike, paintballing, and even crossfit. When they join us for a holiday, food and activities are all provided. We are also looking into partnering with nutritionists, dieticians and practitioners from fitness industries so they can come along with us and they can share their experiences with our members,” adds Andrea. The concept of Active Nation is still very new in Malaysia, whereas in other developed countries like the US or Europe which have been doing this for years, explains

Andrea. “The fitness industry in Malaysia is still small, but it’s growing. It’s a growing trend and more and more people are getting active in this industry.” “Our programme is not only fit tourism where we go on trips all the time, but we also have a normal boot camp training around Malaysia. And currently we are only doing this around Selangor. The boot camp training will be conducted twice a week. And then every weekend, we will have a short getaway to do other activities such as hiking and other outdoor activities with our members,” says Hawari. At the moment, Active Nation can be reached through social media like Facebook and Instagram. Their activities will be posted on both media for those interested to sign up for its programme. “This is a community that we want everyone to feel close. We allow our members to vote on what activities they want to do. Once the majority has decided on what activities they want, then we’ll plan them,” says Andrea. “Fitness is a lifestyle and we want to teach people how they can incorporate all these activities into their lives. Fitness is not just exercising. It’s being active mentally, physically and spiritually. In fitness it’s all about consistency.”

FITNESS VACATION: Hawari (left) and Andrea incorporate fitness into holidays to make your rest a healthy one.

BUSINESS+

2016 | maY

• 19

Managing cancer costs with insurance AIA highlights need for more Malaysians to financially protect themselves against dreaded disease

f there is one disease that many Malaysians fear, it is undoubtedly cancer. Their fears are not unfounded though – in 2012 alone, there were over 37,400 new cases and 21,700 deaths in the country, with one in four Malaysians expected to be diagnosed with the dreaded disease before age 75. Many had witnessed family members or friends battle the disease – some pulled through, while others did not. In addition to the physical and emotional toll it takes on families and loved ones, there are also significant financial risks that come with battling the disease. The recent ASEAN Costs in Oncology (ACTION) study by the George Institute for Global Health underscores the financial impact of cancer, highlighting that 45% of cancer patients suffered from financial catastrophe one year after diagnosis, while 11% did not make it past the first year. AIA Health Services Sdn Bhd

medical director Dr Myralini S. Thesan highlighted the need for more Malaysians to financially protect themselves against cancer at BFM’s Health & Living Live 2016. At a panel discussion on the management of cancer, Dr Myralini pointed out that without sufficient protection, families were at risk of being financially burdened due to the disease. “Cancer is the third leading cause of premature death in Malaysia. Both late detection and rising treatment costs are strong factors that contribute to the untimely demise of cancer patients, especially among the most vulnerable segments. Yet, only 22% of Malaysians have medical insurance or critical illness insurance. This leaves a large segment of the population at risk of facing financial catastrophe if diagnosed with cancer,” she says. Dr Myralini points out that technological advances have led to great improvements in the

detection and treatment of cancer – but they come at a cost. “The most common cancers in Malaysia are the ones that can be treated when detected early. However, many Malaysians either do not get diagnosed early or are unable to access treatments in a timely manner. When this happens, their chances of beating the disease are negatively impacted.” Having the right medical coverage is one of the most effective ways for Malaysians to ensure they are financially prepared to fight this dreaded disease. Unfortunately, even Malaysians who do have medical insurance are often underinsured. “We encourage our customers to review their medical coverage every few years,” explains Dr Myralini. “Just as the cost of living has increased, so has the cost of healthcare in Malaysia. What was considered to be a good coverage amount 10 or 20 years ago may not amount to much today.” Hospitalisation and critical illness plans are also evolving to keep up with advances in medical technology. For example, newer critical illness plans cover the early

PROTECTED: Dr Myralini stresses the importance of having medical insurance as the costs of medical treatments are undeniably expensive. stages of the illnesses, and there are hospitalisation plans that cover out-patient cancer treatment and dialysis. “It is important for customers to be informed and ask their life planners the right questions in order to determine if the plans they are buying meet their needs,” says Dr Myralini. “At the same time, we are also training our life planners to be able to recommend solutions that best fit the needs and affordability of the people they serve.” She says while insurers should continue to prepare Malaysians for life’s challenges, they should also play a more active role in helping their customers lead healthier lives. “We need to put life back at the heart of life insurance. After all, life is just as much about enjoying the present, as it is about planning for the future.”

20 •

SENIOR+

mAY | 2016

Alzheimer’s – symptoms, causes and prevention Most people who get disease are 65 and older, up to 5% have early onset in their 40s or 50s By ALI-AZMIN HASSAN

hen it comes to memory, it’s normal to lose track or forget something. Everyone has those occasional memory lapses. Losing track of where you put your car keys, or forgetting the name of an acquaintance, that’s very normal. But when it comes to a point where your forgetfulness worsens and

persists that it affects your ability to function at work and at home, then quite likely that the memory loss is associated with Alzheimer’s. Alzheimer’s is the most common cause of dementia among older adults. Don’t get me wrong, Alzheimer’s is not a normal part of ageing, although the greatest risk factor is increasing age, and according to the Alzheimer’s Association, the world’s leading voluntary health organisation in Alzheimer’s care, the majority of people with Alzheimer’s are 65 and older. And up to 5% of people with the disease have early onset Alzheimer’s, which often appears

WORK IN PROGRESS: Alzheimer’s has no current cure, but treatments for symptoms are available and research continues.

when they are in their 40s or 50s. What causes Alzheimer’s, you may wonder? Unfortunately, scientists don’t yet fully understand what causes Alzheimer’s disease in most people. Early-onset Alzheimer’s is usually caused by a genetic mutation in the brain, whereas late-onset Alzheimer’s comes from a complex series of brain changes that occur over decades. The causes may have been from a combination of genetic, environmental, and lifestyle factors. In terms of prevention or cure, Alzheimer’s has no current cure. Treatments for symptoms are available and research continues. The treatment for Alzheimer’s does not stop it from progressing, but only temporarily slows the worsening of dementia symptoms. What most people go through with Alzheimer’s disease is dealing with their elderly parents. When it comes to our parents, we are usually very sensible when taking care of them. But dealing with parents with Alzheimer’s, one needs to muster a lot of patience and flexibility to get rid of the frustration, and it can be emotionally exhausting. Nevertheless,

our parents cared for us when we needed them most and taking care of them in return, no matter the circumstances, is our responsibility as children. Now, how can one differentiate between Alzheimer’s and typical age-related memory loss? To compare the differences, signs of Alzheimer’s are poor judgement and decision-making, inability to manage a budget, losing track of the date or the season, difficulty having a conversation, and misplacing things and being unable to retrace steps to find them. On the other hand, typical age-related memory losses are making a bad decision once in a while, missing a monthly payment, forgetting which day it is and remembering later, sometimes forgetting which word to use, and losing things from time to time. If any of these signs and symptoms of Alzheimer’s seems to appear on your close ones, it is advisable to bring them to a hospital for a check-up and an early treatment. In the long run, treatments can be really helpful to slow down the process of dementia.

Negative feelings on ageing can impact memory, hearing Results from a Canadian study suggest that when older adults hold negative feelings towards ageing, it may have a negative impact on their memory and hearing. 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.

SENIOR+

2016 | maY

• 21

Trouble holding it in Incontinence is a common and embarrassing condition to have, but it’s manageable

By Norman Hussaini

here are several meanings to the word incontinence. Philosophically, it can refer to the problem with self-control over sexual desire, but this is not the subject of our discussion. Rather, we are looking at a health issue called urinary incontinence. The act of running to the toilet is commonplace in any types of setting – be it in real life, in books, in movies or in cartoons. Though mostly to depict an amusing situation, the loss of bladder control is no laughing matter. People affected by the condition suffer not only physically, but emotionally as well. Many are forced to stay away from doing normal daily activities for fear of being too far from a toilet. The condition may seriously affect a person’s ability to enjoy life. What is the problem really that makes people lose control

NEGATIVE FEELINGS: The results showed a correlation between negative views on ageing and poor performance in memory and hearing tests. 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 by those around them that their hearing

of their bladders? Who are more susceptible to it? And is there a way to treat it?

 Urge incontinence A sudden, intense urge to urinate followed by an involuntary loss of urine may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as neurologic disorder or diabetes.  Overflow incontinence Experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.  Functional incontinence Where physical or mental impairment affects the ability to urinate at a timely manner. Having arthritis for instance, where unbuttoning pants may prove to be challenging.

What is it? The main type of incontinence is urinary incontinence. It is described as having unintentional passing of urine due to loss of bladder control. Most of the times, incontinence is not a diagnosis of a condition, but rather a symptom to an underlying condition one might have. The severity of the condition varies from one person to another. Milder incontinence can be seen through the occasional leaking of urine when one coughs or sneezes, while more severe ones involve the running-to-the-toilet gag described earlier. There are a few variants in which urinary incontinence manifest itself. These types of incontinence usually depend on the person’s well-being, mentally or physically. They include:  Stress incontinence Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.

and memory are failing,” adds 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 Ageing and carried out by the Yale School of Public Health, linked negative beliefs to a possible increased risk of Alzheimer’s with those holding negative beliefs on ageing 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 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

HOLDING PROBLEMS: The varied types of incontinence results from different disorders.

Causes Causes of urinary incontinence can also come from various sources. There are temporary instances of incontinence whereby an increased volume of alcohol, caffeine, carbonated drinks, artificial sweeteners, vitamins B or C, and certain heat and blood pressure medications are the culprits. It can also be an indication of other conditions such as urinary infections and constipation. These conditions are easily treatable and treatment will cure the conditions, and the incontinence dissipates along with them. There are more conditions that can result in or have incontinence be the indicator. People who experience persistent incontinence may be going through:  Pregnancy  Childbirth  Ageing  Menopause 0 Hystere ctomy (s urger y involving a woman’s reproductive system)  Enlarged prostate

 Prostate cancer  Tumorous obstruction  Neurological disorders Who are more susceptible? It is found that women are more likely to have stress incontinence, while men are more likely to befallen with urge and overflow. It is also found that one in three women and one in five men will experience incontinence in their lifetime. Yet the most prevalent factor men and women is the inevitable, irreversible, age. As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release. Other possible victim’s of incontinence are overweight people. Extra weight increases pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when you cough or sneeze. Other diseases such as neurological disease or diabetes may increase the risk of incontinence. Get checked and get help! Urinary incontinence is a pain in the bottom, or in the bladder, to be more precise. The key to treating it is to identify what are the underlying condition causing it and treat it straight away. There are drugs to help with managing incontinence if all fails, and urologists will have no problem prescribing if required. The courage to talk about something as embarrassing as incontinence may come by so often than not. Yet, when you feel that your loss of bladder control is a frequent one and is affecting your quality of life, then it is time to speak to your doctor about it. It is important to seek medical advice as it can be a precursor or indicator to a more serious condition. It also restricts your activities and limits your social life considerably. And for older adults, having to rush to the toilet every time nature calls may cause unwanted injuries. Information extracted from Mayo Clinic and Continence Foundation of Malaysia.

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MEN+

mAY | 2016

Snip it off please Vasectomy is surest form of male contraception, but think hard and get your partner’s consent most successful contraception is vasectomy at 99%.

By Syed Zaid Syed Osman

amily planning has traditionally been viewed as the woman’s responsibility, but there has been a growing recognition of the need to involve men in family planning programmes as a means of achieving reproductive health objectives as well as attaining greater gender equity. Simultaneously, the proliferation of new contraceptive technology has increased the range of family planning options available to men and women. Contraception is a term used for the idea of keeping the sperm away from the egg or to stop the production of either one or both. Women have many options ranging from pills to sponges, hormone shots, intrauterine device, and careful planning, most of which can be purchased from pharmaceutical establishments. For men, means of contraception are quite limited and include condoms, surgeries, withdrawal techniques, spermicidal agents and abstinence. While condoms are the most convenient contraception with 97% effective rate, the

What is vasectomy? Vasectomy is a surgical procedure to stop sperm produced from being ejaculated with the semen. The vas deferens, the tubes to carry sperm from the testicles, are cut and sealed off by the attending surgeon. Two techniques are available for this procedure, differed by the usage of scalpel. The conventional vasectomy involves making incisions on both sides of the scrotum. The surgeon will then take out the vans deferens from the body, disconnect them with scissors and the end of the cuts are sealed off. Then, the incisions are closed with two or three dissolvable stitches and the procedure is done. The counterpart is called the no scalpel vasectomy. In this procedure, the scrotum is anesthetised and the surgeon will feel the part for the vas deferens. The tube is then held with a round clip. The surgeon will then make a small cut on the skin on top of the vas deferens and it will be disconnected before the end that goes to the abdomen is sealed with a titanium clip. The cut will be given time to heal naturally after the procedure. The no scalpel procedure has been the recent choice of practising

PERMANENT CUT: The surgery is considered permanent once it is done and, although there are ways to restore the man’s fertility, the success rate is the same as the failure rate taking it to a good 50-50 split.

surgeons. The vas deferens will be handled with better care by the surgeon and it requires no sutures or stitches after the surgery. This results in less risk of infection and complete freedom after the procedure. Outcome Vasectomy basically redirects sperm to be absorbed by the body rather than being ejaculated with the semen. Because of that, the concentration of the semen may be affected by a very tiny margin after the procedure. However, the ability to achieve an erection remains unchanged along with sexual characters, desire and the hormone level. The procedure is safe and most effective, but is considered permanent. It is a great option to those who are certain they want to stop having children. On the flip side, infections after the surgery may occur and, as in any other medical procedure, vasectomy does not protect one from sexually transmitted diseases. The usage of condom is still

Where it stands Vasectomy may not be the best option for the younger generations. Even surgeons are usually reluctant to operate on youngsters as other contraception means can be used by the young and sexually active. The surgery is considered permanent once it is done. Although there are ways to restore the man’s fertility, the success rate is the same as the failure rate taking it to a good 50-50 split. Over time, the success rate decreases, additional blockage can be formed and some men develop anti-bodies to their sperm, which will only further the complication of the reversal. Before calling for an appointment for a vasectomy, it is advisable to get your partner’s consent. Counselling services are provided in certain medical centres if the patient requires it. All in all, certainty is compulsory when the decision is made and the surgery may not be for you if it is not your decision.

pharmaceutical industry has managed to create experimental male contraceptives, the drawbacks of the compounds have prevented such drugs from being marketed. One, for example, effectively inhibits fertility but isn’t soluble enough to be taken orally. “No one wants to inject themselves with a needle once a day or once a week for most of their lives,” says Jillian Kyzer, a researcher of the team. Another existing experimental

compound is suitable for oral administration but isn’t very selective in terms of cellular targets in the body and could cause side effects. T h e scientists are gaining improved understanding of how minor modifications to the chemical structure of these test compounds can affect cellular interactions in the body. A first modification allowed them to obtain more soluble compounds. Another tweak then improved the stability of the compounds, so they would last longer in the body. However, these two modifications in turn reduced the compounds’ action on fertility receptors. – AFPRelaxnews

Male birth control pill one step closer to reality Researchers have been trying to design a male contraceptive pill for years. The drug could now be a step closer as an American team from the University of Minnesota College of Pharmacy has announced progress in the chemical formulation of a contraceptive drug. Although a hormonal birth control pill for men isn’t likely to come to market anytime soon, American researchers have presented promising new findings in the domain at the 251st National Meeting & Exposition of the American Chemical Society. Male contraceptive drugs work by bringing an excess of testosterone or another hormone (progesterone) to the body,

effectively tricking the pituitary gland into suppressing the secretion of hormones (FSH and LH) and stopping the production of sperm. Making the right modifications Scientists at the University of Minnesota College of Pharmacy have focused on developing a soluble compound that starts working quickly and doesn’t reduce libido. The contraceptive also needs to be safe to take long term – potentially for decades – while maintaining a reversible effect on fertility in case users hope to have a child. The team’s research was based on existing formulations that have remained at test stage. While the

MALE PILL: Birth control contraceptive pills for women have been available for decades, and it looks men may not have to wait that long for a similar hormonal birth control pill.

recommended to further protect oneself from said risks.

WOMEN+

2016 | maY

• 23

Humour may help, but menopause no laughing matter Emotional symptoms of natural biological process may trigger anxiety or feelings of sadness and loss By Huang Ruifu

enopause the Musical has helped women laugh at the lifedisrupting effects of menopause symptoms for 15 years. Debuting in Orlando, Florida, on March 28, 2001 at a 76-seat theatre that once housed a perfume shop, the iconic musical tells how four disparate women shopping for lingerie at Bloomingdale’s find they are united by their shared experience of hot flashes, night sweats, mood swings and memory fog. Women of all ages, but especially those going through menopause, have flocked to performances of the musical. Each show features 25 songs about chocolate cravings, hot flashes, memory problems, nocturnal sweats, body image and sexual predicaments. The lyrics parody popular tunes, with titles like “Stayin’ Awake” and “Puff, My God I’m Draggin”. For many women, menopause is no laughing matter, although some medical experts say humour can help women with the transition. According to Mayo Clinic, menopause is defined as occurring 12 months after your last menstrual period and marks the end of menstrual cycles. Menopause can happen in your 40s or 50s. Menopause is a natural biological process. Although it also ends fertility, you can stay healthy, vital and sexual. Some women feel relieved because they no longer need to worry about pregnancy. Even so, the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt your sleep, lower your energy or – for some women – trigger anxiety or feelings of sadness and loss. Don’t hesitate to seek treatment for symptoms that bother you. Many effective treatments are available, from lifestyle adjustments to hormone therapy.

Symptoms In the months or years leading up to menopause (perimenopause),

you might experience these signs and symptoms:  Irregular periods  Vaginal dryness  Hot flashes  Night sweats  Sleep problems  Mood changes  Weight gain and slowed metabolism  Thinning hair and dry skin  Loss of breast fullness It’s possible, but very unusual, to menstruate every month right up to your last period. More likely, you’ll experience some irregularity in your periods. Mayo Clinic says skipping periods during perimenopause is common and expected. Often, menstrual periods will occur every two to four months during perimenopause, especially one to two years before menopause. Despite irregular periods, pregnancy is possible. If you’ve skipped a period but aren’t sure you’ve started the menopausal transition, you may want to determine whether you’re pregnant. When to see a doctor Starting at perimenopause, schedule regular visits with your doctor for preventive healthcare and any medical concerns. Continue getting these appointments during and after menopause. Preventive healthcare can include recommended screenings at menopause, such as a colonoscopy, mammography, lipid screening, thyroid testing if suggested by your history, and breast and pelvic exams. Always seek medical advice if you have bleeding from your vagina after menopause. Causes According to Mayo Clinic, menopause can result from:  Natural decline of reproductive hormones. As you approach your late 30s, your ovaries start making less estrogen and progesterone – the hormones that regulate menstruation – and your fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until

FALLING LEAVES: Thinning hair is one of the move visually prevalent sign of menopause.

eventually – on average, by age 51 – you have no more periods.  Hysterectomy. A hysterectomy that removes your uterus but not your ovaries (partial hysterectomy) usually doesn’t cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But surgery that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause, without any transitional phase. Your periods stop immediately, and you’re likely to have hot flashes and other menopausal signs and symptoms, which can be severe, as these hormonal changes occur abruptly rather than over several years. 0 Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures may still be desired.  Primary ovarian insufficiency. About 1% of women experience menopause before age 40 (premature menopause). Menopause may result from primary ovarian insufficiency – when your ovaries fail to produce normal levels of reproductive hormones – stemming from genetic factors or autoimmune disease. But often no cause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones. Complications Mayo Clinic notes that after menopause, your risk of certain medical conditions increases. Examples include: 0 Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. So it’s important to get

regular exercise, eat a healthy diet and maintain a normal weight. Ask your doctor for advice on how to protect your heart, such as how to reduce your cholesterol or blood pressure if it’s too high. 0 Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Post-menopausal women with osteoporosis are especially susceptible to fractures of their hips, wrists and spine. 0 Urinary incontinence As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). You may have urinary tract infections more often. Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve symptoms of incontinence.  Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido). Mayo Clinic says water-based vaginal moisturisers and lubricants may help, and recommend products that don’t contain glycerine because women who are sensitive to this chemical may experience burning and irritation. If a vaginal lubricant isn’t enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet or ring.  Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. Mayo Clinic recommends women to eat less and exercise more, just to maintain their current weight.

24 •

WOMEN+

mAY | 2016

Drugs shield infants from HIV in breastmilk Anti-AIDS medications significantly reduce babies’ risk of contracting killer virus

iving anti-AIDS drugs directly to infants breastfed by their HIV-positive mothers significantly reduces their risk of contracting the killer virus, say researchers. Less than 1.5% of children, given one of two anti-viral drugs during 12 months of breastfeeding, caught the virus from their mothers, according a study published in The Lancet medical journal. This was the first study to assess the effectiveness of AIDS drugs to prevent mother-to-child transmission in infants breastfed for longer than six months. Breastfeeding, especially in poor countries, is one of the best ways to improve infant survival, but is also an avenue for women to pass the AIDS-causing virus on to their infants. The latest findings will feed into an ongoing debate which stacks the nutritional benefits of breastfeeding up against the risk it holds for transmitting the virus which causes AIDS. The World Health Organisation

(WHO) recommends that HIVpositive women, especially in developing countries, breastfeed their infants for at least 12 months – the best way to get the nutrients they need and avoid serious illnesses such as diarrhoea and pneumonia. When the mothers themselves were taking antiretroviral (ARV) drugs, the risk of transmission is about 0.2% per month – thus 2.4% in total over 12 months of breastfeeding. But when special child ARV formulations were given to the baby directly, the risk was about 1.5%, the study reveals, which involved some 1,200 children in Burkina Faso, South Africa, Uganda, and Zambia. The study was done before the UN’s health organ decided earlier this year that all people living with HIV should be given ARVs regardless of the level of CD4 immune cells in their body – a measure of HIV progression. Previously, ARV treatment had been recommended from a level of about 350 cells per cubic mm – compared to about 500-1,200 in a

healthy person. The researchers tested two drugs given directly to the infants – lamivudine and lopinavir – and found they were equally effective. Prolong infant treatment Existing treatments help infected people live longer, healthier lives by delaying and subduing symptoms, but do not cure AIDS. Many people in poor communities do not have access to the life-giving drugs, and there is no preventive vaccine. “This finding justifies the extension of infant pre-exposure prophylaxis until the end of HIV exposure” through breastfeeding, the study authors say. And they highlighted “the

need to inform mothers about the persistent risk of transmission throughout breastfeeding to prevent them stopping giving the treatment to their babies too soon.” The team found that most of the HIV infections in the study groups were due to treatment being stopped. To this end, more research was needed for a more palatable baby medicine, or potentially longacting injectable drugs. Thirty-nine million people have died of AIDS, according to UN estimates, and about 35 million are living with the immune system-destroying virus today, overwhelmingly in poor countries. – AFPRelaxnews

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Cranberry juice-ocean spray What is cranberry?

Cranberry (vaccinium macrocarpon) is a native plant of North America, well known for its high antioxidants content. Antioxidants are useful substances that can help to reduce damage caused by free radicals in the body. The proanthocyanidins found in cranberries have the effect of anti-adhesion on bacteria which helps to block harmful bacteria and prevent E.coli bacteria from adhering to patient’s cell membrane.

What are the functions of cranberry juice?

Cranberry juice contains large amount of vitamin C, salicylic acid, water and important nutrients for the human body such as calcium, magnesium, iron, phosphorus, sodium, potassium and zinc,

Vitamin B6, Vitamin E and Vitamin K. It works as a natural anti-biotic which helps to improve the metabolism of the body and strengthen immunity. Cranberry juice is able to reduce the risk of urinary tract infection (UTI) by forming a layer of protective film on the bladder and urinary tract.

Who are the main target markets?

Many people have the habit of holding in their urine, which can lead to urinary tract infection. According to a report by Women’s Health Association of Taiwan, up to 30% of women are diagnosed with UTI while pregnant and 40% of them show sign of relapse. UTI commonly happens to mothers and their foetuses, causing premature birth, low birth weight and other complicated diseases.

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Precautions

For health purposes, the recommended consumption rate is 300ml of cranberry juice for the average person and two

glasses of 250ml for former patients. However, cranberry juice has high acidic content, so some people may experience diarrhoea, stomach upset and other side effects. Talk to your d o c to r fo r more information.

OPINION+ JUNIOR+

2016 | maY

• 25 JUNIOR

By Dr Ling Shih Gang

Discipline in children:

hen I was young, I recalled witnessing a friend being disciplined by his father. His father, a traditional “Chinaman” and strict disciplinarian, punished his son by making him kneel before him and in front of his peers. The father had no qualms about using the cane on his son whenever he misbehaved. My friend has since grown up and has his own family. Now the father of a child, he believes what his father did to him had caused emotional trauma, and he does not want the same thing to happen to his child. Instead, he believes in being gentle with his child and provides freedom to her to do what she wants. He has resolved never to punish her, but to guide her with kindness and love. Over one generation, the pendulum has swung from a form of discipline that is harsh and strict to one that is gentle and mild. It is no wonder that parents become confused about the best means to instil discipline in their children. Discipline is defined as training that corrects or moulds moral character. It is a form of external force that is exerted on a child to form his character. When a child is young, this external force is required to guide him in the right direction. When properly applied, this external discipline can propel the child to develop internal or self-discipline when he is older. Gradually, less external discipline is required as the child develops more internal discipline. Back to basics So, how best can we provide discipline to our children? Over the years, various techniques have been recommended by different authorities that promise to produce well-behaved children. However, some techniques can be applicable in a particular situation or culture but not in another. What is truly required is to come back to basic principles that are true and unchanging. These principles are applicable in any and every situation and transcend cultural differences. When such basic principles are applied to

any situation, techniques that are most suited to that situation and in harmony with those principles can be borne forth. This article focuses on five important principles that are most applicable in providing the right kind of discipline to our children. 1. Love Discipline is often seen from a negative viewpoint. However, the act of disciplining a child is indeed an act of love. Many parents want to be popular and liked by their children and avoid causing pain to them through discipline. However, the little pain that children experience through discipline could spare them immeasurable suffering in future. Your children will thank and appreciate you in future for loving them through firm discipline.  Communicating love through discipline Discipline is not merely an act of love – discipline must also be felt by the child to be an act of love. Parents certainly do love their children, but this need not necessarily mean that the children would automatically feel loved by their parents. Parents who discipline in a fit of rage with harsh words would certainly not communicate love to their children. Instead parents need to remain cool when disciplining their children. Sometimes a gentle arm around the child’s shoulder while

The Young Ones

Back to basics – part 01

explaining a wrong behaviour before punishment or words of affirmation and kindness after punishment can make discipline as it really should be – an act of love. If for any reason, a child responds negatively to discipline, parents need to evaluate their own attitude, tone of voice and body language. Then ask the question: “Have I communicated love when I discipline my child?”.  Communicating love through daily routines If parents take the effort to communicate love to their children every day, relationships are strengthened. Children will trust their parents and know that even when they are being punished, their parents mean well. In addition, these deposits of love will bring about less behavioural problems from the children because it would hurt them so much to grieve their parents through their disobedience. 2. UNderstanding Parents need to understand the abilities of their children according to their developmental age. For example, a two-year old child cannot be expected to dress himself but a six-year-old child should be held responsible to dress himself every morning. It is certainly not appropriate to discipline a child for failing to do something beyond his ability. Parents also need to understand the intentions of the child when he does something wrong. Sometimes, a child commits an offence out of sheer ignorance, forgetfulness or clumsiness. The child never intended to disobey. In such instances, it would be more

Sometimes a gentle arm around the child’s shoulder while explaining a wrong behaviour before punishment can make discipline as it really should be – an act of love.”

reasonable to issue a reminder, explain the rules and teach again. At other times, he may attempt to disobey by testing the boundaries. When the child has intention to disobey, whatever agreed-upon punishment for the offence must be carried out. Some children deliberately break rules in full view of their parents. They not only have intention to disobey, but also the intention to defy and challenge their parents’ authority. This is among the highest level of offences and must be dealt with the strictest punishment without delay. Does your child understand you?  Understanding the rules Clear boundaries and rules are important to a child and must be made known to them. Discipline cannot be enforced when no clear rules are in place. However, most parents often assume their children will automatically know the rules without explaining them to their children. Some rules which are obvious to a parent may not be obvious to a child. For example, burping in public may be obviously impolite from the parent’s point of view but this may not be so to the child unless someone tells him so. Rules must also be explained in a manner that is easy for the child to comprehend.  Reminding children about rules It is sometimes necessary to remind your children of specific rules particularly when they are in situations where breaking the rules become more likely. For example, before bringing your children to visit a friend in hospital, you can remind them not to run about or shout during the visit.  Explaining an offence Even when a child has committed an offence, it is essential that parents explain what wrong he has done before any disciplinary action is taken. Quite often, children may not be aware that they have committed an offence. DR LING SHIH GANG is a consultant paediatrician at Tropicana Medical Centre.

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JUNIOR+

maY | 2016

Inculcating healthy eating habits in children Family meal time is key to preventing child obesity

By Syed Zaid Syed Osman

t is official – Malaysia is the “fattest nation” in Asia. With the diverse array of high cholesterol food served in almost every other restaurant, no wonder Malaysians continue to grow in size, usually sideways though. A whopping 18% of the population are considered obese while 30% are overweight, which means 13.4 million Malaysians are out of shape. From observation alone, we can quite accurately deduce that the epidemic “recruits victims” at a very young age. We often see children suffering from obesity and, in many instances, are too young to grasp its inherent health risks. The sad part is some parents think that is only “baby fat” and will soon be gone. The truth is, it usually won’t – an overweight child is likely to grow up to be an overweight adult. According to Rozanna M Rosly, head of dietetic services of University of Malaya Specialist Centre, body mass index (BMI) can be used as one of the tools to assess and determine childhood overweight and obesity. “Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex,” she says. A study done on Malaysian primary school students showed that those who are overweight and obese are usually boys aged between 2 and 17 years old. Child obesity rate is the highest among Indians, followed by Bumiputera of Sabah and Sarawak, Chinese and Malay. The prevalence of obesity is similar in urban and rural areas. Complications The young ones are exposed to

 Physiological causes Children are more likely to be overweight or develop type 2 diabetes if their mothers are diabetic, and who themselves are also more likely to be obese. Besides, low birth weight (below 2.5kg) is a risk factor for child obesity as shown in several epidemiological studies.

higher risk of developing heart complications, hypertension, high cholesterol, and type II diabetes mellitus. Besides, their physical appearance may cause psychosocial disturbances, like low self-esteem, which in turn leads to behavioural problems. The actual reason for child obesity is still unknown but studies suggest it is mainly due to genetic or hereditary, hormonal, prenatal and dietary factors. Child obesity must be tackled early through diet modification and physical activities for optimal growth and development. If these are neglected, the problem is likely to persist into adulthood. Causes Rozanna tells Health+ obesity is generally caused by an imbalance between energy intake and energy expenditure. “When energy intake is more than energy expenditure, it results in a positive energy balance which results in weight gain. This is mostly associated with a sedentary lifestyle and unhealthy food intake or food practices. However, when one’s energy expenditure is more than the energy intake, it results in a negative energy balance which will result in weight loss.” The key contributing factors are:  Food choices With multi-flavoured munchies to match our multiracial culture, it’s so easy and tempting for both adults and children to overeat. High-calorie meals are often chosen over fruits and vegetables.  Physical activity Technology often distracts children from leading active lifestyles. Participating in activities, such as watching television, consumes less energy than physical ones.  Obese or overweight parents Children of obese parents are more likely to be overweight themselves. There is an inherited component to childhood overweight that makes it easier for some children to become overweight than others.  Eating habits Skipping meals often leads to higher intake when the food is consumed.

Prevention practices For most children, their parents are their heroes. “The parents are the biggest role model for their children at this point of time,” says Rozanna. As the old saying goes, action speaks louder than word. “Be a good example. When you serve healthy and balanced meals, such as fresh fruits and vegetables, make sure you take them yourself too. When you purchase food, choose wisely and set an example for your child. Don’t encourage high calorie and fat foods and drinks, such as

Be a good sample. When you servehealthy and balanced meals, make sure you take them yourself too.” – Rozanna

EATING TOGETHER: According to research, a family who eats together are relatively healthier than those with separate meal times.

fast food, juices, chocolates, junk food and sugary biscuits.” According to research, families who eat together are relatively healthier than those with separate meal times. During family meal times, more green vegetables are eaten while consumption of soft drinks decreases. “In addition to that, parents should expose their children to a wide range of food from young. Do not be discouraged when children reject certain kinds of food as they may be new to them,” says Rozanna. Serve smaller portions to children. Don’t rush or force feed your children to finish their meals because they need time to determine for themselves the amount of food to consume. If your children continue to dislike the food served, try introducing it to them again at other meals for a few times. Take time to understand your children’s nutritional needs and meal intake when they are in school or nursery. Never skip meals, especially breakfast. Children are able to produce massive amount of energy, so use it as an advantage to help them understand the importance of being physically active. It is never too early to introduce your children to a healthy lifestyle.

JUNIOR+

2016 | maY

• 27

unheard of in a typical female illnesses plan, which usually imposes a waiting period for expectant mothers. Parents can also have peace of mind for their children should the unexpected occur to them. By taking up a rider called Parent Payor, Prudential will pay for your child’s plan if something unfortunate happens to you or your spouse so that his protection and future education fund will stay secure.

Insuring your kids’ future Life insurance addresses two key concerns of most parents – children’s protection and education

By ALI-AZMIN HASSAN

he value of life insurance for children has been a subject of some debate since its introduction years ago. While some might say such insurance is totally unnecessary as it seems morbid, useless and a waste of money, many see it as a useful way to ensure wealth and peace of mind. So why do it then? Simply, it is to ensure your child’s future insurability, Prudential Assurance Malaysia Bhd chief marketing officer Khoo Ai Lin tells Health+. “Even in today’s world where we generally experience greater improvement in public health measures, pregnancy can still pose some risks to expectant mothers and their unborn babies, especially when there are increasingly more women getting pregnant over the age of 35 or even 40, (despite the fact) the risk of pregnancy tends to increase with age. Hence, it is vital to ensure that both expectant mothers and their unborn babies are adequately protected during this crucial period,” says Khoo. To meet the growing need for children’s life insurance, Prudential’s PRUmy Child plan offers

complete protection for every stage of a child’s life, even before birth. It is the first to provide coverage during the crucial pregnancy and infancy periods. How does PRUmy Child benefit the child and his/ her future? PRUmy child is designed to address two main concerns most parents have – protection and education for their children. Not only does it provide comprehensive protection at every stage of the child’s life (as soon he/she is born), it also takes care of education needs by allowing the parents to plan and build (his/ her) education fund as early as possible to give (him/her) the head start in life. The potential danger in delaying insurance cover is that a person becomes uninsurable due to a change for the worst in health. PRUmy child is a regular premium investment-linked plan. When you buy this plan, you are given the option to attach either PRUsaver kid or PRUedusaver that will invest your premiums into Prudential’s series of PRUlink or PRUlink education funds. Do family members or parents benefit from the plan? Mothers can opt for additional coverage by taking up the Infant Care rider which is attachable to the plan. Medical costs arising

from pregnancy complications, such as eclampsia, abruptio placentae, or amniotic fluid embolism, are covered by (Prudential) paying out a lump sum. Another unique feature about Infant Care is that it is equally responsive to pregnant mothers’ needs and concerns, by allowing them to be covered immediately after the policy is in effect. This is virtually

When the child grows up, how would the transition be from PRUmy child to other insurance policies that you offer to adults? PRUmy child is essentially a lifetime protection plan for your child; coverage doesn’t stop after the child is born. In fact, it continues to provide protection during the child’s infancy period, through childhood, adulthood, and until (the age of) 100. It basically covers every stage of the child’s life. Ownership of the policy will be automatically transferred to the child upon reaching the age of 25. From that point onwards, all rights and obligations to the policy rest on the child.

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JUNIOR+

maY | 2016

‘Butterfly children’ need tender care DEBRA Malaysia on mission to help affected children and families cope with epidermolysis bullosa BY NORMAN HUSSAINI

pidermolysis Bullosa (EB) is a rare genetic skin condition whereby a child is born with extremely fragile skin. This means that minor mechanical friction or trauma can result in painful blisters because of the skin’s inability to correctly attach to the body. The fragility of the skin – as fragile as butterfly wings – is the reason sufferers are called “butterfly children”. Families whose children live with this condition carry a heavy responsibility due to the hardship in managing the condition. An international non-profit, nongovernmental organisation called Dystrophic Epidermolysis Bullosa Research Association (DEBRA) was created as a worldwide alliance to support patients with EB and their families. DEBRA has a strong presence globally with more than 50 member countries. In Malaysia, the association is led by its president Dr Leong Kin Fong, a consultant paediatrician at Hospital Kuala Lumpur. Health+ spoke to Dr Leong about the condition, how it affects people and what DEBRA is doing to support the families involved. As fragile as butterfly wings Describing the condition in greater detail, Dr Leong says: “EB is a genetic condition whereby the body cannot properly produce a certain kind of protein that glues together the outer layer (epidermis) of the skin with the middle layer (dermis). When there is deficiency of some of these ‘glue’ protein, the skin becomes unstable and can separate easily”. EB sufferers face a lifetime of pain as their skin can erupt in painful blisters over the slightest of friction. Repetitive blistering will then cause a plethora of

other risks for sufferers, such as infections, loss of mobility, disfigurement and even fatality. The inability to produce certain kind of protein is rare and is the fault of the sufferer’s genetic make-up. Therefore, EB is a condition with no cure yet. Treatment of the condition focuses solely on addressing its symptoms, such as itching, infection and wound care. Although EB is serious, not all sufferers face the same level of severity. “Some of them are mild to moderate. Certain people with EB may develop blisters in only certain parts of the body, while some can withstand a certain amount of friction or trauma before acquiring blisters,” explains Dr Leong. Its prevalence As rare as EB is, there is quite a number of patients in Malaysia. “We don’t have any national data on EB, but based on WHO (World Health Organisation) estimates, we have about 200 to 250 children with EB – with five to 10 new cases each year,” he says. DEBRA Malaysia was established in 2014 and in just two years, Dr Leong has worked

tirelessly with his team to collect as much data as possible of the condition locally. “We manage to gather around 75 EB patients throughout Malaysia under the care of DEBRA, which is about 15-20% of the estimated total.” Burden of families with EB children Due to the nature of the condition, families must closely care for their children. Their butterfly children are in need of continuous changing of bandages, strict protection from even the slightest physical contact and stupendous amount of patience. One can only imagine the pain that these families go through every day to keep their children from any harm. DEBRA’s helping hands DEBRA Malaysia is seeking donations to help families of children living with EB. Dr Leong along with other experts had recently published their second book titled “Atlas of Paediatric Diseases: Cutaneous Fungal & Atypical Bacterial Infection” to help doctors in Malaysia be more acquainted with various conditions in children. With the help of Kotra Pharma Malaysia, the book also includes a link to donate to DEBRA to help the families. The company has pledged to match every ringgit donated to DEBRA to further support the movement. Besides supplying trained nurses and helping families to manage their EB children, DEBRA also provides training to their parents to ensure the best care is given. A large part of caring for the children with EB is bandaging their bodies so that they can wear clothes and are protected at least from minor physical friction. Therefore, DEBRA also supports families by supplying them with a specialised, silicone-based atraumatic dressing to minimise injuries. “Normal bandages will cause more damage to the body surface of a child with EB. Without the specialised dressing, the wounds will never heal correctly which can harm the children further,” explains Dr Leong. DEBRA is also looking at advocating to employers to grant a monthly two-day leave of absence to working parents with EB children. “Apart from taking care of the children, we are looking to also lessen the burden of parents,” he says.

Care for children’s mental health deplorable in the UK The National Health Services (NHS) in UK was recently condemned by general practitioners (GP) as well as the public for their inadequacy to give sufficient attention to children with mental problems. A report reads; “GPs say that, although growing numbers of youngsters are struggling with crippling conditions such as anxiety and depression, many in need of urgent support are missing out because rationing of care means that they are not ill enough to qualify.” There is a certain level of severity patients are to exhibit before adequate help can be given, which resulted in an uproar. A survey of 300 GPs in England has raised particular concern about the availability of NHS help for children aged 11 to 18 who are self-harming. While 61% of GPs are seeing more such cases than five years ago, 83% describe services as either inadequate or totally inadequate. The general consensus among GPs is that there is an immense worry towards young people harming themselves while waiting for treatment. This is because children who doesn’t exhibit enough symptoms to be recognised as having mental illness are not getting earlier help. “I feel mental health services for patients at this age are woefully inadequate. The few patients we manage to get seen still have to wait for often over a year,” a GP had reportedly said. While another said; “It is appalling that someone who has asked for help needs to wait up to six months for any intervention I can provide in a secondary [hospital] setting. Only the most severe get any help.” The issue is due to the short funding of child and adolescent mental health services (CAMHS) of the NHS, and had been a let-down for parents according to a survey involving 1,000 families. A news report had described one particular woman in the UK who had her clinically-depressed daughter denied follow-up treatment after being admitted for attempted suicide. There has been mounting concern among mental health professionals that a shortage of funding has led to CAMHS raising the thresholds for treatment. A report last month found examples of young people being turned away from treatment for anorexia where a child’s weight was not considered low enough, suicidal thoughts, and hearing voices that did not “command particular behaviours”. The issue is still in development and are still not at a closing stage. The technological advancement young people are exposed to now bring about a culture of which there are no sufficient research had gone into. Mental illnesses are exacerbated through social media and the presently dangerous ‘trophy culture’.

2016 | maY

Sculpting body exudes confidence Men’s Skin Centre promises to get rid of that stubborn fat and make you look great again BY ALI-AZMIN HASSAN

hen it comes to working out and losing weight, there’s always that extra hard fat that is really stubborn to be rid of, at least for some of us. You know what I mean, like those not-so-lovable love handles! It’s not to say a more rigorous workout won’t help you lose that hard fat, but there’s absolutely nothing wrong with a little extra boost or treatment to get rid of it. Ever heard of tummy sculpting, perhaps? Men’s Skin Centre (MSC) has been in the market for over 34 years, entrenching itself as the leader in the men’s skincare industry. It has a team of professional consultants and is well equipped with skincare and grooming equipment. Health+ got in touch with the centre to find out more about tummy sculpting and how it can help sculpt your body to look fitter and increase your confidence. If you are looking for a body-contouring procedure that won’t leave you dealing with weeks and weeks of post-operative healing, MSC’s body sculpting treatments offer just that. The whole procedure is divided into three stages to help one obtain that healthy-looking physique. The three-stage slimming treatments break and drain fats, and also to firm and tone flaccid muscles and tissues. The first stage is burn, but don’t worry as there’s no fire involved. This method involves several treatments, such as radio frequency precision sculpt, acoustic wave lipo therapy, fizzy cocoa thermo therapy, power physique wrap and power guam fat burner. Radio frequency precision sculpt delivers energy to precise locations of the body to improve the proportions. It is a proven safe and effective way to help with fat combustion. Deep tissue will be heated to 40-420C to induce fat combustion and enhance lymphathic drainage system. The second stage is detox/drain, which is used to drain fatty acids, glycerols and toxins, after the fats are broken down. The treatments include tri-active body sculpting therapy, high performance drainage therapy, marine detox therapy, intense thermal wrap

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and seaweed thermal therapy. For example, tri-active body sculpting therapy combines the effects of scrub, massage and serum to reduce fatty tissues, boost blood and lymphatic circulation, improve cell metabolism, eliminate toxins and enhance general well-being. The other treatments can help to eliminate toxins, soften stubborn fat, speed up metabolism, tone and tighten flabby skin, and more. And finally, the most vital part of the process is sculpting, which is to firm and tone your flaccid muscles and tissues. This final stage is all about tightening the skin and toning the muscles. The radio frequency precision sculpt

is brought into play again to heat and stimulate bulk production to give firmer and more toned midriff. Some people have the misconception that body sculpting is a shortcut to lose fat without sweating. However, as a matter fact, even with body sculpting, exercising is crucial for you to lose weight and get that perfect body. Body sculpting is but a means to enhance and improve your process of achieving that goal. Denying what is effectively helpful is a waste of potential, especially when it comes to the things that can benefit your health without any moral conflict.

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BEAUTY+

maY | 2016

Shedding some light on Botox As procedure gains popularity by the day, it’s still shrouded in cloud of misconceptions

otox is among the most popular aesthetics procedures. Although the procedure has been around since the 1960s, public misconceptions still abound. The name “Botox”, for instance, is wrongly perceived by many – it’s a brandname and does not describe the procedure generally. Dr Hew Yin Keat, president of the Malaysian Society of Aesthetic Medicine and a pioneer in aesthetic practice in Malaysia, explains to Health+ how Botox came to be and some misconceptions about it. How it came to be “Botulinum toxin is a neurotoxic protein produced by the bacterium clostridium botulinum. Originally discovered as the cause for deadly fo o d p o i s o n i n g s during the 1800s, the bacterium was studied extensively over the years and had found its uses in the field of medicine,” explains Dr Hew. “Of the various toxins d e r i v e d from the bacter ium, botulinum toxin type

A was found to be the most useful to be used in medicine. The toxin was initially used to treat muscle spasm around the eyes and muscle twitching in people with cerebral palsy.” So Botox has been widely used in the field of medicine for some time before being used in aesthetics. “It became noticed as an aesthetic treatment when ophthalmologists injected the toxin in the eye area and found that not only did it treat the twitching of the eye, but the wrinkles around the eye also seemed to reduce. That was the start of it basically,” says Dr Hew. Aesthetic uses Following the discovery of the toxin’s uses in aesthetic medicine, practitioners over the years have identified areas of the body that are safe to inject the toxins. According to Dr Hew, there are only a few areas of the face that are safe to augment by using the toxin. “The toxin has gone into a titration process where the right dosage is identified for safe use. Because just

like anything, too much of it can cause negative response,” he adds. Misconceptions As mentioned earlier, Botox unwillingly carries with it a bag of misconceptions through the years. “Bad news always sells better, that is why we always hear bad things about Botox. There are cases where the treatment had resulted in infections and undesirable effects, but those mostly happen when there is mishandling of the toxin by unqualified practitioners or unsolicited toxins,” says Dr Hew. He says there have been many studies done on Botox proving its safety when the right dosage is used. New developments Dr Hew shares with Health+ discussions of recent developments on Botox at a recent conference which he attended. “There are currently trials on topical Botox (where the toxin is no longer injected into the skin rather applied to the surface only), the use of other types of toxins for similar treatment and the use of the toxin to potentially treat a wide range of other conditions.” In a nutshell, proper dosage of Botox coupled with doctors’ proper techniques creates safe and less

wrinkled skin. The mishandling of the toxin, on the other hand, can lead to undesirable and sometimes dangerous results. The positive thing about the treatment, however, is that it is not permanent. “The dosage of the toxin used for aesthetics is very tiny, so even if it manages to give someone abnormal expression or even mild paralysis of the face, it will still not cause much harm. Moreover, the effect will wear off completely after about six months,” he says. From Dr Hew’s sharing, what can be extrapolated is that the most important factor in relation to Botox treatment comes down to how well the aesthetic practitioner is trained. Dr Hew owns and runs the Malaysian Aesthetic Clinic, one of the pioneering clinics in Malaysia that offers non-invasive and minimally invasive aesthetic procedures. The Malaysian Society of Aesthetic Medicine, in partnership with the Health Ministry, is responsible for the development of guidelines for practitioners of aesthetic medicine. And as the president, Dr Hew says proper knowledge of guidelines and techniques by doctors ensure quality aesthetic practice.

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Suresign ovulation test shows the sure signs Have you ever felt the need to know when is the right time to try? Or maybe you want to know whether your chances to conceive are good? With the fertility rate in the country declining little by little, perhaps it is best to prepare properly so that you can start a family and raise your child. The Suresign Ovulation test detects the release of Luteinsing Hormone (LH) prior to ovulation and is a positive indication for the best time for conception. Older

women, especially, may find it more difficult to conceive. Yet with this test, it helps to target the most fertile period of the month. The test is a rapid, onestep lateral flow immunoassay and is conducted by urinating on the absorbent tip or immersing it in urine. The results are obtained from the coloured lines. The easy-to-use device is packed together with five test strips to maximise the best period for conception with full

instructions included. It can be used both as midstream and dip test. The test detects LH in urine at 35mlU/ml or higher. If you are worried about damaging the product, don’t be. Each strip is individually wrapped

to prolong shelf-life and allows the customer flexibility of use. It is tested to the highest standard with 99% accuracy. The ease of use is only matched with how simple the test is, as the results can be obtained in 10 minutes.

EYE+

2016 | maY

MAKE OR BREAK: Contacts lenses are useful to assist the user’s vision but if abused, they could do the exact opposite.

Seeing through the lenses Contact lenses are safe and useful but they need to be worn responsibly to avoid complications

By SYED ZAID SYED OSMAN

s you can see, the world has been taken over by the style in wearing eyeglasses. Apar t from just appearing smart and sophisticated, eyeglasses are worn by people as a fashion statement while helping to correct their vision. The same concept has since been adopted to create contact lenses, which are basically frameless eyeglasses placed on the eyeballs. Besides being so convenient to those with active lifestyles who appreciate the freedom of not having a frame dangling in front of their faces, contact lenses are widely worn by those who truly value beauty. Colourful lenses are created to further the aesthetic property of contact lenses and variations of size and pattern are up to each wearer. As they say, beauty lies in the eyes of the beholder. There are two kinds of lenses commonly known to the public. The hard lenses, or commonly known as rigid permeable gas contact lenses, retain their shape on the eyes. They promote oxygen

flow in the eyes and have lower risk of infections. Soft lenses, however, are easier to wear, more comfortable and, most of all, come in many different colours and fun designs. Soft lenses come in daily use, monthly and extended use. Dr Michael Law Sie Haur, consultant ophthalmologist and cornea specialist at the International Specialist Eye Centre (ISEC) acknowledges the effectiveness of using contact lenses in daily lives. “They are very safe and useful, but they have to be worn responsibly,” he cautions wearers. He insists the lenses are tools and not “replacement organs” for damaged or flawed eyes. With that in mind, contact lenses are to be worn under strict discipline. The effect of negligence in maintaining contact lenses can be very painful and expensive. “Be reminded to always seek the consultation of a practising optician, optometrist or ophthalmologist before changing to contact lenses from eyeglasses,” he says. Contact lenses may be made suitable for everyone, but there

• 31

may be some factors that make them unsuitable for some to wear. The risk of abusing instructions includes loss of vision, infection in the eyes, scarring on the cornea and other damages to the eyes. “Those with dry eyes and young people who are not ready for the responsibility are not suitable to wear contact lenses,” he says. “Pregnant mothers are reminded to take extra cautious steps because their treatment involves a good amount of drugs.” More and more people are wearing contact lens these days. To meet the growing demand, low quality and uncertified contact lenses are distributed to novelty shops, night market and online establishments. These lenses may damage your eyes even if worn and cared for properly. Take for instance the worldwide Fusarium keratitis outbreak in 2005 which was a shocking discovery. “The sudden and alarming epidemic outbreak was finally traced to the introduction of a new type of contact lens cleaning solution that unexpectedly allowed the growth of this otherwise rare fungus in the contact lens cases, which ultimately resulted in a severe fungal cornea ulcer infection in some contact lens users ,” says Dr Law. Over 200 cases were reported to the United States Disease Control and Prevention, while another 66 was reported in Singapore, China, India, Malaysia, and other European countries. The total number of cases worldwide is still unknown. Parasitic amoebas like acanthamoeba are also a rare, but serious cause of cornea infections in contact lens wearers, and are known to breed in damp places and what better place is there than the inside of the contact lens cases. Never wash your used contact lenses with tap water instead of the disinfecting contact lens cleaning solution.

The residual water on the lens casing creates a good environment for the single celled organism to multiply and thus be transferred onto the stored contact lenses stored within. It goes without saying that you should never sleep, swim or even shower while wearing contact lenses. Then again, the usage of contact lens can take a toll on your eyes due to the long-term exposure. Dr Law says there are some cases where patients develop allergy towards the lenses. In addition, the damage can also be in the form of inflammation, dry eyes, and sensitivity. If you have any of these symptoms, consult your optometrist or ophthalmologist immediately to seek medical attention. Be reminded that contact lenses have expiry dates. According to the type, one may be longer than the other and always respect the lifespan of the lenses. Wearers must be aware that some contact lens cleaning solutions and brands of lenses may have different compatibilities which can initiate the possibility of a chemical reaction in their eyes. Always check with the local optometrist or the ophthalmologist for certainty. “Make sure you wear them responsibly. Be sure to understand the proper care of the lenses and always follow the instructions given by the optician, optometrist or ophthalmologist,” says Dr Law. “They are useful to assist the user’s vision but if abused, they could do the exact opposite.” At the risk of sounding like a broken record, prevention is always better than cure. Most infections can be prevented with proper maintenance of your lenses. Be alert to the duration of wearing and the expiry date. Besides your lenses, proper handling and replacing of the lens cases are vital. Replace them after a month or two and throw the last case away.

Be reminded to always seek the consultation of a practising optometrist or ophthalmologist before changing from eyeglasses to contact lenses.” – Dr Law

32 •

EYE+ OPINION+

maY | 2016

EYE

By Dr Choong Yee Fong

Strabismus: The squinting problem

Types of strabismus There are many different types of strabismus. Strabismus is most commonly described by the direction of the eye misalignment. The common types are esotropia (convergent squint), exotropia (divergent squint), hypotropia (eye is lower than the fellow eye) and hypertropia (eye is higher than the fellow eye). Of these, exotropia is the most common in Malaysia. Strabismus is often present at birth, but is only noticed later in childhood. Older adults can also develop strabismus. The extraocular muscles are responsible for the movements of the eye. These eye muscles can be weak or paralysed, thereby causing strabismus. Some common examples are sixth cranial nerve palsy and fourth cranial nerve palsy. Special patterns of strabismus can have unique names such as Brown syndrome and, Duane syndrome. Types of horizontal strabismus Esotropia is inward turning of the eyes (crossed eyes), and include infantile esotropia, accommodative esotropia and sixth nerve palsy. Exotropia is a term used to describe outward turning of the eyes, and include intermittent exotropia, constant exotropia and third cranial nerve palsy. Types of vertical strabismus The terms hypertropia and hypotropia are used to describe vertical misalignment. Hypertropia is an abnormal eye higher than the normal eye. Hypotropia is where the abnormal eye is lower than the normal eye. These types of strabismus are generally less common than horizontal strabismus. Causes Most childhood onset strabismus is the result of an abnormality of the poorly understood neuromuscular (including brain) control of eye movement. Less commonly, a

Look And See

trabismus is any misalignment of the eyes where they do not line up in the same direction. It is estimated that 3-4% of Malaysians have this eye condition.

problem with the actual eye muscle causes strabismus. Adult-onset squint is usually acquired and may be caused by muscle paralysis due to stroke and traumatic nerve or muscle injury. Poor vision Eye misalignment can cause amblyopia (lazy eye) in children. When the eyes are oriented in different directions, the brain receives two different visual images. In children, the brain may ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. Also, there is a tendency that an eye that sees poorly develops misalignment. Causes in children Strabismus is more common in family with a history of squint.

However, the vast majority of strabismus occurs in children who are otherwise completely normal and have no family history. Conditions that affect the brain such as cerebral palsy, Down syndrome, hydrocephalus and brain tumour, are more likely to develop strabismus. Poor vision or an abnormal eye may also develop strabismus. Causes in adults Stroke is the leading cause of strabismus in adults. Trauma, neurological problems, and Graves disease (thyroid eye disorders) are other common causes of strabismus. Treatments The goal of strabismus treatment is to improve eye alignment which allows for better work together (binocular vision). It is important to treat strabismus early to have the best outcome. Treatments may involve eye glasses, eye exercises, prism, and/or eye muscle surgery. Problems associated with strabismus (including amblyopia, ptosis, and cataract) are usually treated prior to eye muscle surgery. Dr Choong Yee Fong is a consultant ophthalmologist and eye surgeon at International Specialist Eye Centre Malaysia.

The future for wearable eye tech Technological advancement had taken a staggering step forward in recent years, with more and more tech we usually see in movies coming to reality. In 2014, Google came up with a project to help diabetics keep their glucose in check. If that seems a bit mundane, it is actually far from it. The smart contact lens project – as the name entails – is a set of contact lenses which will be able to measure glucose levels in tears using a tiny wireless chip and miniaturized glucose sensor that are embedded between two layers of soft contact lens material. In early April of this year, the Korean tech giant Samsung had patented a design that disclosed a contact lens which houses a tiny camera. Further, a wearer can control that with the blink of his eyes. Although only a patent for a design of a contact lens surfaced, it wouldn’t be long for Samsung to come up with a prototype. A life-long prodigy of the tech world, Sony had reported to develop a more extravagant version of contact lens to what Samsung had patented. It was reported late April that Sony’s version of their contact lens will be able to capture images and record videos. The best thing, it is able to store the images and videos and can be viewed directly with the lens. These ambitious projects from these three companies would have been met with pure scepticism and laughter not 10 years ago. Now however, it is not only a possibility, but has become an expectancy from the public.

TIP OF THE FINGER: The google representation of their lens project to help diabetics manage their blood glucose level. The effects of these wearable eye tech is still far from being a serious discussion among medical practitioners, but the need will soon come. Only time will tell of the health hazards it may pose to users. Recent introduction of Virtual Reality (VR) in video games had already put the health discussion on the table. VR gaming headsets such as Samsung VR, Sony VR, HTC Vive and the Oculus Rift are some of the prominent players in virtual reality. It was reported that large percentages of people experience stress or anxiety after wearing VR headset for more than a few minutes. Other negative physical side effects can include severe eyestrain, nausea and motion sickness.

dental+

2016 | maY

• 33

Brushing oral problems away Oral health among Malaysians is at an alltime low despite brushing our teeth everyday

By Norman Hussaini

r a l healthcare products are simple necessities. As part of our monthly spending , toothbr ush and toothpaste are some of the most basic items we reach for when we walk down the aisle of a supermarket. It is generally understood that brushing our teeth every day ensures good oral hygiene and helps us brighten the day with that award-winning shining smile. Yet, despite our understanding of oral health, the National Oral Health Survey by the Health Ministry showed that 98.3% of Malaysians are in need of better oral healthcare. If the figure comes as a surprise, then you are not alone. The statistics also show that 94% of the population has varied level of gum problems and 88.9% have cavities. Health+ met up with Dr Halina Haron of Halina Dental Clinic to talk more about proper oral healthcare. As a dentist with more than 25 years of experience, Dr Halina has treated many patients at her clinic in Bangsar, Kuala Lumpur. She found that many of them said they brush their teeth every day, yet still came with different oral problems. “I have a lot of patients coming in who felt surprised that they had gum problems and cavities despite

their daily routine of brushing their teeth. It is important to understand that it doesn’t matter if you brush your teeth once or five times a day. If the brushing technique is not proper, then you will have some kind of oral condition sooner or later,” she says. Ideally, we need to brush our teeth twice a day – in the morning and before going to bed at night. “Don’t ever sleep without brushing your teeth. This is because sleeping time is the best environment for bacteria to thrive as you don’t open your mouth often as well as the lack of saliva produced,” she explains.

FULLY EQUIPPED: Dr Halina’s dental clinic is wellequipped to treat various oral conditions due to improper oral care.

Good brushing technique Dr Halina stresses that proper brushing technique is essential to ensure better oral health. The first thing you know is the right type of toothbrush to use. There are three main types of bristles – soft, medium and hard. “The type of bristles (to use) is usually individual preference. Some are comfortable with soft bristles as they might have sensitive gums, while others prefer medium or hard as they feel more

comfortable with it,” she says. Dr Halina personally prefers a battery-powered toothbrush as she says it doubles the cleansing process. “A battery-powered toothbrush vibrates, so it promotes additional cleansing on top of the manual movement during brushing.” She says the movement we make during brushing explains the second important point in a good brushing technique – knowing the proper way to brush our teeth. It is safe to say most people are exposed to proper brushing techniques quite early, usually in primary school days. As a refresher, the toothbrush must reach every part of our teeth from the front side to the backside. “As a guideline, it is ideal to brush for a full two minutes every time. This ensures sufficient amount of cleansing,” she explains. Additionally, studies have also shown that brushing in a circular motion promotes better cleansing of the teeth.

It is important to understand that it doesn’t matter if you brush your teeth once or five times day. If the brushing technique is not proper, then you will have some kind of oral condition sooner or later.” - Dr Halina

Beware of gingivitis and cavities According to Dr Halina, two common conditions among her patients are: Gingivitis Gingivitis is a common and mild form of gum disease (periodontal) that causes irritation, redness and swelling of the gums. Because gingivitis can be mild, you may not be aware that you have the condition. But it’s important to take gingivitis seriously and treat it promptly. Gingivitis can lead to much more serious gum disease

(periodontitis) and eventual tooth loss. Obviously, the most common cause of gingivitis is poor oral hygiene. Good oral practices such as brushing at least twice a day, flossing daily and getting regular dental check-ups helps to prevent the condition. Cavities Cavities or dental caries are basically holes in your teeth. They develop when there is a process of tooth decay. The condition is caused by plaques on

our teeth that we might have failed to remove because of improper oral practices. Plaques are home to bacteria which convert the sugar and carbs we eat to acid which in turn causes tooth decay. Common conception of cavities is that it usually exists in children. But the changes in the mouth (the gradual pulling away of the gums from the teeth) as we age make them an adult problem as well. A cautionary reminder for us to practice proper oral hygiene.

Finally, brushing alone cannot get rid of plaques and bacteria on the surface of our teeth. Therefore, Dr Halina also implores us to start flossing and gargling mouthwash as the finishing touch to our daily teeth brushing routine. Preserve your teeth! Dr Halina advises everyone to maintain a healthy mouth for a healthy body. “We are given only two sets of teeth during our lifetime. The second set of teeth is what we will live with for the rest of our lives, so preserving what we have is the best way. Good oral health can also prevent various other illnesses that can stem from bacteria in the oral cavity.” Create a good relationship with our dentists is also important. Ideally, it is good to visit the dentist once every six months to check up on things, she says. Finding a suitable dentist that you are comfortable with who can also empower and educate you about oral hygiene is a step in the right direction. “Usually people will come in to see their dentists once the condition is already at a painful stage. So treating them can result in more pain. This creates a negative perception of dentists. It shouldn’t be so. Going to the dentist regularly can help prevent us from going through such pain, so book an appointment with your preferred dentist as soon as you can,” says Dr Halina.

34 •

fitness+

mAY | 2016

Biomechanists behind success of top athletes Sports scientists ensure they perform at their optimal level using the best techniques

By ALI-AZMIN HASSAN

ehind the success of every athlete, there’s a sports biomechanist. You’d probably ask yourself – what’s a biomechanist? Is that a career line? What does a biomechanist do? Well, a biomechanist is basically a scientist. We’re not talking about rocket science or astrophysics, but something a little closer and personal. Sports biomechanists learn how athletes can move with less chance of them being injured and also further improve their performance. Desdemona Mollon, a sports officer with the Sports Biomechanics Centre of National Sports Institute of Malaysia (NSI), met up with Health+ to enlighten us on what biomechanists do and

also their efforts and research to improve our national athletes’ performance, raising their chances of bringing home some gold medals in regional and international competitions. For example, how psychology works in volleyball is through decision-making. It’s a combination of psychology and biomechanics. In volleyball, decision-making is very important, especially to the setter, (as) he or she will decide who will (get) the ball and is the one who plans the offence (game plan). Biomechanists generally focus on research and apply the findings to more practical applications. Sports and exercise science are two fields where the practical applications are apparent. “Our job is to ensure that the athletes have optimum performance, potential injury assessment and technique correction,” says Desdemona. Although, one might think why would an athlete need a biomechanist to tell him or her how

NSI TEAM: The biomechanists discuss their findings with each coach to ensure an athlete’s optimum performance.

to play a certain sport? If you play a sport long enough, say football, volleyball or swimming, you’ll be doing it well enough naturally, right? Not exactly. Desdemona says during training to check on an athlete’s performance, the biomechanist involved will ask whether he feels

DEEP PASSION: “Sports is my passion and my main job and priority is to help athletes to improve their performance,” says Desdemona

comfortable or stronger with his technique or form. “We discuss our findings with the coach and the entire sports scientist team. In that way, we can achieve the optimum performance we need for each athlete.” In the sports biomechanics department, there are sports biomechanists and performance analysts. Performance analysts focus on the tactical aspect in game situations, while sports biomechanists deal with the technical part which is applied in athletes’ training. “When I (joined) the swimming team as biomechanist, I analysed the (swimmers’) technique using underwater camera. I compared their techniques with world-class athletes and I saw a lot of difference. And from there, I began to understand that I would be bias if I simply compared our swimmers with world-class (ones) without taking into account other factors, including height. After

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diabetes and hypertension among Malay adult residents. Joint pain or osteoarthritis is an inflammatory disease. It occurs when the cartilage in the joints that acts as a cushion padding for the bones, worn out and fail to function as shock absorbers due to the impact of joint movement. When cartilage is thinning, any movement will cause pain. Joint pain occurs with increasing age due to aging activity and knee pain commonly experienced by the elderly. Occupational related activities like walking, sitting, standing, kneeling, squatting,

climbing, heavy lifting and much of self-care will undoubtedly be difficult and uncomfortable with knee pain.

Who is at risk?

Researcher revealed that women are at high risk of joint pain compared to men. This is because the hipbone of the women is wider than men. The wider hipbone results in more pressure inside the thigh muscle. Obesity people also at high risk of joint pain due to joint in the knee had to

accommodate the excess weight and force the joint to receive more pressure. Usually, the elderly will go through a period where their limbs start to feel ‘tired’ to work. Same goes to their knee joint, the degradation of cartilage occurs in line with the increasing age. Hormonal changes in elderly accelerate the progressive breakdown of cartilage.

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fitness+

2016 | maY

discussion with the senior sports biomechanists, we’ve tried our best to tailor the technique modifications according to the swimmers’ specificity needs.” Hence, we should never judge our athletes’ performance, for without proper techniques and guidance from biomechanists through their extensive research, then it would all be for nothing. “Based on my experience, I’ve learned to apply biomechanical theories in sports. Hence, my relationship with the athletes as a biomechanist is a give-and-take situation. We do the research and educate the athletes on proper techniques, while the athletes educate us on the overall demand of their sports,” says Desdemona. How far can one go as a biomechanist? “It depends. If the athletes bring home gold medals from the Olympics, then you’re the best biomechanist (jokingly). It actually depends on the athletes’ performance. One thing to bear in mind is we are working behind the scene,” she says. “Sports is my passion and my main job and priority is to help athletes to improve their performance. I will be fully satisfied if the athletes can achieve a certain targeted level, especially in the Olympics”. While biomechanics is probably not the most popular choice in considering a science-based career, it’s an interesting and growing field. It has the potential to make a difference in the health and safety of athletes and ordinary people. A biomechanist’s job is to help ensure that movement is as effective and safe as possible, regardless of whether the person is running in the Olympics or just jogging at the park.

for healthy cartilage formation. Glucosamine and chondroitin supplement are produced through laboratory processes to extract chitin, a type of material that can be obtained from the shells of seafood such as shrimp, crab, scallops and many others.

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The combination of glucosamine and chondroitin are certified Halal by the Federation of Islamic Association New Zealand (FIANZ), recognized body by JAKIM. So, these supplements safe for Muslim’s consumers and can take it without any doubt. Quality is assured because these supplements are fully imported from New Zealand and comply with Good Manufacturing Practice (GMP). The natural source of raw material is fresh because New Zealand is well known for its

• 35

Warm up to avoid sports injuries Dr Kuldip Singh Dhillon weighs in on common injuries and ways to prevent them By NORMAN HUSSAINI

porting events such as football and badminton attract a lot of interest among Malaysians. Football especially is a treasured sport that many of us are most passionate about. Sport, however, covers a wide scope of activities and doesn’t just mean football or badminton we see at stadiums or on television. An afternoon session of futsal among co-workers, a family outing in the morning or jogging at a lakeside park are also sporting activities, and the risk of injuries is always lurking. Dr Kuldip Singh Dhillon, a retired sportsman himself, looked after our legendary football team in the 1980s, among others. He is now a consultant orthopaedic surgeon at KPJ Selangor Specialist Hospital. Health+ met up with him to learn more about sports injuries and how we can prevent them. “Sports injuries are pretty standard everywhere in the world, and are usually caused by an individual’s error in technique before, during or after undergoing an activity,” says Dr Kuldip, who is no stranger to sports injuries as he has been a specialist for over 35 years. Who are more susceptible?

fresh and high-quality seafood and dairy farm source. These supplements are clinically tested formula that provides 1500mg of glucosamine and 1200mg of chondroitin for daily consumption to promote joint’s health. Overall, this combination is very beneficial especially to women, obese people and elderly in improving joint health by reducing joint pain especially in the knees, improving joint function and flexibility as well as the movement, protect cartilage from progressive damage, nourishing tissue and helping in the reconstruction of cartilage and increase strength and elasticity of cartilage. Therefore, don’t let your knee pain interrupt your life. For more information, please call Nuvanta Sdn. Bhd. at 1-300-88 1713. This is a medicine product advertisement. KKLIU 0446/2016

SPRAIN EXPERT: Dr Kuldip explains some common injuries resulting from sports and how to prevent them. As stated by Dr Kuldip earlier in our conversation, individuals themselves are the cause of most sports injuries. “Most patients who come to see me are either beginners or those who take part in sports every once in a while,” he says. “The reason is because individuals who are not training every day tend to make mistakes during football, basketball or badminton games, or whatever sports they take part in. One common mistake I have often seen is not warming up properly before a game, then (going) all out while playing.” Dr Kuldip’s statement poses another question: what are the more common injuries? He says some injuries are more common than others, and most usually occur around the leg area. Some examples of common injuries include:  Ankle sprains  Groin pulls  Hamstring strains  Shin splints  Knee injuries “Sprains particularly are very prevalent among individuals taking part in sports, especially in the ankle area. It is one of the simpler injuries which do not need any surgery. The injury will heal on its own and pretty quickly, if the patient follows a simple guideline after a sprain. “This means that an individual should prevent further injury by stopping right away and applying ice and pressure to the injured spot. After that, the individual should restrict any strenuous activities involving the injured area and have a good rest,” says Dr Kuldip. Do not use heat! He points out a common mistake among individuals with sprains, is applying heat instead of ice to sprains and strains. This,

he says, is not advisable. “Heat expands the blood vessels which in turn accelerates swelling in that area. Ice, on the other hand, should be used as the cold will constrict the vessels and may prevent or at least minimise swelling.” In essence, heat should not be used for injuries involving sprains or strains. But this leads to another curious query: why are there then heating products such as creams and ointments? Dr Kuldip explains that heating creams are not meant for sports injuries, but usually used for muscle pain acquired from extended strenuous activities such as driving and walking. “They help to relax muscles and ease pain, rather than preventing swelling from sprains.” Preventing injuries Preventing injuries during sporting activities is easily said than done. We tend to get carried away while enjoying a sport activity. So a good point to start to prevent any injury is to perform proper warm-up before starting any activity. A common warm-up mistake is stretching at the wrong time. According to Dr Kuldip, it is better to go for a quick jog to warm up muscle tissues before stretching. “Warm tissues are easier to stretch, so it lessens the chances of injury if you warm up with a quick jog or jumping jacks, then go for stretching before the game.” Yet the best way to prevent sports injuries is none other than exercising regularly. “A person is more prone to sports injuries when he or she doesn’t exercise regularly in between. It is good to practise regular walks or jogs to keep the body active, even when you are not playing sports,” he says.

36 •

opinion+

mAY | 2016

mental

By Urmilah Dass

Intimacy secrets

n this age of chasing after an income, paying bills and worries, many people have no time to invest wisely in what matters most – relationships. Relationships are core to human beings. We cannot survive solo,

well not in this world anyway. So how does one juggle a career AND be part of a healthy, happy relationship? The level of how healthy and happy a relationship is really based on how strong the intimacy levels are between partners.

And I’m not just talking sex here but much, much more. A successful relationship needs four different kinds of intimacies.

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COMMUNICATION Communication is a key factor of utmost importance. Have you seen couples at restaurants just sitting there looking at their phones, or looking blankly ahead, not talking to their partners? Yes, those couples. This is a big NO-NO. Communication is the essential part to building and keeping a relationship alive. Partners should be able to talk about their day, share information and experiences on a daily basis. Explain what happened at the office, share insights about a political development; anything and everything they want to talk about. This keeps the relationship alive and interesting and this is what you will have even at the age of 80! EXPERIENTIAL INTIMACY Experiential intimacy really means doing things together as a couple. It can be going for a hike together, watching a movie, tending to the garden together, attending a party, etc. It’s all about spending quality time together without talking too much. You look across the room, and you see your partner and you both exchange smiles. Just knowing you are there together is empowering to the relationship. EMOTIONAL INTIMACY Emotional intimacy is very important as this is the area where trust is built and maintained. One should be free to share emotional personal information safely and with no reservations. You can talk about disappointments, anger or even bad behaviour AND know you will not be judged unfairly. If this intimacy is sound, “secrets” will never be thrown at each other’s face during arguments and fights. You will know that your partner is a safe place and whose feelings will not change at the mention of any of your “weaknesses”.

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SEXUAL INTIMACY The last and equally important intimacy is sexual intimacy. This intimacy is not just about sex but encompasses affection, tenderness, attentiveness, and foreplay. Couples need to play with each other and more importantly, be kind to each other. Having regimental sex makes one feel unsatisfied because the prelude to sex is always the more important part. Remember, the brain is the biggest sex organ not your privates. And it’s not always about sex; it’s also about paying attention to each other’s needs, appeasing each other’s sensitivities and showing that the other is appreciated. Intimacy in a relationship is crucial; it is an ongoing endeavour. If you want a happy and content relationship, you need to work as partners to make it better. Many couples start off right but with time and the struggles of everyday life, the romance fizzles off. If you are in love with your partner and want to make things better, you will take the time and effort to set things right. It’s never too late to fall in love all over again. Urmilah Dass is a consultant clinical psychologist at Valley Psych Human Development Centre, Bangsar.

OPINION+

2016 | maY

• 37 WELLNESS

By Datuk Dr Rajbans Singh

ulforaphane was discovered in 1992 by Dr Paul Talalay and Dr Jed W Fahey of the Johns Hopkins University School of Medicine. Through their work they isolated a group of phytochemicals called glucosinolates of which gucoraphanin, contained in broccoli sprouts, is converted to sulforaphane by the action of the enzyme myrosinase. Functions Sulforaphane is a small molecule that is easily taken up by human cells. Once inside the cells, it acts as a “signaling molecule” to send messages to other cells. One of sulforaphane’s most vital functions is to support activation of a “switch” within the cell. This “switch” (a special molecule known as Nrf2) releases a small fragment which then travels into the nucleus. Once inside the nucleus, it locates the genes of the cell’s internal defence activities. In some cases, the DNA in sections of these genes can be completely “switched off”; in other cases, the genes may be just “lazy” or “sleepy”. Certainly as we age or are unwell, the activity of these genes declines. In any case, sulforaphane is capable of restoring the gene’s activity to normal.

Sources Sulforaphane is contained in broccoli sprouts and cruciferous vegetables such as broccoli, cabbage and cauliflower. Individuals who consume high amounts of these vegetable are less likely to develop certain illnesses. However, in practice, many people do not eat enough broccoli to make a difference. More importantly, cooking the broccoli destroys the myrosinase enzyme that is essential for the conversion to sulforaphane. Detoxification enzymes Sulforaphane activates the cell’s detoxification enzymes. What does this mean? All cells produce waste materials because of their routine activities. These wastes will poison the body if the cells do not detoxify and then eliminate them. Some of these waste products are so toxic that they must be neutralised before they can be passed out of the body. If these toxins are not controlled, continued cell damage will eventually lead to diseases. Of course, there are many toxic compounds that we are exposed to in the form of pesticide residues in food and water as well as pollutants in the air. The detoxification enzymes are nature’s way of

WISHNIG WELL

Nutrigenomics: Sulforaphane enhances cellular defence system

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healthy balance of intestinal flora. They reduce the amount of harmful bacteria by replenishing and maintaining the “friendly” bacteria. The depletion of beneficial bacteria can occur as a result of poor diet, taking certain antibiotics, stress, food poisoning, travellers’ diarrhoea or poor overall digestive health.

How do probiotics work?

They maintain optimal levels of good bacteria in our gut (intestines), promote healthy digestion, support a balanced

dealing with these toxins. This is a family of enzymes that is specifically targeted at modifying the chemical structure of toxic molecules so that they can no longer damage cell structures. Research over the past 15 years has shown that the most powerful known natural substance capable of “switching on” or “up regulating’ these detoxification enzymes is sulforaphane. This fact, coupled with its ability to enhance the cell’s antioxidant status, means that sulforaphane is one of the most important compounds available to us to enhance the defence mechanism of human cells. Scientists have found that there are around 200 genes of the cell’s defence system known to be influenced by sulforaphane.

anti-inflammatory response and immune function and also support skin health.

What is GNC Ultra Probiotic Complex 25?

Ultra Probiotic Complex 25 has been designed to provide daily replenishment of healthy bacteria in your digestive tract. Each capsule provides 25 billion live and active cultures of lactobacillus acidophillus and bifidobacterium. It is important to replenish beneficial bacteria for optimal digestive and immune health.

Why take GNC Ultra Probiotic Complex 25?

Clinically studied daily use formula with 25 billion active cultures. With the first dose, Ultra Probiotic

(Source : Cell-Logic-USA, 2014). Datuk Dr Rajbans Singh is a consultant physician and geriatrician, and healthy ageing specialist at Beacon Laureate Sdn Bhd.

Complex 25 improves the balance of beneficial flora in the digestive tract. These probiotics help reduce bloating and stomach discomfort, aid in improving regularity and support a healthy immune system.

Suitable for people:

1. Who consume little or no fermented foods such as yoghurt and cultured drinks. 2. Suffering or recovering from food poisoning, diarrhoea (including traveller’s diarrhoea). 3. Using or have completed their antibiotic course. 4. With poor overall digestive health (for example, bloating and constipation). 5. Leading stressful lifestyles. 6. Concerned about skin health.

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wellness+

maY | 2016

Y Yoga for your well-being Instructor says practice is a way of life that connects our bodies with the world around us

oga is an ancient practice, believed to have originated in India in the fifth or sixth century BC. The name “yoga” is a derivation of the original Sanskrit word describing the relationship between our bodies and the universe. In modern times, yoga has been widely accepted as an effective way to help improve the quality of life through its physical formations. There are, however, some misconceptions about yoga that have given it a bad reputation. In addition, yoga has been oversensationalised by popular cultures to the extent of being disconnected with its original objectives. Health+ spoke to Kumar Superamaniam of Yoga Arogya yoga centre, who is well-versed with the teachings of yoga, to seek some clarifications about this ancient practice and contemporary issues. What is yoga? Kumar says yoga is more than just a form of exercise and keeping certain physical formations. “It is a way of life that connects our bodies with the world around us.” According to him, there is a force which drives humans, and it enables us to move, speak, eat, feel and do pretty much everything. Yoga is a practice which shortens the distance between us and that force, to be aligned with the universe. “When someone is out of touch or unaligned with this force, the person experiences disorder. Disorder means the person will experience unwanted conditions such as stress, tiredness and various other health problems. With yoga, the alignment can be repaired and such things can be prevented.” He says in the practice of yoga, our bodies should adhere to five elements, visualising that our bodies are the earth, water is what we drink, air is what we breathe, fire is our body temperature and

digestion, and space is what we need to exist in. “We can see that these five elements are also connected to our five senses – touch, taste, smell, vision and hearing,” he explains. “The sense of touch is earth, taste is water, air is smell, vision is fire, and hearing is sound.” He points out our sixth sense, which makes us different from animals. We have the mind to think and differentiate right from wrong. The mind, Kumar explains, is the link between the body and the universe. Hence we need to use our minds together with our senses to connect to the universe. What yoga is not As discussed earlier, there are some misconceptions about yoga that many people tend to believe. One of them is that it is part of the Hindu religion, or a religion in itself. It is not, explains Kumar. He says it is beyond physical exercise and envelops our way of life in terms of what we do to the things we eat; it is a practice whereby we are more in line with nature. The sensationalising of yoga has also put it in a rather bad light in the eyes of the masses. Popular cultures such as movies and television shows convey yoga and the people practising it as weird and somehow disconnected with the world, usually for comedic effect. He says yoga is a way of life which trains our physical bodies and subconscious minds to have more discipline and self-preservation. It should not be deemed a religion and viewed negatively. Yoga is life Kumar is yoga instructor and teacher. Apart from teaching at his yoga centre in Semenyih in Selangor, he also travels to different parts of Malaysia and Singapore to spread awareness about yoga. To him, yoga is life. He believes our health and well-being can be preserved with proper practice of yoga.

When someone is out of touch or unaligned with this force, the person experiences disorder. With yoga, the alignment can be repaired and such things can be prevented.” – Kumar

education+

2016 | maY

• 39

Nurses – the unsung heroes MAHSA University prepares students with well-rounded education and training for noble profession

By Young Sin Yee

ursing is a noble profession which even young children can naturally identify with. Children generally regard this profession highly when they are young, and it’s a pretty common ambition for many too. Yet, despite its initial appeal to children, how many actually turn out to be nurses when they mature? Could it be that their perception of the profession changes as they grow up? Or is it due to lack of proper understanding? The latter seems more probable. Children and even adults lack proper understanding of the profession, particularly what a nurse actually does daily. A nurse is a person who has formally been educated and trained in caring for the sick or disabled. Nursing also includes a range of specialties such as in the field of disease prevention, and caring for and monitoring as well as advising pregnant women. In Malaysia, there are a number of nursing courses offered by both the government and private universities. One of them is MAHSA University, which, since its inception in 2005 at its Pusat

Bandar Damansara campus in Kuala Lumpur, has produced more than 5,000 graduates. In 2009, the college was upgraded to university college status and became a university in 2013. MAHSA’s nursing programme has since grown by leaps and bounds in terms of courses offered as well as student enrolment. Today, besides its original diploma nursing programme, the university also offers advanced diplomas, degrees, master’s and doctor of philosophy (PhD) level nursing courses. Entry requirements, core subjects According to Professor Zahrah Said, dean of MAHSA University’s Faculty of Nursing and Midwifery, students must have passed the Sijil Pelajaran Malaysia (SPM) with five credits in Mathematics and Science (Biology, Chemistry, Physics or General Science) (Sains Am), Bahasa Malaysia (for local candidates) and two other subjects (local candidates) or three other subjects (for international candidates). Local candidates must also pass English and History. In addition, English proficiency is required for foreign students whose medium of instruction is not in English. They must have a pass in English (O-Level or equivalent to SPM 1119), IELTS 5.5 or TOEFL 550. The programme has three core subjects – nursing science,

behavioural science and health science. Besides having to complete and pass these three subjects, students are also required to sit and pass the General Studies subjects (Mata Pelajaran Pengajian Umum or MPU) as required by the Malaysia Qualification Agencies.

Arabia, Australia, the United Kingdom, and Canada.

Job placements MAHSA’s student affairs department helps students get job placements in hospitals overseas. Job agencies will contact the university which will then invite them to come over to its campus to interview the students. More than 700 graduates have so far been offered work in Singapore, while many others are already working in Saudi

But what about local hospitals? Professor Zahrah says private hospitals prefer nurses with work experience while the government has frozen its nursing recruitment. Apart from helping students obtain job placements in hospitals, MAHSA also offer students to work in medical centres, community services, wellness centres, and clinics for them to gain experience, she says. Professor Zahrah says MAHSA’s degree nursing course is for nurses with three years’ work experience. Students can do part-time study over three years.

continued through the selected modules, they began applying what they had learned and began applying quality health information, making good health choices, identifying health disparities and the components of community health and wellness, developing advocacy roles, and employing communications strategies. Various experiential activity was done as an implementation of the programme. One of them

was done with students attending an Obesity Cadaver Lab to demonstrate their knowledge of anatomy and physiology they had learned throughout the school year. The potential seen in Project SHARE is a promising one. The innovative yet subtle learning programme could be used as benchmark for future implementation to help students become more aware of their state of health while advocating to others.

Students to make positive choices The University of Maryland Health Sciences and Human Services Library had come up with a curriculum with aim to develop teens into community health advocates. Dubbed Project SHARE, the programme has a vision to get teens to promote health, reduce health disparities and increase teen literacy. It was designed to increase the student’s educational awareness relating to health equity and health disparities on a

personal level, within the family, as well as the community. The curriculum includes six modules, each with five lessons. Each module, or lesson, may be used in a series or standalone with experiential learning to complement the classroom experience. These students experienced classroom learning as well as experiential learning activities along the way, making the experience both fun and rewarding. Additionally, as students

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generalNEWS+

Don’t let sleep apnoea spoil your slumber Lose weight, quit smoking to promote smooth airflow in your body for better rest needs mentioned by Maslow, sleep comes with a few disorders and one of the potentially serious ones is sleep apnoea. There are several types of sleep apnoea, but the common one is obstructive sleep apnoea (OSA). According to Dr Yong Fee Man, a consultant neurologist at Subang Medical Centre, OSA sufferers usually wake up multiple times per minute and the bad part is they are unaware that they have been sleeping on and off through the night. “The obstruction usually occurs at the level of the mouth behind the tongue or a bit lower in the region called the oral pharynx or commonly known as the pallet.” OSA is most prevalent in middle-aged males. Males are between two and three times more likely than women to develop this sleep disorder. This appears to be due, at least in part, to physiological and anatomical differences between the genders. It is believed that men with broad neck have higher risk of

By Syed Zaid Syed Osman

aslow’s hierarchy of needs dictates that sleep is one of the physiological needs for a human being. In a simpler manner of speaking, people need their sleep as much as they require food, drinks, shelter, warmth and even reproduction. However, some people will attest that sleep is not as simple as described. When one sleeps, the body takes the opportunity to reduce activities while cell and muscle repair takes place, and rejuvenate and be ready for the day. It shows that insufficient or low quality sleep causes harm to the body including loss of focus, short-term memory loss, stroke, hypertension and, in some cases, even death. Just as the other physiological

maY | 2016

developing this, especially when the broad neck consists of fat. Dr Yong says the development of OSA can be caused from the physical feature of a person. “If a man has a broad neck, more than 17cm radius especially, there’s good chance he will develop this sleeping disorder due to loose tissues within the neck causing the obstruction. It is also commonly found in men with jaw sticking out or too small and especially when the patients are overweighed.” OSA has certain signs and warnings. A sleeper usually has chronic snores through the night, choking, snorting, gasping during sleep, noticeable pauses in breathing during sleep, daytime fatigue, headaches and many more. Often goes undetected, OSA happens

If a man has a broad neck, more than 17cm radius especially, there’s good chance he will develop this sleeping disorder due to loose tissues within the neck causing the obstruction.” – Dr Yong

when the airflow is interrupted while a person sleeps, causing him or her to partly or completely cut off from airflow. This causes oxygen flow to be reduced or stopped which lowers the quality of sleep and possibly death. This occurrence forces the diaphragm and chest muscle to work harder to push away the obstruction to the oxygen flow, causing the sleeper to let out a loud gasp or snort before normal breathing is resumed. There are not many options to treat OSA. Dr Yong says in less serious cases, drugs can be prescribed to promote the airflow. “But commonly, after extensive sleep studies, the patients would require a continuous positive airway pressure machines. There are surgical procedures available where the surgeon could remove the excess tissues from within but the risk is unnecessary and I would consider it as a final resort.” Dr Yong recommends selfhelp treatments to prevent OSA. “Lifestyle modifications can be a way to promote smooth airflow in the body. As I have mentioned earlier, weight plays a role in preventing this disorder. Try to lose weight and have that loose tissues removed by your body naturally. Smoking also promotes OSA as it increases inflammation in the throat to interfere with breathing.” Sleep position can also play a role in preventing the disorder. “Sleeping sideways can certainly help. By doing that, the tongue falls to the side instead of the back on the neck,” Dr Yong explains. For those who cannot stay in that position in their slumbers, she recommends wedging pillows on the back to remain on the side.

ADVERTORIAL : Women’s Whispers

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our relationship one day.” Ms. Frustrated M

s. M is not alone. You may not know this, but many women aged 18 to 50 around you are facing the same difficulty when it comes to sexual intimacy with their partners1. In fact, it is more serious in women than men, with 43% of women suffering from decreased sexual intimacy versus 20% of men. It is rather easy to guess the cause of the problem. Yes, daily physical and emotional stress is the main culprit in many incidences2 – the stress from work and endless household chores plus children matters are enough to kill all desires and douse all flames at the end of the

day. That’s a really sad ending for a “superwoman” of the modern world. Ultimately, you will find your quality of life and bonding time with your partner compromised. A healthy woman should enjoy intimacy with her partner right into her 60’s and beyond3. Once a week of sexual intimacy is just right to maintain a happy relationship and stay a happy woman4. This is not surprising as sex is reported to have its unique therapeutic effects such as improved immune system, better sleep quality, improved bladder control, lower stress levels and more5. If you are lagging in your sex life like Ms. M, and constantly feel depressed and anxious with a lack of cheerfulness and control,

it could be a serious warning sign! You may be suffering from Early Hormonal Imbalance that throws your Estrogen (E) and Testosterone (T) levels off. Hormonal imbalance, like many other diseases, is affecting many younger women quietly but surely. Normalising your hormonal levels will help to solve your problem and help you to regain your True Love with your partner, while leading to a happier and healthier you. 8 weeks of treatment with Libifem® is clinically proven to increase the levels of E and T in women. The all-natural Libifem® is a non-hormonal, nutraceutical remedy made from Fenugreek seed extract proven to help increase sexual frequency and quality. When combined with Maca root extract, the formulation works to help boost Mood, Vitality and Energy. For more information,

please call Cambert (M) Sdn. Bhd. at 1300-88-1712 or email ask-prime@cambert.com.my. References: Laumann EO et al., Sexual dysfunction in the United States. Prevalence and predictors. JAMA. 1999; 281(6): 537-44. Ventegoldt S et al., Sex and the quality of life in Denmark, Arch Sex Behav. 1998 Jun;27(3):295-307 Roper Starch Worldwide Survey, “Healthy Sexuality and Vital Aging, Executive Summary: A Study by the National Council on Aging” (September 1998), 1-15. Amy Muise et al., Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better, SAGE Online Journal - Social Psychological and Personality Science, Nov 18, 2015 http://www.webmd.com/ sex-relationships/guide/ sex-and-health

generalNEWS+

2016 | maY

• 41

The unsightly naked truth Malaysian Association for the Blind shares the community’s daily struggles like prejudice and lack of job opportunities By Ali-Azmin Hassan

hen it comes to the blind, not many people give them a second look. The community of blind people in Malaysia is obviously smaller than the sighted. It’s not every day we get to help them cross the street, simply because there’re fewer of them in comparison. We normally see them at food outlets at night, asking for a ringgit in exchange for a packet of tissue. And hopefully they get more than a ringgit, clinging to your pity. I won’t lie – we live in an ugly world. But it’s even uglier for the blind for a very long time, trying to survive the common struggles sighted people face every day. Thavasothy S Mailvaganam Pillai, chairman of the Malaysian Association for the Blind (MAB), a part-time lecturer at Brickfields

Asia College, and a member of the blind community, met up with Health+ to share his stories and struggles, trying to survive in a society that has evolved to be less accommodating to the blind. MAB is the preimer voluntary organisation serving visuallyimpaired persons. It provides services that help the blind and prevent the tragedy of avoidable blindness. Employment opportunities for the blind are sorely lacking these days. “Blind graduates find difficulty getting a job. Even though there are some jobs which the blind can do, the public should also give the opportunity to the blind. Without trying, you cannot gauge a person’s ability,” says Thavasothy, who faced the same problem many years ago. After graduating from university, he tried applying for a job. And for a while, he was an assistant producer at Radio Television Malaysia (RTM). “The work can be adjusted even for the blind to do as well. When I was an assistant producer of programmes at RTM,

“Without trying, you cannot gauge a person’s ability,” says Thavasothy

there’re so many things an assistant producer did such as reading the news, getting scripts ready as well as arranging for programmes and interviews,” he recalls. Despite the progress we have made as a society, there’re many who are still prejudiced against the blind. Thavasothy encountered this at his job interview with RTM. “They asked me if I could do a parallel review. Obviously it’s a job a blind person cannot do, but that can be adjusted. It’s all up to employers to do some adjustments in the work. In parallel review, you must see the things like football or badminton matches. It requires someone who can see and telecast. It’s all a matter of adjustment,” he says. “When I applied to colleges for a lecturer’s position, I’d put in my resume (that I’m) visually handicapped. And they didn’t even call me for interviews. But later I thought I’d try the other way around. I didn’t (state I’m) visually handicapped and sent in my resume. They (Brickfields Asia College) called me for an interview. At that interview, I could prove myself and answer the question, ‘How am I going to teach’. That’s how I got the lecturer’s position with Brickfields Asia College.” Thavasothy, who also has a diploma in education, later worked as a teacher in SMK Taman Petaling Girls School for 28 years before retiring. He now lectures

part-time at Brickfields Asia College, teaching Hubungan Etnik, a compulsory subject for college students. “Employers are not willing to give opportunities (to the blind). Maybe the awareness is not there yet. Awareness must also be created (by NGOs). If you look at other countries like Australia where I did my master’s degree, it (giving opportunities to the blind) was all well planned. They were prepared to accommodate blind students, but here, the public still has to be educated. The same goes for employers too,” he says. Employment opportunities for the blind are still lacking, both in the private and government sectors. Some enterprising blind people take the easy way out by taking massage courses so that they could set up their own massage centres. “They all jumped into the massage business, and now there’re too many massage people competing with one another,” says Thavasothy. Perhaps there’re some things beyond our control. However, there’s something within our control, such as assisting MAB financially. For instance, the association’s library is in dire need of repair. Public donations are very important to help the association continue serving the visually impaired by expanding and improving its services.

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generalNEWS+

maY | 2016

Tattoo culture flying high Dragonfly out to stamp its mark in professional tattooing service

By Prasad Chandra Segaran

lthough tattoos have been around for as long as we can remember, getting one is trendy these days. With the mushrooming of tattoo studios everywhere, there are mounting concerns over the safety and health risks in tattooing, particularly skin infections. The fear arises as unscrupulous tattoo studios use cheap inks, equipment and do not carry out proper sterilisation of their needles. Although needles are supposed to be disposed of once they are used, some cheap tattoo studios do not pay heed to this safety and health aspect. As in any business, there are bound to be some who flout standard practices to ensure the safety and health of their clients. That said, there are also many professional tattoo studios that keep the high standards and Dragonfly Tattoo Malaysia is one of them. The tattoo studio was set up in

1995 when Malaysia didn’t have any professional tattoo studio. And Dragonfly Tattoo started off with a proper and standard system. Dragonfly Tattoo creative director Helen Hew came up with the idea of setting up a professional tattoo studio when she met a tattoo artist in Singapore. Back then the island republic already had some professional tattoo artists plying the trade. Deep passion for tattoos To be a tattoo artist, one has to have deep passion for tattoos. “Money shouldn’t be the priority in this field, rather the love towards the art is very important,” says Helen. Over the years, tattoo schools have been set up to teach a growing number of tattoo artists and this has in turn established some kind of standards. Dragonfly Tattoo also has its tattoo school to educate those who want to learn the art of tattooing. “Tattooing is a professional career,” says Helen and she’s proud to be one. She says tattoo is the top art form. “We don’t want tattoos to be a bad influence on the upcoming generation. Instead tattooing can

SINGLE USE: “We dispose of every needle after we’ve used it once,” says Helen.

EXPERT ADVICE: Helen advises those who want get a tattoo to consult with a professional tattoo artist.

How a tattoo is done Most people are curious to know how the ink stays permanently on the skin after tattooing. Well to be short and direct, it’s just a process of inserting small amount of ink onto the skin by piercing it. This is done with a coil

machine and colour inks, piercing accordingly with the design you want. The first thing you need to do before getting a tattoo is to decide on the design. Once you have done that, you go to a tattoo studio where the

be a proper career path for them.” Although tattoos have become pretty common and people are much more open minded and accepting of the art form, Helen says Malaysians are still wary of the practice due to cultural and work issues. Dragonfly Tattoo imports its tattoo equipment, including tattoo machines and ink, from the United States. “We do have local suppliers but we only deal with those that who maintain their standards,” says Helen. “Tattoos can affect people’s health, so we strictly avoid using cheap products.” Why do people get tattoos? “I would say it’s mainly for the art, but some emotional state of mind, some for remembrance, some due to job scope like artists and celebrities, some to hide scars on their skin, some to follow the current trend and some don’t have any reason to tattoo. In some cases, even breast cancer patients come to us to tattoo to re-create their image,” says Helen. “Tattoo trend changes every year. Last year people were interested in infinity tattoo, but this year people are no longer into that, rather they are going for arrow arts. It depends on individuals on the type of art they prefer. Maori tattoos are always popular and they don’t normally fade out in popularity like other tattoos.”

Which parts of body people tattoo? “Previously it was common to tattoo on arms, shoulders, chest and ankle, but now people are very creative and they do tattoos wherever they want,” says Helen. Counselling Dragonfly Tattoo normally counsels clients before they do their tattoos. “This is to make sure they know what they actually want and to let know the benefits and consequences of getting tattoos. The tattoo that you’re going to get is going to be with you forever, so we are there to advise them,” says Helen. How much does it cost to have a tattoo? “It depends on the size of the client’s body, the size of the tattoo and the amount of ink we use for the tattoo. The starting price is RM150 but people have spent up to RM10,000-20,000. In some cases we also charge the client hourly rate depending on the tattoo artist,” says Helen. Safety and health procedures Helen says clients are responsible to ensure their skin which is tattooed is not infected. “The minute they leave our studio, it’s their responsibility to take care of their skin. We will usually give guidelines on the do’s and don’ts after tattooing. If they are ignorant then definitely it would get infected. Any open wound that is not cared for

paper work will be done which is filling up of form and making payment. To develop a tattoo, the tattoo artist draws the outline of the tattoo on your skin. Next is the piercing session with the coil machine and shading to complete the tattoo art. There’ll of course be some plain, quite like a bee sting or a cat scratching the part where the tattoo is done.

generalNEWS+

2016 | maY

• 43

Tattoo removal is trending Dermlaze Skin Laser Clinic serves those wanting to have their tattoos removed

will get infected.” Dragonfly Tattoo normally doesn’t directly ask clients whether they are infected with any kind of disease like AIDS or hepatitis. Instead we have proper procedures prior to getting a tattoo. “Clients have to fill in a form similar to how people register in a hospital. They have to be honest with us and we trust them,” says Helen. Dragon Tattoo is very particular about the safety and health of clients. “We dispose of every needle after we’ve used it once. We will sterilise and seal it before disposal. Our needles are used only once,” she says. Strong bond and good image What makes Dragonfly Tattoo stand out from other professional tattoo studios? “Dragonfly Tattoo pioneered professional tattooing industry in Malaysia and has been in operation since 1995. Through priceless experiences and quality, we have developed a strong bond with clients and a good image nationwide,” says Helen. She advises those who want get a tattoo to consult a professional tattoo artist. “You have to make sure that the place that you are doing a tattoo is safe, that you are comfortable with your artist and that he or she has a good amount of experience tattooing. Make sure you check the history of the artist thoroughly. Be careful of false marketing as a lot of photograph work can be duplicated. Be prepared to pay for quality and assurance. Don’t be afraid to ask questions. And lastly, don’t forget that the tattoo will be your lifelong investment. “You have every right to look at the needle and equipment which will be used to do your tattoo. People have to do some research on whatever they are going to commit and make sure it’s genuine,” says Helen.

etting tattoos is so common these days. While getting them is getting more popular than ever, a growing number of people are also looking to get them removed for whatever reasons. Sometimes it makes us wonder why people spend so much to tattoo their bodies and then splurge more to get them removed. Applying tattoo is big business, so is removing them. Riding on this new trend, many businesses have moved into this burgeoning tattoo removal market, and one of them is Dermlaze Skin Laser Clinic. Set up some 15 years ago, the clinic specialises in treating skin disorders and conditions as well as tattoo removal. How did the clinic venture into tattoo removal? It started with a simple conversation, says its director Dr Jeswender Singh. “One day someone told me he was going to Singapore to remove a tattoo. And I asked him, ‘Why are you going to Singapore (to remove the tattoo) where the cost is so high, plus transport and other expenses?’ I was thinking why someone should go to Singapore when I can initiate this kind of facility with the same quality in our country.” And that in a way prompted Dr Jeswender to start Dermlaze Skin Laser Clinic, although there were

Dr Jeswender many other reasons too. “From then onwards, people don’t have to travel to Singapore and pay in Singapore dollars to remove their tattoos,” he says. As the name of the clinic suggests, laser treatment machines are used to remove clients’ tattoos. The machines are not cheap, and Dr Jeswender insists Dermlaze provides the same quality of service as that offered in Singapore. How prevalent is tattoo removal? Dr Jeswender says based on his experience and knowledge, more than 50% of people remove their tattoos after having them for a while, and this can sometimes be as high as 70-90%. The process Removing tattoos is a tedious process. The time taken depends on the depth, colour and the size of each tattoo. Dr Jeswender says there are many types of tattoos, from amateur to professional ones. “I would say professional tattoos are definitely hard to remove. The time taken depends on the tattoo and the number of sessions. Amateur tattoos require only few sessions, while professional tattoos take a longer time,” he adds. “There was a case where a client burned his skin with a hot knife to remove his tattoo and came here to treat the injury. The tattoo can definitely be removed but the

scar is going to remain, and it will take weeks to heal with a lot of suffering.” People who go for tattooing and piercing are mostly influenced by friends and celebrities, and this usually happens when they are young. “Boys usually get tattoos to show off that they are cool, whereas girls like cute artwork like colourful butterflies on their bodies. After a certain age, the fantasy in them goes out and the reality of life sets in. This makes them realise that no one is interested in what they have on them,” says Dr Jeswender. He says certain jobs and religions don’t allow people to have tattoos, so people have no choice but to remove them. Risk What is the risk of getting skin infection after tattooing? Yes, the risk is there, says Dr Jeswender. “There is definitely a high chance of getting skin infection by doing a tattoo. Bacterial infections are very frequent. Hepatitis and AIDS can be caused by unsterilised needles used in tattooing. It is hard to know what type of sterilisation tattoo studios use for their needles, so it is not 100% safe to do a tattoo.” Dr Jeswender says most of his clients are young people. “The older generation will not want to remove their tattoos because they love what they have on them. They are ones who are crazy about tattoos and they keep on doing more tattoos.” What other methods do people use to remove tattoos? “There is no other official tattoo removal treatment,” says Dr Jeswender. “People try to remove their tattoos by using a hot metal to burn their skin and scalding it with acid, cream and lotion, but eventually the tattoos can’t be removed from their skin. Tattoos can be removed surgically, which is by cutting off the skin area of the tattoo. This is a very old method to remove tattoo, but it is very painful and the scar exists forever.” Dr Jeswender dispels claims that using laser to remove tattoos can cause bone cancer. “I’m sure that side effects from laser treatment are impossible. Laser is just a source of light and it doesn’t cause any side effects.” How much does it cost to remove a tattoo? The cost varies depending on the size, design and multi-coloured implementation of the tattoo. “Each session can cost RM300, RM1,200 or RM1,500. An average of six or even more sessions are needed depending on each individual case,” says Dr Jeswender. What is his advice to those who are contemplating to get a tattoo? “It is the freedom of an individual to get a tattoo or not. We can’t stop people from getting a tattoo because there is not much awareness yet to educate people about the consequences of tattoos. So for now an individual should think (carefully) before getting a tattoo.”

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generalNEWS+

Worrying lack of concern about colorectal cancer Symptoms usually develop after disease has matured, early screening best way to prevent it

s the name suggests, colorectal cancer is the cancer of the colon (large intestines) and rectum (the final part of the large intestines connected to the anus). Though quite common, its symptoms usually develop after the cancer has already matured. This means the risk of a person having colorectal cancer is higher because of the lack of symptoms during its earlier stages. As an expert with years of experience in colorectal cancer, Beacon Hospital consultant gastroenterologist Dr Shanti Palaniappan shares her views with Health+. “As our national cancer registry is a little backdated, we cannot identify how prevalent it (colorectal cancer) is in the country currently. However, as of 2007, it recorded the highest among males and the second highest among females,” she says. “This type of cancer is overtaking cervical cancer among women in Malaysia, which means there is undoubtedly an increase.” The increase in cases, she adds, also increases the concern among medical practitioners in the country. Genetic predisposition and environmental factors “There are always predisposing factors in any type of disease. It usually comes from two factors – genetic and environmental,” says Dr Shanti. From the genetic point of view, certain people are more susceptible to the disease than others, because the same condition may arise earlier in their family members and ancestors. This applies to colorectal cancer in Malaysia as well. “Having a history of cancer in the family always puts someone at greater risk. In Malaysia, moreover, it is observed that people of Chinese descent are more inclined to get colorectal cancer than other races. It doesn’t mean however that other people are not at risk,” she adds. The bigger and more preventable factor in getting the cancer is the environment. “There is a wide range of environmental factors and they are usually through lifestyle and diet. Trigger factors

such as smoking, obesity, eating unhealthily as well as having cancer previously can all lead to colorectal cancer,” she says. Symptoms or lack of them The usual symptoms of colorectal cancer may include: bleeding in the stool a change in regular bowel movement the feel of incompletion after defecating abdominal pain and decrease in red blood cells The risk of colorectal cancer developing to a severe stage is quite high due to lack of symptoms during its earlier stage. “The problem with this type of cancer is usually by the time the symptoms appear, it has already developed to a more advanced stage,” explains Dr Shanti. “This is because the colon is a hollow tube and a tumour growing in the tube can go unnoticed until it starts to bleed or cause blockage. Hence, any symptoms may be absent until the tumour has grown larger and more severe.” Early screening makes a difference Early screening of cancer has been universally accepted to be the best

maY | 2016

t is estimated that 60-90% of sexually-active adults worldwide have herpes. The rate is believed to be higher in the developing world. The transmission risk is also higher from men to women as they age. The vast majority of sufferers of herpes simplex virus (HSV) are unaware of the infections, as they may remain asymptomatic. This makes genital herpes the most common sexually-transmitted infection.

way to prevent the disease. Dr Shanti says there are several tests that can be done to see if you are at risk. “One of the simpler tests involves a faecal occult blood test. This is basically a test to check whether you have blood in your stool.” The test is a good initial test, yet it doesn’t signify cancer 100%. The more effective test to identify colorectal cancer is by a colonoscopy. “Colonoscopy can tell if there are any tumours or polyps (small growth in the colon) in the colon that can most likely point to cancer,” she adds. A colonoscopy can get rid of polyps right away and may prevent the development of the cancer. So how early should a person go for screening? Dr Shanti says “globally, it is said that a person should go for colorectal screenings when they are 50 and above. In the case of a family history of colorectal cancer, a person should go for screenings 10 years earlier.” There is greater advocacy on early screening of colorectal cancer in foreign countries. However, such awareness is still lacking in Malaysia. “Many people are surprised that colorectal cancer is the number two most common cancer in the country. So there is definitely a lack of general awareness on the disease,” Dr Shanti laments.

SORELY LACKING: Dr Shanti says the public must go for regular health screenings when they reach a certain age.

What is herpes? According to herpes.com, herpes is a common contagious viral infection. It causes oral herpes – cold sores or fever blisters – and genital herpes – genital sores or sores usually below the waist. Herpes simplex is easily transmitted by direct contact with a lesion or the body fluid of an infected person. The herpes simplex virus requires a moist environment for survival. There is no known animal carrier – human-to-human spread is the only known mode of transmission. There are two herpes simplex viruses: herpes simplex type 1 (HSV-1) and herpes simplex type 2 (HSV-2). These viruses look identical under the microscope, and either type can infect the mouth or genitals. In the 1960s, the distinction was made that HSV-1 occurs above the waist, and HSV-2 below, but genital HSV-1 infections are increasing. HSV-1 is the virus usually responsible for oral herpes or cold sores. If you receive unprotected oral sex from someone who has (HSV-1) cold sores, you can get genital herpes, or HSV-1 on your genitals. HSV-2 or genital herpes is usually below the waist, but if you perform oral sex on someone who has HSV-2 genital sores, you can get HSV-2 on your face and mouth area. HSV can also infect other parts of the body. Some other areas could be the eyes and the brain. Herpes encephalitis is herpes in the brain. Very rare, and only affecting two per million, encephalitis is very dangerous and can cause a sore throat, headache, fever, vomiting, coma, and even death if left untreated. Prodromal Symptoms Before an actual outbreak, a day or so before, you may feel tingling, itching, burning, pain, or flu-like symptoms. This is called the prodromal stage. This is a very contagious period even without any obvious sores. At this time, you are contagious and can shed the herpes virus, so do not have skin to skin contact with anyone. This means no kissing or oral sex if you have cold sores or if you have genital herpes, no intercourse or oral sex. Also watch your diet and include more lysine and decrease

generalNEWS+

2016 | maY

• 45

Herpes suffers usually unaware of infections This makes genital herpes the most common sexually-transmitted infection your arginine. If you are not already on a prophylactic for outbreaks, begin treatment to suppress your symptoms.

Usually the first attack causes visible sores with a myriad of other symptoms mentioned below, and commonly more intense than recurrent outbreaks. When the sores are completely healed, the active phase of infection is over. When the skin heals, the sores usually leave no scars. Whether a person has symptoms or not, the virus retreats into the nervous system and lays dormant. Asymptomatic shedding (shedding without symptoms) can still occur when no sores are present. Subsequent recurrences of the disease usually cause lesions but may not have the extreme pain and flu-like symptoms as the initial outbreak.

during outbreaks to help healing. Avoid physical contact with the area from the time of the first symptoms (tingling, itching, burning) until all sores are completely healed, not just scabbed-over. Also be aware of possible shedding or “asymptomatic transmission”, even after the sores have healed. Use condoms! When properly used, latex condoms help reduce your risk of spreading or getting herpes. Prevent self-infection to other areas of your body. Wash your hands with soap and water if you touch a sore. Better yet, don’t touch the sores. Prospective parents: If either mother or father has genital herpes, or any of the mother’s or father’s previous sexual partners had genital herpes, tell your doctor about it. It is possible to get genital herpes from cold sores. Women with genital herpes: Don’t skip your annual pap smear. Inform yourself about herpes. For many, diagnosis with herpes can mean a time of confusion, anger, fear and frustration. For many, it seems there is no place to turn for help in dealing with the sensitive aspects of herpes infection. There is help available. Herpes is spread by direct contact. Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make people more susceptible to HIV infection, and it can make HIV-infected individuals more infectious. Other disorders such as herpetic whitlow, herpes gladiatorum, ocular herpes (keratitis), cerebral herpes infection encephalitis, Mollaret’s meningitis, neonatal herpes, and possibly Bell’s palsy are all caused by herpes simplex viruses.

Get more information The better informed you are about herpes, the easier it will be to manage the disease. Give yourself the best possible chance to limit recurrences by maintaining general good health, and keeping stress to a minimum. Take care of the affected skin area. Keep the area dry and clean

Treatment Herpes.com says although there is no cure for herpes, some drugs have been effective in reducing the frequency and duration of outbreaks. It might be a good idea to discuss options with your doctor. During an outbreak, keep the infected area as clean and dry as possible. This will help your natural

Symptoms Herpes.com says symptoms of herpes usually develop within 2-20 days after contact with the virus, although it could take longer. These symptoms may last up to several weeks, varying from one person to the next. In most people, the first infection is so mild that it goes unnoticed. It is possible that a person becomes aware of the “first episode” years after the infection is acquired. Many people who contract HSV are not aware of their infection. If symptoms occur during the first outbreak, they can be quite pronounced. The symptoms can be very severe as many have shared their experiences on this site. Some people couldn’t walk, were in bed for days, having excruciating pain radiating down their legs with weakness and flu-like symptoms. Others didn’t even know they were infected.

ORAL HERPES: The mouth can also be affected.

healing processes. Some doctors recommend warm showers to cleanse the infected area. Afterwards, towel dry gently, or dry the area with a hair dryer on a low or cool setting. To prevent chaffing, some people also find it helpful to avoid tight-fitting underwear

and tight pants. Most creams and lotions do no good and may even irritate. Finally, a healthy immune system may be important in controlling the virus. Don’t ignore the need for proper nutrition, exercise, and rest.

An update on Dengue and Zika in Malaysia The Ministry of Health analysis has seen a continued decrease in dengue cases reported over the past few months (February this year to date). The 19th week (February 8 to 14) saw a 0.3% decline in dengue cases from 1,329 to 1,325 cases from the week before. Having stated that, the ministry had found seven states in Malaysia seeing an increase which includes Johor (25.2%), Sabah (50%), Perak (28.1%), Kedah (88.9%), Sarawak (12.7%), Kelantan (14.3%) and Negeri Sembilan (4.5%). Cumulatively, the total amount of dengue cases since January to May 14 this year was recorded at 46,856. Quite an increase from data recorded last year at the same timeframe, counted at 43,126 cases. The increase is recorded at 8.6% (3,730 cases). Death by dengue had also been on a decline since last week. Four deaths were recorded on the 19th week, compared to seven the week before. Cumulative total of deaths from January to May 14 this year was recorded at 109, a decline from last year with 136. The vector operation destroying breeding grounds of aedes mosquito continues throughout

the country serves as effort to further repress dengue cases among the public. Data of the most recent operation (April 11 to May 16) found 135,870 premises inspected, with 647 penalties given amounting to RM323,500. High prevalence of ‘hotspots’ for aedes mosquitoes is not only a concern for dengue however, as a report from Singapore had stated an infection of the zika virus very recently. The zika virus is spread also through aedes mosquitoes, hence the heighten risk and need to keep aedes mosquitoes at bay. The ministry implores everyone to keep their homes free from the risk of being a breeding ground for the mosquitoes by getting rid of still waters around the house. The public are also warned of the dangers of mosquito bites and are encouraged to wear long pants and long sleeve clothing as well as using insect repellent when in need. Globally, the World Health Organisation (WHO) had recorded 58 countries affected by the zika virus since January 1 2007 to date. Visitors screened for zika virus at international gateways (PMA) around Malaysia continues, yet no reports of visitors tested positive so far.

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generalNEWS+

Chemotherapy patients need balanced diet Forget about food taboos and eat healthy to increase rate of recovery

By Norman Hussaini

s this year’s World Health Day focuses on tackling diabetes, the need to practise a healthier diet is simply the better choice. Diet is somehow linked to obesity and diabetes as both conditions are partly due to what you consume. Yet the need to eat healthy is never exclusive to people who are overweight, obese or wanting to steer away from overweightness and obesity. A balanced diet ensures better overall health and can prevent countless medical conditions. This statement counts for double when a person is living with a medical condition – cancer, for example – as it can increase their rate of recovery. A person’s diet, however, can be greatly affected by the severity of his or her medical condition – mostly due to a decrease in appetite. Health+ discussed with consultant oncologist Dr Azura Rozila Ahmad and dietitian Gurdip Kaur from Beacon Hospital on how chemotherapy – a treatment for cancer – can greatly affect a person’s diet due to its adverse side effects. “Chemotherapy (treatment) is not a walk in the park. It is going to affect you in more ways than one. The heavy physical and mental burden can be unbearable to some. Among the effects of chemotherapy on a person’s diet is loss of appetite,” says Dr Azura. Cancer patients are malnourished According to Dr Azura, many cancer patients are malnourished. “As we know, nutrition is very important. It helps with our daily organ functions and immune system. Even from a cancer treatment point of view, malnutrition will result in loss of blood count which can greatly affect treatment,” she explains. Real issue As a dietitian, Gurdip says much

misinformation is being pandered around when it comes to diets for cancer patients. “I have often been asked by patients and their families about the food that they shouldn’t take after surgery or during treatment, which most of the time is unwarranted.” This is particularly true as we Malaysians have a set of taboos about food. “All these taboo regarding diets should be addressed properly so that malnourishment among patients can be tackled,” Gurdip adds. The belief that we should not be taking a particular type of food while undergoing chemotherapy treatment is untrue most of the time. Dr Azura says total calories and protein needs actually increase during cancer treatment. “So it is never a good idea to limit ourselves from eating certain things because of some taboos we heard from someone,” “I have also seen many patients wanting to become vegetarians after undergoing chemotherapy for fear that meats may harm them. Not that it is wrong to become a vegetarian as vegetables are actually very important in a balanced diet, but that mindset is a little misguided and may affect their overall nourishment,” Gurdip comments. The bottom line is all the

WELL VERSED: As a dietician, Gurdip deals with many families of cancer patients and provide nutritional consultations to fit their conditions.

maY | 2016

C HEALTHY EATING: Dr Azura is passionate about keeping cancer patients undergoing chemotherapy healthy in terms of food intake to ensure better outcome of treatment.

pantang and taboos we might have heard from our grandparents about food may not be so true and, in cases like this, may even worsen the patients’ condition. Improving patients’ appetite Now that we know chemotherapy patients are losing their appetite and further endangering their health, what can we do to help them get the nutrition they need? Dr Azura gives a few pointers. “Loss of appetite can be a result of a few factors in chemotherapy patients. For example, a patient may experience a change in the taste of food because of the chemicals used in chemotherapy which affect their appetite. “This makes eating with a metal spoon or even drinking plain water challenging. So improving their appetite can include substituting metal spoons with plastic ones and adding honey or lemon to plain water to improve the taste.” Gurdip suggests amplifying the taste of food by adding herbs and spices. “Chemotherapy patients usually lose a lot of their sense of taste, so it helps make the food more palatable for them.” Other pointers include eating with caregivers, eating while in the park or while watching television, go for walks before meal time so that they can build their appetite, and making the food more presentable by adding colourful vegetables and fruits. Most important thing Dr Azura and Gurdip gave very insightful tips on how we can help cancer patients with their appetite. The most important thing in caring for chemotherapy patients, however, is to have the knowledge and provide support and motivation. Caregivers are also advised to not adhere to the limiting taboos which may affect cancer patients’ well-being during treatment, and a little nudge can go a long way in that direction.

By Syed Zaid Syed Osman

heck your watch. What time is it? How long has it been since you woke up this morning? Have you gone to work? How many hours did you spend today with your family? How long were you at work? Have you achieved a healthy work-life balance? Work-life balance is relative and may vary for one person to another. A healthy balance is when you get to spend as much time as you desire for work and yourself according to priorities. It is believed that the younger generations might lean on more time for work as a start to the rest of their career lives while the latter generations tend to make more personal time. For stand-up comedian Harith Iskander, it is to make as much time for his family while still being active in the showbiz industry he has aptly carved his name in. The name needs no formal introduction. The man, widely regarded as the godfather of Malaysian comedy, has been hopping from one channel to another to make it seem like he actually lives in the living room television set. On the contrary, the father of three claims that he spends a lot of quality time with his family while also trying to get his head together for his upcoming show on Astro Awani, which will be aired every Saturday from May 28 at 9.30pm. While on his busy shooting days, he might fly off to another continent for a few days or even weeks. Bouncing between one meeting to another, one struggle to the next. To balance out the stress and the time away, he claims that on his slow days, he spends a lot of time with his adorable kids. “On my non-busy days, I’ll wake the kids up, have a little family breakfast and drive them to school before cramming in meetings and appointments to end before the school ends at 12.30pm for my kids, and sometime after lunch, I would play with them for a little while before their naptime,” he says. The remainder of his leisure days is mostly spent in the office he made up in his house. In the evenings, Harith enjoys his regular visits to the gym or a simple run around the block. He believes that work and life balance lies on the priority. “I don’t intend to put my family above my job or the other way around,” he says. “But at times, one priority can overweigh the other.” He says: “If I do not have anything to do, I would spend the spare time with my family.” What are his thoughts of having an efficient wife manager? “Open communication is an important element. When you’re in a relationship you work as partners.

generalNEWS+

2016 | maY

Fine balancing schedule Stand-up comedian Harith Iskander shares candidly how he achieves work-life balance based on priorities TIME MANAGEMENT: Harith sincerely believes we can always make time for what matters to us.

• 47

Don’t forget your healthrelated tax reliefs It’s the time of the year again for individual and corporate taxpayers to file their tax returns. We do it year in, year out, but many individuals are still not aware that there are actually many tax reliefs, rebates and deductions which are in one way or another related to health. Besides the basic reliefs, rebates and deductions, individual taxpayers are entitled to a

number of health-related ones too. According to the Inland Revenue Board website, certain reliefs are given to individual taxpayers with serious diseases or who are disabled – and these are also extended to their parents, spouses and children. The amount varies depending on different situations faced by the taxpayers.

Health-related tax reliefs

Types of Reliefs

Limit

1. Disabled individual (additional)

RM6,000

2. Disabled wife/husband

RM3,500

3 Medical treatments, special needs and care expenses for parents

RM5,000

4 Cost of basic supporting equipment for disabled individuals (self, spouse, child or parent)

RM6,000

5 Medicals expenses on serious diseases (including complete medical examination up to RM500 for self, spouse or child) Cancer

When I was single, it was all about work and having fun. I wasn’t even looking out for my health but now that I am married, it’s important because my life is not about myself anymore. I now have a reason to keep a good relationship between my job and my personal life. I got to stay on top of my game for my family.” – Harith Work out who can do what and who can do it when and try to help each other out in times of need,” he says with absolute confidence. Planning goes a long way, says Harith, especially when he changed his status from single to married. “I had enough of my single life. I had a good run. I would say the changes were easy because I was ready to get married a few years prior to my wedding day. The changes were well planned and the execution came in naturally.” The man feels that his work and life priorities should be balanced for his family’s well-being. “When I was single, it was all about work and having fun. I wasn’t even looking out for my health but now that I am married, it’s important

because my life is not about myself anymore. I now have a reason to keep a good relationship between my job and my personal life. I got to stay on top of my game for my family.” Despite his busy schedule, Harith admits spending a good portion of his time with his family. His wife plays a major role in both his lives – as a familyoriented grown up with kids, and as the nation’s beloved stand-up comedy sweetheart. He admits the changes he went through requires minimum struggle. “I got married pretty late in my life. The silver lining to it is that I have a lot of time to watch my children growing up. I will do what I can so I do not miss a moment.”

Heart Attack

Pulmonary Hypertension

Renal Failure

Chronic Liver Disease

Fulminant Viral Hepatitis

Brain Tumour or Vascular Malformation

Major Burn

Major Organ Transplant

Parkinson’ s Disease

HIV & AIDS

Major Amputation of Limbs

Head Trauma with Neurological

Chronic Skin Disease

Mental Illness

Diabetes Mellitus

Thalassemia Major

RM6,000

Rheumatology Leukaemia 6 Purchase of sports equipment (for any sports activity as defined under Sports Development Act 1997) NOT ELIGIBLE for purchase of sports clothing and shoes

RM300

RM6,000 RM12,000

Deduction for children 18 years old and above Disabled child Disabled child studying at higher educational institute

8 Education and medical insurance premium (self, spouse and child)

Compiled by Young Sin Yee

RM3,000

48 •

Nutrition

maY | 2016

DELICIOUS MIX: The Ambarella was tangy and sweet while the Clean Red gave a kick with its spicyness.

FINE TASTE: The pear, walnut, pomegranate and quinoa salad had good texture.

that made them edible, so I was particularly taken in by the rye grain as it provided an excellent body to the overall dish.

SUPERB: The duo, rye grain salad and roasted beet and wheat berry salad was awesome.

A hidden gem The Daily Habit certainly deserves more patronage with its healthy and delicious food By Norman Hussaini

y ongoing journey exploring healthy food took me to a small, quaint corner of a bustling part of Kuala Lumpur, not far from where I went for my previous food review. This time – together with a colleague – we found ourselves in Bangsar Shopping Centre to experience healthy food, which we were pleasantly surprised with. The Daily Habit is a place where first-timers might find a bit hard to find, as it is attached to a gym in Menara BRDB, which is connected to Bangsar Shopping Centre. After a lapse or two around the mall, we finally found

The Daily Habit. Tucked comfortably at the side of CHI Fitness’ entrance was this simple, modern and comforting place. Opened in 2013, The Daily Habit café is a place where superfood is a term most adequate. Its owner Elisa Larkin is a true believer of clean eating and healthy alternatives to our daily food intake. She told us the café had been sitting under the radar for some time since its opening. What a shame, we later realised, as the food we sampled were among the tastiest we ever had. Warming up We started off with fresh and colourful cold-pressed juices – the Clean Red (beetroot, carrot, apple and ginger) and the Ambarella (kedondong, apple and spirulina). The green Ambarella was a delight as it was tangy and sweet. For the Clean Red, ginger played

MODERN TWIST: Classic sago dessert with mango puree, chia seeds, coconut milk, sago, granola and fresh mango.

GINGERY: A person with the flu can really benefit from the creaminess of this carrot, turmeric, and ginger soup.

the key role, and although it was a bit too spicy for my comfort, I finished it nonetheless. Both juices surprised me as the sweetness would make you feel they contain at least a little bit of sugar, which of course they don’t. Main course As we were enjoying the juices and laying back on the comfy sofas, Elisa started wheeling in different dishes for us to savour. At the end of our review, it’s safe to say we were stuffed to the rafters with delicious and, most importantly, healthy food. Let me describe each of them as well as I can. Rye grain salad / roasted beet and wheat berry salad Elisa started us on a double salad dish made from fresh, organic superfoods on a bed of lettuce. The salads were examples of good understanding of how salads should be. The ingredients were top notch and the texture of each ingredient was perfect. The flavour really came from the ingredients, while the dressing enhances them. I had previously eaten some salads where the dressing was the only ingredient

Pear, walnut, pomegranate and quinoa salad Next on our table was this signature salad of The Daily Habit since day one. Yet, after tasting it, I felt it was a bit underwhelming, compared to the other two. The ingredients fell a bit flat in terms of taste, but the texture was excellent. Carrot, turmeric, and ginger soup served with buckwheat and chia seed bread This classic cream-based soup with the right amount of flavour and creaminess was good but wasn’t anything ground breaking. However, the buckwheat bread was one of the things that surprised me. It was crunchy and tasty despite not being an actual bread in a traditional sense. It didn’t use any flour and was closer to cake than bread, but it was an excellent match with the soup. Mango, coconut and pomegranate salsa served with chicken breast The pinnacle of our meal was translated through this dish. The salsa was sweet and tangy, the chicken was moist and flavourful, and the broccoli and tri-colour quinoa was by far the tastiest I’ve ever had. I’m not ashamed to say I finished every last bit of it. But hey, finishing a plate of healthy and organic food beats a Big Mac with fries by a landslide. Mango pudding Don’t let the simplistic name of this dessert fool you. The ingredients include pure mango puree, chia seeds, coconut milk, sago, granola and of course, fresh mango. It was sophisticated enough to match the style of the café, but felt homey enough to have it on a rainy day at home with a good book. The verdict The Daily Habit may not be that popular despite its good food, which is of course a shame. It has already been operating for three years and Elisa feels underwhelmed. I sincerely hope the café receives more patronage as it clearly deserves.

Alternative

2016 | maY

• 49

Understanding traditional Chinese medicine Ancient medical system doesn’t really treat diseases but their syndromes

By Prasad Chandra Segaran

raditional Chinese medicine (TCM) is a complete medical system that works on its own philosophy. Based on observations of both natural phenomena and nature, it is known to treat a wide range of conditions. It is widely used in China and getting increasingly prevalent in Europe and America. Yet Malaysians, particularly nonChinese communities, have not really taken to it. Health+ met up with Professor Liu Xiao Hang, a traditional Chinese medicine specialist at Tung Shin Hospital, to learn more about this medical system. According to him, traditional Chinese medicine was previously well known only among the Chinese community in Malaysia, but now is slowly being accepted by the Indians and Malays as well. He says Chinese medicine doesn’t really treat diseases but their syndromes. “Chinese traditional medicine doctors don’t diagnose patients by doing health screening. Instead we ask them about their symptoms, observe their tongues and take their pulse readings. We do this to find out their syndromes, and then we prescribe medicine accordingly. For Chinese medicine, the same disease may differentiated by several syndromes and also the same syndromes. If a patient is suffering from deficiencies, we’ll prescribe tonic medicine, if it is caused by heat, we’ll treat the patient with cooling medicine and vice-versa. For skin diseases, we also treat the patients according to syndromes not disease. Different strokes According to Dr Liu, there are different kinds of Chinese traditional medicine, some are herbs used normally in food. “If a traditional medicine doctor has many years of experience, he would know the correct herbs to prescribe to his patients to help them recover.

HERBS GALORE: Dr Liu says traditional Chinese medicine generally uses about 300 to 500 types of herbs.

Different practitioner has different sets of skills to treat their patient, but not all follows the basic TCM principles,” he says. The efficacy of Chinese traditional medicine depends on patients’ conditions. For some, it takes a few days, for others it may be weeks and some even months. He adds that Chinese traditional medicine also treats wounds like cuts and burns on the skin. However, this also depends on the depth of the cuts and the degree of the burns.” If surgical treatment is needed or if it is too severe, then Western medicine would be of much help. Cost of treatment In terms of costs, traditional Chinese medicine is more expensive than Western medicine for shortterm treatment. It is almost the same (over the long term) because Western medicine sometimes requires life-time medication, whereas traditional medicine is for only a certain period and will constantly maintain the positive result, he says. Herbs used Traditional Chinese medicine uses many types of herbs. According to Dr Liu, about 300 to 500 types are generally used. The types of herbs used will depend on each doctor, says Dr Liu. Does traditional Chinese medicine contain 100% natural ingredients? “Yes, actually around 90% of TCM is herbs, some others

contains steroids, Dr Liu dismissed them saying: “A few local traditional clinics don’t follow (the standard practices) by adding steroids to (their medicine) to show faster result to patients, but that would be totally unethical.” Even though TCM includes some surgical treatments, they do not play important roles in treating skin problems. Chinese medicine also prescribes cream and powder for skin problems other than herbal decoction. “Acupuncture also plays some role at times but not very popular in most cases we use only internal and external medication,” adds Dr Liu. DIET WATCH: Dr Liu advises those with skin disorders to be very careful with their diet.

COOLING EFFECT: Avoid taking food that creates heat in your body and concentrate on keeping your body cool, says Dr Liu.

are animal part or minerals. A typical traditional Chinese doctor or herbal hospital will use only classical TCM products in their medicine without adding any chemical or steroid. Tung Shin Hospital has to date (maintained) its standard for traditional medicine,” says Dr Liu. “Older doctors are better as they have more experience. In China, patients look for old doctors because they have more experience treating various kinds of diseases. Perhaps the older doctors know the correct medicine to prescribe to their patients.” He says most of the herbs are imported from China as there are not many of them in Malaysia. Asked to comment on rumours that traditional Chinese medicine

Skin disorders Dr Liu advises those with skin disorders to be very careful with their diet. “Food intake is very important as body heat plays a huge role in skin disorders. Avoid taking food that creates excess heat in your body and concentrate on keeping your body cool, for example taking coconut juice would help to keep your body cool, and reducing intake of red meat (especially mutton and beef), chilli, deep fried food and especially durian and alcoholic drinks which causes heat to your body. Some vegetables like petola, winter melon and Barley are also good for skin disorders. Sea food should be avoided when people are allergic to them. “Because of the hot weather, excess heat in the body is the main problem in skin disorders here,” adds Dr Liu. He says he has a skin allergy although it rarely flared up when he was in China. “But the symptoms are often when I am in Malaysia.” Dr Liu, who started his medical journey in China almost 40 years ago, has clinical experience in both traditional Chinese and Western medicine. A former chief physician of cardiology department at the Hospital of Nanjing University of TCM in China, he has been with Tung Shin Hospital for almost 10 years. Although he specialises in internal medicine, he also treats complicated cases which are related to surgery, gynaecology, dermatology and paediatrics.

50 •

Health Tech

FUTURE IS HERE: Robotic-assisted surgical procedure is the cornerstone of development in the medical field as it helps perform intricate and precise operations.

Robotic-assisted surgery better option With small incisions – just one or two centimetres long – scarring is minimal while, recovery much faster

By Prasad Chandra Segaran

obotic surgery is a g roundbreak ing alternative to both conventional open surgery and traditional laparoscopy. Health+ spoke to obstetrician and gynaecological oncologist Datuk Dr Abdul Aziz Yahya about this new era of surgery. “In traditional surgery, I would use these to operate,” he explains, holding out his hands and arms. “With robotics, we use these,” he adds, holding up thin long rods with pincers on the end. Dr Aziz, who heads Prince Court Medical Centre’s (PCMC) department of obstetrics and g ynaecolog y, explains that robotic-assisted surgery means minimal incisions – just one or two centimetres long – on the patient. “Traditional surgical procedures – the first era, if you like – are still the procedures that are most common. The procedures are efficacious and well known, and are taught at most medical schools. “They are quick and easy

means of access to surgical sites. As they have been the standard procedures for so long, the surgical instruments are readily available. Collaborations with other surgeons are also easier because there are more surgeons performing these open procedures. The downside is that they are highly invasive procedures, which means greater scarring and, therefore, patients

MECHANICALLYTRAINED: Surgeons undergo strict training to perfect their abilities to operate the machines.

maY | 2016

need a longer time to recover,” he says. The next era, laparoscopic surgery is minimally invasive which means shorter recovery time. However, the controls are counterintuitive which means the surgeon uses them in the opposite direction from what he sees on the screen, while viewing what he’s operating in two dimensions. Like traditional surgery, it is also more taxing on the surgeon as he has to stand while performing the surgery. The latest era in modern surgery is the da vinci roboticsassisted surgery or technique. Instruments are three-dimensional and move according to the surgeon’s preferences. The tiny surgical instruments bend and rotate far better than the human wrist. The surgeon is afforded a better view, precision, control, dexterity and comfort as he sits in a chair, while performing the surgical procedure. Because the incisions are small, scarring is minimal and recovery is much faster. There is less post-operative pain, lower risk of infection and less blood loss. PCMC only private hospital with facility PCMC is the only private hospital in Malaysia that has a da vinci robotic unit and suite, and has the latest version since 2007. It is used mainly in the fields of urology and gynaecology. “This is not an experimental surgery. They are US Food and Drug Administration, approved procedures and were first performed over 16 years ago in the US,” explains Dr Aziz. “In some parts of the US, 30-40% of gynaecology surgeries are done with robotics.” Only a handful of doctors in Malaysia, most of them practising at PCMC, are trained to use the da vinci system whose benefits are clear. “I had a patient who needed a hysterectomy but she also wanted to go dancing within a few days. So I operated on her on Thursday, she left the hospital on Saturday and was out partying on Sunday,” relates Dr Aziz, stressing that he wouldn’t recommend this and advises patients to take it easy and rest for at least few days after surgery. However, traditional hysterectomy would have required at least a five-day hospital stay and a much longer recovery period. While there are fewer complications compared with open or laparoscopic surgery, not all patients opt for it. “Cost is a factor. For example, a benign (case) can cost up to RM35,000. For cancer cases, it can cost up to RM55,000. However, there are minimal tissue injuries, less pain and less bleeding. I operate in the morning and by night the patient will be allowed to take food and liquid,” says Dr Aziz. Despite the high cost involved, he says his patients included a woman who is a vegetable farmer

while another is a manicurist. “These patients are grateful because they were able to return to being productive quickly.” Training in robotics Dr Aziz was first trained and then proctored in robotics-assisted surgery under colleagues from the National University of Singapore, and later in South Korea. Proctors and doctors with experience can certify that you are sufficiently skilled and ready to use the da vinci system. He began by watching cases being performed and in 2009 performed the first roboticsassisted hysterectomy in Malaysia. He started with single procedures but now handles more complicated cases. He has so far performed over 100 procedures and is now proctoring two doctors at PCMC as well as one each in Indonesia and the Philippines.

“You need to perform at least 20 robotic surgical procedures per year before the manufacturer of the da vinci system considers you experienced, thus allowing you to start proctoring others,” he explains. So, where does Dr Aziz see the future of robotics-assisted surgery? He currently performs such surgery seated at a console not too far from the patient. But he explains that robotic-assisted surgery was first conceptualised during the Vietnam War when doctors began to think of ways to treat injured soldiers remotely. “In the future, it is possible that we will be able to operate on patients who are in another country while you are sitting in your own operating room,” he predicts.

What’s NEW

2016 | maY

Rice cooker that removes starch Rice has been the staple food of Asians for thousands of years and is also growing in popularity in Middle East countries. Most Malaysians have rice for almost every other meal. While some are aware of its high carbohydrate content, others try to reduce rice intake or abstain from it altogether. The conventional rice cooker has revolutionised how we cook our rice – turning what was once tedious and time-consuming into something simple and fast. However, when rice is cooked, the starch from the grain is absorbed into the water and goes back into

the rice. The starch is responsible for the high sugar content in rice, which is considered very unhealthy by the health conscious. But the burning question is, how do we get rid of sugar in rice? Grayns claims to offer the solution. Its intelligent rice cooker, the first of its kind in the world, is said to do just that! The gelatinous rice cooked using this revolutionary rice cooker has lower sugar content to reduce the risk of cardiovascular diseases, diabetes, obesity, premature ageing, high cholesterol and even cancer. It is said to be most suitable

SMART APP: The device offers wi-fi, monitors driving behaviour, and provides tips for saving fuel.

Samsung drives into the connected car market GUILT-FREE: Grayns offers starch-free rice to those who are particular about their carbohydrate intake. for those who are watching their carbohydrate intake. It promotes digestion and weight loss, while simultaneously helping to control the “side effects” of eating rice such as sleepiness and lethargy.

Nestle’s improved formulation for infants Nestle has launched a new improved formulation for infants to support optimal growth and development. The Nankid® Optipro® HA3 contains protein that have been broken down 10 times smaller, making it easier for infants to digest. This protein, called partially-hydrolysed protein, is also less allergenic than cow’s milk. As a survey shows 50% of Malaysians are unaware that allergies have no cure, it is believed that Nankid® Optipro® HA3 is the key to prevent allergies by providing children with the right nutrition. High-quality proteins, such as whey protein, contain amino acids which

• 51

help repair damaged tissues, support growth and development, and provide energy to build antibodies, enzymes and hormones. Nankid® Optipro® HA3 completes the new experience with its latest packaging innovation, the new Nestle See Clear Lid that comes with an easy scoop. This breakthrough easy scoop is designed to provide enhanced convenience, safety and hygiene for users. It offers convenience with its unique compartment for storing above the powder. The semitransparent window on the See Clear Lid makes it easier for parents to see how much powder is left in the can without having to open the lid.

Alongside new smartphones and a virtual reality camera, Samsung demonstrated its Samsung Connect Auto at the recent Mobile World Congress in Barcelona, Spain. Described by its makers as ushering in “a new era of driving experience”, the Samsung Connect Auto is a dongle that plugs into the diagnostics port of potentially any car built since the 1990s to bring it up to date, technologically speaking. “We have been listening to our customers and pushing boundaries to create a connected car ecosystem that seamlessly integrates our products and partner services for a better driving experience,” says Dr Injong Rhee, executive vice president and head of R&D, Software and Services, Mobile Communications Business at Samsung Electronics. “Through collaborations with valuable partners and experts across many industries, we are carrying out our vision of bringing IoT technology to people’s everyday lives.” The device offers wi-fi, monitors driving behaviour, and provides tips for saving fuel. It can also give maintenance advice, serve as a vehicle locator and tracker in case of theft; and as a black box for helping users lower their insurance premiums. The final touch is support from a number of partners including Cisco, Orange, Here, and AT&T. “Samsung’s willingness to work with others to create an ecosystem of true interoperability will allow it to be one of the leaders in the aftermarket connected vehicle space,” says Chris Penrose, senior vice president, Internet of Things, AT&T Business Solutions. However, the gadget is not a new idea. US startup Automatic Labs has been selling its own US$99 plug-in dongle and smartphone app offering almost identical services since 2012 and in 2015 launched an ecosystem of car-focused apps from other companies. – AFPRelaxnews

Mouthwash to help sensitive teeth sufferers Tooth sensitivity is the biggest oral health issue in Malaysia impacting some three million people. According to GlaxoSmithKline Consumer Healthcare (GSK), about one-third of Malaysians who suffer from this dental problem use sensitive toothpaste to relieve the sensation when they eat, especially something cold, sweet and hot. To help those with sensitive teeth, GSK recently launched its new Sensodyne mouthwash which it claims provide 24-hour protection. Stacy Wallace, general manager of GSK Consumer Healthcare Malaysia and Brunei, says tooth sensitivity is a common dental problem. “Almost 50% of sensitive tooth sufferers adopt a regime care and this means that almost

1.38 million Malaysian adults are advanced oral care regime users. With the increasing incidences of sensitive tooth sufferers in Malaysia, it is timely to launch Sensodyne mouthwash and we see the importance of encouraging sufferers to opt for an advanced oral care regime. The new mouthwash provides lasting freshening effect and fluoride to strengthen teeth and protect against decay,” she says. The mouthwash protects sensitive sufferers from tooth sensitivity for a long-lasting period. Sensitive sufferers can now enjoy their favourite food without scruple because they are free from the zingy sensation due to the sensitive dental problem. Besides, the mouthwash can also kill oral bacteria and prevent tooth decay as well.

24-HOUR GUARD: Stacy (left) and Dr Army Empol, consultant in restorative dentistry, launching the Sensodyne mouthwash.

52 â&#x20AC;¢

MAY | 2016

Most infertile couples are not aware of their conditions, but thereâ&#x20AC;&#x2122;s still hope

Beating infertility... pages 02-03

www.healthplus.com.my

The Pulse of the Nation

may | 2016

More fertility options for couples

Dr Helena Lim discusses alternatives to in vitro fertilisation and their selection factors

... pages 04-05

Bringing hope to the infertile

National Population and Family Development Board offers wide range of services to couples with fertility issues

... page 09

02 •

may | 2016

Beating infertility Many infertile couples are not aware of their conditions, but there’s still hope By Syed Zaid Syed Osman

ark and Alice were so excited when they decided to get started with their family. They had been looking forward to this since they first got married. Unfortunately, Alice had been focusing on her career for the last few years. They wanted to get really stable for the children to come, and had therefore been delaying their plans. After a good long talk, they finally made up their mind. Fast forward to a year later, Mark and Alice were stressed out. The plan they made was pushed a whole year back, and so after trying out traditional methods, the couple thought it was time to speak to a professional. After a few visits to their fertility specialist, it was confirmed that Alice is unable

Longing turns to loving Thanks to in vitro fertilisation, two women find happiness in conceiving and starting families

n vitro fertilisation (IVF) is one of the few assisted reproductive technologies that help people with reproductive limitations to conceive children. The process can be described as manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. The technology is not really new, yet the average Malaysian has a vague understanding of this

conception method. As part of the Turning Longing Into Loving campaign organised by Parker Industries, two women who had gone through the IVF treatment shared their stories to help other couples have a better understanding of the procedure. Zaitul Izam Lebossé and Sarasunathy Kuttan Pillai were married for some time and had problems with having children, not for their lack of trying.

DYNAMIC DUO: Zaitul (left) and Sarasunathy are happy to share their experiences with IVF and how they found happiness with children in their lives.

“I was married for eight years before I had my first child. We decided to take it easy and not have children for the first four years of our marriage. Then when we tried after the first four years, we found that nothing was happening, and that was when we looked into getting help,” says Zaitul. Sarasunathy, on the other hand, says she and her husband wanted to start a family immediately. “I started undergoing

to conceive due to her low quality eggs. What has happened to Alice may not be something many of us are familiar with. Maybe not for the majority, but according to Dr Muhilan Parameswaran, consultant urologist at Tropicana Medical Centre (TMC), one out of ten couples faces infertility problems. “Many think babies are sure products of marriages. Sadly that is not the case for everyone,” he says. It is believed most couples with infertility problems are unaware of the issue themselves. Infertility, says Dr Navdeep Singh Pannu, consultant obstetrician and gynaecologist at TMC, is “where a couple are having regular unprotected intercourse with the will to conceive but are unable to in the duration of six months”. He explains that there are various reasons why a person is infertile and the symptoms and diagnosis differ among genders. Some were unlucky and the source could be

IUI (intrauterine insemination) treatment in 2005 after failing to conceive. It didn’t work out and (this) went on until 2009 and I was still not getting pregnant. So we decided on IVF after that. In total, we were trying but not succeeding for nine years.” Their challenges Both Zaitul and Sarasunathy obviously were very frustrated when they couldn’t conceive. Zaitul recalls going home to celebrate Ramadhan and being pestered by family members about her inability to have children. “The societal pressure towards having children is strong among my family members. When you are married for eight years but still have no children, they will have something to say about it,” she says. Their state of preparedness was also key for them to go for IVF. “When my husband and I did IUI, we were not prepared. By that I mean we didn’t prepare ourselves physically as we should have when going through the process,” says Sarasunathy. “Financial preparedness is also very important,” Zaitul adds. “The procedure is not cheap. My

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2016 | may

THERE’S HOPE: “Treatments are available to those who seek. Infertility is not the end of the world.” – Dr Navdeep

traced back to their birth deformity. In other words, they were born with the inability and this is referred to as the primary cause. Some have lost the privilege due to multiple causes and this is known as the secondary cause. Back in the simpler days where Google and WebMD were yet to be discovered, the blame was on women. Only a handful of men, if not at all, contributed to the infertility chart while their fingers were pointing to the women. In light of recent data, Dr Navdeep says men are contributing to about just the same amount. He says during his years of practising he has seen many couples pointing fingers at each other. “The splits are quite simple – 30% men, 30% women, and 30% both, while the remaining 10% of the cases were inconclusive.” From Dr Muhilan’s point of view, this issue does not discriminate between races. The odds of a Chinese couple being

infertile are basically the same as the odds of the Malays and the Indians. Furthermore, the issue is often found in couples in urban areas. “When the couples are back from work and are tired, their sex drive decreases. From that, the couples tend to delay their plans to conceive until they think they are ready,” he says. “In this case, time is not your friend.” Dr Navdeep says it also shows that the total fertility rate among women decreases in locations where the people are career-driven. According to both specialists, age is one of the outside factors that can affect the total fertility rate. As people get older, the grade of their produce decreases. The sperm count and quality in men decreases with the ovary’s quality. “When a man releases his semen, millions are produced and within the semen, 80 to 90 million roughly, and it takes a minimum of 45 million sperm count to impregnate a woman,” says Dr Muhilan.

“After a man gets to a certain age, there are changes in his hormones. These cause the production to reduce the sperm count when he ejaculates.” Simply put, as a person gets older, the sperm count and quality steadily drops. Dr Muhilan advises couples who are planning to have children to accelerate their plans before the women turn into their 30s. This increases the chance to conceive for the eggs’ quality is at its peak. On the other hand, men are able to produce sperm until they die. Unfortunately, after a man is around 40, the hormone level will drop, causing him to have less sex

Many think babies are sure products of marriages. Sadly that is not the case for everyone.” – Dr Muhilan couples can achieve. Sarasunathy says she and her husband get constant support from their family and friends. “We received more than enough support from our family and friends for our problems.” Although some of their advice involves traditional or alternative methods, they feel it had fuelled them to get help.

You need to focus on the problem and what you want to achieve. You want to have children; it doesn’t matter whose fault it is. Just seek help and solve the problem together.” – Zaitul husband was particularly worried about the cost while I had to prepare myself mentally. I was dealing with the confusion as to whether the treatment would work and how we will deal with it if it doesn’t.” Both of them however found that preparing themselves physically and mentally was much easier with the help of their doctor Datuk Dr Prashant Nadkarni, the medical director of KL Fertility Centre. “He was very straight forward with me. He told me the details of the procedure, the physical preparation as well as the financial (aspect),” says Zaitul. Sarasunathy says the very detailed information provided by the doctor helped her to prepare more easily.

Finding support Both women agreed that the most important part of their experience was finding support from their husbands. “My husband was very open minded on the whole thing. He was the one who suggested that we go through IVF,” says Sarasunathy. “It’s true,” Zaitul concurs. “My husband and I believe in science. So it was easy for us to be on board with IVF once the doctor explained in detail to us.” Getting their husbands’ support proved to be a blessing because both agree some men have an ego problem concerning fertility. Dr Prashant had told Zaitul and Sarasunathy that the inability to conceive is usually blamed on women, even though men could

drive and, as mentioned earlier, the count drops. In addition, the count for healthy perfect-shaped sperms may also decline. “Treatments are available to those who seek. Infertility is not the end of the world,” assures Dr Navdeep. Fertility experts are on top of the case trying to develop more ways to help infertile couples. Counselling and surgeries are available to assist these couples. Dr Muhilan advises infertile couples to seek the attention of a medical expert instead of trying off-the-shelf drugs, which may cause only more complications to them.

ONE HAPPY FAMILY: Sarasunathy and her loving family.

be the cause as well. It is not easy for some people to admit that when there is a problem, the fault could lie with them. So to have their husbands understand that and support the process is not something many

Their advice Sarasunathy explains that some men have an ego problem when it comes to infertility issue. “They feel that if they can’t have children, then they must be something wrong with their wives. This (notion) needs to be addressed properly.” “We can read about it, we can hear stories about it, we can share our experiences with everyone, but at the end of it, the experience is different for everyone. You need to focus on the problem and what you want to achieve. You want to have children; it doesn’t matter whose fault it is. Just seek help and solve the problem together,” adds Zaitul. Both Zaitul and Sarasunathy now live happier lives with their bundles of joy, and love to share their stories and experiences with everyone.

04 •

may | 2016

A helping hand to conceive In vitro fertilisation is one of several assisted reproductive technologies to help infertile couples conceive

By Ali-Azmin Hassan

etting pregnant nowadays is a challenge for some women. One might think: “How hard is it to get pregnant anyway?” It’s a little known fact that, in general, the rate of infertility worldwide is one in 10 couples. Our lifestyle is rapidly evolving both in positive and negative ways. The negatives, which include smoking, excess alcohol consumption and promiscuity, can affect your ability to bear a child and it’s not gender bias. It affects both men and women. And to a few who have trouble getting their own children despite their healthy lifestyles, unfortunately, certain things are just beyond your control. So things didn’t go as planned, and it’s okay. But as they say, if there’s a will, there’s a way. In this day and age, we get to experience the marvels of technology and medical advancement. In the aspect of fertility, there’s in vitro fertilisation (IVF), a fertilisation process which manually combines an egg and sperm in a laboratory dish, and then transfer the embryo to the uterus. Dr Wong Pak Seng (pic), medical director and fertility specialist at Sunfert International Fertility Centre, sat down with Health+ to discuss the issue of fertility and possible treatments. The Process “Basically, in a standard IVF, the woman will go through the injection and we collect the eggs. And the man produces the sperm and then we fertilise them. After that we keep them in an incubator for about two or three days. Then we choose the best-looking ones. Before we put them back into the womb, we do a genetic test. So we take a cell out and check and make sure it’s free from genetic problems such as Down Syndrome, chromosome problems or any abnormality. Then only we put the healthy one back inside.” Another very advanced technology in IVF is the ability to put a camera in the incubator to observe the whole process of the formation of the embryo and its subsequent

growth. The purpose is to gain more information. “It helps us select the best one to increase the pregnancy rate,” explains Dr Wong. RISKS Just like any other medical treatment, IVF has some risks involved. One of the most concerning questions regarding IVF is whether it increases the risk of having abnormal babies. Yes, says Dr Wong. “But the absolute risk is low. If you look at any woman conceiving naturally, the chance of having abnormalities (in her baby) is 0.5% to 1.7%. Abnormalities include cleft lip or hole in the heart problems,” he says. “But if you do IVF, the risk increases by 0.2%, so it’s 0.7% to 1.7% chance of abnormality. So you can see the risk is not that high and it’s an acceptable risk. The risks are higher because it is artificially-induced pregnancy. It’s not natural and involves using medication and drugs to stimulate the ovaries. Other than that, the embryo or fertilised eggs need to be washed with chemicals. But of course it’s very friendly and not toxic to the embryo, but it’s still artificial. “Basically, when we fertilise the eggs for men with very poor sperm, we cannot let them fertilise (on their own). We have to choose one sperm and inject into the

egg. We force it in and it’s called intracytoplasmic sperm injection (ICSI). If an unhealthy sperm is selected, it may affect the fertilisation. If the embryo is unhealthy, it tends not to stick to the wall. But even if it sticks, there’s a chance of miscarriage.” Awareness among couples Dr Wong says other advanced treatments include intrauterine insemination (IUI), which is the insemination of the sperm into the womb, and test tube baby method. The greatest advancement in technology for fertility treatment is screening the embryo or fertilised egg to ensure it’s healthy before it is put back into the womb. In terms of awareness, he says it’s important for couples to plan for children at a younger age. “Age is very important. We advise couples to get a child before the age of 35. Along this line, we also have something which is very new and getting very popular, and that is egg freezing. Let’s say you are now about 30 coming to 40 and you don’t have a life partner or (pursuing) a career or education, your chance of getting pregnant naturally or even with IVF will diminish,” he says. “A possible alternative to that is you may choose to freeze your eggs first. After that, when you are ready to start a family, you have the option to use the eggs that are frozen. Previously, this was not very popular because the success rate was not very good. But now with advancement in freezing technology, the success rate is very good and it’s reasonable to do that.”

hile in vitro fertilisation (IVF) is often regarded as the go-to treatment for couples with fertility problem, there are other options available, depending on the gravity of each situation. Health+ talks to Dr Helena Lim Yun Hsuen, consultant obstetrician and gynaecologist at KL Fertility Centre, on key alternative treatments and their selection factors. She advises couples with fertility problem to consult an obstetrician to help them select the most suitable treatment. The obstetrician will assess the couple’s situation to find out why they have difficulty conceiving, which can either be organic – whereby the problem lies with the body – or timing problem. Dr Helena says there is a surprisingly high incidence of couples facing trouble having babies because they are trying at the wrong time. “This type of problem can be solved simply by knowing the wife’s ovulation period and trying at the right time.” She says the root cause of infertility for which treatments are needed is actually organic in nature such as low sperm count in male and problems with ovulation in female. Treatment options Scanning A number of treatments are available besides IVF, and the simplest one is to do a scan to find out when the woman is ovulating and advise the right time for the couple to try naturally. This, Dr Helena explains, is known as time coitus. Hormonal medications or injections Then there are treatments for

Take care of your reproductive organ By Syed Zaid Syed Osman Infertility has always been a taboo subject, especially among men who often try to avoid any discussion about their reproductive health. As a result, men often neglect proper care of their precious reproductive organs while some choose to dwell in the bliss of ignorance. According to Dr Muhilan Parameswaran, a consultant urologist at Tropicana Medical Centre, improper care of one’s body may lead to infertility. Egg and sperm quality can be affected by external factors such as:

Smoking

Harmful chemicals in smoke

• 05

2016 | may

More fertility options for couples Dr Helena Lim discusses alternatives to in vitro fertilisation and their selection factors

PENETRATING: IVF treatment may involve ICSI procedure.

SHORTCUT: In IUI, sperm cells are injected directly into the uterus of a woman having difficulty conceiving.

in which the husband’s sperm is extracted, concentrated and injected into the uterus. “This type of treatment somewhat creates a shortcut for the sperm to reach the fallopian tube, where it will meet and fertilisation happens.” This treatment, she adds, may increase the women’s chances of getting pregnant by 10-15% each time. Intracytoplasmic sperm injection in IVF treatment According to Dr Helena, IVF is

SOCIALLY SPEAKING: Besides health problems, social interactions between people with different demographics also greatly affect fertility rate, says Dr Helena. problems which are organic in nature. For example, Dr Helena explains that some women have difficulty ovulating due to hormonal imbalance. “For such cases, treatments will include hormonal medications or injections which will stimulate eggs to grow and ovulate properly.

After the treatment, the couple can then choose to try naturally by identifying the ovulation period or go for intrauterine insemination (IUI) treatment.” Intrauterine insemination (IUI) IUI is a form of treatment proceeding the hormonal injections This habit can harm one’s sperm production as the heat can damage the penal artery over long exposure.

true guys: impact to the “manhood area” can lead to infertility.

Surgeries, drugs and medical procedures

Steroids release a high level of testosterone when consumed. The hormone is required to produce sperms. Once the level gets to the desired amount, the production of sperm ceases from natural causes.

Sperm responds negatively to certain types of surgeries, especially chemotherapy and radiotherapy. Those who are undergoing these procedures are unable to produce sperm. The abuse of recreational drugs can also damage sperm production.

Sexually-transmitted infections

are cancerous. The chemicals affect other parts of the body as the nicotine travels through the blood and this can lead to erectile dysfunction.

Diet

Consumption of certain foods can interrupt with one’s hormonal balance which can directly impact the production of sperm. A correct

and healthy balanced diet is always one of the first steps to improve one’s health.

Heat

Technological advancements can be handy, especially computers which have evolved from desktops to laptops and the like, which are often placed on top of or near one’s private area.

different from IUI as it involves extracting a particular egg and sperm for fertilisation in the laboratory, after which it is put back into the uterus. An interesting procedure is carried out in the fertilisation of the egg. Particularly for men with low sperm count, the fertilisation process involves intracytoplasmic sperm injection (ICSI) whereby a single sperm cell is injected directly into the egg, outmanoeuvring the natural process of fertilisation. “In a natural state, the egg is protected by an outer shell. The millions of sperm cells ejaculated work as an army to penetrate the outer shell, leaving one single sperm cell to come in contact with the egg,” explains Dr Helena. “With a low sperm count, the sperm cells ejaculated may not have the strength to successfully penetrate the outer shell. So with ICSI, the process is cut short significantly, ensuring better chance of conceiving.”

Dr Muhilan says certain infections can cause the obstruction in the sexual organ, thus withdrawing sperm from being released into the womb. Those who are sexually active are advised to always use protection.

Damage to penal artery

Any damage from a bike fall during a man’s childhood can go unnoticed until it is checked. The rumours are

Usage of steroids

Dry masturbation

This causes friction which will over time damage receptors located in the penal region. Infertility is developed through poor hygiene and improper care of one’s private part. Some signs may take as long as 15 years without showing early symptoms, while others may show as soon as they develop. Some may be inevitable which make the difference matters. Men and women need to understand their body functions and shortcomings in their physiques, and take the necessary steps to maintain good reproductive health.

06 •

may | 2016

Fertility treatments in line with Islamic teachings JAKIM sheds some light on what Islam says about infertility and methods to fix it

By Norman Hussaini

roblem in conceiving is universal and no respecter of person, race, colour or creed. It is widely understood to be caused by a number of factors, but the good news is various treatments are available to fix it. These treatments, some of which have almost been perfected over years of medical studies and testing, are proven to effectively treat this growing problem. Unsurprisingly, religion also talks a lot about fertility as well as treatment for infertility. Some may believe there is a clear line between religion and science, which one should never cross no matter what. Therefore, it is important to know what religions say about the issue for which science has the answer to. As the majority of Malaysians are Muslims, Health+ approached Department of Islamic Development Malaysia (JAKIM) director-general Datuk Othman Mustapha to lend a hand in explaining the matter. What does Islam say about fertility treatments? “Generally, the teachings of Islam implore everyone to seek treatment for any ailments which had befallen them,” says Othman. “It is one of the key knowledge passed down from the Prophet Muhammad. Specifically in relation to fertility treatment, the Holy Quran does tell a few stories regarding past prophets and their issues to conceive. Infertility is a condition that is advisable to be treated if the couple has the desire to raise children.

“Moreover, getting married and raising a family is highly recommended in Islam as it is part of the Hifz al-Nasab (the preservation of ancestry).” I s l a m ’s a c c e p t a n c e o f modern treatments So, to put it in simple terms, Islam fully supports married couples to have children. Therefore, when they don’t have the ability to do so, it is highly advisable for them to seek treatment. Yet one question remains: Are the modern, scientific treatments available go against the teachings of Islam? Not at all, says Othman. “JAKIM often works with the Health Ministry and other

VALID TREATMENT: Islam accepts IVF treatment and other fertility treatments as they do not go against the teachings of the religion.

agencies to inform Muslims in Malaysia about various medical treatments.” He explains that the 5th National Fatwa Council Committee Discussion on Islamic Matters held in November 1982 had already shed light on the legality of “test tube babies”, also known as in vitro fertilisation (IVF) treatment. The resulting fatwa (edict) says: Babies born through IVF treatment from seeds of two legally married Muslim couples are valid in Islamic law, while babies born through IVF treatment from seeds of two couples who are not joined legally are not valid. Babies born from IVF treatment have the same rights as

babies who were born without the help of treatment. If the technique of extraction of seeds from the male and female does not go against Islamic teachings, then the treatment itself is valid. This clearly means that fertility treatments do not go against Islamic teachings. This is beneficial information for Muslim couples in Malaysia who have problems conceiving yet are sceptical as to the legality of the procedures available. Othman has some advice for Muslims with fertility issues. “My advice to readers with possible problems to conceive is to be patient, seek help and treatment if you can afford it, and always trust in God for guidance and peace.”

Active, passive smoking linked to infertility

Infertility is a condition that is advisable to be treated if the couple has the desire to raise children.” – Othman

Both active and passive smoking are linked to infertility problems and early menopause in women, says a US study. Although previous studies have already found a link between infertility and active smoking, researchers at the Roswell Park Cancer Institute also wanted to look at a link between infertility and passive smoking. The study looked at a total of 93,676 women across 40 different centres in the US, who were all part of the Women’s Health Initiative Observational Study (WHI OS)

between 1993 and 1998. All of the women were between 50 and 79 years old and had already gone through menopause. The team collected information on smoking, lifetime fertility status and age at natural menopause. Those who smoked, or used to smoke, were asked how many cigarettes they smoked or had smoked daily, the age they had started smoking, and for how many years they had smoked. Those who had never smoked were asked if, and for how long, they had lived with a smoker or had

• 07

2016 | may

issues, you might want to think about fertility preservation. It’s always good to get ahead of the game before it’s too late. Dr Wong says egg freezing is a way for women to preserve their fertility for the future. When a woman is ready to start a family, then egg freezing can come in handy when she is past her prime reproductive years. Pregnancy rates from frozen eggs will depend on the woman’s age at the time she freezes her eggs, and it will not be

affected by the time she uses them. To retrieve eggs for freezing, a patient undergoes hormoneinjection process. After the eggs are retrieved, they are frozen for a period of time of your choosing. The freezing can last many years and can be used for in vitro fertilisation (IVF) whenever one is ready. Long storage of frozen eggs does not result in any decrease in quality. Wong says egg freezing was previously not popular due to its low success rate. But now with advanced freezing technology, the success rate has increased and it’s a reasonable option now, he adds.

worked where someone smoked in the workplace. After taking into account other lifestyle factors, the results showed that tobacco exposure through both active and passive smoking can hasten the natural menopause to occur before age 50 and can cause fertility problems. Smokers and ex-smokers showed a 14% greater risk of infertility and a 26% greater risk of menopause before the age of 50 compared with those who had never smoked. And from the women who had the highest level of tobacco exposure, those who had started smoking before the age of 15 experienced the onset of menopause nearly 22 months earlier. Those who smoked more than 25 cigarettes a day experienced the arrival of menopause 18 months earlier. In non-smokers who were exposed to tobacco through passive smoking, the highest level of passive smoke exposure, defined in the

study as 10 or more years of living with a smoker as a child or working with colleagues who smoked, or 20 or more years of living with a partner who smoked at home, caused the arrival of menopause 13 months earlier. In addition, these women were 18% more likely to have had infertility problems than women who had never been exposed to passive smoking. Commenting on the results, the researchers suggested that the results could be due to the toxins in tobacco smoke, which are known to have harmful effects on hormones and reproduction, concluding that, “This is one of the first studies of this size and statistical power to investigate and quantify active and passive smoking and women›s health issues. It strengthens the current evidence that all women need to be protected from active and passive tobacco smoke. The results were published online in the journal Tobacco Control. – AFPRelaxnews

Freezing eggs for future pregnancy By Ali-Azmin Hassan

n this day and age, women are more career minded and independent. Gender equality, feminism and women’s rights are truly among the greatest achievements of our times. Most women nowadays will not simply bow down to the dogma that women are confined to being housewives. Such an idea is slowly but surely diminishing. However, for every action, there’re consequences, and for

most women, chasing their careers means delay in marriage or child bearing. Work or education becomes their priority. Another major reason could be difficulty in finding a life partner. And when it comes to getting pregnant, age is a key factor. Dr Wong Pak Seng, medical director and fertility specialist at Sunfert International Fertility Centre, says chances of women getting pregnant beyond the age of 35 are slimmer. If you are considering having a child in future but are facing these Creative Commons

FERTILITY THREAT: The results showed that tobacco exposure through both active and passive smoking can hasten the natural menopause to occur before age 50 and can cause fertility problems.

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or the Internet and they try to follow everything as suggested,” says Ong. “For some, even after they made the sacrifices and changes but still without success, they get even more stressed out. So by the time they come here, they’re already very stressful.”

Yes, infertility causes stress MindBody Fertility programme helps couples achieve positive experiences while pursuing fertility journey By Ali-Azmin Hassan

e live in a modern society where we are conditioned to believe that almost everything is instant. Whether you get a headache, cold or flu, the medicine is there for you. Everything seems to appear easy and fast, doesn’t it? And when we are used to this instant mentality, it gives us the perception that we are in control of many things in life. However, when you are debilitated with something you have absolutely no control of, only then you realise there’s only so much we can control. And when we reach a point in life where we want a baby, to some, this is something out of their control. CT Ong, a fertility coach of MindBody Fertility programme at Sunfert International Fertility Centre and the only certified HypnoFertility practitioner in Malaysia, shares with Health+ his experience as a fertility coach and how he advises couples on their struggles. “A lot of people work so hard to conceive and it’s not within their easy control – besides seeking

medical help, they look into many other ways for help, such as prayers, alternative treatment, and even their diets. For example, they may deny themselves of coffee even if they crave for one every day. They get many recommendations like these from friends

COACH’S ROLE: Ong listens, reflects and assists couples to change their perception, and provides encouragement.

Desire to be in control The known fact is infertility produces a lot of stress for some. And that is why we want to be in control. “Coming here, some people still have that perception and they want to do all this and that to increase their chances to conceive. To me, if it works, you would have got your baby a long time ago. But the fact that it’s not working and you’re doing the same thing is making you even more stressful. Why?” asks Ong. When one has decided to use in vitro fertilisation (IVF) to try to conceive, some may get the idea the treatment can be stressful. Hence, they get more stressed even before the start of the IVF treatment and it is not helpful at all in this journey. It is worth to note that many are stressed up trying to get rid of the stress itself. “If you look really into it, stress is a relative perception. People come here with a lot of different perceptions. But very often they mistakenly think that IVF is stressful. Here we try to show them it is their perception that is causing their stress,” says Ong. “I’ve found a few unique characteristics of those experiencing high stress. In my research, I found people who are low in emotional stability have higher chances of experiencing high stress. In addition, I noticed many also have high desire to be in control or very result-oriented type. Some of them also go through financial stress after years of seeking fertility treatment. Some get work stress and they are in dilemma whether to continue to be stressed at work or quit which then will cause even more financial stress. “All these are causing them a lot of stress. As I’ve said, this is something that we have no direct easy control. And the more they try to do something to overcome it without understanding the root cause, the more stressful they become. My advice to them, escaping or doing more may not be necessarily helpful, if you are stressed up, seek help and you will understand yourself more in finding the effective ways to handle

“For some, even after they made the sacrifices and changes but still without success, they get even more stressed out. So by the time they come here, they’re already very stressful.” the stress. We are here to take care of the emotional well-being of these people whose emotions are often not being acknowledged and accepted by society,” he adds. Ong has many years of experience working with couples going through fertility issues and dealing with their concerns. “Eventually, we want to give them better quality of life, to show them that they have a choice to change their perception and enjoy life even while enduring this fertility journey. We have to coach them, teach them some techniques and what they can do to reduce their stress and even enjoy life,” he says. JOURNEYING TOGETHER Sunfert is the first fertility centre in Malaysia to integrate MindBody Fertility into its standard IVF programme. The MindBody Fertility programme is designed to help couples achieve a positive experience while pursuing their fertility journey. “Our aim is to give them a different experience, a positive experience during the IVF process,” explains Ong. The programme helps couples address their issues so that they can go through the entire journey positively and hopefully successfully – before, during and after IVF. “This programme really helps the couple to hold together and work as a team. As a coach, my role is to listen, reflect and assist in a change of perception, and also to encourage them in this challenging journey. “We must admit that it is not easy for them to share. This is not something to be proud of or talk with their friends easily. It is somehow still a social taboo and we don’t want to share this partly because it affects our self-esteem and most people don’t really know how to help us. As a result, people shy away from sharing this with their friends or families. Thus having a personal coach during this difficult time is really helpful to them,” says Ong.

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Bringing hope to the infertile

About 40% of infertility cases are caused by male problems alone, which seemed to have increased over the years. Besides chromosomal and congenital defects, some of the associated factors are smoking, sedentary lifestyle leading to lack of exercise, environmental factors (work-related), medical problems, childhood mumps and stress.

National Population and Family Development Board offers wide range of services to couples with fertility issues

growing number of couples are seeking consultation and treatment for fertility issues. As public awareness on fertility treatments gains prevalence, more and more specialist centres have been set up to cater to the growing need. However, fertility-related treatments are not new in Malaysia as the government has been offering such services since 1979 through the National Population and Family Development Board (NPFDB). It is an initiative under the Ministry of Women, Family and Community Development as a way to consult families for the betterment of their quality of life. In an email interview with Health+, Dr Komathy Thiagarajan, head of NPFDB’s men and women reproductive division, sheds some light on its services and some issues pertaining to fertility treatments. What are the treatments offered by NPFDB? A variety of safe and effective modern contraceptive methods are offered, such as barrier method (condoms), hormonal methods (oral contraceptive pills, contraceptive injectables (hormonal implants) and nonhormonal method (intrauterine contraceptive device, IUCD). Counselling is provided by trained healthcare providers and clients are assisted in choosing the most suitable method based on their health status and lifestyles.

Where are the services provided? Are they conducted in government hospitals or does NPFDB have its own centre? The family planning services are provided mainly in the 58 NPFDB static clinics called Klinik Nur Sejahtera and promotion done on mobile clinics and during outreach programmes. Family planning motivation sessions are also conducted in post-delivery wards in government hospitals. Family planning clinic sessions are conducted in some government hospitals that request our expert services. Are the services provided at subsidised rates? Yes, they are. Is treatment for infertility also provided? Of course. Currently there are three NPFDB infertility centres – in the headquarters in Jalan Raja Laut, Kuala Lumpur; in Ipoh, Perak and in Johor Baru. A full range of infertility treatments are offered at the headquarters, which include counselling, treatment with fertility drugs followed by advice on timed intercourse, IUI (Intrauterine or artificial insemination) or, as a last resort, ART (assisted reproductive technology) including IVF (in vitro fertilisation) and ICSI (intracytoplasmic sperm injection). Some severe male conditions may require referral to urologists, either in government hospitals or private centres. The infertility centres in Ipoh and Johor Baru

GIVING HOPE: Dr Komathy is one of three medical practitioners attached with NPFDB’s family planning and fertility treatment services.

offer treatment up to IUI stage, and thereafter clients are referred to the headquarters for ART. Are there any statistics on fertility and infertility rates among men and women in Malaysia? Globally the infertility rate is about 10-20%. According to the Malaysian Population and Family Survey conducted by NPFDB, the infertility rate has increased from 6.9% in 2004 to 8.6% in 2014. The total fertility rate declined from 6.7% in 1957 to 2.1% in 2012. Is infertility among Malaysians a growing problem? Yes. Some of the contributing factors in females are late marriage, delaying childbearing, sedentary lifestyle leading to medical problems and obesity, and stress. According to the Malaysian

Population and Family Survey, the mean age at first marriage for males had increased over the years from 28.9 years in 2004 to 29.3 years in 2014, and for females, from 25.3 to 26.2 years. Physiologically, the fertility rate (the chances to conceive) for women deteriorates with age The involvement of females in the workforce has gradually increased and is currently on par with males (51% in 2014). So, women tend to delay marriage and childbearing which in turn may affect their chances of getting pregnant. About 40% of infertility cases are caused by male problems alone, which seemed to have increased over the years. Besides chromosomal and congenital defects, some of the associated factors are smoking, sedentary lifestyle leading to lack of exercise, environmental factors (work-related), medical problems, childhood mumps and stress. There are many “alternative” treatments for infertility in the market which include products and massage treatments. What is your take on them? There are some vitamin supplements with anti-oxidant properties which may to some extent improve sperm quality in some men. Likewise, there are some herbal preparations that have been proven through research to improve sperm quality in some men. However, there are no alternative medicines to date that have been promising in treating female infertility problems. I would encourage whole body massage as a means of relaxation for those who are highly stressed out. I don’t see any other benefit beyond that.

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More than just erectile dysfunction Erection problem not only wrecks sex lives but also causes family and relationship problems

By Prasad Chandra Segaran

rectile dysfunction (ED) is perhaps one of men’s worst nightmares. Most men who hit 40 have that nagging fear that one day they won’t be able to get or sustain an erection. Some may think ED is just a health condition but it is more than that. It is definitely more than an erection problem that affects the sexual lives of sufferers and their partners, but it also causes family issues and relationship problems. Men with ED are unable to get an erection or sustain that hardness while trying to have sexual intercourse. The frustrating result is that both the affected men and their partners fail to achieve their shared goal – sexual dissatisfaction. According to studies, more than 70% of men who suffer from ED are above 50 years old. However, younger men are not spared – even those as young as 20 are known to be afflicted with this universal

erection problem. Why do some men suffer from ED while others are seemingly blessed with a stiffed manhood well into their senior years? Brig Gen (R) Datuk Dr Selvalingam Sothilingam, consultant urologist at the University Malaya Medical Centre, tells Health+ ED has many possible causes. Psychogenic, organic ED He says ED can be categorised into two big groups – psychogenic and organic. Psychogenic ED is due to psychological problems and affects mainly younger men. “It can be due to depression, anxiety and even relationship problems,” he explains. “Psychogenic ED can happen suddenly to a man – it can happen even in a day. Men who suffer from psychogenic ED still get their usual hardness during their sleep and in the morning but they come to us complaining of ED because they can’t perform well. To treat this, we provide counselling to the patients by asking what is that they are worried about and then counsel them on that,” explains Dr Selvalingam. Patients suffering from severe anxiety problems are referred to a psychologist. Organic ED, on the other hand, is due to complications from other diseases like diabetes and high blood pressure. For men with these diseases, the blood flow to the penis is insufficient to get or sustain an erection. “Diseases like diabetes and high blood pressure can affect flow and the nerves. (Certain) medications taken by patients can sometime lead to ED,” says Dr Selvalingam. At times, men who had gone through major surgeries after serious accidents can also develop ED when blood supply to the penis is insufficient. Even patients who have gone through spine trauma can be affected by ED. Symptoms “ Well, a man will obviously realise he is suffering from

Older mans will have some symptoms if they have testosterone deficiency. They will often have mood swing, get muscle ache, feel tired and have bone pain. In such cases we will prescribe testosterone supplements to the patients.” – Dr Selvalingam ED because he won’t be able to penetrate or sometimes there is penetration but it softens up, during which the man and his partner will definitely notice that. Then the man comes to us complaining of ED,” says Dr Selvalingam. During the early stages of ED, the person can still get an erection, but progressively the hardness or his ability to sustain it will be wane over time, he explains. When a man is suffering from ED in his 40s, he should seek medical attention as evidence shows that ED preceeds cardiovascular disease. This is because the penile artery has a smaller calliber than the coronary artery and often gets blocked first. If the patient doesn’t improve his lifestyle he can have a heart attack in future.”

Dr Selvalingam says a study has shown that about 10% of men in Malaysia are suffering from testosterone deficiency.

THERE IS HOPE The bad news for men with ED problem is they’ve no choice now but to live with it until someone finds a way to reverse the condition. That will indeed be a day of rejoicing for such men and their partners! Meanwhile, they still need to rely on medications like Viagra to help them get an erection and have sexual intercourse. Such medications must be prescribed by medical doctors. “In some serious cases, we do a penile implant which is done through surgery to implant a particular device into the penis. This will be used to pump water into the penis instead of blood to enable the man to get an erection. “Some people are working on a new technology called low intensity shock wave therapy to overcome ED,” says Dr Selvalingam. However, to reverse ED, may be something in the far future, he adds. Some people claim herbal products are effective but the

main concern is many of them have not been scientifically proven. “Sometimes there is even mixture of Viagra in the herbal medicine where the percentage can be high or low. This can actually lead to side effects and in some cases, people had died after taking unreliable medication,” says Dr Selvalingam. Testosterone deficiency Why do men often suffer from ED when they get older? “One of the factors may be because they have testosterone deficiency. Testosterone is also important to have sex urges and to help with erections,” he adds. “Older mans will have some symptoms if they have testosterone deficiency. They will often have mood swing, get muscle ache, feel tired and have bone pain. In such cases we will prescribe testosterone supplements to the patients. A study has shown that about 10% of men in Malaysia are suffering from testosterone deficiency.” Educating men Professor Dr Zulkifli Md Zainuddin, deputy director of human resources and development and senior consultant urologist of Hospital University Kebangsaan Malaysia (HUKM), says the hospital is educating men on ED because it is directly linked to cardiovascular disease. “Men affected by ED are not coming forward to consult a doctor as they see it as an embarrassment. HUKM is trying to employ more male nurses in the urology department, especially for ED cases,” says Dr Zulkifli at a recent talk. Stand-up comedian Harith Islander says it is risky for men to delay and wait for the right time to consult a doctor. “Rather than going when it’s too late, why don’t you go when everything is fine? Patient should depend on themselves. It is not fair to rely on someone else when you can’t rely on yourself.”

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Coming strong in weak moments

The number of men having ED is quite high. People don’t realise this because men don’t come forward to tell if they have ED.” - Dr Hemanth

Don’t be shy but come forward to seek medical help if you have ED problem

ur society may be more educated than ever before, but when it comes to the issue of erectile dysfunction (ED), not many are willing to confront it. Why is that men are generally hesitant to talk about something which they know shouldn’t be that way. Do they fear facing the hard reality or are they too embarrassed to talk about this taboo subject? For whatever reasons, many people still shy away from even stepping into a doctor’s clinic to seek medical help. Tropicana Medical Centre (TMC) consultant urological consultant Dr Hemanth Kumar Ramasamy wants to change that mindset and encourages people with ED to come forward to seek medical help. Due to the shortage of urologists, Dr Hemanth also handles male fertility patients as well although TMC is essentially a fertility specialist hospital. Taking the first step He says ED is quite prevalent among Asians and affects about 10% of men, although the severity varies from mild to severe. “The number of men having ED is quite high. People don’t realise this because men don’t come forward to tell if they have ED.” Dr Hemanth says ED awareness among Asians is still relatively low and this is why many people feel uneasy talking about the problem. Taking the first step, which is walking into a doctor’s room, is already overcoming the first barrier,

he adds. “ED means embarrassment to most men. I have worked overseas and people there didn’t find it hard to walk into a clinic to share their problem. They walked straight to me and said ‘doctor, I am having this problem and I need some help’.” Knowing what causes ED is crucial and so a doctor needs to understand a patient’s underlying problems. “The doctor will get the (entire) patient’s history, including psychological problems due to work and relationship stresses. If you are having problems with your partner, getting an erection is going to be tough. In some cases, there is nothing physically wrong with the patient, and the doctor will send him to a psychiatrist to get some advice or counselling. Physical screening will be done to determine whether the patient is suffering from any other complications like diabetes, hypertension or high cholesterol,” he adds. Are overseas treatments for ED better than those available locally? No, says Dr Hemanth, pointing out that medical technology in Malaysia has progressed and is on par with developed countries. “Treatments here are the same as

Dr Hemanth explains that ED is quite a common occurence among men, yet the difficulty for them to come forward still lacking.

overseas. There’re over 100 urologists in this country and all of us are trained to treat this problem.” Four types of drugs are used to treat ED, each performing different actions. The attending doctor will prescribe the required dosage based on a patient’s need. COMPLICATIONS Dr Hemanth says ED may sometimes cause complications like heart disease and mega psychological problems. It can also lead to low self-esteem and

major depression. “It is proven that smoking can be a main contributing factor to impotency. This is because cigarettes contain various kinds of chemicals which can cause arterial narrowing. Smoking causes arteriosclerosis (thickening and hardening of the walls of arteries) which can lead to ED. People need to stop smoking to prevent various kinds of diseases.” Dr Hemanth encourages those suffering from ED to pick up their courage to discuss their problem with a doctor as any delay may lead to other complications.

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Promoting public awareness on reproductive health

Fertility rate nearing replacement level Gradual drop from 3.29 children per woman in 2000 to 2.58 in 2014 in line with global trends

By Norman Hussaini

alaysia’s fertility rate has been declining since 2000, dropping from 3.29 children per woman to 3.07 in 2005, 2.7 in 2010 and 2.58 in 2014. Federation of Reproductive Health Associations Malaysia (FRHAM) chairman Dr Philip Kho in revealing this to Health+ says: “Global fertility rates are in general decline and this is more pronounced in more developed countries.” Identifying the rate To clarify how the fertility rate is calculated, he says the country’s total fertility rate in 2014 was 2.58 children born per woman. “This gives the figure for the average number of children that would be born per woman if all women lived to the end of their childbearing years and bore children according to a given fertility rate at each age. “A rate of two children per

woman is considered the replacement rate for a population. Rates above two children indicate population growing in size and whose median age is declining. For comparison, the total fertility rates in 2014 in neighbouring countries were 0.8 in Singapore, 1.5 in Thailand, 2.18 in Indonesia and 3.06 in the Philippines.” Contributing factors Dr Kho says the decline is due to various factors, and in women, it’s mainly attributed to the increasing trend of delayed pregnancy. “The chances of getting pregnant decline with age. A healthy 30-year-old has a 20% chance of getting pregnant but this declines to 5% for a 40-year-old. Success rates of assisted conceptions like test tube babies (IVF – in vitro fertilisation) also decline with age,” he says. Yet to put the blame wholly on women is not fair. Dr Kho says that in men, environmental factor – such as diets, lifestyle habits and working conditions – play a key role in their declining fertility. Obesity – one of the country’s biggest lifestyle diseases – is also a contributing factor.

NEVER TOO LATE: The chances of getting pregnant decline with age, says Dr Kho.

Public views Reproductive health is still a sensitive subject which people tend to steer away from, especially in public. However, public awareness on fertility in general is growing. “More are aware about the factors leading to infertility and the help they can get to possibly treat the issue,” says Dr Kho.

The Federation of Reproductive Health Associations Malaysia (FRHAM) is the leading non-governmental organisation (NGO) dedicated to educate, promote and support Malaysians in family planning, sexual and reproductive health and responsible parenthood. Established in 1959, it is one of the pioneering NGOs to help Malaysians be more aware of the importance of their reproductive health. Its chairman Dr Philip Kho, a consultant obstetrician and gynaecologist based in Kuching, says FRHAM’s mission is to champion sexual and reproductive health and rights for everyone, particularly the marginalised and underserved. Its vision is that all people in Malaysia have access to information and services on sexual and reproductive health and rights. “FRHAM is the leading NGO in family planning services and reproductive health. FRHAM advocates for healthy mothers and babies through its mantra of pregnancies being ‘Not too early, Not too late and Not too close’.” As an established organisation, FRHAM is well-versed with the people’s problems regarding fertility rate which is declining as infertility rate rises. Its plans for the next seven years include: Implementing and promoting policies and programmes that respect, protect and fulfil sexual reproductive health rights and gender equality. Informing and empowering people in Malaysia to act on sexual and reproductive health and rights. FRHAM aims to engage and reach out to government agencies, women’s groups, media and 100,000 youths. Providing quality and integrated sexual and reproductive health services to every one, especially the marginalised and underserved, and establish aged-friendly programmes in 50% of the states. Be a high performing, visible and accountable NGO by building a strong and committed volunteer base and having skilled and competent staff.

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why people are diabetic, based on WHO’s report of type 2 diabetes counts for 90% of diabetes cases worldwide. United Nations SecretaryGeneral Ban Ki-moon marked this year’s World Health Day with a urgent call to step up global efforts to halt the rise in diabetes and improve the lives of those living with the dangerous, yet preventable and treatable condition. The WHO had outlined the measures needed to be taken by organisations around the world to commemorate World Health Day 2016. It includes expanding health-promoting environments to reduce diabetes risk factors and strengthening national capacities to help people with diabetes to receive treatment and care needed to manage their condition.

HEALTHY CROWD: The crowd following a simple exercise for diabetics during the launch of World Health Day.

Beacon of hope World Health Day 2016 focuses on halting diabetes amid growing awareness on healthier lifestyle

By Norman Hussaini

iscussing diabetes – the modern, mostly lifestyle disease of epidemic proportions – can be as stale as the potato chips you left out on the kitchen counter a week ago. Many people already know about it, yet the need to put it into the spotlight never wavers. This is because diabetes is very prevalent, to put it nice and simple. The World Health Organisation’s (WHO) global report on diabetes shows 422 million people are living with it, with 1.5 million deaths each year. On April 7, the World Health Day celebration had put diabetes into its crosshair to try and further broaden the awareness of it around the globe. Themed “Diabetes: Scale up prevention, strengthen care, and enhance surveillance”, it works as a goal set up by the WHO to halt the rise of diabetes.

World Health Day is celebrated every year to mark the anniversary of the founding of the WHO in 1948. The theme selected annually highlights a priority area of public health currently washing over the earth’s population. It provides an opportunity for individuals in every community to get involved in activities that can lead to better health and ultimately, better future.

BEAT IT: This year’s theme is to halt the rise of diabetes globally, focusing primarily on the younger generation, as seen in this official art initiated by the WHO.

Diabetes and people The relationship between diabetes and people has existed long before any of us had ever lived. It was one of the first diseases ever recorded in the history of man, within an Egyptian manuscript from 1500 BC. The disease, however, was only a drop in the bucket of history then, as it was a rare condition. This was probably due to people’s diet in the times of Egyptian kings and the Roman empire. The scarcity of food, the strenuous manual labour and the hardship of living in times of war seemed to have made diabetes almost non-existent. Its prevalence now only reflects the evolution of lifestyle humans had gone through. Food now comes just as easy as a tap on a touchscreen or a press of a button, making us eat more which then leads to overweightness and obesity. Obesity is THE culprit

Beating diabetes locally Malaysia has been crowned “the fattest country in Asia” last year with current statistics showing about 3.5 million people are living with diabetes. On April 7, the Health Ministry launched World Health Day 2016 in Gombak, Kuala Lumpur, as an effort to reinforce the awareness of Malaysians towards diabetes. In lieu of the event, the ministry launched a revised version of the national guideline for the clinical treatment of diabetes mellitus aptly named Tumpaskan Diabetes (Defeat Diabetes) which added 11 new chapters and, for the first time, discussing sexual problems faced by women with diabetes. The programme was officiated by Deputy Health Minister Datuk Seri Dr Hilmi Yahaya, who was accompanied by Selangor Deputy Health Director Dr Murniati Hassan and Malaysian Endocrine and Metabolic Society president Professor Dr Nor Azmi Kamaruddin. There were various activities including simple exercises for diabetics, several free health check-up booths, and health forums discussing diabetes and other related diseases. Halting the rise – is it impossible? Diabetes is highly unlikely to be eradicated completely. In fact, the rampant rise in diabetes cases over the years means the condition is becoming more and more synonymous with our modern way of living. Yet with the increased number of diabetes cases, the level of awareness on the disease is also increasing. The growing awareness on a healthier lifestyle can be a beacon of hope for us to at least slow down the number of people contracting diabetes, if not completely stopping it. So, is it impossible to halt the rise of diabetes? Of course not, but it is up to you and me to achieve what World Health Day 2016 has set out to do. It is, and always will be, in our hands.

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Creative Commons

Clean air, our right Research shows air pollution emitted by cigarettes is 10 times greater than diesel car exhaust By Huang Ruifu

e all need clean air to live healthy and enriching lives. All too often, this fundamental right seems too obvious in our increasingly urbanised world. Since we spend so much time indoors, the question of clean air is even more important whether that be in our homes, offices, schools, health centres and wherever we go. And many of us take clean air – or the lack of it – for granted. However, in recent years, with the almost seasonal haze blanketing us and disrupting our lives, clear air is certainly a commodity we have obviously learned to treasure. Whenever we talk about air pollution, we all tend to point our fingers at industry, traffic and open burning, among others, as the chief culprits. But, if we really analyse the air we breathe, it is fairly obvious that smoking pollutes the atmosphere and quite often the ground too. However, it is not always obvious how much smoking pollutes the environment. How smoking harms environment It is a common misconception among cigarette smokers that they are hurting only themselves. The truth is they are not hurting only themselves, but also the earth, and everybody and everything on it, in our generation, and the generations to come. Studies show that cigarettes contain over 4,000 chemicals

which are exhaled and released into the air. Research shows air pollution emitted by cigarettes is 10 times greater than diesel car exhaust. Environmental tobacco smoke produces fine particulate matter, which is the most dangerous element of air pollution for health. Trees are often compared to the lungs in our bodies because they perform basically the same functions as our lungs do, albeit on a global scale. With all the pollutants that trees already filter out for us, it is illogical for any of us to add more to the air that doesn’t need to be added. We need to breathe, but no one needs to smoke. While the problem is invisible to us, the fact is that fine dust or particulate matter (PM) ranging from 10µm (PM10) to as tiny as 2.5µm (PM2.5) can cause serious lung and heart health problems. The World Health Organisation (WHO) estimates that two million people die every year from small particulate matter in the air. Other health problems are coming to light. For instance, a recent study showed a

correlation between higher levels of particulate air pollution and higher numbers of babies born with low birth weights. Second-hand smoke Thanks to the aggressive antismoking campaigns carried out by the public and private sectors, people living in Malaysia have become more and more educated on the various forms of heart disease, lung disease and cancers caused by smoking. It is also common knowledge that smoking causes discoloration of fingernails and teeth as well as other cosmetically-damaging effects. However, one of the most overlooked issues in the whole equation is the deadly effects of second-hand smoke. According Article 8 of the WHO Framework Convention on Tobacco Control, an international health treaty signed and ratified by Malaysia, scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability. It says parties should adopt and implement measures providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places. The WHO guidelines state there is no safe level of exposure

“Trees are often compared to the lungs in our bodies because they perform basically the same functions as our lungs do, albeit on a global scale. With all the pollutants that trees already filter out for us, it is illogical for any of us to add more to the air that doesn’t need to be added. We need to breathe, but no one needs to smoke.”

to second-hand smoke, which contributes to a range of serious and often fatal diseases, including heart disease, respiratory illness, and lung and other cancers. Completely smoke-free environments with no exceptions are the only proven way to protect people from second-hand smoke. It is interesting to note that the WHO guidelines stipulate that separate smoking rooms and ventilation systems do not prevent second-hand smoke exposure. Governments are expected to maintain strong support for laws once they are enacted through proactive and uniform enforcement that achieves high compliance levels. Besides the WHO’s stronglyworded guidelines on second-hand smoke, various studies have also confirmed that second-hand smoke contains carcinogens, toxic metals and poisonous gases. Special scans carried out by some studies have revealed the deadly effects of second-hand smoke. Researchers have shown by using magnetic resonance imaging (MRI) that long-term exposure to second-hand smoke can be a killer. The MRI scan used was a special type which uses colours to show damaged and undamaged areas of the lung. For instance, researchers from the Department of Radiology at the Children’s Hospital in Philadelphia, United States, showed that long-term exposure to second-hand smoke causes structural damage to the lungs that significantly increases the risk of lung cancer and emphysema. Emphysema is a lung disease where the alveoli collapse making it very difficult for enough oxygen to get into the bloodstream and to remove waste carbon dioxide from the bloodstream. It is common among smokers and a major killer in many countries where smoking is prevalent. Impact on babies, children Babies of expectant mothers and newborn children exposed to second-hand smoke are more prone to sudden infant death syndrome. Smoking by parents causes respiratory symptoms and slows lung growth in their children, adds the report. Every exposure to the cancercausing chemicals in tobacco smoke can cause grave diseases, and children are particularly vulnerable. WHO studies also found that young children exposed to second-hand smoke at home are twice as likely to start smoking as those who are not. There are also more likely to have positive thoughts about the smoking habit. In view of the deadly effects of smoking and second-hand smoke, it is obvious that we all need to work together to restore our fundamental right to clean air, and Health+ fully supports any effort towards a cleaner and healthier environment.

• 15

2016 | may

Blue Ribbon says no to tobacco MySihat adopts WHO initiative to rally support of local businesses for nonsmoking movement

By Norman Hussaini

t has been proven time and time again that smoking causes various negative effects to our health and wellbeing, and the awareness for people to curb the smoking habit is almost as old as the cigarette itself. Yet, the habit is still alive and well today. For this reason, the World Health Organisation (WHO) has initiated a campaign to tackle the unhealthy and potentiallydeadly smoking habit. The global Blue Ribbon campaign is to rally local businesses, organisations and individuals to spread the word to promote the no-smoking lifestyle by awarding their efforts – and perpetually attracting the public to do the same. Nationwide campaign The Malaysian Health Promotion Board (MySihat) helms the WHO initiative in Malaysia. Led by its CEO Dr Manimaran Krishnan, MySihat aims to bring Blue Ribbon campaign nationwide to tackle the widespread smoking habit. Manimaran explains to Health+ the prevalence of smoking in Malaysia and the diseases related to it. “Looking at the data collected by the ministry (of health) over the many years, we have not seen a very significant decline in numbers of smokers and the cases of illnesses related to it. Moreover, we are seeing the average age of smokers is becoming younger. This is why the smoking habit is worrying.” The National Strategic Plan for Tobacco Control initiated last year aims to promote, among others, the no-smoking lifestyle to youngsters born from 2009 onwards to ensure a better, healthier future for them as well as the environment. Challenges abound Of the many challenges faced by smokers to quit the habit,

Manimaran points out that the desire to quit is perhaps the most daunting. He explains that the awareness to live a healthier lifestyle is linked to the different cultures in which Malaysians have been brought up. “It is because of the way we have been brought up and how our families have raised us. “These factors result in the different ways we perceive and manage our health and well-being in general.” This, he says, reflects how well we want to improve our health. “To stop smoking is easier said than done, and this is a fact. So the real challenge is how strong an individual’s desire is to actually quit.” Enforcing no smoking It is almost impossible to force any smoker to just stop smoking, and perhaps it is not the right way of doing it either. The Blue Ribbon campaign is aimed at tackling this particular factor, says Manimaran. “The purchasing power of cigarettes in Malaysia is still very high, as with the accessibility to smoking areas, which indirectly make it even harder for smokers to let go of the habit.” The nationwide campaign advocates a no-smoking culture by certifying and awarding organisations and businesses which had made efforts to keep their working environments tobacco-free, subject to some established criteria set by the WHO. MySihat believes that by promoting the Blue Ribbon certification to organisations, it can further induce the public to stop

ALL THE WAY: MySihat aims to bring the campaign nationwide to tackle the widespread smoking habit, says Manimaran.

The purchasing power of cigarettes in Malaysia is still very high, as with the accessibility to smoking areas, which indirectly make it even harder for smokers to let go of the habit.” smoking. This is because the move will limit accessibility to cigarettes and smoking areas in offices, restaurants and other public places. Can it work? The campaign is definitely an interesting initiative to raise the awareness against smoking, with the aim of developing a healthier and cleaner environment, especially in urban areas. But will it really work? “I believe the campaign will come into fruition. There are

already hundreds of participants in the country applying to be certified with the Blue Ribbon. The reception towards it had also been very good. We will be able to see changes in our smoking habits in Malaysia soon,” says a confident Manimaran. With hundreds of organisations applying to be supporters of the no-smoking movement, the prospect of the campaign having a substantial impact seems imminent. Yet, at the end of the day, what truly matters is a person’s willingness to want to change and stop smoking. As stated earlier, forcing someone to quit is almost impossible. However, by creating a wider and more prominent awareness towards a healthier and more enriching life without tobacco, we as a nation might just be able to stop the unhealthy and potentiallydeadly habit, and restore the clean air that rightly belongs to all of us.

16 •

may | 2016

Denormalising smoking in public

he Blue Ribbon campaign was initiated by the Western Pacific Division of the Who Health Organisation (WHO) in 2012 in Singapore and was officially launched in Malaysia in 2013 by the Health Ministry. The campaign aims to empower and recognise individuals, groups, institutions, local governments and other organisations to continue working to denormalise smoking in public and advocate for smoke-free environments. It has been extrapolated by the WHO that exposure to secondhand smoke is a major hazard to public health. Research had shown that there is no safe level of exposure to second-hand smoke, with even a brief exposure to the chemicals emitted by it could cause cardiovascular diseases. In 2010, it was estimated that more than 600,000 people died globally from exposure to

second-hand smoke, and 28% of the deaths were children. In Asia and the Pacific, more than half of women and children are regularly exposed to second-hand smoke in public places and at home. These key factors prompted the WHO to come up with the campaign to raise awareness on the dangers of smoking and also the harm of second-hand smoke to the general public. The WHO encourages health ministries of member states to take full ownership of the national campaign consistent with the objectives of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific Region (2010-2014). The action plan encourages member states to develop a system to publicly recognise outstanding contributions of allies and partners as well as to reinforce social mobilisation efforts in regards to a non-smoking environment.

Criteria for certification There are three categories of awards for presentation to organisations, establishments or individuals who have contributed in support of a smoke-free policy:

 Certificate

This is given to any premises or establishments which have implemented smoke-free indoor and/or outdoor.

 Media award

This is awarded to the mass media, print or electronic, in recognition of their outstanding work in publicising and creating awareness of smokefree policies in line with the Blue Ribbon campaign objectives.

 Outstanding achievement award

This is given to advocates of smokefree environment.

Criteria

Demonstrate management’s commitment with written statement indicating that the premises practise smoke-free policy. Exhibit premises’ smoke-free policy/statement conspicuously on a signage no smaller than A3 size. Smoke-free policy communicated to members and customers. Install adequate “no smoking” signages in any conspicuous area of the premises, especially at the entrance. Not selling cigarettes/tobacco products or any product associated with the brand or cigarette manufacturer. Not putting up posters or any form of cigarette advertising/ promotion. Does not provide any facility

for smoking, including ashtrays, litter bins with ashtrays and room/ smoking area. Do not exhibit any smoking activities on the premises. Install posters on the dangers of smoking and exposure to secondhand smoke hazards, including distributing leaflets to members or customers. Facilitate/prepare/manage quit smoking services for members who smoke. Efforts of the owner or residents of the premises in promoting creative smoke-free premises campaign. Have available mechanism/ approach to ensure that no person smokes in the premises. Information extracted from the Blue Ribbon Campaign website at www. myblueribbon.org.my.

How it will be implemented The WHO has established a few implementation strategies to be used by the health ministries of member states. The first is to establish a steering committee to develop plans to recognise individuals or groups with abilities to monitor with efficiency. Other than that, the implementation will also include orientation meetings, creating a symbol for the national campaign, deciding the timeline for nominations and receipt of applications, criteria for selection and organising public events to announce the recipients.