XTRA Health+ Newspaper November 2015 Issue 01 by Health+ Newspaper

Weak and brittle bones

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Osteoporosis literally leads to abnormally porous bone that is compressible

... page 10

THE PULSE OF THE NATION

NOVEMBER | 2015

Threatening! Aedes mosquitoes swarms to plague Malaysia BY HEALTH+ REPORTERS

HERE is an alarming rise in dengue fever case in Malaysia. Dengue is an infectious disease caused by a virus. Common in warm, wet areas, a person can get it if he or she is bitten by an infected mosquito. Outbreaks happen during the rainy season. Most people with dengue recover within two weeks. Some dengue infections are severe and cause bleeding from your nose, gums or under your skin. Severe dengue can also cause massive bleeding and shock,

which is life-threatening. Symptoms of classic dengue fever usually start within four to seven days with symptoms like fever, nausea and vomiting, pain behind the eye, severe headache, severe joint and muscle pain. Now we have heard of Genetically Modified Mosquitoes and other possible treatments for Dengue and how far away are we from a vaccine or cure for dengue. Datuk Dr Noor Hisham Abdullah director general of Health Malaysia, said at the moment, there is no dengue vaccine available yet worldwide.

A new breakthrough Gene found to pave way for new drugs to help rheumatoid arthritis patients

... page 14

Aedes Aegypti, the urban terrorist.

“Currently, a few dengue vaccine trials are ongoing in many countries including Malaysia. One company has submitted a potential dengue vaccine for registration with the Pharmacy Bureau, Ministry of Health Malaysia and the ministry is at present evaluating on the impact and efficacy of implementing dengue vaccine in this country.” In the absence of a vaccine, many diagnosed with the disease are already accepting traditional treatment such as papaya leaf juice at hospitals and treatment at home. Dr Noor Hisham said the Institute of Medical Research (IMR) had conducted a study on papaya leaves juice in 2013. The study showed that papaya leaves juice significantly accelerates the increase in platelet count among patients with dengue fever and dengue haemorrhagic fever.

CONTINUE PAGE Xtra 08-09

Seeing it right

Children given free check-ups and spectacles in conjunction with World Sight Day 2015

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November | 2015

Lack of enforcement activities to shore up cleanliness In a Q & A with Health+ Datuk Dr Noor Hisham Abdullah answers some pertinent questions about dengue What is dengue? Dengue is a mosquito-borne viral infection causing a severe flu-like illness and, sometimes causing a potentially lethal complication called severe dengue. The dengue virus (DEN) comprises of four distinct serotypes (DEN-1, DEN-2, DEN-3 and DEN-4), which belong to the genus Flavivirus, family Flaviviridae. What is dengue haemorrhagic fever? Severe dengue (also known as dengue hemorrhagic fever) is characterised by fever, abdominal pain, persistent vomiting, bleeding and breathing difficulty and is potentially lethal complication. Early clinical diagnosis and careful clinical management by trained physicians and nurses increase survival of patients. How are dengue and dengue hemorrhagic fever spread? Dengue is transmitted by the bite of a mosquito infected with one of the four dengue virus serotypes. It is a febrile illness that affects infants, young children and adults with symptoms appearing three to 14 days after the infective bite. What are the symptoms of the disease? Dengue should be suspected when a high fever (40°C/104°F) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for two to seven days, after an incubation period of between four and 10 days after the bite from an infected mosquito. What is the treatment for dengue? Is there an effective treatment for dengue haemorrhagic fever? There is no specific treatment for dengue fever. Severe dengue is a potentially lethal complication but early clinical diagnosis and careful clinical management by experienced physicians and nurses often save lives. Where can outbreaks of dengue occur?

A dengue outbreak is defined as the incidence of two or more dengue cases in a single locality. Dengue outbreak can occur anywhere provided there is Aedes mosquito carrying dengue virus. What can be done to reduce the risk of acquiring dengue and how can we prevent epidemics of dengue haemorrhagic fever? Ensuring our environment is clean and free from Aedes breeding site is the key element to prevent dengue disease to occur. Weekly search and destroy activities by the individual or the community are the best solutions to prevent the Aedes from breeding especially in an outbreak area. The public must involve in the COMBI projects and environmental cleanliness activities such as Program Ayuh Gempur Aedes, gotong royong etc. A clean environment will reduce the potential breeding sites for mosquitoes thus reducing the number of dengue cases. The public should wear long sleeve clothes and use insect repellent to protect themselves from mosquito bite especially between 6 and 8am and 6 and 8pm. They can also use aerosols or other insecticide vaporizers to kill the Aedes mosquitoes. If they had symptoms and signs of dengue fever, seek immediate treatment at nearby clinics or hospitals. What do you think of the health reforms in the country? The health reforms should improve the management of public health services in terms of the quality of service deliver, scarce resources and overcome the health issues. What do you think of the public’s attitude towards healthcare and cleanliness? Public’s attitude need to be changed especially towards healthcare and cleanliness. Clean environment can prevent the occurrence of dengue fever and other diseases such as food poisoning and leptospirosis. Do you think there is lack of enforcement in maintaining cleanliness? Yes, there is still lack of enforcement activities in maintaining en-

Datuk Dr Noor Hisham: There is no specific treatment for dengue

vironmental cleanliness. However, the enforcement activities can be improved especially to tackle the issues of illegal rubbish dumping sites and breeding at vacant lands. Local councils should increase the enforcement activities to overcome these problems. What are the best possible ways to educate the public in healthcare? Health education is essential for the control of diseases such as dengue, ensuring that community members understand the mechanisms of infection and the key behaviours or activities that need to be addressed to prevent transmission, reduce severe disease and avoid fatalities. Therefore, the best possible way to educate the public is through the involvement of the community itself in the Communication for Behavioural Impact (COMBI) project for dengue prevention. Health education in schools is another best possible way in gaining their commitment in dengue prevention activities. There has been an alarming rise in dengue fever. What are the main reasons for this? Increase in the people travelling has increased the spread of dengue virus to dengue free areas when a mosquito bites infected travellers, which subsequently spreads the virus to

other healthy individuals. Community behaviour of littering has contributed to the increase of potential breeding places for the Aedes mosquito. When there is rain, discarded containers will be filled with water and this can provide a place for the mosquito to breed. Illegal rubbish dumping has also contributed a place for the mosquito to breed. Changes in serotype, so called the “serotype shift”, is a well-known reason for the occurrence of a dengue surge. Usually seen four to five months after the shift, it has been observed that cases increase due to the lack of immunity towards the new serotype emerging in the community. Climate change especially alternate rainy and hot seasons will facilitate Aedes breeding to increase further. During the rainy season, any containers or locations that collect water will provide a place for the Aedes to breed. Therefore, this will enhance the spread of the dengue virus in the community. Apart from the factors above, Ministry of Health has strengthened the dengue diagnosis by implementing the usage of COMBO rapid test kit to all the suspected dengue cases in 2014. Indirectly, this saw more dengue cases being detected from the public and private clinics and hospitals.

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2015 | november

Alternative treatment

Or the benefit of the public, there are some known traditional approach to treating dengue fever. This involves the use of natural ingredients such as plants and other food items to help the patient fight off dengue.

Dr Ashok Philip, president of the Malaysian Medical Association had also lend a hand in illuminating the matter. He stated that “the platelet count is not the only indicator of severity we look at, nor is it the most important, it is only one of the way to monitor the severity of the fever. It is far more important to monitor the patient’s blood pressure, pulse, symptoms, appetite and urine output.” To simplify things, one of the indicator for dengue fever is the drop in the platelet level, however patients should not be fixated on getting his or her platelet level up as a way of “curing” dengue. The most effective way so far in treating dengue is to first get tested as soon as a fever is present, getting well hydrated and to let the body take its natural course in fighting the virus. “As for the papaya leaf juice, many forms of it have now appeared, and none of them seem to be standardised at all, so there is no way of knowing what one is consuming when taking them,” said Dr Ashok Philip.

PaPaya leaf extract

One of the most common traditional methods is the use of Carica papaya tree leaf extract. It is by popular belief that consuming the juice of papaya tree leaves can help increase the platelet count, which dengue fever tends to do to an infected person. The Ministry of Health stated that “the Institute of Medical research (IMr) had conducted a study on papaya leaf juice in 2013. The study showed that papaya leaf juice significantly accelerates the rate of increase in platelet count among patients with dengue fever and dengue haemorrhagic fever.” The IMr research in 2013 was conducted to investigate the platelet increasing property of Carica papaya tree leaves juice in patients with dengue fever. The abstract from the research reads: “An open labelled randomised controlled trial was carried out on 228 patients with dengue fever (DF) and dengue haemorrhagic fever (DHF). Half of the patients received the Carica papaya leaf juice (CPLJ) for three consecutive days while the others remained as the control group with standard - without consuming papaya leaf juice - medical care. Their full blood count was monitored eight hours for 48 hours in total. There was a significant increase in mean platelet count observed in the intervention group but not in the control group 40 hours since the first dose of the juice. Comparison of mean platelet count between intervention and control group showed that mean platelet count in intervention group was significantly higher than control group after 40 and 48 hours of admission. It was concluded that CPLJ does significantly increase the platelet count in patients with DF and DHF.” The studies however were quite small and showed a slightly higher platelet count in patients who took the extract compared to those who did not. Muhammad Saifullah Hashim, a cook from Malacca had recently been a victim of dengue and a good example of a consumer. “I had taken papaya leaf extract when I was hos-

crab SouP

HealiNg leaf: The Carica papaya leaf said to help dengue patients

Cure from tHe sea: sea crab soup is also said to help increase blood platelets

pitalised for dengue as advised by one of the nurses. According to the doctor, my platelet level was way lower than normal and could worsen my blood’s ability to clot. So I gave the papaya leaf extract a try with the help of my mother. After two days of consuming it was apparent that my platelet count did went up.” Saifullah however, admitted that he continued to follow the doctor’s advice to also drink a lot of water during the fever.

chicken soup or bean soup can be as equally effective, as crabs doesn’t have any specific antiviral effect.”

Another well-known food that is said to help with dengue fever is sea crab soup. There has never once been a study done on crab soup so far, and will likely not to be one soon either. The notion of having something as luxurious as crab to cure a disease sure seems nice, however a bit misguided. Crabs naturally are rich in protein and some essential nutrients. Normally, a person should increase their calorie and protein intake during the controlled period of the fever. So this might show that certain food - crab soup for instance - are helpful, provided that a person is not allergic to crabs. It should be known however that crabs also contain high level of cholesterol and sodium. The nutritional values of crabs does not point to the ability to perhaps increase the platelet level as papaya leaf extract might. The cholesterol and sodium content may also become a problem. But if an increased level of protein is the focus, then there are a lot more protein-rich foods besides crabs. Foods like poultry, eggs, milk and legumes are better - and cheaper - source of protein compared to crabs. Dr Ashok commented: “Chicken soup or bean soup can be as equally effective, as crabs doesn’t have any specific antiviral effect.” This shows that crab soup may help in gaining back some calories and protein during the fever, but it is definitely not a food to treat dengue fever with exclusively.– Norman Hussaini

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NOVEMBER | 2015

Prevention, better than cure

Vaccine, a long way oﬀ?

ETALING JAYA: In a recent interview with Dr Chithradavi Vadivellu, the director of the Department of Environmental Health of Petaling Jaya City Council (MBPJ) on prevention of dengue revealed that it was not at all a laughing matter. According to her, Selangor is going all out its effort to reduce the number of dengue cases. Statistics have shown that Selangor has 50% of Malaysia’s dengue cases. The total number of cases in Malaysia as of Aug 16, 2015 stands at 75,595 and counting, with 212 deaths. Selangor alone counts for about 42,193 cases with 96 deaths. Dr Chithradavi, however, explained that they had seen a decline in the number of cases over the past few months, following their programmes in destroying breeding sights and fumigating. “We are now in maximum prevention mode.” she stated. “The vector unit of MBPJ is well equipped and managed, we have a total of 74 dedicated workers working day and night to try and save lives.” said Dr Chithradavi. The search and destroy team are the ones handling the fumigation equipment, be it hand-held or mounted on 4WD trucks. Their work is cut out for them as they will usually start their day around five in the morning, going to multiple affected areas - also known as “hotspots” - to try and eliminate the threat of Aedes mosquitoes. The search and destroy team are mainly responsible for killing the adult mosquitoes terrorising people with the disease, while another set of teams will scour areas reported to be possible breeding grounds for them. The larvae sightings, as they call it, include spraying a special chemical mix of abate to kill off larvae in stagnant waters. Dr Chithradavi had commended her team by saying “the workers have been very dedicated and have sacrificed a lot of their time and strength to do their job.” Even though the statistics had seen a decline in dengue cases because of fumigation and larvae sightings, the most effective way to reduce dengue cases in Malaysia is to actually prevent them from breeding altogether. Prevention has always been much better than cure, and the war against dengue is still going on because of the inability to control and prevent the Aedes mosquitoes. In a directive from the Ministry of Health, everyone should take at least 10 minutes of their time weekly to check their houses and the surrounding areas for possible breeding grounds. This can greatly improve the effort for prevention and can help the community to be free from infectious diseases. Preventative programmes are still a continuous effort made by the council.

Dr Chithradavi: Vector unit of mBpJ is well eqquipped and managed

Statistics have shown that Selangor has 50% of malaysia’s dengue cases. The total number of cases in malaysia as of aug 16, 2015 stands at 75,595 and counting, with 212 deaths. Selangor alone counts for about 42,193 cases with 96 deaths.

An event recently advocated by them was the “Jom Sapu dan Bersih”, a statewide event where they hired 20 contractors over and above the volunteers to clean up the streets in Selangor by targeting all the known hotspots. The event went on from Aug 15 to Sept 16, 2015, also in correlation with Merdeka Day. The classic “gotong-royong” activity can really make an impact towards the eradication of dengue in Malaysia. Dr Chithradavi mentioned that the mosquitoes are smart creatures. “If given 20 containers filled with water, the mosquitoes will definitely choose to propagate their eggs on all 20 containers. It gives them a higher survival rate”. This means that a thorough cleaning is needed to ensure proper prevention effort. The majority of dengue cases leading to death were unsurprisingly due to people’s disregard for their own health. A report seen by MBPJ stated that a recent case of dengue leading to death was because of the persons’ failure to go for a second visit to the doctor after knowing that he might be a suspect for dengue. The struggle for total eradication of dengue in Malaysia is still going on, with new cases being recorded every day. Looking for a cure can only be viewed as a last resort, as prevention should be the first thing on the list to fight off dengue. What we need as a society is the ability to work together and not be dependent on others. To coin the words said by Dr Chithradavi, “teamwork is most important in our war against dengue.” – Norman Hussaini

CCORDING to Datuk Dr Noor Hisham, a few dengue vaccine trials are currently ongoing in many countries including Malaysia. One company has submitted a potential dengue vaccine for registration with the Pharmacy Bureau of the Ministry of Health Malaysia, and they are at present evaluating the impact and efficacy of implementing a dengue vaccine in the country. The challenge in developing a vaccine for the dengue virus lies in the different strains the virus exists in. Prof Datuk Dr Lam Sai Kit, a well-known research consultant from University Malaya explained: “A person who is protected from only one strain of the virus may be prone to severe complications when exposed to another strain of the virus.” This means that if a vaccine is to be developed, it should be able to protect a person from all four virus strains. Sanofi, the pharmaceutical giant based in France is currently leading the development of a vaccine for dengue. Their clinical trial ended with more than three quarters of the participants protected from the fever. They would likely be the one to win the race in developing a vaccine, as they have now completed their third and final clinical trial. The fate of the Sanofi developed vaccine however remained uncertain to Malaysia as the experimental drug is still being verified by the Ministry of Health, with no certain approval in sight. The ministry stated that the Sanofi vaccine is 75% effective for the DEN-3 and DEN-4 of the virus strain, however showed only 50% effectiveness for DEN-1 and a mere 35% for DEN-2. The inconsistency in effectiveness is the reason why the Ministry still feels the need to re-evaluate their decision. In a more recent news for a vaccine, a partnership

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2015 | NOVEMBER

a vaccine for dengue fever is still in the works, with currently no definite confirmation on the use to prevent them

between Pharmaniaga and a biopharmaceutical company Bavarian Nordic have started researching a vaccine right here in Malaysia. With the involvement of the Malaysian Armed Forces (MAF) Health Services, the Malaysianbased research will take about seven to eight years to complete. The research is to involve a twophase process which includes pre-clinical trials and clinical trials, leading up to a possible vaccine distributed nationwide. The research had already begun back in the middle of 2014 with the intent to eradicate the dengue virus in Malaysia. Gen Tan Sri Zulkifeli Mohd Zin, the chief of the MAF stated in an interview that “we are focusing more on the local strain of the dengue virus in Malaysia and I believe this vaccine will be effective to the local people.” Besides Pharmaniaga, Bavarian Nordic and the MAF, the research had also seen support from the Ministry of Health and Univeriti Teknologi MARA (UiTM).

reaDy to go: mBpJ’s vector unit packs a punch with their high quality equipment

Unsung heroes MBPJ’s vector unit has an arduous task eradication Aedes mosquitoes

BY NORMaN HUSSaINI

ETALING JAYA: In a recent visit to the site where the vector unit of MBPJ’s environmental health department would meet before their daily rounds of larvae sighting and eradication of Aedes mosquitoes in Petaling Jaya, it was clear that the men donning the dark blue overalls are a dedicated bunch. Located along Jalan Tandan, the team met to iron out the work for the day. The people behind the gas mask and hulking fogging machines are usually seen in the afternoon fumigating the neighbourhood especially in the areas when dengue cases

were reported. The vector unit had an exhausting job. The crew has two main exercises they have to do every day, one early in the morning and another in the afternoon going towards dusk. Health+ got to visit them during their afternoon round of search and destroy mission around Petaling Jaya. Their aim, the infectious Aedes mosquitoes roaming across the state and spreading the dengue virus left and right. Each vector unit comprise of four or five members. The afternoon session started around 3pm, when the unit receive reports of a spike in dengue cases around the residential areas of town. Each location known to have reports of people getting infected will have a team assigned to it and have them go to fumigate the area.

After the briefing session by their superiors, the unit went the workshop around 4pm where all the equipment were stored. It seemed that the vector unit was well equipped with the latest fumigation machines. Two types of fumigation machines are typically used, the hand-held machines - which despite the word hand-held, was quite big and heavy – and the truck-mounted machines. The hand-held machines are used usually for indoor fumigation as well as to reach certain narrow areas of the streets while the trucks will usually go around the infectious locations on road. The most important aspect of the fumigation process is the chemical mixture of the insecticides. There is an established formula for the insecticides that the unit must follow which includes how much of it should be mixed in with either water or diesel. An interesting fact to know is that the unit uses both water-based and oil-based insecticides with various uses. The water-based is used primarily for indoor fumigation and the oil-based is used for outdoors. This means that indoor fumigations would not leave undesirable oily surfaces in the house when fumigaCoNtiNue page Xtra 06

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November | 2015

‘termiNators’: from left - mohd saiful Khir, muhammad amran abdullah, Noor azmi sanusi, muhammad azri amir, subramaniam a/l approw

gettiNg reaDy: subramaniam loading the equipment in preparation for the fumigation mission

Vector unit well equipped from page Xtra 05

tion is performed. After a brief examination, the unit loaded all the equipment needed in their vans and cars and would disperse to their assigned locations, which is around 4.30pm. The fumigation may last up to 8pm depending on the traffic and the community’s cooperation. The team over the years has met with a lot of challenges during their daily routine. Noor Azmi, the health assistant of the MBPJ’s vector unit who acts as the overseer for all the workers said that the job can at times, be very challenging. A rise in dengue cases in a certain location means that the area must be fumigated as fast as possible to avoid further spread of the disease, however the community may not well be too cooperative at times. They have been harassed in the past, with people throwing garbage and verbally assaulting them for doing their job. “After working in the field for six years, I have seen a lot of cases where some people even turned aggressive towards us.” Noor Azmi said, referring to a case in 2011 where a worker fumigating a house was nearly attacked by the home owner with a machete. It was clear that this particular job is demanding in terms of labour and being a professional towards the occasional angry mob. “It takes a highly trained personnel to take on this job, but the person must also be able to accept that the job doesn’t pay a lot.” Noor

Azmi stated. Being a highly trained personnel is the main requirement to be a part of the vector unit. Most of the workers in the unit are veterans in their field, with some working for almost 10 years. The workers must undergo training and receive a certificate granting them the title of professional fumigator. Certified workers would also be under a strict procedural watch by the health assistant, as each of them must be under constant observation to curb any unprofessional act. Noor Azmi continued: “Everything we do must be met by a certain practice standard so that we can achieve good results and to avoid any mishaps.”

listeN up: Noor azmi sanusi, giving instruction to muhammad azri amir before commencing the fumigation

all togetHer: Dr. Chithradavi with some of her staff

A steady watch over the workers is possible due to MBPJ’s recent decision to keep the vector unit in-house and not hire contractors as workers. “It was made much easier to monitor workers working directly for us as oppose to outsourcing the job to outside contractors, especially in the matter of mixing the insecticide formula.” explained Dr Chithradavi Vadivellu, director of the Department of Environmental Health of MBPJ. A curious notion of the risk of the chemicals used during the fumigation towards people was explained thoroughly by the health assistant Noor Azmi. He said: “The chemicals does have a long-term effect on people, usually affecting the lungs and skin. Yet a person may seriously be affected only after an extended exposure to the chemical at a very long period of time.” This means that the public would not be in any danger of the chemicals as most will not be exposed to it for an extended length of time. The workers on the other hand has a higher risk of danger, which is why they are equipped with safety overalls and gas masks during fumigation. The clothes will then be washed and the workers are required to take bath after the job to lower the risk of poisoning. Dr Chithradavi weighs in by saying “I take the liberty of transferring the workers to a desk job or to another department when I see fit. A yearly health check-up is done to ensure no workers are at risk of over-exposure to the chemicals they are handling on a daily basis.”

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2015 | november

WHat you need to know HiStory

The name “dengue” is derived from Swahili/Spanish roots. It was named apparently from the posture adopted by its victims. Earliest recorded cases of the disease was first mentioned during the Jin dynasty (265-420 AD). Benjamin rush was the person to first confirm a case of dengue fever in 1789 and gave the name “breakbone fever”. The study of viral etiology and mosquito transmission was established in the 20th century. current Situation

About 2.5 billion people live in areas of the globe where dengue has been reported and about 100 countries have since reported the illness. Annually about 50 million (although numbers are reported to be as much as 350 million) are reported worldwide to be afflicted with the virus with about 500,000 of them suffering from severe disease and about 25,000 dying as a result. Virology

On recovery afflicted individuals have lasting immunity to the particular serotype. As there is no cross protecting antibodies against the other serotypes, a person can get potentially dengue fever up to four times during his/her lifetime. Vector

Aedes mosquitoes will lay eggs three times over the course of their lives, and spawns about 100 eggs each time. Eggs can lie dormant in dry conditions up to nine months and can hatch if conditions become favourable again. clinical PerSPectiVe

The phases in which a person go through when contracted with the disease can be classified to three. The febrile phase (fever), the afebrile phase (no fever), and the recovery phase. Features of dengue includes; Fever A continuous high grade fever of about 38-40 C° which usually lasts about five to seven days followed by a period of no fever on the fifth day which may herald recovery. In primary dengue infection, the period of fever may be shorter, at only around three days. Body aches This symptom is why the dengue fever has been called breakbone fever. This includes retro-orbital

pain (pain in and around the eyeballs), Myalgia (muscle pain and aches), lethargy, and having poor appetite. An uncomplicated dengue usually lasts about 5-7 days, although feelings of lethargy, dizziness and weakness may last another week after fever.

BY DR aNBa

treatment

Treatment is usually symptomatic and supportive. Most patients will be managed by being advised to increase oral fluid intake to about 2.0 -2.5 litres a day for and average adult weighing 70 kg. A patient will also expect to be prescribed with Paracetamol for fevers and body ache and myalgia and Anti emetics like Domperidone for nausea and vomiting. Upon recovery (and after fever), you may develop an itchy rash on your arms, legs and trunk. This is temporary and you might be given antihistamines like loratadine and topical calamine lotion by the doctor. Warning SignS of dengue

During the period of fever, you have; Inappropriate fast pulse rate for your fevers but your blood pressure is normal or have narrow pulse pressure Persistent nausea and or nausea Unable to take orally well Persistent abdominal pain especially right hypochondrial pain (region of the liver) Severe headaches unresponsive to simple analgesics Severe diarrhoea Difficulty in breathing

Your doctor tells you that your Haematocrit or Packed Cell Volume (the % of red blood cells in your Full Blood Count) is high while your platelets are simultaneously decreasing. The above situation is usually seen around the fifth to the seventh day of illness and if not addressed promptly, it may lead to severe dengue. dengue HaemorrHagic feVer (dHf)

A type of dengue with rising packed cell volume and rapid fall of platelet count. Plasma fluid accumulation in third space namely in the pleural space and peritoneal cavity. These features are secondary to exaggerated release of blood antibodies called cytokines which cause immune injury and causes the volume of blood to shrink which in turn causes leakage of plasma (fluid blood) into third

2.5 billion people live in areas

of the globe where dengue has been reported and about

space like peritoneal cavity and pleural cavity. If left uncorrected, it leads to shrinking of intravascular blood volume, low blood pressure, multiorgan failure and eventually death.

100 countries have since

Clinical presentation includes Difficulty in breathing right hypochondrial pain Liver enlargement Abdominal distension

An uncomplicated dengue usually lasts about

Clinical bleeding from nose gums gastrointestinal tract and urinary tract lung and in the brain

reported the illness.

5-7 days, although feelings of lethargy, dizziness and weakness may last another week after fever.

A continuous high grade fever of about

38-40 C° which usually lasts

about five to seven days followed by a period of no fever on the fifth day which may herald recovery.

dengue SHock Syndrome

Dengue Shock Syndrome (DSS) is an elevated stated of DHF, caused by the presence of low blood pressure. It occurs as a result of delay in diagnosis, delay in seeking treatment, failure to recognize severity and instituting appropriate treatment and failure to refer to experts. Dengue is more risky in Young children Elderly People with diabetes mellitus or congestive heart failure People with chronic liver or kidney disease People with pre-existing blood disorder. mytH Surrounding dengue feVer

There is an undue reliance in measuring the platelet count to make a diagnosis as well as prognosis as

many cases of dengue fever does not present the patient with low platelet count an at earlier stage. There is also a misconception about the falling platelet count exclusively leads to clinical bleeding. The right way of managing dengue is by monitoring the percentage of red blood cells in the body (Packed red cell volume) and administer fluids regularly to keep it within appropriate range. Practical steps for personal protection against dengue fever Regularly empty and clean water storage containers Use proper mosquito repellent Correct disposal of tyres and other solid waste Report any symptoms of dengue fever Protect infected people from mosquito bites and use bed nets if they are bedridden. Wear trousers and clothing with long sleeves during the day

Dr Anbazhagan Kuppusamy, MBBS (Madras University), MRCP (UK), Fellowship in Infectious Disease (Australia), FRCP (Glasgow), FRCP (Edinburgh), MACP (USA), Academy of Medicine (Malaysia) is a consultant physician and a specialist in infectious disease.

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NOVEMBER | 2015

MMA oﬀers tips to combat dengue

“The common ﬂu usually display fever that takes no more than three days. So if a person has fever for longer spell, it is safe to say that he is suspected to having dengue.”

ETALING JAYA:The Malaysian Medical Association (MMA) was founded in 1959, with the focus on promoting and maintaining the honour and integrity of the medical profession here in Malaysia. MMA is an association fully made up of doctors and practitioners in Malaysia. They serve as a voice of the profession as a whole and to participate in the conduct of medical education and development of qualified doctors. Any doctor who is practising in Malaysia is entitled to become a member of the MMA, as well as any medical students whether studying here or abroad as student members. With the joint efforts of a number of highly qualified doctors, they are certainly the big fish in the pond of medical authority in Malaysia. When asked on their take on the issue of dengue in Malaysia, Dr Ashok Philip, the president of MMA the association’s primary role in infectious and non-infectious diseases is to engage with policy makers, especially in the Ministry of Health in order to ensure that the best possible measures are adopted for the control of these diseases. This of course also apply to dengue, an infectious disease currently running rampant in Malaysia. “The MMA feels that the current dengue situation is due to several factors.” Said Dr. Ashok. The first is because of the shift in serotype of the dengue virus. This means that the four different serotype of the virus may replace each other in a rather unpredictable fashion. He said: “When someone has recovered from infection with one serotype, then gets infected with another serotype, the chances of developing dengue shock or severe bleeding increases.” This explains the escalating cases of dengue in Malaysia over the past few years and with Aedes mosquitoes breeding in our cities and urban areas, it comes as no surprise that the chances of people getting bit multiple times is at an all-time high. The second factor focus on environment. Dr Ashok said: “are were many building sites at present, and some of them

Dr ashok: mma feels that the current denque situation is due to several factors

are abandoned. They become a perfect spot for the mosquitoes to breed, thus more transmission will take place.” Going back to the MMA’s take on the dengue, they are more directed at educating doctors in early diagnosis and management of the disease. They are the ones to device the guidelines on how to approach the disease during the earlier to the later stage in patients. They also actively interact with the Ministry of Health and local authorities on the matter of dengue control. “Public education lies more within the gambit of the Ministry of Health and the local authorities, though we are always glad to assist when requested.” Dr Ashok stated. The MMA has proven that they benefit the public in a lot of ways. They strive to promote and maintain high professional and ethical standards of practice. The MMA became a resource for people who wish to find out more about the profession or about current health issues. Relevant authorities participating in any of the health issues in Malaysia may also come to the MMA, which provides alternative viewpoint concerning said issue. It is a good way to make sure that the responsible authority has all the information needed to make good public health decisions.

Many accepting traditional from page Xtra 01

“However, papaya leaves juice is only a supplement that gives supportive effect and it is therefore not a treatment. Patients still need to seek proper treatment in hospitals to prevent dengue complications such as multi-organ failure, shock syndrome and bleeding. At the moment, there are no other studies with regard to traditional treatment for dengue,” he said. Asked if the local councils are responsible for the eradication of breeding ground for Aedes mosquito and if MoH is satisfied with the level of enforcement by the local councils, Dr Noor Hisham said: “In order to overcome dengue in the country, Ministry of Health

has established a dengue task force committee that involves seven ministries and local councils. A weekly meeting is conducted and the issues and problems regarding dengue prevention and control activities are discussed to seek for best solutions. The local councils play an important role and they are very supportive in tackling the dengue problems especially in handling the issues of illegal dumping grounds. For example, Kajang Municipal Council has increased the rubbish collection frequency from two times per week to four times per week and without any amount limit of rubbish collection.” He also added that Petaling Jaya City Council (MBPJ) had increased

• 09

2015 | november

General practitioners’ role in the war against dengue

HAH ALAM: Dengue fever is perhaps one of the more susceptible disease a person may catch in Malaysia, as seen by the growing number of cases this year. At an early stage, dengue fever exhibits symptoms not unlike the common flu. A person coming down with a fever will typically go to the nearest clinic to see his or her doctor first. Therefore, the general practitioners automatically plays a big part in the early diagnosis of dengue in Malaysia. Health+ reached out to a doctors at Metro Clinic Kota Kemuning, Shah Alam to have their take on the responsibility they have to diagnose dengue in their patients. Dr Yoshimi Bharath, a resident doctor in Metro Clinic said that they were fortunate to have amenities most clinics don’t have, and it had helped them to identify dengue fever in patients early. “One of the reason I came to work in Metro Clinic Kota Kemuning was because they provide equipment that most clinics doesn’t have and I feel that it helps a lot.” Having the equipment to test patients for dengue are usually reserved for hospitals and medical centres, which most clinics in Malaysia lack. Because of the extra amenities Metro Clinic provides, the role of the doctors there be-

comes bigger and much more substantial. The initial step taken by a general practitioner when looking for dengue in patients is to see the state they are in when they come in the clinic. Dr Yoshimi stated: “We look at the brief history of their symptoms, such as the period of time they are presented with the fever and their level of hydration by the frequency of urination.” The dengue virus exhibits similar symptoms as a common flu, so it is pertinent to know how long the patient has been coming down with a fever. Dr Yoshimi continued: “The common flu usually display fever that takes no more than three days. So if a person has fever for longer spell, it is safe to say that he is suspected to having dengue.” The clinic uses a Full Blood Count (FBC) test as a way to identify various infections and afflictions including dengue. Dr Yoshimi explained that they would administer the test daily to patients suspected of dengue. He said: “We will ask suspected patients to come in every day for seven days and do an FBC test given that they can afford it. A drop in blood count on the fourth day with continued fever means that it is highly probable they have developed dengue.” When a patient

The ms4se, a programmable blood testing device capable of measuring various parameters and are widely used in over 70 countries

treatment their enforcement activities by placing enforcement officers in each of the 24 zones. “So far, seven individuals have been caught and compounded for illegal rubbish dumping. However, the level of enforcement by the local councils with regard to issues of illegal rubbish dumping still needs to be intensified,” said Dr Noor Hisham. Over the years, MoH has been successful in controlling several diseases for example Malaria. On some of the that will be implemented by MoH to eradicate dengue in the future, Dr Noor Hisham said for malaria, there are drugs to kill the parasite that causes the disease and thus reduce the source of

infection to others. “Moreover, we can effectively promote and implement the usage of mosquito net in endemic areas as the peak biting time of the mosquito is during bedtime. We can also manage the breeding of the malaria mosquito vector as it breeds in a specific ecology, which could be manipulated or managed appropriately. However, there is no drug to kill the dengue virus in a patient and carrier. “In contrast, the Aedes mosquito not only bites when we are awake and active, it also breeds in any place that can collect water. Hence this makes the prevention and control of dengue fever far more difficult compared to malaria.

Killer iNseCt: The aedes mosquito

As there is no cure or vaccine available for dengue, MoH will emphasise on environmental cleanliness initiatives in collaboration with other ministries and agencies including community participations,” he said. When asked what role can

is confirmed to have dengue, the next step is to manage the fever well, hence the continued testing. “One thing I’ve noticed nowadays is that many people are focusing more on their platelet count, as they feel that it is the only indication of the severity of the fever.” However another important parameter to consider during the fever management is the level of hydration.” Dr Yoshimi explained. As part of the FBC test, a test called the Haematocrit test measures the volume of whole blood that is made up of red blood cells. This indicates whether the patient is sufficiently hydrated. When asked, as a general practitioner what was her advice to the public to fight dengue, she replied: “Be vigilant. The Aedes mosquitoes does not typically travel far and it is mostly because of us that the disease spreads as far and wide as it does now. So try and destroy nesting grounds around the house and kill any mosquitoes you find. For people who feel that thy have fever, especially ones that lasted for three days, be sure to consult a doctor immediately.” In conclusion, the general practitioners have big shoes to fill in, in our ongoing war against dengue. They are the front men and women in early diagnosis of dengue. Dr Yoshimi said that doctors working in clinics do not have the luxury of overloading hospitals and medical centres. If we can detect dengue at an early stage, we will treat them here in the clinic. It is only when the situation becomes severe we then refer them to hospitals.”

NGOs and corporate organisations play as part of their Corporate Social responsibility (CSr) programme to control the spread of dengue? Dr Noor Hisham said, NGOs and corporate organisations can play an important role in promoting community participation in dengue prevention activities. “This will most often involve health education, source reduction, and environmental cleanliness activities. Examples of CSr programmes are the Dengue Free Malaysia Movement started by Country Heights Group of Companies and Dengue Patrol Programme in schools by Sanofi Pasture. Their objectives are to spread the dengue message to all Malaysians and emphasise what each and every one of us can do to fight dengue. They have volunteers and students to help in running the programmes.

10 •

NOVEMBER | 2015

Weak and brittle bones Osteoporosis literally leads to abnormally porous bone that is compressible

Dr. Lee: More women getting osteoporosis than men

By NUR HIDAYAH HUSLAN

etaling Jaya: Our bones help to support our bodies, keep us straight, protect on internal organs such as lungs and heart as well as to enable us to move. However, bone is a living tissue which grows, break downs and gradually rebuilt through a process called “remodeling”. as we grow old, the bone remodeling might not be keeping pace with our age. Therefore, for individuals with low peak bones mass, developing Osteoporosis will be much easier and quicker for them. Osteoporosis is coined from two words “osteo” which means bones and “porosis” means porous. it is a condition where there is a decrease level in the density of bone and subject to fractures. it is the situation where bones drop its strength and resulting in fragile bones. in fact, Osteoporosis literally leads to abnormally porous bone that is com-

pressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures or brakes in the bones. On the other hand, Osteopenia is slightly diﬀerent but related with Osteoporosis in many ways. it is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis. to add, it might be less severe but it is still worth to be prevented. osteoPorosis in MalaYsia

according to Datuk Dr. lee JoonKiong, a practicing Consultant Orthopaedic Surgeon who is also the president of Osteoporosis awareness Society of Kuala lumpur and Selangor (OaSKlS), there are rather high percentage of women getting Osteoporosis compared to men. according to the recent survey, hip fractures surgical remarks relatively a worrying situation where the percentages divide into 25% of the patients who will fortunately become such in normal condition, 50% will be bound to wheel-chair, stick or anything to support their standings and movements and lastly another

hip fractures surgical survey:

25%

of the patients who will fortunately become such in normal condition

50%

will be bound to wheel-chair, stick or anything to support their standings and movements

25% will probably die

75% who might survive the operation, however they still have to bear the side effects of Osteoporosis for the entire life

25% will probably die. With only 75% who might survive the operation, however they still have to bear the side eﬀects of Osteoporosis for the entire life. in childhood and adolescence, the body constantly breaks down old bone and rebuilds new bone in the process called “remodeling”. During this time, the body builds more bone than it removes, thus it grows and strengthens the bones. it is not a rare fact that women need enough calcium but it is indeed crucial that kids and teenagers are essentially in of need ample bone-boosting calcium. in fact, youngsters must have a balance and healthy lifestyle since their early ages to build strong bones. Diet and exercise are very much needed. normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bones that are aﬀected by osteoporosis can break with relatively minor injury that normally would not cause a bone to fracture. The fracture can be either in the form of cracking or collapsing. The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone. are You at risk?

Osteoporosis can happen due to several factors encompass lifestyle, diet and genetic. Many risk factors can

lead to bone loss and osteoporosis. Dr. lee added that there are things that you might not possibly change while others you possibly can. These are among the factors that you cannot change but perhaps to be taken aware of; gender- women get osteoporosis more often than men, age- the older you are, the greater your risk of osteoporosis, Body size - small, thin and low BMi women are at greater risk, ethnicity - white and asian women are at highest risk. Meanwhile Black and Hispanic women have a lower risk. - Family history - Osteoporosis tends to run in families. if a family member has osteoporosis or breaks a bone, there is a greater chance that you will too, Sex hormones - low estrogen levels due to missing menstrual periods or to menopause can cause osteoporosis in women. low testosterone levels can bring on osteoporosis in men, Other diseases - Diabetes, anorexia nervosa, arthritis and other serious disease. less in calcium and vitamin D intake - a diet low in calcium and vitamin D makes you more prone to bone loss. Medication use - Some medicines increase the risk of osteoporosis. activity level - lack of exercise or long-term bed rest can cause weak bones. Smoking - Cigarettes are bad for bones, and the heart, and lungs, too and Drinking alcohol - too much alcohol can cause bone loss and broken bones.

• 11

2015 | november

Say ‘no’ to high heels to veer away osteoporosis.

Women’s love… Studies show higher incidence of osteoporosis in women who wear high-heeled shoes

etaling Jaya: you may notice that manifold literatures on preventing osteoporosis will include a line or two about avoiding high heels. But how far it is real as a fact that the two has connection or is it merely vague guesswork among researchers and fear-mongers? lots of studies do reveal that there is a higher incidence of osteoporosis in women who wear highheeled shoes for years together because of the marked degeneration in the bones. nevertheless, researchers are unable to identify what exactly increases the risk but they unanimously agree that there is one. in high-heeled shoes, your feet are not flat on the ground but at a steep angle where the heels of your feet are at a level higher than your toes. The weight of your entire body locates at the back part of your feet and deliberately pushing severely right into the bones of your toes. Moreover, high heels actually change your posture. you may walk like a model on the stage doing fashion show and in fact, this is the main reason that many women want to wear heels- to be looking way classy and gorgeous. They make you arch your back and push your bust forward which is deemed sexy. But the matter of fact is, all this actually changes the natural alignment of your bones which

The X-ray of foot wearing high heel

leads to your knees and lower back having to move into unnatural positions to accommodate your balance in heels. Cushion the adverse risks

Research has shown that there is a connection between prolonged high heel use and decrease in synovial fluid in the joints. The fundamental cause is as yet undetermined but the statistics are undeniable. you can prevent osteoporosis by reducing the instances of risk factors in your life. There are plenty of ways to do this through diet and exercise but by far the simplest lifestyle that you possibly can change is to not treat your heels like daily-wear footwear. Wear your heels occasionally in the true sense of the word, i.e. wear them only on special occasions. if you must wear them every day to boost your confidence, well, that requires much deeper work in your personal growth and sense of self-worth, but in the

Too high: high heels can cause leg strain and lead to osteoporosis

interim go ahead and wear your heels while taking the following precautions. high heels lovers?

How you could possibly stop your sexy habit wearing high heels to office or meeting girlfriends over the weekend? it is sort of impossible to trade high heels with flat shoes plus if you are petite. nonetheless, try to veer away risks of getting osteoporosis in the later age might be worth trying. Here are some helpful tips for the high heels lovers! Wear shorter heels; below two inches. avoid stiletto heels as these are deemed the worst by podiatrists and orthopedic surgeons. Opt for heels with a wider base such as wedges instead as they have been

shown to reduce pressure on the knees. Stretch your legs after you have gotten them out of your heels. Do not forget to stretch out your toes and calves too. This will help cramped muscles to elongate, improve blood circulation in the feet and help to get your bones back to their normal shape and alignment. Massaging feet at the end of the day can also be helpful. Make use of an insole for some extra padding for your feet and bones. Rotate your heels. Wear a 3-inch heel one day and a 2-inch one the next. This will prevent your legs from locking into a particular unnatural alignment from wearing the same heels every day. – Nur Hidayah Huslan

12 •

NOVEMBER | 2015

Milk benefits to arrest osteoporosis

etaling Jaya: Most of us were taught at a young age that drinking milk builds strong bones, and it is true that getting adequate calcium from foods is beneficial for skeletal health. The body gets the calcium it needs in particularly two ways. One is by eating foods or supplements that contain calcium such as dairy products, which have the highest concentration per serving of highly absorbable calcium, and dark leafy greens or dried beans, which have varying amounts of absorbable calcium. Furthermore, the other way the body gets calcium is by pulling it from bones. it happens when blood levels of calcium drop too low, usually when it has been awhile since having eaten a meal containing calcium. ideally, the calcium that is absorbed from the bones will be replaced at a later point. But, this does not always happen. However the concern is, calcium that is replaced will not be the same and sufficient simply by eating more calcium.

sloWing doWn osteoPorosis aMong adulthood

Preventing osteoporosis depends on two things; making the strongest bones possible during the first 30 years of life and limiting the amount of bone loss in adulthood. Several complementary strategies can help in slowing down the bone loss during adulthood and old age. according to Datuk Dr. lee, a practicing Consultant Orthopaedic Surgeon and president of Osteoporosis awareness Society of Kuala lumpur and Selangor (OaSKlS), there are several helpful things you should start putting into actions to veer away the risks of getting Osteoporosis.

sorption into the blood and to the kidneys that can minimize calcium loss in the urine. However, make sure that you are exposed to 8am to 10am sunlight in the morning or otherwise you will just burn yourself out under bad UV rays. dose uP vitaMin k

to opt out. With greater muscle strength, one can often avoid falls and situations that cause fractures. Making physical activity a habit can help maintain balance and avoid falls.

engage in regular eXerCise

Physical activities will put some strain on bones. it causes the bones to retain and possibly even gain density throughout life. Such “weightbearing” exercises include walking, dancing, jogging, weightlifting, stair-climbing, racquet sports, and hiking are activities you might want

ensuring adeQuate CalCiuM

Despite the debates surrounding milk and calcium, one thing is crystal clear that adequate calcium both for bone development and for nonbone functions is key to reducing the risk of Osteoporosis. However, the healthiest amount of dietary calcium has not yet been established. But drinking two glasses of milk is not that excessive and might be really helpful to strengthen your bones.

Vitamin K can be found mainly in green, leafy vegetables, likely plays one or more important roles in calcium regulation and bone formation. low levels of circulating vitamin K have been linked with low bone density, and in fact, supplementation with vitamin K shows improvements in biochemical measures of bone health. ModiFiCation oF liFestYle

Smoking and alcohol consumption are very threatening to your bones health. getting rid of unhealthy lifestyle may put you on track of taking care of your skeletons besides living your life at a level best as you age into your golden years.– Nur Hidayah Huslan

eXPosure to natural sunlight

Vitamin D plays a critical role in maintaining bone health. When blood levels of calcium begin to drop, the body responds in several ways. it promotes the conversion of vitamin D into an active form, which then travels to the intestines which can encourage greater calcium ab-

Osteoporosis: Why women at a greater risk? PETALING JAYA: It may seem to be unfair but it is true. If you are a woman, you are prone to get osteoporosis at a greater risk than men do. Study shows that osteoporosis affects approximately 200 million women worldwide. So why the gender gap? Women start lower bone density quicker than men. Thus, they lose bone mass more rapidly than men. As women age, they start to lose one-third of their hip bones between the age of

20 and 80. Osteoporosis may start to root in childhood and adolescence, which is the period when your body does the most bone building. In fact, women reach their peak at building bones at the age of 18, while men at 20. After that, both women and men will gradually build small amount of bone mass but men will add more compared with women. However, at the age of 30, bones will be fully stocked and body will continue to replace old

Women are at a greater risk for osteoporosis

bone cells without producing bone mass any longer at this point of time. Datuk Dr. Lee Joon-kiong, a practicing Consultant Orthopedic Surgeon and also the president of

Osteoporosis Awareness Society of Kuala Lumpur and Selangor (OASKLS) said that, “Bone formation for women and men is gradually increasing and reaching its peak between the age of 20

• 13

2015 | NOVEMBER

No bones to pick DEXA test could be done to measure the changes in the bone mineral density can save your life By NUR HIDAYAH HUSLAN

etaling Jaya: everyone hopes to age gracefully. Sadly, the future might be completely different for people afflicted by Osteoporosis. it is normal that it afflicts elderly, however by realising that bone density and quality decades earlier might put you always in a warning mode. nevertheless, for the Osteoporosis patients, seeking Osteoporosis treatment is basically to reduce bone loss and stimulate bone growth. to ensure your medications are prescribed effectively for you, a Dual energy X-ray absorptiometry (DeXa) test could be done to measure the changes in the bone mineral density. Datuk Dr. lee Joon-kiong (pix), a practicing Consultant Orthopaedic Surgeon at JK lee Orthopaedic & traumatology, assunta Hospital, Beacon international Specialist Centre and advanced neuroscience & Orthopaedic

and 25 and stop at the age of 30. After that age, bone mass will be gradually dropping until women reach their menopause. In fact, menopause will cause bone mass to acutely drop but differ from men, who do not have menopause and therefore, bones density will gradually drop as they are ageing.” WoMen lose estrogen QuiCker than Men Other than that, osteoporosis also will attack women with low production of estrogen. Adding osteoporosis to long-list of health issue among women, besides migraines and mood swings. Estrogen is a hormone that

Centre in Malaysia, said, “a bone density test determines if you have Osteoporosis; a disease that causes bones to become more fragile and more likely to break. in the past, osteoporosis could be detected only after you broke a bone. However, by that time your bones could be quite weak. a bone density test enhances the accuracy of calculating your risk of breaking bones. DeXa scan is recommended to confirm the results.” Other than that, Dr. lee who is also the President of Osteoporosis awareness Society of Kuala lumpur and Selangor (OaSKlS), explained that ultrasound; a screening test that is sometimes oﬀered at events such as health fairs is essentially used to detect problems with your bones early on. Ultrasound is quick, painless, and does not use potentially harmful radiation like X-rays. One disadvantage of ultrasound is that it can not measure the density of the bones most likely to fracture from osteoporosis which are the hip and spine. if results from an ultrasound test find low bone density, DeXa still has to be used to confirm and monitor the disease. Before being screened for osteoporosis, you may want to think about what you will do if the tests show that you have a high chance of getting osteoporosis. The higher your bone mineral content, the denser your bones are. and the denser your bones, the stronger they generally

that helps regulate a woman’s reproductive cycle. At the same time, it plays a role in keeping bones strong and healthy for both men and women. Furthermore, women at the age of 50 will slowly encounter menopause symptoms. As they wonder about getting menopause, they actually face a decreasing level of bone mass resulting to experience bone loss and osteoporosis at the same time. In addition, women are prone to suffer osteoporosis if they have problems relating to menstrual cycle or period. If they experience irregular or infrequent periods, or begin having periods at the later age than normal teenagers, they have a tendency

TESTiNg TiME: A bone density test enhances the accuracy of calculating your risk of breaking bones.

Back pain among women is the obvious symptom of osteoporosis.

are and the less likely they are to break. Bone density tests diﬀer from bone scans. Bone scans require an injectio n beforehand and are usually used to detect fractures, cancer, infections and other abnormalities in the bone. Doctors use bone density testing to: identify decreases in bone density before you break a bone; determine your risk of broken bones or fractures; confirm a diagnosis of osteoporosis, and monitor osteoporosis treatment. nevertheless, a bone density test is suggested for all women 65 years old and above, and younger women who are at increased risk for broken bones caused by osteoporosis and also men with risk factors for osteoporosis, such as being older than 70. Besides that, people who lose height at least 1.6 inches or 4 cm in height that may possibly have compression fractures in spines.

for getting osteoporosis higher than others. Furthermore, having had their ovaries removed also will escalate the risk. In addition, women who are going through menopause at an early age also will have a higher risk of osteoporosis. Research shows that women lose their bone density much quicker in the years immediately after menopause than they do at any other time in their lives. Being female puts you at risk of developing

Dr Lee: osteoporosis causes bones to become fragile

Moreover, people who suﬀer fractured bones which bones become so fragile to the extent sneezing and cough will cause fractures. People who have received transplants in addition are subjected to this test as well as women who experience remarkable drop in hormone levels.

osteoporosis and broken bones. However, you should not be worried about getting it if you know the essentials that most women should be knowing at the early stage. Based on the research done for so many years, approximately one from two women over the age of 50 will break a bone because of osteoporosis. In addition, women tend to have smaller and thinner bones than men. To add to the chances of getting osteoporosis is women will have menopause, hence the osteoporosis may not be peculiar disease among women as the estrogen will decrease sharply after menopause. – Nur Hidayah

Huslan

14 •

NOVEMBER | 2015

A new breakthrough Gene found to pave way for new drugs to help rheumatoid arthritis patients

By ZURINNA RAJA ADAM

Uala lUMPUR: Scientist in Britain and ireland have reportedly identified a gene that is linked to rheumatoid arthritis (Ra), a breakthrough that could pave the way for new drugs and help patients to receive a more personalised treatment. Ra is an autoimmune disease (where your immune system attacks healthy cells in your body by mistake) that causes inflammation, pain, stiffness and damage to the joints of the feet, hips, knees and hands. There is no cure for this disease and patients are prescribed with medication to manage the pain and to help prevent deformed joints. Using a simple method of blood test, early detection could be wellestablish to gauge if patients have the gene for the disease. This may help to fast track treatment by sourcing for the most appropriate and aggressive medication. President of arthritis Foundation Malaysia associate Professor Dr Sargunan Sockalingam noted that gene therapy is rather complicated as there is a possibility that the vehicle that carries the replacement gene or the “fixer” protein might be a virus designed specifically for this purpose. However, he said there are synthetic compounds that can be used, delivered either orally, intravenously or subcutaneously. in any case, the treatment may not be very different from what we have now. “For many years researches have suspected that the disease could be inherited as they have observed more than one member of a family developing the disease (such as mother and daughter, and siblings). Doctors will ask for family history of Ra in patients who present with joint stiffness and joint swellings,” Dr Sargunan said in an email interview. He pointed that the link be-

professor Dr Sargunan: one in every two patients does not get proper treatment

tween genetic and Ra have been widely researched and established, but the disease itself has a number of causes that could be environmental and viral triggers. “More research is going on and i am confident that we are closer to finding a good personalized therapeutic model in the next 10 years. But the reality is we are still quite far away from this approach. We

will have to wait for clinical trials and their results before we are assured of this new mode of treatment,” said Dr Sargunan. a report by national inflammatory arthritis Registry revealed that one in every two arthritis patients does not get proper treatment until at least a year after symptoms present themselves. if a patient receives proper treatment within the first six weeks after experiencing symptoms, there is a higher likelihood that the disease can be successfully managed and even put to remission. The government provides free medication for a number of Ra drugs, such as Prednisolone, Hydroxychloroquine, Methotrexate and leflunamide. according to Dr Sargunan, there are three main challenges for arthritis patients in Malaysia. These include: access to regular and more frequent care to treat the disease optimally, especially during flares; adjustments to work schedules and modifying living and working environments to suit those with advanced disease and disability. Currently people with arthritis are expected to contribute to the economy despite their

What is arthritis? left untreated. WHat CaUSeS artHritiS? the causes of arthritis depend on the form of arthritis. Causes include injury, metabolic abnormalities, hereditary factors, the direct and indirect effect of infections (bacterial and viral), and a misdirected immune system with autoimmunity (such as rA and systemic lupus lupus erythematosus). ArtHrItIS is a term covering over 100 rheumatic disease and conditions which is caused by the body’s own immune system attacking joints in the body causing inflammation, stiffness and pain. the disease can lead to damage joints and eventually physical disability if

WHat are tHe different typeS of artHritiS? there are more than 100 types of arthritis but the most common ones are osteoarthritis, rheumatoid arthritis and psoriatic arthritis. osteoarthritis (oA: is the most common cause of limb joint and spine

disease; and finally the cost of treatment has to be borne by Ra patients. This is especially true of those without support from their employers, and people without access to health insurance. “Our public healthcare system is one of the best in the world. However, it is highly understaffed and overwhelmed. More needs to be done to address these issues,” he said. in conjunction with World arthritis Day this month (October), continuous efforts are underway to raise awareness on the disease to general Practitioners and Family Doctors. While Ra cannot be cured, the message that it can be controlled if detected and treated early must be the emphasis. “Many private clinics have access to laboratories which provide facilities for blood tests, hence the doctor can make diagnosis much earlier,” said Dr Sargunan. Sharing experiences and organising group activities among patients support group is really a way to go to help to bring out a sense of comfort to patients. Family support is vital to patients to help them get back to normal life the sooner, the better.

arthritis which usually happens with age when your joints are considered overused. this disease can also be the result of joint injuries or obesity. What are the symptoms? the common sites of oA are hands, knees and hips. Hands oA – effects the base of the thumb and the joints at the end of the finger. At times, these joint become red, swollen and tender especially when the condition first appear. over the years, firm knobby swellings will start to form on the side of the joints called Heberden nodes. knee oA – pain gets exasperated by use. the knee feels stiff and pain and can vary. Hip oA – pain is felt in the front of the groin and sometimes around the thigh, buttocks or down to the knees. there will be discomfort on walking. rheumatoid Arthritis (rA) – is a disease which makes the joints in our body inflamed. the joint is surrounded by membrane called synovium which produces fluid known as the synovial fluid that act as an lbricant to help the

• 15

2015 | NOVEMBER

A brush with stroke Positive attitude is essential en route to recovery

Ual a lUMPUR: Ungku Mokhsin Ungku Mohamed, 60, had aphasia in 2010. aphasia is a type of stroke that disrupts the speech and language part of the brain. For most people, this part is located on the left side (hemisphere) of the brain. in relating to his experience, Ungku Mokhsin said he led a healthy lifestyle consuming organic food and exercise regularly especially after he was diagnosed with Cardio Myopathy (weak heart condition) in 2004. “that morning when i had stroke, i woke up at around 4.15am and felt strange; like my body somehow doesn’t feel right. i got up of bed and walked to the toilet but i felt blank, unsure of why i was standing in front of the toilet. i tried to switch on the light, but somehow i couldn’t. it’s like my brain was telling my finger to press on the switch but my finger stop midway. i didn’t understand what was happening to me.” “i started pacing up and down the room from the bed to the toilet and this woke my wife up. She asked me if i was going to the toilet and then i remembered that was what i wanted to do. after i went back to bed, my wife asked if i was ok. But i couldn’t respond. i couldn’t talk at all. My wife took my blood pressure and my pulse reading was high. She immediately woke up our daughters and brought me to the hospital.”

Throughout the entire journey to the hospital, Ungku Mokhsin said he was well aware of what was going on. as his daughter and wife were discussing which hospital to go and the fastest route to take, he was alert the whole time but he just couldn’t respond. in fact, he remembered everything that happened that night till today to share his tale. “When i reached the hospital, the doctor asked for my name. That was when i felt like crying because i could not remember my name and i could not utter it. no word seems to be able to come up from my mouth.” Miraculously, at 6pm on the same day he remembered his name and about three days later, he was able to speak, albeit very slowly. Ungku Mokhsin stayed in the hospital for the next 10 days and went through several tests to determine the severity of his stroke. He had a speech therapist but he said what helped him most was his session for six months at national association of Stroke Malaysia (nasam). “i highly recommend nasam for stroke patients. i made many friends there and best of all was the affordable therapy session offered at the centre,” he added. Five years on, Ungku Mokhsin is now fit as a fiddle. He is a founder and chairman of an oil and gas company but is now taking a step back from work and is active with volun-

outer layer move smoothly. In rA, the synovium becomes inflamed due to increased synovial fluid production. the pain in joint is caused by the nerve endings that get irritated by the chemicals produced. the disease effects about five in 1000 people in Malaysia.

type of arthritis is usually limited to just a few joints of the fingers and toes but sometimes it affects the spine giving a painful stiff back, neck or end joint at fingers and toes. Finger and toenails would develop discoloration, thickening and pits. this type of arthritis can start as early as childhood. the skin disease (psoriasis) usually shows up first.

WHat are tHe SymptomS? tender, warm and swollen joints; morning stiffness that may last for hours; fatigue and weight loss. early rA tends to affect the smaller joints first, particularly the joints attached to your fingers to your hands and your toes to your feet. the symptom will spread to the wrists, knees, ankles, elbows, hips and shoulders as the disease develop. Psoriatic Arthritis – inflammation of the skin or psoriasis and joint (arthritis). this

WHat are tHe SymptomS? Pain and stiffness in and around your joints; swollen fingers or toes (dactylitis), caused by inflammation both in joints and tendons; buttock pain, a stiff back or a stiff neck, which is caused by inflammation in your spine; pain and swelling in your heels, caused by inflammation where the Achilles tendon attaches to the bone; and pitting, discoloration and thickening of your nails (source: www.afm.org.my).

Ungku Mokhsin Ungku Mohamed

“i highly recommend nasam for stroke patients. i mad many friends there and best of all was the aﬀordable therapy session oﬀered at the centre.”

references: www. afm.org.my; www. mayoclinic.org; www.webmd.com

Having a positive attitude is an abso-

lute must for stroke survivor. learning from other survivors’ experience and getting the right support system are keys to success in life after stroke. “i would say i am about 90% recovered. it does get frustrating sometime because my brain is faster before my speech could catch up especially when i g et excited like bumping into an old friend,” he said. Ungku Mokhsin said his family played a very important role in helping him to remain positive. “i appreciate the fact that they treat me normal and they humor me. That is very important. My wife, norhuda Kumasi has been my pillar of strength. Despite all the treatment i have been to, reading the Quran is the best therapy of all and my wife assisted me daily to help me read them. When i couldn’t talk, i still pray while my wife helped to read the Surah (verses) for me,” he said. – Zurinna Raja Adam

eXerCiSe People with arthritis often receive conflicting advice regarding exercise. However, according to president of Arthritis Foundation Malaysia (AFM) Associate Professor Dr Sargunan Sockalingam the key to overcoming pain in arthritis is exercise. “Different grades of exercise can cater to different stages or phases of the disease. the idea is to stay fit and active at all times,” he said. While rest is needed to settle an inflamed joint, too much rest will weaken muscle and increase stiffness. During period of remission, exercise can be increased to help strengthen the muscle as well as preventing the joint from becoming unstable during periods of active disease. Patients are encouraged to perform exercise between three

and four times a week. Some of the best fitness exercises recommended are walking, exercising in water, swimming and cycling. Another key component of therapy is sleep. Getting good sleep is very important for all arthritis patients. there are reports that the immune system “fixes” itself during the deeper stages of sleep. Going to bed early is always a good thing.AFM secretary S. Shantamalar said arthritis patient must find the right balance between exercise and rest. “Arthritis patient must learn to accept the disease, seek proper treatment and live with it. the faster you accept, the better you are (in coping with the disease),” she said in an interview. “there is no cure for arthritis. Arthritis patient can only control deterioration by being positive, take the medication, control diet and exercise,” she added.

teerism at ngOs. “There is no such thing as a minor stroke or a major stroke. a stroke is a stroke. The brain is like a library that store many information. When i had aphasia, it’s like the library in my brain had an earthquake and now the “librarian” working in my brain is slowly putting the book back where it belong,” he said. The funny thing is, post-aphasia had Ungku Mokhsin now speaking with an accent and sometime he could converse in French and even Hindi. laughing away during the interview, he said “i don’t know how that happens but it happened. There was this one time i was going inside a lift and there was an indian man and i started greeting him in Hindi. Funnily enough, he understood me,” he said. Staying poSitiVe

16 •

november | 2015

There’s life after recovery Therapy sessions after treatment can help patients recover

etaling jaya:Caregivers of stroke patients must encourage and make time to send their love ones to attend therapy session. This will not only encourage them to recover but will also help the caregivers, free themselves from having a stroke patient depending on them (caregivers). national Stroke association Malaysia (naSaM) janet yeo, 70, pointed out that nasam was set up to help stroke patients receive therapy sessions at a very minimal cost. in fact, for those who cannot afford to pay the minimum fee, the sessions are provided free. “i urge caregivers to stroke survivors to make the time and help the stroke patient dress up every morning and come over to our centre (nasam) continuously for at least a year. Here, they have friends to chat and physiotherapist to help them exercise. all these will help them to recover as they get the support needed and eventually they will be more independent in managing their life after stroke,” she said. “This will also help the caregivers to free themselves from having a stroke patient being dependent on them,” janet added. every year, about 50,000 people in Malaysia suffer from stroke which is the third largest cause of death in the country, after heart diseases and cancer. in the aftermath of a stroke, patient may experience temporary or permanent disability. Depending on how quickly a stroke attack is diagnose and treated, patient may also encounter problems such as control of bladder and bowel movement, paralysis or weakness at one or both side of the body, trouble in expressing emotions and in some cases patient may also fall under depression. janet also known as “iron lady” suffered a stroke when she was 44 while at her peak of her career managing two advertising companies. The first thing janet noticed when she woke up that fateful morning was that her right hand wasn’t following instruction. But she thought nothing of it and drove off to work. When she was climbing the stairs to her office, her body was already lopsided. “i had no idea what a stroke was. So i still went ahead with an interview i had that morning with a local daily. My head was pound-

What is stroke? Stroke happens when blood supply to the brain is disrupted due to blockage or when blood vessels within the brain rupture. When this occurs, brain cells get damaged or will die. there are three main kinds of stroke: Ischemic strokes are caused by a narrowing or blocking of arteries to the brain. Hemorrhagic strokes are caused by blood vessels in and around the brain bursting or leaking. transient ischemic attack (tIA) is known as the “mini-stroke.” It is different from the major types of stroke because blood flow to the brain is blocked for only a short time. However, it is important to note that a tIA could be a warning sign of a future stroke.

Serving the people: Janet Yeo was also a stroke patient

ing and when the phone rang beside me, i couldn’t get it. My right hand couldn’t move by then and my manager drove me to the hospital straightaway.” janet said her husband yeo Chee yan is instrumental in making sure she led an independent life post-stroke. “My husband knows that i rise to a challenge. i also have two young kids (aged one and two) so i have a lot to look forward to. i know i will work hard towards my recovery. My husband refused to get me a maid and made me do everything myself which served as a motivation to know that i could. it is also a good exercise for me to use my affected arm and leg,” she said. janet first attended a stroke rehabilitation centre in Singapore and seven months post-stroke and to las gatos, California, travelling on her own, to attend a stroke rehabilitation centre there. She had another stroke patient as roommate and together they walked from their apartment to the bus stop to board the bus to the hospital daily for therapy. “i had to literally learn to crawl before i could walk. By the second month that i was there, i could walk without a stick anymore,” she said adding that she also improved her speech by reading to her two children every night. janet founded nasam in 1996

SignS and Symptom of Stroke Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or lack of coordination. Sudden severe headache with no known cause. If you think someone may be having a stroke, act F.A.S.t and do the following simple test: F—Face: Ask the person to smile. Does one side of the face droop? A—Arms: Ask the person to raise both arms. Does one arm drift downward? S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange? T—Time: If you observe any of these signs, call 9-1-1 immediately.

Note the time when any symptoms first appear. Some treatments for stroke only work if given in the first 3 hours after symptoms appear. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. recommended measures to prevent stroke : eating a healthy diet Maintaining a healthy weight Getting enough exercise Stop smoking Limiting alcohol use (source: http://www.medicalnewstoday.com/ articles/7624.php#what_causes_stroke)

since she noticed there was a lack of information on the disease as well as the non-existence of a support group for stroke survivors. nasam was the first non-profit organization in Southeast asia that provided rehabilitation and support to stroke survivors and family. its main mission is also to inform the public on the risk of stroke and that there is life after stroke through proper rehabilitation and support. today, nasam runs eight centers nationwide where over 400 stroke survivors attend daily therapy sessions. janet hopes to open more centres in the outskirt areas in future. “When you know of anyone who has a stroke, first listen to the doctor and get the treatment rec-

ommended at the hospital. Once discharged, come to nasam and we will help you with the support you need,” she said. janet’s courage and determination as well as her amazing recovery journey caught the attention across the causeway where she has been asked to assist the establishment of a Stroke Support Station (S3) at Singapore’s enable Village located at Redhill Road. Besides rehabilitation activities, the centre which spans on a 30,000 sq meter site will also provide information services to the disabled, a career centre which offers job placement and job support services. There will also be a mentoring space where the disabled with work experience can mentor disabled students. When asked what she missed the most about her life before stroke, laughing away janet said; “i miss wearing cheongsam and my high heels stilettos.” “But don’t let anything deter you to recover from stroke. Believe in yourself and make recovery as your career. live your life as you progress and don’t stop doing what you want to do. Don’t wait until you recover. just do it,” she said. On Oct 25, nasam is organizing a Colour Walk which will start at MBPj Carpark jalan yong Shook lim, Petaling jaya to raise awareness in stroke in conjunction with World Stroke Day. Details: www. walkforhealth.com.my. – Zurinna Raja Adam

• 17

2015 | NOVEMBER

Seeing it right Children given free check-ups and spectacles in conjunction with World Sight Day 2015

By NUR HIDAYAH HUSLAN

UBang Jaya: your vision is precious. There’s nothing you can do without a sound vision. We use them to navigate the world around us, express our emotions and connect with other people. We can take our eyes for granted but we rely on them so much in everyday life. Sound vision will ensure balance human growth and well-being despite having merely healthy body. There are many things we can do to keep them healthy and make sure we are seeing our best as we age into golden years. Dr. Kenneth Fong Choong Sian, a Consultant Ophthalmologist and Vitreoretinal Surgeon and also the Secretary of Malaysian Society of Ophthalmology (MSO), said, there are three major eye problems reported in recent years. “These common eye diseases reported such glaucoma, diabetic retinopathy, and age-related macular degeneration. These three eye problems usually occur among children, young adults as well as ageing generation.” ChilDren to Be given free CheCK-ups anD speCtaCles

He further added on the behalf of MSO, grabbing the responsibility to educate and create awareness has no second thought. in conjunction with, the World Sight Day 2015 (September), MSO organized a campaign to reach out and promote social awareness among children

of refugees and foreign workers to screen their eyes and provide them with spectacles for free. Prior to the splendid achievement of developing an idea of mobile clinic in 2014, the association this year aims bigger for a more effective campaign to help children. Moreover, their aims are to create awareness and organize programmes to help vision-impaired patients especially children to develop healthy daily routine of taking care of their eyes cannot be belittled. MSO with the donation from Bank Simpanan nasional (BSn) recently has bought a Diabetic Retinopathy scanner machine to take pictures of the back of patients’ eyes to diagnose symptoms of diabetic retinopathy. This eye examination will be given free to the public. MSO furthermore recommends that diabetes patients have retinal examination every year. it is painless, takes less than 10 minutes to complete and administered by the physicians. Dr. Fong stated that, early detection of DR still can be cured, with laser treatment. Thus, it is crucial to detect DR symptoms at the very beginning stage.

people who suffer from diabetic retinopathy or DR. He added that, diabetic retinopathy will perilously result to blindness among diabetic patients if left untreated. it is due to the situation where changes happen in the blood vessels of the retina. it will damage the retina, the section of patient’s eye responsible for capturing visual information. in fact, it is worrying that approximately 2% of children in Malaysia suffer diabetic retinopathy. it is not a normal situation where it happens too early among children. He said, “Most of them are very young and they will face the possibility of having loss of sight which result to unable to work and earn incomes. it is literally will jeopardise their financial and living expenses.” Symptoms of Diabetic Retinopathy include blurred vision; sudden loss of sight in one eye; seeing rings around lights and dark spots or flashing lights.

BLURRY: (pix top) The Yeye disorders gives a blurred image

DiaBetiC retinopathy

People who suffer prolonged diabetes may develop eye disorders such as Diabetic Retinopathy or DR. DR is an eye problem that usually happen to diabetic patients. The longer the patient suffers diabetes, the higher the risk of the developing DR. it refers to damage of blood vessels in the retina. DR can cause severe condition for eyes which is called as Diabetic Macular edema or DMe. it is an advanced type of DR where fluid leakage from dam-

treatMent for DiaBetiC retinopathy

Dr Kenneth Fong

aged blood vessels into the macula. Macula is a part of the retina that provides sharp central vision. When this happens, it may cause the macula to swell. Swollen macula is called as Macular edema that results in blurry and washed-out vision which can possibly lead to blindness if left untreated. according to Dr. Fong, approximately 20% of Malaysians suffer diabetes and it is rather worrying situation that 10% of them will encounter bigger risk of going blind. Therefore, it is close to 80,000

in most mild cases of Diabetic Retinopathy, intense treatment is usually unnecessarily to be conducted. Strict control over blood sugar and blood pressure are sufficient to greatly reduce or get rid of the chances for developing DR. However, in more severe cases of DR, intense treatments are recommended to impede the damage caused by DR as well as to prevent loss of the vision. laser surgery could be one of the treatment options. it could be really helpful in treating DR. it will seal the leaking retina vessels on the damaged retina. in fact, it is believed to greatly reduce the risks of developing greater visual impairment.

18 •

november | 2015

Escalating cases of Myopia among children

etaling Jaya: The inability to see objects or visuals at a distance clearly could possibly be one of the symptom of suffering Myopia among children. Myopia, or near-sightedness occurs when the eyeball is too long, relative to the focusing power of the cornea and lens of the eye. it means that the eye does not bend or refract light properly to a single focus to see images clearly. For people who suffer Myopia, close objects look clear but distant objects appear blurred. Myopia is a common condition that affects mostly children. Myopia is inherited and is often discovered in children when they are between eight and 12 years old. Thus, children may encounter higher risk of getting Myopia if their parents are near-sightedness. Patients with myopia have a higher risk of developing a detached retina. ask your ophthalmologist to discuss the warning signs of retinal detachment with you if you are in this risk category. if the retina does detach and it is discovered early enough, a surgical procedure could possibly help to repair it. it is important to have regular eye examinations by an ophthalmologist to watch for changes in the retina that might lead to retinal detachment. if the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. High myopia will usually stabilize between 20 and 30 years old. With high myopia, you can usually correct vision easily with glasses, contact lenses or sometimes with refractive surgery. as a consequence, people with high myopia may also have a higher than average risk of developing glaucoma and cataracts.

Myopia treatMent

eyeglasses or contact lenses are the most common methods of correcting myopia symptoms. Depending on the degree of your myopia, you may need to wear your glasses or contact lenses all the time or only when you need very clear distance vision, like seeing a chalkboard, driving or watching a movie. They work by refocusing light rays on the

retina, compensating for the shape of your eye. eyeglasses can also help protect your eyes from harmful ultraviolet (UV) light rays. a special lens coating that screens out UV light is available. in many cases, people may choose to correct myopia with laSiK or another similar form of refractive surgery. These surgical procedures are used to correct or improve your vision by reshaping the cornea, or front surface of your eye, effectively adjusting your eye’s focusing ability. However, according to Dr. Fong, children should be getting enough sunlight exposure to reduce the risks of suffering Myopia. Outdoor activities are the most basic necessity should be practiced by children at school or even at home. it is very essential to allocate some quality time to do outdoor activities regularly.

ophthalmic examination. The tests will be very simple and painless to detect any changes in your eye pressure, drainage angle, optic disc and visual field. eye Drops

This is a special eye drop for glaucoma. it is very common for the doctors to prescribe eye drop to treat glaucoma. it will either reduce the formation of fluid in the front of the eye or increase its outflow. Side effects of glaucoma drops may include allergy, redness of the eyes, brief stinging, blurred vision, and irritated eyes. Some glaucoma drugs may affect the heart and lungs.

an insight into glauCoMa

For elder people, glaucoma is a leading cause of blindness in people over 40 years. it is not an infection or contagious. it usually develops when the production of aqueous humour increases or the aqueous humour does not drain adequately. it causes the rise of pressure in the eye that will later damage the nerve fibres and blood vessels due to the compression. This phenomenon will interrupt the transmission process of visual messages to the brain and will result impaired vision and blindness.

laser treatMent

laser surgery for glaucoma slightly increases the outflow of the fluid from the eye in open-angle glaucoma or eliminates fluid blockage in angleclosure glaucoma. it is more like to open the clogged drainage and channel fluid to flow more freely. MiCrosurgery

Diagnosing glauCoMa

you are at an increased risks of having glaucoma if you age over 40, having a family history of glaucoma, having poor vision, suffering from diabetes, consuming certain medications or having experienced trauma on your vision. Chronic glaucoma usually does not show any obvious symptoms. Thus, it is vital for you to have a regular check-up through

Children should be getting enough sunlight exposure to reduce the risks of suffering Myopia.

This operation is called as trabeculectomy. in t his operation, a new channel is created to drain the fluid, thereby reducing intraocular pressure that causes glaucoma. Sometimes this form of glaucoma surgery fails and must be redone. nevertheless, for some patients, a glaucoma implant is the best option. However, this microsurgery could somehow cause other complications for instance some temporary or permanent loss of vision, as well as bleeding or infection.– Nur Hidayah Huslan

• 19

2015 | november

If you want your eyes to stay strong and healthy, then taking care of them on a daily basis is what you really need to put into practice.

See bright as you age Petaling Jaya: Spectacles seem to be fashionable accessory for elder people these days. it is significantly needed in almost everything that they are up to; reading, watching television, looking at signboards, typing on the mobile phone or even looking at themselves on the mirror, they need to put their spectacles on. it is still fortunate that elder generation aged 50 and above are still be able to see clearly with spectacles. However, there is a disease that can cause vision loss among them, which is called age-related Macula Degeneration or aMD. aMD is a common eye condition and a leading cause of losing vision among people age 50 and above. it causes damage to the macula, a small spot near the center of the retina and the part of the eye needed for sharp, central vision, which lets us see objects that are straight ahead. nevertheless, for some people, aMD advances so slowly that vision loss does not occur for a long time. yet, for some others, the disease progresses faster and may lead to a loss of vision in one or both eyes. as aMD progresses, a blurred area near the center of vision is a common symptom. Over time, the blurred area may grow larger or you may develop blank spots in your central vision. thus, objects may not appear to be as bright as they used to be. aMD by itself does not lead to complete blindness, with no ability to see. However, the loss of central vision in aMD can interfere with simple everyday activities, such as the ability to see faces, drive, read, write, or do close work, such as cooking or fixing things around the house. the MaCula aMD happens when there is a deterioration or breakdown of the eye’s macula. the macula is a small area in the retina, the lightsensitive tissue lining the back of the eye. it is the most sensitive part of the retina, which is located at the back of the eye. the macula is the part of the retina that is responsible for your central vision, allowing you to see fine details clearly. the macula is made up of millions of light-sensing cells that provide sharp, central vision. the retina turns light into electrical signals and then sends these electrical signals through the optic nerve to the brain, where they are translated into the images we see. When the macula is damaged, the center of your field of view may appear blurry, distorted, or dark. age is not solely faCtor Dr. Kenneth Fong Choong Sian, the Consultant Ophthalmologist and Vitreoretinal Surgeon of Sunway Medical Centre and also the Secretary of Malaysian Society of Ophthalmology (MSO) stated that, “aMD usually will occur among elderly people age 50 and above. For this group of people, supplement may help to cushion the effects of the disease.” However, good and healthy diet may help reduce the percentage of having aMD but age is still the major risk factor for aMD. the disease is most likely to occur after age 60, but it can occur earlier. Other risk factors for aMD include lifestyle such as smoking, unhealthy diet, insufficient vitamins and nutrients and other related factors for instance race, family historic and genetics. aMD is more common among Caucasians than among african-americans or Hispanics or latinos. Other than that, people with a family history of aMD are at higher risk. at last count, researchers had identified nearly 20 genes that can affect the risk of developing aMD. Change your lifestyle Researchers have found links between aMD and some lifestyle choices, such as smoking. you might be able to reduce your risk of aMD or slow its progression by making healthy choices. Dr. Fong said, “Healthy lifestyle is important especially for elderly people to avoid smoking, exercise regularly, maintain normal blood pressure and cholesterol levels as well as eat healthy diet rich in green, leafy vegetables and proteins.” – Nur Hidayah

Huslan

How to get tip-top peepers

etaling Jaya: everyone knows that to maintain a healthy body you have to eat right and exercise, visit doctors regularly, and take prescribed medications correctly when needed. Well, to maintain healthy eyes relatively the same things apply. if you want your eyes to stay strong and healthy, then taking care of them on a daily basis is what you really need to put into practice. CoMprehensive DilateD eye exaM

you might think your vision is fine and your eyes are healthy, but visiting and seeking advises from your eye care professionals for a comprehensive dilated eye exam and eye care tips are well needed. Many common eye diseases such as glaucoma, diabetic retinopathy and age-related macular degeneration often have no warning signs. a dilated eye exam is the only way to detect these diseases in their early stages. eat right for gooD sight

Carrots are good for your eyes. anyhow, consuming a daily diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale, or collard greens is important for keeping your eyes healthy. Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.

Maintain a healthy weight

Being overweight or obese increases your risk of developing diabetes which can lead to vision loss, such as diabetic eye disease or glaucoma. try to put a healthy weight and practice balance lifestyle. Know your faMily’s eye health history.

it is vital to know if anyone has been diagnosed with a disease or condition since many diseases are hereditary. talk to your family members about their eye health history. This will help to determine if you are

at higher risk for developing an eye disease or condition perhaps not now but it may happen in the future. wear proteCtive eyewear.

Wear protective eyewear such as safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. to add, wear sunglasses to protect you from UVa and UVB that may be harmful especially when you do outdoor activities. Quit sMoKing or never start

Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to increase risk of getting blind by developing age-related macular degeneration, cataract, and optic nerve damage. give your eyes a rest

if you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. try the 20-20-20 rule: every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain. Clean your hanDs anD your ContaCt lenses properly

to avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate.– Nur Hidayah Huslan