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Diabetes and diabetes retinopathy
Diabetes is a disease in which your blood glucose levels are above normal and is generally classified into two main types
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The Pulse of the Nation A few years into life with type 1 diabetes, I learned a lot about Malaysian food and my body – how my blood glucose levels respond to stress, exhaustion and adrenaline rushes.” – Yoshitaa january | 2016
Living strong with diabetes Having diabetes is not the end of the world. Life still goes on and you can pretty much do what you want, with some slight adjustments, for instance, to your diet. The disease does not – and should not –stop you from leading the life you want. With careful management you can control the condition, rather than it controlling you. See page 04
Snuffing out the smoking habit
Health Ministry’s M Quit Smoking Services programme aims to strengthen quit smoking services in Malaysia
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Man-made infertility on the rise
One in six couples in Malaysia faces infertility. The infertility rate is estimated at about 10-15% of the population, which is over 300,000 Malaysians
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january | 2016
The world of diabetes
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iabetes is a metabolic disease in which a person has an abnormal amount of blood glucose – or blood sugar – in the body. The abnormal amount of blood glucose in the body is a result of the body’s cells not being able to respond properly to insulin or the inability to produce enough insulin, or both. People with this disease will typically experience frequent urination (polyuria) and will be hungry (polyphagia) and thirsty (polydipsia) more than usual.
The pancreas produces insulin which is the catalyst that converts glucose into glycogen, the substance we use for energy.
What is insulin? Insulin is a hormone naturally produced by the body, specifically the pancreas. It is a medium for the body to absorb the glucose in food we eat to turn it into energy. Absorbed glucose is stored in the
liver and muscles as glycogen, which the body uses for energy. This is what our bodies normally do on a regular basis. For a person with diabetes, that medium is basically defective, leaving the body with an increased level of blood glucose. Types of diabetics There are three types of diabetes plaguing the world – type 1 diabetes, type 2 diabetes and gestational diabetes. Type 1 diabetes Type 1 diabetes is an autoimmune disease. A person with this disease has his body’s immune system destroying the insulin-producing beta cells in his pancreas. There is no preventable measure to stop the body from naturally killing the beta cells. Most type 1 diabetics are
Symptoms to watch out for Diabetes can exist in a person without him or her even knowing it, at least not until major complications arise. Typical symptoms of diabetes may seem harmless and tend to be overlooked. It is important for someone with at least three symptoms at any one time to get checked as soon as possible, as serious health complications resulting from diabetes can be avoided with early detection.
sources like muscle tissue and fat when glucose cannot be processed properly. Seeking energy from fat and muscle tissue results in the body feeling more tired and irritable. Type 2 diabetes symptoms Those with type 2 diabetes develop all the symptoms of type 1, as well as the following symptoms: Blurred vision Other than muscle tissue and fat, there are times when the body will pull tissue from your eye lenses to be used as energy. This will affect your eye’s ability to focus. There are severe cases in which blindness and prolonged vision problems can occur. This condition can be treated with proper treatment.
Type 1 diabetes symptoms Frequent urination When there is too much glucose in the blood, you will urinate more often than before. This is because the kidneys cannot filter the glucose properly. This results in the kidney taking water from your blood to dilute the glucose, which in turn fills up your bladder more frequently. It will also make you feel dehydrated more than usual. Intense hunger The inability to properly absorb energy from food will make your body yearn for more food – which is the prominent source of energy for us. The intense hunger may
Type 2 diabetes is a disease resulting from a specific lifestyle. Overweightness and a sedentary lifestyle heighten the risk of having the disease. then lead to weight gain. Unusual weight loss Even though hunger and weight
gain are common symptoms of diabetes, sudden weight loss may be a sign too. This happens more commonly for type 1 diabetes due to it developing suddenly compared to the more gradual type 2 diabetes. The body will seek other energy
Cuts and bruises healing more slowly and improperly A high level of glucose in the blood will affect the skin’s ability to heal efficiently, which can then contribute to infections via unhealed cuts and bruises. Women who are diabetic will find it difficult to recover from bladder and vaginal infections. An unusually itchy skin
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2016 | january
The majority of people with type 2 diabetes are either overweight or obese during onset. of normal weight and are otherwise healthy during onset. Type 1 diabetes occurs more sudden in a person as opposed to type 2, and is most commonly detected in children and young adults. Type 2 diabetes Type 2 diabetes is the most common. Also knows as diabetes mellitus, it will usually manifest gradually as we age. Unhealthy and sedentary lifestyle contributes to its development. People with the disease develop insulin resistance, which means body cells are resistant to insulin and cannot use it effectively. The lower level of acceptance towards insulin will increase the level of glucose in the blood. The resistance to insulin will then result in the pancreas producing extra insulin. Over time, however, the pancreas will not be able to keep up and the body will not be able to produce any insulin at all. The majority of people with type 2 diabetes are either overweight or obese during onset. Type 2 diabetes is what currently makes diabetes the number one killer disease. Some 90% of adults with diabetes are diagnosed with type 2 which gradually develops in the human body over time and with an unhealthy lifestyle, can appear earlier in life.
Type 1 diabetes is an autoimmune disease normally detected in children and young adults. may also be connected to this symptom. Swollen and reddish gums A person suspected of having diabetes may have swollen gums that pull away from the teeth. The colour of the gums might turn a more reddish colour. Such symptoms will then escalate to more serious conditions such as gum infections. Sexual dysfunction among men A person over 50 with frequent or constant sexual dysfunction (erectile dysfunction) could be having diabetes. Numbness or tingling of hands and feet When there is too much sugar in the body, your nerves and the tiny blood vessels feeding them could be damaged. Hence the feeling of numbness or tingling in the hands or feet might be a symptom of diabetes.
On a mission to spread the word Dr Pall Singh’s deep passion is to raise awareness about diabetic retinopathy
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By Norman Hussaini
r Pall Singh’s deep passion to raise awareness about diabetic retinopathy (DR) was clearly evident and inspiring when Health+ met up with him recently. The senior ophthalmologist, a pioneer of eye treatment in Malaysia, started his medical practice in 1977. Despite being busy with his practice, he still had time to be actively involved in various societies over the years, and at one time held the title of ophthalmologist president under the Academy of Medicine. Dr Pall, a consultant ophthalmologist at the Tun Hussein Onn Eye Hospital in Petaling Jaya, attributes his strong opinions on DR to his passion as an ophthalmologist, “Most of my patients over the years knew about the condition only after their vision had already been affected. By then it would already be necessary for me to treat them with laser treatment or worse, vitrectomy,” he says. DR, a condition occurring in people with diabetes, causes progressive damage to the retina, the light sensitive lining at the back of the eye. It is a serious complication of diabetes affecting the vision. Diabetes is prevalent in Malaysia and Dr Pall wants to raise awareness among the public, specifically among diabetics, about the dangers of the disease. He says DR develops in phases, and a diabetic patient is unable to notice the condition at the early stage. How DR develops “Diabetes affects blood vessels throughout the body and the eyes are no exception. What happens during the earlier stage of DR is that the blood vessels in the eyes form microaneurysms. This stage is known as non-proliferative DR,” says Dr Pall. Microaneurysms, he says, will in turn cause leakage in the patient’s eyes. Formation of microaneurysms is the
EDUCATOR FIRST: Dr Pall is deeply passionate about spreading awareness about eye diseases. hallmark of DR, and should be a red flag indicating a person has the possibility to become blind because of diabetes. A non-proliferative DR can then develop into the more severe proliferative DR. “The next stage is the formation of new blood vessels to compensate the leakage caused by the microaneurysms. It is actually a healing process, but unfortunately, the new blood vessels formed are very delicate which in turn cause haemorrhage or bleeding.” This, he says, is when the condition starts to affect the vision. “Besides the leaking of blood vessels, another factor contributing to blindness is the formation of fat deposits, especially if they form on the eyes.”
GRATEFUL: Chong considers himself fortunate to be treated by Dr Pall. Treatment Treatment for the condition is possible and this can improve the vision even when a patient has lost much of it. “At the earlier stage, there is a treatment which involves the use of injections to get rid of the fat deposits and reduce the microaneurysms. The injections do not leave scars and
are safer than laser treatment.” For a long time, the standard practice to treat DR involved laser treatment. However, injections are now used as they leave fewer side effects such as scarring. “Injections are also being implemented to prevent new vessels from forming,” explains Dr Pall. However, he says injection and laser treatment cannot be used to treat a diabetic with severe proliferative DR where blood clots have formed. “At this stage, we need to remove the blood clots. The treatment is called vitrectomy and it is considered a major operation,” says Dr Pall. Awareness is important Health+ also met up with Dr Pall’s patient, Chong Tan Yong, the same day he underwent vitrectomy surgery. “I was lucky to see Dr Pall. As a diabetes patient, my usual doctor didn’t even check my eyes although I was slowly losing my vision,” Chong says. The fact that Chong’s previous doctor did not check his eyes knowing he is diabetic only shows that the awareness about DR is still lacking. To raise public awareness, the Asean Association of Eye Hospitals recently launched a movement called “Prevent Diabetic Blindness”. Dr Pall, a member of the association, encourages patients and doctors to find out more about the condition and to take preventive measures early. “If you have diabetes, go and see an eye doctor and have your vision checked. Diabetes affects us in more ways than we usually know.”
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january | 2016
type 1 diabetic has been challenging, especially returning to school. “Going to school was a bad experience for me. I faced stigma and negative judgements from schoolmates and even the headmistress. It made life much harder,” she recalls. Moreover, her experience managing her condition in her teenage and college years was very difficult as she constantly battled with high and low sugar levels. “An individual’s blood sugar level is influenced not only by carbohydrate intake and insulin dosage, but also important factors such as hormones, stress levels and exercise.” Greatest challenge Her greatest challenge is perhaps her apparent limitation to do what she loves. “My passion has always been running, but being active and a diabetic is not a good match. I experienced multiple episode of severe hypoglycemia (low blood sugar) during and a few hours after my run.” On whether her life would be different if she never had diabetes, Yoshitaa says as a matter of fact: “My life would have definitely been very different without diabetes, but I’m not sure if I necessarily prefer it to be that way. Being diagnosed with diabetes at the tender age of 13 has made me the independent person I am today.” Her challenge with insulin injections was somewhat eased after she decided to switch to an insulin pump. The pump has made her more confident overall and is indeed a blessing. “The pump is an amazing technology which makes managing my blood glucose much easier. The precision it delivers has helped me to go for runs with lesser episodes of hypoglycemia.”
Living strong with diabetes Medical student Yoshitaa Jayabalan perseveres despite life’s limitations
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By Norman Hussaini
aving diabetes is definitely not a death sentence. Life still goes on, and Yoshitaa Jayabalan can confidently testify to that. Her resolute outlook on life is what keeps her going all these years living with type 1 diabetes. “Diabetes is a manageable condition. You are able to control the outcome of your disease, so why let it control you? Allow yourself to grow as you are more than just a diabetic, and never be ashamed of it,” she tells Health+ in a recent interview. The 22-year-old medical student, who is doing her final-year clinical training in Hospital Sibu, Sarawak, has diabetes but she strives on despite her limitations. She was diagnosed with the disease at the age of 13. She
remembered having typical diabetes symptoms like excessive thirst, frequent urination, fatigue and hunger a week before she was diagnosed. “I was quickly rushed to the emergency department of Hospital Tengku Ampuan Rahimah, Klang where I was acutely treated and admitted to the medical ward for a week following my diagnosis. My life took a whole new turn after that,” says Yoshitaa. Her family, she says, plays a key role in her journey as a type 1 diabetic. “My family was initially shocked but quickly got on board and has been there every step of the way. I would not be where I am today without my family.” Post-diagnosis, she had to learn how to manage her condition with daily insulin pen injections and a specific diet. “A couple of years into my diagnosis, two daily injections were not sufficient so I had to take four daily subcutaneous injections (three rapid-acting insulin and one slowacting insulin).” “Being diagnosed with diabetes also came with certain diet restrictions,” she adds. “However, it does not mean a diet without
Diabetes is a manageable condition. You are able to control the outcome of your disease, so why let it control you?”
RUNNING PROWESS: Type 1 diabetes doesn’t stop Yoshitaa from enjoying food, studying to become a doctor, and her passion for running.
ice cream or chocolates. It means having to count my carbohydrate intake and give sufficient amount of insulin to match. “A few years into life with type 1 diabetes, I learned a lot about Malaysian food and my body – how my blood glucose levels respond to stress, exhaustion and adrenaline rushes.” Yoshitaa’s experience as a
promoting awareness She now enjoys playing her small part promoting awareness on diabetes among fellow Malaysians. “Eight years into living with diabetes, I have realised that the only reason I received judgmental comments from others was because society lacked awareness. Ever since then, it has been my passion to spread awareness as well as to reach out to other kids with type 1 diabetes.” Yoshitaa aspires to be an endocrinologist, which she says was fuelled by her hardship in building close bonds with other doctors. “I love to communicate, educate and help patients as much as I can. As a diabetic myself, I have a very close relationship with the condition and I can share what I know with other patients.” Her concluding remarks were nothing short of being philosophical: “Diabetes is a manageable condition. You are able to control the outcome of your disease, so why let it control you? Allow yourself to grow as you are more than just a diabetic, and never be ashamed of it.”
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2016 | january
Being diagnosed with diabetes will also bring along other complications. My blood pressure is at an unhealthy level now, not severe though.” does not completely depend on them.
Be happy, don’t worry Suriyati stays positive despite living with disease for nine years, and counting
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By Norman Hussaini
iabetes is probably one of the most common conditions everywhere, affecting more than 2.6 million adults 18 years and older in Malaysia alone, according to the Malaysian Diabetes Association. Health+ chatted with one positive individual who has been living with diabetes for nine years, and counting. Suriyati Mohd Nor has been working as an officer with Sime Darby Property for 22 years. The 44-year-old mother lives a mostly comfortable life working in her office at Oasis Square, Ara Damansara in Petaling Jaya. Suriyati discovered she has diabetes in 2006 after undergoing several tests conducted by a doctor. “I noticed my usual routine somehow changed a bit when I kept waking up in the middle of the night to go to the toilet two to three times. I was also feeling tired
a lot more, thirsty almost all the time, and found that ants started swarming the toilet bowl a few minutes after urination.” Suriyati recalls. She recognised these as common symptoms of diabetes, so she went to a clinic to check for diabetes. After a definitive HB1C test, she was confirmed to have type 2 diabetes. “My initial reaction was of nothing but regret, like how I imagine anyone in my shoes would feel.” The feeling of ‘why me’ persisted over the next few days. The regret was followed by looking at my past, and I saw how unhealthy my eating habits were,” she says. “I used to eat junk food very late at night and sleep right after. French fries and coke were my favourites.” In addition, she says not taking her mother’s advice was probably what fuelled the aggravation of her diabetic condition. Managing her condition Yet it did not take long for Suriyati to get over her regret and instead start managing her life. “I think I am lucky because I am managing my diabetes with only medications.
STAYING POSITIVE: Suriyati is looking at the lighter side of life despite her condition.
I only had to take insulin shots when I was pregnant. I stopped and continued with my meds right after my child’s birth,” she says. However, due to the multiple tablets and pills she is now taking, she has to go for medical check-ups twice a year to see whether her meds are affecting her kidneys. “I also check my blood sugar levels and my cholesterol levels,” she adds. Probably the most important thing to practise when you are diabetic is, of course, to watch what you eat. “My daily diet changed after developing diabetes. I still indulge in roti canai and nasi lemak for breakfast sometimes, and lunch will also consist of white rice with protein and vegetables. However, my portion size has decreased a lot.” Her dinner is always light, either a sandwich or a few cream crackers. She also incorporates alternative foods in her diet as well. She takes honey, olive oil and Nigella sativa, a popular alternative treatment for diabetes. However, she
The challenges “Being diagnosed with diabetes will also bring along other complications. My blood pressure is at an unhealthy level now, not severe though,” says Suriyati. Her greatest challenge as a diabetic is her habit of eating during pressured times. “I believe eating while you are under stress is common, and I find it hard to control myself from eating a lot.” She does keep her eating habits under control as she finds things to do to avoid stress eating. Accepting her situation Her perseverance to continue living a happy life is a result of how she has accepted her condition. “My initial reaction waned away after so many years and I feel I can live a normal life now, with only a few limitations.” The limitations, she says, involve physical activities which she does more cautiously. “I know any cuts or bruises I get can never heal properly, and they could result in severe consequences. So I try not to do any strenuous activity as much as I want to.” Despites being diabetic, Suriyati still manages her condition relatively well because she believes diabetes is not the end of a happy life. “Once you know how you can keep it under control, life is just as wholesome and happy,” she enthuses.
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january | 2016
PHOTO BY AFIQ NOR/Health+
All for the love of a son Mother’s care for her nine-year-old diabetic child knows no bounds
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an Jia Kai was only four years old when he was diagnosed with type 1 diabetes. His mother, Tee Siew Lee, has been managing his condition for five years now. Health+ met up with Siew Lee and Jia Kai – now nine – at Sunway Pyramid to talk about how she takes care of her diabetic son, the challenges they face, and the life he leads as a type 1 diabetic. To start with, talking to Jia Kai is indeed a challenge as he is very shy and soft spoken. He is the second child of four brothers, living with his family in Kemuning Greenhills in Shah Alam. Siew Lee is very busy, overseeing the HR department of Sunway Theme Parks as a director. In 2010, Jia Kai was diagnosed with type 1 diabetes, an autoimmune disease usually diagnosed in children and young adults. Siew Lee initially thought that Jia Kai was acting a little out of place after her mother told her. “My mother was the one who took care of him at home when I was working, and it was fortunate she noticed Jia Kai was always thirsty and exhausted – more than usual,” she recalls. Siew Lee also noticed Jia Kai visited the toilet a lot more than usual, especially at night. She had heard about the symptoms of diabetes and decided to bring him to a doctor to have him checked. He was diagnosed with diabetes on his fourth birthday. “I wasn’t too familiar with diabetes, having no family members with the condition. So it was the
right move on my part to take action then,” she says. pERCEPTION As a medical condition, it is natural for some people to have a certain perception towards type 1 diabetics, and it would be a lie to say Jia Kai was never teased by his friends at school. “Sure, there were one or two of his schoolmates who teased him because of his condition, but there was never any serious bullying,” says Siew Lee. Most of the reactions towards him in school were of curiosity than anything else, she adds. On the challenges she faces in managing Jia Kai’s condition, Siew Lee says: “It was definitely a challenge. Managing him with insulin injections was especially tough. We had to control his eating habits, limiting him to enjoy eating
LOVE WITHOUT BOUNDARIES: Jia Kai and his mother Siew Lee go through life confidently.
SMALL BUT TOUGH: The insulin pump has greatly improved Jia Kai’s management of his condition since 2010. GLUCOSE CHECK: Checking blood sugar level
Yet, other than the injections, I guess the biggest challenge for him as a diabetic is that he is still a child. As a child, it’s really hard feeling he sometimes can’t eat what he wants straight away or do things his friends aredoing. He feels the condition limits him.” ice cream and cheesecake like any child would want.” The injections were definitely the main challenge for Jia Kai to go through. “He never complained, but I knew it was unpleasant for him,” she says proudly of her son. Jia Kai is bright and has learned to use the insulin injector on his own when he was five. He had to use the injector four times a day and it became painful after a while. “Yet, other than the injections, I guess the biggest challenge for him as a diabetic is that he is still a child. As a child, it’s really hard feeling he sometimes can’t eat what he wants straight away or do things his friends are doing. He feels the condition limits him,” she explains. Siew Lee decided to change the method Jia Kai took insulin after she discovered there was a more efficient way to administer it. Her solution was Medtronic’s insulin pump. “It was a relief for us after putting him on the pump. It eased the pain in our hearts seeing him
off the injections and it gives us more flexibility on his diet and lifestyle,” she says. The difference is obvious. Jia Kai has more freedom to eat whatever he feels like it, without having to worry about injecting himself first. “All he needs to do is press a few buttons and eat what he wants, and the pump does the rest,” Siew Lee says with relief in her voice. Despite his condition, Jia Kai is very active in recreational activities, especially swimming. “Jia Kai doesn’t have problems with physical activities. He can run around, play with friends and likes to swim a lot,” says Siew Lee. “Having Jia Kai and managing him is definitely a challenge. It would be smooth sailing for us if he never had diabetes, but we have never felt it was a burden. We are thankful for what we have and Jia Kai will continue to live a normal and fulfilling life,” she says with much hope with Jia Kai seated on her lap. – Norman Hussaini
• 07
2016 | january
PHOTO BY AFIQ NOR/Health+
BETTER SERVICES: The M Quit smoking services programme is the ministry’s effort to elevate and strengthen the services given to people wanting to quit their smoking habits, according to Aryana.
Snuffing out the smoking habit M Quit Smoking Services programme aims to strengthen quit smoking services
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By Norman Hussaini
eople have been smoking for more than a century, making the habit quite an acceptable – although often frowned upon – predisposition for everyone the world over. The new vaping trend in this country looks set to complicate the matter even more. In Malaysia, the success rate for smokers quitting as of 2014 was 21%. What seemed miniscule was actually quite an achievement for
the country, as the global success rate for quit smoking programmes stands at a measly 15%. By early 2016, the Health Ministry aims to strengthen existing quit smoking services and promote a healthier and disease-free lifestyle for all Malaysians. “With the establishment of the M Quit Services programme, we hope to elevate the ease of access to the services provided by the ministry,” Dr Nor Aryana Hassan, senior principal assistant director of the ministry’s noncommunicable disease division, tells Health+. The issue at hand when it comes to smokers trying to quit is that health clinics offering the
The National Tobacco Control Strategic Plan.
The MoU between the ministry and several organisations.
services are usually jam-packed with patients. The sight of long queues is often discouraging, which in turn snuffs out whatever desire smokers have to find help. The M Quit Services programme plans to broaden the services so that they can be offered not only at government health clinics but also pharmacies as well. This then begs the question: aren’t quit smoking programmes also offered in other private medical centres and clinics? EXTEND SERVICES Clarifying this, Aryana says: “We want to extend the services that are approved by the ministry to other facilities besides our health clinics.” The ministry’s standards for quit smoking programme is taken from the UK National Health Services’ quit smoking model. “The way the M Quit programme works is that we will provide training to participating pharmacies or clinics to be well versed in the standards we have set. They will then be accredited and given a plaque showing they are our partners and are offering quit smoking services approved by the ministry.” Aryana says the ministry is also reaching out to private hospitals and clinics to be a part of the programme in order to extend the services to more smokers. The programme aims to help those who want to quit smoking but are discouraged by long queues and long appointment periods. “We want people to be able to get help by just walking into a
pharmacy and signing up as a future non-smoker,” she says. However, the programme doesn’t stop at that. There are also plans to establish a Quit Line system where people who have signed up will receive counselling and coaching over the phone. “Our idea for the Quit Line system is similar to how an insurance company approaches customers. But instead of calling people to offer them insurance, our participating pharmacists or doctors will provide counselling and follow-ups to help people stay off cigarettes.” Aryana explains. MOUs The ministry has signed memoranda of understanding with several organisations, including University of Malaya, Universiti Sains Malaysia, Malaysian Pharmaceutical Academy and Johnson & Johnson Sdn Bhd in November. On the ministry’s take on vaping being perceived as a medium for people to quit smoking, Aryana says: “There has not been any indication that e-cigarettes are helping people to actually be free of nicotine addiction, as no available data is present.” The M Quit Services programme, developed since 2012, only came into fruition this year, and the ministry hopes to reduce nicotine addiction among Malaysians year by year. “With the help of these organisations, we plan to put M Quit in the forefront of quit smoking service programme in Malaysia. Our aim ultimately is to reduce the percentage of smokers in Malaysia to only 5% by 2045,” Aryana says. It now stands at 22.8%. The ministry is an active member of the WHO Framework Convention on Tobacco Control (FCTC), which has a five-year plan called the National Tobacco Control Strategic Plan, of which M Quit is a part of.
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january | 2016
Malaysia should ban e-cigs and liquids
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he Malaysian Council for Tobacco Control representing over 40 NGOs has recommended to the Ministry of Health that e-cigarettes and vaping be banned immediately. The Malaysian Medical Association (MMA) has also taken a similar stand along with several more NGOs. It is accepted worldwide that tobacco use is the single most preventable cause of death globally. The World Health Organisation (WHO) has reported its use had led to more than six million deaths annually worldwide. In Malaysia, we are facing a very big problem of tobacco use as 4.7 million Malaysians aged 15 years and above are smokers. The cost to individuals, families and tax payers runs into Billions of ringgit. We need everyone to help smokers quit and non-smokers not to start smoking. With regards to e-cigarettes and similar devices that are frequently marketed by manufacturers as aids to quit smoking or as healthier alternatives to tobacco, it is simply not true. There are currently very few facts on this issue as well as a lack of integrity. What is true is that the use of these electronic cigarettes continues to increase drastically and is being strongly promoted by the industry which is reaping millions
from the public. WHO reported there is insufficient evidence to conclude that e-cigarettes are helping users to quit smoking. It instead recommends that smokers should first be encouraged to quit by using a combination of alreadyapproved treatments. There are no quality standards for nicotine dose, frequency, contents and safety for these devices. In September 2015, an editorial in the CHEST Journal clearly concluded that the risk of electronic cigarettes exceeds potential benefit. The article concluded that there is no evidence that e-cigarettes are safe, while there is some evidence stating that they may in fact be harmful, both through introducing users to nicotine addiction and through direct effects on the lungs. The Centre for Environmental Health (CEH) reported on Sept 2, 2015 that it found high levels of cancer-causing chemicals in the majority of e-cigarettes tested. The CEH reported: “The majority of e-cigarettes and other vaping products tested produced high levels of the cancer-causing chemicals formaldehyde and acetaldehyde, in violation of California safety standards. The independent lab testing of products from two dozen e-cigarette makers found that 90% of the companies had at least one product that produced high levels
By Prof Dr Lekhraj Rampal
For decades, the tobacco industry mounted a campaign of lies about cigarettes, and now these same companies claim that their e-cigarettes are harmless. Anyone who thinks that vaping is harmless needs to know that our testing unequivocally shows that it’s not safe to vape.” – CEH executive of one or both chemicals, above director Michael the state’s safety limit. A test on one e-cigarette found the level of Green formaldehyde was more than 470 times higher than the California safety standard. In the article, CEH executive director Michael Green stated: “For decades, the tobacco industry mounted a campaign of lies about cigarettes, and now these same companies claim that their e-cigarettes are harmless. Anyone who thinks that vaping is harmless needs to know that our testing unequivocally shows that it’s not safe to vape”. LEGAL ACTION CEH has launched legal action to hold e-cigarette makers accountable for failing to warn consumers. Let us not jump to conclusions that vaping or e-cigarette is a safer alternative to smoking cigarettes. We should let the WHO come out with a directive. Our concern with e-cigarettes and vaping is that firstly, it may contain chemicals which will cause cancer or other diseases in later years. Secondly, it might introduce young, non-smokers to nicotine addiction or smoking. This has be shown to be true in studies carried out in the United States where one third of e-cig users were in fact non-smokers. The use of electronic cigarettes and vaping continues to increase drastically. If it is found 10 to 20 years later that the use of e-cigs causes cancer or other diseases, will the ones marketing these products pay compensation to consumers? If they die at age 40, who is going to take care of their wives and children?
Are e-cigarette producers and distributers willing to give an undertaking now? Yes or no? Everybody gets excited about some research that says it is safe. Who is funding this research? Is the industry funding it directly or indirectly, I simply do not know. Who is paying for the existing problem? And who is going to pay for the cost from the existing problem in the future, if it is found to be harmful? What I know is most of the treatment costs for lung cancer and other cancer patients in Malaysia is borne by tax payers and patients, NOT the industry. Millions will go down the drain with no health or quality of life benefit. We have a very serious problem brewing and the public need to become aware and take necessary action to stop this. In conclusion, the government should ban e-cigarettes, vaping and shisha. It is not a Malaysian culture. We should protect our younger generation and move towards a smoke-free generation. Prevention is always better than cure. A healthy nation is a wealthy nation. Prof Dr Lekhraj Rampal is a senior consultant epidemiologist at the Faculty of Medicine and Health Sciences, Universiti Putra Malaysia.
• 09
2016 | january
Vapour madness takes over The effect of e-cigarettes and vapes on users and others is still hotly debated the matter.
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By Norman Hussaini
aping has become a huge phenomenon in Malaysia as more and more users and shops emerge. Users are largely men but a growing number of women are into it as well. However, the vape as a less harmful “smoking” device still hotly debated. Health Minister Datuk Seri Dr S Subramaniam had warned the public in August that vaping can still cause harm and is just another method of smoking. “Smoking shisha, electronic cigarettes and vaping devices should be temporarily prohibited until the ministry has more information on the effects it may bring to the public,” he said. He had also discouraged the public from viewing vaping as fashionable as it may be in danger of spreading to underage teens as well. The global trend of vaping is at an all-time high as authority in general remains relatively silent on
The debate The debate on whether vapes are actually safe has a few evidence supporting both sides. The positive side of the debate is that when someone smokes a regular cigarette, a particular substance – which is tobacco – is burned and in turn releases nicotine. The burning process, however, will create various hazardous by-products such as tar which damages the lungs, heightening the risk of cancer. This is where vapes come into play. Instead of burning a substance, they vaporise a liquid – better known as e-liquid – containing nicotine and flavourings at a specific temperature where aerosol is produced and inhaled, creating the same feeling as smoking does. By vaporising the substance, tar is not produced, thereby causing less harm to the body. On the negative side of the debate, the e-liquid typically contains propylene glycol (PG), a substance used in smoke machines and is known to cause irritation of the eyes and respiratory infections,
TOP WORD: the word ‘vape’ was the Oxford Dictionaries word of the year in 2014, proving the prevalence of the device and the habit across the globe.
especially with prolonged exposure. Diacetyl, another potentially harmful compound found in e-liquids, is reported to cause constrictive bronchiolitis in the long term. Different flavourings containing various chemicals used for the liquids can also pose health danger to users. As the content of different liquids depends on different producers with very little regulations and standards, the danger may lie in the production of these e-liquids. The effects of these flavoured e-liquids to users are still being researched by scientists with limited findings. Findings have so far suggested the use of e-cigarettes does administer less carcinogenic substance to users, making it less dangerous than smoking. BBC News reported last year that vapes are orders of magnitude safer than smoking according to experts. These findings further support the positive side of the debate. However, less dangerous does not mean safe. A statement issued by the US Preventive Services Task Force reads: “As there are too many unknowns about e-cigarettes and vaporisers, it is hard to safely say they are an effective alternative to smoking.” These devices may also promote bad habit of vaping spreading to youth in the country. Professor Dr Lekhraj Rampal, a senior consultant epidemiologist at Universiti Putra Malaysia, says: “We are seeing a drastic increase in e-cigarette users among Malaysians now, with many non-smokers picking up the habit of vaping.” Dr Lekhraj, who chairs the Malaysian Medical Association’s
Action on Smoking and Health Committee, is strongly against the use of e-cigarettes and vaping, and urge Malaysians to curb the habit. “There are very little facts on the use of e-cigarettes as a way to quit smoking, while the device itself presents more risks than benefits,” he says. Regulate or ban? E-cigarette and vapes are still relatively new but people are already into the habit. There are very few regulations to oversee production of e-cigarettes and e-liquids, which may provide legitimate danger for users. The US Food and Drugs Administration is still in the works to regulate e-cigarettes, with no definite decision made. In conclusion, the effects of cigarettes are well documented as they been around for a very long time. Vapes, on the other hand, are still new, and there is just not enough time for researchers to study its effects, especially over prolonged exposure. We just have to wait and see what the future holds for these vapes and users.
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E-cigs with nicotine pose health risks Swapping traditional tobacco for vaporised nicotine is not a highway to healthier living, according to a new assessment report from the Norwegian Institute of Public Health whose goal is to explore the still relatively new trend of electronic cigarettes. While less harmful than
smoking tobacco, the vapour from e-cigs contains enough nicotine to harm bystanders as with secondhand tobacco smoke. E-cigs supply the same amount of nicotine as tobacco-based cigarettes and those who vape, as the expression goes, should expect the same health risks. – AFPRelaxnews
Vapes banned on planes SEPANG: Batter y -powered electronic smoking devices – or vape mods – are banned from airplanes. The Department of Civil Aviation (DCA) says the ban was made after an incident in October where the battery of a vaporiser caught fire during a Malindo flight from Kota Kinabalu to Kuala Lumpur. On that fateful day, the relationship between airplanes and vaporisers ceased to exist. Malaysia Airports Holdings Bhd (MAHB) says the company is aware of the International Civil Aviation Organisation ruling which bans electronic cigarettes or vapes from being checked into the cargo. The device is, however, permitted to be carried on board as part of a passenger’s carry-on luggage. The guideline for passenger’s safety during flights includes: Passengers and cabin crew are prohibited from carrying
Vape shops raided, e-liquids with nicotine seized
P
UTRAJAYA: After the Health Ministry’s recent announcement that it would be confiscating e-liquids containing nicotine, a number of vape shops had already been raided. E-liquids – or vape juices as some call them – containing nicotine are recognised as products that can be sold by only a selected few. The regulation was set under the Poisons Act 1952 which classifies e-liquids as a Group C substance which can only be sold or prescribed by medical practitioners, registered dentists, veterinary officers or licensed pharmacists. The vape shops raided had their products containing nicotine confiscated for not adhering to the requirements. The raids were obviously met with resistance by some parties. Malaysian E-Vaporisers and Alternative Tobacco Association (MEVTA) president Allan Foo
reportedly said it was unfair for the government to raid stores on such short notice. “Many of the smaller businesses did not have a chance to offload their products. Many owners who were raided have completely lost their investments,” he was quoted as saying. Health Minister Datuk Seri Dr S Subramaniam told reporters on Nov 3 the raid was within the ministry’s powers and it can definitely take action against the sales of e-liquids with nicotine by unlicensed sellers. The move, he added, is to discourage vaping among Malaysians. It seems strange that e-liquids with nicotine are put under the Poisons Act, not the Food Act like tobacco. MEVTA strongly disagreed with the notion. However, the Food Act specifically defines tobacco products as part of regulated food products. That flavoured e-liquids fall under that category seems a little surprising, especially with nicotine added.
NO VAPING WHILE FLYING: Airplanes should add new indicator for the ‘no smoking’ signs in the cabin.
battery-powered portable electronic smoking devices, including electronic cigarettes, in checked-in baggage. Recharging of battery-powered portable electronic smoking devices is disallowed in aircraft cabins. Batteries shall be removed from electronic smoking devices and put in proper storage. “These instructions shall be complied with by airline operators, crew and passengers so as to avoid future incidences,” DCA directorgeneral Datuk Seri Azharuddin Abdul Rahman reportedly said. The recent incident happened right after take-off when the battery of an electronic vaporiser caught fire while stored in a passenger’s bag. A doctor on board treated the passenger and the fire was safely put out. The plane landed safely at klia2 as scheduled.
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Photo Caption for NO_A ban seems imminent (Edited by WW) IN VOGUE: Vaping is perceived more than just as a way to kick the smoking habit but something trendy.
Vapers see no harm in vaping
K
uala Selangor: Many vapers see no harm in vaping, which they consider as an alternative to smoking. “I see no harm in vaping as it is way less dangerous for your health than cigarettes,” Muhammad Izzul Afif Abd Hamid tells Health+. Muhammad Izzul Afif, 26, who manages a vape shop in Kuala Selangor, has been a vape user since 2012. He started using vapes as a way to “blow off steam”, rather than opting for cigarettes to do so. “I was looking for a better way to smoke because of the overall [negative] perception of smoking
TRENDY: Izzul explaining the device in his vape store in Kuala Selangor.
amongst my family and friends. So I decided to find an alternative,” he says. The main concern in using vapes is the lack of regulation in the production of e-liquids, which can pose a danger to public health. Izzul’s vape shop has a steady supply of e-liquids with the good demand from daily customers. And that begs the question: Are there any guidelines for brewers producing e-liquids. According to Izzul, brewers do follow a set of guidelines when brewing their e-liquids. “Brewers follow a certain rule where the amount of propylene glycol/
Ban in KL seems imminent Following the recent move by Johor and Kelantan to ban vaping, the Kuala Lumpur City Hall (DBKL) will probably be next to do so. DBKL director Ibrahim Yussof had said on Dec 18 that DBKL will no longer accept applications for licences from vape traders in Kuala Lumpur. However, existing vape stores have yet to face
any action from the authorities. Ibrahim said DBKL is still discussing the matter. Meanwhile, Johor is expected to implement the ban on Jan 1, with all vape stores in the state closed by then. Kelantan, on the other hand, has given 350 vape traders in the state 14 days from Dec 16 last year to cease operations.
It looks like the future of vape devices and users is all but bright. It is understood a request by the Malaysian Organisation of Vape Entities (MOVE) and the Malaysian E-Vaporisers and Tobacco Alternative Association (MEVTA) to properly regulate the use of vapes similar to cigarettes has yet to be considered by the Health Ministry.
Vaporisers emit vapour, which is harmless to the environment compared with cigarette smoke. We are presenting vapes as part of the ‘go green lifestyle’.”
vegetable glycerin, nicotine, colouring and flavouring should be consistent and do not exceed the guideline,” he says. The guideline is set by the American E-liquid Manufacturing Standards Association (AEMSA). “Cigarettes emit harmful chemicals and can be hazardous to users and non-users alike. We think vapes with nicotine are no different from nicotine patches or pills that smokers get from doctors to curb their smoking habit,” says Izzul. “Vaporisers emit vapour, which is harmless to the environment compared with cigarette smoke. We are presenting vapes as part of the ‘go green lifestyle’.” By venturing into the vaping business, Izzul knew he was running afoul of the Health Ministry’s ruling against vaping. The ruling, which places e-liquids under the Poisons Act, is affecting not just his business,
but also vape users too. “The ruling against vaping has left the public somewhat scared of the devices now. Some of the people I know have gone back to cigarettes after hearing about it,” he says. Vapes and their users generally have somewhat tarnished their own reputation by vaping opening in enclosed places. Some feel vapes are cigarettes so they can be used indoors and in crowded places. So, what is Izzul’s opinion on this? “I think vaping is still inappropriate in public places like shopping malls as the amount of vapour released from vapes is considerably greater than smoke from cigarettes. It may irritate others around you,” he says. He advises vape users to be respectful of others and to vape only in suitable places.
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Man-made infertility on the rise
G
wen was 32 when she married Ben. Ever y thing then revolved around just both of them. Starting a family was furthest from her mind. Ascending the corporate ladder was the proximate goal and so was time together. It was only three years later, after having achieved their career goals, did they decide it was time for the pitter patter of little feet in their home. But little did they realise it was going to be a struggle. After two years of trying and already at 37, Gwen was feeling the pressure of time working against her. Only then did they decide to seek professional help. Gwen was having the problem of infertility, as defined by the World Health Organisation as “the inability of a sexually active, noncontracepting couple to achieve pregnancy in one year”. One in six couples in Malaysia faces infertility. The infertility rate is estimated at about 10-15%
By Dr A Baskaran
OPINION
Prostate health and prevention By Assoc Prof Dr Christopher CK Ho What is the prostate? The prostate is part of a man’s reproductive system. It is located in front of the rectum and under the bladder. The prostate surrounds the urethra, the tube through which urine flows. A healthy prostate is about the size of a walnut. The prostate is a gland and makes part of the seminal fluid. During orgasm, the seminal fluid helps carry sperm out of the man’s body as part of semen. Potential problems in the prostate The prostate can get infected or inflamed, and this is known as prostatitis. Besides that, if the prostate grows too large (benign prostatic hyperplasia), it squeezes the urethra. This may slow or
may compress the urethra which is the pathway for urine to exit the body. This makes it difficult for urine to come out. Therefore, the urine flow will be slow and it will take a longer time to empty the bladder. Sometimes, the resistance is too great, so much so that the man is unable to empty the bladder totally. This will result in residual urine remaining in the bladder. With residual urine remaining, the bladder gets filled up rather quickly and this can cause the person to go to the toilet frequently. To overcome the resistance of the prostate, the man may need to strain to urinate. This build-up of pressure in the bladder may backtrack and cause swelling of the kidneys (hydronephrosis) and in the end, damage the kidneys. In addition to that, enlargement of the prostate may also cause blood in the urine due to bleeding and also stone to form in the bladder.
stop the normal flow of urine. The prostate may also undergo changes and turn into cancer. Benign prostate hyperplasia (BPH) The cause of benign prostatic hyperplasia (BPH) is not well understood; however, it occurs mainly in older men. BPH does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to ageing and the testicles may cause BPH. Dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth, is believed to cause BPH. Therefore, as long men have testes and produce DHT, the prostate will continue to grow and eventually lead to BPH. Problems of prostate enlargement When the prostate is enlarged, a lot of problems may occur. The enlargement of the prostate
of the population, which is over 300,000 Malaysians. Fertility is closely associated with age. For females, fertility reduces after 30 by half in a female aged 35 compared to one who is 31; and by another half when a
Studies have consistently shown that when men have BPH, there is a higher risk of them having diabetes, hypertension, cholesterol and obesity.
woman reaches 38. After that age, fertility drops acutely. However, for male, the reduction is not as marked – it is greatly reduced only after the age of 70. Factors affecting fertility Many factors can possibly affect fertility such as environmental factors like pollution, negative habits like smoking, physical activities, genetic factors as well as diseases. Problems in fertility are not confined solely to the female. Male factors such as problems with sperm production and function account for about 30% of infertility. Obstruction of the male reproductive tract is another possibility. Female factors related to ovulation account for 30% of infertility; combined factors account for 10%; while 30% remain unexplained. Other problems could be obstruction of the fallopian tubes or uterine, cervical or coital problems. Polycystic ovary disease usually affects females from 15-30 years of age. Treatments In about 30% of infertile couples who have undergone physical examination and the usual investigations for infertility, no cause for the infertility may be found due to very subtle or present time unknown causes. Far more can be done and much more cost effective
correlation between symptoms of BPH and erectile dysfunction (ED). As the severity of symptoms of BPH increases, the prevalence of ED increases as well. Therefore, BPH is a marker of ED, thus enabling men to seek early diagnosis and treatment of ED. Metabolic syndrome Metabolic syndrome consists of diabetes, hypertension, cholesterol and obesity. Studies have consistently shown that when men have BPH, there is higher risk of them having diabetes, hypertension, cholesterol and obesity. In fact, a local study done in Subang, Selangor has also shown higher risk of heart problems in those with BPH.
BPH linked to other diseases What many people do not realise is that BPH is not just a single disease on its own. It may co-exist with a package of other problems and diseases that may be detrimental to health.
Quality of life Men with BPH have been shown to have lower quality of life, be it in terms of physical, emotional, social, mental or general health. Besides that, the quality of their wives’ lives is also affected, especially sleep, as they are awakened at night by their husbands needing to go frequently to the toilet. The lifespan of men with BPH is also shorter compared to those without BPH, leading to increased mortality.
Erectile dysfunction Studies have shown a strong
Is BPH preventable? The association between BPH and
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through prevention. This can be achieved by getting education on sexuality and fertility, getting rid of promiscuity and sexually transmitted diseases, not postponing having a child, practising good habits such as avoiding smoking, unnecessary stress, having regular exercise and seeking appropriate treatment for medical conditions. Couples should start to seek help if they are more than 30 years old, after a year of trying or whenever they are concerned they may have difficulties in conceiving. The general rule of the thumb is to seek help early. Treatment for infertility must be done in an orderly fashion. Often, some undergo years of treatment before proper investigations and evaluation. Empirical treatment may be tried for a short period of time, but never over prolonged periods. This treatment may be wasted if there has been a definite disease process causing the infertility, requiring specific therapy. Some couples may opt to jump several steps and subject themselves to expensive assisted conception techniques and their complications, while all that may be required is a simple conventional treatment. There are others who subject themselves to years of conventional therapy when they should have undergone assisted conception technique earlier.
Very frequently, treatment for infertility is directed at enhancing ovulation. This is often the first form of therapy. However, after the necessary investigations, treatment should initially be directed at the cause. If the wife is found to have moderate or severe endometriosis on laparoscopy, she should have the appropriate treatment, medical, and or surgical, first. If the husband is found to have a varicocoele, which is responsible for poor sperm count and function, he should have the necessary surgery. Treatment of the cause would often be directed at promoting ovulation, as failure of ovulation is an key cause of infertility. Several medications are available to promote ovulation, either given orally or by injections. If the husband is found to have poor sperm count, the semen analysis would generally be repeated. He should have a more thorough physical examination and his blood taken to analyse the hormones involved in the production of sperms. Assisted reproductive techniques are employed to improve the chances of contact between the eggs and the sperms. Some techniques improve the chances of implantation of the fertilised egg inside the uterus. There are many such techniques employed, and the common and important
Physical activity In the Massachusetts Male Ageing Study, men reported 50% fewer symptoms of BPH when they indulged in the highest level of exercise. Another Korean study also showed a reduction of 52% in the symptoms of BPH when men regularly exercise. Alcohol For non-Muslims, moderate amounts of alcohol – no more than two small glasses of wine, half pint of beer or thee single shots of spirits – have been shown to reduce the urinary symptoms by about 40%.
Note: Names mentioned in this article have been changed to protect the patients’ real identities. Dr A Baskaran is a consultant obstetrician and gynaecologist at Manipal Hospitals Klang.
Smoking There are many studies showing that smoking increases the risk of BPH and therefore it goes without saying that one should stop smoking, not only for prostate health but for general health.
metabolic syndrome presents a golden opportunity for us to address this problem. Lifestyle modifications have been shown to reduce the risk of prostate enlargement. Diet Studies conducted by Harvard University, US and in Italy have shown that high energy diet rich in carbohydrate, fat and protein is linked with BPH. Men can lower the risk if they frequently eat food like peas, beans, lentils, cooked vegetables, fruits as well as food rich in polyunsaturated fats and omega-6 linoleic acid such as vegetable oils, nuts, seeds and fish.
ones are: Intrauterine Insemination of Sperms (IUI) In-vitro Fertilisation and Embryo Transfer (IVF-ET) Intrac y toplasmic Sper m Innoculation (ICSI)
In general, men with BPH should exercise regularly, consume a balanced diet rich in vegetables and fruits, and maintain healthy weight, with the aim of preventing or reversing all the metabolic syndrome parameters.”
Weight reduction Maintaining an ideal body weight is essential as it is associated with the metabolic syndrome and BPH. Again this can be achieved through regular exercise and diet. Better quality of life BPH is associated with a myriad of other diseases and presents an opportunity for early detection, treatment and prevention of the metabolic syndrome. Men with BPH should seek proper treatment to have a better quality of life and live longer. Health screening is therefore essential. In general, men with BPH should exercise regularly, consume a balanced diet rich in vegetables and fruits, and maintain healthy weight, with the aim of preventing or reversing all the metabolic syndrome parameters. Associate Prof Dr Christopher CK Ho is a consultant urologist at UKM Specialist Centre and Beacon International Specialist Centre.
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PHOTO BY NORMAN HUSSAINI/Health+
rulselvam Arulampalam was an athlete, active in multiple sports such as hockey, rugby, cricket and golf. Despite having asthma, he is certainly staying strong and excelling in sports. He is very healthy and works as a technical assistant specialising in hydrology. And he is also a prostate cancer survivor, and that makes his life journey even more incredible. Arulselvam, or just Arul as he likes to be called, is no longer a young man. Turning 84 this year, he has many life experiences. With a high-intelligence profession in the past, a shelf stuffed with books and an engaging interview, talking to Arul simply reflects how sharp and aware he is despite his age. Arul was diagnosed with prostate cancer in 2010, although doctors had suspected it since 2005. “I went to a doctor at University Malaya Medical Centre (UMMC) and got tested for prostate cancer. After eight samples were taken, it was found all eight showed positive results,” he says. His initial reaction was devastating. “The first thing I thought when I had cancer was ‘Oh Lord,
my life is gone.’” He was prepared to give up everything – his work and his love for sports – and downgraded himself to simply be a couch potato. “I remembered that most of the time the TV was watching me as I usually fell asleep in front of it.” It was a very depressing period of Arul’s life. Thank God, the depression didn’t last. With support and motivation from his family, he sought treatment from the doctors at UMMC. “There were only two things I would not agree to for treatment of my cancer. Because I am asthmatic, surgery was a huge risk, so that option was out. The other thing that I didn’t agree to was chemotherapy treatment.” Arul’s reason for declining chemotherapy was he knew the treatment did not yield 100% guaranteed result. “I have read that chemotherapy may extend cancer patients’ lives by five to six years, but there are many who lived that long without it, so why bother?” Secondly, the thought of the severe side effects of chemotherapy made him reject the treatment. The doctor he consulted with then recommended him hormone injections and radiotherapy treatment. The rate his cancer came under control was surprising fast as his blood test reading came down from 19.8 ng/ml to 0.03 ng/ml after just five hormone injections.
survivors occupying a small classroom in the UMMC building. The support group is a place for cancer survivors to share their experiences and how they are coping with the disease. One participant still in the midst of cancer treatment was happy to share with
the group his experience so far. A great value of the support group was seen in the openness of each participant and the care they have for one another as a result of the disease. It was clear that each and every one of them was passionate in advocating prostate
A
A winner in life despite the Big C
FOREVER AFTER: Arul and Meena live a happy and healthy life together.
Arul survives prostate cancer and can now pretty much do what he wants
By Norman Hussaini
Supporting each other in tough times The famous English writer Charles Dickens once said: “No one is useless in this world who lightens the burden of others.” That’s a fitting saying indeed to describe the efforts of University Malaya’s Prostate Cancer Support Group. Started in 2014, the support group is a monthly gathering of prostate cancer survivors at the University Malaya Medical Centre (UMMC). The support group is led by veteran facilitator A Santhanam Dass, a prostate cancer survivor himself. He is a
PHOTO BY AFIQ NOR/Health+
pioneer in facilitating support groups for prostate cancer patients after becoming a victim. He started the first support group in 2003 as part of an effort by the National Cancer Society. He then went on to continue his advocacy in surviving prostate cancer by creating support groups in Subang Jaya Medical Centre and Hospital Kuala Lumpur. The UMMC support group is his latest. A strong individual with strong opinions, Dass leads the support group with grace and charisma, and is an inspiration to every participant. A recent session of the support group held on Nov 5 saw 15 cancer
SUPPORTIVE YET STRICT: Dass is the face of prostate cancer support across several medical centres in the Klang Valley.
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I gave up red meats completely first, and gradually stopped eating white meats and fish. I have been a strict vegetarian for a year now.” “The doctor told me to stop after five injections instead of the full six as I was getting better,” Arul says with a smile. The treatment, however, did have some side effects. “When you are being treated for prostate cancer, you lose all control of your bladder and bowel movement. When you feel like you need to go to the toilet, you need to go straight away. I had several accidents where I had to sacrifice a few pairs of trousers because I couldn’t get to a toilet fast enough,” Arul says jokingly. Another costly side effect was the dampening effect on his sexual life. “My wife and I have a mutual understanding on the matter and we have been happily married for 56 years, so all is well in that department.” When asked about the difference in terms of lifestyle before and after developing cancer, he says: “There hasn’t been much change. I can pretty much do what
I want now. I guess the only thing that has changed is the way I eat.” Arul has since turned vegetarian in an effort to eat healthier. “I gave up red meats completely first, and gradually stopped eating white meats and fish. I have been a strict vegetarian for a year now.” His wife, Meenambal Nagalingan, is the sole guardian for his healthy eating lifestyle. “She does everything for me. She is the one who is strict about what I eat, and I owe my life to her,” Arul says with much pride and gratitude. On his advice to prostate cancer patients, Arul has this simple but profound message: “Do not give up, and do not give in. Having support from family is very important, and you should always listen to your loved ones. Eating healthy also plays an important part in the road to recovery, and do not rely heavily on drugs. Stay active, embrace spirituality and just adopt a positive outlook in life.”
INSPIRATIONAL CANCER QUOTES “We must embrace pain and burn it as fuel for our journey.” – Kenji Miyazawa “Cancer is a word, not a sentence.” – John Diamon “Time is shortening. But every day that I challenge this cancer and survive is a victory for me.” – Ingrid Bergman “Cancer affects all of us, whether you’re a daughter, mother, sister, friend, coworker, doctor or patient.” –Jennifer Aniston “Some days there won’t be a song in your heart. Sing anyway.” – Emory Austin “There is no hope unmingled with fear, no fear unmingled with hope.” – Baruch Spinoza “Courage is not the absence of fear, but rather the judgment that something else is more important than fear.” – Ambrose Redmoon “We have two options, medically and emotionally: give up or fight like hell.” – Lance Armstrong “Strength is born in the deep silence of long-suffering hearts; not amidst joy.” – Felicia Hemans “When you come to the end of your rope, tie a knot and hang on.” – Franklin D Roosevelt “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at a time of challenge and controversy.” – Dr Martin Luther King Jr
cancer survival amongst them. A few laughs were shared among the men, a gripping story and motivation were given by Dass, and some stories of cancer treatments were told. Very little hesitation or coyness was seen in the participants. The support group ended
with some pizza and a cake. As a monthly support group, the cake is usually to celebrate the birthday boys of the month. The November session saw four birthday celebrations simultaneously – a pleasant ending to a pleasant afternoon.
JOINT DO: The two birthday boys with programme coordinator Dr Jasmine Lim and Dass (right), who also celebrated their birthdays.
“What does not kill us makes us stronger.” – Friedrich Nietzsche “Attitude is a little thing that makes a big difference.” – Winston Churchill
NOVEMBER | 2015 january | 2016
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