Author: Chit Ko Ko Oo

A Cancer Among Men

April 25, 2022 Return

WORDS HANNAH MAY-LEE WONG

Dr Hemanth Kumar Ramasamy

Consultant Urologist & Laparoscopic Surgeon

Following this month’s theme and focus on men’s health, Dr Hemanth delves deep into the topic of prostate cancer, one of the most common types of cancer in men.

The prostate, an organ found exclusively in men, is roughly the size of a walnut. It is a gland that produces seminal fluid, which protects, nourishes and helps transport sperm. “The prostate makes 30% of semen. These fluids are essential for the sperm to survive when it is being sent to the female vagina. It’s got lots a minerals and nutrients for the health and wellbeing of the sperm,” Dr Hemanth explains.

Although the prostate plays a vital role in male reproductive process, prostate cancer rates have been on the rise, and this is certainly an issue men should take note of. Dr Hemanth tells us more in detail.

How common is prostate cancer among men in Malaysia?

From a global perspective, prostate cancer rates are the lowest in South East Asia compared to the rest of the world. Prostate cancer is quite common in the UK, and very common in the US. It is also seen more frequently among the African and American black population.

“Prostate cancer has risen to become the 3rd most common cancer among men.”

In Malaysia, data from the 2007-2011 Malaysian National Cancer Registry Report showed that only six in 100,000 people developed prostate cancer, making it the 5th most common cancer among men at the time. It’s worth noting that in the past, there were fewer urologists, screening tools and overall less awareness on the disease. A recent study conducted by the Malaysian Prostate Cancer Study Group (M-CaP) in 2018, found that prostate cancer has risen to become the 3rd most common cancer among men, occurring in every 12 per 100,000. The breakdown of demographics showed that prostate cancer is most common among the Chinese population, followed by Malays.

Urologists deduce that some of the reasons for the rising numbers could be attributed to: men in Malaysia living longer lives, our shifting diets towards a more western palette (the exact reason for this is still unknown, however studies have shown that a western or meaty diet increases the risk of developing prostate cancer). For example, Japan is a country where prostate cancer incidences are very low. But when we look at the Japanese that have migrated to the US (especially those who are 2nd generation migrants), we notice that their incidences are higher than the Japanese men living in Japan. Therefore, prostate cancer risk could have lots to do with environmental factors.

What are the risk factors of prostate cancer?

The most common risk factor is age. 80% of prostate cancers are picked up after the age of 60, and prostate cancer in men below the age of 45 is rare.

Genetics could be a factor. Prostate cancer is more common in African Americans and Caucasians, and less common in the Asian population.

Family history is very important. If a man has a 1st degree relative who has prostate cancer (like dad or brother), his risk of developing prostate cancer may be higher, and familial prostate cancer tend to appear earlier.

What are the signs and symptoms of prostate cancer?

This depends on which stage of prostate cancer a man is in. In the early stages, there could be no signs and symptoms. Some cases of prostate cancers are accidentally picked up during routine screening tests.

Some men may get symptoms of the lower urinary tract such as: difficulty in passing urine, having a burning sensation during urination, going to the toilet more often, dribbling after urination and so on. These could be the early indications of prostate cancer, but most of the time, these symptoms are associated with benign prostate hyperplasia (BPH)—an enlarged prostate, which is much more common in Malaysia.

For those with late stage prostate cancer where metastasis has occurred, they may get symptoms mainly associated with the bones, as the bones are commonly where the prostate cancer first spreads to. Prostate cancer lesions in the bone are very typical—they’re called sclerotic lesions and can be picked up relatively easily.

How often should men get their prostate checked? What are the tests available?

With the rising awareness of prostate cancer, screening is becoming more common. Usually, screening can be done in men who are above 50. Patients who have relatives with prostate cancer can opt to do screenings from as young as 45.

Screening is done via a prostate- specific antigen (PSA) test and rectal examination. When a screening programme is carried out, a couple of other tests are usually included, namely: the urine test, ultrasound and uroflow (to test urine flow for possible obstructions). Urologists also would take a detailed clinical history and may ask the patient to complete the International Prostate Symptom Score (IPSS) questionnaire.

What are the treatment options for prostate cancer?

A patient’s treatment plan would depend on several different factors including the patient’s age, the aggressiveness of his cancer and whether the cancer has spread. A trans-rectal ultrasound biopsy is usually done if the possibility of prostate cancer is picked up by a PSA test or rectal examination. It involves using a specialized probe which is put through the rectum, and biopsy samples may be taken through a needle. Small cuts of samples are taken from 12 different areas of the prostate, and these are sent to a pathologist for determining the aggressiveness (grade) of the cancer cells. Several other scans, such as bone scans, MRI or CT scans may be used to determine if the cancer has spread beyond the prostate.

Surveillance

For low-risk patients, doctors can offer patients active surveillance. Treating too early may result in complications of treatment such as erectile dysfunction, incontinence, issues with passing urine, blood in the urine, etc. That’s why for patients in this category, doctors may try to delay treatment as much as possible. During active surveillance, the patient sees his doctors every 3 months for follow-up rectal examinations and blood tests. Every 1 year to 18 months, a urologist may perform another biopsy to monitor the cancer’s progress. If signs show that the cancer is progressing, the patient may opt for treatment.

Watchful waiting is another option, for patients with a less aggressive cancer or for those who are advanced in age.

Radiotherapy & Surgery

For intermediate and high-risk patients, definitive treatment options such as radiotherapy or surgery are available. Radiotherapy can be divided into external beam radiation and brachytherapy. With external beam radiation, radiation comes from outside the body and is directed to the prostate cancer. With brachytherapy (there’s a certain criteria for patients who are suited for it), radioactive seeds are placed into the prostate, and these seeds deliver low doses of radiation over time to kill cancer cells. The surgical option is called a radical prostatectomy. It can be done as open surgery or via robotic prostatic surgery.

Hormonal Therapy

For patients who have locally invasive and metastatic disease, they can consider hormonal therapy. Prostate cancer is fuelled by testosterone, and hormonal therapy is used to cut down testosterone levels in the body—in doing so, cancer cells may die off. Sometimes, hormonal therapy may be given to those with locally invasive disease, to shrink the tumour first, before going for radical surgery. If the newer hormonal therapies don’t work for patients with metastatic disease, they can choose to go for chemotherapy.

In summary, patients should work with their doctors to choose a treatment plan most suited to their condition. HT

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Oral Piercing: A New Fad in Body Piercing

April 25, 2022 Return

WORDS DR ANDREW CHAN KIENG HOCK

Consultant Oral Surgeon

Private Dental Practice Klang, Selangor.

Body piercing, including oral piercing, is a form of body art or self-expression with similarities to body tattooing. By definition, body piercing is the practice of puncturing or cutting a part of the human body, in which jewelry or implants can then be inserted. They are often physically visible but sometimes hidden, such as in the case of charm needles (susuk), which are embedded subdermally on the face. In this article, Dr Andrew Chan Kieng Hock discusses some of the more common side- effects due directly to oral piercings and steps that can be taken to minimize them.

The History of Body Piercing

Ample historical records indicated that this practice has been common since ancient times and is practiced by both sexes. The hardware can be metallic or non-metallic objects such as stainless steel, niobium, titanium, gold alloy, silver, bone, ivory, stone, horn or even synthetic materials like PMMA (polymethyl methacrylate) and PTFE (polytetrafluoroethylene).

The reasons for practicing body piercing are numerous. They include religious or spiritual aspects; to conform to a certain popular or tribal culture; for aesthetic value or body adornment; self-expression in making a fashion statement; eccentric lifestyle choices, and even for sexual pleasure.

The most common sites for body piercing are the ear lobes and the noses. Even though in this age of modernity the practice is rampant, some countries—including several states in the US as well as certain European countries—prohibit or ban such practices until the person is at least 16 or 18 years of age; otherwise, parental consent is required. Most state schools, churches, or corporate companies do not allow their members to openly exhibit or display their body piercings due to dress code violation.

Contrary to popular belief, any form of piercing including in the oral cavity is an invasive and risky surgical procedure. Dentists are seeing more and more cases of oral piercings which went wrong, resulting in serious complications.

As far as oral healthcare providers are concerned, oral piercings irrespective of site or materials are not harmless but often come with some side-effects, which most owners are ignorant about. These complications, which have been reported in scientific journals as well as personally encountered by practicing dentists, include:

Speech, swallowing, and chewing impairment
Tooth fracture and chipping as well as damage to fillings and dental prosthetics due to the knocking effect from the jewelry
Gingival trauma and recession
Profuse bleeding especially in the tongue region as the organ is highly vascularized (blood vessels)
Pain
Loss of taste
Risk of blood-borne infections such as HIV, hepatitis B and C, and tetanus due to contaminated equipment
Increased salivary flow resulting in uncontrolled drooling
Numbness due to nerve damage
Infection at the pierced site which in rare cases can lead to septicaemia and bacteria endocarditis. This is because the mouth is home to numerous microorganisms
Swelling which can compromise or obstruct the airway
Interference when taking X-ray
Foreign body reaction leading to keloid scarring
Allergic reactions to the material especially metal alloy with nickel elements.

What role can a dentist play?

If patients intend to perform oral piercing but have yet to do so, they must be advised against it by explaining all the possible side-effects. Nonetheless, in the event they insist on proceeding with the piercing, they should be advised to get the procedure done by a professional or trained body piercer in a piercing studio, which is kept in a clean and hygienic condition at all times, since it is an invasive and risky surgical procedure. The American Dental Association (ADA) lists very helpful guidelines to patients who have existing oral piercings.

List of guidelines from the American Dental Association (ADA) regarding oral piercings:

Contact a dentist or physician immediately if there are any signs of infection such as swelling, pain, fever, chills, shaking, or a red- streaked appearance around the site of the piercing.
Keep the piercing site clean and free of any matter that may collect on the jewelry by using a mouth rinse after every meal.
Try to avoid clicking the jewelry against teeth and avoid putting pressure on the piercing.
Be gentle and aware of the jewelry’s movement when talking and chewing.
Check the tightness of the jewelry periodically with clean hands. This can help prevent from swallowing or choking if the jewelry becomes dislodged.
When taking part in sports, remove the jewelry and protect the mouth with a mouthguard.
See a dentist regularly and remember to brush twice a day and floss daily.

Dentists need to stress to owners of piercings that they need to maintain good oral hygiene and keep up with their dental check-ups regularly. Oral piercings seem to be on an increasing trend as dentists encounter not only more but also younger patients with various forms of oral piercings. This type of body art is associated with real complications, which dentists should themselves be familiar with, so that they in turn can educate patients professionally and appropriately on this issue.

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References:

1. ADA. Guidelines on oral piercing. Retrieved from https://www.ada.org/en/member-center/oral-health-topics/oral- piercing.

2. Levin, L., et al. (2005). Oral and dental complications of intra-oral piercing. Dent Traumatol.;21(6):341–343. 3. De Moor, R.J., et al. (2005). Dental and oral complications of lip and tongue piercings. Br Dent J.;199(8):506–509.

The Demons in My Mind

April 25, 2022 Return

INTERVIEW HANNAH WONG MAY-LEE WORDS LIM TECK CHOON

Cathie Wu MA Coun Psy (CAN, USA) Director and Counselling Psychologist AbriMentalHealth.com “Broken people don’t hide from their monsters. Broken people let themselves be eaten.”− From Eliza and Her Monsters by Francesca Zappia Nobody’s perfect. We all have our own insecurities, jealousies, disappointments, and regrets. Sometimes, they manifest outward, turning us into the type of people that we don’t wish to be. In the first of a special two-part feature, psychologist Cathie Wu shares with us her thoughts on the inner demons that can lurk in our minds, and how we can cast off these inner demons to become someone less fractured— someone that we will be proud to be.

THE EMOTIONAL VAMPIRE

Marissa has problems forming long-lasting relationships. She claims that it’s because no one understands her; she’s a very giving person who is always being taken advantage of by unscrupulous people. Her issue becomes evident when one knows her better. Marissa always has a major life crisis, which becomes the focus of every conversation with her. She also shares her insecurities, fears, and concerns with the people around her, all the while brushing aside suggestions from others on how to improve her situation. Her friends quickly distance themselves from her because her company leaves them feeling emotionally drained. People like Marissa are known as emotional vampires—those who feed off attention and emotions (both good and bad) from the people around them. Some will call them drama queens, while others may use the term ‘narcissists’ and ‘professional victims’.

“Are you an emotional vampire? Here’s how to drive a stake into the issue. ”

Be mindful of boundaries. “It’s your right to share and want to be heard,” says Cathie Wu, “but others also have a right to not have their personal space constantly be invaded.” Walk a mile in the other person’s shoes. Empathy is a virtue when it comes to forming and nurturing emotionally fulfilling relationships. Cathie Wu shares that empathy can be cultivated when you take a moment to imagine how it may be like if you were in the other person’s position. With empathy, you will be able to become more aware and responsive to how the people around you perceive you. It also helps you to connect with these people’s feelings. Learn to suspend judgment. Don’t be so quick to assume the best or the worst of a person or a situation. Instead, listen and pay more attention; avoid making impulsive sweeping generalizations and coming up with drastic solutions. Realize that it is never okay to diminish another person for your own gain. Many, although not all, emotional vampires suffer from self-esteem issues, hence the continual craving for validation and attention as well as the frequent need to be right. To overcome this, it is important to also consider the needs and interests of the other person. It will take some time to make the above mentioned tips into a regular habit, and there will be some lapses along the way, but with empathy and a determination to improve your relationships with other people (as well as some assistance from a therapist if necessary), you will eventually arrive at a more emotionally rewarding place in life.

THE INVISIBLE PERSON

Maryam thought she was happy. Her life was perfect. One day, however, she notices that she spends her time during mealtimes in the kitchen getting the food ready, while her family chat happily among themselves. When she joins them, everyone eats and drinks, giving short dismissive responses to her efforts to start a conversation when they are not messing with their phones. Maryam starts tallying up the various little instances when she is treated more like the efficient domestic helper by the rest of the family. Resentment mounts as the tally grows day by day. She has become invisible to her family—they only recall her existence when they want her to cook, clean or fix something. If you believe that you have become an invisible person, here’s some tips from Cathie Wu to be heard and seen again. Acknowledge your own inherent value. It is human nature to tie the perception of success and happiness to external achievements such as financial success or acclaim from other people. When these external markers are not present,resentment and a sense of inadequacy may arise. Instead of relying on these external markers, you should realize that you always have value as a human being. You are worthy to be appreciated and loved, regardless of how successful or beautiful you are. It is important to recognize your own strengths and weaknesses, so that you will be able to feel good about your accomplishments even should they go unrecognized by other people. By doing this, you will be able to maintain a more balanced, realistic measure of your own happiness and success. It will be easier to manage the negative emotions that can come with the perception that you are being underappreciated or overlooked. This doesn’t mean you should stay silent and let things be, though! See the next two points. Voice your needs and desires. Waiting in silence to be heard or be invited to speak only bring more feelings of powerlessness and/or helplessness. To break this unhealthy pattern, find the strength and courage inside you to speak up and make your feelings heard. Who knows, maybe your loved ones have no idea that you are feeling this way, and when you speak out about your feelings, they may be more willing to be more considerate to your needs. Set up a more balanced structure. If you choose to do everything for everyone, you will be associated to that role over time. This may lead to you being taken for granted by everyone! To prevent yourself from ending up in this situation, delegate responsibilities so that everyone has a reasonable share of the duties involved.

FRANKENSTEIN’S MONSTER

Created with the mind of a simple, loving child, Frankenstein’s monster quickly discovers the fear people have of his large, hideous appearance, and how this fear quickly turns into violence. Eventually, he snaps… with tragic consequences for both himself and the ones he cares for.

“Much of the ‘lashing out’ is often due to prolonged suppression and denial of one’s own needs,” Cathie Wu explains. “Negative feelings build up like gas in a bottle. When we force ourselves to swallow these feelings down for too long, we are basically screwing on a tight cap on the bottle. It’s bound to explode.”

Reflect on the issues that are bothering you. Then evaluate how you can speak up and be heard. Things can only improve when you have the space and opportunity to openly discuss your emotions and circumstances. Realize the power of forgiveness. Lashing out can be cathartic—it feels good to be finally standing up for yourself— but this pattern of suppression and explosion is ultimately destructive, because your resentment will build over a prolonged period.

Some mental health experts believe that the best thing you can do for yourself is to learn to move forward from these negative emotions. Forgiveness is a powerful force. Only by being able to forgive will it be easier to find inner peace, and with inner peace comes the ability to move past the festering darkness in your soul, to a happier and healthier place in life. Hence, you should begin to forgive those who have hurt you, as well as yourself for any perceived sense of failure or weakness on your part. After then, you will find the resolve and the strength inside you to move forward and do better.

“Perhaps you identify with Frankenstein’s monster. Maybe you believe that the world has abused you so much that it is only right that you retaliate in kind. Cathie Wu believes that there are other, more fulfilling ways to manage your emotions and find contentment in your life.”

It won’t always be easy to forgive, but a combination of some or all of the following options may help: having a confidante, anger management, meditation, spiritual or religious beliefs, and support from a qualified mental healthcare professional. HT

“Even broken in spirit as he is, no one can feel more deeply than he does the beauties of nature. The starry sky, the sea, and every sight afforded by these wonderful regions, seems still to have the power of elevating his soul from earth. Such a man has a double existence: he may suffer misery, and be overwhelmed by disappointments; yet, when he has retired into himself, he will be like a celestial spirit that has a halo around him, within whose circle no grief or folly ventures.” − from Mary Shelley’s Frankenstein

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A Porky Problem? African Swine Fever and You

April 25, 2022 Return

WORDS Rachel Soon

With the approach of the 2020 Lunar New Year, Chinese families everywhere are gearing up for a time of feasting and reunion. For many, a key ingredient featured each year on the dinner table is none other than the humble bit (or generous slab) of pork. However, with news headlines highlighting an alarming new disease called African Swine Fever, and the government banning the import of pork products from numerous countries, one might ask: is our pork safe? Should we worry about eating it? Here are some facts to help clear up the issues.

What is African swine fever (ASF)?

ASF is a fast-spreading and usually fatal disease in wild and domestic pigs caused by the African swine fever virus. Depending on how severe the infection is and the type/ species of pig infected, ASF symptoms range from weight loss, intermittent fevers, respiratory issues, and skin ulcers (chronic/ subacute ASF) to high fever, loss of appetite, internal bleeding, vomiting, bloody diarrhoea, and death within 6–20 days (acute ASF).¹

With mortality rates ranging from 30% to 100%, ASF epidemics have devastated whole populations of domestic pigs across the world. The first known outbreak was described in Kenya in 1921 while the first European case was detected in Portugal in 1957.

Since then the virus has gradually spread to other European countries. Although the first cases in Asia only emerged in 2018, it has spread rapidly to more than 10% of pigs in China, Vietnam and Mongolia, with over 5 million culled to try and stop its advance.²

Sounds terrible! Can ASF hurt me?

The good news is: Not at all! Humans can’t catch ASF, and handling and eating pork from infected pigs has no effect on the human body. According to the World Health Organization, the ASF virus is non-zoonotic, meaning it can’t jump from animals to humans.³

But isn’t ASF the same as swine flu?

ASF is not the same as swine flu! Swine flu is a different disease with a different cause and different risks (see table below for a brief comparison).

African swine fever versus swine flu

African swine fever¹	Swine flu⁴
Caused by a unique virus family, Asfarviridae, with no similar “relatives” that affect humans.	Caused by strains of influenza viruses (eg, H1N1, H3N2) very similar to strains that cause flu in humans and birds.
Has not infected humans since discovery in 1921.	Original pig-specific strains rarely infect humans, but can crossover with human/ bird strains to create human-infectious strains; involved in some human flu pandemics between 1918 and 2009.
High death rate in animals (30%-100%).	Low death rate in animals (1%-4%).
Can be transmitted through pork products.	Can’t be transmitted through pork products.

If it doesn’t affect us, why fuss about infected pork?

Because while the virus can’t infect us, it can hurt our local pigs if it becomes a resident of our country. Malaysia’s farms and forests are currently ASF-virus-free places, but like many countries that used to be free of the virus, that could easily change.

The ASF virus can infect wild pigs and blood-feeding insects (eg, ticks, mosquitoes) without causing any symptoms, making them act as disease reservoirs. This means that once the virus has spread among a country’s wildlife, it can be difficult to drive it out.¹

The ASF virus is also a tough cookie. Not only can it remain infectious for up to 1,000 days in frozen raw meat and between 30 to 400 days in dry-cured pork, it can survive heat up to 56°C for over an hour.⁵

Many dried, frozen and cured pork products are not prepared at extreme enough temperatures to destroy every trace of the virus from the meat; ASF virus traces have been found in imported suckling pigs, frozen pork dumplings, frozen meatballs, and canned luncheon meat.^6-8

Migrating wild pigs can carry the ASF virus across borders.

But surely it’s okay if I’m eating it and not the pigs?

Waste human food—kitchen scraps, uneaten leftovers—is one route the virus has been known to spread, as some small farms use it in pig feed, while in some places wild animals have access to the waste we throw out. While you may not personally live anywhere near any pigs, wild or domestic, a blanket ban on potentially infected pork products is the safest measure that can be taken, as there’s no telling where in the country a single can of infected meat can end up.⁵

What should I do about all this?

As of mid-December 2019, the Malaysian government has placed an embargo on pork products from China, Poland, Belgium, Thailand, Vietnam, Cambodia, Hong Kong, Myanmar, Laos, and South Korea. Indonesia was recently added given with recent reports of over 30,000 pigs affected in North Sumatra.^9,10,11 However, despite this, it’s possible to still find banned pork in local stores and restaurants.¹²

As responsible consumers, what we can do is look out for and avoid buying or consuming pork products from embargoed countries. Check the labels of pork products for their country of origin and ask retailers where the pork you’re buying comes from. Avoid bringing back pork products from affected countries on your holidays.

On the plus side, Malaysian pork is still very much ASF-free, according to the Department of Veterinary Services, so feel free to enjoy local pork this Chinese New Year with peace of mind!

Found some questionable pork products? You can report them to the Department of Veterinary Services (Jabatan Perkhidmatan Veterinar) via phone at 03-8870 2000 or email at pro@dvs.gov.my.

References: 1. World Organisation for Animal Health. Information on aquatic and terrestrial animal diseases: African Swine Fever. Retrieved from https://www.oie.int/en/animal-health-in-the-world/animal-diseases/african-swine-fever. 2. Food and Agriculture Organization of the United Nations. One year on, close to 5 million pigs lost to Asia’s swine fever outbreak. Retrieved from http://www.fao.org/news/story/en/item/1204563/icode. 3. World Health Organization. Global Early Warning System for Major Animal Diseases, including Zoonoses (GLEWS). Retrieved from https://www.who.int/zoonoses/outbreaks/glews/en/index2.html. 4. Centers for Disease Control and Prevention (CDC). Information on Swine/Variant Influenza. Retrieved from https://www.cdc.gov/flu/swineflu. 5. Mazur-Panasiuk, N., et al. (2019). African Swine Fever Virus – Persistence in Different Environmental Conditions and the Possibility of its Indirect Transmission. J Vet Res;63(3):303–310. 6. South China Morning Post. African swine fever found in Chinese frozen pork dumplings, but you can still buy them. Retrieved from https://www.scmp.com/news/china/society/article/2186535/african-swine-fever-found-chinese-frozen-pork-dumplings-you-can. 7. The Star Online. Sarawak bans all pork products from China. Retrieved from https://www.thestar.com.my/news/nation/2019/10/28/sarawak-bans-all-pork-products-from-china. 8. The Sun Daily. Restaurants found serving African swine fever-hit pork products. Retrieved from https://www.thesundaily.my/local/restaurants-found-serving-african-swine-fever-hit-pork-products-BF1564322. 9. The Star Online. Task force to tackle imported pork product issue from AFS-infected countries. Retrieved from https://www.thestar.com.my/news/nation/2019/10/31/task-force-to-tackle-imported-pork-product-issue-from-afs-infected-countries. 10. The Star Online. Govt bans pork products from Indonesia. Retrieved from https://www.thestar.com.my/news/nation/2019/12/15/govt-bans-pork-products-from-indonesia. 11. British Broadcasting Corporation (BBC). African swine fever: Fears rise as virus spreads to Indonesia. https://www.bbc.com/news/business-50833054. 12. World of Buzz. Report: Shops in Malaysia Still Selling Imported Pork Products Banned for African Swine Fever. Retrieved from https://www.worldofbuzz.com/report-shops-in-malaysia-still-selling-imported-pork-products-banned-for-african-swine-fever.

Care To Tango, My Dear Mango?

Luscious Lips For The Holidays

April 25, 2022 Return

WORDS PANK JIT SIN

So, how did you like my rhyme in the title? Was it as funny for me as it was for you? Guess not. Well, this month we’ll be looking at a common, but well-loved fruit—the mango. The delicious and fragrant fruit has been incorporated into our daily diet and can be found in lassi (a blend of yoghurt, water, and spices), glutinous rice dessert, ice cream, cake, jelly, pickle, salad, curry, and various other food items.

MANGO, THE KING OF FRUITS IN INDIA

Mango or its scientific name Mangifera indica, is one fruit which has made its way across the globe and is universally known. The ubiquitous mango originates from South Asia, India and Burma (modern day Myanmar), and spread from there. Early European explorers to India anglicized the local name mangay, and it evolved to become mango.¹

As it originates from India, the country considers mango to be its national fruit. There, it is known as their King of Fruits (I think it is because those poor, unfortunate souls don’t have access to durian). Buddhist monks are thought to have brought the fruit along when they spread Buddhism to China and the Southeast Asian region at around 400 B.C. As they’ve had a head start in mango cultivation, it comes as no surprise that India is the world’s largest producer of mangoes, accounting for 50% of all the mangoes produced in the world.³

“MANGO OR ITS SCIENTIFIC NAME MANGIFERA INDICA, IS ONE FRUIT WHICH HAS MADE ITS WAY ACROSS THE GLOBE AND IS UNIVERSALLY KNOWN”

Here’s a little trivia for you. It’s easy to tell the age of a housing area by looking at the presence and height of mango trees. Back when Petaling Jaya was being established as the new satellite town for Kuala Lumpur, mango trees were all the rage and many homes had one planted. In fact, one can tell the age of a housing area from the number and height of its mango trees. These tend to be grown from seed and the quality of the fruits are usually decent, with the trees bearing less tasty fruits having been chopped off earlier.

In recent times, newer homes with smaller lawns and people moving into high rise housing has meant a reduction of big fruit trees being planted in new housing estates. Instead, ornamental palms and smaller shrubs have taken the space of our once common mango and other fruit trees. With these developments, the ubiquitous mango tree may soon be a thing of the past.

YUMMY GOODNESS IN A SWEET PACKAGE

Mangoes are nutritious. A serving (about 165 g) contains 10% of your daily recommended fibre intake. The same serving will give you 100% of your daily recommended Vitamin C and 35% of the daily vitamin A intake. It will further contribute to 20% of your daily folate and 10% of the recommended daily vitamin B6 intake. For a fruit, it has a decent amount of trace copper, contributing 10% of the daily recommended intake.

ZEAXANTHIN

The yellow colour of mango stems from zeaxanthin, which is the pigment also found in corn. This pigment is a natural antioxidant and collects in the retina of the eye. It helps in filtering out blue light emitted from our electronic devices and the sun, thus helping to delay or reduce age-related eyesight degeneration.⁴

BETA-CAROTENE

Mangoes have anywhere from 33% to 103% of the recommended daily intake of beta-carotene. Beta-carotene is also known as pro-vitamin A and is converted in the body to vitamin A. Mango has one of the highest beta-carotene content in fruit but the amount is also dependent on the variety of mango. ⁵

ELLAGIC ACID, GALLOTANNIN, MANGIFERIN

Sounds like a spell phrase but these are phenolic compounds which function as antioxidants. Plant phenolic compounds are molecules produced by plants for various functions but in the human body, they can have antioxidant, anti-inflammatory and antiageing properties.⁷ Again, depending on the variety, mangoes can have moderate phenolic content compared to blackberries. The mango with the highest phenolic content is Ataulfo, which hails from Mexico. Each kilogram of Ataulfo mango has about 1100 mg of phenolic content compared to blackberries, where each kg contains between 5,000 and 8,000 mg of phenolic content. This isn’t bad considering one doesn’t always think of mangoes being rich in antioxidants.⁵

DID YOU KNOW?

Mango is related to poison ivy. The sap of the plant contains a chemical known as urushiol. This compound causes dermatitis or skin inflammation, and is easily absorbed by the skin or mucosal lining (the mouth) and causes your immune system to react, thus resulting in blisters and itch. Urushiol is a compound that can be found in some jungle plants such as Rengas, and it is also found in the skin of the cashew seed.

COMMON VARIETIES OF MANGOES

In Malaysia, the most famous variety is known as the Harumanis, which grows well in the state of Perlis. True to its namesake, the Harumanis is both fragrant and sweet. The fruit is deep yellow when cut but is already ripe even before the skin turns yellow. The aroma is strong when eaten. Traditionally, Harumanis is only available between April and May as it coincides with flowering months of December to February. This period of dryness triggers flowering of the mango trees. It is thought that the stress induces the plant to produce flowers, and thus fruits as they are afraid of dying.²

The price of Harumanis is quite high as far as mangoes go. The Federal Agricultural Marketing Authority (FAMA) has a recommended selling price and this year it is RM15 per kg as base price for the premium grade. However, the price is only a recommendation and independent farmers may sell at a higher or lower price depending on market demand. The demand for this fruit has been going up over the years, resulting in more farmers planting this lucrative fruit. However, a Perlis farmer suggested the fruits planted in other regions of the country lack the fragrance of those grown in Perlis. She surmises it could be the climate in Perlis which makes it perfect for the Harumanis to achieve its full potential. Thus, Harumanis from Perlis usually goes for the highest prices among all Harumanis.

Beyond the Harumanis, we have the golden, rather large Alphonso varieties grown predominantly in India and Pakistan. This variety is known as the ‘King of Mangoes’ but it may just be a marketing gimmick rather than fact. Alphonso is characterized by its light orange skin and fibreless pulp and smooth, creamy taste.

Some other varieties we often encounter are the Golden Lily, Red Irwin, Apple, Maha, Golek, and more. With more than 200 varieties registered in the country and many more overseas, there are plenty to choose from.⁶

Irwin mango

Alphonso mango

Apple mango

PLANTING YOUR OWN MANGO

As usual, we always encourage our readers to try their hands on greening their house and improving the health of the earth. Planting mangoes is easy enough. It isn’t recommended for you to plant the seeds of mangoes you have eaten because the resulting tree will rarely have the same kind of fruit. It’s simply because the offspring plant has different genetic material than the parent.

What you need to do is identify your favourite variety and check out the plant nurseries or online shops. If they don’t have the variety of mango plant you want, you can always place an order and get them to call you once it arrives.

Mangoes need well-draining soil so if your soil is always waterlogged, then it’s not a suitable plant for your area. According to a farmer, the mango tree puts out new shoots and leaves twice a month. The new shoots and leaves are delicious to pests, so it is best to spray some pest repellent during this time to reduce the risk of damage to the tree.

With proper fertilization and watering, a grafted plant will start producing fruit anywhere from 3 to 5 years after you put it into the ground. The quality and taste of fruits improve with age so don’t be disappointed if the first harvest is poor tasting.

Mangoes need a lot of care as they need to be wrapped by the time they are 1–2 cm in diameter, or fruit flies will lay their eggs in the fruit and destroy the fruits from within as they mature. HT

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References: 1. American Academy of Dermatology. 7 Dermatologists’ Tips For Healing Dry, Chapped Lips. Retrieved from: https://www.aad.org/skin-care-basics/heal-dry-chapped-lips 2. Stylecraze. Care for Your Lips. Retrieved from: https://www.stylecraze.com/articles/care-for-your-lips/#gref

Luscious Lips For The Holidays

April 25, 2022 Return

WORDS HANNAH MAY-LEE WONG

The skin on our lips is typically thinner and drier than other parts of the face. Follow these tips to show your lips some extra TLC.

Ahh the lips. We all know what the ideal set of lips should be: smooth, plump, soft and supple. It’s especially desirable for our lips to remain in pristine condition during the holiday season. I mean, how else would we rock a bold lippie for that year-end party? But all too often, our expectations fall short when we wake up to (yet again) find dry, cracked lips. Worst of all, no lipstick can hide dull, crusty lips! Don’t worry, this is quite a common problem among men and women alike.

If you really want luscious lips, sometimes, you’ve got to work for it. Here’s how:

1. KNOW YOUR INGREDIENTS

If you’ve got dry, sensitive lips, try paying more attention to the ingredients in your lip products the next time you go shopping. Choose products that are fragrance free and hypoallergenic.”

According to the American Academy of Dermatology, those with chapped lips should avoid the following ingredients in their lip products:

Camphor
Eucalyptus
Flavouring such as cinnamon, citrus, mint, and peppermint that can be especially irritating to dry, chapped lips
Fragrance
Lanolin
Menthol
Octinoxate or oxybenzone
Phenol (or phenyl)
Propyl gallate
Salicylic acid.

Instead, opt for products that contain these ingredients to help heal cracked lips. Dermatologists recommend choosing lip products that have one or more of the following ingredients:

Castor seed oil
Ceramides
Dimethicone
Hemp seed oil
Mineral oil
Petrolatum
Shea butter
Sun-protective ingredients, such as titanium oxide or zinc oxide
White petroleum jelly

Pro tip: If you apply a product on your lips that starts burning, tingling, stinging or causing you discomfort, these signs don’t point to the product working its magic on your lips. Quite the opposite—it most likely means that the product you are using is irritating your lips, so it is best to stop using that product immediately.

2. MOISTURIZE DAY AND NIGHT

A good lip balm contains nourishing emollients to help form a barrier that protects your lips. If you’ve got dry lips, it’s a good idea to apply lip balm, a moisturizing lipstick or other types of lip moisturizer throughout the day and before bed. Thick ointments such as white petroleum jelly is good for cracked lips—ointments are more effective in locking in moisture than waxes or oils.

Pro tip: A popular Korean product making waves in the beauty scene is the overnight lip mask. These are deeply hydrating and are meant to be put on just before bed so that your lips stay hydrated until the next morning.

3. GET OUT OF THE BAD HABIT OFLICKING OR BITING YOUR LIPS

When your lips are dry, you may be tempted to wet them with saliva. But this often worsens the problem. When saliva evaporates, your lips can become drier. If you need a quick moisture boost, use a lip balm. Biting your lips would also irritate your lips and prevent them from healing.

4. YOUR LIPS NEED SUN PROTECTION TOO

The sun can burn dry and chapped lips, which could lead to cold sores. Protect your lips from the UV rays by using lip balm that has SPF30 or higher. Lip balms that have sun protection typically contain titanium oxide or zinc oxide as ingredients. Don’t forget to reapply every 2 hours.

5. STAY HYDRATED

Drink plenty of water to keep your skin hydrated from within. It’s good for your overall health too.

6. REMOVE MAKEUP AT THE END OF EVERY DAY

Your skin needs time to breathe too. Washing your face and removing makeup thoroughly at the end of every day is an essential step for smooth, healthy skin. If you wear long-lasting/waterproof lipstick, remove your makeup with an oil-based makeup remover to get rid of all traces of makeup.

7. USE A LIP SCRUB

Exfoliating or using a lip scrub can help slough away dead skin cells when necessary. It is recommended to only do this once or twice a week. You can probably find a ready-made lip scrub from your nearby pharmacy or beauty store, but you can also easily make your own at home (check out the recipe below!). Note: If you have sensitive skin, injuries on your lips or severely chapped lips, refrain from exfoliating.

8. KNOW WHEN TO SEEK HELP

Most of the time, dry or chapped lips can heal itself within 2 to 3 weeks. However, peeling lips could also be a sign of an allergic reaction to lipstick, toothpaste, food or certain medication. If the issue persists, it’s best to consult a dermatologist.

9. ALWAYS A GOOD TIME FOR LIPSTICK

On top of providing colour, the right lipstick adds a layer of protection and much-needed moisture to dull lips. There are all kinds of options of lip products to choose from, the trick is to pick what best suits your lifestyle. If you go outdoors a lot, get a lipstick or lip moisturizer with SPF for sun protection. If you’ve got dry lips, avoid wearing matte lipsticks. Instead, choose a lip gloss or moisturizing lipstick that is rich in nourishing and emollient ingredients (such as shea butter or cocoa butter).

You can also add a layer of moisturizing lip balm under your usual lipstick for longer-lasting hydration on your lips. HT

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Can’t Motivate Yourself To Exercise? It’s Time To Eat Like A … Mouse!

Can’t Motivate Yourself To Exercise? It’s Time To Eat Like A ... Mouse!

April 25, 2022 Return

WORDS LIM TECK CHOON

A research team in Japan found that mice exercise more on the wheel when their mealtimes are restricted to a certain amount of time each day.

According to Dr Yuji Tajiri from the Kurume University School of Medicine, these mice were given food for a limited time twice a day. Compared to mice which were given unlimited access to food, they ran on the wheel more as a result.

This could be due to the fact that hunger would boost the production of the hormone ghrelin, which was found in higher levels in the mice that were given limited access to food. This hormone may be involved in the increased motivation to exercise.

Of course, mice and humans aren’t one and the same, and Dr Yuji believes that more research is necessary to support this finding.

However, if you need to lose weight and/or need that motivation to be more physically active, why not keep your mealtimes within a reasonable amount of time so that you don’t overeat, and avoid eating outside of those mealtimes? This may boost your efforts to stay active. Give it a try! HT

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Reference: Mifune, H., et al. (2019). Voluntary exercise is motivated by ghrelin, possibly related to the central reward circuit. Journal of Endocrinology. Retrieved from https://joe.bioscientifica.com/view/journals/joe/aop/joe-19-0213.xml

Venom From A Deadly Spider: A Solution For Erectile Dysfunction?

8 Supplements That May Be Helpful In Dealing With Pain Due To Nerve Damage

April 25, 2022 Return

WORDS LIM TECK CHOON

The Brazilian Wandering Spider (Phoneutria nigriventer) is known as one of the world’s most venomous spiders for a good reason. Its venom can cause its victims to experience paralysis, shutdown of the nervous system, irregular heartbeats, and often, death. It also causes painful, prolonged erections in men. Yes, you read that correctly.

Always the type to look at silver linings, a team of researchers in Brazil recently managed to create a substance similar to PnTx2-6, a component of the venom, in hopes of developing a medication for erectile dysfunction that can be used safely by men with diabetes and high blood pressure.

You see, erectile dysfunction is commonly seen among men with those two health conditions, but currently available medications may not be an option for them. Tadalafil, for example, should not be taken alongside nitrate medications for heart problems, as this may lead to sudden and serious drops in blood pressure.

So far, research on mice with induced diabetes and high blood pressure found that the synthesized substance, called PnPP-19, does work to restore the ability to have an erection. This effect is seen when PnPP-19 is applied topically (on the skin) as well as injected directly into the mice.

More research is needed to support this finding and to determine whether the same effect will be seen in humans. Still, it’s a testament to the marvel of nature that a deadly toxin may end up providing a solution for the happiness of human beings! HT

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Reference: Nunes da Silva, C., et al. (2019). PnPP-19 peptide restores erectile function in hypertensive and diabetic animals through intravenous and topical administration. J Sex Med;16:365–374

8 Supplements That May Be Helpful In Dealing With Pain Due To Nerve Damage

April 25, 2022 Return

WORDS LIM TECK CHOON

Nerve damage or neuropathy is frequently experienced by people with metabolic diseases such as diabetes. It can also occur among people who had undergone chemotherapy. Infections and injuries are also known to cause neuropathy.

Neuropathy can affect any part of the body, and people with this condition may experience pain, weakness, and numbness especially in the hands and feet.

Lifestyle modifications and medications can provide relief to people experiencing the symptoms of neuropathy, but some people may find supplements helpful in addition to these methods.

Here are 8 supplements that are often linked to neuropathy. They may be worth discussing further with a doctor or pharmacist.

#1 ACETYL-L-CARNITINE

Produced naturally in the liver and kidneys, this protein substance is said to be helpful in improving nerve function in people whose neuropathy is linked to diabetes.¹

Studies on its benefits to people with neuropathy due to chemotherapy yielded mixed results, however.

Some found that it could help, while others found that it offered little to no additional benefit.

#2 B-COMPLEX VITAMINS

Vitamins B-1, B-6, folate (B-9), B-12, and others help to support our nerve function, and the ability of our brain to process information that comes in through our senses. Studies often found that inadequate consumption of these vitamins may increase the risk of nerve damage, hence the theory that consumption of these vitamins may help improve nerve function among those affected by neuropathy.

Research on these vitamins have been mixed, however, and more research is needed before we can conclusively determine whether B-complex vitamins can help and if yes, the recommended dosage that will be most helpful. People interested in exploring this option should discuss this matter further with a healthcare professional.

#3 ALPHA-LIPOIC ACID

Alpha-lipoic acid (ALA) is said to be able to help reverse nerve damage caused by free radicals as well as to boost the effects of antioxidants in slowing or stopping nerve damage. How true is this?

Well, it has been suggested that daily supplementation with ALA can reduce the number of symptoms seen in people with diabetic neuropathy; higher dosages, however, tend to lead to more side effects such as nausea.2

#4 MAGNESIUM

Magnesium is often thought to be beneficial to people with neuropathy due to chemotherapy, but to date, studies have yielded only mixed results.

#5 CALCIUM

Just like magnesium, calcium is often said to be useful for people who experience nerve damage due to chemotherapy. We can’t conclusively say whether this is true or not, though, as to date, results from various studies have been mixed.

#6 GLUTAMINE

Glutamine has long been considered as useful for people who underwent chemotherapy and experienced neuropathy as one of the side effects. Just like with calcium and magnesium, studies so far on glutamine have failed to provide any conclusive evidence that this is indeed the case.

#7 GLUTATHIONE

An antioxidant that is also produced naturally in the body, glutathione has been theorized to be able to help reduce symptoms of neuropathy. Research on this matter is still relatively few, and the studies conducted so far have given us only mixed results. We still can’t say for sure whether glutathione will benefit people with neuropathy.

# 8 N-ACETYL CYSTEINE

N-acetyl cysteine (NAC) may help protect the nerves from inflammation and damage, so it may both reduce the risk of and treat neuropathy. Similar to the case of glutathione, the amount of research on NAC and its benefits to people with neuropathy is still relatively few. We may only get a conclusive “Yes, it helps!” or “No, it doesn’t!” response after more research has been conducted. HT

“To minimize risks of side effects and unintended interactions with your medications, always consult your doctor or pharmacist before taking any supplement.”

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References: 1. Sergi, G., et al. (2018). Effects of acetyl-L-carnitine in diabetic neuropathy and other geriatric disorders. Aging Clin Exp Res.;30(2):133–138. 2. Ziegler, D., et al. (2006). Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care;29(11):2365–2370.

Watch Out For Fake Dentistry

April 25, 2022 Return

Dr Andrew Chan Kieng Hock

Consultant Oral Surgeon

Private Dental Practice Klang, Selangor

Fake braces done by a bogus practitioner. (Photo by Dr Andrew Chan Kieng Hock)

The issue of fake or illegal dentistry is a current phenomenon which is becoming more rampant in Malaysia. Its emergence can be attributed in large part due to the advent of social media platforms such as Facebook, Instagram, WhatsApp, and YouTube. The problem is more real and pressing than it would appear at first glance. One notable and memorable incident happened in 2017 where an individual who reportedly learned to carry out orthodontic treatment (dental braces) by watching YouTube videos was arrested, fined RM70,000, and subsequently released after the fine was paid through a crowdfunding exercise initiated by a non-governmental organization.^1,2 This is not an isolated case, as there have been numerous cases of other convictions as highlighted by the mainstream media. In this article, Dr Andrew Chan Kieng Hock discusses what constitutes fake dentistry, how to spot fake dentists, and the adverse effects related to fake dentistry.

What Is Fake Dentistry?

Fake or illegal dentistry is a broad term which may include providing dental procedures or services by an unlicensed, unqualified or uncertified individual in a premise that may or may not be licensed. The definition can also include using unlicensed products sold by unregistered dental dealers locally or overseas, on the patients or customers.

Under the newly amended Dental Act 2018, every practicing dentist— whether working in the public or private sector—must be registrable with the Malaysian Dental Council (MDC) and must possess a valid Annual Practicing Certificate (APC). The APC is subject to annual renewal when the practitioner has accumulated sufficient Continuous Professional Development (CPD) merits, which are regulated by MDC.

In addition, all dental treatment must be carried out in a clinical or healthcare environment that is registered under the Private Healthcare Facilities and Services Act (PHFSA) 1998.³ Under this Act, anyone convicted of practicing illegal dentistry can be fined up to a maximum of RM300,000 and/or face imprisonment for up to 6 years.

How to spot fake dentists?

The modus operandi of most fake dentists includes:

Enticing victims by offering services with fees very much below the market prices charged by professional dentists. They usually advertise their services via social media platforms, flyers, posters, business card, or by word of mouth.
Operating in secretive or dodgy premises such as hotel rooms, homes, shop lots, markets, or even inside beauty salons. They frequently change the locations in order to avoid detection by enforcement officers.
Using dirty or rusty instruments which demonstrate the unhygienic conditions of the workplace or the low quality of the products, which are often purchased from e-commerce websites.
Not displaying or revealing their qualifications when probed.

The adverse effects of fake dentistry:

The treatment provided is substandard and often result in harmful and adverse side-effects.
Monetary losses as patients have to pay extra fees to seek retreatment from a legal dentist to rectify the damage inflicted.
Increased health risks including death due to the unhygienic instruments used. Infection control is often compromised, thus subjecting patients to the risk of serious infection, including HIV/AIDS, hepatitis B and hepatitis C.

The prime motivator of fake dentistry is money. Numerous people have been victimized by fake dentists due to pure ignorance and attraction to the huge discounts offered. The Ministry of Health Malaysia together with several dental bodies and stakeholders have been doing active roadshows and forums to warn the public regarding this issue.

Our enforcement agencies have been aggressively nabbing and convicting them with serious punishment. Hopefully, with all these measures taken, there will be fewer people being duped by bogus dental providers in the future because the consequences, as discussed, can be grave, including loss of money and general health. HT

Fake veneers done by a beautician. (Photo by Dr Andrew Chan Kieng Hock)

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References: 1. The Star Online. Fake dentist grinning from ear to ear. Retrieved from https://www.thestar.com.my/news/nation/2017/10/10/fake- dentist-grinning-from-ear-to-ear-the-quacks-now-ive-got-fame-says-vocational-student-who-got-of. 2. The Star Online. Group denies helping to pay bogus dentist’s fine. Retrieved from https://www.thestar.com.my/news/nation/2017/10/10/group-denies-helping-to-pay-bogus-dentists-fine. 3. Attorney General’s Chambers of Malaysia. Private Healthcare Facilities and Services Act 1998 [Act 586]. Retrieved from http://www.agc.gov.my/ agcportal/uploads/files/Publications/LOM/EN/Act%20586%20KU%2028.12.2015.pdf