Let’s Be Fracture-proof

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Let’s Be Fracture-proof

April 28, 2022   Return

So, how exactly does a bone fracture occur? A bone fracture happens when part of the bone is chipped, cracked or completely broken. Further to that, resulting fragments may even damage surrounding tissues or blood vessels, which can cause swelling around the area. A fracture can be caused by a blow or stress to the limbs. It can also be due to medical conditions such as osteoporosis and bone cancers that increase fracture risk due to bone weakening. People susceptible to bone fracture are those who have suffered from previous falls or limb injuries, menopausal women, elderly and children.

And, what if you do fall? Well, a fall can spell havoc for your existing fractures. Plus, the tendency to fall is also increased if you have health issues such as poor vision, stroke, Parkinson’s disease, or dementia. And here’s the catch, more than half of all fall cases happens at home! Now, you wouldn’t want that, would you? 

Just like the saying “good practices start from home”, you should start preventing falls in your very own home. As we spend most of our times at home if not out, the risk of a fall is naturally greater there than at anywhere else. But, fret not.

There are simple adjustments you can make to ensure that your house is as fracture-proof as it can be.

Keep the floor clear.

  • Clean spills immediately.
  • Put things back where they belong whenever they are spotted lying about.
  • Ensure the floors are swept to remove trip hazards such as grains and small rocks.
  • Sharp objects such as a broken glass should be cleared away immediately.
  • Electrical wires and cords should be kept off the floor and be coiled where possible.

Aim for smooth surfaces.

  • If you are using carpets at home, make sure that they are secured smoothly to the floor.
  • Avoid carpet textures that can increase a fall risk.
  • For houses with floor tiles, use a non-skid wax when waxing.
  • Dry mop the floor.
  • The floor should be non-slippery and dry.

Make the bathrooms secure.

  • Install railings or grab bars near the toilet, bathtub, and shower to provide support and to allow more secure movement.
  • Put a bath mat in the tub or shower so that it would not be slippery.
  • Ensure the bathroom lights are bright enough.
  • Wear non-slip slippers in the bathroom if you must.

Don’t forget the stairs, rooms and other areas.

  • Make sure that there is enough walking space in between furniture. 
  • Ensure stairways and hallways are brightly lit.
  • Switches for lamps and other appliances should be easily accessible.
  • Secure the stair railing.
  • Keep items within an arm’s reach and avoid using stools.
  • Where a step stool is needed, make sure it is wide and sturdy enough and that it comes with a handrail.
  • You may want to purchase a cordless phone to make dialling for help and receiving calls easier.

And lastly, the outdoors.

  • Ensure the lighting of the house exterior is functioning and sufficiently bright.
  • Mend or remove trip hazards such as gravels, broken tiles and other rough spots.
  • If there are ramps, make sure that the railings are sturdy and secured.
  • Wear shoes or boots with proper grip when going out.

That aside, doing exercises may also improve your balance and reduces your risk of a fall. Tai Chi, for instance, is shown to promote proper balance in the elderly.

Exercise can also strengthen your bones and coordination! But of course, exercise alone is not enough. You should also eat a diet that is calcium and vitamin D-rich such as milk, soy beans, and broccoli. Avoid smoking and consumption of alcohol as well, if possible.

So, that’s it! Simple measures for keeping safe while reducing fall risks. Do remember to consult the doctor if you would like to find out more about bone fracture risk factors or even just bone health in general. And again, don’t forget to fracture-proof your home!

References:

About Health. Available at www.about.com

Medical News Today. Available at www.medicalnewstoday.com

National Osteoporosis Foundation. Available at www.nof.org

NIH Osteoporosis and Related Bone Diseases National Resource Center. Available at www.niams.nih.gov

WebMD. Available at www.webmd.com

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Rescheduling Motherhood?

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Rescheduling Motherhood?

April 28, 2022   Return

sperm_egg_Dr Eeson S...

Dr Eeson Sinthamoney Consultant Obstetrician, Gynaecologist and Fertility Specialist

A sad fact of life is that biology is not feminist in nature. Women may have come a long way when it comes to attaining equal rights and becoming more independent, but human biology remains primordial. A woman’s peak fertility period is still in her late teens to her twenties – a time when she may not be ready to become a mother. By the time she is 35 (ironically the age when she may be ready to settle down), a woman’s chance of conceiving per month decreases by half. By age 45, natural fertility is reduced to only one percent.

Ah, but just imagine never having to worry about ‘baby panic’ or the biological clock counting down after hitting the big three-oh: being able to focus on establishing a career, working toward financial stability or emotional readiness. What’s more, if Mr Right is taking his time to show up, it’s no big deal – a lady can wait and not have to settle for less.

If that sounds great, well, these choices are now increasingly possible, thanks to advances in a procedure called egg freezing.

A woman may still have it all

Just like its name states, the procedure involves storing extracted eggs in a very cold environment. The very low temperature keeps the eggs in suspended animation, so that when they are thawed (even years down the road), they can be used to conceive a baby.

Fertility specialist Dr Eeson Sinthamoney explains that, traditionally, egg freezing is viewed as a method to preserve the fertility of women who are about to undergo chemotherapy or other forms of treatment that would affect their ability to produce healthy eggs in the future.

This is still true today, but egg freezing has evolved to become a solution for every woman who wishes to preserve her fertility.

The evolution is made possible because recent improvements made to egg-freezing technology have improved its chances of success.

Dr Eeson explains that, in the past, the freezing process could cause ice crystals to form in the eggs, damaging their structure and making them unusable when thawed.

This changed when a technique called vitrification was developed recently. The technique freezes the eggs very rapidly in order to prevent ice crystal formation. “The eggs can survive better because there is less damage,” Dr Eeson says. As a result, the success rate of egg freezing has improved tremendously. Dr Eeson describes this development as a ‘game-changer’ when it comes to preserving a woman’s fertility.

 

There’s still a catch

Unfortunately, there’s never a foolproof solution. Dr Eeson notes that there are many other factors determining the odds of success.

For example, the eggs that were harvested may already have some abnormalities in them that prevent a successful pregnancy. “The best time for egg freezing to take place is when the woman is in her late twenties to early thirties,” Dr Eeson says. Any later and it may be harder for the fertility specialist to extract enough healthy eggs for future use. This is because a woman is born with only a fixed number of eggs, which decreases as she grows older, and the eggs may also contain more abnormalities as time goes by.

Also, some eggs may be more susceptible to damage compared to others. Fertility specialists do not have a reliable way to ensure that all harvested and frozen eggs are normal or will be able to withstand the freezing process. Hence, there is no guarantee of a healthy pregnancy. 

 

Freezing embryos? Dr Eeson points out that a frozen embryo has a higher chance of resulting in a successful pregnancy compared to a frozen egg. However, the freezing of embryos raises a few issues. One, this may not be an option for an unmarried woman. Two, the freezing of an embryo raises ethical concerns as not all frozen embryos will eventually be used and the unused ones would have to be discarded as a result.

 

What is the procedure like?

  1. The first step is always a consultation, during which the fertility specialist will review the procedure thoroughly with the client. The specialist will also discuss the risks and address any concerns the client may have.
  2. The fertility specialist will then conduct a pre-screening test, called the ovarian reserve testing. This is a simple blood test, usually taken on day three of the menstrual cycle, in which the blood sample is used to measure the levels of anti-Müllerian hormone present. The results will give the fertility specialist a good idea of the woman’s ovarian reserve, which is the number of eggs remaining in her ovaries.
  3. Once all is in order, the client will receive fertility injections to stimulate the production of a large number of eggs.
  4. When the time is right, the fertility specialist would retrieve the eggs while the woman is under deep sedation. This is done using a needle under the guidance of an ultrasound.
  5. The eggs will then be frozen. Special chemicals called cryoprotectants may be used to prevent ice crystal formation.

The entire procedure would take about 10 to 14 days, and would not disrupt the woman’s normal routine much, says Dr Eeson.

For a reasonable annual fee, the fertility centre will store the eggs until they are needed.

 

Frequently asked questions

  • How long can the eggs keep?
    They can keep for a long time, Dr Eeson says. In fact, the actual limiting issue is the age of the woman when she wants to be a mother. Most fertility specialists would prefer that the woman uses her frozen eggs before she turns 50, as pregnancy at age 50 and above has its share of potential complications.
     
  • What happens if the frozen specimens end up missing or damaged?
    Consent forms will have to be signed before any procedure takes place to define what the fertility centre will and will not be held accountable for. Generally, the fertility centre will not be held accountable for any damages that are caused by what’s known as ‘acts of God’: natural disasters and other events that cannot be avoided by any amount of foresight or precautionary measures. If you suspect that the fertility centre has been negligent, you should consult a lawyer for further action.

What happens if the fertility centre goes out of business? What will happen to the frozen eggs?
To the best of Dr Eeson’s knowledge, there are currently no laws or regulations in Malaysia that set out the course of action required when a fertility centre closes shop. To date, no one in Malaysia has had to face such a situation.

Normally, an ethical fertility centre will make arrangements for another fertility centre to take custody of its frozen specimens. Perhaps the best course of action is to ask the fertility centre about this beforehand, as each centre may have its own contingency plan for such a situation.

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Breathe Easy

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Breathe Easy

April 28, 2022   Return

If you’ve just been told that you suffer from sinusitis, fret not. This intimidating term simply means an infection or inflammation of the sinuses. It is a common condition, and symptoms include a green or yellow discharge from the nose, a blocked nose or difficulty breathing through your nose, pain or swelling around the nose, eyes, cheeks or forehead, and a reduced sense of smell.

There are generally two types of sinusitis: acute and chronic. They share similar signs and symptoms, but differ in the duration of infection. Acute sinusitis lasts up to four weeks while chronic sinusitis can linger for months or even years.

Many over-the-counter and prescription remedies have been suggested for the treatment of chronic sinusitis. But if you’ve tried them all and your symptoms don’t seem to get better, you may want to consider balloon sinuplasty.

Subhead: A Balloon Up My Nose?

Balloon sinuplasty is a surgical procedure that uses a balloon to open up blocked sinuses. Performed by ear, nose and throat (ENT) surgeons, this procedure is safe, effective and less invasive than traditional sinus surgeries. While any surgery involves some risk, clinical studies have shown that balloon sinuplasty is very safe, with very low complication rates. Some associated risks include trauma to surrounding tissues or mucous membrane, infection, or injury to the eye.

k_sinuplasty2a

Follow-up studies of patients who had undergone the procedure reported significant and lasting improvement of their symptoms, which means that the procedure is effective.

For the most part, patients need undergo balloon sinuplasty only once; it is unlikely that you would need to repeat the procedure. However, this depends on the severity of your condition and other host factors.

Better yet, because there is no cutting or removal of bone or tissue, there is reduced bleeding and therefore quicker and more comfortable recovery. In fact, the surgery can be performed comfortably under local anaesthesia, and patients may return to work and normal activity within two days. Moreover, undergoing balloon sinuplasty does not limit your future treatment options.

If you’ve tried different treatments for chronic sinusitis to no avail, it is time to consider balloon sinuplasty as a safe, minimally invasive alternative.

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Hair Today, Gone Tomorrow

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Hair Today, Gone Tomorrow

April 28, 2022   Return

Interview by Hannah May-Lee Wong

Dr Ruban Nathan
Consultant Dermatologist & Hair Transplant Surgeon

hair_1copy

We met Dr Ruban Nathan at his favourite vegetarian restaurant – an earthy-looking eatery with plenty of natural shade from the surrounding greens – just a few steps away from his clinic. Dr Ruban himself is no stranger to hair loss. “I am the typical example of male pattern hair loss – high forehead, thin crown,” he says. “It happens differently in females though – they get a straight but low hairline and global thinning of hair”.

He expresses his concerns regarding the Malaysian perception of hair loss. Although many people face hair loss as they age, most continue to believe in unfounded hair myths, herbs that aren’t backed by scientific evidence and hair centres that charge premium prices promising hair regrowth but without the results. The treatment plan for hair loss should depend on the cause, and sometimes, medication or medical procedures (such as hair transplants) are needed. These should be prescribed or performed by a trained medical professional.

  1. What are the causes of hair loss?

By far, the most common cause is androgenetic alopecia, a fancy way of saying male- or female-pattern hair loss. Men experience this form of alopecia (hair loss) more, but some women do as well. In men, hair loss occurs at the crown of the head with hair line recession. In women, there is minimal or no receding hair line; instead, they usually get global hair thinning.

Another common cause would be telogen effluvium, in other words, stress-related hair loss. This is a global loss of hair which follows an emotionally or physically stressful event such as dengue, any major surgery, a loss of a family member or even a physiological event such as pregnancy. When a person experiences such events, a bunch of follicles go into resting phase and after that, the person will experience a lot of hair shedding. Since this type of hair loss is non-scarring, the follicles will revive and hair does grow back.

A slightly rarer cause of hair loss is trichotillomania, where the patient (usually an adolescent or younger child) pulls his or her own hair out as a response to emotional stress. Alopecia areata is an autoimmune disorder that causes patchy hair loss. It is less frequently seen and is often stress induced.

  1. Which of these is the most common cause of hair loss? Do our diets and lifestyle play a part?

The commonest overriding factor is genetic. But stress, poor diet, smoking and lack of sleep would accelerate the process. Neglecting to shampoo as often as one should may also lead to hair loss. Hairs are attached to oil glands, which may contain lots of bacteria. Men, especially, tend to have very oily scalps. It was theorized that excess oil may promote the growth of a certain bacteria that can cause hair loss. Make sure to shampoo regularly to minimize that.

Sometimes when appropriate, doctors will do blood tests to rule out anaemia or thyroid problems which may also contribute to hair loss.

  1. When do most people start experiencing hair loss?

It could happen at any age post puberty.

  1. What are the treatment options for hair loss?

For the most common cause of hair loss – androgenetic alopecia – treatment options can be divided into medical and surgical interventions. Medically, for men, minoxidil 5% and oral finasteride would be recommended. Women can use minoxidil. Medical treatment is long term and is taken for as long as the patient wants to prevent hair loss. Surgically, patients can opt for hair transplants, which involves extraction of hair follicles from the back of the head and planting them on the top of the head where hair loss is most noticeable.

  1. Let’s talk about hair transplants. Can you explain the difference between Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT)?

Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) refer to the different methods of extracting or harvesting hair follicles. Implanting the follicles are similar for both.

Follicular Unit Transplantation (FUT)

Also known as the strip method. This involves the removal of a very thin strip of skin from the lower back of the scalp, where the hairs are genetically more protected from future hair loss. With FUT, shaving of the whole head is not required, so the patient may return to work sooner.

Follicular Unit Extraction (FUE)

For this method, follicular units are individually pulled out of the scalp using a drilling device. An extensive area at the back of the scalp is usually involved. Because FUE uses less “genetically protected hair”, it may jeopardize the survival of hair implants, and affect how long the implants will last. Total scalp shaving is usually required.

With FUE, due to the trauma of individually pulling the donor follicles out, the surrounding pad of fat is at risk of being stripped off, further diminishing the potential survival of grafts. FUE is usually performed if donor density is lacking, and if beard or body to scalp transplants are necessary. Density of hair at the host area may also be affected – after four weeks of full hair regrowth, there might be a slight decrease in hair density. These are the downsides of FUE. But if the patient has a lot hair at the back his head, it shouldn’t be a problem.

A qualified surgeon should be able to offer both these techniques. If the patient is young, I would still recommend doing an FUT. But if the patient is older and the donor hairs aren’t as good quality, then I would do an FUE.

It depends on what the patients want too. If you do an FUE, you’ll have to shave your head and it’ll take weeks to grow back. Doing an FUT means you won’t have to shave it all off. If a patient has an important meeting coming up, I would suggest an FUT.

For both methods, the newly implanted hairs will fall off in two to three weeks and will grow back again in about three to six months, reaching maximum density in 12 to 14 months.

  1. Can women have hair transplants?

Yes, but women usually do very well with medications alone. Therefore, I normally suggest they try medications for at least six months.

  1. What is the difference between going to a dermatologist and going to a hair loss treatment centre?

Sadly, I find some of these non-medical hair treatment centres to be unscrupulous and aggressive in their marketing. Irrespective of whether the cause of hair loss is genetic (in which case there is little they can do about it) or caused by a severe auto-immune condition, some hair centres promise to treat all forms of hair loss, which is simply impossible. I have had scores of patients who complain of paying tens of thousands of Ringgit to these centres without receiving any results.

What’s even more worrying is the tendency for some hair centres to induce anxiety by claiming the presence of mites in their client’s scalp when there is none! The Demodex mite they talk about is rarely present and not at all a significant cause of hair loss. Anyone can Wikipedia this fact!

  1. How can we prevent hair loss or take care of thinning hair?

If you’ve inherited the “hair loss gene”, the best thing to do is to see a dermatologist early on. A dermatologist can advise on the right medication, which will act as a pause button and help halt the shedding.

Besides taking the appropriate medication, get rid of negative lifestyle habits such as smoking, poor diet and lack of exercise. You should also rule out the presence of seborrheic dermatitis (which might cause mild thinning) by seeing a dermatologist.

  1. Are there any supplements that help stimulate hair growth?

There are some supplements being sold in the market, but there is little clinical evidence or large-scale studies to prove their benefits.

 

Hair Myths Debunked

  1. A diet high in monosodium glutamate (MSG) causes hair loss.

Not true. Glutamate in MSG may cause neurochemical changes in the brain, and some people claim that taking too much of it causes headaches, tingling or sweating. But in terms of hair loss, there is no scientific backing for this.

  1. Shampooing your hair regularly leads to hair loss.

Not true. In fact, living in this hot climate, we should shampoo at least once or even twice a day. Build-up of excess oil in the hair follicles may lead to accumulation of bacteria and fungus that may cause hair loss.

  1. If you completely shave off your hair, it will grow thicker.

This is a common myth that is not true. Shaving your scalp every three weeks will not make your hair grow back thicker.

  1. When washing your hair, any shampoo will do.

Dr Ruban says, “Shampoos only vary in terms of texture. Shampoos that claim to prevent hair loss may include certain peptides in their ingredient list, but these peptides will not be left on your scalp long enough to have any effect, considering a regular hair wash is generally quite quick.”

  1. Dyeing and perming your hair causes hair loss over time.

Some textural damage to the hair may occur, but it generally does not result in irreparable hair loss. Only a small population of people might be allergic to a substance commonly found in hair dye –

  1. As you age, you start losing hair all over the body.

Not exactly. Body hair tends to increase in density as you get older, while scalp hair density decreases.

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OHHHH… Why Is the World Spinning?

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OHHHH… Why Is the World Spinning?

April 28, 2022   Return

Words Lim Teck Choon

Vertigo is one of Alfred Hitchcock’s more well-known psychological thrillers, named thus because the protagonist suffered from that condition as well as fear of heights. Unfortunately, the popularity of that movie led some to assume that vertigo, dizziness and fear of heights are one and the same. Consultant ear, nose and throat surgeon Dato’ Paduka Dr Balwant Singh Gendeh sheds some insight into vertigo and how it can be treated.

Entirety with

Dato’ Paduka Dr Balwant Singh Gendeh
Consultant Ear, Nose & Throat Surgeon

Vertigo 101

  • Spinning around. “Vertigo specifically refers to a feeling of disorientation because we think that we, or the world around us, are moving, when we are actually not,” explains Dato’ Paduka Dr Balwant Singh Gendeh. It should not be confused with motion sickness and dizziness.
  • It’s about the ears. In the past, it was assumed that vertigo was a sign that something was not quite right with the brain. Now, we know that the affected area is the inner part of the ear that helps maintain our sense of balance.
  • It’s a symptom. Vertigo is not considered an illness; instead, it is viewed as a symptom of a problem that affects the sense of balance. Therefore, the duration and severity of vertigo can vary, depending on the problem that gives rise to it. We will look closer at some of these problems later.

First, let’s take a closer look at how our body maintains our sense of balance.

A Balancing Act

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If we look at diagrams of our ear, we will come across what seems like a snail with a big head located in the inner ear. This “snail” is called the bony labyrinth, and like its name would suggest, its outer wall is composed of rigid bony layers to protect the soft tissue inside.

There are basically three components of the bony labyrinth: the cochlea, the three semicircular canals and the vestibule.

The cochlea is involved in maintaining our hearing rather than balance, so we won’t be focusing on it in this article. We are more interested in the other two components, the semicircular canals and the vestibule. These two components work closely together with other parts of our body such as the eyes and the nerves as well as bones to help maintain our position, whether we are staying still or in motion.

The semicircular canals. The three canals are filled with a fluid called endolymph. Each canal also has a cup-like structure called cupula. Every time we move, the endolymph also flows in the direction of the movement, and this movement is detected by thin hair-like cells in the inner lining of the cupula. These cells then generate signals, sent via nerve cells, to the brain.

The vestibule. The vestibule also has thin hair-like cells, found in the utricle and saccule. These cells help to detect movements in a straight line as well as acceleration in a horizontal direction.

Additionally, the utricle and succule has a jelly-like covering lined with tiny calcium crystals. Whenever we tilt our head or change our body’s position with respect to gravity (such as when we lie down), the calcium crystals get displaced in the direction of the movement and cause the hair-like cells to bend. These hair-like cells then send signals to the brain informing it about the change in our body’s position.

Our brain pieces the information received from the inner ear together with information sent through our eyes, skeletal system, etc in order to coordinate the maintenance of our sense of balance.

We now delve into three common issues associated with vertigo, but we should keep in mind that there are several other possible conditions that may give rise to vertigo as one of the symptoms. These include injuries and trauma, conditions that cause a sudden decrease in blood supply to the brain such as clots in a blood vessel and more.

Therefore, if we experience bothersome or frequent bouts of vertigo, it’s a good idea to consult an ENT specialist for a more thorough examination.

Benign Paroxysmal Positioning Vertigo (BPPV)

BPPV is the most common form of vertigo. “During a BPPV episode, we experience a sudden, brief sensation that we are spinning,” explains Dr Balwant.

An episode is normally triggered by specific changes in our head’s position, such as when we tilt our head or when we sit upright after lying down to sleep. BPPV can spur mild to intense dizziness that may last for a short period of time (a few seconds to a minute).

Is it serious? BPPV is rarely serious, and the affected person’s hearing will not be affected.

However, Dr Balwant cautions that the elderly may be more prone to falls should they experience a BPPV episode. Given how falls may lead to life-threatening fractures among people in that age group, he advises those affected to consult an ENT specialist if the episodes are frequent.

What causes it? BPPV could be due to the calcium crystals in the utricule getting dislodged and finding their way into a semicircular canal, where they interfere with the flow of the endolymph and make the brain think that we are moving when we are actually staying still.

Diagnosing BPPV. Interestingly, no sophisticated equipment is necessary. This is because when our head is moved into a position that triggers the BPPV, the brain will let us know that we are moving (when we aren’t) and our eyes react by moving in a specific pattern known as “nystagmus”. Thus, during the diagnosis process, the ENT specialist will ask for the patient to move his or her head into various positions while watching for signs of nystagmus.

How do we treat it? The ENT specialist will instruct us on a series of gradual positioning techniques called the Epley manoeuvre, designed to allow the dislodged crystals in the semicircular canal to find their way back to the utricle. We will also be asked to come back a week later for a follow-up examination.

If the episodes are intense, anti-vertigo medications such as betahistine dihydrochloride may also be prescribed.

Labyrinthitis Or Vestibular Neuronitis

Just like most tissues and organs in our body, various components of the bony labyrinth can also become the target of uninvited microorganisms such as bacteria and viruses. When infection occurs in one of the two nerves that connect the inner ear with the brain – called the vestibular nerves – that’s when a condition known as labyrinthitis or vestibula neuronitis arises.

Is it serious? Dr Balwant shares that people affected by labyrinthitis typically experience vertigo alongside dizziness, nausea and even loss of hearing. The hearing loss is normally temporary, but in very rare cases, it may become permanent.

These symptoms tend to occur abruptly, without warning, often after sudden movements of the head, and they may last for several days.

While these symptoms are normally not life-threatening, they can be intense and uncomfortable to undergo. They also disrupt our ability to work, drive and perform other routine activities.

What causes it? It can due to infection of the inner ear. It can also be brought upon by infection of other parts of the body, such as the lungs, stomach, etc. Just like with other infections, we become more susceptible if we smoke, drink excessive amounts of alcohol or indulge in other activities that can weaken our immune system. Allergies and stress may also be risk factors.

How do we treat it? The specialist will prescribe medications based on the cause of the infection. Bacterial infection, for example, can be treated with antibiotics, but infections caused by viruses will require a different type of treatment. Therefore, the specialist will evaluate the best treatment options on a case by case basis.

In the meantime, we should take plenty of rest and drink plenty of water to help us recover better and faster.

Ménière’s Disease

Ménière’s disease is quite rare, with studies reporting the prevalence rate as ranging from 3.5 per 100,000 people to 513 per 100,000.1 This rarity will be small consolation to those affected by this disease, however, as the symptoms tend to be severe.

At a glance

Usually only one ear is affected, and the affected person can experience episodic attacks, during which the following typically occur:

  • Vertigo. This often comes up without warning, and can last from 20 minutes to several hours.
  • Hearing loss. This usually comes and goes during the early stages, but over time, the affected person’s hearing loss may become permanent.
  • Tinnitus. The affected person will hear persistent noise (ringing, buzzing, whistling, hissing, etc) in the ear even when there is no external sound present.
  • A “full” sensation in the ear. There is build-up of pressure in the affected ear or on the side of the head where the affected ear is.
  • Attacks of dizziness.

Episodic attacks may occur in close succession over a few days.

Some people may also experience “brain fog”: they find it difficult to concentrate or recall things, and they are also prone to feeling fatigued and/or demotivated. Consequently, their abilities to sustain meaningful relationships as well as to perform at work or school are affected.

What causes it? Dr Balwant shares that one theory is that Ménière’s disease is the result of excessive endolymph in the inner ear. Normally, the endolymph is contained within a semicircular canal by a membrane. When there is excessive endolymph, the resulting pressure causes the membrane to rupture.

Now, the endolymph is rich in potassium ions, which is positively charged. When it leaks into the surrounding space of the inner ear, it brings with it excess positive charges, which disrupt the ability of the nerve cells in the inner ear to properly generate electrical signals to the brain.

Other researchers speculate that this disease is probably the result of blood vessels experiencing constrictions that reduce the amount of blood passing through them. Some also theorize that Ménière’s disease may be due to viral infections, genetic abnormalities and other factors that prevent the body from regulating the amount of endolymph fluid in the inner ear.

How do we treat it? Unfortunately, we have yet to find a cure. Dr Balwant explains that current treatment regime focuses on managing the symptoms.

  • Medications can be prescribed for severe dizziness, vertigo, nausea, etc.
  • Consumption of salt should be restricted to reduce the amount of fluid retained by the body (this will lead to a reduction of fluid volume and pressure in the inner ear).
  • Smoking, caffeine, alcohol and chocolates should be avoided.
  • Those experiencing emotional issues may find counselling and participation in support groups helpful.

Reference:

  1. Alexander, T.H., & Harris, J.P. (2010). Current epidemiology of Meniere’s syndrome. Otolaryngol Clin North Am.;43(5):965-70. Retrieved in June 1, 2018 from https://www.ncbi.nlm.nih.gov/pubmed/20713236

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Let’s Talk about the Cantonese Cancer

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Let’s Talk about the Cantonese Cancer

April 28, 2022   Return

Words Lim Teck Choon

ENTirety with

Dato’ Paduka Dr Balwant Singh Gendeh

Consultant Ear, Nose & Throat Surgeon


Nasopharyngeal cancer (NPC) isn’t common, but it affects a strikingly high number of Chinese and Bidayuh people. In fact, NPC has been called the Cantonese cancer, since Southern China, especially the Guangdong province and Hong Kong, reports the highest incidences of NPC in the world!

Researchers traced the migration history of people in this province across the world throughout the last few centuries, and unsurprisingly, many Chinese and the Bidayuh people in Malaysia trace their roots back to Southern China. Hence, the threat of NPC is also high among them compared to other races in this country.

This month, Dato’ Paduka Dr Balwant Singh presents an overview of the nature of and the treatment of NPC.

What’s inside the nose?

Dr Balwant explains that when we breathe in, the air travels through our nostrils to the upper part of our throat, behind our nose. As it moves down to the lungs, it passes through our nasal cavity and past the chamber known as the nasopharynx. It is located behind the nose, above the soft part (soft palate) of the mouth. From the nasopharynx, air will head down the throat and to the lungs.

A structure of note is the fossa of Rosenmüller. This is a long, deep, shallow and narrow depression situated immediately behind the eustachian tube opening. At the base of the fossa is a ball-shaped lymph node called the retropharyngeal lymph node or the node of Rouvier. Almost 50 percent of all reported NPC cases originate from this lymph node.

A cancer in Nasopharynx 

Similar to other cancers, nasopharyngeal carcinoma (NPC) arises when abnormal cells begin to grow and divide without stopping.

Breakdown of normal cellular processes that control growth, division and death. Normal cells have internal processes that will stop growth and division once there is no longer any need for such growth and division, but these processes break down in cancerous cells. Also, normal cells die once they become old or damaged, but the processes that activate cell death tend not to work properly in cancerous cells.

As a result, cancer cells will just keep growing and increasing in number, and worse, they live long past their expected life span. Consequently, these cells form masses called malignant tumours.

Invades and damages tissues. Now, imagine this tumour growing in size in a limited space. Over time, it will begin to press against surrounding tissue, eventually invading into the space of its neighbours – the throat, the bones of the surrounding region and eventually the brain. If left unchecked, this will lead to extensive damage to these organs.

Spreads to other organs in the body. Furthermore, cancer cells can spread to distant organs to form malignant tumours in those organs. Dr Balwant explains that NPC can easily spread to the lungs, liver and bones due to the rich network of lymphatic and blood vessels in the nasopharynx connecting to other parts of the body.

This process is called metastasis, and when this occurs, the cancer is said to be at its most advanced stage. Good treatment outcome is difficult to achieve at this stage.

Therefore, NPC should ideally be diagnosed and treated at its early stage. The earlier treatment begins, the better are the chances for a good treatment outcome.

In order to catch NPC at its early stage, we need to first look at the people who are most at risk (and hence should be more watchful of potential signs of NPC) as well as the signs to watch out for.

Who is at risk of NPC? 

Members of high-risk populations. Dr Balwant shares that, in Malaysia, the prevalence is much higher among the Chinese and the Bidayuh populations. Compared to them, the prevalence among Indians is fairly low, while that of the Malays is somewhere in between.

People who consume a diet high in salt. This is a theory developed after researchers examined the typical South-East Asian diet which usually includes salted vegetables, fish and eggs. Dr Balwant adds that hot soups that are often part of the Chinese diet could also be another dietary factor that increases the NPC risk.

People with a family history of cancer. Because cancers such as NPC have a genetic component that can be passed on from parent to child, people whose family members had NPC should consult an ENT specialist on how to reduce the risk and how to spot the symptoms of NPC.

People who are constantly exposed to chemicals that can cause cancer (carcinogens). This includes smokers and people who are exposed to occupational solvents or wood dust (as part of their work).

The Epstein-Barr Virus Connection

The Epstein-Barr virus has been strongly linked to NPC. A common theory is that the virus introduces its DNA into the cells in the nasopharynx, and this leads to abnormal changes in the DNA of those cells. These changes may be the ones responsible for the breakdown in control of growth, division and cell death that will eventually give rise to NPC.

Dr Balwant shares that diets high in salt and/or hot soups and foods may irritate the mucosal lining of the nose, which in turn makes it easier for the Epstein-Barr virus to infect the cells in the affected areas.

This link between NPC and the Epstein-Barr virus has led to the development of a blood test to screen for one’s risk of NPC. In this test, the blood sample is analyzed for antibodies specific for the Epstein-Barr virus – these are substances released by the immune system in the presence of the virus.

Is this test available in Malaysia? Yes. However, Dr Balwant notes that currently there is no standardized guideline for these tests. Therefore, we shouldn’t just rely solely on the test result as a confirmation as to whether we are at risk of NPC; we should instead use the result as a basis for further discussion with an ENT specialist. He or she can perform a nasal endoscopy to view the fossa of Rosenmüller for any evidence of a tumour.

How do we know if we have NPC? 

Dr Balwant shares that the people with the following symptoms are normally referred to an ENT specialist for further examination, in order to rule out NPC:

  • Hearing loss (usually in one ear). Dr Balwant says that this is usually the first symptom seen among people with NPC.
  • A lump on one side of the neck. Some people may have lumps on both sides. These lumps are usually not painful.
  • Persistent headaches.
  • Nosebleeds and/or blood in the saliva.
  • Facial numbness.
  • Double vision (diplopia).

Should we experience any of the above, it’s a good idea to see a doctor for further medical examination.

How is NPC treated? 

Radiation therapy. Cancer cells are very sensitive to radiation, so this remains an effective treatment option for many NPC patients. In this therapy, high-energy x-ray beams are aimed at the main nasopharyngeal tumour as well as nearby lymph nodes to destroy the cancer cells.

There are possible side effects, but most are temporary and will improve over time. One significant side effect that may be permanent is dry mouth.

“Dry mouth is caused by the salivary glands being damaged due to radiation therapy,” Dr Balwant explains. People with dry mouth cannot produce normal amounts of saliva, and hence they have problems eating and swallowing. Fortunately, there are medications (such as pilocarpine), mouth rinsers and assistive devices (such as a humidifier) that may ease the discomfort caused by dry mouth.

Chemotherapy. These are medications that are prescribed to kill cancer cells. Chemotherapy is often given alongside radiation therapy to optimize the elimination of cancer cells in the patient. It may also be given before radiation therapy begins to reduce the size of the tumour.

Patients may experience side effects from chemotherapy, but most of these effects are temporary in nature. Dr Balwant assures us that there are usually ways to reduce pain or discomfort caused by these side effects.
 

 

Side effects? Side effects are no doubt unpleasant, and the thought of them may discourage some people with NPC from seeking treatment. Dr Balwant encourages us to voice any concerns or doubts about treatment to our healthcare team. Most healthcare teams will be happy to have an open, honest discussion so that we can make the best choices for our treatment needs.
 


Surgery (neck dissection). This typically involves the removal of lymph nodes that contain cancer cells that do not respond well to other forms of treatment. If there is evidence of residual or recurrent tumour in the nasopharynx, it can be surgically removed via a procedure called endoscopic visualization or nasopharyngectomy.

NPC treatments may affect the patient’s speech, hearing, and ability to eat and swallow. Hence, many patients will be working closely with speech therapists and audiologists in the months following treatment completion to restore their quality of life. A dental specialist can help with management of dry mouth (if it occurs) and various aspects of dental health.

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Health: Tips on diabetes management

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Health: Tips on diabetes management

April 28, 2022   Return

Diabetes Management: Tips from A Pharmacist

Words Abraham Mathew Saji

Diabetes, the “sweet killer” which is the leading cause of cardiovascular diseases, kidney failure, blindness, amputations and stroke, can affect anyone from any age group and walk of life.

When we eat, our food gets converted to glucose or sugar in our bodies. The pancreas releases a substance known as insulin which enables the conversion of glucose to energy. In a person with diabetes, the pancreas fails to release insulin resulting in a high content of glucose in the blood. There are many reasons for the pancreas failing to release insulin, such as genetics, environmental and lifestyle, to name a few.

Some of the common symptoms of diabetes include:

  • Frequent urination
  • Increased hunger
  • Increased thirst
  • Blurred vision
  • Fatigue
  • Weight loss
  • Mood swings
  • Poor healing of wounds
  • Frequent infections

According to the Diabetes Country Profile for Malaysia published by the World Health Organization (WHO) in 2016, the prevalence of diabetes in Malaysia grew at an alarming rate.

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(Source: WHO Diabetes Country Profiles, Malaysia, 2016)
 

Diabetic complications are one of the key factors leading to cardiovascular diseases. The same 2016 WHO report indicated that diabetes and cardiovascular diseases put together are responsible for 39 percent of deaths in our country.

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(Ref: WHO Diabetes Country Profiles, Malaysia, 2016)
 

In conjunction with World Diabetes Day and with an eye on the alarming statistics surrounding diabetes in Malaysia, here are a few simple and easy-to-practice tips from your friendly pharmacist.

1. Avoid breaking or splitting your pills. Most of the medications for diabetes are formulated to deliver the active ingredients at a particular rate into your bloodstream. Breaking or splitting the pills can cause the formulated matrix to be disturbed, thereby playing havoc with the rate and extent of the active ingredients released. This can have adverse effects on sugar levels in the blood and in other systems in our body.

2. Avoid skipping your dose of medication. Often, people assume that it is acceptable to skip the dose of medication when they don’t eat, when they eat a smaller portion or when they are unwell. Our body can produce glucose from other sources beyond the food that we eat. Hence it is very important to take the medication regularly as prescribed.

3. Follow the instructions given at the time of dispensing, especially in terms of timing of consumption, food and other medications to be avoided. Some medications or food can have serious implications on your blood sugar levels and can also affect blood pressure.

4. Avoid self-medication. Some people may take a myriad of products in a bid to get diabetes-free early. They tend to self-medicate and take a high number of supplements in addition to the medications prescribed. This could lead to “drug-drug interactions” and result in another set of complications or diseases.

5. Follow the prescribed dose of medication. Some people consume double or a higher dose of the prescribed medication in hopes that it will ‘cure’ them sooner. The medication in its prescribed dose is optimized for each individual patient depending on various factors. Not following the prescribed dose can complicate the treatment regimen and worsen the condition.

6. Avoid delaying treatment. Some individuals delay the start of diabetic treatment as they believe that the medications could have side effects. Some people also attribute their diabetic condition to their body weight and start a rigorous weight loss programme instead of taking prescribed medications. Delaying treatment can cause one’s diabetes to progress to the next level, thereby warranting a higher dose or stronger medication.

7. Make lifestyle adjustments. Diabetes is well known as a lifestyle-related disorder, so changing one’s lifestyle can play a major role in the treatment. Eating frequent smaller portions of food, managing stress, sleeping well and getting sufficient exercise are some easy-to-adapt changes one can make.

8. Don’t be shy to ask questions. At the time of your medication being dispensed, feel free to ask any and all questions you have in mind. A few examples of such questions are: will I need to take this medication for life? What if I forget to take a dose of this medication? What are the side effects of this medication? Will this medication have any interaction with my other medicines?

9. Cut down on your salt intake. We tend to relate diabetes directly to the intake of carbohydrates or sweet food. Since pre-diabetics and diabetics are at a higher risk of developing cardiovascular complications or so-called “diabetes induced hypertension”, controlling salt intake is an essential part of management.

10. Reward yourself. Rather than getting discouraged upon diagnosis, reward yourself appropriately at every step of progress made during treatment, as diabetes is a chronic disorder and is to be managed progressively.

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It is very important to take diabetes in one’s stride and incorporate its management, rather than treatment alone, as a routine part of life. The diabetic patient is the most important participant in this management team and holds the master key to the success of the management process and enhancing the quality of life. The management process requires dedicated work with proper planning and commitment. Speak with your doctor, pharmacist or dietitian to see how else you can improve your diabetes care plan.

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Don’t Sweat It

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Don’t Sweat It

April 28, 2022   Return

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Do you sweat so much and so frequently that it makes you uncomfortable or embarrassed? Excessive sweating is actually a medical condition; it’s called hyperhidrosis. The good news is that there are effective methods to alleviate this condition.

 

Dr Ch’ng Chin Chwen

Consultant Dermatologist

 

Words Hannah May-Lee Wong

When we’re stressed or worried, people may tell us, “Don’t sweat it.” But for some people, this is not an option. Excessive sweating that is not normal is called hyperhidrosis. Affected individuals can sweat so much that it soaks through their clothes or even drips off their body. Excessive sweating can happen throughout the day and can cause quite a bit of discomfort and embarrassment. Dr Ch’ng Chin Chwen, a dermatologist, answers our questions about this sweaty problem.

Is this a common problem among Malaysians?

It is quite common. But a lot of people don’t know there is such a disorder and that they can do something about it. Hence, they do not take any measures or see a doctor. I get patients who come in for other conditions, then they talk about their excessive sweating and they are surprised when I tell them there are treatment options available for it.

Is hyperhidrosis prevalent in certain groups of people?

Normally, the people seeking treatment are teenagers or young working adults. I don’t usually see elderly patients complaining about hyperhidrosis. It’s probably because teenagers are more self-conscious and concerned about self-image. As for young adults, they would want to get treatment because it might affect their work.

What causes hyperhidrosis?

It’s mainly caused by genetics. In some people, their sympathetic activities are a little more active causing the eccrine sweat glands to produce more sweat. There are also certain hormone-related issues, for example, thyroid disease or overactivity that may cause one to sweat more. Women going through menopause may get hot flushes and sweat a lot.

Which areas of the body produce excessive sweat in a person with hyperhidrosis?

Some people sweat excessively in a localized area, for example the palms, armpit, feet, chest, thighs or back. Others may sweat excessively throughout the body.

Are there triggers for excessive sweating?

Yes, people tend to sweat excessively when they are anxious or nervous. Heat and exercise also cause sweating, but it is normal to sweat when you are exercising.

How can a person tell when their sweating is ‘normal’ and when they should see a doctor?

One of the methods for testing is the iodine-starch test. We can paint iodine onto areas that are excessively sweaty, such as the palms and armpits. You will be able to observe a change in colour in the sweaty areas. That said, I rarely use the test in practice because it all depends on the individual and how much his or her life is affected by hyperhidrosis.

If you sweat a lot but it doesn’t bother you and you don’t think it needs to be treated, it’s fine.

Whether or not a person seeks treatment depends on his or her job, self-image, lifestyle and the degree of sweating. If your hands get too sweaty, they become slippery and holding onto objects can be difficult. Some people sweat excessively on their thighs and it can be very embarrassing when there are wet patches on their clothing.

Most times, those who do seek help have a localized area of excessive sweating rather than generalized whole body sweating.

How does excessive sweating affect a person’s daily life or functioning?

In professions that require use of the hands, excessive sweating can make it difficult or even dangerous when carrying out certain tasks – for example, wielding a hammer or even driving a vehicle.

When there’s an important occasion like an interview or a big meeting, there may be lots of hand-shaking involved and it can be embarrassing if your palms are too sweaty. Furthermore, sweat in the armpit is associated with bad odour, which affects both men and women.

On top of that, as people tend to sweat more in stressful situations or when they feel anxious, it can become a vicious cycle because a person is anxious or worried about their sweating which results in even more sweating.

How is hyperhidrosis treated?

Treatment options depend on which part of the body is affected and whether it’s localized or generalized excessive sweating. In terms of new developments, there has been a newly approved treatment for hyperhidrosis that isn’t in Malaysia yet, but perhaps it will be available in the near future. The medication comes in the form of wipes and they can reduce sweating.

More traditionally, we use products that contain aluminium chloride to reduce sweating. They come in a solution and patients apply them topically every day. There are also anti-perspiratory roll-on products that contain aluminium chloride, available in pharmacies. Take note that you will have to apply these products on a daily basis.

Be aware that some deodorants only help to control odour, not sweating. Remember to check the label for active ingredients.

Botulinum toxin injections are a more long-lasting treatment option. The effect of each injection lasts six to nine months. It can be injected into the palms, feet or armpits by a doctor. These injections can reduce sweating in those areas by about 80 percent.

Iontophoresis is a treatment which passes low level electric currents through the skin. The patient’s palms or feet would be submerged in a shallow tray of water while the electric currents pass through. (This method is not feasible for the armpits, for obvious reasons.) It is effective in reducing sweating; however, the drawback is that it can be inconvenient. A patient has to have the treatment four times a week, ideally. And since it requires a medical device, the patient will have to go to a hospital or clinic for every session, which is time consuming. Each session only takes around 30 minutes, but treatment usually goes on for a few months. Once sweating is reduced to a satisfactory level, the patient can reduce the frequency.

Another option is surgery. The outcome is permanent and will completely stop sweating in certain areas. But I would not recommend this method. Surgery for treatment of hyperhidrosis involves removing the sympathetic nerve at the armpit so that you don’t sweat there anymore. But there are a few downsides to this. Firstly, as with any other surgery, there are risks involved – infection, bleeding, hospital admission and there is a very small risk of puncturing the lung. But more pertinently, quite a number of patients regret their decision of undergoing this procedure. This is because they may end up with ‘compensatory sweat’ in other areas although there is no more sweating in the area that had undergone surgery. Compensatory sweat can get quite severe, especially when you’re nervous.

Other non-permanent treatments like botulinum toxin injections allow doctors to adjust the dosing and make changes if needed. Usually, the doctor will give a dose that’s enough to reduce sweating without much compensatory sweating at other sites. Even if compensatory sweat occurs, the doctor can adjust and lower the dose accordingly at the next session. A surgical result is irreversible – there is no turning back.

For people with whole body, generalized excessive sweating, there are some oral medications available. But we have to use them with caution. Malaysia is a very hot and humid country, and people do need to sweat to regulate their body temperature. (Sweating helps to keep the body cool.) If the body needs to sweat but the process is suppressed with medications, the person might overheat, especially when he or she is active and exercising. If the body heats up too much, the person might get a heat stroke. As such, this option is probably more suitable for people who spend most of their time indoors and do not have active lifestyles.

Lastly, it may be worth mentioning that there is another localized treatment option using microwaves to reduce sweating by destroying sweat glands. Unfortunately, it is not available in Malaysia yet. This treatment is quite expensive but it reduces sweating more dramatically than botulinum toxin, and the results are permanent after three or four sessions.

As you can see, there are many treatment options to choose from. A doctor will work together with the affected individual to assess how severely hyperhidrosis affects his or her life, and whether it is worthwhile treating it, because these treatments have different costs.

Practical tips on dealing with heavy sweating

< >Try to control your anxiety or worry. If you have an anxiety disorder, get it treated.Use air conditioning on dry mode.Change clothing frequently.Use hand wipes.Apply anti-perspiratory products frequently.

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Enable The Disabled Understanding Down Syndrome

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Enable The Disabled Understanding Down Syndrome

April 28, 2022   Return

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WORDS ABRAHAM MATHEW SAJI

There are seven- and-a-half billion people in the world – with differing characters, skills and abilities. A staggering 15 percent of this global population are disabled, with 80 percent of them living in developing countries.

These figures are on the rise due to increased lifespan, increase in chronic lifestyle disorders and limited support. Unfortunately, there is still a negative attitude toward those who are disabled (perhaps better described as “differently abled”) due to discrimination.And these negative perceptions create barriers that deny equality and inclusiveness towards this population.

Since 1992, the United Nations has been observing December 3rd as a day to honour, respect and acknowledge those with disabilities. The theme for International Day of Persons with Disabilities (IDPD) this year is “Empowering persons with disabilities and ensuring inclusiveness and equality”.

According to the International Classification of Functioning, Disability and Health (ICF), disability is the interaction between individuals with an impaired function or health condition and environmental factors like discrimination or negative attitudes towards them. Disabilities can be of different types and severity, which affects one or more functions of vision, hearing, physical, speech and cognitive including mental and learning abilities.

Among the various impaired abilities, the most common disorder – causing cognitive, intellectual, growth and cardiac complications – is Down syndrome.

THE EXTRA CHROMOSOME

Also known as Down’s syndrome, the condition is named after the person who discovered it – British physician John Langdon Down. It occurs when a baby is born with an extra copy of the 21st chromosome. Every cell in our body contains 23 pairs of chromosomes; half received from each parent. A baby born with Down syndrome has an extra copy of chromosome 21, which means he or she has three copies instead of the normal two. This extra chromosome causes developmental deformities in the brain and other areas of the body. Most of the deformities are lifelong and capable of reducing life expectancy.

Several factors  could be responsible for the risk of developing Down syndrome:

  • Inheritance of genetic translocation from a parent
  • Family history
  • Earlier pregnancy with Down syndrome or other cognitive abnormalities
  • Age of the mother

While the age of both parents are contributing factors, the higher risk is from maternal age, as can be seen from the table below (data from a Swedish study by Hook E.B.):

Maternal AgeIncidence of Down Syndrome
< 30Less than 1 in 1,000
301 in 900
351 in 400
361 in 300
371 in 230
381 in 180
391 in 135
401 in 105
421 in 60
441 in 35
461 in 20
481 in 16
491 in 12

 

Other than these, there is no scientific evidence that Down syndrome is caused by any environmental factors or by the parents’ activities or lifestyles before or during pregnancy.

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SCREENING, SIGNS AND COMPLICATIONS

With advances in medical technology, it is possible to detect the likelihood of carrying a baby with Down syndrome during pregnancy. Ultrasound and blood tests can help to detect the problem to  some extent. Some additional prenatal tests to confirm the diagnosis are:

  • Amniocentesis – a sample of the amniotic fluid is tested for the number of chromosomes
  • Chorionic villus sampling – cells from the placenta are examined for the number of chromosomes
  • Percutaneous umbilical blood sampling – blood from the umbilical cord is examined for the number of chromosomes

However, some parents prefer to avoid these tests due to the associated risk of miscarriage.

Not every baby with Down syndrome will have all of the following characteristics, but the common observable physical signs may include:

  • Upward slant of the eyes
  • Flat face
  • Short neck
  • Abnormally shaped ears
  • Bulging tongue
  • White spots on the iris of the eyes (also known as Brushfield spots)
  • Single deep crease across the palm of the hand
  • Broad hand
  • Short fingers and a wide gap between the first and second toes
  • Late development of teeth, fewer teeth, irregular in sequence and with gaps between them

Additionally, there may also be an increased risk of neurological problems (epilepsy, memory and behavioural problems), endocrine problems (thyroidism and diabetes), cardiovascular problems (atrial and ventricular septal defects), gastrointestinal problems (duodenal, esophageal and anal atresia) and haematological problems (leukemia).

An infant with Down syndrome may be born average sized but have slower cognitive development. A child may exhibit impulsive behavior, short attention span, slow learning capabilities and poor judgement. They are also more prone to infections and can easily contract skin, urinary tract and respiratory infections which do not heal easily.

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LIVING WITH DOWN SYNDROME

Despite the grim list of possible complications and shortcomings, the outlook is not all bleak. With support and education programmes and access to quality healthcare, many people with Down syndrome are able to lead relatively independent lives. There is a wide variety of intervention and occupational therapy programmes to assist with various aspects such as sensory skills, motor skills, social skills, behavioural skills, speech and language and other cognitive abilities. These programmes can enable the child to achieve his or her maximum developmental potential, learn to communicate and be productive. Medical advances have increased the average lifespan of an individual with Down syndrome to about 55 years today; a great improvement from 20+ years just a few decades ago.

THE ROAD AHEAD

Let us keep December 3rd in mind and come together as a community to acknowledge and enable the disabled by helping to develop and foster a more inclusive environment for them. To date, they still need better access to education, focused skill or vocational training to prepare them for employment, improved healthcare facilities, better rehabilitation services, more recreational opportunities and less discrimination.

We can work closely with both governmental and non-governmental bodies to implement policies related to the wellbeing of the disabled, and promote and raise the level of awareness among the public.

Franklin D. Roosevelt, the famous American president who helped guide the United States of America successfully through World War II, was a wheelchair user during his entire term in office. He had contracted what was believed to be polio from drinking water at a campground during the start of his political career. The condition caused him to be paralyzed from the waist down. But he did not let that disability become an impediment to his career. He proved to the world that he was differently abled and till today is recognized as one of the top world leaders.

I would like to end with a quote from  Neil  Marcus, an American actor and playwright who is active in the development of disability culture: “Disability is not a brave struggle or ‘courage in the face of adversity’. Disability is an art. It is an ingenious way to live.”  HT

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As We Grow Older, Which Of Our Five Senses Will Be The First To Go?

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As We Grow Older, Which Of Our Five Senses Will Be The First To Go?

April 28, 2022   Return

WORDS LIM TECK CHOON

There is no clear- cut answer to that question,” consultant geriatrician Professor Dr Tan Maw Pin says when we ask her this question. “There are many factors to consider.”

For one thing, the answer depends on whether the person has any existing health conditions. Someone with type 2 diabetes, for example, may find their sense of touch being affected by the condition over time, especially if their diabetes is not properly controlled.

Other factors may include physical geography and cultural elements. People in the Himalayan region, for example, have a high prevalence of eye problems such as cataract. In Nepal, glaucoma (an eye condition that can lead to blindness) is prevalent as the people in that country age – a survey from the World Health Organization and the Nepal Blindness Survey estimated that the rate could range from 3.2 percent to as high as 9 percent. It is thought that the prevalence of these problems could be due to a combination of poor nutrition, lack of proper sanitation, the climate and other issues.

“There are many variables, and therefore which sense will be affected first by ageing can differ from person to person,” Prof Dr Tan says. “There is no ‘secret formula’, sadly, as everyone is a unique individual! It may be more worthwhile to focus on how we can go for certain screenings as we age to detect potential problems early.”

Let’s find out what these recommended screenings are.

BLOOD PRESSURE

Have our blood pressure checked every year or two.

Where? At any clinic.

Why? Age is a risk factor for high blood pressure. The older we are, the more likely we develop this condition. Earlier detection will allow for better management and reduced risk of heart problems in the future.

EYESIGHT

When we are 40 or older, we should go for an eye screening every 1-2 years.

Where? At an optometrist’s clinic.

Why? This is to check for eye problems such as glaucoma and cataract. Glaucoma is a leading cause of blindness, and our risk of developing this condition increases the older we are.

GUMS & TEETH

Contrary to popular belief, we lose our teeth as we grow older because of gum disease (periodontitis), not age! “It’s possible to have a full set of teeth no matter how old you are!” says Prof Dr Tan.

She recommends going to the dentist once every 6 months, so that gum diseases and other tooth issues can be detected and treated early.

TYPE 2 DIABETES

Age (45 years or older) is a risk factor for type 2 diabetes. The risk increases if we are also sedentary, overweight and/or have high blood pressure and other risk factors.

Where? At any clinic. The test consists of taking our urine sample and using a dipstick to detect the presence of glucose. If the results are normal, the doctor may recommend repeating the screening every few years.

An added advantage of this test is that we can also detect the presence of problems in the bladder or kidneys by analyzing the presence of blood, nitrites, protein and white blood cells in the urine sample.

Why? Early detection of type 2 diabetes will allow for better control and a delay in the development of health problems in the eyes, kidneys, heart and more. If we are found to be at risk of developing type 2 diabetes, the doctor can advise us on making the necessary changes to our daily habits to prevent this.

 

IF WE HAVE A FAMILY HISTORY OF HIGH BLOOD PRESSURE, HEART DISEASE OR TYPE 2 DIABETES, IT IS WORTHWHILE TO BE SCREENED FOR THESE CONDITIONS EVERY YEAR OR TWO.

WHILE SOME SCREENING TESTS MAY SEEM EMBARRASSING OR UNCOMFORTABLE, THE BENEFITS MAY BE WORTH THE TEMPORARY BOTHER

HEARING

Routine hearing screening is not viable due to the low pick-up rate, but Prof Dr Tan says that the test is actually quite simple.

The doctor will run some simple activities, such as whispering near our ears and asking us to repeat what has been said.

If we have difficulties hearing normal conversations, we should consult an audiologist for further examination.

CERVICAL CANCER

Women should routinely get a Pap smear every 3 years from the time they turn 21 years old to the time they hit 65. This test is useful to detect cervical cancer and other abnormal conditions of the cervix.

BREAST CANCER

Women are advised to go for a mammogram every 2-3 years from the time they turn 45 or 55 (different guidelines offer different age suggestions), earlier if they have a family history. We can discuss this further with our doctor.

After the age of 70, the benefits of breast cancer screening are not clearly defined, but some people choose to continue going for it.

Where? Most hospitals and medical centres should be able to offer this.

Why? If breast cancer is detected while it is in an early stage, there is a higher chance of recovery.

PROSTATE CANCER

While there is a screening test for prostate cancer in men, called the prostate- specific antigen (PSA) test, Prof Dr Tan says that a more effective screening method is to have a physical rectal exam performed by a healthcare provider. It may seem like an uncomfortable or embarrassing experience to some people, but it is actually a simple and quick (about a minute or two) procedure. This method also allows for detection of haemorrhoids, lumps and other unusual growths in the rectal area.

MEMORY & BRAIN FUNCTION

Perhaps lesser known compared to other screenings, the memory test (also called a neuropsychological test) allows for the measuring of the capacity of our brain to function in areas such as memory and language skills. This test consists of simple question-and-answer sessions, and the results will be measured against a standardized model.

Where? Most government health clinics have special health documents for older persons which include memory screening. Also, Prof Tan mentions that it is recommended that doctors do this opportunistically when an older person attends their clinic or hospital.

Why? This test can allow for early detection of issues such as memory loss, dementia, Alzheimer’s disease and other often age-related brain function issues.

SOME COMMON SCREENING TESTS MAY NOT BE AS USEFUL WHEN WE GROW OLDER, WHILE OTHER TESTS BECOME MORE USEFUL.

These days, we can walk into any screening facility, and pick and choose for ourselves the ones we want from a list of available screening tests. However, we do not necessarily need to take all of them – some screening tests may actually offer negligible benefits to people in the older age group.

A ggod rule of thumb to follow is to first discuss with a are professional on the types of screening that will the most value for our Ringgit. HT

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