Category: Health

WORDS PANK JIT SIN

Hi there. It’s me. Your friendly neighbourhood health writer. World Asthma Day is around the corner and there are important things you need to be reminded about it.

 

1. Asthma is a chronic disease. It affects your airways leading to the lungs. While you may have heard of someone growing out of asthma, the truth is their airways have broadened or their symptoms lessened.
2. Asthma can strike at any age. Just because you didn’t have asthma as a child, it doesn’t mean you’re scot-free. In fact, older people who develop asthma may have a difficult journey in getting diagnosed, as it is similar in symptoms to diseases such as emphysema and heart disease.
3. My kid will never be a competitive sportsperson! Well, you’re wrong. Proper management of symptoms will allow a child to lead a normal life and this includes being competitive in sports and even going on to achieve greatness. David Beckham (the world-famous footballer), Jackie Joyner Kersee (the Olympian) and Kashyap Parupalli (an elite Indian badminton player) all achieved greatness in spite of asthma.
4. Steroids in the inhalers will cause problems in my kids when they grow up. The misinformation about steroids in inhalers have been going on for generations. It needs to stop. The amount of steroid in each puff is miniscule. The steroids used in asthma inhalers are very safe and have a very low risk of side effects even over many years of use.
5. Not everyone experiences the same symptoms. Symptoms may differ from person to person. Because of this, treatment for every asthma sufferer is also different. Some may need larger doses of inhalers; some may even need to take oral steroids to bring their airway inflammation under control. The key message here is—please visit your doctor regularly for checkups and maintenance.

Every year, the worldwide authority in asthma management decides on a theme and helps empower organizers around the world to undertake their own World Asthma Day event. The body is known as Global Initiative for Asthma or GINA. GINA collects scientific information from existing research and updates the guidelines on asthma treatment periodically.

This year’s theme is ‘STOP for Asthma,’ with STOP being the acronym for Symptom evaluation; Test response, Observe and assess and Proceed to adjust treatment. The acronym is for doctors to quickly recall the steps to undertake each time they see patients with asthma. It is also helpful for persons with asthma to know the basic steps in managing and modifying their treatment each time they go for a follow up with their doctor.

Remember, asthma doesn’t need to be problematic and does not translate to a poorer quality of life. All you need to do is get it under control. The sky is still the limit! HT

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WORDS MAK WEN YAO

On every first Tuesday of May, health advocacy groups and educators from around the globe celebrate World Asthma Day where they strive to improve awareness of the airway disease. As asthma continues to burden both the patients and the health system, it is high time for us to further understand what asthma really is, and what we can do to minimise its impact.

UNDERSTANDING WHAT ASTHMA REALLY IS

Asthma is a chronic condition where the airways become inflamed and stimulated to produce excessive sticky mucus. The bronchial tubes of an asthmatic patient, or the air passageway that connects the windpipe to the lungs, will become narrow as the muscles surrounding them constrict in response to the noxious external stimuli. As these tubes struggle to remain open, the patient’s ability to breathe also becomes compromised. 

An asthma attack is frequently described as having to struggle to draw a full breath, often accompanied by coughing, wheezing, and an overall tightness across the chest. When the airway becomes constricted and obstructed by thick mucus, the patient has to spend every ounce of energy just to draw in enough oxygen to make it to  the next breath. This could be a harrowing experience to patients and uninformed family members. Some patients say, “It’s like drowning in air.”

However, people with asthma may experience the disease in other ways. The condition is largely dependent upon the types of the trigger and other aggravating factors. A mild attack could last only minutes and resolve spontaneously without any treatment, while severe attacks could span hours and may require hospitalisation.

Asthma is a non-communicable disease that is common among children but can affect adults as well. According to the National Health and Morbidity Survey in 2011, more than 1-in-20 Malaysians self-reported that they suffered from asthma (6.4%). In addition, many patients or family members are not fully aware of the disease symptoms or the appropriate management of the condition. The head of the Ministry of Health’s Pulmonology Services, Dr Jamalul Azizi Abdul Rahaman, once said that out of 2 million patients with asthma, only 6% were well controlled. “There is low awareness of the disease, leading to poor compliance,” said Dr Jamalul Azizi.

COMMON CAUSES OF ASTHMA ATTACK

1. POLLUTION                        
2. PETS                         
3. DUST               
4. CHEMICALS                
5. MOLD

Although we have yet to completely understand the fundamental causes of asthma, we now know that the exposure to certain environmental particles or inhaled substances could cause an asthma attack.

Research has revealed a delicate interplay between the physical and psychological components of an asthmatic patient. Available scientific evidence points to a relationship between heightened emotional arousal, such as extreme anger or fear, and dyspnoea—difficulties in breathing—in asthmatic patients.

 Certain household medicines could trigger an attack as well. Aspirin and a group of painkillers known as the non-steroidal anti-inflammatory drugs (NSAIDs) may cause symptoms in certain patient populations. NSAIDs such as ibuprofen or naproxen are thought to increase the production of some pro-inflammatory chemicals in our body that can cause asthma attacks.

It is important to understand that asthma may not always manifest in the same way. Each individual may respond differently even if they were exposed to the same aggravating factor. It would be essential to understand how the body reacts when exposed to a potential allergen and take the appropriate steps as recommended by the doctor.

ASTHMA TREATMENT AND CARE

While there is currently no cure for asthma, the condition can be well controlled if managed appropriately. Advances in medical care allow asthma medicine to be directly administered into the lungs,thus bypassing many unwanted side effects associated with systemic treatment method. The inhaler is, by far, the most extensively used option, but certain patients may have to use a nebuliser (a machine that helps one breathe in the medicine as a mist through a mask or a mouthpiece) or depend on oral medicine as an add-on treatment to the inhaler.

The array of treatment options and medical devices can be confusing. It is important to discuss any treatment option with your doctor and pharmacist in order to gain the best benefits and avoid any asthma emergency.

There are generally two types of asthma treatment:

1. The quick reliever

• functions as the rescue medicine to rapidly relax muscles around the airway during an asthma attack.
• relieves symptoms of breathlessness and helps the patients to regain control of their breathing.

For example, short-acting beta- agonists.

2. Long-term controller medicine

•  functions to prevent asthma attacks.
• reduces inflammation of the airway, making it less likely for allergens to trigger an attack.
• may be given in a combination of inhaled and oral medicine.

For example, long- acting beta-agonists that relax the airway muscles and corticosteroids that reduce airway inflammation and swelling.

USEFUL TIPS

Are you using your inhaler properly?

1. Always shake the inhaler canister before use. This action will mix the active drug well with the propellant to deliver the right dose into the lungs.
2. Your lips should form a tight seal around the inhaler to ensure the dose reaches its target.
3. Time your breathing appropriately while using the inhaler. Breathe out completely and take a deep breath while pressing the canister.
4. Hold your breath for around 10 seconds with your lips closed and then breathe out slowly after a puff is delivered to allow for the medicine to exert its effect.
5. If your doctor prescribed a second puff, wait for about 1 minute. Then, repeat the steps 1-4. HT

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Words Lim Teck Choon 

ENTirety with Professor Dato’ Paduka Dr Balwant Singh Gendeh Consultant Ear, Nose & Throat Surgeon Pantai Hospital Kuala Lumpur

 

Unlike our eyes, our ears do not have any protective lids to keep things from finding their way inside. Perhaps unsurprisingly, ear discomfort is common among those who spend a considerable amount of time in water. We have terms such as ‘surfer’s ear’, which describes a condition in which lumpy bony growth forms in the ear canal due to prolonged irritation from cold and wet conditions. More common, though is ‘swimmer’s ear’, which describes ear discomfort such as pain, redness and swelling.

Swimmer’s ear is commonly attributed to water finding itself into the ear, but the actual cause is infection. The medical term for swimmer’s ear is otitis externa, and it can happen to anyone, not just swimmers.

Let’s find out more about otitis externa this month with Professor Dato’ Paduka Dr Balwant Singh Gendeh.

WHEN OUR EAR CANAL HAS UNINVITED GUESTS

Otitis externa is an infection in the ear canal. Bacteria such as Staphylococcus aureus are the most common unwanted guests that trigger this infection, but it is also possible for fungi (such as Candida albicans) to trigger an infection.

Such infection commonly affects swimmers and other people whose ears are in contact with water for a simple reason: the water that gets into the ear creates a moist environment that encourages the unwanted guests in the ear canal to increase in numbers large enough to cause an infection.

However, Prof Dr Balwant points out that otitis externa is not just a swimmer’s problem. Anyone can be affected by it, so long as certain conditions are present for the unwanted guests to thrive in the ear canal.

“IF WE MAKE IT A HABIT TO REMOVE EARWAX TOO OFTEN, WE ARE MAKING OUR EAR CANAL MORE VULNERABLE TO UNWANTED GUESTS.”

A suitable environment. Our ear canal is dark and warm, which makes it a great place for many bacteria and fungi to move in and live. These guests feed on the dead skin, secretions and various other substances trapped among the fine hairs in the ear canal.

Moisture. Even if we don’t swim regularly, our unwanted guests rarely worry about being deprived of moisture. This is because we live in a tropical climate, where it is humid all year long!

WAIT, SO OUR EARS ARE ALWAYS VULNERABLE TO THESE UNWANTED GUESTS?

Not always. As Prof Dr Balwant points out, our ear has its own defense mechanism – our earwax. Earwax, or cerumen, is secreted in the ear canal and it is an acidic substance containing enzymes that inhibit the growth of bacteria and fungi. It also traps and removes debris and other substances that nourish these unwanted guests.

However, this is not a fool-proof mechanism. Excessive moisture spilling into the ear canal can dislodge the cerumen coating the ear canal. If we make it a habit to remove earwax too often, we are also making our ear canal more vulnerable to these unwanted guests.

1. Therefore, we should always dry our ears as much as possible after a bath, a swim or a hot sweaty day.
2. Also, we should only clean our ear canal once in about every three weeks.
3. We should also avoid inserting our fingers or foreign objects into our ear canals.

WHAT HAPPENS AFTER THE UNWANTED GUESTS MOVE IN?

Prof Dr Balwant points out that so long as our unwanted guests are living happily in our ear canal, there is a risk of infection. This is because the skin lining the ear canal  is very thin, unlike the skin lining elsewhere. Hence, it can be damaged easily due to frequent ear picking resulting in recurrent ear infection.

When there is a tear in the skin, the unwanted guests can move inside. This will trigger our immune system to react and get rid of these guests, resulting in the inflammation seen in otitis externa. The thinness of the ear canal lining and the ease in which it becomes damaged can cause recurrent infection.

LET’S HEAR MORE ABOUT THE SIGNS & TREATMENT OF OTITIS EXTERNA

WHAT ARE THE SYMPTOMS?

• Ear discomfort (otalgia), such as itchiness, ‘fullness’ inside the ear due to swelling, and pain that radiates to the face, neck and side of the head.
• Ear discharge (otorrhoea).
• Some hearing loss (usually temporary).

ARE THERE ANY LONG-TERM COMPLICATIONS?

If not treated properly, the infection can spread over time into surrounding tissues and even nearby bones. Increasingly severe hearing loss may also result.

These complications will require more complex treatments, possibly even surgery.

HOW IS OTITIS EXTERNA TREATED?

Prof Dr Balwant explains that most mild cases can be successfully treated using appropriate topical medications (such as eardrops, ointments or creams). If we are unsure as to what to do, we can seek advice from a general practitioner.

If still no improvements are seen, or if the symptoms are severe, it may be time to visit an ENT specialist.

HOW CAN THE ENT SPECIALIST HELP?

To properly clean the ear canal. The ear canal of someone with otitis externa is often clogged with earwax, debris and various secretions. (In fact, long standing impacted wax is one of the common causes of otitis externa!).

The ENT specialist will perform a procedure called ‘ear toilet’ or rarely  ‘flushing’.  Guided by direct visualization from a device called the otoscope, the specialist will use a medical device to create a gentle suction in order to clean the ear canal. If the debris and  secretions are thick and hard to dislodge through suction alone, the ENT specialist can use antibiotic or hydrogen peroxide droplets to soften them first.

To inspect the eardrum. Our eardrum allows us to hear. It is also a thin piece of tissue. During an infection, the weakened eardrum is especially vulnerable to damage.

The ENT specialist will inspect the eardrum to ensure that it is in good shape. If the eardrum is damaged, the use of water and other fluids (such as eardrops) will be avoided, as doing so may cause damage to other ear structures normally protected behind an intact eardrum.

Damaged eardrum can usually heal on its own after a few months, although sometimes surgery may be necessary. Treatment is determined on a case-by-case basis, so our ENT specialist may advise us on our options after performing an examination.

To determine the nature of the uninvited guests in our ear canal. Oral or topical antibiotics can help with getting rid of bacteria, but they do not work on fungi and viruses. Therefore, determining the type of the microorganisms that are giving us so much problem will allow the ENT specialist to prescribe the best treatment option.

What If Otitis Externa Keeps Coming Back?

Some people may experience long-term infection called chronic otitis externa. It’s more common among people with existing chronic skin- related diseases, such as eczema and psoriasis, as well as people with diabetes or conditions that affect the ability of their immune system to fight infections properly. People with chronic otitis externa should consult an ENT specialist for a proper treatment plan tailored for their conditions instead of self- medicating. HT

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WORDS PANK JIT SIN Almost everyone has a handy bottle of hand sanitizer in their pocket or handbag. These sanitizing products are either gel or liquid based and use alcohol as their main antibacterial and antiviral agent. Some have added chemicals like triclosan and triclocarban. The US Food and Drug Administration (FDA) recently banned the addition of triclosan in soaps and other sanitizing products such as hospital cleaning agents. They didn’t want bacteria to develop resistance to the chemical and render it ineffective in disinfecting hospitals and healthcare settings. HealthToday takes a closer look at triclosan in sanitizers to see how they affect our health. What doesn’t kill you As the saying goes, what doesn’t kill you makes you stronger. The same holds true for bacteria and viruses. At the top of the list is the risk of antimicrobial resistance to products containing triclosan. Hospitals and clinics use disinfecting products containing active ingredients like triclosan and possibly other antiseptics under the assumption these chemicals will kill all germs. If we were to use sanitizers containing the same germicides, the germs will slowly get used to the chemicals and develop resistance. A Canadian study in 2011 found that healthcare workers who used hand sanitizers were significantly more likely to fall ill compared to their colleagues who preferred to use soap and water. It looks like food Sanitizers have caused accidental poisoning of children. Some parents can be overzealous in keeping their children’s hands clean using sanitizers. Children like to put their hands in their mouths, and this will introduce alcohol and other additives found in hand sanitizers into their digestive system. Worse still, some sanitizers are attractive to young children who may drink it and suffer alcohol poisoning, which can lead to low blood sugar, coma and seizures. It can mess with your hormones Triclosan exposure has been associated with changes in thyroid gland, which produces hormones that regulate various body functions, and testosterone levels. It also increases oestrogen sensitivity of cells, thereby potentially speeding up puberty in girls and may have negative effect on boys. The evidence comes from studies on rats which involve oestrogen receptors. People also have oestrogen receptors so triclosan probably has similar effects on them. It can mess with your immune system Triclosan has been associated with an increased likelihood of developing allergies in a US study. While triclosan looks to be the major bad guy found in sanitizers, the US FDA also banned 28 other ingredients including, benzethonium chloride, chloroxylenol, chlorhexidine gluconate, and many more. In essence, FDA is telling users to stick to regular soap and water for their cleaning needs. Soap is a surfactant, which means it makes the surface slippery and prevents things from sticking to it. Lathering our hands with soap dislodges small particles and rinsing with water effectively washes them away, leaving our hands clean.   If you like this article, do subscribe here.

WORDS ABRAHAM MATHEW SAJI

Our liver is one of the major internal organs of our body that works nonstop to purify our blood as well as to produce and store essential micronutrients that are required by our body. When the liver is infected or sore, it fails to perform its functions and this results in the signs and symptoms manifested by hepatitis. The word hepatitis is a combination of hēpar or hēpat, which means liver in ancient Greek, and itis (the Greek word for inflammation). Thus, hepatitis simply means inflammation of the liver.

1. What Are The Causes Of Hepatitis?

Inflammation of the liver can be caused by various conditions, illnesses, some foods and drinks, certain medications and also viruses. Speaking about viruses, virus types A, B, C, D, E, F and G have been reported to cause infectious hepatitis. With medical advances and our quest for knowledge, the alphabetical list will only get longer. The most common are hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Of these, HBV and HCV can cause chronic hepatitis that can lead to conditions of liver cirrhosis and also liver cancer if left untreated.

Hepatitis A infections are often mild and can be treated easily compared to the others. Upon treatment and recovery, patients get immune to the virus. There is also a safe and effective vaccine available. This type is more common in places with poor hygiene and sanitation conditions.

Hepatitis B and hepatitis C infections can be caused by one or more of the following:

• Sharing needle with infected person
• Having unprotected sex with infected person
• Sharing personal items like toothbrush and razor blade with infected person
• Receiving a blood transfusion from an infected person
• Having a tattoo created using an unsterile or infected needl
• Bitten by an infected person
• Through lactation from an infected mother
• When the virus enter through a break in the skin.

Both HBV and HCV infections are treatable, depending on the severity of the infection. There is a safe and effective vaccine available to protect us from HBV. However, there is no vaccine yet against HCV. Ongoing research and medical advances may result in more effective prevention and treatment options soon.

2. What Are The Symptoms Of Hepatitis?

From the time when a person is infected with the virus to the development of symptoms is known as the incubation period. Each type of virus has varying incubation periods eg, 15–45 days for HAV, 45–160 days for HBV and 14–180 days for HCV. At the initial stages—also referred to as acute phase—some of the common symptoms are:

• mild-to-moderate fever
• loss of appetite
• fatigue muscle and joint aches
• nausea
• vomiting
• diarrhoea
• abdominal pain
• weight loss.

Symptoms of chronic hepatitis

 When the acute phase is left untreated, the disease progresses to the long-term (chronic) phase with the following symptoms:

• moderate-to-high fever
• jaundice
• abdominal swelling
• swelling of lower extremities of the body
• yellowness of skin, eyes and tongue (jaundice)
• blood in vomit or faeces
• itchy skin
• dark urine
• hives
• liver cirrhosis
• increase in liver enzymes and tumour markers
• liver cancer.

3. How Is Hepatitis Diagnosed?

As the symptoms of most infectious hepatitis are common, the diagnosis of the type and degree of infection can be done by thorough laboratory investigations like:

• Pathological blood tests that can detect the levels of enzymes, proteins and antibodies
• Pathological nucleic acid tests that can confirm the type of virus and its numbers
• Scans that can detect inflammation and any damage to surface of the liver
• Paracentesis, where a sample of the abdominal fluid is extracted and tested
• Liver biopsy that can detect cancer and extent of liver damage
• Elastography that measures stiffness of the liver
• Liver function tests that can help to identify liver disease.

4. What Are The Treatment Options For Hepatitis?

There is a wide array of treatment options available today and will depend on factors like:

• Type of infection
• Degree of infection
• Age and other underlying conditions of the person.

The treatment dose and duration may also be prolonged based on any or more of the above factors. Advances in research have seen treatment options moving from chemical-based medications to biotechnological interventions like monoclonal antibodies.

5. How Can We Prevent Hepatitis?

As the old adage goes, “An ounce of prevention is better than a pound of cure.” Some of the steps we can take to prevent being infected by hepatitis viruses are:

• Avoid injecting illegal substances into our body
• Avoid sharing of needles, toothbrushes, razors and other personal care items
• Practice safe sex
• Seek and share information with partner about any infection
• Wash hands properly with soap and water after using the toilet
• Consume safe drinking water
• Eat clean and fresh foods
• Ensure needles used in body piercing or tattoo have been sterilized
• Avoid or drink moderate amounts of alcohol
• Consult doctor for vaccination against HAV and HBV.

6. Love your Liver!

Here are some key steps we can take to ensure our liver stays healthy:

• Eat healthy and balanced meals
• Eat small portions of meals that can be easily digested
• Exercise regularly
• Maintain a healthy weight
• Avoid or drink moderate amounts of alcohol
• Consult doctor to ensure the medications we take don’t harm our liver
• Consult doctor before taking supplements

7. Is Recovery Possible?

Complete recovery from infectious hepatitis can be considered when:

• The causative virus has been completely removed from the bloodstream and liver
• Antibodies have been detected in the blood pointing to immunity
• The associated symptoms, which occurred during the infectious state have improved.

8. What Is The Situation In Malaysia?

In 2017, there was an estimated 1 million people who were chronically infected with HBV and an approximate 800,000 were positive for antibody to HCV. An effective nationwide vaccine coverage and the availability of affordable and effective treatment, which has been made possible by the Ministry of Health have been the reasons for these numbers being under control. Based on the newborn vaccination schedule, every newborn would have been immunized against HBV by the age of 6 months, with progressive doses at 1, 2 and 6 months. HT

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