Category: Healthy Living

High blood pressure, also known as hypertension, is widely known as ‘the silent killer’ because people with the condition usually have no signs or symptoms. According to the National Health and Morbidity Survey in 2015, 30.3% of people aged above 18 have high blood pressure. That’s 1-in-3 people in Malaysia walking around with hypertension! Consultant Interventional Cardiologist Dr Ramasami Nandakumar highlights 4 steps you can take to control your blood pressure.

HERE ARE 4 STEPS YOU CAN TAKE TO CONTROL YOUR BLOOD PRESSURE:

1. CHECK YOUR BLOOD PRESSURE REGULARLY

You should get your blood pressure checked at least once a year. How often a person should undergo screening for blood pressure ultimately depends on his health. For young adults, it is alright to undergo yearly screenings. For older adults, it is necessary to check their blood pressure more frequently. Common risk factors for high blood pressure include being overweight, eating lots of salty foods, smoking and a sedentary lifestyle.

2. MORE BLOOD PRESSURE READINGS LEAD TO ACCURATE DIAGNOSIS

It is tricky to measure blood pressure because it continuously rises and drops. For example, it is common for blood pressure to increase when a person is nervous, usually in a doctor’s clinic, otherwise known as ‘white-coat hypertension’. Several blood pressure readings over a period of time are usually needed to confirm that a person has high blood pressure. Currently, there are two standard methods to diagnose high blood pressure accurately. Home Blood pressure Monitoring (HBPM) uses an electronic machine to measure blood pressure at home over a period of weeks at different times of the day. Ambulatory Blood Pressure Monitoring (ABPM) is an alternative and more useful method to measure blood pressure over a 24-hour period using a specialised monitor. This digital monitor actively keeps logs of blood pressure readings throughout the monitoring period and is correlated with activity. HBPM and ABPM are more accurate as the person is more relaxed at home compared to the doctor’s clinic.

3. GO FOR UPPER ARM CUFFS

People who opt for home blood pressure monitors should choose devices with the cuff which should be worn on the upper arm. The cuff must fit properly to produce accurate readings.Finger and wrist monitors are not reliable because of inaccurate readings and the readings must be converted as the wrist blood pressure is different to that of upper arm blood pressure. Patients should consult with their doctor for suitable recommendations.

4. PRACTICE A HEALTHY LIFESTYLE

It is important to adopt a healthy lifestyle to reduce your blood pressure. In fact, most patients need a combination of medication and lifestyle changes  to lower their blood pressure. Doctors recommend using the DASH (Dietary Approaches to Stop Hypertension) diet consisting of mostly fruit, vegetables and low-fat dairy products as well as moderate amounts of whole grains, fish, poultry and nuts. One of the most important changes is to reduce the intake of salt to 2300 mg of sodium or about a teaspoon a day. Another important change is to reduce the BMI (body mass index) to below 25 (23 for Asians). Weight loss can help reduce blood pressure and go a long way in improving  a patient’s life. Weight loss is usually achieved with a combination of diet and exercises such as brisk walking. Stress management and enough sleep also help to lower your blood pressure. HT

If you like this article, do subscribe here. 

Dr Shanthi Palaniappan   Consultant Gastroenterologist

Just mention ‘colonoscopy’ and many people will immediately think of a tube being inserted up one’s rectum – or ‘the back door’.

“Well, I won’t disagree with that definition,” Dr Shanthi tells us with a laugh. She explains that the tube is actually a flexible and thin device called a colonoscope. From the rectum, it can travel up the entire length of the colon. Modern advances have produced increasingly thinner and more flexible tubes, allowing for less discomfort and pain to the patient.

Let’s take a short quiz to see how well you understand the procedure. Just answer TRUE or FALSE to each statement.

1. Colonoscopy is only used to see what is happening ‘down there’.

FALSE. Yes, the colonoscope has a camera fixed to it to send pictures to a screen and allow the doctor to view the inside of your rectum and colon. This is useful for detecting abnormalities such as ulcers, polyps and even tumours. More advanced cameras can provide a complete 360° view, allowing the doctor a really good view indeed!

But there is more. Dr Shanthi explains that, nowadays, we can even remove any abnormal tissue found or collect tissue samples for further examination during a colonoscopy session.

2. It can be uncomfortable.

TRUE. Dr Shanthi says that a certain degree of discomfort is usually unavoidable. However, you will normally be sedated to reduce the degree of discomfort.

“In fact, often, patients just ‘go out’ before the procedure begins, and when they regain consciousness, the procedure has been completed and they do not remember anything about the it,” she explains.

3. There is a risk of bleeding and tearing.

TRUE, but do not panic. “The risk is about 1-in-500,” says Dr Shanthi, “so it’s not a common risk.” Bleeding and tearing can happen because the lining of our colon and intestines can be tender (especially when there is an ulcer or other problems).

“If excessive bleeding does occur during the procedure then the doctor normally will use methods of injecting medicines or clipping the bleeding vessel to circumvent the bleed,” she adds.

4. One has to drink a large amount of unpleasant-tasting liquid before a colonoscopy.

Again, TRUE. But while very few people will claim that it is delicious, Dr Shanthi explains that the liquid – or colon prep – can come in flavours such as orange to improve the taste.

You will not have to drink everything in one go. Instead, you will be advised to drink a cup every few minutes and at given intervals leading up to your colonoscopy session.

The colon prep is necessary to clean the colon and allow the doctor to get a clear view during the colonoscopy. Therefore, you will be going to the toilet often after drinking the fluid, and your stool will be soft and loose.

5. The colonoscopy result is accurate.

TRUE. Dr Shanthi explains that there are other ways to diagnose possible abnormalities in the colon, but colonoscopy is the only method currently that allows the doctor to see the actual lining (mucosa) of the colon.

Given its accuracy and its ability to allow the doctor to extract suspicious tissue samples in one session, the colonoscopy is the ideal front-line go-to diagnostic method. It is certainly cheaper than having to undergo several different diagnostic tests, and less time consuming too!

6. I have to stay in the hospital for a while after a colonoscopy.

FALSE. You can go home shortly after a colonoscopy. However, you may still be experiencing some after-effects of being sedated, so you should not drive yourself home. Dr Shanthi suggests to either arrange beforehand to have someone take you home or just take a taxi.

7. I only need a colonoscopy when something is clearly wrong ‘back and down there’.

FALSE. Screening colonoscopy is recommended for people over 50 to screen for colorectal cancer once every 10 years. Because colorectal cancer usually shows no symptoms until it has reached an advanced stage, screening is important to detect the cancer at its early stage. After all, early detection often means increased chances of recovery.

For those with a family history of colorectal cancer, they are recommended to start screening a little earlier – 10 years before the age of the youngest family member with cancer when he or she was diagnosed. For example, if that person in your family was 40 when the diagnosis occurred, you should start going for screening when you turn 30.

If you like this article, do subscribe here. 

Know your enemy

Have you ever wondered why it is so easy for us to keep getting the flu? And why it can be hard to get rid of?

This is because the flu virus keeps changing.

First, let’s take a look at how your body fights diseases. Germs, viruses and other disease-causing organisms usually have structures on their cells called antigens. These antigens are recognized by the cells of your immune system, marking the disease-causing organisms as enemies that need to be eliminated quickly. However, your immune system usually needs to first come in contact with a disease-causing organism to recognize its antigen. This is why, usually, it is harder for us to get a repeat infection.

The flu virus, however, can experience changes in its genetic materials, causing the antigens it express on its surface to be different from the ones carried by flu viruses of the previous season. Therefore, when this flu virus attacks our body, our immune system fails to recognise it as the enemy and does not attack immediately. So, we succumb to the flu.

Also, complicating the matter is that there are two main types of flu viruses – Influenza A and Influenza B – and there are many variations under each type.Different types and strains could be circulating every flu season.

The flu vaccine: It’s your best shot against the flu!

The flu vaccine contains inactivated flu virus, which will trigger our immune system to recognize the antigens on its surface as ones belonging to the enemy. However, because the flu virus is not active, it will not cause the flu. Think of the flu vaccine as a ‘training session’ for the ‘soldiers’ in our immune system!

The World Health Organization works closely with many health centers all over the world to collect data and identify current circulating flu viruses. Before the next flu season begins, health experts will come together to determine the type of flu vaccine that should be manufactured for the upcoming flu season.3

Therefore, each year, when you get a flu shot, the vaccine is always from a new batch, manufactured based on the health experts’ recommendation. It is designed to work against the anticipated types of flu virus in that particular season.

It is worth noting that the flu vaccine may not offer 100% protection. Each batch of flu vaccine is manufactured in anticipation of the type of flu virus that will be circulating in the coming flu season. There is a possibility that the flu vaccine and the flu virus of that season may not be a perfect match. Age may also play a factor – older people may not respond to the vaccine as well as younger people. Still, as long as you’ve had the flu vaccine, even if you do get the flu, it would most likely be a milder form.Therefore, the flu vaccine is still worth getting, all things considered! 

Sounds good. What kind of vaccine should I get?

There are two types of vaccine at the moment. The trivalent vaccine, which has been around for a while now, protects you against 2 types of Influenza A viruses and 1 type of Influenza B virus. The newer quadrivalent vaccine protects against 2 types of Influenza A viruses and 2 types of Influenza B viruses. It costs a bit more than the trivalent vaccine, but it offers a greater amount of protection.

Do I need the vaccine? I’m generally healthy and I can ‘survive’ a flu attack or two.

Perhaps, but flu medication is not cheap these days – what you spent on getting the vaccine may end up cheaper than what you will spend on medication. Furthermore, your life will not be disrupted and, who knows, your boss may look favorably at you for working like a trooper while your colleagues have to take MC one by one!

But there is another, probably more important, benefit to getting the vaccine: it protects your loved ones, especially those considered ‘high risk’.  Generally, the weaker one’s immune system is, the more one is at risk of complications caused by flu. People of the following groups are especially vulnerable:

• Children younger than 5, but especially children younger than 2 years old.
• Adults 65 years of age and older.
• Pregnant women (and women up to 2 weeks after giving birth).
• Residents of nursing homes and other long-term care facilities.

People with chronic medical conditions such as heart, lung, kidney, liver, blood or metabolic diseases (such as diabetes), or weakened immune systems.

A flu infection can cause pneumonia or worsen any existing medical condition in these groups of people, and in some cases, the complications may lead to death.

According to the World Health Organization, the flu affects about 5%-10% of adults and 20%-30% of children worldwide every year, with about 3 to 5 million cases of severe illness, and about 250,000 to 500,000 deaths.6 As you can see, flu is not a trivial matter – it can be deadly and we should take its threat on our health seriously!

Given how easily the flu virus spreads from one person to another, the flu vaccine, when given to them as well as the people around them (family members, staff, etc), offers the best protection against health complications caused by flu.

I hear there are side effects…

Most vaccines have the potential to cause side effects. The flu vaccine has been known to cause the following side effects:

• Soreness, redness, itching or swelling at the spot where the shot was administered.
• Low-grade fever.
• Body aches.

These side effects are generally mild and temporary.

There is also a very rare possibility of serious allergic reaction caused by the ingredients in the vaccine. Therefore, if you are allergic to egg, gelatin or any other medication, tell your doctor so that he or she can determine whether it is safe for you to get the vaccine.

Can’t I just avoid getting the flu?

Unfortunately, “avoiding the flu virus” is easier said than done.

The flu virus spreads very easily and quickly. All it takes is for an infected person to sneeze, cough or even talk within 2 meters (6 feet) from you. The droplets released into the air will pass the flu virus to you when you breathe them in.

Flu may also spread through contact with an infected person or with an object or surface that has recently come in contact with the person.9

There are ways to cut down your risk of catching the flu virus – avoiding contact with infected people, washing your hands with soap and water regularly, etc.

Realistically, though, it is not easy to avoid the flu virus, which is why many people are resigned to catching it every year.

Don’t bank on luck to keep you away from the virus. The flu vaccine is a more reliable form of protection – bank on it instead!

But I am scared of needles …

You are not the only one, don’t worry. Here are some tips that you can try to keep calm when you are getting your flu shot.

• While waiting to get your shot, distract yourself with a magazine, book, your phone or conversations with the people next to you.
• Tell your doctor or the nurse administering the shot that you are scared of needles. They will do their best to comfort and reassure you while minimising any discomfort you may feel.
• You can also bring a family member or friend with you for support.

Times are hard, and I should prioritize spending my money on more important things …

Health is important, and in the case of the flu vaccine, getting one is not that expensive. As you can see from the ‘Let’s get personal’ account, sometimes we do not know how important good health is until we face the repercussions of taking our good health for granted.

Let’s get personal.

Like most people, this writer never gives flu much serious consideration. “Flu? Well, I can just ‘man up’ and take it!” he thought, until he caught a really bad flu prior to writing this article. More sobering was how his usually healthy 5-year-old niece caught the H1N1 flu virus and ended up in hospital. No one knew how she caught it, but the H1N1 virus could have been easily safeguarded against with a flu shot. So, no more ‘forgetting’ to get a flu shot every year – he and everyone in his family would be getting one from now on!

Well, it looks like I should be getting the flu vaccine after all!

And you should, good for you!

[1] US Department of Health and Human Services. How the flu virus changes. Retrieved on February 23, 2016 from http://www.flu.gov/about_the_flu/virus_changes/

[2] Medline Plus. Immune response. Retrieved on February 23, 2016 from https://www.nlm.nih.gov/medlineplus/ency/article/000821.htm

[3] US Centers for Disease Control and Prevention. Types of Influenza Viruses. Retrieved from February 23, 2016 from http://www.cdc.gov/flu/about/viruses/types.htm

[4] US Centers for Disease Control and Prevention. What are the benefits of flu vaccination? Retrieved on February 23, 2016 from http://www.cdc.gov/flu/pdf/freeresources/general/flu-vaccine-benefits.pdf

[5] U.S. Department of Health and Human Services. Influenza (flu). Retrieved on February 23, 2016 from http://www.vaccines.gov/diseases/flu/

[6] World Health Organization. Influenza (seasonal). Retrieved on February 23, 2016 from http://www.who.int/mediacentre/factsheets/fs211/en/

[7] US Centers for Disease Control and Prevention. Key facts about seasonal flu vaccine. Retrieved from February 23, 2016 from http://www.cdc.gov/flu/protect/keyfacts.htm

[8] US Centers for Disease Control and Prevention. Vaccination: who should do it, who should not and who should take precautions. Retrieved on February 23, 2016 from http://www.cdc.gov/flu/protect/whoshouldvax.htm

[9] US Centers for Disease Control and Prevention. How flu spreads. Retrieved on February 23, 2016 from http://www.cdc.gov/flu/about/disease/spread.htm

If you like this article, do subscribe here. 

In Brazil, the country hit hardest by the Zika, distraught mothers queued outside infant wards, the line spilling even onto the streets, as they waited to see their infants, born with abnormally small heads. Neighbouring countries began warning couples to postpone having children until the outbreak is contained, while researchers are working overnight to uncover more about the link between the Zika outbreak and the birth of babies with abnormally small heads (microcephaly).

To date, up to 1.5 million people in Brazil are believed to have been infected, and the Zika virus had spread to more than 20 other countries and territories.

Blame it on the Aedes

The Zika virus is mainly spread by the female Aedes aegypti mosquitoes, the same ones that are responsible for spreading other diseases such as dengue, yellow fever and chikungunya.

There are also reports of the virus spreading through sexual intercourse with and blood transfusion.

What are the symptoms?

1-in-5 infected people will develop symptoms such as fever, rash, muscle pains, joint pains, headache, and red eyes (conjunctivitis). These symptoms usually show up around 2-7 days after infection, and last for up to a week. Patients rarely have to be admitted to hospital.

That doesn’t sound too bad…

Don’t be so certain. WHO and our Ministry of Health take the Zika threat seriously, for good reasons.

More and more evidence link the Zika infection in pregnant women (especially during the first trimester) to babies born with microcephaly – an untreatable condition caused by abnormal or incomplete brain formation. Children with microcephaly will experience developmental problems as they grow up, often requiring supportive therapies (such as for speech and movement). Since October 2015, Brazil has reported several thousand births of such infants.

There are also concerns that Zika may be linked to Guillain-Barre syndrome, a rare condition in which the immune system attacks the nerve cells in the body to cause temporary paralysis.

Still, Malaysia is a long way from Brazil.

We cannot lower our guard. After all, dengue is a problem in Malaysia all year round, caused by the very same mosquitoes that can carry and spread the Zika virus. More chillingly, Prof Dr Sazaly Abu Bakar, Director of the WHO Collaborating Centre for Arbovirus Reference and Research revealed in February that the Zika virus had been isolated from mosquitoes in 1969 in Bentong, Pahang.

What can we do to protect ourselves?

There is currently no vaccine or cure for Zika. The Ministry of Health recommends avoiding travels to ‘hot spots’ like the Americas and take measures to eliminate breeding spots of mosquitoes in one’s neighbourhood.

References:

The Star. Available at www.thestar.com.my

World Health Organization (WHO). Available at www.who.int

If you like this article, do subscribe here. 

Last August, we were suddenly bombarded with news reports of a typhoid fever outbreak in Malaysia. Later that October, a second batch of cases cropped up with areas such as Kuala Lumpur and Selangor seeing the highest number of cases. Thankfully, none of the cases resulted in deaths. However, the Ministry of Health still cautioned the public to practise vigilance due to a global health alert that a lethal strain of multidrug resistant typhoid was spreading across Africa and Asia.

The tea on typhoid

Induced by Salmonella typhi (related to the very bacteria which causes salmonella food poisoning), typhoid is transmitted through contaminated food, water or close proximity with an infected individual. Although there have been cases in developed countries, they are far and few in between. It is in developing countries (which have poor sewage sanitation and restricted access to clean water) where typhoid fever is a threat.

Symptoms typically present 1-3 weeks after one has been exposed to the bacteria and can range from mild to severe. While typhoid is characterized by increasing fever and extreme exhaustion, other symptoms to look out for include:

• headache
• appetite loss
• diarrhoea
• muscle or abdominal pain
• sweating
• dry cough.

It can be complicated …

Although Malaysia’s typhoid fever situation doesn’t seem serious, don’t let this disease fool you – its complications can be severe, if untreated. Perforation of the bowels or intestines, internal bleeding, sepsis (blood infection), pneumonia and meningitis are some examples.

Time is of the essence

If you experience symptoms which you feel might be indicative of typhoid, do get yourself tested. Aside from enquiring about your travel history (e.g. ‘have you visited any typhoid hot spots lately?’ or ‘have you eaten at a place with questionable hygiene practices?’), your doctor will check your blood or other bodily fluids like stools or urine for Salmonella typhi.

If your test returns positive and if your typhoid fever is still in its early stages, you will be prescribed with a 1-2 week course of antibiotics. More severe cases typically require antibiotic injections. Your condition should improve within several days but regardless, ensure you finish the entire course. If you don’t, the infection is likely to return and you could spread it to others.

Aside from taking medication, drink plenty of fluids (to avoid the dehydration that follows your fever or diarrhoea), have adequate rest and practise good hygiene.

Is there a vaccine for it?

Yes, typhoid fever vaccine is available in 2 forms – pill or injection. Your doctor will prescribe you with the form which best suits your health condition. However, neither form of vaccine provides 100% protection so precautions like consume only boiled or bottled water, wash hands regularly and eat thoroughly cooked food are a must. When it comes to food, abide by the mantra ‘Boil it, cook it, peel it or forget it’ to reduce your risk of developing typhoid fever as much as possible!

References:

Asia One. Available at www.news.asiaone.com

Centers for Disease Control and Prevention. Available at www.cdc.gov

IAMAT. Available at www.iamat.org

Mayo Clinic. Available at www.mayoclinic.org

NHS UK. Available at www.nhs.uk

WebMD. Available at www.webmd.com

If you like this article, do subscribe here.