Category: Healthy Living

Datuk Dr Zulkifli Ismail   Consultant Paediatrician & Paediatric Cardiologist

One of Datuk Dr Zulkifli’s closest childhood friends, Johanuddin, contracted polio when he was a child. He was not vaccinated against the wasting disease. Dr Zul, as he is popularly known as, recalls how, when they were children, he would help carry Johanuddin’s school bag for him. Johanuddin spent his early adult days using calipers on his legs, then needing a walking stick and later a crutch, before eventually having to use a wheelchair. As a close friend of that man, Dr Zul knows firsthand how a single vaccination could have prevented a disease that would affect a person for the rest of that person’s life.

Thus, it is not surprising that, in addition to being a paediatrician, Dr Zul is also well-known as a passionate advocate for vaccination as one of the most important means of prevention of selected infectious diseases. Earlier this year, he was involved in the writing and publication of the book Immunisation Controversies: What You Really Need to Know, which addresses common misperceptions harboured by many Malaysians with regard to vaccines. He is also an active key figure in the Malaysian Paediatric Association as well as parenting educational programme Positive Parenting (www.mypositiveparenting.org) and the vaccination education and awareness programme Immunise-4-Life (www.ifl.my).

With his credentials, we at HealthToday can’t think of a more suitable person to put on the hot seat.

#1: USD3.18 billion awarded to people harmed by vaccine.

The US Government established the National Vaccine Injury Compensation Programme (VICP) in 1988. Since that year, the Vaccine Compensation Court has awarded more than 16,000 families claiming to have been harmed by vaccines, for a total award of USD3.18 billion! Isn’t this evidence that vaccines can be harmful?

Dr Zul:

The number may seem frightening, but we need to take a look at the whole picture.

According to the US Health Resources and Service Administration website (which is run by the US government), over 2.5 billion doses of covered vaccines were distributed in that country from 2006 to 2014. There were 3,491 petitions handled by the Court, and 2,224 of these received compensation. This means that about 1 individual is compensated for every 1.2 million doses of vaccine distributed.

If you look at the number, it’s actually small. In fact, this figure is to be expected, as it corresponds to the risk of vaccine adverse events. For example, only one case of severe allergic reaction is reported for every 1 million doses of measles, mumps and rubella (MMR) vaccine distributed.

Therefore, when you see such numbers, there is nothing to be alarmed of. The risk of developing serious side effects is very small, and the doctor will ask you about your health status before administering a shot, in order to minimize this risk.

#2: Hannah Poling’s autism was caused by her vaccines.

We hear a lot about how the so-called research by Dr Andrew Wakefield, which linked vaccines to the development of autism in children, is thoroughly discredited. And yet, in 2008, the VICP awarded Hannah Poling over USD1.5 million when they determined that her autism developed after receiving five vaccines: diphtheria–tetanus–acellular pertussis, Haemophilus influenzae type b (Hib), MMR, varicella, and polio. So, Dr Wakefield is right, after all!

Dr Zul:

Pinpointing the cause of autism is not easy. We do not know, to this day, what the exact causes are, only that it is very possible that several factors can act in combination to give rise to the condition. We cannot simplify things by pinpointing to vaccines alone as the cause of autism.

With regard to Hannah Poling, this is not as clear cut a case as it seemed on paper. Hannah had several medical conditions from young (including frequent episodes of fever and otitis media), and it is possible that her autism may be caused by a combination of factors that may or may not include receiving her vaccines.

As for Dr Wakefield, he was exposed by a journalist, Brian Deer from the UK Sunday Times who had nothing to do with the medical industry (so no bias or self-interest there!), and he was found to have his own personal interests in seeing vaccines discredited. The research methodology used by him was deeply flawed, irreproducible, even fraudulent, and the paper was thoroughly discredited. So, there is no question as to whether he is right – he isn’t, and he is even barred from practicing in the UK, his own country. 

There are many research papers, published in respectable journals, which have demonstrated that vaccines do not cause autism. The autism claims are all based on a single paper that has been thoroughly discredited over the years. Which would you rather believe?

#3: Vaccines get recalled for safety reasons.

There are well-documented cases of vaccines being called back or withdrawn from the market due to reports of serious side effects. A rotavirus vaccine, for example, had been recalled after it was linked to intussusception, a rare bowel obstruction condition, among babies. Does this mean that members of the public are ‘guinea pigs’ for these pharmaceutical companies to test their products?

Dr Zul:

Let me start by saying that the way vaccines work has come a long way from what we were taught in school. These days, we have developed conjugate vaccines that stimulate the T-memory cells in our body. This improves the body’s future immune response against the specific infection. Therefore, the vaccines today are better, more efficacious and safer.

On the matter of recalls, again, we need to look at the big picture. The numbers of recalls are very small compared to the number of vaccines being distributed. This is because vaccines are continuously monitored by the manufacturer as well as doctors and other relevant authorities, both before and after the vaccines are in use, and often, recalls are made immediately after a cause for concern is discovered.

The rotavirus vaccine that you mentioned was taken off the market after it was found that it was directly related to intussusception in the babies who had received it. This actually proves that the authorities can force industry to stop distribution and production of any vaccine when there is evidence of severe adverse events.

Also, in Malaysia we usually receive vaccines some time (possibly several years) after they were in use in America or Europe, due to the stringent approval process by our Ministry of Health and other factors. By the time a vaccine is approved, its safety and side effects are already well documented. It goes without saying that only the safe-to-use ones will be approved in this country!

#4:Vaccines are not halal?

Muslims should not be expected to accept non-halal vaccines. It is not right!

Dr Zul:

To Muslims concerned about the halal issue, there is some good news: work is done to produce halal vaccines. While we don’t have release dates for such vaccines, we are getting there!

Meanwhile, the current vaccines may not bear the halal stamp, but Islamic bodies both in Malaysia and the rest of the world have stated that it is fine to use these vaccines.

As a Muslim, I am personally concerned about this matter, for myself, my family and my Muslim patients. I went and found out myself how these vaccines are made. While some vaccines may have ingredients taken from pigs, the end vaccine product contains no pig genetic material due to the manufacturing process that includes dilution and refining.  Polymerase chain reaction (PCR) tests on vaccines that use porcine material in their manufacture has revealed no pig DNA in them. This should allay any fears among Muslims in addition to the opinion of scholars.

Furthermore, the Quran states that it is the partaking, or eating, of pork that is forbidden. It does not prohibit the breaking down of porcine elements into molecules to produce a vaccine that will be injected into our body. 

#5: Vaccines are optional, not compulsory

Despite claims that it is our responsibility to vaccinate ourselves and our children, the government has not made it compulsory for us to do so. Is the importance of vaccines, therefore, overstated?

Dr Zul:

Making something compulsory is not as simple as just making and passing a law. I am not a politician, so I can only speculate, based on what is happening in the US, where some states require that certain vaccines must be given to children before they can enroll into school.

Some things to consider – do we want to deny children the right to education just because their parents did not arrange for them to be vaccinated? Would such a law only drive the anti-vaxxers more ‘underground’? There is also a need to create a body to address claims filed by people who feel that they have been harmed by vaccines, such as VICP in the US, as well as a compensation policy.

As you can see, making vaccinations compulsory is not so simple. Its implementation can have effects on other aspects of our lives, so everything has to be considered carefully. Therefore, whether or not vaccination is made compulsory does not change the fact that it is still an important preventive measure against potentially deadly infections.  There is no need to fear vaccination. After all, vaccines sitting on shelves don’t save lives, vaccination does!

References:

The New England Journal of Medicine. Available at www.nejm.org.

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

US Health Resources and Service Administration. Available at www.hrsa.gov. 

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Nothing can be more heart-aching than having to witness a loved one gradually lose themselves, forgetting things they supposedly know by heart and not being able to recall happy memories you both share. You dread the day when they forget your name, but that is often the case with people who have Alzheimer’s disease. After all, it is a disease which robs a person’s brain of its normal functioning. Even more terrifying is the likelihood that it could potentially happen to you in the future.

Award-winning journalist and bestselling author, Maria Shriver had her life touched by Alzheimer’s when her late father, Sargent Shriver, was diagnosed with the debilitating disease in 2003. Watching her father’s mind – which she described as “a finely tuned instrument that left people in awe and inspired” – slowly deteriorate until his death in 2011 prompted her to learn more about the condition. Ever since then, Shriver was a fervent advocate in raising public awareness and research funding for Alzheimer’s.

Her efforts have led to the production of a children’s book, What’s Happening to Grandpa?, the documentary series The Alzheimer’s Project, and the special report A Woman’s Nation Takes on Alzheimer’s. Shriver was also an executive producer of the highly-acclaimed movie Still Alice, in which actress Julian Moore plays a college professor who showed signs of early onset of Alzheimer’s. 

Shriver wants to send a clear message that Alzheimer’s is a disease, and not a natural part of aging. In her work, she emphasized that it is largely a “woman’s disease”, since women make up nearly two-thirds of those diagnosed in the US. Furthermore, more than 60% of unpaid caretakers to family members with Alzheimer’s are women who often ended up dropping out of the workforce to fulfil their roles.

While Alzheimer’s is a progressive brain disease with no cure, it may be prevented with healthy lifestyle choices, such as regular exercise, eating healthy and engaging in brain-stimulating activities. However, so many questions on the risk factors of Alzheimer’s in women are still unanswered. Hence, Shriver launched the Wipe Out Alzheimer’s Challenge campaign in 2015, to engage women as well as to promote education and empowerment on this disease.

Shriver went on to launch another initiative targeting women, called The Women’s Alzheimer’s Challenge, which held its first fundraiser and educational event in May 2016. The initiative is intended to fund gender-specific research on Alzheimer’s disease. As she noted in a 2015 CNN article, “Women are the epicentre of this crisis, which is why I believe they also have to be the solution”.     

References:

CNN. Available at www.edition.cnn.com

Huffington Post. Available at www.huffingtonpost.com

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We often refer to the most important component of something as the ‘backbone’ – the key element that holds everything together. When the human body is concerned, the expression takes on a literal meaning, since the spinal column is the most crucial series of bones that holds the entire musculoskeletal structure in place. Yet, many of us tend to take our spinal health for granted.  

Understanding Our Anatomy

According to the World Health Organization (WHO), spinal and bone problems are one of the greatest threats to our well-being, right after cardiovascular disease, cancer and diabetes. Indeed, the spine does more than just enabling us to stand upright; there are nerves running down the spine that control many of the body’s sensory, metabolic and various other vital bodily functions.

The spine consists of 33 individual bones – known as the vertebrae – that are interlocked together. The entire spinal column is divided into four regions: the neck (cervical), mid-back (thoracic), lower back (lumbar) and tailbone (sacrum and coccyx). Only the first three regions made up of 24 vertebrae are movable, while the remaining nine pieces that form the tailbone are fused.

When a Backache is Not Just a Backache

Do you often have to place one hand on your waist and hold on to something for support when getting up from a seated position? The backache could be just be a minor sprain or caused by something in your gene code, but whatever the cause, it is definitely an indicator that your spine is crying out for help.

“There are many different types and severity of spinal condition, from mild musculoskeletal conditions such as sprains and strains to moderate conditions like ‘slipped discs’, or severe conditions such as cauda equina syndrome that requires immediate surgical intervention,” explains Dr Rita Wong,  a registered chiropractor.

She further clarifies that problems in the spine can either be congenital and acquired. “Some spinal conditions have a strong genetic predisposition, such as scoliosis (a side bending of the spine) and ankylosing spondylosis (a chronic inflammatory autoimmune spinal condition). However, acquired spinal problems often result from lifestyle habits or trauma-related injuries,” says Dr Wong.

With so many possibilities that could cause backache, here are some significant signs and symptoms that may signal serious spinal problems. According to Dr Wong, they should not be taken lightly and require prompt medical attention.

• Pain that does not subside after a few days
• Frequent numbness or tingling in the hands and feet
• Significant muscle weakness or wasting
• Loss of deep tendon reflexes
• Onset of bowel or bladder dysfunction
• Sensory loss in the buttock area
• Pain that remains when lying down and causes sleep disturbances
• Fevers and chills that are accompanied by unexplained weight loss

Additionally, Dr Wong cautions those with a medical history of cancer to pay extra attention to spinal pain. “Breast, lung, gastrointestinal, prostate, renal, and thyroid cancers are more likely to metastasize in the spine,” she said. The same also goes for those who had suffered major or minor trauma from physical injuries, as they are at risk of developing serious mobility problems in the spinal column.    

Apart from these various possibilities, Dr Wong reminds, “Aging is the most common causes of spinal pain.”

The Perils of Modern Conveniences

For generally healthy individuals, spinal problems can develop gradually over time, often the cumulative result of prolonged lifestyle habits that ultimately take their toll. “Modern lifestyle has created many hidden problems for our spine. Immobility from prolonged sitting on office chairs and sofas causes back stiffness and radiating buttock pain, known as sciatica. People spend long hours in front of computers and mobile devices with their head tilting forward and mid-back hunching,” said Dr Wong.

Unfortunately, early signs of spinal problems are usually ignored or dismissed as tiredness from overworking or harmless muscle strains. If you habitually work before a computer for hours on end, and exercise less than three hours per week, these signs may be a cue to start paying attention to your spinal health:

• Bone cracking sounds can be heard when you move your neck, back or joints
• Your neck and back have poor range of motion
• You often feel tired or have difficulty concentrating
• Your feet turned out when you walk
• You tend to slouch when sitting or walking
• You experience pain in the eyes, shoulder, neck and lumbar region

Move that Body!

Maintaining good spinal mobility and slowing down the effects of aging comes down to an obvious yet often overlooked fact: Our bodies are not meant to be sedentary. “Movement is the key to a healthy spine. I would recommend people to get up and walk around every 30 minutes at home or in the office. When driving long distances or taking long flights, be sure to move around every hour. Take a pit stop, or go to the washroom to promote spinal mobility throughout your drive. Some light stretches should also be done on our neck and back every morning and evening, before we start and finish work, in order to condition our muscles and ligaments for the daily activities we take part in,” Dr Wong  said.

While sports and workout-related injuries are among the common causes of spinal problems, the right kind of exercises is also the best prevention. According to Dr Wong, a strong core is the foundation to minimizing injuries.

“Core strengthening is more than just achieving six-pack abs. Developing strong core muscles may actually help prevent back pain by making you less susceptible to back injuries and maintaining proper posture. If you think about it, your core supports the spine, which is the axial skeleton of your body. It needs to be strong to assist in distributing the weight load of your entire body. By improving your core strength, you will also be less likely to rely on other back pain treatments and remedies. Core exercises should involve the major muscles in your abdomen, including your internal and external obliques and the transverse abdominals,” she advises. However, staying active is only half the equation. 

Nourishment for Your Spine

“A healthy spine includes maintaining the well-being of body structures such as bones, muscles and spinal discs,” says Dr Wong. This means ensuring one maintains a balanced diet rich in the essential vitamins and minerals.

Since the spine is basically bones, sufficient calcium intake is important to maintain bone density and prevent osteoporosis. While it does protect from brittle bones that may happen with aging, Dr Wong would like to debunk a common myth about the role of the go-to mineral for bone health, “Calcium does not prevent degenerative joint disease (osteoarthritis). It only supplies mineral to promote stronger bones. Degenerative joint problems usually result from the wear-and-tear of the joint, which is part of the aging process. After repetitive stress, the joint space became narrowed, but taking calcium would not increase the joint space, or reduce the degenerative process.

Luckily, calcium-rich foods sources also contain plenty other nutrients that promote overall spinal column health. Dairy products, dark leafy vegetables, tofu, nuts, lentils and beans are not only rich in calcium, but also iron, magnesium, and Vitamins, A, B12, D and K.

“Iron also aids in the production of myoglobin, an important element of healthy muscles that are needed to support the spine. Magnesium aids in the relaxation and contraction of muscles. It also helps maintain muscle tone and bone density, which in turn can help prevent back problems. Vitamin A is an antioxidant that assists the immune system in fighting off diseases, and helps with tissue repair. Vitamin B12 is beneficial to the bone marrow. Vitamin D helps to improve calcium absorption, which is important for the development of strong and healthy bones to prevent osteoporosis. Finally, the combination of vitamin K and calcium works to maintain strong and healthy bones,” Dr Wong elaborates.

She adds that fruits high in Vitamin C, such as citruses, kiwis, strawberries and tomatoes should also be the staple of one’s diet. “Vitamin C contributes towards the development of collagen tor healing injured tendons, ligaments and vertebral discs, as well as for keeping bones and other tissues strong,” concludes Dr Wong.

References:

Mayfield Clinic. Available at www.mayfieldclinic.com

Ge, T. (2015, Fall). Health Bones Part 1: Healthy Spine, Healthy Body. Meditation & Health; 5(2): 12

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Professor Datin Dr Chia Yook Chin   Professor and Senior Consultant, Department of Primary Care Medicine, Faculty of Medicine, University of Malaya

Sarah Lian, TV personality and actress, is one of those adults who experienced firsthand the misery and pain caused by dengue. Like most Malaysians, she knows about dengue, but she never seriously gave it a thought until she had dengue in 2014.

“I was not sure how I contracted the disease,” she recalls, “but there was a construction site near my apartment – that could have been the cause.”

Fortunately, she recovered, thanks to early treatment as well as partaking in papaya leaf juice, a popular traditional remedy. Papaya leaf juice is clearly a drink that she is not too fond of, judging from her expression as she mentions it!

However, the uncertainties and misery she experienced while receiving treatment jolted her from the apathy she originally felt when it came to dengue. Today, she is an active advocate for dengue awareness, and she encourages Malaysians to take a more active role in eliminating the threat of dengue in our lives.

“I am proof that dengue can affect anyone and everyone,” she says, and reiterates the importance of each and every of us doing our part to eradicate the threat.

Uncertainties and Misery

“Patients with dengue go through quite a large amount of uncertainty, discomfort and fear ” says Professor Datin Dr Chia Yook Chin.

According to her, we currently do not have any specific medications for dengue. Antibiotics do not work on patients with dengue; treatment currently involves supportive care for the patients. Such supportive care includes:

• Painkillers or analgesics for pain.
• Fluid replacement (orally in mild cases, intravenous drips in severe cases).
• Medications to lower fever.
• In severe cases, blood transfusion and other bleeding management methods may be necessary.[1]

As you can see, patients with dengue can undergo considerable amount of uncertainty discomfort  and misery, and they may even face the possibility of death in particularly severe cases.

Additionally, there is the fear and worry that the patient and their family go through, beginning from the diagnosis process. “The wait for a diagnosis can be agonizing,” says Dr Chia. The affected patient has to come daily for blood tests, and sometimes it may take a while for the results to come in. There is also always the fear that the patient’s other family members would be affected by the disease.

When it comes to dengue, prevention is certainly a much more favourable and dependable option than cure. Let us take a look at how we can all do our part to protect ourselves from this disease.

First steps, first

• Cover the gully trap of your sinks or install an anti-mosquito valve in each one.
• Remove the tray of your air-conditioner. Hire a contractor to redirect the water from the air conditioner to the bathroom.

Every day, to keeps the mozzies away

• Turn over or cover containers, bowls, plates and other utensils that can collect water.
• Throw away all unwanted containers that can collect water.
• Always cover your dustbin.

Every 2 days, for better protection

• For flower pot plates, discard collected water every two days and scrub the plate thoroughly to remove mosquito eggs. (It’s best not to use these plates in the first place!)
• Change the water in flower vases. Flush the roots of the plant with running water, and scrub the inside of the vase thoroughly to remove mosquito eggs.

Once a week (that is what weekends are for!)

• Clear drains of fallen leaves and other forms of blockage.
• If you keep a garden, clear debris and remove any stagnant water collected on leaves and branches.

Every month, for maximum protection

• Clear roof gutters of blockages, and add some bleach solution or Bti insecticide. You can also use insecticidal paint on your roof gutters. 
• In areas where the collection of stagnant water is unavoidable (such as at the playground near your house), add in some Bti insecticide or bleach solution.

If your area has plenty of mosquitoes

• Wear long-sleeved shirts and long pants or skirts.
• Place mosquito screens on doors and windows.
• Use a mosquito net when you go to sleep.
• Watch out for signs and symptoms of dengue.

[1] Medscape. Dengue treatment and management. Retrieved on Sept 17, 2015 from http://emedicine.medscape.com/article/215840-treatment

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