Category: Lifestyle

Warm versus Cold

April 29, 2022 Return

WORDS DR AU YONG PUI SAN

Sport Medicine Physician

Are you confused with the conficting information that you have read online or shared by your friends – why does one injury need ice while another needs a warm compress? Perhaps you are puzzled why a cold and/or warm compress were applied at certain times during physiotherapy sessions. For the fourth article in our series on sports injuries, a sports medicine physician explains when you should apply warm and cold therapy for sports-related injuries.

Warm therapy comprises warm compress, warm towels, heat-producing electrotherapeutic modalities and basically anything that provides heat or warmth.

In the same manner, cold therapy includes ice, cold compress and cold-producing electrotherapeutic modalities.

A cold pack is recommended if active inflammation is present especially in acute injuries such as:

acute (newly occurring) muscle strains or tears
acute ligamentous sprains or tears
acute fare of arthritic joints which includes knee osteoarthritis
new bruising due to contusions to soft tissue
delayed onset of muscle soreness (DOMS).

In a nutshell, if you have any injury that causes sudden pain and there is increased warmth in the painful area, you will not go too wrong by applying a cold pack.

WHY IS A COLD PACK USEFUL FOR THE ABOVE CONDITIONS?

There will be bleeding and hematoma (blood clot) in acute soft tissue injuries. Sometimes, the bleeding takes a while to stop which is why you will experience swelling. If the bleeding is superficial enough, there is bruising on the skin. With the new injury, there will be onslaught of inflammatory cells and chemicals that aid in the future process of regeneration of normal tissues.

However, swelling and inflammation causes severe pain and disability so much so the person suffering from the injury cannot proceed with early rehabilitation or even just daily activities of living. Therefore, a cold pack helps to constrict the blood vessels thus reducing the amount of cumulated swelling and controls the number of inflammatory cells entering the injured area.

With the reduction in swelling and number of inflammatory cells, so does the pain felt by the injured person.

A cold pack also to a certain degree, slows the nerve conduction of pain signals to and from the injured area to the brain thus it will be interpreted as reduction in pain.

When it comes to DOMS, the pain felt is due to micro trauma to the muscles caused by physical activity thus it will react exactly like an acute injury but with a much lesser extend and pain subsides quickly. Depending on pain tolerance, sometimes cold therapy is not even necessary but if the discomfort is affecting daily activities, it is advisable to apply a cold pack to ease the symptoms.

“IN A NUTSHELL, IF YOU HAVE ANY INJURY THAT CAUSES SUDDEN PAIN AND THERE IS INCREASED WARMTH IN THE PAINFUL AREA, YOU WILL NOT GO TOO WRONG BY APPLYING A COLD PACK.”

LET’S LOOK AT WARM THERAPY

Indications for warm therapy:

Tight or spastic muscles
Stiff joints – chronic arthritis (not during fare-ups)
Any musculoskeletal discomfort or aches and pains that do not have any symptoms of acute infammation such as no increased warmth of the painful area, no swelling and defnitely not very painful.

Now let’s look into the reasons for the above indications. Muscles that are tight or affected by spasms should ideally be stretched out. However, stretching out tight muscles from the get-go can be tough therefore a warm compress is helpful in this situation. A warm compress increases blood flow to the area thus ‘warming up’ the muscle for stretching making the process much easier.

Sometimes, a warm compress can be applied before you stretch as it helps you stretch faster. This is also the basis of Hot Yoga and Bikram Yoga where the heated surrounding helps you get into the yoga pose.

A warm compress helps to increase blood circulation to stiff joints and the surrounding muscles especially in chronic osteoarthritis. It also eases the movement of the joints for easier and more conducive physical therapy. This is why patients with knee osteoarthritis almost always start with applying warm towels or compress to their knees prior to physiotherapy sessions.

However, sometimes arthritic joints tend to flare or become acutely inflamed due to walking too much so a cold compress is better. In a nutshell, the choice between warm or cold therapy depends on the symptoms.

As long as there are no symptoms of acute injuries or inflammation, a warm compress may help reduce musculoskeletal aches and pains. Many people prefer a warm compress over cold as it is more comfortable.

HOW WOULD YOU APPLY A COLD AND/OR WARM PACK?

For acute injuries or inflammations, apply a cold pack for 20 minutes and repeat every 2 hours. A note of caution when using a cold pack – it is advisable to protect your skin with a towel before applying the ice as direct cold contact to skin can cause a phenomenon known as ice burn, which is as painful as heat burn.

For those who are just returning to sports after an injury, it is better to use a cold pack over the previously injured region almost immediately after sports to prevent possible discomfort or swelling. The use of cold pack can be gradually reduced as participation in the sports become more regular and pain free.

Apply a warm pack over applicable areas for 15-20 minutes prior to stretching tight muscles or for physical therapy in arthritic joints. To prevent heat burn, protect your skin with a towel. HT

“A WARM COMPRESS INCREASES BLOOD FLOW TO THE AREA THUS ‘WARMING UP’ THE MUSCLE FOR STRETCHING MAKING THE PROCESS MUCH EASIER.”

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Let Yoga Heal Your Body And Mind

April 29, 2022 Return

WORDS PANK JIT SIN

This may not be the most well-known fact, but June 21 is International Day of Yoga. The worldwide celebrative day is still fairly new as it was incepted in 2015 by the United Nations General Assembly. However, yoga is anything but young. It is believed to have originated in India around 3000 B.C. with stone carvings of persons in yoga poses being found in the Indus Valley, which is one of the main civilizations during the Bronze Age. The word ‘yoga’ is derived from Sanskrit and means to join or unite, which is a reflection of yoga’s aims of uniting the body and consciousness.

Since then, yoga has seen many changes and in more recent times, different forms or styles of yoga have been introduced, catering to different needs—physical, mental or spiritual. While it should ide- ally be practiced in totality as the benefits of the trinity are syner- gistic, yoga is fine being practiced for its physical benefits. In other words, yoga has been split into its components to cater for the needs of the modern human.

Why do yoga?

Scientifically sound studies point to yoga’s effectiveness in improving many conditions including multiple sclerosis, asthma, irritable bowel syndrome, hypertension, drug addiction, osteoarthritis and mental health issues. It doesn’t take a genius to figure out why yoga is so beneficial for health. It is a low impact exercise and the various poses and stretches performed in yoga improve fitness and blood circulation throughout the body. The end result is improved oxygen delivery to all parts of the body and improved flexibility of the body without the negative impact of injury of more physically demanding sports such as futsal or squash.

The breathing exercises performed during yoga are also good in reducing anxiety, stress and depression—a study concluded that yoga can be considered a complementary medicine as it can reduce a disease treatment costs by reducing the use of medication. It is quite obvious that the calming breathing exercises and shift in focus away from one’s illness are the key reasons for yoga’s potency. Meditation and breathing exercises can help one be ‘present,’ thus improving a person’s mental wellbeing. By being in the ‘now,’ worry about the past and anxiety about the future can be washed away, leading to a present and alert frame of mind.

Jojo Struys, the yoga instructor

Mental health and stability is an important aspect of overall health. Jojo Struys, the famous TV celebrity, yoga practitioner, and cofounder of OhanaJo Studio, says she frequently meets people who suffer from insomnia and are stressed. She can see the signs and symptoms especially in new mothers and people who work long hours. “They [the people who work long hours] come back from work and they can’t disconnect from work,” said Jojo. Similarly, when these people wake up, the first thing they do is check their emails or messages. Should a disturbing or negative message come in early in the morning, that sets the mood for the rest of the day. It destroys one’s initiative to meditate and exercise, which are essential to the mental and physical health of the person. “The world can wait another 20 to 25 minutes. It is important to look after our thoughts and ensure the first part of the day is set aside for yourself, before you interact with the world.”

In light of the mental and physical benefits we can gain from practicing yoga, let’s do some sun salutations now! HT

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LIVING IT UP AT HOME

April 29, 2022 Return

WORDS LIM TECK CHOON AND HANNAH MAY-LEE WONG

Being stuck at home can get lonely and perhaps a little boring; but social distancing is an important step in curbing the spread of COVID-19. Everyone must do their part to stay home as much as possible for this exercise to work, so it’s time for you to get comfortable in your own den.

If you’re stumped on ideas of things to do at home, here are a few suggestions to get you going:

Do some cleaning

With all that extra free time, try the KonMari way of tidying up. Tutorials on folding clothes and such are available on Youtube. If you’re overwhelmed with information at first, this useful guide to help you get started.

Get creative!

Leisurely creativity relieves stress, boosts confidence and increases productivity. Got a musical instrument lying around? A ukulele, keyboard, guitar or harmonica? It’s time to dust them off and learn a new song. If you aren’t musical, find your own outlet to get creative. Great ways include journaling, painting, photoediting, sewing, singing and so on.

Don’t forget to exercise

In this global health crisis, it’s more important than ever that we take good care of our health. Get moving at home by doing simple stretches, taking an online yoga class, doing push-ups, dancing and so on.

Be a home chef

Eating takeaway food can get pricey over time, so why not make a delicious meal at home, just the way you like it? Remember to keep it healthy: incorporate complex carbohydrates, plenty of leafy greens, and the right amount of good fat and protein. If you’re feeling fancy, finish off your meal with a serving of fruits for dessert, paired with some slow brewed coffee or tea. HT

Diabetes Care – Part 1

April 29, 2022 Return

Professor Winnie Chee President, Malaysian Dietitians’ Association

Being diagnosed with diabetes does not prevent anyone from living a fulfilling life! Although there is no cure for diabetes, it can be treated and controlled, and some people may go into remission. Diabetes management is about lessening or reducing complications which typically come with the condition, so that you may live your life as normally as possible.

For starters, you have to get your head around the issue. Be mentally prepared, and get hold of the support you need in view of the lifestyle changes you are about to go through. Family, friends and support groups can help to provide you with ample encouragement and motivation that you will need in order to succeed.

When faced with diabetes, the key point is managing your blood sugar levels. Take your medication, and balance your food intake with medication; perform regular exercises; manage your stress levels and cultivate good sleeping patterns – these are essential lifestyle tips to keep your blood sugar levels as near to normal as possible every day.

Eat Sensibly

People with diabetes know that they need to take control of their eating habits because blood sugar levels in our body are directly affected by the foods we eat. While there are no special diets for diabetes, it is prudent to choose foods sensibly but not at the expense of its enjoyment!

A diabetes diet is an eating plan that is high in nutrients and fibre; low in fat, sugar and salt; and moderate in calories – now doesn’t it sound like a healthy diet for everyone as well? The only difference is that you need to pay more attention to your food choices.

Controlling Carbs

Carbohydrates are the body’s main source of glucose (sugar) to provide energy to fuel the brain and the muscles. If you have diabetes, excessive intake of carbohydrate foods will lead to high blood sugar levels and poor control of diabetes.

Do not stay away from carbohydrate foods altogether; instead, remember that in order to maintain your blood glucose level at a stable level, your carbohydrate intake should be consistent for each meal. Eat the similar amount of foods containing carbohydrate for each meal as advised by your dietitian.

It is advisable to choose starchy carbohydrate foods which are high in fibre to prevent sharp rises in your blood sugar level. Some of the options for this are wholegrain bread, brown rice, oats, chapati, wholegrain noodles/ pasta and wholemeal biscuits. In addition to these starchy foods, there are other sources of carbohydrate you need to watch out for in your diet, such as fruits, beans, milk, yogurt, and sweets – eat these in small amounts according to your meal plan.

Load Up on Greens

Loading up on vegetables, especially green leafy ones will assist in blood sugar control, weight control as well as promoting a healthy heart. Ensure at least half of your plate or bowl is filled with vegetables (preferably lightly sautéed and not too oily) and always have a serving of fruit after each meal.

Choose Wisely when Eating Out

If you do eat out regularly, go for restaurants which offer a variety of meal choices so that it is easier for you to stick with your meal plan. Reduce your food portion size by requesting for less noodles/ rice and avoid dishes with thick gravy (example sar hor fun or mee ladna) or foods fried with flour/breaded (example, chicken chop) as they have the add-on carbohydrates and fat. Order options with lower fat content such as steamed, braised or roasted dishes. You could also opt for more vegetables and have a serving of fruit for dessert.

Regular Mealtimes

For individuals who are on fixed doses of insulin and/or taking oral medication for diabetes, it is important to maintain regular mealtimes to prevent fluctuation in blood sugar levels and optimise the effects of the medication. A regular meal time also helps to regulate appetite and assist in weight control efforts.

Maintaining a Healthy Weight

Type 2 diabetes and obesity are closely linked; reduction of bodyweight improves blood sugar control and decreases the risk of heart disease and other complications of diabetes. Losing just 5% of your body weight through exercise and sensible eating can improve blood glucose levels, reduce blood pressure, reduce blood cholesterol levels – making you feel more energetic and healthier.

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Surviving Anxiety

April 29, 2022 Return

Vanitha Chandrasegaram Dramatherapist/Trainer, Integrative Creative Movements

Several years ago, as a trainee dramatherapist doing my practical training at a mental hospital in London, I had the chance to work with an elderly man who used to be a pilot with the RMAF and who was based in India. He had anxiety disorder. It was interesting to think how courageous he must have been when performing his duties, and yet, decades later, was diagnosed with this condition. He was afraid to even step out of his own home to take the bus to the hospital psychiatric daycare for his biweekly sessions!

Although he had initially agreed to attend the group dramatherapy sessions, I would always to convince him to come for the session for at least 10 minutes before each session began. At the end of the sessions he always informed the group about how glad he attended the session that day and the benefits that he had gained. But he always needed to be persuaded to attend every session.

As the therapist of the group, I always began with a 2-minute breathing meditation – mainly because of this particular client. The meditation always helped him calm down and participate in the session without feeling anxious.

Symptoms of anxiety

This patient is not alone – many people suffer from anxiety disorder. Some of the physical symptoms include: a pounding heart, dizziness, stomach upset, shortness of breath, headaches, muscle tension, insomnia, frequent urination or diarrhoea.

The emotional symptoms of anxiety include: feeling tense and jumpy, feelings of apprehension or dread, irritability, trouble concentrating, expecting the worst situations, restlessness, always looking out for signs of danger.

What are the causes of anxiety?

There may be several causes of anxiety. It may be a symptom of other mental health issues such as substance dependency, depression and withdrawal of long-term substance abuse.

It can also be a symptom of a physical disorder or changes in hormonal levels. This is why it is always important to have a physical check up with your physician before reaching any other conclusions.

It also may be caused by the repression of traumatic experience(s) or grief from the past. Each individual has a different story.

What to do if you experience anxiety?

First, consult your physician. If physical illness is ruled out as a cause of your anxiety, consult a counselor, therapist or psychologist.

These are some self-help techniques you may try if the anxiety is perhaps due to a stressful event that had just occurred in your life, and the feeling has not lasted more than a few days. I still strongly suggest consulting your physician if there are any other underlying physical ailments that may be contributing to the anxiety. It is important to always remember that the mind, body and emotions, all work as one.

Self-help options that may help reduce anxiety:

Meditation, such as breathing techniques, creative (positive) visualisation techniques.
Exercises such as walking, swimming or yoga, which are low-impact and calming.
Reduce caffeine intake. Caffeine is a stimulant and for an individual experiencing anxiety, it may aggravate their condition.
Reduce or eliminate alcohol intake.
Maintain a healthy diet. There is a certain truth about the adage ‘we are what we eat’.
Have sufficient sleep. Some individuals require more sleep than others.
Positive affirmations. Affirmations reinforce our beliefs. Positive affirmations help in turning one’s fears into hopes.
Do not get attached to mental health labels such as ‘anxiety disorder’, ‘depression’, etc. I remember a client who had joined internet support groups to help him with his disorder. Although this helped initially, his strong identification with the label and sense of belonging with that group seem to have contributed to the delay of his recovery process. A person is greater than whatever mental health challenges he or she may be facing. Holding on to labels may limit the capacity to recover and transform.
Focus on the present. Anxiety is based on fear and fear is mostly associated with negative past experiences or the imagined future negative experiences. Most of my clients find, the present to be usually quite safe. This is why meditation helps. Its main focus is in the present.
Write a list of joyful thoughts. As human beings, it is often difficult not to focus on the past or the future. Therefore, focusing on joyful moments from the past and possible joyful events in the future is a better option than the negative thoughts. Like everything else, this comes with practice.
Keep a journal. Writing in a journal may help because it gives a space for the individual to express his or her fears and what he or she is anxious about. This is important, as repression of one’s fears can only increase one’s anxiety in the long run. This method is useful especially if the person does not have anyone to confide his or her fears and worries in.
Be around nature. Generally, being around nature has a calming effect on our general well-being. Being around nature can as simple as resting under a tree, sitting by the beach, looking at trees and flowers, or even just looking up at the sky and noticing the formation of clouds.
Find something you love to do and engage in it regularly. For example, if you like painting, dancing, cooking or anything else, make time to do it often. The more pleasurable things you do in your life, the less anxious you will feel about life in general.
Keep a gratitude journal. Write a minimum of 5 things that you are grateful for each night before you go to bed. It can be something as simple as ‘breathing with ease’ or ‘connecting with a loved one’. This allows you to focus on the good parts of life.

Each individual operates differently. Therefore, some suggestions may work better than others for each person. Try them out and see what works best for you.

If symptoms persist for more than a few days or there seems to be no physical reason for the anxiety, I would highly recommend therapy or counseling.

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Ana, Mia & Me

April 29, 2022 Return

How frequently do we look in the mirror and say “If I could just lose 10 kg, then I would be happy”? Extreme body image disturbances may be part of body dysmorphic disorder, also known as “imagined ugliness”. Individuals with this disorder may have a totally distorted view of what they actually look like. They usually spend hours assessing, attempting to conceal, or obsessing over their perceived flaws. These extreme body image disturbances may lead to eating disorders.

Anorexia nervosa:

This disorder is indicated by an extreme fear of increasing weight and these individuals essentially perceive their bodies to be bigger or “fat” albeit being grossly underweight.

Anorexia nervosa is nicknamed “Ana” – be wary if you notice your child frequently visiting “pro-ana” online sites, as they promote anorexia nervosa as a “lifestyle”. Other signs to watch out for:

Extreme weight loss (though, this could also be due to other reasons such as dieting – don’t rush to assume the worst!).
Picking at food and other distracting habits to hide the fact that she is not eating.
Insisting on taking meals alone in her room.
You find uneaten food hidden around the house or discarded in the dustbin.
She constantly complains about how fat she is, even when she is already very thin.

Bulimia nervosa:

Individuals with this disorder are also very disappointed with their bodies and have extreme concern with body image. It is an eating disorder characterized by binge eating and engaging in inappropriate ways of counteracting the bingeing (such as using laxatives) in order to prevent weight gain.

Bulimia nervosa is nicknamed “Mia”. Be wary if you notice your child frequenting “pro-mia” sites. Other signs to watch out for:

She eats only when nobody is around (such as when everyone is asleep), or always goes out to eat alone.
She eats an unusually large amount of food, but shows no weight gain.
You find a lot of food going missing around the house, or an unusually large amount of food wrappers left in her waste basket.
Insists of exercising strenuously after eating.
Goes off to use the bathroom shortly after every meal (often turning on the taps to hide the sound of vomiting); bathroom often smells of vomit after she uses it.

Eating disorders are complex and often require professional assistance from a team of clinical psychologists, dietitians and other healthcare professionals.

If left unchecked, eating disorders can lead to life-threatening consequences. Therefore, if you suspect that someone in your family has an eating disorder, kindly seek professional assistance and information.

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Are You Doing It Right?

April 29, 2022 Return

Dr Manimaran Subramaniam Consultant Orthopaedic Surgeon

It is not enough to do the right thing in life; we need to do the right thing the right way. Ah, words of wisdom. Before you start questioning my sanity for waxing philosophical in an article that is about bone and joint health, rest assured – I was actually referring to playing sports and exercising. Now, why do I say this? What does the mantra ‘doing the right thing the right way’ have with working out and sports? “A lot, actually,” says Consultant Orthopaedic Surgeon Dr Manimaran Subramaniam.

He goes on to explain, “Malaysians have become more health-conscious these days. Aside from eating healthier, more of us are working out. Gyms are mushrooming all over the place. You see great turnouts at marathons and triathlons. There are also more people, especially youngsters participating in extreme sports such as skateboarding and mountain biking. Even those who aren’t into vigorous exercises are making an effort to be physically active with simple activities like brisk walking and jogging.” While it is great to see more people getting off their bums and into the gym, Dr Manimaran says that an issue has arisen: sports injuries.

“Every physical activity poses some risk of injury. Sports injury refers to an injury which arises directly or indirectly from any sports activities. This is why it’s so crucial for us to not only do sports and exercises but to do it the right way,” he stresses.

Acute vs. chronic

Sports injuries are divided into two types: acute and chronic. How do we know which is which? Dr Manimaran explains that acute injuries occur suddenly when playing or exercising. Sprained ankles, strained backs and fractured hands are some examples. You may have an acute injury if you experience the following:

Sudden severe pain
Swelling
Difficulty in placing weight on leg, knee, foot or ankle
An arm, wrist, elbow, hand or finger that is very tender
Unable to move a joint normally
Extreme weakness in the leg or arm
A bone or joint that is visibly out of place.

Meanwhile, chronic injuries happen after a person has played sports or exercised for a long time. Signs to watch out for include:

Pain when playing sports or exercising
A dull ache when resting
Swelling.

Must I see a doc?

When asked if all sports injuries warrant attention from a healthcare professional, he replies, “There are some injuries which you can treat on your own. This is where R.I.C.E. comes in.” No, we are not talking about the Malaysian food staple. R.I.C.E is a self-care method which helps to alleviate pain and relieve swelling.

R for Rest

Rest is the most effective way to begin the healing process after an injury. A sprained muscle is weak and susceptible to further injury, especially within the first few hours.

I for Ice

The effects of ice are most significant within the first two days of injury. Applying ice to an injury can help relieve pain and prevent swelling as this reduces blood flow to the wounded area. To avoid your skin from becoming too cold, use a cold pack or a bag of frozen peas (wrapped in a towel) instead of ice. If you do use ice, don’t place the ice bag directly on bare skin as frostbite can occur. Apply the ice for 15-20 minutes at a time; allow your skin to return to normal temperature in between icings.

C for Compression

An elastic bandage wrapped firmly around an injury can further prevent swelling and ease pain by keeping the area somewhat immobilized. The bandage doesn’t necessarily keep you from moving, but it can remind you not to move it. If a wrapping causes tingling or numbness in the extremity, remove it and rewrap the area more loosely. It shouldn’t be so tight that it causes discomfort or interferes with blood flow. Even gentle compression can help keep fluid away from the injured area.

E for Elevation

Propping an injury above your heart levels helps fluid drain away from the wounded area while reducing swelling. If you can’t elevate the injured area to a level above your heart, try keeping it at the same level or close to it. If you suffer an injury in the hips or buttocks, lie down with a pillow situated below your buttocks or lower back. This is to help lift the area of injury.

Aside from R.I.C.E., remember not to apply heat to the affected area during the first 72 hours as this will increase blood flow to that area.

When to get it checked

What about sports injuries which require medical attention then? How does one know when to see a doctor? According to Dr Manimaran, you need to get it treated by a doctor if you have the signs below:

Severe pain, swelling or numbness from the injury
Unable to put any weight on the injured limb
The injured joint is deformed or feels unstable
Recurrent injury at the same part of the body.

NSAIDS

There are several treatment options available but the type of treatment prescribed ultimately depends on the patient’s injury. Non-steroidal anti-inflammatory drugs (NSAIDS) for example, are given to inhibit the inflammatory process, and subsequently, reduce pain. NSAIDS are available in oral, patch or paste forms.

Physiotherapy

Post-injury physiotherapy is another key aspect of treatment. After assessing the patient’s injury, the therapist will initiate electrostimulation, ultrasound or cryocuff ice therapy to limit the effects of inflammation.

Rehabilitation

“The last thing you want to do while recovering is to inflict more damage to the injured area. After a certain period of immobilization, controlled movement of the affected area will help the patient to recover faster. With movement, comes stretching,” explains Dr Manimaran. “As the injury heals, scar tissue forms. After a while, the scar tissue will shrink. This shrinking brings the injured tissues back together. When this occurs, the injured area becomes tight or stiff. This significantly ups the risk of further injury. Hence to prevent the injured area from stiffening, stretching is necessary.”

He also cautions, “Don’t play sports until you can stretch the injured area without feeling any pain, stiffness or swelling. Even when you’re ready to play, start slowly and increase the intensity gradually.”

Surgery

When does an injury warrant surgery? “Surgical intervention is required to fix injuries that cannot be treated with the aforementioned methods. Examples of such injuries include torn Achilles tendons, fracture-dislocations of joints and torn anterior cruciate ligament of knee joints,” he explains. “If your doctor recommends surgery, ensure that you discuss matters thoroughly with them so you understand what the surgery entails and how long your rehabilitation is. All these factors matter because they will determine a good surgical outcome.”

Steering clear of injuries

Reiterating his earlier point, Dr Manimaran says, “Sport injuries are never a fun experience so why treat them when you can prevent them? This is why everyone needs to exercise and do sports the right way.”

Citing statistics, he says, “Lack of pre-exercise warm-up contributes to 50% of injuries. Warming up is highly beneficial as it warms up your muscles, gets your blood flowing and lowers injury risk. The easiest way to warm up is to work out slowly for the first few minutes, then pick up the pace. For instance, walk briskly for 5-10 minutes before running.”

But don’t just warm up; cooling down is equally important. “Cooling down post-exercise brings your heart rate and temperature back to normal. Cool down by ending your routine at a slower pace for the last 5-10 minutes.”

Other tips for minimizing your risk of sports injuries include:

Keep your body flexible by doing stretching exercises at least twice weekly.
Ensure you are approaching a particular sport with the right technique.
Listen to your body. If you feel pain when exercising, stop immediately. Don’t work through the injury. You can expect sore muscles post-workout but you should never feel pain when exercising.
Don’t be a weekend warrior. Trying to do a week’s worth of exercise in a day will strain your body tremendously.
Use proper sports attire and equipment. For example, wearing the appropriate shoes can protect you from both acute and chronic overuse injuries. Ensure your equipment fits you properly, is in good working condition, is used correctly and consistently and is the right design for your sport.

Dr Manimaran concludes, “Sports and exercise are excellent tools for staying fit and healthy. However, what’s more crucial is doing these activities correctly. That way, you will be able to enjoy them as long as you desire.” So, do it right, folks!

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The Sweetest Sorrows: Inspired & Staying Motivated

April 29, 2022 Return

Like every person with diabetes, surely you want to stay healthy. However, it can be challenging to change your lifestyle. To manage type 2 diabetes, you will need to unlearn habits that contributed to this condition, adopt new habits and continue to apply these changes to your life every day. This can be easier said and done, but it is possible.

Think positive

The right attitude keeps you motivated during challenging times.

View your diagnosis as an opportunity to step up your healthy lifestyle and get rid of bad habits that are holding you back.
Focus on the benefits you will get from these adjustments (better health, improved sleep, healthier weight, etc).

Know diabetes well

Understanding your condition and how you can control it will give you the confidence to take charge of your health and do what is best for you.

Read up on type 2 diabetes online or in books, and talk to doctors and dietitians to clarify your doubts and concerns.
Be careful of misperceptions and false information, though. Always check with your healthcare team if you are unsure.

Make your goals

Make long-term goals to give yourself a sense of direction as well as purpose. These could be lowering your blood glucose below a certain value, or spending more hours each day being physically active.
Also make short-term goals as you strive to meet your long-term goals. For example, you may want to lose 5 kg by the end of two months. Succeeding in your short-term goals will motivate you to keep going as you strive to achieve your long-term goals.
Give yourself a treat each time you meet a goal.

Be realistic

When setting goals or making plans to adopt a healthy habit, make sure that they are achievable within the time frame you have set for yourself. Otherwise, you are only setting yourself up for failure and disappointment!
Adopting new habits and breaking old habits may take time, so make changes gradually.
For example, if you did not eat fruits and vegetables often in the past and you now want to include more in your plans, you may not be able to quickly adopt a full vegetarian diet. It may be better to instead include a vegetable side dish and a fruit during every main meal, and slowly increase the amount over time.

Can’t enjoy your meals?

You may find yourself missing your old favourite (but unhealthy) meals, or you may need some time to get used to your new diet. Here are some tips to help make your mealtimes enjoyable again.

Get your whole family involved. Healthy, balanced meals with less salt and fats are good for everyone, not just people with diabetes!
There are many recipes online only that will show you how to prepare simple and quick, yet delicious meals that are great for people with diabetes. Try them out!
You can also exchange recipes and cooking tips with other people with diabetes in support groups both online and in real life.
Another benefit to creating your own tasty diabetes-friendly meals is that you will rely less on diabetes-friendly foods and snacks sold in stores, which can be quite costly.
There are many free apps you can download into your phone to make it easier to keep track of your blood glucose, calories and more. They will help make your mealtimes less complex and, hence, more easy to enjoy!

No motivation to exercise?

Often, “I’m too busy to exercise!” or “I am too tired!” is all in your mind. If you really want to, you can spend a healthy part of the day being physically active.

If you are still getting used to your new routine, make the effort to wake up earlier to exercise the first thing in the morning. Better get it out of the way before you start coming up with excuses to put it off!
If you feel self-conscious about your appearance, or you don’t know how to start, find an exercise buddy to help you out. Having an exercise buddy is also good because the two of you can motivate one another.
If you are not fond of exercising with other people, you can exercise at home by following instructional videos (on YouTube and other sources) on yoga, aerobics and more.
If you need extra motivation (and who doesn’t?), there are a variety of free apps you can download on your phone. There are apps to help you keep track of your physical activity, send motivational messages regularly and even make physical activity a fun game that puts you in competition with other users. Getting physically active is now easier, and more fun, than ever!

Oops, slipped up?

You may find yourself backtracking to your old habits, sometimes without realizing it until it is too late.

Don’t give up if this happens. Slipping up only means that you are human like everyone else!
Once you realize that you have slipped up, think back to the circumstances that might have led to this slip-up, and plan on either how to avoid falling into such circumstances again or, failing that, what you can do to avoid giving in to temptation when it arises.
If you find yourself slipping up often, it is time to revisit your goals. How can you motivate yourself again? Perhaps it is time to come up with new goals, or a new approach to reach your goals. You can consult your healthcare team or support group if you need further advice.

Keep track of medications

If you have a hard time keeping track of whether you have taken your medications (especially when you have to take several of them), you can either get a pill case or download a phone app that can help remind you to take your medications.
You should take your medications even when you are feeling healthy, and discuss with your doctor or pharmacist before taking any complementary medicine. Remember that complementary medicine should not replace your current medications.
Also, keep your medical appointments, as they allow your doctor to monitor your health and conduct necessary tests to detect signs of diabetes-related complications.
Don’t forget: get an eye screening test with an ophthalmologist once a year! This will help detect diabetic retinopathy and other diabetes-related eye diseases.

The closing word

We hope this Special Report has shed some light onto some lesser-well known pitfalls of type 2 diabetes, and we have motivated you to take those important steps to take charge of your health.

Living with type 2 diabetes often means having to deal with increased risks of other health conditions, such as diabetic retinopathy and dyslipidaemia, but this does not mean that your future is bleak.

With proper lifestyle adjustments, medications and the right attitude, you can still lead a healthy and fulfilling life. The journey may seem daunting from where you stand right now, but you can do it. And the good thing is, you won’t be alone in your efforts. Remember, your healthcare team will be there every step of the journey. You also have your family and friends. Furthermore, in this time and age, there are fellow people with diabetes whom you can get in touch with through Facebook, Twitter, WhatsApp, Instagram and more. Thanks to modern technology, physical distance is no longer an issue. You are never alone even in your most trying time.

As Olympic track star Jim Ryun said, “Motivation is what gets you started. Habit is what keeps you going.” There is plenty of motivation if you know where to look, and we hope you can find yours to get those healthy habits in place for you to keep going. Good luck and best of health to you!

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Your Gut’s Best Friend

April 28, 2022 Return

Many of us pay our gut very little attention until we eat something that does not agree with us. Maybe it is time to change that, as a healthy gut can make a difference to our health.

While the colon is part of the digestive system, it plays no role in digesting our food. By the time the food reaches the colon, it has already been digested. So, the colon absorbs water from what is left and then, processes the leftovers into the material that normally goes out the back door when we sit on the toilet bowl.

However, the colon has another important role that is not related to the toilet, thanks to the bacteria that make their home there. From the moment we come into this world, bacteria have been growing in our intestines, especially the colon. Do not panic – these bacteria are our friends, and they help us in ways that many of us may not imagine. Chief among these bacteria are those called Bifidobacteria.

Can we call them Fido?

So far, we have identified about 30 types of Bifidobacteria living in our intestines. They feed on some of the food in our gut (do not worry, there are plenty to go around), and in return, they repay us in the following ways:

Keep the bad guys out. Bifidobacteria produce a substance called acetic acid which suppresses the growth of potentially harmful bacteria.

A boost for our immune system. While we do not know the exact mechanism yet, there are strong indications that Bifidobacteria can stimulate the production of antibodies, increase our resistance to toxins and may even suppress the development of cancer cells!

More love for the gut

As you can see, it can be good to encourage the Bifidobacteria families to thrive in our gut. A way to do this is to include prebiotics in our daily diet. Prebiotics are used as an additional food source for the bacteria, and can be found in food rich in dietary fibre.

You can get your dietary fibre from the following:

Fruits and vegetables – eat plenty every day!
Yoghurts and dairy products with added prebiotics – check the food labels to ensure before buying.
Supplements containing both soluble and insoluble fibres.

The US Institute of Medicine recommends the following:
Under 50 years old	Over 50 years old
Men: eat 38g every day Women: eat 25g every day	Men: eat 30g every day Women: eat 21g every day

References:

Ishibashi N, Yaeshima T and Hayasawa H. (1997). Bifidobacteria: their significance in human intestinal health. Mal J Nutr 3: 149-159.

Mayo Clinic. Available at www.mayoclinic.org

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Slow Dancing with a Stranger

April 28, 2022 Return

Dr Nor’izzati Saedon Internal Medicine Specialist, University Malaya Medical Centre

Slow dancing with a stranger. That was how Meryl Comer, an award-winning journalist, once described her caregiving for her husband, who had Alzheimer’s disease. Caregiving is a noble vocation, but it is also a sacrifice borne out of love, one that can drain the caregiver both physically and emotionally. Dr Nor’izzati Saedon, an internal medicine specialist as well as a member of the Malaysian Society of Geriatric Medicine, kindly takes time from her busy schedule to address some common issues faced by caregivers today.

Ramona (not her real name) cares for her elderly father. A housewife, she juggles her role as a caregiver along with being a wife and a mother of two young children. She is constantly stressed and exhausted, and she sometimes loses her temper in front of her father. Ramona feels that she is failing her father as well as her family.

Dr Nor’izzati: Ramona’s predicament is actually a common one among caregivers. For caregivers in such a situation, here is my advice:

First, accept that we are human – we cannot succeed in everything because that is impossible. Know our mental and physical capabilities, and be honest about our limits.
Plan on how we can best provide care for our loved one both in the short term and long term. Our plan should also take into account our own needs and the needs of other people who are dependent on us. To help us plan better, we can attend short courses, talk to doctors and nurses and do some research online.
The first three to six months of caregiving are always the toughest. During this period, we should reach out to others who are going through the same journey for support. There are caregiver support groups, in person or online, that can provide advice as well as a listening ear. I also feel that physiotherapy sessions at the hospital are a good outlet for caregivers to meet and compare notes or experiences with one another. Experienced physiotherapists and occupational therapists are often willing to share insights and ideas on how to best care for loved ones. Watching how they interact with their patients is also a good way for us to improve our communication with our loved ones.
Studies have shown that caregivers have a higher risk of developing depression if they neglect their own well being. Thus, take an hour or two each day to recharge by doing something we enjoy – grab a coffee, take a walk, go to the gym, etc. Also, take time to tend to our spiritual needs (through prayer, meditation, etc).
We don’t have to do anything alone. If we can afford it, we can hire a maid (full or part time) to help. Otherwise, we can enlist our siblings, our partner and even our children. They may need some time to understand how to care for our loved one, but in the long run, they will be a big help.
To lift our spirits when we are down, we can attend motivational classes or listen to motivational speakers (there are many clips on YouTube), read inspirational books or talk to people who understand what we are going through (such as members of a support group). We can find fellow caregivers on social media such as Facebook, Twitter, Snapchat, Pinterest, etc who are willing to share and advise. Remember, we are never alone, so don’t lose hope!

Sara (not her real name) loves her father, but she soon feels trapped by her role as his caregiver. All her time is spent caring for him, and she soon misses her old life. “The rest of my family can do whatever they want, but they expect me to just drop everything to take care of a sick old man,” she complains. She has tried asking them for help, but they always say they are too busy with their own families.

Dr Nor’izzati:

When someone like Sara becomes a caregiver, he or she must accept that there will be significant, even big changes to the person’s life. However, this does not mean that the person must completely put his or her own life on hold. It just means that a little more planning needs to be done.

For example, Sara may want to go on a holiday. She can plan ahead for this, perhaps by engaging the temporary services of a nursing care facility to take care of her father while she is away. Alternatively, she can plan for staggered breaks, such as taking two or three weekends off, by hiring a helper to step in during those weekends.

When it comes to family members who leave all caregiving responsibilities to the caregiver, like Sara’s siblings seem to have done, she cannot force them to help, but she can try to slowly change their ways by bringing them along to the clinic for her father’s medical check-ups. The doctors can be good allies in helping these families understand the need for the entire family to support the caregiver’s efforts.

Universiti Malaya Medical Centre (UMMC) holds clinic sessions that bring together caregivers and their family members, encouraging them to open up, exchange opinions and discuss ways to improve the caregiving situation together. Sara and other caregivers may find such sessions useful. To check out the sessions, just drop by the General Geriatric Outpatient Clinic at Klinik Perubatan 3 on Friday afternoons.

Lin (not her real name) is a caregiver for her mother who is suffering from dementia. Her mother constantly makes unreasonable demands, and often becomes verbally abusive when Lin fails to please her. Lin is overwhelmed, but she is afraid to confide in anyone, as she fears that people may view her ‘failing’ as a sign that she is not a good daughter.

Dr Nor’izzati:

For care-receivers who have dementia or other conditions that affect the brain, it is not uncommon for them to experience personality changes. A formerly patient and loving parent may become irrational and demanding. They may also become verbally and physically abusive.

It can be difficult to care for someone we love, only to be made to feel unappreciated and unloved. We may also feel that we no longer know our loved one – he or she is now a complete stranger.

These emotions are only natural, but we should not allow them to consume us. It is our loved one’s disease that is making him or her behave this way. Diseases that affect the brain can make our loved one say things out of frustration or without basis. Often, our loved one is not aware of what he or she is saying or doing. So, blame the disease, not the person. Doing so will help us to better cope with the situation.

Here are some things that caregivers such as Lin can consider doing:

If a situation becomes too much to handle, take 15 minutes to calm ourselves and gather our feelings. It is fine to leave our loved one alone to do so, as long as they are in a safe environment.
Do not concern ourselves too much with what other people think of us. We should instead take comfort in knowing that we are doing our best for our loved one.
Having said that, we should protect ourselves if our loved one becomes violent. Keep sharp and dangerous items out of this person’s reach. We can also consult a physician for advice; some medications to calm our loved one when he or she becomes agitated and aggressive may be useful.

Rama (not his real name) and his wife care for his father, who has an advanced stage of cancer. The doctors recommend end-of-life care to make his father’s remaining days as comfortable as possible. Rama, however, feels overwhelmed at the thought of losing his father, and finds it very difficult to be even in the same room as him, much less care for him. “Sometimes I wish that he would pass on soon, so that I can stop feeling all this hurt and pain inside my heart,” he admits.

Dr Nor’izzati:

Caring for someone dependent on us is a very physically and emotionally demanding task – it can be overwhelming and even draining. For loved ones who are at the end stage of their life, it is normal for caregivers to feel helpless, as there is not much they can do for the loved one at that time. Sometimes, they may also be reminded of their own mortality – they are aging, and they too will pass on one day – and this realization may only add to their grief.

During this period, caregivers such as Rama should seek emotional support. Here are some suggestions:

Find a person to talk to, in order to unload our stress and anxiety. A caregiver support group will be tremendously helpful.
It may also be good to discover (or rediscover) spirituality (such as by joining a religious group), to find comfort when faced with issues such as the mortality of life.
Meditative and relaxation techniques such as yoga can also be helpful.
If we feel overwhelmed or confused by the care needed by our loved one during this period, it may be good to hire a part time qualified nurse to make daily or weekend visits.
If our loved one needs more specialized care, we can consider locating a good nursing home for him or her. After placing our loved one in a home, we should still visit regularly to monitor the care given to our loved one. Our visits will also provide comfort to our loved one (who may need time to feel safe in a new environment), and knowing that he or she is receiving the best professional care will also be a source of comfort to us.

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