Medicine

Does your child have an allergy?

2011-08-12T16:43:00.000-07:00

POSITIVE PARENTING

There are many ways you can help your child deal with allergies, especially if you recognise the early warning signs and prevent them from becoming more serious.

RUNNY nose, itchy skin, watery eyes. Your child is not sick, but he gets these symptoms, and becomes uncomfortable and miserable. No matter what you do, these symptoms keep coming back, and may even be getting worse. You are at your wits’ end, trying to figure out what is wrong with him.

The answer could be an allergy. Allergies are becoming increasingly common among Malaysian children. Sometimes, these allergies are mild and cause only minor discomfort. But often, mild allergies can develop into more serious ones, and become dangerous to a person’s health.

It is thus important that you recognise the early warning signs and implement the necessary preventive measures.

Understanding allergies

What causes allergies? Blame it on the things called allergens. These are things that your child could be hypersensitive to, for example house dust mites, pollen, animal dander (dead skin flakes) or insects. If your child is allergic to these or other things, like certain foods and medications (e.g. penicillin), he could develop a reaction.

Nobody really knows why some people are sensitive to allergens and others aren’t. Heredity could be part of the reason. If you or your spouse have allergies, your child has an increased risk of developing allergies himself.

Family history is not the only risk factor. Any member of the family who smokes around the child increases his risk of allergies.

Even a pregnant mother who smokes can put her unborn baby at risk of allergies and other conditions.

Some children may be predisposed to allergies and the signs appear as early as infancy. Allergies tend to develop in a certain pattern, which experts call the “Allergy March”. It means that the allergy will affect one part of the body, and move on to another part, as your child grows older.

Some experts believe that the “Allergy March” usually begins with infantile colic. If your baby is suffering from abdominal pains, it could be due to a food allergy. The next sign could be eczema (sometimes known as atopic dermatitis), which appears as skin rashes (see explanation below).

The other allergic reactions usually appear when your child is between seven and 15 years old. He may develop allergic rhinitis (sometimes known as hay fever) and asthma.

The good news is that the “Allergy March” allows you to recognise the signs that appear in infancy, or at least early toddlerhood. You may recognise some of these symptoms in your child, but you don’t know what exactly they are, and what is causing them.

If you suspect that these symptoms are due to an allergic reaction, take your child to the doctor for an examination. The doctor will be able to help you take the necessary steps to prevent any further allergic reactions from developing.

Common allergic reactions affecting the nose and airways

Allergic rhinitis

“Nose running like a tap” is usually how parents describe it. In temperate countries, allergic rhinitis is also described as hay fever.

You will find that your child sneezes, has a blocked, runny nose, and watery eyes all the time. This results from an adverse reaction to common allergens, for example pollen, dust mites, animal dander or feathers.

It can be easy to mistake these symptoms for that of a common cold. However, if they last longer than a week, occur repeatedly and are not accompanied by a fever, your child probably has rhinitis.

Asthma

Asthma affects 10% to 15% of Malaysian children, and can be dangerous if allowed to persist without treatment or prevention. In asthma, the child’s airways become narrowed.

This reduces the airflow and causes breathlessness, coughing and wheezing. Frequent coughing at night and tightness of the chest are important early signs.

Children who have eczema or allergic rhinitis, due to allergic reactions, are quite likely to develop asthma when they are older.

If you do not want your child to be plagued by asthma, keep his environment dust-free! The house dust mite is the biggest trigger of asthma.

It lives in our carpets, curtains, mattresses and soft toys. Dead skin particles from animals are also a common trigger. Cigarette smoke is another allergen that can be easily removed.

For a child who has asthma, the doctor may prescribe quick-relief drugs, which are used to relieve an asthma attack, or preventer drugs, which are used to help prevent asthma attacks. Depending on the severity and frequency of attacks, your doctor will prescribe one or both these medications.

Eczema

Eczema appears as rashes on the hands, as well as in skin creases in areas such as the wrists, the backs of knees, and the insides of elbows. The child may have red and swollen skin, small, fluid-filled blisters, and develop an intense itch (especially at night). He may also have dry, scaly and cracked skin.

Again, the common allergens could trigger eczema. Quite often, your child could also be reacting to something he ate.

Hives

Hives (urticaria) is also an itchy rash that appears as smooth, lumpy areas on the skin that are red or white in colour. It could affect just a part of your child’s skin, or his whole body.

Your child may develop hives as an allergic reaction to a certain food, medication, plant or insect bite.

Swelling

Swelling (angioedema) is a nasty and severe allergic reaction. Usually, the child’s face, lips, tongue or genitals will swell up. His airways may also become constricted. This will cause difficulty in speaking, swallowing or breathing (the most dangerous condition).

Swelling is usually triggered by certain foods, drugs or insects. In severe cases, it may require an immediate injection to reduce the swelling.

Dealing with allergies

If your child has an allergy, take him to a doctor for proper medical treatment. Self-medication will not solve the problem, and may worsen it.

Even with treatment, living with allergies can be tough on your child. He can ease his discomfort by learning to avoid situations where he might be exposed to known allergens.

On your part, it may be as simple as ensuring that his environment is clean. Even if the allergies never go away completely, at least your child will be able to enjoy the journey of learning, discovering and playing.

Wintertime skin most asked questions

2010-12-22T16:15:00.000-08:00

When the temperature outside drops and the temperature inside rises, your skin is under assault. Low humidity, coupled with heavier clothing, and longer, hotter showers and baths can leave your skin feeling dry and itchy. Most people start slathering on lotion and hope for the best, but there are more effective ways to prevent and combat winter skin.

The winter months give our skin a beating. The endless dehydration of heaters, the bad food and alcohol throughout the holidays. November through January we neglect our skin. With holiday stress and heater dryness our skin gets abused. Its time to counter this damage.

Dry skin is a very common skin problem and is often worse during the winter when environmental humidity is low (i.e., "winter itch"). It can occur at all ages and in people with or without other skin problems.

# My skin gets red every time I step outside, how can I help reduce that and what causes it?

* Cover up. The cold constricts the blood vessels while outside and there’s a rebound effect when the skin warms back up and the vessels dilate, creating excessive redness.

# My skin gets very blotchy in the winter, how can I help reduce that and what causes it?

* Very often dry skin is the cause of blotchiness. Avoiding hot showers can help, as can frequent use of moisturizer and using non-soak cleansers. Running a humidifier in the bedroom while sleeping is also a great way to replenish the moisture in your skin.

* Another cause of wintertime redness can be Rosacea. If you have broken blood vessels, bumps, and recurring flare-ups in the same area, you should consult your doctor, as you may be suffering from Rosacea.

# What ingredients should I look out for/avoid when buying skincare products in the winter?

* Avoid anything containing agents that strip the skin of its natural moisture. In the winter we typically decrease the strength of the retinoids we give to patients.

# My skin gets very dry and itchy in the winter, why and what can I do to treat and prevent that?

* See blotchy above…

# My acne get worse in winter/why and what can I do?

* It’s not that acne is worse in the winter, it’s that it improves in the summer due to sunlight on the skin. The bacteria that cause acne flourish in the winter in the absence of UV light. UV and other light-based therapies can help keep acne-causing bacteria in check.

* Also, many people go off their acne medication in the summer. It’s important to get back on it in the fall before the winter hits and acne regains the upper hand.

# Are there certain foods I should be eating in the winter to help reduce dull skin and minimize acne/foods to avoid?

* Eating a healthy diet rich in fruits, vegetables, lean meats, nuts and seeds will help combat acne and make your skin look terrific. Of course drinking plenty of water is also critical for healthy skin. When acne is bad, avoid simple sugars and excessive dairy intake. So ice cream = bad, especially for adolescents.

# My feet, hands and cuticles are very dry, what do you recommend I use?

* Frequent hand washing, especially in winter, can lead to excessive dryness. Avoid hot water and stringent soap, and try to moisturize hands right after washing, before they are fully dried. For the feet, applying moisturizer right after getting out of the shower should help lock the moisture in. Also, rubberized shoes that don’t breathe well can make feet sweat, which leads to skin irritation, which leads to dryness. Avoid shoes that are sealed and make your feet sweat and wear thicker, absorbent socks that wick moisture away from your feet.

Dr. Mitchell Chasin

Healthy Medicine : Birth Control, Women & Aging

2010-10-14T18:09:00.000-07:00

People have used birth control methods for thousands of years. Today, we have many safe and effective birth control methods available to us.All of us who need birth control want to find the method that is best for us. And each of us has different needs when choosing a method. If you are trying to choose, learning about each method may help you make your decision. Use the list of birth control methods above to read about the methods.

There are many unanswered questions when it comes to fertility and the most effective birth control method. In order to ensure that the birth control method chosen is suitable for a woman’s needs she must be well informed about the variety of birth control methods available. She must also take into consideration how her fertility influences the type of contraceptives she decides to use throughout her lifespan.

Practitioner Ian Wahl, DAC, LAC, CH from ChicagoHealers.com, informs women on what they need to know about aging, sex and birth control at every age.

Women in their 20’s :

Sex Drive & Fertility :

· This is a time when fertility peaks, which is why women in their 20’s are more likely to conceive a baby the natural way.

· During her 20’s, a woman is more likely to have a higher sex drive than any other time in her life. This is contributed to high levels of testosterone produced within her body.

Birth Control :

· The only way birth control pills will work is if the woman takes them every day on a regular basis. If she skips a day, it decreases their potency and increases her chance of becoming pregnant.

· Another birth control method women in their twenties should also use is condoms. Not only do condoms help prevent conception, they also protect women from sexually transmitted diseases.

· It is important to invest in two methods of birth control

Women in their 30’s :

Sex Drive & Fertility :

· Women in their 30’s reach their sexual peak

· As a woman ages, the amount of eggs in her ovaries decrease each year by a significant percentage.

· Sexual activity increases; however, there is a slight decrease in the levels of testosterone in her body.

· While women may lose interest in sex, the type of relationship they have with their partner also influences their sex drive and desire for sex. Since it is more common for women in their thirties to find a more fulfilling and stable relationship with their partner during this time, she will engage in more sexual intercourse than she did when she was in her twenties.

Birth Control :

· Birth control pills can be affective as well; however, since her chances of conceiving are less likely during her thirties, a woman still should take precautions against sexually transmitted diseases.

· Since women may be participating in more sexual activity during this time, she will want to invest in spermicidal foam and condoms.

Women in their 40’s:

Sex Drive & Fertility :

· Eggs are released from the ovaries less frequently, which make conceiving a baby less likely, but it is still possible.

· Women in their 40’s may begin to lose their sex drive because their level of testosterone is about half of what it used to be during their 20’s.

· Although women in their 40’s have lower libidos, many are more sexually active now that their children are getting older.

Birth Control :

· Women in their forties can use many different contraceptives. They can use contraceptive sponges or a vaginal ring along with spermicidal lubricant. They should also make sure that their partner uses a condom. The condom helps to protect both partners from STD’s.
For more information please contact Ian Wahl, DAC, LAC, CH at ChicagoHealers.com .

Healthy Medicine : Halloween Healthy Pumkin Foods...

2010-09-29T20:13:00.000-07:00

It's nearly Halloween again and that means: candy, costumes, and carving pumpkins....When you think of pumpkin, what comes to mind? Many people think of carving and smashing them. Others think of Halloween, jack-o-lanterns, pumpkin pie and pumpkin seeds; but did you know that pumpkin is a superfood?

IT’S hard to imagine a vegetable that is as versatile as the humble pumpkin....Pumpkins are rich in Vitamin A and potassium. They are also high in fiber. The conclusion you should now be reaching is that they are therefore good for you. Your conclusion is absolutely correct.....until you start adding other ingredients that make up many pumpkin recipes.

The brilliant colors of Fall are in bloom. With Fall comes a variety of nourishing hearty fruits and vegetables including the great pumpkin. This is the best time to find fresh pumpkin so take advantage of it! Fresh fruits and vegetables will always provide you with the most nutrients and natural enzymes that the body can use more readily. Pumpkin and its seeds provide many important nutrients, on top of loads of fun for family and friends.

Dr. Helen Lee, DC the ChicagoHealers.com Practitioner, offers the following nutritional benefits of pumpkin and its seeds.

Nutritional Benefits of Pumpkins:

# Organ Health: The nutrients in pumpkin and its seeds help support the health of your kidney, bladder and prostate.

# Vitamins: Pumpkin and its seeds contain nutrients such as vitamin C, E, iron, zinc, magnesium, potassium, both beta & alpha carotenoids (anti-oxidants which help prevent cell damage), and lutein (support healthy eyes).

# Sickness Prevention: Helps with minimizing osteoporosis, increases digestive health by helping with parasites & tapeworms, and lowering cholesterol.

# Protein: Pumpkin seeds are high in protein.

# Important Fact: Organic, raw pumpkin seeds will provide you with the most nutrients and enzymes.

# General Benefits: Pumpkin seeds help the body get rid of parasites and other unwelcomed digestive inhabitants, and they contain healthy essential fatty acid oils.

Dr. Helen Lee, DC recommends four ways to incorporate pumpkin into your everyday diet.

Easy ways to incorporate pumpkin into your diet:

# Pumpkin seed butter spread on toast

# A handful of raw pumpkin seeds as a snack or mixed with trail mix, on top of cereal

# Pumpkin baked or browned with spices in risotto, chili, rice, spaghetti

# Pumpkin pie/desserts/pancakes/waffles

Pumpkin is a nutritional powerhouse whose benefits are still being discovered. Pumpkin is filled with vitamins, nutritional value and tremendous health benefits. Few people actually know about the health benefit aspect that pumpkin offers.

Healthy Medicine : Watch out! Halloween candy will rot your teeth out!

2010-09-29T18:43:00.000-07:00

Tips on Halloween Candy and Avoiding Tooth Decay -By Dr. Margaret Mitchell

When did the tradition begin? Which are the top-selling Halloween candies; which are the most unhealthy? Is it better for your teeth to eat..? This from an article last year on CNN: “although some parents may be tempted to space out the amount of candy their children consume after Halloween, dentists have advice to the contrary: When it comes to teeth, it’s better to eat a whole lot of candy at once than to space out candy consumption over time. Basically, the fewer episodes of candy eating, the better.

Kids love candy and Halloween is a great time to celebrate that love. However, what is a parent to do if they are worried about tooth decay from all this candy consumption? Candy usually contains sugar, which the bacteria that cause tooth decay dine on. So eating a food loaded with carbohydrate or sugar feeds the bacteria that cause tooth decay. Consequently, to avoid negative impacts from candy, we have to do two things: 1) Avoid excessive consumption of these sugary treats and 2) Lessen the amount of time the sugar is present in the mouth.

As the owner of Mitchell Dental Spa, a dental spa facility in Chicago’s Water Tower Place, I’d like to offer the following tips to for protecting your kids teeth at Halloween.

# Avoid sticky candy such as taffy, gummy bears, caramel, etc. Sticky Candy adheres to teeth and causes decay

# Examine your child’s candy to see if it meets your approval.

# It is okay for your child to eat any candy that you approve of, but to help lessen the chance for tooth decay, have them brush as soon as possible (after eating the candy). If a child or adult brushes right after, the impact of the candy on the teeth is minimal.

# Prior to Halloween, visit your dentist to have sealants put into the child’s teeth grooves..

# Kids can eat candy ANYTIME, there is not a good time of day/night to eat candy

If brushing soon after eating is not possible, then try the following:

# Consume the candy with a meal. The increased saliva production while eating will help wash the sweet off the teeth.

# Rinse the mouth with water.

Chew a sugarless gum (especially those containing xylitol) after snacking on candy. The increased saliva from chewing will help wash the sugar off the teeth and xylitol gums help control the bacteria that cause tooth decay.

# Avoid sugary sodas. They are: 1) Loaded with sugar (often over 10 teaspoons per 12 ounce serving), 2) Are acidic enough to dissolve away tooth enamel, and 3) Are often sipped for long periods of time, resulting in teeth that are being bathed with sugar and acid almost continuously throughout the day.

# Eat the candy quickly in one sitting to decrease the amount of time it is contact with the teeth. Avoid eating any candy slowly over an extended time or over multiple sittings. Recent studies have shown that length of time eating a sweet can be more harmful than the amount of sweet consumed. This means hard candies, breath mints, etc. (long residence time in the mouth) can actually be worse for your teeth than a chocolate candy bar (shorter residence time in the mouth).www.MitchellDentalSpa.com

calcium supplements causes a 30% increase in heart attacks ?

2010-08-15T15:39:00.000-07:00

A recent study on calcium supplements claims that taking calcium supplements causes a 30% increase in heart attacks. ChicagoHealers.com Practitioner Martha Howard, MD believes there are some serious problems with the study, a meta-analysis by Professor Ian Reid from the Department of Medicine at the University of Auckland, and published in the British Medical Journal.

A prominent researcher on calcium metabolism Professor Chris Nordin, of Royal Adelaide Hospital, has already questioned the findings. He says that the review is misleading because it does not separate men from women in the findings. According to him “Men are much more liable to heart attacks than women, but women need calcium far more than men, so it is absurd to publish a study of the effect of calcium on the heart without separating men from women.”

ChicagoHealers.com Practitioner Dr. Martha Howard, MD, offers the following:

* Objections to the Study:

- We have no way of knowing how accurate the original 11 studies were because there are a lot of hazards in the kind of statistical number-crunching involved in a meta-analysis. Worst case scenario is a meta-analysis of 11 studies is conducted, all of which are flawed in their methods or have doubtful data or conclusions, and a larger conclusion may be reached.

- We do know that in the studies, the calcium was treated as an “independent variable” so magnesium and Vitamin D were not given. Magnesium is needed to balance calcium intake. Vitamin D is needed for proper calcium metabolism.

- Carrying out studies that do not provide the other vitamins and minerals needed could have some very poor results. It is possible that calcium supplements, specifically when given without magnesium and Vitamin D, do cause additional calcium deposits in the arteries. This may lead to more heart attacks, but the meta-analysis is not sufficient evidence to tell.

* Recommendations:

· Calcium, Magnesium, and Vitamin D supplementation is especially important for premenopausal and postmenopausal women. The current recommendation for premenopausal and postmenopausal women is from 1000 to 1500 mg of calcium per day.

· Given that most people do get some calcium in their diet, 500 mg of calcium with 250 mg magnesium and 400 IU of Vitamin D (taken all together) is probably enough supplementation, unless the person is allergic to dairy.

· Vitamin D is very important to bone health. There are many people walking around with Vitamin D deficiency in the United States—not enough sun exposure, and not enough Vitamin D in their diets. In addition to osteoporosis, Vitamin D deficiency also is a factor in Alzheimer’s disease. Get your Vitamin D level taken, and if it is low, take 2000 IU or more per day until your level is normal.

· Take the Vitamin D orally, do not accept high dose injections—they have been associated with atypical bone fractures.

Healthy Medicine: Looking to insure your health

2010-08-14T17:44:00.000-07:00

Healthy Medicine : ONE can fall sick at any time. Diagnosis and treatment can be obtained at any of the clinics and hospitals of the Health Ministry or public universities or similar facilities of the private sector. Private clinics are found in urban and rural areas, and private hospitals in most major towns. Currently, the private hospitals provide about a quarter of all hospital beds in the country.

Different health policies provide different coverage. It is difficult to find a policy that provides coverage for all medical problems. So it is important to know what circumstances or medical conditions are covered by the policy. Although there are no differences in the technical quality of care provided by the public and private sectors, there are many in the population who seek care from the private sector for various reasons, including access, ambience and choice.

As the private sector does not receive subsidies from the state, those who seek care from the sector have to pay for these services out of their own pocket, or through private health insurance.

Private health insurance is a mechanism that provides for expenses incurred as a result of an illness, accident and/or disability. It covers the cost of medical care and/or nursing care, and in some instances, provide an income during hospitalisation and/or disablement.

As the medical expenses incurred may be substantial, health insurance protects the insured from potentially heavy financial loss. It is difficult to predict what medical expenses will be like. In some years, it may be low. In other years, it may be high, especially the older one is.

It is important to know how the health insurance provides for access to doctors and hospitals. For example, is prior approval needed to ensure coverage during hospitalisation for elective surgery?

During the past decade, there has been an increase in the population having private health insurance. As a healthcare provider and as a consumer of health care, I have learnt much about the nuances of private health insurance and managed care, which most consumers are unaware of until the time when there is need to utilise the benefits of the policy.

Health insuring companies : These companies may be health insurance companies, which are regulated by Bank Negara. The medical aspects of insurance come under the purview of the Health Ministry. These companies are owned by shareholders or are mutual companies, which are owned by their policyholders. Both types of companies may distribute their profits as dividends, particularly the former.

Managed care organisations (MCOs) are registered companies regulated by the Registrar of Companies. The Health Ministry regulates the medical aspects of managed care. The MCOs make arrangements for the healthcare of their enrollees.

MCOs in some countries, for example, in the United States, provide care directly to their enrollees. Some MCOs purchase insurance from one or more insurance companies. Others are subsidiaries of insurance companies.

As managed care techniques become more prevalent, it is often difficult to distinguish between the different types of coverage for the insured persons.

Risk pooling :Private health insuring companies pool the healthcare risks of a large group of people so that individual risks are predictable and manageable. The risk pooling should lead to the expected medical expenses of the group of people to be reasonably predictable for the insurer and to be relatively stable over time. The larger the pool of insured persons, the less will be the risk exposure for the companies.

The health insuring company will have a contract (policy) between itself and the policyholder, which may be an individual or an organisation, for example, an employer.

Group and individual insurance : Many employers usually offer group health insurance as a part of the compensation package. It is also provided by membership of an association, union or other groups.

Employees may have a choice of plans or no choice at all. The plans may be indemnity insurance or managed care. The employer usually pays a part or all of the premiums, which will be lower than that of an individual. If one gets group insurance through membership of a group, the advantage is that the premium will be less than what an individual will pay.

Any person can purchase individual insurance directly from the insurance or managed care companies. The premium is entirely paid by the individual and is tax deductible, up to a limit.

Indemnity insurance and managed care : There are similarities between indemnity insurance and managed care. Both cover a wide range of medical services in clinics and hospitals. Medications are usually covered. Some provide coverage for maternity and dental services.

The primary difference between indemnity insurance and managed care is that of choice of doctors, hospitals and healthcare providers, how medical bills are paid and payments out of one’s pocket.

Indemnity insurance offers more choice of doctors and hospitals. In most instances, an insured person can choose the doctor and even change the doctor at any time. A specialist may be consulted with or without a referral.

However, the policy does not pay for all the medical expenses. The insured person has to pay the rest of the medical expenses. Most policies have a maximum for expenses to be paid by the insured person. Claim forms will usually have to be filled. The medical expenses may have to be paid first and then claimed back from the insurer.

Managed care offers a limited choice of doctors and hospitals. It is usual for a referral to be obtained from a general practitioner before a specialist can be consulted.

The medical services covered are usually more limited than indemnity insurance. Most managed care companies provide a medications list to the doctor for which they will cover. There may or may not be out-of-pocket expenses. In many instances, there are no insurance forms to be filled or claim forms to be submitted.

Inherent problems with health insurance : All health insurers attempt to ensure that those in their risk pool have the same risk as that of the general population i.e. they take measures to ensure that there is no disproportionate number of people with poor health in their risk pools.

The term adverse selection is used to describe the tendency for people with a higher than average risk of needing medical care than healthier people to seek health insurance, because they anticipate possible large medical expenses.

If adverse selection is not managed well, it would result in the company having many insured persons with ill health and consequent difficulty in balancing out their medical expenses with that of a large number of healthy insured persons.

People in better health will less likely join the risk pool because of the higher premiums or they may leave to join another risk pool, which has a lower premium.

Another problem with health insurance is that of moral hazard. This occurs when the insurer and insured person enter into a contract but one party takes action, which is not taken into account in the contract.

A common example of moral hazard is that of a situation in which additional tests are carried out. The patient benefits from greater certainty of diagnosis and treatment. The doctor’s risk of allegations of medical negligence is reduced. The costs of these additional tests are borne by the insurer, which has little or no say in the decision.

Insurance techniques : There are several techniques used to address the problems of adverse selection and moral hazard. Most companies do not have one risk pool but instead have multiple risk pools. Product differentiation protects the companies, as problems in one risk pool will not impact directly on the insured in another risk pool.

Medical underwriting is a technique used by insurer to maintain a predictable and stable level of risk in their risk pools, and also to set the terms of coverage for those of different risks within a risk pool.

With underwriting, a decision is made whether or not to accept an applicant for coverage. Premiums are varied according to factors associated with differences in expected medical expenses like age, gender, health status, occupation, and lifestyle habits.

In general, applicants who are likely to incur large amount of medical expenses are denied coverage or charged high premiums to compensate.

An effective underwriting mechanism to avoid adverse selection is to provide coverage to already formed large groups of people e.g. employees of a large organisation. The insuring company knows that the individual members of the group did not join to obtain coverage for medical expenses, so there is a lower likelihood that there is a disproportionate number of individuals with poor health in the group.

In such situations, the underwriting focuses on the group – its claims history, age distribution, industry etc – and not on individual members of the group.

Additional measures to avoid adverse selection include requiring a minimum number of enrollees and/or requiring the employer to contribute a minimum premium.

Another technique used to avoid adverse selection is to exclude coverage for a defined period of time for the treatment of medical conditions that the companies determine to have existed within a specific period prior to the beginning of coverage (pre-existing medical condition).

Moral hazard is addressed by co-payments and deductibles. Co-payments refer to the amount the insured person has to pay each time medical care is provided e.g. a certain amount is paid each time the doctor is consulted, with the insuring company paying the balance. Deductibles refer to the amount that must be paid annually before the insuring company begins paying.

MCOs attempt to influence medical decisions by various techniques, e.g. financial incentives or disincentives for the insured and/or healthcare providers, prior authorisation for certain services, e.g. operations, treatment protocols and so on.

What to consider in private health insurance coverage : There are a number of factors that must be considered prior to obtaining private health insurance coverage, whether as individuals or members of a group. It is essential to understand the policy even if the employer arranges it. Having a copy of the policy and perusing it will be helpful to understand how it works. Questions should be asked before one has to seek medical attention.

- Age limit : Most health insurance products are not available to people above a certain age. It may be better to sign on the policy when one is younger and still healthy.

One should choose a product with a length of coverage that suits one’s needs. For example, retired government servants who are eligible for medical care in public sector facilities may not need private health insurance unless they desire treatment in the private sector.

-Premiums : There are different premiums for different products. Regular premium plans require periodic, regular payments throughout the duration of the policy. Single premium plans require a single premium to be paid at the commencement of coverage.

Many insuring companies change the regular premiums as the insured person gets older. It would be prudent to check whether the policy being considered permits the insurer to do so.

Regular premiums have to be paid when they become due in order to ensure continuing coverage.

- Coverage and exclusions : Different policies provide different coverage. It is difficult to find a policy that provides coverage for all medical problems. So it is important to know what circumstances or medical conditions are covered by the policy.

All products contain exclusions that set out circumstances or medical conditions that are not covered. The exclusions vary from product to product. The most common exclusion is pre-existing medical condition(s). The definition of pre-existing medical condition(s) may vary from product to product. The insured person will have to pay out of his or her own pockets for services that are exclusions in the policy.

It is therefore important to read the policy document carefully to be sure of what circumstance or medical condition(s) is covered or not covered, and whether the coverage is limited to one country, several countries or worldwide.

-Access to doctors and hospitals : It is important to know how the product provides for access to doctors and hospitals. Is a referral from a general practitioner necessary before consultation with a specialist? What hospital can one be admitted to? Can one change the attending doctor or hospital? Does the insurer provide a list of doctors and hospitals? What steps need to be taken to enable one to get the care needed? Is prior approval needed to ensure coverage, for example, hospitalisation for elective surgery?

Does the policy permit the insurer to stop the insured from consulting a general practitioner or specialist who has been providing care to the insured? This question is of particular relevance as it impacts on the continuity and quality of care.

Recently, a large MCO arbitrarily decided and instructed general practitioners not to refer patients to certain hospitals because the latter did not agree to the MCO’s request to give discounts.

According to feedback from general practitioners, this disrupted care to many patients. Fortunately, after intervention by the Health Ministry and Bank Negara, the MCO relented.

Access to care after office hours and in an emergency should also be clarified. Can one go to any healthcare facility even if it is not on the insurer’s list? Is prior approval necessary, and if so, how is it to be obtained after office hours or in an emergency?

-Out of pocket payments : Some products require co-payments and/or deductibles. This information should be provided in the policy

- Making a claim : The process of making a claim should be clear. There are documentary requirements required to support the claim e.g. hospital bills, investigation results, medical reports and so on.

Most policies set a time limit for submission of claims. It is advisable to make a claim as soon as possible.

- Hospitalisation : When one is hospitalised in a private hospital, one needs to check the estimated costs of medical treatment recommended, whether the policy covers the costs and the extent to which it does, consider the options available and choose the ward or treatment according to what is affordable.

- Complaints and appeals : There should be mechanisms stipulated to address complaints and appeals from those who feel aggrieved by the actions of the insuring companies.

- Disclosure : All insuring companies require health information about the individuals or groups to be insured. This is particularly so if one is applying for indemnity insurance. The information include age, gender, occupation, medical and surgical history, any disability, lifestyle habits and so on. If the information provided is incomplete or false, the policy taken up may not provide cover.

At the same time, the insured individuals or groups should check on the information disclosed by the insurance companies or MCOs. All members of a group should ensure that they get a copy of the group policy for each individual’s retention. It is prudent to remember that the small print is as important, if not more important, than the rest of the policy document.

Germs or No Germs? Parents Wanting a Healthy Immune System for their Kids

2010-05-12T17:48:00.000-07:00

Today there are bleaches, disinfectants, antibacterial sprays, cloths, and wipes available to keep bacteria away for parents who are obsessed with keeping their children and their environments clean and healthy . For millions of American parents, cleanliness is next to godliness for the healthy.

However, there is a rising sentiment that we have become too clean. For those who believe that the immune system needs to be challenged, naturally cleanliness is not necessarily next to godliness. The Hygiene Hypothesis basically states that our bodies need to be challenged by friendly bacteria and parasites or the immune system doesn't respond appngies. So, although most people have their wipes, hand sanitizer and multiple other solutions for keeping their kids hands germ-free, kids need to consume some dirt, bacteria and friendly parasites for a healthy immune system.

The body has two sides of the immune system. One side that produces cells called T1 and the other produces T2 cells. When our body comes in contact with a "bad" bacteria or virus, T1 cells are produced to fight that bacteria, this is a normal response. If the immune system receives
inadequate amounts of this simulation, the T2 side becomes over-active, resulting in allergic and autoimmune reactions. The autoimmune disorders associated include MS, Crohn's, ulcerative colitis, hay fever and allergic rashes.

The following tips for challenging the immune system gently and naturally :

a) Play in the Dirt-It's okay for your kids to play in the dirt, and if they eat a little - don't worry about it.

b) Go Wheat and Dairy Free-Take wheat and dairy out of your diet for 90 days. Yes, supplement with B-complex and calcium/magnesium. Most allergy

c) Supplement-Take a good probiotic supplement to aid the digestive in keeping the population of good bugs strong, especially if you are taking an antibiotic. EPA/DHA can help moderate the T1 and T2 cells to balance your immune system

d) Gentle Washing- Washing hands with antibacterial soap, unless you are performing surgery, is not necessary.

e) Eat Fresh and Healthy-Eating fruits, vegetables and lean meats, instead of processed foods from a box or bag, will give the body the nutrients it needs to keep a healthy immune system and feed the good bugs. symptoms clear up within that time frame.

f) Vitamins-Add 1000-2000IU of Vitamin D3 to your vitamin regime. It is also necessary to balance the T1 and T2 sides of your immune system

This healthy information provide by Dr. Kristina Sargent, DC, ChicagoHealers.com

Bike, Riding Right and Preventing Injuries

2010-05-05T02:49:00.000-07:00

Spring has sprung, and cycle season is in full swing. Celebrate National Bike Month (May) by learning how to enjoy this great, low-impact way to stay active, healthy and get around, without the risk of injury. Below the detailed of tips for preventing bicycle injuries, from choosing the right bike to seat height and handlebar position.

a) Choosing the Right Type of Bike and Helmet

b) Generally, for long distances, a sport/touring or racing road bike is ideal. However, many people have comfortably completed long rides on mountain or hybrid bikes by switching to a thinner, smoother road-type tire.

c) A lighter helmet may help to reduce neck pain.

d) Regarding the size of the frame, allow 1 to 2 inches between crotch and top of frame tube on a road bike. If using a mountain bike, the clearance between the crotch and top tube should be 3 to 6 inches.

e) Seat Height-Several methods have been developed to determine proper seat height, but the two most generally accepted are as follows:

e1 - Get on a bike trainer or have someone hold your bike steady while you place the balls of your feet on the pedals, as when riding. When the bottom foot is at the very bottom of the pedal stroke, that leg should have a 35 to 45 degree bend at the knee.

e2 - Place your heels on top of the pedals and pedal backwards. The proper saddle height is the point where the heels maintain contact with the pedals, but the hips do not rock side to side. Also, when the bottom foot reaches the very bottom of the pedal stoke, the leg should be very nearly straight.

e4 - Note that a mountain bike used off road should have the seat lowered slightly.

e5 - A seat that is too high may lead to pain behind the knee. If too low, pain may develop at the front of the knee.

f) Seat Position: Forward/Backward and Tilt :

f1 - A plum line starting at the front end of the knee cap should drop down to the end of the crankarm when the pedals are in the three and nine o'clock position.

f2 - A seat too far forward may result in back and knee pain, but may help to decrease neck and shoulder tension, and vice versa.

f3 - Regarding tilt, your seat should usually be level. A seat tipped forward may cause neck and shoulder pain and/or hand pain and numbness. A seat tipped up can cause unique problems for men: saddle sores, numbness of the groin region, and even erectile dysfunction.

g) Handlebar Position -This should be performed after seat adjustment.

h) A line drawn down from the nose should fall about one inch behind the stem. The back should be lower than 45 degrees and should have no sharp bends. An overly upright position places more stress on the low back and hamstrings. However, elevating the handlebars may reduce neck and shoulder tension as well as hand numbness. A cramped forward position may inhibit normal breathing and cause increased neck stress. Keep in mind that your upper body position is the least exact part of the bike fit, and may require the most experimentation on your part to find the right fit.

i) Miscellaneous Riding Tips

i1 - To prevent knee pain, keep your cadence high - about 80-100 RPM.

i2 - Change gears when appropriate - lower for uphill to maintain proper cadence.

i3 - As a beginner, you may find that you'll want your handlebars higher, but as you grow accustomed to riding, you will be able to tolerate a lower handlebar position.

i4 -To avoid neck, shoulder, wrist, and hand pain and numbness, use padded gloves, change your hand positions often, and keep your elbows unlocked and loose. One helpful accessory for a mountain bike is vertical extensions at the end of the handlebars, which give you another option for hand placement.

i5 - Warm up before riding by starting out at an easy pace with easy resistance, and then stretch after riding.

i6 - If increasing your mileage to complete, for example, a century ride, do so gradually over a period of several months.

i7 - Educate yourself about proper nutrition and especially be sure to drink enough water, and sports drinks when riding for more than two hours.

This healthy information provide by Dr. Ezgur, ChicagoHealers.com.

Healthy Medicine : The body toxic , Love your body, It’s the only home for your soul.

2010-04-30T21:15:00.000-07:00

Healthy Medicine : We have often seen scary reports about the pollution that surround us, and the toxins and poisons in our food. We are unknowingly consuming many food items which are contaminated with banned preservatives, food additives, colourings and other potentially toxic contaminants.

We know that even the fish in the deepest oceans are already contaminated by heavy metals, which means the fish nearer to our shores are more heavily contaminated. The fish in the rivers are even worse. On land, the pollution is much the same, and in some areas even worse.

The problem has come to a point where even though fish is a good source of protein, we have to limit our intake because of the contamination. In the US, pregnant mothers are especially cautioned because of the potential danger to their foetuses.

A study by the US Environmental Working Group (reported in July 2005) that shocked us when it found that all 10 umbilical cord blood samples taken from newborn babies were heavily contaminated. A total of 287 contaminants were detected. Many of these were known or suspected carcinogens, neurotoxins or may cause congenital abnormalities, if present in high concentrations.

If that is the scenario of how our children start their lives, and then get further exposed to toxins and pollutants in the air, water, food and environment, it is not surprising at all that cancer and many other chronic diseases are increasing in prevalence, made worse by our poor diet and unhealthy lifestyle – including smoking, stressful living and lack of exercise.

The main reason why cancer is becoming a menace is the amount of toxins that accumulate in us throughout our lives. Although genes, hormones and infections contribute to certain cancers, the most important factor is the cumulative toxic damage to the cells.

Cumulative damage to the cell by toxins (acting as free radicals at the molecular level) will cause rapid ageing of the cell, with reduction in the efficiency and accuracy of specific cell functions. But as long as the main sequences in the genes remain intact, the cell does not become cancerous.

The first cancer cell is a grossly mutated cell that has lost its instructions to function properly for the benefit of the organ system to which it belongs, and therefore to the body as a whole. Its metabolism becomes abnormal, consuming much more energy in wasteful ways.

It also loses its ability to know when to stop multiplying, and when to stop migrating, thus forming tumours that eat up neighbouring tissues and metastases that eat up distant tissues. How aggressive it behaves depends on the grade (how undifferentiated or how severely mutated) it is.

How to reduce toxin intake..? : Most of us feel helpless when the country is visited by the almost-annual haze. Sometimes it comes here more often, courtesy of our neighbour. During each episode, we go around wearing masks which actually sieve only the big particles but still let in the cancer-causing minute particles.

It is indeed very difficult to avoid inhaling the dangerous particles during a haze. The only remedy is to stay indoors in a room treated by a good air-cleansing/filtering system, preferably one that also produces negative ions. You should of course avoid the most direct and popular cause of self-poisoning – smoking.

The quality of water supplied to our homes is suspect, although much improvement has been made over the decades. We are more conscious of the quality of water we drink.

At home most of us drink treated/filtered water, and when we travel, we drink bottled water. But what about the water used in the stalls and restaurants when we order cold drinks or even fruit juices? Do they use tap water, bottled/treated water or boiled water? If we order hot drinks, we can at least assume that the water is boiled first.

And what about the water we bathe and shower with? Remember that the skin is the largest organ and it absorbs some of the water and whatever contaminants we “wash” it with. Every home should have an outdoor water treatment system that ensures the entire household water supply is clean.

Detoxify your food : When it comes to food, many of you will be shocked to know that even if you wash your foodstuff, you may still be ingesting the residual toxins.

Except for the organic ones, fruits and veggies are invariably sprayed with pesticides in the farms. Some unscrupulous farmers may add gum to the pesticides so that they don’t get washed away every time it rains. Unless you scrub, some pesticide may still remain after washing.

Secondly, remember that these pesticides are toxic chemicals which get absorbed into the skin of the fruits and veggies. Even if you scrub, you can only remove what is on the surface. Whatever has been absorbed will go into your body when you eat the fruit or veggie (unless you remove the skin, but for some fruits, the skin is rich in certain nutrients).

To remove some of the absorbed contaminants, you have to ozonise the fruits and veggies. The food detoxifier/ozoniser machine produces ozone (O3) which is bubbled into a container with the foodstuff submerged in water, just like how oxygen (O2) is bubbled into a small fish tank.

The O3 molecules will rapidly split and finally become O2. In the process, the molecules kill germs and dislodge contaminants from the foodstuff, leaving behind fresh, pure, oxygenated foodstuff. The chemical contaminants will be destroyed, and solid contaminants will separate and float to the surface.

Ozonated water can be consumed and also used for body-washing and bathing. Ozone is also used to treat diabetic ulcers, and some doctors are using intravenous ozone to detoxify and decontaminate the body directly (ozone also kills viruses, bacteria and parasites).

Avoid processed meats : Meats (fish, chicken, beef, mutton, etc) are also heavily contaminated and should be ozonised the same way.

A report by the World Cancer Research Fund, entitled Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective (2007), revealed that processed meats definitely cause cancer. They reviewed 7000 studies on diet and cancer.

Processed meats are meat products that have chemical additives to alter their taste and preserve their shelf-lives so that they become marketable. These include bacon, hotdog, sausage, pepperoni, deli slices, canned meats, and many more. The harmful chemical additives are blamed for increasing cancer risk.

Burnt, barbecued meat also has high levels of carcinogens. So when you eat satay or BBQ, avoid the burnt parts. Better still, eat sushi, like the Japanese!

Detoxify your body : The ways you can detox your body include eating a high fibre diet (supplement if necessary), taking chlorella supplements, drinking plenty of fluids, chlorophyll and detox teas, fasting (juice, water or total fasting), body wash/scrub, dry body-brushing, sweating through exercise or sauna, coffee enema ( stimulates the liver ) and colon hydrotherapy/irrigation.

Some herbs like milk thistle, silymarin and others may protect and help the liver, which is the main detox organ. There are also qigong exercises beneficial for liver health.

Those who don’t eat enough fruits and veggies will have to take extra fibre supplements. A cheap alternative is breakfast bran. The best is one that combines the nutrients and fibres from many fruits and veggies, complete with enzymes and probiotics, taken as a drink.

If your fibre, water, enzymes and probiotics intake are sufficient, and your bowels are healthy, you will have regular bowel movements (one to two times per day).

Accumulation of heavy metals is blamed for many diseases, including cancer and atherosclerosis (which causes clogged arteries). They can be removed through sweating, nutrition, oral chelation, and intravenous chelation therapy.

Chlorophyll is a natural bowel cleanser, apart from being beneficial for the whole body. It is the plant kingdom’s equivalent of our oxygen-carrying haemoglobin. Chlorella (a blue-green algae similar to spirulina) is rich in chlorophyll and a long list of nutrients, and is also a natural body detoxifier.

At the cellular level, antioxidants fight off the toxic free radicals, so an adequate daily dose of antioxidant supplements is recommended as additional defence, in addition to those provided by the fruits and veggies in your diet.

Sweating through exercise or sauna will remove many toxins that would otherwise get trapped in the body because certain toxins are preferentially excreted through sweat.

Sweating a lot also relieves the kidneys and liver from having to deal with these toxins, which would otherwise have to be excreted through these two overworked organs.

Aerobics exercise has added benefits for cardiovascular health, and FIR (far infra-red) sauna nourishes the body with healing energy.

In a previous article (www.superqigong.com/articlesmore.asp?id=26), I wrote about the Gerson therapy, which is a strict programme based on detoxifying the body while nourishing it with nutrients from fruits, veggies and selected foods.

Dr Max Gerson knew long ago that cumulative poisoning causes the body to develop certain chronic diseases and cancer, and also lose the ability to prevent or overcome other health problems.

For those of us who are still healthy and want to avoid disease, a diet based on plenty of ozonised fresh fruits and veggies (organic if available) with minimal meat is advisable. Or you may even decide to become vegetarian after reading the report on processed meats.

Otherwise, make sure you detox your body and nourish it with plenty of nutritional detox and antioxidant foods and supplements.

Toning Shoes-The Way to a New Lower Half?

2010-04-30T03:00:00.000-07:00

More and more physiological footwear seems to be appearing in the market. Shoes aimed at bringing bodies into alignment, balancing the weight, burning calories, and more just for healthy. Do these shoes really accomplish all they promise?

The shoe brands and offers the following insight :

The Design : Many wellness shoes, such as those made by MBT, are known as rocker-style shoes because the negative heel (lower than the toe) and curved bottom results in a gait that, the companies claim, improves posture and creates a natural instability that forces your buttocks and thighs to work harder.

Consider Practical Alternatives : Before you blow your budget on a pair of these shoes, it's important to understand that you can tone your backside without special footwear. For much less money and similar results, you can incorporate balancing exercises into your day.

Make Sure to Stretch : If you're dead-set on buying wellness shoes in a quest for a tighter tush, be sure that you incorporate daily stretching into your life, or you're likely to be sidelined with pulled muscles rather than rocker-walking your way to firmer thighs.

Health Experts Recommendation : My personal preference is the ergonomic Cardiostride(tm) - meaning that it gives you a cardiac workout just be wearing them and moving your body. I have worn the first, second and third generation Cardiostrides(tm), and I love them. (www.mynikken.com/corewellness) Why, you ask?

They tone the body

The lower trunk is heavier than the upper trunk of the body: the shoes align the ankles, knees and hips- pulling in your abs and your gluteus

Wear them to burn calories faster, firm and tone muscles : get in better shape, raise your metabolic rate, and receive cardiovascular conditioning*

When used in conjunction with an exercise program.

"Physiological footwear may have a permanent place in a niche market," says Weinstein, "but it's not going to revolutionize female American butts. Only squats, lunges, and fewer donuts will accomplish that."

This healthy tips provide by Sharon M. Weinstein - ChicagoHealers.com

Healthy, Quick Breakfast-Cereals were Rated and Failed

2010-04-30T01:54:00.000-07:00

Despite studies which show that those who skip breakfast have higher body fat content than those who do not, an ABC News poll showed that 40% still skip the morning meal. Recently,Yahoo! Health rated the best and worst breakfast cereals

All but one (Spoon size Shredded Wheat) had sugar, and one of the "worst list" granolas had 30 grams of sugar-in one serving! Except for the shredded wheat, most cereals on the market today, contain far too much sugar to be the best choice for breakfast.

Below an ideas for healthy, quick, breakfast options :

Healthy Breakfast Shakes : Breakfast shakes with fruit and protein are great and healthy, with lots of bioflavonoids and vitamins from the fruit like A, B1, Folate (folic acid) etc, and added protein to hold you through the morning. The protein can be come from rice, soy, egg, or dairy (whey.)

How to make this healthy shakes..? Just put your mixed fruit and protein in the blender container the night before and put it in the refrigerator. Take it out in the mornig (AM), then add a water or juice or almond milk or yoghurt, whatever you like best, buzz it up, pour it in your carrying cup, and off you go, its very easy & healthy.... ;-).

Good Healthy Cereal Choice : If you are OK with wheat and dairy, the Spoon Size shredded wheat, milk and fruit are a great option. There is no sugar, only 1 gram of fat in the shredded wheat and plenty of protein in the milk. Try organic milk so that you can skip any bovine growth hormone, antibiotics or pesticides that might be lurking in non-organic milk.

Include Healthy Protein : Sandwich is an easy and a quick helathy breakfast , protein-rich way to start the day. Here's a quick, healthy alternative to the egg, cheese and muffin grease-ball that you might get at your local drive-in:

Put some mixed frozen veggies in the refrigerator to thaw the night before. In the morning, pop a piece of whole grain bread in the toaster, throw the veggies in a little non-stick pan with some Earth Balance margarine and an egg or two, maybe a sprinkle of shredded cheese, slap your little "omelet" on the toast. Four minutes and you're gone.

This healthy tips gived by ChicagoHealers.com / practitioner Dr. Martha Howard.

Healthy Medicine : Make Your Food Work Harder for You

2010-04-21T09:33:00.000-07:00

In an ideal world, we would like to get as many nutrients from the foods that we eat. However, with Americans spending over $140 billion a year on nutrient-poor and potentially damaging fast food, this can be very hard to do. To get the most out of what we eat and make your food work harder, Dr. Helen Lee, DC a ChicagoHealers.com practitioner offers the following tips:

A) Choose FRESH: Foods that have the least amount of processing, seasonings, curing, frying, sauces, etc. will offer more nutrients to the body. The more you can identify the protein, vegetable or fruit that you are eating the better! Over-cooking tends to decrease nutritional value of the food.

B) Choose Variety: Switch up what you eat since each food will provide only certain nutrients. For example: avocados contain good fats, Vitamin E, potassium, orange vegetables like carrots and orange peppers provide beta carotene which is great for eyes, skin and hair, Greens like kale, swiss chard, spinach provides calcium, vitamin K and A which is great for immune system and overall healthy pH; Fruits such as blueberries and pomegranates provides antioxidants. So mix it up and have fun!

C) Drink Water Through the Day: Water is crucial for just about every aspect of your body including the digestive, muscular, and nervous systems. Make sure you drink water all through the day to keep your body hydrated and ready to work for you.

D) Slow Down & Practice Moderation: Eat slowly and chew your foods well. The more you chew and breakdown your food the more nutrients your body will be able to access as it moves through your digestion. Eating slower will also allow your body to communicate when it is full. Research has shown that it takes up to 20 minutes for your hormones to let you know that you are full and therefore it lead to overeating. Overeating also creates more demand on our digestive system and can slow down or "overwhelm" it so that it is unable to access nutrients.

E) Prepare your body for mealtime: There are 2 parts of the nervous system, the Sympathetic or work mode, and the Parasympathetic, which is responsible for rest, digestion, and cleansing part of the nervous system. By simply putting your attention on your meal (instead of multi-tasking), and doing some belly/abdominal breathing you can prepare your body to shift into parasympathetic mode which will engage optimal digestion.

For additional information including an interview with ChicagoHealers.com Practitioner Dr. Lee. please visit www.ChicagoHealers.com.

Make Your Food Work Harder for You - Tips from ChicagoHealers.com
Practitioner Dr. Helen Lee

Source: http://www.thehealthyeatingguide.com/healthyeatingstatistics.html

healthy-medicine: 2010 Worst Allergy Season

2010-04-13T22:32:00.000-07:00

Attention allergy sufferers, if you're noticing that your throat is scratchier than usual, your nose is running a marathon and your eyes are tearing up, then you know it is indeed that time of year.It seems almost every year we’re saying this year is a bad allergy year. But this year really is a horrible year for allergies. In fact, this is perhaps the worst allergy season in 40 to 50 years.

Dr. Ian Wahl joins us to give tips to for breathing easy on this Allergy Season : Spring seoson has finally arrived. And with the long-awaited beautiful weather and the shades of green painting our landscape, has come the pollen. ABC News reports that 2010 has been an especially bad year for allergy suffers due to the late onset of Spring and the amount of late Winter rains throughout the country.

According to the American Academy of Allergy, Asthma, and Immunology, roughly 20% of Americans suffer from allergies and Dr. Ian Wahl, DAc, LAc, ChicagoHealers.com practitioner offers the following tips for staying allergy free during this especially bad allergy season.

a) Magnesium eases breathing : Some immunologists suggest taking 400 milligrams of magnesium daily helps with nasal allergies and breathing problems. If you want to supplement your diet with magnesium-rich foods, the best sources are nuts, beans, whole grains, green leafy vegetables, and bananas.

b) Take a whole food based Vitamin C : Vitamin C acts as a natural antihistamine. Methodist Hospital in Brooklyn, NY found that taking vitamin C daily, significantly reduced blood histamine levels

c) Wear sunglasses when going outside : Allergic rhinitis, or hay fever, creates a certain amount of photosensitivity. Wearing sunglasses helps reduce your sensitivity to light and thus helps your eyes from excessive watering.

d) Use your bathroom exhaust fan when taking a shower : This will help prevent to growth of mold in the shower. Cleaning your bathtub or shower liner is also important. Better yet, replace your liner every month or two, if you have mold sensitivities or asthma.

e) Drink a lot of cool water : It probably seems counterintuitive, to recommend drinking water
with all of that liquid in your sinuses, nose and eyes. But rehydrating is one of the best ways to eliminate toxins from your body. Besides, it cools you down and provides some symptom relief.

f) Check the local pollen count : If you have severe allergies, you might consider wearing a mask on days when the pollen count is unusually high. Stay away from dairy I know, it is summer and that means ice cream. But if you have hay fever, eating dairy will produce even more phlegm and make you feel worse.

g) Get rid of clutter : Allergy sufferers need to be especially careful about controlling dust in their homes. And clutter is a major source of dust and dust mites. If you can't see your floors or walls in closets and basements, you have a clutter problem. Just as clutter clogs your house and obstructs the free flow of energy in your home, clutter also clogs your nose and obstructs the free flow of life-giving air into your body.

h) Keep your dryer vent clear : Build-up of lint in the dryer vent will cause an excess of dust in your house. Have your vents cleaned regularly to avoid aggravating your allergy symptoms.

i) Use a vacuum with a HEPA Filter : HEPA filter vacuums do not recirculate back into the air the polluting particles that the vacuum has just picked up. Make sure you have a true HEPA filter and not a HEPA-like filter. You can tell by looking at the manufacturer's test results of their filter. A true HEPA filter will have test results stating that .3 microns are 99.97 percent or above.

For more additional information including an interview with ChicagoHealers.com Practitioner Dr. Wahl , please visit www.ChicagoHealers.com.

ABC News Story: http://cosmos.bcst.yahoo.com/up/player/popup/?cl=19059265

from ChicagoHealers.com practitioner Dr. Ian Wahl

Tips To Prevent Dangerous of Salt

2010-04-01T22:05:00.000-07:00

Tips To Prevent Dangerous of Salt Intake Levels from ChicagoHealers.com Dr. Martha Howard, MD, Dipl. Ac. NCCAOM. The FDA recommends 2.4 grams of sodium, (about a teaspoon of table salt) and the American Heart Association recommends even less only 1.5 grams a day. Yet among Americans aged 31 to 50, more than 95 percent of men and 75 percent of women exceed that guideline.

The Center for Science in the Public Interest (CSPI) estimates that roughly 75 percent of America's sodium intake comes from processed foods, and calls processed food "the Number 1 sodium villain in our diet." For instance, a lunch of:

a) Campbell's Chicken Noodle Soup (1,140mg of sodium)
b) A serving of Kraft Macaroni and Cheese (845mg)
c) A Coke (15mg)
d) Jell-O Instant Chocolate Pudding (420mg)

equals a meal of 2,420 grams of salt ....?

High levels of salt mean high risk for the development of diabetes, high blood pressure, kidney disease, osteoporosis, and other chronic illnesses. ChicagoHealers.com Practitioner Dr. Martha Howard offers the following tips for reducing sodium in your diet.

a) Include Minerals in your Diet- Make sure you get enough of the minerals that balance salt-potassium, calcium and magnesium. That's 4.7 grams of potassium, 1 gram of calcium and .5 grams of magnesium for most adults. Baked potatoes with the skin, apricots, raisins, bananas, and tomato paste are all examples of high potassium foods.

b) Keep Salt Levels Down-Keep your daily salt down to the FDA level of 2.4 grams, about a teaspoon (total salt, not added salt). Make your upper limit 4 grams of salt, and if you have chronic illness, follow the AHA recommendation of 1.5 grams.

c) Use Alternative Seasonings-Use salt-free herb combinations like Spike or Dash, and lemon to season meats, fish or chicken.

d)Knowledge is Power-Check out the salt content of processed foods and fast foods, and stay away from both.

e)Eat Healthy-Eat unprocessed, whole foods, with at least 5-6 servings (a serving is a half cup) of fresh fruits and vegetables.

For additional information including an interview with ChicagoHealers.com Practitioner Dr. Martha Howard, MD, Dipl. Ac. NCCAOM please contact Meredith Hutchings at mhutchings@paramountpr.com or click www.ChicagoHealers.com for more information.

Tips for Oral Cancer Awareness Month

2010-03-23T15:45:00.000-07:00

More than 35,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 35,000 newly diagnosed individuals, only slightly more than half will be alive in 5 years. This is a number which has not significantly improved in decades. The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer, Hodgkin's lymphoma, laryngeal cancer, cancer of the testes, and endocrine system cancers such as thyroid, or skin cancer (malignant melanoma). If you expand the definition of oral cancers to include cancer of the larynx, for which the risk factors are the same, the numbers of diagnosed cases grow to 45,000 individuals, and 12,500 deaths per year in the US alone. Worldwide the problem is much greater, with over 600,000 new cases being found each year.

HPV and Oral Cancer-Preventative Tips for Oral Cancer Awareness Month, from ChicagoHealers.com Practitioner Dr. Kevin Boehm, DDS

April is Oral Cancer Awareness Month. This year alone over 34,000-estimated new oral cancer or pharyngeal (throat) cancer cases will be diagnosed in the U.S. Unfortunately, the death rate associated with oral cancer has now surpassed the rate of cervical cancer in women over the past few years. An estimated 50% of Americans do not visit their dentist regularly or at all, plus, the disease is routinely discovered too late in development. Put all these factors together and a scary public health disaster appears on the horizon.

ChicagoHealers.com Dr. Kevin Boehm, DDS offers the following information and preventative tips for oral cancer in honor of Oral Cancer Awareness Month.

Oral Cancer Information:

#Risk Factors-Risk factors associated with oral cancer are:

a) Ethanol from drinking alcoholic beverages,
b) HPV or Human Papilloma Virus infection.
c) Smoking or chewing tobacco products, and

# Strands of HPV-Some sexually transmitted forms of HPV seem to pose the greatest threat to cancer formation, including HPV-16, HPV-18, HPV-31 and HPV-45. HPV-16 and HPV-18 have been shown to cause up to 95% of cervical cancer in women.

Preventative Tips:

a) Drink alcohol in moderation-Excessive alcohol consumption can be a risk factor for the disease. Also, those who drink and use tobacco have a 15 times greater risk of developing oral cancer.
b) Practice Safe Sex-If appears that most cancer related HPV's are transmitted sexually. Use of condoms to prevent spreading HPV-16 and HPV-18 is helpful, as well as limiting numbers of sexual partners.
c) Don't use tobacco- Tobacco in any form is detrimental to oral health and is a causal factor in oral cancer.
d)Visit the Dentist-Your dentist has a number of early detection techniques aside from a visual assessment such as velscope or vizilite. These use fluorescent light to pick up abnormalities. Brush biopsy techniques allow cells to be collected and sent to a laboratory to check for abnormalities under the microscope.

Please let me know if you are interested in additional information including an interview with ChicagoHealers.com Practitioner Dr. Boehm. For more information, please visit www.ChicagoHealers.com.

Source: http://www.oralcancerfoundation.org/facts/index.htm

Media Contact: Meredith Hutchings
mhutchings@paramountpr.com

Doctors That Make House Calls - iHealthCast.com Conveniently Brings the Medical Experts to You

2010-03-23T15:28:00.000-07:00

Doctors That Make House Calls - iHealthCast.com Conveniently Brings the Medical Experts to You, at Your Home or Office, to Better Manage Your Family’s Health

IRVINE, Calif. (March 17, 2010) – Most people want better access to health care for themselves and their family, however a major obstacle in achieving this is the time and hassle involved in seeing a doctor. Many find the whole process discouraging.

Until now, this process typically involves calling to make an appointment, usually for a much later date, arranging for time off work and then making childcare arrangements. On the day of the appointment, patients tend to wait in cramped waiting rooms, coming into contact with germs. Then, the actual appointment may be rushed as well, leaving patients feeling frustrated.

Introducing “www.iHealthCast.com”, a health website that allows you to consult with a doctor in the comfort of a home or office. Ideal for busy adults and parents who want to make their health a top priority, but who simply can’t find the time to do so as often as they should.

iHealthCast.com makes it much easier to understand health issues, to consult with health care professionals and then to act on the knowledge or advice that’s provided. All this supports healthier living, more vitality and less stress.

iHealthCast.com provides:

a) Free video casts by top doctors to provide an overview of most major health issues, in simple terms people can understand.
b) Personal online consultations with Natural Physicians for a natural approach to health and vitality.
c) Personal online consultations with Medical Doctors with optional prescription support.
d) Affordable Stress Solution Tool, developed by a leading medical school, to objectively assess levels of stress, provide a personal assessment and strategic plan to minimize it.
e) Free Health Strategies for every member of the family. Guidelines that are specific to gender and age range, including health tips on eating, hydration, supplements, exercise and more.
f) Free Heartbeats Blog – interesting articles written by medical experts like Dr. Meletis to raise daily awareness and help people understand all factors that positively and negatively influence health, wellness and vitality – both mentally and physically.
g) Free My Health and Fitness Apps – online tools to better assess and monitor overall personal health as well as set and track goals.
h) Health Market Online Shopping – valuable health products at affordable prices, including Vital XP – the only nutrition based energy drink, plus high-quality dietary supplements, joint supports for wrist, elbow, back, and knee, plus circulation-boosting socks, a body composition analyzer and much more.
i) Ability to use FSA or HSA for tax-deductible medical expenses for consults and prescriptions.

iHealthCast.com features priceless information from Dr. Chris Meletis, one of the most knowledgeable and highly-respected natural physicians in the world. In addition to the nearly 40 FREE online video presentations and 50 health briefs by Dr. Meletis and his colleagues, iHealthCast also provides Dr. Meletis' weekly “Heartbeats Blog” which includes some of the most relevant and current health topics, such as H1N1 (Swine Flu) and the effects of stress that so many people are trying to cope with.

iHealthCast.com offers busy people who are tired of searching through pages and pages of medical articles on other sites to find what they are searching for, then too worn out to read and understand it, a better solution. iHealthCast.com is the closest thing to having unlimited time and access to Dr. Meletis to speak to him directly about personal health issues. This valuable access is more efficiently delivered online, when and where people need it.

iHealthCast.com is also found on the most popular social networks including Facebook and Twitter. To help people remember their daily health priorities, iHealthCast offers Twitter updates of all the latest Heartbeats Blog posts – www.twitter.com/HeartbeatsBlog. People can also ask Dr. Meletis a health question on iHealthCast’s Facebook page and receive a detailed response – www.facebook.com/iHealthCast.

“This is one of the very best options for people who want to take charge of their own health,” said Marty Matthews, iHealthCast’s Director. “Dr. Meletis is amazing in his insights and ability to simplify and empower individuals to achieve their health and vitality goals.”

Media Contact:
Lindy Neubauer
PR Manager
Interush, Inc.
t: 949.265.7750 ext. 110
f: 949.265.7751
e: lindy@interush.net

Minimize the symptoms of heartburn during pregnancy

2009-08-03T18:16:00.000-07:00

The relief of symptoms is rapid - in five minutes - and can last up to four hours. Alginates are not absorbed into the bloodstream, but of course, are eliminated from the body, so this treatment particularly suitable for pregnant women.

Antacids : Antacids neutralize stomach acid so it does not irritate the tube when it flows from the stomach. While it is fast-acting relief, does not last as long as alginates. It is best to avoid antacids containing aluminum and sodium, which can cause constipation in pregnant women.

Each pregnancy is unique so please remember to always consult your doctor to get the most appropriate treatment for you and your baby.

A Healthy Pregnancy : Ignoring the symptoms of heartburn will not go away, but can have negative effects if the unrest continues. The state of his health before and during pregnancy affects your baby's wellbeing at birth and beyond.

Therefore, pregnancy in the event of difficulties, such as heartburn, are affecting their ability to maintain optimal health, you should seek ways to alleviate discomfort with minimal risk to yourself and your baby.

The medication is effective in relieving symptoms of heartburn, but is not the end all and all. There are simple things you can do to minimize the symptoms of heartburn, such as:

# Eat several smaller meals to reduce the stomach

# Chew each mouthful slowly

# Take a walk at a moderate pace after meals to aid digestion

# Avoid lying down within two hours after eating

# Do not bend you on the couch because her tummy crushes

# Wear loose clothing around your belly

# Bend your knees, not the waist to pick things

# Develop effective ways to manage stress - stress can cause digestive slower

# Avoid spicy, very spicy, fatty or fried foods, coffee, alcohol, carbonated drinks, and anything with chemical additives

It is especially important to proactively manage their health during pregnancy. By maintaining a healthy body, which is keeping her healthy baby from conception to birth and that is the best start you can give your child. Pregnancy is one of the most joyful moments that we as women will never experience. Yes, within nine months that follow may be fraught with discomfort and adapt to life inside of us, but do not let discomfort in the way of enjoying your little miracle.

How safe & effective are sunscreens, really?

2009-07-06T21:38:00.000-07:00

Sunscreens are improving, but three of five brand-name products either don't protect the skin from sun damage sufficiently, contain hazardous chemicals, or both, according to a report by the watchdog organization Environmental Working Group (EWG).

"I'd give the industry a C minus," says Jane Houlihan, EWG's senior vice president for research. "They have moved from a D to a C-minus in my book."

Overall, however, she says the industry is "not doing enough to protect consumers from UVA radiation."

The report is called the EWG 2009 Sunscreen Guide. An industry spokesman says the report is flawed.

Dermatologists who reviewed the report for WebMD offered praise and criticism. "Some points are definitely correct,'' says Henry Lim, MD, chairman of the department of dermatology at Henry Ford Health Systems, Detroit. But, he adds, ''This report has somewhat of an alarmist tone.''

Sandra Read, MD, a Washington, D.C., dermatologist and member of the board of directors of the American Academy of Dermatology, says she finds the report discouraging but says she hopes it will raise awareness of the need for sunscreen.
The 2009 Study on Sunscreen Effectiveness

This year's report is the third annual from EWG, which investigated 1,572 sunscreens, lip balms, and daily moisturizers with sun protection factor (SPF) of at least 15, typically the minimum recommended.

This year's study, as those in the past, was triggered, according to EWG, because the FDA has not set comprehensive safety standards for sunscreens. The agency has set guidelines for UVB protection but those for UVA are pending. UVA rays are associated with skin sagging and wrinkles, but more recently have also been associated with skin cancer; UVB rays can lead to skin cancer and sunburn.

The FDA is lagging behind other countries, the report charges, because it has approved only 17 sunscreen chemicals for U.S. use, compared to at least 29 in other countries.- WEBMD

Erika Schwartz, MD, Chief Medical Officer for Cinergy Health (www.cinergyhealth.com) is a general internist, an authority on preventive health and a patient advocate. She is a 25 year health industry veteran, working in both an ER as well as a private practice. She is based in New York and very media savvy (Dr. Erika has appeared on Oprah, The View etc).

From the Desk of Susan M. Rotante :

To do the 2009 study, EWG scientists got a list of ingredients from retailers and then used numerous databases to evaluate safety and effectiveness.

From deak of Looking to interview doctors on sun protection/skin cancer? Summer is officially here and the sun is full force, we’ve all bought our sunscreen for this season, however, a new study shows that three of the five top brand-name sunscreens don’t protect skin sufficiently and contain hazardous chemicals .

Skin cancer is the most common form of cancer in the U.S. More than one million skin cancers are diagnosed annually. There is not enough being done to protect consumers from skin cancer.

I work with several skincare, beauty and health prevention experts who can discuss tips to prevent skin cancer, sun protection and what products to use that DO protect your skin.

Please let me know if you are interested in setting up an interview, bio and headshot are below for your reference:

Susan M. Rotante
5W Public Relations (www.5wpr.com)
1120 Avenue of Americas
7th Floor
NY NY 10036
Direct Dial- 212-584-4317
T- 212-999-5585
F- 646-649-9088

New Internet Intervention Gives Insomnia Patients a Better Night’s Sleep

2009-07-06T21:19:00.000-07:00

healthy medicine : CHARLOTTESVILLE, Va., July 6, 2009 – UVA Health System Study Finds Nearly Three-Fourths of Patients Reported Notable Sustained Improvements in Sleep. The estimated one-third of adults who suffer from insomnia could soon find effective treatment without ever leaving their homes. Researchers at the University of Virginia Health System have developed a unique Internet-based intervention, based on well-established face-to-face cognitive behavioral therapy techniques, that has shown remarkable results in improving patients’ sleep.

In the pilot study, Lee M. Ritterband, Ph.D., associate professor of psychiatry and neurobehavioral sciences at the UVA School of Medicine, and colleagues evaluated the effectiveness of the Internet intervention among 44 adults who had a history of sleep difficulties lasting more than 10 years on average. A total of 22 participants were randomly assigned to a control group and 22 received the Internet intervention, called SHUTi.

“All 44 patients were in the moderate severity range for insomnia when we began our study,” Ritterband says. “After completing our study 73 percent of those who used our system reported no severity of insomnia, whereas all patients who didn’t use the system continued to have the same level of moderate severity.”

Furthermore, Ritterband reports that all patients with improved sleep after using the Internet intervention maintained these improvements six months after the study’s completion. The study, supported by a grant from the National Institute of Mental Health, National Institutes of Health, appears in the July 2009 issue of Archives of General Psychiatry.

The highly interactive nine-week program uses text, graphics, animations, vignettes, quizzes and games to present behavioral, educational and cognitive techniques for improving sleep. For instance, patients were advised to avoid reading and watching television in the bedroom, stop daytime napping and change unhelpful beliefs and thoughts (including worries about the consequences of insomnia) that may exacerbate sleep difficulties.

“Our program is unique in that it engages the user and tailors the treatment to an individual’s particular needs,” says Ritterband. “These interactive components make it like no other online intervention for insomnia out there right now.”

Participants completed daily sleep diaries before and after the intervention and also rated their symptoms on the seven-item Insomnia Severity Index, which produces a score from zero (no symptoms) to 28 (severe insomnia). Among individuals who received the intervention, scores on the index improved from 15.73 to 6.59, whereas scores did not change for the control group. These gains were maintained at a six-month follow-up assessment.

“One of the exciting pieces of Internet-based interventions is to be able to provide treatment to people who otherwise might not get treatment,” says Ritterband.

Cognitive behavioral therapy—a psychological treatment focusing on the behaviors and dysfunctional thoughts that contribute to sleep problems—is one of the most effective treatments for insomnia.

“Unfortunately, availability of cognitive behavioral therapy is severely limited for many reasons, including lack of trained clinicians, poor geographical distribution of knowledgeable professionals, expense and inaccessibility to treatment and clinicians,” says Ritterband.

“An Internet intervention has the potential of meeting the large unmet treatment needs of the population with insomnia by providing effective treatment through the Web. An effective and inexpensive Internet intervention would expand treatment options for large numbers of adults with insomnia, especially those whose geographical location prohibits access to relevant care, and could be a substantive first-line treatment choice.”

Related link: The study is available in the Archives of General Psychiatry, Volume 66 (No. 7), July 2009, or at www.jamamedia.org. - healthy medicine

Could healthy living prevent cancer?

2009-07-01T19:37:00.000-07:00

Healthy Medicine : Looking to interview any health experts who can discuss cancer topics? Cancer is the 2nd leading cause of death in the U.S; however, could it be prevented? An estimated 269,800 women and 292,540 men will die from cancer this year, totaling more than half million Americans. Following Farrah Fawcett’s unfortunate passing; it’s increasingly clear how vulnerable we all are. Despite the fact that we all, “know” we could be at risk, it’s quite another thing to act on it.

Medical Director of Cinergy Health, Dr. Erika Schwartz has provided valuable tips below on cancer prevention and things we can do to improve our health.

Cancer Prevention Tips:

1. Focus on healthy diet: Science supports the importance of eating fresh fruit and vegetables and low intake of animal protein and casein (dairy protein) in preventing and reducing the risk of cancer by 30-60%

2. Exercise: People who exercise 6 days a week lower the risk of getting cancer by more than 30%

3. Sleep: Sleeping 7-8 hours a night increases hormone production and immune system boosters. The result is reduced risk of cancer.

4. Stress management: Addressing stressors and managing their impact on the human body decreases cancer risk significantly.

5. Eliminating alcohol: People who consume more than 7 drinks per week have 60% higher risk of developing cancer. Alcohol is directly connected to increased risk of pancreatic, stomach, liver and liver cancers. Limiting the quantity and frequency of alcohol intake decreases risk of cancer.

6. Obesity and diabetes: 20% higher risk of colon cancer and of course all other types of cancer and diseases.

7. Smoking: Smoking increases the risk of lung cancer, vocal chord cancer, and throat and bladder cancer.

8. Birth control pills: They increase the risk of liver cancer and other synthetic hormones are associated with increased incidence of female organ cancers like ovarian, breast and uterine cancers.

Let me know if you’re interested in an interview, bio and headshot are below for your reference.

Thank you,

Susan

Dr. Erika Schwartz, Medical Director of Cinergy Health is a general internist, an authority on preventive health and a patient advocate. She is a 25 year health industry veteran, working in both an ER as well as a private practice.

Susan M. Rotante (srotante@5wpr.com)

5W Public Relations (www.5wpr.com)

1120 Avenue of Americas

7th Floor

NY NY 10036

Direct Dial- 212-584-4317

T- 212-999-5585

F- 646-649-9088

Healthy Medicine

Mummy, my tummy hurts!

2009-06-20T03:23:00.000-07:00

Your child will most probably experience abdominal pain at some point in his or her life. Here’s a guide to help you understand recurrent abdominal pain and what to watch out for.

PAIN in the stomach or intestinal area is generally described as abdominal pain. Your child has recurrent abdominal pain if he experiences at least three episodes of abdominal pain that are severe enough to affect his daily activities, over a period of at least three months. Studies have shown that about 10% of Malaysian school children aged 11 to 16 years suffer from recurrent abdominal pain.

Recurrent abdominal pain by itself is not a disease, but it is a term used to describe a symptom. The cause can sometimes be organic, which means that there is an underlying disorder/disease such as urinary tract infection, lactose intolerance, inflammatory bowel disease, pancreatitis (inflammation of the pancreas), gastritis (inflammation of the lining of the stomach), oesophagitis (inflammation of the lining of the oesophagus), peptic ulcer, or stool retention.

Is the abdominal pain due to an organic disease?

Features that may suggest an organic cause are:

Site of pain: Non-organic pain tends to be in the centre (periumblical). The further the pain is from the centre, the more likely the pain is caused by an underlying disease.

Sleep disturbance: Does the abdominal pain wake your child up in the middle of the night? If so, there is a much higher chance that there is an underlying organic disorder.

Age of child: In general, the younger the child, the higher the chance that there is an organic disease.

Presence of features of organic disease: Fever, blood in the stools, inflammation (of the joints, skin or eyes), weight loss, poor growth, anaemia, jaundice, pain when urinating, high blood pressure, and recurrent mouth ulcers all point to organic disease.

Family history: If there is a family history of diseases such as inflammatory bowel disease, peptic ulcer disease, or renal disorders, your child may be at a higher risk of developing these diseases.

Recurrent abdominal pain may have negative effects on your child’s physical and psychological state. The pain can interfere with his school attendance as well as affect his appetite, sleep, mood, and emotions.

In addition to his overall well-being, all these problems may affect your child’s growth and development. So if your child suffers from recurrent abdominal pain, it is best to bring him to see the doctor.

Your child may be stressed out!

Studies on recurrent abdominal pain in childhood have shown that 95% of children affected with abdominal pain have no underlying diseases. In such cases, the cause of the abdominal pain is often stress or other emotional problems related to anxiety.

Studies conducted by University of Malaya Medical Centre have shown that children aged nine to 15 years who experienced recent significant life events, such as a death in the family, change of address, failure in a major school examination, or bullying at school, have a higher chance of developing recurrent abdominal pain.

You should not disregard your child’s woes when he cries out in pain. Keep in mind that although there may be no obvious medical causes for the pain, it does not mean that the pain is not real or that your child is making it up. It merely suggests that the abdominal pain could be largely caused by stress, anxiety or depression.

If the doctor is unable to detect an organic cause for your child’s recurrent abdominal pain, it could be caused by stress or anxiety. You can help by being aware of the following:

Timing: Note the time that your child began to complain about his “stomach” pain. Did the pain start at the time of a family upheaval? Or did it occur due to problems at school? At times, there may be no obvious contributing factor. Accompanying features: Be aware of other features such as constipation, diarrhoea, headaches, feeding problems, nightmares, or fear of school.

Family history: Ask yourself if there is a family history of stress-related problems such as headaches, dyspepsia (pain or an uncomfortable feeling in the upper middle part of the stomach), irritable bowel syndrome, backaches or menstrual irregularities.

When your child’s stomach hurts

Help your child feel better at home by doing the following:

Get your child to lie down

● Talk with your child about anything that may be causing him to feel anxious or overly stressed

● Distract your child with interesting activities such as reading or playing with toys

● If your child’s abdominal pain does not improve, it is advisable to seek medical help early as there are many possible causes of abdominal pain and it is important not to miss an organic cause.

Caution: Do not give your child over-the-counter medications for the pain, unless prescribed by a doctor.

Keep your child happy

If your child is suffering from recurrent abdominal pain and an organic cause has been ruled out, do work together with the doctor to try to solve the problem. Spend time listening to your child’s worries and fears. It is important for your child to realise that his feelings matter to you.

Besides that, do take the time to look at your child on the whole, your family, your home environment and your child’s school dynamics. As a parent, it is your responsibility to ensure that your child settles in a supportive and understanding environment at home and at school. Help your child stay happy and joyful by taking action immediately as soon as you detect an issue that is bothering him excessively, to the point of causing abdominal pain.

● Prof Dr Christopher Boey is a consultant paediatrician. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting Digestive Health Initiative and the Malaysian Society of Gastroenterology & Hepatology. The programme is supported by an educational grant from Vitagen Healthy Tummies Programme. For further information, please visit www.mypositiveparenting.org-By PROF Dr CHRISTOPHER BOEY

Yale Launches Global Health Initiative

2009-05-13T17:44:00.000-07:00

New Haven, Conn. – In an ambitious effort to further Yale University’s engagement in global health, President Richard C. Levin announced today the launch of the Yale Global Health Initiative. This is the first endeavor of the University’s new Jackson Institute of Global Affairs, which was announced in April. The purpose of the new initiative is to unite the many global health efforts across campus, foster innovative educational programs to address the growing student interest in global health, and stimulate and support faculty research to enhance healthcare around the world.

With founding support from the Whitney and Betty MacMillan Center for International and Area Studies at Yale, the Yale Global Health Initiative will focus on three areas: education, research and leadership. Initial educational efforts will include the development of a new graduate certificate program in global health at the MacMillan Center, expanded course offerings in Yale College and the Graduate School, and support for student internships and projects in global health.

The initiative will also support innovative and collaborative global health research with seed grants for faculty, support for a postdoctoral training program, and resources for a new interdisciplinary professorship in global health.

Finally, it will provide support for the Global Health Leadership Institute (GHLI), a new program that will hold its inaugural conference on “Strategic Problem Solving in Global Health” in June. The conference, funded by the Glaser Progress Foundation, will bring together public health leaders from around the world to explore new approaches to providing better, more equitable healthcare.

The Yale Global Health Initiative builds upon the University’s long-standing commitment to and engagement in global health issues. It connects a number of successful programs that span the campus: the Yale School of Nursing’s “train-the-trainer” program for HIV prevention in China, Thailand, Vietnam and Russia; numerous research projects on infectious and emerging diseases underway at the School of Medicine; the Center for Interdisciplinary Research projects on HIV/AIDS; the global health concentration at the School of Public Health; and the health studies initiative in Yale College.

In recognition of Yale’s institutional commitment to global health, the Fogarty International Center at the National Institutes of Health this week awarded the University one of its prestigious Framework grants, intended to stimulate cross-disciplinary, international research and training. The Framework grant will help fund the work being done by faculty and support staff dedicated to the new Global Health Initiative. Yale has also been invited to join the Consortium of Universities for Global Health, an organization created to support the expansion of strong academic centers in this field.

The launch of Yale’s Global Health Initiative coincides with President Obama’s request to Congress for support of a new global health strategy focused on combating AIDS, tuberculosis, malaria and a host of other tropical diseases and preventable illnesses that kill millions of people each year, many of them children.

Yale Provost Peter Salovey has appointed Elizabeth Bradley, Professor of Public Health, to direct the Yale Global Health Initiative, with the guidance of a University-wide advisory committee. “I am delighted that Professor Bradley has agreed to lead this extremely important activity. By harnessing individual innovation and stimulating collaborative research and teaching, the Yale Global Health Initiative promises to make significant contributions to global health scholarship, education and leadership,” said Salovey.

Yale University Medical News
Office of Public Affairs
Phone: 203/432-1345
Fax: 203/432-1323
http://www.yale.edu/opa

Contact: Helen Dodson 203-436-3984 or helen.dodson@yale.edu

For immediate release: May 13, 2009

Yale News Releases are available at http://www.opa.yale.edu

Everything you want to know about Swine Flu / H1N1 but were afraid to ask

2009-05-02T00:18:00.000-07:00

As the number of swine flu cases in the United States grows, health-care experts in every state are planning strategies for coping with the disease, which includes a panoply of medical advice and a good deal of common sense. At universities across the country, where large numbers of students share close quarters in dormitories and classrooms, health service staff are working to educate students, faculty, and staff about practical preventive measures. They are also hoping that the virus will keep its distance from campus as final exams and commencement exercises approach.

At BU, officials are in regular contact with the Boston Public Health Commission, and they are carefully tracking the daily recommendations of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). On campus, several steps have been taken to minimize risk. Hand sanitizer dispensers have been made available, and custodial staff are carefully cleaning public spaces. At Student Health Services, director David McBride says that all students with respiratory illness are being asked to wear a mask. The Boston Globe reports that there are no confirmed cases of the virus in Boston, and that the only two cases reported in Massachusetts have recovered, and did not spread the virus to people who were in close contact with them. Massachusetts has 50,000 doses of antiviral medications that are effective against the current strain of swine flu, he says, and the CDC is sending the state hundreds of thousands more doses from the national stockpile.

“A situation like this can be alarming,” McBride says. “Everyone should know that the University is doing what it can to ensure the protection of our community.”

Swine Flu FAQs

The following questions were culled from conversations with students, faculty, and administrators across campus. Answers come from SHS director McBride, David Ozonoff, a School of Public Health professor of environmental health, and the CDC.

More questions are bound to arise. As they do, send them to today@bu.edu. We’ll do our best to find the answers.

Massachusetts residents can also call (2-1-1) for basic information about swine flu. Additional information is available from the CDC, the Massachusetts Department of Public Health, and the Boston Public Health Commission.

Will graduation, summer programs, or orientation be canceled? - Everything is still on track. If the situation changes for the worse, Boston University will work closely with the Boston Public Health Commission to decide what to do. The BPHC is the city’s focal point for responding to public health issues, and has stated that it may — repeat may — recommend closure if there is a case of H1N1 flu on any campus in Boston. A full assessment of the situation would be made in consultation with the BPHC, and a decision announced.

What if I'm sick and I have to take a final? - If you’re sick, you should stay home and stay away from other people.

Where should I study for finals — is it safe to be in the library? - As long as there is no swine flu at Boston University or in Boston, being in public is as safe as ever.

If my roommate gets sick, what should I do? - If someone has swine flu, they will need to be isolated from the general student population. As a close contact, you would need to monitor yourself closely for seven days after your last contact with the ill person. SHS will work closely with exposed students to give advice. Routine administration of antiviral medication is not recommended for healthy contacts with someone infected with flu.

How long should I be isolated if I’m sick? Where should I do this? -If you’re sick, you should isolate yourself until your symptoms have resolved, plus 24 hours. It is best to do this in a private room where others will not be exposed to you.

How does swine flu spread? - The flu spreads mainly through coughing or sneezing. People should be extra careful to cover their mouths when they cough or sneeze. Cough or sneeze into your sleeve or a tissue, not into your hands. This keeps germs from being spread into your hands.

What can I do to stay healthy? - Get plenty of sleep, eat well, and exercise. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective. Avoid touching your eyes, nose or mouth. Germs spread that way.

My family is coming tomorrow from Mexico/San Diego/San Antonio — what should I do? - If a traveler is coming from an area of high transmission, travel may not be advised. Certainly if a family member is sick with flu-like symptoms, he or she should not travel. The CDC will continue to issues travel advisories, but as yet there is only a recommendation to avoid nonessential travel to and from Mexico.

Can you tell the difference between swine flu and “regular” flu or between swine flu and seasonal allergies? - The Centers for Disease Control in Atlanta has facilities set up to “subtype” flu and has trained 140 labs around the country to do the same. Until that test is conclusive, there is no way of knowing for sure what kind of flu you might have contracted. Flu of all kinds tends to subside at this time of year, while allergies erupt with the spring blossoms. One key difference in symptoms between the two is body temperature; flu will cause fever and body aches, allergies usually do not.

Students can always call SHS for advice from a nurse or health-care provider if they are unsure about whether they need to be seen in person. If students have more severe symptoms, fever in particular (greater than 100 degrees F), they should come to SHS or see their regular physician for evaluation. Call ahead to let SHS know that you are coming so that we can make a mask immediately available.

Does BU have antivirals on hand? - We plan to use local pharmacies to provide students with antiviral medication based on a written prescription. SHS has obtained a small supply of medication to keep on hand when this is no longer an option. The state has obtained a large amount of antiviral medication, which may be made available, depending on the course of the flu outbreak.

Can you get swine flu from pork? - Absolutely, unequivocally no. Indeed, there is a move afoot to stop calling this strain of flu “swine,” and use the scientific term — H1N1 — as President Obama did in his news conference Wednesday night.

Will University officials close buildings to sanitize them? - Closing buildings to “sanitize” them would accomplish nothing. Buildings cannot be sterilized, any more than the people who move through them can be made antiseptic. What works much better is old-fashioned hand washing, and the University already has placed scores of antigerm dispensers around campus to make that process simple and easy.

Should students planning to go home between the end of finals and the beginning of summer session not go home? - There are no travel restrictions in place, but good common sense should come into play. If a student lives in an area where there has been a documented flu outbreak — for example, Mexico — it would probably make sense to stay here.

If students have the option, should they travel by car instead of plane? - No public health official is calling for travel restrictions, either within the country or across borders. But then again, if you ever had a hankering to take a road trip and see a slice of America, this might be a great time to do it.

I’m supposed to travel out of the country in the next couple of weeks. Is there a vaccine for swine flu? If I’ll be traveling, should I take medication to prevent the flu? - The Centers for Disease Control Web site provides the best up-to-date information about travel advisories. Travelers should plan to check that site up to the day of travel as advisories may change. There is no vaccine for the swine flu. The CDC is not recommending that healthy people take preventive medication before traveling to an area of high occurrence.

By BU Today

Looking to insure your health

2009-03-25T17:44:00.000-07:00

Learn about the nuances of private health insurance and managed care. Don’t leave it until the time when there is need to utilise the benefits of the policy. ANYONE can fall sick at any time. Diagnosis and treatment can be obtained at any of the clinics and hospitals of the Health Ministry or public universities or similar facilities of the private sector. Private clinics are found in urban and rural areas, and private hospitals in most major towns.

Currently, the private hospitals provide about a quarter of all hospital beds in the country. Different health policies provide different coverage. It is difficult to find a policy that provides coverage for all medical problems. So it is important to know what circumstances or medical conditions are covered by the policy.

Although there are no differences in the technical quality of care provided by the public and private sectors, there are many in the population who seek care from the private sector for various reasons, including access, ambience and choice.

As the private sector does not receive subsidies from the state, those who seek care from the sector have to pay for these services out of their own pocket, or through private health insurance.

Private health insurance is a mechanism that provides for expenses incurred as a result of an illness, accident and/or disability. It covers the cost of medical care and/or nursing care, and in some instances, provide an income during hospitalisation and/or disablement.

As the medical expenses incurred may be substantial, health insurance protects the insured from potentially heavy financial loss. It is difficult to predict what medical expenses will be like. In some years, it may be low. In other years, it may be high, especially the older one is.

It is important to know how the health insurance provides for access to doctors and hospitals. For example, is prior approval needed to ensure coverage during hospitalisation for elective surgery?During the past decade, there has been an increase in the population having private health insurance.

As a healthcare provider and as a consumer of health care, I have learnt much about the nuances of private health insurance and managed care, which most consumers are unaware of until the time when there is need to utilise the benefits of the policy.

Health insuring companies - These companies may be health insurance companies, which are regulated by Bank Negara. The medical aspects of insurance come under the purview of the Health Ministry. These companies are owned by shareholders or are mutual companies, which are owned by their policyholders. Both types of companies may distribute their profits as dividends, particularly the former.

Managed care organisations (MCOs) are registered companies regulated by the Registrar of Companies. The Health Ministry regulates the medical aspects of managed care. The MCOs make arrangements for the healthcare of their enrollees.

MCOs in some countries, for example, in the United States, provide care directly to their enrollees. Some MCOs purchase insurance from one or more insurance companies. Others are subsidiaries of insurance companies.

As managed care techniques become more prevalent, it is often difficult to distinguish between the different types of coverage for the insured persons.

Risk pooling - Private health insuring companies pool the healthcare risks of a large group of people so that individual risks are predictable and manageable. The risk pooling should lead to the expected medical expenses of the group of people to be reasonably predictable for the insurer and to be relatively stable over time. The larger the pool of insured persons, the less will be the risk exposure for the companies.

The health insuring company will have a contract (policy) between itself and the policyholder, which may be an individual or an organisation, for example, an employer.

Group and individual insurance - Many employers usually offer group health insurance as a part of the compensation package. It is also provided by membership of an association, union or other groups.

Employees may have a choice of plans or no choice at all. The plans may be indemnity insurance or managed care. The employer usually pays a part or all of the premiums, which will be lower than that of an individual. If one gets group insurance through membership of a group, the advantage is that the premium will be less than what an individual will pay.

Any person can purchase individual insurance directly from the insurance or managed care companies. The premium is entirely paid by the individual and is tax deductible, up to a limit.

Indemnity insurance and managed care - There are similarities between indemnity insurance and managed care. Both cover a wide range of medical services in clinics and hospitals. Medications are usually covered. Some provide coverage for maternity and dental services.

The primary difference between indemnity insurance and managed care is that of choice of doctors, hospitals and healthcare providers, how medical bills are paid and payments out of one’s pocket.

Indemnity insurance offers more choice of doctors and hospitals. In most instances, an insured person can choose the doctor and even change the doctor at any time. A specialist may be consulted with or without a referral.

However, the policy does not pay for all the medical expenses. The insured person has to pay the rest of the medical expenses. Most policies have a maximum for expenses to be paid by the insured person. Claim forms will usually have to be filled. The medical expenses may have to be paid first and then claimed back from the insurer.

Managed care offers a limited choice of doctors and hospitals. It is usual for a referral to be obtained from a general practitioner before a specialist can be consulted.

The medical services covered are usually more limited than indemnity insurance. Most managed care companies provide a medications list to the doctor for which they will cover. There may or may not be out-of-pocket expenses. In many instances, there are no insurance forms to be filled or claim forms to be submitted.

Inherent problems with health insurance -All health insurers attempt to ensure that those in their risk pool have the same risk as that of the general population i.e. they take measures to ensure that there is no disproportionate number of people with poor health in their risk pools.

The term adverse selection is used to describe the tendency for people with a higher than average risk of needing medical care than healthier people to seek health insurance, because they anticipate possible large medical expenses.

If adverse selection is not managed well, it would result in the company having many insured persons with ill health and consequent difficulty in balancing out their medical expenses with that of a large number of healthy insured persons.

People in better health will less likely join the risk pool because of the higher premiums or they may leave to join another risk pool, which has a lower premium.

Another problem with health insurance is that of moral hazard. This occurs when the insurer and insured person enter into a contract but one party takes action, which is not taken into account in the contract.

A common example of moral hazard is that of a situation in which additional tests are carried out. The patient benefits from greater certainty of diagnosis and treatment. The doctor’s risk of allegations of medical negligence is reduced. The costs of these additional tests are borne by the insurer, which has little or no say in the decision.

Insurance techniques - There are several techniques used to address the problems of adverse selection and moral hazard. Most companies do not have one risk pool but instead have multiple risk pools. Product differentiation protects the companies, as problems in one risk pool will not impact directly on the insured in another risk pool.

Medical underwriting is a technique used by insurer to maintain a predictable and stable level of risk in their risk pools, and also to set the terms of coverage for those of different risks within a risk pool.

With underwriting, a decision is made whether or not to accept an applicant for coverage. Premiums are varied according to factors associated with differences in expected medical expenses like age, gender, health status, occupation, and lifestyle habits.

In general, applicants who are likely to incur large amount of medical expenses are denied coverage or charged high premiums to compensate.

An effective underwriting mechanism to avoid adverse selection is to provide coverage to already formed large groups of people e.g. employees of a large organisation. The insuring company knows that the individual members of the group did not join to obtain coverage for medical expenses, so there is a lower likelihood that there is a disproportionate number of individuals with poor health in the group.

In such situations, the underwriting focuses on the group – its claims history, age distribution, industry etc – and not on individual members of the group.

Additional measures to avoid adverse selection include requiring a minimum number of enrollees and/or requiring the employer to contribute a minimum premium.

Another technique used to avoid adverse selection is to exclude coverage for a defined period of time for the treatment of medical conditions that the companies determine to have existed within a specific period prior to the beginning of coverage (pre-existing medical condition).

Moral hazard is addressed by co-payments and deductibles. Co-payments refer to the amount the insured person has to pay each time medical care is provided e.g. a certain amount is paid each time the doctor is consulted, with the insuring company paying the balance. Deductibles refer to the amount that must be paid annually before the insuring company begins paying.

MCOs attempt to influence medical decisions by various techniques, e.g. financial incentives or disincentives for the insured and/or healthcare providers, prior authorisation for certain services, e.g. operations, treatment protocols and so on.

What to consider in private health insurance coverage - There are a number of factors that must be considered prior to obtaining private health insurance coverage, whether as individuals or members of a group. It is essential to understand the policy even if the employer arranges it. Having a copy of the policy and perusing it will be helpful to understand how it works. Questions should be asked before one has to seek medical attention.

Age limit - Most health insurance products are not available to people above a certain age. It may be better to sign on the policy when one is younger and still healthy.

One should choose a product with a length of coverage that suits one’s needs. For example, retired government servants who are eligible for medical care in public sector facilities may not need private health insurance unless they desire treatment in the private sector.

Premiums - There are different premiums for different products. Regular premium plans require periodic, regular payments throughout the duration of the policy. Single premium plans require a single premium to be paid at the commencement of coverage.

Many insuring companies change the regular premiums as the insured person gets older. It would be prudent to check whether the policy being considered permits the insurer to do so.

Regular premiums have to be paid when they become due in order to ensure continuing coverage.

Coverage and exclusions - Different policies provide different coverage. It is difficult to find a policy that provides coverage for all medical problems. So it is important to know what circumstances or medical conditions are covered by the policy.

All products contain exclusions that set out circumstances or medical conditions that are not covered. The exclusions vary from product to product. The most common exclusion is pre-existing medical condition(s). The definition of pre-existing medical condition(s) may vary from product to product. The insured person will have to pay out of his or her own pockets for services that are exclusions in the policy.

It is therefore important to read the policy document carefully to be sure of what circumstance or medical condition(s) is covered or not covered, and whether the coverage is limited to one country, several countries or worldwide.

Access to doctors and hospitals - It is important to know how the product provides for access to doctors and hospitals. Is a referral from a general practitioner necessary before consultation with a specialist? What hospital can one be admitted to? Can one change the attending doctor or hospital? Does the insurer provide a list of doctors and hospitals? What steps need to be taken to enable one to get the care needed? Is prior approval needed to ensure coverage, for example, hospitalisation for elective surgery?

Does the policy permit the insurer to stop the insured from consulting a general practitioner or specialist who has been providing care to the insured? This question is of particular relevance as it impacts on the continuity and quality of care.

Recently, a large MCO arbitrarily decided and instructed general practitioners not to refer patients to certain hospitals because the latter did not agree to the MCO’s request to give discounts.

According to feedback from general practitioners, this disrupted care to many patients. Fortunately, after intervention by the Health Ministry and Bank Negara, the MCO relented.

Access to care after office hours and in an emergency should also be clarified. Can one go to any healthcare facility even if it is not on the insurer’s list? Is prior approval necessary, and if so, how is it to be obtained after office hours or in an emergency?

Out of pocket payments - Some products require co-payments and/or deductibles. This information should be provided in the policy

Making a claim - The process of making a claim should be clear. There are documentary requirements required to support the claim e.g. hospital bills, investigation results, medical reports and so on. Most policies set a time limit for submission of claims. It is advisable to make a claim as soon as possible.

Hospitalisation - When one is hospitalised in a private hospital, one needs to check the estimated costs of medical treatment recommended, whether the policy covers the costs and the extent to which it does, consider the options available and choose the ward or treatment according to what is affordable.

Complaints and appeals - There should be mechanisms stipulated to address complaints and appeals from those who feel aggrieved by the actions of the insuring companies.

Disclosure - All insuring companies require health information about the individuals or groups to be insured. This is particularly so if one is applying for indemnity insurance. The information include age, gender, occupation, medical and surgical history, any disability, lifestyle habits and so on. If the information provided is incomplete or false, the policy taken up may not provide cover.

At the same time, the insured individuals or groups should check on the information disclosed by the insurance companies or MCOs. All members of a group should ensure that they get a copy of the group policy for each individual’s retention. It is prudent to remember that the small print is as important, if not more important, than the rest of the policy document. - By Dr MILTON LUM

Supplementary for your body

2009-03-19T18:38:00.000-07:00

Glucosamine is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. Supplemental sources are derived from the shrimp and crab shells and chondroitin is derived from cartilage of cows, pigs, and sharks. Glucosamine is an important building block needed by the body to manufacture specialized molecules called glycosaminoglycans, found in cartilage.

Glucosamine is not present in significant amounts in most diets. There is weak evidence that people with mild to moderate osteoarthritis may benefit from taking additional glucosamine supplements in their diets. If glucosamine itself is not helpful in relieving arthritic symptoms, it may be combined with chondroitin, methylsulfonylmethane (MSM) and other nutrients. alternatively, glucosamine and chondroitin can be started together.

Chondroitin is a molecule that occurs naturally in the body. It is a major component of cartilage the tough, connective tissue that cushions the joints. Chondroitin helps to keep cartilage healthy by absorbing fluid (particularly water) into the connective tissue. It may also block enzymes that break down cartilage, and it provides the building blocks for the body to produce new cartilage.

Methylsulfonylmethane (MSM) is also known as dimethyl sulphone, sulphonylbismethane, methyl sulphone and DMSO2. It is derived from DMSO (dimethyl sulphoxide). MSM is a natural sulphur compound and an excellent source of bio-available sulphur. Sulphur is a mineral that is essential to the normal structure and function of the body.

This sulphur is lost from food when it is processed, dried, cooked or preserved. Therefore, MSM serves as an important source of bio-available sulphur. This is critical since sulphur is essential for healthy connective tissue, joint function, proper enzyme activity, hormone balance, and proper function of the immune system.

In this time you can easily share all of this benefit, from Puritan's Pride products, that include glucosamine chondroitin & MSM. This product are the most popular joint support products available today, and they are taken by adults of all ages and fitness levels. Come in several dosages and are manufactured using the highest standards and quality ingredients.

For add-on and looking to "tune-up" your digestive health or intestinal tract, you can also try a high quality acidophilus products. Acidophilus is a lactic acid producing bacteria thought to have beneficial effects on digestion and overall health. Many factors decrease the number of lactic acid producing bacteria that live and work in the gastrointestinal tract and protect us from harmful disease-causing bacteria, aging, alcohol, antibiotics, diet deficiencies, drugs, medications, narcotics, nicotine, and stressful living. Food is digested in the alimentary canal, mouth and stomach, and finally in the intestines. In the intestines, partially-digested food is metabolized by millions and millions of microorganisms, working simultaneously and synergistically. This acidophilus aids the digestive process, helps correct constipation, diarrhea, mucous colitis and diverticulitis, reduces blood cholesterol, enhances the absorption of nutrients, sweetens bad breath, treats acne and other skin disorders, conquers harmful bacteria and certain viruses, helps alleviate candidiasis and other vaginal infections.

Or you can try a fish oils products, Omega-3 and Omega-6 fatty acids, are considered one of the "good" fats important for cellular, heart and metabolic health. Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) are two types of fatty acids that help maintain a healthy heart and circulatory system. Additionally, fish oil also helps maintain triglyceride levels already within a normal range. Fish oil is recommended for a healthy diet because it contains the omega-3 fatty acids, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), precursors to eicosanoids that reduce inflammation throughout the body.

Now If you buy one vitamin, you will automatically get 1 more bottles of the EXACT SAME vitamin and same size for free plus vitamin caddy. Hurry..! its will expired on 21/03/2009. All vitamins are direct from the manufacturer. The company, Puritan's Pride, originally started out selling vitamins through mail catalog over 40 years ago. Over 1,00 vitamins are manufactured in Long Island. The company also offers a money-back-guarantee. If you are unsatisfied with the quality of the vitamins (within a year), return the unused portion with a quick explanation and they will send you a refunded.

Orders can be placed through the website, phone, or fax. Phone orders (800-645-1030) can be placed M-F 8AM-11PM (ET) and Saturday 8AM-6PM. Fax orders (800-719-5824) can be placed 24 hours a day. They accept Master Card, Visa, Discover, American Express, JCB, or "Phone Me" if you don't want to put the credit card number over the web. Online checkout is very easy. Simply click the [buy] button for the vitamins you want then proceed to checkout when you are done shopping. You will need to enter your mailing address and credit card information to complete the order. An e-mail in the form of an invoice will be sent to you for your records.

The Shipping costs is a very reasonable $4.25 shipping/handling regardless of amount or total price of your order. This seems like a great deal -- except they only use parcel post for delivery. The website indicates to allow up to 2 weeks for delivery. Unlike other websites, your shipping options are very limited. Parcel post is your only option, or UPS which is $7.25 ground, $13.80 for 2nd day, or $28.87 for next day. The $4.25 is only the 48 states, shipping to Canada and Mexico is 15% more or 5.00

For more detail you can refer http://www.puritan.com/.

Easing age gap through regular exercise

2009-02-07T18:12:00.000-08:00

OLDER adults may have to work harder than young people to perform the same physical activity, but regular exercise may close that age gap, research findings suggests. In a study comparing sedentary adults in their 60s and 70s with those in their 20s and 30s, researchers found that older men and women had to use much more oxygen to walk at the same speed as their younger counterparts.

But that was before they went through a six-month exercise programme. After taking up walking or jogging, biking and stretching, the senior study participants reversed their loss of exercise `efficiency'.

Exercise efficiency refers to how much energy the body expends to perform a given activity.

At the start of this study, older men and women used 20% more oxygen to walk at the same speed as a younger person, said Dr Wayne C. Levy of the University of Washington in Seattle, the study's senior author.

But six months of regular exercise - 90 minutes, three days per week - improved the older participants' exercise efficiency by 30%, versus only 2% among their younger counterparts. The findings are published in the current issue of the Journal of the American College of Cardiology.

It's well known that as people age, there is a decline in exercise capacity - how much work a person can do before becoming exhausted. But the new findings suggest this is not just a product of the ageing cardiovascular system being less able to send oxygen to working muscles.

The older body also needs more oxygen to perform the same work as a younger one - that is, exercise efficiency declines. But this decline appears to arise largely from inactivity, and may well be reversible

Make a difference!

2009-02-07T17:43:00.000-08:00

SCIENTISTS and oncologists, motivated purely by altruism, sacrifice their time and financial resources in order to cure more patients with cancer. That is the romantic image some of us still harbour.The sceptics will say that all research is motivated by profit as huge pharmaceutical companies pay the piper and call the tune.

In North America and Europe, there is a third important mover of cancer research and treatment. This is the patient advocate. What is patient advocacy? It refers to speaking on behalf of a patient. The patient advocate can be anyone with the interest of the patient at heart. It can be a nurse, a social worker, a loved one, a friend or a former patient.

It can be you and I.

The advocate fights for the rights of the patient, protects her from paternalistic doctors and unscrupulous alternative practitioners. She ensures the patient is well informed. She may play a role in fund raising for public education programmes and research.

And more and more today, the patient advocate influences the direction that research and legislation take.

We have come a longer way in breast cancer than in any other cancer. It is a lot due to patient advocacy. Think of all the advances in screening and early diagnosis (mammography), surgical techniques (immediate breast reconstruction) and the new and effective drugs. A lot more is known about breast cancer at the molecular level.

From all this, fewer patients will die of breast cancer and many will have meaningful lives prolonged.

In the United States, the National Breast Cancer Coalition is one of the most important patient advocacy groups. An important aspect of its work is to influence research and public policy. For example, it has succeeded in increasing the budget of the US government for breast cancer research.

Europa Donna is the equivalent in Europe. It is actively involved in ensuring that women in Europe have equal access to state-of-the-art breast services. It works by disseminating information concerning European guidelines for best practice in both screening and treatment of breast cancer.

Where should our home-grown breast cancer advocacy groups place their emphasis?

For a start, there should be much more work on early diagnosis.

According to a research conducted by a professor from the University Malaya Medical Centre, at least 50% of women present to the doctor with locally advanced breast cancer (Stage III) or metastatic disease (Stage IV). Cure is not realistic in most of these patients.

Is the delay in diagnosis due to shame? Is it the fear of losing her breast to surgery? Is it because the bomoh or sinseh has promised a cure for a breast lump which has yet to be biopsied?

Or is it that our health system is not adequately equipped to deal rationally with the many breast lumps that women present with?

Even if we can identify the important factors, can we do anything about it?

Many lives will be saved if only breast cancer were diagnosed early (Stage 1 or even better pre-Stage 1). In the United States, the great majority of breast cancer patients are diagnosed in the early stages (i.e. Stage I & Stage II). With effective treatment, the five-year survival rate for early breast cancer is now 90%.

There is less glamour in sociological and epidemiological research (research on events happening to large numbers of people). But it is probably more important than basic scientific research (for example, the incidence of BRCA1 and BRCA2 genes in our population) in our local context.

Our local breast advocates can also push for mammographic screening. This is another proven way of decreasing breast cancer deaths. Unfortunately, it would be rather expensive to offer screening to all Malaysian women above 40 (as practised in some countries). Research into who should be screened and who should fund the screening can be undertaken by breast cancer advocacy groups.

I have outlined some ways in which our breast cancer advocacy groups can further the breast cancer agenda. I am sure there are myriad other ways. We can and should do more. Legislative, scientific and clinical decision makers should be lobbied to do more where it matters.

The war on breast cancer should be fought on many fronts.

Many women I know have sacrificed much of their time and energy in helping breast cancer patients. They are usually the breast cancer survivors. They help the newly-diagnosed patients understand the different treatment regimes. They lend a willing ear and a shoulder to cry on. This will all soften the blow of the diagnosis.

Theirs is a labour of love and their role should not be understated.

However, it is time to move beyond tea and sympathy.

Smokers, ways to quit

2009-02-02T19:18:00.000-08:00

For smokers who are attempting to quit the habit, there are many options they can choose from. BY now, even the tobacco companies agree: Smoking is bad for your health – very bad, in fact. Cigarettes are the most hazardous, but cigars, pipes, and smokeless tobacco also contribute to tobacco’s terrible toll. And second-hand smoke is an important cause of death and disability in people who never light up.

We are making progress. In the US, over 45 million people have quit, and many communities prohibit smoking in public places. But more than 20% of adults still smoke, and the habit remains more prevalent in men than women. Tragically, thousands of teenagers take up smoking every day.

We can do better. Fortunately, there are more ways to kick the habit than ever before.

The hazards of smoking

In the US alone, tobacco is responsible for one of every five deaths. That adds up to over 435,000 lives lost each year, and over 8.5 million people suffer from chronic illnesses caused by smoking. All in all, the average non-smoker lives about 14 years longer than the average smoker.

And the worldwide burden is truly staggering. According to the American Cancer Society, smoking will kill about 650 million of the world’s 1.3 billion smokers alive today.

Smoking is a major cause of cardiovascular disease, including heart attacks, strokes, and peripheral artery disease. About 20% of all cardiac deaths are caused by smoking.

Between 80% and 90% of all patients with emphysema owe their lung disease to smoking. Chronic bronchitis and pneumonia are among the other lung diseases that are increased in smokers.

And there’s more. Smoking contributes to many other health problems, ranging from cataracts, sinusitis, and dental disorders to ageing skin, heartburn, diabetes, osteoporosis, and two issues of special concern to men, bladder cancer and erectile dysfunction.

The more you smoke, the higher your risks, but even a few cigarettes a day will harm your health. “Light” and “low-tar” cigarettes are no safer than high-test brands. The only truly safe dose of tobacco is zero.

The benefits of quitting

Quitting helps, even if you’ve smoked for years. Within days, your blood vessels will regain much of the normal function that is damaged by smoking.

Within weeks, you’ll be able to taste food better, and your sense of smell will recover from tobacco’s assault.

Within months, symptoms of chronic bronchitis ease up, and lung function improves within a year.

Quitting reduces the risk of heart attack and stroke within two to five years. And the risk of lung cancer begins to drop substantially within five to nine years of quitting.

People who kick the habit, regardless of age, live longer than those who continue to smoke.

Nicotine is addicting, and quitting is hard work. There is no way to succeed without really trying. But if you set your mind to it, you can quit.

There are four basic strategies for quitting. Look them over and decide which is best for you. Most smokers start by trying to quit on their own, but many end up needing several methods and several attempts before they kick the habit.

And even after you quit, it’s important to keep your guard up. Just as an alcoholic can fall off the wagon after a single drink, just one cigarette can fire up your nicotine craving even after years of abstinence.

Kicking the habit: do it yourself

Don’t kid yourself by trying to cut down; nearly everyone who tries slides back up to their usual dose of nicotine. Cold turkey is the way to go but it takes preparation. And even without professional help, cooperation from family and friends can be important. Here are some tips:

·Make a list of reasons to quit and another list of people who have kicked the habit. The first list will remind you why quitting is important, and the second will show you that folks who are no stronger or smarter than you have succeeded. Keep your lists handy and refer to them whenever you begin to waver.

·Pick a quitting date and stick to it. Plan to quit on a special day, such as a birthday or the American Cancer Society’s Great American Smokeout event on the third Thursday of each November. Steer clear of stressful periods, and avoid holidays if you’re likely to be invited to smoke-filled parties.

·Try to get other smokers in your household or circle of friends to join you in quitting. A 2008 study found that smoking behaviour spreads through both close and distant social ties; your resolve and success can help your friends and, ultimately, your community.

·As your quit date approaches, throw out your ashtrays, clean your house, car, and clothes, and clean your teeth. Once you’re away from it, you’ll see that smoking stinks.

·Anticipate withdrawal symptoms such as grumpiness, restlessness, irritability, hunger, headache, anxiety, and drowsiness or insomnia. The discomfort usually peaks one to three weeks after you quit, and then it gradually diminishes.

To get through the rough patches, stock up on low-calorie snacks and sugarless gum or candy to keep your mouth busy. Plan enjoyable diversions to keep your mind busy. Think of ways to keep your hands busy.

·If you feel tense, try meditation, deep breathing, or yoga.

·Begin an exercise programme. It will relieve tension, promote good sleep, and help control weight gain. Walking for 30 minutes a day can really help.

·Eat a healthy diet.

·Stay away from secondhand smoke. Don’t even think about smoking “just one” – even a single puff will set you back.

·Reward yourself. Put your tobacco money aside in a kitty, and then spend it on a special treat.

·Think positively; you can quit. Take it one day at a time. And if you slip, try, try again, either on your own or with one or more of the other strategies for quitting.

Kicking the habit: behavioural support

Quitting is your responsibility; it may be hard, but it doesn’t have to be lonely. Many employers, health plans, and hospitals offer individual or group counselling. Your doctor can refer you to a programme in your area.

Hypnosis is another alternative that has helped some smokers break free.

Kicking the habit: nicotine-replacement therapy

Cigarette smoke contains thousands of chemicals. Many are harmful, but nicotine is the most addicting. Like other addicting substances, it acts on receptors in the brain’s “reward centre”, creating a sensation of pleasure and a craving for more nicotine.

The craving has made billions of dollars for Big Tobacco, but it has cost the public much more, in health and money. Nicotine-replacement therapy can short-circuit the craving without introducing the other disease-producing chemicals.

Nicotine replacement is safe. You’ll get less nicotine than from cigarettes, and you won’t get any of the tar, carbon monoxide, and other damaging substances in tobacco.

Plan to start nicotine-replacement therapy on the day you quit smoking. If you are a heavy smoker, you’ll need higher doses. Estimate how much nicotine you need based on an average of 1mg to 2mg of nicotine per cigarette.

Start with the full dose, then gradually taper down over several months. Underdosing is more common than overdosing, but you should not smoke while using nicotine-replacement therapy.

There are many types of nicotine replacement that are available. Nicotine patches deliver a steady dose of nicotine throughout the day, providing round-the-clock protection from craving. The other products deliver a higher dose of nicotine faster, but protection also declines faster. The short-acting products can be used on demand to counter a sudden nicotine craving.

If you wear a patch, you can also use short-acting nicotine products to suppress breakthrough craving.

Options for nicotine-replacement therapy:

·Nicotine patches are available over the counter. One popular 24-hour patch comes in three strengths, 21mg, 14mg, and 7mg. Place a new patch on clean, unbroken, hairless skin each day; you can leave it in place all day.

Most smokers should start with the 21mg dose, but if you weigh less than 100 pounds or smoke fewer than 10 cigarettes a day, you should start with the 14mg strength. You can reduce the dose every one to two months as your nicotine addiction resolves.

If you have bad dreams while wearing a patch at night, you can use a 16hour patch that you remove at bedtime. Mild skin irritation is the most common side effect. Store and discard your patches with care to keep them way from young children.

·Nicotine gum is available over the counter. If you smoke more than 25 cigarettes a day, you should use gum that provides 4mg of nicotine per piece; if you smoke less, use the 2mg dose. Chew a piece of the gum whenever the smoking urge surges, up to 30 pieces a day.

Aim to wean off the gum in about three months if possible. Chewing replaces the oral stimulation of smoking, which can be an advantage, but some people find the taste unpleasant, and some develop hiccups or indigestion. Coffee, tea, beer, and soft drinks may interfere with nicotine absorption.

·Nicotine lozenges are available without prescription. If you usually light up within 30 minutes of waking, you should use the 4mg strength, while others can use the 2mg lozenges.

A typical schedule calls for one lozenge every one to two hours for six weeks, then every two to four hours for two weeks, and then every four to eight hours for the final two weeks. Don’t eat or drink while using a lozenge, and as with nicotine gum, you should avoid acidic beverages for at least 15 minutes before use.

Nicotine lozenges are safe for use with dentures. Side effects may include an unpleasant taste, nausea, indigestion, or mouth tingling.

·Nicotine inhalers are available by prescription. Each cartridge delivers a “puff” of vapour containing 4mg of nicotine. The cartridge is placed in a device that resembles a plastic cigarette holder, which may help satisfy a smoker’s oral urge.

The average dose is six to 16 cartridges a day for up to 12 weeks, followed by a gradual reduction in dose over the next 12 weeks. Most of the nicotine is absorbed from the mouth, not the lungs. Side effects may include mouth or throat irritation and cough.

·Nicotine nasal sprays are available by prescription. Each spray delivers 0.5mg of nicotine. Use one spray in each nostril whenever you feel the urge to smoke, up to a maximum of 10 sprays an hour or 80 a day for three months. Side effects may include nasal irritation, sneezing, tearing, and cough.

Individual smokers may prefer one form of nicotine replacement over the others. Experiment with various types and talk to your doctor about the prescription forms.

Remember, too, that nicotine replacement works best when combined with behavioural support, prescription drugs, or both. And smoking cessation always requires a good dose of willpower.

Kicking the habit: prescription drugs

Bupropion was initially approved to treat depression and was then approved for smoking cessation. It does not contain nicotine and can be used in combination with nicotine-replacement therapy.

Start taking bupropion one to two weeks before your quit date. The usual dose is 150mg once a day for the first three days, then 150mg twice a day for eight to 12 weeks, or longer if needed.

Bupropion can reduce weight gain after quitting. Possible side effects may include dry mouth and insomnia; seizures are very rare.

Varenicline is the newest drug approved for smoking cessation; although experience is still limited, it also promises to be the most effective. It blocks nicotine receptors in the brain while also partially stimulating these receptors to reduce nicotine withdrawal symptoms.

The usual dose is 0.5mg once a day for the first three days, then 0.5mg twice a day for four days, followed by the full dose of 1mg twice a day for 12 weeks or longer.

The dose should be lowered in patients with severe kidney disease. Nausea is common, and bad dreams may occur. Mood disturbances and behavioural problems have developed, particularly in smokers with psychiatric problems, but it’s not clear that these are caused by the medication.

Reports of accidents and visual abnormalities are also being investigated by the US Food and Drug Administration. More research is needed. – Harvard Health Letters/Premium Health News Services

Sign and symptoms of bipolar disorder

2009-01-27T16:43:00.000-08:00

Sign and symptoms of bipolar disorder :

Mania

·Racing speech and thoughts

·Increased energy

·Decreased need for sleep

·Elevated mood and exaggerated optimism

·Excessive behaviours like excessive spending, making rash decisions, erratic driving

·Inflated sense of self importance

·Difficulty in concentrating

·Increased physical and mental activity

Depression

·Loss of interest in usual activities

·Prolonged sad or irritable mood

·Loss of energy or fatigue

·Feelings of guilt or worthlessness

·Sleeping too much or inability to sleep

·Inability to experience pleasure

·Appetite loss or over-eating

·Thoughts of death or suicide

·Drop in grades and inability to concentrate

·Anger, worry and anxiety

Tell Me About A Skin cancer

2008-12-17T21:05:00.000-08:00

Skin cancer is actually the most common of all human cancers in Western countries. A person likes to do a lot of gardening. Recently, noticed a suspicious-looking mole on skin which is growing bigger. Worried that it might be skin cancer ...!!! Is this a possibility?

Skin cancer is actually the most common of all human cancers in Western countries like the United States. It is not as common here as breast or lung cancer because although we are exposed to the sun, we have plenty of pigmentation in our skin compared to Caucasians to protect us.

This does not however mean we won’t get skin cancer, just that our incidence compared to other cancers is not as high.

There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Basal cell carcinoma and squamous cell carcinoma are more common in older people while melanoma is more common in people from 25 to 29 years of age.

What does skin cancer look like?

Basal cell carcinoma is a raised, smooth bump on your skin which is usually exposed to sunlight, such as your neck and shoulders. It can be whitish pearl in colour. Sometimes it can bleed and the centre part can break off and form an ulcer.

Be very careful when you notice any skin lesions with small blood vessels on them! A lot of people think basal cell carcinoma is a normal sore which is taking a long time to heal. Therefore if you have such “sores”, you must always check them out with a dermatologist.

Squamous cell carcinoma looks like a red and scaling but well-defined and thickened patch – also on your sun-exposed skin areas. They can also bleed and form ulcers or large ugly masses.

Melanomas look like brown or black pigmented lesions – pretty much like a mole which has just changed (see below). It can be associated with pain, itching, bleeding or ulcers.

Do all moles progress to skin cancer?

No, definitely not. Skin cancers do start out however as precancerous lesions in your skin called “dysplasia”. You have to be very careful to look out for these as they can be arrested early before turning into cancer.

For example: Do look out for a patch of reddish brown rough, scaly skin. This is called actinic keratosis and it may develop into squamous cell carcinoma of the skin.

Do also look out for moles (also called naevus) which are abnormal. Although moles are very common and only very few become cancer, look out for those which have:

·Recently grown in size. Cancerous lesions are usually larger than 6mm in diameter.

·Recently changed in its margins or borders, or when one side of the mole doesn’t look like the other side (asymmetry).

·Recently changed colour.

·Recently become different from the rest of the moles on your body.

These moles can develop into melanoma over time.

I’ve heard that sunlight causes skin cancer. Is this true?

It is the ultraviolet rays of the light spectrum which causes skin cancer. It is important to know that ultraviolet rays do not only come from the sun but also from tanning machines and exposure to unusually high levels of x-rays from x-ray machines.

If your immune system is suppressed (such as if you have AIDS) and your body can’t protect itself or if you have a job that exposes you to certain chemicals and poisons like arsenic, hydrocarbons and oils, you may get skin cancer more easily. Occupations that may endanger you thus include being a farmer or miner.

Other than that, if you have the following, you are more likely to get skin cancer than other people:

·If you have fair skin, especially if you sunburn easily or get freckles.

·If you have a large number of moles and/or unusual moles.

·If you have blond or red hair and blue or green eyes (not applying to the majority of Malaysians, which is why our skin cancer incidence is relatively low)

·If you have had one severe sunburn early in your life.

·If you have family members who have had skin cancer (genetics).

·If you have skin disorders like albinism.

How can skin cancer be treated?

Treatment is usually by surgery for basal cell carcinoma and squamous cell carcinoma. However if the cancer has spread, like malignant melanoma usually does, then not only will you have to remove the offending lesion by surgery, but radiotherapy and chemotherapy might also be required.

How can I prevent skin cancer from happening to me? By not going out into the sun?

If you don’t go out into sunlight, then you’d get a whole host of other diseases, including vitamin D deficiency! No. You have to go about your life normally. But you can certainly reduce your exposure to the sun, such as by not going out in the scorching sun between 10am to 2 pm, applying sunblock with SPF (sun protection factor) of 15 and above when you do go out, wearing long sleeves and wide hats and by avoiding artificial tanning.

What smoking can do to your unborn child…

2008-12-17T21:00:00.000-08:00

IT seems to be an obvious fact that pregnant women should not smoke. In fact, it is an undeniable truth. However, it is important to take a step further into understanding the detrimental dangers of smoking, and how it affects pregnancy. Smoking affects pregnancy in various damaging ways, e.g. miscarriage and spontaneous abortion, and has a long-term effect on the foetus, such as increased risk of developing respiratory illnesses.

Nicotine, the hazardous ingredient in a cigarette, is the major culprit affecting smokers at large and particularly pregnant women. Nicotine intake during pregnancy affects the supply of oxygen and nutrents to the foetus. Nicotine may result in sudden infant death syndrome, abnormal lung development, obesity, type 2 diabetes, and an ectopic pregnancy.

Smoking limits the nutrition that a baby receives while in the womb. Being malnourished is detrimental to a baby’s brain, affecting the mental development. Nicotine also has a damaging effect on developing nerve cells, which might result in brain malformations, poor functioning, and learning problems. There is also a tendency of developing behavioural problems.

The delivery of blood to the placenta and the transmission of oxygen and nutrients to the foetus are greatly affected by spasms of the arteries. The lack of oxygen and nutrients for the foetus can also result in smaller size or underweight babies. Babies who are born prematurely, smaller in size or underweight could struggle with learning problems throughout their entire lives.

Smoking is also known to cause vascular diseases. Therefore, another risk for pregnant women who smoke is blocked blood vessels, leading to placental abruption, the separation of the placenta from the uterus wall. This might lead to vaginal bleeding in late pregnancy, premature birth, foetal distress and even death.

Carbon monoxide is another harmful element found in a cigarette. Mothers who smoke have more carbon monoxide and less oxygen in the body. But babies require a good supply of oxygen to grow. Thus, in order to compensate for the short supply of oxygen, some foetuses try to produce extra red blood cells to carry more oxygen.

In rare cases, the blood tends to get too thick from the increasing amount of red blood cells. Thick blood has the tendency of forming unwanted blood clots that can block blood supply to the vital organs. When vital organs are deprived of blood supply, the consequences can be critical and even fatal.

There are many other possible complications, such as premature rupture of the membranes, congenital heart diseases, asthma and allergies.

For women who have been smoking before they were pregnant, if they are able to quit smoking by 16 weeks of gestation, many of the complications mentioned above could be minimised or even altogether avoided .

Most of us are aware that as long as a pregnant woman remains smoke-free, the mother and foetus will be well. However, a non-smoking expectant mother is not exactly smoke-free. We need to take into account the surrounding environment that the woman lives in.

Passive smoking, also known as second-hand smoke, puts a foetus at risk as much as first-hand smoke does. It increases the risk of genetic mutation to the babies when there is exposure to second-hand smoke during pregnancy, especially during the foetal development stage.

Second-hand smoke exposure is just as damaging as active smoking and leads to lifelong repercussions mentioned earlier in this article, such as affecting survival, birth weight, and susceptibility to diseases. If a woman is trying to build a family, the best option is to quit smoking. Or if the woman is already pregnant, ensure people around her quit smoking for the sake of the unborn child.

Breaking the urge to smoke is not easy due to nicotine dependence. Within seconds of the first inhalation of a cigarette, nicotine arrives at the brain’s reward pathways, where it triggers the release of dopamine, resulting in an immediate reward sensation.

Nicotine binds to nicotinic receptors in the brain, augmenting the release of neurotransmitters, including dopamine.

Consequently, habitual use of nicotine from smoking causes dependency and can cause an increase in tolerance. Because nicotine is so addictive, smokers, especially those who consume more than one pack per day, have a difficult time quitting.

There are smoking cessation aids available in the market such as nicotine replacement therapy and non-nicotine oral tables. It is advisable to speak to a doctor or pharmacist about the best treatment options available, especially for expectant or breastfeeding mothers, as nicotine replacement therapy might be toxic and harmful to the foetus.

Encourage your spouse or family members to kick the habit as second-hand smoke plays a big role too. Smokers need considerable support to quit successfully. It has been proven that a smoking cessation therapy combined with a support programme greatly increases the smoker’s chance of quitting successfully and staying off cigarettes thereafter. The support network can also include the smoker’s family members and friends.

The fear of recurrence

2008-12-17T20:55:00.000-08:00

To many cancer patients, the fear of recurrence can be overwhelming. A lifelong ordeal has just begun. THE patient is diagnosed to have breast cancer. She is in a state of shock and disbelief. She pulls herself together and seeks treatment. She undergoes surgery. This is followed by radiotherapy, chemotherapy and hormonal therapy.

She is exhausted by the side-effects of treatment and the interminable visits to the oncology clinic. Her professional, family, social and sex life suffers. Her private moments are punctuated by worry and tears. Her treatment finally comes to an end. She is told that her disease is in “remission”.

To many breast cancer patients, a lifelong ordeal has just begun. She fears recurrence and there is little she would not do to prevent it. She needs guidance more than ever. She may easily fall prey to doctors and amateurs who promise a lot and deliver little. The fear of recurrence can be paralysing. It can consume almost all her waking hours.

Guidelines are available to partly address concerns regarding recurrence. The American Society of Clinical Oncology (ASCO) updated its guidelines in 2006.

In the first three years following treatment for early breast cancer, patients should be followed up once every three to six months. In year four and five, the follow-up visit to the oncologist should be once every six months. Beyond five years, visits should be annually.

At each visit, a complete history should be taken followed by a thorough physical examination. Annual mammography of the remaining breast (sometimes one, sometimes two in the case of breast conserving surgery) should be performed.

What ASCO does NOT recommend for the breast cancer survivor who is well and without any complaint (asymptomatic in medical terminology) is blood tests, tumour marker tests, a chest x-ray, a radioisotope bone scan, a liver ultrasound scan, a whole body CT scan and a PET/CT scan. Basically, everything an oncologist is pestered to do at each follow-up visit of many such patients.

Doctors working in the UK usually follow the guidelines issued by the National Institute for Health and Clinical Excellence. (The lucky devils in this organisation have an acronym to die for: they are the NICE people).

These guidelines are even more parsimonious than the American ones. Follow-up beyond three years is not justified or recommended. However there will be a revision of the NICE guidelines next year as it is realised that the problems that beset breast cancer survivors last a lifetime and not just three years.

The NICE guidelines, similar to the ASCO guidelines, are resolutely against routine blood tests and imaging scans if the patient is asymptomatic.

These guidelines evolved from randomised controlled trials. These trials showed that the survival times for breast cancer patients were similar whether or not they were followed up with extensive investigations. Evidence-based medicine not only applies to treatment, it also applies to following up patients.

What use, you may ask, is follow-up surveillance if not to do a battery of expensive and unnecessary tests? The answer is: a lot.

Firstly, it is to detect recurrence in the other “normal” breast. It is also to detect recurrence in the breast treated with surgery and radiotherapy. Detection of a small localised cancer usually means cure.

Secondly, follow-up assessment (which consists of a complete history and a thorough physical examination) is to enable the oncologist to order the relevant and necessary blood tests and imaging scans whenever there is a suspicion of recurrence.

Most important, it is an opportunity to counsel the patient. I ask the patients direct questions about the side-effects of treatment (past and present) and see if I can do anything about them. I indirectly touch on their social and sex life to see how they are coping. I ask about fatigue. I look for osteoporosis. I ascertain if there is a cognitive dysfunction (memory loss, slower reflexes, intellectual decline). The young, fertile woman may want to have children and she needs special counselling. I try to manage those with a weight problem.

Despite the most comprehensive and authoritative guidelines and all the well-intentioned counselling, many patients still live fearfully for the rest of their lives.

To them, I advise distraction therapy. Go to the Dewan Filharmonik Petronas for a concert or to the neighbourhood cinema depending on your taste. Read the New Yorker or The Star, whatever you fancy. Join the line dancing class. How about yoga? Walk around the park endlessly. Learn to savour the varieties of burgundy or join the cooking class organised by your residents’ association.

Who knows? You may end up thinking less of cancer recurrence and become the lithe, erudite and discerning belle you always wanted to be.

Menopause and sex

2008-05-17T19:49:00.000-07:00

Q: I’VE been going through menopause for almost two years. I have not had sexual intercourse with my husband for six months due to the discomfort during intercourse. What can I do eliminate the pain?

A: DURING menopausal years, the women’s ovaries stop producing oestrogen.

Low oestrogen levels can sometimes cause dryness and thinning of vaginal tissues, making intercourse uncomfortable and painful.

Anticipation of pain during intercourse due to vaginal dryness and atrophy may dampen a woman’s desire.

Black cohosh, sage, dong guai and other herbs that are rich in natural plant oestrogens such as red clover and soy are highly recommended to those who are going through menopause.

Black cohosh is effective in treating pre-menopausal symptoms and symptoms arising from ovarian insufficiency (lack of oestrogen and progesterone production) such as hot flushes and night sweat.

Dong quai, which is also known as the “female ginseng”, helps restore balance in woman’s reproductive system by toning the uterus, nourishing the blood and stimulating healthy circulation.

A herbal formulation that contains all the five herbs will help women cope with the physical and psychological changes during the menopausal period.

Vagina tearing and infection are common in women who are going through menopause.

Supplementing the diet with friendly bacteria, Lactobacillus GR-1 and RC-14, will help reduce the risk of infection and improve general wellbeing of women.

These strains of friendly bacteria attach to the vaginal lining and prevent the growth of harmful bacteria and yeast.

Naturopathy: Give the eye a break

2008-05-17T19:46:00.000-07:00

Q: MY son spends hours playing computer games during the weekends. I worried about the damage this would do as he is also short-sighted and wears glasses. Can you suggest some ways to improve his vision?

A: YOU have valid reasons to be concerned because sitting for long hours in front of a computer screen can lead to eye discomfort, fatigue and blurred vision.

Taking a break from the computer every 20 minutes for 20 seconds will minimise the development of eye-focusing problems and irritation caused by infrequent blinking.

Traditional herbs like bilberry, eyebright and lycium are good for the eyes.

Bilberry improves capillary blood flow and increases the generation of enzymes responsible for energy production in eyes while eyebright helps relieve itchy and irritated eyes.

Lycium is rich in carotenoids which is beneficial to the eye.

A good eye supplement contains all the three herbs. A good supplement should also contain about 25 per cent of anthocyanidins, which is the active ingredient in bilberry.

Eat plenty of fresh, raw, green leafy vegetables. Apricots, mangoes, carrots and yams are elixirs for the eyes.

Consume foods or supplements that contain beta-carotene, vitamin A, C, E and mineral zinc and selenium to protect against the harmful effects of free radicals.

Heeding the call of nature

2008-05-17T19:41:00.000-07:00

Taking a probiotic supplement, including more fibre and water in one’s diet and exercising can help you empty your bowels more easily and regularly. CONSTIPATION is difficulty in passing motion and/or infrequent bowel movements. It is not a disease, but rather a troublesome condition due to underlying problems.

As bowel transit time is increased, the stools harden and become difficult to pass due to dehydration. The body slowly re-absorbs the fluid content in the faeces and along with it, many soluble toxins. This auto-intoxification is the reason people suffering from constipation have headaches, tiredness, bad breath, a coated tongue and mental dullness.

Common causes of constipation are fibre deficiency, gastrointestinal diseases, low water intake, change in the normal bacterial flora, inactivity, liver dysfunction and chronic use of laxatives and stress.

Constipation can begin early in life. The normal breast-fed child will have a bowel movement approximately 20 minutes after the start of a feed. Over time, as solid foods are introduced, mothers soon become aware that certain foods such as bananas can cause the stools to harden and slow the transit time, while prunes and papayas will soften them and encourage bowel movement.
Later, as the child is weaned and cow’s milk is introduced, bowel movement becomes less regular and more difficult to regulate. Once the child is toilet trained, less attention is placed on regularity in some cases.

Apart from that, during childhood, vegetables and fruits may not be their favourite foods, worsening the problem. With toddlers and also with adults on hectic schedules, the call of nature may be habitually ignored or postponed.

A useful index to take note of is bowel transit time, or the time it takes for food to pass through the body. In diets comprising unrefined cereals, fruits, and plenty of raw vegetables, the transit time is usually 12 hours or so.

On a refined diet, this may extend to 24, 48 or 72 hours or even longer; passing motion may become a once-a-week affair. Another factor is lack of activity and exercise which removes the mechanical action of the muscles on the intestinal content, thus slowing bowel action.

If the main cause of constipation is a fibre-deficient diet, increasing your intake of unrefined carbohydrates, whole grains, fresh vegetables (raw salads) and fruits will be beneficial.

This will promote bowel movement, add bulk to stools and the fibre can also help bind to toxins before being eliminated through the stools. Avoid refined carbohydrates such as sweets, desserts, white rice, noodles, cakes and cookies as these will aggravate the condition.

Increasing water intake is also important to soften the stools and reduce bowel transit time. Exercising will also improve constipation by promoting healthy bowel movements.

Try supplementing your diet with live bacteria such as the clinically-proven strain, Lactobacillus acidophilus NCFM. This group of friendly bacteria re-establishes the gut micro-flora and exerts health benefits on the host by reducing gastrointestinal symptoms such as constipation. Live bacteria may also help improve digestive disorders such as gastritis, ulcerative colitis, indigestion and Helicobacter pylori infection.

When choosing a probiotic supplement, it is important to choose one that conforms to these criteria:

1. Clinically proven

Each probiotic strain has to be studied and clinically proven to confer specific health benefits on humans. For example, Lactobacillus acidophilus NCFM has been studied for more than 30 years and the health benefits are well-documented.

2. The right strain

Experts agree that it cannot be assumed that research published on one strain of probiotic applies to another strain, even of the same species. L. acidophilus NCFM is clinically proven for alleviating digestive problems, L. acidophilus LA-5 and Bifidobacterium BB-12 help improve gut health of children and reduce symptoms of allergies, namely eczema.

3. Refrigeration for optimal potency

Probiotics are sensitive to various environmental conditions such as pH levels, moisture and temperature. All these conditions must be properly controlled to ensure stability and the efficacy of the product. This is especially true in countries with high temperature and humidity like Malaysia.

Probiotic products are best kept refrigerated to ensure high potency and stable probiotic count. The common misconception is that freeze-dried powder or capsule probiotic formulae are stable at room temperature and can be displayed directly on store shelves.

However, the high temperature and humidity in our climate can significantly decrease the viability of the probiotics over time.

According to renowned probiotics manufacturers, refrigeration is the best way to sustain the living colonies for long periods. However, probiotics can be left unrefrigerated for short periods of time, making them convenient for travel.

Dead bacteria can only adhere to the intestinal wall and this is for a short period only. Thus, they do exert a temporary effect of relieving gastrointestinal symptoms.

Live bacteria, on the other hand, not only help the physical, but the physiological function of the gut as well. They help maintain a healthy intestinal digestive tract and stimulate the immune system to ward off infections and improve allergies.

Not just the plumbing

2008-04-22T17:43:00.000-07:00

Erectile dysfunction should not be seen as just a ‘masculinity’ issue.

LOVE makes the world go round. That’s the premise of a famous saying and there is no doubt that many people see love as the most important emotion in the world.

However, while love may be of paramount importance, sex seems to be equally crucial. Australian sex therapist and relationship counsellor Dr Rosie King said: “Sex is both the glue and lubricant of relationships, helping couples to bond and weather the rough patches in life.”

Consultant urologist Dr Peter Ng believes that ED should not solely be seen as a quality of life issue. There may be other health implications.

That it is important is apparent by the results of the Pfizer Global Better Sex Survey which indicated that 93% of men and 83% of women globally believe that sex is important to sustaining a fulfilling relationship. With so much emphasis on the importance of sex, what happens when a man’s “plumbing” is on the blink and puts him out of business between the sheets?

We know that the majority of men with erectile dysfunction (ED) tend to suffer from confidence and self-esteem issues while also believing that their lack of virility has made them less of a man.

There are a host of other consequences too, but the good news is that if they decide to seek treatment, a lot can be done to restore their “masculinity”. Indeed, both patients with ED and physicians rank erection hardness as one of the most desirable outcomes of ED treatment.

Men who have made the decision to seek treatment for ED are more than likely to have their erection hardness measured in accordance with the Erection Hardness Score (EHS), a simple, brief and quantitative self-reported measure of grading erection hardness on a 4-point scoring system.

Grade 1 covers larger but not hard erections while Grade 2 erections are hard but not hard enough for penetration. Grade 3 erections translate into a penis that is hard enough for penetration but is not completely hard while Grade 4 is the measure of a completely hard and fully rigid penis. The ultimate goal and fantasy of men would be a Grade 4 erection.

The EHS tool has helped to simplify ED management while enabling clinicians to develop and monitor individualised treatment plans aimed at achieving a patient’s full erectile potential.

A key goal of therapy is to monitor and treat men with ED to their optimal erection hardness. Grade 4 erections are, naturally, a goal of ED therapy but for men with ED, a shift from Grade 1 to Grade 3 erections are a significant improvement in sexual intercourse success.

There is a lot to celebrate for men who make it all the way to the hard end of the scale. Studies show that post-treatment men with ED who have shifted from Grade 3 to Grade 4 erections reported that they were more sexually satisfied, confident and had higher levels of self-esteem because of their harder erections.

Indeed, as erection hardness improves, other aspects of the overall sexual experience also improve, resulting in a better sex life.

While there is a lot to be achieved from seeking treatment for ED, many men remain undiagnosed and untreated. This is because many people still see ED as a quality of life issue – something that is of low priority when compared to life-or-death medical conditions. They argue that ED is of no consequence as one does not have to worry about heading for an early grave.

Consultant urologist Dr Peter Ng believes that ED should not solely be seen as a quality of life issue. “One of the causes of ED is vascular, where the blood supply to the penis is compromised and slows down to a trickle due to the progressive laying down of fat in the lining of the arteries.

“Because of this, men with high blood pressure and strokes almost always have ED. Indeed, while chest pains used to be the earliest symptom of heart disease, today it is ED.

“ED has become a life and death issue as ED patients must be screened for heart disease,” he said.

Tuberculosis-A threat once more

2008-04-02T22:21:00.000-07:00

Tuberculosis, the most common infectious disease worldwide and the number one killer, is on the rise.

TUBERCULOSIS (TB) is caused by the bacterium, Mycobacterium tuberculosis. It is spread by air droplets when an infectious TB patient coughs or sneezes. The bacterium may be killed by the body’s immune system, multiply and cause primary TB, remain dormant and remain asymptomatic, or proliferate after a latency period.

An infected person may not develop the disease. Such people are not infectious, that is, they do not spread TB to others. TB usually affects the lungs but can also affect other parts of the body like the bone, joints, genito-urinary tract, gastro-intestinal tract and brain.

TB is the most common infectious disease worldwide and the number one killer. The World Health Organisation (WHO) estimates that about two billion people have latent TB and the annual global deaths are about three million.

According to the Health Ministry, the incidence of TB in 2005 was 61.2 cases per 100,000 population and the mortality rate, 5.5 per 100,000 population. The comparative data for dengue, the next most common infectious disease here, was 60.71 and 0 per 100,000 population.

TB affects all ages, especially children below the age of three, older people and those with impaired immunity. TB may present in many ways and diagnosis may be difficult. The complications of TB include respiratory problems, infertility, limb disablements, incapacity and death.

The incidence of TB has been decreasing until about a decade ago when it began to increase due to the increase in the incidence of HIV/AIDS and multi-drug resistance to TB.

BCG vaccine

The Bacille Calmette-Guerin (BCG) vaccine is a live attenuated strain of Mycobacterium bovis. It has been in use since World War I and provides protection against TB meningitis and disseminated TB in infants and children, both of which are fatal, if untreated. However, it does not prevent primary infection and reactivation of latent TB of the lungs, which is the main source of the spread of TB in the general population. As such, BCG vaccination has primarily no impact on the transmission of TB.

Despite its shortcomings, the BCG vaccine is an important component of TB control as its use has saved many lives.

The vaccine requires one injection into the skin over the shoulder tip of the newborn child. The injection usually leads to a minor local reaction of redness, swelling and tenderness. This is often followed by the formation of a small ulcer at the injection site. The extent of this reaction is related to the age of the recipient, dose and strain of the vaccine, and the skills of the health care professional who does the vaccination.

After a few months, a small scar forms. The presence of a typical scar is an indicator of previous BCG vaccination but not that of protection against TB. If a scar is absent in older children, BCG vaccination is given.

Effectiveness and safety

The BCG vaccine is effective. The average protection against TB meningitis and disseminated TB is about 80%. However, the protection against TB of the lungs varies from 0 to 80%, with a lower protective effect in tropical countries. The duration of protection after BCG vaccination of the newborn is not well known. It is believed to decline gradually after 10 to 20 years.

BCG vaccination is safe as complications are rare. The incidence of death after vaccination has involved accidental vaccination of individuals with severely compromised cellular immunity. BCG vaccine is not given to persons who have impaired immunity, are receiving immunosuppressive medicines or who are pregnant.

Adverse events are usually related to infection by the live attenuated bacteria, and errors in achieving intra-dermal inoculation. They are mild or severe. The most common adverse effect is a local abscess. More extensive and prolonged local reactions do occur.

However, secondary infections of the injection site are uncommon. Swelling of the lymph glands in the armpit and neck may occur. It heals spontaneously in most instances without any treatment. Antibiotics may be required occasionally.

Systemic infection by BCG is a recognised but rare adverse event. It is seen only seen in children with severe immune deficiencies. Other rare adverse events include BCG-induced bone infections such as osteitis and osteomyelitis.

Special situations

Premature infants born less than 33 weeks of pregnancy are less likely to develop the BCG scar. As such, premature infants are not given the BCG vaccine until they are at least 34 weeks, and with a body weight more than 1.8kg to 2kg. BCG vaccine is not given to children with symptoms of HIV. Babies born to HIV-positive mothers are not likely to have symptoms of HIV. The WHO recommendation is that they be given the BCG vaccine.

Many new vaccines against TB are being assessed in current research. The primary objectives of these evaluations are protection against infection in those who have never been infected, prevention of reactivation of latent infection and prevention of relapse in TB patients.

The BCG vaccine is safe and does not interfere with other vaccines given simultaneously. It provides about 80% protection against TB meningitis and disseminated TB. It does not, however, impact significantly on the diseases burden of TB. This together with the growing incidence of HIV/AIDS and the increasing multi-drug resistance, threaten current TB control strategies.

Until improved vaccines are available, control of TB is dependent on the currently available tools of early detection, directly observed therapy, and appropriate preventive and infection control measures.

Pregnant skin

2008-04-02T17:42:00.000-07:00

There are many changes that occur in the body during pregnancy.

YOU may hear some horror stories about how your skin will change during pregnancy. Some of these changes, such as stretch marks, are inevitable in everyone, while some women will be fortunate to escape certain problems.

These changes occur because your hormone levels increase during pregnancy. Not only does oestrogen increase, but so does the melanocyte-stimulating hormone, a hormone that stimulates the cells controlling skin pigmentation.

Although these changes are not harmful to you or your baby, it can be distressing to see your skin becoming darker, stretched or pimply. But don’t worry – these problems will disappear a few months after you deliver.

In the meantime, it helps to know what’s in store for you so that you do not get a rude shock when you look in the mirror.
Glowing

They say that pregnant women glow – this is not just a figure of speech. During pregnancy, your body produces more blood to support your baby. Because there are many blood vessels just under the skin’s surface, your skin will appear flushed due to the increased blood volume.
Darkening

Have you heard of the “mask of pregnancy”, where a pregnant woman’s face suddenly appears covered with brownish or yellowish patches (resembling a mask)? Don’t panic – this doesn’t happen to all women, nor is it permanent.

Medically known as melasma, this condition happens because the hormones in your body stimulate the melanin cells in your skin to produce more pigmentation. However, this pigmentation is not uniform, so you end up with uneven patches, usually on the forehead, upper cheeks, nose, upper lip or chin.

Pimples can be a problem for some pregnant women, especially during the first trimester.
You can’t control your hormone levels at this point, but you can protect yourself from ultraviolet light so as to reduce the pigmentation. Use a broad-spectrum sunscreen and wear hats under the sunlight.

Other areas on your skin that are already heavily coloured may become darker, such as your nipples, areola, armpits and genitals. Moles, freckles and birthmarks may become bigger and darker.

New moles may appear, although you should check with your doctor if the moles appear abnormally raised, dark or have irregular borders.

A dark belly line (linea nigra) may appear from the lower chest through the navel to the pubic area. This line will also disappear after the baby is born.

As I mentioned earlier, most of these changes will disappear a few months after your baby is born. You do not have to do anything drastic, such as using bleaching creams.
Stretching

Stretch marks are the bane of all pregnant women. As your stomach, breasts, buttocks and hips enlarge for baby, the elastic tissue in your skin will eventually break.

There are creams and lotions that you can apply, but the truth is, there is nothing that can completely prevent stretch marks. And unlike some of the other skin changes, these lines won’t go away so quickly after childbirth, although they will eventually fade and become less noticeable.

Itching

An itch is a terrible thing. During pregnancy, your skin may become dry and flaky, causing it to itch. You may also get a prickly heat rash because you are perspiring more and your skin may be rubbing against itself, especially where the stomach rubs against the top of the pubic area and the inner thighs rub against each other.

Some pregnant women get intensely itchy, red bumps on their abdomen, thighs, arms and buttocks. This condition has a long name: pruritic urticarial papules and plaques of pregnancy (PUPP).

It usually appears around week 34 and disappears shortly after delivery. Corticosteroid creams, prescribed by your doctor, may offer relief.

There are other skin conditions that can occur during pregnancy and cause intense itching, such as papular dermatitis of pregnancy, prurigo gestationis, herpes gestationis, and impetigo herpetiformis. Any skin changes, rashes or itching that seem abnormal should be brought up with your doctor, as some conditions that cause rashes are dangerous to you and your baby.
Acne

Pimples can be a problem for some pregnant women, especially during the first trimester. However, your skin will probably clear up after the third month, or after you give birth.

Spider veins and more

As I mentioned earlier, your blood circulation will increase during pregnancy. One of the consequences of this is spider veins, so called because the tiny, squiggly red blood vessels under your skin (resembling spider webs) branch out and become more visible.

Spider veins are most common on the face, neck and arms. If they do not go away on their own after delivery, you can seek advice from a dermatologist on how to remove them. You may find that a little make-up can disguise the problem too.

The veins in your legs may also look different, as they become more enlarged and seem to protrude through the skin. These are called varicose veins and, unlike the other skin changes of pregnancy, may not disappear completely after pregnancy. If you are very troubled by them, you can ask your doctor for ways to treat them.

You may also notice your palms and soles turning pink or red. There is nothing harmful about this, and it will probably disappear after delivery.

Skin tags
Don’t be overly alarmed if you find tiny bumps or polyps under your arms, between your neck folds, or under your bra lines. These are skin tags, caused by hyperactive growth of a layer of skin in areas where your skin rubs together or against clothing.

You can wait for them to disappear after delivery, or talk to your dermatologist about having them removed.

Most of the changes described in this article are normal and to be expected during pregnancy. As always, discuss any changes with your doctor to put your mind at ease.

In the meantime, try not to worry too much about the way your skin looks. Rest assured that most of these changes are temporary!

Big girls don’t cry

2008-04-02T17:41:00.000-07:00

Dry eye disease is a common disorder affecting mainly females, especially those in the older age group.

FIFTY years ago, Henrik Sjogren described a disease characterised by autoimmune damage to the lacrimal gland tissues (tear glands), decreased tear secretion and ocular surface disease and called it keratoconjunctivitis sicca.

Today, dry eye is defined as ocular surface disease that results from any condition or circumstance that decrease tear secretion or increase tear film evaporation.

An International Task Force of dry eye disease experts propose that the term “dry eye disease” be replaced with “ dysfunctional tear syndrome” to reflect current understanding of the condition’s pathophysiology.

Research in recent years has shown that the disease involves progressive, self-reinforcing alterations of the tear film composition that promote inflammation. Although these inflammatory changes of the ocular surface are usually not apparent in routine clinical examination, they are now understood to underlie dry eye disease.

In dry eye disease, patients feel that their eyes are tired, blurred and have difficulty in keeping them open.
Tear production in humans is divided into two parts:

# The basic secretors (goblet cells, accessory lacrimal glands and oil glands)

# The reflex secretor (controlled mainly by the main lacrimal gland) which is modulated by sensory reflex arcs and emotion.

Dry eye disease is common condition affecting mainly those above 40 years of age. Risk factors include older age, female sex, postmenopausal status and previous lasik (laser-in-situ keratomileusis) surgery for refractive errors.

Common symptoms include eye discomfort and irritation such as grittiness, scratchiness, foreign body sensation and burning sensation.

Patients feel that their eyes are tired, blurred and have difficulty in keeping them open. Very often, there is paradoxical tearing even when their eyes are dry due to reflex tearing from the main lacrimal gland.

Symptoms usually get worst as the day progresses and are aggravated by the presence of wind, smoke, air-conditioning or wearing contact lenses.

Prolonged use of video display terminals and excessive reading or watching television can worsen the condition.

Diagnostic tests

The usefulness of a diagnostic test is determined in part by its sensitivity and specificity.

Shirmer’s test makes use of a filter paper inverted into the inferior fornix of the eye, at the lateral one third of the lower lid margin. This test has been shown to be quite inaccurate in diagnosing dry eye, with a high rate of false positive and false negative results.

Rose Bengal test makes use of a vital dye to stain parts of the cornea and conjunctival epithelium. This test is particularly useful in the diagnosis of keratoconjunctivitis sicca

Dry eye disease encompasses diverse etiologies and varies in severity. Furthermore, correlations between symptoms, clinical signs and diagnostic test results are variable, rendering the diagnosis and treatment of this condition challenging and frustrating.

Treatment of dry eye disease

An individual’s quality of life can be significantly affected by this condition, reducing one’s zeal in life and even contributing to depression. Traditional treatment options available are often palliative in nature.

It has been commonly taught that the initial treatment of dry eye involves the use of artificial tears. However, artificial tears do not contain the balanced mixture of proteins, electrolytes, nutrients and growth factors that a person’s own tears contain. These nutrients and proteins are important for preventing infection and keeping the cornea nourished.

Moreover, due to the toxicity of the preservatives used and the short retention time of the drops, the use of artificial tears is frequently a frustrating experience.

More recently, newer and more viscous drops which are preservative-free are available in the market. Lubricating gels are also available as these can last longer than drops.

Punctal occlusion is therapeutic for those with dry eye disorders characterised by elevated tear film osmolarity.

Punctal occlusion can be reversible with the use of silicone punctual plugs or irreversible by cauterisation of the inferior punctum. With punctual occlusion, non-preserved artificial tears would be more effective. (The entrance to the nasolacrimal drainage channel is called the lacrimal punctum, a small opening in each of our eyelids. In punctal occlusion, a small plug is inserted in one or more puncta to slow the drainage of tears from your eyes. By slowing the rate of tear drainage, more tears stay on your eyes, relieving dry eye symptoms.)

A key recommendation in the treatment of dry eye is the application of topical anti-inflammatory agents including corticosteroids, cyclosporine A and doxycycline.

These should be used even if ocular surface inflammation is not clinically apparent as research in recent years has shown that the disease involves progressive changes in the tear film composition that promote inflammation.

Furthermore, in dry eye associated with postmenopausal status, the hormonal support that normally maintains the ocular surface in a non-inflammatory state is compromised.

The effective use of topical steroids, in short durations, to reduce the severity of the dry eye attest to the inflammatory nature of the disease. However, long term application of steroids is not advisable due to its side effects like glaucoma and steroid induced cataracts.

Longer term topical cyclosporine A therapy has been shown to normalise the tear film composition early in the clinical course of the disease and may have the potential to slow, prevent or reverse the progression of dry eye disease.

Due to its safety profile in chronic use, topical cyclosporine A has been approved by the FDA for use in the therapy of dry eye. It results in the restoration of lacrimal gland function, resulting in increased tear production and restoration of the ocular surface.

In conclusion, dysfunctional tear syndrome or dry eye disease, is a common disorder affecting mainly females, especially in the older age group. Routine treatment using artificial tears is often palliative and unrewarding.

However, with the advent of topical anti-inflammatory agents, a definitive treatment of the disorder is now possible.

Eating and the environment

2008-04-02T17:40:00.000-07:00

What effect does food production have on climate change and what can we all do to reduce adverse effects on the environment?

GLOBAL warming, climate changes, carbon emissions, sustainable development – these topics are becoming all too familiar as governments grapple with the effects of human activities on the environment.

The world’s insatiable demands for power, mobility and material goods have meant that our environment is suffering.

A 2006 report from the Food and Agriculture Organization (FAO) looked at the greenhouse gas emissions (GHG) from the production of livestock. The report estimated that 18% of GHG emissions could be accounted for by livestock production. - AP photo
In the past 12 months, the amount of greenhouse gases (GHGs) – which include CO2 – released into the environment has continued to rise.

There have also been increases in average temperatures, prolonged droughts, failing crops and melting of ice shelves.

Food provides us with the energy and nutrients we need to survive. But what effect does food production have on climate change and what can we all do to reduce adverse effects on the environment?

Carbon footprints

A carbon footprint is a way of estimating the actual amount of greenhouse gas emissions a person, product or service generates.

Take your own shopping bags for your groceries instead of relying on plastic shopping bags from the store. - Reuters photo
A carbon footprint refers to the amount of carbon dioxide (CO2) and other greenhouse gases (GHGs) emitted over the lifetime of a product or service. It’s usually expressed as grams of CO2 equivalents and takes into account the different global warming effects of various GHGs.

A carbon footprint is calculated by using a tool called the “Life Cycle Assessment” (LCA), which looks at energy consumption and GHG emissions based on the production cycle of a product.

In the case of individuals, the LCA looks at the use of various energy-consuming devices (televisions, refrigerators, computers, and lighting) and choice of various transport options (cars, public transport usage, air travel).

Almost everything we do affects our carbon footprint. Just leaving an appliance plugged in (even if its not on) increases energy use, which in turn increases the amount of fossil fuels burnt and the release of CO2 into the atmosphere.

Reducing carbon footprints

Because so many of our everyday actions affect the amount of energy we use, there are many ways to reduce your carbon footprint when you are preparing food.

Don’t just fill the kettle to the brim for one cup of tea. Only boil as much water as you need.
Recycle! It has been estimated that people in cities can save more than one tonne of CO2 per year just be recycling half of their household waste.
Walk more. Don’t automatically take the car for short trips to the supermarket – use your legs and think about the many additional benefits it will have for your health.
Choose unpackaged foods, especially fruits and vegetables, where possible to reduce packaging waste.
Buy local seasonal fruits and vegetables to cut down on transportation costs.
When cooking, make sure that the pan fits the size of the ring on the stove; if the pan is too small, a lot of energy is wasted.
Choose energy efficient appliances.
Take your own shopping bags for your groceries instead of relying on plastic shopping bags from the store.
Rather than sitting on the couch after a meal, turn off the television and get outside to plant some shrubs and trees. You can help reduce your energy usage, “green” the environment and get fitter all at the same time!

The big picture

The energy costs of supplying food don’t just start and end in the household kitchen. The production of food – from the farm right up to the table – requires energy.

According to the UK Department for Environment, Food and Rural Affairs (DEFRA), the total carbon footprint of the United Kingdom is 659 million tonnes of CO2. Of this, the food industry (including food production and distribution as well as retailing) accounts for about 17% (111 million tonnes).

This includes carbon emissions from the production of foods, transportation and distribution charges, energy use in offices and buildings, energy costs for refrigeration and other storage requirements, waste management, business travel and even employee commuting costs.

Energy saving measures, such as the more efficient use of energy as well as energy saving devices, are being used by industry to reduce the carbon footprint.

Electricity usage, for example, can be reduced by switching to low energy lighting, using cold air retrieval systems to recirculate air and reduce the costs associated with air conditioning, natural refrigerant solutions, more efficient distribution systems and self generated energy (solar, wind, biomass and geothermal energy production). CO2 emissions that can’t be solved by energy saving measures are addressed by other solutions.

One way to address the problem is by “carbon offsetting”, which looks at opportunities to reduce CO2 emissions – for instance by switching to biofuels or planting trees, avoiding deforestation, industrial gas sequestration, renewable energy and even capturing the methane emissions from livestock.

Livestock production

Animal proteins play an important role by offering a source of high quality protein as well as several key nutrients, including iron and zinc, which are often in short supply in peoples diets.

Yet like other methods of food production, the production of animal foods requires energy consumption in relation to the direct effects of production as well as the costs of producing livestock feed and land usage.

A 2006 report from the Food and Agriculture Organization (FAO) looked at the greenhouse gas emissions (GHG) from the production of livestock. The report estimated that 18% of GHG emissions could be accounted for by livestock production.

This figure is higher than previous estimates because the FAO used a different method of estimating emissions, which included all aspects of livestock production – feed production (including fertiliser usage, deforestation and pasture degradation), animal production (enteric fermentation and nitrous oxide emissions from manure) and CO2 emissions via the transportation and distribution chain.

The livestock industry has been working with governments to reduce the environmental effects of livestock production by:

Improving the quality and digestibility of feed. Healthy animals on good quality feed have lower GHG emission intensity.
Managing herds to reduce the number of unproductive animals.
Making sure that animals are healthy.
Adding substances to feeds reduce methane emission by cattle.

Early studies in Australia, New Zealand and Europe show that these efforts are leading to reductions in GHG emissions.

The future

A lot of time and effort is being directed towards the effects of our current lifestyles and consumption habits on our environment. Increased information and education will intensify awareness and action in this important area.

Climate change and GHGs are still relatively young sciences and there is an urgent need for continued research efforts and reliable data to ensure that strategies to address the problem are correctly targeted so that our footprints in time won’t have adverse effects on the living standards of future generations.

Start the day right

2008-03-29T22:24:00.000-07:00

A nutritious wellbalanced breakfast can give your child a head start to the day.

WE have all heard the saying, “Eat breakfast like a king, lunch like a prince and dinner like a pauper.” We know the importance of breakfast but somehow, it remains the one meal that we often skip.

With the morning rush to get ready for work and get the children off to school, many families have ignored breakfast even though it is the most important meal of the day.

But your children need a good start to the day, as they have to concentrate in class. If your child is not paying attention in class, then he won’t be learning as much as he should. This is where breakfast plays an important role.

The importance of breakfast can be figured out from the word itself, which can be divided into “break” and “fast”. This means that your child’s body has been fasting during the night when he is asleep. After this overnight fast, your child needs all the energy in the morning to prepare him for physical and mental activities that will fill the rest of the day.

“Breakfast is the first energy-giver of the day. A good healthy breakfast allows children to concentrate better and be more energetic in school. As breakfast is usually prepared at home, parents have greater control over their kids’ nutritional needs,” said Tracy Lew, Corporation Nutrition Adviser of Nestle Malaysia. “If they do not have enough energy in the morning, they will not be able to concentrate in class or even play with their friends. All they can think about is food when they are hungry during morning classes.

“Breakfast is the first nourishment a kid’s body will receive for the day, so it is essential to prepare a well-balanced breakfast. Primary school-going children need about 1,600 to 2,200kcal of energy each day. The breakfast they eat in the morning should supply one-quarter to one-third of their energy requirements,” said Lew.

“The food from breakfast replenishes your child’s energy. Breakfast need not be very heavy, just enough to last until recess,” said consultant dietitian Mary Easaw-John Mary.

“A balanced diet that provides a variety of foods helps ensure your child receives all the nutrients he needs.”

“Variety is important as the body needs all the essential nutrients to function properly. A single food or group cannot provide all the nutrients a child needs. The more variety you have, the more interesting breakfast can be.”

“A child has different needs from adults,” said Lew. “For example, in comparison to his lower body weight, a child needs more protein than an adult. It’s also important to know how much your child needs to eat in a day so that you don’t prepare too much.”

Achieving the right balance for your child is not difficult once you know what he needs. To have a balanced diet, your child needs a variety of food from all the food groups:
# Carbohydrate like grains and cereals;
# Fruits and vegetables;
# Protein like meat, poultry and fish;
# Milk and dairy products.

Knowing what your child needs makes it easier for you to prepare a healthy and nutritious breakfast for him.

A balanced diet provides essential nutrients such as carbohydrate, protein, essential fatty acids, vitamins and minerals for your child’s growth and development.

A word of caution though: Eating more does not mean getting more nutrition. It is important to know what food to give your kids so that they are on the right path to proper nutrition. We need to make informed choices about the food we buy, the meals we prepare and the food our children consume.

Even though we know that breakfast is important for us and our children, a recent study conducted by a team of nutritionists from Universiti Kebangsaan Malaysia showed otherwise.

Out of 12,000 primary school kids (aged between seven and 12) surveyed, they found out that more than 30% of them skip breakfast, the most important meal of the day. It is not surprising to figure out why children are skipping breakfast, as it is also the same reasons we give when we skip breakfast.

First, waking up early for breakfast is hard to do. And when children wake up late, they don’t have the time for breakfast. Primary schoolkids in the morning session also might not have the appetite to eat.

UKM also found that 77% of the children understood the importance of nutrition and the need for breakfast. However, 48% of the children who skip breakfast said they do not have the time for it, while 30% said they do not have appetite during breakfast.

However, this does not mean that the trend has to continue. Our body converts nutrients in the food to simple forms, which are then absorbed. For example, carbohydrate is converted into glucose. Glucose is then absorbed by our digestive system and transported to body cells to be converted into energy.

“Other than providing energy, food can provide carbohydrate, protein and essential fats,” said Easaw-John. “It also provides different vitamins and minerals and these nutrients are important to the health of your child.”

Alcoholic, riding the wine wagon

2008-03-21T21:19:00.000-07:00

To your health, cheers, but too much drink and nobody knows your name.

I ENJOY a glass of wine with my food. When the match is right, for example, salmon and Pinot Noir, or a light-bodied Chablis and oysters, the meal becomes an exquisitely enjoyable experience. I enjoy wine with music and art. A glass of champagne does wonders to a romantic evening. Wine adds much to the pursuit of beauty and pleasure.

Over the past decade, more and more peoples are drinking wine, especially red wine.I initially thought that there was an Epicurean movement in the making. When I saw wine served in Chinese tea glasses at room temperature (over 30C recently) and in a raucous, noisome and odoriferous ambience, I thought again.

Instead of sipping and savouring, there was gobbling and gulping. It was not for reason of aesthetics that most of them have taken to drinking wine. It was for reasons of health!

And since the colour red is auspicious and Bin 888 is one of their favourites, courting Lady Luck is another incentive to drink wine!

If only the attainment of health and wealth were so easy and enjoyable!

I discuss the French Paradox, resveratrol – a molecule which resonates with promise – and wine and health, in particular cancer.

In the US in the early 90s, the TV series 60 Minutes aired a report on a phenomenon known as the French Paradox – the fact that the French have a lower rate of heart disease than Americans, despite a diet higher in fat.

The one thing that the American diet lacks in comparison to the French diet is red wine. Some researchers looked for a link between the consumption of red wine and heart disease and found it!

In the year following this report, Americans increased their purchase of red wine by 39%. I guess we are not alone in jumping onto the “wine wagon”; it is just that we are almost a decade behind.

Drinking small amounts of alcohol (not necessarily red wine) can reduce your risk of heart disease. Cancer Research UK is one authority that concurs. However, this applies only to men above 40 and women who have been through the menopause.

The maximum amount of alcohol you should be drinking is two units per day for women and three units per day for men. A standard 175ml glass of wine (of 11 to 12% volume) contains two units. A premium pint of beer (5%) contains three units. Beyond that, the harm (heart disease, cancer) outdoes the good.

There is actually some science behind the supposed benefits of red wine. Red wine is rich in resveratrol. It is a part of the plant’s defence system against disease.

Resveratrol has been shown to reduce tumour incidence in animals. Scientists are studying resveratrol to learn more about its cancer preventive activities in man. This research is in its infancy.

Even when resveratrol is proven to be anti-cancer, the amount you get in each glass of red wine is so minuscule, you will probably need 100 glasses of wine daily to tap its anticancer properties! In years to come, it may be possible to take a tablet of pure resveratrol. It is certainly more practicable.

Too much alcohol puts you at risk of cancer of the mouth, larynx (voice box), oesophagus (foodpipe), liver, breast and perhaps colon. Smoking and drinking together (de rigueur for a night out with the boys) increases your risk even more.

How does alcohol cause cancer? We are not entirely sure but there are several ideas.

Alcohol is converted in the body into a chemical called acetaldehyde. This causes cancer by damaging our DNA and preventing it from being repaired. Alcohol can also increase the level of oestrogen in the body and this may be how alcohol causes breast cancer. Alcohol can cause cirrhosis of the liver and this in turn causes liver cancer.

Finally, alcohol reduces the amount of folate in our blood. Folate is a B vitamin that our cells use to create new DNA correctly. Lack of folate can lead to mistakes in DNA and this may lead to cancer.

Alcoholism is not quite the problem it is in Malaysia the way that smoking is. Nevertheless, with our new affluence and the way we tend to binge, we may soon be on par with the first world.

The incidence of mouth cancer is high in Malaysia. There is a high incidence of concurrent smoking and drinking alcohol among the victims. Liver cancer is very common in persons infected with hepatitis B or C virus. With alcoholism, the risks will be greater.

In the UK, a study estimated that alcohol causes 2,000 breast cancer cases a year (out of a total of 44,000 cases). Alcoholism is not a big problem among women in Malaysia at present. However, one can never know what the future holds with the lifestyle trends we are witnessing today.

Drink by all means and be merry. But drink wisely and be the aesthete, not the alcoholic. If your buy a basketball ticket from Ticketamerica.com, at chicago bulls tickets or portland trail blazers tickets or dallas mavericks tickets, dont bring a wagon of alcohol in the stadium..... ;-)

att: Ticketamerica.com also has tickets for the chicago bulls and the portland trail blazers and the dallas mavericks tickets..enjoy your sport without an alcohol....!!!

Smokers face higher risks

2008-03-15T22:19:00.000-07:00

WHILE smoking has always been associated with lung cancer, many may not be aware that the habit is also the most common cause of another lung disease known as chronic obstructive pulmonary disease or COPD.

COPD is not one single disease but an umbrella term which includes chronic bronchitis and emphysema. While patients can have either of these diseases, both often occur simultaneously.

Those suffering from COPD experience chronic airflow limitation, shortness of breath, cough and increased mucus production.

Institute of Respiratory Medicine director Datin Dr Aziah Ahmad Mahayiddin says the lack of awareness of COPD stems from misconceptions about the symptoms as many do not feel they are serious enough to see a doctor.
“Most patients do not complain or seek help. Sometimes they have come to expect coughing and shortness of breath as something that come naturally with smoking or ageing.

“We also need more proactive physicians to actively screen patients, especially smokers or ex-smokers above 40 years of age.”

Smoking is responsible for 90 per cent of COPD cases. Those at risk are men and women aged above 40, who have been smoking a pack of cigarettes for the past 20 years. However, Dr Aziah says with the increase in teen smokers, the onset of the disease might develop earlier.

Smoking causes inflammation of the airways and increased mucus production which result in chronic airflow obstruction.

“As 49 per cent of males in this country smoke, naturally they are at higher risks. But as the number of female smokers is on the rise, women too have at least the same risk of developing COPD.”

It was reported that smokers with COPD have higher death rates than non-smokers with the disease. They also have more frequent respiratory symptoms such as coughing and shortness of breath as well as more deterioration in lung function than non-smokers. Passive smokers are also at risk of the disease.

Other contributing factors include occupational exposure to dust, indoor pollution from wood-burning and coal-burning stoves and air pollution, especially exposure to sulphur dioxide and black smoke. Diets and genetics may also play a part in COPD.

Due to a lack of awareness of the disease, by the time a patient is diagnosed, an irreversible damage has already occurred.

“It is vital that we are aware of the disease symptoms and treatment options as early diagnosis can reduce the amount of damage to the lungs. Proper advice from medical professionals can also lead to better management of the disease.”

COPD is often misdiagnosed as asthma or goes undiagnosed in its mild and moderate stages. Making it more difficult is that as the disease generally strikes after the age of 40, symptoms are often first attributed to ageing.

A simple breathing test known as spirometry would be able to detect if a person suffers from COPD. The test enables the doctor to tell the difference between COPD and other respiratory diseases such as asthma.

COPD is easily diagnosed and early diagnosis can improve the chances of stopping the progression of the disease and the deterioration of lung function.

“Don’t ignore symptoms as shortness of breath, morning cough and increased mucus production as these could be an indication of mild COPD.

“Those with the disease should be more proactive in taking control of it.”

According to the latest World Health Organisation figures, currently there are 210 million people with COPD. The disease will become the fourth leading cause of death worldwide by 2030.

The number is expected to be higher in the Asia Pacific, where there are high rates of tobacco smoking and widespread use of biomass fuels — the two key reasons for COPD.

In Malaysia, it is estimated that 16,000 people were admitted for COPD each year for the last six years and, in the same period, there were 1,000 deaths reported annually. There are about 448,000 moderate to severe COPD sufferers in the country. COPD is ranked fifth in Malaysia in terms of disease burden.

Dr Aziah says lifestyle modifications that can help prevent or improve function in COPD patients include stopping smoking, avoiding being exposed to second-hand smoking, respiratory irritants, infections and allergens, maintaining good nutrition and drinking a lot of fluid.

COPD cannot be cured but treatments are able to relieve the symptoms and help patients breathe easier.

“Treatments generally aim to slow the progress of the disease, improve exercise tolerance, prevent and treat complications and sudden onset of problems and improve overall health.

“Quitting smoking is the single most important thing you can do to reduce your risk of developing COPD and slow the progress of the disease.”

ABC of science

2008-03-14T22:15:00.000-07:00

A - IS for agnosticism. Science is agnostic by its very nature. All true scientists are agnostic by implication or inference. We know as much as we can, based on analysis of the data available to us. Data that fit a mathematical model.

Ultimate causes are unknowable. A related word is positivism. We cannot know more than what we know. We don’t speculate and we are not metaphysicians or soothsayers. It is true that something not proven today, for example, meridians in the human body, may one day be fait accompli. All we say is that all the extant data show that meridians do not conclusively exist.

B - is for bravery. It is courage in the face of prejudice. Evolutionary biology, a subset of scientific knowledge, riles many. It is the study of the web of life. All life forms are interconnected in geography and in history. The brave and courageous post-Darwinians (and I count myself as one of them) sometimes face an onslaught of invective even in today’s enlightened world. Oncology is part of biology. Cancer can be studied in evolutionary terms. In fact, it is very rewarding to study it that way.

C - is for count, calibrate and calculate. Measurements and mathematics matter a lot in science. (See D for more.) C is also for change. Scientific knowledge is ever changing. It is provisional. New data generate new theories. Theories are subjected to repeated experiments. When the findings of such experiments converge and corroborate each other, the theories become fact. Sometimes what we accept as fact needs revision in the face of new data. Science is not cocky. We go back to the drawing board and start all over again.
C is also for critical thinking. We exalt critical thinking but are we prepared to accept where critical thinking will lead us?

D - is, of course, for data. We collect lots of data whether we study the cosmos or cancer. Tied to data is measurement. We make lots and lots of measurements. And we subject these measurements to mathematical and statistical calculations. As I always tell my patients, if it is not measurable (as in most of the claims of traditional and complementary medicine), it isn’t science.

E - is for experiment. Every assertion about how the universe works is subjected to experiment. When we think of experiments, we think of mixing chemicals in the laboratory to verify the validity of chemical equations. We feed different compounds to laboratory rats to see their effects on the rats’ physiology (this is to be done within the strictest guidelines on animal experimentation). But even free will and consciousness are subjects of scientific inquiry today. (This is also tied to B for bravery as free will and consciousness are prickly to many people when approached scientifically.) E is also for evidence. From experiments (or clinical trials in the context of cancer medicine), we make conclusions. We discuss these conclusions thoroughly and eventually we make recommendations. For example, guidelines on how to treat early breast cancer are published every year.

F - is for fallible. (See also C for change.) Science never purports to be the ultimate truth. It approximates the truth. If you like mathematics, science can be likened to the asymptote. Science is fallible in the way that religion is not.

G - is for guru. We think of Copernicus, Galileo, Darwin, Einstein, Watson and Crick who laid the foundation of today’s science. We now have Hawking, Dawkins and Pinker. But big names and personalities are not important in science. There is no place for cults or worship of deities. We are all smaller than the grandeur of the science we know and the science that we pursue.

H - is for intellectual honesty. If there is one thing that science is and ought to be, it is intellectual honesty.

And finally O. (I to Z except O later.) Oncology is but a subset of science. It is the study of the nature and treatment of cancer. It is firstly based on the accepted body of knowledge of the structure and function of the human body. This knowledge is built up over the eons. Experiments are conducted on animals and human cells and tissues. Finally when a drug is identified that may possibly work in cancer patients, it is subjected to clinical trials. We conclude from these trials that this new drug is superior to our previous standard treatment. We then use this drug in our daily practice. This laborious process is driven by intellectual honesty.

Oncologists then make recommendations and guidelines for cancer treatment (provisional of course). Next year, we may change our minds based on newer and more robust data. This flexibility goes to show the innate strength and humility of science.

Oncology, for all its “failings”, is good and true science.

Alternative Medicine: Probiotics and gut health

2008-03-13T22:13:00.000-07:00

THE probiotic concept was born in the early 20th century by Russian scientist Elie Metchnikoff. Dr Metchnikoff proposed that the health, well-being and longevity of Balkan populations were attributable to their consumption of large quantities of fermented milk containing beneficial micro-organisms.

In Europe, Japan and Australia, probiotics and related products to improve intestinal health currently represent the largest segment of the functional food market.

A healthy balance of intestinal flora is necessary for the human body to function optimally and maintain health. Beneficial flora strongly influences multiple aspects of health, from intestinal function to skin condition. Furthermore, microbial balance is the key factor that determines whether substances in the colon are converted into compounds that are beneficial or detrimental to the host.

Unfortunately, ageing as well as many of our modern lifestyle factors including poor diet, antacids, travelling and food or water contaminants can upset the delicate balance of intestinal bacteria and lead to poor health.

While many factors of everyday life can negatively impact the balance of intestinal microflora, and therefore digestion, an extremely common cause is antibiotic use without reinoculation of “friendly” organisms. Antibiotics have been one of the greatest discoveries in modern medicine, and they are now the second most commonly prescribed category of drugs in the US. However, in addition to destroying disease-causing bacteria, they also destroy the essential friendly bacteria.

Diarrhoea and stomach upset are common side-effects of the elimination beneficial GI bacteria when broad-spectrum antibiotics are used for an extended period of time. Hence, probiotics can be taken following the completion of antibiotic therapy to help re-establish beneficial intestinal flora for healthy digestive function. Lactic acid bacteria such as Lactobacillus acidophilus NCFM have long been considered safe and suitable for human consumption.

Lactobacillus acidophilus NCFM exhibits a broad range of benefits in those who consume them. They have been shown to:

Help re-establish beneficial intestinal flora to support healthy digestive function following the use of antibiotics.
Support vitamin and short chain fatty acid (SCFA) synthesis and assimilation of nutrients, thus promoting intestinal and overall health.
Protect the intestinal mucosa from increased permeability by supporting intestinal cell growth and differentiation (improve ’leaky gut’ syndrome).
Detoxify the intestine, thereby supporting liver function and protecting intestinal and colon cells.
Provide lactase activity, which facilitates the digestion of lactose (milk sugar).
Support healthy immune responses.
Support the healthy metabolism of cholesterol.

An important attribute for certain probiotic bacteria functions is survival and growth in the intestinal tract. Once in the GI tract, probiotic bacteria have the ability to influence the populations and activities of different intestinal bacteria.

Therefore, demonstrating that a probiotic can survive GI transit and influence GI tract flora is important for establishing its characteristics. Studies have demonstrated that levels of Lactobacilli increase significantly in the faeces of human subjects consuming non-fermented milk containing NCFM. These show that NCFM strain survives the GI passage and exerts its beneficial effect on the host.

Discharged!

2008-03-11T17:42:00.000-07:00

By Prof Dr A. KULENTHRAN

MRS Chong (not her real name) came to see me the other day. She has been plagued by a vaginal discharge that never seems to go away.

“It is not like pus, has a sort of a grayish-white colour, not very itchy, does not distress me very much, but it smells horrible, at least to me. I really feel unclean and it is really getting me down, doc,” she lamented.

“How long have you had it?” I asked.

“For more than a year,” was her reply.

“But have you sought treatment?” I interjected.

“I have consulted almost every other doctor in town,” she exaggerated.

“All they do is either give me a course of antibiotics or a course of vaginal tablets. I do get some relief but within a week or two it is back.”

“How long does a course of antibiotics last?” I asked with curiosity.

“About three to four days” was her reply.

“That’s too short,” I murmured to myself.

“Did they do any tests for the discharge?” I asked. No was her prompt reply.

“I have even tried to douche myself with antiseptic solutions but it only made it worse,” she said. I knew what was coming next.

“Just out of curiosity, doc. Has my husband been up to no good?” she asked. I avoided the question and reserved my reply till I had more facts.

About ‘itis’ and ‘osis’

Mrs Chong’s problem, like so many other women’s, is becoming an increasingly common one. She was probably having bacterial vaginosis. In medical parlance, an “itis” means an inflammation and an “osis” generally means that “something has gone wrong”.

The fact that it is called a bacterial vaginosis rather than a vaginitis implies that it is not an infection per se by bacteria. Rather, something has simply gone wrong with the vaginal bacterial ecosystem.

If you recollect, the previous article emphasised that the vagina has an ecosystem of its own – the silent guardian of which is the Lactobacillus species. It maintains the pH of the vaginal milieu acidic.

The problem occurs when for some reason, hitherto still unclear, certain bacteria called anaerobes (because they thrive in less oxygen) overgrow and replace the lactobacillus species. Their scientific names include the Gardnerella and Mycoplasma species.

Besides causing a discharge and sloughing of the vaginal lining, the pH of the vagina becomes less acidic and this further propagates the problem.

A common problem

Bacterial vaginosis is now recognised as the most common cause of vaginal discharge in middle aged women, being present in about 10% to 40% of women attending gynaecological clinics.

It was initially thought to be a sexually transmitted disease because of its presence in sexually active women. However, the bacteria has been isolated in virgins, and treatment of the male partner makes no difference to the recurrence rate. (In any case, Mrs Chong was reassured.)

Notwithstanding, there are pre-disposing conditions and these include douching with antiseptics, previously sexually transmitted disease, a change in sexual partner and the use of intra-uterine contraceptive device.

The diagnosis

Making a diagnosis is not easy. The type of discharge and its characteristic smell are some clues but not accurate ways to a diagnosis because such appearances are also present in other kinds of discharge.

Placing a bit of the discharge in a solution of potassium hydroxide will emit a characteristic “fishy” odour.

The gold standard however, is to do a smear of the vaginal discharge and after suitable preparation, the cells are examined under the microscope to look for the characteristic “clue cell”.

Unfortunately most of these techniques are seldom carried out by the doctor because they take time and involve cost, and he usually makes a diagnosis on a “hunch”.

The treatment

Once a diagnosis is made, treatment should be started. The usual drugs are either metronidazole or clindamycin.

Metronidazole is taken as tablets but clindamycin can either be taken either as tablets or given vaginally.

Be that as it may, the important thing is to give an adequate course and the treatment must be completed – at least seven days. It has been found that one of the common causes for a recurrence is inadequate treatment at the first go.

Treatment may be effective, but that is not the end of the story. There is about a 60% that the infection will return within a year.

The complications

It was fortunate that Mrs Chong was no more going to be in the family way because there are long-term gynaecological and obstetric complications too.

Pelvic inflammatory disease (PID) may occur through an ascending infection into the pelvis via the cervix, uterus and fallopian tubes. Once PID sets in, it is difficult to eradicate and the ability to conceive is compromised.

The cervix may become infected, resulting in a possible, but not proven, risk of developing pre-cancerous lesions there. But it is the risks during pregnancy that we must pay heed to.

Inflammation to the lining of the water bags or chorioamnionitis by the bacteria is the forerunner to a bigger problem – that of premature labour and pre-mature rupture of the water bags.

The consequences of having a premature baby are only too well known. Furthermore, during the postpartum period, there is always the risk of infecting the womb, a condition called endometritis.

These complications cannot be taken lightly because the prevalence of bacterial vaginosis in pregnancy is not small – up to 20% of pregnant women harbour the infection.

A healthy vaginal ecosystem

How then do we deal with this perplexing and enigmatic problem?

Since the root cause of the problem is a “take over” of the vaginal ecosystem, the most sensible strategy therefore would be some form of pro-biotic therapy with Lactobacilli.

To the best of the author’s knowledge, such a strategy, though well established for intestinal disorders, has not proven to be the case with the vagina.

The next best alternative would be to create an environment that promotes the growth of Lactobacillus species. One such strategy would be to maintain the vaginal pH in an acidic state with an appropriate solution and hopefully, with time, the vaginal ecosystem will return to its original state.

Keep the passion burning

2008-02-26T10:18:00.000-08:00

You’ve been together for 15 years – where has all the passion gone?

MARK and Angela have been married for 15 years. In the early days of their courtship, they talked all the time, held hands while walking and kissed and cuddled – even if sex wasn’t on the agenda later that day. Over the last few years, the sizzle seems to have gone out of their relationship and sex life.

Australian sex therapist and relationship councillor Dr Rosie King says that loss of passion, as in the case of Mark and Angela, is inevitable in all long-term relationships. “In the beginning, lovers find each other fascinating and enchanting. Like Romeo and Juliet, they want to be together every moment of the day and can’t keep their hands off each other.

“This state of ecstatic excitement does not last forever. Three years down the road, Romeo and Juliet have settled into a committed relationship and fireworks may explode only occasionally or not at all,” she said.

Dr King said that lust levels peak during the first 12 to 18 months of a relationship due to changes in brain chemicals. This period is known as “limerence”.

“As limerence fades, the chemical high slowly declines, returning us to our usual state of sexual desire. For women, in particular, this decline is disappointing because so many end up with little or no sexual desire. This is disappointing for their male partners too. They get the cold shoulder more often than not when they approach their partners for sex,” Dr King said.

That women do not seem to get as much pleasure from sexual activity as the years go by is apparent by the results of the Pfizer Global Better Sex Survey. It indicated that 24% of women aged between 45 and 54 and 44% of women aged from 55 to 64 received little or no pleasure from sex over a four-week period prior to the study.

Dr King said that no one should shoulder the blame for the loss of passion and desire.

“She’s not frigid and he’s not a sex maniac with only one thing on his mind. The majority of women in committed relationships say they feel fairly ‘neutral’ about sex. They don’t feel a strong appetite for sex, have sexual fantasies and miss sex if they don’t have it.

“However, most women find that once they get started with sex, given the right stimulation, they can usually get sexually aroused and enjoy lovemaking. It’s just getting started that’s the problem.

“Men on the other hand, thanks to 10 times more testosterone in their systems, are usually keen for sex. They feel urgent sexual desire, think about sex often, look for opportunities to initiate sex and become uncomfortable if they don’t have it,” she said.

It doesn’t have to be a case of complete doom and gloom. Dr King said that it is possible to overcome the desire discrepancy with understanding and compromise.

“Women shouldn’t wait until they feel lust before they have sex because it may never happen. On a fairly regular basis, they need to simply say ‘Yes’ to sex when the man initiates.

“While he decides when sex is going to happen, she has final say on what type of sex will occur. She may be in the mood for sexual intercourse and be ready to get sexually aroused and perhaps try for orgasm or she may prefer sex at a lower level of participation.

“He may not get everything he wants from sex and she may give a little more than she prefers but in the end a compromise is the only solution,’’ she said.

Dr King added: ‘‘Some women take a hard line and refuse to meet their partner’s sexual needs. This breaks the promise we all make, either explicitly or implicitly, in long-term relationships to take care of our partner’s emotional, physical and sexual needs.

“In romantic relationships, sex is an integral part of the bargain. If you expect your partner to remain faithful, you will need to be a co-operative sexual partner.’’

Lowdown on Chikungunya

2008-02-25T10:16:00.000-08:00

Here are frequently asked questions about the Chikungunya virus.

RECENTLY, nine people were reported to have contracted Chikungunya fever in Singapore. And apparently last year there were 10 cases reported. “Chiku what?” you’re probably asking.

Chikungunya is thought to be derived from the Makonde (of south-eastern Tanzania and northern Mozambique) word kungunyala meaning “to dry up or become contorted.”

A girl looking at a model of an aedes mosquito, which transmits the Chikungunya virus. The fever is a viral disease transmitted by the bite of infected female mosquitoes. In fact, the mosquito is from the Aedes species, the same that can transmit the dengue and yellow fever virus, among others.

Here in Malaysia it is very rare and there were only three outbreaks reported. The first reported outbreak was in Port Klang in 1999 and it affected 27 people. In April 2006, 37 people in a small village, Bagan Panchor in Perak were diagnosed with it. Then in December that same year in Ipoh, it was confined to a very small area and 30 people were afflicted. Those affected were either workers from India or Malaysian workers who had returned from India (where an outbreak had been reported earlier).

To get you up to speed on the disease and the Chikungunya virus (CHIKV) here is a list of commonly asked questions.

What are the symptoms?

Those infected often have fever, headache, fatigue, nausea, vomiting, muscle pain, rash (but no related haemorrhaging), and severe and sometimes persistent joint pain. The fever lasts a few days to a couple of weeks, but some patients have prolonged fatigue lasting several weeks.

Some patients have reported prolonged joint pain and arthritis. As you may have noticed, many of the symptoms are similar to dengue except for prolonged joint pain.

The incubation period (time from infection to illness) can be two to 12 days but normally it is three to seven days.

Recovery is expected but elderly folks take longer and some may take a year or more. The authoritative health organisations say that no deaths have been conclusively proven due to CHIKV. And good news of sorts – infection (even “silent” ones without illness) is thought to confer life-long immunity.

The incidence of CHIKV infection may be higher than reported because of misdiagnosis (due to the symptoms resembling dengue).

How do you get infected?

A mosquito spreads it after biting a person who is already infected, in the daytime. Monkeys and possibly other animals may also serve as reservoirs.

The mosquito involved is the Aedes aegypti (white spotted body and legs) and there have been cases where the Aedes albopictus (the Asian tiger mosquito) has been the culprit.
How is it treated?
There is no vaccine or specific antiviral treatment for the fever (as in dengue). Treatment is rest, ingesting fluids and medication for mitigating pain and fever. Aspirin should be avoided.

It is recommended that the patient’s movements be restricted so that exposure to mosquitoes is limited in order to avoid further spreading of the virus. Note that there is no direct human-to-human transmission.
How do you prevent it?

Do what is normally done to prevent mosquito bites – use insect repellents, mosquito coils/mats/nets, proper clothing (that covers your body) and so on.

But the best way is to stop the mosquito from breeding. As they breed in clean stagnant water, any place or receptacle which has still water should either be covered or drained (whichever is applicable). Properly dispose used containers (cups, bottles and so on) as they will collect water.

Sad, benign guts

2008-02-21T10:15:00.000-08:00

In the conclusion of this two-part series, we look at the benign diseases of the upper gastrointestinal tract.

ALTHOUGH stomach cancer can be a possible cause for stomach discomfort, there is no reason to panic when we experience pain in the stomach region.

...‘When people describe their abdominal pain as ‘gastric’, they are usually talking about a condition called dyspepsia.’...

There are also some diseases which are not cancerous that could affect the health of your stomach as well, said upper gastrointestinal surgeon Dr Ramesh Gurunathan.

For 26-year-old Mohd Sobree Johad, irregular eating habits and a penchant for hot and spicy food has taken a toll on his stomach.

As a silat teacher, he would teach all day without taking solid food, except for the occasional cup of Milo and teh tarik to keep him going during busy days. When he finally sits down to have a meal, he spices up his meal with sambal and cili api.

After three months preparing for a competition with those eating habits, he developed what he termed as “gastric”.

“At first it was just a dull stomach discomfort when I eat after a long day without solid food, then it progressed to an excruciating pain that hits me intermittently throughout the day,” Mohd Sobree said.

He then underwent an endoscopy and found out that there were infection and lesions in his stomach. Soon after, when the medications he took for about a year had ceased to assuage his pain, he was referred for an operation to remove part of his gastrointestinal tract.

“At first I was unsure about the operation and delayed it ... now I’m just relieved that it is all over,” he added.

Now, he is a changed man. Apart from eating more vegetables and staying away from spicy food, he is also determined to eat regularly and reduce his smoking.

While traditional medicine may offer relief to symptoms of some benign diseases, it is also important to get medical consultation to diagnose your condition before embarking on any form of treatment, Dr Ramesh added.

Many common diseases of the stomach such as the Helicobacter pylori (H. pylori) infection and gastroesophageal reflux may lead to more serious illnesses (such as stomach cancer and perforation of the gastrointestinal tract).

“Besides endoscopy (which is the gold standard for diagnosing diseases of the stomach), benign diseases such as peptic ulcer and gastroesophageal reflux can also be diagnosed with other tests such as blood tests,” said Dr Ramesh.

That is why your doctor may carry out other tests to rule out benign diseases before referring you for an “invasive” procedure such as an endoscopy.
What do you mean by ‘gastric’?

“When people describe their abdominal pain as ‘gastric’, they are usually talking about a condition called dyspepsia,” Dr Ramesh said.

Dyspepsia, sometimes also known as indigestion, can be described as a bloated feeling and a feeling of discomfort in the stomach region.

Other signs of dyspepsia may include a gnawing or burning stomach pain, nausea, vomiting or burping. However, signs and symptoms may differ between individuals2.

“The pain may be caused by many contributing factors, including causes other than gastric (stomach) ones,” surgeon Dr Ahmad Sudirman said.

“It may be due to diseases of the stomach such as stomach ulcers, gastritis, gastric reflux, cancer or other causes such as gall stones, inflammation to the pancreas, heart disease and lung infection.

“But the most common causes of upper abdominal pain are still peptic ulcer and gastritis,” he added.

If the symptoms of dyspepsia are persistent even with medication – and come with other symptoms such as sudden and unintentional loss of weight, having trouble swallowing solid food, persistent vomiting and passing black stools – you might need to seek medical assistance as soon as possible.
Usually, blood and stool tests can be done to identify the cause of gastritis so that you can be treated accordingly. If further investigation is needed, you may be referred for an upper gastrointestinal endoscopy to examine your stomach lining

Other than cancer, what could go wrong?

Gastritis

There are a number of factors that lead to gastritis (inflammation of the stomach).

It can be caused by drinking too much alcohol, prolonged use of drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, certain chronic diseases such as pernicious anaemia (autoimmune disease) and chronic bile reflux.

“Infection with H. pylori can also cause gastritis as well,” said Dr Sudirman, who emphasised that a proper diagnosis of stomach diseases should be done, as their symptoms are similar.

Common symptoms of gastritis are abdominal upset or pain, belching, a feeling of fullness or burning in the upper abdomen. Other symptoms such as blood in your vomit or black stools may be a sign of bleeding in your stomach, which requires immediate medical attention4.

Usually, blood tests and stool tests can be done to identify the cause of the gastritis so that you can be treated accordingly. If further investigation is needed, you may be referred for an upper gastrointestinal endoscopy to examine your stomach lining.

The treatment of gastritis depends on the cause of the condition. If your gastritis is caused by an infection such as H. pylori, your doctor may prescribe antibiotics to clear the infection.

As stomach acid irritates inflamed tissue in the stomach, treatment also usually involves taking drugs (antacids) to reduce stomach acids so that the healing process can be facilitated.

Peptic ulcer

A peptic ulcer is a sore in the lining of your stomach or duodenum (first part of your small intestines).

The most common symptom of this condition is a burning pain in the gut that feels like a dull ache. It comes and goes for a few days or weeks and starts two to three hours after a meal. Sometimes it comes in the middle of the night when your stomach is empty and usually goes away after you eat3.

Peptic ulcer is one of the most common causes of abdominal pain.

According to the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), H. pylori causes almost two-thirds of all ulcers. However, not everyone who has an infection will develop an ulcer.

Other causes include the chronic usage of NSAIDs like aspirin and ibuprofen and rare disorders such as the Zollinger-Ellison syndrome.

But isn’t peptic ulcer also about stress and spicy foods? Surprisingly, according to the NIDDK, neither of them causes ulcers. However, just like alcohol and smoking, they could make ulcers worse.

Tests that could be done to diagnose peptic ulcers are a barium x-ray (you drink liquid containing barium and do an x-ray) or an endoscopy.

Although it is benign in nature, peptic ulcers should not be taken lightly. As ulcers involve the erosion of the stomach lining, it may carry a risk of perforation (the ulcer has gone through the stomach or duodenal wall).

Certain symptoms to look out for are black or bloody stools and bloody vomit. These could be signs of the ulcer damaging a blood vessel, stopped food from moving from the stomach into the small intestines or gone through the stomach wall3. If you have these symptoms, medical treatment must be sought quickly.

Peptic ulcers can be treated by medication such as proton pump inhibitors, said upper gastrointestinal surgeon Dr Grace Lim. If there is a bacterial origin to the ulcer, antibiotics are given to kill the bacteria.

Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) is a more serious form of the common gastroesophageal reflux (GER)1. An endoscopy can show the examining doctor lesions in the gastrointestinal tract such as ulcers and growths.

“Most of the patients say that they have burning chest pains which goes up to the mouth, and sometimes they have a bitter taste in their mouths,” Dr Ramesh said.

“Some of them can’t sleep at night, because when they lie down after meals they feel a volume of acid going up (from their stomach). These are typical symptoms of reflux.”

GER with atypical symptoms such as chronic cough and sore throat may be difficult to diagnose, he added.

Food regurgitation and feeling bloated are also typical symptoms of GER, Dr Sudirman said.

The reason some people develop GERD is still unclear1. However, one of the reasons associated with the disease is loss of tone in the stomach muscle that prevents the acid from the stomach from going to the oesophagus, Dr Ramesh said.

The weakening of these muscles will allow the acid to go into the oesophagus, causing the burning sensation in the upper abdomen or chest, Dr Lim added.

Other factors that may contribute to GERD include obesity, pregnancy and smoking.

In a fact sheet on GERD by the NIDDK in May 2007,it is stated that there are a few common foods that can worsen reflux symptoms.

They are citrus fruits, chocolate, drinks with caffeine or alcohol, fatty and fried foods, garlic and onions, mint flavourings, spicy foods and tomato-based foods such as spaghetti, salsa, chilli and pizza.

“The way to assess a (gastroesophageal) reflux is to have an endoscopy done,” Dr Lim said.
Dr Ahmad Sudirman ... ‘The most common causes of upper abdominal pain are still peptic ulcer and gastritis.’

“Manometry studies to assess your muscle tone and pH studies to assess the pH levels in the stomach are also ways to confirm the diagnosis,” Dr Ramesh added.

Depending on the severity of your GERD, treatment may involve one or more of lifestyle changes, medications and surgery.

Examples of these lifestyle changes are smoking cessation, weight loss if needed, eating small but frequent meals, wearing loose-fitting clothes and avoiding lying down for three hours after a meal1.

For Mohd Sobree, whose GERD had become serious, surgery was the best option.

After his operation, Mohd Sobree reckoned that it was not as bad as he thought. Rather, he was relieved that he was finally feeling better.

“Do not be afraid of going to the hospital ... seek treatment before it is too late,” Mohd Sobree advised.

Getting to know H. pylori

2008-02-18T10:15:00.000-08:00

SINCE its “discovery” in 1982 by Prof Barry Marshall and Dr Robin Warren, H. pylori has been extensively researched. Known to cause gastritis, peptic ulcer and possibly some cancers, more and more doctors are treating this infection seriously.

What is Helicobacter pylori?

It is bacteria found in the mucous layer of the stomach lining or first part of the small intestine, which causes more than 90% of ulcers1. Ulcers are sores in the lining of the stomach. Before 1982, when this bacterium was discovered, spicy food, acid, stress, and lifestyle were considered the major causes of ulcers. Since we now know that most ulcers are caused by an infection with H. pylori, they can be cured with appropriate antibiotics.

Who gets H. pylori?

About two-thirds of the world’s population is infected with H. pylori. In the United States, H. pylori is found more often in older adults, African Americans, Hispanics, and those in the lower socio economic groups.

In Malaysia, it was found that the prevalence of H. pylori infection was higher in patients more than 50 years of age compared to those below 30 years4.

It is still not known how H. pylori gets into the body or why some people with H. pylori become ill while others do not. The bacteria is most likely spread from person to person through the faecal-oral route (when infected faecal matter comes in contact with hands, food, or water) or the oral-oral route (when infected saliva or vomit comes in contact with hands, food, or water).

How does H. pylori get into the stomach?

Although much research has been devoted to determine how Helicobacter infections are acquired, the simple answer is that, with the exception of a few patients who have been infected during gastric endoscopy, we don’t know how this organism is introduced into the stomach.

An update in January 1997 suggested that food contaminated with the bacteria may be the route of infection. Adequate nutritional status, especially frequent consumption of fruits and vegetables and of vitamin C, appears to protect against infection with H. pylori.

In contrast, food prepared under less than ideal conditions or exposed to contaminated water or soil may increase the risk of infection.

What are the symptoms?

The most common symptom of ulcers are gnawing or burning pain in the stomach area, between the breastbone and the navel. Commonly, the pain occurs when the stomach is empty, between meals and in the early morning hours, but it can also occur at other times of the day.

Less common ulcer symptoms include nausea, vomiting, and loss of appetite. Bleeding can also occur and prolonged bleeding may cause anaemia leading to weakness and fatigue.

If the bleeding is heavy, vomiting of blood or passage of bloody stools may occur. Dark stools or dark vomit often indicate old bleeding.

How is H. pylori infection diagnosed?

Doctors have several methods to test for H. pylori infection. By measuring antibodies against H. pylori, blood tests can determine if a person had been infected.

A breath test (urease breath test) can determine if H. pylori is still present in the patient’s stomach. In this test, the patient is given a harmless substance to drink; some of the residue from the substance is broken down and exhaled in the breath. By collecting this breath, the healthcare provider can determine if H. pylori is present.

A doctor can also perform endoscopy, in which a small flexible instrument with a camera inside is inserted through the mouth into the throat, stomach, and intestine to look for ulcers.

During endoscopy, stomach lining tissue samples can be obtained. Several tests can be performed on these tissue samples to determine if a patient is infected with H. pylori.

What is the treatment for H. pylori?

The treatment for H. pylori infection consists of one to two weeks of one or two effective antibiotics. Successful rates range from 70% to 90% depending on the regimen used. Antibiotic resistance and patient non-compliance are the two major reasons for treatment failure1.

Chemotherapy 101

2008-02-13T10:14:00.000-08:00

Too many myths surround chemotherapy. It’s time for the facts, and only the facts.

I AM losing my hair and it is not because I am receiving chemotherapy for cancer. It is because I pull out my hair each time a patient tells me, “I don’t want to undertake chemotherapy because chemotherapy kills the good cells as well as the bad cells.”

This is told to me in all its Hokkien and Cantonese variants. Can someone try to translate this statement to Bahasa Melayu? I hear this unfounded statement several times a day!.

We ascribe human attributes to rocks, trees and mountains and infuse them with a spirit. Is there a word for this? I think it is paganism. It seems now that the cells in our body can also take on human characteristics.

There is no such thing as “good cells”. Even if we were to use “good cells” to mean normal tissues (as opposed to “bad” or cancerous cells), chemotherapy does not kill good cells. Not in the sense of annihilate, decimate or exterminate. Not with any finality.

Chemotherapy is used a lot in nations which have emerged from the pre-scientific era: North and South America, Europe, Australasia, most of Asia that is not at war, north of the Sahara and South Africa.

An example of a chemoport through which chemotherapy drugs can be delivered. This one is inserted into the abdomen.

Almost all patients with lung, breast and colorectal cancer will need chemotherapy in both the early and advanced settings. Patients with nasopharyngeal cancer (NPC) and cervical cancer will need chemotherapy given at the same time with radiotherapy. The list of cancers treated with chemotherapy goes on and on.

It is true that chemotherapy suppresses bone marrow function. The three kinds of blood cells produced by the marrow that concern us here are red blood cells (RBCs), white blood cells (WBCs) and platelets.

This important side effect is not such a problem these days. A lowering of RBCs (anaemia) can be easily treated with a combination of a good diet (lots of red meat, please), iron pills, blood transfusion and a drug called epoetin-alpha.

We oncologists always ensure the patient’s RBCs are adequate during chemotherapy to prevent tiredness, fatigue and a poor quality of life.

A lowering of WBCs makes a patient more prone to fever and infection. Again, this is not a problem. We have a drug called filgrastim (and its long-acting sister, pegylated filgrastim) which is given to prevent WBCs from becoming dangerously low.

Nausea, retching and vomiting are dreaded side effects of chemotherapy. This is much better managed today.

At your first chemotherapy session, your oncologist will prescribe an anti-emetic i.e. an anti-vomiting drug. If you still vomit badly despite the anti-emetic given, make sure your oncologist formulates a more effective cocktail at your second and subsequent chemotherapy courses.

I give you a checklist of the drugs you may need either singly or in combination to prevent vomiting: metoclopramide, dexamethasone, ondansetron/granisetron/tropisetron (one of these three will do) and aprepitant.

The problems of diarrhoea and its converse, constipation, plague some patients undergoing chemotherapy. If there is diarrhoea, avoid a high fibre diet. There are also many effective anti-diarrhoeals e.g. loperamide, diphenoxylate, dihydrocodeine.

If you are all bunged up, a laxative will help. There is no point in loading up on fibre, bran, fruit and vegetable to combat constipation. It is too much hard work. Also, your intestines will not tolerate such a load (99% of which is destined for the loo the next day anyway) during chemotherapy.

“Burnt”, “scalded”, inflamed veins are a thing of the past with the introduction of the chemoport. This is a device implanted beneath the skin below the collar bone. It allows chemotherapy, drugs and intravenous fluids to be given with ease. Blood can also be taken for examination from the chemoport.

Certain chemotherapy drugs (adriamycin, trastuzumab, lapatinib) may cause damage to the heart. It is imperative to measure the cardiac function before such drugs are given and thereafter every three months. With this precaution, hardly any patient will suffer from chemotherapy-induced heart disease.

Sadly, there is no effective way of preventing hair loss induced by chemotherapy. But, hey, this is the time to be creative. Hair scarfs, bandanna and tudung come in all shapes, fabrics and colours. Hair pieces can give you a new vibrant look.

Also, to some, a shaven head is a fashion statement (think of sexy Yul Brynner or even sexier Persis Khambatta).

Of course, not all chemotherapy drugs cause alopecia (medical term for baldness). Gemcitabine, pemetrexed, vinorelbine, oxaliplatin and liposomal doxorubicin are some drugs that do not cause significant hair loss. However, these drugs may not be suitable in your case. Remember, cancer is 1,000 disease entities.

The other phrase that makes me pull out my hair is “This herb and this health supplement will boost my immune system during chemotherapy.” I shall discuss this in another article.

And so, like the ancient mariner, I shall stoppeth one of three or maybe even one of two to tell my tale again and again. The tale about chemotherapy curing cancer and prolonging good quality life. About how to overcome chemotherapy-induced side effects. About how almost all chemotherapy-induced side effects are temporary, reversible and manageable.

I have to persevere in my quest in educating the credulous public and the unfortunate cancer patients. I have to keep on dispelling the fears and misconceptions about cancer and cancer treatment. I have to re-educate people about “good versus bad cells” and “boost the immune system”.

ED and your body

2008-02-12T10:13:00.000-08:00

Experts warn of the implications of erectile dysfunction on overall health.

Millions of men around the word suffer from this condition in varying degrees, and doctors now know that while the psychological and physical effects of ED may affect the quality of a man’s life, the development of ED itself is very likely to point to more serious illnesses that lie ahead.

WE’VE all made jokes about those “uplifting pills” and a man’s waning ability to stand to attention when he so desires it, but in truth erectile dysfunction (ED) is no laughing matter.

First off, let’s be clear on what ED or impotence is. Simply put, it is the inability of a man to achieve or maintain a penile erection sufficient for his sexual needs or the needs of his partner.

According to the European Society for Sexual Medicine (ESSM), it is estimated that around 152 million men worldwide (that is to say 16% of all men aged 20 to 75) experience erection difficulties. Despite this, no more than 20% of those suffering from ED seek treatment from a doctor.

Implications on overall health

Associate Prof Dr Zulkifli Md. Zainuddin is a consultant urologist who has been treating ED for more than a decade. In a recent interview, he explained: “The most important thing about erectile dysfunction is that it is actually a symptom of more serious diseases. A man who suffers from ED will usually also feel fatigue, his body will have more fat and less muscle.

“ED could be a sign of anything from heart disease to osteoporosis and anaemia. It makes sense that ED is linked to the early onset of heart disease when you think about the narrowing of the vessels.

“Aside from this, there are lots of psychological effects because a man might feel that he is somehow less of a man if he is unable to maintain an erection.”

“Luckily there are ways to treat the ED itself. Testosterone deficiency (which is also known as hypogonadism) can be treated. Hormone replacement therapy is more commonly known for women, but we can replace the testosterone for men through injections. Of course the use of PDE-5 inhibitors is usually the first option.”

Dr Zulkifli emphasised that while ED can be treated, there is no substitute for a healthy diet and exercise regime. “There is no miracle cure. This is not the fountain of youth.”

As to what constitutes a healthy sex life, Dr Zulkifli says there is no universal standard that can be applied. “You can’t simply refer to a table. As long as both partners are satisfied, that can be considered a healthy sex life.
According to consultant urologist Assoc Prof Dr Zulkifli Md. Zainuddin, embarrassment and other cultural factors play a major in whether or not a man seeks treatment for ED.

“This really varies from individuals as sometimes it can be once or twice a day, but with other couples it might be just two or three times a month. Of course younger couples tend to have sex more often, but even in younger men, ED can occur, usually because of performance anxiety.”
Cultural factors

Embarrassment and other cultural factors play a major in whether or not a man seeks treatment for ED. Dr Zulkifli said that Asian men are particularly reluctant to consult a doctor about the problem.

“In the West, maybe 20% of men seek treatment, but here there was a study conducted by the Lembaga Penduduk dan Pembangunan Keluarga Negara (National Population and Family Development Board) a few years ago which shows that only 6% of Malaysian men will seek treatment through a doctor.”

Indeed Asian men are famous for turning to all kinds of traditional treatments, from the the tongkat ali root to bear bile and rhino horns. However Dr Zulfili advises against it. “These are traditional treatments that have been passed down from ancient times but I have seen no indication that they work. Even the urut batin (a sensual massage designed to increase the libido) doesn’t work, as far as I see.”

Malaysian men who don’t resort to such traditional methods are also likely to take “performance-enhancing” pills on the sly. “A majority of our men don’t want the women to know that they are having problems so they self-administer, but this is not advisable,” said Dr Zulkifli.

Another condition that concerns the function of the male sexual organ is that of premature ejaculation. Dr Zulkfili says that while this too is a treatable condition, it is not related to ED, not is it as serious an indicator of a man’s overall health.

“ED should not be confused with premature ejaculation, although they can co-exist. In the first case, the male is unable to satisfactorily achieve an erection, whereas in the latter he can achieve an erection but he ejaculates too soon after achieving it, usually during intercourse.”

“Premature ejaculation is not usually associated with co-morbidities, in other words unlike ED it is not a signal of more serious conditions. They have found that one of the side-effects of anti-depressants is that it retards ejaculation so this treatment can be made.”
European sexual conference

Dr Zulkfili’s comments certainly echoed that of a panel of experts who spoke at the 10th Congress of the ESSM, which was held at Portugal, Lisbon in late November 2007.

Speaking on the issue of ED and its impact on a man’s relationship and life, ESSM Secretary-General Dr John Dean emphasised the importance of ED as an indicator of more serious health issues.

“While most people look at the immediate sexual health issue as one of paramount importance, and indeed it is important, ED is most important as a barometer of men’s health.
President of the World Association For Sexual Health, Dr Eusebio Rubio-Aurioles ... ‘We do not recommend the use of PDE-5 inhibitors for the healthy man.’

“Research has also shown that a man’s partner plays a great role in whether he decides to seek treatment or not.

“If he has a proactive and supportive partner, then he is much more likely to go to a doctor to discuss the issue. Otherwise he is liable to withdraw into himself and not seek any sort of treatment for the condition.”

Dean’s colleague Dr Eusebio Rubio-Aurioles is a Mexican professor who is the President of the World Association For Sexual Health. He has conducted numerous studies regarding sexual health since first qualifying as a doctor in 1978.

He warned against the usage of drugs to enhance a man’s libido when there is actually nothing wrong with him. “ We do not recommend the use of PDE-5 inhibitors for the healthy man. We cannot say that it is unsafe, but neither is it recommended.”

Dr Zulkifli concurs. “It doesn’t really work ... if you don’t have a problem, you should not be taking all these pills. It wouldn’t surprise me

Picky about pain relief

2008-02-12T10:11:00.000-08:00

WHETHER you need to get on with life or with work, pain is one of those things that can easily derail the best-laid plans.

There are two main categories of people who need relief from pain – most of us need it occasionally when headaches and toothaches strike, or when we’re down with a fever.

The other category involves people who need pain relief on a more regular basis, whether this is daily, for weeks, months or even years.

Long-term users require ongoing relief because they suffer from chronic conditions such as osteoarthritis, or muscle and joint pain as a consequence of ageing.

In situations like these, it’s important to understand the concept of pain management, which requires medication to be taken on a regular basis to provide better control and sustained relief so that a person can go about his/her daily business.

But whether you’re using pain relief for a day or a year, you need to be aware that not all pain relievers are the same.

Many people self-medicate when they are in pain, either using leftover medication or borrowing some from a friend. Others may purchase medicine from a pharmacist or get their supply straight off the shelf.

In itself, self-medication is not a problem so long as people are careful in selecting suitable medication and following the instructions on its usage, particularly where dosage is concerned.

Taking less than the recommended dose will not provide sufficient relief, and waiting too long before the next dose will allow pain to flare up again, thus making it more difficult to control or manage. Hence, the problem is not with the medication per se, but how it is taken.

The evolution of pain relievers, or analgesics, over the years has led to a wide selection of different classes of medication, from the tried and trusted paracetamol to newer versions of non-steroidal anti-inflammatory drugs (NSAIDs) called COX-2 inhibitors.

Although NSAIDs and the newer COX-2 inhibitors are effective drugs, there is also clear evidence that they contribute to an increased risk of cardiovascular events and gastrointestinal bleeding, making them unsuitable for:

The elderly

Patients with congestive heart failure

Patients with liver disease

Patients with kidney disease (e.g. chronic renal failure)

In the US alone, the cost of treating complications from NSAIDs amounts to more than US$2bil (RM6.8bil) a year.

Hence, it’s advisable for patients to be aware of the kind of medication they consume, whether it’s an over-the-counter treatment or a prescription medication.

It’s also crucial for patients to inform their doctors of any medication they have taken, as NSAIDs have the potential to interact with other medications3.

As a general rule, patients should visit one regular doctor so that their complete healthcare records are in one place.

Furthermore, any patient leaving the doctor’s office should know the name of their medication, what it’s for, how frequently they should take it and what kind of side effects are associated with that particular medication.

In any situation where pain relief or any other medication is required, it’s important that patients try the safest option first. Doctors often refer to this as the risk-benefit ratio, where in simple terms, the benefits of the treatment should far outweigh the risks.

In pain relief, paracetamol remains the analgesic with the best safety profile as it has a low risk of side effects, a long history of safe use and established clinical data that shows its effectiveness in relieving pain.

In addition, paracetamol does not interact with other medications, making it safe and effective even when used concurrently with other drugs.

For these reasons, it is commonly listed in patient educational material as well as clinical practice guidelines as the recommended first line therapy for pain.

At the end of the day, any long-term usage of pain relief should come under the advice of a doctor, with regular follow up to determine that the patient is receiving optimal care with optimal results.

Healing electric power

2008-02-08T18:19:00.000-08:00

TO RID the body of aches and pains or to find cures when afflicted with a certain disease seems to be the common preoccupation among people.

When conventional medicine does not work, the belief is that the unconventional might render a glimmer of hope to scores of people seeking healing remedies.

Many people swear by alternative therapies, though some of these therapies may seem outlandish, and even border on the bizarre.

Electrotherapy is one of the latest treatments available and it seems to be gaining popularity among Malaysians from all walks of life.

One area where such "electrifying" experiences takes place is in Lucky Garden, Bangsar.

A handful of people gather at 10am daily just two shoplots away from the Pizza Hut outlet. Soon the handful turns into a mini crowd numbering about 40 people.
By 10.45am, the number doubles as the steel shutters of the shoplot called Happy Life roll open.

The crowd, comprising senior citizens and titled folk, teenagers and young executives, housewives and the middle aged, elbow their way in.

After being registered and screened, they are seated on electrotherapy pads in batches of 30 for 20 minutes.

Electric wires carrying high voltage alternating energy criss-cross along the chairs "electrifying" those seated on them.

"The idea is to create ionisation on the surface of the human body and an electric field in the surrounding atmosphere," says Anthony Chung, the managing director of Happy Life.

Chung says the treatment can help adjust the acidity-alkalinity balance of the blood and promote metabolism of tissue cells.

The treatment, which is offered free to the public, also helps to enhance the natural healing power of the body and align the autonomic nervous system.

"Stressful city living and heavy work pressure result in headaches, insomnia, constipation, muscle stiffness and shoulder and neck pain," says Chung, adding that electrotherapy treatment can help alleviate these complaints.

The treatment can be safely administered to just about anyone, with the exception of those undergoing medical treatment for very chronic conditions, expectant mothers, people suffering from malignant tumours, heart disorders, infectious diseases and fever.

"People with implanted medical devices such as pacemakers cannot be treated with the electrotherapy method," Chung cautions.

Apart from these restrictions, he adds, the general public can benefit from this treatment which is part of mainstream medicine in more than 70 hospitals in Japan.

Accessories like electro pads and pens are also used to give localised treatment on trouble spots like eyes, neck and knees.

During the 20-minute sessions, patients are given a health talk on varying subjects to encourage them to inculcate a healthy lifestyle.

Multi-purpose tree

2008-02-07T18:18:00.000-08:00

NATIVE to China, Ginkgo biloba is a deciduous tree that lives as long as 1,000 years and may grow to a height of 33m to 40m and a diameter of about a metre.

The ginkgo has short horizontal branches with short shoots bearing fan-shaped leaves. Because the leaf resembles those of maidenhair fern, the ginkgo has been called "the maidenhair tree".

Beautiful and hardy, this Asian native is widely planted today as an ornamental and can be found lining the streets of many American cities.

The leaves and seeds of Ginkgo biloba have been used therapeutically for a wide array of diseases and conditions for thousands of years, particularly in China.

The Chinese traditionally make tea from parts of the ginkgo tree for the treatment of asthma and bronchitis.

Today, standardised Ginkgo biloba leaf extract (GBE, with 24% flavone glycosides and 6% terpenes) constitutes one of the most widely prescribed medicines in numerous European countries.

Promoting blood circulation

Blood flow distributes nutrients and oxygen to every cell in the body. Hence, adequate circulation is essential for optimum health.

One of the ginkgo's main attributes is its ability to increase the rate of blood flow in capillary vessels and certain small arteries, especially in the brain.

This is because the ginkgo flavonoid found can penetrate blood capillaries and enhance the dilation of the blood vessels.

Frequent intake of ginkgo leaves has the ability to prevent poor blood circulation in extremities and help relieve vascular circulation related conditions like cold feet and hand, numbness of limbs and back as well as intermittent claudication (a condition characterised by pain, cramping and weakness in the leg).

Preventing cardiovascular diseases

A platelet is a specialised cell that is crucial in wound healing because of its ability to promote clotting and seal leaks in blood vessels.

Once the platelets adhere to the injured vessels, they send out chemical messengers that cause other platelets to cluster around the damaged area and form a thrombus -- a blood clot that forms inside a blood vessel or cavity of the heart.

However, the thickening of thrombus over time can obstruct the smooth blood flow.

If the blood flow is restricted to the heart, a heart attack results and if blood flow is impeded to the brain, it results in a stroke due to oxygen insufficiency.

Ginkgo supplementation has been proven to reduce platelet aggregation, thus preventing thrombus formation which may help prevent the occurrence of coronary thrombosis and cerebral stroke.

Boosting memory

Ginkgo can stimulate cerebral blood flow and speed up neurotransmission and may help delay the onset of memory impairment due to the degeneration of brain cells and nerve cells.

Many elderly who often show the symptoms such as depression, forgetfulness and distractability are found to have poor blood circulation in the brain area that results in hypoxia (inadequate oxygen supply).

Numerous studies indicate that regular ginkgo supplementation could enhance one's memory, improve alertness and increase the learning ability.

Furthermore, ginkgo acts as a potent free radicals scavenger that safeguard body cells from oxidative damages and thus, delay ageing.

Alleviating tinnitus, vertigo and migraine

Tinnitus or ringing in the ears can arise from central nervous system damages that are caused by swelling and hardening of arteries in the ear.

Ginkgo improves tinnitus and hearing loss induced by obstructed blood flow by increasing blood circulation to the inner ear.

A Spanish study demonstrated that supplementation with ginkgo for about 6 months in patients with migraine headache caused by central nervous system disorder significantly improved symptoms such as dizziness and tinnitus.

Managing clouded vision

2008-02-05T18:17:00.000-08:00

A CATARACT is a cloudy area that appears on the lens of the eye.

Cataracts are painless, start out small and usually go unnoticed for many years until they grow to a point where they begin to interfere with normal vision.
In advanced stages, symptoms of cataracts include:

Blurred or "clouded" vision
Increased sensitivity of affected eye to light (especially at night)
Increased nearsightedness
Double vision
Colour change of the pupil

Cataract is normally regarded as an ageing disorder and usually occurs after 50. However, excessive usage of certain medications such as cortisone can cause cataracts at an earlier age.

Although cataracts cannot be cured at present, they can be corrected to a significant degree by surgery.

Cataracts are never operated on unless they become truly troublesome and impair day-to-day life of the patient.

For that reason, corrective surgery usually is not done until many years have passed from the time when the cataract was first diagnosed.

Prevention

Early diagnosis is imperative for managing cataracts.

Adults between the ages of 40 and 64 are encouraged to make an appointment with an eye doctor or ophthalmologist once every 2 to 4 years for a thorough eye examination.

Those above 64 should see an ophthalmologist once every 1 to 2 years.

Long-term exposure to ultraviolet rays from sunlight is believed to promote the formation of cataracts.

As such, many experts recommend wearing sunglasses to screen out ultraviolet rays during the day to reduce the risk of cataracts.

This is especially important when doing activities like long distance driving, where the eyes are subjected to intense glare for extended periods.

Not all types of sunglasses provide the same degree of protection, so it is important to consult an optician when choosing glasses for this purpose.

Following a diet which is high in antioxidants, carotenoids, flavonoids and protein may reduce the risk of getting cataracts.

Beta-carotene from carrots and bright orange fruit is a pro-vitamin A and anti-oxidant which may play a role in preventing cataracts.

Dark green vegetables, in particular spinach are rich in beneficial carotenoids called lutein and zeaxanthin.

These nutrients are of special interest for preventing cataracts as lutein and zeaxanthin from food eventually become concentrated in the eye tissue.

Both have been shown to be 10 times more potent than vitamin E for protecting the eye from ultraviolet light.

The natural pigments or flavonoids from certain fruit may protect the eye in a similar fashion.

Studies indicate that bilberries, blue berries and cranberries contain flavonoids with the potential for treating and preventing cataracts by scavenging free-radicals and increasing eye microcirculation.

The essential contraceptive

2008-02-03T18:16:00.000-08:00

Prior to availability of birth control pills, women had little control over the number of children they conceived.

For centuries, women tried all sorts of methods in order to determine the number of children they wanted to conceive or even control the spacing between births. But many of these methods were hit-and-miss affairs; the only way to ensure that they did not get pregnant was to refrain from sexual intercourse.

But the introduction in the 1960s of modern oral contraceptives, which were made of new, safer compounds, helped change all that: women finally had access to a birth control pills that were both effective and reliable. In conjunction with International Women's Day this month, we look at a brief history of the pill and how it's come a long way to changing the lives of women around the world.

* 4,000 years ago

The ancient Egyptians had their own contraceptive medicine: they ground up pomegranate seeds and, with the help of wax, formed small cones. The fruit contains a natural oestrogen, and it is possible that the Egyptian mixture, like the modern pill, prevented ovulation.

* 1550 BC

What is probably the first prescription for a contraceptive is written on papyrus. Historians presume that the substance was crocodile dung, which the woman was to put into her vagina before sexual intercourse.

* The Middle Ages

People use condoms made from animal gut or fish skin, sometimes even from linen. These are, however, not effective methods of contraception; unwanted pregnancies are common.
* 1919

In animal experiments, physiologist Ludwig Haberlandt from Innsbruck (1885 - 1932) discovers the principle of the pill. He proves that transplanting the ovaries of pregnant rabbits into non-pregnant animals inhibits ovulation.

* 1928

Pharmaceutical company Schering introduces the first hormonal drug into the market.

* 1938

Schering employees Hans Inhoffen and Walter Hohlweg make history: In the main laboratory they develop ethinylestradiol, the first oral active oestrogen worldwide. This substance remains an integral content of every classic oral contraceptive. The scientists also succeed in producing the first synthetic progestin preparation.

* 1961

On June 1, 1961 Schering AG introduces in West Germany the first oral contraceptive in Europe. It is also introduced in Australia in the same year. It is available only in pharmacies, and only on prescription.

* 1965 - 1968

A difficult start: In the first years, the pill is a controversial matter in Europe. It is only recommended for regulating menstrual disorders, and only for married women.

* Mid 1970s and throughout the 1980s

Estrogen and progestin levels in the pill, which is widely used by women all over the world, start to decrease -- with oestrogen doses dropping from 150mg to as low as 20mg and the introduction of new progestin compounds which provide benefits beyond contraception.

* The pill today

The pill and other contraceptives are a normal part of life. Schering's research continues. Current product developments aim at researching new compounds, or at reducing the dosages even further, so the preparations become even better tolerated.

Schering introduces the first pill containing the innovative progestin drospirenone. Drospirenone has a special feature: it counteracts the water-retentive properties of oestrogen and thus does not lead to a weight gain, which many women fear when starting the pill. Drospirenone was developed by Schering scientists.

Power of the Pill

2008-02-01T18:15:00.000-08:00

THERE WAS a time when society actually believed that women who resorted to taking birth control pills were sexually liberated and having an active sex life. However, perceptions have changed as oral contraceptives, also known as birth control pills, have been a boon for women, especially those who are into family planning.

According to Assoc Prof Dr Jamiyah Hassan (pix), a consultant at the Obstetrics & Gynaecology Department of Universiti Malaya Medical Centre, there has been a lot of medical advancement over the years and the stigma initially attached to the Pill has slowly been erased.

"In terms of family planning in Malaysia, it is what we recommend. Some 70% of the women prefer the Pill as opposed to other methods," says Jamiyah. Other methods here refer to using contraceptives such as condoms and diaphragms or even calculating one's monthly cycle.

"The Pill is still one of the best contraceptive measures around today. More than 70 million women are on the Pill. It is very popular."

Still, the Pill isn't something you can go into a pharmacy and buy over the counter.

"You have to visit a doctor first to discuss all the pros and cons, because not all women can go on the Pill. They can only buy it with a prescription. The Pill is not for women who have a history of breast cancer, liver disease, hypertension or thrombo embolism, or who are very obese and chronic smokers."

This is because the Pill contains estrogen, a hormone that triggers off problems such as embolism.

When the Pill was first produced 50 years ago, it had 50mcg of estrogen. The Pill being manufactured now has oestrogen levels as low as 20 or 30mcg.

The Pill has both oestrogen and progestin (a natural or synthetic progestational substance that mimics some or all of the actions of progesterone). This oestrogen and progestin correspond directly with the woman's menstrual cycle.

The Pill has to be taken from day one of the menstrual cycle. It is packed in such a way that each packet contains 21 tablets meant for 21 days and must be taken daily.

If the Pill is taken as prescribed, there is a 99% chance of preventing pregnancy. Otherwise, the chances of getting pregnant go higher, even if the woman is on the Pill.

Those on the Pill who decide to have a baby just have to get off the Pill. "Studies have shown that the fertility and ovulation rates return to normal from the next cycle. So there is no problem or complication," adds Jamiyah.

Inherent risks involved

* Long-term risks
Previously, the risk of embolism was always present due to high oestrogen levels. But levels of oestrogen in the Pill are now lower, so the risk of embolism is also much lower.

* Short-term risks
Progestin used to cause side-effects like water retention, weight gain, mood changes and so on. But not any more. "Nowadays, we have a pill that contains progestin called Drospirenone. It reduces water retention and reduces the chances of weight gain," Jamiyah says.

This also reduces the painful effect of pre-menstrual syndrome, or PMS.

Other benefits

Oral contraceptives or birth control pills have other benefits as well.

"The long-term benefits are many. It reduces risk of ovarian cancer by 50%," says Jamiyah. "When we ovulate, we produce eggs, it raptures on the surface of the ovary.

"This causes trauma and it has been postulated as one of the possible causes of cancer of the ovaries.

"When you go on the Pill, you don't produce eggs. Because there is no trauma of the surface, it protects you from ovarian cancer."

She also adds that the risk of uterine cancer and benign breast diseases is also much less.

"It also reduces the risk of anaemia. Some patients bleed a lot. When you go on the Pill, you bleed much less. It also reduces pain and congestion."

Doctors can recommend the Pill not only for family planning but also for women with irregular menstrual cycles.

This is provided the patient does not desire to get pregnant at the moment.

Stop dengue at its source

2008-01-31T18:15:00.000-08:00

While many of us understand the threat of dengue fever, the fight to keep our environment free from Aedes mosquitoes is hampered by apathy. This is why there has been a resurgence of dengue fever in urban areas.

The Aedes mosquito breeds in clear, stagnant water, so containers with water that are not cleared for more than two days may become the breeding ground for the mosquito.

There are a lot of places for water to collect, such as flower pot bases, rooftops, blocked drain gutters and in empty containers or bottles left in the open. Many people do not bother to check these water traps often, allowing for the Aedes mosquito larvae to breed there.

Dr Mohamad Ikhsan Selamat, assistant director of the Disease Control Division (DCD) of the Health Ministry, says other common breeding ground are abandoned housing or building projects.

"Because no one checks on them or cleans them up, mosquitoes can easily breed there," he said. "There have been cases where dengue fever broke out and we found that the mosquitoes originated from an abandoned building."

He adds that while it is essentially the job of local authorities to clean up such places, the public also need to play a role.

"If a member of the public sees or suspects a certain place to be breeding Aedes mosquitoes, he/she must contact the ministry immediately and get the relevant authorities to do an inspection of the premises."

Prevention methods

The most commonly known method for eliminating the Aedes mosquito is fogging. This involves the spraying of insecticide to kill the mosquito or its larvae in areas where there are cases of dengue fever. It is often done in the morning and evening when the Aedes mosquitoes are most active.

Ikhsan said the ministry has implemented several community projects to involve the people in realising the threat of dengue and to help clean up their neighbourhoods.

"We have projects called Comfog and Combi. Comfog is basically community fogging, where the residents carry out the fogging under our supervision, using machines loaned from us.

"Combi is short for Communication for Behavioural Impact, or gotong-royong. We get the community together to search and destroy the Aedes mosquito's breeding grounds."

Using the right larvicide

While the people are aware that there is a certain larvicide they can use to kill Aedes mosquito larvae, many do not know where to get it.

Dr Mohamad Ikhsan Selamat of the Health Ministry's Disease Control Division says: "The right larvicide is Abate, and it kills the Aedes mosquito larvae in water containers. While normally you should regularly clean and wash all water containers such as the ones used for drinking and bathing, some water containers cannot be emptied, such as those on the roof.

"Instead, residents can buy the larvicide and mix one teaspoon for every 100 litres of water. The larvicide will work for three months, or until you can change the water."

Abate is available at major hypermarkets and hardware stores, at the local authorities such as the various city councils as well as the Health Ministry office.

Understanding dengue

Dengue fever is a flu-like viral disease, spread by the bite of infected, day-biting Aedes aegypti and Aedes albopictus mosquitoes. The mosquito transmits the disease by biting an infected person and then biting someone else.

This virus has four flavours, called serotypes, which are named 1, 2, 3 and 4. Getting infected with one serotype does not protect you against the other serotypes; in fact, getting a second dengue infection leads to an even worse infection.

There are two distinct clinical forms of the disease -- simple "classical" dengue and the less common but much more dangerous dengue haemorrhagic fever and dengue shock syndrome. The latter is a severe, often fatal, complication of dengue. It is particularly dangerous in children, who suffer the most and who are at the greatest risk.

Dengue has a short incubation period -- often days, usually less than a week.

The signs and symptoms of dengue include a sudden, rapidly climbing fever, a severe headache, nausea and vomiting, loss of appetite, rash and deep muscle and joint pains. The disease is nicknamed "breakbone fever" for these last two symptoms.

The rash usually shows up three to four days after the start of the symptoms and begins on the torso, spreading out to the face, arms and legs. The illness can last up to 10 days, but complete recovery can take as long as a month.

With dengue haemorrhagic fever, the blood cells are crippled and bleeding develops -- in the gums, the skin and the intestinal tract. Bruising can be a sign of bleeding inside the body.

Without prompt treatment, the blood vessels can collapse, leading to dengue shock syndrome. This is fatal in about 5% of cases, mostly among children and young adults.

Dengue is diagnosed by a blood test. There is no specific treatment for dengue, no vaccine and no cure; this leaves us with prevention being the only option. Prevention centres on avoiding mosquito bites in areas where dengue occurs or might occur and eliminating breeding sites.

The Aedes mosquito likes to bite in the mornings and evenings, often indoors or in the shade. The Aedes mosquito is a day biter, so during daylight hours, in areas where mosquitoes are present, protect yourself by properly using anti-mosquito measures.

Ways to avoid mosquito bites

Use mosquito repellents on skin and clothing.
When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants tucked into socks. To keep from over-heating and from aggressive mosquito punctures, wear loose-fitting clothes.
Avoid heavily populated residential areas.
When indoors, stay in air-conditioned or screened areas. Use mosquito nets if sleeping areas are not screened or air-conditioned.

Cooking healthy meals

2008-01-28T18:13:00.000-08:00

Food lovers will find a great deal of insight into the world of Greek cuisine when they tune into Discovery Travel & Living’s My Greek Kitchen (Astro Channel 707) tonight as Tonia Buxton, 39, whips up sumptuous meals inspired by the country’s rich culture in this 15-part series.

From beautiful coastal islands to bustling cities around Greece and Cyprus, host Buxton and her family go out and about to local markets, tavernas and homes, discovering the secrets of Greek gastronomy. Throughout the series, Buxton will show viewers not only how to cook a complete and healthy meal for the family and also how to effectively put together a party.

Buxton is a Classical History major who also enjoys sports, having taken part in triathlons and body-building events. Having an in-depth knowledge on health, nutrition and alternative theories, Buxton is not just a fitness expert, but a lifestyle guru as well.

She is also a proud mother of three who has written a book about post-pregnancy maintenance, and she continues to write lifestyle articles regularly for newspapers.

Her interest in food is something she attributes to her own Greek culture, said Buxton during a tele-conference interview.

"When you’re Greek and you come from a Greek culture, it’s all about food. We would always have big family gatherings and there would always be lots and lots of food around. So from a really young age, I would be cooking and I would be learning. My mother and my grandmother were excellent cooks. So when it comes to cooking icons, I think my mother has to be the number one for me."

Greek cuisine is considered to be among the healthiest in the world. "What makes it so healthy, actually, is that the Greeks use olive oil. It’s been proven because they did a study in Crete in the 60s for a decade and there was no heart disease in Crete at all. It turned out that they only use extra virgin olive oil in all of their foods and cooking.

"The one thing that the Greeks eat is whatever is seasonal. That makes a big difference to your diet. You’re literally eating foods that come off the land. All of that put together makes a healthy diet."

The idea of My Greek Kitchen came out of a discussion Buxton had with her husband about how Greek food has never been highlighted on television before.

"If you ask someone about Greek food, they’ll say a couple of things like kabas, and that’ll be it. I really wanted to show people the type of foods that you would get if you have a friend that’s Greek."

As a fitness enthusiast, Buxton said that the biggest myth about eating healthy is that you need to cut down on food.

"Actually, to eat healthy and to get all the nutrients that you need throughout the day, you have to eat a lot, but it’s about eating the right stuff. You should never have to be hungry when you’re eating healthy."

Greek cooking has yet to take off in the Asian region unlike Italian and Spanish foods.

When asked about this, Buxton said: "It hasn’t come over yet. That’s the only reason. The only reason that you like Italian and Spanish more than Greek is because we haven’t come over and show you the real stuff.

"The ancient Greeks were the first to write down recipes. The ancient Greeks were the first to actually start mixing flavours together. Then the Romans, the Italians, came and nicked all our ideas, so Italian food is Greek food anyway; they just stole it all."

Buxton had a great time shooting for the first season of My Greek Kitchen and is currently working on the second season.

My Greek Kitchen will be aired on Discovery Travel & Living Channel (Astro Channel 707) tonight at 8p

Yoga for the young

2008-01-26T18:13:00.000-08:00

Children too, need relief from the stresses of everyday life as well as build up their mental and physical health

When people think of stress, it is often considered a condition that adults have to deal with, but these days, even children find themselves falling prey to its effects.

The expectations of parents and teachers in school, peer pressure from friends or even the fast-paced modern lifestyle of an urban environment can all contribute to making a child feel tired, oppressed, fearful and unsure. Therefore, it is very important that children be taught how to relax at a very young age.

One way is with yoga, which is meant for people of all ages.

At the True Fitness health centre, Rupali Kolte teaches yoga once a week to children aged between six and 12.

"The difference between yoga for adults and children is in the postures," the 27-year-old Rupali says. "Children's muscles are weaker and less developed than adults, so we teach them the more simple postures.

"For children, it's more about controlling their breathing and meditation."

India-born Rupali herself had been taught yoga as a 12-year-old. "I was a marathon runner in school, and my coach sent me for yoga lessons to help me concentrate on my breathing.

"It helped me develop my stamina and mind, and later I went on to study how to become a yoga instructor. I now have a diploma in Yogic Studies from the Kaivalyadhama Institute, one of the oldest and most reputed yoga institutes in India."

She taught children's yoga for five years in India, before being hired by True Fitness last year.

She says: "For children, meditation is the main part of the lesson. For the first class, I tell them to imagine the postures they will be doing.

Then I tell them the benefits of each one and get them mentally prepared. We only do the postures when they are ready.

"The postures are also to get them more interested in the breathing exercises, because children like it if there are some physical activities involved. It also helps to stimulate their imagination and creativity."

She adds: "The syllabus itself involves a total of 20 postures, taught over five months. They are simple enough that even the youngest children can learn them. Usually, the younger children will observe the older ones and copy what they do."

She explains that yoga benefits more than just physical health. "Children feel no pressure from yoga. It is a non-competitive exercise that goes at their own pace, boosting their self-esteem. It also helps increase their concentration in school and tuition class."

Rupali also says that while there are no differences among children of different ages, she does have another set of postures for children with breathing difficulties and back problems.

In India, yoga is incorporated in the school syllabus, and is a part of life for most people there.

"It is not just a physical exercise. It involves the mind and spirit," she says.

"I really believe that children would benefit the most from such an activity, especially at an early age. I want to help them make it a part of their lifestyle."

The best for the growing child

2008-01-22T17:20:00.000-08:00

Balancing the food needs which include sufficiently catch of protein and calcium among the young people. RESEARCH proved that the regular physical activity offers a certain number of service-disease for children, including remaining suitable body weight and commander and healthy bones of maintenance.

During the years of growing, the regular profit of bone of increases in exercise and contributes to the maximum mass of bone in the adulthood. At the same time as the regular physical activity, a balanced mode also ensures a child in good health and credit. And milk is one of the best sources of food to ensure the growth and the health total of a child because it contains many essential food, including protein and calcium.

The protein is employed to form the muscles, the bones and the teeth forts, to prepare hormones and enzymes, to reinforce the immune system, and to carry oxygen to the cells. Whole this, one of its more important functions must build new cells and muscles. Our muscles are composed of the beams of cells and flexible fibres which can be contracted and increased to produce our movements of body. And the principal component of these cells and fibres is protein. Because the children are in the fast physical growth, their needs for protein are higher for their size of body than of the adults, because their body constantly establishes new cells of muscle. The protein ser also of the fuel of body in the form of amino acids (modules of protein). Consequently, the children must maintain their protein catch to increase their total strength.

The livestock products provide the good protein which is complete in all the essential amino acids. The products of soya are also one of proteins. But among the best sources of high quality the protein is milk.

The force of calcium

Calcium is one of the most important food required during childhood and of the years of adolescence because the bones of the children develop quickly. It helps to reinforce the bones to make them strong.

It development aid of the maximum mass of bone which is crucial to prevent damage and the osteoporosis of bone he of the posterior years. It is because the mass of the bones of our bodies exhausts while we age, thus we must continue to fill it of fuel with calcium so it to continue to be strong and in good health. Os of arrangement the skeletal increases in mass seven- yield birth to the teenagers and then others triple during the teenagers. Calcium and other food found out of milk are necessary by increasing bodies to help to develop and build the strong bones during this time.

The maximum mass of bone is carried out at approximately the age of 20. It is the moment when our bones will be with their more extremely during our life. It is important to help them length as far as us can because the more the maximum mass of bone is carried out high, the more the bones of reservation must mainly hold account of the mineral losses of normal bone which occurs in the posterior life.

The needs for calcium

The directives of nutrition recommend that the children of the ages seven to nine obtain 700mg calcium per day, or approximately two milk portions group foods daily. The years of adolescence and the young adults, of ages 10 to 18, need more than calcium because their bones increase more than with other times of their lives.

They should have 1,000mg calcium per day, or approximately three milk portions group foods daily. Glass 250ml or package of milk has about 300mg calcium, so much just three glasses or the packages can go a long way towards obtaining calcium necessary each day.

Other milk sugar refineries

Without counting that calcium, the vitamin D And phosphorus are also important in strong bones of building because they function the hand-inhand with calcium in the mass of bone of building.

The assistances of the vitamin D Support the absorption of calcium and increase the mineralisation of bone while phosphorus also helps to reinforce bones. Few foods naturally contain the rickets recently identified of D. Researchers of vitamin, a disease of deficiency of vitamin which causes the weak or deformed bones, in solutions of replacement of Federal infants with the cow's milk. As a relative, you play a positive part by influencing the choices of drink of your children.

A recent study of the mothers and their five-year-old women girls noted that the mothers who drank milk more frequently had the girls who also drank milk more frequently. Moreover, the milk-drinkable pairs of mother-girl consumed few nonalcoholic beverages and had more raised calcium levels.