Sunday December 12, 2010
The road to recovery
By INDRA BALARATNAM

Practical tips to eating well after undergoing surgery.

PROPER nutrition is important for health and wellbeing. This is especially so when you are recovering from surgery.

The process of surgery can be very draining on the body. Many patients I see (after surgery) experience a loss of weight for several reasons – namely muscle wastage, lack of appetite, and dehydration.
When you’re recuperating from surgery, make sure you always have a protein serving during meals. For example, instead of just making plain porridge, be sure to fortify it with protein by adding minced meat, or fish, or egg.

This type of weight loss can negatively affect the quality of life by prolonging healing and recovery. This in turn leaves the patient susceptible to developing post-surgery complications.

Once they have left the hospital and returned home, many patients are anxious about their recovery.

Even their family members have lots of questions to ask about what are the best foods they can prepare and give to their family member who has just had surgery.

The nutrition goal for a person recovering from surgery is to ensure they eat sufficient calories and protein by having balanced meals.

After undergoing surgery, it would be beneficial for you to seek the help of a qualified dietitian to help assess and make recommendations for meal planning. Ask your doctor or surgeon to refer you to see a dietitian. The main goals for a patient during this post-surgery time are:

·To prevent or replenish nutrient deficiencies

·To preserve lean muscle mass and muscle

·To protect the patient’s immune function to reduce the risk of secondary infection

More importantly, the main purpose of good nutrition is to maximise quality of life. Your illness and subsequent surgery may have struck you a blow, but now it’s time to fight back.

Here are some practical tips to help you do this.

Eat small but frequent meals

You won’t get sufficient calories if you don’t make a conscientious effort to eat. Eating large meals may seem daunting, so start slow by eating small, frequent meals throughout the day.

Even if it’s a beverage with crackers, it is still energy that will help to replenish loss of nutrients.

Fortified nutritional supplement drinks are particularly helpful as they are fortified with essential nutrients, vitamins, and minerals. A small cup is equivalent to having a small meal of rice, meat, and vegetables.

Focus on calorie-dense foods

Since you’ll be eating small portions frequently, make sure that the small amount of food is calorie-dense and boosted with protein.

For a body that is recovering from surgery, these nutrients will aid in providing energy and rebuilding tissue.

High protein food sources are meats, fish, cheese, milk, yogurt, eggs, beans, taufu, soya milk, and fortified nutritional supplement drinks. A serving of meat suitable for a post-surgery patient is 150 grams of lean meat, two eggs (if you’re watching your cholesterol, discard one of the egg yolks), 1½ cup of beans/legumes, one to two squares of tofu or two tablespoons of peanut butter.

Start slow if your appetite is still poor, but aim to eat a little more protein each day as your appetite returns.

So, if you’re making a meal, make sure you always have a protein serving. For example, a popular post-recovery dish is rice porridge.

Instead of just making plain porridge, be sure to fortify it with protein by adding minced meat or fish or egg. Similarly, you can add an egg into broth, such as egg-drop soup. Pureed cream soups are also an excellent calorie-dense dish to make, such as cream of pumpkin, or cream of potato soup.

Keep yourself hydrated

Post surgery and medications can dehydrate, so it’s important to remember to constantly replenish fluid loss by drinking sufficiently.

Recommended liquids are water, non-carbonated isotonic drinks with electrolytes, milk, fruit juices, soya bean milk, soups, and foods prepared with broth, gravies, and liquids.

Bear in mind that caffeine drinks such as coffee and tea are diuretics, meaning they draw water out of your body. If the taste of plain water is too bland, you can always flavour it by using a small amount of cordial or diluting fruit juice with water.

Unless you are on a fluid restriction diet advised by your doctor and dietitian, aim to drink two to three litres per day (about eight to 12 cups) to keep you sufficiently hydrated.

I recommend you keep a large container of water which is two or three litres in volume. By the end of the day, you should finish that container of water. Keep glasses of water everywhere you are in the house – by your bedside, by the chair where you watch TV, so that it’ll constantly remind you to sip on fluids.

Have snacks to boost calorie intake

It is perfectly fine to snack in between meals to boost your energy intake. Go for calorie-dense snacks such as sandwiches, puddings, fortified nutritional supplement drinks, boiled eggs, pau, crackers, oatmeal, wholegrain cereals, granola bars, cheese, salted nuts, toast with butter and jam, to name several examples.

Get family and friends to eat with you

Many of my patients find that they have more appetite when someone accompanies them during meal times. If you can manage it, come out of your bedroom to have your meals at the dining table.

Having your meals in bed can dampen your appetite as it feels too much like being in a hospital.

You can always invite friends over to have a meal with you while recuperating at home. Seeing your friends and having a chit chat will definitely lift up your spirits.

When meal times become more fun, your appetite will increase as well.

Good nutrition is important as part of your recuperation and recovery process to allow your body to rebuild itself. All it takes is some pre-planning and it will not seem so overwhelming. In no time, you will be fit as a fiddle again.

> Indra Balaratnam (Bsc Dietetics, US) is a consultant dietitian who runs her own dietetic practice in Kuala Lumpur. She specialises in making home visits to patients who require dietary counseling. She is also the co-author of the nutrition cookbook “Healthy Eating – Recipes for the Asian Palate” (2004 Marshall Cavendish). This article is courtesy of Enercal Plus.

Sunday December 12, 2010
Surviving breast cancer, together
By LIM WEY WEN
starhealth@thestar.com.my

Spouses of women with breast cancer are also equally affected by the diagnosis.

WHEN a loved one breaks bad news to you, any variation of the remark, “This is not good” (as if they don’t already know), might not the best thing to say.
Ranjit Kaur ... Most husbands respond to the diagnosis of breast cancer as one would do towards any other cancer. They have a similar emotional response of uncertainty, fear, and guilt.

But that was what author Marc Silver muttered to his wife when she told him over the phone that her doctor suspected she had breast cancer.

He describes his experience in the introduction of his book, Breast Cancer Husband: How to Help Your Wife (and Yourself) during Diagnosis, Treatment and Beyond: “Deeply distraught, Marsha called me as soon as she was out of the doctor’s office. She wanted to share her pain and to seek some husbandly solace. On a scale of one to 10, with 10 being truly superb and one being utterly inadequate, my reaction deserved, oh, maybe a minus 11...

“My wife still likes to remind me of my exact (and insipid) words: Ew, that doesn’t sound good”.

At that point, he wished he had a manual to guide him on everything – on what he is supposed to do at the doctor’s, how to protect Marsha when her doctor suggests something she is not comfortable with, how to support and comfort her, and how to deal with both their emotions.

Above all, he was terrified of doing or saying the wrong thing.

“If you goof up on Valentine’s Day or forget your wife’s birthday, you can always make amends next year. But when your wife is fighting a life-threatening disease, you want to be on top of your game. The problem is, you’ve never been on the playing field before,” he wrote.

However, as he has met many other guys who have had similar experiences, he added: “Of course, you are not alone in your ineptitude. Most guys are complete novices when it comes to this caregiving thing.”

My wife has breast cancer

Certainly, not all women with breast cancer are married or have significant others (I will call them husbands here), but many of them are.

However, there aren’t many books written about this subject (Silver’s is one of the few). What we do have, are many studies (that doesn’t always make it to the news pages) about how men react when their partners are diagnosed with breast cancer.

Some of the commonly documented feelings are that of shock and disbelief, helplessness, worry, fear, and guilt.
When his wife was diagnosed with breast cancer, author Marc Silver wished he had a manual to guide him on what to do. He proceeded to write one himself. - The Baltimore Sun photo by Gene Sweeney Jr.

“Most husbands respond to the diagnosis of breast cancer as one would towards any other cancer. They have a similar emotional response of uncertainty, fear, guilt, etc,” says president of the Breast Cancer Welfare Association, Ranjit Kaur.

“The man himself is fearful of losing his life partner and is grieving as much as his wife,” she explains via email.

To Marc Heyison, the president and one of the founders of Men Against Breast Cancer in the US, it is hard to quantify personal experiences as it varies between individuals and is dependent on the circumstances they are in.

“For me personally, and if not for all, then for almost all the men I have worked with and talked to, there is an overwhelming sense of fear, helplessness, and hopelessness that the woman you love is going to die,” he says when contacted via email.

“I know for me, when I heard ‘Your mum has breast cancer’, I felt like a little boy whose mummy was going to die,” he says. “I was 29 at the time.”

To help other men in the US deal with similar experiences, Heyison and Steve Peck founded Men Against Breast Cancer, a non-profit organisation in the US to provide support services to educate and empower men to be effective caregivers as well as active participants in the fight against breast cancer.

Studies seem to confirm what Ranjit and Heyison have shared. Having examined the experiences told them by 48 spouses of wives who are newly diagnosed with breast cancer, researchers at the University of Washington School of Nursing are able to organise, using respondents’ own words, the responses they collected into four groups in a paper published last January.

The first group – feeling nailed by the breast cancer – describes the spouses’ feelings of being emotionally overwhelmed by the diagnosis. “Men described feeling ‘powerless’ when it came to helping their wife. They experienced the breast cancer as an uncontrolled situation and as something they could not change,” wrote the researchers. “It bothered them to see her in pain and sick from treatment,” they continued.

The second batch – changing us – describes the spouses’ reports of changes in the relationship. Being no different than any adversity, the diagnosis either brought the couple closer or made the relationship more difficult. Some also expressed challenges in parenting their children about breast cancer.
"Click on image to view bigger picture"

In the next group, taking care of me, the spouses’ experience in getting support varied greatly. “Although some men appreciated and sought help from others, others chose not to talk about what was happening.” Some reported receiving support, while others claimed friends abandoned them. Likewise, some took time for themselves while others did not.

Last, but certainly not the least, are the kind of responses that come under the description: making things work. Spouses in the study have devised and used various methods to get through breast cancer, which includes doing more housework, making the effort to understand and support their wives, and adopting attitudes they believe will help their wives in dealing with the cancer.

The paper quoted one of the responses. “You try something different until you find out what works. You know, it’s just a matter of making things work.”

As the men who participated are mostly Caucasians in long-term marriages and were interviewed within six months of their wives’ initial diagnosis, researchers are not sure if they belong to a unique population of men. However, the researchers’ study has provided some insights to what men really think when their wives or loved one is diagnosed.

How men can help their wives (and themselves)

Of course, cases of husbands who are not exactly sterling examples are also common. Like the guy in Silver’s book who asked his newly wed wife, “I thought you were healthy when I married you”. However, Silver suspects that sometimes they just do not know what to do.

Having lost his wife to breast cancer that had spread to the lungs almost a decade ago, former auditor Gursharan Singh recalls his conversations with some of the husbands he met after he volunteered for Cancerlink Foundation, an organisation that provides information about cancer and support for those living with cancer.

“Most of them want to know, ‘what can I do now’?” says Gursharan, who is now cancerlink’s honorary treasurer.

Unfortunately, the possibility that their husbands may be going through hell may not get through to women diagnosed with breast cancer often enough. “We have come across men who tell their wives, ‘I married you, not your breasts’,” says Ranjit.

There is no doubt that even with the abundance of information made available to the public these days, the news may still come as a shock. However, you can be somewhat prepared when you know your wife’s options (see Breast cancer stages and options).

After that, if you ask Heyison and Gursharan, it is mostly about being there for your loved one.

“There is no finite list, or even a top 10 list of things you should do,” says Heyison. “That’s not to say that there are not quantifiable and tangible things we can do, i.e. take care of the kids, take care of the house, cook, clean, go to doctor’s appointments, take notes, and be the gatekeeper with friends and family, to name a few.

“There are, however, several things we must do, and that all starts with being there for her, and for her to know that you love her and will be there with her every step of the way,” he explains.

“If she knows that and feels that love, then all things are possible, and as a couple, you work through the crisis of breast cancer and the myriad obstacles that you face – but you face them together,” he adds.

For Gursharan, being there for his wife had meant spending time with her. “I was lucky because I had understanding superiors and an extended family that is very supportive.”

However, being an action-oriented bunch, men sometimes have problems with the simple act of just being there for their loved ones. “Sometimes men will ask me – what can I do when I am there with her as I have nothing to do?” says Gursharan.

“I always tell them, you don’t have to do anything. Just be there for her. You can both go about doing what you normally do. You don’t even have to talk because silence is also a powerful way to communicate,” he says.

“Your presence gives her peace of mind,” he observed.

That said, there is no doubt that caregiving can be tiring at times, and men need to take care of themselves in ways appropriate and acceptable to their loved ones in treatment.

“Men may feel self-imposed guilt if they play a round of golf, go out with a buddy, or go to a sporting event,” says Heyison. However, if these are discussed in a loving manner and agreed upon with those back at home, men should do these for their own mental well-being as stress is unavoidable and a normal part of life.

Is it unfair to expect all these from men? After all, some have walked away from a loved one because they are only human and have career goals and other needs, I asked Gursharan.

His rhetorical answer says it all. “What if I turn it around and asked how would they feel if their wives did the same when they are sick? Would they be able to accept it?”

For Heyison, it is just a simple matter of repaying the good that his mother had shown him. “We must never lose sight that women we love, and in my case, my mum, did not raise her hand to get breast cancer ... My mum was always there for us and it was our time to be there for her,” he says.

Perhaps, it all boils down to whether men are willing to dedicate time and effort to care for their loved ones. As the old saying goes, when there is a will, there is usually a way of working things out.

> For more information about breast cancer, visit Cancerlink Foundation and the Malaysian National Cancer Society’s website www.cancerlinkfoundation.org and www.cancer.org.my. If you are interested to know more about caregiving for men, visit the Men Against Breast Cancer website, www.menagainstbreastcancer.org.

Masalah biasa cuma tahap berbeza

Oleh Siti Zarinah Sahib

CARI MAKLUMAT...ramai wanita segan ceritakan masalah berkaitan alat kelamin.

RAMAI menganggap menceritakan mengenai masalah alat sulit atau alat kelamin kepada orang lain sesuatu yang tabu atau memalukan. Akibatnya ramai wanita mengambil sikap berdiam diri apabila berhadapan masalah ini kerana tidak mahu diketahui orang lain.
Hakikatnya pada zaman sains dan teknologi ini, hal berkaitan masalah membabitkan kawasan paling sensitif bagi wanita tidak sepatutnya disembunyikan.
Dalam kehidupan mereka, penjagaan alat sulit dianggap penting kerana berkait rapat dengan perkara yang berlaku kepada hampir semua wanita seperti pengeluaran darah haid serta hubungan seksual dan kehamilan bagi wanita yang sudah mendirikan rumah tangga.
Alat sulit yang tidak dijaga sepenuhnya akan menyebabkan jangkitan kuman yang menjadi punca kepada masalah keputihan serta penyakit berkaitan seksual.

Menurut Pakar Sakit Puan Hospital Pakar KPJ Tawakal, Dr Jaafar Yaakob, keputihan adalah masalah normal yang berlaku pada semua wanita. Bezanya sama ada masalah ini serius atau sebaliknya.
Ini berlaku kerana bahagian alat sulit wanita sangat sensitif pada perubahan persekitaran terutama keasidan dan kealkalian. Justeru, setiap perubahan sama ada disebabkan jangkitan kuman seperti bakteria, virus dan kulat, penggunaan produk pembersih atau persekitaran akan menyebabkan ketidakselesaan, gatal atau mengeluarkan keputihan yang tidak normal serta berbau.
"Keputihan adalah cairan atau lendir yang keluar daripada liang faraj selain daripada darah haid. Ada keputihan yang normal dan ada yang tidak normal serta memerlukan rawatan selanjutnya," katanya.

Menurut Dr Jaafar, pengeluaran cairan atau lendir pada kelenjar mulut vagina (faraj) dipengaruhi rangsangan berahi. Oleh kerana itu lendir ini akan meningkat jumlahnya dalam keadaan terangsang dan pada waktu berlakunya persetubuhan.
Pengeluaran cairan pada selaput liang vagina dan rongga rahim dipengaruhi oleh hormon. Oleh itu lendir ini akan meningkat jumlahnya sebelum dan sesudah haid atau sewaktu menghampiri waktu subur. Pada peringkat menopaus, pengeluaran cairan atau lendir ini akan berkurang.

"Dalam kes normal, cairan atau lendir daripada ketiga-tiga sumber ini berwarna jernih, tidak berbau dan tidak diiringi rasa gatal. Kadangkala cairan ini boleh keluar dengan banyak, tetapi tetap jernih. Ini banyak berlaku kepada semua wanita yang menghampiri waktu subur, sebelum atau sesudah datang bulan," katanya.

Selain itu, cairan normal ini juga boleh berlaku kepada wanita yang sedang mengalami gangguan jiwa seperti bersedih atau gembira, wanita hamil, wanita yang mengambil pil perancang keluarga, wanita yang sedang dalam rawatan menggunakan ubat hormon malah bayi perempuan di antara umur satu hingga 10 hari boleh menghasilkan cairan daripada vaginanya akibat pengaruh hormon yang dihasilkan oleh plasenta atau uri.

"Wanita yang mengalami semua tanda di atas tidak perlu risau kerana ini adalah perkara biasa asalkan keputihan dialami tidak menyebabkan rasa tidak selesa atau gatal.

"Untuk mengenali keputihan yang tidak normal, biasanya cairan yang keluar bersifat putih pekat, kelihatan seperti nanah, sering berbau busuk serta diiringi rasa gatal pada sekeliling faraj," katanya yang menolak dakwaan keputihan disebabkan faktor pemakanan.

Dr Jaafar menjelaskan, keputihan biasa berlaku disebabkan jangkitan bakteria dan kulat. Keputihan disebabkan jangkitan bakteria akan berwarna kuning, berbau hamis dan gatal pada kemaluan. Keputihan yang disebabkan jangkitan kulat pula berwarna susu bergumpal, berbau masam, rasa gatal dan kemaluan akan membengkak dan merah.

Katanya, keputihan kerap berlaku kepada wanita hamil, namun tidak berbahaya kerana disebabkan faktor psikologi saja. Apabila sudah melahirkan anak, masalah ini hilang dengan sendirinya.

"Namun, jangan diabaikan jika keputihan yang anda alami berada pada tahap kritikal kerana akan menyebabkan kelahiran bayi pramatang manakala kuman betahemolytic staph aureus akan menjejaskan kesihatan bayi. Bagi wanita yang belum berkahwin, keputihan akan menyebabkan mereka sukar mendapat anak, gangguan haid, kesakitan serta ketidakselesaan ketika 'bersama'," katanya lagi.

Menurut Dr Jaafar, keputihan yang tidak normal boleh dielakkan jika wanita mengamalkan penjagaan kebersihan alat sulit terutama ketika haid.

"Ketika haid, wanita dinasihatkan kerap menukar tuala wanita terutama pada hari yang banyak darah keluar. Ini kerana darah adalah medium yang sesuai untuk kuman membiak. Bagi wanita yang menggunakan tampon mereka perlu ingat untuk menukarnya selalu," katanya.
Selain itu, elakkan menyabun atau menyapu gel pembersih pada alat kelamin kerana ini mungkin menyebabkan kekeringan, radang kulit dan gatal. Sesetengah wanita sensitif dan alah pada pewangi dalam buih sabun.
Pasangan suami isteri pula digalakkan membersihkan alat kelamin dengan air sebelum dan selepas hubungan seks untuk kebersihan yang optimum, begitu juga selepas membuang air kecil serta besar.

Amalan melakukan douching iaitu memasukkan jari atau pancutan ke dalam faraj dengan tujuan membersihkan bahagian dalam faraj adalah tidak baik dan boleh menyebabkan punca keputihan.

"Ini kerana perbuatan ini akan menyingkirkan sejenis bakteria baik iaitu lactobacilli dari faraj di samping mendedahkan faraj dan bahagian luar kemaluan kepada bahan kimia yang boleh mengakibatkan masalah kulit," ujarnya.

Katanya, pemakaian pakaian dalam jenis sintetik yang terlalu ketat akan menambahkan lagi masalah keputihan. Ini kerana fabrik jenis ini akan menyebabkan kulit berpeluh, tiada peredaran udara pada kulit dan akhirnya menggalakkan kuman membiak.
Sebaiknya pakai pakaian dalam jenis kapas dan menukar setiap hari dan lebih kerap pada hari mengalami keputihan. Seeloknya pakai pelapik seluar dalam supaya tidak melekat pada pakaian dalam yang menyebabkan ketidakselesaan.

Bagi wanita yang mengalami masalah keputihan yang serius, biasanya rawatan diberikan mengikut jenis kuman pada cairan vagina. Selepas itu doktor akan memberikan antibiotik bagi mengawalnya.
"Namun begitu, seelok-eloknya wanita yang mengalami masalah keputihan dinasihatkan berjumpa doktor untuk mendapatkan pengesahan sama ada ia berpenyakit atau tidak, supaya rawatan dapat diberikan sebelum penyakit serius," jelasnya.