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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.

Clean Your Kidneys

Article below is taken from the mail I'm received how to clean your kidneys. Low cost option.
Is anybody has try please share it..

Clean Your Kidneys with LESS Than $1.00

Years pass by and our kidneys are filtering the blood by removing salt, poison and any unwanted entering our body. With time, the salt accumulates and this needs to undergo cleaning treatments and how are we going to overcome this?
It is very easy, first take a bunch of parsley (MALLI Leaves)and wash it clean
Then cut it in small pieces and put it in a pot and pour clean water and boil it for ten minutes and let it cool down and then filter it and pour in a clean bottle and keep it inside refrigerator to cool.
Drink one glass daily and you will notice all salt and other accumulated poison coming out of your kidney by urination also you will be able to notice the difference which you never felt before.
Parsley is known as best cleaning treatment for kidneys and it is natural!

What You Should Know about Water?

Di sini saya nak berkongsi berkenaan dengan air yang saya rasa sangat menarik untuk dikongsikan bersama. Anda boleh layari web seperti gambar yang dilampirkan di bawah atau klik link ini allaboutwater

Bad for babies

THE DOCTOR SAYS
By DR MILTON LUM

If you smoke during pregnancy, you’ll be passing on all the toxins from tobacco to your foetus.
NOT many smokers know what they are consuming when they light up a cigarette. The tobacco in cigarettes is usually blended from two types of tobacco leaves, which have about 2.5% to 4% nicotine. The cigarette is designed to deliver a steady dose of nicotine to the smoker.
In addition to the tobacco leaf, the cigarette contains fillers made from other parts of the tobacco plant and they are mixed with various flavours and additives. The additives increase the acceptability of the cigarette to the smoker as well as increase the addictiveness of cigarettes. The additives include sugars, which make it easier to inhale the smoke, and flavourings like mint. Some of these are harmless by themselves but when taken in combination with other substances, they may be harmful.
It is usual for the cigarettes, sold today, to have a filter at the mouth end. The filters, which are produced from cellulose, trap some of the smoke and tar from the inhaled smoke. Claims have been made that filtered brands contain less tar than others. There are also claims that they are safer because of the filters but these claims are poorly substantiated. But the fact remains that there is no such thing as a safe cigarette.
Tobacco smoke
The effects of cigarette smoking depend on the quantity smoked, type of cigarette and how the tobacco is prepared. There are two types of smoke from a cigarette: the mainstream smoke from the mouth end or filter, and the sidestream smoke from the burning tip of the cigarette. When a smoker inhales, the cigarette has been found to burn at 700°C at the tip and 60°C at the core. The tobacco is broken down to produce numerous chemicals, which are released into the atmosphere as invisible gases and particles, with the smoke making up 5% to 8% of a cigarette’s output. The gases include carbon monoxide, formaldehyde, hydrogen cyanide and dimethylnitrosamine. The particles include nicotine, benzene, benzopyrene and tar.
Most smokers are unaware of the uses of some of the gases and particles found in tobacco smoke. Formaldehyde is used to embalm the dead; acetone to remove nail varnish; benzene as a petrol additive; and cyanide in gas chambers during WWII.
Carbon monoxide, a toxic gas found in motor vehicle exhaust fumes, is present in all cigarette smoke. This poisonous gas attaches itself to the haemoglobin in the blood more readily than oxygen, thereby reducing the ability of the blood to carry oxygen. Britain’s Royal College of Physicians has reported a 15% reduction in the oxygen carrying capability of heavy smokers.
Nicotine is contained in the moisture of the tobacco leaf. When the cigarette is lit, the nicotine evaporates and attaches itself to the droplets in the tobacco smoke inhaled by the smoker. It is absorbed very rapidly by the body and reaches the brain within 10 to 15 seconds. Nicotine stimulates the central nervous system and increases the heart rate and blood pressure, resulting in an increased need for more oxygen. Nicotine is a very powerful drug. When 60mg of pure nicotine is placed on an individual’s tongue, it kills within minutes. Nicotine causes addiction in the similar manner as heroin and cocaine. Nicotine deprivation leads to a strong craving, which is accompanied by anxiety, irritability, hunger, restlessness and decreased concentration.
All cigarettes produce tar in varying amounts. It is always taken into the body when a smoker inhales the smoke in a lit cigarette. The tar, which is composed of many chemicals, contains known cancer-causing agents (carcinogens). They include compounds like formaldehyde, arsenic, cyanide, benzopyrene, benzene, toluene and acrolein. When the tar condenses, it forms the sticky brown substance that stains the smokers’ teeth and fingers yellow brown.
Some of the contents of tobacco smoke are irritants and more than 50 of the compounds are carcinogens or toxins. A study, which was reported in the respected journal, Science, has established a link between smoking and lung cancer at the cellular level. Other substances are known or suspected mutagens that can cause permanent and harmful changes in the genetic materials in the cells.
Low-tar cigarettes
When it became known about half a century ago that the tar in the tobacco smoke was associated with an increased risk of lung cancer, a programme was established to gradually reduce the tar content of cigarettes. Studies from the United States report that the widespread usage of low-tar cigarettes has not prevented an increase in lung cancer among older male Americans. The presumed advantage of low tar cigarettes has been largely offset by an increase in the number of cigarettes smoked and/or deeper inhalation, because of the smokers’ need to compensate for the lower nicotine content in low tar cigarettes.
Pregnancy
The single most preventable cause of illness and death in mothers and infants is smoking. Female and male smokers have decreased fertility. The sperm quality of smokers is impaired with decreases in the count, motility and form. There may be erectile difficulties. It is believed that smoking affects sex hormone production in the female and egg transport in the fallopian tubes to the uterus.
A foetus gets all its nutrients and oxygen from the pregnant woman via the placenta and umbilical cord. A pregnant woman exposed to tobacco smoke will transmit the toxins in it to the foetus. The carbon monoxide content of foetal blood is increased leading to it containing less oxygen than normal, which means that the foetal heart has to beat harder on every occasion the pregnant woman inhales tobacco smoke. The toxins of tobacco smoke also affects placental function and hence, foetal nutrition.
Women who smoke during pregnancy are at increased risk of miscarriage and stillbirth. They have double the risk of premature rupture of the membranes, placental abruption and placenta praevia, all of which can lead to prematurity and even stillbirth.
The babies of mothers exposed to tobacco smoke are at increased risk of prematurity and low birth weight, that is, below 2.5kg. Their babies’ organs are smaller than that of non-smokers’ babies. These babies’ lung function is poorer and they are more likely to get middle ear infections and asthmatic bronchitis in early childhood. Their likelihood of cot death (sudden infant death syndrome) is increased by 1.5 to 3 times. They are sick more often than babies of non-smokers. In addition, the babies are more likely to become smokers when they grow up.
Cessation
It is never too late to cease smoking. The damage from smoking can be reversed when there is cessation of smoking. There is evidence that women who cease smoking in mid-pregnancy gave birth to babies with the same average birth weight as non-smokers. Many women smokers ceased smoking during their pregnancies and never smoked again. The greatest gift that a pregnant smoker can give to her unborn child is to cease smoking. It is important to remember that the foetus is totally dependent on the mother to prevent toxins from poisoning him or her.
Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

source: http://thestar.com.my 

We’re only human

By Dr ALBERT LIM KOK HOOI

Genes, experience, and limited free will – what is it that makes us human?
THANK you for being such an attentive audience. Dr. Lim, I am sure, will be only too happy to take questions.
The chairman’s remarks are made after a round of polite applause. I have just concluded another public lecture on the theme, Prevention of Cancer, and I brace myself for questions.
Inevitably, like death and worsening climate change, one hand shoots up. “Doctor, my grandpa smoked two packs of cigarettes a day for 50 years and he did not contract lung cancer. Yet I know of many non-smokers who have been diagnosed with lung cancer. Your comments doc?” Sometimes, the question is laced with cynicism and swagger. Sometimes it is asked rhetorically, as if to say we should all smoke, eat, and drink with gay abandon.
I scan the two hundred eager faces awaiting my rejoinder. I know the lecture hall is not the time or place to speak of the genome, the epigenome, and the question of nature versus nurture. Instead, I usually entertain my listeners with one of my parables about risk.

Epigenetics can help explain certain scientific mysteries, such as why one of a pair of identical twins can develop a certain disease, such as asthma, even though the other is fine. –Reuters

“Let us say you drive home from work in a car designed and made in the continent. And let us say you comply with the highway code in its entirety. You haven’t had a drink for the last 24 hours. You have no worries about your job or family. The roads are clear and dry. The chances are you will arrive home safely, although an accident is not completely ruled out.
“On the other hand, your blood alcohol limit has been exceeded, your car is long overdue for a service, the roads are wet and you text a message to your irate husband as you drive. You may still arrive home in one piece, but your chances of meeting an accident are greatly enhanced.
“Ladies and gentlemen, we are speaking of risk and how we can increase or decrease it. Life is probabilistic and many scientific endeavours are devoted to lowering your risk of a premature death or suffering a disease or disability. Think of all the effort put into road and other transport safety, advice on what to eat and what to avoid, vaccinations, occupational safety, global warming, prediction of earthquakes, and tsunamis.”
This usually satisfies the audience ... until the next lecture when another hand shoots up and I hear the inevitable, “Doctor, my grandpa ...”
Risk and probability in the human context is underpinned by the nature/nurture question. For the last hundred years, scientists and thinkers have pondered the question of nature versus nurture. How much of our bodies, minds, personalities, traits, and abilities are a result of our genes, ie determined by what we inherit from our parents? How much is a result of the environmental forces we are subjected to from the time we are conceived? How much do our childhoods and teenage experiences matter?
Things began to change just over a decade ago. We realised that it was no longer nature versus nurture, but rather nature via nurture. In other words, we are no longer slaves to our genes. Neither can manipulating the environment shape us this way and that like a pretzel. Rather, it is that our genes can be switched on and off by our environment.
We also realise that with whatever limited free will we have, we can strive to realise the full potential of our genes by sheer perseverance, practice, or a change in our lifestyles.
We now add another dimension to the nature (DNA, genes), nurture (environment) equation. It is epigenetics. Genes provide the codes to build proteins which determine how we are built and how we function, at least to a first approximation.
Epigenetic marks (mainly the methyl group, CH3, but there are others) sit atop genes and offer basic instructions to them, telling them to switch on and off. Environmental factors, like a rich diet, can activate epigenetic marks, which can in turn modify our DNA. There, changes can turn our genes on or off.
Epigenetics could also help to explain certain scientific mysteries that traditional genetics never could. For instance, why one of a pair of identical twins can develop bipolar disorder or asthma even though the other is fine. Or why autism strikes boys four times as often as girls. Or why your grandpa smoked and smoked to a coughing fit and never contracted lung cancer while some other non-smoker died of lung cancer in her 40s.
It all comes down to one basic question that has vexed humanity since antiquity. How much of our life has already been determined when we are born and how much is within our control? I am optimistic that science will uncover more about this conundrum in the coming years.
In the meantime, try to quit smoking and drive safely. You have more, and less, free will than you think.
Dr Albert Lim Kok Hooi is a consultant oncologist. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

source:http://thestar.com.my

10 tips for 2010

By LIM WEY WEN

In the light-hearted spirit of the season, here’s an easy-peasy, offbeat guide to staying healthy - our way of kicking off a brand new lunar year of wellness and wellbeing.
starhealth@thestar.com.my
THE way to good health is simple and straightforward, or so we are told. How hard can it be? You just need to eat well, exercise, sit back and relax.

Smile, and your brain smiles with you. – AP Photo

It sounds easy enough, until we get to the part where it translates into keeping our blood pressure below 120/80mmHg, our HDL (high-density lipoprotein) up and LDL (low density lipoprotein) down (“What on earth are those?”), walking as much as we can (“Can’t I just drive to the nearest hypermarket?”), and taking time out from our hectic lifestyles (“There’s no time!”).
The truth is, it doesn’t always have to be so exasperating, complicated, or nearly as much work. As our interviews with doctors often reveal, it’s the little things that can go a long way towards improving our quality of health, and life. It’s just that amidst reading about drugs and surgeries to treat heart disease and cancer and arthritis and neurofibromatosis, the small print – small, but important stuff like “please consult your doctor before taking any medication” – is often forgotten.
So, to start off this lunar New Year, we’ve compiled a list of the little things you can do to keep well with - we hope - minimal effort and fuss.
1. Start your day funny
Who needs caffeine when a funny video can perk you up with a heady dose of happy juices swimming about in your system? You don’t even have to laugh; all your body needs is that little twitch in your cheeks to remind it of all the good times you’ve had.
That act of facial muscle lifting will cue your brain to release endorphins – chemicals that make you feel uplifted, happy and relaxed. Just smile. Giggle. Chuckle. Bite a pencil. Anything. All you have to do is raise your cheek muscles. It will do you good.
2. Tune in
You may not be a fan of the evening news, but switching your TV on to catch the 8pm bulletin for current health updates is not a bad idea.
You don’t have to know exactly what the doctor-patient ratio currently is in Malaysia, but you might find information on infectious diseases and pandemics particularly useful if you are a frequent traveller, or if a disease had just broken out in the neighbourhood next door.
Most news reports will also include advice on the perennial question “What can you do next?” so you don’t have to call your best friend and scare the wits out of each other with hearsay. And if you missed the news, or simply don’t like to watch TV (which is highly unlikely), you can always catch up with the papers the next day.

Telling your doctor you take ‘the blue one’ is not enough for him to identify the pills you’re on. – AP Photo

3. See one doctor. That’s (usually) enough
If your latest health problem hasn’t gone away after gulping down the handful of pills your doctor just prescribed, it is common to want to see another – one who gives you medicines that actually work! Never mind that, given some time, your body will recover from whatever’s bothering you without the second round of chemical ammunition. Never mind that by going back to the same doctor, you might just find out you were misdiagnosed the first time (it does happen quite often). Just because you recover after seeing the second (or the seventh) doctor, that doctor must be better!
This may well be the case, particularly when “your doctor refuses to explore options with you, is wedded to one drug or one treatment approach, or has written off your persistent physical symptoms as “mental” problems,” says Mary Shomon in her About.com article Are you a doctor-hopper? But she also lists four reasons why you shouldn’t be seeing five, or 15, doctors for your back pain.
First, getting well takes time. Second, making sure the treatments your doctors give you don’t mess each other up is going to be a nightmare. Third, you end up paying for the same thing over and over. Lastly, you will only get frustrated when treatment after treatment fails.
4. Keep a health log, or I-know-you-love-trees-but-don’t-recycle-your-lab reports

To incur minimum damage from your high-risk heels, avoid wearing them when you know you’ll be hitting the pavement hard and long.

In its latest clinical practice guidelines on the management of dengue infection in adults, the Health Ministry encouraged patients suspected of having dengue to keep a daily record of their temperature and blood test results from day three of their fever until at least three days after their fever subsides. This way, their doctors can monitor their condition and give timely treatment when needed.
The idea could also be applied to any other disease. In an interview not too long ago, a doctor described how he was once amazed at the level of commitment an old man had in making sure he is well taken care of. His secret weapon was a pocket-sized notebook in which he catalogued every single reading and piece of medical advice he had ever received since he was diagnosed with high blood pressure.
“When a patient whips out a notebook, you know he cares a lot,” the doctor said.
But this is not just about keeping good records or holding your doctor accountable for his actions. In diseases such as dengue infections, keeping tabs on your test results could be life-saving too.
5. Heel only when necessary
If you are a guy and wonder why women subject themselves to the torture of skyscraper stilettos, here’s why: It’s usually not about you. It’s because it does wonders for our self-esteem, our legs, and our posture. And, it makes us feel incredibly sexy and tall.
But ladies, there’s no doubt that they are called torture devices for a reason – wearing them all the time can do serious damage to our feet. Little irritants like corns and calluses can creep up on us, and we might risk developing more complex problems like bunions and excruciating pain in the balls of our feet over time.
The trick is to incur minimum damage to achieve maximum impact. Keep those killer shoes in the closet when you need to walk around and save them for that hot date.
6. Read and ask before you pop any pill
There is one important thing you absolutely need to know about any pill you are about to put in your mouth, besides how much to take, how to take it, and why you took it in the first place. And that is: its name.
No, that’s not a lame joke. A pharmacist we’re in contact with laments that people often show up at emergency departments with bags of drugs, which they know little about beyond that they are for their high blood pressure, diabetes, or uric acid.
That isn’t helpful, particularly when they are admitted for emergencies and the attending doctor needs to know exactly what kinds of medications they take, fast. Indeed, generic names like sildenafil citrate can be difficult to remember, but if you know the trade name of the original drug (Viagra), it’s often easier to recall.
Other things you need to know about your pills, creams, or syrups are their possible side effects, expiry dates, and contraindications (medical speak for “If you have these conditions, please do not use this drug.”). All this information can be found in the piece of paper that comes with the drug – the package insert. So, read it first.
7. Lift it slowly and carefully
You might think that lifting things safely is a skill you’re born with. However, according to medical website WebMD.com, it is not.
In fact, people tend to lean over and lift with their backs. However, the website cautions, as easy as it may be to do, this can lead to injury.
Learning the correct way to lift heavy things can help you avoid those injuries and a great deal of pain in your arms, legs, and back. Here is a pictorial guide to help you safely lift those crates of mandarin oranges this season. (See illustration on SF2)
8. Carry your vital statistics around
It’s not your bust-waist-hip measurements you should be carrying around, but the following information. During a medical emergency, what’s below can be useful for you, or anyone assissting you, to get appropriate help:
·Your full name
·Your identity card number
·Your blood type
·The medications you take long-term
·Anything you know you are allergic to
Don’t forget to add these phone numbers to your list:
·Your regular doctor (office hours and after office hours)
·The person to contact at home
·The person to contact at work
Keep this list in handy places at all times – in your wallet, your office, or at home – and carry it with you whenever you go to the hospital.
9. Mark your calendar
If you can mark the rerun of Terminator: Salvation on your calendar, you can also mark your doctors’ appointments, annual check-ups, vaccination dates, and a little “me” time on it so you won’t miss them too.
If you are a woman, marking the first day of your menstrual cycle (the first day of your period) on a personal and private calendar could also give you an idea of how regular your period is, so changes in your personal rhythm can be picked up early. For those who are married, this information can be helpful particularly when you are trying to have a baby or avoid having one.
10. Unplug and get real In the wired society we now live in, it is getting easier and easier to communicate without human contact. You can now pull a sickie with a text message or an email, and you don’t even have to turn your head to look for a lunch partner – you can just email or Facebook or IM (short for internet messaging) them. Or, if you want to have a quick chat, your avatar and their avatars can take turns to spout speech bubbles in a virtual café in Second Life. All you need to do is type and click.
But human contact – the touch that when taken away during infancy produces more aggressive and violent children – is imperative to our sanity and wellbeing. As psychiatrist Charles Nemeroff said in a Discovery Health interview about human contact and affection, intimacy, closeness, and friendship can prevent one from feeling the effects of stress. In fact, intimacy has been shown to prevent chronic stress.
So, if you think trading tweets and updating your status are enough to help you de-stress, try asking a colleague you get along with out for tea instead. You may find real-life conversations and laughter more potent than any capitalised “l-o-l” you’ve ever typed.
We would like to hear from you!
Have you any interesting, oddball health tips to share? Email us at starhealth@thestar.com.my

Environmental and health concerns

Several of the ingredients in toothpastes are found by some environmentally damaging or hazardous to the personal health. These ingredients include[11]:

* Fluoride
* Artificial flavoring
* Artificial colors
* Triclosan
* Sodium bicarbonate (baking soda)
* Detergents
* Binding agents
* Humectants
* Preservatives such as Methylparaben and Ethylparaben-parabens
* Pyrophosphate
* Potassium nitrate
* Lauryl sarcosinate
* Polyethylene glycol
* Polypropylene glycol
* Sodium saccharin/aspartame


Sumber:http://en.wikipedia.org/wiki/Toothpaste

13 July, 2009

Visit us: www.neways.com.my

123 Privileged Membership Campaign

Now is the best time to join Neways! When you purchase 300PV and above, you are entitled to: 1. Starter Kit worth RM 65 2. One free gift from the following choices: CS Balancing Cleanser CS Balancing Lotion Replenishing Mist Sunbrero 3. Special Buy Voucher Terms & Conditions 1. Promotion period is from 1st July 2009 to 30th September 2009 2. All gifts do not carry PV/BV 3. Each distributor will only be entitled to ONE gift only 4. All free item are not exchangeable for cash or in kin 5. The company reserves the right to reject any qualification upon its sole discretion 6. The company decision is final and no correspondence will be entertained 7. The Terms and Conditions herein are subject to change without prior notice 8. The decision of the management’s interpretation of the campaign will prevail. The management reserves the right not to issue gift to distributors who have conducted business unethically while participating in the campaign Click here for campaign flyer 1，2，3新人很简单 现在是加入Neways的最好时机! 当您购买超过300PV的产品时，您将享有以下的好处： 1. 价值RM 65的企业配套 2. 任选以上其中一种赠品* 3. 促销礼券 赠品为* Replenishing Mist* * Sunbrero*Clear Science Balancing Lotion *Clear Science Balancing Cleanser 条件与规则 1. 促进期间是从2009年7月1日到2009年9月30日 。 2. 所有礼物不含任何的PV/BV 。 3. 每个传销商只限换取一次特别的产品。 4. 所有的免费产品不可兑换现金或其他产品。 5. 公司保留拒绝任何资格的决定权利。 6. 公司的决定是最后的决定，恕不接受任何的书面投诉。 7. 公司保留权利更改、增删条件与规则。 8. 公司管理层的决定是最后的决定。倘若在促销期间的诠释上存有任何差异，则以公司的诠释为准，公司保留权利不发布赠品予在活动里使用不道德的手段的传销商。 欲浏览宣传单张，请点击123新人很简单

321 Personal Growth Campaign

When you purchase of 200PV and have TWO new recruitments with purchases of 300PV in a month, you are entitled to get one of the products below for FREE: CS Balancing Cleanser CS Balancing Lotion Replenishing Mist Sunbrero This allows you 3. to achieve your monthly 150PV requirement 2. get a free product and 1. expand your business So don’t MISS THIS GOLDEN OPPORTUNITY! Terms & Conditions: 1. Promotion period is from 1st July 2009 to 30 September 2009 2. All gifts do not carry PV/BV 3. Each distributor will only be entitled to ONE gift in a month 4. All free items are not exchangeable for cash or in kind 5. The company reserves the right to reject any qualification upon its sole discretion 6. The company decision is final and no correspondence will be entertained 7. The Terms and Conditions herein are subject to change without prior notice 8. The decision of the management’s interpretation of the campaign will prevail. The management reserves the right not to issue gift to distributors who have conducted business unethically while participating in the campaign Click here for campaign flyer 3，2，1进人很简单 当您购买200PV的产品并且在一个月内成功招募2位已消费购300PV的新传销商时，您将享有以下的好处： 1. 拓展您的事业价值 2. 任选以上其中一种赠品* 3. 达到每月PV要求 赠品为 * Replenishing Mist* * Sunbrero*Clear Science Balancing Lotion *Clear Science Balancing Cleanser 条件与规则 1. 促进期间是从2009年7月1日到2009年9月30日 。 2. 所有礼物不含任何的PV/BV 。 3. 每个传销商每个月只限换取一次特别的产品。 4. 所有的免费产品不可兑换现金或其他产品。 5. 公司保留拒绝任何资格的决定权利。 6. 公司的决定是最后的决定，恕不接受任何的书面投诉。 7. 公司保留权利更改、增删条件与规则。 8. 公司管理层的决定是最后的决定。倘若在促销期间的诠释上存有任何差异，则以公司的诠释为准，公司保留权利不发布赠品予在活动里使用不道德的手段的传销商。 欲浏览宣传单张，请点击321进人很简单

Product Promotion from 13th July - 31st July 2009

Fried eyes

By LEE TSE LING

Eyes need as much protection as skin from ultra-violet light. Find out why.

MANY of us know excessive exposure to ultra-violet (UV) light is hazardous, but only associate harmful effects with skin disorders, most commonly with sunburn, premature aging, and cancer, and perhaps less commonly with sun allergies, systemic erythematosus lupus, and pre-cancerous growths/lesions.

Falling somewhere in between the two is the awareness that UV light can cause long-term damage to sight.

What is UV light?

Natural UV light is a component of sunlight - a combination of UVA, UVB, and UVC rays that’s invisible to the human eye.

UVC rays are blocked by the ozone layer. UVA rays make up 90% of UV light that reaches earth. They give you a suntan, but also penetrate deeply into the eye, hitting the retina (the light-detecting layer of the eye). UVB rays make up 10% and are nastier. They cause sunburn and cancer, and are absorbed by the cornea (the clear layer in front of the eyeball) and lens (the bit that focuses light on the retina).

Interestingly, UV light is visible to some birds and all bees. Raptors like eagles and falcons can track prey whose urine absorbs UV light, leaving a visible trail to follow. Bees are directed to nectar by plants displaying UV markings on their flowers.

So UV light has an important role to play in the natural world. For us, too much can cause the eye- and sight-related disorders below, cautions consultant ophthalmologist Dr Linda Teoh.

Cataracts: A cataract is a clouding of the lens inside the eye, which can scatter light entering the eye irregularly, or block it altogether, resulting in blurry vision, shortsightedness, photosensitivity, or blindness.

Click to view graphic

They are a major cause of visual impairment worldwide, but are preventable, treatable (surgical removal), and the blindness they cause is usually reversible.

“It’s not a disease, it’s an ageing process that occurs in the eye,” Dr Teoh reassures. Consult your physician early, even if your cataract is not disabling, as it may conceal other eye problems. To prevent them, Dr Teoh recommends UV-blocking eyewear, vitamin supplements, quitting smoking, and controlling blood sugar levels (uncontrolled blood sugar levels, eg in diabetics, can accelerate cataract development).

Age-related macular degeneration (AMD): AMD occurs when the cells of your macula (the part of your retina that registers the sharpest images) die. This destroys sharp central vision, as if someone has smudged out the middle of your field of vision. A person with AMD can see hazy peripheral outlines, but not fine details necessary for, say, reading and driving safely.

There are two forms: dry AMD progresses slowly with age, wet AMD progresses quickly due to blood vessels growing abnormally under the macula, which displace it. Both are painless, and easy to ignore or accept with a resigned sigh as part of “growing old”. Don’t. It’s one of the leading causes of chronic blindness worldwide.

While controllable risk factors include smoking, being obese, and exposure to UV light, age is the greatest risk factor. So from 60 onwards especially, see an ophthalmologist if you develop blurry vision (eg have difficulty recognising faces or words on a page) that may improve in brighter light; a small, growing blind spot in the middle of your field of vision; or if straight lines appear crooked to you.

Pterygium: A non-cancerous growth on the white of the eye that extends onto the cornea that can block or distort vision, and cause irritation (eg itching, burning, or a “gritty” feeling). More often it is painless, but may be considered unsightly, and so be surgically removed (note: it tends to recur).

It’s seen most often in adults who work outdoors, exposed to sun and wind. Untreated, it can cause vision loss.

Photokeratitis: A.k.a. corneal sunburn, caused by excessive UVB exposure eg from too much time spent on a sunny beach without eye protection. Symptoms may not appear until six or more hours after exposure, last one to two days, and include very sore, bloodshot, and teary eyes; blurry vision or temporary vision loss; and photosensitivity. Treatment consists of symptomatic relief.

Preventing UV damage

When it comes to your eyes, an ounce of prevention is definitely worth a pound of cure:

● Ensure all eyewear provides 100% UVA and UVB blockage. Check that it comes with a World Council of Optometry seal of acceptance for UV blockers/absorbers.

● Consider wraparound sunglasses, larger frames and/or side panels for added protection.

● Wear a hat/cap (minimum brim width: 8cm) outdoors.

● Seek shade, especially from 10am to 3pm.

● Take extra care when UV exposure is enhanced ie when light is reflected off pavements, water, sand, and snow.

● Be aware of UV risk wherever you go. Get a seven-day solar UV Index (UVI) forecast of locations around the world at asia.transitions.com/healthysight/uv/local.htm (the World Health Organisation- established UVI runs from 0: Low to >11:Extreme).

● Protect children’s eyes as early as possible. Kids spend more time outdoors, may not remember to protect themselves, and are more vulnerable (the immature lenses of children under 10 block just 25% compared to 90% in adults aged 30). Studies have also shown higher UV exposure in teenagers and young adults is linked to a higher risk of developing cataracts and AMD later on.

Hidden danger

By MAGGIE FOX

A chemical commonly found in plastic can affect heart cells and worsen heart attacks.

HORMONE experts are worried by a chemical called bisphenol A, which some politicians want taken out of products and which consumers are increasingly shunning.

They said they have gathered a growing body evidence to show the compound, also known as BPA, might damage human health. The Endocrine Society issued a scientific statement last week calling for better studies into its effects.

Studies presented at the group’s annual meeting show BPA can affect the hearts of women, permanently damage the DNA of mice, and appear to be pouring into the human body from a variety of unknown sources.

BPA, used to stiffen plastic bottles, line cans and make smooth paper receipts, belongs to a broad class of compounds called endocrine disruptors.The United States Food and Drug Administration is examining their safety but there has not been much evidence to show that they are any threat to human health.

“We present evidence that endocrine disruptors do have effects on male and female development, prostate cancer, thyroid disease, cardiovascular disease,” said Dr Robert Carey of the University of Virginia, who is president of the Endocrine Society.

The society issued a lengthy scientific statement about the chemicals in general that admits the evidence is not yet overwhelming, but is worrying.

Dr Hugh Taylor of Yale University in Connecticut found evidence in mice that the compounds could affect unborn pups. “We exposed some mice to bisphenol A and then we looked at their offspring,” Taylorsaid. “We found that even when they had a brief exposure during pregnancy, mice exposed to these chemicals as a foetus carried these changes throughout their lives.”

The BPA did not directly change DNA through mutations, but rather through a process called epigenetics – when chemicals attach to the DNA and change its function.

Taylor noted studies have shown that most people have some BPA in their blood, although the effects of these levels are not clear. Dr Frede­rick Vom Saal of the University of Missouri, who has long studied endocrine disruptors, said tests on monkeys showed the body quickly clears BPA – which may at first sound reassuring. But he said when tests show most people have high levels, this suggests they are being repeatedly exposed to BPA.

“We are really concerned that there is a very large amount of bisphenol A that must be coming from other sources,” Vom Saal said.

Dr Scott Belcher of the University of Cincinnati in Ohio and colleagues found that BPA could affect the heart cells of female mice, sending them into an uneven beating pattern called an arrhythmia.

“These effects are specific on the female heart. The male heart does not respond in this way and we understand why,” Belcher said. He said BPA interacts with estrogen and said the findings may help explain why young women are more likely to die when they have a heart attack than men of the same age.

US government toxicologists at the US National Institute of Environmental Health Sciences expressed concern last year that BPA may hurt development of the prostate and brain. A 2008 study by British researchers linked high levels of BPA to heart disease, diabetes and liver-enzyme abnormalities. – Reuters

It’s a hormone thing

A woman can suffer a variety of symptoms directly linked to the level of oestrogen in her body

FEELING hot, flush and your temper on edge all the time? Your once flawless skin beginning to feel dry and showing signs of wrinkles? Millions of women around the world would be able to identify with these symptoms.

What they are unaware of is that these symptoms could be closely linked to the level of hormones in their bodies.

The demands and stress from today’s modern lifestyle can affect the production of the female hormone, oestrogen, which is crucial to a woman’s physical development.

It plays a role in her ability to bear children, and has bearings on her overall health. It is also responsible for the woman’s menstrual cycle, breast formation and manages her libido.

Therefore, any imbalance to the level of oestrogen in the body can cause severe repercussions to a woman’s health, resulting in symptoms like those above. So it is imperative that the level of oestrogen in a woman’s body be maintained at an acceptable level.

In a clinical study conducted on genistein, Dr Francesco Squadrito discovered that women who took 54mg of genistein a day (equivalent to two gallons of soy milk per day) have far denser bones than those who did not.

Genistein is one of the most active ingredients contained in soy isoflavones, which refers to a group of natural compounds extracted from soy. Another name for genistein is ‘phytoestrogen’.

The combination of ‘phyto’ (which means plant) and ‘oestrogen’ (the female hormone) implies that genistein has the ability to mimic the functions of oestrogen in the body, which enables it to modulate any imbalance.

The benefits of genistein include:

» Radiant, flawless and supple skin

Any fluctuations in the oestrogen level caused by everyday stresses can greatly reduce the ability of the cells in our skin to manufacture collagen and hyaluronic acid, which are the two key components for healthy, radiant skin. Therefore, balancing the fluctuation is important to maintain good skin health.

» Moisturising skin from the inside

Hyaluronic acid is a natural moisturiser contained within our skin cells. However, when the skin is exposed to environmental pollutants and stress for a long period of time, the production of hyaluronic acid reduce progressively. This will then cause our skin to become dry and wrinkled.

One of the most important discoveries about genistein is its ability to stimulate skin cells to increase the production of hyaluronic acid, which keeps the skin moisturised. Thus, it is advisable to drink at least eight glasses of water when consuming genistein.

» Alleviating menopausal symptoms

Hot flushes, irregular periods, night sweats, interrupted sleep, mood swings and vaginal thinning are some of the common symptoms of menopause. The more severe symptoms lead to an increased risk of osteoporosis (brittle bones) and heart problems. All these symptoms are directly linked to the decline of oestrogen in the body.

Genistein is a natural and safe alternative to increase the level of oestrogen in the body, hence alleviating the symptoms.

» Keeps calcium ‘locked in’ bones

Bones are dynamic living tissues that continuously ‘dissolve’ and ‘reform’ at an average of 10% annually. An adult skeleton is estimated to experience a complete cycle once in every 10 years.

The level of oestrogen in the body controls the process of bone reformation. A drop in the oestrogen level will result in the process of bone dissolving at a faster rate compared to the ability of the bone to reform.

As calcium – which is a mineral responsible for keeping bones strong and healthy – is stored in the bone, the increased rate of bones dissolving also indicates a loss of calcium. This will then lead to an increased risk from osteoporosis, or commonly known as brittle bones.

Genistein mimics the action of oestrogen, therefore, slowing down the process of calcium-loss in bones. This keeps bones stronger and denser over time.

It is advisable to include a variety of dairy products or calcium supplements in our daily diet to facilitate the cells to form stronger bones.

Choosing a good source of genistein is important as not all genistein supplements are the same. Here are some tips to identifying a good genistein supplement:

• Ensure that it contains a fixed and standard amount of genistein required by the body.

• Ensure that it is in tablet or capsule form. Genistein in powdered form may contain additional flavouring or proteins that may interfere with its absorption.

• Ensure that it is extracted from organic soy beans.

• Ensure that it has a low protein content. This is especially important when consumed by individuals with a history of gout.

• Ensure that it is sugar and flavour free. This is important for diabetics and those who are weight conscious.

• Ensure that it is made from non-genetically modified (non-GMO) soy beans.

• Ensure that it is individually packed in aluminium blister to maintain freshness and effectiveness.

Guide to a woman’s heart

By LIM WEY WEN

Clinical Practice Guidelines for the prevention of cardiovascular disease in women.

TO medical professionals, drawing up a typical patient profile for various diseases has its virtues – it allows them to make quick clinical decisions on a daily basis. But this kind of stereotyping has its flaws. Patients with atypical symptoms may be overlooked or misdiagnosed. Preventative measures preached to high-risk groups may fall on deaf ears for others who do not fit the profile.

Such is the case with cardiovascular disease (CVD).

Initially thought of as a disease that affects mostly men, the manifestation of the disease in women has been overlooked until recently, as statistics have begun to show that women are equally at risk.

Health Ministry director-general Tan Sri Dr Ismail Merican stressed the need to address this disparity in his message for the 2008 Clinical Practise Guidelines (CPG) on the prevention of CVD in women. “With increasing and longer life expectancy of 76.4 years in the Malaysian woman, CVD will become the most common cause of morbidity and mortality for women in Malaysia ...” he wrote.

Unfortunately, many women and healthcare professionals have not been able to shake the perception of CVD as a men’s disease. To address this issue, the new CPG aims to increase the awareness of healthcare providers about CVD in women by addressing five clinical questions.

1. Are there gender specific differences in the epidemiology of CVD?

CHD

·In general, women develop coronary heart disease (CHD) about 10 years later than men.

·Due to certain cultural norms, such as a passive nature and a tendency towards denial, women with CHD symptoms are less likely to be referred for appropriate investigations. The presence of other diseases or conditions such as arthritis and obesity may also cause physicians to overlook the possibility of CHD.

Stroke

·Stroke is now the second leading cause of death in women worldwide after CHD.

·Data from the United States National Health and Nutrition Examination Survey (NHANES) showed that women in the age group 45-54 were twice as likely as men in the same age group to suffer strokes.

2. Do women with CVD present in the same manner as men?

CHD

·When CVD is present in women, early symptoms are often atypical ones such as shortness of breath, sleep disturbances and fatigue. However, during a heart attack, women are as likely as men to present with typical chest pains associated with sweating.

·Conventional stress tests have a lower diagnostic accuracy in women. However, a normal stress ECG at an adequate workload is a good indication that there is no significant blocks in the coronary arteries.

Stroke

·Women are more likely to report vague sensations not classical of stroke, such as changes in consciousness or disorientation. They could also experience non-neurological symptoms such as shortness of breath and chest pain.

3. Are there gender differences in the management of CVD?

·Although data on the management of CHD in women are limited, those available suggest most of the benefits seen in men can be extrapolated to women.

·Women with CHD should be treated in the same manner and as aggressively as men.

4. Are the risk factors for cardiovascular disease different in women?

Generally speaking, obesity, diabetes, sedentary lifestyles and smoking are CVD risk factors for both men and women, but their impact may differ.

CHD

·Elderly hypertensive women and young female smokers are especially at risk of CHD.

·Women who smoke or consume alcohol are more at risk of CVD than their male counterparts. This risk is greatly increased if a woman smoker is also on combination oral contraceptives.

Stroke

·Women and men share many common risk factors for stroke, which includes a family history of premature stroke and a previous history of stroke.

·Women also face additional gender-specific risk factors such as certain low-dose oral contraceptive use, combined hormone therapy for postmenopausal women, complications in pregnancy (pre-eclampsia) and migraine.

5. How do you prevent cardiovascular disease in women?

Even without overt symptoms, women should have their cardiovascular risk assessed. Assessment of CVD risk involves:

1. History: Look for symptoms of CHD, family history of premature CHD (CHD at an early age), smoking status, and physical activity.

2. Physical examination: BMI, waist circumference, pulse and blood pressure.

3. Laboratory investigations: Blood sugar levels, and lipid profile.

The prevention of CVD involves:

1. Those with high risk: Intensive risk factor reduction with lifestyle changes and medication to achieve target levels.

2. Those at risk: Non-pharmacological intervention with diet and physical activity. If the targets are not achieved, the use of medication may be considered.

3. Those with optimal risk: Continue with healthy lifestyle measures.

This article is a summary of the 2008 Clinical Practise Guidelines on the Prevention of Cardiovascular Disease in Women. The full version of the guidelines can be downloaded from the Ministry of Health website, www.moh.gov.my.