The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 13 Jul 2011 04:52 AM PDT Hernias can be a very painful medical condition, but two main procedures are available to treat them. HAVE you ever felt pain in your groin area, only for it to subside when you lie down? Have you felt a swelling in your groin, which gets worse when you cough or when you do some heavy lifting? If you have experienced these symptoms, chances are, you may have a groin hernia, medically known as an inguinal hernia. Locally, people refer to it as angin pasang, uluran or burut. According to Prof Dr Chin Kin Fah of Universiti Malaya Medical Centre (UMMC), groin hernias are most common among adults. A hernia can either cause mild discomfort or debilitating pain to the patient. Most people assume that hernias are a male-only medical condition. It is true that some types of hernia are more common in males than females. But females are also susceptible to hernias. "While more common in men, they also occur in women, with a ratio of about 10 to one. An inguinal hernia develops as a result of a weakness or opening in the abdominal wall of the lower abdomen at the inguinal canal," says Prof Chin. Hernias can occur in almost anyone, and does not discriminate according to gender or age group. It can happen to both sexes; infant or elderly; healthy or unhealthy. Yes, even infants may not be spared from developing an hernia. Statistically, it is estimated that one in 500 have some form of hernia. This is an alarmingly high figure. While a hernia does not result in fatality, timely diagnosis and treatment can prevent much pain and a reduced quality of life. Understanding hernias What is an inguinal hernia? Can such hernias be cured? What can be done to prevent them? Put simply, an inguinal hernia is a gap, hole or defect in the abdominal wall. The gap can be caused by damage to the abdominal walls or a muscle tissue tear. When this occurs, the contents of the abdominal cavity, such as intestine, fat and tissues, can sometimes be pushed through this gap. As the internal body parts protrude through the gap, a bulge or localised area of swelling will become evident beneath the skin of the abdominal wall. This causes much pain and discomfort. The pain usually worsens when one is lifting heavy objects, standing or undergoing stress. Physical exercise also tends to aggravate the hernia. Demanding physical activities – such as exercise, coughing, games and jogging – increase the pressure within the abdominal wall. Consequently, more abdominal contents tend to protrude through the gap. This results in enlargement of the size of the hole, which can cause great pain to the patient. At later stages, the hernia can lead to excruciating pain. In most patients, the hernia starts off as a small bump, which subsequently grows. The area will start to hurt and severe nausea may occur. If left untreated, hernias can lead to a major medical emergency. Almost all hernia patients risk having the blood supply of the trapped organ being cut off, due to "strangulation". This happens during a hernia bulge in which the blood vessels are constricted due to pressure. This causes the blood supply to be cut off. When this occurs, an emergency surgery may be required. The good news is that inguinal hernias are treatable. "The only treatment for an inguinal hernia is surgery. The aims of surgery are to close the abdominal wall defect, alleviate the symptom of pain/discomfort, prevent serious complication and reduce the risk of recurrence," Prof Chin explains. Locally, many patients seek massages as a form of treatment for hernias. Going for a massage will only help push the contents that protrude back into position. However, according to Prof Chin, massages will not be able to provide a lasting solution as the gap is not closed. In 1989, Dr Irving Lichtenstein put forth a bold new way to treat hernias – by using a polypropylene mesh. His idea was to place the mesh to cover the hernia gap. According to Dr Lichtenstein, patients who were treated using the polypropylene mesh experienced minimal complications after a follow-up period of between one and five years. This was remarkable, indeed. The Lichtenstein technique was further developed with emerging technology. Today, many medical devices manufacturers, like B. Braun, produce sterile, high quality, lightweight polypropylene mesh to aid doctors. The other alternative is laparoscopy surgery. It is a minimally invasive surgical procedure; some patients can usually go home a few hours after surgery. However, laparoscopic surgery can only be performed by trained and experienced surgeons. It is also expensive. The Lichtenstein technique employs a regional or local anaesthesia to complete the entire procedure. Earlier methods of treating hernias mainly involved the stitching of the gap or cavity. But according to the US-based Lichtenstein Hernia Institute (LHI), this has its disadvantages. Firstly, sewing together the tissues that caused the gap creates distortion of the muscle fibres and undue tension to the tissues. This creates stress and "pulling" along the tissue lining, causing pain, thus resulting in a longer recovery period. "In an old-fashioned tension operation, the surgeon simply stitches together the edges of the patient's weakened tissue," says Prof Dr Parviz Amid. "When the patient coughs or strains, the edges of the defect can tear apart. Also, when the edges of the tissue are brought together forcefully, it causes greater post-op pain and a longer recovery period – sometimes as long as two months." According to him, the Lichtenstein repair "bypasses the problem of working with degenerated tissue, by placing the edges of the patch on surrounding healthy tissue, providing a stronger reinforcement for the abdominal wall." Prof Amid is a fellow of the American College of Surgeons and Royal College of Surgeons of England, and co-founder of LHI. An expert on hernias, he has published more than 150 scientific articles and book chapters on the subject of abdominal wall hernias. Prof Chin agrees. "It is a tension-free repair using a mesh to reinforce the wall of the abdominal wall, and is considered a successful and effective repair technique of inguinal hernias with complication rates of less than 1%," he says. UMMC's Associate Prof Dr April Camilla Roslani adds: "The Lichtenstein method is a tried and trusted method. It is easy to teach and to learn. (The technique reportedly has) a low recurrence rate and complication rates, even in relatively inexperienced hands." "It is the technique of choice in open repair of inguinal hernias, especially in patients who are not fit for general anaesthesia," Prof Chin opines. Both the laparoscopic and Lichtenstein methods have their advantages and disadvantages. The laparoscopic method provides for a smaller incision compared to the Lichtenstein method. "(Laparoscopic method) is a minimally invasive surgery with smaller skin incisions and allows us to repair the hernia defect from the inside of the abdomen cavity using a piece of mesh (10cm x 15cm). The abdominal pressure will hold the mesh in position, thus reducing the risk of recurrence," says Prof Chin. While the laparoscopic method is ideal for certain patients, when expertise is available, Assoc Prof April is of the view that it takes longer for trainees to learn the method effectively. At present, only experienced specialists perform the laparoscopic procedure, since the procedure is very delicate. "In healthcare systems where trained, experienced laparoscopic surgeons are few and far between, there is still a major role for the open method (Lichtenstein method), as up to 80% of inguinal hernioplasties are performed by trainees. In contrast, the laparoscopic method takes longer to learn, and in our current training system, it does not appear feasible to train medical officers to perform the procedure," she says. However, Prof Chin, who has worked as a consultant surgeon in Britain, has indicated that the National Institute of Clinical Excellence in the UK has accepted the laparoscopic repair of inguinal hernias as the treatment of choice by specially trained laparoscopic surgeons who regularly carry out this procedure. It is particularly useful for patients with recurrent hernias or bilateral inguinal hernias, as well as patients who want to return to work faster and lower the risk of having persistent pain (such as those in the armed forces). UMMC's Miles Skill Centre now runs regular training workshops for laparoscopic inguinal hernia surgery, in order to propagate this specialised technique among general surgeons in Malaysia. However, the laparoscopic procedure is not suitable for everyone, for instance, patients who cannot undergo general anaesthesia and those who have had previous abdominal surgery with bad adhesions. In contrast, says Assoc Prof April, the Lichtenstein method can be performed without the use of general anaesthesia, thereby avoiding general anaesthesia-related complications. The Lichtenstein method can be performed under regional or even local anaesthesia (in suitable patients), which may save procedural costs. Nevertheless, she admits, the cost-benefit analysis is complex. Reduced post-op pain in the laparoscopic approach results in a faster return to work, which may reduce hospital stay and loss of income for the patient, and so reduce indirect costs. However, the direct costs for the laparoscopic approach are normally much higher. The pros and cons of both procedures should be discussed with the patients when deciding on the best approach. The individual skills of the surgeon and institutional facilities should also be taken into consideration. >Come July 18-20, Prof Amid, together with members of UMMC's Department of Surgery will share the laparoscopic technique with fellow surgeons in a workshop run by Aesculap Academy (the education arm of B. Braun) and the UMMC Miles Skill Centre. Full Feed Generated by Get Full RSS, sponsored by USA Best Price. |
| Posted: 13 Jul 2011 02:48 AM PDT Clearing up some of the myths of detox. THE word detox often conjures up sceptical disdain, as well as enthusiastic excitement, depending on who you mention the word to. Stirring this "hornet's nest" may invite a stinging backlash from both proponents and non-believers alike, hence conventional wisdom dictates that one should be mute on the subject. However, there is a compelling need to touch on this sensitive matter as the marketplace is abuzz with so many bizarre practices that hook onto the concept of detoxification, to sell oils, salts, juices, supplements, laxatives and beverages. Some claim to cure ailments from cancer to Alzheimer's disease. Coffee is the bane of many troubles and yet professes some health benefits, which gives caffeine lovers – like yours truly – a reason to continue consuming the beverage. It's flavourful to discerning taste buds in the oral cavity, but for some ill understood and scientifically unaccepted rationale, there are those who prefer to hose the beverage up the other end. Spring-cleaning the gut Colon-cleansing practices date back to the ancient Egyptians, whose belief of decay within the gut led to the concept of "auto-intoxication", a theory that is still held to this day in some circles. Largely rejected by mainstream medicine, various forms of colon-flushing have surged in popularity for the wrong reasons. Competitors to coffee include plain colon hydrotherapy (using water), herbs or other liquids. Apart from experiencing discomfort, there is a risk of injury, infection, and fluid and electrolyte disturbances. Recently, anecdotal testimonials of gallstone-flushing (even in the absence of medical evidence of stones in the gall bladder) have generated confused euphoria. A friend of a friend who undertook a detox fast consumed a concoction of lemon juice, olive oil and laxatives. On the third day, he unabashedly took a video of the stuff that "arose" in the sanitary bowl and announced to anyone who cared to listen that he had passed out 20 gallstones. Hilarious, to say the least, as stones – from the tonsils to the kidneys – do not float! What then are these popcorn-like stuff that can be as small as a pea to as large as the thumb? Firstly, it is mind-boggling to fathom that an object the size of a grape could squeeze through the bile ducts without excruciating pain. Sceptics' rationale for that odd phenomenon that many attribute to stones is in fact due to soap formation (saponification) of the oil ingested. Anything that melts in the sun or the frying pan cannot be stones! After a fast, the stomach acid is at an all-time low. As the acidic lemon juice trickles down, alkaline pancreatic secretions are squeezed into the intestines. In the presence of the alkaline environment, the fats which are already dispersed by the bile juices (emulsification) become flocculated into a waxy deposit, mixed with faecal material. The finishing touches that colour the "stone" green are compliments of bile pigments. The grand finale is when they pop up one by one, to the amazement of the onlooker. Without portraying a jaundiced view, it is acknowledged that drinking a cup of olive oil is certainly going to cause some curious effect on the gut, including contractions of the gallbladder. If there really are stones, one may get impacted in the bile duct and the poor soul would probably land in hospital for emergency surgery for obstructive acute cholangitis! Conversely, there are reports that such gall bladder flushes can eliminate bile sludge or even expel small cholesterol stones of less than 5mm from the gallbladder. However, in the presence of clinically proven multiple gallstones, such flushes may be a little dicey. Until there is conclusive scientific verdict that gallstone extrication can be a safe home remedy, it is unlikely that any surgeon would trade the knife for the prescription of a bottle of olive oil. Vacuuming toxins Another trendy practice is chelation therapy, which apart from binding with heavy metals and poisons, is also purported to reduce cardiac risk. The procedure is not accepted as standard medical protocol but is widely embraced by the alternative fraternity. The process of chelation converts the fat-soluble toxins into water-soluble complexes. After major wars, ground troops exposed to poison gases were given chelation treatment to bind with arsenic to aid its expulsion. In the blood disorder known as thalassaemia, the result of repeated blood transfusions (to treat anaemia) lead to toxic iron accumulation within vital organs. Excess iron is chelated and excreted in the urine. Chelation therapy for other indications are not sanctioned by mainstream medical authorities. Fad list The list of detoxification regimens that are available is voluminous and there are hundreds of books and websites promoting different approaches, just like the many fad diets that are around. As if a 10-day abstinence from solid foods, surviving on lemon, water, maple syrup and cayenne pepper is not bad enough, throwing in two quarts of salt water and laxative tea seals the deal for physiological turmoil! Detoxification is, however, not a myth. The cleansing process is continuously occurring in every compartment via the body's own (endogenous) antioxidant system. The liver takes up most of the responsibility since it is nearest to the port of entry (namely the gut), and involves multiple enzymes, rendering the various metabolic wastes and toxins harmless and water-soluble so that they can be discharged in the urinary waterways. However, any machine has its own threshold, and the liver is no different. There are two phases involved in detoxification – phase 1, where the bad stuff is converted to less toxic residues (in some cases, more poisonous than the parent compound), waiting in queue for the phase 2 processing, where this metabolic garbage is made water-soluble and finally released via the faeces, sweat, breath and the urine. If the toxic burden exceeds the processing, the backlog translates to ill health, such as fatigue, headaches and irritability, to name a few maladies. The much adhered to philosophy of doing a detox is akin to sending the car in for a service and oil change, quite often following prolonged periods of wanton neglect. A 10-day fast does wonders for the conscience but potential disservice to the body due to nutritional imbalances, as well as mineral and electrolyte upheavals. Moreover, returning to old habits after a short-term "cleansing" serves little purpose. Since the body is constantly working round the clock to detoxify naturally, the onus is on the owner to consistently facilitate the task of this wondrous biological self-cleaning machine. Alas, most of us are not aware of the compounding toxic load that modern lifestyle imposes on the body. Yet, some knowingly practise self-sabotage, preferring intoxication over detoxification! > Dr C.S. Foo is a medical practitioner. For more 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. 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| Posted: 13 Jul 2011 02:46 AM PDT Check out this new Hollywood fitness fave: drumstick-smashing. MOVE over, pole-dancing, kettlebells and Zumba. Drumstick-smashing is the latest rage to hit the Hollywood exercise circuit, offering a workout similar to Pilates or boot camp, but without the serenity of a yoga studio or the bark of a drill instructor. The high-volume group fitness class, called Pound, was devised by Cristina Peerenboom, 25, and Kirsten Potenza, 26, who promote it as a fun and energetic alternative to the usual sweat-inducing routines. Using weighted drumsticks or wooden ones provided in the class, members smack the ground repeatedly to a fast-paced soundtrack of hip-hop and rock songs. Once participants are panting, Peerenboom complements their vigour and makes occasional lewd jokes. The two fit, bubbly instructors say they came up with the idea last year at a party attended by rock royalty in the Hollywood Hills. Matt Sorum, former drummer for the rock group Guns N' Roses, had just wrapped up a set on the drums at the rowdy party when the women approached the kit. Both had played drums in the admittedly nerdy setting of school bands and both had been athletes most of their lives. That night, the two worlds collided. "We were drumming without a drum stool to accompany the kit and we were squatting over it and realised that the movement of the arms was acting to throw the entire body off and in order to counteract that, we were having to squeeze ... our core muscles," Peerenboom said. From there, Peerenboom's background as a dancer and choreographer helped piece together a sequence of drumming movements that take the body through a broad range of motion. A typical progression could have drummers standing with legs spread, before moving their torsos in a wide arc, bending to pound the ground next to one foot, standing to smack the sticks together overhead to the beat and then bending to pummel the ground next to the other foot, pivoting back and forth. Another move focuses on abs and back muscles, with pounders sitting on the ground with legs raised, leaning back to form their bodies in a V-shape. They drum the floor alongside their bodies in a move similar to a core Pilates exercise, which requires people to hold the position while swatting their hands up and down 100 times. American College of Sports Medicine spokesman Mike Bracko praised the Pound fitness model, saying "anytime you add music, especially if it's up-tempo music, people just have a tendency to go with the beat of the music" and work harder than they might without it. "Bilateral movements like drumming, with left hand up while right hand is down, in a boat or a lunge position would certainly challenge the core muscles," Bracko added. The class is slated to roll out to nine Equinox gyms across Southern California during the mid-year warm season and to New York and other locations in the United States in the next year. After holding classes at a few private studios in January, Pound classes started up at Crunch Fitness in West Hollywood in March. The gym's new offerings are frequently rolled out to members interested in keeping up with the latest trends in exercise. Every few months, the chain updates or replaces yesteryear's fitness fads, from the spandex-wearing aerobics of Olivia Newton John to kickboxing classes, with fresh offerings like Afro-Brazilian dance, striptease classes and Skatergie, a workout that mimics movements in ice skating. Dozens of people filled the Pound class to capacity recently. With the pounding of the drumsticks, "you're literally hearing if you're doing the workout correctly," said Potenza. But no musical skill is required to break a sweat with drum rolls and fills. "Something we worried about in the beginning was 'are people who don't have any musical ability going to be able to do this?' But I think if you can clap your hands, you can do Pound," said Potenza. The instructors warn people who take their class that although the 45-minute class will zoom by, they can expect to feel it the next day. Cindy Hemming was sore for two days after her first class, but now the athletic 55-year-old is hooked. Though she runs marathons, swims and dances to stay fit, Hemming takes the Pound class three days a week. After a recent class, still breathing heavily and sweating through her clothes, Hemming smiled broadly and said: "It goes by so fast and it works absolutely everything." – AP Full Feed Generated by Get Full RSS, sponsored by USA Best Price. |
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