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Posted: 28 Aug 2011 05:36 AM PDT

A cancer survivor gives back to his community by translating a cancer guidebook.

BEING a health-conscious person, KT Phong was shocked when he was told he had colorectal cancer five years ago (at the age of 64).

That was probably because he had done everything he possibly could to look after his health. He exercised, refrained from smoking and consuming alcohol, and underwent regular medical examinations since he was young.

"But then I thought, since I already have this problem, I have to solve it," he says, as we settle down at a outdoor cafe in the park he visits every morning.

This positive outlook has served him well. However, he attributes his survival to the knowledge he has about his disease, and his determination to lead a normal life despite cancer. He went for treatment and continued his daily exercise routine and made sure he ate even though he did not have the appetite.

"A lot of cancer patients I speak to and their families are shocked when they hear about the diagnosis. They do not know what to do," he says. "Some of them even think that it is as good as being pronounced dead. Actually, it is not that bad. In most cases, cancer can be treated."

His desire to get the message out coincided with an opportunity to do so when he was asked to translate an English cancer guidebook into Chinese. "As a lot of the information on cancer are available in English, this would help those who only read Chinese get the information they need," he says.

The cancer guidebook, titled My Journal, is a nationwide community service project by The Cancer Advocacy Society of Malaysia (EMPOWERED) that serves as a resource for cancer patients and survivors. Its second edition, now available in English, Malay, Chinese and Tamil, comes in the form of a personal organiser that allows patients or caregivers to file their reports or important articles that may help them in their journey with cancer.

Having had first hand experience with the disease, Phong can relate to many of the tips given in the guidebook. Many of them are the side effects of treatment, like hair loss, mouth ulcers, numbness and the loss of appetite.

However, as everyone is different, he encourages fellow cancer survivors to listen to their doctors' advice and take steps to care for themselves.

To this end, having good nutrition and exercise is vital, as eating healthily can give the body the nutrition and strength it needs to heal, and exercising may help reduce the side effects of cancer treatment.

Phong, who does light qigong exercises every morning (even when he was undergoing treatment), gives an example, "If you exercise, you don't feel that bad. You don't have to do (strenuous) exercises. Sometimes, just walking around will do."

When Phong was treated for colorectal cancer, only the first edition of the guidebook (available in English only) was available.

However, as he benefited from the information in the book, Phong showed his support by agreeing to share his story at the launch of the second edition of the guidebook.

"I just want to let people know that some of the things (that are explained in the book) are usually what cancer patients and their families usually have to go through," he says.

While doctors may not have the time to explain and discuss everything in detail, patients and their families can make the best of the short consultation by preparing for it.

In the guidebook, basic information about the tests patients may undergo, the treatments that are available, and the effects cancer can have on their personal relationships, for instance, can help patients list down questions to ask their doctors.

Even though journaling may not be every patient's way of coping with the physical and emotional demands of cancer, Phong says at least the guidebook gives patients some idea about their diagnosis and what they can do about it.

In this case, knowledge can be a good cushion for a patient who has to deal with the shock of a cancer diagnosis.

■ My Journal (2nd Edition) is available for sale at Pantai Hospital Kuala Lumpur, Sunway Medical Centre Petaling Jaya, Sabah Medical Centre and LohGuanLye Specialists Centre Penang. It can also be purchased directly from EMPOWERED! (www.empowered.org.my). For each copy of My Journal sold, a copy will be given free to a less fortunate cancer survivor.

Now you see it ...

Posted: 28 Aug 2011 05:33 AM PDT

Connecting technology, physicians and patients makes common sense. Accessing critical patient imaging data on a mobile device may be useful in a variety of medical settings.

EACH day, referring physicians encounter enormous tasks serving patients and making accurate diagnoses. Regardless of location, they want to be on the go and demand easy access to online patients' images and exams. Being mobile whilst carrying out these tasks is key to a physician's productivity and efficiency.

The cornerstone of such efficiency is technology that can provide broad access to patient reports and images, enhancing communications among physicians and patients, while protecting patient data.

Carestream Health's innovative Vue Motion zero-footprint, Web-based enterprise viewer enables convenient on-demand access to imaging data and patient information by clinicians anytime, anywhere.

"This viewer's support of mobile devices such as Apple iPads and tablet PCs enable referring physicians to view images they have ordered and sharing them with patients, to make faster decisions for their patients and hence improving overall workflow. For the radiologists, the platform offers access to images while they are away from their base for hours or being asked for a second opinion," said Cristine Kao, Carestream Health's Worldwide marketing manager.

"The viewer launches via a Web-browser that can be Windows- or Macintosh-based computers, or mobile devices including laptop PCs, smart phones and tablets. Unlike a dedicated client or app, the viewer does not require a download. Thus, it can be easily deployed to provide high performance and rapid access to images."

The core of every radiology report is the image, yet referring physicians and other clinicians typically see only words. These reports are dictated with conclusions drawn by radiologists. Some radiology information systems support the embedding of images, but even in such cases, referring physicians see only selected views and seldom at a resolution high enough to see the details they want.

Alternatively, clinicians may receive digital images stored on portable media, such as CDs. Providing digital images this way represents an improvement over films, whose delivery outside the facility raises the prospect of loss.

Like films, CDs must be physically delivered yet, unlike films, offer no guarantee that referring physicians will be able to see the images due to the multitude of viewing software applications, file formats, hardware configurations, security settings, and types of media in use today.

Non compliance with the DICOM (Digital Imaging and Communications in Medicine) standard or corresponding IHE (Integrating the Healthcare Enterprise) profile are also issues.

These problems may delay the delivery of appropriate clinical or surgical care and could potentially have a detrimental effect on patient outcomes.

Overcoming these challenges by providing easy access to patient images may cut down on the ordering of duplicate and, therefore, unnecessary imaging exams. This promises to help contain rising healthcare costs and minimise radiation exposure to patients.

This potential was documented in a study of patients transferred from one hospital emergency department to another. When a system for uploading CD images was implemented at Brigham and Women's Hospital in Boston, the rate of subsequent imaging for transferred emergency patients fell by 17%.

The Brigham researchers found that importing images into the picture archiving and communication system (PACS) allowed efficient review by multiple members of the healthcare team, even when those members were at different locations. When attempts to import images failed because a CD was damaged, lost or in a non-standard image format, replacement imaging studies were often performed, driving up healthcare costs, delaying patient care, and often exposing patients to additional ionising radiation and intravenous contrast material, according to the researchers.

If the results from the Brigham study were extrapolated to the 2.2 million patient transfers each year between American emergency departments, successfully importing images to PACS would result in 484,000 fewer CT scans, they reported.

Electronic access to reports and images promises the same benefits as those provided by CDs but with increased efficiency and greater likelihood of the images being readable. This promises to benefit the patient, whose therapy or intervention might begin more quickly or whose concerns might be alleviated sooner. Early efforts toward this goal involved the use of wireless local area networking, utilising viewing software that interfaced far-flung workstations with PACS.

One such network implemented at the turn of this century at Jikei University Hospital in Tokyo connected emergency and radiology departments with future plans calling for extension to all hospital wards, ICUs, ORs, and outpatient departments.

The Japanese researchers later explored this concept further by examining the integration into this network of personal digital assistants, the forerunners of today's tablet PCs and smart phones. Radiological images were displayed on these PDAs using Web browsers. The Japanese researchers concluded that such wireless technology could efficiently handle heavy loads of lossless DICOM image data.

"A zero footprint viewer provides the missing link between radiologists, referring physicians and patients. Accessing critical patient imaging data on a mobile device may be useful in a variety of medical settings, notably in rural medical settings, where primary care physicians may need to consult with specialists such as neurologists," said Kao.

"In every day practice at facilities with electronic medical records, such a viewer, embedded in the EMR system, can provide comprehensive access to images in the context of other patient data. It can do so easily and with no costs in time or money that would otherwise accompany the installation of interfaces between PACS and other information systems, potentially helping to drive the adoption of EMR systems by increasing their utility and clinical value."

Eventually, patients will be on the receiving end of the benefits of computer technology as medical practitioners can enhance customer service as a result of more accurate and insightful diagnosis and reduced, if not eliminate, time and location constraints.

Eat according to your genes

Posted: 28 Aug 2011 05:33 AM PDT

Plagued by a family history of heart disease, diabetes or cancer? Scientists say you can potentially change your destiny, by changing your diet to one that's designed for your DNA.

EVER wonder why some people can stay skinny all their lives, even as they swear by a steady diet of fried chicken and cheesy potato wedges? A common brush-off would be: "It's all in the genes."

In actual fact, that may not be so far from the truth, but don't blame your parents just yet.

Recent studies in the new and emerging field nutrigenetics have unveiled that you can now quell "bad" genes by simply matching your diet to your DNA.

"Genetics doesn't mean that you are destined. It just tells you that you have to watch out," said California-based Dr Shyam Ramakrishnan, Ph.D, of the Nutrilite Health Institute (NHI), which produces Amway's Nutrilite brand of dietary supplements.

The nutrigenetics research and development scientist was in town to visit Amway's headquarters in Petaling Jaya, Selangor recently, after attending the XI Asia Congress of Nutrition in Singapore.

Never mind if you're born with genes that bolster heart disease, diabetes or cancer; scientists say there's hope. Essentially, nutrigenetics is the science of studying how our genes interact with nutrition – and their relation to health and disease.

"Just because your father has diabetes doesn't mean that you will eventually get it too," said Dr Shyam, 45. "Genetics is a loaded gun," he added. "But your lifestyle is the trigger."

Bad genes can be turned up or down, depending on the food and lifestyle choices you make today.

Of course, the general rule is that you have to eat plenty of fruits and vegetables and exercise regularly. What nutrigenetics is saying now, however, is that the one-size-fits-all approach to staying healthy is not necessarily applicable to everyone.

For one, individuals supposedly respond differently to different diets, due to small variations in our DNA. What keeps you healthy (apples and yogurt, for instance) may not necessarily have the same effect on somebody else. Certainly, it's not enough to be packing on fresh juices and leafy greens; you need to know specifically which of the fruits and vegetables work best with your genotype.

"Everyone can be different, even within the same family," said Dr Shyam.

According to him, certain DNA variants have the propensity to reduce the activity of "good" genes. "Some can cause your system to metabolise vitamins inefficiently," he said.

When this happens, one may need double the dosage of vitamins to override the genetic deficiency.

A case in point: while popping a daily 500mg vitamin C tablet may be sufficient for you, others may not benefit from following the recommended dosage to a tee.

So how will you know what's right for your type? The answer lies in a simple DNA test – a cheek swab is enough to disclose whether you have a predisposition towards a certain disease; a personalised diet plan can then be created based on the results.

NHI's Gensona Heart Health Genetic Test, for example, has begun profiling certain individuals based on genetic patterns of the Interleukin-1 (IL-1) gene. Elevated levels of this gene are known to cause inflammation of the cells – a condition that could eventually lead to heart failure.

In a clinical trial carried out on 64 individuals, NHI concocted specialised herbal supplements to create a balance for those who over expressed the IL-1 gene. The results proved that the combination of herbals used were successful in significantly lowering the health risks of the participants.

A New York Times article suggested that mass market products like corn flakes may one day come in different varieties, geared to different subsets of people based on their genes. While this is entirely possible, Dr Shyam believes that customising food according to genotype can be a tad cumbersome.

"A lot of experiments need to be done to uncover the effects of various food pairings on different individuals. Instead of modifying our food, it is easier to introduce customised herbal supplements to our diets."

Despite what you may think, these supplements do not contain gene-modifying properties. "People have this fear that anything with the word 'genetics' is associated with modifying your genes, but that's not true. You can't modify your genes, but you can certainly change how they affect you," Dr Shyam observed.

Nutrigenetics has given new life to the phrase prevention is better than cure.

"Our grandmothers used to say this but we never listened," said Dr Shyam. "Prevention is the key to improving our quality of life."

Nevertheless, the concept of nutrigenetics was never meant to replace the need for medication.

"It's just here to provide you with the guidance on how to live your life in a very optimal way," Dr Shyam explained.

"If it was 50 years ago and someone had a risk gene, he would not be as affected. Today, our whole physiology has changed – we sit in front of our computers for hours. We're also surrounded by environmental risk factors – pollution on the road and cigarette smoke inside a restaurant. Our DNAs may not have changed in the last 100 years, but the environment has, and our lifestyle too."

While D-I-Y genetic tests and personalised diet plans have already been made available to the American public, the service has yet to make headways in Malaysia.

Revealing that the NHI is currently focusing on the areas of curbing diabetes, obesity and cardiovascular conditions, Dr Shyam said: "Nutrigenetics is a growing field. A lot of research still needs to be done. It may take another 10 to 20 years before this type of comprehensive personalised care is available to everyone."

Kredit: www.thestar.com.my

Ahad, 28 Ogos 2011

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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