The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 07 Sep 2011 03:09 AM PDT Drs Yahoo and Google may be readily available when you feel that ache or pain, but the dangers of self-diagnosis cannot be overemphasised. THE neighbourhood hardware shop is stocked with an assortment of D.I.Y. equipment. Speaking from experience, hanging the family portrait on a wrong nail may bring it crashing down, not to mention the hole in the wall as the plaster is sloughed off. In a similar vein, there is plenty of information regarding health and disease from the media, magazines, books, and the most voluminous of all, cyberspace. These days, we have Dr Yahoo and Dr Google that offer many seemingly convincing diagnostic algorithms to help the "surfer" find the clue. Alas, quite often, an arrow or two is misdirected, pointing the way to misdiagnosis. Search engines are great vehicles for information. However, a little knowledge is risky and too much material is a liability, both clouding judgement. We cannot deny the benefits that can be tapped from cyberspace, only if one is discerning enough to differentiate objective information from junk. Googling a specific symptom brings on an entire list of possible conditions, each apparently describing a situation closely similar to the problem. Upper abdominal discomfort is a common complaint in many intestinal ailments, ranging from indigestion, gastritis, pancreas inflammation, gallstone or even cancer. Not infrequently, a sinister heart attack can mimic symptoms of gastritis. Like a multiple choice question, the answer is one or all of the above! Headaches and high blood pressure are commonly associated with one another as the throbbing head discomfort has been described in severe hypertension. However, in general, elevated blood pressure is frequently asymptomatic, thereby lending a false sense of security. Apart from making the wrong call, attempts at self-diagnosis can create distress. The state where the concern about a particular symptom becomes disproportionate to the condition, to the extent of causing distress and anxiety, is known as hypochondriasis. Many such personalities believe that the minor irritation that they have picked up is attributed to a serious underlying disease, based on what they have read or heard. Despite the reassurances of the physician (whom they mistrust in the first place), these poor folks continue searching and will literally spend a significant part of their wealth chasing one imaginary diagnosis after another. Eventually, some will land in the uncharted territory of quack science, after exhausting doctors and themselves. Extracting pieces of the jigsaw puzzle from cyberspace and pasting them in an "ad hoc" manner create a distorted impression, often leading to a gravely wrong conclusion. The computer information age has given birth to a new category of sufferers in "dis-ease", namely victims of "cyberchondria" (unfounded anxiety pertaining to health issues after assessing health and medical websites). A recent encounter with Mr X exemplifies the dangers of why and how too much information in a salad bowl of facts and fancies can clog mental digestion. He was annoyed by the incessant flatulence and bloating after meals. His "research" brought him to many web addresses, each discussing a disease, with one being more serious than the other. In the end, he was convinced that he had "leaky gut", pituitary disorder, inflammatory bowel disease, and finally, developed insomnia after reading up on colon cancer! Subsequent investigations confirmed that he was harbouring a stomach bacteria called H. pylori. Treatment would have been a simple and short course of a couple of antibiotics that have been shown to eradicate this bug. Unfortunately, he "read somewhere" that antibiotics are detrimental and he opted for "natural therapy" instead. Eventually, he chose a fasting regimen (presumably to starve the bacteria) and a herbal extract based on the advice of an internet holistic practitioner. If Ripley's Believe It Or Not opens its doors to pseudoscience based on fantastic facts and fancies, there will be no standing room. The sad part is people out there readily embrace what they read. There is the case of an old lady in the advanced stage of malignancy, who was given some sort of "fish DNA" to repair the genetic material (which purportedly triggered the cancer in the first place). One may find it amusing, but some people take this seriously! One of the gravest dangers of self-diagnosis is missing out on red flag symptoms that can be rather subtle. Constipation and piles are common complaints that occur concurrently, with the former innocuously leading to the latter. What may not be so innocent is when the constipation is part of a recent change in bowel habits and the blood is more of staining, mixed with stools, or discoloured rather than squirting like a tap. This calls for professional assessment rather than seeking answers from Dr Google! An obese diabetic may be overwhelmingly pleased with a sudden loss of weight, as that article described correctly that reduced BMI improves sensitivity to insulin, thereby improving blood sugar. Unfortunately, there is bad news hidden in between the lines, as the reverse is true. As the blood sugar shoots through the ceiling, a state of cellular starvation sets in, with the breakdown of fat and protein. This leads to a state of ketoacidosis and weight loss, which is potentially dangerous, with coma imminent if left untreated. Anyone who can read would have come across an article or headline rolling the drumbeat of heart disease, diabetes, cancer and many other chronic ailments, which is the pivotal formula to sell the newest snake oil, highest grade supplement, herbs, drugs and health packages. The mushrooming of private laboratories, pharmacies, hospitals, clinics and naturopathic centres have made health assessment "competitive". It is an inherent tendency to get "value for money" and it is no different when it comes to undergoing a health screening. Apart from pricing, the most common query is, "How many tests are included?" The cost of building a high quality house should not be based on the number of bricks alone, but the quality of the material used! It pays to be austere, but don't sell your health to the lowest bidder. The trend of today's marketplace is "going direct", bypassing the very important assessment of the physician. In arriving at a diagnostic interpretation, there is more than meets the eye. How does one react to isolated deviations from the norm? What about the slightly raised lipids, borderline blood sugar, and a hint of liver enzyme disturbances? There is also the tendency towards denial as those who seek self testing often choose to dismiss certain signs, for example, the slightly raised blood pressure and the expanding waistline. These little derangements are the warning lights of worse things to come, as in all likelihood they are the beginning of the metabolic syndrome (the harbinger of a host of chronic ailments such as hypertension, diabetes, etc). Failure to recognise this crucial pre-disease state may rob one of optimal health in years to come. However, if appropriate focus is given to these biochemical rumblings in the early stages and the right action instituted, potential disasters can be averted. Unfortunately, the test records often find its home in a remote drawer, blissfully out of sight and out of mind. With the widespread availability of information and wider acceptance of alternative medicine, many do resort to self-medication or acquiring herbal remedies, occasionally purchasing products online, in the same shopping cart with Victoria's Secret! With the ever expanding list of over-the-counter drugs, which are medications that can be obtained without a doctor's prescription, many patients do the necessary purchase for simple ailments from the neighborhood pharmacy. Generally, most trivial illnesses do not need a whole lot of medication in the first place, other than for the relief of symptoms. A common household drug like paracetamol can cause nasty allergies in susceptible individuals or liver damage in accidental overdose. Self-diagnosis and treatment can run the risk of missing out on a more serious underlying condition. A persistent nasal congestion may be more than the common cold, turning out to be acute sinusitis. That severe "gastric" pain that is not relieved by antacids may be masking a perforated appendix! Health supplements hit the market in waves. Some are very science-based, high quality and effective, while some are fads, fail to meet required standards, and are of dubious benefit. These products fill up the shelves of pharmacies or the garage of some direct selling distributor. Due to overhyped sales literature and pressure to sell, there are times that a poorly trained store clerk or product distributor endows oneself with a false sense of empowerment, giving erroneous advice to replace medications with supplements. This is a dangerous trend as titration of medication falls solely on the shoulders of the doctor. Information is a double edged sword, as it cuts both ways. Used correctly, it transforms into knowledge that is objective and sound. Conversely, if the wrong kind of information is pieced together, it becomes a potpourri of shaky ideology, leading the seeker from one dark hole to another, ultimately towards an abyss of confusion, much to the detriment of self and others. > Dr C.S. Foo is a medical practitioner. For further details, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional. 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. |
| Posted: 06 Sep 2011 04:52 PM PDT The National Poison Centre is the only centre in the country that serves health professionals and the public on chemical safety and poisoning related information, including venomous bites. What is the role of the National Poison Centre (NPC) and what part does it play in emergency cases such as poisoning or bites by poisonous creatures and insects? Adilah Mohamed Ariff, senior pharmacist and head of Service Call Centre Unit at the National Poison Centre, Universiti Sains Malaysia, Penang, gives us more insight about the centre's services. Does the National Poison Centre provide antivenom to state hospitals to treat cases involving bites by poisonous creatures (venomous snakes) and insects (wasps, jellyfish stings)? The National Poison Centre does not stock/develop/import any antivenom, but it facilitates enquiries on availability of antivenom in Malaysian hospitals. We have a database on the availability of antivenom based on information provided by pharmacists in local hospitals. Hospitals do not import antivenom directly but purchase them from local pharmaceutical companies licensed by the Health Ministry to import the antivenom from manufacturers. In the absence of antivenom, an anti-tetanus jab ALONE is not sufficient because both have different functions. Antivenom neutralise venom while anti-tetanus jab prevents and treats tetanus, (a.k.a. lockjaw), a serious bacterial infection. In Malaysia, what are the typical (common) poisonous snake bites? Based on epidemiological studies in Malaysia, the Malayan pit viper, cobra, shore pit viper and Wagler's pit viper are the four commonest species of snakes associated with snake bite envenomation. However, there are also many cases where the snake was unknown as victims can't see the features clearly. It's important to see as much as possible the physical appearance of the snake even though we can't identify it by name. Remember the shape of the head and the colour of the body as these details may be helpful to identify the possible type of the snake and to differentiate between the venomous and non-venomous snake. Identification of the snake may help to save the bite victim's life as appropriate antivenom can be given immediately. There are three common families of venomous snakes in Malaysia: > Elapidae family – cobra, King cobra, kraits, coral snakes. > Crotalidae family – Malayan pit viper, shore pit viper. > Hydrophidae family – most of the sea snakes. What should be done in an emergency? Do's 1. Phone or send for medical assistance. 2. Reassure the the victim who may be very anxious and encourage him/her to remain calm. 3. Have the victim remain as still as possible. Do not attempt to catch or kill the snake. 4. Immobilise the bitten limb with a splint or sling because movement or muscular contraction increases absorption of venom into blood and lymphatics. 5. Apply a pressure bandage to the envenomed limb. If the bite is to the trunk, apply firm pressure to the bitten area. The only universally accepted bandage technique is recognised as "pressure immobilisation bandage (PIB)". This technique is done by putting splint and bandage with a "not so light and not so hard" pressure. However, if the type of snake is unknown or the rescuer is not familiar with PIB, simply help the patient to remain still as much as possible while seeking medical assistance. Pressure immobilisation method may prevent or delay the development of life-threatening paralysis from cobra, king cobra, kraits and sea snake bites. Ideally, an elastic, stretchy crepe bandage about 10 cm wide and 4.5 metres long should be bound firmly around the entire bitten limb, starting distally around fingers or toes and moving proximally, to include a rigid splint too. It should not be too tight that the peripheral pulse is occluded or that a finger cannot easily slip between its layers. Important: Pressure immobilisation is recommended for bites by neurotoxic elapid snakes including sea snakes, but should not be used for bites by vipers whose venoms cause local necrosis. 6. Remove any items or clothing which may constrict the bitten limb if it swells (rings, bracelets, watches, footwear, etc). 7. Avoid any interference with the bite wound as this may introduce infection, increase absorption of the venom and increase local bleeding. If there is any bleeding on the bite site, hold a clean cloth/cotton on the area for about 5 minutes until the blood stop. 8. Where possible, help should be brought to the patient rather than moving the patient. Don'ts 1. Do not apply any traditional or even modern topical cream/lotion/ointment. 2. Do not tie or apply tourniquet at any part of the limb because it may cause venom to deposit in one area, causing more complications like compartmental syndrome and/or disability. 3. Do not incise the bite site. 4. Do not suck the venom with any method. 5. Do not apply hard pressure on the bitten area. 7. Do not give the victim anything to eat or drink, especially consumable alcohol that may accelerate absorption of venom. 8. Do not administer stimulants or pain medications to the victim, unless specifically directed by a physician. What if a person is bitten by a cobra on the neck? The same emergency measures can be taken as a bite on other parts of the body; minimise movement and seek medical assistance as soon as possible. Are there cases of tarantula or other poisonous animal bites? To date, no tarantula bite cases have been referred to the NPC. However, other unknown type of spider bite cases have been referred as well as bites by scorpion, centipede, bee, wasp, ant, and marine poisonous creatures like jellyfish, puffer fish, catfish, red snapper and red tide (harmful algal bloom). Based on an unpublished study in 1999-2001, the actual number of cases admitted to government hospitals due to animal toxins exposure outnumber poisoning cases involving chemical agents. However, very few animal bites cases were referred to NPC. What is the role of the National Poison Centre with regards to assistance given to public, private hospitals and the public? Its Drug and Poison Information Services (DPIS) is available to the public and health professionals 24 hours a day, seven days a week. E-mail enquiries are also entertained from time to time. NPC can be consulted on: > Acute and chronic poisoning involving drugs and medicals products, pesticides, household products, industrial chemicals and natural toxins. > Misuse and abuse of medicines/drugs. > Drug-related problems, including adverse reactions. Currently, the DPIS is fully utilised by health professionals from government health facilities, with an increasing number of poisoning cases referred for enquiries every year. Enquiries from private hospitals and the public are still very few since not many poisoning cases are admitted to private hospitals and most Malaysians will normally send poisoned patients to hospitals rather than call the NPC beforehand. NPC also assists health professionals and public in dealing with poisoning cases through prevention, education and training programmes. Laboratory analysis is also available for them to identify poison in products or biological sample. > The National Poison Centre 24-hours Drug and Poison Information Service – (Monday-Fridays: 8.10am–5.10pm): 04-657 0099 or 1800-88-8099; after-office hours (weekends & public holidays): 012-430 9499; website: www.prn.usm.my |
| Posted: 06 Sep 2011 04:52 PM PDT WHEN a bee or a wasp is spotted, it's only natural for us mere mortals to take flight. None of us want to be stung. And it's also a smart move not to antagonise any unfriendly or stray dogs to avoid them sinking their teeth and tearing us apart. An army of fire ants or even a lone ant can cause pain and swelling if one is bitten. Some people suffer more from allergic reactions to ant bites. In Malaysia, there are no antidote for centipedes bites or bee, wasp and jellyfish stings. (according to National Poison Centre). Victims are sent to the hospital for symptomatic treatment and supportive care. There are likely to be antivenom for snakes in most general hospitals, particularly in Kedah (where the incidence of snake bites is higher, probably due to the prevalence of paddy fields). Here's a quick look at what to do in case you get bitten by some of these creatures. Dog and cat With their strong jaws, dogs can crush tissue and tear the skin when they bite someone. The bite can be susceptible to infection. Cats leave puncture wounds because of their thin and sharp teeth. These wounds can reach into joints and bones and introduce bacteria deep into the tissue. Wash the wound with plenty of soap and warm water to remove dirt, saliva and bacteria. Next, wash with antiseptic solution and apply antibiotic ointment. Cover the wound with gauze or a bandage. Then, seek medical advice. You may have to take antibiotics to prevent an infection, and a tetanus booster. If you are bitten by a wild or stray animal that could have rabies, you may need anti-rabies treatment. Fire ant The fire ant sting causes red hive-like lesions that burn and itch, and sometimes cause painful pus-filled lesions. Cold packs, pain relievers and antihistamines can relieve discomfort. Take note that a large number of stings may trigger a toxic or severe life-threatening allergic reaction. Centipede Centipede bites do not occur as frequently as ant, wasp, bee or hornet stings. Large centipede bites can be intensely painful, though rarely fatal. They puncture the skin with their powerful pair of clawed legs located behind the head. They use the legs and claws like syringes to draw venom within the body trunk and inject it into the victim. The centipede bite can cause pain (like a bee sting), redness and localised swelling. More serious symptoms can be intense itching, local tenderness, headache, swollen lymph glands, dizziness, nausea, palpitations, anxiety and increased blood pressure and local tissue damage. Wash the bite area with soap and water to minimise infection. Apply ice at 10 minutes interval or a cool wet dressing and a local anesthetic agent for pain relief. Seek medical care if symptoms are serious. Bee and wasp Bees and wasps inject venom with their stinger. Sometimes, the stinger may be left in the skin. The venom of bees and wasps is poisonous. Allergic reaction of the stings can result in serious medical problems and deaths. This occurs in certain people whose immune systems are allergic (overly sensitive) to the venom. When they get stung, their body may overreact to the poison and trigger an allergic reaction in the body. Whilst multiple stings increase the potential danger in allergic cases, a serious or even fatal allergic reaction can occur from a single sting. In serious cases, most deaths from stings occur within the first hour. Pull out the (honey) bee stinger quickly to reduce any reaction to its venom. Honey bees leave a stinger in the victim while wasps, yellow jackets and hornets do not. There will be redness, swelling and pain at the sting site. Although the pain subsides, swelling may last more than a day. Oral antihistamines or calamine lotion will help relieve itching and ice pack, to reduce swelling. If symptoms worsen or the victim has breathing difficulty, epinephrine is required. If a victim has been stung more than 10 times, send him to the hospital. Antihistamines can slow an anaphylactic reaction (a life-threatening allergic reaction) reaction but won't stop it. Python The bite can cause stiffness and swelling. The treatment for a puncture (the bite) is a tetanus shot. Watch for possible signs of infection, like red streaks up your arm a few days after the bite. Sea urchin It can be quite a torture if you accidentally stepped on a sea urchin. Some of them have spines several inches long. They are driven into the skin when one steps or falls on or brushes against the creatures. The hard spines of these echinoids can break and lodge in the skin, causing much pain. Secondary infection follows if the spines are left in. One has to tediously extract every one of the spines for relief. Treatment of any injury caused by a sea urchin should be conducted by a physician because attempts to remove spines yourself can cause the spines to fracture within your skin. Embedded pedicellaria (tiny forceps-shaped growths of a sea urchin) can still pump toxin into the human body. Sometimes surgery is necessary to remove deeply embedded spines. Tetanus shots are usually administered to prevent an infection at the puncture or bite site. Corticosteroids help curb itching around the wound while hydrocortisone can help decrease inflammation. Jellyfish Swimmers sometime get stung by jellyfish and the pain can be stinging, sometimes life-threatening. A sting by venomous types of jellyfish such as a box jellyfish purportedly can cause death in minutes. The tentacles of jellyfish are covered with sacs filled with venom. Other than the pain, there may be itching, rash and raised welts. Progressive effects may include nausea, vomiting, diarrhoea, lymph node swelling, abdominal pain, numbness/tingling and muscle spasms. Severe reactions from the stings can lead to difficulty in breathing, coma and death. Peeing on the jellyfish sting site is a common suggestion by swimmers who swear that it works for pain relief. But then, it does not work for everyone because urine does not always have enough acid to neutralise the venom. Rub sand on the sting area quickly until it does not feel slimy. Do not rinse the sting with fresh water (unless it is the sting of a man of war, a jelly-like marine invertebrate, which has a different type of venom). You can also rinse away any remaining jellyfish tentacles using hot water if possible (or salt water). Fresh water may worsen the stinging pain. Remove tentacles with a glove (not bare hands), stick or tweezers. The tentacles can still sting after they've been ripped from the jellyfish. |
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