The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 17 Sep 2011 04:52 PM PDT Restoring speech and communication after a stroke. Sharon (not her real name) suffered a stroke. On our first meeting, I remember vividly her body language, which was much more expressive than any sentence she could put together. It displayed total openness, and her eyes said it all – "Can you help me?" Although she understood all that took place around her, and showed this by her head nods and hand gestures as we spoke, she had significant trouble when she attempted to speak. As with a few of my other patients, without asking, she gestured me to listen to her speak. "Bow (one), bu (two), tatatata (three), orh (four) ," she counted one to four, raising each functional left finger as she spoke. She then raised her hands in exasperation, and gestured, "Can you fix this?" My first thought was, "Here is a remarkable woman, a fighter," and our journey to recovery began. Surviving a stroke brings a new facet of life, not only to the stroke survivor, but to their loving caregivers as well. "Stroke" by definition means "sudden". It is commonly used in daily language, such as a stroke of luck, a stroke of lightning, and such. It is aptly use by laypersons to depict a cerebral vascular accident (abbreviated as CVA). A stroke is the sudden death of a portion of the brain due to the lack of oxygen. A stroke occurs when blood flow to the brain is hampered, resulting in abnormal function of the brain. It is caused by blockage or rupture of an artery in the brain. Sudden are all its changes. A stroke leads to challenges in walking, eating, everyday self-help skills, speaking, communicating, thinking, information processing, judgement, personality change, and much more. Needless to say, the magnitude of change and the challenges it poses are different for each person, and so is its recovery. Frightening is often a word that describes the feeling of many. Recovery after a stroke After a stroke, some spontaneous recovery takes place for most people. Abilities that may have been lost will begin to return. This process can take place very quickly over the first few weeks, and then, it may begin to taper off. This can be a very frustrating time for the stroke survivor as they become aware of their limitations from the stroke. Often, this is the period where anger or depression can set in. During this period, and even months after, it is helpful to begin intensive rehabilitation to help with regaining lost skills. In more recent times, researchers and clinicians have been studying and documenting the evidence of what we now know as brain plasticity (plasticine-ness if there is such a word). Although not fully understood, it is certain now that the brain is able to change, reorganising itself following damage such that the remaining healthy cells of the brain are able to take over jobs that were previously carried out by brain cells which were destroyed. This means that certain lost functions, such as speech and language, can re-emerge as the result of intensive rehabilitation. One way to do this is to practise your speech, language and thinking skills on a DAILY BASIS. Speech disorders after a stroke can take the form of dysarthria – commonly referring to speech problems due to weak muscles; dyspraxia – referring to the inability to coordinate and perform speech and oral movements in spite of having no paralysis or muscle damage. Language deficits are known as aphasia. Aphasia affects all modes of expressive and receptive communication, including speaking, writing, reading, understanding and gesturing. This can be loosely grouped into either receptive aphasia (understanding skills) or expressive aphasia (expression skills). Needless to say, this means a myriad of possible combinations of the above challenges. It is NOT helpful to compare Mr Ahmad to Mr Ali in the hopes of encouraging our loved ones to work hard. Constant, reliable support is a great accompaniment to stroke recovery. Restoring speech Speech language pathologists are qualified professionals who can assist your family by assessing, planning, working individually or demonstrating what you can do to help with restoring speech and language skills at home. In Malaysia, most government hospitals have at least one attending speech language pathologist today. Others can be found at private hospital set-ups, private centres or home-based visiting clinicians. Every person can be an element of support and encouragement. Here are a few things to bear in mind: 1. Reassure the person that he/she is still needed and important. Include him/her in family activities and decisions even if the verbal output is minimal. 2. Encourage the person to maintain his social life. A good social life builds up one's confidence and motivation to regain his/her speech language and communication skills. Invite his/her friends over (with permission) for casual chats. 3. Make speaking a pleasant experience and provide stimulating conversation. Tell him/her what's been happening, share with him/her no matter what sort of response you get. Ignore errors when possible and avoid criticisms/corrections. 4. Take a calm, friendly, respectful approach when communicating. Remember that you are speaking to an adult. 5. Find a quiet place to talk. If not, minimise or eliminate background noise (such as television, radio, other people). 6. Allow time for the person to understand what you say and to formulate his responses. In Malaysia, we have a growing prevalence of stroke. It has been reported that six Malaysians experiencing a stroke EVERY hour, and about 52,000 Malaysians suffer a stroke annually. Act FAST After countless therapy sessions and the sheer hard work that she put in daily with the support of her loved ones, Sharon now enjoys communication, speaks confidently, and is actively giving back to society in her own way. Albeit needing more time than others, she is now back on both the mobile and email network, is able to cook, read, and drive herself places (after having her car suitably modified). If you suspect someone of having a possible stroke, act F.A.S.T. F – Face: Ask them to smile and see if it's even. A – Arms: Ask them to raise both arms and notice if one drops, or can't be raised equally well. S – Speech: Ask them to repeat a sentence and note if it's perfect. T – Time: Time is off the essence to prevent further damage, so get them to a hospital FAST. If we have family members or colleagues at work who are at risk of having a stroke from an unhealthy sedentary lifestyle, obesity, smoking, and a failure to control their hypertension, diabetes and high cholesterol, paste this reminder on your fridge or your office billboard. You may just give them a second chance at life. > Pamela Thomas Joseph is a speech language pathologist and a member of the Malaysian Association of Speech Language & Hearing (MASH). She will be running a workshop for caregivers on September 24, 2011, in Petaling Jaya, Selangor. For details, contact Coreen at 013-3301728 or email her at coreen@trainingtrack.biz. |
| Posted: 17 Sep 2011 04:50 PM PDT The good and bad of screening tests. PREVENTION is better than cure. This is an oft repeated advice from well-meaning friends. Yes, getting ill these days can be an expensive affair. Some diseases can be prevented if we take the appropriate steps − immunisation, wearing safety helmets and practising a healthy lifestyle are good examples. This kind of prevention is also called "primary prevention". These methods of preventing the occurrence of disease in the first place are the best form of disease prevention. What is screening? For many of diseases, health professionals are still in the dark about the actual causes or the best ways of preventing them. Cancer is a good example. Many causes of cancer have been identified, but the best ways of preventing them from happening is still elusive. Since we cannot prevent them from happening, is it possible to detect the cancer at an early stage when treatment is likely to be more effective? It does sound like a good idea if we can do that. In medical parlance, this is also a kind of prevention – we call this "secondary prevention", or screening. The good Screening aims to try and detect the disease at such an early stage before it causes symptoms or ill health. For example, using mammography (a special kind of breast X-ray), it may be possible to pick up a tiny cancerous breast lump that is not even detectable by the human hand. It is believed that treating the early breast cancer at this stage is easier and more effective (ie the cancer may be curable at this stage). In the case of breast cancer, the screening test mentioned is mammography (an X-ray). In other cases, the screening test may be a clinical examination by a doctor, a blood test, or a clinical procedure. The Pap smear is a clinical procedure that samples cells from the cervix of women with the aim of detecting cells that may indicate an increased risk of cancer of the cervix. By detecting the abnormal cells in the cervix (she does not have cancer yet), the affected woman can be treated, thus preventing her from getting cancer of the cervix. Sometimes, screening can be a simple clinical examination by doctors or other healthcare practitioners. Did you know that getting your blood pressure checked is also considered screening? High blood pressure hardly ever causes symptoms. If your blood pressure is consistently high (after several measurements), modifying your lifestyle or taking blood pressure pills will reduce your chances of getting bad outcomes such as heart attacks and strokes. Screening can indeed be good for the health of the individual when the screening tests lead to the detection of serious health problems in the early stages and starting specific treatment to prevent the associated complications. The bad Since screening is capable of early detection of cancer and other dreadful diseases, is it always a good idea to go for screening? Well, the answer is a guarded yes. It all depends on the type of screening test and the specific diseases that the screening tests are aimed for. A woman had a blood test called tumour marker CA19.9, which has been touted as a good screening test for cancer of the pancreas. Her CA19.9 level was slightly elevated. Despite extensive investigations such as CT scan of the abdomen and an invasive X-ray called ERCP, no cancer of the pancreas was found. She ended up spending lots of money and had to be subjected to tests that may be harmful to the body. A smoker requests his doctor to do a chest X-ray to look for lung cancer. If his chest X-ray is normal, does it mean that he does not have lung cancer? Maybe not, as a chest X-ray can only pick up fairly advanced lung cancer, and it is not good enough to detect very early tumour. The above two case scenarios point to some problems with screening tests: positive results do not always mean the person has the disease (this is called "false positive"), and negative results do not always mean the person does not have the disease (this is called "false negative"). What it means is that many screening tests that are in common use are actually not good enough. This problem has serious implications for the person requesting for screening because doctors may be forced to initiate a wild goose chase for a non-existing cancer. And worse still, the person may be wrongly reassured because the screening test is "normal". Breast self-examination has been promoted as a good way to detect breast lumps that may be cancerous. However, studies in various parts of the world have shown that many women are unable to detect small breast lumps despite being taught the technique of breast self-examination. Women who perform breast self-examination regularly are more likely to have a breast biopsy. Even if breast cancer is detected initially by self-examination, at the end, they did not really fare much better than women with breast cancer who did not do self-examination regularly. Thus, in developed countries, breast self-examination is now not recommended since it does not do much good and may possible lead to potential harm (such as increasing the chances of needless breast biopsy and the associated anxiety). What screening should we go for? Despite the problem with screening tests, there is still a place for screening. The United States Preventive Services Task Force publishes recommendations on screening tests regularly. In this report, the medical problems, type of screening tests, and the screening frequency are clearly identified. Some examples of useful screening tests are: ·All adults should have blood pressure checks. ·Adults with raised blood pressure should be checked for diabetes. ·Adults 35 years and above should have blood lipids checked regularly. ·Men and women 50 years and above should be checked for colon cancer. ·Sexually active women should have regular Pap smears. ·Women 50 years and above should have mammography once in two years. ·Pregnant women should have a HIV test. As the frequency of medical problems vary from place to place, and may be altered by personal characteristics, do discuss whether you need screening (and for which disease) with your doctor. You doctor may recommend screening at a younger age for specific conditions if your family has a hereditary type of disease. If you have certain risk factors (eg obesity, family history of heart attack), you may benefit from earlier checks for diabetes and blood lipids level. Many of us have friends and relatives who have gone for "screening packages" that include a battery of tests. Not unusually, one or more of these tests may be abnormal and eventually may turn out to be erroneous or harmless. The tumour markers in particular is something that is seldom needed in a general medical checkup. Screening tests should ideally be done after careful consideration of its benefits and potential harms. > Dr C.L. Teng is a family physician at the IMU Specialist Clinic, International Medical University. He is also professor & head of the Department of Family Medicine, International Medical University. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my. The Star Health & Ageing Advisory Panel provides this information 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 regarding the reader's own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article. |
| Posted: 17 Sep 2011 04:48 PM PDT September 15 marked the eighth anniversary of World Lymphoma Awareness Day. The event aims to increase public awareness on lymphoma, in terms of symptoms of the disease, diagnosis, and treatment modalities. THE incidence of lymphoma is increasing, with one million people worldwide living with lymphoma and almost 1,000 patients diagnosed every day. In Malaysia, according to the National Cancer Registry 2007, lymphoma is the sixth most common cancer among Malaysians and the sixth most common cancer in males, whereas in females, it is the eighth most common cancer. The Chinese were found to have a higher incidence rate of lymphoma in comparison to Malays and Indians. Even though it is one of the most common cancers diagnosed, there is still low public awareness on lymphoma compared to other cancers such as breast and lung cancer. The following is some pertinent information on lymphoma as shared by consultant haematologist Datuk Dr Vijaya Sangkar Jaganathan. What is lymphoma? Lymphoma is the general term for cancer of the lymphatic system, and it is one of the more common cancers that is faced by doctors worldwide every year. The lymphatic system is comprised of lymphatic vessels/tract and lymph nodes in the neck, armpit, chest, abdomen and groin. Functionally, the lymphatics sieve and remove excess fluids from the body and play an important role in the immune system. The core lymphoma pathology is abnormal white cells called lymphocytes, which become cancer cells, multiply, and accumulate or infiltrate the lymph nodes. Lymphomas are divided into two categories: Hodgkin's Disease (HD) and Non-Hodgkin's Lymphoma (NHL). The main differentiating feature is from the microscopic description from a biopsied tissue sample, thus explaining the mandatory lymph node biopsy for an accurate diagnosis. Generally NHL is more common than HD. Worldwide, the incidence is reported to be increasing either due to earlier detection or an absolute rise in incidence. The need to differentiate the pathology has therapeutic implications since HD and NHL are treated with different types of medications, and generally have variable outcomes. Risk factors The exact risk factors or etiology for the development of lymphoma is essentially unknown, but people with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, auto-immune disease and previous radiation exposure have a higher risk of developing this cancer. Infections with Epstein Barr Virus have been noted to be a trigger factor in genetically prone persons. This however has not been consistently seen. Some of the more common presenting clinical features in lymphoma patients are as follows: ·Enlarged and palpable lymph nodes, commonly in the neck, armpit and groin. ·Unexplained febrile illness. ·Loss of weight. ·Loss of appetite. ·Unexplained itch/pruritus. ·Chest tightness, swelling and breath difficulties. Assessment The most important initial assessment is a thorough history and a complete physical examination, paying particular attention to other medical and surgical issues in the individual. Physical examination also aids in looking for the best possible site for lymph node biopsy, with minimal morbidities. After a solid pathological diagnosis is achieved, the individual will have the following tests performed for completion of clinical staging and risk stratification: ·Blood test to determine organ function ·Imaging, commonly whole body CT scan and occasionally PET scan ·Bone marrow examination The initial assessment will give the treating doctor a complete view of the disease, taking into account the stage of disease, co-morbidities, and prognostic factors. Such information is vital in designing a treatment plan. One important lymphoma feature that is not used in many risk stratification guidelines is bulk of disease. The size of the lymph node does play a crucial role in determining treatment type, schedule and consolidation therapy. Clinical trials are suggested to some eligible patients, but this pathway is not very well accepted in this country in comparison to many parts of the world where most of their patients are involved in ongoing clinical trials using newer modalities of treatment or therapeutic breakthrough. However, in the past three to five years, many more of our patients have consented to be involved in clinical trials. This will enable doctors to understand the disease better and improve treatment outcomes. The ultimate staging in lymphoma is not to be accepted as something dreadful, although we know that Stage I/II do better than III/IV; staging is used to determine the intensity of treatment and for consolidation therapy once treatment is completed. Overview of treatment Not all lymphomas need to be treated as soon as possible. This is true for low grade lymphoma such as limited stage follicular lymphoma. A small cohort of NHL can be treated with surgical and antibiotic therapy, but this is very infrequent. Stage I or very limited stage Hodgkin's lymphoma can be solely treated with involved-field radiotherapy. A large majority of patients would require treatment, and they are generally grouped as follows: ·Cytotoxic chemotherapy. ·Targeted therapy using monoclonal antibodies. ·Combination chemo-immunotherapy. ·Stem cell transplantation, usually using autologous cells as a measure to consolidate treatment after the initial intensive chemotherapy to optimise long term outcomes. (Autologous means using the patients own stem cells after the disease is controlled.) No two lymphomas will behave in the same way and this is because of the different disease biology, thus making interim assessment vital. For patients who demonstrate first line or second line chemotherapy resistance, the long term outcome is generally poor. Salvage therapy is sometimes advocated and if they do show chemosensitivity, than allogeneic (using a sibling or a matched unrelated person) stem cell transplantation can be performed. Despite this, a significant cohort can still relapse. Cure is possible in lymphomas when it is detected at an early stage or in very limited stage disease such as Stage I-II non bulky disease. Certainly, with current modalities of treatment, cure is seen in limited stage Hodgkin's lymphoma. Low grade NHL is essentially non-curable, but adequate therapy can put a patient in long term remission. In comparison, high grade lymphomas are treated more aggressively, and in certain situations, upfront stem cell transplantation is advocated after a complete remission (a state of disease-free period) is achieved. This decision is based on individual response, ie chemosensitivity, underlying medical fitness, level of tolerance to chemotherapy, and infection risk. Can you prevent lymphoma? Lymphoma is not a hereditary disease, and in general, nothing can be done to prevent you from getting this cancer as the cause or etiology is not clearly understood and it is probably related to underlying somatic mutation in a genetically prone person. From his years of experience in managing lymphoma cases, Dr Vijaya highlighted some important points to consider when an individual is faced with lymphoma: ·Undergo complete assessment to get a good overall picture of disease. ·Be compliant to therapy. ·Do not take antioxidants during chemotherapy as this may technically protect cancer cells and make chemotherapy less effective. ·Increase fluid intake. ·Consume healthy and cooked food. ·Stay away from crowded areas to minimise infection risk. ·Do not consume herbal or any other traditional supplement as this may interact with conventional chemotherapy, making them either more toxic, or chemotherapy less effective. > Some useful websites on NHL include www.lymphomacoalition.org; www.lymphoma-net.org; www.lymphoma.org.au; www.lymphomainfo.net. |
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