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Posted: 12 Nov 2011 07:17 PM PST

Stroke leads to acute loss of blood supply to the affected portion of the brain, resulting in irreversible brain damage and loss of bodily functions, including possibly eyesight.

DR Fong: Sudden loss of vision to one of our eyes is one of the most frightening things we can encounter. This is usually caused by a blockage to one of the main blood vessels of the eye. This can be loosely called an "eye stroke".

An eye stroke occurs when a clot forms in a small blood vessel within the eye. The interruption of blood flow destroys the retina, the light-sensitive nerve layer that captures images. The attack is sudden, painless, but can cause partial or complete vision loss in one eye. The other eye is usually unaffected.

Stroke refers to an acute loss of blood supply to any portion of the brain, resulting in irreversible brain damage and loss of bodily functions controlled by that part of the brain.

The eye is connected to the brain by the optic nerve, which directly comes from the brain. In fact, the eye is the only part of our body where we can look at our brain directly. Eye doctors use an ophthalmoscope to look at the optic nerve through the pupil of the eye to look for various eye diseases. Because of this direct eye/brain connection, stroke frequently affects both vision and the ability to coordinate the movements of both eyes.

So, the term "eye stroke' is actually quite accurate.

The retina at the back of the eye requires a constant blood supply. This blood supply makes sure that the cells of the retina get all the nutrients they need to continue working. The blood supply also removes any waste material that the cells have finished with.

Like the rest of the body, there are two types of blood vessels concerned with the blood supply to the retina; arteries and veins. Arteries carry fresh blood from the heart and lungs to all the cells in our bodies. Veins take away the blood that has been used by the cells and return it to the lungs and heart to be refreshed with oxygen and other nutrients.

When the arteries become blocked, then this fresh blood cannot reach the cells and the retinal cells quickly suffer from the lack of oxygen. This stops them working and sight can be affected quite badly.

The amount of sight that is affected varies according to the location of the blockage. We can imagine our blood vessels spreading across the retina like a tree. Thinking of them like this helps in understanding how much sight is affected by an artery occlusion.

The retinal arteries have a large trunk of a blood vessel that splits into smaller branches to feed all parts of the retina. If the trunk of the tree is blocked then a lot of sight will be affected; less sight will be affected if the blockage happens further along in one of the branch arteries.

Supply blockage

The main cause of a retinal artery occlusion is atherosclerosis. Atherosclerosis is a problem with the condition of the inside of the blood vessel's wall. Our blood vessels are like a tube with the blood flowing through it. The tube is usually wide and smooth so that the blood flows directly through it.

However, in some people, the inside of this tube becomes thinner or sticky, which means it is harder for the blood to flow through it. These patches of sticky blood vessels are called atherosclerotic plaques. Problems occur because these sticky patches can catch any debris in the blood, which in turn makes the plaques bigger.

If the plaques become bigger, they can cut off part or all of the blood going to or from the retina. Large pieces of debris can also get caught and block off the blood vessel, leading to an artery occlusion.

A rare cause of retinal artery occlusion is a giant cell arteritis, which is a disease where the blood vessels are blocked due to inflammation of the blood vessel wall. This needs treatment with steroid tablets or injection.

Eye stroke is an emergency and needs immediate attention by an eye doctor to determine whether it is an artery or vein occlusion. Unfortunately, there is little treatment available for retinal artery occlusions because the cells on the retina are very sensitive to a lack of blood supply.

A disturbance for any length of time in the supply of fresh blood to the retinal cells will cause permanent sight loss.

Risk factors

There are a number of common risk factors for eye stroke. They are quite familiar since these same risk factors can cause other problems like heart attacks and brain strokes. The main risk factors are:

·Age – most eye strokes happen in people over the age of 50 years

·High blood pressure

·High cholesterol levels

·Diabetes

·Smoking

·Overweight.

Although nothing can be done about our age, all the other risk factors can be controlled.

Regular visits to your family doctor to diagnose problems like high blood pressure and cholesterol levels, good diabetic control, a healthy diet, and stopping smoking can all help to reduce the risk of getting an eye stroke.

What concerns me is that I am seeing more patients with eye stroke who are younger than 50 years old. This suggests that the general well being of the population in terms of blood pressure control, high cholesterol levels, and diabetes incidence, is getting worse rather than better.

My colleagues in the UK have found that more than 12% of patients who presented with eye stroke went on to suffer a stroke or heart attack within two years, and 70% of these patients had the stroke or heart attack within two months of the loss of vision.

What this means is that getting an eye stroke is an indicator of future severe life-threatening events, and the patient needs to have their general medical condition reviewed and have all their potential risk factors treated adequately.

Being male and having high blood pressure puts you at much higher risk of getting a full blown stroke or heart attack after getting an eye stroke.

An eye stroke is a shock to most people. At first, you may find that you are constantly aware of the change in your vision and that the sight loss in one eye dominates your vision, making it difficult to see using both eyes.

However, after a few months, you will probably find that this becomes less of a problem. This happens because our brains are able adjust to a new level of vision and are able to make the eye with good sight the dominant one.

Usually, people find that with time their good eye "takes over" and that tasks that were difficult become easier. When sight in one eye is affected, it can affect our depth perception. You may find that you have trouble judging distances, how high a step is, or how far away a table is.

With time you should be able to judge these distances better, but you should take care in the first couple of months.

Chui Hoong: What you eat can modulate your risk factors for eye stroke. Your healthy diet should incorporate the following:

1. Fat intake

Cut back on total fat intake. Choose healthier cooking methods. Reduce saturated fat and trans-fat intake. These are found mostly in animal fats (eg fatty cuts of meat), processed foods (sausages, burgers), baked goods (cakes, cookies, pastries, pies) and coconut milk.

Replace the saturated or trans-fat with unsaturated fat sources (eg oily fish, nuts).

2. Fruits, vegetables, wholegrains and pulses

Increase fruit, vegetable, wholegrains and pulses intake. They are good sources of total and soluble fibre, and rich in antioxidants. Fruits and vegetables are also good sources of potassium, which helps to lower blood pressure.

Five portions of fruits and vegetables a day is hardly enough. You should aim to get more than seven portions a day!

3. Maintain a healthy body weight

As a guide, Malaysians should aim to have a body mass index of 19-23.

I have included a simple breakfast recipe that uses oats and is naturally sweetened with fresh fruits. Breakfast is an important meal and it helps in weight management.

> Dr Fong Choong Sian is a consultant ophthalmologist while Goo Chui Hoong is a consultant dietitian. They are publishing a book on eye health and diet next year. For further information, 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 regarding the reader's own medical care. 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.

Oat porridge with banana and passionfruit

OATS are a great breakfast option that can be prepared sweet or savoury.

Oats have a moderate glycaemic index, and keeps you full for longer. Adding fruit into the oat porridge is an easy way to increase your antioxidant intake.

Here, I have included bananas and passionfruit. Feel free to substitute with your favourite fruits.

Serves three

Preparation & cooking time: 10 minutes

375ml (1 ½ cups) skimmed or low-fat milk

½ teaspoon ground cinnamon

95gm (1 cup) wholegrain oats

130gm (½ cup) mashed ripe bananas (about 1 large)

130gm (1) banana, sliced

18gm (1) passionfruit

1 tablespoon coarsely chopped toasted walnuts

To cook the oats:

In a medium saucepan, bring milk and spice to a gentle boil. Stir in oats. Return to a boil, then reduce heat to medium.

Cook one minute for instant oats, five minutes for uncooked oats, or until most of the liquid is absorbed.

To serve:

Remove oatmeal from heat. Stir in mashed bananas. Spoon oatmeal into three cereal bowls and top with some sliced bananas.

Cut the passionfruit into half and scoop out the pulp, seeds and juice. Divide this over the three bowls of porridge. Sprinkle with chopped walnuts and serve warm.

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Beware nerve damage

Posted: 12 Nov 2011 03:53 PM PST

Preventing or slowing down the rate of nerve damage that occurs with diabetes is important.

CAN'T remember the last time you said "ouch"? Do you seem to have lost your senses or have a delayed response when touching something hot or sharp? It may be that your nerves are damaged, especially if you've diabetes. This is called diabetic neuropathy.

"People with diabetes have about a 60% chance of getting neuropathy of any kind," says Dr Dace L. Trence, an endocrinologist and director of the Diabetes Care Centre at the University of Washington Medical Centre in Seattle. "It's probably an equal risk of getting neuropathy with type 1 and type 2 diabetes."

The majority of the peripheral nerves are responsible for sensations you feel such as touch, pain and temperature. There are literally millions of these nerve endings in your fingers, hands, toes and feet, which are designed to keep you out of danger and away from the things that are hot, cold, sharp, etc.

You may have tingling, pain, or numbness in your feet and hands – common signs of peripheral neuropathy. Or you may have damage to the nerves that send signals to your heart, stomach, bladder, or sex organs, called autonomic neuropathy. Nerve damage can also be "silent", meaning you have no symptoms at all.

How can you tell if you have nerve damage?

Doctors diagnose nerve damage on the basis of symptoms and a physical examination. During the examination, your doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch.

Experts recommend that people with diabetes have a comprehensive foot examination each year to check for peripheral neuropathy. People diagnosed with peripheral neuropathy need more frequent foot examinations. A comprehensive foot examination assesses the skin, muscles, bones, circulation, and sensation of the feet.

Your doctor may assess protective sensation or feeling in your feet by touching your foot with a nylon monofilament – similar to a bristle on a hairbrush-attached to a wand or by pricking your foot with a pin.

People who cannot sense pressure from a pinprick or monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly.

The doctor may also check temperature perception, or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception. The doctor may perform other tests as part of your diagnosis, including nerve conduction studies, heart rate check, and even ultrasound of the bladder, etc.

Damage control

The good news? Many of the risk factors for diabetic neuropathy are under your control. So while you may not be able to prevent nerve pain and damage completely, you may be able to help slow it down.

You can reduce your risk of nerve damage and other diabetes complications by keeping your blood sugars under tight control, says the National Diabetes Information Clearinghouse (NDIC).

A healthy lifestyle helps lower your risk of heart disease, stroke, and other diabetes complications, as well. So know your risk for complications, and work to control the ones you can control.

About 60-70% of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk increases with age, as well as the duration of diabetes.

The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood sugar, as well as those with high levels of fat, those who suffer from high blood pressure, and those who are overweight.

Treatment

How are diabetic nerve damage (neuropathies) treated? The first step is to bring blood glucose levels within the normal range to help prevent further nerve damage. Blood glucose monitoring, meal planning, physical activity, and diabetes medicines or insulin will help control blood glucose levels.

Symptoms may get worse when blood glucose is first brought under control, but over time, maintaining lower blood glucose levels helps lessen symptoms. Good blood glucose control may also help prevent or delay the onset of further problems.

Japanese scientists have recently discovered that damaged nerves can be regenerated with a simple supplement known as mecobalamin or methylcobalamin, the active form of vitamin B12.

With mecobalamin, the liver does not need to convert the inactive form of B12, cyanocobalamin, to mecobalamin as it is already orally active. Mecobalamin protects against neurological (nerve) disease and ageing by a unique mechanism that differs from current therapies. Some of the disorders that may be preventable or treatable with this natural vitamin therapy include peripheral neuropathies. Take one capsule of 500mcg three times daily.

Are you at risk for diabetic neuropathy?

1. You have high blood sugar.

The risk: Who are the people at highest risk of nerve pain and damage from diabetes? Those who have trouble controlling their blood sugar.

2. You've had diabetes for many years.

The risk: Nerve pain and damage is more common in people who have had diabetes for more than 25 years.

3. You're overweight.

The risk: Being overweight is double trouble for people with diabetes. It puts you at higher risk of diabetic nerve damage, as well as higher risk of deadly diabetes complications like heart attack and stroke.

4. You're off-target with your blood fats.

The risk: The wrong levels of fats in your blood put you at higher risk of diabetic neuropathy. Often, people with diabetes have high levels of the blood fat called triglycerides. To make matters worse, an elevated LDL ("bad cholesterol") can increase the risk of a heart attack. A grim fact is that about 65% of deaths in people with diabetes will be due to a heart attack or stroke.

5. You smoke. The risk: Smokers are at greater risk of nerve damage from diabetes. And as you no doubt know, smoking has been linked to heart disease for years.

6. You drink a lot of alcohol.

The risk: Alcohol can seriously affect blood sugar levels. Even more sobering? Alcohol can raise your level of unhealthy blood fats called triglycerides.

> This article is courtesy of Live-well Nutraceuticals, for more information, please consult your pharmacist or call Live-well INFOline: 03-6142 6570 or e-mail info@live-well.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 regarding the reader's own medical care. 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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Pregnant travelling

Posted: 12 Nov 2011 03:49 PM PST

Travelling when pregnant is an option; just be smart about it.

ARE you wondering whether you can go for a holiday or a business trip during your pregnancy? Have your friends or relatives warned you not to travel just because you are pregnant?

"Can I travel?" is one of the most common questions I get from my expecting patients. There are a lot of misconceptions regarding the safety of travelling during pregnancy, so many women are confused and tend to err on the side of caution.

While it is right to be cautious, you also need not overreact. There is no reason why you should not nail that sales meeting overseas or enjoy a relaxing beach holiday with your husband, as long as you do it within safe measures and take the right precautions.

When is a good time to go

The best time to travel is during the second trimester of pregnancy, which is from the 14th to the 28th week. At this point, you should not be experiencing any more nausea or vomiting from morning sickness, as that will subside by the end of the first trimester.

Your body will also have adjusted to carrying the baby, so you will not feel as fatigued as you initially did.

Plan your travel around prenatal checkups, so that you do not miss any of these important appointments with your obstetrician.

How about travelling during the third trimester? Conventional wisdom dictates that women cannot travel, particularly fly, during the last three months of pregnancy.

Most doctors advise this because it is risky for the woman (there is a higher chance of going into labour prematurely), not to mention uncomfortable because the uterus is pressing on the bladder and she will get tired easily.

However, some experts have different opinions regarding this. Some obstetricians give their patients the green light to travel if they are in good health and the pregnancy appears normal.

But after week 32, women should not travel by plane, only by car. From week 36, women are encouraged to stay put.

Taking precautions

It is important to consider your travel destination and itinerary carefully.

Avoid going to places where you cannot access good quality medical facilities (cities are generally fine, safari trips are out of the question!), just in case an emergency should occur.

Bear in mind that language, cost and the standard of healthcare in your destination country may be an issue, especially if you are travelling to a less-developed country. Discuss this with your obstetrician, who may be able to give you the contact details of a trusted healthcare provider in that country.

You may need to get certain immunisation shots before you travel to some countries. Check with your obstetrician first whether these vaccinations are safe for your unborn baby.

If your doctor deems it unsafe for you to receive the vaccination, you may want to reconsider your travel plans.

Certain illnesses, such as malaria, are endemic in some countries and can cause serious harm to your pregnancy.

Always carry with you a copy of your medical records, especially information about your pregnancy, allergies, medications and any conditions you are being treated for. Keep these documents in your carry-on bag and with you at all times.

Before you travel, check with your insurance provider whether your health insurance covers prenatal complications or delivery in foreign countries.

Dress comfortably for the journey – wear loose clothing (several layers, if you are travelling in air-conditioned vehicles) and comfy shoes.

For long journeys, make sure you go to the bathroom whenever you need to. Stretch once every hour and take a 10-minute walk every two hours.

If you're travelling by car, make sure you wear your seat belt, with the bottom belt across your hips and below your abdomen.

Drink plenty of water, especially if you are on a flight, and eat small, frequent snacks to prevent low blood sugar and nausea.

While travel is generally safe for most expectant mothers, there are some women who are the exception.

If you have a high-risk or complicated pregnancy (meaning if you are expecting twins, suffer severe nausea and vomiting, have placenta previa or other complications), travel may be out of the question for you, depending on your doctor's advice.

If you have a history of miscarriage, premature labour, high blood pressure, diabetes or bleeding, you should also postpone your travel plans. In all cases, it is always best to check with your obstetrician first.

Do's and don'ts

If you are going on a holiday, these are some precautions you should take when it comes to vacation activities.

Swimming, walking and moderate hiking are acceptable, but use your common sense to decide what degree of activity will be too strenuous for you.

Remember, even though you used to be able to do the difficult stuff, it doesn't mean that they are suitable for you right now.

Certain activities are out of the question, including scuba diving, water-skiing, sun-bathing and saunas.

Scuba diving is dangerous because going deep underwater exerts too much pressure on the womb, while water-skiing can force water into the cervix.

Sunbathing, saunas and hot tubs can raise a woman's core temperature, which is bad for the unborn baby.

You will also tire easily now that you are pregnant, so keep the activities to a minimum. Take the opportunity to relax and spend quality time with your partner or friends – these will come at a premium once the baby arrives!

If you are travelling for work, you may be spending a lot of time in meetings, conferences or on site visits.

Take frequent breaks to put up your feet, if you need too, or to stretch and move your limbs. Make sure that your site visits do not involve any hazardous activities, and that you will not be too far from medical facilities.

Many travel websites and agencies are now promoting "babymoon" packages – a pre-baby honeymoon for expecting parents who need to have one last break before the baby arrives.

The term "babymoon" was coined by a British author and childbirth educator Sheila Kitzinger in 1996. It was initially envisioned as a period where new parents take time to bond together with their newborn baby and adjust to their new roles as mother and father.

Clever marketing by the travel industry has turned the babymoon into a commercial activity, with packages by luxury hotels and resorts.

If you can afford the time and money for a babymoon with your husband, why not? Look at it this way, it will be your first ever trip with your child, even if he/she is still in your womb!

> Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. 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 regarding the reader's own medical care. 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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Kredit: www.thestar.com.my

Ahad, 13 November 2011

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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