The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 17 Dec 2011 04:03 PM PST Quality of life counts when it comes to this painful and debilitating condition. CANCER is not a word that any of us take lightly; oftentimes the term equals death in our minds, despite the strides that have been taken in medicine in treating cancer. The disease is caused by rapid and abnormal cell divisions that result in a tumour, which ends up choking the organ, and eventually, the body. A benign tumour — like a large mole on the skin — is not life-threatening, whereas a malignant tumour continues to grow and brings about death, if treatment is not sought. The metastasis of cancer essentially means the movement of cancer cells from the primary site of growth to other parts of the body through the bloodstream, causing secondary tumours, and even, tertiary ones. Cancer can occur in any part of the body, and though there is treatment for these cancers, not all are effective. Certain organs, like the liver and pancreas, are harder to treat and cure because they are such crucial organs to life, and they are also easy targets for metastasis. The spinal cord is another such organ. In a healthy human, the spinal cord monitors, collects and sends information from the body to the brain for processing. Together, the brain and the spinal cord make up the central nervous system. This delicate structure is protected by the spine, which is made up of vertebrae and the skull. Cancer can occur in the spine either as a primary cancer, or through metastasis, which results in a secondary cancer. Cancer of the spine requires urgent attention. If left untreated, the cancer cells can destroy the spinal bones (vertebrae), causing enormous pain, and also, instability of the spinal column. In some cases, collapse of the vertebrae is a possible result. When this happens, the cancerous mass may compress the spinal cord or the spinal nerves, resulting in pain, paralysis, sensory failure, and loss of bowel or bladder control. A world of pain Spinal cancers can be extremely painful in the late stages. According to Baltimore-based healthcare service provider Lifebridge Health in the US: "For the patients who develop symptoms, understanding the treatment options and choosing the most appropriate one can be very stressful and confusing." Depending on the type and stage of the spinal cancer, various forms of treatment modalities are available today, ranging from chemotherapy and radiotherapy aimed at destroying the cancerous cells to surgical treatment. When combined together, surgery plus radiotherapy can potentially give the best possible outcome to some patients. "When metastasis occurs, the spine is an easy target," says Dr Mohd Hisam Muhamad Ariffin, orthopaedic and spine surgeon at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Cheras, Kuala Lumpur. There is no specific data regarding spinal cancer in Malaysia. However, according to LifeBridge Health, spinal metastasis occurs in about 70% of cancer patients. In an autopsy study, spinal metastasis was found in nearly 90% of cancer patients. In the United States, about 18,000 cases are diagnosed with spinal metastasis annually. Symptoms of spinal cancers include mild to excruciating pain, which is typically pain that can wake you up from sleep. Sometimes, this type of pain can be mistaken for arthritis or muscular spasms. "Cancers of the spine can result in the patient having compressed nerves or (compression of the) spinal cord; (vertebral) bones become destroyed from the cancer and can't hold the person's body upright anymore. "This results in the patient being immobile, (either) from pain or from being paralysed due to the spinal cord compression. "They can also feel a lot of pain and the patient has a very poor quality of life," explains Dr Hisam. Moreover, if the cancer is detected late, and it is in its advanced stage, surgery is usually not recommended by doctors. Most treatment at this point is for pain management and keeping patients as comfortable as possible. "At present, some doctors are of the opinion that as the cancer is incurable, carrying out the surgery is a waste of time and money. Besides, the know-how to do so is limited to particular medical centres. "But with the increase in cancer occurrence, including cancer of the spine, more and more people are facing the decision of whether (or not) to opt for surgery," says Dr Hisam. He adds that he advocates improving the quality of the patient's life, which should be the priority for the patient's caregivers. Improving quality of life According to Dr Hisam, there are many ways of helping improve the patient's quality of life. Currently, when a patient comes with a simple compression fracture from spinal metastasis, doctors would suggest the use of a brace, a short course of radiotherapy, or sometimes, a simple surgical procedure called a vertebroplasty or kyphoplasty. In this procedure, cement is injected into the destroyed vertebrae through small needles inserted into the spine, using X-rays for guidance. The injected cement has two functions, to make the diseased bone stronger and to relieve pain. For spinal cancer patients who suffer from paralysis due to spinal cord compression, and eventually, the destruction of the spinal co-lumn, Dr Hisam advocates surgery to remove the compression from the spinal cord. According to him, most doctors use titanium metal implants to stabilise the column. The surgery can be performed via the traditional open method or using minimally-invasive spine surgery. In the latter, metal implants are inserted via small incisions, utilising special instruments. After the surgery, patients are normally scheduled to undergo a short course of radiotherapy. For Dr Hisam, opting for metal implants to increase the patient's quality of life makes sense. "If the patient is fit for surgery and the money is available, patients should consider undergoing surgical treatment to improve their quality of life," he says. In his opinion, to be able to sit up and walk, even if it is just around the house, is a great boost for the patient. Furthermore, pain is also reduced, and their bowel and bladder can be controlled, which is a big improvement for the patient. "We want to educate patients with such medical conditions on why they should consider intervention via surgery and radiotherapy, even if the patient is terminal," he says. High quality innovative spinal implants are available in Malaysia, but the cost of the titanium implants can be expensive. Patients and their family will have to weigh the cost carefully. However, for civil servants and pensioners, the Government will bear the cost of the implants for procedures done at public hospitals, like UKMMC. > The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. Full content generated by Get Full RSS. |
| Posted: 17 Dec 2011 04:00 PM PST A family's experience in fighting whooping cough, and how their lives have been changed by it. SHEILA Prasannan and her family's determined fight against pertussis (also known as whooping cough) is an experience to be shared with all. This contagious respiratory disease caused by the bacteria Bordetella pertussis, infected the entire family in a matter of days through the inadvertent transmission from mother to baby, and eventually, to the rest of the family. Pertussis can be difficult to diagnose as the early symptoms of this disease resembles that of the common cold or bronchitis. In addition, pertussis occurs more commonly in children because its symptoms are hardly diagnosed in adults. As a result, the disease often goes undetected, misdiagnosed or undertreated in both adults and children. This was precisely what Sheila and her baby experienced when they contracted the disease and were initially misdiagnosed. A normal cough? On July 12, Sheila gave birth to her second son, Krishen, at a hospital in Kuala Lumpur. Two weeks after discharge, she developed a mild cough and sneezing, which gradually became more frequent. Worried that she might pass on the cough to her baby while breastfeeding him, she went to a clinic for a check-up. "I was informed by the clinic's doctor that it might be my asthma recurring, although I had not had asthma symptoms for 15 years. The doctor also assured me that it was safe to go on breastfeeding my son, though my doubts on this persisted," she said. She was then treated for asthma and given a course of antibiotics. However, her cough became progressively worse over the next few days, and was accompanied by bouts of vomiting. Sometimes, a "whoop" sound could be heard while she gasped for breath at the end of a coughing spell. Various clinics that she once again visited informed her that it was just a mild cough and would go away. Some even concluded that it was food poisoning! Sheila's worst fears were confirmed when her infant son started coughing and vomiting as well. His cough increased with frequency over the next week until he was coughing every few minutes and gasping for breath. "I took my son to a paediatrician, who told me that it was just a normal cough and that I should not overly worry about it. "My son was also given a course of antibiotics. Unfortunately, his cough failed to get better. "My own cough by then had become really bad and I was vomiting almost every five minutes. Breathing also became very difficult for me as my asthma had now recurred," she added. It's pertussis! As Sheila and baby Krishen's health continued to worsen, they were both taken to a nearby hospital and admitted for observation. The doctor attending her case was quick to suspect that both mother and child had contracted whooping cough and administered them a course of antibiotics used to treat pertussis. "The doctor explained to me that whooping cough is a very serious childhood illness and is less common in adults. "In addition to fever, sneezing, vomiting, and runny nose, the severity of the cough can cause a child to turn blue or experience bleeding within the whites of the eyes during severe coughing spells. "Life-threatening complications such as fits, broken ribs, brain and lung damage, pneumonia, and even death, can occur in very severe cases. "He also explained that because my son had not been vaccinated against pertussis, it was easier for him to contract it. I was also very surprised that pertussis could affect adults too," she shared. While in the hospital, Sheila's elder son, 1½-year-old Naga, her husband and mother also contracted the cough, although in a milder form. All three of them however, are recovering as they were immediately put on the same course of antibiotics as Sheila and Krishen. How life has changed After both mother and baby were discharged from hospital, Sheila proceeded to find out more about whooping cough from various resources and online websites, and came across a Positive Parenting (PP) article on 'Pertussis in Adults' in The Star Online. "I am very grateful to PP for having published this article as not many Malaysian resources online give such detailed information on whooping cough. "Through this article, I also managed to get in contact with the author of the article, Datuk Dr Zulkifli, to get a second opinion, and learn more about this disease. "Because pertussis is highly contagious, Dr Zulkifli advised us to quarantine ourselves for about 100 days to observe if this disease progresses. He has been guiding us ever since," Sheila added. She describes this contagious illness as "a living nightmare", and has yet to fully recover from the symptoms of pertussis. She recalls feeling the utmost frustration that many medical practitioners lacked knowledge on pertussis, and this added to her own sense of helplessness as she herself had never heard of whooping cough before. Had there been more widespread information on whooping cough, the doctors may have been able to detect the disease as pertussis much earlier, and given them the right tests, medications and vaccination needed to fight the infection. "I strongly advise other parents to get the pertussis booster shots for themselves and for their children as soon as possible, as it is better to pay a little more now than to bear the consequences later on. "Also, read up online to get more information, even though you or your children have (only) a slight cough or cold. Get different opinions from different medical professionals so that you know your options to make an informed decision," Sheila advised. Both her children have now been vaccinated with DTaP vaccine (Diptheria-Tetanus-acellular Pertussis), a recommended childhood immunisation, and are now in the stages of recovery. The adults need to be vaccinated with the adult Tdap vaccine, which has lower pertussis and diphteria antigens, compared with the childhood vaccine. Get vaccinated "There are vaccinations for both children and adults to protect against pertussis. "In Malaysia, infants are given the DTaP vaccine at two, three, and five months, plus a booster dose at 18 months of age. Children at age 7 receive Diphtheria and Tetanus (DT) vaccinations (but not the pertussis component). "However, because the protective effects of the vaccine wear off after four to 12 years, children, adolescents and adults have to be re-vaccinated against the disease. It is advisable that they are vaccinated with the Tdap vaccine, which is used as a booster shot to reinforce immunity," advises Dr Zulkifli. If you are pregnant and want to be vaccinated against whooping cough, it is advisable to wait until the second or third trimester before getting the vaccination. For those of you who intend to travel overseas, it is advised that you get the pertussis booster shots to reduce your risk of contracting the disease while abroad. In any event, do consult a doctor or paediatrician for the optimum time to get vaccinated. ■ This article is courtesy of the Malaysian Paediatric Association's Positive Parenting Programme that is supported by an educational grant from GlaxoSmithKline. For further information, please visit www.mypositiveparenting.org Fast facts ● Pertussis can cause serious illness in infants, children, and adults, and can even be life-threatening, especially in infants. ● Worldwide, there are 30-50 million cases of pertussis, and about 300,000 deaths per year. ● More than half of infants less than one year of age who get pertussis must be hospitalised. ● Vaccination of pre-teens, teens and adults with Tdap is especially important for families with new infants. Full content generated by Get Full RSS. |
| Posted: 17 Dec 2011 03:58 PM PST We take a look at ADHD. ATTENTION deficit hyperactivity disorder (ADHD) comprises behavioural symptoms of inattentiveness, impulsiveness and hyperactivity. People with ADHD have a short attention span, are easily restless, get distracted easily and fidget incessantly. Whether ADHD is an extreme form of normal behaviour, or part of a separate range of behaviour, is not well understood. It is estimated ADHD affects about 3-9% of schoolgoing children and young people, and about 2% of adults. It is the most common behavioural disorder in many countries. ADHD starts at an early age and becomes obvious when the child's situation changes, eg starting school. It is more common in males. Whether ADHD can occur in adults without it occurring in childhood has not been elucidated. It is estimated that at age 25, about 15% of childhood ADHD patients still have a full range of symptoms, and 65% have symptoms affecting their daily lives. What causes ADHD? The causes of ADHD are not well understood. It is believed to be due to a combination of genetic and environmental factors. ADHD occurs in families. Both parents and siblings of a child with ADHD are four to five times more likely to have ADHD. Brain function in ADHD is different from people without the condition. It is believed that there is impaired function of the brain chemicals that transmit messages. Activities in the sections of the brain that control attention and activity appear to be less. There are also findings that indicate impaired function of the frontal lobes that control decision-making, and altered levels of chemicals like dopamine and noradrenaline. Pregnant smokers and alcohol and drug abusers have an increased risk of giving birth to a child with ADHD. Males are more likely to be diagnosed with ADHD. This may be because loud and disruptive behaviour are more noticeable in males. It may also be that the diagnosis is missed in females because they are more likely to have attention deficit disorder (ADD), which is a type of ADHD. Although there is insufficient evidence linking television to ADHD, it is believed that watching tv for several hours a day by children below three years of age could be a contributing factor to attention problems and ADHD later. There are suggestions of associations between ADHD and common food allergens like milk and wheat. Other suggested causes are premature birth (before 37 weeks of pregnancy), low birth weight, brain damage in utero or in the first few years of life. Symptoms of the disease The features of ADHD can be classified into two: inattentiveness, and impulsiveness and hyperactivity. There are three types of ADHD, ie mainly inattentive, mainly hyperactive-impulsive, and combined. The combined type is the most common. The mainly inattentive is also known as ADD. As females are more likely to have ADD, it is possible that the condition is more common than thought because of underdiagnosis. The features of inattentiveness are a short attention span; easy distraction; forgetfulness; carelessness; inability to concentrate, carry out instructions and carry out time-consuming tasks; and constant changing of activity. The features of impulsiveness are acting without thinking; interrupting conversations; inability to wait for a turn; breaking of rules; and inability to appreciate danger. The features of hyperactivity are inability to stay still; continuous fidgeting; excessive movement and talking; and inability to carry out tasks. ADHD is associated with other conditions like epilepsy, involuntary movements and sounds, sleep disorders, learning difficulties, anxiety disorders, depression, and conduct disorders, which is usually associated with antisocial behaviour. However, there is no effect of ADHD on intelligence. The features of ADHD in adults are more subtle. They include carelessness, forgetfulness, restlessness, inability to focus or prioritise, irritability, mood swings, risk taking and poor organisational skills. There may be problems in respect of relationships, drugs, employment and crime. ADHD is associated with obsessive compulsive, bipolar and personality disorders. There is no single diagnostic test for ADHD. If the condition is suspected, an appointment with the doctor is advisable. The doctor will ask about the symptoms and its impact on the child's quality of life, any changes in social circumstances, family history of ADHD, other health problems and any functional effects, eg inability to make or keep friends or to wash or eat, underachievement in school, and disciplinary problems. A referral to a specialist may be made for a detailed assessment which includes a physical examination; tests for short-term memory, concentration and problem-solving skills; and a series of interviews or reports from parents, teachers and/or partners. There are diagnostic criteria in children. They must show symptoms continuously for at least six months beginning before the age of seven (in some cases, a diagnosis can still be made if symptoms do not start until after); having symptoms in at least two different settings, eg at home and at school; and showing symptoms that make social, academic or occupational lives more difficult, which are not just part of a developmental disorder or difficult phase, and are not accounted for by another condition. There are no diagnostic criteria for adults. Currently, a diagnosis of adult ADHD cannot be made unless symptoms have been present since childhood. The symptoms cause impairment of daily activities, eg keeping friends and relationships, underachievement at work or in education, and dangerous driving. Managing ADHD There is no cure for ADHD. However, treatment reduces its severity and makes life less problematic. A combination of medicines and therapy is the best approach. Treatment is usually prescribed by a psychiatrist and can be monitored by the general practitioner. The medicines include central nervous system stimulants, eg methylphenidate and dexamfetamine, and a selective noradrenaline uptake inhibitor, ie atomoxetine. The medicines provide a short period after each dose for the ADHD person to be calmer, less impulsive, concentrate better, and learn and practise new skills. All the medicines used in treating ADHD are prescription items. The dosages will be small initially, and may then be increased gradually. The factors considered by the doctor before prescribing include the presence of any other health conditions, its side effects, its contraindications, and whether the dosage prescribed interferes with school or work. All three medicines cannot be prescribed for pregnant or lactating females. Methyphenidate cannot be prescribed for patients with glaucoma or severe depression. Dexamfetamine cannot be prescribed in patients with car-diovascular disease, eg high blood pressure or overactive thyroid (hyperthyroidism). Atomoxetine cannot be prescribed for those with glaucoma. As is the case with most medicines, all three have side effects. Regular check-ups by the doctor are necessary to assess the effectiveness of the medicine. If there is improvement, the doctor may advise a break from medicine for a short period to assess how the patient manages without the medicine. There are different modalities of therapy. Psychotherapy involves the patient discussing the condition and its effects. This can help the patient to cope and live with the condition. Behaviour therapy involves managing behaviour with a system of rewards and penalties. This also provides support for parents, teachers and carers. Appropriate behaviour is rewarded with praise and encouragement, while there is a small penalty for inappropriate behaviour. Cognitive behavioural therapy (CBT) involves the therapist trying to change how the ADHD patient feels about a circumstance, which would in turn lead to a change in behaviour. This would help increase self-esteem, reduce negative thoughts, and improve problem-solving skills. Social skills training involve the child participating in role-play. Its objective is to teach the child how to behave socially by learning how their behaviour affects others. Parents and caregivers can also learn management skills, eg specific ways of talking to the child and working with them to improve attention and behaviour. This also increases the parents' confidence in their ability to care for their children and their relationship with their child. As with everyone in the population, regular exercise is beneficial for a person with ADHD. Other treatment modalities used include omitting the consumption of certain foods and the taking of supplements. However, there is no scientific evidence that they work. Needless to say, it would be prudent to seek medical advice prior to embarking on these modalities as they are potentially harmful if carried out in the long term. Although there is no cure for ADHD, it can be managed with a combination of medicines and psychological, social and education therapies. Continual compliance with treatment will make life more manageable for patients, parents, carers and teachers. > Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. Full content generated by Get Full RSS. |
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