The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 25 Aug 2012 04:25 PM PDT CrossFit, a strength and conditioning programme that utilises a short-duration, high-intensity protocol using constantly varied functional movements, has long been known for its punitive workouts. This writer shares her experience with the gruelling exercise programme. FOR someone who trains up to five times a week, you would think that three bouts of burpees, push-ups, sit-ups and squats; interspersed by a 100m sprint in between, would be nothing, right? Wrong! Barely five minutes into the timed challenge at a CrossFit beginner's course, I was down and panting like a dog. I thought my heart was going to explode. The experience left me gobsmacked, and frankly, quite embarrassed. I mean, hello, this is someone who's been known to regularly attend back-to-back spinning classes, yet there I was, emerging from the hellhole-challenge as the single most pathetic weakling on the planet. More alarmingly, what transpired served only as a mild glimpse of a broad spectrum of gruelling workouts inherent to the exercise programme. CrossFit Inc, a fitness company founded by Greg Glassman in 2000, first gained popularity in the early 2000s and is known for its intense regimes and punitive WODS (workouts-of-the-day). To date, it is practised by members of approximately 3,400 affiliated gym, most of which are located in the United States. Essentially, it is a strength and conditioning programme that utilises a short-duration, high-intensity protocol using constantly varied functional movements. It is also the training programme of choice for many police academies and tactical operations teams, military special operations units, champion martial artists, and professional athletes. In short, CrossFit is something of an exercise nightmare for the average Jane, and if its killer reputation doesn't make you quake in your shoes, walking into a CrossFit gym to suddenly find that you're the least fit person amid a throng of super-strong regulars will. Admittedly, my first visit to Pushmore, the pioneer CrossFit affiliate in Malaysia and South East Asia did leave me pretty intimidated. The gym, which occupies the premises of Merchant Square in Petaling Jaya, is decidedly Spartan at first glance. Minus the gigantic weight machines and treadmills I have grown so accustomed to, this self-proclaimed "fitness enthusiast" was suddenly lost. Meeting Jonathan Wong, Pushmore's compact and muscular founder, did nothing for my floundering self-esteem. He has muscles on his muscles, for crying out loud! Wong, who is also the founder and director of CrossFit Malaysia, shares that he started the gym in 2008 after he stumbled upon the exercise programme on the Internet just the year before. While he acknowledges that CrossFit can overwhelm the unsuspecting newcomer, he tells this writer not to freak out. "The point of CrossFit is to take in the kind of training that athletes perform and make it accessible to the masses," he explains. "Athletes train for specificity – whether it's to run faster, lift heavier weights or throw a javelin further. "What CrossFit does is combine these training regiments from different sports with the aim of promoting 'all-round fitness'." Something of a one-size-fits-all programme, Wong adds that because the programme is designed for universal scalability, the same routines are used, whether you are an athlete or a housewife. "Athletes strive for performance, but a housewife still needs a certain amount of strength training to perform her daily routine, such as picking up things from the ground, picking up the kids or a flowerpot. "We don't change programmes. Instead, we scale load and intensity according to an individual's abilities and fitness levels." CrossFit incorporates three types of movements, Wong elaborates: Gymnastic movements (that use your own body weight); weightlifting (using equipment like dumbbells, sandbags, barbells and kettlebells); and metabolic conditioning (which incorporates cardiovascular activities such as sprinting, skipping, swimming and cycling. "All these elements make up our workouts, and we vary them so the body is constantly challenged." The variation will result in a steady rise in your fitness level that can span up to 10 years, he says. "No other exercise programme can actually do that." Currently, Wong, who looks only to be slightly taller than this 1.63m writer, can carry up to 210kg, a vast improvement from his 130kg marker only five years before. Other improvements he has experienced include a change in his body composition. "My body fat percentage has gone down from 8% to 5-6%, he says (the average body fat percentage for a fit adult male usually ranges between 14-17%, while a professional athlete strives to keep a body fat percentage between 6-13%). But while CrossFit can offer significant gains in strength and even long-duration endurance events, the high-octane nature of the programme also leads to higher injury risks. A classic CrossFit injury would be like the case of one Brian Anderson, a 38-year-old member of the special weapons and tactics (SWAT) team in a sheriff's office in Tacoma, Washington in the United States, who ended up in intensive care and developed rhabdomyolysis (rapid breakdown of the muscle tissue due to injury) after his session of CrossFit. Anderson had attempted to swing a 44-pound steel ball with a handle over his head and between his legs. The goal was to do 50 quick repetitions, rest and repeat. But just six months later, Anderson was back in the gym, performing the very exercises that put him in hospital. "I see pushing my body to the point where the muscles destroy themselves as a huge benefit of Crossfit," he told The New York Times in a 2005 interview. Glassman himself had said that CrossFit can kill you. Wong does not discount the regiment's risk, even to those who are already exercising, but approaches the subject more pragmatically: "I think any programme can kill you. People who play football or tennis get heart attacks and die. You can die even if you walk out the street." That said, he concedes that CrossFit can be very dangerous when implemented incorrectly, especially for those who jump into the programme without prior screening. The Foundation Series at Pushmore (the beginner's course that this writer undertook), aims to introduce core movements such as the "snatch" and the "clean", and CrossFit concepts to beginners, to mitigate the risk of injuries. Wong, who has been training up to six times a week (and often two to three times in a day) to compete in the upcoming CrossFit Games (the Olympics of Crossfit, if you will), says he has sustained a series of injuries himself: "I've injured my back, shoulder, elbow, knees... everything. But as an athlete, I accept that injuries are part and parcel of my training." But don't let all that put you off. Beginners are generally encouraged to go slow to ensure that they're working out and moving first before they load. Members at the gym are also constantly monitored by a group of instructors that are certified by the American Council on Exercise (ACE). They currently have six instructors on board. Despite its brutal reputation, Wong is adamant that anyone can take up the programme, including older adults and even those who are a little on the chubby side. "My oldest client is 62," says Wong. "Even my son, who is seven-years-old, is doing Crossfit, but as more of a game than a structured programme. "The goal is to introduce exercise as a lifestyle and not as an option or hobby. If you don't make the time now, it will probably be too late when you finally do." It has been seven classes, and I am just one class away from completing my beginner's course as I write this. Last night, I attempted a handstand push-up in class – an exercise that strengthens the shoulders and core – without success, ending up a sweaty, defeated pile on the floor. The truth is, I haven't been able to do most of the movements that are integral to the programme so far (they include things like ring dips, pull-ups, chin-ups and push-ups) and that can be rather discouraging. I can't even do five proper push-ups to be honest. But between taking up this new challenge to get harder, faster, better and stronger, and crawling back to the familiar comforts of the spinning studio, I am opting for the former. Simply because I'm a believer in moving forward and pushing my limits. (And also because I am just kiasu like that...) After all, if a 62-year-old can do it, why can't I? n Fiona Ho is a fitness enthusiast and an aspiring CrossFitter, who aims to be able to do 20 push-ups by the end of the year. |
| Posted: 25 Aug 2012 04:22 PM PDT There are a few factors that contribute to the successful management of a twin pregnancy and delivery. TWINS could either be non-identical or identical. Non-identical twins arise from two ova fertilised by two separate sperms. Each twin has a separate placenta. They have separate sacs, each with an inner membrane (amnion) and outer membrane (chorion). Two out of three of all twin pregnancies are non-identical (dichorionic diamniotic). Identical twins occur in one out of three twin pregnancies. They arise from a single ovum fertilised by a single sperm, which then divides into two identical embryos. If the division occurs in the first three days after fertilisation, the twins will have their own placenta and membranes (dichorionic diamniotic). Their ultrasound appearance will be the same as non-identical twins. If the division occurs between the fourth and ninth day, the twin will share the same placenta and chorion, but have separate amnions (monochorionic diamniotic). If the division occurs after the ninth day, the twins will be in a single sac (monochorionic monoamniotic). Two in three identical twins are monochorionic diamniotic; one in three dichorionic diamniotic and one in 100 monochorionic monoamniotic. The diagnosis of twin pregnancy is enhanced by routine ultrasound. Without it, about four in 10 twin pregnancies will not be diagnosed until 26 weeks gestation, and about two in 10 remain undiagnosed until term. Ultrasound in the first or second trimester will usually determine with more than 95% accuracy if the twins share the same placenta. The detection of foetal anomalies, of which the incidence is three times more in twin pregnancy, is best done with ultrasound between 16 and 20 weeks. Foetal growth can be reliably assessed with serial ultrasounds in the second and third trimesters. The incidence of twin pregnancies has increased worldwide and is the major reason for the increase in pre-term births. More than five in 10 twin, and more than 98 in 100 triplet, pregnancies deliver before 36 weeks gestation. Because of the increased incidence of pre-term births, these babies will need to spend some time in the neonatal intensive care unit. There is no single method that predicts the likelihood of pre-term labour and birth. However, there is evidence that pre-term labour and birth can be predicted by vaginal examination, which detects premature change in the state of the mother's cervix. There is also evidence that ultrasound measurement of the cervical length and/or the presence of cervico-vaginal foetal fibronectin is predictive of pre-term labour. It is essential that there be a discussion with the obstetrician about the modes of delivery early in pregnancy. They are vaginal delivery or Caesarean section, which can be planned or unplanned. Because the likelihood of complications with twin deliveries is increased, an early decision will also have to be made about the place of delivery as neonatal intensive care units (NICU) are only found in certain hospitals. Labour Labour in twin pregnancy is the same as that of a single pregnancy. The lie and presentation of each foetus is checked on admission, preferably with ultrasound. An intravenous line would be inserted, and blood sent for screening and/or matching. The obstetrician, anaesthetist, paediatrician, neonatal intensive care unit and operating theatre are informed early that there is a twin pregnancy admitted. Both foetuses are monitored closely with continuous electronic monitoring of their heart rates. A foetal scalp electrode may be applied to the first twin when the membranes rupture. Labour may need to be augmented. Pain relief with an epidural is often recommended as it facilitates assisted delivery, should problems arise. The indications for any intervention for either twin are evidence-based. Vaginal delivery About five in 10 twins are delivered vaginally. The delivery process is the same as that of a single pregnancy. If the first twin is presenting by the head and there are no obstetric or medical problems, the obstetrician will usually recommend a vaginal delivery. The occasions when vaginal delivery is assisted with a vacuum extraction (ventouse) or forceps are similar to that of a single pregnancy. After the first twin has been delivered, the obstetrician will perform an abdominal and vaginal examination to determine the longitudinal axis (lie) and presenting part of the second twin. If the lie is longitudinal, the membranes of the second twin will be ruptured artificially (amniotomy), and labour augmented with an intravenous drip containing oxytocin, if the contractions have slowed down or stopped after the first twin's delivery. If the lie is not longitudinal, an external cephalic version (ECV) may be carried out, followed by amniotomy and augmentation of labour. Alternatively, the obstetrician may insert a hand into the birth canal to grasp one or both foetal feet and draw it through the cervix (internal podalic version), followed by a breech extraction. Internal podalic version (IPV) requires a skilled obstetrician and is not done often nowadays. If the second twin, with an estimated weight between 1.5 to 4.0kg, is presenting by breech, a vaginal delivery can be carried out, provided the obstetrician is comfortable with, and skilled in, vaginal breech delivery. The maternal and neonatal outcomes of breech extraction with or without IPV are the same as ECV in twins weighing more than 1.5kg. The optimal delivery interval between the first and second twin has been debated often. It is reasonable to expedite delivery of the second twin by amniotomy, intravenous oxytocin and assisted vaginal delivery. Alternatively, it is also reasonable to allow a longer interval between the deliveries, provided the foetal heart rate, monitored electronically, is reassuring. However, if a breech extraction with or without IPV is considered, it should be done without delay. Caesarean section The reasons for planned Caesarean section include a breech (buttocks, feet, or knees) presentation of the first twin, a transverse lie of the first twin, twins with a shared placenta, conjoined twins, triplets and other higher order pregnancies, and indications as in single pregnancies, eg placenta sited over the birth canal (praevia), maternal hypertension, and difficulty in previous delivery. Sometimes, a mother may choose to have a Caesarean section even when there are no complications. An unplanned Caesarean section will be carried out should any problems arise during labour or after the delivery of the first twin. The former includes maternal hypertension, non-reassuring foetal heart rate(s), an umbilical cord dropping into the birth canal below the foetal presenting part (cord prolapse), poor progress, or failed assisted vaginal delivery. The latter occurs in less than five in 100 twin deliveries, and is usually because of non-reassuring foetal heart rate. Pre-term babies The longer the foetuses are in the mother's uterus, the higher are their chances of being healthy. Pre-term birth has immediate and long-term health implications for the babies. The earlier the birth, the higher is the risk to health. One out every two babies born before 24 weeks live, and the other may die or have long-term problems. On the other hand, the survival rate of babies born after 32 weeks is high, and most do not develop long-term complications. Pre-term babies have immediate problems with breathing, feeding and maintaining temperature. This requires nursing in an incubator, oxygen by mask or ventilator, and feeding by a tube inserted into the stomach or into a blood vessel. Pre-term babies born in a hospital with a NICU have the best outcomes. However, not every hospital has a NICU. As such, it may be necessary to transfer the mother and babies to another hospital with a NICU, preferably before delivery, or if not possible, immediately after the babies' births. The longer term problems of pre-term babies include developmental delay, asthma, behavioural problems and learning difficulties. The earlier pre-term birth occurs, the more likely the babies will be readmitted to hospital in the first few months of life, compared to those born at full-term. There are several factors that contribute to the successful management of a twin pregnancy and delivery. The most important are a competent and dedicated obstetrician, paediatrician, anaesthetist and nursing staff with adequate medical equipment. In short, effective teamwork makes the difference. n 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. 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. |
| Posted: 25 Aug 2012 04:21 PM PDT Going for regular eye examinations and eating the right foods are the key to preventing loss of eyesight from this common condition. WOULD you rather lose your eyesight or a limb? How about giving up 10 years of your life in exchange for your eyesight? If you would rather lose a limb or 10 years of your life than go blind, you are not alone. A recent international survey by eye healthcare company Bausch + Lomb found that two-thirds of the 11,000 respondents from 11 countries around the world would rather shorten their lives by 10 years than to lose their eyesight. The results of the survey called Barometer of Global Eye Health announced last month, also revealed that 68% preferred to lose their limbs rather than their sight, while 78% would rather give up their hearing, and 79%, their sense of taste. Despite that, the survey found that less than one-third of respondents take the necessary steps to preserve their eyesight, with only 21% having gone for regular eye examinations over the past five years. And the reason given by 65% of those respondents who do not examine their eyes regularly for not going for these check-ups is that they did not have any eye symptoms. However, this is a dangerous line of reasoning, as many eye diseases can develop quite extensively without any obvious symptoms. One of these diseases is age-related macular degeneration (AMD). How we see According to consultant ophthalmologist Dr Kenneth Fong, AMD is the leading cause of blindness in people aged above 60 years in the developed world. As stated by its name, AMD is a disease of the macula, that area of the eye that is the most sensitive part of the retina. Our retina, located on the rear wall of our eyeball, is where the images we perceive are received as different frequencies of light waves, and translated into electrical signals to be sent to our brain, where they are processed into the images we actually see. The retina is able to do this as it is made up of specialised photoreceptor cells that are sensitive to light. These photoreceptor cells can be divided into two main types, named after their shapes: cones and rods. Each type has its own particular speciality; cones enable us to make out fine detail and colours under daylight conditions, while rods provide our sight in low-light or night conditions. The macula contains most of the cone cells in the retina, hence, enabling us to read, write, drive, recognise faces, and do fine work, like sewing and handicraft, among others. These cone cells are particularly concentrated in the fovea, which is the central region of the macula. The macula itself is located next to the optic nerve bundle, which sends the signals from the eye to the brain. Wear and tear There are two forms of AMD: dry AMD, which makes up 80% of cases, and wet AMD, which comprise the rest. Dry AMD is essentially caused by the breakdown of the photoreceptor cells in the macula. The scary thing about this condition is that it is untreatable, and symptoms only start to show up after it has progressed to the intermediate stage. In addition, it is primarily a condition of old age, due to the wear-and-tear our eyes go through after functioning for several decades of our lives. And its incidence is increasing in Malaysia because as Dr Fong points out, "our population is growing older and living longer". Although its symptoms, like blurry vision, requiring more light to see and loss of central vision, only show up later in the progression of the disease, dry AMD can be picked up earlier by eye specialists. Part of a regular eye examination – ideally done once a year – includes dilating the eye to give the ophthalmologist a better view of the interior of the eyeball. This method enables the doctor to better detect yellowish deposits called drusen on the retina, which are a sign that dry AMD might develop. Dr Fong explains that as we grow older, a cellular layer called Bruch's membrane, located between the blood vessel-rich choroid and the waste-processing retinal pigment epithelium (RPE), becomes less permeable. This causes the waste from the RPE to start to accumulate on the membrane, which results in drusen. (The RPE is in charge of processing waste from the photoreceptor cells, which are located just next to it, on the opposite side to Bruch's membrane.) However, Dr Fong notes that while all cases of dry AMD have drusen, not everyone with drusen will develop dry AMD. Preventive diet You might be asking at this point why should anyone bother undergoing an eye examination every year to detect this condition when it cannot be treated anyway? The reason is, research has shown that the progress of AMD can be prevented and slowed down by certain foods and nutritional supplements. Consultant dietitian Goo Chui Hoong shares that a major clinical study called the Age-Related Eye Disease Study (AREDS) had found that a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc, delayed the progression of the disease. The results of the study published in 2001 showed that those at high risk of developing AMD, including those with intermediate AMD and advanced AMD in one eye only, had their risk of the disease progressing further lowered by 25%, and their risk of vision loss lowered by 19%. However, no apparent benefits were seen in those who had early or no AMD. "So, diet is the only way to delay it, and there is definitely evidence to support that," she says. Goo adds that while there are plenty of nutritional supplements available in the marketplace, consumers who want to delay their AMD must be careful to ensure that they get the right doses as the AREDS concentrations are higher than the norm. In addition, they should consult their doctors before taking such high dose supplements as such high doses might have adverse effects under certain conditions. The effective concentration of the antioxidants taken in the study were 500mg of vitamin C; 400 I.U. of vitamin E; 15mg of beta-carotene; 80mg of zinc as zinc oxide; and 2mg of copper as cupric oxide to help prevent copper deficiency due to the high levels of zinc consumed. Goo also shares that the current ongoing AREDS 2 study is looking at the effects of replacing the beta-carotenes in the original formulation with lutein and zeaxanthin, as well as examining the effects of adding omega-3 polyunsaturated fatty acids to the group of supplements. "Certain beta-carotenes are used in the AREDS formulation now, but they cannot be taken by smokers because it increases their risk of lung cancer," she explains. "In AREDS 2, the beta-carotenes are replaced by lutein and zeaxanthin, which are xanthophyll pigments found in the retina that help protect it against UV rays." These pigments need to be obtained through the diet, and are particularly abundant in green, leafy vegetables. This fact also explains why previous research has suggested that people who eat a lot of such vegetables have a lower risk of developing AMD. Goo suggests that in addition to eating more green, leafy vegetables, those who wish to prevent or delay AMD can increase their intake of oily fish like salmon, sardines and tuna, which contain omega-3 fatty acids, as well as modify their diet to a low-glycaemic one. The results of the AREDS 2 study are expected to be out next year. In addition, certain risk factors for AMD like smoking, an overall unhealthy diet and a sedentary lifestyle, can be changed with some willpower. Other risk factors like growing old or having a family history of AMD, unfortunately, cannot be avoided. Bleeding in the macula Because of the high density of photoreceptor cells in this area, the macula is well-supplied with blood vessels that provide them with oxygen and nutrients, and remove waste. As we age, abnormal blood vessels start to grow into the macula from the choroid, which contains most of the eye's blood vessels. These blood vessels tend to be fragile and leak blood and fluids, causing haemorrhage and swelling in the macula, which results in wet AMD. Symptoms in wet AMD, like seeing straight lines as wavy and developing a blind spot in the centre of your field of vision, develop more rapidly than those of dry AMD. This is probably a good thing in a way, as wet AMD can be treated, and the sooner it is treated, the better the chances of preserving your vision. There are two main forms of treatment for this condition: injections of anti-vascular endothelial growth factor (VEGF) and photodynamic therapy. In wet AMD, there are abnormally high levels of VEGF secreted in the eyes, which promotes the growth of new blood vessels. The anti-VEGF injections aim to block this growth. However, this treatment needs to be repeated as the abnormal blood vessels will grow back again. As Dr Fong puts it: "It is like spraying herbicide on lalang, after one month it will grow back again because we can't kill the roots." There are two drugs that can be used for this treatment: ranibizumab and bevacizumab. According to Dr Fong, the main difference between them is their price and approval for use in wet AMD. While ranibizumab has undergone specific clinical trials for the treatment of wet AMD and has been shown to be effective, bevacizumab, which is only approved for use in certain tyoes of colorectal, lung, kidney and brain cancers, has not. However, many doctors have been using bevacizumab off-label (ie without official approval from drug authorities) to treat wet AMD. And last year, they were proven right to do so when the results of the two-year Comparison of AMD Treatments Trials (CATT) showed that both drugs produced similar results in treating the condition. Equally important, as Dr Fong shares, is that the cost of one injection of ranibizumab is RM3,100, while bevacizumab costs RM100. Another treatment for wet AMD is photodynamic treatment, which Dr Fong says can be used for certain types of wet AMD. In this procedure, a drug called verteporfin is injected into the patient's arm, which then travels through the body, including into the blood vessels in the macula. When the drug reaches the macula, the ophthalmologist shines a laser beam into the eye to activate the drug to destroy the new blood vessels, and slow the progression of the condition. Check your eyes For Dr Fong, the take-home message is for Malaysians over 60 to regularly check for AMD and other eye conditions. "Very often, patients don't present (to doctors) until they have lost sight in both eyes because the condition is not painful," he says, adding that most people are also unaware of AMD in general. These observations, in addition to the facts that dry AMD can be delayed by diet and wet AMD can be treated if caught early, are what inspired him and his wife, Goo, to co-author a book called Food For Your Eyes. Published by Star Publications (M) Bhd, this bilingual book in English and Chinese presents both information on common eye diseases and recipes that help promote eye health. AMD, and dishes that incorporate nutrients to help prevent and delay it, form an important part of the book. ■ Food For Your Eyes will be available in major bookstores and selected Klang Valley Focus Point outlets from next month onwards. |
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