The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: 26 Jan 2013 08:58 PM PST Fertility awareness methods of contraception include all methods that are based on the identification of the fertile days of the menstrual cycle. FERTILITY awareness is a term for individuals' understanding of their reproductive anatomy and physiology in relation to fertility. In the case of a woman, it includes identification of the fertile time during the menstrual cycle. In the case of a male, it includes understanding of his reproductive potential. In the case of a couple, it includes the development of a shared understanding about their fertility potential at different stages of their lives and their ability to communicate about fertility issues with one other and healthcare professionals. Fertility awareness methods (FAM) of contraception include all methods that are based on the identification of the fertile days of the menstrual cycle (fertile time), which is at or about the time when the ovary releases the egg (ovulation). FAM works by keeping sperm out of the vagina during the fertile time. The effectiveness of these methods depend on two important variables – the identification of the fertile time and the modification of sexual behaviour during this time. Couples can either abstain from vaginal intercourse or use a barrier method correctly during the fertile time. FAMs are suitable for individuals or couples who do not find other methods of avoiding pregnancy acceptable because of personal, cultural or religious reasons. Fertility pattern In order to know when one is most likely to get pregnant, a woman has to be familiar with her menstrual cycle. Pregnancy occurs when the woman's egg is fertilised by the man's sperm. There are days in the menstrual cycle when fertilisation can occur and there are days when they cannot. There are some days when fertilisation is unlikely but still possible. Vaginal intercourse during the days when it is possible for fertilisation (fertile time) is necessary for pregnancy to occur. The length of a menstrual cycle is measured from the first day of menstruation, ie fresh red bleeding, up to, but not including, the first day of the next menstruation. The normal cycle length varies widely in healthy women and even in the same woman at different stages of her life. The fertile time depends on the length of the cycle. The ovary invariably releases an egg (ovulation) about 12 to 14 days before the next menstruation. The time before ovulation, however, is more variable. The fertile time depends on the life spans of the egg and the sperm, which are about 17 hours and seven days respectively. Fertilisation must take place during those few hours after ovulation if pregnancy is to occur. Various studies reported that nearly all pregnancies occurred within a six day fertile window. The fertility pattern varies in different women. Some women have different fertility times in different months of their menstrual cycles. The advantages of FAMs include the planning and avoidance of pregnancy; acceptability to all religions and cultures; absence of physical side effects; and no use of chemical agents or physical devices. It is relatively cheap and educational as it promotes fertility awareness. It encourages shared responsibility and increases communication. It is effective provided the user is taught well and follows the instructions given. The disadvantages include the keeping of daily records, which some women find difficulty with; taking at least three to six menstrual cycles for effective learning; abstinence or use of a barrier method during the fertile time, which some couples find difficulty with; and no protection against sexually transmitted infections. Its success depends on strong commitment by both partners all the time. Events like illness, stress, shift work and travel may make the interpretation of fertility indicators more difficult. The fertility monitoring devices are relatively more expensive than other more effective family planning methods. The fertile time can be identified by observation of physiological indicators, calculations based on cycle length or fertility monitoring devices. Physiological indicators method The physiological indicators of the fertile time include basal body temperature, cervical secretions and changes in the cervix that occur in response to the changes in the levels of oestrogen and progesterone during the menstrual cycle. These indicators may be used alone or in combination to improve effectiveness. Progesterone causes an increase in basal body temperature (BBT, or waking temperature), which is the temperature before getting out of bed and after resting for at least three hours. As soon as ovulation occurs, progesterone increases the BBT by at least 0.2 degrees Celsius (0.4 degrees Fahrenheit). The higher temperature is maintained until the progesterone level falls at menstruation. The temperature needs to be charted, using a fertility or digital thermometer, every day upon awaking in the morning (before eating or drinking). The temperature chart does not identify the start of the fertile time. The fertile time ends after the temperatures recorded for three days in a row are higher than all the previous six days. This means that couples using BBT as a single indicator method have to abstain from intercourse from the beginning of menstruation until they have recorded three successive temperatures of at least 0.2 degrees Celsius higher than the preceding six days. It is important to remember that the temperature can change because of reasons other than ovulation, eg if the temperature is taken earlier or later than usual, if there is an illness like flu or cold (the temperature can go up), or if painkillers are taken (the temperature can go down). When used on its own, BBT's overall failure rate is 5.4%, ie 5.4 pregnancies in 100 women in one year of use. It is only effective if used by highly motivated couples able to tolerate at least two weeks of abstinence because they have to abstain from the start of the cycle until after the temperature increase. Cervical secretions are influenced by oestrogen and progesterone. After menstruation, when the oestrogen levels are low, there are no secretions, or they are minimal, thick, white and sticky, leading to rapid destruction of sperm by the acidic environment of the vagina. With increasing levels of oestrogen, the cervical secretions increase in amount and become clearer, wetter, slippery and stretchy, like the white of a raw egg, leading to facilitation of sperm movements. The fertile time starts when the woman is first aware of any cervical secretions. The last day of the transparent, wet and slippery secretions (peak day) coincides closely with ovulation. With ovulation, the cervical secretions thicken, under the influence of progesterone, to form a thick plug, which does not favour sperm penetration. The peak day is only recognised on the day after the peak when the cervical secretions have become cloudy and thick. The fertile time ends on the fourth morning after the peak day. A study by the World Health Organization (WHO) reported that 94% of women could detect changes in cervical secretions indicating the start of the fertile time. Most women need to observe these changes for at least three months before they can recognise the changes with some degree of confidence. It is important to remember that the changes in cervical secretions can be affected by semen, vaginal infections or spermicides. When used on its own, the overall failure rate is about 20%, ie 20 pregnancies in 100 women in one year of use. Changes in the muscle and connective tissue of the cervix are influenced by oestrogen and progesterone. These changes can be recognised by gently feeling the cervix with the fingers at about the same time every day. The fertile time starts at the first sign of the cervix becoming soft, open or high. It ends after the cervix has been firm, closed and low for three days. It will take several months to gain confidence in making out the cervical changes. These changes are of value in women with long menstrual cycles, during breastfeeding, and around the time of the menopause. Although there are reports that these changes correlate with the cervical secretion and BBT in identifying the fertile time, there are no studies of the effectiveness of using the cervical changes as an indicator alone. Oestrogen and progesterone also cause other recognisable changes – mid-cycle abdominal pain or spotting, abdominal heaviness, breast changes, and changes in desire and mood. Although the changes may be consistent in some individuals, they cannot be depended upon. Some of these changes may be symptoms of underlying medical conditions, which require treatment. Cycle length method The length of the menstrual cycle can also help detect the fertile time. This requires a record of the menstrual cycle for at least six months. A WHO study reported that in women whose menstrual cycle lengths are between 26 and 32 days, the fertile time is likely to occur from days eight to 19 of the cycle, day one being the first day of menstruation (first day of fresh red bleeding). Further studies are needed to determine its effectiveness and acceptability to users. The calculation method based on previous cycle lengths takes into consideration the survival time of the egg and the sperm. It is based on the length of a woman's previous six to 12 menstrual cycles. From a record of at least the previous six cycles, 20 days is subtracted from the shortest cycle to give the first fertile day, and 10 days is subtracted from the longest cycle to give the last fertile day. If the longest or shortest menstrual cycle length changes, a recalculation has to be made. The reported failure rates vary from 5-47%, with an overall failure rate of about 20%, ie 20 pregnancies in 100 women in one year of use. The Standard Days Method can be used by women with menstrual cycle lengths between 26 and 32 days, with the fertile time likely to occur within days eight to 19 of the cycle. Arevalo, Jennings and Sinai reported a probability of pregnancy of 4.75% over 13 cycles with correct use of the method, and 11.96% probability of pregnancy with typical use. Fertility monitoring devices Different fertility monitoring devices can provide the user useful information about her fertile time. The devices include hormone monitoring systems, computerised thermometers, luteinizing hormone sticks and saliva testing devices. There is large variation in the pricing and effectiveness of these devices. A discussion with the doctor is advisable if you're considering fertility monitoring devices. A combination of FAM methods improves the accuracy in predicting the fertile time. One method can confirm that of the other, eg cervical secretions are helpful if the BBT is affected by sickness. The common combined methods include BBT, cervical secretions and cycle length. The commonest combination is the symptom-thermal method, which involves BBT and cervical secretions. The effectiveness of combined methods is more than that of a single method. Successful use requires a high degree of motivation. A recent study of combined methods reported an overall failure rate of 2.6%, i.e. 2.6 pregnancies in 100 women in one year of use. Lactational amenorrhoea method Breastfeeding reduces fertility because ovulation is suppressed by the raised prolactin levels during breastfeeding. A woman has effective protection against pregnancy in the first six months after giving birth if she has no periods and the baby is breastfed all the time, ie the baby is not given other food or drink. Another contraceptive method has to be used when the periods return or the baby gets to six months of age or is given other food or drink regularly. The failure rate of the lactational amenorrhoea method is 2%, ie two pregnancies in 100 women in one year of use. 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: 26 Jan 2013 08:57 PM PST Increasingly, obsessive habits or behaviours are eating into the Malaysian psyche. Fit4Life investigates the physical and psychological impacts of such addictions. THE idea of addiction as a brain disease is a fairly new one. Historically, addiction was thought to be a personality flaw or a sign of weakness. Unfortunately, this stigma continues to hound the disease, creating a major problem for addicts, as well as those who treat them. Addiction is the continued use of a mood-altering substance or behaviour despite adverse dependency consequences. When a person can't stop using drugs even if he wants to, he is likely to be suffering from addiction. It is an urge so strong, that even if an addict knows that regular drug use can cause harm or lead to death, he is unable to stop. The thing is, when people start using drugs, they don't plan on getting addicted. For some, it is a form of escapism from the harsher realities of life. Drugs just make them feel better. However, as taking drugs or substances will alter the natural chemistry of the brain over time, drug users will start to need the drug just to feel "normal". At this stage, reducing or discontinuing the use of a substance that the body has grown dependent on can lead to acute withdrawal symptoms. These can include anxiety, irritability, intense cravings for the substance, nausea, hallucinations, headaches, cold sweat and tremors. Addiction can take over a person's life, replacing even vital aspects, such as the need to eat and sleep. Worse, an addict might resort to doing things like stealing or hurting someone in order to sustain their drug or behavioural habits. According to Dr Nivashinie Mohan, a neuro-psychologist from Gleneagles Hospital Kuala Lumpur, "All addictive substances or behaviours directly satisfy the pleasure centres in the brain. This causes the person to experience a physical or mental 'high'. "However, this high will become increasingly difficult to achieve over time. As a result, a person who is addicted will have to keep increasing the frequency or volume of whatever substance or behaviour they have grown dependent to, to achieve the high." According to Dr Nivashinie, alcohol abuse and drug abuse are among the most common types of addictions in Malaysia. The country's proximity to the notorious 'golden triangle' of drugs makes them relatively easy to obtain, she opines. The golden triangle is infamously known as a production region of drugs. "Alcohol is another commonly abused substance because it is often considered harmless, and again, it is easy to obtain," she adds. However, psychological disorders such as having an addiction to shopping, eating, social media, as well as pornographic materials and sex, are also becoming more common. Let's look at the physical and psychological symptoms that follow these "unassuming" addictions. Sexual addiction Sexual addiction has been described in many terms: hypersexuality, nymphomania, Don Juanism. In essence, it is a conceptual model devised to provide a scientific explanation for sexual urges, behaviours, or thoughts that are extreme in frequency, and may be occurring out of one's control. The list of behaviours associated with sexual addiction includes consistent use of pornography, engaging in frequent and unsafe sex, having extra-marital affairs, voyeurism and visiting prostitutes. For some people, the addiction can escalate to involve illegal activities such as exhibitionism (exposing oneself in public) and molestation. However, not all sex addicts will end up becoming sex offenders. The biggest challenge for sex addicts is that it is often treated as an issue of morality rather than a genuine mental problem. Despite the increase in people seeking therapy, most of those affected by it often try to deal with the addiction alone. But while some experts regard sexual addiction as a medical form of clinical addiction, there are others who believe it is a myth perpetuated by social and cultural influences. For the sex addict, their urges are not only real and uncontrollable, they can yield serious and devastating consequences. People have lost their families and homes, and have even become suicidal because they feel that they will never be able to embark on a proper relationship. Compulsive shopping With the scorching sun, and a lack of public amenities and facilities available, it is no wonder that shopping malls are such popular hangout places for Malaysians. Just try navigating through a local shopping mall on a weekend and you'll know what we mean. Most Malaysians enjoy shopping. And let's face it, we've all succumbed to the occasional impulse to buy that perfect pair of heels to complement your little black dress. But when your wardrobe starts to explode with too many shoes or clothes, you could be suffering from a serious shopping addiction. Oniomania is the technical term for the compulsive desire to shop. The phenomenon is often linked with a preoccupation with buying new things; distress or impairment as a result of the activity; as well as hypo-manic or manic episodes resulting from compulsive buying. Many balk at the idea of compulsive buying as a real addiction, although it has the potential to create a whirlwind of emotional and financial distress. Like all addictions, these shopping addicts often experience highs and lows associated with their compulsion to buy. For instance, the "high" derived from buying may be followed by a sense of disappointment or guilt. This could lead to an urge for yet another shopping spree in a never-ending pursuit for satisfaction. More alarmingly, compulsive shopping could result in serious financial debts, which may lead the habit to become a secretive act. Some shopping addicts end up hiding or destroying their purchases because they feel ashamed of their addiction. Addiction to social media By now, most of us would have a Facebook account. In fact, according to an October 2012 report, approximately 13 million out of the 28 million-strong Malaysian population are on Facebook. This suggests that about 45% of Malaysians now have Facebook accounts. In fact, you are probably refreshing your Facebook page even as you read this. But it is one thing to be a kaypochee (nosy parker) who likes to be in the know about your friends' love lives, gastronomical adventures or work-related rants, and another to be obsessively keeping track of your Facebook newsfeed. According to Dr Nivashinie, the term Facebook Addiction Disorder (FAD) was coined by American psychologists to describe the addiction to Facebook. Because it is not seen to be as harmful as tobacco or drugs, FAD often goes undetected because most addicts do not realise or want to admit they have a problem. However, if you prefer to interact on Facebook rather than have a normal real-life conversation, you could be suffering from a real psychological disorder, she warns. Like any other addiction, being addicted to social media prevents one from participating in daily activities, which could in turn cause anxiety or depression. "Addicts feel the need to be connected to their Facebook friends all the time as they fear they may miss out something important if they don't cosntantly check out the website," she adds. According to Dr Nivashinie, research has shown that it is mostly adults in their 20s and 30s who are addicted to social media. "As these groups make up the working population, the implications are manifold – from the breaking of families to loss of work productivity, isolation and depression, when away from social media," she says. The doctor concludes: "Technology is important and we cannot deny the benefits of it, but social media should not replace actual social interaction. Excessive use of social media can also turn us into a more individualistic and narcissistic society. People become more self-absorbed and isolated, choosing to be online, rather than out and about." Food junkie There is no denying that food and incessant eating are part and parcel of our national culture. Malaysians are, in fact, notorious for stuffing themselves with obscene amounts of food at any given time of the day. Given these habits, it is no wonder that Malaysia is now the fattest country in South-East Asia. Current findings by the Health Ministry reveal that two in every five adults are either overweight or obese. However, there is a difference between being just plain greedy and being a compulsive overeater. The latter is often characterised by an individual who has an obsessive-compulsive relationship with food. The food junkie often engages in frequent episodes of uncontrolled eating or binge-eating, during which they may feel overwhelmed or out of control. Often, they may even consume food past the point of being comfortable. Food addicts eat even when they are not hungry. Their obsession is further exacerbated by spending excessive amounts of time and thought (and often money) on food, and secretly planning or fantasising about their next meal. Not surprisingly, many individuals suffering from food addiction are overweight or obese. That said, not everyone who has a weight problem is a compulsive overeater. People of normal or average weight can also be affected by this addiction. During binges, a compulsive overeater may consume up to 15,000 calories daily (an average person needs only about 1,600 calories!). For the food junkie, eating provides a temporary relief from psychological stress through an addictive high that is similarly experienced by drug and alcohol users. Left untreated, the over-indulgence can lead to serious medical conditions, including high cholesterol, diabetes, hypertension and heart diseases. Addiction to exercise Even the seemingly innocuous domain of exercise is not exempt from the grips of addiction. According to the American Running Association, when the commitment to exercise crosses the line to dependency and compulsion, it can create a physical, social and psychological quagmire for the ardent exerciser. This phenomenon typically affects runners. To the addict, exercise has become overvalued compared to other important elements in life, including work, family and friends. Anything that comes in between them and exercise is immediately scorned and resented. Signs of addiction to exercise include withdrawal symptoms like anxiety, irritability and depression when one's circumstances prevents one from engaging in physical activity. Exercise addiction can cost you more than just a night out with friends. The obsession can bite back in the form of osteoarthritis, a lesser-known but equally malignant cousin of osteoporosis, due to trauma and overuse of the joints. According to the Journal of the American Osteopathic Association, "People who engaged in sports or other physically demanding activities are known to be at an increased risk of osteoarthritis in the joints they use most (eg knees and hips in soccer players, and hands in boxers). That's not all, an addict's manic devotion to exercise could end up destroying one's relationship with their family, friends or significant other. The solution to most of these habits or behavioural problems may be obvious – just cut down or limit whatever acts or vices that could be disrupting your daily life. Of course, in most cases, this is easier said than done. The road to recovery begins with acknowledging the problem. To do that, a person suffering from addiction must first learn to recognise the signs of addiction, before progressing to seek therapy or medical help. Change will not occur overnight, but by taking that first step, an addict stands a chance in regaining control of their lives, and with that, a second chance to live. |
| Posted: 26 Jan 2013 08:57 PM PST The knee is a complex joint that is highly susceptible to injuries. IT bends, straightens and rotates slightly. Sometimes it creaks, and when the situation is bad, it gives way. Such are the workings of the knee joint. Many of us know at least two persons with a knee problem who complain about the nagging pain. If it's your grandma or grandpa, you can excuse them as over time, the joint gets worn out. But I've seen young hikers, runners and dancers wearing a knee brace for support. Since the knee absorbs 80% of our body weight while standing, it is at a high risk for injury. The knee is formed by the articulation of the femur (thigh bone) and tibia (bone of the lower leg), and is encased in the joint capsule. It contains an assortment of ligaments and tendons, which provide the structural framework for the joint. The stability of the knee joint and the primary restrictions of action are provided by the complex ligament structure of the knee. The knee joint is surrounded by a large thigh muscle in front of the leg (the quadriceps), an equally large muscle at the back of the leg (the hamstring), muscles at the back of the lower leg (the calf muscles) and a long band of connective tissue that stretches from the hip bone, running alongside the outside of the thigh, down to the outside of the knee (the iliotibial band). As we age, our fast twitch or explosive muscle fibres (eg hamstring, bicep) which are used for sprinting, atrophy at a faster rate than our slow twitch or endurance muscle fibres (eg quadriceps, triceps) used for marathons. Activating fast-twitch muscle fibres is the key to improved strength, speed and power. Unlike slow-twitch muscle fibres, which are responsible for most of our day-to-day muscular activity, fast twitch muscle fibres are quite lazy and tend to slumber until called to action. It is also easily fatigued, and if pushed beyond its capacity, gets injured easily. I always tell my students that if they sustain a back or knee injury, it's going to stay with them for life. Unless it's a simple sprain or strain, the likelihood of injuries recurring is extremely high, but the good news is that it can be managed by strengthening the muscles surrounding the knee. A few months ago, one of my dance students came to me with incessant knee pain. Every time she did grande plies or landed from a jump, she would feel a sharp pain. She iced the area diligently and sought treatment from a sinseh, but it didn't help much. The fact that she was dancing at least 30 hours a week compounded the problem. It got so bad to a point she started to limp and could barely take steps down. I packed her off to see a specialist. The orthopaedist couldn't find anything major and diagnosed it as a soft tissue injury. He prescribed her anti-inflammatory medication and glucosamine supplements. I was shocked. Glucosamine at 21? My grandmother only started taking it at 80, and this kid was barely out of university. She hadn't even started her professional career! I had to force her to stop all activities and reluctantly, she agreed. We worked on strengthening and stretching the appropriate muscles and slowly, the pain subsided. Today, among other things, she can leap, take a tumble and do knee spins without pain. There are many causes of knee injuries, including bursitis, tendonitis, ligament tears, worn-out cartilages, arthritis, sprains, strains and a host of other problems. Postural misalignment such as knock-knees or bowlegs may also predispose a person to knee injuries. According to fitness trainer Mark Vella, women have a four to six times greater chance of sustaining serious knee injuries than men. In his book, Anatomy for Strength and Fitness Training for Women, Vella says women have a tendency to begin exercising from a knock-knee position, and when they start flexing the knees (bending), this position is aggravated further. Their wider pelvic structures also result in a more acute angle from the femur to the knee joint. Women also have softer ligaments and tendons due to hormonal effects, which are pronounced during ovulation and pregnancy. Many women are concerned that leg exercises such as squats will cause their buttocks to become bigger, but this is far from the truth. The natural tilt of a woman's pelvis is more likely to be slightly anterior than in men, thus creating an increased lordosis (arched lower back), which then emphasises the buttocks. If less strengthening emphasis on the glutes is desired, then when doing squats, a wider stance should be used. There are always alternatives. It may come as a surprise but exercise is one of the best remedies to alleviate pain and relieve stiffness among those suffering from knee arthritis. Here are a few simple exercises I find most effective when strengthening the muscles surrounding the knee. Start off with three sets of 10-12 repetitions. Wide-stance or duck squats (second position plie, feet turned out) Stand with feet wider than shoulder-width apart, toes turned out 45° to 75° with hands on the hips or folded in front. Bend your knees (making sure it doesn't go past the toes) until it forms a 90° angle to your thighs. Hold the stance for two seconds and come back up. To make it harder, you can hold on to dumb bells or lift the heels off the ground while in squat position. Lunges Stand with feet parallel, six inches apart, and take a huge step forward with one leg. Bend both your knees (keeping the front foot flat on the floor) so your rear heel lifts off and the knee is almost in contact with the floor. Come back up. Repeat 10-12 times, keeping your body erect. Return to starting position and switch legs. Wall slides Stand with your back against the wall, foot shoulder-width apart and about 12 inches or more in front of you. Slowly bend your knees and slide your back down the wall until you knees are bent no more than 90° and are not extending past your toes. Beginners will probably not able to go past 45°. Hold this position for five seconds. Focus on pressing your heels to the ground as you slowly slide back up until you're back to starting position. Once you get stronger, try one-legged wall slides. Standing calf raises Stand on the edge of a step or elevated platform with heels hanging over the edge. Tuck in your stomach and squeeze your glutes. Rise up, hold for two seconds and come down. I like to do these in three positions. First stand with feel parallel, then with feet turned out and lastly, with feet pointed inwards. Hamstring curls with stability ball Lie on your back on a mat, keep your knees straight and place your heel on top of a stability ball. Lift your back off the floor and contract your abdominal and butt muscles. Slowly and with control, bring your heels toward your body as you roll the stability ball underneath your legs. When you've moved about 10-12 inches, return your legs to the fully extended starting position. Not only do these exercises do wonders for strengthening the muscles surrounding the knee, it also helps peel the layers of fat and gives you a great looking tush! However, use your own discretion when performing these exercises. If at any time you feel pain, then skip it. You can try it again after working on the other exercises for a couple of weeks. The important thing is to listen to your body, to challenge it, but not to overstress it. The writer is a certified fitness trainer who tries to battle gravity and continues to dance, but longs for some bulk and flesh in the right places. |
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