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Posted: 25 May 2013 06:55 PM PDT

An early diagnosis for multiple sclerosis can be easily missed as it is a rare disease and symptoms can sometimes be non-specific or mimic other more common medical conditions.

SHARIFAH was 18 years old when she was diagnosed with multiple sclerosis (MS). She has had a few minor relapses or acute attacks since diagnosis was confirmed by her neurologist. She has opted not to be on treatment in spite of being aware that her disease could take a severe turn.

Sharifah has been lucky as she was able to complete her studies and now has a steady job. She is married with two children and leads a normal life. It would be hard to imagine she has a chronic illness.

Jessie was diagnosed at age 23 in 2003. However, there were no treatment options for her at the time when she was diagnosed, and her attacks were severe. She could not continue with her studies and is currently bedbound and fully dependent on her family for her daily care.

Her disease is now too far advanced for any form of treatment – her doctors have informed her that the common treatments will not work and can increase the risk of infection.

Mohammed Adnan was diagnosed with MS at age 26, and was put on treatment. He has had one attack since treatment started, but the treatment has reduced the frequency of his attacks. He continues to have severe imbalance and mild speech defects, but he is able to work with his limitations and will be starting a new job soon.

The above individuals have MS, and their various conditions describe the unpredictable nature of the disease and how severity can vary between people. It's essential to understand the disease to anticipate what's ahead, to decide on treatment options, and to plan one's life.

The basic structure of the central nervous system is made up of a neuron, and each of these neuron is covered by a protective sheath called myelin. Myelin protects neurons and enables them to function normally and allow signal transmission.

Myelin is damaged in MS. Healing which occurs after after such nerve cell damage (acute attack) can be either complete or partial, and can leave permanent scars, which might cause functional disability.

Many experts believe that MS is an autoimmune disease where the body, through its immune system, attacks its own tissues. With MS, it is the nerve-insulating myelin that is being attacked.

Preceding infection, physical and emotional stress, and immunisation is believed to trigger an acute attack.

Multiple sclerosis is more common among females (with a ratio of two to one) than males and is often seen in young individuals between 20 and 40 years of age. It has been seen in younger and much older individuals, although that might be rare.

Environmental and genetic factors are linked to MS, and research has been ongoing, looking for causative factors.

Periods of active MS symptoms are called attacks, exacerbations or relapses. These can be followed by quiet periods called remissions. These episodes can be unpredictable as neither the person with MS nor the doctors can anticipate the next attack and it's severity.

There a four types of MS:

1. Relasping-remitting – This is the most common, with about 80% of patients presenting to the doctor with this type.

2. Secondary-progressive – After several years of relapsing and remitting periods, one progressively develops disability.

3. Primary-progressive – The disease progresses from the onset without any acute attack.

4. Progressive-relapsing – There's steady progression from onset of disease with intermittent relapses.

The symptoms of the disease include:

·Blurring of vision

·Double vision

·Numbness and weakness involving both hand and legs

·Loss of balance (vertigo)

·Fatigue

·Speech difficulty

·Urinary and bowel problems

·Memory issues

·Depression

An early diagnosis can be missed as MS is a rare disease and symptoms sometimes can be non-specific or mimic other more common medical conditions.

When MS is suspected, doctors will perform a series of tests such as blood investigations and MRI (Magnetic Resonance Imaging) of the brain and spinal cord, which might reveal lesions or white spots. In addition, a lumbar puncture (also called a spinal tap) where fluid between the spinal space is collected for examination and evoked potentials (recording of electrical stimuli and response) may be carried out.

In certain situations, more than one MRI and close surveillance might be required to make a definite diagnosis.

There are treatments available for MS, but there is no cure. Management of the disease consists of treating acute attacks with steroids, which might reduce the severity of the symptoms.

The long-term treatments are life-long and they are meant to reduce the number of attacks, disability and brain lesions.

There are two types of long-term treatment available in Malaysia: an injectable subcutaneous shot given three times a week, which is interferon beta 1a, and a subcutaneous shot given every other day called interferon beta 1b.

There are other medicines used to treat MS, such as natalizumab, which is an infusion given at the hospital every month. There is also a new oral drug fingolimod. The last two drugs are preferably used as second-line therapy when the first-line injectables do not work adequately. Another second-line therapy is mitoxantrone.

Multidisclpinary management by a team consisting of a neurologist, psychiatrist, urologist, nurses, physiotherapist and occupational therapist will be necessary in managing MS.

People with MS and their caregivers should educate themselves about the disease from various MS websites and other resources, which are available. All questions and doubts are best discussed with a healthcare professional.

As MS is a rare disease, we need to raise awareness in Malaysia. Understanding the disease enables those with MS and their caregivers to cope with their illness better.

Supporting and participating in events organised by the Multiple Sclerosis Society would benefit people with MS and their caregivers. The society does need more volunteers, members and ambassadors for support.

n Dr Joyce Joseph is a consultant neurologist at Hospital Kuala Lumpur and adviser to the Multiple Sclerosis Society in Malaysia.

Empowered against gut cancer

Posted: 25 May 2013 06:58 PM PDT

EMPOWERED continues its fight against colorectal cancer, with another 10,000 under-resourced Malaysians reached this year.

COLORECTAL cancer is the most common cancer affecting men, and the second commonest cancer affecting women in Malaysia. It accounts for one of the highest causes of cancer-related mortalities globally.

Although colorectal cancer screening is an established practice in developed parts of the world, it has not as yet been widely applied in most parts of the developing world. Earlier national initiatives such as the Australian Task Force and the UK Colorectal Cancer Screening Project have reported a fall in mortality through the implementation of faecal occult blood testing.

Malaysians living in under-resourced communities are faced with numerous unmet basic needs. EMPOWERED – The Cancer Advocacy Society of Malaysia has had first hand experience of their poor understanding of cancer, its prevalence and fatal outcomes if not picked up early.

EMPOWERED's tireless efforts to bridge the health gap in poor Malaysian communities since 2010 is fuelled by the many lives saved through the implementation of its early detection and treatment programmes for colorectal cancer.

Officially launched in April 2009, EMPOWERED – The Cancer Advocacy Society of Malaysia is a non-profit organisation committed to saving lives, preventing cancer and eliminating suffering amongst the poor in Malaysia.

Since 2010, EMPOWERED's incessant efforts to execute vital colorectal cancer screening and treatment programmes has reached the homes of nearly 50,000 under-privileged Malaysians.

This year, the project blueprint has been further customised to encourage maximal uptake by the residents living in EMPOWERED's target communities in Setapak, Selangor. It is working closely with Setapak community leaders to execute this year's project in four phases.

Phase 1 – Pre-Selection & Awareness Workshop

·EMPOWERED works with community leaders to conduct demographic surveys that aim to identify the number of individuals at risk of developing colorectal cancer.

·Awareness workshops are organised at the communities to raise awareness about colorectal cancer through customised educational sessions on healthy diet and lifestyle issues.

Phase 2 – Screening Workshop

·Screening workshops are conducted in Bahasa Malaysia, Mandarin and Tamil. Residents will be registered and instructed on how to use the faecal immunohistochemical test (FIT) kit.

FIT has been shown in studies to have superior detection rates of advanced colonic lesions compared with the older guaiac-based faecal occult blood test, with greater simplicity of sample collection and better patient adherence rate.

Phase 3 – Return of Used Test (FIT) Kits

·Residents are given two days to have their stool sample collected using the FIT kits at home.

·Used FIT kits are dropped off by participating residents at respective collection stations within their communities. The kits are collected and sent off for processing.

Phase 4 – Patient Support Programme

·EMPOWERED's volunteers from the Malaysian Enterostomal Nurses Association will break the news to affected residents, in the privacy of their homes, about positive blood findings in their stool.

·Appointments for colonoscopy at Hospital Selayang is arranged.

·Appropriate medical management is administered for all diagnosed conditions, including cancer.

·Transportation for all hospital visits is provided for these residents.

·An elaborate support mechanism is put in place to provide the beneficiaries with complete emotional and moral support throughout their medical journey.

Consultant medical oncologist Dr Christina Ng is president and founder of EMPOWERED. She shares: "In the last three years, we have seen a significant improvement in the rate of return of used FIT kits, from 66% in 2010 to 85% in 2012, by our participating subjects. I would attribute this to EMPOWERED's continuous efforts to make this programme more tailored and personalised for our beneficiaries based on learnings from each yearly campaign.

"The rate of compliance to colonoscopic assessment for our subjects who are found to have blood in the stool remained high at about 90% every year."

She adds: "About 7-8% of our entire population who participated in the programme tested positive for occult blood in the stool and about 1-2% of all subjects were diagnosed with asymptomatic stage 1 to 2 colorectal cancer. Those diagnosed with pre-cancerous polyps underwent appropriate endoscopic therapeutic procedures and were subsequently placed in medical surveillance programmes.

"It is interesting to note that whilst the Malays formed the largest racial group within our screened population, the Chinese subjects were more likely to have blood picked up on FIT and more likely to have significant pathology found during colonoscopic assessment, including cancer, in comparison with subjects from other racial groups."

EMPOWERED's efforts to enable under-resourced Malaysians make important health changes in their lives is well received on the ground.

Tan Chu Tea is a 53-year-old colorectal cancer survivor and beneficiary of EMPOWERED's screening campaign in Nov 2011. "I am very thankful to EMPOWERED for holding this programme in our community. I have not come across a charitable organisation that is so caring and dedicated to helping the poor people by providing colon cancer screening and then making all the arrangements to send them to hospital for colonoscopy and further treatment. EMPOWERED had even paid for all our hospital fees and charges. For this, I want to say a big thank you to EMPOWERED," he shares.

Dr Ng recognises that the support of corporate partners is critical in realising such vital initiatives.

"Outreach projects like these are critical for the well being of the community. As an organisation, we are proud to fund an initiative that opens access for all segments of Malaysians to education, information and total disease support for a morbid disease such as cancer", said C.M. Phang, operating officer of Scientex Foundation, who is the main sponsor for EMPOWERED's 2013 Colorectal Cancer Screening and Treatment Project.

For more information about EMPOWERED – The Cancer Advocacy Society of Malaysia, visit www.empowered.org.my.

A healthy state of affairs

Posted: 25 May 2013 07:01 PM PDT

It was mainly about getting educated in a fun way about health matters for the 40,000 who thronged The Star Health Fair 2013 last month.

FOR many people, learning about health can be very boring, the general impression being of dry facts and figures that tend to scare you into changing your lifestyle.

Maybe that's why events such as health fairs can be an effective way to spread awareness of health issues in an engaging manner.

The Star Health Fair 2013 was such an event, with many exhibitors and expert organisations at hand to help visitors "digest" relevant information that will be useful to maintaining good health.

Here's a recap of the three-day event in pictures, in the hopes that you'll be hungry for more next year.

Kredit: www.thestar.com.my

Ahad, 26 Mei 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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