The Star Online: Lifestyle: Health
The Star Online: Lifestyle: Health |
| Posted: When an athlete is injured in a sports event, doctors have to be equipped with the knowledge to make snap decisions. Soon, there will be a manual providing a structured, evidence-based guideline on emergency procedures. WHILE the field of sports medicine has been growing rapidly, very little focus has been given to emergencies in sports, although there are more sporting activities taking place worldwide. "Previously, it was only the orthopaedic stuff, and no attention was given to sports emergencies. Once the athletes get into hospital, they can be looked after, but when they're injured on the field, what do you do when there is no sophisticated medical equipment available? "Half the time, doctors on the field are ill-prepared and don't know how to use the equipment. Only the paramedics do. In an emergency situation, doctors shouldn't be making a diagnosis; rather, they should be looking for symptoms and treating them," said Dr David McDonagh, president of the medical committee of the International Bobsleigh Federation and the co-author of the International Olympic Council's Manual on Emergency Care in Olympic sports (to be published in 2014). The manual, the first of its kind, was written with contribution from 60 others and lists all kinds of possible injuries in the Olympics and Paralympics sports. It provides a structured, evidence-based guideline on emergency procedures. He said: "Doctors need guidelines, although most have a fair idea of what to do. When you're dealing with athletes, you have to treat them differently and reduce the disruption to the sporting process. Doctors have to know how to initiate basic but correct primary care and make the difficult decision on whether the athlete should return to play."  Dr David McDonagh If early intervention can prevent death, Dr McDonagh said that is a sign of good medical care. He cited the case of Bolton's Fabrice Muamba whose heart stopped for 78 minutes after he collapsed during an FA cup match. Thanks to CPR being performed immediately, Muamba, 23, was brought back to life by paramedics, in what is considered to be a medical miracle. Usually, the longer the resuscitation process goes on, the less chance there is of survival. In the footballer's case, he didn't suffer any brain damage and has made full recovery, although he has decided to retire from professional football. "There was one case where the athlete died because the doctor insisted on carrying the injured athlete to the car. Always perform the CPR there and then, not carry the athlete off the pitch! It's a matter of life and death," Dr McDonagh asserted. "If there is no ambulance on standby, stabilise and keep him alive if it's a serious injury. If there is a lot of blood loss, then get him to the hospital as soon as possible." Dr McDonagh and colleague Dr Johan Hegvik were here recently to conduct a one-day intensive emergency sports medicine course for physicians. Both are also assistant professors at the National University in Trondheim, Norway. From his practice, Dr McDonagh observed that injuries comprise a third or a quarter of all emergency consultations, and of these, 20% are sports injuries. In any sporting event, there is always an element of risk involved. As most of the winter sports involve high velocity, he said there is an increased rate of injury to the head, chest and pelvic areas. Dr McDonagh was there during the 2010 Winter Olympics in Vancouver, Canada, when Georgian luger Nodar Kumaritashvili's sled flipped during a trial run, causing him to smash into a steel pole. Efforts to resuscitate him failed and he died as a result of massive head injuries. "One of the major indicators of head injuries and concussion is the respiratory rate. Other potential signs to look out for are headaches that worsen, severe neck pain, a drowsy look, deteriorating consciousness, unusual behaviour change, repeated vomiting, slurred speech, weakness or numbness in limbs, seizures, increased confusion or irritability, facial neurological signs and a patient who doesn't recognise people or places," he said. In summer sports, the injuries are not as serious and usually comprise muscle sprains, pulls, tears and fractures.  Footballer Fabrice Muamba's heart stopped for 78 minutes after he collapsed during a match. Thanks to CPR being performed immediately, Muamba, 23, was brought back to life by paramedics, in what is considered to be a medical miracle. -AFP For injuries such as punctures (in fencing), the object should not be removed as it can cut and cause more bleeding internally. Rush the athlete to the hospital. For dislocations, which are common in shoulders and fingers, Dr McDonagh said it's best to pull it into place. "The longer the joint is out of place, the greater the damage to the tissues. Once the joint is in place, take an x-ray," he said while demonstrating various methods of pulling the joint back to position to the 20-odd doctors who attended the course. Both doctors felt Malaysia had one of the most knowledgeable doctors in the region. "They are not experts in emergency care, but that can be learnt. What is important is that there must be a team leader in the group who can make decisions," said Dr Hegvic. |
| Posted: For many couples, married life can spell chaos, especially when the new and unfamiliar order of a new family unit sets in. Marriage counseling may just help to put things back into perspective. MANY couples flounce into their big day expecting a lifetime filled with magical moments. Unfortunately, skipping into the sunset after the wedding day is hardly the end of the story. It is only the beginning, as both man and wife will discover upon their foray into marriage. In place of amorous delights, there are suddenly bills to pay, a household to maintain, and young children to run after. In the thick of this new and unfamiliar order, tempers flare and resentment kicks in. What started out as one of the most promising events in your life could end up in a painful descent down the rabbit-hole. American country singer Billy Ray Cyrus was headed for an achy, breaky heartbreak, when his wife, Tish, decided to call for a divorce after 19 years of marriage in June. This came after the couple decided to kiss and make up just two years ago, following an earlier petition for divorce in Oct 2010. The 51-year-old singer had filed for divorce from his wife, 53, but he dropped his filing in March 2011. Still, trouble in paradise doesn't always lead to splitsville. Their recent call for divorce is reportedly off again, just one month after their divorce papers were filed. The couple tells the media that marriage therapy played a large part in their reconciliation. "We both woke up and realised we love each other and decided we want to stay together. We both went into couples therapy – something we haven't done in 22 years of being together, and its brought us closer together and really opened up our communication in amazing ways," Billy Ray's rep said in a statement to US Weekly. Together, Billy Ray and Tish have three children – Miley, 20, Braison, 19 and Noah 13. Billy Ray also adopted Brandi, 26, and Trace, 24, Tish's children from a previous relationship. The country singer also has son Christopher, 21, from a previous relationship. Like the Cyrus', many couples who face problems in their relationships can benefit from couples therapy, or marriage counselling, as it is better known on the local front. Fit4life explores the cause-and-effects of marital problems, and how marriage counseling can help put things back into perspective.  American country singer Billy Ray Cyrus was headed for an achy, breaky heartbreak, when his wife, Tish, decided to call for a divorce after 19 years of marriage in June. Thanks to couples therapy, the pair reconciled just a month afterwards. -EPA Love changes Most love stories begin this way: boy-meets-girl, they fall madly in love, boy and girl start dating, boy and girl get married. This initial phase of love, often characterised by "wonderful, romantic feelings and red Valentine's day hearts" is known as Eros love, says Dr Johnben Loy, founder and clinical director of Rekindle International Marriage and Family Therapy Centre. Eros love, also referred to as "erotic love", is typically built on physical attraction, and is defined by strong, passionate feelings that usually occur during the first stages of a romantic relationship. The weakness of this type of love is obvious – it doesn't last. With marriage, Eros love often metamorphoses into Agape love – a more steady kind of love that involves commitment and taking care of the children, says Dr Loy, also a marriage and family therapist. In his book, The Four Loves, author C.S. Lewis used Agape love to describe what he believed was the highest order of love known to humanity – a selfless love, a love that was devoted to the well-being of the other. However, this constant and relatively more sedate version of love could set a humdrum tone for married life. Dr Loy explains: "Agape love does not necessarily feel like 'romance' or that 'Valentine's day' kind of love. It is a different kind of love." In the absence of racing hearts and butterflies in the stomach, it can feel as though the "passion" in a romantic relationship has burned out. Why the marriage cookie crumbles In 2011, the National Registration Department (NRD) registered a total of 5,634 divorces in non-Muslim couples. It was previously reported that Malaysia has seen a steady increase in the number of divorces over a 10-year period, with over 33,000 couples splitting up in 2010. According to the Malaysian Quality of Life (MQLI) 2011 report, 0.22% of Malaysians between the ages of 18 and 50 (in 2010) are divorced, almost double the 0.13% recorded in 2000, and 0.14% in 1990. According to Dr Loy, being ill-prepared for married life is the main reason for divorce among younger couples. "There is a tendency, that if you get married at a younger age, you are not quite ready to settle down. This could lead to conflict, especially if there is a child and one person is not ready yet. Maybe they haven't had enough fun yet. Maybe they got married because their girlfriend got pregnant, and that is the right thing to do," Dr Loy shares. Often, young married couples succumb to the stresses of work and finance. It gets worse when they have difficulty learning how to cope with a new family unit. Those who cannot manage their new responsibilities and differences will eventually choose to end their marriage, he says. "As for older couples, the biggest trigger factor for divorce appears to be extramarital affairs," says Dr Loy, whose clients are mostly aged between 30 and 50. He points out that cultural and socio-economical shifts in recent years have altered the traditional dynamics in a marriage. "I think women have become more in charge of their relationships. Up to 70% of my clients are women. They are the ones who usually seek help first. I think the reason for this is because women have a natural tendency to be more interested in relationships and are constantly looking out for the 'temperature' of their marriage." "Also, back then, women did not have the financial freedom to walk away. These days, there are women who are powerful and wealthy, and they have the ability to say: 'Let's just part and be friends,' when things do not work out. It's less torturous that way." How marriage counseling works Marriage counseling, sometimes called couples therapy, helps couples understand and resolve conflicts surrounding their relationships. It gives them the tools to communicate better as well as negotiate and solve problems in a healthy way. Marriage counseling is often short term. Most people usually need only a few sessions to smooth things out. However, if your relationship has greatly deteriorated, you may need counseling for several weeks or months. Counseling sessions are generally provided by licensed therapists or counselors, with a specific focus towards a couple's relationship. Most people usually see a therapist or a counselor once a week. Dr Loy likens a couple in a trouble marriaged to two dancers who have lost their rhythim. Their movements are no longer in-sync.  Dr Johnben Loy "Everytime they do a dance move, they end up hurting each other. He sprains his back, she gets a stubbed toe, and so forth. "Despite their inefficiencies, they keep repeating the same moves because they can't seem to correct it. They feel that they have to move and dance this way, even if it hurts, cuts and creates conflict," he describes. This metaphoric dance gets even more disoriented with the stresses in life, and over time, these clashes could end up eating into a relationship. "I assume the role of a choreographer here. I try to help couples learn how to move differently, in a way that will help them rediscover a balance that they lack in their relationship. "Maybe I'll help hold his foot, or teach her to twirl in a different way, so that they will no longer get in each other's way or hurt each other when they move. They will learn how to dance beautifully together again." Among the strategies he utilises in his sessions include emotion-focused couples therapy, an empirically-supported treatment that is based on methods to help people accept, express, regulate, understand and transform emotion. This approach, which has become popular in recent years, focuses on the development of emotional intelligence and the importance of a secure relationship. Another popular strategy used in marriage counselling is cognitive behavioural therapy, Dr Loy shares. The principle of cognitive behavioural therapy is that a person's belief system affects his or her emotions and behaviour. As such, this approach focuses on reconciling the correlation between cognitions (thoughts), actions (behaviours) and feelings (affect), and the role they play in determining a person's attitude, functioning and quality of life. By reconciling these three components, changes can be made in how a person thinks, acts and feels about his or her circumstances. "When couples come to see me, I usually like to see them together, so I can hear both sides of their experiences. Otherwise, it is not the complete picture," says Dr Loy. "By observing the way they interact, I am able to gauge the health of their relationship." Does marriage counseling actually work? In Malaysia, a session of marriage counseling (which could range from 50-75 minutes), could cost anywhere from RM300 to RM500, or more, depending on the centre and the therapist. Dr Loy claims that most of these sessions will yield favourable outcomes. "Success rate is very high if the couple wants to work on their issues. I almost want to say there is 100% success rate," he says.  The absence of racing hearts and butterflies in the stomach could set a humdrum However, he notes that "success" first needs to be defined. Most people seek marriage counseling because they want to work on their issues, so they can continue living together. But there are others who are here to seek resolution, so that they may come to an amicable end. He explains: "Therapy is always about change. Often, it is about changing yourself for the sake of your relationship. However, there is only so much we can change about ourselves. "Sometimes, the final change isn't what we should do to fix a relationship, but what we can do to part ways in a civil and harmonious manner, especially if there are children involved." "Success isn't always about getting back together. Sometimes, it is also about learning how to let go," he concludes. |
| Posted: Some new mums swear by consuming baby's placenta. MOLLY Halper never dreamed she'd consume her baby's placenta, an organ that serves as a link between mother and foetus and is usually discarded after birth. "My husband and I used to make jokes" about people who did that, said Halper, who lives in Arlington Heights, Illinois, with her family. "We're not vegetarians or tree-hugging, granola-eating people. We're suburban Republicans. We thought it was some hippie thing." But after struggling twice with the baby blues and needing to supplement her breast milk supply with formula, Halper became intrigued by the idea that the hormones in a placenta could help. To reduce the ick factor, Halper paid someone to process the tissue into capsules when her third child was born. Medical experts say there is no scientific evidence that consuming placenta benefits women, as no controlled studies have tested it versus a placebo. Nor have placenta pills been analysed to see what substances they contain. "Until all the science is in, the cautions outweigh the expected benefits," said Mark Kristal, a New York neuroscientist who has studied placentophagy – the scientific name for placenta consumption – in laboratory animals. Yet the idea is popular enough that Halper's doula, Deb Pocica, said she has encapsulated more than 250 placentas for about US$250 (RM775) apiece. Pocica said she also has trained 30 people to make placenta capsules, mostly in the Chicago area. Women who have consumed their baby's placenta claim benefits including reduction of fatigue, a more balanced mood and increased breast milk production. Those reported gains also could be nothing more than the placebo effect, some doctors and researchers say. Encapsulation and digestion probably would destroy at least one class of hormones in the placenta, they note. Halper said her doctors didn't object to her plan. Worst-case scenario, they said, the pills would have no effect. Her husband also was supportive. So, after Halper's daughter was born, Pocica encapsulated the placenta and Halper took the pills for about six weeks.  Medical experts say there is no scientific evidence that consuming placenta benefits women, as no controlled studies have tested it versus a placebo. Nor have placenta pills been analysed to see what substances they contain. Physically, she felt energetic and recovered quickly, Halper said. She was able to breastfeed her daughter without supplementing with formula, and she had no problems with the baby blues. At her six-week appointment, her obstetrician remarked on how well she seemed to be doing. "I was so shocked at how much better I felt," Halper said. "I can't recommend it enough." In a survey of 189 women who had consumed their babies' placentas – raw, cooked or in capsule form – 95% reported their experience was either positive or very positive, and 98% said they would repeat the experience. "Of course, we don't know if those are placebo effects and their positive results are based on their expectations," said Daniel Benyshek, corresponding author of the study and associate professor in the department of anthropology at the University of Nevada at Las Vegas. The survey results were published this year in Ecology of Food and Nutrition. The report disclosed that the first author, Jodi Selander, is the founder of Placenta Benefits, an online information source that also offers training for placenta encapsulators. Kristal, a professor of psychology at the State University of New York at Buffalo, has documented some benefits among rats that consumed raw placenta and amniotic fluid after giving birth. But he cautioned against attributing benefits to placenta consumption by human mothers. "The science in humans just isn't there," he said. "There's nothing we can point to that says scientifically that eating placenta is helpful and that it is completely harmless." Benyshek said he is in the final planning stages of a double-blind pilot study that would compare the effects of placenta capsules and a placebo on women's postpartum experiences. The placenta, a rounded organ roughly the size of a Frisbee, grows inside the womb and serves as the boundary between woman and foetus, delivering nutrients and oxygen via the umbilical cord and carrying away waste and carbon dioxide. It also takes over a mother's hormone production during pregnancy. Many other female mammals, including humans' closest primate relatives, eat the placenta soon after birth, but there is no evidence that the behaviour is common in new mothers from any human culture, according to Kristal and Benyshek. Kristal's work on laboratory rats has found that consuming both amniotic fluid and placenta leads to an increased tolerance for pain and quicker onset of maternal behaviour by modifying how some signals are processed in the brain. He thinks the molecule that contributes to those positive effects probably is present and can function in people, too. Yet Kristal said he suspects most benefits that mothers report from consuming their baby's placenta are rooted in the placebo effect. He notes that, among women who cite benefits, it does not seem to matter how the placenta is prepared, when the woman consumes it, or how much she consumes. "It's almost part of human nature to assign causality where it doesn't necessarily exist," Kristal said. "Two things happen and people relate them in their minds. We all do it." Dr Marybeth Lore, an assistant professor of obstetrics and gynaecology at the Northwestern University Feinberg School of Medicine, said she also thinks benefits can be attributed to the placebo effect. Still, she added, it's hard to find fault with a placebo if it improves symptoms. Kristal said he thinks one type of placental product – molecules called peptides – would be destroyed during processing or later in the digestive tract. But steroid hormones, which include progesterone and oestrogen, could be intact in placenta pills and survive digestion to be absorbed in the small intestine, he said. None of those ideas has been scientifically tested, he emphasised. Nor is it clear whether consuming a placenta could be dangerous. "I don't think it's a huge risk; I think it's possibly a slight risk," Kristal said. "We just have to be very careful about whether there's a negative side to it or not." Dr Lore said that in 15 years, she has encountered perhaps five patients who wanted to consume their baby's placenta. While she tries not to be obstructive, Dr Lore said she does not encourage women to do it. "It's unlikely to be harmful, but you don't know." Thirty-one percent of the women who responded to the survey on placentophagy did report some negative aspects, including unpleasant taste or smell, headache and cost to encapsulate. Selander, who lives in Las Vegas and took placenta pills after the births of two of her three daughters, views encapsulation as a way to reduce the risk of postpartum blues during a time of fluctuating hormones. "In every case, we're talking about healthy women consuming healthy placentas," which minimises potential risk, Selander said.  Deb Pocica, who has been a placenta encapsulator for five years, encapsulates a dried placenta at the home of a client. Hospitals in Chicago have varying policies on patients who want to keep the placenta. Northwestern Memorial Hospital, for instance, requires the mother to sign a release form. She then is asked to take personal possession and transfer it out of the hospital, said Sue Fulara, operations manager of triage and labour and delivery. Pocica, of Schiller Park, said the woman's partner or another family member usually brings the placenta home on ice. Pocica likes to start the encapsulation process within 24 to 48 hours, so the organ is as fresh as possible. First, she lightly steams the placenta, then dehydrates it overnight in a food dehydrator. The next day, she grinds the dried placenta into a powder and puts the powder into capsules, which are kept in the fridge. She said she sterilises all her equipment and wears gloves. New Lenox resident Marcy Pluchar said her husband introduced the idea of placenta encapsulation during her second pregnancy. He hoped it would help her feel better than she had after the birth of their first daughter, she said. "I was never diagnosed with postpartum depression, but I think I had it with my first." Pluchar said taking placenta pills "really helped" – she even found herself checking her watch to see if it was time for the next dose. Because of her positive experience, it was "not even a question" that she would enlist Pocica to encapsulate the placentas of her next children, twins now almost five months old. "I think it's awesome," Pluchar said. "Could it be partly the placebo effect, that it works because I think it's going to work? Sure. But I don't care." – Chicago Tribune/McClatchy-Tribune Information Services |
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