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School's out! While teachers rejoice, we take a look at some strategies to calm your parental jitters during the school holidays.

WHEN your kids are officially out of school and home for their semester break, and you are stuck with the task of constantly trying to keep them entertained, while juggling your day job, on top of your regular mummy (and daddy) duties, things can occasionally get a bit dicey.

Sure, it is great to be spending quality time with your children, but being huddled up at home all day can put a tonne of pressure on parents who want to make sure that their kids stay active and continue learning new things.

Trying to maintain a functional household by managing chores such as washing, cleaning and grocery shopping, while trying to keep up with the children's daily activities, can be overwhelming for parents.

You can end up feeling exhausted and stressed out from trying to meet these incessant demands.

Prolonged periods of stress can wreck havoc on both mental and physical health. Stress has also been linked to mood swings and a weakened immune system, leaving you more vulnerable to illnesses.

According to the Mayo Clinic, the simple act of learning how to chill out can provide benefits such as lowering your blood pressure, reducing muscle tension, improving concentration, as well as giving your confidence a boost.

Some tried-and-tested antidotes for stress include taking some time off to relax and getting enough rest. Restoring balance in your life can help defuse some tension and promote better overall health.

Other methods that can help alleviate stress include regular exercise, meditating, and maintaining regular contact with like-minded friends.

While teachers rejoice, we take a look at a few strategies to calm your parental jitters about the school holiday season, and how to keep your kids happy while you're at it.

Have a little structure

School's out, and your kids are bent on sleeping all day and staying up all night. It is tempting to throw all semblance of a schedule out the window during the holiday season, but having no structure at all can lead to chaos in your children's lives.

For starters, it pays to maintain a regular sleep schedule. Children aged five to 12 require about 10 to 11 hours of sleep. Poor or inadequate sleep at this age can lead to mood swings, behavioural problems such as hyperactivity, as well as cognitive problems that can impact their ability to learn.

Allocating specific time slots for different activities throughout the day can help parents create some structure and balance for their kids during the holiday season.

They can include activities such as reading and writing, light chores like gardening or watering the plants, and practising skills such as painting, singing or playing the piano.

Homemaker Teh Wen Li, 31, shares her experience in keeping up with her two daughters, aged five and eight.

"Holidays can get too long, and sometimes, the kids can get restless and bored," she observes. The chatty mum says she tries to find a good mix of activities that her daughters can participate in throughout the day. "They can't be watching television the entire day, so I set up a routine for them, and establish slots for revision, playtime, and fun activities like going to the park."

Go for a relaxing retreat

Family holidays are a perfect opportunity for fun-filled memories that will stay with you and your children for life. The real magic of a family holiday lies in the quality time you spend together.

Whether it is watching your kids learn how to swim, exploring new destinations together, or relaxing over a nice family meal, family retreats are a great opportunity to bond.

Just ask Nurul Suhaida Musa, a 40-year-old mother of seven. Nurul, who is a dance instructor, has four sons and three daughters – including a pair of twins – aged two, three, eight, 14, 18 and 20. While her older children have outgrown their school-going years, Nurul still spends a significant amount of time managing the lives of her younger offspring.

"I always prefer family getaways to staying at home," she tells this writer.

"During long holidays, I usually bring my kids back to my hometown in Pahang to visit their grandmother, as well as my brother and my sister."

For Nurul, going out of town provides a peaceful escapade from the bustling city.

"My kids are usually glued to the computer at home. They certainly spend more time participating in outdoor activities when we balik kampung," she shares.

"My boys would play games like football, while my girls would spend time with their grandmother in the kitchen.

"The best part about school holidays is that I do not have to wake up as early to send my children to school," she says with a laugh.

Do activities together

Doing things with your children is not only a great way to set the pace for the holidays, it also helps promote parent-child bonding.

Creating an environment of mutual trust is integral during your child's formative years.

Activities like colouring, playing board games, baking and going to the park together, are just some of the things you can do with your kids.

You can even go high-tech by engaging your child with games and learning programmes that emphasises good old-fashioned fun, using the latest gadgets and technologies.

Despite his busy schedule, corporate trainer Palani Murugappan makes it a point to take time off work to do activities with his 10-year-old son. Palani, 47, also has a six-month-old daughter.

"Child number two isn't much of an issue for the time being, as she is still very young.

"The eldest, however, can be really demanding. He always expects me to do things with him," he says with a laugh.

To placate the active youngster, Palani says he often takes his son out for activities such as jungle trekking and cycling.

"I prefer outdoor activities to staying at home. I think it's better for my son to be exposed to nature, rather than be glued to his gadgets," says the doting dad.

Set play dates with other parents

Play dates are a great way for children to develop and practise their social skills.

It also allows them to gain confidence and tact in a social environment.

Spending time with other children their age also allows them to sharpen their abilities to engage, connect and empathise.

An added bonus is that, while your kids are busy fiddling with Lego blocks or enjoying a game of badminton, you get at least a couple of hours off to indulge in some precious "me-time".

You can start by talking to other parents at your children's school, or friends who have children of the same age.

Parents can devise simple games or programmes for their children, or even set up mini-competitions to heighten the excitement.

However, it may be a good idea to establish some basic ground rules, such as, "eat only in the kitchen" or "the door must always stay open" before your kids proceed with their play dates, to ensure a safe and pleasant experience.

It may also be a good idea to keep a play date to under two hours – just enough time for your kids to have fun, and for you to chill out and unwind with activities such as going to the gym.

Ship them off to a sleep-away camp

Plenty of parents agree that sending their kids away for a sleep-away camp provides a much-needed respite from their hectic schedules.

Sleep-away camps also provide a good opportunity for kids to gain a sense of independence, while developing social and living skills.

Going for a camping trip may give your child a chance to interact with nature, and gain fresh and novel experiences.

The best part is, they will come home with tonnes of new friends and funny stories to tell. They might even pick up some useful skills such as cooking and starting a camp fire.

Pick up a new skill

If your child isn't ready to be sent away for the weekend, picking up a new skill makes a cool and equally intriguing alternative.

Maybe your child has always fancied ballet or the piano. Or like the pint-sized proteges in the tv show Junior Masterchef: Australia, has always displayed a knack for whipping up delicious meals.

Whatever their hobbies and interests, the holiday season might be the perfect time for them to try it out.

Enrolling your child into group classes allows him or her to socialise with other like-minded youngsters, as well as help nurture their talents.

Being in a group setting may even encourage them to speak up, be assertive, and develop leadership abilities.

Juggling life and kids, especially during the school holidays, can leave you physically and mentally drained.

However, the holidays provide a good opportunity for parents to bond with their children, and to create memories, as well as important life lessons that they will take into adulthood.

If you are normally busy at work, perhaps now is the perfect time to take a breather and spend some quality time with your family.

In any case, keep calm and parent on.

E-liminating fatty liver disease

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Recent studies show that vitamin E tocotrienols may have a positive effect on fatty liver disease.

IT is understood that as your belly expands, fat also piles up in your liver, and this fat could clog the liver, causing a state of malfunction.

The liver is the metabolic factory of the body, so a clogged liver certainly spells trouble. Poor liver function could set off health problems, such as cardiovascular disease and metabolic conditions.

Among the spectrum of metabolic diseases resulting from poor function of the liver are diabetes, hypertension and fatty liver.

Fatty liver disease is a term used to describe a build-up of excess fat in the liver cells.

It may not sound like a big deal, but fat build-up in the liver could result in dangerous health consequences, such as liver inflammation, liver tissue scarring (fibrosis), and even liver cancer.

While heavy drinkers are more likely to end up having lots of fat deposits in the liver, teetotallers or casual drinkers are not exempt from this scourge.

People who drink little or no alcohol, and have no history of alcoholism, can develop a liver condition known as non-alcoholic fatty liver disease (NAFLD).

"In the 1980s, medical experts discovered liver lesions – commonly caused by alcohol abuse – in patients who had never been significant consumers of alcohol," explains Dr Marilyn O. Arguillas, of Davao Doctors Hospital's Department of Internal Medicine in the Philippines.

"Their liver biopsies showed that they had fatty livers, similar to that of alcoholics. This phenomenon, now known as NAFLD, occurred mostly in people who were diabetic or obese," the gastroenterologist tells Fit4life in an interview.

Both alcoholic and non-alcoholic fatty liver disease are becoming more common around the world.

"Ultimately, both variations of fatty liver disease are two roads that are head towards the same destination, which is liver tissue scarring or fibrosis.

"The development of fibrosis marks the connection between fatty liver disease and end-stage liver disease," says Dr Arguillas.

Liver disease on the rise

The prevalence of NAFLD is disturbingly high around the world. In Western countries, NAFLD affects between 15% and 30% of the general adult population.

In Japan, the incidence of NAFLD is believed to range from 18% to 30%, and about 14% in Thailand.

Dr Arguillas believes that NAFLD is becoming a common problem in the South-East Asian region, due to modern lifestyle factors such as a diet high in fructose corn syrup and fat, as well as physical inactivity.

"Popular fast food joints, for instance, are now just as easily available here in South-East Asia as they are in the West," she says.

The rising incidence of diabetes and obesity, especially in Malaysia, contributes to the prevalence of NAFLD.

Diabetics who have poor blood sugar control are at an increased risk of developing fatty liver disease.

Those who are overweight or obese, and have high blood cholesterol, also have the tendency to accumulate fat in the liver. This will affect the cells, as well as impede liver function.

Often, the symptoms of liver disease are not obvious, and are often dismissed as tiredness, or a general feeling of being unwell.

Most patients do not show many visible symptoms, and NAFLD is usually discovered incidentally when doctors discover abnormal liver function test readings, or find an enlarged liver in the course of looking for something unrelated.

Fighting liver fat

Recent studies show evidence that vitamin E tocotrienols may play a role in helping to improve,, or even correct, health conditions brought about by fatty liver disease, Dr Arguillas shares.

Dr Arguillas cites a study carried out by Dr Enrico Magosso and his team at Universiti Sains Malaysia (USM) that demonstrated the correlation between regular intake of vitamin E tocotrienols and fatty liver disease.

In 2010, at the Liver Meeting of the American Association for the Study of Liver Diseases in Boston, US, Dr Magosso's team presented a study that shows that tocotrienols can improve, and even cure, NAFLD.

In the study, the first of its kind, 30 patients were supplemented with a full spectrum of tocotrienols for a year. Of the 30 NAFLD patients, 15 were completely cured of the disease by the end of the year, as evidenced by ultrasound diagnosis.

Meanwhile, another five patients showed significant improvement in their liver health.

Dr Magosso speculates that vitamin E tocotrienols impact on multiple pathways when it comes to the treatment of fatty liver disease.

For one, they have been found to inhibit the build-up of fat in liver cells.

Vitamin E tocotrienols have also been noted for their ability to activate multiple gene signals in liver cells. This facilitates fat metabolism, while preventing fatty build-up.

Dr Arguillas predicts that vitamin E tocotrienols will become a significant player in fatty liver disease prevention, although more evidence and clinical studies are needed to substantiate the current claims.

The doctor adds: "We are looking for a cost-effective treatment for fatty liver disease. With these ongoing clinical trials with vitamin E tocotrienols, I think we are seeing some promise."

"We hope to conduct larger clinical trials that will involve more fatty liver disease patients in the near future," she says.

My baby will not live

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Preparing for death with a hospice programme for women carrying babies who're unable to survive.

JENNY Mohler lay on an examining bed holding her pregnant belly at Sinai Hospital in northwest Baltimore, US. Sonogram pictures hung from a machine in the right corner of the room. She was nervous, unable to block a feeling of uneasiness as she waited for a specialist to come in and decipher the images.

Just two days earlier, she had received a call while sitting at her desk at a Catholic Charities health clinic in Baltimore, where she worked as a school counsellor. There were developmental concerns about the baby, Dr Mary Ann Sorra told her. The baby's head was misshapen and its limbs short. Don't worry, Dr Sorra told Jenny, but more tests were needed as soon as possible.

Jenny, who was 19 weeks into her pregnancy, began a frantic Internet search, typing "developmental disorders" and "short limbs" into her office computer. Could it be Down syndrome? Or maybe dwarfism?

As she and husband John, now 33, waited at Sinai that September day last year, he tried to assure her that nothing major was wrong. She wanted to stay positive, but it was difficult.

A perinatologist, who deals in high-risk pregnancies, came into the room to deliver the diagnosis: Your baby has thanatophoric dysplasia, they remember him saying.

The Mohlers' unborn child was suffering from a rare disorder – whose name meant "death-bearing malformation" in Greek – that would prevent the rib cage from growing, smothering the heart and lungs. The baby would likely be stillborn. Or it would die shortly after birth, unable to breathe on its own.

The baby, whose gender they didn't even know yet, had just been given a death sentence.

Two months later, across town at Johns Hopkins Hospital, Kimberly Queen lay in a bed – 30 weeks' pregnant and fighting for her life. Machines beeped all around her, monitoring her blood pressure, heart rate and other vital signs. A nutritional tube ran from her arm, trying to nourish a body so frail that her organs were on the verge of shutting down.

Queen's health was deteriorating from hyperemesis gravidarum, a condition that causes severe nausea and vomiting, making it hard for expectant mothers to keep enough nutrients in their bodies. She had cycled in and out of the hospital her entire pregnancy, and just days before Thanksgiving, was admitted to Howard County General Hospital.

Her symptoms were so severe that doctors transferred her by ambulance to Hopkins for more specialised care.

A small group of doctors in scrubs entered her room to give Queen and her fiance, Keith Brown, now 34, some news about her fourth child. Brown held her hand while two doctors sat in chairs near the bed. One did most of the talking.

An ultrasound, the doctor said, showed blood and fluid around the brain of the baby Queen had already named Kirsten. The baby's weight was below normal, and she probably wouldn't survive the pregnancy.

If she did, her quality of life would not be good. She might not be able to breathe on her own, the doctors said, urging Queen to consider terminating the pregnancy.

Queen, a certified nurse technician at Johns Hopkins Bayview Medical Center, took the news as if she were on the job. She felt the doctors were talking about some other patient, someone other than her. She found herself explaining to her fiance what the doctors were saying, but not fully absorbing the news herself. She said little to them.

But in the middle of the night, her maternal instinct kicked in. She woke up and could only think of one thing: Her baby might die.

Queen and Jenny discovered themselves in a spot they would never have predicted: grieving instead of celebrating new life and growing families. Terminating the pregnancy was not an option for either. Jenny cited her strong Catholic beliefs. Queen wanted to give her baby every chance to live, no matter the odds.

Their predicaments would become the most trying they had ever confronted.

Doctors encouraged Queen and Jenny to connect with a hospice programme to handle the myriad of emotions.

Both women turned to Gilchrist Kids, a division of Towson, Maryland-based Gilchrist Hospice Care, one of a handful of hospices in the area with a perinatal component.

Through the programme, they were connected with social worker Briana Shirey, who became a lifeline and source of comfort through their pregnancies.

Queen, now 33, said her doctors focused on the possibility of terminating the pregnancy and pushed palliative care for the baby to prepare her for death after she was born. But Queen did not want to think about that; she even ignored advice to contact Gilchrist.

"I was feeling my baby moving around in me," she recalled. "I had already seen the sonogram with her features. She had the nose of my son, the mouth of my daughter. In order for me to accept the possibility that my child wasn't going to be here anymore, I had to know I did everything I could to make sure the doctors did what they could to save her."

One afternoon, she was sitting in her apartment watching television when the phone rang. She picked up to hear a soothing voice: Shirey from Gilchrist Kids. Shirey had reached out, despite Queen's reluctance to contact her.

The social worker asked some simple questions: How are you feeling? Is there anything bothering you?

For Queen, talking about what was going on brought clarity to her situation and a sense of relief.

"She made it easier to concentrate," Queen said. "She made me realise that whatever happened, I could deal with it."

Queen's plan called for doctors to do "whatever was necessary" to keep Kirsten alive. She also wanted to bathe, dress and hold the baby right away – she knew Kirsten's life might be measured in minutes.

As the months of pregnancy passed, Shirey also worked with the Mohlers, encouraging them to bond with their child.

Talk to the baby, she said. Rub Jenny's belly and interact with him anyway you can, she urged husband John.

"Your time is limited, so during pregnancy, that is your time," Jenny said. "That is your time to love the baby, to bond with the baby and parent while the baby is in the womb – and while the baby is still alive."

Jenny, now 32, had no illusions about the chances of their baby's survival – the condition occurs in one in 20,000 to 50,000 newborns, and few survive. It was the first case Dr Sorra had seen since she began practising medicine in 1997.

The Mohlers had to accept that they wouldn't have long with their baby.

The couple felt unconditional love for their unborn child, and drew strength from their faith during the pregnancy.

The Mohlers hadn't planned on finding out the gender of the baby until it was born. After the diagnosis, they wanted to know.

They named him Joseph Angelo Mohler – Angelo because Jenny felt she was carrying an angel in her womb.

They took him to concerts – the Allman Brothers at Merriweather Post Pavilion – and to a football game at Virginia Tech, their alma mater.

John frequently sang to him, mostly "Silent Night" and other Christmas songs. Their daughter, Abby, two, talked to her little brother through the womb.

"It was hard to explain to her because she was so young," Jenny said. "We just told her that this was her little brother and he would soon be an angel."

Creating these memories helps families better prepare for the death of a baby, says Shirey, who lives in Towson. When it actually happens, it does not come as a shock and they are less overwhelmed.

Shirey has been drawn to helping families cope with life's big moments ever since she was an undergraduate studying mental health, social work and psychology.

People have always found her easy to talk to and trust, which has helped her in her career. She has counselled children from abusive families and helped spouses navigate divorces.

She thought the hospice job would be a new challenge as advances in prenatal testing put more parents in the position of grieving during pregnancy.

Dealing with death day after day is not an easy job, Shirey acknowledges.

She tries not to think about her own family, including her two children. Instead, she focuses on how she can help someone else's family.

Mohler entered the hospital on Dec 13, 2013. Joseph's head had grown too large and doctors needed to perform an emergency Caesarean soon.

Dr Sorra started to worry that the baby would die in the womb, putting the mother at risk. Jenny had gotten frequent sonograms throughout the pregnancy to monitor the baby's development.

Within seconds of delivery, Jenny and her husband were greeted by a sound they weren't sure they would ever hear from Joseph. He cried. Their son was alive.

Dr Sorra felt a sense of relief. She went into the waiting room to deliver the news to the Mohlers' parents.

"Congratulations," she said. "Everything went well. You have a grandson."

John, the father, swaddled Joseph and nuzzled him.

He held him up so Jenny could see her son as doctors sutured the incision from her C-section.

He then brought him over for Jenny to kiss on the cheek. The parents remember their baby gazing at them almost knowingly.

The Mohlers took their son to another room, where their parents, young Abby, Shirey, and other relatives and friends waited.

Photos were taken as everyone in the room bonded with the baby. They made moulds of his tiny feet and hands.

Their actions stirred the emotions of the medical staff, Dr Sorra said.

"It was extremely moving," she said. "There was so much joy and tragedy at the same time."

Soon, the baby's breaths became further and further apart. He became still, as if he was sleeping. A doctor came in to say Joseph had died.

Joseph lived one precious hour, which the Mohlers say they will remember forever.

"It was very peaceful," Jenny said. "We didn't even realise he had passed."

"I know most people would expect us to say the most difficult day was the day of his death, but to be honest, it wasn't at all," she said.

"December 13th was an amazingly grace-filled and peaceful day full of love.

"Because we had good care and we were prepared, the hour we spent with our son was truly one of the most beautiful and meaningful of my life."

As Queen's pregnancy progressed, her baby began to defy the doctor's dire diagnosis. The bleeding in Kirsten's brain stopped and the swelling went down.

She went into labour at 37 weeks on Jan 13. Doctors at Hopkins were prepared for the worst, stationing equipment nearby to help resuscitate Kirsten if that were needed.

"None of us knew if the baby was going to breathe at birth," recalls Dr Renee Boss, a neonatologist.

"None of us knew if the baby would have a normal heart rate.

"We were prepared to do whatever we needed to do for the baby if it came to that."

After three days of labour, Queen delivered Kirsten, who weighed 5 pounds 9 ounces and had a healthy heartbeat. She looked like her father, but had Queen's nose.

"She's breathing," fiance Brown bellowed upon hearing his baby girl's cries. "She's breathing."

Queen felt an overwhelming sense of happiness and relief.

"She came out crying," she recalls. "It was the best sound ever." – The Baltimore Sun/McClatchy-Tribune Information Services

Kredit: www.thestar.com.my

Ahad, 4 Ogos 2013

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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